1.1                          A bill for an act 
  1.2             relating to human services; making technical changes 
  1.3             to continuing care programs; amending Minnesota 
  1.4             Statutes 2000, sections 256B.0915, subdivisions 4, 6, 
  1.5             by adding a subdivision; 256B.431, subdivisions 14, 
  1.6             30; 256B.5012, subdivision 2; Minnesota Statutes 2001 
  1.7             Supplement, sections 256B.0913, subdivisions 4, 5, 8, 
  1.8             10, 12, 14; 256B.0915, subdivision 5; 256B.431, 
  1.9             subdivisions 2e, 33; 256B.437, subdivision 3; 256B.76. 
  1.10  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.11     Section 1.  Minnesota Statutes 2001 Supplement, section 
  1.12  256B.0913, subdivision 4, is amended to read: 
  1.13     Subd. 4.  [ELIGIBILITY FOR FUNDING FOR SERVICES FOR 
  1.14  NONMEDICAL ASSISTANCE RECIPIENTS.] (a) Funding for services 
  1.15  under the alternative care program is available to persons who 
  1.16  meet the following criteria: 
  1.17     (1) the person has been determined by a community 
  1.18  assessment under section 256B.0911 to be a person who would 
  1.19  require the level of care provided in a nursing facility, but 
  1.20  for the provision of services under the alternative care 
  1.21  program; 
  1.22     (2) the person is age 65 or older; 
  1.23     (3) the person would be eligible for medical assistance 
  1.24  within 180 days of admission to a nursing facility; 
  1.25     (4) the person is not ineligible for the medical assistance 
  1.26  program due to an asset transfer penalty; 
  1.27     (5) the person needs services that are not funded through 
  2.1   other state or federal funding; and 
  2.2      (6) the monthly cost of the alternative care services 
  2.3   funded by the program for this person does not exceed 75 percent 
  2.4   of the statewide weighted average monthly nursing facility rate 
  2.5   of the case mix resident class to which the individual 
  2.6   alternative care client would be assigned under Minnesota Rules, 
  2.7   parts 9549.0050 to 9549.0059, less the recipient's maintenance 
  2.8   needs allowance as described in section 256B.0915, subdivision 
  2.9   1d, paragraph (a), until the first day of the state fiscal year 
  2.10  in which the resident assessment system, under section 256B.437, 
  2.11  for nursing home rate determination is implemented.  Effective 
  2.12  on the first day of the state fiscal year in which a resident 
  2.13  assessment system, under section 256B.437, for nursing home rate 
  2.14  determination is implemented and the first day of each 
  2.15  subsequent state fiscal year, the monthly cost of alternative 
  2.16  care services for this person shall not exceed the alternative 
  2.17  care monthly cap for the case mix resident class to which the 
  2.18  alternative care client would be assigned under Minnesota Rules, 
  2.19  parts 9549.0050 to 9549.0059, which was in effect on the last 
  2.20  day of the previous state fiscal year, and adjusted by the 
  2.21  greater of any legislatively adopted home and community-based 
  2.22  services cost-of-living percentage increase or any legislatively 
  2.23  adopted statewide percent rate increase for nursing facilities.  
  2.24  This monthly limit does not prohibit the alternative care client 
  2.25  from payment for additional services, but in no case may the 
  2.26  cost of additional services purchased under this section exceed 
  2.27  the difference between the client's monthly service limit 
  2.28  defined under section 256B.0915, subdivision 3, and the 
  2.29  alternative care program monthly service limit defined in this 
  2.30  paragraph.  If medical supplies and equipment or environmental 
  2.31  modifications are or will be purchased for an alternative care 
  2.32  services recipient, the costs may be prorated on a monthly basis 
  2.33  for up to 12 consecutive months beginning with the month of 
  2.34  purchase.  If the monthly cost of a recipient's other 
  2.35  alternative care services exceeds the monthly limit established 
  2.36  in this paragraph, the annual cost of the alternative care 
  3.1   services shall be determined.  In this event, the annual cost of 
  3.2   alternative care services shall not exceed 12 times the monthly 
  3.3   limit described in this paragraph. 
  3.4      (b) Alternative care funding under this subdivision is not 
  3.5   available for a person who is a medical assistance recipient or 
  3.6   who would be eligible for medical assistance without a spenddown 
  3.7   or waiver obligation.  A person whose initial application for 
  3.8   medical assistance is being processed may be served under the 
  3.9   alternative care program for a period up to 60 days.  If the 
  3.10  individual is found to be eligible for medical assistance, 
  3.11  medical assistance must be billed for services payable under the 
  3.12  federally approved elderly waiver plan and delivered from the 
  3.13  date the individual was found eligible for the federally 
  3.14  approved elderly waiver plan.  Notwithstanding this provision, 
  3.15  upon federal approval, alternative care funds may not be used to 
  3.16  pay for any service the cost of which is payable by medical 
  3.17  assistance or which is used by a recipient to meet a medical 
  3.18  assistance income spenddown or waiver obligation.  
  3.19     (c) Alternative care funding is not available for a person 
  3.20  who resides in a licensed nursing home, certified boarding care 
  3.21  home, hospital, or intermediate care facility, except for case 
  3.22  management services which are provided in support of the 
  3.23  discharge planning process to a nursing home resident or 
  3.24  certified boarding care home resident who is ineligible for case 
  3.25  management funded by medical assistance. 
  3.26     Sec. 2.  Minnesota Statutes 2001 Supplement, section 
  3.27  256B.0913, subdivision 5, is amended to read: 
  3.28     Subd. 5.  [SERVICES COVERED UNDER ALTERNATIVE CARE.] (a) 
  3.29  Alternative care funding may be used for payment of costs of: 
  3.30     (1) adult foster care; 
  3.31     (2) adult day care; 
  3.32     (3) home health aide; 
  3.33     (4) homemaker services; 
  3.34     (5) personal care; 
  3.35     (6) case management; 
  3.36     (7) respite care; 
  4.1      (8) assisted living; 
  4.2      (9) residential care services; 
  4.3      (10) care-related supplies and equipment; 
  4.4      (11) meals delivered to the home; 
  4.5      (12) transportation; 
  4.6      (13) skilled nursing services; 
  4.7      (14) chore services; 
  4.8      (15) companion services; 
  4.9      (16) nutrition services; 
  4.10     (17) training for direct informal caregivers; 
  4.11     (18) telemedicine telehome care devices to monitor 
  4.12  recipients in their own homes as an alternative to hospital 
  4.13  care, nursing home care, or home visits; 
  4.14     (19) other services which includes discretionary funds and 
  4.15  direct cash payments to clients, following approval by the 
  4.16  commissioner, subject to the provisions of paragraph (j).  Total 
  4.17  annual payments for "other services" for all clients within a 
  4.18  county may not exceed either ten percent of that county's annual 
  4.19  alternative care program base allocation or $5,000, whichever is 
  4.20  greater.  In no case shall this amount exceed the county's total 
  4.21  annual alternative care program base allocation; and 
  4.22     (20) environmental modifications. 
  4.23     (b) The county agency must ensure that the funds are not 
  4.24  used to supplant services available through other public 
  4.25  assistance or services programs. 
  4.26     (c) Unless specified in statute, the service services, 
  4.27  service definitions, and standards for alternative care services 
  4.28  shall be the same as the service services, service definitions, 
  4.29  and standards specified in the federally approved elderly waiver 
  4.30  plan.  Except for the county agencies' approval of direct cash 
  4.31  payments to clients as described in paragraph (j) or for a 
  4.32  provider of supplies and equipment when the monthly cost of the 
  4.33  supplies and equipment is less than $250, persons or agencies 
  4.34  must be employed by or under a contract with the county agency 
  4.35  or the public health nursing agency of the local board of health 
  4.36  in order to receive funding under the alternative care program.  
  5.1   Supplies and equipment may be purchased from a vendor not 
  5.2   certified to participate in the Medicaid program if the cost for 
  5.3   the item is less than that of a Medicaid vendor.  
  5.4      (d) The adult foster care rate shall be considered a 
  5.5   difficulty of care payment and shall not include room and 
  5.6   board.  The adult foster care rate shall be negotiated between 
  5.7   the county agency and the foster care provider.  The alternative 
  5.8   care payment for the foster care service in combination with the 
  5.9   payment for other alternative care services, including case 
  5.10  management, must not exceed the limit specified in subdivision 
  5.11  4, paragraph (a), clause (6). 
  5.12     (e) Personal care services must meet the service standards 
  5.13  defined in the federally approved elderly waiver plan, except 
  5.14  that a county agency may contract with a client's relative who 
  5.15  meets the relative hardship waiver requirement as defined in 
  5.16  section 256B.0627, subdivision 4, paragraph (b), clause (10), to 
  5.17  provide personal care services if the county agency ensures 
  5.18  supervision of this service by a registered nurse or mental 
  5.19  health practitioner qualified professional as defined in section 
  5.20  256B.0625, subdivision 19c.  
