1.1                          A bill for an act
  1.2             relating to human services; changing nursing home 
  1.3             moratorium conditions; authorizing the commissioner of 
  1.4             public safety to issue certain cards to program 
  1.5             clients; authorizing therapy providers to represent 
  1.6             clients at agency hearings; changing the state share 
  1.7             of certain program costs; authorizing assistance 
  1.8             transaction card fees; modifying ICF/MR client 
  1.9             classification requirements; authorizing an hourly 
  1.10            job-coach rate for day training services; modifying 
  1.11            the chemical dependency treatment fund allocation; 
  1.12            establishing an Indian elders coordinator position; 
  1.13            authorizing mental retardation waivered services in an 
  1.14            unlicensed facility under certain conditions; 
  1.15            authorizing children's mental health transition 
  1.16            services to persons over 18 years of age under certain 
  1.17            conditions; modifying allocation procedures for the 
  1.18            child care funds; establishing a public assistance 
  1.19            lien under certain circumstances; making Minnesota 
  1.20            family investment plan participants subject to fraud 
  1.21            statutes; modifying program disqualification 
  1.22            requirements; strengthening lien enforcement 
  1.23            provisions; modifying income and asset allowance 
  1.24            provisions and other provisions relating to medical 
  1.25            assistance; requiring a plan to restructure 
  1.26            alternative care and otherwise modifying alternative 
  1.27            care and waivered service programs; modifying the 
  1.28            traumatic brain injury program; making technical 
  1.29            modifications in nursing facility reimbursement and 
  1.30            reporting; requiring recommendations on a new ICF/MR 
  1.31            reimbursement system; modifying asset allowances under 
  1.32            general assistance medical care; requiring various 
  1.33            studies and reports; providing MA payment for persons 
  1.34            with special needs in state operated services; 
  1.35            providing elderly housing with supportive services; 
  1.36            amending Minnesota Statutes 1994, sections 16B.08, 
  1.37            subdivision 5; 144.0723, subdivisions 1, 2, 3, 4, and 
  1.38            6; 144A.071, subdivisions 2, 4a, and by adding a 
  1.39            subdivision; 144A.073, subdivisions 1, 2, 3, 4, 8, and 
  1.40            by adding a subdivision; 144B.01, subdivision 5; 
  1.41            171.07, by adding a subdivision; 245.4871, by adding a 
  1.42            subdivision; 245.4875, by adding a subdivision; 
  1.43            246.56, by adding a subdivision; 252.27, subdivision 
  1.44            1a; 252.275, subdivisions 3, 4, and 8; 252.46, 
  1.45            subdivisions 1, 3, and 17; 254B.02, subdivision 1; 
  1.46            254B.05, subdivision 1; 256.014, subdivision 1; 
  2.1             256.015, subdivisions 1 and 2; 256.034, subdivision 1; 
  2.2             256.045, subdivisions 3, 4, and 5; 256.73, subdivision 
  2.3             2; 256.9353, subdivision 8; 256.969, subdivisions 10 
  2.4             and 16; 256.975, by adding a subdivision; 256.98, 
  2.5             subdivisions 1 and 8; 256B.042, subdivision 2; 
  2.6             256B.056, subdivision 4; 256B.0575; 256B.059, 
  2.7             subdivisions 1, 3, and 5; 256B.0595, subdivisions 1, 
  2.8             2, 3, and 4; 256B.06, subdivision 4; 256B.0625, 
  2.9             subdivisions 5, 13a, and 18; 256B.0628, subdivision 2; 
  2.10            256B.0911, subdivisions 2, 2a, and 3; 256B.0913, 
  2.11            subdivisions 4, 5, 8, 12, and 14; 256B.0915, 
  2.12            subdivisions 3, 5, and by adding a subdivision; 
  2.13            256B.092, by adding a subdivision; 256B.093, 
  2.14            subdivisions 1, 2, 3, and by adding a subdivision; 
  2.15            256B.431, subdivision 15, and by adding a subdivision; 
  2.16            256B.432, subdivisions 1, 2, 3, 5, and 6; 256B.501, 
  2.17            subdivisions 1, 3g, 8, and by adding subdivisions; 
  2.18            256B.69, subdivision 4; 256D.03, subdivision 3; 
  2.19            256D.05, subdivision 7; 256D.46, subdivisions 1 and 2; 
  2.20            256F.09; 256H.01, subdivisions 9 and 12; 256H.02; 
  2.21            256H.03, subdivisions 1, 2a, 6, and by adding a 
  2.22            subdivision; 256H.08; 256H.11, subdivision 1; 256H.12, 
  2.23            subdivision 1, and by adding a subdivision; 256H.15, 
  2.24            subdivision 1; 256H.18; 256I.03, subdivision 5, and by 
  2.25            adding a subdivision; 256I.04, subdivision 2b; 
  2.26            256I.05, subdivisions 1 and 5; 256I.06, subdivisions 2 
  2.27            and 6; 524.6-207; and 550.37, subdivision 14; Laws 
  2.28            1993, First Special Session chapter 1, article 8, 
  2.29            section 30, subdivision 2; proposing coding for new 
  2.30            law in Minnesota Statutes, chapter 256B; proposing 
  2.31            coding for new law as Minnesota Statutes, chapter 
  2.32            144D; repealing Minnesota Statutes 1994, sections 
  2.33            144.0723, subdivision 5; 144A.073, subdivision 3a; 
  2.34            252.275, subdivisions 4a and 10; and 256H.03, 
  2.35            subdivisions 2 and 5. 
  2.36  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  2.37                             ARTICLE 1
  2.38     DEPARTMENT OF HUMAN SERVICES FINANCE AND MANAGEMENT POLICY
  2.39     Section 1.  Minnesota Statutes 1994, section 16B.08, 
  2.40  subdivision 5, is amended to read: 
  2.41     Subd. 5.  [FEDERAL GENERAL SERVICES ADMINISTRATION AGENCY 
  2.42  PRICE SCHEDULES.] Notwithstanding anything in this chapter to 
  2.43  the contrary, the commissioner may, instead of soliciting bids, 
  2.44  contract for purchases with suppliers who have published 
  2.45  schedules of prices effective for sales to the General Services 
  2.46  Administration any federal agency of the United States.  These 
  2.47  contracts may be entered into, regardless of the amount of the 
  2.48  purchase price, if the commissioner considers them advantageous 
  2.49  and if the purchase price of all the commodities purchased under 
  2.50  the contract do not exceed the price specified by the schedule.  
  2.51     Sec. 2.  Minnesota Statutes 1994, section 171.07, is 
  2.52  amended by adding a subdivision to read: 
  2.53     Subd. 10.  [AGREEMENTS WITH OTHER AGENCIES.] The 
  3.1   commissioner of public safety is authorized to enter into 
  3.2   agreements with other agencies to issue cards to clients of 
  3.3   those agencies for use in their programs.  The cards may be 
  3.4   issued to persons who do not qualify for a Minnesota driver's 
  3.5   license or do not provide evidence of name and identity as 
  3.6   required by rule for a Minnesota identification card.  Persons 
  3.7   issued cards under this subdivision will meet the identification 
  3.8   verification requirements of the contracting agency. 
  3.9      The interagency agreement may include provisions for the 
  3.10  payment of the county fee provided in section 171.06, 
  3.11  subdivision 4, and the actual cost to manufacture the card. 
  3.12     Cards issued under this subdivision are not Minnesota 
  3.13  identification cards for the purposes defined in sections 
  3.14  48.512, 201.061, 201.161, 332.50, and 340A.503. 
  3.15     Sec. 3.  Minnesota Statutes 1994, section 256.014, 
  3.16  subdivision 1, is amended to read: 
  3.17     Subdivision 1.  [ESTABLISHMENT OF SYSTEMS.] The 
  3.18  commissioner of human services shall establish and enhance 
  3.19  computer systems necessary for the efficient operation of the 
  3.20  programs the commissioner supervises, including: 
  3.21     (1) management and administration of the food stamp and 
  3.22  income maintenance programs, including the electronic 
  3.23  distribution of benefits; 
  3.24     (2) management and administration of the child support 
  3.25  enforcement program; and 
  3.26     (3) administration of medical assistance and general 
  3.27  assistance medical care. 
  3.28     The commissioner shall distribute the nonfederal share of 
  3.29  the costs of operating and maintaining the systems to the 
  3.30  commissioner and to the counties participating in the system in 
  3.31  a manner that reflects actual system usage, except that the 
  3.32  nonfederal share of the costs of the MAXIS computer system and 
  3.33  child support enforcement systems shall be borne entirely by the 
  3.34  commissioner.  Development costs must not be assessed against 
  3.35  county agencies. 
  3.36     Sec. 4.  Minnesota Statutes 1994, section 256.045, 
  4.1   subdivision 4, is amended to read: 
  4.2      Subd. 4.  [CONDUCT OF HEARINGS.] All hearings held pursuant 
  4.3   to subdivision 3, 3a, or 4a shall be conducted according to the 
  4.4   provisions of the federal Social Security Act and the 
  4.5   regulations implemented in accordance with that act to enable 
  4.6   this state to qualify for federal grants-in-aid, and according 
  4.7   to the rules and written policies of the commissioner of human 
  4.8   services.  County agencies shall install equipment necessary to 
  4.9   conduct telephone hearings.  A state human services referee may 
  4.10  schedule a telephone conference hearing when the distance or 
  4.11  time required to travel to the county agency offices will cause 
  4.12  a delay in the issuance of an order, or to promote efficiency, 
  4.13  or at the mutual request of the parties.  Hearings may be 
  4.14  conducted by telephone conferences unless the applicant, 
  4.15  recipient, or former recipient objects.  The hearing shall not 
  4.16  be held earlier than five days after filing of the required 
  4.17  notice with the county or state agency.  The state human 
  4.18  services referee shall notify all interested persons of the 
  4.19  time, date, and location of the hearing at least five days 
  4.20  before the date of the hearing.  Interested persons may be 
  4.21  represented by legal counsel or other representative of their 
  4.22  choice, including a provider of therapy services, at the hearing 
  4.23  and may appear personally, testify and offer evidence, and 
  4.24  examine and cross-examine witnesses.  The applicant, recipient, 
  4.25  or former recipient shall have the opportunity to examine the 
  4.26  contents of the case file and all documents and records to be 
  4.27  used by the county or state agency at the hearing at a 
  4.28  reasonable time before the date of the hearing and during the 
  4.29  hearing.  Upon request, the county agency shall provide 
  4.30  reimbursement for transportation, child care, photocopying, 
  4.31  medical assessment, witness fee, and other necessary and 
  4.32  reasonable costs incurred by the applicant, recipient, or former 
  4.33  recipient in connection with the appeal.  All evidence, except 
  4.34  that privileged by law, commonly accepted by reasonable people 
  4.35  in the conduct of their affairs as having probative value with 
  4.36  respect to the issues shall be submitted at the hearing and such 
  5.1   hearing shall not be "a contested case" within the meaning of 
  5.2   section 14.02, subdivision 3.  The agency must present its 
  5.3   evidence prior to or at the hearing, and may not submit evidence 
  5.4   after the hearing except by agreement of the parties at the 
  5.5   hearing, provided the recipient has the opportunity to respond. 
  5.6      Sec. 5.  Minnesota Statutes 1994, section 256.045, 
  5.7   subdivision 5, is amended to read: 
  5.8      Subd. 5.  [ORDERS OF THE COMMISSIONER OF HUMAN SERVICES.] A 
  5.9   state human services referee shall conduct a hearing on the 
  5.10  appeal and shall recommend an order to the commissioner of human 
  5.11  services.  The recommended order must be based on all relevant 
  5.12  evidence and must not be limited to a review of the propriety of 
  5.13  the state or county agency's action.  A referee may take 
  5.14  official notice of adjudicative facts.  The commissioner of 
  5.15  human services may accept the recommended order of a state human 
  5.16  services referee and issue the order to the county agency and 
  5.17  the applicant, recipient, former recipient, or prepaid health 
  5.18  plan.  The commissioner on refusing to accept the recommended 
  5.19  order of the state human services referee, shall notify the 
  5.20  county agency and the applicant, recipient, former recipient, or 
  5.21  prepaid health plan of that fact and shall state reasons 
  5.22  therefor and shall allow each party ten days' time to submit 
  5.23  additional written argument on the matter.  After the expiration 
  5.24  of the ten-day period, the commissioner shall issue an order on 
  5.25  the matter to the county agency and the applicant, recipient, 
  5.26  former recipient, or prepaid health plan. 
