Minnesota Legislature
HF 4706
1st Engrossment - 92nd Legislature (2021 - 2022) Posted on 04/19/2022 11:31am
Bill Text Versions
| Engrossments | ||
|---|---|---|
| Introduction | Posted on 03/30/2022 | |
| 1st Engrossment | Posted on 04/19/2022 |
Current Version - 1st Engrossment
2.45 2.46
2.47 2.48 2.49 2.50 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 3.24 3.25 3.26 3.27 3.28 3.29 3.30 3.31 3.32 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19 4.20 4.21 4.22 4.23 4.24 4.25 4.26 4.27 4.28 4.29 4.30 4.31 4.32 4.33 4.34 5.1 5.2
5.3
5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11 5.12
5.13 5.14 5.15 5.16 5.17 5.18 5.19 5.20 5.21 5.22
5.23 5.24 5.25 5.26 5.27 5.28 5.29 5.30 5.31 5.32 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 6.10 6.11 6.12 6.13 6.14 6.15 6.16 6.17 6.18 6.19 6.20 6.21 6.22 6.23 6.24 6.25 6.26 6.27 6.28 6.29 6.30 6.31 6.32 6.33 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9 7.10 7.11 7.12 7.13 7.14 7.15 7.16 7.17 7.18 7.19 7.20 7.21 7.22 7.23 7.24 7.25 7.26 7.27 7.28 7.29 7.30 7.31 7.32 7.33 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8
8.9 8.10 8.11 8.12 8.13 8.14 8.15 8.16 8.17 8.18 8.19 8.20 8.21 8.22 8.23 8.24 8.25 8.26 8.27 8.28 8.29 8.30 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 9.9 9.10 9.11 9.12
9.13 9.14 9.15 9.16 9.17 9.18 9.19 9.20 9.21 9.22 9.23 9.24 9.25 9.26 9.27 9.28 9.29 9.30 9.31 9.32 9.33
10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9 10.10 10.11 10.12 10.13 10.14 10.15 10.16 10.17 10.18 10.19 10.20 10.21 10.22
10.23 10.24 10.25 10.26 10.27 10.28 10.29 10.30 10.31 10.32 10.33 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 11.9 11.10 11.11 11.12 11.13 11.14 11.15 11.16 11.17 11.18 11.19 11.20 11.21 11.22 11.23 11.24 11.25 11.26
11.27 11.28 11.29 11.30 11.31 11.32 12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8 12.9 12.10 12.11 12.12
12.13 12.14 12.15 12.16 12.17 12.18 12.19 12.20 12.21 12.22 12.23 12.24 12.25 12.26 12.27 12.28 12.29 12.30 12.31 12.32 12.33 13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 13.9 13.10 13.11 13.12 13.13 13.14
13.15 13.16 13.17 13.18 13.19 13.20 13.21 13.22 13.23 13.24 13.25 13.26 13.27 13.28 13.29 13.30 13.31 13.32 14.1 14.2 14.3 14.4 14.5 14.6 14.7 14.8 14.9 14.10 14.11 14.12 14.13 14.14 14.15 14.16 14.17 14.18 14.19 14.20 14.21 14.22 14.23 14.24 14.25 14.26 14.27 14.28 14.29 14.30 14.31 14.32 14.33 14.34 14.35 14.36 15.1 15.2 15.3 15.4 15.5 15.6 15.7 15.8 15.9 15.10 15.11 15.12 15.13 15.14 15.15 15.16 15.17 15.18 15.19 15.20 15.21 15.22 15.23 15.24 15.25 15.26 15.27 15.28 15.29 15.30 15.31 15.32 15.33 15.34 15.35 15.36 16.1 16.2 16.3 16.4
16.5 16.6 16.7 16.8 16.9 16.10 16.11 16.12 16.13 16.14 16.15 16.16 16.17 16.18 16.19 16.20 16.21 16.22 16.23 16.24 16.25 16.26 16.27 16.28 16.29 16.30 16.31 17.1 17.2 17.3 17.4 17.5 17.6 17.7 17.8 17.9 17.10 17.11 17.12 17.13 17.14 17.15 17.16 17.17 17.18 17.19 17.20 17.21 17.22 17.23 17.24 17.25 17.26 17.27 17.28 17.29
18.1 18.2 18.3 18.4 18.5 18.6 18.7 18.8 18.9 18.10 18.11 18.12 18.13 18.14 18.15 18.16 18.17 18.18 18.19 18.20 18.21 18.22 18.23 18.24 18.25 18.26 18.27 18.28 18.29 18.30 18.31 18.32 18.33 18.34 19.1 19.2 19.3 19.4 19.5 19.6 19.7 19.8
19.9 19.10 19.11 19.12 19.13 19.14 19.15 19.16 19.17 19.18 19.19 19.20 19.21 19.22 19.23 19.24 19.25 19.26 19.27 19.28 19.29 19.30
20.1 20.2 20.3 20.4 20.5 20.6 20.7 20.8 20.9 20.10 20.11 20.12 20.13 20.14 20.15 20.16 20.17 20.18 20.19 20.20 20.21 20.22 20.23 20.24 20.25 20.26 20.27 20.28 20.29 20.30 20.31 20.32 20.33 20.34 20.35 20.36 21.1 21.2 21.3 21.4 21.5 21.6 21.7 21.8 21.9 21.10 21.11
21.12 21.13 21.14 21.15 21.16 21.17 21.18 21.19 21.20 21.21 21.22 21.23 21.24 21.25 21.26 21.27 21.28 21.29 21.30 21.31 21.32 21.33 22.1 22.2 22.3 22.4 22.5 22.6 22.7 22.8 22.9 22.10 22.11 22.12 22.13 22.14 22.15 22.16 22.17 22.18 22.19 22.20 22.21 22.22 22.23 22.24 22.25 22.26 22.27 22.28 22.29 22.30 22.31 22.32 22.33 22.34 23.1 23.2 23.3 23.4 23.5 23.6 23.7 23.8 23.9 23.10 23.11 23.12 23.13 23.14
23.15 23.16 23.17 23.18 23.19 23.20 23.21 23.22 23.23 23.24 23.25 23.26 23.27 23.28 23.29 23.30 24.1 24.2 24.3 24.4 24.5 24.6 24.7 24.8 24.9 24.10 24.11 24.12 24.13 24.14 24.15 24.16 24.17 24.18 24.19 24.20 24.21 24.22 24.23 24.24 24.25 24.26 24.27 24.28 24.29 24.30 24.31 24.32
25.1 25.2 25.3 25.4 25.5 25.6 25.7 25.8 25.9 25.10 25.11 25.12 25.13 25.14 25.15 25.16 25.17 25.18 25.19 25.20 25.21 25.22 25.23 25.24 25.25 25.26 25.27 25.28 25.29 25.30 25.31 26.1 26.2 26.3 26.4 26.5 26.6 26.7 26.8 26.9 26.10 26.11 26.12 26.13 26.14 26.15 26.16 26.17 26.18 26.19 26.20 26.21 26.22 26.23 26.24 26.25 26.26 26.27 26.28 26.29 26.30 26.31 26.32 27.1 27.2 27.3 27.4 27.5 27.6 27.7 27.8 27.9 27.10 27.11 27.12 27.13 27.14 27.15 27.16 27.17 27.18 27.19 27.20 27.21 27.22 27.23 27.24 27.25 27.26 27.27 27.28 27.29 27.30 27.31 27.32 28.1 28.2 28.3 28.4 28.5 28.6 28.7 28.8 28.9 28.10 28.11 28.12 28.13 28.14 28.15
28.16 28.17 28.18 28.19 28.20 28.21 28.22 28.23 28.24 28.25 28.26 28.27 28.28 28.29 28.30 28.31 29.1 29.2 29.3 29.4 29.5 29.6 29.7 29.8 29.9 29.10 29.11 29.12 29.13 29.14 29.15 29.16 29.17 29.18 29.19 29.20 29.21 29.22 29.23 29.24 29.25 29.26 29.27 29.28 29.29 29.30 29.31 30.1 30.2 30.3 30.4 30.5
30.6 30.7 30.8 30.9 30.10 30.11 30.12 30.13 30.14 30.15 30.16 30.17 30.18 30.19 30.20 30.21 30.22 30.23 30.24 30.25 30.26 30.27 30.28 30.29 30.30 30.31 30.32 31.1 31.2 31.3 31.4 31.5 31.6 31.7 31.8 31.9 31.10 31.11 31.12 31.13
31.14 31.15 31.16 31.17 31.18 31.19 31.20 31.21 31.22 31.23 31.24 31.25 31.26 31.27 31.28 31.29 31.30 31.31 31.32 32.1 32.2 32.3 32.4 32.5 32.6 32.7 32.8 32.9 32.10 32.11 32.12 32.13 32.14 32.15 32.16 32.17 32.18 32.19 32.20 32.21 32.22 32.23 32.24 32.25 32.26 32.27 32.28 32.29 32.30 32.31 32.32 33.1 33.2 33.3 33.4 33.5 33.6 33.7 33.8 33.9 33.10 33.11 33.12 33.13 33.14 33.15 33.16 33.17 33.18 33.19 33.20 33.21 33.22 33.23 33.24 33.25
33.26 33.27 33.28 33.29 33.30 33.31 33.32 34.1 34.2 34.3 34.4 34.5 34.6 34.7 34.8 34.9 34.10 34.11 34.12 34.13 34.14 34.15 34.16 34.17 34.18 34.19 34.20 34.21 34.22 34.23 34.24 34.25 34.26 34.27 34.28 34.29 34.30 34.31 34.32 34.33 35.1 35.2 35.3 35.4 35.5 35.6 35.7 35.8 35.9 35.10 35.11 35.12 35.13 35.14 35.15 35.16 35.17 35.18 35.19 35.20 35.21 35.22 35.23 35.24 35.25 35.26 35.27 35.28 35.29 35.30 35.31 35.32 35.33 36.1 36.2 36.3 36.4 36.5 36.6 36.7 36.8 36.9
36.10 36.11 36.12 36.13 36.14 36.15 36.16 36.17 36.18 36.19 36.20 36.21 36.22 36.23 36.24 36.25 36.26 36.27 36.28 36.29 36.30 36.31 36.32
37.1 37.2 37.3 37.4 37.5 37.6 37.7 37.8 37.9 37.10 37.11 37.12 37.13 37.14 37.15 37.16 37.17 37.18 37.19 37.20 37.21 37.22 37.23 37.24 37.25 37.26 37.27 37.28 37.29 37.30 37.31
38.1 38.2 38.3 38.4 38.5 38.6 38.7 38.8 38.9 38.10 38.11 38.12 38.13 38.14 38.15 38.16 38.17 38.18 38.19 38.20 38.21 38.22 38.23
38.24 38.25 38.26 38.27 38.28 38.29 38.30 38.31 38.32 39.1 39.2 39.3 39.4 39.5 39.6 39.7 39.8 39.9 39.10 39.11 39.12 39.13 39.14 39.15 39.16 39.17 39.18 39.19 39.20 39.21 39.22 39.23 39.24 39.25 39.26 39.27 39.28 39.29 39.30 39.31 39.32 39.33 39.34 39.35 39.36
40.1 40.2 40.3 40.4 40.5 40.6 40.7 40.8 40.9 40.10 40.11 40.12 40.13 40.14
40.15
40.16 40.17 40.18 40.19 40.20 40.21 40.22 40.23 40.24 40.25 40.26 40.27 40.28 40.29 40.30 40.31 40.32 41.1 41.2 41.3 41.4 41.5 41.6 41.7 41.8 41.9 41.10 41.11 41.12 41.13 41.14 41.15 41.16 41.17 41.18 41.19 41.20 41.21 41.22 41.23 41.24
41.25
41.26 41.27 41.28 41.29 42.1 42.2 42.3 42.4 42.5 42.6 42.7 42.8 42.9 42.10 42.11 42.12 42.13 42.14 42.15 42.16 42.17 42.18 42.19 42.20 42.21 42.22 42.23 42.24 42.25 42.26 42.27 42.28 42.29 42.30 42.31 43.1 43.2 43.3 43.4 43.5 43.6 43.7 43.8 43.9 43.10 43.11 43.12 43.13 43.14 43.15 43.16 43.17 43.18 43.19 43.20 43.21 43.22 43.23 43.24 43.25 43.26 43.27 43.28 43.29 43.30 43.31 43.32 44.1 44.2 44.3 44.4 44.5 44.6 44.7 44.8 44.9 44.10 44.11 44.12 44.13 44.14 44.15 44.16 44.17 44.18 44.19 44.20 44.21 44.22 44.23 44.24 44.25 44.26 44.27 44.28 44.29 44.30 44.31 44.32 44.33 45.1 45.2 45.3 45.4 45.5 45.6 45.7 45.8 45.9 45.10 45.11
45.12
45.13 45.14 45.15 45.16 45.17 45.18 45.19 45.20 45.21 45.22 45.23 45.24 45.25 45.26 45.27 45.28 45.29 45.30 45.31 45.32 45.33 46.1 46.2 46.3 46.4 46.5 46.6 46.7 46.8 46.9 46.10 46.11
46.12
46.13 46.14 46.15 46.16 46.17 46.18 46.19 46.20 46.21 46.22 46.23
46.24
46.25 46.26 46.27 46.28 46.29 46.30 46.31 47.1 47.2 47.3 47.4 47.5 47.6 47.7 47.8 47.9 47.10 47.11 47.12 47.13 47.14 47.15 47.16 47.17 47.18 47.19 47.20 47.21 47.22 47.23 47.24 47.25 47.26 47.27 47.28 47.29 47.30 47.31 47.32 47.33 48.1 48.2 48.3 48.4
48.5 48.6 48.7 48.8 48.9
48.10 48.11 48.12 48.13 48.14 48.15 48.16 48.17 48.18 48.19 48.20 48.21 48.22 48.23 48.24 48.25 48.26 48.27 48.28 48.29 48.30 48.31 49.1 49.2
49.3 49.4 49.5 49.6 49.7 49.8 49.9 49.10 49.11 49.12 49.13 49.14 49.15 49.16 49.17 49.18 49.19 49.20 49.21 49.22 49.23 49.24 49.25 49.26 49.27 49.28 49.29 49.30 49.31 49.32 50.1 50.2 50.3 50.4 50.5 50.6 50.7 50.8 50.9
50.10 50.11 50.12 50.13 50.14
50.15 50.16 50.17 50.18 50.19 50.20 50.21 50.22 50.23 50.24 50.25 50.26 50.27 50.28 50.29 50.30 50.31
51.1 51.2 51.3 51.4 51.5 51.6 51.7 51.8 51.9 51.10 51.11 51.12 51.13 51.14 51.15 51.16 51.17 51.18 51.19 51.20 51.21 51.22 51.23 51.24 51.25 51.26 51.27
51.28 51.29 51.30 51.31 52.1 52.2 52.3 52.4 52.5 52.6 52.7 52.8 52.9 52.10 52.11 52.12 52.13 52.14 52.15 52.16 52.17 52.18 52.19 52.20 52.21 52.22 52.23 52.24 52.25 52.26 52.27 52.28 52.29 52.30 52.31 52.32 53.1 53.2 53.3 53.4 53.5 53.6 53.7 53.8 53.9 53.10 53.11 53.12 53.13 53.14 53.15 53.16 53.17
53.18 53.19 53.20 53.21 53.22 53.23 53.24 53.25 53.26 53.27 53.28 53.29 53.30 53.31 53.32 53.33 54.1 54.2 54.3 54.4 54.5 54.6 54.7 54.8 54.9 54.10
54.11 54.12 54.13 54.14 54.15 54.16 54.17 54.18 54.19 54.20 54.21 54.22 54.23 54.24 54.25 54.26 54.27 54.28 54.29 54.30 54.31 55.1 55.2 55.3 55.4 55.5 55.6 55.7 55.8 55.9 55.10 55.11 55.12 55.13 55.14 55.15 55.16 55.17 55.18 55.19 55.20 55.21 55.22 55.23 55.24 55.25 55.26 55.27 55.28 55.29 55.30 55.31 56.1 56.2 56.3 56.4 56.5 56.6 56.7 56.8 56.9 56.10 56.11 56.12 56.13 56.14 56.15 56.16 56.17 56.18 56.19 56.20 56.21 56.22 56.23 56.24 56.25 56.26 56.27 56.28 56.29 56.30 56.31 57.1 57.2 57.3 57.4 57.5 57.6 57.7 57.8 57.9 57.10 57.11 57.12 57.13 57.14 57.15 57.16 57.17 57.18 57.19
57.20 57.21 57.22 57.23 57.24 57.25 57.26 57.27 57.28 57.29 57.30 57.31 57.32
58.1 58.2 58.3 58.4 58.5 58.6 58.7 58.8 58.9 58.10 58.11 58.12 58.13 58.14 58.15 58.16 58.17 58.18 58.19 58.20 58.21 58.22 58.23 58.24 58.25 58.26 58.27 58.28 58.29
58.30 58.31 58.32 58.33 59.1 59.2 59.3 59.4 59.5 59.6 59.7 59.8 59.9 59.10 59.11 59.12 59.13 59.14 59.15 59.16 59.17 59.18
59.19 59.20 59.21 59.22 59.23 59.24 59.25 59.26 59.27 59.28 59.29 59.30 59.31 60.1 60.2 60.3 60.4 60.5 60.6 60.7 60.8 60.9
60.10 60.11 60.12 60.13 60.14
60.15 60.16 60.17 60.18 60.19 60.20 60.21 60.22 60.23 60.24 60.25 60.26 60.27 60.28 60.29 60.30 61.1 61.2 61.3 61.4 61.5 61.6 61.7 61.8 61.9 61.10 61.11 61.12 61.13 61.14 61.15 61.16 61.17 61.18 61.19 61.20 61.21 61.22 61.23 61.24 61.25 61.26 61.27 61.28 61.29 61.30 61.31 61.32 61.33 62.1 62.2 62.3 62.4 62.5 62.6 62.7 62.8 62.9 62.10 62.11 62.12 62.13 62.14 62.15 62.16 62.17 62.18 62.19 62.20 62.21 62.22 62.23 62.24 62.25 62.26 62.27 62.28 62.29 62.30 62.31 63.1 63.2 63.3 63.4 63.5 63.6 63.7 63.8 63.9 63.10 63.11 63.12 63.13 63.14 63.15 63.16 63.17 63.18 63.19 63.20 63.21 63.22 63.23 63.24 63.25 63.26 63.27 63.28 63.29 63.30 63.31 64.1 64.2 64.3 64.4 64.5 64.6 64.7 64.8 64.9 64.10 64.11 64.12 64.13 64.14 64.15 64.16 64.17 64.18 64.19 64.20 64.21 64.22 64.23 64.24 64.25 64.26 64.27 64.28 64.29 64.30 64.31 65.1 65.2 65.3 65.4 65.5 65.6 65.7 65.8 65.9 65.10 65.11 65.12 65.13 65.14 65.15
65.16 65.17 65.18 65.19 65.20 65.21 65.22 65.23 65.24 65.25 65.26 65.27 65.28 65.29 65.30 65.31 66.1 66.2 66.3 66.4 66.5 66.6 66.7 66.8 66.9 66.10 66.11 66.12 66.13 66.14 66.15 66.16 66.17 66.18 66.19 66.20 66.21 66.22 66.23 66.24 66.25 66.26 66.27 66.28 66.29 66.30 67.1 67.2 67.3 67.4 67.5 67.6 67.7 67.8 67.9 67.10 67.11 67.12 67.13 67.14 67.15 67.16 67.17 67.18 67.19 67.20 67.21 67.22 67.23 67.24 67.25 67.26 67.27 67.28 67.29 68.1 68.2 68.3 68.4 68.5 68.6 68.7 68.8 68.9 68.10 68.11 68.12 68.13 68.14 68.15 68.16 68.17 68.18 68.19 68.20 68.21 68.22 68.23 68.24 68.25 68.26 68.27 68.28 68.29 68.30 68.31 69.1 69.2 69.3 69.4 69.5 69.6 69.7
69.8 69.9 69.10 69.11 69.12 69.13 69.14 69.15 69.16 69.17 69.18 69.19 69.20 69.21 69.22 69.23 69.24 69.25 69.26 69.27 69.28 69.29 69.30 69.31 69.32 70.1 70.2 70.3 70.4 70.5 70.6
70.7 70.8 70.9 70.10 70.11 70.12 70.13 70.14 70.15 70.16 70.17 70.18 70.19 70.20 70.21 70.22 70.23 70.24 70.25
70.26 70.27 70.28 70.29 70.30
71.1 71.2 71.3 71.4 71.5 71.6
71.7 71.8 71.9 71.10 71.11 71.12 71.13 71.14 71.15 71.16 71.17 71.18 71.19 71.20 71.21 71.22 71.23 71.24 71.25 71.26 71.27 71.28 71.29 71.30 72.1 72.2 72.3 72.4 72.5 72.6 72.7 72.8 72.9 72.10 72.11
72.12 72.13 72.14 72.15
72.16 72.17 72.18 72.19 72.20 72.21 72.22 72.23 72.24
72.25 72.26 72.27 72.28
73.1 73.2 73.3 73.4 73.5 73.6
73.7 73.8 73.9 73.10 73.11 73.12 73.13 73.14 73.15 73.16 73.17 73.18 73.19 73.20 73.21 73.22 73.23 73.24 73.25 73.26 73.27 73.28 73.29 73.30 74.1 74.2 74.3 74.4 74.5 74.6 74.7 74.8 74.9
74.10 74.11 74.12 74.13 74.14 74.15 74.16 74.17 74.18 74.19 74.20 74.21 74.22 74.23 74.24 74.25 74.26 74.27 74.28 74.29 74.30 74.31 75.1 75.2 75.3 75.4 75.5 75.6 75.7 75.8 75.9 75.10 75.11 75.12 75.13 75.14 75.15 75.16 75.17 75.18 75.19 75.20 75.21 75.22 75.23 75.24 75.25 75.26 75.27 75.28 75.29 75.30 75.31 75.32 76.1 76.2 76.3 76.4 76.5
76.6 76.7 76.8 76.9 76.10 76.11 76.12 76.13
76.14 76.15 76.16 76.17 76.18 76.19 76.20 76.21 76.22 76.23 76.24 76.25 76.26 76.27 76.28 76.29 76.30 77.1 77.2 77.3 77.4 77.5 77.6 77.7 77.8 77.9 77.10 77.11 77.12 77.13 77.14 77.15 77.16 77.17 77.18 77.19 77.20 77.21
77.22 77.23 77.24 77.25 77.26 77.27 77.28 77.29 77.30
78.1 78.2 78.3 78.4 78.5
78.6 78.7 78.8 78.9 78.10 78.11 78.12 78.13
78.14 78.15 78.16 78.17 78.18 78.19 78.20 78.21
78.22 78.23 78.24 78.25 78.26 78.27 78.28
78.29 78.30 79.1 79.2 79.3 79.4 79.5 79.6
79.7 79.8 79.9 79.10 79.11 79.12 79.13 79.14 79.15 79.16 79.17 79.18 79.19 79.20 79.21 79.22 79.23 79.24 79.25 79.26
79.27 79.28 79.29 79.30 80.1 80.2
80.3 80.4 80.5 80.6 80.7 80.8
80.9 80.10 80.11 80.12 80.13 80.14 80.15 80.16 80.17 80.18 80.19 80.20 80.21 80.22 80.23 80.24 80.25 80.26 80.27 80.28 80.29 80.30
81.1 81.2 81.3 81.4 81.5 81.6
81.7 81.8 81.9 81.10 81.11 81.12 81.13 81.14 81.15 81.16 81.17 81.18 81.19 81.20 81.21 81.22 81.23 81.24
81.25 81.26 81.27 81.28 81.29 81.30 81.31 82.1 82.2 82.3 82.4 82.5 82.6 82.7 82.8 82.9 82.10 82.11
82.12 82.13 82.14 82.15 82.16 82.17 82.18 82.19 82.20 82.21 82.22 82.23 82.24 82.25 82.26 82.27 82.28 82.29 82.30 82.31 82.32 82.33 82.34 83.1 83.2 83.3 83.4 83.5 83.6 83.7 83.8 83.9 83.10 83.11
83.12 83.13 83.14 83.15 83.16
83.17 83.18 83.19 83.20 83.21 83.22
83.23 83.24 83.25 83.26 83.27 83.28 83.29 83.30
84.1 84.2 84.3 84.4 84.5 84.6
84.7 84.8 84.9 84.10 84.11 84.12
84.13 84.14 84.15 84.16 84.17 84.18 84.19
84.20 84.21 84.22 84.23 84.24 84.25 84.26 84.27 84.28 84.29 84.30 84.31 84.32 85.1 85.2 85.3 85.4 85.5 85.6 85.7 85.8 85.9 85.10 85.11 85.12 85.13 85.14 85.15 85.16 85.17 85.18 85.19 85.20 85.21 85.22 85.23 85.24 85.25 85.26 85.27 85.28 85.29 85.30 85.31 85.32 86.1 86.2 86.3 86.4 86.5 86.6 86.7 86.8 86.9 86.10 86.11 86.12 86.13 86.14 86.15 86.16 86.17 86.18 86.19 86.20 86.21 86.22 86.23 86.24 86.25 86.26 86.27 86.28 86.29 86.30 86.31 86.32
87.1 87.2 87.3 87.4 87.5 87.6 87.7 87.8 87.9 87.10 87.11 87.12 87.13 87.14 87.15 87.16 87.17 87.18 87.19 87.20
87.21 87.22 87.23 87.24 87.25 87.26 87.27 87.28 87.29 87.30 87.31 87.32 88.1 88.2
88.3 88.4 88.5 88.6 88.7 88.8 88.9 88.10 88.11 88.12 88.13 88.14 88.15 88.16 88.17
88.18 88.19 88.20 88.21 88.22 88.23 88.24 88.25 88.26 88.27 88.28 88.29 88.30 89.1 89.2
89.3 89.4 89.5 89.6 89.7 89.8 89.9 89.10 89.11 89.12 89.13 89.14
89.15 89.16 89.17 89.18 89.19 89.20 89.21 89.22 89.23 89.24 89.25 89.26 89.27 89.28 89.29 90.1 90.2 90.3 90.4 90.5 90.6 90.7 90.8 90.9 90.10 90.11 90.12 90.13 90.14 90.15 90.16 90.17 90.18 90.19 90.20 90.21 90.22 90.23 90.24 90.25 90.26 90.27 90.28 90.29 90.30 90.31 90.32 90.33 91.1 91.2 91.3 91.4 91.5 91.6 91.7 91.8 91.9 91.10 91.11 91.12 91.13 91.14 91.15 91.16 91.17 91.18 91.19 91.20 91.21 91.22 91.23 91.24 91.25 91.26 91.27 91.28 91.29 91.30 91.31 91.32 91.33 91.34 92.1 92.2 92.3 92.4 92.5 92.6 92.7 92.8 92.9 92.10 92.11 92.12 92.13 92.14 92.15 92.16 92.17 92.18 92.19 92.20 92.21
92.22 92.23 92.24 92.25 92.26 92.27 92.28 92.29 92.30 92.31
93.1 93.2 93.3 93.4 93.5 93.6 93.7 93.8 93.9 93.10 93.11 93.12 93.13 93.14 93.15 93.16 93.17 93.18 93.19 93.20 93.21 93.22 93.23 93.24 93.25 93.26 93.27 93.28 93.29 93.30
94.1 94.2 94.3 94.4 94.5 94.6 94.7 94.8 94.9 94.10 94.11 94.12 94.13 94.14 94.15 94.16 94.17 94.18 94.19 94.20 94.21 94.22 94.23 94.24
94.25 94.26 94.27 94.28 94.29 94.30 94.31 95.1 95.2 95.3 95.4 95.5 95.6 95.7 95.8 95.9 95.10 95.11 95.12 95.13 95.14 95.15 95.16 95.17 95.18 95.19 95.20 95.21 95.22 95.23 95.24 95.25 95.26 95.27 95.28 95.29 95.30 95.31 95.32 95.33 96.1 96.2 96.3 96.4 96.5 96.6 96.7 96.8 96.9 96.10 96.11 96.12 96.13 96.14 96.15 96.16 96.17 96.18 96.19 96.20 96.21 96.22 96.23 96.24 96.25 96.26 96.27 96.28 96.29 96.30
96.31 96.32 97.1 97.2 97.3 97.4 97.5
97.6 97.7 97.8 97.9 97.10 97.11 97.12 97.13 97.14 97.15 97.16 97.17 97.18 97.19 97.20 97.21 97.22 97.23 97.24 97.25 97.26 97.27 97.28 97.29 97.30 97.31 98.1 98.2 98.3 98.4 98.5 98.6 98.7
98.8 98.9 98.10 98.11 98.12 98.13 98.14 98.15 98.16 98.17 98.18 98.19 98.20 98.21 98.22 98.23 98.24 98.25 98.26 98.27 98.28
98.29 98.30 98.31 98.32 99.1 99.2 99.3 99.4 99.5
99.6 99.7 99.8 99.9 99.10 99.11 99.12 99.13 99.14 99.15 99.16
99.17 99.18 99.19 99.20 99.21 99.22 99.23 99.24 99.25 99.26 99.27
99.28 99.29 99.30 100.1 100.2 100.3 100.4 100.5 100.6 100.7 100.8 100.9 100.10 100.11 100.12 100.13 100.14 100.15 100.16 100.17 100.18 100.19 100.20 100.21 100.22 100.23 100.24 100.25 100.26 100.27 100.28 100.29 100.30 100.31 100.32 100.33 100.34 101.1 101.2 101.3 101.4 101.5 101.6
101.7 101.8 101.9 101.10 101.11 101.12 101.13 101.14 101.15 101.16 101.17 101.18 101.19 101.20 101.21 101.22 101.23 101.24 101.25 101.26 101.27 101.28 101.29 101.30 101.31 101.32 101.33 102.1 102.2 102.3 102.4 102.5 102.6 102.7 102.8 102.9 102.10 102.11 102.12 102.13 102.14 102.15 102.16 102.17 102.18 102.19 102.20 102.21 102.22 102.23 102.24 102.25 102.26 102.27
102.28 102.29 102.30 102.31 103.1 103.2 103.3 103.4 103.5 103.6 103.7 103.8 103.9 103.10 103.11 103.12 103.13 103.14 103.15 103.16 103.17 103.18 103.19 103.20 103.21 103.22 103.23 103.24 103.25 103.26 103.27 103.28 103.29 103.30 103.31 104.1 104.2 104.3 104.4 104.5 104.6 104.7 104.8 104.9 104.10 104.11 104.12 104.13 104.14 104.15 104.16 104.17 104.18 104.19 104.20 104.21
104.22 104.23 104.24 104.25 104.26 104.27 104.28 104.29 104.30 104.31 104.32 105.1 105.2 105.3 105.4 105.5 105.6 105.7 105.8 105.9 105.10 105.11 105.12 105.13 105.14 105.15 105.16 105.17 105.18 105.19 105.20 105.21 105.22 105.23 105.24 105.25 105.26 105.27 105.28 105.29
106.1 106.2 106.3 106.4 106.5 106.6 106.7 106.8 106.9 106.10 106.11 106.12 106.13 106.14 106.15
106.16 106.17
106.18 106.19 106.20 106.21 106.22 106.23 106.24 106.25 106.26 106.27 106.28 106.29 106.30 106.31 107.1 107.2 107.3 107.4 107.5 107.6 107.7 107.8 107.9 107.10 107.11 107.12 107.13 107.14 107.15 107.16 107.17 107.18 107.19 107.20 107.21 107.22 107.23 107.24 107.25 107.26 107.27 107.28 107.29 107.30 107.31 108.1 108.2
108.3 108.4 108.5 108.6 108.7 108.8 108.9 108.10 108.11 108.12 108.13 108.14 108.15 108.16 108.17 108.18 108.19 108.20 108.21 108.22 108.23 108.24 108.25 108.26 108.27 108.28 108.29
109.1 109.2 109.3 109.4
109.5 109.6 109.7 109.8 109.9 109.10 109.11 109.12 109.13 109.14 109.15 109.16 109.17 109.18 109.19 109.20 109.21 109.22 109.23 109.24 109.25 109.26 109.27 109.28 109.29 110.1 110.2 110.3 110.4 110.5 110.6 110.7 110.8 110.9 110.10 110.11 110.12 110.13 110.14 110.15
110.16 110.17 110.18 110.19 110.20 110.21 110.22 110.23 110.24 110.25 110.26 110.27 110.28 110.29 110.30 110.31 110.32 110.33 111.1 111.2 111.3 111.4 111.5 111.6 111.7 111.8 111.9
111.10 111.11 111.12 111.13 111.14 111.15 111.16 111.17 111.18 111.19 111.20 111.21 111.22 111.23 111.24 111.25 111.26 111.27 111.28 111.29 111.30
112.1 112.2 112.3 112.4 112.5 112.6 112.7 112.8 112.9 112.10 112.11 112.12 112.13 112.14 112.15 112.16 112.17 112.18 112.19 112.20 112.21 112.22 112.23 112.24 112.25 112.26 112.27 112.28 112.29 112.30 112.31 112.32 113.1 113.2 113.3 113.4 113.5 113.6 113.7 113.8 113.9 113.10 113.11 113.12 113.13 113.14 113.15 113.16 113.17 113.18 113.19 113.20 113.21 113.22 113.23 113.24 113.25 113.26 113.27 113.28 113.29 113.30 113.31 113.32 113.33 114.1 114.2 114.3 114.4 114.5 114.6 114.7 114.8 114.9 114.10 114.11 114.12 114.13 114.14 114.15 114.16 114.17 114.18 114.19 114.20 114.21 114.22 114.23 114.24 114.25 114.26 114.27 114.28 114.29 114.30 114.31 114.32 115.1 115.2 115.3 115.4 115.5 115.6 115.7 115.8 115.9 115.10 115.11 115.12 115.13 115.14 115.15 115.16 115.17 115.18 115.19 115.20 115.21 115.22 115.23 115.24 115.25 115.26 115.27 115.28 115.29 115.30 116.1 116.2 116.3 116.4 116.5 116.6 116.7 116.8 116.9 116.10 116.11 116.12 116.13 116.14 116.15 116.16 116.17 116.18 116.19 116.20 116.21 116.22 116.23 116.24 116.25 116.26 116.27 116.28 116.29 116.30 116.31 116.32 116.33 116.34 117.1 117.2 117.3 117.4 117.5 117.6 117.7 117.8 117.9 117.10 117.11 117.12 117.13 117.14 117.15 117.16 117.17 117.18 117.19 117.20 117.21 117.22 117.23 117.24 117.25 117.26 117.27
117.28 117.29 117.30 117.31 117.32 117.33 117.34 118.1 118.2 118.3 118.4 118.5 118.6 118.7 118.8 118.9 118.10 118.11 118.12 118.13 118.14 118.15 118.16 118.17 118.18 118.19 118.20 118.21 118.22 118.23 118.24 118.25 118.26 118.27 118.28 118.29 118.30 118.31
119.1 119.2 119.3 119.4 119.5 119.6 119.7 119.8 119.9 119.10 119.11 119.12 119.13 119.14 119.15 119.16 119.17 119.18 119.19 119.20 119.21 119.22 119.23 119.24 119.25 119.26 119.27 119.28 119.29 119.30
119.31
120.1 120.2 120.3 120.4 120.5 120.6 120.7 120.8 120.9 120.10 120.11 120.12 120.13 120.14 120.15 120.16 120.17 120.18 120.19 120.20 120.21 120.22 120.23 120.24 120.25
120.26 120.27 120.28 120.29 121.1 121.2 121.3 121.4 121.5 121.6
121.7 121.8 121.9 121.10 121.11 121.12 121.13 121.14 121.15 121.16 121.17 121.18 121.19 121.20 121.21 121.22 121.23 121.24 121.25 121.26 121.27 121.28 121.29 121.30
122.1 122.2 122.3 122.4 122.5 122.6 122.7 122.8 122.9 122.10 122.11 122.12 122.13
122.14 122.15 122.16 122.17 122.18 122.19 122.20 122.21 122.22 122.23 122.24 122.25 122.26 122.27 122.28 123.1 123.2 123.3 123.4
123.5 123.6 123.7 123.8 123.9 123.10 123.11 123.12 123.13 123.14
123.15 123.16 123.17 123.18 123.19 123.20 123.21 123.22 123.23 123.24 123.25 123.26 123.27 123.28 123.29 123.30 123.31 124.1 124.2 124.3 124.4 124.5 124.6 124.7 124.8 124.9 124.10 124.11
124.12 124.13 124.14 124.15 124.16 124.17 124.18 124.19 124.20 124.21
124.22 124.23 124.24 124.25 124.26 124.27 124.28 124.29 124.30 124.31 124.32 125.1 125.2 125.3 125.4 125.5 125.6 125.7 125.8 125.9 125.10 125.11 125.12 125.13 125.14 125.15 125.16 125.17 125.18 125.19 125.20 125.21 125.22 125.23 125.24 125.25 125.26 125.27 125.28 125.29 125.30 125.31 126.1 126.2 126.3 126.4 126.5 126.6 126.7 126.8 126.9 126.10 126.11 126.12 126.13 126.14 126.15 126.16 126.17 126.18 126.19 126.20 126.21 126.22 126.23 126.24 126.25 126.26 126.27 126.28 126.29 126.30 126.31 126.32 126.33 127.1 127.2 127.3 127.4 127.5 127.6 127.7 127.8 127.9 127.10 127.11 127.12 127.13 127.14 127.15 127.16 127.17 127.18 127.19 127.20 127.21 127.22 127.23 127.24 127.25 127.26 127.27 127.28 127.29 127.30
127.31
128.1 128.2 128.3 128.4 128.5 128.6 128.7 128.8 128.9 128.10 128.11 128.12 128.13 128.14 128.15 128.16 128.17 128.18 128.19 128.20 128.21 128.22 128.23 128.24 128.25 128.26 128.27 128.28 128.29 128.30 128.31 129.1 129.2 129.3 129.4 129.5 129.6 129.7 129.8 129.9 129.10 129.11 129.12 129.13 129.14 129.15 129.16 129.17 129.18 129.19 129.20 129.21 129.22 129.23 129.24 129.25 129.26 129.27 129.28 129.29 129.30 129.31 129.32 130.1 130.2 130.3 130.4 130.5 130.6 130.7 130.8 130.9 130.10 130.11 130.12 130.13 130.14 130.15 130.16 130.17
130.18
130.19 130.20 130.21 130.22 130.23 130.24 130.25 130.26 130.27 130.28 130.29 130.30 130.31 131.1 131.2 131.3 131.4 131.5 131.6 131.7 131.8
131.9 131.10 131.11 131.12 131.13 131.14 131.15 131.16 131.17 131.18 131.19 131.20 131.21 131.22
131.23
131.24 131.25 131.26 131.27 131.28 131.29 131.30 131.31 132.1 132.2 132.3 132.4 132.5 132.6 132.7 132.8 132.9 132.10 132.11 132.12 132.13 132.14 132.15 132.16 132.17 132.18 132.19 132.20 132.21 132.22 132.23 132.24 132.25 132.26 132.27 132.28 132.29 132.30 132.31 133.1 133.2 133.3 133.4 133.5 133.6 133.7 133.8 133.9 133.10 133.11
133.12
133.13 133.14 133.15 133.16 133.17 133.18 133.19 133.20 133.21 133.22 133.23 133.24 133.25 133.26 133.27 133.28 133.29 133.30 134.1 134.2 134.3 134.4 134.5 134.6 134.7 134.8 134.9
134.10
134.11 134.12 134.13 134.14 134.15 134.16 134.17 134.18 134.19 134.20 134.21 134.22 134.23 134.24 134.25 134.26 134.27 134.28 134.29 134.30 135.1 135.2 135.3 135.4 135.5 135.6
135.7 135.8 135.9 135.10 135.11 135.12 135.13 135.14 135.15 135.16 135.17 135.18 135.19 135.20 135.21 135.22 135.23 135.24 135.25 135.26 135.27 135.28 135.29 135.30 135.31 136.1 136.2 136.3 136.4 136.5 136.6 136.7
136.8 136.9 136.10 136.11 136.12 136.13 136.14 136.15 136.16 136.17
136.18 136.19 136.20 136.21
136.22 136.23 136.24 136.25 136.26 136.27 136.28 136.29 136.30 136.31 136.32 137.1 137.2 137.3 137.4 137.5 137.6 137.7 137.8 137.9 137.10 137.11 137.12 137.13 137.14 137.15 137.16 137.17 137.18 137.19
137.20 137.21 137.22 137.23 137.24 137.25 137.26 137.27 137.28 137.29 137.30 137.31 138.1 138.2 138.3 138.4
138.5 138.6 138.7 138.8 138.9
138.10 138.11 138.12 138.13 138.14 138.15 138.16 138.17 138.18 138.19 138.20 138.21 138.22 138.23 138.24 138.25 138.26 138.27 138.28 138.29 139.1 139.2 139.3 139.4 139.5 139.6 139.7 139.8 139.9 139.10 139.11 139.12 139.13 139.14
139.15 139.16 139.17 139.18 139.19 139.20 139.21
139.22 139.23 139.24 139.25 139.26 139.27 139.28 139.29 139.30 140.1 140.2 140.3 140.4 140.5 140.6 140.7 140.8 140.9 140.10 140.11 140.12 140.13 140.14
140.15 140.16 140.17 140.18 140.19 140.20 140.21 140.22 140.23 140.24 140.25 140.26 140.27 140.28 140.29 140.30 140.31 140.32 141.1 141.2 141.3 141.4
141.5 141.6 141.7 141.8 141.9
141.10 141.11 141.12 141.13 141.14 141.15 141.16 141.17 141.18 141.19 141.20 141.21 141.22 141.23 141.24 141.25 141.26 141.27 141.28 141.29 141.30 141.31 141.32 142.1 142.2 142.3 142.4 142.5 142.6 142.7
142.8 142.9 142.10 142.11 142.12 142.13 142.14 142.15 142.16 142.17 142.18 142.19 142.20 142.21 142.22 142.23 142.24 142.25 142.26 142.27 142.28 142.29 142.30 142.31 142.32 142.33 143.1 143.2 143.3 143.4 143.5 143.6 143.7 143.8 143.9 143.10
143.11 143.12 143.13 143.14 143.15 143.16 143.17 143.18 143.19 143.20 143.21 143.22 143.23 143.24 143.25
143.26 143.27 143.28 143.29 143.30 143.31 144.1 144.2 144.3 144.4 144.5 144.6 144.7 144.8 144.9 144.10 144.11 144.12 144.13 144.14
144.15 144.16 144.17 144.18 144.19 144.20 144.21
144.22 144.23
144.24 144.25 144.26 144.27 144.28 144.29 144.30 144.31 144.32 145.1 145.2
145.3 145.4 145.5 145.6 145.7 145.8 145.9 145.10 145.11 145.12 145.13 145.14 145.15 145.16 145.17 145.18
145.19 145.20 145.21 145.22 145.23 145.24 145.25 145.26 145.27 145.28 145.29 145.30 146.1 146.2 146.3
146.4 146.5 146.6 146.7 146.8 146.9 146.10 146.11 146.12 146.13 146.14 146.15 146.16 146.17 146.18 146.19 146.20 146.21 146.22 146.23 146.24 146.25 146.26 146.27 146.28 146.29 147.1 147.2 147.3 147.4 147.5 147.6 147.7 147.8 147.9 147.10 147.11 147.12 147.13 147.14 147.15 147.16 147.17 147.18 147.19 147.20 147.21 147.22 147.23 147.24 147.25 147.26 147.27 147.28 147.29 147.30 147.31 147.32 148.1 148.2 148.3
148.4 148.5 148.6
148.7 148.8 148.9 148.10 148.11 148.12 148.13 148.14 148.15 148.16 148.17 148.18 148.19 148.20 148.21 148.22 148.23 148.24 148.25 148.26 148.27 148.28 148.29 148.30 148.31 148.32
149.1 149.2 149.3 149.4 149.5 149.6 149.7 149.8 149.9 149.10 149.11 149.12 149.13 149.14 149.15 149.16 149.17 149.18 149.19 149.20 149.21 149.22 149.23 149.24
149.25 149.26 149.27 149.28 149.29 149.30 149.31 150.1 150.2 150.3 150.4 150.5 150.6 150.7 150.8 150.9 150.10 150.11 150.12 150.13 150.14 150.15 150.16 150.17 150.18 150.19
150.20 150.21 150.22 150.23 150.24 150.25 150.26 150.27 150.28 150.29 150.30 151.1 151.2 151.3 151.4 151.5 151.6 151.7 151.8 151.9 151.10 151.11 151.12 151.13 151.14 151.15 151.16
151.17 151.18 151.19 151.20 151.21 151.22 151.23 151.24 151.25 151.26 151.27 151.28 151.29 151.30 151.31 152.1 152.2 152.3 152.4 152.5 152.6 152.7 152.8 152.9 152.10 152.11 152.12 152.13 152.14 152.15 152.16 152.17 152.18 152.19 152.20 152.21 152.22 152.23 152.24 152.25 152.26 152.27 152.28 152.29 152.30
153.1 153.2 153.3 153.4
153.5 153.6 153.7 153.8 153.9 153.10 153.11 153.12 153.13 153.14 153.15 153.16 153.17 153.18 153.19 153.20 153.21
153.22 153.23 153.24 153.25 153.26 153.27 153.28 153.29 154.1 154.2 154.3 154.4
154.5 154.6 154.7 154.8 154.9
154.10 154.11 154.12 154.13 154.14 154.15 154.16 154.17 154.18
154.19 154.20 154.21 154.22 154.23 154.24 154.25 154.26 154.27 154.28
155.1 155.2 155.3 155.4 155.5 155.6 155.7 155.8 155.9 155.10 155.11 155.12 155.13 155.14 155.15 155.16 155.17 155.18 155.19 155.20 155.21 155.22 155.23 155.24 155.25 155.26
155.27 155.28 155.29 155.30 155.31 155.32 155.33 156.1 156.2 156.3 156.4 156.5 156.6 156.7 156.8 156.9 156.10 156.11 156.12 156.13 156.14 156.15 156.16 156.17 156.18 156.19 156.20 156.21 156.22 156.23 156.24
156.25 156.26 156.27 156.28 156.29 157.1 157.2 157.3 157.4 157.5 157.6 157.7 157.8 157.9 157.10 157.11 157.12 157.13 157.14 157.15 157.16 157.17 157.18 157.19 157.20 157.21
157.22 157.23 157.24 157.25 157.26 157.27 157.28 157.29 157.30 157.31 157.32 157.33 158.1 158.2 158.3 158.4 158.5 158.6 158.7 158.8 158.9 158.10 158.11 158.12 158.13
158.14 158.15 158.16 158.17 158.18 158.19 158.20 158.21 158.22 158.23 158.24 158.25
158.26 158.27 158.28 158.29 158.30 158.31 158.32 158.33 159.1 159.2 159.3 159.4 159.5 159.6
159.7 159.8 159.9 159.10 159.11 159.12 159.13 159.14
159.15 159.16 159.17 159.18 159.19 159.20 159.21 159.22 159.23 159.24 159.25 159.26 159.27 159.28 159.29 159.30 160.1 160.2 160.3 160.4 160.5 160.6 160.7
160.8 160.9 160.10 160.11 160.12 160.13 160.14 160.15 160.16 160.17 160.18
160.19 160.20 160.21 160.22 160.23 160.24 160.25 160.26 160.27 160.28 160.29 160.30 161.1 161.2
161.3 161.4 161.5 161.6 161.7 161.8 161.9 161.10 161.11 161.12 161.13 161.14 161.15 161.16 161.17 161.18 161.19 161.20 161.21 161.22 161.23 161.24 161.25 161.26 161.27 161.28 161.29 161.30 161.31 162.1 162.2 162.3 162.4 162.5 162.6
162.7 162.8 162.9 162.10 162.11 162.12 162.13 162.14 162.15 162.16 162.17 162.18 162.19 162.20
162.21 162.22 162.23 162.24 162.25
162.26 162.27 162.28 162.29 162.30 162.31 163.1 163.2 163.3 163.4 163.5 163.6 163.7 163.8 163.9 163.10 163.11 163.12 163.13 163.14 163.15 163.16 163.17 163.18 163.19 163.20 163.21 163.22 163.23 163.24 163.25 163.26 163.27 163.28 163.29 163.30 163.31 163.32 164.1 164.2 164.3 164.4 164.5 164.6 164.7 164.8 164.9 164.10 164.11 164.12 164.13
164.14 164.15 164.16 164.17 164.18 164.19 164.20 164.21 164.22 164.23 164.24 164.25 164.26 164.27 164.28 164.29 164.30 164.31 164.32 165.1 165.2 165.3 165.4 165.5 165.6 165.7 165.8 165.9 165.10 165.11 165.12 165.13 165.14 165.15 165.16 165.17 165.18 165.19 165.20 165.21 165.22 165.23 165.24 165.25 165.26 165.27 165.28
165.29 165.30 165.31 165.32 165.33 165.34 166.1 166.2 166.3 166.4 166.5 166.6 166.7 166.8 166.9 166.10 166.11 166.12 166.13 166.14 166.15 166.16 166.17 166.18 166.19 166.20 166.21 166.22 166.23 166.24 166.25 166.26 166.27 166.28 166.29 166.30 166.31 166.32 166.33 166.34 167.1 167.2 167.3 167.4 167.5 167.6 167.7 167.8 167.9 167.10 167.11 167.12 167.13 167.14 167.15 167.16 167.17 167.18 167.19 167.20 167.21 167.22 167.23 167.24 167.25 167.26 167.27 167.28 167.29 167.30 167.31 167.32 167.33 168.1 168.2 168.3 168.4 168.5 168.6 168.7 168.8 168.9 168.10
168.11 168.12 168.13 168.14 168.15 168.16 168.17 168.18 168.19 168.20 168.21 168.22 168.23 168.24 168.25 168.26 168.27 168.28 168.29 168.30 168.31 168.32 169.1 169.2 169.3 169.4 169.5 169.6 169.7 169.8 169.9 169.10 169.11 169.12 169.13 169.14 169.15 169.16 169.17 169.18 169.19 169.20 169.21 169.22 169.23 169.24 169.25 169.26 169.27 169.28
169.29 169.30 169.31 169.32 170.1 170.2 170.3 170.4 170.5 170.6 170.7 170.8 170.9 170.10 170.11 170.12 170.13 170.14 170.15 170.16 170.17 170.18 170.19 170.20 170.21 170.22 170.23 170.24 170.25 170.26 170.27 170.28 170.29
171.1 171.2 171.3 171.4 171.5 171.6 171.7 171.8 171.9 171.10 171.11 171.12
171.13 171.14 171.15 171.16 171.17 171.18 171.19 171.20 171.21 171.22 171.23 171.24 171.25 171.26 171.27 171.28 171.29 171.30 171.31 172.1 172.2 172.3 172.4 172.5 172.6 172.7 172.8 172.9 172.10 172.11 172.12 172.13 172.14 172.15 172.16 172.17 172.18 172.19 172.20 172.21 172.22 172.23 172.24 172.25 172.26 172.27 172.28 172.29
173.1 173.2 173.3 173.4 173.5 173.6 173.7 173.8 173.9 173.10 173.11 173.12 173.13 173.14 173.15 173.16 173.17 173.18 173.19 173.20 173.21 173.22 173.23 173.24 173.25 173.26 173.27 173.28 173.29 173.30 173.31 174.1 174.2 174.3 174.4 174.5 174.6 174.7 174.8 174.9 174.10 174.11 174.12 174.13 174.14 174.15 174.16 174.17 174.18 174.19 174.20 174.21 174.22 174.23 174.24 174.25 174.26 174.27 174.28 174.29 174.30 175.1 175.2
175.3 175.4 175.5 175.6 175.7 175.8 175.9 175.10 175.11
175.12 175.13 175.14 175.15 175.16
175.17 175.18
175.19 175.20
175.21 175.22 175.23 175.24 175.25 175.26 175.27
176.1 176.2 176.3 176.4 176.5 176.6 176.7 176.8 176.9 176.10 176.11 176.12 176.13 176.14 176.15 176.16 176.17 176.18 176.19 176.20 176.21 176.22 176.23 176.24 176.25 176.26 176.27 176.28 176.29 176.30 176.31 177.1 177.2 177.3 177.4 177.5 177.6 177.7 177.8 177.9 177.10 177.11 177.12 177.13 177.14 177.15 177.16 177.17 177.18 177.19 177.20 177.21 177.22 177.23 177.24 177.25 177.26 177.27 177.28 177.29 177.30 177.31 178.1 178.2 178.3 178.4 178.5 178.6
178.7 178.8 178.9 178.10 178.11 178.12 178.13 178.14 178.15 178.16 178.17 178.18 178.19 178.20 178.21 178.22 178.23 178.24 178.25 178.26 178.27 178.28 178.29 178.30 178.31 178.32 179.1 179.2 179.3 179.4
179.5 179.6 179.7 179.8 179.9 179.10 179.11 179.12 179.13 179.14 179.15 179.16 179.17 179.18 179.19 179.20 179.21 179.22 179.23 179.24 179.25 179.26 179.27 179.28 179.29 179.30 180.1 180.2 180.3 180.4 180.5 180.6 180.7
180.8 180.9 180.10 180.11 180.12 180.13 180.14 180.15 180.16 180.17 180.18 180.19 180.20 180.21 180.22 180.23 180.24 180.25 180.26 180.27 180.28 180.29 180.30 181.1 181.2 181.3 181.4 181.5 181.6 181.7 181.8 181.9 181.10 181.11 181.12 181.13 181.14 181.15 181.16 181.17 181.18 181.19 181.20 181.21 181.22 181.23 181.24 181.25 181.26 181.27 181.28 181.29 181.30 181.31 182.1 182.2 182.3 182.4 182.5 182.6 182.7 182.8 182.9 182.10 182.11 182.12 182.13
182.14 182.15 182.16 182.17 182.18 182.19 182.20 182.21 182.22 182.23 182.24 182.25 182.26 182.27 182.28 182.29 182.30 182.31 182.32 182.33 183.1 183.2 183.3 183.4 183.5 183.6 183.7 183.8 183.9 183.10 183.11 183.12 183.13 183.14 183.15 183.16 183.17 183.18 183.19 183.20 183.21 183.22 183.23 183.24 183.25 183.26 183.27 183.28 183.29 183.30 183.31 184.1 184.2 184.3 184.4 184.5 184.6 184.7 184.8 184.9 184.10 184.11 184.12 184.13 184.14 184.15 184.16 184.17 184.18 184.19 184.20 184.21 184.22 184.23 184.24 184.25 184.26 184.27 184.28 184.29 184.30 184.31 184.32 184.33 184.34 185.1 185.2 185.3 185.4 185.5 185.6 185.7 185.8 185.9 185.10 185.11 185.12
185.13 185.14 185.15 185.16 185.17 185.18 185.19 185.20 185.21 185.22 185.23 185.24 185.25 185.26 185.27 185.28 185.29 185.30 185.31 186.1 186.2 186.3 186.4 186.5 186.6 186.7 186.8 186.9 186.10 186.11 186.12 186.13 186.14
186.15 186.16 186.17 186.18 186.19 186.20 186.21 186.22 186.23 186.24 186.25 186.26 186.27 186.28 186.29 186.30 186.31 187.1 187.2 187.3 187.4 187.5 187.6 187.7 187.8 187.9 187.10 187.11 187.12 187.13 187.14 187.15 187.16 187.17 187.18 187.19 187.20 187.21 187.22
187.23 187.24 187.25 187.26 187.27 187.28 187.29 187.30 187.31 187.32 188.1 188.2
188.3 188.4 188.5 188.6 188.7 188.8 188.9 188.10
188.11
188.12 188.13 188.14 188.15 188.16 188.17 188.18 188.19 188.20 188.21 188.22 188.23 188.24 188.25 188.26 188.27 188.28 188.29 188.30 188.31 189.1 189.2 189.3 189.4 189.5 189.6 189.7 189.8 189.9 189.10 189.11 189.12 189.13 189.14 189.15 189.16 189.17 189.18 189.19 189.20 189.21 189.22 189.23 189.24 189.25 189.26 189.27 189.28 189.29 189.30 189.31 190.1 190.2 190.3 190.4 190.5 190.6 190.7 190.8 190.9 190.10 190.11 190.12 190.13 190.14 190.15 190.16 190.17 190.18 190.19 190.20 190.21 190.22 190.23 190.24 190.25 190.26 190.27 190.28 190.29 190.30 190.31 191.1 191.2 191.3 191.4 191.5 191.6 191.7 191.8 191.9 191.10 191.11 191.12 191.13 191.14 191.15 191.16 191.17 191.18 191.19 191.20 191.21 191.22 191.23 191.24 191.25 191.26 191.27 191.28 191.29 191.30 191.31 192.1 192.2 192.3 192.4 192.5 192.6 192.7 192.8 192.9 192.10 192.11 192.12 192.13 192.14 192.15 192.16
192.17
192.18 192.19 192.20 192.21 192.22 192.23 192.24 192.25 192.26 192.27 192.28 192.29 192.30 192.31 192.32 193.1 193.2 193.3 193.4 193.5 193.6 193.7 193.8 193.9 193.10 193.11 193.12 193.13 193.14 193.15 193.16 193.17 193.18 193.19
193.20 193.21 193.22 193.23 193.24 193.25 193.26 193.27 193.28 193.29 193.30 193.31 194.1 194.2 194.3 194.4 194.5 194.6 194.7 194.8 194.9 194.10 194.11 194.12 194.13 194.14 194.15 194.16 194.17 194.18 194.19
194.20
194.21 194.22 194.23 194.24 194.25 194.26 194.27 194.28 194.29 194.30 195.1 195.2 195.3 195.4 195.5 195.6 195.7 195.8 195.9 195.10 195.11 195.12 195.13 195.14 195.15 195.16 195.17 195.18 195.19 195.20 195.21 195.22
195.23 195.24 195.25 195.26 195.27 195.28 195.29 195.30 196.1 196.2 196.3
196.4
196.5 196.6 196.7 196.8 196.9 196.10 196.11 196.12 196.13 196.14 196.15 196.16 196.17 196.18 196.19 196.20 196.21 196.22 196.23 196.24 196.25 196.26 196.27 196.28 196.29 196.30 196.31 196.32 196.33 197.1 197.2 197.3 197.4 197.5 197.6 197.7 197.8 197.9 197.10 197.11 197.12 197.13 197.14 197.15 197.16 197.17 197.18 197.19 197.20 197.21 197.22 197.23 197.24 197.25 197.26 197.27 197.28
197.29 197.30 197.31 197.32 197.33
198.1 198.2 198.3 198.4 198.5 198.6 198.7 198.8 198.9 198.10 198.11 198.12 198.13 198.14 198.15 198.16 198.17 198.18 198.19 198.20 198.21 198.22 198.23 198.24
198.25 198.26 198.27 198.28 198.29 198.30 198.31 198.32 199.1 199.2 199.3 199.4 199.5 199.6 199.7 199.8
199.9 199.10 199.11
199.12 199.13 199.14 199.15 199.16 199.17 199.18 199.19 199.20 199.21 199.22 199.23 199.24 199.25 199.26 199.27 199.28 199.29 200.1 200.2 200.3 200.4 200.5 200.6 200.7 200.8 200.9 200.10 200.11 200.12 200.13 200.14 200.15 200.16 200.17 200.18 200.19 200.20 200.21 200.22 200.23 200.24 200.25 200.26 200.27 200.28 200.29 201.1 201.2 201.3 201.4 201.5 201.6
201.7 201.8 201.9
201.10 201.11 201.12 201.13 201.14 201.15 201.16 201.17 201.18 201.19 201.20 201.21 201.22 201.23 201.24 201.25 201.26 201.27 201.28 201.29 201.30 201.31 201.32 202.1 202.2 202.3 202.4 202.5 202.6 202.7 202.8 202.9 202.10 202.11 202.12 202.13 202.14 202.15 202.16 202.17 202.18 202.19 202.20 202.21 202.22 202.23 202.24 202.25 202.26 202.27 202.28 202.29 202.30 202.31 202.32 203.1 203.2 203.3 203.4 203.5 203.6 203.7 203.8 203.9 203.10 203.11 203.12 203.13 203.14 203.15 203.16 203.17 203.18 203.19 203.20 203.21 203.22 203.23 203.24 203.25 203.26 203.27 203.28 203.29 203.30 203.31 203.32 204.1 204.2 204.3 204.4 204.5 204.6 204.7 204.8 204.9 204.10 204.11 204.12 204.13 204.14 204.15 204.16 204.17 204.18 204.19 204.20 204.21 204.22 204.23 204.24 204.25 204.26 204.27 204.28 204.29 204.30 204.31 205.1 205.2 205.3 205.4 205.5 205.6 205.7 205.8 205.9 205.10 205.11 205.12 205.13 205.14 205.15 205.16 205.17 205.18 205.19 205.20 205.21 205.22 205.23 205.24 205.25 205.26 205.27 205.28 205.29 205.30 205.31 205.32 206.1 206.2 206.3
206.4
206.5 206.6 206.7 206.8 206.9 206.10 206.11 206.12 206.13 206.14 206.15 206.16 206.17 206.18 206.19 206.20 206.21 206.22 206.23 206.24 206.25 206.26 206.27 206.28 206.29
206.30
207.1 207.2 207.3 207.4 207.5 207.6 207.7 207.8 207.9 207.10 207.11 207.12 207.13 207.14 207.15
207.16 207.17 207.18 207.19 207.20 207.21 207.22
207.23 207.24 207.25 207.26 207.27 207.28 207.29 207.30 208.1 208.2 208.3 208.4 208.5 208.6 208.7 208.8 208.9 208.10 208.11
208.12
208.13 208.14 208.15 208.16 208.17 208.18 208.19 208.20
208.21 208.22 208.23
208.24 208.25 208.26 208.27 208.28 208.29 208.30 208.31 209.1 209.2 209.3 209.4 209.5 209.6 209.7 209.8 209.9 209.10 209.11 209.12 209.13 209.14 209.15 209.16 209.17 209.18 209.19 209.20 209.21 209.22 209.23 209.24 209.25 209.26 209.27 209.28 209.29 209.30 209.31 209.32 209.33 209.34 209.35 210.1 210.2 210.3 210.4 210.5 210.6 210.7 210.8 210.9 210.10 210.11 210.12 210.13 210.14 210.15 210.16 210.17 210.18 210.19 210.20 210.21 210.22 210.23 210.24 210.25 210.26 210.27 210.28 210.29 210.30 210.31 210.32 211.1 211.2 211.3 211.4 211.5 211.6 211.7 211.8 211.9 211.10 211.11 211.12 211.13 211.14 211.15 211.16 211.17 211.18 211.19 211.20 211.21 211.22 211.23 211.24 211.25 211.26 211.27 211.28 211.29 211.30 211.31 211.32 212.1 212.2 212.3 212.4 212.5 212.6 212.7 212.8 212.9 212.10 212.11 212.12 212.13 212.14 212.15 212.16 212.17 212.18 212.19 212.20 212.21 212.22 212.23 212.24 212.25 212.26 212.27 212.28 212.29 212.30 212.31 213.1 213.2 213.3 213.4 213.5 213.6 213.7 213.8 213.9 213.10 213.11 213.12 213.13 213.14 213.15 213.16 213.17 213.18 213.19 213.20 213.21 213.22 213.23 213.24 213.25 213.26 213.27 213.28 213.29 213.30 213.31 213.32 213.33 214.1 214.2 214.3 214.4 214.5 214.6 214.7 214.8 214.9 214.10 214.11 214.12 214.13 214.14 214.15 214.16 214.17 214.18 214.19 214.20 214.21 214.22 214.23 214.24 214.25 214.26 214.27 214.28 214.29
214.30 214.31 214.32 214.33 214.34 215.1 215.2 215.3 215.4 215.5 215.6 215.7 215.8 215.9 215.10 215.11 215.12 215.13 215.14 215.15 215.16 215.17 215.18 215.19 215.20 215.21 215.22 215.23 215.24 215.25 215.26 215.27 215.28 215.29 215.30 215.31 215.32 216.1 216.2 216.3 216.4 216.5 216.6 216.7 216.8 216.9 216.10 216.11 216.12 216.13 216.14 216.15 216.16 216.17 216.18 216.19 216.20 216.21 216.22 216.23 216.24 216.25 216.26
216.27 216.28 216.29
217.1 217.2 217.3 217.4 217.5 217.6 217.7 217.8 217.9 217.10 217.11 217.12 217.13 217.14 217.15 217.16 217.17 217.18 217.19 217.20 217.21 217.22 217.23 217.24 217.25 217.26 217.27 217.28 217.29 217.30 217.31 218.1 218.2 218.3 218.4 218.5 218.6 218.7 218.8 218.9 218.10 218.11 218.12 218.13 218.14 218.15 218.16 218.17 218.18 218.19 218.20 218.21 218.22 218.23 218.24 218.25 218.26 218.27 218.28 218.29 218.30 219.1 219.2
219.3 219.4 219.5
219.6 219.7 219.8 219.9 219.10 219.11 219.12 219.13 219.14 219.15 219.16 219.17 219.18 219.19 219.20 219.21 219.22 219.23 219.24 219.25 219.26 219.27 219.28 219.29 219.30 219.31 220.1 220.2 220.3 220.4 220.5 220.6 220.7 220.8 220.9 220.10 220.11 220.12 220.13 220.14 220.15 220.16 220.17 220.18 220.19 220.20 220.21 220.22 220.23 220.24 220.25 220.26 220.27 220.28 220.29 220.30 220.31 220.32 221.1 221.2 221.3 221.4 221.5 221.6 221.7 221.8 221.9 221.10 221.11 221.12 221.13 221.14 221.15 221.16 221.17 221.18 221.19 221.20 221.21 221.22 221.23 221.24 221.25
221.26 221.27 221.28 221.29 221.30 222.1 222.2 222.3 222.4 222.5 222.6 222.7 222.8 222.9 222.10 222.11 222.12 222.13 222.14 222.15 222.16 222.17 222.18 222.19 222.20 222.21 222.22 222.23 222.24 222.25 222.26 222.27 222.28 222.29 222.30 222.31 222.32 222.33 223.1 223.2 223.3 223.4 223.5 223.6 223.7
223.8 223.9 223.10 223.11 223.12 223.13 223.14 223.15 223.16 223.17 223.18 223.19 223.20 223.21 223.22 223.23 223.24 223.25 223.26 223.27 223.28 223.29 223.30 223.31 223.32 224.1 224.2 224.3 224.4 224.5 224.6 224.7 224.8 224.9 224.10 224.11 224.12 224.13 224.14 224.15 224.16 224.17 224.18 224.19 224.20 224.21 224.22 224.23 224.24 224.25 224.26 224.27 224.28
224.29 224.30 224.31 224.32 224.33 225.1 225.2 225.3 225.4 225.5 225.6 225.7 225.8 225.9 225.10 225.11 225.12 225.13 225.14 225.15 225.16 225.17 225.18 225.19 225.20 225.21 225.22 225.23 225.24 225.25 225.26 225.27 225.28 225.29 225.30 225.31 225.32 226.1 226.2 226.3 226.4 226.5 226.6 226.7 226.8 226.9 226.10 226.11 226.12 226.13 226.14 226.15 226.16 226.17 226.18 226.19 226.20 226.21 226.22 226.23 226.24 226.25 226.26 226.27 226.28
226.29
226.30 226.31 226.32 227.1 227.2 227.3 227.4 227.5 227.6 227.7 227.8 227.9 227.10 227.11 227.12 227.13 227.14 227.15 227.16 227.17 227.18 227.19 227.20 227.21 227.22 227.23 227.24 227.25 227.26 227.27 227.28 227.29 227.30 227.31 227.32
228.1 228.2 228.3 228.4 228.5 228.6 228.7 228.8 228.9 228.10 228.11 228.12 228.13 228.14 228.15 228.16 228.17 228.18 228.19 228.20 228.21 228.22 228.23 228.24 228.25 228.26 228.27 228.28 228.29 228.30 228.31 228.32 228.33 229.1 229.2 229.3 229.4 229.5 229.6 229.7 229.8 229.9 229.10 229.11 229.12 229.13 229.14 229.15 229.16
229.17
229.18 229.19 229.20 229.21 229.22 229.23 229.24 229.25 229.26 229.27 229.28 229.29 229.30 230.1 230.2 230.3 230.4 230.5 230.6 230.7 230.8 230.9 230.10 230.11 230.12 230.13 230.14
230.15
230.16 230.17 230.18 230.19 230.20 230.21 230.22 230.23 230.24
230.25
230.26 230.27 230.28 230.29 230.30 230.31 230.32 231.1 231.2 231.3 231.4 231.5 231.6 231.7 231.8 231.9 231.10 231.11 231.12 231.13
231.14 231.15 231.16 231.17 231.18 231.19 231.20 231.21 231.22 231.23 231.24 231.25 231.26 231.27 231.28 231.29 232.1 232.2 232.3 232.4
232.5
232.6 232.7 232.8 232.9 232.10 232.11 232.12 232.13 232.14 232.15 232.16 232.17 232.18 232.19 232.20 232.21 232.22 232.23 232.24 232.25 232.26 232.27 232.28
232.29
233.1 233.2 233.3 233.4 233.5 233.6 233.7 233.8 233.9 233.10 233.11 233.12 233.13 233.14 233.15 233.16 233.17 233.18 233.19 233.20 233.21 233.22 233.23 233.24 233.25 233.26 233.27 233.28 233.29 233.30 233.31 233.32 233.33 234.1 234.2 234.3 234.4 234.5
234.6
234.7 234.8 234.9 234.10 234.11 234.12 234.13 234.14 234.15 234.16 234.17 234.18 234.19 234.20 234.21 234.22 234.23 234.24 234.25 234.26 234.27 234.28 234.29 234.30 234.31 234.32 234.33 235.1 235.2 235.3 235.4 235.5 235.6 235.7 235.8 235.9 235.10 235.11 235.12 235.13 235.14 235.15 235.16 235.17 235.18 235.19 235.20 235.21 235.22 235.23 235.24 235.25 235.26 235.27 235.28 235.29 235.30 235.31 235.32 235.33 235.34 236.1 236.2 236.3 236.4 236.5 236.6
236.7 236.8 236.9 236.10 236.11 236.12 236.13 236.14 236.15 236.16
236.17
236.18 236.19 236.20 236.21 236.22 236.23 236.24 236.25 236.26 236.27 236.28 236.29 236.30 236.31 236.32 237.1 237.2
237.3 237.4 237.5 237.6 237.7 237.8 237.9 237.10 237.11 237.12 237.13 237.14 237.15 237.16
237.17 237.18 237.19 237.20 237.21 237.22 237.23
237.24 237.25 237.26 237.27 237.28 237.29
238.1 238.2 238.3 238.4
238.5 238.6 238.7 238.8 238.9 238.10
238.11 238.12 238.13 238.14 238.15 238.16 238.17 238.18 238.19 238.20 238.21 238.22 238.23 238.24 238.25
238.26
238.27 238.28 238.29 238.30 238.31 238.32 239.1 239.2 239.3
239.4 239.5 239.6 239.7 239.8 239.9
239.10 239.11 239.12 239.13 239.14 239.15 239.16 239.17 239.18 239.19 239.20
239.21 239.22 239.23 239.24 239.25 239.26
239.27 239.28 239.29 239.30 239.31 239.32 239.33 240.1 240.2 240.3 240.4 240.5 240.6 240.7 240.8 240.9 240.10 240.11 240.12 240.13 240.14 240.15 240.16 240.17 240.18 240.19 240.20 240.21 240.22 240.23 240.24 240.25 240.26 240.27 240.28 240.29 240.30 240.31 240.32 240.33 240.34 240.35 241.1 241.2 241.3
241.4 241.5 241.6 241.7 241.8 241.9 241.10
241.11 241.12 241.13 241.14 241.15 241.16 241.17 241.18 241.19 241.20 241.21 241.22 241.23 241.24 241.25 241.26 241.27 241.28 241.29 241.30 241.31 241.32 241.33 242.1 242.2 242.3 242.4 242.5 242.6 242.7 242.8 242.9 242.10 242.11 242.12 242.13 242.14 242.15 242.16 242.17 242.18 242.19 242.20 242.21 242.22 242.23 242.24 242.25 242.26 242.27 242.28 242.29 242.30
242.31 242.32 242.33 243.1 243.2 243.3 243.4 243.5 243.6 243.7 243.8 243.9 243.10 243.11 243.12 243.13 243.14 243.15 243.16 243.17 243.18 243.19 243.20 243.21 243.22 243.23 243.24 243.25 243.26 243.27 243.28 243.29 243.30 243.31 243.32 243.33 244.1 244.2 244.3 244.4 244.5 244.6 244.7 244.8 244.9 244.10 244.11 244.12 244.13 244.14 244.15 244.16 244.17 244.18 244.19 244.20 244.21 244.22 244.23 244.24 244.25 244.26 244.27 244.28 244.29 244.30 244.31 244.32 244.33 245.1 245.2 245.3 245.4 245.5 245.6 245.7 245.8 245.9 245.10 245.11 245.12 245.13 245.14 245.15 245.16 245.17 245.18 245.19 245.20 245.21 245.22 245.23 245.24 245.25 245.26 245.27 245.28 245.29 245.30 245.31 245.32 246.1 246.2 246.3 246.4 246.5 246.6 246.7 246.8 246.9 246.10 246.11 246.12 246.13 246.14 246.15 246.16 246.17 246.18 246.19 246.20 246.21 246.22 246.23 246.24 246.25 246.26 246.27 246.28 246.29 246.30 246.31 246.32 246.33 247.1 247.2 247.3 247.4 247.5 247.6 247.7 247.8 247.9 247.10 247.11 247.12 247.13 247.14 247.15 247.16 247.17 247.18 247.19 247.20 247.21 247.22 247.23 247.24 247.25 247.26 247.27 247.28 247.29 247.30 247.31 247.32 247.33 247.34 248.1 248.2 248.3 248.4 248.5 248.6 248.7 248.8 248.9 248.10 248.11 248.12 248.13 248.14 248.15 248.16 248.17 248.18 248.19 248.20 248.21 248.22 248.23 248.24 248.25 248.26 248.27 248.28 248.29 248.30 248.31 248.32 248.33 248.34 249.1 249.2 249.3 249.4 249.5 249.6 249.7 249.8 249.9 249.10 249.11 249.12 249.13 249.14 249.15 249.16 249.17 249.18 249.19 249.20 249.21 249.22 249.23 249.24 249.25 249.26 249.27 249.28 249.29 249.30 249.31 249.32 249.33 250.1 250.2 250.3 250.4 250.5 250.6 250.7 250.8 250.9 250.10 250.11 250.12 250.13 250.14 250.15 250.16 250.17 250.18 250.19 250.20 250.21 250.22 250.23 250.24 250.25 250.26 250.27 250.28 250.29 250.30 250.31 250.32 250.33 250.34 250.35 251.1 251.2 251.3 251.4 251.5 251.6 251.7 251.8 251.9 251.10 251.11 251.12 251.13 251.14 251.15 251.16 251.17 251.18 251.19 251.20 251.21 251.22 251.23 251.24 251.25 251.26 251.27 251.28 251.29 251.30 251.31 251.32 251.33 251.34 252.1 252.2 252.3 252.4 252.5 252.6 252.7 252.8 252.9 252.10 252.11 252.12 252.13 252.14 252.15 252.16 252.17 252.18 252.19 252.20 252.21 252.22 252.23 252.24 252.25 252.26 252.27 252.28 252.29 252.30 252.31 252.32 252.33 252.34 252.35 253.1 253.2 253.3
253.4 253.5 253.6 253.7 253.8 253.9 253.10 253.11 253.12 253.13 253.14 253.15 253.16 253.17 253.18 253.19 253.20 253.21 253.22 253.23 253.24 253.25 253.26 253.27 253.28 253.29 253.30 253.31 253.32 254.1 254.2 254.3 254.4 254.5 254.6 254.7
254.8 254.9 254.10 254.11 254.12 254.13 254.14 254.15 254.16 254.17 254.18 254.19 254.20 254.21 254.22 254.23 254.24 254.25 254.26 254.27 254.28 254.29 254.30 254.31 255.1 255.2
255.3 255.4 255.5 255.6 255.7 255.8 255.9 255.10 255.11 255.12 255.13 255.14 255.15 255.16 255.17 255.18 255.19 255.20 255.21 255.22 255.23 255.24 255.25 255.26 255.27 255.28 255.29 255.30 255.31 256.1 256.2 256.3 256.4 256.5 256.6 256.7 256.8 256.9 256.10 256.11 256.12 256.13 256.14 256.15 256.16 256.17 256.18 256.19 256.20 256.21 256.22 256.23 256.24 256.25 256.26 256.27 256.28
256.29 256.30 256.31 256.32 256.33 257.1 257.2 257.3 257.4 257.5 257.6 257.7 257.8
257.9
257.10 257.11 257.12 257.13 257.14 257.15 257.16 257.17 257.18 257.19 257.20 257.21 257.22 257.23 257.24 257.25 257.26 257.27 257.28 257.29 257.30 258.1 258.2 258.3
258.4
258.5 258.6 258.7 258.8 258.9 258.10 258.11 258.12 258.13 258.14 258.15 258.16 258.17 258.18 258.19 258.20
258.21
258.22 258.23 258.24 258.25 258.26 258.27 258.28 258.29 258.30 258.31 259.1 259.2 259.3 259.4 259.5 259.6 259.7 259.8 259.9 259.10 259.11 259.12 259.13 259.14 259.15 259.16 259.17 259.18 259.19 259.20
259.21 259.22 259.23 259.24 259.25 259.26 259.27 259.28 259.29 259.30 259.31 260.1 260.2 260.3 260.4 260.5 260.6 260.7 260.8 260.9 260.10 260.11 260.12 260.13 260.14 260.15 260.16 260.17 260.18 260.19
260.20 260.21
260.22
260.23 260.24
260.25 260.26 260.27 260.28 260.29 261.1 261.2 261.3 261.4 261.5 261.6 261.7 261.8 261.9 261.10 261.11 261.12 261.13 261.14
261.15 261.16 261.17 261.18 261.19 261.20
261.21
261.22 261.23 261.24 261.25 261.26 261.27 261.28 261.29 261.30 262.1 262.2 262.3 262.4 262.5 262.6 262.7 262.8 262.9 262.10 262.11 262.12 262.13 262.14 262.15 262.16 262.17 262.18 262.19 262.20 262.21 262.22 262.23 262.24 262.25 262.26 262.27 262.28
262.29
262.30 262.31 262.32 262.33 263.1 263.2 263.3 263.4 263.5 263.6 263.7 263.8 263.9 263.10 263.11 263.12 263.13 263.14 263.15 263.16 263.17 263.18 263.19 263.20 263.21 263.22 263.23
263.24 263.25 263.26 263.27 263.28 263.29 263.30 263.31 264.1 264.2 264.3 264.4 264.5 264.6 264.7 264.8 264.9 264.10 264.11 264.12 264.13 264.14 264.15 264.16 264.17 264.18 264.19 264.20 264.21 264.22 264.23 264.24 264.25 264.26 264.27 264.28 264.29
264.30 264.31 264.32 264.33 265.1 265.2 265.3 265.4 265.5 265.6 265.7 265.8 265.9 265.10 265.11 265.12 265.13 265.14 265.15 265.16 265.17 265.18 265.19 265.20 265.21 265.22 265.23 265.24 265.25 265.26 265.27 265.28 265.29 265.30 265.31 265.32 265.33 265.34 266.1 266.2 266.3 266.4 266.5 266.6 266.7 266.8 266.9 266.10 266.11 266.12 266.13 266.14 266.15 266.16 266.17 266.18 266.19 266.20 266.21 266.22 266.23 266.24 266.25 266.26 266.27 266.28 266.29 266.30 266.31 266.32 266.33 267.1 267.2 267.3 267.4 267.5 267.6 267.7 267.8 267.9 267.10 267.11 267.12 267.13 267.14 267.15 267.16 267.17 267.18 267.19 267.20 267.21 267.22 267.23 267.24 267.25 267.26 267.27 267.28 267.29 267.30 267.31 268.1 268.2 268.3 268.4 268.5 268.6 268.7 268.8 268.9 268.10 268.11 268.12 268.13
268.14
268.15 268.16 268.17 268.18 268.19 268.20 268.21 268.22 268.23 268.24 268.25 268.26 268.27 268.28 268.29 268.30 268.31 269.1 269.2 269.3 269.4 269.5 269.6 269.7 269.8 269.9 269.10 269.11 269.12 269.13 269.14 269.15 269.16 269.17 269.18 269.19 269.20 269.21 269.22 269.23 269.24 269.25 269.26 269.27 269.28 269.29 269.30 269.31 269.32 270.1 270.2 270.3 270.4 270.5 270.6 270.7 270.8 270.9 270.10 270.11 270.12 270.13 270.14 270.15 270.16 270.17 270.18 270.19 270.20 270.21 270.22 270.23 270.24 270.25
270.26 270.27 270.28 270.29 270.30 270.31 271.1 271.2 271.3 271.4 271.5
271.6 271.7 271.8 271.9 271.10 271.11 271.12 271.13 271.14 271.15 271.16 271.17 271.18 271.19 271.20 271.21 271.22 271.23 271.24 271.25 271.26 271.27 271.28 271.29 271.30 272.1 272.2 272.3 272.4 272.5 272.6 272.7 272.8 272.9 272.10 272.11 272.12 272.13 272.14 272.15 272.16 272.17 272.18 272.19 272.20 272.21 272.22 272.23 272.24 272.25 272.26 272.27 272.28 272.29 272.30 272.31 272.32 273.1 273.2 273.3 273.4 273.5 273.6 273.7 273.8 273.9 273.10 273.11 273.12 273.13 273.14 273.15 273.16 273.17 273.18 273.19 273.20 273.21 273.22 273.23 273.24 273.25 273.26 273.27 273.28 273.29 273.30 273.31 274.1 274.2 274.3
274.4
274.5 274.6 274.7 274.8 274.9 274.10 274.11 274.12 274.13 274.14
274.15 274.16 274.17 274.18 274.19
274.20 274.21
274.22 274.23 274.24 274.25 274.26 274.27
274.28 274.29
275.1 275.2 275.3 275.4 275.5 275.6 275.7 275.8 275.9 275.10 275.11 275.12 275.13 275.14 275.15 275.16 275.17 275.18 275.19 275.20 275.21 275.22 275.23 275.24 275.25 275.26 275.27 275.28
275.29 275.30
275.31 275.32 275.33 276.1 276.2 276.3 276.4 276.5 276.6 276.7 276.8 276.9 276.10
276.11 276.12
276.13 276.14 276.15 276.16 276.17 276.18 276.19 276.20 276.21 276.22 276.23 276.24 276.25
276.26 276.27
276.28 276.29 276.30 276.31 276.32 277.1 277.2 277.3 277.4 277.5 277.6 277.7 277.8
277.9 277.10
277.11 277.12 277.13 277.14 277.15 277.16 277.17 277.18 277.19 277.20 277.21 277.22 277.23 277.24 277.25 277.26 277.27 277.28
277.29 277.30
278.1 278.2 278.3 278.4 278.5 278.6 278.7 278.8 278.9 278.10 278.11 278.12 278.13 278.14 278.15 278.16 278.17 278.18 278.19 278.20 278.21 278.22 278.23 278.24 278.25 278.26 278.27 278.28 278.29 278.30 278.31 279.1 279.2 279.3 279.4 279.5 279.6 279.7 279.8 279.9 279.10 279.11 279.12 279.13 279.14 279.15 279.16 279.17 279.18 279.19 279.20 279.21 279.22
279.23 279.24 279.25 279.26 279.27 279.28 279.29 279.30 279.31 280.1 280.2 280.3 280.4 280.5 280.6 280.7 280.8 280.9 280.10 280.11 280.12 280.13 280.14 280.15 280.16 280.17 280.18 280.19 280.20 280.21 280.22 280.23 280.24 280.25 280.26 280.27 280.28 280.29 280.30 280.31 280.32 281.1 281.2 281.3 281.4 281.5 281.6
281.7 281.8 281.9 281.10 281.11 281.12 281.13 281.14 281.15 281.16
281.17 281.18 281.19 281.20 281.21 281.22 281.23 281.24 281.25 281.26 281.27 281.28 281.29 281.30 282.1 282.2 282.3 282.4 282.5 282.6 282.7 282.8 282.9 282.10 282.11 282.12 282.13 282.14 282.15 282.16 282.17 282.18 282.19 282.20 282.21
282.22 282.23 282.24 282.25 282.26 282.27 282.28 282.29 282.30 282.31 282.32 283.1 283.2 283.3 283.4 283.5 283.6 283.7 283.8 283.9 283.10 283.11 283.12 283.13
283.14 283.15 283.16 283.17 283.18 283.19 283.20 283.21 283.22 283.23 283.24 283.25 283.26 283.27 283.28 283.29
284.1 284.2 284.3 284.4 284.5 284.6 284.7 284.8 284.9 284.10
284.11 284.12 284.13 284.14 284.15 284.16 284.17 284.18
284.19 284.20 284.21 284.22 284.23 284.24 284.25 284.26 284.27
285.1 285.2 285.3 285.4 285.5 285.6 285.7 285.8 285.9 285.10 285.11
285.12 285.13 285.14 285.15 285.16 285.17 285.18 285.19 285.20 285.21 285.22 285.23 285.24 285.25
285.26 285.27 285.28 286.1 286.2 286.3 286.4 286.5 286.6 286.7 286.8 286.9 286.10 286.11 286.12 286.13 286.14 286.15 286.16 286.17 286.18 286.19 286.20 286.21 286.22 286.23 286.24 286.25 286.26 286.27 286.28 286.29 286.30 286.31 286.32 286.33 287.1 287.2 287.3 287.4 287.5 287.6 287.7 287.8 287.9 287.10 287.11 287.12 287.13 287.14 287.15 287.16 287.17 287.18 287.19 287.20 287.21 287.22 287.23 287.24 287.25 287.26 287.27 287.28 287.29 287.30 287.31 287.32 288.1 288.2 288.3 288.4 288.5 288.6 288.7 288.8 288.9 288.10 288.11 288.12 288.13 288.14 288.15 288.16 288.17 288.18
288.19 288.20 288.21 288.22 288.23 288.24 288.25 288.26 288.27 288.28 288.29 288.30 289.1 289.2 289.3 289.4 289.5 289.6 289.7 289.8 289.9 289.10 289.11 289.12 289.13 289.14 289.15 289.16 289.17 289.18 289.19 289.20 289.21 289.22
289.23
289.24 289.25 289.26 289.27 289.28 289.29 289.30 289.31 289.32 290.1 290.2 290.3 290.4 290.5 290.6 290.7 290.8 290.9 290.10 290.11 290.12 290.13 290.14 290.15 290.16 290.17 290.18 290.19 290.20 290.21 290.22 290.23 290.24 290.25 290.26 290.27 290.28 290.29 290.30 290.31 290.32 291.1 291.2 291.3 291.4 291.5 291.6 291.7 291.8 291.9 291.10 291.11 291.12 291.13 291.14 291.15 291.16 291.17 291.18 291.19 291.20 291.21 291.22 291.23 291.24 291.25 291.26 291.27 291.28 291.29 291.30 291.31 291.32 291.33 292.1 292.2 292.3 292.4 292.5 292.6 292.7 292.8 292.9 292.10 292.11 292.12 292.13 292.14 292.15 292.16 292.17 292.18 292.19 292.20 292.21 292.22 292.23 292.24 292.25 292.26 292.27 292.28 292.29 292.30 292.31 292.32 292.33 292.34 293.1 293.2 293.3 293.4 293.5 293.6 293.7 293.8 293.9 293.10 293.11 293.12 293.13 293.14
293.15
293.16 293.17
293.18 293.19
293.20 293.21 293.22 293.23 293.24 293.25 293.26 293.27 293.28 293.29 293.30 293.31 293.32 294.1 294.2 294.3 294.4 294.5 294.6
294.7 294.8 294.9 294.10 294.11 294.12 294.13 294.14 294.15 294.16 294.17 294.18 294.19 294.20 294.21 294.22 294.23 294.24 294.25 294.26 294.27 294.28 294.29 294.30 294.31 295.1 295.2 295.3 295.4 295.5 295.6 295.7 295.8 295.9 295.10 295.11 295.12 295.13 295.14 295.15 295.16 295.17 295.18 295.19 295.20 295.21 295.22 295.23 295.24 295.25 295.26 295.27 295.28 295.29 295.30
296.1 296.2 296.3 296.4 296.5 296.6 296.7 296.8 296.9 296.10 296.11 296.12 296.13 296.14 296.15 296.16 296.17 296.18 296.19 296.20 296.21 296.22 296.23 296.24 296.25 296.26 296.27
296.28
297.1 297.2 297.3 297.4 297.5 297.6 297.7 297.8 297.9 297.10 297.11 297.12 297.13 297.14 297.15 297.16 297.17 297.18 297.19 297.20 297.21 297.22 297.23 297.24 297.25 297.26 297.27 297.28 297.29 297.30 297.31 298.1 298.2 298.3 298.4 298.5 298.6 298.7 298.8 298.9 298.10 298.11 298.12 298.13 298.14 298.15 298.16 298.17 298.18 298.19 298.20 298.21 298.22 298.23 298.24 298.25 298.26 298.27 298.28 298.29 298.30 298.31 299.1 299.2 299.3 299.4 299.5 299.6 299.7 299.8 299.9 299.10 299.11 299.12 299.13 299.14 299.15 299.16 299.17 299.18 299.19 299.20 299.21 299.22 299.23 299.24 299.25 299.26 299.27 299.28 299.29 299.30 300.1 300.2 300.3 300.4 300.5 300.6 300.7 300.8 300.9 300.10 300.11 300.12 300.13 300.14 300.15 300.16 300.17 300.18 300.19 300.20 300.21 300.22 300.23 300.24 300.25 300.26 300.27 300.28 300.29 300.30 300.31 301.1 301.2 301.3 301.4 301.5 301.6 301.7 301.8 301.9 301.10 301.11 301.12 301.13 301.14 301.15 301.16 301.17 301.18 301.19 301.20 301.21 301.22 301.23 301.24 301.25 301.26 301.27 301.28 301.29 301.30 302.1 302.2 302.3 302.4 302.5 302.6 302.7 302.8 302.9 302.10 302.11 302.12 302.13 302.14 302.15 302.16 302.17 302.18 302.19 302.20 302.21 302.22 302.23 302.24 302.25 302.26 302.27 302.28 302.29 303.1 303.2 303.3 303.4 303.5 303.6 303.7 303.8 303.9 303.10 303.11 303.12 303.13 303.14 303.15 303.16 303.17 303.18 303.19 303.20 303.21 303.22 303.23 303.24 303.25 303.26 303.27 303.28 303.29 303.30 303.31 303.32 303.33 303.34 304.1 304.2 304.3 304.4 304.5 304.6 304.7 304.8 304.9 304.10 304.11 304.12 304.13 304.14 304.15 304.16 304.17 304.18 304.19 304.20 304.21 304.22 304.23 304.24
304.25 304.26 304.27 304.28 304.29 304.30 305.1 305.2 305.3 305.4 305.5 305.6 305.7 305.8 305.9 305.10 305.11 305.12 305.13 305.14 305.15 305.16 305.17 305.18 305.19 305.20 305.21 305.22 305.23 305.24 305.25 305.26 305.27
305.28 305.29 305.30 306.1 306.2 306.3 306.4 306.5 306.6 306.7 306.8 306.9 306.10 306.11 306.12 306.13 306.14 306.15 306.16 306.17 306.18 306.19 306.20 306.21 306.22 306.23 306.24 306.25 306.26 306.27 306.28 306.29 306.30 306.31 307.1 307.2 307.3 307.4 307.5 307.6 307.7 307.8 307.9 307.10 307.11 307.12
307.13 307.14 307.15 307.16 307.17 307.18 307.19 307.20 307.21 307.22 307.23 307.24 307.25 307.26 307.27 307.28 307.29 307.30 307.31 308.1 308.2 308.3 308.4 308.5 308.6 308.7 308.8 308.9 308.10 308.11 308.12 308.13 308.14 308.15 308.16 308.17
308.18 308.19 308.20 308.21 308.22 308.23 308.24 308.25 308.26 308.27 308.28 308.29 308.30 308.31 308.32 308.33 309.1 309.2 309.3 309.4 309.5 309.6 309.7 309.8 309.9 309.10 309.11 309.12 309.13 309.14 309.15 309.16 309.17 309.18 309.19
309.20 309.21 309.22 309.23 309.24 309.25 309.26 309.27 309.28 309.29 309.30
309.31 309.32 309.33 310.1 310.2 310.3 310.4 310.5 310.6 310.7
310.8 310.9 310.10 310.11 310.12 310.13 310.14 310.15 310.16 310.17 310.18 310.19 310.20 310.21 310.22 310.23 310.24 310.25
310.26 310.27 310.28 310.29 310.30 311.1 311.2 311.3 311.4 311.5 311.6 311.7 311.8 311.9 311.10 311.11
311.12 311.13 311.14 311.15 311.16 311.17 311.18 311.19 311.20 311.21 311.22 311.23 311.24 311.25 311.26
311.27 311.28 311.29 311.30 311.31 312.1 312.2 312.3 312.4 312.5 312.6 312.7
312.8 312.9 312.10 312.11 312.12 312.13 312.14 312.15 312.16 312.17 312.18 312.19 312.20 312.21 312.22 312.23 312.24 312.25 312.26 312.27 312.28 312.29
313.1 313.2 313.3 313.4 313.5 313.6 313.7 313.8 313.9 313.10 313.11 313.12 313.13 313.14 313.15 313.16 313.17 313.18 313.19 313.20 313.21 313.22 313.23 313.24 313.25 313.26 313.27 313.28 313.29 313.30 314.1 314.2 314.3 314.4 314.5 314.6 314.7 314.8 314.9 314.10 314.11 314.12 314.13 314.14 314.15 314.16 314.17 314.18 314.19 314.20 314.21 314.22 314.23 314.24 314.25 314.26 314.27 314.28 314.29 314.30
315.1 315.2 315.3 315.4 315.5 315.6 315.7 315.8 315.9 315.10 315.11 315.12 315.13 315.14 315.15 315.16 315.17 315.18 315.19 315.20 315.21 315.22 315.23 315.24 315.25 315.26 315.27 315.28 315.29 315.30 315.31 316.1 316.2
316.3 316.4 316.5 316.6 316.7 316.8 316.9 316.10 316.11 316.12 316.13 316.14 316.15 316.16 316.17 316.18 316.19 316.20 316.21 316.22 316.23 316.24 316.25 316.26 316.27 316.28 316.29 316.30 317.1 317.2
317.3 317.4 317.5 317.6 317.7 317.8 317.9 317.10 317.11 317.12 317.13 317.14 317.15 317.16 317.17 317.18 317.19 317.20 317.21 317.22 317.23 317.24 317.25 317.26 317.27 317.28 317.29 317.30 318.1 318.2
318.3 318.4 318.5 318.6 318.7
318.8 318.9 318.10 318.11
318.12 318.13 318.14 318.15 318.16 318.17 318.18 318.19 318.20 318.21 318.22 318.23 318.24 318.25 318.26 318.27 318.28 318.29 318.30 319.1 319.2 319.3 319.4 319.5 319.6 319.7 319.8 319.9 319.10 319.11 319.12 319.13 319.14 319.15 319.16 319.17 319.18 319.19 319.20 319.21 319.22 319.23 319.24 319.25 319.26
319.27 319.28 319.29 319.30 319.31 320.1 320.2 320.3 320.4 320.5 320.6 320.7 320.8 320.9 320.10 320.11 320.12 320.13 320.14 320.15 320.16 320.17
320.18 320.19 320.20 320.21 320.22 320.23 320.24 320.25 320.26 320.27 320.28 320.29 320.30 320.31 321.1 321.2 321.3 321.4 321.5 321.6
321.7 321.8 321.9 321.10
321.11 321.12 321.13 321.14 321.15 321.16 321.17 321.18 321.19 321.20 321.21 321.22 321.23 321.24 321.25 321.26 321.27 321.28 321.29 321.30 321.31 322.1 322.2 322.3 322.4 322.5 322.6 322.7 322.8 322.9 322.10 322.11 322.12 322.13 322.14 322.15 322.16 322.17 322.18 322.19 322.20 322.21 322.22 322.23 322.24 322.25
322.26 322.27 322.28 322.29 322.30 323.1 323.2 323.3 323.4 323.5 323.6 323.7
323.8 323.9 323.10 323.11 323.12
323.13 323.14
323.15 323.16 323.17 323.18 323.19 323.20 323.21 323.22 323.23 323.24 323.25 323.26 323.27 323.28 323.29 323.30 324.1 324.2 324.3 324.4 324.5 324.6 324.7 324.8 324.9 324.10 324.11 324.12 324.13
324.14 324.15 324.16 324.17 324.18 324.19 324.20 324.21 324.22 324.23 324.24 324.25 324.26 324.27 324.28 324.29 324.30 325.1 325.2 325.3 325.4 325.5 325.6 325.7 325.8 325.9 325.10 325.11 325.12 325.13 325.14 325.15 325.16 325.17 325.18 325.19 325.20 325.21 325.22 325.23 325.24 325.25 325.26 325.27 325.28 325.29 325.30 325.31 325.32
326.1 326.2 326.3 326.4 326.5 326.6 326.7 326.8 326.9 326.10 326.11 326.12 326.13 326.14 326.15 326.16 326.17 326.18 326.19 326.20 326.21 326.22 326.23 326.24 326.25 326.26 326.27 326.28 326.29 326.30 326.31 327.1 327.2
327.3 327.4 327.5 327.6 327.7 327.8 327.9 327.10 327.11 327.12 327.13 327.14 327.15 327.16 327.17 327.18 327.19 327.20 327.21 327.22 327.23 327.24 327.25 327.26 327.27 327.28 327.29 327.30 327.31 328.1 328.2
328.3 328.4 328.5 328.6 328.7 328.8 328.9 328.10 328.11 328.12 328.13 328.14 328.15 328.16 328.17 328.18 328.19 328.20 328.21 328.22 328.23 328.24 328.25 328.26 328.27 328.28 328.29 329.1 329.2 329.3 329.4 329.5 329.6 329.7 329.8 329.9 329.10 329.11 329.12 329.13 329.14 329.15 329.16 329.17 329.18
329.19 329.20 329.21 329.22 329.23 329.24 329.25 329.26 329.27 329.28 329.29 329.30 329.31 329.32 330.1 330.2 330.3 330.4 330.5 330.6 330.7 330.8 330.9 330.10 330.11 330.12 330.13 330.14 330.15 330.16 330.17 330.18 330.19 330.20 330.21 330.22 330.23 330.24 330.25 330.26 330.27 330.28 330.29 330.30 330.31 331.1 331.2 331.3 331.4 331.5 331.6 331.7 331.8 331.9 331.10
331.11 331.12 331.13 331.14 331.15 331.16 331.17 331.18 331.19 331.20 331.21 331.22 331.23 331.24 331.25 331.26 331.27 331.28 331.29 331.30 332.1 332.2 332.3 332.4 332.5 332.6 332.7 332.8 332.9
332.10 332.11 332.12 332.13 332.14 332.15
332.16 332.17 332.18 332.19 332.20 332.21 332.22 332.23 332.24 332.25 332.26 332.27 332.28
332.29 332.30 332.31 333.1 333.2
333.3 333.4 333.5 333.6 333.7 333.8 333.9 333.10 333.11 333.12 333.13 333.14 333.15 333.16
333.17 333.18 333.19 333.20 333.21 333.22 333.23 333.24 333.25 333.26 333.27 333.28 333.29 333.30 333.31 334.1 334.2 334.3 334.4 334.5
334.6 334.7
334.8 334.9 334.10 334.11 334.12 334.13 334.14 334.15 334.16 334.17 334.18 334.19 334.20 334.21 334.22 334.23 334.24 334.25 334.26 334.27 334.28 334.29 334.30 334.31 334.32 335.1 335.2
335.3 335.4 335.5 335.6 335.7 335.8 335.9 335.10 335.11 335.12 335.13 335.14 335.15 335.16 335.17 335.18 335.19 335.20 335.21 335.22 335.23 335.24 335.25 335.26 335.27 335.28 335.29 335.30 335.31 335.32 336.1 336.2 336.3 336.4 336.5 336.6 336.7 336.8 336.9 336.10 336.11 336.12 336.13 336.14 336.15 336.16 336.17 336.18 336.19 336.20 336.21 336.22 336.23 336.24 336.25 336.26 336.27
336.28 336.29
336.30 336.31 336.32 337.1 337.2 337.3 337.4 337.5 337.6 337.7 337.8 337.9 337.10 337.11 337.12 337.13 337.14 337.15 337.16 337.17 337.18 337.19 337.20 337.21 337.22 337.23 337.24 337.25 337.26 337.27 337.28 337.29 337.30 337.31 337.32 338.1 338.2
338.3
338.4 338.5 338.6 338.7 338.8 338.9 338.10 338.11 338.12 338.13 338.14 338.15 338.16 338.17 338.18 338.19 338.20 338.21 338.22 338.23 338.24 338.25 338.26 338.27 338.28 338.29 338.30 338.31 339.1 339.2 339.3 339.4 339.5 339.6 339.7 339.8 339.9 339.10 339.11 339.12 339.13 339.14 339.15 339.16 339.17 339.18 339.19 339.20 339.21 339.22 339.23 339.24
339.25
339.26 339.27 339.28 339.29 339.30 339.31 339.32 340.1 340.2 340.3 340.4 340.5 340.6
340.7 340.8 340.9 340.10 340.11 340.12 340.13 340.14 340.15 340.16 340.17 340.18 340.19 340.20 340.21 340.22 340.23 340.24 340.25 340.26 340.27 340.28 340.29 340.30 340.31 340.32 340.33 341.1 341.2 341.3 341.4 341.5 341.6 341.7 341.8 341.9 341.10 341.11 341.12 341.13 341.14 341.15 341.16 341.17 341.18 341.19 341.20 341.21 341.22 341.23 341.24 341.25 341.26 341.27 341.28 341.29 341.30 341.31 341.32 342.1 342.2 342.3 342.4 342.5 342.6 342.7 342.8 342.9 342.10 342.11 342.12 342.13 342.14 342.15 342.16 342.17 342.18 342.19 342.20 342.21 342.22 342.23 342.24 342.25 342.26 342.27 342.28 342.29 342.30 342.31
343.1 343.2 343.3 343.4 343.5
343.6
343.7 343.8 343.9 343.10 343.11 343.12 343.13
343.14
343.15 343.16 343.17 343.18 343.19 343.20 343.21 343.22 343.23 343.24 343.25 343.26 343.27 343.28 343.29 343.30 343.31 344.1 344.2 344.3 344.4 344.5 344.6 344.7 344.8 344.9
344.10 344.11 344.12 344.13 344.14 344.15 344.16 344.17 344.18 344.19 344.20 344.21 344.22 344.23 344.24 344.25 344.26 344.27 344.28 344.29 344.30 344.31 344.32 344.33 345.1 345.2 345.3 345.4 345.5 345.6 345.7 345.8 345.9 345.10 345.11 345.12 345.13 345.14 345.15 345.16 345.17 345.18 345.19 345.20 345.21 345.22 345.23 345.24 345.25 345.26 345.27 345.28 345.29 345.30 345.31 345.32 345.33 345.34 346.1 346.2 346.3 346.4 346.5 346.6 346.7 346.8 346.9 346.10 346.11 346.12 346.13 346.14 346.15 346.16 346.17 346.18 346.19 346.20 346.21 346.22 346.23 346.24 346.25 346.26 346.27 346.28 346.29 346.30 346.31 346.32 346.33 346.34 347.1 347.2 347.3 347.4 347.5 347.6 347.7 347.8 347.9 347.10 347.11 347.12 347.13 347.14 347.15 347.16 347.17 347.18 347.19 347.20 347.21 347.22 347.23 347.24 347.25 347.26 347.27 347.28 347.29 347.30 347.31 347.32 348.1 348.2 348.3 348.4 348.5 348.6 348.7 348.8 348.9 348.10 348.11 348.12 348.13 348.14 348.15 348.16 348.17 348.18 348.19 348.20
348.21 348.22 348.23 348.24 348.25 348.26 348.27 348.28 348.29 348.30 348.31 348.32 349.1 349.2 349.3 349.4 349.5 349.6 349.7 349.8 349.9 349.10 349.11 349.12 349.13 349.14 349.15 349.16 349.17 349.18 349.19 349.20 349.21 349.22 349.23 349.24 349.25 349.26 349.27 349.28 349.29 349.30 349.31 349.32 349.33 349.34 350.1 350.2 350.3 350.4 350.5 350.6 350.7 350.8 350.9 350.10 350.11 350.12 350.13 350.14 350.15 350.16 350.17 350.18 350.19 350.20 350.21 350.22 350.23 350.24 350.25 350.26 350.27 350.28 350.29 350.30 350.31 350.32 350.33 350.34 351.1 351.2 351.3 351.4 351.5 351.6 351.7 351.8 351.9 351.10 351.11 351.12 351.13 351.14 351.15 351.16 351.17 351.18 351.19 351.20 351.21 351.22 351.23 351.24 351.25 351.26 351.27 351.28 351.29 351.30 351.31 351.32 351.33 351.34 352.1 352.2 352.3 352.4 352.5 352.6 352.7 352.8 352.9 352.10 352.11 352.12 352.13 352.14 352.15 352.16 352.17 352.18 352.19 352.20 352.21 352.22 352.23 352.24 352.25 352.26 352.27 352.28 352.29 352.30
353.1 353.2 353.3 353.4 353.5 353.6 353.7 353.8 353.9 353.10 353.11 353.12 353.13 353.14
353.15 353.16 353.17 353.18 353.19 353.20 353.21 353.22 353.23 353.24 353.25 353.26 353.27 353.28 353.29 353.30 353.31 353.32 354.1 354.2 354.3 354.4 354.5 354.6 354.7 354.8 354.9 354.10 354.11 354.12 354.13 354.14 354.15 354.16 354.17 354.18
354.19 354.20 354.21 354.22 354.23 354.24 354.25 354.26 354.27 354.28 354.29 354.30 354.31 355.1 355.2 355.3 355.4 355.5 355.6 355.7 355.8 355.9 355.10 355.11 355.12 355.13 355.14 355.15 355.16 355.17 355.18 355.19 355.20 355.21 355.22 355.23 355.24 355.25 355.26 355.27 355.28 355.29 355.30 355.31 356.1 356.2 356.3 356.4 356.5 356.6 356.7 356.8 356.9 356.10 356.11 356.12 356.13 356.14 356.15 356.16 356.17 356.18 356.19 356.20 356.21 356.22 356.23 356.24 356.25 356.26 356.27 356.28 356.29 356.30 357.1 357.2 357.3 357.4 357.5 357.6 357.7 357.8 357.9 357.10 357.11 357.12 357.13 357.14 357.15 357.16 357.17 357.18 357.19 357.20 357.21 357.22 357.23 357.24 357.25 357.26 357.27 357.28 357.29 357.30 357.31 358.1 358.2 358.3 358.4 358.5 358.6 358.7 358.8 358.9 358.10 358.11 358.12 358.13 358.14 358.15 358.16 358.17 358.18 358.19 358.20 358.21 358.22 358.23 358.24 358.25 358.26 358.27 358.28 358.29 358.30 358.31 358.32 359.1 359.2 359.3 359.4 359.5 359.6 359.7 359.8 359.9 359.10 359.11 359.12 359.13 359.14 359.15 359.16 359.17 359.18 359.19 359.20 359.21 359.22 359.23 359.24 359.25 359.26 359.27 359.28 359.29 359.30 359.31 359.32 360.1 360.2 360.3 360.4 360.5 360.6 360.7 360.8 360.9 360.10 360.11 360.12 360.13 360.14 360.15 360.16 360.17 360.18 360.19 360.20 360.21 360.22 360.23 360.24 360.25 360.26 360.27 360.28 360.29 360.30 360.31 360.32 360.33 360.34 361.1 361.2 361.3 361.4 361.5 361.6 361.7 361.8 361.9 361.10 361.11 361.12 361.13 361.14 361.15 361.16 361.17 361.18 361.19 361.20 361.21 361.22 361.23 361.24 361.25 361.26 361.27 361.28 361.29 361.30 361.31 361.32 362.1 362.2 362.3 362.4 362.5 362.6 362.7 362.8 362.9 362.10 362.11 362.12 362.13 362.14 362.15 362.16 362.17 362.18 362.19 362.20 362.21 362.22 362.23 362.24 362.25 362.26 362.27 362.28 362.29 362.30 362.31 362.32 363.1 363.2 363.3 363.4 363.5 363.6 363.7 363.8 363.9 363.10 363.11 363.12 363.13 363.14 363.15 363.16 363.17 363.18 363.19 363.20 363.21 363.22 363.23 363.24 363.25 363.26 363.27 363.28 363.29 363.30 363.31 363.32 363.33 364.1 364.2 364.3 364.4 364.5
364.6 364.7 364.8 364.9 364.10 364.11 364.12 364.13 364.14 364.15 364.16 364.17 364.18 364.19 364.20 364.21 364.22 364.23 364.24 364.25 364.26 364.27 364.28 364.29 364.30 365.1 365.2 365.3 365.4 365.5 365.6 365.7 365.8 365.9 365.10 365.11 365.12 365.13 365.14 365.15 365.16 365.17 365.18 365.19 365.20 365.21 365.22 365.23 365.24 365.25 365.26 365.27 365.28 365.29 365.30 365.31 365.32 365.33 365.34 366.1 366.2 366.3 366.4 366.5 366.6 366.7 366.8 366.9 366.10 366.11 366.12 366.13 366.14 366.15 366.16 366.17 366.18 366.19 366.20 366.21 366.22 366.23 366.24 366.25 366.26 366.27 366.28 366.29 366.30 366.31 366.32 366.33 367.1 367.2 367.3 367.4 367.5 367.6 367.7 367.8 367.9 367.10 367.11 367.12 367.13 367.14 367.15 367.16 367.17 367.18 367.19 367.20 367.21
367.22 367.23 367.24 367.25 367.26 367.27 367.28 367.29 367.30 367.31 367.32 367.33 368.1 368.2 368.3 368.4 368.5 368.6 368.7 368.8 368.9 368.10 368.11 368.12 368.13 368.14 368.15 368.16 368.17 368.18 368.19 368.20 368.21 368.22 368.23 368.24 368.25 368.26 368.27 368.28 368.29 368.30 368.31 368.32 368.33 368.34 369.1 369.2 369.3 369.4 369.5 369.6 369.7 369.8 369.9 369.10 369.11 369.12 369.13 369.14 369.15 369.16 369.17 369.18 369.19 369.20
369.21 369.22 369.23 369.24 369.25 369.26 369.27 369.28 369.29 369.30 369.31 369.32 369.33 370.1 370.2 370.3 370.4 370.5 370.6 370.7 370.8 370.9 370.10 370.11 370.12 370.13 370.14 370.15 370.16 370.17 370.18 370.19 370.20 370.21 370.22 370.23 370.24 370.25 370.26 370.27 370.28 370.29 370.30 370.31 370.32 371.1 371.2 371.3 371.4
371.5 371.6 371.7 371.8 371.9 371.10 371.11 371.12
371.13 371.14
371.15 371.16 371.17 371.18 371.19 371.20 371.21 371.22 371.23 371.24 371.25 371.26 371.27 371.28 371.29 371.30 371.31 372.1 372.2 372.3 372.4 372.5 372.6 372.7 372.8 372.9 372.10 372.11
372.12 372.13
372.14 372.15 372.16 372.17 372.18 372.19 372.20 372.21 372.22 372.23 372.24 372.25 372.26 372.27 372.28 372.29 372.30
372.31 372.32
373.1 373.2 373.3 373.4 373.5 373.6 373.7 373.8
373.9 373.10
373.11 373.12 373.13 373.14 373.15 373.16
373.17 373.18
373.19 373.20 373.21 373.22 373.23 373.24 373.25 373.26 373.27 373.28 373.29
373.30 373.31
374.1 374.2 374.3 374.4 374.5 374.6 374.7 374.8 374.9 374.10 374.11 374.12 374.13 374.14 374.15 374.16 374.17 374.18 374.19 374.20 374.21 374.22 374.23 374.24 374.25 374.26 374.27
374.28 374.29
375.1 375.2 375.3 375.4 375.5
375.6
375.7 375.8 375.9 375.10 375.11
375.12
375.13 375.14 375.15 375.16 375.17 375.18 375.19 375.20 375.21 375.22 375.23 375.24 375.25 375.26 375.27 375.28 376.1 376.2 376.3 376.4 376.5 376.6 376.7 376.8 376.9 376.10 376.11 376.12 376.13
376.14
376.15 376.16 376.17 376.18 376.19 376.20 376.21 376.22 376.23 376.24 376.25 376.26 376.27 376.28 376.29
376.30
377.1 377.2
377.3 377.4 377.5 377.6 377.7 377.8
377.9 377.10 377.11 377.12 377.13 377.14 377.15 377.16 377.17 377.18 377.19 377.20 377.21 377.22 377.23 377.24 377.25 377.26 377.27 377.28 377.29 377.30 377.31 378.1 378.2 378.3 378.4 378.5 378.6 378.7 378.8 378.9 378.10 378.11 378.12 378.13 378.14 378.15 378.16 378.17 378.18 378.19 378.20 378.21 378.22 378.23 378.24 378.25 378.26 378.27 378.28 378.29 378.30 378.31 379.1 379.2 379.3 379.4 379.5 379.6 379.7 379.8 379.9 379.10 379.11 379.12 379.13 379.14 379.15 379.16 379.17 379.18 379.19 379.20 379.21 379.22 379.23 379.24 379.25 379.26 379.27 379.28 379.29 379.30 379.31 379.32 380.1 380.2 380.3 380.4 380.5 380.6 380.7 380.8 380.9 380.10 380.11 380.12 380.13 380.14 380.15 380.16 380.17 380.18 380.19 380.20 380.21 380.22 380.23 380.24 380.25 380.26 380.27
380.28 380.29 380.30 380.31 380.32 381.1 381.2 381.3 381.4 381.5 381.6 381.7 381.8 381.9 381.10 381.11 381.12 381.13 381.14 381.15 381.16 381.17 381.18
381.19 381.20 381.21 381.22 381.23 381.24 381.25 381.26 381.27
381.28 381.29 381.30 382.1 382.2 382.3 382.4 382.5 382.6 382.7 382.8 382.9 382.10 382.11 382.12 382.13 382.14
382.15 382.16 382.17 382.18 382.19 382.20 382.21 382.22 382.23 382.24 382.25 382.26 382.27 382.28 382.29 382.30 382.31 382.32
383.1 383.2 383.3 383.4 383.5 383.6 383.7 383.8 383.9 383.10 383.11 383.12 383.13 383.14 383.15 383.16 383.17 383.18 383.19 383.20 383.21 383.22 383.23 383.24 383.25 383.26 383.27 383.28
384.1 384.2 384.3 384.4 384.5 384.6 384.7 384.8 384.9 384.10 384.11 384.12 384.13 384.14 384.15 384.16 384.17 384.18 384.19 384.20 384.21 384.22 384.23 384.24 384.25 384.26 384.27 384.28 384.29 384.30 384.31 385.1 385.2 385.3 385.4 385.5 385.6
385.7 385.8 385.9 385.10 385.11 385.12 385.13 385.14 385.15 385.16 385.17 385.18 385.19 385.20 385.21 385.22 385.23 385.24 385.25 385.26 385.27 385.28 385.29 385.30
386.1 386.2 386.3 386.4 386.5 386.6 386.7 386.8 386.9 386.10 386.11 386.12 386.13 386.14 386.15 386.16 386.17 386.18 386.19 386.20 386.21 386.22
386.23 386.24
386.25 386.26 386.27 386.28 386.29 386.30 386.31 387.1 387.2 387.3 387.4 387.5 387.6 387.7 387.8 387.9 387.10 387.11 387.12 387.13 387.14 387.15 387.16 387.17 387.18 387.19 387.20 387.21 387.22 387.23 387.24 387.25 387.26 387.27 388.1 388.2 388.3 388.4 388.5 388.6 388.7 388.8 388.9 388.10 388.11 388.12 388.13 388.14 388.15 388.16 388.17 388.18 388.19 388.20 388.21 388.22 388.23 388.24 388.25 388.26 388.27 389.1 389.2 389.3 389.4 389.5 389.6 389.7 389.8 389.9 389.10 389.11 389.12 389.13 389.14 389.15 389.16 389.17 389.18 389.19 389.20 389.21 389.22 389.23 389.24 389.25 389.26 389.27 389.28 389.29 390.1 390.2 390.3 390.4 390.5 390.6 390.7 390.8 390.9 390.10 390.11 390.12 390.13 390.14 390.15 390.16 390.17 390.18 390.19 390.20 390.21 390.22 390.23 390.24 390.25 390.26 390.27 390.28 390.29 390.30 391.1 391.2 391.3 391.4 391.5 391.6 391.7 391.8 391.9 391.10 391.11 391.12 391.13 391.14 391.15 391.16 391.17 391.18 391.19 391.20 391.21 391.22 391.23 391.24 391.25 391.26 391.27 391.28 392.1 392.2 392.3 392.4 392.5 392.6 392.7 392.8 392.9 392.10 392.11 392.12 392.13 392.14 392.15 392.16 392.17 392.18 392.19 392.20 392.21 392.22 392.23 392.24 392.25 392.26 392.27 393.1 393.2 393.3 393.4 393.5 393.6 393.7 393.8 393.9 393.10 393.11 393.12 393.13 393.14 393.15 393.16 393.17 393.18 393.19 393.20 393.21 393.22 393.23 393.24 393.25 393.26 393.27 394.1 394.2 394.3 394.4 394.5 394.6 394.7 394.8 394.9 394.10 394.11 394.12 394.13 394.14 394.15 394.16 394.17 394.18 394.19 394.20 394.21 394.22 394.23 394.24 394.25 394.26 394.27 394.28 394.29 394.30 395.1 395.2 395.3 395.4 395.5 395.6 395.7 395.8 395.9 395.10 395.11 395.12 395.13 395.14 395.15 395.16 395.17 395.18 395.19 395.20 395.21 395.22 395.23 395.24 395.25 395.26 395.27 395.28 396.1 396.2 396.3 396.4 396.5 396.6 396.7 396.8 396.9 396.10 396.11 396.12 396.13 396.14 396.15 396.16 396.17 396.18 396.19 396.20 396.21 396.22 396.23 396.24 396.25 396.26 396.27 396.28 396.29 397.1 397.2 397.3 397.4 397.5 397.6 397.7 397.8 397.9 397.10 397.11 397.12 397.13 397.14 397.15 397.16 397.17 397.18 397.19 397.20 397.21 397.22 397.23 397.24 397.25 397.26 397.27 397.28 397.29 397.30 397.31 398.1 398.2 398.3 398.4 398.5 398.6 398.7 398.8 398.9 398.10 398.11 398.12 398.13 398.14 398.15 398.16 398.17 398.18 398.19 398.20 398.21 398.22 398.23 398.24 398.25 398.26 398.27 398.28 398.29 398.30 398.31 398.32 398.33 399.1 399.2 399.3 399.4 399.5 399.6 399.7 399.8 399.9 399.10 399.11 399.12 399.13 399.14 399.15 399.16 399.17 399.18 399.19 399.20 399.21 399.22 399.23 399.24 399.25 399.26 399.27 399.28 399.29 399.30 400.1 400.2 400.3 400.4 400.5 400.6 400.7 400.8 400.9 400.10 400.11 400.12 400.13 400.14 400.15 400.16 400.17 400.18 400.19 400.20 400.21 400.22 400.23 400.24 400.25 400.26 400.27 400.28 400.29 400.30 401.1 401.2 401.3 401.4 401.5 401.6 401.7 401.8 401.9 401.10 401.11 401.12 401.13 401.14 401.15 401.16 401.17 401.18 401.19 401.20 401.21 401.22 401.23
401.24 401.25
401.26 401.27 401.28 401.29 402.1 402.2 402.3 402.4 402.5 402.6 402.7 402.8 402.9 402.10 402.11 402.12 402.13 402.14 402.15 402.16 402.17 402.18 402.19 402.20 402.21 402.22 402.23 402.24 402.25 402.26 402.27 402.28 403.1 403.2 403.3 403.4 403.5 403.6 403.7 403.8 403.9 403.10 403.11 403.12 403.13 403.14 403.15 403.16 403.17 403.18 403.19 403.20 403.21 403.22 403.23 403.24 403.25 403.26 403.27 403.28 403.29 403.30 404.1 404.2 404.3 404.4 404.5 404.6 404.7 404.8 404.9 404.10 404.11 404.12 404.13 404.14 404.15 404.16 404.17 404.18 404.19 404.20 404.21 404.22 404.23 404.24 404.25 404.26 404.27 404.28 405.1 405.2 405.3 405.4 405.5 405.6 405.7 405.8 405.9 405.10 405.11 405.12 405.13 405.14 405.15 405.16 405.17 405.18 405.19 405.20 405.21 405.22 405.23 405.24
405.25 405.26
405.27 405.28 405.29 405.30
406.1 406.2 406.3 406.4
406.5 406.6 406.7 406.8 406.9 406.10 406.11 406.12 406.13 406.14 406.15 406.16 406.17 406.18
406.19 406.20 406.21 406.22 406.23 406.24 406.25 406.26 406.27 406.28
407.1 407.2 407.3 407.4 407.5 407.6 407.7 407.8 407.9 407.10 407.11 407.12 407.13 407.14 407.15 407.16 407.17 407.18 407.19 407.20 407.21 407.22 407.23 407.24 407.25 407.26 407.27 407.28 407.29 407.30 407.31 407.32 407.33 408.1 408.2 408.3 408.4 408.5 408.6 408.7 408.8 408.9 408.10 408.11 408.12 408.13 408.14 408.15 408.16 408.17 408.18
408.19 408.20 408.21 408.22 408.23 408.24 408.25 408.26 408.27 408.28 408.29 408.30 408.31 409.1 409.2 409.3 409.4 409.5 409.6 409.7 409.8 409.9 409.10 409.11 409.12 409.13 409.14 409.15 409.16 409.17 409.18 409.19 409.20 409.21 409.22 409.23 409.24 409.25 409.26 409.27 409.28 409.29 409.30 410.1 410.2 410.3 410.4 410.5 410.6 410.7 410.8 410.9 410.10 410.11 410.12 410.13 410.14 410.15 410.16 410.17 410.18 410.19 410.20 410.21 410.22 410.23 410.24 410.25 410.26 410.27 410.28 410.29 410.30 410.31 410.32 410.33 411.1 411.2 411.3
411.4 411.5 411.6 411.7 411.8 411.9 411.10 411.11 411.12
411.13
411.14 411.15 411.16 411.17 411.18 411.19 411.20 411.21 411.22 411.23
411.24 411.25 411.26 411.27 411.28
411.29 411.30
411.31 412.1 412.2 412.3 412.4 412.5 412.6 412.7 412.8 412.9 412.10 412.11 412.12
412.13 412.14 412.15 412.16 412.17 412.18 412.19 412.20 412.21 412.22 412.23 412.24 412.25 412.26 412.27 412.28 412.29 412.30 412.31 412.32 412.33 413.1 413.2 413.3 413.4 413.5 413.6 413.7 413.8 413.9 413.10
413.11
413.12 413.13
413.14 413.15 413.16 413.17 413.18 413.19 413.20 413.21 413.22 413.23 413.24 413.25 413.26 413.27 413.28 413.29
413.30 413.31 414.1 414.2 414.3 414.4 414.5 414.6 414.7 414.8 414.9 414.10 414.11 414.12 414.13 414.14 414.15 414.16 414.17 414.18 414.19 414.20 414.21 414.22 414.23 414.24 414.25 414.26 414.27 414.28 414.29 414.30 414.31 414.32 414.33 415.1 415.2 415.3 415.4 415.5 415.6 415.7 415.8 415.9 415.10 415.11 415.12 415.13 415.14 415.15 415.16 415.17 415.18 415.19 415.20 415.21 415.22 415.23 415.24 415.25 415.26 415.27 415.28 415.29 415.30 415.31 415.32 415.33 415.34 416.1 416.2 416.3 416.4 416.5 416.6 416.7 416.8 416.9 416.10 416.11 416.12 416.13 416.14 416.15 416.16 416.17 416.18 416.19 416.20 416.21 416.22 416.23 416.24 416.25 416.26 416.27 416.28 416.29 416.30 416.31 416.32 416.33 416.34 417.1 417.2 417.3 417.4 417.5 417.6 417.7 417.8 417.9 417.10 417.11 417.12 417.13 417.14 417.15 417.16 417.17 417.18 417.19 417.20 417.21 417.22 417.23 417.24 417.25 417.26 417.27 417.28 417.29 417.30 417.31 417.32 417.33 417.34 418.1 418.2 418.3 418.4 418.5 418.6 418.7 418.8 418.9 418.10 418.11 418.12 418.13 418.14 418.15 418.16 418.17 418.18 418.19 418.20 418.21 418.22 418.23 418.24 418.25 418.26 418.27 418.28 418.29 418.30 418.31 418.32 418.33 418.34 419.1 419.2 419.3 419.4 419.5 419.6 419.7 419.8 419.9 419.10 419.11 419.12 419.13 419.14 419.15 419.16 419.17 419.18 419.19 419.20 419.21 419.22 419.23 419.24 419.25 419.26 419.27 419.28 419.29 419.30 419.31 419.32 419.33 419.34 419.35 420.1 420.2 420.3 420.4 420.5 420.6 420.7 420.8 420.9 420.10 420.11 420.12 420.13 420.14 420.15 420.16 420.17 420.18 420.19 420.20 420.21 420.22 420.23 420.24 420.25 420.26 420.27 420.28 420.29 420.30 420.31 420.32 420.33 420.34 421.1 421.2 421.3 421.4 421.5 421.6 421.7 421.8 421.9 421.10 421.11 421.12 421.13 421.14 421.15 421.16 421.17 421.18 421.19 421.20 421.21 421.22 421.23 421.24 421.25 421.26 421.27 421.28 421.29 421.30 421.31 421.32 421.33 421.34 421.35 421.36 422.1 422.2 422.3 422.4 422.5 422.6 422.7 422.8 422.9 422.10 422.11 422.12 422.13 422.14 422.15 422.16 422.17 422.18 422.19 422.20 422.21 422.22 422.23 422.24 422.25 422.26 422.27 422.28 422.29 422.30 422.31 422.32 422.33 422.34 423.1 423.2 423.3 423.4 423.5 423.6 423.7 423.8 423.9 423.10 423.11 423.12 423.13 423.14 423.15 423.16 423.17 423.18 423.19 423.20 423.21 423.22 423.23 423.24 423.25 423.26 423.27 423.28 423.29 423.30 423.31 423.32 423.33 423.34 423.35 424.1 424.2 424.3 424.4 424.5 424.6 424.7 424.8 424.9 424.10 424.11 424.12 424.13 424.14 424.15 424.16 424.17 424.18 424.19 424.20 424.21 424.22 424.23 424.24 424.25 424.26 424.27 424.28 424.29 424.30 424.31 424.32 424.33 424.34 425.1 425.2 425.3 425.4 425.5 425.6 425.7 425.8 425.9 425.10 425.11 425.12 425.13 425.14 425.15 425.16 425.17 425.18 425.19 425.20 425.21 425.22 425.23 425.24 425.25 425.26 425.27 425.28 425.29 425.30 425.31 425.32 425.33 425.34 426.1 426.2 426.3 426.4 426.5 426.6 426.7 426.8 426.9 426.10 426.11 426.12 426.13 426.14 426.15 426.16 426.17 426.18 426.19 426.20 426.21 426.22 426.23 426.24 426.25 426.26 426.27 426.28 426.29 426.30 426.31 426.32 426.33 426.34 427.1 427.2 427.3 427.4 427.5 427.6 427.7 427.8 427.9 427.10 427.11 427.12 427.13 427.14 427.15 427.16 427.17 427.18 427.19 427.20 427.21 427.22 427.23 427.24 427.25 427.26 427.27 427.28 427.29 427.30 427.31 427.32 427.33 427.34 428.1 428.2 428.3 428.4 428.5 428.6 428.7 428.8 428.9 428.10 428.11 428.12 428.13 428.14 428.15 428.16 428.17 428.18 428.19 428.20 428.21 428.22 428.23 428.24 428.25 428.26 428.27 428.28 428.29 428.30 428.31 428.32 428.33 429.1 429.2 429.3 429.4 429.5 429.6 429.7 429.8 429.9 429.10 429.11 429.12 429.13 429.14 429.15 429.16 429.17 429.18 429.19 429.20 429.21 429.22 429.23 429.24 429.25 429.26 429.27 429.28 429.29 429.30 429.31 429.32 429.33 430.1 430.2 430.3 430.4 430.5 430.6 430.7 430.8 430.9 430.10 430.11 430.12 430.13 430.14 430.15 430.16 430.17 430.18 430.19 430.20 430.21 430.22 430.23 430.24 430.25 430.26 430.27 430.28 430.29 430.30 430.31 430.32 430.33 430.34 430.35 431.1 431.2 431.3 431.4 431.5 431.6 431.7 431.8 431.9 431.10 431.11 431.12 431.13 431.14 431.15 431.16 431.17 431.18 431.19 431.20 431.21 431.22 431.23 431.24 431.25 431.26 431.27 431.28 431.29 431.30 431.31 431.32 431.33 431.34 432.1 432.2 432.3 432.4 432.5 432.6 432.7 432.8 432.9 432.10 432.11 432.12 432.13 432.14 432.15 432.16 432.17 432.18 432.19 432.20 432.21 432.22 432.23 432.24 432.25 432.26 432.27 432.28 432.29 432.30 432.31 432.32 432.33 433.1 433.2 433.3 433.4 433.5 433.6 433.7 433.8 433.9 433.10 433.11 433.12 433.13 433.14 433.15 433.16 433.17 433.18 433.19 433.20 433.21 433.22 433.23 433.24 433.25 433.26 433.27 433.28 433.29 433.30 433.31 433.32 433.33 433.34 434.1 434.2 434.3 434.4 434.5 434.6 434.7 434.8 434.9 434.10 434.11 434.12 434.13 434.14 434.15 434.16 434.17 434.18 434.19 434.20 434.21 434.22 434.23 434.24 434.25 434.26 434.27 434.28 434.29 434.30 434.31 434.32 434.33 434.34 434.35 435.1 435.2 435.3 435.4 435.5 435.6 435.7 435.8 435.9 435.10 435.11 435.12 435.13 435.14 435.15 435.16 435.17 435.18 435.19 435.20 435.21 435.22 435.23 435.24 435.25 435.26 435.27 435.28 435.29 435.30 435.31 435.32 435.33 435.34 435.35 436.1 436.2 436.3 436.4 436.5 436.6 436.7 436.8 436.9 436.10 436.11 436.12 436.13 436.14 436.15 436.16 436.17 436.18 436.19 436.20 436.21 436.22 436.23 436.24 436.25 436.26 436.27 436.28 436.29 436.30 436.31 436.32 436.33 436.34 437.1 437.2 437.3 437.4 437.5 437.6 437.7 437.8 437.9 437.10 437.11 437.12 437.13 437.14 437.15 437.16 437.17 437.18 437.19 437.20 437.21 437.22 437.23 437.24 437.25 437.26 437.27 437.28 437.29 437.30 437.31 437.32 437.33 437.34 438.1 438.2 438.3 438.4 438.5 438.6 438.7 438.8 438.9 438.10 438.11 438.12 438.13 438.14 438.15 438.16 438.17 438.18 438.19 438.20 438.21 438.22 438.23 438.24 438.25 438.26
438.27 438.28 438.29 438.30 438.31 438.32 438.33 438.34 439.1 439.2 439.3 439.4 439.5 439.6 439.7 439.8 439.9 439.10 439.11 439.12 439.13 439.14 439.15 439.16 439.17 439.18 439.19 439.20 439.21 439.22 439.23 439.24 439.25 439.26 439.27 439.28 439.29 439.30 439.31 439.32 439.33 439.34 439.35 440.1 440.2 440.3 440.4 440.5 440.6 440.7 440.8 440.9 440.10 440.11 440.12 440.13 440.14 440.15 440.16 440.17 440.18 440.19 440.20 440.21 440.22 440.23 440.24 440.25 440.26 440.27 440.28 440.29 440.30 440.31 440.32 440.33 440.34 440.35 441.1 441.2 441.3 441.4 441.5 441.6 441.7 441.8 441.9 441.10 441.11 441.12 441.13 441.14 441.15 441.16 441.17 441.18 441.19 441.20 441.21 441.22 441.23 441.24 441.25 441.26 441.27 441.28 441.29 441.30 441.31 441.32 441.33 441.34 441.35 442.1 442.2 442.3 442.4 442.5 442.6 442.7 442.8 442.9 442.10 442.11 442.12 442.13 442.14 442.15 442.16 442.17 442.18 442.19 442.20 442.21 442.22 442.23 442.24 442.25 442.26 442.27 442.28 442.29 442.30 442.31 442.32 442.33 442.34 442.35 443.1 443.2 443.3 443.4 443.5 443.6 443.7 443.8 443.9 443.10 443.11 443.12 443.13 443.14 443.15 443.16 443.17 443.18 443.19 443.20 443.21 443.22 443.23 443.24 443.25 443.26 443.27 443.28 443.29 443.30 443.31 443.32 443.33 444.1 444.2 444.3 444.4 444.5 444.6 444.7 444.8 444.9 444.10 444.11 444.12 444.13 444.14 444.15 444.16 444.17 444.18 444.19 444.20 444.21 444.22 444.23 444.24 444.25 444.26 444.27 444.28 444.29 444.30 444.31 444.32 444.33 444.34 445.1 445.2 445.3 445.4 445.5 445.6 445.7 445.8 445.9 445.10 445.11 445.12 445.13 445.14 445.15 445.16 445.17 445.18 445.19 445.20 445.21 445.22 445.23 445.24 445.25 445.26 445.27 445.28 445.29 445.30 445.31 445.32 445.33 445.34 446.1 446.2 446.3 446.4 446.5 446.6 446.7 446.8 446.9 446.10 446.11 446.12 446.13 446.14 446.15 446.16 446.17 446.18 446.19 446.20 446.21 446.22 446.23 446.24 446.25 446.26 446.27 446.28 446.29 446.30 446.31 446.32 446.33 446.34 446.35 447.1 447.2 447.3 447.4 447.5 447.6 447.7 447.8 447.9 447.10 447.11 447.12 447.13 447.14 447.15 447.16 447.17 447.18 447.19 447.20 447.21 447.22 447.23 447.24 447.25 447.26 447.27 447.28 447.29 447.30 447.31 447.32 447.33 447.34 448.1 448.2 448.3 448.4 448.5 448.6 448.7 448.8 448.9 448.10 448.11 448.12 448.13 448.14 448.15 448.16 448.17 448.18 448.19 448.20 448.21 448.22 448.23 448.24 448.25 448.26 448.27 448.28 448.29 448.30 448.31 448.32 448.33 448.34 448.35 449.1 449.2 449.3 449.4 449.5 449.6 449.7 449.8 449.9 449.10 449.11 449.12 449.13 449.14 449.15 449.16 449.17 449.18 449.19 449.20 449.21 449.22 449.23 449.24 449.25 449.26 449.27 449.28 449.29 449.30 449.31 449.32 449.33 449.34 449.35 450.1 450.2 450.3 450.4 450.5 450.6 450.7 450.8 450.9 450.10 450.11 450.12 450.13 450.14 450.15 450.16 450.17 450.18 450.19 450.20 450.21 450.22 450.23 450.24 450.25 450.26 450.27 450.28 450.29 450.30 450.31 450.32 450.33 450.34 451.1 451.2 451.3 451.4 451.5 451.6 451.7 451.8 451.9 451.10 451.11 451.12 451.13 451.14 451.15 451.16 451.17 451.18 451.19 451.20 451.21 451.22 451.23 451.24 451.25 451.26 451.27 451.28 451.29 451.30 451.31 451.32 451.33 451.34 451.35 452.1 452.2 452.3 452.4 452.5 452.6 452.7 452.8 452.9 452.10 452.11 452.12 452.13 452.14 452.15 452.16 452.17 452.18 452.19 452.20 452.21 452.22 452.23 452.24 452.25 452.26 452.27 452.28 452.29 452.30 452.31 452.32 452.33 452.34 452.35 453.1 453.2 453.3 453.4 453.5 453.6 453.7 453.8 453.9 453.10 453.11 453.12 453.13 453.14 453.15 453.16 453.17 453.18 453.19 453.20 453.21 453.22 453.23 453.24 453.25 453.26 453.27 453.28 453.29 453.30 453.31 453.32 453.33 453.34 453.35 454.1 454.2 454.3 454.4
454.5 454.6 454.7 454.8 454.9 454.10 454.11 454.12 454.13 454.14 454.15 454.16 454.17 454.18 454.19 454.20 454.21 454.22 454.23 454.24 454.25 454.26 454.27
454.28
454.29 454.30 454.31
454.32 455.1 455.2 455.3 455.4 455.5 455.6 455.7
455.8 455.9 455.10 455.11 455.12 455.13 455.14 455.15 455.16 455.17
455.18 455.19 455.20 455.21 455.22 455.23 455.24 455.25 455.26 455.27 455.28 455.29 455.30 455.31 455.32 455.33 456.1 456.2 456.3 456.4 456.5 456.6
456.7 456.8 456.9 456.10 456.11 456.12 456.13 456.14 456.15 456.16
456.17 456.18 456.19 456.20 456.21 456.22 456.23 456.24 456.25
456.26 456.27 456.28 456.29 456.30 456.31 456.32 456.33 457.1 457.2 457.3 457.4 457.5 457.6 457.7 457.8 457.9 457.10 457.11 457.12 457.13 457.14 457.15 457.16 457.17 457.18 457.19 457.20 457.21 457.22 457.23 457.24 457.25 457.26 457.27 457.28 457.29 457.30 457.31 457.32 457.33 457.34 457.35 458.1 458.2 458.3 458.4
458.5 458.6 458.7 458.8 458.9 458.10 458.11 458.12 458.13 458.14 458.15 458.16 458.17 458.18 458.19 458.20 458.21 458.22 458.23 458.24 458.25 458.26 458.27 458.28 458.29 458.30 458.31 458.32 458.33 458.34 459.1 459.2 459.3 459.4 459.5 459.6 459.7 459.8 459.9 459.10 459.11 459.12 459.13 459.14 459.15 459.16 459.17 459.18 459.19 459.20 459.21 459.22 459.23 459.24 459.25 459.26 459.27 459.28 459.29 459.30 459.31 459.32
460.1 460.2 460.3 460.4 460.5 460.6 460.7 460.8 460.9 460.10 460.11 460.12 460.13 460.14 460.15 460.16 460.17 460.18 460.19 460.20 460.21 460.22 460.23 460.24 460.25 460.26 460.27 460.28
460.29 460.30 460.31 460.32 460.33 460.34 461.1 461.2 461.3 461.4 461.5 461.6 461.7 461.8 461.9 461.10 461.11 461.12 461.13 461.14 461.15 461.16 461.17 461.18 461.19 461.20 461.21 461.22 461.23 461.24 461.25 461.26 461.27 461.28 461.29 461.30 461.31 461.32 461.33 461.34 461.35
462.1 462.2 462.3 462.4 462.5 462.6 462.7 462.8 462.9 462.10 462.11 462.12 462.13
462.14 462.15 462.16 462.17 462.18 462.19 462.20 462.21 462.22 462.23
462.24 462.25 462.26 462.27 462.28 462.29 462.30 463.1 463.2 463.3 463.4 463.5 463.6 463.7 463.8 463.9 463.10 463.11 463.12 463.13 463.14
463.15 463.16 463.17 463.18 463.19 463.20 463.21 463.22 463.23 463.24 463.25 463.26
464.1 464.2 464.3 464.4 464.5 464.6 464.7 464.8 464.9 464.10 464.11 464.12 464.13 464.14
464.15 464.16 464.17 464.18 464.19 464.20 464.21 464.22 464.23 464.24
464.25 464.26 464.27 464.28 464.29 464.30
465.1 465.2 465.3
465.4 465.5 465.6
465.7 465.8
A bill for an act
relating to health; changing provisions for health care and nursing facilities, hospital
construction moratorium, radioactive material, ST elevation myocardial infarction
response, health care coverage, cancer reporting system, lead hazard, safe drinking
water, nursing home and health profession licensure, certain advisory councils,
assisted living and home care providers, body art, medical cannabis, health care
financing, certain health care and provider fees, certain health profession loan
forgiveness programs, hospital core staffing plans, certain grant programs;
modifying certain definitions; adding provisions for hemp and edible cannabinoid
product requirements; prohibiting discrimination in access to transplants; changing
provisions for medical assistance eligibility and coverage, co-payments, report
requirements, treatment of trusts, telehealth requirements, health-related licensing
board requirements, practice of pharmacy, temporary ambulance service,
prescription drug price reporting and public posting, drug administration,
medication repository program, health insurance coverage; establishing certain
advisory councils and boards, managed care opt-out, public MinnesotaCare option,
climate resiliency program, long COVID program, national suicide prevention
lifeline number, drug overdose and substance abuse prevention, ombudsperson
for managed care, certain grants, school health initiative, Emmett Louis Till Victims
Recovery, Keeping Nurses at the Bedside Act, registry for life-sustaining treatment
orders; allowing change of sex designation; addressing health disparities; requiring
balance billing and analysis of Universal Health Reform proposal; making forecast
adjustments; providing for fees; providing civil penalties; requiring reports;
appropriating money; amending Minnesota Statutes 2020, sections 34A.01,
subdivision 4; 62A.02, subdivision 1; 62A.25, subdivision 2; 62A.28, subdivision
2; 62A.30, by adding a subdivision; 62J.2930, subdivision 3; 62J.84, as amended;
62Q.021, by adding a subdivision; 62Q.55, subdivision 5; 62Q.556; 62Q.56,
subdivision 2; 62Q.73, subdivision 7; 62U.04, subdivision 11, by adding a
subdivision; 62U.10, subdivision 7; 137.68; 144.1201, subdivisions 2, 4; 144.122;
144.1501, subdivision 4; 144.1503; 144.1505; 144.1911, subdivision 4; 144.292,
subdivision 6; 144.383; 144.497; 144.554; 144.565, subdivision 4; 144.586, by
adding a subdivision; 144.6502, subdivision 1; 144.651, by adding a subdivision;
144.69; 144.7055; 144.9501, subdivisions 9, 26a, 26b; 144.9505, subdivisions 1,
1h; 144A.01; 144A.03, subdivision 1; 144A.04, subdivisions 4, 6; 144A.06;
144A.4799, subdivisions 1, 3; 144A.75, subdivision 12; 144G.08, by adding a
subdivision; 144G.15; 144G.17; 144G.19, by adding a subdivision; 144G.20,
subdivisions 1, 4, 5, 8, 9, 12, 15; 144G.30, subdivision 5; 144G.31, subdivisions
4, 8; 144G.41, subdivisions 7, 8; 144G.42, subdivision 10; 144G.50, subdivision
2; 144G.52, subdivisions 2, 8, 9; 144G.53; 144G.55, subdivisions 1, 3; 144G.56,
subdivisions 3, 5; 144G.57, subdivisions 1, 3, 5; 144G.70, subdivisions 2, 4;
144G.80, subdivision 2; 144G.90, subdivision 1, by adding a subdivision; 144G.91,
subdivisions 13, 21; 144G.92, subdivision 1; 144G.93; 144G.95; 145.56, by adding
subdivisions; 145.924; 145A.131, subdivisions 1, 5; 145A.14, by adding a
subdivision; 146B.04, subdivision 1; 148B.33, by adding a subdivision; 148E.100,
subdivision 3; 148E.105, subdivision 3; 148E.106, subdivision 3; 148E.110,
subdivision 7; 149A.01, subdivisions 2, 3; 149A.02, subdivision 13a, by adding
subdivisions; 149A.03; 149A.09; 149A.11; 149A.60; 149A.61, subdivisions 4, 5;
149A.62; 149A.63; 149A.65, subdivision 2; 149A.70, subdivisions 3, 4, 5, 7;
149A.90, subdivisions 2, 4, 5; 149A.94, subdivision 1; 150A.06, subdivisions 1c,
2c, 6, by adding a subdivision; 150A.09; 150A.091, subdivisions 2, 5, 8, 9, by
adding subdivisions; 151.01, subdivisions 23, 27, by adding subdivisions; 151.071,
subdivisions 1, 2; 151.37, by adding a subdivision; 151.555, as amended; 151.72,
subdivisions 1, 2, 3, 4, 6, by adding a subdivision; 152.01, subdivision 23; 152.02,
subdivisions 2, 3; 152.11, by adding a subdivision; 152.12, by adding a subdivision;
152.125; 152.22, subdivision 8, by adding subdivisions; 152.25, subdivision 1, by
adding a subdivision; 152.29, subdivisions 3a, 4, by adding a subdivision; 152.30;
152.32; 152.33, subdivision 1; 152.35; 152.36; 153.16, subdivision 1; 256.01, by
adding a subdivision; 256.969, by adding a subdivision; 256B.021, subdivision 4;
256B.055, subdivisions 2, 17; 256B.056, subdivisions 3, 3b, 3c, 4, 7, 11;
256B.0595, subdivision 1; 256B.0625, subdivisions 13f, 17a, 18h, 22, 28b, 64, by
adding subdivisions; 256B.0631, as amended; 256B.69, subdivisions 4, 5c, 28,
36; 256B.692, subdivision 1; 256B.6925, subdivisions 1, 2; 256B.6928, subdivision
3; 256B.76, subdivision 1; 256B.77, subdivision 13; 256L.03, subdivisions 1a, 5;
256L.04, subdivisions 1c, 7a, 10, by adding a subdivision; Minnesota Statutes
2021 Supplement, sections 62J.497, subdivisions 1, 3; 62J.84, subdivisions 6, 9;
144.0724, subdivision 4; 144.1481, subdivision 1; 144.1501, subdivisions 1, 2, 3;
144.551, subdivision 1; 144.9501, subdivision 17; 148B.5301, subdivision 2;
151.335; 151.72, subdivision 5; 152.27, subdivision 2; 152.29, subdivisions 1, 3;
256B.0371, subdivision 4; 256B.04, subdivision 14; 256B.0625, subdivisions 3b,
9, as amended, 13, 17, 30, 31; 256B.0631, subdivision 1, as amended; 256L.07,
subdivision 1; 256L.15, subdivision 2; 363A.50; Laws 2015, chapter 71, article
14, section 2, subdivision 5, as amended; Laws 2020, First Special Session chapter
7, section 1, subdivisions 1, as amended, 5, as amended; Laws 2021, First Special
Session chapter 2, article 1, section 4, subdivision 2; Laws 2021, First Special
Session chapter 7, article 1, section 36; article 3, section 44; article 16, section 2,
subdivisions 29, 31, 33; article 17, sections 3; 6; 10; 11; 12; 17, subdivision 3;
proposing coding for new law in Minnesota Statutes, chapters 62A; 62J; 62Q;
62W; 115; 144; 144A; 145; 149A; 152; 256B; 256L; repealing Minnesota Statutes
2020, sections 150A.091, subdivisions 3, 15, 17; 256B.057, subdivision 7;
256B.063; 256B.69, subdivision 20; 501C.0408, subdivision 4; 501C.1206;
Minnesota Statutes 2021 Supplement, section 144G.07, subdivision 6.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
ARTICLE 1
DEPARTMENT OF HEALTH FINANCE
Section 1.