  5.21     (f) For purposes of this section, residential care services 
  5.22  are services which are provided to individuals living in 
  5.23  residential care homes.  Residential care homes are currently 
  5.24  licensed as board and lodging establishments and are registered 
  5.25  with the department of health as providing special services 
  5.26  under section 157.17 and are not subject to registration under 
  5.27  chapter 144D.  Residential care services are defined as 
  5.28  "supportive services" and "health-related services."  
  5.29  "Supportive services" means the provision of up to 24-hour 
  5.30  supervision and oversight.  Supportive services includes:  (1) 
  5.31  transportation, when provided by the residential care home only; 
  5.32  (2) socialization, when socialization is part of the plan of 
  5.33  care, has specific goals and outcomes established, and is not 
  5.34  diversional or recreational in nature; (3) assisting clients in 
  5.35  setting up meetings and appointments; (4) assisting clients in 
  5.36  setting up medical and social services; (5) providing assistance 
  6.1   with personal laundry, such as carrying the client's laundry to 
  6.2   the laundry room.  Assistance with personal laundry does not 
  6.3   include any laundry, such as bed linen, that is included in the 
  6.4   room and board rate.  "Health-related services" are limited to 
  6.5   minimal assistance with dressing, grooming, and bathing and 
  6.6   providing reminders to residents to take medications that are 
  6.7   self-administered or providing storage for medications, if 
  6.8   requested.  Individuals receiving residential care services 
  6.9   cannot receive homemaking services funded under this section.  
  6.10     (g) For the purposes of this section, "assisted living" 
  6.11  refers to supportive services provided by a single vendor to 
  6.12  clients who reside in the same apartment building of three or 
  6.13  more units which are not subject to registration under chapter 
  6.14  144D and are licensed by the department of health as a class A 
  6.15  home care provider or a class E home care provider.  Assisted 
  6.16  living services are defined as up to 24-hour supervision, and 
  6.17  oversight, supportive services as defined in clause (1), 
  6.18  individualized home care aide tasks as defined in clause (2), 
  6.19  and individualized home management tasks as defined in clause 
  6.20  (3) provided to residents of a residential center living in 
  6.21  their units or apartments with a full kitchen and bathroom.  A 
  6.22  full kitchen includes a stove, oven, refrigerator, food 
  6.23  preparation counter space, and a kitchen utensil storage 
  6.24  compartment.  Assisted living services must be provided by the 
  6.25  management of the residential center or by providers under 
  6.26  contract with the management or with the county. 
  6.27     (1) Supportive services include:  
  6.28     (i) socialization, when socialization is part of the plan 
  6.29  of care, has specific goals and outcomes established, and is not 
  6.30  diversional or recreational in nature; 
  6.31     (ii) assisting clients in setting up meetings and 
  6.32  appointments; and 
  6.33     (iii) providing transportation, when provided by the 
  6.34  residential center only.  
  6.35     (2) Home care aide tasks means:  
  6.36     (i) preparing modified diets, such as diabetic or low 
  7.1   sodium diets; 
  7.2      (ii) reminding residents to take regularly scheduled 
  7.3   medications or to perform exercises; 
  7.4      (iii) household chores in the presence of technically 
  7.5   sophisticated medical equipment or episodes of acute illness or 
  7.6   infectious disease; 
  7.7      (iv) household chores when the resident's care requires the 
  7.8   prevention of exposure to infectious disease or containment of 
  7.9   infectious disease; and 
  7.10     (v) assisting with dressing, oral hygiene, hair care, 
  7.11  grooming, and bathing, if the resident is ambulatory, and if the 
  7.12  resident has no serious acute illness or infectious disease.  
  7.13  Oral hygiene means care of teeth, gums, and oral prosthetic 
  7.14  devices.  
  7.15     (3) Home management tasks means:  
  7.16     (i) housekeeping; 
  7.17     (ii) laundry; 
  7.18     (iii) preparation of regular snacks and meals; and 
  7.19     (iv) shopping.  
  7.20     Individuals receiving assisted living services shall not 
  7.21  receive both assisted living services and homemaking services.  
  7.22  Individualized means services are chosen and designed 
  7.23  specifically for each resident's needs, rather than provided or 
  7.24  offered to all residents regardless of their illnesses, 
  7.25  disabilities, or physical conditions.  Assisted living services 
  7.26  as defined in this section shall not be authorized in boarding 
  7.27  and lodging establishments licensed according to sections 
  7.28  157.011 and 157.15 to 157.22. 
  7.29     (h) For establishments registered under chapter 144D, 
  7.30  assisted living services under this section means either the 
  7.31  services described in paragraph (g) and delivered by a class E 
  7.32  home care provider licensed by the department of health or the 
  7.33  services described under section 144A.4605 and delivered by an 
  7.34  assisted living home care provider or a class A home care 
  7.35  provider licensed by the commissioner of health. 
  7.36     (i) Payment for assisted living services and residential 
  8.1   care services shall be a monthly rate negotiated and authorized 
  8.2   by the county agency based on an individualized service plan for 
  8.3   each resident and may not cover direct rent or food costs.  
  8.4      (1) The individualized monthly negotiated payment for 
  8.5   assisted living services as described in paragraph (g) or (h), 
  8.6   and residential care services as described in paragraph (f), 
  8.7   shall not exceed the nonfederal share in effect on July 1 of the 
  8.8   state fiscal year for which the rate limit is being calculated 
  8.9   of the greater of either the statewide or any of the geographic 
  8.10  groups' weighted average monthly nursing facility payment rate 
  8.11  of the case mix resident class to which the alternative care 
  8.12  eligible client would be assigned under Minnesota Rules, parts 
  8.13  9549.0050 to 9549.0059, less the maintenance needs allowance as 
  8.14  described in section 256B.0915, subdivision 1d, paragraph (a), 
  8.15  until the first day of the state fiscal year in which a resident 
  8.16  assessment system, under section 256B.437, of nursing home rate 
  8.17  determination is implemented.  Effective on the first day of the 
  8.18  state fiscal year in which a resident assessment system, under 
  8.19  section 256B.437, of nursing home rate determination is 
  8.20  implemented and the first day of each subsequent state fiscal 
  8.21  year, the individualized monthly negotiated payment for the 
  8.22  services described in this clause shall not exceed the limit 
  8.23  described in this clause which was in effect on the last day of 
  8.24  the previous state fiscal year and which has been adjusted by 
  8.25  the greater of any legislatively adopted home and 
  8.26  community-based services cost-of-living percentage increase or 
  8.27  any legislatively adopted statewide percent rate increase for 
  8.28  nursing facilities. 
  8.29     (2) The individualized monthly negotiated payment for 
  8.30  assisted living services described under section 144A.4605 and 
  8.31  delivered by a provider licensed by the department of health as 
  8.32  a class A home care provider or an assisted living home care 
  8.33  provider and provided in a building that is registered as a 
  8.34  housing with services establishment under chapter 144D and that 
  8.35  provides 24-hour supervision in combination with the payment for 
  8.36  other alternative care services, including case management, must 
  9.1   not exceed the limit specified in subdivision 4, paragraph (a), 
  9.2   clause (6). 
  9.3      (j) A county agency may make payment from their alternative 
  9.4   care program allocation for "other services" which include use 
  9.5   of "discretionary funds" for services that are not otherwise 
  9.6   defined in this section and direct cash payments to the client 
  9.7   for the purpose of purchasing the services.  The following 
  9.8   provisions apply to payments under this paragraph: 
  9.9      (1) a cash payment to a client under this provision cannot 
  9.10  exceed 80 percent of the monthly payment limit for that client 
  9.11  as specified in subdivision 4, paragraph (a), clause (6); 
  9.12     (2) a county may not approve any cash payment for a client 
  9.13  who meets either of the following: 
  9.14     (i) has been assessed as having a dependency in 
  9.15  orientation, unless the client has an authorized 
  9.16  representative.  An "authorized representative" means an 
  9.17  individual who is at least 18 years of age and is designated by 
  9.18  the person or the person's legal representative to act on the 
  9.19  person's behalf.  This individual may be a family member, 
  9.20  guardian, representative payee, or other individual designated 
  9.21  by the person or the person's legal representative, if any, to 
  9.22  assist in purchasing and arranging for supports; or 
  9.23     (ii) is concurrently receiving adult foster care, 
  9.24  residential care, or assisted living services; 
  9.25     (3) cash payments to a person or a person's family will be 
  9.26  provided through a monthly payment and be in the form of cash, 
  9.27  voucher, or direct county payment to a vendor.  Fees or premiums 
  9.28  assessed to the person for eligibility for health and human 
  9.29  services are not reimbursable through this service option.  