  5.27     A party aggrieved by an order of the commissioner may 
  5.28  appeal under subdivision 7, or request reconsideration by the 
  5.29  commissioner within 30 days after the date the commissioner 
  5.30  issues the order.  The commissioner may reconsider an order upon 
  5.31  request of any party or on the commissioner's own motion.  A 
  5.32  request for reconsideration does not stay implementation of the 
  5.33  commissioner's order.  Upon reconsideration, the commissioner 
  5.34  may issue an amended order or an order affirming the original 
  5.35  order. 
  5.36     Any order of the commissioner issued under this subdivision 
  6.1   shall be conclusive upon the parties unless appeal is taken in 
  6.2   the manner provided by subdivision 7.  Any order of the 
  6.3   commissioner is binding on the parties and must be implemented 
  6.4   by the state agency or a county agency until the order is 
  6.5   reversed by the district court, or unless the commissioner or a 
  6.6   district court orders monthly assistance or aid or services paid 
  6.7   or provided under subdivision 10. 
  6.8      Except for a prepaid health plan, a vendor of medical care 
  6.9   as defined in section 256B.02, subdivision 7, or a vendor under 
  6.10  contract with a county agency to provide social services under 
  6.11  section 256E.08, subdivision 4, is not a party and may not 
  6.12  request a hearing or seek judicial review of an order issued 
  6.13  under this section, unless assisting a recipient as provided in 
  6.14  subdivision 4. 
  6.15                             ARTICLE 2
  6.16                LIFE SKILLS SELF-SUFFICIENCY POLICY
  6.17     Section 1.  Minnesota Statutes 1994, section 144.0723, 
  6.18  subdivision 1, is amended to read: 
  6.19     Subdivision 1.  [CLIENT REIMBURSEMENT CLASSIFICATIONS.] The 
  6.20  commissioner of health shall establish reimbursement 
  6.21  classifications based upon the assessment of each client in 
  6.22  intermediate care facilities for the mentally retarded conducted 
  6.23  after December 31, 1988 1993, under section 256B.501, 
  6.24  subdivision 3g, or under rules established by the commissioner 
  6.25  of human services under section 256B.501, subdivision 3j.  
  6.26  The reimbursement classifications established by the 
  6.27  commissioner must conform to the section 256B.501, subdivision 
  6.28  3g, and subsequent rules established by the commissioner of 
  6.29  human services to set payment rates for intermediate care 
  6.30  facilities for the mentally retarded beginning on or after 
  6.31  October 1, 1990. 
  6.32     Sec. 2.  Minnesota Statutes 1994, section 144.0723, 
  6.33  subdivision 2, is amended to read: 
  6.34     Subd. 2.  [NOTICE OF CLIENT REIMBURSEMENT CLASSIFICATION.] 
  6.35  The commissioner of health shall notify each client and 
  6.36  intermediate care facility for the mentally retarded in which 
  7.1   the client resides of the reimbursement classification 
  7.2   classifications established under subdivision 1 for each client 
  7.3   residing in the facility.  The notice must inform the 
  7.4   client intermediate care facility for the mentally retarded of 
  7.5   the classification classifications that was are assigned, the 
  7.6   opportunity to review the documentation supporting the 
  7.7   classification, the opportunity to obtain clarification from the 
  7.8   commissioner, and the opportunity to request a reconsideration 
  7.9   of the classification any classifications assigned.  The notice 
  7.10  of classification must be sent by first-class mail.  The 
  7.11  individual client notices may be sent to the client's 
  7.12  intermediate care facility for the mentally retarded for 
  7.13  distribution to the client.  The facility must distribute the 
  7.14  notice to the client's case manager and to the client or to the 
  7.15  client's representative.  This notice must be distributed within 
  7.16  three working days after the facility receives the notices from 
  7.17  the department.  For the purposes of this section, 
  7.18  "representative" includes the client's legal representative as 
  7.19  defined in Minnesota Rules, part 9525.0015, subpart 18, the 
  7.20  person authorized to pay the client's facility expenses, or any 
  7.21  other individual designated by the client. 
  7.22     Sec. 3.  Minnesota Statutes 1994, section 144.0723, 
  7.23  subdivision 3, is amended to read: 
  7.24     Subd. 3.  [REQUEST FOR RECONSIDERATION.] The client, 
  7.25  client's representative, or the intermediate care facility for 
  7.26  the mentally retarded may request that the commissioner 
  7.27  reconsider the assigned classification.  The request for 
  7.28  reconsideration must be submitted in writing to the commissioner 
  7.29  within 30 days after the receipt of the notice of client 
  7.30  classification.  The request for reconsideration must include 
  7.31  the name of the client, the name and address of the facility in 
  7.32  which the client resides, the reasons for the reconsideration, 
  7.33  the requested classification changes, and documentation 
  7.34  supporting the requested classification.  The documentation 
  7.35  accompanying the reconsideration request is limited to 
  7.36  documentation establishing that the needs of the client and 
  8.1   services provided to the client at the time of the assessment 
  8.2   resulting in the disputed classification justify a change of 
  8.3   classification. 
  8.4      Sec. 4.  Minnesota Statutes 1994, section 144.0723, 
  8.5   subdivision 4, is amended to read: 
  8.6      Subd. 4.  [ACCESS TO INFORMATION.] Annually, at the 
  8.7   interdisciplinary team meeting, the intermediate care facility 
  8.8   for the mentally retarded shall inform the client or the 
  8.9   client's representative and case manager of the client's most 
  8.10  recent classification as determined by the department of 
  8.11  health.  Upon written request, the intermediate care facility 
  8.12  for the mentally retarded must give the client's case manager, 
  8.13  the client, or the client's representative a copy of the 
  8.14  assessment form and the other documentation that was given to 
  8.15  the department to support the assessment findings.  The facility 
  8.16  shall also provide access to and a copy of other information 
  8.17  from the client's record that has been requested by or on behalf 
  8.18  of the client to support a client's reconsideration request.  A 
  8.19  copy of any requested material must be provided within three 
  8.20  working days after the facility receives a written request for 
  8.21  the information.  If the facility fails to provide the material 
  8.22  within this time, it is subject to the issuance of a correction 
  8.23  order and penalty assessment.  Notwithstanding this section, any 
  8.24  order issued by the commissioner under this subdivision must 
  8.25  require that the facility immediately comply with the request 
  8.26  for information and that as of the date the order is issued, the 
  8.27  facility shall forfeit to the state a $100 fine the first day of 
  8.28  noncompliance, and an increase in the $100 fine by $50 
  8.29  increments for each day the noncompliance continues. 
  8.30     Sec. 5.  Minnesota Statutes 1994, section 144.0723, 
  8.31  subdivision 6, is amended to read: 
  8.32     Subd. 6.  [RECONSIDERATION.] The commissioner's 
  8.33  reconsideration must be made by individuals not involved in 
  8.34  reviewing the assessment that established the disputed 
  8.35  classification.  The reconsideration must be based upon the 
  8.36  initial assessment and upon the information provided to the 
  9.1   commissioner under subdivisions subdivision 3 and 5.  If 
  9.2   necessary for evaluating the reconsideration request, the 
  9.3   commissioner may conduct on-site reviews.  At the commissioner's 
  9.4   discretion, the commissioner may review the reimbursement 
  9.5   classifications assigned to all clients in the facility.  Within 
  9.6   15 working days after receiving the request for reconsideration, 
  9.7   the commissioner shall affirm or modify the original client 
  9.8   classification.  The original classification must be modified if 
  9.9   the commissioner determines that the assessment resulting in the 
  9.10  classification did not accurately reflect the status of the 
  9.11  client at the time of the assessment.  The client and the 
  9.12  intermediate care facility for the mentally retarded shall be 
  9.13  notified within five working days after the decision is made.  
  9.14  The commissioner's decision under this subdivision is the final 
  9.15  administrative decision of the agency. 
  9.16     Sec. 6.  Minnesota Statutes 1994, section 252.27, 
  9.17  subdivision 1a, is amended to read: 
  9.18     Subd. 1a.  [DEFINITIONS.] A person has a "related 
  9.19  condition" if that person has is a condition that is found to be 
  9.20  closely related to mental retardation, including, but not 
  9.21  limited to, cerebral palsy, epilepsy, autism, and Prader-Willi 
  9.22  syndrome and that meets all of the following criteria:  (a) is 
  9.23  severe, and chronic disability that meets all of the following 
  9.24  conditions:  (a) is attributable to cerebral palsy, epilepsy, 
  9.25  autism, Prader-Willi syndrome, or any other condition, other 
  9.26  than mental illness as defined under section 245.462, 
  9.27  subdivision 20, or an emotional disturbance, as defined under 
  9.28  section 245.4871, subdivision 15, found to be closely related to 
  9.29  mental retardation because the condition; (b) results in 
  9.30  impairment of general intellectual functioning or adaptive 
  9.31  behavior similar to that of persons with mental retardation and; 
  9.32  (c) requires treatment or services similar to those required for 
  9.33  persons with mental retardation; (b) (d) is manifested before 
  9.34  the person reaches 22 years of age; (c) (e) is likely to 
  9.35  continue indefinitely; and (d) (f) results in substantial 
  9.36  functional limitations in three or more of the following areas 
 10.1   of major life activity:  (1) self-care, (2) understanding and 
 10.2   use of language, (3) learning, (4) mobility, (5) self-direction, 
 10.3   (6) capacity for independent living; and (g) is not attributable 
 10.4   to mental illness as defined in section 245.462, subdivision 20, 
 10.5   or an emotional disturbance as defined in section 245.4871, 
 10.6   subdivision 15.  For purposes of clause (g), notwithstanding 
 10.7   section 245.462, subdivision 20, or 245.4871, subdivision 15, 
 10.8   "mental illness" does not include autism or other pervasive 
 10.9   developmental disorders. 
 10.10     Sec. 7.  Minnesota Statutes 1994, section 252.275, 
 10.11  subdivision 3, is amended to read: 
 10.12     Subd. 3.  [REIMBURSEMENT.] Counties shall be reimbursed for 
 10.13  all expenditures made pursuant to subdivision 1 at a rate of 70 
 10.14  percent, up to the allocation determined pursuant to 
 10.15  subdivisions 4, 4a, and 4b.  However, the commissioner shall not 
 10.16  reimburse costs of services for any person if the costs exceed 
 10.17  the state share of the average medical assistance costs for 
 10.18  services provided by intermediate care facilities for a person 
 10.19  with mental retardation or a related condition for the same 
 10.20  fiscal year, and shall not reimburse costs of a one-time living 
 10.21  allowance for any person if the costs exceed $1,500 in a state 
 10.22  fiscal year.  For the biennium ending June 30, 1993, the 
 10.23  commissioner shall not reimburse costs in excess of the 85th 
 10.24  percentile of hourly service costs based upon the cost 
 10.25  information supplied to the legislature in the proposed budget 
 10.26  for the biennium.  The commissioner may make payments to each 
 10.27  county in quarterly installments.  The commissioner may certify 
 10.28  an advance of up to 25 percent of the allocation.  Subsequent 
 10.29  payments shall be made on a reimbursement basis for reported 
 10.30  expenditures and may be adjusted for anticipated spending 
 10.31  patterns.  
