Minnesota Legislature
HF 4571
1st Engrossment - 93rd Legislature (2023 - 2024) Posted on 04/26/2024 12:30pm
Bill Text Versions
| Engrossments | ||
|---|---|---|
| Introduction | Posted on 03/04/2024 | |
| 1st Engrossment | Posted on 04/26/2024 |
Current Version - 1st Engrossment
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 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 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 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 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 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 8.31 8.32 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 11.33 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 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 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 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 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 16.32 16.33 16.34 16.35 16.36 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 17.30 17.31 17.32 17.33 17.34 17.35 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 18.35
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 19.31 19.32 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 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
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 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 23.31 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
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
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 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 28.32 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 29.32 29.33 29.34 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 30.33 30.34 30.35 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 31.33 31.34 31.35 31.36 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 32.33 32.34 32.35 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 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
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 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 36.33 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
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 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 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 41.30 41.31 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 43.33 43.34 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 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 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 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 48.32 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 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 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 55.32
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 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 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 59.32 59.33 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 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 62.32 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
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 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 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
67.30 67.31 67.32 67.33 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 68.32 68.33 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 69.33 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 70.31 70.32 70.33 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 71.31 71.32 71.33 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 72.29 72.30 72.31 72.32 72.33 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 73.31 73.32 73.33 73.34
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
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 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 76.31 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 77.31 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 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 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 83.31 83.32 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 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 87.33 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 88.31 88.32 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 89.30 89.31 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 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 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
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 93.31 93.32 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 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 97.32 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 99.31 100.1 100.2 100.3 100.4 100.5 100.6 100.7 100.8 100.9 100.10 100.11 100.12 100.13 100.14 100.15 100.16 100.17 100.18 100.19 100.20 100.21
100.22 100.23 100.24 100.25 100.26 100.27 100.28 100.29
100.30 100.31 100.32 100.33 101.1 101.2 101.3 101.4 101.5 101.6
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
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
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
105.8 105.9 105.10 105.11 105.12 105.13 105.14 105.15 105.16 105.17 105.18 105.19 105.20 105.21 105.22 105.23 105.24 105.25 105.26 105.27 105.28 105.29 105.30
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
106.24 106.25 106.26 106.27 106.28 106.29 106.30 106.31 106.32 107.1 107.2 107.3 107.4 107.5 107.6 107.7 107.8
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
108.1 108.2 108.3 108.4 108.5 108.6 108.7 108.8 108.9 108.10 108.11 108.12 108.13 108.14 108.15 108.16 108.17 108.18 108.19 108.20 108.21 108.22 108.23 108.24 108.25 108.26 108.27 108.28 108.29 108.30 108.31 109.1 109.2 109.3 109.4 109.5 109.6
109.7
109.8 109.9 109.10 109.11 109.12 109.13
109.14
109.15 109.16 109.17 109.18 109.19 109.20 109.21 109.22 109.23 109.24 109.25 109.26 109.27 109.28 109.29 109.30
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
111.18 111.19 111.20 111.21 111.22 111.23 111.24 111.25 111.26 111.27 111.28 111.29 111.30 111.31 111.32 111.33 112.1 112.2 112.3 112.4 112.5 112.6 112.7 112.8 112.9 112.10 112.11 112.12 112.13 112.14
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
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
113.24 113.25 113.26 113.27 113.28 113.29 113.30 113.31 114.1 114.2 114.3 114.4 114.5 114.6 114.7 114.8 114.9 114.10 114.11 114.12 114.13 114.14 114.15 114.16 114.17 114.18 114.19 114.20 114.21 114.22 114.23 114.24 114.25 114.26 114.27 114.28 114.29 114.30 114.31 114.32 115.1 115.2 115.3 115.4 115.5
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
117.1 117.2 117.3 117.4 117.5 117.6 117.7 117.8 117.9 117.10 117.11 117.12 117.13 117.14 117.15 117.16 117.17 117.18 117.19 117.20 117.21 117.22 117.23 117.24 117.25 117.26 117.27 117.28 117.29 117.30 117.31 117.32 118.1 118.2 118.3 118.4 118.5 118.6 118.7
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
118.24 118.25 118.26 118.27 118.28 118.29 118.30 118.31 119.1 119.2 119.3 119.4 119.5 119.6 119.7 119.8 119.9 119.10 119.11 119.12 119.13 119.14 119.15 119.16 119.17 119.18 119.19 119.20 119.21 119.22 119.23 119.24 119.25 119.26 119.27 119.28 119.29 119.30 119.31 119.32 119.33 120.1 120.2 120.3
120.4 120.5 120.6 120.7 120.8 120.9 120.10
120.11 120.12 120.13 120.14 120.15 120.16 120.17 120.18 120.19 120.20 120.21 120.22 120.23 120.24 120.25 120.26 120.27 120.28 120.29 120.30 120.31 120.32 121.1 121.2 121.3 121.4 121.5 121.6 121.7
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
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
122.26 122.27 122.28 122.29 123.1 123.2
123.3 123.4 123.5 123.6 123.7 123.8 123.9 123.10
123.11 123.12 123.13 123.14 123.15 123.16 123.17 123.18 123.19 123.20 123.21 123.22 123.23 123.24 123.25 123.26 123.27 123.28 123.29 124.1 124.2 124.3 124.4 124.5 124.6 124.7 124.8 124.9 124.10 124.11 124.12 124.13
124.14 124.15 124.16 124.17 124.18 124.19 124.20 124.21 124.22 124.23 124.24 124.25 124.26 124.27 124.28 124.29 124.30 125.1 125.2 125.3 125.4 125.5 125.6 125.7 125.8 125.9 125.10 125.11 125.12 125.13 125.14 125.15 125.16 125.17 125.18 125.19 125.20 125.21 125.22 125.23 125.24 125.25 125.26 125.27 125.28 125.29 125.30 125.31 125.32 125.33 125.34 126.1 126.2 126.3 126.4 126.5 126.6
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
127.29 127.30 127.31 127.32 128.1 128.2 128.3 128.4 128.5 128.6 128.7 128.8 128.9 128.10 128.11 128.12 128.13 128.14
128.15 128.16 128.17 128.18 128.19 128.20
128.21 128.22 128.23 128.24 128.25 128.26 128.27 128.28 128.29 128.30 128.31 128.32 128.33 129.1 129.2 129.3 129.4 129.5 129.6 129.7 129.8 129.9 129.10
129.11 129.12 129.13 129.14 129.15 129.16 129.17
129.18 129.19 129.20 129.21 129.22 129.23 129.24 129.25 129.26 129.27 129.28 129.29 129.30 129.31 130.1 130.2 130.3 130.4 130.5 130.6 130.7 130.8 130.9 130.10 130.11 130.12 130.13 130.14 130.15 130.16 130.17 130.18 130.19 130.20 130.21 130.22 130.23 130.24 130.25 130.26 130.27 130.28 130.29 130.30 130.31 130.32 131.1 131.2 131.3 131.4 131.5 131.6 131.7 131.8 131.9 131.10 131.11 131.12 131.13 131.14 131.15 131.16 131.17 131.18 131.19 131.20 131.21 131.22 131.23 131.24 131.25 131.26 131.27 131.28 131.29 131.30 132.1 132.2 132.3 132.4 132.5 132.6 132.7 132.8 132.9 132.10 132.11 132.12 132.13 132.14 132.15 132.16 132.17 132.18 132.19 132.20 132.21 132.22 132.23 132.24 132.25 132.26 132.27 132.28 132.29 132.30 132.31 132.32 132.33 133.1 133.2 133.3 133.4 133.5 133.6 133.7 133.8 133.9 133.10 133.11 133.12 133.13 133.14 133.15 133.16 133.17 133.18 133.19 133.20 133.21 133.22 133.23 133.24 133.25 133.26 133.27 133.28 133.29 133.30 133.31 133.32 133.33 133.34 133.35 134.1 134.2 134.3 134.4 134.5 134.6 134.7 134.8 134.9 134.10 134.11 134.12 134.13 134.14 134.15
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
134.31 134.32 134.33 135.1 135.2 135.3
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
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
137.1 137.2 137.3 137.4 137.5 137.6 137.7 137.8 137.9 137.10 137.11 137.12 137.13 137.14 137.15 137.16 137.17 137.18 137.19 137.20 137.21 137.22 137.23 137.24 137.25 137.26 137.27 137.28 137.29 137.30 137.31 137.32 137.33 138.1 138.2 138.3 138.4 138.5 138.6 138.7 138.8 138.9 138.10 138.11 138.12 138.13 138.14 138.15 138.16 138.17 138.18 138.19 138.20 138.21 138.22 138.23 138.24 138.25 138.26 138.27 138.28 138.29 139.1 139.2 139.3 139.4 139.5 139.6 139.7 139.8 139.9 139.10 139.11 139.12 139.13 139.14 139.15 139.16 139.17 139.18 139.19 139.20 139.21 139.22 139.23 139.24 139.25 139.26 139.27 139.28 139.29 139.30 139.31 139.32 139.33 139.34 140.1 140.2 140.3 140.4 140.5 140.6 140.7 140.8 140.9 140.10 140.11 140.12 140.13 140.14 140.15 140.16 140.17 140.18 140.19 140.20 140.21 140.22 140.23 140.24 140.25 140.26 140.27 140.28 140.29 140.30 140.31 140.32 140.33 140.34 140.35 141.1 141.2 141.3 141.4 141.5 141.6 141.7 141.8 141.9 141.10 141.11 141.12 141.13 141.14 141.15 141.16 141.18 141.17 141.20 141.19 141.21 141.22 141.23 141.24 141.25 141.26 141.27 141.28 141.29 141.30 141.31 141.32 141.33 141.34 141.35 142.1 142.2 142.3 142.4 142.5 142.6 142.7 142.8 142.9 142.10 142.11 142.12 142.13 142.14 142.15 142.16 142.17 142.18 142.19 142.20 142.21 142.22 142.23 142.24 142.25 142.26 142.27 142.28 142.29 142.30 142.31 142.32 143.1 143.2 143.3 143.4 143.5 143.6 143.7 143.8 143.9 143.10 143.11 143.12 143.13 143.14 143.15 143.16 143.17 143.18 143.19 143.20 143.21 143.22 143.23 143.24 143.25 143.26 143.27 143.28 143.29 143.30 143.31 143.32 143.33 144.1 144.2 144.3 144.4 144.5 144.6 144.7 144.8 144.9 144.10 144.11 144.12 144.13 144.14 144.15 144.16 144.17 144.18 144.19 144.20 144.21 144.22
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
145.16 145.17 145.18 145.19 145.20 145.21 145.22 145.23 145.24 145.25 145.26 145.27 145.28 145.29 145.30 146.1 146.2 146.3 146.4 146.5 146.6 146.7 146.8 146.9 146.10 146.11 146.12 146.13 146.14 146.15 146.16 146.17 146.18 146.19 146.20 146.21 146.22 146.23 146.24 146.25 146.26 146.27 146.28 146.29 146.30 147.1 147.2 147.3 147.4 147.5 147.6 147.7 147.8 147.9 147.10 147.11 147.12 147.13 147.14 147.15 147.16 147.17 147.18 147.19 147.20 147.21 147.22 147.23 147.24 147.25 147.26 147.27
147.28 147.29 147.30 147.31 147.32 147.33 148.1 148.2 148.3 148.4 148.5 148.6 148.7
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
150.29 150.30 150.31 151.1 151.2 151.3 151.4 151.5 151.6 151.7 151.8 151.9 151.10 151.11 151.12 151.13 151.14 151.15 151.16
151.17 151.18 151.19 151.20 151.21 151.22 151.23 151.24 151.25 151.26 151.27 151.28 151.29 151.30 151.31 151.32 151.33 152.1 152.2 152.3 152.4 152.5 152.6 152.7 152.8 152.9 152.10 152.11 152.12 152.13 152.14 152.15 152.16 152.17 152.18 152.19 152.20 152.21 152.22 152.23 152.24 152.25 152.26 152.27 152.28 152.29 152.30 152.31 152.32 153.1 153.2 153.3 153.4 153.5 153.6 153.7
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
153.26 153.27 153.28 153.29 153.30 153.31 153.32 153.33 154.1 154.2 154.3 154.4 154.5 154.6 154.7 154.8 154.9
154.10 154.11 154.12 154.13 154.14 154.15 154.16 154.17 154.18 154.19 154.20 154.21 154.22 154.23 154.24 154.25 154.26 154.27 154.28 154.29 154.30 154.31 154.32 154.33 155.1 155.2 155.3 155.4 155.5 155.6 155.7 155.8 155.9 155.10 155.11 155.12 155.13 155.14 155.15 155.16 155.17 155.18 155.19 155.20 155.21 155.22 155.23 155.24 155.25 155.26 155.27 155.28 155.29 155.30 155.31 155.32 155.33 156.1 156.2 156.3 156.4 156.5 156.6 156.7 156.8 156.9 156.10 156.11 156.12 156.13 156.14 156.15 156.16 156.17 156.18
156.19 156.20 156.21 156.22 156.23 156.24 156.25 156.26 156.27 156.28 156.29 156.30 156.31 156.32 157.1 157.2 157.3 157.4 157.5 157.6 157.7 157.8 157.9 157.10 157.11 157.12 157.13 157.14 157.15 157.16 157.17 157.18 157.19 157.20 157.21 157.22 157.23 157.24 157.25 157.26 157.27 157.28 157.29 157.30 157.31 158.1 158.2 158.3 158.4 158.5 158.6 158.7 158.8
158.9 158.10 158.11 158.12 158.13 158.14 158.15 158.16 158.17 158.18 158.19 158.20 158.21 158.22 158.23 158.24 158.25 158.26 158.27 158.28 158.29 158.30 158.31 158.32 159.1 159.2 159.3 159.4 159.5 159.6 159.7 159.8 159.9 159.10 159.11 159.12 159.13 159.14
159.15 159.16 159.17 159.18 159.19 159.20 159.21
159.22 159.23 159.24 159.25 159.26 159.27 159.28 159.29 159.30 159.31 160.1 160.2 160.3 160.4 160.5 160.6 160.7 160.8 160.9 160.10 160.11 160.12 160.13 160.14 160.15 160.16 160.17 160.18 160.19 160.20 160.21 160.22
160.23 160.24 160.25 160.26 160.27 160.28 160.29 160.30 160.31 161.1 161.2
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
162.30 162.31 162.32 163.1 163.2 163.3 163.4
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
163.22 163.23 163.24 163.25 163.26 163.27 163.28 163.29 163.30 164.1 164.2 164.3
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
164.26 164.27 164.28 164.29 165.1 165.2 165.3 165.4 165.5
165.6 165.7 165.8 165.9 165.10 165.11 165.12 165.13 165.14 165.15 165.16 165.17
165.18 165.19 165.20 165.21 165.22 165.23 165.24 165.25 165.26 165.27 165.28 165.29 165.30 165.31 166.1 166.2 166.3 166.4 166.5 166.6 166.7 166.8 166.9 166.10 166.11 166.12 166.13 166.14 166.15 166.16 166.17 166.18 166.19 166.20 166.21 166.22 166.23 166.24 166.25 166.26 166.27 166.28 166.29 166.30 166.31 166.32 167.1 167.2 167.3 167.4 167.5 167.6 167.7 167.8 167.9 167.10 167.11 167.12 167.13 167.14 167.15 167.16 167.17 167.18 167.19 167.20 167.21 167.22 167.23 167.24 167.25 167.26 167.27 167.28 167.29 167.30 167.31 167.32 167.33 168.1 168.2 168.3 168.4 168.5 168.6 168.7 168.8 168.9 168.10 168.11 168.12 168.13 168.14 168.15 168.16 168.17 168.18 168.19 168.20 168.21 168.22 168.23 168.24 168.25 168.26 168.27 168.28 168.29 168.30 168.31 168.32 169.1 169.2 169.3 169.4 169.5 169.6 169.7 169.8 169.9 169.10 169.11 169.12 169.13 169.14 169.15 169.16 169.17 169.18 169.19 169.20 169.21 169.22 169.23 169.24 169.25 169.26 169.27 169.28 169.29 169.30 169.31 169.32 169.33 170.1 170.2 170.3 170.4 170.5 170.6 170.7 170.8 170.9 170.10 170.11 170.12 170.13 170.14 170.15 170.16 170.17 170.18 170.19 170.20 170.21 170.22 170.23 170.24 170.25 170.26 170.27 170.28 170.29 170.30 170.31 170.32 170.33 170.34 171.1 171.2 171.3 171.4 171.5 171.6 171.7 171.8 171.9 171.10 171.11 171.12 171.13 171.14 171.15 171.16 171.17 171.18 171.19 171.20 171.21 171.22 171.23 171.24 171.25 171.26 171.27 171.28 171.29 171.30
172.1 172.2 172.3 172.4 172.5
172.6 172.7 172.8 172.9 172.10 172.11 172.12 172.13 172.14 172.15 172.16 172.17 172.18 172.19 172.20 172.21 172.22 172.23 172.24 172.25 172.26 172.27 172.28 172.29 172.30 172.31 172.32 172.33 172.34 173.1 173.2 173.3 173.4 173.5 173.6 173.7 173.8 173.9 173.10 173.11 173.12 173.13 173.14 173.15 173.16 173.17 173.18 173.19 173.20 173.21 173.22 173.23 173.24 173.25 173.26 173.27 173.28 173.29 173.30 173.31 173.32 173.33
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
175.1 175.2 175.3 175.4 175.5 175.6 175.7 175.8 175.9 175.10 175.11 175.12 175.13 175.14 175.15 175.16 175.17 175.18 175.19 175.20 175.21 175.22 175.23 175.24 175.25 175.26 175.27 175.28 175.29 175.30 175.31 175.32 175.33 176.1 176.2 176.3 176.4 176.5 176.6 176.7 176.8 176.9 176.10 176.11 176.12 176.13 176.14 176.15 176.16 176.17 176.18 176.19 176.20 176.21 176.22 176.23 176.24 176.25 176.26 176.27 176.28 176.29 176.30 176.31 176.32 177.1 177.2 177.3
177.4 177.5 177.6 177.7 177.8
177.9 177.10 177.11 177.12 177.13 177.14 177.15 177.16 177.17 177.18 177.19 177.20 177.21 177.22 177.23 177.24 177.25 177.26 177.27 177.28 177.29 177.30 178.1 178.2 178.3 178.4 178.5 178.6 178.7 178.8 178.9 178.10 178.11 178.12 178.13 178.14 178.15 178.16 178.17 178.18 178.19 178.20 178.21 178.22 178.23 178.24 178.25 178.26 178.27 178.28 178.29 178.30 178.31 178.32 179.1 179.2 179.3 179.4 179.5 179.6 179.7 179.8 179.9 179.10 179.11 179.12 179.13 179.14 179.15 179.16 179.17 179.18 179.19 179.20 179.21 179.22 179.23 179.24 179.25
179.26 179.27 179.28 179.29 179.30 179.31
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
180.17 180.18 180.19 180.20 180.21 180.22 180.23 180.24 180.25 180.26 180.27 180.28 180.29 181.1 181.2 181.3 181.4 181.5 181.6 181.7 181.8 181.9 181.10
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
181.25 181.26 181.27 181.28 181.29 181.30 181.31 181.32 182.1 182.2 182.3 182.4
182.5 182.6 182.7 182.8 182.9 182.10
182.11 182.12 182.13 182.14 182.15 182.16 182.17 182.18 182.19 182.20 182.21 182.22 182.23 182.24 182.25 182.26 182.27 182.28 182.29 183.1 183.2 183.3 183.4 183.5 183.6
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
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
184.26 184.27 184.28 184.29 185.1 185.2 185.3
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
185.18 185.19 185.20 185.21 185.22 185.23 185.24 185.25 185.26 185.27 185.28 185.29 186.1 186.2 186.3 186.4 186.5 186.6 186.7 186.8 186.9 186.10 186.11 186.12 186.13 186.14 186.15 186.16 186.17 186.18 186.19 186.20 186.21 186.22 186.23 186.24 186.25 186.26 186.27
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
190.25 190.26 190.27 190.28 190.29 190.30 190.31 190.32 191.1 191.2
191.3
191.4 191.5 191.6 191.7 191.8 191.9 191.10 191.11 191.12
191.13
191.14 191.15 191.16 191.17 191.18 191.19 191.20 191.21 191.22 191.23 191.24 191.25 191.26 191.27 191.28 191.29 191.30 192.1 192.2 192.3 192.4 192.5 192.6 192.7 192.8 192.9 192.10 192.11 192.12 192.13 192.14 192.15 192.16 192.17 192.18 192.19 192.20 192.21 192.22 192.23 192.24 192.25 192.26 192.27 192.28 192.29 192.30 192.31 192.32 193.1 193.2
193.3
193.4 193.5 193.6 193.7 193.8 193.9 193.10 193.11 193.12 193.13 193.14 193.15 193.16 193.17 193.18 193.19 193.20 193.21 193.22 193.23 193.24 193.25 193.26 193.27 193.28 193.29 194.1 194.2 194.3
194.4
194.5 194.6 194.7 194.8 194.9 194.10 194.11 194.12 194.13 194.14 194.15 194.16 194.17 194.18 194.19 194.20 194.21 194.22 194.23 194.24 194.25 194.26 194.27 194.28 194.29 194.30 194.31 195.1 195.2 195.3 195.4
195.5
195.6 195.7 195.8 195.9 195.10 195.11 195.12 195.13 195.14 195.15 195.16 195.17 195.18 195.19 195.20 195.21 195.22 195.23 195.24 195.25 195.26 195.27 195.28 195.29 195.30 195.31 195.32 196.1 196.2 196.3 196.4 196.5 196.6 196.7 196.8
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
197.1 197.2 197.3 197.4 197.5 197.6 197.7 197.8 197.9 197.10 197.11 197.12 197.13 197.14 197.15 197.16 197.17 197.18 197.19 197.20 197.21 197.22 197.23 197.24 197.25 197.26 197.27 197.28 197.29 197.30 197.31 198.1 198.2 198.3 198.4 198.5 198.6 198.7 198.8 198.9 198.10 198.11 198.12 198.13 198.14 198.15 198.16 198.17 198.18 198.19 198.20 198.21 198.22 198.23 198.24 198.25
198.26 198.27 198.28 198.29 198.30 198.31 198.32 198.33 199.1 199.2 199.3 199.4 199.5 199.6 199.7 199.8 199.9 199.10 199.11
199.12
199.13 199.14 199.15 199.16 199.17 199.18 199.19 199.20 199.21 199.22 199.23 199.24 199.25 199.26 199.27 199.28 199.29 199.30 199.31 199.32 200.1 200.2 200.3 200.4 200.5 200.6 200.7 200.8 200.9 200.10
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
201.1 201.2 201.3 201.4 201.5 201.6 201.7 201.8 201.9 201.10 201.11 201.12 201.13 201.14 201.15 201.16 201.17 201.18 201.19 201.20 201.21 201.22 201.23 201.24 201.25 201.26 201.27 201.28 201.29 201.30 202.1 202.2 202.3 202.4 202.5 202.6 202.7 202.8 202.9 202.10 202.11 202.12 202.13 202.14 202.15 202.16 202.17
202.18
202.19 202.20 202.21 202.22 202.23 202.24 202.25 202.26 202.27 202.28 202.29 202.30 202.31 203.1 203.2 203.3 203.4 203.5 203.6 203.7 203.8 203.9 203.10 203.11 203.12 203.13 203.14 203.15 203.16 203.17 203.18 203.19 203.20 203.21 203.22 203.23 203.24 203.25 203.26 203.27 203.28 203.29 203.30 204.1 204.2 204.3
204.4 204.5 204.6 204.7 204.8 204.9 204.10 204.11 204.12 204.13 204.14 204.15 204.16 204.17 204.18 204.19 204.20 204.21 204.22 204.23 204.24 204.25 204.26 204.27 204.28 204.29 204.30 204.31 204.32 204.33 205.1 205.2 205.3
205.4 205.5 205.6 205.7 205.8 205.9 205.10
205.11 205.12 205.13 205.14 205.15 205.16 205.17 205.18 205.19 205.20 205.21 205.22 205.23 205.24 205.25 205.26 205.27 205.28 205.29 205.30 206.1 206.2 206.3 206.4 206.5 206.6 206.7 206.8 206.9 206.10 206.11 206.12 206.13 206.14 206.15 206.16 206.17 206.18 206.19 206.20 206.21 206.22 206.23 206.24 206.25 206.26 206.27 206.28
206.29
206.30 206.31 206.32 207.1 207.2 207.3 207.4 207.5 207.6 207.7 207.8 207.9 207.10 207.11 207.12 207.13 207.14 207.15 207.16 207.17 207.18 207.19 207.20 207.21 207.22 207.23 207.24 207.25 207.26 207.27
207.28
207.29 207.30 207.31 207.32 208.1 208.2 208.3 208.4 208.5 208.6 208.7 208.8 208.9 208.10 208.11 208.12 208.13 208.14 208.15 208.16
208.17 208.18 208.19 208.20 208.21 208.22 208.23 208.24 208.25 208.26 208.27 208.28 209.1 209.2 209.3 209.4 209.5 209.6 209.7 209.8 209.9 209.10 209.11 209.12 209.13 209.14 209.15 209.16 209.17 209.18 209.19 209.20 209.21 209.22 209.23 209.24
209.25 209.26 209.27 209.28 209.29 209.30 209.31 210.1 210.2
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
210.21 210.22 210.23 210.24 210.25 210.26 210.27 210.28 210.29 210.30 211.1 211.2 211.3 211.4 211.5 211.6 211.7 211.8 211.9 211.10 211.11 211.12 211.13 211.14 211.15 211.16 211.17 211.18 211.19 211.20 211.21
211.22 211.23 211.24 211.25 211.26 211.27 211.28 211.29 211.30 212.1 212.2 212.3 212.4 212.5 212.6
212.7 212.8 212.9 212.10 212.11 212.12 212.13 212.14 212.15 212.16 212.17 212.18 212.19 212.20 212.21 212.22 212.23 212.24 212.25 212.26 212.27 212.28 212.29 212.30 212.31 212.32 212.33 213.1 213.2 213.3 213.4 213.5
213.6
213.7 213.8 213.9 213.10 213.11 213.12 213.13
213.14
213.15 213.16 213.17 213.18 213.19 213.20 213.21 213.22 213.23 213.24 213.25 213.26 213.27 213.28 213.29 213.30 213.31 214.1 214.2
214.3
214.4 214.5 214.6 214.7 214.8 214.9 214.10 214.11 214.12 214.13 214.14 214.15 214.16 214.17 214.18 214.19 214.20 214.21 214.22 214.23 214.24 214.25 214.26 214.27 214.28 214.29 214.30 214.31 214.32 215.1 215.2 215.3 215.4 215.5 215.6 215.7 215.8 215.9 215.10 215.11 215.12 215.13 215.14 215.15 215.16 215.17 215.18 215.19 215.20 215.21 215.22 215.23 215.24 215.25 215.26 215.27 215.28 215.29 215.30 215.31 215.32 216.1 216.2 216.3 216.4 216.5 216.6 216.7 216.8 216.9 216.10 216.11 216.12 216.13 216.14 216.15 216.16 216.17 216.18 216.19 216.20 216.21 216.22 216.23 216.24 216.25 216.26 216.27 216.28 216.29 216.30 216.31 216.32 216.33 217.1 217.2 217.3 217.4 217.5 217.6 217.7 217.8 217.9 217.10 217.11 217.12 217.13 217.14 217.15 217.16 217.17 217.18 217.19 217.20 217.21 217.22 217.23 217.24 217.25 217.26 217.27 217.28 217.29 217.30 217.31 217.32 218.1 218.2 218.3 218.4 218.5 218.6 218.7 218.8 218.9 218.10 218.11 218.12 218.13 218.14 218.15 218.16 218.17 218.18 218.19 218.20 218.21 218.22 218.23 218.24 218.25 218.26 218.27 218.28 218.29 218.30 218.31 218.32 218.33 218.34 219.1 219.2 219.3 219.4 219.5 219.6 219.7 219.8 219.9 219.10 219.11 219.12 219.13 219.14 219.15
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
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
221.22 221.23 221.24 221.25 221.26 221.27 221.28 222.1 222.2 222.3
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
222.23 222.24 222.25 222.26 222.27 222.28 222.29 222.30 222.31 222.32 223.1 223.2 223.3 223.4 223.5 223.6 223.7 223.8 223.9 223.10 223.11 223.12 223.13
223.14 223.15 223.16 223.17
223.18
223.19 223.20
223.21 223.22 223.23 223.24 223.25 223.26 223.27 223.28 223.29 223.30 223.31 224.1 224.2 224.3 224.4 224.5 224.6 224.7 224.8 224.9 224.10 224.11 224.12 224.13 224.14 224.15 224.16 224.17 224.18 224.19 224.20 224.21 224.22 224.23 224.24 224.25 224.26 224.27 224.28 224.29 224.30 224.31 224.32 224.33 225.1 225.2 225.3 225.4 225.5 225.6 225.7 225.8 225.9 225.10 225.11 225.12 225.13 225.14 225.15 225.16 225.17 225.18
225.19 225.20
225.21 225.22 225.23 225.24 225.25 225.26 225.27 225.28 225.29 225.30 225.31 225.32 225.33
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
230.32 230.33
231.1 231.2 231.3 231.4 231.5 231.6 231.7 231.8 231.9 231.10 231.11 231.12 231.13 231.14 231.15 231.16 231.17 231.18 231.19 231.20 231.21 231.22 231.23 231.24 231.25 231.26 231.27 231.28 231.29 231.30 231.31 231.32 232.1 232.2 232.3 232.4 232.5 232.6 232.7 232.8 232.9 232.10 232.11 232.12 232.13 232.14 232.15 232.16 232.17 232.18 232.19 232.20 232.21 232.22 232.23 232.24 232.25 232.26 232.27 232.28 232.29 232.30 232.31 232.32 232.33 233.1 233.2 233.3 233.4
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
233.22 233.23 233.24 233.25 233.26 233.27 233.28 233.29 233.30 233.31 234.1 234.2 234.3 234.4 234.5 234.6 234.7
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
234.21 234.22 234.23 234.24 234.25 234.26 234.27 234.28 234.29 235.1 235.2 235.3 235.4 235.5 235.6 235.7 235.8 235.9 235.10 235.11 235.12 235.13 235.14 235.15 235.16 235.17 235.18 235.19 235.20 235.21 235.22 235.23 235.24 235.25 235.26 235.27 235.28 235.29 235.30 235.31 236.1 236.2 236.3 236.4 236.5 236.6 236.7 236.8 236.9 236.10 236.11 236.12 236.13 236.14 236.15 236.16 236.17
236.18 236.19 236.20 236.21 236.22 236.23 236.24 236.25
236.26 236.27 236.28 236.29 236.30 236.31 237.1 237.2
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
237.20 237.21 237.22 237.23 237.24 237.25 237.26 237.27 237.28 237.29 237.30 237.31 237.32 238.1 238.2 238.3 238.4 238.5 238.6 238.7 238.8 238.9 238.10 238.11 238.12 238.13 238.14 238.15 238.16 238.17 238.18 238.19 238.20
238.21 238.22 238.23 238.24 238.25 238.26 238.27 238.28 238.29 238.30 238.31 239.1 239.2
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
239.20 239.21 239.22 239.23 239.24 239.25 239.26 239.27 239.28 239.29 239.30 239.31 240.1 240.2 240.3 240.4 240.5 240.6 240.7 240.8 240.9 240.10 240.11 240.12
240.13 240.14 240.15 240.16 240.17 240.18 240.19 240.20 240.21 240.22 240.23 240.24 240.25 240.26 240.27 240.28 240.29 240.30 240.31 240.32 240.33 241.1 241.2 241.3 241.4 241.5 241.6 241.7 241.8 241.9 241.10 241.11
241.12 241.13 241.14 241.15 241.16 241.17 241.18 241.19 241.20 241.21 241.22 241.23 241.24 241.25 241.26 241.27 241.28 241.29 241.30 241.31 242.1 242.2 242.3 242.4 242.5 242.6
242.7 242.8
242.9 242.10 242.11 242.12 242.13 242.14 242.15 242.16 242.17 242.18 242.19 242.20 242.21 242.22 242.23 242.24 242.25 242.26 242.27 242.28 242.29 242.30 242.31 242.32 243.1 243.2 243.3 243.4 243.5 243.6 243.7 243.8 243.9 243.10 243.11 243.12 243.13 243.14 243.15 243.16 243.17 243.18 243.19 243.20 243.21 243.22 243.23 243.24 243.25 243.26 243.27 243.28 243.29 244.1 244.2 244.3 244.4 244.5
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
245.1 245.2 245.3 245.4 245.5 245.6 245.7 245.8 245.9 245.10 245.11 245.12 245.13 245.14 245.15 245.16 245.17 245.18 245.19 245.20 245.21 245.22 245.23 245.24 245.25 245.26 245.27 245.28 245.29 245.30 245.31 245.32 245.33 246.1 246.2 246.3 246.4 246.5 246.6 246.7 246.8 246.9 246.10 246.11 246.12 246.13 246.14 246.15 246.16 246.17 246.18 246.19 246.20 246.21 246.22 246.23 246.24 246.25 246.26 246.27 246.28 246.29 246.30 246.31 246.32 246.33 247.1 247.2 247.3 247.4 247.5 247.6 247.7 247.8 247.9 247.10 247.11 247.12 247.13 247.14 247.15 247.16 247.17 247.18 247.19 247.20 247.21 247.22 247.23 247.24 247.25 247.26 247.27 247.28 247.29 247.30 247.31 247.32 248.1 248.2 248.3 248.4 248.5 248.6 248.7 248.8 248.9 248.10 248.11 248.12 248.13 248.14 248.15 248.16 248.17 248.18 248.19 248.20 248.21 248.22
248.23 248.24 248.25 248.26 248.27 248.28 248.29 248.30 248.31 248.32 249.1 249.2 249.3 249.4 249.5 249.6 249.7 249.8 249.9 249.10 249.11 249.12 249.13 249.14 249.15 249.16 249.17 249.18 249.19 249.20 249.21 249.22 249.23 249.24 249.25 249.26 249.27 249.28 249.29 249.30 249.31 249.32 250.1 250.2 250.3 250.4 250.5 250.6 250.7 250.8 250.9 250.10 250.11 250.12 250.13 250.14 250.15 250.16 250.17 250.18 250.19 250.20 250.21 250.22 250.23 250.24 250.25 250.26 250.27 250.28 250.29 250.30 250.31 250.32 251.1 251.2 251.3 251.4 251.5 251.6 251.7 251.8 251.9 251.10 251.11 251.12 251.13 251.14
251.15 251.16 251.17 251.18 251.19 251.20 251.21 251.22 251.23 251.24 251.25 251.26 251.27 251.28 251.29 251.30 251.31 251.32 251.33 252.1 252.2 252.3 252.4 252.5 252.6 252.7 252.8 252.9 252.10 252.11 252.12 252.13 252.14 252.15 252.16 252.17 252.18 252.19 252.20 252.21 252.22 252.23 252.24 252.25 252.26 252.27 252.28 252.29 252.30 252.31 252.32 252.33 252.34 253.1 253.2 253.3 253.4 253.5 253.6 253.7 253.8 253.9
253.10 253.11 253.12 253.13 253.14 253.15 253.16 253.17 253.18 253.19 253.20 253.21 253.22 253.23 253.24 253.25 253.26 253.27 253.28 253.29 253.30 253.31 253.32 254.1 254.2 254.3 254.4 254.5 254.6 254.7 254.8 254.9 254.10 254.11 254.12 254.13 254.14 254.15 254.16 254.17 254.18 254.19 254.20 254.21 254.22 254.23 254.24 254.25 254.26 254.27 254.28 254.29 254.30 254.31 254.32 255.1 255.2 255.3 255.4 255.5 255.6 255.7 255.8 255.9 255.10 255.11 255.12 255.13 255.14 255.15 255.16 255.17 255.18 255.19 255.20 255.21 255.22 255.23 255.24 255.25 255.26
255.27 255.28 255.29 255.30 255.31 255.32 256.1 256.2 256.3 256.4 256.5 256.6 256.7 256.8 256.9
256.10 256.11
256.12 256.13 256.14 256.15 256.16 256.17 256.18 256.19 256.20 256.21 256.22 256.23 256.24 256.25 256.26 256.27 256.28 256.29 256.30 256.31 256.32 257.1 257.2 257.3 257.4 257.5 257.6 257.7 257.8 257.9 257.10 257.11 257.12 257.13 257.14 257.15 257.16 257.17 257.18 257.19 257.20 257.21 257.22 257.23 257.24 257.25 257.26 257.27 257.28 257.29 257.30 257.31 257.32 257.33 257.34 258.1 258.2 258.3 258.4 258.5 258.6 258.7 258.8 258.9 258.10 258.11 258.12 258.13 258.14 258.15 258.16 258.17 258.18 258.19 258.20 258.21 258.22 258.23 258.24 258.25 258.26 258.27 258.28 258.29 258.30 258.31 258.32 258.33 259.1 259.2 259.3 259.4 259.5 259.6 259.7 259.8 259.9 259.10 259.11 259.12 259.13 259.14 259.15 259.16 259.17
259.18 259.19 259.20 259.21 259.22 259.23 259.24 259.25 259.26 259.27 259.28 259.29 259.30 259.31 259.32 259.33 260.1 260.2 260.3 260.4 260.5 260.6 260.7 260.8 260.9 260.10 260.11 260.12 260.13 260.14 260.15 260.16 260.17 260.18 260.19 260.20 260.21 260.22 260.23 260.24 260.25 260.26 260.27 260.28 260.29 260.30 260.31 260.32 260.33 260.34 261.1 261.2 261.3 261.4 261.5 261.6 261.7 261.8 261.9 261.10 261.11 261.12 261.13 261.14 261.15 261.16 261.17 261.18 261.19 261.20 261.21 261.22 261.23 261.24 261.25 261.26 261.27 261.28 261.29 261.30 261.31 262.1 262.2 262.3 262.4 262.5 262.6
262.7 262.8 262.9 262.10 262.11 262.12 262.13 262.14 262.15 262.16 262.17 262.18 262.19 262.20 262.21 262.22 262.23 262.24 262.25 262.26 262.27 262.28 262.29 262.30 262.31 263.1 263.2 263.3 263.4 263.5 263.6 263.7 263.8 263.9
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
264.5 264.6 264.7 264.8 264.9 264.10 264.11 264.12 264.13 264.14 264.15 264.16 264.17 264.18 264.19 264.20 264.21 264.22 264.23 264.24 264.25 264.26 264.27 264.28 264.29 264.30 264.31 265.1 265.2 265.3 265.4 265.5 265.6 265.7 265.8 265.9 265.10 265.11 265.12 265.13 265.14 265.15 265.16 265.17 265.18 265.19 265.20 265.21 265.22 265.23 265.24 265.25 265.26 265.27 265.28 265.29 266.1 266.2 266.3 266.4 266.5 266.6 266.7 266.8 266.9 266.10 266.11 266.12 266.13 266.14 266.15 266.16 266.17 266.18 266.19 266.20
266.21 266.22 266.23 266.24 266.25 266.26 266.27 266.28 266.29 266.30 266.31 267.1 267.2 267.3 267.4 267.5 267.6 267.7 267.8 267.9 267.10 267.11 267.12 267.13 267.14 267.15 267.16 267.17
267.18 267.19 267.20 267.21 267.22 267.23 267.24 267.25 267.26 267.27 267.28 267.29 267.30 267.31 267.32 268.1 268.2 268.3 268.4 268.5 268.6 268.7 268.8 268.9 268.10 268.11 268.12 268.13 268.14 268.15 268.16 268.17 268.18 268.19 268.20 268.21 268.22 268.23 268.24 268.25
268.26
268.27 268.28 268.29 268.30 268.31 268.32 269.1 269.2 269.3 269.4 269.5 269.6 269.7 269.8 269.9 269.10 269.11 269.12 269.13 269.14 269.15 269.16 269.17 269.18 269.19 269.20 269.21 269.22 269.23 269.24 269.25 269.26 269.27 269.28 269.29 269.30 270.1 270.2 270.3 270.4 270.5 270.6 270.7
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
271.15 271.16 271.17 271.18 271.19 271.20 271.21 271.22 271.23 271.24 271.25 271.26 271.27 271.28 271.29 271.30 271.31 272.1 272.2 272.3 272.4 272.5 272.6 272.7 272.8 272.9 272.10 272.11 272.12 272.13 272.14 272.15 272.16 272.17 272.18 272.19 272.20 272.21 272.22 272.23 272.24 272.25 272.26 272.27 272.28 272.29 272.30 272.31 272.32 272.33 272.34 273.1 273.2 273.3 273.4 273.5 273.6 273.7 273.8 273.9 273.10 273.11 273.12 273.13 273.14 273.15 273.16 273.17 273.18 273.19 273.20 273.21 273.22 273.23 273.24 273.25 273.26 273.27 273.28 273.29 273.30 273.31 273.32 273.33 274.1 274.2 274.3 274.4 274.5 274.6 274.7 274.8 274.9 274.10 274.11 274.12 274.13 274.14 274.15 274.16 274.17 274.18 274.19 274.20 274.21 274.22 274.23 274.24 274.25 274.26 274.27 274.28 274.29 274.30 274.31 274.32 274.33 274.34 275.1 275.2 275.3 275.4 275.5 275.6 275.7 275.8 275.9 275.10 275.11 275.12 275.13
275.14
275.15 275.16 275.17 275.18 275.19 275.20 275.21 275.22 275.23 275.24 275.25 275.26 275.27 275.28 275.29 275.30 275.31 275.32 276.1 276.2 276.3 276.4 276.5 276.6 276.7 276.8 276.9 276.10 276.11 276.12 276.13 276.14 276.15 276.16 276.17 276.18 276.19 276.20 276.21 276.22 276.23 276.24 276.25 276.26 276.27 276.28 276.29 276.30 277.1 277.2 277.3 277.4 277.5 277.6 277.7 277.8 277.9 277.10 277.11 277.12 277.13 277.14 277.15 277.16 277.17 277.18
277.19 277.20 277.21 277.22 277.23 277.24 277.25 277.26 277.27 277.28 277.29 277.30 277.31 277.32 278.1 278.2 278.3
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
278.24 278.25 278.26 278.27 278.28 278.29 278.30 279.1 279.2 279.3 279.4 279.5 279.6 279.7 279.8 279.9 279.10 279.11 279.12 279.13 279.14 279.15 279.16 279.17 279.18 279.19 279.20 279.21 279.22 279.23 279.24 279.25 279.26 279.27 279.28 279.29 279.30 279.31 279.32 279.33 280.1 280.2 280.3 280.4 280.5 280.6 280.7 280.8 280.9 280.10 280.11 280.12 280.13
280.14
280.15 280.16 280.17 280.18 280.19 280.20 280.21 280.22 280.23 280.24 280.25 280.26 280.27 280.28 280.29 280.30 280.31 281.1 281.2 281.3 281.4 281.5 281.6 281.7 281.8 281.9 281.10 281.11 281.12 281.13
281.14
281.15 281.16 281.17 281.18 281.19 281.20 281.21 281.22 281.23 281.24 281.25 281.26 281.27 281.28 281.29 281.30 281.31 282.1 282.2 282.3 282.4 282.5 282.6 282.7 282.8
282.9
282.10 282.11 282.12 282.13 282.14
282.15
282.16 282.17 282.18 282.19 282.20 282.21 282.22 282.23 282.24 282.25 282.26 282.27 282.28 282.29 282.30 282.31 282.32 282.33 283.1 283.2 283.3 283.4 283.5 283.6 283.7 283.8 283.9 283.10 283.11 283.12 283.13
283.14
283.15 283.16 283.17 283.18 283.19 283.20 283.21 283.22 283.23 283.24 283.25 283.26 283.27 283.28 283.29 283.30 283.31 283.32 284.1 284.2
284.3 284.4 284.5 284.6 284.7 284.8 284.9 284.10 284.11 284.12 284.13 284.14 284.15 284.16 284.17 284.18 284.19 284.20 284.21 284.22 284.23 284.24 284.25 284.26 284.27 284.28 284.29 284.30 284.31 284.32 284.33
285.1
285.2 285.3 285.4 285.5 285.6 285.7 285.8 285.9 285.10 285.11 285.12 285.13 285.14 285.15 285.16 285.17 285.18 285.19 285.20 285.21 285.22 285.23 285.24 285.25 285.26 285.27 285.28 285.29 285.30 286.1 286.2 286.3 286.4 286.5 286.6 286.7 286.8 286.9
286.10
286.11 286.12 286.13 286.14 286.15 286.16 286.17 286.18 286.19
286.20
286.21 286.22 286.23 286.24 286.25 286.26 286.27 286.28 286.29 286.30 286.31 286.32 287.1 287.2 287.3 287.4 287.5 287.6 287.7 287.8 287.9 287.10 287.11 287.12 287.13
287.14
287.15 287.16 287.17 287.18 287.19 287.20 287.21 287.22 287.23 287.24
287.25 287.26 287.27 287.28 287.29 287.30 287.31 288.1 288.2 288.3 288.4 288.5 288.6 288.7 288.8 288.9 288.10 288.11 288.12 288.13 288.14 288.15 288.16 288.17
288.18 288.19 288.20 288.21 288.22 288.23 288.24 288.25 288.26 288.27 288.28 288.29 288.30 288.31 288.32 289.1 289.2 289.3
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
289.25 289.26 289.27 289.28 289.29 289.30 289.31 290.1 290.2 290.3 290.4 290.5 290.6 290.7 290.8 290.9 290.10 290.11 290.12 290.13 290.14 290.15 290.16 290.17 290.18 290.19 290.20 290.21 290.22 290.23 290.24 290.25 290.26 290.27 290.28
290.29 290.30 290.31 290.32 290.33 291.1 291.2 291.3 291.4 291.5 291.6 291.7 291.8 291.9 291.10 291.11 291.12 291.13 291.14 291.15 291.16 291.17 291.18 291.19 291.20 291.21 291.22 291.23 291.24 291.25 291.26 291.27 291.28 291.29 291.30 291.31 291.32 291.33 292.1 292.2 292.3 292.4 292.5 292.6 292.7 292.8 292.9 292.10 292.11 292.12 292.13 292.14 292.15 292.16 292.17 292.18 292.19 292.20 292.21 292.22 292.23 292.24 292.25 292.26 292.27 292.28 292.29 292.30 292.31 292.32 292.33 293.1 293.2 293.3 293.4
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
293.25 293.26 293.27 293.28 293.29 293.30 293.31 294.1 294.2 294.3 294.4 294.5
294.6 294.7 294.8 294.9 294.10 294.11
294.12 294.13 294.14 294.15 294.16 294.17
294.18 294.19 294.20 294.21 294.22 294.23 294.24 294.25 294.26 294.27 294.28 294.29 294.30 295.1 295.2 295.3 295.4 295.5 295.6 295.7 295.8 295.9 295.10 295.11 295.12 295.13 295.14 295.15 295.16 295.17 295.18 295.19 295.20 295.21 295.22 295.23 295.24 295.25 295.26 295.27 295.28 295.29 295.30
296.1 296.2 296.3 296.4 296.5 296.6 296.7 296.8 296.9 296.10 296.11 296.12 296.13 296.14 296.15 296.16 296.17 296.18 296.19 296.20 296.21 296.22 296.23 296.24 296.25 296.26 296.27 296.28 296.29 296.30 296.31 296.32 296.33 296.34 297.1 297.2 297.3 297.4 297.5 297.6 297.7 297.8 297.9 297.10
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
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
299.31
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
300.26 300.27 300.28 300.29 300.30 300.31 301.1 301.2 301.3 301.4 301.5 301.6 301.7 301.8 301.9 301.10 301.11 301.12 301.13 301.14 301.15 301.16 301.17 301.18 301.19 301.20 301.21 301.22 301.23 301.24 301.25 301.26 301.27 301.28 301.29 301.30 301.31 301.32 301.33 302.1 302.2 302.3 302.4 302.5 302.6 302.7 302.8 302.9 302.10 302.11 302.12 302.13 302.14 302.15 302.16 302.17 302.18 302.19 302.20 302.21
302.22
302.23 302.24 302.25 302.26 302.27 302.28 302.29 302.30 302.31 302.32 302.33 303.1 303.2 303.3 303.4 303.5 303.6 303.7 303.8 303.9 303.10 303.11 303.12 303.13 303.14 303.15 303.16 303.17 303.18 303.19 303.20 303.21 303.22 303.23 303.24 303.25 303.26 303.27 303.28 303.29 303.30 303.31 303.32 304.1 304.2 304.3 304.4 304.5
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
305.9 305.10 305.11 305.12 305.13 305.14 305.15 305.16 305.17 305.18 305.19 305.20 305.21 305.22 305.23 305.24 305.25 305.26 305.27 305.28 305.29 305.30 305.31 305.32 306.1 306.2 306.3 306.4 306.5
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
308.1 308.2 308.3 308.4 308.5 308.6 308.7 308.8 308.9 308.10 308.11 308.12 308.13 308.14 308.15 308.16 308.17 308.18 308.19 308.20 308.21 308.22 308.23 308.24 308.25 308.26 308.27 308.28 308.29 308.30 308.31 308.32 308.33 308.34 309.1 309.2 309.3 309.4 309.5 309.6 309.7
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
311.1 311.2 311.3 311.4 311.5 311.6 311.7 311.8 311.9 311.10 311.11 311.12 311.13 311.14 311.15 311.16 311.17 311.18 311.19 311.20 311.21 311.22 311.23 311.24 311.25 311.26 311.27 311.28 311.29 311.30 311.31 311.32
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
312.20 312.21 312.22 312.23 312.24 312.25 312.26 312.27 312.28 312.29 312.30 312.31 312.32 313.1 313.2 313.3 313.4 313.5 313.6 313.7 313.8 313.9 313.10 313.11 313.12 313.13 313.14 313.15 313.16 313.17 313.18 313.19 313.20 313.21 313.22 313.23 313.24 313.25 313.26 313.27 313.28 313.29 313.30 313.31 313.32 313.33 314.1 314.2
314.3
314.4 314.5 314.6 314.7 314.8 314.9 314.10 314.11 314.12 314.13 314.14 314.15 314.16 314.17 314.18 314.19 314.20 314.21 314.22 314.23 314.24 314.25 314.26 314.27 314.28 314.29 314.30 314.31 315.1
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
316.17 316.18 316.19 316.20 316.21 316.22 316.23 316.24 316.25 316.26 316.27 316.28 316.29 316.30 316.31 316.32 317.1 317.2 317.3 317.4
317.5 317.6 317.7 317.8 317.9
317.10 317.11
317.12 317.13 317.14 317.15 317.16 317.17 317.18 317.19 317.20 317.21 317.22 317.23 317.24 317.25 317.26 317.27 317.28 317.29 318.1 318.2 318.3 318.4 318.5 318.6 318.7 318.8 318.9 318.10 318.11 318.12 318.13 318.14 318.15 318.16 318.17 318.18 318.19 318.20 318.21 318.22 318.23 318.24 318.25 318.26 318.27 318.28
318.29 318.30 318.31 318.32 318.33 319.1 319.2 319.3 319.4 319.5 319.6 319.7 319.8 319.9 319.10 319.11 319.12 319.13 319.14 319.15 319.16 319.17 319.18 319.19
319.20 319.21
319.22 319.23
319.24 319.25 319.26 319.27 319.28 319.29 319.30 320.1 320.2 320.3 320.4 320.5 320.6 320.7 320.8 320.9 320.10
320.11 320.12 320.13 320.14 320.15 320.16 320.17
320.18 320.19 320.20 320.21 320.22 320.23 320.24 320.25 320.26 320.27 320.28 320.29 320.30 321.1 321.2 321.3 321.4 321.5 321.6 321.7 321.8 321.9 321.10 321.11 321.12 321.13 321.14 321.15 321.16 321.17 321.18 321.19 321.20 321.21 321.22 321.23 321.24 321.25 321.26 321.27 321.28 321.29 321.30 321.31 321.32 322.1 322.2 322.3 322.4 322.5 322.6
322.7 322.8 322.9
322.10 322.11 322.12 322.13 322.14 322.15 322.16 322.17 322.18 322.19 322.20 322.21 322.22 322.23 322.24 322.25 322.26 322.27 322.28 322.29 322.30 322.31 322.32 322.33 322.34 323.1 323.2 323.3
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
323.17 323.18 323.19 323.20 323.21 323.22 323.23 323.24 323.25 323.26 323.27 323.28 323.29 323.30 323.31 323.32 324.1 324.2 324.3 324.4 324.5 324.6 324.7 324.8 324.9 324.10 324.11 324.12 324.13 324.14 324.15 324.16 324.17
324.18 324.19 324.20 324.21 324.22 324.23 324.24 324.25 324.26 324.27 324.28 324.29 324.30 324.31 324.32 325.1 325.2 325.3 325.4 325.5 325.6 325.7 325.8 325.9 325.10 325.11 325.12 325.13 325.14
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
327.21 327.22 327.23 327.24 327.25 327.26 327.27 327.28 327.29 327.30 328.1 328.2
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
328.30 329.1 329.2 329.3 329.4 329.5 329.6 329.7 329.8 329.9 329.10 329.11 329.12 329.13 329.14 329.15
329.16 329.17 329.18 329.19 329.20 329.21 329.22 329.23 329.24 329.25 329.26 329.27 329.28 329.29 329.30 329.31 329.32 329.33 329.34 330.1 330.2 330.3 330.4 330.5 330.6 330.7 330.8 330.9 330.10 330.11 330.12 330.13 330.14 330.15 330.16 330.17 330.18 330.19 330.20 330.21 330.22 330.23 330.24 330.25 330.26 330.27 330.28 330.29 330.30 330.31 330.32 330.33 330.34 331.1 331.2
331.3
331.4 331.5 331.6 331.7 331.8 331.9 331.10 331.11 331.12 331.13 331.14 331.15 331.16 331.17 331.18 331.19 331.20 331.21 331.22 331.23 331.24 331.25 331.26 331.27 331.28 331.29 331.30 331.31 331.32 331.33 331.34 332.1 332.2 332.3 332.4 332.5 332.6 332.7 332.8 332.9 332.10 332.11 332.12 332.13 332.14 332.15 332.16 332.17 332.18
332.19
332.20 332.21 332.22 332.23 332.24 332.25 332.26 332.27 332.28 332.29 332.30 332.31 332.32 332.33 333.1 333.2 333.3 333.4 333.5 333.6 333.7 333.8
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
333.25 333.26 333.27 333.28 333.29 333.30 333.31 333.32 334.1 334.2 334.3 334.4 334.5 334.6 334.7 334.8 334.9 334.10 334.11 334.12 334.13 334.14 334.15 334.16 334.17 334.18
334.19
334.20 334.21 334.22 334.23 334.24 334.25 334.26 334.27 334.28 334.29 334.30 334.31 334.32 334.33 335.1 335.2 335.3 335.4 335.5 335.6 335.7 335.8 335.9 335.10 335.11 335.12 335.13 335.14 335.15 335.16 335.17 335.18 335.19 335.20 335.21 335.22 335.23 335.24 335.25 335.26 335.27 335.28 335.29 335.30 335.31 335.32 335.33 335.34 336.1 336.2 336.3 336.4 336.5
336.6
336.7 336.8 336.9 336.10 336.12 336.11 336.13 336.14 336.15 336.16 336.17 336.18 336.19 336.20 336.21 336.22 336.23 336.24 336.25 336.26 336.27 336.28 336.29 336.30 336.31 336.32 336.33 336.34 337.1 337.2 337.3 337.4 337.5 337.6 337.7 337.8 337.9 337.10 337.11 337.12
337.13
337.14 337.15 337.16 337.17 337.18 337.19 337.20 337.21 337.22 337.23 337.24 337.25 337.26 337.27 337.28 337.29 337.30 337.31 337.32 337.33 337.34 338.1 338.2 338.3 338.4 338.5 338.6 338.7 338.8 338.9 338.10 338.11 338.12 338.13 338.14 338.15 338.16 338.17 338.18 338.19 338.20 338.21 338.22 338.23 338.24 338.25 338.26 338.27 338.28 338.29 338.30 338.31 338.32 338.33 338.34 338.35 339.1 339.2 339.3 339.4 339.5 339.6
339.7 339.8 339.9 339.10 339.11 339.12 339.13 339.14 339.15 339.16 339.17 339.18 339.19 339.20 339.21 339.22 339.23 339.24 339.25 339.26 339.27 339.28 339.29 339.30 339.31 339.32 339.33 339.34 340.1 340.2 340.3 340.4 340.5 340.6 340.7 340.8 340.9 340.10 340.11 340.12 340.13 340.14 340.15 340.16 340.17 340.18 340.19 340.20 340.21 340.22 340.23 340.24 340.25 340.26 340.27 340.28 340.29 340.30 340.31 340.32 340.33 340.34 340.35 341.1 341.2 341.3 341.4 341.5 341.6 341.7 341.8 341.9 341.10 341.11 341.12 341.13 341.14 341.15 341.16 341.17 341.18 341.19 341.20 341.21 341.22 341.23 341.24 341.25 341.26 341.27 341.28 341.29 341.30 341.31 341.32 341.33 341.34 342.1 342.2 342.3 342.4 342.5 342.6 342.7 342.8 342.9 342.10 342.11 342.12 342.13 342.14 342.15 342.16 342.17 342.18 342.19 342.20 342.21 342.22 342.23 342.24 342.25 342.26 342.27 342.28 342.29 342.30 342.31 342.32 342.33 343.1 343.2 343.3 343.4 343.5 343.6 343.7 343.8 343.9 343.10 343.11 343.12 343.13 343.14 343.15 343.16 343.17 343.18 343.19 343.20 343.21 343.22 343.23 343.24 343.25 343.26 343.27 343.28 343.29 343.30 343.31 343.32 343.33 343.34 344.1 344.2 344.3 344.4 344.5 344.6 344.7 344.8 344.9 344.10 344.11 344.12 344.13 344.14 344.15 344.16 344.17 344.18 344.19 344.20 344.21 344.22 344.23 344.24 344.25 344.26 344.27 344.28 344.29 344.30 344.31 344.32 344.33 344.34 345.1 345.2 345.3 345.4 345.5 345.6 345.7 345.8 345.9 345.10 345.11 345.12 345.13 345.14 345.15 345.16 345.17 345.18 345.19 345.20 345.21 345.22 345.23 345.24 345.25 345.26 345.27 345.28 345.29 345.30 345.31 345.32 345.33 345.34 346.1 346.2 346.3 346.4 346.5 346.6 346.7 346.8 346.9 346.10 346.11 346.12 346.13 346.14 346.15 346.16 346.17 346.18 346.19 346.20 346.21 346.22 346.23 346.24 346.25 346.26 346.27 346.28 346.29 346.30 346.31 346.32 346.33 346.34 347.1 347.2 347.3 347.4 347.5 347.6 347.7 347.8 347.9 347.10 347.11 347.12 347.13 347.14 347.15 347.16 347.17 347.18 347.19 347.20 347.21 347.22 347.23 347.24 347.25 347.26 347.27 347.28 347.29 347.30 347.31 347.32 347.33 347.34 348.1 348.2 348.3 348.4 348.5 348.6 348.7 348.8 348.9 348.10 348.11 348.12 348.13 348.14 348.15 348.16 348.17 348.18 348.19 348.20 348.21 348.22 348.23 348.24 348.25 348.26 348.27 348.28 348.29 348.30 348.31 348.32 348.33 348.34 349.1 349.2 349.3 349.4 349.5 349.6 349.7 349.8 349.9 349.10 349.11 349.12 349.13 349.14 349.15 349.16 349.17 349.18 349.19 349.20 349.21 349.22 349.23 349.24 349.25 349.26 349.27 349.28 349.29 349.30 349.31 349.32 349.33 349.34 349.35 350.1 350.2 350.3 350.4 350.5 350.6 350.7 350.8 350.9 350.10 350.11 350.12 350.13 350.14 350.15 350.16 350.17 350.18 350.19 350.20 350.21 350.22 350.23 350.24 350.25 350.26 350.27 350.28 350.29 350.30 350.31 350.32 350.33 350.34 351.1 351.2 351.3 351.4 351.5 351.6 351.7 351.8 351.9 351.10 351.11 351.12 351.13 351.14 351.15 351.16 351.17 351.18 351.19 351.20 351.21 351.22 351.23 351.24 351.25 351.26 351.27 351.28 351.29 351.30 351.31 351.32 351.33 351.34 352.1 352.2 352.3 352.4 352.5 352.6 352.7 352.8 352.9 352.10 352.11 352.12 352.13 352.14 352.15 352.16 352.17 352.18
352.19 352.20
352.21 352.22 352.23 352.24 352.25 352.26 352.27 352.28 352.29 352.30 352.31 352.32 352.33 353.1 353.2 353.3 353.4 353.5 353.6 353.7 353.8 353.9 353.10 353.11 353.12 353.13 353.14 353.15 353.16 353.17 353.18 353.19 353.20 353.21
353.22 353.23 353.24
353.25 353.26 353.27
353.28 353.29 353.30 353.31
354.1
A bill for an act
relating to state government; modifying provisions for human services health care
finance, human services health care policy, health care generally, health insurance,
Department of Health finance, Department of Health policy, emergency medical
services, pharmacy practice, mental health, Department of Human Services Office
of Inspector General; substance use disorder treatment licensing; imposing
penalties; making forecast adjustments; requiring reports; appropriating money;
amending Minnesota Statutes 2022, sections 62A.28, subdivision 2; 62D.02,
subdivisions 4, 7; 62D.03, subdivision 1; 62D.05, subdivision 1; 62D.06,
subdivision 1; 62D.12, subdivision 19; 62D.14, subdivision 1; 62D.19; 62D.20,
subdivision 1; 62D.22, subdivision 5, by adding a subdivision; 62E.02, subdivision
3; 62J.49, subdivision 1; 62J.61, subdivision 5; 62M.01, subdivision 3; 62M.02,
subdivisions 1a, 5, 11, 12, 21, by adding a subdivision; 62M.04, subdivision 1;
62M.05, subdivision 3a; 62M.07, subdivisions 2, 4, by adding a subdivision;
62M.10, subdivisions 7, 8; 62M.17, subdivision 2; 62Q.14; 62Q.1841, subdivision
2; 62Q.19, subdivisions 3, 5, by adding a subdivision; 62Q.73, subdivision 2;
62V.05, subdivision 12; 62V.08; 62V.11, subdivision 4; 103I.621, subdivisions
1, 2; 144.05, subdivisions 6, 7; 144.058; 144.0724, subdivisions 2, 3a, 4, 6, 7, 8,
9, 11; 144.1464, subdivisions 1, 2, 3; 144.1501, subdivision 5; 144.1911,
subdivision 2; 144.292, subdivision 6; 144.293, subdivisions 2, 4, 9, 10; 144.493,
by adding a subdivision; 144.494, subdivision 2; 144.551, subdivision 1; 144.555,
subdivisions 1a, 1b, 2, by adding subdivisions; 144.605, by adding a subdivision;
144.7067, subdivision 2; 144A.10, subdivisions 15, 16; 144A.44, subdivision 1;
144A.471, by adding a subdivision; 144A.474, subdivision 13; 144A.70,
subdivisions 3, 5, 6, 7; 144A.71, subdivision 2, by adding a subdivision; 144A.72,
subdivision 1; 144A.73; 144E.001, subdivision 3a, by adding subdivisions;
144E.101, by adding a subdivision; 144E.16, subdivisions 5, 7; 144E.19,
subdivision 3; 144E.27, subdivisions 3, 5, 6; 144E.28, subdivisions 3, 5, 6, 8;
144E.285, subdivisions 1, 2, 4, 6, by adding subdivisions; 144E.287; 144E.305,
subdivision 3; 144G.08, subdivision 29; 144G.10, by adding a subdivision;
144G.16, subdivision 6; 146B.03, subdivision 7a; 146B.10, subdivisions 1, 3;
148F.025, subdivision 2; 149A.02, subdivisions 3, 16, 26a, 27, 35, 37c, by adding
subdivisions; 149A.03; 149A.65; 149A.70, subdivisions 1, 2, 3, 5; 149A.71,
subdivisions 2, 4; 149A.72, subdivisions 3, 9; 149A.73, subdivision 1; 149A.74,
subdivision 1; 149A.93, subdivision 3; 149A.94, subdivisions 1, 3, 4; 151.01,
subdivisions 23, 27; 151.37, by adding a subdivision; 151.74, subdivision 6;
214.025; 214.04, subdivision 2a; 214.29; 214.31; 214.355; 245.462, subdivision
6; 245.4663, subdivision 2; 245A.04, by adding a subdivision; 245A.043,
subdivisions 2, 4, by adding subdivisions; 245A.07, subdivision 6; 245A.52,
subdivision 2; 245C.05, subdivision 5; 245C.08, subdivision 4; 245C.10,
subdivision 18; 245C.14, by adding a subdivision; 245C.22, subdivision 4; 245C.24,
subdivisions 2, 5, 6; 245C.30, by adding a subdivision; 245F.09, subdivision 2;
245F.14, by adding a subdivision; 245F.17; 245G.07, subdivision 4; 245G.08,
subdivisions 5, 6; 245G.10, by adding a subdivision; 245G.11, subdivisions 5, 7;
245G.22, subdivisions 6, 7; 245I.02, subdivisions 17, 19; 245I.04, subdivision 6;
245I.10, subdivision 9; 245I.11, subdivision 1, by adding a subdivision; 245I.20,
subdivision 4; 245I.23, subdivision 14; 256.9657, subdivision 8, by adding a
subdivision; 256.969, by adding subdivisions; 256B.056, subdivisions 1a, 10;
256B.0622, subdivisions 2a, 3a, 7a, 7d; 256B.0623, subdivision 5; 256B.0625,
subdivisions 12, 20, 32, by adding subdivisions; 256B.0757, subdivisions 4a, 4d;
256B.0943, subdivision 12; 256B.0947, subdivision 5; 256B.69, by adding a
subdivision; 256I.04, subdivision 2f; 256R.02, subdivision 20; 260E.33, subdivision
2, as amended; 317A.811, subdivision 1; 334.01, by adding a subdivision; 519.05;
524.3-801, as amended; Minnesota Statutes 2023 Supplement, sections 13.46,
subdivision 4, as amended; 15A.0815, subdivision 2; 43A.08, subdivision 1a;
62Q.46, subdivision 1; 62Q.522, subdivision 1; 62Q.523, subdivision 1; 144.0526,
subdivision 1; 144.1501, subdivision 2; 144.1505, subdivision 2; 144.587,
subdivisions 1, 4; 144A.4791, subdivision 10; 144E.101, subdivisions 6, 7, as
amended; 145.561, subdivision 4; 145D.01, subdivision 1; 151.555, subdivisions
1, 4, 5, 6, 7, 8, 9, 11, 12; 151.74, subdivision 3; 152.126, subdivision 6; 245.4889,
subdivision 1; 245.991, subdivision 1; 245A.03, subdivision 2, as amended;
245A.043, subdivision 3; 245A.07, subdivision 1, as amended; 245A.11,
subdivision 7; 245A.16, subdivision 1, as amended; 245A.211, subdivision 4;
245A.242, subdivision 2; 245C.02, subdivision 13e; 245C.033, subdivision 3;
245C.08, subdivision 1; 245C.10, subdivision 15; 245G.22, subdivisions 2, 17;
254B.04, subdivision 1a; 256.046, subdivision 3; 256.0471, subdivision 1, as
amended; 256.9631; 256.969, subdivision 2b; 256B.0622, subdivisions 7b, 8;
256B.0625, subdivisions 5m, 13e, as amended, 13f, 16; 256B.064, subdivision 4;
256B.0671, subdivision 5; 256B.0701, subdivision 6; 256B.0947, subdivision 7;
256B.764; 256D.01, subdivision 1a; 256I.05, subdivisions 1a, 11; 256L.03,
subdivision 1; 270A.03, subdivision 2; 342.06; 342.63, by adding a subdivision;
Laws 2020, chapter 73, section 8; Laws 2023, chapter 22, section 4, subdivision
2; Laws 2023, chapter 70, article 20, sections 2, subdivisions 5, 7, 29; 3, subdivision
2; 12, as amended; Laws 2024, chapter 80, article 2, sections 6, subdivisions 2, 3,
by adding subdivisions; 10, subdivisions 1, 6; proposing coding for new law in
Minnesota Statutes, chapters 62A; 62C; 62D; 62J; 62M; 62Q; 62V; 144; 144A;
144E; 145D; 149A; 151; 245C; 256B; 332; proposing coding for new law as
Minnesota Statutes, chapter 332C; repealing Minnesota Statutes 2022, sections
62A.041, subdivision 3; 144.497; 144E.001, subdivision 5; 144E.01; 144E.123,
subdivision 5; 144E.27, subdivisions 1, 1a; 144E.50, subdivision 3; 151.74,
subdivision 16; 245C.125; 256D.19, subdivisions 1, 2; 256D.20, subdivisions 1,
2, 3, 4; 256D.23, subdivisions 1, 2, 3; 256R.02, subdivision 46; Minnesota Statutes
2023 Supplement, sections 62J.312, subdivision 6; 62Q.522, subdivisions 3, 4;
144.0528, subdivision 5; 245C.08, subdivision 2; Laws 2023, chapter 70, article
20, section 2, subdivision 31, as amended; Laws 2023, chapter 75, section 10;
Laws 2024, chapter 80, article 2, section 6, subdivision 4; Minnesota Rules, parts
2960.0620, subpart 3; 9502.0425, subpart 5.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
ARTICLE 1
DEPARTMENT OF HUMAN SERVICES HEALTH CARE FINANCE
Section 1.
new text begin
[62V.12] STATE-FUNDED COST-SHARING REDUCTIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
(a) The board must develop and administer a state-funded
cost-sharing reduction program for eligible persons who enroll in a silver level qualified
health plan through MNsure. The board must implement the cost-sharing reduction program
for plan years beginning on or after January 1, 2027.
new text end
new text begin
(b) For purposes of this section, an "eligible person" is an individual who meets the
eligibility criteria to receive a cost-sharing reduction under Code of Federal Regulations,
title 45, section 155.305(g).
new text end
new text begin Subd. 2. new text end
new text begin Reduction in cost-sharing. new text end
new text begin
The cost-sharing reduction program must use state
money to reduce enrollee cost-sharing by increasing the actuarial value of silver level health
plans for eligible persons beyond the 73 percent value established in Code of Federal
Regulations, title 45, section 156.420(a)(3)(ii), to an actuarial value of 87 percent.
new text end
new text begin Subd. 3. new text end
new text begin Administration. new text end
new text begin
The board, when administering the program, must:
new text end
new text begin
(1) allow eligible persons to enroll in a silver level health plan with a state-funded
cost-sharing reduction;
new text end
new text begin
(2) modify the MNsure shopping tool to display the total cost-sharing reduction benefit
available to individuals eligible under this section; and
new text end
new text begin
(3) reimburse health carriers on a quarterly basis for the cost to the health plan providing
the state-funded cost-sharing reductions.
new text end
Sec. 2.
Minnesota Statutes 2023 Supplement, section 256.9631, is amended to read:
256.9631 deleted text begin DIRECT PAYMENT SYSTEMdeleted text end new text begin ALTERNATIVE CARE DELIVERY
MODELSnew text end FOR MEDICAL ASSISTANCE AND MINNESOTACARE.
Subdivision 1.
Direction to the commissioner.
(a) The commissionernew text begin , in order to deliver
services to eligible individuals, achieve better health outcomes, and reduce the cost of health
care for the state,new text end shall develop deleted text begin andeleted text end implementation deleted text begin plandeleted text end new text begin plansnew text end for deleted text begin a direct payment system
to deliver services to eligible individuals in order to achieve better health outcomes and
reduce the cost of health care for the state. Under this system,deleted text end new text begin at least three care delivery
models that:
new text end
new text begin
(1) are alternatives to the use of commercial managed care plans to deliver health care
to Minnesota health care program enrollees; and
new text end
new text begin
(2) do not shift financial risk to nongovernmental entities.
new text end
new text begin (b) One of the alternative models must be a direct payment system under whichnew text end eligible
individuals deleted text begin mustdeleted text end receive services through the deleted text begin medical assistancedeleted text end fee-for-service system,
county-based purchasing plans, deleted text begin ordeleted text end new text begin andnew text end county-owned health maintenance organizations. new text begin At
least one additional model must include county-based purchasing plans and county-owned
health maintenance organizations in their design, and must allow these entities to deliver
care in geographic areas on a single plan basis, if:
new text end
new text begin
(1) these entities contract with all providers that agree to contract terms for network
participation; and
new text end
new text begin
(2) the commissioner of human services determines that an entity's provider network is
adequate to ensure enrollee access and choice.
new text end
new text begin
(c) Before determining the alternative models for which implementation plans will be
developed, the commissioner shall consult with the chairs and ranking minority members
of the legislative committees with jurisdiction over health care finance and policy.
new text end
new text begin (d) new text end The commissioner shall present deleted text begin andeleted text end implementation deleted text begin plandeleted text end new text begin plansnew text end for the deleted text begin direct payment
systemdeleted text end new text begin selected modelsnew text end to the chairs and ranking minority members of the legislative
committees with jurisdiction over health care finance and policy by January 15, 2026. The
commissioner may contract for technical assistance in developing the implementation deleted text begin plandeleted text end new text begin
plansnew text end and conducting related studies and analyses.
deleted text begin
(b) For the purposes of the direct payment system, the commissioner shall make the
following assumptions:
deleted text end
deleted text begin
(1) health care providers are reimbursed directly for all medical assistance covered
services provided to eligible individuals, using the fee-for-service payment methods specified
in chapters
deleted text end
deleted text begin
256
deleted text end
deleted text begin
,
deleted text end
deleted text begin
256B
deleted text end
deleted text begin
,
deleted text end
deleted text begin
256R
deleted text end
deleted text begin
, and
deleted text end
deleted text begin
256S
deleted text end
deleted text begin
;
deleted text end
deleted text begin
(2) payments to a qualified hospital provider are equivalent to the payments that would
have been received based on managed care direct payment arrangements. If necessary, a
qualified hospital provider may use a county-owned health maintenance organization to
receive direct payments as described in section 256B.1973; and
deleted text end
deleted text begin
(3) county-based purchasing plans and county-owned health maintenance organizations
must be reimbursed at the capitation rate determined under sections 256B.69 and 256B.692.
deleted text end
Subd. 2.
Definitions.
(a) For purposes of this section, the following terms have the
meanings given.
(b) "Eligible individuals" means deleted text begin qualifieddeleted text end new text begin allnew text end medical assistance deleted text begin enrollees, defined as
persons eligible for medical assistance as families and children and adults without childrendeleted text end new text begin
and MinnesotaCare enrolleesnew text end .
new text begin
(c) "Minnesota health care programs" means the medical assistance and MinnesotaCare
programs.
new text end
deleted text begin (c)deleted text end new text begin (d)new text end "Qualified hospital provider" means a nonstate government teaching hospital
with high medical assistance utilization and a level 1 trauma center, and all of the hospital's
owned or affiliated health care professionals, ambulance services, sites, and clinics.
Subd. 3.
Implementation deleted text begin plandeleted text end new text begin plansnew text end .
(a) deleted text begin Thedeleted text end new text begin Eachnew text end implementation plan must include:
(1) a timeline for the development and recommended implementation date of the deleted text begin direct
payment systemdeleted text end new text begin alternative modelnew text end . In recommending a timeline, the commissioner must
consider:
(i) timelines required by the existing contracts with managed care plans and county-based
purchasing plans to sunset existing delivery models;
(ii) in counties that choose to operate a county-based purchasing plan under section
256B.692, timelines for any new procurements required for those counties to establish a
new county-based purchasing plan or participate in an existing county-based purchasing
plan;
(iii) in counties that choose to operate a county-owned health maintenance organization
under section 256B.69, timelines for any new procurements required for those counties to
establish a new county-owned health maintenance organization or to continue serving
enrollees through an existing county-owned health maintenance organization; and
(iv) a recommendation on whether the commissioner should contract with a third-party
administrator to administer the deleted text begin direct payment systemdeleted text end new text begin alternative model,new text end and the timeline
needed for procuring an administrator;
(2) the procedures to be used to ensure continuity of care for enrollees who transition
from managed care to fee-for-service and any administrative resources needed to carry out
these procedures;
(3) recommended quality measures for health care service delivery;
(4) any changes to fee-for-service payment rates that the commissioner determines are
necessary to ensure provider access and high-quality care and to reduce health disparities;
(5) recommendations on ensuring effective care coordination under the deleted text begin direct payment
systemdeleted text end new text begin alternative modelnew text end , especially for enrollees whonew text begin :
new text end
new text begin
(i) are age 65 or older, blind, or have disabilities;
new text end
new text begin (ii)new text end have complex medical conditionsdeleted text begin , whodeleted text end new text begin ;
new text end
new text begin (iii)new text end face socioeconomic barriers to receiving caredeleted text begin , or whodeleted text end new text begin ; or
new text end
new text begin (iv)new text end are from underserved populations that experience health disparities;
(6) recommendations on deleted text begin whether the direct payment system should provide supplemental
paymentsdeleted text end new text begin payment arrangementsnew text end for care coordination, including:
(i) the provider types eligible for deleted text begin supplementaldeleted text end new text begin care coordinationnew text end payments;
(ii) procedures to coordinate deleted text begin supplementaldeleted text end new text begin care coordinationnew text end payments with existing
supplemental or cost-based payment methods or to replace these existing methods; and
(iii) procedures to align care coordination initiatives funded deleted text begin through supplemental
paymentsdeleted text end under deleted text begin this sectiondeleted text end new text begin the alternative modelnew text end with existing care coordination initiatives;
(7) recommendations on whether the deleted text begin direct payment systemdeleted text end new text begin alternative modelnew text end should
include funding to providers for outreach initiatives to patients who, because of mental
illness, homelessness, or other circumstances, are unlikely to obtain needed care and
treatment;
(8) recommendations for a supplemental payment to qualified hospital providers to offset
any potential revenue losses resulting from the shift from managed care payments;new text begin and
new text end
deleted text begin
(9) recommendations on whether and how the direct payment system should be expanded
to deliver services and care coordination to medical assistance enrollees who are age 65 or
older, are blind, or have a disability and to persons enrolled in MinnesotaCare; and
deleted text end
deleted text begin (10)deleted text end new text begin (9)new text end recommendations for statutory changes necessary to implement the deleted text begin direct
payment systemdeleted text end new text begin alternative modelnew text end .
(b) In developing deleted text begin thedeleted text end new text begin eachnew text end implementation plan, the commissioner shall:
(1) calculate the projected cost of deleted text begin a direct payment systemdeleted text end new text begin the alternative modelnew text end relative
to the cost of the current system;
(2) assess gaps in care coordination under the current medical assistance and
MinnesotaCare programs;
(3) evaluate the effectiveness of approaches other states have taken to coordinate care
under a fee-for-service system, including the coordination of care provided to persons who
new text begin are age 65 or older, new text end are blindnew text begin ,new text end or have disabilities;
(4) estimate the loss of revenue and cost savings from other payment enhancements
based on managed care plan directed payments and pass-throughs;
(5) estimate cost trends under deleted text begin a direct payment systemdeleted text end new text begin the alternative modelnew text end for managed
care payments to county-based purchasing plans and county-owned health maintenance
organizations;
(6) estimate the impact of deleted text begin a direct payment systemdeleted text end new text begin the alternative modelnew text end on other revenue,
including taxes, surcharges, or other federally approved in lieu of services and on other
arrangements allowed under managed care;
(7) consider allowing eligible individuals to opt out of managed care as an alternative
approach;
deleted text begin
(8) assess the feasibility of a medical assistance outpatient prescription drug benefit
carve-out under section 256B.69, subdivision 6d, and in consultation with the commissioners
of commerce and health, assess the feasibility of including MinnesotaCare enrollees and
private sector enrollees of health plan companies in the drug benefit carve-out. The
assessment of feasibility must address and include recommendations related to the process
and terms by which the commissioner would contract with health plan companies to
administer prescription drug benefits and develop and manage a drug formulary, and the
impact of the drug-benefit carve-out on health care providers, including small pharmacies;
deleted text end
deleted text begin (9)deleted text end new text begin (8)new text end consult with the commissioners of health and commerce and the contractor or
contractors analyzing the Minnesota Health Plan deleted text begin under section 19deleted text end and other health reform
models on plan design and assumptions; and
deleted text begin (10)deleted text end new text begin (9)new text end conduct other analyses necessary to develop the implementation plan.
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 2022, section 256.9657, is amended by adding a subdivision
to read:
new text begin Subd. 2a. new text end
new text begin Teaching hospital surcharge. new text end
new text begin
(a) Each teaching hospital shall pay to the
medical assistance account a surcharge equal to 0.01 percent of net non-Medicare patient
care revenue. The initial surcharge must be paid 60 days after both this subdivision and
section 256.969, subdivision 2g, have received federal approval, and subsequent surcharge
payments must be made annually in the form and manner specified by the commissioner.
new text end
new text begin
(b) The commissioner shall use revenue from the surcharge only to pay the nonfederal
share of the medical assistance supplemental payments described in section 256.969,
subdivision 2g, and to supplement, and not supplant, medical assistance reimbursement to
teaching hospitals. The surcharge must comply with Code of Federal Regulations, title 42,
section 433.63.
new text end
new text begin
(c) For purposes of this subdivision, "teaching hospital" means any Minnesota hospital,
except facilities of the federal Indian Health Service and regional treatment centers, with a
Centers for Medicare and Medicaid Services designation of "teaching hospital" as reported
on form CMS-2552-10, worksheet S-2, line 56, that is eligible for reimbursement under
section 256.969, subdivision 2g.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the later of January 1, 2025, or federal
approval of this section and sections 4 and 5. The commissioner of human services shall
notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 4.
Minnesota Statutes 2023 Supplement, section 256.969, subdivision 2b, is amended
to read:
Subd. 2b.
Hospital payment rates.
(a) For discharges occurring on or after November
1, 2014, hospital inpatient services for hospitals located in Minnesota shall be paid according
to the following:
(1) critical access hospitals as defined by Medicare shall be paid using a cost-based
methodology;
(2) long-term hospitals as defined by Medicare shall be paid on a per diem methodology
under subdivision 25;
(3) rehabilitation hospitals or units of hospitals that are recognized as rehabilitation
distinct parts as defined by Medicare shall be paid according to the methodology under
subdivision 12; and
(4) all other hospitals shall be paid on a diagnosis-related group (DRG) methodology.
(b) For the period beginning January 1, 2011, through October 31, 2014, rates shall not
be rebased, except that a Minnesota long-term hospital shall be rebased effective January
1, 2011, based on its most recent Medicare cost report ending on or before September 1,
2008, with the provisions under subdivisions 9 and 23, based on the rates in effect on
December 31, 2010. For rate setting periods after November 1, 2014, in which the base
years are updated, a Minnesota long-term hospital's base year shall remain within the same
period as other hospitals.
(c) Effective for discharges occurring on and after November 1, 2014, payment rates
for hospital inpatient services provided by hospitals located in Minnesota or the local trade
area, except for the hospitals paid under the methodologies described in paragraph (a),
clauses (2) and (3), shall be rebased, incorporating cost and payment methodologies in a
manner similar to Medicare. The base year or years for the rates effective November 1,
2014, shall be calendar year 2012. The rebasing under this paragraph shall be budget neutral,
ensuring that the total aggregate payments under the rebased system are equal to the total
aggregate payments that were made for the same number and types of services in the base
year. Separate budget neutrality calculations shall be determined for payments made to
critical access hospitals and payments made to hospitals paid under the DRG system. Only
the rate increases or decreases under subdivision 3a or 3c that applied to the hospitals being
rebased during the entire base period shall be incorporated into the budget neutrality
calculation.
(d) For discharges occurring on or after November 1, 2014, through the next rebasing
that occurs, the rebased rates under paragraph (c) that apply to hospitals under paragraph
(a), clause (4), shall include adjustments to the projected rates that result in no greater than
a five percent increase or decrease from the base year payments for any hospital. Any
adjustments to the rates made by the commissioner under this paragraph and paragraph (e)
shall maintain budget neutrality as described in paragraph (c).
(e) For discharges occurring on or after November 1, 2014, the commissioner may make
additional adjustments to the rebased rates, and when evaluating whether additional
adjustments should be made, the commissioner shall consider the impact of the rates on the
following:
(1) pediatric services;
(2) behavioral health services;
(3) trauma services as defined by the National Uniform Billing Committee;
(4) transplant services;
(5) obstetric services, newborn services, and behavioral health services provided by
hospitals outside the seven-county metropolitan area;
(6) outlier admissions;
(7) low-volume providers; and
(8) services provided by small rural hospitals that are not critical access hospitals.
(f) Hospital payment rates established under paragraph (c) must incorporate the following:
(1) for hospitals paid under the DRG methodology, the base year payment rate per
admission is standardized by the applicable Medicare wage index and adjusted by the
hospital's disproportionate population adjustment;
(2) for critical access hospitals, payment rates for discharges between November 1, 2014,
and June 30, 2015, shall be set to the same rate of payment that applied for discharges on
October 31, 2014;
(3) the cost and charge data used to establish hospital payment rates must only reflect
inpatient services covered by medical assistance; and
(4) in determining hospital payment rates for discharges occurring on or after the rate
year beginning January 1, 2011, through December 31, 2012, the hospital payment rate per
discharge shall be based on the cost-finding methods and allowable costs of the Medicare
program in effect during the base year or years. In determining hospital payment rates for
discharges in subsequent base years, the per discharge rates shall be based on the cost-finding
methods and allowable costs of the Medicare program in effect during the base year or
years.
(g) The commissioner shall validate the rates effective November 1, 2014, by applying
the rates established under paragraph (c), and any adjustments made to the rates under
paragraph (d) or (e), to hospital claims paid in calendar year 2013 to determine whether the
total aggregate payments for the same number and types of services under the rebased rates
are equal to the total aggregate payments made during calendar year 2013.
(h) Effective for discharges occurring on or after July 1, 2017, and every two years
thereafter, payment rates under this section shall be rebased to reflect only those changes
in hospital costs between the existing base year or years and the next base year or years. In
any year that inpatient claims volume falls below the threshold required to ensure a
statistically valid sample of claims, the commissioner may combine claims data from two
consecutive years to serve as the base year. Years in which inpatient claims volume is
reduced or altered due to a pandemic or other public health emergency shall not be used as
a base year or part of a base year if the base year includes more than one year. Changes in
costs between base years shall be measured using the lower of the hospital cost index defined
in subdivision 1, paragraph (a), or the percentage change in the case mix adjusted cost per
claim. The commissioner shall establish the base year for each rebasing period considering
the most recent year or years for which filed Medicare cost reports are available, except
that the base years for the rebasing effective July 1, 2023, are calendar years 2018 and 2019.
The estimated change in the average payment per hospital discharge resulting from a
scheduled rebasing must be calculated and made available to the legislature by January 15
of each year in which rebasing is scheduled to occur, and must include by hospital the
differential in payment rates compared to the individual hospital's costs.
(i) Effective for discharges occurring on or after July 1, 2015, inpatient payment rates
for critical access hospitals located in Minnesota or the local trade area shall be determined
using a new cost-based methodology. The commissioner shall establish within the
methodology tiers of payment designed to promote efficiency and cost-effectiveness.
Payment rates for hospitals under this paragraph shall be set at a level that does not exceed
the total cost for critical access hospitals as reflected in base year cost reports. Until the
next rebasing that occurs, the new methodology shall result in no greater than a five percent
decrease from the base year payments for any hospital, except a hospital that had payments
that were greater than 100 percent of the hospital's costs in the base year shall have their
rate set equal to 100 percent of costs in the base year. The rates paid for discharges on and
after July 1, 2016, covered under this paragraph shall be increased by the inflation factor
in subdivision 1, paragraph (a). The new cost-based rate shall be the final rate and shall not
be settled to actual incurred costs. Hospitals shall be assigned a payment tier based on the
following criteria:
(1) hospitals that had payments at or below 80 percent of their costs in the base year
shall have a rate set that equals 85 percent of their base year costs;
(2) hospitals that had payments that were above 80 percent, up to and including 90
percent of their costs in the base year shall have a rate set that equals 95 percent of their
base year costs; and
(3) hospitals that had payments that were above 90 percent of their costs in the base year
shall have a rate set that equals 100 percent of their base year costs.
(j) The commissioner may refine the payment tiers and criteria for critical access hospitals
to coincide with the next rebasing under paragraph (h). The factors used to develop the new
methodology may include, but are not limited to:
(1) the ratio between the hospital's costs for treating medical assistance patients and the
hospital's charges to the medical assistance program;
(2) the ratio between the hospital's costs for treating medical assistance patients and the
hospital's payments received from the medical assistance program for the care of medical
assistance patients;
(3) the ratio between the hospital's charges to the medical assistance program and the
hospital's payments received from the medical assistance program for the care of medical
assistance patients;
(4) the statewide average increases in the ratios identified in clauses (1), (2), and (3);
(5) the proportion of that hospital's costs that are administrative and trends in
administrative costs; and
(6) geographic location.
(k) new text begin Subject to section 256.969, subdivision 2g, paragraph (i), new text end effective for discharges
occurring on or after January 1, 2024, the rates paid to hospitals described in paragraph (a),
clauses (2) to (4), must include a rate factor specific to each hospital that qualifies for a
medical education and research cost distribution under section 62J.692, subdivision 4,
paragraph (a).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the later of January 1, 2025, or federal
approval of this section and sections 3 and 5. The commissioner of human services shall
notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 5.