new text begin
[62J.811] PROVIDER BALANCE BILLING REQUIREMENTS.
new text end
new text begin Subdivision 1. new text end
new text begin Requirements. new text end
new text begin
(a) Each health provider and health facility shall comply
with Division BB, Title I of the Consolidated Appropriations Act, 2021, also known as the
"No Surprises Act," including any federal regulations adopted under that act, to the extent
that it imposes requirements that apply in this state but are not required under the laws of
this state. This section does not require compliance with any provision of the No Surprises
Act before January 1, 2022.
new text end
new text begin
(b) For the purposes of this section, "provider" or "facility" means any health care
provider or facility pursuant to section 62A.63, subdivision 2, or 62J.03, subdivision 8, that
is subject to relevant provisions of the No Surprises Act.
new text end
new text begin Subd. 2. new text end
new text begin Compliance and investigations. new text end
new text begin
(a) The commissioner of health shall, to the
extent practicable, seek the cooperation of health care providers and facilities in obtaining
compliance with this section.
new text end
new text begin
(b) A person who believes a health care provider or facility has not complied with the
requirements of the No Surprises Act or this section may file a complaint with the
commissioner of health. Complaints filed under this section must be filed in writing, either
on paper or electronically. The commissioner may prescribe additional procedures for the
filing of complaints.
new text end
new text begin
(c) The commissioner may also conduct compliance reviews to determine whether health
care providers and facilities are complying with this section.
new text end
new text begin
(d) The commissioner will investigate complaints filed under this section. The
commissioner may prioritize complaint investigations, compliance reviews, and the collection
of any possible civil monetary penalties under paragraph (g), clause (2), based on factors
such as repeat complaints or violations, the seriousness of the complaint or violation, and
other factors as determined by the commissioner.
new text end
new text begin
(e) The commissioner shall inform the health care provider or facility of the complaint
or findings of a compliance review and shall provide an opportunity for the health care
provider or facility to submit information the health care provider or facility considers
relevant to further review and investigation of the complaint or the findings of the compliance
review. The health care provider or facility must submit any such information to the
commissioner within 30 days of receipt of notification of a complaint or compliance review
under this section.
new text end
new text begin
(f) If, after reviewing any information described in paragraph (e) and the results of any
investigation, the commissioner determines that the provider or facility has not violated this
section, the commissioner shall notify the provider or facility as well as any relevant
complainant.
new text end
new text begin
(g) If, after reviewing any information described in paragraph (e) and the results of any
investigation, the commissioner determines that the provider or facility is in violation of
this section, the commissioner shall notify the provider or facility and take the following
steps:
new text end
new text begin
(1) in cases of noncompliance with this section, the commissioner shall first attempt to
achieve compliance through successful remediation on the part of the noncompliant provider
or facility including completion of a corrective action plan or other agreement; and
new text end
new text begin
(2) if, after taking the action in clause (1) compliance has not been achieved, the
commissioner of health shall notify the provider or facility that the provider or facility is in
violation of this section and that the commissioner is imposing a civil monetary penalty. If
the commissioner determines that more than one health care provider or facility was
responsible for a violation, the commissioner may impose a civil money penalty against
each health care provider or facility. The amount of a civil money penalty shall be up to
$100 for each violation, but shall not exceed $25,000 for identical violations during a
calendar year; and
new text end
new text begin
(3) no civil money penalty shall be imposed under this section for violations that occur
prior to January 1, 2023. Warnings must be issued and any compliance issues must be
referred to the federal government for enforcement pursuant to the federal No Surprises Act
or other applicable federal laws and regulations.
new text end
new text begin
(h) A health care provider or facility may contest whether the finding of facts constitute
a violation of this section according to the contested case proceeding in sections 14.57 to
14.62, subject to appeal according to sections 14.63 to 14.68.
new text end
new text begin
(i) When steps in paragraphs (b) to (h) have been completed as needed, the commissioner
shall notify the health care provider or facility and, if the matter arose from a complaint,
the complainant regarding the disposition of complaint or compliance review.
new text end
new text begin
(j) Any data collected by the commissioner of health as part of an active investigation
or active compliance review under this section are classified as protected nonpublic data
pursuant to section 13.02, subdivision 13, in the case of data not on individuals and
confidential pursuant to section 13.02, subdivision 3, in the case of data on individuals.
Data describing the final disposition of an investigation or compliance review are classified
as public.
new text end
new text begin
(k) Civil money penalties imposed and collected under this subdivision shall be deposited
into the general fund and are appropriated to the commissioner of health for the purposes
of this section, including the provision of compliance reviews and technical assistance.
new text end
new text begin
(l) Any compliance and investigative action taken by the department under this section
shall only include potential violations that occur on or after the effective date of this section.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 2.
Minnesota Statutes 2020, section 62Q.021, is amended by adding a subdivision to
read:
new text begin Subd. 3. new text end
new text begin Compliance with 2021 federal law. new text end
new text begin
Each health plan company, health provider,
and health facility shall comply with Division BB, Title I of the Consolidated Appropriations
Act, 2021, also known as the "No Surprises Act," including any federal regulations adopted
under that act, to the extent that it imposes requirements that apply in this state but are not
required under the laws of this state. This section does not require compliance with any
provision of the No Surprises Act before the effective date provided for that provision in
the Consolidated Appropriations Act. The commissioner shall enforce this subdivision.
new text end
Sec. 3.
Minnesota Statutes 2020, section 62Q.55, subdivision 5, is amended to read:
Subd. 5.
Coverage restrictions or limitations.
If emergency services are provided by
a nonparticipating provider, with or without prior authorization, the health plan company
shall not impose coverage restrictions or limitations that are more restrictive than apply to
emergency services received from a participating provider. Cost-sharing requirements that
apply to emergency services received out-of-network must be the same as the cost-sharing
requirements that apply to services received in-networknew text begin and shall count toward the in-network
deductible. All coverage and charges for emergency services must comply with all
requirements of Division BB, Title I of the Consolidated Appropriations Act, 2021, including
any federal regulations adopted under that actnew text end .
Sec. 4.
Minnesota Statutes 2020, section 62Q.556, is amended to read:
62Q.556 deleted text begin UNAUTHORIZED PROVIDER SERVICESdeleted text end new text begin CONSUMER
PROTECTIONS AGAINST BALANCE BILLINGnew text end .
Subdivision 1.
deleted text begin Unauthorized provider servicesdeleted text end new text begin Nonparticipating provider balance
billing prohibitionnew text end .
(a) Except as provided in paragraph deleted text begin (c)deleted text end new text begin (b)new text end , deleted text begin unauthorized provider
services occurdeleted text end new text begin balance billing is prohibitednew text end when an enrollee receives services:
(1) from a nonparticipating provider at a participating hospital or ambulatory surgical
center, deleted text begin when the services are rendered:deleted text end new text begin as described by Division BB, Title I of the
Consolidated Appropriations Act, 2021, including any federal regulations adopted under
that act;
new text end
deleted text begin
(i) due to the unavailability of a participating provider;
deleted text end
deleted text begin
(ii) by a nonparticipating provider without the enrollee's knowledge; or
deleted text end
deleted text begin
(iii) due to the need for unforeseen services arising at the time the services are being
rendered; or
deleted text end
(2) from a participating provider that sends a specimen taken from the enrollee in the
participating provider's practice setting to a nonparticipating laboratory, pathologist, or other
medical testing facilitydeleted text begin .deleted text end new text begin ; or
new text end
deleted text begin
(b) Unauthorized provider services do not include emergency services as defined in
section 62Q.55, subdivision 3.
deleted text end
new text begin
(3) from a nonparticipating provider or facility providing emergency services as defined
in section 62Q.55, subdivision 3, and other services as described in the requirements of
Division BB, Title I of the Consolidated Appropriations Act, 2021, including any federal
regulations adopted under that act.
new text end
deleted text begin (c)deleted text end new text begin (b)new text end The services described in paragraph (a), deleted text begin clausedeleted text end new text begin clauses (1) andnew text end (2), new text begin as defined in
Division BB, Title I of the Consolidated Appropriations Act, 2021, and any federal
regulations adopted under that act, new text end are deleted text begin not unauthorized provider servicesdeleted text end new text begin subject to balance
billingnew text end if the enrollee deleted text begin gives advance writtendeleted text end new text begin informednew text end consent deleted text begin to thedeleted text end new text begin prior to receiving
services from the nonparticipatingnew text end provider acknowledging that the use of a provider, or
the services to be rendered, may result in costs not covered by the health plan.new text begin The informed
consent must comply with all requirements of Division BB, Title I of the Consolidated
Appropriations Act, 2021, including any federal regulations adopted under that act.
new text end
Subd. 2.
deleted text begin Prohibitiondeleted text end new text begin Cost-sharing requirements and independent dispute
resolutionnew text end .
(a) An enrollee's financial responsibility for the deleted text begin unauthorizeddeleted text end new text begin nonparticipatingnew text end
provider services new text begin described in subdivision 1, paragraph (a), new text end shall be the same cost-sharing
requirements, including co-payments, deductibles, coinsurance, coverage restrictions, and
coverage limitations, as those applicable to services received by the enrollee from a
participating provider. A health plan company must apply any enrollee cost sharing
requirements, including co-payments, deductibles, and coinsurance, for unauthorized provider
services to the enrollee's annual out-of-pocket limit to the same extent payments to a
participating provider would be applied.
(b) A health plan company deleted text begin must attempt to negotiate the reimbursement, less any
applicable enrollee cost sharing under paragraph (a), for the unauthorized provider services
with the nonparticipating provider. If a health plan company's and nonparticipating provider's
attempts to negotiate reimbursement for the health care services do not result in a resolution,
the health plan company or provider may elect to refer the matter for binding arbitration,
chosen in accordance with paragraph (c). A nondisclosure agreement must be executed by
both parties prior to engaging an arbitrator in accordance with this section. The cost of
arbitration must be shared equally between the partiesdeleted text end new text begin and nonparticipating provider shall
initiate open negotiations of disputed amounts. If there is no agreement, either party may
initiate the federal independent dispute resolution process pursuant to Division BB, Title I
of the Consolidated Appropriations Act, 2021, including any federal regulations adopted
under that actnew text end .
deleted text begin
(c) The commissioner of health, in consultation with the commissioner of the Bureau
of Mediation Services, must develop a list of professionals qualified in arbitration, for the
purpose of resolving disputes between a health plan company and nonparticipating provider
arising from the payment for unauthorized provider services. The commissioner of health
shall publish the list on the Department of Health website, and update the list as appropriate.
deleted text end
deleted text begin
(d) The arbitrator must consider relevant information, including the health plan company's
payments to other nonparticipating providers for the same services, the circumstances and
complexity of the particular case, and the usual and customary rate for the service based on
information available in a database in a national, independent, not-for-profit corporation,
and similar fees received by the provider for the same services from other health plans in
which the provider is nonparticipating, in reaching a decision.
deleted text end
new text begin Subd. 3. new text end
new text begin Annual data reporting. new text end
new text begin
(a) Beginning April 1, 2023, a health plan company
must report annually to the commissioner:
new text end
new text begin
(1) the total number of claims and total billed and paid amount for nonparticipating
provider services, by service and provider type, submitted to the health plan in the prior
calendar year; and
new text end
new text begin
(2) the total number of enrollee complaints received regarding the rights and protections
established by Division BB, Title I of the Consolidated Appropriations Act, 2021, including
any federal regulations adopted under that act, in the prior calendar year.
new text end
new text begin
(b) The commissioners of commerce and health may develop the form and manner for
health plan companies to comply with paragraph (a).
new text end
new text begin Subd. 4. new text end
new text begin Enforcement. new text end
new text begin
(a) Any provider or facility, including a health care provider or
facility pursuant to section 62A.63, subdivision 2, or 62J.03, subdivision 8, that is subject
to relevant provisions of the No Surprises Act is subject to the requirements of this section.
new text end
new text begin
(b) The commissioner of commerce or health may enforce this section.
new text end
new text begin
(c) If the commissioner of health has cause to believe that any hospital or facility licensed
under chapter 144 has violated this section, the commissioner may investigate, examine,
and otherwise enforce this section pursuant to chapter 144 or may refer the potential violation
to the relevant licensing board with regulatory authority over the provider.
new text end
new text begin
(d) If a health-related licensing board has cause to believe that a provider has violated
this section, it may further investigate and enforce the provisions of this section pursuant
to chapter 214.
new text end
Sec. 5.
Minnesota Statutes 2020, section 62Q.56, subdivision 2, is amended to read:
Subd. 2.
Change in health plans.
(a) If an enrollee is subject to a change in health plans,
the enrollee's new health plan company must provide, upon request, authorization to receive
services that are otherwise covered under the terms of the new health plan through the
enrollee's current provider:
(1) for up to 120 days if the enrollee is engaged in a current course of treatment for one
or more of the following conditions:
(i) an acute condition;
(ii) a life-threatening mental or physical illness;
(iii) pregnancy deleted text begin beyond the first trimester of pregnancydeleted text end ;
(iv) a physical or mental disability defined as an inability to engage in one or more major
life activities, provided that the disability has lasted or can be expected to last for at least
one year, or can be expected to result in death; or
(v) a disabling or chronic condition that is in an acute phase; or
(2) for the rest of the enrollee's life if a physician certifies that the enrollee has an expected
lifetime of 180 days or less.
For all requests for authorization under this paragraph, the health plan company must grant
the request for authorization unless the enrollee does not meet the criteria provided in this
paragraph.
(b) The health plan company shall prepare a written plan that provides a process for
coverage determinations regarding continuity of care of up to 120 days for new enrollees
who request continuity of care with their former provider, if the new enrollee:
(1) is receiving culturally appropriate services and the health plan company does not
have a provider in its preferred provider network with special expertise in the delivery of
those culturally appropriate services within the time and distance requirements of section
62D.124, subdivision 1; or
(2) does not speak English and the health plan company does not have a provider in its
preferred provider network who can communicate with the enrollee, either directly or through
an interpreter, within the time and distance requirements of section 62D.124, subdivision
1.
The written plan must explain the criteria that will be used to determine whether a need for
continuity of care exists and how it will be provided.
(c) This subdivision applies only to group coverage and continuation and conversion
coverage, and applies only to changes in health plans made by the employer.
Sec. 6.
Minnesota Statutes 2020, section 62Q.73, subdivision 7, is amended to read:
Subd. 7.
Standards of review.
(a) For an external review of any issue in an adverse
determination that does not require a medical necessity determination, the external review
must be based on whether the adverse determination was in compliance with the enrollee's
health benefit plannew text begin and any applicable state and federal lawnew text end .
(b) For an external review of any issue in an adverse determination by a health plan
company licensed under chapter 62D that requires a medical necessity determination, the
external review must determine whether the adverse determination was consistent with the
definition of medically necessary care in Minnesota Rules, part 4685.0100, subpart 9b.
(c) For an external review of any issue in an adverse determination by a health plan
company, other than a health plan company licensed under chapter 62D, that requires a
medical necessity determination, the external review must determine whether the adverse
determination was consistent with the definition of medically necessary care in section
62Q.53, subdivision 2.
(d) For an external review of an adverse determination involving experimental or
investigational treatment, the external review entity must base its decision on all documents
submitted by the health plan company and enrollee, including medical records, the attending
physician, advanced practice registered nurse, or health care professional's recommendation,
consulting reports from health care professionals, the terms of coverage, federal Food and
Drug Administration approval, and medical or scientific evidence or evidence-based
standards.
Sec. 7.
Minnesota Statutes 2020, section 62U.04, is amended by adding a subdivision to
read:
new text begin Subd. 5b. new text end
new text begin Non-claims-based payments. new text end
new text begin
(a) Beginning in 2024, all health plan companies
and third-party administrators shall submit to a private entity designated by the commissioner
of health all non-claims-based payments made to health care providers. The data shall be
submitted in a form, manner, and frequency specified by the commissioner. Non-claims-based
payments are payments to health care providers designed to pay for value of health care
services over volume of health care services and include alternative payment models or
incentives, payments for infrastructure expenditures or investments, and payments for
workforce expenditures or investments. Non-claims-based payments submitted under this
subdivision must, to the extent possible, be attributed to a health care provider in the same
manner in which claims-based data are attributed to a health care provider and, where
appropriate, must be combined with data collected under subdivisions 4 and 5 in analyses
of health care spending.
new text end
new text begin
(b) Data collected under this subdivision are nonpublic data as defined in section 13.02.
Notwithstanding the definition of summary data in section 13.02, subdivision 19, summary
data prepared under this subdivision may be derived from nonpublic data. The commissioner
shall establish procedures and safeguards to protect the integrity and confidentiality of any
data maintained by the commissioner.
new text end
new text begin
(c) The commissioner shall consult with health plan companies, hospitals, and health
care providers in developing the data reported under this subdivision and standardized
reporting forms.
new text end
Sec. 8.
Minnesota Statutes 2020, section 62U.04, subdivision 11, is amended to read:
Subd. 11.
Restricted uses of the all-payer claims data.
(a) Notwithstanding subdivision
4, paragraph (b), and subdivision 5, paragraph (b), the commissioner or the commissioner's
designee shall only use the data submitted under subdivisions 4 deleted text begin anddeleted text end new text begin ,new text end 5new text begin , and 5bnew text end for the
following purposes:
(1) to evaluate the performance of the health care home program as authorized under
section 62U.03, subdivision 7;
(2) to study, in collaboration with the reducing avoidable readmissions effectively
(RARE) campaign, hospital readmission trends and rates;
(3) to analyze variations in health care costs, quality, utilization, and illness burden based
on geographical areas or populations;
(4) to evaluate the state innovation model (SIM) testing grant received by the Departments
of Health and Human Services, including the analysis of health care cost, quality, and
utilization baseline and trend information for targeted populations and communities; and
(5) to compile one or more public use files of summary data or tables that must:
(i) be available to the public for no or minimal cost by March 1, 2016, and available by
web-based electronic data download by June 30, 2019;
(ii) not identify individual patients, payers, or providers;
(iii) be updated by the commissioner, at least annually, with the most current data
available;
(iv) contain clear and conspicuous explanations of the characteristics of the data, such
as the dates of the data contained in the files, the absence of costs of care for uninsured
patients or nonresidents, and other disclaimers that provide appropriate context; and
(v) not lead to the collection of additional data elements beyond what is authorized under
this section as of June 30, 2015.
(b) The commissioner may publish the results of the authorized uses identified in
paragraph (a) so long as the data released publicly do not contain information or descriptions
in which the identity of individual hospitals, clinics, or other providers may be discerned.
(c) Nothing in this subdivision shall be construed to prohibit the commissioner from
using the data collected under subdivision 4 to complete the state-based risk adjustment
system assessment due to the legislature on October 1, 2015.
deleted text begin
(d) The commissioner or the commissioner's designee may use the data submitted under
subdivisions 4 and 5 for the purpose described in paragraph (a), clause (3), until July 1,
2023.
deleted text end
deleted text begin (e)deleted text end new text begin (d)new text end The commissioner shall consult with the all-payer claims database work group
established under subdivision 12 regarding the technical considerations necessary to create
the public use files of summary data described in paragraph (a), clause (5).
Sec. 9.
Minnesota Statutes 2020, section 62U.10, subdivision 7, is amended to read:
Subd. 7.
Outcomes reporting; savings determination.
(a) deleted text begin Beginning November 1,
2016, anddeleted text end Each November 1 deleted text begin thereafterdeleted text end , the commissioner of health shall determine the
actual total private and public health care and long-term care spending for Minnesota
residents related to each health indicator projected in subdivision 6 for the most recent
calendar year available. The commissioner shall determine the difference between the
projected and actual spending for each health indicator and for each year, and determine
the savings attributable to changes in these health indicators. The assumptions and research
methods used to calculate actual spending must be determined to be appropriate by an
independent actuarial consultant. If the actual spending is less than the projected spending,
the commissioner, in consultation with the commissioners of human services and management
and budget, shall use the proportion of spending for state-administered health care programs
to total private and public health care spending for each health indicator for the calendar
year two years before the current calendar year to determine the percentage of the calculated
aggregate savings amount accruing to state-administered health care programs.
(b) The commissioner may use the data submitted under section 62U.04, subdivisions
4 deleted text begin anddeleted text end new text begin ,new text end 5, new text begin and 5b, new text end to complete the activities required under this section, but may only report
publicly on regional data aggregated to granularity of 25,000 lives or greater for this purpose.
Sec. 10.
new text begin
[115.7411] ADVISORY COUNCIL ON WATER SUPPLY SYSTEMS AND
WASTEWATER TREATMENT FACILITIES.
new text end
new text begin Subdivision 1. new text end
new text begin Purpose; membership. new text end
new text begin
The advisory council on water supply systems
and wastewater treatment facilities shall advise the commissioners of health and the Pollution
Control Agency regarding classification of water supply systems and wastewater treatment
facilities, qualifications and competency evaluation of water supply system operators and
wastewater treatment facility operators, and additional laws, rules, and procedures that may
be desirable for regulating the operation of water supply systems and of wastewater treatment
facilities. The advisory council is composed of 11 voting members, of whom:
new text end
new text begin
(1) one member must be from the Department of Health, Division of Environmental
Health, appointed by the commissioner of health;
new text end
new text begin
(2) one member must be from the Pollution Control Agency, appointed by the
commissioner of the Pollution Control Agency;
new text end
new text begin
(3) three members must be certified water supply system operators, appointed by the
commissioner of health, one of whom must represent a nonmunicipal community or
nontransient noncommunity water supply system;
new text end
new text begin
(4) three members must be certified wastewater treatment facility operators, appointed
by the commissioner of the Pollution Control Agency;
new text end
new text begin
(5) one member must be a representative from an organization representing municipalities,
appointed by the commissioner of health with the concurrence of the commissioner of the
Pollution Control Agency; and
new text end
new text begin
(6) two members must be members of the public who are not associated with water
supply systems or wastewater treatment facilities. One must be appointed by the
commissioner of health and the other by the commissioner of the Pollution Control Agency.
Consideration should be given to one of these members being a representative of academia
knowledgeable in water or wastewater matters.
new text end
new text begin Subd. 2. new text end
new text begin Geographic representation. new text end
new text begin
At least one of the water supply system operators
and at least one of the wastewater treatment facility operators must be from outside the
seven-county metropolitan area, and one wastewater treatment facility operator must be
from the Metropolitan Council.
new text end
new text begin Subd. 3. new text end
new text begin Terms; compensation. new text end
new text begin
The terms of the appointed members and the
compensation and removal of all members are governed by section 15.059.
new text end
new text begin Subd. 4. new text end
new text begin Officers. new text end
new text begin
When new members are appointed to the council, a chair must be
elected at the next council meeting. The Department of Health representative shall serve as
secretary of the council.
new text end
Sec. 11.
Minnesota Statutes 2020, section 144.122, is amended to read:
144.122 LICENSE, PERMIT, AND SURVEY FEES.
(a) The state commissioner of health, by rule, may prescribe procedures and fees for
filing with the commissioner as prescribed by statute and for the issuance of original and
renewal permits, licenses, registrations, and certifications issued under authority of the
commissioner. The expiration dates of the various licenses, permits, registrations, and
certifications as prescribed by the rules shall be plainly marked thereon. Fees may include
application and examination fees and a penalty fee for renewal applications submitted after
the expiration date of the previously issued permit, license, registration, and certification.
The commissioner may also prescribe, by rule, reduced fees for permits, licenses,
registrations, and certifications when the application therefor is submitted during the last
three months of the permit, license, registration, or certification period. Fees proposed to
be prescribed in the rules shall be first approved by the Department of Management and
Budget. All fees proposed to be prescribed in rules shall be reasonable. The fees shall be
in an amount so that the total fees collected by the commissioner will, where practical,
approximate the cost to the commissioner in administering the program. All fees collected
shall be deposited in the state treasury and credited to the state government special revenue
fund unless otherwise specifically appropriated by law for specific purposes.
(b) The commissioner may charge a fee for voluntary certification of medical laboratories
and environmental laboratories, and for environmental and medical laboratory services
provided by the department, without complying with paragraph (a) or chapter 14. Fees
charged for environment and medical laboratory services provided by the department must
be approximately equal to the costs of providing the services.
(c) The commissioner may develop a schedule of fees for diagnostic evaluations
conducted at clinics held by the services for children with disabilities program. All receipts
generated by the program are annually appropriated to the commissioner for use in the
maternal and child health program.
(d) The commissioner shall set license fees for hospitals and nursing homes that are not
boarding care homes at the following levels:
| Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and American Osteopathic Association (AOA) hospitals |
$7,655 plus $16 per bed |
| Non-JCAHO and non-AOA hospitals |
$5,280 plus $250 per bed |
| Nursing home |
$183 plus $91 per bed until June 30, 2018. $183 plus $100 per bed between July 1, 2018, and June 30, 2020. $183 plus $105 per bed beginning July 1, 2020. |
The commissioner shall set license fees for outpatient surgical centers, boarding care
homes, supervised living facilities, assisted living facilities, and assisted living facilities
with dementia care at the following levels:
| Outpatient surgical centers |
$3,712 |
| Boarding care homes |
$183 plus $91 per bed |
| Supervised living facilities |
$183 plus $91 per bed. |
| Assisted living facilities with dementia care |
$3,000 plus $100 per resident. |
| Assisted living facilities |
$2,000 plus $75 per resident. |
Fees collected under this paragraph are nonrefundable. The fees are nonrefundable even if
received before July 1, 2017, for licenses or registrations being issued effective July 1, 2017,
or later.
(e) Unless prohibited by federal law, the commissioner of health shall charge applicants
the following fees to cover the cost of any initial certification surveys required to determine
a provider's eligibility to participate in the Medicare or Medicaid program:
| Prospective payment surveys for hospitals |
$ |
900 |
| Swing bed surveys for nursing homes |
$ |
1,200 |
| Psychiatric hospitals |
$ |
1,400 |
| Rural health facilities |
$ |
1,100 |
| Portable x-ray providers |
$ |
500 |
| Home health agencies |
$ |
1,800 |
| Outpatient therapy agencies |
$ |
800 |
| End stage renal dialysis providers |
$ |
2,100 |
| Independent therapists |
$ |
800 |
| Comprehensive rehabilitation outpatient facilities |
$ |
1,200 |
| Hospice providers |
$ |
1,700 |
| Ambulatory surgical providers |
$ |
1,800 |
| Hospitals |
$ |
4,200 |
| Other provider categories or additional resurveys required to complete initial certification |
Actual surveyor costs: average surveyor cost x number of hours for the survey process. |
|
These fees shall be submitted at the time of the application for federal certification and
shall not be refunded. All fees collected after the date that the imposition of fees is not
prohibited by federal law shall be deposited in the state treasury and credited to the state
government special revenue fund.
(f) Notwithstanding section 16A.1283, the commissioner may adjust the fees assessed
on assisted living facilities and assisted living facilities with dementia care under paragraph
(d), in a revenue-neutral manner in accordance with the requirements of this paragraph:
(1) a facility seeking to renew a license shall pay a renewal fee in an amount that is up
to ten percent lower than the applicable fee in paragraph (d) if residents who receive home
and community-based waiver services under chapter 256S and section 256B.49 comprise
more than 50 percent of the facility's capacity in the calendar year prior to the year in which
the renewal application is submitted; and
(2) a facility seeking to renew a license shall pay a renewal fee in an amount that is up
to ten percent higher than the applicable fee in paragraph (d) if residents who receive home
and community-based waiver services under chapter 256S and section 256B.49 comprise
less than 50 percent of the facility's capacity during the calendar year prior to the year in
which the renewal application is submitted.
The commissioner may annually adjust the percentages in clauses (1) and (2), to ensure this
paragraph is implemented in a revenue-neutral manner. The commissioner shall develop a
method for determining capacity thresholds in this paragraph in consultation with the
commissioner of human services and must coordinate the administration of this paragraph
with the commissioner of human services for purposes of verification.
new text begin
(g) The commissioner shall charge hospitals an annual licensing base fee of $1,150 per
hospital, plus an additional $15 per licensed bed/bassinet fee. Revenue shall be deposited
to the state government special revenue fund and credited toward trauma hospital designations
under sections 144.605 and 144.6071.
new text end
Sec. 12.
Minnesota Statutes 2021 Supplement, section 144.1501, subdivision 1, is amended
to read:
Subdivision 1.
Definitions.
(a) For purposes of this section, the following definitions
apply.
new text begin
(b) "Acupuncture practitioner" means an individual licensed to practice acupuncture
under chapter 147B.
new text end
deleted text begin (b)deleted text end new text begin (c)new text end "Advanced dental therapist" means an individual who is licensed as a dental
therapist under section 150A.06, and who is certified as an advanced dental therapist under
section 150A.106.
new text begin
(d) "Advanced practice provider" means a nurse practitioner, nurse-midwife, nurse
anesthetist, clinical nurse specialist, or physician assistant.
new text end
deleted text begin (c)deleted text end new text begin (e)new text end "Alcohol and drug counselor" means an individual who is licensed as an alcohol
and drug counselor under chapter 148F.
deleted text begin (d)deleted text end new text begin (f)new text end "Dental therapist" means an individual who is licensed as a dental therapist under
section 150A.06.
deleted text begin (e)deleted text end new text begin (g)new text end "Dentist" means an individual who is licensed to practice dentistry.
deleted text begin (f)deleted text end new text begin (h)new text end "Designated rural area" means a statutory and home rule charter city or township
that is outside the seven-county metropolitan area as defined in section 473.121, subdivision
2, excluding the cities of Duluth, Mankato, Moorhead, Rochester, and St. Cloud.
deleted text begin (g)deleted text end new text begin (i)new text end "Emergency circumstances" means those conditions that make it impossible for
the participant to fulfill the service commitment, including death, total and permanent
disability, or temporary disability lasting more than two years.
deleted text begin (h)deleted text end new text begin (j)new text end "Mental health professional" means an individual providing clinical services in
the treatment of mental illness who is qualified in at least one of the ways specified in section
245.462, subdivision 18.
deleted text begin (i)deleted text end new text begin (k)new text end "Medical resident" means an individual participating in a medical residency in
family practice, internal medicine, obstetrics and gynecology, pediatrics, or psychiatry.
deleted text begin
(j) "Midlevel practitioner" means a nurse practitioner, nurse-midwife, nurse anesthetist,
advanced clinical nurse specialist, or physician assistant.
deleted text end
deleted text begin (k)deleted text end new text begin (l)new text end "Nurse" means an individual who has completed training and received all licensing
or certification necessary to perform duties as a licensed practical nurse or registered nurse.
deleted text begin (l)deleted text end new text begin (m)new text end "Nurse-midwife" means a registered nurse who has graduated from a program
of study designed to prepare registered nurses for advanced practice as nurse-midwives.
deleted text begin (m)deleted text end new text begin (n)new text end "Nurse practitioner" means a registered nurse who has graduated from a program
of study designed to prepare registered nurses for advanced practice as nurse practitioners.
deleted text begin (n)deleted text end new text begin (o)new text end "Pharmacist" means an individual with a valid license issued under chapter 151.
deleted text begin (o)deleted text end new text begin (p)new text end "Physician" means an individual who is licensed to practice medicine in the areas
of family practice, internal medicine, obstetrics and gynecology, pediatrics, or psychiatry.
deleted text begin (p)deleted text end new text begin (q)new text end "Physician assistant" means a person licensed under chapter 147A.
new text begin
(r) "Public health employee" means an individual working in a local, Tribal, or state
public health department.
new text end
deleted text begin (q)deleted text end new text begin (s)new text end "Public health nurse" means a registered nurse licensed in Minnesota who has
obtained a registration certificate as a public health nurse from the Board of Nursing in
accordance with Minnesota Rules, chapter 6316.
deleted text begin (r)deleted text end new text begin (t)new text end "Qualified educational loan" means a government, commercial, or foundation loan
for actual costs paid for tuition, reasonable education expenses, and reasonable living
expenses related to the graduate or undergraduate education of a health care professional.
new text begin
(u) "Underserved patient population" means patients who are state public program
enrollees or patients receiving sliding fee schedule discounts through a formal sliding fee
schedule meeting the standards established by the United States Department of Health and
Human Services under Code of Federal Regulations, title 42, section 51c.303.
new text end
deleted text begin (s)deleted text end new text begin (v)new text end "Underserved urban community" means a Minnesota urban area or population
included in the list of designated primary medical care health professional shortage areas
(HPSAs), medically underserved areas (MUAs), or medically underserved populations
(MUPs) maintained and updated by the United States Department of Health and Human
Services.
Sec. 13.
Minnesota Statutes 2021 Supplement, section 144.1501, subdivision 2, is amended
to read:
Subd. 2.
Creation of account.
(a) A health professional education loan forgiveness
program account is established. The commissioner of health shall use money from the
account to establish a loan forgiveness program:
(1) for medical residents, mental health professionals, and alcohol and drug counselors
agreeing to practice in designated rural areas ornew text begin innew text end underserved urban communitiesnew text begin , or
agreeing to provide at least 25 percent of the provider's yearly patient encounters to patients
in an underserved patient population,new text end or specializing in the area of pediatric psychiatry;
(2) for deleted text begin midlevel practitionersdeleted text end new text begin advanced practice providersnew text end agreeing to practice in
designated rural areas or to teach at least 12 credit hours, or 720 hours per year in the nursing
field in a postsecondary program at the undergraduate level or the equivalent at the graduate
level;
(3) for nurses who agree to practice in a Minnesota nursing home; an intermediate care
facility for persons with developmental disability; a hospital if the hospital owns and operates
a Minnesota nursing home and a minimum of 50 percent of the hours worked by the nurse
is in the nursing home; a housing with services establishment as defined in section 144D.01,
subdivision 4; new text begin a school district or charter school; new text end or for a home care provider as defined in
section 144A.43, subdivision 4; or agree to teach at least 12 credit hours, or 720 hours per
year in the nursing field in a postsecondary program at the undergraduate level or the
equivalent at the graduate level;
(4) for other health care technicians agreeing to teach at least 12 credit hours, or 720
hours per year in their designated field in a postsecondary program at the undergraduate
level or the equivalent at the graduate level. The commissioner, in consultation with the
Healthcare Education-Industry Partnership, shall determine the health care fields where the
need is the greatest, including, but not limited to, respiratory therapy, clinical laboratory
technology, radiologic technology, and surgical technology;
(5) for pharmacists, advanced dental therapists, dental therapists, new text begin acupuncture
practitioners, new text end and public health nurses who agree to practice in designated rural areas; deleted text begin and
deleted text end
(6) for dentists agreeing to deliver at least 25 percent of the dentist's yearly patient
encounters to deleted text begin state public program enrollees or patients receiving sliding fee schedule
discounts through a formal sliding fee schedule meeting the standards established by the
United States Department of Health and Human Services under Code of Federal Regulations,
title 42, section 51, chapter 303.deleted text end new text begin patients in an underserved patient population;
new text end
new text begin
(7) for mental health professionals agreeing to provide up to 768 hours per year of clinical
supervision in their designated field; and
new text end
new text begin
(8) for public health employees serving in a local, Tribal, or state public health department
in an area of high need as determined by the commissioner.
new text end
(b) Appropriations made to the account do not cancel and are available until expended,
except that at the end of each biennium, any remaining balance in the account that is not
committed by contract and not needed to fulfill existing commitments shall cancel to the
fund.
Sec. 14.
Minnesota Statutes 2021 Supplement, section 144.1501, subdivision 3, is amended
to read:
Subd. 3.
Eligibility.
(a) To be eligible to participate in the loan forgiveness program, an
individual must:
(1) be a medical or dental resident; a licensed pharmacist; or be enrolled in a training or
education program to become a dentist, dental therapist, advanced dental therapist, mental
health professional, alcohol and drug counselor, pharmacist, new text begin public health employee, new text end public
health nurse, deleted text begin midlevel practitionerdeleted text end new text begin advanced practice providernew text end , new text begin acupuncture practitioner,
new text end registered nurse, or a licensed practical nurse. The commissioner may also consider
applications submitted by graduates in eligible professions who are licensed and in practice;
and
(2) submit an application to the commissioner of health.
(b) new text begin Except as provided in paragraph (c), new text end an applicant selected to participate must sign a
contract to agree to serve a minimum three-year full-time service obligation according to
subdivision 2, which shall begin no later than March 31 following completion of required
training, with the exception of a nurse, who must agree to serve a minimum two-year
full-time service obligation according to subdivision 2, which shall begin no later than
March 31 following completion of required training.
new text begin
(c) An applicant selected to participate who is a public health employee is eligible for
loan forgiveness within three years after completion of required training. An applicant
selected to participate who is a nurse and who agrees to teach according to subdivision 2,
paragraph (a), clause (3), must sign a contract to agree to teach for a minimum of two years.
new text end
Sec. 15.
Minnesota Statutes 2020, section 144.1501, subdivision 4, is amended to read:
Subd. 4.
Loan forgiveness.
new text begin (a) new text end The commissioner of health may select applicants each
year for participation in the loan forgiveness program, within the limits of available funding.
new text begin For public health employees, available funds are limited to the appropriations funded in
fiscal year 2022. new text end In considering applicationsnew text begin from applicants who are mental health
professionals, the commissioner shall give preference to applicants who work in rural or
culturally specific organizations. In considering applications from all other applicantsnew text end , the
commissioner shall give preference to applicants who document diverse cultural
competencies. new text begin Except as provided in paragraph (b), new text end the commissioner shall distribute
available funds for loan forgiveness proportionally among the eligible professions according
to the vacancy rate for each profession in the required geographic area, facility type, teaching
area, patient group, or specialty type specified in subdivision 2. The commissioner shall
allocate funds for physician loan forgiveness so that 75 percent of the funds available are
used for rural physician loan forgiveness and 25 percent of the funds available are used for
underserved urban communitiesnew text begin , physicians agreeing to provide at least 25 percent of the
physician's yearly patient encounters to patients in an underserved patient population,new text end and
pediatric psychiatry loan forgiveness. If the commissioner does not receive enough qualified
applicants each year to use the entire allocation of funds for any eligible profession, the
remaining funds may be allocated proportionally among the other eligible professions
according to the vacancy rate for each profession in the required geographic area, patient
group, or facility type specified in subdivision 2. Applicants are responsible for securing
their own qualified educational loans. The commissioner shall select participants based on
their suitability for practice serving the required geographic area or facility type specified
in subdivision 2, as indicated by experience or training. The commissioner shall give
preference to applicants closest to completing their training. new text begin Except as specified in paragraph
(c), new text end for each year that a participant meets the service obligation required under subdivision
3, up to a maximum of four years, the commissioner shall make annual disbursements
directly to the participant equivalent to 15 percent of the average educational debt for
indebted graduates in their profession in the year closest to the applicant's selection for
which information is available, not to exceed the balance of the participant's qualifying
educational loans. Before receiving loan repayment disbursements and as requested, the
participant must complete and return to the commissioner a confirmation of practice form
provided by the commissioner verifying that the participant is practicing as required under
subdivisions 2 and 3. The participant must provide the commissioner with verification that
the full amount of loan repayment disbursement received by the participant has been applied
toward the designated loans. After each disbursement, verification must be received by the
commissioner and approved before the next loan repayment disbursement is made.
Participants who move their practice remain eligible for loan repayment as long as they
practice as required under subdivision 2.
new text begin
(b) The commissioner shall distribute available funds for loan forgiveness for public
health employees according to areas of high need as determined by the commissioner.
new text end
new text begin
(c) For each year that a participant who is a nurse and who has agreed to teach according
to subdivision 2 meets the teaching obligation required in subdivision 3, the commissioner
shall make annual disbursements directly to the participant equivalent to 15 percent of the
average annual educational debt for indebted graduates in the nursing profession in the year
closest to the participant's selection for which information is available, not to exceed the
balance of the participant's qualifying educational loans.
new text end
Sec. 16.
Minnesota Statutes 2020, section 144.1503, is amended to read:
144.1503 HOME AND COMMUNITY-BASED SERVICES EMPLOYEE
SCHOLARSHIP new text begin AND LOAN FORGIVENESS new text end PROGRAM.
Subdivision 1.
Creation.
The home and community-based services employee scholarship
new text begin and loan forgiveness new text end grant program is established deleted text begin for the purpose of assistingdeleted text end new text begin to assistnew text end
qualified provider applicants deleted text begin to funddeleted text end new text begin in fundingnew text end employee scholarships new text begin and qualified
educational loan repayments new text end for educationnew text begin , training, field experience, and examinationsnew text end in
nursing deleted text begin anddeleted text end new text begin ,new text end other health care fieldsnew text begin , and licensure as an assisted living director under section
144A.20, subdivision 4new text end .
new text begin Subd. 1a. new text end
new text begin Definition. new text end
new text begin
For purposes of this section, "qualified educational loan" means
a government, commercial, or foundation loan secured by an employee of a qualifying
provider for actual costs paid for tuition, training, and examinations; reasonable education,
training, and field experience expenses; and reasonable living expenses related to the
employee's graduate or undergraduate education.
new text end
Subd. 2.
Provision of grants.
The commissioner shall make grants available to qualified
providers of older adult services. Grants must be used by home and community-based service
providers to recruit and train staff through the establishment of an employee scholarship
new text begin and loan forgiveness new text end fund.
Subd. 3.
Eligibility.
(a) Eligible providers must primarily provide services to individuals
who are 65 years of age and older in home and community-based settings, including housing
with services establishments as defined in section 144D.01, subdivision 4; new text begin assisted living
facilities as defined in section 144G.08, subdivision 7; new text end adult day care as defined in section
245A.02, subdivision 2a; and home care services as defined in section 144A.43, subdivision
3.
(b) Qualifying providers must establish a home and community-based services employee
scholarship new text begin and loan forgiveness new text end program, as specified in subdivision 4. Providers that
receive funding under this section must use the funds to award scholarships tonew text begin , and to repay
qualified educational loans of,new text end employees who work an average of at least 16 hours per
week for the provider.
Subd. 4.
Home and community-based services employee scholarship new text begin and loan
forgiveness new text end program.
Each qualifying provider under this section must propose a home
and community-based services employee scholarship new text begin and loan forgiveness new text end program. Providers
must establish criteria by which funds are to be distributed among employees. At a minimum,
the scholarship new text begin and loan forgiveness new text end program must cover employee costsnew text begin and repay qualified
educational loans of employeesnew text end related to a course of study that is expected to lead to career
advancement with the provider or in the field of long-term care, including home care, care
of persons with disabilities, deleted text begin ordeleted text end nursingnew text begin , or management as a licensed assisted living directornew text end .
Subd. 5.
Participating providers.
The commissioner shall publish a request for proposals
in the State Register, specifying provider eligibility requirements, criteria for a qualifying
employee scholarship new text begin and loan forgiveness new text end program, provider selection criteria,
documentation required for program participation, maximum award amount, and methods
of evaluation. The commissioner must publish additional requests for proposals each year
in which funding is available for this purpose.
Subd. 6.
Application requirements.
Eligible providers seeking a grant shall submit an
application to the commissioner. Applications must contain a complete description of the
employee scholarship new text begin and loan forgiveness new text end program being proposed by the applicant,
including the need for the organization to enhance the education of its workforce, the process
for determining which employees will be eligible for scholarshipsnew text begin or loan repaymentnew text end , any
other sources of funding for scholarshipsnew text begin or loan repaymentnew text end , the expected degrees or
credentials eligible for scholarshipsnew text begin or loan repaymentnew text end , the amount of funding sought for
the scholarship new text begin and loan forgiveness new text end program, a proposed budget detailing how funds will
be spent, and plans for retaining eligible employees after completion of their scholarshipnew text begin
or repayment of their loannew text end .
Subd. 7.
Selection process.
The commissioner shall determine a maximum award for
grants and make grant selections based on the information provided in the grant application,
including the demonstrated need for an applicant provider to enhance the education of its
workforce, the proposed employee scholarship new text begin and loan forgiveness new text end selection process, the
applicant's proposed budget, and other criteria as determined by the commissioner.
Notwithstanding any law or rule to the contrary, funds awarded to grantees in a grant
agreement do not lapse until the grant agreement expires.
Subd. 8.
Reporting requirements.
Participating providers shall submit an invoice for
reimbursement and a report to the commissioner on a schedule determined by the
commissioner and on a form supplied by the commissioner. The report shall include the
amount spent on scholarshipsnew text begin and loan repaymentnew text end ; the number of employees who received
scholarshipsnew text begin and the number of employees for whom loans were repaidnew text end ; and, for each
scholarship new text begin or loan forgiveness new text end recipient, the name of the recipient, the current position of
the recipient, the amount awardednew text begin or loan amount repaidnew text end , the educational institution attended,
the nature of the educational program, and the expected or actual program completion date.
During the grant period, the commissioner may require and collect from grant recipients
other information necessary to evaluate the program.
Sec. 17.
new text begin
[144.1504] HOSPITAL NURSING LOAN FORGIVENESS PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Definition. new text end
new text begin
(a) For purposes of this section, the following definitions
apply.
new text end
new text begin
(b) "Nurse" means an individual who is licensed as a registered nurse and who is
providing direct patient care in a nonprofit hospital.
new text end
new text begin
(c) "PSLF program" means the federal Public Student Loan Forgiveness program
established under Code of Federal Regulations, title 34, section 685.21.
new text end
new text begin Subd. 2. new text end
new text begin Eligibility. new text end
new text begin
(a) To be eligible to participate in the hospital nursing loan
forgiveness program, a nurse must be:
new text end
new text begin
(1) enrolled in the PSLF program;
new text end
new text begin
(2) employed full time as a registered nurse by a nonprofit hospital that is an eligible
employer under the PSLF program; and
new text end
new text begin
(3) providing direct care to patients at the nonprofit hospital.
new text end
new text begin
(b) An applicant for loan forgiveness must submit to the commissioner of health:
new text end
new text begin
(1) a completed application on forms provided by the commissioner;
new text end
new text begin
(2) proof that the applicant is enrolled in the PSLF program; and
new text end
new text begin
(3) confirmation that the applicant is employed full time as a registered nurse by a
nonprofit hospital and is providing direct patient care.
new text end
new text begin
(c) The applicant selected to participate must sign a contract to agree to continue to
provide direct patient care as a registered nurse at a nonprofit hospital for the repayment
period of the participant's eligible loan under the PSLF program.
new text end
new text begin Subd. 3. new text end
new text begin Loan forgiveness. new text end
new text begin
(a) The commissioner of health shall select applicants each
year for participation in the hospital nursing loan forgiveness program, within limits of
available funding. Applicants are responsible for applying for and maintaining eligibility
for the PSLF program.
new text end
new text begin
(b) For each year that a participant meets the eligibility requirements described in
subdivision 2, the commissioner shall make an annual disbursement directly to the participant
in an amount equal to the minimum loan payments required to be paid by the participant
under the participant's repayment plan under the PSLF program for the previous loan year.
Before receiving the annual loan repayment disbursement, the participant must complete
and return to the commissioner a confirmation of practice form provided by the
commissioner, verifying that the participant continues to meet the eligibility requirements
under subdivision 2.
new text end
new text begin
(c) The participant must provide the commissioner with verification that the full amount
of loan repayment disbursement received by the participant has been applied toward the
loan for which forgiveness is sought under the PSLF program.
new text end
new text begin Subd. 4. new text end
new text begin Penalty for nonfulfillment. new text end
new text begin
If a participant does not fulfill the required
minimum commitment of service as required under subdivision 2, or the secretary of
education determines that the participant does not meet eligibility requirements for the PSLF
program, the commissioner shall collect from the participant the total amount paid to the
participant under the hospital nursing loan forgiveness program plus interest at a rate
established according to section 270C.40. The commissioner shall deposit the money
collected in the health care access fund to be credited to the health professional education
loan forgiveness program account established in section 144.1501, subdivision 2. The
commissioner shall allow waivers of all or part of the money owed to the commissioner as
a result of a nonfulfillment penalty if emergency circumstances prevent fulfillment of the
service commitment or if the PSLF program is discontinued before the participant's service
commitment is fulfilled.
new text end
Sec. 18.
Minnesota Statutes 2020, section 144.1505, is amended to read:
144.1505 HEALTH PROFESSIONALS CLINICAL TRAINING EXPANSION
new text begin AND RURAL AND UNDERSERVED CLINICAL ROTATIONS new text end GRANT deleted text begin PROGRAMdeleted text end new text begin
PROGRAMSnew text end .
Subdivision 1.
Definitions.
For purposes of this section, the following definitions apply:
(1) "eligible advanced practice registered nurse program" means a program that is located
in Minnesota and is currently accredited as a master's, doctoral, or postgraduate level
advanced practice registered nurse program by the Commission on Collegiate Nursing
Education or by the Accreditation Commission for Education in Nursing, or is a candidate
for accreditation;
new text begin
(2) "eligible dental program" means a dental residency training program that is located
in Minnesota and is currently accredited by the accrediting body or is a candidate for
accreditation;
new text end
deleted text begin (2)deleted text end new text begin (3)new text end "eligible dental therapy program" means a dental therapy education program or
advanced dental therapy education program that is located in Minnesota and is either:
(i) approved by the Board of Dentistry; or
(ii) currently accredited by the Commission on Dental Accreditation;
deleted text begin (3)deleted text end new text begin (4)new text end "eligible mental health professional program" means a program that is located
in Minnesota and is listed as a mental health professional program by the appropriate
accrediting body for clinical social work, psychology, marriage and family therapy, or
licensed professional clinical counseling, or is a candidate for accreditation;
deleted text begin (4)deleted text end new text begin (5)new text end "eligible pharmacy program" means a program that is located in Minnesota and
is currently accredited as a doctor of pharmacy program by the Accreditation Council on
Pharmacy Education;
deleted text begin (5)deleted text end new text begin (6)new text end "eligible physician assistant program" means a program that is located in
Minnesota and is currently accredited as a physician assistant program by the Accreditation
Review Commission on Education for the Physician Assistant, or is a candidate for
accreditation;
new text begin
(7) "eligible physician program" means a physician residency training program that is
located in Minnesota and is currently accredited by the accrediting body or is a candidate
for accreditation;
new text end
deleted text begin (6)deleted text end new text begin (8)new text end "mental health professional" means an individual providing clinical services in
the treatment of mental illness who meets one of the qualifications under section 245.462,
subdivision 18; and
deleted text begin (7)deleted text end new text begin (9)new text end "project" means a project to establish or expand clinical training for physician
assistants, advanced practice registered nurses, pharmacists, new text begin physicians, dentists, new text end dental
therapists, advanced dental therapists, or mental health professionals in Minnesota.
Subd. 2.
new text begin Health professionals clinical training expansion grant new text end program.
(a) The
commissioner of health shall award health professional training site grants to eligible
physician assistant, advanced practice registered nurse, pharmacy, dental therapy, and mental
health professional programs to plan and implement expanded clinical training. A planning
grant shall not exceed $75,000, and a training grant shall not exceed $150,000 for the first
year, $100,000 for the second year, and $50,000 for the third year per program.
(b) Funds may be used for:
(1) establishing or expanding clinical training for physician assistants, advanced practice
registered nurses, pharmacists, dental therapists, advanced dental therapists, and mental
health professionals in Minnesota;
(2) recruitment, training, and retention of students and faculty;
(3) connecting students with appropriate clinical training sites, internships, practicums,
or externship activities;
(4) travel and lodging for students;
(5) faculty, student, and preceptor salaries, incentives, or other financial support;
(6) development and implementation of cultural competency training;
(7) evaluations;
(8) training site improvements, fees, equipment, and supplies required to establish,
maintain, or expand a physician assistant, advanced practice registered nurse, pharmacy,
dental therapy, or mental health professional training program; and
(9) supporting clinical education in which trainees are part of a primary care team model.
new text begin Subd. 2a. new text end
new text begin
Health professional rural and underserved clinical rotations grant
program.
new text end
new text begin
(a) The commissioner of health shall award health professional training site grants
to eligible physician, physician assistant, advanced practice registered nurse, pharmacy,
dentistry, dental therapy, and mental health professional programs to augment existing
clinical training programs by adding rural and underserved rotations or clinical training
experiences, such as credential or certificate rural tracks or other specialized training. For
physician and dentist training, the expanded training must include rotations in primary care
settings such as community clinics, hospitals, health maintenance organizations, or practices
in rural communities.
new text end
new text begin
(b) Funds may be used for:
new text end
new text begin
(1) establishing or expanding rotations and clinical trainings;
new text end
new text begin
(2) recruitment, training, and retention of students and faculty;
new text end
new text begin
(3) connecting students with appropriate clinical training sites, internships, practicums,
or externship activities;
new text end
new text begin
(4) travel and lodging for students;
new text end
new text begin
(5) faculty, student, and preceptor salaries, incentives, or other financial support;
new text end
new text begin
(6) development and implementation of cultural competency training;
new text end
new text begin
(7) evaluations;
new text end
new text begin
(8) training site improvements, fees, equipment, and supplies required to establish,
maintain, or expand training programs; and
new text end
new text begin
(9) supporting clinical education in which trainees are part of a primary care team model.
new text end
Subd. 3.
Applications.
Eligible physician assistant, advanced practice registered nurse,
pharmacy, dental therapy, deleted text begin anddeleted text end mental health professionalnew text begin , physician, and dentalnew text end programs
seeking a grant shall apply to the commissioner. Applications must include a description
of the number of additional students who will be trained using grant funds; attestation that
funding will be used to support an increase in the number of clinical training slots; a
description of the problem that the proposed project will address; a description of the project,
including all costs associated with the project, sources of funds for the project, detailed uses
of all funds for the project, and the results expected; and a plan to maintain or operate any
component included in the project after the grant period. The applicant must describe
achievable objectives, a timetable, and roles and capabilities of responsible individuals in
the organization.new text begin Applicants applying under subdivision 2a must also include information
about the length of training and training site settings, the geographic locations of rural sites,
and rural populations expected to be served.
new text end
Subd. 4.
Consideration of applications.
The commissioner shall review each application
to determine whether or not the application is complete and whether the program and the
project are eligible for a grant. In evaluating applications, the commissioner shall score each
application based on factors including, but not limited to, the applicant's clarity and
thoroughness in describing the project and the problems to be addressed, the extent to which
the applicant has demonstrated that the applicant has made adequate provisions to ensure
proper and efficient operation of the training program once the grant project is completed,
the extent to which the proposed project is consistent with the goal of increasing access to
primary care and mental health services for rural and underserved urban communities, the
extent to which the proposed project incorporates team-based primary care, and project
costs and use of funds.
Subd. 5.
Program oversight.
The commissioner shall determine the amount of a grant
to be given to an eligible program based on the relative score of each eligible program's
applicationnew text begin and rural locations if applicable under subdivision 2bnew text end , other relevant factors
discussed during the review, and the funds available to the commissioner. Appropriations
made to the program do not cancel and are available until expended. During the grant period,
the commissioner may require and collect from programs receiving grants any information
necessary to evaluate the program.
Sec. 19.
new text begin
[144.1507] PRIMARY CARE RURAL RESIDENCY TRAINING GRANT
PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "Eligible program" means a program that meets the following criteria:
new text end
new text begin
(1) is located in Minnesota;
new text end
new text begin
(2) trains medical residents in the specialties of family medicine, general internal
medicine, general pediatrics, psychiatry, geriatrics, or general surgery; and
new text end
new text begin
(3) is accredited by the Accreditation Council for Graduate Medical Education or presents
a credible plan to obtain accreditation.
new text end
new text begin
(c) "Rural residency training program" means a residency program that utilizes local
clinics and community hospitals and that provides an initial year of training in an existing
accredited residency program in Minnesota. The subsequent years of the residency program
are based in rural communities with specialty rotations in nearby regional medical centers.
new text end
new text begin
(d) "Eligible project" means a project to establish and maintain a rural residency training
program.
new text end
new text begin Subd. 2. new text end
new text begin Rural residency training program. new text end
new text begin
(a) The commissioner of health shall
award rural residency training program grants to eligible programs to plan and implement
rural residency training programs. A rural residency training program grant shall not exceed
$250,000 per resident per year for the first year of planning and development, and $225,000
for each of the following years.
new text end
new text begin
(b) Funds may be spent to cover the costs of:
new text end
new text begin
(1) planning related to establishing an accredited rural residency training program;
new text end
new text begin
(2) obtaining accreditation by the Accreditation Council for Graduate Medical Education
or another national body that accredits rural residency training programs;
new text end
new text begin
(3) establishing new rural residency training programs;
new text end
new text begin
(4) recruitment, training, and retention of new residents and faculty;
new text end
new text begin
(5) travel and lodging for new residents;
new text end
new text begin
(6) faculty, new resident, and preceptor salaries related to new rural residency training
program;
new text end
new text begin
(7) training site improvements, fees, equipment, and supplies required for new rural
residency training program; and
new text end
new text begin
(8) supporting clinical education in which trainees are part of a primary care team model.
new text end
new text begin Subd. 3. new text end
new text begin Applications for rural residency training program grants. new text end
new text begin
(a) Eligible
programs seeking a grant shall apply to the commissioner. Applications must include: (1)
the number of new primary care rural residency training program slots planned, under
development, or under contract; (2) a description of the training program, including the
location of the established residency program and rural training sites; (3) a description of
the project, including all costs associated with the project; (4) all sources of funds for the
project; (5) detailed uses of all funds for the project; (6) the results expected; and (7) a plan
to seek federal funding for graduate medical education for the site if eligible.
new text end
new text begin
(b) The applicant must describe achievable objectives, a timetable, and the roles and
capabilities of responsible individuals in the organization.
new text end
new text begin Subd. 4. new text end
new text begin Consideration of grant applications. new text end
new text begin
The commissioner shall review each
application to determine if the residency program application is complete, if the proposed
rural residency program and residency slots are eligible for a grant, and if the program is
eligible for federal graduate medical education funding, and when funding becomes available.
The commissioner shall award grants to support training programs in family medicine,
general internal medicine, general pediatrics, psychiatry, geriatrics, and general surgery.
new text end
new text begin Subd. 5. new text end
new text begin Program oversight. new text end
new text begin
During the grant period, the commissioner may require
and collect from grantees any information necessary to evaluate the program. Appropriations
made to the program do not cancel and are available until expended.
new text end
Sec. 20.
new text begin
[144.1508] MENTAL HEALTH PROVIDER SUPERVISION GRANT
PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "Mental health professional" means an individual with a qualification specified in
section 245I.04, subdivision 2.
new text end
new text begin
(c) "Underrepresented community" has the meaning given in section 148E.010,
subdivision 20.
new text end
new text begin Subd. 2. new text end
new text begin Grant program established. new text end
new text begin
The commissioner of health shall award grants
to licensed or certified mental health providers who meet the criteria in subdivision 3 to
fund supervision of interns and clinical trainees who are working toward becoming a licensed
mental health professional and to subsidize the costs of mental health professional licensing
applications and examination fees for clinical trainees.
new text end
new text begin Subd. 3. new text end
new text begin Eligible providers. new text end
new text begin
In order to be eligible for a grant under this section, a mental
health provider must:
new text end
new text begin
(1) provide at least 25 percent of the provider's yearly patient encounters to state public
program enrollees or patients receiving sliding fee schedule discounts through a formal
sliding fee schedule meeting the standards established by the United States Department of
Health and Human Services under Code of Federal Regulations, title 42, section 51c.303;
or
new text end
new text begin
(2) primarily serve persons from communities of color or underrepresented communities.
new text end
new text begin Subd. 4. new text end
new text begin Application; grant award. new text end
new text begin
A mental health provider seeking a grant under
this section must apply to the commissioner at a time and in a manner specified by the
commissioner. The commissioner shall review each application to determine if the application
is complete, the mental health provider is eligible for a grant, and the proposed project is
an allowable use of grant funds. The commissioner shall give preference to grant applicants
who work in rural or culturally specific organizations. The commissioner must determine
the grant amount awarded to applicants that the commissioner determines will receive a
grant.
new text end
new text begin Subd. 5. new text end
new text begin Allowable uses of grant funds. new text end
new text begin
A mental health provider must use grant funds
received under this section for one or more of the following:
new text end
new text begin
(1) to pay for direct supervision hours for interns and clinical trainees, in an amount up
to $7,500 per intern or clinical trainee;
new text end
new text begin
(2) to establish a program to provide supervision to multiple interns or clinical trainees;
or
new text end
new text begin
(3) to pay mental health professional licensing application and examination fees for
clinical trainees.
new text end
new text begin Subd. 6. new text end
new text begin Program oversight. new text end
new text begin
During the grant period, the commissioner may require
grant recipients to provide the commissioner with information necessary to evaluate the
program.
new text end
Sec. 21.
new text begin
[144.1509] MENTAL HEALTH PROFESSIONAL SCHOLARSHIP GRANT
PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "Mental health professional" means an individual with a qualification specified in
section 245I.04, subdivision 2.
new text end
new text begin
(c) "Underrepresented community" has the meaning given in section 148E.010,
subdivision 20.
new text end
new text begin Subd. 2. new text end
new text begin Grant program established. new text end
new text begin
A mental health professional scholarship program
is established to assist mental health providers in funding employee scholarships for master's
level education programs in order to create a pathway to becoming a mental health
professional.
new text end
new text begin Subd. 3. new text end
new text begin Provision of grants. new text end
new text begin
The commissioner of health shall award grants to licensed
or certified mental health providers who meet the criteria in subdivision 4 to provide tuition
reimbursement for master's level programs and certain related costs for individuals who
have worked for the mental health provider for at least the past two years in one or more of
the following roles:
new text end
new text begin
(1) a mental health behavioral aide who meets a qualification in section 245I.04,
subdivision 16;
new text end
new text begin
(2) a mental health certified family peer specialist who meets the qualifications in section
245I.04, subdivision 12;
new text end
new text begin
(3) a mental health certified peer specialist who meets the qualifications in section
245I.04, subdivision 10;
new text end
new text begin
(4) a mental health practitioner who meets a qualification in section 245I.04, subdivision
4;
new text end
new text begin
(5) a mental health rehabilitation worker who meets the qualifications in section 245I.04,
subdivision 14;
new text end
new text begin
(6) an individual employed in a role in which the individual provides face-to-face client
services at a mental health center or certified community behavioral health center; or
new text end
new text begin
(7) a staff person who provides care or services to residents of a residential treatment
facility.
new text end
new text begin Subd. 4. new text end
new text begin Eligibility. new text end
new text begin
In order to be eligible for a grant under this section, a mental health
provider must:
new text end
new text begin
(1) primarily provide at least 25 percent of the provider's yearly patient encounters to
state public program enrollees or patients receiving sliding fee schedule discounts through
a formal sliding fee schedule meeting the standards established by the United States
Department of Health and Human Services under Code of Federal Regulations, title 42,
section 51c.303; or
new text end
new text begin
(2) primarily serve people from communities of color or underrepresented communities.
new text end
new text begin Subd. 5. new text end
new text begin Request for proposals. new text end
new text begin
The commissioner must publish a request for proposals
in the State Register specifying provider eligibility requirements, criteria for a qualifying
employee scholarship program, provider selection criteria, documentation required for
program participation, the maximum award amount, and methods of evaluation. The
commissioner must publish additional requests for proposals each year in which funding is
available for this purpose.
new text end
new text begin Subd. 6. new text end
new text begin Application requirements. new text end
new text begin
An eligible provider seeking a grant under this
section must submit an application to the commissioner. An application must contain a
complete description of the employee scholarship program being proposed by the applicant,
including the need for the mental health provider to enhance the education of its workforce,
the process the mental health provider will use to determine which employees will be eligible
for scholarships, any other funding sources for scholarships, the amount of funding sought
for the scholarship program, a proposed budget detailing how funds will be spent, and plans
to retain eligible employees after completion of the education program.
new text end
new text begin Subd. 7. new text end
new text begin Selection process. new text end
new text begin
The commissioner shall determine a maximum award amount
for grants and shall select grant recipients based on the information provided in the grant
application, including the demonstrated need for the applicant provider to enhance the
education of its workforce, the proposed process to select employees for scholarships, the
applicant's proposed budget, and other criteria as determined by the commissioner. The
commissioner shall give preference to grant applicants who work in rural or culturally
specific organizations.
new text end
new text begin Subd. 8. new text end
new text begin Grant agreements. new text end
new text begin
Notwithstanding any law or rule to the contrary, funds
awarded to a grant recipient in a grant agreement do not lapse until the grant agreement
expires.
new text end
new text begin Subd. 9. new text end
new text begin Allowable uses of grant funds. new text end
new text begin
A mental health provider receiving a grant
under this section must use the grant funds for one or more of the following:
new text end
new text begin
(1) to provide employees with tuition reimbursement for a master's level program in a
discipline that will allow the employee to qualify as a mental health professional; or
new text end
new text begin
(2) for resources and supports, such as child care and transportation, that allow an
employee to attend a master's level program specified in clause (1).
new text end
new text begin Subd. 10. new text end
new text begin Reporting requirements. new text end
new text begin
A mental health provider receiving a grant under
this section shall submit to the commissioner an invoice for reimbursement and a report,
on a schedule determined by the commissioner and using a form supplied by the
commissioner. The report must include the amount spent on scholarships; the number of
employees who received scholarships; and, for each scholarship recipient, the recipient's
name, current position, amount awarded, educational institution attended, name of the
educational program, and expected or actual program completion date.
new text end
Sec. 22.
new text begin
[144.1511] CLINICAL HEALTH CARE TRAINING.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "Accredited clinical training" means the clinical training provided by a medical
education program that is accredited through an organization recognized by the Department
of Education, the Centers for Medicare and Medicaid Services, or another national body
that reviews the accrediting organizations for multiple disciplines and whose standards for
recognizing accrediting organizations are reviewed and approved by the commissioner of
health.
new text end
new text begin
(c) "Commissioner" means the commissioner of health.
new text end
new text begin
(d) "Clinical medical education program" means the accredited clinical training of
physicians, medical students and residents, doctor of pharmacy practitioners, doctors of
chiropractic, dentists, advanced practice registered nurses, clinical nurse specialists, certified
registered nurse anesthetists, nurse practitioners, and certified nurse midwives, physician
assistants, dental therapists and advanced dental therapists, psychologists, clinical social
workers, community paramedics, community health workers, and other medical professions
as determined by the commissioner.
new text end
new text begin
(e) "Eligible entity" means an organization that is located in Minnesota, provides a
clinical medical education experience, and hosts students, residents or other trainee types
as determined by the commissioner and are from an accredited Minnesota teaching program
and institution.
new text end
new text begin
(f) "Teaching institution" means a hospital, medical center, clinic, or other organization
that conducts a clinical medical education program in Minnesota and which is accountable
to the accrediting body.
new text end
new text begin
(g) "Trainee" means a student, resident, fellow, or other postgraduate involved in a
clinical medical education program from an accredited Minnesota teaching program and
institution.
new text end
new text begin
(h) "Eligible trainee FTEs" means the number of trainees, as measured by full-time
equivalent counts, that are training in Minnesota at an entity with either currently active
medical assistance enrollment status and a National Provider Identification (NPI) number
or documentation that they provide sliding fee services. Training may occur in an inpatient
or ambulatory patient care setting or alternative setting as determined by the commissioner.
Training that occurs in nursing facility settings is not eligible for funding under this section.
new text end
new text begin Subd. 2. new text end
new text begin Application process. new text end
new text begin
(a) An eligible entity hosting clinical trainees from a
clinical medical education program and teaching institution is eligible for funds under
subdivision 3 if the entity:
new text end
new text begin
(1) is funded in part by sliding fee scale services or enrolled in the Minnesota health
care program;
new text end
new text begin
(2) faces increased financial pressure as a result of competition with nonteaching patient
care entities; and
new text end
new text begin
(3) emphasizes primary care or specialties that are in undersupply in rural or underserved
areas of Minnesota.
new text end
new text begin
(b) An entity hosting a clinical medical education program for advanced practice nursing
is eligible for funds under subdivision 3 if the program meets the eligibility requirements
in paragraph (a) and is sponsored by the University of Minnesota Academic Health Center,
the Mayo Foundation, or an institution that is part of the Minnesota State Colleges and
Universities system or a member of the Minnesota Private College Council.
new text end
new text begin
(c) An application must be submitted to the commissioner by an eligible entity or teaching
institution and contain the following information:
new text end
new text begin
(1) the official name and address and the site address of the clinical medical education
program where eligible trainees are hosted;
new text end
new text begin
(2) the name, title, and business address of those persons responsible for administering
the funds; and
new text end
new text begin
(3) for each applicant: (i) the type and specialty orientation of trainees in the program;
(ii) the name, entity address, and medical assistance provider number and national provider
identification number of each training site used in the program, as appropriate; (iii) the
federal tax identification number of each training site, where available; (iv) the total number
of trainees at each training site; (v) the total number of eligible trainee FTEs at each site;
and (vi) other supporting information the commissioner deems necessary.
new text end
new text begin
(d) An applicant that does not provide information requested by the commissioner shall
not be eligible for funds for the current funding cycle.
new text end
new text begin Subd. 3. new text end
new text begin Distribution of funds. new text end
new text begin
(a) The commissioner may distribute funds for clinical
training in areas of Minnesota and for professions listed in subdivision 1, paragraph (d)
determined by the commissioner as a high need area and profession shortage. The
commissioner shall annually distribute medical education funds to qualifying applicants
under this section based on costs to train, service level needs, and profession or training site
shortages. Use of funds is limited to related clinical training costs for eligible programs.
new text end
new text begin
(b) To ensure the quality of clinical training, eligible entities must demonstrate that they
hold contracts in good standing with eligible educational institutions that specify the terms,
expectations, and outcomes of the clinical training conducted at sites. Funds shall be
distributed in an administrative process determined by the commissioner to be efficient.
new text end
new text begin Subd. 4. new text end
new text begin Report. new text end
new text begin
(a) Teaching institutions receiving funds under this section must sign
and submit a medical education grant verification report (GVR) to verify that the correct
grant amount was forwarded to each eligible entity. If the teaching institution fails to submit
the GVR by the stated deadline, or to request and meet the deadline for an extension, the
sponsoring institution is required to return the full amount of funds received to the
commissioner within 30 days of receiving notice from the commissioner. The commissioner
shall distribute returned funds to the appropriate training sites in accordance with the
commissioner's approval letter.
new text end
new text begin
(b) Teaching institutions receiving funds under this section must provide any other
information the commissioner deems appropriate to evaluate the effectiveness of the use of
funds for medical education.
new text end
Sec. 23.
Minnesota Statutes 2020, section 144.1911, subdivision 4, is amended to read:
Subd. 4.
Career guidance and support services.
deleted text begin (a)deleted text end The commissioner shall award
grants to eligible nonprofit organizations new text begin and eligible postsecondary educational institutions,
including the University of Minnesota, new text end to provide career guidance and support services to
immigrant international medical graduates seeking to enter the Minnesota health workforce.
Eligible grant activities include the following:
(1) educational and career navigation, including information on training and licensing
requirements for physician and nonphysician health care professions, and guidance in
determining which pathway is best suited for an individual international medical graduate
based on the graduate's skills, experience, resources, and interests;
(2) support in becoming proficient in medical English;
(3) support in becoming proficient in the use of information technology, including
computer skills and use of electronic health record technology;
(4) support for increasing knowledge of and familiarity with the United States health
care system;
(5) support for other foundational skills identified by the commissioner;
(6) support for immigrant international medical graduates in becoming certified by the
Educational Commission on Foreign Medical Graduates, including help with preparation
for required licensing examinations and financial assistance for fees; and
(7) assistance to international medical graduates in registering with the program's
Minnesota international medical graduate roster.
deleted text begin
(b) The commissioner shall award the initial grants under this subdivision by December
31, 2015.
deleted text end
Sec. 24.
new text begin
[144.2182] CHANGE OF SEX.
new text end
new text begin Subdivision 1. new text end
new text begin Request to make change. new text end
new text begin
A person whose birth is registered in Minnesota
may request that the commissioner change or remove the sex, if any, assigned to that person
on the person's original birth certificate. If the person is a minor, a parent or guardian may
make the request on behalf of the minor.
new text end
new text begin Subd. 2. new text end
new text begin Documentation required. new text end
new text begin
A person making a request under this section must
submit any forms or fees required by the commissioner and provide acceptable documentation
to satisfy to the commissioner that granting the request will not harm the integrity and
accuracy of vital records. Acceptable documentation includes but is not limited to:
new text end
new text begin
(1) a written statement from a provider of medical services that the requested change is
appropriate in their medical opinion;
new text end
new text begin
(2) a certified copy of a court order from a court of competent jurisdiction in this or
another state granting the requested change; or
new text end
new text begin
(3) a sworn statement provided by the person who is the subject of the birth certificate,
or by the parent or guardian of the minor who is the subject of the birth certificate, that the
request is not based upon an intent to defraud or mislead and is made in good faith and, if
the subject is a minor, that the change is in the minor's best interest.
new text end
new text begin Subd. 3. new text end
new text begin Court orders. new text end
new text begin
A person may file a petition in district court to change or remove
the sex assigned on their original birth certificate. If the person is a minor, a parent or
guardian may file a petition on behalf of the minor. The court shall consider petitions filed
by persons over whom the court has jurisdiction for an order granting a change of sex on
an original birth certificate irrespective of the jurisdiction in which the original birth
certificate was issued. The court shall issue an order under this section upon a finding that
the request is not based upon an intent to defraud or mislead and is made in good faith and,
if the subject of the birth certificate is a minor, that the change is in the minor's best interest.
new text end
new text begin Subd. 4. new text end
new text begin Records sealed. new text end
new text begin
When the commissioner has received the necessary information
and made the requested change on the birth certificate, the commissioner shall provide a
certified copy of the corrected birth certificate to the person requesting the change. Upon
issuance of a corrected birth certificate under this section, the original record of birth shall
be classified as confidential data pursuant to section 13.02, subdivision 3, and shall not be
disclosed except pursuant to court order or section 144.2252.
new text end
Sec. 25.
Minnesota Statutes 2020, section 144.383, is amended to read:
144.383 AUTHORITY OF COMMISSIONERnew text begin ; SAFE DRINKING WATERnew text end .
In order to deleted text begin insuredeleted text end new text begin ensurenew text end safe drinking water in all public water supplies, the commissioner
has the deleted text begin following powersdeleted text end new text begin power tonew text end :
deleted text begin (a) Todeleted text end new text begin (1)new text end approve the site, design, and construction and alteration of all public water
supplies and, for community and nontransient noncommunity water systems as defined in
Code of Federal Regulations, title 40, section 141.2, to approve documentation that
demonstrates the technical, managerial, and financial capacity of those systems to comply
with rules adopted under this section;
deleted text begin (b) Todeleted text end new text begin (2)new text end enter the premises of a public water supply, or part thereof, to inspect the
facilities and records kept pursuant to rules promulgated by the commissioner, to conduct
sanitary surveys and investigate the standard of operation and service delivered by public
water supplies;
deleted text begin (c) Todeleted text end new text begin (3)new text end contract with community health boards as defined in section 145A.02,
subdivision 5, for routine surveys, inspections, and testing of public water supply quality;
deleted text begin (d) Todeleted text end new text begin (4)new text end develop an emergency plan to protect the public when a decline in water
quality or quantity creates a serious health risk, and to issue emergency orders if a health
risk is imminent;
deleted text begin (e) Todeleted text end new text begin (5)new text end promulgate rules, pursuant to chapter 14 but no less stringent than federal
regulation, which may include the granting of variances and exemptionsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(6) maintain a database of lead service lines, provide technical assistance to community
water systems, and ensure the lead service inventory data is accessible to the public with
relevant educational materials about health risks related to lead and ways to reduce exposure.
new text end
Sec. 26.
Minnesota Statutes 2020, section 144.554, is amended to read:
144.554 HEALTH FACILITIES CONSTRUCTION PLAN SUBMITTAL AND
FEES.
For hospitals, nursing homes, boarding care homes, residential hospices, supervised
living facilities, freestanding outpatient surgical centers, and end-stage renal disease facilities,
the commissioner shall collect a fee for the review and approval of architectural, mechanical,
and electrical plans and specifications submitted before construction begins for each project
relative to construction of new buildings, additions to existing buildings, or remodeling or
alterations of existing buildings. All fees collected in this section shall be deposited in the
state treasury and credited to the state government special revenue fund. Fees must be paid
at the time of submission of final plans for review and are not refundable. The fee is
calculated as follows:
| Construction project total estimated cost |
Fee |
| $0 - $10,000 |
deleted text begin
$30
deleted text end
new text begin
$45 new text end |
| $10,001 - $50,000 |
deleted text begin
$150
deleted text end
new text begin
$225 new text end |
| $50,001 - $100,000 |
deleted text begin
$300
deleted text end
new text begin
$450 new text end |
| $100,001 - $150,000 |
deleted text begin
$450
deleted text end
new text begin
$675 new text end |
| $150,001 - $200,000 |
deleted text begin
$600
deleted text end
new text begin
$900 new text end |
| $200,001 - $250,000 |
deleted text begin
$750
deleted text end
new text begin
$1,125 new text end |
| $250,001 - $300,000 |
deleted text begin
$900
deleted text end
new text begin
$1,350 new text end |
| $300,001 - $350,000 |
deleted text begin
$1,050
deleted text end
new text begin
$1,575 new text end |
| $350,001 - $400,000 |
deleted text begin
$1,200
deleted text end
new text begin
$1,800 new text end |
| $400,001 - $450,000 |
deleted text begin
$1,350
deleted text end
new text begin
$2,025 new text end |
| $450,001 - $500,000 |
deleted text begin
$1,500
deleted text end
new text begin
$2,250 new text end |
| $500,001 - $550,000 |
deleted text begin
$1,650
deleted text end
new text begin
$2,475 new text end |
| $550,001 - $600,000 |
deleted text begin
$1,800
deleted text end
new text begin
$2,700 new text end |
| $600,001 - $650,000 |
deleted text begin
$1,950
deleted text end
new text begin
$2,925 new text end |
| $650,001 - $700,000 |
deleted text begin
$2,100
deleted text end
new text begin
$3,150 new text end |
| $700,001 - $750,000 |
deleted text begin
$2,250
deleted text end
new text begin
$3,375 new text end |
| $750,001 - $800,000 |
deleted text begin
$2,400
deleted text end
new text begin
$3,600 new text end |
| $800,001 - $850,000 |
deleted text begin
$2,550
deleted text end
new text begin
$3,825 new text end |
| $850,001 - $900,000 |
deleted text begin
$2,700
deleted text end
new text begin
$4,050 new text end |
| $900,001 - $950,000 |
deleted text begin
$2,850
deleted text end
new text begin
$4,275 new text end |
| $950,001 - $1,000,000 |
deleted text begin
$3,000
deleted text end
new text begin
$4,500 new text end |
| $1,000,001 - $1,050,000 |
deleted text begin
$3,150
deleted text end
new text begin
$4,725 new text end |
| $1,050,001 - $1,100,000 |
deleted text begin
$3,300
deleted text end
new text begin
$4,950 new text end |
| $1,100,001 - $1,150,000 |
deleted text begin
$3,450
deleted text end
new text begin
$5,175 new text end |
| $1,150,001 - $1,200,000 |
deleted text begin
$3,600
deleted text end
new text begin
$5,400 new text end |
| $1,200,001 - $1,250,000 |
deleted text begin
$3,750
deleted text end
new text begin
$5,625 new text end |
| $1,250,001 - $1,300,000 |
deleted text begin
$3,900
deleted text end
new text begin
$5,850 new text end |
| $1,300,001 - $1,350,000 |
deleted text begin
$4,050
deleted text end
new text begin
$6,075 new text end |
| $1,350,001 - $1,400,000 |
deleted text begin
$4,200
deleted text end
new text begin
$6,300 new text end |
| $1,400,001 - $1,450,000 |
deleted text begin
$4,350
deleted text end
new text begin
$6,525 new text end |
| $1,450,001 - $1,500,000 |
deleted text begin
$4,500
deleted text end
new text begin
$6,750 new text end |
| $1,500,001 and over |
deleted text begin
$4,800
deleted text end
new text begin
$7,200 new text end |
Sec. 27.
new text begin
[144.7051] DEFINITIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Applicability. new text end
new text begin
For the purposes of sections 144.7051 to 144.7059, the
terms defined in this section have the meanings given.
new text end
new text begin Subd. 2. new text end
new text begin Commissioner. new text end
new text begin
"Commissioner" means the commissioner of health.
new text end
new text begin Subd. 3. new text end
new text begin Daily staffing schedule. new text end
new text begin
"Daily staffing schedule" means the actual number
of full-time equivalent nonmanagerial care staff assigned to an inpatient care unit and
providing care in that unit during a 24-hour period and the actual number of patients assigned
to each direct care registered nurse present and providing care in the unit.
new text end
new text begin Subd. 4. new text end
new text begin Direct care registered nurse. new text end
new text begin
"Direct care registered nurse" means a registered
nurse, as defined in section 148.171, subdivision 20, who is nonsupervisory and
nonmanagerial and who directly provides nursing care to patients more than 60 percent of
the time.
new text end
new text begin Subd. 5. new text end
new text begin Hospital. new text end
new text begin
"Hospital" means any setting that is licensed as a hospital under
sections 144.50 to 144.56.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 1, 2024.
new text end
Sec. 28.
new text begin
[144.7053] HOSPITAL NURSE STAFFING COMMITTEES.
new text end
new text begin Subdivision 1. new text end
new text begin Hospital nurse staffing committee required. new text end
new text begin
Each hospital must establish
and maintain a functioning hospital nurse staffing committee. A hospital may assign the
functions and duties of a hospital nurse staffing committee to an existing committee, provided
the existing committee meets the membership requirements applicable to a hospital nurse
staffing committee.
new text end
new text begin Subd. 2. new text end
new text begin Committee membership. new text end
new text begin
(a) At least 35 percent of the committee's membership
must be direct care registered nurses typically assigned to a specific unit for an entire shift,
and at least 15 percent of the committee's membership must be other direct care workers
typically assigned to a specific unit for an entire shift. Direct care registered nurses and
other direct care workers who are members of a collective bargaining unit shall be appointed
or elected to the committee according to the guidelines of the applicable collective bargaining
agreement. If there is no collective bargaining agreement, direct care registered nurses shall
be elected to the committee by direct care registered nurses employed by the hospital, and
other direct care workers shall be elected to the committee by other direct care workers
employed by the hospital.
new text end
new text begin
(b) The hospital shall appoint no more than 50 percent of the committee's membership.
new text end
new text begin Subd. 3. new text end
new text begin Compensation. new text end
new text begin
A hospital must treat participation in committee meetings by
any hospital employee as scheduled work time and compensate each committee member at
the employee's existing rate of pay. A hospital must relieve all direct care registered nurse
members of the hospital nurse staffing committee of other work duties during the times at
which the committee meets.
new text end
new text begin Subd. 4. new text end
new text begin Meeting frequency. new text end
new text begin
Each hospital nurse staffing committee must meet at least
quarterly.
new text end
new text begin Subd. 5. new text end
new text begin Committee duties. new text end
new text begin
(a) Each hospital nurse staffing committee shall create,
implement, continuously evaluate, and update as needed evidence-based written core staffing
plans to guide the creation of daily staffing schedules for each inpatient care unit of the
hospital.
new text end
new text begin
(b) Each hospital nurse staffing committee must:
new text end
new text begin
(1) establish a secure and anonymous method for any hospital employee or patient to
submit directly to the committee any concerns related to safe staffing;
new text end
new text begin
(2) review each concern related to safe staffing submitted directly to the committee;
new text end
new text begin
(3) review the documentation of compliance maintained by the hospital under section
144.7056, subdivision 5;
new text end
new text begin
(4) conduct a trend analysis of the data related to all reported concerns regarding safe
staffing;
new text end
new text begin
(5) develop a mechanism for tracking and analyzing staffing trends within the hospital;
new text end
new text begin
(6) submit to the commissioner a nurse staffing report; and
new text end
new text begin
(7) record in the committee minutes for each meeting a summary of the discussions and
recommendations of the committee. Each committee must maintain the minutes, records,
and distributed materials for five years.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 1, 2024.
new text end
Sec. 29.
Minnesota Statutes 2020, section 144.7055, is amended to read:
144.7055 new text begin HOSPITAL CORE new text end STAFFING PLAN deleted text begin REPORTSdeleted text end .
Subdivision 1.
Definitions.
deleted text begin
(a) For the purposes of this section, the following terms have
the meanings given.
deleted text end
deleted text begin (b)deleted text end new text begin (a)new text end "Core staffing plan" means deleted text begin the projected number of full-time equivalent
nonmanagerial care staff that will be assigned in a 24-hour period to an inpatient care unitdeleted text end new text begin
a plan described in subdivision 2new text end .
deleted text begin (c)deleted text end new text begin (b)new text end "Nonmanagerial care staff" means registered nurses, licensed practical nurses,
and other health care workers, which may include but is not limited to nursing assistants,
nursing aides, patient care technicians, and patient care assistants, who perform
nonmanagerial direct patient care functions for more than 50 percent of their scheduled
hours on a given patient care unit.
deleted text begin (d)deleted text end new text begin (c)new text end "Inpatient care unit"new text begin or "unit"new text end means a designated inpatient area for assigning
patients and staff for which a deleted text begin distinct staffing plandeleted text end new text begin daily staffing schedulenew text end exists and that
operates 24 hours per day, seven days per week in a hospital setting. Inpatient care unit does
not include any hospital-based clinic, long-term care facility, or outpatient hospital
department.
deleted text begin (e)deleted text end new text begin (d)new text end "Staffing hours per patient day" means the number of full-time equivalent
nonmanagerial care staff who will ordinarily be assigned to provide direct patient care
divided by the expected average number of patients upon which such assignments are based.
deleted text begin
(f) "Patient acuity tool" means a system for measuring an individual patient's need for
nursing care. This includes utilizing a professional registered nursing assessment of patient
condition to assess staffing need.
deleted text end
Subd. 2.
Hospitalnew text begin corenew text end staffing deleted text begin reportdeleted text end new text begin plansnew text end .
(a) The deleted text begin chief nursing executive or nursing
designeedeleted text end new text begin hospital nurse staffing committeenew text end of every deleted text begin reportingdeleted text end hospital deleted text begin in Minnesota under
section 144.50 willdeleted text end new text begin mustnew text end develop a core staffing plan for each deleted text begin patientdeleted text end new text begin inpatientnew text end care unit.
(b) Core staffing plans deleted text begin shalldeleted text end new text begin mustnew text end specifynew text begin all of the following:
new text end
new text begin (1) new text end thenew text begin projected number ofnew text end full-time equivalent deleted text begin fordeleted text end new text begin nonmanagerial care staff that will
be assigned in a 24-hour period tonew text end each deleted text begin patientdeleted text end new text begin inpatientnew text end care unit deleted text begin for each 24-hour period.deleted text end new text begin ;
new text end
new text begin
(2) the maximum number of patients on each inpatient care unit for whom a direct care
registered nurse can be assigned and for whom a licensed practical nurse or certified nursing
assistant can typically safely care;
new text end
new text begin
(3) criteria for determining when circumstances exist on each inpatient care unit such
that a direct care nurse cannot safely care for the typical number of patients and when
assigning a lower number of patients to each nurse on the inpatient unit would be appropriate;
new text end
new text begin
(4) a procedure for each inpatient care unit to make shift-to-shift adjustments in staffing
levels when such adjustments are required by patient acuity and nursing intensity in the
unit;
new text end
new text begin
(5) a contingency plan for each inpatient unit to safely address circumstances in which
patient care needs unexpectedly exceed the staffing resources provided for in a daily staffing
schedule. A contingency plan must include a method to quickly identify for each daily
staffing schedule additional direct care registered nurses who are available to provide direct
care on the inpatient care unit; and
new text end
new text begin
(6) strategies to enable direct care registered nurses to take breaks to which they are
entitled under law or under an applicable collective bargaining agreement.
new text end
(c) new text begin Core staffing plans must ensure that:
new text end
new text begin
(1) the person creating a daily staffing schedule has sufficiently detailed information to
create a daily staffing schedule that meets the requirements of the plan;
new text end
new text begin
(2) daily staffing nurse schedules do not rely on assigning individual nonmanagerial
care staff to work overtime hours in excess of 16 hours in a 24-hour period or to work
consecutive 24-hour periods requiring 16 or more hours;
new text end
new text begin
(3) a direct care registered nurse is not required or expected to perform functions outside
the nurse's professional license;
new text end
new text begin
(4) light duty direct care registered nurses are given appropriate assignments; and
new text end
new text begin
(5) daily staffing schedules do not interfere with applicable collective bargaining
agreements.
new text end
new text begin Subd. 2a. new text end
new text begin Development of hospital core staffing plans. new text end
new text begin (a) new text end Prior to deleted text begin submittingdeleted text end new text begin
completing or updatingnew text end the core staffing plan, deleted text begin as required in subdivision 3, hospitals shalldeleted text end new text begin
a hospital nurse staffing committee mustnew text end consult with representatives of the hospital medical
staff, managerial and nonmanagerial care staff, and other relevant hospital personnel about
the core staffing plan and the expected average number of patients upon which thenew text begin corenew text end
staffing plan is based.
new text begin
(b) When developing a core staffing plan, a hospital nurse staffing committee must
consider all of the following:
new text end
new text begin
(1) the individual needs and expected census of each inpatient care unit;
new text end
new text begin
(2) unit-specific patient acuity, including fall risk and behaviors requiring intervention,
such as physical aggression toward self or others, or destruction of property;
new text end
new text begin
(3) unit-specific demands on direct care registered nurses' time, including: frequency of
admissions, discharges, and transfers; frequency and complexity of patient evaluations and
assessments; frequency and complexity of nursing care planning; planning for patient
discharge; assessing for patient referral; patient education; and implementing infectious
disease protocols;
new text end
new text begin
(4) the architecture and geography of the inpatient care unit, including the placement of
patient rooms, treatment areas, nursing stations, medication preparation areas, and equipment;
new text end
new text begin
(5) mechanisms and procedures to provide for one-to-one patient observation for patients
on psychiatric or other units;
new text end
new text begin
(6) the stress under which direct care nurses are placed when required to work extreme
amounts of overtime, such as shifts in excess of 12 hours or multiple consecutive double
shifts;
new text end
new text begin
(7) the need for specialized equipment and technology on the unit;
new text end
new text begin
(8) other special characteristics of the unit or community patient population, including
age, cultural and linguistic diversity and needs, functional ability, communication skills,
and other relevant social and socioeconomic factors;
new text end
new text begin
(9) the skill mix of personnel other than direct care registered nurses providing or
supporting direct patient care on the unit;
new text end
new text begin
(10) mechanisms and procedures for identifying additional registered nurses who are
available for direct patient care when patients' unexpected needs exceed the planned workload
for direct care staff; and
new text end
new text begin
(11) demands on direct care registered nurses' time not directly related to providing
direct care on a unit, such as involvement in quality improvement activities, professional
development, service to the hospital, including serving on the hospital nurse staffing
committee, and service to the profession.
new text end
Subd. 3.
Standard electronic reporting deleted text begin developeddeleted text end new text begin of core staffing plansnew text end .
deleted text begin (a) Hospitalsdeleted text end new text begin
Each hospitalnew text end must submit the core staffing plansnew text begin approved by the hospital's nurse staffing
committeenew text end to the Minnesota Hospital Association deleted text begin by January 1, 2014deleted text end . The Minnesota
Hospital Association shall include each deleted text begin reportingdeleted text end hospital's core staffing deleted text begin plandeleted text end new text begin plansnew text end on the
Minnesota Hospital Association's Minnesota Hospital Quality Report website deleted text begin by April 1,
2014deleted text end new text begin by June 1, 2024new text end . new text begin Hospitals shall submit to the Minnesota Hospital Association new text end any
substantial deleted text begin changesdeleted text end new text begin updatesnew text end to deleted text begin thedeleted text end new text begin anew text end core staffing plan deleted text begin shall be updateddeleted text end within 30 daysnew text begin of
the approval of the updates by the hospital's nurse staffing committee or of amendment
through arbitration. The Minnesota Hospital Association shall update the Minnesota Hospital
Quality Report website with the updated core staffing plans within 30 days of receipt of the
updated plannew text end .
new text begin Subd. 4. new text end
new text begin Standard electronic reporting of direct patient care report. new text end
deleted text begin (b)deleted text end The Minnesota
Hospital Association shall include on its website for each reporting hospital on a quarterly
basis the actual direct patient care hours per patient and per unit. Hospitals must submit the
direct patient care report to the Minnesota Hospital Association deleted text begin by July 1, 2014, anddeleted text end quarterly
deleted text begin thereafterdeleted text end .
new text begin Subd. 5. new text end
new text begin Mandatory submission of core staffing plan to commissioner. new text end
new text begin
Each hospital
must submit the core staffing plans and any updates to the commissioner on the same
schedule described in subdivision 3. Core staffing plans held by the commissioner are public.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 1, 2024.
new text end
Sec. 30.
new text begin
[144.7056] IMPLEMENTATION OF HOSPITAL CORE STAFFING PLANS.
new text end
new text begin Subdivision 1. new text end
new text begin Plan implementation required. new text end
new text begin
A hospital must implement the core
staffing plans approved by a majority vote of the hospital nurse staffing committee.
new text end
new text begin Subd. 2. new text end
new text begin Public posting of core staffing plans. new text end
new text begin
A hospital must post the core staffing
plan for the inpatient care unit in a public area on the unit.
new text end
new text begin Subd. 3. new text end
new text begin Public posting of compliance with plan. new text end
new text begin
For each publicly posted core staffing
plan, a hospital must post a notice stating whether the current staffing on the unit complies
with the hospital's core staffing plan for that unit. The public notice of compliance must
include a list of the number of nonmanagerial care staff working on the unit during the
current shift and the number of patients assigned to each direct care registered nurse working
on the unit during the current shift. The list must enumerate the nonmanagerial care staff
by health care worker type. The public notice of compliance must be posted immediately
adjacent to the publicly posted core staffing plan.
new text end
new text begin Subd. 4. new text end
new text begin Public distribution of core staffing plan and notice of compliance. new text end
new text begin
(a) A
hospital must include with the posted materials described in subdivisions 2 and 3, a statement
that individual copies of the posted materials are available upon request to any patient on
the unit or to any visitor of a patient on the unit. The statement must include specific
instructions for obtaining copies of the posted materials.
new text end
new text begin
(b) A hospital must, within four hours after the request, provide individual copies of all
the posted materials described in subdivisions 2 and 3 to any patient on the unit or to any
visitor of a patient on the unit who requests the materials.
new text end
new text begin Subd. 5. new text end
new text begin Documentation of compliance. new text end
new text begin
Each hospital must document compliance with
its core nursing plans and maintain records demonstrating compliance for each inpatient
care unit for five years. Each hospital must provide its nurse staffing committee with access
to all documentation required under this subdivision.
new text end
new text begin Subd. 6. new text end
new text begin Dispute resolution. new text end
new text begin
(a) If hospital management objects to a core staffing plan
approved by a majority vote of the hospital nurse staffing committee, the hospital may elect
to attempt to amend the core staffing plan through arbitration.
new text end
new text begin
(b) During an ongoing dispute resolution process, a hospital must continue to implement
the core staffing plan as written and approved by the hospital nurse staffing committee.
new text end
new text begin
(c) If the dispute resolution process results in an amendment to the core staffing plan,
the hospital must implement the amended core staffing plan.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective June 1, 2024.
new text end
Sec. 31.
new text begin
[144.7059] RETALIATION PROHIBITED.
new text end
new text begin
Neither a hospital or nor a health-related licensing board may retaliate against or discipline
a hospital employee regulated by the health-related licensing board, either formally or
informally, for:
new text end
new text begin
(1) challenging the process by which a hospital nurse staffing committee is formed or
conducts its business;
new text end
new text begin
(2) challenging a core staffing plan approved by a hospital nurse staffing committee;
new text end
new text begin
(3) objecting to or submitting a grievance related to a patient assignment that leads to a
direct care registered nurse violating medical restrictions recommended by the nurse's
medical provider; or
new text end
new text begin
(4) submitting a report of unsafe staffing conditions.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 1, 2024.
new text end
Sec. 32.
new text begin
[144.8611] DRUG OVERDOSE AND SUBSTANCE ABUSE PREVENTION.
new text end
new text begin Subdivision 1. new text end
new text begin Strategies. new text end
new text begin
The commissioner of health shall support collaboration and
coordination between state and community partners to develop, refine, and expand
comprehensive funding to address the drug overdose epidemic by implementing three
strategies: (1) regional multidisciplinary overdose prevention teams to implement overdose
prevention in local communities and local public health organizations; (2) enhance supportive
services for the homeless who are at risk of overdose by providing emergency and short-term
housing subsidies through the Homeless Overdose Prevention Hub; and (3) enhance employer
resources to promote health and well-being of employees through the recovery friendly
workplace initiative. These strategies address the underlying social conditions that impact
health status.
new text end
new text begin Subd. 2. new text end
new text begin Regional teams. new text end
new text begin
The commissioner of health shall establish community-based
prevention grants and contracts for the eight regional multidisciplinary overdose prevention
teams. These teams are geographically aligned with the eight emergency medical services
regions described in section 144E.52. The regional teams shall implement prevention
programs, policies, and practices that are specific to the challenges and responsive to the
data of the region.
new text end
new text begin Subd. 3. new text end
new text begin Homeless Overdose Prevention Hub. new text end
new text begin
The commissioner of health shall
establish a community-based grant to enhance supportive services for the homeless who
are at risk of overdose by providing emergency and short-term housing subsidies through
the Homeless Overdose Prevention Hub. The Homeless Overdose Prevention Hub serves
primarily urban American Indians in Minneapolis and Saint Paul and is managed by the
Native American Community Clinic.
new text end
new text begin Subd. 4. new text end
new text begin Workplace health. new text end
new text begin
The commissioner of health shall establish a grants and
contracts program to strengthen the recovery friendly workplace initiative. This initiative
helps create work environments that promote employee health, safety, and well-being by:
(1) preventing abuse and misuse of drugs in the first place; (2) providing training to
employers; and (3) reducing stigma and supporting recovery for people seeking services
and who are in recovery.
new text end
new text begin Subd. 5. new text end
new text begin Eligible grantees. new text end
new text begin
(a) Organizations eligible to receive grant funding under
subdivision 4 include not-for-profit agencies or organizations with existing organizational
structure, capacity, trainers, facilities, and infrastructure designed to deliver model workplace
policies and practices; that have training and education for employees, supervisors, and
executive leadership of companies, businesses, and industry; and that have the ability to
evaluate the three goals of the workplace initiative specified in subdivision 4.
new text end
new text begin
(b) At least one organization may be selected for a grant under subdivision 4 with
statewide reach and influence. Up to five smaller organizations may be selected to reach
specific geographic or population groups.
new text end
new text begin Subd. 6. new text end
new text begin Evaluation. new text end
new text begin
The commissioner of health shall design, conduct, and evaluate
each of the components of the drug overdose and substance abuse prevention program using
measures such as mortality, morbidity, homelessness, workforce wellness, employee
retention, and program reach.
new text end
new text begin Subd. 7. new text end
new text begin Report. new text end
new text begin
Grantees must report grant program outcomes to the commissioner on
the forms and according to the timelines established by the commissioner.
new text end
Sec. 33.
Minnesota Statutes 2020, section 144.9501, subdivision 9, is amended to read:
Subd. 9.
Elevated blood lead level.
"Elevated blood lead level" means a diagnostic
blood lead test with a result that is equal to or greater than deleted text begin tendeleted text end new text begin 3.5new text end micrograms of lead per
deciliter of whole blood in any person, unless the commissioner finds that a lower
concentration is necessary to protect public health.
Sec. 34.
new text begin
[144.9981] CLIMATE RESILIENCY.
new text end
new text begin Subdivision 1. new text end
new text begin Climate resiliency program. new text end
new text begin
The commissioner of health shall implement
a climate resiliency program to:
new text end
new text begin
(1) increase awareness of climate change;
new text end
new text begin
(2) track the public health impacts of climate change and extreme weather events;
new text end
new text begin
(3) provide technical assistance and tools that support climate resiliency to local public
health, Tribal health, soil and water conservation districts, and other local governmental
and nongovernmental organizations; and
new text end
new text begin
(4) coordinate with the commissioners of the pollution control agency, natural resources,
agriculture and other state agencies in climate resiliency related planning and implementation.
new text end
new text begin Subd. 2. new text end
new text begin Grants authorized; allocation. new text end
new text begin
(a) The commissioner of health shall manage
a grant program for the purpose of climate resiliency planning. The commissioner shall
award grants through a request for proposals process to local public health organizations,
Tribal health organizations, soil and water conservation districts, or other local organizations
for planning for the health impacts of extreme weather events and developing adaptation
actions. Priority shall be given to small rural water systems and organizations incorporating
the needs of private water supplies into their planning. Priority shall also be given to
organizations that serve communities that are disproportionately impacted by climate change.
new text end
new text begin
(b) Grantees must use the funds to develop a plan or implement strategies that will reduce
the risk of health impacts from extreme weather events. The grant application must include:
new text end
new text begin
(1) a description of the plan or project for which the grant funds will be used;
new text end
new text begin
(2) a description of the pathway between the plan or project and its impacts on health;
new text end
new text begin
(3) a description of the objectives, a work plan, and a timeline for implementation; and
new text end
new text begin
(4) the community or group the grant proposes to focus on.
new text end
Sec. 35.
new text begin
[145.361] LONG COVID; SUPPORTING SURVIVORS AND MONITORING
IMPACT.
new text end
new text begin Subdivision 1. new text end
new text begin Definition. new text end
new text begin
For the purpose of this section, "long COVID" means health
problems that people experience four or more weeks after being infected with SARS-CoV-2,
the virus that causes COVID-19. Long COVID is also called post COVID, long-haul COVID,
chronic COVID, post-acute COVID, or post-acute sequelae of COVID-19 (PASC).
new text end
new text begin Subd. 2. new text end
new text begin Statewide monitoring. new text end
new text begin
The commissioner of health shall establish a program
to conduct community needs assessments, perform epidemiologic studies, and establish a
population-based surveillance system to address long COVID. The purpose of these
assessments, studies, and surveillance system is to:
new text end
new text begin
(1) monitor trends in incidence, prevalence, mortality, care management, health outcomes,
quality of life, and needs of individuals with long COVID and to detect potential public
health problems, predict risks, and assist in investigating long COVID health disparities;
new text end
new text begin
(2) more accurately target intervention resources for communities and patients and their
families;
new text end
new text begin
(3) inform health professionals and citizens about risks, early detection, and treatment
of long COVID known to be elevated in their communities; and
new text end
new text begin
(4) promote high quality studies to provide better information for long COVID prevention
and control and to address public concerns and questions about long COVID.
new text end
new text begin Subd. 3. new text end
new text begin Partnerships. new text end
new text begin
The commissioner of health shall, in consultation with health
care professionals, the Department of Human Services, local public health organizations,
health insurers, employers, schools, long COVID survivors, and community organizations
serving people at high risk of long COVID, routinely identify priority actions and activities
to address the need for communication, services, resources, tools, strategies, and policies
to support long COVID survivors and their families.
new text end
new text begin Subd. 4. new text end
new text begin Grants and contracts. new text end
new text begin
The commissioner of health shall coordinate and
collaborate with community and organizational partners to implement evidence-informed
priority actions, including through community-based grants and contracts.
new text end
new text begin Subd. 5. new text end
new text begin Grant recipient and contractor eligibility. new text end
new text begin
The commissioner of health shall
award contracts and competitive grants to organizations that serve communities
disproportionately impacted by COVID-19 and long COVID including but not limited to
rural and low-income areas, Black and African Americans, African immigrants, American
Indians, Asian American-Pacific Islanders, Latino, LGBTQ+, and persons with disabilities.
Organizations may also address intersectionality within such groups.
new text end
new text begin Subd. 6. new text end
new text begin Grants and contracts authorized. new text end
new text begin
The commissioner of health shall award
grants and contracts to eligible organizations to plan, construct, and disseminate resources
and information to support survivors of long COVID, their caregivers, health care providers,
ancillary health care workers, workplaces, schools, communities, local and Tribal public
health, and other entities deemed necessary.
new text end
Sec. 36.
Minnesota Statutes 2020, section 145.56, is amended by adding a subdivision to
read:
new text begin Subd. 6. new text end
new text begin 988; National Suicide Prevention Lifeline number. new text end
new text begin
The National Suicide
Prevention Lifeline is expanded to improve the quality of care and access to behavioral
health crisis services and to further health equity and save lives.
new text end
Sec. 37.
Minnesota Statutes 2020, section 145.56, is amended by adding a subdivision to
read:
new text begin Subd. 7. new text end
new text begin Definitions. new text end
new text begin
(a) For the purposes of this section, the following terms have the
meanings given.
new text end
new text begin
(b) "National Suicide Prevention Lifeline" means a national network of certified local
crisis centers maintained by the Federal Substance Abuse and Mental Health Services
Administration that provides free and confidential emotional support to people in suicidal
crisis or emotional distress 24 hours a day, seven days a week.
new text end
new text begin
(c) "988 Hotline" or "Lifeline Center" means a state identified center that is a member
of the National Suicide Prevention Lifeline network that responds to statewide or regional
988 contacts.
new text end
new text begin
(d) "988 administrator" means the administrator of the 988 National Suicide Prevention
Lifeline.
new text end
new text begin
(e) "Veterans Crisis Line" means the Veterans Crisis Line maintained by the Secretary
of Veterans Affairs under United States Code, title 38, section 170F(h).
new text end
new text begin
(f) "Department" means the Department of Health.
new text end
new text begin
(g) "Commissioner" means the commissioner of health.
new text end
Sec. 38.
Minnesota Statutes 2020, section 145.56, is amended by adding a subdivision to
read:
new text begin Subd. 8. new text end
new text begin 988 National Suicide Prevention Lifeline. new text end
new text begin
(a) The commissioner of health
shall administer the designated lifeline and oversee a Lifeline Center or a network of Lifeline
Centers to answer contacts from individuals accessing the National Suicide Prevention
Lifeline 24 hours per day, seven days per week.
new text end
new text begin
(b) The designated Lifeline Center(s) shall:
new text end
new text begin
(1) have an active agreement with the administrator of the 988 National Suicide
Prevention Lifeline for participation within the network;
new text end
new text begin
(2) meet the 988 administrator requirements and best practice guidelines for operational
and clinical standards;
new text end
new text begin
(3) provide data, report, and participate in evaluations and related quality improvement
activities as required by the 988 administrator and the department;
new text end
new text begin
(4) use technology that is interoperable across crisis and emergency response systems
used in the state, such as 911 systems, emergency medical services, and the National Suicide
Prevention Lifeline;
new text end
new text begin
(5) deploy crisis and outgoing services, including mobile crisis teams in accordance with
guidelines established by the 988 administrator and the department;
new text end
new text begin
(6) actively collaborate with local mobile crisis teams to coordinate linkages for persons
contacting the 988 Hotline for ongoing care needs;
new text end
new text begin
(7) offer follow-up services to individuals accessing the Lifeline Center that are consistent
with guidance established by the 988 administrator and the department; and
new text end
new text begin
(8) meet the requirements set by the 988 administrator and the department for serving
high risk and specialized populations.
new text end
new text begin
(c) The department shall collaborate with the National Suicide Prevention Lifeline and
Veterans Crisis Line networks for the purpose of ensuring consistency of public messaging
about 988 services.
new text end
Sec. 39.
new text begin
[145.871] UNIVERSAL, VOLUNTARY HOME VISITING PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Grant program. new text end
new text begin
(a) The commissioner of health shall award grants to
eligible individuals and entities to establish voluntary home visiting services to families
expecting or caring for an infant, including families adopting an infant. The following
individuals and entities are eligible for a grant under this section: community health boards;
nonprofit organizations; Tribal Nations; and health care providers, including doulas,
community health workers, perinatal health educators, early childhood family education
home visiting providers, nurses, community health technicians, and local public health
nurses.
new text end
new text begin
(b) The grant money awarded under this section must be used to establish home visiting
services that:
new text end
new text begin
(1) provide a range of one to six visits that occur prenatally or within the first four months
of the expected birth or adoption of an infant; and
new text end
new text begin
(2) improve outcomes in two or more of the following areas:
new text end
new text begin
(i) maternal and newborn health;
new text end
new text begin
(ii) school readiness and achievement;
new text end
new text begin
(iii) family economic self-sufficiency;
new text end
new text begin
(iv) coordination and referral for other community resources and supports;
new text end
new text begin
(v) reduction in child injuries, abuse, or neglect; or
new text end
new text begin
(vi) reduction in crime or domestic violence.
new text end
new text begin
(c) The commissioner shall ensure that the voluntary home visiting services established
under this section are available to all families residing in the state by June 30, 2025. In
awarding grants prior to the home visiting services being available statewide, the
commissioner shall prioritize applicants serving high-risk or high-need populations of
pregnant women and families with infants, including populations with insufficient access
to prenatal care, high incidence of mental illness or substance use disorder, low
socioeconomic status, and other factors as determined by the commissioner.
new text end
new text begin Subd. 2. new text end
new text begin Home visiting services. new text end
new text begin
(a) The home visiting services provided under this
section must, at a minimum:
new text end
new text begin
(1) offer information on infant care, child growth and development, positive parenting,
preventing diseases, preventing exposure to environmental hazards, and support services
in the community;
new text end
new text begin
(2) provide information on and referrals to health care services, including information
on and assistance in applying for health care coverage for which the child or family may
be eligible, and provide information on the availability of group prenatal care, preventative
services, developmental assessments, and public assistance programs as appropriate;
new text end
new text begin
(3) include an assessment of the physical, social, and emotional factors affecting the
family and provide information and referrals to address each family's identified needs;
new text end
new text begin
(4) connect families to additional resources available in the community, including early
care and education programs, health or mental health services, family literacy programs,
employment agencies, and social services, as needed;
new text end
new text begin
(5) utilize appropriate racial, ethnic, and cultural approaches to providing home visiting
services; and
new text end
new text begin
(6) be voluntary and free of charge to families.
new text end
new text begin
(b) Home visiting services under this section may be provided through telephone or
video communication when the commissioner determines the methods are necessary to
protect the health and safety of individuals receiving the visits and the home visiting
workforce.
new text end
new text begin Subd. 3. new text end
new text begin Administrative costs. new text end
new text begin
The commissioner may use up to seven percent of the
annual appropriation under this section to provide training and technical assistance, to
administer the program, and to conduct ongoing evaluations of the program. The
commissioner may contract for training, capacity-building support for grantees or potential
grantees, technical assistance, and evaluation support.
new text end
Sec. 40.
Minnesota Statutes 2020, section 145.924, is amended to read:
145.924 AIDS PREVENTION GRANTS.
(a) The commissioner may award grants to community health boards as defined in section
145A.02, subdivision 5, state agencies, state councils, or nonprofit corporations to provide
evaluation and counseling services to populations at risk for acquiring human
immunodeficiency virus infection, including, but not limited to, minorities, adolescents,
intravenous drug users, and homosexual men.
(b) The commissioner may award grants to agencies experienced in providing services
to communities of color, for the design of innovative outreach and education programs for
targeted groups within the community who may be at risk of acquiring the human
immunodeficiency virus infection, including intravenous drug users and their partners,
adolescents, gay and bisexual individuals and women. Grants shall be awarded on a request
for proposal basis and shall include funds for administrative costs. Priority for grants shall
be given to agencies or organizations that have experience in providing service to the
particular community which the grantee proposes to serve; that have policy makers
representative of the targeted population; that have experience in dealing with issues relating
to HIV/AIDS; and that have the capacity to deal effectively with persons of differing sexual
orientations. For purposes of this paragraph, the "communities of color" are: the
American-Indian community; the Hispanic community; the African-American community;
and the Asian-Pacific community.