 10.32     Sec. 8.  Minnesota Statutes 1994, section 252.275, 
 10.33  subdivision 4, is amended to read: 
 10.34     Subd. 4.  [FORMULA.] Effective January 1, 1992, The 
 10.35  commissioner shall allocate funds on a calendar year basis.  For 
 10.36  calendar year 1992, funds shall be allocated based on each 
 11.1   county's portion of the statewide reimbursement received under 
 11.2   this section for state fiscal year 1991.  For subsequent 
 11.3   calendar years, funds shall be Beginning with the calendar year 
 11.4   in the 1996 grant period, funds shall be allocated first in 
 11.5   amounts equal to each county's guaranteed floor according to 
 11.6   subdivision 4b, with any remaining available funds allocated 
 11.7   based on each county's portion of the statewide expenditures 
 11.8   eligible for reimbursement under this section during the 12 
 11.9   months ending on June 30 of the preceding calendar year. 
 11.10     If the legislature appropriates funds for special purposes, 
 11.11  the commissioner may allocate the funds based on proposals 
 11.12  submitted by the counties to the commissioner in a format 
 11.13  prescribed by the commissioner.  Nothing in this section 
 11.14  prevents a county from using other funds to pay for additional 
 11.15  costs of semi-independent living services. 
 11.16     Sec. 9.  Minnesota Statutes 1994, section 252.275, 
 11.17  subdivision 8, is amended to read: 
 11.18     Subd. 8.  [USE OF FEDERAL FUNDS AND TRANSFER OF FUNDS TO 
 11.19  MEDICAL ASSISTANCE.] (a) The commissioner shall make every 
 11.20  reasonable effort to maximize the use of federal funds for 
 11.21  semi-independent living services. 
 11.22     (b) The commissioner shall reduce the payments to be made 
 11.23  under this section to each county from January 1, 1994 to June 
 11.24  30, 1996, by the amount of the state share of medical assistance 
 11.25  reimbursement for services other than residential services 
 11.26  provided under the home and community-based waiver program under 
 11.27  section 256B.092 from January 1, 1994 to June 30, 1996, for 
 11.28  clients for whom the county is financially responsible and who 
 11.29  have been transferred by the county from the semi-independent 
 11.30  living services program to the home and community-based waiver 
 11.31  program.  Unless otherwise specified, all reduced amounts shall 
 11.32  be transferred to the medical assistance state account. 
 11.33     (c) For fiscal year 1997, the base appropriation available 
 11.34  under this section shall be reduced by the amount of the state 
 11.35  share of medical assistance reimbursement for services other 
 11.36  than residential services provided under the home and 
 12.1   community-based waiver program authorized in section 256B.092 
 12.2   from January 1, 1995 to December 31, 1995, for persons who have 
 12.3   been transferred from the semi-independent living services 
 12.4   program to the home and community-based waiver program.  The 
 12.5   base appropriation for the medical assistance state account 
 12.6   shall be increased by the same amount. 
 12.7      (d) For purposes of calculating the guaranteed floor under 
 12.8   subdivision 4b and to establish the calendar year 1996 
 12.9   allocations, each county's original allocation for calendar year 
 12.10  1995 shall be reduced by the amount transferred to the state 
 12.11  medical assistance account under paragraph (b) during the six 
 12.12  months ending on June 30, 1995.  For purposes of calculating the 
 12.13  guaranteed floor under subdivision 4b and to establish the 
 12.14  calendar year 1997 allocations, each county's original 
 12.15  allocation for calendar year 1996 shall be reduced by the amount 
 12.16  transferred to the state medical assistance account under 
 12.17  paragraph (b) during the six months ending on June 30, 1996 
 12.18  December 31, 1995. 
 12.19     Sec. 10.  Minnesota Statutes 1994, section 252.46, 
 12.20  subdivision 1, is amended to read: 
 12.21     Subdivision 1.  [RATES.] Payment rates to vendors, except 
 12.22  regional centers, for county-funded day training and 
 12.23  habilitation services and transportation provided to persons 
 12.24  receiving day training and habilitation services established by 
 12.25  a county board are governed by subdivisions 2 to 19.  The 
 12.26  commissioner shall approve the following three payment rates for 
 12.27  services provided by a vendor: 
 12.28     (1) a full-day service rate for persons who receive at 
 12.29  least six service hours a day, including the time it takes to 
 12.30  transport the person to and from the service site; 
 12.31     (2) a partial-day service rate that must not exceed 75 
 12.32  percent of the full-day service rate for persons who receive 
 12.33  less than a full day of service; and 
 12.34     (3) a transportation rate for providing, or arranging and 
 12.35  paying for, transportation of a person to and from the person's 
 12.36  residence to the service site. 
 13.1      The commissioner may also approve an hourly job-coach, 
 13.2   follow-along rate for services provided by one employee en route 
 13.3   to or from community locations to supervise, support, and assist 
 13.4   one person receiving the vendor's services to learn job-related 
 13.5   skills necessary to obtain or retain employment when and where 
 13.6   no other persons receiving services are present and when all the 
 13.7   following criteria are met: 
 13.8      (1) the vendor requests and the county recommends an 
 13.9   optional rate; 
 13.10     (2) the service is prior authorized by the county on the 
 13.11  medicaid management information system for no more than 414 
 13.12  hours in a 12-month period and the daily per person charge to 
 13.13  medical assistance does not exceed the vendor's approved full 
 13.14  day plus transportation rates; 
 13.15     (3) separate full day, partial day, and transportation 
 13.16  rates are not billed for the same person on the same day; 
 13.17     (4) the approved hourly rate does not exceed the sum of the 
 13.18  vendor's current average hourly direct service wage, including 
 13.19  fringe benefits and taxes, plus a component equal to the 
 13.20  vendor's average hourly nondirect service wage expenses; and 
 13.21     (5) the actual revenue received for provision of hourly 
 13.22  job-coach, follow-along services is subtracted from the vendor's 
 13.23  total expenses for the same time period and those adjusted 
 13.24  expenses are used for determining recommended full day and 
 13.25  transportation payment rates under subdivision 5 in accordance 
 13.26  with the limitations in subdivision 3. 
 13.27     Medical assistance rates for home and community-based 
 13.28  service provided under section 256B.501, subdivision 4, by 
 13.29  licensed vendors of day training and habilitation services must 
 13.30  not be greater than the rates for the same services established 
 13.31  by counties under sections 252.40 to 252.47.  For very dependent 
 13.32  persons with special needs the commissioner may approve an 
 13.33  exception to the approved payment rate under section 256B.501, 
 13.34  subdivision 4 or 8. 
 13.35     Sec. 11.  Minnesota Statutes 1994, section 252.46, 
 13.36  subdivision 3, is amended to read: 
 14.1      Subd. 3.  [RATE MAXIMUM.] Unless a variance is granted 
 14.2   under subdivision 6, the maximum payment rates for each vendor 
 14.3   for a calendar year must be equal to the payment rates approved 
 14.4   by the commissioner for that vendor in effect December 1 of the 
 14.5   previous calendar year.  The commissioner of finance shall 
 14.6   include as a budget change request in each biennial detailed 
 14.7   expenditure budget submitted to the legislature under section 
 14.8   16A.11 annual inflation adjustments in reimbursement rates for 
 14.9   each vendor, based upon the projected percentage change in the 
 14.10  urban consumer price index, all items, published by the United 
 14.11  States Department of Labor, for the upcoming calendar year over 
 14.12  the current calendar year.  The commissioner shall not provide 
 14.13  an annual inflation adjustment for the biennium ending June 30, 
 14.14  1993. 
 14.15     Sec. 12.  Minnesota Statutes 1994, section 252.46, 
 14.16  subdivision 17, is amended to read: 
 14.17     Subd. 17.  [HOURLY RATE STRUCTURE.] Counties participating 
 14.18  as host counties under the pilot study of hourly rates 
 14.19  established under Laws 1988, chapter 689, article 2, section 
 14.20  117, may recommend continuation of the hourly rates for 
 14.21  participating vendors.  The recommendation must be made annually 
 14.22  under subdivision 5 and according to the methods and standards 
 14.23  provided by the commissioner.  The commissioner shall approve 
 14.24  the hourly rates when service authorization, billing, and 
 14.25  payment for services is possible through the Medicaid management 
 14.26  information system and the other criteria in this subdivision 
 14.27  are met.  Counties and vendors operating under the pilot study 
 14.28  of hourly rates established under Laws 1988, chapter 689, 
 14.29  article 2, section 117, shall work with the commissioner to 
 14.30  translate the hourly rates and actual expenditures into rates 
 14.31  meeting the criteria in subdivisions 1 to 16 unless hourly rates 
 14.32  are approved under this subdivision.  If the rates meeting the 
 14.33  criteria in subdivisions 1 to 16 are lower than the county's or 
 14.34  vendor's current rate, the county or vendor must continue to 
 14.35  receive the current rate. 
 14.36     Sec. 13.  Minnesota Statutes 1994, section 254B.02, 
 15.1   subdivision 1, is amended to read: 
 15.2      Subdivision 1.  [CHEMICAL DEPENDENCY TREATMENT ALLOCATION.] 
 15.3   The chemical dependency funds appropriated for allocation shall 
 15.4   be placed in a special revenue account.  For the fiscal year 
 15.5   beginning July 1, 1987, funds shall be transferred to operate 
 15.6   the vendor payment, invoice processing, and collections system 
 15.7   for one year.  The commissioner shall annually transfer funds 
 15.8   from the chemical dependency fund to pay for operation of the 
 15.9   drug and alcohol abuse normative evaluation system and to pay 
 15.10  for all costs incurred by adding two positions for licensing of 
 15.11  chemical dependency treatment and rehabilitation programs 
 15.12  located in hospitals for which funds are not otherwise 
 15.13  appropriated.  The commissioner shall annually divide the money 
 15.14  available in the chemical dependency fund that is not held in 
 15.15  reserve by counties from a previous allocation.  Twelve percent 
 15.16  of the remaining money must be reserved for treatment of 
 15.17  American Indians by eligible vendors under section 254B.05.  The 
 15.18  remainder of the money must be allocated among the counties 
 15.19  according to the following formula, using state demographer data 
 15.20  and other data sources determined by the commissioner: 
 15.21     (a) The county non-Indian and over age 14 per capita-months 
 15.22  of eligibility for aid to families with dependent children, 
 15.23  general assistance, and medical assistance is divided by the 
 15.24  total state non-Indian and over age 14 per capita-months of 
 15.25  eligibility to determine the caseload factor for each county. 
 15.26     (b) The average median married couple income for the 
 15.27  previous three years for the state is divided by the average 
 15.28  median married couple income for the previous three years for 
 15.29  each county to determine the income factor.  
 15.30     (c) The non-Indian and over age 14 population of the county 
 15.31  is multiplied by the sum of the income factor and the caseload 
 15.32  factor to determine the adjusted population.  
 15.33     (a) For purposes of this formula, American Indians and 
 15.34  children under age 14 are subtracted from the population of each 
 15.35  county to determine the restricted population. 
 15.36     (b) The amount of chemical dependency fund expenditures for 
 16.1   entitled persons for services not covered by prepaid plans 
 16.2   governed by section 256B.69 in the previous year is divided by 
 16.3   the amount of chemical dependency fund expenditures for entitled 
 16.4   persons for all services to determine the proportion of exempt 
 16.5   service expenditures for each county. 
 16.6      (c) The prepaid plan months of eligibility is multiplied by 
 16.7   the proportion of exempt service expenditures to determine the 
 16.8   adjusted prepaid plan months of eligibility for each county. 
 16.9      (d) The adjusted prepaid plan months of eligibility is 
 16.10  added to the number of restricted population fee for service 
 16.11  months of eligibility for aid to families with dependent 
 16.12  children, general assistance, and medical assistance and divided 
 16.13  by the county restricted population to determine county per 
 16.14  capita months of covered service eligibility. 
 16.15     (e) The number of adjusted prepaid plan months of 
 16.16  eligibility for the state is added to the number of fee for 
 16.17  service months of eligibility for aid to families with dependent 
 16.18  children, general assistance, and medical assistance for the 
 16.19  state restricted population and divided by the state restricted 
 16.20  population to determine state per capita months of covered 
 16.21  service eligibility. 