Minnesota Statutes 2022, section 256.969, is amended by adding a subdivision to
read:
new text begin Subd. 2g. new text end
new text begin
Annual supplemental payments; direct and indirect physician graduate
medical education.
new text end
new text begin
(a) For discharges occurring on or after January 1, 2025, the
commissioner shall determine and pay annual supplemental payments to all eligible hospitals
as provided in this subdivision for direct and indirect physician graduate medical education
cost reimbursement. A hospital must be an eligible hospital to receive an annual supplemental
payment under this subdivision.
new text end
new text begin
(b) The commissioner must use the following information to calculate the total cost of
direct graduate medical education incurred by each eligible hospital:
new text end
new text begin
(1) the total allowable direct graduate medical education cost, as calculated by adding
form CMS-2552-10, worksheet B, part 1, columns 21 and 22, line 202; and
new text end
new text begin
(2) the Medicaid share of total allowable direct graduate medical education cost
percentage, representing the allocation of total graduate medical education costs to Medicaid
based on the share of all Medicaid inpatient days, as reported on form CMS-2552-10,
worksheets S-2 and S-3, divided by the hospital's total inpatient days, as reported on
worksheet S-3.
new text end
new text begin
(c) The commissioner may obtain the information in paragraph (b) from an eligible
hospital upon request by the commissioner or from the eligible hospital's most recently filed
form CMS-2552-10.
new text end
new text begin
(d) The commissioner must use the following information to calculate the total allowable
indirect cost of graduate medical education incurred by each eligible hospital:
new text end
new text begin
(1) for eligible hospitals that are not children's hospitals, the indirect graduate medical
education amount attributable to Medicaid, calculated based on form CMS-2552-10,
worksheet E, part A, including:
new text end
new text begin
(i) the Medicare indirect medical education formula, using Medicaid variables;
new text end
new text begin
(ii) Medicaid payments for inpatient services under fee-for-service and managed care,
as determined by the commissioner in consultation with each eligible hospital;
new text end
new text begin
(iii) total inpatient beds available, as reported on form CMS-2552-10, worksheet E, part
A, line 4; and
new text end
new text begin
(iv) full-time employees, as determined by adding form CMS-2552-10, worksheet E,
part A, lines 10 and 11; and
new text end
new text begin
(2) for eligible hospitals that are children's hospitals:
new text end
new text begin
(i) the Medicare indirect medical education formula, using Medicaid variables;
new text end
new text begin
(ii) Medicaid payments for inpatient services under fee-for-service and managed care,
as determined by the commissioner in consultation with each eligible hospital;
new text end
new text begin
(iii) total inpatient beds available, as reported on form CMS-2552-10, worksheet S-3,
part 1; and
new text end
new text begin
(iv) full-time equivalent interns and residents, as determined by adding form
CMS-2552-10, worksheet E-4, lines 6, 10.01, and 15.01.
new text end
new text begin
(e) The commissioner shall determine each eligible hospital's maximum allowable
Medicaid direct graduate medical education supplemental payment amount by calculating
the sum of:
new text end
new text begin
(1) the total allowable direct graduate medical education costs determined under paragraph
(b), clause (1), multiplied by the Medicaid share of total allowable direct graduate medical
education cost percentage in paragraph (b), clause (2); and
new text end
new text begin
(2) the total allowable direct graduate medical education costs determined under paragraph
(b), clause (1), multiplied by the most recently updated Medicaid utilization percentage
from form CMS-2552-10, as submitted to Medicare by each eligible hospital.
new text end
new text begin
(f) The commissioner shall determine each eligible hospital's indirect graduate medical
education supplemental payment amount by multiplying the total allowable indirect cost
of graduate medical education amount calculated in paragraph (d) by:
new text end
new text begin
(1) 0.95 for prospective payment system, for hospitals that are not children's hospitals
and have fewer than 50 full-time equivalent trainees;
new text end
new text begin
(2) 1.0 for prospective payment system, for hospitals that are not children's hospitals
and have equal to or greater than 50 full-time equivalent trainees; and
new text end
new text begin
(3) 1.05 for children's hospitals.
new text end
new text begin
(g) An eligible hospital's annual supplemental payment under this subdivision equals
the sum of the amount calculated for the eligible hospital under paragraph (e) and the amount
calculated for the eligible hospital under paragraph (f).
new text end
new text begin
(h) The annual supplemental payments under this subdivision are contingent upon federal
approval and must conform with the requirements for permissible supplemental payments
for direct and indirect graduate medical education under all applicable federal laws.
new text end
new text begin
(i) An eligible hospital is only eligible for reimbursement under section 62J.692 for
nonphysician graduate medical education training costs that are not accounted for in the
calculation of an annual supplemental payment under this section. An eligible hospital must
not accept reimbursement under section 62J.692 for physician graduate medical education
training costs that are accounted for in the calculation of an annual supplemental payment
under this section.
new text end
new text begin
(j) For purposes of this subdivision, "children's hospital" means a Minnesota hospital
designated as a children's hospital under Medicare.
new text end
new text begin
(k) For purposes of this subdivision, "eligible hospital" means a hospital located in
Minnesota:
new text end
new text begin
(1) participating in Minnesota's medical assistance program;
new text end
new text begin
(2) that has received fee-for-service medical assistance payments in the payment year;
and
new text end
new text begin
(3) that is either:
new text end
new text begin
(i) eligible to receive graduate medical education payments from the Medicare program
under Code of Federal Regulations, title 42, section 413.75; or
new text end
new text begin
(ii) a children's hospital.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the later of January 1, 2025, or federal
approval of this section and sections 3 and 4. The commissioner of human services shall
notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 6.
Minnesota Statutes 2022, section 256.969, is amended by adding a subdivision to
read:
new text begin Subd. 2h. new text end
new text begin Alternate inpatient payment rate for a discharge. new text end
new text begin
(a) Effective retroactively
from January 1, 2024, in any rate year in which a children's hospital discharge is included
in the federally required disproportionate share hospital payment audit where the patient
discharged had resided in a children's hospital for over 20 years, the commissioner shall
compute an alternate inpatient rate for the children's hospital. The alternate payment rate
must be the rate computed under this section excluding the disproportionate share hospital
payment under subdivision 9, paragraph (d), clause (1), increased by an amount equal to
99 percent of what the disproportionate share hospital payment would have been under
subdivision 9, paragraph (d), clause (1), had the discharge been excluded.
new text end
new text begin
(b) In any rate year in which payment to a children's hospital is made using this alternate
payment rate, payments must not be made to the hospital under subdivisions 2e, 2f, and 9.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 7.
Minnesota Statutes 2023 Supplement, section 256B.0625, subdivision 13e, as
amended by Laws 2024, chapter 85, section 66, is amended to read:
Subd. 13e.
Payment rates.
(a) The basis for determining the amount of payment shall
be the lower of the ingredient costs of the drugs plus the professional dispensing fee; or the
usual and customary price charged to the public. The usual and customary price means the
lowest price charged by the provider to a patient who pays for the prescription by cash,
check, or charge account and includes prices the pharmacy charges to a patient enrolled in
a prescription savings club or prescription discount club administered by the pharmacy or
pharmacy chain. The amount of payment basis must be reduced to reflect all discount
amounts applied to the charge by any third-party provider/insurer agreement or contract for
submitted charges to medical assistance programs. The net submitted charge may not be
greater than the patient liability for the service. The professional dispensing fee shall be
deleted text begin $10.77deleted text end new text begin $11.55new text end for prescriptions filled with legend drugs meeting the definition of "covered
outpatient drugs" according to United States Code, title 42, section 1396r-8(k)(2). The
dispensing fee for intravenous solutions that must be compounded by the pharmacist shall
be deleted text begin $10.77deleted text end new text begin $11.55new text end per claim. The professional dispensing fee for prescriptions filled with
over-the-counter drugs meeting the definition of covered outpatient drugs shall be deleted text begin $10.77deleted text end new text begin
$11.55new text end for dispensed quantities equal to or greater than the number of units contained in
the manufacturer's original package. The professional dispensing fee shall be prorated based
on the percentage of the package dispensed when the pharmacy dispenses a quantity less
than the number of units contained in the manufacturer's original package. The pharmacy
dispensing fee for prescribed over-the-counter drugs not meeting the definition of covered
outpatient drugs shall be $3.65 for quantities equal to or greater than the number of units
contained in the manufacturer's original package and shall be prorated based on the
percentage of the package dispensed when the pharmacy dispenses a quantity less than the
number of units contained in the manufacturer's original package. The National Average
Drug Acquisition Cost (NADAC) shall be used to determine the ingredient cost of a drug.
For drugs for which a NADAC is not reported, the commissioner shall estimate the ingredient
cost at the wholesale acquisition cost minus two percent. The ingredient cost of a drug for
a provider participating in the federal 340B Drug Pricing Program shall be either the 340B
Drug Pricing Program ceiling price established by the Health Resources and Services
Administration or NADAC, whichever is lower. Wholesale acquisition cost is defined as
the manufacturer's list price for a drug or biological to wholesalers or direct purchasers in
the United States, not including prompt pay or other discounts, rebates, or reductions in
price, for the most recent month for which information is available, as reported in wholesale
price guides or other publications of drug or biological pricing data. The maximum allowable
cost of a multisource drug may be set by the commissioner and it shall be comparable to
the actual acquisition cost of the drug product and no higher than the NADAC of the generic
product. Establishment of the amount of payment for drugs shall not be subject to the
requirements of the Administrative Procedure Act.
(b) Pharmacies dispensing prescriptions to residents of long-term care facilities using
an automated drug distribution system meeting the requirements of section 151.58, or a
packaging system meeting the packaging standards set forth in Minnesota Rules, part
6800.2700, that govern the return of unused drugs to the pharmacy for reuse, may employ
retrospective billing for prescription drugs dispensed to long-term care facility residents. A
retrospectively billing pharmacy must submit a claim only for the quantity of medication
used by the enrolled recipient during the defined billing period. A retrospectively billing
pharmacy must use a billing period not less than one calendar month or 30 days.
(c) A pharmacy provider using packaging that meets the standards set forth in Minnesota
Rules, part 6800.2700, is required to credit the department for the actual acquisition cost
of all unused drugs that are eligible for reuse, unless the pharmacy is using retrospective
billing. The commissioner may permit the drug clozapine to be dispensed in a quantity that
is less than a 30-day supply.
(d) If a pharmacy dispenses a multisource drug, the ingredient cost shall be the NADAC
of the generic product or the maximum allowable cost established by the commissioner
unless prior authorization for the brand name product has been granted according to the
criteria established by the Drug Formulary Committee as required by subdivision 13f,
paragraph (a), and the prescriber has indicated "dispense as written" on the prescription in
a manner consistent with section 151.21, subdivision 2.
(e) The basis for determining the amount of payment for drugs administered in an
outpatient setting shall be the lower of the usual and customary cost submitted by the
provider, 106 percent of the average sales price as determined by the United States
Department of Health and Human Services pursuant to title XVIII, section 1847a of the
federal Social Security Act, the specialty pharmacy rate, or the maximum allowable cost
set by the commissioner. If average sales price is unavailable, the amount of payment must
be lower of the usual and customary cost submitted by the provider, the wholesale acquisition
cost, the specialty pharmacy rate, or the maximum allowable cost set by the commissioner.
The commissioner shall discount the payment rate for drugs obtained through the federal
340B Drug Pricing Program by 28.6 percent. The payment for drugs administered in an
outpatient setting shall be made to the administering facility or practitioner. A retail or
specialty pharmacy dispensing a drug for administration in an outpatient setting is not
eligible for direct reimbursement.
(f) The commissioner may establish maximum allowable cost rates for specialty pharmacy
products that are lower than the ingredient cost formulas specified in paragraph (a). The
commissioner may require individuals enrolled in the health care programs administered
by the department to obtain specialty pharmacy products from providers with whom the
commissioner has negotiated lower reimbursement rates. Specialty pharmacy products are
defined as those used by a small number of recipients or recipients with complex and chronic
diseases that require expensive and challenging drug regimens. Examples of these conditions
include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis C,
growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms of
cancer. Specialty pharmaceutical products include injectable and infusion therapies,
biotechnology drugs, antihemophilic factor products, high-cost therapies, and therapies that
require complex care. The commissioner shall consult with the Formulary Committee to
develop a list of specialty pharmacy products subject to maximum allowable cost
reimbursement. In consulting with the Formulary Committee in developing this list, the
commissioner shall take into consideration the population served by specialty pharmacy
products, the current delivery system and standard of care in the state, and access to care
issues. The commissioner shall have the discretion to adjust the maximum allowable cost
to prevent access to care issues.
(g) Home infusion therapy services provided by home infusion therapy pharmacies must
be paid at rates according to subdivision 8d.
(h) The commissioner shall contract with a vendor to conduct a cost of dispensing survey
for all pharmacies that are physically located in the state of Minnesota that dispense outpatient
drugs under medical assistance. The commissioner shall ensure that the vendor has prior
experience in conducting cost of dispensing surveys. Each pharmacy enrolled with the
department to dispense outpatient prescription drugs to fee-for-service members must
respond to the cost of dispensing survey. The commissioner may sanction a pharmacy under
section 256B.064 for failure to respond. The commissioner shall require the vendor to
measure a single statewide cost of dispensing for specialty prescription drugs and a single
statewide cost of dispensing for nonspecialty prescription drugs for all responding pharmacies
to measure the mean, mean weighted by total prescription volume, mean weighted by
medical assistance prescription volume, median, median weighted by total prescription
volume, and median weighted by total medical assistance prescription volume. The
commissioner shall post a copy of the final cost of dispensing survey report on the
department's website. The initial survey must be completed no later than January 1, 2021,
and repeated every three years. The commissioner shall provide a summary of the results
of each cost of dispensing survey and provide recommendations for any changes to the
dispensing fee to the chairs and ranking minority members of the legislative committees
with jurisdiction over medical assistance pharmacy reimbursement. Notwithstanding section
256.01, subdivision 42, this paragraph does not expire.
(i) The commissioner shall increase the ingredient cost reimbursement calculated in
paragraphs (a) and (f) by 1.8 percent for prescription and nonprescription drugs subject to
the wholesale drug distributor tax under section 295.52.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2024.
new text end
Sec. 8.
Minnesota Statutes 2022, section 256B.69, is amended by adding a subdivision to
read:
new text begin Subd. 38. new text end
new text begin Reimbursement of network providers. new text end
new text begin
(a) A managed care plan that is a
staff model health plan company, when reimbursing network providers for services provided
to medical assistance and MinnesotaCare enrollees, must not reimburse network providers
who are employees at a higher rate than network providers who provide services under
contract for each separate service or grouping of services. This requirement does not apply
to reimbursement:
new text end
new text begin
(1) of network providers when participating in value-based purchasing models that are
intended to recognize value or outcomes over volume of services, including:
new text end
new text begin
(i) total cost of care and risk/gain sharing arrangements under section 256B.0755; and
new text end
new text begin
(ii) other pay-for-performance arrangements or service payments, as long as the terms
and conditions of the value-based purchasing model are applied uniformly to all participating
network providers; and
new text end
new text begin
(2) for services furnished by providers who are out-of-network.
new text end
new text begin
(b) Any contract or agreement between a managed care plan and a network administrator,
for purposes of delivering services to medical assistance and MinnesotaCare enrollees, must
require the network administrator to comply with the requirements that apply to a managed
care plan that is a staff model health plan company under paragraph (a) when reimbursing
providers who are employees of the network administrator and providers who provide
services under contract with the network administrator. This provision applies whether or
not the managed care plan, network administrator, and providers are under the same corporate
ownership.
new text end
new text begin
(c) For purposes of this subdivision, "network provider" has the meaning specified in
subdivision 37. For purposes of this subdivision, "network administrator" means any entity
that furnishes a provider network for a managed care plan company, or furnishes individual
health care providers or provider groups to a managed care plan for inclusion in the managed
care plan's provider network.
new text end
Sec. 9. new text begin COUNTY-ADMINISTERED MEDICAL ASSISTANCE MODEL.
new text end
new text begin Subdivision 1. new text end
new text begin Model development. new text end
new text begin
(a) The commissioner of human services, in
collaboration with the Association of Minnesota Counties and county-based purchasing
plans, shall develop a county-administered medical assistance (CAMA) model and a detailed
plan for implementing the CAMA model.
new text end
new text begin
(b) The CAMA model must be designed to achieve the following objectives:
new text end
new text begin
(1) provide a distinct county owned and administered alternative to the prepaid medical
assistance program;
new text end
new text begin
(2) facilitate greater integration of health care and social services to address social
determinants of health in rural and nonrural communities, with the degree of integration of
social services varying with each county's needs and resources;
new text end
new text begin
(3) account for differences between counties in the number of medical assistance enrollees
and locally available providers of behavioral health, oral health, specialty and tertiary care,
nonemergency medical transportation, and other health care services in rural communities;
and
new text end
new text begin
(4) promote greater accountability for health outcomes, health equity, customer service,
community outreach, and cost of care.
new text end
new text begin Subd. 2. new text end
new text begin County participation. new text end
new text begin
(a) The CAMA model must give each rural and nonrural
county the option of applying to participate in the CAMA model as an alternative to
participation in the prepaid medical assistance program. The CAMA model must include a
process for the commissioner to determine whether and how a county can participate.
new text end
new text begin
(b) The CAMA model may allow a county-administered managed care organization to
deliver care on a single-plan basis to all medical assistance enrollees residing in a county
if:
new text end
new text begin
(1) the managed care organization contracts with all health care providers that agree to
accept the contract terms for network participation; and
new text end
new text begin
(2) the commissioner determines that the health care provider network of the managed
care organization is adequate to ensure enrollee access to care and enrollee choice of
providers.
new text end
new text begin Subd. 3. new text end
new text begin Report to the legislature. new text end
new text begin
(a) The commissioner shall report recommendations
and an implementation plan for the CAMA model to the chairs and ranking minority members
of the legislative committees with jurisdiction over health care policy and finance by January
15, 2025. The CAMA model and implementation plan must address the issues and consider
the recommendations identified in the document titled "Recommendations Not Contingent
on Outcome(s) of Current Litigation," attached to the September 13, 2022, e-filing to the
Second Judicial District Court (Correspondence for Judicial Approval Index #102), that
relates to the final contract decisions of the commissioner of human services regarding
South Country Health Alliance v. Minnesota Department of Human Services, No.
62-CV-22-907 (Ramsey Cnty. Dist. Ct. 2022).
new text end
new text begin
(b) The report must also identify the clarifications, approvals, and waivers that are needed
from the Centers for Medicare and Medicaid Services and include any draft legislation
necessary to implement the CAMA model.
new text end
Sec. 10. new text begin REVISOR INSTRUCTION.
new text end
new text begin
When the proposed rule published at Federal Register, volume 88, page 25313, becomes
effective, the revisor of statutes must change: (1) the reference in Minnesota Statutes, section
256B.06, subdivision 4, paragraph (d), from Code of Federal Regulations, title 8, section
103.12, to Code of Federal Regulations, title 42, section 435.4; and (2) the reference in
Minnesota Statutes, section 256L.04, subdivision 10, paragraph (a), from Code of Federal
Regulations, title 8, section 103.12, to Code of Federal Regulations, title 45, section 155.20.
The commissioner of human services shall notify the revisor of statutes when the proposed
rule published at Federal Register, volume 88, page 25313, becomes effective.
new text end
ARTICLE 2
DEPARTMENT OF HUMAN SERVICES HEALTH CARE POLICY
Section 1.
Minnesota Statutes 2023 Supplement, section 256.0471, subdivision 1, as
amended by Laws 2024, chapter 80, article 1, section 76, is amended to read:
Subdivision 1.
Qualifying overpayment.
Any overpayment fornew text begin state-funded medicalnew text end
assistancenew text begin under chapter 256B and state-funded MinnesotaCare under chapter 256Lnew text end granted
pursuant to section 256.045, subdivision 10; deleted text begin chapter 256B for state-funded medical
assistance;deleted text end and chapters 256D, 256I, 256K, and 256L for state-funded MinnesotaCare except
agency error claims, become a judgment by operation of law 90 days after the notice of
overpayment is personally served upon the recipient in a manner that is sufficient under
rule 4.03(a) of the Rules of Civil Procedure for district courts, or by certified mail, return
receipt requested. This judgment shall be entitled to full faith and credit in this and any
other state.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2024.
new text end
Sec. 2.
Minnesota Statutes 2022, section 256.9657, subdivision 8, is amended to read:
Subd. 8.
Commissioner's duties.
deleted text begin
(a) Beginning October 1, 2023, the commissioner of
human services shall annually report to the chairs and ranking minority members of the
legislative committees with jurisdiction over health care policy and finance regarding the
provider surcharge program. The report shall include information on total billings, total
collections, and administrative expenditures for the previous fiscal year. This paragraph
expires January 1, 2032.
deleted text end
deleted text begin (b)deleted text end new text begin (a)new text end The surcharge shall be adjusted by inflationary and caseload changes in future
bienniums to maintain reimbursement of health care providers in accordance with the
requirements of the state and federal laws governing the medical assistance program,
including the requirements of the Medicaid moratorium amendments of 1991 found in
Public Law No. 102-234.
deleted text begin (c)deleted text end new text begin (b)new text end The commissioner shall request the Minnesota congressional delegation to support
a change in federal law that would prohibit federal disallowances for any state that makes
a good faith effort to comply with Public Law 102-234 by enacting conforming legislation
prior to the issuance of federal implementing regulations.
Sec. 3.
Minnesota Statutes 2022, section 256B.056, subdivision 1a, is amended to read:
Subd. 1a.
Income and assets generally.
(a)(1) Unless specifically required by state law
or rule or federal law or regulation, the methodologies used in counting income and assets
to determine eligibility for medical assistance for persons whose eligibility category is based
on blindness, disability, or age of 65 or more years, the methodologies for the Supplemental
Security Income program shall be used, except as provided deleted text begin underdeleted text end new text begin in clause (2) andnew text end
subdivision 3, paragraph (a), clause (6).
new text begin
(2) State tax credits, rebates, and refunds must not be counted as income. State tax credits,
rebates, and refunds must not be counted as assets for a period of 12 months after the month
of receipt.
new text end
deleted text begin (2)deleted text end new text begin (3)new text end Increases in benefits under title II of the Social Security Act shall not be counted
as income for purposes of this subdivision until July 1 of each year. Effective upon federal
approval, for children eligible under section 256B.055, subdivision 12, or for home and
community-based waiver services whose eligibility for medical assistance is determined
without regard to parental income, child support payments, including any payments made
by an obligor in satisfaction of or in addition to a temporary or permanent order for child
support, and Social Security payments are not counted as income.
(b)(1) The modified adjusted gross income methodology as defined in United States
Code, title 42, section 1396a(e)(14), shall be used for eligibility categories based on:
(i) children under age 19 and their parents and relative caretakers as defined in section
256B.055, subdivision 3a;
(ii) children ages 19 to 20 as defined in section 256B.055, subdivision 16;
(iii) pregnant women as defined in section 256B.055, subdivision 6;
(iv) infants as defined in sections 256B.055, subdivision 10, and 256B.057, subdivision
1; and
(v) adults without children as defined in section 256B.055, subdivision 15.
For these purposes, a "methodology" does not include an asset or income standard, or
accounting method, or method of determining effective dates.
(2) For individuals whose income eligibility is determined using the modified adjusted
gross income methodology in clause (1):
(i) the commissioner shall subtract from the individual's modified adjusted gross income
an amount equivalent to five percent of the federal poverty guidelines; and
(ii) the individual's current monthly income and household size is used to determine
eligibility for the 12-month eligibility period. If an individual's income is expected to vary
month to month, eligibility is determined based on the income predicted for the 12-month
eligibility period.
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 2022, section 256B.056, subdivision 10, is amended to read:
Subd. 10.
Eligibility verification.
(a) The commissioner shall require women who are
applying for the continuation of medical assistance coverage following the end of the
12-month postpartum period to update their income and asset information and to submit
any required income or asset verification.
(b) The commissioner shall determine the eligibility of private-sector health care coverage
for infants less than one year of age eligible under section 256B.055, subdivision 10, or
256B.057, subdivision 1, paragraph (c), and shall pay for private-sector coverage if this is
determined to be cost-effective.
(c) The commissioner shall verify assets and income for all applicants, and for all
recipients upon renewal.
(d) The commissioner shall utilize information obtained through the electronic service
established by the secretary of the United States Department of Health and Human Services
and other available electronic data sources in Code of Federal Regulations, title 42, sections
435.940 to 435.956, to verify eligibility requirements. The commissioner shall establish
standards to define when information obtained electronically is reasonably compatible with
information provided by applicants and enrollees, including use of self-attestation, to
accomplish real-time eligibility determinations and maintain program integrity.
(e) Each person applying for or receiving medical assistance under section 256B.055,
subdivision 7, and any other person whose resources are required by law to be disclosed to
determine the applicant's or recipient's eligibility must authorize the commissioner to obtain
information from financial institutions to deleted text begin identify unreported accountsdeleted text end new text begin verify assetsnew text end as
required in section 256.01, subdivision 18f. If a person refuses or revokes the authorization,
the commissioner may determine that the applicant or recipient is ineligible for medical
assistance. For purposes of this paragraph, an authorization to deleted text begin identify unreported accountsdeleted text end new text begin
verify assetsnew text end meets the requirements of the Right to Financial Privacy Act, United States
Code, title 12, chapter 35, and need not be furnished to the financial institution.
(f) County and tribal agencies shall comply with the standards established by the
commissioner for appropriate use of the asset verification system specified in section 256.01,
subdivision 18f.
Sec. 5.
Minnesota Statutes 2023 Supplement, section 256B.0701, subdivision 6, is amended
to read:
Subd. 6.
Recuperative care facility rate.
(a) The recuperative care facility rate is for
facility costs and must be paid from state money in an amount equal to the deleted text begin medical assistance
room and boarddeleted text end new text begin MSA equivalentnew text end rate new text begin as defined in section 256I.03, subdivision 11a, new text end at the
time the recuperative care services were provided. The eligibility standards in chapter 256I
do not apply to the recuperative care facility rate. The recuperative care facility rate is only
paid when the recuperative care services rate is paid to a provider. Providers may opt to
only receive the recuperative care services rate.
(b) Before a recipient is discharged from a recuperative care setting, the provider must
ensure that the recipient's medical condition is stabilized or that the recipient is being
discharged to a setting that is able to meet that recipient's needs.
Sec. 6.
Minnesota Statutes 2022, section 256B.0757, subdivision 4a, is amended to read:
Subd. 4a.
Behavioral health home services provider requirements.
A behavioral
health home services provider must:
(1) be an enrolled Minnesota Health Care Programs provider;
(2) provide a medical assistance covered primary care or behavioral health service;
(3) utilize an electronic health record;
(4) utilize an electronic patient registry that contains data elements required by the
commissioner;
(5) demonstrate the organization's capacity to administer screenings approved by the
commissioner for substance use disorder or alcohol and tobacco use;
(6) demonstrate the organization's capacity to refer an individual to resources appropriate
to the individual's screening results;
(7) have policies and procedures to track referrals to ensure that the referral met the
individual's needs;
(8) conduct a brief needs assessment when an individual begins receiving behavioral
health home services. The brief needs assessment must be completed with input from the
individual and the individual's identified supports. The brief needs assessment must address
the individual's immediate safety and transportation needs and potential barriers to
participating in behavioral health home services;
(9) conduct a health wellness assessment within 60 days after intake that contains all
required elements identified by the commissioner;
(10) conduct a health action plan that contains all required elements identified by the
commissioner. The plan must be completed within 90 days after intake and must be updated
at least once every six months, or more frequently if significant changes to an individual's
needs or goals occur;
(11) agree to cooperate with and participate in the state's monitoring and evaluation of
behavioral health home services; and
(12) obtain the individual's deleted text begin writtendeleted text end consent to begin receiving behavioral health home
services using a form approved by the commissioner.
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 2022, section 256B.0757, subdivision 4d, is amended to read:
Subd. 4d.
Behavioral health home services delivery standards.
(a) A behavioral health
home services provider must meet the following service delivery standards:
(1) establish and maintain processes to support the coordination of an individual's primary
care, behavioral health, and dental care;
(2) maintain a team-based model of care, including regular coordination and
communication between behavioral health home services team members;
(3) use evidence-based practices that recognize and are tailored to the medical, social,
economic, behavioral health, functional impairment, cultural, and environmental factors
affecting the individual's health and health care choices;
(4) use person-centered planning practices to ensure the individual's health action plan
accurately reflects the individual's preferences, goals, resources, and optimal outcomes for
the individual and the individual's identified supports;
(5) use the patient registry to identify individuals and population subgroups requiring
specific levels or types of care and provide or refer the individual to needed treatment,
intervention, or services;
(6) deleted text begin utilize the Department of Human Services Partner Portal todeleted text end identify past and current
treatment or services and identify potential gaps in carenew text begin using a tool approved by the
commissionernew text end ;
(7) deliver services consistent with the standards for frequency and face-to-face contact
required by the commissioner;
(8) ensure that a diagnostic assessment is completed for each individual receiving
behavioral health home services within six months of the start of behavioral health home
services;
(9) deliver services in locations and settings that meet the needs of the individual;
(10) provide a central point of contact to ensure that individuals and the individual's
identified supports can successfully navigate the array of services that impact the individual's
health and well-being;
(11) have capacity to assess an individual's readiness for change and the individual's
capacity to integrate new health care or community supports into the individual's life;
(12) offer or facilitate the provision of wellness and prevention education on
evidenced-based curriculums specific to the prevention and management of common chronic
conditions;
(13) help an individual set up and prepare for medical, behavioral health, social service,
or community support appointments, including accompanying the individual to appointments
as appropriate, and providing follow-up with the individual after these appointments;
(14) offer or facilitate the provision of health coaching related to chronic disease
management and how to navigate complex systems of care to the individual, the individual's
family, and identified supports;
(15) connect an individual, the individual's family, and identified supports to appropriate
support services that help the individual overcome access or service barriers, increase
self-sufficiency skills, and improve overall health;
(16) provide effective referrals and timely access to services; and
(17) establish a continuous quality improvement process for providing behavioral health
home services.
(b) The behavioral health home services provider must also create a plan, in partnership
with the individual and the individual's identified supports, to support the individual after
discharge from a hospital, residential treatment program, or other setting. The plan must
include protocols for:
(1) maintaining contact between the behavioral health home services team member, the
individual, and the individual's identified supports during and after discharge;
(2) linking the individual to new resources as needed;
(3) reestablishing the individual's existing services and community and social supports;
and
(4) following up with appropriate entities to transfer or obtain the individual's service
records as necessary for continued care.
(c) If the individual is enrolled in a managed care plan, a behavioral health home services
provider must:
(1) notify the behavioral health home services contact designated by the managed care
plan within 30 days of when the individual begins behavioral health home services; and
(2) adhere to the managed care plan communication and coordination requirements
described in the behavioral health home services manual.
(d) Before terminating behavioral health home services, the behavioral health home
services provider must:
(1) provide a 60-day notice of termination of behavioral health home services to all
individuals receiving behavioral health home services, the commissioner, and managed care
plans, if applicable; and
(2) refer individuals receiving behavioral health home services to a new behavioral
health home services provider.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 8.
Minnesota Statutes 2023 Supplement, section 256B.764, is amended to read:
256B.764 REIMBURSEMENT FOR FAMILY PLANNING SERVICES.
(a) Effective for services rendered on or after July 1, 2007, payment rates for family
planning services shall be increased by 25 percent over the rates in effect June 30, 2007,
when these services are provided by a community clinic as defined in section 145.9268,
subdivision 1.
(b) Effective for services rendered on or after July 1, 2013, payment rates for family
planning services shall be increased by 20 percent over the rates in effect June 30, 2013,
when these services are provided by a community clinic as defined in section 145.9268,
subdivision 1. The commissioner shall adjust capitation rates to managed care and
county-based purchasing plans to reflect this increase, and shall require plans to pass on the
full amount of the rate increase to eligible community clinics, in the form of higher payment
rates for family planning services.
(c) Effective for services provided on or after January 1, 2024, payment rates for family
planningnew text begin , when such services are provided by an eligible community clinic as defined in
section 145.9268, subdivision 1,new text end and abortion services shall be increased by 20 percent.
This increase does not apply to federally qualified health centers, rural health centers, or
Indian health services.
Sec. 9.
Minnesota Statutes 2023 Supplement, section 256L.03, subdivision 1, is amended
to read:
Subdivision 1.
Covered health services.
(a) "Covered health services" means the health
services reimbursed under chapter 256B, with the exception of special education services,
home care nursing services, deleted text begin adult dental care services other than services covered under
section 256B.0625, subdivision 9, orthodontic services,deleted text end nonemergency medical transportation
services, personal care assistance and case management services, community first services
and supports under section 256B.85, behavioral health home services under section
256B.0757, housing stabilization services under section 256B.051, and nursing home or
intermediate care facilities services.
(b) Covered health services shall be expanded as provided in this section.
(c) For the purposes of covered health services under this section, "child" means an
individual younger than 19 years of age.
Sec. 10.
Minnesota Statutes 2022, section 524.3-801, as amended by Laws 2024, chapter
79, article 9, section 20, is amended to read:
524.3-801 NOTICE TO CREDITORS.
(a) Unless notice has already been given under this section, upon appointment of a
general personal representative in informal proceedings or upon the filing of a petition for
formal appointment of a general personal representative, notice thereof, in the form prescribed
by court rule, shall be given under the direction of the court administrator by publication
once a week for two successive weeks in a legal newspaper in the county wherein the
proceedings are pending giving the name and address of the general personal representative
and notifying creditors of the estate to present their claims within four months after the date
of the court administrator's notice which is subsequently published or be forever barred,
unless they are entitled to further service of notice under paragraph (b) or (c).
(b) The personal representative shall, within three months after the date of the first
publication of the notice, serve a copy of the notice upon each then known and identified
creditor in the manner provided in paragraph (c). If the decedent or a predeceased spouse
of the decedent received assistance for which a claim could be filed under section 246.53,
256B.15, 256D.16, or 261.04, notice to the commissioner of human services or direct care
and treatment executive board, as applicable, must be given under paragraph (d) instead of
under this paragraph or paragraph (c). A creditor is "known" if: (i) the personal representative
knows that the creditor has asserted a claim that arose during the decedent's life against
either the decedent or the decedent's estate; (ii) the creditor has asserted a claim that arose
during the decedent's life and the fact is clearly disclosed in accessible financial records
known and available to the personal representative; or (iii) the claim of the creditor would
be revealed by a reasonably diligent search for creditors of the decedent in accessible
financial records known and available to the personal representative. Under this section, a
creditor is "identified" if the personal representative's knowledge of the name and address
of the creditor will permit service of notice to be made under paragraph (c).
(c) Unless the claim has already been presented to the personal representative or paid,
the personal representative shall serve a copy of the notice required by paragraph (b) upon
each creditor of the decedent who is then known to the personal representative and identified
either by delivery of a copy of the required notice to the creditor, or by mailing a copy of
the notice to the creditor by certified, registered, or ordinary first class mail addressed to
the creditor at the creditor's office or place of residence.
(d)(1) Effective for decedents dying on or after July 1, 1997, if the decedent or a
predeceased spouse of the decedent received assistance for which a claim could be filed
under section 246.53, 256B.15, 256D.16, or 261.04, the personal representative or the
attorney for the personal representative shall serve the commissioner or executive board,
as applicable, with notice in the manner prescribed in paragraph (c)new text begin , or electronically in a
manner prescribed by the commissioner,new text end as soon as practicable after the appointment of the
personal representative. The notice must state the decedent's full name, date of birth, and
Social Security number and, to the extent then known after making a reasonably diligent
inquiry, the full name, date of birth, and Social Security number for each of the decedent's
predeceased spouses. The notice may also contain a statement that, after making a reasonably
diligent inquiry, the personal representative has determined that the decedent did not have
any predeceased spouses or that the personal representative has been unable to determine
one or more of the previous items of information for a predeceased spouse of the decedent.
A copy of the notice to creditors must be attached to and be a part of the notice to the
commissioner or executive board.
(2) Notwithstanding a will or other instrument or law to the contrary, except as allowed
in this paragraph, no property subject to administration by the estate may be distributed by
the estate or the personal representative until 70 days after the date the notice is served on
the commissioner or executive board as provided in paragraph (c), unless the local agency
consents as provided for in clause (6). This restriction on distribution does not apply to the
personal representative's sale of real or personal property, but does apply to the net proceeds
the estate receives from these sales. The personal representative, or any person with personal
knowledge of the facts, may provide an affidavit containing the description of any real or
personal property affected by this paragraph and stating facts showing compliance with this
paragraph. If the affidavit describes real property, it may be filed or recorded in the office
of the county recorder or registrar of titles for the county where the real property is located.
This paragraph does not apply to proceedings under sections 524.3-1203 and 525.31, or
when a duly authorized agent of a county is acting as the personal representative of the
estate.
(3) At any time before an order or decree is entered under section 524.3-1001 or
524.3-1002, or a closing statement is filed under section 524.3-1003, the personal
representative or the attorney for the personal representative may serve an amended notice
on the commissioner or executive board to add variations or other names of the decedent
or a predeceased spouse named in the notice, the name of a predeceased spouse omitted
from the notice, to add or correct the date of birth or Social Security number of a decedent
or predeceased spouse named in the notice, or to correct any other deficiency in a prior
notice. The amended notice must state the decedent's name, date of birth, and Social Security
number, the case name, case number, and district court in which the estate is pending, and
the date the notice being amended was served on the commissioner or executive board. If
the amendment adds the name of a predeceased spouse omitted from the notice, it must also
state that spouse's full name, date of birth, and Social Security number. The amended notice
must be served on the commissioner or executive board in the same manner as the original
notice. Upon service, the amended notice relates back to and is effective from the date the
notice it amends was served, and the time for filing claims arising under section 246.53,
256B.15, 256D.16 or 261.04 is extended by 60 days from the date of service of the amended
notice. Claims filed during the 60-day period are undischarged and unbarred claims, may
be prosecuted by the entities entitled to file those claims in accordance with section
524.3-1004, and the limitations in section 524.3-1006 do not apply. The personal
representative or any person with personal knowledge of the facts may provide and file or
record an affidavit in the same manner as provided for in clause (1).
(4) Within one year after the date an order or decree is entered under section 524.3-1001
or 524.3-1002 or a closing statement is filed under section 524.3-1003, any person who has
an interest in property that was subject to administration by the estate may serve an amended
notice on the commissioner or executive board to add variations or other names of the
decedent or a predeceased spouse named in the notice, the name of a predeceased spouse
omitted from the notice, to add or correct the date of birth or Social Security number of a
decedent or predeceased spouse named in the notice, or to correct any other deficiency in
a prior notice. The amended notice must be served on the commissioner or executive board
in the same manner as the original notice and must contain the information required for
amendments under clause (3). If the amendment adds the name of a predeceased spouse
omitted from the notice, it must also state that spouse's full name, date of birth, and Social
Security number. Upon service, the amended notice relates back to and is effective from
the date the notice it amends was served. If the amended notice adds the name of an omitted
predeceased spouse or adds or corrects the Social Security number or date of birth of the
decedent or a predeceased spouse already named in the notice, then, notwithstanding any
other laws to the contrary, claims against the decedent's estate on account of those persons
resulting from the amendment and arising under section 246.53, 256B.15, 256D.16, or
261.04 are undischarged and unbarred claims, may be prosecuted by the entities entitled to
file those claims in accordance with section 524.3-1004, and the limitations in section
524.3-1006 do not apply. The person filing the amendment or any other person with personal
knowledge of the facts may provide and file or record an affidavit describing affected real
or personal property in the same manner as clause (1).
(5) After one year from the date an order or decree is entered under section 524.3-1001
or 524.3-1002, or a closing statement is filed under section 524.3-1003, no error, omission,
or defect of any kind in the notice to the commissioner or executive board required under
this paragraph or in the process of service of the notice on the commissioner or executive
board, or the failure to serve the commissioner or executive board with notice as required
by this paragraph, makes any distribution of property by a personal representative void or
voidable. The distributee's title to the distributed property shall be free of any claims based
upon a failure to comply with this paragraph.
(6) The local agency may consent to a personal representative's request to distribute
property subject to administration by the estate to distributees during the 70-day period after
service of notice on the commissioner or executive board. The local agency may grant or
deny the request in whole or in part and may attach conditions to its consent as it deems
appropriate. When the local agency consents to a distribution, it shall give the estate a written
certificate evidencing its consent to the early distribution of assets at no cost. The certificate
must include the name, case number, and district court in which the estate is pending, the
name of the local agency, describe the specific real or personal property to which the consent
applies, state that the local agency consents to the distribution of the specific property
described in the consent during the 70-day period following service of the notice on the
commissioner or executive board, state that the consent is unconditional or list all of the
terms and conditions of the consent, be dated, and may include other contents as may be
appropriate. The certificate must be signed by the director of the local agency or the director's
designees and is effective as of the date it is dated unless it provides otherwise. The signature
of the director or the director's designee does not require any acknowledgment. The certificate
shall be prima facie evidence of the facts it states, may be attached to or combined with a
deed or any other instrument of conveyance and, when so attached or combined, shall
constitute a single instrument. If the certificate describes real property, it shall be accepted
for recording or filing by the county recorder or registrar of titles in the county in which the
property is located. If the certificate describes real property and is not attached to or combined
with a deed or other instrument of conveyance, it shall be accepted for recording or filing
by the county recorder or registrar of titles in the county in which the property is located.
The certificate constitutes a waiver of the 70-day period provided for in clause (2) with
respect to the property it describes and is prima facie evidence of service of notice on the
commissioner or executive board. The certificate is not a waiver or relinquishment of any
claims arising under section 246.53, 256B.15, 256D.16, or 261.04, and does not otherwise
constitute a waiver of any of the personal representative's duties under this paragraph.
Distributees who receive property pursuant to a consent to an early distribution shall remain
liable to creditors of the estate as provided for by law.
(7) All affidavits provided for under this paragraph:
(i) shall be provided by persons who have personal knowledge of the facts stated in the
affidavit;
(ii) may be filed or recorded in the office of the county recorder or registrar of titles in
the county in which the real property they describe is located for the purpose of establishing
compliance with the requirements of this paragraph; and
(iii) are prima facie evidence of the facts stated in the affidavit.
(8) This paragraph applies to the estates of decedents dying on or after July 1, 1997.
Clause (5) also applies with respect to all notices served on the commissioner of human
services before July 1, 1997, under Laws 1996, chapter 451, article 2, section 55. All notices
served on the commissioner before July 1, 1997, pursuant to Laws 1996, chapter 451, article
2, section 55, shall be deemed to be legally sufficient for the purposes for which they were
intended, notwithstanding any errors, omissions or other defects.
ARTICLE 3
HEALTH CARE
Section 1.
new text begin
[62J.805] DEFINITIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Application. new text end
new text begin
For purposes of sections 62J.805 to 62J.808, the following
terms have the meanings given.
new text end
new text begin Subd. 2. new text end
new text begin Group practice. new text end
new text begin
"Group practice" has the meaning given to health care provider
group practice in section 145D.01, subdivision 1.
new text end
new text begin Subd. 3. new text end
new text begin Health care provider. new text end
new text begin
"Health care provider" means:
new text end
new text begin
(1) a health professional who is licensed or registered by the state to provide health
treatments and services within the professional's scope of practice and in accordance with
state law;
new text end
new text begin
(2) a group practice; or
new text end
new text begin
(3) a hospital.
new text end
new text begin Subd. 4. new text end
new text begin Health plan. new text end
new text begin
"Health plan" has the meaning given in section 62A.011,
subdivision 3.
new text end
new text begin Subd. 5. new text end
new text begin Hospital. new text end
new text begin
"Hospital" means a health care facility licensed as a hospital under
sections 144.50 to 144.56.
new text end
new text begin Subd. 6. new text end
new text begin Medically necessary. new text end
new text begin
"Medically necessary" means:
new text end
new text begin
(1) safe and effective;
new text end
new text begin
(2) not experimental or investigational, except as provided in Code of Federal Regulations,
title 42, section 411.15(o);
new text end
new text begin
(3) furnished in accordance with acceptable medical standards of medical practice for
the diagnosis or treatment of the patient's condition or to improve the function of a malformed
body member;
new text end
new text begin
(4) furnished in a setting appropriate to the patient's medical need and condition;
new text end
new text begin
(5) ordered and furnished by qualified personnel;
new text end
new text begin
(6) meets, but does not exceed, the patient's medical need; and
new text end
new text begin
(7) is at least as beneficial as an existing and available medically appropriate alternative.
new text end
new text begin Subd. 7. new text end
new text begin Miscode. new text end
new text begin
"Miscode" means a health care provider or a health care provider's
designee, using a coding system and for billing purposes, assigns a numeric or alphanumeric
code to a health treatment or service provided to a patient and the code assigned does not
accurately reflect the health treatment or service provided based on factors that include the
patient's diagnosis and the complexity of the patient's condition.
new text end
new text begin Subd. 8. new text end
new text begin Payment. new text end
new text begin
"Payment" includes co-payments and coinsurance and deductible
payments made by a patient.
new text end
Sec. 2.
new text begin
[62J.806] POLICY FOR COLLECTION OF MEDICAL DEBT.
new text end
new text begin Subdivision 1. new text end
new text begin Requirement. new text end
new text begin
Each health care provider must make available to the
public the health care provider's policy for the collection of medical debt from patients. This
policy must be made available by:
new text end
new text begin
(1) clearly posting it on the health care provider's website or, for health professionals,
on the website of the health clinic, group practice, or hospital at which the health professional
is employed or under contract; and
new text end
new text begin
(2) providing a copy of the policy to any individual who requests it.
new text end
new text begin Subd. 2. new text end
new text begin Content. new text end
new text begin
A policy made available under this section must at least specify the
procedures followed by the health care provider for:
new text end
new text begin
(1) communicating with patients about the medical debt owed and collecting medical
debt;
new text end
new text begin
(2) referring medical debt to a collection agency or law firm for collection; and
new text end
new text begin
(3) identifying medical debt as uncollectible or satisfied, and ending collection activities.
new text end
Sec. 3.
new text begin
[62J.807] DENIAL OF HEALTH TREATMENTS OR SERVICES DUE TO
OUTSTANDING MEDICAL DEBT.
new text end
new text begin
(a) A health care provider must not deny medically necessary health treatments or services
to a patient or any member of the patient's family or household because of outstanding
medical debt owed by the patient or any member of the patient's family or household to the
health care provider, regardless of whether the health treatment or service may be available
from another health care provider.
new text end
new text begin
(b) As a condition of providing medically necessary health treatments or services in the
circumstances described in paragraph (a), a health care provider may require the patient to
enroll in a payment plan for the outstanding medical debt owed to the health care provider.
new text end
Sec. 4.
new text begin
[62J.808] BILLING AND PAYMENT FOR MISCODED HEALTH
TREATMENTS AND SERVICES.
new text end
new text begin Subdivision 1. new text end
new text begin Participation and cooperation required. new text end
new text begin
Each health care provider
must participate in, and cooperate with, all processes and investigations to identify, review,
and correct the coding of health treatments and services that are miscoded by the health
care provider or a designee.
new text end
new text begin Subd. 2. new text end
new text begin Notice; billing and payment during review. new text end
new text begin
(a) When a health care provider
receives notice, other than notice from a health plan company as provided in paragraph (b),
or otherwise determines that a health treatment or service may have been miscoded, the
health care provider must notify the health plan company administering the patient's health
plan in a timely manner of the potentially miscoded health treatment or service.
new text end
new text begin
(b) When a health plan company receives notice, other than notice from a health care
provider as provided in paragraph (a), or otherwise determines that a health treatment or
service may have been miscoded, the health plan company must notify the health care
provider who provided the health treatment or service of the potentially miscoded health
treatment or service.
new text end
new text begin
(c) When a review of a potentially miscoded health treatment or service is commenced,
the health care provider and health plan company must notify the patient that a miscoding
review is being conducted and that the patient will not be billed for any health treatment or
service subject to the review and is not required to submit payments for any health treatment
or service subject to the review until the review is complete and any miscoded health
treatments or services are correctly coded.
new text end
new text begin
(d) While a review of a potentially miscoded health treatment or service is being
conducted, the health care provider and health plan company must not bill the patient for,
or accept payment from the patient for, any health treatment or service subject to the review.
new text end
new text begin Subd. 3. new text end
new text begin Billing and payment after completion of review. new text end
new text begin
The health care provider
and health plan company may bill the patient for, and accept payment from the patient for,
the health treatment or service that was subject to the miscoding review only after the review
is complete and any miscoded health treatments or services have been correctly coded.
new text end
Sec. 5.
Minnesota Statutes 2023 Supplement, section 144.587, subdivision 1, is amended
to read:
Subdivision 1.
Definitions.
(a) The terms defined in this subdivision apply to this section
and sections 144.588 to 144.589.
(b) "Charity care" means the provision of free or discounted care to a patient according
to a hospital's financial assistance policies.
(c) "Hospital" means a private, nonprofit, or municipal hospital licensed under sections
144.50 to 144.56.
(d) "Insurance affordability program" has the meaning given in section 256B.02,
subdivision 19.
(e) "Navigator" has the meaning given in section 62V.02, subdivision 9.
(f) "Presumptive eligibility" has the meaning given in section 256B.057, subdivision
12.
deleted text begin
(g) "Revenue recapture" means the use of the procedures in chapter
deleted text end
deleted text begin
270A
deleted text end
deleted text begin
to collect debt.
deleted text end
deleted text begin (h)deleted text end new text begin (g)new text end "Uninsured service or treatment" means any service or treatment that is not
covered by:
(1) a health plan, contract, or policy that provides health coverage to a patient; or
(2) any other type of insurance coverage, including but not limited to no-fault automobile
coverage, workers' compensation coverage, or liability coverage.
deleted text begin (i)deleted text end new text begin (h)new text end "Unreasonable burden" includes requiring a patient to apply for enrollment in a
state or federal program for which the patient is obviously or categorically ineligible or has
been found to be ineligible in the previous 12 months.
Sec. 6.
Minnesota Statutes 2023 Supplement, section 144.587, subdivision 4, is amended
to read:
Subd. 4.
Prohibited actions.
new text begin (a) new text end A hospital must not initiate one or more of the following
actions until the hospital determines that the patient is ineligible for charity care or denies
an application for charity care:
(1) offering to enroll or enrolling the patient in a payment plan;
(2) changing the terms of a patient's payment plan;
(3) offering the patient a loan or line of credit, application materials for a loan or line of
credit, or assistance with applying for a loan or line of credit, for the payment of medical
debt;
(4) referring a patient's debt for collections, including in-house collections, third-party
collections, deleted text begin revenue recapture,deleted text end or any other process for the collection of debt;new text begin or
new text end
deleted text begin
(5) denying health care services to the patient or any member of the patient's household
because of outstanding medical debt, regardless of whether the services are deemed necessary
or may be available from another provider; or
deleted text end
deleted text begin (6)deleted text end new text begin (5)new text end accepting a credit card payment of over $500 for the medical debt owed to the
hospital.
new text begin
(b) A hospital is subject to section 62J.807.
new text end
Sec. 7.
Minnesota Statutes 2023 Supplement, section 151.555, 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) "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) deleted text begin a health care facility as defined in this subdivisiondeleted text end new text begin 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 donationnew text end ;new text begin or
new text end
(2) deleted text begin a skilled nursing facility licensed under chapter deleted text end deleted text begin 144Adeleted text end deleted text begin ;deleted text end new text begin any entity legally authorized
to possess medicine with a license or permit in good standing in the state in which it is
located, without further restrictions, including but not limited to a health care facility, skilled
nursing facility, assisted living facility, pharmacy, wholesaler, and drug manufacturer.
new text end
deleted text begin
(3) an assisted living facility licensed under chapter
deleted text end
deleted text begin
144G
deleted text end
deleted text begin
;
deleted text end
deleted text begin
(4) a pharmacy licensed under section 151.19, and located either in the state or outside
the state;
deleted text end
deleted text begin
(5) a drug wholesaler licensed under section 151.47;
deleted text end
deleted text begin
(6) a drug manufacturer licensed under section 151.252; or
deleted text end
deleted text begin
(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.
deleted text end
(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 or nonprescription medical
supplies needed to administer a 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.
Sec. 8.
Minnesota Statutes 2023 Supplement, section 151.555, subdivision 4, is amended
to read:
Subd. 4.
Local repository requirements.
(a) To be eligible for participation in the
medication repository program, a health care facility must agree to comply with all applicable
federal and state laws, rules, and regulations pertaining to the medication 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 medication repository program is voluntary. A local repository
may withdraw from participation in the medication 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. deleted text begin 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.
deleted text end
Sec. 9.
Minnesota Statutes 2023 Supplement, section 151.555, subdivision 5, is amended
to read:
Subd. 5.
Individual eligibility and application requirements.
(a) deleted text begin To be eligible for
the medication repository programdeleted text end new text begin At the time of or before receiving donated drugs or
supplies as a new eligible patientnew text end , an individual must submit to a local repository an new text begin electronic
or physical new text end intake application form that is signed by the individual and attests that the
individual:
(1) is a resident of Minnesota;
(2) is uninsured deleted text begin and is not enrolled in the medical assistance program under chapter
deleted text end deleted text begin 256Bdeleted text end deleted text begin or the MinnesotaCare program under chapter deleted text end deleted text begin 256Ldeleted text end , 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.
deleted text begin
(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.
deleted text end
deleted text begin (c)deleted text end new text begin (b)new text end The local repository shall send a copy of the intake application form to the central
repository by regular mail, facsimile, or secured email within ten days from the date the
application is approved by the local repository.
deleted text begin (d)deleted text end new text begin (c)new text end The board shall develop and make available on the board's website an application
form deleted text begin and the format for the identification carddeleted text end .
Sec. 10.
Minnesota Statutes 2023 Supplement, section 151.555, subdivision 6, is amended
to read:
Subd. 6.
Standards and procedures for accepting donations of drugs and supplies.
(a)
new text begin Notwithstanding any other law or rule, new text end a donor may donate 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 drug is eligible for donation under the medication repository program if the
following requirements are met:
deleted text begin
(1) the donation is accompanied by a medication 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);
deleted text end
deleted text begin (2)deleted text end new text begin (1)new text end 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;
deleted text begin (3)deleted text end new text begin (2)new text end 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;
deleted text begin (4)deleted text end new text begin (3)new text end the drug or the packaging does not have any physical signs of tampering,
misbranding, deterioration, compromised integrity, or adulteration;
deleted text begin (5)deleted text end new text begin (4)new text end 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
deleted text begin (6)deleted text end new text begin (5)new text end the drug is not a controlled substance.
(c) A medical supply is eligible for donation under the medication 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;new text begin and
new text end
deleted text begin
(3) the donation is accompanied by a medication 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
deleted text end
deleted text begin (4)deleted text end new text begin (3)new text end 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 medication repository donor form and make it available
on the board's website. deleted text begin 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.deleted text end new text begin Prior to the first donation from a new donor, a central repository
or local repository shall verify and record the following information on the donor form:
new text end
new text begin
(1) the donor's name, address, phone number, and license number, if applicable;
new text end
new text begin
(2) that the donor will only make donations in accordance with the program;
new text end
new text begin
(3) to the best of the donor's knowledge, only drugs or supplies that have been properly
stored under appropriate temperature and humidity conditions will be donated; and
new text end
new text begin
(4) to the best of the donor's knowledge, only drugs or supplies that have never been
opened, used, tampered with, adulterated, or misbranded will be donated.
new text end
(e) new text begin Notwithstanding any other law or rule, a central repository or a local repository may
receive donated drugs from donors. new text end 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 deleted text begin to accept donationsdeleted text end new text begin prior to
dispensingnew text end . A drop box must not be used to deliver or accept donations.
(f) The central repository and local repository shall new text begin maintain a written or electronic
new text end inventory new text begin of new text end all drugs and supplies donated to the repositorynew text begin upon acceptance of each drug
or supplynew text end . 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.new text begin The board
may waive the requirement under this paragraph if an entity is under common ownership
or control with a central repository or local repository and either the entity or the repository
maintains an inventory containing all the information required under this paragraph.
new text end
Sec. 11.
Minnesota Statutes 2023 Supplement, section 151.555, subdivision 7, is amended
to read:
Subd. 7.
Standards and procedures for inspecting and storing donated 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 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. deleted text begin The pharmacist
or practitioner who inspects the drugs or supplies shall sign an inspection record stating that
the requirements for donation have been met.deleted text end 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 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 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.
new text begin
No other record of destruction is required.
new text end
Sec. 12.
Minnesota Statutes 2023 Supplement, section 151.555, subdivision 8, is amended
to read:
Subd. 8.
Dispensing requirements.
(a) Donated new text begin prescription new text end 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 drugs in compliance with
applicable federal and state laws and regulations for dispensing 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 deleted text begin adeleted text end new text begin the firstnew text end drug or supply is dispensed or administered to an individual, the
individual must sign deleted text begin adeleted text end new text begin an electronic or physicalnew text end drug repository recipient form acknowledging
that the individual understands deleted text begin 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
informationdeleted text end :
(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 medication 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.
Sec. 13.
Minnesota Statutes 2023 Supplement, section 151.555, subdivision 9, is amended
to read:
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
medication repository program shall not receive reimbursement under the medical assistance
program or the MinnesotaCare program for that dispensed or administered drug or supply.
new text begin
(c) A supply or handling fee must not be charged to an individual enrolled in the medical
assistance or MinnesotaCare program.
new text end
Sec. 14.
Minnesota Statutes 2023 Supplement, section 151.555, subdivision 11, is amended
to read:
Subd. 11.
Forms and record-keeping requirements.
(a) The following forms developed
for the administration of this program deleted text begin shall be utilized by the participants of the program
anddeleted text end 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) medication repository donor form described under subdivision 6;
(5) record of destruction form described under subdivision 7; and
(6) medication repository recipient form described under subdivision 8.
new text begin
Participants may use substantively similar electronic or physical forms.
new text end
(b) All records, including drug inventorydeleted text begin , inspection,deleted text end and disposal of donated 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 medication 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.
Sec. 15.
Minnesota Statutes 2023 Supplement, section 151.555, subdivision 12, is amended
to read:
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, deleted text begin ordeleted text end a donor of a drug or medical supplynew text begin , or a person or entity
that facilitates any of the abovenew text end 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 deleted text begin pharmacist
or practitionerdeleted text end new text begin person or entitynew text end 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.
Sec. 16.
Minnesota Statutes 2023 Supplement, section 151.74, subdivision 3, is amended
to read:
Subd. 3.
Access to urgent-need insulin.
(a) MNsure shall develop an application form
to be used by an individual who is in urgent need of insulin. The application must ask the
individual to attest to the eligibility requirements described in subdivision 2. The form shall
be accessible through MNsure's website. MNsure shall also make the form available to
pharmacies and health care providers who prescribe or dispense insulin, hospital emergency
departments, urgent care clinics, and community health clinics. By submitting a completed,
signed, and dated application to a pharmacy, the individual attests that the information
contained in the application is correct.
(b) If the individual is in urgent need of insulin, the individual may present a completed,
signed, and dated application form to a pharmacy. The individual must also:
(1) have a valid insulin prescription; and
(2) present the pharmacist with identification indicating Minnesota residency in the form
of a valid Minnesota identification card, driver's license or permit, individual taxpayer
identification number, or Tribal identification card as defined in section 171.072, paragraph
(b). If the individual in urgent need of insulin is under the age of 18, the individual's parent
or legal guardian must provide the pharmacist with proof of residency.
(c) Upon receipt of a completed and signed application, the pharmacist shall dispense
the prescribed insulin in an amount that will provide the individual with a 30-day supply.
The pharmacy must notify the health care practitioner who issued the prescription order no
later than 72 hours after the insulin is dispensed.
(d) The pharmacy may submit to the manufacturer of the dispensed insulin product or
to the manufacturer's vendor a claim for payment that is in accordance with the National
Council for Prescription Drug Program standards for electronic claims processing, unless
the manufacturer agrees to send to the pharmacy a replacement supply of the same insulin
as dispensed in the amount dispensed. If the pharmacy submits an electronic claim to the
manufacturer or the manufacturer's vendor, the manufacturer or vendor shall reimburse the
pharmacy in an amount that covers the pharmacy's acquisition cost.
(e) The pharmacy may collect an insulin co-payment from the individual to cover the
pharmacy's costs of processing and dispensing in an amount not to exceed $35 for the 30-day
supply of insulin dispensed.
(f) The pharmacy shall also provide each eligible individual with the information sheet
described in subdivision 7 and a list of trained navigators provided by the Board of Pharmacy
for the individual to contact if the individual deleted text begin is in need of accessingdeleted text end new text begin needs to accessnew text end ongoing
insulin coverage options, including assistance in:
(1) applying for medical assistance or MinnesotaCare;
(2) applying for a qualified health plan offered through MNsure, subject to open and
special enrollment periods;
(3) accessing information on providers who participate in prescription drug discount
programs, including providers who are authorized to participate in the 340B program under
section 340b of the federal Public Health Services Act, United States Code, title 42, section
256b; and
(4) accessing insulin manufacturers' patient assistance programs, co-payment assistance
programs, and other foundation-based programs.
(g) The pharmacist shall retain a copy of the application form submitted by the individual
to the pharmacy for reporting and auditing purposes.
new text begin
(h) A manufacturer may submit to the commissioner of administration a request for
reimbursement in an amount not to exceed $35 for each 30-day supply of insulin the
manufacturer provides under paragraph (d). The commissioner of administration shall
determine the manner and format for submitting and processing requests for reimbursement.
After receiving a reimbursement request, the commissioner of administration shall reimburse
the manufacturer in an amount not to exceed $35 for each 30-day supply of insulin the
manufacturer provided under paragraph (d).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2024.
new text end
Sec. 17.
Minnesota Statutes 2022, section 151.74, subdivision 6, is amended to read:
Subd. 6.
Continuing safety net program; process.
(a) The individual shall submit to
a pharmacy the statement of eligibility provided by the manufacturer under subdivision 5,
paragraph (b). Upon receipt of an individual's eligibility status, the pharmacy shall submit
an order containing the name of the insulin product and the daily dosage amount as contained
in a valid prescription to the product's manufacturer.
(b) The pharmacy must include with the order to the manufacturer the following
information:
(1) the pharmacy's name and shipping address;
(2) the pharmacy's office telephone number, fax number, email address, and contact
name; and
(3) any specific days or times when deliveries are not accepted by the pharmacy.
(c) Upon receipt of an order from a pharmacy and the information described in paragraph
(b), the manufacturer shall send to the pharmacy a 90-day supply of insulin as ordered,
unless a lesser amount is requested in the order, at no charge to the individual or pharmacy.
(d) Except as authorized under paragraph (e), the pharmacy shall provide the insulin to
the individual at no charge to the individual. The pharmacy shall not provide insulin received
from the manufacturer to any individual other than the individual associated with the specific
order. The pharmacy shall not seek reimbursement for the insulin received from the
manufacturer or from any third-party payer.
(e) The pharmacy may collect a co-payment from the individual to cover the pharmacy's
costs for processing and dispensing in an amount not to exceed $50 for each 90-day supply
if the insulin is sent to the pharmacy.
(f) The pharmacy may submit to a manufacturer a reorder for an individual if the
individual's eligibility statement has not expired. Upon receipt of a reorder from a pharmacy,
the manufacturer must send to the pharmacy an additional 90-day supply of the product,
unless a lesser amount is requested, at no charge to the individual or pharmacy if the
individual's eligibility statement has not expired.
(g) Notwithstanding paragraph (c), a manufacturer may send the insulin as ordered
directly to the individual if the manufacturer provides a mail order service option.
new text begin
(h) A manufacturer may submit to the commissioner of administration a request for
reimbursement in an amount not to exceed $105 for each 90-day supply of insulin the
manufacturer provides under paragraphs (c) and (f). The commissioner of administration
shall determine the manner and format for submitting and processing requests for
reimbursement. After receiving a reimbursement request, the commissioner of administration
shall reimburse the manufacturer in an amount not to exceed $105 for each 90-day supply
of insulin the manufacturer provided under paragraphs (c) and (f). If the manufacturer
provides less than a 90-day supply of insulin under paragraphs (c) and (f), the manufacturer
may submit a request for reimbursement not to exceed $35 for each 30-day supply of insulin
provided.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2024.
new text end
Sec. 18.
new text begin
[151.741] INSULIN MANUFACTURER REGISTRATION FEE.
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) "Board" means the Minnesota Board of Pharmacy under section 151.02.
new text end
new text begin
(c) "Manufacturer" means a manufacturer licensed under section 151.252 and engaged
in the manufacturing of prescription insulin.
new text end
new text begin Subd. 2. new text end
new text begin Assessment of registration fee. new text end
new text begin
(a) The board shall assess each manufacturer
an annual registration fee of $100,000, except as provided in paragraph (b). The board shall
notify each manufacturer of this requirement beginning November 1, 2024, and each
November 1 thereafter.
new text end
new text begin
(b) A manufacturer may request an exemption from the annual registration fee. The
board shall exempt a manufacturer from the annual registration fee if the manufacturer can
demonstrate to the board, in the form and manner specified by the board, that sales of
prescription insulin produced by that manufacturer and sold or delivered within or into the
state totaled $2,000,000 or less in the previous calendar year.
new text end
new text begin Subd. 3. new text end
new text begin Payment of the registration fee; deposit of fee. new text end
new text begin
(a) Each manufacturer must
pay the registration fee by March 1, 2025, and by each March 1 thereafter. In the event of
a change in ownership of the manufacturer, the new owner must pay the registration fee
that the original owner would have been assessed had the original owner retained ownership.
The board may assess a late fee of ten percent per month or any portion of a month that the
registration fee is paid after the due date.
new text end
new text begin
(b) The registration fee, including any late fees, must be deposited in the insulin safety
net program account.
new text end
new text begin Subd. 4. new text end
new text begin Insulin safety net program account. new text end
new text begin
The insulin safety net program account
is established in the special revenue fund in the state treasury. Money in the account is
appropriated each fiscal year to:
new text end
new text begin
(1) the MNsure board in an amount sufficient to carry out assigned duties under section
151.74, subdivision 7; and
new text end
new text begin
(2) the Board of Pharmacy in an amount sufficient to cover costs incurred by the board
in assessing and collecting the registration fee under this section and in administering the
insulin safety net program under section 151.74.
new text end
new text begin Subd. 5. new text end
new text begin Insulin repayment account; annual transfer from health care access fund. new text end
new text begin
(a)
The insulin repayment account is established in the special revenue fund in the state treasury.
Money in the account is appropriated each fiscal year to the commissioner of administration
in an amount sufficient for the commissioner to reimburse manufacturers for insulin dispensed
under the insulin safety net program in section 151.74, in accordance with section 151.74,
subdivisions 3, paragraph (h), and 6, paragraph (h), and to cover costs incurred by the
commissioner in providing these reimbursement payments.
new text end
new text begin
(b) The commissioner of management and budget shall transfer from the health care
access fund to the insulin repayment account, beginning July 1, 2025, and each July 1
thereafter, an amount sufficient for the commissioner of administration to implement
paragraph (a).
new text end
new text begin Subd. 6. new text end
new text begin Contingent transfer by commissioner. new text end
new text begin
If subdivisions 2 and 3, or the
application of subdivisions 2 and 3 to any person or circumstance, are held invalid for any
reason in a court of competent jurisdiction, the validity of subdivisions 2 and 3 does not
affect other provisions of this act, and the commissioner of management and budget shall
annually transfer from the health care access fund to the insulin safety net program account
an amount sufficient to implement subdivision 4.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2024.
new text end
Sec. 19.
Minnesota Statutes 2023 Supplement, section 270A.03, subdivision 2, is amended
to read:
Subd. 2.
Claimant agency.
"Claimant agency" means any state agency, as defined by
section 14.02, subdivision 2, the regents of the University of Minnesota, any district court
of the state, any county, any statutory or home rule charter city, including a city that is
presenting a claim for deleted text begin a municipal hospital ordeleted text end a public library deleted text begin or a municipal ambulance
service, a hospital district, any ambulance service licensed under chapter 144Edeleted text end , any public
agency responsible for child support enforcement, any public agency responsible for the
collection of court-ordered restitution, and any public agency established by general or
special law that is responsible for the administration of a low-income housing program.
Sec. 20.
new text begin
[332.371] MEDICAL DEBT CREDIT REPORTING PROHIBITED.
new text end
new text begin
(a) A consumer reporting agency is prohibited from making a consumer report containing
an item of information that the consumer reporting agency knows or should know concerns
(1) medical information; or (2) debt arising from: (i) the provision of medical care, treatment,
services, devices, or medicines; or (ii) procedures to maintain, diagnose, or treat a person's
physical or mental health.
new text end
new text begin
(b) For purposes of this section, "consumer report," "consumer reporting agency," and
"medical information" have the meanings given in the Fair Credit Reporting Act, United
States Code, title 15, section 1681a.
new text end
Sec. 21.
new text begin
[332C.01] DEFINITIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Application. new text end
new text begin
For purposes of this chapter, the following terms have the
meanings given.
new text end
new text begin Subd. 2. new text end
new text begin Collecting party. new text end
new text begin
"Collecting party" means a party engaged in the collection
of medical debt for any account, bill, or other indebtedness, except as hereinafter provided.
new text end
new text begin Subd. 3. new text end
new text begin Debtor. new text end
new text begin
"Debtor" means a person obligated or alleged to be obligated to pay
any debt.
new text end
new text begin Subd. 4. new text end
new text begin Medical debt. new text end
new text begin
"Medical debt" means debt incurred primarily for necessary
medical care and related services. Medical debt does not include debt charged to a credit
card unless the credit card is issued under a credit plan offered solely for the payment of
health care treatment or services.
new text end
new text begin Subd. 5. new text end
new text begin Person. new text end
new text begin
"Person" means any individual, partnership, association, or corporation.
new text end
Sec. 22.
new text begin
[332C.02] PROHIBITED PRACTICES.
new text end
new text begin
No collecting party shall:
new text end
new text begin
(1) in a collection letter, publication, invoice, or any oral or written communication,
threaten wage garnishment or legal suit by a particular lawyer, unless the collecting party
has actually retained the lawyer to do so;
new text end
new text begin
(2) use or employ sheriffs or any other officer authorized to serve legal papers in
connection with the collection of a claim, except when performing their legally authorized
duties;
new text end
new text begin
(3) use or threaten to use methods of collection which violate Minnesota law;
new text end
new text begin
(4) furnish legal advice to debtors or represent that the collecting party is competent or
able to furnish legal advice to debtors;
new text end
new text begin
(5) communicate with debtors in a misleading or deceptive manner by falsely using the
stationery of a lawyer, forms or instruments which only lawyers are authorized to prepare,
or instruments which simulate the form and appearance of judicial process;
new text end
new text begin
(6) publish or cause to be published any list of debtors, use shame cards or shame
automobiles, advertise or threaten to advertise for sale any claim as a means of forcing
payment thereof, or use similar devices or methods of intimidation;
new text end
new text begin
(7) operate under a name or in a manner which falsely implies the collecting party is a
branch of or associated with any department of federal, state, county, or local government
or an agency thereof;
new text end
new text begin
(8) transact business or hold itself out as a debt settlement company, debt management
company, debt adjuster, or any person who settles, adjusts, prorates, pools, liquidates, or
pays the indebtedness of a debtor, unless there is no charge to the debtor, or the pooling or
liquidation is done pursuant to court order or under the supervision of a creditor's committee;
new text end
new text begin
(9) unless an exemption in the law exists, violate Code of Federal Regulations, title 12,
part 1006, while attempting to collect on any account, bill, or other indebtedness. For
purposes of this section, Public Law 95-109 and Code of Federal Regulations, title 12, part
1006, apply to collecting parties;
new text end
new text begin
(10) communicate with a debtor by use of an automatic telephone dialing system or an
artificial or prerecorded voice after the debtor expressly informs the collecting party to cease
communication utilizing an automatic telephone dialing system or an artificial or prerecorded
voice. For purposes of this clause, an automatic telephone dialing system or an artificial or
prerecorded voice includes but is not limited to (i) artificial intelligence chat bots, and (ii)
the usage of the term under the Telephone Consumer Protection Act, United States Code,
title 47, section 227(b)(1)(A);
new text end
new text begin
(11) in collection letters or publications, or in any oral or written communication, imply
or suggest that medically necessary health treatment or services will be denied as a result
of a medical debt;
new text end
new text begin
(12) when a debtor has a listed telephone number, enlist the aid of a neighbor or third
party to request that the debtor contact the collecting party, except a person who resides
with the debtor or a third party with whom the debtor has authorized with the collecting
party to place the request. This clause does not apply to a call back message left at the
debtor's place of employment which is limited solely to the collecting party's telephone
number and name;
new text end
new text begin
(13) when attempting to collect a medical debt, fail to provide the debtor with the full
name of the collecting party, as registered with the secretary of state;
new text end
new text begin
(14) fail to return any amount of overpayment from a debtor to the debtor or to the state
of Minnesota pursuant to the requirements of chapter 345;
new text end
new text begin
(15) accept currency or coin as payment for a medical debt without issuing an original
receipt to the debtor and maintaining a duplicate receipt in the debtor's payment records;
new text end
new text begin
(16) attempt to collect any amount, including any interest, fee, charge, or expense
incidental to the charge-off obligation, from a debtor unless the amount is expressly
authorized by the agreement creating the medical debt or is otherwise permitted by law;
new text end
new text begin
(17) falsify any documents with the intent to deceive;
new text end
new text begin
(18) when initially contacting a Minnesota debtor by mail to collect a medical debt, fail
to include a disclosure on the contact notice, in a type size or font which is equal to or larger
than the largest other type of type size or font used in the text of the notice, that includes
and identifies the Office of the Minnesota Attorney General's general telephone number,
and states: "You have the right to hire your own attorney to represent you in this matter.";
new text end
new text begin
(19) commence legal action to collect a medical debt outside the limitations period set
forth in section 541.053;
new text end
new text begin
(20) report to a credit reporting agency any medical debt which the collecting party
knows or should know is or was originally owed to a health care provider, as defined in
section 62J.805, subdivision 2; or
new text end
new text begin
(21) challenge a debtor's claim of exemption to garnishment or levy in a manner that is
baseless, frivolous, or otherwise in bad faith.
new text end
Sec. 23.
new text begin
[332C.04] DEFENDING MEDICAL DEBT CASES.
new text end
new text begin
A debtor who successfully defends against a claim for payment of medical debt that is
alleged by a collecting party must be awarded the debtor's costs, including a reasonable
attorney fee, incurred in defending against the collecting party's claim for debt payment.
new text end
Sec. 24.
new text begin
[332C.05] ENFORCEMENT.
new text end
new text begin
(a) The attorney general may enforce this chapter under section 8.31.
new text end
new text begin
(b) A collecting party that violates this chapter is strictly liable to the debtor in question
for the sum of:
new text end
new text begin
(1) actual damage sustained by the debtor as a result of the violation;
new text end
new text begin
(2) additional damages as the court may allow, but not exceeding $1,000 per violation;
and
new text end
new text begin
(3) in the case of any successful action to enforce the foregoing, the costs of the action,
together with a reasonable attorney fee as determined by the court.
new text end
new text begin
(c) A collecting party that willfully and maliciously violates this chapter is strictly liable
to the debtor for three times the sums allowable under paragraph (b), clauses (1) and (2).
new text end
new text begin
(d) The dollar amount limit under paragraph (b), clause (2), changes on July 1 of each
even-numbered year in an amount equal to changes made in the Consumer Price Index,
compiled by the United States Bureau of Labor Statistics. The Consumer Price Index for
December 2024 is the reference base index. If the Consumer Price Index is revised, the
percentage of change made under this section must be calculated on the basis of the revised
Consumer Price Index. If a Consumer Price Index revision changes the reference base index,
a revised reference base index must be determined by multiplying the reference base index
that is effective at the time by the rebasing factor furnished by the Bureau of Labor Statistics.
new text end
new text begin
(e) If the Consumer Price Index is superseded, the Consumer Price Index referred to in
this section is the Consumer Price Index represented by the Bureau of Labor Statistics as
most accurately reflecting changes in the prices paid by consumers for consumer goods and
services.
new text end
new text begin
(f) The attorney general must publish the base reference index under paragraph (c) in
the State Register no later than September 1, 2024. The attorney general must calculate and
then publish the revised Consumer Price Index under paragraph (c) in the State Register no
later than September 1 each even-numbered year.
new text end
new text begin
(g) An action brought under this section benefits the public.
new text end
Sec. 25.
Minnesota Statutes 2022, section 334.01, is amended by adding a subdivision to
read:
new text begin Subd. 4. new text end
new text begin Contracts for medical care. new text end
new text begin
Interest for any debt owed to a health care provider
incurred in exchange for care, treatment, services, devices, medicines, or procedures to
maintain, diagnose, or treat a person's physical or mental health shall be at a rate of $4 upon
$100 for a year.
new text end
Sec. 26.
Minnesota Statutes 2022, section 519.05, is amended to read:
519.05 LIABILITY OF deleted text begin HUSBAND AND WIFEdeleted text end new text begin SPOUSESnew text end .
(a) A spouse is not liable to a creditor for any debts of the other spouse. deleted text begin Where husband
and wife are living together, theydeleted text end new text begin Spousesnew text end shall be jointly and severally liable for deleted text begin necessary
medical services that have been furnished to either spouse, includingdeleted text end any claims arising
under section deleted text begin 246.53,deleted text end 256B.15deleted text begin , 256D.16, or 261.04, and necessary household articles and
supplies furnished to and used by the familydeleted text end . Notwithstanding this paragraph, in a proceeding
under chapter 518 the court may apportion such debt between the spouses.
(b) Either spouse may close a credit card account or other unsecured consumer line of
credit on which both spouses are contractually liable, by giving written notice to the creditor.
Sec. 27.
Laws 2020, chapter 73, section 8, is amended to read:
Sec. 8. APPROPRIATIONS.
(a) $297,000 is appropriated in fiscal year 2020 from the health care access fund to the
Board of Directors of MNsure deleted text begin to train navigators to assist individuals and provide
compensation as requireddeleted text end new text begin for the insulin safety net programnew text end under Minnesota Statutes,
section 151.74deleted text begin , subdivision 7deleted text end . deleted text begin Of this appropriation, $108,000 is for implementing the
training requirements for navigators and $189,000 is for application assistance bonus
payments.deleted text end This is a onetime appropriation and is available until deleted text begin December 31, 2024deleted text end new text begin June
30, 2027new text end .
(b) $250,000 is appropriated in fiscal year 2020 from the health care access fund to the
Board of Directors of MNsure for a public awareness campaign for the insulin safety net
program established under Minnesota Statutes, section 151.74. This is a onetime appropriation
and is available until December 31, 2024.
(c) $76,000 is appropriated in fiscal year 2021 from the health care access fund to the
Board of Pharmacy to implement Minnesota Statutes, section 151.74. The base for this
appropriation is $76,000 in fiscal year 2022; $76,000 in fiscal year 2023; $76,000 in fiscal
year 2024; $38,000 in fiscal year 2025; and $0 in fiscal year 2026.
(d) $136,000 in fiscal year 2021 is appropriated from the health care access fund to the
commissioner of health to implement the survey to assess program satisfaction in Minnesota
Statutes, section 151.74, subdivision 12. The base for this appropriation is $80,000 in fiscal
year 2022 and $0 in fiscal year 2023. This is a onetime appropriation.
Sec. 28. new text begin REPEALER; SUNSET FOR THE LONG-TERM SAFETY NET INSULIN
PROGRAM.
new text end
new text begin
Minnesota Statutes 2022, section 151.74, subdivision 16,
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 the day following final enactment.
new text end
ARTICLE 4
HEALTH INSURANCE
Section 1.
Minnesota Statutes 2022, section 62A.28, subdivision 2, is amended to read:
Subd. 2.
Required coverage.
new text begin (a) new text end 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 prosthesesnew text begin , including all equipment and accessories necessary of regular use of scalp
hair prostheses,new text end worn for hair loss suffered as a result of new text begin a health condition, including, but
not limited to,new text end alopecia areatanew text begin or the treatment for cancer, unless there is a clinical basis for
limitationnew text end .
new text begin (b) new 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
(c) The coverage required by this section for scalp hair prostheses is limited to $1,000
per benefit year.
new text end
new text begin
(d) A scalp hair prostheses must be prescribed by a doctor to be covered under this
section.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025, and applies to all policies,
plans, certificates, and contracts offered, issued, or renewed on or after that date.
new text end
Sec. 2.
new text begin
[62A.3098] RAPID WHOLE GENOME SEQUENCING; COVERAGE.
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 section, "rapid whole genome sequencing"
or "rWGS" means an investigation of the entire human genome, including coding and
noncoding regions and mitochondrial deoxyribonucleic acid, to identify disease-causing
genetic changes that returns the final results in 14 days. Rapid whole genome sequencing
includes patient-only whole genome sequencing and duo and trio whole genome sequencing
of the patient and the patient's biological parent or parents.
new text end
new text begin Subd. 2. new text end
new text begin Required coverage. new text end
new text begin
A health plan that provides coverage to Minnesota residents
must cover rWGS testing if the enrollee:
new text end
new text begin
(1) is 21 years of age or younger;
new text end
new text begin
(2) has a complex or acute illness of unknown etiology that is not confirmed to have
been caused by an environmental exposure, toxic ingestion, an infection with a normal
response to therapy, or trauma; and
new text end
new text begin
(3) is receiving inpatient hospital services in an intensive care unit or a neonatal or high
acuity pediatric care unit.
new text end
new text begin Subd. 3. new text end
new text begin Coverage criteria. new text end
new text begin
Coverage may be based on the following medical necessity
criteria:
new text end
new text begin
(1) the enrollee has symptoms that suggest a broad differential diagnosis that would
require an evaluation by multiple genetic tests if rWGS testing is not performed;
new text end
new text begin
(2) timely identification of a molecular diagnosis is necessary in order to guide clinical
decision making, and the rWGS testing may aid in guiding the treatment or management
of the enrollee's condition; and
new text end
new text begin
(3) the enrollee's complex or acute illness of unknown etiology includes at least one of
the following conditions:
new text end
new text begin
(i) congenital anomalies involving at least two organ systems, or complex or multiple
congenital anomalies in one organ system;
new text end
new text begin
(ii) specific organ malformations that are highly suggestive of a genetic etiology;
new text end
new text begin
(iii) abnormal laboratory tests or abnormal chemistry profiles suggesting the presence
of a genetic disease, complex metabolic disorder, or inborn error of metabolism;
new text end
new text begin
(iv) refractory or severe hypoglycemia or hyperglycemia;
new text end
new text begin
(v) abnormal response to therapy related to an underlying medical condition affecting
vital organs or bodily systems;
new text end
new text begin
(vi) severe muscle weakness, rigidity, or spasticity;
new text end
new text begin
(vii) refractory seizures;
new text end
new text begin
(viii) a high-risk stratification on evaluation for a brief resolved unexplained event with
any of the following features:
new text end
new text begin
(A) a recurrent event without respiratory infection;
new text end
new text begin
(B) a recurrent seizure-like event; or
new text end
new text begin
(C) a recurrent cardiopulmonary resuscitation;
new text end
new text begin
(ix) abnormal cardiac diagnostic testing results that are suggestive of possible
channelopathies, arrhythmias, cardiomyopathies, myocarditis, or structural heart disease;
new text end
new text begin
(x) abnormal diagnostic imaging studies that are suggestive of underlying genetic
condition;
new text end
new text begin
(xi) abnormal physiologic function studies that are suggestive of an underlying genetic
etiology; or
new text end
new text begin
(xii) family genetic history related to the patient's condition.
new text end
new text begin Subd. 4. new text end
new text begin Cost sharing. new text end
new text begin
Coverage provided in this section is subject to the enrollee's
health plan cost-sharing requirements, including any deductibles, co-payments, or coinsurance
requirements that apply to diagnostic testing services.
new text end
new text begin Subd. 5. new text end
new text begin Payment for services provided. new text end
new text begin
If the enrollee's health plan uses a capitated
or bundled payment arrangement to reimburse a provider for services provided in an inpatient
setting, reimbursement for services covered under this section must be paid separately and
in addition to any reimbursement otherwise payable to the provider under the capitated or
bundled payment arrangement, unless the health carrier and the provider have negotiated
an increased capitated or bundled payment rate that includes the services covered under this
section.
new text end
new text begin Subd. 6. new text end
new text begin Genetic data. new text end
new text begin
Genetic data generated as a result of performing rWGS and
covered under this section: (1) must be used for the primary purpose of assisting the ordering
provider and treating care team to diagnose and treat the patient; (2) is protected health
information as set forth under the Health Insurance Portability and Accountability Act
(HIPAA), the Health Information Technology for Economic and Clinical Health Act, and
any promulgated regulations, including but not limited to Code of Federal Regulations, title
45, parts 160 and 164, subparts A and E; and (3) is a protected health record under sections
144.291 to 144.298.
new text end
new text begin Subd. 7. new text end
new text begin Reimbursement. new text end
new text begin
The commissioner of commerce must reimburse health
carriers for coverage under this section. Reimbursement is available only for coverage that
would not have been provided by the health carrier without the requirements of this section.
Each fiscal year, an amount necessary to make payments to health carriers to defray the
cost of providing coverage under this section is appropriated to the commissioner of
commerce. Health carriers must report to the commissioner quantified costs attributable to
the additional benefit under this section in a format developed by the commissioner. The
commissioner must evaluate submissions and make payments to health carriers as provided
in Code of Federal Regulations, title 45, section 155.170.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025, and applies to a health
plan offered, issued, or sold on or after that date.
new text end
Sec. 3.
new text begin
[62A.59] COVERAGE OF SERVICE; PRIOR AUTHORIZATION.
new text end
new text begin Subdivision 1. new text end
new text begin Service for which prior authorization not required. new text end
new text begin
A health carrier
must not retrospectively deny or limit coverage of a health care service for which prior
authorization was not required by the health carrier, unless there is evidence that the health
care service was provided based on fraud or misinformation.
new text end
new text begin Subd. 2. new text end
new text begin Service for which prior authorization required but not obtained. new text end
new text begin
A health
carrier must not deny or limit coverage of a health care service which the enrollee has already
received solely on the basis of lack of prior authorization if the service would otherwise
have been covered had the prior authorization been obtained.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2026, and applies to health
plans offered, sold, issued, or renewed on or after that date.
new text end
Sec. 4.
new text begin
[62C.045] APPLICATION OF OTHER LAW.
new text end
new text begin
Sections 145D.30 to 145D.37 apply to service plan corporations operating under this
chapter.
new text end
Sec. 5.
Minnesota Statutes 2022, section 62D.02, subdivision 4, is amended to read:
Subd. 4.
Health maintenance organization.
"Health maintenance organization" means
a deleted text begin foreign or domesticdeleted text end new text begin nonprofitnew text end corporationnew text begin organized under chapter 317Anew text end , or a local
governmental unit as defined in subdivision 11, controlled and operated as provided in
sections 62D.01 to 62D.30, which provides, either directly or through arrangements with
providers or other persons, comprehensive health maintenance services, or arranges for the
provision of these services, to enrollees on the basis of a fixed prepaid sum without regard
to the frequency or extent of services furnished to any particular enrollee.
Sec. 6.
Minnesota Statutes 2022, section 62D.02, subdivision 7, is amended to read:
Subd. 7.
Comprehensive health maintenance services.
"Comprehensive health
maintenance services" means a set of comprehensive health services which the enrollees
might reasonably require to be maintained in good health including as a minimum, but not
limited to, emergency care, emergency ground ambulance transportation services, inpatient
hospital and physician care, outpatient health services and preventive health services.
deleted text begin Elective, induced abortion, except as medically necessary to prevent the death of the mother,
whether performed in a hospital, other abortion facility or the office of a physician, shall
not be mandatory for any health maintenance organization.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025, and applies to health
plans offered, sold, issued, or renewed on or after that date.
new text end
Sec. 7.
Minnesota Statutes 2022, section 62D.03, subdivision 1, is amended to read:
Subdivision 1.
Certificate of authority required.
Notwithstanding any law of this state
to the contrary, any deleted text begin foreign or domesticdeleted text end new text begin nonprofitnew text end corporation organized to do so or a local
governmental unit may apply to the commissioner of health for a certificate of authority to
establish and operate a health maintenance organization in compliance with sections 62D.01
to 62D.30. No person shall establish or operate a health maintenance organization in this
state, nor sell or offer to sell, or solicit offers to purchase or receive advance or periodic
consideration in conjunction with a health maintenance organization or health maintenance
contract unless the organization has a certificate of authority under sections 62D.01 to
62D.30.
Sec. 8.
Minnesota Statutes 2022, section 62D.05, subdivision 1, is amended to read:
Sec. 9.
Minnesota Statutes 2022, section 62D.06, subdivision 1, is amended to read:
Subdivision 1.
Governing body composition; enrollee advisory body.
The governing
body of any health maintenance organization which is a new text begin nonprofit new text end corporation may include
enrollees, providers, or other individuals; provided, however, that after a health maintenance
organization which is a new text begin nonprofit new text end corporation has been authorized under sections 62D.01
to 62D.30 for one year, at least 40 percent of the governing body shall be composed of
enrollees and members elected by the enrollees and members from among the enrollees and
members. For purposes of this section, "member" means a consumer who receives health
care services through a self-insured contract that is administered by the health maintenance
organization or its related third-party administrator. The number of members elected to the
governing body shall not exceed the number of enrollees elected to the governing body. An
enrollee or member elected to the governing board may not be a person:
(1) whose occupation involves, or before retirement involved, the administration of
health activities or the provision of health services;
(2) who is or was employed by a health care facility as a licensed health professional;
or
(3) who has or had a direct substantial financial or managerial interest in the rendering
of a health service, other than the payment of a reasonable expense reimbursement or
compensation as a member of the board of a health maintenance organization.
After a health maintenance organization which is a local governmental unit has been
authorized under sections 62D.01 to 62D.30 for one year, an enrollee advisory body shall
be established. The enrollees who make up this advisory body shall be elected by the enrollees
from among the enrollees.
Sec. 10.
Minnesota Statutes 2022, section 62D.12, subdivision 19, is amended to read:
Subd. 19.
Coverage of service.
A health maintenance organization may not deny or
limit coverage of a service which the enrollee has already received solely on the basis of
lack of prior authorization or second opinion, to the extent that the service would otherwise
have been covered under the member's contract by the health maintenance organization had
prior authorization or second opinion been obtained.new text begin This subdivision expires December
31, 2025, for health plans offered, sold, issued, or renewed on or after that date.
new text end
Sec. 11.
Minnesota Statutes 2022, section 62D.19, is amended to read:
62D.19 UNREASONABLE EXPENSES.
No health maintenance organization shall incur or pay for any expense of any nature
which is unreasonably high in relation to the value of the service or goods provided. The
commissioner of health shall implement and enforce this section by rules adopted under
this section.
In an effort to achieve the stated purposes of sections 62D.01 to 62D.30new text begin , in order to
safeguard the underlying nonprofit status of health maintenance organizations,new text end and new text begin in order
new text end to ensure that the payment of health maintenance organization money to major participating
entities results in a corresponding benefit to the health maintenance organization and its
enrollees, when determining whether an organization has incurred an unreasonable expense
in relation to a major participating entity, due consideration shall be given to, in addition
to any other appropriate factors, whether the officers and trustees of the health maintenance
organization have acted with good faith and in the best interests of the health maintenance
organization in entering into, and performing under, a contract under which the health
maintenance organization has incurred an expense. The commissioner has standing to sue,
on behalf of a health maintenance organization, officers or trustees of the health maintenance
organization who have breached their fiduciary duty in entering into and performing such
contracts.
Sec. 12.
Minnesota Statutes 2022, section 62D.20, subdivision 1, is amended to read:
Subdivision 1.
Rulemaking.
The commissioner of health may, pursuant to chapter 14,
promulgate such reasonable rules as are necessary or proper to carry out the provisions of
sections 62D.01 to 62D.30. Included among such rules shall be those which provide minimum
requirements for the provision of comprehensive health maintenance services, as defined
in section 62D.02, subdivision 7, and reasonable exclusions therefrom. deleted text begin Nothing in such
rules shall force or require a health maintenance organization to provide elective, induced
abortions, except as medically necessary to prevent the death of the mother, whether
performed in a hospital, other abortion facility, or the office of a physician; the rules shall
provide every health maintenance organization the option of excluding or including elective,
induced abortions, except as medically necessary to prevent the death of the mother, as part
of its comprehensive health maintenance services.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025, and applies to health
plans offered, sold, issued, or renewed on or after that date.
new text end
Sec. 13.
Minnesota Statutes 2022, section 62D.22, subdivision 5, is amended to read:
Subd. 5.
Other state law.
Except as otherwise provided in sections 62A.01 to 62A.42
and 62D.01 to 62D.30, deleted text begin and except as they eliminate elective, induced abortions, wherever
performed, from health or maternity benefits,deleted text end provisions of the insurance laws and provisions
of nonprofit health service plan corporation laws shall not be applicable to any health
maintenance organization granted a certificate of authority under sections 62D.01 to 62D.30.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025, and applies to health
plans offered, sold, issued, or renewed on or after that date.
new text end
Sec. 14.
Minnesota Statutes 2022, section 62D.22, is amended by adding a subdivision to
read:
new text begin Subd. 5a. new text end
new text begin Application of other law. new text end
new text begin
Sections 145D.30 to 145D.37 apply to nonprofit
health maintenance organizations operating under this chapter.
new text end
Sec. 15.
new text begin
[62D.221] OVERSIGHT OF TRANSACTIONS.
new text end
new text begin Subdivision 1. new text end
new text begin
Insurance provisions applicable to health maintenance
organizations.
new text end
new text begin
(a) Health maintenance organizations are subject to sections 60A.135,
60A.136, 60A.137, 60A.16, 60A.161, 60D.17, 60D.18, and 60D.20 and must comply with
the provisions of these sections applicable to insurers. In applying these sections to health
maintenance organizations, "the commissioner" means the commissioner of health. Health
maintenance organizations are subject to Minnesota Rules, chapter 2720, as applicable to
sections 60D.17, 60D.18, and 60D.20, and must comply with those provisions of the chapter
applicable to insurers unless the commissioner of health adopts rules to implement this
subdivision.
new text end
new text begin
(b) In addition to the conditions in section 60D.17, subdivision 1, subjecting a health
maintenance organization to filing requirements, no person other than the issuer shall acquire
all or substantially all of the assets of a domestic nonprofit health maintenance organization
through any means unless at the time the offer, request, or invitation is made or the agreement
is entered into the person has filed with the commissioner and has sent to the health
maintenance organization a statement containing the information required in section 60D.17
and the offer, request, invitation, agreement, or acquisition has been approved by the
commissioner of health in the manner prescribed in section 60D.17.
new text end
new text begin Subd. 2. new text end
new text begin Conversion transactions. new text end
new text begin
If a health maintenance organization must notify or
report a transaction to the commissioner under subdivision 1, the health maintenance
organization must include information regarding the plan for a conversion benefit entity,
in the form and manner determined by the commissioner, if the reportable transaction
qualifies as a conversion transaction as defined in section 145D.30, subdivision 5. The
commissioner may consider information regarding the conversion transaction and the
conversion benefit entity plan in any actions taken under subdivision 1, including in decisions
to approve or disapprove transactions, and may extend time frames to a total of 90 days,
with notice to the parties to the transaction.
new text end
Sec. 16.