(c) All state grants awarded under this section for programs targeted to adolescents shall
include the promotion of abstinence from sexual activity and drug use.
new text begin
(d) The commissioner may manage a program and award grants to agencies experienced
in syringe services programs for expanding access to harm reduction services and improving
linkages to care to prevent HIV/AIDS, hepatitis, and other infectious diseases for those
experiencing homelessness or housing instability.
new text end
Sec. 41.
new text begin
[145.9271] COMMUNITY SOLUTIONS FOR HEALTHY CHILD
DEVELOPMENT GRANT PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The commissioner of health shall establish the community
solutions for a healthy child development grant program. The purposes of the program are
to:
new text end
new text begin
(1) improve child development outcomes related to the well-being of children of color
and American Indian children from prenatal to grade 3 and their families, including but not
limited to the goals outlined by the Department of Human Service's early childhood systems
reform effort that include: early learning; health and well-being; economic security; and
safe, stable, nurturing relationships and environments, by funding community-based solutions
for challenges that are identified by the affected communities;
new text end
new text begin
(2) reduce racial disparities in children's health and development from prenatal to grade
3; and
new text end
new text begin
(3) promote racial and geographic equity.
new text end
new text begin Subd. 2. new text end
new text begin Commissioner's duties. new text end
new text begin
The commissioner of health shall:
new text end
new text begin
(1) develop a request for proposals for the healthy child development grant program in
consultation with the community solutions advisory council established in subdivision 3;
new text end
new text begin
(2) provide outreach, technical assistance, and program development support to increase
capacity for new and existing service providers in order to better meet statewide needs,
particularly in greater Minnesota and areas where services to reduce health disparities have
not been established;
new text end
new text begin
(3) review responses to requests for proposals, in consultation with the community
solutions advisory council, and award grants under this section;
new text end
new text begin
(4) ensure communication with the ethnic councils, Minnesota Indian Affairs Council,
and the Children's Cabinet on the request for proposal process;
new text end
new text begin
(5) establish a transparent and objective accountability process, in consultation with the
community solutions advisory council, focused on outcomes that grantees agree to achieve;
new text end
new text begin
(6) provide grantees with access to data to assist grantees in establishing and
implementing effective community-led solutions;
new text end
new text begin
(7) maintain data on outcomes reported by grantees; and
new text end
new text begin
(8) contract with an independent third-party entity to evaluate the success of the grant
program and to build the evidence base for effective community solutions in reducing health
disparities of children of color and American Indian children from prenatal to grade 3.
new text end
new text begin Subd. 3. new text end
new text begin
Community solutions advisory council; establishment; duties;
compensation.
new text end
new text begin
(a) The commissioner of health shall establish a community solutions
advisory council. By October 1, 2022, the commissioner shall convene a 12-member
community solutions advisory council. Members of the advisory council are:
new text end
new text begin
(1) two members representing the African Heritage community;
new text end
new text begin
(2) two members representing the Latino community;
new text end
new text begin
(3) two members representing the Asian-Pacific Islander community;
new text end
new text begin
(4) two members representing the American Indian community;
new text end
new text begin
(5) two parents who are Black, indigenous, or nonwhite people of color with children
under nine years of age;
new text end
new text begin
(6) one member with research or academic expertise in racial equity and healthy child
development; and
new text end
new text begin
(7) one member representing an organization that advocates on behalf of communities
of color or American Indians.
new text end
new text begin
(b) At least three of the 12 members of the advisory council must come from outside
the seven-county metropolitan area.
new text end
new text begin
(c) The community solutions advisory council shall:
new text end
new text begin
(1) advise the commissioner on the development of the request for proposals for
community solutions healthy child development grants. In advising the commissioner, the
council must consider how to build on the capacity of communities to promote child and
family well-being and address social determinants of healthy child development;
new text end
new text begin
(2) review responses to requests for proposals and advise the commissioner on the
selection of grantees and grant awards;
new text end
new text begin
(3) advise the commissioner on the establishment of a transparent and objective
accountability process focused on outcomes the grantees agree to achieve;
new text end
new text begin
(4) advise the commissioner on ongoing oversight and necessary support in the
implementation of the program; and
new text end
new text begin
(5) support the commissioner on other racial equity and early childhood grant efforts.
new text end
new text begin
(d) Each advisory council member shall be compensated as provided in section 15.059,
subdivision 3.
new text end
new text begin Subd. 4. new text end
new text begin Eligible grantees. new text end
new text begin
Organizations eligible to receive grant funding under this
section include:
new text end
new text begin
(1) organizations or entities that work with Black, indigenous, and non-Black people of
color communities;
new text end
new text begin
(2) Tribal nations and Tribal organizations as defined in section 658P of the Child Care
and Development Block Grant Act of 1990; and
new text end
new text begin
(3) organizations or entities focused on supporting healthy child development.
new text end
new text begin Subd. 5. new text end
new text begin
Strategic consideration and priority of proposals; eligible populations;
grant awards.
new text end
new text begin
(a) The commissioner, in consultation with the community solutions advisory
council, shall develop a request for proposals for healthy child development grants. In
developing the proposals and awarding the grants, the commissioner shall consider building
on the capacity of communities to promote child and family well-being and address social
determinants of healthy child development. Proposals must focus on increasing racial equity
and healthy child development and reducing health disparities experienced by children of
Black, nonwhite people of color, and American Indian communities from prenatal to grade
3 and their families.
new text end
new text begin
(b) In awarding the grants, the commissioner shall provide strategic consideration and
give priority to proposals from:
new text end
new text begin
(1) organizations or entities led by Black and other nonwhite people of color and serving
Black and nonwhite communities of color;
new text end
new text begin
(2) organizations or entities led by American Indians and serving American Indians,
including Tribal nations and Tribal organizations;
new text end
new text begin
(3) organizations or entities with proposals focused on healthy development from prenatal
to age three;
new text end
new text begin
(4) organizations or entities with proposals focusing on multigenerational solutions;
new text end
new text begin
(5) organizations or entities located in or with proposals to serve communities located
in counties that are moderate to high risk according to the Wilder Research Risk and Reach
Report; and
new text end
new text begin
(6) community-based organizations that have historically served communities of color
and American Indians and have not traditionally had access to state grant funding.
new text end
new text begin
(c) The advisory council may recommend additional strategic considerations and priorities
to the commissioner.
new text end
new text begin
(d) The first round of grants must be awarded no later than April 15, 2023.
new text end
new text begin Subd. 6. new text end
new text begin Geographic distribution of grants. new text end
new text begin
To the extent possible, the commissioner
and the advisory council shall ensure that grant funds are prioritized and awarded to
organizations and entities that are within counties that have a higher proportion of Black,
nonwhite people of color, and American Indians than the state average.
new text end
new text begin Subd. 7. new text end
new text begin Report. new text end
new text begin
Grantees must report grant program outcomes to the commissioner on
the forms and according to the timelines established by the commissioner.
new text end
Sec. 42.
new text begin
[145.9272] LEAD REMEDIATION IN SCHOOLS AND CHILD CARE
SETTINGS GRANT PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment; purpose. new text end
new text begin
The commissioner of health shall develop a
grant program for the purpose of remediating identified sources of lead in drinking water
in schools and child care settings.
new text end
new text begin Subd. 2. new text end
new text begin Grants authorized. new text end
new text begin
The commissioner shall award grants through a request
for proposals process to schools and child care settings. Priority shall be given to schools
and child care settings with: (1) higher levels of lead detected in water samples; (2) evidence
of lead service lines or lead plumbing materials; and (3) school districts that serve
disadvantaged communities.
new text end
new text begin Subd. 3. new text end
new text begin Grant allocation. new text end
new text begin
Grantees must use the funds to address sources of lead
contamination in their facilities including but not limited to service connections, premise
plumbing, and implementing best practices for water management within the building.
new text end
Sec. 43.
new text begin
[145.9275] SKIN-LIGHTENING PRODUCTS PUBLIC AWARENESS AND
EDUCATION GRANT PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Grant program. new text end
new text begin
The commissioner of health shall award grants through
a request for proposal process to community-based organizations that serve ethnic
communities and focus on public health outreach to Black and people of color communities
on the issues of colorism, skin-lightening products, and chemical exposures from these
products. Priority in awarding grants shall be given to organizations that have historically
provided services to ethnic communities on the skin-lightening and chemical exposure issue
for the past four years.
new text end
new text begin Subd. 2. new text end
new text begin Uses of grant funds. new text end
new text begin
Grant recipients must use grant funds awarded under this
section to conduct public awareness and education activities that are culturally specific and
community-based and that focus on:
new text end
new text begin
(1) increasing public awareness and providing education on the health dangers associated
with using skin-lightening creams and products that contain mercury and hydroquinone and
are manufactured in other countries, brought into this country, and sold illegally online or
in stores; the dangers of exposure to mercury through dermal absorption, inhalation,
hand-to-mouth contact, and contact with individuals who have used these skin-lightening
products; the health effects of mercury poisoning, including the permanent effects on the
central nervous system and kidneys; and the dangers to mothers and infants of using these
products or being exposed to these products during pregnancy and while breastfeeding;
new text end
new text begin
(2) identifying products that contain mercury and hydroquinone by testing skin-lightening
products;
new text end
new text begin
(3) developing a train the trainer curriculum to increase community knowledge and
influence behavior changes by training community leaders, cultural brokers, community
health workers, and educators;
new text end
new text begin
(4) continuing to build the self-esteem and overall wellness of young people who are
using skin-lightening products or are at risk of starting the practice of skin lightening; and
new text end
new text begin
(5) building the capacity of community-based organizations to continue to combat
skin-lightening practices and chemical exposure.
new text end
Sec. 44.
new text begin
[145.9282] COMMUNITY HEALTH WORKERS; REDUCING HEALTH
DISPARITIES WITH COMMUNITY-LED CARE.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The commissioner of health shall support collaboration
and coordination between state and community partners to develop, refine, and expand the
community health workers profession across the state equipping them to address health
needs and to improve health outcomes by addressing the social conditions that impact health
status. Community health professionals' work expands beyond health care to bring health
and racial equity into public safety, social services, youth and family services, schools,
neighborhood associations, and more.
new text end
new text begin Subd. 2. new text end
new text begin Grants authorized; eligibility. new text end
new text begin
The commissioner of health shall establish a
community-based grant to expand and strengthen the community health workers workforce
across the state. The grantee must be a not-for-profit community organization serving,
convening, and supporting community health workers (CHW) statewide.
new text end
new text begin Subd. 3. new text end
new text begin Evaluation. new text end
new text begin
The commissioner of health shall design, conduct, and evaluate
the CHW initiative using measures of workforce capacity, employment opportunity, reach
of services, and return on investment, as well as descriptive measures of the extant CHW
models as they compare with the national community health workers' landscape. These
more proximal measures are collected and analyzed as foundational to longer-term change
in social determinants of health and rates of death and injury by suicide, overdose, firearms,
alcohol, and chronic disease.
new text end
new text begin Subd. 4. new text end
new text begin Report. new text end
new text begin
Grantees must report grant program outcomes to the commissioner on
the forms and according to the timelines established by the commissioner.
new text end
Sec. 45.
new text begin
[145.9283] REDUCING HEALTH DISPARITIES AMONG PEOPLE WITH
DISABILITIES; GRANTS.
new text end
new text begin Subdivision 1. new text end
new text begin Goal and establishment. new text end
new text begin
The commissioner of health shall support
collaboration and coordination between state and community partners to address equity
barriers to health care and preventative services for chronic diseases among people with
disabilities. The commissioner of health, in consultation with the Olmstead Implementation
Office, Department of Human Services, Board on Aging, health care professionals, local
public health, and other community organizations that serve people with disabilities, shall
routinely identify priorities and action steps to address identified gaps in services, resources,
and tools.
new text end
new text begin Subd. 2. new text end
new text begin Assessment and tracking. new text end
new text begin
The commissioner of health shall conduct community
needs assessments and establish a health surveillance and tracking plan in collaboration
with community and organizational partners to identify and address health disparities.
new text end
new text begin Subd. 3. new text end
new text begin Grants authorized. new text end
new text begin
The commissioner of health shall establish
community-based grants to support establishing inclusive evidence-based chronic disease
prevention and management services to address identified gaps and disparities.
new text end
new text begin Subd. 4. new text end
new text begin Technical assistance. new text end
new text begin
The commissioner of health shall provide and evaluate
training and capacity-building technical assistance on accessible preventive health care for
public health and health care providers of chronic disease prevention and management
programs and services.
new text end
new text begin Subd. 5. new text end
new text begin Report. new text end
new text begin
Grantees must report grant program outcomes to the commissioner on
the forms and according to the timelines established by the commissioner.
new text end
Sec. 46.
new text begin
[145.9292] PUBLIC HEALTH AMERICORPS.
new text end
new text begin
The commissioner may award a grant to a statewide, nonprofit organization to support
Public Health AmeriCorps members. The organization awarded the grant shall provide the
commissioner with any information needed by the commissioner to evaluate the program
in the form and at the timelines specified by the commissioner.
new text end
Sec. 47.
new text begin
[145.987] HEALTHY BEGINNINGS, HEALTHY FAMILIES ACT.
new text end
new text begin Subdivision 1. new text end
new text begin Purpose. new text end
new text begin
The purpose of the Healthy Beginnings, Healthy Families Act
is to: (1) address the significant disparities in early childhood outcomes and increase the
number of children who are school ready through establishing the Minnesota collaborative
to prevent infant mortality; (2) sustain the Help Me Connect online navigator; (3) improve
universal access to developmental and social-emotional screening and follow-up; and (4)
sustain and expand the model jail practices for children of incarcerated parents in Minnesota
jails.
new text end
new text begin Subd. 2. new text end
new text begin Minnesota collaborative to prevent infant mortality. new text end
new text begin
(a) The Minnesota
collaborative to prevent infant mortality is established. The goal of the Minnesota
collaborative to prevent infant mortality program is to:
new text end
new text begin
(1) build a statewide multisectoral partnership including the state government, local
public health organizations, Tribes, the private sector, and community nonprofit organizations
with the shared goal of decreasing infant mortality rates among populations with significant
disparities, including among Black, American Indian, other nonwhite communities, and
rural populations;
new text end
new text begin
(2) address the leading causes of poor infant health outcomes such as premature birth,
infant sleep-related deaths, and congenital anomalies through strategies to change social
and environmental determinants of health; and
new text end
new text begin
(3) promote the development, availability, and use of data-informed, community-driven
strategies to improve infant health outcomes.
new text end
new text begin
(b) The commissioner of health shall establish a statewide partnership program to engage
communities, exchange best practices, share summary data on infant health, and promote
policies to improve birth outcomes and eliminate preventable infant mortality.
new text end
new text begin Subd. 3. new text end
new text begin Grants authorized. new text end
new text begin
(a) The commissioner of health shall award grants to
eligible applicants to convene, coordinate, and implement data-driven strategies and culturally
relevant activities to improve infant health by reducing preterm births, sleep-related infant
deaths, and congenital malformations and by addressing social and environmental
determinants of health. Grants shall be awarded to support community nonprofit
organizations, Tribal governments, and community health boards. Grants shall be awarded
to all federally recognized Tribal governments whose proposals demonstrate the ability to
implement programs designed to achieve the purposes in subdivision 2 and other requirements
of this section. An eligible applicant must submit an application to the commissioner of
health on a form designated by the commissioner and by the deadline established by the
commissioner. The commissioner shall award grants to eligible applicants in metropolitan
and rural areas of the state and may consider geographic representation in grant awards.
new text end
new text begin
(b) Grantee activities shall:
new text end
new text begin
(1) address the leading cause or causes of infant mortality;
new text end
new text begin
(2) be based on community input;
new text end
new text begin
(3) be focused on policy, systems, and environmental changes that support infant health;
and
new text end
new text begin
(4) address the health disparities and inequities that are experienced in the grantee's
community.
new text end
new text begin
(c) The commissioner shall review each application to determine whether the application
is complete and whether the applicant and the project are eligible for a grant. In evaluating
applications under this subdivision, the commissioner shall establish criteria including but
not limited to: (1) the eligibility of the project; (2) the applicant's thoroughness and clarity
in describing the infant health issues grant funds are intended to address; (3) a description
of the applicant's proposed project; (4) a description of the population demographics and
service area of the proposed project; and (5) evidence of efficiencies and effectiveness
gained through collaborative efforts.
new text end
new text begin
(d) Grant recipients shall report their activities to the commissioner in a format and at
a time specified by the commissioner.
new text end
new text begin Subd. 4. new text end
new text begin Technical assistance. new text end
new text begin
(a) The commissioner shall provide content expertise,
technical expertise, training to grant recipients, and advice on data-driven strategies.
new text end
new text begin
(b) For the purposes of carrying out the grant program under this section, including for
administrative purposes, the commissioner shall award contracts to appropriate entities to
assist in training and to provide technical assistance to grantees.
new text end
new text begin
(c) Contracts awarded under paragraph (b) may be used to provide technical assistance
and training in the areas of:
new text end
new text begin
(1) partnership development and capacity building;
new text end
new text begin
(2) Tribal support;
new text end
new text begin
(3) implementation support for specific infant health strategies;
new text end
new text begin
(4) communications, convening, and sharing lessons learned; and
new text end
new text begin
(5) health equity.
new text end
new text begin Subd. 5. new text end
new text begin Help Me Connect. new text end
new text begin
The Help Me Connect online navigator is established. The
goal of Help Me Connect is to connect pregnant and parenting families with young children
from birth to eight years of age with services in their local communities that support healthy
child development and family well-being. The commissioner of health shall work
collaboratively with the commissioners of human services and education to implement this
subdivision.
new text end
new text begin Subd. 6. new text end
new text begin Duties of Help Me Connect. new text end
new text begin
(a) Help Me Connect shall facilitate collaboration
across sectors covering child health, early learning and education, child welfare, and family
supports by:
new text end
new text begin
(1) providing early childhood provider outreach to support early detection, intervention,
and knowledge about local resources; and
new text end
new text begin
(2) linking children and families to appropriate community-based services.
new text end
new text begin
(b) Help Me Connect shall provide community outreach that includes support for and
participation in the help me connect system, including disseminating information and
compiling and maintaining a current resource directory that includes but is not limited to
primary and specialty medical care providers, early childhood education and child care
programs, developmental disabilities assessment and intervention programs, mental health
services, family and social support programs, child advocacy and legal services, public
health and human services and resources, and other appropriate early childhood information.
new text end
new text begin
(c) Help Me Connect shall maintain a centralized access point for parents and
professionals to obtain information, resources, and other support services.
new text end
new text begin
(d) Help Me Connect shall provide a centralized mechanism that facilitates
provider-to-provider referrals to community resources and monitors referrals to ensure that
families are connected to services.
new text end
new text begin
(e) Help Me Connect shall collect program evaluation data to increase the understanding
of all aspects of the current and ongoing system under this section, including identification
of gaps in service, barriers to finding and receiving appropriate service, and lack of resources.
new text end
new text begin Subd. 7. new text end
new text begin
Universal and voluntary developmental and social-emotional screening
and follow-up.
new text end
new text begin
(a) The commissioner shall establish a universal and voluntary developmental
and social-emotional screening to identify young children at risk for developmental and
behavioral concerns. Follow-up services shall be provided to connect families and young
children to appropriate community-based resources and programs. The commissioner of
health shall work with the commissioners of human services and education to implement
this subdivision and promote interagency coordination with other early childhood programs
including those that provide screening and assessment.
new text end
new text begin
(b) The commissioner shall:
new text end
new text begin
(1) increase the awareness of universal and voluntary developmental and social-emotional
screening and follow-up in coordination with community and state partners;
new text end
new text begin
(2) expand existing electronic screening systems to administer developmental and
social-emotional screening of children from birth to kindergarten entrance;
new text end
new text begin
(3) provide universal and voluntary periodic screening for developmental and
social-emotional delays based on current recommended best practices;
new text end
new text begin
(4) review and share the results of the screening with the child's parent or guardian;
new text end
new text begin
(5) support families in their role as caregivers by providing typical growth and
development information, anticipatory guidance, and linkages to early childhood resources
and programs;
new text end
new text begin
(6) ensure that children and families are linked to appropriate community-based services
and resources when any developmental or social-emotional concerns are identified through
screening; and
new text end
new text begin
(7) establish performance measures and collect, analyze, and share program data regarding
population-level outcomes of developmental and social-emotional screening, and make
referrals to community-based services and follow-up activities.
new text end
new text begin Subd. 8. new text end
new text begin Grants authorized. new text end
new text begin
The commissioner shall award grants to community health
boards and Tribal nations to support follow-up services for children with developmental or
social-emotional concerns identified through screening in order to link children and their
families to appropriate community-based services and resources. The commissioner shall
provide technical assistance, content expertise, and training to grant recipients to ensure
that follow-up services are effectively provided.
new text end
new text begin Subd. 9. new text end
new text begin Model jails practices for incarcerated parents. new text end
new text begin
(a) The commissioner of
health may make special grants to counties, groups of counties, or nonprofit organizations
to implement model jails practices to benefit the children of incarcerated parents.
new text end
new text begin
(b) "Model jail practices" means a set of practices that correctional administrators can
implement to remove barriers that may prevent a child from cultivating or maintaining
relationships with the child's incarcerated parent or parents during and immediately after
incarceration without compromising the safety or security of the correctional facility.
new text end
new text begin Subd. 10. new text end
new text begin Grants authorized. new text end
new text begin
(a) The commissioner of health shall award grants to
eligible county jails to implement model jail practices and separate grants to county
governments, Tribal governments, or nonprofit organizations in corresponding geographic
areas to build partnerships with county jails to support children of incarcerated parents and
their caregivers.
new text end
new text begin
(b) Grantee activities may include but are not limited to:
new text end
new text begin
(1) parenting classes or groups;
new text end
new text begin
(2) family-centered intake and assessment of inmate programs;
new text end
new text begin
(3) family notification, information, and communication strategies;
new text end
new text begin
(4) correctional staff training;
new text end
new text begin
(5) policies and practices for family visits; and
new text end
new text begin
(6) family-focused reentry planning.
new text end
new text begin
(c) Grant recipients shall report their activities to the commissioner in a format and at a
time specified by the commissioner.
new text end
new text begin Subd. 11. new text end
new text begin Technical assistance and oversight. new text end
new text begin
(a) The commissioner shall provide
content expertise, training to grant recipients, and advice on evidence-based strategies,
including evidence-based training to support incarcerated parents.
new text end
new text begin
(b) For the purposes of carrying out the grant program under this section, including for
administrative purposes, the commissioner shall award contracts to appropriate entities to
assist in training and provide technical assistance to grantees.
new text end
new text begin
(c) Contracts awarded under paragraph (b) may be used to provide technical assistance
and training in the areas of:
new text end
new text begin
(1) evidence-based training for incarcerated parents;
new text end
new text begin
(2) partnership building and community engagement;
new text end
new text begin
(3) evaluation of process and outcomes of model jail practices; and
new text end
new text begin
(4) expert guidance on reducing the harm caused to children of incarcerated parents and
application of model jail practices.
new text end
Sec. 48.
new text begin
[145.988] MINNESOTA SCHOOL HEALTH INITIATIVE.
new text end
new text begin Subdivision 1. new text end
new text begin Purpose. new text end
new text begin
(a) The purpose of the Minnesota School Health Initiative is
to implement evidence-based practices to strengthen and expand health promotion and
health care delivery activities in schools to improve the holistic health of students. To better
serve students, the Minnesota School Health Initiative shall unify the best practices of the
school-based health center and Whole School, Whole Community, Whole Child models.
new text end
new text begin
(b) The commissioner of health and the commissioner of education shall coordinate the
projects and initiatives funded under this section with other efforts at the local, state, or
national level to avoid duplication and promote complementary efforts.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have the
meanings given.
new text end
new text begin
(b) "School-based health center" or "comprehensive school-based health center" means
a safety net health care delivery model that is located in or near a school facility and that
offers comprehensive health care, including preventive and behavioral health services, by
licensed and qualified health professionals in accordance with federal, state, and local law.
When not located on school property, the school-based health center must have an established
relationship with one or more schools in the community and operate primarily to serve those
student groups.
new text end
new text begin
(c) "Sponsoring organization" means any of the following that operate a school-based
health center:
new text end
new text begin
(1) health care providers;
new text end
new text begin
(2) community clinics;
new text end
new text begin
(3) hospitals;
new text end
new text begin
(4) federally qualified health centers and look-alikes as defined in section 145.9269;
new text end
new text begin
(5) health care foundations or nonprofit organizations;
new text end
new text begin
(6) higher education institutions; or
new text end
new text begin
(7) local health departments.
new text end
new text begin Subd. 3. new text end
new text begin Expansion of Minnesota school-based health centers. new text end
new text begin
(a) The commissioner
of health shall administer a program to provide grants to school districts, school-based health
centers, and sponsoring organizations to support existing centers and facilitate the growth
of school-based health centers in Minnesota.
new text end
new text begin
(b) Grant funds distributed under this subdivision shall be used to support new or existing
school-based health centers that:
new text end
new text begin
(1) operate in partnership with a school or district and with the permission of the school
or district board;
new text end
new text begin
(2) provide health services through a sponsoring organization that is specified in
subdivision 2; and
new text end
new text begin
(3) provide health services to all students and youth within a school or district regardless
of ability to pay, insurance coverage, or immigration status, and in accordance with federal,
state, and local law.
new text end
new text begin
(c) Grant recipients shall report their activities and annual performance measures as
defined by the commissioner in a format and time specified by the commissioner.
new text end
new text begin Subd. 4. new text end
new text begin School-based health center services. new text end
new text begin
Services provided by a school-based
health center may include but are not limited to:
new text end
new text begin
(1) preventative health care;
new text end
new text begin
(2) chronic medical condition management, including diabetes and asthma care;
new text end
new text begin
(3) mental health care and crisis management;
new text end
new text begin
(4) acute care for illness and injury;
new text end
new text begin
(5) oral health care;
new text end
new text begin
(6) vision care;
new text end
new text begin
(7) nutritional counseling;
new text end
new text begin
(8) substance abuse counseling;
new text end
new text begin
(9) referral to a specialist, medical home, or hospital for care;
new text end
new text begin
(10) additional services that address social determinants of health; and
new text end
new text begin
(11) emerging services such as mobile health and telehealth.
new text end
new text begin Subd. 5. new text end
new text begin Sponsoring organization. new text end
new text begin
A sponsoring organization that agrees to operate a
school-based health center must enter into a memorandum of agreement with the school or
district. The memorandum of agreement must require the sponsoring organization to be
financially responsible for the operation of school-based health centers in the school or
district and must identify the costs that are the responsibility of the school or district, such
as Internet access, custodial services, utilities, and facility maintenance. To the greatest
extent possible, a sponsoring organization must bill private insurers, medical assistance,
and other public programs for services provided in the school-based health center in order
to maintain the financial sustainability of the school-based health center.
new text end
new text begin Subd. 6. new text end
new text begin Oral health in school settings. new text end
new text begin
(a) The commissioner of health shall administer
a program to provide competitive grants to schools, oral health providers, and other
community groups to build capacity and infrastructure to establish, expand, link, or strengthen
oral health services in school settings.
new text end
new text begin
(b) Grant funds distributed under this subdivision must be used to support new or existing
oral health services in schools that:
new text end
new text begin
(1) provide oral health risk assessment, screening, education, and anticipatory guidance;
new text end
new text begin
(2) provide oral health services, including fluoride varnish and dental sealants;
new text end
new text begin
(3) make referrals for restorative and other follow-up dental care as needed; and
new text end
new text begin
(4) provide free access to fluoridated drinking water to give students a healthy alternative
to sugar-sweetened beverages.
new text end
new text begin
(c) Grant recipients must collect, monitor, and submit to the commissioner of health
baseline and annual data and provide information to improve the quality and impact of oral
health strategies.
new text end
new text begin Subd. 7. new text end
new text begin Whole School, Whole Community, Whole Child Grants. new text end
new text begin
(a) The
commissioner of health shall administer a program to provide competitive grants to local
public health organizations, schools, and community organizations using the evidence-based
Whole School, Whole Community, Whole Child (WSCC) model to increase alignment,
integration, and collaboration between public health and education sectors to improve each
child's cognitive, physical, oral, social, and emotional development.
new text end
new text begin
(b) Grant funds distributed under this subdivision must be used to support new or existing
programs that implement elements of the WSCC model in schools that:
new text end
new text begin
(1) align health and learning strategies to improve health outcomes and academic
achievement;
new text end
new text begin
(2) improve the physical, nutritional, psychological, social, and emotional environments
of schools;
new text end
new text begin
(3) create collaborative approaches to engage schools, parents and guardians, and
communities; and
new text end
new text begin
(4) promote and establish lifelong healthy behaviors.
new text end
new text begin
(c) Grant recipients shall report grant activities and progress to the commissioner in a
time and format specified by the commissioner.
new text end
new text begin Subd. 8. new text end
new text begin Technical assistance and oversight. new text end
new text begin
(a) The commissioner shall provide
content expertise, technical expertise, and training to grant recipients under subdivisions 6
and 7.
new text end
new text begin
(b) For the purposes of carrying out the grant program under this section, including for
administrative purposes, the commissioner shall award contracts to appropriate entities to
assist in training and provide technical assistance to grantees.
new text end
new text begin
(c) Contracts awarded under paragraph (b) may be used to provide technical assistance
and training in the areas of:
new text end
new text begin
(1) needs assessment;
new text end
new text begin
(2) community engagement and capacity building;
new text end
new text begin
(3) community asset building and risk behavior reduction;
new text end
new text begin
(4) dental provider training in calibration;
new text end
new text begin
(5) dental services related equipment, instruments, supplies;
new text end
new text begin
(6) communications;
new text end
new text begin
(7) community, school, health care, work site, and other site-specific strategies;
new text end
new text begin
(8) health equity;
new text end
new text begin
(9) data collection and analysis; and
new text end
new text begin
(10) evaluation.
new text end
Sec. 49.
Minnesota Statutes 2020, section 145A.131, subdivision 1, is amended to read:
Subdivision 1.
Funding formula for community health boards.
(a) Base funding for
each community health board eligible for a local public health grant under section 145A.03,
subdivision 7, shall be determined by each community health board's fiscal year 2003
allocations, prior to unallotment, for the following grant programs: community health
services subsidy; state and federal maternal and child health special projects grants; family
home visiting grants; TANF MN ENABL grants; TANF youth risk behavior grants; and
available women, infants, and children grant funds in fiscal year 2003, prior to unallotment,
distributed based on the proportion of WIC participants served in fiscal year 2003 within
the CHS service area.
(b) Base funding for a community health board eligible for a local public health grant
under section 145A.03, subdivision 7, as determined in paragraph (a), shall be adjusted by
the percentage difference between the base, as calculated in paragraph (a), and the funding
available for the local public health grant.
(c) Multicounty or multicity community health boards shall receive a local partnership
base of up to $5,000 per year for each county or city in the case of a multicity community
health board included in the community health board.
(d) The State Community Health new text begin Services new text end Advisory Committee may recommend a
formula to the commissioner to use in distributing funds to community health boards.
(e) Notwithstanding any adjustment in paragraph (b), community health boards, all or
a portion of which are located outside of the counties of Anoka, Chisago, Carver, Dakota,
Hennepin, Isanti, Ramsey, Scott, Sherburne, Washington, and Wright, are eligible to receive
an increase equal to ten percent of the grant award to the community health board under
paragraph (a) starting July 1, 2015. The increase in calendar year 2015 shall be prorated for
the last six months of the year. For calendar years beginning on or after January 1, 2016,
the amount distributed under this paragraph shall be adjusted each year based on available
funding and the number of eligible community health boards.
new text begin
(f) Funding for foundational public health responsibilities shall be distributed based on
a formula determined by the commissioner in consultation with the State Community Health
Services Advisory Committee. Community health boards must use these funds as specified
in subdivision 5.
new text end
Sec. 50.
Minnesota Statutes 2020, section 145A.131, subdivision 5, is amended to read:
Subd. 5.
Use of funds.
new text begin (a) new text end Community health boards may use new text begin the base funding of new text end their
local public health grant funds new text begin distributed according to subdivision 1, paragraphs (a) to (e),
new text end to address the areas of public health responsibility and local priorities developed through
the community health assessment and community health improvement planning process.
new text begin
(b) A community health board must use funding for foundational public health
responsibilities that is distributed according to subdivision 1, paragraph (f), to fulfill
foundational public health responsibilities as defined by the commissioner in consultation
with the State Community Health Services Advisory Committee.
new text end
new text begin
(c) Notwithstanding paragraph (b), if a community health board can demonstrate that
foundational public health responsibilities are fulfilled, the community health board may
use funding for foundational public health responsibilities for local priorities developed
through the community health assessment and community health improvement planning
process.
new text end
new text begin
(d) Notwithstanding paragraphs (a) to (c), by July 1, 2026, community health boards
must use all local public health funds first to fulfill foundational public health responsibilities.
Once a community health board can demonstrate foundational public health responsibilities
are fulfilled, funds may be used for local priorities developed through the community health
assessment and community health improvement planning process.
new text end
Sec. 51.
Minnesota Statutes 2020, section 145A.14, is amended by adding a subdivision
to read:
new text begin Subd. 2b. new text end
new text begin Tribal governments; foundational public health responsibilities. new text end
new text begin
The
commissioner shall distribute grants to Tribal governments for foundational public health
responsibilities as defined by each Tribal government.
new text end
Sec. 52.
Minnesota Statutes 2020, section 149A.01, subdivision 2, is amended to read:
Subd. 2.
Scope.
In Minnesota no person shall, without being licensed new text begin or registered new text end by
the commissioner of health:
(1) take charge of or remove from the place of death a dead human body;
(2) prepare a dead human body for final disposition, in any manner; or
(3) arrange, direct, or supervise a funeral, memorial service, or graveside service.
Sec. 53.
Minnesota Statutes 2020, section 149A.01, subdivision 3, is amended to read:
Subd. 3.
Exceptions to licensure.
(a) Except as otherwise provided in this chapter,
nothing in this chapter shall in any way interfere with the duties of:
(1) an anatomical bequest program located within an accredited school of medicine or
an accredited college of mortuary science;
(2) a person engaged in the performance of duties prescribed by law relating to the
conditions under which unclaimed dead human bodies are held subject to anatomical study;
(3) authorized personnel from a licensed ambulance service in the performance of their
duties;
(4) licensed medical personnel in the performance of their duties; or
(5) the coroner or medical examiner in the performance of the duties of their offices.
(b) This chapter does not apply to or interfere with the recognized customs or rites of
any culture or recognized religion in the ceremonial washing, dressing, casketing, and public
transportation of their dead, to the extent that all other provisions of this chapter are complied
with.
(c) Noncompensated persons with the right to control the dead human body, under section
149A.80, subdivision 2, may remove a body from the place of death; transport the body;
prepare the body for disposition, except embalming; or arrange for final disposition of the
body, provided that all actions are in compliance with this chapter.
(d) Persons serving internships pursuant to section 149A.20, subdivision 6, deleted text begin ordeleted text end students
officially registered for a practicum or clinical through a program of mortuary science
accredited by the American Board of Funeral Service Educationnew text begin , or transfer care specialists
registered pursuant to section 149A.47new text end are not required to be licensed, provided that the
persons or students are registered with the commissioner and act under the direct and
exclusive supervision of a person holding a current license to practice mortuary science in
Minnesota.
(e) Notwithstanding this subdivision, nothing in this section shall be construed to prohibit
an institution or entity from establishing, implementing, or enforcing a policy that permits
only persons licensed by the commissioner to remove or cause to be removed a dead body
or body part from the institution or entity.
(f) An unlicensed person may arrange for and direct or supervise a memorial service if
that person or that person's employer does not have charge of the dead human body. An
unlicensed person may not take charge of the dead human body, unless that person has the
right to control the dead human body under section 149A.80, subdivision 2, or is that person's
noncompensated designee.
Sec. 54.
Minnesota Statutes 2020, section 149A.02, is amended by adding a subdivision
to read:
new text begin Subd. 12c. new text end
new text begin Dead human body or body. new text end
new text begin
"Dead human body" or "body" includes an
identifiable human body part that is detached from a human body.
new text end
Sec. 55.
Minnesota Statutes 2020, section 149A.02, subdivision 13a, is amended to read:
Subd. 13a.
Direct supervision.
"Direct supervision" means overseeing the performance
of an individual. For the purpose of a clinical, practicum, deleted text begin ordeleted text end internship, new text begin or registration, new text end direct
supervision means that the supervisor is available to observe and correct, as needed, the
performance of the traineenew text begin or registrantnew text end . The mortician supervisor is accountable for the
actions of the clinical student, practicum student, deleted text begin ordeleted text end internnew text begin , or registrantnew text end throughout the
course of the training. The supervising mortician is accountable for any violations of law
or rule, in the performance of their duties, by the clinical student, practicum student, deleted text begin ordeleted text end
internnew text begin , or registrantnew text end .
Sec. 56.
Minnesota Statutes 2020, section 149A.02, is amended by adding a subdivision
to read:
new text begin Subd. 37d. new text end
new text begin Registrant. new text end
new text begin
"Registrant" means any person who is registered as a transfer
care specialist under section 149A.47.
new text end
Sec. 57.
Minnesota Statutes 2020, section 149A.02, is amended by adding a subdivision
to read:
new text begin Subd. 37e. new text end
new text begin Transfer care specialist. new text end
new text begin
"Transfer care specialist" means an individual who
is registered with the commissioner in accordance with section 149A.47 and is authorized
to perform the removal of a dead human body from the place of death under the direct
supervision of a licensed mortician.
new text end
Sec. 58.
Minnesota Statutes 2020, section 149A.03, is amended to read:
149A.03 DUTIES OF COMMISSIONER.
The commissioner shall:
(1) enforce all laws and adopt and enforce rules relating to the:
(i) removal, preparation, transportation, arrangements for disposition, and final disposition
of dead human bodies;
(ii) licensurenew text begin , registration,new text end and professional conduct of funeral directors, morticians,
interns, new text begin transfer care specialists, new text end practicum students, and clinical students;
(iii) licensing and operation of a funeral establishment;
(iv) licensing and operation of an alkaline hydrolysis facility; and
(v) licensing and operation of a crematory;
(2) provide copies of the requirements for licensurenew text begin , registration,new text end and permits to all
applicants;
(3) administer examinations and issue licensesnew text begin , registrations,new text end and permits to qualified
persons and other legal entities;
(4) maintain a record of the name and location of all current licenseesnew text begin , registrants,new text end and
interns;
(5) perform periodic compliance reviews and premise inspections of licensees;
(6) accept and investigate complaints relating to conduct governed by this chapter;
(7) maintain a record of all current preneed arrangement trust accounts;
(8) maintain a schedule of application, examination, permit, new text begin registration, new text end and licensure
fees, initial and renewal, sufficient to cover all necessary operating expenses;
(9) educate the public about the existence and content of the laws and rules for mortuary
science licensing and the removal, preparation, transportation, arrangements for disposition,
and final disposition of dead human bodies to enable consumers to file complaints against
licensees and others who may have violated those laws or rules;
(10) evaluate the laws, rules, and procedures regulating the practice of mortuary science
in order to refine the standards for licensing and to improve the regulatory and enforcement
methods used; and
(11) initiate proceedings to address and remedy deficiencies and inconsistencies in the
laws, rules, or procedures governing the practice of mortuary science and the removal,
preparation, transportation, arrangements for disposition, and final disposition of dead
human bodies.
Sec. 59.
Minnesota Statutes 2020, section 149A.09, is amended to read:
149A.09 DENIAL; REFUSAL TO REISSUE; REVOCATION; SUSPENSION;
LIMITATION OF LICENSEnew text begin , REGISTRATION,new text end OR PERMIT.
Subdivision 1.
Denial; refusal to renew; revocation; and suspension.
The regulatory
agency may deny, refuse to renew, revoke, or suspend any licensenew text begin , registration,new text end or permit
applied for or issued pursuant to this chapter when the person subject to regulation under
this chapter:
(1) does not meet or fails to maintain the minimum qualification for holding a licensenew text begin ,
registration,new text end or permit under this chapter;
(2) submits false or misleading material information to the regulatory agency in
connection with a licensenew text begin , registration,new text end or permit issued by the regulatory agency or the
application for a licensenew text begin , registration,new text end or permit;
(3) violates any law, rule, order, stipulation agreement, settlement, compliance agreement,
license, new text begin registration, new text end or permit that regulates the removal, preparation, transportation,
arrangements for disposition, or final disposition of dead human bodies in Minnesota or
any other state in the United States;
(4) is convicted of a crime, including a finding or verdict of guilt, an admission of guilt,
or a no contest plea in any court in Minnesota or any other jurisdiction in the United States.
"Conviction," as used in this subdivision, includes a conviction for an offense which, if
committed in this state, would be deemed a felony or gross misdemeanor without regard to
its designation elsewhere, or a criminal proceeding where a finding or verdict of guilty is
made or returned, but the adjudication of guilt is either withheld or not entered;
(5) is convicted of a crime, including a finding or verdict of guilt, an admission of guilt,
or a no contest plea in any court in Minnesota or any other jurisdiction in the United States
that the regulatory agency determines is reasonably related to the removal, preparation,
transportation, arrangements for disposition or final disposition of dead human bodies, or
the practice of mortuary science;
(6) is adjudicated as mentally incompetent, mentally ill, developmentally disabled, or
mentally ill and dangerous to the public;
(7) has a conservator or guardian appointed;
(8) fails to comply with an order issued by the regulatory agency or fails to pay an
administrative penalty imposed by the regulatory agency;
(9) owes uncontested delinquent taxes in the amount of $500 or more to the Minnesota
Department of Revenue, or any other governmental agency authorized to collect taxes
anywhere in the United States;
(10) is in arrears on any court ordered family or child support obligations; or
(11) engages in any conduct that, in the determination of the regulatory agency, is
unprofessional as prescribed in section 149A.70, subdivision 7, or renders the person unfit
to practice mortuary science or to operate a funeral establishment or crematory.
Subd. 2.
Hearings related to refusal to renew, suspension, or revocation of licensenew text begin ,
registration,new text end or permit.
If the regulatory agency proposes to deny renewal, suspend, or
revoke a licensenew text begin , registration,new text end or permit issued under this chapter, the regulatory agency
must first notify, in writing, the person against whom the action is proposed to be taken and
provide an opportunity to request a hearing under the contested case provisions of sections
14.57 to 14.62. If the subject of the proposed action does not request a hearing by notifying
the regulatory agency, by mail, within 20 calendar days after the receipt of the notice of
proposed action, the regulatory agency may proceed with the action without a hearing and
the action will be the final order of the regulatory agency.
Subd. 3.
Review of final order.
A judicial review of the final order issued by the
regulatory agency may be requested in the manner prescribed in sections 14.63 to 14.69.
Failure to request a hearing pursuant to subdivision 2 shall constitute a waiver of the right
to further agency or judicial review of the final order.
Subd. 4.
Limitations or qualifications placed on licensenew text begin , registration,new text end or permit.
The
regulatory agency may, where the facts support such action, place reasonable limitations
or qualifications on the right to practice mortuary science deleted text begin ordeleted text end new text begin ,new text end to operate a funeral
establishment or crematorynew text begin , or to conduct activities or actions permitted under this chapternew text end .
Subd. 5.
Restoring licensenew text begin , registration,new text end or permit.
The regulatory agency may, where
there is sufficient reason, restore a licensenew text begin , registration,new text end or permit that has been revoked,
reduce a period of suspension, or remove limitations or qualifications.
Sec. 60.
Minnesota Statutes 2020, section 149A.11, is amended to read:
149A.11 PUBLICATION OF DISCIPLINARY ACTIONS.
The regulatory agencies shall report all disciplinary measures or actions taken to the
commissioner. At least annually, the commissioner shall publish and make available to the
public a description of all disciplinary measures or actions taken by the regulatory agencies.
The publication shall include, for each disciplinary measure or action taken, the name and
business address of the licenseenew text begin , registrant,new text end or interndeleted text begin ,deleted text end new text begin ;new text end the nature of the misconductdeleted text begin ,deleted text end new text begin ;new text end and
the measure or action taken by the regulatory agency.
Sec. 61.
new text begin
[149A.47] TRANSFER CARE SPECIALIST.
new text end
new text begin Subdivision 1. new text end
new text begin General. new text end
new text begin
A transfer care specialist may remove a dead human body from
the place of death under the direct supervision of a licensed mortician if the transfer care
specialist is registered with the commissioner in accordance with this section. A transfer
care specialist is not licensed to engage in the practice of mortuary science and shall not
engage in the practice of mortuary science except as provided in this section.
new text end
new text begin Subd. 2. new text end
new text begin Registration. new text end
new text begin
To be eligible for registration as a transfer care specialist, an
applicant must submit to the commissioner:
new text end
new text begin
(1) a complete application on a form provided by the commissioner that includes at a
minimum:
new text end
new text begin
(i) the applicant's name, home address and telephone number, business name, and business
address and telephone number; and
new text end
new text begin
(ii) the name, license number, business name, and business address and telephone number
of the supervising licensed mortician;
new text end
new text begin
(2) proof of completion of a training program that meets the requirements specified in
subdivision 4; and
new text end
new text begin
(3) the appropriate fees specified in section 149A.65.
new text end
new text begin Subd. 3. new text end
new text begin Duties. new text end
new text begin
A transfer care specialist registered under this section is authorized to
perform the removal of a dead human body from the place of death in accordance with this
chapter to a licensed funeral establishment. The transfer care specialist must work under
the direct supervision of a licensed mortician. The supervising mortician is responsible for
the work performed by the transfer care specialist. A licensed mortician may supervise up
to six transfer care specialists at any one time.
new text end
new text begin Subd. 4. new text end
new text begin Training program. new text end
new text begin
(a) Each transfer care specialist must complete a training
program that has been approved by the commissioner. To be approved, a training program
must be at least seven hours long and must cover, at a minimum, the following:
new text end
new text begin
(1) ethical care and transportation procedures for a deceased person;
new text end
new text begin
(2) health and safety concerns to the public and the individual performing the transfer
of the deceased person; and
new text end
new text begin
(3) all relevant state and federal laws and regulations related to the transfer and
transportation of deceased persons.
new text end
new text begin
(b) A transfer care specialist must complete a training program every five years.
new text end
new text begin Subd. 5. new text end
new text begin Registration renewal. new text end
new text begin
(a) A registration issued under this section expires one
year after the date of issuance and must be renewed to remain valid.
new text end
new text begin
(b) To renew a registration, the transfer care specialist must submit a completed renewal
application as provided by the commissioner and the appropriate fees specified in section
149A.65. Every five years, the renewal application must include proof of completion of a
training program that meets the requirements in subdivision 4.
new text end
Sec. 62.
Minnesota Statutes 2020, section 149A.60, is amended to read:
149A.60 PROHIBITED CONDUCT.
The regulatory agency may impose disciplinary measures or take disciplinary action
against a person whose conduct is subject to regulation under this chapter for failure to
comply with any provision of this chapter or laws, rules, orders, stipulation agreements,
settlements, compliance agreements, licenses, new text begin registrations, new text end and permits adopted, or issued
for the regulation of the removal, preparation, transportation, arrangements for disposition
or final disposition of dead human bodies, or for the regulation of the practice of mortuary
science.
Sec. 63.
Minnesota Statutes 2020, section 149A.61, subdivision 4, is amended to read:
Subd. 4.
Licenseesnew text begin , registrants, new text end and interns.
A licenseenew text begin , registrant,new text end or intern regulated
under this chapter may report to the commissioner any conduct that the licenseenew text begin , registrant,new text end
or intern has personal knowledge of, and reasonably believes constitutes grounds for,
disciplinary action under this chapter.
Sec. 64.
Minnesota Statutes 2020, section 149A.61, subdivision 5, is amended to read:
Subd. 5.
Courts.
The court administrator of district court or any court of competent
jurisdiction shall report to the commissioner any judgment or other determination of the
court that adjudges or includes a finding that a licenseenew text begin , registrant,new text end or intern is a person who
is mentally ill, mentally incompetent, guilty of a felony or gross misdemeanor, guilty of
violations of federal or state narcotics laws or controlled substances acts; appoints a guardian
or conservator for the licenseenew text begin , registrant,new text end or intern; or commits a licenseenew text begin , registrant,new text end or
intern.
Sec. 65.
Minnesota Statutes 2020, section 149A.62, is amended to read:
149A.62 IMMUNITY; REPORTING.
Any person, private agency, organization, society, association, licensee, new text begin registrant, new text end or
intern who, in good faith, submits information to a regulatory agency under section 149A.61
or otherwise reports violations or alleged violations of this chapter, is immune from civil
liability or criminal prosecution. This section does not prohibit disciplinary action taken by
the commissioner against any licenseenew text begin , registrant,new text end or intern pursuant to a self report of a
violation.
Sec. 66.
Minnesota Statutes 2020, section 149A.63, is amended to read:
149A.63 PROFESSIONAL COOPERATION.
A licensee, clinical student, practicum student, new text begin registrant, new text end intern, or applicant for licensure
under this chapter that is the subject of or part of an inspection or investigation by the
commissioner or the commissioner's designee shall cooperate fully with the inspection or
investigation. Failure to cooperate constitutes grounds for disciplinary action under this
chapter.
Sec. 67.
Minnesota Statutes 2020, section 149A.65, subdivision 2, is amended to read:
Subd. 2.
Mortuary science fees.
Fees for mortuary science are:
(1) $75 for the initial and renewal registration of a mortuary science intern;
(2) $125 for the mortuary science examination;
(3) $200 for issuance of initial and renewal mortuary science licenses;
(4) $100 late fee charge for a license renewal; deleted text begin and
deleted text end
(5) $250 for issuing a mortuary science license by endorsementnew text begin ; and
new text end
new text begin (6) $687 for the initial and renewal registration of a transfer care specialistnew text end .
Sec. 68.
Minnesota Statutes 2020, section 149A.70, subdivision 3, is amended to read:
Subd. 3.
Advertising.
No licensee, new text begin registrant, new text end clinical student, practicum student, or
intern shall publish or disseminate false, misleading, or deceptive advertising. False,
misleading, or deceptive advertising includes, but is not limited to:
(1) identifying, by using the names or pictures of, persons who are not licensed to practice
mortuary science in a way that leads the public to believe that those persons will provide
mortuary science services;
(2) using any name other than the names under which the funeral establishment, alkaline
hydrolysis facility, or crematory is known to or licensed by the commissioner;
(3) using a surname not directly, actively, or presently associated with a licensed funeral
establishment, alkaline hydrolysis facility, or crematory, unless the surname had been
previously and continuously used by the licensed funeral establishment, alkaline hydrolysis
facility, or crematory; and
(4) using a founding or establishing date or total years of service not directly or
continuously related to a name under which the funeral establishment, alkaline hydrolysis
facility, or crematory is currently or was previously licensed.
Any advertising or other printed material that contains the names or pictures of persons
affiliated with a funeral establishment, alkaline hydrolysis facility, or crematory shall state
the position held by the persons and shall identify each person who is licensed or unlicensed
under this chapter.
Sec. 69.
Minnesota Statutes 2020, section 149A.70, subdivision 4, is amended to read:
Subd. 4.
Solicitation of business.
No licensee shall directly or indirectly pay or cause
to be paid any sum of money or other valuable consideration for the securing of business
or for obtaining the authority to dispose of any dead human body.
For purposes of this subdivision, licensee includes a registered intern new text begin or transfer care
specialist new text end or any agent, representative, employee, or person acting on behalf of the licensee.
Sec. 70.
Minnesota Statutes 2020, section 149A.70, subdivision 5, is amended to read:
Subd. 5.
Reimbursement prohibited.
No licensee, clinical student, practicum student,
deleted text begin ordeleted text end internnew text begin , or transfer care specialistnew text end shall offer, solicit, or accept a commission, fee, bonus,
rebate, or other reimbursement in consideration for recommending or causing a dead human
body to be disposed of by a specific body donation program, funeral establishment, alkaline
hydrolysis facility, crematory, mausoleum, or cemetery.
Sec. 71.
Minnesota Statutes 2020, section 149A.70, subdivision 7, is amended to read:
Subd. 7.
Unprofessional conduct.
No licenseenew text begin , registrant,new text end or intern shall engage in or
permit others under the licensee'snew text begin , registrant's,new text end or intern's supervision or employment to
engage in unprofessional conduct. Unprofessional conduct includes, but is not limited to:
(1) harassing, abusing, or intimidating a customer, employee, or any other person
encountered while within the scope of practice, employment, or business;
(2) using profane, indecent, or obscene language within the immediate hearing of the
family or relatives of the deceased;
(3) failure to treat with dignity and respect the body of the deceased, any member of the
family or relatives of the deceased, any employee, or any other person encountered while
within the scope of practice, employment, or business;
(4) the habitual overindulgence in the use of or dependence on intoxicating liquors,
prescription drugs, over-the-counter drugs, illegal drugs, or any other mood altering
substances that substantially impair a person's work-related judgment or performance;
(5) revealing personally identifiable facts, data, or information about a decedent, customer,
member of the decedent's family, or employee acquired in the practice or business without
the prior consent of the individual, except as authorized by law;
(6) intentionally misleading or deceiving any customer in the sale of any goods or services
provided by the licensee;
(7) knowingly making a false statement in the procuring, preparation, or filing of any
required permit or document; or
(8) knowingly making a false statement on a record of death.
Sec. 72.
Minnesota Statutes 2020, section 149A.90, subdivision 2, is amended to read:
Subd. 2.
Removal from place of death.
No person subject to regulation under this
chapter shall remove or cause to be removed any dead human body from the place of death
without being licensed new text begin or registered new text end by the commissioner. Every dead human body shall be
removed from the place of death by a licensed mortician or funeral director, except as
provided in section 149A.01, subdivision 3new text begin , or 149A.47new text end .
Sec. 73.
Minnesota Statutes 2020, section 149A.90, subdivision 4, is amended to read:
Subd. 4.
Certificate of removal.
No dead human body shall be removed from the place
of death by a mortician deleted text begin ordeleted text end new text begin ,new text end funeral directornew text begin , or transfer care specialistnew text end or by a noncompensated
person with the right to control the dead human body without the completion of a certificate
of removal and, where possible, presentation of a copy of that certificate to the person or a
representative of the legal entity with physical or legal custody of the body at the death site.
The certificate of removal shall be in the format provided by the commissioner that contains,
at least, the following information:
(1) the name of the deceased, if known;
(2) the date and time of removal;
(3) a brief listing of the type and condition of any personal property removed with the
body;
(4) the location to which the body is being taken;
(5) the name, business address, and license number of the individual making the removal;
and
(6) the signatures of the individual making the removal and, where possible, the individual
or representative of the legal entity with physical or legal custody of the body at the death
site.
Sec. 74.
Minnesota Statutes 2020, section 149A.90, subdivision 5, is amended to read:
Subd. 5.
Retention of certificate of removal.
A copy of the certificate of removal shall
be given, where possible, to the person or representative of the legal entity having physical
or legal custody of the body at the death site. The original certificate of removal shall be
retained by the individual making the removal and shall be kept on file, at the funeral
establishment to which the body was taken, for a period of three calendar years following
the date of the removal. new text begin If the removal was performed by a transfer care specialist not
employed by the funeral establishment to which the body was taken, the transfer care
specialist shall retain a copy of the certificate on file at the transfer care specialist's business
address as registered with the commissioner for a period of three calendar years following
the date of removal. new text end Following this period, and subject to any other laws requiring retention
of records, the funeral establishment may then place the records in storage or reduce them
to microfilm, microfiche, laser disc, or any other method that can produce an accurate
reproduction of the original record, for retention for a period of ten calendar years from the
date of the removal of the body. At the end of this period and subject to any other laws
requiring retention of records, the funeral establishment may destroy the records by shredding,
incineration, or any other manner that protects the privacy of the individuals identified in
the records.
Sec. 75.
Minnesota Statutes 2020, section 149A.94, subdivision 1, is amended to read:
Subdivision 1.
Generally.
new text begin (a) new text end Every dead human body lying within the state, except
unclaimed bodies delivered for dissection by the medical examiner, those delivered for
anatomical study pursuant to section 149A.81, subdivision 2, or lawfully carried through
the state for the purpose of disposition elsewhere; and the remains of any dead human body
after dissection or anatomical study, shall be decently buried or entombed in a public or
private cemetery, alkaline hydrolyzed, or cremated within a reasonable time after death.
Where final disposition of a body will not be accomplished within 72 hours following death
or release of the body by a competent authority with jurisdiction over the body, the body
must be properly embalmed, refrigerated, or packed with dry ice. A body may not be deleted text begin kept
in refrigeration for a period exceeding six calendar days, ordeleted text end packed in dry ice for a period
that exceeds four calendar days, from the time of death or release of the body from the
coroner or medical examiner.new text begin A body may be kept in refrigeration for up to 30 calendar
days from the time of death or release of the body from the coroner or medical examiner,
provided the dignity of the body is maintained and the funeral establishment complies with
paragraph (b) if applicable. A body may be kept in refrigeration for more than 30 calendar
days from the time of death or release of the body from the coroner or medical examiner in
accordance with paragraphs (c) and (d).
new text end
new text begin
(b) For a body to be kept in refrigeration for between 15 and 30 calendar days, no later
than the 14th day of keeping the body in refrigeration the funeral establishment must notify
the person with the right to control final disposition that the body will be kept in refrigeration
for more than 14 days and that the person with the right to control final disposition has the
right to seek other arrangements.
new text end
new text begin
(c) For a body to be kept in refrigeration for more than 30 calendar days, the funeral
establishment must:
new text end
new text begin
(1) report at least the following to the commissioner on a form and in a manner prescribed
by the commissioner: body identification details determined by the commissioner, the funeral
establishment's plan to achieve final disposition of the body within the permitted time frame,
and other information required by the commissioner; and
new text end
new text begin
(2) store each refrigerated body in a manner that maintains the dignity of the body.
new text end
new text begin
(d) Each report filed with the commissioner under paragraph (c) authorizes a funeral
establishment to keep a body in refrigeration for an additional 30 calendar days.
new text end
new text begin
(e) Failure to submit a report required by paragraph (c) subjects a funeral establishment
to enforcement under this chapter.
new text end
Sec. 76.
Minnesota Statutes 2020, section 152.22, is amended by adding a subdivision to
read:
new text begin Subd. 1a. new text end
new text begin Bona fide labor organization. new text end
new text begin
"Bona fide labor organization" means a labor
union that represents or is actively seeking to represent workers of a medical cannabis
manufacturer.
new text end
Sec. 77.
Minnesota Statutes 2020, section 152.22, is amended by adding a subdivision to
read:
new text begin Subd. 5d. new text end
new text begin Indian lands. new text end
new text begin
"Indian lands" means all lands within the limits of any Indian
reservation within the boundaries of Minnesota and any lands within the boundaries of
Minnesota title which are either held in trust by the United States or over which an Indian
Tribe exercises governmental power.
new text end
Sec. 78.
Minnesota Statutes 2020, section 152.22, is amended by adding a subdivision to
read:
new text begin Subd. 5e. new text end
new text begin Labor peace agreement. new text end
new text begin
"Labor peace agreement" means an agreement
between a medical cannabis manufacturer and a bona fide labor organization that protects
the state's interests by, at a minimum, prohibiting the labor organization from engaging in
picketing, work stoppages, or boycotts against the manufacturer. This type of agreement
shall not mandate a particular method of election or certification of the bona fide labor
organization.
new text end
Sec. 79.
Minnesota Statutes 2020, section 152.22, is amended by adding a subdivision to
read:
new text begin Subd. 15. new text end
new text begin Tribal medical cannabis board. new text end
new text begin
"Tribal medical cannabis board" means an
agency established by each federally recognized Tribal government and duly authorized by
each Tribe's governing body to perform regulatory oversight and monitor compliance with
a Tribal medical cannabis program and applicable regulations.
new text end
Sec. 80.
Minnesota Statutes 2020, section 152.22, is amended by adding a subdivision to
read:
new text begin Subd. 16. new text end
new text begin Tribal medical cannabis program. new text end
new text begin
"Tribal medical cannabis program" means
a program established by a federally recognized Tribal government within the boundaries
of Minnesota regarding the commercial production, processing, sale or distribution, and
possession of medical cannabis and medical cannabis products.
new text end
Sec. 81.
Minnesota Statutes 2020, section 152.22, is amended by adding a subdivision to
read:
new text begin Subd. 17. new text end
new text begin Tribal medical cannabis program patient. new text end
new text begin
"Tribal medical cannabis program
patient" means a person who possesses a valid registration verification card or equivalent
document that is issued under the laws or regulations of a Tribal Nation within the boundaries
of Minnesota and that verifies that the person is enrolled in or authorized to participate in
that Tribal Nation's Tribal medical cannabis program.
new text end
Sec. 82.
Minnesota Statutes 2020, section 152.25, subdivision 1, is amended to read:
Subdivision 1.
Medical cannabis manufacturer registrationnew text begin and renewalnew text end .
(a) The
commissioner shall register deleted text begin twodeleted text end new text begin at least four and up to tennew text end in-state manufacturers for the
production of all medical cannabis within the state. deleted text begin Adeleted text end new text begin Thenew text end registration deleted text begin agreement between
the commissioner and a manufacturerdeleted text end is new text begin valid for two years, unless revoked under subdivision
1a, and is new text end nontransferable. deleted text begin The commissioner shall register new manufacturers or reregister
the existing manufacturers by December 1 every two years, using the factors described in
this subdivision. The commissioner shall accept applications after December 1, 2014, if one
of the manufacturers registered before December 1, 2014, ceases to be registered as a
manufacturer. The commissioner's determination that no manufacturer exists to fulfill the
duties under sections 152.22 to 152.37 is subject to judicial review in Ramsey County
District Court.deleted text end new text begin Once the commissioner has registered more than two manufacturers,
registration renewal for at least one manufacturer must occur each year. The commissioner
shall begin registering additional manufacturers by December 1, 2022. The commissioner
shall renew a registration if the manufacturer meets the factors described in this subdivision
and submits the registration renewal fee under section 152.35.
new text end
new text begin (b) An individual or entity seeking registration or registration renewal under this
subdivision must apply to the commissioner in a form and manner established by the
commissioner. As part of the application, the applicant must submit an attestation signed
by a bona fide labor organization stating that the applicant has entered into a labor peace
agreement. Before accepting applications for registration or registration renewal, the
commissioner must publish on the Office of Medical Cannabis website the application
scoring criteria established by the commissioner to determine whether the applicant meets
requirements for registration or registration renewal.new text end Data submitted during the application
process are private data on individuals or nonpublic data as defined in section 13.02 until
the manufacturer is registered under this section. Data on a manufacturer that is registered
are public data, unless the data are trade secret or security information under section 13.37.
deleted text begin (b)deleted text end new text begin (c)new text end As a condition for registrationdeleted text begin , a manufacturer must agree todeleted text end new text begin or registration
renewalnew text end :
deleted text begin
(1) begin supplying medical cannabis to patients by July 1, 2015; and
deleted text end
deleted text begin (2)deleted text end new text begin (1) a manufacturer mustnew text end comply with all requirements under sections 152.22 to
152.37deleted text begin .deleted text end new text begin ;
new text end
new text begin
(2) if the manufacturer is a business entity, the manufacturer must be incorporated in
the state or otherwise formed or organized under the laws of the state; and
new text end
new text begin
(3) the manufacturer must fulfill commitments made in the application for registration
or registration renewal, including but not limited to maintenance of a labor peace agreement.
new text end
deleted text begin (c)deleted text end new text begin (d)new text end The commissioner shall consider the following factors when determining which
manufacturer to registernew text begin or when determining whether to renew a registrationnew text end :
(1) the technical expertise of the manufacturer in cultivating medical cannabis and
converting the medical cannabis into an acceptable delivery method under section 152.22,
subdivision 6;
(2) the qualifications of the manufacturer's employees;
(3) the long-term financial stability of the manufacturer;
(4) the ability to provide appropriate security measures on the premises of the
manufacturer;
(5) whether the manufacturer has demonstrated an ability to meet the medical cannabis
production needs required by sections 152.22 to 152.37; deleted text begin and
deleted text end
(6) the manufacturer's projection and ongoing assessment of fees on patients with a
qualifying medical conditiondeleted text begin .deleted text end new text begin ;
new text end
new text begin
(7) the manufacturer's inclusion of leadership or beneficial ownership, as defined in
section 302A.011, subdivision 41, by:
new text end
new text begin
(i) minority persons as defined in section 116M.14, subdivision 6;
new text end
new text begin
(ii) women;
new text end
new text begin
(iii) individuals with disabilities as defined in section 363A.03, subdivision 12; or
new text end
new text begin
(iv) military veterans who satisfy the requirements of section 197.447;
new text end
new text begin
(8) the extent to which registering the manufacturer or renewing the registration will
expand service to a currently underserved market;
new text end
new text begin
(9) the extent to which registering the manufacturer or renewing the registration will
promote development in a low-income area as defined in section 116J.982, subdivision 1,
paragraph (e);
new text end
new text begin
(10) beneficial ownership as defined in section 302A.011, subdivision 41, of the
manufacturer by Minnesota residents; and
new text end
new text begin
(11) other factors the commissioner determines are necessary to protect patient health
and ensure public safety.
new text end
new text begin
(e) Commitments made by an applicant in the applicant's application for registration or
registration renewal, including but not limited to maintenance of a labor peace agreement,
shall be an ongoing material condition of maintaining a manufacturer registration.
new text end
deleted text begin (d)deleted text end new text begin (f)new text end If an officer, director, or controlling person of the manufacturer pleads or is found
guilty of intentionally diverting medical cannabis to a person other than allowed by law
under section 152.33, subdivision 1, the commissioner may decide not to renew the
registration of the manufacturer, provided the violation occurred while the person was an
officer, director, or controlling person of the manufacturer.
deleted text begin
(e) The commissioner shall require each medical cannabis manufacturer to contract with
an independent laboratory to test medical cannabis produced by the manufacturer. The
commissioner shall approve the laboratory chosen by each manufacturer and require that
the laboratory report testing results to the manufacturer in a manner determined by the
commissioner.
deleted text end
Sec. 83.
Minnesota Statutes 2020, section 152.25, is amended by adding a subdivision to
read:
new text begin Subd. 1d. new text end
new text begin Background study. new text end
new text begin
(a) Before the commissioner registers a manufacturer or
renews a registration, each officer, director, and controlling person of the manufacturer
must consent to a background study and must submit to the commissioner a completed
criminal history records check consent form, a full set of classifiable fingerprints, and the
required fees. The commissioner must submit these materials to the Bureau of Criminal
Apprehension. The bureau must conduct a Minnesota criminal history records check, and
the superintendent is authorized to exchange fingerprints with the Federal Bureau of
Investigation to obtain national criminal history record information. The bureau must return
the results of the Minnesota and federal criminal history records checks to the commissioner.
new text end
new text begin
(b) The commissioner must not register a manufacturer or renew a registration if an
officer, director, or controlling person of the manufacturer has been convicted of, pled guilty
to, or received a stay of adjudication for:
new text end
new text begin
(1) a violation of state or federal law related to theft, fraud, embezzlement, breach of
fiduciary duty, or other financial misconduct that is a felony under Minnesota law or would
be a felony if committed in Minnesota; or
new text end
new text begin
(2) a violation of state or federal law relating to unlawful manufacture, distribution,
prescription, or dispensing of a controlled substance that is a felony under Minnesota law
or would be a felony if committed in Minnesota.
new text end
Sec. 84.
Minnesota Statutes 2020, section 152.29, subdivision 4, is amended to read:
Subd. 4.
Report.
new text begin (a) new text end Each manufacturer shall report to the commissioner on a monthly
basis the following information on each individual patient for the month prior to the report:
(1) the amount and dosages of medical cannabis distributed;
(2) the chemical composition of the medical cannabis; and
(3) the tracking number assigned to any medical cannabis distributed.
new text begin
(b) For transactions involving Tribal medical cannabis program patients, each
manufacturer shall report to the commissioner on a weekly basis the following information
on each individual Tribal medical cannabis program patient for the week prior to the report:
new text end
new text begin
(1) the name of the Tribal medical cannabis program in which the Tribal medical cannabis
program patient is enrolled;
new text end
new text begin
(2) the amount and dosages of medical cannabis distributed;
new text end
new text begin
(3) the chemical composition of the medical cannabis; and
new text end
new text begin
(4) the tracking number assigned to the medical cannabis distributed.
new text end
Sec. 85.
Minnesota Statutes 2020, section 152.29, is amended by adding a subdivision to
read:
new text begin Subd. 5. new text end
new text begin Distribution to Tribal medical cannabis program patient. new text end
new text begin
(a) A manufacturer
may distribute medical cannabis in accordance with subdivisions 1 to 4 to a Tribal medical
cannabis program patient.
new text end
new text begin
(b) Prior to distribution, the Tribal medical cannabis program patient must provide to
the manufacturer:
new text end
new text begin
(1) a valid medical cannabis registration verification card or equivalent document issued
by a Tribal medical cannabis program that indicates that the Tribal medical cannabis program
patient is authorized to use medical cannabis on Indian lands over which the Tribe has
jurisdiction; and
new text end
new text begin
(2) a valid photographic identification card issued by the Tribal medical cannabis
program, valid driver's license, or valid state identification card.
new text end
new text begin
(c) A manufacturer shall distribute medical cannabis to a Tribal medical cannabis program
patient only in a form allowed under section 152.22, subdivision 6.
new text end
Sec. 86.
new text begin
[152.291] TRIBAL MEDICAL CANNABIS PROGRAM;
MANUFACTURERS.
new text end
new text begin Subdivision 1. new text end
new text begin Manufacturer. new text end
new text begin
Notwithstanding the requirements and limitations in
section 152.29, subdivision 1, paragraph (a), a Tribal medical cannabis program operated
by a federally recognized Indian Tribe located in Minnesota shall be recognized as a medical
cannabis manufacturer.
new text end
new text begin Subd. 2. new text end
new text begin Manufacturer transportation. new text end
new text begin
(a) A manufacturer registered with a Tribal
medical cannabis program may transport medical cannabis to testing laboratories and to
other Indian lands in the state.
new text end
new text begin
(b) A manufacturer registered with a Tribal medical cannabis program must staff a motor
vehicle used to transport medical cannabis with at least two employees of the manufacturer.
Each employee in the transport vehicle must carry identification specifying that the employee
is an employee of the manufacturer, and one employee in the transport vehicle must carry
a detailed transportation manifest that includes the place and time of departure, the address
of the destination, and a description and count of the medical cannabis being transported.
new text end
Sec. 87.
Minnesota Statutes 2020, section 152.30, is amended to read:
152.30 PATIENT DUTIES.
(a) A patient shall apply to the commissioner for enrollment in the registry program by
submitting an application as required in section 152.27 and an annual registration fee as
determined under section 152.35.
(b) As a condition of continued enrollment, patients shall agree to:
(1) continue to receive regularly scheduled treatment for their qualifying medical
condition from their health care practitioner; and
(2) report changes in their qualifying medical condition to their health care practitioner.
(c) A patient shall only receive medical cannabis from a registered manufacturer new text begin or
Tribal medical cannabis program new text end but is not required to receive medical cannabis products
from only a registered manufacturernew text begin or Tribal medical cannabis programnew text end .
Sec. 88.
Minnesota Statutes 2020, section 152.32, is amended to read:
152.32 PROTECTIONS FOR REGISTRY PROGRAM PARTICIPATIONnew text begin OR
PARTICIPATION IN A TRIBAL MEDICAL CANNABIS PROGRAMnew text end .
Subdivision 1.
Presumption.
(a) There is a presumption that a patient enrolled in the
registry program under sections 152.22 to 152.37 new text begin or a Tribal medical cannabis program
patient enrolled in a Tribal medical cannabis program new text end is engaged in the authorized use of
medical cannabis.
(b) The presumption may be rebuttednew text begin :
new text end
new text begin (1)new text end by evidence that new text begin a patient's new text end conduct related to use of medical cannabis was not for
the purpose of treating or alleviating the patient's qualifying medical condition or symptoms
associated with the patient's qualifying medical conditionnew text begin ; or
new text end
new text begin (2) by evidence that a Tribal medical cannabis program patient's use of medical cannabis
was not for a purpose authorized by the Tribal medical cannabis programnew text end .
Subd. 2.
Criminal and civil protections.
(a) Subject to section 152.23, the following
are not violations under this chapter:
(1) use or possession of medical cannabis or medical cannabis products by a patient
enrolled in the registry programdeleted text begin , ordeleted text end new text begin ;new text end possession by a registered designated caregiver or the
parent, legal guardian, or spouse of a patient if the parent, legal guardian, or spouse is listed
on the registry verification;new text begin or use or possession of medical cannabis or medical cannabis
products by a Tribal medical cannabis program patient;
new text end
(2) possession, dosage determination, or sale of medical cannabis or medical cannabis
products by a medical cannabis manufacturer, employees of a manufacturer, a laboratory
conducting testing on medical cannabis, or employees of the laboratory; and
(3) possession of medical cannabis or medical cannabis products by any person while
carrying out the duties required under sections 152.22 to 152.37.
(b) Medical cannabis obtained and distributed pursuant to sections 152.22 to 152.37 and
associated property is not subject to forfeiture under sections 609.531 to 609.5316.
(c) The commissioner, new text begin members of a Tribal medical cannabis board, new text end the commissioner's
new text begin or Tribal medical cannabis board's new text end staff, the commissioner'snew text begin or Tribal medical cannabis
board'snew text end agents or contractors, and any health care practitioner are not subject to any civil or
disciplinary penalties by the Board of Medical Practice, the Board of Nursing, or by any
business, occupational, or professional licensing board or entity, solely for the participation
in the registry program under sections 152.22 to 152.37new text begin or in a Tribal medical cannabis
programnew text end . A pharmacist licensed under chapter 151 is not subject to any civil or disciplinary
penalties by the Board of Pharmacy when acting in accordance with the provisions of
sections 152.22 to 152.37. Nothing in this section affects a professional licensing board
from taking action in response to violations of any other section of law.
(d) Notwithstanding any law to the contrary, the commissioner, the governor of
Minnesota, or an employee of any state agency may not be held civilly or criminally liable
for any injury, loss of property, personal injury, or death caused by any act or omission
while acting within the scope of office or employment under sections 152.22 to 152.37.
(e) Federal, state, and local law enforcement authorities are prohibited from accessing
the patient registry under sections 152.22 to 152.37 except when acting pursuant to a valid
search warrant.
(f) Notwithstanding any law to the contrary, neither the commissioner nor a public
employee may release data or information about an individual contained in any report,
document, or registry created under sections 152.22 to 152.37 or any information obtained
about a patient participating in the program, except as provided in sections 152.22 to 152.37.
(g) No information contained in a report, document, or registry or obtained from a patient
new text begin or a Tribal medical cannabis program patient new text end under sections 152.22 to 152.37 may be
admitted as evidence in a criminal proceeding unless independently obtained or in connection
with a proceeding involving a violation of sections 152.22 to 152.37.
(h) Notwithstanding section 13.09, any person who violates paragraph (e) or (f) is guilty
of a gross misdemeanor.
(i) An attorney may not be subject to disciplinary action by the Minnesota Supreme
Courtnew text begin , a Tribal court,new text end or new text begin the new text end professional responsibility board for providing legal assistance
to prospective or registered manufacturers or others related to activity that is no longer
subject to criminal penalties under state law pursuant to sections 152.22 to 152.37new text begin , or for
providing legal assistance to a Tribal medical cannabis programnew text end .
(j) Possession of a registry verification or application for enrollment in the program by
a person entitled to possess or apply for enrollment in the registry programnew text begin , or possession
of a verification or equivalent issued by a Tribal medical cannabis program by a person
entitled to possess such verification,new text end does not constitute probable cause or reasonable
suspicion, nor shall it be used to support a search of the person or property of the person
possessing or applying for the registry verificationnew text begin or equivalentnew text end , or otherwise subject the
person or property of the person to inspection by any governmental agency.
Subd. 3.
Discrimination prohibited.
(a) No school or landlord may refuse to enroll or
lease to and may not otherwise penalize a person solely for the person's status as a patient
enrolled in the registry program under sections 152.22 to 152.37new text begin or for the person's status
as a Tribal medical cannabis program patient enrolled in a Tribal medical cannabis programnew text end ,
unless failing to do so would violate federal law or regulations or cause the school or landlord
to lose a monetary or licensing-related benefit under federal law or regulations.
(b) For the purposes of medical care, including organ transplants, a registry program
enrollee's use of medical cannabis under sections 152.22 to 152.37new text begin , or a Tribal medical
cannabis program patient's use of medical cannabis as authorized by the Tribal medical
cannabis program,new text end is considered the equivalent of the authorized use of any other medication
used at the discretion of a physician or advanced practice registered nurse and does not
constitute the use of an illicit substance or otherwise disqualify a patient from needed medical
care.
(c) Unless a failure to do so would violate federal law or regulations or cause an employer
to lose a monetary or licensing-related benefit under federal law or regulations, an employer
may not discriminate against a person in hiring, termination, or any term or condition of
employment, or otherwise penalize a person, if the discrimination is based upon deleted text begin eitherdeleted text end new text begin anynew text end
of the following:
(1) the person's status as a patient enrolled in the registry program under sections 152.22
to 152.37; deleted text begin or
deleted text end
new text begin
(2) the person's status as a Tribal medical cannabis program patient enrolled in a Tribal
medical cannabis program; or
new text end
deleted text begin (2)deleted text end new text begin (3)new text end a patient's positive drug test for cannabis components or metabolites, unless the
patient used, possessed, or was impaired by medical cannabis on the premises of the place
of employment or during the hours of employment.
(d) An employee who is required to undergo employer drug testing pursuant to section
181.953 may present verification of enrollment in the patient registry new text begin or of enrollment in a
Tribal medical cannabis program new text end as part of the employee's explanation under section 181.953,
subdivision 6.
(e) A person shall not be denied custody of a minor child or visitation rights or parenting
time with a minor child solely based on the person's status as a patient enrolled in the registry
program under sections 152.22 to 152.37new text begin or on the person's status as a Tribal medical
cannabis program patient enrolled in a Tribal medical cannabis programnew text end . There shall be no
presumption of neglect or child endangerment for conduct allowed under sections 152.22
to 152.37new text begin or under a Tribal medical cannabis programnew text end , unless the person's behavior is such
that it creates an unreasonable danger to the safety of the minor as established by clear and
convincing evidence.
Sec. 89.
Minnesota Statutes 2020, section 152.33, subdivision 1, is amended to read:
Subdivision 1.
Intentional diversion; criminal penalty.
In addition to any other
applicable penalty in law, a manufacturer or an agent of a manufacturer who intentionally
transfers medical cannabis to a person other than another registered manufacturer, a patient,
a registered designated caregivernew text begin , a Tribal medical cannabis program patient,new text end or, if listed
on the registry verification, a parent, legal guardian, or spouse of a patient is guilty of a
felony punishable by imprisonment for not more than two years or by payment of a fine of
not more than $3,000, or both. A person convicted under this subdivision may not continue
to be affiliated with the manufacturer and is disqualified from further participation under
sections 152.22 to 152.37.
Sec. 90.
Minnesota Statutes 2020, section 152.35, is amended to read:
152.35 FEES; DEPOSIT OF REVENUE.
(a) The commissioner shall collect an enrollment fee of deleted text begin $200deleted text end new text begin $40new text end from patients enrolled
under deleted text begin thisdeleted text end sectionnew text begin 152.27new text end . deleted text begin If the patient provides evidence of receiving Social Security
disability insurance (SSDI), Supplemental Security Income (SSI), veterans disability, or
railroad disability payments, or being enrolled in medical assistance or MinnesotaCare, then
the fee shall be $50. For purposes of this section:
deleted text end
deleted text begin
(1) a patient is considered to receive SSDI if the patient was receiving SSDI at the time
the patient was transitioned to retirement benefits by the United States Social Security
Administration; and
deleted text end
deleted text begin
(2) veterans disability payments include VA dependency and indemnity compensation.
deleted text end
deleted text begin Unless a patient provides evidence of receiving payments from or participating in one of
the programs specifically listed in this paragraph, the commissioner of health must collect
the $200 enrollment fee from a patient to enroll the patient in the registry program.deleted text end The fees
shall be payable annually and are due on the anniversary date of the patient's enrollment.
The fee amount shall be deposited in the state treasury and credited to the state government
special revenue fund.
(b) The commissioner shall collect deleted text begin andeleted text end new text begin a nonrefundable registrationnew text end application fee of
deleted text begin $20,000deleted text end new text begin $10,000new text end from each entity submitting an application for registration as a medical
cannabis manufacturer. Revenue from the fee shall be deposited in the state treasury and
credited to the state government special revenue fund.
(c) The commissioner shall establish and collect an annualnew text begin registration renewalnew text end fee from
a medical cannabis manufacturer equal to the cost of regulating and inspecting the
manufacturer deleted text begin in that yeardeleted text end new text begin for the upcoming registration periodnew text end . Revenue from the fee amount
shall be deposited in the state treasury and credited to the state government special revenue
fund.
(d) A medical cannabis manufacturer may charge patients enrolled in the registry program
a reasonable fee for costs associated with the operations of the manufacturer. The
manufacturer may establish a sliding scale of patient fees based upon a patient's household
income and may accept private donations to reduce patient fees.
Sec. 91.
Laws 2021, First Special Session chapter 7, article 3, section 44, is amended to
read:
Sec. 44. MENTAL HEALTH CULTURAL COMMUNITY CONTINUING
EDUCATION GRANT PROGRAM.
new text begin (a) new text end The commissioner of health shall develop a grant program, in consultation with the
relevant mental health licensing boards, tonew text begin :
new text end
new text begin (1)new text end provide for the continuing education necessary for social workers, marriage and
family therapists, psychologists, and professional clinical counselors to become supervisors
for individuals pursuing licensure in mental health professionsnew text begin ;
new text end
new text begin
(2) cover the costs when supervision is required for professionals becoming supervisors;
and
new text end
new text begin (3) cover the supervisory costs for mental health practitioners pursuing licensure at the
professional levelnew text end .
new text begin (b)new text end Social workers, marriage and family therapists, psychologists, and professional
clinical counselors obtaining continuing education new text begin and mental health practitioners needing
supervised hours to become licensed as professionals new text end under this section must:
(1) be members of communities of color or underrepresented communities as defined
in Minnesota Statutes, section 148E.010, subdivision 20new text begin , or practice in a mental health
professional shortage areanew text end ; and
(2) deleted text begin work for community mental health providers anddeleted text end agree to deliver at least 25 percent
of their yearly patient encounters to state public program enrollees or patients receiving
sliding fee schedule discounts through a formal sliding fee schedule meeting the standards
established by the United States Department of Health and Human Services under Code of
Federal Regulations, title 42, section 51, chapter 303.
Sec. 92. new text begin BENEFIT AND COST ANALYSIS OF A UNIVERSAL HEALTH REFORM
PROPOSAL.
new text end
new text begin Subdivision 1. new text end
new text begin Contract for analysis of proposal. new text end
new text begin
The commissioner of health shall
contract with the University of Minnesota School of Public Health and the Carlson School
of Management to conduct an analysis of the benefits and costs of a legislative proposal for
a universal health care financing system and a similar analysis of the current health care
financing system to assist the state in comparing the proposal to the current system.
new text end
new text begin Subd. 2. new text end
new text begin Proposal. new text end
new text begin
The commissioner of health, with input from the commissioners of
human services and commerce, shall submit to the University of Minnesota for analysis a
legislative proposal known as the Minnesota Health Plan that would offer a universal health
care plan designed to meet the following principles:
new text end
new text begin
(1) ensure all Minnesotans are covered;
new text end
new text begin
(2) cover all necessary care, including dental, vision and hearing, mental health, chemical
dependency treatment, prescription drugs, medical equipment and supplies, long-term care,
and home care; and
new text end
new text begin
(3) allow patients to choose their doctors, hospitals, and other providers.
new text end
new text begin Subd. 3. new text end
new text begin Proposal analysis. new text end
new text begin
(a) The analysis must measure the performance of both the
Minnesota Health Plan and the current health care financing system over a ten-year period
to contrast the impact on:
new text end
new text begin
(1) the number of people covered versus the number of people who continue to lack
access to health care because of financial or other barriers, if any;
new text end
new text begin
(2) the completeness of the coverage and the number of people lacking coverage for
dental, long-term care, medical equipment or supplies, vision and hearing, or other health
services that are not covered, if any;
new text end
new text begin
(3) the adequacy of the coverage, the level of underinsured in the state, and whether
people with coverage can afford the care they need or whether cost prevents them from
accessing care;
new text end
new text begin
(4) the timeliness and appropriateness of the care received and whether people turn to
inappropriate care such as emergency rooms because of a lack of proper care in accordance
with clinical guidelines; and
new text end
new text begin
(5) total public and private health care spending in Minnesota under the current system
versus under the legislative proposal, including all spending by individuals, businesses, and
government. "Total public and private health care spending" means spending on all medical
care including but not limited to dental, vision and hearing, mental health, chemical
dependency treatment, prescription drugs, medical equipment and supplies, long-term care,
and home care, whether paid through premiums, co-pays and deductibles, other out-of-pocket
payments, or other funding from government, employers, or other sources. Total public and
private health care spending also includes the costs associated with administering, delivering,
and paying for the care. The costs of administering, delivering, and paying for the care
includes all expenses by insurers, providers, employers, individuals, and government to
select, negotiate, purchase, and administer insurance and care including but not limited to
coverage for health care, dental, long-term care, prescription drugs, medical expense portions
of workers compensation and automobile insurance, and the cost of administering and
paying for all health care products and services that are not covered by insurance. The
analysis of total health care spending shall examine whether there are savings or additional
costs under the legislative proposal compared to the existing system due to:
new text end
new text begin
(i) reduced insurance, billing, underwriting, marketing, evaluation, and other
administrative functions including savings from global budgeting for hospitals and
institutional care instead of billing for individual services provided;
new text end
new text begin
(ii) reduced prices on medical services and products including pharmaceuticals due to
price negotiations, if applicable under the proposal;
new text end
new text begin
(iii) changes in utilization, better health outcomes, and reduced time away from work
due to prevention, early intervention, health-promoting activities, and to the extent possible
given available data and resources;
new text end
new text begin
(iv) shortages or excess capacity of medical facilities and equipment under either the
current system or the proposal;
new text end
new text begin
(v) the impact on state, local, and federal government non-health-care expenditures such
as reduced crime and out-of-home placement costs due to mental health or chemical
dependency coverage; and
new text end
new text begin
(vi) job losses or gains in health care delivery, health billing and insurance administration,
and elsewhere in the economy under the proposal due to implementation of the reforms and
the resulting reduction of insurance and administrative burdens on businesses.
new text end
new text begin
(b) The analysts may consult with authors of the legislative proposal to gain understanding
or clarification of the specifics of the proposal. The analysis shall assume that the provisions
in the proposal are not preempted by federal law or that the federal government gives a
waiver to the preemptions.
new text end
new text begin
(c) The commissioner shall issue a final report by January 15, 2023, and may provide
interim reports and status updates to the governor and the chairs and ranking minority
members of the legislative committees with jurisdiction over health and human services
policy and finance.
new text end
Sec. 93. new text begin NURSING WORKFORCE REPORT.
new text end
new text begin
The commissioner of health shall provide a public report on the following topics:
new text end
new text begin
(1) Minnesota's supply of active licensed registered nurses;
new text end
new text begin
(2) trends in Minnesota regarding retention by hospitals of licensed registered nurses;
new text end
new text begin
(3) reasons licensed registered nurses are leaving direct care positions at hospitals; and
new text end
new text begin
(4) reasons licensed registered nurses are choosing not to renew their licenses and leaving
the profession.
new text end
Sec. 94. new text begin EMMETT LOUIS TILL VICTIMS RECOVERY PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Short title. new text end
new text begin
This section shall be known as the Emmett Louis Till Victims
Recovery Program.
new text end
new text begin Subd. 2. new text end
new text begin Program established; grants. new text end
new text begin
(a) The commissioner of health shall establish
the Emmett Louis Till Victims Recovery Program to address the health and wellness needs
of victims who experienced trauma, including historical trauma, resulting from
government-sponsored activities, and to address the health and wellness needs of the families
and heirs of these victims.
new text end
new text begin
(b) The commissioner, in consultation with family members of victims who experienced
trauma resulting from government-sponsored activities and with community-based
organizations that provide culturally appropriate services to victims experiencing trauma
and their families, shall award competitive grants to applicants for projects to provide the
following services to victims who experienced trauma resulting from government-sponsored
activities and their families and heirs:
new text end
new text begin
(1) health and wellness services, which may include services and support to address
physical health, mental health, and cultural needs;
new text end
new text begin
(2) remembrance and legacy preservation activities;
new text end
new text begin
(3) cultural awareness services; and
new text end
new text begin
(4) community resources and services to promote healing for victims who experienced
trauma resulting from government-sponsored activities and their families and heirs.
new text end
new text begin
(c) In awarding grants under this section, the commissioner must prioritize grant awards
to community-based organizations experienced in providing support and services to victims
and families who experienced trauma resulting from government-sponsored activities.
new text end
new text begin Subd. 3. new text end
new text begin Evaluation. new text end
new text begin
Grant recipients must provide the commissioner with information
required by the commissioner to evaluate the grant program, in a time and manner specified
by the commissioner.
new text end
new text begin Subd. 4. new text end
new text begin Report. new text end
new text begin
By January 15, 2023, the commissioner must submit a status report
on the operation and results of the grant program, to the extent possible. The report must
be submitted to the chairs and ranking minority members of the legislative committees with
jurisdiction over health care. The report must include information on grant program activities
to date, services offered by grant recipients, and an assessment of the need to continue to
offer services to victims, families, and heirs who experienced trauma resulting from
government-sponsored activities.
new text end
Sec. 95. new text begin IDENTIFY STRATEGIES FOR REDUCTION OF ADMINISTRATIVE
SPENDING AND LOW-VALUE CARE; REPORT.
new text end
new text begin
(a) The commissioner of health shall develop recommendations for strategies to reduce
the volume and growth of administrative spending by health care organizations and group
purchasers and the amount of low-value care delivered to Minnesota residents. In support
of the development of recommendations, the commissioner shall:
new text end
new text begin
(1) review the availability of data and identify gaps in the data infrastructure to estimate
aggregated and disaggregated administrative spending and low-value care;
new text end
new text begin
(2) based on available data, estimate the volume and change over time of administrative
spending and low-value care in Minnesota;
new text end
new text begin
(3) conduct an environmental scan and key informant interviews with experts in health
care finance, health economics, health care management or administration, or the
administration of health insurance benefits to identify drivers of spending growth for spending
on administrative services or the provision of low-value care; and
new text end
new text begin
(4) convene a clinical learning community and an employer task force to review the
evidence from clauses (1) to (3) and develop a set of actionable strategies to address
administrative spending volume and growth and the magnitude of the volume of low-value
care.
new text end
new text begin
(b) By December 15, 2024, the commissioner shall report the recommendations to the
chairs and ranking members of the legislative committees with jurisdiction over health and
human services financing and policy.
new text end
Sec. 96. new text begin INITIAL IMPLEMENTATION OF THE KEEPING NURSES AT THE
BEDSIDE ACT.
new text end
new text begin
(a) By April 1, 2024, each hospital must establish and convene a hospital nurse staffing
committee as described under Minnesota Statutes, section 144.7053.
new text end
new text begin
(b) By June 1, 2024, each hospital must implement core staffing plans developed by its
hospital nurse staffing committee and satisfy the plan posting requirements under Minnesota
Statutes, section 144.7056.
new text end
new text begin
(c) By June 1, 2024, each hospital must submit to the commissioner of health core
staffing plans meeting the requirements of Minnesota Statutes, section 144.7055.
new text end
Sec. 97. new text begin LEAD SERVICE LINE INVENTORY GRANT PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The commissioner of health must establish a grant
program to provide financial assistance to municipalities for producing an inventory of
publicly and privately owned lead service lines within their jurisdiction.
new text end
new text begin Subd. 2. new text end
new text begin Eligible uses. new text end
new text begin
A municipality receiving a grant under this section may use the
grant funds to:
new text end
new text begin
(1) survey households to determine the material of which their water service line is
made;
new text end
new text begin
(2) create publicly available databases or visualizations of lead service lines; and
new text end
new text begin
(3) comply with the lead service line inventory requirements in the Environmental
Protection Agency's Lead and Copper Rule.
new text end
Sec. 98. new text begin PAYMENT MECHANISMS IN RURAL HEALTH CARE.
new text end
new text begin
The commissioner shall develop a plan to assess readiness of rural communities and
rural health care providers to adopt value-based, global budgeting, or alternative payment
systems and recommend steps needed to implement. The commissioner may use the
development of case studies and modeling of alternate payment systems to demonstrate
value-based payment systems that ensure a baseline level of essential community or regional
health services and address population health needs. The commissioner shall develop
recommendations for pilot projects by January 1, 2025, with the aim of ensuring financial
viability of rural health care systems in the context of spending growth targets. The
commissioner shall share findings with the Minnesota Health Care Spending Growth Target
Commission.
new text end
Sec. 99. new text begin PROGRAM TO DISTRIBUTE COVID-19 TESTS, MASKS, AND
RESPIRATORS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) The terms defined in this subdivision apply to this section.
new text end
new text begin
(b) "Antigen test" means a lateral flow immunoassay intended for the qualitative detection
of nucleocapsid protein antigens from the SARS-CoV-2 virus in nasal swabs, that has
emergency use authorization from the United States Food and Drug Administration and
that is authorized for nonprescription home use with self-collected nasal swabs.
new text end
new text begin
(c) "COVID-19 test" means a test authorized by the United States Food and Drug
Administration to detect the presence of genetic material of the SARS-CoV-2 virus either
through a molecular method that detects the RNA or nucleic acid component of the virus,
such as polymerase chain reaction or isothermal amplification, or through a rapid lateral
flow immunoassay that detects the nucleocapsid protein antigens from the SARS-CoV-2
virus.
new text end
new text begin
(d) "KN95 respirator" means a type of filtering facepiece respirator that is commonly
made and used in China, is designed and tested to meet an international standard, and does
not include an exhalation valve.
new text end
new text begin
(e) "Mask" means a face covering intended to contain droplets and particles in a person's
breath, cough, or sneeze.
new text end
new text begin
(f) "Respirator" means a face covering that filters the air and fits closely on the face to
filter out particles, including the SARS-CoV-2 virus.
new text end
new text begin Subd. 2. new text end
new text begin Program established. new text end
new text begin
In order to help reduce the number of cases of COVID-19
in the state, the commissioner of health must administer a program to distribute to individuals
in Minnesota, COVID-19 tests, including antigen tests; and masks and respirators, including
KN95 respirators and similar respirators approved by the Centers for Disease Control and
Prevention and authorized by the commissioner for distribution under this program. Masks
and respirators distributed under this program may include child-sized masks and respirators,
if such masks and respirators are available and the commissioner finds there is a need for
them. COVID-19 tests, masks, and respirators must be distributed at no cost to the individuals
receiving them and may be shipped directly to individuals; distributed through local health
departments, COVID community coordinators, and other community-based organizations;
and distributed through other means determined by the commissioner. The commissioner
may prioritize distribution under this section to communities and populations who are
disproportionately impacted by COVID-19 or who have difficulty accessing COVID-19
tests, masks, or respirators.
new text end
new text begin Subd. 3. new text end
new text begin Process to order COVID-19 tests, masks, and respirators. new text end
new text begin
The commissioner
may establish a process for individuals to order COVID-19 tests, masks, and respirators to
be shipped directly to the individual.
new text end
new text begin Subd. 4. new text end
new text begin Notice. new text end
new text begin
An entity distributing KN95 respirators or similar respirators under this
section may include with the respirators a notice that individuals with a medical condition
that may make it difficult to wear a KN95 respirator or similar respirator should consult
with a health care provider before use.
new text end
new text begin Subd. 5. new text end
new text begin Coordination. new text end
new text begin
The commissioner may coordinate this program with other state
and federal programs that distribute COVID-19 tests, masks, or respirators to the public.
new text end
Sec. 100. new text begin REPORT ON TRANSPARENCY OF HEALTH CARE PAYMENTS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) The terms defined in this subdivision apply to this section.
new text end
new text begin
(b) "Commissioner" means the commissioner of health.
new text end
new text begin
(c) "Non-claims-based payments" means payments to health care providers designed to
support and reward value of health care services over volume of health care services and
includes alternative payment models or incentives, payments for infrastructure expenditures
or investments, and payments for workforce expenditures or investments.
new text end
new text begin
(d) "Nonpublic data" has the meaning given in Minnesota Statutes, section 13.02,
subdivision 9.
new text end
new text begin
(e) "Primary care services" means integrated, accessible health care services provided
by clinicians who are accountable for addressing a large majority of personal health care
needs, developing a sustained partnership with patients, and practicing in the context of
family and community. Primary care services include but are not limited to preventive
services, office visits, administration of vaccines, annual physicals, pre-operative physicals,
assessments, care coordination, development of treatment plans, management of chronic
conditions, and diagnostic tests.
new text end
new text begin Subd. 2. new text end
new text begin Report. new text end
new text begin
(a) To provide the legislature with information needed to meet the
evolving health care needs of Minnesotans, the commissioner shall report to the legislature
by February 15, 2023, on the volume and distribution of health care spending across payment
models used by health plan companies and third-party administrators, with a particular focus
on value-based care models and primary care spending.
new text end
new text begin
(b) The report must include specific health plan and third-party administrator estimates
of health care spending for claims-based payments and non-claims-based payments for the
most recent available year, reported separately for Minnesotans enrolled in state health care
programs, Medicare Advantage, and commercial health insurance. The report must also
include recommendations on changes needed to gather better data from health plan companies
and third-party administrators on the use of value-based payments that pay for value of
health care services provided over volume of services provided, promote the health of all
Minnesotans, reduce health disparities, and support the provision of primary care services
and preventive services.
new text end
new text begin
(c) In preparing the report, the commissioner shall:
new text end
new text begin
(1) describe the form, manner, and timeline for submission of data by health plan
companies and third-party administrators to produce estimates as specified in paragraph
(b);
new text end
new text begin
(2) collect summary data that permits the computation of:
new text end
new text begin
(i) the percentage of total payments that are non-claims-based payments; and
new text end
new text begin
(ii) the percentage of payments in item (i) that are for primary care services;
new text end
new text begin
(3) where data was not directly derived, specify the methods used to estimate data
elements;
new text end
new text begin
(4) notwithstanding Minnesota Statutes, section 62U.04, subdivision 11, conduct analyses
of the magnitude of primary care payments using data collected by the commissioner under
Minnesota Statutes, section 62U.04; and
new text end
new text begin
(5) conduct interviews with health plan companies and third-party administrators to
better understand the types of non-claims-based payments and models in use, the purposes
or goals of each, the criteria for health care providers to qualify for these payments, and the
timing and structure of health plan companies or third-party administrators making these
payments to health care provider organizations.
new text end
new text begin
(d) Health plan companies and third-party administrators must comply with data requests
from the commissioner under this section within 60 days after receiving the request.
new text end
new text begin
(e) Data collected under this section are nonpublic data. Notwithstanding the definition
of summary data in Minnesota Statutes, section 13.02, subdivision 19, summary data prepared
under this section may be derived from nonpublic data. The commissioner shall establish
procedures and safeguards to protect the integrity and confidentiality of any data maintained
by the commissioner.
new text end
Sec. 101. new text begin SAFETY IMPROVEMENTS FOR STATE LICENSED LONG-TERM
CARE FACILITIES.
new text end
new text begin Subdivision 1. new text end
new text begin
Temporary grant program for long-term care safety
improvements.
new text end
new text begin
The commissioner of health shall develop, implement, and manage a
temporary, competitive grant process for state-licensed long-term care facilities to improve
their ability to reduce the transmission of COVID-19 or other similar conditions.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) For the purposes of this section, the following terms have the
meanings given.
new text end
new text begin
(b) "Eligible facility" means:
new text end
new text begin
(1) an assisted living facility licensed under chapter 144G;
new text end
new text begin
(2) a supervised living facility licensed under chapter 144;
new text end
new text begin
(3) a board and care facility that is not federally certified and is licensed under chapter
144; and
new text end
new text begin
(4) a nursing home that is not federally certified and is licensed under chapter 144A.
new text end
new text begin
(c) "Eligible project" means a modernization project to update, remodel or replace
outdated equipment, systems, technology, or physical spaces.
new text end
new text begin Subd. 3. new text end
new text begin Program. new text end
new text begin
(a) The commissioner of health shall award improvement grants to
an eligible facility. An improvement grant shall not exceed $1,250,000.
new text end
new text begin
(b) Funds may be used to improve the safety, quality of care, and livability of aging
infrastructure in a Department of Health licensed eligible facility with an emphasis on
reducing the transmission risk of COVID-19 and other infections. Projects include but are
not limited to:
new text end
new text begin
(1) heating, ventilation, and air-conditioning systems improvements to reduce airborne
exposures;
new text end
new text begin
(2) physical space changes for infection control; and
new text end
new text begin
(3) technology improvements to reduce social isolation and improve resident or client
well-being.
new text end
new text begin
(c) Notwithstanding any law to the contrary, funds awarded in a grant agreement do not
lapse until expended by the grantee.
new text end
new text begin Subd. 4. new text end
new text begin Applications. new text end
new text begin
An eligible facility seeking a grant shall apply to the
commissioner. The application must include a description of the resident population
demographics, the problem the proposed project will address, a description of the project
including construction and remodeling drawings or specifications, sources of funds for the
project, including any in-kind resources, uses of funds for the project, the results expected,
and a plan to maintain or operate any facility or equipment included in the project. The
applicant must describe achievable objectives, a timetable, and roles and capabilities of
responsible individuals and organization. An applicant must submit to the commissioner
evidence that competitive bidding was used to select contractors for the project.
new text end
new text begin Subd. 5. new text end
new text begin Consideration of applications. new text end
new text begin
The commissioner shall review each application
to determine if the application is complete and if the facility and the project are eligible for
a grant. In evaluating applications, the commissioner shall develop a standardized scoring
system that assesses: (1) the applicant's understanding of the problem, description of the
project and the likelihood of a successful outcome of the project; (2) the extent to which
the project will reduce the transmission of COVID-19; (3) the extent to which the applicant
has demonstrated that it has made adequate provisions to ensure proper and efficient operation
of the facility once the project is completed; (4) and other relevant factors as determined
by the commissioner. During application review, the commissioner may request additional
information about a proposed project, including information on project cost. Failure to
provide the information requested disqualifies an applicant.
new text end
new text begin Subd. 6. new text end
new text begin Program oversight. new text end
new text begin
The commissioner shall determine the amount of a grant
to be given to an eligible facility based on the relative score of each eligible facility's
application, other relevant factors discussed during the review, and the funds available to
the commissioner. During the grant period and within one year after completion of the grant
period, the commissioner may collect from an eligible facility receiving a grant, any
information necessary to evaluate the program.
new text end
new text begin Subd. 7. new text end
new text begin Expiration. new text end
new text begin
This section expires June 30, 2025.
new text end
Sec. 102. new text begin STUDY OF THE DEVELOPMENT OF A STATEWIDE REGISTRY FOR
PROVIDER ORDERS FOR LIFE-SUSTAINING TREATMENT.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "Commissioner" means the commissioner of health.
new text end
new text begin
(c) "Life-sustaining treatment" means any medical procedure, pharmaceutical drug,
medical device, or medical intervention that maintains life by sustaining, restoring, or
supplanting a vital function. Life-sustaining treatment does not include routine care necessary
to sustain patient cleanliness and comfort.
new text end
new text begin
(d) "POLST" means a provider order for life-sustaining treatment, signed by a physician,
advanced practice registered nurse, or physician assistant, to ensure that the medical treatment
preferences of a patient with an advanced serious illness who is nearing the end of the their
life are honored.
new text end
new text begin
(e) "POLST form" means a portable medical form used to communicate a physician's
order to help ensure that a patient's medical treatment preferences are conveyed to emergency
medical service personnel and other health care providers.
new text end
new text begin Subd. 2. new text end
new text begin Study. new text end
new text begin
(a) The commissioner, in consultation with the advisory committee
established in paragraph (c), shall study the issues related to creating a statewide registry
of POLST forms to ensure that a patient's medical treatment preferences are followed by
all health care providers. The registry must allow for the submission of completed POLST
forms and for the forms to be accessed by health care providers and emergency medical
service personnel in a timely manner, for the provision of care or services.
new text end
new text begin
(b) As a part of the study, the commissioner shall develop recommendations on the
following:
new text end
new text begin
(1) electronic capture, storage, and security of information in the registry;
new text end
new text begin
(2) procedures to protect the accuracy and confidentiality of information submitted to
the registry;
new text end
new text begin
(3) limits as to who can access the registry;
new text end
new text begin
(4) where the registry should be housed;
new text end
new text begin
(5) ongoing funding models for the registry; and
new text end
new text begin
(6) any other action needed to ensure that patients' rights are protected and that their
health care decisions are followed.
new text end
new text begin
(c) The commissioner shall create an advisory committee with members representing
physicians, physician assistants, advanced practice registered nurses, nursing homes,
emergency medical system providers, hospice and palliative care providers, the disability
community, attorneys, medical ethicists, and the religious community.
new text end
new text begin Subd. 3. new text end
new text begin Report. new text end
new text begin
The commissioner shall submit a report on the results of the study,
including recommendations on establishing a statewide registry of POLST forms, to the
chairs and ranking minority members of the legislative committees with jurisdiction over
health and human services policy and finance by February 1, 2023.
new text end
Sec. 103. new text begin REVISOR INSTRUCTION.
new text end
new text begin
(a) The revisor of statutes shall codify Laws 2021, First Special Session chapter 7, article
3, section 44, as Minnesota Statutes, section 144.1512. The revisor of statutes may make
any necessary cross-reference changes.
new text end
new text begin
(b) The revisor of statutes shall correct cross-references in Minnesota Statutes to conform
with the relettering of paragraphs in Minnesota Statutes, section 144.1501, subdivision 1.
new text end
new text begin
(c) In Minnesota Statutes, section 144.7055, the revisor shall renumber paragraphs (b)
to (e) alphabetically as individual subdivisions under Minnesota Statutes, section 144.7051.
The revisor shall make any necessary changes to sentence structure for this renumbering
while preserving the meaning of the text. The revisor shall also make necessary
cross-reference changes in Minnesota Statutes and Minnesota Rules consistent with the
renumbering.
new text end
new text begin
(d) The revisor of statutes shall renumber Minnesota Statutes, sections 145A.145 and
145A.17, as new sections following Minnesota Statutes, section 145.871. The revisor shall
also make necessary cross-reference changes consistent with the renumbering.
new text end
ARTICLE 2
DEPARTMENT OF HEALTH POLICY
Section 1.
Minnesota Statutes 2021 Supplement, section 144.0724, subdivision 4, is
amended to read:
Subd. 4.
Resident assessment schedule.
(a) A facility must conduct and electronically
submit to the federal database MDS assessments that conform with the assessment schedule
defined by the Long Term Care Facility Resident Assessment Instrument User's Manual,
version 3.0, or its successor issued by the Centers for Medicare and Medicaid Services. The
commissioner of health may substitute successor manuals or question and answer documents
published by the United States Department of Health and Human Services, Centers for
Medicare and Medicaid Services, to replace or supplement the current version of the manual
or document.
(b) The assessments required under the Omnibus Budget Reconciliation Act of 1987
(OBRA) used to determine a case mix classification for reimbursement include deleted text begin the followingdeleted text end :
(1) a new admission comprehensive assessment, which must have an assessment reference
date (ARD) within 14 calendar days after admission, excluding readmissions;
(2) an annual comprehensive assessment, which must have an ARD within 92 days of
a previous quarterly review assessment or a previous comprehensive assessment, which
must occur at least once every 366 days;
(3) a significant change in status comprehensive assessment, which must have an ARD
within 14 days after the facility determines, or should have determined, that there has been
a significant change in the resident's physical or mental condition, whether an improvement
or a decline, and regardless of the amount of time since the last comprehensive assessment
or quarterly review assessment;
(4) a quarterly review assessment must have an ARD within 92 days of the ARD of the
previous quarterly review assessment or a previous comprehensive assessment;
(5) any significant correction to a prior comprehensive assessment, if the assessment
being corrected is the current one being used for RUG classification;
(6) any significant correction to a prior quarterly review assessment, if the assessment
being corrected is the current one being used for RUG classification;
(7) a required significant change in status assessment when:
(i) all speech, occupational, and physical therapies have ended. new text begin If the most recent OBRA
comprehensive or quarterly assessment completed does not result in a rehabilitation case
mix classification, then the significant change in status assessment is not required. new text end The ARD
of this assessment must be set on day eight after all therapy services have ended; and
(ii) isolation for an infectious disease has ended. new text begin If isolation was not coded on the most
recent OBRA comprehensive or quarterly assessment completed, then the significant change
in status assessment is not required. new text end The ARD of this assessment must be set on day 15 after
isolation has ended; and
(8) any modifications to the most recent assessments under clauses (1) to (7).
(c) In addition to the assessments listed in paragraph (b), the assessments used to
determine nursing facility level of care include the following:
(1) preadmission screening completed under section 256.975, subdivisions 7a to 7c, by
the Senior LinkAge Line or other organization under contract with the Minnesota Board on
Aging; and
(2) a nursing facility level of care determination as provided for under section 256B.0911,
subdivision 4e, as part of a face-to-face long-term care consultation assessment completed
under section 256B.0911, by a county, tribe, or managed care organization under contract
with the Department of Human Services.
Sec. 2.
Minnesota Statutes 2020, section 144.1201, subdivision 2, is amended to read:
Subd. 2.
deleted text begin By-product nucleardeleted text end new text begin Byproductnew text end material.
"deleted text begin By-product nucleardeleted text end new text begin Byproductnew text end
material" means deleted text begin a radioactive material, other than special nuclear material, yielded in or
made radioactive by exposure to radiation created incident to the process of producing or
utilizing special nuclear material.deleted text end new text begin :
new text end
new text begin
(1) any radioactive material, except special nuclear material, yielded in or made
radioactive by exposure to the radiation incident to the process of producing or using special
nuclear material;
new text end
new text begin
(2) the tailings or wastes produced by the extraction or concentration of uranium or
thorium from ore processed primarily for its source material content, including discrete
surface wastes resulting from uranium solution extraction processes. Underground ore
bodies depleted by these solution extraction operations do not constitute byproduct material
within this definition;
new text end
new text begin
(3) any discrete source of radium-226 that is produced, extracted, or converted after
extraction for commercial, medical, or research activity, or any material that:
new text end
new text begin
(i) has been made radioactive by use of a particle accelerator; and
new text end
new text begin
(ii) is produced, extracted, or converted after extraction for commercial, medical, or
research activity; and
new text end
new text begin
(4) any discrete source of naturally occurring radioactive material, other than source
nuclear material, that:
new text end
new text begin
(i) the United States Nuclear Regulatory Commission, in consultation with the
Administrator of the Environmental Protection Agency, the Secretary of Energy, the Secretary
of Homeland Security, and the head of any other appropriate federal agency determines
would pose a threat similar to the threat posed by a discrete source of radium-226 to the
public health and safety or the common defense and security; and
new text end
new text begin
(ii) is extracted or converted after extraction for use in a commercial, medical, or research
activity.
new text end
Sec. 3.
Minnesota Statutes 2020, section 144.1201, subdivision 4, is amended to read:
Subd. 4.
Radioactive material.
"Radioactive material" means a matter that emits
radiation. Radioactive material includes special nuclear material, source nuclear material,
and deleted text begin by-product nucleardeleted text end new text begin byproductnew text end material.
Sec. 4.
Minnesota Statutes 2021 Supplement, section 144.1481, subdivision 1, is amended
to read:
Subdivision 1.
Establishment; membership.
The commissioner of health shall establish
a deleted text begin 16-memberdeleted text end new text begin 21-membernew text end Rural Health Advisory Committee. The committee shall consist
of the following members, all of whom must reside outside the seven-county metropolitan
area, as defined in section 473.121, subdivision 2:
(1) two members from the house of representatives of the state of Minnesota, one from
the majority party and one from the minority party;
(2) two members from the senate of the state of Minnesota, one from the majority party
and one from the minority party;
(3) a volunteer member of an ambulance service based outside the seven-county
metropolitan area;
(4) a representative of a hospital located outside the seven-county metropolitan area;
(5) a representative of a nursing home located outside the seven-county metropolitan
area;
(6) a medical doctor or doctor of osteopathic medicine licensed under chapter 147;
(7) a dentist licensed under chapter 150A;
(8) deleted text begin a midlevel practitionerdeleted text end new text begin an advanced practice providernew text end ;
(9) a registered nurse or licensed practical nurse;
(10) a licensed health care professional from an occupation not otherwise represented
on the committee;
(11) a representative of an institution of higher education located outside the seven-county
metropolitan area that provides training for rural health care providers; deleted text begin and
deleted text end
new text begin
(12) a member of a Tribal nation;
new text end
new text begin
(13) a representative of a local public health agency or community health board;
new text end
new text begin
(14) a health professional or advocate with experience working with people with mental
illness;
new text end
new text begin
(15) a representative of a community organization that works with individuals
experiencing health disparities;
new text end
new text begin
(16) an individual with expertise in economic development, or an employer working
outside the seven-county metropolitan area; and
new text end
deleted text begin (12)deleted text end new text begin (17)new text end three consumers, at least one of whom must be deleted text begin an advocate for persons who
are mentally ill or developmentally disableddeleted text end new text begin from a community experiencing health
disparitiesnew text end .
The commissioner will make recommendations for committee membership. Committee
members will be appointed by the governor. In making appointments, the governor shall
ensure that appointments provide geographic balance among those areas of the state outside
the seven-county metropolitan area. The chair of the committee shall be elected by the
members. The advisory committee is governed by section 15.059, except that the members
do not receive per diem compensation.
Sec. 5.
Minnesota Statutes 2020, section 144.292, subdivision 6, is amended to read:
Subd. 6.
Cost.
(a) When a patient requests a copy of the patient's record for purposes of
reviewing current medical care, the provider must not charge a fee.
(b) When a provider or its representative makes copies of patient records upon a patient's
request under this section, the provider or its representative may charge the patient or the
patient's representative no more than 75 cents per page, plus $10 for time spent retrieving
and copying the records, unless other law or a rule or contract provide for a lower maximum
charge. This limitation does not apply to x-rays. The provider may charge a patient no more
than the actual cost of reproducing x-rays, plus no more than $10 for the time spent retrieving
and copying the x-rays.
(c) The respective maximum charges of 75 cents per page and $10 for time provided in
this subdivision are in effect for calendar year 1992 and may be adjusted annually each
calendar year as provided in this subdivision. The permissible maximum charges shall
change each year by an amount that reflects the change, as compared to the previous year,
in the Consumer Price Index for all Urban Consumers, Minneapolis-St. Paul (CPI-U),
published by the Department of Labor.
(d) A provider or its representative may charge the $10 retrieval fee, but must not charge
a per page fee to provide copies of records requested by a patient or the patient's authorized
representative if the request for copies of records is for purposes of appealing a denial of
Social Security disability income or Social Security disability benefits under title II or title
XVI of the Social Security Act; except that no fee shall be charged to a deleted text begin persondeleted text end new text begin patientnew text end who
is receiving public assistance, new text begin or to a patient new text end who is represented by an attorney on behalf
of a civil legal services program or a volunteer attorney program based on indigency. For
the purpose of further appeals, a patient may receive no more than two medical record
updates without charge, but only for medical record information previously not provided.
For purposes of this paragraph, a patient's authorized representative does not include units
of state government engaged in the adjudication of Social Security disability claims.
Sec. 6.
Minnesota Statutes 2020, section 144.497, is amended to read:
144.497 ST ELEVATION MYOCARDIAL INFARCTION.
The commissioner of health shall assess deleted text begin and report ondeleted text end the quality of care provided in
the state for ST elevation myocardial infarction response and treatment. The commissioner
shall:
(1) utilize and analyze data provided by ST elevation myocardial infarction receiving
centers to the ACTION Registry-Get with the guidelines or an equivalent data platform that
does not identify individuals or associate specific ST elevation myocardial infarction heart
attack events with an identifiable individual;new text begin and
new text end
deleted text begin
(2) quarterly post a summary report of the data in aggregate form on the Department of
Health website;
deleted text end
deleted text begin
(3) annually inform the legislative committees with jurisdiction over public health of
progress toward improving the quality of care and patient outcomes for ST elevation
myocardial infarctions; and
deleted text end
deleted text begin (4)deleted text end new text begin (2)new text end coordinate to the extent possible with national voluntary health organizations
involved in ST elevation myocardial infarction heart attack quality improvement to encourage
ST elevation myocardial infarction receiving centers to report data consistent with nationally
recognized guidelines on the treatment of individuals with confirmed ST elevation myocardial
infarction heart attacks within the state and encourage sharing of information among health
care providers on ways to improve the quality of care of ST elevation myocardial infarction
patients in Minnesota.
Sec. 7.
Minnesota Statutes 2021 Supplement, section 144.551, subdivision 1, is amended
to read:
Subdivision 1.
Restricted construction or modification.
(a) The following construction
or modification may not be commenced:
(1) any erection, building, alteration, reconstruction, modernization, improvement,
extension, lease, or other acquisition by or on behalf of a hospital that increases the bed
capacity of a hospital, relocates hospital beds from one physical facility, complex, or site
to another, or otherwise results in an increase or redistribution of hospital beds within the
state; and
(2) the establishment of a new hospital.
(b) This section does not apply to:
(1) construction or relocation within a county by a hospital, clinic, or other health care
facility that is a national referral center engaged in substantial programs of patient care,
medical research, and medical education meeting state and national needs that receives more
than 40 percent of its patients from outside the state of Minnesota;
(2) a project for construction or modification for which a health care facility held an
approved certificate of need on May 1, 1984, regardless of the date of expiration of the
certificate;
(3) a project for which a certificate of need was denied before July 1, 1990, if a timely
appeal results in an order reversing the denial;
(4) a project exempted from certificate of need requirements by Laws 1981, chapter 200,
section 2;
(5) a project involving consolidation of pediatric specialty hospital services within the
Minneapolis-St. Paul metropolitan area that would not result in a net increase in the number
of pediatric specialty hospital beds among the hospitals being consolidated;
(6) a project involving the temporary relocation of pediatric-orthopedic hospital beds to
an existing licensed hospital that will allow for the reconstruction of a new philanthropic,
pediatric-orthopedic hospital on an existing site and that will not result in a net increase in
the number of hospital beds. Upon completion of the reconstruction, the licenses of both
hospitals must be reinstated at the capacity that existed on each site before the relocation;
(7) the relocation or redistribution of hospital beds within a hospital building or
identifiable complex of buildings provided the relocation or redistribution does not result
in: (i) an increase in the overall bed capacity at that site; (ii) relocation of hospital beds from
one physical site or complex to another; or (iii) redistribution of hospital beds within the
state or a region of the state;
(8) relocation or redistribution of hospital beds within a hospital corporate system that
involves the transfer of beds from a closed facility site or complex to an existing site or
complex provided that: (i) no more than 50 percent of the capacity of the closed facility is
transferred; (ii) the capacity of the site or complex to which the beds are transferred does
not increase by more than 50 percent; (iii) the beds are not transferred outside of a federal
health systems agency boundary in place on July 1, 1983; (iv) the relocation or redistribution
does not involve the construction of a new hospital building; and (v) the transferred beds
are used first to replace within the hospital corporate system the total number of beds
previously used in the closed facility site or complex for mental health services and substance
use disorder services. Only after the hospital corporate system has fulfilled the requirements
of this item may the remainder of the available capacity of the closed facility site or complex
be transferred for any other purpose;
(9) a construction project involving up to 35 new beds in a psychiatric hospital in Rice
County that primarily serves adolescents and that receives more than 70 percent of its
patients from outside the state of Minnesota;
(10) a project to replace a hospital or hospitals with a combined licensed capacity of
130 beds or less if: (i) the new hospital site is located within five miles of the current site;
and (ii) the total licensed capacity of the replacement hospital, either at the time of
construction of the initial building or as the result of future expansion, will not exceed 70
licensed hospital beds, or the combined licensed capacity of the hospitals, whichever is less;
(11) the relocation of licensed hospital beds from an existing state facility operated by
the commissioner of human services to a new or existing facility, building, or complex
operated by the commissioner of human services; from one regional treatment center site
to another; or from one building or site to a new or existing building or site on the same
campus;
(12) the construction or relocation of hospital beds operated by a hospital having a
statutory obligation to provide hospital and medical services for the indigent that does not
result in a net increase in the number of hospital beds, notwithstanding section 144.552, 27
beds, of which 12 serve mental health needs, may be transferred from Hennepin County
Medical Center to Regions Hospital under this clause;
(13) a construction project involving the addition of up to 31 new beds in an existing
nonfederal hospital in Beltrami County;
(14) a construction project involving the addition of up to eight new beds in an existing
nonfederal hospital in Otter Tail County with 100 licensed acute care beds;
(15) a construction project involving the addition of 20 new hospital beds in an existing
hospital in Carver County serving the southwest suburban metropolitan area;
(16) a project for the construction or relocation of up to 20 hospital beds for the operation
of up to two psychiatric facilities or units for children provided that the operation of the
facilities or units have received the approval of the commissioner of human services;
(17) a project involving the addition of 14 new hospital beds to be used for rehabilitation
services in an existing hospital in Itasca County;
(18) a project to add 20 licensed beds in existing space at a hospital in Hennepin County
that closed 20 rehabilitation beds in 2002, provided that the beds are used only for
rehabilitation in the hospital's current rehabilitation building. If the beds are used for another
purpose or moved to another location, the hospital's licensed capacity is reduced by 20 beds;
(19) a critical access hospital established under section 144.1483, clause (9), and section
1820 of the federal Social Security Act, United States Code, title 42, section 1395i-4, that
delicensed beds since enactment of the Balanced Budget Act of 1997, Public Law 105-33,
to the extent that the critical access hospital does not seek to exceed the maximum number
of beds permitted such hospital under federal law;
(20) notwithstanding section 144.552, a project for the construction of a new hospital
in the city of Maple Grove with a licensed capacity of up to 300 beds provided that:
(i) the project, including each hospital or health system that will own or control the entity
that will hold the new hospital license, is approved by a resolution of the Maple Grove City
Council as of March 1, 2006;
(ii) the entity that will hold the new hospital license will be owned or controlled by one
or more not-for-profit hospitals or health systems that have previously submitted a plan or
plans for a project in Maple Grove as required under section 144.552, and the plan or plans
have been found to be in the public interest by the commissioner of health as of April 1,
2005;
(iii) the new hospital's initial inpatient services must include, but are not limited to,
medical and surgical services, obstetrical and gynecological services, intensive care services,
orthopedic services, pediatric services, noninvasive cardiac diagnostics, behavioral health
services, and emergency room services;
(iv) the new hospital:
(A) will have the ability to provide and staff sufficient new beds to meet the growing
needs of the Maple Grove service area and the surrounding communities currently being
served by the hospital or health system that will own or control the entity that will hold the
new hospital license;
(B) will provide uncompensated care;
(C) will provide mental health services, including inpatient beds;
(D) will be a site for workforce development for a broad spectrum of health-care-related
occupations and have a commitment to providing clinical training programs for physicians
and other health care providers;
(E) will demonstrate a commitment to quality care and patient safety;
(F) will have an electronic medical records system, including physician order entry;
(G) will provide a broad range of senior services;
(H) will provide emergency medical services that will coordinate care with regional
providers of trauma services and licensed emergency ambulance services in order to enhance
the continuity of care for emergency medical patients; and
(I) will be completed by December 31, 2009, unless delayed by circumstances beyond
the control of the entity holding the new hospital license; and
(v) as of 30 days following submission of a written plan, the commissioner of health
has not determined that the hospitals or health systems that will own or control the entity
that will hold the new hospital license are unable to meet the criteria of this clause;
(21) a project approved under section 144.553;
(22) a project for the construction of a hospital with up to 25 beds in Cass County within
a 20-mile radius of the state Ah-Gwah-Ching facility, provided the hospital's license holder
is approved by the Cass County Board;
(23) a project for an acute care hospital in Fergus Falls that will increase the bed capacity
from 108 to 110 beds by increasing the rehabilitation bed capacity from 14 to 16 and closing
a separately licensed 13-bed skilled nursing facility;
(24) notwithstanding section 144.552, a project for the construction and expansion of a
specialty psychiatric hospital in Hennepin County for up to 50 beds, exclusively for patients
who are under 21 years of age on the date of admission. The commissioner conducted a
public interest review of the mental health needs of Minnesota and the Twin Cities
metropolitan area in 2008. No further public interest review shall be conducted for the
construction or expansion project under this clause;
(25) a project for a 16-bed psychiatric hospital in the city of Thief River Falls, if the
commissioner finds the project is in the public interest after the public interest review
conducted under section 144.552 is complete;
(26)(i) a project for a 20-bed psychiatric hospital, within an existing facility in the city
of Maple Grove, exclusively for patients who are under 21 years of age on the date of
admission, if the commissioner finds the project is in the public interest after the public
interest review conducted under section 144.552 is complete;
(ii) this project shall serve patients in the continuing care benefit program under section
256.9693. The project may also serve patients not in the continuing care benefit program;
and
(iii) if the project ceases to participate in the continuing care benefit program, the
commissioner must complete a subsequent public interest review under section 144.552. If
the project is found not to be in the public interest, the license must be terminated six months
from the date of that finding. If the commissioner of human services terminates the contract
without cause or reduces per diem payment rates for patients under the continuing care
benefit program below the rates in effect for services provided on December 31, 2015, the
project may cease to participate in the continuing care benefit program and continue to
operate without a subsequent public interest review;
(27) a project involving the addition of 21 new beds in an existing psychiatric hospital
in Hennepin County that is exclusively for patients who are under 21 years of age on the
date of admission;
(28) a project to add 55 licensed beds in an existing safety net, level I trauma center
hospital in Ramsey County as designated under section 383A.91, subdivision 5, of which
15 beds are to be used for inpatient mental health and 40 are to be used for other services.
In addition, five unlicensed observation mental health beds shall be added;
(29) upon submission of a plan to the commissioner for public interest review under
section 144.552 and the addition of the 15 inpatient mental health beds specified in clause
(28), to its bed capacity, a project to add 45 licensed beds in an existing safety net, level I
trauma center hospital in Ramsey County as designated under section 383A.91, subdivision
5. Five of the 45 additional beds authorized under this clause must be designated for use
for inpatient mental health and must be added to the hospital's bed capacity before the
remaining 40 beds are added. Notwithstanding section 144.552, the hospital may add licensed
beds under this clause prior to completion of the public interest review, provided the hospital
submits its plan by the 2021 deadline and adheres to the timelines for the public interest
review described in section 144.552; deleted text begin or
deleted text end
(30) upon submission of a plan to the commissioner for public interest review under
section 144.552, a project to add up to 30 licensed beds in an existing psychiatric hospital
in Hennepin County that exclusively provides care to patients who are under 21 years of
age on the date of admission. Notwithstanding section 144.552, the psychiatric hospital
may add licensed beds under this clause prior to completion of the public interest review,
provided the hospital submits its plan by the 2021 deadline and adheres to the timelines for
the public interest review described in section 144.552deleted text begin .deleted text end new text begin ;
new text end
new text begin
(31) a project to add licensed beds in a hospital in Cook County that: (i) is designated
as a critical access hospital under section 144.1483, clause (9), and United States Code, title
42, section 1395i-4; (ii) has a licensed bed capacity of fewer than 25 beds; and (iii) has an
attached nursing home, so long as the total number of licensed beds in the hospital after the
bed addition does not exceed 25 beds; or
new text end
new text begin
(32) upon submission of a plan to the commissioner for public interest review under
section 144.552, a project to add 22 licensed beds at a Minnesota freestanding children's
hospital in St. Paul that is part of an independent pediatric health system with freestanding
inpatient hospitals located in Minneapolis and St. Paul. The beds shall be utilized for pediatric
inpatient behavioral health services. Notwithstanding section 144.552, the hospital may add
licensed beds under this clause prior to completion of the public interest review, provided
the hospital submits its plan by the 2022 deadline and adheres to the timelines for the public
interest review described in section 144.552.
new text end
Sec. 8.
Minnesota Statutes 2020, section 144.565, subdivision 4, is amended to read:
Subd. 4.
Definitions.
(a) For purposes of this section, the following terms have the
meanings givendeleted text begin :deleted text end new text begin .
new text end
(b) "Diagnostic imaging facility" means a health care facility that is not a hospital or
location licensed as a hospital which offers diagnostic imaging services in Minnesota,
regardless of whether the equipment used to provide the service is owned or leased. For the
purposes of this section, diagnostic imaging facility includes, but is not limited to, facilities
such as a physician's office, clinic, mobile transport vehicle, outpatient imaging center, or
surgical center.new text begin A dental clinic or office is not considered a diagnostic imaging facility for
the purpose of this section when the clinic or office performs diagnostic imaging through
dental cone beam computerized tomography.
new text end
(c) "Diagnostic imaging service" means the use of ionizing radiation or other imaging
technique on a human patient includingdeleted text begin ,deleted text end but not limited todeleted text begin ,deleted text end magnetic resonance imaging
(MRI) or computerized tomography (CT)new text begin other than dental cone beam computerized
tomographynew text end , positron emission tomography (PET), or single photon emission computerized
tomography (SPECT) scans using fixed, portable, or mobile equipment.
(d) "Financial or economic interest" means a direct or indirect:
(1) equity or debt security issued by an entity, including, but not limited to, shares of
stock in a corporation, membership in a limited liability company, beneficial interest in a
trust, units or other interests in a partnership, bonds, debentures, notes or other equity
interests or debt instruments, or any contractual arrangements;
(2) membership, proprietary interest, or co-ownership with an individual, group, or
organization to which patients, clients, or customers are referred to; or
(3) employer-employee or independent contractor relationship, including, but not limited
to, those that may occur in a limited partnership, profit-sharing arrangement, or other similar
arrangement with any facility to which patients are referred, including any compensation
between a facility and a health care provider, the group practice of which the provider is a
member or employee or a related party with respect to any of them.
(e) "Fixed equipment" means a stationary diagnostic imaging machine installed in a
permanent location.
(f) "Mobile equipment" means a diagnostic imaging machine in a self-contained transport
vehicle designed to be brought to a temporary offsite location to perform diagnostic imaging
services.
(g) "Portable equipment" means a diagnostic imaging machine designed to be temporarily
transported within a permanent location to perform diagnostic imaging services.
(h) "Provider of diagnostic imaging services" means a diagnostic imaging facility or an
entity that offers and bills for diagnostic imaging services at a facility owned or leased by
the entity.
Sec. 9.
Minnesota Statutes 2020, section 144.586, is amended by adding a subdivision to
read:
new text begin Subd. 4. new text end
new text begin Screening for eligibility for health coverage or assistance. new text end
new text begin
(a) A hospital
must screen a patient who is uninsured or whose insurance coverage status is not known by
the hospital, for eligibility for charity care from the hospital, eligibility for state or federal
public health care programs using presumptive eligibility or another similar process, and
eligibility for a premium tax credit. The hospital must attempt to complete this screening
process in person or by telephone within 30 days after the patient's admission to the hospital.
new text end
new text begin
(b) If the patient is eligible for charity care from the hospital, the hospital must assist
the patient in applying for charity care and must refer the patient to the appropriate
department in the hospital for follow-up.
new text end
new text begin
(c) If the patient is presumptively eligible for a public health care program, the hospital
must assist the patient in completing an insurance affordability program application, help
schedule an appointment for the patient with a navigator organization, or provide the patient
with contact information for navigator services. If the patient is eligible for a premium tax
credit, the hospital may schedule an appointment for the patient with a navigator organization
or provide the patient with contact information for navigator services.
new text end
new text begin
(d) A patient may decline to participate in the screening process, to apply for charity
care, to complete an insurance affordability program application, to schedule an appointment
with a navigator organization, or to accept information about navigator services.
new text end
new text begin
(e) For purposes of this subdivision:
new text end
new text begin
(1) "hospital" means a private, nonprofit, or municipal hospital licensed under sections
144.50 to 144.56;
new text end
new text begin
(2) "navigator" has the meaning given in section 62V.02, subdivision 9;
new text end
new text begin
(3) "premium tax credit" means a tax credit or premium subsidy under the federal Patient
Protection and Affordable Care Act, Public Law 111-148, as amended, including the federal
Health Care and Education Reconciliation Act of 2010, Public Law 111-152, and any
amendments to and federal guidance and regulations issued under these acts; and
new text end
new text begin
(4) "presumptive eligibility" has the meaning given in section 256B.057, subdivision
12.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective November 1, 2022.
new text end
Sec. 10.
Minnesota Statutes 2020, section 144.6502, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For the purposes of this section, the terms defined in this
subdivision have the meanings given.
(b) "Commissioner" means the commissioner of health.
(c) "Department" means the Department of Health.
(d) "Electronic monitoring" means the placement and use of an electronic monitoring
device deleted text begin by a residentdeleted text end in the resident's room or private living unit in accordance with this
section.
(e) "Electronic monitoring device" means a camera or other device that captures, records,
or broadcasts audio, video, or both, that is placed in a resident's room or private living unit
and is used to monitor the resident or activities in the room or private living unit.
(f) "Facility" means a facility that is:
(1) licensed as a nursing home under chapter 144A;
(2) licensed as a boarding care home under sections 144.50 to 144.56;
(3) until August 1, 2021, a housing with services establishment registered under chapter
144D that is either subject to chapter 144G or has a disclosed special unit under section
325F.72; or
(4) on or after August 1, 2021, an assisted living facility.