  9.30  Services and goods purchased through cash payments must be 
  9.31  identified in the person's individualized care plan and must 
  9.32  meet all of the following criteria: 
  9.33     (i) they must be over and above the normal cost of caring 
  9.34  for the person if the person did not have functional 
  9.35  limitations; 
  9.36     (ii) they must be directly attributable to the person's 
 10.1   functional limitations; 
 10.2      (iii) they must have the potential to be effective at 
 10.3   meeting the goals of the program; 
 10.4      (iv) they must be consistent with the needs identified in 
 10.5   the individualized service plan.  The service plan shall specify 
 10.6   the needs of the person and family, the form and amount of 
 10.7   payment, the items and services to be reimbursed, and the 
 10.8   arrangements for management of the individual grant; and 
 10.9      (v) the person, the person's family, or the legal 
 10.10  representative shall be provided sufficient information to 
 10.11  ensure an informed choice of alternatives.  The local agency 
 10.12  shall document this information in the person's care plan, 
 10.13  including the type and level of expenditures to be reimbursed; 
 10.14     (4) the state of Minnesota, county, lead agency under 
 10.15  contract, or tribal government under contract to administer the 
 10.16  alternative care program shall not be liable for damages, 
 10.17  injuries, or liabilities sustained through the purchase of 
 10.18  direct supports or goods by the person, the person's family, or 
 10.19  the authorized representative with funds received through the 
 10.20  cash payments under this section.  Liabilities include, but are 
 10.21  not limited to, workers' compensation, the Federal Insurance 
 10.22  Contributions Act (FICA), or the Federal Unemployment Tax Act 
 10.23  (FUTA); 
 10.24     (5) persons receiving grants under this section shall have 
 10.25  the following responsibilities: 
 10.26     (i) spend the grant money in a manner consistent with their 
 10.27  individualized service plan with the local agency; 
 10.28     (ii) notify the local agency of any necessary changes in 
 10.29  the grant expenditures; 
 10.30     (iii) arrange and pay for supports; and 
 10.31     (iv) inform the local agency of areas where they have 
 10.32  experienced difficulty securing or maintaining supports; and 
 10.33     (6) the county shall report client outcomes, services, and 
 10.34  costs under this paragraph in a manner prescribed by the 
 10.35  commissioner. 
 10.36     (k) Upon implementation of direct cash payments to clients 
 11.1   under this section, any person determined eligible for the 
 11.2   alternative care program who chooses a cash payment approved by 
 11.3   the county agency shall receive the cash payment under this 
 11.4   section and not under section 256.476 unless the person was 
 11.5   receiving a consumer support grant under section 256.476 before 
 11.6   implementation of direct cash payments under this section. 
 11.7      Sec. 3.  Minnesota Statutes 2001 Supplement, section 
 11.8   256B.0913, subdivision 8, is amended to read: 
 11.9      Subd. 8.  [REQUIREMENTS FOR INDIVIDUAL CARE PLAN.] (a) The 
 11.10  case manager shall implement the plan of care for each 
 11.11  alternative care client and ensure that a client's service needs 
 11.12  and eligibility are reassessed at least every 12 months.  The 
 11.13  plan shall include any services prescribed by the individual's 
 11.14  attending physician as necessary to allow the individual to 
 11.15  remain in a community setting.  In developing the individual's 
 11.16  care plan, the case manager should include the use of volunteers 
 11.17  from families and neighbors, religious organizations, social 
 11.18  clubs, and civic and service organizations to support the formal 
 11.19  home care services.  The county shall be held harmless for 
 11.20  damages or injuries sustained through the use of volunteers 
 11.21  under this subdivision including workers' compensation 
 11.22  liability.  The lead agency shall provide documentation in each 
 11.23  individual's plan of care and, if requested, to the commissioner 
 11.24  that the most cost-effective alternatives available have been 
 11.25  offered to the individual and that the individual was free to 
 11.26  choose among available qualified providers, both public and 
 11.27  private.  The case manager must give the individual a ten-day 
 11.28  written notice of any decrease in or denial, termination, or 
 11.29  reduction of alternative care services. 
 11.30     (b) If the county administering alternative care services 
 11.31  is different than the county of financial responsibility, the 
 11.32  care plan may be implemented without the approval of the county 
 11.33  of financial responsibility. 
 11.34     Sec. 4.  Minnesota Statutes 2001 Supplement, section 
 11.35  256B.0913, subdivision 10, is amended to read: 
 11.36     Subd. 10.  [ALLOCATION FORMULA.] (a) The alternative care 
 12.1   appropriation for fiscal years 1992 and beyond shall cover only 
 12.2   alternative care eligible clients.  Prior to By July 1 of each 
 12.3   year, the commissioner shall allocate to county agencies the 
 12.4   state funds available for alternative care for persons eligible 
 12.5   under subdivision 2. 
 12.6      (b) The adjusted base for each county is the county's 
 12.7   current fiscal year base allocation plus any targeted funds 
 12.8   approved during the current fiscal year.  Calculations for 
 12.9   paragraphs (c) and (d) are to be made as follows:  for each 
 12.10  county, the determination of alternative care program 
 12.11  expenditures shall be based on payments for services rendered 
 12.12  from April 1 through March 31 in the base year, to the extent 
 12.13  that claims have been submitted and paid by June 1 of that year. 
 12.14     (c) If the alternative care program expenditures as defined 
 12.15  in paragraph (b) are 95 percent or more of the county's adjusted 
 12.16  base allocation, the allocation for the next fiscal year is 100 
 12.17  percent of the adjusted base, plus inflation to the extent that 
 12.18  inflation is included in the state budget. 
 12.19     (d) If the alternative care program expenditures as defined 
 12.20  in paragraph (b) are less than 95 percent of the county's 
 12.21  adjusted base allocation, the allocation for the next fiscal 
 12.22  year is the adjusted base allocation less the amount of unspent 
 12.23  funds below the 95 percent level. 
 12.24     (e) If the annual legislative appropriation for the 
 12.25  alternative care program is inadequate to fund the combined 
 12.26  county allocations for a biennium, the commissioner shall 
 12.27  distribute to each county the entire annual appropriation as 
 12.28  that county's percentage of the computed base as calculated in 
 12.29  paragraphs (c) and (d). 
 12.30     Sec. 5.  Minnesota Statutes 2001 Supplement, section 
 12.31  256B.0913, subdivision 12, is amended to read: 
 12.32     Subd. 12.  [CLIENT PREMIUMS.] (a) A premium is required for 
 12.33  all alternative care eligible clients to help pay for the cost 
 12.34  of participating in the program.  The amount of the premium for 
 12.35  the alternative care client shall be determined as follows: 
 12.36     (1) when the alternative care client's income less 
 13.1   recurring and predictable medical expenses is greater than the 
 13.2   recipient's maintenance needs allowance as defined in section 
 13.3   256B.0915, subdivision 1d, paragraph (a), but less than 150 
 13.4   percent of the federal poverty guideline effective on July 1 of 
 13.5   the state fiscal year in which the premium is being computed, 
 13.6   and total assets are less than $10,000, the fee is zero; 
 13.7      (2) when the alternative care client's income less 
 13.8   recurring and predictable medical expenses is greater than 150 
 13.9   percent of the federal poverty guideline effective on July 1 of 
 13.10  the state fiscal year in which the premium is being computed, 
 13.11  and total assets are less than $10,000, the fee is 25 percent of 
 13.12  the cost of alternative care services or the difference between 
 13.13  150 percent of the federal poverty guideline effective on July 1 
 13.14  of the state fiscal year in which the premium is being computed 
 13.15  and the client's income less recurring and predictable medical 
 13.16  expenses, whichever is less; and 
 13.17     (3) when the alternative care client's total assets are 
 13.18  greater than $10,000, the fee is 25 percent of the cost of 
 13.19  alternative care services.  
 13.20     For married persons, total assets are defined as the total 
 13.21  marital assets less the estimated community spouse asset 
 13.22  allowance, under section 256B.059, if applicable.  For married 
 13.23  persons, total income is defined as the client's income less the 
 13.24  monthly spousal allotment, under section 256B.058. 
 13.25     All alternative care services except case management shall 
 13.26  be included in the estimated costs for the purpose of 
 13.27  determining 25 percent of the costs. 
 13.28     The monthly premium shall be calculated based on the cost 
 13.29  of the first full month of alternative care services and shall 
 13.30  continue unaltered until the next reassessment is completed or 
 13.31  at the end of 12 months, whichever comes first.  Premiums are 
 13.32  due and payable each month alternative care services are 
 13.33  received unless the actual cost of the services is less than the 
 13.34  premium. 