Minnesota Statutes 2022, section 62E.02, subdivision 3, is amended to read:
Subd. 3.
Health maintenance organization.
"Health maintenance organization" means
a new text begin nonprofit new text end corporation licensed and operated as provided in chapter 62D.
Sec. 17.
Minnesota Statutes 2022, section 62M.01, subdivision 3, is amended to read:
Subd. 3.
Scope.
(a) Nothing in this chapter applies to review of claims after submission
to determine eligibility for benefits under a health benefit plan. The appeal procedure
described in section 62M.06 applies to any complaint as defined under section 62Q.68,
subdivision 2, that requires a medical determination in its resolution.
(b) new text begin Effective January 1, 2026, new text end this chapter deleted text begin does not applydeleted text end new text begin appliesnew text end to managed care plans
or county-based purchasing plans when the plan is providing coverage to state public health
care program enrollees under chapter 256B or 256L.
new text begin
(c) Effective January 1, 2026, the following sections of this chapter apply to services
delivered through fee-for-service under chapters 256B and 256L: 62M.02, subdivisions 1
to 5, 7 to 12, 13, 14 to 18, and 21; 62M.04; 62M.05, subdivisions 1 to 4; 62M.06, subdivisions
1 to 3; 62M.07; 62M.072; 62M.09; 62M.10; 62M.12; and 62M.17, subdivision 2.
new text end
Sec. 18.
Minnesota Statutes 2022, section 62M.02, subdivision 1a, is amended to read:
Subd. 1a.
Adverse determination.
"Adverse determination" means a decision by a
utilization review organization relating to an admission, extension of stay, or health care
service that is partially or wholly adverse to the enrollee, includingnew text begin :
new text end
new text begin (1)new text end a decision to deny an admission, extension of stay, or health care service on the basis
that it is not medically necessarynew text begin ; or
new text end
new text begin (2) an authorization for a health care service that is less intensive than the health care
service specified in the original request for authorizationnew 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. 19.
Minnesota Statutes 2022, section 62M.02, subdivision 5, is amended to read:
Subd. 5.
Authorization.
"Authorization" means a determination by a utilization review
organization that an admission, extension of stay, or other health care service has been
reviewed and that, based on the information provided, it satisfies the utilization review
requirements of the applicable health new text begin benefit new text end plan and the health plan company new text begin or
commissioner new text end will then pay for the covered benefit, provided the preexisting limitation
provisions, the general exclusion provisions, and any deductible, co-payment, coinsurance,
or other policy requirements have been met.
Sec. 20.
Minnesota Statutes 2022, section 62M.02, is amended by adding a subdivision
to read:
new text begin Subd. 8a. new text end
new text begin Commissioner. new text end
new text begin
"Commissioner" means, effective January 1, 2026, for the
sections specified in section 62M.01, subdivision 3, paragraph (c), the commissioner of
human services, unless otherwise specified.
new text end
Sec. 21.
Minnesota Statutes 2022, section 62M.02, subdivision 11, is amended to read:
Subd. 11.
Enrollee.
"Enrollee" meansnew text begin :
new text end
new text begin (1)new text end an individual covered by a health benefit plan and includes an insured policyholder,
subscriber, contract holder, member, covered person, or certificate holdernew text begin ; or
new text end
new text begin (2) effective January 1, 2026, for the sections specified in section 62M.01, subdivision
3, paragraph (c), a recipient receiving coverage through fee-for-service under chapters 256B
and 256Lnew text end .
Sec. 22.
Minnesota Statutes 2022, section 62M.02, subdivision 12, is amended to read:
Subd. 12.
Health benefit plan.
new text begin (a) new text end "Health benefit plan" meansnew text begin :
new text end
new text begin (1)new text end a policy, contract, or certificate issued by a health plan company for the coverage of
medical, dental, or hospital benefitsnew text begin ; or
new text end
new text begin (2) effective January 1, 2026, for the sections specified in section 62M.01, subdivision
3, paragraph (c), coverage of medical, dental, or hospital benefits through fee-for-service
under chapters 256B and 256L, as specified by the commissioner on the agency's public
website or through other forms of recipient and provider guidancenew text end .
new text begin (b)new text end A health benefit plan does not include coverage that is:
(1) limited to disability or income protection coverage;
(2) automobile medical payment coverage;
(3) supplemental to liability insurance;
(4) designed solely to provide payments on a per diem, fixed indemnity, or nonexpense
incurred basis;
(5) credit accident and health insurance issued under chapter 62B;
(6) blanket accident and sickness insurance as defined in section 62A.11;
(7) accident only coverage issued by a licensed and tested insurance agent; or
(8) workers' compensation.
Sec. 23.
Minnesota Statutes 2022, section 62M.02, subdivision 21, is amended to read:
Subd. 21.
Utilization review organization.
"Utilization review organization" means an
entity including but not limited to an insurance company licensed under chapter 60A to
offer, sell, or issue a policy of accident and sickness insurance as defined in section 62A.01;
a prepaid limited health service organization issued a certificate of authority and operating
under sections 62A.451 to 62A.4528; a health service plan licensed under chapter 62C; a
health maintenance organization licensed under chapter 62D; a community integrated service
network licensed under chapter 62N; an accountable provider network operating under
chapter 62T; a fraternal benefit society operating under chapter 64B; a joint self-insurance
employee health plan operating under chapter 62H; a multiple employer welfare arrangement,
as defined in section 3 of the Employee Retirement Income Security Act of 1974 (ERISA),
United States Code, title 29, section 1103, as amended; a third-party administrator licensed
under section 60A.23, subdivision 8, which conducts utilization review and authorizes or
makes adverse determinations regarding an admission, extension of stay, or other health
care services for a Minnesota resident; new text begin effective January 1, 2026, for the sections specified
in section 62M.01, subdivision 3, paragraph (c), the commissioner of human services for
purposes of delivering services through fee-for-service under chapters 256B and 256L; new text end any
other entity that provides, offers, or administers hospital, outpatient, medical, prescription
drug, or other health benefits to individuals treated by a health professional under a policy,
plan, or contract; or any entity performing utilization review that is affiliated with, under
contract with, or conducting utilization review on behalf of, a business entity in this state.
Utilization review organization does not include a clinic or health care system acting pursuant
to a written delegation agreement with an otherwise regulated utilization review organization
that contracts with the clinic or health care system. The regulated utilization review
organization is accountable for the delegated utilization review activities of the clinic or
health care system.
Sec. 24.
Minnesota Statutes 2022, section 62M.04, subdivision 1, is amended to read:
Subdivision 1.
Responsibility for obtaining authorization.
A health benefit plan that
includes utilization review requirements must specify the process for notifying the utilization
review organization in a timely manner and obtaining authorization for health care services.
Each health plan company must provide a clear and concise description of this process to
an enrollee as part of the policy, subscriber contract, or certificate of coverage. new text begin Effective
January 1, 2026, the commissioner must provide a clear and concise description of this
process to fee-for-service recipients receiving services under chapters 256B and 256L,
through the agency's public website or through other forms of recipient guidance. new text end In addition
to the enrollee, the utilization review organization must allow any provider or provider's
designee, or responsible patient representative, including a family member, to fulfill the
obligations under the health new text begin benefit new text end plan.
A claims administrator that contracts directly with providers for the provision of health
care services to enrollees may, through contract, require the provider to notify the review
organization in a timely manner and obtain authorization for health care services.
Sec. 25.
Minnesota Statutes 2022, section 62M.05, subdivision 3a, is amended to read:
Subd. 3a.
Standard review determination.
(a) deleted text begin Notwithstanding subdivision 3b, a
standard review determination on all requests for utilization review must be communicated
to the provider and enrollee in accordance with this subdivision within five business days
after receiving the request if the request is received electronically, or within six business
days if received through nonelectronic means, provided that all information reasonably
necessary to make a determination on the request has been made available to the utilization
review organization. Effective January 1, 2022,deleted text end A standard review determination on all
requests for utilization review must be communicated to the provider and enrollee in
accordance with this subdivision within five business days after receiving the request,
regardless of how the request was received, provided that all information reasonably
necessary to make a determination on the request has been made available to the utilization
review organization.
(b) When a determination is made to authorize, notification must be provided promptly
by telephone to the provider. The utilization review organization shall send written
notification to the provider or shall maintain an audit trail of the determination and telephone
notification. For purposes of this subdivision, "audit trail" includes documentation of the
telephone notification, including the date; the name of the person spoken to; the enrollee;
the service, procedure, or admission authorized; and the date of the service, procedure, or
admission. If the utilization review organization indicates authorization by use of a number,
the number must be called the "authorization number." For purposes of this subdivision,
notification may also be made by facsimile to a verified number or by electronic mail to a
secure electronic mailbox. These electronic forms of notification satisfy the "audit trail"
requirement of this paragraph.
(c) When an adverse determination is made, notification must be provided within the
time periods specified in paragraph (a) by telephone, by facsimile to a verified number, or
by electronic mail to a secure electronic mailbox to the attending health care professional
and hospital or physician office as applicable. Written notification must also be sent to the
hospital or physician office as applicable and attending health care professional if notification
occurred by telephone. For purposes of this subdivision, notification may be made by
facsimile to a verified number or by electronic mail to a secure electronic mailbox. Written
notification must be sent to the enrollee and may be sent by United States mail, facsimile
to a verified number, or by electronic mail to a secure mailbox. The written notification
must include all reasons relied on by the utilization review organization for the determination
and the process for initiating an appeal of the determination. Upon request, the utilization
review organization shall provide the provider or enrollee with the criteria used to determine
the necessity, appropriateness, and efficacy of the health care service and identify the
database, professional treatment parameter, or other basis for the criteria. Reasons for an
adverse determination may include, among other things, the lack of adequate information
to authorize after a reasonable attempt has been made to contact the provider or enrollee.
(d) When an adverse determination is made, the written notification must inform the
enrollee and the attending health care professional of the right to submit an appeal to the
internal appeal process described in section 62M.06 and the procedure for initiating the
internal appeal. The written notice shall be provided in a culturally and linguistically
appropriate manner consistent with the provisions of the Affordable Care Act as defined
under section 62A.011, subdivision 1a.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 26.
Minnesota Statutes 2022, section 62M.07, subdivision 2, is amended to read:
Subd. 2.
Prior authorization of deleted text begin emergencydeleted text end new text begin certainnew text end services prohibited.
No utilization
review organization, health plan company, or claims administrator may conduct or require
prior authorization ofnew text begin :
new text end
new text begin (1)new text end emergency confinement or an emergency service. The enrollee or the enrollee's
authorized representative may be required to notify the health plan company, claims
administrator, or utilization review organization as soon as reasonably possible after the
beginning of the emergency confinement or emergency servicedeleted text begin .deleted text end new text begin ;
new text end
new text begin
(2) oral buprenorphine to treat a substance use disorder;
new text end
new text begin
(3) outpatient mental health treatment or outpatient substance use disorder treatment,
except for treatment which is: (i) a medication; and (ii) not otherwise listed in this
subdivision. Prior authorizations required for medications used for outpatient mental health
treatment or outpatient substance use disorder treatment, and not otherwise listed in this
subdivision, must be processed according to section 62M.05, subdivision 3b, for initial
determinations, and according to section 62M.06, subdivision 2, for appeals;
new text end
new text begin
(4) antineoplastic cancer treatment that is consistent with guidelines of the National
Comprehensive Cancer Network, except for treatment which is: (i) a medication; and (ii)
not otherwise listed in this subdivision. Prior authorizations required for medications used
for antineoplastic cancer treatment, and not otherwise listed in this subdivision, must be
processed according to section 62M.05, subdivision 3b, for initial determinations, and
according to section 62M.06, subdivision 2, for appeals;
new text end
new text begin
(5) services that currently have a rating of A or B from the United States Preventive
Services Task Force, immunizations recommended by the Advisory Committee on
Immunization Practices of the Centers for Disease Control and Prevention, or preventive
services and screenings provided to women as described in Code of Federal Regulations,
title 45, section 147.130;
new text end
new text begin
(6) pediatric hospice services provided by a hospice provider licensed under sections
144A.75 to 144A.755; and
new text end
new text begin
(7) treatment delivered through a neonatal abstinence program operated by pediatric
pain or palliative care subspecialists.
new text end
new text begin
Clauses (2) to (7) are effective January 1, 2026, and apply to health benefit plans offered,
sold, issued, or renewed on or after that date.
new text end
Sec. 27.
Minnesota Statutes 2022, section 62M.07, subdivision 4, is amended to read:
Subd. 4.
Submission of prior authorization requests.
new text begin (a) new text end If prior authorization for a
health care service is required, the utilization review organization, health plan company, or
claim administrator must allow providers to submit requests for prior authorization of the
health care services without unreasonable delay by telephone, facsimile, or voice mail or
through an electronic mechanism 24 hours a day, seven days a week. This subdivision does
not apply to dental service covered under MinnesotaCare or medical assistance.
new text begin
(b) Effective January 1, 2027, for health benefit plans offered, sold, issued, or renewed
on or after that date, utilization review organizations, health plan companies, and claims
administrators must have and maintain a prior authorization application programming
interface (API) that automates the prior authorization process for health care services,
excluding prescription drugs and medications. The API must allow providers to determine
whether a prior authorization is required for health care services, identify prior authorization
information and documentation requirements, and facilitate the exchange of prior
authorization requests and determinations from provider electronic health records or practice
management systems. The API must use the Health Level Seven (HL7) Fast Healthcare
Interoperability Resources (FHIR) standard in accordance with Code of Federal Regulations,
title 45, section 170.215(a)(1), and the most recent standards and guidance adopted by the
United States Department of Health and Human Services to implement that section. Prior
authorization submission requests for prescription drugs and medications must comply with
the requirements of section 62J.497.
new text end
Sec. 28.
Minnesota Statutes 2022, section 62M.07, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin Treatment of a chronic condition. new text end
new text begin
This subdivision is effective January 1,
2026, and applies to health benefit plans offered, sold, issued, or renewed on or after that
date. An authorization for treatment of a chronic health condition does not expire unless
the standard of treatment for that health condition changes. A chronic health condition is a
condition that is expected to last one year or more and:
new text end
new text begin
(1) requires ongoing medical attention to effectively manage the condition or prevent
an adverse health event; or
new text end
new text begin
(2) limits one or more activities of daily living.
new text end
Sec. 29.
Minnesota Statutes 2022, section 62M.10, subdivision 7, is amended to read:
Subd. 7.
Availability of criteria.
(a) For utilization review determinations other than
prior authorization, a utilization review organization shall, upon request, provide to an
enrollee, a provider, and the commissioner of commerce the criteria used to determine the
medical necessity, appropriateness, and efficacy of a procedure or service and identify the
database, professional treatment guideline, or other basis for the criteria.
(b) For prior authorization determinations, a utilization review organization must submit
the organization's current prior authorization requirements and restrictions, including written,
evidence-based, clinical criteria used to make an authorization or adverse determination, to
all health plan companies for which the organization performs utilization review. A health
plan company must post on its public website the prior authorization requirements and
restrictions of any utilization review organization that performs utilization review for the
health plan company. These prior authorization requirements and restrictions must be detailed
and written in language that is easily understandable to providers.new text begin This paragraph does not
apply to the commissioner of human services when delivering services through fee-for-service
under chapters 256B and 256L.
new text end
new text begin
(c) Effective January 1, 2026, the commissioner of human services must post on the
department's public website the prior authorization requirements and restrictions, including
written, evidence-based, clinical criteria used to make an authorization or adverse
determination, that apply to prior authorization determinations for fee-for-service under
chapters 256B and 256L. These prior authorization requirements and restrictions must be
detailed and written in language that is easily understandable to providers.
new text end
Sec. 30.
Minnesota Statutes 2022, section 62M.10, subdivision 8, is amended to read:
Subd. 8.
Notice; new prior authorization requirements or restrictions; change to
existing requirement or restriction.
(a) Before a utilization review organization may
implement a new prior authorization requirement or restriction or amend an existing prior
authorization requirement or restriction, the utilization review organization must submit the
new or amended requirement or restriction to all health plan companies for which the
organization performs utilization review. A health plan company must post on its website
the new or amended requirement or restriction.new text begin This paragraph does not apply to the
commissioner of human services when delivering services through fee-for-service under
chapters 256B and 256L.
new text end
(b) At least 45 days before a new prior authorization requirement or restriction or an
amended existing prior authorization requirement or restriction is implemented, the utilization
review organization, health plan company, or claims administrator must provide written or
electronic notice of the new or amended requirement or restriction to all Minnesota-based,
in-network attending health care professionals who are subject to the prior authorization
requirements and restrictions.new text begin This paragraph does not apply to the commissioner of human
services when delivering services through fee-for-service under chapters 256B and 256L.
new text end
new text begin
(c) Effective January 1, 2026, before the commissioner of human services may implement
a new prior authorization requirement or restriction or amend an existing prior authorization
requirement or restriction, the commissioner, at least 45 days before the new or amended
requirement or restriction takes effect, must provide written or electronic notice of the new
or amended requirement or restriction, to all health care professionals participating as
fee-for-service providers under chapters 256B and 256L who are subject to the prior
authorization requirements and restrictions.
new text end
Sec. 31.
Minnesota Statutes 2022, section 62M.17, subdivision 2, is amended to read:
Subd. 2.
Effect of change in prior authorization clinical criteria.
(a) If, during a plan
year, a utilization review organization changes coverage terms for a health care service or
the clinical criteria used to conduct prior authorizations for a health care service, the change
in coverage terms or change in clinical criteria shall not apply until the next plan year for
any enrollee who received prior authorization for a health care service using the coverage
terms or clinical criteria in effect before the effective date of the change.
(b) Paragraph (a) does not apply if a utilization review organization changes coverage
terms for a drug or device that has been deemed unsafe by the United States Food and Drug
Administration (FDA); that has been withdrawn by either the FDA or the product
manufacturer; or when an independent source of research, clinical guidelines, or
evidence-based standards has issued drug- or device-specific warnings or recommended
changes in drug or device usage.
(c) Paragraph (a) does not apply if a utilization review organization changes coverage
terms for a service or the clinical criteria used to conduct prior authorizations for a service
when an independent source of research, clinical guidelines, or evidence-based standards
has recommended changes in usage of the service for reasons related to patient harm.new text begin This
paragraph expires December 31, 2025, for health benefit plans offered, sold, issued, or
renewed on or after that date.
new text end
new text begin
(d) Effective January 1, 2026, and applicable to health benefit plans offered, sold, issued,
or renewed on or after that date, paragraph (a) does not apply if a utilization review
organization changes coverage terms for a service or the clinical criteria used to conduct
prior authorizations for a service when an independent source of research, clinical guidelines,
or evidence-based standards has recommended changes in usage of the service for reasons
related to previously unknown and imminent patient harm.
new text end
deleted text begin (d)deleted text end new text begin (e)new text end Paragraph (a) does not apply if a utilization review organization removes a brand
name drug from its formulary or places a brand name drug in a benefit category that increases
the enrollee's cost, provided the utilization review organization (1) adds to its formulary 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 (2) provides at least a 60-day notice to
prescribers, pharmacists, and affected enrollees.
Sec. 32.
new text begin
[62M.19] ANNUAL REPORT TO COMMISSIONER OF HEALTH; PRIOR
AUTHORIZATIONS.
new text end
new text begin
On or before September 1 each year, each utilization review organization must report
to the commissioner of health, in a form and manner specified by the commissioner,
information on prior authorization requests for the previous calendar year. The report
submitted under this subdivision must include the following data:
new text end
new text begin
(1) the total number of prior authorization requests received;
new text end
new text begin
(2) the number of prior authorization requests for which an authorization was issued;
new text end
new text begin
(3) the number of prior authorization requests for which an adverse determination was
issued;
new text end
new text begin
(4) the number of adverse determinations reversed on appeal;
new text end
new text begin
(5) the 25 codes with the highest number of prior authorization requests and the
percentage of authorizations for each of these codes;
new text end
new text begin
(6) the 25 codes with the highest percentage of prior authorization requests for which
an authorization was issued and the total number of the requests;
new text end
new text begin
(7) the 25 codes with the highest percentage of prior authorization requests for which
an adverse determination was issued but which was reversed on appeal and the total number
of the requests;
new text end
new text begin
(8) the 25 codes with the highest percentage of prior authorization requests for which
an adverse determination was issued and the total number of the requests; and
new text end
new text begin
(9) the reasons an adverse determination to a prior authorization request was issued,
expressed as a percentage of all adverse determinations. The reasons listed may include but
are not limited to:
new text end
new text begin
(i) the patient did not meet prior authorization criteria;
new text end
new text begin
(ii) incomplete information was submitted by the provider to the utilization review
organization;
new text end
new text begin
(iii) the treatment program changed; and
new text end
new text begin
(iv) the patient is no longer covered by the health benefit plan.
new text end
Sec. 33.
Minnesota Statutes 2022, section 62Q.14, is amended to read:
62Q.14 RESTRICTIONS ON ENROLLEE SERVICES.
No health plan company may restrict the choice of an enrollee as to where the enrollee
receives services related to:
(1) the voluntary planning of the conception and bearing of childrendeleted text begin , provided that this
clause does not refer to abortion servicesdeleted text end ;
(2) the diagnosis of infertility;
(3) the testing and treatment of a sexually transmitted disease; and
(4) the testing for AIDS or other HIV-related conditions.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025, and applies to health
plans offered, sold, issued, or renewed on or after that date.
new text end
Sec. 34.
Minnesota Statutes 2022, section 62Q.1841, subdivision 2, is amended to read:
Subd. 2.
Prohibition on use of new text begin prior authorization or new text end step therapy protocols.
A health
plan that provides coverage for the treatment of stage four advanced metastatic cancer or
associated conditions must not limit or exclude coverage for a drug approved by the United
States Food and Drug Administration deleted text begin that is on the health plan's prescription drug formularydeleted text end
by mandating that an enrollee with stage four advanced metastatic cancer or associated
conditions new text begin obtain a prior authorization or new text end follow a step therapy protocol if the use of the
approved drug is consistent with:
(1) a United States Food and Drug Administration-approved indication; and
(2) a clinical practice guideline published by the National Comprehensive Care Network.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025, and applies to health
plans offered, sold, issued, or renewed on or after that date.
new text end
Sec. 35.
Minnesota Statutes 2022, section 62Q.19, subdivision 3, is amended to read:
Subd. 3.
Health plan company affiliation.
A health plan company must offer a provider
contract to deleted text begin anydeleted text end new text begin allnew text end designated essential community deleted text begin providerdeleted text end new text begin providersnew text end located within the
area served by the health plan company. new text begin A health plan company must include all essential
community providers that have accepted a contract in each of the company's provider
networks. new text end A health plan company shall not restrict enrollee access to services designated
to be provided by the essential community provider for the population that the essential
community provider is certified to serve. A health plan company may also make other
providers available for these services. A health plan company may require an essential
community provider to meet all data requirements, utilization review, and quality assurance
requirements on the same basis as other health plan providers.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025, and applies to health
plans offered, issued, or renewed on or after that date.
new text end
Sec. 36.
Minnesota Statutes 2022, section 62Q.19, is amended by adding a subdivision to
read:
new text begin Subd. 4a. new text end
new text begin Contract payment rates; private. new text end
new text begin
An essential community provider and a
health plan company may negotiate the payment rate for covered services provided by the
essential community provider. This rate must be at least the same rate per unit of service
as is paid by the health plan company to the essential community provider under the provider
contract between the two with the highest number of enrollees receiving health care services
from the provider or, if there is no provider contract between the health plan company and
the essential community provider, the rate must be at least the same rate per unit of service
as is paid to other plan providers for the same or similar services. The provider contract
used to set the rate under this subdivision must be in relation to an individual, small group,
or large group health plan. This subdivision applies only to provider contracts in relation
to individual, small employer, and large group health plans.
new text end
Sec. 37.
Minnesota Statutes 2022, section 62Q.19, subdivision 5, is amended to read:
Subd. 5.
Contract payment ratesnew text begin ; publicnew text end .
An essential community provider and a
health plan company may negotiate the payment rate for covered services provided by the
essential community provider. This rate must be at least the same rate per unit of service
as is paid to other health plan providers for the same or similar services. new text begin This subdivision
applies only to provider contracts in relation to health plans offered through the State
Employee Group Insurance Program, medical assistance, and MinnesotaCare.
new text end
Sec. 38.
Minnesota Statutes 2023 Supplement, section 62Q.522, subdivision 1, is amended
to read:
Subdivision 1.
Definitions.
(a) The definitions in this subdivision apply to this section.
deleted text begin
(b) "Closely held for-profit entity" means an entity that:
deleted text end
deleted text begin
(1) is not a nonprofit entity;
deleted text end
deleted text begin
(2) has more than 50 percent of the value of its ownership interest owned directly or
indirectly by five or fewer owners; and
deleted text end
deleted text begin
(3) has no publicly traded ownership interest.
deleted text end
deleted text begin
For purposes of this paragraph:
deleted text end
deleted text begin
(i) ownership interests owned by a corporation, partnership, limited liability company,
estate, trust, or similar entity are considered owned by that entity's shareholders, partners,
members, or beneficiaries in proportion to their interest held in the corporation, partnership,
limited liability company, estate, trust, or similar entity;
deleted text end
deleted text begin
(ii) ownership interests owned by a nonprofit entity are considered owned by a single
owner;
deleted text end
deleted text begin
(iii) ownership interests owned by all individuals in a family are considered held by a
single owner. For purposes of this item, "family" means brothers and sisters, including
half-brothers and half-sisters, a spouse, ancestors, and lineal descendants; and
deleted text end
deleted text begin
(iv) if an individual or entity holds an option, warrant, or similar right to purchase an
ownership interest, the individual or entity is considered to be the owner of those ownership
interests.
deleted text end
deleted text begin (c)deleted text end new text begin (b)new text end "Contraceptive method" means a drug, device, or other product approved by the
Food and Drug Administration to prevent unintended pregnancy.
deleted text begin (d)deleted text end new text begin (c)new text end "Contraceptive service" means consultation, examination, procedures, and medical
services related to the prevention of unintended pregnancy, excluding vasectomies. This
includes but is not limited to voluntary sterilization procedures, patient education, counseling
on contraceptives, and follow-up services related to contraceptive methods or services,
management of side effects, counseling for continued adherence, and device insertion or
removal.
deleted text begin
(e) "Eligible organization" means an organization that opposes providing coverage for
some or all contraceptive methods or services on account of religious objections and that
is:
deleted text end
deleted text begin
(1) organized as a nonprofit entity and holds itself out to be religious; or
deleted text end
deleted text begin
(2) organized and operates as a closely held for-profit entity, and the organization's
owners or highest governing body has adopted, under the organization's applicable rules of
governance and consistent with state law, a resolution or similar action establishing that the
organization objects to covering some or all contraceptive methods or services on account
of the owners' sincerely held religious beliefs.
deleted text end
deleted text begin
(f) "Exempt organization" means an organization that is organized and operates as a
nonprofit entity and meets the requirements of section 6033(a)(3)(A)(i) or (iii) of the Internal
Revenue Code of 1986, as amended.
deleted text end
deleted text begin (g)deleted text end new text begin (d)new text end "Medical necessity" includes but is not limited to considerations such as severity
of side effects, difference in permanence and reversibility of a contraceptive method or
service, and ability to adhere to the appropriate use of the contraceptive method or service,
as determined by the attending provider.
deleted text begin (h)deleted text end new text begin (e)new text end "Therapeutic equivalent version" means a drug, device, or product that can be
expected to have the same clinical effect and safety profile when administered to a patient
under the conditions specified in the labeling, and that:
(1) is approved as safe and effective;
(2) is a pharmaceutical equivalent: (i) containing identical amounts of the same active
drug ingredient in the same dosage form and route of administration; and (ii) meeting
compendial or other applicable standards of strength, quality, purity, and identity;
(3) is bioequivalent in that:
(i) the drug, device, or product does not present a known or potential bioequivalence
problem and meets an acceptable in vitro standard; or
(ii) if the drug, device, or product does present a known or potential bioequivalence
problem, it is shown to meet an appropriate bioequivalence standard;
(4) is adequately labeled; and
(5) is manufactured in compliance with current manufacturing practice regulations.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025, and applies to health
plans offered, sold, issued, or renewed on of after that date.
new text end
Sec. 39.
Minnesota Statutes 2023 Supplement, section 62Q.523, subdivision 1, is amended
to read:
Subdivision 1.
Scope of coverage.
Except as otherwise provided in section deleted text begin 62Q.522deleted text end new text begin
62Q.679new text end , subdivisions new text begin 2 and new text end 3 deleted text begin and 4deleted text end , all health plans that provide prescription coverage
must comply with the requirements of this section.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025, and applies to health
plans offered, sold, issued, or renewed on or after that date.
new text end
Sec. 40.
new text begin
[62Q.524] COVERAGE OF ABORTIONS AND ABORTION-RELATED
SERVICES.
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 section, "abortion" means any medical
treatment intended to induce the termination of a pregnancy with a purpose other than
producing a live birth.
new text end
new text begin Subd. 2. new text end
new text begin Required coverage; cost-sharing. new text end
new text begin
(a) A health plan must provide coverage
for abortions and abortion-related services, including preabortion services and follow-up
services.
new text end
new text begin
(b) A health plan must not impose on the coverage under this section any co-payment,
coinsurance, deductible, or other enrollee cost-sharing that is greater than the cost-sharing
that applies to similar services covered under the health plan.
new text end
new text begin
(c) A health plan must not impose any limitation on the coverage under this section,
including but not limited to any utilization review, prior authorization, referral requirements,
restrictions, or delays, that is not generally applicable to other coverages under the plan.
new text end
new text begin Subd. 3. new text end
new text begin Exclusion. new text end
new text begin
This section does not apply to managed care organizations or
county-based purchasing plans when the plan provides coverage to public health care
program enrollees under chapter 256B or 256L.
new text end
new text begin Subd. 4. new text end
new text begin Reimbursement. new text end
new text begin
The commissioner of commerce must reimburse health plan
companies for coverage under this section. Reimbursement is available only for coverage
that would not have been provided by the health plan company without the requirements
of this section. Each fiscal year, an amount necessary to make payments to health plan
companies to defray the cost of providing coverage under this section is appropriated to the
commissioner of commerce. Health plan companies must report to the commissioner
quantified costs attributable to the additional benefit under this section in a format developed
by the commissioner. The commissioner must evaluate submissions and make payments to
health plan companies as provided in Code of Federal Regulations, title 45, section 155.170.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025, and applies to health
plans offered, sold, issued, or renewed on or after that date.
new text end
Sec. 41.
new text begin
[62Q.531] AMINO ACID-BASED FORMULA COVERAGE.
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 term has the
meaning given.
new text end
new text begin
(b) "Formula" means an amino acid-based elemental formula.
new text end
new text begin Subd. 2. new text end
new text begin Required coverage. new text end
new text begin
A health plan company must provide coverage for formula
when formula is medically necessary.
new text end
new text begin Subd. 3. new text end
new text begin Covered conditions. new text end
new text begin
Conditions for which formula is medically necessary
include but are not limited to:
new text end
new text begin
(1) cystic fibrosis;
new text end
new text begin
(2) amino acid, organic acid, and fatty acid metabolic and malabsorption disorders;
new text end
new text begin
(3) IgE mediated allergies to food proteins;
new text end
new text begin
(4) food protein-induced enterocolitis syndrome;
new text end
new text begin
(5) eosinophilic esophagitis;
new text end
new text begin
(6) eosinophilic gastroenteritis;
new text end
new text begin
(7) eosinophilic colitis; and
new text end
new text begin
(8) mast cell activation syndrome.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025, and applies to health
plans offered, issued, or sold on or after that date.
new text end
Sec. 42.
new text begin
[62Q.585] GENDER-AFFIRMING CARE COVERAGE; MEDICALLY
NECESSARY CARE.
new text end
new text begin Subdivision 1. new text end
new text begin Requirement. new text end
new text begin
No health plan that covers physical or mental health
services may be offered, sold, issued, or renewed in this state that:
new text end
new text begin
(1) excludes coverage for medically necessary gender-affirming care; or
new text end
new text begin
(2) requires gender-affirming treatments to satisfy a definition of "medically necessary
care," "medical necessity," or any similar term that is more restrictive than the definition
provided in subdivision 2.
new text end
new text begin Subd. 2. new text end
new text begin Minimum definition. new text end
new text begin
"Medically necessary care" means health care services
appropriate in terms of type, frequency, level, setting, and duration to the enrollee's diagnosis
or condition and diagnostic testing and preventive services. Medically necessary care must
be consistent with generally accepted practice parameters as determined by health care
providers in the same or similar general specialty as typically manages the condition,
procedure, or treatment at issue and must:
new text end
new text begin
(1) help restore or maintain the enrollee's health; or
new text end
new text begin
(2) prevent deterioration of the enrollee's condition.
new text end
new text begin Subd. 3. 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) "Gender-affirming care" means all medical, surgical, counseling, or referral services,
including telehealth services, that an individual may receive to support and affirm the
individual's gender identity or gender expression and that are legal under the laws of this
state.
new text end
new text begin
(c) "Health plan" has the meaning given in section 62Q.01, subdivision 3, but includes
the coverages listed in section 62A.011, subdivision 3, clauses (7) and (10).
new text end
Sec. 43.
new text begin
[62Q.665] COVERAGE FOR ORTHOTIC AND PROSTHETIC DEVICES.
new text end
new text begin Subdivision 1. 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) "Accredited facility" means any entity that is accredited to provide comprehensive
orthotic or prosthetic devices or services by a Centers for Medicare and Medicaid Services
approved accrediting agency.
new text end
new text begin
(c) "Orthosis" means:
new text end
new text begin
(1) an external medical device that is:
new text end
new text begin
(i) custom-fabricated or custom-fitted to a specific patient based on the patient's unique
physical condition;
new text end
new text begin
(ii) applied to a part of the body to correct a deformity, provide support and protection,
restrict motion, improve function, or relieve symptoms of a disease, syndrome, injury, or
postoperative condition; and
new text end
new text begin
(iii) deemed medically necessary by a prescribing physician or licensed health care
provider who has authority in Minnesota to prescribe orthotic and prosthetic devices, supplies,
and services; and
new text end
new text begin
(2) any provision, repair, or replacement of a device that is furnished or performed by:
new text end
new text begin
(i) an accredited facility in comprehensive orthotic services; or
new text end
new text begin
(ii) a health care provider licensed in Minnesota and operating within the provider's
scope of practice which allows the provider to provide orthotic or prosthetic devices, supplies,
or services.
new text end
new text begin
(d) "Orthotics" means:
new text end
new text begin
(1) the science and practice of evaluating, measuring, designing, fabricating, assembling,
fitting, adjusting, or servicing and providing the initial training necessary to accomplish the
fitting of an orthotic device for the support, correction, or alleviation of a neuromuscular
or musculoskeletal dysfunction, disease, injury, or deformity;
new text end
new text begin
(2) evaluation, treatment, and consultation related to an orthotic device;
new text end
new text begin
(3) basic observation of gait and postural analysis;
new text end
new text begin
(4) assessing and designing orthosis to maximize function and provide support and
alignment necessary to prevent or correct a deformity or to improve the safety and efficiency
of mobility and locomotion;
new text end
new text begin
(5) continuing patient care to assess the effect of an orthotic device on the patient's
tissues; and
new text end
new text begin
(6) proper fit and function of the orthotic device by periodic evaluation.
new text end
new text begin
(e) "Prosthesis" means:
new text end
new text begin
(1) an external medical device that is:
new text end
new text begin
(i) used to replace or restore a missing limb, appendage, or other external human body
part; and
new text end
new text begin
(ii) deemed medically necessary by a prescribing physician or licensed health care
provider who has authority in Minnesota to prescribe orthotic and prosthetic devices, supplies,
and services; and
new text end
new text begin
(2) any provision, repair, or replacement of a device that is furnished or performed by:
new text end
new text begin
(i) an accredited facility in comprehensive prosthetic services; or
new text end
new text begin
(ii) a health care provider licensed in Minnesota and operating within the provider's
scope of practice which allows the provider to provide orthotic or prosthetic devices, supplies,
or services.
new text end
new text begin
(f) "Prosthetics" means:
new text end
new text begin
(1) the science and practice of evaluating, measuring, designing, fabricating, assembling,
fitting, aligning, adjusting, or servicing, as well as providing the initial training necessary
to accomplish the fitting of, a prosthesis through the replacement of external parts of a
human body lost due to amputation or congenital deformities or absences;
new text end
new text begin
(2) the generation of an image, form, or mold that replicates the patient's body segment
and that requires rectification of dimensions, contours, and volumes for use in the design
and fabrication of a socket to accept a residual anatomic limb to, in turn, create an artificial
appendage that is designed either to support body weight or to improve or restore function
or anatomical appearance, or both;
new text end
new text begin
(3) observational gait analysis and clinical assessment of the requirements necessary to
refine and mechanically fix the relative position of various parts of the prosthesis to maximize
function, stability, and safety of the patient;
new text end
new text begin
(4) providing and continuing patient care in order to assess the prosthetic device's effect
on the patient's tissues; and
new text end
new text begin
(5) assuring proper fit and function of the prosthetic device by periodic evaluation.
new text end
new text begin Subd. 2. new text end
new text begin Coverage. new text end
new text begin
(a) A health plan must provide coverage for orthotic and prosthetic
devices, supplies, and services, including repair and replacement, at least equal to the
coverage provided under federal law for health insurance for the aged and disabled under
sections 1832, 1833, and 1834 of the Social Security Act, United States Code, title 42,
sections 1395k, 1395l, and 1395m, but only to the extent consistent with this section.
new text end
new text begin
(b) A health plan must not subject orthotic and prosthetic benefits to separate financial
requirements that apply only with respect to those benefits. A health plan may impose
co-payment and coinsurance amounts on those benefits, except that any financial
requirements that apply to such benefits must not be more restrictive than the financial
requirements that apply to the health plan's medical and surgical benefits, including those
for internal restorative devices.
new text end
new text begin
(c) A health plan may limit the benefits for, or alter the financial requirements for,
out-of-network coverage of prosthetic and orthotic devices, except that the restrictions and
requirements that apply to those benefits must not be more restrictive than the financial
requirements that apply to the out-of-network coverage for the health plan's medical and
surgical benefits.
new text end
new text begin
(d) A health plan must cover orthoses and prostheses when furnished under an order by
a prescribing physician or licensed health care prescriber who has authority in Minnesota
to prescribe orthoses and prostheses, and that coverage for orthotic and prosthetic devices,
supplies, accessories, and services must include those devices or device systems, supplies,
accessories, and services that are customized to the covered individual's needs.
new text end
new text begin
(e) A health plan must cover orthoses and prostheses determined by the enrollee's provider
to be the most appropriate model that meets the medical needs of the enrollee for purposes
of performing physical activities, as applicable, including but not limited to running, biking,
and swimming, and maximizing the enrollee's limb function.
new text end
new text begin
(f) A health plan must cover orthoses and prostheses for showering or bathing.
new text end
new text begin Subd. 3. new text end
new text begin Prior authorization. new text end
new text begin
A health plan may require prior authorization for orthotic
and prosthetic devices, supplies, and services in the same manner and to the same extent as
prior authorization is required for any other covered benefit.
new text end
new text begin Subd. 4. new text end
new text begin Reimbursement. new text end
new text begin
The commissioner of commerce must reimburse health plan
companies for coverage under this section. Reimbursement is available only for coverage
that would not have been provided by the health plan company without the requirements
of this section. Each fiscal year, an amount necessary to make payments to health plan
companies to defray the cost of providing coverage under this section is appropriated to the
commissioner of commerce. Health plan companies must report to the commissioner
quantified costs attributable to the additional benefit under this section in a format developed
by the commissioner. The commissioner must evaluate submissions and make payments to
health plan companies as provided in Code of Federal Regulations, title 45, section 155.170.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025, and applies to all health
plans offered, issued, or renewed on or after that date.
new text end
Sec. 44.
new text begin
[62Q.666] MEDICAL NECESSITY AND NONDISCRIMINATION
STANDARDS FOR COVERAGE OF PROSTHETICS OR ORTHOTICS.
new text end
new text begin
(a) When performing a utilization review for a request for coverage of prosthetic or
orthotic benefits, a health plan company shall apply the most recent version of evidence-based
treatment and fit criteria as recognized by relevant clinical specialists.
new text end
new text begin
(b) A health plan company shall render utilization review determinations in a
nondiscriminatory manner and shall not deny coverage for habilitative or rehabilitative
benefits, including prosthetics or orthotics, solely on the basis of an enrollee's actual or
perceived disability.
new text end
new text begin
(c) A health plan company shall not deny a prosthetic or orthotic benefit for an individual
with limb loss or absence that would otherwise be covered for a nondisabled person seeking
medical or surgical intervention to restore or maintain the ability to perform the same
physical activity.
new text end
new text begin
(d) A health plan offered, issued, or renewed in Minnesota that offers coverage for
prosthetics and custom orthotic devices shall include language describing an enrollee's rights
pursuant to paragraphs (b) and (c) in its evidence of coverage and any benefit denial letters.
new text end
new text begin
(e) A health plan that provides coverage for prosthetic or orthotic services shall ensure
access to medically necessary clinical care and to prosthetic and custom orthotic devices
and technology from not less than two distinct prosthetic and custom orthotic providers in
the plan's provider network located in Minnesota. In the event that medically necessary
covered orthotics and prosthetics are not available from an in-network provider, the health
plan company shall provide processes to refer a member to an out-of-network provider and
shall fully reimburse the out-of-network provider at a mutually agreed upon rate less member
cost sharing determined on an in-network basis.
new text end
new text begin
(f) If coverage for prosthetic or custom orthotic devices is provided, payment shall be
made for the replacement of a prosthetic or custom orthotic device or for the replacement
of any part of the devices, without regard to continuous use or useful lifetime restrictions,
if an ordering health care provider determines that the provision of a replacement device,
or a replacement part of a device, is necessary because:
new text end
new text begin
(1) of a change in the physiological condition of the patient;
new text end
new text begin
(2) of an irreparable change in the condition of the device or in a part of the device; or
new text end
new text begin
(3) the condition of the device, or the part of the device, requires repairs and the cost of
the repairs would be more than 60 percent of the cost of a replacement device or of the part
being replaced.
new text end
new text begin
(g) Confirmation from a prescribing health care provider may be required if the prosthetic
or custom orthotic device or part being replaced is less than three years old.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025, and applies to all health
plans offered, issued, or renewed on or after that date.
new text end
Sec. 45.
new text begin
[62Q.679] RELIGIOUS OBJECTIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) The definitions in this subdivision apply to this section.
new text end
new text begin
(b) "Closely held for-profit entity" means an entity that is not a nonprofit entity, has
more than 50 percent of the value of its ownership interest owned directly or indirectly by
five or fewer owners, and has no publicly traded ownership interest. For purposes of this
paragraph:
new text end
new text begin
(1) ownership interests owned by a corporation, partnership, limited liability company,
estate, trust, or similar entity are considered owned by that entity's shareholders, partners,
members, or beneficiaries in proportion to their interest held in the corporation, partnership,
limited liability company, estate, trust, or similar entity;
new text end
new text begin
(2) ownership interests owned by a nonprofit entity are considered owned by a single
owner;
new text end
new text begin
(3) ownership interests owned by all individuals in a family are considered held by a
single owner. For purposes of this clause, "family" means brothers and sisters, including
half-brothers and half-sisters, a spouse, ancestors, and lineal descendants; and
new text end
new text begin
(4) if an individual or entity holds an option, warrant, or similar right to purchase an
ownership interest, the individual or entity is considered to be the owner of those ownership
interests.
new text end
new text begin
(c) "Eligible organization" means an organization that opposes covering some or all
health benefits under section 62Q.522, 62Q.524, or 62Q.585 on account of religious
objections and that is:
new text end
new text begin
(1) organized as a nonprofit entity and holds itself out to be religious; or
new text end
new text begin
(2) organized and operates as a closely held for-profit entity, and the organization's
owners or highest governing body has adopted, under the organization's applicable rules of
governance and consistent with state law, a resolution or similar action establishing that the
organization objects to covering some or all health benefits under section 62Q.522, 62Q.524,
or 62Q.585 on account of the owners' sincerely held religious beliefs.
new text end
new text begin
(d) "Exempt organization" means an organization that is organized and operates as a
nonprofit entity and meets the requirements of section 6033(a)(3)(A)(i) or (iii) of the Internal
Revenue Code of 1986, as amended.
new text end
new text begin Subd. 2. new text end
new text begin Exemption. new text end
new text begin
(a) An exempt organization is not required to provide coverage
under section 62Q.522, 62Q.524, or 62Q.585 if the exempt organization has religious
objections to the coverage. An exempt organization that chooses to not provide coverage
pursuant to this paragraph must notify employees as part of the hiring process and must
notify all employees at least 30 days before:
new text end
new text begin
(1) an employee enrolls in the health plan; or
new text end
new text begin
(2) the effective date of the health plan, whichever occurs first.
new text end
new text begin
(b) If the exempt organization provides partial coverage under section 62Q.522, 62Q.524,
or 62Q.585, the notice required under paragraph (a) must provide a list of the portions of
such coverage which the organization refuses to cover.
new text end
new text begin Subd. 3. new text end
new text begin Accommodation for eligible organizations. new text end
new text begin
(a) A health plan established or
maintained by an eligible organization complies with the coverage requirements of section
62Q.522, 62Q.524, or 62Q.585, with respect to the health benefits identified in the notice
under this paragraph, if the eligible organization provides notice to any health plan company
with which the eligible organization contracts that it is an eligible organization and that the
eligible organization has a religious objection to coverage for all or a subset of the health
benefits under section 62Q.522, 62Q.524, or 62Q.585.
new text end
new text begin
(b) The notice from an eligible organization to a health plan company under paragraph
(a) must include: (1) the name of the eligible organization; (2) a statement that it objects to
coverage for some or all of the health benefits under section 62Q.522, 62Q.524, or 62Q.585,
including a list of the health benefits to which the eligible organization objects, if applicable;
and (3) the health plan name. The notice must be executed by a person authorized to provide
notice on behalf of the eligible organization.
new text end
new text begin
(c) An eligible organization must provide a copy of the notice under paragraph (a) to
prospective employees as part of the hiring process and to all employees at least 30 days
before:
new text end
new text begin
(1) an employee enrolls in the health plan; or
new text end
new text begin
(2) the effective date of the health plan, whichever occurs first.
new text end
new text begin
(d) A health plan company that receives a copy of the notice under paragraph (a) with
respect to a health plan established or maintained by an eligible organization must, for all
future enrollments in the health plan:
new text end
new text begin
(1) expressly exclude coverage for those health benefits identified in the notice under
paragraph (a) from the health plan; and
new text end
new text begin
(2) provide separate payments for any health benefits required to be covered under
section 62Q.522, 62Q.524, or 62Q.585 for enrollees as long as the enrollee remains enrolled
in the health plan.
new text end
new text begin
(e) The health plan company must not impose any cost-sharing requirements, including
co-pays, deductibles, or coinsurance, or directly or indirectly impose any premium, fee, or
other charge for the health benefits under section 62Q.522 on the enrollee. The health plan
company must not directly or indirectly impose any premium, fee, or other charge for the
health benefits under section 62Q.522, 62Q.524, or 62Q.585 on the eligible organization
or health plan.
new text end
new text begin
(f) On January 1, 2024, and every year thereafter a health plan company must notify the
commissioner, in a manner determined by the commissioner, of the number of eligible
organizations granted an accommodation under this subdivision.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025, and applies to health
plans offered, sold, issued, or renewed on or after that date.
new text end
Sec. 46.
Minnesota Statutes 2022, section 62Q.73, subdivision 2, is amended to read:
Subd. 2.
Exception.
(a) This section does not apply to governmental programs except
as permitted under paragraph (b). For purposes of this subdivision, "governmental programs"
means the prepaid medical assistance programdeleted text begin ,deleted text end new text begin ;new text end new text begin effective January 1, 2026, the medical
assistance fee-for-service program; new text end the MinnesotaCare programdeleted text begin ,deleted text end new text begin ;new text end the demonstration project
for people with disabilitiesdeleted text begin ,deleted text end new text begin ;new text end and the federal Medicare program.
(b) In the course of a recipient's appeal of a medical determination to the commissioner
of human services under section 256.045, the recipient may request an expert medical
opinion be arranged by the external review entity under contract to provide independent
external reviews under this section. If such a request is made, the cost of the review shall
be paid by the commissioner of human services. Any medical opinion obtained under this
paragraph shall only be used by a state human services judge as evidence in the recipient's
appeal to the commissioner of human services under section 256.045.
(c) Nothing in this subdivision shall be construed to limit or restrict the appeal rights
provided in section 256.045 for governmental program recipients.
Sec. 47.
Minnesota Statutes 2022, section 62V.05, subdivision 12, is amended to read:
Subd. 12.
Reports on interagency agreements and intra-agency transfers.
The
MNsure Board shall provide deleted text begin quarterly reports to the chairs and ranking minority members
of the legislative committees with jurisdiction over health and human services policy and
finance on:deleted text end new text begin legislative reports on interagency agreements and intra-agency transfers according
to section 15.0395.
new text end
deleted text begin
(1) interagency agreements or service-level agreements and any renewals or extensions
of existing interagency or service-level agreements with a state department under section
15.01, state agency under section 15.012, or the Department of Information Technology
Services, with a value of more than $100,000, or related agreements with the same department
or agency with a cumulative value of more than $100,000; and
deleted text end
deleted text begin
(2) transfers of appropriations of more than $100,000 between accounts within or between
agencies.
deleted text end
deleted text begin
The report must include the statutory citation authorizing the agreement, transfer or dollar
amount, purpose, and effective date of the agreement, the duration of the agreement, and a
copy of the agreement.
deleted 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. 48.
Minnesota Statutes 2022, section 62V.08, is amended to read:
62V.08 REPORTS.
(a) MNsure shall submit a report to the legislature by deleted text begin January 15, 2015deleted text end new text begin March 31, 2025new text end ,
and each deleted text begin January 15deleted text end new text begin March 31new text end thereafter, on: (1) the performance of MNsure operations;
(2) meeting MNsure responsibilities; (3) an accounting of MNsure budget activities; (4)
practices and procedures that have been implemented to ensure compliance with data
practices laws, and a description of any violations of data practices laws or procedures; and
(5) the effectiveness of the outreach and implementation activities of MNsure in reducing
the rate of uninsurance.
(b) MNsure must publish its administrative and operational costs on a website to educate
consumers on those costs. The information published must include: (1) the amount of
premiums and federal premium subsidies collected; (2) the amount and source of revenue
received under section 62V.05, subdivision 1, paragraph (b), clause (3); (3) the amount and
source of any other fees collected for purposes of supporting operations; and (4) any misuse
of funds as identified in accordance with section 3.975. The website must be updated at
least annually.
Sec. 49.
Minnesota Statutes 2022, section 62V.11, subdivision 4, is amended to read:
Subd. 4.
Review of costs.
The board shall submit for review the annual budget of MNsure
for the next fiscal year by March deleted text begin 15deleted text end new text begin 31new text end of each year, beginning March deleted text begin 15, 2014deleted text end new text begin 31, 2025new text end .
Sec. 50.
Minnesota Statutes 2023 Supplement, section 145D.01, subdivision 1, is amended
to read:
Subdivision 1.
Definitions.
(a) For purposes of this deleted text begin chapterdeleted text end new text begin section and section 145D.02new text end ,
the following terms have the meanings given.
(b) "Captive professional entity" means a professional corporation, limited liability
company, or other entity formed to render professional services in which a beneficial owner
is a health care provider employed by, controlled by, or subject to the direction of a hospital
or hospital system.
(c) "Commissioner" means the commissioner of health.
(d) "Control," including the terms "controlling," "controlled by," and "under common
control with," means the possession, direct or indirect, of the power to direct or cause the
direction of the management and policies of a health care entity, whether through the
ownership of voting securities, membership in an entity formed under chapter 317A, by
contract other than a commercial contract for goods or nonmanagement services, or otherwise,
unless the power is the result of an official position with, corporate office held by, or court
appointment of, the person. Control is presumed to exist if any person, directly or indirectly,
owns, controls, holds with the power to vote, or holds proxies representing 40 percent or
more of the voting securities of any other person, or if any person, directly or indirectly,
constitutes 40 percent or more of the membership of an entity formed under chapter 317A.
The attorney general may determine that control exists in fact, notwithstanding the absence
of a presumption to that effect.
(e) "Health care entity" means:
(1) a hospital;
(2) a hospital system;
(3) a captive professional entity;
(4) a medical foundation;
(5) a health care provider group practice;
(6) an entity organized or controlled by an entity listed in clauses (1) to (5); or
(7) an entity that owns or exercises control over an entity listed in clauses (1) to (5).
(f) "Health care provider" means a physician licensed under chapter 147, a physician
assistant licensed under chapter 147A, or an advanced practice registered nurse as defined
in section 148.171, subdivision 3, who provides health care services, including but not
limited to medical care, consultation, diagnosis, or treatment.
(g) "Health care provider group practice" means two or more health care providers legally
organized in a partnership, professional corporation, limited liability company, medical
foundation, nonprofit corporation, faculty practice plan, or other similar entity:
(1) in which each health care provider who is a member of the group provides services
that a health care provider routinely provides, including but not limited to medical care,
consultation, diagnosis, and treatment, through the joint use of shared office space, facilities,
equipment, or personnel;
(2) for which substantially all services of the health care providers who are group
members are provided through the group and are billed in the name of the group practice
and amounts so received are treated as receipts of the group; or
(3) in which the overhead expenses of, and the income from, the group are distributed
in accordance with methods previously determined by members of the group.
An entity that otherwise meets the definition of health care provider group practice in this
paragraph shall be considered a health care provider group practice even if its shareholders,
partners, members, or owners include a professional corporation, limited liability company,
or other entity in which any beneficial owner is a health care provider and that is formed to
render professional services.
(h) "Hospital" means a health care facility licensed as a hospital under sections 144.50
to 144.56.
(i) "Medical foundation" means a nonprofit legal entity through which health care
providers perform research or provide medical services.
(j) "Transaction" means a single action, or a series of actions within a five-year period,
which occurs in part within the state of Minnesota or involves a health care entity formed
or licensed in Minnesota, that constitutes:
(1) a merger or exchange of a health care entity with another entity;
(2) the sale, lease, or transfer of 40 percent or more of the assets of a health care entity
to another entity;
(3) the granting of a security interest of 40 percent or more of the property and assets
of a health care entity to another entity;
(4) the transfer of 40 percent or more of the shares or other ownership of a health care
entity to another entity;
(5) an addition, removal, withdrawal, substitution, or other modification of one or more
members of the health care entity's governing body that transfers control, responsibility for,
or governance of the health care entity to another entity;
(6) the creation of a new health care entity;
(7) an agreement or series of agreements that results in the sharing of 40 percent or more
of the health care entity's revenues with another entity, including affiliates of such other
entity;
(8) an addition, removal, withdrawal, substitution, or other modification of the members
of a health care entity formed under chapter 317A that results in a change of 40 percent or
more of the membership of the health care entity; or
(9) any other transfer of control of a health care entity to, or acquisition of control of a
health care entity by, another entity.
(k) A transaction as defined in paragraph (j) does not include:
(1) an action or series of actions that meets one or more of the criteria set forth in
paragraph (j), clauses (1) to (9), if, immediately prior to all such actions, the health care
entity directly, or indirectly through one or more intermediaries, controls, is controlled by,
or is under common control with, all other parties to the action or series of actions;
(2) a mortgage or other secured loan for business improvement purposes entered into
by a health care entity that does not directly affect delivery of health care or governance of
the health care entity;
(3) a clinical affiliation of health care entities formed solely for the purpose of
collaborating on clinical trials or providing graduate medical education;
(4) the mere offer of employment to, or hiring of, a health care provider by a health care
entity;
(5) contracts between a health care entity and a health care provider primarily for clinical
services; or
(6) a single action or series of actions within a five-year period involving only entities
that operate solely as a nursing home licensed under chapter 144A; a boarding care home
licensed under sections 144.50 to 144.56; a supervised living facility licensed under sections
144.50 to 144.56; an assisted living facility licensed under chapter 144G; a foster care setting
licensed under Minnesota Rules, parts 9555.5105 to 9555.6265, for a physical location that
is not the primary residence of the license holder; a community residential setting as defined
in section 245D.02, subdivision 4a; or a home care provider licensed under sections 144A.471
to 144A.483.
Sec. 51.
new text begin
[145D.30] DEFINITIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Application. new text end
new text begin
For purposes of sections 145D.30 to 145D.37, the following
terms have the meanings given unless the context clearly indicates otherwise.
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 commerce for a
nonprofit health coverage entity that is a nonprofit health service plan corporation operating
under chapter 62C or the commissioner of health for a nonprofit health coverage entity that
is a nonprofit health maintenance organization operating under chapter 62D.
new text end
new text begin Subd. 3. new text end
new text begin Control. new text end
new text begin
"Control," including the terms "controlling," "controlled by," and
"under common control with," means the possession, direct or indirect, of the power to
direct or cause the direction of the management and policies of a nonprofit health coverage
entity, whether through the ownership of voting securities, through membership in an entity
formed under chapter 317A, by contract other than a commercial contract for goods or
nonmanagement services, or otherwise, unless the power is the result of an official position
with, corporate office held by, or court appointment of the person. Control is presumed to
exist if any person, directly or indirectly, owns, controls, holds with the power to vote, or
holds proxies representing 40 percent or more of the voting securities of any other person
or if any person, directly or indirectly, constitutes 40 percent or more of the membership
of an entity formed under chapter 317A. The attorney general may determine that control
exists in fact, notwithstanding the absence of a presumption to that effect.
new text end
new text begin Subd. 4. new text end
new text begin Conversion benefit entity. new text end
new text begin
"Conversion benefit entity" means a foundation,
corporation, limited liability company, trust, partnership, or other entity that receives, in
connection with a conversion transaction, the value of any public benefit asset in accordance
with section 145D.32, subdivision 5.
new text end
new text begin Subd. 5. new text end
new text begin Conversion transaction. new text end
new text begin
"Conversion transaction" means a transaction otherwise
permitted under applicable law in which a nonprofit health coverage entity:
new text end
new text begin
(1) merges, consolidates, converts, or transfers all or substantially all of its assets to any
entity except a corporation that is exempt under United States Code, title 26, section
501(c)(3);
new text end
new text begin
(2) makes a series of separate transfers within a 60-month period that in the aggregate
constitute a transfer of all or substantially all of the nonprofit health coverage entity's assets
to any entity except a corporation that is exempt under United States Code, title 26, section
501(c)(3); or
new text end
new text begin
(3) adds or substitutes one or more directors or officers that effectively transfer the
control of, responsibility for, or governance of the nonprofit health coverage entity to any
entity except a corporation that is exempt under United States Code, title 26, section
501(c)(3).
new text end
new text begin Subd. 6. new text end
new text begin Corporation. new text end
new text begin
"Corporation" has the meaning given in section 317A.011,
subdivision 6, and also includes a nonprofit limited liability company organized under
section 322C.1101.
new text end
new text begin Subd. 7. new text end
new text begin Director. new text end
new text begin
"Director" has the meaning given in section 317A.011, subdivision
7.
new text end
new text begin Subd. 8. new text end
new text begin Family member. new text end
new text begin
"Family member" means a spouse, parent, child, spouse of
a child, brother, sister, or spouse of a brother or sister.
new text end
new text begin Subd. 9. new text end
new text begin Full and fair value. new text end
new text begin
"Full and fair value" means at least the amount that the
public benefit assets of the nonprofit health coverage entity would be worth if the assets
were equal to stock in the nonprofit health coverage entity, if the nonprofit health coverage
entity was a for-profit corporation and if the nonprofit health coverage entity had 100 percent
of its stock authorized by the corporation and available for purchase without transfer
restrictions. The valuation shall consider market value, investment or earning value, net
asset value, goodwill, amount of donations received, and control premium, if any.
new text end
new text begin Subd. 10. new text end
new text begin Key employee. new text end
new text begin
"Key employee" means an individual, regardless of title, who:
new text end
new text begin
(1) has responsibilities, power, or influence over an organization similar to those of an
officer or director;
new text end
new text begin
(2) manages a discrete segment or activity of the organization that represents ten percent
or more of the activities, assets, income, or expenses of the organization, as compared to
the organization as a whole; or
new text end
new text begin
(3) has or shares authority to control or determine ten percent or more of the organization's
capital expenditures, operating budget, or compensation for employees.
new text end
new text begin Subd. 11. new text end
new text begin Nonprofit health coverage entity. new text end
new text begin
"Nonprofit health coverage entity" means
a nonprofit health service plan corporation operating under chapter 62C or a nonprofit health
maintenance organization operating under chapter 62D.
new text end
new text begin Subd. 12. new text end
new text begin Officer. new text end
new text begin
"Officer" has the meaning given in section 317A.011, subdivision
15.
new text end
new text begin Subd. 13. new text end
new text begin Public benefit assets. new text end
new text begin
"Public benefit assets" means the entirety of a nonprofit
health coverage entity's assets, whether tangible or intangible, including but not limited to
its goodwill and anticipated future revenue.
new text end
new text begin Subd. 14. new text end
new text begin Related organization. new text end
new text begin
"Related organization" has the meaning given in section
317A.011, subdivision 18.
new text end
Sec. 52.
new text begin
[145D.31] CERTAIN CONVERSION TRANSACTIONS PROHIBITED.
new text end
new text begin
A nonprofit health coverage entity must not enter into a conversion transaction if:
new text end
new text begin
(1) doing so would result in less than the full and fair market value of all public benefit
assets remaining dedicated to the public benefit; or
new text end
new text begin
(2) an individual who has been an officer, director, or other executive of the nonprofit
health coverage entity or of a related organization, or a family member of such an individual:
new text end
new text begin
(i) has held or will hold, whether guaranteed or contingent, an ownership stake, stock,
securities, investment, or other financial interest in an entity to which the nonprofit health
coverage entity transfers public benefit assets in connection with the conversion transaction;
new text end
new text begin
(ii) has received or will receive any type of compensation or other financial benefit from
an entity to which the nonprofit health coverage entity transfers public benefit assets in
connection with the conversion transaction;
new text end
new text begin
(iii) has held or will hold, whether guaranteed or contingent, an ownership stake, stock,
securities, investment, or other financial interest in an entity that has or will have a business
relationship with an entity to which the nonprofit health coverage entity transfers public
benefit assets in connection with the conversion transaction; or
new text end
new text begin
(iv) has received or will receive any type of compensation or other financial benefit from
an entity that has or will have a business relationship with an entity to which the nonprofit
health coverage entity transfers public benefit assets in connection with the conversion
transaction.
new text end
Sec. 53.
new text begin
[145D.32] REQUIREMENTS FOR NONPROFIT HEALTH COVERAGE
ENTITY CONVERSION TRANSACTIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Notice. new text end
new text begin
(a) Before entering into a conversion transaction, a nonprofit
health coverage entity must notify the attorney general according to section 317A.811. In
addition to the elements listed in section 317A.811, subdivision 1, the notice required by
this subdivision must also include: (1) an itemization of the nonprofit health coverage entity's
public benefit assets and an independent third-party valuation of the nonprofit health coverage
entity's public benefit assets; (2) a proposed plan to distribute the value of those public
benefit assets to a conversion benefit entity that meets the requirements of section 145D.33;
and (3) other information contained in forms provided by the attorney general.
new text end
new text begin
(b) When the nonprofit health coverage entity provides the attorney general with the
notice and other information required under paragraph (a), the nonprofit health coverage
entity must also provide a copy of this notice and other information to the applicable
commissioner.
new text end
new text begin Subd. 2. new text end
new text begin Nonprofit health coverage entity requirements. new text end
new text begin
Before entering into a
conversion transaction, a nonprofit health coverage entity must ensure that:
new text end
new text begin
(1) the proposed conversion transaction complies with chapters 317A and 501B and
other applicable laws;
new text end
new text begin
(2) the proposed conversion transaction does not involve or constitute a breach of
charitable trust;
new text end
new text begin
(3) the nonprofit health coverage entity shall receive full and fair value for its public
benefit assets;
new text end
new text begin
(4) the value of the public benefit assets to be transferred has not been manipulated in
a manner that causes or caused the value of the assets to decrease;
new text end
new text begin
(5) the proceeds of the proposed conversion transaction shall be used in a manner
consistent with the public benefit for which the assets are held by the nonprofit health
coverage entity;
new text end
new text begin
(6) the proposed conversion transaction shall not result in a breach of fiduciary duty;
and
new text end
new text begin
(7) the conversion benefit entity that receives the value of the nonprofit health coverage
entity's public benefit assets meets the requirements in section 145D.33.
new text end
new text begin Subd. 3. new text end
new text begin Listening sessions and public comment. new text end
new text begin
The attorney general or the
commissioner may hold public listening sessions or forums and may solicit public comments
regarding the proposed conversion transaction, including on the formation of a conversion
benefit entity under section 145D.33.
new text end
new text begin Subd. 4. new text end
new text begin Waiting period. new text end
new text begin
(a) Subject to paragraphs (b) and (c), a nonprofit health
coverage entity must not enter into a conversion transaction until 90 days after the nonprofit
health coverage entity has given written notice as required in subdivision 1.
new text end
new text begin
(b) The attorney general may waive all or part of the waiting period or may extend the
waiting period for an additional 90 days by notifying the nonprofit health coverage entity
of the extension in writing.
new text end
new text begin
(c) The time periods specified in this subdivision shall be suspended while an
investigation into the conversion transaction is pending or while a request from the attorney
general for additional information is outstanding.
new text end
new text begin Subd. 5. new text end
new text begin Transfer of value of assets required. new text end
new text begin
As part of a conversion transaction for
which notice is provided under subdivision 1, the nonprofit health coverage entity must
transfer the entirety of the full and fair value of its public benefit assets to one or more
conversion benefit entities that meet the requirements in section 145D.33.
new text end
new text begin Subd. 6. new text end
new text begin Funds restricted for a particular purpose. new text end
new text begin
Nothing in this section relieves a
nonprofit health coverage entity from complying with requirements for funds that are
restricted for a particular purpose. Funds restricted for a particular purpose must continue
to be used in accordance with the purpose for which they were restricted under sections
317A.671 and 501B.31. A nonprofit health coverage entity may not convert assets that
would conflict with their restricted purpose.
new text end
Sec. 54.
new text begin
[145D.33] CONVERSION BENEFIT ENTITY REQUIREMENTS.
new text end
new text begin Subdivision 1. new text end
new text begin Requirements. new text end
new text begin
In order to receive the value of a nonprofit health coverage
entity's public benefit assets as part of a conversion transaction, a conversion benefit entity
must:
new text end
new text begin
(1) be: (i) an existing or new domestic, nonprofit corporation operating under chapter
317A, a nonprofit limited liability company operating under chapter 322C, or a wholly
owned subsidiary thereof; and (ii) exempt under United States Code, title 26, section
501(c)(3);
new text end
new text begin
(2) have in place procedures and policies to prohibit conflicts of interest, including but
not limited to conflicts of interest relating to any grant-making activities that may benefit:
new text end
new text begin
(i) the officers, directors, or key employees of the conversion benefit entity;
new text end
new text begin
(ii) any entity to which the nonprofit health coverage entity transfers public benefit assets
in connection with a conversion transaction; or
new text end
new text begin
(iii) any officers, directors, or key employees of an entity to which the nonprofit health
coverage entity transfers public benefit assets in connection with a conversion transaction;
new text end
new text begin
(3) operate to benefit the health of the people in this state;
new text end
new text begin
(4) have in place procedures and policies that prohibit:
new text end
new text begin
(i) an officer, director, or key employee of the nonprofit health coverage entity from
serving as an officer, director, or key employee of the conversion benefit entity for the
five-year period following the conversion transaction;
new text end
new text begin
(ii) an officer, director, or key employee of the nonprofit health coverage entity or of
the conversion benefit entity from directly or indirectly benefiting from the conversion
transaction; and
new text end
new text begin
(iii) elected or appointed public officials from serving as an officer, director, or key
employee of the conversion benefit entity;
new text end
new text begin
(5) not make grants or payments or otherwise provide financial benefit to an entity to
which a nonprofit health coverage entity transfers public benefit assets as part of a conversion
transaction or to a related organization of the entity to which the nonprofit health coverage
entity transfers public benefit assets as part of a conversion transaction; and
new text end
new text begin
(6) not have as an officer director, or key employee any individual who has been an
officer, director, or key employee of an entity that receives public benefit assets as part of
a conversion transaction.
new text end
new text begin Subd. 2. new text end
new text begin Review and approval. new text end
new text begin
The commissioner must review and approve a conversion
benefit entity before the conversion benefit entity receives the value of public benefit assets
from a nonprofit health coverage entity. In order to be approved under this subdivision, the
conversion benefit entity's governance must be broadly based in the community served by
the nonprofit health coverage entity and must be independent of the entity to which the
nonprofit health coverage entity transfers public benefit assets as part of the conversion
transaction. As part of the review of the conversion benefit entity's governance, the
commissioner may hold a public hearing. The public hearing, if held by the commissioner
of health, may be held concurrently with the hearing authorized under section 62D.31. If
the commissioner finds it necessary, a portion of the value of the public benefit assets must
be used to develop a community-based plan for use by the conversion benefit entity.
new text end
new text begin Subd. 3. new text end
new text begin Community advisory committee. new text end
new text begin
The commissioner must establish a
community advisory committee for a conversion benefit entity receiving the value of public
benefit assets. The members of the community advisory committee must be selected to
represent the diversity of the community previously served by the nonprofit health coverage
entity. The community advisory committee must:
new text end
new text begin
(1) provide a slate of three nominees for each vacancy on the governing board of the
conversion benefit entity, from which the remaining board members must select new
members to the board;
new text end
new text begin
(2) provide the conversion benefit entity's governing board with guidance on the health
needs of the community previously served by the nonprofit health coverage entity; and
new text end
new text begin
(3) promote dialogue and information sharing between the conversion benefit entity and
the community previously served by the nonprofit health coverage entity.
new text end
Sec. 55.
new text begin
[145D.34] ENFORCEMENT AND REMEDIES.
new text end
new text begin Subdivision 1. new text end
new text begin Investigation. new text end
new text begin
The attorney general has the powers in section 8.31.
Nothing in this subdivision limits the powers, remedies, or responsibilities of the attorney
general under this chapter; chapter 8, 309, 317A, or 501B; or any other chapter. For purposes
of this section, an approval by the commissioner for regulatory purposes does not impair
or inform the attorney general's authority.
new text end
new text begin Subd. 2. new text end
new text begin Enforcement and penalties. new text end
new text begin
(a) The attorney general may bring an action in
district court to enjoin or unwind a conversion transaction or seek other equitable relief
necessary to protect the public interest if:
new text end
new text begin
(1) a nonprofit health coverage entity or conversion transaction violates sections 145D.30
to 145D.33; or
new text end
new text begin
(2) the conversion transaction is contrary to the public interest.
new text end
new text begin
In seeking injunctive relief, the attorney general must not be required to establish irreparable
harm but must instead establish that a violation of sections 145D.30 to 145D.33 occurred
or that the requested order promotes the public interest.
new text end
new text begin
(b) Factors informing whether a conversion transaction is contrary to the public interest
include but are not limited to whether:
new text end
new text begin
(1) the conversion transaction shall result in increased health care costs for patients; and
new text end
new text begin
(2) the conversion transaction shall adversely impact provider cost trends and containment
of total health care spending.
new text end
new text begin
(c) The attorney general may enforce sections 145D.30 to 145D.33 under section 8.31.
new text end
new text begin
(d) Failure of the entities involved in a conversion transaction to provide timely
information as required by the attorney general or the commissioner shall be an independent
and sufficient ground for a court to enjoin or unwind the transaction or provide other equitable
relief, provided the attorney general notifies the entities of the inadequacy of the information
provided and provides the entities with a reasonable opportunity to remedy the inadequacy.
new text end
new text begin
(e) An officer, director, or other executive found to have violated sections 145D.30 to
145D.33 shall be subject to a civil penalty of up to $100,000 for each violation. A corporation
or other entity which is a party to or materially participated in a conversion transaction
found to have violated sections 145D.30 to 145D.33 shall be subject to a civil penalty of
up to $1,000,000. A court may also award reasonable attorney fees and costs of investigation
and litigation.
new text end
new text begin Subd. 3. new text end
new text begin Commissioner of health; data and research. new text end
new text begin
The commissioner of health
must provide the attorney general, upon request, with data and research on broader market
trends, impacts on prices and outcomes, public health and population health considerations,
and health care access, for the attorney general to use when evaluating whether a conversion
transaction is contrary to public interest. The commissioner may share with the attorney
general, according to section 13.05, subdivision 9, any not public data, as defined in section
13.02, subdivision 8a, held by the commissioner to aid in the investigation and review of
the conversion transaction, and the attorney general must maintain this data with the same
classification according to section 13.03, subdivision 4, paragraph (c).
new text end
new text begin Subd. 4. new text end
new text begin Failure to take action. new text end
new text begin
Failure by the attorney general to take action with
respect to a conversion transaction under this section does not constitute approval of the
conversion transaction or waiver, nor shall failure prevent the attorney general from taking
action in the same, similar, or subsequent circumstances.
new text end
Sec. 56.
new text begin
[145D.35] DATA PRACTICES.
new text end
new text begin
Section 13.65 applies to data provided by a nonprofit health coverage entity or the
commissioner to the attorney general under sections 145D.30 to 145D.33. Section 13.39
applies to data provided by a nonprofit health coverage entity to the commissioner under
sections 145D.30 to 145D.33. The attorney general or the commissioner may make any
data classified as confidential or protected nonpublic under this section accessible to any
civil or criminal law enforcement agency if the attorney general or commissioner determines
that the access aids the law enforcement process.
new text end
Sec. 57.
new text begin
[145D.36] COMMISSIONER OF HEALTH; REPORTS AND ANALYSIS.
new text end
new text begin
Notwithstanding any law to the contrary, the commissioner of health may use data or
information submitted under sections 60A.135 to 60A.137, 60A.17, 60D.18, 60D.20,
62D.221, and 145D.32 to conduct analyses of the aggregate impact of transactions within
nonprofit health coverage entities and organizations which include nonprofit health coverage
entities or their affiliates on access to or the cost of health care services, health care market
consolidation, and health care quality. The commissioner of health must issue periodic
public reports on the number and types of conversion transactions subject to sections 145D.30
to 145D.35 and on the aggregate impact of conversion transactions on health care costs,
quality, and competition in Minnesota.
new text end
Sec. 58.
new text begin
[145D.37] RELATION TO OTHER LAW.
new text end
new text begin
(a) Sections 145D.30 to 145D.36 are in addition to and do not affect or limit any power,
remedy, or responsibility of a health maintenance organization, a service plan corporation,
a conversion benefit entity, the attorney general, the commissioner of health, or the
commissioner of commerce under this chapter; chapter 8, 62C, 62D, 309, 317A, or 501B;
or other law.
new text end
new text begin
(b) Nothing in sections 145D.03 to 145D.36 authorizes a nonprofit health coverage entity
to enter into a conversion transaction not otherwise permitted under chapter 317A or 501B
or other law.
new text end
Sec. 59.
Minnesota Statutes 2022, section 256B.0625, subdivision 12, is amended to read:
Subd. 12.
Eyeglassesdeleted text begin , dentures, and prosthetic and orthotic devicesdeleted text end .
deleted text begin (a)deleted text end Medical
assistance covers eyeglassesdeleted text begin , dentures, and prosthetic and orthotic devicesdeleted text end if prescribed by
a licensed practitioner.
deleted text begin
(b) For purposes of prescribing prosthetic and orthotic devices, "licensed practitioner"
includes a physician, an advanced practice registered nurse, a physician assistant, or a
podiatrist.
deleted 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. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 60.
Minnesota Statutes 2023 Supplement, section 256B.0625, subdivision 16, is
amended to read:
Subd. 16.
Abortion services.
Medical assistance covers deleted text begin abortion services determined
to be medically necessary by the treating provider and delivered in accordance with all
applicable Minnesota lawsdeleted text end new text begin abortions and abortion-related services, including preabortion
services and follow-up servicesnew 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. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 61.
Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 25c. new text end
new text begin Applicability of utilization review provisions. new text end
new text begin
Effective January 1, 2026,
the following provisions of chapter 62M apply to the commissioner when delivering services
through fee-for-service under chapters 256B and 256L: 62M.02, subdivisions 1 to 5, 7 to
12, 13, 14 to 18, and 21; 62M.04; 62M.05, subdivisions 1 to 4; 62M.06, subdivisions 1 to
3; 62M.07; 62M.072; 62M.09; 62M.10; 62M.12; and 62M.17, subdivision 2.
new text end
Sec. 62.
Minnesota Statutes 2022, section 256B.0625, subdivision 32, is amended to read:
Subd. 32.
Nutritional products.
Medical assistance covers nutritional products needed
for nutritional supplementation because solid food or nutrients thereof cannot be properly
absorbed by the body or needed for treatment of phenylketonuria, hyperlysinemia, maple
syrup urine disease, a combined allergy to human milk, cow's milk, and soy formula, or
any other childhood or adult diseases, conditions, or disorders identified by the commissioner
as requiring a similarly necessary nutritional product. new text begin Medical assistance covers amino
acid-based elemental formulas in the same manner as is required under section 62Q.531.
new text end Nutritional products needed for the treatment of a combined allergy to human milk, cow's
milk, and soy formula require prior authorization. Separate payment shall not be made for
nutritional products for residents of long-term care facilities. Payment for dietary
requirements is a component of the per diem rate paid to these facilities.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 63.
Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 72. new text end
new text begin Orthotic and prosthetic devices. new text end
new text begin
Medical assistance covers orthotic and
prosthetic devices, supplies, and services according to section 256B.066.
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. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 64.
Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 73. new text end
new text begin Rapid whole genome sequencing. new text end
new text begin
Medical assistance covers rapid whole
genome sequencing (rWGS) testing. Coverage and eligibility for rWGS testing, and the use
of genetic data, must meet the requirements specified in section 62A.3098, subdivisions 1
to 3 and 6.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 65.
Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 74. new text end
new text begin Scalp hair prostheses. new text end
new text begin
Medical assistance covers scalp hair prostheses
prescribed for hair loss suffered as a result of treatment for cancer. Medical assistance must
meet the requirements that would otherwise apply to a health plan under section 62A.28,
except for the limitation on coverage required per benefit year set forth in section 62A.28,
subdivision 2, paragraph (c).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 66.
new text begin
[256B.066] ORTHOTIC AND PROSTHETIC DEVICES, SUPPLIES, AND
SERVICES.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
All terms used in this section have the meanings given them
in section 62Q.665, subdivision 1.
new text end
new text begin Subd. 2. new text end
new text begin Coverage requirements. new text end
new text begin
(a) Medical assistance covers orthotic and prosthetic
devices, supplies, and services:
new text end
new text begin
(1) furnished under an order by a prescribing physician or licensed health care prescriber
who has authority in Minnesota to prescribe orthoses and prostheses. Coverage for orthotic
and prosthetic devices, supplies, accessories, and services under this clause includes those
devices or device systems, supplies, accessories, and services that are customized to the
enrollee's needs;
new text end
new text begin
(2) determined by the enrollee's provider to be the most appropriate model that meets
the medical needs of the enrollee for purposes of performing physical activities, as applicable,
including but not limited to running, biking, and swimming, and maximizing the enrollee's
limb function; or
new text end
new text begin
(3) for showering or bathing.
new text end
new text begin
(b) The coverage set forth in paragraph (a) includes the repair and replacement of those
orthotic and prosthetic devices, supplies, and services described therein.
new text end
new text begin
(c) Coverage of a prosthetic or orthotic benefit must not be denied for an individual with
limb loss or absence that would otherwise be covered for a nondisabled person seeking
medical or surgical intervention to restore or maintain the ability to perform the same
physical activity.
new text end
new text begin
(d) If coverage for prosthetic or custom orthotic devices is provided, payment must be
made for the replacement of a prosthetic or custom orthotic device or for the replacement
of any part of the devices, without regard to useful lifetime restrictions, if an ordering health
care provider determines that the provision of a replacement device, or a replacement part
of a device, is necessary because:
new text end
new text begin
(1) of a change in the physiological condition of the enrollee;
new text end
new text begin
(2) of an irreparable change in the condition of the device or in a part of the device; or
new text end
new text begin
(3) the condition of the device, or the part of the device, requires repairs and the cost of
the repairs would be more than 60 percent of the cost of a replacement device or of the part
being replaced.
new text end
new text begin Subd. 3. new text end
new text begin Restrictions on coverage. new text end
new text begin
(a) Prior authorization may be required for orthotic
and prosthetic devices, supplies, and services.
new text end
new text begin
(b) A utilization review for a request for coverage of prosthetic or orthotic benefits must
apply the most recent version of evidence-based treatment and fit criteria as recognized by
relevant clinical specialists.
new text end
new text begin
(c) Utilization review determinations must be rendered in a nondiscriminatory manner
and must not deny coverage for habilitative or rehabilitative benefits, including prosthetics
or orthotics, solely on the basis of an enrollee's actual or perceived disability.
new text end
new text begin
(d) Evidence of coverage and any benefit denial letters must include language describing
an enrollee's rights pursuant to paragraphs (b) and (c).
new text end
new text begin
(e) Confirmation from a prescribing health care provider may be required if the prosthetic
or custom orthotic device or part being replaced is less than three years old.
new text end
new text begin Subd. 4. new text end
new text begin Managed care plan access to care. new text end
new text begin
(a) Managed care plans and county-based
purchasing plans subject to this section must ensure access to medically necessary clinical
care and to prosthetic and custom orthotic devices and technology from at least two distinct
prosthetic and custom orthotic providers in the plan's provider network located in Minnesota.
new text end
new text begin
(b) In the event that medically necessary covered orthotics and prosthetics are not
available from an in-network provider, the plan must provide processes to refer an enrollee
to an out-of-network provider and must fully reimburse the out-of-network provider at a
mutually agreed upon rate less enrollee cost sharing determined on an in-network basis.
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. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 67.
Minnesota Statutes 2022, section 317A.811, subdivision 1, is amended to read:
Subdivision 1.
When required.
(a) Except as provided in subdivision 6, the following
corporations shall notify the attorney general of their intent to dissolve, merge, consolidate,
or convert, or to transfer all or substantially all of their assets:
(1) a corporation that holds assets for a charitable purpose as defined in section 501B.35,
subdivision 2; deleted text begin or
deleted text end
(2) a corporation that is exempt under section 501(c)(3) of the Internal Revenue Code
of 1986, or any successor sectiondeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(3) a nonprofit health coverage entity as defined in section 145D.30.
new text end
(b) The notice must include:
(1) the purpose of the corporation that is giving the notice;
(2) a list of assets owned or held by the corporation for charitable purposes;
(3) a description of restricted assets and purposes for which the assets were received;
(4) a description of debts, obligations, and liabilities of the corporation;
(5) a description of tangible assets being converted to cash and the manner in which
they will be sold;
(6) anticipated expenses of the transaction, including attorney fees;
(7) a list of persons to whom assets will be transferred, if known, or the name of the
converted organization;
(8) the purposes of persons receiving the assets or of the converted organization; and
(9) the terms, conditions, or restrictions, if any, to be imposed on the transferred or
converted assets.
The notice must be signed on behalf of the corporation by an authorized person.
Sec. 68. new text begin COMMISSIONER OF HEALTH; ANALYSIS AND REPORT TO THE
LEGISLATURE.
new text end
new text begin
(a) The commissioner of health must use the data submitted by utilization review
organizations under Minnesota Statutes, section 62M.19, and other data available to the
commissioner to analyze the use of utilization management tools, including prior
authorization, in health care. The analysis must evaluate the effect utilization management
tools have on patient access to care, the administrative burden the use of utilization
management tools places on health care providers, and system costs. The commissioner
must also develop recommendations on how to simplify health insurance prior authorization
standards and processes to improve health care access, reduce delays in care, reduce the
administrative burden on health care providers, and maximize quality of care, including
recommendations for a prior authorization exemption process for providers and group
practices that have an authorization rate for all submitted requests for authorization at or
above a level determined by the commissioner as qualifying for the exemption. When
conducting the analysis and developing recommendations, the commissioner must consult,
as appropriate, with physicians, other providers, health plan companies, consumers, and
other health care experts.
new text end
new text begin
(b) The commissioner must issue a report to the legislature by December 15, 2026,
containing the commissioner's analysis and recommendations under paragraph (a).
new text end
Sec. 69. new text begin INITIAL REPORTS TO COMMISSIONER OF HEALTH; UTILIZATION
MANAGEMENT TOOLS.
new text end
new text begin
Utilization review organizations must submit initial reports to the commissioner of health
under Minnesota Statutes, section 62M.19, by September 1, 2025.
new text end
Sec. 70. new text begin TRANSITION.
new text end
new text begin
(a) A health maintenance organization that has a certificate of authority under Minnesota
Statutes, chapter 62D, but that is not a nonprofit corporation organized under Minnesota
Statutes, chapter 317A, or a local governmental unit, as defined in Minnesota Statutes,
section 62D.02, subdivision 11:
new text end
new text begin
(1) must not offer, sell, issue, or renew any health maintenance contracts on or after
August 1, 2024;
new text end
new text begin
(2) may otherwise continue to operate as a health maintenance organization until
December 31, 2025; and
new text end
new text begin
(3) must provide notice to the health maintenance organization's enrollees as of August
1, 2024, of the date the health maintenance organization will cease to operate in this state
and any plans to transition enrollee coverage to another insurer. This notice must be provided
by October 1, 2024.
new text end
new text begin
(b) The commissioner of health must not issue or renew a certificate of authority to
operate as a health maintenance organization on or after August 1, 2024, unless the entity
seeking the certificate of authority meets the requirements for a health maintenance
organization under Minnesota Statutes, chapter 62D, in effect on or after August 1, 2024.
new text end
Sec. 71. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2022, section 62A.041, subdivision 3,
new text end
new text begin
is repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Statutes 2023 Supplement, section 62Q.522, subdivisions 3 and 4,
new text end
new text begin
are
repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025, and applies to health
plans offered, sold, issued, or renewed on or after that date.
new text end
ARTICLE 5
DEPARTMENT OF HEALTH FINANCE
Section 1.
Minnesota Statutes 2022, section 62D.14, subdivision 1, is amended to read:
Subdivision 1.
Examination authority.
The commissioner of health may make an
examination of the affairs of any health maintenance organization and its contracts,
agreements, or other arrangements with any participating entity as often as the commissioner
of health deems necessary for the protection of the interests of the people of this state, but
not less frequently than once every deleted text begin threedeleted text end new text begin fivenew text end years. Examinations of participating entities
pursuant to this subdivision shall be limited to their dealings with the health maintenance
organization and its enrollees, except that examinations of major participating entities may
include inspection of the entity's financial statements kept in the ordinary course of business.
The commissioner may require major participating entities to submit the financial statements
directly to the commissioner. Financial statements of major participating entities are subject
to the provisions of section 13.37, subdivision 1, clause (b), upon request of the major
participating entity or the health maintenance organization with which it contracts.
Sec. 2.
Minnesota Statutes 2022, section 103I.621, subdivision 1, is amended to read:
Subdivision 1.
Permit.
(a) Notwithstanding any department or agency rule to the contrary,
the commissioner shall issue, on request by the owner of the property and payment of the
permit fee, permits for the reinjection of water by a properly constructed well into the same
aquifer from which the water was drawn for the operation of a groundwater thermal exchange
device.
(b) As a condition of the permit, an applicant must agree to allow inspection by the
commissioner during regular working hours for department inspectors.
(c) Not more than 200 permits may be issued for small systems having maximum
capacities of 20 gallons per minute or lessnew text begin and that are compliant with the natural resource
water-use requirements under subdivision 2new text end . deleted text begin The small systems are subject to inspection
twice a year.
deleted text end
(d) Not more than deleted text begin tendeleted text end new text begin 100new text end permits may be issued for larger systems having maximum
capacities deleted text begin fromdeleted text end new text begin overnew text end 20 deleted text begin to 50deleted text end gallons per minutenew text begin and are compliant with the natural resource
water-use requirements under subdivision 2new text end . deleted text begin The larger systems are subject to inspection
four times a year.
deleted text end
(e) A person issued a permit must comply with this section new text begin and permit conditions deemed
necessary to protect public health and safety of groundwater new text end deleted text begin for the permit to be validdeleted text end . new text begin The
permit conditions may include but are not limited to requirements for:
new text end
new text begin
(1) notification to the commissioner at intervals specified in the permit conditions;
new text end
new text begin
(2) system operation and maintenance;
new text end
new text begin
(3) system location and construction;
new text end
new text begin
(4) well location and construction;
new text end
new text begin
(5) signage;
new text end
new text begin
(6) reports of system construction, performance, operation, and maintenance;
new text end
new text begin
(7) removal of the system upon termination of its use or system failure;
new text end
new text begin
(8) disclosure of the system at the time of property transfer;
new text end
new text begin
(9) obtaining approval from the commissioner prior to deviation from the approval plan
and conditions;
new text end
new text begin
(10) groundwater level monitoring; or
new text end
new text begin
(11) groundwater quality monitoring.
new text end
new text begin
(f) The property owner or the property owner's agent must submit to the commissioner
a permit application on a form provided by the commissioner, or in a format approved by
the commissioner, that provides any information necessary to protect public health and
safety of groundwater.
new text end
new text begin
(g) A permit granted under this section is not valid if a water-use permit is required for
the project and is not approved by the commissioner of natural resources.
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. 3.
Minnesota Statutes 2022, section 103I.621, subdivision 2, is amended to read:
Subd. 2.
Water-use requirements apply.
Water-use permit requirements and penalties
under chapter deleted text begin 103Fdeleted text end new text begin 103Gnew text end and related rules adopted and enforced by the commissioner of
natural resources apply to groundwater thermal exchange permit recipients. A person who
violates a provision of this section is subject to enforcement or penalties for the noncomplying
activity that are available to the commissioner and the Pollution Control Agency.
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 2022, section 144.05, subdivision 6, is amended to read:
Subd. 6.
Reports on interagency agreements and intra-agency transfers.
The
commissioner of health shall provide deleted text begin quarterly reports to the chairs and ranking minority
members of the legislative committees with jurisdiction over health and human services
policy and finance on:deleted text end new text begin the interagency agreements and intra-agency transfers report per
section 15.0395.
new text end
deleted text begin
(1) interagency agreements or service-level agreements and any renewals or extensions
of existing interagency or service-level agreements with a state department under section
15.01, state agency under section 15.012, or the Department of Information Technology
Services, with a value of more than $100,000, or related agreements with the same department
or agency with a cumulative value of more than $100,000; and
deleted text end
deleted text begin
(2) transfers of appropriations of more than $100,000 between accounts within or between
agencies.
deleted text end
deleted text begin
The report must include the statutory citation authorizing the agreement, transfer or dollar
amount, purpose, and effective date of the agreement, duration of the agreement, and a copy
of the agreement.
deleted text end
Sec. 5.
Minnesota Statutes 2023 Supplement, section 144.1501, subdivision 2, is amended
to read:
Subd. 2.
deleted text begin Creation of accountdeleted text end new text begin Availabilitynew text end .