(g) "Resident" means a person 18 years of age or older residing in a facility.
(h) "Resident representative" means one of the following in the order of priority listed,
to the extent the person may reasonably be identified and located:
(1) a court-appointed guardian;
(2) a health care agent as defined in section 145C.01, subdivision 2; or
(3) a person who is not an agent of a facility or of a home care provider designated in
writing by the resident and maintained in the resident's records on file with the facility.
Sec. 11.
Minnesota Statutes 2020, section 144.651, is amended by adding a subdivision
to read:
new text begin Subd. 10a. new text end
new text begin Designated support person for pregnant patient. new text end
new text begin
(a) A health care provider
and a health care facility must allow, at a minimum, one designated support person of a
pregnant patient's choosing to be physically present while the patient is receiving health
care services including during a hospital stay.
new text end
new text begin
(b) For purposes of this subdivision, "designated support person" means any person
necessary to provide comfort to the patient including but not limited to the patient's spouse,
partner, family member, or another person related by affinity. Certified doulas and traditional
midwives may not be counted toward the limit of one designated support person.
new text end
Sec. 12.
Minnesota Statutes 2020, section 144.69, is amended to read:
144.69 CLASSIFICATION OF DATA ON INDIVIDUALS.
new text begin Subdivision 1. new text end
new text begin Data collected by the cancer reporting system. new text end
Notwithstanding any
law to the contrary, including section 13.05, subdivision 9, data collected on individuals by
the cancer deleted text begin surveillancedeleted text end new text begin reportingnew text end system, including the names and personal identifiers of
persons required in section 144.68 to report, shall be private and may only be used for the
purposes set forth in this section and sections 144.671, 144.672, and 144.68. Any disclosure
other than is provided for in this section and sections 144.671, 144.672, and 144.68, is
declared to be a misdemeanor and punishable as such. Except as provided by rule, and as
part of an epidemiologic investigation, an officer or employee of the commissioner of health
may interview patients named in any such report, or relatives of any such patient, only after
deleted text begin the consent ofdeleted text end new text begin notifyingnew text end the attending physician, advanced practice registered nurse, or
surgeon deleted text begin is obtaineddeleted text end .
new text begin Subd. 2. new text end
new text begin
Transfers of information to non-Minnesota state and federal government
agencies.
new text end
new text begin
(a) Information containing personal identifiers collected by the cancer reporting
system may be provided to the statewide cancer registry of other states solely for the purposes
consistent with this section and sections 144.671, 144.672, and 144.68, provided that the
other state agrees to maintain the classification of the information as provided under
subdivision 1.
new text end
new text begin
(b) Information, excluding direct identifiers such as name, Social Security number,
telephone number, and street address, collected by the cancer reporting system may be
provided to the Centers for Disease Control and Prevention's National Program of Cancer
Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results
Program registry.
new text end
Sec. 13.
Minnesota Statutes 2021 Supplement, section 144.9501, subdivision 17, is amended
to read:
Subd. 17.
Lead hazard reduction.
new text begin (a) new text end "Lead hazard reduction" means abatementnew text begin , swab
team services,new text end or interim controls undertaken to make a residence, child care facility, school,
playground, or other location where lead hazards are identified lead-safe by complying with
the lead standards and methods adopted under section 144.9508.
new text begin
(b) Lead hazard reduction does not include renovation activity that is primarily intended
to remodel, repair, or restore a given structure or dwelling rather than abate or control
lead-based paint hazards.
new text end
new text begin
(c) Lead hazard reduction does not include activities that disturb painted surfaces that
total:
new text end
new text begin
(1) less than 20 square feet (two square meters) on exterior surfaces; or
new text end
new text begin
(2) less than two square feet (0.2 square meters) in an interior room.
new text end
Sec. 14.
Minnesota Statutes 2020, section 144.9501, subdivision 26a, is amended to read:
Subd. 26a.
Regulated lead work.
deleted text begin (a)deleted text end "Regulated lead work" means:
(1) abatement;
(2) interim controls;
(3) a clearance inspection;
(4) a lead hazard screen;
(5) a lead inspection;
(6) a lead risk assessment;
(7) lead project designer services;
(8) lead sampling technician services;
(9) swab team services;
(10) renovation activities; deleted text begin or
deleted text end
new text begin
(11) lead hazard reduction; or
new text end
deleted text begin (11)deleted text end new text begin (12)new text end activities performed to comply with lead orders issued by deleted text begin a community health
boarddeleted text end new text begin an assessing agencynew text end .
deleted text begin
(b) Regulated lead work does not include abatement, interim controls, swab team services,
or renovation activities that disturb painted surfaces that total no more than:
deleted text end
deleted text begin
(1) 20 square feet (two square meters) on exterior surfaces; or
deleted text end
deleted text begin
(2) six square feet (0.6 square meters) in an interior room.
deleted text end
Sec. 15.
Minnesota Statutes 2020, section 144.9501, subdivision 26b, is amended to read:
Subd. 26b.
Renovation.
new text begin (a) new text end "Renovation" means the modification of any pre-1978
affected property new text begin for compensation new text end that results in the disturbance of known or presumed
lead-containing painted surfaces defined under section 144.9508, unless that activity is
performed as lead hazard reduction. A renovation performed for the purpose of converting
a building or part of a building into an affected property is a renovation under this
subdivision.
new text begin
(b) Renovation does not include activities that disturb painted surfaces that total:
new text end
new text begin
(1) less than 20 square feet (two square meters) on exterior surfaces; or
new text end
new text begin
(2) less than six square feet (0.6 square meters) in an interior room.
new text end
Sec. 16.
Minnesota Statutes 2020, section 144.9505, subdivision 1, is amended to read:
Subdivision 1.
Licensing, certification, and permitting.
(a) Fees collected under this
section shall be deposited into the state treasury and credited to the state government special
revenue fund.
(b) Persons shall not advertise or otherwise present themselves as lead supervisors, lead
workers, lead inspectors, lead risk assessors, lead sampling technicians, lead project designers,
renovation firms, or lead firms unless they have licenses or certificates issued by the
commissioner under this section.
(c) The fees required in this section for inspectors, risk assessors, and certified lead firms
are waived for state or local government employees performing services for or as an assessing
agency.
(d) An individual who is the owner of property on which deleted text begin regulated lead workdeleted text end new text begin lead hazard
reductionnew text end is to be performed or an adult individual who is related to the property owner, as
defined under section 245A.02, subdivision 13, is exempt from the requirements to obtain
a license and pay a fee according to this section.
(e) A person that employs individuals to perform deleted text begin regulated lead workdeleted text end new text begin lead hazard
reduction, clearance inspections, lead risk assessments, lead inspections, lead hazard screens,
lead project designer services, lead sampling technician services, and swab team servicesnew text end
outside of the person's property must obtain certification as a certified lead firm. An
individual who performs lead hazard reduction, lead hazard screens, lead inspections, lead
risk assessments, clearance inspections, lead project designer services, lead sampling
technician services, swab team services, and activities performed to comply with lead orders
must be employed by a certified lead firm, unless the individual is a sole proprietor and
does not employ any other individualsdeleted text begin ,deleted text end new text begin ;new text end the individual is employed by a person that does
not perform deleted text begin regulated lead workdeleted text end new text begin lead hazard reduction, clearance inspections, lead risk
assessments, lead inspections, lead hazard screens, lead project designer services, lead
sampling technician services, and swab team servicesnew text end outside of the person's propertydeleted text begin ,deleted text end new text begin ;new text end or
the individual is employed by an assessing agency.
Sec. 17.
Minnesota Statutes 2020, section 144.9505, subdivision 1h, is amended to read:
Subd. 1h.
Certified renovation firm.
A person who deleted text begin employs individuals to performdeleted text end new text begin
performsnew text end renovation activities deleted text begin outside of the person's propertydeleted text end must obtain certification as
a renovation firm. The certificate must be in writing, contain an expiration date, be signed
by the commissioner, and give the name and address of the person to whom it is issued. A
renovation firm certificate is valid for two years. The certification fee is $100, is
nonrefundable, and must be submitted with each application. The renovation firm certificate
or a copy of the certificate must be readily available at the worksite for review by the
contracting entity, the commissioner, and other public health officials charged with the
health, safety, and welfare of the state's citizens.
Sec. 18.
Minnesota Statutes 2020, section 144A.01, is amended to read:
144A.01 DEFINITIONS.
Subdivision 1.
Scope.
For the purposes of sections 144A.01 to 144A.27, the terms
defined in this section have the meanings given them.
Subd. 2.
Commissioner of health.
"Commissioner of health" means the state
commissioner of health established by section 144.011.
Subd. 3.
Board of Executivesnew text begin for Long Term Services and Supportsnew text end .
"Board of
Executivesnew text begin for Long Term Services and Supportsnew text end " means the Board of Executives for Long
Term Services and Supports established by section 144A.19.
Subd. 3a.
Certified.
"Certified" means certified for participation as a provider in the
Medicare or Medicaid programs under title XVIII or XIX of the Social Security Act.
Subd. 4.
Controlling deleted text begin persondeleted text end new text begin individualnew text end .
(a) "Controlling deleted text begin persondeleted text end new text begin individualnew text end " means deleted text begin any
public body, governmental agency, business entity,deleted text end new text begin an owner and the following individuals
and entities, if applicable:
new text end
new text begin (1) eachnew text end officernew text begin of the organizationnew text end , new text begin including the chief executive officer and the chief
financial officer;
new text end
new text begin (2) the new text end nursing home administratordeleted text begin ,deleted text end new text begin ;new text end or deleted text begin director whose responsibilities include the
direction of the management or policies of a nursing home
deleted text end
new text begin (3) any managerial officialnew text end .
new text begin (b) new text end "Controlling deleted text begin persondeleted text end new text begin individualnew text end " also means any new text begin entity or natural new text end person whodeleted text begin , directly
or indirectly, beneficially owns anydeleted text end new text begin has any direct or indirect ownershipnew text end interest in:
(1) any corporation, partnership or other business association which is a controlling
deleted text begin persondeleted text end new text begin individualnew text end ;
new text begin
(2) any other legal or business entity;
new text end
deleted text begin (2)deleted text end new text begin (3)new text end the land on which a nursing home is located;
deleted text begin (3)deleted text end new text begin (4)new text end the structure in which a nursing home is located;
deleted text begin (4)deleted text end new text begin (5)new text end any new text begin entity with at least a five percent new text end mortgage, contract for deed, new text begin deed of trust,
new text end or other deleted text begin obligation secured in whole or part bydeleted text end new text begin security interest innew text end the land or structure
comprising a nursing home; or
deleted text begin (5)deleted text end new text begin (6)new text end any lease or sublease of the land, structure, or facilities comprising a nursing
home.
deleted text begin (b)deleted text end new text begin (c)new text end "Controlling deleted text begin persondeleted text end new text begin individualnew text end " does not include:
(1) a bank, savings bank, trust company, savings association, credit union, industrial
loan and thrift company, investment banking firm, or insurance company unless the entity
directly or through a subsidiary operates a nursing home;
new text begin
(2) government and government-sponsored entities such as the United States Department
of Housing and Urban Development, Ginnie Mae, Fannie Mae, Freddie Mac, and the
Minnesota Housing Finance Agency which provide loans, financing, and insurance products
for housing sites;
new text end
deleted text begin (2)deleted text end new text begin (3)new text end an individual new text begin who is a new text end state new text begin or federal new text end official deleted text begin ordeleted text end new text begin , anew text end state new text begin or federal new text end employee, or
a member or employee of the governing body of a political subdivision of the state deleted text begin whichdeleted text end new text begin
or federal government thatnew text end operates one or more nursing homes, unless the individual is
also an officer deleted text begin or director of adeleted text end new text begin , owner, or managerial official of thenew text end nursing home, receives
any remuneration from a nursing home, or deleted text begin owns any of the beneficial interestsdeleted text end new text begin who is a
controlling individualnew text end not new text begin otherwise new text end excluded in this subdivision;
deleted text begin (3)deleted text end new text begin (4)new text end a natural person who is a member of a tax-exempt organization under section
290.05, subdivision 2, unless the individual is also deleted text begin an officer or director of a nursing home,
or owns any of the beneficial interestsdeleted text end new text begin a controlling individualnew text end not new text begin otherwise new text end excluded in
this subdivision; and
deleted text begin (4)deleted text end new text begin (5)new text end a natural person who owns less than five percent of the outstanding common
shares of a corporation:
(i) whose securities are exempt by virtue of section 80A.45, clause (6); or
(ii) whose transactions are exempt by virtue of section 80A.46, clause (7).
Subd. 4a.
Emergency.
"Emergency" means a situation or physical condition that creates
or probably will create an immediate and serious threat to a resident's health or safety.
Subd. 5.
Nursing home.
"Nursing home" means a facility or that part of a facility which
provides nursing care to five or more persons. "Nursing home" does not include a facility
or that part of a facility which is a hospital, a hospital with approved swing beds as defined
in section 144.562, clinic, doctor's office, diagnostic or treatment center, or a residential
program licensed pursuant to sections 245A.01 to 245A.16 or 252.28.
Subd. 6.
Nursing care.
"Nursing care" means health evaluation and treatment of patients
and residents who are not in need of an acute care facility but who require nursing supervision
on an inpatient basis. The commissioner of health may by rule establish levels of nursing
care.
Subd. 7.
Uncorrected violation.
"Uncorrected violation" means a violation of a statute
or rule or any other deficiency for which a notice of noncompliance has been issued and
fine assessed and allowed to be recovered pursuant to section 144A.10, subdivision 8.
Subd. 8.
Managerial deleted text begin employeedeleted text end new text begin officialnew text end .
"Managerial deleted text begin employeedeleted text end new text begin officialnew text end " means an
deleted text begin employee of adeleted text end new text begin individual who has the decision-making authority related to the operation of
thenew text end nursing home deleted text begin whose duties includedeleted text end new text begin and the responsibility for either: (1) the ongoing
management of the nursing home; or (2)new text end the direction of deleted text begin some or all of the management ordeleted text end
policiesnew text begin , services, or employeesnew text end of the nursing home.
Subd. 9.
Nursing home administrator.
"Nursing home administrator" means a person
who administers, manages, supervises, or is in general administrative charge of a nursing
home, whether or not the individual has an ownership interest in the home, and whether or
not the person's functions and duties are shared with one or more individuals, and who is
licensed pursuant to section 144A.21.
Subd. 10.
Repeated violation.
"Repeated violation" means the issuance of two or more
correction orders, within a 12-month period, for a violation of the same provision of a statute
or rule.
new text begin Subd. 11. new text end
new text begin Change of ownership. new text end
new text begin
"Change of ownership" means a change in the licensee.
new text end
new text begin Subd. 12. new text end
new text begin Direct ownership interest. new text end
new text begin
"Direct ownership interest" means an individual
or legal entity with the possession of at least five percent equity in capital, stock, or profits
of the licensee or who is a member of a limited liability company of the licensee.
new text end
new text begin Subd. 13. new text end
new text begin Indirect ownership interest. new text end
new text begin
"Indirect ownership interest" means an individual
or legal entity with a direct ownership interest in an entity that has a direct or indirect
ownership interest of at least five percent in an entity that is a licensee.
new text end
new text begin Subd. 14. new text end
new text begin Licensee. new text end
new text begin
"Licensee" means a person or legal entity to whom the commissioner
issues a license for a nursing home and who is responsible for the management, control,
and operation of the nursing home.
new text end
new text begin Subd. 15. new text end
new text begin Management agreement. new text end
new text begin
"Management agreement" means a written, executed
agreement between a licensee and manager regarding the provision of certain services on
behalf of the licensee.
new text end
new text begin Subd. 16. new text end
new text begin Manager. new text end
new text begin
"Manager" means an individual or legal entity designated by the
licensee through a management agreement to act on behalf of the licensee in the on-site
management of the nursing home.
new text end
new text begin Subd. 17. new text end
new text begin Managing control. new text end
new text begin
"Managing control" means any organization that exercises
operational or managerial control over the nursing home or conducts the day-to-day
operations of the nursing home.
new text end
new text begin Subd. 18. new text end
new text begin Owner. new text end
new text begin
"Owner" means: (1) an individual or legal entity that has a direct or
indirect ownership interest of five percent or more in a licensee; and (2) for purposes of this
chapter, owner of a nonprofit corporation means the president and treasurer of the board of
directors; and (3) for an entity owned by an employee stock ownership plan, owner means
the president and treasurer of the entity. A government entity that is issued a license under
this chapter shall be designated the owner.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
Sec. 19.
Minnesota Statutes 2020, section 144A.03, subdivision 1, is amended to read:
Subdivision 1.
Form; requirements.
new text begin (a) new text end The commissioner of health by rule shall
establish forms and procedures for the processing of nursing home license applications.
new text begin (b) new text end An application for a nursing home license shall include deleted text begin the following informationdeleted text end :
(1) the deleted text begin namesdeleted text end new text begin business namenew text end and deleted text begin addresses of all controlling persons and managerial
employees of the facility to be licenseddeleted text end new text begin legal entity name of the licenseenew text end ;
(2) the new text begin street new text end addressnew text begin , mailing address,new text end and legal property description of the facility;
new text begin
(3) the names, e-mail addresses, telephone numbers, and mailing addresses of all owners,
controlling individuals, managerial officials, and the nursing home administrator;
new text end
new text begin
(4) the name and e-mail address of the managing agent and manager, if applicable;
new text end
new text begin
(5) the licensed bed capacity;
new text end
new text begin
(6) the license fee in the amount specified in section 144.122;
new text end
new text begin
(7) documentation of compliance with the background study requirements in section
144.057 for the owner, controlling individuals, and managerial officials. Each application
for a new license must include documentation for the applicant and for each individual with
five percent or more direct or indirect ownership in the applicant;
new text end
deleted text begin (3)deleted text end new text begin (8)new text end a copy of the architectural and engineering plans and specifications of the facility
as prepared and certified by an architect or engineer registered to practice in this state; deleted text begin and
deleted text end
new text begin
(9) a copy of the executed lease agreement between the landlord and the licensee, if
applicable;
new text end
new text begin
(10) a copy of the management agreement, if applicable;
new text end
new text begin
(11) a copy of the operations transfer agreement or similar agreement, if applicable;
new text end
new text begin
(12) an organizational chart that identifies all organizations and individuals with an
ownership interest in the licensee of five percent or greater and that specifies their relationship
with the licensee and with each other;
new text end
new text begin
(13) whether the applicant, owner, controlling individual, managerial official, or nursing
home administrator of the facility has ever been convicted of:
new text end
new text begin
(i) a crime or found civilly liable for a federal or state felony-level offense that was
detrimental to the best interests of the facility and its residents within the last ten years
preceding submission of the license application. Offenses include: (A) felony crimes against
persons and other similar crimes for which the individual was convicted, including guilty
pleas and adjudicated pretrial diversions; (B) financial crimes such as extortion,
embezzlement, income tax evasion, insurance fraud, and other similar crimes for which the
individual was convicted, including guilty pleas and adjudicated pretrial diversions; (C)
any felonies involving malpractice that resulted in a conviction of criminal neglect or
misconduct; and (D) any felonies that would result in a mandatory exclusion under section
1128(a) of the Social Security Act;
new text end
new text begin
(ii) any misdemeanor under federal or state law related to the delivery of an item or
service under Medicaid or a state health care program or the abuse or neglect of a patient
in connection with the delivery of a health care item or service;
new text end
new text begin
(iii) any misdemeanor under federal or state law related to theft, fraud, embezzlement,
breach of fiduciary duty, or other financial misconduct in connection with the delivery of
a health care item or service;
new text end
new text begin
(iv) any felony or misdemeanor under federal or state law relating to the interference
with or obstruction of any investigation into any criminal offense described in Code of
Federal Regulations, title 42, section 1001.101 or 1001.201;
new text end
new text begin
(v) any felony or misdemeanor under federal or state law relating to the unlawful
manufacture, distribution, prescription, or dispensing of a controlled substance; or
new text end
new text begin
(vi) any felony or gross misdemeanor that relates to the operation of a nursing home or
assisted living facility or directly affects resident safety or care during that period;
new text end
new text begin
(14) whether the applicant, owner, controlling individual, managerial official, or nursing
home administrator of the facility has had:
new text end
new text begin
(i) any revocation or suspension of a license to provide health care by any state licensing
authority. This includes the surrender of the license while a formal disciplinary proceeding
was pending before a state licensing authority;
new text end
new text begin
(ii) any revocation or suspension of accreditation; or
new text end
new text begin
(iii) any suspension or exclusion from participation in, or any sanction imposed by, a
federal or state health care program or any debarment from participation in any federal
executive branch procurement or nonprocurement program;
new text end
new text begin
(15) whether in the preceding three years the applicant or any owner, controlling
individual, managerial official, or nursing home administrator of the facility has a record
of defaulting in the payment of money collected for others, including the discharge of debts
through bankruptcy proceedings;
new text end
new text begin
(16) the signature of the owner of the licensee or an authorized agent of the licensee;
new text end
new text begin
(17) identification of all states where the applicant or individual having a five percent
or more ownership currently or previously has been licensed as an owner or operator of a
long-term care, community-based, or health care facility or agency where the applicant's or
individual's license or federal certification has been denied, suspended, restricted, conditioned,
refused, not renewed, or revoked under a private or state-controlled receivership or where
these same actions are pending under the laws of any state or federal authority;
new text end
new text begin
(18) statistical information required by the commissioner; and
new text end
deleted text begin (4)deleted text end new text begin (19)new text end any other relevant information which the commissioner of health by rule or
otherwise may determine is necessary to properly evaluate an application for license.
new text begin (c) new text end A controlling deleted text begin persondeleted text end new text begin individualnew text end which is a corporation shall submit copies of its
articles of incorporation and bylaws and any amendments thereto as they occur, together
with the names and addresses of its officers and directors. A controlling deleted text begin persondeleted text end new text begin individualnew text end
which is a foreign corporation shall furnish the commissioner of health with a copy of its
certificate of authority to do business in this state. deleted text begin An application on behalf of a controlling
person which is a corporation, association or a governmental unit or instrumentality shall
be signed by at least two officers or managing agents of that entity.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
Sec. 20.
Minnesota Statutes 2020, section 144A.04, subdivision 4, is amended to read:
Subd. 4.
Controlling deleted text begin persondeleted text end new text begin individualnew text end restrictions.
(a) The new text begin commissioner has discretion
to bar any new text end controlling deleted text begin personsdeleted text end new text begin individualnew text end of a nursing home deleted text begin may not include anydeleted text end new text begin if the new text end
person deleted text begin whodeleted text end was a controlling deleted text begin persondeleted text end new text begin individualnew text end of deleted text begin anotherdeleted text end new text begin any othernew text end nursing home deleted text begin during
any period of timedeleted text end new text begin , assisted living facility, long-term care or health care facility, or agencynew text end
in the previous two-year periodnew text begin andnew text end :
(1) during deleted text begin whichdeleted text end new text begin that period ofnew text end time deleted text begin of control that other nursing homedeleted text end new text begin the facility or
agencynew text end incurred the following number of uncorrected or repeated violations:
(i) two or more uncorrected violations or one or more repeated violations which created
an imminent risk to direct resident new text begin or client new text end care or safety; or
(ii) four or more uncorrected violations or two or more repeated violations deleted text begin of any nature
for which the fines are in the four highest daily fine categories prescribed in ruledeleted text end new text begin that created
an imminent risk to direct resident or client care or safetynew text end ; or
(2) deleted text begin whodeleted text end new text begin during that period of time,new text end was convicted of a felony or gross misdemeanor that
deleted text begin relatesdeleted text end new text begin relatednew text end to operation of the deleted text begin nursing homedeleted text end new text begin facility or agencynew text end or directly deleted text begin affectsdeleted text end new text begin affectednew text end
resident safety or caredeleted text begin , during that perioddeleted text end .
(b) The provisions of this subdivision shall not apply to any controlling deleted text begin persondeleted text end new text begin individualnew text end
who had no legal authority to affect or change decisions related to the operation of the
nursing home which incurred the uncorrected violations.
new text begin
(c) When the commissioner bars a controlling individual under this subdivision, the
controlling individual has the right to appeal under chapter 14.
new text end
Sec. 21.
Minnesota Statutes 2020, section 144A.04, subdivision 6, is amended to read:
Subd. 6.
Managerial deleted text begin employeedeleted text end new text begin officialnew text end or licensed administrator; employment
prohibitions.
A nursing home may not employ as a managerial deleted text begin employeedeleted text end new text begin officialnew text end or as its
licensed administrator any person who was a managerial deleted text begin employeedeleted text end new text begin officialnew text end or the licensed
administrator of another facility during any period of time in the previous two-year period:
(1) during which time of employment that other nursing home incurred the following
number of uncorrected violations which were in the jurisdiction and control of the managerial
deleted text begin employeedeleted text end new text begin officialnew text end or the administrator:
(i) two or more uncorrected violations deleted text begin or one or more repeated violations which created
an imminent risk to direct resident care or safetydeleted text end ; or
(ii) four or more uncorrected violations or two or more repeated violations of any nature
for which the fines are in the four highest daily fine categories prescribed in rule; or
(2) who was convicted of a felony or gross misdemeanor that relates to operation of the
nursing home or directly affects resident safety or care, during that period.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
Sec. 22.
Minnesota Statutes 2020, section 144A.06, is amended to read:
144A.06 TRANSFER OF deleted text begin INTERESTSdeleted text end new text begin LICENSE PROHIBITEDnew text end .
Subdivision 1.
deleted text begin Notice; expiration of licensedeleted text end new text begin Transfers prohibitednew text end .
deleted text begin
Any controlling
person who makes any transfer of a beneficial interest in a nursing home shall notify the
commissioner of health of the transfer within 14 days of its occurrence. The notification
shall identify by name and address the transferor and transferee and shall specify the nature
and amount of the transferred interest. On determining that the transferred beneficial interest
exceeds ten percent of the total beneficial interest in the nursing home facility, the structure
in which the facility is located, or the land upon which the structure is located, the
commissioner may, and on determining that the transferred beneficial interest exceeds 50
percent of the total beneficial interest in the facility, the structure in which the facility is
located, or the land upon which the structure is located, the commissioner shall require that
the license of the nursing home expire 90 days after the date of transfer. The commissioner
of health shall notify the nursing home by certified mail of the expiration of the license at
least 60 days prior to the date of expiration.
deleted text end
new text begin
A nursing home license may not be transferred.
new text end
Subd. 2.
deleted text begin Relicensuredeleted text end new text begin New license required; change of ownershipnew text end .
new text begin (a) new text end The
commissioner of health by rule shall prescribe procedures for deleted text begin relicensuredeleted text end new text begin licensurenew text end under
this section. deleted text begin The commissioner of health shall relicense a nursing home if the facility satisfies
the requirements for license renewal established by section 144A.05. A facility shall not be
relicensed by the commissioner if at the time of transfer there are any uncorrected violations.
The commissioner of health may temporarily waive correction of one or more violations if
the commissioner determines that:
deleted text end
deleted text begin
(1) temporary noncorrection of the violation will not create an imminent risk of harm
to a nursing home resident; and
deleted text end
deleted text begin
(2) a controlling person on behalf of all other controlling persons:
deleted text end
deleted text begin
(i) has entered into a contract to obtain the materials or labor necessary to correct the
violation, but the supplier or other contractor has failed to perform the terms of the contract
and the inability of the nursing home to correct the violation is due solely to that failure; or
deleted text end
deleted text begin
(ii) is otherwise making a diligent good faith effort to correct the violation.
deleted text end
new text begin
(b) A new license is required and the prospective licensee must apply for a license prior
to operating a currently licensed nursing home. The licensee must change whenever one of
the following events occur:
new text end
new text begin
(1) the form of the licensee's legal entity structure is converted or changed to a different
type of legal entity structure;
new text end
new text begin
(2) the licensee dissolves, consolidates, or merges with another legal organization and
the licensee's legal organization does not survive;
new text end
new text begin
(3) within the previous 24 months, 50 percent or more of the licensee's ownership interest
is transferred, whether by a single transaction or multiple transactions to:
new text end
new text begin
(i) a different person; or
new text end
new text begin
(ii) a person who had less than a five percent ownership interest in the facility at the
time of the first transaction; or
new text end
new text begin
(4) any other event or combination of events that results in a substitution, elimination,
or withdrawal of the licensee's responsibility for the facility.
new text end
new text begin Subd. 3. new text end
new text begin Compliance. new text end
new text begin
The commissioner must consult with the commissioner of human
services regarding the history of financial and cost reporting compliance of the prospective
licensee and prospective licensee's financial operations in any nursing home that the
prospective licensee or any controlling individual listed in the license application has had
an interest in.
new text end
new text begin Subd. 4. new text end
new text begin Facility operation. new text end
new text begin
The current licensee remains responsible for the operation
of the nursing home until the nursing home is licensed to the prospective licensee.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
Sec. 23.
new text begin
[144A.32] CONSIDERATION OF APPLICATIONS.
new text end
new text begin
(a) Before issuing a provisional license or license or renewing an existing license, the
commissioner shall consider an applicant's compliance history in providing care in a facility
that provides care to children, the elderly, ill individuals, or individuals with disabilities.
new text end
new text begin
(b) The applicant's compliance history shall include repeat violations, rule violations,
and any license or certification involuntarily suspended or terminated during an enforcement
process.
new text end
new text begin
(c) The commissioner may deny, revoke, suspend, restrict, or refuse to renew the license
or impose conditions if:
new text end
new text begin
(1) the applicant fails to provide complete and accurate information on the application
and the commissioner concludes that the missing or corrected information is needed to
determine if a license is granted;
new text end
new text begin
(2) the applicant, knowingly or with reason to know, made a false statement of a material
fact in an application for the license or any data attached to the application or in any matter
under investigation by the department;
new text end
new text begin
(3) the applicant refused to allow agents of the commissioner to inspect the applicant's
books, records, files related to the license application, or any portion of the premises;
new text end
new text begin
(4) the applicant willfully prevented, interfered with, or attempted to impede in any way:
new text end
new text begin
(i) the work of any authorized representative of the commissioner, the ombudsman for
long-term care, or the ombudsman for mental health and developmental disabilities; or
new text end
new text begin
(ii) the duties of the commissioner, local law enforcement, city or county attorneys, adult
protection, county case managers, or other local government personnel;
new text end
new text begin
(5) the applicant has a history of noncompliance with federal or state regulations that
were detrimental to the health, welfare, or safety of a resident or a client; or
new text end
new text begin
(6) the applicant violates any requirement in this chapter or chapter 256R.
new text end
new text begin
(d) If a license is denied, the applicant has the reconsideration rights available under
chapter 14.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
Sec. 24.
Minnesota Statutes 2020, section 144A.4799, subdivision 1, is amended to read:
Subdivision 1.
Membership.
The commissioner of health shall appoint deleted text begin eightdeleted text end new text begin 13new text end persons
to a home care and assisted living program advisory council consisting of the following:
(1) deleted text begin threedeleted text end new text begin twonew text end public members as defined in section 214.02 who shall be persons who
are currently receiving home care services, persons who have received home care services
within five years of the application date, persons who have family members receiving home
care services, or persons who have family members who have received home care services
within five years of the application date;
(2) deleted text begin threedeleted text end new text begin twonew text end Minnesota home care licensees representing basic and comprehensive
levels of licensure who may be a managerial official, an administrator, a supervising
registered nurse, or an unlicensed personnel performing home care tasks;
(3) one member representing the Minnesota Board of Nursing;
(4) one member representing the Office of Ombudsman for Long-Term Care; deleted text begin and
deleted text end
new text begin
(5) one member representing the Office of Ombudsman for Mental Health and
Developmental Disabilities;
new text end
deleted text begin (5)deleted text end new text begin (6)new text end beginning July 1, 2021, one member of a county health and human services or
county adult protection officedeleted text begin .deleted text end new text begin ;
new text end
new text begin
(7) two Minnesota assisted living facility licensees representing assisted living facilities
and assisted living facilities with dementia care levels of licensure who may be the facility's
assisted living director, managerial official, or clinical nurse supervisor;
new text end
new text begin
(8) one organization representing long-term care providers, home care providers, and
assisted living providers in Minnesota; and
new text end
new text begin
(9) two public members as defined in section 214.02. One public member shall be a
person who either is or has been a resident in an assisted living facility and one public
member shall be a person who has or had a family member living in an assisted living
facility setting.
new text end
Sec. 25.
Minnesota Statutes 2020, section 144A.4799, subdivision 3, is amended to read:
Subd. 3.
Duties.
(a) At the commissioner's request, the advisory council shall provide
advice regarding regulations of Department of Health licensed new text begin assisted living and new text end home
care providers in this chapter, including advice on the following:
(1) community standards for home care practices;
(2) enforcement of licensing standards and whether certain disciplinary actions are
appropriate;
(3) ways of distributing information to licensees and consumers of home care and assisted
livingnew text begin services defined under chapter 144Gnew text end ;
(4) training standards;
(5) identifying emerging issues and opportunities in home care and assisted livingnew text begin services
defined under chapter 144Gnew text end ;
(6) identifying the use of technology in home and telehealth capabilities;
(7) allowable home care licensing modifications and exemptions, including a method
for an integrated license with an existing license for rural licensed nursing homes to provide
limited home care services in an adjacent independent living apartment building owned by
the licensed nursing home; and
(8) recommendations for studies using the data in section 62U.04, subdivision 4, including
but not limited to studies concerning costs related to dementia and chronic disease among
an elderly population over 60 and additional long-term care costs, as described in section
62U.10, subdivision 6.
(b) The advisory council shall perform other duties as directed by the commissioner.
(c) The advisory council shall annually make recommendations to the commissioner for
the purposes in section 144A.474, subdivision 11, paragraph (i). The recommendations shall
address ways the commissioner may improve protection of the public under existing statutes
and laws and include but are not limited to projects that create and administer training of
licensees and their employees to improve residents' lives, supporting ways that licensees
can improve and enhance quality care and ways to provide technical assistance to licensees
to improve compliance; information technology and data projects that analyze and
communicate information about trends of violations or lead to ways of improving client
care; communications strategies to licensees and the public; and other projects or pilots that
benefit clients, families, and the public.
Sec. 26.
Minnesota Statutes 2020, section 144A.75, subdivision 12, is amended to read:
Subd. 12.
Palliative care.
"Palliative care" means deleted text begin the total active care of patients whose
disease is not responsive to curative treatment. Control of pain, of other symptoms, and of
psychological, social, and spiritual problems is paramountdeleted text end new text begin specialized medical care for
people living with a serious illness or life-limiting conditionnew text end . new text begin This type of care is focused
on reducing the pain, symptoms, and stress of a serious illness or condition. Palliative care
is a team-based approach to care, providing essential support at any age or stage of a serious
illness or condition, and is often provided together with curative treatment. new text end The goal of
palliative care is deleted text begin the achievement of the best quality of life for patients and their familiesdeleted text end new text begin
to improve quality of life for both the patient and the patient's family or care partnernew text end .
Sec. 27.
Minnesota Statutes 2020, section 144G.08, is amended by adding a subdivision
to read:
new text begin Subd. 62a. new text end
new text begin Serious injury. new text end
new text begin
"Serious injury" has the meaning given in section 245.91,
subdivision 6.
new text end
Sec. 28.
Minnesota Statutes 2020, section 144G.15, is amended to read:
144G.15 CONSIDERATION OF APPLICATIONS.
(a) Before issuing a provisional license or license or renewing a license, the commissioner
shall consider an applicant's compliance history in providing care in new text begin this state or any other
state in new text end a facility that provides care to children, the elderly, ill individuals, or individuals
with disabilities.
(b) The applicant's compliance history shall include repeat violation, rule violations, and
any license or certification involuntarily suspended or terminated during an enforcement
process.
(c) The commissioner may deny, revoke, suspend, restrict, or refuse to renew the license
or impose conditions if:
(1) the applicant fails to provide complete and accurate information on the application
and the commissioner concludes that the missing or corrected information is needed to
determine if a license shall be granted;
(2) the applicant, knowingly or with reason to know, made a false statement of a material
fact in an application for the license or any data attached to the application or in any matter
under investigation by the department;
(3) the applicant refused to allow agents of the commissioner to inspect its books, records,
and files related to the license application, or any portion of the premises;
(4) the applicant willfully prevented, interfered with, or attempted to impede in any way:
(i) the work of any authorized representative of the commissioner, the ombudsman for
long-term care, or the ombudsman for mental health and developmental disabilities; or (ii)
the duties of the commissioner, local law enforcement, city or county attorneys, adult
protection, county case managers, or other local government personnel;
(5) the applicantnew text begin , owner, controlling individual, managerial official, or assisted living
director for the facilitynew text end has a history of noncompliance with federal or state regulations that
were detrimental to the health, welfare, or safety of a resident or a client; or
(6) the applicant violates any requirement in this chapter.
(d) If a license is denied, the applicant has the reconsideration rights available under
section 144G.16, subdivision 4.
Sec. 29.
Minnesota Statutes 2020, section 144G.17, is amended to read:
144G.17 LICENSE RENEWAL.
A license that is not a provisional license may be renewed for a period of up to one year
if the licensee:
(1) submits an application for renewal in the format provided by the commissioner at
least 60 calendar days before expiration of the license;
(2) submits the renewal fee under section 144G.12, subdivision 3;
(3) submits the late fee under section 144G.12, subdivision 4, if the renewal application
is received less than 30 days before the expiration date of the license or after the expiration
of the license;
(4) provides information sufficient to show that the applicant meets the requirements of
licensure, including items required under section 144G.12, subdivision 1; deleted text begin and
deleted text end
new text begin
(5) provides information sufficient to show the licensee provided assisted living services
to at least one resident during the immediately preceding license year and at the assisted
living facility listed on the license; and
new text end
deleted text begin (5)deleted text end new text begin (6)new text end provides any other information deemed necessary by the commissioner.
Sec. 30.
Minnesota Statutes 2020, section 144G.19, is amended by adding a subdivision
to read:
new text begin Subd. 4. new text end
new text begin Change of licensee. new text end
new text begin
Notwithstanding any other provision of law, a change of
licensee under subdivision 2 does not require the facility to meet the design requirements
of section 144G.45, subdivisions 4 to 6, or 144G.81, subdivision 3.
new text end
Sec. 31.
Minnesota Statutes 2020, section 144G.20, subdivision 1, is amended to read:
Subdivision 1.
Conditions.
(a) The commissioner may refuse to grant a provisional
license, refuse to grant a license as a result of a change in ownership, refuse to renew a
license, suspend or revoke a license, or impose a conditional license if the owner, controlling
individual, or employee of an assisted living facility:
(1) is in violation of, or during the term of the license has violated, any of the requirements
in this chapter or adopted rules;
(2) permits, aids, or abets the commission of any illegal act in the provision of assisted
living services;
(3) performs any act detrimental to the health, safety, and welfare of a resident;
(4) obtains the license by fraud or misrepresentation;
(5) knowingly makes a false statement of a material fact in the application for a license
or in any other record or report required by this chapter;
(6) denies representatives of the department access to any part of the facility's books,
records, files, or employees;
(7) interferes with or impedes a representative of the department in contacting the facility's
residents;
(8) interferes with or impedes ombudsman access according to section 256.9742,
subdivision 4new text begin , or interferes with or impedes access by the Office of Ombudsman for Mental
Health and Developmental Disabilities according to section 245.94, subdivision 1new text end ;
(9) interferes with or impedes a representative of the department in the enforcement of
this chapter or fails to fully cooperate with an inspection, survey, or investigation by the
department;
(10) destroys or makes unavailable any records or other evidence relating to the assisted
living facility's compliance with this chapter;
(11) refuses to initiate a background study under section 144.057 or 245A.04;
(12) fails to timely pay any fines assessed by the commissioner;
(13) violates any local, city, or township ordinance relating to housing or assisted living
services;
(14) has repeated incidents of personnel performing services beyond their competency
level; or
(15) has operated beyond the scope of the assisted living facility's license category.
(b) A violation by a contractor providing the assisted living services of the facility is a
violation by the facility.
Sec. 32.
Minnesota Statutes 2020, section 144G.20, subdivision 4, is amended to read:
Subd. 4.
Mandatory revocation.
Notwithstanding the provisions of subdivision 13,
paragraph (a), the commissioner must revoke a license if a controlling individual of the
facility is convicted of a felony or gross misdemeanor that relates to operation of the facility
or directly affects resident safety or care. The commissioner shall notify the facility and the
Office of Ombudsman for Long-Term Care new text begin and the Office of Ombudsman for Mental Health
and Developmental Disabilities new text end 30 calendar days in advance of the date of revocation.
Sec. 33.
Minnesota Statutes 2020, section 144G.20, subdivision 5, is amended to read:
Subd. 5.
Owners and managerial officials; refusal to grant license.
(a) The owners
and managerial officials of a facility whose Minnesota license has not been renewed or
whose deleted text begin Minnesotadeleted text end license new text begin in this state or any other state new text end has been revoked because of
noncompliance with applicable laws or rules shall not be eligible to apply for nor will be
granted an assisted living facility license under this chapter or a home care provider license
under chapter 144A, or be given status as an enrolled personal care assistance provider
agency or personal care assistant by the Department of Human Services under section
256B.0659, for five years following the effective date of the nonrenewal or revocation. If
the owners or managerial officials already have enrollment status, the Department of Human
Services shall terminate that enrollment.
(b) The commissioner shall not issue a license to a facility for five years following the
effective date of license nonrenewal or revocation if the owners or managerial officials,
including any individual who was an owner or managerial official of another licensed
provider, had a deleted text begin Minnesotadeleted text end license new text begin in this state or any other state new text end that was not renewed or
was revoked as described in paragraph (a).
(c) Notwithstanding subdivision 1, the commissioner shall not renew, or shall suspend
or revoke, the license of a facility that includes any individual as an owner or managerial
official who was an owner or managerial official of a facility whose deleted text begin Minnesotadeleted text end license new text begin in
this state or any other state new text end was not renewed or was revoked as described in paragraph (a)
for five years following the effective date of the nonrenewal or revocation.
(d) The commissioner shall notify the facility 30 calendar days in advance of the date
of nonrenewal, suspension, or revocation of the license.
Sec. 34.
Minnesota Statutes 2020, section 144G.20, subdivision 8, is amended to read:
Subd. 8.
Controlling individual restrictions.
(a) The commissioner has discretion to
bar any controlling individual of a facility if the person was a controlling individual of any
other nursing homenew text begin , home care provider licensed under chapter 144A, or given status as an
enrolled personal care assistance provider agency or personal care assistant by the Department
of Human Services under section 256B.0659,new text end or assisted living facility in the previous
two-year period and:
(1) during that period of time the nursing homenew text begin , home care provider licensed under
chapter 144A, or given status as an enrolled personal care assistance provider agency or
personal care assistant by the Department of Human Services under section 256B.0659,new text end or
assisted living facility incurred the following number of uncorrected or repeated violations:
(i) two or more repeated violations that created an imminent risk to direct resident care
or safety; or
(ii) four or more uncorrected violations that created an imminent risk to direct resident
care or safety; or
(2) during that period of time, was convicted of a felony or gross misdemeanor that
related to the operation of the nursing homenew text begin , home care provider licensed under chapter
144A, or given status as an enrolled personal care assistance provider agency or personal
care assistant by the Department of Human Services under section 256B.0659,new text end or assisted
living facility, or directly affected resident safety or care.
(b) When the commissioner bars a controlling individual under this subdivision, the
controlling individual may appeal the commissioner's decision under chapter 14.
Sec. 35.
Minnesota Statutes 2020, section 144G.20, subdivision 9, is amended to read:
Subd. 9.
Exception to controlling individual restrictions.
Subdivision 8 does not apply
to any controlling individual of the facility who had no legal authority to affect or change
decisions related to the operation of the nursing home deleted text begin ordeleted text end new text begin ,new text end assisted living facilitynew text begin , or home
carenew text end that incurred the uncorrected new text begin or repeated new text end violations.
Sec. 36.
Minnesota Statutes 2020, section 144G.20, subdivision 12, is amended to read:
Subd. 12.
Notice to residents.
(a) Within five business days after proceedings are initiated
by the commissioner to revoke or suspend a facility's license, or a decision by the
commissioner not to renew a living facility's license, the controlling individual of the facility
or a designee must provide to the commissioner deleted text begin anddeleted text end new text begin ,new text end the ombudsman for long-term carenew text begin ,
and the Office of Ombudsman for Mental Health and Developmental Disabilitiesnew text end the names
of residents and the names and addresses of the residents' designated representatives and
legal representatives, and family or other contacts listed in the assisted living contract.
(b) The controlling individual or designees of the facility must provide updated
information each month until the proceeding is concluded. If the controlling individual or
designee of the facility fails to provide the information within this time, the facility is subject
to the issuance of:
(1) a correction order; and
(2) a penalty assessment by the commissioner in rule.
(c) Notwithstanding subdivisions 21 and 22, any correction order issued under this
subdivision must require that the facility immediately comply with the request for information
and that, as of the date of the issuance of the correction order, the facility shall forfeit to the
state a $500 fine the first day of noncompliance and an increase in the $500 fine by $100
increments for each day the noncompliance continues.
(d) Information provided under this subdivision may be used by the commissioner deleted text begin ordeleted text end new text begin ,new text end
the ombudsman for long-term carenew text begin , or the Office of Ombudsman for Mental Health and
Developmental Disabilitiesnew text end only for the purpose of providing affected consumers information
about the status of the proceedings.
(e) Within ten business days after the commissioner initiates proceedings to revoke,
suspend, or not renew a facility license, the commissioner must send a written notice of the
action and the process involved to each resident of the facility, legal representatives and
designated representatives, and at the commissioner's discretion, additional resident contacts.
(f) The commissioner shall provide the ombudsman for long-term care new text begin and the Office
of Ombudsman for Mental Health and Developmental Disabilities new text end with monthly information
on the department's actions and the status of the proceedings.
Sec. 37.
Minnesota Statutes 2020, section 144G.20, subdivision 15, is amended to read:
Subd. 15.
Plan required.
(a) The process of suspending, revoking, or refusing to renew
a license must include a plan for transferring affected residents' cares to other providers by
the facility. The commissioner shall monitor the transfer plan. Within three calendar days
of being notified of the final revocation, refusal to renew, or suspension, the licensee shall
provide the commissioner, the lead agencies as defined in section 256B.0911, county adult
protection and case managers, deleted text begin anddeleted text end the ombudsman for long-term carenew text begin , and the Office of
Ombudsman for Mental Health and Developmental Disabilitiesnew text end with the following
information:
(1) a list of all residents, including full names and all contact information on file;
(2) a list of the resident's legal representatives and designated representatives and family
or other contacts listed in the assisted living contract, including full names and all contact
information on file;
(3) the location or current residence of each resident;
(4) the payor sources for each resident, including payor source identification numbers;
and
(5) for each resident, a copy of the resident's service plan and a list of the types of services
being provided.
(b) The revocation, refusal to renew, or suspension notification requirement is satisfied
by mailing the notice to the address in the license record. The licensee shall cooperate with
the commissioner and the lead agencies, county adult protection and case managers, deleted text begin anddeleted text end
the ombudsman for long-term carenew text begin , and the Office of Ombudsman for Mental Health and
Developmental Disabilitiesnew text end during the process of transferring care of residents to qualified
providers. Within three calendar days of being notified of the final revocation, refusal to
renew, or suspension action, the facility must notify and disclose to each of the residents,
or the resident's legal and designated representatives or emergency contact persons, that the
commissioner is taking action against the facility's license by providing a copy of the
revocation, refusal to renew, or suspension notice issued by the commissioner. If the facility
does not comply with the disclosure requirements in this section, the commissioner shall
notify the residents, legal and designated representatives, or emergency contact persons
about the actions being taken. Lead agencies, county adult protection and case managers,
and the Office of Ombudsman for Long-Term Care may also provide this information. The
revocation, refusal to renew, or suspension notice is public data except for any private data
contained therein.
(c) A facility subject to this subdivision may continue operating while residents are being
transferred to other service providers.
Sec. 38.
Minnesota Statutes 2020, section 144G.30, subdivision 5, is amended to read:
Subd. 5.
Correction orders.
(a) A correction order may be issued whenever the
commissioner finds upon survey or during a complaint investigation that a facility, a
managerial official, new text begin an agent of the facility, new text end or an employee of the facility is not in compliance
with this chapter. The correction order shall cite the specific statute and document areas of
noncompliance and the time allowed for correction.
(b) The commissioner shall mail or e-mail copies of any correction order to the facility
within 30 calendar days after the survey exit date. A copy of each correction order and
copies of any documentation supplied to the commissioner shall be kept on file by the
facility and public documents shall be made available for viewing by any person upon
request. Copies may be kept electronically.
(c) By the correction order date, the facility must document in the facility's records any
action taken to comply with the correction order. The commissioner may request a copy of
this documentation and the facility's action to respond to the correction order in future
surveys, upon a complaint investigation, and as otherwise needed.
Sec. 39.
Minnesota Statutes 2020, section 144G.31, subdivision 4, is amended to read:
Subd. 4.
Fine amounts.
(a) Fines and enforcement actions under this subdivision may
be assessed based on the level and scope of the violations described in subdivisions 2 and
3 as follows and may be imposed immediately with no opportunity to correct the violation
prior to imposition:
(1) Level 1, no fines or enforcement;
(2) Level 2, a fine of $500 per violation, in addition to any enforcement mechanism
authorized in section 144G.20 for widespread violations;
(3) Level 3, a fine of $3,000 per violation deleted text begin per incidentdeleted text end , in addition to any enforcement
mechanism authorized in section 144G.20;
(4) Level 4, a fine of $5,000 per deleted text begin incidentdeleted text end new text begin violationnew text end , in addition to any enforcement
mechanism authorized in section 144G.20; and
(5) for maltreatment violations for which the licensee was determined to be responsible
for the maltreatment under section 626.557, subdivision 9c, paragraph (c), a fine of $1,000
new text begin per incidentnew text end . A fine of $5,000 new text begin per incidentnew text end may be imposed if the commissioner determines
the licensee is responsible for maltreatment consisting of sexual assault, death, or abuse
resulting in serious injury.
(b) When a fine is assessed against a facility for substantiated maltreatment, the
commissioner shall not also impose an immediate fine under this chapter for the same
circumstance.
Sec. 40.
Minnesota Statutes 2020, section 144G.31, subdivision 8, is amended to read:
Subd. 8.
Deposit of fines.
Fines collected under this section shall be deposited in a
dedicated special revenue account. On an annual basis, the balance in the special revenue
account shall be appropriated to the commissioner for special projects to improve deleted text begin home
caredeleted text end new text begin resident quality of care and outcomes in assisted living facilities licensed under chapter
144Gnew text end in Minnesota as recommended by the advisory council established in section
144A.4799.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective retroactively for fines collected on or
after August 1, 2021.
new text end
Sec. 41.
Minnesota Statutes 2020, section 144G.41, subdivision 7, is amended to read:
Subd. 7.
Resident grievances; reporting maltreatment.
All facilities must post in a
conspicuous place information about the facilities' grievance procedure, and the name,
telephone number, and e-mail contact information for the individuals who are responsible
for handling resident grievances. The notice must also have the contact information for the
deleted text begin state and applicable regionaldeleted text end Office of Ombudsman for Long-Term Care and the Office of
Ombudsman for Mental Health and Developmental Disabilities, and must have information
for reporting suspected maltreatment to the Minnesota Adult Abuse Reporting Center.new text begin The
notice must also state that if an individual has a complaint about the facility or person
providing services, the individual may contact the Office of Health Facility Complaints at
the Minnesota Department of Health.
new text end
Sec. 42.
Minnesota Statutes 2020, section 144G.41, subdivision 8, is amended to read:
Subd. 8.
Protecting resident rights.
All facilities shall ensure that every resident has
access to consumer advocacy or legal services by:
(1) providing names and contact information, including telephone numbers and e-mail
addresses of at least three organizations that provide advocacy or legal services to residentsnew text begin ,
one of which must include the designated protection and advocacy organization in Minnesota
that provides advice and representation to individuals with disabilitiesnew text end ;
(2) providing the name and contact information for the Minnesota Office of Ombudsman
for Long-Term Care and the Office of Ombudsman for Mental Health and Developmental
Disabilitiesdeleted text begin , including both the state and regional contact informationdeleted text end ;
(3) assisting residents in obtaining information on whether Medicare or medical assistance
under chapter 256B will pay for services;
(4) making reasonable accommodations for people who have communication disabilities
and those who speak a language other than English; and
(5) providing all information and notices in plain language and in terms the residents
can understand.
Sec. 43.
Minnesota Statutes 2020, section 144G.42, subdivision 10, is amended to read:
Subd. 10.
Disaster planning and emergency preparedness plan.
(a) The facility must
meet the following requirements:
(1) have a written emergency disaster plan that contains a plan for evacuation, addresses
elements of sheltering in place, identifies temporary relocation sites, and details staff
assignments in the event of a disaster or an emergency;
(2) post an emergency disaster plan prominently;
(3) provide building emergency exit diagrams to all residents;
(4) post emergency exit diagrams on each floor; and
(5) have a written policy and procedure regarding missing deleted text begin tenantdeleted text end residents.
(b) The facility must provide emergency and disaster training to all staff during the initial
staff orientation and annually thereafter and must make emergency and disaster training
annually available to all residents. Staff who have not received emergency and disaster
training are allowed to work only when trained staff are also working on site.
(c) The facility must meet any additional requirements adopted in rule.
Sec. 44.
Minnesota Statutes 2020, section 144G.50, subdivision 2, is amended to read:
Subd. 2.
Contract information.
(a) The contract must include in a conspicuous place
and manner on the contract the legal name and the deleted text begin license numberdeleted text end new text begin health facility identificationnew text end
of the facility.
(b) The contract must include the name, telephone number, and physical mailing address,
which may not be a public or private post office box, of:
(1) the facility and contracted service provider when applicable;
(2) the licensee of the facility;
(3) the managing agent of the facility, if applicable; and
(4) the authorized agent for the facility.
(c) The contract must include:
(1) a disclosure of the category of assisted living facility license held by the facility and,
if the facility is not an assisted living facility with dementia care, a disclosure that it does
not hold an assisted living facility with dementia care license;
(2) a description of all the terms and conditions of the contract, including a description
of and any limitations to the housing or assisted living services to be provided for the
contracted amount;
(3) a delineation of the cost and nature of any other services to be provided for an
additional fee;
(4) a delineation and description of any additional fees the resident may be required to
pay if the resident's condition changes during the term of the contract;
(5) a delineation of the grounds under which the resident may be deleted text begin discharged, evicted,
ordeleted text end transferred or have new text begin housing or new text end services terminatednew text begin or be subject to an emergency
relocationnew text end ;
(6) billing and payment procedures and requirements; and
(7) disclosure of the facility's ability to provide specialized diets.
(d) The contract must include a description of the facility's complaint resolution process
available to residents, including the name and contact information of the person representing
the facility who is designated to handle and resolve complaints.
(e) The contract must include a clear and conspicuous notice of:
(1) the right under section 144G.54 to appeal the termination of an assisted living contract;
(2) the facility's policy regarding transfer of residents within the facility, under what
circumstances a transfer may occur, and the circumstances under which resident consent is
required for a transfer;
(3) contact information for the Office of Ombudsman for Long-Term Care, the
Ombudsman for Mental Health and Developmental Disabilities, and the Office of Health
Facility Complaints;
(4) the resident's right to obtain services from an unaffiliated service provider;
(5) a description of the facility's policies related to medical assistance waivers under
chapter 256S and section 256B.49 and the housing support program under chapter 256I,
including:
(i) whether the facility is enrolled with the commissioner of human services to provide
customized living services under medical assistance waivers;
(ii) whether the facility has an agreement to provide housing support under section
256I.04, subdivision 2, paragraph (b);
(iii) whether there is a limit on the number of people residing at the facility who can
receive customized living services or participate in the housing support program at any
point in time. If so, the limit must be provided;
(iv) whether the facility requires a resident to pay privately for a period of time prior to
accepting payment under medical assistance waivers or the housing support program, and
if so, the length of time that private payment is required;
(v) a statement that medical assistance waivers provide payment for services, but do not
cover the cost of rent;
(vi) a statement that residents may be eligible for assistance with rent through the housing
support program; and
(vii) a description of the rent requirements for people who are eligible for medical
assistance waivers but who are not eligible for assistance through the housing support
program;
(6) the contact information to obtain long-term care consulting services under section
256B.0911; and
(7) the toll-free phone number for the Minnesota Adult Abuse Reporting Center.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment, except
that the amendment to paragraph (a) is effective for assisted living contracts executed on
or after August 1, 2022.
new text end
Sec. 45.
Minnesota Statutes 2020, section 144G.52, subdivision 2, is amended to read:
Subd. 2.
Prerequisite to termination of a contract.
(a) Before issuing a notice of
termination of an assisted living contract, a facility must schedule and participate in a meeting
with the resident and the resident's legal representative and designated representative. The
purposes of the meeting are to:
(1) explain in detail the reasons for the proposed termination; and
(2) identify and offer reasonable accommodations or modifications, interventions, or
alternatives to avoid the termination or enable the resident to remain in the facility, including
but not limited to securing services from another provider of the resident's choosing that
may allow the resident to avoid the termination. A facility is not required to offer
accommodations, modifications, interventions, or alternatives that fundamentally alter the
nature of the operation of the facility.
(b) The meeting must be scheduled to take place at least seven days before a notice of
termination is issued. The facility must make reasonable efforts to ensure that the resident,
legal representative, and designated representative are able to attend the meeting.
(c) The facility must notify the resident that the resident may invite family members,
relevant health professionals, a representative of the Office of Ombudsman for Long-Term
Care, new text begin a representative of the Office of Ombudsman for Mental Health and Developmental
Disabilities, new text end or other persons of the resident's choosing to participate in the meeting. For
residents who receive home and community-based waiver services under chapter 256S and
section 256B.49, the facility must notify the resident's case manager of the meeting.
(d) In the event of an emergency relocation under subdivision 9, where the facility intends
to issue a notice of termination and an in-person meeting is impractical or impossible, the
facility deleted text begin may attempt to schedule and participate in a meeting under this subdivision viadeleted text end new text begin must
usenew text end telephone, video, or other new text begin electronic new text end meansnew text begin to conduct and participate in the meeting
required under this subdivision and rules within Minnesota Rules, chapter 4659new text end .
Sec. 46.
Minnesota Statutes 2020, section 144G.52, subdivision 8, is amended to read:
Subd. 8.
Content of notice of termination.
The notice required under subdivision 7
must contain, at a minimum:
(1) the effective date of the termination of the assisted living contract;
(2) a detailed explanation of the basis for the termination, including the clinical or other
supporting rationale;
(3) a detailed explanation of the conditions under which a new or amended contract may
be executed;
(4) a statement that the resident has the right to appeal the termination by requesting a
hearing, and information concerning the time frame within which the request must be
submitted and the contact information for the agency to which the request must be submitted;
(5) a statement that the facility must participate in a coordinated move to another provider
or caregiver, as required under section 144G.55;
(6) the name and contact information of the person employed by the facility with whom
the resident may discuss the notice of termination;
(7) information on how to contact the Office of Ombudsman for Long-Term Care new text begin and
the Office of Ombudsman for Mental Health and Developmental Disabilities new text end to request an
advocate to assist regarding the termination;
(8) information on how to contact the Senior LinkAge Line under section 256.975,
subdivision 7, and an explanation that the Senior LinkAge Line may provide information
about other available housing or service options; and
(9) if the termination is only for services, a statement that the resident may remain in
the facility and may secure any necessary services from another provider of the resident's
choosing.
Sec. 47.
Minnesota Statutes 2020, section 144G.52, subdivision 9, is amended to read:
Subd. 9.
Emergency relocation.
(a) A facility may remove a resident from the facility
in an emergency if necessary due to a resident's urgent medical needs or an imminent risk
the resident poses to the health or safety of another facility resident or facility staff member.
An emergency relocation is not a termination.
(b) In the event of an emergency relocation, the facility must provide a written notice
that contains, at a minimum:
(1) the reason for the relocation;
(2) the name and contact information for the location to which the resident has been
relocated and any new service provider;
(3) contact information for the Office of Ombudsman for Long-Term Carenew text begin and the Office
of Ombudsman for Mental Health and Developmental Disabilitiesnew text end ;
(4) if known and applicable, the approximate date or range of dates within which the
resident is expected to return to the facility, or a statement that a return date is not currently
known; and
(5) a statement that, if the facility refuses to provide housing or services after a relocation,
the resident has the right to appeal under section 144G.54. The facility must provide contact
information for the agency to which the resident may submit an appeal.
(c) The notice required under paragraph (b) must be delivered as soon as practicable to:
(1) the resident, legal representative, and designated representative;
(2) for residents who receive home and community-based waiver services under chapter
256S and section 256B.49, the resident's case manager; and
(3) the Office of Ombudsman for Long-Term Care if the resident has been relocated
and has not returned to the facility within four days.
(d) Following an emergency relocation, a facility's refusal to provide housing or services
constitutes a termination and triggers the termination process in this section.
Sec. 48.
Minnesota Statutes 2020, section 144G.53, is amended to read:
144G.53 NONRENEWAL OF HOUSING.
(a) If a facility decides to not renew a resident's housing under a contract, the facility
must either (1) provide the resident with 60 calendar days' notice of the nonrenewal and
assistance with relocation planning, or (2) follow the termination procedure under section
144G.52.
(b) The notice must include the reason for the nonrenewal and contact information of
the Office of Ombudsman for Long-Term Carenew text begin and the Office of Ombudsman for Mental
Health and Developmental Disabilitiesnew text end .
(c) A facility must:
(1) provide notice of the nonrenewal to the Office of Ombudsman for Long-Term Care;
(2) for residents who receive home and community-based waiver services under chapter
256S and section 256B.49, provide notice to the resident's case manager;
(3) ensure a coordinated move to a safe location, as defined in section 144G.55,
subdivision 2, that is appropriate for the resident;
(4) ensure a coordinated move to an appropriate service provider identified by the facility,
if services are still needed and desired by the resident;
(5) consult and cooperate with the resident, legal representative, designated representative,
case manager for a resident who receives home and community-based waiver services under
chapter 256S and section 256B.49, relevant health professionals, and any other persons of
the resident's choosing to make arrangements to move the resident, including consideration
of the resident's goals; and
(6) prepare a written plan to prepare for the move.
(d) A resident may decline to move to the location the facility identifies or to accept
services from a service provider the facility identifies, and may instead choose to move to
a location of the resident's choosing or receive services from a service provider of the
resident's choosing within the timeline prescribed in the nonrenewal notice.
Sec. 49.
Minnesota Statutes 2020, section 144G.55, subdivision 1, is amended to read:
Subdivision 1.
Duties of facility.
(a) If a facility terminates an assisted living contract,
reduces services to the extent that a resident needs to movenew text begin or obtain a new service provider
because of a reduction or elimination of services or the facility has its license restricted
under section 144G.20new text end , or new text begin the facility new text end conducts a planned closure under section 144G.57,
the facility:
(1) must ensure, subject to paragraph (c), a coordinated move to a safe location that is
appropriate for the resident and that is identified by the facility prior to any hearing under
section 144G.54;
(2) must ensure a coordinated move of the resident to an appropriate service provider
identified by the facility prior to any hearing under section 144G.54, provided services are
still needed and desired by the resident; and
(3) must consult and cooperate with the resident, legal representative, designated
representative, case manager for a resident who receives home and community-based waiver
services under chapter 256S and section 256B.49, relevant health professionals, and any
other persons of the resident's choosing to make arrangements to move the resident, including
consideration of the resident's goals.
(b) A facility may satisfy the requirements of paragraph (a), clauses (1) and (2), by
moving the resident to a different location within the same facility, if appropriate for the
resident.
(c) A resident may decline to move to the location the facility identifies or to accept
services from a service provider the facility identifies, and may choose instead to move to
a location of the resident's choosing or receive services from a service provider of the
resident's choosing within the timeline prescribed in the termination notice.
(d) Sixty days before the facility plans to reduce or eliminate one or more services for
a particular resident, the facility must provide written notice of the reduction that includes:
(1) a detailed explanation of the reasons for the reduction and the date of the reduction;
(2) the contact information for the Office of Ombudsman for Long-Term Carenew text begin , the Office
of Ombudsman for Mental Health and Developmental Disabilities,new text end and the name and contact
information of the person employed by the facility with whom the resident may discuss the
reduction of services;
(3) a statement that if the services being reduced are still needed by the resident, the
resident may remain in the facility and seek services from another provider; and
(4) a statement that if the reduction makes the resident need to move, the facility must
participate in a coordinated move of the resident to another provider or caregiver, as required
under this section.
(e) In the event of an unanticipated reduction in services caused by extraordinary
circumstances, the facility must provide the notice required under paragraph (d) as soon as
possible.
(f) If the facility, a resident, a legal representative, or a designated representative
determines that a reduction in services will make a resident need to move to a new location,
the facility must ensure a coordinated move in accordance with this section, and must provide
notice to the Office of Ombudsman for Long-Term Care.
(g) Nothing in this section affects a resident's right to remain in the facility and seek
services from another provider.
Sec. 50.
Minnesota Statutes 2020, section 144G.55, subdivision 3, is amended to read:
Subd. 3.
Relocation plan required.
The facility must prepare a relocation plan to prepare
for the move to deleted text begin thedeleted text end new text begin anew text end new new text begin safe new text end location or new text begin appropriate new text end service providernew text begin , as required by this
sectionnew text end .
Sec. 51.
Minnesota Statutes 2020, section 144G.56, subdivision 3, is amended to read:
Subd. 3.
Notice required.
(a) A facility must provide at least 30 calendar days' advance
written notice to the resident and the resident's legal and designated representative of a
facility-initiated transfer. The notice must include:
(1) the effective date of the proposed transfer;
(2) the proposed transfer location;
(3) a statement that the resident may refuse the proposed transfer, and may discuss any
consequences of a refusal with staff of the facility;
(4) the name and contact information of a person employed by the facility with whom
the resident may discuss the notice of transfer; and
(5) contact information for the Office of Ombudsman for Long-Term Carenew text begin and the Office
of Ombudsman for Mental Health and Developmental Disabilitiesnew text end .
(b) Notwithstanding paragraph (a), a facility may conduct a facility-initiated transfer of
a resident with less than 30 days' written notice if the transfer is necessary due to:
(1) conditions that render the resident's room or private living unit uninhabitable;
(2) the resident's urgent medical needs; or
(3) a risk to the health or safety of another resident of the facility.
Sec. 52.
Minnesota Statutes 2020, section 144G.56, subdivision 5, is amended to read:
Subd. 5.
Changes in facility operations.
(a) In situations where there is a curtailment,
reduction, or capital improvement within a facility necessitating transfers, the facility must:
(1) minimize the number of transfers it initiates to complete the project or change in
operations;
(2) consider individual resident needs and preferences;
(3) provide reasonable accommodations for individual resident requests regarding the
transfers; and
(4) in advance of any notice to any residents, legal representatives, or designated
representatives, provide notice to the Office of Ombudsman for Long-Term Care anddeleted text begin , when
appropriate,deleted text end the Office of Ombudsman for Mental Health and Developmental Disabilities
of the curtailment, reduction, or capital improvement and the corresponding needed transfers.
Sec. 53.
Minnesota Statutes 2020, section 144G.57, subdivision 1, is amended to read:
Subdivision 1.
Closure plan required.
In the event that an assisted living facility elects
to voluntarily close the facility, the facility must notify the commissioner deleted text begin anddeleted text end new text begin ,new text end the Office
of Ombudsman for Long-Term Carenew text begin , and the Office of Ombudsman for Mental Health and
Developmental Disabilitiesnew text end in writing by submitting a proposed closure plan.
Sec. 54.
Minnesota Statutes 2020, section 144G.57, subdivision 3, is amended to read:
Subd. 3.
Commissioner's approval required prior to implementation.
(a) The plan
shall be subject to the commissioner's approval and subdivision 6. The facility shall take
no action to close the residence prior to the commissioner's approval of the plan. The
commissioner shall approve or otherwise respond to the plan as soon as practicable.
(b) The commissioner may require the facility to work with a transitional team comprised
of department staff, staff of the Office of Ombudsman for Long-Term Care, new text begin the Office of
Ombudsman for Mental Health and Developmental Disabilities, new text end and other professionals the
commissioner deems necessary to assist in the proper relocation of residents.
Sec. 55.
Minnesota Statutes 2020, section 144G.57, subdivision 5, is amended to read:
Subd. 5.
Notice to residents.
After the commissioner has approved the relocation plan
and at least 60 calendar days before closing, except as provided under subdivision 6, the
facility must notify residents, designated representatives, and legal representatives of the
closure, the proposed date of closure, the contact information of the ombudsman for long-term
carenew text begin and the ombudsman for mental health and developmental disabilitiesnew text end , and that the
facility will follow the termination planning requirements under section 144G.55, and final
accounting and return requirements under section 144G.42, subdivision 5. For residents
who receive home and community-based waiver services under chapter 256S and section
256B.49, the facility must also provide this information to the resident's case manager.
Sec. 56.
Minnesota Statutes 2020, section 144G.70, subdivision 2, is amended to read:
Subd. 2.
Initial reviews, assessments, and monitoring.
(a) Residents who are not
receiving any new text begin assisted living new text end services shall not be required to undergo an initial nursing
assessment.
(b) An assisted living facility shall conduct a nursing assessment by a registered nurse
of the physical and cognitive needs of the prospective resident and propose a temporary
service plan prior to the date on which a prospective resident executes a contract with a
facility or the date on which a prospective resident moves in, whichever is earlier. If
necessitated by either the geographic distance between the prospective resident and the
facility, or urgent or unexpected circumstances, the assessment may be conducted using
telecommunication methods based on practice standards that meet the resident's needs and
reflect person-centered planning and care delivery.
(c) Resident reassessment and monitoring must be conducted no more than 14 calendar
days after initiation of services. Ongoing resident reassessment and monitoring must be
conducted as needed based on changes in the needs of the resident and cannot exceed 90
calendar days from the last date of the assessment.
(d) For residents only receiving assisted living services specified in section 144G.08,
subdivision 9, clauses (1) to (5), the facility shall complete an individualized initial review
of the resident's needs and preferences. The initial review must be completed within 30
calendar days of the start of services. Resident monitoring and review must be conducted
as needed based on changes in the needs of the resident and cannot exceed 90 calendar days
from the date of the last review.
(e) A facility must inform the prospective resident of the availability of and contact
information for long-term care consultation services under section 256B.0911, prior to the
date on which a prospective resident executes a contract with a facility or the date on which
a prospective resident moves in, whichever is earlier.
Sec. 57.
Minnesota Statutes 2020, section 144G.70, subdivision 4, is amended to read:
Subd. 4.
Service plan, implementation, and revisions to service plan.
(a) No later
than 14 calendar days after the date that services are first provided, an assisted living facility
shall finalize a current written service plan.
(b) The service plan and any revisions must include a signature or other authentication
by the facility and by the resident documenting agreement on the services to be provided.
The service plan must be revised, if needed, based on resident reassessment under subdivision
2. The facility must provide information to the resident about changes to the facility's fee
for services and how to contact the Office of Ombudsman for Long-Term Carenew text begin and the
Office of Ombudsman for Mental Health and Developmental Disabilitiesnew text end .
(c) The facility must implement and provide all services required by the current service
plan.
(d) The service plan and the revised service plan must be entered into the resident record,
including notice of a change in a resident's fees when applicable.
(e) Staff providing services must be informed of the current written service plan.
(f) The service plan must include:
(1) a description of the services to be provided, the fees for services, and the frequency
of each service, according to the resident's current assessment and resident preferences;
(2) the identification of staff or categories of staff who will provide the services;
(3) the schedule and methods of monitoring assessments of the resident;
(4) the schedule and methods of monitoring staff providing services; and
(5) a contingency plan that includes:
(i) the action to be taken if the scheduled service cannot be provided;
(ii) information and a method to contact the facility;
(iii) the names and contact information of persons the resident wishes to have notified
in an emergency or if there is a significant adverse change in the resident's condition,
including identification of and information as to who has authority to sign for the resident
in an emergency; and
(iv) the circumstances in which emergency medical services are not to be summoned
consistent with chapters 145B and 145C, and declarations made by the resident under those
chapters.
Sec. 58.
Minnesota Statutes 2020, section 144G.80, subdivision 2, is amended to read:
Subd. 2.
Demonstrated capacity.
(a) An applicant for licensure as an assisted living
facility with dementia care must have the ability to provide services in a manner that is
consistent with the requirements in this section. The commissioner shall consider the
following criteria, including, but not limited to:
(1) the experience of the deleted text begin applicant indeleted text end new text begin applicant's assisted living director, managerial
official, and clinical nurse supervisornew text end managing residents with dementia or previous long-term
care experience; and
(2) the compliance history of the applicant in the operation of any care facility licensed,
certified, or registered under federal or state law.
(b) If the deleted text begin applicant doesdeleted text end new text begin applicant's assisted living director, managerial official, and
clinical nurse supervisor donew text end not have experience in managing residents with dementia, the
applicant must employ a consultant for at least the first six months of operation. The
consultant must meet the requirements in paragraph (a), clause (1), and make
recommendations on providing dementia care services consistent with the requirements of
this chapter. The consultant must (1) have two years of work experience related to dementia,
health care, gerontology, or a related field, and (2) have completed at least the minimum
core training requirements in section 144G.64. The applicant must document an acceptable
plan to address the consultant's identified concerns and must either implement the
recommendations or document in the plan any consultant recommendations that the applicant
chooses not to implement. The commissioner must review the applicant's plan upon request.
(c) The commissioner shall conduct an on-site inspection prior to the issuance of an
assisted living facility with dementia care license to ensure compliance with the physical
environment requirements.
(d) The label "Assisted Living Facility with Dementia Care" must be identified on the
license.
Sec. 59.
Minnesota Statutes 2020, section 144G.90, subdivision 1, is amended to read:
Subdivision 1.
Assisted living bill of rights; notification to resident.
(a) An assisted
living facility must provide the resident a written notice of the rights under section 144G.91
before the initiation of services to that resident. The facility shall make all reasonable efforts
to provide notice of the rights to the resident in a language the resident can understand.
(b) In addition to the text of the assisted living bill of rights in section 144G.91, the
notice shall also contain the following statement describing how to file a complaint or report
suspected abuse:
"If you want to report suspected abuse, neglect, or financial exploitation, you may contact
the Minnesota Adult Abuse Reporting Center (MAARC). If you have a complaint about
the facility or person providing your services, you may contact the Office of Health Facility
Complaints, Minnesota Department of Health. new text begin If you would like to request advocacy services,
new text end you may deleted text begin alsodeleted text end contact the Office of Ombudsman for Long-Term Care or the Office of
Ombudsman for Mental Health and Developmental Disabilities."
(c) The statement must include contact information for the Minnesota Adult Abuse
Reporting Center and the telephone number, website address, e-mail address, mailing
address, and street address of the Office of Health Facility Complaints at the Minnesota
Department of Health, the Office of Ombudsman for Long-Term Care, and the Office of
Ombudsman for Mental Health and Developmental Disabilities. The statement must include
the facility's name, address, e-mail, telephone number, and name or title of the person at
the facility to whom problems or complaints may be directed. It must also include a statement
that the facility will not retaliate because of a complaint.
(d) A facility must obtain written acknowledgment from the resident of the resident's
receipt of the assisted living bill of rights or shall document why an acknowledgment cannot
be obtained. Acknowledgment of receipt shall be retained in the resident's record.
Sec. 60.
Minnesota Statutes 2020, section 144G.90, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin Notice to residents. new text end
new text begin
For any notice to a resident, legal representative, or
designated representative provided under this chapter or under Minnesota Rules, chapter
4659, that is required to include information regarding the Office of Ombudsman for
Long-Term Care and the Office of Ombudsman for Mental Health and Developmental
Disabilities, the notice must contain the following language: "You may contact the
Ombudsman for Long-Term Care for questions about your rights as an assisted living facility
resident and to request advocacy services. As an assisted living facility resident, you may
contact the Ombudsman for Mental Health and Developmental Disabilities to request
advocacy regarding your rights, concerns, or questions on issues relating to services for
mental health, developmental disabilities, or chemical dependency."
new text end
Sec. 61.
Minnesota Statutes 2020, section 144G.91, subdivision 13, is amended to read:
Subd. 13.
Personal and treatment privacy.
(a) Residents have the right to consideration
of their privacy, individuality, and cultural identity as related to their social, religious, and
psychological well-being. Staff must respect the privacy of a resident's space by knocking
on the door and seeking consent before entering, except in an emergency or deleted text begin where clearly
inadvisable ordeleted text end unless otherwise documented in the resident's service plan.
(b) Residents have the right to have and use a lockable door to the resident's unit. The
facility shall provide locks on the resident's unit. Only a staff member with a specific need
to enter the unit shall have keys. This right may be restricted in certain circumstances if
necessary for a resident's health and safety and documented in the resident's service plan.
(c) Residents have the right to respect and privacy regarding the resident's service plan.
Case discussion, consultation, examination, and treatment are confidential and must be
conducted discreetly. Privacy must be respected during toileting, bathing, and other activities
of personal hygiene, except as needed for resident safety or assistance.
Sec. 62.
Minnesota Statutes 2020, section 144G.91, subdivision 21, is amended to read:
Subd. 21.
Access to counsel and advocacy services.
Residents have the right to the
immediate access by:
(1) the resident's legal counsel;
(2) any representative of the protection and advocacy system designated by the state
under Code of Federal Regulations, title 45, section 1326.21; or
(3) any representative of the Office of Ombudsman for Long-Term Carenew text begin or the Office
of Ombudsman for Mental Health and Developmental Disabilitiesnew text end .
Sec. 63.
Minnesota Statutes 2020, section 144G.92, subdivision 1, is amended to read:
Subdivision 1.
Retaliation prohibited.
A facility or agent of a facility may not retaliate
against a resident or employee if the resident, employee, or any person acting on behalf of
the resident:
(1) files a good faith complaint or grievance, makes a good faith inquiry, or asserts any
right;
(2) indicates a good faith intention to file a complaint or grievance, make an inquiry, or
assert any right;
(3) files, in good faith, or indicates an intention to file a maltreatment report, whether
mandatory or voluntary, under section 626.557;
(4) seeks assistance from or reports a reasonable suspicion of a crime or systemic
problems or concerns to the director or manager of the facility, the Office of Ombudsman
for Long-Term Care, new text begin the Office of Ombudsman for Mental Health and Developmental
Disabilities, new text end a regulatory or other government agency, or a legal or advocacy organization;
(5) advocates or seeks advocacy assistance for necessary or improved care or services
or enforcement of rights under this section or other law;
(6) takes or indicates an intention to take civil action;
(7) participates or indicates an intention to participate in any investigation or
administrative or judicial proceeding;
(8) contracts or indicates an intention to contract to receive services from a service
provider of the resident's choice other than the facility; or
(9) places or indicates an intention to place a camera or electronic monitoring device in
the resident's private space as provided under section 144.6502.
Sec. 64.
Minnesota Statutes 2020, section 144G.93, is amended to read:
144G.93 CONSUMER ADVOCACY AND LEGAL SERVICES.
Upon execution of an assisted living contract, every facility must provide the resident
with the names and contact information, including telephone numbers and e-mail addresses,
of:
(1) nonprofit organizations that provide advocacy or legal services to residents including
but not limited to the designated protection and advocacy organization in Minnesota that
provides advice and representation to individuals with disabilities; and
(2) the Office of Ombudsman for Long-Term Caredeleted text begin , including both the state and regional
contact informationdeleted text end new text begin and the Office of Ombudsman for Mental Health and Developmental
Disabilitiesnew text end .
Sec. 65.
Minnesota Statutes 2020, section 144G.95, is amended to read:
144G.95 OFFICE OF OMBUDSMAN FOR LONG-TERM CAREnew text begin AND OFFICE
OF OMBUDSMAN FOR MENTAL HEALTH AND DEVELOPMENTAL
DISABILITIESnew text end .
Subdivision 1.
Immunity from liability.
new text begin (a) new text end The Office of Ombudsman for Long-Term
Care and representatives of the office are immune from liability for conduct described in
section 256.9742, subdivision 2.
new text begin
(b) The Office of Ombudsman for Mental Health and Developmental Disabilities and
representatives of the office are immune from liability for conduct described in section
245.96.
new text end
Subd. 2.
Data classification.
new text begin (a) new text end All forms and notices received by the Office of
Ombudsman for Long-Term Care under this chapter are classified under section 256.9744.
new text begin
(b) All data collected or received by the Office of Ombudsman for Mental Health and
Developmental Disabilities are classified under section 245.94.
new text end
Sec. 66.
new text begin
[145.9231] HEALTH EQUITY ADVISORY AND LEADERSHIP (HEAL)
COUNCIL.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment; composition of advisory council. new text end
new text begin
(a) The commissioner
shall establish and appoint a Health Equity Advisory and Leadership (HEAL) Council to
provide guidance to the commissioner of health regarding strengthening and improving the
health of communities most impacted by health inequities across the state. The council shall
consist of 18 members who will provide representation from the following groups:
new text end
new text begin
(1) African American and African heritage communities;
new text end
new text begin
(2) Asian American and Pacific Islander communities;
new text end
new text begin
(3) Latina/o/x communities;
new text end
new text begin
(4) American Indian communities and Tribal Government/Nations;
new text end
new text begin
(5) disability communities;
new text end
new text begin
(6) lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities; and
new text end
new text begin
(7) representatives who reside outside the seven-county metropolitan area.
new text end
new text begin
(b) No members shall be employees of the Minnesota Department of Health.
new text end
new text begin Subd. 2. new text end
new text begin Organization and meetings. new text end
new text begin
The advisory council shall be organized and
administered under section 15.059, except that the members do not receive per diem
compensation. Meetings shall be held at least quarterly and hosted by the department.
Subcommittees may be developed as necessary. Advisory council meetings are subject to
Open Meeting Law under chapter 13D.
new text end
new text begin Subd. 3. new text end
new text begin Duties. new text end
new text begin
The advisory council shall:
new text end
new text begin
(1) advise the commissioner on health equity issues and the health equity priorities and
concerns of the populations specified in subdivision 1;
new text end
new text begin
(2) assist the agency in efforts to advance health equity, including consulting in specific
agency policies and programs, providing ideas and input about potential budget and policy
proposals, and recommending review of particular agency policies, standards, or procedures
that may create or perpetuate health inequities; and
new text end
new text begin
(3) assist the agency in developing and monitoring meaningful performance measures
related to advancing health equity.
new text end
new text begin Subd. 4. new text end
new text begin Expiration. new text end
new text begin
Notwithstanding section 15.059, subdivision 6, the advisory council
shall remain in existence until health inequities in the state are eliminated. Health inequities
will be considered eliminated when race, ethnicity, income, gender, gender identity,
geographic location, or other identity or social marker will no longer be predictors of health
outcomes in the state. Section 145.928 describes nine health disparities that must be
considered when determining whether health inequities have been eliminated in the state.
new text end
Sec. 67.
Minnesota Statutes 2020, section 146B.04, subdivision 1, is amended to read:
Subdivision 1.
General.
Before an individual may work as a guest artist, the
commissioner shall issue a temporary license to the guest artist. The guest artist shall submit
an application to the commissioner on a form provided by the commissioner. new text begin The
commissioner must receive the application at least 14 calendar days before the guest artist
applicant conducts a body art procedure. new text end The form must include:
(1) the name, home address, and date of birth of the guest artist;
(2) the name of the licensed technician sponsoring the guest artist;
(3) proof of having satisfactorily completed coursework within the year preceding
application and approved by the commissioner on bloodborne pathogens, the prevention of
disease transmission, infection control, and aseptic technique;
(4) the starting and anticipated completion dates the guest artist will be working; and
(5) a copy of any current body art credential or licensure issued by another local or state
jurisdiction.
Sec. 68.
Minnesota Statutes 2020, section 152.22, subdivision 8, is amended to read:
Subd. 8.
Medical cannabis deleted text begin productdeleted text end new text begin paraphernalianew text end .
"Medical cannabis deleted text begin productdeleted text end new text begin
paraphernalianew text end " means any delivery device or related supplies and educational materials used
in the administration of medical cannabis for a patient with a qualifying medical condition
enrolled in the registry program.
Sec. 69.
Minnesota Statutes 2020, section 152.25, subdivision 1, is amended to read:
Subdivision 1.
Medical cannabis manufacturer registration.
(a) The commissioner
shall register two in-state manufacturers for the production of all medical cannabis within
the state. A registration agreement between the commissioner and a manufacturer is
nontransferable. The commissioner shall register new manufacturers or reregister the existing
manufacturers by December 1 every two years, using the factors described in this subdivision.
The commissioner shall accept applications after December 1, 2014, if one of the
manufacturers registered before December 1, 2014, ceases to be registered as a manufacturer.
The commissioner's determination that no manufacturer exists to fulfill the duties under
sections 152.22 to 152.37 is subject to judicial review in Ramsey County District Court.
Data submitted during the application process are private data on individuals or nonpublic
data as defined in section 13.02 until the manufacturer is registered under this section. Data
on a manufacturer that is registered are public data, unless the data are trade secret or security
information under section 13.37.
(b) As a condition for registration, a manufacturer must agree to:
(1) begin supplying medical cannabis to patients deleted text begin by July 1, 2015deleted text end new text begin within eight months
of its initial registrationnew text end ; and
(2) comply with all requirements under sections 152.22 to 152.37.
(c) The commissioner shall consider the following factors when determining which
manufacturer to register:
(1) the technical expertise of the manufacturer in cultivating medical cannabis and
converting the medical cannabis into an acceptable delivery method under section 152.22,
subdivision 6;
(2) the qualifications of the manufacturer's employees;
(3) the long-term financial stability of the manufacturer;
(4) the ability to provide appropriate security measures on the premises of the
manufacturer;
(5) whether the manufacturer has demonstrated an ability to meet the medical cannabis
production needs required by sections 152.22 to 152.37; and
(6) the manufacturer's projection and ongoing assessment of fees on patients with a
qualifying medical condition.
(d) If an officer, director, or controlling person of the manufacturer pleads or is found
guilty of intentionally diverting medical cannabis to a person other than allowed by law
under section 152.33, subdivision 1, the commissioner may decide not to renew the
registration of the manufacturer, provided the violation occurred while the person was an
officer, director, or controlling person of the manufacturer.
(e) The commissioner shall require each medical cannabis manufacturer to contract with
an independent laboratory to test medical cannabis produced by the manufacturer. The
commissioner shall approve the laboratory chosen by each manufacturer and require that
the laboratory report testing results to the manufacturer in a manner determined by the
commissioner.
new text begin
(f) The commissioner shall implement a state-centralized medical cannabis electronic
database to monitor and track the manufacturers' medical cannabis inventories from the
seed or clone source through cultivation, processing, testing, and distribution or disposal.
The inventory tracking database must allow for information regarding medical cannabis to
be updated instantaneously. Any manufacturer or third-party laboratory licensed under this
chapter must submit to the commissioner any information the commissioner deems necessary
for maintaining the inventory tracking database. The commissioner may contract with a
separate entity to establish and maintain all or any part of the inventory tracking database.
The provisions of section 13.05, subdivision 11, apply to a contract entered between the
commissioner and a third party under this paragraph.
new text end
Sec. 70.
Minnesota Statutes 2021 Supplement, section 152.27, subdivision 2, is amended
to read:
Subd. 2.
Commissioner duties.
(a) The commissioner shall:
(1) give notice of the program to health care practitioners in the state who are eligible
to serve as health care practitioners and explain the purposes and requirements of the
program;
(2) allow each health care practitioner who meets or agrees to meet the program's
requirements and who requests to participate, to be included in the registry program to
collect data for the patient registry;
(3) provide explanatory information and assistance to each health care practitioner in
understanding the nature of therapeutic use of medical cannabis within program requirements;
(4) create and provide a certification to be used by a health care practitioner for the
practitioner to certify whether a patient has been diagnosed with a qualifying medical
condition deleted text begin and include in the certification an option for the practitioner to certify whether
the patient, in the health care practitioner's medical opinion, is developmentally or physically
disabled and, as a result of that disability, the patient requires assistance in administering
medical cannabis or obtaining medical cannabis from a distribution facilitydeleted text end ;
(5) supervise the participation of the health care practitioner in conducting patient
treatment and health records reporting in a manner that ensures stringent security and
record-keeping requirements and that prevents the unauthorized release of private data on
individuals as defined by section 13.02;
(6) develop safety criteria for patients with a qualifying medical condition as a
requirement of the patient's participation in the program, to prevent the patient from
undertaking any task under the influence of medical cannabis that would constitute negligence
or professional malpractice on the part of the patient; and
(7) conduct research and studies based on data from health records submitted to the
registry program and submit reports on intermediate or final research results to the legislature
and major scientific journals. The commissioner may contract with a third party to complete
the requirements of this clause. Any reports submitted must comply with section 152.28,
subdivision 2.
(b) The commissioner may add a delivery method under section 152.22, subdivision 6,
or add, remove, or modify a qualifying medical condition under section 152.22, subdivision
14, upon a petition from a member of the public or the task force on medical cannabis
therapeutic research or as directed by law. The commissioner shall evaluate all petitions to
add a qualifying medical condition or to remove or modify an existing qualifying medical
condition submitted by the task force on medical cannabis therapeutic research or as directed
by law and may make the addition, removal, or modification if the commissioner determines
the addition, removal, or modification is warranted based on the best available evidence
and research. If the commissioner wishes to add a delivery method under section 152.22,
subdivision 6, or add or remove a qualifying medical condition under section 152.22,
subdivision 14, the commissioner must notify the chairs and ranking minority members of
the legislative policy committees having jurisdiction over health and public safety of the
addition or removal and the reasons for its addition or removal, including any written
comments received by the commissioner from the public and any guidance received from
the task force on medical cannabis research, by January 15 of the year in which the
commissioner wishes to make the change. The change shall be effective on August 1 of that
year, unless the legislature by law provides otherwise.
Sec. 71.
Minnesota Statutes 2021 Supplement, section 152.29, subdivision 1, is amended
to read:
Subdivision 1.
Manufacturer; requirements.
(a) A manufacturer may operate eight
distribution facilities, which may include the manufacturer's single location for cultivation,
harvesting, manufacturing, packaging, and processing but is not required to include that
location. The commissioner shall designate the geographical service areas to be served by
each manufacturer based on geographical need throughout the state to improve patient
access. A manufacturer shall not have more than two distribution facilities in each
geographical service area assigned to the manufacturer by the commissioner. A manufacturer
shall operate only one location where all cultivation, harvesting, manufacturing, packaging,
and processing of medical cannabis shall be conducted. This location may be one of the
manufacturer's distribution facility sites. The additional distribution facilities may dispense
medical cannabis and medical cannabis deleted text begin productsdeleted text end new text begin paraphernalianew text end but may not contain any
medical cannabis in a form other than those forms allowed under section 152.22, subdivision
6, and the manufacturer shall not conduct any cultivation, harvesting, manufacturing,
packaging, or processing at the other distribution facility sites. Any distribution facility
operated by the manufacturer is subject to all of the requirements applying to the
manufacturer under sections 152.22 to 152.37, including, but not limited to, security and
distribution requirements.
(b) A manufacturer may acquire hemp grown in this state from a hemp grower, and may
acquire hemp products produced by a hemp processor. A manufacturer may manufacture
or process hemp and hemp products into an allowable form of medical cannabis under
section 152.22, subdivision 6. Hemp and hemp products acquired by a manufacturer under
this paragraph are subject to the same quality control program, security and testing
requirements, and other requirements that apply to medical cannabis under sections 152.22
to 152.37 and Minnesota Rules, chapter 4770.
(c) A medical cannabis manufacturer shall contract with a laboratory approved by the
commissioner, subject to any additional requirements set by the commissioner, for purposes
of testing medical cannabis manufactured or hemp or hemp products acquired by the medical
cannabis manufacturer as to content, contamination, and consistency to verify the medical
cannabis meets the requirements of section 152.22, subdivision 6.new text begin The laboratory must
collect, or contract with a third party that is not a manufacturer to collect, from the
manufacturer's production facility the medical cannabis samples it will test.new text end The cost ofnew text begin
collecting samples andnew text end laboratory testing shall be paid by the manufacturer.
(d) The operating documents of a manufacturer must include:
(1) procedures for the oversight of the manufacturer and procedures to ensure accurate
record keeping;
(2) procedures for the implementation of appropriate security measures to deter and
prevent the theft of medical cannabis and unauthorized entrance into areas containing medical
cannabis; and
(3) procedures for the delivery and transportation of hemp between hemp growers and
manufacturers and for the delivery and transportation of hemp products between hemp
processors and manufacturers.
(e) A manufacturer shall implement security requirements, including requirements for
the delivery and transportation of hemp and hemp products, protection of each location by
a fully operational security alarm system, facility access controls, perimeter intrusion
detection systems, and a personnel identification system.
(f) A manufacturer shall not share office space with, refer patients to a health care
practitioner, or have any financial relationship with a health care practitioner.
(g) A manufacturer shall not permit any person to consume medical cannabis on the
property of the manufacturer.
(h) A manufacturer is subject to reasonable inspection by the commissioner.
(i) For purposes of sections 152.22 to 152.37, a medical cannabis manufacturer is not
subject to the Board of Pharmacy licensure or regulatory requirements under chapter 151.
(j) A medical cannabis manufacturer may not employ any person who is under 21 years
of age or who has been convicted of a disqualifying felony offense. An employee of a
medical cannabis manufacturer must submit a completed criminal history records check
consent form, a full set of classifiable fingerprints, and the required fees for submission to
the Bureau of Criminal Apprehension before an employee may begin working with the
manufacturer. The bureau must conduct a Minnesota criminal history records check and
the superintendent is authorized to exchange the fingerprints with the Federal Bureau of
Investigation to obtain the applicant's national criminal history record information. The
bureau shall return the results of the Minnesota and federal criminal history records checks
to the commissioner.
(k) A manufacturer may not operate in any location, whether for distribution or
cultivation, harvesting, manufacturing, packaging, or processing, within 1,000 feet of a
public or private school existing before the date of the manufacturer's registration with the
commissioner.
(l) A manufacturer shall comply with reasonable restrictions set by the commissioner
relating to signage, marketing, display, and advertising of medical cannabis.
(m) Before a manufacturer acquires hemp from a hemp grower or hemp products from
a hemp processor, the manufacturer must verify that the hemp grower or hemp processor
has a valid license issued by the commissioner of agriculture under chapter 18K.
(n) Until a state-centralized, seed-to-sale system is implemented that can track a specific
medical cannabis plant from cultivation through testing and point of sale, the commissioner
shall conduct at least one unannounced inspection per year of each manufacturer that includes
inspection of:
(1) business operations;
(2) physical locations of the manufacturer's manufacturing facility and distribution
facilities;
(3) financial information and inventory documentation, including laboratory testing
results; and
(4) physical and electronic security alarm systems.
Sec. 72.
Minnesota Statutes 2021 Supplement, section 152.29, subdivision 3, is amended
to read:
Subd. 3.
Manufacturer; distribution.
(a) A manufacturer shall require that employees
licensed as pharmacists pursuant to chapter 151 be the only employees to give final approval
for the distribution of medical cannabis to a patient. A manufacturer may transport medical
cannabis or medical cannabis deleted text begin productsdeleted text end new text begin paraphernalianew text end that have been cultivated, harvested,
manufactured, packaged, and processed by that manufacturer to another registered
manufacturer for the other manufacturer to distribute.
(b) A manufacturer may distribute medical cannabis deleted text begin productsdeleted text end new text begin paraphernalianew text end , whether
or not the deleted text begin productsdeleted text end new text begin medical cannabis paraphernalianew text end have been manufactured by that
manufacturer.
(c) Prior to distribution of any medical cannabis, the manufacturer shall:
(1) verify that the manufacturer has received the registry verification from the
commissioner for that individual patient;
(2) verify that the person requesting the distribution of medical cannabis is the patient,
the patient's registered designated caregiver, or the patient's parent, legal guardian, or spouse
listed in the registry verification using the procedures described in section 152.11, subdivision
2d;
(3) assign a tracking number to any medical cannabis distributed from the manufacturer;
(4) ensure that any employee of the manufacturer licensed as a pharmacist pursuant to
chapter 151 has consulted with the patient to determine the proper dosage for the individual
patient after reviewing the ranges of chemical compositions of the medical cannabis and
the ranges of proper dosages reported by the commissioner. For purposes of this clause, a
consultation may be conducted remotely by secure videoconference, telephone, or other
remote means, so long as the employee providing the consultation is able to confirm the
identity of the patient and the consultation adheres to patient privacy requirements that apply
to health care services delivered through telehealth. A pharmacist consultation under this
clause is not required when a manufacturer is distributing medical cannabis to a patient
according to a patient-specific dosage plan established with that manufacturer and is not
modifying the dosage or product being distributed under that plan and the medical cannabis
is distributed by a pharmacy technician;
(5) properly package medical cannabis in compliance with the United States Poison
Prevention Packing Act regarding child-resistant packaging and exemptions for packaging
for elderly patients, and label distributed medical cannabis with a list of all active ingredients
and individually identifying information, including:
(i) the patient's name and date of birth;
(ii) the name and date of birth of the patient's registered designated caregiver or, if listed
on the registry verification, the name of the patient's parent or legal guardian, if applicable;
(iii) the patient's registry identification number;
(iv) the chemical composition of the medical cannabis; and
(v) the dosage; and
(6) ensure that the medical cannabis distributed contains a maximum of a 90-day supply
of the dosage determined for that patient.
(d) A manufacturer shall require any employee of the manufacturer who is transporting
medical cannabis or medical cannabis deleted text begin productsdeleted text end new text begin paraphernalianew text end to a distribution facility or to
another registered manufacturer to carry identification showing that the person is an employee
of the manufacturer.
(e) A manufacturer shall distribute medical cannabis in dried raw cannabis form only
to a patient age 21 or older, or to the registered designated caregiver, parent, legal guardian,
or spouse of a patient age 21 or older.
Sec. 73.
Minnesota Statutes 2020, section 152.29, subdivision 3a, is amended to read:
Subd. 3a.
Transportation of medical cannabis; new text begin transport new text end staffing.
(a) A medical
cannabis manufacturer may staff a transport motor vehicle with only one employee if the
medical cannabis manufacturer is transporting medical cannabis to deleted text begin either a certified
laboratory for the purpose of testing ordeleted text end a facility for the purpose of disposal. If the medical
cannabis manufacturer is transporting medical cannabis for any other purpose or destination,
the transport motor vehicle must be staffed with a minimum of two employees as required
by rules adopted by the commissioner.
(b) Notwithstanding paragraph (a), a medical cannabis manufacturer that is only
transporting hemp for any purpose may staff the transport motor vehicle with only one
employee.
new text begin
(c) A medical cannabis manufacturer may contract with a third party for armored car
services for deliveries of medical cannabis from its production facility to distribution
facilities. A medical cannabis manufacturer that contracts for armored car services remains
responsible for compliance with transportation manifest and inventory tracking requirements
in rules adopted by the commissioner.
new text end
new text begin
(d) A third-party testing laboratory may staff a transport motor vehicle with one or more
employees when transporting medical cannabis from a manufacturer's production facility
to the testing laboratory for the purpose of testing samples.
new text end
new text begin
(e) Department of Health staff may transport medical cannabis for the purposes of
delivering medical cannabis and other samples to a laboratory for testing under rules adopted
by the commissioner and in cases of special investigations when the commissioner has
determined there is a potential threat to public health. The transport motor vehicle must be
staffed by a minimum of two Department of Health employees. The employees must carry
their Department of Health identification cards and a transport manifest that meets the
requirements in Minnesota Rules, part 4770.1100, subpart 2.
new text end
new text begin
(f) A Tribal medical cannabis program operated by a federally recognized Indian Tribe
located within the state of Minnesota may transport samples of medical cannabis to testing
laboratories and to other Indian lands in the state. Transport vehicles must be staffed by at
least two employees of the Tribal medical cannabis program. Transporters must carry
identification identifying them as employees of the Tribal medical cannabis program and
a detailed transportation manifest that includes the place and time of departure, the address
of the destination, and a description and count of the medical cannabis being transported.
new text end
Sec. 74.
Minnesota Statutes 2020, section 152.30, is amended to read:
152.30 PATIENT DUTIES.
(a) A patient shall apply to the commissioner for enrollment in the registry program by
submitting an application as required in section 152.27 and an annual registration fee as
determined under section 152.35.
(b) As a condition of continued enrollment, patients shall agree to:
(1) continue to receive regularly scheduled treatment for their qualifying medical
condition from their health care practitioner; and
(2) report changes in their qualifying medical condition to their health care practitioner.
(c) A patient shall only receive medical cannabis from a registered manufacturer but is
not required to receive medical cannabis deleted text begin productsdeleted text end new text begin paraphernalianew text end from only a registered
manufacturer.
Sec. 75.
Minnesota Statutes 2020, section 152.32, subdivision 2, is amended to read:
Subd. 2.
Criminal and civil protections.
(a) Subject to section 152.23, the following
are not violations under this chapter:
(1) use or possession of medical cannabis or medical cannabis products by a patient
enrolled in the registry program, or possession by a registered designated caregiver or the
parent, legal guardian, or spouse of a patient if the parent, legal guardian, or spouse is listed
on the registry verification;
(2) possession, dosage determination, or sale of medical cannabis or medical cannabis
products by a medical cannabis manufacturer, employees of a manufacturer, a laboratory
conducting testing on medical cannabis, or employees of the laboratory; and
(3) possession of medical cannabis or medical cannabis deleted text begin productsdeleted text end new text begin paraphernalianew text end by any
person while carrying out the duties required under sections 152.22 to 152.37.
(b) Medical cannabis obtained and distributed pursuant to sections 152.22 to 152.37 and
associated property is not subject to forfeiture under sections 609.531 to 609.5316.
(c) The commissioner, the commissioner's staff, the commissioner's agents or contractors,
and any health care practitioner are not subject to any civil or disciplinary penalties by the
Board of Medical Practice, the Board of Nursing, or by any business, occupational, or
professional licensing board or entity, solely for the participation in the registry program
under sections 152.22 to 152.37. A pharmacist licensed under chapter 151 is not subject to
any civil or disciplinary penalties by the Board of Pharmacy when acting in accordance
with the provisions of sections 152.22 to 152.37. Nothing in this section affects a professional
licensing board from taking action in response to violations of any other section of law.
(d) Notwithstanding any law to the contrary, the commissioner, the governor of
Minnesota, or an employee of any state agency may not be held civilly or criminally liable
for any injury, loss of property, personal injury, or death caused by any act or omission
while acting within the scope of office or employment under sections 152.22 to 152.37.
(e) Federal, state, and local law enforcement authorities are prohibited from accessing
the patient registry under sections 152.22 to 152.37 except when acting pursuant to a valid
search warrant.
(f) Notwithstanding any law to the contrary, neither the commissioner nor a public
employee may release data or information about an individual contained in any report,
document, or registry created under sections 152.22 to 152.37 or any information obtained
about a patient participating in the program, except as provided in sections 152.22 to 152.37.
(g) No information contained in a report, document, or registry or obtained from a patient
under sections 152.22 to 152.37 may be admitted as evidence in a criminal proceeding
unless independently obtained or in connection with a proceeding involving a violation of
sections 152.22 to 152.37.
(h) Notwithstanding section 13.09, any person who violates paragraph (e) or (f) is guilty
of a gross misdemeanor.
(i) An attorney may not be subject to disciplinary action by the Minnesota Supreme
Court or professional responsibility board for providing legal assistance to prospective or
registered manufacturers or others related to activity that is no longer subject to criminal
penalties under state law pursuant to sections 152.22 to 152.37.
(j) Possession of a registry verification or application for enrollment in the program by
a person entitled to possess or apply for enrollment in the registry program does not constitute
probable cause or reasonable suspicion, nor shall it be used to support a search of the person
or property of the person possessing or applying for the registry verification, or otherwise
subject the person or property of the person to inspection by any governmental agency.
Sec. 76.
Minnesota Statutes 2020, section 152.36, is amended to read:
152.36 IMPACT ASSESSMENT OF MEDICAL CANNABIS THERAPEUTIC
RESEARCH.
Subdivision 1.
Task force on medical cannabis therapeutic research.
(a) A 23-member
task force on medical cannabis therapeutic research is created to conduct an impact
assessment of medical cannabis therapeutic research. The task force shall consist of the
following members:
(1) two members of the house of representatives, one selected by the speaker of the
house, the other selected by the minority leader;
(2) two members of the senate, one selected by the majority leader, the other selected
by the minority leader;
(3) four members representing consumers or patients enrolled in the registry program,
including at least two parents of patients under age 18;
(4) four members representing health care providers, including one licensed pharmacist;
(5) four members representing law enforcement, one from the Minnesota Chiefs of
Police Association, one from the Minnesota Sheriff's Association, one from the Minnesota
Police and Peace Officers Association, and one from the Minnesota County Attorneys
Association;
(6) four members representing substance use disorder treatment providers; and
(7) the commissioners of health, human services, and public safety.
(b) Task force members listed under paragraph (a), clauses (3), (4), (5), and (6), shall
be appointed by the governor under the appointment process in section 15.0597. Members
shall serve on the task force at the pleasure of the appointing authority. deleted text begin All members must
be appointed by July 15, 2014, and the commissioner of health shall convene the first meeting
of the task force by August 1, 2014.
deleted text end
(c) There shall be two cochairs of the task force chosen from the members listed under
paragraph (a). One cochair shall be selected by the speaker of the house and the other cochair
shall be selected by the majority leader of the senate. The authority to convene meetings
shall alternate between the cochairs.
(d) Members of the task force other than those in paragraph (a), clauses (1), (2), and (7),
shall receive expenses as provided in section 15.059, subdivision 6.
Subd. 1a.
Administration.
The commissioner of health shall provide administrative and
technical support to the task force.
Subd. 2.
Impact assessment.
The task force shall hold hearings to evaluate the impact
of the use of medical cannabis and hemp and Minnesota's activities involving medical
cannabis and hemp, including, but not limited to:
(1) program design and implementation;
(2) the impact on the health care provider community;
(3) patient experiences;
(4) the impact on the incidence of substance abuse;
(5) access to and quality of medical cannabis, hemp, and medical cannabis deleted text begin productsdeleted text end new text begin
paraphernalianew text end ;
(6) the impact on law enforcement and prosecutions;
(7) public awareness and perception; and
(8) any unintended consequences.
deleted text begin Subd. 3. deleted text end
deleted text begin Cost assessment. deleted text end
deleted text begin
By January 15 of each year, beginning January 15, 2015,
and ending January 15, 2019, the commissioners of state departments impacted by the
medical cannabis therapeutic research study shall report to the cochairs of the task force on
the costs incurred by each department on implementing sections 152.22 to 152.37. The
reports must compare actual costs to the estimated costs of implementing these sections and
must be submitted to the task force on medical cannabis therapeutic research.
deleted text end
Subd. 4.
Reports to the legislature.
(a) The cochairs of the task force shall submit deleted text begin the
following reportsdeleted text end new text begin an impact assessment reportnew text end to the chairs and ranking minority members
of the legislative committees and divisions with jurisdiction over health and human services,
public safety, judiciary, and civil lawdeleted text begin :
deleted text end
deleted text begin (1)deleted text end by February 1, 2015, deleted text begin a report on the design and implementation of the registry
program;deleted text end and every two years thereafterdeleted text begin , a complete impact assessment report; anddeleted text end new text begin .
new text end
deleted text begin
(2) upon receipt of a cost assessment from a commissioner of a state agency, the
completed cost assessment.
deleted text end
(b) The task force may make recommendations to the legislature on whether to add or
remove conditions from the list of qualifying medical conditions.
Subd. 5.
No expiration.
The task force on medical cannabis therapeutic research does
not expire.
Sec. 77. new text begin COMMISSIONER OF HEALTH; RECOMMENDATION REGARDING
EXCEPTION TO HOSPITAL CONSTRUCTION MORATORIUM.
new text end
new text begin
By February 1, 2023, the commissioner of health, in consultation with the commissioner
of human services, shall make a recommendation to the chairs and ranking minority members
of the legislative committees with jurisdiction over health and human services finance as
to whether Minnesota Statutes, section 144.551, subdivision 1, should be amended to
authorize exceptions, for hospitals in other counties and without a public interest review,
that are substantially similar to the exception in Minnesota Statutes, section 144.551,
subdivision 1, paragraph (b), clause (31).
new text end
Sec. 78. new text begin REVISOR INSTRUCTION.
new text end
new text begin
(a) The revisor of statutes shall change the term "cancer surveillance system" to "cancer
reporting system" wherever it appears in Minnesota Statutes and Minnesota Rules.
new text end
new text begin
(b) The revisor of statutes shall make any necessary cross-reference changes required
as a result of the amendments in sections 17 to 22.
new text end
Sec. 79. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2021 Supplement, section 144G.07, subdivision 6,
new text end
new text begin
is repealed.
new text end
ARTICLE 3
HEALTH CARE FINANCE
Section 1.
new text begin
[62J.86] DEFINITIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
For the purposes of sections 62J.86 to 62J.92, the following
terms have the meanings given.
new text end
new text begin Subd. 2. new text end
new text begin Advisory council. new text end
new text begin
"Advisory council" means the Health Care Affordability
Advisory Council established under section 62J.88.
new text end
new text begin Subd. 3. new text end
new text begin Board. new text end
new text begin
"Board" means the Health Care Affordability Board established under
section 62J.87.
new text end
Sec. 2.
new text begin
[62J.87] HEALTH CARE AFFORDABILITY BOARD.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The Health Care Affordability Board is established and
shall be governed as a board under section 15.012, paragraph (a), to protect consumers,
state and local governments, health plan companies, providers, and other health care system
stakeholders from unaffordable health care costs. The board must be operational by January
1, 2023.
new text end
new text begin Subd. 2. new text end
new text begin Membership. new text end
new text begin
(a) The Health Care Affordability Board consists of 13 members,
appointed as follows:
new text end
new text begin
(1) five members appointed by the governor;
new text end
new text begin
(2) two members appointed by the majority leader of the senate;
new text end
new text begin
(3) two members appointed by the minority leader of the senate;
new text end
new text begin
(4) two members appointed by the speaker of the house; and
new text end
new text begin
(5) two members appointed by the minority leader of the house of representatives.
new text end
new text begin
(b) All appointed members must have knowledge and demonstrated expertise in one or
more of the following areas: health care finance, health economics, health care management
or administration at a senior level, health care consumer advocacy, representing the health
care workforce as a leader in a labor organization, purchasing health care insurance as a
health benefits administrator, delivery of primary care, health plan company administration,
public or population health, and addressing health disparities and structural inequities.
new text end
new text begin
(c) A member may not participate in board proceedings involving an organization,
activity, or transaction in which the member has either a direct or indirect financial interest,
other than as an individual consumer of health services.
new text end
new text begin
(d) The Legislative Coordinating Commission shall coordinate appointments under this
subdivision to ensure that board members are appointed by August 1, 2022, and that board
members as a whole meet all of the criteria related to the knowledge and expertise specified
in paragraph (b).
new text end
new text begin Subd. 3. new text end
new text begin Terms. new text end
new text begin
(a) Board appointees shall serve four-year terms. A board member shall
not serve more than three consecutive terms.
new text end
new text begin
(b) A board member may resign at any time by giving written notice to the board.
new text end
new text begin Subd. 4. new text end
new text begin Chair; other officers. new text end
new text begin
(a) The governor shall designate an acting chair from
the members appointed by the governor.
new text end
new text begin
(b) The board shall elect a chair to replace the acting chair at the first meeting of the
board by a majority of the members. The chair shall serve for two years.
new text end
new text begin
(c) The board shall elect a vice-chair and other officers from its membership as it deems
necessary.
new text end
new text begin Subd. 5. new text end
new text begin Staff; technical assistance; contracting. new text end
new text begin
(a) The board shall hire a full-time
executive director and other staff, who shall serve in the unclassified service. The executive
director must have significant knowledge and expertise in health economics and demonstrated
experience in health policy.
new text end
new text begin
(b) The attorney general shall provide legal services to the board.
new text end
new text begin
(c) The Health Economics Program within the Department of Health shall provide
technical assistance to the board in analyzing health care trends and costs and in setting
health care spending growth targets.
new text end
new text begin
(d) The board may employ or contract for professional and technical assistance, including
actuarial assistance, as the board deems necessary to perform the board's duties.
new text end
new text begin Subd. 6. new text end
new text begin Access to information. new text end
new text begin
(a) The board may request that a state agency provide
the board with any publicly available information in a usable format as requested by the
board, at no cost to the board.
new text end
new text begin
(b) The board may request from a state agency unique or custom data sets, and the agency
may charge the board for providing the data at the same rate the agency would charge any
other public or private entity.
new text end
new text begin
(c) Any information provided to the board by a state agency must be de-identified. For
purposes of this subdivision, "de-identification" means the process used to prevent the
identity of a person or business from being connected with the information and ensuring
all identifiable information has been removed.
new text end
new text begin
(d) Any data submitted to the board retains its original classification under the Minnesota
Data Practices Act in chapter 13.
new text end
new text begin Subd. 7. new text end
new text begin Compensation. new text end
new text begin
Board members shall not receive compensation but may receive
reimbursement for expenses as authorized under section 15.059, subdivision 3.
new text end
new text begin Subd. 8. new text end
new text begin Meetings. new text end
new text begin
(a) Meetings of the board are subject to chapter 13D. The board shall
meet publicly at least quarterly. The board may meet in closed session when reviewing
proprietary information as specified in section 62J.71, subdivision 4.
new text end
new text begin
(b) The board shall announce each public meeting at least two weeks prior to the
scheduled date of the meeting. Any materials for the meeting must be made public at least
one week prior to the scheduled date of the meeting.
new text end
new text begin
(c) At each public meeting, the board shall provide the opportunity for comments from
the public, including the opportunity for written comments to be submitted to the board
prior to a decision by the board.
new text end
Sec. 3.
new text begin
[62J.88] HEALTH CARE AFFORDABILITY ADVISORY COUNCIL.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The governor shall appoint a Health Care Affordability
Advisory Council of up to 15 members to provide advice to the board on health care costs
and access issues and to represent the views of patients and other stakeholders. Members
of the advisory council must be appointed based on their knowledge and demonstrated
expertise in one or more of the following areas: health care delivery, ensuring health care
access for diverse populations, public and population health, patient perspectives, health
care cost trends and drivers, clinical and health services research, innovation in health care
delivery, and health care benefits management.
new text end
new text begin Subd. 2. new text end
new text begin Duties; reports. new text end
new text begin
(a) The council shall provide technical recommendations to
the board on:
new text end
new text begin
(1) the identification of economic indicators and other metrics related to the development
and setting of health care spending growth targets;
new text end
new text begin
(2) data sources for measuring health care spending; and
new text end
new text begin
(3) measurement of the impact of health care spending growth targets on diverse
communities and populations, including but not limited to those communities and populations
adversely affected by health disparities.
new text end
new text begin
(b) The council shall report technical recommendations and a summary of its activities
to the board at least annually, and shall submit additional reports on its activities and
recommendations to the board, as requested by the board or at the discretion of the council.
new text end
new text begin Subd. 3. new text end
new text begin Terms. new text end
new text begin
(a) The initial appointed advisory council members shall serve staggered
terms of two, three, or four years determined by lot by the secretary of state. Following the
initial appointments, advisory council members shall serve four-year terms.
new text end
new text begin
(b) Removal and vacancies of advisory council members are governed by section 15.059.
new text end
new text begin Subd. 4. new text end
new text begin Compensation. new text end
new text begin
Advisory council members may be compensated according to
section 15.059.
new text end
new text begin Subd. 5. new text end
new text begin Meetings. new text end
new text begin
The advisory council shall meet at least quarterly. Meetings of the
advisory council are subject to chapter 13D.
new text end
new text begin Subd. 6. new text end
new text begin Exemption. new text end
new text begin
Notwithstanding section 15.059, the advisory council shall not
expire.
new text end
Sec. 4.
new text begin
[62J.89] DUTIES OF THE BOARD.
new text end
new text begin Subdivision 1. new text end
new text begin General. new text end
new text begin
(a) The board shall monitor the administration and reform of
the health care delivery and payment systems in the state. The board shall:
new text end
new text begin
(1) set health care spending growth targets for the state, as specified under section 62J.90;
new text end
new text begin
(2) enhance the transparency of provider organizations;
new text end
new text begin
(3) monitor the adoption and effectiveness of alternative payment methodologies;
new text end
new text begin
(4) foster innovative health care delivery and payment models that lower health care
cost growth while improving the quality of patient care;
new text end
new text begin
(5) monitor and review the impact of changes within the health care marketplace; and
new text end
new text begin
(6) monitor patient access to necessary health care services.
new text end
new text begin
(b) The board shall establish goals to reduce health care disparities in racial and ethnic
communities and to ensure access to quality care for persons with disabilities or with chronic
or complex health conditions.
new text end
new text begin Subd. 2. new text end
new text begin Market trends. new text end
new text begin
The board shall monitor efforts to reform the health care
delivery and payment system in Minnesota to understand emerging trends in the commercial
health insurance market, including large self-insured employers and the state's public health
care programs, in order to identify opportunities for state action to achieve:
new text end
new text begin
(1) improved patient experience of care, including quality and satisfaction;
new text end
new text begin
(2) improved health of all populations, including a reduction in health disparities; and
new text end
new text begin
(3) a reduction in the growth of health care costs.
new text end
new text begin Subd. 3. new text end
new text begin Recommendations for reform. new text end
new text begin
The board shall recommend legislative policy,
market, or any other reforms to:
new text end
new text begin
(1) lower the rate of growth in commercial health care costs and public health care
program spending in the state;
new text end
new text begin
(2) positively impact the state's rankings in the areas listed in this subdivision and
subdivision 2; and
new text end
new text begin
(3) improve the quality and value of care for all Minnesotans, and for specific populations
adversely affected by health inequities.
new text end
new text begin Subd. 4. new text end
new text begin Office of Patient Protection. new text end
new text begin
The board shall establish an Office of Patient
Protection, to be operational by January 1, 2024. The office shall assist consumers with
issues related to access and quality of health care, and advise the legislature on ways to
reduce consumer health care spending and improve consumer experiences by reducing
complexity for consumers.
new text end
Sec. 5.
new text begin
[62J.90] HEALTH CARE SPENDING GROWTH TARGETS.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment and administration. new text end
new text begin
The board shall establish and
administer the health care spending growth target program to limit health care spending
growth in the state, and shall report regularly to the legislature and the public on progress
toward these targets.
new text end
new text begin Subd. 2. new text end
new text begin Methodology. new text end
new text begin
(a) The board shall develop a methodology to establish annual
health care spending growth targets and the economic indicators to be used in establishing
the initial and subsequent target levels.
new text end
new text begin
(b) The health care spending growth target must:
new text end
new text begin
(1) use a clear and operational definition of total state health care spending;
new text end
new text begin
(2) promote a predictable and sustainable rate of growth for total health care spending
as measured by an established economic indicator, such as the rate of increase of the state's
economy or of the personal income of residents of this state, or a combination;
new text end
new text begin
(3) define the health care markets and the entities to which the targets apply;
new text end
new text begin
(4) take into consideration the potential for variability in targets across public and private
payers;
new text end
new text begin
(5) account for the health status of patients; and
new text end
new text begin
(6) incorporate specific benchmarks related to health equity.
new text end
new text begin
(c) In developing, implementing, and evaluating the growth target program, the board
shall:
new text end
new text begin
(1) consider the incorporation of quality of care and primary care spending goals;
new text end
new text begin
(2) ensure that the program does not place a disproportionate burden on communities
most impacted by health disparities, the providers who primarily serve communities most
impacted by health disparities, or individuals who reside in rural areas or have high health
care needs;
new text end
new text begin
(3) explicitly consider payment models that help ensure financial sustainability of rural
health care delivery systems and the ability to provide population health;
new text end
new text begin
(4) allow setting growth targets that encourage an individual health care entity to serve
populations with greater health care risks by incorporating:
new text end
new text begin
(i) a risk factor adjustment reflecting the health status of the entity's patient mix; and
new text end
new text begin
(ii) an equity adjustment accounting for the social determinants of health and other
factors related to health equity for the entity's patient mix;
new text end
new text begin
(5) ensure that growth targets:
new text end
new text begin
(i) do not constrain the Minnesota health care workforce, including the need to provide
competitive wages and benefits;
new text end
new text begin
(ii) do not limit the use of collective bargaining or place a floor or ceiling on health care
workforce compensation; and
new text end
new text begin
(iii) promote workforce stability and maintain high-quality health care jobs; and
new text end
new text begin
(6) consult with the advisory council and other stakeholders.
new text end
new text begin Subd. 3. new text end
new text begin Data. new text end
new text begin
The board shall identify data to be used for tracking performance in
meeting the growth target and identify methods of data collection necessary for efficient
implementation by the board. In identifying data and methods, the board shall:
new text end
new text begin
(1) consider the availability, timeliness, quality, and usefulness of existing data, including
the data collected under section 62U.04;
new text end
new text begin
(2) assess the need for additional investments in data collection, data validation, or data
analysis capacity to support the board in performing its duties; and
new text end
new text begin
(3) minimize the reporting burden to the extent possible.
new text end
new text begin Subd. 4. new text end
new text begin Setting growth targets; related duties. new text end
new text begin
(a) The board, by June 15, 2023, and
by June 15 of each succeeding calendar year through June 15, 2027, shall establish annual
health care spending growth targets for the next calendar year consistent with the
requirements of this section. The board shall set annual health care spending growth targets
for the five-year period from January 1, 2024, through December 31, 2028.
new text end
new text begin
(b) The board shall periodically review all components of the health care spending
growth target program methodology, economic indicators, and other factors. The board may
revise the annual spending growth targets after a public hearing, as appropriate. If the board
revises a spending growth target, the board must provide public notice at least 60 days
before the start of the calendar year to which the revised growth target will apply.
new text end
new text begin
(c) The board, based on an analysis of drivers of health care spending and evidence from
public testimony, shall evaluate strategies and new policies, including the establishment of
accountability mechanisms, that are able to contribute to meeting growth targets and limiting
health care spending growth without increasing disparities in access to health care.
new text end
new text begin Subd. 5. new text end
new text begin Hearings. new text end
new text begin
At least annually, the board shall hold public hearings to present
findings from spending growth target monitoring. The board shall also regularly hold public
hearings to take testimony from stakeholders on health care spending growth, setting and
revising health care spending growth targets, the impact of spending growth and growth
targets on health care access and quality, and as needed to perform the duties assigned under
section 62J.89, subdivisions 1, 2, and 3.
new text end
Sec. 6.
new text begin
[62J.91] NOTICE TO HEALTH CARE ENTITIES.
new text end
new text begin Subdivision 1. new text end
new text begin Notice. new text end
new text begin
(a) The board shall provide notice to all health care entities that
have been identified by the board as exceeding the spending growth target for any given
year.
new text end
new text begin
(b) For purposes of this section, "health care entity" must be defined by the board during
the development of the health care spending growth methodology. When developing this
methodology, the board shall consider a definition of health care entity that includes clinics,
hospitals, ambulatory surgical centers, physician organizations, accountable care
organizations, integrated provider and plan systems, and other entities defined by the board,
provided that physician organizations with a patient panel of 15,000 or fewer, or which
represent providers who collectively receive less than $25,000,000 in annual net patient
service revenue from health plan companies and other payers, are exempt.
new text end
new text begin Subd. 2. new text end
new text begin Performance improvement plans. new text end
new text begin
(a) The board shall establish and implement
procedures to assist health care entities to improve efficiency and reduce cost growth by
requiring some or all health care entities provided notice under subdivision 1 to file and
implement a performance improvement plan. The board shall provide written notice of this
requirement to health care entities.
new text end
new text begin
(b) Within 45 days of receiving a notice of the requirement to file a performance
improvement plan, a health care entity shall:
new text end
new text begin
(1) file a performance improvement plan with the board; or
new text end
new text begin
(2) file an application with the board to waive the requirement to file a performance
improvement plan or extend the timeline for filing a performance improvement plan.
new text end
new text begin
(c) The health care entity may file any documentation or supporting evidence with the
board to support the health care entity's application to waive or extend the timeline to file
a performance improvement plan. The board shall require the health care entity to submit
any other relevant information it deems necessary in considering the waiver or extension
application, provided that this information must be made public at the discretion of the
board. The board may waive or delay the requirement for a health care entity to file a
performance improvement plan in response to a waiver or extension request in light of all
information received from the health care entity, based on a consideration of the following
factors:
new text end
new text begin
(1) the costs, price, and utilization trends of the health care entity over time, and any
demonstrated improvement in reducing per capita medical expenses adjusted by health
status;
new text end
new text begin
(2) any ongoing strategies or investments that the health care entity is implementing to
improve future long-term efficiency and reduce cost growth;
new text end
new text begin
(3) whether the factors that led to increased costs for the health care entity can reasonably
be considered to be unanticipated and outside of the control of the entity.
new text end
new text begin
These factors may
include but are not limited to age and other health status adjusted factors and other cost
inputs such as pharmaceutical expenses and medical device expenses;
new text end
new text begin
(4) the overall financial condition of the health care entity; and
new text end
new text begin
(5) any other factors the board considers relevant. If the board declines to waive or
extend the requirement for the health care entity to file a performance improvement plan,
the board shall provide written notice to the health care entity that its application for a waiver
or extension was denied and the health care entity shall file a performance improvement
plan.
new text end
new text begin
(d) A health care entity shall file a performance improvement plan with the board:
new text end
new text begin
(1) within 45 days of receipt of an initial notice;
new text end
new text begin
(2) if the health care entity has requested a waiver or extension, within 45 days of receipt
of a notice that such waiver or extension has been denied; or
new text end
new text begin
(3) if the health care entity is granted an extension, on the date given on the extension.
new text end
new text begin
(e) The performance improvement plan must identify the causes of the entity's cost
growth and include but not be limited to specific strategies, adjustments, and action steps
the entity proposes to implement to improve cost performance. The proposed performance
improvement plan must include specific identifiable and measurable expected outcomes
and a timetable for implementation. The timetable for a performance improvement plan
must not exceed 18 months.
new text end
new text begin
(f) The board shall approve any performance improvement plan it determines is
reasonably likely to address the underlying cause of the entity's cost growth and has a
reasonable expectation for successful implementation. If the board determines that the
performance improvement plan is unacceptable or incomplete, the board may provide
consultation on the criteria that have not been met and may allow an additional time period
of up to 30 calendar days for resubmission. Upon approval of the proposed performance
improvement plan, the board shall notify the health care entity to begin immediate
implementation of the performance improvement plan. The board shall provide public notice
on its website identifying that the health care entity is implementing a performance
improvement plan. All health care entities implementing an approved performance
improvement plan shall be subject to additional reporting requirements and compliance
monitoring, as determined by the board. The board shall provide assistance to the health
care entity in the successful implementation of the performance improvement plan.
new text end
new text begin
(g) All health care entities shall in good faith work to implement the performance
improvement plan. At any point during the implementation of the performance improvement
plan, the health care entity may file amendments to the performance improvement plan,
subject to approval of the board. At the conclusion of the timetable established in the
performance improvement plan, the health care entity shall report to the board regarding
the outcome of the performance improvement plan. If the board determines the performance
improvement plan was not implemented successfully, the board shall:
new text end
new text begin
(1) extend the implementation timetable of the existing performance improvement plan;
new text end
new text begin
(2) approve amendments to the performance improvement plan as proposed by the health
care entity;
new text end
new text begin
(3) require the health care entity to submit a new performance improvement plan; or
new text end
new text begin
(4) waive or delay the requirement to file any additional performance improvement
plans.
new text end
new text begin
(h) Upon the successful completion of the performance improvement plan, the board
shall remove the identity of the health care entity from the board's website. The board may
assist health care entities with implementing the performance improvement plans or otherwise
ensure compliance with this subdivision.
new text end
new text begin
(i) If the board determines that a health care entity has:
new text end
new text begin
(1) willfully neglected to file a performance improvement plan with the board within
45 days as required;
new text end
new text begin
(2) failed to file an acceptable performance improvement plan in good faith with the
board;
new text end
new text begin
(3) failed to implement the performance improvement plan in good faith; or
new text end
new text begin
(4) knowingly failed to provide information required by this subdivision to the board or
knowingly provided false information, the board may assess a civil penalty to the health
care entity of not more than $500,000. The board must only impose a civil penalty as a last
resort.
new text end
Sec. 7.
new text begin
[62J.92] REPORTING REQUIREMENTS.
new text end
new text begin Subdivision 1. new text end
new text begin General requirement. new text end
new text begin
(a) The board shall present the reports required
by this section to the chairs and ranking members of the legislative committees with primary
jurisdiction over health care finance and policy. The board shall also make these reports
available to the public on the board's website.
new text end
new text begin
(b) The board may contract with a third-party vendor for technical assistance in preparing
the reports.
new text end
new text begin Subd. 2. new text end
new text begin Progress reports. new text end
new text begin
The board shall submit written progress updates about the
development and implementation of the health care spending growth target program by
February 15, 2024, and February 15, 2025. The updates must include reporting on board
membership and activities, program design decisions, planned timelines for implementation
of the program, and the progress of implementation. The reports must include the
methodological details underlying program design decisions.
new text end
new text begin Subd. 3. new text end
new text begin Health care spending trends. new text end
new text begin
By December 15, 2024, and every December
15 thereafter, the board shall submit a report on health care spending trends and the health
care spending growth target program that includes:
new text end
new text begin
(1) spending growth in aggregate and for entities subject to health care spending growth
targets relative to established target levels;
new text end
new text begin
(2) findings from analyses of drivers of health care spending growth;
new text end
new text begin
(3) estimates of the impact of health care spending growth on Minnesota residents,
including for communities most impacted by health disparities, related to their access to
insurance and care, value of health care, and the ability to pursue other spending priorities;
new text end
new text begin
(4) the potential and observed impact of the health care growth targets on the financial
viability of the rural delivery system;
new text end
new text begin
(5) changes under consideration for revising the methodology to monitor or set growth
targets;
new text end
new text begin
(6) recommendations for initiatives to assist health care entities in meeting health care
spending growth targets, including broader and more transparent adoption of value-based
payment arrangements; and
new text end
new text begin
(7) the number of health care entities whose spending growth exceeded growth targets,
information on performance improvement plans and the extent to which the plans were
completed, and any civil penalties imposed on health care entities related to noncompliance
with performance improvement plans and related requirements.
new text end
Sec. 8.
Minnesota Statutes 2020, section 62U.04, subdivision 11, is amended to read:
Subd. 11.
Restricted uses of the all-payer claims data.