 13.35     (b) The fee shall be waived by the commissioner when: 
 13.36     (1) a person who is residing in a nursing facility is 
 14.1   receiving case management only; 
 14.2      (2) a person is applying for medical assistance; 
 14.3      (3) a married couple is requesting an asset assessment 
 14.4   under the spousal impoverishment provisions; 
 14.5      (4) a person is found eligible for alternative care, but is 
 14.6   not yet receiving alternative care services; or 
 14.7      (5) a person's fee under paragraph (a) is less than $25. 
 14.8      (c) The county agency must record in the state's receivable 
 14.9   system the client's assessed premium amount or the reason the 
 14.10  premium has been waived.  The commissioner will bill and collect 
 14.11  the premium from the client.  Money collected must be deposited 
 14.12  in the general fund and is appropriated to the commissioner for 
 14.13  the alternative care program.  The client must supply the county 
 14.14  with the client's social security number at the time of 
 14.15  application.  The county shall supply the commissioner with the 
 14.16  client's social security number and other information the 
 14.17  commissioner requires to collect the premium from the client.  
 14.18  The commissioner shall collect unpaid premiums using the Revenue 
 14.19  Recapture Act in chapter 270A and other methods available to the 
 14.20  commissioner.  The commissioner may require counties to inform 
 14.21  clients of the collection procedures that may be used by the 
 14.22  state if a premium is not paid.  This paragraph does not apply 
 14.23  to alternative care pilot projects authorized in Laws 1993, 
 14.24  First Special Session chapter 1, article 5, section 133, if a 
 14.25  county operating under the pilot project reports the following 
 14.26  dollar amounts to the commissioner quarterly: 
 14.27     (1) total premiums billed to clients; 
 14.28     (2) total collections of premiums billed; and 
 14.29     (3) balance of premiums owed by clients. 
 14.30  If a county does not adhere to these reporting requirements, the 
 14.31  commissioner may terminate the billing, collecting, and 
 14.32  remitting portions of the pilot project and require the county 
 14.33  involved to operate under the procedures set forth in this 
 14.34  paragraph. 
 14.35     (d) The commissioner shall begin to adopt emergency or 
 14.36  permanent rules governing client premiums within 30 days after 
 15.1   July 1, 1991, including criteria for determining when services 
 15.2   to a client must be terminated due to failure to pay a premium.  
 15.3      Sec. 6.  Minnesota Statutes 2001 Supplement, section 
 15.4   256B.0913, subdivision 14, is amended to read: 
 15.5      Subd. 14.  [PROVIDER REQUIREMENTS, PAYMENT, AND RATE 
 15.6   ADJUSTMENTS.] (a) Unless otherwise specified in statute, 
 15.7   providers must be enrolled in the state's Minnesota health care 
 15.8   program and abide by the requirements for provider participation 
 15.9   according to Minnesota Rules, part 9505.0195. 
 15.10     (b) Payment for provided alternative care services as 
 15.11  approved by the client's case manager shall be occur through the 
 15.12  invoice processing procedures of the department's Medicaid 
 15.13  Management Information System (MMIS).  To receive payment, the 
 15.14  county or vendor must submit invoices within 12 months following 
 15.15  the date of service.  The county agency and its vendors under 
 15.16  contract shall not be reimbursed for services which exceed the 
 15.17  county allocation. 
 15.18     (b) (c) The county shall negotiate individual rates with 
 15.19  vendors and may authorize service payment for actual costs up to 
 15.20  the county's current approved rate.  Notwithstanding any other 
 15.21  rule or statutory provision to the contrary, the commissioner 
 15.22  shall not be authorized to increase rates by an annual inflation 
 15.23  factor, unless so authorized by the legislature.  To improve 
 15.24  access to community services and eliminate payment disparities 
 15.25  between the alternative care program and the elderly waiver 
 15.26  program, the commissioner shall establish statewide maximum 
 15.27  service rate limits and eliminate county-specific service rate 
 15.28  limits. 
 15.29     (1) Effective July 1, 2001, for service rate limits, except 
 15.30  those in subdivision 5, paragraphs (d) and (i), the rate limit 
 15.31  for each service shall be the greater of the alternative care 
 15.32  statewide maximum rate or the elderly waiver statewide maximum 
 15.33  rate. 
 15.34     (2) Counties may negotiate individual service rates with 
 15.35  vendors for actual costs up to the statewide maximum service 
 15.36  rate limit. 
 16.1      Sec. 7.  Minnesota Statutes 2000, section 256B.0915, 
 16.2   subdivision 4, is amended to read: 
 16.3      Subd. 4.  [TERMINATION NOTICE.] The case manager must give 
 16.4   the individual a ten-day written notice of any decrease in 
 16.5   denial, reduction, or termination of waivered services. 
 16.6      Sec. 8.  Minnesota Statutes 2001 Supplement, section 
 16.7   256B.0915, subdivision 5, is amended to read: 
 16.8      Subd. 5.  [ASSESSMENTS AND REASSESSMENTS FOR WAIVER 
 16.9   CLIENTS.] Each client shall receive an initial assessment of 
 16.10  strengths, informal supports, and need for services in 
 16.11  accordance with section 256B.0911, subdivisions 3, 3a, and 3b.  
 16.12  A reassessment of a client served under the elderly waiver must 
 16.13  be conducted at least every 12 months and at other times when 
 16.14  the case manager determines that there has been significant 
 16.15  change in the client's functioning.  This may include instances 
 16.16  where the client is discharged from the hospital.  
 16.17     Sec. 9.  Minnesota Statutes 2000, section 256B.0915, 
 16.18  subdivision 6, is amended to read: 
 16.19     Subd. 6.  [IMPLEMENTATION OF CARE PLAN.] Each elderly 
 16.20  waiver client shall be provided a copy of a written care plan 
 16.21  that meets the requirements outlined in section 256B.0913, 
 16.22  subdivision 8.  If the county administering waivered services is 
 16.23  different than the county of financial responsibility, the care 
 16.24  plan may be implemented without the approval of the county of 
 16.25  financial responsibility. 
 16.26     Sec. 10.  Minnesota Statutes 2000, section 256B.0915, is 
 16.27  amended by adding a subdivision to read: 
 16.28     Subd. 8.  [SERVICES AND SUPPORTS.] (a) Services and 
 16.29  supports shall meet the requirements set out in United States 
 16.30  Code, title 42, section 1396n. 
 16.31     (b) Services and supports shall promote consumer choice and 
 16.32  be arranged and provided consistent with individualized, written 
 16.33  care plans. 
 16.34     (c) The state of Minnesota, county, or tribal government 
 16.35  under contract to administer the elderly waiver shall not be 
 16.36  liable for damages, injuries, or liabilities sustained through 
 17.1   the purchase of direct supports or goods by the person, the 
 17.2   person's family, or the authorized representatives with funds 
 17.3   received through consumer directed community support services 
 17.4   under the federally approved waiver plan.  Liabilities include, 
 17.5   but are not limited to, workers' compensation liability, the 
 17.6   Federal Insurance Contributions Act (FICA), or the Federal 
 17.7   Unemployment Tax Act (FUTA). 
 17.8      Sec. 11.  Minnesota Statutes 2001 Supplement, section 
 17.9   256B.431, subdivision 2e, is amended to read: 
 17.10     Subd. 2e.  [CONTRACTS FOR SERVICES FOR VENTILATOR-DEPENDENT 
 17.11  PERSONS.] The commissioner may contract negotiate with a nursing 
 17.12  facility eligible to receive medical assistance payments to 
 17.13  provide services to a ventilator-dependent person identified by 
 17.14  the commissioner according to criteria developed by the 
 17.15  commissioner, including:  
 17.16     (1) nursing facility care has been recommended for the 
 17.17  person by a preadmission screening team; 
 17.18     (2) the person has been hospitalized and no longer requires 
 17.19  inpatient acute care hospital services; and 
 17.20     (3) the commissioner has determined that necessary services 
 17.21  for the person cannot be provided under existing nursing 
 17.22  facility rates.  
 17.23     The commissioner may issue a request for proposals to 
 17.24  provide services to a ventilator-dependent person to nursing 
 17.25  facilities eligible to receive medical assistance payments and 
 17.26  shall select nursing facilities from among respondents according 
 17.27  to criteria developed by the commissioner, including:  
 17.28     (1) the cost-effectiveness and appropriateness of services; 
 17.29     (2) the nursing facility's compliance with federal and 
 17.30  state licensing and certification standards; and 
 17.31     (3) the proximity of the nursing facility to a 
 17.32  ventilator-dependent person identified by the commissioner who 
 17.33  requires nursing facility placement.  