(a) deleted text begin A health professional education loan
forgiveness program account is established.deleted text end The commissioner of health shall use money
deleted text begin from the account to establish adeleted text end new text begin appropriated for health professional educationnew text end loan forgiveness
deleted text begin programdeleted text end new text begin in this sectionnew text end :
(1) for medical residents, new text begin physicians,new text end mental health professionals, and alcohol and drug
counselors agreeing to practice in designated rural areas or underserved urban communities
or specializing in the area of pediatric psychiatry;
(2) for midlevel practitioners 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; in an intermediate
care facility for persons with developmental disability; in 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; in an assisted living facility as defined in section
144G.08, subdivision 7; 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, and public health nurses
who agree to practice in designated rural areas;
(6) for dentists agreeing to deliver at least 25 percent of the dentist'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 deleted text begin 51, chapter 303deleted text end new text begin 51c.303new text end ; and
(7) for nurses employed as a hospital nurse by a nonprofit hospital and providing direct
care to patients at the nonprofit hospital.
(b) Appropriations made deleted text begin to the accountdeleted text end new text begin for health professional education loan forgiveness
in this sectionnew text end 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. 6.
Minnesota Statutes 2022, section 144.1501, subdivision 5, is amended to read:
Subd. 5.
Penalty for nonfulfillment.
If a participant does not fulfill the required
minimum commitment of service according to subdivision 3, the commissioner of health
shall collect from the participant the total amount paid to the participant under the loan
forgiveness program plus interest at a rate established according to section 270C.40. The
commissioner shall deposit the money collected in deleted text begin the health care access fund to be credited
todeleted text end new text begin a dedicated account in the special revenue fund. The balance of the account is appropriated
annually to the commissioner fornew text end the health professional education loan forgiveness program
deleted text begin accountdeleted text end established in subdivision 2. The commissioner shall allow waivers of all or part
of the money owed the commissioner as a result of a nonfulfillment penalty if emergency
circumstances prevented fulfillment of the minimum service commitment.
Sec. 7.
Minnesota Statutes 2023 Supplement, section 144.1505, subdivision 2, is amended
to read:
Subd. 2.
Programs.
(a) For advanced practice provider clinical training expansion grants,
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 anew text begin three-yearnew text end training grant shall not exceed deleted text begin $150,000
for the first year, $100,000 for the second year, and $50,000 for the third yeardeleted text end new text begin $300,000new text end per
deleted text begin programdeleted text end new text begin project. The commissioner may provide a one-year, no-cost extension for grantsnew text end .
(b) For health professional rural and underserved clinical rotations grants, 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 to add 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.
(c) Funds may be used for:
(1) establishing or expanding rotations and clinical training;
(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 training program; and
(9) supporting clinical education in which trainees are part of a primary care team model.
Sec. 8.
Minnesota Statutes 2022, section 144.555, subdivision 1a, is amended to read:
Subd. 1a.
Notice of closing, curtailing operations, relocating services, or ceasing to
offer certain services; hospitals.
(a) The controlling persons of a hospital licensed under
sections 144.50 to 144.56 or a hospital campus must notify the commissioner of health deleted text begin anddeleted text end new text begin ,new text end
the publicnew text begin , and othersnew text end at least deleted text begin 120deleted text end new text begin 182new text end days before the hospital or hospital campus voluntarily
plans to implement one of the following scheduled actions:
(1) cease operations;
(2) curtail operations to the extent that patients must be relocated;
(3) relocate the provision of health services to another hospital or another hospital
campus; or
(4) cease offering maternity care and newborn care services, intensive care unit services,
inpatient mental health services, or inpatient substance use disorder treatment services.
new text begin
(b) A notice required under this subdivision must comply with the requirements in
subdivision 1d.
new text end
deleted text begin (b)deleted text end new text begin (c)new text end The commissioner shall cooperate with the controlling persons and advise them
about relocating the patients.
Sec. 9.
Minnesota Statutes 2022, section 144.555, subdivision 1b, is amended to read:
Subd. 1b.
Public hearing.
Within deleted text begin 45deleted text end new text begin 30new text end days after receiving notice under subdivision
1a, the commissioner shall conduct a public hearing on the scheduled cessation of operations,
curtailment of operations, relocation of health services, or cessation in offering health
services. The commissioner must provide adequate public notice of the hearing in a time
and manner determined by the commissioner. The controlling persons of the hospital or
hospital campus must participate in the public hearing. The public hearing new text begin must be held at
a location that is within 30 miles of the hospital or hospital campus and that is provided or
arranged by the hospital or hospital campus. A hospital or hospital campus is encouraged
to hold the public hearing at a location that is within ten miles of the hospital or hospital
campus. Video conferencing technology must be used to allow members of the public to
view and participate in the hearing. The public hearing new text end must include:
(1) an explanation by the controlling persons of the reasons for ceasing or curtailing
operations, relocating health services, or ceasing to offer any of the listed health services;
(2) a description of the actions that controlling persons will take to ensure that residents
in the hospital's or campus's service area have continued access to the health services being
eliminated, curtailed, or relocated;
(3) an opportunity for public testimony on the scheduled cessation or curtailment of
operations, relocation of health services, or cessation in offering any of the listed health
services, and on the hospital's or campus's plan to ensure continued access to those health
services being eliminated, curtailed, or relocated; and
(4) an opportunity for the controlling persons to respond to questions from interested
persons.
Sec. 10.
Minnesota Statutes 2022, section 144.555, is amended by adding a subdivision
to read:
new text begin Subd. 1d. new text end
new text begin Methods of providing notice; content of notice. new text end
new text begin
(a) A notice required under
subdivision 1a must be provided to patients, hospital personnel, the public, local units of
government, and the commissioner of health using at least the following methods:
new text end
new text begin
(1) posting a notice of the proposed cessation of operations, curtailment, relocation of
health services, or cessation in offering health services at the main public entrance of the
hospital or hospital campus;
new text end
new text begin
(2) providing written notice to the commissioner of health, to the city council in the city
where the hospital or hospital campus is located, and to the county board in the county
where the hospital or hospital campus is located;
new text end
new text begin
(3) providing written notice to the local health department as defined in section 145A.02,
subdivision 8b, for the community where the hospital or hospital campus is located;
new text end
new text begin
(4) providing notice to the public through a written public announcement which must
be distributed to local media outlets;
new text end
new text begin
(5) providing written notice to existing patients of the hospital or hospital campus; and
new text end
new text begin
(6) notifying all personnel currently employed in the unit, hospital, or hospital campus
impacted by the proposed cessation, curtailment, or relocation.
new text end
new text begin
(b) A notice required under subdivision 1a must include:
new text end
new text begin
(1) a description of the proposed cessation of operations, curtailment, relocation of health
services, or cessation in offering health services. The description must include:
new text end
new text begin
(i) the number of beds, if any, that will be eliminated, repurposed, reassigned, or otherwise
reconfigured to serve populations or patients other than those currently served;
new text end
new text begin
(ii) the current number of beds in the impacted unit, hospital, or hospital campus, and
the number of beds in the impacted unit, hospital, or hospital campus after the proposed
cessation, curtailment, or relocation takes place;
new text end
new text begin
(iii) the number of existing patients who will be impacted by the proposed cessation,
curtailment, or relocation;
new text end
new text begin
(iv) any decrease in personnel, or relocation of personnel to a different unit, hospital, or
hospital campus, caused by the proposed cessation, curtailment, or relocation;
new text end
new text begin
(v) a description of the health services provided by the unit, hospital, or hospital campus
impacted by the proposed cessation, curtailment, or relocation; and
new text end
new text begin
(vi) identification of the three nearest available health care facilities where patients may
obtain the health services provided by the unit, hospital, or hospital campus impacted by
the proposed cessation, curtailment, or relocation, and any potential barriers to seamlessly
transition patients to receive services at one of these facilities. If the unit, hospital, or hospital
campus impacted by the proposed cessation, curtailment, or relocation serves medical
assistance or Medicare enrollees, the information required under this item must specify
whether any of the three nearest available facilities serves medical assistance or Medicare
enrollees; and
new text end
new text begin
(2) a telephone number, email address, and address for each of the following, to which
interested parties may offer comments on the proposed cessation, curtailment, or relocation:
new text end
new text begin
(i) the hospital or hospital campus; and
new text end
new text begin
(ii) the parent entity, if any, or the entity under contract, if any, that acts as the corporate
administrator of the hospital or hospital campus.
new text end
Sec. 11.
Minnesota Statutes 2022, section 144.555, subdivision 2, is amended to read:
Subd. 2.
Penaltynew text begin ; facilities other than hospitalsnew text end .
Failure to notify the commissioner
under subdivision 1deleted text begin , 1a, or 1c or failure to participate in a public hearing under subdivision
1bdeleted text end may result in issuance of a correction order under section 144.653, subdivision 5.
Sec. 12.
Minnesota Statutes 2022, section 144.555, is amended by adding a subdivision
to read:
new text begin Subd. 3. new text end
new text begin Penalties; hospitals. new text end
new text begin
(a) Failure to participate in a public hearing under
subdivision 1b or failure to notify the commissioner under subdivision 1c may result in
issuance of a correction order under section 144.653, subdivision 5.
new text end
new text begin
(b) Notwithstanding any law to the contrary, the commissioner must impose on the
controlling persons of a hospital or hospital campus a fine of $20,000 for each failure to
provide notice to an individual or entity or at a location required under subdivision 1d,
paragraph (a), with the total fine amount imposed not to exceed $60,000 for failures to
comply with the notice requirements for a single scheduled action. The commissioner is
not required to issue a correction order before imposing a fine under this paragraph. Section
144.653, subdivision 8, applies to fines imposed under this paragraph.
new text end
Sec. 13.
new text begin
[144.556] RIGHT OF FIRST REFUSAL; SALE OF HOSPITAL OR
HOSPITAL CAMPUS.
new text end
new text begin
(a) The controlling persons of a hospital licensed under sections 144.50 to 144.56 or a
hospital campus must not sell or convey the hospital or hospital campus, offer to sell or
convey the hospital or hospital campus to a person other than a local unit of government
listed in this paragraph, or voluntarily cease operations of the hospital or hospital campus
unless the controlling persons have first made a good faith offer to sell or convey the hospital
or hospital campus to the home rule charter or statutory city, county, town, or hospital
district in which the hospital or hospital campus is located.
new text end
new text begin
(b) The offer to sell or convey the hospital or hospital campus to a local unit of
government under paragraph (a) must be at a price that does not exceed the current fair
market value of the hospital or hospital campus. A party to whom an offer is made under
paragraph (a) must accept or decline the offer within 60 days of receipt. If the party to whom
the offer is made fails to respond within 60 days of receipt, the offer is deemed declined.
new text end
Sec. 14.
Minnesota Statutes 2022, section 144A.70, subdivision 3, is amended to read:
Subd. 3.
Controlling person.
"Controlling person" means a business entitynew text begin or entitiesnew text end ,
officer, program administrator, or directornew text begin ,new text end whose responsibilities include deleted text begin the direction of
the management or policies of a supplemental nursing services agencydeleted text end new text begin the management and
decision-making authority to establish or control business policy and all other policies of a
supplemental nursing services agencynew text end . Controlling person also means an individual who,
directly or indirectly, beneficially owns an interest in a corporation, partnership, or other
business association that is a controlling person.
Sec. 15.
Minnesota Statutes 2022, section 144A.70, subdivision 5, is amended to read:
Subd. 5.
Person.
"Person" includes an individual, deleted text begin firm,deleted text end corporation, partnership,new text begin limited
liability company,new text end or association.
Sec. 16.
Minnesota Statutes 2022, section 144A.70, subdivision 6, is amended to read:
Subd. 6.
Supplemental nursing services agency.
"Supplemental nursing services
agency" means a person, deleted text begin firm,deleted text end corporation, partnership, new text begin limited liability company, new text end or
association engaged for hire in the business of providing or procuring temporary employment
in health care facilities for nurses, nursing assistants, nurse aides, and orderlies. Supplemental
nursing services agency does not include an individual who only engages in providing the
individual's services on a temporary basis to health care facilities. Supplemental nursing
services agency does not include a professional home care agency licensed under section
144A.471 that only provides staff to other home care providers.
Sec. 17.
Minnesota Statutes 2022, section 144A.70, subdivision 7, is amended to read:
Subd. 7.
Oversight.
The commissioner is responsible for the oversight of supplemental
nursing services agencies through deleted text begin annualdeleted text end new text begin semiannualnew text end unannounced surveysnew text begin and follow-up
surveysnew text end , complaint investigations under sections 144A.51 to 144A.53, and other actions
necessary to ensure compliance with sections 144A.70 to 144A.74.
Sec. 18.
Minnesota Statutes 2022, section 144A.71, subdivision 2, is amended to read:
Subd. 2.
Application information and fee.
The commissioner shall establish forms and
procedures for processing each supplemental nursing services agency registration application.
An application for a supplemental nursing services agency registration must include at least
the following:
(1) the names and addresses of deleted text begin the owner or ownersdeleted text end new text begin all owners and controlling personsnew text end
of the supplemental nursing services agency;
(2) if the owner is a corporation, copies of its articles of incorporation and current bylaws,
together with the names and addresses of its officers and directors;
(3) deleted text begin satisfactory proof of compliance with section 144A.72, subdivision 1, clauses (5) to
(7)deleted text end new text begin if the owner is a limited liability company, copies of its articles of organization and
operating agreement, together with the names and addresses of its officers and directorsnew text end ;
new text begin
(4) documentation that the supplemental nursing services agency has medical malpractice
insurance to insure against the loss, damage, or expense of a claim arising out of the death
or injury of any person as the result of negligence or malpractice in the provision of health
care services by the supplemental nursing services agency or by any employee of the agency;
new text end
new text begin
(5) documentation that the supplemental nursing services agency has an employee
dishonesty bond in the amount of $10,000;
new text end
new text begin
(6) documentation that the supplemental nursing services agency has insurance coverage
for workers' compensation for all nurses, nursing assistants, nurse aides, and orderlies
provided or procured by the agency;
new text end
new text begin
(7) documentation that the supplemental nursing services agency filed with the
commissioner of revenue: (i) the name and address of the bank, savings bank, or savings
association in which the supplemental nursing services agency deposits all employee income
tax withholdings; and (ii) the name and address of any nurse, nursing assistant, nurse aide,
or orderly whose income is derived from placement by the agency, if the agency purports
the income is not subject to withholding;
new text end
deleted text begin (4)deleted text end new text begin (8)new text end any other relevant information that the commissioner determines is necessary to
properly evaluate an application for registration;
deleted text begin (5)deleted text end new text begin (9)new text end a policy and procedure that describes how the supplemental nursing services
agency's records will be immediately available at all times to the commissionernew text begin and facilitynew text end ;
and
deleted text begin (6)deleted text end new text begin (10)new text end a new text begin nonrefundable new text end registration fee of $2,035.
If a supplemental nursing services agency fails to provide the items in this subdivision
to the department, the commissioner shall immediately suspend or refuse to issue the
supplemental nursing services agency registration. The supplemental nursing services agency
may appeal the commissioner's findings according to section 144A.475, subdivisions 3a
and 7, except that the hearing must be conducted by an administrative law judge within 60
calendar days of the request for hearing assignment.
Sec. 19.
Minnesota Statutes 2022, section 144A.71, is amended by adding a subdivision
to read:
new text begin Subd. 2a. new text end
new text begin Renewal applications. new text end
new text begin
An applicant for registration renewal must complete
the registration application form supplied by the department. An application must be
submitted at least 60 days before the expiration of the current registration.
new text end
Sec. 20.
new text begin
[144A.715] PENALTIES.
new text end
new text begin Subdivision 1. new text end
new text begin Authority. new text end
new text begin
The fines imposed under this section are in accordance with
section 144.653, subdivision 6.
new text end
new text begin Subd. 2. new text end
new text begin Fines. new text end
new text begin
Each violation of sections 144A.70 to 144A.74, not corrected at the time
of a follow-up survey, is subject to a fine. A fine must be assessed according to the schedules
established in the sections violated.
new text end
new text begin Subd. 3. new text end
new text begin Failure to correct. new text end
new text begin
If, upon a subsequent follow-up survey after a fine has been
imposed under subdivision 2, a violation is still not corrected, another fine shall be assessed.
The fine shall be double the amount of the previous fine.
new text end
new text begin Subd. 4. new text end
new text begin Payment of fines. new text end
new text begin
Payment of fines is due 15 business days from the registrant's
receipt of notice of the fine from the department.
new text end
Sec. 21.
Minnesota Statutes 2022, section 144A.72, subdivision 1, is amended to read:
Subdivision 1.
Minimum criteria.
(a) The commissioner shall require that, as a condition
of registration:
new text begin
(1) all owners and controlling persons must complete a background study under section
144.057 and receive a clearance or set aside of any disqualification;
new text end
deleted text begin (1)deleted text end new text begin (2)new text end the supplemental nursing services agency shall document that each temporary
employee provided to health care facilities currently meets the minimum licensing, training,
and continuing education standards for the position in which the employee will be workingnew text begin
and verifies competency for the position. A violation of this provision may be subject to a
fine of $3,000new text end ;
deleted text begin (2)deleted text end new text begin (3)new text end the supplemental nursing services agency shall comply with all pertinent
requirements relating to the health and other qualifications of personnel employed in health
care facilities;
deleted text begin (3)deleted text end new text begin (4)new text end the supplemental nursing services agency must not restrict in any manner the
employment opportunities of its employeesdeleted text begin ;deleted text end new text begin . A violation of this provision may be subject
to a fine of $3,000;
new text end
deleted text begin
(4) the supplemental nursing services agency shall carry medical malpractice insurance
to insure against the loss, damage, or expense incident to a claim arising out of the death
or injury of any person as the result of negligence or malpractice in the provision of health
care services by the supplemental nursing services agency or by any employee of the agency;
deleted text end
deleted text begin
(5) the supplemental nursing services agency shall carry an employee dishonesty bond
in the amount of $10,000;
deleted text end
deleted text begin
(6) the supplemental nursing services agency shall maintain insurance coverage for
workers' compensation for all nurses, nursing assistants, nurse aides, and orderlies provided
or procured by the agency;
deleted text end
deleted text begin
(7) the supplemental nursing services agency shall file with the commissioner of revenue:
(i) the name and address of the bank, savings bank, or savings association in which the
supplemental nursing services agency deposits all employee income tax withholdings; and
(ii) the name and address of any nurse, nursing assistant, nurse aide, or orderly whose income
is derived from placement by the agency, if the agency purports the income is not subject
to withholding;
deleted text end
deleted text begin (8)deleted text end new text begin (5)new text end the supplemental nursing services agency must not, in any contract with any
employee or health care facility, require the payment of liquidated damages, employment
fees, or other compensation should the employee be hired as a permanent employee of a
health care facilitydeleted text begin ;deleted text end new text begin . A violation of this provision may be subject to a fine of $3,000;
new text end
deleted text begin (9)deleted text end new text begin (6)new text end the supplemental nursing services agency shall document that each temporary
employee provided to health care facilities is an employee of the agency and is not an
independent contractor; and
deleted text begin (10)deleted text end new text begin (7)new text end the supplemental nursing services agency shall retain all records for five calendar
years. All records of the supplemental nursing services agency must be immediately available
to the department.
(b) In order to retain registration, the supplemental nursing services agency must provide
services to a health care facility deleted text begin during the yeardeleted text end new text begin in Minnesota within the past 12 monthsnew text end
preceding the supplemental nursing services agency's registration renewal date.
Sec. 22.
Minnesota Statutes 2022, section 144A.73, is amended to read:
144A.73 COMPLAINT SYSTEM.
The commissioner shall establish a system for reporting complaints against a supplemental
nursing services agency or its employees. Complaints may be made by any member of the
public. Complaints against a supplemental nursing services agency shall be investigated by
the deleted text begin Office of Health Facility Complaintsdeleted text end new text begin commissioner of healthnew text end under sections 144A.51
to 144A.53.
Sec. 23.
Minnesota Statutes 2023 Supplement, section 145.561, subdivision 4, is amended
to read:
Subd. 4.
988 telecommunications fee.
(a) In compliance with the National Suicide
Hotline Designation Act of 2020, deleted text begin the commissioner shall impose a monthly statewide fee
ondeleted text end each subscriber of a wireline, wireless, or IP-enabled voice service deleted text begin at a rate that providesdeleted text end new text begin
must pay a monthly fee to providenew text end for the robust creation, operation, and maintenance of a
statewide 988 suicide prevention and crisis system.
deleted text begin
(b) The commissioner shall annually recommend to the Public Utilities Commission an
adequate and appropriate fee to implement this section. The amount of the fee must comply
with the limits in paragraph (c). The commissioner shall provide telecommunication service
providers and carriers a minimum of 45 days' notice of each fee change.
deleted text end
deleted text begin (c)deleted text end new text begin (b)new text end The amount of the 988 telecommunications fee deleted text begin must not be more than 25deleted text end new text begin is 12new text end
cents per month deleted text begin on or after January 1, 2024,deleted text end for each consumer access line, including trunk
equivalents as designated by the deleted text begin commissiondeleted text end new text begin Public Utilities Commissionnew text end pursuant to section
403.11, subdivision 1. The 988 telecommunications fee must be the same for all subscribers.
deleted text begin (d)deleted text end new text begin (c)new text end Each wireline, wireless, and IP-enabled voice telecommunication service provider
shall collect the 988 telecommunications fee and transfer the amounts collected to the
commissioner of public safety in the same manner as provided in section 403.11, subdivision
1, paragraph (d).
deleted text begin (e)deleted text end new text begin (d)new text end The commissioner of public safety shall deposit the money collected from the
988 telecommunications fee to the 988 special revenue account established in subdivision
3.
deleted text begin (f)deleted text end new text begin (e)new text end All 988 telecommunications fee revenue must be used to supplement, and not
supplant, federal, state, and local funding for suicide prevention.
deleted text begin (g)deleted text end new text begin (f)new text end The 988 telecommunications fee amount shall be adjusted as needed to provide
for continuous operation of the lifeline centers and 988 hotline, volume increases, and
maintenance.
deleted text begin (h)deleted text end new text begin (g)new text end The commissioner shall annually report to the Federal Communications
Commission on revenue generated by the 988 telecommunications fee.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 1, 2024.
new text end
Sec. 24.
Minnesota Statutes 2022, section 149A.02, subdivision 3, is amended to read:
Subd. 3.
Arrangements for disposition.
"Arrangements for disposition" means any
action normally taken by a funeral provider in anticipation of or preparation for the
entombment, burial in a cemetery, alkaline hydrolysis, deleted text begin ordeleted text end cremationnew text begin , or, effective July 1,
2025, natural organic reductionnew text end of a dead human body.
Sec. 25.
Minnesota Statutes 2022, section 149A.02, subdivision 16, is amended to read:
Subd. 16.
Final disposition.
"Final disposition" means the acts leading to and the
entombment, burial in a cemetery, alkaline hydrolysis, deleted text begin ordeleted text end cremationnew text begin , or, effective July 1,
2025, natural organic reductionnew text end of a dead human body.
Sec. 26.
Minnesota Statutes 2022, section 149A.02, subdivision 26a, is amended to read:
Subd. 26a.
Inurnment.
"Inurnment" means placing hydrolyzed or cremated remains in
a hydrolyzed or cremated remains container suitable for placement, burial, or shipment.new text begin
Effective July 1, 2025, inurnment also includes placing naturally reduced remains in a
naturally reduced remains container suitable for placement, burial, or shipment.
new text end
Sec. 27.
Minnesota Statutes 2022, section 149A.02, subdivision 27, is amended to read:
Subd. 27.
Licensee.
"Licensee" means any person or entity that has been issued a license
to practice mortuary science, to operate a funeral establishment, to operate an alkaline
hydrolysis facility, deleted text begin ordeleted text end to operate a crematorynew text begin , or, effective July 1, 2025, to operate a natural
organic reduction facilitynew text end by the Minnesota commissioner of health.
Sec. 28.
Minnesota Statutes 2022, section 149A.02, is amended by adding a subdivision
to read:
new text begin Subd. 30b. new text end
new text begin Natural organic reduction or naturally reduce. new text end
new text begin
"Natural organic reduction"
or "naturally reduce" means the contained, accelerated conversion of a dead human body
to soil. This subdivision is effective July 1, 2025.
new text end
Sec. 29.
Minnesota Statutes 2022, section 149A.02, is amended by adding a subdivision
to read:
new text begin Subd. 30c. new text end
new text begin Natural organic reduction facility. new text end
new text begin
"Natural organic reduction facility"
means a structure, room, or other space in a building or real property where natural organic
reduction of a dead human body occurs. This subdivision is effective July 1, 2025.
new text end
Sec. 30.
Minnesota Statutes 2022, section 149A.02, is amended by adding a subdivision
to read:
new text begin Subd. 30d. new text end
new text begin Natural organic reduction vessel. new text end
new text begin
"Natural organic reduction vessel" means
the enclosed container in which natural organic reduction takes place. This subdivision is
effective July 1, 2025.
new text end
Sec. 31.
Minnesota Statutes 2022, section 149A.02, is amended by adding a subdivision
to read:
new text begin Subd. 30e. new text end
new text begin Naturally reduced remains. new text end
new text begin
"Naturally reduced remains" means the soil
remains following the natural organic reduction of a dead human body and the accompanying
plant material. This subdivision is effective July 1, 2025.
new text end
Sec. 32.
Minnesota Statutes 2022, section 149A.02, is amended by adding a subdivision
to read:
new text begin Subd. 30f. new text end
new text begin Naturally reduced remains container. new text end
new text begin
"Naturally reduced remains container"
means a receptacle in which naturally reduced remains are placed. This subdivision is
effective July 1, 2025.
new text end
Sec. 33.
Minnesota Statutes 2022, section 149A.02, subdivision 35, is amended to read:
Subd. 35.
Processing.
"Processing" means the removal of foreign objects, drying or
cooling, and the reduction of the hydrolyzed deleted text begin ordeleted text end new text begin remains, new text end crematednew text begin remains, or, effective
July 1, 2025, naturally reducednew text end remains by mechanical means including, but not limited to,
grinding, crushing, or pulverizing, to a granulated appearance appropriate for final
disposition.
Sec. 34.
Minnesota Statutes 2022, section 149A.02, subdivision 37c, is amended to read:
Subd. 37c.
Scattering.
"Scattering" means the authorized dispersal of hydrolyzed deleted text begin ordeleted text end new text begin
remains,new text end cremated remainsnew text begin , or, effective July 1, 2025, naturally reduced remainsnew text end in a defined
area of a dedicated cemetery or in areas where no local prohibition exists provided that the
hydrolyzed deleted text begin ordeleted text end new text begin ,new text end crematednew text begin , or naturally reducednew text end remains are not distinguishable to the public,
are not in a container, and that the person who has control over disposition of the hydrolyzed
deleted text begin ordeleted text end new text begin ,new text end crematednew text begin , or naturally reducednew text end remains has obtained written permission of the property
owner or governing agency to scatter on the property.
Sec. 35.
Minnesota Statutes 2022, 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) licensure and professional conduct of funeral directors, morticians, interns, practicum
students, and clinical students;
(iii) licensing and operation of a funeral establishment;
(iv) licensing and operation of an alkaline hydrolysis facility; deleted text begin and
deleted text end
(v) licensing and operation of a crematory;new text begin and
new text end
new text begin
(vi) effective July 1, 2025, licensing and operation of a natural organic reduction facility;
new text end
(2) provide copies of the requirements for licensure and permits to all applicants;
(3) administer examinations and issue licenses and permits to qualified persons and other
legal entities;
(4) maintain a record of the name and location of all current licensees 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, 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. 36.
new text begin
[149A.56] LICENSE TO OPERATE A NATURAL ORGANIC REDUCTION
FACILITY.
new text end
new text begin Subdivision 1. new text end
new text begin License requirement. new text end
new text begin
This section is effective July 1, 2025. Except as
provided in section 149A.01, subdivision 3, no person shall maintain, manage, or operate
a place or premises devoted to or used in the holding and natural organic reduction of a
dead human body without possessing a valid license to operate a natural organic reduction
facility issued by the commissioner of health.
new text end
new text begin Subd. 2. new text end
new text begin Requirements for natural organic reduction facility. new text end
new text begin
(a) A natural organic
reduction facility licensed under this section must consist of:
new text end
new text begin
(1) a building or structure that complies with applicable local and state building codes,
zoning laws and ordinances, and environmental standards, and that contains one or more
natural organic reduction vessels for the natural organic reduction of dead human bodies;
new text end
new text begin
(2) a motorized mechanical device for processing naturally reduced remains; and
new text end
new text begin
(3) an appropriate refrigerated holding facility for dead human bodies awaiting natural
organic reduction.
new text end
new text begin
(b) A natural organic reduction facility licensed under this section may also contain a
display room for funeral goods.
new text end
new text begin Subd. 3. new text end
new text begin Application procedure; documentation; initial inspection. new text end
new text begin
(a) An applicant
for a license to operate a natural organic reduction facility shall submit a completed
application to the commissioner. A completed application includes:
new text end
new text begin
(1) a completed application form, as provided by the commissioner;
new text end
new text begin
(2) proof of business form and ownership; and
new text end
new text begin
(3) proof of liability insurance coverage or other financial documentation, as determined
by the commissioner, that demonstrates the applicant's ability to respond in damages for
liability arising from the ownership, maintenance, management, or operation of a natural
organic reduction facility.
new text end
new text begin
(b) Upon receipt of the application and appropriate fee, the commissioner shall review
and verify all information. Upon completion of the verification process and resolution of
any deficiencies in the application information, the commissioner shall conduct an initial
inspection of the premises to be licensed. After the inspection and resolution of any
deficiencies found and any reinspections as may be necessary, the commissioner shall make
a determination, based on all the information available, to grant or deny licensure. If the
commissioner's determination is to grant the license, the applicant shall be notified and the
license shall issue and remain valid for a period prescribed on the license, but not to exceed
one calendar year from the date of issuance of the license. If the commissioner's determination
is to deny the license, the commissioner must notify the applicant, in writing, of the denial
and provide the specific reason for denial.
new text end
new text begin Subd. 4. new text end
new text begin Nontransferability of license. new text end
new text begin
A license to operate a natural organic reduction
facility is not assignable or transferable and shall not be valid for any entity other than the
one named. Each license issued to operate a natural organic reduction facility is valid only
for the location identified on the license. A 50 percent or more change in ownership or
location of the natural organic reduction facility automatically terminates the license. Separate
licenses shall be required of two or more persons or other legal entities operating from the
same location.
new text end
new text begin Subd. 5. new text end
new text begin Display of license. new text end
new text begin
Each license to operate a natural organic reduction facility
must be conspicuously displayed in the natural organic reduction facility at all times.
Conspicuous display means in a location where a member of the general public within the
natural organic reduction facility is able to observe and read the license.
new text end
new text begin Subd. 6. new text end
new text begin Period of licensure. new text end
new text begin
All licenses to operate a natural organic reduction facility
issued by the commissioner are valid for a period of one calendar year beginning on July 1
and ending on June 30, regardless of the date of issuance.
new text end
new text begin Subd. 7. new text end
new text begin Reporting changes in license information. new text end
new text begin
Any change of license information
must be reported to the commissioner, on forms provided by the commissioner, no later
than 30 calendar days after the change occurs. Failure to report changes is grounds for
disciplinary action.
new text end
new text begin Subd. 8. new text end
new text begin Licensing information. new text end
new text begin
Section 13.41 applies to data collected and maintained
by the commissioner pursuant to this section.
new text end
Sec. 37.
new text begin
[149A.57] RENEWAL OF LICENSE TO OPERATE A NATURAL
ORGANIC REDUCTION FACILITY.
new text end
new text begin Subdivision 1. new text end
new text begin Renewal required. new text end
new text begin
This section is effective July 1, 2025. All licenses
to operate a natural organic reduction facility issued by the commissioner expire on June
30 following the date of issuance of the license and must be renewed to remain valid.
new text end
new text begin Subd. 2. new text end
new text begin Renewal procedure and documentation. new text end
new text begin
(a) Licensees who wish to renew
their licenses must submit to the commissioner a completed renewal application no later
than June 30 following the date the license was issued. A completed renewal application
includes:
new text end
new text begin
(1) a completed renewal application form, as provided by the commissioner; and
new text end
new text begin
(2) proof of liability insurance coverage or other financial documentation, as determined
by the commissioner, that demonstrates the applicant's ability to respond in damages for
liability arising from the ownership, maintenance, management, or operation of a natural
organic reduction facility.
new text end
new text begin
(b) Upon receipt of the completed renewal application, the commissioner shall review
and verify the information. Upon completion of the verification process and resolution of
any deficiencies in the renewal application information, the commissioner shall make a
determination, based on all the information available, to reissue or refuse to reissue the
license. If the commissioner's determination is to reissue the license, the applicant shall be
notified and the license shall issue and remain valid for a period prescribed on the license,
but not to exceed one calendar year from the date of issuance of the license. If the
commissioner's determination is to refuse to reissue the license, section 149A.09, subdivision
2, applies.
new text end
new text begin Subd. 3. new text end
new text begin Penalty for late filing. new text end
new text begin
Renewal applications received after the expiration date
of a license will result in the assessment of a late filing penalty. The late filing penalty must
be paid before the reissuance of the license and received by the commissioner no later than
31 calendar days after the expiration date of the license.
new text end
new text begin Subd. 4. new text end
new text begin Lapse of license. new text end
new text begin
A license to operate a natural organic reduction facility shall
automatically lapse when a completed renewal application is not received by the
commissioner within 31 calendar days after the expiration date of a license, or a late filing
penalty assessed under subdivision 3 is not received by the commissioner within 31 calendar
days after the expiration of a license.
new text end
new text begin Subd. 5. new text end
new text begin Effect of lapse of license. new text end
new text begin
Upon the lapse of a license, the person to whom the
license was issued is no longer licensed to operate a natural organic reduction facility in
Minnesota. The commissioner shall issue a cease and desist order to prevent the lapsed
license holder from operating a natural organic reduction facility in Minnesota and may
pursue any additional lawful remedies as justified by the case.
new text end
new text begin Subd. 6. new text end
new text begin Restoration of lapsed license. new text end
new text begin
The commissioner may restore a lapsed license
upon receipt and review of a completed renewal application, receipt of the late filing penalty,
and reinspection of the premises, provided that the receipt is made within one calendar year
from the expiration date of the lapsed license and the cease and desist order issued by the
commissioner has not been violated. If a lapsed license is not restored within one calendar
year from the expiration date of the lapsed license, the holder of the lapsed license cannot
be relicensed until the requirements in section 149A.56 are met.
new text end
new text begin Subd. 7. new text end
new text begin Reporting changes in license information. new text end
new text begin
Any change of license information
must be reported to the commissioner, on forms provided by the commissioner, no later
than 30 calendar days after the change occurs. Failure to report changes is grounds for
disciplinary action.
new text end
new text begin Subd. 8. new text end
new text begin Licensing information. new text end
new text begin
Section 13.41 applies to data collected and maintained
by the commissioner pursuant to this section.
new text end
Sec. 38.
Minnesota Statutes 2022, section 149A.65, is amended by adding a subdivision
to read:
new text begin Subd. 6a. new text end
new text begin Natural organic reduction facilities. new text end
new text begin
This subdivision is effective July 1,
2025. The initial and renewal fee for a natural organic reduction facility is $425. The late
fee charge for a license renewal is $100.
new text end
Sec. 39.
Minnesota Statutes 2022, section 149A.70, subdivision 1, is amended to read:
Subdivision 1.
Use of titles.
Only a person holding a valid license to practice mortuary
science issued by the commissioner may use the title of mortician, funeral director, or any
other title implying that the licensee is engaged in the business or practice of mortuary
science. Only the holder of a valid license to operate an alkaline hydrolysis facility issued
by the commissioner may use the title of alkaline hydrolysis facility, water cremation,
water-reduction, biocremation, green-cremation, resomation, dissolution, or any other title,
word, or term implying that the licensee operates an alkaline hydrolysis facility. Only the
holder of a valid license to operate a funeral establishment issued by the commissioner may
use the title of funeral home, funeral chapel, funeral service, or any other title, word, or
term implying that the licensee is engaged in the business or practice of mortuary science.
Only the holder of a valid license to operate a crematory issued by the commissioner may
use the title of crematory, crematorium, green-cremation, or any other title, word, or term
implying that the licensee operates a crematory or crematorium. new text begin Effective July 1, 2025,
only the holder of a valid license to operate a natural organic reduction facility issued by
the commissioner may use the title of natural organic reduction facility, human composting,
or any other title, word, or term implying that the licensee operates a natural organic reduction
facility.
new text end
Sec. 40.
Minnesota Statutes 2022, section 149A.70, subdivision 2, is amended to read:
Subd. 2.
Business location.
A funeral establishment, alkaline hydrolysis facility, deleted text begin ordeleted text end
crematorynew text begin , or, effective July 1, 2025, natural organic reduction facilitynew text end shall not do business
in a location that is not licensed as a funeral establishment, alkaline hydrolysis facility, deleted text begin ordeleted text end
crematorynew text begin , or natural organic reduction facilitynew text end and shall not advertise a service that is
available from an unlicensed location.
Sec. 41.
Minnesota Statutes 2022, section 149A.70, subdivision 3, is amended to read:
Subd. 3.
Advertising.
No licensee, 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, deleted text begin ordeleted text end crematorynew text begin , or, effective July 1, 2025, natural organic reduction facilitynew text end
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, deleted text begin ordeleted text end crematory, new text begin or, effective July 1, 2025, natural
organic reduction facility, new text end unless the surname had been previously and continuously used
by the licensed funeral establishment, alkaline hydrolysis facility, deleted text begin ordeleted text end crematorynew text begin , or natural
organic reduction facilitynew text end ; 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, deleted text begin ordeleted text end crematorynew text begin , or, effective July 1, 2025, natural organic reduction facilitynew text end 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, deleted text begin ordeleted text end crematorynew text begin , or, effective
July 1, 2025, natural organic reduction facilitynew text end shall state the position held by the persons
and shall identify each person who is licensed or unlicensed under this chapter.
Sec. 42.
Minnesota Statutes 2022, section 149A.70, subdivision 5, is amended to read:
Subd. 5.
Reimbursement prohibited.
No licensee, clinical student, practicum student,
or intern 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, deleted text begin ordeleted text end cemeterynew text begin , or, effective July 1, 2025, natural organic
reduction facilitynew text end .
Sec. 43.
Minnesota Statutes 2022, section 149A.71, subdivision 2, is amended to read:
Subd. 2.
Preventive requirements.
(a) To prevent unfair or deceptive acts or practices,
the requirements of this subdivision must be met.new text begin This subdivision applies to natural organic
reduction and naturally reduced remains goods and services effective July 1, 2025.
new text end
(b) Funeral providers must tell persons who ask by telephone about the funeral provider's
offerings or prices any accurate information from the price lists described in paragraphs (c)
to (e) and any other readily available information that reasonably answers the questions
asked.
(c) Funeral providers must make available for viewing to people who inquire in person
about the offerings or prices of funeral goods or burial site goods, separate printed or
typewritten price lists using a ten-point font or larger. Each funeral provider must have a
separate price list for each of the following types of goods that are sold or offered for sale:
(1) caskets;
(2) alternative containers;
(3) outer burial containers;
(4) alkaline hydrolysis containers;
(5) cremation containers;
(6) hydrolyzed remains containers;
(7) cremated remains containers;
(8) markers; deleted text begin and
deleted text end
(9) headstonesdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(10) naturally reduced remains containers.
new text end
(d) Each separate price list must contain the name of the funeral provider's place of
business, address, and telephone number and a caption describing the list as a price list for
one of the types of funeral goods or burial site goods described in paragraph (c), clauses
(1) to deleted text begin (9)deleted text end new text begin (10)new text end . The funeral provider must offer the list upon beginning discussion of, but
in any event before showing, the specific funeral goods or burial site goods and must provide
a photocopy of the price list, for retention, if so asked by the consumer. The list must contain,
at least, the retail prices of all the specific funeral goods and burial site goods offered which
do not require special ordering, enough information to identify each, and the effective date
for the price list. However, funeral providers are not required to make a specific price list
available if the funeral providers place the information required by this paragraph on the
general price list described in paragraph (e).
(e) Funeral providers must give a printed price list, for retention, to persons who inquire
in person about the funeral goods, funeral services, burial site goods, or burial site services
or prices offered by the funeral provider. The funeral provider must give the list upon
beginning discussion of either the prices of or the overall type of funeral service or disposition
or specific funeral goods, funeral services, burial site goods, or burial site services offered
by the provider. This requirement applies whether the discussion takes place in the funeral
establishment or elsewhere. However, when the deceased is removed for transportation to
the funeral establishment, an in-person request for authorization to embalm does not, by
itself, trigger the requirement to offer the general price list. If the provider, in making an
in-person request for authorization to embalm, discloses that embalming is not required by
law except in certain special cases, the provider is not required to offer the general price
list. Any other discussion during that time about prices or the selection of funeral goods,
funeral services, burial site goods, or burial site services triggers the requirement to give
the consumer a general price list. The general price list must contain the following
information:
(1) the name, address, and telephone number of the funeral provider's place of business;
(2) a caption describing the list as a "general price list";
(3) the effective date for the price list;
(4) the retail prices, in any order, expressed either as a flat fee or as the prices per hour,
mile, or other unit of computation, and other information described as follows:
(i) forwarding of remains to another funeral establishment, together with a list of the
services provided for any quoted price;
(ii) receiving remains from another funeral establishment, together with a list of the
services provided for any quoted price;
(iii) separate prices for each alkaline hydrolysisnew text begin , natural organic reduction,new text end or cremation
offered by the funeral provider, with the price including an alternative container new text begin or shroud
new text end or alkaline hydrolysisnew text begin facilitynew text end or cremation containerdeleted text begin ,deleted text end new text begin ;new text end any alkaline hydrolysisnew text begin , natural
organic reduction facility,new text end or crematory chargesdeleted text begin ,deleted text end new text begin ;new text end and a description of the services and
container included in the price, where applicable, and the price of alkaline hydrolysis or
cremation where the purchaser provides the container;
(iv) separate prices for each immediate burial offered by the funeral provider, including
a casket or alternative container, and a description of the services and container included
in that price, and the price of immediate burial where the purchaser provides the casket or
alternative container;
(v) transfer of remains to the funeral establishment or other location;
(vi) embalming;
(vii) other preparation of the body;
(viii) use of facilities, equipment, or staff for viewing;
(ix) use of facilities, equipment, or staff for funeral ceremony;
(x) use of facilities, equipment, or staff for memorial service;
(xi) use of equipment or staff for graveside service;
(xii) hearse or funeral coach;
(xiii) limousine; and
(xiv) separate prices for all cemetery-specific goods and services, including all goods
and services associated with interment and burial site goods and services and excluding
markers and headstones;
(5) the price range for the caskets offered by the funeral provider, together with the
statement "A complete price list will be provided at the funeral establishment or casket sale
location." or the prices of individual caskets, as disclosed in the manner described in
paragraphs (c) and (d);
(6) the price range for the alternative containers new text begin or shrouds new text end offered by the funeral provider,
together with the statement "A complete price list will be provided at the funeral
establishment or alternative container sale location." or the prices of individual alternative
containers, as disclosed in the manner described in paragraphs (c) and (d);
(7) the price range for the outer burial containers offered by the funeral provider, together
with the statement "A complete price list will be provided at the funeral establishment or
outer burial container sale location." or the prices of individual outer burial containers, as
disclosed in the manner described in paragraphs (c) and (d);
(8) the price range for the alkaline hydrolysis container offered by the funeral provider,
together with the statement "A complete price list will be provided at the funeral
establishment or alkaline hydrolysis container sale location." or the prices of individual
alkaline hydrolysis containers, as disclosed in the manner described in paragraphs (c) and
(d);
(9) the price range for the hydrolyzed remains container offered by the funeral provider,
together with the statement "A complete price list will be provided at the funeral
establishment or hydrolyzed remains container sale location." or the prices of individual
hydrolyzed remains container, as disclosed in the manner described in paragraphs (c) and
(d);
(10) the price range for the cremation containers offered by the funeral provider, together
with the statement "A complete price list will be provided at the funeral establishment or
cremation container sale location." or the prices of individual cremation containers, as
disclosed in the manner described in paragraphs (c) and (d);
(11) the price range for the cremated remains containers offered by the funeral provider,
together with the statement, "A complete price list will be provided at the funeral
establishment or cremated remains container sale location," or the prices of individual
cremation containers as disclosed in the manner described in paragraphs (c) and (d);
new text begin
(12) the price range for the naturally reduced remains containers offered by the funeral
provider, together with the statement, "A complete price list will be provided at the funeral
establishment or naturally reduced remains container sale location," or the prices of individual
naturally reduced remains containers as disclosed in the manner described in paragraphs
(c) and (d);
new text end
deleted text begin (12)deleted text end new text begin (13)new text end the price for the basic services of funeral provider and staff, together with a
list of the principal basic services provided for any quoted price and, if the charge cannot
be declined by the purchaser, the statement "This fee for our basic services will be added
to the total cost of the funeral arrangements you select. (This fee is already included in our
charges for alkaline hydrolysis, new text begin natural organic reduction, new text end direct cremations, immediate
burials, and forwarding or receiving remains.)" If the charge cannot be declined by the
purchaser, the quoted price shall include all charges for the recovery of unallocated funeral
provider overhead, and funeral providers may include in the required disclosure the phrase
"and overhead" after the word "services." This services fee is the only funeral provider fee
for services, facilities, or unallocated overhead permitted by this subdivision to be
nondeclinable, unless otherwise required by law;
deleted text begin (13)deleted text end new text begin (14)new text end the price range for the markers and headstones offered by the funeral provider,
together with the statement "A complete price list will be provided at the funeral
establishment or marker or headstone sale location." or the prices of individual markers and
headstones, as disclosed in the manner described in paragraphs (c) and (d); and
deleted text begin (14)deleted text end new text begin (15)new text end any package priced funerals offered must be listed in addition to and following
the information required in paragraph (e) and must clearly state the funeral goods and
services being offered, the price being charged for those goods and services, and the
discounted savings.
(f) Funeral providers must give an itemized written statement, for retention, to each
consumer who arranges an at-need funeral or other disposition of human remains at the
conclusion of the discussion of the arrangements. The itemized written statement must be
signed by the consumer selecting the goods and services as required in section 149A.80. If
the statement is provided by a funeral establishment, the statement must be signed by the
licensed funeral director or mortician planning the arrangements. If the statement is provided
by any other funeral provider, the statement must be signed by an authorized agent of the
funeral provider. The statement must list the funeral goods, funeral services, burial site
goods, or burial site services selected by that consumer and the prices to be paid for each
item, specifically itemized cash advance items (these prices must be given to the extent then
known or reasonably ascertainable if the prices are not known or reasonably ascertainable,
a good faith estimate shall be given and a written statement of the actual charges shall be
provided before the final bill is paid), and the total cost of goods and services selected. At
the conclusion of an at-need arrangement, the funeral provider is required to give the
consumer a copy of the signed itemized written contract that must contain the information
required in this paragraph.
(g) Upon receiving actual notice of the death of an individual with whom a funeral
provider has entered a preneed funeral agreement, the funeral provider must provide a copy
of all preneed funeral agreement documents to the person who controls final disposition of
the human remains or to the designee of the person controlling disposition. The person
controlling final disposition shall be provided with these documents at the time of the
person's first in-person contact with the funeral provider, if the first contact occurs in person
at a funeral establishment, alkaline hydrolysis facility, crematory, new text begin natural organic reduction
facility, new text end or other place of business of the funeral provider. If the contact occurs by other
means or at another location, the documents must be provided within 24 hours of the first
contact.
Sec. 44.
Minnesota Statutes 2022, section 149A.71, subdivision 4, is amended to read:
Subd. 4.
Casket, alternate container, alkaline hydrolysis container, new text begin naturally reduced
remains container, new text end and cremation container sales; records; required disclosures.
Any
funeral provider who sells or offers to sell a casket, alternate container, alkaline hydrolysis
container, hydrolyzed remains container, cremation container, deleted text begin ordeleted text end cremated remains containernew text begin ,
or, effective July 1, 2025, naturally reduced remains containernew text end to the public must maintain
a record of each sale that includes the name of the purchaser, the purchaser's mailing address,
the name of the decedent, the date of the decedent's death, and the place of death. These
records shall be open to inspection by the regulatory agency. Any funeral provider selling
a casket, alternate container, or cremation container to the public, and not having charge of
the final disposition of the dead human body, shall provide a copy of the statutes and rules
controlling the removal, preparation, transportation, arrangements for disposition, and final
disposition of a dead human body. This subdivision does not apply to morticians, funeral
directors, funeral establishments, crematories, or wholesale distributors of caskets, alternate
containers, alkaline hydrolysis containers, or cremation containers.
Sec. 45.
Minnesota Statutes 2022, section 149A.72, subdivision 3, is amended to read:
Subd. 3.
Casket for alkaline hydrolysisnew text begin , natural organic reduction,new text end or cremation
provisions; deceptive acts or practices.
In selling or offering to sell funeral goods or
funeral services to the public, it is a deceptive act or practice for a funeral provider to
represent that a casket is required for alkaline hydrolysis deleted text begin ordeleted text end new text begin ,new text end cremationsnew text begin , or, effective July
1, 2025, natural organic reductionnew text end by state or local law or otherwise.
Sec. 46.
Minnesota Statutes 2022, section 149A.72, subdivision 9, is amended to read:
Subd. 9.
Deceptive acts or practices.
In selling or offering to sell funeral goods, funeral
services, burial site goods, or burial site services to the public, it is a deceptive act or practice
for a funeral provider to represent that federal, state, or local laws, or particular cemeteries,
alkaline hydrolysis facilities, deleted text begin ordeleted text end crematoriesnew text begin , or, effective July 1, 2025, natural organic
reduction facilitiesnew text end require the purchase of any funeral goods, funeral services, burial site
goods, or burial site services when that is not the case.
Sec. 47.
Minnesota Statutes 2022, section 149A.73, subdivision 1, is amended to read:
Subdivision 1.
Casket for alkaline hydrolysisnew text begin , natural organic reduction,new text end or cremation
provisions; deceptive acts or practices.
In selling or offering to sell funeral goods, funeral
services, burial site goods, or burial site services to the public, it is a deceptive act or practice
for a funeral provider to require that a casket be purchased for alkaline hydrolysis deleted text begin ordeleted text end new text begin ,new text end
cremationnew text begin , or, effective July 1, 2025, natural organic reductionnew text end .
Sec. 48.
Minnesota Statutes 2022, section 149A.74, subdivision 1, is amended to read:
Subdivision 1.
Services provided without prior approval; deceptive acts or
practices.
In selling or offering to sell funeral goods or funeral services to the public, it is
a deceptive act or practice for any funeral provider to embalm a dead human body unless
state or local law or regulation requires embalming in the particular circumstances regardless
of any funeral choice which might be made, or prior approval for embalming has been
obtained from an individual legally authorized to make such a decision. In seeking approval
to embalm, the funeral provider must disclose that embalming is not required by law except
in certain circumstances; that a fee will be charged if a funeral is selected which requires
embalming, such as a funeral with viewing; and that no embalming fee will be charged if
the family selects a service which does not require embalming, such as direct alkaline
hydrolysis, direct cremation, deleted text begin ordeleted text end immediate burialnew text begin , or, effective July 1, 2025, natural organic
reductionnew text end .
Sec. 49.
Minnesota Statutes 2022, section 149A.93, subdivision 3, is amended to read:
Subd. 3.
Disposition permit.
A disposition permit is required before a body can be
buried, entombed, alkaline hydrolyzed, deleted text begin ordeleted text end crematednew text begin , or, effective July 1, 2025, naturally
reducednew text end . No disposition permit shall be issued until a fact of death record has been completed
and filed with the state registrar of vital records.
Sec. 50.
Minnesota Statutes 2022, section 149A.94, subdivision 1, is amended to read:
Subdivision 1.
Generally.
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, deleted text begin ordeleted text end crematednew text begin , or, effective July 1, 2025, naturally
reducednew text end within a reasonable time after death. Where final disposition of a body will not be
accomplishednew text begin , or, effective July 1, 2025, when natural organic reduction will not be initiated,new text end
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 kept in refrigeration for a period exceeding six calendar
days, or 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.
Sec. 51.
Minnesota Statutes 2022, section 149A.94, subdivision 3, is amended to read:
Subd. 3.
Permit required.
No dead human body shall be buried, entombed, deleted text begin ordeleted text end crematednew text begin ,
alkaline hydrolyzed, or, effective July 1, 2025, naturally reducednew text end without a disposition
permit. The disposition permit must be filed with the person in charge of the place of final
disposition. Where a dead human body will be transported out of this state for final
disposition, the body must be accompanied by a certificate of removal.
Sec. 52.
Minnesota Statutes 2022, section 149A.94, subdivision 4, is amended to read:
Subd. 4.
Alkaline hydrolysis deleted text begin ordeleted text end new text begin ,new text end cremationnew text begin , or natural organic reductionnew text end .
Inurnment
of alkaline hydrolyzed deleted text begin ordeleted text end new text begin remains,new text end cremated remainsnew text begin , or, effective July 1, 2025, naturally
reduced remainsnew text end and release to an appropriate party is considered final disposition and no
further permits or authorizations are required for transportation, interment, entombment, or
placement of the deleted text begin cremateddeleted text end remains, except as provided in section 149A.95, subdivision 16.
Sec. 53.
new text begin
[149A.955] NATURAL ORGANIC REDUCTION FACILITIES AND
NATURAL ORGANIC REDUCTION.
new text end
new text begin Subdivision 1. new text end
new text begin License required. new text end
new text begin
This section is effective July 1, 2025. A dead human
body may only undergo natural organic reduction in this state at a natural organic reduction
facility licensed by the commissioner of health.
new text end
new text begin Subd. 2. new text end
new text begin General requirements. new text end
new text begin
Any building to be used as a natural organic reduction
facility must comply with all applicable local and state building codes, zoning laws and
ordinances, and environmental standards. A natural organic reduction facility must have,
on site, a natural organic reduction system approved by the commissioner and a motorized
mechanical device for processing naturally reduced remains and must have, in the building,
a refrigerated holding facility for the retention of dead human bodies awaiting natural organic
reduction. The holding facility must be secure from access by anyone except the authorized
personnel of the natural organic reduction facility, preserve the dignity of the remains, and
protect the health and safety of the natural organic reduction facility personnel.
new text end
new text begin Subd. 3. new text end
new text begin Aerobic reduction vessel. new text end
new text begin
A natural organic reduction facility must use as a
natural organic reduction vessel, a contained reduction vessel that is designed to promote
aerobic reduction and that minimizes odors.
new text end
new text begin Subd. 4. new text end
new text begin Unlicensed personnel. new text end
new text begin
A licensed natural organic reduction facility may employ
unlicensed personnel, provided that all applicable provisions of this chapter are followed.
It is the duty of the licensed natural organic reduction facility to provide proper training for
all unlicensed personnel, and the licensed natural organic reduction facility shall be strictly
accountable for compliance with this chapter and other applicable state and federal regulations
regarding occupational and workplace health and safety.
new text end
new text begin Subd. 5. new text end
new text begin Authorization to naturally reduce. new text end
new text begin
No natural organic reduction facility shall
naturally reduce or cause to be naturally reduced any dead human body or identifiable body
part without receiving written authorization to do so from the person or persons who have
the legal right to control disposition as described in section 149A.80 or the person's legal
designee. The written authorization must include:
new text end
new text begin
(1) the name of the deceased and the date of death of the deceased;
new text end
new text begin
(2) a statement authorizing the natural organic reduction facility to naturally reduce the
body;
new text end
new text begin
(3) the name, address, phone number, relationship to the deceased, and signature of the
person or persons with the legal right to control final disposition or a legal designee;
new text end
new text begin
(4) directions for the disposition of any non-naturally reduced materials or items recovered
from the natural organic reduction vessel;
new text end
new text begin
(5) acknowledgment that some of the naturally reduced remains will be mechanically
reduced to a granulated appearance and included in the appropriate containers with the
naturally reduced remains; and
new text end
new text begin
(6) directions for the ultimate disposition of the naturally reduced remains.
new text end
new text begin Subd. 6. new text end
new text begin Limitation of liability. new text end
new text begin
The limitations in section 149A.95, subdivision 5, apply
to natural organic reduction facilities.
new text end
new text begin Subd. 7. new text end
new text begin Acceptance of delivery of body. new text end
new text begin
(a) No dead human body shall be accepted
for final disposition by natural organic reduction unless:
new text end
new text begin
(1) a licensed mortician is present;
new text end
new text begin
(2) the body is wrapped in a container, such as a pouch or shroud, that is impermeable
or leak-resistant;
new text end
new text begin
(3) the body is accompanied by a disposition permit issued pursuant to section 149A.93,
subdivision 3, including a photocopy of the complete death record or a signed release
authorizing natural organic reduction received from a coroner or medical examiner; and
new text end
new text begin
(4) the body is accompanied by a natural organic reduction authorization that complies
with subdivision 5.
new text end
new text begin
(b) A natural organic reduction facility shall refuse to accept delivery of the dead human
body:
new text end
new text begin
(1) where there is a known dispute concerning natural organic reduction of the body
delivered;
new text end
new text begin
(2) where there is a reasonable basis for questioning any of the representations made on
the written authorization to naturally reduce; or
new text end
new text begin
(3) for any other lawful reason.
new text end
new text begin
(c) When a container, pouch, or shroud containing a dead human body shows evidence
of leaking bodily fluid, the container, pouch, or shroud and the body must be returned to
the contracting funeral establishment, or the body must be transferred to a new container,
pouch, or shroud by a licensed mortician.
new text end
new text begin
(d) If a dead human body is delivered to a natural organic reduction facility in a container,
pouch, or shroud that is not suitable for placement in a natural organic reduction vessel, the
transfer of the body to the vessel must be performed by a licensed mortician.
new text end
new text begin Subd. 8. new text end
new text begin Bodies awaiting natural organic reduction. new text end
new text begin
A dead human body must be
placed in the natural organic reduction vessel to initiate the natural reduction process within
24 hours after the natural organic reduction facility accepts legal and physical custody of
the body.
new text end
new text begin Subd. 9. new text end
new text begin Handling of dead human bodies. new text end
new text begin
All natural organic reduction facility
employees handling the containers, pouches, or shrouds for dead human bodies shall use
universal precautions and otherwise exercise all reasonable precautions to minimize the
risk of transmitting any communicable disease from the body. No dead human body shall
be removed from the container, pouch, or shroud in which it is delivered to the natural
organic reduction facility without express written authorization of the person or persons
with legal right to control the disposition and only by a licensed mortician. The remains
shall be considered a dead human body until after the processing and curing of the remains
are completed.
new text end
new text begin Subd. 10. new text end
new text begin Identification of the body. new text end
new text begin
All licensed natural organic reduction facilities
shall develop, implement, and maintain an identification procedure whereby dead human
bodies can be identified from the time the natural organic reduction facility accepts delivery
of the body until the naturally reduced remains are released to an authorized party. After
natural organic reduction, an identifying disk, tab, or other permanent label shall be placed
within the naturally reduced remains container or containers before the remains are released
from the natural organic reduction facility. Each identification disk, tab, or label shall have
a number that shall be recorded on all paperwork regarding the decedent. This procedure
shall be designed to reasonably ensure that the proper body is naturally reduced and that
the remains are returned to the appropriate party. Loss of all or part of the remains or the
inability to individually identify the remains is a violation of this subdivision.
new text end
new text begin Subd. 11. new text end
new text begin Natural organic reduction vessel for human remains. new text end
new text begin
A licensed natural
organic reduction facility shall knowingly naturally reduce only dead human bodies or
human remains in a natural organic reduction vessel.
new text end
new text begin Subd. 12. new text end
new text begin Natural organic reduction procedures; privacy. new text end
new text begin
The final disposition of
dead human bodies by natural organic reduction shall be done in privacy. Unless there is
written authorization from the person with the legal right to control the final disposition,
only authorized natural organic reduction facility personnel shall be permitted in the natural
organic reduction area while any human body is awaiting placement in a natural organic
reduction vessel, being removed from the vessel, or being processed for placement in a
naturally reduced remains container. This does not prohibit an in-person laying-in ceremony
to honor the deceased and the transition prior to the placement.
new text end
new text begin Subd. 13. new text end
new text begin
Natural organic reduction procedures; commingling of bodies
prohibited.
new text end
new text begin
Except with the express written permission of the person with the legal right
to control the final disposition, no natural organic reduction facility shall naturally reduce
more than one dead human body at the same time and in the same natural organic reduction
vessel or introduce a second dead human body into same natural organic reduction vessel
until reasonable efforts have been employed to remove all fragments of remains from the
preceding natural organic reduction. This subdivision does not apply where commingling
of human remains during natural organic reduction is otherwise provided by law. The fact
that there is incidental and unavoidable residue in the natural organic reduction vessel used
in a prior natural organic reduction is not a violation of this subdivision.
new text end
new text begin Subd. 14. new text end
new text begin
Natural organic reduction procedures; removal from natural organic
reduction vessel.
new text end
new text begin
Upon completion of the natural organic reduction process, reasonable
efforts shall be made to remove from the natural organic reduction vessel all the recoverable
naturally reduced remains. The naturally reduced remains shall be transported to the
processing area, and any non-naturally reducible materials or items shall be separated from
the naturally reduced remains and disposed of, in any lawful manner, by the natural organic
reduction facility.
new text end
new text begin Subd. 15. new text end
new text begin
Natural organic reduction procedures; processing naturally reduced
remains.
new text end
new text begin
The remaining intact naturally reduced remains shall be reduced by a motorized
mechanical processor to a granulated appearance. The granulated remains and the rest of
the naturally reduced remains shall be returned to a natural organic reduction vessel for
final reduction.
new text end
new text begin Subd. 16. new text end
new text begin
Natural organic reduction procedures; commingling of naturally reduced
remains prohibited.
new text end
new text begin
Except with the express written permission of the person with the
legal right to control the final deposition or as otherwise provided by law, no natural organic
reduction facility shall mechanically process the naturally reduced remains of more than
one body at a time in the same mechanical processor, or introduce the naturally reduced
remains of a second body into a mechanical processor until reasonable efforts have been
employed to remove all fragments of naturally reduced remains already in the processor.
The presence of incidental and unavoidable residue in the mechanical processor does not
violate this subdivision.
new text end
new text begin Subd. 17. new text end
new text begin
Natural organic reduction procedures; testing naturally reduced
remains.
new text end
new text begin
A natural organic reduction facility must:
new text end
new text begin
(1) ensure that the material in the natural organic reduction vessel naturally reaches and
maintains a minimum temperature of 131 degrees Fahrenheit for a minimum of 72
consecutive hours during the process of natural organic reduction;
new text end
new text begin
(2) analyze each instance of the naturally reduced remains for physical contaminants,
including but are not limited to intact bone, dental fillings, and medical implants, and ensure
naturally reduced remains have less than 0.01 mg/kg dry weight of any physical contaminants;
new text end
new text begin
(3) collect material samples for analysis that are representative of each instance of natural
organic reduction, using a sampling method such as that described in the U.S. Composting
Council 2002 Test Methods for the Examination of Composting and Compost, method
02.01-A through E;
new text end
new text begin
(4) develop and use a natural organic reduction process in which the naturally reduced
remains from the process do not exceed the following limits:
new text end
|
new text begin
Metals and other testing parameters new text end |
new text begin
Limit (mg/kg dry weight), unless otherwise specified new text end |
|
|
new text begin
Fecal coliform new text end |
new text begin
Less than 1,000 most probable number per gram of total solids (dry weight) new text end |
|
|
new text begin
Salmonella new text end |
new text begin
Less than 3 most probable number per 4 grams of total solids (dry weight) new text end |
|
|
new text begin
Arsenic new text end |
new text begin
Less than or equal to 11 ppm new text end |
|
|
new text begin
Cadmium new text end |
new text begin
Less than or equal to 7.1 ppm new text end |
|
|
new text begin
Lead new text end |
new text begin
Less than or equal to 150 ppm new text end |
|
|
new text begin
Mercury new text end |
new text begin
Less than or equal to 8 ppm new text end |
|
|
new text begin
Selenium new text end |
new text begin
Less than or equal to 18 ppm; new text end |
new text begin
(5) analyze, using a third-party laboratory, the natural organic reduction facility's material
samples of naturally reduced remains according to the following schedule:
new text end
new text begin
(i) the natural organic reduction facility must analyze each of the first 20 instances of
naturally reduced remains for the parameters in clause (4);
new text end
new text begin
(ii) if any of the first 20 instances of naturally reduced remains yield results exceeding
the limits in clause (4), the natural organic reduction facility must conduct appropriate
processes to correct the levels of the substances in clause (4) and have the resultant remains
tested to ensure they fall within the identified limits;
new text end
new text begin
(iii) if any of the first 20 instances of naturally reduced remains yield results exceeding
the limits in clause (4), the natural organic reduction facility must analyze each additional
instance of naturally reduced remains for the parameters in clause (4) until a total of 20
samples, not including those from remains that were reprocessed as required in item (ii),
have yielded results within the limits in clause (4) on initial testing;
new text end
new text begin
(iv) after 20 material samples of naturally reduced remains have met the limits in clause
(4), the natural organic reduction facility must analyze at least 25 percent of the natural
organic reduction facility's monthly instances of naturally reduced remains for the parameters
in clause (4) until 80 total material samples of naturally reduced remains are found to meet
the limits in clause (4), not including any samples that required reprocessing to meet those
limits; and
new text end
new text begin
(v) after 80 material samples of naturally reduced remains are found to meet the limits
in clause (4), the natural organic reduction facility must analyze at least one instance of
naturally reduced remains each month for the parameters in clause (4);
new text end
new text begin
(6) comply with any testing requirements established by the commissioner for content
parameters in addition to those specified in clause (4);
new text end
new text begin
(7) not release any naturally reduced remains that exceed the limits in clause (4); and
new text end
new text begin
(8) prepare, maintain, and provide to the commissioner upon request, a report for each
calendar year detailing the natural organic reduction facility's activities during the previous
calendar year. The report must include the following information:
new text end
new text begin
(i) the name and address of the natural organic reduction facility;
new text end
new text begin
(ii) the calendar year covered by the report;
new text end
new text begin
(iii) the annual quantity of naturally reduced remains;
new text end
new text begin
(iv) the results of any laboratory analyses of naturally reduced remains; and
new text end
new text begin
(v) any additional information required by the commissioner.
new text end
new text begin Subd. 18. new text end
new text begin
Natural organic reduction procedures; use of more than one naturally
reduced remains container.
new text end
new text begin
If the naturally reduced remains are to be separated into two
or more naturally reduced remains containers according to the directives provided in the
written authorization for natural organic reduction, all of the containers shall contain duplicate
identification disks, tabs, or permanent labels and all paperwork regarding the given body
shall include a notation of the number of and disposition of each container, as provided in
the written authorization.
new text end
new text begin Subd. 19. new text end
new text begin
Natural organic reduction procedures; disposition of accumulated
residue.
new text end
new text begin
Every natural organic reduction facility shall provide for the removal and disposition
of any accumulated residue from any natural organic reduction vessel, mechanical processor,
or other equipment used in natural organic reduction. Disposition of accumulated residue
shall be by any lawful manner deemed appropriate.
new text end
new text begin Subd. 20. new text end
new text begin
Natural organic reduction procedures; release of naturally reduced
remains.
new text end
new text begin
Following completion of the natural organic reduction process, the inurned naturally
reduced remains shall be released according to the instructions given on the written
authorization for natural organic reduction. If the remains are to be shipped, they must be
securely packaged and transported by a method which has an internal tracing system available
and which provides a receipt signed by the person accepting delivery. Where there is a
dispute over release or disposition of the naturally reduced remains, a natural organic
reduction facility may deposit the naturally reduced remains in accordance with the directives
of a court of competent jurisdiction pending resolution of the dispute or retain the naturally
reduced remains until the person with the legal right to control disposition presents
satisfactory indication that the dispute is resolved. A natural organic reduction facility must
not sell naturally reduced remains and must make every effort to not release naturally reduced
remains for sale or for use for commercial purposes.
new text end
new text begin Subd. 21. new text end
new text begin Unclaimed naturally reduced remains. new text end
new text begin
If, after 30 calendar days following
the inurnment, the naturally reduced remains are not claimed or disposed of according to
the written authorization for natural organic reduction, the natural organic reduction facility
shall give written notice, by certified mail, to the person with the legal right to control the
final disposition or a legal designee, that the naturally reduced remains are unclaimed and
requesting further release directions. Should the naturally reduced remains be unclaimed
120 calendar days following the mailing of the written notification, the natural organic
reduction facility may return the remains to the earth respectfully in any lawful manner
deemed appropriate.
new text end
new text begin Subd. 22. new text end
new text begin Required records. new text end
new text begin
Every natural organic reduction facility shall create and
maintain on its premises or other business location in Minnesota an accurate record of every
natural organic reduction provided. The record shall include all of the following information
for each natural organic reduction:
new text end
new text begin
(1) the name of the person or funeral establishment delivering the body for natural
organic reduction;
new text end
new text begin
(2) the name of the deceased and the identification number assigned to the body;
new text end
new text begin
(3) the date of acceptance of delivery;
new text end
new text begin
(4) the names of the operator of the natural organic reduction process and mechanical
processor operator;
new text end
new text begin
(5) the times and dates that the body was placed in and removed from the natural organic
reduction vessel;
new text end
new text begin
(6) the time and date that processing and inurnment of the naturally reduced remains
was completed;
new text end
new text begin
(7) the time, date, and manner of release of the naturally reduced remains;
new text end
new text begin
(8) the name and address of the person who signed the authorization for natural organic
reduction;
new text end
new text begin
(9) all supporting documentation, including any transit or disposition permits, a photocopy
of the death record, and the authorization for natural organic reduction; and
new text end
new text begin
(10) the type of natural organic reduction vessel.
new text end
new text begin Subd. 23. new text end
new text begin Retention of records. new text end
new text begin
Records required under subdivision 22 shall be
maintained for a period of three calendar years after the release of the naturally reduced
remains. Following this period and subject to any other laws requiring retention of records,
the natural organic reduction facility may then place the records in storage or reduce them
to microfilm, a digital format, 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 release
of the naturally reduced remains. At the end of this period and subject to any other laws
requiring retention of records, the natural organic reduction facility may destroy the records
by shredding, incineration, or any other manner that protects the privacy of the individuals
identified.
new text end
Sec. 54. new text begin REQUEST FOR INFORMATION; EVALUATION OF STATEWIDE
HEALTH CARE NEEDS AND CAPACITY AND PROJECTIONS OF FUTURE
HEALTH CARE NEEDS.
new text end
new text begin
(a) By November 1, 2024, the commissioner of health must publish a request for
information to assist the commissioner in a future comprehensive evaluation of current
health care needs and capacity in the state and projections of future health care needs in the
state based on population and provider characteristics. The request for information:
new text end
new text begin
(1) must provide guidance on defining the scope of the study and assist in answering
methodological questions that will inform the development of a request for proposals to
contract for performance of the study; and
new text end
new text begin
(2) may address topics that include but are not limited to how to define health care
capacity, expectations for capacity by geography or service type, how to consider health
centers that have areas of particular expertise or services that generally have a higher margin,
how hospital-based services should be considered as compared with evolving
nonhospital-based services, the role of technology in service delivery, health care workforce
supply issues, and other issues related to data or methods.
new text end
new text begin
(b) By February 1, 2025, the commissioner must submit a report to the chairs and ranking
minority members of the legislative committees with jurisdiction over health care, with the
results of the request for information and recommendations regarding conducting a
comprehensive evaluation of current health care needs and capacity in the state and
projections of future health care needs in the state.
new text end
Sec. 55. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2023 Supplement, section 144.0528, subdivision 5,
new text end
new text begin
is repealed.
new text end
ARTICLE 6
DEPARTMENT OF HEALTH POLICY
Section 1.
new text begin
[62J.461] 340B COVERED ENTITY REPORT.
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) "340B covered entity" or "covered entity" means a covered entity as defined in United
States Code, title 42, section 256b(a)(4), with a service address in Minnesota as of January
1 of the reporting year. 340B covered entity includes all entity types and grantees. All
facilities that are identified as child sites or grantee associated sites under the federal 340B
Drug Pricing Program are considered part of the 340B covered entity.
new text end
new text begin
(c) "340B Drug Pricing Program" or "340B program" means the drug discount program
established under United States Code, title 42, section 256b.
new text end
new text begin
(d) "340B entity type" is the designation of the 340B covered entity according to the
entity types specified in United States Code, title 42, section 256b(a)(4).
new text end
new text begin
(e) "340B ID" is the unique identification number provided by the Health Resources
and Services Administration to identify a 340B-eligible entity in the 340B Office of Pharmacy
Affairs Information System.
new text end
new text begin
(f) "Contract pharmacy" means a pharmacy with which a 340B covered entity has an
arrangement to dispense drugs purchased under the 340B Drug Pricing Program.
new text end
new text begin
(g) "Pricing unit" means the smallest dispensable amount of a prescription drug product
that can be dispensed or administered.
new text end
new text begin Subd. 2. new text end
new text begin Current registration. new text end
new text begin
Beginning April 1, 2024, each 340B covered entity must
maintain a current registration with the commissioner in a form and manner prescribed by
the commissioner. The registration must include the following information:
new text end
new text begin
(1) the name of the 340B covered entity;
new text end
new text begin
(2) the 340B ID of the 340B covered entity;
new text end
new text begin
(3) the servicing address of the 340B covered entity; and
new text end
new text begin
(4) the 340B entity type of the 340B covered entity.
new text end
new text begin Subd. 3. new text end
new text begin Reporting by covered entities to the commissioner. new text end
new text begin
(a) Each 340B covered
entity shall report to the commissioner by April 1, 2024, and by April 1 of each year
thereafter, the following information for transactions conducted by the 340B covered entity
or on its behalf, and related to its participation in the federal 340B program for the previous
calendar year:
new text end
new text begin
(1) the aggregated acquisition cost for prescription drugs obtained under the 340B
program;
new text end
new text begin
(2) the aggregated payment amount received for drugs obtained under the 340B program
and dispensed or administered to patients;
new text end
new text begin
(3) the number of pricing units dispensed or administered for prescription drugs described
in clause (2); and
new text end
new text begin
(4) the aggregated payments made:
new text end
new text begin
(i) to contract pharmacies to dispense drugs obtained under the 340B program;
new text end
new text begin
(ii) to any other entity that is not the covered entity and is not a contract pharmacy for
managing any aspect of the covered entity's 340B program; and
new text end
new text begin
(iii) for all other expenses related to administering the 340B program.
new text end
new text begin
The information under clauses (2) and (3) must be reported by payer type, including but
not limited to commercial insurance, medical assistance, MinnesotaCare, and Medicare, in
the form and manner prescribed by the commissioner.
new text end
new text begin
(b) For covered entities that are hospitals, the information required under paragraph (a),
clauses (1) to (3), must also be reported at the national drug code level for the 50 most
frequently dispensed or administered drugs by the facility under the 340B program.
new text end
new text begin
(c) Data submitted to the commissioner under paragraphs (a) and (b) are classified as
nonpublic data, as defined in section 13.02, subdivision 9.
new text end
new text begin Subd. 4. new text end
new text begin Enforcement and exceptions. new text end
new text begin
(a) Any health care entity subject to reporting
under this section that fails to provide data in the form and manner prescribed by the
commissioner is subject to a fine paid to the commissioner of up to $500 for each day the
data are past due. Any fine levied against the entity under this subdivision is subject to the
contested case and judicial review provisions of sections 14.57 and 14.69.
new text end
new text begin
(b) The commissioner may grant an entity an extension of or exemption from the reporting
obligations under this subdivision, upon a showing of good cause by the entity.
new text end
new text begin Subd. 5. new text end
new text begin Reports to the legislature. new text end
new text begin
By November 15, 2024, and by November 15 of
each year thereafter, the commissioner shall submit to the chairs and ranking minority
members of the legislative committees with jurisdiction over health care finance and policy,
a report that aggregates the data submitted under subdivision 3, paragraphs (a) and (b). The
following information must be included in the report for all 340B entities whose net 340B
revenue constitutes a significant share, as determined by the commissioner, of all net 340B
revenue across all 340B covered entities in Minnesota:
new text end
new text begin
(1) the information submitted under subdivision 2; and
new text end
new text begin
(2) for each 340B entity identified in subdivision 2, that entity's 340B net revenue as
calculated using the data submitted under subdivision 3, paragraph (a), with net revenue
being subdivision 3, paragraph (a), clause (2), less the sum of subdivision 3, paragraph (a),
clauses (1) and (4).
new text end
new text begin
For all other entities, the data in the report must be aggregated to the entity type or groupings
of entity types in a manner that prevents the identification of an individual entity and any
entity's specific data value reported for an individual data element.
new text end
Sec. 2.
Minnesota Statutes 2022, section 62J.61, subdivision 5, is amended to read:
Subd. 5.
deleted text begin Biennial review of rulemaking procedures and rulesdeleted text end new text begin Opportunity for
commentnew text end .
The commissioner shall deleted text begin biennially seek comments from affected partiesdeleted text end new text begin maintain
an email address for submission of comments from interested parties to provide inputnew text end about
the effectiveness of and continued need for the rulemaking procedures set out in subdivision
2 and about the quality and effectiveness of rules adopted using these procedures. The
commissioner deleted text begin shall seek comments by holding a meeting and by publishing a notice in the
State Register that contains the date, time, and location of the meeting and a statement that
invites oral or written comments. The notice must be published at least 30 days before the
meeting date. The commissioner shall write a report summarizing the comments and shall
submit the report to the Minnesota Health Data Institute and to the Minnesota Administrative
Uniformity Committee by January 15 of every even-numbered yeardeleted text end new text begin may seek additional
input and provide additional opportunities for input as needednew text end .
Sec. 3.
Minnesota Statutes 2022, section 144.05, subdivision 7, is amended to read:
Subd. 7.
Expiration of report mandates.
(a) If the submission of a report by the
commissioner of health to the legislature is mandated by statute and the enabling legislation
does not include a date for the submission of a final report, the mandate to submit the report
shall expire in accordance with this section.
(b) If the mandate requires the submission of an annual report and the mandate was
enacted before January 1, 2021, the mandate shall expire on January 1, 2023. If the mandate
requires the submission of a biennial or less frequent report and the mandate was enacted
before January 1, 2021, the mandate shall expire on January 1, 2024.
(c) Any reporting mandate enacted on or after January 1, 2021, shall expire three years
after the date of enactment if the mandate requires the submission of an annual report and
shall expire five years after the date of enactment if the mandate requires the submission
of a biennial or less frequent report, unless the enacting legislation provides for a different
expiration date.
(d) The commissioner shall submit a list to the chairs and ranking minority members of
the legislative committees with jurisdiction over health by February 15 of each year,
beginning February 15, 2022, of all reports set to expire during the following calendar year
in accordance with this section.new text begin The mandate to submit a report to the legislature under this
paragraph does not expire.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective retroactively from January 1, 2024.
new text end
Sec. 4.
Minnesota Statutes 2023 Supplement, section 144.0526, subdivision 1, is amended
to read:
Subdivision 1.
Establishment.
The commissioner of health shall establish the Minnesota
One Health Antimicrobial Stewardship Collaborative. The commissioner shall deleted text begin appointdeleted text end new text begin hirenew text end
a director to execute operations, conduct health education, and provide technical assistance.
Sec. 5.
Minnesota Statutes 2022, section 144.058, is amended to read:
144.058 INTERPRETER SERVICES QUALITY INITIATIVE.
(a) The commissioner of health shall establish a voluntary statewide rosterdeleted text begin ,deleted text end and develop
a plan for a registry and certification process for interpreters who provide high quality,
spoken language health care interpreter services. The roster, registry, and certification
process shall be based on the findings and recommendations set forth by the Interpreter
Services Work Group required under Laws 2007, chapter 147, article 12, section 13.
(b) By January 1, 2009, the commissioner shall establish a roster of all available
interpreters to address access concerns, particularly in rural areas.
(c) By January 15, 2010, the commissioner shall:
(1) develop a plan for a registry of spoken language health care interpreters, including:
(i) development of standards for registration that set forth educational requirements,
training requirements, demonstration of language proficiency and interpreting skills,
agreement to abide by a code of ethics, and a criminal background check;
(ii) recommendations for appropriate alternate requirements in languages for which
testing and training programs do not exist;
(iii) recommendations for appropriate fees; and
(iv) recommendations for establishing and maintaining the standards for inclusion in
the registry; and
(2) develop a plan for implementing a certification process based on national testing and
certification processes for spoken language interpreters 12 months after the establishment
of a national certification process.
(d) The commissioner shall consult with the Interpreter Stakeholder Group of the Upper
Midwest Translators and Interpreters Association for advice on the standards required to
plan for the development of a registry and certification process.
(e) The commissioner shall charge an annual fee of $50 to include an interpreter in the
roster. Fee revenue shall be deposited in the state government special revenue fund.new text begin All fees
are nonrefundable.
new text end
Sec. 6.
Minnesota Statutes 2022, section 144.0724, subdivision 2, is amended to read:
Subd. 2.
Definitions.
For purposes of this section, the following terms have the meanings
given.
(a) "Assessment reference date" or "ARD" means the specific end point for look-back
periods in the MDS assessment process. This look-back period is also called the observation
or assessment period.
(b) "Case mix index" means the weighting factors assigned to the deleted text begin RUG-IVdeleted text end new text begin case mix
reimbursementnew text end classificationsnew text begin determined by an assessmentnew text end .
(c) "Index maximization" means classifying a resident who could be assigned to more
than one category, to the category with the highest case mix index.
(d) "Minimum Data Set" or "MDS" means a core set of screening, clinical assessment,
and functional status elements, that include common definitions and coding categories
specified by the Centers for Medicare and Medicaid Services and designated by the
Department of Health.
(e) "Representative" means a person who is the resident's guardian or conservator, the
person authorized to pay the nursing home expenses of the resident, a representative of the
Office of Ombudsman for Long-Term Care whose assistance has been requested, or any
other individual designated by the resident.
deleted text begin
(f) "Resource utilization groups" or "RUG" means the system for grouping a nursing
facility's residents according to their clinical and functional status identified in data supplied
by the facility's Minimum Data Set.
deleted text end
deleted text begin (g)deleted text end new text begin (f)new text end "Activities of daily living" includes personal hygiene, dressing, bathing,
transferring, bed mobility, locomotion, eating, and toileting.
deleted text begin (h)deleted text end new text begin (g)new text end "Nursing facility level of care determination" means the assessment process that
results in a determination of a resident's or prospective resident's need for nursing facility
level of care as established in subdivision 11 for purposes of medical assistance payment
of long-term care services for:
(1) nursing facility services under deleted text begin section 256B.434 ordeleted text end chapter 256R;
(2) elderly waiver services under chapter 256S;
(3) CADI and BI waiver services under section 256B.49; and
(4) state payment of alternative care services under section 256B.0913.
Sec. 7.
Minnesota Statutes 2022, section 144.0724, subdivision 3a, is amended to read:
Subd. 3a.
Resident deleted text begin reimbursementdeleted text end case mixnew text begin reimbursementnew text end classifications deleted text begin beginning
January 1, 2012deleted text end .
(a) deleted text begin Beginning January 1, 2012,deleted text end Resident deleted text begin reimbursementdeleted text end case mixnew text begin
reimbursementnew text end classifications shall be based on the Minimum Data Set, version 3.0
assessment instrument, or its successor version mandated by the Centers for Medicare and
Medicaid Services that nursing facilities are required to complete for all residents. deleted text begin The
commissioner of health shall establish resident classifications according to the RUG-IV,
48 group, resource utilization groups. Resident classification must be established based on
the individual items on the Minimum Data Set, which must be completed according to 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.deleted text end new text begin Case mix
reimbursement classifications shall also be based on assessments required under subdivision
4. Assessments must be completed according to the Long Term Care Facility Resident
Assessment Instrument User's Manual Version 3.0 or a successor manual issued by the
Centers for Medicare and Medicaid Services. The optional state assessment must be
completed according to the OSA Manual Version 1.0 v.2.
new text end
(b) Each resident must be classified based on the information from the Minimum Data
Set according to new text begin the new text end general categories issued by the Minnesota Department of Healthnew text begin ,
utilized for reimbursement purposesnew text end .
Sec. 8.
Minnesota Statutes 2022, 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 mixnew text begin reimbursementnew text end classification deleted text begin for reimbursementdeleted text end
include:
(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 deleted text begin RUGdeleted text end new text begin reimbursementnew text end classification;
(6) any significant correction to a prior quarterly review assessment, if the assessment
being corrected is the current one being used for deleted text begin RUGdeleted text end new text begin reimbursementnew text end classification;new text begin and
new text end
deleted text begin
(7) a required significant change in status assessment when:
deleted text end
deleted text begin
(i) all speech, occupational, and physical therapies have ended. 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. The ARD
of this assessment must be set on day eight after all therapy services have ended; and
deleted text end
deleted text begin
(ii) isolation for an infectious disease has ended. 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. The ARD of this assessment must be set on day 15 after
isolation has ended; and
deleted text end
(8)new text begin (7)new text end any modifications to the most recent assessments under clauses (1) to deleted text begin (7)deleted text end new text begin (6)new text end .
new text begin
(c) The optional state assessment must accompany all OBRA assessments. The optional
state assessment is also required to determine reimbursement when:
new text end
new text begin
(i) all speech, occupational, and physical therapies have ended. If the most recent optional
state assessment completed does not result in a rehabilitation case mix reimbursement
classification, then the optional state assessment is not required. The ARD of this assessment
must be set on day eight after all therapy services have ended; and
new text end
new text begin
(ii) isolation for an infectious disease has ended. If isolation was not coded on the most
recent optional state assessment completed, then the optional state assessment is not required.
The ARD of this assessment must be set on day 15 after isolation has ended.
new text end
deleted text begin (c)deleted text end new text begin (d)new text end In addition to the assessments listed in deleted text begin paragraphdeleted text end new text begin paragraphsnew text end (b)new text begin and (c)new text end , 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 26, 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. 9.
Minnesota Statutes 2022, section 144.0724, subdivision 6, is amended to read:
Subd. 6.
Penalties for late or nonsubmission.
(a) A facility that fails to complete or
submit an assessment according to subdivisions 4 and 5 for a deleted text begin RUG-IVdeleted text end new text begin case mix
reimbursementnew text end classification deleted text begin within seven days of the time requirements listed in the
Long-Term Care Facility Resident Assessment Instrument User's Manualdeleted text end new text begin when the
assessment is duenew text end is subject to a reduced rate for that resident. The reduced rate shall be the
lowest rate for that facility. The reduced rate is effective on the day of admission for new
admission assessments, on the ARD for significant change in status assessments, or on the
day that the assessment was due for all other assessments and continues in effect until the
first day of the month following the date of submission and acceptance of the resident's
assessment.
(b) If loss of revenue due to penalties incurred by a facility for any period of 92 days
are equal to or greater than 0.1 percent of the total operating costs on the facility's most
recent annual statistical and cost report, a facility may apply to the commissioner of human
services for a reduction in the total penalty amount. The commissioner of human services,
in consultation with the commissioner of health, may, at the sole discretion of the
commissioner of human services, limit the penalty for residents covered by medical assistance
to ten days.
Sec. 10.
Minnesota Statutes 2022, section 144.0724, subdivision 7, is amended to read:
Subd. 7.
Notice of resident deleted text begin reimbursementdeleted text end case mixnew text begin reimbursementnew text end classification.
(a)
The commissioner of health shall provide to a nursing facility a notice for each resident of
the classification established under subdivision 1. The notice must inform the resident of
the case mixnew text begin reimbursementnew text end classification assigned, the opportunity to review the
documentation supporting the classification, the opportunity to obtain clarification from the
commissioner, deleted text begin anddeleted text end the opportunity to request a reconsideration of the classification new text begin ,new text end and
the address and telephone number of the Office of Ombudsman for Long-Term Care. The
commissioner must transmit the notice of resident classification by electronic means to the
nursing facility. The nursing facility is responsible for the distribution of the notice to each
resident or the resident's representative. This notice must be distributed within three business
days after the facility's receipt.
(b) If a facility submits a deleted text begin modifyingdeleted text end new text begin modifiednew text end assessment resulting in a change in the
case mixnew text begin reimbursementnew text end classification, the facility must provide a written notice to the
resident or the resident's representative regarding the item or items that were modified and
the reason for the modifications. Thenew text begin writtennew text end notice must be provided within three business
days after distribution of the resident case mixnew text begin reimbursementnew text end classification notice.
Sec. 11.
Minnesota Statutes 2022, section 144.0724, subdivision 8, is amended to read:
Subd. 8.
Request for reconsideration of resident classifications.
(a) The resident, deleted text begin ordeleted text end new text begin
thenew text end resident's representative, deleted text begin ordeleted text end the nursing facilitynew text begin ,new text end ornew text begin thenew text end boarding care home may request
that the commissioner of health reconsider the assigned deleted text begin reimbursementdeleted text end case mixnew text begin
reimbursementnew text end classification and any item or items changed during the audit process. The
request for reconsideration must be submitted in writing to the commissioner of health.
(b) For reconsideration requests initiated by the resident or the resident's representative:
(1) The resident or the resident's representative must submit in writing a reconsideration
request to the facility administrator within 30 days of receipt of the resident classification
notice. The written request must include the reasons for the reconsideration request.
(2) Within three business days of receiving the reconsideration request, the nursing
facility must submit to the commissioner of health a completed reconsideration request
form, a copy of the resident's or resident's representative's written request, and all supporting
documentation used to complete the assessment being deleted text begin considereddeleted text end new text begin reconsiderednew text end . If the facility
fails to provide the required information, the reconsideration will be completed with the
information submitted and the facility cannot make further reconsideration requests on this
classification.
(3) Upon written request and within three business days, the nursing facility must give
the resident or the resident's representative a copy of the assessment being reconsidered and
all supporting documentation used to complete the assessment. Notwithstanding any law
to the contrary, the facility may not charge a fee for providing copies of the requested
documentation. If a facility fails to provide the required documents within this time, it is
subject to the issuance of a correction order and penalty assessment under sections 144.653
and 144A.10. Notwithstanding those sections, any correction order issued under this
subdivision must require that the nursing facility immediately comply with the request for
information, and as of the date of the issuance of the correction order, the facility shall
forfeit to the state a $100 fine for the first day of noncompliance, and an increase in the
$100 fine by $50 increments for each day the noncompliance continues.
(c) For reconsideration requests initiated by the facility:
(1) The facility is required to inform the resident or the resident's representative in writing
that a reconsideration of the resident's case mixnew text begin reimbursementnew text end classification is being
requested. The notice must inform the resident or the resident's representative:
(i) of the date and reason for the reconsideration request;
(ii) of the potential for anew text begin case mix reimbursementnew text end classificationnew text begin changenew text end and subsequent
rate change;
(iii) of the extent of the potential rate change;
(iv) that copies of the request and supporting documentation are available for review;
and
(v) that the resident or the resident's representative has the right to request a
reconsiderationnew text begin alsonew text end .
(2) Within 30 days of receipt of the audit exit report or resident classification notice, the
facility must submit to the commissioner of health a completed reconsideration request
form, all supporting documentation used to complete the assessment being reconsidered,
and a copy of the notice informing the resident or the resident's representative that a
reconsideration of the resident's classification is being requested.
(3) If the facility fails to provide the required information, the reconsideration request
may be denied and the facility may not make further reconsideration requests on this
classification.
(d) Reconsideration by the commissioner must be made by individuals not involved in
reviewing the assessment, audit, or reconsideration that established the disputed classification.
The reconsideration must be based upon the assessment that determined the classification
and upon the information provided to the commissioner of health under paragraphs (a) to
(c). If necessary for evaluating the reconsideration request, the commissioner may conduct
on-site reviews. Within 15 business days of receiving the request for reconsideration, the
commissioner shall affirm or modify the original resident classification. The original
classification must be modified if the commissioner determines that the assessment resulting
in the classification did not accurately reflect characteristics of the resident at the time of
the assessment. The commissioner must transmit the reconsideration classification notice
by electronic means to the nursing facility. The nursing facility is responsible for the
distribution of the notice to the resident or the resident's representative. The notice must be
distributed by the nursing facility within three business days after receipt. A decision by
the commissioner under this subdivision is the final administrative decision of the agency
for the party requesting reconsideration.