(a) Notwithstanding subdivision
4, paragraph (b), and subdivision 5, paragraph (b), the commissioner or the commissioner's
designee shall only use the data submitted under subdivisions 4 and 5 for the following
purposes:
(1) to evaluate the performance of the health care home program as authorized under
section 62U.03, subdivision 7;
(2) to study, in collaboration with the reducing avoidable readmissions effectively
(RARE) campaign, hospital readmission trends and rates;
(3) to analyze variations in health care costs, quality, utilization, and illness burden based
on geographical areas or populations;
(4) to evaluate the state innovation model (SIM) testing grant received by the Departments
of Health and Human Services, including the analysis of health care cost, quality, and
utilization baseline and trend information for targeted populations and communities; deleted text begin and
deleted text end
(5) to compile one or more public use files of summary data or tables that must:
(i) be available to the public for no or minimal cost by March 1, 2016, and available by
web-based electronic data download by June 30, 2019;
(ii) not identify individual patients, payers, or providers;
(iii) be updated by the commissioner, at least annually, with the most current data
available;
(iv) contain clear and conspicuous explanations of the characteristics of the data, such
as the dates of the data contained in the files, the absence of costs of care for uninsured
patients or nonresidents, and other disclaimers that provide appropriate context; and
(v) not lead to the collection of additional data elements beyond what is authorized under
this section as of June 30, 2015deleted text begin .deleted text end new text begin ; and
new text end
new text begin
(6) to provide technical assistance to the Health Care Affordability Board to implement
sections 62J.86 to 62J.92.
new text end
(b) The commissioner may publish the results of the authorized uses identified in
paragraph (a) so long as the data released publicly do not contain information or descriptions
in which the identity of individual hospitals, clinics, or other providers may be discerned.
(c) Nothing in this subdivision shall be construed to prohibit the commissioner from
using the data collected under subdivision 4 to complete the state-based risk adjustment
system assessment due to the legislature on October 1, 2015.
(d) The commissioner or the commissioner's designee may use the data submitted under
subdivisions 4 and 5 for the purpose described in paragraph (a), clause (3), until July 1,
2023.
(e) The commissioner shall consult with the all-payer claims database work group
established under subdivision 12 regarding the technical considerations necessary to create
the public use files of summary data described in paragraph (a), clause (5).
Sec. 9.
Minnesota Statutes 2020, section 256.01, is amended by adding a subdivision to
read:
new text begin Subd. 43. new text end
new text begin Education on contraceptive options. new text end
new text begin
The commissioner shall require hospitals
and primary care providers serving medical assistance and MinnesotaCare enrollees to
develop and implement protocols to provide these enrollees, when appropriate, with
comprehensive and scientifically accurate information on the full range of contraceptive
options in a medically ethical, culturally competent, and noncoercive manner. The
information provided must be designed to assist enrollees in identifying the contraceptive
method that best meets their needs and the needs of their families. The protocol must specify
the enrollee categories to which this requirement will be applied, the process to be used,
and the information and resources to be provided. Hospitals and providers must make this
protocol available to the commissioner upon request.
new text end
Sec. 10.
Minnesota Statutes 2020, section 256.969, is amended by adding a subdivision
to read:
new text begin Subd. 31. new text end
new text begin Long-acting reversible contraceptives. new text end
new text begin
(a) The commissioner must provide
separate reimbursement to hospitals for long-acting reversible contraceptives provided
immediately postpartum in the inpatient hospital setting. This payment must be in addition
to the diagnostic related group (DRG) reimbursement for labor and delivery.
new text end
new text begin
(b) The commissioner must require managed care and county-based purchasing plans
to comply with this subdivision when providing services to medical assistance enrollees.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 11.
Minnesota Statutes 2020, section 256B.021, subdivision 4, is amended to read:
Subd. 4.
Projects.
The commissioner shall request permission and funding to further
the following initiatives.
(a) Health care delivery demonstration projects. This project involves testing alternative
payment and service delivery models in accordance with sections 256B.0755 and 256B.0756.
These demonstrations will allow the Minnesota Department of Human Services to engage
in alternative payment arrangements with provider organizations that provide services to a
specified patient population for an agreed upon total cost of care or risk/gain sharing payment
arrangement, but are not limited to these models of care delivery or payment. Quality of
care and patient experience will be measured and incorporated into payment models alongside
the cost of care. Demonstration sites should include Minnesota health care programs
fee-for-services recipients and managed care enrollees and support a robust primary care
model and improved care coordination for recipients.
(b) Promote personal responsibility and encourage and reward healthy outcomes. This
project provides Medicaid funding to provide individual and group incentives to encourage
healthy behavior, prevent the onset of chronic disease, and reward healthy outcomes. Focus
areas may include diabetes prevention and management, tobacco cessation, reducing weight,
lowering cholesterol, and lowering blood pressure.
(c) Encourage utilization of high quality, cost-effective care. This project creates
incentives deleted text begin through Medicaid and MinnesotaCare enrollee cost-sharing and other meansdeleted text end to
encourage the utilization of high-quality, low-cost, high-value providers, as determined by
the state's provider peer grouping initiative under section 62U.04.
(d) Adults without children. This proposal includes requesting federal authority to impose
a limit on assets for adults without children in medical assistance, as defined in section
256B.055, subdivision 15, who have a household income equal to or less than 75 percent
of the federal poverty limit, and to impose a 180-day durational residency requirement in
MinnesotaCare, consistent with section 256L.09, subdivision 4, for adults without children,
regardless of income.
(e) Empower and encourage work, housing, and independence. This project provides
services and supports for individuals who have an identified health or disabling condition
but are not yet certified as disabled, in order to delay or prevent permanent disability, reduce
the need for intensive health care and long-term care services and supports, and to help
maintain or obtain employment or assist in return to work. Benefits may include:
(1) coordination with health care homes or health care coordinators;
(2) assessment for wellness, housing needs, employment, planning, and goal setting;
(3) training services;
(4) job placement services;
(5) career counseling;
(6) benefit counseling;
(7) worker supports and coaching;
(8) assessment of workplace accommodations;
(9) transitional housing services; and
(10) assistance in maintaining housing.
(f) Redesign home and community-based services. This project realigns existing funding,
services, and supports for people with disabilities and older Minnesotans to ensure community
integration and a more sustainable service system. This may involve changes that promote
a range of services to flexibly respond to the following needs:
(1) provide people less expensive alternatives to medical assistance services;
(2) offer more flexible and updated community support services under the Medicaid
state plan;
(3) provide an individual budget and increased opportunity for self-direction;
(4) strengthen family and caregiver support services;
(5) allow persons to pool resources or save funds beyond a fiscal year to cover unexpected
needs or foster development of needed services;
(6) use of home and community-based waiver programs for people whose needs cannot
be met with the expanded Medicaid state plan community support service options;
(7) target access to residential care for those with higher needs;
(8) develop capacity within the community for crisis intervention and prevention;
(9) redesign case management;
(10) offer life planning services for families to plan for the future of their child with a
disability;
(11) enhance self-advocacy and life planning for people with disabilities;
(12) improve information and assistance to inform long-term care decisions; and
(13) increase quality assurance, performance measurement, and outcome-based
reimbursement.
This project may include different levels of long-term supports that allow seniors to remain
in their homes and communities, and expand care transitions from acute care to community
care to prevent hospitalizations and nursing home placement. The levels of support for
seniors may range from basic community services for those with lower needs, access to
residential services if a person has higher needs, and targets access to nursing home care to
those with rehabilitation or high medical needs. This may involve the establishment of
medical need thresholds to accommodate the level of support needed; provision of a
long-term care consultation to persons seeking residential services, regardless of payer
source; adjustment of incentives to providers and care coordination organizations to achieve
desired outcomes; and a required coordination with medical assistance basic care benefit
and Medicare/Medigap benefit. This proposal will improve access to housing and improve
capacity to maintain individuals in their existing home; adjust screening and assessment
tools, as needed; improve transition and relocation efforts; seek federal financial participation
for alternative care and essential community supports; and provide Medigap coverage for
people having lower needs.
(g) Coordinate and streamline services for people with complex needs, including those
with multiple diagnoses of physical, mental, and developmental conditions. This project
will coordinate and streamline medical assistance benefits for people with complex needs
and multiple diagnoses. It would include changes that:
(1) develop community-based service provider capacity to serve the needs of this group;
(2) build assessment and care coordination expertise specific to people with multiple
diagnoses;
(3) adopt service delivery models that allow coordinated access to a range of services
for people with complex needs;
(4) reduce administrative complexity;
(5) measure the improvements in the state's ability to respond to the needs of this
population; and
(6) increase the cost-effectiveness for the state budget.
(h) Implement nursing home level of care criteria. This project involves obtaining any
necessary federal approval in order to implement the changes to the level of care criteria in
section 144.0724, subdivision 11, and implement further changes necessary to achieve
reform of the home and community-based service system.
(i) Improve integration of Medicare and Medicaid. This project involves reducing
fragmentation in the health care delivery system to improve care for people eligible for both
Medicare and Medicaid, and to align fiscal incentives between primary, acute, and long-term
care. The proposal may include:
(1) requesting an exception to the new Medicare methodology for payment adjustment
for fully integrated special needs plans for dual eligible individuals;
(2) testing risk adjustment models that may be more favorable to capturing the needs of
frail dually eligible individuals;
(3) requesting an exemption from the Medicare bidding process for fully integrated
special needs plans for the dually eligible;
(4) modifying the Medicare bid process to recognize additional costs of health home
services; and
(5) requesting permission for risk-sharing and gain-sharing.
(j) Intensive residential treatment services. This project would involve providing intensive
residential treatment services for individuals who have serious mental illness and who have
other complex needs. This proposal would allow such individuals to remain in these settings
after mental health symptoms have stabilized, in order to maintain their mental health and
avoid more costly or unnecessary hospital or other residential care due to their other complex
conditions. The commissioner may pursue a specialized rate for projects created under this
section.
(k) Seek federal Medicaid matching funds for Anoka-Metro Regional Treatment Center
(AMRTC). This project involves seeking Medicaid reimbursement for medical services
provided to patients to AMRTC, including requesting a waiver of United States Code, title
42, section 1396d, which prohibits Medicaid reimbursement for expenditures for services
provided by hospitals with more than 16 beds that are primarily focused on the treatment
of mental illness. This waiver would allow AMRTC to serve as a statewide resource to
provide diagnostics and treatment for people with the most complex conditions.
(l) Waivers to allow Medicaid eligibility for children under age 21 receiving care in
residential facilities. This proposal would seek Medicaid reimbursement for any
Medicaid-covered service for children who are placed in residential settings that are
determined to be "institutions for mental diseases," under United States Code, title 42,
section 1396d.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 12.
Minnesota Statutes 2021 Supplement, section 256B.0371, subdivision 4, is
amended to read:
Subd. 4.
Dental utilization report.
(a) The commissioner shall submit an annual report
beginning March 15, 2022, and ending March 15, 2026, to the chairs and ranking minority
members of the legislative committees with jurisdiction over health and human services
policy and finance that includes the percentage for adults and children one through 20 years
of age for the most recent complete calendar year receiving at least one dental visit for both
fee-for-service and the prepaid medical assistance program. The report must include:
(1) statewide utilization for both fee-for-service and for the prepaid medical assistance
program;
(2) utilization by county;
(3) utilization by children receiving dental services through fee-for-service and through
a managed care plan or county-based purchasing plan;
(4) utilization by adults receiving dental services through fee-for-service and through a
managed care plan or county-based purchasing plan.
(b) The report must also include a description of any corrective action plans required to
be submitted under subdivision 2.
(c) The initial report due on March 15, 2022, must include the utilization metrics described
in paragraph (a) for each of the following calendar years: 2017, 2018, 2019, and 2020.
new text begin
(d) In the annual report due on March 15, 2023, and in each report due thereafter, the
commissioner shall include the following:
new text end
new text begin
(1) the number of dentists enrolled with the commissioner as a medical assistance dental
provider and the congressional district or districts in which the dentist provides services;
new text end
new text begin
(2) the number of enrolled dentists who provided fee-for-service dental services to
medical assistance or MinnesotaCare patients within the previous calendar year in the
following increments: one to nine patients, ten to 100 patients, and over 100 patients;
new text end
new text begin
(3) the number of enrolled dentists who provided dental services to medical assistance
or MinnesotaCare patients through a managed care plan or county-based purchasing plan
within the previous calendar year in the following increments: one to nine patients, ten to
100 patients, and over 100 patients; and
new text end
new text begin
(4) the number of dentists who provided dental services to a new patient who was enrolled
in medical assistance or MinnesotaCare within the previous calendar year.
new text end
new text begin
(e) The report due on March 15, 2023, must include the metrics described in paragraph
(d) for each of the following years: 2017, 2018, 2019, 2020, and 2021.
new text end
Sec. 13.
Minnesota Statutes 2021 Supplement, section 256B.04, subdivision 14, is amended
to read:
Subd. 14.
Competitive bidding.
(a) When determined to be effective, economical, and
feasible, the commissioner may utilize volume purchase through competitive bidding and
negotiation under the provisions of chapter 16C, to provide items under the medical assistance
program including but not limited to the following:
(1) eyeglasses;
(2) oxygen. The commissioner shall provide for oxygen needed in an emergency situation
on a short-term basis, until the vendor can obtain the necessary supply from the contract
dealer;
(3) hearing aids and supplies;
(4) durable medical equipment, including but not limited to:
(i) hospital beds;
(ii) commodes;
(iii) glide-about chairs;
(iv) patient lift apparatus;
(v) wheelchairs and accessories;
(vi) oxygen administration equipment;
(vii) respiratory therapy equipment;
(viii) electronic diagnostic, therapeutic and life-support systems; and
(ix) allergen-reducing products as described in section 256B.0625, subdivision 67,
paragraph (c) or (d);
(5) nonemergency medical transportation level of need determinations, disbursement of
public transportation passes and tokens, and volunteer and recipient mileage and parking
reimbursements; and
(6) drugs.
(b) Rate changes deleted text begin and recipient cost-sharingdeleted text end under this chapter and chapter 256L do not
affect contract payments under this subdivision unless specifically identified.
(c) The commissioner may not utilize volume purchase through competitive bidding
and negotiation under the provisions of chapter 16C for special transportation services or
incontinence products and related supplies.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 14.
Minnesota Statutes 2021 Supplement, section 256B.04, subdivision 14, is amended
to read:
Subd. 14.
Competitive bidding.
(a) When determined to be effective, economical, and
feasible, the commissioner may utilize volume purchase through competitive bidding and
negotiation under the provisions of chapter 16C, to provide items under the medical assistance
program including but not limited to the following:
(1) eyeglasses;
(2) oxygen. The commissioner shall provide for oxygen needed in an emergency situation
on a short-term basis, until the vendor can obtain the necessary supply from the contract
dealer;
(3) hearing aids and supplies;
(4) durable medical equipment, including but not limited to:
(i) hospital beds;
(ii) commodes;
(iii) glide-about chairs;
(iv) patient lift apparatus;
(v) wheelchairs and accessories;
(vi) oxygen administration equipment;
(vii) respiratory therapy equipment;
(viii) electronic diagnostic, therapeutic and life-support systems; and
(ix) allergen-reducing products as described in section 256B.0625, subdivision 67,
paragraph (c) or (d);
(5) nonemergency medical transportation level of need determinations, disbursement of
public transportation passes and tokens, and volunteer and recipient mileage and parking
reimbursements; deleted text begin and
deleted text end
(6) drugsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(7) quitline services as described in section 256B.0625, subdivision 68.
new text end
(b) Rate changes and recipient cost-sharing under this chapter and chapter 256L do not
affect contract payments under this subdivision unless specifically identified.
(c) The commissioner may not utilize volume purchase through competitive bidding
and negotiation under the provisions of chapter 16C for special transportation services or
incontinence products and related supplies.
Sec. 15.
Minnesota Statutes 2020, section 256B.055, subdivision 17, is amended to read:
Subd. 17.
Adults who were in foster care at the age of 18.
new text begin (a) new text end Medical assistance may
be paid for a person under 26 years of age who was in foster care under the commissioner's
responsibility on the date of attaining 18 years of agenew text begin or oldernew text end , and who was enrolled in
medical assistance under deleted text begin thedeleted text end new text begin anew text end state plan or a waiver of deleted text begin thedeleted text end new text begin anew text end plan while in foster care, in
accordance with section 2004 of the Affordable Care Act.
new text begin
(b) Beginning January 1, 2023, medical assistance may be paid for a person under 26
years of age who was in foster care and enrolled in another state's Medicaid program while
in foster care, in accordance with Public Law 115-271, section 1002, the Substance
Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and
Communities Act.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 16.
Minnesota Statutes 2020, section 256B.056, subdivision 3, is amended to read:
Subd. 3.
Asset limitations for certain individuals.
(a) To be eligible for medical
assistance, a person must not individually own more than deleted text begin $3,000deleted text end new text begin $20,000new text end in assets, or if a
member of a household with two family members, husband and wife, or parent and child,
the household must not own more than deleted text begin $6,000deleted text end new text begin $40,000new text end in assets, plus $200 for each
additional legal dependent. In addition to these maximum amounts, an eligible individual
or family may accrue interest on these amounts, but they must be reduced to the maximum
at the time of an eligibility redetermination. The accumulation of the clothing and personal
needs allowance according to section 256B.35 must also be reduced to the maximum at the
time of the eligibility redetermination. The value of assets that are not considered in
determining eligibility for medical assistance is the value of those assets excluded under
the Supplemental Security Income program for aged, blind, and disabled persons, with the
following exceptions:
(1) household goods and personal effects are not considered;
(2) capital and operating assets of a trade or business that the local agency determines
are necessary to the person's ability to earn an income are not considered;
(3) motor vehicles are excluded to the same extent excluded by the Supplemental Security
Income program;
(4) assets designated as burial expenses are excluded to the same extent excluded by the
Supplemental Security Income program. Burial expenses funded by annuity contracts or
life insurance policies must irrevocably designate the individual's estate as contingent
beneficiary to the extent proceeds are not used for payment of selected burial expenses;
(5) for a person who no longer qualifies as an employed person with a disability due to
loss of earnings, assets allowed while eligible for medical assistance under section 256B.057,
subdivision 9, are not considered for 12 months, beginning with the first month of ineligibility
as an employed person with a disability, to the extent that the person's total assets remain
within the allowed limits of section 256B.057, subdivision 9, paragraph (d);
(6) a designated employment incentives asset account is disregarded when determining
eligibility for medical assistance for a person age 65 years or older under section 256B.055,
subdivision 7. An employment incentives asset account must only be designated by a person
who has been enrolled in medical assistance under section 256B.057, subdivision 9, for a
24-consecutive-month period. A designated employment incentives asset account contains
qualified assets owned by the person and the person's spouse in the last month of enrollment
in medical assistance under section 256B.057, subdivision 9. Qualified assets include
retirement and pension accounts, medical expense accounts, and up to $17,000 of the person's
other nonexcluded assets. An employment incentives asset account is no longer designated
when a person loses medical assistance eligibility for a calendar month or more before
turning age 65. A person who loses medical assistance eligibility before age 65 can establish
a new designated employment incentives asset account by establishing a new
24-consecutive-month period of enrollment under section 256B.057, subdivision 9. The
income of a spouse of a person enrolled in medical assistance under section 256B.057,
subdivision 9, during each of the 24 consecutive months before the person's 65th birthday
must be disregarded when determining eligibility for medical assistance under section
256B.055, subdivision 7. Persons eligible under this clause are not subject to the provisions
in section 256B.059; deleted text begin and
deleted text end
(7) effective July 1, 2009, certain assets owned by American Indians are excluded as
required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
Law 111-5. For purposes of this clause, an American Indian is any person who meets the
definition of Indian according to Code of Federal Regulations, title 42, section 447.50deleted text begin .deleted text end new text begin ; and
new text end
new text begin
(8) for individuals who were enrolled in medical assistance during the COVID-19 federal
public health emergency declared by the United States Secretary of Health and Human
Services and who are subject to the asset limits established by this subdivision, assets in
excess of the limits must be disregarded until 95 days after the individual's first renewal
occurring after the expiration of the COVID-19 federal public health emergency declared
by the United States Secretary of Health and Human Services.
new text end
(b) No asset limit shall apply to persons eligible under section 256B.055, subdivision
15.
new text begin EFFECTIVE DATE. new text end
new text begin
The amendment to paragraph (a) increasing the asset limits is
effective January 1, 2025, or upon federal approval, whichever is later. The amendment to
paragraph (a) adding clause (8) is effective July 1, 2022, or upon federal approval, whichever
is later. The commissioner of human services shall notify the revisor of statutes when federal
approval is obtained.
new text end
Sec. 17.
Minnesota Statutes 2020, section 256B.056, subdivision 4, is amended to read:
Subd. 4.
Income.
(a) To be eligible for medical assistance, a person eligible under section
256B.055, subdivisions 7, 7a, and 12, may have income up to 100 percent of the federal
poverty guidelinesnew text begin , and effective January 1, 2025, income up to 133 percent of the federal
poverty guidelinesnew text end . Effective January 1, 2000, and each successive January, recipients of
Supplemental Security Income may have an income up to the Supplemental Security Income
standard in effect on that date.
(b) To be eligible for medical assistance under section 256B.055, subdivision 3a, a parent
or caretaker relative may have an income up to 133 percent of the federal poverty guidelines
for the household size.
(c) To be eligible for medical assistance under section 256B.055, subdivision 15, a
person may have an income up to 133 percent of federal poverty guidelines for the household
size.
(d) To be eligible for medical assistance under section 256B.055, subdivision 16, a child
age 19 to 20 may have an income up to 133 percent of the federal poverty guidelines for
the household size.
(e) To be eligible for medical assistance under section 256B.055, subdivision 3a, a child
under age 19 may have income up to 275 percent of the federal poverty guidelines for the
household size.
(f) In computing income to determine eligibility of persons under paragraphs (a) to (e)
who are not residents of long-term care facilities, the commissioner shall disregard increases
in income as required by Public Laws 94-566, section 503; 99-272; and 99-509. For persons
eligible under paragraph (a), veteran aid and attendance benefits and Veterans Administration
unusual medical expense payments are considered income to the recipient.
Sec. 18.
Minnesota Statutes 2020, section 256B.056, subdivision 7, is amended to read:
Subd. 7.
Period of eligibility.
(a) Eligibility is available for the month of application
and for three months prior to application if the person was eligible in those prior months.
A redetermination of eligibility must occur every 12 months.
(b) For a person eligible for an insurance affordability program as defined in section
256B.02, subdivision 19, who reports a change that makes the person eligible for medical
assistance, eligibility is available for the month the change was reported and for three months
prior to the month the change was reported, if the person was eligible in those prior months.
new text begin
(c) Once determined eligible for medical assistance, a child under the age of 21 is
continuously eligible for a period of up to 12 months, unless:
new text end
new text begin
(1) the child reaches age 21;
new text end
new text begin
(2) the child requests voluntary termination of coverage;
new text end
new text begin
(3) the child ceases to be a resident of Minnesota;
new text end
new text begin
(4) the child dies; or
new text end
new text begin
(5) the agency determines the child's eligibility was erroneously granted due to agency
error or enrollee fraud, abuse, or perjury.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 19.
Minnesota Statutes 2021 Supplement, section 256B.0625, subdivision 9, is
amended to read:
Subd. 9.
Dental services.
(a) Medical assistance covers new text begin medically necessary new text end dental
services.
deleted text begin
(b) Medical assistance dental coverage for nonpregnant adults is limited to the following
services:
deleted text end
deleted text begin
(1) comprehensive exams, limited to once every five years;
deleted text end
deleted text begin
(2) periodic exams, limited to one per year;
deleted text end
deleted text begin
(3) limited exams;
deleted text end
deleted text begin
(4) bitewing x-rays, limited to one per year;
deleted text end
deleted text begin
(5) periapical x-rays;
deleted text end
deleted text begin
(6) panoramic x-rays, limited to one every five years except (1) when medically necessary
for the diagnosis and follow-up of oral and maxillofacial pathology and trauma or (2) once
every two years for patients who cannot cooperate for intraoral film due to a developmental
disability or medical condition that does not allow for intraoral film placement;
deleted text end
deleted text begin
(7) prophylaxis, limited to one per year;
deleted text end
deleted text begin
(8) application of fluoride varnish, limited to one per year;
deleted text end
deleted text begin
(9) posterior fillings, all at the amalgam rate;
deleted text end
deleted text begin
(10) anterior fillings;
deleted text end
deleted text begin
(11) endodontics, limited to root canals on the anterior and premolars only;
deleted text end
deleted text begin
(12) removable prostheses, each dental arch limited to one every six years;
deleted text end
deleted text begin
(13) oral surgery, limited to extractions, biopsies, and incision and drainage of abscesses;
deleted text end
deleted text begin
(14) palliative treatment and sedative fillings for relief of pain;
deleted text end
deleted text begin
(15) full-mouth debridement, limited to one every five years; and
deleted text end
deleted text begin
(16) nonsurgical treatment for periodontal disease, including scaling and root planing
once every two years for each quadrant, and routine periodontal maintenance procedures.
deleted text end
deleted text begin
(c) In addition to the services specified in paragraph (b), medical assistance covers the
following services for adults, if provided in an outpatient hospital setting or freestanding
ambulatory surgical center as part of outpatient dental surgery:
deleted text end
deleted text begin
(1) periodontics, limited to periodontal scaling and root planing once every two years;
deleted text end
deleted text begin
(2) general anesthesia; and
deleted text end
deleted text begin
(3) full-mouth survey once every five years.
deleted text end
deleted text begin (d) Medical assistance covers medically necessary dental services for children and
pregnant women.deleted text end The following guidelines apply:
(1) posterior fillings are paid at the amalgam rate;
(2) application of sealants are covered once every five years per permanent molar deleted text begin for
children onlydeleted text end ;
(3) application of fluoride varnish is covered once every six months; and
(4) orthodontia is eligible for coverage for children only.
deleted text begin (e)deleted text end new text begin (b)new text end In addition to the services specified in deleted text begin paragraphs (b) and (c)deleted text end new text begin paragraph (a)new text end ,
medical assistance covers the following services deleted text begin for adultsdeleted text end :
(1) house calls or extended care facility calls for on-site delivery of covered services;
(2) behavioral management when additional staff time is required to accommodate
behavioral challenges and sedation is not used;
(3) oral or IV sedation, if the covered dental service cannot be performed safely without
it or would otherwise require the service to be performed under general anesthesia in a
hospital or surgical center; and
(4) prophylaxis, in accordance with an appropriate individualized treatment plan, but
no more than four times per year.
deleted text begin (f)deleted text end new text begin (c)new text end The commissioner shall not require prior authorization for the services included
in paragraph deleted text begin (e)deleted text end new text begin (b)new text end , clauses (1) to (3), and shall prohibit managed care and county-based
purchasing plans from requiring prior authorization for the services included in paragraph
deleted text begin (e)deleted text end new text begin (b)new text end , clauses (1) to (3), when provided under sections 256B.69, 256B.692, and 256L.12.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 20.
Minnesota Statutes 2021 Supplement, section 256B.0625, subdivision 17, is
amended to read:
Subd. 17.
Transportation costs.
(a) "Nonemergency medical transportation service"
means motor vehicle transportation provided by a public or private person that serves
Minnesota health care program beneficiaries who do not require emergency ambulance
service, as defined in section 144E.001, subdivision 3, to obtain covered medical services.
(b) Medical assistance covers medical transportation costs incurred solely for obtaining
emergency medical care or transportation costs incurred by eligible persons in obtaining
emergency or nonemergency medical care when paid directly to an ambulance company,
nonemergency medical transportation company, or other recognized providers of
transportation services. Medical transportation must be provided by:
(1) nonemergency medical transportation providers who meet the requirements of this
subdivision;
(2) ambulances, as defined in section 144E.001, subdivision 2;
(3) taxicabs that meet the requirements of this subdivision;
(4) public transit, as defined in section 174.22, subdivision 7; or
(5) not-for-hire vehicles, including volunteer drivers, as defined in section 65B.472,
subdivision 1, paragraph (h).
(c) Medical assistance covers nonemergency medical transportation provided by
nonemergency medical transportation providers enrolled in the Minnesota health care
programs. All nonemergency medical transportation providers must comply with the
operating standards for special transportation service as defined in sections 174.29 to 174.30
and Minnesota Rules, chapter 8840, and all drivers must be individually enrolled with the
commissioner and reported on the claim as the individual who provided the service. All
nonemergency medical transportation providers shall bill for nonemergency medical
transportation services in accordance with Minnesota health care programs criteria. Publicly
operated transit systems, volunteers, and not-for-hire vehicles are exempt from the
requirements outlined in this paragraph.
(d) An organization may be terminated, denied, or suspended from enrollment if:
(1) the provider has not initiated background studies on the individuals specified in
section 174.30, subdivision 10, paragraph (a), clauses (1) to (3); or
(2) the provider has initiated background studies on the individuals specified in section
174.30, subdivision 10, paragraph (a), clauses (1) to (3), and:
(i) the commissioner has sent the provider a notice that the individual has been
disqualified under section 245C.14; and
(ii) the individual has not received a disqualification set-aside specific to the special
transportation services provider under sections 245C.22 and 245C.23.
(e) The administrative agency of nonemergency medical transportation must:
(1) adhere to the policies defined by the commissioner in consultation with the
Nonemergency Medical Transportation Advisory Committee;
(2) pay nonemergency medical transportation providers for services provided to
Minnesota health care programs beneficiaries to obtain covered medical services;
(3) provide data monthly to the commissioner on appeals, complaints, no-shows, canceled
trips, and number of trips by mode; and
(4) by July 1, 2016, in accordance with subdivision 18e, utilize a web-based single
administrative structure assessment tool that meets the technical requirements established
by the commissioner, reconciles trip information with claims being submitted by providers,
and ensures prompt payment for nonemergency medical transportation services.
(f) Until the commissioner implements the single administrative structure and delivery
system under subdivision 18e, clients shall obtain their level-of-service certificate from the
commissioner or an entity approved by the commissioner that does not dispatch rides for
clients using modes of transportation under paragraph (i), clauses (4), (5), (6), and (7).
(g) The commissioner may use an order by the recipient's attending physician, advanced
practice registered nurse, or a medical or mental health professional to certify that the
recipient requires nonemergency medical transportation services. Nonemergency medical
transportation providers shall perform driver-assisted services for eligible individuals, when
appropriate. Driver-assisted service includes passenger pickup at and return to the individual's
residence or place of business, assistance with admittance of the individual to the medical
facility, and assistance in passenger securement or in securing of wheelchairs, child seats,
or stretchers in the vehicle.
Nonemergency medical transportation providers must take clients to the health care
provider using the most direct route, and must not exceed 30 miles for a trip to a primary
care provider or 60 miles for a trip to a specialty care provider, unless the client receives
authorization from the local agency.
Nonemergency medical transportation providers may not bill for separate base rates for
the continuation of a trip beyond the original destination. Nonemergency medical
transportation providers must maintain trip logs, which include pickup and drop-off times,
signed by the medical provider or client, whichever is deemed most appropriate, attesting
to mileage traveled to obtain covered medical services. Clients requesting client mileage
reimbursement must sign the trip log attesting mileage traveled to obtain covered medical
services.
(h) The administrative agency shall use the level of service process established by the
commissioner in consultation with the Nonemergency Medical Transportation Advisory
Committee to determine the client's most appropriate mode of transportation. If public transit
or a certified transportation provider is not available to provide the appropriate service mode
for the client, the client may receive a onetime service upgrade.
(i) The covered modes of transportation are:
(1) client reimbursement, which includes client mileage reimbursement provided to
clients who have their own transportation, or to family or an acquaintance who provides
transportation to the client;
(2) volunteer transport, which includes transportation by volunteers using their own
vehicle;
(3) unassisted transport, which includes transportation provided to a client by a taxicab
or public transit. If a taxicab or public transit is not available, the client can receive
transportation from another nonemergency medical transportation provider;
(4) assisted transport, which includes transport provided to clients who require assistance
by a nonemergency medical transportation provider;
(5) lift-equipped/ramp transport, which includes transport provided to a client who is
dependent on a device and requires a nonemergency medical transportation provider with
a vehicle containing a lift or ramp;
(6) protected transport, which includes transport provided to a client who has received
a prescreening that has deemed other forms of transportation inappropriate and who requires
a provider: (i) with a protected vehicle that is not an ambulance or police car and has safety
locks, a video recorder, and a transparent thermoplastic partition between the passenger and
the vehicle driver; and (ii) who is certified as a protected transport provider; and
(7) stretcher transport, which includes transport for a client in a prone or supine position
and requires a nonemergency medical transportation provider with a vehicle that can transport
a client in a prone or supine position.
(j) The local agency shall be the single administrative agency and shall administer and
reimburse for modes defined in paragraph (i) according to paragraphs (m) and (n) when the
commissioner has developed, made available, and funded the web-based single administrative
structure, assessment tool, and level of need assessment under subdivision 18e. The local
agency's financial obligation is limited to funds provided by the state or federal government.
(k) The commissioner shall:
(1) in consultation with the Nonemergency Medical Transportation Advisory Committee,
verify that the mode and use of nonemergency medical transportation is appropriate;
(2) verify that the client is going to an approved medical appointment; and
(3) investigate all complaints and appeals.
(l) The administrative agency shall pay for the services provided in this subdivision and
seek reimbursement from the commissioner, if appropriate. As vendors of medical care,
local agencies are subject to the provisions in section 256B.041, the sanctions and monetary
recovery actions in section 256B.064, and Minnesota Rules, parts 9505.2160 to 9505.2245.
(m) Payments for nonemergency medical transportation must be paid based on the client's
assessed mode under paragraph (h), not the type of vehicle used to provide the service. The
medical assistance reimbursement rates for nonemergency medical transportation services
that are payable by or on behalf of the commissioner for nonemergency medical
transportation services are:
(1) $0.22 per mile for client reimbursement;
(2) up to 100 percent of the Internal Revenue Service business deduction rate for volunteer
transport;
(3) equivalent to the standard fare for unassisted transport when provided by public
transit, and $11 for the base rate and $1.30 per mile when provided by a nonemergency
medical transportation provider;
(4) $13 for the base rate and $1.30 per mile for assisted transport;
(5) $18 for the base rate and $1.55 per mile for lift-equipped/ramp transport;
(6) $75 for the base rate and $2.40 per mile for protected transport; and
(7) $60 for the base rate and $2.40 per mile for stretcher transport, and $9 per trip for
an additional attendant if deemed medically necessary.
(n) The base rate for nonemergency medical transportation services in areas defined
under RUCA to be super rural is equal to 111.3 percent of the respective base rate in
paragraph (m), clauses (1) to (7). The mileage rate for nonemergency medical transportation
services in areas defined under RUCA to be rural or super rural areas is:
(1) for a trip equal to 17 miles or less, equal to 125 percent of the respective mileage
rate in paragraph (m), clauses (1) to (7); and
(2) for a trip between 18 and 50 miles, equal to 112.5 percent of the respective mileage
rate in paragraph (m), clauses (1) to (7).
(o) For purposes of reimbursement rates for nonemergency medical transportation
services under paragraphs (m) and (n), the zip code of the recipient's place of residence
shall determine whether the urban, rural, or super rural reimbursement rate applies.
(p) For purposes of this subdivision, "rural urban commuting area" or "RUCA" means
a census-tract based classification system under which a geographical area is determined
to be urban, rural, or super rural.
(q) The commissioner, when determining reimbursement rates for nonemergency medical
transportation under paragraphs (m) and (n), shall exempt all modes of transportation listed
under paragraph (i) from Minnesota Rules, part 9505.0445, item R, subitem (2).
new text begin
(r) Effective for the first day of each calendar quarter in which the price of gasoline as
posted publicly by the United States Energy Information Administration exceeds $3.00 per
gallon, the commissioner shall adjust the rate paid per mile in paragraph (m) by one percent
up or down for every increase or decrease of ten cents for the price of gasoline. The increase
or decrease must be calculated using a base gasoline price of $3.00. The percentage increase
or decrease must be calculated using the average of the most recently available price of all
grades of gasoline for Minnesota as posted publicly by the United States Energy Information
Administration.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 21.
Minnesota Statutes 2020, section 256B.0625, subdivision 17a, is amended to
read:
Subd. 17a.
Payment for ambulance services.
(a) Medical assistance covers ambulance
services. Providers shall bill ambulance services according to Medicare criteria.
Nonemergency ambulance services shall not be paid as emergencies. Effective for services
rendered on or after July 1, 2001, medical assistance payments for ambulance services shall
be paid at the Medicare reimbursement rate or at the medical assistance payment rate in
effect on July 1, 2000, whichever is greater.
(b) Effective for services provided on or after July 1, 2016, medical assistance payment
rates for ambulance services identified in this paragraph are increased by five percent.
Capitation payments made to managed care plans and county-based purchasing plans for
ambulance services provided on or after January 1, 2017, shall be increased to reflect this
rate increase. The increased rate described in this paragraph applies to ambulance service
providers whose base of operations as defined in section 144E.10 is located:
(1) outside the metropolitan counties listed in section 473.121, subdivision 4, and outside
the cities of Duluth, Mankato, Moorhead, St. Cloud, and Rochester; or
(2) within a municipality with a population of less than 1,000.
new text begin
(c) Effective for the first day of each calendar quarter in which the price of gasoline as
posted publicly by the United States Energy Information Administration exceeds $3.00 per
gallon, the commissioner shall adjust the rate paid per mile in paragraphs (a) and (b) by one
percent up or down for every increase or decrease of ten cents for the price of gasoline. The
increase or decrease must be calculated using a base gasoline price of $3.00. The percentage
increase or decrease must be calculated using the average of the most recently available
price of all grades of gasoline for Minnesota as posted publicly by the United States Energy
Information Administration.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 22.
Minnesota Statutes 2020, section 256B.0625, subdivision 18h, is amended to
read:
Subd. 18h.
new text begin Nonemergency medical transportation provisions related to new text end managed
care.
(a) The following new text begin nonemergency medical transportation new text end subdivisions apply to managed
care plans and county-based purchasing plans:
(1) subdivision 17, paragraphs (a), (b), (i), and (n);
(2) subdivision 18; and
(3) subdivision 18a.
(b) A nonemergency medical transportation provider must comply with the operating
standards for special transportation service specified in sections 174.29 to 174.30 and
Minnesota Rules, chapter 8840. Publicly operated transit systems, volunteers, and not-for-hire
vehicles are exempt from the requirements in this paragraph.
new text begin
(c) Managed care and county-based purchasing plans must provide a fuel adjustment
for nonemergency medical transportation payment rates when the price of gasoline exceeds
$3.00 per gallon.
new text end
Sec. 23.
Minnesota Statutes 2020, section 256B.0625, subdivision 22, is amended to read:
Subd. 22.
Hospice care.
Medical assistance covers hospice care services under Public
Law 99-272, section 9505, to the extent authorized by rule, except that a recipient age 21
or under who elects to receive hospice services does not waive coverage for services that
are related to the treatment of the condition for which a diagnosis of terminal illness has
been made.new text begin Hospice respite and end-of-life care under subdivision 22a are not hospice care
services under this subdivision.
new text end
Sec. 24.
Minnesota Statutes 2020, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 22a. new text end
new text begin
Residential hospice facility; hospice respite and end-of-life care for
children.
new text end
new text begin
(a) Medical assistance covers hospice respite and end-of-life care if the care is
for recipients age 21 or under who elect to receive hospice care delivered in a facility that
is licensed under sections 144A.75 to 144A.755 and that is a residential hospice facility
under section 144A.75, subdivision 13, paragraph (a). Hospice care services under
subdivision 22 are not hospice respite or end-of-life care under this subdivision.
new text end
new text begin
(b) The payment rates for coverage under this subdivision must be 100 percent of the
Medicare rate for continuous home care hospice services as published in the Centers for
Medicare and Medicaid Services annual final rule updating payments and policies for hospice
care. Payment for hospice respite and end-of-life care under this subdivision must be made
from state funds, though the commissioner shall seek to obtain federal financial participation
for the payments. Payment for hospice respite and end-of-life care must be paid to the
residential hospice facility and are not included in any limits or cap amount applicable to
hospice services payments to the elected hospice services provider.
new text end
new text begin
(c) Certification of the residential hospice facility by the federal Medicare program must
not be a requirement of medical assistance payment for hospice respite and end-of-life care
under this subdivision.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 25.
Minnesota Statutes 2020, section 256B.0625, subdivision 28b, is amended to
read:
Subd. 28b.
Doula services.
Medical assistance covers doula services provided by a
certified doula as defined in section 148.995, subdivision 2, of the mother's choice. For
purposes of this section, "doula services" means childbirth education and support services,
including emotional and physical support provided during pregnancy, labor, birth, and
postpartum.new text begin The commissioner shall enroll doula agencies and individual treating doulas
in order to provide direct reimbursement.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024, subject to federal
approval. The commissioner of human services shall notify the revisor of statutes when
federal approval is obtained.
new text end
Sec. 26.
Minnesota Statutes 2021 Supplement, section 256B.0625, subdivision 30, is
amended to read:
Subd. 30.
Other clinic services.
(a) Medical assistance covers rural health clinic services,
federally qualified health center services, nonprofit community health clinic services, and
public health clinic services. Rural health clinic services and federally qualified health center
services mean services defined in United States Code, title 42, section 1396d(a)(2)(B) and
(C). Payment for rural health clinic and federally qualified health center services shall be
made according to applicable federal law and regulation.
(b) A federally qualified health center (FQHC) that is beginning initial operation shall
submit an estimate of budgeted costs and visits for the initial reporting period in the form
and detail required by the commissioner. An FQHC that is already in operation shall submit
an initial report using actual costs and visits for the initial reporting period. Within 90 days
of the end of its reporting period, an FQHC shall submit, in the form and detail required by
the commissioner, a report of its operations, including allowable costs actually incurred for
the period and the actual number of visits for services furnished during the period, and other
information required by the commissioner. FQHCs that file Medicare cost reports shall
provide the commissioner with a copy of the most recent Medicare cost report filed with
the Medicare program intermediary for the reporting year which support the costs claimed
on their cost report to the state.
(c) In order to continue cost-based payment under the medical assistance program
according to paragraphs (a) and (b), an FQHC or rural health clinic must apply for designation
as an essential community provider within six months of final adoption of rules by the
Department of Health according to section 62Q.19, subdivision 7. For those FQHCs and
rural health clinics that have applied for essential community provider status within the
six-month time prescribed, medical assistance payments will continue to be made according
to paragraphs (a) and (b) for the first three years after application. For FQHCs and rural
health clinics that either do not apply within the time specified above or who have had
essential community provider status for three years, medical assistance payments for health
services provided by these entities shall be according to the same rates and conditions
applicable to the same service provided by health care providers that are not FQHCs or rural
health clinics.
(d) Effective July 1, 1999, the provisions of paragraph (c) requiring an FQHC or a rural
health clinic to make application for an essential community provider designation in order
to have cost-based payments made according to paragraphs (a) and (b) no longer apply.
(e) Effective January 1, 2000, payments made according to paragraphs (a) and (b) shall
be limited to the cost phase-out schedule of the Balanced Budget Act of 1997.
(f) Effective January 1, 2001, through December 31, 2020, each FQHC and rural health
clinic may elect to be paid either under the prospective payment system established in United
States Code, title 42, section 1396a(aa), or under an alternative payment methodology
consistent with the requirements of United States Code, title 42, section 1396a(aa), and
approved by the Centers for Medicare and Medicaid Services. The alternative payment
methodology shall be 100 percent of cost as determined according to Medicare cost
principles.
(g) Effective for services provided on or after January 1, 2021, all claims for payment
of clinic services provided by FQHCs and rural health clinics shall be paid by the
commissioner, according to an annual election by the FQHC or rural health clinic, under
the current prospective payment system described in paragraph (f) or the alternative payment
methodology described in paragraph (l).
(h) For purposes of this section, "nonprofit community clinic" is a clinic that:
(1) has nonprofit status as specified in chapter 317A;
(2) has tax exempt status as provided in Internal Revenue Code, section 501(c)(3);
(3) is established to provide health services to low-income population groups, uninsured,
high-risk and special needs populations, underserved and other special needs populations;
(4) employs professional staff at least one-half of which are familiar with the cultural
background of their clients;
(5) charges for services on a sliding fee scale designed to provide assistance to
low-income clients based on current poverty income guidelines and family size; and
(6) does not restrict access or services because of a client's financial limitations or public
assistance status and provides no-cost care as needed.
(i) Effective for services provided on or after January 1, 2015, all claims for payment
of clinic services provided by FQHCs and rural health clinics shall be paid by the
commissioner. the commissioner shall determine the most feasible method for paying claims
from the following options:
(1) FQHCs and rural health clinics submit claims directly to the commissioner for
payment, and the commissioner provides claims information for recipients enrolled in a
managed care or county-based purchasing plan to the plan, on a regular basis; or
(2) FQHCs and rural health clinics submit claims for recipients enrolled in a managed
care or county-based purchasing plan to the plan, and those claims are submitted by the
plan to the commissioner for payment to the clinic.
(j) For clinic services provided prior to January 1, 2015, the commissioner shall calculate
and pay monthly the proposed managed care supplemental payments to clinics, and clinics
shall conduct a timely review of the payment calculation data in order to finalize all
supplemental payments in accordance with federal law. Any issues arising from a clinic's
review must be reported to the commissioner by January 1, 2017. Upon final agreement
between the commissioner and a clinic on issues identified under this subdivision, and in
accordance with United States Code, title 42, section 1396a(bb), no supplemental payments
for managed care plan or county-based purchasing plan claims for services provided prior
to January 1, 2015, shall be made after June 30, 2017. If the commissioner and clinics are
unable to resolve issues under this subdivision, the parties shall submit the dispute to the
arbitration process under section 14.57.
(k) The commissioner shall seek a federal waiver, authorized under section 1115 of the
Social Security Act, to obtain federal financial participation at the 100 percent federal
matching percentage available to facilities of the Indian Health Service or tribal organization
in accordance with section 1905(b) of the Social Security Act for expenditures made to
organizations dually certified under Title V of the Indian Health Care Improvement Act,
Public Law 94-437, and as a federally qualified health center under paragraph (a) that
provides services to American Indian and Alaskan Native individuals eligible for services
under this subdivision.
(l) All claims for payment of clinic services provided by FQHCs and rural health clinics,
that have elected to be paid under this paragraph, shall be paid by the commissioner according
to the following requirements:
(1) the commissioner shall establish a single medical and single dental organization
encounter rate for each FQHC and rural health clinic when applicable;
(2) each FQHC and rural health clinic is eligible for same day reimbursement of one
medical and one dental organization encounter rate if eligible medical and dental visits are
provided on the same day;
(3) the commissioner shall reimburse FQHCs and rural health clinics, in accordance
with current applicable Medicare cost principles, their allowable costs, including direct
patient care costs and patient-related support services. Nonallowable costs include, but are
not limited to:
(i) general social services and administrative costs;
(ii) retail pharmacy;
(iii) patient incentives, food, housing assistance, and utility assistance;
(iv) external lab and x-ray;
(v) navigation services;
(vi) health care taxes;
(vii) advertising, public relations, and marketing;
(viii) office entertainment costs, food, alcohol, and gifts;
(ix) contributions and donations;
(x) bad debts or losses on awards or contracts;
(xi) fines, penalties, damages, or other settlements;
(xii) fund-raising, investment management, and associated administrative costs;
(xiii) research and associated administrative costs;
(xiv) nonpaid workers;
(xv) lobbying;
(xvi) scholarships and student aid; and
(xvii) nonmedical assistance covered services;
(4) the commissioner shall review the list of nonallowable costs in the years between
the rebasing process established in clause (5), in consultation with the Minnesota Association
of Community Health Centers, FQHCs, and rural health clinics. The commissioner shall
publish the list and any updates in the Minnesota health care programs provider manual;
(5) the initial applicable base year organization encounter rates for FQHCs and rural
health clinics shall be computed for services delivered on or after January 1, 2021, and:
(i) must be determined using each FQHC's and rural health clinic's Medicare cost reports
from 2017 and 2018;
(ii) must be according to current applicable Medicare cost principles as applicable to
FQHCs and rural health clinics without the application of productivity screens and upper
payment limits or the Medicare prospective payment system FQHC aggregate mean upper
payment limit;
(iii) must be subsequently rebased every two years thereafter using the Medicare cost
reports that are three and four years prior to the rebasing year. Years in which organizational
cost or claims volume is reduced or altered due to a pandemic, disease, or other public health
emergency shall not be used as part of a base year when the base year includes more than
one year. The commissioner may use the Medicare cost reports of a year unaffected by a
pandemic, disease, or other public health emergency, or previous two consecutive years,
inflated to the base year as established under item (iv);
(iv) must be inflated to the base year using the inflation factor described in clause (6);
and
(v) the commissioner must provide for a 60-day appeals process under section 14.57;
(6) the commissioner shall annually inflate the applicable organization encounter rates
for FQHCs and rural health clinics from the base year payment rate to the effective date by
using the CMS FQHC Market Basket inflator established under United States Code, title
42, section 1395m(o), less productivity;
(7) FQHCs and rural health clinics that have elected the alternative payment methodology
under this paragraph shall submit all necessary documentation required by the commissioner
to compute the rebased organization encounter rates no later than six months following the
date the applicable Medicare cost reports are due to the Centers for Medicare and Medicaid
Services;
(8) the commissioner shall reimburse FQHCs and rural health clinics an additional
amount relative to their medical and dental organization encounter rates that is attributable
to the tax required to be paid according to section 295.52, if applicable;
(9) FQHCs and rural health clinics may submit change of scope requests to the
commissioner if the change of scope would result in an increase or decrease of 2.5 percent
or higher in the medical or dental organization encounter rate currently received by the
FQHC or rural health clinic;
(10) for FQHCs and rural health clinics seeking a change in scope with the commissioner
under clause (9) that requires the approval of the scope change by the federal Health
Resources Services Administration:
(i) FQHCs and rural health clinics shall submit the change of scope request, including
the start date of services, to the commissioner within seven business days of submission of
the scope change to the federal Health Resources Services Administration;
(ii) the commissioner shall establish the effective date of the payment change as the
federal Health Resources Services Administration date of approval of the FQHC's or rural
health clinic's scope change request, or the effective start date of services, whichever is
later; and
(iii) within 45 days of one year after the effective date established in item (ii), the
commissioner shall conduct a retroactive review to determine if the actual costs established
under clause (3) or encounters result in an increase or decrease of 2.5 percent or higher in
the medical or dental organization encounter rate, and if this is the case, the commissioner
shall revise the rate accordingly and shall adjust payments retrospectively to the effective
date established in item (ii);
(11) for change of scope requests that do not require federal Health Resources Services
Administration approval, the FQHC and rural health clinic shall submit the request to the
commissioner before implementing the change, and the effective date of the change is the
date the commissioner received the FQHC's or rural health clinic's request, or the effective
start date of the service, whichever is later. The commissioner shall provide a response to
the FQHC's or rural health clinic's request within 45 days of submission and provide a final
approval within 120 days of submission. This timeline may be waived at the mutual
agreement of the commissioner and the FQHC or rural health clinic if more information is
needed to evaluate the request;
(12) the commissioner, when establishing organization encounter rates for new FQHCs
and rural health clinics, shall consider the patient caseload of existing FQHCs and rural
health clinics in a 60-mile radius for organizations established outside of the seven-county
metropolitan area, and in a 30-mile radius for organizations in the seven-county metropolitan
area. If this information is not available, the commissioner may use Medicare cost reports
or audited financial statements to establish base rates;
(13) the commissioner shall establish a quality measures workgroup that includes
representatives from the Minnesota Association of Community Health Centers, FQHCs,
and rural health clinics, to evaluate clinical and nonclinical measures; and
(14) the commissioner shall not disallow or reduce costs that are related to an FQHC's
or rural health clinic's participation in health care educational programs to the extent that
the costs are not accounted for in the alternative payment methodology encounter rate
established in this paragraph.
new text begin
(m) Effective July 1, 2022, an enrolled Indian Health Service facility or a Tribal health
center operating under a 638 contract or compact may elect to also enroll as a Tribal FQHC.
No requirements that otherwise apply to FQHCs covered in this subdivision apply to Tribal
FQHCs enrolled under this paragraph, except those necessary to comply with federal
regulations. The commissioner shall establish an alternative payment method for Tribal
FQHCs enrolled under this paragraph that uses the same method and rates applicable to a
Tribal facility or health center that does not enroll as a Tribal FQHC.
new text end
Sec. 27.
Minnesota Statutes 2021 Supplement, section 256B.0625, subdivision 31, is
amended to read:
Subd. 31.
Medical supplies and equipment.
(a) Medical assistance covers medical
supplies and equipment. Separate payment outside of the facility's payment rate shall be
made for wheelchairs and wheelchair accessories for recipients who are residents of
intermediate care facilities for the developmentally disabled. Reimbursement for wheelchairs
and wheelchair accessories for ICF/DD recipients shall be subject to the same conditions
and limitations as coverage for recipients who do not reside in institutions. A wheelchair
purchased outside of the facility's payment rate is the property of the recipient.
(b) Vendors of durable medical equipment, prosthetics, orthotics, or medical supplies
must enroll as a Medicare provider.
(c) When necessary to ensure access to durable medical equipment, prosthetics, orthotics,
or medical supplies, the commissioner may exempt a vendor from the Medicare enrollment
requirement if:
(1) the vendor supplies only one type of durable medical equipment, prosthetic, orthotic,
or medical supply;
(2) the vendor serves ten or fewer medical assistance recipients per year;
(3) the commissioner finds that other vendors are not available to provide same or similar
durable medical equipment, prosthetics, orthotics, or medical supplies; and
(4) the vendor complies with all screening requirements in this chapter and Code of
Federal Regulations, title 42, part 455. The commissioner may also exempt a vendor from
the Medicare enrollment requirement if the vendor is accredited by a Centers for Medicare
and Medicaid Services approved national accreditation organization as complying with the
Medicare program's supplier and quality standards and the vendor serves primarily pediatric
patients.
(d) new text begin "new text end Durable medical equipmentnew text begin "new text end means a device or equipment that:
(1) can withstand repeated use;
(2) is generally not useful in the absence of an illness, injury, or disability; and
(3) is provided to correct or accommodate a physiological disorder or physical condition
or is generally used primarily for a medical purpose.
(e) Electronic tablets may be considered durable medical equipment if the electronic
tablet will be used as an augmentative and alternative communication system as defined
under subdivision 31a, paragraph (a). To be covered by medical assistance, the device must
be locked in order to prevent use not related to communication.
(f) Notwithstanding the requirement in paragraph (e) that an electronic tablet must be
locked to prevent use not as an augmentative communication device, a recipient of waiver
services may use an electronic tablet for a use not related to communication when the
recipient has been authorized under the waiver to receive one or more additional applications
that can be loaded onto the electronic tablet, such that allowing the additional use prevents
the purchase of a separate electronic tablet with waiver funds.
(g) An order or prescription for medical supplies, equipment, or appliances must meet
the requirements in Code of Federal Regulations, title 42, part 440.70.
(h) Allergen-reducing products provided according to subdivision 67, paragraph (c) or
(d), shall be considered durable medical equipment.
new text begin
(i) Seizure detection devices are covered as durable medical equipment under this
subdivision if:
new text end
new text begin
(1) the seizure detection device is medically appropriate based on the recipient's medical
condition or status; and
new text end
new text begin
(2) the recipient's health care provider has identified that a seizure detection device
would:
new text end
new text begin
(i) likely assist in reducing bodily harm to or death of the recipient as a result of the
recipient experiencing a seizure; or
new text end
new text begin
(ii) provide data to the health care provider necessary to appropriately diagnose or treat
the recipient's health condition that causes the seizure activity.
new text end
new text begin
(j) For purposes of paragraph (i), "seizure detection device" means a United States Food
and Drug Administration approved monitoring device and any related service or subscription
supporting the prescribed use of the device, including technology that:
new text end
new text begin
(1) provides ongoing patient monitoring and alert services that detects nocturnal seizure
activity and transmits notification of the seizure activity to a caregiver for appropriate
medical response; or
new text end
new text begin
(2) collects data of the seizure activity of the recipient that can be used by a health care
provider to diagnose or appropriately treat a health care condition that causes the seizure
activity.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 28.
Minnesota Statutes 2020, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 68. new text end
new text begin Tobacco and nicotine cessation. new text end
new text begin
(a) Medical assistance covers tobacco and
nicotine cessation services, drugs to treat tobacco and nicotine addiction or dependence,
and drugs to help individuals discontinue use of tobacco and nicotine products. Medical
assistance must cover services and drugs as provided in this subdivision consistent with
evidence-based or evidence-informed best practices.
new text end
new text begin
(b) Medical assistance must cover in-person individual and group tobacco and nicotine
cessation education and counseling services if provided by a health care practitioner whose
scope of practice encompasses tobacco and nicotine cessation education and counseling.
Service providers include but are not limited to the following:
new text end
new text begin
(1) mental health practitioners under section 245.462, subdivision 17;
new text end
new text begin
(2) mental health professionals under section 245.462, subdivision 18;
new text end
new text begin
(3) mental health certified peer specialists under section 256B.0615;
new text end
new text begin
(4) alcohol and drug counselors licensed under chapter 148F;
new text end
new text begin
(5) recovery peers as defined in section 245F.02, subdivision 21;
new text end
new text begin
(6) certified tobacco treatment specialists;
new text end
new text begin
(7) community health workers;
new text end
new text begin
(8) physicians;
new text end
new text begin
(9) physician assistants;
new text end
new text begin
(10) advanced practice registered nurses; or
new text end
new text begin
(11) other licensed or nonlicensed professionals or paraprofessionals with training in
providing tobacco and nicotine cessation education and counseling services.
new text end
new text begin
(c) Medical assistance covers telephone cessation counseling services provided through
a quitline. Notwithstanding subdivision 3b, quitline services may be provided through
audio-only communications. The commissioner may use volume purchasing for quitline
services consistent with section 256B.04, subdivision 14.
new text end
new text begin
(d) Medical assistance must cover all prescription and over-the-counter pharmacotherapy
drugs approved by the United States Food and Drug Administration for cessation of tobacco
and nicotine use or treatment of tobacco and nicotine dependence, and that are subject to a
Medicaid drug rebate agreement.
new text end
new text begin
(e) Services covered under this subdivision may be provided by telemedicine.
new text end
new text begin
(f) The commissioner must not:
new text end
new text begin
(1) restrict or limit the type, duration, or frequency of tobacco and nicotine cessation
services;
new text end
new text begin
(2) prohibit the simultaneous use of multiple cessation services, including but not limited
to simultaneous use of counseling and drugs;
new text end
new text begin
(3) require counseling prior to receiving drugs or as a condition of receiving drugs;
new text end
new text begin
(4) limit pharmacotherapy drug dosage amounts for a dosing regimen for treatment of
a medically accepted indication, as defined in United States Code, title 42, section
1396r-8(k)(6); limit dosing frequency; or impose duration limits;
new text end
new text begin
(5) prohibit simultaneous use of multiple drugs, including prescription and
over-the-counter drugs;
new text end
new text begin
(6) require or authorize step therapy; or
new text end
new text begin
(7) require or utilize prior authorization or require a co-payment or deductible for any
tobacco and nicotine cessation services and drugs covered under this subdivision.
new text end
new text begin
(g) The commissioner must require all participating entities under contract with the
commissioner to comply with this subdivision when providing coverage, services, or care
management for medical assistance and MinnesotaCare enrollees. For purposes of this
subdivision, "participating entity" means any of the following:
new text end
new text begin
(1) a health carrier as defined in section 62A.011, subdivision 2;
new text end
new text begin
(2) a county-based purchasing plan established under section 256B.692;
new text end
new text begin
(3) an accountable care organization or other entity participating as an integrated health
partnership under section 256B.0755;
new text end
new text begin
(4) an entity operating a county integrated health care delivery network pilot project
authorized under section 256B.0756;
new text end
new text begin
(5) a network of health care providers established to offer services under medical
assistance or MinnesotaCare; or
new text end
new text begin
(6) any other entity that has a contract with the commissioner to cover, provide, or
manage health care services provided to medical assistance or MinnesotaCare enrollees on
a capitated or risk-based payment arrangement or under a reimbursement methodology with
substantial financial incentives to reduce the total cost of health care for a population of
patients that is enrolled with or assigned or attributed to the entity.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 29.
Minnesota Statutes 2020, section 256B.0631, as amended by Laws 2021, First
Special Session chapter 7, article 1, section 17, is amended to read:
256B.0631 MEDICAL ASSISTANCE CO-PAYMENTS.
Subdivision 1.
Cost-sharing.
(a) Except as provided in subdivision 2, the medical
assistance benefit plan shall include the following cost-sharing for all recipients, effective
for services provided on or after September 1, 2011new text begin , through December 31, 2022new text end :
(1) $3 per nonpreventive visit, except as provided in paragraph (b). For purposes of this
subdivision, a visit means an episode of service which is required because of a recipient's
symptoms, diagnosis, or established illness, and which is delivered in an ambulatory setting
by a physician or physician assistant, chiropractor, podiatrist, nurse midwife, advanced
practice nurse, audiologist, optician, or optometrist;
(2) $3.50 for nonemergency visits to a hospital-based emergency room, except that this
co-payment shall be increased to $20 upon federal approval;
(3) $3 per brand-name drug prescription, $1 per generic drug prescription, and $1 per
prescription for a brand-name multisource drug listed in preferred status on the preferred
drug list, subject to a $12 per month maximum for prescription drug co-payments. No
co-payments shall apply to antipsychotic drugs when used for the treatment of mental illness;
(4) a family deductible equal to $2.75 per month per family and adjusted annually by
the percentage increase in the medical care component of the CPI-U for the period of
September to September of the preceding calendar year, rounded to the next higher five-cent
increment; and
(5) total monthly cost-sharing must not exceed five percent of family income. For
purposes of this paragraph, family income is the total earned and unearned income of the
individual and the individual's spouse, if the spouse is enrolled in medical assistance and
also subject to the five percent limit on cost-sharing. This paragraph does not apply to
premiums charged to individuals described under section 256B.057, subdivision 9.
(b) Recipients of medical assistance are responsible for all co-payments and deductibles
in this subdivision.
(c) Notwithstanding paragraph (b), the commissioner, through the contracting process
under sections 256B.69 and 256B.692, may allow managed care plans and county-based
purchasing plans to waive the family deductible under paragraph (a), clause (4). The value
of the family deductible shall not be included in the capitation payment to managed care
plans and county-based purchasing plans. Managed care plans and county-based purchasing
plans shall certify annually to the commissioner the dollar value of the family deductible.
(d) Notwithstanding paragraph (b), the commissioner may waive the collection of the
family deductible described under paragraph (a), clause (4), from individuals and allow
long-term care and waivered service providers to assume responsibility for payment.
(e) Notwithstanding paragraph (b), the commissioner, through the contracting process
under section 256B.0756 shall allow the pilot program in Hennepin County to waive
co-payments. The value of the co-payments shall not be included in the capitation payment
amount to the integrated health care delivery networks under the pilot program.
new text begin
(f) Paragraphs (a) to (e) apply only for services provided through December 31, 2022.
Effective for services provided on or after January 1, 2023, the medical assistance program
shall not require deductibles, co-payments, coinsurance, or any other form of enrollee
cost-sharing.
new text end
Subd. 2.
Exceptions.
Co-payments and deductibles shall be subjectnew text begin , through December
31, 2022,new text end to the following exceptions:
(1) children under the age of 21;
(2) pregnant women for services that relate to the pregnancy or any other medical
condition that may complicate the pregnancy;
(3) recipients expected to reside for at least 30 days in a hospital, nursing home, or
intermediate care facility for the developmentally disabled;
(4) recipients receiving hospice care;
(5) 100 percent federally funded services provided by an Indian health service;
(6) emergency services;
(7) family planning services;
(8) services that are paid by Medicare, resulting in the medical assistance program paying
for the coinsurance and deductible;
(9) co-payments that exceed one per day per provider for nonpreventive visits, eyeglasses,
and nonemergency visits to a hospital-based emergency room;
(10) services, fee-for-service payments subject to volume purchase through competitive
bidding;
(11) American Indians who meet the requirements in Code of Federal Regulations, title
42, sections 447.51 and 447.56;
(12) persons needing treatment for breast or cervical cancer as described under section
256B.057, subdivision 10; and
(13) services that currently have a rating of A or B from the United States Preventive
Services Task Force (USPSTF), immunizations recommended by the Advisory Committee
on Immunization Practices of the Centers for Disease Control and Prevention, and preventive
services and screenings provided to women as described in Code of Federal Regulations,
title 45, section 147.130.
Subd. 3.
Collection.
(a) The medical assistance reimbursement to the provider shall be
reduced by the amount of the co-payment or deductible, except that reimbursements shall
not be reduced:
(1) once a recipient has reached the $12 per month maximum for prescription drug
co-payments; or
(2) for a recipient who has met their monthly five percent cost-sharing limit.
(b) The provider collects the co-payment or deductible from the recipient. Providers
may not deny services to recipients who are unable to pay the co-payment or deductible.
(c) Medical assistance reimbursement to fee-for-service providers and payments to
managed care plans shall not be increased as a result of the removal of co-payments or
deductibles effective on or after January 1, 2009.
new text begin
(d) Paragraphs (a) to (c) apply only for services provided through December 31, 2022.
new text end
Sec. 30.
Minnesota Statutes 2021 Supplement, section 256B.0631, subdivision 1, is
amended to read:
Subdivision 1.
Cost-sharing.
(a) Except as provided in subdivision 2, the medical
assistance benefit plan deleted text begin shalldeleted text end new text begin mustnew text end include the following cost-sharing for all recipients,
effective for services provided on or after September 1, 2011:
(1) $3 per nonpreventive visit, except as provided in paragraph (b)new text begin and except that a
co-payment must not apply to tobacco and nicotine cessation services covered under section
256B.0625, subdivision 68new text end . For purposes of this subdivision, a visit means an episode of
service which is required because of a recipient's symptoms, diagnosis, or established illness,
and which is delivered in an ambulatory setting by a physician or physician assistant,
chiropractor, podiatrist, nurse midwife, advanced practice nurse, audiologist, optician, or
optometrist;
(2) $3.50 for nonemergency visits to a hospital-based emergency room, except that this
co-payment shall be increased to $20 upon federal approval;
(3) $3 per brand-name drug prescription, $1 per generic drug prescription, and $1 per
prescription for a brand-name multisource drug listed in preferred status on the preferred
drug list, subject to a $12 per month maximum for prescription drug co-payments. deleted text begin Nodeleted text end
Co-payments deleted text begin shalldeleted text end new text begin must notnew text end apply to antipsychotic drugs when used for the treatment of
mental illnessnew text begin . Co-payments must not apply to drugs when used for tobacco and nicotine
cessationnew text end ;
(4) a family deductible equal to $2.75 per month per family and adjusted annually by
the percentage increase in the medical care component of the CPI-U for the period of
September to September of the preceding calendar year, rounded to the next higher five-cent
increment; and
(5) total monthly cost-sharing must not exceed five percent of family income. For
purposes of this paragraph, family income is the total earned and unearned income of the
individual and the individual's spouse, if the spouse is enrolled in medical assistance and
also subject to the five percent limit on cost-sharing. This paragraph does not apply to
premiums charged to individuals described under section 256B.057, subdivision 9.
(b) Recipients of medical assistance are responsible for all co-payments and deductibles
in this subdivision.
(c) Notwithstanding paragraph (b), the commissioner, through the contracting process
under sections 256B.69 and 256B.692, may allow managed care plans and county-based
purchasing plans to waive the family deductible under paragraph (a), clause (4). The value
of the family deductible deleted text begin shalldeleted text end new text begin mustnew text end not be included in the capitation payment to managed
care plans and county-based purchasing plans. Managed care plans and county-based
purchasing plans deleted text begin shalldeleted text end new text begin mustnew text end certify annually to the commissioner the dollar value of the
family deductible.
(d) Notwithstanding paragraph (b), the commissioner may waive the collection of the
family deductible described under paragraph (a), clause (4), from individuals and allow
long-term care and waivered service providers to assume responsibility for payment.
(e) Notwithstanding paragraph (b), the commissioner, through the contracting process
under section 256B.0756 shall allow the pilot program in Hennepin County to waive
co-payments. The value of the co-payments deleted text begin shalldeleted text end new text begin mustnew text end not be included in the capitation
payment amount to the integrated health care delivery networks under the pilot program.
Sec. 31.
new text begin
[256B.161] CLIENT ERROR OVERPAYMENT.
new text end
new text begin Subdivision 1. new text end
new text begin Scope. new text end
new text begin
(a) Subject to federal law and regulation, when a local agency or
the Department of Human Services determines a person under section 256.98, subdivision
4, is liable for recovery of medical assistance incorrectly paid as a result of client error or
when a recipient or former recipient receives medical assistance while an appeal is pending
pursuant to section 256.045, subdivision 10, and the recipient or former recipient is later
determined to have been ineligible for the medical assistance received or for less medical
assistance than was received during the pendency of the appeal, the local agency or the
Department of Human Services must:
new text end
new text begin
(1) determine the eligibility months during which medical assistance was incorrectly
paid;
new text end
new text begin
(2) redetermine eligibility for the incorrectly paid months using department policies and
procedures that were in effect during each eligibility month that was incorrectly paid; and
new text end
new text begin
(3) assess an overpayment against persons liable for recovery under section 256.98,
subdivision 4, for the amount of incorrectly paid medical assistance pursuant to section
256.98, subdivision 3.
new text end
new text begin
(b) Notwithstanding section 256.98, subdivision 4, medical assistance incorrectly paid
to a recipient as a result of client error when the recipient is under 21 years of age is not
recoverable from the recipient or recipient's estate. This section does not prohibit the state
agency from:
new text end
new text begin
(1) receiving payment from a trust pursuant to United States Code, title 42, section
1396p(d)(4)(A) or (C), for medical assistance paid on behalf of the trust beneficiary for
services received at any age; or
new text end
new text begin
(2) claiming against the designated beneficiary of an Achieving a Better Life Experience
(ABLE) account or the ABLE account itself pursuant to Code of Federal Regulations, title
26, section 1.529A-2(o), for the amount of the total medical assistance paid for the designated
beneficiary at any age after establishment of the ABLE account.
new text end
new text begin Subd. 2. new text end
new text begin Recovering client error overpayment. new text end
new text begin
(a) The local agency or the Department
of Human Services must not attempt recovery of the overpayment amount pursuant to
chapter 270A or section 256.0471 when a person liable for a client error overpayment under
section 256.98, subdivision 4, voluntarily repays the overpayment amount or establishes a
payment plan in writing with the local agency or the Department of Human Services to
repay the overpayment amount within 90 days after receiving the overpayment notice or
after resolution of a fair hearing regarding the overpayment under section 256.045, whichever
is later. When a liable person agrees to a payment plan in writing with the local agency or
the Department of Human Services but has not repaid any amount six months after entering
the agreement, the local agency or Department of Human Services must pursue recovery
under paragraph (b).
new text end
new text begin
(b) If the liable person does not voluntarily repay the overpayment amount or establish
a repayment agreement under paragraph (a), the local agency or the Department of Human
Services must attempt recovery of the overpayment amount pursuant to chapter 270A when
the overpayment amount is eligible for recovery as a public assistance debt under chapter
270A. For any overpaid amount of solely state-funded medical assistance, the local agency
or the Department of Human Services must attempt recovery pursuant to section 256.0471.
new text end
new text begin Subd. 3. new text end
new text begin Writing off client error overpayment. new text end
new text begin
A local agency or the Department of
Human Services must not attempt to recover a client error overpayment of less than $350,
unless the overpayment is for medical assistance received pursuant to section 256.045,
subdivision 10, during the pendency of an appeal or unless the recovery is from the recipient's
estate or the estate of the recipient's surviving spouse. A local agency or the Department of
Human Services may write off any remaining balance of a client error overpayment when
the overpayment has not been repaid five years after the effective date of the overpayment
and the local agency or the Department of Human Services determines it is no longer cost
effective to attempt recovery of the remaining balance.
new text end
Sec. 32.
Minnesota Statutes 2020, section 256B.69, subdivision 4, is amended to read:
Subd. 4.
Limitation of choicenew text begin ; opportunity to opt outnew text end .
(a) The commissioner shall
develop criteria to determine when limitation of choice may be implemented in the
experimental countiesnew text begin , but shall provide all eligible individuals the opportunity to opt out
of enrollment in managed care under this sectionnew text end . The criteria shall ensure that all eligible
individuals in the county have continuing access to the full range of medical assistance
services as specified in subdivision 6.
(b) The commissioner shall exempt the following persons from participation in the
project, in addition to those who do not meet the criteria for limitation of choice:
(1) persons eligible for medical assistance according to section 256B.055, subdivision
1;
(2) persons eligible for medical assistance due to blindness or disability as determined
by the Social Security Administration or the state medical review team, unless:
(i) they are 65 years of age or older; or
(ii) they reside in Itasca County or they reside in a county in which the commissioner
conducts a pilot project under a waiver granted pursuant to section 1115 of the Social
Security Act;
(3) recipients who currently have private coverage through a health maintenance
organization;
(4) recipients who are eligible for medical assistance by spending down excess income
for medical expenses other than the nursing facility per diem expense;
(5) recipients who receive benefits under the Refugee Assistance Program, established
under United States Code, title 8, section 1522(e);
(6) children who are both determined to be severely emotionally disturbed and receiving
case management services according to section 256B.0625, subdivision 20, except children
who are eligible for and who decline enrollment in an approved preferred integrated network
under section 245.4682;
(7) adults who are both determined to be seriously and persistently mentally ill and
received case management services according to section 256B.0625, subdivision 20;
(8) persons eligible for medical assistance according to section 256B.057, subdivision
10;
(9) persons with access to cost-effective employer-sponsored private health insurance
or persons enrolled in a non-Medicare individual health plan determined to be cost-effective
according to section 256B.0625, subdivision 15; and
(10) persons who are absent from the state for more than 30 consecutive days but still
deemed a resident of Minnesota, identified in accordance with section 256B.056, subdivision
1, paragraph (b).
Children under age 21 who are in foster placement may enroll in the project on an elective
basis. Individuals excluded under clauses (1), (6), and (7) may choose to enroll on an elective
basis. The commissioner may enroll recipients in the prepaid medical assistance program
for seniors who are (1) age 65 and over, and (2) eligible for medical assistance by spending
down excess income.
(c) The commissioner may allow persons with a one-month spenddown who are otherwise
eligible to enroll to voluntarily enroll or remain enrolled, if they elect to prepay their monthly
spenddown to the state.
(d) The commissioner may requirenew text begin , subject to the opt-out provision under paragraph (a),new text end
those individuals to enroll in the prepaid medical assistance program who otherwise would
have been excluded under paragraph (b), clauses (1), (3), and (8), and under Minnesota
Rules, part 9500.1452, subpart 2, items H, K, and L.
(e) Before limitation of choice is implemented, eligible individuals shall be notified and
new text begin given the opportunity to opt out of managed care enrollment. new text end After notification, new text begin those
individuals who choose not to opt out new text end shall be allowed to choose only among demonstration
providers. The commissioner may assign an individual with private coverage through a
health maintenance organization, to the same health maintenance organization for medical
assistance coverage, if the health maintenance organization is under contract for medical
assistance in the individual's county of residence. After initially choosing a provider, the
recipient is allowed to change that choice only at specified times as allowed by the
commissioner. If a demonstration provider ends participation in the project for any reason,
a recipient enrolled with that provider must select a new provider but may change providers
without cause once more within the first 60 days after enrollment with the second provider.
(f) An infant born to a woman who is eligible for and receiving medical assistance and
who is enrolled in the prepaid medical assistance program shall be retroactively enrolled to
the month of birth in the same managed care plan as the mother once the child is enrolled
in medical assistance unless the child is determined to be excluded from enrollment in a
prepaid plan under this section.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 33.
Minnesota Statutes 2020, section 256B.69, subdivision 5c, is amended to read:
Subd. 5c.
Medical education and research fund.
(a) The commissioner of human
services shall transfer each year to the medical education and research fund established
under section 62J.692, an amount specified in this subdivision. The commissioner shall
calculate the following:
(1) an amount equal to the reduction in the prepaid medical assistance payments as
specified in this clause. After January 1, 2002, the county medical assistance capitation base
rate prior to plan specific adjustments is reduced 6.3 percent for Hennepin County, two
percent for the remaining metropolitan counties, and 1.6 percent for nonmetropolitan
Minnesota counties. Nursing facility and elderly waiver payments and demonstration project
payments operating under subdivision 23 are excluded from this reduction. The amount
calculated under this clause shall not be adjusted for periods already paid due to subsequent
changes to the capitation payments;
(2) beginning July 1, 2003, $4,314,000 from the capitation rates paid under this section;
(3) beginning July 1, 2002, an additional $12,700,000 from the capitation rates paid
under this section; and
(4) beginning July 1, 2003, an additional $4,700,000 from the capitation rates paid under
this section.
(b) This subdivision shall be effective upon approval of a federal waiver which allows
federal financial participation in the medical education and research fund. The amount
specified under paragraph (a), clauses (1) to (4), shall not exceed the total amount transferred
for fiscal year 2009. Any excess shall first reduce the amounts specified under paragraph
(a), clauses (2) to (4). Any excess following this reduction shall proportionally reduce the
amount specified under paragraph (a), clause (1).
(c) Beginning September 1, 2011, of the amount in paragraph (a), the commissioner
shall transfer $21,714,000 each fiscal year to the medical education and research fund.
(d) Beginning September 1, 2011, of the amount in paragraph (a), following the transfer
under paragraph (c), the commissioner shall transfer to the medical education research fund
deleted text begin $23,936,000 in fiscal years 2012 and 2013 anddeleted text end $49,552,000 in fiscal year 2014 and thereafter.
new text begin
(e) If the federal waiver described in paragraph (b) is not renewed, the transfer described
in paragraph (c) and corresponding payments under section 62J.692, subdivision 7, are
terminated effective the first month in which the waiver is no longer in effect, and the state
share of the amount described in paragraph (d) must be transferred to the medical education
and research fund and distributed according to the provisions of section 62J.692, subdivision
4a.
new text end
Sec. 34.
Minnesota Statutes 2020, section 256B.69, subdivision 28, is amended to read:
Subd. 28.
Medicare special needs plans; medical assistance basic health care.
(a)
The commissioner may contract with demonstration providers and current or former sponsors
of qualified Medicare-approved special needs plans, to provide medical assistance basic
health care services to persons with disabilities, including those with developmental
disabilities. Basic health care services include:
(1) those services covered by the medical assistance state plan except for ICF/DD services,
home and community-based waiver services, case management for persons with
developmental disabilities under section 256B.0625, subdivision 20a, and personal care and
certain home care services defined by the commissioner in consultation with the stakeholder
group established under paragraph (d); and
(2) basic health care services may also include risk for up to 100 days of nursing facility
services for persons who reside in a noninstitutional setting and home health services related
to rehabilitation as defined by the commissioner after consultation with the stakeholder
group.
The commissioner may exclude other medical assistance services from the basic health
care benefit set. Enrollees in these plans can access any excluded services on the same basis
as other medical assistance recipients who have not enrolled.
(b) The commissioner may contract with demonstration providers and current and former
sponsors of qualified Medicare special needs plans, to provide basic health care services
under medical assistance to persons who are dually eligible for both Medicare and Medicaid
and those Social Security beneficiaries eligible for Medicaid but in the waiting period for
Medicare. The commissioner shall consult with the stakeholder group under paragraph (d)
in developing program specifications for these services. Payment for Medicaid services
provided under this subdivision for the months of May and June will be made no earlier
than July 1 of the same calendar year.
(c) deleted text begin Notwithstanding subdivision 4, beginning January 1, 2012,deleted text end The commissioner shall
enroll persons with disabilities in managed care under this section, unless the individual
chooses to opt out of enrollment. The commissioner shall establish enrollment and opt out
procedures consistent with applicable enrollment procedures under this section.
(d) The commissioner shall establish a state-level stakeholder group to provide advice
on managed care programs for persons with disabilities, including both MnDHO and contracts
with special needs plans that provide basic health care services as described in paragraphs
(a) and (b). The stakeholder group shall provide advice on program expansions under this
subdivision and subdivision 23, including:
(1) implementation efforts;
(2) consumer protections; and
(3) program specifications such as quality assurance measures, data collection and
reporting, and evaluation of costs, quality, and results.
(e) Each plan under contract to provide medical assistance basic health care services
shall establish a local or regional stakeholder group, including representatives of the counties
covered by the plan, members, consumer advocates, and providers, for advice on issues that
arise in the local or regional area.
(f) The commissioner is prohibited from providing the names of potential enrollees to
health plans for marketing purposes. The commissioner shall mail no more than two sets
of marketing materials per contract year to potential enrollees on behalf of health plans, at
the health plan's request. The marketing materials shall be mailed by the commissioner
within 30 days of receipt of these materials from the health plan. The health plans shall
cover any costs incurred by the commissioner for mailing marketing materials.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 35.
Minnesota Statutes 2020, section 256B.69, subdivision 36, is amended to read:
Subd. 36.
Enrollee support system.
(a) The commissioner shall establish an enrollee
support system that provides support to an enrollee before and during enrollment in a
managed care plan.
(b) The enrollee support system must:
(1) provide access to counseling for each potential enrollee on choosing a managed care
plannew text begin or opting out of managed carenew text end ;
(2) assist an enrollee in understanding enrollment in a managed care plan;
(3) provide an access point for complaints regarding enrollment, covered services, and
other related matters;
(4) provide information on an enrollee's grievance and appeal rights within the managed
care organization and the state's fair hearing process, including an enrollee's rights and
responsibilities; and
(5) provide assistance to an enrollee, upon request, in navigating the grievance and
appeals process within the managed care organization and in appealing adverse benefit
determinations made by the managed care organization to the state's fair hearing process
after the managed care organization's internal appeals process has been exhausted. Assistance
does not include providing representation to an enrollee at the state's fair hearing, but may
include a referral to appropriate legal representation sources.
(c) Outreach to enrollees through the support system must be accessible to an enrollee
through multiple formats, including telephone, Internet, in-person, and, if requested, through
auxiliary aids and services.
(d) The commissioner may designate enrollment brokers to assist enrollees on selecting
a managed care organization and providing necessary enrollment information. For purposes
of this subdivision, "enrollment broker" means an individual or entity that performs choice
counseling or enrollment activities in accordance with Code of Federal Regulations, part
42, section 438.810, or both.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 36.
Minnesota Statutes 2020, section 256B.692, subdivision 1, is amended to read:
Subdivision 1.
In general.
County boards or groups of county boards may elect to
purchase or provide health care services on behalf of persons eligible for medical assistance
who would otherwise be required to or may elect to participate in the prepaid medical
assistance program according to section 256B.69new text begin , subject to the opt-out provision of section
256B.69, subdivision 4, paragraph (a)new text end . Counties that elect to purchase or provide health
care under this section must provide all services included in prepaid managed care programs
according to section 256B.69, subdivisions 1 to 22. County-based purchasing under this
section is governed by section 256B.69, unless otherwise provided for under this section.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 37.
Minnesota Statutes 2020, section 256B.6925, subdivision 1, is amended to read:
Subdivision 1.
Information provided by commissioner.
The commissioner shall provide
to each potential enrollee the following information:
(1) basic features of receiving services through managed care;
(2) which individuals are excluded from managed care enrollment, subject to deleted text begin mandatory
managed care enrollmentdeleted text end new text begin the opt-out provision of section 256B.69, subdivision 4, paragraph
(a)new text end , or who may choose to enroll voluntarily;
(3) deleted text begin for mandatory and voluntary enrollment,deleted text end the length of the enrollment period and
information about an enrollee's right to disenroll in accordance with Code of Federal
Regulations, part 42, section 438.56;
(4) the service area covered by each managed care organization;
(5) covered services, including services provided by the managed care organization and
services provided by the commissioner;
(6) the provider directory and drug formulary for each managed care organization;
(7) cost-sharing requirements;
(8) requirements for adequate access to services, including provider network adequacy
standards;
(9) a managed care organization's responsibility for coordination of enrollee care; and
(10) quality and performance indicators, including enrollee satisfaction for each managed
care organization, if available.
Sec. 38.
Minnesota Statutes 2020, section 256B.6925, subdivision 1, is amended to read:
Subdivision 1.
Information provided by commissioner.
The commissioner shall provide
to each potential enrollee the following information:
(1) basic features of receiving services through managed care;
(2) which individuals are excluded from managed care enrollment, subject to mandatory
managed care enrollment, or who may choose to enroll voluntarily;
(3) for mandatory and voluntary enrollment, the length of the enrollment period and
information about an enrollee's right to disenroll in accordance with Code of Federal
Regulations, part 42, section 438.56;
(4) the service area covered by each managed care organization;
(5) covered services, including services provided by the managed care organization and
services provided by the commissioner;
(6) the provider directory and drug formulary for each managed care organization;
deleted text begin
(7) cost-sharing requirements;
deleted text end
deleted text begin (8)deleted text end new text begin (7)new text end requirements for adequate access to services, including provider network adequacy
standards;
deleted text begin (9)deleted text end new text begin (8)new text end a managed care organization's responsibility for coordination of enrollee care;
and
deleted text begin (10)deleted text end new text begin (9)new text end quality and performance indicators, including enrollee satisfaction for each
managed care organization, if available.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 39.
Minnesota Statutes 2020, section 256B.6925, subdivision 2, is amended to read:
Subd. 2.
Information provided by managed care organization.
The commissioner
shall ensure that managed care organizations provide to each enrollee the following
information:
(1) an enrollee handbook within a reasonable time after receiving notice of the enrollee's
enrollment. The handbook must, at a minimum, include information on benefits provided,
how and where to access benefits, deleted text begin cost-sharing requirements,deleted text end how transportation is provided,
and other information as required by Code of Federal Regulations, part 42, section 438.10,
paragraph (g);
(2) a provider directory for the following provider types: physicians, specialists, hospitals,
pharmacies, behavioral health providers, and long-term supports and services providers, as
appropriate. The directory must include the provider's name, group affiliation, street address,
telephone number, website, specialty if applicable, whether the provider accepts new
enrollees, the provider's cultural and linguistic capabilities as identified in Code of Federal
Regulations, part 42, section 438.10, paragraph (h), and whether the provider's office
accommodates people with disabilities;
(3) a drug formulary that includes both generic and name brand medications that are
covered and each medication tier, if applicable;
(4) written notice of termination of a contracted provider. Within 15 calendar days after
receipt or issuance of the termination notice, the managed care organization must make a
good faith effort to provide notice to each enrollee who received primary care from, or was
seen on a regular basis by, the terminated provider; and
(5) upon enrollee request, the managed care organization's physician incentive plan.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 40.
Minnesota Statutes 2020, section 256B.6928, subdivision 3, is amended to read:
Subd. 3.
Rate development standards.
(a) In developing capitation rates, the
commissioner shall:
(1) identify and develop base utilization and price data, including validated encounter
data and audited financial reports received from the managed care organizations that
demonstrate experience for the populations served by the managed care organizations, for
the three most recent and complete years before the rating period;
(2) develop and apply reasonable trend factors, including cost and utilization, to base
data that are developed from actual experience of the medical assistance population or a
similar population according to generally accepted actuarial practices and principles;
(3) develop the nonbenefit component of the rate to account for reasonable expenses
related to the managed care organization's administration; taxes; licensing and regulatory
fees; contribution to reserves; risk margin; cost of capital and other operational costs
associated with the managed care organization's provision of covered services to enrollees;
deleted text begin
(4) consider the value of cost-sharing for rate development purposes, regardless of
whether the managed care organization imposes the cost-sharing on the enrollee or the
cost-sharing is collected by the provider;
deleted text end
deleted text begin (5)deleted text end new text begin (4)new text end make appropriate and reasonable adjustments to account for changes to the base
data, programmatic changes, changes to nonbenefit components, and any other adjustment
necessary to establish actuarially sound rates. Each adjustment must reasonably support the
development of an accurate base data set for purposes of rate setting, reflect the health status
of the enrolled population, and be developed in accordance with generally accepted actuarial
principles and practices;
deleted text begin (6)deleted text end new text begin (5)new text end consider the managed care organization's past medical loss ratio in the development
of the capitation rates and consider the projected medical loss ratio; and
deleted text begin (7)deleted text end new text begin (6)new text end select a prospective or retrospective risk adjustment methodology that must be
developed in a budget-neutral manner consistent with generally accepted actuarial principles
and practices.
(b) The base data must be derived from the medical assistance population or, if data on
the medical assistance population is not available, derived from a similar population and
adjusted to make the utilization and price data comparable to the medical assistance
population. Data must be in accordance with actuarial standards for data quality and an
explanation of why that specific data is used must be provided in the rate certification. If
the commissioner is unable to base the rates on data that are within the three most recent
and complete years before the rating period, the commissioner may request an approval
from the Centers for Medicare and Medicaid Services for an exception. The request must
describe why an exception is necessary and describe the actions that the commissioner
intends to take to comply with the request.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 41.
Minnesota Statutes 2020, section 256B.76, subdivision 1, is amended to read:
Subdivision 1.
Physician reimbursement.
(a) Effective for services rendered on or after
October 1, 1992, the commissioner shall make payments for physician services as follows:
(1) payment for level one Centers for Medicare and Medicaid Services' common
procedural coding system codes titled "office and other outpatient services," "preventive
medicine new and established patient," "delivery, antepartum, and postpartum care," "critical
care," cesarean delivery and pharmacologic management provided to psychiatric patients,
and level three codes for enhanced services for prenatal high risk, shall be paid at the lower
of (i) submitted charges, or (ii) 25 percent above the rate in effect on June 30, 1992;
(2) payments for all other services shall be paid at the lower of (i) submitted charges,
or (ii) 15.4 percent above the rate in effect on June 30, 1992; and
(3) all physician rates shall be converted from the 50th percentile of 1982 to the 50th
percentile of 1989, less the percent in aggregate necessary to equal the above increases
except that payment rates for home health agency services shall be the rates in effect on
September 30, 1992.
(b) Effective for services rendered on or after January 1, 2000, payment rates for physician
and professional services shall be increased by three percent over the rates in effect on
December 31, 1999, except for home health agency and family planning agency services.
The increases in this paragraph shall be implemented January 1, 2000, for managed care.
(c) Effective for services rendered on or after July 1, 2009, payment rates for physician
and professional services shall be reduced by five percent, except that for the period July
1, 2009, through June 30, 2010, payment rates shall be reduced by 6.5 percent for the medical
assistance and general assistance medical care programs, over the rates in effect on June
30, 2009. This reduction and the reductions in paragraph (d) do not apply to office or other
outpatient visits, preventive medicine visits and family planning visits billed by physicians,
advanced practice nurses, or physician assistants in a family planning agency or in one of
the following primary care practices: general practice, general internal medicine, general
pediatrics, general geriatrics, and family medicine. This reduction and the reductions in
paragraph (d) do not apply to federally qualified health centers, rural health centers, and
Indian health services. Effective October 1, 2009, payments made to managed care plans
and county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall
reflect the payment reduction described in this paragraph.
(d) Effective for services rendered on or after July 1, 2010, payment rates for physician
and professional services shall be reduced an additional seven percent over the five percent
reduction in rates described in paragraph (c). This additional reduction does not apply to
physical therapy services, occupational therapy services, and speech pathology and related
services provided on or after July 1, 2010. This additional reduction does not apply to
physician services billed by a psychiatrist or an advanced practice nurse with a specialty in
mental health. Effective October 1, 2010, payments made to managed care plans and
county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall reflect
the payment reduction described in this paragraph.
(e) Effective for services rendered on or after September 1, 2011, through June 30, 2013,
payment rates for physician and professional services shall be reduced three percent from
the rates in effect on August 31, 2011. This reduction does not apply to physical therapy
services, occupational therapy services, and speech pathology and related services.
(f) Effective for services rendered on or after September 1, 2014, payment rates for
physician and professional services, including physical therapy, occupational therapy, speech
pathology, and mental health services shall be increased by five percent from the rates in
effect on August 31, 2014. In calculating this rate increase, the commissioner shall not
include in the base rate for August 31, 2014, the rate increase provided under section
256B.76, subdivision 7. This increase does not apply to federally qualified health centers,
rural health centers, and Indian health services. Payments made to managed care plans and
county-based purchasing plans shall not be adjusted to reflect payments under this paragraph.
(g) Effective for services rendered on or after July 1, 2015, payment rates for physical
therapy, occupational therapy, and speech pathology and related services provided by a
hospital meeting the criteria specified in section 62Q.19, subdivision 1, paragraph (a), clause
(4), shall be increased by 90 percent from the rates in effect on June 30, 2015. Payments
made to managed care plans and county-based purchasing plans shall not be adjusted to
reflect payments under this paragraph.
(h) Any ratables effective before July 1, 2015, do not apply to early intensive
developmental and behavioral intervention (EIDBI) benefits described in section 256B.0949.
new text begin
(i) Medical assistance may reimburse for the cost incurred to pay the Department of
Health for metabolic disorder testing of newborns who are medical assistance recipients
when the sample is collected outside of an inpatient hospital setting or freestanding birth
center setting because the newborn was born outside of a hospital or freestanding birth
center or because it is not medically appropriate to collect the sample during the inpatient
stay for the birth.
new text end
Sec. 42.
Minnesota Statutes 2020, section 256L.03, subdivision 1a, is amended to read:
Subd. 1a.
Children; MinnesotaCare health care reform waiver.
Children are eligible
for coverage of all services that are eligible for reimbursement under the medical assistance
program according to chapter 256B, except special education services and that abortion
services under MinnesotaCare shall be limited as provided under subdivision 1. deleted text begin Children
are exempt from the provisions of subdivision 5, regarding co-payments.deleted text end Children who are
lawfully residing in the United States but who are not "qualified noncitizens" under title IV
of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Public
Law 104-193, Statutes at Large, volume 110, page 2105, are eligible for coverage of all
services provided under the medical assistance program according to chapter 256B.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 43.
Minnesota Statutes 2020, section 256L.03, subdivision 5, is amended to read:
Subd. 5.
Cost-sharing.
(a) Co-payments, coinsurance, and deductibles do not apply to
children under the age of 21 and to American Indians as defined in Code of Federal
Regulations, title 42, section 600.5.
(b) The commissioner shall adjust co-payments, coinsurance, and deductibles for covered
services in a manner sufficient to maintain the actuarial value of the benefit to 94 percent.
The cost-sharing changes described in this paragraph do not apply to eligible recipients or
services exempt from cost-sharing under state law. The cost-sharing changes described in
this paragraph shall not be implemented prior to January 1, 2016new text begin , or after December 31,
2022new text end .
(c) The cost-sharing changes authorized under paragraph (b) must satisfy the requirements
for cost-sharing under the Basic Health Program as set forth in Code of Federal Regulations,
title 42, sections 600.510 and 600.520.
new text begin
(d) Paragraphs (a) to (c) apply only to services provided through December 31, 2022.
Effective for services provided on or after January 1, 2023, the MinnesotaCare program
shall not require deductibles, co-payments, coinsurance, or any other form of enrollee
cost-sharing.
new text end
Sec. 44.
Minnesota Statutes 2020, section 256L.03, subdivision 5, is amended to read:
Subd. 5.
Cost-sharing.
(a) Co-payments, coinsurance, and deductibles do not apply to
children under the age of 21 and to American Indians as defined in Code of Federal
Regulations, title 42, section 600.5.
(b) The commissioner deleted text begin shalldeleted text end new text begin mustnew text end adjust co-payments, coinsurance, and deductibles for
covered services in a manner sufficient to maintain the actuarial value of the benefit to 94
percent. The cost-sharing changes described in this paragraph do not apply to eligible
recipients or services exempt from cost-sharing under state law. The cost-sharing changes
described in this paragraph shall not be implemented prior to January 1, 2016.
(c) The cost-sharing changes authorized under paragraph (b) must satisfy the requirements
for cost-sharing under the Basic Health Program as set forth in Code of Federal Regulations,
title 42, sections 600.510 and 600.520.
new text begin
(d) Cost-sharing must not apply to drugs used for tobacco and nicotine cessation or to
tobacco and nicotine cessation services covered under section 256B.0625, subdivision 68.
new text end
Sec. 45.
Minnesota Statutes 2020, section 256L.04, subdivision 1c, is amended to read:
Subd. 1c.
General requirements.
To be eligible for MinnesotaCare, a person must meet
the eligibility requirements of this section. A person eligible for MinnesotaCare deleted text begin shalldeleted text end new text begin with
an income less than or equal to 200 percent of the federal poverty guidelines mustnew text end not be
considered a qualified individual under section 1312 of the Affordable Care Act, and is not
eligible for enrollment in a qualified health plan offered through MNsure under chapter
62V.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025, or upon federal approval,
whichever is later, but only if the commissioner of human services certifies to the legislature
that implementation of this section will not result in federal penalties to federal basic health
program funding for MinnesotaCare enrollees with incomes not exceeding 200 percent of
the federal poverty guidelines. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end
Sec. 46.
Minnesota Statutes 2020, section 256L.04, subdivision 7a, is amended to read:
Subd. 7a.
Ineligibility.
Adults whose income is greater than the limits established under
this section may not enroll in the MinnesotaCare programnew text begin , except as provided in subdivision
15new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025, or upon federal approval,
whichever is later, but only if the commissioner of human services certifies to the legislature
that implementation of this section will not result in federal penalties to federal basic health
program funding for MinnesotaCare enrollees with incomes not exceeding 200 percent of
the federal poverty guidelines. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end
Sec. 47.
Minnesota Statutes 2020, section 256L.04, subdivision 10, is amended to read:
Subd. 10.
Citizenship requirements.
(a) Eligibility for MinnesotaCare is limited to
citizens or nationals of the United States and lawfully present noncitizens as defined in
Code of Federal Regulations, title 8, section 103.12. Undocumented noncitizensnew text begin , with the
exception of children under age 19,new text end are ineligible for MinnesotaCare. For purposes of this
subdivision, an undocumented noncitizen is an individual who resides in the United States
without the approval or acquiescence of the United States Citizenship and Immigration
Services. Families with children who are citizens or nationals of the United States must
cooperate in obtaining satisfactory documentary evidence of citizenship or nationality
according to the requirements of the federal Deficit Reduction Act of 2005, Public Law
109-171.
(b) Notwithstanding subdivisions 1 and 7, eligible persons include families and
individuals who are lawfully present and ineligible for medical assistance by reason of
immigration status and who have incomes equal to or less than 200 percent of federal poverty
guidelines.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024.
new text end
Sec. 48.
Minnesota Statutes 2020, section 256L.04, is amended by adding a subdivision
to read:
new text begin Subd. 15. new text end
new text begin Persons eligible for public option. new text end
new text begin
(a) Families and individuals with income
above the maximum income eligibility limit specified in subdivision 1 or 7, who meet all
other MinnesotaCare eligibility requirements, are eligible for MinnesotaCare. All other
provisions of this chapter apply unless otherwise specified.
new text end
new text begin
(b) Families and individuals may enroll in MinnesotaCare under this subdivision only
during an annual open enrollment period or special enrollment period, as designated by
MNsure in compliance with Code of Federal Regulations, title 45, parts 155.410 and 155.420.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025, or upon federal approval,
whichever is later, but only if the commissioner of human services certifies to the legislature
that implementation of this section will not result in federal penalties to federal basic health
program funding for MinnesotaCare enrollees with incomes not exceeding 200 percent of
the federal poverty guidelines. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end
Sec. 49.
Minnesota Statutes 2020, section 256L.07, subdivision 1, is amended to read:
Subdivision 1.
General requirements.
Individuals enrolled in MinnesotaCare under
section 256L.04, subdivision 1, and individuals enrolled in MinnesotaCare under section
256L.04, subdivision 7, whose income increases above 200 percent of the federal poverty
guidelinesdeleted text begin ,deleted text end are no longer eligible for the program and deleted text begin shalldeleted text end new text begin mustnew text end be disenrolled by the
commissionernew text begin , unless the individuals continue MinnesotaCare enrollment through the public
option under section 256L.04, subdivision 15new text end . For persons disenrolled under this subdivision,
MinnesotaCare coverage terminates the last day of the calendar month in which the
commissioner sends advance notice according to Code of Federal Regulations, title 42,
section 431.211, that indicates the income of a family or individual exceeds program income
limits.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025, or upon federal approval,
whichever is later, but only if the commissioner of human services certifies to the legislature
that implementation of this section will not result in federal penalties to federal basic health
program funding for MinnesotaCare enrollees with incomes not exceeding 200 percent of
the federal poverty guidelines. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end
Sec. 50.
Minnesota Statutes 2021 Supplement, section 256L.15, subdivision 2, is amended
to read:
Subd. 2.
Sliding fee scale; monthly individual or family income.
(a) The commissioner
shall establish a sliding fee scale to determine the percentage of monthly individual or family
income that households at different income levels must pay to obtain coverage through the
MinnesotaCare program. The sliding fee scale must be based on the enrollee's monthly
individual or family income.
deleted text begin
(b) Beginning January 1, 2014, MinnesotaCare enrollees shall pay premiums according
to the premium scale specified in paragraph (d).
deleted text end
deleted text begin (c)deleted text end new text begin (b)new text end Paragraph deleted text begin (b)deleted text end new text begin (a)new text end does not apply todeleted text begin :
deleted text end
deleted text begin (1)deleted text end children 20 years of age or youngerdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(2) individuals with household incomes below 35 percent of the federal poverty
guidelines.
deleted text end
deleted text begin
(d) The following premium scale is established for each individual in the household who
is 21 years of age or older and enrolled in MinnesotaCare:
deleted text end
|
deleted text begin
Federal Poverty Guideline Greater than or Equal to deleted text end |
deleted text begin
Less than deleted text end |
deleted text begin
Individual Premium Amount deleted text end |
|
deleted text begin
35% deleted text end |
deleted text begin
55% deleted text end |
deleted text begin
$4 deleted text end |
|
deleted text begin
55% deleted text end |
deleted text begin
80% deleted text end |
deleted text begin
$6 deleted text end |
|
deleted text begin
80% deleted text end |
deleted text begin
90% deleted text end |
deleted text begin
$8 deleted text end |
|
deleted text begin
90% deleted text end |
deleted text begin
100% deleted text end |
deleted text begin
$10 deleted text end |
|
deleted text begin
100% deleted text end |
deleted text begin
110% deleted text end |
deleted text begin
$12 deleted text end |
|
deleted text begin
110% deleted text end |
deleted text begin
120% deleted text end |
deleted text begin
$14 deleted text end |
|
deleted text begin
120% deleted text end |
deleted text begin
130% deleted text end |
deleted text begin
$15 deleted text end |
|
deleted text begin
130% deleted text end |
deleted text begin
140% deleted text end |
deleted text begin
$16 deleted text end |
|
deleted text begin
140% deleted text end |
deleted text begin
150% deleted text end |
deleted text begin
$25 deleted text end |
|
deleted text begin
150% deleted text end |
deleted text begin
160% deleted text end |
deleted text begin
$37 deleted text end |
|
deleted text begin
160% deleted text end |
deleted text begin
170% deleted text end |
deleted text begin
$44 deleted text end |
|
deleted text begin
170% deleted text end |
deleted text begin
180% deleted text end |
deleted text begin
$52 deleted text end |
|
deleted text begin
180% deleted text end |
deleted text begin
190% deleted text end |
deleted text begin
$61 deleted text end |
|
deleted text begin
190% deleted text end |
deleted text begin
200% deleted text end |
deleted text begin
$71 deleted text end |
|
deleted text begin
200% deleted text end |
deleted text begin
$80 deleted text end |
deleted text begin (e)deleted text end new text begin (c)new text end Beginning January 1, deleted text begin 2021deleted text end new text begin 2023new text end ,new text begin the commissioner shall continue to charge
premiums in accordance with the simplified premium scale established to comply with the
American Rescue Plan Act of 2021, in effect from January 1, 2021, through December 31,
2022, for families and individuals eligible under section 256L.04, subdivisions 1 and 7.new text end The
commissioner shall adjust the premium scale deleted text begin established under paragraph (d)deleted text end new text begin as needednew text end to
ensure that premiums do not exceed the amount that an individual would have been required
to pay if the individual was enrolled in an applicable benchmark plan in accordance with
the Code of Federal Regulations, title 42, section 600.505 (a)(1).
new text begin
(d) The commissioner shall establish a sliding premium scale for persons eligible through
the buy-in option under section 256L.04, subdivision 15. Beginning January 1, 2025, persons
eligible through the buy-in option shall pay premiums according to the premium scale
established by the commissioner. Persons 20 years of age or younger are exempt from
paying premiums.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, except that the sliding
premium scale established under paragraph (d) is effective January 1, 2025, or upon federal
approval, whichever is later, but only if the commissioner of human services certifies to the
legislature that implementation of paragraph (d) will not result in federal penalties to federal
basic health program funding for MinnesotaCare enrollees with incomes not exceeding 200
percent of the federal poverty guidelines. The commissioner of human services shall notify
the revisor of statutes when federal approval is obtained.
new text end
Sec. 51.
new text begin
[256L.181] CLIENT ERROR OVERPAYMENT.
new text end
new text begin Subdivision 1. new text end
new text begin Scope. new text end
new text begin
(a) Subject to federal law and regulation, when a local agency or
the Department of Human Services determines a person under section 256.98, subdivision
4, is liable for recovery of medical assistance incorrectly paid as a result of client error or
when a recipient or former recipient receives medical assistance while an appeal is pending
pursuant to section 256.045, subdivision 10, and the recipient or former recipient is later
determined to have been ineligible for the medical assistance received or for less medical
assistance than was received during the pendency of the appeal, the local agency or the
Department of Human Services must:
new text end
new text begin
(1) determine the eligibility months during which medical assistance was incorrectly
paid;
new text end
new text begin
(2) redetermine eligibility for the incorrectly paid months using department policies and
procedures that were in effect during each eligibility month that was incorrectly paid; and
new text end
new text begin
(3) assess an overpayment against persons liable for recovery under section 256.98,
subdivision 4, for the amount of incorrectly paid medical assistance pursuant to section
256.98, subdivision 3.
new text end
new text begin
(b) Notwithstanding section 256.98, subdivision 4, medical assistance incorrectly paid
to a recipient as a result of client error when the recipient is under 21 years of age is not
recoverable from the recipient or recipient's estate. This section does not prohibit the state
agency from:
new text end
new text begin
(1) receiving payment from a trust pursuant to United States Code, title 42, section
1396p(d)(4)(A) or (C), for medical assistance paid on behalf of the trust beneficiary for
services received at any age; or
new text end
new text begin
(2) claiming against the designated beneficiary of an Achieving a Better Life Experience
(ABLE) account or the ABLE account itself pursuant to Code of Federal Regulations, title
26, section 1.529A-2(o), for the amount of the total medical assistance paid for the designated
beneficiary at any age after establishment of the ABLE account.
new text end
new text begin Subd. 2. new text end
new text begin Recovering client error overpayment. new text end
new text begin
(a) The local agency or the Department
of Human Services must not attempt recovery of the overpayment amount pursuant to
chapter 270A or section 256.0471 when a person liable for a client error overpayment under
section 256.98, subdivision 4, voluntarily repays the overpayment amount or establishes a
payment plan in writing with the local agency or the Department of Human Services to
repay the overpayment amount within 90 days after receiving the overpayment notice or
after resolution of a fair hearing regarding the overpayment under section 256.045, whichever
is later. When a liable person agrees to a payment plan in writing with the local agency or
the Department of Human Services but has not repaid any amount six months after entering
the agreement, the local agency or Department of Human Services must pursue recovery
under paragraph (b).
new text end
new text begin
(b) If the liable person does not voluntarily repay the overpayment amount or establish
a repayment agreement under paragraph (a), the local agency or the Department of Human
Services must attempt recovery of the overpayment amount pursuant to chapter 270A when
the overpayment amount is eligible for recovery as a public assistance debt under chapter
270A. For any overpaid amount of solely state-funded medical assistance, the local agency
or the Department of Human Services must attempt recovery pursuant to section 256.0471.
new text end
new text begin Subd. 3. new text end
new text begin Writing off client error overpayment. new text end
new text begin
A local agency or the Department of
Human Services must not attempt to recover a client error overpayment of less than $350,
unless the overpayment is for medical assistance received pursuant to section 256.045,
subdivision 10, during the pendency of an appeal or unless the recovery is from the recipient's
estate or the estate of the recipient's surviving spouse. A local agency or the Department of
Human Services may write off any remaining balance of a client error overpayment when
the overpayment has not been repaid five years after the effective date of the overpayment
and the local agency or the Department of Human Services determines it is no longer cost
effective to attempt recovery of the remaining balance.
new text end
Sec. 52.
Laws 2015, chapter 71, article 14, section 2, subdivision 5, as amended by Laws
2015, First Special Session chapter 6, section 1, is amended to read:
Subd. 5.Grant Programs
|
||||||
The amounts that may be spent from this
appropriation for each purpose are as follows:
| (a) Support Services Grants |
||||||
| Appropriations by Fund |
||
| General |
13,133,000 |
8,715,000 |
| Federal TANF |
96,311,000 |
96,311,000 |
| (b) Basic Sliding Fee Child Care Assistance Grants |
48,439,000 |
51,559,000 |
||||
Basic Sliding Fee Waiting List Allocation.
Notwithstanding Minnesota Statutes, section
119B.03, $5,413,000 in fiscal year 2016 is to
reduce the basic sliding fee program waiting
list as follows:
(1) The calendar year 2016 allocation shall be
increased to serve families on the waiting list.
To receive funds appropriated for this purpose,
a county must have:
(i) a waiting list in the most recent published
waiting list month;
(ii) an average of at least ten families on the
most recent six months of published waiting
list; and
(iii) total expenditures in calendar year 2014
that met or exceeded 80 percent of the county's
available final allocation.
(2) Funds shall be distributed proportionately
based on the average of the most recent six
months of published waiting lists to counties
that meet the criteria in clause (1).
(3) Allocations in calendar years 2017 and
beyond shall be calculated using the allocation
formula in Minnesota Statutes, section
119B.03.
(4) The guaranteed floor for calendar year
2017 shall be based on the revised calendar
year 2016 allocation.
Base Level Adjustment. The general fund
base is increased by $810,000 in fiscal year
2018 and increased by $821,000 in fiscal year
2019.
| (c) Child Care Development Grants |
1,737,000 |
1,737,000 |
||||
| (d) Child Support Enforcement Grants |
50,000 |
50,000 |
||||
| (e) Children's Services Grants |
||||||
| Appropriations by Fund |
||
| General |
39,015,000 |
38,665,000 |
| Federal TANF |
140,000 |
140,000 |
Safe Place for Newborns. $350,000 from the
general fund in fiscal year 2016 is to distribute
information on the Safe Place for Newborns
law in Minnesota to increase public awareness
of the law. This is a onetime appropriation.
Child Protection. $23,350,000 in fiscal year
2016 and $23,350,000 in fiscal year 2017 are
to address child protection staffing and
services under Minnesota Statutes, section
256M.41. $1,650,000 in fiscal year 2016 and
$1,650,000 in fiscal year 2017 are for child
protection grants to address child welfare
disparities under Minnesota Statutes, section
256E.28.
Title IV-E Adoption Assistance. Additional
federal reimbursement to the state as a result
of the Fostering Connections to Success and
Increasing Adoptions Act's expanded
eligibility for title IV-E adoption assistance is
appropriated to the commissioner for
postadoption services, including a
parent-to-parent support network.
Adoption Assistance Incentive Grants.
Federal funds available during fiscal years
2016 and 2017 for adoption incentive grants
are appropriated to the commissioner for
postadoption services, including a
parent-to-parent support network.
| (f) Children and Community Service Grants |
56,301,000 |
56,301,000 |
||||
| (g) Children and Economic Support Grants |
26,778,000 |
26,966,000 |
||||
Mobile Food Shelf Grants. (a) $1,000,000
in fiscal year 2016 and $1,000,000 in fiscal
year 2017 are for a grant to Hunger Solutions.
This is a onetime appropriation and is
available until June 30, 2017.
(b) Hunger Solutions shall award grants of up
to $75,000 on a competitive basis. Grant
applications must include:
(1) the location of the project;
(2) a description of the mobile program,
including size and scope;
(3) evidence regarding the unserved or
underserved nature of the community in which
the project is to be located;
(4) evidence of community support for the
project;
(5) the total cost of the project;
(6) the amount of the grant request and how
funds will be used;
(7) sources of funding or in-kind contributions
for the project that will supplement any grant
award;
(8) a commitment to mobile programs by the
applicant and an ongoing commitment to
maintain the mobile program; and
(9) any additional information requested by
Hunger Solutions.
(c) Priority may be given to applicants who:
(1) serve underserved areas;
(2) create a new or expand an existing mobile
program;
(3) serve areas where a high amount of need
is identified;
(4) provide evidence of strong support for the
project from citizens and other institutions in
the community;
(5) leverage funding for the project from other
private and public sources; and
(6) commit to maintaining the program on a
multilayer basis.
Homeless Youth Act. At least $500,000 of
the appropriation for the Homeless Youth Act
must be awarded to providers in greater
Minnesota, with at least 25 percent of this
amount for new applicant providers. The
commissioner shall provide outreach and
technical assistance to greater Minnesota
providers and new providers to encourage
responding to the request for proposals.
Stearns County Veterans Housing. $85,000
in fiscal year 2016 and $85,000 in fiscal year
2017 are for a grant to Stearns County to
provide administrative funding in support of
a service provider serving veterans in Stearns
County. The administrative funding grant may
be used to support group residential housing
services, corrections-related services, veteran
services, and other social services related to
the service provider serving veterans in
Stearns County.
Safe Harbor. $800,000 in fiscal year 2016
and $800,000 in fiscal year 2017 are from the
general fund for emergency shelter and
transitional and long-term housing beds for
sexually exploited youth and youth at risk of
sexual exploitation. Of this appropriation,
$150,000 in fiscal year 2016 and $150,000 in
fiscal year 2017 are from the general fund for
statewide youth outreach workers connecting
sexually exploited youth and youth at risk of
sexual exploitation with shelter and services.
Minnesota Food Assistance Program.
Unexpended funds for the Minnesota food
assistance program for fiscal year 2016 do not
cancel but are available for this purpose in
fiscal year 2017.
Base Level Adjustment. The general fund
base is decreased by $816,000 in fiscal year
2018 and is decreased by $606,000 in fiscal
year 2019.
| (h) Health Care Grants |
||||||
| Appropriations by Fund |
||
| General |
536,000 |
2,482,000 |
| Health Care Access |
3,341,000 |
3,465,000 |
Grants for Periodic Data Matching for
Medical Assistance and MinnesotaCare. Of
the general fund appropriation, $26,000 in
fiscal year 2016 and $1,276,000 in fiscal year
2017 are for grants to counties for costs related
to periodic data matching for medical
assistance and MinnesotaCare recipients under
Minnesota Statutes, section 256B.0561. The
commissioner must distribute these grants to
counties in proportion to each county's number
of cases in the prior year in the affected
programs.
Base Level Adjustment. The general fund
base is deleted text begin increased by $1,637,000 in fiscal year
2018 and increased by $1,229,000 in fiscal
year 2019deleted text end new text begin maintained in fiscal years 2020 and
2021new text end .
| (i) Other Long-Term Care Grants |
1,551,000 |
3,069,000 |
||||
Transition Populations. $1,551,000 in fiscal
year 2016 and $1,725,000 in fiscal year 2017
are for home and community-based services
transition grants to assist in providing home
and community-based services and treatment
for transition populations under Minnesota
Statutes, section 256.478.
Base Level Adjustment. The general fund
base is increased by $156,000 in fiscal year
2018 and by $581,000 in fiscal year 2019.
| (j) Aging and Adult Services Grants |
28,463,000 |
28,162,000 |
||||
Dementia Grants. $750,000 in fiscal year
2016 and $750,000 in fiscal year 2017 are for
the Minnesota Board on Aging for regional
and local dementia grants authorized in
Minnesota Statutes, section 256.975,
subdivision 11.
| (k) Deaf and Hard-of-Hearing Grants |
2,225,000 |
2,375,000 |
||||
Deaf, Deafblind, and Hard-of-Hearing
Grants. $350,000 in fiscal year 2016 and
$500,000 in fiscal year 2017 are for deaf and
hard-of-hearing grants. The funds must be
used to increase the number of deafblind
Minnesotans receiving services under
Minnesota Statutes, section 256C.261, and to
provide linguistically and culturally
appropriate mental health services to children
who are deaf, deafblind, and hard-of-hearing.
This is a onetime appropriation.
Base Level Adjustment. The general fund
base is decreased by $500,000 in fiscal year
2018 and by $500,000 in fiscal year 2019.
| (l) Disabilities Grants |
20,820,000 |
20,858,000 |
||||
State Quality Council. $573,000 in fiscal
year 2016 and $600,000 in fiscal year 2017
are for the State Quality Council to provide
technical assistance and monitoring of
person-centered outcomes related to inclusive
community living and employment. The
funding must be used by the State Quality
Council to assure a statewide plan for systems
change in person-centered planning that will
achieve desired outcomes including increased
integrated employment and community living.
| (m) Adult Mental Health Grants |
||||||
| Appropriations by Fund |
||
| General |
69,992,000 |
71,244,000 |
| Health Care Access |
1,575,000 |
2,473,000 |
| Lottery Prize |
1,733,000 |
1,733,000 |
Funding Usage. Up to 75 percent of a fiscal
year's appropriation for adult mental health
grants may be used to fund allocations in that
portion of the fiscal year ending December
31.
Culturally Specific Mental Health Services.
$100,000 in fiscal year 2016 is for grants to
nonprofit organizations to provide resources
and referrals for culturally specific mental
health services to Southeast Asian veterans
born before 1965 who do not qualify for
services available to veterans formally
discharged from the United States armed
forces.
Problem Gambling. $225,000 in fiscal year
2016 and $225,000 in fiscal year 2017 are
from the lottery prize fund for a grant to the
state affiliate recognized by the National
Council on Problem Gambling. The affiliate
must provide services to increase public
awareness of problem gambling, education,
and training for individuals and organizations
providing effective treatment services to
problem gamblers and their families, and
research related to problem gambling.
Sustainability Grants. $2,125,000 in fiscal
year 2016 and $2,125,000 in fiscal year 2017
are for sustainability grants under Minnesota
Statutes, section 256B.0622, subdivision 11.
Beltrami County Mental Health Services
Grant. $1,000,000 in fiscal year 2016 and
$1,000,000 in fiscal year 2017 are from the
general fund for a grant to Beltrami County
to fund the planning and development of a
comprehensive mental health services program
under article 2, section 41, Comprehensive
Mental Health Program in Beltrami County.
This is a onetime appropriation.
Base Level Adjustment. The general fund
base is increased by $723,000 in fiscal year
2018 and by $723,000 in fiscal year 2019. The
health care access fund base is decreased by
$1,723,000 in fiscal year 2018 and by
$1,723,000 in fiscal year 2019.
| (n) Child Mental Health Grants |
23,386,000 |
24,313,000 |
||||
Services and Supports for First Episode
Psychosis. $177,000 in fiscal year 2017 is for
grants under Minnesota Statutes, section
245.4889, to mental health providers to pilot
evidence-based interventions for youth at risk
of developing or experiencing a first episode
of psychosis and for a public awareness
campaign on the signs and symptoms of
psychosis. The base for these grants is
$236,000 in fiscal year 2018 and $301,000 in
fiscal year 2019.
Adverse Childhood Experiences. The base
for grants under Minnesota Statutes, section
245.4889, to children's mental health and
family services collaboratives for adverse
childhood experiences (ACEs) training grants
and for an interactive Web site connection to
support ACEs in Minnesota is $363,000 in
fiscal year 2018 and $363,000 in fiscal year
2019.
Funding Usage. Up to 75 percent of a fiscal
year's appropriation for child mental health
grants may be used to fund allocations in that
portion of the fiscal year ending December
31.
Base Level Adjustment. The general fund
base is increased by $422,000 in fiscal year
2018 and is increased by $487,000 in fiscal
year 2019.
| (o) Chemical Dependency Treatment Support Grants |
1,561,000 |
1,561,000 |
||||
Chemical Dependency Prevention. $150,000
in fiscal year 2016 and $150,000 in fiscal year
2017 are for grants to nonprofit organizations
to provide chemical dependency prevention
programs in secondary schools. When making
grants, the commissioner must consider the
expertise, prior experience, and outcomes
achieved by applicants that have provided
prevention programming in secondary
education environments. An applicant for the
grant funds must provide verification to the
commissioner that the applicant has available
and will contribute sufficient funds to match
the grant given by the commissioner. This is
a onetime appropriation.
Fetal Alcohol Syndrome Grants. $250,000
in fiscal year 2016 and $250,000 in fiscal year
2017 are for grants to be administered by the
Minnesota Organization on Fetal Alcohol
Syndrome to provide comprehensive,
gender-specific services to pregnant and
parenting women suspected of or known to
use or abuse alcohol or other drugs. This
appropriation is for grants to no fewer than
three eligible recipients. Minnesota
Organization on Fetal Alcohol Syndrome must
report to the commissioner of human services
annually by January 15 on the grants funded
by this appropriation. The report must include
measurable outcomes for the previous year,
including the number of pregnant women
served and the number of toxic-free babies
born.
Base Level Adjustment. The general fund
base is decreased by $150,000 in fiscal year
2018 and by $150,000 in fiscal year 2019.
Sec. 53.
Laws 2020, First Special Session chapter 7, section 1, subdivision 1, as amended
by Laws 2021, First Special Session chapter 7, article 2, section 71, is amended to read:
Subdivision 1.
Waivers and modifications; federal funding extension.
When the
peacetime emergency declared by the governor in response to the COVID-19 outbreak
expires, is terminated, or is rescinded by the proper authority, the following waivers and
modifications to human services programs issued by the commissioner of human services
pursuant to Executive Orders 20-11 and 20-12 that are required to comply with federal law
may remain in effect for the time period set out in applicable federal law or for the time
period set out in any applicable federally approved waiver or state plan amendment,
whichever is later:
(1) CV15: allowing telephone or video visits for waiver programs;
(2) CV17: preserving health care coverage for Medical Assistance and MinnesotaCarenew text begin
as needed to comply with federal guidance from the Centers for Medicare and Medicaid
Services, and until the enrollee's first renewal following the resumption of medical assistance
and MinnesotaCare renewals after the end of the COVID-19 public health emergency
declared by the United States Secretary of Health and Human Servicesnew text end ;
(3) CV18: implementation of federal changes to the Supplemental Nutrition Assistance
Program;
(4) CV20: eliminating cost-sharing for COVID-19 diagnosis and treatment;
(5) CV24: allowing telephone or video use for targeted case management visits;
(6) CV30: expanding telemedicine in health care, mental health, and substance use
disorder settings;
(7) CV37: implementation of federal changes to the Supplemental Nutrition Assistance
Program;
(8) CV39: implementation of federal changes to the Supplemental Nutrition Assistance
Program;
(9) CV42: implementation of federal changes to the Supplemental Nutrition Assistance
Program;
(10) CV43: expanding remote home and community-based waiver services;
(11) CV44: allowing remote delivery of adult day services;
(12) CV59: modifying eligibility period for the federally funded Refugee Cash Assistance
Program;
(13) CV60: modifying eligibility period for the federally funded Refugee Social Services
Program; and
(14) CV109: providing 15 percent increase for Minnesota Food Assistance Program and
Minnesota Family Investment Program maximum food benefits.
Sec. 54.
Laws 2021, First Special Session chapter 7, article 1, section 36, is amended to
read:
Sec. 36. RESPONSE TO COVID-19 PUBLIC HEALTH EMERGENCY.
(a) Notwithstanding Minnesota Statutes, section 256B.057, subdivision 9, 256L.06,
subdivision 3, or any other provision to the contrary, the commissioner shall not collect any
unpaid premium for a coverage month deleted text begin that occurred duringdeleted text end new text begin until the enrollee's first renewal
after the resumption of medical assistance renewals following the end ofnew text end the COVID-19
public health emergency declared by the United States Secretary of Health and Human
Services.
(b) Notwithstanding any provision to the contrary, periodic data matching under
Minnesota Statutes, section 256B.0561, subdivision 2, may be suspended for up to deleted text begin sixdeleted text end new text begin 12new text end
months following the deleted text begin last day ofdeleted text end new text begin resumption of medical assistance and MinnesotaCare
renewals after the end ofnew text end the COVID-19 public health emergency declared by the United
States Secretary of Health and Human Services.
(c) Notwithstanding any provision to the contrary, the requirement for the commissioner
of human services to issue an annual report on periodic data matching under Minnesota
Statutes, section 256B.0561, is suspended for one year following the last day of the
COVID-19 public health emergency declared by the United States Secretary of Health and
Human Services.
new text begin
(d) The commissioner of human services shall take necessary actions to comply with
federal guidance pertaining to the appropriate redetermination of medical assistance enrollee
eligibility following the end of the COVID-19 public health emergency declared by the
United States Secretary of Health and Human Services and may waive currently existing
Minnesota statutes to the minimum level necessary to achieve federal compliance. All
changes implemented must be reported to the chairs and ranking minority members of the
legislative committees with jurisdiction over human services within 90 days.
new text end
Sec. 55. new text begin DENTAL HOME PILOT PROJECT.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment; requirements. new text end
new text begin
(a) The commissioner of human services
shall establish a dental home pilot project to increase access of medical assistance and
MinnesotaCare enrollees to dental care, improve patient experience, and improve oral health
clinical outcomes, in a manner that sustains the financial viability of the dental workforce
and broader dental care delivery and financing system. Dental homes must provide
high-quality, patient-centered, comprehensive, and coordinated oral health services across
clinical and community-based settings, including virtual oral health care.
new text end
new text begin
(b) The design and operation of the dental home pilot project must be consistent with
the recommendations made by the Dental Services Advisory Committee to the legislature
under Laws 2021, First Special Session chapter 7, article 1, section 33.
new text end
new text begin
(c) The commissioner shall establish baseline requirements and performance measures
for dental homes participating in the pilot project. These baseline requirements and
performance measures must address access and patient experience and oral health clinical
outcomes.
new text end
new text begin Subd. 2. new text end
new text begin Project design and timeline. new text end
new text begin
(a) The commissioner shall issue a preliminary
project description and a request for information to obtain stakeholder feedback and input
on project design issues, including but not limited to:
new text end
new text begin
(1) the timeline for project implementation;
new text end
new text begin
(2) the length of each project phase and the date for full project implementation;
new text end
new text begin
(3) the number of providers to be selected for participation;
new text end
new text begin
(4) grant amounts;
new text end
new text begin
(5) criteria and procedures for any value-based payments;
new text end
new text begin
(6) the extent to which pilot project requirements may vary with provider characteristics;
new text end
new text begin
(7) procedures for data collection;
new text end
new text begin
(8) the role of dental partners, such as dental professional organizations and educational
institutions;
new text end
new text begin
(9) provider support and education; and
new text end
new text begin
(10) other topics identified by the commissioner.
new text end
new text begin
(b) The commissioner shall consider the feedback and input obtained in paragraph (a)
and shall develop and issue a request for proposals for participation in the pilot project.
new text end
new text begin
(c) The pilot project must be implemented by July 1, 2023, and must include initial pilot
testing and the collection and analysis of data on baseline requirements and performance
measures to evaluate whether these requirements and measures are appropriate. Under this
phase, the commissioner shall provide grants to individual providers and provider networks
in addition to medical assistance and MinnesotaCare payments received for services provided.
new text end
new text begin
(d) The pilot project may test and analyze value-based payments to providers to determine
whether varying payments based on dental home performance measures is appropriate and
effective.
new text end
new text begin
(e) The commissioner shall ensure provider diversity in selecting project participants.
In selecting providers, the commissioner shall consider: geographic distribution; provider
size, type, and location; providers serving different priority populations; health equity issues;
and provider accessibility for patients with varying levels and types of disability.
new text end
new text begin
(f) In designing and implementing the pilot project, the commissioner shall regularly
consult with project participants and other stakeholders, and as relevant shall continue to
seek the input of participants and other stakeholders on the topics listed in paragraph (a).
new text end
new text begin Subd. 3. new text end
new text begin Reporting. new text end
new text begin
(a) The commissioner, beginning February 15, 2023, and each
February 15 thereafter for the duration of the demonstration project, shall report on the
design, implementation, operation, and results of the demonstration project to the chairs
and ranking minority members of the legislative committees with jurisdiction over health
care finance and policy.
new text end
new text begin
(b) The commissioner, within six months from the date the pilot project ceases operation,
shall report to the chairs and ranking minority members of the legislative committees with
jurisdiction over health care finance and policy on the results of the demonstration project,
and shall include in the report recommendations on whether the demonstration project, or
specific features of the demonstration project, should be extended to all dental providers
serving medical assistance and MinnesotaCare enrollees.
new text end
Sec. 56. new text begin SMALL EMPLOYER PUBLIC OPTION.
new text end
new text begin
The commissioner of human services, in consultation with representatives of small
employers, shall develop a small employer public option that allows employees of businesses
with fewer than 50 employees to receive employer contributions toward MinnesotaCare.