 17.34     The commissioner may negotiate an adjustment to the 
 17.35  operating cost payment rate for a nursing facility selected by 
 17.36  the commissioner from among respondents to the request for 
 18.1   proposals with a resident who is ventilator-dependent, for that 
 18.2   resident.  The negotiated adjustment must reflect only the 
 18.3   actual additional cost of meeting the specialized care needs of 
 18.4   a ventilator-dependent person identified by the commissioner for 
 18.5   whom necessary services cannot be provided under existing 
 18.6   nursing facility rates and which are not otherwise covered under 
 18.7   Minnesota Rules, parts 9549.0010 to 9549.0080 or 9505.0170 to 
 18.8   9505.0475.  For persons who are initially admitted to a nursing 
 18.9   facility before July 1, 2001, and have their payment rate under 
 18.10  this subdivision negotiated after July 1, 2001, the negotiated 
 18.11  payment rate must not exceed 200 percent of the highest multiple 
 18.12  bedroom payment rate for the facility, as initially established 
 18.13  by the commissioner for the rate year for case mix 
 18.14  classification K; or, upon implementation of the RUGs-based case 
 18.15  mix system, 200 percent of the highest RUGs rate.  For persons 
 18.16  initially admitted to a nursing facility on or after July 1, 
 18.17  2001, the negotiated payment rate must not exceed 300 percent of 
 18.18  the facility's multiple bedroom payment rate for case mix 
 18.19  classification K; or, upon implementation of the RUGs-based case 
 18.20  mix system, 300 percent of the highest RUGs rate.  The 
 18.21  negotiated adjustment shall not affect the payment rate charged 
 18.22  to private paying residents under the provisions of section 
 18.23  256B.48, subdivision 1.  
 18.24     Sec. 12.  Minnesota Statutes 2000, section 256B.431, 
 18.25  subdivision 14, is amended to read: 
 18.26     Subd. 14.  [LIMITATIONS ON SALES OF NURSING FACILITIES.] 
 18.27  (a) For rate periods beginning on October 1, 1992, and for rate 
 18.28  years beginning after June 30, 1993, a nursing facility's 
 18.29  property-related payment rate as established under subdivision 
 18.30  13 shall be adjusted by either paragraph (b) or (c) for the sale 
 18.31  of the nursing facility, including sales occurring after June 
 18.32  30, 1992, as provided in this subdivision. 
 18.33     (b) If the nursing facility's property-related payment rate 
 18.34  under subdivision 13 prior to sale is greater than the nursing 
 18.35  facility's rental rate under Minnesota Rules, parts 9549.0010 to 
 18.36  9549.0080, and this section prior to sale, the nursing 
 19.1   facility's property-related payment rate after sale shall be the 
 19.2   greater of its property-related payment rate under subdivision 
 19.3   13 prior to sale or its rental rate under Minnesota Rules, parts 
 19.4   9549.0010 to 9549.0080, and this section calculated after sale. 
 19.5      (c) If the nursing facility's property-related payment rate 
 19.6   under subdivision 13 prior to sale is equal to or less than the 
 19.7   nursing facility's rental rate under Minnesota Rules, parts 
 19.8   9549.0010 to 9549.0080, and this section prior to sale, the 
 19.9   nursing facility's property-related payment rate after sale 
 19.10  shall be the nursing facility's property-related payment rate 
 19.11  under subdivision 13 plus the difference between its rental rate 
 19.12  calculated under Minnesota Rules, parts 9549.0010 to 9549.0080, 
 19.13  and this section prior to sale and its rental rate calculated 
 19.14  under Minnesota Rules, parts 9549.0010 to 9549.0080, and this 
 19.15  section calculated after sale. 
 19.16     (d) For purposes of this subdivision, "sale" means the 
 19.17  purchase of a nursing facility's capital assets with cash or 
 19.18  debt.  The term sale does not include a stock purchase of a 
 19.19  nursing facility or any of the following transactions:  
 19.20     (1) a sale and leaseback to the same licensee that does not 
 19.21  constitute a change in facility license; 
 19.22     (2) a transfer of an interest to a trust; 
 19.23     (3) gifts or other transfers for no consideration; 
 19.24     (4) a merger of two or more related organizations; 
 19.25     (5) a change in the legal form of doing business, other 
 19.26  than a publicly held organization that becomes privately held or 
 19.27  vice versa; 
 19.28     (6) the addition of a new partner, owner, or shareholder 
 19.29  who owns less than 20 percent of the nursing facility or the 
 19.30  issuance of stock; and 
 19.31     (7) a sale, merger, reorganization, or any other transfer 
 19.32  of interest between related organizations other than those 
 19.33  permitted in this section.  
 19.34     (e) For purposes of this subdivision, "sale" includes the 
 19.35  sale or transfer of a nursing facility to a close relative as 
 19.36  defined in Minnesota Rules, part 9549.0020, subpart 38, item C, 
 20.1   upon the death of an owner, due to serious illness or 
 20.2   disability, as defined under the Social Security Act, under 
 20.3   United States Code, title 42, section 423(d)(1)(A), or upon 
 20.4   retirement of an owner from the business of owning or operating 
 20.5   a nursing home at 62 years of age or older.  For sales to a 
 20.6   close relative allowed under this paragraph, otherwise 
 20.7   nonallowable debt resulting from seller financing of all or a 
 20.8   portion of the debt resulting from the sale shall be allowed and 
 20.9   shall not be subject to Minnesota Rules, part 9549.0060, subpart 
 20.10  5, item E, provided that in addition to existing requirements 
 20.11  for allowance of debt and interest, the debt is subject to 
 20.12  repayment through annual principal payments and the interest 
 20.13  rate on the related organization debt does not exceed three 
 20.14  percentage points above the posted yield for standard 
 20.15  conventional fixed rate mortgages of the Federal Home Loan 
 20.16  Mortgage Corporation for delivery in 60 days in effect on the 
 20.17  day of sale.  If at any time, the seller forgives the related 
 20.18  organization debt allowed under this paragraph for other than 
 20.19  equal amount of payment on that debt, then the buyer shall pay 
 20.20  to the state the total revenue received by the nursing facility 
 20.21  after the sale attributable to the amount of allowable debt 
 20.22  which has been forgiven.  Any assignment, sale, or transfer of 
 20.23  the debt instrument entered into by the close relatives, either 
 20.24  directly or indirectly, which grants to the close relative buyer 
 20.25  the right to receive all or a portion of the payments under the 
 20.26  debt instrument shall, effective on the date of the transfer, 
 20.27  result in the prospective reduction in the corresponding portion 
 20.28  of the allowable debt and interest expense.  Upon the death of 
 20.29  the close relative seller, any remaining balance of the close 
 20.30  relative debt must be refinanced and such refinancing shall be 
 20.31  subject to the provisions of Minnesota Rules, part 9549.0060, 
 20.32  subpart 7, item G.  This paragraph shall not apply to sales 
 20.33  occurring on or after June 30, 1997.  
 20.34     (f) For purposes of this subdivision, "effective date of 
 20.35  sale" means the later of either the date on which legal title to 
 20.36  the capital assets is transferred or the date on which closing 
 21.1   for the sale occurred.  
 21.2      (g) The effective day for the property-related payment rate 
 21.3   determined under this subdivision shall be the first day of the 
 21.4   month following the month in which the effective date of sale 
 21.5   occurs or October 1, 1992, whichever is later, provided that the 
 21.6   notice requirements under section 256B.47, subdivision 2, have 
 21.7   been met. 
 21.8      (h) Notwithstanding Minnesota Rules, part 9549.0060, 
 21.9   subparts 5, item A, subitems (3) and (4), and 7, items E and F, 
 21.10  the commissioner shall limit the total allowable debt and 
 21.11  related interest for sales occurring after June 30, 1992, to the 
 21.12  sum of clauses (1) to (3):  
 21.13     (1) the historical cost of capital assets, as of the 
 21.14  nursing facility's most recent previous effective date of sale 
 21.15  or, if there has been no previous sale, the nursing facility's 
 21.16  initial historical cost of constructing capital assets; 
 21.17     (2) the average annual capital asset additions after 
 21.18  deduction for capital asset deletions, not including 
 21.19  depreciations; and 
 21.20     (3) one-half of the allowed inflation on the nursing 
 21.21  facility's capital assets.  The commissioner shall compute the 
 21.22  allowed inflation as described in paragraph (h) (i). 