(e) The case mixnew text begin reimbursementnew text end classification established by the commissioner shall be
the classification which applies to the resident while the request for reconsideration is
pending. If a request for reconsideration applies to an assessment used to determine nursing
facility level of care under subdivision 4, paragraph deleted text begin (c)deleted text end new text begin (d)new text end , the resident shall continue to
be eligible for nursing facility level of care while the request for reconsideration is pending.
(f) The commissioner may request additional documentation regarding a reconsideration
necessary to make an accurate reconsideration determination.
new text begin
(g) Data collected as part of the reconsideration process under this section is classified
as private data on individuals and nonpublic data pursuant to section 13.02. Notwithstanding
the classification of these data as private or nonpublic, the commissioner is authorized to
share these data with the U.S. Centers for Medicare and Medicaid Services and the
commissioner of human services as necessary for reimbursement purposes.
new text end
Sec. 12.
Minnesota Statutes 2022, section 144.0724, subdivision 9, is amended to read:
Subd. 9.
Audit authority.
(a) The commissioner shall audit the accuracy of resident
assessments performed under section 256R.17 through any of the following: desk audits;
on-site review of residents and their records; and interviews with staff, residents, or residents'
families. The commissioner shall reclassify a resident if the commissioner determines that
the resident was incorrectly classified.
(b) The commissioner is authorized to conduct on-site audits on an unannounced basis.
(c) A facility must grant the commissioner access to examine the medical records relating
to the resident assessments selected for audit under this subdivision. The commissioner may
also observe and speak to facility staff and residents.
(d) The commissioner shall consider documentation under the time frames for coding
items on the minimum data set as set out in the Long-Term Care Facility Resident Assessment
Instrument User's Manual new text begin or OSA Manual version 1.0 v.2 new text end published by the Centers for
Medicare and Medicaid Services.
(e) The commissioner shall develop an audit selection procedure that includes the
following factors:
(1) Each facility shall be audited annually. If a facility has two successive audits in which
the percentage of change is five percent or less and the facility has not been the subject of
a special audit in the past 36 months, the facility may be audited biannually. A stratified
sample of 15 percent, with a minimum of ten assessments, of the most current assessments
shall be selected for audit. If more than 20 percent of the deleted text begin RUG-IVdeleted text end new text begin case mix reimbursementnew text end
classifications are changed as a result of the audit, the audit shall be expanded to a second
15 percent sample, with a minimum of ten assessments. If the total change between the first
and second samples is 35 percent or greater, the commissioner may expand the audit to all
of the remaining assessments.
(2) If a facility qualifies for an expanded audit, the commissioner may audit the facility
again within six months. If a facility has two expanded audits within a 24-month period,
that facility will be audited at least every six months for the next 18 months.
(3) The commissioner may conduct special audits if the commissioner determines that
circumstances exist that could alter or affect the validity of case mixnew text begin reimbursementnew text end
classifications of residents. These circumstances include, but are not limited to, the following:
(i) frequent changes in the administration or management of the facility;
(ii) an unusually high percentage of residents in a specific case mixnew text begin reimbursementnew text end
classification;
(iii) a high frequency in the number of reconsideration requests received from a facility;
(iv) frequent adjustments of case mixnew text begin reimbursementnew text end classifications as the result of
reconsiderations or audits;
(v) a criminal indictment alleging provider fraud;
(vi) other similar factors that relate to a facility's ability to conduct accurate assessments;
(vii) an atypical pattern of scoring minimum data set items;
(viii) nonsubmission of assessments;
(ix) late submission of assessments; or
(x) a previous history of audit changes of 35 percent or greater.
(f) If the audit results in a case mixnew text begin reimbursementnew text end classification change, the
commissioner must transmit the audit classification notice by electronic means to the nursing
facility within 15 business days of completing an audit. The nursing facility is responsible
for distribution of the notice to each resident or the resident's representative. This notice
must be distributed by the nursing facility within three business days after receipt. The
notice must inform the resident of the case mixnew text begin reimbursementnew text end classification assigned, the
opportunity to review the documentation supporting the classification, the opportunity to
obtain clarification from the commissioner, the opportunity to request a reconsideration of
the classification, and the address and telephone number of the Office of Ombudsman for
Long-Term Care.
Sec. 13.
Minnesota Statutes 2022, section 144.0724, subdivision 11, is amended to read:
Subd. 11.
Nursing facility level of care.
(a) For purposes of medical assistance payment
of long-term care services, a recipient must be determined, using assessments defined in
subdivision 4, to meet one of the following nursing facility level of care criteria:
(1) the person requires formal clinical monitoring at least once per day;
(2) the person needs the assistance of another person or constant supervision to begin
and complete at least four of the following activities of living: bathing, bed mobility, dressing,
eating, grooming, toileting, transferring, and walking;
(3) the person needs the assistance of another person or constant supervision to begin
and complete toileting, transferring, or positioning and the assistance cannot be scheduled;
(4) the person has significant difficulty with memory, using information, daily decision
making, or behavioral needs that require intervention;
(5) the person has had a qualifying nursing facility stay of at least 90 days;
(6) the person meets the nursing facility level of care criteria determined 90 days after
admission or on the first quarterly assessment after admission, whichever is later; or
(7) the person is determined to be at risk for nursing facility admission or readmission
through a face-to-face long-term care consultation assessment as specified in section
256B.0911, subdivision 17 to 21, 23, 24, 27, or 28, by a county, tribe, or managed care
organization under contract with the Department of Human Services. The person is
considered at risk under this clause if the person currently lives alone or will live alone or
be homeless without the person's current housing and also meets one of the following criteria:
(i) the person has experienced a fall resulting in a fracture;
(ii) the person has been determined to be at risk of maltreatment or neglect, including
self-neglect; or
(iii) the person has a sensory impairment that substantially impacts functional ability
and maintenance of a community residence.
(b) The assessment used to establish medical assistance payment for nursing facility
services must be the most recent assessment performed under subdivision 4, deleted text begin paragraphdeleted text end new text begin
paragraphsnew text end (b)new text begin and (c)new text end , that occurred no more than 90 calendar days before the effective
date of medical assistance eligibility for payment of long-term care services. In no case
shall medical assistance payment for long-term care services occur prior to the date of the
determination of nursing facility level of care.
(c) The assessment used to establish medical assistance payment for long-term care
services provided under chapter 256S and section 256B.49 and alternative care payment
for services provided under section 256B.0913 must be the most recent face-to-face
assessment performed under section 256B.0911, subdivisions 17 to 21, 23, 24, 27, or 28,
that occurred no more than 60 calendar days before the effective date of medical assistance
eligibility for payment of long-term care services.
Sec. 14.
Minnesota Statutes 2022, section 144.1464, subdivision 1, is amended to read:
Subdivision 1.
Summer internships.
The commissioner of health, through a contract
with a nonprofit organization as required by subdivision 4, shall award grants, within
available appropriations, to hospitals, clinics, nursing facilities, new text begin assisted living facilities,
new text end and home care providers to establish a secondary and postsecondary summer health care
intern program. The purpose of the program is to expose interested secondary and
postsecondary pupils to various careers within the health care profession.
Sec. 15.
Minnesota Statutes 2022, section 144.1464, subdivision 2, is amended to read:
Subd. 2.
Criteria.
(a) The commissioner, through the organization under contract, shall
award grants to hospitals, clinics, nursing facilities, new text begin assisted living facilities, new text end and home care
providers that agree to:
(1) provide secondary and postsecondary summer health care interns with formal exposure
to the health care profession;
(2) provide an orientation for the secondary and postsecondary summer health care
interns;
(3) pay one-half the costs of employing the secondary and postsecondary summer health
care intern;
(4) interview and hire secondary and postsecondary pupils for a minimum of six weeks
and a maximum of 12 weeks; and
(5) employ at least one secondary student for each postsecondary student employed, to
the extent that there are sufficient qualifying secondary student applicants.
(b) In order to be eligible to be hired as a secondary summer health intern by a hospital,
clinic, nursing facility, new text begin assisted living facility, new text end or home care provider, a pupil must:
(1) intend to complete high school graduation requirements and be between the junior
and senior year of high school; and
(2) be from a school district in proximity to the facility.
(c) In order to be eligible to be hired as a postsecondary summer health care intern by
a hospital or clinic, a pupil must:
(1) intend to complete a health care training program or a two-year or four-year degree
program and be planning on enrolling in or be enrolled in that training program or degree
program; and
(2) be enrolled in a Minnesota educational institution or be a resident of the state of
Minnesota; priority must be given to applicants from a school district or an educational
institution in proximity to the facility.
(d) Hospitals, clinics, nursing facilities, new text begin assisted living facilities, new text end and home care providers
awarded grants may employ pupils as secondary and postsecondary summer health care
interns deleted text begin beginning on or after June 15, 1993deleted text end , if they agree to pay the intern, during the period
before disbursement of state grant money, with money designated as the facility's 50 percent
contribution towards internship costs.
Sec. 16.
Minnesota Statutes 2022, section 144.1464, subdivision 3, is amended to read:
Subd. 3.
Grants.
The commissioner, through the organization under contract, shall
award separate grants to hospitals, clinics, nursing facilities, new text begin assisted living facilities, new text end and
home care providers meeting the requirements of subdivision 2. The grants must be used
to pay one-half of the costs of employing secondary and postsecondary pupils in a hospital,
clinic, nursing facility, new text begin assisted living facility, new text end or home care setting during the course of the
program. No more than 50 percent of the participants may be postsecondary students, unless
the program does not receive enough qualified secondary applicants per fiscal year. No
more than five pupils may be selected from any secondary or postsecondary institution to
participate in the program and no more than one-half of the number of pupils selected may
be from the seven-county metropolitan area.
Sec. 17.
Minnesota Statutes 2022, section 144.1911, subdivision 2, is amended to read:
Subd. 2.
Definitions.
(a) For the purposes of this section, the following terms have the
meanings given.
(b) "Commissioner" means the commissioner of health.
(c) "Immigrant international medical graduate" means an international medical graduate
who was born outside the United States, now resides permanently in the United Statesnew text begin or
who has entered the United States on a temporary status based on urgent humanitarian or
significant public benefit reasonsnew text end , and who did not enter the United States on a J1 or similar
nonimmigrant visa following acceptance into a United States medical residency or fellowship
program.
(d) "International medical graduate" means a physician who received a basic medical
degree or qualification from a medical school located outside the United States and Canada.
(e) "Minnesota immigrant international medical graduate" means an immigrant
international medical graduate who has lived in Minnesota for at least two years.
(f) "Rural community" 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.
(g) "Underserved community" means a Minnesota area or population included in the
list of designated primary medical care health professional shortage areas, medically
underserved areas, or medically underserved populations (MUPs) maintained and updated
by the United States Department of Health and Human Services.
Sec. 18.
Minnesota Statutes 2022, 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 feenew text begin , a retrieval fee, or any other feenew text end 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 Actdeleted text begin ; except that no fee
shall be charged to a patient who is receiving public assistance, or to a patient who is
represented by an attorney on behalf of a civil legal services program or a volunteer attorney
program based on indigency.deleted text end new text begin when the patient is:
new text end
new text begin
(1) receiving public assistance;
new text end
new text begin
(2) represented by an attorney on behalf of a civil legal services program; or
new text end
new text begin
(3) represented by a volunteer attorney program based on indigency.
new text end
new text begin
The patient or the patient's representative must submit one of the following to show that
they are entitled to receive records without charge under this paragraph: (1) a public
assistance statement from the county or state administering assistance; (2) a request for
records on the letterhead of the civil legal services program or volunteer attorney program
based on indigency; or (3) a benefits statement from the Social Security Administration.
new text end
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. 19.
new text begin
[144.2925] CONSTRUCTION.
new text end
new text begin
Sections 144.291 to 144.298 shall be construed to protect the privacy of a patient's health
records in a more stringent manner than provided in Code of Federal Regulations, title 45,
part 164. For purposes of this section, "more stringent" has the meaning given to that term
in Code of Federal Regulations, title 45, section 160.202, with respect to a use or disclosure
or the need for express legal permission from an individual to disclose individually
identifiable health information.
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. 20.
Minnesota Statutes 2022, section 144.293, subdivision 2, is amended to read:
Subd. 2.
Patient consent to release of records.
A provider, or a person who receives
health records from a provider, may not release a patient's health records to a person without:
(1) a signed and dated consent from the patient or the patient's legally authorized
representative authorizing the release;
(2) specific authorization in new text begin Minnesota new text end law; or
(3) a representation from a provider that holds a signed and dated consent from the
patient authorizing the release.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment and
applies to health records released on or after that date.
new text end
Sec. 21.
Minnesota Statutes 2022, section 144.293, subdivision 4, is amended to read:
Subd. 4.
Duration of consent.
Except as provided in this section, a consent is valid for
one year or for a period specified in the consent or for a different period provided by
new text begin Minnesota new text end law.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment and
applies to health records released on or after that date.
new text end
Sec. 22.
Minnesota Statutes 2022, section 144.293, subdivision 9, is amended to read:
Subd. 9.
Documentation of release.
(a) In cases where a provider releases health records
without patient consent as authorized by new text begin Minnesota new text end law, the release must be documented
in the patient's health record. In the case of a release under section 144.294, subdivision 2,
the documentation must include the date and circumstances under which the release was
made, the person or agency to whom the release was made, and the records that were released.
(b) When a health record is released using a representation from a provider that holds a
consent from the patient, the releasing provider shall document:
(1) the provider requesting the health records;
(2) the identity of the patient;
(3) the health records requested; and
(4) the date the health records were requested.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment and
applies to health records released on or after that date.
new text end
Sec. 23.
Minnesota Statutes 2022, section 144.293, subdivision 10, is amended to read:
Subd. 10.
Warranties regarding consents, requests, and disclosures.
(a) When
requesting health records using consent, a person warrants that the consent:
(1) contains no information known to the person to be false; and
(2) accurately states the patient's desire to have health records disclosed or that there is
specific authorization in new text begin Minnesota new text end law.
(b) When requesting health records using consent, or a representation of holding a
consent, a provider warrants that the request:
(1) contains no information known to the provider to be false;
(2) accurately states the patient's desire to have health records disclosed or that there is
specific authorization in new text begin Minnesota new text end law; and
(3) does not exceed any limits imposed by the patient in the consent.
(c) When disclosing health records, a person releasing health records warrants that the
person:
(1) has complied with the requirements of this section regarding disclosure of health
records;
(2) knows of no information related to the request that is false; and
(3) has complied with the limits set by the patient in the consent.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment and
applies to health records released on or after that date.
new text end
Sec. 24.
Minnesota Statutes 2022, section 144.493, is amended by adding a subdivision
to read:
new text begin Subd. 2a. new text end
new text begin Thrombectomy-capable stroke center. new text end
new text begin
A hospital meets the criteria for a
thrombectomy-capable stroke center if the hospital has been certified as a
thrombectomy-capable stroke center by the joint commission or another nationally recognized
accreditation entity, or is a primary stroke center that is not certified as a thrombectomy-based
capable stroke center but the hospital has attained a level of stroke care distinction by offering
mechanical endovascular therapies and has been certified by a department approved certifying
body that is a nationally recognized guidelines-based organization.
new text end
Sec. 25.
Minnesota Statutes 2022, section 144.494, subdivision 2, is amended to read:
Subd. 2.
Designation.
A hospital that voluntarily meets the criteria for a comprehensive
stroke center, new text begin thrombectomy-capable stroke center, new text end primary stroke center, or acute stroke
ready hospital may apply to the commissioner for designation, and upon the commissioner's
review and approval of the application, shall be designated as a comprehensive stroke center,
new text begin a thrombectomy-capable stroke center, new text end a primary stroke center, or an acute stroke ready
hospital for a three-year period. If a hospital loses its certification as a comprehensive stroke
center or primary stroke center from the joint commission or other nationally recognized
accreditation entity, or no longer participates in the Minnesota stroke registry program, its
Minnesota designation shall be immediately withdrawn. Prior to the expiration of the
deleted text begin three-yeardeleted text end designationnew text begin periodnew text end , a hospital seeking to remain part of the voluntary acute stroke
system may reapply to the commissioner for designation.
Sec. 26.
Minnesota Statutes 2022, 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;
(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 144.552;
(31) any project to add licensed beds in a hospital located in Cook County or Mahnomen
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. Notwithstanding
section 144.552, a public interest review is not required for a project authorized under this
clause;
(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; deleted text begin or
deleted text end
(33) a project for a 144-bed psychiatric hospital on the site of the former Bethesda
hospital in the city of Saint Paul, Ramsey County, if the commissioner finds the project is
in the public interest after the public interest review conducted under section 144.552 is
complete. Following the completion of the construction project, the commissioner of health
shall monitor the hospital, including by assessing the hospital's case mix and payer mix,
patient transfers, and patient diversions. The hospital must have an intake and assessment
area. The hospital must accommodate patients with acute mental health needs, whether they
walk up to the facility, are delivered by ambulances or law enforcement, or are transferred
from other facilities. The hospital must comply with subdivision 1a, paragraph (b). The
hospital must annually submit de-identified data to the department in the format and manner
defined by the commissionerdeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(34) a project involving the relocation of up to 26 licensed long-term acute care hospital
beds from an existing long-term care hospital located in Hennepin County with a licensed
capacity prior to the relocation of 92 beds to dedicated space on the campus of an existing
safety net, level I trauma center hospital in Ramsey County as designated under section
383A.91, subdivision 5, provided both the commissioner finds the project is in the public
interest after the public interest review conducted under section 144.552 is complete and
the relocated beds continue to be used as long-term acute care hospital beds after the
relocation.
new text end
Sec. 27.
Minnesota Statutes 2022, section 144.605, is amended by adding a subdivision
to read:
new text begin Subd. 10. new text end
new text begin Chapter 16C waiver. new text end
new text begin
Pursuant to subdivisions 4, paragraph (b), and 5,
paragraph (b), the commissioner of administration may waive provisions of chapter 16C
for the purposes of approving contracts for independent clinical teams.
new text end
Sec. 28.
new text begin
[144.6985] COMMUNITY HEALTH NEEDS ASSESSMENT; COMMUNITY
HEALTH IMPROVEMENT SERVICES; IMPLEMENTATION.
new text end
new text begin Subdivision 1. new text end
new text begin Community health needs assessment. new text end
new text begin
A nonprofit hospital that is exempt
from taxation under section 501(c)(3) of the Internal Revenue Code must make available
to the public and submit to the commissioner of health, by January 15, 2026, the most recent
community health needs assessment submitted by the hospital to the Internal Revenue
Service. Each time the hospital conducts a subsequent community health needs assessment,
the hospital must, within 15 business days after submitting the subsequent community health
needs assessment to the Internal Revenue Service, make the subsequent assessment available
to the public and submit the subsequent assessment to the commissioner.
new text end
new text begin Subd. 2. new text end
new text begin Description of community. new text end
new text begin
A nonprofit hospital subject to subdivision 1 must
make available to the public and submit to the commissioner of health a description of the
community served by the hospital. The description must include a geographic description
of the area where the hospital is located, a description of the general population served by
the hospital, and demographic information about the community served by the hospital,
such as leading causes of death, levels of chronic illness, and descriptions of the medically
underserved, low-income, minority, or chronically ill populations in the community. A
hospital is not required to separately make the information available to the public or
separately submit the information to the commissioner if the information is included in the
hospital's community health needs assessment made available and submitted under
subdivision 1.
new text end
new text begin Subd. 3. new text end
new text begin Addendum; community health improvement services. new text end
new text begin
(a) A nonprofit hospital
subject to subdivision 1 must annually submit to the commissioner an addendum which
details information about hospital activities identified as community health improvement
services with a cost of $5,000 or more. The addendum must include the type of activity, the
method through which the activity was delivered, how the activity relates to an identified
community need in the community health needs assessment, the target population for the
activity, strategies to reach the target population, identified outcome metrics, the cost to the
hospital to provide the activity, the methodology used to calculate the hospital's costs, and
the number of people served by the activity. If a community health improvement service is
administered by an entity other than the hospital, the administering entity must be identified
in the addendum. This paragraph does not apply to hospitals required to submit an addendum
under paragraph (b).
new text end
new text begin
(b) A nonprofit hospital subject to subdivision 1 must annually submit to the
commissioner an addendum which details information about the ten highest-cost activities
of the hospital identified as community health improvement services if the nonprofit hospital:
new text end
new text begin
(1) is designated as a critical access hospital under section 144.1483, clause (9), and
United States Code, title 42, section 1395i-4;
new text end
new text begin
(2) meets the definition of sole community hospital in section 62Q.19, subdivision 1,
paragraph (a), clause (5); or
new text end
new text begin
(3) meets the definition of rural emergency hospital in United States Code, title 42,
section 1395x(kkk)(2).
new text end
new text begin
The addendum must include the type of activity, the method in which the activity was
delivered, how the activity relates to an identified community need in the community health
needs assessment, the target population for the activity, strategies to reach the target
population, identified outcome metrics, the cost to the hospital to provide the activity, the
methodology used to calculate the hospital's costs, and the number of people served by the
activity. If a community health improvement service is administered by an entity other than
the hospital, the administering entity must be identified in the addendum.
new text end
new text begin Subd. 4. new text end
new text begin Community benefit implementation strategy. new text end
new text begin
A nonprofit hospital subject
to subdivision 1 must make available to the public, within one year after completing each
community health needs assessment, a community benefit implementation strategy. In
developing the community benefit implementation strategy, the hospital must consult with
community-based organizations, stakeholders, local public health organizations, and others
as determined by the hospital. The implementation strategy must include how the hospital
shall address the top three community health priorities identified in the community health
needs assessment. Implementation strategies must be evidence-based, when available, and
development and implementation of innovative programs and strategies may be supported
by evaluation measures.
new text end
new text begin Subd. 5. new text end
new text begin Information made available to the public. new text end
new text begin
A nonprofit hospital required to
make information available to the public under this section may do so by posting the
information on the hospital's website in a consolidated location and with clear labeling.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2026.
new text end
Sec. 29.
Minnesota Statutes 2022, section 144.7067, subdivision 2, is amended to read:
Subd. 2.
Duty to analyze reports; communicate findings.
new text begin (a) new text end The commissioner shall:
(1) analyze adverse event reports, corrective action plans, and findings of the root cause
analyses to determine patterns of systemic failure in the health care system and successful
methods to correct these failures;
(2) communicate to individual facilities the commissioner's conclusions, if any, regarding
an adverse event reported by the facility;
(3) communicate with relevant health care facilities any recommendations for corrective
action resulting from the commissioner's analysis of submissions from facilities; and
(4) publish an annual report:
(i) describing, by institution, adverse events reported;
(ii) outlining, in aggregate, corrective action plans and the findings of root cause analyses;
and
(iii) making recommendations for modifications of state health care operations.
new text begin
(b) Notwithstanding section 144.05, subdivision 7, the mandate to publish an annual
report under this subdivision does not expire.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective retroactively from January 1, 2023.
new text end
Sec. 30.
Minnesota Statutes 2022, section 144A.10, subdivision 15, is amended to read:
Subd. 15.
Informal dispute resolution.
The commissioner shall respond in writing to
a request from a nursing facility certified under the federal Medicare and Medicaid programs
for an informal dispute resolution within deleted text begin 30 days of the exit date of the facility's surveydeleted text end new text begin ten
calendar days of the facility's receipt of the notice of deficienciesnew text end . The commissioner's
response shall identify the commissioner's decision regarding deleted text begin the continuation ofdeleted text end each
deficiency citation challenged by the nursing facility, as well as a statement of any changes
in findings, level of severity or scope, and proposed remedies or sanctions for each deficiency
citation.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2024.
new text end
Sec. 31.
Minnesota Statutes 2022, section 144A.10, subdivision 16, is amended to read:
Subd. 16.
Independent informal dispute resolution.
(a) Notwithstanding subdivision
15, a facility certified under the federal Medicare or Medicaid programs new text begin that has been
assessed a civil money penalty as provided by Code of Federal Regulations, title 42, section
488.430, new text end may request from the commissioner, in writing, an independent informal dispute
resolution process regarding any deficiency deleted text begin citation issued to the facilitydeleted text end . The facility must
deleted text begin specify in its written request each deficiency citation that it disputes. The commissioner
shall provide a hearing under sections 14.57 to 14.62. Upon the written request of the facility,
the parties must submit the issues raised to arbitration by an administrative law judgedeleted text end new text begin submit
its request in writing within ten calendar days of receiving notice that a civil money penalty
will be imposednew text end .
new text begin
(b) The facility and commissioner have the right to be represented by an attorney at the
hearing.
new text end
new text begin
(c) An independent informal dispute resolution may not be requested for any deficiency
that is the subject of an active informal dispute resolution requested under subdivision 15.
The facility must withdraw its informal dispute resolution prior to requesting independent
informal dispute resolution.
new text end
deleted text begin (b) Upondeleted text end new text begin (d) Within five calendar days ofnew text end receipt of a written request for an deleted text begin arbitration
proceedingdeleted text end new text begin independent informal dispute resolutionnew text end , the commissioner shall file with the
Office of Administrative Hearings a request for the appointment of an deleted text begin arbitratordeleted text end new text begin
administrative law judge from the Office of Administrative Hearingsnew text end and simultaneously
serve the facility with notice of the request. deleted text begin The arbitrator for the dispute shall be an
administrative law judge appointed by the Office of Administrative Hearings. The disclosure
provisions of section 572B.12 and the notice provisions of section 572B.15, subsection (c),
apply. The facility and the commissioner have the right to be represented by an attorney.
deleted text end
new text begin
(e) An independent informal dispute resolution proceeding shall be scheduled to occur
within 30 calendar days of the commissioner's request to the Office of Administrative
Hearings, unless the parties agree otherwise or the chief administrative law judge deems
the timing to be unreasonable. The independent informal dispute resolution process must
be completed within 60 calendar days of the facility's request.
new text end
deleted text begin (c)deleted text end new text begin (f) Five working days in advance of the scheduled proceeding,new text end the commissioner
and the facility deleted text begin may presentdeleted text end new text begin must submitnew text end written new text begin statements and arguments, documentary
new text end evidence, depositions, and deleted text begin oral statements and arguments at the arbitration proceeding. Oral
statements and arguments may be made by telephonedeleted text end new text begin any other materials supporting their
position to the administrative law judgenew text end .
new text begin
(g) The independent informal dispute resolution proceeding shall be informal and
conducted in a manner so as to allow the parties to fully present their positions and respond
to the opposing party's positions. This may include presentation of oral statements and
arguments at the proceeding.
new text end
deleted text begin (d)deleted text end new text begin (h)new text end Within ten working days of the close of the deleted text begin arbitrationdeleted text end proceeding, the
administrative law judge shall issue findings new text begin and recommendations new text end regarding each of the
deficiencies in dispute. The findings shall be one or more of the following:
(1) Supported in full. The citation is supported in full, with no deletion of findings and
no change in the scope or severity assigned to the deficiency citation.
(2) Supported in substance. The citation is supported, but one or more findings are
deleted without any change in the scope or severity assigned to the deficiency.
(3) Deficient practice cited under wrong requirement of participation. The citation is
amended by moving it to the correct requirement of participation.
(4) Scope not supported. The citation is amended through a change in the scope assigned
to the citation.
(5) Severity not supported. The citation is amended through a change in the severity
assigned to the citation.
(6) No deficient practice. The citation is deleted because the findings did not support
the citation or the negative resident outcome was unavoidable. deleted text begin The findings of the arbitrator
are not binding on the commissioner.
deleted text end
new text begin
(i) The findings and recommendations of the administrative law judge are not binding
on the commissioner.
new text end
new text begin
(j) Within ten calendar days of receiving the administrative law judge's findings and
recommendations, the commissioner shall issue a recommendation to the Center for Medicare
and Medicaid Services.
new text end
deleted text begin (e)deleted text end new text begin (k)new text end The commissioner shall reimburse the Office of Administrative Hearings for the
costs incurred by that office for the deleted text begin arbitrationdeleted text end proceeding. deleted text begin The facility shall reimburse the
commissioner for the proportion of the costs that represent the sum of deficiency citations
supported in full under paragraph (d), clause (1), or in substance under paragraph (d), clause
(2), divided by the total number of deficiencies disputed. A deficiency citation for which
the administrative law judge's sole finding is that the deficient practice was cited under the
wrong requirements of participation shall not be counted in the numerator or denominator
in the calculation of the proportion of costs.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 1, 2024, or upon federal approval,
whichever is later, and applies to appeals of deficiencies which are issued after October 1,
2024, or on or after the date upon which federal approval is obtained, whichever is later.
The commissioner of health shall notify the revisor of statutes when federal approval is
obtained.
new text end
Sec. 32.
Minnesota Statutes 2022, section 144A.44, subdivision 1, is amended to read:
Subdivision 1.
Statement of rights.
(a) A client who receives home care services deleted text begin in the
community or in an assisted living facility licensed under chapter deleted text end deleted text begin 144Gdeleted text end has these rights:
(1) receive written information, in plain language, about rights before receiving services,
including what to do if rights are violated;
(2) receive care and services according to a suitable and up-to-date plan, and subject to
accepted health care, medical or nursing standards and person-centered care, to take an
active part in developing, modifying, and evaluating the plan and services;
(3) be told before receiving services the type and disciplines of staff who will be providing
the services, the frequency of visits proposed to be furnished, other choices that are available
for addressing home care needs, and the potential consequences of refusing these services;
(4) be told in advance of any recommended changes by the provider in the service plan
and to take an active part in any decisions about changes to the service plan;
(5) refuse services or treatment;
(6) know, before receiving services or during the initial visit, any limits to the services
available from a home care provider;
(7) be told before services are initiated what the provider charges for the services; to
what extent payment may be expected from health insurance, public programs, or other
sources, if known; and what charges the client may be responsible for paying;
(8) know that there may be other services available in the community, including other
home care services and providers, and to know where to find information about these
services;
(9) choose freely among available providers and to change providers after services have
begun, within the limits of health insurance, long-term care insurance, medical assistance,
other health programs, or public programs;
(10) have personal, financial, and medical information kept private, and to be advised
of the provider's policies and procedures regarding disclosure of such information;
(11) access the client's own records and written information from those records in
accordance with sections 144.291 to 144.298;
(12) be served by people who are properly trained and competent to perform their duties;
(13) be treated with courtesy and respect, and to have the client's property treated with
respect;
(14) be free from physical and verbal abuse, neglect, financial exploitation, and all forms
of maltreatment covered under the Vulnerable Adults Act and the Maltreatment of Minors
Act;
(15) reasonable, advance notice of changes in services or charges;
(16) know the provider's reason for termination of services;
(17) at least ten calendar days' advance notice of the termination of a service by a home
care providerdeleted text begin , except at least 30 calendar days' advance notice of the service termination
shall be given by a home care provider for services provided to a client residing in an assisted
living facility as defined in section 144G.08, subdivision 7deleted text end . This clause does not apply in
cases where:
(i) the client engages in conduct that significantly alters the terms of the service plan
with the home care provider;
(ii) the client, person who lives with the client, or others create an abusive or unsafe
work environment for the person providing home care services; or
(iii) an emergency or a significant change in the client's condition has resulted in service
needs that exceed the current service plan and that cannot be safely met by the home care
provider;
(18) a coordinated transfer when there will be a change in the provider of services;
(19) complain to staff and others of the client's choice about services that are provided,
or fail to be provided, and the lack of courtesy or respect to the client or the client's property
and the right to recommend changes in policies and services, free from retaliation including
the threat of termination of services;
(20) know how to contact an individual associated with the home care provider who is
responsible for handling problems and to have the home care provider investigate and
attempt to resolve the grievance or complaint;
(21) know the name and address of the state or county agency to contact for additional
information or assistance;new text begin and
new text end
(22) assert these rights personally, or have them asserted by the client's representative
or by anyone on behalf of the client, without retaliationdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(23) place an electronic monitoring device in the client's or resident's space in compliance
with state requirements.
deleted text end
(b) When providers violate the rights in this section, they are subject to the fines and
license actions in sections 144A.474, subdivision 11, and 144A.475.
(c) Providers must do all of the following:
(1) encourage and assist in the fullest possible exercise of these rights;
(2) provide the names and telephone numbers of individuals and organizations that
provide advocacy and legal services for clients deleted text begin and residentsdeleted text end seeking to assert their rights;
(3) make every effort to assist clients deleted text begin or residentsdeleted text end in obtaining information regarding
whether Medicare, medical assistance, other health programs, or public programs will pay
for services;
(4) make reasonable accommodations for people who have communication disabilities,
or those who speak a language other than English; and
(5) provide all information and notices in plain language and in terms the client deleted text begin or
residentdeleted text end can understand.
(d) No provider may require or request a client deleted text begin or residentdeleted text end to waive any of the rights
listed in this section at any time or for any reasons, including as a condition of initiating
services deleted text begin or entering into an assisted living contractdeleted text end .
Sec. 33.
Minnesota Statutes 2022, section 144A.471, is amended by adding a subdivision
to read:
new text begin Subd. 1a. new text end
new text begin Licensure under other law. new text end
new text begin
A home care licensee must not provide sleeping
accommodations as a provision of home care services. For purposes of this subdivision, the
provision of sleeping accommodations and assisted living services under section 144G.08,
subdivision 9, requires assisted living licensure under chapter 144G.
new text end
Sec. 34.
Minnesota Statutes 2022, section 144A.474, subdivision 13, is amended to read:
Subd. 13.
Home care surveyor training.
(a) Before conducting a home care survey,
each home care surveyor must receive training on the following topics:
(1) Minnesota home care licensure requirements;
(2) Minnesota home care bill of rights;
(3) Minnesota Vulnerable Adults Act and reporting of maltreatment of minors;
(4) principles of documentation;
(5) survey protocol and processes;
(6) Offices of the Ombudsman roles;
(7) Office of Health Facility Complaints;
(8) Minnesota landlord-tenant deleted text begin and housing with servicesdeleted text end laws;
(9) types of payors for home care services; and
(10) Minnesota Nurse Practice Act for nurse surveyors.
(b) Materials used for the training in paragraph (a) shall be posted on the department
website. Requisite understanding of these topics will be reviewed as part of the quality
improvement plan in section 144A.483.
Sec. 35.
Minnesota Statutes 2023 Supplement, section 144A.4791, subdivision 10, is
amended to read:
Subd. 10.
Termination of service plan.
(a) If a home care provider terminates a service
plan with a client, and the client continues to need home care services, the home care provider
shall provide the client and the client's representative, if any, with a written notice of
termination which includes the following information:
(1) the effective date of termination;
(2) the reason for termination;
(3) for clients age 18 or older, a statement that the client may contact the Office of
Ombudsman for Long-Term Care to request an advocate to assist regarding the termination
and contact information for the office, including the office's central telephone number;
(4) a list of known licensed home care providers in the client's immediate geographic
area;
(5) a statement that the home care provider will participate in a coordinated transfer of
care of the client to another home care provider, health care provider, or caregiver, as
required by the home care bill of rights, section 144A.44, subdivision 1, clause (17);new text begin and
new text end
(6) the name and contact information of a person employed by the home care provider
with whom the client may discuss the notice of terminationdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(7) if applicable, a statement that the notice of termination of home care services does
not constitute notice of termination of any housing contract.
deleted text end
(b) When the home care provider voluntarily discontinues services to all clients, the
home care provider must notify the commissioner, lead agencies, and ombudsman for
long-term care about its clients and comply with the requirements in this subdivision.
Sec. 36.
Minnesota Statutes 2022, section 144E.16, subdivision 7, is amended to read:
Subd. 7.
Stroke transport protocols.
Regional emergency medical services programs
and any ambulance service licensed under this chapter must develop stroke transport
protocols. The protocols must include standards of care for triage and transport of acute
stroke patients within a specific time frame from symptom onset until transport to the most
appropriate designated acute stroke ready hospital, primary stroke center,
new text begin thrombectomy-capable stroke center, new text end or comprehensive stroke center.
Sec. 37.
Minnesota Statutes 2022, section 144G.08, subdivision 29, is amended to read:
Subd. 29.
Licensed health professional.
"Licensed health professional" means a person
deleted text begin licensed in Minnesota to practice a profession described in section 214.01, subdivision 2deleted text end new text begin ,
other than a registered nurse or licensed practical nurse, who provides assisted living services
within the scope of practice of that person's health occupation license, registration, or
certification as a regulated person who is licensed by an appropriate Minnesota state board
or agencynew text end .
Sec. 38.
Minnesota Statutes 2022, section 144G.10, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin Protected title; restriction on use. new text end
new text begin
(a) Effective January 1, 2026, no person
or entity may use the phrase "assisted living," whether alone or in combination with other
words and whether orally or in writing, to: advertise; market; or otherwise describe, offer,
or promote itself, or any housing, service, service package, or program that it provides
within this state, unless the person or entity is a licensed assisted living facility that meets
the requirements of this chapter. A person or entity entitled to use the phrase "assisted living"
shall use the phrase only in the context of its participation that meets the requirements of
this chapter.
new text end
new text begin
(b) Effective January 1, 2026, the licensee's name for a new assisted living facility may
not include the terms "home care" or "nursing home."
new text end
Sec. 39.
Minnesota Statutes 2022, section 144G.16, subdivision 6, is amended to read:
Subd. 6.
Requirements for notice and transfer.
A provisional licensee whose license
is denied must comply with the requirements for notification and the coordinated move of
residents in sections 144G.52 and 144G.55.new text begin If the license denial is upheld by the
reconsideration process, the licensee must submit a closure plan as required by section
144G.57 within ten calendar days of receipt of the reconsideration decision.
new text end
Sec. 40.
Minnesota Statutes 2022, section 146B.03, subdivision 7a, is amended to read:
Subd. 7a.
Supervisors.
(a) A technician must have been licensed in Minnesota or in a
jurisdiction with which Minnesota has reciprocity for at least:
(1) two years as a tattoo techniciannew text begin licensed under section 146B.03, subdivision 4, 6, or
8new text end , in order to supervise a temporary tattoo technician; or
(2) one year as a body piercing techniciannew text begin licensed under section 146B.03, subdivision
4, 6, or 8,new text end or must have performed at least 500 body piercings, in order to supervise a
temporary body piercing technician.
(b) Any technician who agrees to supervise more than two temporary tattoo technicians
during the same time period, or more than four body piercing technicians during the same
time period, must provide to the commissioner a supervisory plan that describes how the
technician will provide supervision to each temporary technician in accordance with section
146B.01, subdivision 28.
(c) The supervisory plan must include, at a minimum:
(1) the areas of practice under supervision;
(2) the anticipated supervision hours per week;
(3) the anticipated duration of the training period; and
(4) the method of providing supervision if there are multiple technicians being supervised
during the same time period.
(d) If the supervisory plan is terminated before completion of the technician's supervised
practice, the supervisor must notify the commissioner in writing within 14 days of the change
in supervision and include an explanation of why the plan was not completed.
(e) The commissioner may refuse to approve as a supervisor a technician who has been
disciplined in Minnesota or in another jurisdiction after considering the criteria in section
146B.02, subdivision 10, paragraph (b).
Sec. 41.
Minnesota Statutes 2022, section 146B.10, subdivision 1, is amended to read:
Subdivision 1.
Licensing fees.
(a) The fee for the initial technician licensurenew text begin applicationnew text end
and biennial licensure renewalnew text begin applicationnew text end is $420.
(b) The fee for temporary technician licensurenew text begin applicationnew text end is $240.
(c) The fee for the temporary guest artist licensenew text begin applicationnew text end is $140.
(d) The fee for a dual body art technician licensenew text begin applicationnew text end is $420.
(e) The fee for a provisional establishment licensenew text begin application required in section 146B.02,
subdivision 5, paragraph (c),new text end is $1,500.
(f) The fee for an initial establishment licensenew text begin applicationnew text end and the two-year license
renewal periodnew text begin applicationnew text end required in section 146B.02, subdivision 2, paragraph (b), is
$1,500.
(g) The fee for a temporary body art establishment event permitnew text begin applicationnew text end is $200.
(h) The commissioner shall prorate the initial two-year technician license fee based on
the number of months in the initial licensure period. The commissioner shall prorate the
first renewal fee for the establishment license based on the number of months from issuance
of the provisional license to the first renewal.
(i) The fee for verification of licensure to other states is $25.
deleted text begin
(j) The fee to reissue a provisional establishment license that relocates prior to inspection
and removal of provisional status is $350. The expiration date of the provisional license
does not change.
deleted text end
deleted text begin (k)deleted text end new text begin (j)new text end The fee to change an establishment name or establishment type, such as tattoo,
piercing, or dual, is $50.
Sec. 42.
Minnesota Statutes 2022, section 146B.10, subdivision 3, is amended to read:
Subd. 3.
Deposit.
Fees collected by the commissioner under this section must be deposited
in the state government special revenue fund.new text begin All fees are nonrefundable.
new text end
Sec. 43.
Minnesota Statutes 2022, section 149A.65, is amended to read:
149A.65 FEES.
Subdivision 1.
Generally.
This section establishes thenew text begin applicationnew text end fees for registrations,
examinations, initial and renewal licenses, and late fees authorized under the provisions of
this chapter.
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 deleted text begin issuance ofdeleted text end initial and renewal mortuary science deleted text begin licensesdeleted text end new text begin license applicationsnew text end ;
(4) $100 late fee charge for a license renewalnew text begin applicationnew text end ; and
(5) $250 for deleted text begin issuing adeleted text end new text begin an application fornew text end mortuary science license by endorsement.
Subd. 3.
Funeral directors.
The license renewalnew text begin applicationnew text end fee for funeral directors is
$200. The late fee charge for a license renewal is $100.
Subd. 4.
Funeral establishments.
The initial and renewalnew text begin applicationnew text end fee for funeral
establishments is $425. The late fee charge for a license renewal is $100.
Subd. 5.
Crematories.
The initial and renewalnew text begin applicationnew text end fee for a crematory is $425.
The late fee charge for a license renewal is $100.
Subd. 6.
Alkaline hydrolysis facilities.
The initial and renewalnew text begin applicationnew text end fee for an
alkaline hydrolysis facility is $425. The late fee charge for a license renewal is $100.
Subd. 7.
State government special revenue fund.
Fees collected by the commissioner
under this section must be deposited in the state treasury and credited to the state government
special revenue fund.new text begin All fees are nonrefundable.
new text end
Sec. 44.
Minnesota Statutes 2022, section 256R.02, subdivision 20, is amended to read:
Subd. 20.
Facility average case mix index.
"Facility average case mix index" or "CMI"
means a numerical score that describes the relative resource use for all residents within the
case mix deleted text begin classifications under the resource utilization group (RUG)deleted text end classification system
prescribed by the commissioner based on an assessment of each resident. The facility average
CMI shall be computed as the standardized days divided by the sum of the facility's resident
days. The case mix indices used shall be based on the system prescribed in section 256R.17.
Sec. 45. new text begin REVISOR INSTRUCTION.
new text end
new text begin
The revisor of statutes shall substitute the term "employee" with the term "staff" in the
following sections of Minnesota Statutes and make any grammatical changes needed without
changing the meaning of the sentence: Minnesota Statutes, sections 144G.08, subdivisions
18 and 36; 144G.13, subdivision 1, paragraph (c); 144G.20, subdivisions 1, 2, and 21;
144G.30, subdivision 5; 144G.42, subdivision 8; 144G.45, subdivision 2; 144G.60,
subdivisions 1, paragraph (c), and 3, paragraph (a); 144G.63, subdivision 2, paragraph (a),
clause (9); 144G.64, paragraphs (a), clauses (2), (3), and (5), and (c); 144G.70, subdivision
7; and 144G.92, subdivisions 1 and 3.
new text end
Sec. 46. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2022, sections 144.497; and 256R.02, subdivision 46,
new text end
new text begin
are repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Statutes 2023 Supplement, section 62J.312, subdivision 6,
new text end
new text begin
is repealed.
new text end
ARTICLE 7
EMERGENCY MEDICAL SERVICES
Section 1.
Minnesota Statutes 2023 Supplement, section 15A.0815, subdivision 2, is
amended to read:
Subd. 2.
Agency head salaries.
The salary for a position listed in this subdivision shall
be determined by the Compensation Council under section 15A.082. The commissioner of
management and budget must publish the salaries on the department's website. This
subdivision applies to the following positions:
Commissioner of administration;
Commissioner of agriculture;
Commissioner of education;
Commissioner of children, youth, and families;
Commissioner of commerce;
Commissioner of corrections;
Commissioner of health;
Commissioner, Minnesota Office of Higher Education;
Commissioner, Minnesota IT Services;
Commissioner, Housing Finance Agency;
Commissioner of human rights;
Commissioner of human services;
Commissioner of labor and industry;
Commissioner of management and budget;
Commissioner of natural resources;
Commissioner, Pollution Control Agency;
Commissioner of public safety;
Commissioner of revenue;
Commissioner of employment and economic development;
Commissioner of transportation;
Commissioner of veterans affairs;
Executive director of the Gambling Control Board;
Executive director of the Minnesota State Lottery;
Commissioner of Iron Range resources and rehabilitation;
Commissioner, Bureau of Mediation Services;
Ombudsman for mental health and developmental disabilities;
Ombudsperson for corrections;
Chair, Metropolitan Council;
Chair, Metropolitan Airports Commission;
School trust lands director;
Executive director of pari-mutuel racing; deleted text begin and
deleted text end
Commissioner, Public Utilities Commissiondeleted text begin .deleted text end new text begin ; and
new text end
new text begin
Director of the Office of Emergency Medical Services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 2.
Minnesota Statutes 2023 Supplement, section 43A.08, subdivision 1a, is amended
to read:
Subd. 1a.
Additional unclassified positions.
Appointing authorities for the following
agencies may designate additional unclassified positions according to this subdivision: the
Departments of Administration; Agriculture; Children, Youth, and Families; Commerce;
Corrections; Direct Care and Treatment; Education; Employment and Economic
Development; Explore Minnesota Tourism; Management and Budget; Health; Human
Rights; Human Services; Labor and Industry; Natural Resources; Public Safety; Revenue;
Transportation; and Veterans Affairs; the Housing Finance and Pollution Control Agencies;
the State Lottery; the State Board of Investment; the Office of Administrative Hearings; the
Department of Information Technology Services; the Offices of the Attorney General,
Secretary of State, and State Auditor; the Minnesota State Colleges and Universities; the
Minnesota Office of Higher Education; the Perpich Center for Arts Education; deleted text begin anddeleted text end the
Minnesota Zoological Boardnew text begin ; and the Office of Emergency Medical Servicesnew text end .
A position designated by an appointing authority according to this subdivision must
meet the following standards and criteria:
(1) the designation of the position would not be contrary to other law relating specifically
to that agency;
(2) the person occupying the position would report directly to the agency head or deputy
agency head and would be designated as part of the agency head's management team;
(3) the duties of the position would involve significant discretion and substantial
involvement in the development, interpretation, and implementation of agency policy;
(4) the duties of the position would not require primarily personnel, accounting, or other
technical expertise where continuity in the position would be important;
(5) there would be a need for the person occupying the position to be accountable to,
loyal to, and compatible with, the governor and the agency head, the employing statutory
board or commission, or the employing constitutional officer;
(6) the position would be at the level of division or bureau director or assistant to the
agency head; and
(7) the commissioner has approved the designation as being consistent with the standards
and criteria in this subdivision.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 3.
Minnesota Statutes 2022, section 62J.49, subdivision 1, is amended to read:
Subdivision 1.
Establishment.
The new text begin director of the Office of new text end Emergency Medical Services
deleted text begin Regulatory Boarddeleted text end established under chapter deleted text begin 144deleted text end new text begin 144Enew text end shall establish a financial data
collection system for all ambulance services licensed in this state. To establish the financial
database, the deleted text begin Emergency Medical Services Regulatory Boarddeleted text end new text begin directornew text end may contract with
an entity that has experience in ambulance service financial data collection.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 4.
Minnesota Statutes 2022, section 144E.001, subdivision 3a, is amended to read:
Subd. 3a.
Ambulance service personnel.
"Ambulance service personnel" means
individuals who are authorized by a licensed ambulance service to provide emergency care
for the ambulance service and are:
(1) EMTs, AEMTs, or paramedics;
(2) Minnesota registered nurses who are: (i) EMTs, are currently practicing nursing, and
have deleted text begin passed a paramedic practical skills test, as approved by the board and administered by
an educational program approved by the boarddeleted text end new text begin been approved by the ambulance service
medical directornew text end ; (ii) on the roster of an ambulance service on or before January 1, 2000;
deleted text begin ordeleted text end (iii) after petitioning the board, deemed by the board to have training and skills equivalent
to an EMT, as determined on a case-by-case basis;new text begin or (iv) certified as a certified flight
registered nurse or certified emergency nurse;new text end or
(3) Minnesota licensed physician assistants who are: (i) EMTs, are currently practicing
as physician assistants, and have deleted text begin passed a paramedic practical skills test, as approved by
the board and administered by an educational program approved by the boarddeleted text end new text begin been approved
by the ambulance service medical directornew text end ; (ii) on the roster of an ambulance service on or
before January 1, 2000; or (iii) after petitioning the board, deemed by the board to have
training and skills equivalent to an EMT, as determined on a case-by-case basis.
Sec. 5.
Minnesota Statutes 2022, section 144E.001, is amended by adding a subdivision
to read:
new text begin Subd. 16. new text end
new text begin Director. new text end
new text begin
"Director" means the director of the Office of Emergency Medical
Services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 6.
Minnesota Statutes 2022, section 144E.001, is amended by adding a subdivision
to read:
new text begin Subd. 17. new text end
new text begin Office. new text end
new text begin
"Office" means the Office of Emergency Medical Services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 7.
new text begin
[144E.011] OFFICE OF EMERGENCY MEDICAL SERVICES.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The Office of Emergency Medical Services is established
with the powers and duties established in law. In administering this chapter, the office must
promote the public health and welfare, protect the safety of the public, and effectively
regulate and support the operation of the emergency medical services system in this state.
new text end
new text begin Subd. 2. new text end
new text begin Director. new text end
new text begin
The governor must appoint a director for the office with the advice
and consent of the senate. The director must be in the unclassified service and must serve
at the pleasure of the governor. The salary of the director shall be determined according to
section 15A.0815. The director shall direct the activities of the office.
new text end
new text begin Subd. 3. new text end
new text begin Powers and duties. new text end
new text begin
The director has the following powers and duties:
new text end
new text begin
(1) administer and enforce this chapter and adopt rules as needed to implement this
chapter. Rules for which notice is published in the State Register before July 1, 2026, may
be adopted using the expedited rulemaking process in section 14.389;
new text end
new text begin
(2) license ambulance services in the state and regulate their operation;
new text end
new text begin
(3) establish and modify primary service areas;
new text end
new text begin
(4) designate an ambulance service as authorized to provide service in a primary service
area and remove an ambulance service's authorization to provide service in a primary service
area;
new text end
new text begin
(5) register medical response units in the state and regulate their operation;
new text end
new text begin
(6) certify emergency medical technicians, advanced emergency medical technicians,
community emergency medical technicians, paramedics, and community paramedics and
to register emergency medical responders;
new text end
new text begin
(7) approve education programs for ambulance service personnel and emergency medical
responders and administer qualifications for instructors of education programs;
new text end
new text begin
(8) administer grant programs related to emergency medical services;
new text end
new text begin
(9) report to the legislature by February 15 each year on the work of the office and the
advisory councils in the previous calendar year and with recommendations for any needed
policy changes related to emergency medical services, including but not limited to improving
access to emergency medical services, improving service delivery by ambulance services
and medical response units, and improving the effectiveness of the state's emergency medical
services system. The director must develop the reports and recommendations in consultation
with the office's deputy directors and advisory councils;
new text end
new text begin
(10) investigate complaints against and hold hearings regarding ambulance services,
ambulance service personnel, and emergency medical responders and to impose disciplinary
action or otherwise resolve complaints; and
new text end
new text begin
(11) perform other duties related to the provision of emergency medical services in the
state.
new text end
new text begin Subd. 4. new text end
new text begin Employees. new text end
new text begin
The director may employ personnel in the classified service and
unclassified personnel as necessary to carry out the duties of this chapter.
new text end
new text begin Subd. 5. new text end
new text begin Work plan. new text end
new text begin
The director must prepare a work plan to guide the work of the
office. The work plan must be updated biennially.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 8.
new text begin
[144E.015] MEDICAL SERVICES DIVISION.
new text end
new text begin
A Medical Services Division is created in the Office of Emergency Medical Services.
The Medical Services Division shall be under the supervision of a deputy director of medical
services appointed by the director. The deputy director of medical services must be a
physician licensed under chapter 147. The deputy director, under the direction of the director,
shall enforce and coordinate the laws, rules, and policies assigned by the director, which
may include overseeing the clinical aspects of prehospital medical care and education
programs for emergency medical service personnel.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 9.
new text begin
[144E.016] AMBULANCE SERVICES DIVISION.
new text end
new text begin
An Ambulance Services Division is created in the Office of Emergency Medical Services.
The Ambulance Services Division shall be under the supervision of a deputy director of
ambulance services appointed by the director. The deputy director, under the direction of
the director, shall enforce and coordinate the laws, rules, and policies assigned by the director,
which may include operating standards and licensing of ambulance services, registration
and operation of medical response units, establishment and modification of primary service
areas, authorization of ambulance services to provide service in a primary service area and
revocation of such authorization, coordination of ambulance services within regions and
across the state, and administration of grants.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 10.
new text begin
[144E.017] EMERGENCY MEDICAL SERVICE PROVIDERS DIVISION.
new text end
new text begin
An Emergency Medical Service Providers Division is created in the Office of Emergency
Medical Services. The Emergency Medical Service Providers Division shall be under the
supervision of a deputy director of emergency medical service providers appointed by the
director. The deputy director, under the direction of the director, shall enforce and coordinate
the laws, rules, and policies assigned by the director, which may include certification and
registration of individual emergency medical service providers; overseeing worker safety,
worker well-being, and working conditions; implementation of education programs; and
administration of grants.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 11.
new text begin
[144E.03] EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment; membership. new text end
new text begin
The Emergency Medical Services Advisory
Council is established and consists of the following members:
new text end
new text begin
(1) one emergency medical technician currently practicing with a licensed ambulance
service, appointed by the Minnesota Ambulance Association;
new text end
new text begin
(2) one paramedic currently practicing with a licensed ambulance service or a medical
response unit, appointed jointly by the Minnesota Professional Fire Fighters Association
and the Minnesota Ambulance Association;
new text end
new text begin
(3) one medical director of a licensed ambulance service, appointed by the National
Association of EMS Physicians, Minnesota Chapter;
new text end
new text begin
(4) one firefighter currently serving as an emergency medical responder, appointed by
the Minnesota State Fire Chiefs Association;
new text end
new text begin
(5) one registered nurse who is certified or currently practicing as a flight nurse, appointed
jointly by the regional emergency services boards of the designated regional emergency
medical services systems;
new text end
new text begin
(6) one hospital administrator, appointed by the Minnesota Hospital Association;
new text end
new text begin
(7) one social worker, appointed by the Board of Social Work;
new text end
new text begin
(8) one member of a federally recognized Tribal Nation in Minnesota, appointed by the
Minnesota Indian Affairs Council;
new text end
new text begin
(9) three public members, appointed by the governor;
new text end
new text begin
(10) one member with experience working as an employee organization representative
representing emergency medical service providers, appointed by an employee organization
representing emergency medical service providers;
new text end
new text begin
(11) one member representing a local government, appointed by the Coalition of Greater
Minnesota Cities;
new text end
new text begin
(12) one member representing a local government in the seven-county metropolitan area,
appointed by the League of Minnesota Cities;
new text end
new text begin
(13) one member of the house of representatives and one member of the senate, appointed
according to subdivision 2; and
new text end
new text begin
(14) the commissioner of health and commissioner of public safety or their designees
as ex officio members.
new text end
new text begin Subd. 2. new text end
new text begin Legislative members. new text end
new text begin
The speaker of the house must appoint one member of
the house of representatives to serve on the advisory council and the senate majority leader
must appoint one member of the senate to serve on the advisory council. Legislative members
appointed under this subdivision serve until successors are appointed. Legislative members
may receive per diem compensation and reimbursement for expenses according to the rules
of their respective bodies.
new text end
new text begin Subd. 3. new text end
new text begin Terms, compensation, removal, vacancies, and expiration. new text end
new text begin
Compensation
and reimbursement for expenses for members appointed under subdivision 1, clauses (1)
to (12); removal of members; filling of vacancies of members; and, except for initial
appointments, membership terms are governed by section 15.059. Notwithstanding section
15.059, subdivision 6, the advisory council does not expire.
new text end
new text begin Subd. 4. new text end
new text begin Officers; meetings. new text end
new text begin
(a) The advisory council must elect a chair and vice-chair
from among its membership and may elect other officers as the advisory council deems
necessary.
new text end
new text begin
(b) The advisory council must meet quarterly or at the call of the chair.
new text end
new text begin
(c) Meetings of the advisory council are subject to chapter 13D.
new text end
new text begin Subd. 5. new text end
new text begin Duties. new text end
new text begin
The advisory council must review and make recommendations to the
director and the deputy director of ambulance services on the administration of this chapter,
the regulation of ambulance services and medical response units, the operation of the
emergency medical services system in the state, and other topics as directed by the director.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 12.
new text begin
[144E.035] EMERGENCY MEDICAL SERVICES PHYSICIAN ADVISORY
COUNCIL.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment; membership. new text end
new text begin
The Emergency Medical Services Physician
Advisory Council is established and consists of the following members:
new text end
new text begin
(1) eight physicians who meet the qualifications for medical directors in section 144E.265,
subdivision 1, with one physician appointed by each of the regional emergency services
boards of the designated regional emergency medical services systems;
new text end
new text begin
(2) one physician who meets the qualifications for medical directors in section 144E.265,
subdivision 1, appointed by the Minnesota State Fire Chiefs Association;
new text end
new text begin
(3) one physician who is board-certified in pediatrics, appointed by the Minnesota
Emergency Medical Services for Children program; and
new text end
new text begin
(4) the medical director member of the Emergency Medical Services Advisory Council
appointed under section 144E.03, subdivision 1, clause (3).
new text end
new text begin Subd. 2. new text end
new text begin Terms, compensation, removal, vacancies, and expiration. new text end
new text begin
Compensation
and reimbursement for expenses, removal of members, filling of vacancies of members,
and, except for initial appointments, membership terms are governed by section 15.059.
Notwithstanding section 15.059, subdivision 6, the advisory council does not expire.
new text end
new text begin Subd. 3. new text end
new text begin Officers; meetings. new text end
new text begin
(a) The advisory council must elect a chair and vice-chair
from among its membership and may elect other officers as it deems necessary.
new text end
new text begin
(b) The advisory council must meet twice per year or upon the call of the chair.
new text end
new text begin
(c) Meetings of the advisory council are subject to chapter 13D.
new text end
new text begin Subd. 4. new text end
new text begin Duties. new text end
new text begin
The advisory council must:
new text end
new text begin
(1) review and make recommendations to the director and deputy director of medical
services on clinical aspects of prehospital medical care. In doing so, the advisory council
must incorporate information from medical literature, advances in bedside clinical practice,
and advisory council member experience; and
new text end
new text begin
(2) serve as subject matter experts for the director and deputy director of medical services
on evolving topics in clinical medicine, including but not limited to infectious disease,
pharmaceutical and equipment shortages, and implementation of new therapeutics.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 13.
new text begin
[144E.04] LABOR AND EMERGENCY MEDICAL SERVICE PROVIDERS
ADVISORY COUNCIL.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment; membership. new text end
new text begin
The Labor and Emergency Medical Service
Providers Advisory Council is established and consists of the following members:
new text end
new text begin
(1) one emergency medical service provider of any type from each of the designated
regional emergency medical services systems, appointed by their respective regional
emergency services boards;
new text end
new text begin
(2) one emergency medical technician instructor, appointed by an employee organization
representing emergency medical service providers;
new text end
new text begin
(3) two members with experience working as an employee organization representative
representing emergency medical service providers, appointed by an employee organization
representing emergency medical service providers;
new text end
new text begin
(4) one emergency medical service provider based in a fire department, appointed jointly
by the Minnesota State Fire Chiefs Association and the Minnesota Professional Fire Fighters
Association; and
new text end
new text begin
(5) one emergency medical service provider not based in a fire department, appointed
by the League of Minnesota Cities.
new text end
new text begin Subd. 2. new text end
new text begin Terms, compensation, removal, vacancies, and expiration. new text end
new text begin
Compensation
and reimbursement for expenses for members appointed under subdivision 1; removal of
members; filling of vacancies of members; and, except for initial appointments, membership
terms are governed by section 15.059. Notwithstanding section 15.059, subdivision 6, the
advisory council does not expire.
new text end
new text begin Subd. 3. new text end
new text begin Officers; meetings. new text end
new text begin
(a) The advisory council must elect a chair and vice-chair
from among its membership and may elect other officers as the advisory council deems
necessary.
new text end
new text begin
(b) The advisory council must meet quarterly or at the call of the chair.
new text end
new text begin
(c) Meetings of the advisory council are subject to chapter 13D.
new text end
new text begin Subd. 4. new text end
new text begin Duties. new text end
new text begin
The advisory council must review and make recommendations to the
director and deputy director of emergency medical service providers on the laws, rules, and
policies assigned to the Emergency Medical Service Providers Division and other topics as
directed by the director.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 14.
Minnesota Statutes 2023 Supplement, section 144E.101, subdivision 6, is amended
to read:
Subd. 6.
Basic life support.
(a) Except as provided in paragraph (f)new text begin or subdivision 6anew text end ,
a basic life-support ambulance shall be staffed by at least two deleted text begin EMTs, one of whomdeleted text end new text begin individuals
who meet one of the following requirements: (1) are certified as an EMT; (2) are a Minnesota
registered nurse who meets the qualification requirements in section 144E.001, subdivision
3a, clause (2); or (3) are a Minnesota licensed physician assistant who meets the qualification
requirements in section 144E.001, subdivision 3a, clause (3). One of the individuals staffing
a basic life-support ambulancenew text end must accompany the patient and provide a level of care deleted text begin so
asdeleted text end to ensure that:
deleted text begin (1)deleted text end new text begin (i)new text end life-threatening situations and potentially serious injuries are recognized;
deleted text begin (2)deleted text end new text begin (ii)new text end patients are protected from additional hazards;
deleted text begin (3)deleted text end new text begin (iii)new text end basic treatment to reduce the seriousness of emergency situations is administered;
and
deleted text begin (4)deleted text end new text begin (iv)new text end patients are transported to an appropriate medical facility for treatment.
(b) A basic life-support service shall provide basic airway management.
(c) A basic life-support service shall provide automatic defibrillation.
(d) A basic life-support service shall administer opiate antagonists consistent with
protocols established by the service's medical director.
(e) A basic life-support service licensee's medical director may authorize ambulance
service personnel to perform intravenous infusion and use equipment that is within the
licensure level of the ambulance service. Ambulance service personnel must be properly
trained. Documentation of authorization for use, guidelines for use, continuing education,
and skill verification must be maintained in the licensee's files.
(f) For emergency ambulance calls and interfacility transfers, an ambulance service may
staff its basic life-support ambulances with one deleted text begin EMTdeleted text end new text begin individual who meets the qualification
requirements in paragraph (a)new text end , who must accompany the patient, and one registered
emergency medical responder driver. deleted text begin For purposes of this paragraph, "ambulance service"
means either an ambulance service whose primary service area is mainly located outside
deleted text end deleted text begin the metropolitan counties listed in section 473.121, subdivision 4, and outside the cities of
Duluth, Mankato, Moorhead, Rochester, and St. Cloud; or an ambulance service based in
a community with a population of less than 2,500.
deleted text end
new text begin
(g) In order for a registered nurse to staff a basic life-support ambulance as a driver, the
registered nurse must have successfully completed a certified emergency vehicle operators
program.
new text end
Sec. 15.
Minnesota Statutes 2022, section 144E.101, is amended by adding a subdivision
to read:
new text begin Subd. 6a. new text end
new text begin Variance; staffing of basic life-support ambulance. new text end
new text begin
(a) Upon application
from an ambulance service that includes evidence demonstrating hardship, the board may
grant a variance from the staff requirements in subdivision 6, paragraph (a), and may
authorize a basic life-support ambulance to be staffed, for all emergency calls and interfacility
transfers, with one individual who meets the qualification requirements in paragraph (b) to
drive the ambulance and one individual who meets the qualification requirements in
subdivision 6, paragraph (a), and who must accompany the patient. The variance applies to
basic life-support ambulances until the ambulance service renews its license. When the
variance expires, the ambulance service may apply for a new variance under this subdivision.
new text end
new text begin
(b) In order to drive an ambulance under a variance granted under this subdivision, an
individual must:
new text end
new text begin
(1) hold a valid driver's license from any state;
new text end
new text begin
(2) have attended an emergency vehicle driving course approved by the ambulance
service;
new text end
new text begin
(3) have completed a course on cardiopulmonary resuscitation approved by the ambulance
service; and
new text end
new text begin
(4) register with the board according to a process established by the board.
new text end
new text begin
(c) If an individual serving as a driver under this subdivision commits or has a record
of committing an act listed in 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
section 144E.27, subdivisions 5 and 6.
new text end
Sec. 16.
Minnesota Statutes 2023 Supplement, section 144E.101, subdivision 7, as amended
by Laws 2024, chapter 85, section 32, is amended to read:
Subd. 7.
Advanced life support.
(a) Except as provided in paragraphs (f) and (g), an
advanced life-support ambulance shall be staffed by at least:
(1) one EMT or one AEMT and one paramedic;
(2) one EMT or one AEMT and one registered nurse whonew text begin : (i)new text end is an EMT or an AEMT,
is currently practicing nursing, and deleted text begin has passed a paramedic practical skills test approved by
the board and administered by an education programdeleted text end new text begin has been approved by the ambulance
service medical directornew text end ;new text begin or (ii) is certified as a certified flight registered nurse or certified
emergency nurse;new text end or
(3) one EMT or one AEMT and one physician assistant who is an EMT or an AEMT,
is currently practicing as a physician assistant, and deleted text begin has passed a paramedic practical skills
test approved by the board and administered by an education programdeleted text end new text begin has been approved
by the ambulance service medical directornew text end .
(b) An advanced life-support service shall provide basic life support, as specified under
subdivision 6, paragraph (a), advanced airway management, manual defibrillation,
administration of intravenous fluids and pharmaceuticals, and administration of opiate
antagonists.
(c) In addition to providing advanced life support, an advanced life-support service may
staff additional ambulances to provide basic life support according to subdivision 6 and
section 144E.103, subdivision 1.
(d) An ambulance service providing advanced life support shall have a written agreement
with its medical director to ensure medical control for patient care 24 hours a day, seven
days a week. The terms of the agreement shall include a written policy on the administration
of medical control for the service. The policy shall address the following issues:
(1) two-way communication for physician direction of ambulance service personnel;
(2) patient triage, treatment, and transport;
(3) use of standing orders; and
(4) the means by which medical control will be provided 24 hours a day.
The agreement shall be signed by the licensee's medical director and the licensee or the
licensee's designee and maintained in the files of the licensee.
(e) When an ambulance service provides advanced life support, the authority of a
paramedic, Minnesota registered nurse-EMT, or Minnesota registered physician
assistant-EMT to determine the delivery of patient care prevails over the authority of an
EMT.
(f) Upon application from an ambulance service that includes evidence demonstrating
hardship, the board may grant a variance from the staff requirements in paragraph (a), clause
(1), and may authorize an advanced life-support ambulance to be staffed by a registered
emergency medical responder driver with a paramedic for all emergency calls and interfacility
transfers. The variance shall apply to advanced life-support ambulance services until the
ambulance service renews its license. When the variance expires, an ambulance service
may apply for a new variance under this paragraph. deleted text begin This paragraph applies only to an
ambulance service whose primary service area is mainly located outside the metropolitan
counties listed in section 473.121, subdivision 4, and outside the cities of Duluth, Mankato,
Moorhead, Rochester, and St. Cloud, or an ambulance service based in a community with
a population of less than 1,000 persons.
deleted text end
(g) After an initial emergency ambulance call, each subsequent emergency ambulance
response, until the initial ambulance is again available, and interfacility transfers, may be
staffed by one registered emergency medical responder driver and an EMT or paramedic.
deleted text begin This paragraph applies only to an ambulance service whose primary service area is mainly
located outside the metropolitan counties listed in section 473.121, subdivision 4, and outside
the cities of Duluth, Mankato, Moorhead, Rochester, and St. Cloud, or an ambulance service
based in a community with a population of less than 1,000 persons.
deleted text end
new text begin
(h) In order for a registered nurse to staff an advanced life-support ambulance as a driver,
the registered nurse must have successfully completed a certified emergency vehicle operators
program.
new text end
Sec. 17.
Minnesota Statutes 2022, section 144E.16, subdivision 5, is amended to read:
Subd. 5.
Local government's powers.
(a) Local units of government may, with the
approval of the deleted text begin boarddeleted text end new text begin directornew text end , establish standards for ambulance services which impose
additional requirements upon such services. Local units of government intending to impose
additional requirements shall consider whether any benefit accruing to the public health
would outweigh the costs associated with the additional requirements.
(b) Local units of government that desire to impose additional requirements shall, prior
to adoption of relevant ordinances, rules, or regulations, furnish the deleted text begin boarddeleted text end new text begin directornew text end with a
copy of the proposed ordinances, rules, or regulations, along with information that
affirmatively substantiates that the proposed ordinances, rules, or regulations:
(1) will in no way conflict with the relevant rules of the deleted text begin boarddeleted text end new text begin officenew text end ;
(2) will establish additional requirements tending to protect the public health;
(3) will not diminish public access to ambulance services of acceptable quality; and
(4) will not interfere with the orderly development of regional systems of emergency
medical care.
(c) The deleted text begin boarddeleted text end new text begin directornew text end shall base any decision to approve or disapprove local standards
upon whether or not the local unit of government in question has affirmatively substantiated
that the proposed ordinances, rules, or regulations meet the criteria specified in paragraph
(b).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 18.
Minnesota Statutes 2022, section 144E.19, subdivision 3, is amended to read:
Subd. 3.
Temporary suspension.
(a) In addition to any other remedy provided by law,
the deleted text begin boarddeleted text end new text begin directornew text end may temporarily suspend the license of a licensee after conducting a
preliminary inquiry to determine whether the deleted text begin boarddeleted text end new text begin director new text end believes that the licensee has
violated a statute or rule that the deleted text begin boarddeleted text end new text begin directornew text end is empowered to enforce and determining
that the continued provision of service by the licensee would create an imminent risk to
public health or harm to others.
(b) A temporary suspension order prohibiting a licensee from providing ambulance
service shall give notice of the right to a preliminary hearing according to paragraph (d)
and shall state the reasons for the entry of the temporary suspension order.
(c) Service of a temporary suspension order is effective when the order is served on the
licensee personally or by certified mail, which is complete upon receipt, refusal, or return
for nondelivery to the most recent address provided to the deleted text begin boarddeleted text end new text begin directornew text end for the licensee.
(d) At the time the deleted text begin boarddeleted text end new text begin directornew text end issues a temporary suspension order, the deleted text begin boarddeleted text end new text begin directornew text end
shall schedule a hearingdeleted text begin , to be held before a group of its members designated by the board,deleted text end
that shall begin within 60 days after issuance of the temporary suspension order or within
15 working days of the date of the deleted text begin board'sdeleted text end new text begin director'snew text end receipt of a request for a hearing from
a licensee, whichever is sooner. The hearing shall be on the sole issue of whether there is
a reasonable basis to continue, modify, or lift the temporary suspension. A hearing under
this paragraph is not subject to chapter 14.
(e) Evidence presented by the deleted text begin boarddeleted text end new text begin directornew text end or licensee may be in the form of an affidavit.
The licensee or the licensee's designee may appear for oral argument.
(f) Within five working days of the hearing, the deleted text begin boarddeleted text end new text begin directornew text end shall issue its order and,
if the suspension is continued, notify the licensee of the right to a contested case hearing
under chapter 14.
(g) If a licensee requests a contested case hearing within 30 days after receiving notice
under paragraph (f), the deleted text begin boarddeleted text end new text begin director new text end shall initiate a contested case hearing according to
chapter 14. The administrative law judge shall issue a report and recommendation within
30 days after the closing of the contested case hearing record. The deleted text begin boarddeleted text end new text begin directornew text end shall issue
a final order within 30 days after receipt of the administrative law judge's report.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 19.
Minnesota Statutes 2022, section 144E.27, subdivision 3, is amended to read:
Subd. 3.
Renewal.
(a) The board may renew the registration of an emergency medical
responder who:
(1) successfully completes a board-approved refresher course; deleted text begin and
deleted text end
new text begin
(2) successfully completes a course in cardiopulmonary resuscitation approved by the
board or by the licensee's medical director. This course may be a component of a
board-approved refresher course; and
new text end
deleted text begin (2)deleted text end new text begin (3)new text end submits a completed renewal application to the board before the registration
expiration date.
(b) The board may renew the lapsed registration of an emergency medical responder
who:
(1) successfully completes a board-approved refresher course; deleted text begin and
deleted text end
new text begin
(2) successfully completes a course in cardiopulmonary resuscitation approved by the
board or by the licensee's medical director. This course may be a component of a
board-approved refresher course; and
new text end
deleted text begin (2)deleted text end new text begin (3)new text end submits a completed renewal application to the board within deleted text begin 12deleted text end new text begin 48new text end months after
the registration expiration date.
Sec. 20.
Minnesota Statutes 2022, section 144E.27, subdivision 5, is amended to read:
Subd. 5.
Denial, suspension, revocation.
(a) The deleted text begin boarddeleted text end new text begin director new text end may deny, suspend,
revoke, place conditions on, or refuse to renew the registration of an individual who the
deleted text begin boarddeleted text end new text begin director new text end determines:
(1) violates sections 144E.001 to 144E.33 or the rules adopted under those sections, an
agreement for corrective action, or an order that the deleted text begin boarddeleted text end new text begin director new text end issued or is otherwise
empowered to enforce;
(2) misrepresents or falsifies information on an application form for registration;
(3) is convicted or pleads guilty or nolo contendere to any felony; any gross misdemeanor
relating to assault, sexual misconduct, theft, or the illegal use of drugs or alcohol; or any
misdemeanor relating to assault, sexual misconduct, theft, or the illegal use of drugs or
alcohol;
(4) is actually or potentially unable to provide emergency medical services with
reasonable skill and safety to patients by reason of illness, use of alcohol, drugs, chemicals,
or any other material, or as a result of any mental or physical condition;
(5) engages in unethical conduct, including, but not limited to, conduct likely to deceive,
defraud, or harm the public, or demonstrating a willful or careless disregard for the health,
welfare, or safety of the public;
(6) maltreats or abandons a patient;
(7) violates any state or federal controlled substance law;
(8) engages in unprofessional conduct or any other conduct which has the potential for
causing harm to the public, including any departure from or failure to conform to the
minimum standards of acceptable and prevailing practice without actual injury having to
be established;
(9) provides emergency medical services under lapsed or nonrenewed credentials;
(10) is subject to a denial, corrective, disciplinary, or other similar action in another
jurisdiction or by another regulatory authority;
(11) engages 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; deleted text begin or
deleted text end
(12) makes a false statement or knowingly provides false information to the deleted text begin boarddeleted text end new text begin
directornew text end , or fails to cooperate with an investigation of the deleted text begin boarddeleted text end new text begin director new text end as required by
section 144E.30deleted text begin .deleted text end new text begin ; or
new text end
new text begin
(13) fails to engage with the health professionals services program or diversion program
required under section 144E.287 after being referred to the program, violates the terms of
the program participation agreement, or leaves the program except upon fulfilling the terms
for successful completion of the program as set forth in the participation agreement.
new text end
(b) Before taking action under paragraph (a), the deleted text begin boarddeleted text end new text begin director new text end shall give notice to an
individual of the right to a contested case hearing under chapter 14. If an individual requests
a contested case hearing within 30 days after receiving notice, the deleted text begin boarddeleted text end new text begin director new text end shall initiate
a contested case hearing according to chapter 14.
(c) The administrative law judge shall issue a report and recommendation within 30
days after closing the contested case hearing record. The deleted text begin boarddeleted text end new text begin director new text end shall issue a final
order within 30 days after receipt of the administrative law judge's report.
(d) After six months from the deleted text begin board'sdeleted text end new text begin director's new text end decision to deny, revoke, place conditions
on, or refuse renewal of an individual's registration for disciplinary action, the individual
shall have the opportunity to apply to the deleted text begin boarddeleted text end new text begin director new text end for reinstatement.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 21.
Minnesota Statutes 2022, section 144E.27, subdivision 5, is amended to read:
Subd. 5.
Denial, suspension, revocationnew text begin ; emergency medical responders and
driversnew text end .
(a) new text begin This subdivision applies to individuals seeking registration or registered as an
emergency medical responder and to individuals seeking registration or registered as a driver
of a basic life-support ambulance under section 144E.101, subdivision 6a. new text end The board may
deny, suspend, revoke, place conditions on, or refuse to renew the registration of an individual
who the board determines:
(1) violates sections 144E.001 to 144E.33 or the rules adopted under those sections, an
agreement for corrective action, or an order that the board issued or is otherwise empowered
to enforce;
(2) misrepresents or falsifies information on an application form for registration;
(3) is convicted or pleads guilty or nolo contendere to any felony; any gross misdemeanor
relating to assault, sexual misconduct, theft, or the illegal use of drugs or alcohol; or any
misdemeanor relating to assault, sexual misconduct, theft, or the illegal use of drugs or
alcohol;
(4) is actually or potentially unable to provide emergency medical services new text begin or drive an
ambulance new text end with reasonable skill and safety to patients by reason of illness, use of alcohol,
drugs, chemicals, or any other material, or as a result of any mental or physical condition;
(5) engages in unethical conduct, including, but not limited to, conduct likely to deceive,
defraud, or harm the public, or demonstrating a willful or careless disregard for the health,
welfare, or safety of the public;
(6) maltreats or abandons a patient;
(7) violates any state or federal controlled substance law;
(8) engages in unprofessional conduct or any other conduct which has the potential for
causing harm to the public, including any departure from or failure to conform to the
minimum standards of acceptable and prevailing practice without actual injury having to
be established;
(9) new text begin for emergency medical responders, new text end provides emergency medical services under
lapsed or nonrenewed credentials;
(10) is subject to a denial, corrective, disciplinary, or other similar action in another
jurisdiction or by another regulatory authority;
(11) engages 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; or
(12) makes a false statement or knowingly provides false information to the board, or
fails to cooperate with an investigation of the board as required by section 144E.30.
(b) Before taking action under paragraph (a), the board shall give notice to an individual
of the right to a contested case hearing under chapter 14. If an individual requests a contested
case hearing within 30 days after receiving notice, the board shall initiate a contested case
hearing according to chapter 14.
(c) The administrative law judge shall issue a report and recommendation within 30
days after closing the contested case hearing record. The board shall issue a final order
within 30 days after receipt of the administrative law judge's report.
(d) After six months from the board's decision to deny, revoke, place conditions on, or
refuse renewal of an individual's registration for disciplinary action, the individual shall
have the opportunity to apply to the board for reinstatement.
Sec. 22.
Minnesota Statutes 2022, section 144E.27, subdivision 6, is amended to read:
Subd. 6.
Temporary suspensionnew text begin ; emergency medical responders and driversnew text end .
(a)
new text begin This subdivision applies to emergency medical responders registered under this section and
to individuals registered as drivers of basic life-support ambulances under section 144E.101,
subdivision 6a. new text end In addition to any other remedy provided by law, the board may temporarily
suspend the registration of an individual after conducting a preliminary inquiry to determine
whether the board believes that the individual has violated a statute or rule that the board
is empowered to enforce and determining that the continued provision of service by the
individual would create an imminent risk to public health or harm to others.
(b) A temporary suspension order prohibiting an individual from providing emergency
medical care new text begin or from driving a basic life-support ambulance new text end shall give notice of the right
to a preliminary hearing according to paragraph (d) and shall state the reasons for the entry
of the temporary suspension order.
(c) Service of a temporary suspension order is effective when the order is served on the
individual personally or by certified mail, which is complete upon receipt, refusal, or return
for nondelivery to the most recent address provided to the board for the individual.
(d) At the time the board issues a temporary suspension order, the board shall schedule
a hearing, to be held before a group of its members designated by the board, that shall begin
within 60 days after issuance of the temporary suspension order or within 15 working days
of the date of the board's receipt of a request for a hearing from the individual, whichever
is sooner. The hearing shall be on the sole issue of whether there is a reasonable basis to
continue, modify, or lift the temporary suspension. A hearing under this paragraph is not
subject to chapter 14.
(e) Evidence presented by the board or the individual may be in the form of an affidavit.
The individual or the individual's designee may appear for oral argument.
(f) Within five working days of the hearing, the board shall issue its order and, if the
suspension is continued, notify the individual of the right to a contested case hearing under
chapter 14.
(g) If an individual requests a contested case hearing within 30 days after receiving
notice under paragraph (f), the board shall initiate a contested case hearing according to
chapter 14. The administrative law judge shall issue a report and recommendation within
30 days after the closing of the contested case hearing record. The board shall issue a final
order within 30 days after receipt of the administrative law judge's report.
Sec. 23.
Minnesota Statutes 2022, section 144E.28, subdivision 3, is amended to read:
Subd. 3.
Reciprocity.
The board may certify an individual who possesses a current
National Registry of Emergency Medical Technicians deleted text begin registrationdeleted text end new text begin certificationnew text end from another
jurisdiction if the individual submits a board-approved application form. The board
certification classification shall be the same as the National Registry's classification.
Certification shall be for the duration of the applicant's deleted text begin registrationdeleted text end new text begin certificationnew text end period in
another jurisdiction, not to exceed two years.
Sec. 24.
Minnesota Statutes 2022, section 144E.28, subdivision 5, is amended to read:
Subd. 5.
Denial, suspension, revocation.
(a) The deleted text begin boarddeleted text end new text begin director new text end may deny certification
or take any action authorized in subdivision 4 against an individual who the deleted text begin boarddeleted text end new text begin director
new text end determines:
(1) violates sections 144E.001 to 144E.33 or the rules adopted under those sections, or
an order that the deleted text begin boarddeleted text end new text begin director new text end issued or is otherwise authorized or empowered to enforce,
or agreement for corrective action;
(2) misrepresents or falsifies information on an application form for certification;
(3) is convicted or pleads guilty or nolo contendere to any felony; any gross misdemeanor
relating to assault, sexual misconduct, theft, or the illegal use of drugs or alcohol; or any
misdemeanor relating to assault, sexual misconduct, theft, or the illegal use of drugs or
alcohol;
(4) is actually or potentially unable to provide emergency medical services with
reasonable skill and safety to patients by reason of illness, use of alcohol, drugs, chemicals,
or any other material, or as a result of any mental or physical condition;
(5) engages in unethical conduct, including, but not limited to, conduct likely to deceive,
defraud, or harm the public or demonstrating a willful or careless disregard for the health,
welfare, or safety of the public;
(6) maltreats or abandons a patient;
(7) violates any state or federal controlled substance law;
(8) engages in unprofessional conduct or any other conduct which has the potential for
causing harm to the public, including any departure from or failure to conform to the
minimum standards of acceptable and prevailing practice without actual injury having to
be established;
(9) provides emergency medical services under lapsed or nonrenewed credentials;
(10) is subject to a denial, corrective, disciplinary, or other similar action in another
jurisdiction or by another regulatory authority;
(11) engages 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; deleted text begin or
deleted text end
(12) makes a false statement or knowingly provides false information to the deleted text begin boarddeleted text end new text begin director
new text end or fails to cooperate with an investigation of the deleted text begin boarddeleted text end new text begin director new text end as required by section
144E.30deleted text begin .deleted text end new text begin ; or
new text end
new text begin
(13) fails to engage with the health professionals services program or diversion program
required under section 144E.287 after being referred to the program, violates the terms of
the program participation agreement, or leaves the program except upon fulfilling the terms
for successful completion of the program as set forth in the participation agreement.
new text end
(b) Before taking action under paragraph (a), the deleted text begin boarddeleted text end new text begin director new text end shall give notice to an
individual of the right to a contested case hearing under chapter 14. If an individual requests
a contested case hearing within 30 days after receiving notice, the deleted text begin boarddeleted text end new text begin director new text end shall initiate
a contested case hearing according to chapter 14 and no disciplinary action shall be taken
at that time.
(c) The administrative law judge shall issue a report and recommendation within 30
days after closing the contested case hearing record. The deleted text begin boarddeleted text end new text begin director new text end shall issue a final
order within 30 days after receipt of the administrative law judge's report.
(d) After six months from the deleted text begin board'sdeleted text end new text begin director's new text end decision to deny, revoke, place conditions
on, or refuse renewal of an individual's certification for disciplinary action, the individual
shall have the opportunity to apply to the deleted text begin boarddeleted text end new text begin director new text end for reinstatement.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 25.
Minnesota Statutes 2022, section 144E.28, subdivision 6, is amended to read:
Subd. 6.
Temporary suspension.
(a) In addition to any other remedy provided by law,
the deleted text begin boarddeleted text end new text begin directornew text end may temporarily suspend the certification of an individual after conducting
a preliminary inquiry to determine whether the deleted text begin boarddeleted text end new text begin directornew text end believes that the individual
has violated a statute or rule that the deleted text begin boarddeleted text end new text begin directornew text end is empowered to enforce and determining
that the continued provision of service by the individual would create an imminent risk to
public health or harm to others.
(b) A temporary suspension order prohibiting an individual from providing emergency
medical care shall give notice of the right to a preliminary hearing according to paragraph
(d) and shall state the reasons for the entry of the temporary suspension order.
(c) Service of a temporary suspension order is effective when the order is served on the
individual personally or by certified mail, which is complete upon receipt, refusal, or return
for nondelivery to the most recent address provided to the deleted text begin boarddeleted text end new text begin directornew text end for the individual.
(d) At the time the deleted text begin boarddeleted text end new text begin directornew text end issues a temporary suspension order, the deleted text begin boarddeleted text end new text begin directornew text end
shall schedule a hearingdeleted text begin , to be held before a group of its members designated by the board,deleted text end
that shall begin within 60 days after issuance of the temporary suspension order or within
15 working days of the date of the deleted text begin board'sdeleted text end new text begin director'snew text end receipt of a request for a hearing from
the individual, whichever is sooner. The hearing shall be on the sole issue of whether there
is a reasonable basis to continue, modify, or lift the temporary suspension. A hearing under
this paragraph is not subject to chapter 14.
(e) Evidence presented by the deleted text begin boarddeleted text end new text begin directornew text end or the individual may be in the form of an
affidavit. The individual or individual's designee may appear for oral argument.
(f) Within five working days of the hearing, the deleted text begin boarddeleted text end new text begin directornew text end shall issue its order and,
if the suspension is continued, notify the individual of the right to a contested case hearing
under chapter 14.
(g) If an individual requests a contested case hearing within 30 days of receiving notice
under paragraph (f), the deleted text begin boarddeleted text end new text begin directornew text end shall initiate a contested case hearing according to
chapter 14. The administrative law judge shall issue a report and recommendation within
30 days after the closing of the contested case hearing record. The deleted text begin boarddeleted text end new text begin directornew text end shall issue
a final order within 30 days after receipt of the administrative law judge's report.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 26.
Minnesota Statutes 2022, section 144E.28, subdivision 8, is amended to read:
Subd. 8.
Reinstatement.
(a) Within four years of a certification expiration date, a person
whose certification has expired under subdivision 7, paragraph (d), may have the certification
reinstated upon submission of:
(1) evidence to the board of training equivalent to the continuing education requirements
of subdivision 7new text begin or, for community paramedics, evidence to the board of training equivalent
to the continuing education requirements of subdivision 9, paragraph (c)new text end ; and
(2) a board-approved application form.
(b) If more than four years have passed since a certificate expiration date, an applicant
must complete the initial certification process required under subdivision 1.
new text begin
(c) Beginning July 1, 2024, through December 31, 2025, and notwithstanding paragraph
(b), a person whose certification as an EMT, AEMT, paramedic, or community paramedic
expired more than four years ago but less than ten years ago may have the certification
reinstated upon submission of:
new text end
new text begin
(1) evidence to the board of the training required under paragraph (a), clause (1). This
training must have been completed within the 24 months prior to the date of the application
for reinstatement;
new text end
new text begin
(2) a board-approved application form; and
new text end
new text begin
(3) a recommendation from an ambulance service medical director.
new text end
new text begin
This paragraph expires December 31, 2025.
new text end
Sec. 27.
Minnesota Statutes 2022, section 144E.285, subdivision 1, is amended to read:
Subdivision 1.
Approval required.
(a) All education programs for an new text begin EMR, new text end EMT,
AEMT, or paramedic must be approved by the board.
(b) To be approved by the board, an education program must:
(1) submit an application prescribed by the board that includes:
(i) type deleted text begin and lengthdeleted text end of course to be offered;
(ii) names, addresses, and qualifications of the program medical director, program
education coordinator, and instructors;
deleted text begin
(iii) names and addresses of clinical sites, including a contact person and telephone
number;
deleted text end
deleted text begin (iv)deleted text end new text begin (iii)new text end admission criteria for students; and
deleted text begin (v)deleted text end new text begin (iv)new text end materials and equipment to be used;
(2) for each course, implement the most current version of the United States Department
of Transportation EMS Education Standards, or its equivalent as determined by the board
applicable to new text begin EMR, new text end EMT, AEMT, or paramedic education;
(3) have a program medical director and a program coordinator;
(4) utilize instructors who meet the requirements of section 144E.283 for teaching at
least 50 percent of the course content. The remaining 50 percent of the course may be taught
by guest lecturers approved by the education program coordinator or medical director;
deleted text begin
(5) have at least one instructor for every ten students at the practical skill stations;
deleted text end
deleted text begin
(6) maintain a written agreement with a licensed hospital or licensed ambulance service
designating a clinical training site;
deleted text end
deleted text begin (7)deleted text end new text begin (5)new text end retain documentation of program approval by the board, course outline, and
student information;
deleted text begin (8)deleted text end new text begin (6)new text end notify the board of the starting date of a course prior to the beginning of a course;new text begin
and
new text end
deleted text begin (9)deleted text end new text begin (7)new text end submit the appropriate fee as required under section 144E.29deleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(10) maintain a minimum average yearly pass rate as set by the board on an annual basis.
The pass rate will be determined by the percent of candidates who pass the exam on the
first attempt. An education program not meeting this yearly standard shall be placed on
probation and shall be on a performance improvement plan approved by the board until
meeting the pass rate standard. While on probation, the education program may continue
providing classes if meeting the terms of the performance improvement plan as determined
by the board. If an education program having probation status fails to meet the pass rate
standard after two years in which an EMT initial course has been taught, the board may
take disciplinary action under subdivision 5.
deleted text end
Sec. 28.
Minnesota Statutes 2022, section 144E.285, is amended by adding a subdivision
to read:
new text begin Subd. 1a. new text end
new text begin EMR education program requirements. new text end
new text begin
The National EMS Education
Standards established by the National Highway Traffic Safety Administration of the United
States Department of Transportation specify the minimum requirements for knowledge and
skills for emergency medical responders. An education program applying for approval to
teach EMRs must comply with the requirements under subdivision 1, paragraph (b). A
medical director of an emergency medical responder group may establish additional
knowledge and skill requirements for EMRs.
new text end
Sec. 29.
Minnesota Statutes 2022, section 144E.285, is amended by adding a subdivision
to read:
new text begin Subd. 1b. new text end
new text begin EMT education program requirements. new text end
new text begin
In addition to the requirements
under subdivision 1, paragraph (b), an education program applying for approval to teach
EMTs must:
new text end
new text begin
(1) include in the application prescribed by the board the names and addresses of clinical
sites, including a contact person and telephone number;
new text end
new text begin
(2) maintain a written agreement with at least one clinical training site that is of a type
recognized by the National EMS Education Standards established by the National Highway
Traffic Safety Administration; and
new text end
new text begin
(3) maintain a minimum average yearly pass rate as set by the board. An education
program not meeting this standard must be placed on probation and must comply with a
performance improvement plan approved by the board until the program meets the pass
rate standard. While on probation, the education program may continue to provide classes
if the program meets the terms of the performance improvement plan, as determined by the
board. If an education program that is on probation status fails to meet the pass rate standard
after two years in which an EMT initial course has been taught, the board may take
disciplinary action under subdivision 5.
new text end
Sec. 30.