The commissioner shall determine whether the employer makes contributions to the
commissioner directly or the employee makes contributions through a qualified small
employer health reimbursement arrangement account or other arrangement. In determining
the structure of the small employer public option, the commissioner shall consult with
federal officials to determine which arrangement will result in the employer contributions
being tax deductible to the employer and not being considered taxable income to the
employee. The commissioner shall present recommendations for a small employer public
option to the chairs and ranking minority members of the legislative committees with
jurisdiction over health and human services policy and finance by December 15, 2023.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 57. new text begin TRANSITION TO MINNESOTACARE PUBLIC OPTION.
new text end
new text begin
(a) The commissioner of human services shall continue to administer MinnesotaCare
as a basic health program in accordance with Minnesota Statutes, section 256L.02,
subdivision 5, and shall seek federal waivers, approvals, and law changes necessary to
implement this act.
new text end
new text begin
(b) The commissioner shall present an implementation plan for the MinnesotaCare public
option under Minnesota Statutes, section 256L.04, subdivision 15, to the chairs and ranking
minority members of the legislative committees with jurisdiction over health care policy
and finance by December 15, 2023. The plan must include:
new text end
new text begin
(1) recommendations for any changes to the MinnesotaCare public option necessary to
continue federal basic health program funding or to receive other federal funding;
new text end
new text begin
(2) recommendations for implementing any small employer option in a manner that
would allow any employee payments toward premiums to be pretax;
new text end
new text begin
(3) recommendations for ensuring sufficient provider participation in MinnesotaCare;
new text end
new text begin
(4) estimates of state costs related to the MinnesotaCare public option;
new text end
new text begin
(5) a description of the proposed premium scale for persons eligible through the public
option, including an analysis of the extent to which the proposed premium scale:
new text end
new text begin
(i) ensures affordable premiums for persons across the income spectrum enrolled under
the public option; and
new text end
new text begin
(ii) avoids premium cliffs for persons transitioning to and enrolled under the public
option; and
new text end
new text begin
(6) draft legislation that includes any additional policy and conforming changes necessary
to implement the MinnesotaCare public option and the implementation plan
recommendations.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 58. new text begin REQUEST FOR FEDERAL APPROVAL.
new text end
new text begin
(a) The commissioner of human services shall seek any federal waivers, approvals, and
law changes necessary to implement this act, including but not limited to those waivers,
approvals, and law changes necessary to allow the state to:
new text end
new text begin
(1) continue receiving federal basic health program payments for basic health
program-eligible MinnesotaCare enrollees and to receive other federal funding for the
MinnesotaCare public option;
new text end
new text begin
(2) receive federal payments equal to the value of premium tax credits and cost-sharing
reductions that MinnesotaCare enrollees with household incomes greater than 200 percent
of the federal poverty guidelines would otherwise have received; and
new text end
new text begin
(3) receive federal payments equal to the value of emergency medical assistance that
would otherwise have been paid to the state for covered services provided to eligible
enrollees.
new text end
new text begin
(b) In implementing this section, the commissioner of human services shall consult with
the commissioner of commerce and the Board of Directors of MNsure and may contract
for technical and actuarial assistance.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 59. new text begin DELIVERY REFORM ANALYSIS REPORT.
new text end
new text begin
(a) The commissioner of human services shall present to the chairs and ranking minority
members of the legislative committees with jurisdiction over health care policy and finance,
by January 15, 2024, a report comparing service delivery and payment system models for
delivering services to medical assistance enrollees for whom income eligibility is determined
using the modified adjusted gross income methodology under Minnesota Statutes, section
256B.056, subdivision 1a, paragraph (b), clause (1), and MinnesotaCare enrollees eligible
under Minnesota Statutes, chapter 256L. The report must compare the current delivery
model with at least two alternative models. The alternative models must include a state-based
model in which the state holds the plan risk as the insurer and may contract with a third-party
administrator for claims processing and plan administration. The alternative models may
include but are not limited to:
new text end
new text begin
(1) expanding the use of integrated health partnerships under Minnesota Statutes, section
256B.0755;
new text end
new text begin
(2) delivering care under fee-for-service through a primary care case management system;
and
new text end
new text begin
(3) continuing to contract with managed care and county-based purchasing plans for
some or all enrollees under modified contracts.
new text end
new text begin
(b) The report must include:
new text end
new text begin
(1) a description of how each model would address:
new text end
new text begin
(i) racial and other inequities in the delivery of health care and health care outcomes;
new text end
new text begin
(ii) geographic inequities in the delivery of health care;
new text end
new text begin
(iii) the provision of incentives for preventive care and other best practices;
new text end
new text begin
(iv) reimbursement of providers for high-quality, value-based care at levels sufficient
to sustain or increase enrollee access to care; and
new text end
new text begin
(v) transparency and simplicity for enrollees, health care providers, and policymakers;
new text end
new text begin
(2) a comparison of the projected cost of each model; and
new text end
new text begin
(3) an implementation timeline for each model that includes the earliest date by which
each model could be implemented if authorized during the 2024 legislative session and a
discussion of barriers to implementation.
new text end
Sec. 60. new text begin RECOMMENDATIONS; OFFICE OF PATIENT PROTECTION.
new text end
new text begin
(a) The commissioners of human services, health, and commerce and the MNsure board
shall submit to the health care affordability board and the chairs and ranking minority
members of the legislative committees with primary jurisdiction over health and human
services finance and policy and commerce by January 15, 2023, a report on the organization
and duties of the Office of Patient Protection, to be established under Minnesota Statutes,
section 62J.89, subdivision 4. The report must include recommendations on how the office
shall:
new text end
new text begin
(1) coordinate or consolidate within the office existing state agency patient protection
activities, including but not limited to the activities of ombudsman offices and the MNsure
board;
new text end
new text begin
(2) enforce standards and procedures under Minnesota Statutes, chapter 62M, for
utilization review organizations;
new text end
new text begin
(3) work with private sector and state agency consumer assistance programs to assist
consumers with questions or concerns relating to public programs and private insurance
coverage;
new text end
new text begin
(4) establish and implement procedures to assist consumers aggrieved by restrictions on
patient choice, denials of services, and reductions in quality of care resulting from any final
action by a payer or provider; and
new text end
new text begin
(5) make health plan company quality of care and patient satisfaction information and
other information collected by the office readily accessible to consumers on the board's
website.
new text end
new text begin
(b) The commissioners and the MNsure board shall consult with stakeholders as they
develop the recommendations. The stakeholders consulted must include but are not limited
to organizations and individuals representing: underserved communities; persons with
disabilities; low-income Minnesotans; senior citizens; and public and private sector health
plan enrollees, including persons who purchase coverage through MNsure, health plan
companies, and public and private sector purchasers of health coverage.
new text end
new text begin
(c) The commissioners and the MNsure board may contract with a third party to develop
the report and recommendations.
new text end
Sec. 61. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2020, section 256B.063,
new text end
new text begin
is repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
ARTICLE 4
HEALTH CARE POLICY
Section 1.
Minnesota Statutes 2020, section 62J.2930, subdivision 3, is amended to read:
Subd. 3.
Consumer information.
(a) The information clearinghouse or another entity
designated by the commissioner shall provide consumer information to health plan company
enrollees to:
(1) assist enrollees in understanding their rights;
(2) explain and assist in the use of all available complaint systems, including internal
complaint systems within health carriers, community integrated service networks, and the
Departments of Health and Commerce;
(3) provide information on coverage options in each region of the state;
(4) provide information on the availability of purchasing pools and enrollee subsidies;
and
(5) help consumers use the health care system to obtain coverage.
(b) The information clearinghouse or other entity designated by the commissioner for
the purposes of this subdivision shall not:
(1) provide legal services to consumers;
(2) represent a consumer or enrollee; or
(3) serve as an advocate for consumers in disputes with health plan companies.
(c) Nothing in this subdivision shall interfere with the ombudsman program established
under section deleted text begin 256B.69, subdivision 20deleted text end new text begin 256B.6903new text end , or other existing ombudsman programs.
Sec. 2.
Minnesota Statutes 2020, section 256B.055, subdivision 2, is amended to read:
Subd. 2.
Subsidized foster children.
Medical assistance may be paid for a child eligible
for or receiving foster care maintenance payments under Title IV-E of the Social Security
Act, United States Code, title 42, sections 670 to 676, and for a child who is not eligible for
Title IV-E of the Social Security Act but who is deleted text begin determined eligible fordeleted text end new text begin placed innew text end foster
carenew text begin as determined by Minnesota Statutesnew text end or kinship assistance under chapter 256N.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 3.
Minnesota Statutes 2020, section 256B.056, subdivision 3b, is amended to read:
Subd. 3b.
Treatment of trusts.
new text begin
(a) It is the public policy of this state that individuals
use all available resources to pay for the cost of long-term care services, as defined in section
256B.0595, before turning to Minnesota health care program funds, and that trust instruments
should not be permitted to shield available resources of an individual or an individual's
spouse from such use.
new text end
deleted text begin (a)deleted text end new text begin (b)new text end A "medical assistance qualifying trust" is a revocable or irrevocable trust, or
similar legal device, established on or before August 10, 1993, by a person or the person's
spouse under the terms of which the person receives or could receive payments from the
trust principal or income and the trustee has discretion in making payments to the person
from the trust principal or income. Notwithstanding that definition, a medical assistance
qualifying trust does not include: (1) a trust set up by will; (2) a trust set up before April 7,
1986, solely to benefit a person with a developmental disability living in an intermediate
care facility for persons with developmental disabilities; or (3) a trust set up by a person
with payments made by the Social Security Administration pursuant to the United States
Supreme Court decision in Sullivan v. Zebley, 110 S. Ct. 885 (1990). The maximum amount
of payments that a trustee of a medical assistance qualifying trust may make to a person
under the terms of the trust is considered to be available assets to the person, without regard
to whether the trustee actually makes the maximum payments to the person and without
regard to the purpose for which the medical assistance qualifying trust was established.
deleted text begin (b)deleted text end new text begin (c)new text end Trusts established after August 10, 1993, are treated according to United States
Code, title 42, section 1396p(d).
deleted text begin (c)deleted text end new text begin (d)new text end For purposes of paragraph deleted text begin (d)deleted text end new text begin (e)new text end , a pooled trust means a trust established under
United States Code, title 42, section 1396p(d)(4)(C).
deleted text begin (d)deleted text end new text begin (e)new text end A beneficiary's interest in a pooled trust is considered an available asset unless
the trust provides that upon the death of the beneficiary or termination of the trust during
the beneficiary's lifetime, whichever is sooner, the department receives any amount, up to
the amount of medical assistance benefits paid on behalf of the beneficiary, remaining in
the beneficiary's trust account after a deduction for reasonable administrative fees and
expenses, and an additional remainder amount. The retained remainder amount of the
subaccount must not exceed ten percent of the account value at the time of the beneficiary's
death or termination of the trust, and must only be used for the benefit of disabled individuals
who have a beneficiary interest in the pooled trust.
deleted text begin (e)deleted text end new text begin (f)new text end Trusts may be established on or after December 12, 2016, by a person who has
been determined to be disabled, according to United States Code, title 42, section
1396p(d)(4)(A), as amended by section 5007 of the 21st Century Cures Act, Public Law
114-255.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 4.
Minnesota Statutes 2020, section 256B.056, subdivision 3c, is amended to read:
Subd. 3c.
Asset limitations for families and children.
(a) A household of two or more
persons must not own more than $20,000 in total net assets, and a household of one person
must not own more than $10,000 in total net assets. In addition to these maximum amounts,
an eligible individual or family may accrue interest on these amounts, but they must be
reduced to the maximum at the time of an eligibility redetermination. The value of assets
that are not considered in determining eligibility for medical assistance for families and
children is the value of those assets excluded under the AFDC state plan as of July 16, 1996,
as required by the Personal Responsibility and Work Opportunity Reconciliation Act of
1996 (PRWORA), Public Law 104-193, with the following exceptions:
(1) household goods and personal effects are not considered;
(2) capital and operating assets of a trade or business up to $200,000 are not considered;
(3) one motor vehicle is excluded for each person of legal driving age who is employed
or seeking employment;
(4) assets designated as burial expenses are excluded to the same extent they are excluded
by the Supplemental Security Income program;
(5) court-ordered settlements up to $10,000 are not considered;
(6) individual retirement accounts and funds are not considered;
(7) assets owned by children are not considered; and
(8) deleted text begin effective July 1, 2009,deleted text end certain assets owned by American Indians are excluded as
required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
Law 111-5. For purposes of this clause, an American Indian is any person who meets the
definition of Indian according to Code of Federal Regulations, title 42, section 447.50.
(b) deleted text begin Beginning January 1, 2014, this subdivisiondeleted text end new text begin Paragraph (a)new text end applies only to parents
and caretaker relatives who qualify for medical assistance under subdivision 5.
new text begin
(c) Eligibility for children under age 21 must be determined without regard to the asset
limitations described in paragraphs (a) and (b) and subdivision 3.
new text end
Sec. 5.
Minnesota Statutes 2020, section 256B.056, subdivision 11, is amended to read:
Subd. 11.
Treatment of annuities.
(a) Any person requesting medical assistance payment
of long-term care services shall provide a complete description of any interest either the
person or the person's spouse has in annuities on a form designated by the department. The
form shall include a statement that the state becomes a preferred remainder beneficiary of
annuities or similar financial instruments by virtue of the receipt of medical assistance
payment of long-term care services. The person and the person's spouse shall furnish the
agency responsible for determining eligibility with complete current copies of their annuities
and related documents and complete the form designating the state as the preferred remainder
beneficiary for each annuity in which the person or the person's spouse has an interest.
(b) The department shall provide notice to the issuer of the department's right under this
section as a preferred remainder beneficiary under the annuity or similar financial instrument
for medical assistance furnished to the person or the person's spouse, and provide notice of
the issuer's responsibilities as provided in paragraph (c).
(c) An issuer of an annuity or similar financial instrument who receives notice of the
state's right to be named a preferred remainder beneficiary as described in paragraph (b)
shall provide confirmation to the requesting agency that the state has been made a preferred
remainder beneficiary. The issuer shall also notify the county agency when a change in the
amount of income or principal being withdrawn from the annuity or other similar financial
instrument or a change in the state's preferred remainder beneficiary designation under the
annuity or other similar financial instrument occurs. The county agency shall provide the
issuer with the name, address, and telephone number of a unit within the department that
the issuer can contact to comply with this paragraph.
(d) "Preferred remainder beneficiary" for purposes of this subdivision and sections
256B.0594 and 256B.0595 means the state is a remainder beneficiary in the first position
in an amount equal to the amount of medical assistance paid on behalf of the institutionalized
person, or is a remainder beneficiary in the second position if the institutionalized person
designates and is survived by a remainder beneficiary who is (1) a spouse who does not
reside in a medical institution, (2) a minor child, or (3) a child of any age who is blind or
permanently and totally disabled as defined in the Supplemental Security Income program.
Notwithstanding this paragraph, the state is the remainder beneficiary in the first position
if the spouse or child disposes of the remainder for less than fair market value.
(e) For purposes of this subdivision, "institutionalized person" and "long-term care
services" have the meanings given in section 256B.0595, subdivision 1, paragraph deleted text begin (g)deleted text end new text begin (f)new text end .
(f) For purposes of this subdivision, "medical institution" means a skilled nursing facility,
intermediate care facility, intermediate care facility for persons with developmental
disabilities, nursing facility, or inpatient hospital.
Sec. 6.
Minnesota Statutes 2020, section 256B.0595, subdivision 1, is amended to read:
Subdivision 1.
Prohibited transfers.
(a) Effective for transfers made after August 10,
1993, an institutionalized person, an institutionalized person's spouse, or any person, court,
or administrative body with legal authority to act in place of, on behalf of, at the direction
of, or upon the request of the institutionalized person or institutionalized person's spouse,
may not give away, sell, or dispose of, for less than fair market value, any asset or interest
therein, except assets other than the homestead that are excluded under the Supplemental
Security Income program, for the purpose of establishing or maintaining medical assistance
eligibility. This applies to all transfers, including those made by a community spouse after
the month in which the institutionalized spouse is determined eligible for medical assistance.
For purposes of determining eligibility for long-term care services, any transfer of such
assets within 36 months before or any time after an institutionalized person requests medical
assistance payment of long-term care services, or 36 months before or any time after a
medical assistance recipient becomes an institutionalized person, for less than fair market
value may be considered. Any such transfer is presumed to have been made for the purpose
of establishing or maintaining medical assistance eligibility and the institutionalized person
is ineligible for long-term care services for the period of time determined under subdivision
2, unless the institutionalized person furnishes convincing evidence to establish that the
transaction was exclusively for another purpose, or unless the transfer is permitted under
subdivision 3 or 4. In the case of payments from a trust or portions of a trust that are
considered transfers of assets under federal law, or in the case of any other disposal of assets
made on or after February 8, 2006, any transfers made within 60 months before or any time
after an institutionalized person requests medical assistance payment of long-term care
services and within 60 months before or any time after a medical assistance recipient becomes
an institutionalized person, may be considered.
(b) This section applies to transfers, for less than fair market value, of income or assets,
including assets that are considered income in the month received, such as inheritances,
court settlements, and retroactive benefit payments or income to which the institutionalized
person or the institutionalized person's spouse is entitled but does not receive due to action
by the institutionalized person, the institutionalized person's spouse, or any person, court,
or administrative body with legal authority to act in place of, on behalf of, at the direction
of, or upon the request of the institutionalized person or the institutionalized person's spouse.
(c) This section applies to payments for care or personal services provided by a relative,
unless the compensation was stipulated in a notarized, written agreement deleted text begin whichdeleted text end new text begin thatnew text end was
in existence when the service was performed, the care or services directly benefited the
person, and the payments made represented reasonable compensation for the care or services
provided. A notarized written agreement is not required if payment for the services was
made within 60 days after the service was provided.
deleted text begin
(d) This section applies to the portion of any asset or interest that an institutionalized
person, an institutionalized person's spouse, or any person, court, or administrative body
with legal authority to act in place of, on behalf of, at the direction of, or upon the request
of the institutionalized person or the institutionalized person's spouse, transfers to any
annuity that exceeds the value of the benefit likely to be returned to the institutionalized
person or institutionalized person's spouse while alive, based on estimated life expectancy
as determined according to the current actuarial tables published by the Office of the Chief
Actuary of the Social Security Administration. The commissioner may adopt rules reducing
life expectancies based on the need for long-term care. This section applies to an annuity
purchased on or after March 1, 2002, that:
deleted text end
deleted text begin
(1) is not purchased from an insurance company or financial institution that is subject
to licensing or regulation by the Minnesota Department of Commerce or a similar regulatory
agency of another state;
deleted text end
deleted text begin
(2) does not pay out principal and interest in equal monthly installments; or
deleted text end
deleted text begin
(3) does not begin payment at the earliest possible date after annuitization.
deleted text end
deleted text begin (e)deleted text end new text begin (d)new text end Effective for transactions, including the purchase of an annuity, occurring on or
after February 8, 2006, by or on behalf of an institutionalized person who has applied for
or is receiving long-term care services or the institutionalized person's spouse shall be treated
as the disposal of an asset for less than fair market value unless the department is named a
preferred remainder beneficiary as described in section 256B.056, subdivision 11. Any
subsequent change to the designation of the department as a preferred remainder beneficiary
shall result in the annuity being treated as a disposal of assets for less than fair market value.
The amount of such transfer shall be the maximum amount the institutionalized person or
the institutionalized person's spouse could receive from the annuity or similar financial
instrument. Any change in the amount of the income or principal being withdrawn from the
annuity or other similar financial instrument at the time of the most recent disclosure shall
be deemed to be a transfer of assets for less than fair market value unless the institutionalized
person or the institutionalized person's spouse demonstrates that the transaction was for fair
market value. In the event a distribution of income or principal has been improperly
distributed or disbursed from an annuity or other retirement planning instrument of an
institutionalized person or the institutionalized person's spouse, a cause of action exists
against the individual receiving the improper distribution for the cost of medical assistance
services provided or the amount of the improper distribution, whichever is less.
deleted text begin (f)deleted text end new text begin (e)new text end Effective for transactions, including the purchase of an annuity, occurring on or
after February 8, 2006, by or on behalf of an institutionalized person applying for or receiving
long-term care services shall be treated as a disposal of assets for less than fair market value
unless it is:
(1) an annuity described in subsection (b) or (q) of section 408 of the Internal Revenue
Code of 1986; or
(2) purchased with proceeds from:
(i) an account or trust described in subsection (a), (c), or (p) of section 408 of the Internal
Revenue Code;
(ii) a simplified employee pension within the meaning of section 408(k) of the Internal
Revenue Code; or
(iii) a Roth IRA described in section 408A of the Internal Revenue Code; or
(3) an annuity that is irrevocable and nonassignable; is actuarially sound as determined
in accordance with actuarial publications of the Office of the Chief Actuary of the Social
Security Administration; and provides for payments in equal amounts during the term of
the annuity, with no deferral and no balloon payments made.
deleted text begin (g)deleted text end new text begin (f)new text end For purposes of this section, long-term care services include services in a nursing
facility, services that are eligible for payment according to section 256B.0625, subdivision
2, because they are provided in a swing bed, intermediate care facility for persons with
developmental disabilities, and home and community-based services provided pursuant to
chapter 256S and sections 256B.092 and 256B.49. For purposes of this subdivision and
subdivisions 2, 3, and 4, "institutionalized person" includes a person who is an inpatient in
a nursing facility or in a swing bed, or intermediate care facility for persons with
developmental disabilities or who is receiving home and community-based services under
chapter 256S and sections 256B.092 and 256B.49.
deleted text begin (h)deleted text end new text begin (g)new text end This section applies to funds used to purchase a promissory note, loan, or mortgage
unless the note, loan, or mortgage:
(1) has a repayment term that is actuarially sound;
(2) provides for payments to be made in equal amounts during the term of the loan, with
no deferral and no balloon payments made; and
(3) prohibits the cancellation of the balance upon the death of the lender.
new text begin (h) new text end In the case of a promissory note, loan, or mortgage that does not meet an exception
innew text begin paragraph (g),new text end clauses (1) to (3), the value of such note, loan, or mortgage shall be the
outstanding balance due as of the date of the institutionalized person's request for medical
assistance payment of long-term care services.
(i) This section applies to the purchase of a life estate interest in another person's home
unless the purchaser resides in the home for a period of at least one year after the date of
purchase.
(j) This section applies to transfers into a pooled trust that qualifies under United States
Code, title 42, section 1396p(d)(4)(C), by:
(1) a person age 65 or older or the person's spouse; or
(2) any person, court, or administrative body with legal authority to act in place of, on
behalf of, at the direction of, or upon the request of a person age 65 or older or the person's
spouse.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 7.
Minnesota Statutes 2021 Supplement, section 256B.0625, subdivision 3b, is
amended to read:
Subd. 3b.
Telehealth services.
(a) Medical assistance covers medically necessary services
and consultations delivered by a health care provider through telehealth in the same manner
as if the service or consultation was delivered through in-person contact. Services or
consultations delivered through telehealth shall be paid at the full allowable rate.
(b) The commissioner may establish criteria that a health care provider must attest to in
order to demonstrate the safety or efficacy of delivering a particular service through
telehealth. The attestation may include that the health care provider:
(1) has identified the categories or types of services the health care provider will provide
through telehealth;
(2) has written policies and procedures specific to services delivered through telehealth
that are regularly reviewed and updated;
(3) has policies and procedures that adequately address patient safety before, during,
and after the service is delivered through telehealth;
(4) has established protocols addressing how and when to discontinue telehealth services;
and
(5) has an established quality assurance process related to delivering services through
telehealth.
(c) As a condition of payment, a licensed health care provider must document each
occurrence of a health service delivered through telehealth to a medical assistance enrollee.
Health care service records for services delivered through telehealth must meet the
requirements set forth in Minnesota Rules, part 9505.2175, subparts 1 and 2, and must
document:
(1) the type of service delivered through telehealth;
(2) the time the service began and the time the service ended, including an a.m. and p.m.
designation;
(3) the health care provider's basis for determining that telehealth is an appropriate and
effective means for delivering the service to the enrollee;
(4) the mode of transmission used to deliver the service through telehealth and records
evidencing that a particular mode of transmission was utilized;
(5) the location of the originating site and the distant site;
(6) if the claim for payment is based on a physician's consultation with another physician
through telehealth, the written opinion from the consulting physician providing the telehealth
consultation; and
(7) compliance with the criteria attested to by the health care provider in accordance
with paragraph (b).
(d) Telehealth visitsdeleted text begin , as described in this subdivision provided through audio and visual
communication,deleted text end may be used to satisfy the face-to-face requirement for reimbursement
under the payment methods that apply to a federally qualified health center, rural health
clinic, Indian health service, 638 Tribal clinic, and certified community behavioral health
clinic, if the service would have otherwise qualified for payment if performed in person.
(e) For mental health services or assessments delivered through telehealth that are based
on an individual treatment plan, the provider may document the client's verbal approval or
electronic written approval of the treatment plan or change in the treatment plan in lieu of
the client's signature in accordance with Minnesota Rules, part 9505.0371.
(f) For purposes of this subdivision, unless otherwise covered under this chapter:
(1) "telehealth" means the delivery of health care services or consultations deleted text begin through the
use ofdeleted text end new text begin usingnew text end real-time two-way interactive audio and visual communication new text begin or accessible
telemedicine video-based platforms new text end to provide or support health care delivery and facilitate
the assessment, diagnosis, consultation, treatment, education, and care management of a
patient's health care. Telehealth includes the application of secure video conferencingdeleted text begin ,deleted text end new text begin
consisting of a real-time, full-motion synchronized video;new text end store-and-forward technologydeleted text begin ,deleted text end new text begin ;new text end
and synchronous interactions between a patient located at an originating site and a health
care provider located at a distant site. Telehealth does not include communication between
health care providers, or between a health care provider and a patient that consists solely
of an audio-only communication, e-mail, or facsimile transmission or as specified by law;
(2) "health care provider" meansnew text begin :
new text end
new text begin (i)new text end a health care provider as defined under section 62A.673deleted text begin ,deleted text end new text begin ;
new text end
new text begin (ii)new text end a community paramedic as defined under section 144E.001, subdivision 5fdeleted text begin ,deleted text end new text begin ;
new text end
new text begin (iii)new text end a community health worker who meets the criteria under subdivision 49, paragraph
(a)deleted text begin ,deleted text end new text begin ;
new text end
new text begin (iv)new text end a mental health certified peer specialist under section 256B.0615, subdivision 5deleted text begin ,deleted text end new text begin ;
new text end
new text begin (v)new text end a mental health certified family peer specialist under section 256B.0616, subdivision
5deleted text begin ,deleted text end new text begin ;
new text end
new text begin (vi)new text end a mental health rehabilitation worker under section 256B.0623, subdivision 5,
paragraph (a), clause (4), and paragraph (b)deleted text begin ,deleted text end new text begin ;
new text end
new text begin (vii)new text end a mental health behavioral aide under section 256B.0943, subdivision 7, paragraph
(b), clause (3)deleted text begin ,deleted text end new text begin ;
new text end
new text begin (viii)new text end a treatment coordinator under section 245G.11, subdivision 7deleted text begin ,deleted text end new text begin ;
new text end
new text begin (ix)new text end an alcohol and drug counselor under section 245G.11, subdivision 5deleted text begin ,deleted text end new text begin ; or
new text end
new text begin (x)new text end a recovery peer under section 245G.11, subdivision 8; and
(3) "originating site," "distant site," and "store-and-forward technology" have the
meanings given in section 62A.673, subdivision 2.
Sec. 8.
Minnesota Statutes 2020, section 256B.0625, subdivision 64, is amended to read:
Subd. 64.
Investigational drugs, biological products, devices, and clinical
trials.
Medical assistance and the early periodic screening, diagnosis, and treatment (EPSDT)
program do not cover deleted text begin the costs of any services that are incidental to, associated with, or
resulting from the use ofdeleted text end investigational drugs, biological products, or devices as defined
in section 151.375 or any other treatment that is part of an approved clinical trial as defined
in section 62Q.526. Participation of an enrollee in an approved clinical trial does not preclude
coverage of medically necessary services covered under this chapter that are not related to
the approved clinical trial.new text begin Any items or services that are provided solely to satisfy data
collection and analysis for a clinical trial, and not for direct clinical management of the
enrollee, are not covered.
new text end
Sec. 9.
new text begin
[256B.6903] OMBUDSPERSON FOR MANAGED CARE.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given them.
new text end
new text begin
(b) "Adverse benefit determination" has the meaning provided in Code of Federal
Regulations, title 42, section 438.400, subpart (b).
new text end
new text begin
(c) "Appeal" means an oral or written request from an enrollee to the managed care
organization for review of an adverse benefit determination.
new text end
new text begin
(d) "Commissioner" means the commissioner of human services.
new text end
new text begin
(e) "Complaint" means an enrollee's informal expression of dissatisfaction about any
matter relating to the enrollee's prepaid health plan other than an adverse benefit
determination.
new text end
new text begin
(f) "Data analyst" means the person employed by the ombudsperson that uses research
methodologies to conduct research on data collected from prepaid health plans, including
but not limited to scientific theory; hypothesis testing; survey research techniques; data
collection; data manipulation; and statistical analysis interpretation, including multiple
regression techniques.
new text end
new text begin
(g) "Enrollee" means a person enrolled in a prepaid health plan under section 256B.69.
When applicable, an enrollee includes an enrollee's authorized representative.
new text end
new text begin
(h) "External review" means the process described under Code of Federal Regulations,
title 42, section 438.408, subpart (f); and section 62Q.73, subdivision 2.
new text end
new text begin
(i) "Grievance" means an enrollee's expression of dissatisfaction about any matter relating
to the enrollee's prepaid health plan other than an adverse benefit determination that follows
the procedures outlined in Code of Federal Regulations, title 42, part 438, subpart (f). A
grievance may include but is not limited to concerns relating to quality of care, services
provided, or failure to respect an enrollee's rights under a prepaid health plan.
new text end
new text begin
(j) "Managed care advocate" means a county or Tribal employee who works with
managed care enrollees when the enrollee has service, billing, or access problems with the
enrollee's prepaid health plan.
new text end
new text begin
(k) "Prepaid health plan" means a plan under contract with the commissioner according
to section 256B.69.
new text end
new text begin
(l) "State fair hearing" means the appeals process mandated under section 256.045,
subdivision 3a.
new text end
new text begin Subd. 2. new text end
new text begin Ombudsperson. new text end
new text begin
The commissioner must designate an ombudsperson to advocate
for enrollees. At the time of enrollment in a prepaid health plan, the local agency must
inform enrollees about the ombudsperson.
new text end
new text begin Subd. 3. new text end
new text begin Duties and cost. new text end
new text begin
(a) The ombudsperson must work to ensure enrollees receive
covered services as described in the enrollee's prepaid health plan by:
new text end
new text begin
(1) providing assistance and education to enrollees, when requested, regarding covered
health care benefits or services; billing and access; or the grievance, appeal, or state fair
hearing processes;
new text end
new text begin
(2) with the enrollee's permission and within the ombudsperson's discretion, using an
informal review process to assist an enrollee with a resolution involving the enrollee's
prepaid health plan's benefits;
new text end
new text begin
(3) assisting enrollees, when requested, with prepaid health plan grievances, appeals, or
the state fair hearing process;
new text end
new text begin
(4) overseeing, reviewing, and approving documents used by enrollees relating to prepaid
health plans' grievances, appeals, and state fair hearings;
new text end
new text begin
(5) reviewing all state fair hearings and requests by enrollees for external review;
overseeing entities under contract to provide external reviews, processes, and payments for
services; and utilizing aggregated results of external reviews to recommend health care
benefits policy changes; and
new text end
new text begin
(6) providing trainings to managed care advocates.
new text end
new text begin
(b) The ombudsperson must not charge an enrollee for the ombudsperson's services.
new text end
new text begin Subd. 4. new text end
new text begin Powers. new text end
new text begin
In exercising the ombudsperson's authority under this section, the
ombudsperson may:
new text end
new text begin
(1) gather information and evaluate any practice, policy, procedure, or action by a prepaid
health plan, state human services agency, county, or Tribe; and
new text end
new text begin
(2) prescribe the methods by which complaints are to be made, received, and acted upon.
The ombudsperson's authority under this clause includes but is not limited to:
new text end
new text begin
(i) determining the scope and manner of a complaint;
new text end
new text begin
(ii) holding a prepaid health plan accountable to address a complaint in a timely manner
as outlined in state and federal laws;
new text end
new text begin
(iii) requiring a prepaid health plan to respond in a timely manner to a request for data,
case details, and other information as needed to help resolve a complaint or to improve a
prepaid health plan's policy; and
new text end
new text begin
(iv) making recommendations for policy, administrative, or legislative changes regarding
prepaid health plans to the proper partners.
new text end
new text begin Subd. 5. new text end
new text begin Data. new text end
new text begin
(a) The data analyst must review and analyze prepaid health plan data
on denial, termination, and reduction notices (DTRs), grievances, appeals, and state fair
hearings by:
new text end
new text begin
(1) analyzing, reviewing, and reporting on DTRs, grievances, appeals, and state fair
hearings data collected from each prepaid health plan;
new text end
new text begin
(2) collaborating with the commissioner's partners and the Department of Health for the
Triennial Compliance Assessment under Code of Federal Regulations, title 42, section
438.358, subpart (b);
new text end
new text begin
(3) reviewing state fair hearing decisions for policy or coverage issues that may affect
enrollees; and
new text end
new text begin
(4) providing data required under Code of Federal Regulations, title 42, section 438.66
(2016), to the Centers for Medicare and Medicaid Services.
new text end
new text begin
(b) The data analyst must share the data analyst's data observations and trends under
this subdivision with the ombudsperson, prepaid health plans, and commissioner's partners.
new text end
new text begin Subd. 6. new text end
new text begin Collaboration and independence. new text end
new text begin
(a) The ombudsperson must work in
collaboration with the commissioner and the commissioner's partners when the
ombudsperson's collaboration does not otherwise interfere with the ombudsperson's duties
under this section.
new text end
new text begin
(b) The ombudsperson may act independently of the commissioner when:
new text end
new text begin
(1) providing information or testimony to the legislature; and
new text end
new text begin
(2) contacting and making reports to federal and state officials.
new text end
new text begin Subd. 7. new text end
new text begin Civil actions. new text end
new text begin
The ombudsperson is not civilly liable for actions taken under
this section if the action was taken in good faith, was within the scope of the ombudsperson's
authority, and did not constitute willful or reckless misconduct.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 10.
Minnesota Statutes 2020, section 256B.77, subdivision 13, is amended to read:
Subd. 13.
Ombudsman.
Enrollees shall have access to ombudsman services established
in section deleted text begin 256B.69, subdivision 20deleted text end new text begin 256B.6903new text end , and advocacy services provided by the
ombudsman for mental health and developmental disabilities established in sections 245.91
to 245.97. The managed care ombudsman and the ombudsman for mental health and
developmental disabilities shall coordinate services provided to avoid duplication of services.
For purposes of the demonstration project, the powers and responsibilities of the Office of
Ombudsman for Mental Health and Developmental Disabilities, as provided in sections
245.91 to 245.97 are expanded to include all eligible individuals, health plan companies,
agencies, and providers participating in the demonstration project.
Sec. 11. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2020, section 256B.057, subdivision 7,
new text end
new text begin
is repealed on July 1,
2022.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Statutes 2020, sections 256B.69, subdivision 20; 501C.0408, subdivision
4; and 501C.1206,
new text end
new text begin
are repealed the day following final enactment.
new text end
ARTICLE 5
HEALTH-RELATED LICENSING BOARDS
Section 1.
Minnesota Statutes 2020, section 148B.33, is amended by adding a subdivision
to read:
new text begin Subd. 1a. new text end
new text begin Supervision requirement; postgraduate experience. new text end
new text begin
The board must allow
an applicant to satisfy the requirement for supervised postgraduate experience in marriage
and family therapy with all required hours of supervision provided through real-time,
two-way interactive audio and visual communication.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment and
applies to supervision requirements in effect on or after that date.
new text end
Sec. 2.
Minnesota Statutes 2021 Supplement, section 148B.5301, subdivision 2, is amended
to read:
Subd. 2.
Supervision.
(a) To qualify as a LPCC, an applicant must have completed
4,000 hours of post-master's degree supervised professional practice in the delivery of
clinical services in the diagnosis and treatment of mental illnesses and disorders in both
children and adults. The supervised practice shall be conducted according to the requirements
in paragraphs (b) to (e).
(b) The supervision must have been received under a contract that defines clinical practice
and supervision from a mental health professional who is qualified according to section
245I.04, subdivision 2, or by a board-approved supervisor, who has at least two years of
postlicensure experience in the delivery of clinical services in the diagnosis and treatment
of mental illnesses and disorders. All supervisors must meet the supervisor requirements in
Minnesota Rules, part 2150.5010.
(c) The supervision must be obtained at the rate of two hours of supervision per 40 hours
of professional practice. The supervision must be evenly distributed over the course of the
supervised professional practice. At least 75 percent of the required supervision hours must
be received in personnew text begin or through real-time, two-way interactive audio and visual
communication, and the board must allow an applicant to satisfy this supervision requirement
with all required hours of supervision received through real-time, two-way interactive audio
and visual communicationnew text end . The remaining 25 percent of the required hours may be received
by telephone or by audio or audiovisual electronic device. At least 50 percent of the required
hours of supervision must be received on an individual basis. The remaining 50 percent
may be received in a group setting.
(d) The supervised practice must include at least 1,800 hours of clinical client contact.
(e) The supervised practice must be clinical practice. Supervision includes the observation
by the supervisor of the successful application of professional counseling knowledge, skills,
and values in the differential diagnosis and treatment of psychosocial function, disability,
or impairment, including addictions and emotional, mental, and behavioral disorders.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment and
applies to supervision requirements in effect on or after that date.
new text end
Sec. 3.
Minnesota Statutes 2020, section 148E.100, subdivision 3, is amended to read:
Subd. 3.
Types of supervision.
Of the 100 hours of supervision required under
subdivision 1:
(1) 50 hours must be provided through one-on-one supervisiondeleted text begin , including: (i) a minimum
of 25 hours of in-person supervision, and (ii) no more than 25 hours of supervisiondeleted text end new text begin . The
supervision must be provided either in person ornew text end via eye-to-eye electronic media, while
maintaining visual contactnew text begin . The board must allow a licensed social worker to satisfy the
supervision requirement of this clause with all required hours of supervision provided via
eye-to-eye electronic media, while maintaining visual contactnew text end ; and
(2) 50 hours must be provided through: (i) one-on-one supervision, or (ii) group
supervision. The supervision may be in person, by telephone, or via eye-to-eye electronic
media, while maintaining visual contact. The supervision must not be provided by e-mail.
Group supervision is limited to six supervisees.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment and
applies to supervision requirements in effect on or after that date.
new text end
Sec. 4.
Minnesota Statutes 2020, section 148E.105, subdivision 3, is amended to read:
Subd. 3.
Types of supervision.
Of the 100 hours of supervision required under
subdivision 1:
(1) 50 hours must be provided deleted text begin thoughdeleted text end new text begin throughnew text end one-on-one supervisiondeleted text begin , including: (i) a
minimum of 25 hours of in-person supervision, and (ii) no more than 25 hours of supervisiondeleted text end new text begin .
The supervision must be provided either in person ornew text end via eye-to-eye electronic media, while
maintaining visual contactnew text begin . The board must allow a licensed graduate social worker to satisfy
the supervision requirement of this clause with all required hours of supervision provided
via eye-to-eye electronic media, while maintaining visual contactnew text end ; and
(2) 50 hours must be provided through: (i) one-on-one supervision, or (ii) group
supervision. The supervision may be in person, by telephone, or via eye-to-eye electronic
media, while maintaining visual contact. The supervision must not be provided by e-mail.
Group supervision is limited to six supervisees.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment and
applies to supervision requirements in effect on or after that date.
new text end
Sec. 5.
Minnesota Statutes 2020, section 148E.106, subdivision 3, is amended to read:
Subd. 3.
Types of supervision.
Of the 200 hours of supervision required under
subdivision 1:
(1) 100 hours must be provided through one-on-one supervisiondeleted text begin , including: (i) a minimum
of 50 hours of in-person supervision, and (ii) no more than 50 hours of supervisiondeleted text end new text begin . The
supervision must be provided either in person ornew text end via eye-to-eye electronic media, while
maintaining visual contactnew text begin . The board must allow a licensed graduate social worker to satisfy
the supervision requirement of this clause with all required hours of supervision provided
via eye-to-eye electronic media, while maintaining visual contactnew text end ; and
(2) 100 hours must be provided through: (i) one-on-one supervision, or (ii) group
supervision. The supervision may be in person, by telephone, or via eye-to-eye electronic
media, while maintaining visual contact. The supervision must not be provided by e-mail.
Group supervision is limited to six supervisees.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment and
applies to supervision requirements in effect on or after that date.
new text end
Sec. 6.
Minnesota Statutes 2020, section 148E.110, subdivision 7, is amended to read:
Subd. 7.
Supervision; clinical social work practice after licensure as licensed
independent social worker.
Of the 200 hours of supervision required under subdivision
5:
(1) 100 hours must be provided through one-on-one supervisiondeleted text begin , including:deleted text end new text begin . The
supervision must be provided either in person or via eye-to-eye electronic media, while
maintaining visual contact. The board must allow a licensed independent social worker to
satisfy the supervision requirement of this clause with all required hours of supervision
provided via eye-to-eye electronic media, while maintaining visual contact; and
new text end
deleted text begin
(i) a minimum of 50 hours of in-person supervision; and
deleted text end
deleted text begin
(ii) no more than 50 hours of supervision via eye-to-eye electronic media, while
maintaining visual contact; and
deleted text end
(2) 100 hours must be provided through:
(i) one-on-one supervision; or
(ii) group supervision.
The supervision may be in person, by telephone, or via eye-to-eye electronic media, while
maintaining visual contact. The supervision must not be provided by e-mail. Group
supervision is limited to six supervisees.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment and
applies to supervision requirements in effect on or after that date.
new text end
Sec. 7.
Minnesota Statutes 2020, section 150A.06, subdivision 1c, is amended to read:
Subd. 1c.
Specialty dentists.
(a) The board may grant one or more specialty licenses in
the specialty areas of dentistry that are recognized by the Commission on Dental
Accreditation.
(b) An applicant for a specialty license shall:
(1) have successfully completed a postdoctoral specialty program accredited by the
Commission on Dental Accreditation, or have announced a limitation of practice before
1967;
(2) have been certified by a specialty board approved by the Minnesota Board of
Dentistry, or provide evidence of having passed a clinical examination for licensure required
for practice in any state or Canadian province, or in the case of oral and maxillofacial
surgeons only, have a Minnesota medical license in good standing;
(3) have been in active practice or a postdoctoral specialty education program or United
States government service at least 2,000 hours in the 36 months prior to applying for a
specialty license;
(4) if requested by the board, be interviewed by a committee of the board, which may
include the assistance of specialists in the evaluation process, and satisfactorily respond to
questions designed to determine the applicant's knowledge of dental subjects and ability to
practice;
(5) if requested by the board, present complete records on a sample of patients treated
by the applicant. The sample must be drawn from patients treated by the applicant during
the 36 months preceding the date of application. The number of records shall be established
by the board. The records shall be reasonably representative of the treatment typically
provided by the applicant for each specialty area;
(6) at board discretion, pass a board-approved English proficiency test if English is not
the applicant's primary language;
(7) pass all components of the National Board Dental Examinations;
(8) pass the Minnesota Board of Dentistry jurisprudence examination;
(9) abide by professional ethical conduct requirements; and
(10) meet all other requirements prescribed by the Board of Dentistry.
(c) The application must include:
(1) a completed application furnished by the board;
deleted text begin
(2) at least two character references from two different dentists for each specialty area,
one of whom must be a dentist practicing in the same specialty area, and the other from the
director of each specialty program attended;
deleted text end
deleted text begin
(3) a licensed physician's statement attesting to the applicant's physical and mental
condition;
deleted text end
deleted text begin
(4) a statement from a licensed ophthalmologist or optometrist attesting to the applicant's
visual acuity;
deleted text end
deleted text begin (5)deleted text end new text begin (2)new text end a nonrefundable fee; and
deleted text begin (6)deleted text end new text begin (3)new text end a deleted text begin notarized, unmounted passport-type photograph, three inches by three inches,
taken not more than six months before the date of applicationdeleted text end new text begin copy of the applicant's
government issued photo identification cardnew text end .
(d) A specialty dentist holding one or more specialty licenses is limited to practicing in
the dentist's designated specialty area or areas. The scope of practice must be defined by
each national specialty board recognized by the Commission on Dental Accreditation.
(e) A specialty dentist holding a general dental license is limited to practicing in the
dentist's designated specialty area or areas if the dentist has announced a limitation of
practice. The scope of practice must be defined by each national specialty board recognized
by the Commission on Dental Accreditation.
(f) All specialty dentists who have fulfilled the specialty dentist requirements and who
intend to limit their practice to a particular specialty area or areas may apply for one or more
specialty licenses.
Sec. 8.
Minnesota Statutes 2020, section 150A.06, subdivision 2c, is amended to read:
Subd. 2c.
Guest license.
(a) The board shall grant a guest license to practice as a dentist,
dental hygienist, or licensed dental assistant if the following conditions are met:
(1) the dentist, dental hygienist, or dental assistant is currently licensed in good standing
in another United States jurisdiction;
(2) the dentist, dental hygienist, or dental assistant is currently engaged in the practice
of that person's respective profession in another United States jurisdiction;
(3) the dentist, dental hygienist, or dental assistant will limit that person's practice to a
public health setting in Minnesota that (i) is approved by the board; (ii) was established by
a nonprofit organization that is tax exempt under chapter 501(c)(3) of the Internal Revenue
Code of 1986; and (iii) provides dental care to patients who have difficulty accessing dental
care;
(4) the dentist, dental hygienist, or dental assistant agrees to treat indigent patients who
meet the eligibility criteria established by the clinic; and
(5) the dentist, dental hygienist, or dental assistant has applied to the board for a guest
license and has paid a nonrefundable license fee to the board deleted text begin not to exceed $75deleted text end .
(b) A guest license must be renewed annually with the board and an annual renewal fee
deleted text begin not to exceed $75deleted text end must be paid to the board. Guest licenses expire on December 31 of each
year.
(c) A dentist, dental hygienist, or dental assistant practicing under a guest license under
this subdivision shall have the same obligations as a dentist, dental hygienist, or dental
assistant who is licensed in Minnesota and shall be subject to the laws and rules of Minnesota
and the regulatory authority of the board. If the board suspends or revokes the guest license
of, or otherwise disciplines, a dentist, dental hygienist, or dental assistant practicing under
this subdivision, the board shall promptly report such disciplinary action to the dentist's,
dental hygienist's, or dental assistant's regulatory board in the jurisdictions in which they
are licensed.
(d) The board may grant a guest license to a dentist, dental hygienist, or dental assistant
licensed in another United States jurisdiction to provide dental care to patients on a voluntary
basis without compensation for a limited period of time. The board shall not assess a fee
for the guest license for volunteer services issued under this paragraph.
new text begin (e) new text end The board shall issue a guest license for volunteer services if:
(1) the board determines that the applicant's services will provide dental care to patients
who have difficulty accessing dental care;
(2) the care will be provided without compensation; and
(3) the applicant provides adequate proof of the status of all licenses to practice in other
jurisdictions. The board may require such proof on an application form developed by the
board.
new text begin (f) new text end The guest license for volunteer services shall limit the licensee to providing dental
care services for a period of time not to exceed ten days in a calendar year. Guest licenses
expire on December 31 of each year.
new text begin (g) new text end The holder of a guest license for volunteer services shall be subject to state laws and
rules regarding dentistry and the regulatory authority of the board. The board may revoke
the license of a dentist, dental hygienist, or dental assistant practicing under this subdivision
or take other regulatory action against the dentist, dental hygienist, or dental assistant. If an
action is taken, the board shall report the action to the regulatory board of those jurisdictions
where an active license is held by the dentist, dental hygienist, or dental assistant.
Sec. 9.
Minnesota Statutes 2020, section 150A.06, subdivision 6, is amended to read:
Subd. 6.
Display of name and certificates.
(a) The renewal certificate of deleted text begin every dentist,
dental therapist, dental hygienist, or dental assistantdeleted text end new text begin every licensee or registrant new text end must be
conspicuously displayed in plain sight of patients in every office in which that person
practices. Duplicate renewal certificates may be obtained from the board.
(b) Near or on the entrance door to every office where dentistry is practiced, the name
of each dentist practicing there, as inscribed on the current license certificate, must be
displayed in plain sight.
(c) The board must allow the display of a mini-license for guest license holders
performing volunteer dental services. There is no fee for the mini-license for guest volunteers.
Sec. 10.
Minnesota Statutes 2020, section 150A.06, is amended by adding a subdivision
to read:
new text begin Subd. 12. new text end
new text begin Licensure by credentials for dental therapy. new text end
new text begin
(a) Any dental therapist may,
upon application and payment of a fee established by the board, apply for licensure based
on an evaluation of the applicant's education, experience, and performance record. The
applicant may be interviewed by the board to determine if the applicant:
new text end
new text begin
(1) graduated with a baccalaureate or master's degree from a dental therapy program
accredited by the Commission on Dental Accreditation;
new text end
new text begin
(2) provided evidence of successfully completing the board's jurisprudence examination;
new text end
new text begin
(3) actively practiced at least 2,000 hours within 36 months of the application date or
passed a board-approved reentry program within 36 months of the application date;
new text end
new text begin
(4) either:
new text end
new text begin
(i) is currently licensed in another state or Canadian province and not subject to any
pending or final disciplinary action; or
new text end
new text begin
(ii) was previously licensed in another state or Canadian province in good standing and
not subject to any final or pending disciplinary action at the time of surrender;
new text end
new text begin
(5) passed a board-approved English proficiency test if English is not the applicant's
primary language required at the board's discretion; and
new text end
new text begin
(6) met all curriculum equivalency requirements regarding dental therapy scope of
practice in Minnesota.
new text end
new text begin
(b) The 2,000 practice hours required by clause (3) may count toward the 2,000 practice
hours required for consideration for advanced dental therapy certification, provided that all
other requirements of section 150A.106, subdivision 1, are met.
new text end
new text begin
(c) The board, at its discretion, may waive specific licensure requirements in paragraph
(a).
new text end
new text begin
(d) The board must license an applicant who fulfills the conditions of this subdivision
and demonstrates the minimum knowledge in dental subjects required for licensure under
subdivision 1d to practice the applicant's profession.
new text end
new text begin
(e) The board must deny the application if the applicant does not demonstrate the
minimum knowledge in dental subjects required for licensure under subdivision 1d. If
licensure is denied, the board may notify the applicant of any specific remedy the applicant
could take to qualify for licensure. A denial does not prohibit the applicant from applying
for licensure under subdivision 1d.
new text end
new text begin
(e) A candidate may appeal a denied application to the board according to subdivision
4a.
new text end
Sec. 11.
Minnesota Statutes 2020, section 150A.09, is amended to read:
150A.09 deleted text begin REGISTRATION OFdeleted text end LICENSES deleted text begin ANDdeleted text end new text begin ORnew text end REGISTRATION
CERTIFICATES.
Subdivision 1.
Registration information and procedure.
On or before the license
certificate expiration date every deleted text begin licensed dentist, dental therapist, dental hygienist, and
dental assistantdeleted text end new text begin licensee or registrantnew text end shall deleted text begin transmit to the executive secretary of the board,
pertinent informationdeleted text end new text begin submit the renewalnew text end required by the board, together with thenew text begin applicablenew text end
fee deleted text begin established by the boarddeleted text end new text begin under section 150A.091new text end . At least 30 days before a license
certificate expiration date, the board shall send a written notice stating the amount and due
date of the fee deleted text begin and the information to be provided to every licensed dentist, dental therapist,
dental hygienist, and dental assistantdeleted text end .
Subd. 3.
Current address, change of address.
Every deleted text begin dentist, dental therapist, dental
hygienist, and dental assistantdeleted text end new text begin licensee or registrantnew text end shall maintain with the board a correct
and current mailing address and electronic mail address. For dentists engaged in the practice
of dentistry, the postal address shall be that of the location of the primary dental practice.
Within 30 days after changing postal or electronic mail addresses, every deleted text begin dentist, dental
therapist, dental hygienist, and dental assistantdeleted text end new text begin licensee or registrantnew text end shall provide the board
deleted text begin writtendeleted text end notice deleted text begin of the new address either personally or by first class maildeleted text end .
Subd. 4.
Duplicate certificates.
Duplicate licenses or duplicate certificates of deleted text begin licensedeleted text end
renewal may be issued by the board upon satisfactory proof of the need for the duplicates
and upon payment of the fee established by the board.
Subd. 5.
Late fee.
A late fee established by the board shall be paid if the deleted text begin information
anddeleted text end fee required by subdivision 1 is not received by deleted text begin the executive secretary ofdeleted text end the board on
or before the registration or deleted text begin licensedeleted text end renewal date.
Sec. 12.
Minnesota Statutes 2020, section 150A.091, subdivision 2, is amended to read:
Subd. 2.
Applicationnew text begin and initial license or registrationnew text end fees.
Each applicant shall
submit with a license, advanced dental therapist certificate, or permit application a
nonrefundable fee in the following amounts in order to administratively process an
application:
(1) dentist, deleted text begin $140deleted text end new text begin $308new text end ;
(2) full faculty dentist, deleted text begin $140deleted text end new text begin $308new text end ;
(3) limited faculty dentist, $140;
(4) resident dentist or dental provider, $55;
(5) advanced dental therapist, $100;
(6) dental therapist, deleted text begin $100deleted text end new text begin $220new text end ;
(7) dental hygienist, deleted text begin $55deleted text end new text begin $115new text end ;
(8) licensed dental assistant, deleted text begin $55; anddeleted text end new text begin $115;
new text end
(9) dental assistant with deleted text begin a permitdeleted text end new text begin registrationnew text end as described in Minnesota Rules, part
3100.8500, subpart 3, deleted text begin $15.deleted text end new text begin $27; and
new text end
new text begin
(10) guest license, $50.
new text end
Sec. 13.
Minnesota Statutes 2020, section 150A.091, subdivision 5, is amended to read:
Subd. 5.
Biennial license or deleted text begin permitdeleted text end new text begin registration renewalnew text end fees.
Each of the following
applicants shall submit with a biennial license or permit renewal application a fee as
established by the board, not to exceed the following amounts:
(1) dentist or full faculty dentist, $475;
(2) dental therapist, $300;
(3) dental hygienist, $200;
(4) licensed dental assistant, $150; and
(5) dental assistant with a deleted text begin permitdeleted text end new text begin registrationnew text end as described in Minnesota Rules, part
3100.8500, subpart 3, $24.
Sec. 14.
Minnesota Statutes 2020, section 150A.091, subdivision 8, is amended to read:
Subd. 8.
Duplicate license or certificate fee.
Each applicant shall submit, with a request
for issuance of a duplicate of the original license, or of an annual or biennial renewal
certificate for a license or permit, a fee in the following amounts:
(1) original dentist, full faculty dentist, dental therapist, dental hygiene, or dental assistant
license, $35;new text begin and
new text end
(2) annual or biennial renewal certificates, $10deleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(3) wallet-sized license and renewal certificate, $15.
deleted text end
Sec. 15.
Minnesota Statutes 2020, section 150A.091, subdivision 9, is amended to read:
Subd. 9.
Licensure by credentials.
Each applicant for licensure as a dentist, dental
hygienist, or dental assistant by credentials pursuant to section 150A.06, subdivisions 4 and
8, and Minnesota Rules, part 3100.1400, shall submit with the license application a fee in
the following amounts:
(1) dentist, deleted text begin $725deleted text end new text begin $893new text end ;
(2) dental hygienist, deleted text begin $175; anddeleted text end new text begin $235;
new text end
(3) dental assistant, deleted text begin $35.deleted text end new text begin $71; and
new text end
new text begin
(4) dental therapist, $340.
new text end
Sec. 16.
Minnesota Statutes 2020, section 150A.091, is amended by adding a subdivision
to read:
new text begin Subd. 21. new text end
new text begin Failure to practice with a current license. new text end
new text begin
(a) If a licensee practices without
a current license and pursues reinstatement, the board may take the following administrative
actions based on the length of time practicing without a current license:
new text end
new text begin
(1) for under one month, the board may not assess a penalty fee;
new text end
new text begin
(2) for one month to six months, the board may assess a penalty of $250;
new text end
new text begin
(3) for over six months, the board may assess a penalty of $500; and
new text end
new text begin
(4) for over 12 months, the board may assess a penalty of $1,000.
new text end
new text begin
(b) In addition to the penalty fee, the board shall initiate the complaint process against
the licensee for failure to practice with a current license for over 12 months.
new text end
Sec. 17.
Minnesota Statutes 2020, section 150A.091, is amended by adding a subdivision
to read:
new text begin Subd. 22. new text end
new text begin
Delegating regulated procedures to an individual with a terminated
license.
new text end
new text begin
(a) If a dentist or dental therapist delegates regulated procedures to another dental
professional who had their license terminated, the board may take the following
administrative actions against the delegating dentist or dental therapist based on the length
of time they delegated regulated procedures:
new text end
new text begin
(1) for under one month, the board may not assess a penalty fee;
new text end
new text begin
(2) for one month to six months, the board may assess a penalty of $100;
new text end
new text begin
(3) for over six months, the board may assess a penalty of $250; and
new text end
new text begin
(4) for over 12 months, the board may assess a penalty of $500.
new text end
new text begin
(b) In addition to the penalty fee, the board shall initiate the complaint process against
a dentist or dental therapist who delegated regulated procedures to a dental professional
with a terminated license for over 12 months.
new text end
Sec. 18.
Minnesota Statutes 2020, section 151.01, subdivision 27, is amended to read:
Subd. 27.
Practice of pharmacy.
"Practice of pharmacy" means:
(1) interpretation and evaluation of prescription drug orders;
(2) compounding, labeling, and dispensing drugs and devices (except labeling by a
manufacturer or packager of nonprescription drugs or commercially packaged legend drugs
and devices);
(3) participation in clinical interpretations and monitoring of drug therapy for assurance
of safe and effective use of drugs, including the performance of laboratory tests that are
waived under the federal Clinical Laboratory Improvement Act of 1988, United States Code,
title 42, section 263a et seq., provided that a pharmacist may interpret the results of laboratory
tests but may modify drug therapy only pursuant to a protocol or collaborative practice
agreement;
(4) participation in drug and therapeutic device selection; drug administration for first
dosage and medical emergencies; intramuscular and subcutaneous new text begin drug new text end administration deleted text begin used
for the treatment of alcohol or opioid dependencedeleted text end new text begin under a prescription drug ordernew text end ; drug
regimen reviews; and drug or drug-related research;
(5) drug administration, through intramuscular and subcutaneous administration used
to treat mental illnesses as permitted under the following conditions:
(i) upon the order of a prescriber and the prescriber is notified after administration is
complete; or
(ii) pursuant to a protocol or collaborative practice agreement as defined by section
151.01, subdivisions 27b and 27c, and participation in the initiation, management,
modification, administration, and discontinuation of drug therapy is according to the protocol
or collaborative practice agreement between the pharmacist and a dentist, optometrist,
physician, podiatrist, or veterinarian, or an advanced practice registered nurse authorized
to prescribe, dispense, and administer under section 148.235. Any changes in drug therapy
or medication administration made pursuant to a protocol or collaborative practice agreement
must be documented by the pharmacist in the patient's medical record or reported by the
pharmacist to a practitioner responsible for the patient's care;
(6) participation in administration of influenza vaccines and vaccines approved by the
United States Food and Drug Administration related to COVID-19 or SARS-CoV-2 to all
eligible individuals six years of age and older and all other vaccines to patients 13 years of
age and older by written protocol with a physician licensed under chapter 147, a physician
assistant authorized to prescribe drugs under chapter 147A, or an advanced practice registered
nurse authorized to prescribe drugs under section 148.235, provided that:
(i) the protocol includes, at a minimum:
(A) the name, dose, and route of each vaccine that may be given;
(B) the patient population for whom the vaccine may be given;
(C) contraindications and precautions to the vaccine;
(D) the procedure for handling an adverse reaction;
(E) the name, signature, and address of the physician, physician assistant, or advanced
practice registered nurse;
(F) a telephone number at which the physician, physician assistant, or advanced practice
registered nurse can be contacted; and
(G) the date and time period for which the protocol is valid;
(ii) the pharmacist has successfully completed a program approved by the Accreditation
Council for Pharmacy Education specifically for the administration of immunizations or a
program approved by the board;
(iii) the pharmacist utilizes the Minnesota Immunization Information Connection to
assess the immunization status of individuals prior to the administration of vaccines, except
when administering influenza vaccines to individuals age nine and older;
(iv) the pharmacist reports the administration of the immunization to the Minnesota
Immunization Information Connection; and
(v) the pharmacist complies with guidelines for vaccines and immunizations established
by the federal Advisory Committee on Immunization Practices, except that a pharmacist
does not need to comply with those portions of the guidelines that establish immunization
schedules when administering a vaccine pursuant to a valid, patient-specific order issued
by a physician licensed under chapter 147, a physician assistant authorized to prescribe
drugs under chapter 147A, or an advanced practice registered nurse authorized to prescribe
drugs under section 148.235, provided that the order is consistent with the United States
Food and Drug Administration approved labeling of the vaccine;
(7) participation in the initiation, management, modification, and discontinuation of
drug therapy according to a written protocol or collaborative practice agreement between:
(i) one or more pharmacists and one or more dentists, optometrists, physicians, podiatrists,
or veterinarians; or (ii) one or more pharmacists and one or more physician assistants
authorized to prescribe, dispense, and administer under chapter 147A, or advanced practice
registered nurses authorized to prescribe, dispense, and administer under section 148.235.
Any changes in drug therapy made pursuant to a protocol or collaborative practice agreement
must be documented by the pharmacist in the patient's medical record or reported by the
pharmacist to a practitioner responsible for the patient's care;
(8) participation in the storage of drugs and the maintenance of records;
(9) patient counseling on therapeutic values, content, hazards, and uses of drugs and
devices;
(10) offering or performing those acts, services, operations, or transactions necessary
in the conduct, operation, management, and control of a pharmacy;
(11) participation in the initiation, management, modification, and discontinuation of
therapy with opiate antagonists, as defined in section 604A.04, subdivision 1, pursuant to:
(i) a written protocol as allowed under clause (7); or
(ii) a written protocol with a community health board medical consultant or a practitioner
designated by the commissioner of health, as allowed under section 151.37, subdivision 13;
deleted text begin and
deleted text end
(12) prescribing self-administered hormonal contraceptives; nicotine replacement
medications; and opiate antagonists for the treatment of an acute opiate overdose pursuant
to section 151.37, subdivision 14, 15, or 16deleted text begin .deleted text end new text begin ; and
new text end
new text begin
(13) participation in the placement of drug monitoring devices according to a prescription,
protocol, or collaborative practice agreement.
new text end
Sec. 19.
Minnesota Statutes 2020, section 153.16, subdivision 1, is amended to read:
Subdivision 1.
License requirements.
The board shall issue a license to practice podiatric
medicine to a person who meets the following requirements:
(a) The applicant for a license shall file a written notarized application on forms provided
by the board, showing to the board's satisfaction that the applicant is of good moral character
and satisfies the requirements of this section.
(b) The applicant shall present evidence satisfactory to the board of being a graduate of
a podiatric medical school approved by the board based upon its faculty, curriculum, facilities,
accreditation by a recognized national accrediting organization approved by the board, and
other relevant factors.
(c) The applicant must have received a passing score on each part of the national board
examinations, parts one and two, prepared and graded by the National Board of Podiatric
Medical Examiners. The passing score for each part of the national board examinations,
parts one and two, is as defined by the National Board of Podiatric Medical Examiners.
(d) Applicants graduating after deleted text begin 1986deleted text end new text begin 1990new text end from a podiatric medical school shall present
evidence of successful completion of a residency program approved by a national accrediting
podiatric medicine organization.
(e) The applicant shall appear in person before the board or its designated representative
to show that the applicant satisfies the requirements of this section, including knowledge
of laws, rules, and ethics pertaining to the practice of podiatric medicine. The board may
establish as internal operating procedures the procedures or requirements for the applicant's
personal presentation. Upon completion of all other application requirements, a doctor of
podiatric medicine applying for a temporary military license has six months in which to
comply with this subdivision.
(f) The applicant shall pay a fee established by the board by rule. The fee shall not be
refunded.
(g) The applicant must not have engaged in conduct warranting disciplinary action
against a licensee. If the applicant does not satisfy the requirements of this paragraph, the
board may refuse to issue a license unless it determines that the public will be protected
through issuance of a license with conditions and limitations the board considers appropriate.
(h) Upon payment of a fee as the board may require, an applicant who fails to pass an
examination and is refused a license is entitled to reexamination within one year of the
board's refusal to issue the license. No more than two reexaminations are allowed without
a new application for a license.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 20. new text begin TEMPORARY REQUIREMENTS GOVERNING AMBULANCE SERVICE
OPERATIONS AND THE PROVISION OF EMERGENCY MEDICAL SERVICES.
new text end
new text begin Subdivision 1. new text end
new text begin Application. new text end
new text begin
Notwithstanding any law to the contrary in Minnesota
Statutes, chapter 144E, an ambulance service may operate according to this section, and
emergency medical technicians, advanced emergency medical technicians, and paramedics
may provide emergency medical services according to this section.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) The terms defined in this subdivision apply to this section.
new text end
new text begin
(b) "Advanced emergency medical technician" has the meaning given in Minnesota
Statutes, section 144E.001, subdivision 5d.
new text end
new text begin
(c) "Advanced life support" has the meaning given in Minnesota Statutes, section
144E.001, subdivision 1b.
new text end
new text begin
(d) "Ambulance" has the meaning given in Minnesota Statutes, section 144E.001,
subdivision 2.
new text end
new text begin
(e) "Ambulance service personnel" has the meaning given in Minnesota Statutes, section
144E.001, subdivision 3a.
new text end
new text begin
(f) "Basic life support" has the meaning given in Minnesota Statutes, section 144E.001,
subdivision 4b.
new text end
new text begin
(g) "Board" means the Emergency Medical Services Regulatory Board.
new text end
new text begin
(h) "Emergency medical technician" has the meaning given in Minnesota Statutes, section
144E.001, subdivision 5c.
new text end
new text begin
(i) "Paramedic" has the meaning given in Minnesota Statutes, section 144E.001,
subdivision 5e.
new text end
new text begin
(j) "Primary service area" means the area designated by the board according to Minnesota
Statutes, section 144E.06, to be served by an ambulance service.
new text end
new text begin Subd. 3. new text end
new text begin Staffing. new text end
new text begin
(a) For emergency ambulance calls in an ambulance service's primary
service area, an ambulance service must staff an ambulance that provides basic life support
with at least:
new text end
new text begin
(1) one emergency medical technician, who must be in the patient compartment when
a patient is being transported; and
new text end
new text begin
(2) one individual to drive the ambulance. The driver must hold a valid driver's license
from any state, must have attended an emergency vehicle driving course approved by the
ambulance service, and must have completed a course on cardiopulmonary resuscitation
approved by the ambulance service.
new text end
new text begin
(b) For emergency ambulance calls in an ambulance service's primary service area, an
ambulance service must staff an ambulance that provides advanced life support with at least:
new text end
new text begin
(1) one paramedic; one registered nurse who meets the requirements in Minnesota
Statutes, section 144E.001, subdivision 3a, clause (2); or one physician assistant who meets
the requirements in Minnesota Statutes, section 144E.001, subdivision 3a, clause (3), and
who must be in the patient compartment when a patient is being transported; and
new text end
new text begin
(2) one individual to drive the ambulance. The driver must hold a valid driver's license
from any state, must have attended an emergency vehicle driving course approved by the
ambulance service, and must have completed a course on cardiopulmonary resuscitation
approved by the ambulance service.
new text end
new text begin
(c) The ambulance service director and medical director must approve the staffing of
an ambulance according to this subdivision.
new text end
new text begin
(d) An ambulance service staffing an ambulance according to this subdivision must
immediately notify the board in writing and in a manner prescribed by the board. The notice
must specify how the ambulance service is staffing its basic life support or advanced life
support ambulances and the time period the ambulance service plans to staff the ambulances
according to this subdivision. If an ambulance service continues to staff an ambulance
according to this subdivision after the date provided to the board in its initial notice, the
ambulance service must provide a new notice to the board in a manner that complies with
this paragraph.
new text end
new text begin
(e) If an individual serving as a driver under this subdivision commits an act listed in
Minnesota Statutes, section 144E.27, subdivision 5, paragraph (a), the board may temporarily
suspend or prohibit the individual from driving an ambulance or place conditions on the
individual's ability to drive an ambulance using the procedures and authority in Minnesota
Statutes, section 144E.27, subdivisions 5 and 6.
new text end
new text begin Subd. 4. new text end
new text begin Use of expired emergency medications and medical supplies. new text end
new text begin
(a) If an
ambulance service experiences a shortage of an emergency medication or medical supply,
ambulance service personnel may use an emergency medication or medical supply for up
to six months after the emergency medication's or medical supply's specified expiration
date, provided:
new text end
new text begin
(1) the ambulance service director and medical director approve the use of the expired
emergency medication or medical supply;
new text end
new text begin
(2) ambulance service personnel use an expired emergency medication or medical supply
only after depleting the ambulance service's supply of that emergency medication or medical
supply that is unexpired;
new text end
new text begin
(3) the ambulance service has stored and maintained the expired emergency medication
or medical supply according to the manufacturer's instructions;
new text end
new text begin
(4) if possible, ambulance service personnel obtain consent from the patient to use the
expired emergency medication or medical supply prior to its use; and
new text end
new text begin
(5) when the ambulance service obtains a supply of that emergency medication or medical
supply that is unexpired, ambulance service personnel cease use of the expired emergency
medication or medical supply and instead use the unexpired emergency medication or
medical supply.
new text end
new text begin
(b) Before approving the use of an expired emergency medication, an ambulance service
director and medical director must consult with the Board of Pharmacy regarding the safety
and efficacy of using the expired emergency medication.
new text end
new text begin
(c) An ambulance service must keep a record of all expired emergency medications and
all expired medical supplies used and must submit that record in writing to the board in a
time and manner specified by the board. The record must list the specific expired emergency
medications and medical supplies used and the time period during which ambulance service
personnel used the expired emergency medication or medical supply.
new text end
new text begin Subd. 5. new text end
new text begin Provision of emergency medical services after certification expires. new text end
new text begin
(a) At
the request of an emergency medical technician, advanced emergency medical technician,
or paramedic, and with the approval of the ambulance service director, an ambulance service
medical director may authorize the emergency medical technician, advanced emergency
medical technician, or paramedic to provide emergency medical services for the ambulance
service for up to three months after the certification of the emergency medical technician,
advanced emergency medical technician, or paramedic expires.
new text end
new text begin
(b) An ambulance service must immediately notify the board each time its medical
director issues an authorization under paragraph (a). The notice must be provided in writing
and in a manner prescribed by the board and must include information on the time period
each emergency medical technician, advanced emergency medical technician, or paramedic
will provide emergency medical services according to an authorization under this subdivision;
information on why the emergency medical technician, advanced emergency medical
technician, or paramedic needs the authorization; and an attestation from the medical director
that the authorization is necessary to help the ambulance service adequately staff its
ambulances.
new text end
new text begin Subd. 6. new text end
new text begin Reports. new text end
new text begin
The board must provide quarterly reports to the chairs and ranking
minority members of the legislative committees with jurisdiction over the board regarding
actions taken by ambulance services according to subdivisions 3, 4, and 5. The board must
submit reports by June 30, September 30, and December 31 of 2022; and by March 31, June
30, September 30, and December 31 of 2023. Each report must include the following
information:
new text end
new text begin
(1) for each ambulance service staffing basic life support or advanced life support
ambulances according to subdivision 3, the primary service area served by the ambulance
service, the number of ambulances staffed according to subdivision 3, and the time period
the ambulance service has staffed and plans to staff the ambulances according to subdivision
3;
new text end
new text begin
(2) for each ambulance service that authorized the use of an expired emergency
medication or medical supply according to subdivision 4, the expired emergency medications
and medical supplies authorized for use and the time period the ambulance service used
each expired emergency medication or medical supply; and
new text end
new text begin
(3) for each ambulance service that authorized the provision of emergency medical
services according to subdivision 5, the number of emergency medical technicians, advanced
emergency medical technicians, and paramedics providing emergency medical services
under an expired certification and the time period each emergency medical technician,
advanced emergency medical technician, or paramedic provided and will provide emergency
medical services under an expired certification.
new text end
new text begin Subd. 7. new text end
new text begin Expiration. new text end
new text begin
This section expires January 1, 2024.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 21. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2020, section 150A.091, subdivisions 3, 15, and 17,
new text end
new text begin
are repealed.
new text end
ARTICLE 6
PRESCRIPTION DRUGS
Section 1.
Minnesota Statutes 2020, section 62A.02, subdivision 1, is amended to read:
Subdivision 1.
Filing.
For purposes of this section, "health plan" means a health plan
as defined in section 62A.011 or a policy of accident and sickness insurance as defined in
section 62A.01. No health plan shall be issued or delivered to any person in this state, nor
shall any application, rider, or endorsement be used in connection with the health plan, until
a copy of its form and of the classification of risks and the premium rates pertaining to the
form have been filed with the commissioner. new text begin The filing must include the health plan's
prescription drug formulary. Proposed revisions to the health plan's prescription drug
formulary must be filed with the commissioner no later than August 1 of the application
year. new text end The filing for nongroup health plan forms shall include a statement of actuarial reasons
and data to support the rate. For health benefit plans as defined in section 62L.02, and for
health plans to be issued to individuals, the health carrier shall file with the commissioner
the information required in section 62L.08, subdivision 8. For group health plans for which
approval is sought for sales only outside of the small employer market as defined in section
62L.02, this section applies only to policies or contracts of accident and sickness insurance.
All forms intended for issuance in the individual or small employer market must be
accompanied by a statement as to the expected loss ratio for the form. Premium rates and
forms relating to specific insureds or proposed insureds, whether individuals or groups,
need not be filed, unless requested by the commissioner.
Sec. 2.
Minnesota Statutes 2021 Supplement, section 62J.497, subdivision 1, is amended
to read:
Subdivision 1.
Definitions.
(a) For the purposes of this section, the following terms have
the meanings given.
(b) "Dispense" or "dispensing" has the meaning given in section 151.01, subdivision
30. Dispensing does not include the direct administering of a controlled substance to a
patient by a licensed health care professional.
(c) "Dispenser" means a person authorized by law to dispense a controlled substance,
pursuant to a valid prescription.
(d) "Electronic media" has the meaning given under Code of Federal Regulations, title
45, part 160.103.
(e) "E-prescribing" means the transmission using electronic media of prescription or
prescription-related information between a prescriber, dispenser, pharmacy benefit manager,
or group purchaser, either directly or through an intermediary, including an e-prescribing
network. E-prescribing includes, but is not limited to, two-way transmissions between the
point of care and the dispenser and two-way transmissions related to eligibility, formulary,
and medication history information.
(f) "Electronic prescription drug program" means a program that provides for
e-prescribing.
(g) "Group purchaser" has the meaning given in section 62J.03, subdivision 6.
(h) "HL7 messages" means a standard approved by the standards development
organization known as Health Level Seven.
(i) "National Provider Identifier" or "NPI" means the identifier described under Code
of Federal Regulations, title 45, part 162.406.
(j) "NCPDP" means the National Council for Prescription Drug Programs, Inc.
(k) "NCPDP Formulary and Benefits Standard" means the most recent version of the
National Council for Prescription Drug Programs Formulary and Benefits Standard or the
most recent standard adopted by the Centers for Medicare and Medicaid Services for
e-prescribing under Medicare Part D as required by section 1860D-4(e)(4)(D) of the Social
Security Act and regulations adopted under it. The standards shall be implemented according
to the Centers for Medicare and Medicaid Services schedule for compliance.
new text begin
(l) "NCPDP Real-Time Prescription Benefit Standard" means the most recent National
Council for Prescription Drug Programs Real-Time Prescription Benefit Standard adopted
by the Centers for Medicare and Medicaid Services for e-prescribing under Medicare Part
D as required by section 1860D-4(e)(2) of the Social Security Act and regulations adopted
under it.
new text end
deleted text begin (l)deleted text end new text begin (m)new text end "NCPDP SCRIPT Standard" means the most recent version of the National
Council for Prescription Drug Programs SCRIPT Standard, or the most recent standard
adopted by the Centers for Medicare and Medicaid Services for e-prescribing under Medicare
Part D as required by section 1860D-4(e)(4)(D) of the Social Security Act, and regulations
adopted under it. The standards shall be implemented according to the Centers for Medicare
and Medicaid Services schedule for compliance.
deleted text begin (m)deleted text end new text begin (n)new text end "Pharmacy" has the meaning given in section 151.01, subdivision 2.
new text begin
(o) "Pharmacy benefit manager" has the meaning given in section 62W.02, subdivision
15.
new text end
deleted text begin (n)deleted text end new text begin (p)new text end "Prescriber" means a licensed health care practitioner, other than a veterinarian,
as defined in section 151.01, subdivision 23.
deleted text begin (o)deleted text end new text begin (q)new text end "Prescription-related information" means information regarding eligibility for
drug benefits, medication history, or related health or drug information.
deleted text begin (p)deleted text end new text begin (r)new text end "Provider" or "health care provider" has the meaning given in section 62J.03,
subdivision 8.
new text begin
(s) "Real-time prescription benefit tool" means a tool that is capable of being integrated
into a prescriber's e-prescribing system and that provides a prescriber with up-to-date and
patient-specific formulary and benefit information at the time the prescriber submits a
prescription.
new text end
Sec. 3.
Minnesota Statutes 2021 Supplement, section 62J.497, subdivision 3, is amended
to read:
Subd. 3.
Standards for electronic prescribing.
(a) Prescribers and dispensers must use
the NCPDP SCRIPT Standard for the communication of a prescription or prescription-related
information.
(b) Providers, group purchasers, prescribers, and dispensers must use the NCPDP SCRIPT
Standard for communicating and transmitting medication history information.
(c) Providers, group purchasers, prescribers, and dispensers must use the NCPDP
Formulary and Benefits Standard for communicating and transmitting formulary and benefit
information.
(d) Providers, group purchasers, prescribers, and dispensers must use the national provider
identifier to identify a health care provider in e-prescribing or prescription-related transactions
when a health care provider's identifier is required.
(e) Providers, group purchasers, prescribers, and dispensers must communicate eligibility
information and conduct health care eligibility benefit inquiry and response transactions
according to the requirements of section 62J.536.
new text begin
(f) Group purchasers and pharmacy benefit managers must use a real-time prescription
benefit tool that complies with the NCPDP Real-Time Prescription Benefit Standard and
that, at a minimum, notifies a prescriber:
new text end
new text begin
(1) if a prescribed drug is covered by the patient's group purchaser or pharmacy benefit
manager;
new text end
new text begin
(2) if a prescribed drug is included on the formulary or preferred drug list of the patient's
group purchaser or pharmacy benefit manager;
new text end
new text begin
(3) of any patient cost-sharing for the prescribed drug;
new text end
new text begin
(4) if prior authorization is required for the prescribed drug; and
new text end
new text begin
(5) of a list of any available alternative drugs that are in the same class as the drug
originally prescribed and for which prior authorization is not required.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 4.
Minnesota Statutes 2020, section 62J.84, as amended by Laws 2021, chapter 30,
article 3, sections 5 to 9, is amended to read:
62J.84 PRESCRIPTION DRUG PRICE TRANSPARENCY.
Subdivision 1.
Short title.
This section may be cited as the "Prescription Drug Price
Transparency Act."
Subd. 2.
Definitions.
(a) For purposes of this section, the terms defined in this subdivision
have the meanings given.
(b) "Biosimilar" means a drug that is produced or distributed pursuant to a biologics
license application approved under United States Code, title 42, section 262(K)(3).
(c) "Brand name drug" means a drug that is produced or distributed pursuant to:
(1) an original, new drug application approved under United States Code, title 21, section
355(c), except for a generic drug as defined under Code of Federal Regulations, title 42,
section 447.502; or
(2) a biologics license application approved under United States Code, title deleted text begin 45deleted text end new text begin 42new text end , section
262(a)(c).
(d) "Commissioner" means the commissioner of health.
new text begin
(e) "Course of treatment" means the total dosage of a single prescription for a prescription
drug recommended by the Food and Drug Administration (FDA)-approved prescribing
label. If the FDA-approved prescribing label includes more than one recommended dosage
for a single course of treatment, the course of treatment is the maximum recommended
dosage on the FDA-approved prescribing label.
new text end
deleted text begin (e)deleted text end new text begin (f)new text end "Generic drug" means a drug that is marketed or distributed pursuant to:
(1) an abbreviated new drug application approved under United States Code, title 21,
section 355(j);
(2) an authorized generic as defined under Code of Federal Regulations, title deleted text begin 45deleted text end new text begin 42new text end ,
section 447.502; or
(3) a drug that entered the market the year before 1962 and was not originally marketed
under a new drug application.
deleted text begin (f)deleted text end new text begin (g)new text end "Manufacturer" means a drug manufacturer licensed under section 151.252.
new text begin
(h) "National Drug Code" means the three-segment code maintained by the FDA that
includes a labeler code, a product code, and a package code for a drug product and that has
been converted to an 11-digit format consisting of five digits in the first segment, four digits
in the second segment, and two digits in the third segment. A three-segment code shall be
considered converted to an 11-digit format when, as necessary, at least one "0" has been
added to the front of each segment containing less than the specified number of digits so
that each segment contains the specified number of digits.
new text end
deleted text begin (g)deleted text end new text begin (i)new text end "New prescription drug" or "new drug" means a prescription drug approved for
marketing by the United States Food and Drug Administration for which no previous
wholesale acquisition cost has been established for comparison.
deleted text begin (h)deleted text end new text begin (j)new text end "Patient assistance program" means a program that a manufacturer offers to the
public in which a consumer may reduce the consumer's out-of-pocket costs for prescription
drugs by using coupons, discount cards, prepaid gift cards, manufacturer debit cards, or by
other means.
deleted text begin (i)deleted text end new text begin (k)new text end "Prescription drug" or "drug" has the meaning provided in section 151.441,
subdivision 8.
deleted text begin (j)deleted text end new text begin (l)new text end "Price" means the wholesale acquisition cost as defined in United States Code,
title 42, section 1395w-3a(c)(6)(B).
new text begin
(m) "Rebate" means a discount, chargeback, or other price concession that affects the
price of a prescription drug product, regardless of whether conferred through regular
aggregate payments, on a claim-by-claim basis at the point of sale, as part of retrospective
financial reconciliations including reconciliations that also reflect other contractual
arrangements, or by any other method. Rebate does not mean a bona fide service fee, as the
term is defined in Code of Federal Regulations, title 42, section 447.502.
new text end
new text begin
(n) "30-day supply" means the total daily dosage units of a prescription drug
recommended by the prescribing label approved by the FDA for 30 days. If the
FDA-approved prescribing label includes more than one recommended daily dosage, the
30-day supply is based on the maximum recommended daily dosage on the FDA-approved
prescribing label.
new text end
Subd. 3.
Prescription drug price increases reporting.
(a) Beginning January 1, 2022,
a drug manufacturer must submit to the commissioner the information described in paragraph
(b) for each prescription drug for which the price was $100 or greater for a 30-day supply
or for a course of treatment lasting less than 30 days and:
(1) for brand name drugs where there is an increase of ten percent or greater in the price
over the previous 12-month period or an increase of 16 percent or greater in the price over
the previous 24-month period; and
(2) for generic new text begin or biosimilar new text end drugs where there is an increase of 50 percent or greater in
the price over the previous 12-month period.
(b) For each of the drugs described in paragraph (a), the manufacturer shall submit to
the commissioner no later than 60 days after the price increase goes into effect, in the form
and manner prescribed by the commissioner, the following information, if applicable:
(1) the namenew text begin , description,new text end and price of the drug and the net increase, expressed as a
percentagedeleted text begin ;deleted text end new text begin , with the following listed separately:
new text end
new text begin
(i) National Drug Code;
new text end
new text begin
(ii) product name;
new text end
new text begin
(iii) dosage form;
new text end
new text begin
(iv) strength; and
new text end
new text begin
(v) package size;
new text end
(2) the factors that contributed to the price increase;
(3) the name of any generic version of the prescription drug available on the market;
(4) the introductory price of the prescription drug new text begin when it was introduced for sale in the
United States and the price of the drug on the last day of each of the five calendar years
preceding the price increase new text end when it was approved for marketing by the Food and Drug
Administration and the net yearly increase, by calendar year, in the price of the prescription
drug during the previous five years;
(5) the direct costs incurred new text begin during the previous 12-month period new text end by the manufacturer
that are associated with the prescription drug, listed separately:
(i) to manufacture the prescription drug;
(ii) to market the prescription drug, including advertising costs; and
(iii) to distribute the prescription drug;
new text begin
(6) the number of units of the prescription drug sold during the previous 12-month period;
new text end
new text begin
(7) the total rebate payable amount accrued for the prescription drug during the previous
12-month period;
new text end
deleted text begin (6)deleted text end new text begin (8)new text end the total sales revenue for the prescription drug during the previous 12-month
period;
deleted text begin (7)deleted text end new text begin (9)new text end the manufacturer's net profit attributable to the prescription drug during the
previous 12-month period;
deleted text begin (8)deleted text end new text begin (10)new text end the total amount of financial assistance the manufacturer has provided through
patient prescription assistance programsnew text begin during the previous 12-month periodnew text end , if applicable;
deleted text begin (9)deleted text end new text begin (11)new text end any agreement between a manufacturer and another entity contingent upon any
delay in offering to market a generic version of the prescription drug;
deleted text begin (10)deleted text end new text begin (12)new text end the patent expiration date of the prescription drug if it is under patent;
deleted text begin (11)deleted text end new text begin (13)new text end the name and location of the company that manufactured the drug; deleted text begin and
deleted text end
deleted text begin (12)deleted text end new text begin (14)new text end if a brand name prescription drug, the ten highest prices paid for the prescription
drug during the previous calendar year in deleted text begin any country other thandeleted text end new text begin the ten countries, excluding new text end
the United Statesdeleted text begin .deleted text end new text begin , that charged the highest single price for the prescription drug; and
new text end
new text begin
(15) if the prescription drug was acquired by the manufacturer during the previous
12-month period, all of the following information:
new text end
new text begin
(i) price at acquisition;
new text end
new text begin
(ii) price in the calendar year prior to acquisition;
new text end
new text begin
(iii) name of the company from which the drug was acquired;
new text end
new text begin
(iv) date of acquisition; and
new text end
new text begin
(v) acquisition price.
new text end
(c) The manufacturer may submit any documentation necessary to support the information
reported under this subdivision.
Subd. 4.
New prescription drug price reporting.
(a) Beginning January 1, 2022, no
later than 60 days after a manufacturer introduces a new prescription drug for sale in the
United States that is a new brand name drug with a price that is greater than the tier threshold
established by the Centers for Medicare and Medicaid Services for specialty drugs in the
Medicare Part D program for a 30-day supply new text begin or for a course of treatment lasting less than
30 days new text end or a new generic or biosimilar drug with a price that is greater than the tier threshold
established by the Centers for Medicare and Medicaid Services for specialty drugs in the
Medicare Part D program for a 30-day supply new text begin or for a course of treatment lasting less than
30 days new text end and is not at least 15 percent lower than the referenced brand name drug when the
generic or biosimilar drug is launched, the manufacturer must submit to the commissioner,
in the form and manner prescribed by the commissioner, the following information, if
applicable:
new text begin
(1) the description of the drug, with the following listed separately:
new text end
new text begin
(i) National Drug Code;
new text end
new text begin
(ii) product name;
new text end
new text begin
(iii) dosage form;
new text end
new text begin
(iv) strength; and
new text end
new text begin
(v) package size
new text end
deleted text begin (1)deleted text end new text begin (2)new text end the price of the prescription drug;
deleted text begin (2)deleted text end new text begin (3)new text end whether the Food and Drug Administration granted the new prescription drug a
breakthrough therapy designation or a priority review;
deleted text begin (3)deleted text end new text begin (4)new text end the direct costs incurred by the manufacturer that are associated with the
prescription drug, listed separately:
(i) to manufacture the prescription drug;
(ii) to market the prescription drug, including advertising costs; and
(iii) to distribute the prescription drug; and
deleted text begin (4)deleted text end new text begin (5)new text end the patent expiration date of the drug if it is under patent.
(b) The manufacturer may submit documentation necessary to support the information
reported under this subdivision.
Subd. 5.
Newly acquired prescription drug price reporting.
(a) Beginning January
1, 2022, the acquiring drug manufacturer must submit to the commissioner the information
described in paragraph (b) for each newly acquired prescription drug for which the price
was $100 or greater for a 30-day supply or for a course of treatment lasting less than 30
days and:
(1) for a newly acquired brand name drug where there is an increase of ten percent or
greater in the price over the previous 12-month period or an increase of 16 percent or greater
in price over the previous 24-month period; and
(2) for a newly acquired generic new text begin or biosimilarnew text end drug where there is an increase of 50
percent or greater in the price over the previous 12-month period.
(b) For each of the drugs described in paragraph (a), the acquiring manufacturer shall
submit to the commissioner no later than 60 days after the acquiring manufacturer begins
to sell the newly acquired drug, in the form and manner prescribed by the commissioner,
the following information, if applicable:
new text begin
(1) the description of the drug, with the following listed separately:
new text end
new text begin
(i) National Drug Code;
new text end
new text begin
(ii) product name;
new text end
new text begin
(iii) dosage form;
new text end
new text begin
(iv) strength; and
new text end
new text begin
(v) package size
new text end
deleted text begin (1)deleted text end new text begin (2)new text end the price of the prescription drug at the time of acquisition and in the calendar
year prior to acquisition;
deleted text begin (2)deleted text end new text begin (3)new text end the name of the company from which the prescription drug was acquired, the
date acquired, and the purchase price;
deleted text begin (3)deleted text end new text begin (4)new text end the year the prescription drug was introduced to market and the price of the
prescription drug at the time of introduction;
deleted text begin (4)deleted text end new text begin (5)new text end the price of the prescription drug for the previous five years;
deleted text begin (5)deleted text end new text begin (6)new text end any agreement between a manufacturer and another entity contingent upon any
delay in offering to market a generic version of the manufacturer's drug; and
deleted text begin (6)deleted text end new text begin (7)new text end the patent expiration date of the drug if it is under patent.
(c) The manufacturer may submit any documentation necessary to support the information
reported under this subdivision.
Subd. 6.
Public posting of prescription drug price information.
(a) The commissioner
shall post on the department's website, or may contract with a private entity or consortium
that satisfies the standards of section 62U.04, subdivision 6, to meet this requirement, the
following information:
(1) a list of the prescription drugs reported under subdivisions 3, 4, and 5, and the
manufacturers of those prescription drugs; and
(2) information reported to the commissioner under subdivisions 3, 4, and 5.
(b) The information must be published in an easy-to-read format and in a manner that
identifies the information that is disclosed on a per-drug basis and must not be aggregated
in a manner that prevents the identification of the prescription drug.
(c) The commissioner shall not post to the department's website or a private entity
contracting with the commissioner shall not post any information described in this section
if the information is not public data under section 13.02, subdivision 8a; or is trade secret
information under section 13.37, subdivision 1, paragraph (b); or is trade secret information
pursuant to the Defend Trade Secrets Act of 2016, United States Code, title 18, section
1836, as amended. If a manufacturer believes information should be withheld from public
disclosure pursuant to this paragraph, the manufacturer must clearly and specifically identify
that information and describe the legal basis in writing when the manufacturer submits the
information under this section. If the commissioner disagrees with the manufacturer's request
to withhold information from public disclosure, the commissioner shall provide the
manufacturer written notice that the information will be publicly posted 30 days after the
date of the notice.
(d) If the commissioner withholds any information from public disclosure pursuant to
this subdivision, the commissioner shall post to the department's website a report describing
the nature of the information and the commissioner's basis for withholding the information
from disclosure.
(e) To the extent the information required to be posted under this subdivision is collected
and made available to the public by another state, by the University of Minnesota, or through
an online drug pricing reference and analytical tool, the commissioner may reference the
availability of this drug price data from another source including, within existing
appropriations, creating the ability of the public to access the data from the source for
purposes of meeting the reporting requirements of this subdivision.
Subd. 7.
Consultation.
(a) The commissioner may consult with a private entity or
consortium that satisfies the standards of section 62U.04, subdivision 6, the University of
Minnesota, or the commissioner of commerce, as appropriate, in issuing the form and format
of the information reported under this section; in posting information pursuant to subdivision
6; and in taking any other action for the purpose of implementing this section.
(b) The commissioner may consult with representatives of the manufacturers to establish
a standard format for reporting information under this section and may use existing reporting
methodologies to establish a standard format to minimize administrative burdens to the state
and manufacturers.
Subd. 8.
Enforcement and penalties.
(a) A manufacturer may be subject to a civil
penalty, as provided in paragraph (b), for:
(1) failing to submit timely reports or notices as required by this section;
(2) failing to provide information required under this section; or
(3) providing inaccurate or incomplete information under this section.
(b) The commissioner shall adopt a schedule of civil penalties, not to exceed $10,000
per day of violation, based on the severity of each violation.
(c) The commissioner shall impose civil penalties under this section as provided in
section 144.99, subdivision 4.
(d) The commissioner may remit or mitigate civil penalties under this section upon terms
and conditions the commissioner considers proper and consistent with public health and
safety.
(e) Civil penalties collected under this section shall be deposited in the health care access
fund.
Subd. 9.
Legislative report.
(a) No later than May 15, 2022, and by January 15 of each
year thereafter, the commissioner shall report to the chairs and ranking minority members
of the legislative committees with jurisdiction over commerce and health and human services
policy and finance on the implementation of this section, including but not limited to the
effectiveness in addressing the following goals:
(1) promoting transparency in pharmaceutical pricing for the state and other payers;
(2) enhancing the understanding on pharmaceutical spending trends; and
(3) assisting the state and other payers in the management of pharmaceutical costs.
(b) The report must include a summary of the information submitted to the commissioner
under subdivisions 3, 4, and 5.
Sec. 5.
Minnesota Statutes 2020, section 62J.84, subdivision 2, is amended to read:
Subd. 2.
Definitions.
(a) For purposes of this sectionnew text begin and section 62J.841new text end , the terms
defined in this subdivision have the meanings given.
(b) "Biosimilar" means a drug that is produced or distributed pursuant to a biologics
license application approved under United States Code, title 42, section 262(K)(3).
(c) "Brand name drug" means a drug that is produced or distributed pursuant to:
(1) an original, new drug application approved under United States Code, title 21, section
355(c), except for a generic drug as defined under Code of Federal Regulations, title 42,
section 447.502; or
(2) a biologics license application approved under United States Code, title 45, section
262(a)(c).
(d) "Commissioner" means the commissioner of health.
(e) "Generic drug" means a drug that is marketed or distributed pursuant to:
(1) an abbreviated new drug application approved under United States Code, title 21,
section 355(j);
(2) an authorized generic as defined under Code of Federal Regulations, title 45, section
447.502; or
(3) a drug that entered the market the year before 1962 and was not originally marketed
under a new drug application.
(f) "Manufacturer" means a drug manufacturer licensed under section 151.252new text begin , but does
not include an entity required to be licensed under that section solely because the entity
repackages or relabels drugsnew text end .
(g) "New prescription drug" or "new drug" means a prescription drug approved for
marketing by the United States Food and Drug Administration for which no previous
wholesale acquisition cost has been established for comparison.
(h) "Patient assistance program" means a program that a manufacturer offers to the public
in which a consumer may reduce the consumer's out-of-pocket costs for prescription drugs
by using coupons, discount cards, prepaid gift cards, manufacturer debit cards, or by other
means.
(i) "Prescription drug" or "drug" has the meaning provided in section 151.441, subdivision
8.
(j) "Price" means the wholesale acquisition cost as defined in United States Code, title
42, section 1395w-3a(c)(6)(B).
Sec. 6.
Minnesota Statutes 2020, section 62J.84, subdivision 2, is amended to read:
Subd. 2.
Definitions.
(a) For purposes of this section, the terms defined in this subdivision
have the meanings given.
(b) "Biosimilar" means a drug that is produced or distributed pursuant to a biologics
license application approved under United States Code, title 42, section 262(K)(3).
(c) "Brand name drug" means a drug that is produced or distributed pursuant to:
(1) an original, new drug application approved under United States Code, title 21, section
355(c), except for a generic drug as defined under Code of Federal Regulations, title 42,
section 447.502; or
(2) a biologics license application approved under United States Code, title 45, section
262(a)(c).
(d) "Commissioner" means the commissioner of health.
new text begin
(e) "Drug product family" means a group of one or more prescription drugs that share
a unique generic drug description or nontrade name and dosage form.
new text end
deleted text begin (e)deleted text end new text begin (f)new text end "Generic drug" means a drug that is marketed or distributed pursuant to:
(1) an abbreviated new drug application approved under United States Code, title 21,
section 355(j);
(2) an authorized generic as defined under Code of Federal Regulations, title 45, section
447.502; or
(3) a drug that entered the market the year before 1962 and was not originally marketed
under a new drug application.
deleted text begin (f)deleted text end new text begin (g)new text end "Manufacturer" means a drug manufacturer licensed under section 151.252.
deleted text begin (g)deleted text end new text begin (h)new text end "New prescription drug" or "new drug" means a prescription drug approved for
marketing by the United States Food and Drug Administration for which no previous
wholesale acquisition cost has been established for comparison.
deleted text begin (h)deleted text end new text begin (i)new text end "Patient assistance program" means a program that a manufacturer offers to the
public in which a consumer may reduce the consumer's out-of-pocket costs for prescription
drugs by using coupons, discount cards, prepaid gift cards, manufacturer debit cards, or by
other means.
new text begin
(j) "Pharmacy" or "pharmacy provider" means a place of business licensed by the Board
of Pharmacy under section 151.19 in which prescription drugs are prepared, compounded,
or dispensed under the supervision of a pharmacist.
new text end
new text begin
(k) "Pharmacy benefits manager (PBM)" means an entity licensed to act as a pharmacy
benefits manager under section 62W.03.
new text end
deleted text begin (i)deleted text end new text begin (l)new text end "Prescription drug" or "drug" has the meaning provided in section 151.441,
subdivision 8.
deleted text begin (j)deleted text end new text begin (m)new text end "Price" means the wholesale acquisition cost as defined in United States Code,
title 42, section 1395w-3a(c)(6)(B).
new text begin
(n) "Pricing Unit" means the smallest dispensable amount of a prescription drug product
that could be dispensed.
new text end
new text begin
(o) "Reporting entity" means any manufacturer, pharmacy, pharmacy benefits manager,
wholesale drug distributor, or any other entity required to submit data under this section.
new text end
new text begin
(p) "Wholesale drug distributor" or "wholesaler" means an entity that:
new text end
new text begin
(1) is licensed to act as a wholesale drug distributor under section 151.47; and
new text end
new text begin
(2) distributes prescription drugs, of which it is not the manufacturer, to persons or
entities other than a consumer or patient in the state.
new text end
Sec. 7.
Minnesota Statutes 2021 Supplement, section 62J.84, subdivision 6, is amended
to read:
Subd. 6.
Public posting of prescription drug price information.
(a) The commissioner
shall post on the department's website, or may contract with a private entity or consortium
that satisfies the standards of section 62U.04, subdivision 6, to meet this requirement, the
following information:
(1) a list of the prescription drugs reported under subdivisions 3, 4, and 5, and the
manufacturers of those prescription drugs; deleted text begin and
deleted text end
(2) information reported to the commissioner under subdivisions 3, 4, and 5deleted text begin .deleted text end new text begin ; and
new text end
new text begin
(3) information reported to the commissioner under section 62J.841, subdivision 2.
new text end
(b) The information must be published in an easy-to-read format and in a manner that
identifies the information that is disclosed on a per-drug basis and must not be aggregated
in a manner that prevents the identification of the prescription drug.
(c) The commissioner shall not post to the department's website or a private entity
contracting with the commissioner shall not post any information described in this section
if the information is not public data under section 13.02, subdivision 8a; or is trade secret
information under section 13.37, subdivision 1, paragraph (b)new text begin , subject to section 62J.841,
subdivision 2, paragraph (e)new text end ; or is trade secret information pursuant to the Defend Trade
Secrets Act of 2016, United States Code, title 18, section 1836, as amendednew text begin , subject to
section 62J.841, subdivision 2, paragraph (e)new text end . If a manufacturer believes information should
be withheld from public disclosure pursuant to this paragraph, the manufacturer must clearly
and specifically identify that information and describe the legal basis in writing when the
manufacturer submits the information under this section. If the commissioner disagrees
with the manufacturer's request to withhold information from public disclosure, the
commissioner shall provide the manufacturer written notice that the information will be
publicly posted 30 days after the date of the notice.
(d) If the commissioner withholds any information from public disclosure pursuant to
this subdivision, the commissioner shall post to the department's website a report describing
the nature of the information and the commissioner's basis for withholding the information
from disclosure.
(e) To the extent the information required to be posted under this subdivision is collected
and made available to the public by another state, by the University of Minnesota, or through
an online drug pricing reference and analytical tool, the commissioner may reference the
availability of this drug price data from another source including, within existing
appropriations, creating the ability of the public to access the data from the source for
purposes of meeting the reporting requirements of this subdivision.
Sec. 8.
Minnesota Statutes 2021 Supplement, section 62J.84, subdivision 6, is amended
to read:
Subd. 6.
Public posting of prescription drug price information.
(a) The commissioner
shall post on the department's website, or may contract with a private entity or consortium
that satisfies the standards of section 62U.04, subdivision 6, to meet this requirement, the
following information:
(1) a list of the prescription drugs reported under subdivisions 3, 4, deleted text begin anddeleted text end 5,new text begin 11, 12, 13,
and 14new text end and the manufacturers of those prescription drugs; and
(2) information reported to the commissioner under subdivisions 3, 4, deleted text begin anddeleted text end 5new text begin , 11, 12, 13,
and 14new text end .
(b) The information must be published in an easy-to-read format and in a manner that
identifies the information that is disclosed on a per-drug basis and must not be aggregated
in a manner that prevents the identification of the prescription drug.
(c) The commissioner shall not post to the department's website or a private entity
contracting with the commissioner shall not post any information described in this section
if the information is not public data under section 13.02, subdivision 8a; or is trade secret
information under section 13.37, subdivision 1, paragraph (b); or is trade secret information
pursuant to the Defend Trade Secrets Act of 2016, United States Code, title 18, section
1836, as amended. If a manufacturer believes information should be withheld from public
disclosure pursuant to this paragraph, the manufacturer must clearly and specifically identify
that information and describe the legal basis in writing when the manufacturer submits the
information under this section. If the commissioner disagrees with the manufacturer's request
to withhold information from public disclosure, the commissioner shall provide the
manufacturer written notice that the information will be publicly posted 30 days after the
date of the notice.
(d) If the commissioner withholds any information from public disclosure pursuant to
this subdivision, the commissioner shall post to the department's website a report describing
the nature of the information and the commissioner's basis for withholding the information
from disclosure.
(e) To the extent the information required to be posted under this subdivision is collected
and made available to the public by another state, by the University of Minnesota, or through
an online drug pricing reference and analytical tool, the commissioner may reference the
availability of this drug price data from another source including, within existing
appropriations, creating the ability of the public to access the data from the source for
purposes of meeting the reporting requirements of this subdivision.
Sec. 9.
Minnesota Statutes 2020, section 62J.84, subdivision 7, is amended to read:
Subd. 7.
Consultation.
(a) The commissioner may consult with a private entity or
consortium that satisfies the standards of section 62U.04, subdivision 6, the University of
Minnesota, or the commissioner of commerce, as appropriate, in issuing the form and format
of the information reported under this sectionnew text begin and section 62J.841new text end ; in posting information
pursuant to subdivision 6; and in taking any other action for the purpose of implementing
this sectionnew text begin and section 62J.841new text end .
(b) The commissioner may consult with representatives of the manufacturers to establish
a standard format for reporting information under this section new text begin and section 62J.841 new text end and may
use existing reporting methodologies to establish a standard format to minimize
administrative burdens to the state and manufacturers.
Sec. 10.
Minnesota Statutes 2020, section 62J.84, subdivision 7, is amended to read:
Subd. 7.
Consultation.
(a) The commissioner may consult with a private entity or
consortium that satisfies the standards of section 62U.04, subdivision 6, the University of
Minnesota, or the commissioner of commerce, as appropriate, in issuing the form and format
of the information reported under this section; in posting information pursuant to subdivision
6; and in taking any other action for the purpose of implementing this section.
(b) The commissioner may consult with representatives of the deleted text begin manufacturersdeleted text end new text begin reporting
entitiesnew text end to establish a standard format for reporting information under this section and may
use existing reporting methodologies to establish a standard format to minimize
administrative burdens to the state and deleted text begin manufacturersdeleted text end new text begin reporting entitiesnew text end .
Sec. 11.
Minnesota Statutes 2020, section 62J.84, subdivision 8, is amended to read:
Subd. 8.
Enforcement and penalties.
(a) A manufacturer may be subject to a civil
penalty, as provided in paragraph (b), for:
(1) failing to submit timely reports or notices as required by this sectionnew text begin and section
62J.841new text end ;
(2) failing to provide information required under this sectionnew text begin and section 62J.841new text end ; deleted text begin or
deleted text end
(3) providing inaccurate or incomplete information under this sectionnew text begin and section 62J.841;
or
new text end
new text begin (4) failing to comply with section 62J.841, subdivisions 2, paragraph (e), and 4new text end .
(b) The commissioner shall adopt a schedule of civil penalties, not to exceed $10,000
per day of violation, based on the severity of each violation.
(c) The commissioner shall impose civil penalties under this section new text begin and section 62J.841
new text end as provided in section 144.99, subdivision 4.
(d) The commissioner may remit or mitigate civil penalties under this section new text begin and section
62J.481 new text end upon terms and conditions the commissioner considers proper and consistent with
public health and safety.
(e) Civil penalties collected under this section new text begin and section 62J.841 new text end shall be deposited in
the health care access fund.
Sec. 12.
Minnesota Statutes 2020, section 62J.84, subdivision 8, is amended to read:
Subd. 8.
Enforcement and penalties.
(a) A deleted text begin manufacturerdeleted text end new text begin reporting entitynew text end may be subject
to a civil penalty, as provided in paragraph (b), for:
new text begin
(1) failing to register under subdivision 15;
new text end
deleted text begin (1)deleted text end new text begin (2)new text end failing to submit timely reports or notices as required by this section;
deleted text begin (2)deleted text end new text begin (3)new text end failing to provide information required under this section; or
deleted text begin (3)deleted text end new text begin (4)new text end providing inaccurate or incomplete information under this section.
(b) The commissioner shall adopt a schedule of civil penalties, not to exceed $10,000
per day of violation, based on the severity of each violation.
(c) The commissioner shall impose civil penalties under this section as provided in
section 144.99, subdivision 4.
(d) The commissioner may remit or mitigate civil penalties under this section upon terms
and conditions the commissioner considers proper and consistent with public health and
safety.
(e) Civil penalties collected under this section shall be deposited in the health care access
fund.
Sec. 13.
Minnesota Statutes 2021 Supplement, section 62J.84, subdivision 9, is amended
to read:
Subd. 9.
Legislative report.
(a) No later than May 15, 2022, and by January 15 of each
year thereafter, the commissioner shall report to the chairs and ranking minority members
of the legislative committees with jurisdiction over commerce and health and human services
policy and finance on the implementation of this sectionnew text begin and section 62J.841new text end , including but
not limited to the effectiveness in addressing the following goals:
(1) promoting transparency in pharmaceutical pricing for the statenew text begin , health carriers,new text end and
other payers;
(2) enhancing the understanding on pharmaceutical spending trends; and
(3) assisting the statenew text begin , health carriers,new text end and other payers in the management of
pharmaceutical costsnew text begin and limiting formulary changes due to prescription drug cost increases
during a coverage yearnew text end .
(b) The report must include a summary of the information submitted to the commissioner
under subdivisions 3, 4, and 5new text begin , and section 62J.841new text end .
Sec. 14.
Minnesota Statutes 2021 Supplement, section 62J.84, subdivision 9, is amended
to read:
Subd. 9.
Legislative report.
(a) No later than May 15, 2022, and by January 15 of each
year thereafter, the commissioner shall report to the chairs and ranking minority members
of the legislative committees with jurisdiction over commerce and health and human services
policy and finance on the implementation of this section, including but not limited to the
effectiveness in addressing the following goals:
(1) promoting transparency in pharmaceutical pricing for the state and other payers;
(2) enhancing the understanding on pharmaceutical spending trends; and
(3) assisting the state and other payers in the management of pharmaceutical costs.
(b) The report must include a summary of the information submitted to the commissioner
under subdivisions 3, 4, deleted text begin anddeleted text end 5new text begin , 11, 12, 13, and 14new text end .
Sec. 15.
Minnesota Statutes 2020, section 62J.84, is amended by adding a subdivision to
read:
new text begin Subd. 10. new text end
new text begin Notice of prescription drugs of substantial public interest. new text end
new text begin
(a) No later than
January 31, 2023, and quarterly thereafter, the commissioner shall produce and post on the
department's website a list of prescription drugs that the department determines to represent
a substantial public interest and for which the department intends to request data under
subdivisions 11, 12, 13, and 14, subject to paragraph (c). The department shall base its
inclusion of prescription drugs on any information the department determines is relevant
to providing greater consumer awareness of the factors contributing to the cost of prescription
drugs in the state, and the department shall consider drug product families that include
prescription drugs:
new text end
new text begin
(1) that triggered reporting under subdivisions 3, 4, or 5 during the previous calendar
quarter;
new text end
new text begin
(2) for which average claims paid amounts exceeded 125 percent of the price as of the
claim incurred date during the most recent calendar quarter for which claims paid amounts
are available; or
new text end
new text begin
(3) that are identified by members of the public during a public comment period process.
new text end
new text begin
(b) No sooner than 30 days after publicly posting the list of prescription drugs under
paragraph (a), the department shall notify, via e-mail, reporting entities registered with the
department of the requirement to report under subdivisions 11, 12, 13, and 14.
new text end
new text begin
(c) No more than 500 prescription drugs may be designated as having a substantial public
interest in any one notice.
new text end
Sec. 16.
Minnesota Statutes 2020, section 62J.84, is amended by adding a subdivision to
read:
new text begin Subd. 11. new text end
new text begin Manufacturer prescription drug substantial public interest reporting. new text end
new text begin
(a)
Beginning January 1, 2023, a manufacturer must submit to the commissioner the information
described in paragraph (b) for any prescription drug:
new text end
new text begin
(1) included in a notification to report issued to the manufacturer by the department
under subdivision 10;
new text end
new text begin
(2) which the manufacturer manufactures or repackages;
new text end
new text begin
(3) for which the manufacturer sets the wholesale acquisition cost; and
new text end
new text begin
(4) for which the manufacturer has not submitted data under subdivisions 3 or 5 during
the 120-day period prior to the date of the notification to report.
new text end
new text begin
(b) For each of the drugs described in paragraph (a), the manufacturer shall submit to
the commissioner no later than 60 days after the date of the notification to report, in the
form and manner prescribed by the commissioner, the following information, if applicable:
new text end
new text begin
(1) a description of the drug with the following listed separately:
new text end
new text begin
(i) National Drug Code;
new text end
new text begin
(ii) product name;
new text end
new text begin
(iii) dosage form;
new text end
new text begin
(iv) strength; and
new text end
new text begin
(v) package size;
new text end
new text begin
(2) the price of the drug product on the later of:
new text end
new text begin
(i) the day one year prior to the date of the notification to report;
new text end
new text begin
(ii) the introduced to market date; or
new text end
new text begin
(iii) the acquisition date;
new text end
new text begin
(3) the price of the drug product on the date of the notification to report;
new text end
new text begin
(4) the introductory price of the prescription drug when it was introduced for sale in the
United States and the price of the drug on the last day of each of the five calendar years
preceding the date of the notification to report;
new text end
new text begin
(5) the direct costs incurred during the 12-month period prior to the date of the notification
to report by the manufacturer that are associated with the prescription drug, listed separately:
new text end
new text begin
(i) to manufacture the prescription drug;
new text end
new text begin
(ii) to market the prescription drug, including advertising costs; and
new text end
new text begin
(iii) to distribute the prescription drug;
new text end
new text begin
(6) the number of units of the prescription drug sold during the 12-month period prior
to the date of the notification to report;
new text end
new text begin
(7) the total sales revenue for the prescription drug during the 12-month period prior to
the date of the notification to report;
new text end
new text begin
(8) the total rebate payable amount accrued for the prescription drug during the 12-month
period prior to the date of the notification to report;
new text end
new text begin
(9) the manufacturer's net profit attributable to the prescription drug during the 12-month
period prior to the date of the notification to report;
new text end
new text begin
(10) the total amount of financial assistance the manufacturer has provided through
patient prescription assistance programs during the 12-month period prior to the date of the
notification to report, if applicable;
new text end
new text begin
(11) any agreement between a manufacturer and another entity contingent upon any
delay in offering to market a generic version of the prescription drug;
new text end
new text begin
(12) the patent expiration date of the prescription drug if it is under patent;
new text end
new text begin
(13) the name and location of the company that manufactured the drug;
new text end
new text begin
(14) if a brand name prescription drug, the ten countries other than the United States
that paid the highest prices for the prescription drug during the previous calendar year and
their prices; and
new text end
new text begin
(15) if the prescription drug was acquired by the manufacturer within the 12-month
period prior to the date of the notification to report, all of the following information:
new text end
new text begin
(i) price at acquisition;
new text end
new text begin
(ii) price in the calendar year prior to acquisition;
new text end
new text begin
(iii) name of the company from which the drug was acquired;
new text end
new text begin
(iv) date of acquisition; and
new text end
new text begin
(v) acquisition price.
new text end
new text begin
(c) The manufacturer may submit any documentation necessary to support the information
reported under this subdivision.
new text end
Sec. 17.
Minnesota Statutes 2020, section 62J.84, is amended by adding a subdivision to
read:
new text begin Subd. 12. new text end
new text begin Pharmacy prescription drug substantial public interest reporting. new text end
new text begin
(a)
Beginning January 1, 2023, a pharmacy must submit to the commissioner the information
described in paragraph (b) for any prescription drug included in a notification to report
issued to the pharmacy by the department under subdivision 10.
new text end
new text begin
(b) For each of the drugs described in paragraph (a), the pharmacy shall submit to the
commissioner no later than 60 days after the date of the notification to report in the form
and manner prescribed by the commissioner the following information, if applicable:
new text end
new text begin
(1) a description of the drug with the following listed separately:
new text end
new text begin
(i) National Drug Code;
new text end
new text begin
(ii) product name;
new text end
new text begin
(iii) dosage form;
new text end
new text begin
(iv) strength; and
new text end
new text begin
(v) package size;
new text end
new text begin
(2) the number of units of the drug acquired during the 12-month period prior to the date
of the notification to report;
new text end
new text begin
(3) the total spent before rebates by the pharmacy to acquire the drug during the 12-month
period prior to the date of the notification to report;
new text end
new text begin
(4) the total rebate receivable amount accrued by the pharmacy for the drug during the
12-month period prior to the date of the notification to report;
new text end
new text begin
(5) the number of pricing units of the drug dispensed by the pharmacy during the
12-month period prior to the date of the notification to report;
new text end
new text begin
(6) the total payment receivable by the pharmacy for dispensing the drug, including
ingredient cost, dispensing fee, and administrative fees, during the 12-month period prior
to the date of the notification to report;
new text end
new text begin
(7) the total rebate payable amount accrued by the pharmacy for the drug during the
12-month period prior to the date of the notification to report; and
new text end
new text begin
(8) the average cash price paid by consumers per pricing unit for prescriptions dispensed
where no claim was submitted to a health care service plan or health insurer during the
12-month period prior to the date of the notification to report.
new text end
new text begin
(c) The pharmacy may submit any documentation necessary to support the information
reported under this subdivision.
new text end
Sec. 18.
Minnesota Statutes 2020, section 62J.84, is amended by adding a subdivision to
read:
new text begin Subd. 13. new text end
new text begin
Pharmacy benefit manager (PBM) prescription drug substantial public
interest reporting.
new text end
new text begin
(a) Beginning January 1, 2023, a PBM as defined in section 62W.02,
subdivision 14, must submit to the commissioner the information described in paragraph
(b) for any prescription drug included in a notification to report issued to the PBM by the
department under subdivision 10.
new text end
new text begin
(b) For each of the drugs described in paragraph (a), the PBM shall submit to the
commissioner no later than 60 days after the date of the notification to report, in the form
and manner prescribed by the commissioner, the following information, if applicable:
new text end
new text begin
(1) a description of the drug with the following listed separately:
new text end
new text begin
(i) National Drug Code;
new text end
new text begin
(ii) product name;
new text end
new text begin
(iii) dosage form;
new text end
new text begin
(iv) strength; and
new text end
new text begin
(v) package size;
new text end
new text begin
(2) the number of pricing units of the drug product filled for which the PBM administered
claims during the 12-month period prior to the date of the notification to report;
new text end
new text begin
(3) the total reimbursement amount accrued and payable to pharmacies for pricing units
of the drug product filled for which the PBM administered claims during the 12-month
period prior to the date of the notification to report;
new text end
new text begin
(4) the total reimbursement or administrative fee amount or both accrued and receivable
from payers for pricing units of the drug product filled for which the PBM administered
claims during the 12-month period prior to the date of the notification to report;
new text end
new text begin
(5) the total rebate receivable amount accrued by the PBM for the drug product during
the 12-month period prior to the date of the notification to report; and
new text end
new text begin
(6) the total rebate payable amount accrued by the PBM for the drug product during the
12-month period prior to the date of the notification to report.
new text end
new text begin
(c) The PBM may submit any documentation necessary to support the information
reported under this subdivision.
new text end
Sec. 19.
Minnesota Statutes 2020, section 62J.84, is amended by adding a subdivision to
read:
new text begin Subd. 14. new text end
new text begin Wholesaler prescription drug substantial public interest reporting. new text end
new text begin
(a)
Beginning January 1, 2023, a wholesaler must submit to the commissioner the information
described in paragraph (b) for any prescription drug included in a notification to report
issued to the wholesaler by the department under subdivision 10.
new text end
new text begin
(b) For each of the drugs described in paragraph (a), the wholesaler shall submit to the
commissioner no later than 60 days after the date of the notification to report, in the form
and manner prescribed by the commissioner, the following information, if applicable:
new text end
new text begin
(1) a description of the drug with the following listed separately:
new text end
new text begin
(i) National Drug Code;
new text end
new text begin
(ii) product name;
new text end
new text begin
(iii) dosage form;
new text end
new text begin
(iv) strength; and
new text end
new text begin
(v) package size;
new text end
new text begin
(2) the number of units of the drug product acquired by the wholesale drug distributor
during the 12-month period prior to the date of the notification to report;
new text end
new text begin
(3) the total spent before rebates by the wholesale drug distributor to acquire the drug
product during the 12-month period prior to the date of the notification to report;
new text end
new text begin
(4) the total rebate receivable amount accrued by the wholesale drug distributor for the
drug product during the 12-month period prior to the date of the notification to report;
new text end
new text begin
(5) the number of units of the drug product sold by the wholesale drug distributor during
the 12-month period prior to the date of the notification to report;
new text end
new text begin
(6) gross revenue from sales in the United States generated by the wholesale drug
distributor for the drug product during the 12-month period prior to the date of the notification
to report; and
new text end
new text begin
(7) total rebate payable amount accrued by the wholesale drug distributor for the drug
product during the 12-month period prior to the date of the notification to report.
new text end
new text begin
(c) The wholesaler may submit any documentation necessary to support the information
reported under this subdivision.
new text end
Sec. 20.
Minnesota Statutes 2020, section 62J.84, is amended by adding a subdivision to
read:
new text begin Subd. 15. new text end
new text begin Registration requirement. new text end
new text begin
Beginning January 1, 2023, a reporting entity
subject to this chapter shall register with the department in a form and manner prescribed
by the commissioner.
new text end
Sec. 21.
Minnesota Statutes 2020, section 62J.84, is amended by adding a subdivision to
read:
new text begin Subd. 16. new text end
new text begin Rulemaking. new text end
new text begin
For the purposes of this section, the commissioner may use the
expedited rulemaking process under section 14.389.
new text end
Sec. 22.
new text begin
[62J.841] REPORTING PRESCRIPTION DRUG PRICES; FORMULARY
DEVELOPMENT AND PRICE STABILITY.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the terms in this subdivision
have the meanings given.
new text end
new text begin
(b) "Average wholesale price" means the customary reference price for sales by a drug
wholesaler to a retail pharmacy, as established and published by the manufacturer.
new text end
new text begin
(c) "National drug code" means the numerical code maintained by the United States
Food and Drug Administration and includes the label code, product code, and package code.
new text end
new text begin
(d) "Unit" has the meaning given in United States Code, title 42, section 1395w-3a(b)(2).
new text end
new text begin
(e) "Wholesale acquisition cost" has the meaning given in United States Code, title 42,
section 1395w-3a(c)(6)(B).
new text end
new text begin Subd. 2. new text end
new text begin Price reporting. new text end
new text begin
(a) Beginning July 31, 2023, and by July 31 each year
thereafter, a manufacturer must report to the commissioner the information in paragraph
(b) for every drug with a wholesale acquisition cost of $100 or more for a 30-day supply
or for a course of treatment lasting less than 30 days, as applicable to the next calendar year.
new text end
new text begin
(b) A manufacturer shall report a drug's:
new text end
new text begin
(1) national drug code, labeler code, and the manufacturer name associated with the
labeler code;
new text end
new text begin
(2) brand name, if applicable;
new text end
new text begin
(3) generic name, if applicable;
new text end
new text begin
(4) wholesale acquisition cost for one unit;
new text end
new text begin
(5) measure that constitutes a wholesale acquisition cost unit;
new text end
new text begin
(6) average wholesale price; and
new text end
new text begin
(7) status as brand name or generic.
new text end
new text begin
(c) The effective date of the information described in paragraph (b) must be included in
the report to the commissioner.
new text end
new text begin
(d) A manufacturer must report the information described in this subdivision in the form
and manner specified by the commissioner.
new text end
new text begin
(e) Information reported under this subdivision is classified as public data not on
individuals, as defined in section 13.02, subdivision 14, and must not be classified by the
manufacturer as trade secret information, as defined in section 13.37, subdivision 1, paragraph
(b).
new text end
new text begin
(f) A manufacturer's failure to report the information required by this subdivision is
grounds for disciplinary action under section 151.071, subdivision 2.
new text end
new text begin Subd. 3. new text end
new text begin Public posting of prescription drug price information. new text end
new text begin
By October 1 of each
year, beginning October 1, 2023, the commissioner must post the information reported
under subdivision 2 on the department website, as required by section 62J.84, subdivision
6.
new text end
new text begin Subd. 4. new text end
new text begin Price change. new text end
new text begin
(a) If a drug subject to price reporting under subdivision 2 is
included in the formulary of a health plan submitted to and approved by the commissioner
of commerce for the next calendar year under section 62A.02, subdivision 1, the manufacturer
may increase the wholesale acquisition cost of the drug for the next calendar year only after
providing the commissioner with at least 90 days' written notice.
new text end
new text begin
(b) A manufacturer's failure to meet the requirements of paragraph (a) is grounds for
disciplinary action under section 151.071, subdivision 2.
new text end
Sec. 23.
new text begin
[62J.841] DEFINITIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Scope. new text end
new text begin
For purposes of sections 62J.841 to 62J.845, the following
definitions apply.
new text end
new text begin Subd. 2. new text end
new text begin Consumer Price Index. new text end
new text begin
"Consumer Price Index" means the Consumer Price
Index, Annual Average, for All Urban Consumers, CPI-U: U.S. City Average, All Items,
reported by the United States Department of Labor, Bureau of Labor Statistics, or its
successor or, if the index is discontinued, an equivalent index reported by a federal authority
or, if no such index is reported, "Consumer Price Index" means a comparable index chosen
by the Bureau of Labor Statistics.
new text end
new text begin Subd. 3. new text end
new text begin Generic or off-patent drug. new text end
new text begin
"Generic or off-patent drug" means any prescription
drug for which any exclusive marketing rights granted under the Federal Food, Drug, and
Cosmetic Act; section 351 of the federal Public Health Service Act; and federal patent law
have expired, including any drug-device combination product for the delivery of a generic
drug.
new text end
new text begin Subd. 4. new text end
new text begin Manufacturer. new text end
new text begin
"Manufacturer" has the meaning provided in section 151.01,
subdivision 14a.
new text end
new text begin Subd. 5. new text end
new text begin Prescription drug. new text end
new text begin
"Prescription drug" means a drug for human use subject
to United States Code, title 21, section 353(b)(1).
new text end
new text begin Subd. 6. new text end
new text begin Wholesale acquisition cost. new text end
new text begin
"Wholesale acquisition cost" has the meaning
provided in United States Code, title 42, section 1395w-3a.
new text end
new text begin Subd. 7. new text end
new text begin Wholesale distributor. new text end
new text begin
"Wholesale distributor" has the meaning provided in
section 151.441, subdivision 14.
new text end
Sec. 24.
new text begin
[62J.842] EXCESSIVE PRICE INCREASES PROHIBITED.
new text end
new text begin Subdivision 1. new text end
new text begin Prohibition. new text end
new text begin
No manufacturer shall impose, or cause to be imposed, an
excessive price increase, whether directly or through a wholesale distributor, pharmacy, or
similar intermediary, on the sale of any generic or off-patent drug sold, dispensed, or
delivered to any consumer in the state.
new text end
new text begin Subd. 2. new text end
new text begin Excessive price increase. new text end
new text begin
A price increase is excessive for purposes of this
section when:
new text end
new text begin
(1) the price increase, adjusted for inflation utilizing the Consumer Price Index, exceeds:
new text end
new text begin
(i) 15 percent of the wholesale acquisition cost over the immediately preceding calendar
year; or
new text end
new text begin
(ii) 40 percent of the wholesale acquisition cost over the immediately preceding three
calendar years; and
new text end
new text begin
(2) the price increase, adjusted for inflation utilizing the Consumer Price Index, exceeds
$30 for:
new text end
new text begin
(i) a 30-day supply of the drug; or
new text end
new text begin
(ii) a course of treatment lasting less than 30 days.
new text end
new text begin Subd. 3. new text end
new text begin Exemption. new text end
new text begin
It is not a violation of this section for a wholesale distributor or
pharmacy to increase the price of a generic or off-patent drug if the price increase is directly
attributable to additional costs for the drug imposed on the wholesale distributor or pharmacy
by the manufacturer of the drug.
new text end
Sec. 25.
new text begin
[62J.843] REGISTERED AGENT AND OFFICE WITHIN THE STATE.
new text end
new text begin
Any manufacturer that sells, distributes, delivers, or offers for sale any generic or
off-patent drug in the state is required to maintain a registered agent and office within the
state.
new text end
Sec. 26.
new text begin
[62J.844] ENFORCEMENT.
new text end
new text begin Subdivision 1. new text end
new text begin Notification. new text end
new text begin
The commissioner of management and budget and any
other state agency that provides or purchases a pharmacy benefit, except the Department
of Human Services, and any entity under contract with a state agency to provide a pharmacy
benefit other than an entity under contract with the Department of Human Services, shall
notify the manufacturer of a generic or off-patent drug, the attorney general, and the Board
of Pharmacy of any price increase in violation of section 62J.842.
new text end
new text begin Subd. 2. new text end
new text begin
Submission of drug cost statement and other information by manufacturer;
investigation by attorney general.
new text end
new text begin
(a) Within 45 days of receiving a notice under subdivision
1, the manufacturer of the generic or off-patent drug shall submit a drug cost statement to
the attorney general. The statement must:
new text end
new text begin
(1) itemize the cost components related to production of the drug;
new text end
new text begin
(2) identify the circumstances and timing of any increase in materials or manufacturing
costs that caused any increase during the preceding calendar year, or preceding three calendar
years as applicable, in the price of the drug; and
new text end
new text begin
(3) provide any other information that the manufacturer believes to be relevant to a
determination of whether a violation of section 62J.842 has occurred.
new text end
new text begin
(b) The attorney general may investigate whether a violation of section 62J.842 has
occurred, is occurring, or is about to occur, in accordance with section 8.31, subdivision 2.
new text end
new text begin Subd. 3. new text end
new text begin Petition to court. new text end
new text begin
(a) On petition of the attorney general, a court may issue an
order:
new text end
new text begin
(1) compelling the manufacturer of a generic or off-patent drug to:
new text end
new text begin
(i) provide the drug cost statement required under subdivision 2, paragraph (a); and
new text end
new text begin
(ii) answer interrogatories, produce records or documents, or be examined under oath,
as required by the attorney general under subdivision 2, paragraph (b);
new text end
new text begin
(2) restraining or enjoining a violation of sections 62J.841 to 62J.845, including issuing
an order requiring that drug prices be restored to levels that comply with section 62J.842;
new text end
new text begin
(3) requiring the manufacturer to provide an accounting to the attorney general of all
revenues resulting from a violation of section 62J.842;
new text end
new text begin
(4) requiring the manufacturer to repay to all consumers, including any third-party payers,
any money acquired as a result of a price increase that violates section 62J.842;
new text end
new text begin
(5) notwithstanding section 16A.151, if a manufacturer is unable to determine the
individual transactions necessary to provide the repayments described in clause (4), requiring
that all revenues generated from a violation of section 62J.842 be remitted to the state and
deposited into a special fund to be used for initiatives to reduce the cost to consumers of
acquiring prescription drugs;
new text end
new text begin
(6) imposing a civil penalty of up to $10,000 per day for each violation of section 62J.842;
new text end
new text begin
(7) providing for the attorney general's recovery of its costs and disbursements incurred
in bringing an action against a manufacturer found in violation of section 62J.842, including
the costs of investigation and reasonable attorney's fees; and
new text end
new text begin
(8) providing any other appropriate relief, including any other equitable relief as
determined by the court.
new text end
new text begin
(b) For purposes of paragraph (a), clause (6), every individual transaction in violation
of section 62J.842 must be considered a separate violation.
new text end
new text begin Subd. 4. new text end
new text begin Private right of action. new text end
new text begin
Any action brought pursuant to section 8.31, subdivision
3a, by a person injured by a violation of this section is for the benefit of the public.
new text end
Sec. 27.
new text begin
[62J.845] PROHIBITION ON WITHDRAWAL OF GENERIC OR
OFF-PATENT DRUGS FOR SALE.
new text end
new text begin Subdivision 1. new text end
new text begin Prohibition. new text end
new text begin
A manufacturer of a generic or off-patent drug is prohibited
from withdrawing that drug from sale or distribution within this state for the purpose of
avoiding the prohibition on excessive price increases under section 62J.842.
new text end
new text begin Subd. 2. new text end
new text begin Notice to board and attorney general. new text end
new text begin
Any manufacturer that intends to
withdraw a generic or off-patent drug from sale or distribution within the state shall provide
a written notice of withdrawal to the Board of Pharmacy and the attorney general at least
180 days prior to the withdrawal.
new text end
new text begin Subd. 3. new text end
new text begin Financial penalty. new text end
new text begin
The attorney general shall assess a penalty of $500,000 on
any manufacturer of a generic or off-patent drug that it determines has failed to comply
with the requirements of this section.
new text end
Sec. 28.
new text begin
[62J.846] SEVERABILITY.
new text end
new text begin
If any provision of sections 62J.841 to 62J.845 or the application thereof to any person
or circumstance is held invalid for any reason in a court of competent jurisdiction, the
invalidity does not affect other provisions or any other application of sections 62J.841 to
62J.845 that can be given effect without the invalid provision or application.
new text end
Sec. 29.
new text begin
[62J.85] CITATION.
new text end
new text begin
Sections 62J.85 to 62J.95 may be cited as the "Prescription Drug Affordability Act."
new text end
Sec. 30.
new text begin
[62J.86] DEFINITIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
For the purposes of sections 62J.85 to 62J.95, the following
terms have the meanings given.
new text end
new text begin Subd. 2. new text end
new text begin Advisory council. new text end
new text begin
"Advisory council" means the Prescription Drug Affordability
Advisory Council established under section 62J.88.
new text end
new text begin Subd. 3. new text end
new text begin Biologic. new text end
new text begin
"Biologic" means a drug that is produced or distributed in accordance
with a biologics license application approved under Code of Federal Regulations, title 42,
section 447.502.
new text end
new text begin Subd. 4. new text end
new text begin Biosimilar. new text end
new text begin
"Biosimilar" has the meaning provided in section 62J.84, subdivision
2, paragraph (b).
new text end
new text begin Subd. 5. new text end
new text begin Board. new text end
new text begin
"Board" means the Prescription Drug Affordability Board established
under section 62J.87.
new text end
new text begin Subd. 6. new text end
new text begin Brand name drug. new text end
new text begin
"Brand name drug" has the meaning provided in section
62J.84, subdivision 2, paragraph (c).
new text end
new text begin Subd. 7. new text end
new text begin Generic drug. new text end
new text begin
"Generic drug" has the meaning provided in section 62J.84,
subdivision 2, paragraph (e).
new text end
new text begin Subd. 8. new text end
new text begin Group purchaser. new text end
new text begin
"Group purchaser" has the meaning given in section 62J.03,
subdivision 6, and includes pharmacy benefit managers as defined in section 62W.02,
subdivision 15.
new text end
new text begin Subd. 9. new text end
new text begin Manufacturer. new text end
new text begin
"Manufacturer" means an entity that:
new text end
new text begin
(1) engages in the manufacture of a prescription drug product or enters into a lease with
another manufacturer to market and distribute a prescription drug product under the entity's
own name; and
new text end
new text begin
(2) sets or changes the wholesale acquisition cost of the prescription drug product it
manufacturers or markets.
new text end
new text begin Subd. 10. new text end
new text begin Prescription drug product. new text end
new text begin
"Prescription drug product" means a brand name
drug, a generic drug, a biologic, or a biosimilar.
new text end
new text begin Subd. 11. new text end
new text begin Wholesale acquisition cost or WAC. new text end
new text begin
"Wholesale acquisition cost" or "WAC"
has the meaning given in United States Code, title 42, section 1395W-3a(c)(6)(B).
new text end
Sec. 31.
new text begin
[62J.87] PRESCRIPTION DRUG AFFORDABILITY BOARD.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The commissioner of commerce shall establish the
Prescription Drug Affordability Board, which shall be governed as a board under section
15.012, paragraph (a), to protect consumers, state and local governments, health plan
companies, providers, pharmacies, and other health care system stakeholders from
unaffordable costs of certain prescription drugs.
new text end
new text begin Subd. 2. new text end
new text begin Membership. new text end
new text begin
(a) The Prescription Drug Affordability Board consists of nine
members appointed as follows:
new text end
new text begin
(1) seven voting members appointed by the governor;
new text end
new text begin
(2) one nonvoting member appointed by the majority leader of the senate; and
new text end
new text begin
(3) one nonvoting member appointed by the speaker of the house.
new text end
new text begin
(b) All members appointed must have knowledge and demonstrated expertise in
pharmaceutical economics and finance or health care economics and finance. A member
must not be an employee of, a board member of, or a consultant to a manufacturer or trade
association for manufacturers or a pharmacy benefit manager or trade association for
pharmacy benefit managers.
new text end
new text begin
(c) Initial appointments must be made by January 1, 2023.
new text end
new text begin Subd. 3. new text end
new text begin Terms. new text end
new text begin
(a) Board appointees shall serve four-year terms, except that initial
appointees shall serve staggered terms of two, three, or four years as determined by lot by
the secretary of state. A board member shall serve no more than two consecutive terms.
new text end
new text begin
(b) A board member may resign at any time by giving written notice to the board.
new text end
new text begin Subd. 4. new text end
new text begin Chair; other officers. new text end
new text begin
(a) The governor shall designate an acting chair from
the members appointed by the governor. The acting chair shall convene the first meeting
of the board.
new text end
new text begin
(b) The board shall elect a chair to replace the acting chair at the first meeting of the
board by a majority of the members. The chair shall serve for one year.
new text end
new text begin
(c) The board shall elect a vice-chair and other officers from its membership as it deems
necessary.
new text end
new text begin Subd. 5. new text end
new text begin Staff; technical assistance. new text end
new text begin
(a) The board shall hire an executive director and
other staff, who shall serve in the unclassified service. The executive director must have
knowledge and demonstrated expertise in pharmacoeconomics, pharmacology, health policy,
health services research, medicine, or a related field or discipline. The board may employ
or contract for professional and technical assistance as the board deems necessary to perform
the board's duties.
new text end
new text begin
(b) The attorney general shall provide legal services to the board.
new text end
new text begin Subd. 6. new text end
new text begin Compensation. new text end
new text begin
The board members shall not receive compensation but may
receive reimbursement for expenses as authorized under section 15.059, subdivision 3.
new text end
new text begin Subd. 7. new text end
new text begin Meetings. new text end
new text begin
(a) Meetings of the board are subject to chapter 13D. The board shall
meet publicly at least every three months to review prescription drug product information
submitted to the board under section 62J.90. If there are no pending submissions, the chair
of the board may cancel or postpone the required meeting. The board may meet in closed
session when reviewing proprietary information as determined under the standards developed
in accordance with section 62J.91, subdivision 4.
new text end
new text begin
(b) The board shall announce each public meeting at least two weeks prior to the
scheduled date of the meeting. Any materials for the meeting must be made public at least
one week prior to the scheduled date of the meeting.
new text end
new text begin
(c) At each public meeting, the board shall provide the opportunity for comments from
the public, including the opportunity for written comments to be submitted to the board
prior to a decision by the board.
new text end
Sec. 32.
new text begin
[62J.88] PRESCRIPTION DRUG AFFORDABILITY ADVISORY
COUNCIL.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The governor shall appoint a 12-member stakeholder
advisory council to provide advice to the board on drug cost issues and to represent
stakeholders' views. The members of the advisory council shall be appointed based on their
knowledge and demonstrated expertise in one or more of the following areas: the
pharmaceutical business; practice of medicine; patient perspectives; health care cost trends
and drivers; clinical and health services research; and the health care marketplace.
new text end
new text begin Subd. 2. new text end
new text begin Membership. new text end
new text begin
The council's membership shall consist of the following:
new text end
new text begin
(1) two members representing patients and health care consumers;
new text end
new text begin
(2) two members representing health care providers;
new text end
new text begin
(3) one member representing health plan companies;
new text end
new text begin
(4) two members representing employers, with one member representing large employers
and one member representing small employers;
new text end
new text begin
(5) one member representing government employee benefit plans;
new text end
new text begin
(6) one member representing pharmaceutical manufacturers;
new text end
new text begin
(7) one member who is a health services clinical researcher;
new text end
new text begin
(8) one member who is a pharmacologist; and
new text end
new text begin
(9) one member representing the commissioner of health with expertise in health
economics.
new text end
new text begin Subd. 3. new text end
new text begin Terms. new text end
new text begin
(a) The initial appointments to the advisory council must be made by
January 1, 2023. The initial appointed advisory council members shall serve staggered terms
of two, three, or four years determined by lot by the secretary of state. Following the initial
appointments, the advisory council members shall serve four-year terms.
new text end
new text begin
(b) Removal and vacancies of advisory council members are governed by section 15.059.
new text end
new text begin Subd. 4. new text end
new text begin Compensation. new text end
new text begin
Advisory council members may be compensated according to
section 15.059.
new text end
new text begin Subd. 5. new text end
new text begin Meetings. new text end
new text begin
Meetings of the advisory council are subject to chapter 13D. The
advisory council shall meet publicly at least every three months to advise the board on drug
cost issues related to the prescription drug product information submitted to the board under
section 62J.90.
new text end
new text begin Subd. 6. new text end
new text begin Exemption. new text end
new text begin
Notwithstanding section 15.059, the advisory council shall not
expire.
new text end
Sec. 33.
new text begin
[62J.89] CONFLICTS OF INTEREST.
new text end
new text begin Subdivision 1. new text end
new text begin Definition. new text end
new text begin
(a) For purposes of this section, "conflict of interest" means
a financial or personal association that has the potential to bias or have the appearance of
biasing a person's decisions in matters related to the board or the advisory council, or in the
conduct of the board's or council's activities.
new text end
new text begin
(b) A conflict of interest includes any instance in which a person or a person's immediate
family member has received or could receive a direct or indirect financial benefit of any
amount deriving from the result or findings of a decision or determination of the board.
new text end
new text begin
(c) For purposes of this section, a person's immediate family member includes a spouse,
parent, child, or other legal dependent, or an in-law of any of the preceding individuals.
new text end
new text begin
(d) For purposes of this section, a financial benefit includes honoraria, fees, stock, the
value of stock holdings, and any direct financial benefit deriving from the finding of a review
conducted under sections 62J.85 to 62J.95.
new text end
new text begin
(e) Ownership of securities is not a conflict of interest if the securities are: (1) part of a
diversified mutual or exchange traded fund; or (2) in a tax-deferred or tax-exempt retirement
account that is administered by an independent trustee.
new text end
new text begin Subd. 2. new text end
new text begin General. new text end
new text begin
(a) A board or advisory council member, board staff member, or
third-party contractor must disclose any conflicts of interest to the appointing authority or
the board prior to the acceptance of an appointment, an offer of employment, or a contractual
agreement. The information disclosed must include the type, nature, and magnitude of the
interests involved.
new text end
new text begin
(b) A board member, board staff member, or third-party contractor with a conflict of
interest relating to any prescription drug product under review must recuse themselves from
any discussion, review, decision, or determination made by the board relating to the
prescription drug product.
new text end
new text begin
(c) Any conflict of interest must be disclosed in advance of the first meeting after the
conflict is identified or within five days after the conflict is identified, whichever is earlier.
new text end
new text begin Subd. 3. new text end
new text begin Prohibitions. new text end
new text begin
Board members, board staff, or third-party contractors are
prohibited from accepting gifts, bequeaths, or donations of services or property that raise
the specter of a conflict of interest or have the appearance of injecting bias into the activities
of the board.
new text end
Sec. 34.
new text begin
[62J.90] PRESCRIPTION DRUG PRICE INFORMATION; DECISION
TO CONDUCT COST REVIEW.
new text end
new text begin Subdivision 1. new text end
new text begin
Drug price information from the commissioner of health and other
sources.
new text end
new text begin
(a) The commissioner of health shall provide to the board the information reported
to the commissioner by drug manufacturers under section 62J.84, subdivisions 3, 4, and 5.