 21.23     (i) For purposes of computing the amount of allowed 
 21.24  inflation, the commissioner must apply the following principles: 
 21.25     (1) the lesser of the Consumer Price Index for all urban 
 21.26  consumers or the Dodge Construction Systems Costs for Nursing 
 21.27  Homes for any time periods during which both are available must 
 21.28  be used.  If the Dodge Construction Systems Costs for Nursing 
 21.29  Homes becomes unavailable, the commissioner shall substitute the 
 21.30  index in subdivision 3f, or such other index as the secretary of 
 21.31  the health care financing administration may designate; 
 21.32     (2) the amount of allowed inflation to be applied to the 
 21.33  capital assets in paragraph (g), clauses (1) and (2), must be 
 21.34  computed separately; 
 21.35     (3) the amount of allowed inflation must be determined on 
 21.36  an annual basis, prorated on a monthly basis for partial years 
 22.1   and if the initial month of use is not determinable for a 
 22.2   capital asset, then one-half of that calendar year shall be used 
 22.3   for purposes of prorating; 
 22.4      (4) the amount of allowed inflation to be applied to the 
 22.5   capital assets in paragraph (g), clauses (1) and (2), must not 
 22.6   exceed 300 percent of the total capital assets in any one of 
 22.7   those clauses; and 
 22.8      (5) the allowed inflation must be computed starting with 
 22.9   the month following the nursing facility's most recent previous 
 22.10  effective date of sale or, if there has been no previous sale, 
 22.11  the month following the date of the nursing facility's initial 
 22.12  occupancy, and ending with the month preceding the effective 
 22.13  date of sale. 
 22.14     (j) If the historical cost of a capital asset is not 
 22.15  readily available for the date of the nursing facility's most 
 22.16  recent previous sale or if there has been no previous sale for 
 22.17  the date of the nursing facility's initial occupancy, then the 
 22.18  commissioner shall limit the total allowable debt and related 
 22.19  interest after sale to the extent recognized by the Medicare 
 22.20  intermediary after the sale.  For a nursing facility that has no 
 22.21  historical capital asset cost data available and does not have 
 22.22  allowable debt and interest calculated by the Medicare 
 22.23  intermediary, the commissioner shall use the historical cost of 
 22.24  capital asset data from the point in time for which capital 
 22.25  asset data is recorded in the nursing facility's audited 
 22.26  financial statements. 
 22.27     (k) The limitations in this subdivision apply only to debt 
 22.28  resulting from a sale of a nursing facility occurring after June 
 22.29  30, 1992, including debt assumed by the purchaser of the nursing 
 22.30  facility. 
 22.31     Sec. 13.  Minnesota Statutes 2000, section 256B.431, 
 22.32  subdivision 30, is amended to read: 
 22.33     Subd. 30.  [BED LAYAWAY AND DELICENSURE.] (a) For rate 
 22.34  years beginning on or after July 1, 2000, a nursing facility 
 22.35  reimbursed under this section which has placed beds on layaway 
 22.36  shall, for purposes of application of the downsizing incentive 
 23.1   in subdivision 3a, paragraph (d) (c), and calculation of the 
 23.2   rental per diem, have those beds given the same effect as if the 
 23.3   beds had been delicensed so long as the beds remain on layaway.  
 23.4   At the time of a layaway, a facility may change its single bed 
 23.5   election for use in calculating capacity days under Minnesota 
 23.6   Rules, part 9549.0060, subpart 11.  The property payment rate 
 23.7   increase shall be effective the first day of the month following 
 23.8   the month in which the layaway of the beds becomes effective 
 23.9   under section 144A.071, subdivision 4b. 
 23.10     (b) For rate years beginning on or after July 1, 2000, 
 23.11  notwithstanding any provision to the contrary under section 
 23.12  256B.434, a nursing facility reimbursed under that section which 
 23.13  has placed beds on layaway shall, for so long as the beds remain 
 23.14  on layaway, be allowed to: 
 23.15     (1) aggregate the applicable investment per bed limits 
 23.16  based on the number of beds licensed immediately prior to 
 23.17  entering the alternative payment system; 
 23.18     (2) retain or change the facility's single bed election for 
 23.19  use in calculating capacity days under Minnesota Rules, part 
 23.20  9549.0060, subpart 11; and 
 23.21     (3) establish capacity days based on the number of beds 
 23.22  immediately prior to the layaway and the number of beds after 
 23.23  the layaway. 
 23.24  The commissioner shall increase the facility's property payment 
 23.25  rate by the incremental increase in the rental per diem 
 23.26  resulting from the recalculation of the facility's rental per 
 23.27  diem applying only the changes resulting from the layaway of 
 23.28  beds and clauses (1), (2), and (3).  If a facility reimbursed 
 23.29  under section 256B.434 completes a moratorium exception project 
 23.30  after its base year, the base year property rate shall be the 
 23.31  moratorium project property rate.  The base year rate shall be 
 23.32  inflated by the factors in section 256B.434, subdivision 4, 
 23.33  paragraph (c).  The property payment rate increase shall be 
 23.34  effective the first day of the month following the month in 
 23.35  which the layaway of the beds becomes effective. 
 23.36     (c) If a nursing facility removes a bed from layaway status 
 24.1   in accordance with section 144A.071, subdivision 4b, the 
 24.2   commissioner shall establish capacity days based on the number 
 24.3   of licensed and certified beds in the facility not on layaway 
 24.4   and shall reduce the nursing facility's property payment rate in 
 24.5   accordance with paragraph (b). 
 24.6      (d) For the rate years beginning on or after July 1, 2000, 
 24.7   notwithstanding any provision to the contrary under section 
 24.8   256B.434, a nursing facility reimbursed under that section, 
 24.9   which has delicensed beds after July 1, 2000, by giving notice 
 24.10  of the delicensure to the commissioner of health according to 
 24.11  the notice requirements in section 144A.071, subdivision 4b, 
 24.12  shall be allowed to: 
 24.13     (1) aggregate the applicable investment per bed limits 
 24.14  based on the number of beds licensed immediately prior to 
 24.15  entering the alternative payment system; 
 24.16     (2) retain or change the facility's single bed election for 
 24.17  use in calculating capacity days under Minnesota Rules, part 
 24.18  9549.0060, subpart 11; and 
 24.19     (3) establish capacity days based on the number of beds 
 24.20  immediately prior to the delicensure and the number of beds 
 24.21  after the delicensure. 
 24.22  The commissioner shall increase the facility's property payment 
 24.23  rate by the incremental increase in the rental per diem 
 24.24  resulting from the recalculation of the facility's rental per 
 24.25  diem applying only the changes resulting from the delicensure of 
 24.26  beds and clauses (1), (2), and (3).  If a facility reimbursed 
 24.27  under section 256B.434 completes a moratorium exception project 
 24.28  after its base year, the base year property rate shall be the 
 24.29  moratorium project property rate.  The base year rate shall be 
 24.30  inflated by the factors in section 256B.434, subdivision 4, 
 24.31  paragraph (c).  The property payment rate increase shall be 
 24.32  effective the first day of the month following the month in 
 24.33  which the delicensure of the beds becomes effective. 
 24.34     (e) For nursing facilities reimbursed under this section or 
 24.35  section 256B.434, any beds placed on layaway shall not be 
 24.36  included in calculating facility occupancy as it pertains to 
 25.1   leave days defined in Minnesota Rules, part 9505.0415. 
 25.2      (f) For nursing facilities reimbursed under this section or 
 25.3   section 256B.434, the rental rate calculated after placing beds 
 25.4   on layaway may not be less than the rental rate prior to placing 
 25.5   beds on layaway. 
 25.6      (g) A nursing facility receiving a rate adjustment as a 
 25.7   result of this section shall comply with section 256B.47, 
 25.8   subdivision 2. 
 25.9      (h) A facility that does not utilize the space made 
 25.10  available as a result of bed layaway or delicensure under this 
 25.11  subdivision to reduce the number of beds per room or provide 
 25.12  more common space for nursing facility uses or perform other 
 25.13  activities related to the operation of the nursing facility 
 25.14  shall have its property rate increase calculated under this 
 25.15  subdivision reduced by the ratio of the square footage made 
 25.16  available that is not used for these purposes to the total 
 25.17  square footage made available as a result of bed layaway or 
 25.18  delicensure. 
 25.19     Sec. 14.  Minnesota Statutes 2001 Supplement, section 
 25.20  256B.431, subdivision 33, is amended to read: 
 25.21     Subd. 33.  [STAGED REDUCTION IN RATE DISPARITIES.] (a) For 
 25.22  the rate years beginning July 1, 2001, and July 1, 2002, the 
 25.23  commissioner shall adjust the operating payment rates for 
 25.24  low-rate nursing facilities reimbursed under this section or 
 25.25  section 256B.434.  