Minnesota Statutes 2022, section 144E.285, subdivision 2, is amended to read:
Subd. 2.
AEMT and paramedic new text begin education program new text end requirements.
(a) In addition to
the requirements under subdivision 1, paragraph (b), an education program applying for
approval to teach AEMTs and paramedics mustnew text begin :
new text end
new text begin (1)new text end be administered by an educational institution accredited by the Commission of
Accreditation of Allied Health Education Programs (CAAHEP)deleted text begin .deleted text end new text begin ;
new text end
new text begin
(2) include in the application prescribed by the board the names and addresses of clinical
sites, including a contact person and telephone number; and
new text end
new text begin
(3) maintain a written agreement with a licensed hospital or licensed ambulance service
designating a clinical training site.
new text end
(b) An AEMT and paramedic education program that is administered by an educational
institution not accredited by CAAHEP, but that is in the process of completing the
accreditation process, may be granted provisional approval by the board upon verification
of submission of its self-study report and the appropriate review fee to CAAHEP.
(c) An educational institution that discontinues its participation in the accreditation
process must notify the board immediately and provisional approval shall be withdrawn.
deleted text begin
(d) This subdivision does not apply to a paramedic education program when the program
is operated by an advanced life-support ambulance service licensed by the Emergency
Medical Services Regulatory Board under this chapter, and the ambulance service meets
the following criteria:
deleted text end
deleted text begin
(1) covers a rural primary service area that does not contain a hospital within the primary
service area or contains a hospital within the primary service area that has been designated
as a critical access hospital under section 144.1483, clause (9);
deleted text end
deleted text begin
(2) has tax-exempt status in accordance with the Internal Revenue Code, section
501(c)(3);
deleted text end
deleted text begin
(3) received approval before 1991 from the commissioner of health to operate a paramedic
education program;
deleted text end
deleted text begin
(4) operates an AEMT and paramedic education program exclusively to train paramedics
for the local ambulance service; and
deleted text end
deleted text begin
(5) limits enrollment in the AEMT and paramedic program to five candidates per
biennium.
deleted text end
Sec. 31.
Minnesota Statutes 2022, section 144E.285, subdivision 4, is amended to read:
Subd. 4.
Reapproval.
An education program shall apply to the board for reapproval at
least deleted text begin three monthsdeleted text end new text begin 30 daysnew text end prior to the expiration date of its approval and must:
(1) submit an application prescribed by the board specifying any changes from the
information provided for prior approval and any other information requested by the board
to clarify incomplete or ambiguous information presented in the application; deleted text begin and
deleted text end
(2) comply with the requirements under subdivision 1, paragraph (b), clauses (2) to deleted text begin (10).deleted text end new text begin
(7);
new text end
new text begin
(3) be subject to a site visit by the board;
new text end
new text begin
(4) for education programs that teach EMRs, comply with the requirements in subdivision
1a;
new text end
new text begin
(5) for education programs that teach EMTs, comply with the requirements in subdivision
1b; and
new text end
new text begin
(6) for education programs that teach AEMTs and paramedics, comply with the
requirements in subdivision 2 and maintain accreditation with CAAHEP.
new text end
Sec. 32.
Minnesota Statutes 2022, section 144E.285, subdivision 6, is amended to read:
Subd. 6.
Temporary suspension.
(a) In addition to any other remedy provided by law,
the deleted text begin boarddeleted text end new text begin directornew text end may temporarily suspend approval of the education program after
conducting a preliminary inquiry to determine whether the deleted text begin boarddeleted text end new text begin directornew text end believes that the
education program has violated a statute or rule that the deleted text begin boarddeleted text end new text begin directornew text end is empowered to
enforce and determining that the continued provision of service by the education program
would create an imminent risk to public health or harm to others.
(b) A temporary suspension order prohibiting the education program from providing
emergency medical care training shall give notice of the right to a preliminary hearing
according to paragraph (d) and shall state the reasons for the entry of the temporary
suspension order.
(c) Service of a temporary suspension order is effective when the order is served on the
education program personally or by certified mail, which is complete upon receipt, refusal,
or return for nondelivery to the most recent address provided to the deleted text begin boarddeleted text end new text begin directornew text end for the
education program.
(d) At the time the deleted text begin boarddeleted text end new text begin directornew text end issues a temporary suspension order, the deleted text begin boarddeleted text end new text begin directornew text end
shall schedule a hearingdeleted text begin , to be held before a group of its members designated by the board,deleted text end
that shall begin within 60 days after issuance of the temporary suspension order or within
15 working days of the date of the deleted text begin board'sdeleted text end new text begin director'snew text end receipt of a request for a hearing from
the education program, whichever is sooner. The hearing shall be on the sole issue of whether
there is a reasonable basis to continue, modify, or lift the temporary suspension. A hearing
under this paragraph is not subject to chapter 14.
(e) Evidence presented by the deleted text begin boarddeleted text end new text begin directornew text end or the individual may be in the form of an
affidavit. The education program or counsel of record may appear for oral argument.
(f) Within five working days of the hearing, the deleted text begin boarddeleted text end new text begin directornew text end shall issue its order and,
if the suspension is continued, notify the education program of the right to a contested case
hearing under chapter 14.
(g) If an education program requests a contested case hearing within 30 days of receiving
notice under paragraph (f), the deleted text begin boarddeleted text end new text begin directornew text end shall initiate a contested case hearing according
to chapter 14. The administrative law judge shall issue a report and recommendation within
30 days after the closing of the contested case hearing record. The deleted text begin boarddeleted text end new text begin directornew text end shall issue
a final order within 30 days after receipt of the administrative law judge's report.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 33.
Minnesota Statutes 2022, section 144E.287, is amended to read:
144E.287 DIVERSION PROGRAM.
The deleted text begin boarddeleted text end new text begin directornew text end shall either conduct a health professionals deleted text begin servicedeleted text end new text begin servicesnew text end program
deleted text begin under sections 214.31 to 214.37deleted text end or contract for a diversion program deleted text begin under section 214.28deleted text end
for professionals regulated deleted text begin by the boarddeleted text end new text begin under this chapternew text end who are unable to perform their
duties with reasonable skill and safety by reason of illness, use of alcohol, drugs, chemicals,
or any other materials, or as a result of any mental, physical, or psychological condition.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 34.
Minnesota Statutes 2022, section 144E.305, subdivision 3, is amended to read:
Subd. 3.
Immunity.
(a) An individual, licensee, health care facility, business, or
organization is immune from civil liability or criminal prosecution for submitting in good
faith a report to the deleted text begin boarddeleted text end new text begin director new text end under subdivision 1 or 2 or for otherwise reporting in
good faith to the deleted text begin boarddeleted text end new text begin director new text end violations or alleged violations of sections 144E.001 to
144E.33. Reports are classified as confidential data on individuals or protected nonpublic
data under section 13.02 while an investigation is active. Except for the deleted text begin board'sdeleted text end new text begin director's
new text end final determination, all communications or information received by or disclosed to the deleted text begin boarddeleted text end
new text begin director new text end relating to disciplinary matters of any person or entity subject to the deleted text begin board'sdeleted text end new text begin director's
new text end regulatory jurisdiction are confidential and privileged and any disciplinary hearing shall be
closed to the public.
(b) deleted text begin Members of the boarddeleted text end new text begin The directornew text end , persons employed by the deleted text begin boarddeleted text end new text begin directornew text end , persons
engaged in the investigation of violations and in the preparation and management of charges
of violations of sections 144E.001 to 144E.33 on behalf of the deleted text begin boarddeleted text end new text begin directornew text end , and persons
participating in the investigation regarding charges of violations are immune from civil
liability and criminal prosecution for any actions, transactions, or publications, made in
good faith, in the execution of, or relating to, their duties under sections 144E.001 to 144E.33.
deleted text begin
(c) For purposes of this section, a member of the board is considered a state employee
under section 3.736, subdivision 9.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 35.
Minnesota Statutes 2023 Supplement, section 152.126, subdivision 6, is amended
to read:
Subd. 6.
Access to reporting system data.
(a) Except as indicated in this subdivision,
the data submitted to the board under subdivision 4 is private data on individuals as defined
in section 13.02, subdivision 12, and not subject to public disclosure.
(b) Except as specified in subdivision 5, the following persons shall be considered
permissible users and may access the data submitted under subdivision 4 in the same or
similar manner, and for the same or similar purposes, as those persons who are authorized
to access similar private data on individuals under federal and state law:
(1) a prescriber or an agent or employee of the prescriber to whom the prescriber has
delegated the task of accessing the data, to the extent the information relates specifically to
a current patient, to whom the prescriber is:
(i) prescribing or considering prescribing any controlled substance;
(ii) providing emergency medical treatment for which access to the data may be necessary;
(iii) providing care, and the prescriber has reason to believe, based on clinically valid
indications, that the patient is potentially abusing a controlled substance; or
(iv) providing other medical treatment for which access to the data may be necessary
for a clinically valid purpose and the patient has consented to access to the submitted data,
and with the provision that the prescriber remains responsible for the use or misuse of data
accessed by a delegated agent or employee;
(2) a dispenser or an agent or employee of the dispenser to whom the dispenser has
delegated the task of accessing the data, to the extent the information relates specifically to
a current patient to whom that dispenser is dispensing or considering dispensing any
controlled substance and with the provision that the dispenser remains responsible for the
use or misuse of data accessed by a delegated agent or employee;
(3) a licensed dispensing practitioner or licensed pharmacist to the extent necessary to
determine whether corrections made to the data reported under subdivision 4 are accurate;
(4) a licensed pharmacist who is providing pharmaceutical care for which access to the
data may be necessary to the extent that the information relates specifically to a current
patient for whom the pharmacist is providing pharmaceutical care: (i) if the patient has
consented to access to the submitted data; or (ii) if the pharmacist is consulted by a prescriber
who is requesting data in accordance with clause (1);
(5) an individual who is the recipient of a controlled substance prescription for which
data was submitted under subdivision 4, or a guardian of the individual, parent or guardian
of a minor, or health care agent of the individual acting under a health care directive under
chapter 145C. For purposes of this clause, access by individuals includes persons in the
definition of an individual under section 13.02;
(6) personnel or designees of a health-related licensing board listed in section 214.01,
subdivision 2, or of the new text begin Office of new text end Emergency Medical Services deleted text begin Regulatory Boarddeleted text end , assigned
to conduct a bona fide investigation of a complaint received by that board new text begin or office new text end that
alleges that a specific licensee is impaired by use of a drug for which data is collected under
subdivision 4, has engaged in activity that would constitute a crime as defined in section
152.025, or has engaged in the behavior specified in subdivision 5, paragraph (a);
(7) personnel of the board engaged in the collection, review, and analysis of controlled
substance prescription information as part of the assigned duties and responsibilities under
this section;
(8) authorized personnel under contract with the board, or under contract with the state
of Minnesota and approved by the board, who are engaged in the design, evaluation,
implementation, operation, or maintenance of the prescription monitoring program as part
of the assigned duties and responsibilities of their employment, provided that access to data
is limited to the minimum amount necessary to carry out such duties and responsibilities,
and subject to the requirement of de-identification and time limit on retention of data specified
in subdivision 5, paragraphs (d) and (e);
(9) federal, state, and local law enforcement authorities acting pursuant to a valid search
warrant;
(10) personnel of the Minnesota health care programs assigned to use the data collected
under this section to identify and manage recipients whose usage of controlled substances
may warrant restriction to a single primary care provider, a single outpatient pharmacy, and
a single hospital;
(11) personnel of the Department of Human Services assigned to access the data pursuant
to paragraph (k);
(12) personnel of the health professionals services program established under section
214.31, to the extent that the information relates specifically to an individual who is currently
enrolled in and being monitored by the program, and the individual consents to access to
that information. The health professionals services program personnel shall not provide this
data to a health-related licensing board deleted text begin or the Emergency Medical Services Regulatory
Boarddeleted text end , except as permitted under section 214.33, subdivision 3;
(13) personnel or designees of a health-related licensing board other than the Board of
Pharmacy listed in section 214.01, subdivision 2, assigned to conduct a bona fide
investigation of a complaint received by that board that alleges that a specific licensee is
inappropriately prescribing controlled substances as defined in this section. For the purposes
of this clause, the health-related licensing board may also obtain utilization data; and
(14) personnel of the board specifically assigned to conduct a bona fide investigation
of a specific licensee or registrant. For the purposes of this clause, the board may also obtain
utilization data.
(c) By July 1, 2017, every prescriber licensed by a health-related licensing board listed
in section 214.01, subdivision 2, practicing within this state who is authorized to prescribe
controlled substances for humans and who holds a current registration issued by the federal
Drug Enforcement Administration, and every pharmacist licensed by the board and practicing
within the state, shall register and maintain a user account with the prescription monitoring
program. Data submitted by a prescriber, pharmacist, or their delegate during the registration
application process, other than their name, license number, and license type, is classified
as private pursuant to section 13.02, subdivision 12.
(d) Notwithstanding paragraph (b), beginning January 1, 2021, a prescriber or an agent
or employee of the prescriber to whom the prescriber has delegated the task of accessing
the data, must access the data submitted under subdivision 4 to the extent the information
relates specifically to the patient:
(1) before the prescriber issues an initial prescription order for a Schedules II through
IV opiate controlled substance to the patient; and
(2) at least once every three months for patients receiving an opiate for treatment of
chronic pain or participating in medically assisted treatment for an opioid addiction.
(e) Paragraph (d) does not apply if:
(1) the patient is receiving palliative care, or hospice or other end-of-life care;
(2) the patient is being treated for pain due to cancer or the treatment of cancer;
(3) the prescription order is for a number of doses that is intended to last the patient five
days or less and is not subject to a refill;
(4) the prescriber and patient have a current or ongoing provider/patient relationship of
a duration longer than one year;
(5) the prescription order is issued within 14 days following surgery or three days
following oral surgery or follows the prescribing protocols established under the opioid
prescribing improvement program under section 256B.0638;
(6) the controlled substance is prescribed or administered to a patient who is admitted
to an inpatient hospital;
(7) the controlled substance is lawfully administered by injection, ingestion, or any other
means to the patient by the prescriber, a pharmacist, or by the patient at the direction of a
prescriber and in the presence of the prescriber or pharmacist;
(8) due to a medical emergency, it is not possible for the prescriber to review the data
before the prescriber issues the prescription order for the patient; or
(9) the prescriber is unable to access the data due to operational or other technological
failure of the program so long as the prescriber reports the failure to the board.
(f) Only permissible users identified in paragraph (b), clauses (1), (2), (3), (4), (7), (8),
(10), and (11), may directly access the data electronically. No other permissible users may
directly access the data electronically. If the data is directly accessed electronically, the
permissible user shall implement and maintain a comprehensive information security program
that contains administrative, technical, and physical safeguards that are appropriate to the
user's size and complexity, and the sensitivity of the personal information obtained. The
permissible user shall identify reasonably foreseeable internal and external risks to the
security, confidentiality, and integrity of personal information that could result in the
unauthorized disclosure, misuse, or other compromise of the information and assess the
sufficiency of any safeguards in place to control the risks.
(g) The board shall not release data submitted under subdivision 4 unless it is provided
with evidence, satisfactory to the board, that the person requesting the information is entitled
to receive the data.
(h) The board shall maintain a log of all persons who access the data for a period of at
least three years and shall ensure that any permissible user complies with paragraph (c)
prior to attaining direct access to the data.
(i) Section 13.05, subdivision 6, shall apply to any contract the board enters into pursuant
to subdivision 2. A vendor shall not use data collected under this section for any purpose
not specified in this section.
(j) The board may participate in an interstate prescription monitoring program data
exchange system provided that permissible users in other states have access to the data only
as allowed under this section, and that section 13.05, subdivision 6, applies to any contract
or memorandum of understanding that the board enters into under this paragraph.
(k) With available appropriations, the commissioner of human services shall establish
and implement a system through which the Department of Human Services shall routinely
access the data for the purpose of determining whether any client enrolled in an opioid
treatment program licensed according to chapter 245A has been prescribed or dispensed a
controlled substance in addition to that administered or dispensed by the opioid treatment
program. When the commissioner determines there have been multiple prescribers or multiple
prescriptions of controlled substances, the commissioner shall:
(1) inform the medical director of the opioid treatment program only that the
commissioner determined the existence of multiple prescribers or multiple prescriptions of
controlled substances; and
(2) direct the medical director of the opioid treatment program to access the data directly,
review the effect of the multiple prescribers or multiple prescriptions, and document the
review.
If determined necessary, the commissioner of human services shall seek a federal waiver
of, or exception to, any applicable provision of Code of Federal Regulations, title 42, section
2.34, paragraph (c), prior to implementing this paragraph.
(l) The board shall review the data submitted under subdivision 4 on at least a quarterly
basis and shall establish criteria, in consultation with the advisory task force, for referring
information about a patient to prescribers and dispensers who prescribed or dispensed the
prescriptions in question if the criteria are met.
(m) The board shall conduct random audits, on at least a quarterly basis, of electronic
access by permissible users, as identified in paragraph (b), clauses (1), (2), (3), (4), (7), (8),
(10), and (11), to the data in subdivision 4, to ensure compliance with permissible use as
defined in this section. A permissible user whose account has been selected for a random
audit shall respond to an inquiry by the board, no later than 30 days after receipt of notice
that an audit is being conducted. Failure to respond may result in deactivation of access to
the electronic system and referral to the appropriate health licensing board, or the
commissioner of human services, for further action. The board shall report the results of
random audits to the chairs and ranking minority members of the legislative committees
with jurisdiction over health and human services policy and finance and government data
practices.
(n) A permissible user who has delegated the task of accessing the data in subdivision
4 to an agent or employee shall audit the use of the electronic system by delegated agents
or employees on at least a quarterly basis to ensure compliance with permissible use as
defined in this section. When a delegated agent or employee has been identified as
inappropriately accessing data, the permissible user must immediately remove access for
that individual and notify the board within seven days. The board shall notify all permissible
users associated with the delegated agent or employee of the alleged violation.
(o) A permissible user who delegates access to the data submitted under subdivision 4
to an agent or employee shall terminate that individual's access to the data within three
business days of the agent or employee leaving employment with the permissible user. The
board may conduct random audits to determine compliance with this requirement.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 36.
Minnesota Statutes 2022, section 214.025, is amended to read:
214.025 COUNCIL OF HEALTH BOARDS.
The health-related licensing boards may establish a Council of Health Boards consisting
of representatives of the health-related licensing boards deleted text begin and the Emergency Medical Services
Regulatory Boarddeleted text end . When reviewing legislation or legislative proposals relating to the
regulation of health occupations, the council shall include the commissioner of health or a
designeenew text begin and the director of the Office of Emergency Medical Services or a designeenew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 37.
Minnesota Statutes 2022, section 214.04, subdivision 2a, is amended to read:
Subd. 2a.
Performance of executive directors.
The governor may request that a
health-related licensing board deleted text begin or the Emergency Medical Services Regulatory Boarddeleted text end review
the performance of the board's executive director. Upon receipt of the request, the board
must respond by establishing a performance improvement plan or taking disciplinary or
other corrective action, including dismissal. The board shall include the governor's
representative as a voting member of the board in the board's discussions and decisions
regarding the governor's request. The board shall report to the governor on action taken by
the board, including an explanation if no action is deemed necessary.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 38.
Minnesota Statutes 2022, section 214.29, is amended to read:
214.29 PROGRAM REQUIRED.
Each health-related licensing boarddeleted text begin , including the Emergency Medical Services
Regulatory Board under chapter 144E,deleted text end shall either conduct a health professionals service
program under sections 214.31 to 214.37 or contract for a diversion program under section
214.28.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 39.
Minnesota Statutes 2022, section 214.31, is amended to read:
214.31 AUTHORITY.
Two or more of the health-related licensing boards listed in section 214.01, subdivision
2, may jointly conduct a health professionals services program to protect the public from
persons regulated by the boards who are unable to practice with reasonable skill and safety
by reason of illness, use of alcohol, drugs, chemicals, or any other materials, or as a result
of any mental, physical, or psychological condition. The program does not affect a board's
authority to discipline violations of a board's practice act. deleted text begin For purposes of sections 214.31
to 214.37, the emergency medical services regulatory board shall be included in the definition
of a health-related licensing board under chapter 144E.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 40.
Minnesota Statutes 2022, section 214.355, is amended to read:
214.355 GROUNDS FOR DISCIPLINARY ACTION.
Each health-related licensing boarddeleted text begin , including the Emergency Medical Services
Regulatory Board under chapter 144E,deleted text end shall consider it grounds for disciplinary action if a
regulated person violates the terms of the health professionals services program participation
agreement or leaves the program except upon fulfilling the terms for successful completion
of the program as set forth in the participation agreement.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 41. new text begin INITIAL MEMBERS AND FIRST MEETING; EMERGENCY MEDICAL
SERVICES ADVISORY COUNCIL.
new text end
new text begin
(a) Initial appointments of members to the Emergency Medical Services Advisory
Council must be made by January 1, 2025. The terms of initial appointees must be determined
by lot by the secretary of state and must be as follows:
new text end
new text begin
(1) eight members shall serve two-year terms; and
new text end
new text begin
(2) eight members shall serve three-year terms.
new text end
new text begin
(b) The medical director appointee must convene the first meeting of the Emergency
Medical Services Advisory Council by February 1, 2025.
new text end
Sec. 42. new text begin INITIAL MEMBERS AND FIRST MEETING; EMERGENCY MEDICAL
SERVICES PHYSICIAN ADVISORY COUNCIL.
new text end
new text begin
(a) Initial appointments of members to the Emergency Medical Services Physician
Advisory Council must be made by January 1, 2025. The terms of initial appointees must
be determined by lot by the secretary of state and must be as follows:
new text end
new text begin
(1) five members shall serve two-year terms;
new text end
new text begin
(2) five members shall serve three-year terms; and
new text end
new text begin
(3) the term for the medical director appointee to the Emergency Medical Services
Physician Advisory Council must coincide with that member's term on the Emergency
Medical Services Advisory Council.
new text end
new text begin
(b) The medical director appointee must convene the first meeting of the Emergency
Medical Services Physician Advisory Council by February 1, 2025.
new text end
Sec. 43. new text begin INITIAL MEMBERS AND FIRST MEETING; LABOR AND EMERGENCY
MEDICAL SERVICE PROVIDERS ADVISORY COUNCIL.
new text end
new text begin
(a) Initial appointments of members to the Labor and Emergency Medical Service
Providers Advisory Council must be made by January 1, 2025. The terms of initial appointees
must be determined by lot by the secretary of state and must be as follows:
new text end
new text begin
(1) six members shall serve two-year terms; and
new text end
new text begin
(2) seven members shall serve three-year terms.
new text end
new text begin
(b) The emergency medical technician instructor appointee must convene the first meeting
of the Labor and Emergency Medical Service Providers Advisory Council by February 1,
2025.
new text end
Sec. 44. new text begin TRANSITION.
new text end
new text begin Subdivision 1. new text end
new text begin Appointment of director; operation of office. new text end
new text begin
No later than October
1, 2024, the governor shall appoint a director-designee of the Office of Emergency Medical
Services. The individual appointed as the director-designee of the Office of Emergency
Medical Services shall become the governor's appointee as director of the Office of
Emergency Medical Services on January 1, 2025. Effective January 1, 2025, the
responsibilities to regulate emergency medical services in the state under Minnesota Statutes,
chapter 144E, and Minnesota Rules, chapter 4690, are transferred from the Emergency
Medical Services Regulatory Board to the Office of Emergency Medical Services and the
director of the Office of Emergency Medical Services.
new text end
new text begin Subd. 2. new text end
new text begin Transfer of responsibilities. new text end
new text begin
Minnesota Statutes, section 15.039, applies to
the transfer of responsibilities from the Emergency Medical Services Regulatory Board to
the Office of Emergency Medical Services required by this act. The commissioner of
administration, with the approval of the governor, may issue reorganization orders under
Minnesota Statutes, section 16B.37, as necessary to carry out the transfer of responsibilities
required by this act. The provision of Minnesota Statutes, section 16B.37, subdivision 1,
which states that transfers under that section may be made only to an agency that has been
in existence for at least one year, does not apply to transfers in this act to the Office of
Emergency Medical Services.
new text end
Sec. 45. new text begin REVISOR INSTRUCTION.
new text end
new text begin
(a) In Minnesota Statutes, chapter 144E, the revisor of statutes shall replace "board"
with "director"; "board's" with "director's"; "Emergency Medical Services Regulatory Board"
or "Minnesota Emergency Medical Services Regulatory Board" with "director"; and
"board-approved" with "director-approved," except that:
new text end
new text begin
(1) in Minnesota Statutes, section 144E.11, the revisor of statutes shall not modify the
term "county board," "community health board," or "community health boards";
new text end
new text begin
(2) in Minnesota Statutes, sections 144E.40, subdivision 2; 144E.42, subdivision 2;
144E.44; and 144E.45, subdivision 2, the revisor of statutes shall not modify the term "State
Board of Investment"; and
new text end
new text begin
(3) in Minnesota Statutes, sections 144E.50 and 144E.52, the revisor of statutes shall
not modify the term "regional emergency medical services board," "regional board," "regional
emergency medical services board's," or "regional boards."
new text end
new text begin
(b) In the following sections of Minnesota Statutes, the revisor of statutes shall replace
"Emergency Medical Services Regulatory Board" with "director of the Office of Emergency
Medical Services": sections 13.717, subdivision 10; 62J.49, subdivision 2; 144.604; 144.608;
147.09; 156.12, subdivision 2; 169.686, subdivision 3; and 299A.41, subdivision 4.
new text end
new text begin
(c) In the following sections of Minnesota Statutes, the revisor of statutes shall replace
"Emergency Medical Services Regulatory Board" with "Office of Emergency Medical
Services": sections 144.603 and 161.045, subdivision 3.
new text end
new text begin
(d) In making the changes specified in this section, the revisor of statutes may make
technical and other necessary changes to sentence structure to preserve the meaning of the
text.
new text end
Sec. 46. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2022, sections 144E.001, subdivision 5; 144E.01; 144E.123,
subdivision 5; and 144E.50, subdivision 3,
new text end
new text begin
are repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Statutes 2022, section 144E.27, subdivisions 1 and 1a,
new text end
new text begin
are repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraph (a) is effective January 1, 2025.
new text end
ARTICLE 8
PHARMACY PRACTICE
Section 1.
Minnesota Statutes 2023 Supplement, section 62Q.46, subdivision 1, is amended
to read:
Subdivision 1.
Coverage for preventive items and services.
(a) "Preventive items and
services" has the meaning specified in the Affordable Care Act. Preventive items and services
includes:
(1) evidence-based items or services that have in effect a rating of A or B in the current
recommendations of the United States Preventive Services Task Force with respect to the
individual involved;
(2) immunizations for routine use in children, adolescents, and adults that have in effect
a recommendation from the Advisory Committee on Immunization Practices of the Centers
for Disease Control and Prevention with respect to the individual involved. For purposes
of this clause, a recommendation from the Advisory Committee on Immunization Practices
of the Centers for Disease Control and Prevention is considered in effect after the
recommendation has been adopted by the Director of the Centers for Disease Control and
Prevention, and a recommendation is considered to be for routine use if the recommendation
is listed on the Immunization Schedules of the Centers for Disease Control and Prevention;
(3) with respect to infants, children, and adolescents, evidence-informed preventive care
and screenings provided for in comprehensive guidelines supported by the Health Resources
and Services Administration;
(4) with respect to women, additional preventive care and screenings that are not listed
with a rating of A or B by the United States Preventive Services Task Force but that are
provided for in comprehensive guidelines supported by the Health Resources and Services
Administration;
(5) all contraceptive methods established in guidelines published by the United States
Food and Drug Administration;
(6) screenings for human immunodeficiency virus for:
(i) all individuals at least 15 years of age but less than 65 years of age; and
(ii) all other individuals with increased risk of human immunodeficiency virus infection
according to guidance from the Centers for Disease Control;
(7) all preexposure prophylaxis when used for the prevention or treatment of human
immunodeficiency virus, including but not limited to all preexposure prophylaxis, as defined
in any guidance by the United States Preventive Services Task Force or the Centers for
Disease Control, including the June 11, 2019, Preexposure Prophylaxis for the Prevention
of HIV Infection United States Preventive Services Task Force Recommendation Statement;
and
(8) all postexposure prophylaxis when used for the prevention or treatment of human
immunodeficiency virus, including but not limited to all postexposure prophylaxis as defined
in any guidance by the United States Preventive Services Task Force or the Centers for
Disease Control.
(b) A health plan company must provide coverage for preventive items and services at
a participating provider without imposing cost-sharing requirements, including a deductible,
coinsurance, or co-payment. Nothing in this section prohibits a health plan company that
has a network of providers from excluding coverage or imposing cost-sharing requirements
for preventive items or services that are delivered by an out-of-network provider.
(c) A health plan company is not required to provide coverage for any items or services
specified in any recommendation or guideline described in paragraph (a) if the
recommendation or guideline is no longer included as a preventive item or service as defined
in paragraph (a). Annually, a health plan company must determine whether any additional
items or services must be covered without cost-sharing requirements or whether any items
or services are no longer required to be covered.
(d) Nothing in this section prevents a health plan company from using reasonable medical
management techniques to determine the frequency, method, treatment, or setting for a
preventive item or service to the extent not specified in the recommendation or guideline.
new text begin
(e) A health plan shall not require prior authorization or step therapy for preexposure
prophylaxis, except that if the United States Food and Drug Administration has approved
one or more therapeutic equivalents of a drug, device, or product for the prevention of HIV,
this paragraph does not require a health plan to cover all of the therapeutically equivalent
versions without prior authorization or step therapy, if at least one therapeutically equivalent
version is covered without prior authorization or step therapy.
new text end
deleted text begin (e)deleted text end new text begin (f)new text end This section does not apply to grandfathered plans.
deleted text begin (f)deleted text end new text begin (g)new text end This section does not apply to plans offered by the Minnesota Comprehensive
Health Association.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2026, and applies to health
plans offered, issued, or renewed on or after that date.
new text end
Sec. 2.
Minnesota Statutes 2022, 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 .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2026.
new text end
Sec. 3.
Minnesota Statutes 2022, 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 deleted text begin the performance ofdeleted text end new text begin ordering and performingnew text end
laboratory tests that are waived under the federal Clinical Laboratory Improvement Act of
1988, United States Code, title 42, section 263a et seq.deleted text begin , provided that a pharmacist may
interpret the results of laboratory tests but may modifydeleted text end new text begin A pharmacist may collect specimens,
interpret results, notify the patient of results, and refer the patient to other health care
providers for follow-up care and may initiate, modify, or discontinuenew text end drug therapy only
pursuant to a protocol or collaborative practice agreementnew text begin . A pharmacist may delegate the
authority to administer tests under this clause to a pharmacy technician or pharmacy intern.
A pharmacy technician or pharmacy intern may perform tests authorized under this clause
if the technician or intern is working under the direct supervision of a pharmacistnew text end ;
(4) participation in drug and therapeutic device selection; drug administration for first
dosage and medical emergencies; intramuscular and subcutaneous drug administration under
a prescription drug order; 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, physician assistant, 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) deleted text begin participation in administration of influenza vaccines anddeleted text end new text begin initiating, ordering, and
administering influenza and COVID-19 or SARS-CoV-2 new text end vaccines new text begin authorized or new text end approved
by the United States Food and Drug Administration deleted text begin related to COVID-19 or SARS-CoV-2deleted text end
to all eligible individuals deleted text begin sixdeleted text end new text begin threenew text end years of age and older and all other new text begin United States Food
and Drug Administration-approvednew text end vaccines to patients deleted text begin 13deleted text end new text begin sixnew text end years of age and older deleted text begin by
written deleted text end deleted text begin protocol with a physician licensed under chapter deleted text end deleted text begin 147deleted text end deleted text begin , a physician assistant authorized
to prescribe drugs under chapter deleted text end deleted text begin 147Adeleted text end deleted text begin , or an advanced practice registered nurse authorized
to prescribe drugs under section 148.235, provided thatdeleted text end new text begin according to the federal Advisory
Committee on Immunization Practices recommendations. A pharmacist may delegate the
authority to administer vaccines under this clause to a pharmacy technician or pharmacy
intern who has completed training in vaccine administration ifnew text end :
deleted text begin
(i) the protocol includes, at a minimum:
deleted text end
deleted text begin
(A) the name, dose, and route of each vaccine that may be given;
deleted text end
deleted text begin
(B) the patient population for whom the vaccine may be given;
deleted text end
deleted text begin
(C) contraindications and precautions to the vaccine;
deleted text end
deleted text begin
(D) the procedure for handling an adverse reaction;
deleted text end
deleted text begin
(E) the name, signature, and address of the physician, physician assistant, or advanced
practice registered nurse;
deleted text end
deleted text begin
(F) a telephone number at which the physician, physician assistant, or advanced practice
registered nurse can be contacted; and
deleted text end
deleted text begin
(G) the date and time period for which the protocol is valid;
deleted text end
deleted text begin (ii)deleted text end new text begin (i)new text end the pharmacist deleted text begin hasdeleted text end new text begin and the pharmacy technician or pharmacy intern havenew text end
successfully completed a program approved by the Accreditation Council for Pharmacy
Education new text begin (ACPE) new text end specifically for the administration of immunizations or a program
approved by the board;
deleted text begin (iii)deleted text end new text begin (ii)new text end 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;
deleted text begin (iv)deleted text end new text begin (iii)new text end the pharmacist reports the administration of the immunization to the Minnesota
Immunization Information Connection; deleted text begin and
deleted text end
deleted text begin
(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
deleted text end
deleted text begin
147
deleted text end
deleted text begin
, a physician assistant authorized to prescribe
drugs under chapter
deleted text end
deleted text begin
147A
deleted text end
deleted text begin
, 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;
deleted text end
new text begin
(iv) if the patient is 18 years of age or younger, the pharmacist, pharmacy technician,
or pharmacy intern informs the patient and any adult caregiver accompanying the patient
of the importance of a well-child visit with a pediatrician or other licensed primary care
provider; and
new text end
new text begin
(v) in the case of a pharmacy technician administering vaccinations while being
supervised by a licensed pharmacist:
new text end
new text begin
(A) the supervision is in-person and must not be done through telehealth as defined
under section 62A.673, subdivision 2;
new text end
new text begin
(B) the pharmacist is readily and immediately available to the immunizing pharmacy
technician;
new text end
new text begin
(C) the pharmacy technician has a current certificate in basic cardiopulmonary
resuscitation;
new text end
new text begin
(D) the pharmacy technician has completed a minimum of two hours of ACPE-approved,
immunization-related continuing pharmacy education as part of the pharmacy technician's
two-year continuing education schedule; and
new text end
new text begin
(E) the pharmacy technician has completed one of two training programs listed under
Minnesota Rules, part 6800.3850, subpart 1h, item B;
new text end
(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, physician
assistants, 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;
(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 16; deleted text begin and
deleted text end
(13) participation in the placement of drug monitoring devices according to a prescription,
protocol, or collaborative practice agreementdeleted text begin .deleted text end new text begin ;
new text end
new text begin
(14) prescribing, dispensing, and administering drugs for preventing the acquisition of
human immunodeficiency virus (HIV) if the pharmacist meets the requirements in section
151.37, subdivision 17; and
new text end
new text begin
(15) ordering, conducting, and interpreting laboratory tests necessary for therapies that
use drugs for preventing the acquisition of HIV, if the pharmacist meets the requirements
in section 151.37, subdivision 17.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2024, except that clauses (14)
and (15) are effective January 1, 2026.
new text end
Sec. 4.
Minnesota Statutes 2022, 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, 2025, 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 in 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 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
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2026, except that paragraph
(b) is effective the day following final enactment.
new text end
Sec. 5.
Minnesota Statutes 2023 Supplement, 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) Prior authorization must not be required for liquid methadone if only one version of
liquid methadone is available. If more than one version of liquid methadone is available,
the commissioner shall ensure that at least one version of liquid methadone is available
without prior authorization.
(e) Prior authorization may be required for an oral liquid form of a drug, except as
described in paragraph (d). A prior authorization request under this paragraph must be
automatically approved within 24 hours if the drug is being prescribed for a Food and Drug
Administration-approved condition for a patient who utilizes an enteral tube for feedings
or medication administration, even if the patient has current or prior claims for pills for that
condition. If more than one version of the oral liquid form of a drug is available, the
commissioner may select the version that is able to be approved for a Food and Drug
Administration-approved condition for a patient who utilizes an enteral tube for feedings
or medication administration. This paragraph applies to any multistate preferred drug list
or supplemental drug rebate program established or administered by the commissioner. The
commissioner shall design and implement a streamlined prior authorization form for patients
who utilize an enteral tube for feedings or medication administration and are prescribed an
oral liquid form of a drug. 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.
(f) 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.
(g) Prior authorization under this subdivision shall comply with section 62Q.184.
(h) Any step therapy protocol requirements established by the commissioner must comply
with section 62Q.1841.
new text begin
(i) Notwithstanding any law to the contrary, prior authorization or step therapy shall not
be required or utilized for any class of drugs that is approved by the United States Food and
Drug Administration for preexposure prophylaxis of HIV and AIDS, except under the
conditions specified in section 62Q.46, subdivision 1, paragraph (e).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2026.
new text end
Sec. 6.
Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 13l. new text end
new text begin Vaccines and laboratory tests provided by pharmacists. new text end
new text begin
(a) Medical
assistance covers vaccines initiated, ordered, or administered by a licensed pharmacist,
according to the requirements of section 151.01, subdivision 27, clause (6), at no less than
the rate for which the same services are covered when provided by any other licensed
practitioner.
new text end
new text begin
(b) Medical assistance covers laboratory tests ordered and performed by a licensed
pharmacist, according to the requirements of section 151.01, subdivision 27, clause (3), at
no less than the rate for which the same services are covered when provided by any other
licensed practitioner.
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. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
ARTICLE 9
MENTAL HEALTH
Section 1.
Minnesota Statutes 2022, section 245.462, subdivision 6, is amended to read:
Subd. 6.
Community support services program.
"Community support services program"
means services, other than inpatient or residential treatment services, provided or coordinated
by an identified program and staff under the treatment supervision of a mental health
professional designed to help adults with serious and persistent mental illness to function
and remain in the community. A community support services program includes:
(1) client outreach,
(2) medication monitoring,
(3) assistance in independent living skills,
(4) development of employability and work-related opportunities,
(5) crisis assistance,
(6) psychosocial rehabilitation,
(7) help in applying for government benefits, and
(8) housing support services.
The community support services program must be coordinated with the case management
services specified in section 245.4711.new text begin A program that meets the accreditation standards
for Clubhouse International model programs meets the requirements of this subdivision.
new text end
Sec. 2.
Minnesota Statutes 2022, section 245.4663, subdivision 2, is amended to read:
Subd. 2.
Eligible providers.
In order to be eligible for a grant under this section, a mental
health provider must:
(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;
deleted text begin or
deleted text end
(2) primarily serve underrepresented communities as defined in section 148E.010,
subdivision 20deleted text begin .deleted text end new text begin ; or
new text end
new text begin
(3) provide services to people in a city or township that is not within the seven-county
metropolitan area as defined in section 473.121, subdivision 2, and is not the city of Duluth,
Mankato, Moorhead, Rochester, or St. Cloud.
new text end
Sec. 3.
Minnesota Statutes 2023 Supplement, section 245.4889, subdivision 1, is amended
to read:
Subdivision 1.
Establishment and authority.
(a) The commissioner is authorized to
make grants from available appropriations to assist:
(1) counties;
(2) Indian tribes;
(3) children's collaboratives under section 124D.23 or 245.493; or
(4) mental health service providers.
(b) The following services are eligible for grants under this section:
(1) services to children with emotional disturbances as defined in section 245.4871,
subdivision 15, and their families;
(2) transition services under section 245.4875, subdivision 8, for young adults under
age 21 and their families;
(3) respite care services for children with emotional disturbances or severe emotional
disturbances who are at risk of deleted text begin out-of-home placement ordeleted text end new text begin residential treatment or
hospitalization, who arenew text end already in out-of-home placement in family foster settings as defined
in chapter 245A and at risk of change in out-of-home placement or placement in a residential
facility or other higher level of carenew text begin , who have utilized crisis services or emergency room
services, or who have experienced a loss of in-home staffing supportnew text end . Allowable activities
and expenses for respite care services are defined under subdivision 4. A child is not required
to have case management services to receive respite care servicesnew text begin . Counties must work to
provide access to regularly scheduled respite carenew text end ;
(4) children's mental health crisis services;
(5) child-, youth-, and family-specific mobile response and stabilization services models;
(6) mental health services for people from cultural and ethnic minorities, including
supervision of clinical trainees who are Black, indigenous, or people of color;
(7) children's mental health screening and follow-up diagnostic assessment and treatment;
(8) services to promote and develop the capacity of providers to use evidence-based
practices in providing children's mental health services;
(9) school-linked mental health services under section 245.4901;
(10) building evidence-based mental health intervention capacity for children birth to
age five;
(11) suicide prevention and counseling services that use text messaging statewide;
(12) mental health first aid training;
(13) training for parents, collaborative partners, and mental health providers on the
impact of adverse childhood experiences and trauma and development of an interactive
website to share information and strategies to promote resilience and prevent trauma;
(14) transition age services to develop or expand mental health treatment and supports
for adolescents and young adults 26 years of age or younger;
(15) early childhood mental health consultation;
(16) evidence-based interventions for youth at risk of developing or experiencing a first
episode of psychosis, and a public awareness campaign on the signs and symptoms of
psychosis;
(17) psychiatric consultation for primary care practitioners; and
(18) providers to begin operations and meet program requirements when establishing a
new children's mental health program. These may be start-up grants.
(c) Services under paragraph (b) must be designed to help each child to function and
remain with the child's family in the community and delivered consistent with the child's
treatment plan. Transition services to eligible young adults under this paragraph must be
designed to foster independent living in the community.
(d) As a condition of receiving grant funds, a grantee shall obtain all available third-party
reimbursement sources, if applicable.
(e) The commissioner may establish and design a pilot program to expand the mobile
response and stabilization services model for children, youth, and families. The commissioner
may use grant funding to consult with a qualified expert entity to assist in the formulation
of measurable outcomes and explore and position the state to submit a Medicaid state plan
amendment to scale the model statewide.
Sec. 4.
Minnesota Statutes 2022, section 245I.02, subdivision 17, is amended to read:
Subd. 17.
Functional assessment.
"Functional assessment" means the assessment of a
client's current level of functioning relative to functioning that is appropriate for someone
the client's age. deleted text begin For a client five years of age or younger, a functional assessment is the
Early Childhood Service Intensity Instrument (ESCII). For a client six to 17 years of age,
a functional assessment is the Child and Adolescent Service Intensity Instrument (CASII).
For a client 18 years of age or older, a functional assessment is the functional assessment
described in section 245I.10, subdivision 9.
deleted text end
Sec. 5.
Minnesota Statutes 2022, section 245I.02, subdivision 19, is amended to read:
Subd. 19.
Level of care assessment.
"Level of care assessment" means the level of care
decision support tool appropriate to the client's age. deleted text begin For a client five years of age or younger,
a level of care assessment is the Early Childhood Service Intensity Instrument (ESCII). For
a client six to 17 years of age, a level of care assessment is the Child and Adolescent Service
Intensity Instrument (CASII). For a client 18 years of age or older, a level of care assessment
is the Level of Care Utilization System for Psychiatric and Addiction Services (LOCUS)
or another tool authorized by the commissioner.
deleted text end
Sec. 6.
Minnesota Statutes 2022, section 245I.04, subdivision 6, is amended to read:
Subd. 6.
Clinical trainee qualifications.
(a) A clinical trainee is a staff person who: (1)
is enrolled in an accredited graduate program of study to prepare the staff person for
independent licensure as a mental health professional and who is participating in a practicum
or internship with the license holder through the individual's graduate program; deleted text begin ordeleted text end (2) has
completed an accredited graduate program of study to prepare the staff person for independent
licensure as a mental health professional and who is in compliance with the requirements
of the applicable health-related licensing board, including requirements for supervised
practicedeleted text begin .deleted text end new text begin ; or (3) has completed an accredited graduate program of study to prepare the staff
person for independent licensure as a mental health professional, has completed a practicum
or internship and has not yet taken or received the results from the required test or is waiting
for the final licensure decision.
new text end
(b) A clinical trainee is responsible for notifying and applying to a health-related licensing
board to ensure that the trainee meets the requirements of the health-related licensing board.
As permitted by a health-related licensing board, treatment supervision under this chapter
may be integrated into a plan to meet the supervisory requirements of the health-related
licensing board but does not supersede those requirements.
Sec. 7.
Minnesota Statutes 2022, section 245I.10, subdivision 9, is amended to read:
Subd. 9.
Functional assessment; required elements.
new text begin (a) new text end When a license holder is
completing a functional assessment for an adult client, the license holder must:
(1) complete a functional assessment of the client after completing the client's diagnostic
assessment;
(2) use a collaborative process that allows the client and the client's family and other
natural supports, the client's referral sources, and the client's providers to provide information
about how the client's symptoms of mental illness impact the client's functioning;
(3) if applicable, document the reasons that the license holder did not contact the client's
family and other natural supports;
(4) assess and document how the client's symptoms of mental illness impact the client's
functioning in the following areas:
(i) the client's mental health symptoms;
(ii) the client's mental health service needs;
(iii) the client's substance use;
(iv) the client's vocational and educational functioning;
(v) the client's social functioning, including the use of leisure time;
(vi) the client's interpersonal functioning, including relationships with the client's family
and other natural supports;
(vii) the client's ability to provide self-care and live independently;
(viii) the client's medical and dental health;
(ix) the client's financial assistance needs; and
(x) the client's housing and transportation needs;
deleted text begin
(5) include a narrative summarizing the client's strengths, resources, and all areas of
functional impairment;
deleted text end
deleted text begin (6)deleted text end new text begin (5)new text end complete the client's functional assessment before the client's initial individual
treatment plan unless a service specifies otherwise; and
deleted text begin (7)deleted text end new text begin (6)new text end update the client's functional assessment with the client's current functioning
whenever there is a significant change in the client's functioning or at least every deleted text begin 180deleted text end new text begin 365new text end
days, unless a service specifies otherwise.
new text begin
(b) A license holder may use any available, validated measurement tool, including but
not limited to the Daily Living Activities-20, when completing the required elements of a
functional assessment under this subdivision.
new text end
Sec. 8.
Minnesota Statutes 2022, section 245I.11, subdivision 1, is amended to read:
Subdivision 1.
Generally.
new text begin (a) new text end If a license holder is licensed as a residential program,
stores or administers client medications, or observes clients self-administer medications,
the license holder must ensure that a staff person who is a registered nurse or licensed
prescriber is responsible for overseeing storage and administration of client medications
and observing as a client self-administers medications, including training according to
section 245I.05, subdivision 6, and documenting the occurrence according to section 245I.08,
subdivision 5.
new text begin
(b) For purposes of this section, "observed self-administration" means the preparation
and administration of a medication by a client to themselves under the direct supervision
of a registered nurse or a staff member to whom a registered nurse delegates supervision
duty. Observed self-administration does not include a client's use of a medication that they
keep in their own possession while participating in a program.
new text end
Sec. 9.
Minnesota Statutes 2022, section 245I.11, is amended by adding a subdivision to
read:
new text begin Subd. 6. new text end
new text begin Medication administration in children's day treatment settings. new text end
new text begin
(a) For a
program providing children's day treatment services under section 256B.0943, the license
holder must maintain policies and procedures that state whether the program will store
medication and administer or allow observed self-administration.
new text end
new text begin
(b) For a program providing children's day treatment services under section 256B.0943
that does not store medications but allows clients to use a medication that they keep in their
own possession while participating in a program, the license holder must maintain
documentation from a licensed prescriber regarding the safety of medications held by clients,
including:
new text end
new text begin
(1) an evaluation that the client is capable of holding and administering the medication
safely;
new text end
new text begin
(2) an evaluation of whether the medication is prone to diversion, misuse, or self-injury;
and
new text end
new text begin
(3) any conditions under which the license holder should no longer allow the client to
maintain the medication in their own possession.
new text end
Sec. 10.
Minnesota Statutes 2022, section 245I.20, subdivision 4, is amended to read:
Subd. 4.
Minimum staffing standards.
(a) A certification holder's treatment team must
consist of at least four mental health professionals. At least two of the mental health
professionals must be employed by or under contract with the mental health clinic for a
minimum of 35 hours per week each. deleted text begin Each of the two mental health professionals must
specialize in a different mental health discipline.
deleted text end
(b) The treatment team must include:
(1) a physician qualified as a mental health professional according to section 245I.04,
subdivision 2, clause (4), or a nurse qualified as a mental health professional according to
section 245I.04, subdivision 2, clause (1); and
(2) a psychologist qualified as a mental health professional according to section 245I.04,
subdivision 2, clause (3).
(c) The staff persons fulfilling the requirement in paragraph (b) must provide clinical
services at least:
(1) eight hours every two weeks if the mental health clinic has over 25.0 full-time
equivalent treatment team members;
(2) eight hours each month if the mental health clinic has 15.1 to 25.0 full-time equivalent
treatment team members;
(3) four hours each month if the mental health clinic has 5.1 to 15.0 full-time equivalent
treatment team members; or
(4) two hours each month if the mental health clinic has 2.0 to 5.0 full-time equivalent
treatment team members or only provides in-home services to clients.
(d) The certification holder must maintain a record that demonstrates compliance with
this subdivision.
Sec. 11.
Minnesota Statutes 2022, section 245I.23, subdivision 14, is amended to read:
Subd. 14.
Weekly team meetings.
(a) The license holder must hold weekly team meetings
and ancillary meetings according to this subdivision.
(b) A mental health professional or certified rehabilitation specialist must hold at least
one team meeting each calendar week deleted text begin anddeleted text end new text begin . The mental health professional or certified
rehabilitation specialist must lead andnew text end be physically present at the team meetingnew text begin , except as
permitted under paragraph (e)new text end . All treatment team members, including treatment team
members who work on a part-time or intermittent basis, must participate in a minimum of
one team meeting during each calendar week when the treatment team member is working
for the license holder. The license holder must document all weekly team meetings, including
the names of meeting attendeesnew text begin , and indicate whether the meeting was conducted remotely
under paragraph (e)new text end .
(c) If a treatment team member cannot participate in a weekly team meeting, the treatment
team member must participate in an ancillary meeting. A mental health professional, certified
rehabilitation specialist, clinical trainee, or mental health practitioner who participated in
the most recent weekly team meeting may lead the ancillary meeting. During the ancillary
meeting, the treatment team member leading the ancillary meeting must review the
information that was shared at the most recent weekly team meeting, including revisions
to client treatment plans and other information that the treatment supervisors exchanged
with treatment team members. The license holder must document all ancillary meetings,
including the names of meeting attendees.
new text begin
(d) If a treatment team member working only one shift during a week cannot participate
in a weekly team meeting or participate in an ancillary meeting, the treatment team member
must read the minutes of the weekly team meeting required to be documented in paragraph
(b). The treatment team member must sign to acknowledge receipt of this information, and
document pertinent information or questions. The mental health professional or certified
rehabilitation specialist must review any documented questions or pertinent information
before the next weekly team meeting.
new text end
new text begin
(e) A license holder may permit a mental health professional or certified rehabilitation
specialist to lead the weekly meeting remotely due to medical or weather conditions. If the
conditions that do not permit physical presence persist for longer than one week, the license
holder must request a variance to conduct additional meetings remotely.
new text end
Sec. 12.
new text begin
[256B.0617] MENTAL HEALTH SERVICES PROVIDER
CERTIFICATION.
new text end
new text begin
(a) The commissioner of human services shall establish an initial provider entity
application and certification and recertification processes to determine whether a provider
entity has administrative and clinical infrastructures that meet the certification requirements.
This process applies to providers of the following services:
new text end
new text begin
(1) children's intensive behavioral health services under section 256B.0946; and
new text end
new text begin
(2) intensive nonresidential rehabilitative mental health services under section 256B.0947.
new text end
new text begin
(b) The commissioner shall recertify a provider entity every three years using the
individual provider's certification anniversary or the calendar year end. The commissioner
may approve a recertification extension in the interest of sustaining services when a certain
date for recertification is identified.
new text end
new text begin
(c) The commissioner shall establish a process for decertification of a provider entity
and shall require corrective action, medical assistance repayment, or decertification of a
provider entity that no longer meets the requirements in this section or that fails to meet the
clinical quality standards or administrative standards provided by the commissioner in the
application and certification process.
new text end
new text begin
(d) The commissioner must provide the following to provider entities for the certification,
recertification, and decertification processes:
new text end
new text begin
(1) a structured listing of required provider certification criteria;
new text end
new text begin
(2) a formal written letter with a determination of certification, recertification, or
decertification signed by the commissioner or the appropriate division director; and
new text end
new text begin
(3) a formal written communication outlining the process for necessary corrective action
and follow-up by the commissioner signed by the commissioner or their designee, if
applicable. In the case of corrective action, the commissioner may schedule interim
recertification site reviews to confirm certification or decertification.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2024, and the commissioner of
human services must implement all requirements of this section by September 1, 2024.
new text end
Sec. 13.
Minnesota Statutes 2022, section 256B.0622, subdivision 2a, is amended to read:
Subd. 2a.
Eligibility for assertive community treatment.
new text begin (a) new text end An eligible client for
assertive community treatment is an individual who meets the following criteria as assessed
by an ACT team:
(1) is age 18 or older. Individuals ages 16 and 17 may be eligible upon approval by the
commissioner;
(2) has a primary diagnosis of schizophrenia, schizoaffective disorder, major depressive
disorder with psychotic features, other psychotic disorders, or bipolar disorder. Individuals
with other psychiatric illnesses may qualify for assertive community treatment if they have
a serious mental illness and meet the criteria outlined in clauses (3) and (4), but no more
than ten percent of an ACT team's clients may be eligible based on this criteria. Individuals
with a primary diagnosis of a substance use disorder, intellectual developmental disabilities,
borderline personality disorder, antisocial personality disorder, traumatic brain injury, or
an autism spectrum disorder are not eligible for assertive community treatment;
(3) has significant functional impairment as demonstrated by at least one of the following
conditions:
(i) significant difficulty consistently performing the range of routine tasks required for
basic adult functioning in the community or persistent difficulty performing daily living
tasks without significant support or assistance;
(ii) significant difficulty maintaining employment at a self-sustaining level or significant
difficulty consistently carrying out the head-of-household responsibilities; or
(iii) significant difficulty maintaining a safe living situation;
(4) has a need for continuous high-intensity services as evidenced by at least two of the
following:
(i) two or more psychiatric hospitalizations or residential crisis stabilization services in
the previous 12 months;
(ii) frequent utilization of mental health crisis services in the previous six months;
(iii) 30 or more consecutive days of psychiatric hospitalization in the previous 24 months;
(iv) intractable, persistent, or prolonged severe psychiatric symptoms;
(v) coexisting mental health and substance use disorders lasting at least six months;
(vi) recent history of involvement with the criminal justice system or demonstrated risk
of future involvement;
(vii) significant difficulty meeting basic survival needs;
(viii) residing in substandard housing, experiencing homelessness, or facing imminent
risk of homelessness;
(ix) significant impairment with social and interpersonal functioning such that basic
needs are in jeopardy;
(x) coexisting mental health and physical health disorders lasting at least six months;
(xi) residing in an inpatient or supervised community residence but clinically assessed
to be able to live in a more independent living situation if intensive services are provided;
(xii) requiring a residential placement if more intensive services are not available; or
(xiii) difficulty effectively using traditional office-based outpatient services;
(5) there are no indications that other available community-based services would be
equally or more effective as evidenced by consistent and extensive efforts to treat the
individual; and
(6) in the written opinion of a licensed mental health professional, has the need for mental
health services that cannot be met with other available community-based services, or is
likely to experience a mental health crisis or require a more restrictive setting if assertive
community treatment is not provided.
new text begin
(b) An individual meets the criteria for assertive community treatment under this section
immediately following participation in a first episode of psychosis program if the individual:
new text end
new text begin
(1) meets the eligibility requirements outlined in paragraph (a), clauses (1), (2), (5), and
(6);
new text end
new text begin
(2) is currently participating in a first episode of psychosis program under section
245.4905; and
new text end
new text begin
(3) needs the level of intensity provided by an ACT team, in the opinion of the individual's
first episode of psychosis program, in order to prevent crisis services, hospitalization,
homelessness, and involvement with the criminal justice system.
new text end
Sec. 14.
Minnesota Statutes 2022, section 256B.0622, subdivision 3a, is amended to read:
Subd. 3a.
Provider certification and contract requirements for assertive community
treatment.
(a) The assertive community treatment provider mustdeleted text begin :
deleted text end
deleted text begin
(1) have a contract with the host county to provide assertive community treatment
services; and
deleted text end
deleted text begin (2)deleted text end have each ACT team be certified by the state following the certification process and
procedures developed by the commissioner. The certification process determines whether
the ACT team meets the standards for assertive community treatment under this section,
the standards in chapter 245I as required in section 245I.011, subdivision 5, and minimum
program fidelity standards as measured by a nationally recognized fidelity tool approved
by the commissioner. Recertification must occur at least every three years.
(b) An ACT team certified under this subdivision must meet the following standards:
(1) have capacity to recruit, hire, manage, and train required ACT team members;
(2) have adequate administrative ability to ensure availability of services;
(3) ensure flexibility in service delivery to respond to the changing and intermittent care
needs of a client as identified by the client and the individual treatment plan;
(4) keep all necessary records required by law;
(5) be an enrolled Medicaid provider; and
(6) establish and maintain a quality assurance plan to determine specific service outcomes
and the client's satisfaction with services.
(c) The commissioner may intervene at any time and decertify an ACT team with cause.
The commissioner shall establish a process for decertification of an ACT team and shall
require corrective action, medical assistance repayment, or decertification of an ACT team
that no longer meets the requirements in this section or that fails to meet the clinical quality
standards or administrative standards provided by the commissioner in the application and
certification process. The decertification is subject to appeal to the state.
Sec. 15.
Minnesota Statutes 2022, section 256B.0622, subdivision 7a, is amended to read:
Subd. 7a.
Assertive community treatment team staff requirements and roles.
(a)
The required treatment staff qualifications and roles for an ACT team are:
(1) the team leader:
(i) shall be a mental health professional. Individuals who are not licensed but who are
eligible for licensure and are otherwise qualified may also fulfill this role deleted text begin but must obtain
full licensure within 24 months of assuming the role of team leaderdeleted text end ;
(ii) must be an active member of the ACT team and provide some direct services to
clients;
(iii) must be a single full-time staff member, dedicated to the ACT team, who is
responsible for overseeing the administrative operations of the teamdeleted text begin , providing treatment
supervision of services in conjunction with the psychiatrist or psychiatric care provider,deleted text end and
supervising team members to ensure delivery of best and ethical practices; and
(iv) must be available to deleted text begin providedeleted text end new text begin ensure thatnew text end overall treatment supervision to the ACT
team new text begin is available new text end after regular business hours and on weekends and holidaysdeleted text begin . The team
leader may delegate this duty to anotherdeleted text end new text begin and is provided by anew text end qualified member of the ACT
team;
(2) the psychiatric care provider:
(i) must be a mental health professional permitted to prescribe psychiatric medications
as part of the mental health professional's scope of practice. The psychiatric care provider
must have demonstrated clinical experience working with individuals with serious and
persistent mental illness;
(ii) shall collaborate with the team leader in sharing overall clinical responsibility for
screening and admitting clients; monitoring clients' treatment and team member service
delivery; educating staff on psychiatric and nonpsychiatric medications, their side effects,
and health-related conditions; actively collaborating with nurses; and helping provide
treatment supervision to the team;
(iii) shall fulfill the following functions for assertive community treatment clients:
provide assessment and treatment of clients' symptoms and response to medications, including
side effects; provide brief therapy to clients; provide diagnostic and medication education
to clients, with medication decisions based on shared decision making; monitor clients'
nonpsychiatric medical conditions and nonpsychiatric medications; and conduct home and
community visits;
(iv) shall serve as the point of contact for psychiatric treatment if a client is hospitalized
for mental health treatment and shall communicate directly with the client's inpatient
psychiatric care providers to ensure continuity of care;
(v) shall have a minimum full-time equivalency that is prorated at a rate of 16 hours per
50 clients. Part-time psychiatric care providers shall have designated hours to work on the
team, with sufficient blocks of time on consistent days to carry out the provider's clinical,
supervisory, and administrative responsibilities. No more than two psychiatric care providers
may share this role; and
(vi) shall provide psychiatric backup to the program after regular business hours and on
weekends and holidays. The psychiatric care provider may delegate this duty to another
qualified psychiatric provider;
(3) the nursing staff:
(i) shall consist of one to three registered nurses or advanced practice registered nurses,
of whom at least one has a minimum of one-year experience working with adults with
serious mental illness and a working knowledge of psychiatric medications. No more than
two individuals can share a full-time equivalent position;
(ii) are responsible for managing medication, administering and documenting medication
treatment, and managing a secure medication room; and
(iii) shall develop strategies, in collaboration with clients, to maximize taking medications
as prescribed; screen and monitor clients' mental and physical health conditions and
medication side effects; engage in health promotion, prevention, and education activities;
communicate and coordinate services with other medical providers; facilitate the development
of the individual treatment plan for clients assigned; and educate the ACT team in monitoring
psychiatric and physical health symptoms and medication side effects;
(4) the co-occurring disorder specialist:
(i) shall be a full-time equivalent co-occurring disorder specialist who has received
specific training on co-occurring disorders that is consistent with national evidence-based
practices. The training must include practical knowledge of common substances and how
they affect mental illnesses, the ability to assess substance use disorders and the client's
stage of treatment, motivational interviewing, and skills necessary to provide counseling to
clients at all different stages of change and treatment. The co-occurring disorder specialist
may also be an individual who is a licensed alcohol and drug counselor as described in
section 148F.01, subdivision 5, or a counselor who otherwise meets the training, experience,
and other requirements in section 245G.11, subdivision 5. No more than two co-occurring
disorder specialists may occupy this role; and
(ii) shall provide or facilitate the provision of co-occurring disorder treatment to clients.
The co-occurring disorder specialist shall serve as a consultant and educator to fellow ACT
team members on co-occurring disorders;
(5) the vocational specialist:
(i) shall be a full-time vocational specialist who has at least one-year experience providing
employment services or advanced education that involved field training in vocational services
to individuals with mental illness. An individual who does not meet these qualifications
may also serve as the vocational specialist upon completing a training plan approved by the
commissioner;
(ii) shall provide or facilitate the provision of vocational services to clients. The vocational
specialist serves as a consultant and educator to fellow ACT team members on these services;
and
(iii) must not refer individuals to receive any type of vocational services or linkage by
providers outside of the ACT team;
(6) the mental health certified peer specialist:
(i) shall be a full-time equivalent. No more than two individuals can share this position.
The mental health certified peer specialist is a fully integrated team member who provides
highly individualized services in the community and promotes the self-determination and
shared decision-making abilities of clients. This requirement may be waived due to workforce
shortages upon approval of the commissioner;
(ii) must provide coaching, mentoring, and consultation to the clients to promote recovery,
self-advocacy, and self-direction, promote wellness management strategies, and assist clients
in developing advance directives; and
(iii) must model recovery values, attitudes, beliefs, and personal action to encourage
wellness and resilience, provide consultation to team members, promote a culture where
the clients' points of view and preferences are recognized, understood, respected, and
integrated into treatment, and serve in a manner equivalent to other team members;
(7) the program administrative assistant shall be a full-time office-based program
administrative assistant position assigned to solely work with the ACT team, providing a
range of supports to the team, clients, and families; and
(8) additional staff:
(i) shall be based on team size. Additional treatment team staff may include mental
health professionals; clinical trainees; certified rehabilitation specialists; mental health
practitioners; or mental health rehabilitation workers. These individuals shall have the
knowledge, skills, and abilities required by the population served to carry out rehabilitation
and support functions; and
(ii) shall be selected based on specific program needs or the population served.
(b) Each ACT team must clearly document schedules for all ACT team members.
(c) Each ACT team member must serve as a primary team member for clients assigned
by the team leader and are responsible for facilitating the individual treatment plan process
for those clients. The primary team member for a client is the responsible team member
knowledgeable about the client's life and circumstances and writes the individual treatment
plan. The primary team member provides individual supportive therapy or counseling, and
provides primary support and education to the client's family and support system.
(d) Members of the ACT team must have strong clinical skills, professional qualifications,
experience, and competency to provide a full breadth of rehabilitation services. Each staff
member shall be proficient in their respective discipline and be able to work collaboratively
as a member of a multidisciplinary team to deliver the majority of the treatment,
rehabilitation, and support services clients require to fully benefit from receiving assertive
community treatment.
(e) Each ACT team member must fulfill training requirements established by the
commissioner.
Sec. 16.
Minnesota Statutes 2023 Supplement, section 256B.0622, subdivision 7b, is
amended to read:
Subd. 7b.
Assertive community treatment program deleted text begin size and opportunitiesdeleted text end new text begin scoresnew text end .
deleted text begin (a)deleted text end
Each ACT team deleted text begin shall maintain an annual average caseload that does not exceed 100 clients.
Staff-to-client ratios shall be based on team size as follows:deleted text end new text begin must demonstrate that the team
attained a passing score according to the most recently issued Tool for Measurement of
Assertive Community Treatment (TMACT).
new text end
deleted text begin
(1) a small ACT team must:
deleted text end
deleted text begin
(i) employ at least six but no more than seven full-time treatment team staff, excluding
the program assistant and the psychiatric care provider;
deleted text end
deleted text begin
(ii) serve an annual average maximum of no more than 50 clients;
deleted text end
deleted text begin
(iii) ensure at least one full-time equivalent position for every eight clients served;
deleted text end
deleted text begin
(iv) schedule ACT team staff on weekdays and on-call duty to provide crisis services
and deliver services after hours when staff are not working;
deleted text end
deleted text begin
(v) provide crisis services during business hours if the small ACT team does not have
sufficient staff numbers to operate an after-hours on-call system. During all other hours,
the ACT team may arrange for coverage for crisis assessment and intervention services
through a reliable crisis-intervention provider as long as there is a mechanism by which the
ACT team communicates routinely with the crisis-intervention provider and the on-call
ACT team staff are available to see clients face-to-face when necessary or if requested by
the crisis-intervention services provider;
deleted text end
deleted text begin
(vi) adjust schedules and provide staff to carry out the needed service activities in the
evenings or on weekend days or holidays, when necessary;
deleted text end
deleted text begin
(vii) arrange for and provide psychiatric backup during all hours the psychiatric care
provider is not regularly scheduled to work. If availability of the ACT team's psychiatric
care provider during all hours is not feasible, alternative psychiatric prescriber backup must
be arranged and a mechanism of timely communication and coordination established in
writing; and
deleted text end
deleted text begin
(viii) be composed of, at minimum, one full-time team leader, at least 16 hours each
week per 50 clients of psychiatric provider time, or equivalent if fewer clients, one full-time
equivalent nursing, one full-time co-occurring disorder specialist, one full-time equivalent
mental health certified peer specialist, one full-time vocational specialist, one full-time
program assistant, and at least one additional full-time ACT team member who has mental
health professional, certified rehabilitation specialist, clinical trainee, or mental health
practitioner status; and
deleted text end
deleted text begin
(2) a midsize ACT team shall:
deleted text end
deleted text begin
(i) be composed of, at minimum, one full-time team leader, at least 16 hours of psychiatry
time for 51 clients, with an additional two hours for every six clients added to the team, 1.5
to two full-time equivalent nursing staff, one full-time co-occurring disorder specialist, one
full-time equivalent mental health certified peer specialist, one full-time vocational specialist,
one full-time program assistant, and at least 1.5 to two additional full-time equivalent ACT
members, with at least one dedicated full-time staff member with mental health professional
status. Remaining team members may have mental health professional, certified rehabilitation
specialist, clinical trainee, or mental health practitioner status;
deleted text end
deleted text begin
(ii) employ seven or more treatment team full-time equivalents, excluding the program
assistant and the psychiatric care provider;
deleted text end
deleted text begin
(iii) serve an annual average maximum caseload of 51 to 74 clients;
deleted text end
deleted text begin
(iv) ensure at least one full-time equivalent position for every nine clients served;
deleted text end
deleted text begin
(v) schedule ACT team staff for a minimum of ten-hour shift coverage on weekdays
and six- to eight-hour shift coverage on weekends and holidays. In addition to these minimum
specifications, staff are regularly scheduled to provide the necessary services on a
client-by-client basis in the evenings and on weekends and holidays;
deleted text end
deleted text begin
(vi) schedule ACT team staff on-call duty to provide crisis services and deliver services
when staff are not working;
deleted text end
deleted text begin
(vii) have the authority to arrange for coverage for crisis assessment and intervention
services through a reliable crisis-intervention provider as long as there is a mechanism by
which the ACT team communicates routinely with the crisis-intervention provider and the
on-call ACT team staff are available to see clients face-to-face when necessary or if requested
by the crisis-intervention services provider; and
deleted text end
deleted text begin
(viii) arrange for and provide psychiatric backup during all hours the psychiatric care
provider is not regularly scheduled to work. If availability of the psychiatric care provider
during all hours is not feasible, alternative psychiatric prescriber backup must be arranged
and a mechanism of timely communication and coordination established in writing;
deleted text end
deleted text begin
(3) a large ACT team must:
deleted text end
deleted text begin
(i) be composed of, at minimum, one full-time team leader, at least 32 hours each week
per 100 clients, or equivalent of psychiatry time, three full-time equivalent nursing staff,
one full-time co-occurring disorder specialist, one full-time equivalent mental health certified
peer specialist, one full-time vocational specialist, one full-time program assistant, and at
least two additional full-time equivalent ACT team members, with at least one dedicated
full-time staff member with mental health professional status. Remaining team members
may have mental health professional or mental health practitioner status;
deleted text end
deleted text begin
(ii) employ nine or more treatment team full-time equivalents, excluding the program
assistant and psychiatric care provider;
deleted text end
deleted text begin
(iii) serve an annual average maximum caseload of 75 to 100 clients;
deleted text end
deleted text begin
(iv) ensure at least one full-time equivalent position for every nine individuals served;
deleted text end
deleted text begin
(v) schedule staff to work two eight-hour shifts, with a minimum of two staff on the
second shift providing services at least 12 hours per day weekdays. For weekends and
holidays, the team must operate and schedule ACT team staff to work one eight-hour shift,
with a minimum of two staff each weekend day and every holiday;
deleted text end
deleted text begin
(vi) schedule ACT team staff on-call duty to provide crisis services and deliver services
when staff are not working; and
deleted text end
deleted text begin
(vii) arrange for and provide psychiatric backup during all hours the psychiatric care
provider is not regularly scheduled to work. If availability of the ACT team psychiatric care
provider during all hours is not feasible, alternative psychiatric backup must be arranged
and a mechanism of timely communication and coordination established in writing.
deleted text end
deleted text begin
(b) An ACT team of any size may have a staff-to-client ratio that is lower than the
requirements described in paragraph (a) upon approval by the commissioner, but may not
exceed a one-to-ten staff-to-client ratio.
deleted text end
Sec. 17.
Minnesota Statutes 2022, section 256B.0622, subdivision 7d, is amended to read:
Subd. 7d.
Assertive community treatment assessment and individual treatment
plan.
(a) An initial assessment shall be completed the day of the client's admission to
assertive community treatment by the ACT team leader or the psychiatric care provider,
with participation by designated ACT team members and the client. The initial assessment
must include obtaining or completing a standard diagnostic assessment according to section
245I.10, subdivision 6, and completing a 30-day individual treatment plan. The team leader,
psychiatric care provider, or other mental health professional designated by the team leader
or psychiatric care provider, must update the client's diagnostic assessment deleted text begin at least annuallydeleted text end new text begin
as required under section 245I.10, subdivision 2, paragraphs (f) and (g)new text end .
(b) A functional assessment must be completed according to section 245I.10, subdivision
9. Each part of the functional assessment areas shall be completed by each respective team
specialist or an ACT team member with skill and knowledge in the area being assessed.
(c) Between 30 and 45 days after the client's admission to assertive community treatment,
the entire ACT team must hold a comprehensive case conference, where all team members,
including the psychiatric provider, present information discovered from the completed
assessments and provide treatment recommendations. The conference must serve as the
basis for the first individual treatment plan, which must be written by the primary team
member.
(d) The client's psychiatric care provider, primary team member, and individual treatment
team members shall assume responsibility for preparing the written narrative of the results
from the psychiatric and social functioning history timeline and the comprehensive
assessment.
(e) The primary team member and individual treatment team members shall be assigned
by the team leader in collaboration with the psychiatric care provider by the time of the first
treatment planning meeting or 30 days after admission, whichever occurs first.
(f) Individual treatment plans must be developed through the following treatment planning
process:
(1) The individual treatment plan shall be developed in collaboration with the client and
the client's preferred natural supports, and guardian, if applicable and appropriate. The ACT
team shall evaluate, together with each client, the client's needs, strengths, and preferences
and develop the individual treatment plan collaboratively. The ACT team shall make every
effort to ensure that the client and the client's family and natural supports, with the client's
consent, are in attendance at the treatment planning meeting, are involved in ongoing
meetings related to treatment, and have the necessary supports to fully participate. The
client's participation in the development of the individual treatment plan shall be documented.
(2) The client and the ACT team shall work together to formulate and prioritize the
issues, set goals, research approaches and interventions, and establish the plan. The plan is
individually tailored so that the treatment, rehabilitation, and support approaches and
interventions achieve optimum symptom reduction, help fulfill the personal needs and
aspirations of the client, take into account the cultural beliefs and realities of the individual,
and improve all the aspects of psychosocial functioning that are important to the client. The
process supports strengths, rehabilitation, and recovery.
(3) Each client's individual treatment plan shall identify service needs, strengths and
capacities, and barriers, and set specific and measurable short- and long-term goals for each
service need. The individual treatment plan must clearly specify the approaches and
interventions necessary for the client to achieve the individual goals, when the interventions
shall happen, and identify which ACT team member shall carry out the approaches and
interventions.
(4) The primary team member and the individual treatment team, together with the client
and the client's family and natural supports with the client's consent, are responsible for
reviewing and rewriting the treatment goals and individual treatment plan whenever there
is a major decision point in the client's course of treatment or at least every six months.
(5) The primary team member shall prepare a summary that thoroughly describes in
writing the client's and the individual treatment team's evaluation of the client's progress
and goal attainment, the effectiveness of the interventions, and the satisfaction with services
since the last individual treatment plan. The client's most recent diagnostic assessment must
be included with the treatment plan summary.
(6) The individual treatment plan and review must be approved or acknowledged by the
client, the primary team member, the team leader, the psychiatric care provider, and all
individual treatment team members. A copy of the approved individual treatment plan must
be made available to the client.
Sec. 18.
Minnesota Statutes 2023 Supplement, section 256B.0622, subdivision 8, is
amended to read:
Subd. 8.
Medical assistance payment for assertive community treatment and
intensive residential treatment services.
(a) Payment for intensive residential treatment
services and assertive community treatment in this section shall be based on one daily rate
per provider inclusive of the following services received by an eligible client in a given
calendar day: all rehabilitative services under this section, staff travel time to provide
rehabilitative services under this section, and nonresidential crisis stabilization services
under section 256B.0624.
(b) Except as indicated in paragraph (c), payment will not be made to more than one
entity for each client for services provided under this section on a given day. If services
under this section are provided by a team that includes staff from more than one entity, the
team must determine how to distribute the payment among the members.
(c) The commissioner shall determine one rate for each provider that will bill medical
assistance for residential services under this section and one rate for each assertive community
treatment provider. If a single entity provides both services, one rate is established for the
entity's residential services and another rate for the entity's nonresidential services under
this section. A provider is not eligible for payment under this section without authorization
from the commissioner. The commissioner shall develop rates using the following criteria:
(1) the provider's cost for services shall include direct services costs, other program
costs, and other costs determined as follows:
(i) the direct services costs must be determined using actual costs of salaries, benefits,
payroll taxes, and training of direct service staff and service-related transportation;
(ii) other program costs not included in item (i) must be determined as a specified
percentage of the direct services costs as determined by item (i). The percentage used shall
be determined by the commissioner based upon the average of percentages that represent
the relationship of other program costs to direct services costs among the entities that provide
similar services;
(iii) physical plant costs calculated based on the percentage of space within the program
that is entirely devoted to treatment and programming. This does not include administrative
or residential space;
(iv) assertive community treatment physical plant costs must be reimbursed as part of
the costs described in item (ii); and
(v) subject to federal approval, up to an additional five percent of the total rate may be
added to the program rate as a quality incentive based upon the entity meeting performance
criteria specified by the commissioner;
(2) actual cost is defined as costs which are allowable, allocable, and reasonable, and
consistent with federal reimbursement requirements under Code of Federal Regulations,
title 48, chapter 1, part 31, relating to for-profit entities, and Office of Management and
Budget Circular Number A-122, relating to nonprofit entities;
(3) the number of service units;
(4) the degree to which clients will receive services other than services under this section;
and
(5) the costs of other services that will be separately reimbursed.
(d) The rate for intensive residential treatment services and assertive community treatment
must exclude the medical assistance room and board rate, as defined in section 256B.056,
subdivision 5d, and services not covered under this section, such as partial hospitalization,
home care, and inpatient services.
(e) Physician services that are not separately billed may be included in the rate to the
extent that a psychiatrist, or other health care professional providing physician services
within their scope of practice, is a member of the intensive residential treatment services
treatment team. Physician services, whether billed separately or included in the rate, may
be delivered by telehealth. For purposes of this paragraph, "telehealth" has the meaning
given to "mental health telehealth" in section 256B.0625, subdivision 46, when telehealth
is used to provide intensive residential treatment services.
(f) When services under this section are provided by an assertive community treatment
provider, case management functions must be an integral part of the team.
(g) The rate for a provider must not exceed the rate charged by that provider for the
same service to other payors.
(h) The rates for existing programs must be established prospectively based upon the
expenditures and utilization over a prior 12-month period using the criteria established in
paragraph (c). The rates for new programs must be established based upon estimated
expenditures and estimated utilization using the criteria established in paragraph (c).
(i) Effective for the rate years beginning on and after January 1, 2024, rates for assertive
community treatment, adult residential crisis stabilization services, and intensive residential
treatment services must be annually adjusted for inflation using the Centers for Medicare
and Medicaid Services Medicare Economic Index, as forecasted in the deleted text begin fourthdeleted text end new text begin thirdnew text end quarter
of the calendar year before the rate year. The inflation adjustment must be based on the
12-month period from the midpoint of the previous rate year to the midpoint of the rate year
for which the rate is being determined.
(j) Entities who discontinue providing services must be subject to a settle-up process
whereby actual costs and reimbursement for the previous 12 months are compared. In the
event that the entity was paid more than the entity's actual costs plus any applicable
performance-related funding due the provider, the excess payment must be reimbursed to
the department. If a provider's revenue is less than actual allowed costs due to lower
utilization than projected, the commissioner may reimburse the provider to recover its actual
allowable costs. The resulting adjustments by the commissioner must be proportional to the
percent of total units of service reimbursed by the commissioner and must reflect a difference
of greater than five percent.
(k) A provider may request of the commissioner a review of any rate-setting decision
made under this subdivision.
Sec. 19.
Minnesota Statutes 2022, section 256B.0623, subdivision 5, is amended to read:
Subd. 5.
Qualifications of provider staff.
Adult rehabilitative mental health services
must be provided by qualified individual provider staff of a certified provider entity.
Individual provider staff must be qualified as:
(1) a mental health professional who is qualified according to section 245I.04, subdivision
2;
(2) a certified rehabilitation specialist who is qualified according to section 245I.04,
subdivision 8;
(3) a clinical trainee who is qualified according to section 245I.04, subdivision 6;
(4) a mental health practitioner qualified according to section 245I.04, subdivision 4;
(5) a mental health certified peer specialist who is qualified according to section 245I.04,
subdivision 10; deleted text begin or
deleted text end
(6) a mental health rehabilitation worker who is qualified according to section 245I.04,
subdivision 14deleted text begin .deleted text end new text begin ; or
new text end
new text begin
(7) a licensed occupational therapist, as defined in section 148.6402, subdivision 14.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective upon federal approval. The commissioner
of human services must notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 20.
Minnesota Statutes 2023 Supplement, section 256B.0625, subdivision 5m, is
amended to read:
Subd. 5m.
Certified community behavioral health clinic services.
(a) Medical
assistance covers services provided by a not-for-profit certified community behavioral health
clinic (CCBHC) that meets the requirements of section 245.735, subdivision 3.
(b) The commissioner shall reimburse CCBHCs on a per-day basis for each day that an
eligible service is delivered using the CCBHC daily bundled rate system for medical
assistance payments as described in paragraph (c). The commissioner shall include a quality
incentive payment in the CCBHC daily bundled rate system as described in paragraph (e).
There is no county share for medical assistance services when reimbursed through the
CCBHC daily bundled rate system.
(c) The commissioner shall ensure that the CCBHC daily bundled rate system for CCBHC
payments under medical assistance meets the following requirements:
(1) the CCBHC daily bundled rate shall be a provider-specific rate calculated for each
CCBHC, based on the daily cost of providing CCBHC services and the total annual allowable
CCBHC costs divided by the total annual number of CCBHC visits. For calculating the
payment rate, total annual visits include visits covered by medical assistance and visits not
covered by medical assistance. Allowable costs include but are not limited to the salaries
and benefits of medical assistance providers; the cost of CCBHC services provided under
section 245.735, subdivision 3, paragraph (a), clauses (6) and (7); and other costs such as
insurance or supplies needed to provide CCBHC services;
(2) payment shall be limited to one payment per day per medical assistance enrollee
when an eligible CCBHC service is provided. A CCBHC visit is eligible for reimbursement
if at least one of the CCBHC services listed under section 245.735, subdivision 3, paragraph
(a), clause (6), is furnished to a medical assistance enrollee by a health care practitioner or
licensed agency employed by or under contract with a CCBHC;
(3) initial CCBHC daily bundled rates for newly certified CCBHCs under section 245.735,
subdivision 3, shall be established by the commissioner using a provider-specific rate based
on the newly certified CCBHC's audited historical cost report data adjusted for the expected
cost of delivering CCBHC services. Estimates are subject to review by the commissioner
and must include the expected cost of providing the full scope of CCBHC services and the
expected number of visits for the rate period;
(4) the commissioner shall rebase CCBHC rates once every two years following the last
rebasing and no less than 12 months following an initial rate or a rate change due to a change
in the scope of servicesnew text begin . For CCBHCs certified after September 31, 2020, and before January
1, 2021, the commissioner shall rebase rates according to this clause beginning for dates of
service provided on January 1, 2024new text end ;
(5) the commissioner shall provide for a 60-day appeals process after notice of the results
of the rebasing;
(6) an entity that receives a CCBHC daily bundled rate that overlaps with another federal
Medicaid rate is not eligible for the CCBHC rate methodology;
(7) payments for CCBHC services to individuals enrolled in managed care shall be
coordinated with the state's phase-out of CCBHC wrap payments. The commissioner shall
complete the phase-out of CCBHC wrap payments within 60 days of the implementation
of the CCBHC daily bundled rate system in the Medicaid Management Information System
(MMIS), for CCBHCs reimbursed under this chapter, with a final settlement of payments
due made payable to CCBHCs no later than 18 months thereafter;
(8) the CCBHC daily bundled rate for each CCBHC shall be updated by trending each
provider-specific rate by the Medicare Economic Index for primary care services. This
update shall occur each year in between rebasing periods determined by the commissioner
in accordance with clause (4). CCBHCs must provide data on costs and visits to the state
annually using the CCBHC cost report established by the commissioner; and
(9) a CCBHC may request a rate adjustment for changes in the CCBHC's scope of
services when such changes are expected to result in an adjustment to the CCBHC payment
rate by 2.5 percent or more. The CCBHC must provide the commissioner with information
regarding the changes in the scope of services, including the estimated cost of providing
the new or modified services and any projected increase or decrease in the number of visits
resulting from the change. Estimated costs are subject to review by the commissioner. Rate
adjustments for changes in scope shall occur no more than once per year in between rebasing
periods per CCBHC and are effective on the date of the annual CCBHC rate update.
(d) Managed care plans and county-based purchasing plans shall reimburse CCBHC
providers at the CCBHC daily bundled rate. The commissioner shall monitor the effect of
this requirement on the rate of access to the services delivered by CCBHC providers. If, for
any contract year, federal approval is not received for this paragraph, the commissioner
must adjust the capitation rates paid to managed care plans and county-based purchasing
plans for that contract year to reflect the removal of this provision. Contracts between
managed care plans and county-based purchasing plans and providers to whom this paragraph
applies must allow recovery of payments from those providers if capitation rates are adjusted
in accordance with this paragraph. Payment recoveries must not exceed the amount equal
to any increase in rates that results from this provision. This paragraph expires if federal
approval is not received for this paragraph at any time.
(e) The commissioner shall implement a quality incentive payment program for CCBHCs
that meets the following requirements:
(1) a CCBHC shall receive a quality incentive payment upon meeting specific numeric
thresholds for performance metrics established by the commissioner, in addition to payments
for which the CCBHC is eligible under the CCBHC daily bundled rate system described in
paragraph (c);
(2) a CCBHC must be certified and enrolled as a CCBHC for the entire measurement
year to be eligible for incentive payments;
(3) each CCBHC shall receive written notice of the criteria that must be met in order to
receive quality incentive payments at least 90 days prior to the measurement year; and
(4) a CCBHC must provide the commissioner with data needed to determine incentive
payment eligibility within six months following the measurement year. The commissioner
shall notify CCBHC providers of their performance on the required measures and the
incentive payment amount within 12 months following the measurement year.
(f) All claims to managed care plans for CCBHC services as provided under this section
shall be submitted directly to, and paid by, the commissioner on the dates specified no later
than January 1 of the following calendar year, if:
(1) one or more managed care plans does not comply with the federal requirement for
payment of clean claims to CCBHCs, as defined in Code of Federal Regulations, title 42,
section 447.45(b), and the managed care plan does not resolve the payment issue within 30
days of noncompliance; and
(2) the total amount of clean claims not paid in accordance with federal requirements
by one or more managed care plans is 50 percent of, or greater than, the total CCBHC claims
eligible for payment by managed care plans.
If the conditions in this paragraph are met between January 1 and June 30 of a calendar
year, claims shall be submitted to and paid by the commissioner beginning on January 1 of
the following year. If the conditions in this paragraph are met between July 1 and December
31 of a calendar year, claims shall be submitted to and paid by the commissioner beginning
on July 1 of the following year.
(g) Peer services provided by a CCBHC certified under section 245.735 are a covered
service under medical assistance when a licensed mental health professional or alcohol and
drug counselor determines that peer services are medically necessary. Eligibility under this
subdivision for peer services provided by a CCBHC supersede eligibility standards under
sections 256B.0615, 256B.0616, and 245G.07, subdivision 2, clause (8).
Sec. 21.
Minnesota Statutes 2022, section 256B.0625, subdivision 20, is amended to read:
Subd. 20.
Mental health case management.
(a) To the extent authorized by rule of the
state agency, medical assistance covers case management services to persons with serious
and persistent mental illness and children with severe emotional disturbance. Services
provided under this section must meet the relevant standards in sections 245.461 to 245.4887,
the Comprehensive Adult and Children's Mental Health Acts, Minnesota Rules, parts
9520.0900 to 9520.0926, and 9505.0322, excluding subpart 10.
(b) Entities meeting program standards set out in rules governing family community
support services as defined in section 245.4871, subdivision 17, are eligible for medical
assistance reimbursement for case management services for children with severe emotional
disturbance when these services meet the program standards in Minnesota Rules, parts
9520.0900 to 9520.0926 and 9505.0322, excluding subparts 6 and 10.
(c) Medical assistance and MinnesotaCare payment for mental health case management
shall be made on a monthly basis. In order to receive payment for an eligible child, the
provider must document at least a face-to-face contact either in person or by interactive
video that meets the requirements of subdivision 20b with the child, the child's parents, or
the child's legal representative. To receive payment for an eligible adult, the provider must
document:
(1) at least a face-to-face contact with the adult or the adult's legal representative either
in person or by interactive video that meets the requirements of subdivision 20b; or
(2) at least a telephone contactnew text begin or contact via secure electronic message, if preferred by
the adult client,new text end with the adult or the adult's legal representative and document a face-to-face
contact either in person or by interactive video that meets the requirements of subdivision
20b with the adult or the adult's legal representative within the preceding two months.
(d) Payment for mental health case management provided by county or state staff shall
be based on the monthly rate methodology under section 256B.094, subdivision 6, paragraph
(b), with separate rates calculated for child welfare and mental health, and within mental
health, separate rates for children and adults.
(e) Payment for mental health case management provided by Indian health services or
by agencies operated by Indian tribes may be made according to this section or other relevant
federally approved rate setting methodology.
(f) Payment for mental health case management provided by vendors who contract with
a county must be calculated in accordance with section 256B.076, subdivision 2. Payment
for mental health case management provided by vendors who contract with a Tribe must
be based on a monthly rate negotiated by the Tribe. The rate must not exceed the rate charged
by the vendor for the same service to other payers. If the service is provided by a team of
contracted vendors, the team shall determine how to distribute the rate among its members.
No reimbursement received by contracted vendors shall be returned to the county or tribe,
except to reimburse the county or tribe for advance funding provided by the county or tribe
to the vendor.
(g) If the service is provided by a team which includes contracted vendors, tribal staff,
and county or state staff, the costs for county or state staff participation in the team shall be
included in the rate for county-provided services. In this case, the contracted vendor, the
tribal agency, and the county may each receive separate payment for services provided by
each entity in the same month. In order to prevent duplication of services, each entity must
document, in the recipient's file, the need for team case management and a description of
the roles of the team members.
(h) Notwithstanding section 256B.19, subdivision 1, the nonfederal share of costs for
mental health case management shall be provided by the recipient's county of responsibility,
as defined in sections 256G.01 to 256G.12, from sources other than federal funds or funds
used to match other federal funds. If the service is provided by a tribal agency, the nonfederal
share, if any, shall be provided by the recipient's tribe. When this service is paid by the state
without a federal share through fee-for-service, 50 percent of the cost shall be provided by
the recipient's county of responsibility.
(i) Notwithstanding any administrative rule to the contrary, prepaid medical assistance
and MinnesotaCare include mental health case management. When the service is provided
through prepaid capitation, the nonfederal share is paid by the state and the county pays no
share.
(j) The commissioner may suspend, reduce, or terminate the reimbursement to a provider
that does not meet the reporting or other requirements of this section. The county of
responsibility, as defined in sections 256G.01 to 256G.12, or, if applicable, the tribal agency,
is responsible for any federal disallowances. The county or tribe may share this responsibility
with its contracted vendors.
(k) The commissioner shall set aside a portion of the federal funds earned for county
expenditures under this section to repay the special revenue maximization account under
section 256.01, subdivision 2, paragraph (o). The repayment is limited to:
(1) the costs of developing and implementing this section; and
(2) programming the information systems.
(l) Payments to counties and tribal agencies for case management expenditures under
this section shall only be made from federal earnings from services provided under this
section. When this service is paid by the state without a federal share through fee-for-service,
50 percent of the cost shall be provided by the state. Payments to county-contracted vendors
shall include the federal earnings, the state share, and the county share.
(m) Case management services under this subdivision do not include therapy, treatment,
legal, or outreach services.
(n) If the recipient is a resident of a nursing facility, intermediate care facility, or hospital,
and the recipient's institutional care is paid by medical assistance, payment for case
management services under this subdivision is limited to the lesser of:
(1) the last 180 days of the recipient's residency in that facility and may not exceed more
than six months in a calendar year; or
(2) the limits and conditions which apply to federal Medicaid funding for this service.
(o) Payment for case management services under this subdivision shall not duplicate
payments made under other program authorities for the same purpose.