 16.22     (f) The county per capita months of covered service 
 16.23  eligibility is divided by the state per capita months of covered 
 16.24  service eligibility to determine the county welfare caseload 
 16.25  factor. 
 16.26     (g) The median married couple income for the most recent 
 16.27  three-year period available for the state is divided by the 
 16.28  median married couple income for the same period for each county 
 16.29  to determine the income factor for each county. 
 16.30     (h) The county restricted population is multiplied by the 
 16.31  sum of the county welfare caseload factor and the county income 
 16.32  factor to determine the adjusted population. 
 16.33     (d) (i) $15,000 shall be allocated to each county.  
 16.34     (e) (j) The remaining funds shall be allocated proportional 
 16.35  to the county adjusted population. 
 16.36     Sec. 14.  Minnesota Statutes 1994, section 254B.05, 
 17.1   subdivision 1, is amended to read: 
 17.2      Subdivision 1.  [LICENSURE REQUIRED.] Programs licensed by 
 17.3   the commissioner are eligible vendors.  Hospitals may apply for 
 17.4   and receive licenses to be eligible vendors, notwithstanding the 
 17.5   provisions of section 245A.03.  American Indian programs located 
 17.6   on federally recognized tribal lands that provide chemical 
 17.7   dependency primary treatment, extended care, transitional 
 17.8   residence, or outpatient treatment services, and are licensed by 
 17.9   tribal government are eligible vendors.  Detoxification programs 
 17.10  are not eligible vendors.  Programs that are not licensed as a 
 17.11  chemical dependency residential or nonresidential treatment 
 17.12  program by the commissioner or by tribal government are not 
 17.13  eligible vendors.  To be eligible for payment under the 
 17.14  Consolidated Chemical Dependency Treatment Fund, a vendor must 
 17.15  participate in the Drug and Alcohol Abuse Normative Evaluation 
 17.16  System and the treatment accountability plan. 
 17.17     Sec. 15.  Minnesota Statutes 1994, section 256.975, is 
 17.18  amended by adding a subdivision to read: 
 17.19     Subd. 6.  [INDIAN ELDERS POSITION.] The Minnesota board on 
 17.20  aging shall create an Indian elders coordinator position, and 
 17.21  shall hire staff as appropriations permit for the purposes of 
 17.22  coordinating efforts with the National Indian Council on Aging 
 17.23  and developing a comprehensive statewide service system for 
 17.24  Indian elders.  An Indian elder is defined for purposes of this 
 17.25  subdivision as an Indian enrolled in a band or tribe who is 55 
 17.26  years or older.  The statewide service system must include the 
 17.27  following components: 
 17.28     (1) an assessment of the program eligibility, examining the 
 17.29  need to change the age-based eligibility criteria to need-based 
 17.30  eligibility criteria; 
 17.31     (2) a planning system that would grant or make 
 17.32  recommendations for granting federal and state funding for 
 17.33  services; 
 17.34     (3) a plan for service focal points, senior centers, or 
 17.35  community centers for socialization and service accessibility 
 17.36  for Indian elders; 
 18.1      (4) a plan to develop and implement education and public 
 18.2   awareness campaigns including awareness programs, sensitivity 
 18.3   cultural training, and public education on Indian elder needs; 
 18.4      (5) a plan for information and referral services including 
 18.5   trained advocates and an Indian elder newsletter; 
 18.6      (6) a plan for a coordinated health care system including 
 18.7   health promotion/prevention, in-home service, long-term care 
 18.8   service, and health care services; 
 18.9      (7) a plan for ongoing research involving Indian elders 
 18.10  including needs assessment and needs analysis; 
 18.11     (8) information and referral services for legal advice or 
 18.12  legal counsel; and 
 18.13     (9) a plan to coordinate services with existing 
 18.14  organizations including the council of Indian affairs, the 
 18.15  Minnesota Indian council of elders, the Minnesota board on 
 18.16  aging, and tribal governments. 
 18.17     Sec. 16.  Minnesota Statutes 1994, section 256B.092, is 
 18.18  amended by adding a subdivision to read: 
 18.19     Subd. 4c.  [LIVING ARRANGEMENTS BASED ON A 24-HOUR PLAN OF 
 18.20  CARE.] (a) Notwithstanding the requirements for licensure under 
 18.21  Minnesota Rules, part 9525.1860, subpart 6, item D, and upon 
 18.22  federal approval of an amendment to the home- and 
 18.23  community-based services waiver for persons with mental 
 18.24  retardation or related conditions, a person receiving home- and 
 18.25  community-based services may choose to live in their own home 
 18.26  without requiring that the living arrangement be licensed under 
 18.27  Minnesota Rules, parts 9555.5050 to 9555.6265, provided the 
 18.28  following conditions are met: 
 18.29     (1) the person receiving home- and community-based services 
 18.30  has chosen to live in their own home; 
 18.31     (2) home- and community-based services are provided by a 
 18.32  qualified vendor who meets the provider standards as approved in 
 18.33  the Minnesota home- and community-based services waiver plan for 
 18.34  persons with mental retardation or related conditions; 
 18.35     (3) the person, or their legal representative, individually 
 18.36  or with others has purchased or rents the home and the person's 
 19.1   service provider has no financial interest in the home; and 
 19.2      (4) the service planning team, as defined in Minnesota 
 19.3   Rules, part 9525.0004, subpart 24, has determined that the 
 19.4   planned services, the 24-hour plan of care, and the housing 
 19.5   arrangement are appropriate to address the health, safety, and 
 19.6   welfare of the person. 
 19.7      (b) The county agency may require safety inspections of the 
 19.8   selected housing as part of their determination of the adequacy 
 19.9   of the living arrangement. 
 19.10     Sec. 17.  [REPEALER.] 
 19.11     Minnesota Statutes 1994, sections 144.0723, subdivision 5; 
 19.12  and 252.275, subdivisions 4a and 10, are repealed. 
 19.13                             ARTICLE 3
 19.14                     CHILDREN'S PROGRAMS POLICY
 19.15     Section 1.  Minnesota Statutes 1994, section 245.4871, is 
 19.16  amended by adding a subdivision to read: 
 19.17     Subd. 35.  [TRANSITION SERVICES.] "Transition services" 
 19.18  means mental health services, designed within an outcome 
 19.19  oriented process that promotes movement from school to 
 19.20  postschool activities, including post-secondary education, 
 19.21  vocational training, integrated employment including supported 
 19.22  employment, continuing and adult education, adult mental health 
 19.23  and social services, other adult services, independent living, 
 19.24  or community participation. 
 19.25     Sec. 2.  Minnesota Statutes 1994, section 245.4875, is 
 19.26  amended by adding a subdivision to read: 
 19.27     Subd. 8.  [TRANSITION SERVICES.] The county board may 
 19.28  continue to provide mental health services as defined in 
 19.29  sections 245.487 to 245.4888 to persons over 18 years of age, 
 19.30  but under 21 years of age, if the person was receiving case 
 19.31  management or family community support services prior to age 18, 
 19.32  and if one of the following conditions is met:  
 19.33     (1) the person is receiving special education services 
 19.34  through the local school district; or 
 19.35     (2) it is in the best interest of the person to continue 
 19.36  services defined in sections 245.487 to 245.4888. 
 20.1      Sec. 3.  Minnesota Statutes 1994, section 256F.09, is 
 20.2   amended to read: 
 20.3      256F.09 [GRANTS FOR CHILDREN'S SAFETY FAMILY VISITATION 
 20.4   CENTERS.] 
 20.5      Subdivision 1.  [PURPOSE.] The commissioner shall issue a 
 20.6   request for proposals from existing local nonprofit, 
 20.7   nongovernmental organizations, to use existing local facilities 
 20.8   as pilot children's safety family visitation centers.  The 
 20.9   commissioner shall award grants in amounts up to $50,000 for the 
 20.10  purpose of creating children's safety or maintaining family 
 20.11  visitation centers to reduce children's vulnerability to 
 20.12  violence and trauma related to family visitation, where there 
 20.13  has been a history of domestic violence or abuse within the 
 20.14  family.  At least one of the pilot projects shall be located in 
 20.15  the seven-county metropolitan area and at least one of the 
 20.16  projects shall be located outside the seven-county metropolitan 
 20.17  area, and the commissioner shall award the grants to provide the 
 20.18  greatest possible number of safety centers and to locate them to 
 20.19  provide for the broadest possible geographic distribution of the 
 20.20  centers throughout the state.  
 20.21     Each children's safety family visitation center must use 
 20.22  existing local facilities to provide a healthy interactive 
 20.23  environment for parents who are separated or divorced and for 
 20.24  parents with children in foster homes to visit with their 
 20.25  children.  The centers must be available for use by district 
 20.26  courts who may order visitation to occur at a safety visitation 
 20.27  center.  The centers may also be used as drop-off sites, so that 
 20.28  parents who are under court order to have no contact with each 
 20.29  other can exchange children for visitation at a neutral site.  
 20.30  Each center must provide sufficient security to ensure a safe 
 20.31  visitation environment for children and their parents.  A 
 20.32  grantee must demonstrate the ability to provide a local match, 
 20.33  which may include in-kind contributions. 
 20.34     Subd. 2.  [PRIORITIES.] In awarding grants under the 
 20.35  program, the commissioner shall give priority to: 
 20.36     (1) areas of the state where no children's safety other 
 21.1   family visitation center or similar facility exists; 
 21.2      (2) applicants who demonstrate that private funding for the 
 21.3   center is available and will continue; and 
 21.4      (3) facilities that are adapted for use to care for 
 21.5   children, such as day care centers, religious institutions, 
 21.6   community centers, schools, technical colleges, parenting 
 21.7   resource centers, and child care referral services. 
 21.8      Subd. 3.  [ADDITIONAL SERVICES.] Each center may provide 
 21.9   parenting and child development classes, and offer support 
 21.10  groups to participating custodial parents and hold regular 
 21.11  classes designed to assist children who have experienced 
 21.12  domestic violence and abuse. 
 21.13     Subd. 4.  [REPORT.] The commissioner shall evaluate the 
 21.14  operation of the pilot children's safety family visitation 
 21.15  centers and report to the legislature by February 1, 1994, with 
 21.16  recommendations. 
 21.17     Sec. 4.  Minnesota Statutes 1994, section 256H.01, 
 21.18  subdivision 9, is amended to read: 
 21.19     Subd. 9.  [FAMILY.] "Family" means parents, stepparents, 
 21.20  guardians and their spouses, or other eligible relative 
 21.21  caretakers and their spouses, and their blood related dependent 
 21.22  children and adoptive siblings under the age of 18 years living 
 21.23  in the same home including children temporarily absent from the 
 21.24  household in settings such as schools, foster care, and 
 21.25  residential treatment facilities.  When a minor parent or 
 21.26  parents and his, her, or their child or children are living with 
 21.27  other relatives, and the minor parent or parents apply for a 
 21.28  child care subsidy, "family" means only the minor parent or 
 21.29  parents and the child or children.  An adult may be considered a 
 21.30  dependent member of the family unit if 50 percent of the adult's 
 21.31  support is being provided by the parents, stepparents, guardians 
 21.32  and their spouses, or eligible relative caretakers and their 
 21.33  spouses, residing in the same household.  An adult age 18 who is 
 21.34  a full-time high school student and can reasonably be expected 
 21.35  to graduate before age 19 may be considered a dependent member 
 21.36  of the family unit. 
 22.1      Sec. 5.  Minnesota Statutes 1994, section 256H.01, 
 22.2   subdivision 12, is amended to read: 
 22.3      Subd. 12.  [PROVIDER.] "Provider" means a child care 
 22.4   license holder who operates a family day care home, a group 
 22.5   family day care home, a day care center, a nursery school, a day 
 22.6   nursery, an extended day school age child care program; a person 
 22.7   exempt from licensure who meets child care standards established 
 22.8   legal nonlicensed extended day school age child care program 
 22.9   which operates under the auspices of a local school board that 
 22.10  has adopted school age child care standards which meet or exceed 
 22.11  standards recommended by the state board department of 
 22.12  education; or a legal nonlicensed caregiver who is at least 18 
 22.13  years of age, and who is not a member of the AFDC assistance 
 22.14  unit.  