 25.26     (b) For the rate year beginning July 1, 2001, for each case 
 25.27  mix level, if the amount computed under subdivision 32 31 is 
 25.28  less than the amount in clause (1), the commissioner shall make 
 25.29  available the lesser of the amount in clause (1) or an increase 
 25.30  of ten percent over the rate in effect on June 30, 2001, as an 
 25.31  adjustment to the operating payment rate.  For the rate year 
 25.32  beginning July 1, 2002, for each case mix level, if the amount 
 25.33  computed under subdivision 32 31 is less than the amount in 
 25.34  clause (2), the commissioner shall make available the lesser of 
 25.35  the amount in clause (2) or an increase of ten percent over the 
 25.36  rate in effect on June 30, 2002, as an adjustment to the 
 26.1   operating payment rate.  For purposes of this subdivision, 
 26.2   nursing facilities shall be considered to be metro if they are 
 26.3   located in Anoka, Carver, Dakota, Hennepin, Olmsted, Ramsey, 
 26.4   Scott, or Washington counties; or in the cities of Moorhead or 
 26.5   Breckenridge; or in St. Louis county, north of Toivola and south 
 26.6   of Cook; or in Itasca county, east of a north south line two 
 26.7   miles west of Grand Rapids:  
 26.8      (1) Operating Payment Rate Target Level for July 1, 2001: 
 26.9       Case Mix Classification        Metro       Nonmetro
 26.10                A                    $ 76.00     $ 68.13
 26.11                B                    $ 83.40     $ 74.46
 26.12                C                    $ 91.67     $ 81.63
 26.13                D                    $ 99.51     $ 88.04
 26.14                E                    $107.46     $ 94.87
 26.15                F                    $107.96     $ 95.29
 26.16                G                    $114.67     $100.98
 26.17                H                    $126.99     $111.31
 26.18                I                    $131.42     $115.06
 26.19                J                    $138.34     $120.85
 26.20                K                    $152.26     $133.10
 26.21     (2) Operating Payment Rate Target Level for July 1, 2002: 
 26.22      Case Mix Classification        Metro       Nonmetro
 26.23                A                    $ 78.28     $ 70.51
 26.24                B                    $ 85.91     $ 77.16
 26.25                C                    $ 94.42     $ 84.62
 26.26                D                    $102.50     $ 91.42
 26.27                E                    $110.68     $ 98.40
 26.28                F                    $111.20     $ 98.84
 26.29                G                    $118.11     $104.77
 26.30                H                    $130.80     $115.64
 26.31                I                    $135.38     $119.50
 26.32                J                    $142.49     $125.38
 26.33                K                    $156.85     $137.77
 26.34     Sec. 15.  Minnesota Statutes 2001 Supplement, section 
 26.35  256B.437, subdivision 3, is amended to read: 
 26.36     Subd. 3.  [APPLICATIONS FOR PLANNED CLOSURE OF NURSING 
 27.1   FACILITIES.] (a) By August 15, 2001, the commissioner of human 
 27.2   services shall implement and announce a program for closure or 
 27.3   partial closure of nursing facilities.  Names and identifying 
 27.4   information provided in response to the announcement shall 
 27.5   remain private unless approved, according to the timelines 
 27.6   established in the plan.  The announcement must specify: 
 27.7      (1) the criteria in subdivision 4 that will be used by the 
 27.8   commissioner to approve or reject applications; 
 27.9      (2) a requirement for the submission of a letter of intent 
 27.10  before the submission of an application; 
 27.11     (3) the information that must accompany an application; and 
 27.12     (4) (3) that applications may combine planned closure rate 
 27.13  adjustments with moratorium exception funding, in which case a 
 27.14  single application may serve both purposes. 
 27.15  Between August 1, 2001, and June 30, 2003, the commissioner may 
 27.16  approve planned closures of up to 5,140 nursing facility beds, 
 27.17  less the number of licensed beds delicensed in facilities that 
 27.18  close during the same time period without approved closure plans 
 27.19  or that have notified the commissioner of health of their intent 
 27.20  to close without an approved closure plan. 
 27.21     (b) A facility or facilities reimbursed under section 
 27.22  256B.431 or 256B.434 with a closure plan approved by the 
 27.23  commissioner under subdivision 5 may assign a planned closure 
 27.24  rate adjustment to another facility or facilities that are not 
 27.25  closing or in the case of a partial closure, to the facility 
 27.26  undertaking the partial closure.  A facility may also elect to 
 27.27  have a planned closure rate adjustment shared equally by the 
 27.28  five nursing facilities with the lowest total operating payment 
 27.29  rates in the state development region designated under section 
 27.30  462.385, in which the facility that is closing is located.  The 
 27.31  planned closure rate adjustment must be calculated under 
 27.32  subdivision 6.  Facilities that close delicense beds without a 
 27.33  closure plan, or whose closure plan is not approved by the 
 27.34  commissioner, are not eligible to assign a planned closure rate 
 27.35  adjustment under subdivision 6.  For delicensures adding up to 
 27.36  five or more beds, the commissioner shall calculate the amount 
 28.1   the facility or facilities would have been eligible to assign 
 28.2   under subdivision 6, and shall use this amount to provide equal 
 28.3   rate adjustments to the five nursing facilities with the lowest 
 28.4   total operating payment rates in the state development region 
 28.5   designated under section 462.385, in which the facility or 
 28.6   facilities that closed is delicense beds are located. 
 28.7      (c) To be considered for approval, an application must 
 28.8   include: 
 28.9      (1) a description of the proposed closure plan, which must 
 28.10  include identification of the facility or facilities to receive 
 28.11  a planned closure rate adjustment and the amount and timing of a 
 28.12  planned closure rate adjustment proposed for each facility; 
 28.13     (2) the proposed timetable for any proposed closure, 
 28.14  including the proposed dates for announcement to residents, 
 28.15  commencement of closure, and completion of closure; 
 28.16     (3) if available, the proposed relocation plan for current 
 28.17  residents of any facility designated for closure.  The proposed 
 28.18  If a relocation plan is not available, the application must 
 28.19  include a statement agreeing to develop a relocation plan must 
 28.20  be designed to comply with all applicable state and federal 
 28.21  statutes and regulations, including, but not limited to, section 
 28.22  144A.161; 
 28.23     (4) a description of the relationship between the nursing 
 28.24  facility that is proposed for closure and the nursing facility 
 28.25  or facilities proposed to receive the planned closure rate 
 28.26  adjustment.  If these facilities are not under common ownership, 
 28.27  copies of any contracts, purchase agreements, or other documents 
 28.28  establishing a relationship or proposed relationship must be 
 28.29  provided; 
 28.30     (5) documentation, in a format approved by the 
 28.31  commissioner, that all the nursing facilities receiving a 
 28.32  planned closure rate adjustment under the plan have accepted 
 28.33  joint and several liability for recovery of overpayments under 
 28.34  section 256B.0641, subdivision 2, for the facilities designated 
 28.35  for closure under the plan; and 
 28.36     (6) an explanation of how the application coordinates with 
 29.1   planning efforts under subdivision 2.  If the planning group 
 29.2   does not support a level of nursing facility closures that the 
 29.3   commissioner considers to be reasonable, the commissioner may 
 29.4   approve a planned closure proposal without its support. 
 29.5      (d) The application must address the criteria listed in 
 29.6   subdivision 4. 
 29.7      Sec. 16.  Minnesota Statutes 2000, section 256B.5012, 
 29.8   subdivision 2, is amended to read: 
 29.9      Subd. 2.  [OPERATING PAYMENT RATE.] (a) The operating 
 29.10  payment rate equals the facility's total payment rate in effect 
 29.11  on September 30, 2000, minus the property rate.  The operating 
 29.12  payment rate includes the special operating rate and the 
 29.13  efficiency incentive in effect as of September 30, 2000.  Within 
 29.14  the limits of appropriations specifically for this purpose, the 
 29.15  operating payment shall be increased for each rate year by the 
 29.16  annual percentage change in the Employment Cost Index for 
 29.17  Private Industry Workers - Total Compensation, as forecasted by 
 29.18  the commissioner of finance's economic consultant, in the second 
 29.19  quarter of the calendar year preceding the start of each rate 
 29.20  year.  In the case of the initial rate year beginning October 1, 
 29.21  2000, and continuing through December 31, 2001, the percentage 
 29.22  change shall be based on the percentage change in the Employment 
 29.23  Cost Index for Private Industry Workers - Total Compensation for 
 29.24  the 15-month period beginning October 1, 2000, as forecast by 
 29.25  Data Resources, Inc., in the first quarter of 2000. 
 29.26     (b) Effective October 1, 2000, the operating payment rate 
 29.27  shall be adjusted to reflect an occupancy rate equal to 100 
 29.28  percent of the facility's capacity days as of September 30, 2000.
 29.29     (c) Effective July 1, 2001, the operating payment rate 
 29.30  shall be adjusted for the increases in the department of health 
 29.31  licensing fees that were adopted by the legislature. 