(p) If the recipient is receiving care in a hospital, nursing facility, or residential setting
licensed under chapter 245A or 245D that is staffed 24 hours a day, seven days a week,
mental health targeted case management services must actively support identification of
community alternatives for the recipient and discharge planning.
Sec. 22.
Minnesota Statutes 2023 Supplement, section 256B.0671, subdivision 5, is
amended to read:
Subd. 5.
new text begin Child and new text end family psychoeducation services.
(a) Medical assistance coversnew text begin
child andnew text end family psychoeducation services provided to a child deleted text begin up todeleted text end new text begin undernew text end age 21 deleted text begin withdeleted text end new text begin and
the child's family members when determined to be medically necessary due tonew text end a deleted text begin diagnoseddeleted text end
mental health condition deleted text begin whendeleted text end new text begin or diagnosed mental illnessnew text end identified in the child's individual
treatment plan and provided by a mental health professionalnew text begin who is qualified under section
245I.04, subdivision 2, and practicing within the scope of practice under section 245I.04,
subdivision 3; a mental health practitioner who is qualified under section 245I.04, subdivision
4, and practicing within the scope of practice under section 245I.04, subdivision 5;new text end or a
clinical trainee who deleted text begin has determined it medically necessary to involve family members in
the child's caredeleted text end new text begin is qualified under section 245I.04, subdivision 6, and practicing within the
scope of practice under section 245I.04, subdivision 7new text end .
(b) "new text begin Child and new text end family psychoeducation services" means information or demonstration
provided to an individual or family as part of an individual, family, multifamily group, or
peer group session to explain, educate, and support the child and family in understanding
a child's symptoms of mental illness, the impact on the child's development, and needed
components of treatment and skill development so that the individual, family, or group can
help the child to prevent relapse, prevent the acquisition of comorbid disorders, and achieve
optimal mental health and long-term resilience.
new text begin
(c) Child and family psychoeducation services include individual, family, or group skills
development or training to:
new text end
new text begin
(1) support the development of psychosocial skills that are medically necessary to support
the child to an age-appropriate developmental trajectory when the child's development was
disrupted by a mental health condition or diagnosed mental illness; or
new text end
new text begin
(2) enable the child to self-monitor, compensate for, cope with, counteract, or replace
skills deficits or maladaptive skills acquired over the course of the child's mental health
condition or mental illness.
new text end
new text begin
(d) Skills development or training delivered to a child or the child's family under this
subdivision must be targeted to the specific deficits related to the child's mental health
condition or mental illness and must be prescribed in the child's individual treatment plan.
Group skills training may be provided to multiple recipients who, because of the nature of
their emotional, behavioral, or social functional ability, may benefit from interaction in a
group setting.
new text end
Sec. 23.
Minnesota Statutes 2022, section 256B.0943, subdivision 12, is amended to read:
Subd. 12.
Excluded services.
The following services are not eligible for medical
assistance payment as children's therapeutic services and supports:
(1) service components of children's therapeutic services and supports simultaneously
provided by more than one provider entity unless prior authorization is obtained;
(2) treatment by multiple providers within the same agency at the same clock timenew text begin ,
unless one service is delivered to the child and the other service is delivered to the child's
family or treatment team without the child presentnew text end ;
(3) children's therapeutic services and supports provided in violation of medical assistance
policy in Minnesota Rules, part 9505.0220;
(4) mental health behavioral aide services provided by a personal care assistant who is
not qualified as a mental health behavioral aide and employed by a certified children's
therapeutic services and supports provider entity;
(5) service components of CTSS that are the responsibility of a residential or program
license holder, including foster care providers under the terms of a service agreement or
administrative rules governing licensure; and
(6) adjunctive activities that may be offered by a provider entity but are not otherwise
covered by medical assistance, including:
(i) a service that is primarily recreation oriented or that is provided in a setting that is
not medically supervised. This includes sports activities, exercise groups, activities such as
craft hours, leisure time, social hours, meal or snack time, trips to community activities,
and tours;
(ii) a social or educational service that does not have or cannot reasonably be expected
to have a therapeutic outcome related to the client's emotional disturbance;
(iii) prevention or education programs provided to the community; and
(iv) treatment for clients with primary diagnoses of alcohol or other drug abuse.
Sec. 24.
Minnesota Statutes 2022, section 256B.0947, subdivision 5, is amended to read:
Subd. 5.
Standards for intensive nonresidential rehabilitative providers.
(a) Services
must meet the standards in this section and chapter 245I as required in section 245I.011,
subdivision 5.
(b) The treatment team must have specialized training in providing services to the specific
age group of youth that the team serves. An individual treatment team must serve youth
who are: (1) at least eight years of age or older and under 16 years of age, or (2) at least 14
years of age or older and under 21 years of age.
(c) The treatment team for intensive nonresidential rehabilitative mental health services
comprises both permanently employed core team members and client-specific team members
as follows:
(1) Based on professional qualifications and client needs, clinically qualified core team
members are assigned on a rotating basis as the client's lead worker to coordinate a client's
care. The core team must comprise at least four full-time equivalent direct care staff and
must minimally include:
(i) a mental health professional who serves as team leader to provide administrative
direction and treatment supervision to the team;
(ii) an advanced-practice registered nurse with certification in psychiatric or mental
health care or a board-certified child and adolescent psychiatrist, either of which must be
credentialed to prescribe medications;
deleted text begin
(iii) a licensed alcohol and drug counselor who is also trained in mental health
interventions; and
deleted text end
deleted text begin (iv)deleted text end new text begin (iii) new text end a mental health certified peer specialist who is qualified according to section
245I.04, subdivision 10, and is also a former children's mental health consumerdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(iv) a co-occurring disorder specialist who meets the requirements under section
256B.0622, subdivision 7a, paragraph (a), clause (4), who will provide or facilitate the
provision of co-occurring disorder treatment to clients.
new text end
(2) The core team may also include any of the following:
(i) additional mental health professionals;
(ii) a vocational specialist;
(iii) an educational specialist with knowledge and experience working with youth
regarding special education requirements and goals, special education plans, and coordination
of educational activities with health care activities;
(iv) a child and adolescent psychiatrist who may be retained on a consultant basis;
(v) a clinical trainee qualified according to section 245I.04, subdivision 6;
(vi) a mental health practitioner qualified according to section 245I.04, subdivision 4;
(vii) a case management service provider, as defined in section 245.4871, subdivision
4;
(viii) a housing access specialist; and
(ix) a family peer specialist as defined in subdivision 2, paragraph (j).
(3) A treatment team may include, in addition to those in clause (1) or (2), ad hoc
members not employed by the team who consult on a specific client and who must accept
overall clinical direction from the treatment team for the duration of the client's placement
with the treatment team and must be paid by the provider agency at the rate for a typical
session by that provider with that client or at a rate negotiated with the client-specific
member. Client-specific treatment team members may include:
(i) the mental health professional treating the client prior to placement with the treatment
team;
(ii) the client's current substance use counselor, if applicable;
(iii) a lead member of the client's individualized education program team or school-based
mental health provider, if applicable;
(iv) a representative from the client's health care home or primary care clinic, as needed
to ensure integration of medical and behavioral health care;
(v) the client's probation officer or other juvenile justice representative, if applicable;
and
(vi) the client's current vocational or employment counselor, if applicable.
(d) The treatment supervisor shall be an active member of the treatment team and shall
function as a practicing clinician at least on a part-time basis. The treatment team shall meet
with the treatment supervisor at least weekly to discuss recipients' progress and make rapid
adjustments to meet recipients' needs. The team meeting must include client-specific case
reviews and general treatment discussions among team members. Client-specific case
reviews and planning must be documented in the individual client's treatment record.
(e) The staffing ratio must not exceed ten clients to one full-time equivalent treatment
team position.
(f) The treatment team shall serve no more than 80 clients at any one time. Should local
demand exceed the team's capacity, an additional team must be established rather than
exceed this limit.
(g) Nonclinical staff shall have prompt access in person or by telephone to a mental
health practitioner, clinical trainee, or mental health professional. The provider shall have
the capacity to promptly and appropriately respond to emergent needs and make any
necessary staffing adjustments to ensure the health and safety of clients.
(h) The intensive nonresidential rehabilitative mental health services provider shall
participate in evaluation of the assertive community treatment for youth (Youth ACT) model
as conducted by the commissioner, including the collection and reporting of data and the
reporting of performance measures as specified by contract with the commissioner.
(i) A regional treatment team may serve multiple counties.
Sec. 25.
Minnesota Statutes 2023 Supplement, section 256B.0947, subdivision 7, is
amended to read:
Subd. 7.
Medical assistance payment and rate setting.
(a) Payment for services in this
section must be based on one daily encounter rate per provider inclusive of the following
services received by an eligible client in a given calendar day: all rehabilitative services,
supports, and ancillary activities under this section, staff travel time to provide rehabilitative
services under this section, and crisis response services under section 256B.0624.
(b) Payment must not be made to more than one entity for each client for services
provided under this section on a given day. If services under this section are provided by a
team that includes staff from more than one entity, the team shall determine how to distribute
the payment among the members.
(c) The commissioner shall establish regional cost-based rates for entities that will bill
medical assistance for nonresidential intensive rehabilitative mental health services. In
developing these rates, the commissioner shall consider:
(1) the cost for similar services in the health care trade area;
(2) actual costs incurred by entities providing the services;
(3) the intensity and frequency of services to be provided to each client;
(4) the degree to which clients will receive services other than services under this section;
and
(5) the costs of other services that will be separately reimbursed.
(d) The rate for a provider must not exceed the rate charged by that provider for the
same service to other payers.
(e) Effective for the rate years beginning on and after January 1, 2024, rates must be
annually adjusted for inflation using the Centers for Medicare and Medicaid Services
Medicare Economic Index, as forecasted in the deleted text begin fourthdeleted text end new text begin thirdnew text end quarter of the calendar year
before the rate year. The inflation adjustment must be based on the 12-month period from
the midpoint of the previous rate year to the midpoint of the rate year for which the rate is
being determined.
Sec. 26. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES;
CHILDREN'S RESIDENTIAL FACILITY RULEMAKING.
new text end
new text begin
(a) The commissioner of human services must use the expedited rulemaking process
and comply with all requirements under Minnesota Statutes, section 14.389, to adopt the
amendments required under this section. Notwithstanding Laws 1995, chapter 226, article
3, sections 50, 51, and 60, or any other law to the contrary, joint rulemaking authority with
the commissioner of corrections does not apply to rule amendments applicable only to the
commissioner of human services. An amendment to jointly administered rule parts must be
related to requirements under this section or to amendments that are necessary for consistency
with this section.
new text end
new text begin
(b) The commissioner of human services must amend Minnesota Rules, chapter 2960,
to replace all instances of the term "clinical supervision" with the term "treatment
supervision."
new text end
new text begin
(c) The commissioner of human services must amend Minnesota Rules, part 2960.0020,
to replace all instances of the term "clinical supervisor" with the term "treatment supervisor."
new text end
new text begin
(d) The commissioner of human services must amend Minnesota Rules, part 2960.0020,
to add the definition of "licensed prescriber" to mean an individual who is authorized to
prescribe legend drugs under Minnesota Statutes, section 151.37.
new text end
new text begin
(e) The commissioner of human services must amend Minnesota Rules, parts 2960.0020
to 2960.0710, to replace all instances of "physician" with "licensed prescriber." Amendments
to rules under this paragraph must apply only to the Department of Human Services.
new text end
new text begin
(f) The commissioner of human services must amend Minnesota Rules, part 2960.0620,
subpart 2, to strike all of the current language and insert the following language: "If a resident
is prescribed a psychotropic medication, the license holder must monitor for side effects of
the medication. Within 24 hours of admission, a registered nurse or licensed prescriber must
assess the resident for and document any current side effects and document instructions for
how frequently the license holder must monitor for side effects of the psychotropic
medications the resident is taking. When a resident begins taking a new psychotropic
medication or stops taking a psychotropic medication, the license holder must monitor for
side effects according to the instructions of the registered nurse or licensed prescriber. The
license holder must monitor for side effects using standardized checklists, rating scales, or
other tools according to the instructions of the registered nurse or licensed prescriber. The
license holder must provide the results of the checklist, rating scale, or other tool to the
licensed prescriber for review."
new text end
new text begin
(g) The commissioner of human services must amend Minnesota Rules, part 2960.0630,
subpart 2, to allow license holders to use the ancillary meeting process under Minnesota
Statutes, section 245I.23, subdivision 14, paragraph (c), if a staff member cannot participate
in a weekly clinical supervision session.
new text end
new text begin
(h) The commissioner of human services must amend Minnesota Rules, part 2960.0630,
subpart 3, to strike item D.
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. 27. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; MEDICAL
ASSISTANCE CHILDREN'S RESIDENTIAL MENTAL HEALTH CRISIS
STABILIZATION.
new text end
new text begin
(a) The commissioner of human services must consult with providers, advocates, Tribal
Nations, counties, people with lived experience as or with a child in a mental health crisis,
and other interested community members to develop a covered benefit under medical
assistance to provide residential mental health crisis stabilization for children. The benefit
must:
new text end
new text begin
(1) consist of evidence-based promising practices or culturally responsive treatment
services for children under the age of 21 experiencing a mental health crisis;
new text end
new text begin
(2) embody an integrative care model that supports individuals experiencing a mental
health crisis who may also be experiencing co-occurring conditions;
new text end
new text begin
(3) qualify for federal financial participation; and
new text end
new text begin
(4) include services that support children and families, including but not limited to:
new text end
new text begin
(i) an assessment of the child's immediate needs and factors that led to the mental health
crisis;
new text end
new text begin
(ii) individualized care to address immediate needs and restore the child to a precrisis
level of functioning;
new text end
new text begin
(iii) 24-hour on-site staff and assistance;
new text end
new text begin
(iv) supportive counseling and clinical services;
new text end
new text begin
(v) skills training and positive support services, as identified in the child's individual
crisis stabilization plan;
new text end
new text begin
(vi) referrals to other service providers in the community as needed and to support the
child's transition from residential crisis stabilization services;
new text end
new text begin
(vii) development of an individualized and culturally responsive crisis response action
plan; and
new text end
new text begin
(viii) assistance to access and store medication.
new text end
new text begin
(b) When developing the new benefit, the commissioner must make recommendations
for providers to be reimbursed for room and board.
new text end
new text begin
(c) The commissioner must consult with or contract with rate-setting experts to develop
a prospective data-based rate methodology for the children's residential mental health crisis
stabilization benefit.
new text end
new text begin
(d) No later than January 15, 2025, the commissioner must submit to the chairs and
ranking minority members of the legislative committees with jurisdiction over human
services policy and finance a report detailing for the children's residential mental health
crisis stabilization benefit the proposed:
new text end
new text begin
(1) eligibility criteria, clinical and service requirements, provider standards, licensing
requirements, and reimbursement rates;
new text end
new text begin
(2) the process for community engagement, community input, and crisis models studied
in other states;
new text end
new text begin
(3) a deadline for the commissioner to submit a state plan amendment to the Centers for
Medicare and Medicaid Services; and
new text end
new text begin
(4) draft legislation with the statutory changes necessary to implement the benefit.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2024.
new text end
Sec. 28. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; MENTAL
HEALTH PROCEDURE CODES.
new text end
new text begin
The commissioner of human services must develop recommendations, in consultation
with external partners and medical coding and compliance experts, on simplifying mental
health procedure codes and the feasibility of converting mental health procedure codes to
the current procedural terminology (CPT) code structure. By October 1, 2025, the
commissioner must submit a report to the chairs and ranking minority members of the
legislative committees with jurisdiction over mental health on the recommendations and
methodology to simplify and restructure mental health procedure codes with corresponding
resource-based relative value scale (RBRVS) values.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2024.
new text end
Sec. 29. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; RESPITE
CARE ACCESS.
new text end
new text begin
The commissioner of human services, in coordination with interested parties, must
develop proposals by December 31, 2025, to increase access to licensed respite foster care
homes that take into consideration the new rule directing title IV-E agencies to adopt one
set of licensing or approval standards for all relative or kinship foster family homes that is
different from the licensing or approval standards used for nonrelative or nonkinship foster
family homes, as provided by the Federal Register, volume 88, page 66700.
new text end
Sec. 30. new text begin MENTAL HEALTH SERVICES FORMULA-BASED ALLOCATION.
new text end
new text begin
The commissioner of human services shall consult with the commissioner of management
and budget, counties, Tribes, mental health providers, and advocacy organizations to develop
recommendations for moving from the children's and adult mental health grant funding
structure to a formula-based allocation structure for mental health services. The
recommendations must consider formula-based allocations for grants for respite care,
school-linked behavioral health, mobile crisis teams, and first episode of psychosis programs.
new text end
Sec. 31. new text begin REVISOR INSTRUCTION.
new text end
new text begin
The revisor of statutes, in consultation with the Office of Senate Counsel, Research and
Fiscal Analysis; the House Research Department; and the commissioner of human services,
shall prepare legislation for the 2025 legislative session to recodify Minnesota Statutes,
section 256B.0622, to move provisions related to assertive community treatment and intensive
residential treatment services into separate sections of statute. The revisor shall correct any
cross-references made necessary by this recodification.
new text end
Sec. 32. new text begin REPEALER.
new text end
new text begin
Minnesota Rules, part 2960.0620, subpart 3,
new text end
new text begin
is repealed.
new text end
ARTICLE 10
DEPARTMENT OF HUMAN SERVICES OFFICE OF INSPECTOR GENERAL
Section 1.
Minnesota Statutes 2023 Supplement, section 13.46, subdivision 4, as amended
by Laws 2024, chapter 80, article 8, section 4, is amended to read:
Subd. 4.
Licensing data.
(a) As used in this subdivision:
(1) "licensing data" are all data collected, maintained, used, or disseminated by the
welfare system pertaining to persons licensed or registered or who apply for licensure or
registration or who formerly were licensed or registered under the authority of the
commissioner of human services;
(2) "client" means a person who is receiving services from a licensee or from an applicant
for licensure; and
(3) "personal and personal financial data" are Social Security numbers, identity of and
letters of reference, insurance information, reports from the Bureau of Criminal
Apprehension, health examination reports, and social/home studies.
(b)(1)(i) Except as provided in paragraph (c), the following data on applicants,new text begin
certification holders,new text end license holders, and former licensees are public: name, address,
telephone number of licensees, new text begin email addresses except for family child foster carenew text end new text begin , new text end date of
receipt of a completed application, dates of licensure, licensed capacity, type of client
preferred, variances granted, record of training and education in child care and child
development, type of dwelling, name and relationship of other family members, previous
license history, class of license, the existence and status of complaints, and the number of
serious injuries to or deaths of individuals in the licensed program as reported to the
commissioner of human services; the commissioner of children, youth, and families; the
local social services agency; or any other county welfare agency. For purposes of this clause,
a serious injury is one that is treated by a physician.
(ii) Except as provided in item (v), when a correction order, an order to forfeit a fine,
an order of license suspension, an order of temporary immediate suspension, an order of
license revocation, an order of license denial, or an order of conditional license has been
issued, or a complaint is resolved, the following data on current and former licensees and
applicants are public: the general nature of the complaint or allegations leading to the
temporary immediate suspension; the substance and investigative findings of the licensing
or maltreatment complaint, licensing violation, or substantiated maltreatment; the existence
of settlement negotiations; the record of informal resolution of a licensing violation; orders
of hearing; findings of fact; conclusions of law; specifications of the final correction order,
fine, suspension, temporary immediate suspension, revocation, denial, or conditional license
contained in the record of licensing action; whether a fine has been paid; and the status of
any appeal of these actions.
(iii) When a license denial under section 142A.15 or 245A.05 or a sanction under section
142B.18 or 245A.07 is based on a determination that a license holder, applicant, or controlling
individual is responsible for maltreatment under section 626.557 or chapter 260E, the identity
of the applicant, license holder, or controlling individual as the individual responsible for
maltreatment is public data at the time of the issuance of the license denial or sanction.
(iv) When a license denial under section 142A.15 or 245A.05 or a sanction under section
142B.18 or 245A.07 is based on a determination that a license holder, applicant, or controlling
individual is disqualified under chapter 245C, the identity of the license holder, applicant,
or controlling individual as the disqualified individual is public data at the time of the
issuance of the licensing sanction or denial. If the applicant, license holder, or controlling
individual requests reconsideration of the disqualification and the disqualification is affirmed,
the reason for the disqualification and the reason to not set aside the disqualification are
private data.
(v) A correction order or fine issued to a child care provider for a licensing violation is
private data on individuals under section 13.02, subdivision 12, or nonpublic data under
section 13.02, subdivision 9, if the correction order or fine is seven years old or older.
(2) For applicants who withdraw their application prior to licensure or denial of a license,
the following data are public: the name of the applicant, the city and county in which the
applicant was seeking licensure, the dates of the commissioner's receipt of the initial
application and completed application, the type of license sought, and the date of withdrawal
of the application.
(3) For applicants who are denied a license, the following data are public: the name and
address of the applicant, the city and county in which the applicant was seeking licensure,
the dates of the commissioner's receipt of the initial application and completed application,
the type of license sought, the date of denial of the application, the nature of the basis for
the denial, the existence of settlement negotiations, the record of informal resolution of a
denial, orders of hearings, findings of fact, conclusions of law, specifications of the final
order of denial, and the status of any appeal of the denial.
(4) When maltreatment is substantiated under section 626.557 or chapter 260E and the
victim and the substantiated perpetrator are affiliated with a program licensed under chapter
142B or 245A; the commissioner of human services; commissioner of children, youth, and
families; local social services agency; or county welfare agency may inform the license
holder where the maltreatment occurred of the identity of the substantiated perpetrator and
the victim.
(5) Notwithstanding clause (1), for child foster care, only the name of the license holder
and the status of the license are public if the county attorney has requested that data otherwise
classified as public data under clause (1) be considered private data based on the best interests
of a child in placement in a licensed program.
(c) The following are private data on individuals under section 13.02, subdivision 12,
or nonpublic data under section 13.02, subdivision 9: personal and personal financial data
on family day care program and family foster care program applicants and licensees and
their family members who provide services under the license.
(d) The following are private data on individuals: the identity of persons who have made
reports concerning licensees or applicants that appear in inactive investigative data, and the
records of clients or employees of the licensee or applicant for licensure whose records are
received by the licensing agency for purposes of review or in anticipation of a contested
matter. The names of reporters of complaints or alleged violations of licensing standards
under chapters 142B, 245A, 245B, 245C, and 245D, and applicable rules and alleged
maltreatment under section 626.557 and chapter 260E, are confidential data and may be
disclosed only as provided in section 260E.21, subdivision 4; 260E.35; or 626.557,
subdivision 12b.
(e) Data classified as private, confidential, nonpublic, or protected nonpublic under this
subdivision become public data if submitted to a court or administrative law judge as part
of a disciplinary proceeding in which there is a public hearing concerning a license which
has been suspended, immediately suspended, revoked, or denied.
(f) Data generated in the course of licensing investigations that relate to an alleged
violation of law are investigative data under subdivision 3.
(g) Data that are not public data collected, maintained, used, or disseminated under this
subdivision that relate to or are derived from a report as defined in section 260E.03, or
626.5572, subdivision 18, are subject to the destruction provisions of sections 260E.35,
subdivision 6, and 626.557, subdivision 12b.
(h) Upon request, not public data collected, maintained, used, or disseminated under
this subdivision that relate to or are derived from a report of substantiated maltreatment as
defined in section 626.557 or chapter 260E may be exchanged with the Department of
Health for purposes of completing background studies pursuant to section 144.057 and with
the Department of Corrections for purposes of completing background studies pursuant to
section 241.021.
(i) Data on individuals collected according to licensing activities under chapters 142B,
245A, and 245C, data on individuals collected by the commissioner of human services
according to investigations under section 626.557 and chapters 142B, 245A, 245B, 245C,
245D, and 260E may be shared with the Department of Human Rights, the Department of
Health, the Department of Corrections, the ombudsman for mental health and developmental
disabilities, and the individual's professional regulatory board when there is reason to believe
that laws or standards under the jurisdiction of those agencies may have been violated or
the information may otherwise be relevant to the board's regulatory jurisdiction. Background
study data on an individual who is the subject of a background study under chapter 245C
for a licensed service for which the commissioner of human services or children, youth,
and families is the license holder may be shared with the commissioner and the
commissioner's delegate by the licensing division. Unless otherwise specified in this chapter,
the identity of a reporter of alleged maltreatment or licensing violations may not be disclosed.
(j) In addition to the notice of determinations required under sections 260E.24,
subdivisions 5 and 7, and 260E.30, subdivision 6, paragraphs (b), (c), (d), (e), and (f), if the
commissioner of children, youth, and families or the local social services agency has
determined that an individual is a substantiated perpetrator of maltreatment of a child based
on sexual abuse, as defined in section 260E.03, and the commissioner or local social services
agency knows that the individual is a person responsible for a child's care in another facility,
the commissioner or local social services agency shall notify the head of that facility of this
determination. The notification must include an explanation of the individual's available
appeal rights and the status of any appeal. If a notice is given under this paragraph, the
government entity making the notification shall provide a copy of the notice to the individual
who is the subject of the notice.
(k) All not public data collected, maintained, used, or disseminated under this subdivision
and subdivision 3 may be exchanged between the Department of Human Services, Licensing
Division, and the Department of Corrections for purposes of regulating services for which
the Department of Human Services and the Department of Corrections have regulatory
authority.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 2.
Minnesota Statutes 2023 Supplement, section 245A.03, subdivision 2, as amended
by Laws 2024, chapter 80, article 2, section 35, and Laws 2024, chapter 85, section 52, is
amended to read:
Subd. 2.
Exclusion from licensure.
(a) This chapter does not apply to:
(1) residential or nonresidential programs that are provided to a person by an individual
who is related;
(2) nonresidential programs that are provided by an unrelated individual to persons from
a single related family;
(3) residential or nonresidential programs that are provided to adults who do not misuse
substances or have a substance use disorder, a mental illness, a developmental disability, a
functional impairment, or a physical disability;
(4) sheltered workshops or work activity programs that are certified by the commissioner
of employment and economic development;
(5) programs operated by a public school for children 33 months or older;
(6) nonresidential programs primarily for children that provide care or supervision for
periods of less than three hours a day while the child's parent or legal guardian is in the
same building as the nonresidential program or present within another building that is
directly contiguous to the building in which the nonresidential program is located;
(7) nursing homes or hospitals licensed by the commissioner of health except as specified
under section 245A.02;
(8) board and lodge facilities licensed by the commissioner of health that do not provide
children's residential services under Minnesota Rules, chapter 2960, mental health or
substance use disorder treatment;
(9) programs licensed by the commissioner of corrections;
(10) recreation programs for children or adults that are operated or approved by a park
and recreation board whose primary purpose is to provide social and recreational activities;
(11) noncertified boarding care homes unless they provide services for five or more
persons whose primary diagnosis is mental illness or a developmental disability;
(12) programs for children such as scouting, boys clubs, girls clubs, and sports and art
programs, and nonresidential programs for children provided for a cumulative total of less
than 30 days in any 12-month period;
(13) residential programs for persons with mental illness, that are located in hospitals;
(14) camps licensed by the commissioner of health under Minnesota Rules, chapter
4630;
(15) mental health outpatient services for adults with mental illness or children with
emotional disturbance;
(16) residential programs serving school-age children whose sole purpose is cultural or
educational exchange, until the commissioner adopts appropriate rules;
(17) community support services programs as defined in section 245.462, subdivision
6, and family community support services as defined in section 245.4871, subdivision 17;
(18) deleted text begin settings registered under chapter 144G that provide home care services licensed by
the commissioner of health to fewer than seven adultsdeleted text end new text begin assisted living facilities licensed by
the commissioner of health under chapter 144Gnew text end ;
(19) substance use disorder treatment activities of licensed professionals in private
practice as defined in section 245G.01, subdivision 17;
(20) consumer-directed community support service funded under the Medicaid waiver
for persons with developmental disabilities when the individual who provided the service
is:
(i) the same individual who is the direct payee of these specific waiver funds or paid by
a fiscal agent, fiscal intermediary, or employer of record; and
(ii) not otherwise under the control of a residential or nonresidential program that is
required to be licensed under this chapter when providing the service;
(21) a county that is an eligible vendor under section 254B.05 to provide care coordination
and comprehensive assessment services;
(22) a recovery community organization that is an eligible vendor under section 254B.05
to provide peer recovery support services; or
(23) programs licensed by the commissioner of children, youth, and families in chapter
142B.
(b) For purposes of paragraph (a), clause (6), a building is directly contiguous to a
building in which a nonresidential program is located if it shares a common wall with the
building in which the nonresidential program is located or is attached to that building by
skyway, tunnel, atrium, or common roof.
(c) Except for the home and community-based services identified in section 245D.03,
subdivision 1, nothing in this chapter shall be construed to require licensure for any services
provided and funded according to an approved federal waiver plan where licensure is
specifically identified as not being a condition for the services and funding.
Sec. 3.
Minnesota Statutes 2022, section 245A.04, is amended by adding a subdivision to
read:
new text begin Subd. 7b. new text end
new text begin
Notification to commissioner of changes in key staff positions; children's
residential facilities and detoxification programs.
new text end
new text begin
(a) A license holder must notify the
commissioner within five business days of a change or vacancy in a key staff position under
paragraph (b) or (c). The license holder must notify the commissioner of the staffing change
on a form approved by the commissioner and include the name of the staff person now
assigned to the key staff position and the staff person's qualifications for the position. The
license holder must notify the program licensor of a vacancy to discuss how the duties of
the key staff position will be fulfilled during the vacancy.
new text end
new text begin
(b) The key staff position for a children's residential facility licensed according to
Minnesota Rules, parts 2960.0130 to 2960.0220, is a program director; and
new text end
new text begin
(c) The key staff positions for a detoxification program licensed according to Minnesota
Rules, parts 9530.6510 to 9530.6590, are:
new text end
new text begin
(1) a program director as required by Minnesota Rules, part 9530.6560, subpart 1;
new text end
new text begin
(2) a registered nurse as required by Minnesota Rules, part 9530.6560, subpart 4; and
new text end
new text begin
(3) a medical director as required by Minnesota Rules, part 9530.6560, subpart 5.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 4.
Minnesota Statutes 2022, section 245A.043, subdivision 2, is amended to read:
Subd. 2.
Change in ownership.
(a) If the commissioner determines that there is a change
in ownership, the commissioner shall require submission of a new license application. This
subdivision does not apply to a licensed program or service located in a home where the
license holder resides. A change in ownership occurs when:
(1) new text begin except as provided in paragraph (b), new text end the license holder sells or transfers 100 percent
of the property, stock, or assets;
(2) the license holder merges with another organization;
(3) the license holder consolidates with two or more organizations, resulting in the
creation of a new organization;
(4) there is a change to the federal tax identification number associated with the license
holder; or
(5) new text begin except as provided in paragraph (b), new text end all controlling individuals deleted text begin associated withdeleted text end new text begin fornew text end
the original deleted text begin applicationdeleted text end new text begin licensenew text end have changed.
(b) deleted text begin Notwithstandingdeleted text end new text begin For changes undernew text end paragraph (a), clauses (1) deleted text begin anddeleted text end new text begin ornew text end (5), no change
in ownership has occurred new text begin and a new license application is not required new text end if at least one
controlling individual has been deleted text begin listeddeleted text end new text begin affiliatednew text end as a controlling individual for the license
for at least the previous 12 monthsnew text begin immediately preceding the changenew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 5.
Minnesota Statutes 2023 Supplement, section 245A.043, subdivision 3, is amended
to read:
Subd. 3.
new text begin Standard new text end change of ownership process.
(a) When a change in ownership is
proposed and the party intends to assume operation without an interruption in service longer
than 60 days after acquiring the program or service, the license holder must provide the
commissioner with written notice of the proposed change on a form provided by the
commissioner at least deleted text begin 60deleted text end new text begin 90new text end days before the anticipated date of the change in ownership.
For purposes of this deleted text begin subdivision and subdivision 4deleted text end new text begin sectionnew text end , "party" means the party that
intends to operate the service or program.
(b) The party must submit a license application under this chapter on the form and in
the manner prescribed by the commissioner at least deleted text begin 30deleted text end new text begin 90new text end days before the change in
ownership is new text begin anticipated to be new text end completedeleted text begin ,deleted text end and must include documentation to support the
upcoming change. The party must comply with background study requirements under chapter
245C and shall pay the application fee required under section 245A.10.
new text begin (c)new text end A party that intends to assume operation without an interruption in service longer
than 60 days after acquiring the program or service is exempt from the requirements of
sections 245G.03, subdivision 2, paragraph (b), and 254B.03, subdivision 2, paragraphs (c)
and (d).
deleted text begin (c)deleted text end new text begin (d)new text end The commissioner may streamline application procedures when the party is an
existing license holder under this chapter and is acquiring a program licensed under this
chapter or service in the same service class as one or more licensed programs or services
the party operates and those licenses are in substantial compliance. For purposes of this
subdivision, "substantial compliance" means within the previous 12 months the commissioner
did not (1) issue a sanction under section 245A.07 against a license held by the party, or
(2) make a license held by the party conditional according to section 245A.06.
deleted text begin (d) Except when a temporary change in ownership license is issued pursuant to
subdivision 4deleted text end new text begin (e) While the standard change of ownership process is pendingnew text end , the existing
license holder deleted text begin is solelydeleted text end new text begin remainsnew text end responsible for operating the program according to applicable
laws and rules until a license under this chapter is issued to the party.
deleted text begin (e)deleted text end new text begin (f)new text end If a licensing inspection of the program or service was conducted within the
previous 12 months and the existing license holder's license record demonstrates substantial
compliance with the applicable licensing requirements, the commissioner may waive the
party's inspection required by section 245A.04, subdivision 4. The party must submit to the
commissioner (1) proof that the premises was inspected by a fire marshal or that the fire
marshal deemed that an inspection was not warranted, and (2) proof that the premises was
inspected for compliance with the building code or that no inspection was deemed warranted.
deleted text begin (f)deleted text end new text begin (g)new text end If the party is seeking a license for a program or service that has an outstanding
action under section 245A.06 or 245A.07, the party must submit a deleted text begin letterdeleted text end new text begin written plannew text end as part
of the application process identifying how the party has or will come into full compliance
with the licensing requirements.
deleted text begin (g)deleted text end new text begin (h)new text end The commissioner shall evaluate the party's application according to section
245A.04, subdivision 6. If the commissioner determines that the party has remedied or
demonstrates the ability to remedy the outstanding actions under section 245A.06 or 245A.07
and has determined that the program otherwise complies with all applicable laws and rules,
the commissioner shall issue a license or conditional license under this chapter. new text begin A conditional
license issued under this section is final and not subject to reconsideration under section
245A.06, subdivision 4. new text end The conditional license remains in effect until the commissioner
determines that the grounds for the action are corrected or no longer exist.
deleted text begin (h)deleted text end new text begin (i)new text end The commissioner may deny an application as provided in section 245A.05. An
applicant whose application was denied by the commissioner may appeal the denial according
to section 245A.05.
deleted text begin (i)deleted text end new text begin (j)new text end This subdivision does not apply to a licensed program or service located in a home
where the license holder resides.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 6.
Minnesota Statutes 2022, section 245A.043, is amended by adding a subdivision
to read:
new text begin Subd. 3a. new text end
new text begin Emergency change in ownership process. new text end
new text begin
(a) In the event of a death of a
license holder or sole controlling individual or a court order or other event that results in
the license holder being inaccessible or unable to operate the program or service, a party
may submit a request to the commissioner to allow the party to assume operation of the
program or service under an emergency change in ownership process to ensure persons
continue to receive services while the commissioner evaluates the party's license application.
new text end
new text begin
(b) To request the emergency change of ownership process, the party must immediately:
new text end
new text begin
(1) notify the commissioner of the event resulting in the inability of the license holder
to operate the program and of the party's intent to assume operations; and
new text end
new text begin
(2) provide the commissioner with documentation that demonstrates the party has a legal
or legitimate ownership interest in the program or service if applicable and is able to operate
the program or service.
new text end
new text begin
(c) If the commissioner approves the party to continue operating the program or service
under an emergency change in ownership process, the party must:
new text end
new text begin
(1) request to be added as a controlling individual or license holder to the existing license;
new text end
new text begin
(2) notify persons receiving services of the emergency change in ownership in a manner
approved by the commissioner;
new text end
new text begin
(3) submit an application for a new license within 30 days of approval;
new text end
new text begin
(4) comply with the background study requirements under chapter 245C; and
new text end
new text begin
(5) pay the application fee required under section 245A.10.
new text end
new text begin
(d) While the emergency change of ownership process is pending, a party approved
under this subdivision is responsible for operating the program under the existing license
according to applicable laws and rules until a new license under this chapter is issued.
new text end
new text begin
(e) The provisions in subdivision 3, paragraphs (c), (d), and (f) to (i) apply to this
subdivision.
new text end
new text begin
(f) Once a party is issued a new license or has decided not to seek a new license, the
commissioner must close the existing license.
new text end
new text begin
(g) This subdivision applies to any program or service licensed under this chapter.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 7.
Minnesota Statutes 2022, section 245A.043, subdivision 4, is amended to read:
Subd. 4.
Temporary deleted text begin change in ownershipdeleted text end new text begin transitionalnew text end license.
deleted text begin
(a) After receiving the
party's application pursuant to subdivision 3, upon the written request of the existing license
holder and the party, the commissioner may issue a temporary change in ownership license
to the party while the commissioner evaluates the party's application. Until a decision is
made to grant or deny a license under this chapter, the existing license holder and the party
shall both be responsible for operating the program or service according to applicable laws
and rules, and the sale or transfer of the existing license holder's ownership interest in the
licensed program or service does not terminate the existing license.
deleted text end
deleted text begin
(b) The commissioner may issue a temporary change in ownership license when a license
holder's death, divorce, or other event affects the ownership of the program and an applicant
seeks to assume operation of the program or service to ensure continuity of the program or
service while a license application is evaluated.
deleted text end
deleted text begin
(c) This subdivision applies to any program or service licensed under this chapter.
deleted text end
new text begin
If a party's application under subdivision 2 is for a satellite license for a community
residential setting under section 245D.23 or day services facility under 245D.27 and if the
party already holds an active license to provide services under chapter 245D, the
commissioner may issue a temporary transitional license to the party for the community
residential setting or day services facility while the commissioner evaluates the party's
application. Until a decision is made to grant or deny a community residential setting or
day services facility satellite license, the party must be solely responsible for operating the
program according to applicable laws and rules, and the existing license must be closed.
The temporary transitional license expires after 12 months from the date it was issued or
upon issuance of the community residential setting or day services facility satellite license,
whichever occurs first.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 8.
Minnesota Statutes 2022, section 245A.043, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin Failure to comply. new text end
new text begin
If the commissioner finds that the applicant or license holder
has not fully complied with this section, the commissioner may impose a licensing sanction
under section 245A.05, 245A.06, or 245A.07.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 9.
Minnesota Statutes 2023 Supplement, section 245A.07, subdivision 1, as amended
by Laws 2024, chapter 80, article 2, section 44, is amended to read:
Subdivision 1.
Sanctions; appeals; license.
(a) In addition to making a license conditional
under section 245A.06, the commissioner may suspend or revoke the license, impose a fine,
or secure an injunction against the continuing operation of the program of a license holder
who does not comply with applicable law or rule. When applying sanctions authorized under
this section, the commissioner shall consider the nature, chronicity, or severity of the violation
of law or rule and the effect of the violation on the health, safety, or rights of persons served
by the program.
(b) If a license holder appeals the suspension or revocation of a license and the license
holder continues to operate the program pending a final order on the appeal, the commissioner
shall issue the license holder a temporary provisional license.new text begin The commissioner may include
terms the license holder must follow pending a final order on the appeal.new text end Unless otherwise
specified by the commissioner, variances in effect on the date of the license sanction under
appeal continue under the temporary provisional license. If a license holder fails to comply
with applicable law or rule while operating under a temporary provisional license, the
commissioner may impose additional sanctions under this section and section 245A.06, and
may terminate any prior variance. If a temporary provisional license is set to expire, a new
temporary provisional license shall be issued to the license holder upon payment of any fee
required under section 245A.10. The temporary provisional license shall expire on the date
the final order is issued. If the license holder prevails on the appeal, a new nonprovisional
license shall be issued for the remainder of the current license period.
(c) If a license holder is under investigation and the license issued under this chapter is
due to expire before completion of the investigation, the program shall be issued a new
license upon completion of the reapplication requirements and payment of any applicable
license fee. Upon completion of the investigation, a licensing sanction may be imposed
against the new license under this section, section 245A.06, or 245A.08.
(d) Failure to reapply or closure of a license issued under this chapter by the license
holder prior to the completion of any investigation shall not preclude the commissioner
from issuing a licensing sanction under this section or section 245A.06 at the conclusion
of the investigation.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 10.
Minnesota Statutes 2022, section 245A.07, subdivision 6, is amended to read:
Subd. 6.
Appeal of multiple sanctions.
(a) When the license holder appeals more than
one licensing action or sanction that were simultaneously issued by the commissioner, the
license holder shall specify the actions or sanctions that are being appealed.
(b) If there are different timelines prescribed in statutes for the licensing actions or
sanctions being appealed, the license holder must submit the appeal within the longest of
those timelines specified in statutes.
(c) The appeal must be made in writing by certified mail deleted text begin ordeleted text end new text begin ,new text end personal servicenew text begin , or through
the provider licensing and reporting hubnew text end . If mailed, the appeal must be postmarked and sent
to the commissioner within the prescribed timeline with the first day beginning the day after
the license holder receives the certified letter. If a request is made by personal service, it
must be received by the commissioner within the prescribed timeline with the first day
beginning the day after the license holder receives the certified letter.new text begin If the appeal is made
through the provider hub, the appeal must be received by the commissioner within the
prescribed timeline with the first day beginning the day after the commissioner issued the
order through the hub.
new text end
(d) When there are different timelines prescribed in statutes for the appeal of licensing
actions or sanctions simultaneously issued by the commissioner, the commissioner shall
specify in the notice to the license holder the timeline for appeal as specified under paragraph
(b).
Sec. 11.
Minnesota Statutes 2023 Supplement, section 245A.11, subdivision 7, is amended
to read:
Subd. 7.
Adult foster carenew text begin and community residential settingnew text end ; variance for alternate
overnight supervision.
(a) The commissioner may grant a variance under section 245A.04,
subdivision 9, to new text begin statute or new text end rule parts requiring a caregiver to be present in an adult foster
care home new text begin or a community residential setting new text end during normal sleeping hours to allow for
alternative methods of overnight supervision. The commissioner may grant the variance if
the local county licensing agency recommends the variance and the county recommendation
includes documentation verifying that:
(1) the county has approved the license holder's plan for alternative methods of providing
overnight supervision and determined the plan protects the residents' health, safety, and
rights;
(2) the license holder has obtained written and signed informed consent from each
resident or each resident's legal representative documenting the resident's or legal
representative's agreement with the alternative method of overnight supervision; and
(3) the alternative method of providing overnight supervision, which may include the
use of technology, is specified for each resident in the resident's: (i) individualized plan of
care; (ii) deleted text begin individual servicedeleted text end new text begin supportnew text end plan under section 256B.092, subdivision 1b, if required;
or (iii) individual resident placement agreement under Minnesota Rules, part 9555.5105,
subpart 19, if required.
(b) To be eligible for a variance under paragraph (a), the adult foster care new text begin or community
residential setting new text end license holder must not have had a conditional license issued under section
245A.06, or any other licensing sanction issued under section 245A.07 during the prior 24
months based on failure to provide adequate supervision, health care services, or resident
safety in the adult foster care homenew text begin or a community residential settingnew text end .
(c) A license holder requesting a variance under this subdivision to utilize technology
as a component of a plan for alternative overnight supervision may request the commissioner's
review in the absence of a county recommendation. Upon receipt of such a request from a
license holder, the commissioner shall review the variance request with the county.
deleted text begin
(d) The variance requirements under this subdivision for alternative overnight supervision
do not apply to community residential settings licensed under chapter
deleted text end
deleted text begin
245D
deleted text end
deleted text begin
.
deleted 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. 12.
Minnesota Statutes 2023 Supplement, section 245A.16, subdivision 1, as amended
by Laws 2024, chapter 80, article 2, section 65, is amended to read:
Subdivision 1.
Delegation of authority to agencies.
(a) County agencies that have been
designated by the commissioner to perform licensing functions and activities under section
245A.04; to recommend denial of applicants under section 245A.05; to issue correction
orders, to issue variances, and recommend a conditional license under section 245A.06; or
to recommend suspending or revoking a license or issuing a fine under section 245A.07,
shall comply with rules and directives of the commissioner governing those functions and
with this section. The following variances are excluded from the delegation of variance
authority and may be issued only by the commissioner:
(1) dual licensure of family child foster care and family adult foster care, dual licensure
of child foster residence setting and community residential setting, and dual licensure of
family adult foster care and family child care;
(2) adult foster carenew text begin or community residential settingnew text end maximum capacity;
(3) adult foster carenew text begin or community residential settingnew text end minimum age requirement;
(4) child foster care maximum age requirement;
(5) variances regarding disqualified individuals;
(6) the required presence of a caregiver in the adult foster care residence during normal
sleeping hours;
(7) variances to requirements relating to chemical use problems of a license holder or a
household member of a license holder; and
(8) variances to section 142B.46 for the use of a cradleboard for a cultural
accommodation.
(b) For family adult day services programs, the commissioner may authorize licensing
reviews every two years after a licensee has had at least one annual review.
(c) A license issued under this section may be issued for up to two years.
(d) During implementation of chapter 245D, the commissioner shall consider:
(1) the role of counties in quality assurance;
(2) the duties of county licensing staff; and
(3) the possible use of joint powers agreements, according to section 471.59, with counties
through which some licensing duties under chapter 245D may be delegated by the
commissioner to the counties.
Any consideration related to this paragraph must meet all of the requirements of the corrective
action plan ordered by the federal Centers for Medicare and Medicaid Services.
(e) Licensing authority specific to section 245D.06, subdivisions 5, 6, 7, and 8, or
successor provisions; and section 245D.061 or successor provisions, for family child foster
care programs providing out-of-home respite, as identified in section 245D.03, subdivision
1, paragraph (b), clause (1), is excluded from the delegation of authority to county agencies.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 13.
Minnesota Statutes 2023 Supplement, section 245A.211, subdivision 4, is amended
to read:
Subd. 4.
Contraindicated physical restraints.
A license or certification holder must
not implement a restraint on a person receiving services in a program in a way that is
contraindicated for any of the person's known medical or psychological conditions. Prior
to using restraints on a persondeleted text begin , the license or certification holder must assess and document
a determination of anydeleted text end new text begin with a knownnew text end medical or psychological conditions that restraints are
contraindicated fornew text begin , the license or certification holder must document the contraindicationnew text end
and the type of restraints that will not be used on the person based on this determination.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 14.
Minnesota Statutes 2023 Supplement, section 245A.242, subdivision 2, is amended
to read:
Subd. 2.
Emergency overdose treatment.
new text begin (a) new text end A license holder must maintain a supply
of opiate antagonists as defined in section 604A.04, subdivision 1, available for emergency
treatment of opioid overdose and must have a written standing order protocol by a physician
who is licensed under chapter 147, advanced practice registered nurse who is licensed under
chapter 148, or physician assistant who is licensed under chapter 147A, that permits the
license holder to maintain a supply of opiate antagonists on site. A license holder must
require staff to undergo training in the specific mode of administration used at the program,
which may include intranasal administration, intramuscular injection, or both.
new text begin
(b) Notwithstanding any requirements to the contrary in Minnesota Rules, chapters 2960
and 9530, and Minnesota Statutes, chapters 245F, 245G, and 245I:
new text end
new text begin
(1) emergency opiate antagonist medications are not required to be stored in a locked
area and staff and adult clients may carry this medication on them and store it in an unlocked
location;
new text end
new text begin
(2) staff persons who only administer emergency opiate antagonist medications only
require the training required by paragraph (a), which any knowledgeable trainer may provide.
The trainer is not required to be a registered nurse or part of an accredited educational
institution; and
new text end
new text begin
(3) nonresidential substance use disorder treatment programs that do not administer
client medications beyond emergency opiate antagonist medications are not required to
have the policies and procedures required in section 245G.08, subdivisions 5 and 6, and
must instead describe the program's procedures for administering opiate antagonist
medications in the license holder's description of health care services under section 245G.08,
subdivision 1.
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. 15.
Minnesota Statutes 2022, section 245A.52, subdivision 2, is amended to read:
Subd. 2.
Door to attached garage.
deleted text begin
Notwithstanding Minnesota Rules, part 9502.0425,
subpart 5, day care residences with an attached garage are not required to have a self-closing
door to the residence. The door to the residence may be
deleted text end
new text begin
(a) If there is an opening between
an attached garage and a day care residence, there must be a door that is:
new text end
new text begin
(1) a solid wood bonded-core door at least 1-3/8 inches thick;
new text end
new text begin (2)new text end a steel insulated door deleted text begin if the door isdeleted text end at least 1-3/8 inches thickdeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(3) a door with a fire protection rating of 20 minutes.
new text end
new text begin
(b) The separation wall on the garage side between the residence and garage must consist
of 1/2-inch-thick gypsum wallboard or its equivalent.
new text end
Sec. 16.
Minnesota Statutes 2023 Supplement, section 245C.02, subdivision 13e, is
amended to read:
Subd. 13e.
NETStudy 2.0.
new text begin (a) new text end "NETStudy 2.0" means the commissioner's system that
replaces both NETStudy and the department's internal background study processing system.
NETStudy 2.0 is designed to enhance protection of children and vulnerable adults by
improving the accuracy of background studies through fingerprint-based criminal record
checks and expanding the background studies to include a review of information from the
Minnesota Court Information System and the national crime information database. NETStudy
2.0 is also designed to increase efficiencies in and the speed of the hiring process by:
(1) providing access to and updates from public web-based data related to employment
eligibility;
(2) decreasing the need for repeat studies through electronic updates of background
study subjects' criminal records;
(3) supporting identity verification using subjects' Social Security numbers and
photographs;
(4) using electronic employer notifications;
(5) issuing immediate verification of subjects' eligibility to provide services as more
studies are completed under the NETStudy 2.0 system; and
(6) providing electronic access to certain notices for entities and background study
subjects.
new text begin
(b) Information obtained by entities from public web-based data through NETStudy 2.0
under paragraph (a), clause (1), or any other source that is not direct correspondence from
the commissioner is not a notice of disqualification from the commissioner under this
chapter.
new text end
Sec. 17.
Minnesota Statutes 2023 Supplement, section 245C.033, subdivision 3, is amended
to read:
Subd. 3.
Procedure; maltreatment and state licensing agency data.
new text begin (a) For requests
paid directly by the guardian or conservator, new text end requests for maltreatment and state licensing
agency data checks must be submitted by the guardian or conservator to the commissioner
on the form or in the manner prescribed by the commissioner. Upon receipt of a signed
informed consent and payment under section 245C.10, the commissioner shall complete
the maltreatment and state licensing agency checks. Upon completion of the checks, the
commissioner shall provide the requested information to the courts on the form or in the
manner prescribed by the commissioner.
new text begin
(b) For requests paid by the court based on the in forma pauperis status of the guardian
or conservator, requests for maltreatment and state licensing agency data checks must be
submitted by the court to the commissioner on the form or in the manner prescribed by the
commissioner. The form will serve as certification that the individual has been granted in
forma pauperis status. Upon receipt of a signed data request consent form from the court,
the commissioner shall initiate the maltreatment and state licensing agency checks. Upon
completion of the checks, the commissioner shall provide the requested information to the
courts on the form or in the manner prescribed by the commissioner.
new text end
Sec. 18.
new text begin
[245C.041] EMERGENCY WAIVER TO TEMPORARILY MODIFY
BACKGROUND STUDY REQUIREMENTS.
new text end
new text begin
(a) In the event of an emergency identified by the commissioner, the commissioner may
temporarily waive or modify provisions in this chapter, except that the commissioner shall
not waive or modify:
new text end
new text begin
(1) disqualification standards in section 245C.14 or 245C; or
new text end
new text begin
(2) any provision regarding the scope of individuals required to be subject to a background
study conducted under this chapter.
new text end
new text begin
(b) For the purposes of this section, an emergency may include, but is not limited to a
public health emergency, environmental emergency, natural disaster, or other unplanned
event that the commissioner has determined prevents the requirements in this chapter from
being met. This authority shall not exceed the amount of time needed to respond to the
emergency and reinstate the requirements of this chapter. The commissioner has the authority
to establish the process and time frame for returning to full compliance with this chapter.
The commissioner shall determine the length of time an emergency study is valid.
new text end
new text begin
(c) At the conclusion of the emergency, entities must submit a new, compliant background
study application and fee for each individual who was the subject of background study
affected by the powers created in this section, referred to as an "emergency study" to have
a new study that fully complies with this chapter within a time frame and notice period
established by the commissioner.
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. 19.
Minnesota Statutes 2022, section 245C.05, subdivision 5, is amended to read:
Subd. 5.
Fingerprints and photograph.
(a) Notwithstanding paragraph deleted text begin (b)deleted text end new text begin (c)new text end , for
background studies conducted by the commissioner for child foster care, children's residential
facilities, adoptions, or a transfer of permanent legal and physical custody of a child, the
subject of the background study, who is 18 years of age or older, shall provide the
commissioner with a set of classifiable fingerprints obtained from an authorized agency for
a national criminal history record check.
new text begin
(b) Notwithstanding paragraph (c), for background studies conducted by the commissioner
for Head Start programs, the subject of the background study shall provide the commissioner
with a set of classifiable fingerprints obtained from an authorized agency for a national
criminal history record check.
new text end
deleted text begin (b)deleted text end new text begin (c)new text end For background studies initiated on or after the implementation of NETStudy
2.0, except as provided under subdivision 5a, every subject of a background study must
provide the commissioner with a set of the background study subject's classifiable fingerprints
and photograph. The photograph and fingerprints must be recorded at the same time by the
authorized fingerprint collection vendor or vendors and sent to the commissioner through
the commissioner's secure data system described in section 245C.32, subdivision 1a,
paragraph (b).
deleted text begin (c)deleted text end new text begin (d)new text end The fingerprints shall be submitted by the commissioner to the Bureau of Criminal
Apprehension and, when specifically required by law, submitted to the Federal Bureau of
Investigation for a national criminal history record check.
deleted text begin (d)deleted text end new text begin (e)new text end The fingerprints must not be retained by the Department of Public Safety, Bureau
of Criminal Apprehension, or the commissioner. The Federal Bureau of Investigation will
not retain background study subjects' fingerprints.
deleted text begin (e)deleted text end new text begin (f)new text end The authorized fingerprint collection vendor or vendors shall, for purposes of
verifying the identity of the background study subject, be able to view the identifying
information entered into NETStudy 2.0 by the entity that initiated the background study,
but shall not retain the subject's fingerprints, photograph, or information from NETStudy
2.0. The authorized fingerprint collection vendor or vendors shall retain no more than the
name and date and time the subject's fingerprints were recorded and sent, only as necessary
for auditing and billing activities.
deleted text begin (f)deleted text end new text begin (g)new text end For any background study conducted under this chapter, the subject shall provide
the commissioner with a set of classifiable fingerprints when the commissioner has reasonable
cause to require a national criminal history record check as defined in section 245C.02,
subdivision 15a.
Sec. 20.
Minnesota Statutes 2023 Supplement, section 245C.08, subdivision 1, is amended
to read:
Subdivision 1.
Background studies conducted by Department of Human Services.
(a)
For a background study conducted by the Department of Human Services, the commissioner
shall review:
(1) information related to names of substantiated perpetrators of maltreatment of
vulnerable adults that has been received by the commissioner as required under section
626.557, subdivision 9c, paragraph (j);
(2) the commissioner's records relating to the maltreatment of minors in licensed
programs, and from findings of maltreatment of minors as indicated through the social
service information system;
(3) information from juvenile courts as required deleted text begin in subdivision 4 for individuals listed
in section 245C.03, subdivision 1, paragraph (a),deleted text end new text begin for studies under this chapternew text end when there
is reasonable cause;
(4) information from the Bureau of Criminal Apprehension, including information
regarding a background study subject's registration in Minnesota as a predatory offender
under section 243.166;
(5) except as provided in clause (6), information received as a result of submission of
fingerprints for a national criminal history record check, as defined in section 245C.02,
subdivision 13c, when the commissioner has reasonable cause for a national criminal history
record check as defined under section 245C.02, subdivision 15a, or as required under section
144.057, subdivision 1, clause (2);
(6) for a background study related to a child foster family setting application for licensure,
foster residence settings, children's residential facilities, a transfer of permanent legal and
physical custody of a child under sections 260C.503 to 260C.515, or adoptions, and for a
background study required for family child care, certified license-exempt child care, child
care centers, and legal nonlicensed child care authorized under chapter 119B, the
commissioner shall also review:
(i) information from the child abuse and neglect registry for any state in which the
background study subject has resided for the past five years;
(ii) when the background study subject is 18 years of age or older, or a minor under
section 245C.05, subdivision 5a, paragraph (c), information received following submission
of fingerprints for a national criminal history record check; and
(iii) when the background study subject is 18 years of age or older or a minor under
section 245C.05, subdivision 5a, paragraph (d), for licensed family child care, certified
license-exempt child care, licensed child care centers, and legal nonlicensed child care
authorized under chapter 119B, information obtained using non-fingerprint-based data
including information from the criminal and sex offender registries for any state in which
the background study subject resided for the past five years and information from the national
crime information database and the national sex offender registry;
(7) for a background study required for family child care, certified license-exempt child
care centers, licensed child care centers, and legal nonlicensed child care authorized under
chapter 119B, the background study shall also include, to the extent practicable, a name
and date-of-birth search of the National Sex Offender Public website; and
(8) for a background study required for treatment programs for sexual psychopathic
personalities or sexually dangerous persons, the background study shall only include a
review of the information required under paragraph (a), clauses (1) to (4).
(b) Except as otherwise provided in this paragraph, notwithstanding expungement by a
court, the commissioner may consider information obtained under paragraph (a), clauses
(3) and (4), unless:
(1) the commissioner received notice of the petition for expungement and the court order
for expungement is directed specifically to the commissioner; or
(2) the commissioner received notice of the expungement order issued pursuant to section
609A.017, 609A.025, or 609A.035, and the order for expungement is directed specifically
to the commissioner.
The commissioner may not consider information obtained under paragraph (a), clauses (3)
and (4), or from any other source that identifies a violation of chapter 152 without
determining if the offense involved the possession of marijuana or tetrahydrocannabinol
and, if so, whether the person received a grant of expungement or order of expungement,
or the person was resentenced to a lesser offense. If the person received a grant of
expungement or order of expungement, the commissioner may not consider information
related to that violation but may consider any other relevant information arising out of the
same incident.
(c) The commissioner shall also review criminal case information received according
to section 245C.04, subdivision 4a, from the Minnesota court information system that relates
to individuals who have already been studied under this chapter and who remain affiliated
with the agency that initiated the background study.
(d) When the commissioner has reasonable cause to believe that the identity of a
background study subject is uncertain, the commissioner may require the subject to provide
a set of classifiable fingerprints for purposes of completing a fingerprint-based record check
with the Bureau of Criminal Apprehension. Fingerprints collected under this paragraph
shall not be saved by the commissioner after they have been used to verify the identity of
the background study subject against the particular criminal record in question.
(e) The commissioner may inform the entity that initiated a background study under
NETStudy 2.0 of the status of processing of the subject's fingerprints.
Sec. 21.
Minnesota Statutes 2022, section 245C.08, subdivision 4, is amended to read:
Subd. 4.
Juvenile court records.
(a) For a background study conducted by the
Department of Human Services, the commissioner shall review records from the juvenile
courts for an individual studied under deleted text begin section 245C.03, subdivision 1, paragraph (a),deleted text end new text begin this
chapternew text end when the commissioner has reasonable cause.
deleted text begin
(b) For a background study conducted by a county agency for family child care before
the implementation of NETStudy 2.0, the commissioner shall review records from the
juvenile courts for individuals listed in section 245C.03, subdivision 1, who are ages 13
through 23 living in the household where the licensed services will be provided. The
commissioner shall also review records from juvenile courts for any other individual listed
under section 245C.03, subdivision 1, when the commissioner has reasonable cause.
deleted text end
deleted text begin (c)deleted text end new text begin (b)new text end The juvenile courts shall help with the study by giving the commissioner existing
juvenile court records relating to delinquency proceedings held on individuals deleted text begin described in
section 245C.03, subdivision 1, paragraph (a),deleted text end new text begin who are subjects of studies under this chapternew text end
when requested pursuant to this subdivision.
deleted text begin (d)deleted text end new text begin (c)new text end For purposes of this chapter, a finding that a delinquency petition is proven in
juvenile court shall be considered a conviction in state district court.
deleted text begin (e)deleted text end new text begin (d)new text end Juvenile courts shall provide orders of involuntary and voluntary termination of
parental rights under section 260C.301 to the commissioner upon request for purposes of
conducting a background study under this chapter.
Sec. 22.
Minnesota Statutes 2023 Supplement, section 245C.10, subdivision 15, is amended
to read:
Subd. 15.
Guardians and conservators.
new text begin (a) new text end The commissioner shall recover the cost
of conducting maltreatment and state licensing agency checks for guardians and conservators
under section 245C.033 through a fee of no more than $50. The fees collected under this
subdivision are appropriated to the commissioner for the purpose of conducting maltreatment
and state licensing agency checks.
new text begin (b)new text end The fee must be paid directly to and in the manner prescribed by the commissioner
before any maltreatment and state licensing agency checks under section 245C.033 may be
conducted.
new text begin
(c) Notwithstanding paragraph (b), the court shall pay the fee for an applicant who has
been granted in forma pauperis status upon receipt of the invoice from the commissioner.
new text end
Sec. 23.
Minnesota Statutes 2022, section 245C.10, subdivision 18, is amended to read:
Subd. 18.
Applicants, licensees, and other occupations regulated by commissioner
of health.
The applicant or license holder is responsible for paying to the Department of
Human Services all fees associated with the preparation of the fingerprints, the criminal
records check consent form, andnew text begin , through a fee of no more than $44 per study,new text end the criminal
background check.
Sec. 24.
Minnesota Statutes 2022, section 245C.14, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin Basis for disqualification. new text end
new text begin
Information obtained by entities from public
web-based data through NETStudy 2.0 or any other source that is not direct correspondence
from the commissioner is not a notice of disqualification from the commissioner under this
chapter.
new text end
Sec. 25.
Minnesota Statutes 2022, section 245C.22, subdivision 4, is amended to read:
Subd. 4.
Risk of harm; set aside.
(a) The commissioner may set aside the disqualification
if the commissioner finds that the individual has submitted sufficient information to
demonstrate that the individual does not pose a risk of harm to any person served by the
applicant, license holder, or other entities as provided in this chapter.
(b) In determining whether the individual has met the burden of proof by demonstrating
the individual does not pose a risk of harm, the commissioner shall consider:
(1) the nature, severity, and consequences of the event or events that led to the
disqualification;
(2) whether there is more than one disqualifying event;
(3) the age and vulnerability of the victim at the time of the event;
(4) the harm suffered by the victim;
(5) vulnerability of persons served by the program;
(6) the similarity between the victim and persons served by the program;
(7) the time elapsed without a repeat of the same or similar event;
(8) documentation of successful completion by the individual studied of training or
rehabilitation pertinent to the event; and
(9) any other information relevant to reconsideration.
new text begin
(c) For an individual seeking a child foster care license who is a relative of the child,
the commissioner shall consider the importance of maintaining the child's relationship with
relatives as an additional significant factor in determining whether a background study
disqualification should be set aside.
new text end
deleted text begin (c)deleted text end new text begin (d)new text end If the individual requested reconsideration on the basis that the information relied
upon to disqualify the individual was incorrect or inaccurate and the commissioner determines
that the information relied upon to disqualify the individual is correct, the commissioner
must also determine if the individual poses a risk of harm to persons receiving services in
accordance with paragraph (b).
deleted text begin (d)deleted text end new text begin (e)new text end For an individual seeking employment in the substance use disorder treatment
field, the commissioner shall set aside the disqualification if the following criteria are met:
(1) the individual is not disqualified for a crime of violence as listed under section
624.712, subdivision 5, except for the following crimes: crimes listed under section 152.021,
subdivision 2 or 2a; 152.022, subdivision 2; 152.023, subdivision 2; 152.024; or 152.025;
(2) the individual is not disqualified under section 245C.15, subdivision 1;
(3) the individual is not disqualified under section 245C.15, subdivision 4, paragraph
(b);
(4) the individual provided documentation of successful completion of treatment, at least
one year prior to the date of the request for reconsideration, at a program licensed under
chapter 245G, and has had no disqualifying crimes or conduct under section 245C.15 after
the successful completion of treatment;
(5) the individual provided documentation demonstrating abstinence from controlled
substances, as defined in section 152.01, subdivision 4, for the period of one year prior to
the date of the request for reconsideration; and
(6) the individual is seeking employment in the substance use disorder treatment field.
Sec. 26.
Minnesota Statutes 2022, section 245C.24, subdivision 2, is amended to read:
Subd. 2.
Permanent bar to set aside a disqualification.
(a) Except as provided in
paragraphs (b) to deleted text begin (f)deleted text end new text begin (g)new text end , the commissioner may not set aside the disqualification of any
individual disqualified pursuant to this chapter, regardless of how much time has passed,
if the individual was disqualified for a crime or conduct listed in section 245C.15, subdivision
1.
(b) For an individual in the substance use disorder or corrections field who was
disqualified for a crime or conduct listed under section 245C.15, subdivision 1, and whose
disqualification was set aside prior to July 1, 2005, the commissioner must consider granting
a variance pursuant to section 245C.30 for the license holder for a program dealing primarily
with adults. A request for reconsideration evaluated under this paragraph must include a
letter of recommendation from the license holder that was subject to the prior set-aside
decision addressing the individual's quality of care to children or vulnerable adults and the
circumstances of the individual's departure from that service.
(c) If an individual who requires a background study for nonemergency medical
transportation services under section 245C.03, subdivision 12, was disqualified for a crime
or conduct listed under section 245C.15, subdivision 1, and if more than 40 years have
passed since the discharge of the sentence imposed, the commissioner may consider granting
a set-aside pursuant to section 245C.22. A request for reconsideration evaluated under this
paragraph must include a letter of recommendation from the employer. This paragraph does
not apply to a person disqualified based on a violation of sections 243.166; 609.185 to
609.205; 609.25; 609.342 to 609.3453; 609.352; 617.23, subdivision 2, clause (1), or 3,
clause (1); 617.246; or 617.247.
(d) When a licensed foster care provider adopts an individual who had received foster
care services from the provider for over six months, and the adopted individual is required
to receive a background study under section 245C.03, subdivision 1, paragraph (a), clause
(2) or (6), the commissioner may grant a variance to the license holder under section 245C.30
to permit the adopted individual with a permanent disqualification to remain affiliated with
the license holder under the conditions of the variance when the variance is recommended
by the county of responsibility for each of the remaining individuals in placement in the
home and the licensing agency for the home.
(e) For an individual 18 years of age or older affiliated with a licensed family foster
setting, the commissioner must not set aside or grant a variance for the disqualification of
any individual disqualified pursuant to this chapter, regardless of how much time has passed,
if the individual was disqualified for a crime or conduct listed in section 245C.15, subdivision
4a, paragraphs (a) and (b).
(f) In connection with a family foster setting license, the commissioner may grant a
variance to the disqualification for an individual who is under 18 years of age at the time
the background study is submitted.
new text begin
(g) In connection with foster residence settings and children's residential facilities, the
commissioner must not set aside or grant a variance for the disqualification of any individual
disqualified pursuant to this chapter, regardless of how much time has passed, if the individual
was disqualified for a crime or conduct listed in section 245C.15, subdivision 4a, paragraph
(a) or (b).
new text end
Sec. 27.
Minnesota Statutes 2022, section 245C.24, subdivision 5, is amended to read:
Subd. 5.
Five-year bar to set aside new text begin or variance new text end disqualification; children's residential
facilitiesnew text begin , foster residence settingsnew text end .
The commissioner shall not set aside new text begin or grant a variance
for new text end the disqualification of an individual in connection with a license for a children's residential
facility new text begin or foster residence setting new text end who was convicted of a felony within the past five years
for: (1) physical assault or battery; or (2) a drug-related offense.
Sec. 28.
Minnesota Statutes 2022, section 245C.24, subdivision 6, is amended to read:
Subd. 6.
Five-year bar to set aside disqualification; family foster setting.
(a) The
commissioner shall not set aside or grant a variance for the disqualification of an individual
18 years of age or older in connection with a foster family setting license if within five years
preceding the study the individual is convicted of a felony in section 245C.15, subdivision
4a, paragraph (d).
(b) In connection with a foster family setting license, the commissioner may set aside
or grant a variance to the disqualification for an individual who is under 18 years of age at
the time the background study is submitted.
new text begin
(c) In connection with a foster family setting license, the commissioner may set aside
or grant a variance to the disqualification for an individual who is under 18 years of age at
the time the background study is submitted.
new text end
Sec. 29.
Minnesota Statutes 2022, section 245C.30, is amended by adding a subdivision
to read:
new text begin Subd. 1b. new text end
new text begin Child foster care variances. new text end
new text begin
For an individual seeking a child foster care
license who is a relative of the child, the commissioner shall consider the importance of
maintaining the child's relationship with relatives as an additional significant factor in
determining whether the individual should be granted a variance.
new text end
Sec. 30.
Minnesota Statutes 2022, section 245F.09, subdivision 2, is amended to read:
Subd. 2.
Protective procedures plan.
A license holder must have a written policy and
procedure that establishes the protective procedures that program staff must follow when
a patient is in imminent danger of harming self or others. The policy must be appropriate
to the type of facility and the level of staff training. The protective procedures policy must
include:
(1) an approval signed and dated by the program director and medical director prior to
implementation. Any changes to the policy must also be approved, signed, and dated by the
current program director and the medical director prior to implementation;
(2) which protective procedures the license holder will use to prevent patients from
imminent danger of harming self or others;
(3) the emergency conditions under which the protective procedures are permitted to be
used, if any;
(4) the patient's health conditions that limit the specific procedures that may be used and
alternative means of ensuring safety;
(5) emergency resources the program staff must contact when a patient's behavior cannot
be controlled by the procedures established in the policy;
(6) the training that staff must have before using any protective procedure;
(7) documentation of approved therapeutic holds;
(8) the use of law enforcement personnel as described in subdivision 4;
(9) standards governing emergency use of seclusion. Seclusion must be used only when
less restrictive measures are ineffective or not feasible. The standards in items (i) to (vii)
must be met when seclusion is used with a patient:
(i) seclusion must be employed solely for the purpose of preventing a patient from
imminent danger of harming self or others;
(ii) seclusion rooms must be equipped in a manner that prevents patients from self-harm
using projections, windows, electrical fixtures, or hard objects, and must allow the patient
to be readily observed without being interrupted;
(iii) seclusion must be authorized by the program director, a licensed physician, a
registered nurse, or a licensed physician assistant. If one of these individuals is not present
in the facility, the program director or a licensed physician, registered nurse, or physician
assistant must be contacted and authorization must be obtained within 30 minutes of initiating
seclusion, according to written policies;
(iv) patients must not be placed in seclusion for more than 12 hours at any one time;
(v) once the condition of a patient in seclusion has been determined to be safe enough
to end continuous observation, a patient in seclusion must be observed at a minimum of
every 15 minutes for the duration of seclusion and must always be within hearing range of
program staff;
(vi) a process for program staff to use to remove a patient to other resources available
to the facility if seclusion does not sufficiently assure patient safety; and
(vii) a seclusion area may be used for other purposes, such as intensive observation, if
the room meets normal standards of care for the purpose and if the room is not locked; and
(10) physical holds may only be used when less restrictive measures are not feasible.
The standards in items (i) to (iv) must be met when physical holds are used with a patient:
(i) physical holds must be employed solely for preventing a patient from imminent
danger of harming self or others;
(ii) physical holds must be authorized by the program director, a licensed physician, a
registered nurse, or a physician assistant. If one of these individuals is not present in the
facility, the program director or a licensed physician, registered nurse, or physician assistant
must be contacted and authorization must be obtained within 30 minutes of initiating a
physical hold, according to written policies;
(iii) the patient's health concerns must be considered in deciding whether to use physical
holds and which holds are appropriate for the patient; and
(iv) only approved holds may be utilized. Pronenew text begin and contraindicatednew text end holds are not allowed
new text begin according to section 245A.211 new text end and must not be authorized.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 31.
Minnesota Statutes 2022, section 245F.14, is amended by adding a subdivision
to read:
new text begin Subd. 8. new text end
new text begin Notification to commissioner of changes in key staff positions. new text end
new text begin
A license
holder must notify the commissioner within five business days of a change or vacancy in a
key staff position. The key positions are a program director as required by subdivision 1, a
registered nurse as required by subdivision 4, and a medical director as required by
subdivision 5. The license holder must notify the commissioner of the staffing change on
a form approved by the commissioner and include the name of the staff person now assigned
to the key staff position and the staff person's qualifications for the position. The license
holder must notify the program licensor of a vacancy to discuss how the duties of the key
staff position will be fulfilled during the vacancy.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 32.
Minnesota Statutes 2022, section 245F.17, is amended to read:
245F.17 PERSONNEL FILES.
A license holder must maintain a separate personnel file for each staff member. At a
minimum, the file must contain:
(1) a completed application for employment signed by the staff member that contains
the staff member's qualifications for employment and documentation related to the applicant's
background study data, as defined in chapter 245C;
(2) documentation of the staff member's current professional license or registration, if
relevant;
(3) documentation of orientation and subsequent training;new text begin and
new text end
deleted text begin
(4) documentation of a statement of freedom from substance use problems; and
deleted text end
deleted text begin (5)deleted text end new text begin (4)new text end an annual job performance evaluation.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 33.
Minnesota Statutes 2022, section 245G.07, subdivision 4, is amended to read:
Subd. 4.
Location of service provision.
deleted text begin
The license holder may provide services at any
of the license holder's licensed locations or at another suitable location including a school,
government building, medical or behavioral health facility, or social service organization,
upon notification and approval of the commissioner. If services are provided off site from
the licensed site, the reason for the provision of services remotely must be documented.
The license holder may provide additional services under subdivision 2, clauses (2) to (5),
off-site if the license holder includes a policy and procedure detailing the off-site location
as a part of the treatment service description and the program abuse prevention plan.
deleted text end
new text begin
(a) The license holder must provide all treatment services a client receives at one of the
license holder's substance use disorder treatment licensed locations or at a location allowed
under paragraphs (b) to (f). If the services are provided at the locations in paragraphs (b) to
(d), the license holder must document in the client record the location services were provided.
new text end
new text begin
(b) The license holder may provide nonresidential individual treatment services at a
client's home or place of residence.
new text end
new text begin
(c) If the license holder provides treatment services by telehealth, the services must be
provided according to this paragraph:
new text end
new text begin
(1) the license holder must maintain a licensed physical location in Minnesota where
the license holder must offer all treatment services in subdivision 1, paragraph (a), clauses
(1) to (4), physically in-person to each client;
new text end
new text begin
(2) the license holder must meet all requirements for the provision of telehealth in sections
254B.05, subdivision 5, paragraph (f), and 256B.0625, subdivision 3b. The license holder
must document all items in section 256B.0625, subdivision 3b, paragraph (c), for each client
receiving services by telehealth, regardless of payment type or whether the client is a medical
assistance enrollee;
new text end
new text begin
(3) the license holder may provide treatment services by telehealth to clients individually;
new text end
new text begin
(4) the license holder may provide treatment services by telehealth to a group of clients
that are each in a separate physical location;
new text end
new text begin
(5) the license holder must not provide treatment services remotely by telehealth to a
group of clients meeting together in person, unless permitted under clause (7);
new text end
new text begin
(6) clients and staff may join an in-person group by telehealth if a staff member qualified
to provide the treatment service is physically present with the group of clients meeting
together in person; and
new text end
new text begin
(7) the qualified professional providing a residential group treatment service by telehealth
must be physically present on-site at the licensed residential location while the service is
being provided. If weather conditions prohibit a qualified professional from traveling to the
residential program and another qualified professional is not available to provide the service,
a qualified professional may provide a residential group treatment service by telehealth
from a location away from the licensed residential location.
new text end
new text begin
(d) The license holder may provide the additional treatment services under subdivision
2, clauses (2) to (6) and (8), away from the licensed location at a suitable location appropriate
to the treatment service.
new text end
new text begin
(e) Upon written approval from the commissioner for each satellite location, the license
holder may provide nonresidential treatment services at satellite locations that are in a
school, jail, or nursing home. A satellite location may only provide services to students of
the school, inmates of the jail, or residents of the nursing home. Schools, jails, and nursing
homes are exempt from the licensing requirements in section 245A.04, subdivision 2a, to
document compliance with building codes, fire and safety codes, health rules, and zoning
ordinances.
new text end
new text begin
(f) The commissioner may approve other suitable locations as satellite locations for
nonresidential treatment services. The commissioner may require satellite locations under
this paragraph to meet all applicable licensing requirements. The license holder may not
have more than two satellite locations per license under this paragraph.
new text end
new text begin
(g) The license holder must provide the commissioner access to all files, documentation,
staff persons, and any other information the commissioner requires at the main licensed
location for all clients served at any location under paragraphs (b) to (f).
new text end
new text begin
(h) Notwithstanding sections 245A.65, subdivision 2, and 626.557, subdivision 14, a
program abuse prevention plan is not required for satellite or other locations under paragraphs
(b) to (e). An individual abuse prevention plan is still required for any client that is a
vulnerable adult as defined in section 626.5572, subdivision 21.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 34.
Minnesota Statutes 2022, section 245G.08, subdivision 5, is amended to read:
Subd. 5.
Administration of medication and assistance with self-medication.
(a) A
license holder must meet the requirements in this subdivision if a service provided includes
the administration of medication.
(b) A staff member, other than a licensed practitioner or nurse, who is delegated by a
licensed practitioner or a registered nurse the task of administration of medication or assisting
with self-medication, must:
(1) successfully complete a medication administration training program for unlicensed
personnel through an accredited Minnesota postsecondary educational institution. A staff
member's completion of the course must be documented in writing and placed in the staff
member's personnel file;
(2) be trained according to a formalized training program that is taught by a registered
nurse and offered by the license holder. deleted text begin The training must include the process for
administration of naloxone, if naloxone is kept on site.deleted text end A staff member's completion of the
training must be documented in writing and placed in the staff member's personnel records;
or
(3) demonstrate to a registered nurse competency to perform the delegated activity. A
registered nurse must be employed or contracted to develop the policies and procedures for
administration of medication or assisting with self-administration of medication, or both.
(c) A registered nurse must provide supervision as defined in section 148.171, subdivision
23. The registered nurse's supervision must include, at a minimum, monthly on-site
supervision or more often if warranted by a client's health needs. The policies and procedures
must include:
(1) a provision that a delegation of administration of medication is limited to a method
a staff member has been trained to administer and limited to:
(i) a medication that is administered orally, topically, or as a suppository, an eye drop,
an ear drop, an inhalant, or an intranasal; and
(ii) an intramuscular injection of deleted text begin naloxonedeleted text end new text begin an opiate antagonist as defined in section
604A.04, subdivision 1,new text end or epinephrine;
(2) a provision that each client's file must include documentation indicating whether
staff must conduct the administration of medication or the client must self-administer
medication, or both;
(3) a provision that a client may carry emergency medication such as nitroglycerin as
instructed by the client's physician, advanced practice registered nurse, or physician assistant;
(4) a provision for the client to self-administer medication when a client is scheduled to
be away from the facility;
(5) a provision that if a client self-administers medication when the client is present in
the facility, the client must self-administer medication under the observation of a trained
staff member;
(6) a provision that when a license holder serves a client who is a parent with a child,
the parent may only administer medication to the child under a staff member's supervision;
(7) requirements for recording the client's use of medication, including staff signatures
with date and time;
(8) guidelines for when to inform a nurse of problems with self-administration of
medication, including a client's failure to administer, refusal of a medication, adverse
reaction, or error; and
(9) procedures for acceptance, documentation, and implementation of a prescription,
whether written, verbal, telephonic, or electronic.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 35.
Minnesota Statutes 2022, section 245G.08, subdivision 6, is amended to read:
Subd. 6.
Control of drugs.
A license holder must have and implement written policies
and procedures developed by a registered nurse that contain:
(1) a requirement that each drug must be stored in a locked compartment. A Schedule
II drug, as defined by section 152.02, subdivision 3, must be stored in a separately locked
compartment, permanently affixed to the physical plant or medication cart;
(2) a system which accounts for all scheduled drugs each shift;
(3) a procedure for recording the client's use of medication, including the signature of
the staff member who completed the administration of the medication with the time and
date;
(4) a procedure to destroy a discontinued, outdated, or deteriorated medication;
(5) a statement that only authorized personnel are permitted access to the keys to a locked
compartment;
(6) a statement that no legend drug supply for one client shall be given to another client;
and
(7) a procedure for monitoring the available supply of deleted text begin naloxonedeleted text end new text begin an opiate antagonist as
defined in section 604A.04, subdivision 1,new text end on sitedeleted text begin ,deleted text end new text begin andnew text end replenishing the deleted text begin naloxonedeleted text end supply
when neededdeleted text begin , and destroying naloxone according to clause (4)deleted 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. 36.
Minnesota Statutes 2022, section 245G.10, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin Notification to commissioner of changes in key staff positions. new text end
new text begin
A license
holder must notify the commissioner within five business days of a change or vacancy in a
key staff position. The key positions are a treatment director as required by subdivision 1,
an alcohol and drug counselor supervisor as required by subdivision 2, and a registered
nurse as required by section 245G.08, subdivision 5, paragraph (c). The license holder must
notify the commissioner of the staffing change on a form approved by the commissioner
and include the name of the staff person now assigned to the key staff position and the staff
person's qualifications for the position. The license holder must notify the program licensor
of a vacancy to discuss how the duties of the key staff position will be fulfilled during the
vacancy.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 37.
Minnesota Statutes 2023 Supplement, section 245G.22, 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 them.
(b) "Diversion" means the use of a medication for the treatment of opioid addiction being
diverted from intended use of the medication.
(c) "Guest dose" means administration of a medication used for the treatment of opioid
addiction to a person who is not a client of the program that is administering or dispensing
the medication.
(d) "Medical director" means a practitioner licensed to practice medicine in the
jurisdiction that the opioid treatment program is located who assumes responsibility for
administering all medical services performed by the program, either by performing the
services directly or by delegating specific responsibility to a practitioner of the opioid
treatment program.
(e) "Medication used for the treatment of opioid use disorder" means a medication
approved by the Food and Drug Administration for the treatment of opioid use disorder.
(f) "Minnesota health care programs" has the meaning given in section 256B.0636.
(g) "Opioid treatment program" has the meaning given in Code of Federal Regulations,
title 42, section 8.12, and includes programs licensed under this chapter.
(h) "Practitioner" means a staff member holding a current, unrestricted license to practice
medicine issued by the Board of Medical Practice or nursing issued by the Board of Nursing
and is currently registered with the Drug Enforcement Administration to order or dispense
controlled substances in Schedules II to V under the Controlled Substances Act, United
States Code, title 21, part B, section 821. deleted text begin Practitioner includes an advanced practice registered
nurse and physician assistant if the staff member receives a variance by the state opioid
treatment authority under section 254A.03 and the federal Substance Abuse and Mental
Health Services Administration.
deleted text end
(i) "Unsupervised usenew text begin " or "take-homenew text end " means the use of a medication for the treatment
of opioid use disorder dispensed for use by a client outside of the program setting.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 38.
Minnesota Statutes 2022, section 245G.22, subdivision 6, is amended to read:
Subd. 6.
Criteria for unsupervised use.
(a) To limit the potential for diversion of
medication used for the treatment of opioid use disorder to the illicit market, medication
dispensed to a client for unsupervised use shall be subject to the requirements of this
subdivision. Any client in an opioid treatment program may receive deleted text begin a single unsupervised
use dose for a day that the clinic is closed for business, including Sundays and state and
federal holidaysdeleted text end new text begin their individualized take-home doses as ordered for days that the clinic is
closed for business, on one weekend day (e.g., Sunday) and state and federal holidays, no
matter their length of time in treatment, as allowed under Code of Federal Regulations, title
42, part 8.12 (i)(1)new text end .
(b) new text begin For take-home doses beyond those allowed by paragraph (a), new text end a practitioner deleted text begin withdeleted text end
deleted text begin authority to prescribedeleted text end must review and document the criteria in deleted text begin this paragraph and paragraph
(c)deleted text end new text begin the Code of Federal Regulations, title 42, part 8.12 (i)(2),new text end when determining whether
dispensing medication for a client's unsupervised use is new text begin safe and it is new text end appropriate to
implement, increase, or extend the amount of time between visits to the program. deleted text begin The criteria
are:
deleted text end
deleted text begin
(1) absence of recent abuse of drugs including but not limited to opioids, non-narcotics,
and alcohol;
deleted text end
deleted text begin
(2) regularity of program attendance;
deleted text end
deleted text begin
(3) absence of serious behavioral problems at the program;
deleted text end
deleted text begin
(4) absence of known recent criminal activity such as drug dealing;
deleted text end
deleted text begin
(5) stability of the client's home environment and social relationships;
deleted text end
deleted text begin
(6) length of time in comprehensive maintenance treatment;
deleted text end
deleted text begin
(7) reasonable assurance that unsupervised use medication will be safely stored within
the client's home; and
deleted text end
deleted text begin
(8) whether the rehabilitative benefit the client derived from decreasing the frequency
of program attendance outweighs the potential risks of diversion or unsupervised use.
deleted text end
(c) The determination, including the basis of the determination must be documented new text begin by
a practitioner new text end in the client's medical record.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 39.
Minnesota Statutes 2022, section 245G.22, subdivision 7, is amended to read:
Subd. 7.
Restrictions for unsupervised use of methadone hydrochloride.
(a) If a
deleted text begin medical director or prescribingdeleted text end practitioner assesses deleted text begin anddeleted text end new text begin ,new text end determinesnew text begin , and documentsnew text end that
a client meets the criteria in subdivision 6 deleted text begin and may be dispensed a medication used for the
treatment of opioid addiction, the restrictions in this subdivision must be followed when
the medication to be dispensed is methadone hydrochloride. The results of the assessment
must be contained in the client file. The number of unsupervised use medication doses per
week in paragraphs (b) to (d) is in addition to the number of unsupervised use medication
doses a client may receive for days the clinic is closed for business as allowed by subdivision
6, paragraph (a)deleted text end new text begin and that a patient is safely able to manage unsupervised doses of methadone,
the number of take-home doses the client receives must be limited by the number allowed
by the Code of Federal Regulations, title 42, part 8.12 (i)(3)new text end .
deleted text begin
(b) During the first 90 days of treatment, the unsupervised use medication supply must
be limited to a maximum of a single dose each week and the client shall ingest all other
doses under direct supervision.
deleted text end
deleted text begin
(c) In the second 90 days of treatment, the unsupervised use medication supply must be
limited to two doses per week.
deleted text end
deleted text begin
(d) In the third 90 days of treatment, the unsupervised use medication supply must not
exceed three doses per week.
deleted text end
deleted text begin
(e) In the remaining months of the first year, a client may be given a maximum six-day
unsupervised use medication supply.
deleted text end
deleted text begin
(f) After one year of continuous treatment, a client may be given a maximum two-week
unsupervised use medication supply.
deleted text end
deleted text begin
(g) After two years of continuous treatment, a client may be given a maximum one-month
unsupervised use medication supply, but must make monthly visits to the program.
deleted 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. 40.
Minnesota Statutes 2023 Supplement, section 245G.22, subdivision 17, is amended
to read:
Subd. 17.
Policies and procedures.
(a) A license holder must develop and maintain the
policies and procedures required in this subdivision.
(b) For a program that is not open every day of the year, the license holder must maintain
a policy and procedure that covers requirements under section 245G.22, subdivisions 6 and
7. Unsupervised use of medication used for the treatment of opioid use disorder for days
that the program is closed for businessdeleted text begin , including but not limited to Sundaysdeleted text end new text begin on one weekend
daynew text end and state and federal holidays, must meet the requirements under section 245G.22,
subdivisions 6 and 7.
(c) The license holder must maintain a policy and procedure that includes specific
measures to reduce the possibility of diversion. The policy and procedure must:
(1) specifically identify and define the responsibilities of the medical and administrative
staff for performing diversion control measures; and
(2) include a process for contacting no less than five percent of clients who have
unsupervised use of medication, excluding clients approved solely under subdivision 6,
paragraph (a), to require clients to physically return to the program each month. The system
must require clients to return to the program within a stipulated time frame and turn in all
unused medication containers related to opioid use disorder treatment. The license holder
must document all related contacts on a central log and the outcome of the contact for each
client in the client's record. The medical director must be informed of each outcome that
results in a situation in which a possible diversion issue was identified.
(d) Medication used for the treatment of opioid use disorder must be ordered,
administered, and dispensed according to applicable state and federal regulations and the
standards set by applicable accreditation entities. If a medication order requires assessment
by the person administering or dispensing the medication to determine the amount to be
administered or dispensed, the assessment must be completed by an individual whose
professional scope of practice permits an assessment. For the purposes of enforcement of
this paragraph, the commissioner has the authority to monitor the person administering or
dispensing the medication for compliance with state and federal regulations and the relevant
standards of the license holder's accreditation agency and may issue licensing actions
according to sections 245A.05, 245A.06, and 245A.07, based on the commissioner's
determination of noncompliance.
(e) A counselor in an opioid treatment program must not supervise more than 50 clients.
(f) Notwithstanding paragraph (e), from July 1, 2023, to June 30, 2024, a counselor in
an opioid treatment program may supervise up to 60 clients. The license holder may continue
to serve a client who was receiving services at the program on June 30, 2024, at a counselor
to client ratio of up to one to 60 and is not required to discharge any clients in order to return
to the counselor to client ratio of one to 50. The license holder may not, however, serve a
new client after June 30, 2024, unless the counselor who would supervise the new client is
supervising fewer than 50 existing clients.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 41.
Minnesota Statutes 2023 Supplement, section 256.046, subdivision 3, is amended
to read:
Subd. 3.
Administrative disqualification of child care providers caring for children
receiving child care assistance.
(a) The department shall pursue an administrative
disqualification, if the child care provider is accused of committing an intentional program
violation, in lieu of a criminal action when it has not been pursued. Intentional program
violations include intentionally making false or misleading statements; intentionally
misrepresenting, concealing, or withholding facts; and repeatedly and intentionally violating
program regulations under chapters 119B and 245E. Intent may be proven by demonstrating
a pattern of conduct that violates program rules under chapters 119B and 245E.
(b) To initiate an administrative disqualification, the commissioner must deleted text begin maildeleted text end new text begin sendnew text end
written notice deleted text begin by certified maildeleted text end new text begin using a signature-verified confirmed delivery methodnew text end to the
provider against whom the action is being taken. Unless otherwise specified under chapter
119B or 245E or Minnesota Rules, chapter 3400, the commissioner must deleted text begin maildeleted text end new text begin sendnew text end the
written notice at least 15 calendar days before the adverse action's effective date. The notice
shall state (1) the factual basis for the agency's determination, (2) the action the agency
intends to take, (3) the dollar amount of the monetary recovery or recoupment, if known,
and (4) the provider's right to appeal the agency's proposed action.
(c) The provider may appeal an administrative disqualification by submitting a written
request to the Department of Human Services, Appeals Division. A provider's request must
be received by the Appeals Division no later than 30 days after the date the commissioner
mails the notice.
(d) The provider's appeal request must contain the following:
(1) each disputed item, the reason for the dispute, and, if applicable, an estimate of the
dollar amount involved for each disputed item;
(2) the computation the provider believes to be correct, if applicable;
(3) the statute or rule relied on for each disputed item; and
(4) the name, address, and telephone number of the person at the provider's place of
business with whom contact may be made regarding the appeal.
(e) On appeal, the issuing agency bears the burden of proof to demonstrate by a
preponderance of the evidence that the provider committed an intentional program violation.