The commissioner shall provide this information to the board within 30 days of the date the
information is received from drug manufacturers.
new text end
new text begin
(b) The board shall subscribe to one or more prescription drug pricing files, such as
Medispan or FirstDatabank, or as otherwise determined by the board.
new text end
new text begin Subd. 2. new text end
new text begin Identification of certain prescription drug products. new text end
new text begin
(a) The board, in
consultation with the advisory council, shall identify the following prescription drug products:
new text end
new text begin
(1) brand name drugs or biologics for which the WAC increases by more than ten percent
or by more than $10,000 during any 12-month period or course of treatment if less than 12
months, after adjusting for changes in the consumer price index (CPI);
new text end
new text begin
(2) brand name drugs or biologics introduced at a WAC of $30,000 or more per calendar
year or per course of treatment;
new text end
new text begin
(3) biosimilar drugs introduced at a WAC that is not at least 15 percent lower than the
referenced brand name biologic at the time the biosimilar is introduced; and
new text end
new text begin
(4) generic drugs for which the WAC:
new text end
new text begin
(i) is $100 or more, after adjusting for changes in the CPI, for:
new text end
new text begin
(A) a 30-day supply lasting a patient for a period of 30 consecutive days based on the
recommended dosage approved for labeling by the United States Food and Drug
Administration (FDA);
new text end
new text begin
(B) a supply lasting a patient for fewer than 30 days based on recommended dosage
approved for labeling by the FDA; or
new text end
new text begin
(C) one unit of the drug if the labeling approved by the FDA does not recommend a
finite dosage; and
new text end
new text begin
(ii) has increased by 200 percent or more during the immediate preceding 12-month
period, as determined by the difference between the resulting WAC and the average of the
WAC reported over the preceding 12 months, after adjusting for changes in the CPI.
new text end
new text begin
(b) The board, in consultation with the advisory council, shall identify prescription drug
products not described in paragraph (a) that may impose costs that create significant
affordability challenges for the state health care system or for patients, including but not
limited to drugs to address public health emergencies.
new text end
new text begin
(c) The board shall make available to the public the names and related price information
of the prescription drug products identified under this subdivision, with the exception of
information determined by the board to be proprietary under the standards developed by
the board under section 62J.91, subdivision 4.
new text end
new text begin Subd. 3. new text end
new text begin Determination to proceed with review. new text end
new text begin
(a) The board may initiate a cost
review of a prescription drug product identified by the board under this section.
new text end
new text begin
(b) The board shall consider requests by the public for the board to proceed with a cost
review of any prescription drug product identified under this section.
new text end
new text begin
(c) If there is no consensus among the members of the board on whether or not to initiate
a cost review of a prescription drug product, any member of the board may request a vote
to determine whether or not to review the cost of the prescription drug product.
new text end
Sec. 35.
new text begin
[62J.91] PRESCRIPTION DRUG PRODUCT REVIEWS.
new text end
new text begin Subdivision 1. new text end
new text begin General. new text end
new text begin
Once the board decides to proceed with a cost review of a
prescription drug product, the board shall conduct the review and make a determination as
to whether appropriate utilization of the prescription drug under review, based on utilization
that is consistent with the United States Food and Drug Administration (FDA) label or
standard medical practice, has led or will lead to affordability challenges for the state health
care system or for patients.
new text end
new text begin Subd. 2. new text end
new text begin Review considerations. new text end
new text begin
In reviewing the cost of a prescription drug product,
the board may consider the following factors:
new text end
new text begin
(1) the price at which the prescription drug product has been and will be sold in the state;
new text end
new text begin
(2) the average monetary price concession, discount, or rebate the manufacturer provides
to a group purchaser in this state as reported by the manufacturer and the group purchaser,
expressed as a percent of the WAC for the prescription drug product under review;
new text end
new text begin
(3) the price at which therapeutic alternatives have been or will be sold in the state;
new text end
new text begin
(4) the average monetary price concession, discount, or rebate the manufacturer provides
or is expected to provide to a group purchaser or group purchasers in the state for therapeutic
alternatives;
new text end
new text begin
(5) the cost to group purchasers based on patient access consistent with the FDA-labeled
indications;
new text end
new text begin
(6) the impact on patient access resulting from the cost of the prescription drug product
relative to insurance benefit design;
new text end
new text begin
(7) the current or expected dollar value of drug-specific patient access programs supported
by manufacturers;
new text end
new text begin
(8) the relative financial impacts to health, medical, or other social services costs that
can be quantified and compared to baseline effects of existing therapeutic alternatives;
new text end
new text begin
(9) the average patient co-pay or other cost-sharing for the prescription drug product in
the state;
new text end
new text begin
(10) any information a manufacturer chooses to provide; and
new text end
new text begin
(11) any other factors as determined by the board.
new text end
new text begin Subd. 3. new text end
new text begin Further review factors. new text end
new text begin
If, after considering the factors described in subdivision
2, the board is unable to determine whether a prescription drug product will produce or has
produced an affordability challenge, the board may consider:
new text end
new text begin
(1) manufacturer research and development costs, as indicated on the manufacturer's
federal tax filing for the most recent tax year, in proportion to the manufacturer's sales in
the state;
new text end
new text begin
(2) the portion of direct-to-consumer marketing costs eligible for favorable federal tax
treatment in the most recent tax year that is specific to the prescription drug product under
review, multiplied by the ratio of total manufacturer in-state sales to total manufacturer
sales in the United States for the product under review;
new text end
new text begin
(3) gross and net manufacturer revenues for the most recent tax year;
new text end
new text begin
(4) any information and research related to the manufacturer's selection of the introductory
price or price increase, including but not limited to:
new text end
new text begin
(i) life cycle management;
new text end
new text begin
(ii) market competition and context; and
new text end
new text begin
(iii) projected revenue; and
new text end
new text begin
(5) any additional factors determined by the board to be relevant.
new text end
new text begin Subd. 4. new text end
new text begin Public data; proprietary information. new text end
new text begin
(a) Any submission made to the board
related to a drug cost review must be made available to the public with the exception of
information determined by the board to be proprietary.
new text end
new text begin
(b) The board shall establish the standards for the information to be considered proprietary
under paragraph (a) and section 62J.90, subdivision 2, including standards for heightened
consideration of proprietary information for submissions for a cost review of a drug that is
not yet approved by the FDA.
new text end
new text begin
(c) Prior to the board establishing the standards under paragraph (b), the public must be
provided notice and the opportunity to submit comments.
new text end
Sec. 36.
new text begin
[62J.92] DETERMINATIONS; COMPLIANCE; REMEDIES.
new text end
new text begin Subdivision 1. new text end
new text begin Upper payment limit. new text end
new text begin
(a) In the event the board finds that the spending
on a prescription drug product reviewed under section 62J.91 creates an affordability
challenge for the state health care system or for patients, the board shall establish an upper
payment limit after considering:
new text end
new text begin
(1) the cost of administering the drug;
new text end
new text begin
(2) the cost of delivering the drug to consumers;
new text end
new text begin
(3) the range of prices at which the drug is sold in the United States according to one or
more pricing files accessed under section 62J.90, subdivision 1, and the range at which
pharmacies are reimbursed in Canada; and
new text end
new text begin
(4) any other relevant pricing and administrative cost information for the drug.
new text end
new text begin
(b) The upper payment limit must apply to all public and private purchases, payments,
and payer reimbursements for the prescription drug products received by an individual in
the state in person, by mail, or by other means.
new text end
new text begin Subd. 2. new text end
new text begin Noncompliance. new text end
new text begin
(a) The failure of an entity to comply with an upper payment
limit established by the board under this section shall be referred to the Office of the Attorney
General.
new text end
new text begin
(b) If the Office of the Attorney General finds that an entity was noncompliant with the
upper payment limit requirements, the attorney general may pursue remedies consistent
with chapter 8 or appropriate criminal charges if there is evidence of intentional profiteering.
new text end
new text begin
(c) An entity that obtains price concessions from a drug manufacturer that result in a
lower net cost to the stakeholder than the upper payment limit established by the board must
not be considered to be in noncompliance.
new text end
new text begin
(d) The Office of the Attorney General may provide guidance to stakeholders concerning
activities that could be considered noncompliant.
new text end
new text begin Subd. 3. new text end
new text begin Appeals. new text end
new text begin
(a) Persons affected by a decision of the board may request an appeal
of the board's decision within 30 days of the date of the decision. The board shall hear the
appeal and render a decision within 60 days of the hearing.
new text end
new text begin
(b) All appeal decisions are subject to judicial review in accordance with chapter 14.
new text end
Sec. 37.
new text begin
[62J.93] REPORTS.
new text end
new text begin
Beginning March 1, 2023, and each March 1 thereafter, the board shall submit a report
to the governor and legislature on general price trends for prescription drug products and
the number of prescription drug products that were subject to the board's cost review and
analysis, including the result of any analysis and the number and disposition of appeals and
judicial reviews.
new text end
Sec. 38.
new text begin
[62J.94] ERISA PLANS AND MEDICARE DRUG PLANS.
new text end
new text begin
(a) Nothing in sections 62J.85 to 62J.95 shall be construed to require ERISA plans or
Medicare Part D plans to comply with decisions of the board. ERISA plans or Medicare
Part D plans may choose to exceed the upper payment limit established by the board under
section 62J.92.
new text end
new text begin
(b) Providers who dispense and administer drugs in the state must bill all payers no more
than the upper payment limit without regard to whether or not an ERISA plan or Medicare
Part D plan chooses to reimburse the provider in an amount greater than the upper payment
limit established by the board.
new text end
new text begin
(c) For purposes of this section, an ERISA plan or group health plan is an employee
welfare benefit plan established or maintained by an employer or an employee organization,
or both, that provides employer sponsored health coverage to employees and the employee's
dependents and is subject to the Employee Retirement Income Security Act of 1974 (ERISA).
new text end
Sec. 39.
new text begin
[62J.95] SEVERABILITY.
new text end
new text begin
If any provision of sections 62J.85 to 62J.94 or the application thereof to any person or
circumstance is held invalid for any reason in a court of competent jurisdiction, the invalidity
does not affect other provisions or any other application of sections 62J.85 to 62J.94 that
can be given effect without the invalid provision or application.
new text end
Sec. 40.
new text begin
[62Q.1842] PROHIBITION ON USE OF STEP THERAPY FOR
ANTIRETROVIRAL DRUGS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following definitions
apply.
new text end
new text begin
(b) "Health plan" has the meaning given in section 62Q.01, subdivision 3, and includes
health coverage provided by a managed care plan or a county-based purchasing plan
participating in a public program under chapter 256B or 256L or an integrated health
partnership under section 256B.0755.
new text end
new text begin
(c) "Step therapy protocol" has the meaning given in section 62Q.184.
new text end
new text begin Subd. 2. new text end
new text begin Prohibition on use of step therapy protocols. new text end
new text begin
A health plan that covers
antiretroviral drugs that are medically necessary for the prevention of HIV/AIDS, including
preexposure prophylaxis and postexposure prophylaxis, must not limit or exclude coverage
for the antiretroviral drugs by requiring prior authorization or by requiring an enrollee to
follow a step therapy protocol.
new text end
Sec. 41.
new text begin
[62Q.481] COST-SHARING FOR PRESCRIPTION DRUGS AND RELATED
MEDICAL SUPPLIES TO TREAT CHRONIC DISEASE.
new text end
new text begin Subdivision 1. new text end
new text begin Cost-sharing limits. new text end
new text begin
(a) A health plan must limit the amount of any
enrollee cost-sharing for prescription drugs prescribed to treat a chronic disease to no more
than $25 per one-month supply for each prescription drug and to no more than $50 per
month in total for all related medical supplies. Coverage under this section must not be
subject to any deductible.
new text end
new text begin
(b) If application of this section before an enrollee has met their plan's deductible would
result in health savings account ineligibility under United States Code, title 26, section 223,
then this section must apply to that specific prescription drug or related medical supply only
after the enrollee has met their plan's deductible.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have the
meanings given.
new text end
new text begin
(b) "Chronic disease" means diabetes, asthma, and allergies requiring the use of
epinephrine auto-injectors.
new text end
new text begin
(c) "Cost-sharing" means co-payments and coinsurance.
new text end
new text begin
(d) "Related medical supplies" means syringes, insulin pens, insulin pumps, epinephrine
auto-injectors, test strips, glucometers, continuous glucose monitors, and other medical
supply items necessary to effectively and appropriately administer a prescription drug
prescribed to treat a chronic disease.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, and applies to health
plans offered, issued, or renewed on or after that date.
new text end
Sec. 42.
new text begin
[62Q.524] COVERAGE FOR DRUGS TO PREVENT THE ACQUISITION
OF HUMAN IMMUNODEFICIENCY VIRUS.
new text end
new text begin
(a) A health plan that provides prescription drug coverage must provide coverage in
accordance with this section for:
new text end
new text begin
(1) any antiretroviral drug approved by the United States Food and Drug Administration
(FDA) for preventing the acquisition of human immunodeficiency virus (HIV) that is
prescribed, dispensed, or administered by a pharmacist who meets the requirements described
in section 151.37, subdivision 17; and
new text end
new text begin
(2) any laboratory testing necessary for therapy that uses the drugs described in clause
(1) that is ordered, performed, and interpreted by a pharmacist who meets the requirements
described in section 151.37, subdivision 17.
new text end
new text begin
(b) A health plan must provide the same terms of prescription drug coverage for drugs
to prevent the acquisition of HIV that are prescribed or administered by a pharmacist if the
pharmacist meets the requirements described in section 151.37, subdivision 17, as would
apply had the drug been prescribed or administered by a physician, physician assistant, or
advanced practice registered nurse. The health plan may require pharmacists or pharmacies
to meet reasonable medical management requirements when providing the services described
in paragraph (a) if other providers are required to meet the same requirements.
new text end
new text begin
(c) A health plan must reimburse an in-network pharmacist or pharmacy for the drugs
and testing described in paragraph (a) at a rate equal to the rate of reimbursement provided
to a physician, physician assistant, or advanced practice registered nurse if providing similar
services.
new text end
new text begin
(d) A health plan is not required to cover the drugs and testing described in paragraph
(a) if provided by a pharmacist or pharmacy that is out-of-network unless the health plan
covers similar services provided by out-of-network providers. A health plan must ensure
that the health plan's provider network includes in-network pharmacies that provide the
services described in paragraph (a).
new text end
Sec. 43.
new text begin
[62Q.83] PRESCRIPTION DRUG BENEFIT TRANSPARENCY AND
MANAGEMENT.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "Drug" has the meaning given in section 151.01, subdivision 5.
new text end
new text begin
(c) "Enrollee contract term" means the 12-month term during which benefits associated
with health plan company products are in effect. For managed care plans and county-based
purchasing plans under section 256B.69 and chapter 256L, enrollee contract term means a
single calendar quarter.
new text end
new text begin
(d) "Formulary" means a list of prescription drugs developed by clinical and pharmacy
experts that represents the health plan company's medically appropriate and cost-effective
prescription drugs approved for use.
new text end
new text begin
(e) "Health plan company" has the meaning given in section 62Q.01, subdivision 4, and
includes an entity that performs pharmacy benefits management for the health plan company.
For purposes of this paragraph, "pharmacy benefits management" means the administration
or management of prescription drug benefits provided by the health plan company for the
benefit of the plan's enrollees and may include but is not limited to procurement of
prescription drugs, clinical formulary development and management services, claims
processing, and rebate contracting and administration.
new text end
new text begin
(f) "Prescription" has the meaning given in section 151.01, subdivision 16a.
new text end
new text begin Subd. 2. new text end
new text begin Prescription drug benefit disclosure. new text end
new text begin
(a) A health plan company that provides
prescription drug benefit coverage and uses a formulary must make the plan's formulary
and related benefit information available by electronic means and, upon request, in writing
at least 30 days before annual renewal dates.
new text end
new text begin
(b) Formularies must be organized and disclosed consistent with the most recent version
of the United States Pharmacopeia's (USP) Model Guidelines.
new text end
new text begin
(c) For each item or category of items on the formulary, the specific enrollee benefit
terms must be identified, including enrollee cost-sharing and expected out-of-pocket costs.
new text end
new text begin Subd. 3. new text end
new text begin Formulary changes. new text end
new text begin
(a) Once a formulary has been established, a health plan
company may, at any time during the enrollee's contract term:
new text end
new text begin
(1) expand its formulary by adding drugs to the formulary;
new text end
new text begin
(2) reduce co-payments or coinsurance; or
new text end
new text begin
(3) move a drug to a benefit category that reduces an enrollee's cost.
new text end
new text begin
(b) A health plan company may remove a brand name drug from the plan's formulary
or place a brand name drug in a benefit category that increases an enrollee's cost only upon
the addition to the formulary of a generic or multisource brand name drug rated as
therapeutically equivalent according to the FDA Orange Book or a biologic drug rated as
interchangeable according to the FDA Purple Book at a lower cost to the enrollee, and upon
at least a 60-day notice to prescribers, pharmacists, and affected enrollees.
new text end
new text begin
(c) A health plan company may change utilization review requirements or move drugs
to a benefit category that increases an enrollee's cost during the enrollee's contract term
upon at least a 60-day notice to prescribers, pharmacists, and affected enrollees, provided
that these changes do not apply to enrollees who are currently taking the drugs affected by
these changes for the duration of the enrollee's contract term.
new text end
new text begin
(d) A health plan company may remove any drugs from the plan's formulary that have
been deemed unsafe by the Food and Drug Administration; that have been withdrawn by
either the Food and Drug Administration or the product manufacturer; or when an
independent source of research, clinical guidelines, or evidence-based standards has issued
drug-specific warnings or recommended changes in drug usage.
new text end
new text begin
(e) The state employee group insurance program and coverage offered through that
program are exempt from the requirements of this subdivision.
new text end
new text begin Subd. 4. new text end
new text begin Not severable. new text end
new text begin
(a) The provisions of this section are not severable from the
amendments and enactments in this act to sections 62A.02, subdivision 1; 62J.84,
subdivisions 2, 6, 7, 8, and 9; 62J.841; and 151.071, subdivision 2.
new text end
new text begin
(b) If any amendment or enactment listed in paragraph (a) or its application to any
individual, entity, or circumstance is found to be void for any reason, this section is also
void.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024, and applies to health
plans offered, sold, issued, or renewed on or after that date.
new text end
Sec. 44.
new text begin
[62W.0751] ALTERNATIVE BIOLOGICAL PRODUCTS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "Biological product" has the meaning given in section 151.01, subdivision 40.
new text end
new text begin
(c) "Biosimilar" or "biosimilar product" has the meaning given in section 151.01,
subdivision 43.
new text end
new text begin
(d) "Interchangeable biological product" has the meaning given in section 151.01,
subdivision 41.
new text end
new text begin
(e) "Reference biological product" has the meaning given in section 151.01, subdivision
44.
new text end
new text begin Subd. 2. new text end
new text begin
Pharmacy and provider choice related to dispensing reference biological
products, interchangeable biological products, or biosimilar products.
new text end
new text begin
(a)
Notwithstanding paragraph (b), a pharmacy benefit manager or health carrier must not
require or demonstrate a preference for a reference biological product administered to a
patient by a physician or health care provider or any product that is biosimilar to the reference
biological product or an interchangeable biological product administered to a patient by a
physician or health care provider.
new text end
new text begin
(b) If a pharmacy benefit manager or health carrier elects coverage of a product listed
in paragraph (a), and there are two or less biosimilar products available relative to the
reference product, the pharmacy benefit manager or health carrier must elect equivalent
coverage for all of the products that are biosimilar to the reference biological product or
interchangeable biological product.
new text end
new text begin
(c) If a pharmacy benefit manager or health carrier elects coverage of a product listed
in paragraph (a), and there are greater than two biosimilar products available relative to the
reference product, the pharmacy benefit manager or health carrier must elect preferential
coverage for all of the products that are biosimilar to the reference biological or
interchangeable biological products.
new text end
new text begin
(d) A pharmacy benefit manager or health carrier must not impose limits on access to a
product required to be covered under paragraph (b) that are more restrictive than limits
imposed on access to a product listed in paragraph (a), or that otherwise have the same
effect as giving preferred status to a product listed in paragraph (a) over the product required
to be covered under paragraph (b).
new text end
new text begin
(e) This section only applies to new administrations of a reference biological product.
Nothing in this section requires switching from a prescribed reference biological product
for a patient on an active course of treatment.
new text end
new text begin Subd. 3. new text end
new text begin Exemption. new text end
new text begin
The state employee group insurance program, and coverage offered
through that program, are exempt from the requirements of this section.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 45.
new text begin
[62W.15] CLINICIAN-ADMINISTERED DRUGS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "Affiliated pharmacy" means a pharmacy in which a pharmacy benefit manager or
health carrier has an ownership interest either directly or indirectly, or through an affiliate
or subsidiary.
new text end
new text begin
(c) "Clinician-administered drug" means an outpatient prescription drug other than a
vaccine that:
new text end
new text begin
(1) cannot reasonably be self-administered by the patient to whom the drug is prescribed
or by an individual assisting the patient with self-administration; and
new text end
new text begin
(2) is typically administered:
new text end
new text begin
(i) by a health care provider authorized to administer the drug, including when acting
under a physician's delegation and supervision; and
new text end
new text begin
(ii) in a physician's office, hospital outpatient infusion center, or other clinical setting.
new text end
new text begin Subd. 2. new text end
new text begin Prohibition on requiring coverage as a pharmacy benefit. new text end
new text begin
A pharmacy
benefit manager or health carrier shall not require that a clinician-administered drug or the
administration of a clinician-administered drug be covered as a pharmacy benefit.
new text end
new text begin Subd. 3. new text end
new text begin Enrollee choice. new text end
new text begin
A pharmacy benefit manager or health carrier:
new text end
new text begin
(1) shall permit an enrollee to obtain a clinician-administered drug from a health care
provider authorized to administer the drug, or a pharmacy;
new text end
new text begin
(2) shall not interfere with the enrollee's right to obtain a clinician-administered drug
from their provider or pharmacy of choice, and shall not offer financial or other incentives
to influence the enrollee's choice of a provider or pharmacy;
new text end
new text begin
(3) shall not require clinician-administered drugs to be dispensed by a pharmacy selected
by the pharmacy benefit manager or health carrier; and
new text end
new text begin
(4) shall not limit or exclude coverage for a clinician-administered drug when it is not
dispensed by a pharmacy selected by the pharmacy benefit manager or health carrier, if the
drug would otherwise be covered.
new text end
new text begin Subd. 4. new text end
new text begin Cost-sharing and reimbursement. new text end
new text begin
A pharmacy benefit manager or health
carrier:
new text end
new text begin
(1) may impose coverage or benefit limitations on an enrollee who obtains a
clinician-administered drug from a health care provider authorized to administer the drug,
or a pharmacy, only if these limitations would also be imposed were the drug to be obtained
from an affiliated pharmacy or a pharmacy selected by the pharmacy benefit manager or
health carrier; and
new text end
new text begin
(2) may impose cost-sharing requirements on an enrollee who obtains a
clinician-administered drug from a health care provider authorized to administer the drug,
or a pharmacy, only if these requirements would also be imposed were the drug to be obtained
from an affiliated pharmacy or a pharmacy selected by the pharmacy benefit manager or
health carrier.
new text end
new text begin Subd. 5. new text end
new text begin Other requirements. new text end
new text begin
A pharmacy benefit manager or health carrier:
new text end
new text begin
(1) shall not require or encourage the dispensing of a clinician-administered drug to an
enrollee in a manner that is inconsistent with the supply chain security controls and chain
of distribution set by the federal Drug Supply Chain Security Act, United States Code, title
21, section 360eee, et seq.;
new text end
new text begin
(2) shall not require a specialty pharmacy to dispense a clinician-administered medication
directly to a patient with the intention that the patient will transport the medication to a
health care provider for administration; and
new text end
new text begin
(3) may offer, but shall not require:
new text end
new text begin
(i) the use of a home infusion pharmacy to dispense or administer clinician-administered
drugs to enrollees; and
new text end
new text begin
(ii) the use of an infusion site external to the enrollee's provider office or clinic.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 46.
Minnesota Statutes 2020, section 151.01, subdivision 23, is amended to read:
Subd. 23.
Practitioner.
"Practitioner" means a licensed doctor of medicine, licensed
doctor of osteopathic medicine duly licensed to practice medicine, licensed doctor of
dentistry, licensed doctor of optometry, licensed podiatrist, licensed veterinarian, licensed
advanced practice registered nurse, or licensed physician assistant. For purposes of sections
151.15, subdivision 4; 151.211, subdivision 3; 151.252, subdivision 3; 151.37, subdivision
2, paragraph (b); and 151.461, "practitioner" also means a dental therapist authorized to
dispense and administer under chapter 150A. For purposes of sections 151.252, subdivision
3, and 151.461, "practitioner" also means a pharmacist authorized to prescribe
self-administered hormonal contraceptives, nicotine replacement medications, or opiate
antagonists under section 151.37, subdivision 14, 15, or 16new text begin , or authorized to prescribe drugs
to prevent the acquisition of human immunodeficiency virus (HIV) under section 151.37,
subdivision 17new text end .
Sec. 47.
Minnesota Statutes 2020, section 151.01, subdivision 27, is amended to read:
Subd. 27.
Practice of pharmacy.
"Practice of pharmacy" means:
(1) interpretation and evaluation of prescription drug orders;
(2) compounding, labeling, and dispensing drugs and devices (except labeling by a
manufacturer or packager of nonprescription drugs or commercially packaged legend drugs
and devices);
(3) participation in clinical interpretations and monitoring of drug therapy for assurance
of safe and effective use of drugs, including the performance of laboratory tests that are
waived under the federal Clinical Laboratory Improvement Act of 1988, United States Code,
title 42, section 263a et seq., provided that a pharmacist may interpret the results of laboratory
tests but may modify drug therapy only pursuant to a protocol or collaborative practice
agreement;
(4) participation in drug and therapeutic device selection; drug administration for first
dosage and medical emergencies; intramuscular and subcutaneous administration used for
the treatment of alcohol or opioid dependence; drug regimen reviews; and drug or
drug-related research;
(5) drug administration, through intramuscular and subcutaneous administration used
to treat mental illnesses as permitted under the following conditions:
(i) upon the order of a prescriber and the prescriber is notified after administration is
complete; or
(ii) pursuant to a protocol or collaborative practice agreement as defined by section
151.01, subdivisions 27b and 27c, and participation in the initiation, management,
modification, administration, and discontinuation of drug therapy is according to the protocol
or collaborative practice agreement between the pharmacist and a dentist, optometrist,
physician, podiatrist, or veterinarian, or an advanced practice registered nurse authorized
to prescribe, dispense, and administer under section 148.235. Any changes in drug therapy
or medication administration made pursuant to a protocol or collaborative practice agreement
must be documented by the pharmacist in the patient's medical record or reported by the
pharmacist to a practitioner responsible for the patient's care;
(6) participation in administration of influenza vaccines and vaccines approved by the
United States Food and Drug Administration related to COVID-19 or SARS-CoV-2 to all
eligible individuals six years of age and older and all other vaccines to patients 13 years of
age and older by written protocol with a physician licensed under chapter 147, a physician
assistant authorized to prescribe drugs under chapter 147A, or an advanced practice registered
nurse authorized to prescribe drugs under section 148.235, provided that:
(i) the protocol includes, at a minimum:
(A) the name, dose, and route of each vaccine that may be given;
(B) the patient population for whom the vaccine may be given;
(C) contraindications and precautions to the vaccine;
(D) the procedure for handling an adverse reaction;
(E) the name, signature, and address of the physician, physician assistant, or advanced
practice registered nurse;
(F) a telephone number at which the physician, physician assistant, or advanced practice
registered nurse can be contacted; and
(G) the date and time period for which the protocol is valid;
(ii) the pharmacist has successfully completed a program approved by the Accreditation
Council for Pharmacy Education specifically for the administration of immunizations or a
program approved by the board;
(iii) the pharmacist utilizes the Minnesota Immunization Information Connection to
assess the immunization status of individuals prior to the administration of vaccines, except
when administering influenza vaccines to individuals age nine and older;
(iv) the pharmacist reports the administration of the immunization to the Minnesota
Immunization Information Connection; and
(v) the pharmacist complies with guidelines for vaccines and immunizations established
by the federal Advisory Committee on Immunization Practices, except that a pharmacist
does not need to comply with those portions of the guidelines that establish immunization
schedules when administering a vaccine pursuant to a valid, patient-specific order issued
by a physician licensed under chapter 147, a physician assistant authorized to prescribe
drugs under chapter 147A, or an advanced practice registered nurse authorized to prescribe
drugs under section 148.235, provided that the order is consistent with the United States
Food and Drug Administration approved labeling of the vaccine;
(7) participation in the initiation, management, modification, and discontinuation of
drug therapy according to a written protocol or collaborative practice agreement between:
(i) one or more pharmacists and one or more dentists, optometrists, physicians, podiatrists,
or veterinarians; or (ii) one or more pharmacists and one or more physician assistants
authorized to prescribe, dispense, and administer under chapter 147A, or advanced practice
registered nurses authorized to prescribe, dispense, and administer under section 148.235.
Any changes in drug therapy made pursuant to a protocol or collaborative practice agreement
must be documented by the pharmacist in the patient's medical record or reported by the
pharmacist to a practitioner responsible for the patient's care;
(8) participation in the storage of drugs and the maintenance of records;
(9) patient counseling on therapeutic values, content, hazards, and uses of drugs and
devices;
(10) offering or performing those acts, services, operations, or transactions necessary
in the conduct, operation, management, and control of a pharmacy;
(11) participation in the initiation, management, modification, and discontinuation of
therapy with opiate antagonists, as defined in section 604A.04, subdivision 1, pursuant to:
(i) a written protocol as allowed under clause (7); or
(ii) a written protocol with a community health board medical consultant or a practitioner
designated by the commissioner of health, as allowed under section 151.37, subdivision 13;
deleted text begin and
deleted text end
(12) prescribing self-administered hormonal contraceptives; nicotine replacement
medications; and opiate antagonists for the treatment of an acute opiate overdose pursuant
to section 151.37, subdivision 14, 15, or 16deleted text begin .deleted text end new text begin ;
new text end
new text begin
(13) prescribing, dispensing, and administering drugs for preventing the acquisition of
human immunodeficiency virus (HIV) if the pharmacist meets the requirements under
section 151.37, subdivision 17; and
new text end
new text begin
(14) ordering, conducting, and interpreting laboratory tests necessary for therapies that
use drugs for preventing the acquisition of HIV, if the pharmacist meets the requirements
under section 151.37, subdivision 17.
new text end
Sec. 48.
Minnesota Statutes 2020, section 151.01, is amended by adding a subdivision to
read:
new text begin Subd. 43. new text end
new text begin Biosimilar product. new text end
new text begin
"Biosimilar product" or "interchangeable biologic product"
means a biological product that the United States Food and Drug Administration has licensed
and determined to be biosimilar under United States Code, title 42, section 262(i)(2).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 49.
Minnesota Statutes 2020, section 151.01, is amended by adding a subdivision to
read:
new text begin Subd. 44. new text end
new text begin Reference biological product. new text end
new text begin
"Reference biological product" means the
single biological product for which the United States Food and Drug Administration has
approved an initial biological product license application, against which other biological
products are evaluated for licensure as biosimilar products or interchangeable biological
products.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 50.
Minnesota Statutes 2020, section 151.071, subdivision 1, is amended to read:
Subdivision 1.
Forms of disciplinary action.
When the board finds that a licensee,
registrant, or applicant has engaged in conduct prohibited under subdivision 2, it may do
one or more of the following:
(1) deny the issuance of a license or registration;
(2) refuse to renew a license or registration;
(3) revoke the license or registration;
(4) suspend the license or registration;
(5) impose limitations, conditions, or both on the license or registration, including but
not limited to: the limitation of practice to designated settings; the limitation of the scope
of practice within designated settings; the imposition of retraining or rehabilitation
requirements; the requirement of practice under supervision; the requirement of participation
in a diversion program such as that established pursuant to section 214.31 or the conditioning
of continued practice on demonstration of knowledge or skills by appropriate examination
or other review of skill and competence;
(6) impose a civil penalty not exceeding $10,000 for each separate violation,new text begin except that
a civil penalty not exceeding $25,000 may be imposed for each separate violation of section
62J.842,new text end the amount of the civil penalty to be fixed so as to deprive a licensee or registrant
of any economic advantage gained by reason of the violation, to discourage similar violations
by the licensee or registrant or any other licensee or registrant, or to reimburse the board
for the cost of the investigation and proceeding, including but not limited to, fees paid for
services provided by the Office of Administrative Hearings, legal and investigative services
provided by the Office of the Attorney General, court reporters, witnesses, reproduction of
records, board members' per diem compensation, board staff time, and travel costs and
expenses incurred by board staff and board members; and
(7) reprimand the licensee or registrant.
Sec. 51.
Minnesota Statutes 2020, section 151.071, subdivision 2, is amended to read:
Subd. 2.
Grounds for disciplinary action.
The following conduct is prohibited and is
grounds for disciplinary action:
(1) failure to demonstrate the qualifications or satisfy the requirements for a license or
registration contained in this chapter or the rules of the board. The burden of proof is on
the applicant to demonstrate such qualifications or satisfaction of such requirements;
(2) obtaining a license by fraud or by misleading the board in any way during the
application process or obtaining a license by cheating, or attempting to subvert the licensing
examination process. Conduct that subverts or attempts to subvert the licensing examination
process includes, but is not limited to: (i) conduct that violates the security of the examination
materials, such as removing examination materials from the examination room or having
unauthorized possession of any portion of a future, current, or previously administered
licensing examination; (ii) conduct that violates the standard of test administration, such as
communicating with another examinee during administration of the examination, copying
another examinee's answers, permitting another examinee to copy one's answers, or
possessing unauthorized materials; or (iii) impersonating an examinee or permitting an
impersonator to take the examination on one's own behalf;
(3) for a pharmacist, pharmacy technician, pharmacist intern, applicant for a pharmacist
or pharmacy license, or applicant for a pharmacy technician or pharmacist intern registration,
conviction of a felony reasonably related to the practice of pharmacy. Conviction as used
in this subdivision includes a conviction of an offense that if committed in this state would
be deemed a felony without regard to its designation elsewhere, or a criminal proceeding
where a finding or verdict of guilt is made or returned but the adjudication of guilt is either
withheld or not entered thereon. The board may delay the issuance of a new license or
registration if the applicant has been charged with a felony until the matter has been
adjudicated;
(4) for a facility, other than a pharmacy, licensed or registered by the board, if an owner
or applicant is convicted of a felony reasonably related to the operation of the facility. The
board may delay the issuance of a new license or registration if the owner or applicant has
been charged with a felony until the matter has been adjudicated;
(5) for a controlled substance researcher, conviction of a felony reasonably related to
controlled substances or to the practice of the researcher's profession. The board may delay
the issuance of a registration if the applicant has been charged with a felony until the matter
has been adjudicated;
(6) disciplinary action taken by another state or by one of this state's health licensing
agencies:
(i) revocation, suspension, restriction, limitation, or other disciplinary action against a
license or registration in another state or jurisdiction, failure to report to the board that
charges or allegations regarding the person's license or registration have been brought in
another state or jurisdiction, or having been refused a license or registration by any other
state or jurisdiction. The board may delay the issuance of a new license or registration if an
investigation or disciplinary action is pending in another state or jurisdiction until the
investigation or action has been dismissed or otherwise resolved; and
(ii) revocation, suspension, restriction, limitation, or other disciplinary action against a
license or registration issued by another of this state's health licensing agencies, failure to
report to the board that charges regarding the person's license or registration have been
brought by another of this state's health licensing agencies, or having been refused a license
or registration by another of this state's health licensing agencies. The board may delay the
issuance of a new license or registration if a disciplinary action is pending before another
of this state's health licensing agencies until the action has been dismissed or otherwise
resolved;
(7) for a pharmacist, pharmacy, pharmacy technician, or pharmacist intern, violation of
any order of the board, of any of the provisions of this chapter or any rules of the board or
violation of any federal, state, or local law or rule reasonably pertaining to the practice of
pharmacy;
(8) for a facility, other than a pharmacy, licensed by the board, violations of any order
of the board, of any of the provisions of this chapter or the rules of the board or violation
of any federal, state, or local law relating to the operation of the facility;
(9) engaging in any unethical conduct; conduct likely to deceive, defraud, or harm the
public, or demonstrating a willful or careless disregard for the health, welfare, or safety of
a patient; or pharmacy practice that is professionally incompetent, in that it may create
unnecessary danger to any patient's life, health, or safety, in any of which cases, proof of
actual injury need not be established;
(10) aiding or abetting an unlicensed person in the practice of pharmacy, except that it
is not a violation of this clause for a pharmacist to supervise a properly registered pharmacy
technician or pharmacist intern if that person is performing duties allowed by this chapter
or the rules of the board;
(11) for an individual licensed or registered by the board, adjudication as mentally ill
or developmentally disabled, or as a chemically dependent person, a person dangerous to
the public, a sexually dangerous person, or a person who has a sexual psychopathic
personality, by a court of competent jurisdiction, within or without this state. Such
adjudication shall automatically suspend a license for the duration thereof unless the board
orders otherwise;
(12) for a pharmacist or pharmacy intern, engaging in unprofessional conduct as specified
in the board's rules. In the case of a pharmacy technician, engaging in conduct specified in
board rules that would be unprofessional if it were engaged in by a pharmacist or pharmacist
intern or performing duties specifically reserved for pharmacists under this chapter or the
rules of the board;
(13) for a pharmacy, operation of the pharmacy without a pharmacist present and on
duty except as allowed by a variance approved by the board;
(14) for a pharmacist, the inability to practice pharmacy with reasonable skill and safety
to patients by reason of illness, use of alcohol, drugs, narcotics, chemicals, or any other type
of material or as a result of any mental or physical condition, including deterioration through
the aging process or loss of motor skills. In the case of registered pharmacy technicians,
pharmacist interns, or controlled substance researchers, the inability to carry out duties
allowed under this chapter or the rules of the board with reasonable skill and safety to
patients by reason of illness, use of alcohol, drugs, narcotics, chemicals, or any other type
of material or as a result of any mental or physical condition, including deterioration through
the aging process or loss of motor skills;
(15) for a pharmacist, pharmacy, pharmacist intern, pharmacy technician, medical gas
dispenser, or controlled substance researcher, revealing a privileged communication from
or relating to a patient except when otherwise required or permitted by law;
(16) for a pharmacist or pharmacy, improper management of patient records, including
failure to maintain adequate patient records, to comply with a patient's request made pursuant
to sections 144.291 to 144.298, or to furnish a patient record or report required by law;
(17) fee splitting, including without limitation:
(i) paying, offering to pay, receiving, or agreeing to receive, a commission, rebate,
kickback, or other form of remuneration, directly or indirectly, for the referral of patients;
(ii) referring a patient to any health care provider as defined in sections 144.291 to
144.298 in which the licensee or registrant has a financial or economic interest as defined
in section 144.6521, subdivision 3, unless the licensee or registrant has disclosed the
licensee's or registrant's financial or economic interest in accordance with section 144.6521;
and
(iii) any arrangement through which a pharmacy, in which the prescribing practitioner
does not have a significant ownership interest, fills a prescription drug order and the
prescribing practitioner is involved in any manner, directly or indirectly, in setting the price
for the filled prescription that is charged to the patient, the patient's insurer or pharmacy
benefit manager, or other person paying for the prescription or, in the case of veterinary
patients, the price for the filled prescription that is charged to the client or other person
paying for the prescription, except that a veterinarian and a pharmacy may enter into such
an arrangement provided that the client or other person paying for the prescription is notified,
in writing and with each prescription dispensed, about the arrangement, unless such
arrangement involves pharmacy services provided for livestock, poultry, and agricultural
production systems, in which case client notification would not be required;
(18) engaging in abusive or fraudulent billing practices, including violations of the
federal Medicare and Medicaid laws or state medical assistance laws or rules;
(19) engaging in conduct with a patient that is sexual or may reasonably be interpreted
by the patient as sexual, or in any verbal behavior that is seductive or sexually demeaning
to a patient;
(20) failure to make reports as required by section 151.072 or to cooperate with an
investigation of the board as required by section 151.074;
(21) knowingly providing false or misleading information that is directly related to the
care of a patient unless done for an accepted therapeutic purpose such as the dispensing and
administration of a placebo;
(22) aiding suicide or aiding attempted suicide in violation of section 609.215 as
established by any of the following:
(i) a copy of the record of criminal conviction or plea of guilty for a felony in violation
of section 609.215, subdivision 1 or 2;
(ii) a copy of the record of a judgment of contempt of court for violating an injunction
issued under section 609.215, subdivision 4;
(iii) a copy of the record of a judgment assessing damages under section 609.215,
subdivision 5; or
(iv) a finding by the board that the person violated section 609.215, subdivision 1 or 2.
The board must investigate any complaint of a violation of section 609.215, subdivision 1
or 2;
(23) for a pharmacist, practice of pharmacy under a lapsed or nonrenewed license. For
a pharmacist intern, pharmacy technician, or controlled substance researcher, performing
duties permitted to such individuals by this chapter or the rules of the board under a lapsed
or nonrenewed registration. For a facility required to be licensed under this chapter, operation
of the facility under a lapsed or nonrenewed license or registration; deleted text begin and
deleted text end
(24) for a pharmacist, pharmacist intern, or pharmacy technician, termination or discharge
from the health professionals services program for reasons other than the satisfactory
completion of the programnew text begin ; and
new text end
new text begin (25) for a drug manufacturer, failure to comply with section 62J.841new text end .
Sec. 52.
Minnesota Statutes 2020, section 151.071, subdivision 2, is amended to read:
Subd. 2.
Grounds for disciplinary action.
The following conduct is prohibited and is
grounds for disciplinary action:
(1) failure to demonstrate the qualifications or satisfy the requirements for a license or
registration contained in this chapter or the rules of the board. The burden of proof is on
the applicant to demonstrate such qualifications or satisfaction of such requirements;
(2) obtaining a license by fraud or by misleading the board in any way during the
application process or obtaining a license by cheating, or attempting to subvert the licensing
examination process. Conduct that subverts or attempts to subvert the licensing examination
process includes, but is not limited to: (i) conduct that violates the security of the examination
materials, such as removing examination materials from the examination room or having
unauthorized possession of any portion of a future, current, or previously administered
licensing examination; (ii) conduct that violates the standard of test administration, such as
communicating with another examinee during administration of the examination, copying
another examinee's answers, permitting another examinee to copy one's answers, or
possessing unauthorized materials; or (iii) impersonating an examinee or permitting an
impersonator to take the examination on one's own behalf;
(3) for a pharmacist, pharmacy technician, pharmacist intern, applicant for a pharmacist
or pharmacy license, or applicant for a pharmacy technician or pharmacist intern registration,
conviction of a felony reasonably related to the practice of pharmacy. Conviction as used
in this subdivision includes a conviction of an offense that if committed in this state would
be deemed a felony without regard to its designation elsewhere, or a criminal proceeding
where a finding or verdict of guilt is made or returned but the adjudication of guilt is either
withheld or not entered thereon. The board may delay the issuance of a new license or
registration if the applicant has been charged with a felony until the matter has been
adjudicated;
(4) for a facility, other than a pharmacy, licensed or registered by the board, if an owner
or applicant is convicted of a felony reasonably related to the operation of the facility. The
board may delay the issuance of a new license or registration if the owner or applicant has
been charged with a felony until the matter has been adjudicated;
(5) for a controlled substance researcher, conviction of a felony reasonably related to
controlled substances or to the practice of the researcher's profession. The board may delay
the issuance of a registration if the applicant has been charged with a felony until the matter
has been adjudicated;
(6) disciplinary action taken by another state or by one of this state's health licensing
agencies:
(i) revocation, suspension, restriction, limitation, or other disciplinary action against a
license or registration in another state or jurisdiction, failure to report to the board that
charges or allegations regarding the person's license or registration have been brought in
another state or jurisdiction, or having been refused a license or registration by any other
state or jurisdiction. The board may delay the issuance of a new license or registration if an
investigation or disciplinary action is pending in another state or jurisdiction until the
investigation or action has been dismissed or otherwise resolved; and
(ii) revocation, suspension, restriction, limitation, or other disciplinary action against a
license or registration issued by another of this state's health licensing agencies, failure to
report to the board that charges regarding the person's license or registration have been
brought by another of this state's health licensing agencies, or having been refused a license
or registration by another of this state's health licensing agencies. The board may delay the
issuance of a new license or registration if a disciplinary action is pending before another
of this state's health licensing agencies until the action has been dismissed or otherwise
resolved;
(7) for a pharmacist, pharmacy, pharmacy technician, or pharmacist intern, violation of
any order of the board, of any of the provisions of this chapter or any rules of the board or
violation of any federal, state, or local law or rule reasonably pertaining to the practice of
pharmacy;
(8) for a facility, other than a pharmacy, licensed by the board, violations of any order
of the board, of any of the provisions of this chapter or the rules of the board or violation
of any federal, state, or local law relating to the operation of the facility;
(9) engaging in any unethical conduct; conduct likely to deceive, defraud, or harm the
public, or demonstrating a willful or careless disregard for the health, welfare, or safety of
a patient; or pharmacy practice that is professionally incompetent, in that it may create
unnecessary danger to any patient's life, health, or safety, in any of which cases, proof of
actual injury need not be established;
(10) aiding or abetting an unlicensed person in the practice of pharmacy, except that it
is not a violation of this clause for a pharmacist to supervise a properly registered pharmacy
technician or pharmacist intern if that person is performing duties allowed by this chapter
or the rules of the board;
(11) for an individual licensed or registered by the board, adjudication as mentally ill
or developmentally disabled, or as a chemically dependent person, a person dangerous to
the public, a sexually dangerous person, or a person who has a sexual psychopathic
personality, by a court of competent jurisdiction, within or without this state. Such
adjudication shall automatically suspend a license for the duration thereof unless the board
orders otherwise;
(12) for a pharmacist or pharmacy intern, engaging in unprofessional conduct as specified
in the board's rules. In the case of a pharmacy technician, engaging in conduct specified in
board rules that would be unprofessional if it were engaged in by a pharmacist or pharmacist
intern or performing duties specifically reserved for pharmacists under this chapter or the
rules of the board;
(13) for a pharmacy, operation of the pharmacy without a pharmacist present and on
duty except as allowed by a variance approved by the board;
(14) for a pharmacist, the inability to practice pharmacy with reasonable skill and safety
to patients by reason of illness, use of alcohol, drugs, narcotics, chemicals, or any other type
of material or as a result of any mental or physical condition, including deterioration through
the aging process or loss of motor skills. In the case of registered pharmacy technicians,
pharmacist interns, or controlled substance researchers, the inability to carry out duties
allowed under this chapter or the rules of the board with reasonable skill and safety to
patients by reason of illness, use of alcohol, drugs, narcotics, chemicals, or any other type
of material or as a result of any mental or physical condition, including deterioration through
the aging process or loss of motor skills;
(15) for a pharmacist, pharmacy, pharmacist intern, pharmacy technician, medical gas
dispenser, or controlled substance researcher, revealing a privileged communication from
or relating to a patient except when otherwise required or permitted by law;
(16) for a pharmacist or pharmacy, improper management of patient records, including
failure to maintain adequate patient records, to comply with a patient's request made pursuant
to sections 144.291 to 144.298, or to furnish a patient record or report required by law;
(17) fee splitting, including without limitation:
(i) paying, offering to pay, receiving, or agreeing to receive, a commission, rebate,
kickback, or other form of remuneration, directly or indirectly, for the referral of patients;
(ii) referring a patient to any health care provider as defined in sections 144.291 to
144.298 in which the licensee or registrant has a financial or economic interest as defined
in section 144.6521, subdivision 3, unless the licensee or registrant has disclosed the
licensee's or registrant's financial or economic interest in accordance with section 144.6521;
and
(iii) any arrangement through which a pharmacy, in which the prescribing practitioner
does not have a significant ownership interest, fills a prescription drug order and the
prescribing practitioner is involved in any manner, directly or indirectly, in setting the price
for the filled prescription that is charged to the patient, the patient's insurer or pharmacy
benefit manager, or other person paying for the prescription or, in the case of veterinary
patients, the price for the filled prescription that is charged to the client or other person
paying for the prescription, except that a veterinarian and a pharmacy may enter into such
an arrangement provided that the client or other person paying for the prescription is notified,
in writing and with each prescription dispensed, about the arrangement, unless such
arrangement involves pharmacy services provided for livestock, poultry, and agricultural
production systems, in which case client notification would not be required;
(18) engaging in abusive or fraudulent billing practices, including violations of the
federal Medicare and Medicaid laws or state medical assistance laws or rules;
(19) engaging in conduct with a patient that is sexual or may reasonably be interpreted
by the patient as sexual, or in any verbal behavior that is seductive or sexually demeaning
to a patient;
(20) failure to make reports as required by section 151.072 or to cooperate with an
investigation of the board as required by section 151.074;
(21) knowingly providing false or misleading information that is directly related to the
care of a patient unless done for an accepted therapeutic purpose such as the dispensing and
administration of a placebo;
(22) aiding suicide or aiding attempted suicide in violation of section 609.215 as
established by any of the following:
(i) a copy of the record of criminal conviction or plea of guilty for a felony in violation
of section 609.215, subdivision 1 or 2;
(ii) a copy of the record of a judgment of contempt of court for violating an injunction
issued under section 609.215, subdivision 4;
(iii) a copy of the record of a judgment assessing damages under section 609.215,
subdivision 5; or
(iv) a finding by the board that the person violated section 609.215, subdivision 1 or 2.
The board must investigate any complaint of a violation of section 609.215, subdivision 1
or 2;
(23) for a pharmacist, practice of pharmacy under a lapsed or nonrenewed license. For
a pharmacist intern, pharmacy technician, or controlled substance researcher, performing
duties permitted to such individuals by this chapter or the rules of the board under a lapsed
or nonrenewed registration. For a facility required to be licensed under this chapter, operation
of the facility under a lapsed or nonrenewed license or registration; deleted text begin and
deleted text end
(24) for a pharmacist, pharmacist intern, or pharmacy technician, termination or discharge
from the health professionals services program for reasons other than the satisfactory
completion of the programdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(25) for a manufacturer, a violation of section 62J.842 or 62J.845.
new text end
Sec. 53.
Minnesota Statutes 2021 Supplement, section 151.335, is amended to read:
151.335 DELIVERY THROUGH COMMON CARRIER; COMPLIANCE WITH
TEMPERATURE REQUIREMENTS.
In addition to complying with the requirements of Minnesota Rules, part 6800.3000, a
mail order or specialty pharmacy that employs the United States Postal Service or other
common carrier to deliver a filled prescription directly to a patient must ensure that the drug
is delivered in compliance with temperature requirements established by the manufacturer
of the drug. new text begin The methods used to ensure compliance must include but are not limited to
enclosing in each medication's packaging a device recognized by the United States
Pharmacopeia by which the patient can easily detect improper storage or temperature
variations. new text end The pharmacy must develop written policies and procedures that are consistent
with United States Pharmacopeia, chapters 1079 and 1118, and with nationally recognized
standards issued by standard-setting or accreditation organizations recognized by the board
through guidance. The policies and procedures must be provided to the board upon request.
Sec. 54.
Minnesota Statutes 2020, section 151.37, is amended by adding a subdivision to
read:
new text begin Subd. 17. new text end
new text begin Drugs for preventing the acquisition of HIV. new text end
new text begin
(a) A pharmacist is authorized
to prescribe and administer drugs to prevent the acquisition of human immunodeficiency
virus (HIV) in accordance with this subdivision.
new text end
new text begin
(b) By January 1, 2023, the board of pharmacy shall develop a standardized protocol
for a pharmacist to follow in prescribing the drugs described in paragraph (a). In developing
the protocol, the board may consult with community health advocacy groups, the board of
medical practice, the board of nursing, the commissioner of health, professional pharmacy
associations, and professional associations for physicians, physician assistants, and advanced
practice registered nurses.
new text end
new text begin
(c) Before a pharmacist is authorized to prescribe a drug described in paragraph (a), the
pharmacist must successfully complete a training program specifically developed for
prescribing drugs for preventing the acquisition of HIV that is offered by a college of
pharmacy, a continuing education provider that is accredited by the Accreditation Council
for Pharmacy Education, or a program approved by the board. To maintain authorization
to prescribe, the pharmacist shall complete continuing education requirements as specified
by the board.
new text end
new text begin
(d) Before prescribing a drug described in paragraph (a), the pharmacist shall follow the
appropriate standardized protocol developed under paragraph (b) and, if appropriate, may
dispense to a patient a drug described in paragraph (a).
new text end
new text begin
(e) Before dispensing a drug described under paragraph (a) that is prescribed by the
pharmacist, the pharmacist must provide counseling to the patient on the use of the drugs
and must provide the patient with a fact sheet that includes the indications and
contraindications for the use of these drugs, the appropriate method for using these drugs,
the need for medical follow up, and any other additional information listed in Minnesota
Rules, part 6800.0910, subpart 2, that is required to be provided to a patient during the
counseling process.
new text end
new text begin
(f) A pharmacist is prohibited from delegating the prescribing authority provided under
this subdivision to any other person. A pharmacist intern registered under section 151.101
may prepare the prescription, but before the prescription is processed or dispensed, a
pharmacist authorized to prescribe under this subdivision must review, approve, and sign
the prescription.
new text end
new text begin
(g) Nothing in this subdivision prohibits a pharmacist from participating in the initiation,
management, modification, and discontinuation of drug therapy according to a protocol as
authorized in this section and in section 151.01, subdivision 27.
new text end
Sec. 55.
Minnesota Statutes 2020, section 151.555, as amended by Laws 2021, chapter
30, article 5, sections 2 to 5, is amended to read:
151.555 deleted text begin PRESCRIPTION DRUGdeleted text end new text begin MEDICATIONnew text end REPOSITORY PROGRAM.
Subdivision 1.
Definitions.
(a) For the purposes of this section, the terms defined in this
subdivision have the meanings given.
(b) "Central repository" means a wholesale distributor that meets the requirements under
subdivision 3 and enters into a contract with the Board of Pharmacy in accordance with this
section.
(c) "Distribute" means to deliver, other than by administering or dispensing.
(d) "Donor" means:
(1) a health care facility as defined in this subdivision;
(2) a skilled nursing facility licensed under chapter 144A;
(3) an assisted living facility licensed under chapter 144G;
(4) a pharmacy licensed under section 151.19, and located either in the state or outside
the state;
(5) a drug wholesaler licensed under section 151.47;
(6) a drug manufacturer licensed under section 151.252; or
(7) an individual at least 18 years of age, provided that the drug or medical supply that
is donated was obtained legally and meets the requirements of this section for donation.
(e) "Drug" means any prescription drug that has been approved for medical use in the
United States, is listed in the United States Pharmacopoeia or National Formulary, and
meets the criteria established under this section for donation; or any over-the-counter
medication that meets the criteria established under this section for donation. This definition
includes cancer drugs and antirejection drugs, but does not include controlled substances,
as defined in section 152.01, subdivision 4, or a prescription drug that can only be dispensed
to a patient registered with the drug's manufacturer in accordance with federal Food and
Drug Administration requirements.
(f) "Health care facility" means:
(1) a physician's office or health care clinic where licensed practitioners provide health
care to patients;
(2) a hospital licensed under section 144.50;
(3) a pharmacy licensed under section 151.19 and located in Minnesota; or
(4) a nonprofit community clinic, including a federally qualified health center; a rural
health clinic; public health clinic; or other community clinic that provides health care utilizing
a sliding fee scale to patients who are low-income, uninsured, or underinsured.
(g) "Local repository" means a health care facility that elects to accept donated drugs
and medical supplies and meets the requirements of subdivision 4.
(h) "Medical supplies" or "supplies" means any prescription deleted text begin anddeleted text end new text begin ornew text end nonprescription
medical supplies needed to administer a deleted text begin prescriptiondeleted text end drug.
(i) "Original, sealed, unopened, tamper-evident packaging" means packaging that is
sealed, unopened, and tamper-evident, including a manufacturer's original unit dose or
unit-of-use container, a repackager's original unit dose or unit-of-use container, or unit-dose
packaging prepared by a licensed pharmacy according to the standards of Minnesota Rules,
part 6800.3750.
(j) "Practitioner" has the meaning given in section 151.01, subdivision 23, except that
it does not include a veterinarian.
Subd. 2.
Establishmentnew text begin ; contract and oversightnew text end .
new text begin (a) new text end By January 1, 2020, the Board of
Pharmacy shall establish a deleted text begin drugdeleted text end new text begin medicationnew text end repository program, through which donors may
donate a drug or medical supply for use by an individual who meets the eligibility criteria
specified under subdivision 5.
new text begin (b)new text end The board shall contract with a central repository that meets the requirements of
subdivision 3 to implement and administer the deleted text begin prescription drugdeleted text end new text begin medicationnew text end repository
program.new text begin The contract must:
new text end
new text begin
(1) require the board to transfer to the central repository any money appropriated by the
legislature for the purpose of operating the medication repository program and require the
central repository to spend any money transferred only for purposes specified in the contract;
new text end
new text begin
(2) require the central repository to report the following performance measures to the
board:
new text end
new text begin
(i) the number of individuals served and the types of medications these individuals
received;
new text end
new text begin
(ii) the number of clinics, pharmacies, and long-term care facilities with which the central
repository partnered;
new text end
new text begin
(iii) the number and cost of medications accepted for inventory, disposed of, and
dispensed to individuals in need; and
new text end
new text begin
(iv) locations within the state to which medications are shipped or delivered; and
new text end
new text begin
(3) require the board to annually audit the expenditure by the central repository of any
funds appropriated by the legislature and transferred by the board to ensure that this funding
is used only for purposes specified in the contract.
new text end
Subd. 3.
Central repository requirements.
(a) The board may publish a request for
proposal for participants who meet the requirements of this subdivision and are interested
in acting as the central repository for the deleted text begin drugdeleted text end new text begin medicationnew text end repository program. If the board
publishes a request for proposal, it shall follow all applicable state procurement procedures
in the selection process. The board may also work directly with the University of Minnesota
to establish a central repository.
(b) To be eligible to act as the central repository, the participant must be a wholesale
drug distributor located in Minnesota, licensed pursuant to section 151.47, and in compliance
with all applicable federal and state statutes, rules, and regulations.
(c) The central repository shall be subject to inspection by the board pursuant to section
151.06, subdivision 1.
(d) The central repository shall comply with all applicable federal and state laws, rules,
and regulations pertaining to the deleted text begin drugdeleted text end new text begin medicationnew text end repository program, drug storage, and
dispensing. The facility must maintain in good standing any state license or registration that
applies to the facility.
Subd. 4.
Local repository requirements.
(a) To be eligible for participation in the deleted text begin drugdeleted text end new text begin
medicationnew text end repository program, a health care facility must agree to comply with all applicable
federal and state laws, rules, and regulations pertaining to the deleted text begin drugdeleted text end new text begin medicationnew text end repository
program, drug storage, and dispensing. The facility must also agree to maintain in good
standing any required state license or registration that may apply to the facility.
(b) A local repository may elect to participate in the program by submitting the following
information to the central repository on a form developed by the board and made available
on the board's website:
(1) the name, street address, and telephone number of the health care facility and any
state-issued license or registration number issued to the facility, including the issuing state
agency;
(2) the name and telephone number of a responsible pharmacist or practitioner who is
employed by or under contract with the health care facility; and
(3) a statement signed and dated by the responsible pharmacist or practitioner indicating
that the health care facility meets the eligibility requirements under this section and agrees
to comply with this section.
(c) Participation in the deleted text begin drugdeleted text end new text begin medicationnew text end repository program is voluntary. A local
repository may withdraw from participation in the deleted text begin drugdeleted text end new text begin medicationnew text end repository program at
any time by providing written notice to the central repository on a form developed by the
board and made available on the board's website. The central repository shall provide the
board with a copy of the withdrawal notice within ten business days from the date of receipt
of the withdrawal notice.
Subd. 5.
Individual eligibility and application requirements.
(a) To be eligible for
the deleted text begin drugdeleted text end new text begin medicationnew text end repository program, an individual must submit to a local repository an
intake application form that is signed by the individual and attests that the individual:
(1) is a resident of Minnesota;
(2) is uninsured and is not enrolled in the medical assistance program under chapter
256B or the MinnesotaCare program under chapter 256L, has no prescription drug coverage,
or is underinsured;
(3) acknowledges that the drugs or medical supplies to be received through the program
may have been donated; and
(4) consents to a waiver of the child-resistant packaging requirements of the federal
Poison Prevention Packaging Act.
(b) Upon determining that an individual is eligible for the program, the local repository
shall furnish the individual with an identification card. The card shall be valid for one year
from the date of issuance and may be used at any local repository. A new identification card
may be issued upon expiration once the individual submits a new application form.
(c) The local repository shall send a copy of the intake application form to the central
repository by regular mail, facsimile, or secured e-mail within ten days from the date the
application is approved by the local repository.
(d) The board shall develop and make available on the board's website an application
form and the format for the identification card.
Subd. 6.
Standards and procedures for accepting donations of drugs and supplies.
(a)
A donor may donate deleted text begin prescriptiondeleted text end drugs or medical supplies to the central repository or a
local repository if the drug or supply meets the requirements of this section as determined
by a pharmacist or practitioner who is employed by or under contract with the central
repository or a local repository.
(b) A deleted text begin prescriptiondeleted text end drug is eligible for donation under the deleted text begin drugdeleted text end new text begin medicationnew text end repository
program if the following requirements are met:
(1) the donation is accompanied by a deleted text begin drugdeleted text end new text begin medicationnew text end repository donor form described
under paragraph (d) that is signed by an individual who is authorized by the donor to attest
to the donor's knowledge in accordance with paragraph (d);
(2) the drug's expiration date is at least six months after the date the drug was donated.
If a donated drug bears an expiration date that is less than six months from the donation
date, the drug may be accepted and distributed if the drug is in high demand and can be
dispensed for use by a patient before the drug's expiration date;
(3) the drug is in its original, sealed, unopened, tamper-evident packaging that includes
the expiration date. Single-unit-dose drugs may be accepted if the single-unit-dose packaging
is unopened;
(4) the drug or the packaging does not have any physical signs of tampering, misbranding,
deterioration, compromised integrity, or adulteration;
(5) the drug does not require storage temperatures other than normal room temperature
as specified by the manufacturer or United States Pharmacopoeia, unless the drug is being
donated directly by its manufacturer, a wholesale drug distributor, or a pharmacy located
in Minnesota; and
(6) the deleted text begin prescriptiondeleted text end drug is not a controlled substance.
(c) A medical supply is eligible for donation under the deleted text begin drugdeleted text end new text begin medicationnew text end repository
program if the following requirements are met:
(1) the supply has no physical signs of tampering, misbranding, or alteration and there
is no reason to believe it has been adulterated, tampered with, or misbranded;
(2) the supply is in its original, unopened, sealed packaging;
(3) the donation is accompanied by a deleted text begin drugdeleted text end new text begin medicationnew text end repository donor form described
under paragraph (d) that is signed by an individual who is authorized by the donor to attest
to the donor's knowledge in accordance with paragraph (d); and
(4) if the supply bears an expiration date, the date is at least six months later than the
date the supply was donated. If the donated supply bears an expiration date that is less than
six months from the date the supply was donated, the supply may be accepted and distributed
if the supply is in high demand and can be dispensed for use by a patient before the supply's
expiration date.
(d) The board shall develop the deleted text begin drugdeleted text end new text begin medicationnew text end repository donor form and make it
available on the board's website. The form must state that to the best of the donor's knowledge
the donated drug or supply has been properly stored under appropriate temperature and
humidity conditions and that the drug or supply has never been opened, used, tampered
with, adulterated, or misbranded.
(e) Donated drugs and supplies may be shipped or delivered to the premises of the central
repository or a local repository, and shall be inspected by a pharmacist or an authorized
practitioner who is employed by or under contract with the repository and who has been
designated by the repository to accept donations. A drop box must not be used to deliver
or accept donations.
(f) The central repository and local repository shall inventory all drugs and supplies
donated to the repository. For each drug, the inventory must include the drug's name, strength,
quantity, manufacturer, expiration date, and the date the drug was donated. For each medical
supply, the inventory must include a description of the supply, its manufacturer, the date
the supply was donated, and, if applicable, the supply's brand name and expiration date.
Subd. 7.
Standards and procedures for inspecting and storing donated deleted text begin prescriptiondeleted text end
drugs and supplies.
(a) A pharmacist or authorized practitioner who is employed by or
under contract with the central repository or a local repository shall inspect all donated
deleted text begin prescriptiondeleted text end drugs and supplies before the drug or supply is dispensed to determine, to the
extent reasonably possible in the professional judgment of the pharmacist or practitioner,
that the drug or supply is not adulterated or misbranded, has not been tampered with, is safe
and suitable for dispensing, has not been subject to a recall, and meets the requirements for
donation. The pharmacist or practitioner who inspects the drugs or supplies shall sign an
inspection record stating that the requirements for donation have been met. If a local
repository receives drugs and supplies from the central repository, the local repository does
not need to reinspect the drugs and supplies.
(b) The central repository and local repositories shall store donated drugs and supplies
in a secure storage area under environmental conditions appropriate for the drug or supply
being stored. Donated drugs and supplies may not be stored with nondonated inventory.
(c) The central repository and local repositories shall dispose of all deleted text begin prescriptiondeleted text end drugs
and medical supplies that are not suitable for donation in compliance with applicable federal
and state statutes, regulations, and rules concerning hazardous waste.
(d) In the event that controlled substances or deleted text begin prescriptiondeleted text end drugs that can only be dispensed
to a patient registered with the drug's manufacturer are shipped or delivered to a central or
local repository for donation, the shipment delivery must be documented by the repository
and returned immediately to the donor or the donor's representative that provided the drugs.
(e) Each repository must develop drug and medical supply recall policies and procedures.
If a repository receives a recall notification, the repository shall destroy all of the drug or
medical supply in its inventory that is the subject of the recall and complete a record of
destruction form in accordance with paragraph (f). If a drug or medical supply that is the
subject of a Class I or Class II recall has been dispensed, the repository shall immediately
notify the recipient of the recalled drug or medical supply. A drug that potentially is subject
to a recall need not be destroyed if its packaging bears a lot number and that lot of the drug
is not subject to the recall. If no lot number is on the drug's packaging, it must be destroyed.
(f) A record of destruction of donated drugs and supplies that are not dispensed under
subdivision 8, are subject to a recall under paragraph (e), or are not suitable for donation
shall be maintained by the repository for at least two years. For each drug or supply destroyed,
the record shall include the following information:
(1) the date of destruction;
(2) the name, strength, and quantity of the drug destroyed; and
(3) the name of the person or firm that destroyed the drug.
Subd. 8.
Dispensing requirements.
(a) Donated drugs and supplies may be dispensed
if the drugs or supplies are prescribed by a practitioner for use by an eligible individual and
are dispensed by a pharmacist or practitioner. A repository shall dispense drugs and supplies
to eligible individuals in the following priority order: (1) individuals who are uninsured;
(2) individuals with no prescription drug coverage; and (3) individuals who are underinsured.
A repository shall dispense donated deleted text begin prescriptiondeleted text end drugs in compliance with applicable federal
and state laws and regulations for dispensing deleted text begin prescriptiondeleted text end drugs, including all requirements
relating to packaging, labeling, record keeping, drug utilization review, and patient
counseling.
(b) Before dispensing or administering a drug or supply, the pharmacist or practitioner
shall visually inspect the drug or supply for adulteration, misbranding, tampering, and date
of expiration. Drugs or supplies that have expired or appear upon visual inspection to be
adulterated, misbranded, or tampered with in any way must not be dispensed or administered.
(c) Before a drug or supply is dispensed or administered to an individual, the individual
must sign a drug repository recipient form acknowledging that the individual understands
the information stated on the form. The board shall develop the form and make it available
on the board's website. The form must include the following information:
(1) that the drug or supply being dispensed or administered has been donated and may
have been previously dispensed;
(2) that a visual inspection has been conducted by the pharmacist or practitioner to ensure
that the drug or supply has not expired, has not been adulterated or misbranded, and is in
its original, unopened packaging; and
(3) that the dispensing pharmacist, the dispensing or administering practitioner, the
central repository or local repository, the Board of Pharmacy, and any other participant of
the deleted text begin drugdeleted text end new text begin medicationnew text end repository program cannot guarantee the safety of the drug or medical
supply being dispensed or administered and that the pharmacist or practitioner has determined
that the drug or supply is safe to dispense or administer based on the accuracy of the donor's
form submitted with the donated drug or medical supply and the visual inspection required
to be performed by the pharmacist or practitioner before dispensing or administering.
Subd. 9.
Handling fees.
(a) The central or local repository may charge the individual
receiving a drug or supply a handling fee of no more than 250 percent of the medical
assistance program dispensing fee for each drug or medical supply dispensed or administered
by that repository.
(b) A repository that dispenses or administers a drug or medical supply through the drug
repository program shall not receive reimbursement under the medical assistance program
or the MinnesotaCare program for that dispensed or administered drug or supply.
Subd. 10.
Distribution of donated drugs and supplies.
(a) The central repository and
local repositories may distribute drugs and supplies donated under the drug repository
program to other participating repositories for use pursuant to this program.
(b) A local repository that elects not to dispense donated drugs or supplies must transfer
all donated drugs and supplies to the central repository. A copy of the donor form that was
completed by the original donor under subdivision 6 must be provided to the central
repository at the time of transfer.
Subd. 11.
Forms and record-keeping requirements.
(a) The following forms developed
for the administration of this program shall be utilized by the participants of the program
and shall be available on the board's website:
(1) intake application form described under subdivision 5;
(2) local repository participation form described under subdivision 4;
(3) local repository withdrawal form described under subdivision 4;
(4) deleted text begin drugdeleted text end new text begin medicationnew text end repository donor form described under subdivision 6;
(5) record of destruction form described under subdivision 7; and
(6) deleted text begin drugdeleted text end new text begin medicationnew text end repository recipient form described under subdivision 8.
(b) All records, including drug inventory, inspection, and disposal of donated deleted text begin prescriptiondeleted text end
drugs and medical supplies, must be maintained by a repository for a minimum of two years.
Records required as part of this program must be maintained pursuant to all applicable
practice acts.
(c) Data collected by the deleted text begin drugdeleted text end new text begin medicationnew text end repository program from all local repositories
shall be submitted quarterly or upon request to the central repository. Data collected may
consist of the information, records, and forms required to be collected under this section.
(d) The central repository shall submit reports to the board as required by the contract
or upon request of the board.
Subd. 12.
Liability.
(a) The manufacturer of a drug or supply is not subject to criminal
or civil liability for injury, death, or loss to a person or to property for causes of action
described in clauses (1) and (2). A manufacturer is not liable for:
(1) the intentional or unintentional alteration of the drug or supply by a party not under
the control of the manufacturer; or
(2) the failure of a party not under the control of the manufacturer to transfer or
communicate product or consumer information or the expiration date of the donated drug
or supply.
(b) A health care facility participating in the program, a pharmacist dispensing a drug
or supply pursuant to the program, a practitioner dispensing or administering a drug or
supply pursuant to the program, or a donor of a drug or medical supply is immune from
civil liability for an act or omission that causes injury to or the death of an individual to
whom the drug or supply is dispensed and no disciplinary action by a health-related licensing
board shall be taken against a pharmacist or practitioner so long as the drug or supply is
donated, accepted, distributed, and dispensed according to the requirements of this section.
This immunity does not apply if the act or omission involves reckless, wanton, or intentional
misconduct, or malpractice unrelated to the quality of the drug or medical supply.
Subd. 13.
Drug returned for credit.
Nothing in this section allows a long-term care
facility to donate a drug to a central or local repository when federal or state law requires
the drug to be returned to the pharmacy that initially dispensed it, so that the pharmacy can
credit the payer for the amount of the drug returned.
Subd. 14.
Cooperation.
The central repository, as approved by the Board of Pharmacy,
may enter into an agreement with another state that has an established drug repository or
drug donation program if the other state's program includes regulations to ensure the purity,
integrity, and safety of the drugs and supplies donated, to permit the central repository to
offer to another state program inventory that is not needed by a Minnesota resident and to
accept inventory from another state program to be distributed to local repositories and
dispensed to Minnesota residents in accordance with this program.
new text begin Subd. 15. new text end
new text begin Funding. new text end
new text begin
The central repository may seek grants and other funds from nonprofit
charitable organizations, the federal government, and other sources to fund the ongoing
operations of the medication repository program.
new text end
Sec. 56.
Minnesota Statutes 2020, section 152.125, is amended to read:
152.125 INTRACTABLE PAIN.
Subdivision 1.
deleted text begin Definitiondeleted text end new text begin Definitionsnew text end .
new text begin (a) new text end For purposes of this section, new text begin the terms in this
subdivision have the meanings given.
new text end
new text begin
(b) "Drug diversion" means the unlawful transfer of prescription drugs from their licit
medical purpose to the illicit marketplace.
new text end
new text begin (c) new text end "Intractable pain" means a pain state in which the cause of the pain cannot be removed
or otherwise treated with the consent of the patient and in which, in the generally accepted
course of medical practice, no relief or cure of the cause of the pain is possible, or none has
been found after reasonable efforts. new text begin Conditions associated with intractable pain include but
are not limited to cancer and the recovery period, sickle cell disease, noncancer pain, rare
diseases, orphan diseases, severe injuries, and health conditions requiring the provision of
palliative care or hospice care. new text end Reasonable efforts for relieving or curing the cause of the
pain may be determined on the basis of, but are not limited to, the following:
(1) when treating a nonterminally ill patient for intractable pain, new text begin an new text end evaluation new text begin conducted
new text end by the attending physician and one or more physicians specializing in pain medicine or the
treatment of the area, system, or organ of the body new text begin confirmed or new text end perceived as the source of
the new text begin intractable new text end pain; or
(2) when treating a terminally ill patient, new text begin an new text end evaluation new text begin conducted new text end by the attending
physician who does so in accordance with new text begin the standard of care and new text end the level of care, skill,
and treatment that would be recognized by a reasonably prudent physician under similar
conditions and circumstances.
new text begin
(d) "Palliative care" has the meaning provided in section 144A.75, subdivision 12.
new text end
new text begin
(e) "Rare disease" means a disease, disorder, or condition that affects fewer than 200,000
individuals in the United States and is chronic, serious, life altering, or life threatening.
new text end
new text begin Subd. 1a. new text end
new text begin Criteria for the evaluation and treatment of intractable pain. new text end
new text begin
The evaluation
and treatment of intractable pain when treating a nonterminally ill patient is governed by
the following criteria:
new text end
new text begin
(1) a diagnosis of intractable pain by the treating physician and either by a physician
specializing in pain medicine or a physician treating the area, system, or organ of the body
that is the source of the pain is sufficient to meet the definition of intractable pain; and
new text end
new text begin
(2) the cause of the diagnosis of intractable pain must not interfere with medically
necessary treatment including but not limited to prescribing or administering a controlled
substance in Schedules II to V of section 152.02.
new text end
Subd. 2.
Prescription and administration of controlled substances for intractable
pain.
new text begin (a) new text end Notwithstanding any other provision of this chapter, a physiciannew text begin , advanced practice
registered nurse, or physician assistantnew text end may prescribe or administer a controlled substance
in Schedules II to V of section 152.02 to deleted text begin an individualdeleted text end new text begin a patientnew text end in the course of the
physician'snew text begin , advanced practice registered nurse's, or physician assistant'snew text end treatment of the
deleted text begin individualdeleted text end new text begin patientnew text end for a diagnosed condition causing intractable pain. No physiciannew text begin , advanced
practice registered nurse, or physician assistantnew text end shall be subject to disciplinary action by
the Board of Medical Practice new text begin or Board of Nursing new text end for appropriately prescribing or
administering a controlled substance in Schedules II to V of section 152.02 in the course
of treatment of deleted text begin an individualdeleted text end new text begin a patientnew text end for intractable pain, provided the physiciannew text begin , advanced
practice registered nurse, or physician assistant:
new text end
new text begin (1) new text end keeps accurate records of the purpose, use, prescription, and disposal of controlled
substances, writes accurate prescriptions, and prescribes medications in conformance with
chapter 147deleted text begin .deleted text end new text begin or 148 or in accordance with the current standard of care; and
new text end
new text begin
(2) enters into a patient-provider agreement that meets the criteria in subdivision 5.
new text end
new text begin
(b) No physician, advanced practice registered nurse, or physician assistant, acting in
good faith and based on the needs of the patient, shall be subject to any civil or criminal
action or investigation, disenrollment, or termination by the commissioner of health or
human services solely for prescribing a dosage that equates to an upward deviation from
morphine milligram equivalent dosage recommendations or thresholds specified in state or
federal opioid prescribing guidelines or policies, including but not limited to the Guideline
for Prescribing Opioids for Chronic Pain issued by the Centers for Disease Control and
Prevention, Minnesota opioid prescribing guidelines, the Minnesota opioid prescribing
improvement program, and the Minnesota quality improvement program established under
section 256B.0638.
new text end
new text begin
(c) A physician, advanced practice registered nurse, or physician assistant treating
intractable pain by prescribing, dispensing, or administering a controlled substance in
Schedules II to V of section 152.02 that includes but is not opioid analgesics must not taper
a patient's medication dosage solely to meet a predetermined morphine milligram equivalent
dosage recommendation or threshold if the patient is stable and compliant with the treatment
plan, is experiencing no serious harm from the level of medication currently being prescribed
or previously prescribed, and is in compliance with the patient-provider agreement as
described in subdivision 5.
new text end
new text begin
(d) A physician's, advanced practice registered nurse's, or physician assistant's decision
to taper a patient's medication dosage must be based on factors other than a morphine
milligram equivalent recommendation or threshold.
new text end
new text begin
(e) No pharmacist, health plan company, or pharmacy benefit manager shall refuse to
fill a prescription for an opiate issued by a licensed practitioner with the authority to prescribe
opiates solely based on the prescription exceeding a predetermined morphine milligram
equivalent dosage recommendation or threshold.
new text end
Subd. 3.
Limits on applicability.
This section does not apply to:
(1) a physician'snew text begin , advanced practice registered nurse's, or physician assistant'snew text end treatment
of deleted text begin an individualdeleted text end new text begin a patientnew text end for chemical dependency resulting from the use of controlled
substances in Schedules II to V of section 152.02;
(2) the prescription or administration of controlled substances in Schedules II to V of
section 152.02 to deleted text begin an individualdeleted text end new text begin a patientnew text end whom the physiciannew text begin , advanced practice registered
nurse, or physician assistantnew text end knows to be using the controlled substances for nontherapeutic
new text begin or drug diversion new text end purposes;
(3) the prescription or administration of controlled substances in Schedules II to V of
section 152.02 for the purpose of terminating the life of deleted text begin an individualdeleted text end new text begin a patientnew text end having
intractable pain; or
(4) the prescription or administration of a controlled substance in Schedules II to V of
section 152.02 that is not a controlled substance approved by the United States Food and
Drug Administration for pain relief.
Subd. 4.
Notice of risks.
Prior to treating deleted text begin an individualdeleted text end new text begin a patientnew text end for intractable pain in
accordance with subdivision 2, a physiciannew text begin , advanced practice registered nurse, or physician
assistantnew text end shall discuss with the deleted text begin individualdeleted text end new text begin patient or the patient's legal guardian, if applicable,new text end
the risks associated with the controlled substances in Schedules II to V of section 152.02
to be prescribed or administered in the course of the physician'snew text begin , advanced practice registered
nurse's, or physician assistant'snew text end treatment of deleted text begin an individualdeleted text end new text begin a patientnew text end , and document the
discussion in the deleted text begin individual'sdeleted text end new text begin patient'snew text end recordnew text begin as required in the patient-provider agreement
described in subdivision 5new text end .
new text begin Subd. 5. new text end
new text begin Patient-provider agreement. new text end
new text begin
(a) Before treating a patient for intractable pain,
a physician, advanced practice registered nurse, or physician assistant and the patient or the
patient's legal guardian, if applicable, must mutually agree to the treatment and enter into
a provider-patient agreement. The agreement must include a description of the prescriber's
and the patient's expectations, responsibilities, and rights according to best practices and
current standards of care.
new text end
new text begin
(b) The agreement must be signed by the patient or the patient's legal guardian, if
applicable, and the physician, advanced practice registered nurse, or physician assistant and
included in the patient's medical records. A copy of the signed agreement must be provided
to the patient.
new text end
new text begin
(c) The agreement must be reviewed by the patient and the physician, advanced practice
registered nurse, or physician assistant annually. If there is a change in the patient's treatment
plan, the agreement must be updated and a revised agreement must be signed by the patient
or the patient's legal guardian. A copy of the revised agreement must be included in the
patient's medical record and a copy must be provided to the patient.
new text end
new text begin
(d) A patient-provider agreement is not required in an emergency or inpatient hospital
setting.
new text end
Sec. 57.
Minnesota Statutes 2021 Supplement, section 256B.0625, subdivision 13, is
amended to read:
Subd. 13.
Drugs.
(a) Medical assistance covers drugs, except for fertility drugs when
specifically used to enhance fertility, if prescribed by a licensed practitioner and dispensed
by a licensed pharmacist, by a physician enrolled in the medical assistance program as a
dispensing physician, or by a physician, a physician assistant, or an advanced practice
registered nurse employed by or under contract with a community health board as defined
in section 145A.02, subdivision 5, for the purposes of communicable disease control.
(b) The dispensed quantity of a prescription drug must not exceed a 34-day supply,
unless authorized by the commissioner or the drug appears on the 90-day supply list published
by the commissioner. The 90-day supply list shall be published by the commissioner on the
department's website. The commissioner may add to, delete from, and otherwise modify
the 90-day supply list after providing public notice and the opportunity for a 15-day public
comment period. The 90-day supply list may include cost-effective generic drugs and shall
not include controlled substances.
(c) For the purpose of this subdivision and subdivision 13d, an "active pharmaceutical
ingredient" is defined as a substance that is represented for use in a drug and when used in
the manufacturing, processing, or packaging of a drug becomes an active ingredient of the
drug product. An "excipient" is defined as an inert substance used as a diluent or vehicle
for a drug. The commissioner shall establish a list of active pharmaceutical ingredients and
excipients which are included in the medical assistance formulary. Medical assistance covers
selected active pharmaceutical ingredients and excipients used in compounded prescriptions
when the compounded combination is specifically approved by the commissioner or when
a commercially available product:
(1) is not a therapeutic option for the patient;
(2) does not exist in the same combination of active ingredients in the same strengths
as the compounded prescription; and
(3) cannot be used in place of the active pharmaceutical ingredient in the compounded
prescription.
(d) Medical assistance covers the following over-the-counter drugs when prescribed by
a licensed practitioner or by a licensed pharmacist who meets standards established by the
commissioner, in consultation with the board of pharmacy: antacids, acetaminophen, family
planning products, aspirin, insulin, products for the treatment of lice, vitamins for adults
with documented vitamin deficiencies, vitamins for children under the age of seven and
pregnant or nursing women, and any other over-the-counter drug identified by the
commissioner, in consultation with the Formulary Committee, as necessary, appropriate,
and cost-effective for the treatment of certain specified chronic diseases, conditions, or
disorders, and this determination shall not be subject to the requirements of chapter 14. A
pharmacist may prescribe over-the-counter medications as provided under this paragraph
for purposes of receiving reimbursement under Medicaid. When prescribing over-the-counter
drugs under this paragraph, licensed pharmacists must consult with the recipient to determine
necessity, provide drug counseling, review drug therapy for potential adverse interactions,
and make referrals as needed to other health care professionals.
(e) Effective January 1, 2006, medical assistance shall not cover drugs that are coverable
under Medicare Part D as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-2(e), for individuals eligible
for drug coverage as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-1(a)(3)(A). For these
individuals, medical assistance may cover drugs from the drug classes listed in United States
Code, title 42, section 1396r-8(d)(2), subject to this subdivision and subdivisions 13a to
13g, except that drugs listed in United States Code, title 42, section 1396r-8(d)(2)(E), shall
not be covered.
(f) Medical assistance covers drugs acquired through the federal 340B Drug Pricing
Program and dispensed by 340B covered entities and ambulatory pharmacies under common
ownership of the 340B covered entity. Medical assistance does not cover drugs acquired
through the federal 340B Drug Pricing Program and dispensed by 340B contract pharmacies.
(g) Notwithstanding paragraph (a), medical assistance covers self-administered hormonal
contraceptives prescribed and dispensed by a licensed pharmacist in accordance with section
151.37, subdivision 14; nicotine replacement medications prescribed and dispensed by a
licensed pharmacist in accordance with section 151.37, subdivision 15; and opiate antagonists
used for the treatment of an acute opiate overdose prescribed and dispensed by a licensed
pharmacist in accordance with section 151.37, subdivision 16.
new text begin
(h) Medical assistance coverage of, and reimbursement for, antiretroviral drugs to prevent
the acquisition of human immunodeficiency virus (HIV) and any laboratory testing necessary
for therapy that uses these drugs must meet the requirements that would otherwise apply to
a health plan under section 62Q.524.
new text end
Sec. 58.
Minnesota Statutes 2020, section 256B.0625, subdivision 13f, is amended to read:
Subd. 13f.
Prior authorization.
(a) The Formulary Committee shall review and
recommend drugs which require prior authorization. The Formulary Committee shall
establish general criteria to be used for the prior authorization of brand-name drugs for
which generically equivalent drugs are available, but the committee is not required to review
each brand-name drug for which a generically equivalent drug is available.
(b) Prior authorization may be required by the commissioner before certain formulary
drugs are eligible for payment. The Formulary Committee may recommend drugs for prior
authorization directly to the commissioner. The commissioner may also request that the
Formulary Committee review a drug for prior authorization. Before the commissioner may
require prior authorization for a drug:
(1) the commissioner must provide information to the Formulary Committee on the
impact that placing the drug on prior authorization may have on the quality of patient care
and on program costs, information regarding whether the drug is subject to clinical abuse
or misuse, and relevant data from the state Medicaid program if such data is available;
(2) the Formulary Committee must review the drug, taking into account medical and
clinical data and the information provided by the commissioner; and
(3) the Formulary Committee must hold a public forum and receive public comment for
an additional 15 days.
The commissioner must provide a 15-day notice period before implementing the prior
authorization.
(c) Except as provided in subdivision 13j, prior authorization shall not be required or
utilized for any atypical antipsychotic drug prescribed for the treatment of mental illness
if:
(1) there is no generically equivalent drug available; and
(2) the drug was initially prescribed for the recipient prior to July 1, 2003; or
(3) the drug is part of the recipient's current course of treatment.
This paragraph applies to any multistate preferred drug list or supplemental drug rebate
program established or administered by the commissioner. Prior authorization shall
automatically be granted for 60 days for brand name drugs prescribed for treatment of mental
illness within 60 days of when a generically equivalent drug becomes available, provided
that the brand name drug was part of the recipient's course of treatment at the time the
generically equivalent drug became available.
(d) The commissioner may require prior authorization for brand name drugs whenever
a generically equivalent product is available, even if the prescriber specifically indicates
"dispense as written-brand necessary" on the prescription as required by section 151.21,
subdivision 2.
(e) Notwithstanding this subdivision, the commissioner may automatically require prior
authorization, for a period not to exceed 180 days, for any drug that is approved by the
United States Food and Drug Administration on or after July 1, 2005. The 180-day period
begins no later than the first day that a drug is available for shipment to pharmacies within
the state. The Formulary Committee shall recommend to the commissioner general criteria
to be used for the prior authorization of the drugs, but the committee is not required to
review each individual drug. In order to continue prior authorizations for a drug after the
180-day period has expired, the commissioner must follow the provisions of this subdivision.
(f) Prior authorization under this subdivision shall comply with deleted text begin sectiondeleted text end new text begin sectionsnew text end 62Q.184new text begin
and 62Q.1842new text end .
(g) Any step therapy protocol requirements established by the commissioner must comply
with deleted text begin sectiondeleted text end new text begin sectionsnew text end 62Q.1841new text begin and 62Q.1842new text end .
Sec. 59. new text begin STUDY OF PHARMACY AND PROVIDER CHOICE OF BIOLOGICAL
PRODUCTS.
new text end
new text begin
The commissioner of health, within the limits of existing resources, shall analyze the
effect of Minnesota Statutes, section 62W.0751, on the net price for different payors of
biological products, interchangeable biological products, and biosimilar products. The
commissioner of health shall report findings to the chairs and ranking minority members
of the legislative committees with jurisdiction over health and human services finance and
policy and insurance by December 15, 2024.
new text end
ARTICLE 7
HEALTH INSURANCE
Section 1.
Minnesota Statutes 2020, section 62A.25, subdivision 2, is amended to read:
Subd. 2.
Required coverage.
(a) Every policy, plan, certificate or contract to which this
section applies shall provide benefits for reconstructive surgery when such service is
incidental to or follows surgery resulting from injury, sickness or other diseases of the
involved part or when such service is performed on a covered dependent child because of
congenital disease or anomaly which has resulted in a functional defect as determined by
the attending physician.
(b) The coverage limitations on reconstructive surgery in paragraph (a) do not apply to
reconstructive breast surgerynew text begin : (1)new text end following mastectomiesnew text begin ; or (2) if the patient has been
diagnosed with ectodermal dysplasia and has congenitally absent breast tissue or nipplesnew text end .
deleted text begin In these cases,deleted text end deleted text begin Coverage for reconstructive surgery must be provided if the mastectomy is
medically necessary as determined by the attending physician.
deleted text end
(c) Reconstructive surgery benefits include all stages of reconstruction deleted text begin of the breast on
which the mastectomy has been performeddeleted text end ,new text begin includingnew text end surgery and reconstruction of the
other breast to produce a symmetrical appearance, and prosthesis and physical complications
at all stages deleted text begin of a mastectomydeleted text end , including lymphedemas, in a manner determined in consultation
with the attending physician and patient. Coverage may be subject to annual deductible,
co-payment, and coinsurance provisions as may be deemed appropriate and as are consistent
with those established for other benefits under the plan or coverage. Coverage may not:
(1) deny to a patient eligibility, or continued eligibility, to enroll or to renew coverage
under the terms of the plan, solely for the purpose of avoiding the requirements of this
section; and
(2) penalize or otherwise reduce or limit the reimbursement of an attending provider, or
provide monetary or other incentives to an attending provider to induce the provider to
provide care to an individual participant or beneficiary in a manner inconsistent with this
section.
Written notice of the availability of the coverage must be delivered to the participant upon
enrollment and annually thereafter.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, and applies to health
plans offered, issued, or sold on or after that date.
new text end
Sec. 2.
new text begin
[62A.255] COVERAGE OF LYMPHEDEMA TREATMENT.
new text end
new text begin Subdivision 1. new text end
new text begin Scope of coverage. new text end
new text begin
This section applies to all health plans that are sold,
issued, or renewed to a Minnesota resident.
new text end
new text begin Subd. 2. new text end
new text begin Required coverage. new text end
new text begin
(a) Each health plan must provide coverage for lymphedema
treatment, including coverage for compression treatment items, complex decongestive
therapy, and outpatient self-management training and education during lymphedema treatment
if prescribed by a licensed health care professional. Lymphedema compression treatment
items include: (1) compression garments, stockings, and sleeves; (2) compression devices;
and (3) bandaging systems, components, and supplies that are primarily and customarily
used in the treatment of lymphedema.
new text end
new text begin
(b) If applicable to the enrollee's health plan, a health carrier may require the prescribing
health care professional to be within the enrollee's health plan provider network if the
provider network meets network adequacy requirements under section 62K.10.
new text end
new text begin
(c) A health plan must not apply any cost-sharing requirements, benefit limitations, or
service limitations for lymphedema treatment and compression treatment items that place
a greater financial burden on the enrollee or are more restrictive than cost-sharing
requirements or limitations applied by the health plan to other similar services or benefits.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, and applies to any health
plan issued, sold, or renewed on or after that date.
new text end
Sec. 3.
Minnesota Statutes 2020, section 62A.28, subdivision 2, is amended to read:
Subd. 2.
Required coverage.
Every policy, plan, certificate, or contract referred to in
subdivision 1 deleted text begin issued or renewed after August 1, 1987,deleted text end must provide coverage for scalp hair
prostheses worn for hair loss suffered as a result of alopecia areatanew text begin or ectodermal dysplasiasnew text end .
The coverage required by this section is subject to the co-payment, coinsurance,
deductible, and other enrollee cost-sharing requirements that apply to similar types of items
under the policy, plan, certificate, or contract and may be limited to one prosthesis per
benefit year.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, and applies to health
plans offered, issued, or sold on or after that date.
new text end
Sec. 4.
Minnesota Statutes 2020, section 62A.30, is amended by adding a subdivision to
read:
new text begin Subd. 5. new text end
new text begin Mammogram; diagnostic services and testing. new text end
new text begin
If a health care provider
determines an enrollee requires additional diagnostic services or testing after a mammogram,
a health plan must provide coverage for the additional diagnostic services or testing with
no cost sharing, including co-pay, deductible, or coinsurance.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, and applies to health
plans offered, issued, or sold on or after that date.
new text end
Sec. 5.
new text begin
[62A.3096] COVERAGE FOR ECTODERMAL DYSPLASIAS.
new text end
new text begin Subdivision 1. new text end
new text begin Definition. new text end
new text begin
For purposes of this chapter, "ectodermal dysplasias" means
a genetic disorder involving the absence or deficiency of tissues and structures derived from
the embryonic ectoderm.
new text end
new text begin Subd. 2. new text end
new text begin Coverage. new text end
new text begin
A health plan must provide coverage for the treatment of ectodermal
dysplasias.
new text end
new text begin Subd. 3. new text end
new text begin Dental coverage. new text end
new text begin
(a) A health plan must provide coverage for dental treatments
related to ectodermal dysplasias. Covered dental treatments must include but are not limited
to bone grafts, dental implants, orthodontia, dental prosthodontics, and dental maintenance.
new text end
new text begin
(b) If a dental treatment is eligible for coverage under a dental insurance plan or other
health plan, the coverage under this subdivision is secondary.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, and applies to health
plans offered, issued, or sold on or after that date.
new text end
Sec. 6.
new text begin
[62Q.451] UNRESTRICTED ACCESS TO SERVICES FOR THE
DIAGNOSIS, MONITORING, AND TREATMENT OF RARE DISEASES.
new text end
new text begin
(a) No health plan company may restrict the choice of an enrollee as to where the enrollee
receives services from a licensed health care provider related to the diagnosis, monitoring,
and treatment of a rare disease or condition. Except as provided in paragraph (b), for purposes
of this section, "rare disease or condition" means any disease or condition:
new text end
new text begin
(1) that affects fewer than 200,000 persons in the United States and is chronic, serious,
life-altering, or life-threatening;
new text end
new text begin
(2) that affects more than 200,000 persons in the United States and a drug for treatment
has been designated as such pursuant to United States Code, title 21, section 360bb;
new text end
new text begin
(3) that is labeled as a rare disease or condition on the Genetic and Rare Diseases
Information Center list created by the National Institutes of Health; or
new text end
new text begin
(4) for which a pediatric patient:
new text end
new text begin
(i) has received two or more clinical consultations from a primary care provider or
specialty provider;
new text end
new text begin
(ii) has a delay in skill acquisition and development, regression in skill acquisition,
failure to thrive, or multisystemic involvement; and
new text end
new text begin
(iii) had laboratory or clinical testing that failed to provide a definitive diagnosis or
resulted in conflicting diagnoses.
new text end
new text begin
(b) A rare disease or condition does not include an infectious disease that has widely
available and known protocols for diagnosis and treatment and that is commonly treated in
a primary care setting, even if it affects less than 200,000 persons in the United States.
new text end
new text begin
(c) Cost-sharing requirements and benefit or services limitations for the diagnosis and
treatment of a rare disease or condition must not place a greater financial burden on the
enrollee or be more restrictive than those requirements for in-network medical treatment.
new text end
new text begin
(d) This section does not apply to health plan coverage provided through the State
Employee Group Insurance Program (SEGIP) under chapter 43A.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, and applies to health
plans offered, issued, or renewed on or after that date.
new text end
Sec. 7.
Minnesota Statutes 2020, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 68. new text end
new text begin
Services for the diagnosis, monitoring, and treatment of rare
diseases.
new text end
new text begin
Medical assistance coverage for services related to the diagnosis, monitoring, and
treatment of a rare disease or condition must meet the requirements in section 62Q.451.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 8.
Minnesota Statutes 2020, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 69. new text end
new text begin Ectodermal dysplasias. new text end
new text begin
Medical assistance and MinnesotaCare cover treatment
for ectodermal dysplasias. Coverage must meet the requirements of sections 62A.25, 62A.28,
and 62A.3096.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 9.
Minnesota Statutes 2020, section 256B.0631, subdivision 2, is amended to read:
Subd. 2.
Exceptions.
Co-payments and deductibles shall be subject to the following
exceptions:
(1) children under the age of 21;
(2) pregnant women for services that relate to the pregnancy or any other medical
condition that may complicate the pregnancy;
(3) recipients expected to reside for at least 30 days in a hospital, nursing home, or
intermediate care facility for the developmentally disabled;
(4) recipients receiving hospice care;
(5) 100 percent federally funded services provided by an Indian health service;
(6) emergency services;
(7) family planning services;
(8) services that are paid by Medicare, resulting in the medical assistance program paying
for the coinsurance and deductible;
(9) co-payments that exceed one per day per provider for nonpreventive visits, eyeglasses,
and nonemergency visits to a hospital-based emergency room;
(10) services, fee-for-service payments subject to volume purchase through competitive
bidding;
(11) American Indians who meet the requirements in Code of Federal Regulations, title
42, sections 447.51 and 447.56;
(12) persons needing treatment for breast or cervical cancer as described under section
256B.057, subdivision 10; deleted text begin and
deleted text end
(13) services that currently have a rating of A or B from the United States Preventive
Services Task Force (USPSTF), immunizations recommended by the Advisory Committee
on Immunization Practices of the Centers for Disease Control and Prevention, and preventive
services and screenings provided to women as described in Code of Federal Regulations,
title 45, section 147.130deleted text begin .deleted text end new text begin ; and
new text end
new text begin
(14) additional diagnostic services or testing that a health care provider determines an
enrollee requires after a mammogram, as specified under section 62A.30, subdivision 5.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 10.
Minnesota Statutes 2020, section 256L.03, subdivision 5, is amended to read:
Subd. 5.
Cost-sharing.
(a) Co-payments, coinsurance, and deductibles do not apply to
children under the age of 21 and to American Indians as defined in Code of Federal
Regulations, title 42, section 600.5.
(b) The commissioner shall adjust co-payments, coinsurance, and deductibles for covered
services in a manner sufficient to maintain the actuarial value of the benefit to 94 percent.
The cost-sharing changes described in this paragraph do not apply to eligible recipients or
services exempt from cost-sharing under state law. The cost-sharing changes described in
this paragraph shall not be implemented prior to January 1, 2016.
(c) The cost-sharing changes authorized under paragraph (b) must satisfy the requirements
for cost-sharing under the Basic Health Program as set forth in Code of Federal Regulations,
title 42, sections 600.510 and 600.520.
new text begin
(d) Co-payments, coinsurance, and deductibles do not apply to additional diagnostic
services or testing that a health care provider determines an enrollee requires after a
mammogram, as specified under section 62A.30, subdivision 5.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
ARTICLE 8
MISCELLANEOUS
Section 1.
Minnesota Statutes 2020, section 34A.01, subdivision 4, is amended to read:
Subd. 4.
Food.
"Food" means every ingredient used for, entering into the consumption
of, or used or intended for use in the preparation of food, drink, confectionery, or condiment
for humans or other animals, whether simple, mixed, or compound; and articles used as
components of these ingredientsnew text begin , except that edible cannabinoid products, as defined in
section 151.72, subdivision 1, paragraph (c), are not foodnew text end .
Sec. 2.
Minnesota Statutes 2020, section 137.68, is amended to read:
137.68 new text begin MINNESOTA RARE DISEASE new text end ADVISORY COUNCIL deleted text begin ON RARE
DISEASESdeleted text end .
Subdivision 1.
Establishment.
deleted text begin The University of Minnesota is requested to establishdeleted text end new text begin
There is establishednew text end an advisory council on rare diseases to provide advice onnew text begin policies,
access, equity,new text end research, diagnosis, treatment, and education related to rare diseases.new text begin The
advisory council is established in honor of Chloe Barnes and her experiences in the health
care system.new text end For purposes of this section, "rare disease" has the meaning given in United
States Code, title 21, section 360bb. The council shall be called the deleted text begin Chloe Barnes Advisory
Council on Rare Diseasesdeleted text end new text begin Minnesota Rare Disease Advisory Councilnew text end .new text begin The Council on
Disability shall house the advisory council.
new text end
Subd. 2.
Membership.
(a) The advisory council deleted text begin maydeleted text end new text begin shallnew text end consist of new text begin at least 17 new text end public
members new text begin who reflect statewide representation and are new text end appointed by deleted text begin the Board of Regents
or a designeedeleted text end new text begin the governornew text end according to paragraph (b) and four members of the legislature
appointed according to paragraph (c).
(b) deleted text begin The Board of Regents or a designee is requested todeleted text end new text begin The governor shallnew text end appoint new text begin at
least new text end the following public membersnew text begin according to section 15.059new text end :
(1) three physicians licensed and practicing in the state with experience researching,
diagnosing, or treating rare diseases, including one specializing in pediatrics;
(2) one registered nurse or advanced practice registered nurse licensed and practicing
in the state with experience treating rare diseases;
(3) at least two hospital administrators, or their designees, from hospitals in the state
that provide care to persons diagnosed with a rare disease. One administrator or designee
appointed under this clause must represent a hospital in which the scope of service focuses
on rare diseases of pediatric patients;
(4) three persons age 18 or older who either have a rare disease or are a caregiver of a
person with a rare diseasenew text begin . One person appointed under this clause must reside in rural
Minnesotanew text end ;
(5) a representative of a rare disease patient organization that operates in the state;
(6) a social worker with experience providing services to persons diagnosed with a rare
disease;
(7) a pharmacist with experience with drugs used to treat rare diseases;
(8) a dentist licensed and practicing in the state with experience treating rare diseases;
(9) a representative of the biotechnology industry;
(10) a representative of health plan companies;
(11) a medical researcher with experience conducting research on rare diseases; deleted text begin and
deleted text end
(12) a genetic counselor with experience providing services to persons diagnosed with
a rare disease or caregivers of those personsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(13) representatives with other areas of expertise as identified by the advisory council.
new text end
(c) The advisory council shall include two members of the senate, one appointed by the
majority leader and one appointed by the minority leader; and two members of the house
of representatives, one appointed by the speaker of the house and one appointed by the
minority leader.
(d) The commissioner of health or a designee, a representative of Mayo Medical School,
and a representative of the University of Minnesota Medical School shall serve as ex officio,
nonvoting members of the advisory council.
(e) deleted text begin Initial appointments to the advisory council shall be made no later than September
1, 2019.deleted text end new text begin Notwithstanding section 15.059,new text end members appointed according to paragraph (b)
shall serve for a term of three years, except that the initial members appointed according to
paragraph (b) shall have an initial term of two, three, or four years determined by lot by the
chairperson. Members appointed according to paragraph (b) shall serve until their successors
have been appointed.
new text begin
(f) Members may be reappointed for additional terms according to the advisory council's
operating procedures.
new text end
Subd. 3.
Meetings.
deleted text begin The Board of Regents or a designee is requested to convene the first
meeting of the advisory council no later than October 1, 2019.deleted text end The advisory council shall
meet at the call of the chairperson or at the request of a majority of advisory council members.new text begin
Meetings of the advisory council are subject to section 13D.01, and notice of its meetings
is governed by section 13D.04.
new text end
new text begin Subd. 3a. new text end
new text begin Chairperson; executive director; staff; executive committee. new text end
new text begin
(a) The
advisory council shall elect a chairperson and other officers as it deems necessary and in
accordance with the advisory council's operating procedures.
new text end
new text begin
(b) The advisory council shall be governed by an executive committee elected by the
members of the advisory council. One member of the executive committee must be the
advisory council chairperson.
new text end
new text begin
(c) The advisory council shall appoint an executive director. The executive director
serves as an ex officio nonvoting member of the executive committee. The advisory council
may delegate to the executive director any powers and duties under this section that do not
require advisory council approval. The executive director serves in the unclassified service
and may be removed at any time by a majority vote of the advisory council. The executive
director may employ and direct staff necessary to carry out advisory council mandates,
policies, activities, and objectives.
new text end
new text begin
(d) The executive committee may appoint additional subcommittees and work groups
as necessary to fulfill the duties of the advisory council.
new text end
Subd. 4.
Duties.
(a) The advisory council's duties may include, but are not limited to:
(1) in conjunction with the state's medical schools, the state's schools of public health,
and hospitals in the state that provide care to persons diagnosed with a rare disease,
developing resources or recommendations relating to quality of and access to treatment and
services in the state for persons with a rare disease, including but not limited to:
(i) a list of existing, publicly accessible resources on research, diagnosis, treatment, and
education relating to rare diseases;
(ii) identifying best practices for rare disease care implemented in other states, at the
national level, and at the international level that will improve rare disease care in the state
and seeking opportunities to partner with similar organizations in other states and countries;
(iii) identifyingnew text begin and addressingnew text end problems faced by patients with a rare disease when
changing health plans, including recommendations on how to remove obstacles faced by
these patients to finding a new health plan and how to improve the ease and speed of finding
a new health plan that meets the needs of patients with a rare disease; deleted text begin and
deleted text end
new text begin
(iv) identifying and addressing barriers faced by patients with a rare disease to obtaining
care, caused by prior authorization requirements in private and public health plans; and
new text end
deleted text begin (iv)deleted text end new text begin (v)new text end identifyingnew text begin , recommending, and implementingnew text end best practices to ensure health
care providers are adequately informed of the most effective strategies for recognizing and
treating rare diseases; deleted text begin and
deleted text end
(2) advising, consulting, and cooperating with the Department of Health,new text begin includingnew text end the
Advisory Committee on Heritable and Congenital Disordersdeleted text begin ,deleted text end new text begin ; the Department of Human
Services, including the Drug Utilization Review Board and the Drug Formulary Committee;new text end
and other agencies of state government in developing new text begin recommendations, new text end informationnew text begin ,new text end and
programs for the public and the health care community relating to diagnosis, treatment, and
awareness of rare diseasesdeleted text begin .deleted text end new text begin ;
new text end
new text begin
(3) advising on policy issues and advancing policy initiatives at the state and federal
levels; and
new text end
new text begin
(4) receiving funds and issuing grants.
new text end
(b) The advisory council shall collect additional topic areas for study and evaluation
from the general public. In order for the advisory council to study and evaluate a topic, the
topic must be approved for study and evaluation by the advisory council.
Subd. 5.
Conflict of interest.
Advisory council members are subject to the deleted text begin Board of
Regents policy on conflictsdeleted text end new text begin advisory council's conflictnew text end of interestnew text begin policy as outlined in the
advisory council's operating proceduresnew text end .
Subd. 6.
Annual report.
By January 1 of each year, beginning January 1, 2020, the
advisory council shall report to the chairs and ranking minority members of the legislative
committees with jurisdiction over higher education and health care policy on the advisory
council's activities under subdivision 4 and other issues on which the advisory council may
choose to report.
Sec. 3.
Minnesota Statutes 2020, section 151.72, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For the purposes of this section, the following terms have
the meanings given.
new text begin
(b) "Certified hemp" means hemp plants that have been tested and found to meet the
requirements of chapter 18K and the rules adopted thereunder.
new text end
new text begin
(c) "Edible cannabinoid product" means any product that is intended to be eaten or
consumed as a beverage by humans, contains a cannabinoid in combination with food
ingredients, and is not a drug.
new text end
deleted text begin (b)deleted text end new text begin (d)new text end "Hemp" has the meaning given to "industrial hemp" in section 18K.02, subdivision
3.
new text begin
(e) "Label" has the meaning given in section 151.01, subdivision 18.
new text end
deleted text begin (c)deleted text end new text begin (f)new text end "Labeling" means all labels and other written, printed, or graphic matter that are:
(1) affixed to the immediate container in which a product regulated under this section
is sold; deleted text begin or
deleted text end
(2) provided, in any manner, with the immediate container, including but not limited to
outer containers, wrappers, package inserts, brochures, or pamphletsdeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(3) provided on that portion of a manufacturer's website that is linked by a scannable
barcode or matrix barcode.
new text end
new text begin
(g) "Matrix barcode" means a code that stores data in a two-dimensional array of
geometrically shaped dark and light cells capable of being read by the camera on a
smartphone or other mobile device.
new text end
new text begin
(h) "Nonintoxicating cannabinoid" means substances extracted from certified hemp
plants that do not produce intoxicating effects when consumed by any route of administration.
new text end
Sec. 4.
Minnesota Statutes 2020, section 151.72, subdivision 2, is amended to read:
Subd. 2.
Scope.
(a) This section applies to the sale of any product that contains
deleted text begin nonintoxicatingdeleted text end cannabinoids extracted from hemp deleted text begin other than fooddeleted text end new text begin andnew text end that isnew text begin an edible
cannabinoid product or isnew text end intended for human or animal consumption by any route of
administration.
(b) This section does not apply to any product dispensed by a registered medical cannabis
manufacturer pursuant to sections 152.22 to 152.37.
new text begin
(c) The board must have no authority over food products, as defined in section 34A.01,
subdivision 4, that do not contain cannabinoids extracted or derived from hemp.
new text end
Sec. 5.
Minnesota Statutes 2020, section 151.72, subdivision 3, is amended to read:
Subd. 3.
Sale of cannabinoids derived from hemp.
new text begin (a) new text end Notwithstanding any other
section of this chapter, a product containing nonintoxicating cannabinoidsnew text begin , including an
edible cannabinoid product,new text end may be sold for human or animal consumption new text begin only new text end if all of
the requirements of this section are metnew text begin , provided that a product sold for human or animal
consumption does not contain more than 0.3 percent of any tetrahydrocannabinol and an
edible cannabinoid product does not contain an amount of any tetrahydrocannabinol that
exceeds the limits established in subdivision 5a, paragraph (f)new text end .
new text begin
(b) No other substance extracted or otherwise derived from hemp may be sold for human
consumption if the substance is intended:
new text end
new text begin
(1) for external or internal use in the diagnosis, cure, mitigation, treatment, or prevention
of disease in humans or other animals; or
new text end
new text begin
(2) to affect the structure or any function of the bodies of humans or other animals.
new text end
new text begin
(c) No product containing any cannabinoid or tetrahydrocannabinol extracted or otherwise
derived from hemp may be sold to any individual who is under the age of 21.
new text end
new text begin
(d) Products that meet the requirements of this section are not controlled substances
under section 152.02.
new text end
Sec. 6.
Minnesota Statutes 2020, section 151.72, subdivision 4, is amended to read:
Subd. 4.
Testing requirements.
(a) A manufacturer of a product regulated under this
section must submit representative samples of the product to an independent, accredited
laboratory in order to certify that the product complies with the standards adopted by the
board. Testing must be consistent with generally accepted industry standards for herbal and
botanical substances, and, at a minimum, the testing must confirm that the product:
(1) contains the amount or percentage of cannabinoids that is stated on the label of the
product;
(2) does not contain more than trace amounts of any new text begin mold, residual solvents, new text end pesticides,
fertilizers, or heavy metals; and
(3) does not contain deleted text begin a delta-9 tetrahydrocannabinol concentration that exceeds the
concentration permitted for industrial hemp as defined in section 18K.02, subdivision 3deleted text end new text begin
more than 0.3 percent of any tetrahydrocannabinolnew text end .
(b) Upon the request of the board, the manufacturer of the product must provide the
board with the results of the testing required in this section.
new text begin
(c) Testing of the hemp from which the nonintoxicating cannabinoid was derived, or
possession of a certificate of analysis for such hemp, does not meet the testing requirements
of this section.
new text end
Sec. 7.
Minnesota Statutes 2021 Supplement, section 151.72, subdivision 5, is amended
to read:
Subd. 5.
Labeling requirements.
(a) A product regulated under this section must bear
a label that contains, at a minimum:
(1) the name, location, contact phone number, and website of the manufacturer of the
product;
(2) the name and address of the independent, accredited laboratory used by the
manufacturer to test the product; and
(3) an accurate statement of the amount or percentage of cannabinoids found in each
unit of the product meant to be consumeddeleted text begin ; ordeleted text end new text begin .
new text end
deleted text begin
(4) instead of the information required in clauses (1) to (3), a scannable bar code or QR
code that links to the manufacturer's website.
deleted text end
new text begin
(b) The information in paragraph (a) may be provided on an outer package if the
immediate container that holds the product is too small to contain all of the information.
new text end
new text begin
(c) The information required in paragraph (a) may be provided through the use of a
scannable barcode or matrix barcode that links to a page on the manufacturer's website if
that page contains all of the information required by this subdivision.
new text end
new text begin (d) new text end The label must also include a statement stating that deleted text begin thisdeleted text end new text begin thenew text end product does not claim
to diagnose, treat, cure, or prevent any disease and has not been evaluated or approved by
the United States Food and Drug Administration (FDA) unless the product has been so
approved.
deleted text begin (b)deleted text end new text begin (e)new text end The information required deleted text begin to be on the labeldeleted text end new text begin by this subdivisionnew text end must be prominently
and conspicuously placed deleted text begin anddeleted text end new text begin on the label or displayed on the websitenew text end in terms that can be
easily read and understood by the consumer.
deleted text begin (c)deleted text end new text begin (f)new text end The deleted text begin labeldeleted text end new text begin labelingnew text end must not contain any claim that the product may be used or is
effective for the prevention, treatment, or cure of a disease or that it may be used to alter
the structure or function of human or animal bodies, unless the claim has been approved by
the FDA.
Sec. 8.
Minnesota Statutes 2020, section 151.72, is amended by adding a subdivision to
read:
new text begin Subd. 5a. new text end
new text begin Additional requirements for edible cannabinoid products. new text end
new text begin
(a) In addition
to the testing and labeling requirements under subdivisions 4 and 5, an edible cannabinoid
must meet the requirements of this subdivision.
new text end
new text begin
(b) An edible cannabinoid product must not:
new text end
new text begin
(1) bear the likeness or contain cartoon-like characteristics of a real or fictional person,
animal, or fruit that appeals to children;
new text end
new text begin
(2) be modeled after a brand of products primarily consumed by or marketed to children;
new text end
new text begin
(3) be made by applying an extracted or concentrated hemp-derived cannabinoid to a
commercially available candy or snack food item;
new text end
new text begin
(4) contain an ingredient, other than a hemp-derived cannabinoid, that is not approved
by the United States Food and Drug Administration for use in food;
new text end
new text begin
(5) be packaged in a way that resembles the trademarked, characteristic, or
product-specialized packaging of any commercially available food product; or
new text end
new text begin
(6) be packaged in a container that includes a statement, artwork, or design that could
reasonably mislead any person to believe that the package contains anything other than an
edible cannabinoid product.
new text end
new text begin
(c) An edible cannabinoid product must be prepackaged in packaging or a container that
is child-resistant, tamper-evident, and opaque or placed in packaging or a container that is
child-resistant, tamper-evident, and opaque at the final point of sale to a customer. The
requirement that packaging be child-resistant does not apply to an edible cannabinoid product
that is intended to be consumed as a beverage and which contains no more than a trace
amount of any tetrahydrocannabinol.
new text end
new text begin
(d) If an edible cannabinoid product is intended for more than a single use or contains
multiple servings, each serving must be indicated by scoring, wrapping, or other indicators
designating the individual serving size.
new text end
new text begin
(e) A label containing at least the following information must be affixed to the packaging
or container of all edible cannabinoid products sold to consumers:
new text end
new text begin
(1) the serving size;
new text end
new text begin
(2) the cannabinoid profile per serving and in total;
new text end
new text begin
(3) a list of ingredients, including identification of any major food allergens declared
by name; and
new text end
new text begin
(4) the following statement: "Keep this product out of reach of children."
new text end
new text begin
(f) An edible cannabinoid product must not contain more than five milligrams of any
tetrahydrocannabinol in a single serving, or more than a total of 50 milligrams of any
tetrahydrocannabinol per package.
new text end
Sec. 9.
Minnesota Statutes 2020, section 151.72, subdivision 6, is amended to read:
Subd. 6.
Enforcement.
(a) A product deleted text begin solddeleted text end new text begin regulatednew text end under this sectionnew text begin , including an
edible cannabinoid product,new text end shall be considered an adulterated drug if:
(1) it consists, in whole or in part, of any filthy, putrid, or decomposed substance;
(2) it has been produced, prepared, packed, or held under unsanitary conditions where
it may have been rendered injurious to health, or where it may have been contaminated with
filth;
(3) its container is composed, in whole or in part, of any poisonous or deleterious
substance that may render the contents injurious to health;
(4) it contains any new text begin food additives, new text end color additivesnew text begin ,new text end or excipients that have been found by
the FDA to be unsafe for human or animal consumption; deleted text begin or
deleted text end
(5) it contains an amount or percentage of new text begin nonintoxicating new text end cannabinoids that is different
than the amount or percentage stated on the labeldeleted text begin .deleted text end new text begin ;
new text end
new text begin
(6) it contains more than 0.3 percent of any tetrahydrocannabinol or, if the product is
an edible cannabinoid product, an amount of tetrahydrocannabinol that exceeds the limits
established in subdivision 5a, paragraph (f); or
new text end
new text begin
(7) it contains more than trace amounts of mold, residual solvents, pesticides, fertilizers,
or heavy metals.
new text end
(b) A product deleted text begin solddeleted text end new text begin regulatednew text end under this section shall be considered a misbranded drug
if the product's labeling is false or misleading in any manner or in violation of the
requirements of this section.
(c) The board's authority to issue cease and desist orders under section 151.06; to embargo
adulterated and misbranded drugs under section 151.38; and to seek injunctive relief under
section 214.11, extends to any violation of this section.
Sec. 10.
Minnesota Statutes 2020, section 152.01, subdivision 23, is amended to read:
Subd. 23.
Analog.
(a) Except as provided in paragraph (b), "analog" means a substance,
the chemical structure of which is substantially similar to the chemical structure of a
controlled substance in Schedule I or II:
(1) that has a stimulant, depressant, or hallucinogenic effect on the central nervous system
that is substantially similar to or greater than the stimulant, depressant, or hallucinogenic
effect on the central nervous system of a controlled substance in Schedule I or II; or
(2) with respect to a particular person, if the person represents or intends that the substance
have a stimulant, depressant, or hallucinogenic effect on the central nervous system that is
substantially similar to or greater than the stimulant, depressant, or hallucinogenic effect
on the central nervous system of a controlled substance in Schedule I or II.
(b) "Analog" does not include:
(1) a controlled substance;
(2) any substance for which there is an approved new drug application under the Federal
Food, Drug, and Cosmetic Act; deleted text begin or
deleted text end
(3) with respect to a particular person, any substance, if an exemption is in effect for
investigational use, for that person, as provided by United States Code, title 21, section 355,
and the person is registered as a controlled substance researcher as required under section
152.12, subdivision 3, to the extent conduct with respect to the substance is pursuant to the
exemption and registrationnew text begin ; or
new text end
new text begin (4) marijuana or tetrahydrocannabinols naturally contained in a plant of the genus
cannabis or in the resinous extractives of the plantnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022, and applies to crimes
committed on or after that date.
new text end
Sec. 11.
Minnesota Statutes 2020, section 152.02, subdivision 2, is amended to read:
Subd. 2.
Schedule I.
(a) Schedule I consists of the substances listed in this subdivision.