 29.32     Sec. 17.  Minnesota Statutes 2001 Supplement, section 
 29.33  256B.76, is amended to read: 
 29.34     256B.76 [PHYSICIAN AND DENTAL REIMBURSEMENT.] 
 29.35     (a) Effective for services rendered on or after October 1, 
 29.36  1992, the commissioner shall make payments for physician 
 30.1   services as follows: 
 30.2      (1) payment for level one Health Care Finance 
 30.3   Administration's common procedural coding system (HCPCS) codes 
 30.4   titled "office and other outpatient services," "preventive 
 30.5   medicine new and established patient," "delivery, antepartum, 
 30.6   and postpartum care," "critical care," cesarean delivery and 
 30.7   pharmacologic management provided to psychiatric patients, and 
 30.8   HCPCS level three codes for enhanced services for prenatal high 
 30.9   risk, shall be paid at the lower of (i) submitted charges, or 
 30.10  (ii) 25 percent above the rate in effect on June 30, 1992.  If 
 30.11  the rate on any procedure code within these categories is 
 30.12  different than the rate that would have been paid under the 
 30.13  methodology in section 256B.74, subdivision 2, then the larger 
 30.14  rate shall be paid; 
 30.15     (2) payments for all other services shall be paid at the 
 30.16  lower of (i) submitted charges, or (ii) 15.4 percent above the 
 30.17  rate in effect on June 30, 1992; 
 30.18     (3) all physician rates shall be converted from the 50th 
 30.19  percentile of 1982 to the 50th percentile of 1989, less the 
 30.20  percent in aggregate necessary to equal the above increases 
 30.21  except that payment rates for home health agency services shall 
 30.22  be the rates in effect on September 30, 1992; 
 30.23     (4) effective for services rendered on or after January 1, 
 30.24  2000, payment rates for physician and professional services 
 30.25  shall be increased by three percent over the rates in effect on 
 30.26  December 31, 1999, except for home health agency and family 
 30.27  planning agency services; and 
 30.28     (5) the increases in clause (4) shall be implemented 
 30.29  January 1, 2000, for managed care. 
 30.30     (b) Effective for services rendered on or after October 1, 
 30.31  1992, the commissioner shall make payments for dental services 
 30.32  as follows: 
 30.33     (1) dental services shall be paid at the lower of (i) 
 30.34  submitted charges, or (ii) 25 percent above the rate in effect 
 30.35  on June 30, 1992; 
 30.36     (2) dental rates shall be converted from the 50th 
 31.1   percentile of 1982 to the 50th percentile of 1989, less the 
 31.2   percent in aggregate necessary to equal the above increases; 
 31.3      (3) effective for services rendered on or after January 1, 
 31.4   2000, payment rates for dental services shall be increased by 
 31.5   three percent over the rates in effect on December 31, 1999; 
 31.6      (4) the commissioner shall award grants to community 
 31.7   clinics or other nonprofit community organizations, political 
 31.8   subdivisions, professional associations, or other organizations 
 31.9   that demonstrate the ability to provide dental services 
 31.10  effectively to public program recipients.  Grants may be used to 
 31.11  fund the costs related to coordinating access for recipients, 
 31.12  developing and implementing patient care criteria, upgrading or 
 31.13  establishing new facilities, acquiring furnishings or equipment, 
 31.14  recruiting new providers, or other development costs that will 
 31.15  improve access to dental care in a region.  In awarding grants, 
 31.16  the commissioner shall give priority to applicants that plan to 
 31.17  serve areas of the state in which the number of dental providers 
 31.18  is not currently sufficient to meet the needs of recipients of 
 31.19  public programs or uninsured individuals.  The commissioner 
 31.20  shall consider the following in awarding the grants: 
 31.21     (i) potential to successfully increase access to an 
 31.22  underserved population; 
 31.23     (ii) the ability to raise matching funds; 
 31.24     (iii) the long-term viability of the project to improve 
 31.25  access beyond the period of initial funding; 
 31.26     (iv) the efficiency in the use of the funding; and 
 31.27     (v) the experience of the proposers in providing services 
 31.28  to the target population. 
 31.29     The commissioner shall monitor the grants and may terminate 
 31.30  a grant if the grantee does not increase dental access for 
 31.31  public program recipients.  The commissioner shall consider 
 31.32  grants for the following: 
 31.33     (i) implementation of new programs or continued expansion 
 31.34  of current access programs that have demonstrated success in 
 31.35  providing dental services in underserved areas; 
 31.36     (ii) a pilot program for utilizing hygienists outside of a 
 32.1   traditional dental office to provide dental hygiene services; 
 32.2   and 
 32.3      (iii) a program that organizes a network of volunteer 
 32.4   dentists, establishes a system to refer eligible individuals to 
 32.5   volunteer dentists, and through that network provides donated 
 32.6   dental care services to public program recipients or uninsured 
 32.7   individuals; 
 32.8      (5) beginning October 1, 1999, the payment for tooth 
 32.9   sealants and fluoride treatments shall be the lower of (i) 
 32.10  submitted charge, or (ii) 80 percent of median 1997 charges; 
 32.11     (6) the increases listed in clauses (3) and (5) shall be 
 32.12  implemented January 1, 2000, for managed care; and 
 32.13     (7) effective for services provided on or after January 1, 
 32.14  2002, payment for diagnostic examinations and dental x-rays 
 32.15  provided to children under age 21 shall be the lower of (i) the 
 32.16  submitted charge, or (ii) 85 percent of median 1999 charges.  
 32.17     (c) Effective for dental services rendered on or after 
 32.18  January 1, 2002, the commissioner may, within the limits of 
 32.19  available appropriation, increase reimbursements to dentists and 
 32.20  dental clinics deemed by the commissioner to be critical access 
 32.21  dental providers.  Reimbursement to a critical access dental 
 32.22  provider may be increased by not more than 50 percent above the 
 32.23  reimbursement rate that would otherwise be paid to the 
 32.24  provider.  Payments to health plan companies shall be adjusted 
 32.25  to reflect increased reimbursements to critical access dental 
 32.26  providers as approved by the commissioner.  In determining which 
 32.27  dentists and dental clinics shall be deemed critical access 
 32.28  dental providers, the commissioner shall review: 
 32.29     (1) the utilization rate in the service area in which the 
 32.30  dentist or dental clinic operates for dental services to 
 32.31  patients covered by medical assistance, general assistance 
 32.32  medical care, or MinnesotaCare as their primary source of 
 32.33  coverage; 
 32.34     (2) the level of services provided by the dentist or dental 
 32.35  clinic to patients covered by medical assistance, general 
 32.36  assistance medical care, or MinnesotaCare as their primary 
 33.1   source of coverage; and 
 33.2      (3) whether the level of services provided by the dentist 
 33.3   or dental clinic is critical to maintaining adequate levels of 
 33.4   patient access within the service area. 
 33.5   In the absence of a critical access dental provider in a service 
 33.6   area, the commissioner may designate a dentist or dental clinic 
 33.7   as a critical access dental provider if the dentist or dental 
 33.8   clinic is willing to provide care to patients covered by medical 
 33.9   assistance, general assistance medical care, or MinnesotaCare at 
 33.10  a level which significantly increases access to dental care in 
 33.11  the service area. 
 33.12     (d) Effective July 1, 2001, the medical assistance rates 
 33.13  for outpatient mental health services provided by an entity that 
 33.14  operates: 
 33.15     (1) a Medicare-certified comprehensive outpatient 
 33.16  rehabilitation facility; and 
 33.17     (2) a facility that was certified prior to January 1, 1993, 
 33.18  with at least 33 percent of the clients receiving rehabilitation 
 33.19  services in the most recent calendar year are medical assistance 
 33.20  recipients, will be increased by 38 percent, when those services 
 33.21  are provided within the comprehensive outpatient rehabilitation 
 33.22  facility and provided to residents of nursing facilities owned 
 33.23  by the entity. 
 33.24     (e) An entity that operates both a Medicare certified 
 33.25  comprehensive outpatient rehabilitation facility and a facility 
 33.26  which was certified prior to January 1, 1993, that is licensed 
 33.27  under Minnesota Rules, parts 9570.2000 to 9570.3600, and for 
 33.28  whom at least 33 percent of the clients receiving rehabilitation 
 33.29  services in the most recent calendar year are medical assistance 
 33.30  recipients, shall be reimbursed by the commissioner for 
 33.31  rehabilitation services at rates that are 38 percent greater 
 33.32  than the maximum reimbursement rate allowed under paragraph (a), 
 33.33  clause (2), when those services are (1) provided within the 
 33.34  comprehensive outpatient rehabilitation facility and (2) 
 33.35  provided to residents of nursing facilities owned by the entity.