(f) The hearing is subject to the requirements of sections 256.045 and 256.0451. The
human services judge may combine a fair hearing and administrative disqualification hearing
into a single hearing if the factual issues arise out of the same or related circumstances and
the provider receives prior notice that the hearings will be combined.
(g) A provider found to have committed an intentional program violation and is
administratively disqualified shall be disqualified, for a period of three years for the first
offense and permanently for any subsequent offense, from receiving any payments from
any child care program under chapter 119B.
(h) Unless a timely and proper appeal made under this section is received by the
department, the administrative determination of the department is final and binding.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2024.
new text end
Sec. 42.
Minnesota Statutes 2023 Supplement, section 256B.064, subdivision 4, is amended
to read:
Subd. 4.
Notice.
(a) The department shall serve the notice required under subdivision 2
deleted text begin by certified mail atdeleted text end new text begin using a signature-verified confirmed delivery method tonew text end the address
submitted to the department by the individual or entity. Service is complete upon mailing.
(b) The department shall give notice in writing to a recipient placed in the Minnesota
restricted recipient program under section 256B.0646 and Minnesota Rules, part 9505.2200.
The department shall send the notice by first class mail to the recipient's current address on
file with the department. A recipient placed in the Minnesota restricted recipient program
may contest the placement by submitting a written request for a hearing to the department
within 90 days of the notice being mailed.
Sec. 43.
Minnesota Statutes 2022, section 260E.33, subdivision 2, as amended by Laws
2024, chapter 80, article 8, section 44, is amended to read:
Subd. 2.
Request for reconsideration.
(a) Except as provided under subdivision 5, an
individual or facility that the commissioner of human services; commissioner of children,
youth, and families; a local welfare agency; or the commissioner of education determines
has maltreated a child, an interested person acting on behalf of the child, regardless of the
determination, who contests the investigating agency's final determination regarding
maltreatment may request the investigating agency to reconsider its final determination
regarding maltreatment. The request for reconsideration must be submitted in writingnew text begin or
submitted in the provider licensing and reporting hubnew text end to the investigating agency within 15
calendar days after receipt of notice of the final determination regarding maltreatment or,
if the request is made by an interested person who is not entitled to notice, within 15 days
after receipt of the notice by the parent or guardian of the child. If mailed, the request for
reconsideration must be postmarked and sent to the investigating agency within 15 calendar
days of the individual's or facility's receipt of the final determination. If the request for
reconsideration is made by personal service, it must be received by the investigating agency
within 15 calendar days after the individual's or facility's receipt of the final determination.new text begin
Upon implementation of the provider licensing and reporting hub, the individual or facility
must use the hub to request reconsideration. The reconsideration must be received by the
commissioner within 15 calendar days of the individual's receipt of the notice of
disqualification.
new text end
(b) An individual who was determined to have maltreated a child under this chapter and
who was disqualified on the basis of serious or recurring maltreatment under sections
245C.14 and 245C.15 may request reconsideration of the maltreatment determination and
the disqualification. The request for reconsideration of the maltreatment determination and
the disqualification must be submitted within 30 calendar days of the individual's receipt
of the notice of disqualification under sections 245C.16 and 245C.17. If mailed, the request
for reconsideration of the maltreatment determination and the disqualification must be
postmarked and sent to the investigating agency within 30 calendar days of the individual's
receipt of the maltreatment determination and notice of disqualification. If the request for
reconsideration is made by personal service, it must be received by the investigating agency
within 30 calendar days after the individual's receipt of the notice of disqualification.
Sec. 44.
Laws 2024, chapter 80, article 2, section 6, subdivision 2, is amended to read:
Subd. 2.
Change in ownership.
(a) If the commissioner determines that there is a change
in ownership, the commissioner shall require submission of a new license application. This
subdivision does not apply to a licensed program or service located in a home where the
license holder resides. A change in ownership occurs when:
(1) new text begin except as provided in paragraph (b), new text end the license holder sells or transfers 100 percent
of the property, stock, or assets;
(2) the license holder merges with another organization;
(3) the license holder consolidates with two or more organizations, resulting in the
creation of a new organization;
(4) there is a change to the federal tax identification number associated with the license
holder; or
(5) new text begin except as provided in paragraph (b), new text end all controlling individuals deleted text begin associated withdeleted text end new text begin fornew text end
the original deleted text begin applicationdeleted text end new text begin licensenew text end have changed.
(b) deleted text begin Notwithstandingdeleted text end new text begin For changes undernew text end paragraph (a), deleted text begin clausesdeleted text end new text begin clausenew text end (1) deleted text begin anddeleted text end new text begin ornew text end (5), no
change in ownership has occurrednew text begin and a new license application is not requirednew text end if at least
one controlling individual has been deleted text begin listeddeleted text end new text begin affiliatednew text end as a controlling individual for the license
for at least the previous 12 monthsnew text begin immediately preceding the changenew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 45.
Laws 2024, chapter 80, article 2, section 6, subdivision 3, is amended to read:
Subd. 3.
new text begin Standard new text end change of ownership process.
(a) When a change in ownership is
proposed and the party intends to assume operation without an interruption in service longer
than 60 days after acquiring the program or service, the license holder must provide the
commissioner with written notice of the proposed change on a form provided by the
commissioner at least deleted text begin 60deleted text end new text begin 90new text end days before the anticipated date of the change in ownership.
For purposes of this deleted text begin subdivision and subdivision 4deleted text end new text begin sectionnew text end , "party" means the party that
intends to operate the service or program.
(b) The party must submit a license application under this chapter on the form and in
the manner prescribed by the commissioner at least deleted text begin 30deleted text end new text begin 90new text end days before the change in
ownership is new text begin anticipated to be new text end complete and must include documentation to support the
upcoming change. The party must comply with background study requirements under chapter
245C and shall pay the application fee required under section 245A.10.
(c) The commissioner may streamline application procedures when the party is an existing
license holder under this chapter and is acquiring a program licensed under this chapter or
service in the same service class as one or more licensed programs or services the party
operates and those licenses are in substantial compliance. For purposes of this subdivision,
"substantial compliance" means within the previous 12 months the commissioner did not
(1) issue a sanction under section 245A.07 against a license held by the party, or (2) make
a license held by the party conditional according to section 245A.06.
(d) deleted text begin Except when a temporary change in ownership license is issued pursuant to
subdivision 4deleted text end new text begin While the standard change of ownership process is pendingnew text end , the existing
license holder deleted text begin is solelydeleted text end new text begin remainsnew text end responsible for operating the program according to applicable
laws and rules until a license under this chapter is issued to the party.
(e) If a licensing inspection of the program or service was conducted within the previous
12 months and the existing license holder's license record demonstrates substantial
compliance with the applicable licensing requirements, the commissioner may waive the
party's inspection required by section 245A.04, subdivision 4. The party must submit to the
commissioner (1) proof that the premises was inspected by a fire marshal or that the fire
marshal deemed that an inspection was not warranted, and (2) proof that the premises was
inspected for compliance with the building code or that no inspection was deemed warranted.
(f) If the party is seeking a license for a program or service that has an outstanding action
under section 245A.06 or 245A.07, the party must submit a letter as part of the application
process identifying how the party has or will come into full compliance with the licensing
requirements.
(g) The commissioner shall evaluate the party's application according to section 245A.04,
subdivision 6. If the commissioner determines that the party has remedied or demonstrates
the ability to remedy the outstanding actions under section 245A.06 or 245A.07 and has
determined that the program otherwise complies with all applicable laws and rules, the
commissioner shall issue a license or conditional license under this chapter.new text begin A conditional
license issued under this section is final and not subject to reconsideration under section
new text end new text begin 142B.16, subdivision 4.new text end The conditional license remains in effect until the commissioner
determines that the grounds for the action are corrected or no longer exist.
(h) The commissioner may deny an application as provided in section 245A.05. An
applicant whose application was denied by the commissioner may appeal the denial according
to section 245A.05.
(i) This subdivision does not apply to a licensed program or service located in a home
where the license holder resides.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 46.
Laws 2024, chapter 80, article 2, section 6, is amended by adding a subdivision
to read:
new text begin Subd. 3a. new text end
new text begin Emergency change in ownership process. new text end
new text begin
(a) In the event of a death of a
license holder or sole controlling individual or a court order or other event that results in
the license holder being inaccessible or unable to operate the program or service, a party
may submit a request to the commissioner to allow the party to assume operation of the
program or service under an emergency change in ownership process to ensure persons
continue to receive services while the commissioner evaluates the party's license application.
new text end
new text begin
(b) To request the emergency change of ownership process, the party must immediately:
new text end
new text begin
(1) notify the commissioner of the event resulting in the inability of the license holder
to operate the program and of the party's intent to assume operations; and
new text end
new text begin
(2) provide the commissioner with documentation that demonstrates the party has a legal
or legitimate ownership interest in the program or service if applicable and is able to operate
the program or service.
new text end
new text begin
(c) If the commissioner approves the party to continue operating the program or service
under an emergency change in ownership process, the party must:
new text end
new text begin
(1) request to be added as a controlling individual or license holder to the existing license;
new text end
new text begin
(2) notify persons receiving services of the emergency change in ownership in a manner
approved by the commissioner;
new text end
new text begin
(3) submit an application for a new license within 30 days of approval;
new text end
new text begin
(4) comply with the background study requirements under chapter 245C; and
new text end
new text begin
(5) pay the application fee required under section 142B.12.
new text end
new text begin
(d) While the emergency change of ownership process is pending, a party approved
under this subdivision is responsible for operating the program under the existing license
according to applicable laws and rules until a new license under this chapter is issued.
new text end
new text begin
(e) The provisions in subdivision 3, paragraphs (c), (g), and (h), apply to this subdivision.
new text end
new text begin
(f) Once a party is issued a new license or has decided not to seek a new license, the
commissioner must close the existing license.
new text end
new text begin
(g) This subdivision applies to any program or service licensed under this chapter.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 47.
Laws 2024, chapter 80, article 2, section 6, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin Failure to comply. new text end
new text begin
If the commissioner finds that the applicant or license holder
has not fully complied with this section, the commissioner may impose a licensing sanction
under section 142B.15, 142B.16, or 142B.18.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 48.
Laws 2024, chapter 80, article 2, section 10, subdivision 1, is amended to read:
Subdivision 1.
Sanctions; appeals; license.
(a) In addition to making a license conditional
under section 142B.16, the commissioner may suspend or revoke the license, impose a fine,
or secure an injunction against the continuing operation of the program of a license holder
who:
(1) does not comply with applicable law or rule;
(2) has nondisqualifying background study information, as described in section 245C.05,
subdivision 4, that reflects on the license holder's ability to safely provide care to foster
children; or
(3) has an individual living in the household where the licensed services are provided
or is otherwise subject to a background study, and the individual has nondisqualifying
background study information, as described in section 245C.05, subdivision 4, that reflects
on the license holder's ability to safely provide care to foster children.
When applying sanctions authorized under this section, the commissioner shall consider
the nature, chronicity, or severity of the violation of law or rule and the effect of the violation
on the health, safety, or rights of persons served by the program.
(b) If a license holder appeals the suspension or revocation of a license and the license
holder continues to operate the program pending a final order on the appeal, the commissioner
shall issue the license holder a temporary provisional license. Unless otherwise specified
by the commissioner, variances in effect on the date of the license sanction under appeal
continue under the temporary provisional license. new text begin The commissioner may include terms the
license holder must follow pending a final order on the appeal.new text end new text begin new text end If a license holder fails to
comply with applicable law or rule while operating under a temporary provisional license,
the commissioner may impose additional sanctions under this section and section 142B.16
and may terminate any prior variance. If a temporary provisional license is set to expire, a
new temporary provisional license shall be issued to the license holder upon payment of
any fee required under section 142B.12. The temporary provisional license shall expire on
the date the final order is issued. If the license holder prevails on the appeal, a new
nonprovisional license shall be issued for the remainder of the current license period.
(c) If a license holder is under investigation and the license issued under this chapter is
due to expire before completion of the investigation, the program shall be issued a new
license upon completion of the reapplication requirements and payment of any applicable
license fee. Upon completion of the investigation, a licensing sanction may be imposed
against the new license under this section or section 142B.16 or 142B.20.
(d) Failure to reapply or closure of a license issued under this chapter by the license
holder prior to the completion of any investigation shall not preclude the commissioner
from issuing a licensing sanction under this section or section 142B.16 at the conclusion of
the investigation.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 49.
Laws 2024, chapter 80, article 2, section 10, subdivision 6, is amended to read:
Subd. 6.
Appeal of multiple sanctions.
(a) When the license holder appeals more than
one licensing action or sanction that were simultaneously issued by the commissioner, the
license holder shall specify the actions or sanctions that are being appealed.
(b) If there are different timelines prescribed in statutes for the licensing actions or
sanctions being appealed, the license holder must submit the appeal within the longest of
those timelines specified in statutes.
(c) The appeal must be made in writing by certified mail deleted text begin ordeleted text end new text begin ,new text end personal servicenew text begin , or through
the provider licensing and reporting hubnew text end . If mailed, the appeal must be postmarked and sent
to the commissioner within the prescribed timeline with the first day beginning the day after
the license holder receives the certified letter. If a request is made by personal service, it
must be received by the commissioner within the prescribed timeline with the first day
beginning the day after the license holder receives the certified letter.new text begin If the appeal is made
through the provider hub, the appeal must be received by the commissioner within the
prescribed timeline with the first day beginning the day after the commissioner issued the
order through the hub.
new text end
(d) When there are different timelines prescribed in statutes for the appeal of licensing
actions or sanctions simultaneously issued by the commissioner, the commissioner shall
specify in the notice to the license holder the timeline for appeal as specified under paragraph
(b).
Sec. 50. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2022, section 245C.125,
new text end
new text begin
is repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Statutes 2023 Supplement, section 245C.08, subdivision 2,
new text end
new text begin
is repealed.
new text end
new text begin
(c)
new text end
new text begin
Minnesota Rules, part 9502.0425, subpart 5,
new text end
new text begin
is repealed.
new text end
new text begin
(d)
new text end
new text begin
Laws 2024, chapter 80, article 2, section 6, subdivision 4,
new text end
new text begin
is repealed.
new text end
ARTICLE 11
SUBSTANCE USE DISORDER TREATMENT LICENSING
Section 1.
Minnesota Statutes 2022, section 245G.11, subdivision 5, is amended to read:
Subd. 5.
Alcohol and drug counselor qualifications.
(a) An alcohol and drug counselor
must either be licensed or exempt from licensure under chapter 148F.
(b) An individual who is exempt from licensure under chapter 148F, must meet one of
the following additional requirements:
(1) completion of at least a baccalaureate degree with a major or concentration in social
work, nursing, sociology, human services, or psychology, or licensure as a registered nurse;
successful completion of a minimum of 120 hours of classroom instruction in which each
of the core functions listed in chapter 148F is covered; and successful completion of 440
hours of supervised experience as an alcohol and drug counselor, either as a student or a
staff member;
(2) completion of at least 270 hours of drug counselor training in which each of the core
functions listed in chapter 148F is covered, and successful completion of 880 hours of
supervised experience as an alcohol and drug counselor, either as a student or as a staff
member;
(3) current certification as an alcohol and drug counselor or alcohol and drug counselor
reciprocal, through the evaluation process established by the International Certification and
Reciprocity Consortium Alcohol and Other Drug Abuse, Inc.;
(4) completion of a bachelor's degree including 480 hours of alcohol and drug counseling
education from an accredited school or educational program and 880 hours of alcohol and
drug counseling practicum; deleted text begin or
deleted text end
(5) employment in a program formerly licensed under Minnesota Rules, parts 9530.5000
to 9530.6400, and successful completion of 6,000 hours of supervised work experience in
a licensed program as an alcohol and drug counselor prior to January 1, 2005deleted text begin .deleted text end new text begin ;
new text end
new text begin
(6) qualification as a mental health professional under section 245I.04, subdivision 2,
and completion of training in addiction, co-occurring disorders, or substance use disorder
diagnosis and treatment as required under section 245G.13, subdivision 2, paragraph (f).
An individual exempt from licensure under this clause must engage in practice exclusively
within the scope of practice under the individual's professional licensing statutes. This clause
expires December 31, 2026;
new text end
new text begin
(7) qualification as a clinical trainee under section 245I.04, subdivision 6. An individual
exempt from licensure under this clause must practice under the supervision of a mental
health professional who is practicing in accordance with this section. This clause expires
on December 31, 2026; and
new text end
new text begin
(8) licensure as a registered nurse under section 148.171, subdivision 20, and completion
of training in addiction, co-occurring disorders, or substance use disorder diagnosis and
treatment as required under section 245G.13, subdivision 2, paragraph (f). An individual
exempt from licensure under this clause must engage in practice exclusively within the
scope of practice under the individual's professional licensing statutes. This clause expires
on December 31, 2026.
new text end
(c) An alcohol and drug counselor may not provide a treatment service that requires
professional licensure unless the individual possesses the necessary license. For the purposes
of enforcing this section, the commissioner has the authority to monitor a service provider's
compliance with the relevant standards of the service provider's profession and may issue
licensing actions against the license holder according to sections 245A.05, 245A.06, and
245A.07, based on the commissioner's determination of noncompliance.
Sec. 2.
Minnesota Statutes 2022, section 245G.11, subdivision 7, is amended to read:
Subd. 7.
Treatment coordination provider qualifications.
(a) Treatment coordination
must be provided by qualified staff. An individual is qualified to provide treatment
coordination if the individual meets the qualifications of an alcohol and drug counselor
under subdivision 5 or if the individual:
(1) is skilled in the process of identifying and assessing a wide range of client needs;
(2) is knowledgeable about local community resources and how to use those resources
for the benefit of the client;
(3) has successfully completed deleted text begin 30 hours of classroom instruction on treatment
coordination for an individual with substance use disorderdeleted text end new text begin 15 hours of training on treatment
coordination for an individual with substance use disordernew text end ;new text begin and
new text end
(4) deleted text begin has eitherdeleted text end new text begin meets one of the following criterianew text end :
(i) new text begin has new text end a bachelor's degree in one of the behavioral sciences or related fieldsnew text begin and at least
1,000 hours of supervised experience working with individuals with substance use disordernew text end ;
deleted text begin or
deleted text end
(ii) new text begin is a mental health practitioner qualified under section 245I.04, subdivision 4; or
new text end
new text begin (iii) has a new text end current certification as an alcohol and drug counselor, level I, by the Upper
Midwest Indian Council on Addictive Disordersdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(5) has at least 2,000 hours of supervised experience working with individuals with
substance use disorder.
deleted text end
(b) A treatment coordinator must receive at least one hour of supervision regarding
individual service delivery from an alcohol and drug counselor, or a mental health
professional who has substance use treatment and assessments within the scope of their
practice, on a monthly basis.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective upon federal approval. The commissioner
of human services must notify the revisor of statutes when federal approval is obtained.
new text end
ARTICLE 12
MISCELLANEOUS
Section 1.
Minnesota Statutes 2022, section 148F.025, subdivision 2, is amended to read:
Subd. 2.
Education requirements for licensure.
An applicant for licensure must submit
evidence satisfactory to the board that the applicant has:
(1) received a bachelor's new text begin or master's new text end degree from an accredited school or educational
program; and
(2) received 18 semester credits or 270 clock hours of academic course work and 880
clock hours of supervised alcohol and drug counseling practicum from an accredited school
or education program. The course work and practicum do not have to be part of the bachelor's
degree earned under clause (1). The academic course work must be in the following areas:
(i) an overview of the transdisciplinary foundations of alcohol and drug counseling,
including theories of chemical dependency, the continuum of care, and the process of change;
(ii) pharmacology of substance abuse disorders and the dynamics of addiction, including
substance use disorder treatment with medications for opioid use disorder;
(iii) professional and ethical responsibilities;
(iv) multicultural aspects of chemical dependency;
(v) co-occurring disorders; and
(vi) the core functions defined in section 148F.01, subdivision 10.
Sec. 2.
Minnesota Statutes 2023 Supplement, section 245.991, subdivision 1, is amended
to read:
Subdivision 1.
Establishment.
The commissioner of human services must establish new text begin the
new text end projects for assistance in transition from homelessness program to prevent or end
homelessness for people with serious mental illnessnew text begin , substance use disorder,new text end or co-occurring
substance use disorder and ensure the commissioner achieves the goals of the housing
mission statement in section 245.461, subdivision 4.
Sec. 3.
Minnesota Statutes 2023 Supplement, section 254B.04, subdivision 1a, is amended
to read:
Subd. 1a.
Client eligibility.
(a) Persons eligible for benefits under Code of Federal
Regulations, title 25, part 20, who meet the income standards of section 256B.056,
subdivision 4, and are not enrolled in medical assistance, are entitled to behavioral health
fund services. State money appropriated for this paragraph must be placed in a separate
account established for this purpose.
(b) Persons with dependent children who are determined to be in need of substance use
disorder treatment pursuant to an assessment under section 260E.20, subdivision 1, or in
need of chemical dependency treatment pursuant to a case plan under section 260C.201,
subdivision 6, or 260C.212, shall be assisted by the local agency to access needed treatment
services. Treatment services must be appropriate for the individual or family, which may
include long-term care treatment or treatment in a facility that allows the dependent children
to stay in the treatment facility. The county shall pay for out-of-home placement costs, if
applicable.
(c) Notwithstanding paragraph (a), persons enrolled in medical assistance are eligible
for room and board services under section 254B.05, subdivision 5, paragraph (b), clause
(12).
(d) A client is eligible to have substance use disorder treatment paid for with funds from
the behavioral health fund when the client:
(1) is eligible for MFIP as determined under chapter 256J;
(2) is eligible for medical assistance as determined under Minnesota Rules, parts
9505.0010 to 9505.0150;
(3) is eligible for general assistance, general assistance medical care, or work readiness
as determined under Minnesota Rules, parts 9500.1200 to 9500.1318; or
(4) has income that is within current household size and income guidelines for entitled
persons, as defined in this subdivision and subdivision 7.
(e) Clients who meet the financial eligibility requirement in paragraph (a) and who have
a third-party payment source are eligible for the behavioral health fund if the third-party
payment source pays less than 100 percent of the cost of treatment services for eligible
clients.
(f) A client is ineligible to have substance use disorder treatment services paid for with
behavioral health fund money if the client:
(1) has an income that exceeds current household size and income guidelines for entitled
persons as defined in this subdivision and subdivision 7; or
(2) has an available third-party payment source that will pay the total cost of the client's
treatment.
(g) A client who is disenrolled from a state prepaid health plan during a treatment episode
is eligible for continued treatment service that is paid for by the behavioral health fund until
the treatment episode is completed or the client is re-enrolled in a state prepaid health plan
if the client:
(1) continues to be enrolled in MinnesotaCare, medical assistance, or general assistance
medical care; or
(2) is eligible according to paragraphs (a) and (b) and is determined eligible by a local
agency under section 254B.04.
(h) When a county commits a client under chapter 253B to a regional treatment center
for substance use disorder services and the client is ineligible for the behavioral health fund,
the county is responsible for the payment to the regional treatment center according to
section 254B.05, subdivision 4.
new text begin
(i) Notwithstanding paragraph (a), persons enrolled in MinnesotaCare are eligible for
room and board services under section 254B.05, subdivision 1a, paragraph (e).
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. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 4.
Minnesota Statutes 2023 Supplement, section 256D.01, subdivision 1a, is amended
to read:
Subd. 1a.
Standards.
(a) A principal objective in providing general assistance is to
provide for single adults, childless couples, or children as defined in section 256D.02,
subdivision 2b, ineligible for federal programs who are unable to provide for themselves.
The minimum standard of assistance determines the total amount of the general assistance
grant without separate standards for shelter, utilities, or other needs.
(b) The standard of assistance for an assistance unit consisting of a recipient who is
childless and unmarried or living apart from children and spouse and who does not live with
a parent or parents or a legal custodian, or consisting of a childless couple, is $350 per month
effective October 1, 2024, and must be adjusted by a percentage equal to the change in the
consumer price index as of January 1 every year, beginning October 1, 2025.
(c) For an assistance unit consisting of a single adult who lives with a parent or parents,
the general assistance standard of assistance is $350 per month effective October 1, deleted text begin 2023deleted text end new text begin
2024new text end , and must be adjusted by a percentage equal to the change in the consumer price index
as of January 1 every year, beginning October 1, 2025. Benefits received by a responsible
relative of the assistance unit under the Supplemental Security Income program, a workers'
compensation program, the Minnesota supplemental aid program, or any other program
based on the responsible relative's disability, and any benefits received by a responsible
relative of the assistance unit under the Social Security retirement program, may not be
counted in the determination of eligibility or benefit level for the assistance unit. Except as
provided below, the assistance unit is ineligible for general assistance if the available
resources or the countable income of the assistance unit and the parent or parents with whom
the assistance unit lives are such that a family consisting of the assistance unit's parent or
parents, the parent or parents' other family members and the assistance unit as the only or
additional minor child would be financially ineligible for general assistance. For the purposes
of calculating the countable income of the assistance unit's parent or parents, the calculation
methods must follow the provisions under section 256P.06.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 5.
Minnesota Statutes 2022, section 256I.04, subdivision 2f, is amended to read:
Subd. 2f.
Required services.
(a) In deleted text begin licensed and registereddeleted text end new text begin authorizednew text end settings under
subdivision 2a, providers shall ensure that participants have at a minimum:
(1) food preparation and service for three nutritional meals a day on site;
(2) a bed, clothing storage, linen, bedding, laundering, and laundry supplies or service;
(3) housekeeping, including cleaning and lavatory supplies or service; and
(4) maintenance and operation of the building and grounds, including heat, water, garbage
removal, electricity, telephone for the site, cooling, supplies, and parts and tools to repair
and maintain equipment and facilities.
(b) In addition, when providers serve participants described in subdivision 1, paragraph
(c), the providers are required to assist the participants in applying for continuing housing
support payments before the end of the eligibility period.
Sec. 6.
Minnesota Statutes 2023 Supplement, section 256I.05, subdivision 1a, is amended
to read:
Subd. 1a.
Supplementary service rates.
(a) Subject to the provisions of section 256I.04,
subdivision 3, the agency may negotiate a payment not to exceed $494.91 for other services
necessary to provide room and board if the residence is licensed by or registered by the
Department of Health, or licensed by the Department of Human Services to provide services
in addition to room and board, and if the provider of services is not also concurrently
receiving funding for services for a recipient in the residence under the following programs
or funding sources: (1) home and community-based waiver services under chapter 256S or
section 256B.0913, 256B.092, or 256B.49; (2) personal care assistance under section
256B.0659; (3) community first services and supports under section 256B.85; or (4) services
for adults with mental illness grants under section 245.73. If funding is available for other
necessary services through a home and community-based waiver under chapter 256S, or
section 256B.0913, 256B.092, or 256B.49; personal care assistance services under section
256B.0659; community first services and supports under section 256B.85; or services for
adults with mental illness grants under section 245.73, then the housing support rate is
limited to the rate set in subdivision 1. Unless otherwise provided in law, in no case may
the supplementary service rate exceed $494.91. The registration and licensure requirement
does not apply to establishments which are exempt from state licensure because they are
located on Indian reservations and for which the tribe has prescribed health and safety
requirements. Service payments under this section may be prohibited under rules to prevent
the supplanting of federal funds with state funds.
deleted text begin
(b) The commissioner is authorized to make cost-neutral transfers from the housing
support fund for beds under this section to other funding programs administered by the
department after consultation with the agency in which the affected beds are located. The
commissioner may also make cost-neutral transfers from the housing support fund to agencies
for beds permanently removed from the housing support census under a plan submitted by
the agency and approved by the commissioner. The commissioner shall report the amount
of any transfers under this provision annually to the legislature.
deleted text end
deleted text begin (c)deleted text end new text begin (b)new text end Agencies must not negotiate supplementary service rates with providers of housing
support that are licensed as board and lodging with special services and that do not encourage
a policy of sobriety on their premises and make referrals to available community services
for volunteer and employment opportunities for residents.
Sec. 7.
Minnesota Statutes 2023 Supplement, section 256I.05, subdivision 11, is amended
to read:
Subd. 11.
deleted text begin Transfer of emergency shelter fundsdeleted text end new text begin Cost-neutral transfers from the
housing support fundnew text end .
new text begin
(a) The commissioner is authorized to make cost-neutral transfers
from the housing support fund for beds under this section to other funding programs
administered by the department after consultation with the agency in which the affected
beds are located.
new text end
new text begin
(b) The commissioner may also make cost-neutral transfers from the housing support
fund to agencies for beds removed from the housing support census under a plan submitted
by the agency and approved by the commissioner.
new text end
deleted text begin (a)deleted text end new text begin (c)new text end The commissioner shall make a cost-neutral transfer of funding from the housing
support fund to the agency for emergency shelter beds removed from the housing support
census under a deleted text begin biennialdeleted text end plan submitted by the agency and approved by the commissioner.new text begin
Plans submitted under this paragraph must include anticipated and actual outcomes for
persons experiencing homelessness in emergency shelters.
new text end
deleted text begin The plandeleted text end new text begin (d) Plans submitted under paragraph (b) or (c)new text end must describe: (1) deleted text begin anticipated
and actual outcomes for persons experiencing homelessness in emergency shelters; (2)deleted text end
improved efficiencies in administration; deleted text begin (3)deleted text end new text begin (2)new text end requirements for individual eligibility; and
deleted text begin (4)deleted text end new text begin (3)new text end plans for quality assurance monitoring and quality assurance outcomes. The
commissioner shall review deleted text begin thedeleted text end agency deleted text begin plandeleted text end new text begin plansnew text end to monitor implementation and outcomes
at least biennially, and more frequently if the commissioner deems necessary.
deleted text begin (b) Thedeleted text end new text begin (e)new text end Funding under paragraph deleted text begin (a)deleted text end new text begin (b), (c), or (d)new text end may be used for the provision
of room and board or supplemental services according to section 256I.03, subdivisions 14a
and 14b. Providers must meet the requirements of section 256I.04, subdivisions 2a to 2f.
Funding must be allocated annually, and the room and board portion of the allocation shall
be adjusted according to the percentage change in the housing support room and board rate.
deleted text begin The room and board portion of the allocation shall be determined at the time of transfer.deleted text end
The commissioner or agency may return beds to the housing support fund with 180 days'
notice, including financial reconciliation.
Sec. 8.
Minnesota Statutes 2023 Supplement, section 342.06, is amended to read:
342.06 APPROVAL OF CANNABIS FLOWER, PRODUCTS, AND
CANNABINOIDS.
(a) For the purposes of this section, "product category" means a type of product that
may be sold in different sizes, distinct packaging, or at various prices but is still created
using the same manufacturing or agricultural processes. A new or additional stock keeping
unit (SKU) or Universal Product Code (UPC) shall not prevent a product from being
considered the same type as another unit. All other terms have the meanings provided in
section 342.01.
(b) The office shall approve product categories of cannabis flower, cannabis products,
lower-potency hemp edibles, and hemp-derived consumer products for retail sale.
(c) The office may establish limits on the total THC of cannabis flower, cannabis products,
and hemp-derived consumer products. As used in this paragraph, "total THC" means the
sum of the percentage by weight of tetrahydrocannabinolic acid multiplied by 0.877 plus
the percentage by weight of all tetrahydrocannabinols.
(d) The office shall not approve any cannabis product, lower-potency hemp edible, or
hemp-derived consumer product that:
(1) is or appears to be a lollipop or ice cream;
(2) bears the likeness or contains characteristics of a real or fictional person, animal, or
fruit;
(3) is modeled after a type or brand of products primarily consumed by or marketed to
children;
(4) is substantively similar to a meat food product; poultry food product as defined in
section 31A.02, subdivision 10; or a dairy product as defined in section 32D.01, subdivision
7;
(5) contains a synthetic cannabinoid;
(6) is made by applying a cannabinoid, including but not limited to an artificially derived
cannabinoid, to a finished food product that does not contain cannabinoids and is sold to
consumers, including but not limited to a candy or snack food; or
(7) if the product is an edible cannabis product or lower-potency hemp edible, contains
an ingredient, other than a cannabinoid, that is not approved by the United States Food and
Drug Administration for use in food.
new text begin
(e) The office must not approve any cannabis flower, cannabis product, or hemp-derived
consumer product intended to be inhaled as smoke, aerosol, or vapor from the product that:
new text end
new text begin
(1) contains any added artificial, synthetic, or natural flavoring, either in the product
itself or in its components or parts;
new text end
new text begin
(2) presents any descriptor or depiction of flavor that would imply to an ordinary person
that the product contains flavors other than the natural taste or smell of cannabis;
new text end
new text begin
(3) imparts a taste or smell, other than the taste or smell of cannabis, that is distinguishable
by an ordinary consumer prior to or during the consumption of the product; or
new text end
new text begin
(4) imparts a cooling, a burning, a numbing, or another sensation distinguishable by an
ordinary consumer to impart a flavor other than cannabis either prior to or during the
consumption of the product.
new text end
new text begin
(f) Notwithstanding paragraph (e), the office may approve cannabis flower, cannabis
products, or hemp-derived consumer products intended to be inhaled as smoke, aerosol, or
vapor that contain or impart a flavor or smell only if the additives are terpenes extracted
from cannabis plants or hemp plants and are present at no greater concentrations than those
found naturally occurring in the cannabis plants or hemp plants from which the
tetrahydrocannabinol was extracted.
new text end
Sec. 9.
Minnesota Statutes 2023 Supplement, section 342.63, is amended by adding a
subdivision to read:
new text begin Subd. 7. new text end
new text begin
Content of label; products intended to be inhaled as smoke, aerosol, or
vapor.
new text end
new text begin
All cannabis flower, cannabis products, and hemp-derived consumer products
intended to be inhaled as smoke, aerosol, or vapor and sold to customers or patients must
not present, on the label or affixed on the packaging or container, any descriptor or depiction
of flavor that would imply to an ordinary person that the product contains flavors other than
the natural taste or smell of cannabis. A cannabis plant or hemp plant strain name that
includes a descriptor of a fruit, flavor, or food term may be listed on the label or affixed to
the packaging or container only in a font that does not exceed six points and in black or
white type.
new text end
Sec. 10. new text begin REVISOR INSTRUCTION.
new text end
new text begin
The revisor of statutes shall renumber Minnesota Statutes, section 256D.21, as Minnesota
Statutes, section 261.004.
new text end
Sec. 11. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2022, sections 256D.19, subdivisions 1 and 2; 256D.20, subdivisions
1, 2, 3, and 4; and 256D.23, subdivisions 1, 2, and 3,
new text end
new text begin
are repealed.
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 13
HUMAN SERVICES FORECAST ADJUSTMENTS
Section 1. new text begin HUMAN SERVICES FORECAST ADJUSTMENTS.
|
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 2023, chapter 61, article 9, and
Laws 2023, chapter 70, article 20, to the commissioner of human services from the general
fund or other named fund for the purposes specified in section 2 and are available for the
fiscal years indicated for each purpose. The figures "2024" and "2025" 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, 2024, or June 30, 2025, respectively.
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
2024 new text end |
new text begin
2025 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
137,604,000 new text end |
new text begin
$ new text end |
new text begin
329,432,000 new text end |
||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General Fund new text end |
new text begin
139,746,000 new text end |
new text begin
325,606,000 new text end |
|
new text begin
Health Care Access Fund new text end |
new text begin
10,542,000 new text end |
new text begin
6,224,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
(12,684,000) new text end |
new text begin
(2,398,000) 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
(5,990,000) new text end |
new text begin
(2,793,000) new text end |
|
new text begin
Federal TANF new text end |
new text begin
(12,684,000) new text end |
new text begin
(2,398,000) new text end |
|
new text begin
(b) MFIP Child Care Assistance new text end |
new text begin
(36,726,000) new text end |
new text begin
(26,004,000) new text end |
||||
|
new text begin
(c) General Assistance new text end |
new text begin
(567,000) new text end |
new text begin
292,000 new text end |
||||
|
new text begin
(d) Minnesota Supplemental Aid new text end |
new text begin
1,424,000 new text end |
new text begin
1,500,000 new text end |
||||
|
new text begin
(e) Housing Support new text end |
new text begin
11,200,000 new text end |
new text begin
14,667,000 new text end |
||||
|
new text begin
(f) Northstar Care for Children new text end |
new text begin
(3,697,000) new text end |
new text begin
(11,309,000) new text end |
||||
|
new text begin
(g) MinnesotaCare new text end |
new text begin
10,542,000 new text end |
new text begin
6,224,000 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
180,321,000 new text end |
new text begin
352,357,000 new text end |
||||
|
new text begin
(i) Behavioral Health Fund new text end |
new text begin
(6,219,000) new text end |
new text begin
(3,104,000) new text end |
||||
Sec. 3. new text begin EFFECTIVE DATE.
new text end
new text begin
This article is effective the day following final enactment.
new text end
ARTICLE 14
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 2023, chapter 70, article 20, 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 "2024" and "2025" 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, 2024, or June 30, 2025, respectively. Base adjustments mean the addition to or
subtraction from the base level adjustment set in Laws 2023, chapter 70, article 20.
Supplemental appropriations and reductions to appropriations for the fiscal year ending
June 30, 2024, 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
2024 new text end |
new text begin
2025 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
(3,352,000) new text end |
new text begin
$ new text end |
new text begin
4,420,000 new text end |
||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2024 new text end |
new text begin
2025 new text end |
|
|
new text begin
General new text end |
new text begin
(136,000) new text end |
new text begin
2,944,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
(3,216,000) new text end |
new text begin
1,476,000 new text end |
new text begin
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
Central Office; Operations
|
||||||
|
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
(1,039,000) new text end |
|
new text begin
Health Care Access new text end |
new text begin
-0- new text end |
new text begin
572,000 new text end |
new text begin
(a) Residential Mental Health Crisis
Stabilization. $204,000 in fiscal year 2025 is
from the general fund to develop a covered
benefit under medical assistance to provide
residential mental health crisis stabilization
for children and submit a report to the
legislature. This is a onetime appropriation.
new text end
new text begin
(b) Base Level Adjustment. The general fund
base is increased by $331,000 in fiscal year
2026 and $252,000 in fiscal year 2027. The
health care access fund base is increased by
$114,000 in fiscal year 2026 and $114,000 in
fiscal year 2027.
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
400,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
(3,216,000) new text end |
new text begin
3,216,000 new text end |
new text begin Subd. 5. new text end
new text begin
Forecasted Programs; MinnesotaCare
|
new text begin
-0- new text end |
new text begin
(2,306,000) new text end |
||||
new text begin
This appropriation is from the health care
access fund.
new text end
new text begin Subd. 6. 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
1,444,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
-0- new text end |
new text begin
(6,000) new text end |
new text begin Subd. 7. new text end
new text begin
Grant Programs; Children's Mental
|
new text begin
-0- new text end |
new text begin
8,112,000 new text end |
||||
new text begin
Respite Care Services. $8,112,000 in fiscal
year 2025 is for respite care services under
Minnesota Statutes, section 245.4889,
subdivision 1, paragraph (b), clause (3). Of
this appropriation, $1,000,000 in fiscal year
2025 only is for grants to private child-placing
agencies, as defined in Minnesota Rules,
chapter 9545, to conduct recruitment and
support licensing activities that are specific to
increasing the availability of licensed foster
homes to provide respite care services. The
base for this appropriation is $8,945,000 in
fiscal year 2026 and $8,945,000 in fiscal year
2027.
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. 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
(541,000) new text end |
new text begin
$ new text end |
new text begin
(2,446,000) new text end |
||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2024 new text end |
new text begin
2025 new text end |
|
|
new text begin
General new text end |
new text begin
(545,000) new text end |
new text begin
290,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
4,000 new text end |
new text begin
(2,736,000) new text end |
new text begin
The amount that may be spent for each
purpose is specified in the following
subdivisions.
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
(545,000) new text end |
new text begin
(100,000) new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
-0- new text end |
new text begin
(2,880,000) new text end |
new text begin
(a) Request for Information; Evaluation of
Statewide Health Care Needs and Capacity.
$150,000 in fiscal year 2025 is from the
general fund for a request for information for
a future evaluation of statewide health care
needs and capacity and projections of future
health care needs. This is a onetime
appropriation.
new text end
new text begin
(b) Base Level Adjustment. The general fund
base is reduced by $43,000 in fiscal year 2026
and increased by $301,000 in fiscal year 2027.
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
390,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
-0- new text end |
new text begin
144,000 new text end |
new text begin
(a) Natural Organic Reduction. $140,000 in
fiscal year 2025 is from the state government
special revenue fund for the licensure of
natural organic reduction facilities. The base
for this appropriation is $85,000 in fiscal year
2026 and $16,000 in fiscal year 2027.
new text end
new text begin
(b) Groundwater Thermal Exchange Device
Permitting. $4,000 in fiscal year 2024 and
$4,000 in fiscal year 2025 are from the state
government special revenue fund for costs
related to issuing permits for groundwater
thermal exchange devices.
new text end
new text begin
(c) Base Level Adjustment. The general fund
base is increased by $448,000 in fiscal year
2026 and $185,000 in fiscal year 2027. The
state government special revenue fund base is
increased by $89,000 in fiscal year 2026 and
$20,000 in fiscal year 2027.
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. 4. new text begin BOARD OF PHARMACY
|
new text begin
$ new text end |
new text begin
1,500,000 new text end |
new text begin
$ new text end |
new text begin
36,000 new text end |
||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
1,500,000 new text end |
new text begin
-0- new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
-0- new text end |
new text begin
36,000 new text end |
new text begin
(a) Legal Costs. $1,500,000 in fiscal year
2024 is from the general fund for legal costs
of the board. This is a onetime appropriation.
new text end
new text begin
(b) Pharmacist Authority; Laboratory Tests
and Vaccines. $27,000 in fiscal year 2025 is
from the state government special revenue
fund for board costs related to pharmacist
authority to order and perform laboratory tests
and initiate, order, and administer vaccines.
new text end
new text begin
(c) Statewide Protocol; Drugs to Prevent
the Acquisition of HIV. $9,000 in fiscal year
2025 is from the state government special
revenue fund for the board to develop a
statewide protocol for administering drugs to
prevent the acquisition of human
immunodeficiency virus (HIV). This is a
onetime appropriation.
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. 5. 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
807,000 new text end |
||
new text begin
Cost-Sharing Reduction Program
Administration. $807,000 in fiscal year 2025
is from the general fund for MNsure
information technology and administrative
costs for the cost-sharing reduction program.
The base for this appropriation is $506,000 in
fiscal year 2026 and $0 in fiscal year 2027.
new text end
Sec. 6. new text begin TRANSFERS.
new text end
new text begin
(a) $8,830,000 in fiscal year 2026 is transferred from the premium security plan account
under Minnesota Statutes, section 62E.25, subdivision 1, to the general fund. This is a
onetime transfer.
new text end
new text begin
(b) $50,000 in fiscal year 2025, $50,000 in fiscal year 2026, and $50,000 in fiscal year
2027 are transferred from the health care access fund to the insulin repayment account under
Minnesota Statutes, section 151.741, subdivision 5. These are onetime transfers.
new text end
Sec. 7.
Laws 2023, chapter 22, section 4, subdivision 2, is amended to read:
Subd. 2.
Grants to navigators.
(a) $1,936,000 in fiscal year 2024 is
appropriated from the health care access fund
to the commissioner of human services for
grants to organizations with a MNsure grant
services navigator assister contract in good
standing as of the date of enactment. The grant
payment 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 years 2020 and 2023, as determined by
MNsure's navigator payment process. This is
a onetime appropriation and is available until
June 30, 2025.
(b) $3,000,000 in fiscal year 2024 is
appropriated from the health care access fund
to the commissioner of human services for
grants to organizations with a MNsure grant
services navigator assister contract for
successful enrollments in medical assistance
and MinnesotaCare. This is a onetime
appropriationnew text begin and is available until June 30,
2025new 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. 8.
Laws 2023, chapter 70, article 20, section 2, subdivision 5, is amended to read:
Subd. 5.Central Office; Health Care
|
||||||
| Appropriations by Fund |
||
| General |
35,807,000 |
31,349,000 |
| Health Care Access |
30,668,000 |
50,168,000 |
(a) Medical assistance and MinnesotaCare
accessibility improvements. deleted text begin $4,000,000deleted text end new text begin
$784,000new text end in fiscal year 2024 deleted text begin isdeleted text end new text begin and $3,216,000
in fiscal year 2025 arenew text end from the general fund
for interactive voice response upgrades and
translation services for medical assistance and
MinnesotaCare enrollees with limited English
proficiency. This appropriation is available
until June 30, deleted text begin 2025deleted text end new text begin 2027new text end .
(b) Transforming service delivery. $155,000
in fiscal year 2024 and $180,000 in fiscal year
2025 are from the general fund for
transforming service delivery projects.
(c) Improving the Minnesota eligibility
technology system functionality. $1,604,000
in fiscal year 2024 and $711,000 in fiscal year
2025 are from the general fund for improving
the Minnesota eligibility technology system
functionality. The base for this appropriation
is $1,421,000 in fiscal year 2026 and $0 in
fiscal year 2027.
(d) Actuarial and economic analyses.
$2,500,000 is from the health care access fund
for actuarial and economic analyses and to
prepare and submit a state innovation waiver
under section 1332 of the federal Affordable
Care Act for a Minnesota public option health
care plan. This is a onetime appropriation and
is available until June 30, 2025.
(e) Contingent appropriation for Minnesota
public option health care plan. $22,000,000
in fiscal year 2025 is from the health care
access fund to implement a Minnesota public
option health care plan. This is a onetime
appropriation and is available upon approval
of a state innovation waiver under section
1332 of the federal Affordable Care Act. This
appropriation is available until June 30, 2027.
(f) Carryforward authority. Notwithstanding
Minnesota Statutes, section 16A.28,
subdivision 3, $2,367,000 of the appropriation
in fiscal year 2024 is available until June 30,
2027.
(g) Base level adjustment. The general fund
base is $32,315,000 in fiscal year 2026 and
$27,536,000 in fiscal year 2027. The health
care access fund base is $28,168,000 in fiscal
year 2026 and $28,168,000 in fiscal year 2027.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 9.
Laws 2023, chapter 70, article 20, section 2, subdivision 7, is amended to read:
Subd. 7.Central Office; Behavioral Health, Deaf
|
||||||
| Appropriations by Fund |
||
| General |
deleted text begin
27,870,000 deleted text end new text begin 27,734,000 new text end |
deleted text begin
27,592,000 deleted text end new text begin 27,728,000 new text end |
| Lottery Prize |
163,000 |
163,000 |
(a) Homeless management system. $250,000
in fiscal year 2024 and $1,000,000 in fiscal
year 2025 are from the general fund for a
homeless management information system.
The base for this appropriation is $1,140,000
in fiscal year 2026 and $1,140,000 in fiscal
year 2027.
(b) Online behavioral health program
locator. $959,000 in fiscal year 2024 and
$959,000 in fiscal year 2025 are from the
general fund for an online behavioral health
program locator.
(c) Integrated services for children and
families. $286,000 in fiscal year 2024 and
$286,000 in fiscal year 2025 are from the
general fund for integrated services for
children and families projects.
Notwithstanding Minnesota Statutes, section
16A.28, subdivision 3, $1,797,000 of the
appropriation in fiscal year 2024 is available
until June 30, 2027.
(d) Carryforward authority.
Notwithstanding Minnesota Statutes, section
16A.28, subdivision 3, $842,000 of the
appropriation in fiscal year 2024 is available
until June 30, 2027, new text begin $136,000 of the
appropriation in fiscal year 2025 is available
until June 30, 2027, new text end and $852,000 of the
appropriation in fiscal year 2025 is available
until June 30, 2028.
(f) Base level adjustment. The general fund
base is $25,243,000 in fiscal year 2026 and
$24,682,000 in fiscal year 2027.
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.
Laws 2023, chapter 70, article 20, section 2, subdivision 29, is amended to read:
Subd. 29.Grant Programs; Adult Mental Health
|
132,327,000 |
121,270,000 |
||||
(a) Mobile crisis grants to Tribal Nations.
$1,000,000 in fiscal year 2024 and $1,000,000
in fiscal year 2025 are for mobile crisis grants
under Minnesota Statutes deleted text begin sectiondeleted text end new text begin , sectionsnew text end
245.4661, subdivision 9, paragraph (b), clause
(15),new text begin and 245.4889, subdivision 1, paragraph
(b), clause (4),new text end to Tribal Nations.
(b) Mental health provider supervision
grant program. $1,500,000 in fiscal year
2024 and $1,500,000 in fiscal year 2025 are
for the mental health provider supervision
grant program under Minnesota Statutes,
section 245.4663.
(c) Minnesota State University, Mankato
community behavioral health center.
$750,000 in fiscal year 2024 and $750,000 in
fiscal year 2025 are for a grant to the Center
for Rural Behavioral Health at Minnesota State
University, Mankato to establish a community
behavioral health center and training clinic.
The community behavioral health center must
provide comprehensive, culturally specific,
trauma-informed, practice- and
evidence-based, person- and family-centered
mental health and substance use disorder
treatment services in Blue Earth County and
the surrounding region to individuals of all
ages, regardless of an individual's ability to
pay or place of residence. The community
behavioral health center and training clinic
must also provide training and workforce
development opportunities to students enrolled
in the university's training programs in the
fields of social work, counseling and student
personnel, alcohol and drug studies,
psychology, and nursing. Upon request, the
commissioner must make information
regarding the use of this grant funding
available to the chairs and ranking minority
members of the legislative committees with
jurisdiction over behavioral health. This is a
onetime appropriation and is available until
June 30, 2027.
(d) White Earth Nation; adult mental health
initiative. $300,000 in fiscal year 2024 and
$300,000 in fiscal year 2025 are for adult
mental health initiative grants to the White
Earth Nation. This is a onetime appropriation.
(e) Mobile crisis grants. $8,472,000 in fiscal
year 2024 and $8,380,000 in fiscal year 2025
are for the mobile crisis grants under
Minnesota Statutes, deleted text begin sectiondeleted text end new text begin sectionsnew text end 245.4661,
subdivision 9, paragraph (b), clause (15)new text begin , and
245.4889, subdivision 1, paragraph (b), clause
(4)new text end . This is a onetime appropriation and is
available until June 30, 2027.
(f) Base level adjustment. The general fund
base is $121,980,000 in fiscal year 2026 and
$121,980,000 in fiscal year 2027.
Sec. 11.
Laws 2023, chapter 70, article 20, section 3, subdivision 2, is amended to read:
Subd. 2.Health Improvement
|
||||||
| Appropriations by Fund |
||
| General |
229,600,000 |
210,030,000 |
| State Government Special Revenue |
12,392,000 |
12,682,000 |
| Health Care Access |
49,051,000 |
53,290,000 |
| Federal TANF |
11,713,000 |
11,713,000 |
(a) Studies of telehealth expansion and
payment parity. $1,200,000 in fiscal year
2024 is from the general fund for studies of
telehealth expansion and payment parity. This
is a onetime appropriation and is available
until June 30, 2025.
(b) Advancing equity through capacity
building and resource allocation grant
program. $916,000 in fiscal year 2024 and
$916,000 in fiscal year 2025 are from the
general fund for grants under Minnesota
Statutes, section 144.9821. This is a onetime
appropriation.
(c) Grant to Minnesota Community Health
Worker Alliance. $971,000 in fiscal year
2024 and $971,000 in fiscal year 2025 are
from the general fund for Minnesota Statutes,
section 144.1462.
(d) Community solutions for healthy child
development grants. $2,730,000 in fiscal year
2024 and $2,730,000 in fiscal year 2025 are
from the general fund for grants under
Minnesota Statutes, section 145.9257. The
base for this appropriation is $2,415,000 in
fiscal year 2026 and $2,415,000 in fiscal year
2027.
(e) Comprehensive Overdose and Morbidity
Prevention Act. $9,794,000 in fiscal year
2024 and $10,458,000 in fiscal year 2025 are
from the general fund for comprehensive
overdose and morbidity prevention strategies
under Minnesota Statutes, section 144.0528.
The base for this appropriation is $10,476,000
in fiscal year 2026 and $10,476,000 in fiscal
year 2027.
(f) Emergency preparedness and response.
$10,486,000 in fiscal year 2024 and
$14,314,000 in fiscal year 2025 are from the
general fund for public health emergency
preparedness and response, the sustainability
of the strategic stockpile, and COVID-19
pandemic response transition. The base for
this appropriation is $11,438,000 in fiscal year
2026 and $11,362,000 in fiscal year 2027.
(g) Healthy Beginnings, Healthy Families.
(1) $8,440,000 in fiscal year 2024 and
$7,305,000 in fiscal year 2025 are from the
general fund for grants under Minnesota
Statutes, sections 145.9571 to 145.9576. The
base for this appropriation is $1,500,000 in
fiscal year 2026 and $1,500,000 in fiscal year
2027. (2) Of the amount in clause (1),
$400,000 in fiscal year 2024 is to support the
transition from implementation of activities
under Minnesota Statutes, section 145.4235,
to implementation of activities under
Minnesota Statutes, sections 145.9571 to
145.9576. The commissioner shall award four
sole-source grants of $100,000 each to Face
to Face, Cradle of Hope, Division of Indian
Work, and Minnesota Prison Doula Project.
The amount in this clause is a onetime
appropriation.
(h) Help Me Connect. $463,000 in fiscal year
2024 and $921,000 in fiscal year 2025 are
from the general fund for the Help Me
Connect program under Minnesota Statutes,
section 145.988.
(i) Home visiting. $2,000,000 in fiscal year
2024 and $2,000,000 in fiscal year 2025 are
from the general fund for home visiting under
Minnesota Statutes, section 145.87, to provide
home visiting to priority populations under
Minnesota Statutes, section 145.87,
subdivision 1, paragraph (e).
(j) No Surprises Act enforcement.
$1,210,000 in fiscal year 2024 and $1,090,000
in fiscal year 2025 are from the general fund
for implementation of the federal No Surprises
Act under Minnesota Statutes, section
62Q.021, and an assessment of the feasibility
of a statewide provider directory. The general
fund base for this appropriation is $855,000
in fiscal year 2026 and $855,000 in fiscal year
2027.
(k) Office of African American Health.
$1,000,000 in fiscal year 2024 and $1,000,000
in fiscal year 2025 are from the general fund
for grants under the authority of the Office of
African American Health under Minnesota
Statutes, section 144.0756.
(l) Office of American Indian Health.
$1,000,000 in fiscal year 2024 and $1,000,000
in fiscal year 2025 are from the general fund
for grants under the authority of the Office of
American Indian Health under Minnesota
Statutes, section 144.0757.
(m) Public health system transformation
grants. (1) $9,844,000 in fiscal year 2024 and
$9,844,000 in fiscal year 2025 are from the
general fund for grants under Minnesota
Statutes, section 145A.131, subdivision 1,
paragraph (f).
(2) $535,000 in fiscal year 2024 and $535,000
in fiscal year 2025 are from the general fund
for grants under Minnesota Statutes, section
145A.14, subdivision 2b.
(3) $321,000 in fiscal year 2024 and $321,000
in fiscal year 2025 are from the general fund
for grants under Minnesota Statutes, section
144.0759.
(n) Health care workforce. (1) $1,010,000
in fiscal year 2024 and $2,550,000 in fiscal
year 2025 are from the health care access fund
for rural training tracks and rural clinicals
grants under Minnesota Statutes, sections
144.1505 and 144.1507. The base for this
appropriation is $4,060,000 in fiscal year 2026
and $3,600,000 in fiscal year 2027.
(2) $420,000 in fiscal year 2024 and $420,000
in fiscal year 2025 are from the health care
access fund for immigrant international
medical graduate training grants under
Minnesota Statutes, section 144.1911.
(3) $5,654,000 in fiscal year 2024 and
$5,550,000 in fiscal year 2025 are from the
health care access fund for site-based clinical
training grants under Minnesota Statutes,
section 144.1508. The base for this
appropriation is $4,657,000 in fiscal year 2026
and $3,451,000 in fiscal year 2027.
(4) $1,000,000 in fiscal year 2024 and
$1,000,000 in fiscal year 2025 are from the
health care access fund for mental health for
health care professional grants. This is a
onetime appropriation and is available until
June 30, 2027.
(5) $502,000 in fiscal year 2024 and $502,000
in fiscal year 2025 are from the health care
access fund for workforce research and data
analysis of shortages, maldistribution of health
care providers in Minnesota, and the factors
that influence decisions of health care
providers to practice in rural areas of
Minnesota.
(o) School health. $800,000 in fiscal year
2024 and $1,300,000 in fiscal year 2025 are
from the general fund for grants under
Minnesota Statutes, section 145.903. The base
for this appropriation is $2,300,000 in fiscal
year 2026 and $2,300,000 in fiscal year 2027.
(p) Long COVID. $3,146,000 in fiscal year
2024 and $3,146,000 in fiscal year 2025 are
from the general fund for grants and to
implement Minnesota Statutes, section
145.361.
(q) Workplace safety grants. $4,400,000 in
fiscal year 2024 is from the general fund for
grants to health care entities to improve
employee safety or security. This is a onetime
appropriation and is available until June 30,
2027. The commissioner may use up to ten
percent of this appropriation for
administration.
(r) Clinical dental education innovation
grants. $1,122,000 in fiscal year 2024 and
$1,122,000 in fiscal year 2025 are from the
general fund for clinical dental education
innovation grants under Minnesota Statutes,
section 144.1913.
(s) Emmett Louis Till Victims Recovery
Program. $500,000 in fiscal year 2024 is from
the general fund for a grant to the Emmett
Louis Till Victims Recovery Program. The
commissioner must not use any of this
appropriation for administration. This is a
onetime appropriation and is available until
June 30, 2025.
(t) Center for health care affordability.
$2,752,000 in fiscal year 2024 and $3,989,000
in fiscal year 2025 are from the general fund
to establish a center for health care
affordability and to implement Minnesota
Statutes, section 62J.312. The general fund
base for this appropriation is $3,988,000 in
fiscal year 2026 and $3,988,000 in fiscal year
2027.
(u) Federally qualified health centers
apprenticeship program. $690,000 in fiscal
year 2024 and $690,000 in fiscal year 2025
are from the general fund for grants under
Minnesota Statutes, section 145.9272.
(v) Alzheimer's public information
program. $80,000 in fiscal year 2024 and
$80,000 in fiscal year 2025 are from the
general fund for grants to community-based
organizations to co-create culturally specific
messages to targeted communities and to
promote public awareness materials online
through diverse media channels.
(w) deleted text begin Keeping Nurses at the Bedside Act;
contingent appropriationdeleted text end new text begin Nurse and Patient
Safety Actnew text end . deleted text begin The appropriations in this
paragraph are contingent upon legislative
enactment of 2023 Senate File 1384 by the
93rd Legislature.deleted text end The appropriations in this
paragraph are available until June 30, 2027.
(1) $5,317,000 in fiscal year 2024 and
$5,317,000 in fiscal year 2025 are from the
general fund for loan forgiveness under
Minnesota Statutes, section 144.1501, for
eligible nurses who have agreed to work as
hospital nurses in accordance with Minnesota
Statutes, section 144.1501, subdivision 2,
paragraph (a), clause (7).
(2) $66,000 in fiscal year 2024 and $66,000
in fiscal year 2025 are from the general fund
for loan forgiveness under Minnesota Statutes,
section 144.1501, for eligible nurses who have
agreed to teach in accordance with Minnesota
Statutes, section 144.1501, subdivision 2,
paragraph (a), clause (3).
deleted text begin
(3) $545,000 in fiscal year 2024 and $879,000
in fiscal year 2025 are from the general fund
to administer Minnesota Statutes, section
144.7057; to perform the evaluation duties
described in Minnesota Statutes, section
144.7058; to continue prevention of violence
in health care program activities; to analyze
potential links between adverse events and
understaffing; to convene stakeholder groups
and create a best practices toolkit; and for a
report on the current status of the state's
nursing workforce employed by hospitals. The
base for this appropriation is $624,000 in fiscal
year 2026 and $454,000 in fiscal year 2027.
deleted text end
(x) Supporting healthy development of
babies. $260,000 in fiscal year 2024 and
$260,000 in fiscal year 2025 are from the
general fund for a grant to the Amherst H.
Wilder Foundation for the African American
Babies Coalition initiative. The base for this
appropriation is $520,000 in fiscal year 2026
and $0 in fiscal year 2027. Any appropriation
in fiscal year 2026 is available until June 30,
2027. This paragraph expires on June 30,
2027.
(y) Health professional education loan
forgiveness. $2,780,000 in fiscal year 2024
is from the general fund for eligible mental
health professional loan forgiveness under
Minnesota Statutes, section 144.1501. This is
a onetime appropriation. The commissioner
may use up to ten percent of this appropriation
for administration.
(z) Primary care residency expansion grant
program. $400,000 in fiscal year 2024 and
$400,000 in fiscal year 2025 are from the
general fund for a psychiatry resident under
Minnesota Statutes, section 144.1506.
(aa) Pediatric primary care mental health
training grant program. $1,000,000 in fiscal
year 2024 and $1,000,000 in fiscal year 2025
are from the general fund for grants under
Minnesota Statutes, section 144.1509. The
commissioner may use up to ten percent of
this appropriation for administration.
(bb) Mental health cultural community
continuing education grant program.
$500,000 in fiscal year 2024 and $500,000 in
fiscal year 2025 are from the general fund for
grants under Minnesota Statutes, section
144.1511. The commissioner may use up to
ten percent of this appropriation for
administration.
(cc) Labor trafficking services grant
program. $500,000 in fiscal year 2024 and
$500,000 in fiscal year 2025 are from the
general fund for grants under Minnesota
Statutes, section 144.3885.
(dd) Palliative Care Advisory Council.
deleted text begin $40,000deleted text end new text begin $44,000new text end in fiscal year 2024 and
deleted text begin $40,000deleted text end new text begin $44,000new text end in fiscal year 2025 are from
the general fund for deleted text begin grantsdeleted text end new text begin administrationnew text end
under Minnesota Statutes, section 144.059.
(ee) Analysis of a universal health care
financing system. $1,815,000 in fiscal year
2024 and $580,000 in fiscal year 2025 are
from the general fund to the commissioner to
contract for 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. The base for this appropriation is
$580,000 in fiscal year 2026 and $0 in fiscal
year 2027. This appropriation is available until
June 30, 2027.
(ff) Charitable assets public interest review.
(1) The appropriations under this paragraph
are contingent upon legislative enactment of
2023 House File 402 by the 93rd Legislature.
(2) $1,584,000 in fiscal year 2024 and
$769,000 in fiscal year 2025 are from the
general fund to review certain health care
entity transactions; to conduct analyses of the
impacts of health care transactions on health
care cost, quality, and competition; and to
issue public reports on health care transactions
in Minnesota and their impacts. The base for
this appropriation is $710,000 in fiscal year
2026 and $710,000 in fiscal year 2027.
(gg) Study of the development of a statewide
registry for provider orders for
life-sustaining treatment. $365,000 in fiscal
year 2024 and $365,000 in fiscal year 2025
are from the general fund for a study of the
development of a statewide registry for
provider orders for life-sustaining treatment.
This is a onetime appropriation.
(hh) Task Force on Pregnancy Health and
Substance Use Disorders. $199,000 in fiscal
year 2024 and $100,000 in fiscal year 2025
are from the general fund for the Task Force
on Pregnancy Health and Substance Use
Disorders. This is a onetime appropriation and
is available until June 30, 2025.
(ii) 988 Suicide and crisis lifeline. $4,000,000
in fiscal year 2024 is from the general fund
for 988 national suicide prevention lifeline
grants under Minnesota Statutes, section
145.561. This is a onetime appropriation.
(jj) Equitable Health Care Task Force.
$779,000 in fiscal year 2024 and $749,000 in
fiscal year 2025 are from the general fund for
the Equitable Health Care Task Force. This is
a onetime appropriation.
(kk) Psychedelic Medicine Task Force.
$338,000 in fiscal year 2024 and $171,000 in
fiscal year 2025 are from the general fund for
the Psychedelic Medicine Task Force. This is
a onetime appropriation.
(ll) Medical education and research costs.
$300,000 in fiscal year 2024 and $300,000 in
fiscal year 2025 are from the general fund for
the medical education and research costs
program under Minnesota Statutes, section
62J.692.
(mm) Special Guerilla Unit Veterans grant
program. $250,000 in fiscal year 2024 and
$250,000 in fiscal year 2025 are from the
general fund for a grant to the Special
Guerrilla Units Veterans and Families of the
United States of America to offer
programming and culturally specific and
specialized assistance to support the health
and well-being of Special Guerilla Unit
Veterans. The base for this appropriation is
$500,000 in fiscal year 2026 and $0 in fiscal
year 2027. Any amount appropriated in fiscal
year 2026 is available until June 30, 2027.
This paragraph expires June 30, 2027.
(nn) Safe harbor regional navigator.
$300,000 in fiscal year 2024 and $300,000 in
fiscal year 2025 are for a regional navigator
in northwestern Minnesota. The commissioner
may use up to ten percent of this appropriation
for administration.
(oo) Network adequacy. $798,000 in fiscal
year 2024 and $491,000 in fiscal year 2025
are from the general fund for reviews of
provider networks under Minnesota Statutes,
section 62K.10, to determine network
adequacy.
new text begin
(pp) Grants to Minnesota Alliance for
Volunteer Advancement. $278,000 in fiscal
year 2024 is from the general fund for a grant
to the Minnesota Alliance for Volunteer
Advancement to administer needs-based
volunteerism subgrants targeting
underresourced nonprofit organizations in
greater Minnesota. Subgrants must be used to
support the ongoing efforts of selected
organizations to address and minimize
disparities in access to human services through
increased volunteerism. Subgrant applicants
must demonstrate that the populations to be
served by the subgrantee are underserved or
suffer from or are at risk of homelessness,
hunger, poverty, lack of access to health care,
or deficits in education. The Minnesota
Alliance for Volunteer Advancement must
give priority to organizations that are serving
the needs of vulnerable populations. This is a
onetime appropriation and is available until
June 30, 2025.
new text end
deleted text begin (pp)(1)deleted text end new text begin (qq)(1)new text end TANF Appropriations. TANF
funds must be used as follows:
(i) $3,579,000 in fiscal year 2024 and
$3,579,000 in fiscal year 2025 are from the
TANF fund for home visiting and nutritional
services listed under Minnesota Statutes,
section 145.882, subdivision 7, clauses (6) and
(7). Funds must be distributed to community
health boards according to Minnesota Statutes,
section 145A.131, subdivision 1;
(ii) $2,000,000 in fiscal year 2024 and
$2,000,000 in fiscal year 2025 are from the
TANF fund for decreasing racial and ethnic
disparities in infant mortality rates under
Minnesota Statutes, section 145.928,
subdivision 7;
(iii) $4,978,000 in fiscal year 2024 and
$4,978,000 in fiscal year 2025 are from the
TANF fund for the family home visiting grant
program under Minnesota Statutes, section
145A.17. $4,000,000 of the funding in fiscal
year 2024 and $4,000,000 in fiscal year 2025
must be distributed to community health
boards under Minnesota Statutes, section
145A.131, subdivision 1. $978,000 of the
funding in fiscal year 2024 and $978,000 in
fiscal year 2025 must be distributed to Tribal
governments under Minnesota Statutes, section
145A.14, subdivision 2a;
(iv) $1,156,000 in fiscal year 2024 and
$1,156,000 in fiscal year 2025 are from the
TANF fund for sexual and reproductive health
services grants under Minnesota Statutes,
section 145.925; and
(v) the commissioner may use up to 6.23
percent of the funds appropriated from the
TANF fund each fiscal year to conduct the
ongoing evaluations required under Minnesota
Statutes, section 145A.17, subdivision 7, and
training and technical assistance as required
under Minnesota Statutes, section 145A.17,
subdivisions 4 and 5.
(2) TANF Carryforward. Any unexpended
balance of the TANF appropriation in the first
year does not cancel but is available in the
second year.
deleted text begin (qq)deleted text end new text begin (rr)new text end Base level adjustments. The general
fund base is $197,644,000 in fiscal year 2026
and $195,714,000 in fiscal year 2027. The
health care access fund base is $53,354,000
in fiscal year 2026 and $50,962,000 in fiscal
year 2027.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment, except
paragraph (pp) is effective retroactively from July 1, 2023.
new text end
Sec. 12.
Laws 2023, chapter 70, article 20, section 12, as amended by Laws 2023, chapter
75, section 13, is amended to read:
Sec. 12. COMMISSIONER OF
|
$ |
12,932,000 |
$ |
3,412,000 |
||
(a) Outcomes and evaluation consultation.
$450,000 in fiscal year 2024 and $450,000 in
fiscal year 2025 are for outcomes and
evaluation consultation requirements.
(b) Department of Children, Youth, and
Families. $11,931,000 in fiscal year 2024 and
$2,066,000 in fiscal year 2025 are to establish
the Department of Children, Youth, and
Families. This is a onetime appropriation.
deleted text begin
(c) Keeping Nurses at the Bedside Act
impact evaluation; contingent
appropriation. $232,000 in fiscal year 2025
is for the Keeping Nurses at the Bedside Act
impact evaluation. This appropriation is
contingent upon legislative enactment by the
93rd Legislature of a provision substantially
similar to the impact evaluation provision in
2023 S.F. No. 2995, the third engrossment,
article 3, section 22. This is a onetime
appropriation and is available until June 30,
2029.
deleted text end
deleted text begin (d)deleted text end new text begin (c)new text end Health care subcabinet. $551,000 in
fiscal year 2024 and $664,000 in fiscal year
2025 are to hire an executive director for the
health care subcabinet and to provide staffing
and administrative support for the health care
subcabinet.
deleted text begin (e)deleted text end new text begin (d)new text end Base level adjustment. The general
fund base is $1,114,000 in fiscal year 2026
and $1,114,000 in fiscal year 2027.
Sec. 13. new text begin APPROPRIATIONS GIVEN EFFECT ONCE.
new text end
new text begin
If an appropriation or transfer in this article is enacted more than once during the 2024
regular session, the appropriation or transfer must be given effect once.
new text end
Sec. 14. new text begin EXPIRATION OF UNCODIFIED LANGUAGE.
new text end
new text begin
All uncodified language contained in this article expires on June 30, 2025, unless a
different expiration date is explicit.
new text end
Sec. 15. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Laws 2023, chapter 70, article 20, section 2, subdivision 31, as amended by Laws
2023, chapter 75, section 12,
new text end
new text begin
is repealed.
new text end
new text begin
(b)
new text end
new text begin
Laws 2023, chapter 75, section 10,
new text end
new text begin
is repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraph (b) is effective the day following final enactment.
new text end
APPENDIX
Repealed Minnesota Statutes: H4571-1
62A.041 MATERNITY BENEFITS.
Subd. 3.
Abortion.
For the purposes of this section, the term "maternity benefits" shall not include elective, induced abortion whether performed in a hospital, other abortion facility, or the office of a physician.
This section applies to policies and contracts issued, delivered, or renewed after August 1, 1985, that cover Minnesota residents.
62J.312 CENTER FOR HEALTH CARE AFFORDABILITY.
Subd. 6.
340B covered entity report.
(a) Beginning April 1, 2024, each 340B covered entity, as defined by section 340B(a)(4) of the Public Health Service Act, must report to the commissioner of health by April 1 of each year the following information related to its participation in the federal 340B program for the previous calendar year:
(1) the National Provider Identification (NPI) number;
(2) the name of the 340B covered entity;
(3) the servicing address of the 340B covered entity;
(4) the classification of the 340B covered entity;
(5) the aggregated acquisition cost for prescription drugs obtained under the 340B program;
(6) the aggregated payment amount received for drugs obtained under the 340B program and dispensed to patients;
(7) the aggregated payment made to pharmacies under contract to dispense drugs obtained under the 340B program; and
(8) the number of claims for prescription drugs described in clause (6).
(b) The information required under paragraph (a) must be reported by payer type, including commercial insurance, medical assistance and MinnesotaCare, and Medicare, in the form and manner defined by the commissioner. For covered entities that are hospitals, the information required under paragraph (a), clauses (5) to (8), must also be reported at the national drug code level for the 50 most frequently dispensed drugs by the facility under the 340B program.
(c) Data submitted under paragraph (a) must include prescription drugs dispensed by outpatient facilities that are identified as child facilities under the federal 340B program based on their inclusion on the hospital's Medicare cost report.
(d) Data submitted to the commissioner under paragraph (a) must be classified as nonpublic data as defined in section 13.02, subdivision 9.
(e) Beginning November 15, 2024, and by November 15 of each year thereafter, the commissioner shall prepare a report that aggregates the data submitted under paragraph (a). The commissioner shall submit this report to the chairs and ranking minority members of the legislative committees with jurisdiction over health care finance and policy.
62Q.522 COVERAGE OF CONTRACEPTIVE METHODS AND SERVICES.
Subd. 3.
Exemption.
(a) An exempt organization is not required to cover contraceptives or contraceptive services if the exempt organization has religious objections to the coverage. An exempt organization that chooses to not provide coverage for some or all contraceptives and contraceptive services must notify employees as part of the hiring process and to all employees at least 30 days before:
(1) an employee enrolls in the health plan; or
(2) the effective date of the health plan, whichever occurs first.
(b) If the exempt organization provides coverage for some contraceptive methods or services, the notice required under paragraph (a) must provide a list of the contraceptive methods or services the organization refuses to cover.
Subd. 4.
Accommodation for eligible organizations.
(a) A health plan established or maintained by an eligible organization complies with the requirements of subdivision 2 to provide coverage of contraceptive methods and services, with respect to the contraceptive methods or services identified in the notice under this paragraph, if the eligible organization provides notice to any health plan company the eligible organization contracts with that it is an eligible organization and that the eligible organization has a religious objection to coverage for all or a subset of contraceptive methods or services.
(b) The notice from an eligible organization to a health plan company under paragraph (a) must include: (1) the name of the eligible organization; (2) a statement that it objects to coverage for some or all of contraceptive methods or services, including a list of the contraceptive methods or services the eligible organization objects to, if applicable; and (3) the health plan name. The notice must be executed by a person authorized to provide notice on behalf of the eligible organization.
(c) An eligible organization must provide a copy of the notice under paragraph (a) to prospective employees as part of the hiring process and to all employees at least 30 days before:
(1) an employee enrolls in the health plan; or
(2) the effective date of the health plan, whichever occurs first.
(d) A health plan company that receives a copy of the notice under paragraph (a) with respect to a health plan established or maintained by an eligible organization must, for all future enrollments in the health plan:
(1) expressly exclude coverage for those contraceptive methods or services identified in the notice under paragraph (a) from the health plan; and
(2) provide separate payments for any contraceptive methods or services required to be covered under subdivision 2 for enrollees as long as the enrollee remains enrolled in the health plan.
(e) The health plan company must not impose any cost-sharing requirements, including co-pays, deductibles, or coinsurance, or directly or indirectly impose any premium, fee, or other charge for contraceptive services or methods on the eligible organization, health plan, or enrollee.
(f) On January 1, 2024, and every year thereafter a health plan company must notify the commissioner, in a manner determined by the commissioner, of the number of eligible organizations granted an accommodation under this subdivision.
144.0528 COMPREHENSIVE DRUG OVERDOSE AND MORBIDITY PREVENTION ACT.
Subd. 5.
Promotion; administration.
In fiscal years 2026 and beyond, the commissioner may spend up to 25 percent of the total funding appropriated for the comprehensive drug overdose and morbidity program in each fiscal year to promote, administer, support, and evaluate the programs authorized under this section and to provide technical assistance to program grantees.
144.497 ST ELEVATION MYOCARDIAL INFARCTION.
The commissioner of health shall assess and report on 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;
(2) annually post a summary report of the data in aggregate form on the Department of Health website; and
(3) 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.
144E.001 DEFINITIONS.
Subd. 5.
Board.
"Board" means the Emergency Medical Services Regulatory Board.
144E.01 EMERGENCY MEDICAL SERVICES REGULATORY BOARD.
Subdivision 1.
Membership.
(a) The Emergency Medical Services Regulatory Board consists of the following members, all of whom must work in Minnesota, except for the person listed in clause (14):
(1) an emergency physician certified by the American Board of Emergency Physicians;
(2) a representative of Minnesota hospitals;
(3) a representative of fire chiefs;
(4) a full-time firefighter who serves as an emergency medical responder on or within a nontransporting or nonregistered agency and who is a member of a professional firefighter's union;
(5) a volunteer firefighter who serves as an emergency medical responder on or within a nontransporting or nonregistered agency;
(6) an attendant currently practicing on a licensed ambulance service who is a paramedic or an emergency medical technician;
(7) an ambulance director for a licensed ambulance service;
(8) a representative of sheriffs;
(9) a member of a community health board to represent community health services;
(10) two representatives of regional emergency medical services programs, one of whom must be from the metropolitan regional emergency medical services program;
(11) a registered nurse currently practicing in a hospital emergency department;
(12) a pediatrician, certified by the American Board of Pediatrics, with experience in emergency medical services;
(13) a family practice physician who is currently involved in emergency medical services;
(14) a public member who resides in Minnesota; and
(15) the commissioners of health and public safety or their designees.
(b) The governor shall appoint members under paragraph (a). Appointments under paragraph (a), clauses (1) to (9) and (11) to (13), are subject to the advice and consent of the senate. In making appointments under paragraph (a), clauses (1) to (9) and (11) to (13), the governor shall consider recommendations of the American College of Emergency Physicians, the Minnesota Hospital Association, the Minnesota and State Fire Chief's Association, the Minnesota Ambulance Association, the Minnesota Emergency Medical Services Association, the Minnesota State Sheriff's Association, the Association of Minnesota Counties, the Minnesota Nurses Association, and the Minnesota chapter of the Academy of Pediatrics.
(c) At least seven members appointed under paragraph (a) must reside outside of the seven-county metropolitan area, as defined in section 473.121.
Subd. 2.
Ex officio members.
The speaker of the house and the Committee on Rules and Administration of the senate shall appoint one representative and one senator to serve as ex officio, nonvoting members.
Subd. 3.
Chair.
The governor shall designate one of the members appointed under subdivision 1 as chair of the board.
Subd. 4.
Compensation; terms.
Membership terms, compensation, and removal of members appointed under subdivision 1, are governed by section 15.0575.
Subd. 5.
Staff.
The board shall appoint an executive director who shall serve in the unclassified service and may appoint other staff. The service of the executive director shall be subject to the terms described in section 214.04, subdivision 2a.
Subd. 6.
Duties of board.
(a) The Emergency Medical Services Regulatory Board shall:
(1) administer and enforce the provisions of this chapter and other duties as assigned to the board;
(2) advise applicants for state or federal emergency medical services funds, review and comment on such applications, and approve the use of such funds unless otherwise required by federal law;
(3) make recommendations to the legislature on improving the access, delivery, and effectiveness of the state's emergency medical services delivery system; and
(4) establish procedures for investigating, hearing, and resolving complaints against emergency medical services providers.
(b) The Emergency Medical Services Board may prepare an initial work plan, which may be updated biennially. The work plan may include provisions to:
(1) prepare an emergency medical services assessment which addresses issues affecting the statewide delivery system;
(2) establish a statewide public information and education system regarding emergency medical services;
(3) create, in conjunction with the Department of Public Safety, a statewide injury and trauma prevention program; and
(4) designate an annual emergency medical services personnel recognition day.
Subd. 7.
Conflict of interest.
No member of the Emergency Medical Services Board may participate or vote in board proceedings in which the member has a direct conflict of interest, financial or otherwise.
144E.123 PREHOSPITAL CARE DATA.
Subd. 5.
Working group.
By October 1, 2011, the board must convene a working group composed of six members, three of which must be appointed by the board and three of which must be appointed by the Minnesota Ambulance Association, to redesign the board's policies related to collection of data from licenses. The issues to be considered include, but are not limited to, the following: user-friendly reporting requirements; data sets; improved accuracy of reported information; appropriate use of information gathered through the reporting system; and methods for minimizing the financial impact of data reporting on licenses, particularly for rural volunteer services. The working group must report its findings and recommendations to the board no later than July 1, 2012.
144E.27 EDUCATION PROGRAMS; BOARD APPROVAL.
Subdivision 1.
Education program instructor.
An education program instructor must be an emergency medical responder, EMT, AEMT, paramedic, physician, physician assistant, or registered nurse.
Subd. 1a.
Approval required.
(a) All education programs for an emergency medical responder must be approved by the board.
(b) To be approved by the board, an education program must:
(1) submit an application prescribed by the board that includes:
(i) type and length of course to be offered;
(ii) names, addresses, and qualifications of the program medical director, program education coordinator, and instructors;
(iii) admission criteria for students; and
(iv) materials and equipment to be used;
(2) for each course, implement the most current version of the United States Department of Transportation EMS Education Standards, or its equivalent as determined by the board applicable to Emergency Medical Responder registration education;
(3) have a program medical director and a program coordinator;
(4) have at least one instructor for every ten students at the practical skill stations;
(5) retain documentation of program approval by the board, course outline, and student information; and
(6) submit the appropriate fee as required under section 144E.29.
(c) The National EMS Education Standards by the NHTSA, United States Department of Transportation contains the minimal entry level of knowledge and skills for emergency medical responders. Medical directors of emergency medical responder groups may expand the knowledge and skill set.
144E.50 EMERGENCY MEDICAL SERVICES FUND.
Subd. 3.
Definition.
For purposes of this section, "board" means the Emergency Medical Services Regulatory Board.
151.74 INSULIN SAFETY NET PROGRAM.
Subd. 16.
Legislative review; sunset.
(a) The legislature shall review the reports from the Board of Pharmacy under subdivision 13, paragraph (b); the program review by the legislative auditor under subdivision 14; and the report from the commissioner of health on the survey results under subdivision 15, paragraph (e); and any other relevant information related to the cost, access, and affordability of insulin, and make a determination on whether there is a need for the continued implementation of the long-term safety net program described in subdivisions 4 to 6 to ensure that Minnesota residents have access to affordable emergency and long-term insulin or whether the market has sufficiently changed to where the continuation of this program is no longer needed past December 31, 2024, or whether there are more appropriate options available to ensure access to affordable insulin for all Minnesota residents.
(b) Subdivisions 4 to 6, 8, and 9 expire December 31, 2024, unless the legislature affirmatively determines the need for the continuation of the long-term safety net program described in subdivisions 4 to 6.
245C.08 BACKGROUND STUDY; COMMISSIONER REVIEWS.
Subd. 2.
Background studies conducted by a county agency for family child care.
(a) Before the implementation of NETStudy 2.0, for a background study conducted by a county agency for family child care services, the commissioner shall review:
(1) information from the county agency's record of substantiated maltreatment of adults and the maltreatment of minors;
(2) information from juvenile courts as required in subdivision 4 for:
(i) individuals listed in section 245C.03, subdivision 1, paragraph (a), who are ages 13 through 23 living in the household where the licensed services will be provided; and
(ii) any other individual listed under section 245C.03, subdivision 1, when there is reasonable cause; and
(3) information from the Bureau of Criminal Apprehension.
(b) If the individual has resided in the county for less than five years, the study shall include the records specified under paragraph (a) for the previous county or counties of residence for the past five years.
(c) Notwithstanding expungement by a court, the county agency may consider information obtained under paragraph (a), clause (3), unless:
(1) the commissioner received notice of the petition for expungement and the court order for expungement is directed specifically to the commissioner; or
(2) the commissioner received notice of the expungement order issued pursuant to section 609A.017, 609A.025, or 609A.035, and the order for expungement is directed specifically to the commissioner.
245C.125 BACKGROUND STUDY; HEAD START PROGRAMS.
(a) Head Start programs that receive funds under section 119A.52 may contract with the commissioner to:
(1) conduct background studies on individuals affiliated with a Head Start program; and
(2) obtain background study data on individuals affiliated with a Head Start program.
(b) The commissioner must include a national criminal history record check in a background study conducted under paragraph (a).
(c) A Head Start program site that does not contract with the commissioner, is not licensed, and is not registered to receive payments under chapter 119B is exempt from the relevant requirements in this chapter. Nothing in this section supersedes requirements for background studies in this chapter or chapter 119B or 245H that relate to licensed child care programs or programs registered to receive payments under chapter 119B. For a background study conducted under this section to be transferable to other child care entities, the study must include all components of studies for a certified license-exempt child care center under this chapter.
256D.19 ABOLITION OF TOWNSHIP SYSTEM OF POOR RELIEF.
Subdivision 1.
Town system abolished.
The town system for caring for the poor in each of the counties in which it is in effect is hereby abolished. The local social services agency of each county shall administer general assistance under the provisions of Laws 1973, chapter 650, article 21.
Subd. 2.
Local social services agencies duty.
All local social services agencies affected by Laws 1973, chapter 650, article 21 are hereby authorized to take over for the county as of January 1, 1974, the ownership of all case records relating to the administration of poor relief.
256D.20 TRANSFER OF TOWN EMPLOYEES.
Subdivision 1.
Rules for merit system.
The term "merit system" as used herein shall mean the rules for a merit system of personnel administration for employees of local social services agencies adopted by the commissioner of human services in accordance with the provisions of section 393.07, including the merit system established for Hennepin County pursuant to Laws 1965, chapter 855, as amended, the federal Social Security article as amended, and merit system standards and regulations issued by the federal Social Security Board and the United States Children's Bureau.
Subd. 2.
Designation of employees.
All employees of any municipality or town who are engaged full time in poor relief work therein on January 1, 1974 shall be retained as employees of the county and placed under the jurisdiction of its local social services agency.
All transferred employees shall be blanketed into the merit system with comparable status, classification, longevity, and seniority, and subject to the administrative requirements of the local social services agency. Employees with permanent status under any civil service provision on January 1, 1974, shall be granted permanent status under the merit system at comparable classifications and in accordance with work assignments made under the authority of the local social services agency as provided by the merit system rules.
The determination of proper job allocation shall be the responsibility of the personnel officer or director as provided under merit system rules applicable to the county involved with the right of appeal of allocation to the Merit System Council or personnel board by any employee affected by this transfer.
All transferred employees shall receive salaries for the classification to which they are allocated in accordance with the schedule in effect for local social services agency employees and at a salary step which they normally would have received had they been employed by the local social services agency for the same period of service they had previously served under the civil service provisions of any municipality or town; provided, however, that no salary shall be reduced as a result of the transfer.
All accumulated sick leave of transferred employees in the amount of 60 days or less shall be transferred to the records of the local social services agency and such accumulated sick leave shall be the legal liability of the local social services agency. All accumulated sick leave in excess of 60 days shall be paid in cash to transferred employees by the municipality or town by which they were employed prior to their transfer, at the time of transfer. In lieu of the cash payment, the municipality or town shall, at the option of the employee concerned, allow a leave of absence with pay, prior to transfer, for all or part of the accumulated sick leave.
Subd. 3.
Merit system transfer.
Employees of municipalities and towns engaged in the work of administering poor relief who are not covered by civil service provisions shall be blanketed into the merit system subject to a qualifying examination. Employees with one year or more service shall be subject to a qualifying examination and those with less than one year's service shall be subject to an open competitive examination.
Subd. 4.
Disbursement of vacation time.
All vacation leave of employees referred to in subdivision 2, accumulated prior to their transfer to county employment shall be paid in cash to them by the municipality or town by which they were employed prior to their transfer, and at the time of their transfer. In lieu of the cash payment, the municipality or town shall, at the option of the employee concerned, allow a leave of absence with pay, prior to such transfer, for all or part of the accumulated vacation time.
256D.23 TEMPORARY COUNTY ASSISTANCE PROGRAM.
Subdivision 1.
Program established.
Minnesota residents who meet the income and resource standards of section 256D.01, subdivision 1a, but do not qualify for cash benefits under sections 256D.01 to 256D.21, may qualify for a county payment under this section.
Subd. 2.
Payment amount, duration, and method.
(a) A county may make a payment of up to $203 for a single individual and up to $260 for a married couple under the terms of this subdivision.
(b) Payments to an individual or married couple may only be made once in a calendar year. If the applicant qualifies for a payment as a result of an emergency, as defined by the county, the payment shall be made within ten working days of the date of application. If the applicant does not qualify under the county definition of emergency, the payment shall be made at the beginning of the second month following the month of application, and the applicant must receive the payment in person at the local agency office.
(c) Payments may be made in the form of cash or as vendor payments for rent and utilities. If vendor payments are made, they shall be equal to $203 for a single individual or $260 for a married couple, or the actual amount of rent and utilities, whichever is less.
(d) Each county must develop policies and procedures as necessary to implement this section.
(e) Payments under this section are not an entitlement. No county is required to make a payment in excess of the amount available to the county under subdivision 3.
Subd. 3.
State allocation to counties.
The commissioner shall allocate to each county on an annual basis the amount specifically appropriated for payments under this section. The allocation shall be based on each county's proportionate share of state fiscal year 1994 work readiness expenditures.
256R.02 DEFINITIONS.
Subd. 46.
Resource utilization group.
"Resource utilization groups" or "RUG" has the meaning given in section 144.0724, subdivision 2, paragraph (f).
Repealed Minnesota Session Laws: H4571-1
Laws 2023, chapter 70, article 20, section 2, subdivision 31, as amended by Laws 2023, chapter 75, section 12;
Sec. 2. new text begin COMMISSIONER OF HUMAN SERVICESnew text end |
||||||
Subd. 31.Direct Care and Treatment - Mental Health and Substance Abuse |
-0- | 6,109,000 | ||||
(a) Keeping Nurses at the Bedside Act; contingent appropriation. The appropriation in this subdivision is contingent upon legislative enactmentnew text begin by the 93rd Legislaturenew text end of deleted text begin 2023 Senate File 1384 by the 93rd Legislaturedeleted text end new text begin provisions substantially similar to 2023 S.F. No. 1561, the second engrossment, article 2new text end .
(b) Base level adjustment. The general fund base is increased by $7,566,000 in fiscal year 2026 and increased by $7,566,000 in fiscal year 2027.
Laws 2023, chapter 75, section 10
Sec. 10. new text begin USE OF APPROPRIATION; LOAN FORGIVENESS ADMINISTRATION.new text end
new text begin The commissioner of health may also use the appropriation in S.F. No. 2995, article 20, section 3, subdivision 2, paragraph (w), clause (3), if enacted during 2023 regular legislative session, for administering sections 2 to 5. new text end
Laws 2024, chapter 80, article 2, section 6, subdivision 4
Sec. 6.
new text begin [142B.11] LICENSE APPLICATION AFTER CHANGE OF OWNERSHIP. new text end
new text begin Subd. 4. new text end
new text begin Temporary change in ownership license. new text end
new text begin (a) After receiving the party's application pursuant to subdivision 3, upon the written request of the existing license holder and the party, the commissioner may issue a temporary change in ownership license to the party while the commissioner evaluates the party's application. Until a decision is made to grant or deny a license under this chapter, the existing license holder and the party shall both be responsible for operating the program or service according to applicable laws and rules, and the sale or transfer of the existing license holder's ownership interest in the licensed program or service does not terminate the existing license. new text end
new text begin (b) The commissioner may issue a temporary change in ownership license when a license holder's death, divorce, or other event affects the ownership of the program and an applicant seeks to assume operation of the program or service to ensure continuity of the program or service while a license application is evaluated. new text end
new text begin (c) This subdivision applies to any program or service licensed under this chapter. new text end
Repealed Minnesota Rule: H4571-1
2960.0620 USE OF PSYCHOTROPIC MEDICATIONS.
Subp. 3.
Monitoring for tardive dyskinesia.
The license holder, under the direction of a medically licensed person, must monitor for tardive dyskinesia at least every three months if a resident is prescribed antipsychotic medication or amoxapine and must document the monitoring. A resident prescribed antipsychotic medication or amoxapine for more than 90 days must be checked for tardive dyskinesia at least 30 and 60 days after discontinuation of the antipsychotic medication or amoxapine. Monitoring must include use of a standardized rating scale and examination procedure. The license holder must provide the assessments to the physician for review if the results meet criteria that require physician review.
9502.0425 PHYSICAL ENVIRONMENT.
Subp. 5.
Occupancy separations.
Day care residences with an attached garage must have a self-closing, tight fitting solid wood bonded core door at least 1-3/8 inch thick, or door with a fire protection rating of 20 minutes or greater and a separation wall consisting of 5/8 inch thick gypsum wallboard or its equivalent on the garage side between the residence and garage.