 22.15     Sec. 6.  Minnesota Statutes 1994, section 256H.02, is 
 22.16  amended to read: 
 22.17     256H.02 [DUTIES OF COMMISSIONER.] 
 22.18     The commissioner shall develop standards for county and 
 22.19  human services boards to provide child care services to enable 
 22.20  eligible families to participate in employment, training, or 
 22.21  education programs.  Within the limits of available 
 22.22  appropriations, the commissioner shall distribute money to 
 22.23  counties to reduce the costs of child care for eligible 
 22.24  families.  The commissioner shall adopt rules to govern the 
 22.25  program in accordance with this section.  The rules must 
 22.26  establish a sliding schedule of fees for parents receiving child 
 22.27  care services.  In the rules adopted under this section, county 
 22.28  and human services boards shall be authorized to establish 
 22.29  policies for payment of child care spaces for absent children, 
 22.30  when the payment is required by the child's regular provider.  
 22.31  The rules shall not set a maximum number of days for which 
 22.32  absence payments can be made, but instead shall direct the 
 22.33  county agency to set limits and pay for absences according to 
 22.34  the prevailing market practice in the county.  County policies 
 22.35  for payment of absences shall be subject to the approval of the 
 22.36  commissioner.  The commissioner shall maximize the use of 
 23.1   federal money under the AFDC employment special needs program in 
 23.2   section 256.736, subdivision 8, and other programs that provide 
 23.3   federal reimbursement for child care services for recipients of 
 23.4   aid to families with dependent children who are in education, 
 23.5   training, job search, or other activities allowed under those 
 23.6   programs.  Money appropriated under this section must be 
 23.7   coordinated with the AFDC employment special needs program and 
 23.8   other programs that provide federal reimbursement for child care 
 23.9   services to accomplish this purpose.  Federal reimbursement 
 23.10  obtained must be allocated to the county that spent money for 
 23.11  child care that is federally reimbursable under programs that 
 23.12  provide federal reimbursement for child care services.  The 
 23.13  counties shall use the federal money to expand child care 
 23.14  services.  The commissioner may adopt rules under chapter 14 to 
 23.15  implement and coordinate federal program requirements. 
 23.16     Sec. 7.  Minnesota Statutes 1994, section 256H.03, 
 23.17  subdivision 1, is amended to read: 
 23.18     Subdivision 1.  [ALLOCATION PERIOD; NOTICE OF ALLOCATION.] 
 23.19  When the commissioner notifies county and human service boards 
 23.20  of the forms and instructions they are to follow in the 
 23.21  development of their biennial community social services plans 
 23.22  required under section 256E.08, the commissioner shall also 
 23.23  notify county and human services boards of their estimated child 
 23.24  care fund program allocation for the two years covered by the 
 23.25  plan.  By June October 1 of each year, the commissioner shall 
 23.26  notify all counties of their final child care fund program 
 23.27  allocation. 
 23.28     Sec. 8.  Minnesota Statutes 1994, section 256H.03, 
 23.29  subdivision 2a, is amended to read: 
 23.30     Subd. 2a.  [ELIGIBLE RECIPIENTS.] Families that meet the 
 23.31  eligibility requirements under sections 256H.10, except AFDC 
 23.32  recipients, MFIP recipients, and transition year families, and 
 23.33  256H.11 are eligible for child care assistance under the basic 
 23.34  sliding fee program.  From July 1, 1990, to June 30, 1991, a 
 23.35  county may not accept new applications for the basic sliding fee 
 23.36  program unless the county can demonstrate that its state money 
 24.1   expenditures for the basic sliding fee program for this period 
 24.2   will not exceed 95 percent of the county's allocation of state 
 24.3   money for the fiscal year ending June 30, 1990.  As basic 
 24.4   sliding fee program money becomes available to serve new 
 24.5   families, eligible families whose benefits were terminated 
 24.6   during the fiscal year ending June 30, 1990, for reasons other 
 24.7   than loss of eligibility shall be reinstated.  Families enrolled 
 24.8   in the basic sliding fee program as of July 1, 1990, shall be 
 24.9   continued until they are no longer eligible.  Counties shall 
 24.10  make vendor payments to the child care provider or pay the 
 24.11  parent directly for eligible child care expenses on a 
 24.12  reimbursement basis.  Child care assistance provided through the 
 24.13  child care fund is considered assistance to the parent. 
 24.14     Sec. 9.  Minnesota Statutes 1994, section 256H.03, is 
 24.15  amended by adding a subdivision to read: 
 24.16     Subd. 4a.  [SIX-MONTH ALLOCATION.] For the period from July 
 24.17  1, 1995, to December 31, 1995, every county shall receive an 
 24.18  allocation at least equal and proportionate to one-half of its 
 24.19  original allocation in state fiscal year 1995.  This six-month 
 24.20  allocation shall be combined with the calendar year 1996 
 24.21  allocation and be administered as one 18-month allocation. 
 24.22     Sec. 10.  Minnesota Statutes 1994, section 256H.03, 
 24.23  subdivision 6, is amended to read: 
 24.24     Subd. 6.  [GUARANTEED FLOOR.] (a) Each county's guaranteed 
 24.25  floor shall equal the lesser of:  
 24.26     (1) the county's original allocation in the preceding state 
 24.27  fiscal year; or 
 24.28     (2) 110 percent of the county's basic sliding fee child 
 24.29  care program state and federal earnings for the 12-month period 
 24.30  ending on December 31 of the preceding state fiscal year.  For 
 24.31  purposes of this clause, "state and federal earnings" means the 
 24.32  reported direct child care expenditures adjusted for the 
 24.33  administrative allowance and 15 percent required county 
 24.34  match.  Beginning January 1, 1996, each county's guaranteed 
 24.35  floor shall equal 90 percent of the allocation received in the 
 24.36  preceding calendar year.  For the calendar year 1996 allocation, 
 25.1   the preceding calendar year shall be considered to be double the 
 25.2   six-month allocation as provided for in subdivision 4a.  
 25.3      (b) When the amount of funds available for allocation is 
 25.4   less than the amount available in the previous year, each 
 25.5   county's previous year allocation shall be reduced in proportion 
 25.6   to the reduction in the statewide funding, for the purpose of 
 25.7   establishing the guaranteed floor. 
 25.8      Sec. 11.  Minnesota Statutes 1994, section 256H.08, is 
 25.9   amended to read: 
 25.10     256H.08 [USE OF MONEY.] 
 25.11     Money for persons listed in sections 256H.03, subdivision 
 25.12  2a, and 256H.05, subdivision 1b, shall be used to reduce the 
 25.13  costs of child care for students, including the costs of child 
 25.14  care for students while employed if enrolled in an eligible 
 25.15  education program at the same time and making satisfactory 
 25.16  progress towards completion of the program.  Counties may not 
 25.17  limit the duration of child care subsidies for a person in an 
 25.18  employment or educational program, except when the person is 
 25.19  found to be ineligible under the child care fund eligibility 
 25.20  standards.  Any limitation must be based on a person's 
 25.21  employability plan in the case of an AFDC recipient, and county 
 25.22  policies included in the child care allocation plan.  Time 
 25.23  limitations for child care assistance, as specified in Minnesota 
 25.24  Rules, parts 9565.5000 to 9565.5200, do not apply to basic or 
 25.25  remedial educational programs needed to prepare for 
 25.26  post-secondary education or employment.  These programs 
 25.27  include:  high school, general equivalency diploma, and English 
 25.28  as a second language.  Programs exempt from this time limit must 
 25.29  not run concurrently with a post-secondary program.  High school 
 25.30  students who are participating in a post-secondary options 
 25.31  program and who receive a high school diploma issued by the 
 25.32  school district are exempt from the time limitations while 
 25.33  pursuing a high school diploma.  Financially eligible students 
 25.34  who have received child care assistance for one academic year 
 25.35  shall be provided child care assistance in the following 
 25.36  academic year if funds allocated under sections 256H.03 and 
 26.1   256H.05 are available.  If an AFDC recipient who is receiving 
 26.2   AFDC child care assistance under this chapter moves to another 
 26.3   county, continues to participate in educational or training 
 26.4   programs authorized in their employability development plans, 
 26.5   and continues to be eligible for AFDC child care assistance 
 26.6   under this chapter, the AFDC caretaker must receive continued 
 26.7   child care assistance from the county responsible for their 
 26.8   current employability development plan, without interruption. 
 26.9      Sec. 12.  Minnesota Statutes 1994, section 256H.11, 
 26.10  subdivision 1, is amended to read: 
 26.11     Subdivision 1.  [ASSISTANCE FOR PERSONS SEEKING AND 
 26.12  RETAINING EMPLOYMENT.] Persons who are seeking employment and 
 26.13  who are eligible for assistance under this section are eligible 
 26.14  to receive the equivalent of up to one month of child care up to 
 26.15  240 hours of child care assistance per calendar year.  Employed 
 26.16  persons who work at least an average of ten hours a week and 
 26.17  receive at least a minimum wage for all hours worked are 
 26.18  eligible for continued child care assistance.  
 26.19     Sec. 13.  Minnesota Statutes 1994, section 256H.12, 
 26.20  subdivision 1, is amended to read: 
 26.21     Subdivision 1.  [COUNTY CONTRIBUTIONS REQUIRED.] Beginning 
 26.22  July 1, 1995, in addition to payments from parents basic sliding 
 26.23  fee child care program participants, counties shall contribute 
 26.24  from county tax or other sources a minimum of 15 percent of the 
 26.25  cost of the basic sliding fee program at the local match 
 26.26  percentage calculated according to subdivision 1a.  The 
 26.27  commissioner shall recover funds from the county as necessary to 
 26.28  bring county expenditures into compliance with this subdivision. 
 26.29     Sec. 14.  Minnesota Statutes 1994, section 256H.12, is 
 26.30  amended by adding a subdivision to read: 
 26.31     Subd. 1a.  [LOCAL MATCH PERCENTAGE.] The local match 
 26.32  percentage shall equal the lesser of either 15 percent of the 
 26.33  cost of the basic sliding fee program or the statewide required 
 26.34  local match in state fiscal year 1995, divided by the sum of the 
 26.35  current year's basic sliding fee allocation, plus the statewide 
 26.36  required local match in state fiscal year 1995.  The resulting 
 27.1   local match percentage shall be adjusted to reflect a statewide 
 27.2   local match of five percent on any state and federal funding for 
 27.3   the basic sliding fee program above the initial state fiscal 
 27.4   year 1995 statewide allocation.  For purposes of this 
 27.5   computation, the statewide required local match in state fiscal 
 27.6   year 1995 shall be equal to the initial state fiscal year 1995 
 27.7   basic sliding fee allocation, divided by 85 percent, and then 
 27.8   multiplied by 15 percent.  The calendar year 1996 local match 
 27.9   percentage shall be in effect for the six-month allocation 
 27.10  period defined in section 256H.03. 