(b) Opiates. Unless specifically excepted or unless listed in another schedule, any of the
following substances, including their analogs, isomers, esters, ethers, salts, and salts of
isomers, esters, and ethers, whenever the existence of the analogs, isomers, esters, ethers,
and salts is possible:
(1) acetylmethadol;
(2) allylprodine;
(3) alphacetylmethadol (except levo-alphacetylmethadol, also known as levomethadyl
acetate);
(4) alphameprodine;
(5) alphamethadol;
(6) alpha-methylfentanyl benzethidine;
(7) betacetylmethadol;
(8) betameprodine;
(9) betamethadol;
(10) betaprodine;
(11) clonitazene;
(12) dextromoramide;
(13) diampromide;
(14) diethyliambutene;
(15) difenoxin;
(16) dimenoxadol;
(17) dimepheptanol;
(18) dimethyliambutene;
(19) dioxaphetyl butyrate;
(20) dipipanone;
(21) ethylmethylthiambutene;
(22) etonitazene;
(23) etoxeridine;
(24) furethidine;
(25) hydroxypethidine;
(26) ketobemidone;
(27) levomoramide;
(28) levophenacylmorphan;
(29) 3-methylfentanyl;
(30) acetyl-alpha-methylfentanyl;
(31) alpha-methylthiofentanyl;
(32) benzylfentanyl beta-hydroxyfentanyl;
(33) beta-hydroxy-3-methylfentanyl;
(34) 3-methylthiofentanyl;
(35) thenylfentanyl;
(36) thiofentanyl;
(37) para-fluorofentanyl;
(38) morpheridine;
(39) 1-methyl-4-phenyl-4-propionoxypiperidine;
(40) noracymethadol;
(41) norlevorphanol;
(42) normethadone;
(43) norpipanone;
(44) 1-(2-phenylethyl)-4-phenyl-4-acetoxypiperidine (PEPAP);
(45) phenadoxone;
(46) phenampromide;
(47) phenomorphan;
(48) phenoperidine;
(49) piritramide;
(50) proheptazine;
(51) properidine;
(52) propiram;
(53) racemoramide;
(54) tilidine;
(55) trimeperidine;
(56) N-(1-Phenethylpiperidin-4-yl)-N-phenylacetamide (acetyl fentanyl);
(57) 3,4-dichloro-N-[(1R,2R)-2-(dimethylamino)cyclohexyl]-N-
methylbenzamide(U47700);
(58) N-phenyl-N-[1-(2-phenylethyl)piperidin-4-yl]furan-2-carboxamide(furanylfentanyl);
(59) 4-(4-bromophenyl)-4-dimethylamino-1-phenethylcyclohexanol (bromadol);
(60) N-(1-phenethylpiperidin-4-yl)-N-phenylcyclopropanecarboxamide (Cyclopropryl
fentanyl);
(61) N-(1-phenethylpiperidin-4-yl)-N-phenylbutanamide) (butyryl fentanyl);
(62) 1-cyclohexyl-4-(1,2-diphenylethyl)piperazine) (MT-45);
(63) N-(1-phenethylpiperidin-4-yl)-N-phenylcyclopentanecarboxamide (cyclopentyl
fentanyl);
(64) N-(1-phenethylpiperidin-4-yl)-N-phenylisobutyramide (isobutyryl fentanyl);
(65) N-(1-phenethylpiperidin-4-yl)-N-phenylpentanamide (valeryl fentanyl);
(66) N-(4-chlorophenyl)-N-(1-phenethylpiperidin-4-yl)isobutyramide
(para-chloroisobutyryl fentanyl);
(67) N-(4-fluorophenyl)-N-(1-phenethylpiperidin-4-yl)butyramide (para-fluorobutyryl
fentanyl);
(68) N-(4-methoxyphenyl)-N-(1-phenethylpiperidin-4-yl)butyramide
(para-methoxybutyryl fentanyl);
(69) N-(2-fluorophenyl)-2-methoxy-N-(1-phenethylpiperidin-4-yl)acetamide (ocfentanil);
(70) N-(4-fluorophenyl)-N-(1-phenethylpiperidin-4-yl)isobutyramide (4-fluoroisobutyryl
fentanyl or para-fluoroisobutyryl fentanyl);
(71) N-(1-phenethylpiperidin-4-yl)-N-phenylacrylamide (acryl fentanyl or
acryloylfentanyl);
(72) 2-methoxy-N-(1-phenethylpiperidin-4-yl)-N-phenylacetamide (methoxyacetyl
fentanyl);
(73) N-(2-fluorophenyl)-N-(1-phenethylpiperidin-4-yl)propionamide (ortho-fluorofentanyl
or 2-fluorofentanyl);
(74) N-(1-phenethylpiperidin-4-yl)-N-phenyltetrahydrofuran-2-carboxamide
(tetrahydrofuranyl fentanyl); and
(75) Fentanyl-related substances, their isomers, esters, ethers, salts and salts of isomers,
esters and ethers, meaning any substance not otherwise listed under another federal
Administration Controlled Substance Code Number or not otherwise listed in this section,
and for which no exemption or approval is in effect under section 505 of the Federal Food,
Drug, and Cosmetic Act, United States Code , title 21, section 355, that is structurally related
to fentanyl by one or more of the following modifications:
(i) replacement of the phenyl portion of the phenethyl group by any monocycle, whether
or not further substituted in or on the monocycle;
(ii) substitution in or on the phenethyl group with alkyl, alkenyl, alkoxyl, hydroxyl, halo,
haloalkyl, amino, or nitro groups;
(iii) substitution in or on the piperidine ring with alkyl, alkenyl, alkoxyl, ester, ether,
hydroxyl, halo, haloalkyl, amino, or nitro groups;
(iv) replacement of the aniline ring with any aromatic monocycle whether or not further
substituted in or on the aromatic monocycle; or
(v) replacement of the N-propionyl group by another acyl group.
(c) Opium derivatives. Any of the following substances, their analogs, salts, isomers,
and salts of isomers, unless specifically excepted or unless listed in another schedule,
whenever the existence of the analogs, salts, isomers, and salts of isomers is possible:
(1) acetorphine;
(2) acetyldihydrocodeine;
(3) benzylmorphine;
(4) codeine methylbromide;
(5) codeine-n-oxide;
(6) cyprenorphine;
(7) desomorphine;
(8) dihydromorphine;
(9) drotebanol;
(10) etorphine;
(11) heroin;
(12) hydromorphinol;
(13) methyldesorphine;
(14) methyldihydromorphine;
(15) morphine methylbromide;
(16) morphine methylsulfonate;
(17) morphine-n-oxide;
(18) myrophine;
(19) nicocodeine;
(20) nicomorphine;
(21) normorphine;
(22) pholcodine; and
(23) thebacon.
(d) Hallucinogens. Any material, compound, mixture or preparation which contains any
quantity of the following substances, their analogs, salts, isomers (whether optical, positional,
or geometric), and salts of isomers, unless specifically excepted or unless listed in another
schedule, whenever the existence of the analogs, salts, isomers, and salts of isomers is
possible:
(1) methylenedioxy amphetamine;
(2) methylenedioxymethamphetamine;
(3) methylenedioxy-N-ethylamphetamine (MDEA);
(4) n-hydroxy-methylenedioxyamphetamine;
(5) 4-bromo-2,5-dimethoxyamphetamine (DOB);
(6) 2,5-dimethoxyamphetamine (2,5-DMA);
(7) 4-methoxyamphetamine;
(8) 5-methoxy-3, 4-methylenedioxyamphetamine;
(9) alpha-ethyltryptamine;
(10) bufotenine;
(11) diethyltryptamine;
(12) dimethyltryptamine;
(13) 3,4,5-trimethoxyamphetamine;
(14) 4-methyl-2, 5-dimethoxyamphetamine (DOM);
(15) ibogaine;
(16) lysergic acid diethylamide (LSD);
(17) mescaline;
(18) parahexyl;
(19) N-ethyl-3-piperidyl benzilate;
(20) N-methyl-3-piperidyl benzilate;
(21) psilocybin;
(22) psilocyn;
(23) tenocyclidine (TPCP or TCP);
(24) N-ethyl-1-phenyl-cyclohexylamine (PCE);
(25) 1-(1-phenylcyclohexyl) pyrrolidine (PCPy);
(26) 1-[1-(2-thienyl)cyclohexyl]-pyrrolidine (TCPy);
(27) 4-chloro-2,5-dimethoxyamphetamine (DOC);
(28) 4-ethyl-2,5-dimethoxyamphetamine (DOET);
(29) 4-iodo-2,5-dimethoxyamphetamine (DOI);
(30) 4-bromo-2,5-dimethoxyphenethylamine (2C-B);
(31) 4-chloro-2,5-dimethoxyphenethylamine (2C-C);
(32) 4-methyl-2,5-dimethoxyphenethylamine (2C-D);
(33) 4-ethyl-2,5-dimethoxyphenethylamine (2C-E);
(34) 4-iodo-2,5-dimethoxyphenethylamine (2C-I);
(35) 4-propyl-2,5-dimethoxyphenethylamine (2C-P);
(36) 4-isopropylthio-2,5-dimethoxyphenethylamine (2C-T-4);
(37) 4-propylthio-2,5-dimethoxyphenethylamine (2C-T-7);
(38) 2-(8-bromo-2,3,6,7-tetrahydrofuro [2,3-f][1]benzofuran-4-yl)ethanamine
(2-CB-FLY);
(39) bromo-benzodifuranyl-isopropylamine (Bromo-DragonFLY);
(40) alpha-methyltryptamine (AMT);
(41) N,N-diisopropyltryptamine (DiPT);
(42) 4-acetoxy-N,N-dimethyltryptamine (4-AcO-DMT);
(43) 4-acetoxy-N,N-diethyltryptamine (4-AcO-DET);
(44) 4-hydroxy-N-methyl-N-propyltryptamine (4-HO-MPT);
(45) 4-hydroxy-N,N-dipropyltryptamine (4-HO-DPT);
(46) 4-hydroxy-N,N-diallyltryptamine (4-HO-DALT);
(47) 4-hydroxy-N,N-diisopropyltryptamine (4-HO-DiPT);
(48) 5-methoxy-N,N-diisopropyltryptamine (5-MeO-DiPT);
(49) 5-methoxy-α-methyltryptamine (5-MeO-AMT);
(50) 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT);
(51) 5-methylthio-N,N-dimethyltryptamine (5-MeS-DMT);
(52) 5-methoxy-N-methyl-N-isopropyltryptamine (5-MeO-MiPT);
(53) 5-methoxy-α-ethyltryptamine (5-MeO-AET);
(54) 5-methoxy-N,N-dipropyltryptamine (5-MeO-DPT);
(55) 5-methoxy-N,N-diethyltryptamine (5-MeO-DET);
(56) 5-methoxy-N,N-diallyltryptamine (5-MeO-DALT);
(57) methoxetamine (MXE);
(58) 5-iodo-2-aminoindane (5-IAI);
(59) 5,6-methylenedioxy-2-aminoindane (MDAI);
(60) 2-(4-bromo-2,5-dimethoxyphenyl)-N-(2-methoxybenzyl)ethanamine (25B-NBOMe);
(61) 2-(4-chloro-2,5-dimethoxyphenyl)-N-(2-methoxybenzyl)ethanamine (25C-NBOMe);
(62) 2-(4-iodo-2,5-dimethoxyphenyl)-N-(2-methoxybenzyl)ethanamine (25I-NBOMe);
(63) 2-(2,5-Dimethoxyphenyl)ethanamine (2C-H);
(64) 2-(4-Ethylthio-2,5-dimethoxyphenyl)ethanamine (2C-T-2);
(65) N,N-Dipropyltryptamine (DPT);
(66) 3-[1-(Piperidin-1-yl)cyclohexyl]phenol (3-HO-PCP);
(67) N-ethyl-1-(3-methoxyphenyl)cyclohexanamine (3-MeO-PCE);
(68) 4-[1-(3-methoxyphenyl)cyclohexyl]morpholine (3-MeO-PCMo);
(69) 1-[1-(4-methoxyphenyl)cyclohexyl]-piperidine (methoxydine, 4-MeO-PCP);
(70) 2-(2-Chlorophenyl)-2-(ethylamino)cyclohexan-1-one (N-Ethylnorketamine,
ethketamine, NENK);
(71) methylenedioxy-N,N-dimethylamphetamine (MDDMA);
(72) 3-(2-Ethyl(methyl)aminoethyl)-1H-indol-4-yl (4-AcO-MET); and
(73) 2-Phenyl-2-(methylamino)cyclohexanone (deschloroketamine).
(e) Peyote. All parts of the plant presently classified botanically as Lophophora williamsii
Lemaire, whether growing or not, the seeds thereof, any extract from any part of the plant,
and every compound, manufacture, salts, derivative, mixture, or preparation of the plant,
its seeds or extracts. The listing of peyote as a controlled substance in Schedule I does not
apply to the nondrug use of peyote in bona fide religious ceremonies of the American Indian
Church, and members of the American Indian Church are exempt from registration. Any
person who manufactures peyote for or distributes peyote to the American Indian Church,
however, is required to obtain federal registration annually and to comply with all other
requirements of law.
(f) Central nervous system depressants. Unless specifically excepted or unless listed in
another schedule, any material compound, mixture, or preparation which contains any
quantity of the following substances, their analogs, salts, isomers, and salts of isomers
whenever the existence of the analogs, salts, isomers, and salts of isomers is possible:
(1) mecloqualone;
(2) methaqualone;
(3) gamma-hydroxybutyric acid (GHB), including its esters and ethers;
(4) flunitrazepam;
(5) 2-(2-Methoxyphenyl)-2-(methylamino)cyclohexanone (2-MeO-2-deschloroketamine,
methoxyketamine);
(6) tianeptine;
(7) clonazolam;
(8) etizolam;
(9) flubromazolam; and
(10) flubromazepam.
(g) Stimulants. Unless specifically excepted or unless listed in another schedule, any
material compound, mixture, or preparation which contains any quantity of the following
substances, their analogs, salts, isomers, and salts of isomers whenever the existence of the
analogs, salts, isomers, and salts of isomers is possible:
(1) aminorex;
(2) cathinone;
(3) fenethylline;
(4) methcathinone;
(5) methylaminorex;
(6) N,N-dimethylamphetamine;
(7) N-benzylpiperazine (BZP);
(8) methylmethcathinone (mephedrone);
(9) 3,4-methylenedioxy-N-methylcathinone (methylone);
(10) methoxymethcathinone (methedrone);
(11) methylenedioxypyrovalerone (MDPV);
(12) 3-fluoro-N-methylcathinone (3-FMC);
(13) methylethcathinone (MEC);
(14) 1-benzofuran-6-ylpropan-2-amine (6-APB);
(15) dimethylmethcathinone (DMMC);
(16) fluoroamphetamine;
(17) fluoromethamphetamine;
(18) α-methylaminobutyrophenone (MABP or buphedrone);
(19) 1-(1,3-benzodioxol-5-yl)-2-(methylamino)butan-1-one (butylone);
(20) 2-(methylamino)-1-(4-methylphenyl)butan-1-one (4-MEMABP or BZ-6378);
(21) 1-(naphthalen-2-yl)-2-(pyrrolidin-1-yl) pentan-1-one (naphthylpyrovalerone or
naphyrone);
(22) (alpha-pyrrolidinopentiophenone (alpha-PVP);
(23) (RS)-1-(4-methylphenyl)-2-(1-pyrrolidinyl)-1-hexanone (4-Me-PHP or MPHP);
(24) 2-(1-pyrrolidinyl)-hexanophenone (Alpha-PHP);
(25) 4-methyl-N-ethylcathinone (4-MEC);
(26) 4-methyl-alpha-pyrrolidinopropiophenone (4-MePPP);
(27) 2-(methylamino)-1-phenylpentan-1-one (pentedrone);
(28) 1-(1,3-benzodioxol-5-yl)-2-(methylamino)pentan-1-one (pentylone);
(29) 4-fluoro-N-methylcathinone (4-FMC);
(30) 3,4-methylenedioxy-N-ethylcathinone (ethylone);
(31) alpha-pyrrolidinobutiophenone (α-PBP);
(32) 5-(2-Aminopropyl)-2,3-dihydrobenzofuran (5-APDB);
(33) 1-phenyl-2-(1-pyrrolidinyl)-1-heptanone (PV8);
(34) 6-(2-Aminopropyl)-2,3-dihydrobenzofuran (6-APDB);
(35) 4-methyl-alpha-ethylaminopentiophenone (4-MEAPP);
(36) 4'-chloro-alpha-pyrrolidinopropiophenone (4'-chloro-PPP);
(37) 1-(1,3-Benzodioxol-5-yl)-2-(dimethylamino)butan-1-one (dibutylone, bk-DMBDB);
(38) 1-(3-chlorophenyl) piperazine (meta-chlorophenylpiperazine or mCPP);
(39) 1-(1,3-benzodioxol-5-yl)-2-(ethylamino)-pentan-1-one (N-ethylpentylone, ephylone);
and
(40) any other substance, except bupropion or compounds listed under a different
schedule, that is structurally derived from 2-aminopropan-1-one by substitution at the
1-position with either phenyl, naphthyl, or thiophene ring systems, whether or not the
compound is further modified in any of the following ways:
(i) by substitution in the ring system to any extent with alkyl, alkylenedioxy, alkoxy,
haloalkyl, hydroxyl, or halide substituents, whether or not further substituted in the ring
system by one or more other univalent substituents;
(ii) by substitution at the 3-position with an acyclic alkyl substituent;
(iii) by substitution at the 2-amino nitrogen atom with alkyl, dialkyl, benzyl, or
methoxybenzyl groups; or
(iv) by inclusion of the 2-amino nitrogen atom in a cyclic structure.
(h) deleted text begin Marijuana,deleted text end new text begin Syntheticnew text end tetrahydrocannabinolsdeleted text begin ,deleted text end and synthetic cannabinoids. Unless
specifically excepted or unless listed in another schedule, any deleted text begin natural ordeleted text end synthetic material,
compound, mixture, or preparation that contains any quantity of the following substances,
their analogs, isomers, esters, ethers, salts, and salts of isomers, esters, and ethers, whenever
the existence of the isomers, esters, ethers, or salts is possible:
deleted text begin
(1) marijuana;
deleted text end
deleted text begin (2)deleted text end new text begin (1) syntheticnew text end tetrahydrocannabinols deleted text begin naturally contained in a plant of the genus
Cannabis,deleted text end new text begin that are thenew text end synthetic equivalents of the substances contained in the cannabis
plant or in the resinous extractives of the plant, or synthetic substances with similar chemical
structure and pharmacological activity to those substances contained in the plant or resinous
extract, including, but not limited to, 1 cis or trans tetrahydrocannabinol, 6 cis or trans
tetrahydrocannabinol, and 3,4 cis or trans tetrahydrocannabinol;new text begin and
new text end
deleted text begin (3)deleted text end new text begin (2)new text end synthetic cannabinoids, including the following substances:
(i) Naphthoylindoles, which are any compounds containing a 3-(1-napthoyl)indole
structure with substitution at the nitrogen atom of the indole ring by an alkyl, haloalkyl,
alkenyl, cycloalkylmethyl, cycloalkylethyl, 1-(N-methyl-2-piperidinyl)methyl or
2-(4-morpholinyl)ethyl group, whether or not further substituted in the indole ring to any
extent and whether or not substituted in the naphthyl ring to any extent. Examples of
naphthoylindoles include, but are not limited to:
(A) 1-Pentyl-3-(1-naphthoyl)indole (JWH-018 and AM-678);
(B) 1-Butyl-3-(1-naphthoyl)indole (JWH-073);
(C) 1-Pentyl-3-(4-methoxy-1-naphthoyl)indole (JWH-081);
(D) 1-[2-(4-morpholinyl)ethyl]-3-(1-naphthoyl)indole (JWH-200);
(E) 1-Propyl-2-methyl-3-(1-naphthoyl)indole (JWH-015);
(F) 1-Hexyl-3-(1-naphthoyl)indole (JWH-019);
(G) 1-Pentyl-3-(4-methyl-1-naphthoyl)indole (JWH-122);
(H) 1-Pentyl-3-(4-ethyl-1-naphthoyl)indole (JWH-210);
(I) 1-Pentyl-3-(4-chloro-1-naphthoyl)indole (JWH-398);
(J) 1-(5-fluoropentyl)-3-(1-naphthoyl)indole (AM-2201).
(ii) Napthylmethylindoles, which are any compounds containing a
1H-indol-3-yl-(1-naphthyl)methane structure with substitution at the nitrogen atom of the
indole ring by an alkyl, haloalkyl, alkenyl, cycloalkylmethyl, cycloalkylethyl,
1-(N-methyl-2-piperidinyl)methyl or 2-(4-morpholinyl)ethyl group, whether or not further
substituted in the indole ring to any extent and whether or not substituted in the naphthyl
ring to any extent. Examples of naphthylmethylindoles include, but are not limited to:
(A) 1-Pentyl-1H-indol-3-yl-(1-naphthyl)methane (JWH-175);
(B) 1-Pentyl-1H-indol-3-yl-(4-methyl-1-naphthyl)methane (JWH-184).
(iii) Naphthoylpyrroles, which are any compounds containing a 3-(1-naphthoyl)pyrrole
structure with substitution at the nitrogen atom of the pyrrole ring by an alkyl, haloalkyl,
alkenyl, cycloalkylmethyl, cycloalkylethyl, 1-(N-methyl-2-piperidinyl)methyl or
2-(4-morpholinyl)ethyl group whether or not further substituted in the pyrrole ring to any
extent, whether or not substituted in the naphthyl ring to any extent. Examples of
naphthoylpyrroles include, but are not limited to,
(5-(2-fluorophenyl)-1-pentylpyrrol-3-yl)-naphthalen-1-ylmethanone (JWH-307).
(iv) Naphthylmethylindenes, which are any compounds containing a naphthylideneindene
structure with substitution at the 3-position of the indene ring by an alkyl, haloalkyl, alkenyl,
cycloalkylmethyl, cycloalkylethyl, 1-(N-methyl-2-piperidinyl)methyl or
2-(4-morpholinyl)ethyl group whether or not further substituted in the indene ring to any
extent, whether or not substituted in the naphthyl ring to any extent. Examples of
naphthylemethylindenes include, but are not limited to,
E-1-[1-(1-naphthalenylmethylene)-1H-inden-3-yl]pentane (JWH-176).
(v) Phenylacetylindoles, which are any compounds containing a 3-phenylacetylindole
structure with substitution at the nitrogen atom of the indole ring by an alkyl, haloalkyl,
alkenyl, cycloalkylmethyl, cycloalkylethyl, 1-(N-methyl-2-piperidinyl)methyl or
2-(4-morpholinyl)ethyl group whether or not further substituted in the indole ring to any
extent, whether or not substituted in the phenyl ring to any extent. Examples of
phenylacetylindoles include, but are not limited to:
(A) 1-(2-cyclohexylethyl)-3-(2-methoxyphenylacetyl)indole (RCS-8);
(B) 1-pentyl-3-(2-methoxyphenylacetyl)indole (JWH-250);
(C) 1-pentyl-3-(2-methylphenylacetyl)indole (JWH-251);
(D) 1-pentyl-3-(2-chlorophenylacetyl)indole (JWH-203).
(vi) Cyclohexylphenols, which are compounds containing a
2-(3-hydroxycyclohexyl)phenol structure with substitution at the 5-position of the phenolic
ring by an alkyl, haloalkyl, alkenyl, cycloalkylmethyl, cycloalkylethyl,
1-(N-methyl-2-piperidinyl)methyl or 2-(4-morpholinyl)ethyl group whether or not substituted
in the cyclohexyl ring to any extent. Examples of cyclohexylphenols include, but are not
limited to:
(A) 5-(1,1-dimethylheptyl)-2-[(1R,3S)-3-hydroxycyclohexyl]-phenol (CP 47,497);
(B) 5-(1,1-dimethyloctyl)-2-[(1R,3S)-3-hydroxycyclohexyl]-phenol
(Cannabicyclohexanol or CP 47,497 C8 homologue);
(C) 5-(1,1-dimethylheptyl)-2-[(1R,2R)-5-hydroxy-2-(3-hydroxypropyl)cyclohexyl]
-phenol (CP 55,940).
(vii) Benzoylindoles, which are any compounds containing a 3-(benzoyl)indole structure
with substitution at the nitrogen atom of the indole ring by an alkyl, haloalkyl, alkenyl,
cycloalkylmethyl, cycloalkylethyl, 1-(N-methyl-2-piperidinyl)methyl or
2-(4-morpholinyl)ethyl group whether or not further substituted in the indole ring to any
extent and whether or not substituted in the phenyl ring to any extent. Examples of
benzoylindoles include, but are not limited to:
(A) 1-Pentyl-3-(4-methoxybenzoyl)indole (RCS-4);
(B) 1-(5-fluoropentyl)-3-(2-iodobenzoyl)indole (AM-694);
(C) (4-methoxyphenyl-[2-methyl-1-(2-(4-morpholinyl)ethyl)indol-3-yl]methanone (WIN
48,098 or Pravadoline).
(viii) Others specifically named:
(A) (6aR,10aR)-9-(hydroxymethyl)-6,6-dimethyl-3-(2-methyloctan-2-yl)
-6a,7,10,10a-tetrahydrobenzo[c]chromen-1-ol (HU-210);
(B) (6aS,10aS)-9-(hydroxymethyl)-6,6-dimethyl-3-(2-methyloctan-2-yl)
-6a,7,10,10a-tetrahydrobenzo[c]chromen-1-ol (Dexanabinol or HU-211);
(C) 2,3-dihydro-5-methyl-3-(4-morpholinylmethyl)pyrrolo[1,2,3-de]
-1,4-benzoxazin-6-yl-1-naphthalenylmethanone (WIN 55,212-2);
(D) (1-pentylindol-3-yl)-(2,2,3,3-tetramethylcyclopropyl)methanone (UR-144);
(E) (1-(5-fluoropentyl)-1H-indol-3-yl)(2,2,3,3-tetramethylcyclopropyl)methanone
(XLR-11);
(F) 1-pentyl-N-tricyclo[3.3.1.13,7]dec-1-yl-1H-indazole-3-carboxamide
(AKB-48(APINACA));
(G) N-((3s,5s,7s)-adamantan-1-yl)-1-(5-fluoropentyl)-1H-indazole-3-carboxamide
(5-Fluoro-AKB-48);
(H) 1-pentyl-8-quinolinyl ester-1H-indole-3-carboxylic acid (PB-22);
(I) 8-quinolinyl ester-1-(5-fluoropentyl)-1H-indole-3-carboxylic acid (5-Fluoro PB-22);
(J) N-[(1S)-1-(aminocarbonyl)-2-methylpropyl]-1-pentyl-1H-indazole- 3-carboxamide
(AB-PINACA);
(K) N-[(1S)-1-(aminocarbonyl)-2-methylpropyl]-1-[(4-fluorophenyl)methyl]-
1H-indazole-3-carboxamide (AB-FUBINACA);
(L) N-[(1S)-1-(aminocarbonyl)-2-methylpropyl]-1-(cyclohexylmethyl)-1H-
indazole-3-carboxamide(AB-CHMINACA);
(M) (S)-methyl 2-(1-(5-fluoropentyl)-1H-indazole-3-carboxamido)-3- methylbutanoate
(5-fluoro-AMB);
(N) [1-(5-fluoropentyl)-1H-indazol-3-yl](naphthalen-1-yl) methanone (THJ-2201);
(O) (1-(5-fluoropentyl)-1H-benzo[d]imidazol-2-yl)(naphthalen-1-yl)methanone)
(FUBIMINA);
(P) (7-methoxy-1-(2-morpholinoethyl)-N-((1S,2S,4R)-1,3,3-trimethylbicyclo
[2.2.1]heptan-2-yl)-1H-indole-3-carboxamide (MN-25 or UR-12);
(Q) (S)-N-(1-amino-3-methyl-1-oxobutan-2-yl)-1-(5-fluoropentyl)
-1H-indole-3-carboxamide (5-fluoro-ABICA);
(R) N-(1-amino-3-phenyl-1-oxopropan-2-yl)-1-(5-fluoropentyl)
-1H-indole-3-carboxamide;
(S) N-(1-amino-3-phenyl-1-oxopropan-2-yl)-1-(5-fluoropentyl)
-1H-indazole-3-carboxamide;
(T) methyl 2-(1-(cyclohexylmethyl)-1H-indole-3-carboxamido) -3,3-dimethylbutanoate;
(U) N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl)-1(cyclohexylmethyl)-1
H-indazole-3-carboxamide (MAB-CHMINACA);
(V) N-(1-Amino-3,3-dimethyl-1-oxo-2-butanyl)-1-pentyl-1H-indazole-3-carboxamide
(ADB-PINACA);
(W) methyl (1-(4-fluorobenzyl)-1H-indazole-3-carbonyl)-L-valinate (FUB-AMB);
(X) N-[(1S)-2-amino-2-oxo-1-(phenylmethyl)ethyl]-1-(cyclohexylmethyl)-1H-Indazole-
3-carboxamide. (APP-CHMINACA);
(Y) quinolin-8-yl 1-(4-fluorobenzyl)-1H-indole-3-carboxylate (FUB-PB-22); and
(Z) methyl N-[1-(cyclohexylmethyl)-1H-indole-3-carbonyl]valinate (MMB-CHMICA).
(ix) Additional substances specifically named:
(A) 1-(5-fluoropentyl)-N-(2-phenylpropan-2-yl)-1
H-pyrrolo[2,3-B]pyridine-3-carboxamide (5F-CUMYL-P7AICA);
(B) 1-(4-cyanobutyl)-N-(2- phenylpropan-2-yl)-1 H-indazole-3-carboxamide
(4-CN-Cumyl-Butinaca);
(C) naphthalen-1-yl-1-(5-fluoropentyl)-1-H-indole-3-carboxylate (NM2201; CBL2201);
(D) N-(1-amino-3-methyl-1-oxobutan-2-yl)-1-(5-fluoropentyl)-1
H-indazole-3-carboxamide (5F-ABPINACA);
(E) methyl-2-(1-(cyclohexylmethyl)-1H-indole-3-carboxamido)-3,3-dimethylbutanoate
(MDMB CHMICA);
(F) methyl 2-(1-(5-fluoropentyl)-1H-indazole-3-carboxamido)-3,3-dimethylbutanoate
(5F-ADB; 5F-MDMB-PINACA); and
(G) N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl)-1-(4-fluorobenzyl)
1H-indazole-3-carboxamide (ADB-FUBINACA).
(i) A controlled substance analog, to the extent that it is implicitly or explicitly intended
for human consumption.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022, and applies to crimes
committed on or after that date.
new text end
Sec. 12.
Minnesota Statutes 2020, section 152.02, subdivision 3, is amended to read:
Subd. 3.
Schedule II.
(a) Schedule II consists of the substances listed in this subdivision.
(b) Unless specifically excepted or unless listed in another schedule, any of the following
substances whether produced directly or indirectly by extraction from substances of vegetable
origin or independently by means of chemical synthesis, or by a combination of extraction
and chemical synthesis:
(1) Opium and opiate, and any salt, compound, derivative, or preparation of opium or
opiate.
(i) Excluding:
(A) apomorphine;
(B) thebaine-derived butorphanol;
(C) dextrophan;
(D) nalbuphine;
(E) nalmefene;
(F) naloxegol;
(G) naloxone;
(H) naltrexone; and
(I) their respective salts;
(ii) but including the following:
(A) opium, in all forms and extracts;
(B) codeine;
(C) dihydroetorphine;
(D) ethylmorphine;
(E) etorphine hydrochloride;
(F) hydrocodone;
(G) hydromorphone;
(H) metopon;
(I) morphine;
(J) oxycodone;
(K) oxymorphone;
(L) thebaine;
(M) oripavine;
(2) any salt, compound, derivative, or preparation thereof which is chemically equivalent
or identical with any of the substances referred to in clause (1), except that these substances
shall not include the isoquinoline alkaloids of opium;
(3) opium poppy and poppy straw;
(4) coca leaves and any salt, cocaine compound, derivative, or preparation of coca leaves
(including cocaine and ecgonine and their salts, isomers, derivatives, and salts of isomers
and derivatives), and any salt, compound, derivative, or preparation thereof which is
chemically equivalent or identical with any of these substances, except that the substances
shall not include decocainized coca leaves or extraction of coca leaves, which extractions
do not contain cocaine or ecgonine;
(5) concentrate of poppy straw (the crude extract of poppy straw in either liquid, solid,
or powder form which contains the phenanthrene alkaloids of the opium poppy).
(c) Any of the following opiates, including their isomers, esters, ethers, salts, and salts
of isomers, esters and ethers, unless specifically excepted, or unless listed in another schedule,
whenever the existence of such isomers, esters, ethers and salts is possible within the specific
chemical designation:
(1) alfentanil;
(2) alphaprodine;
(3) anileridine;
(4) bezitramide;
(5) bulk dextropropoxyphene (nondosage forms);
(6) carfentanil;
(7) dihydrocodeine;
(8) dihydromorphinone;
(9) diphenoxylate;
(10) fentanyl;
(11) isomethadone;
(12) levo-alpha-acetylmethadol (LAAM);
(13) levomethorphan;
(14) levorphanol;
(15) metazocine;
(16) methadone;
(17) methadone - intermediate, 4-cyano-2-dimethylamino-4, 4-diphenylbutane;
(18) moramide - intermediate, 2-methyl-3-morpholino-1, 1-diphenyl-propane-carboxylic
acid;
(19) pethidine;
(20) pethidine - intermediate - a, 4-cyano-1-methyl-4-phenylpiperidine;
(21) pethidine - intermediate - b, ethyl-4-phenylpiperidine-4-carboxylate;
(22) pethidine - intermediate - c, 1-methyl-4-phenylpiperidine-4-carboxylic acid;
(23) phenazocine;
(24) piminodine;
(25) racemethorphan;
(26) racemorphan;
(27) remifentanil;
(28) sufentanil;
(29) tapentadol;
(30) 4-Anilino-N-phenethylpiperidine.
(d) Unless specifically excepted or unless listed in another schedule, any material,
compound, mixture, or preparation which contains any quantity of the following substances
having a stimulant effect on the central nervous system:
(1) amphetamine, its salts, optical isomers, and salts of its optical isomers;
(2) methamphetamine, its salts, isomers, and salts of its isomers;
(3) phenmetrazine and its salts;
(4) methylphenidate;
(5) lisdexamfetamine.
(e) Unless specifically excepted or unless listed in another schedule, any material,
compound, mixture, or preparation which contains any quantity of the following substances
having a depressant effect on the central nervous system, including its salts, isomers, and
salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible
within the specific chemical designation:
(1) amobarbital;
(2) glutethimide;
(3) secobarbital;
(4) pentobarbital;
(5) phencyclidine;
(6) phencyclidine immediate precursors:
(i) 1-phenylcyclohexylamine;
(ii) 1-piperidinocyclohexanecarbonitrile;
(7) phenylacetone.
(f) new text begin Cannabis and new text end cannabinoids:
(1) nabilone;
new text begin
(2) unless specifically excepted or unless listed in another schedule, any natural material,
compound, mixture, or preparation that contains any quantity of the following substances,
their analogs, isomers, esters, ethers, salts, and salts of isomers, esters, and ethers, whenever
the existence of the isomers, esters, ethers, or salts is possible:
new text end
new text begin
(i) marijuana; and
new text end
new text begin
(ii) tetrahydrocannabinols naturally contained in a plant of the genus cannabis or in the
resinous extractives of the plant, except that a product containing tetrahydrocannabinols is
not included if it meets the requirements of section 151.72; and
new text end
deleted text begin (2)deleted text end new text begin (3)new text end dronabinol [(-)-delta-9-trans-tetrahydrocannabinol (delta-9-THC)] in an oral
solution in a drug product approved for marketing by the United States Food and Drug
Administration.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022, and applies to crimes
committed on or after that date.
new text end
Sec. 13.
Minnesota Statutes 2020, section 152.11, is amended by adding a subdivision to
read:
new text begin Subd. 5. new text end
new text begin Exception. new text end
new text begin
References in this section to Schedule II controlled substances do
not extend to marijuana or tetrahydrocannabinols.
new text end
Sec. 14.
Minnesota Statutes 2020, section 152.12, is amended by adding a subdivision to
read:
new text begin Subd. 6. new text end
new text begin Exception. new text end
new text begin
References in this section to Schedule II controlled substances do
not extend to marijuana or tetrahydrocannabinols.
new text end
Sec. 15.
Minnesota Statutes 2020, section 152.125, subdivision 3, is amended to read:
Subd. 3.
Limits on applicability.
This section does not apply to:
(1) a physician's treatment of an individual for chemical dependency resulting from the
use of controlled substances in Schedules II to V of section 152.02;
(2) the prescription or administration of controlled substances in Schedules II to V of
section 152.02 to an individual whom the physician knows to be using the controlled
substances for nontherapeutic purposes;
(3) the prescription or administration of controlled substances in Schedules II to V of
section 152.02 for the purpose of terminating the life of an individual having intractable
pain; deleted text begin or
deleted text end
(4) the prescription or administration of a controlled substance in Schedules II to V of
section 152.02 that is not a controlled substance approved by the United States Food and
Drug Administration for pain reliefnew text begin ; or
new text end
new text begin (5) the administration of medical cannabis under sections 152.22 to 152.37new text end .
Sec. 16.
Minnesota Statutes 2020, section 152.32, subdivision 1, is amended to read:
Subdivision 1.
deleted text begin Presumptiondeleted text end new text begin Presumptionsnew text end .
(a) There is a presumption that a patient
enrolled in the registry program under sections 152.22 to 152.37 is engaged in the authorized
use of medical cannabis.
(b) The presumption new text begin in paragraph (a) new text end may be rebutted by evidence that conduct related
to use of medical cannabis was not for the purpose of treating or alleviating the patient's
qualifying medical condition or symptoms associated with the patient's qualifying medical
condition.
new text begin
(c) Sections 152.22 to 152.37 do not create any positive conflict with federal drug laws
or regulations and are consistent with United States Code, title 21, section 903.
new text end
Sec. 17.
Minnesota Statutes 2020, section 152.32, subdivision 2, is amended to read:
Subd. 2.
Criminal and civil protections.
(a) Subject to section 152.23, the following
are not violations under this chapter:
(1) use or possession of medical cannabis or medical cannabis products by a patient
enrolled in the registry program, or possession by a registered designated caregiver or the
parent, legal guardian, or spouse of a patient if the parent, legal guardian, or spouse is listed
on the registry verification;
(2) possession, dosage determination, or sale of medical cannabis or medical cannabis
products by a medical cannabis manufacturer, employees of a manufacturer, a laboratory
conducting testing on medical cannabis, or employees of the laboratory; and
(3) possession of medical cannabis or medical cannabis products by any person while
carrying out the duties required under sections 152.22 to 152.37.
(b) Medical cannabis obtained and distributed pursuant to sections 152.22 to 152.37 and
associated property is not subject to forfeiture under sections 609.531 to 609.5316.
(c) The commissioner, the commissioner's staff, the commissioner's agents or contractors,
and any health care practitioner are not subject to any civil or disciplinary penalties by the
Board of Medical Practice, the Board of Nursing, or by any business, occupational, or
professional licensing board or entity, solely for the participation in the registry program
under sections 152.22 to 152.37. A pharmacist licensed under chapter 151 is not subject to
any civil or disciplinary penalties by the Board of Pharmacy when acting in accordance
with the provisions of sections 152.22 to 152.37. Nothing in this section affects a professional
licensing board from taking action in response to violations of any other section of law.
(d) Notwithstanding any law to the contrary, the commissioner, the governor of
Minnesota, or an employee of any state agency may not be held civilly or criminally liable
for any injury, loss of property, personal injury, or death caused by any act or omission
while acting within the scope of office or employment under sections 152.22 to 152.37.
(e) Federal, state, and local law enforcement authorities are prohibited from accessing
the patient registry under sections 152.22 to 152.37 except when acting pursuant to a valid
search warrant.
(f) Notwithstanding any law to the contrary, neither the commissioner nor a public
employee may release data or information about an individual contained in any report,
document, or registry created under sections 152.22 to 152.37 or any information obtained
about a patient participating in the program, except as provided in sections 152.22 to 152.37.
(g) No information contained in a report, document, or registry or obtained from a patient
under sections 152.22 to 152.37 may be admitted as evidence in a criminal proceeding
unless independently obtained or in connection with a proceeding involving a violation of
sections 152.22 to 152.37.
(h) Notwithstanding section 13.09, any person who violates paragraph (e) or (f) is guilty
of a gross misdemeanor.
(i) An attorney may not be subject to disciplinary action by the Minnesota Supreme
Court or professional responsibility board for providing legal assistance to prospective or
registered manufacturers or others related to activity that is no longer subject to criminal
penalties under state law pursuant to sections 152.22 to 152.37.
(j) Possession of a registry verification or application for enrollment in the program by
a person entitled to possess or apply for enrollment in the registry program does not constitute
probable cause or reasonable suspicion, nor shall it be used to support a search of the person
or property of the person possessing or applying for the registry verification, or otherwise
subject the person or property of the person to inspection by any governmental agency.
new text begin
(k) Subject to section 152.23, the listing of tetrahydrocannabinols as a Schedule I
controlled substance under this chapter does not apply to protected activities specified in
this subdivision.
new text end
Sec. 18.
Minnesota Statutes 2021 Supplement, section 363A.50, is amended to read:
363A.50 NONDISCRIMINATION IN ACCESS TO TRANSPLANTS.
Subdivision 1.
Definitions.
(a) For purposes of this section, the following terms have
the meanings given unless the context clearly requires otherwise.
(b) "Anatomical gift" has the meaning given in section 525A.02, subdivision 4.
(c) "Auxiliary aids and services" include, but are not limited to:
(1) qualified interpreters or other effective methods of making aurally delivered materials
available to individuals with hearing impairmentsnew text begin and to non-English-speaking individualsnew text end ;
(2) qualified readers, taped texts, texts in accessible electronic format, or other effective
methods of making visually delivered materials available to individuals with visual
impairments;
(3) the provision of information in a format that is accessible for individuals with
cognitive, neurological, developmental, intellectual, or physical disabilities;
(4) the provision of supported decision-making services; and
(5) the acquisition or modification of equipment or devices.
(d) "Covered entity" means:
(1) any licensed provider of health care services, including licensed health care
practitioners, hospitals, nursing facilities, laboratories, intermediate care facilities, psychiatric
residential treatment facilities, institutions for individuals with intellectual or developmental
disabilities, and prison health centers; or
(2) any entity responsible for matching anatomical gift donors to potential recipients.
(e) "Disability" has the meaning given in section 363A.03, subdivision 12.
(f) "Organ transplant" means the transplantation or infusion of a part of a human body
into the body of another for the purpose of treating or curing a medical condition.
(g) "Qualified individual" means an individual who, with or without available support
networks, the provision of auxiliary aids and services, or reasonable modifications to policies
or practices, meets the essential eligibility requirements for the receipt of an anatomical
gift.
(h) "Reasonable modifications" include, but are not limited to:
(1) communication with individuals responsible for supporting an individual with
postsurgical and post-transplantation care, including medication; and
(2) consideration of support networks available to the individual, including family,
friends, and home and community-based services, including home and community-based
services funded through Medicaid, Medicare, another health plan in which the individual
is enrolled, or any program or source of funding available to the individual, in determining
whether the individual is able to comply with post-transplant medical requirements.
(i) "Supported decision making" has the meaning given in section 524.5-102, subdivision
16a.
Subd. 2.
Prohibition of discrimination.
(a) A covered entity may not, on the basis of
a qualified individual'snew text begin race, ethnicity,new text end mental new text begin disability, new text end or physical disability:
(1) deem an individual ineligible to receive an anatomical gift or organ transplant;
(2) deny medical or related organ transplantation services, including evaluation, surgery,
counseling, and postoperative treatment and care;
(3) refuse to refer the individual to a transplant center or other related specialist for the
purpose of evaluation or receipt of an anatomical gift or organ transplant;
(4) refuse to place an individual on an organ transplant waiting list or place the individual
at a lower-priority position on the list than the position at which the individual would have
been placed if not for the individual's new text begin race, ethnicity, or new text end disability; or
(5) decline insurance coverage for any procedure associated with the receipt of the
anatomical gift or organ transplant, including post-transplantation and postinfusion care.
(b) Notwithstanding paragraph (a), a covered entity may take an individual's disability
into account when making treatment or coverage recommendations or decisions, solely to
the extent that the physical or mental disability has been found by a physician, following
an individualized evaluation of the potential recipient to be medically significant to the
provision of the anatomical gift or organ transplant. The provisions of this section may not
be deemed to require referrals or recommendations for, or the performance of, organ
transplants that are not medically appropriate given the individual's overall health condition.
(c) If an individual has the necessary support system to assist the individual in complying
with post-transplant medical requirements, an individual's inability to independently comply
with those requirements may not be deemed to be medically significant for the purposes of
paragraph (b).
(d) A covered entity must make reasonable modifications to policies, practices, or
procedures, when such modifications are necessary to make services such as
transplantation-related counseling, information, coverage, or treatment available to qualified
individuals with disabilities, unless the entity can demonstrate that making such modifications
would fundamentally alter the nature of such services.
(e) A covered entity must take such steps as may be necessary to ensure that no qualified
individual with a disability is denied services such as transplantation-related counseling,
information, coverage, or treatment because of the absence of auxiliary aids and services,
unless the entity can demonstrate that taking such steps would fundamentally alter the nature
of the services being offered or result in an undue burden. A covered entity is not required
to provide supported decision-making services.
(f) A covered entity must otherwise comply with the requirements of Titles II and III of
the Americans with Disabilities Act of 1990, the Americans with Disabilities Act
Amendments Act of 2008, and the Minnesota Human Rights Act.
(g) The provisions of this section apply to each part of the organ transplant process.
Subd. 3.
Remedies.
In addition to all other remedies available under this chapter, any
individual who has been subjected to discrimination in violation of this section may initiate
a civil action in a court of competent jurisdiction to enjoin violations of this section.
Sec. 19.
Laws 2020, First Special Session chapter 7, section 1, subdivision 5, as amended
by Laws 2021, First Special Session chapter 7, article 2, section 73, is amended to read:
Subd. 5.
Waivers and modifications; extension deleted text begin for 365 daysdeleted text end .
When the peacetime
emergency declared by the governor in response to the COVID-19 outbreak expires, is
terminated, or is rescinded by the proper authority, waiver CV23: modifying background
study requirements, issued by the commissioner of human services pursuant to Executive
Orders 20-11 and 20-12, including any amendments to the modification issued before the
peacetime emergency expires, shall remain in effect deleted text begin for 365 days after the peacetime
emergency endsdeleted text end new text begin until January 1, 2023new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 20. new text begin FEDERAL SCHEDULE I EXEMPTION APPLICATION FOR MEDICAL
USE OF CANNABIS.
new text end
new text begin
By September 1, 2022, the commissioner of health shall apply to the Drug Enforcement
Administration's Office of Diversion Control for an exception under Code of Federal
Regulations, title 21, section 1307.03, and request formal written acknowledgment that the
listing of marijuana, marijuana extract, and tetrahydrocannabinols as controlled substances
in federal Schedule I does not apply to the protected activities in Minnesota Statutes, section
152.32, subdivision 2, pursuant to the medical cannabis program established under Minnesota
Statutes, sections 152.22 to 152.37. The application must include the list of presumptions
in Minnesota Statutes, section 152.32, subdivision 1.
new text end
Sec. 21. new text begin REVISOR INSTRUCTION.
new text end
new text begin
The revisor of statutes shall renumber as Minnesota Statutes, section 256.4835, the
Minnesota Rare Disease Advisory Council that is currently coded as Minnesota Statutes,
section 137.68. The revisor shall also make necessary cross-reference changes consistent
with the renumbering.
new text end
ARTICLE 9
FORECAST ADJUSTMENTS
Section 1. new text begin HUMAN SERVICES APPROPRIATION.
|
new text begin
The dollar amounts shown in the columns marked "Appropriations" are added to or, if
shown in parentheses, are subtracted from the appropriations in Laws 2021, First Special
Session chapter 7, article 16, from the general fund or any fund named to the Department
of Human Services for the purposes specified in this article, to be available for the fiscal
year indicated for each purpose. The figures "2022" and "2023" used in this article mean
that the appropriations listed under them are available for the fiscal years ending June 30,
2022, or June 30, 2023, respectively. "The first year" is fiscal year 2022. "The second year"
is fiscal year 2023. "The biennium" is fiscal years 2022 and 2023.
new text end
|
new text begin
APPROPRIATIONS new text end |
||||||
|
new text begin
Available for the Year new text end |
||||||
|
new text begin
Ending June 30 new text end |
||||||
|
new text begin
2022 new text end |
new text begin
2023 new text end |
|||||
Sec. 2. new text begin COMMISSIONER OF HUMAN
|
||||||
new text begin Subdivision 1. new text end
new text begin
Total Appropriation
|
new text begin
$ new text end |
new text begin
(585,901,000) new text end |
new text begin
$ new text end |
new text begin
182,791,000 new text end |
||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General Fund new text end |
new text begin
(406,629,000) new text end |
new text begin
185,395,000 new text end |
|
new text begin
Health Care Access Fund new text end |
new text begin
(86,146,000) new text end |
new text begin
(11,799,000) new text end |
|
new text begin
Federal TANF new text end |
new text begin
(93,126,000) new text end |
new text begin
9,195,000 new text end |
new text begin Subd. 2. new text end
new text begin
Forecasted Programs
|
||||||
|
new text begin
(a) MFIP/DWP new text end |
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General Fund new text end |
new text begin
72,106,000 new text end |
new text begin
(14,397,000) new text end |
|
new text begin
Federal TANF new text end |
new text begin
(93,126,000) new text end |
new text begin
9,195,000 new text end |
|
new text begin
(b) MFIP Child Care Assistance new text end |
new text begin
(103,347,000) new text end |
new text begin
(73,738,000) new text end |
||||
|
new text begin
(c) General Assistance new text end |
new text begin
(4,175,000) new text end |
new text begin
(1,488,000) new text end |
||||
|
new text begin
(d) Minnesota Supplemental Aid new text end |
new text begin
318,000 new text end |
new text begin
1,613,000 new text end |
||||
|
new text begin
(e) Housing Support new text end |
new text begin
(1,994,000) new text end |
new text begin
9,257,000 new text end |
||||
|
new text begin
(f) Northstar Care for Children new text end |
new text begin
(9,613,000) new text end |
new text begin
(4,865,000) new text end |
||||
|
new text begin
(g) MinnesotaCare new text end |
new text begin
(86,146,000) new text end |
new text begin
(11,799,000) new text end |
||||
new text begin
These appropriations are from the health care
access fund.
new text end
|
new text begin
(h) Medical Assistance new text end |
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General Fund new text end |
new text begin
(348,364,000) new text end |
new text begin
292,880,000 new text end |
|
new text begin
Health Care Access Fund new text end |
new text begin
-0- new text end |
new text begin
-0- new text end |
|
new text begin
(i) Alternative Care Program new text end |
new text begin
-0- new text end |
new text begin
-0- new text end |
||||
|
new text begin
(j) Behavioral Health Fund new text end |
new text begin
(11,560,000) new text end |
new text begin
(23,867,000) new text end |
||||
new text begin Subd. 3. new text end
new text begin
Technical Activities
|
new text begin
-0- new text end |
new text begin
-0- new text end |
||||
new text begin
These appropriations are from the federal
TANF fund.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
ARTICLE 10
APPROPRIATIONS
Section 1. new text begin HEALTH AND HUMAN SERVICES APPROPRIATIONS.
|
new text begin
The sums shown in the columns marked "Appropriations" are added to or, if shown in
parentheses, subtracted from the appropriations in Laws 2021, First Special Session chapter
7, article 16, to the agencies and for the purposes specified in this article. The appropriations
are from the general fund or other named fund and are available for the fiscal years indicated
for each purpose. The figures "2022" and "2023" used in this article mean that the addition
to or subtraction from the appropriation listed under them is available for the fiscal year
ending June 30, 2022, or June 30, 2023, respectively. Base adjustments mean the addition
to or subtraction from the base level adjustment set in Laws 2021, First Special Session
chapter 7, article 16. Supplemental appropriations and reductions to appropriations for the
fiscal year ending June 30, 2022, are effective the day following final enactment unless a
different effective date is explicit.
new text end
|
new text begin
APPROPRIATIONS new text end |
||||||
|
new text begin
Available for the Year new text end |
||||||
|
new text begin
Ending June 30 new text end |
||||||
|
new text begin
2022 new text end |
new text begin
2023 new text end |
|||||
Sec. 2. new text begin COMMISSIONER OF HUMAN
|
||||||
new text begin Subdivision 1. new text end
new text begin
Total Appropriation
|
new text begin
$ new text end |
new text begin
32,461,000 new text end |
new text begin
$ new text end |
new text begin
308,754,000 new text end |
||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2022 new text end |
new text begin
2023 new text end |
|
|
new text begin
General new text end |
new text begin
34,397,000 new text end |
new text begin
402,226,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
(1,936,000) new text end |
new text begin
(88,042,000) new text end |
|
new text begin
Federal TANF new text end |
new text begin
-0- new text end |
new text begin
7,000 new text end |
|
new text begin
Opiate Epidemic Response new text end |
new text begin
-0- new text end |
new text begin
760,000 new text end |
new text begin Subd. 2. new text end
new text begin
Central Office; Operations
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
397,000 new text end |
new text begin
96,487,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
-0- new text end |
new text begin
13,729,000 new text end |
new text begin
(a) Background Studies. (1) $1,779,000 in
fiscal year 2023 is to provide a credit to
providers who paid for emergency background
studies in NETStudy 2.0. This is a onetime
appropriation.
new text end
new text begin
(2) $1,851,000 in fiscal year 2023 is to fund
the costs of reprocessing emergency studies
conducted under interagency agreements. This
is a onetime appropriation.
new text end
new text begin
(b) Supporting Drug Pricing Litigation
Costs. $228,000 in fiscal year 2022 is for costs
to comply with litigation requirements related
to pharmaceutical drug price litigation. This
is a onetime appropriation.
new text end
new text begin
(c) Base Level Adjustment. The general fund
base is increased $11,846,000 in fiscal year
2024 and $9,359,000 in fiscal year 2025. The
health care access fund base is increased
$1,551,000 in fiscal year 2024 and $1,455,000
in fiscal year 2025.
new text end
new text begin Subd. 3. new text end
new text begin
Central Office; Children and Families
|
new text begin
-0- new text end |
new text begin
21,992,000 new text end |
||||
new text begin
(a) Foster Care Federal Cash Assistance
Benefits Plan. $373,000 in fiscal year 2023
is for the commissioner to develop the foster
care federal cash assistance benefits plan. The
base for this appropriation is $342,000 in fiscal
year 2024 and $127,000 in fiscal year 2025.
new text end
new text begin
(b) Base Level Adjustment. The general fund
base is increased $7,823,000 in fiscal year
2024 and $7,578,000 in fiscal year 2025.
new text end
new text begin Subd. 4. new text end
new text begin
Central Office; Health Care
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
-0- new text end |
new text begin
4,500,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
-0- new text end |
new text begin
2,475,000 new text end |
new text begin
(a) Interactive Voice Response and
Improving Access for Applications and
Forms. $1,350,000 in fiscal year 2023 is for
the improvement of accessibility to Minnesota
health care programs applications, forms, and
other consumer support resources and services
to enrollees with limited English proficiency.
This is a onetime appropriation and is
available until June 30, 2025.
new text end
new text begin
(b) Community-Driven Improvements.
$680,000 in fiscal year 2023 is for Minnesota
health care program enrollee engagement
activities.
new text end
new text begin
(c) Responding to COVID-19 in Minnesota
Health Care Programs. $1,000,000 in fiscal
year 2023 is for contract assistance relating to
the resumption of eligibility and
redetermination processes in Minnesota health
care programs after the expiration of the
federal public health emergency. Contracts
entered into under this section are for
emergency acquisition and are not subject to
solicitation requirements under Minnesota
Statutes, section 16C.10, subdivision 2. This
is a onetime appropriation and is available
until June 30, 2025.
new text end
new text begin
(d) Initial PACE Implementation Funding.
$270,000 in fiscal year 2023 is from the
general fund to complete the initial actuarial
and administrative work necessary to
recommend a financing mechanism for the
operation of PACE under Minnesota Statutes,
section 256B.69, subdivision 23, paragraph
(e).
new text end
new text begin
(e) Base Level Adjustment. The general fund
base is increased $3,607,000 in fiscal year
2024 and $5,123,000 in fiscal year 2025. The
health care access fund base is increased
$4,357,000 in fiscal year 2024 and $7,550,000
in fiscal year 2025.
new text end
new text begin Subd. 5. new text end
new text begin
Central Office; Continuing Care
|
new text begin
-0- new text end |
new text begin
177,000 new text end |
||||
new text begin
(a) Lifesharing Services. $57,000 in fiscal
year 2023 is for engaging stakeholders and
developing recommendations regarding
establishing a lifesharing service under the
state's medical assistance disability waivers
and elderly waiver. The base for this
appropriation is $43,000 in fiscal year 2024.
new text end
new text begin
(b) Initial PACE Implementation Funding.
$120,000 in fiscal year 2023 is to complete
the initial actuarial and administrative work
necessary to recommend a financing
mechanism for the operation of PACE under
Minnesota Statutes, section 256B.69,
subdivision 23, paragraph (e).
new text end
new text begin
(c) new text begin Base Level Adjustment.new text end The general fund
base is increased $43,000 in fiscal year 2024.
new text end
new text begin Subd. 6. new text end
new text begin
Central Office; Community Supports
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
-0- new text end |
new text begin
8,531,000 new text end |
|
new text begin
Opioid Epidemic Response new text end |
new text begin
-0- new text end |
new text begin
760,000 new text end |
new text begin
(a) SEIU Health Care Arbitration Award.
$5,444 in fiscal year 2023 is for arbitration
awards resulting from a SEIU grievance. This
is a onetime appropriation.
new text end
new text begin
(b) Lifesharing Services. $57,000 in fiscal
year 2023 is from the general fund for
engaging stakeholders and developing
recommendations regarding establishing a
lifesharing service under the state's medical
assistance disability waivers and elderly
waiver. The general fund base for this
appropriation is $43,000 in fiscal year 2024.
new text end
new text begin
(c) Intermediate Care Facilities for Persons
with Developmental Disabilities; Rate
Study. $250,000 in fiscal year 2023 is from
the general fund for a study of medical
assistance rates for intermediate care facilities
for persons with developmental disabilities
under Minnesota Statutes, sections 256B.5011
to 256B.5015. This is a onetime appropriation.
new text end
new text begin
(d) Online tool accessibility and capacity
expansion. $395,000 in fiscal year 2023 is to
expand the accessibility and capacity of online
tools for people receiving services and direct
support workers. The base for this
appropriation is $664,000 in fiscal year 2024
and $681,000 in fiscal year 2025.
new text end
new text begin
(e) Systemic critical incident review team.
$459,000 in fiscal year 2023 is to implement
the systemic critical incident review process
in Minnesota Statutes, section 256.01,
subdivision 12b. The base for this
appropriation is $498,000 in fiscal year 2024
and $498,000 in fiscal year 2025.
new text end
new text begin
(f) new text begin Base Level Adjustment.new text end The general fund
base is increased $9,908,000 in fiscal year
2024 and $8,210,000 in fiscal year 2025. The
opiate epidemic response base is increased
$790,000 in fiscal year 2024 and $790,000 in
fiscal year 2025.
new text end
new text begin Subd. 7. new text end
new text begin
Forecasted Programs; MFIP/DWP
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
-0- new text end |
new text begin
4,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
-0- new text end |
new text begin
7,000 new text end |
new text begin Subd. 8. new text end
new text begin
Forecasted Programs; MFIP Child Care
|
new text begin
-0- new text end |
new text begin
1,000 new text end |
||||
new text begin Subd. 9. new text end
new text begin
Forecasted Programs; Minnesota
|
new text begin
-0- new text end |
new text begin
1,000 new text end |
||||
new text begin Subd. 10. new text end
new text begin
Forecasted Programs; Housing
|
new text begin
-0- new text end |
new text begin
4,304,000 new text end |
||||
new text begin Subd. 11. new text end
new text begin
Forecasted Programs; MinnesotaCare
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
-0- new text end |
new text begin
(17,943,000) new text end |
|
new text begin
Health Care Access new text end |
new text begin
-0- new text end |
new text begin
28,724,000 new text end |
new text begin
This appropriation is from the health care
access fund.
new text end
new text begin Subd. 12. new text end
new text begin
Forecasted Programs; Medical
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
-0- new text end |
new text begin
(56,518,000) new text end |
|
new text begin
Health Care Access new text end |
new text begin
-0- new text end |
new text begin
(136,906,000) new text end |
new text begin Subd. 13. new text end
new text begin
Forecasted Programs; Alternative
|
new text begin
-0- new text end |
new text begin
530,000 new text end |
||||
new text begin Subd. 14. new text end
new text begin
Grant Programs; BSF Child Care
|
new text begin
-0- new text end |
new text begin
6,000 new text end |
||||
new text begin
Base Level Adjustment. The general fund
base is increased $29,000 in fiscal year 2024
and $248,000 in fiscal year 2025.
new text end
new text begin Subd. 15. new text end
new text begin
Grant Programs; Child Care
|
new text begin
-0- new text end |
new text begin
-0- new text end |
||||
new text begin Subd. 16. new text end
new text begin
Grant Programs; Children's Services
|
new text begin
-0- new text end |
new text begin
8,984,000 new text end |
||||
new text begin
(a) American Indian Child Welfare
Initiative; Mille Lacs Band of Ojibwe
Planning. $1,263,000 in fiscal year 2023 is
to support activities necessary for the Mille
Lacs Band of Ojibwe to join the American
Indian child welfare initiative.
new text end
new text begin
(b) Expand Parent Support Outreach
Program. The base shall include $7,000,000
in fiscal year 2024 and $7,000,000 in fiscal
year 2025 to expand the parent support
outreach program to community-based
agencies, public health agencies, and schools
to prevent reporting of and entry into the child
welfare system.
new text end
new text begin
(c) Thriving Families Safer Children. The
base shall include $30,000 in fiscal year 2024
to plan for an education attendance support
diversionary program to prevent entry into the
child welfare system. The commissioner shall
report back to the chairs and ranking minority
members of the legislative committees that
oversee child welfare by January 1, 2025, on
the plan for this program. This is a onetime
appropriation.
new text end
new text begin
(d) Family Group Decision Making. The
base shall include $5,000,000 in fiscal year
2024 and $5,000,000 in fiscal year 2025 to
expand the use of family group decision
making to provide opportunity for family
voices concerning critical decisions in child
safety and prevent entry into the child welfare
system.
new text end
new text begin
(e) Child Welfare Promising Practices. The
base shall include $5,000,000 in fiscal year
2024 and $5,000,000 in fiscal year 2025 to
develop promising practices for prevention of
out-of-home placement of children and youth.
new text end
new text begin
(f) Family Assessment Response. The base
shall include $23,550,000 in fiscal year 2024
and $23,550,000 in fiscal year 2025 to support
counties and Tribes that are members of the
American Indian child welfare initiative in
providing case management services and
support for families being served under family
assessment response and to prevent entry into
the child welfare system.
new text end
new text begin
(g) Extend Support for Youth Leaving
Foster Care. $600,000 in fiscal year 2023 is
to extend financial supports for young adults
aging out of foster care to age 22.
new text end
new text begin
(h) Grants to Counties for Child Protection
Staff. $1,000,000 in fiscal year 2023 is to
provide grants to counties and American
Indian child welfare initiative Tribes to be
used to reduce extended foster care caseload
sizes to ten cases per worker.
new text end
new text begin
(i) Statewide Pool of Qualified Individuals.
$1,177,400 in fiscal year 2023 is for grants to
one or more grantees to establish and manage
a pool of state-funded qualified individuals to
assess potential out-of-home placement of a
child in a qualified residential treatment
program. Up to $200,000 of the grants each
fiscal year is available for grantee contracts to
manage the state-funded pool of qualified
individuals. This amount shall also pay for
qualified individual training, certification, and
background studies. Remaining grant money
shall be available until expended to provide
qualified individual services to counties and
Tribes that have joined the American Indian
child welfare initiative pursuant to Minnesota
Statutes, section 256.01, subdivision 14b, to
provide qualified residential treatment
program assessments at no cost to the county
or Tribal agency.
new text end
new text begin
(j) Quality Parenting Initiative Grant.
$100,000 in fiscal year 2023 is for a grant to
the Quality Parenting Initiative Minnesota, to
implement Quality Parenting Initiative
principles and practices and support children
and families experiencing foster care
placements. The grantee shall use grant funds
to provide training and technical assistance to
county and Tribal agencies, community-based
agencies, and other stakeholders on conducting
initial foster care phone calls under Minnesota
Statutes, section 260C.219, subdivision 6;
supporting practices that create partnerships
between birth and foster families; and
informing child welfare practices by
supporting youth leadership and the
participation of individuals with experience
in the foster care system. Upon request, the
commissioner shall make information
regarding the use of this grant funding
available to the chairs and ranking minority
members of the legislative committees with
jurisdiction over human services. This is a
onetime appropriation.
new text end
new text begin
(k) Costs of Foster Care or Care,
Examination, or Treatment. $5,000,000 in
fiscal year 2023 is for grants to counties and
Tribes, to reimburse counties and Tribes for
the costs of foster care or care, examination,
or treatment that would previously have been
paid by the parents or custodians of a child in
foster care using parental income and
resources, child support payments, or income
and resources attributable to a child under
Minnesota Statutes, sections 242.19, 256N.26,
260B.331, and 260C.331. Counties and Tribes
must apply for grant funds in a form
prescribed by the commissioner, and must
provide the information and data necessary to
calculate grant fund allocations accurately and
equitably, as determined by the commissioner.
new text end
new text begin
(l) Grants to Counties; Foster Care Federal
Cash Assistance Benefits Plan. $50,000 in
fiscal year 2023 is for the commissioner to
provide grants to counties to assist counties
with gathering and reporting the county data
required for the commissioner to develop the
foster care federal cash assistance benefits
plan.
new text end
new text begin
(m) Base Level Adjustment. The general fund
base is increased $52,386,000 in fiscal year
2024 and $49,715,000 in fiscal year 2025.
new text end
new text begin Subd. 17. new text end
new text begin
Grant Programs; Children and
|
new text begin
-0- new text end |
new text begin
-0- new text end |
||||
new text begin
Base Level Adjustment.
new text end
new text begin
The opiate epidemic
response base is increased $100,000 in fiscal
year 2025.
new text end
new text begin Subd. 18. new text end
new text begin
Grant Programs; Children and
|
new text begin
14,000,000 new text end |
new text begin
145,931,000 new text end |
||||
new text begin
(a) Family and Community Resource Hubs.
$2,550,000 in fiscal year 2023 is to implement
a sustainable family and community resource
hub model through the community action
agencies under Minnesota Statutes, section
256E.31, and federally recognized Tribes. The
community resource hubs must offer
navigation to several supports and services,
including but not limited to basic needs and
economic assistance, disability services,
healthy development and screening,
developmental and behavioral concerns,
family well-being and mental health, early
learning and child care, dental care, legal
services, and culturally specific services for
American Indian families.
new text end
new text begin
(b) Tribal Food Sovereignty Infrastructure
Grants. $4,000,000 in fiscal year 2023 is for
capital and infrastructure development to
support food system changes and provide
equitable access to existing and new methods
of food support for American Indian
communities, including federally recognized
Tribes and American Indian nonprofit
organizations. This is a onetime appropriation
and is available until June 30, 2025.
new text end
new text begin
(c) Tribal Food Security. $2,836,000 in fiscal
year 2023 is to promote food security for
American Indian communities, including
federally recognized Tribes and American
Indian nonprofit organizations. This includes
hiring staff, providing culturally relevant
training for building food access, purchasing
technical assistance materials and supplies,
and planning for sustainable food systems.
new text end
new text begin
(d) Capital for Emergency Food
Distribution Facilities. $14,931,000 in fiscal
year 2023 is for improving and expanding the
infrastructure of food shelf facilities across
the state, including adding freezer or cooler
space and dry storage space, improving the
safety and sanitation of existing food shelves,
and addressing deferred maintenance or other
facility needs of existing food shelves. Grant
money shall be made available to nonprofit
organizations, federally recognized Tribes,
and local units of government. This is a
onetime appropriation and is available until
June 30, 2025.
new text end
new text begin
(e) Food Support Grants. $5,000,000 in
fiscal year 2023 is to provide additional
resources to a diverse food support network
that includes food shelves, food banks, and
meal and food outreach programs. Grant
money shall be made available to nonprofit
organizations, federally recognized Tribes,
and local units of government.
new text end
new text begin
(f) Transitional Housing. $2,500,000 in fiscal
year 2023 is for transitional housing programs
under Minnesota Statutes, section 256E.33.
new text end
new text begin
(g) Shelter-Linked Youth Mental Health
Grants. $1,650,000 in fiscal year 2023 is for
shelter-linked youth mental health grants under
Minnesota Statutes, section 256K.46.
new text end
new text begin
(h) Emergency Services Grants. $35,000,000
in fiscal year 2023 is for emergency services
under Minnesota Statutes, section 256E.36.
The base for this appropriation is $25,000,000
in fiscal year 2024 and $25,000,000 in fiscal
year 2025. Grant allocation balances in the
first year do not cancel but are available in the
second year.
new text end
new text begin
(i) Homeless Youth Act. $10,000,000 in fiscal
year 2023 is for homeless youth act grants
under Minnesota Statutes, section 256K.45,
subdivision 1. Grant allocation balances in the
first year do not cancel but are available in the
second year.
new text end
new text begin
(j) Pregnant and Parenting Homeless Youth
Study. $300,000 in fiscal year 2023 is to fund
a study of the prevalence of pregnancy and
parenting among homeless youths and youths
who are at risk of homelessness. This is a
onetime appropriation and is available until
June 30, 2024.
new text end
new text begin
(k) new text begin Safe Harbor Grants.new text end $5,500,000 in fiscal
year 2023 is for safe harbor grants to fund
street outreach, emergency shelter, and
transitional and long-term housing beds for
sexually exploited youth and youth at risk of
exploitation.
new text end
new text begin
(l) new text begin Emergency Shelter Facilities.new text end $75,000,000
in fiscal year 2023 is for grants to eligible
applicants for the acquisition of property; site
preparation, including demolition; predesign;
design; construction; renovation; furnishing;
and equipping of emergency shelter facilities
in accordance with emergency shelter facilities
project criteria in this act. This is a onetime
appropriation and is available until June 30,
2025.
new text end
new text begin
(m) new text begin Heading Home Ramsey Continuum of
Care.new text end (1) $8,000,000 in fiscal year 2022 is for
a grant to fund and support Heading Home
Ramsey Continuum of Care. This is a onetime
appropriation. The grant shall be used for:
new text end
new text begin
(i) maintaining funding for a 100-bed family
shelter that had been funded by CARES Act
money;
new text end
new text begin
(ii) maintaining funding for an existing
100-bed single room occupancy shelter and
developing a replacement single-room
occupancy shelter for housing up to 100 single
adults; and
new text end
new text begin
(iii) maintaining current day shelter
programming that had been funded with
CARES Act money and developing a
replacement for current day shelter facilities.
new text end
new text begin
(2) Ramsey County may use up to ten percent
of this appropriation for administrative
expenses. This appropriation is available until
June 30, 2025.
new text end
new text begin
(n)
new text end
new text begin
new text begin Hennepin County Funding for Serving
Homeless Persons.new text end (1) $6,000,000 in fiscal
year 2022 is for a grant to fund and support
Hennepin County shelters and services for
persons experiencing homelessness. This is a
onetime appropriation. Of this appropriation:
new text end
new text begin
(i) up to $4,000,000 in matching grant funding
is to design, construct, equip, and furnish the
Simpson Housing Services shelter facility in
the city of Minneapolis; and
new text end
new text begin
(ii) up to $2,000,000 is to maintain current
shelter and homeless response programming
that had been funded with federal funding
from the CARES Act of the American Rescue
Plan Act, including:
new text end
new text begin
(A) shelter operations and services to maintain
services at Avivo Village, including a shelter
comprised of 100 private dwellings and the
American Indian Community Development
Corporation Homeward Bound 50-bed shelter;
new text end
new text begin
(B) shelter operations and services to maintain
shelter services 24 hours per day, seven days
per week;
new text end
new text begin
(C) housing-focused case management; and
new text end
new text begin
(D) shelter diversion services.
new text end
new text begin
(2) Hennepin County may contract with
eligible nonprofit organizations and local and
Tribal governmental units to provide services
under the grant program. This appropriation
is available until June 30, 2025.
new text end
new text begin
(o) Chosen Family Hosting to Prevent
Youth Homelessness Pilot Program.
$1,000,000 in fiscal year 2023 is for the
chosen family hosting to prevent youth
homelessness pilot program to provide funds
to providers serving homeless youth. Of this
amount, $218,000 is for a contract with a
technical assistance provider to: (1) provide
technical assistance to funding recipients; (2)
facilitate a monthly learning cohort for funding
recipients; (3) evaluate the efficacy and
cost-effectiveness of the pilot program; and
(4) submit annual updates and a final report
to the commissioner. This is a onetime
appropriation and is available until June 30,
2027.
new text end
new text begin
(p) Minnesota Association for Volunteer
Administration. $1,000,000 in fiscal year
2023 is for a grant to the Minnesota
Association for Volunteer Administration to
administer needs-based volunteerism subgrants
targeting underresourced nonprofit
organizations in greater Minnesota to support
selected organizations' ongoing efforts to
address and minimize disparities in access to
human services through increased
volunteerism. Successful subgrant applicants
must demonstrate that the populations to be
served by the subgrantee are considered
underserved or suffer from or are at risk of
homelessness, hunger, poverty, lack of access
to health care, or deficits in education. The
Minnesota Association for Volunteer
Administration must give priority to
organizations that are serving the needs of
vulnerable populations. By December 15,
2023, the Minnesota Association for Volunteer
Administration must report data on outcomes
from the subgrants and recommendations for
improving and sustaining volunteer efforts
statewide to the chairs and ranking minority
members of the legislative committees and
divisions with jurisdiction over human
services. This is a onetime appropriation and
is available until June 30, 2024.
new text end
new text begin
(q) Base Level Adjustment. The general fund
base is increased $63,104,000 in fiscal year
2024 and $66,754,000 in fiscal year 2025.
new text end
new text begin Subd. 19. new text end
new text begin
Grant Programs; Health Care Grants
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2022 new text end |
new text begin
2023 new text end |
|
|
new text begin
General Fund new text end |
new text begin
-0- new text end |
new text begin
2,500,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
(1,936,000) new text end |
new text begin
3,936,000 new text end |
new text begin
(a) Grant Funding to Support Urban
American Indians in Minnesota Health
Care Programs. $2,500,000 in fiscal year
2023 is from the general fund for funding to
the Indian Health Board of Minneapolis to
support continued access to health care
coverage through Minnesota health care
programs, improve access to quality care, and
increase vaccination rates among urban
American Indians.
new text end
new text begin
(b) Grants for Navigator Organizations.
new text end
new text begin
(1) $1,936,000 in fiscal year 2023 is from the
health care access fund for grants to
organizations with a MNsure grant services
navigator assister contract in good standing
as of July 1, 2022. The grants to each
organization must be in proportion to the
number of medical assistance and
MinnesotaCare enrollees each organization
assisted that resulted in a successful
enrollment in the second quarter of fiscal year
2022, as determined by MNsure's navigator
payment process. This is a onetime
appropriation and is available until June 30,
2025.
new text end
new text begin
(2) $2,000,000 in fiscal year 2023 is from the
health care access fund for incentive payments
as defined in Minnesota Statutes, section
256.962, subdivision 5. This appropriation is
available until June 30, 2025. The health care
access fund base for this appropriation is
$1,000,000 in fiscal year 2024 and $0 in fiscal
year 2025.
new text end
new text begin
(c) Base Level Adjustment. The general fund
base is increased $3,750,000 in fiscal year
2024 and $1,250,000 in fiscal year 2025. The
health care access fund base is increased
$1,000,000 in fiscal year 2024, and $0 in fiscal
year 2025.
new text end
new text begin Subd. 20. new text end
new text begin
Grant Programs; Other Long-Term
|
new text begin
-0- new text end |
new text begin
119,336,000 new text end |
||||
new text begin
(a)
new text end
new text begin
Workforce Incentive Fund Grant
Program. $118,000,000 in fiscal year 2023
is to assist disability, housing, substance use,
and older adult service providers of public
programs to pay for incentive benefits to
current and new workers. This is a onetime
appropriation and is available until June 30,
2025. Three percent of the total amount of the
appropriation may be used to administer the
program, which may include contracting with
a third-party administrator.
new text end
new text begin
(b) Supported Decision Making. $600,000
in fiscal year 2023 is for a grant to Volunteers
for America for the Centers for Excellence in
Supported Decision Making to assist older
adults and people with disabilities in avoiding
unnecessary guardianships through using less
restrictive alternatives, such as supported
decision making. The base for this
appropriation is $600,000 in fiscal year 2024,
$600,000 in fiscal year 2025, and $0 in fiscal
year 2026.
new text end
new text begin
(c) Support Coordination Training.
$736,000 in fiscal year 2023 is to develop and
implement a curriculum and training plan for
case managers to ensure all case managers
have the knowledge and skills necessary to
fulfill support planning and coordination
responsibilities for people who use home and
community-based disability services waivers
authorized under Minnesota Statutes, sections
256B.0913, 256B.092, and 256B.49, and
chapter 256S, and live in own-home settings.
Case manager support planning and
coordination responsibilities to be addressed
in the training include developing a plan with
the participant and their family to address
urgent staffing changes or unavailability and
other support coordination issues that may
arise for a participant. The commissioner shall
work with lead agencies, advocacy
organizations, and other stakeholders to
develop the training. An initial support
coordination training and competency
evaluation must be completed by all staff
responsible for case management, and the
support coordination training and competency
evaluation must be available to all staff
responsible for case management following
the initial training. The base for this
appropriation is $377,000 in fiscal year 2024,
$377,000 in fiscal year 2025, and $0 in fiscal
year 2026.
new text end
new text begin
(d) Base Level Adjustment. The general fund
base is increased $977,000 in fiscal year 2024
and $977,000 in fiscal year 2025.
new text end
new text begin Subd. 21. new text end
new text begin
Grant Programs; Disabilities Grants
|
new text begin
-0- new text end |
new text begin
8,950,000 new text end |
||||
new text begin
(a) Electronic Visit Verification (EVV)
Stipends. $6,440,000 in fiscal year 2023 is
for onetime stipends of $200 to bargaining
members to offset the potential costs related
to people using individual devices to access
EVV. $5,600,000 of the appropriation is for
stipends and the remaining 15 percent is for
administration of these stipends. This is a
onetime appropriation.
new text end
new text begin
(b) Self-Directed Collective Bargaining
Agreement; Temporary Rate Increase
Memorandum of Understanding. $1,610,000
in fiscal year 2023 is for onetime stipends for
individual providers covered by the SEIU
collective bargaining agreement based on the
memorandum of understanding related to the
temporary rate increase in effect between
December 1, 2020, and February 7, 2021.
$1,400,000 of the appropriation is for stipends
and the remaining 15 percent is for
administration of the stipends. This is a
onetime appropriation.
new text end
new text begin
(c) Service Employees International Union
Memorandums. The memorandums of
understanding submitted by the commissioner
of management and budget to the Legislative
Coordinating Commission Subcommittee on
Employee Relations on March 17, 2022, are
ratified.
new text end
new text begin
(d) Direct Care Service Corps Pilot Project.
$500,000 in fiscal year 2023 is for a grant to
HealthForce Minnesota at Winona State
University for purposes of the direct care
service corps pilot project in this act. Up to
$25,000 may be used by HealthForce
Minnesota for administrative costs. This is a
onetime appropriation.
new text end
new text begin
(e) Task Force on Disability Services
Accessibility. $250,000 in fiscal year 2023 is
for the Task Force on Disability Services
Accessibility. Of this amount, $....... must be
used to provide pilot project grants. This is a
onetime appropriation and is available until
March 31, 2026.
new text end
new text begin
(f) Base Level Adjustment. The general fund
base is increased $805,000 in fiscal year 2024
and $2,420,000 in fiscal year 2025.
new text end
new text begin Subd. 22. new text end
new text begin
Grant Programs; Adult Mental Health
|
new text begin
20,000,000 new text end |
new text begin
31,076,000 new text end |
||||
new text begin
(a) Inpatient Psychiatric and Psychiatric
Residential Treatment Facilities.
$10,000,000 in fiscal year 2023 is for
competitive grants to hospitals or mental
health providers to retain, build, or expand
children's inpatient psychiatric beds for
children in need of acute high-level psychiatric
care or psychiatric residential treatment facility
beds as described in Minnesota Statutes,
section 256B.0941. In order to be eligible for
a grant, a hospital or mental health provider
must serve individuals covered by medical
assistance under Minnesota Statutes, section
256B.0625.
new text end
new text begin
(b) Expanding Support for Psychiatric
Residential Treatment Facilities. $800,000
in fiscal year 2023 is for start-up grants to
psychiatric residential treatment facilities as
described in Minnesota Statutes, section
256B.0941. Grantees may use grant money
for emergency workforce shortage uses.
Allowable grant uses related to emergency
workforce shortages may include but are not
limited to hiring and retention bonuses,
recruitment of a culturally responsive
workforce, and allowing providers to increase
the hourly rate in order to be competitive in
the market.
new text end
new text begin
(c) Workforce Incentive Fund Grant
Program. $20,000,000 in fiscal year 2022 is
to provide mental health public program
providers the ability to pay for incentive
benefits to current and new workers. This is
a onetime appropriation and is available until
June 30, 2025. Three percent of the total
amount of the appropriation may be used to
administer the program, which may include
contracting with a third-party administrator.
new text end
new text begin
(d) Cultural and Ethnic Infrastructure
Grant Funding. $10,000,000 in fiscal year
2023 is for increasing cultural and ethnic
infrastructure grant funding under Minnesota
Statutes, section 245.4903. The base for this
appropriation is $5,000,000 in fiscal year 2024
and $5,000,000 in fiscal year 2025.
new text end
new text begin
(e) Culturally Specific Grants. $2,000,000
in fiscal year 2023 is for grants for small to
midsize nonprofit organizations who represent
and support American Indian, Indigenous, and
other communities disproportionately affected
by the opiate crisis. These grants utilize
traditional healing practices and other
culturally congruent and relevant supports to
prevent and curb opiate use disorders through
housing, treatment, education, aftercare, and
other activities as determined by the
commissioner. The base for this appropriation
is $2,000,000 in fiscal year 2024 and $0 in
fiscal year 2025.
new text end
new text begin
(f) African American Community Mental
Health Center Grant. $1,000,000 in fiscal
year 2023 is for a grant to an African
American mental health service provider that
is a licensed community mental health center
specializing in services for African American
children and families. The center must offer
culturally specific, comprehensive,
trauma-informed, practice- and
evidence-based, person- and family-centered
mental health and substance use disorder
services; supervision and training; and care
coordination to all ages, regardless of ability
to pay or place of residence. Upon request, the
commissioner shall make information
regarding the use of this grant funding
available to the chairs and ranking minority
members of the legislative committees with
jurisdiction over human services. This is a
onetime appropriation.
new text end
new text begin
(g) Behavioral Health Peer Training.
$1,000,000 in fiscal year 2023 is for training
and development for mental health certified
peer specialists, mental health certified family
peer specialists, and recovery peer specialists.
Training and development may include but is
not limited to initial training and certification.
new text end
new text begin
(h) Intensive Residential Treatment Services
Locked Facilities. $2,796,000 in fiscal year
2023 is for start-up funds to intensive
residential treatment service providers to
provide treatment in locked facilities for
patients who have been transferred from a jail
or who have been deemed incompetent to
stand trial and a judge has determined that the
patient needs to be in a secure facility. This is
a onetime appropriation.
new text end
new text begin
(i) Base Level Adjustment. The general fund
base is increased $27,092,000 in fiscal year
2024 and $34,216,000 in fiscal year 2025. The
opiate epidemic response base is increased
$2,000,000 in fiscal year 2025.
new text end
new text begin Subd. 23. new text end
new text begin
Grant Programs; Child Mental Health
|
new text begin
-0- new text end |
new text begin
13,660,000 new text end |
||||
new text begin
(a) First Episode of Psychosis Grants.
$300,000 in fiscal year 2023 is for first
episode of psychosis grants under Minnesota
Statutes, section 245.4905.
new text end
new text begin
(b) Children's Residential Treatment
Services Emergency Funding. $2,500,000
in fiscal year 2023 is from the general fund to
provide licensed children's residential
treatment facilities with emergency funding
for staff overtime, one-to-one staffing as
needed, staff recruitment and retention, and
training and related costs to maintain quality
staff. Up to $500,000 of this appropriation
may be allocated to support group home
organizations supporting children transitioning
to lower levels of care. This is a onetime
appropriation.
new text end
new text begin
(c) Children's Residential Facility Crisis
Stabilization. $3,000,000 in fiscal year 2023
is for implementing children's residential
facility crisis stabilization services licensing
requirements and reimbursing county costs
for children's residential crisis stabilization
services as required under Minnesota Statutes,
section 245.4882, subdivision 6.
new text end
new text begin
(d) new text begin Base Level Adjustment.new text end The general fund
base is increased $16,100,000 in fiscal year
2024 and $1,100,000 in fiscal year 2025.
new text end
new text begin Subd. 24. new text end
new text begin
Grant Programs; Chemical
|
new text begin
-0- new text end |
new text begin
2,000,000 new text end |
||||
new text begin
(a) Emerging Mood Disorder Grant
Program. $1,000,000 in fiscal year 2023 is
for emerging mood disorder grants under
Minnesota Statutes, section 245.4904.
Grantees must use grant money as required in
Minnesota Statutes, section 245.4904,
subdivision 2.
new text end
new text begin
(b) Substance Use Disorder Treatment and
Prevention Grants. The base shall include
$4,000,000 in fiscal year 2024 and $4,000,000
in fiscal year 2025 for substance use disorder
treatment and prevention grants recommended
by the substance use disorder advisory council.
new text end
new text begin
(c) Traditional Healing Grants. The base
shall include $2,000,000 in fiscal year 2025
to extend the traditional healing grant funding
appropriated in Laws 2019, chapter 63, article
3, section 1, paragraph (h), from the opiate
epidemic response account to the
commissioner of human services. This funding
is awarded to all Tribal nations and to five
urban Indian communities for traditional
healing practices to American Indians and to
increase the capacity of culturally specific
providers in the behavioral health workforce.
new text end
new text begin
(d) Base Level Adjustment. The general fund
base is increased $2,000,000 in fiscal year
2024 and $2,000,000 in fiscal year 2025.
new text end
new text begin Subd. 25. new text end
new text begin
Direct Care and Treatment -
|
new text begin
-0- new text end |
new text begin
6,501,000 new text end |
||||
new text begin
Base Level Adjustment. The general fund
base is increased $5,267,000 in fiscal year
2024 and $0 in fiscal year 2025.
new text end
new text begin Subd. 26. new text end
new text begin
Technical Activities
|
new text begin
-0- new text end |
new text begin
-0- new text end |
||||
new text begin
(a) Transfers; Child Care and Development
Fund. For fiscal years 2024 and 2025, the base
shall include a transfer of $23,500,000 in fiscal
year 2024 and $23,500,000 in fiscal year 2025
from the TANF fund to the child care and
development fund. These are onetime
transfers.
new text end
new text begin
(b) Base Level Adjustment. The TANF base
is increased $23,500,000 in fiscal year 2024,
$23,500,000 in fiscal year 2025, and $0 in
fiscal year 2026.
new text end
Sec. 3. new text begin COMMISSIONER OF HEALTH
|
||||||
new text begin Subdivision 1. new text end
new text begin
Total Appropriation
|
new text begin
$ new text end |
new text begin
-0- new text end |
new text begin
$ new text end |
new text begin
266,507,000 new text end |
||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2022 new text end |
new text begin
2023 new text end |
|
|
new text begin
General new text end |
new text begin
-0- new text end |
new text begin
258,888,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
-0- new text end |
new text begin
6,044,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
-0- new text end |
new text begin
21,575,000 new text end |
new text begin Subd. 2. new text end
new text begin
Health Improvement
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
-0- new text end |
new text begin
222,757,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
-0- new text end |
new text begin
509,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
-0- new text end |
new text begin
21,575,000 new text end |
new text begin
(a) 988 National Suicide Prevention Lifeline.
$8,671,000 in fiscal year 2023 is from the
general fund for the 988 suicide prevention
lifeline in Minnesota Statutes, section 145.56.
Of this appropriation, $455,000 is for
administration and $7,890,000 is for grants.
The general fund base for this appropriation
is $8,671,000 in fiscal year 2024, of which
$455,000 is for administration and $7,890,000
is for grants, and $8,671,000 in fiscal year
2025, of which $455,000 is for administration
and $7,890,000 is for grants.
new text end
new text begin
(b) Address Growing Health Care Costs.
new text end
new text begin
$2,476,000 in fiscal year 2023 is from the
general fund for initiatives aimed at addressing
growth in health care spending while ensuring
stability in rural health care programs. The
general fund base for this appropriation is
$3,057,000 in fiscal year 2024 and $3,057,000
in fiscal year 2025.
new text end
new text begin
(c)
new text end
new text begin
Community Health Workers.
new text end
new text begin
$1,462,000
in fiscal year 2023 is from the general fund
for a public health approach to developing
community health workers across Minnesota
under Minnesota Statutes, section 145.9282.
Of this appropriation, $462,000 is for
administration and $1,000,000 is for grants.
The general fund base for this appropriation
is $1,097,000 in fiscal year 2024, of which
$337,000 is for administration and $760,000
is for grants, and $1,098,000 in fiscal year
2025, of which $338,000 is for administration
and $760,000 is for grants.
new text end
new text begin
(d) Community Solutions for Healthy Child
Development. $10,000,000 in fiscal year 2023
is from the general fund for the community
solutions for the healthy child development
grant program under Minnesota Statutes,
section 145.9271. Of this appropriation,
$1,250,000 is for administration and
$8,750,000 is for grants. The general fund base
appropriation is $10,000,000 in fiscal year
2024 and $10,000,000 in fiscal year 2025, of
which $1,250,000 is for administration and
$8,750,000 is for grants in each fiscal year.
new text end
new text begin
(e) Disability as a Health Equity Issue.
$1,575,000 in fiscal year 2023 is from the
general fund to reduce disability-related health
disparities through collaboration and
coordination between state and community
partners under Minnesota Statutes, section
145.9283. Of this appropriation, $1,130,000
is for administration and $445,000 is for
grants. The general fund base for this
appropriation is $1,585,000 in fiscal year 2024
and $1,585,000 in fiscal year 2025, of which
$1,140,000 is for administration and $445,000
is for grants.
new text end
new text begin
(f) Drug Overdose and Substance Abuse
Prevention. $5,042,000 in fiscal year 2023 is
from the general fund for a public health
prevention approach to drug overdose and
substance use disorder in Minnesota Statutes,
section 144.8611. Of this appropriation,
$921,000 is for administration and $4,121,000
is for grants.
new text end
new text begin
(g) Healthy Beginnings, Healthy Families.
$11,700,000 in fiscal year 2023 is from the
general fund for Healthy Beginnings, Healthy
Families services under Minnesota Statutes,
section 145.987. The general fund base for
this appropriation is $11,818,000 in fiscal year
2024 and $11,763,000 in fiscal year 2025. Of
this appropriation:
new text end
new text begin
(1) $7,510,000 in fiscal year 2023 is for the
Minnesota Collaborative to Prevent Infant
Mortality under Minnesota Statutes, section
145.987, subdivisions 2, 3, and 4, of which
$1,535,000 is for administration and
$5,975,000 is for grants. The general fund base
for this appropriation is $7,501,000 in fiscal
year 2024, of which $1,526,000 is for
administration and $5,975,000 is for grants,
and $7,501,000 in fiscal year 2025, of which
$1,526,000 is for administration and
$5,975,000 is for grants.
new text end
new text begin
(2) $340,000 in fiscal year 2023 is for Help
Me Connect under Minnesota Statutes, section
145.987, subdivisions 5 and 6. The general
fund base for this appropriation is $663,000
in fiscal year 2024 and $663,000 in fiscal year
2025.
new text end
new text begin
(3) $1,940,000 in fiscal year 2023 is for
voluntary developmental and social-emotional
screening and follow-up under Minnesota
Statutes, section 145.987, subdivisions 7 and
8, of which $1,190,000 is for administration
and $750,000 is for grants. The general fund
base for this appropriation is $1,764,000 in
fiscal year 2024, of which $1,014,000 is for
administration and $750,000 is for grants, and
$1,764,000 in fiscal year 2025, of which
$1,014,000 is for administration and $750,000
is for grants.
new text end
new text begin
(4) $1,910,000 in fiscal year 2023 is for model
jail practices for incarcerated parents under
Minnesota Statutes, section 145.987,
subdivisions 9, 10, and 11, of which $485,000
is for administration and $1,425,000 is for
grants. The general fund base for this
appropriation is $1,890,000 in fiscal year
2024, of which $465,000 is for administration
and $1,425,000 is for grants, and $1,835,000
in fiscal year 2025, of which $410,000 is for
administration and $1,425,000 is for grants.
new text end
new text begin
(h) Home Visiting. $62,386,000 in fiscal year
2023 is from the general fund for universal,
voluntary home visiting services under
Minnesota Statutes, section 145.871. Of this
appropriation, ten percent is for administration
and 90 percent is for implementation grants
of home visiting services to families. The
general fund base for this appropriation is
$63,386,000 in fiscal year 2024 and
$63,386,000 in fiscal year 2025.
new text end
new text begin
(i) Long COVID. $2,669,000 in fiscal year
2023 is from the general fund for a public
health approach to supporting long COVID
survivors under Minnesota Statutes, section
145.361. Of this appropriation, $2,119,000 is
for administration and $550,000 is for grants.
The base for this appropriation is $3,706,000
in fiscal year 2024 and $3,706,000 in fiscal
year 2025, of which $3,156,000 is for
administration and $550,000 is for grants in
each fiscal year.
new text end
new text begin
(j) Medical Education Research Cost
(MERC). Of the amount previously
appropriated in the general fund by Laws
2015, chapter 71, article 3, section 2, for the
MERC program, $150,000 in fiscal year 2023
and each year thereafter is for the
administration of grants under Minnesota
Statutes, section 62J.692.
new text end
new text begin
(k) No Surprises Act Enforcement. $964,000
in fiscal year 2023 is from the general fund
for implementation of the federal No Surprises
Act portion of the Consolidated
Appropriations Act, 2021, under Minnesota
Statutes, section 62Q.021, subdivision 3. The
general fund base for this appropriation is
$763,000 in fiscal year 2024 and $757,000 in
fiscal year 2025.
new text end
new text begin
(l) Public Health System Transformation.
$23,531,000 in fiscal year 2023 is from the
general fund for public health system
transformation. Of this appropriation:
new text end
new text begin
(1) $20,000,000 is for grants to community
health boards under Minnesota Statutes,
section 145A.131, subdivision 1, paragraph
(f).
new text end
new text begin
(2) $1,000,000 is for grants to Tribal
governments under Minnesota Statutes, section
145A.14, subdivision 2b.
new text end
new text begin
(3) $1,000,000 is for a public health
AmeriCorps program grant under Minnesota
Statutes, section 145.9292.
new text end
new text begin
(4) $1,531,000 is for the commissioner to
oversee and administer activities under this
paragraph.
new text end
new text begin
(m) Revitalize Health Care Workforce.
$21,575,000 in fiscal year 2023 is from the
health care access fund to address challenges
of Minnesota's health care workforce. Of this
appropriation:
new text end
new text begin
(1) $2,073,000 in fiscal year 2023 is for the
health professionals clinical training expansion
and rural and underserved clinical rotations
grant programs under Minnesota Statutes,
section 144.1505, of which $423,000 is for
administration and $1,650,000 is for grants.
Grant appropriations are available until
expended under Minnesota Statutes, section
144.1505, subdivision 2.
new text end
new text begin
(2) $4,507,000 in fiscal year 2023 is for the
primary care rural residency training grant
program under Minnesota Statutes, section
144.1507, of which $207,000 is for
administration and $4,300,000 is for grants.
Grant appropriations are available until
expended under Minnesota Statutes, section
144.1507, subdivision 2.
new text end
new text begin
(3) $430,000 in fiscal year 2023 is for the
international medical graduates assistance
program under Minnesota Statutes, section
144.1911, for international immigrant medical
graduates to fill a gap in their preparedness
for medical residencies or transition to a new
career making use of their medical degrees.
Of this appropriation, $55,000 is for
administration and $375,000 is for grants.
new text end
new text begin
(4) $12,565,000 in fiscal year 2023 is for a
grant program to health care systems,
hospitals, clinics, and other providers to ensure
the availability of clinical training for students,
residents, and graduate students to meet health
professions educational requirements under
Minnesota Statutes, section 144.1511, of
which $565,000 is for administration and
$12,000,000 is for grants.
new text end
new text begin
(5) $2,000,000 in fiscal year 2023 is for the
mental health cultural community continuing
education grant program, of which $460,000
is for administration and $1,540,000 is for
grants.
new text end
new text begin
(n) School Health. $837,000 in fiscal year
2023 is from the general fund for the School
Health Initiative under Minnesota Statutes,
section 145.988. The general fund base for
this appropriation is $3,462,000 in fiscal year
2024, of which $1,212,000 is for
administration and $2,250,000 is for grants
and $3,287,000 in fiscal year 2025, of which
$1,037,000 is for administration and
$2,250,000 is for grants.
new text end
new text begin
(o) Trauma System. $61,000 in fiscal year
2023 is from the general fund to administer
the trauma care system throughout the state
under Minnesota Statutes, sections 144.602,
144.603, 144.604, 144.606, and 144.608.
$430,000 in fiscal year 2023 is from the state
government special revenue fund for trauma
designations according to Minnesota Statutes,
sections 144.122, paragraph (g), 144.605, and
144.6071.
new text end
new text begin
(p) Mental Health Providers; Loan
Forgiveness, Grants, Information
Clearinghouse. $4,275,000 in fiscal year 2023
is from the general fund for activities to
increase the number of mental health
professionals in the state. Of this
appropriation:
new text end
new text begin
(1) $1,000,000 is for loan forgiveness under
the health professional education loan
forgiveness program under Minnesota Statutes,
section 144.1501, notwithstanding the
priorities and distribution requirements in that
section, for eligible mental health
professionals who provide clinical supervision
in their designated field;
new text end
new text begin
(2) $3,000,000 is for the mental health
provider supervision grant program under
Minnesota Statutes, section 144.1508;
new text end
new text begin
(3) $250,000 is for the mental health
professional scholarship grant program under
Minnesota Statutes, section 144.1509; and
new text end
new text begin
(4) $25,000 is for the commissioner to
establish and maintain a website to serve as
an information clearinghouse for mental health
professionals and individuals seeking to
qualify as a mental health professional. The
website must contain information on the
various master's level programs to become a
mental health professional, requirements for
supervision, where to find supervision, how
to access tools to study for the applicable
licensing examination, links to loan
forgiveness programs and tuition
reimbursement programs, and other topics of
use to individuals seeking to become a mental
health professional. This is a onetime
appropriation.
new text end
new text begin
(q) Palliative Care Advisory Council.
$44,000 in fiscal year 2023 is from the general
fund for the Palliative Care Advisory Council
under Minnesota Statutes, section 144.059.
new text end
new text begin
(r) Emmett Louis Till Victims Recovery
Program. $500,000 in fiscal year 2023 is from
the general fund for the Emmett Louis Till
Victims Recovery Program. This is a onetime
appropriation and is available until June 30,
2024.
new text end
new text begin
(s) Changes to Birth Certificates. $75,000
in fiscal year 2023 is from the state
government special revenue fund for
implementation of Minnesota Statutes, section
144.2182. The state government special
revenue fund base for this appropriation is
$7,000 in fiscal year 2024 and $7,000 in fiscal
year 2025.
new text end
new text begin
(t) Study; POLST Forms. $292,000 in fiscal
year 2023 is from the general fund for the
commissioner to study the creation of a
statewide registry of provider orders for
life-sustaining treatment and issue a report and
recommendations.
new text end
new text begin
(u) Benefit and Cost Analysis of Universal
Health Reform Proposal. $461,000 in fiscal
year 2023 is from the general fund for an
analysis of the benefits and costs of a universal
health care financing system and a similar
analysis of the current health care financing
system. Of this appropriation, $250,000 is for
a contract with the University of Minnesota
School of Public Health and the Carlson
School of Management. The general fund base
for this appropriation is $288,000 in fiscal year
2024, of which $250,000 is for a contract with
the University of Minnesota School of Public
Health and the Carlson School of
Management, and $0 in fiscal year 2025.
new text end
new text begin
(v) Technical Assistance; Health Care
Trends and Costs. $5,000,000 in fiscal year
2023 is from the general fund for technical
assistance to the Health Care Affordability
Board in analyzing health care trends and costs
and setting health care spending growth
targets.
new text end
new text begin
(w) Sexual Exploitation and Trafficking
Study. $300,000 in fiscal year 2023 is to fund
a prevalence study on youth and adult victim
survivors of sexual exploitation and
trafficking. This is a onetime appropriation
and is available until June 30, 2024.
new text end
new text begin
(x) Local and Tribal Public Health
Emergency Preparedness and Response.
$9,000,000 in fiscal year 2023 is from the
general fund for distribution to local and Tribal
public health organizations for emergency
preparedness and response capabilities. At
least 90 percent of this appropriation must be
distributed to local and Tribal public health
organizations, and up to ten percent of this
appropriation may be used by the
commissioner for administrative costs. Use of
this appropriation must align with the Centers
for Disease Control and Prevention's issued
report: Public Health Emergency Preparedness
and Response Capabilities: National Standards
for State, Local, Tribal, and Territorial Public
Health.
new text end
new text begin
(y) Grants to Local Public Health
Departments. $16,172,000 in fiscal year 2023
is from the general fund for grants to local
public health departments for public health
response related to defining elevated blood
lead level as 3.5 micrograms of lead or greater
per deciliter of whole blood. Of this amount,
$172,000 is available to the commissioner for
administrative costs. This appropriation is
available until June 30, 2025. The general fund
base for this appropriation is $5,000,000 in
fiscal year 2024 and $5,000,000 in fiscal year
2025.
new text end
new text begin
(z) Loan Forgiveness for Nursing
Instructors. Notwithstanding the priorities
and distribution requirements in Minnesota
Statutes, section 144.1501, $50,000 in fiscal
year 2023 is from the general fund for loan
forgiveness under the health professional
education loan forgiveness program under
Minnesota Statutes, section 144.1501, for
eligible nurses who agree to teach.
new text end
new text begin
(aa) Mental Health of Health Care Workers.
$1,000,000 in fiscal year 2023 is from the
general fund for competitive grants to
hospitals, community health centers, rural
health clinics, and medical professional
associations to establish or enhance
evidence-based or evidence-informed
programs dedicated to improving the mental
health of health care professionals.
new text end
new text begin
(bb) Prevention of Violence in Health Care.
$50,000 in fiscal year 2023 is from the general
fund to continue the prevention of violence in
health care programs and to create violence
prevention resources for hospitals and other
health care providers to use to train their staff
on violence prevention.
new text end
new text begin
(cc) Hospital Nursing Loan Forgiveness.
$5,000,000 in fiscal year 2023 is from the
general fund for the hospital nursing loan
forgiveness program under Minnesota Statutes,
section 144.1501.
new text end
new text begin
(dd) Program to Distribute COVID-19
Tests, Masks, and Respirators. $15,000,000
in fiscal year 2023 is from the general fund
for a program to distribute COVID-19 tests,
masks, and respirators to individuals in the
state. This is a onetime appropriation.
new text end
new text begin
(ee) Safe Harbor Grants. $1,000,000 in fiscal
year 2023 is for grants to fund supportive
services, including but not limited to legal
services, mental health therapy, substance use
disorder counseling, and case management for
sexually exploited youth or youth at risk of
sexual exploitation under Minnesota Statutes,
section 145.4716.
new text end
new text begin
(ff) Safe Harbor Regional Navigators.
$700,000 in fiscal year 2023 is for safe harbor
regional navigators under Minnesota Statutes,
section 145.4717.
new text end
new text begin
(gg) Base Level Adjustments. The general
fund base is increased $195,645,000 in fiscal
year 2024 and $195,063,000 in fiscal year
2025. The health care access fund base is
increased $21,575,000 in fiscal year 2024 and
$21,575,000 in fiscal year 2025. The state
government special revenue fund base is
increased $437,000 in fiscal year 2024 and
$437,000 in fiscal year 2025.
new text end
new text begin Subd. 3. new text end
new text begin
Health Protection
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
-0- new text end |
new text begin
36,131,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
-0- new text end |
new text begin
5,535,000 new text end |
new text begin
(a) Climate Resiliency. $1,977,000 in fiscal
year 2023 is from the general fund for climate
resiliency actions under Minnesota Statutes,
section 144.9981. Of this appropriation,
$977,000 is for administration and $1,000,000
is for grants. The general fund base for this
appropriation is $988,000 in fiscal year 2024,
of which $888,000 is for administration and
$100,000 is for grants, and $989,000 in fiscal
year 2025, of which $889,000 is for
administration and $100,000 is for grants.
new text end
new text begin
(b) Lead Remediation in Schools and Child
Care Settings. $2,054,000 in fiscal year 2023
is from the general fund for a lead in drinking
water remediation in schools and child care
settings grant program under Minnesota
Statutes, section 145.9272. Of this
appropriation, $454,000 is for administration
and $1,600,000 is for grants. The general fund
base for this appropriation is $1,540,000 in
fiscal year 2024, of which $370,000 is for
administration and $1,170,000 is for grants,
and $1,541,000 in fiscal year 2025, of which
$371,000 is for administration and $1,170,000
is for grants.
new text end
new text begin
(c) Lead Service Line Inventory. $4,029,000
in fiscal year 2023 is from the general fund
for grants to public water suppliers to complete
a lead service line inventory of their
distribution systems under Minnesota Statutes,
section 144.383, clause (6). Of this
appropriation, $279,000 is for administration
and $3,750,000 is for grants. The general fund
base for this appropriation is $4,029,000 in
fiscal year 2024, of which $279,000 is for
administration and $3,750,000 is for grants,
and $140,000 in fiscal year 2025, which is for
administration.
new text end
new text begin
(d) Lead Service Line Replacement.
$5,000,000 in fiscal year 2023 is from the
general fund for administrative costs related
to the replacement of lead service lines in the
state.
new text end
new text begin
(e) Mercury in Skin-Lightening Products
Grants. $100,000 in fiscal year 2023 is from
the general fund for a skin-lightening products
public awareness and education grant program
under Minnesota Statutes, section 145.9275.
new text end
new text begin
(f) HIV Prevention for People Experiencing
Homelessness. $1,129,000 in fiscal year 2023
is from the general fund for expanding access
to harm reduction services and improving
linkages to care to prevent HIV/AIDS,
hepatitis, and other infectious diseases for
those experiencing homelessness or housing
instability under Minnesota Statutes, section
145.924, paragraph (d). Of this appropriation,
$169,000 is for administration and $960,000
is for grants.
new text end
new text begin
(g) Safety Improvements for State-Licensed
Long-Term Care Facilities. $5,500,000 in
fiscal year 2023 is from the general fund for
a temporary grant program for safety
improvements for state-licensed long-term
care facilities. Of this appropriation, $500,000
is for administration and $5,000,000 is for
grants. The general fund base for this
appropriation is $8,200,000 in fiscal year 2024
and $0 in fiscal year 2025. Of this
appropriation in fiscal year 2024, $700,000 is
for administration and $7,500,000 is for
grants. This appropriation is available until
June 30, 2025.
new text end
new text begin
(h) Mortuary Science. $219,000 in fiscal year
2023 is from the state government special
revenue fund for regulation of transfer care
specialists under Minnesota Statutes, chapter
149A, and for additional reporting
requirements under Minnesota Statutes,
section 149A.94. The state government special
revenue fund base for this appropriation is
$132,000 in fiscal year 2024 and $61,000 in
fiscal year 2025.
new text end
new text begin
(i) Drinking Water Lead Testing and
Remediation; Day Care Facilities.
$1,000,000 in fiscal year 2023 is from the
general fund for statewide testing of day care
facilities for the presence of lead in drinking
water and for remediation of contamination
where found.
new text end
new text begin
(j) Public Health Response Contingency
Account. $20,000,000 in fiscal year 2023 is
from the general fund for transfer to the public
health response contingency account under
Minnesota Statutes, section 144.4199.
new text end
new text begin
(k) Base Level Adjustments. The general
fund base is increased $17,269,000 in fiscal
year 2024 and $5,065,000 in fiscal year 2025.
The state government special revenue fund
base is increased $5,242,000 in fiscal year
2024 and $5,171,000 in fiscal year 2025.
new text end
Sec. 4. new text begin HEALTH-RELATED BOARDS
|
||||||
new text begin Subdivision 1. new text end
new text begin
Total Appropriation
|
new text begin
$ new text end |
new text begin
-0- new text end |
new text begin
$ new text end |
new text begin
203,000 new text end |
||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General Fund new text end |
new text begin
-0- new text end |
new text begin
175,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
-0- new text end |
new text begin
28,000 new text end |
new text begin
This appropriation is from the state
government special revenue fund unless
specified otherwise. The amounts that may be
spent for each purpose are specified in the
following subdivisions.
new text end
new text begin Subd. 2. new text end
new text begin
Board of Dentistry
|
new text begin
-0- new text end |
new text begin
3,000 new text end |
||||
new text begin Subd. 3. new text end
new text begin
Board of Dietetics and Nutrition
|
new text begin
-0- new text end |
new text begin
25,000 new text end |
||||
new text begin Subd. 4. new text end
new text begin
Board of Pharmacy
|
new text begin
-0- new text end |
new text begin
175,000 new text end |
||||
new text begin
This appropriation is from the general fund.
new text end
new text begin
Medication repository program.
new text end
new text begin
$175,000
in fiscal year 2023 is from the general fund
for transfer by the Board of Pharmacy to the
central repository to be used to administer the
medication repository program according to
the contract between the central repository and
the Board of Pharmacy.
new text end
Sec. 5. new text begin COUNCIL ON DISABILITY
|
new text begin
$ new text end |
new text begin
-0- new text end |
new text begin
$ new text end |
new text begin
375,000 new text end |
||
Sec. 6. new text begin EMERGENCY MEDICAL SERVICES
|
new text begin
$ new text end |
new text begin
-0- new text end |
new text begin
$ new text end |
new text begin
200,000 new text end |
||
new text begin
This is a onetime appropriation.
new text end
Sec. 7. new text begin BOARD OF DIRECTORS OF MNSURE
|
new text begin
$ new text end |
new text begin
-0- new text end |
new text begin
$ new text end |
new text begin
7,775,000 new text end |
||
new text begin
This appropriation may be transferred to the
MNsure account established in Minnesota
Statutes, section 62V.07.
new text end
new text begin
Base Adjustment. The general fund base for
this appropriation is $10,982,000 in fiscal year
2024, $6,450,000 in fiscal year 2025, and $0
in fiscal year 2026.
new text end
Sec. 8. new text begin HEALTH CARE AFFORDABILITY
|
new text begin
$ new text end |
new text begin
-0- new text end |
new text begin
$ new text end |
new text begin
1,070,000 new text end |
||
new text begin
(a) Health Care Affordability Board.
$1,070,000 in fiscal year 2023 is from the
general fund for the Health Care Affordability
Board to implement Minnesota Statutes,
sections 62J.86 to 62J.72.
new text end
new text begin
(b)
new text end
new text begin
Base Level Adjustment. The general fund
base is increased $347,000 in fiscal year 2024
and $415,000 in fiscal year 2025.
new text end
Sec. 9. new text begin COMMISSIONER OF COMMERCE
|
new text begin
$ new text end |
new text begin
-0- new text end |
new text begin
$ new text end |
new text begin
251,000 new text end |
||
new text begin
(a) Prescription Drug Affordability Board.
$197,000 in fiscal year 2023 is from the
general fund for the commissioner of
commerce to establish the Prescription Drug
Affordability Board under Minnesota Statutes,
section 62J.87, and for the Prescription Drug
Affordability Board to implement the
Prescription Drug Affordability Act.
Following the first meeting of the board and
prior to June 30, 2023, the commissioner of
commerce shall transfer any funds remaining
from this appropriation to the board. The
general fund base for this appropriation is
$357,000 in fiscal year 2024 and $357,000 in
fiscal year 2025.
new text end
new text begin
(b) Ectodermal Dysplasias. $54,000 in fiscal
year 2023 is from the general fund for costs
related to insurance coverage of ectodermal
dysplasias. The general fund base for this
appropriation is $58,000 in fiscal year 2024
and $62,000 in fiscal year 2025.
new text end
Sec. 10. new text begin COMMISSIONER OF LABOR AND
|
new text begin
$ new text end |
new text begin
-0- new text end |
new text begin
$ new text end |
new text begin
641,000 new text end |
||
new text begin
Nursing Home Workforce Standards
Board. $641,000 in fiscal year 2023 is for
establishment and operation of the Nursing
Home Workforce Standards Board in
Minnesota Statutes, sections 181.211 to
181.217. The general fund base for this
appropriation is $322,000 in fiscal year 2024
and $368,000 in fiscal year 2025.
new text end
Sec. 11. new text begin ATTORNEY GENERAL
|
new text begin
$ new text end |
new text begin
-0- new text end |
new text begin
$ new text end |
new text begin
456,000 new text end |
||
new text begin
(a) Expert Witnesses. $200,000 in fiscal year
2023 is for expert witnesses and investigations
under Minnesota Statutes, section 62J.844.
This is a onetime appropriation.
new text end
new text begin
(b) Prescription Drug Enforcement.
$256,000 in fiscal year 2023 is for prescription
drug enforcement. This is a onetime
appropriation.
new text end
Sec. 12.
Laws 2021, First Special Session chapter 2, article 1, section 4, subdivision 2, is
amended to read:
Subd. 2.Operations and Maintenance
|
621,968,000 |
621,968,000 |
||||
(a) $15,000,000 in fiscal year 2022 and
$15,000,000 in fiscal year 2023 are to: (1)
increase the medical school's research
capacity; (2) improve the medical school's
ranking in National Institutes of Health
funding; (3) ensure the medical school's
national prominence by attracting and
retaining world-class faculty, staff, and
students; (4) invest in physician training
programs in rural and underserved
communities; and (5) translate the medical
school's research discoveries into new
treatments and cures to improve the health of
Minnesotans.
(b) $7,800,000 in fiscal year 2022 and
$7,800,000 in fiscal year 2023 are for health
training restoration. This appropriation must
be used to support all of the following: (1)
faculty physicians who teach at eight residency
program sites, including medical resident and
student training programs in the Department
of Family Medicine; (2) the Mobile Dental
Clinic; and (3) expansion of geriatric
education and family programs.
(c) $4,000,000 in fiscal year 2022 and
$4,000,000 in fiscal year 2023 are for the
Minnesota Discovery, Research, and
InnoVation Economy funding program for
cancer care research.
(d) $500,000 in fiscal year 2022 and $500,000
in fiscal year 2023 are for the University of
Minnesota, Morris branch, to cover the costs
of tuition waivers under Minnesota Statutes,
section 137.16.
(e) $150,000 in fiscal year 2022 and $150,000
in fiscal year 2023 are for the Chloe Barnes
Advisory Council on Rare Diseases under
Minnesota Statutes, section 137.68. new text begin The fiscal
year 2023 appropriation shall be transferred
to the Council on Disability. new text end The base for this
appropriation is $0 in fiscal year 2024 and
later.
(f) The total operations and maintenance base
for fiscal year 2024 and later is $620,818,000.
Sec. 13.
Laws 2021, First Special Session chapter 7, article 16, section 2, subdivision 29,
is amended to read:
Subd. 29.Grant Programs; Disabilities Grants
|
31,398,000 |
31,010,000 |
||||
(a) Training Stipends for Direct Support
Services Providers. $1,000,000 in fiscal year
2022 is from the general fund for stipends for
individual providers of direct support services
as defined in Minnesota Statutes, section
256B.0711, subdivision 1. These stipends are
available to individual providers who have
completed designated voluntary trainings
made available through the State-Provider
Cooperation Committee formed by the State
of Minnesota and the Service Employees
International Union Healthcare Minnesota.
Any unspent appropriation in fiscal year 2022
is available in fiscal year 2023. This is a
onetime appropriation. This appropriation is
available only if the labor agreement between
the state of Minnesota and the Service
Employees International Union Healthcare
Minnesota under Minnesota Statutes, section
179A.54, is approved under Minnesota
Statutes, section 3.855.
(b) Parent-to-Parent Peer Support. $125,000
in fiscal year 2022 and $125,000 in fiscal year
2023 are from the general fund for a grant to
an alliance member of Parent to Parent USA
to support the alliance member's
parent-to-parent peer support program for
families of children with a disability or special
health care need.
(c) Self-Advocacy Grants. (1) $143,000 in
fiscal year 2022 and $143,000 in fiscal year
2023 are from the general fund for a grant
under Minnesota Statutes, section 256.477,
subdivision 1.
(2) $105,000 in fiscal year 2022 and $105,000
in fiscal year 2023 are from the general fund
for subgrants under Minnesota Statutes,
section 256.477, subdivision 2.
(d) Minnesota Inclusion Initiative Grants.
$150,000 in fiscal year 2022 and $150,000 in
fiscal year 2023 are from the general fund for
grants under Minnesota Statutes, section
256.4772.
(e) Grants to Expand Access to Child Care
for Children with Disabilities. $250,000 in
fiscal year 2022 and $250,000 in fiscal year
2023 are from the general fund for grants to
expand access to child care for children with
disabilities.new text begin Any unspent amount in fiscal year
2022 is available through June 30, 2023.new text end This
is a onetime appropriation.
(f) Parenting with a Disability Pilot Project.
The general fund base includes $1,000,000 in
fiscal year 2024 and $0 in fiscal year 2025 to
implement the parenting with a disability pilot
project.
(g) Base Level Adjustment. The general fund
base is $29,260,000 in fiscal year 2024 and
$22,260,000 in fiscal year 2025.
Sec. 14.
Laws 2021, First Special Session chapter 7, article 16, section 2, subdivision 31,
is amended to read:
Subd. 31.Grant Programs; Adult Mental Health
|
||||||
| Appropriations by Fund |
||
| General |
98,772,000 |
98,703,000 |
| Opiate Epidemic Response |
2,000,000 |
2,000,000 |
(a) Culturally and Linguistically
Appropriate Services Implementation
Grants. $2,275,000 in fiscal year 2022 and
$2,206,000 in fiscal year 2023 are from the
general fund for grants to disability services,
mental health, and substance use disorder
treatment providers to implement culturally
and linguistically appropriate services
standards, according to the implementation
and transition plan developed by the
commissioner.new text begin Any unspent amount in fiscal
year 2022 is available through June 30, 2023.new text end
The general fund base for this appropriation
is $1,655,000 in fiscal year 2024 and $0 in
fiscal year 2025.
(b) Base Level Adjustment. The general fund
base is $93,295,000 in fiscal year 2024 and
$83,324,000 in fiscal year 2025. The opiate
epidemic response fund base is $2,000,000 in
fiscal year 2024 and $0 in fiscal year 2025.
Sec. 15.
Laws 2021, First Special Session chapter 7, article 16, section 2, subdivision 33,
is amended to read:
Subd. 33.Grant Programs; Chemical
|
||||||
| Appropriations by Fund |
||
| General |
4,273,000 |
4,274,000 |
| Lottery Prize |
1,733,000 |
1,733,000 |
| Opiate Epidemic Response |
500,000 |
500,000 |
(a) Problem Gambling. $225,000 in fiscal
year 2022 and $225,000 in fiscal year 2023
are from the lottery prize fund for a grant to
the state affiliate recognized by the National
Council on Problem Gambling. The affiliate
must provide services to increase public
awareness of problem gambling, education,
training for individuals and organizations
providing effective treatment services to
problem gamblers and their families, and
research related to problem gambling.
(b) Recovery Community Organization
Grants. $2,000,000 in fiscal year 2022 and
$2,000,000 in fiscal year 2023 are from the
general fund for grants to recovery community
organizations, as defined in Minnesota
Statutes, section 254B.01, subdivision 8, to
provide for costs and community-based peer
recovery support services that are not
otherwise eligible for reimbursement under
Minnesota Statutes, section 254B.05, as part
of the continuum of care for substance use
disorders.new text begin Any unspent amount in fiscal year
2022 is available through June 30, 2023.new text end The
general fund base for this appropriation is
$2,000,000 in fiscal year 2024 and $0 in fiscal
year 2025
(c) Base Level Adjustment. The general fund
base is $4,636,000 in fiscal year 2024 and
$2,636,000 in fiscal year 2025. The opiate
epidemic response fund base is $500,000 in
fiscal year 2024 and $0 in fiscal year 2025.
Sec. 16.
Laws 2021, First Special Session chapter 7, article 17, section 3, is amended to
read:
Sec. 3. GRANTS FOR TECHNOLOGY FOR HCBS RECIPIENTS.
(a) This act includes $500,000 in fiscal year 2022 and $2,000,000 in fiscal year 2023
for the commissioner of human services to issue competitive grants to home and
community-based service providers. Grants must be used to provide technology assistance,
including but not limited to Internet services, to older adults and people with disabilities
who do not have access to technology resources necessary to use remote service delivery
and telehealth.new text begin Any unspent amount in fiscal year 2022 is available through June 30, 2023.new text end
The general fund base included in this act for this purpose is $1,500,000 in fiscal year 2024
and $0 in fiscal year 2025.
(b) All grant activities must be completed by March 31, 2024.
(c) This section expires June 30, 2024.
Sec. 17.
Laws 2021, First Special Session chapter 7, article 17, section 6, is amended to
read:
Sec. 6. TRANSITION TO COMMUNITY INITIATIVE.
(a) This act includes $5,500,000 in fiscal year 2022 and $5,500,000 in fiscal year 2023
for additional funding for grants awarded under the transition to community initiative
described in Minnesota Statutes, section 256.478.new text begin Any unspent amount in fiscal year 2022
is available through June 30, 2023.new text end The general fund base in this act for this purpose is
$4,125,000 in fiscal year 2024 and $0 in fiscal year 2025.
(b) All grant activities must be completed by March 31, 2024.
(c) This section expires June 30, 2024.
Sec. 18.
Laws 2021, First Special Session chapter 7, article 17, section 10, is amended to
read:
Sec. 10. PROVIDER CAPACITY GRANTS FOR RURAL AND UNDERSERVED
COMMUNITIES.
(a) This act includes $6,000,000 in fiscal year 2022 and $8,000,000 in fiscal year 2023
for the commissioner to establish a grant program for small provider organizations that
provide services to rural or underserved communities with limited home and
community-based services provider capacity. The grants are available to build organizational
capacity to provide home and community-based services in Minnesota and to build new or
expanded infrastructure to access medical assistance reimbursement.new text begin Any unspent amount
in fiscal year 2022 is available through June 30, 2023.new text end The general fund base in this act for
this purpose is $8,000,000 in fiscal year 2024 and $0 in fiscal year 2025.
(b) The commissioner shall conduct community engagement, provide technical assistance,
and establish a collaborative learning community related to the grants available under this
section and work with the commissioner of management and budget and the commissioner
of the Department of Administration to mitigate barriers in accessing grant funds. Funding
awarded for the community engagement activities described in this paragraph is exempt
from state solicitation requirements under Minnesota Statutes, section 16B.97, for activities
that occur in fiscal year 2022.
(c) All grant activities must be completed by March 31, 2024.
(d) This section expires June 30, 2024.
Sec. 19.
Laws 2021, First Special Session chapter 7, article 17, section 11, is amended to
read:
Sec. 11. EXPAND MOBILE CRISIS.
(a) This act includes $8,000,000 in fiscal year 2022 and $8,000,000 in fiscal year 2023
for additional funding for grants for adult mobile crisis services under Minnesota Statutes,
section 245.4661, subdivision 9, paragraph (b), clause (15).new text begin Any unspent amount in fiscal
year 2022 is available through June 30, 2023.new text end The general fund base in this act for this
purpose is $4,000,000 in fiscal year 2024 and $0 in fiscal year 2025.
(b) Beginning April 1, 2024, counties may fund and continue conducting activities
funded under this section.
(c) All grant activities must be completed by March 31, 2024.
(d) This section expires June 30, 2024.
Sec. 20.
Laws 2021, First Special Session chapter 7, article 17, section 12, is amended to
read:
Sec. 12. PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY AND CHILD
AND ADOLESCENT MOBILE TRANSITION UNIT.
(a) This act includes $2,500,000 in fiscal year 2022 and $2,500,000 in fiscal year 2023
for the commissioner of human services to create children's mental health transition and
support teams to facilitate transition back to the community of children from psychiatric
residential treatment facilities, and child and adolescent behavioral health hospitals.new text begin Any
unspent amount in fiscal year 2022 is available through June 30, 2023.new text end The general fund
base included in this act for this purpose is $1,875,000 in fiscal year 2024 and $0 in fiscal
year 2025.
(b) Beginning April 1, 2024, counties may fund and continue conducting activities
funded under this section.
(c) This section expires March 31, 2024.
Sec. 21.
Laws 2021, First Special Session chapter 7, article 17, section 17, subdivision 3,
is amended to read:
Subd. 3.
Respite services for older adults grants.
(a) This act includes $2,000,000 in
fiscal year 2022 and $2,000,000 in fiscal year 2023 for the commissioner of human services
to establish a grant program for respite services for older adults. The commissioner must
award grants on a competitive basis to respite service providers.new text begin Any unspent amount in
fiscal year 2022 is available through June 30, 2023.new text end The general fund base included in this
act for this purpose is $2,000,000 in fiscal year 2024 and $0 in fiscal year 2025.
(b) All grant activities must be completed by March 31, 2024.
(c) This subdivision expires June 30, 2024.
Sec. 22. new text begin APPROPRIATIONS FOR ADVISORY COUNCIL ON RARE DISEASES.
new text end
new text begin
In accordance with Minnesota Statutes, section 15.039, subdivision 6, the unexpended
balance of money appropriated from the general fund to the Board of Regents of the
University of Minnesota for purposes of the advisory council on rare diseases under
Minnesota Statutes, section 137.68, shall be under control of the Minnesota Rare Disease
Advisory Council and the Council on Disability.
new text end
Sec. 23. new text begin APPROPRIATION ENACTED MORE THAN ONCE.
new text end
new text begin
If an appropriation is enacted more than once in the 2022 legislative session, the
appropriation must be given effect only once.
new text end
Sec. 24. new text begin SUNSET OF UNCODIFIED LANGUAGE.
new text end
new text begin
All uncodified language contained in this article expires on June 30, 2023, unless a
different effective date is explicit.
new text end
Sec. 25. new text begin EFFECTIVE DATE.
new text end
new text begin
This article is effective the day following final enactment.
new text end
APPENDIX
Repealed Minnesota Statutes: H4706-1
144G.07 RETALIATION PROHIBITED.
Subd. 6.
Other laws.
Nothing in this section affects the rights and remedies available under section 626.557, subdivisions 10, 17, and 20.
150A.091 FEES.
Subd. 3.
Initial license or permit fees.
Along with the application fee, each of the following applicants shall submit a separate initial license or permit fee. The initial fee shall be established by the board not to exceed the following nonrefundable fee amounts:
(1) dentist or full faculty dentist, $168;
(2) dental therapist, $120;
(3) dental hygienist, $60;
(4) licensed dental assistant, $36; and
(5) dental assistant with a permit as described in Minnesota Rules, part 3100.8500, subpart 3, $12.
Subd. 15.
Verification of licensure.
Each institution or corporation shall submit with a request for verification of a license a fee in the amount of $5 for each license to be verified.
Subd. 17.
Advanced dental therapy examination fee.
Any dental therapist eligible to sit for the advanced dental therapy certification examination must submit with the application a fee as established by the board, not to exceed $250.
256B.057 ELIGIBILITY REQUIREMENTS FOR SPECIAL CATEGORIES.
Subd. 7.
Waiver of maintenance of effort requirement.
Unless a federal waiver of the maintenance of effort requirement of section 2105(d) of title XXI of the Balanced Budget Act of 1997, Public Law 105-33, Statutes at Large, volume 111, page 251, is granted by the federal Department of Health and Human Services by September 30, 1998, eligibility for children under age 21 must be determined without regard to asset standards established in section 256B.056, subdivision 3c. The commissioner of human services shall publish a notice in the State Register upon receipt of a federal waiver.
256B.063 COST SHARING.
Notwithstanding the provisions of section 256B.05, subdivision 2, the commissioner is authorized to promulgate rules pursuant to the Administrative Procedure Act, and to require a nominal enrollment fee, premium, or similar charge for recipients of medical assistance, if and to the extent required by applicable federal regulation.
256B.69 PREPAID HEALTH PLANS.
Subd. 20.
Ombudsperson.
The commissioner shall designate an ombudsperson to advocate for persons required to enroll in prepaid health plans under this section. The ombudsperson shall advocate for recipients enrolled in prepaid health plans through complaint and appeal procedures and ensure that necessary medical services are provided either by the prepaid health plan directly or by referral to appropriate social services. At the time of enrollment in a prepaid health plan, the local agency shall inform recipients about the ombudsperson program and their right to a resolution of a complaint by the prepaid health plan if they experience a problem with the plan or its providers.
501C.0408 TRUST FOR CARE OF ANIMAL.
Subd. 4.
Public health programs and trusts.
An irrevocable inter vivos trust created under this section is subject to section 501C.1206.
501C.1206 PUBLIC HEALTH CARE PROGRAMS AND CERTAIN TRUSTS.
(a) It is the public policy of this state that individuals use all available resources to pay for the cost of long-term care services, as defined in section 256B.0595, before turning to Minnesota health care program funds, and that trust instruments should not be permitted to shield available resources of an individual or an individual's spouse from such use.
(b) When a state or local agency makes a determination on an application by the individual or the individual's spouse for payment of long-term care services through a Minnesota public health care program pursuant to chapter 256B, any irrevocable inter vivos trust or any legal instrument, device, or arrangement similar to an irrevocable inter vivos trust created on or after July 1, 2005, containing assets or income of an individual or an individual's spouse, including those created by a person, court, or administrative body with legal authority to act in place of, at the direction of, upon the request of, or on behalf of the individual or individual's spouse, becomes revocable for the sole purpose of that determination. For purposes of this section, any inter vivos trust and any legal instrument, device, or arrangement similar to an inter vivos trust:
(1) shall be deemed to be located in and subject to the laws of this state; and
(2) is created as of the date it is fully executed by or on behalf of all of the settlors or others.
(c) For purposes of this section, a legal instrument, device, or arrangement similar to an irrevocable inter vivos trust means any instrument, device, or arrangement which involves a settlor who transfers or whose property is transferred by another including, but not limited to, any court, administrative body, or anyone else with authority to act on their behalf or at their direction, to an individual or entity with fiduciary, contractual, or legal obligations to the settlor or others to be held, managed, or administered by the individual or entity for the benefit of the settlor or others. These legal instruments, devices, or other arrangements are irrevocable inter vivos trusts for purposes of this section.
(d) In the event of a conflict between this section and the provisions of an irrevocable trust created on or after July 1, 2005, this section shall control.
(e) This section does not apply to trusts that qualify as supplemental needs trusts under section 501C.1205 or to trusts meeting the criteria of United States Code, title 42, section 1396p (d)(4)(a) and (c) for purposes of eligibility for medical assistance.
(f) This section applies to all trusts first created on or after July 1, 2005, as permitted under United States Code, title 42, section 1396p, and to all interests in real or personal property regardless of the date on which the interest was created, reserved, or acquired.