 27.11     Sec. 15.  Minnesota Statutes 1994, section 256H.15, 
 27.12  subdivision 1, is amended to read: 
 27.13     Subdivision 1.  [SUBSIDY RESTRICTIONS.] (a) Until June 30, 
 27.14  1991, the maximum child care rate is determined under this 
 27.15  paragraph.  The county board may limit the subsidy allowed by 
 27.16  setting a maximum on the provider child care rate that the 
 27.17  county shall subsidize.  The maximum rate set by any county 
 27.18  shall not be lower than 110 percent or higher than 125 percent 
 27.19  of the median rate in that county for like care arrangements for 
 27.20  all types of care, including special needs and handicapped care, 
 27.21  as determined by the commissioner.  If the county sets a maximum 
 27.22  rate, it must pay the provider's rate for each child receiving a 
 27.23  subsidy, up to the maximum rate set by the county.  If a county 
 27.24  does not set a maximum provider rate, it shall pay the 
 27.25  provider's rate for every child in care.  The maximum state 
 27.26  payment is 125 percent of the median provider rate.  If the 
 27.27  county has not set a maximum provider rate and the provider rate 
 27.28  is greater than 125 percent of the median provider rate in the 
 27.29  county, the county shall pay the amount in excess of 125 percent 
 27.30  of the median provider rate from county funding sources.  The 
 27.31  county shall pay the provider's full charges for every child in 
 27.32  care up to the maximum established.  The commissioner shall 
 27.33  determine the maximum rate for each type of care, including 
 27.34  special needs and handicapped care.  
 27.35     (b) Effective July 1, 1991, the maximum rate paid for child 
 27.36  care assistance under the child care fund is the maximum rate 
 28.1   eligible for federal reimbursement except that a provider 
 28.2   receiving reimbursement under paragraph (a) as of January 1, 
 28.3   1991, shall be paid at a rate no less than the rate of 
 28.4   reimbursement received under that paragraph.  A rate which 
 28.5   includes a provider bonus paid under subdivision 2 or a special 
 28.6   needs rate paid under subdivision 3 may be in excess of the 
 28.7   maximum rate allowed under this subdivision.  The department of 
 28.8   human services shall monitor the effect of this paragraph on 
 28.9   provider rates.  The county shall pay the provider's full 
 28.10  charges for every child in care up to the maximum established.  
 28.11  The commissioner shall determine the maximum rate for each type 
 28.12  of care, including special needs and handicapped care.  
 28.13     (c) When the provider charge is greater than the maximum 
 28.14  provider rate allowed, the parent is responsible for payment of 
 28.15  the difference in the rates in addition to any family copayment 
 28.16  fee. 
 28.17     Sec. 16.  Minnesota Statutes 1994, section 256H.18, is 
 28.18  amended to read: 
 28.19     256H.18 [ADMINISTRATIVE EXPENSES.] 
 28.20     The commissioner shall use up to seven percent one-eleventh 
 28.21  of the state and federal funds appropriated available for the 
 28.22  basic sliding fee program for payments to counties for 
 28.23  administrative expenses.  The commissioner shall use up to ten 
 28.24  percent of federal funds for payments to counties for 
 28.25  administrative expenses. 
 28.26     Sec. 17.  [REPEALER.] 
 28.27     Minnesota Statutes 1994, section 256H.03, subdivisions 2 
 28.28  and 5, are repealed.  
 28.29                             ARTICLE 4
 28.30                  ECONOMIC SELF-SUFFICIENCY POLICY
 28.31     Section 1.  Minnesota Statutes 1994, section 256.034, 
 28.32  subdivision 1, is amended to read: 
 28.33     Subdivision 1.  [CONSOLIDATION OF TYPES OF ASSISTANCE.] 
 28.34  Under the Minnesota family investment plan, assistance 
 28.35  previously provided to families through the AFDC, food stamp, 
 28.36  and general assistance programs must be combined into a single 
 29.1   cash assistance program.  As authorized by Congress, families 
 29.2   receiving assistance through the Minnesota family investment 
 29.3   plan are automatically eligible for and entitled to medical 
 29.4   assistance under chapter 256B.  Federal, state, and local funds 
 29.5   that would otherwise be allocated for assistance to families 
 29.6   under the AFDC, food stamp, and general assistance programs must 
 29.7   be transferred to the Minnesota family investment plan.  The 
 29.8   provisions of the Minnesota family investment plan prevail over 
 29.9   any provisions of sections 245.771, 256.72 to 256.87, 256D.01 to 
 29.10  256D.21, or 393.07, subdivisions 10 and 10a, and any rules 
 29.11  implementing those sections with which they are irreconcilable.  
 29.12  The food stamp, general assistance, and work readiness programs 
 29.13  for single persons and couples who are not responsible for the 
 29.14  care of children are not replaced by the Minnesota family 
 29.15  investment plan.  Unless stated otherwise in statutes or rules 
 29.16  governing the Minnesota family investment plan, participants in 
 29.17  the Minnesota family investment plan shall be considered to be 
 29.18  recipients of aid under aid to families with dependent children, 
 29.19  family general assistance, and food stamps for the purposes of 
 29.20  statutes and rules affecting such recipients or allocations of 
 29.21  funding based on the assistance status of the recipients, and to 
 29.22  specifically be subject to the provisions of section 256.98.  
 29.23     Sec. 2.  Minnesota Statutes 1994, section 256.045, 
 29.24  subdivision 3, is amended to read: 
 29.25     Subd. 3.  [STATE AGENCY HEARINGS.] (a) Any person applying 
 29.26  for, receiving or having received public assistance or a program 
 29.27  of social services granted by the state agency or a county 
 29.28  agency under sections 252.32, 256.031 to 256.036, and 256.72 to 
 29.29  256.879, chapters 256B, 256D, 256E, 261, or the federal Food 
 29.30  Stamp Act whose application for assistance is denied, not acted 
 29.31  upon with reasonable promptness, or whose assistance is 
 29.32  suspended, reduced, terminated, or claimed to have been 
 29.33  incorrectly paid, or any patient or relative aggrieved by an 
 29.34  order of the commissioner under section 252.27, or a party 
 29.35  aggrieved by a ruling of a prepaid health plan, may contest that 
 29.36  action or decision before the state agency by submitting a 
 30.1   written request for a hearing to the state agency within 30 days 
 30.2   after receiving written notice of the action or decision, or 
 30.3   within 90 days of such written notice if the applicant, 
 30.4   recipient, patient, or relative shows good cause why the request 
 30.5   was not submitted within the 30-day time limit. 
 30.6      (b) Except for a prepaid health plan, a vendor of medical 
 30.7   care as defined in section 256B.02, subdivision 7, or a vendor 
 30.8   under contract with a county agency to provide social services 
 30.9   under section 256E.08, subdivision 4, is not a party and may not 
 30.10  request a hearing under this section, except if assisting a 
 30.11  recipient as provided in subdivision 4. 
 30.12     (c) An applicant or recipient is not entitled to receive 
 30.13  social services beyond the services included in the amended 
 30.14  community social services plan developed under section 256E.081, 
 30.15  subdivision 3, if the county agency has met the requirements in 
 30.16  section 256E.081. 
 30.17     Sec. 3.  Minnesota Statutes 1994, section 256.73, 
 30.18  subdivision 2, is amended to read: 
 30.19     Subd. 2.  [ALLOWANCE BARRED BY OWNERSHIP OF PROPERTY.] 
 30.20  Ownership by an assistance unit of property as follows is a bar 
 30.21  to any allowance under sections 256.72 to 256.87: 
 30.22     (1) The value of real property other than the homestead, 
 30.23  which when combined with other assets exceeds the limits of 
 30.24  paragraph (2), unless the assistance unit is making a good faith 
 30.25  effort to sell the nonexcludable real property.  The time period 
 30.26  for disposal must not exceed nine consecutive months.  The 
 30.27  assistance unit must sign an agreement to dispose of the 
 30.28  property and to repay assistance received during the nine months 
 30.29  that would not have been paid had the property been sold at the 
 30.30  beginning of such period, but not to exceed the amount of the 
 30.31  net sale proceeds.  The family has five working days from the 
 30.32  date it realizes cash from the sale of the property to repay the 
 30.33  overpayment.  If the property is not sold within the required 
 30.34  time or the assistance unit becomes ineligible for any reason 
 30.35  during the nine-month period, the amount payable under the 
 30.36  agreement will not be determined and recovery will not begin 
 31.1   until the property is in fact sold. execute a lien covering that 
 31.2   property with the amount of assistance expended over the 
 31.3   nine-month period covered by the agreement.  The amount payable 
 31.4   should be calculated and entered onto the lien form which shall 
 31.5   be filed for record with the recorder in the county where the 
 31.6   real property is situated.  The lien takes priority from the 
 31.7   time of its attaching over all other liens subsequently acquired 
 31.8   and subsequent conveyances.  The lien shall be enforced in the 
 31.9   manner provided by law for the enforcement of mechanics liens 
 31.10  upon real property and at such time as the property is in fact 
 31.11  sold.  If the property is intentionally sold at less than fair 
 31.12  market value or if a good faith effort to sell the property is 
 31.13  not being made, the overpayment amount shall be computed using 
 31.14  the fair market value determined at the beginning of the 
 31.15  nine-month period.  For the purposes of this section, 
 31.16  "homestead" means the home that is owned by, and is the usual 
 31.17  residence of, the child, relative, or other member of the 
 31.18  assistance unit together with the surrounding property which is 
 31.19  not separated from the home by intervening property owned by 
 31.20  others.  "Usual residence" includes the home from which the 
 31.21  child, relative, or other members of the assistance unit is 
 31.22  temporarily absent due to an employability development plan 
 31.23  approved by the local human service agency, which includes 
 31.24  education, training, or job search within the state but outside 
 31.25  of the immediate geographic area.  Public rights-of-way, such as 
 31.26  roads which run through the surrounding property and separate it 
 31.27  from the home, will not affect the exemption of the property; or 
 31.28     (2) Personal property of an equity value in excess of 
 31.29  $1,000 for the entire assistance unit, exclusive of personal 
 31.30  property used as the home, one motor vehicle of an equity value 
 31.31  not exceeding $1,500 or the entire equity value of a motor 
 31.32  vehicle determined to be necessary for the operation of a 
 31.33  self-employment business, one burial plot for each member of the 
 31.34  assistance unit, one prepaid burial contract with an equity 
 31.35  value of no more than $1,000 for each member of the assistance 
 31.36  unit, clothing and necessary household furniture and equipment 
 32.1   and other basic maintenance items essential for daily living, in 
 32.2   accordance with rules promulgated by and standards established 
 32.3   by the commissioner of human services. 
 32.4      Sec. 4.  Minnesota Statutes 1994, section 256.98, 
 32.5   subdivision 1, is amended to read: 
 32.6      Subdivision 1.  [WRONGFULLY OBTAINING ASSISTANCE.] A person 
 32.7   who obtains, or attempts to obtain, or aids or abets any person 
 32.8   to obtain by means of a willfully false statement or 
 32.9   representation, by intentional concealment of a material fact, 
 32.10  or by impersonation or other fraudulent device, assistance to 
 32.11  which the person is not entitled or assistance greater than that 
 32.12  to which the person is entitled, or who knowingly aids or abets 
 32.13  in buying or in any way disposing of the property of a recipient 
 32.14  or applicant of assistance without the consent of the county 
 32.15  agency with intent to defeat the purposes of sections 
 32.16  256.12, 256.031 to 256.0361, 256.72 to 256.871, and chapter 
 32.17  256B, or all of these sections is guilty of theft and shall be 
 32.18  sentenced pursuant to section 609.52, subdivision 3, clauses 
 32.19  (2), (3)(a) and (c), (4), and (5). 
 32.20     Sec. 5.  Minnesota Statutes 1994, section 256.98, 
 32.21  subdivision 8, is amended to read: 
 32.22     Subd. 8.  [DISQUALIFICATION FROM PROGRAM.] Any person found 
 32.23  to be guilty of wrongfully obtaining assistance by a federal or 
 32.24  state court or by an administrative hearing determination, or 
 32.25  waiver thereof, through a disqualification consent agreement, or 
 32.26  as part of any approved diversion plan under section 401.065 in 
 32.27  either the aid to families with dependent children program or, 
 32.28  the food stamp program, the Minnesota family investment plan, 
 32.29  the general assistance or family general assistance program, the 
 32.30  Minnesota supplemental aid program, or the work readiness 
 32.31  program shall be disqualified from that program.  The needs of 
 32.32  that individual shall not be taken into consideration in 
 32.33  determining the grant level for that assistance unit:  
 32.34     (1) for six months after the first offense; 
 32.35     (2) for 12 months after the second offense; and 
 32.36     (3) permanently after the third or subsequent offense.  
 33.1      Any The period for which sanctions are imposed is 
 33.2   effective, of program disqualification shall begin on the date 
 33.3   stipulated on the advance notice of disqualification without 
 33.4   possibility of postponement for administrative stay, or hearing 
 33.5   and shall continue through completion unless and until the 
 33.6   findings upon which the sanctions were imposed are reversed by a 
 33.7   court of competent jurisdiction.  The period for which sanctions 
 33.8   are imposed is not subject to review.  The sanctions provided 
 33.9   under this subdivision are in addition to, and not in 
 33.10  substitution for, any other sanctions that may be provided for 
 33.11  by law for the offense involved.  Notwithstanding clauses (1) to 
 33.12  (3), the disqualification period shall not begin until the 
 33.13  disqualified individual establishes that they are otherwise 
 33.14  eligible for the program which is the subject of the 
 33.15  disqualification. 
 33.16     Sec. 6.  Minnesota Statutes 1994, section 256D.05, 
 33.17  subdivision 7, is amended to read: 
 33.18     Subd. 7.  [INELIGIBILITY FOR GENERAL ASSISTANCE.] No person 
 33.19  disqualified from any federally aided assistance program shall 
 33.20  be eligible for general assistance during the a period covered 
 33.21  by the disqualification sanction of disqualification from any 
 33.22  federally aided assistance program; or if the person could be 
 33.23  considered an essential person under section 256.74, subdivision 
 33.24  1.  
 33.25     Sec. 7.  Minnesota Statutes 1994, section 256D.46, 
 33.26  subdivision 1, is amended to read: 
 33.27     Subdivision 1.  [ELIGIBILITY.] Emergency Minnesota 
 33.28  supplemental aid must be granted if the recipient is without 
 33.29  adequate resources to resolve an emergency that, if unresolved, 
 33.30  will threaten the health or safety of the recipient.  For the 
 33.31  purposes of this section, the term "recipient" includes persons 
 33.32  for whom a group residential housing benefit is being paid under 
 33.33  sections 256I.01 to 256I.06. 
 33.34     Sec. 8.  Minnesota Statutes 1994, section 256D.46, 
 33.35  subdivision 2, is amended to read: 
 33.36     Subd. 2.  [INCOME AND RESOURCE TEST.] All income and 
 34.1   resources available to the recipient during the month in which 
 34.2   the need for emergency Minnesota supplemental aid arises must be 
 34.3   considered in determining the recipient's ability to meet the 
 34.4   emergency need.  Property that can be liquidated in time to 
 34.5   resolve the emergency and income (excluding Minnesota 
 34.6   supplemental aid issued for current month's need) that is 
 34.7   normally disregarded or excluded under the Minnesota 
 34.8   supplemental aid program must be considered available to meet 
 34.9   the emergency need.  
 34.10     Sec. 9.  Minnesota Statutes 1994, section 256I.03, 
 34.11  subdivision 5, is amended to read: 
 34.12     Subd. 5.  [MSA EQUIVALENT RATE.] "MSA equivalent rate" 
 34.13  means an amount equal to the total of:  
 34.14     (1) the combined maximum shelter and basic needs standards 
 34.15  for MSA recipients living alone specified in section 256D.44, 
 34.16  subdivisions 2, paragraph (a); and 3, paragraph (a); plus 
 34.17     (2) for persons who are not eligible to receive food stamps 
 34.18  due to living arrangement, the maximum allotment authorized by 
 34.19  the federal Food Stamp Program for a single individual which is 
 34.20  in effect on the first day of July each year; less 
 34.21     (3) the personal needs allowance authorized for medical 
 34.22  assistance recipients under section 256B.35.  
 34.23     The MSA equivalent rate is to be adjusted on the first day 
 34.24  of July each year to reflect changes in any of the component 
 34.25  rates under clauses (1) to (3). 
 34.26     Sec. 10.  Minnesota Statutes 1994, section 256I.03, is 
 34.27  amended by adding a subdivision to read: 
 34.28     Subd. 7.  [COUNTABLE INCOME.] "Countable income" means all 
 34.29  income received by an applicant or recipient less any applicable 
 34.30  exclusions or disregards.  For a recipient of any cash benefit 
 34.31  from the SSI program, countable income means the SSI benefit 
 34.32  limit in effect at the time the person is in a GRH setting less 
 34.33  $20, less the medical assistance personal needs allowance.  If 
 34.34  the SSI limit has been reduced for a person due to events 
 34.35  occurring prior to the persons entering the GRH setting, 
 34.36  countable income means actual income less any applicable 
 35.1   exclusions and disregards. 
 35.2      Sec. 11.  Minnesota Statutes 1994, section 256I.04, 
 35.3   subdivision 2b, is amended to read: 
 35.4      Subd. 2b.  [GROUP RESIDENTIAL HOUSING AGREEMENTS.] 
 35.5   Agreements between county agencies and providers of group 
 35.6   residential housing must be in writing and must specify the name 
 35.7   and address under which the establishment subject to the 
 35.8   agreement does business and under which the establishment, or 
 35.9   service provider, if different from the group residential 
 35.10  housing establishment, is licensed by the department of health 
 35.11  or the department of human services; the specific license or 
 35.12  registration from the department of health or the department of 
 35.13  human services held by the provider and the number of beds 
 35.14  subject to that license; the address of the location or 
 35.15  locations at which group residential housing is provided under 
 35.16  this agreement; the per diem and monthly rates that are to be 
 35.17  paid from group residential housing funds for each eligible 
 35.18  resident at each location; the number of beds at each location 
 35.19  which are subject to the group residential housing agreement; 
 35.20  whether the license holder is a not-for-profit corporation under 
 35.21  section 501(c)(3) of the Internal Revenue Code; and a statement 
 35.22  that the agreement is subject to the provisions of sections 
 35.23  256I.01 to 256I.06 and subject to any changes to those sections. 
 35.24     Sec. 12.  Minnesota Statutes 1994, section 256I.05, 
 35.25  subdivision 1, is amended to read: 
 35.26     Subdivision 1.  [MAXIMUM RATES.] (a) Monthly room and board 
 35.27  rates negotiated by a county agency for a recipient living in 
 35.28  group residential housing must not exceed the MSA equivalent 
 35.29  rate specified under section 256I.03, subdivision 5, with the 
 35.30  exception that a county agency may negotiate a room and board 
 35.31  rate that exceeds the MSA equivalent rate by up to $426.37 for 
 35.32  recipients of waiver services under title XIX of the Social 
 35.33  Security Act.  This exception is subject to the following 
 35.34  conditions: 
 35.35     (1) that the Secretary of Health and Human Services has not 
 35.36  approved a state request to include room and board costs which 
 36.1   exceed the MSA equivalent rate in an individual's set of waiver 
 36.2   services under title XIX of the Social Security Act; or 
 36.3      (2) that the Secretary of Health and Human Services has 
 36.4   approved the inclusion of room and board costs which exceed the 
 36.5   MSA equivalent rate, but in an amount that is insufficient to 
 36.6   cover costs which are included in a group residential housing 
 36.7   agreement in effect on June 30, 1994,; and 
 36.8      (3) the amount of the rate that is above the MSA equivalent 
 36.9   rate has been approved by the commissioner.  The county agency 
 36.10  may at any time negotiate a lower room and board rate than the 
 36.11  rate that would otherwise be paid under this subdivision. 
 36.12     (b) The maximum monthly rate for an establishment that 
 36.13  enters into an initial group residential housing agreement with 
 36.14  a county agency on or after June 1, 1989, may not exceed 90 
 36.15  percent of the maximum rate established under this subdivision.  
 36.16  This is effective until June 30, 1994. 
 36.17     Sec. 13.  Minnesota Statutes 1994, section 256I.05, 
 36.18  subdivision 5, is amended to read: 
 36.19     Subd. 5.  [ADULT FOSTER CARE RATES.] The commissioner shall 
 36.20  annually establish statewide maintenance and difficulty of 
 36.21  care rates limits for adults in foster care.  The commissioner 
 36.22  shall adopt rules to implement statewide rates.  In adopting 
 36.23  rules, the commissioner shall consider existing maintenance and 
 36.24  difficulty of care rates so that, to the extent possible, an 
 36.25  adult for whom a maintenance or difficulty of care rate is 
 36.26  established will not be adversely affected.  
 36.27     Sec. 14.  Minnesota Statutes 1994, section 256I.06, 
 36.28  subdivision 2, is amended to read: 
 36.29     Subd. 2.  [TIME OF PAYMENT.] A county agency may make 
 36.30  payments to a group residence in advance for an individual whose 
 36.31  stay in the group residence is expected to last beyond the 
 36.32  calendar month for which the payment is made and who does not 
 36.33  expect to receive countable earned income during the month for 
 36.34  which the payment is made.  Group residential housing payments 
 36.35  made by a county agency on behalf of an individual who is not 
 36.36  expected to remain in the group residence beyond the month for 
 37.1   which payment is made must be made subsequent to the 
 37.2   individual's departure from the group residence.  Group 
 37.3   residential housing payments made by a county agency on behalf 
 37.4   of an individual with countable earned income must be made 
 37.5   subsequent to receipt of a monthly household report form. 
 37.6      Sec. 15.  Minnesota Statutes 1994, section 256I.06, 
 37.7   subdivision 6, is amended to read: 
 37.8      Subd. 6.  [REPORTS.] Recipients must report changes in 
 37.9   circumstances that affect eligibility or group residential 
 37.10  housing payment amounts within ten days of the change.  
 37.11  Recipients with countable earned income must complete a monthly 
 37.12  household report form.  If the report form is not received 
 37.13  before the end of the month in which it is due, the county 
 37.14  agency must terminate eligibility for group residential housing 
 37.15  payments.  The termination shall be effective on the first day 
 37.16  of the month following the month in which the report was due.  
 37.17  If a complete report is received within the month eligibility 
 37.18  was terminated, the individual is considered to have continued 
 37.19  an application for group residential housing payment effective 
 37.20  the first day of the month the eligibility was terminated. 
 37.21     Sec. 16.  Minnesota Statutes 1994, section 524.6-207, is 
 37.22  amended to read: 
 37.23     524.6-207 [RIGHTS OF CREDITORS.] 
 37.24     No multiple-party account will be effective against an 
 37.25  estate of a deceased party to transfer to a survivor sums needed 
 37.26  to pay debts, taxes, and expenses of administration, including 
 37.27  statutory allowances to the surviving spouse, minor children and 
 37.28  dependent children, if other assets of the estate are 
 37.29  insufficient, to the extent the deceased party is the source of 
 37.30  the funds or beneficial owner.  A surviving party or P.O.D. 
 37.31  payee who receives payment from a multiple-party account after 
 37.32  the death of a deceased party shall be liable to account to the 
 37.33  deceased party's personal representative or a county agency with 
 37.34  a claim authorized by section 256B.15 for amounts the decedent 
 37.35  owned beneficially immediately before death to the extent 
 37.36  necessary to discharge any such claims and charges remaining 
 38.1   unpaid after the application of the assets of the decedent's 
 38.2   estate.  No proceeding to assert this liability shall be 
 38.3   commenced unless the personal representative or a county agency 
 38.4   with a claim authorized by section 256B.15 has received a 
 38.5   written demand by a surviving spouse, a creditor or one acting 
 38.6   for a minor dependent child of the decedent, and no proceeding 
 38.7   shall be commenced later than two years following the death of 
 38.8   the decedent.  Sums recovered by the personal representative or 
 38.9   a county agency with a claim authorized by section 256B.15 shall 
 38.10  be administered as part of the decedent's estate.  This section 
 38.11  shall not affect the right of a financial institution to make 
 38.12  payment on multiple-party accounts according to the terms 
 38.13  thereof, or make it liable to the estate of a deceased party 
 38.14  unless, before payment, the institution has been served with 
 38.15  process in a proceeding by the personal representative or a 
 38.16  county agency with a claim authorized by section 256B.15.  
 38.17     Sec. 17.  Minnesota Statutes 1994, section 550.37, 
 38.18  subdivision 14, is amended to read: 
 38.19     Subd. 14.  [PUBLIC ASSISTANCE.] All relief based on need, 
 38.20  and the earnings or salary of a person who is a recipient of 
 38.21  relief based on need, shall be exempt from all claims of 
 38.22  creditors including any contractual setoff or security interest 
 38.23  asserted by a financial institution.  For the purposes of this 
 38.24  chapter, relief based on need includes AFDC, general assistance 
 38.25  medical care, supplemental security income, medical assistance, 
 38.26  Minnesota supplemental assistance, and general assistance.  The 
 38.27  salary or earnings of any debtor who is or has been a an 
 38.28  eligible recipient of relief based on need, or an inmate of a 
 38.29  correctional institution shall, upon the debtor's return to 
 38.30  private employment or farming after having been a an eligible 
 38.31  recipient of relief based on need, or an inmate of a 
 38.32  correctional institution, be exempt from attachment, 
 38.33  garnishment, or levy of execution for a period of six months 
 38.34  after the debtor's return to employment or farming and after all 
 38.35  public assistance for which eligibility existed has been 
 38.36  terminated.  The exemption provisions contained in this 
 39.1   subdivision also apply for 60 days after deposit in any 
 39.2   financial institution, whether in a single or joint account.  In 
 39.3   tracing the funds, the first-in first-out method of accounting 
 39.4   shall be used.  The burden of establishing that funds are exempt 
 39.5   rests upon the debtor.  Agencies distributing relief and the 
 39.6   correctional institutions shall, at the request of creditors, 
 39.7   inform them whether or not any debtor has been a an eligible 
 39.8   recipient of relief based on need, or an inmate of a 
 39.9   correctional institution, within the preceding six months. 
 39.10     Sec. 18.  Laws 1993, First Special Session chapter 1, 
 39.11  article 8, section 30, subdivision 2, is amended to read: 
 39.12     Subd. 2.  Sections 1 to 3, 8, 9, 13 to 17, 22, 23, and 26 
 39.13  to 29 are effective July 1, 1994, contingent upon federal 
 39.14  recognition that group residential housing payments qualify as 
 39.15  optional state supplement payments to the supplemental security 
 39.16  income program under title XVI of the Social Security Act and 
 39.17  confer categorical eligibility for medical assistance under the 
 39.18  state plan for medical assistance.  The amendments and repeals 
 39.19  by Laws 1993, First Special Session chapter 1, article 8, 
 39.20  sections 1 to 3, 8, 9, 13 to 17, 22, 23, 26, and 29, are 
 39.21  effective July 1, 1994. 
 39.22     Sec. 19.  [EFFECTIVE DATE.] 
 39.23     Sections 9 to 15, and 18 (256I.03, subdivisions 5 and 7; 
 39.24  256I.04, subdivision 2b, 256I.05, subdivisions 1 and 5; 256I.06, 
 39.25  subdivisions 2 and 6; and Laws 1993 effective date) are 
 39.26  effective the day following final enactment. 
 39.27     Sections 3 (256.73, subdivision 2), 16 (524.6-207), and 17 
 39.28  (550.37, subdivision 14) are effective August 1, 1995. 
 39.29                             ARTICLE 5
 39.30                         HEALTH CARE POLICY
 39.31     Section 1.  Minnesota Statutes 1994, section 144A.071, 
 39.32  subdivision 2, is amended to read: 
 39.33     Subd. 2.  [MORATORIUM.] The commissioner of health, in 
 39.34  coordination with the commissioner of human services, shall deny 
 39.35  each request for new licensed or certified nursing home or 
 39.36  certified boarding care beds except as provided in subdivision 3 
 40.1   or 4a, or section 144A.073.  "Certified bed" means a nursing 
 40.2   home bed or a boarding care bed certified by the commissioner of 
 40.3   health for the purposes of the medical assistance program, under 
 40.4   United States Code, title 42, sections 1396 et seq.  
 40.5      The commissioner of human services, in coordination with 
 40.6   the commissioner of health, shall deny any request to issue a 
 40.7   license under section 252.28 and chapter 245A to a nursing home 
 40.8   or boarding care home, if that license would result in an 
 40.9   increase in the medical assistance reimbursement amount.  
 40.10     In addition, the commissioner of health must not approve 
 40.11  any construction project whose cost exceeds $500,000, or 25 
 40.12  percent of the facility's appraised value, whichever is less, 
 40.13  unless: 
 40.14     (a) any construction costs exceeding the lesser of $500,000 
 40.15  or 25 percent of the facility's appraised value are not added to 
 40.16  the facility's appraised value and are not included in the 
 40.17  facility's payment rate for reimbursement under the medical 
 40.18  assistance program; or 
 40.19     (b) the project: 
 40.20     (1) has been approved through the process described in 
 40.21  section 144A.073; 
 40.22     (2) meets an exception in subdivision 3 or 4a; 
 40.23     (3) is necessary to correct violations of state or federal 
 40.24  law issued by the commissioner of health; 
 40.25     (4) is necessary to repair or replace a portion of the 
 40.26  facility that was destroyed damaged by fire, lightning, or other 
 40.27  hazards provided that the provisions of subdivision 4a, clause 
 40.28  (a), are met; 
 40.29     (5) as of May 1, 1992, the facility has submitted to the 
 40.30  commissioner of health written documentation evidencing that the 
 40.31  facility meets the "commenced construction" definition as 
 40.32  specified in subdivision 1a, clause (d), or that substantial 
 40.33  steps have been taken prior to April 1, 1992, relating to the 
 40.34  construction project.  "Substantial steps" require that the 
 40.35  facility has made arrangements with outside parties relating to 
 40.36  the construction project and include the hiring of an architect 
 41.1   or construction firm, submission of preliminary plans to the 
 41.2   department of health or documentation from a financial 
 41.3   institution that financing arrangements for the construction 
 41.4   project have been made; or 
 41.5      (6) is being proposed by a licensed nursing facility that 
 41.6   is not certified to participate in the medical assistance 
 41.7   program and will not result in new licensed or certified beds. 
 41.8      Prior to the final plan approval of any construction 
 41.9   project, the commissioner of health shall be provided with an 
 41.10  itemized cost estimate for the project construction costs.  If a 
 41.11  construction project is anticipated to be completed in phases, 
 41.12  the total estimated cost of all phases of the project shall be 
 41.13  submitted to the commissioner and shall be considered as one 
 41.14  construction project.  Once the construction project is 
 41.15  completed and prior to the final clearance by the commissioner, 
 41.16  the total project construction costs for the construction 
 41.17  project shall be submitted to the commissioner.  If the final 
 41.18  project construction cost exceeds the dollar threshold in this 
 41.19  subdivision, the commissioner of human services shall not 
 41.20  recognize any of the project construction costs or the related 
 41.21  financing costs in excess of this threshold in establishing the 
 41.22  facility's property-related payment rate. 
 41.23     The dollar thresholds for construction projects are as 
 41.24  follows:  for construction projects other than those authorized 
 41.25  in clauses (1) to (6), the dollar threshold is $500,000 or 25 
 41.26  percent of appraised value, whichever is less.  For projects 
 41.27  authorized after July 1, 1993, under clause (1), the dollar 
 41.28  threshold is the cost estimate submitted with a proposal for an 
 41.29  exception under section 144A.073, plus inflation as calculated 
 41.30  according to section 256B.431, subdivision 3f, paragraph (a).  
 41.31  For projects authorized under clauses (2) to (4), the dollar 
 41.32  threshold is the itemized estimate project construction costs 
 41.33  submitted to the commissioner of health at the time of final 
 41.34  plan approval, plus inflation as calculated according to section 
 41.35  256B.431, subdivision 3f, paragraph (a). 
 41.36     The commissioner of health shall adopt emergency or 
 42.1   permanent rules to implement this section or to amend the 
 42.2   emergency rules for granting exceptions to the moratorium on 
 42.3   nursing homes under section 144A.073.  The authority to adopt 
 42.4   emergency rules continues to December 30, 1992. 
 42.5      Sec. 2.  Minnesota Statutes 1994, section 144A.071, 
 42.6   subdivision 4a, is amended to read: 
 42.7      Subd. 4a.  [EXCEPTIONS FOR REPLACEMENT BEDS.] It is in the 
 42.8   best interest of the state to ensure that nursing homes and 
 42.9   boarding care homes continue to meet the physical plant 
 42.10  licensing and certification requirements by permitting certain 
 42.11  construction projects.  Facilities should be maintained in 
 42.12  condition to satisfy the physical and emotional needs of 
 42.13  residents while allowing the state to maintain control over 
 42.14  nursing home expenditure growth. 
 42.15     The commissioner of health in coordination with the 
 42.16  commissioner of human services, may approve the renovation, 
 42.17  replacement, upgrading, or relocation of a nursing home or 
 42.18  boarding care home, under the following conditions: 
 42.19     (a) to license or certify beds in a new facility 
 42.20  constructed to replace a facility or to make repairs in an 
 42.21  existing facility that was destroyed or damaged after June 30, 
 42.22  1987, by fire, lightning, or other hazard provided:  
 42.23     (i) destruction was not caused by the intentional act of or 
 42.24  at the direction of a controlling person of the facility; 
 42.25     (ii) at the time the facility was destroyed or damaged the 
 42.26  controlling persons of the facility maintained insurance 
 42.27  coverage for the type of hazard that occurred in an amount that 
 42.28  a reasonable person would conclude was adequate; 
 42.29     (iii) the net proceeds from an insurance settlement for the 
 42.30  damages caused by the hazard are applied to the cost of the new 
 42.31  facility or repairs; 
 42.32     (iv) the new facility is constructed on the same site as 
 42.33  the destroyed facility or on another site subject to the 
 42.34  restrictions in section 144A.073, subdivision 5; 
 42.35     (v) the number of licensed and certified beds in the new 
 42.36  facility does not exceed the number of licensed and certified 
 43.1   beds in the destroyed facility; and 
 43.2      (vi) the commissioner determines that the replacement beds 
 43.3   are needed to prevent an inadequate supply of beds as defined in 
 43.4   subdivision 3, paragraph (a). 
 43.5   Project construction costs incurred for repairs authorized under 
 43.6   this clause shall not be considered in the dollar threshold 
 43.7   amount defined in subdivision 2; 
 43.8      (b) to license or certify beds that are moved from one 
 43.9   location to another within a nursing home facility, provided the 
 43.10  total costs of remodeling performed in conjunction with the 
 43.11  relocation of beds does not exceed 25 percent of the appraised 
 43.12  value of the facility or $500,000, whichever is less; 
 43.13     (c) to license or certify beds in a project recommended for 
 43.14  approval under section 144A.073; 
 43.15     (d) to license or certify beds that are moved from an 
 43.16  existing state nursing home to a different state facility, 
 43.17  provided there is no net increase in the number of state nursing 
 43.18  home beds; 
 43.19     (e) to certify and license as nursing home beds boarding 
 43.20  care beds in a certified boarding care facility if the beds meet 
 43.21  the standards for nursing home licensure, or in a facility that 
 43.22  was granted an exception to the moratorium under section 
 43.23  144A.073, and if the cost of any remodeling of the facility does 
 43.24  not exceed 25 percent of the appraised value of the facility or 
 43.25  $500,000, whichever is less.  If boarding care beds are licensed 
 43.26  as nursing home beds, the number of boarding care beds in the 
 43.27  facility must not increase beyond the number remaining at the 
 43.28  time of the upgrade in licensure.  The provisions contained in 
 43.29  section 144A.073 regarding the upgrading of the facilities do 
 43.30  not apply to facilities that satisfy these requirements; 
 43.31     (f) to license and certify up to 40 beds transferred from 
 43.32  an existing facility owned and operated by the Amherst H. Wilder 
 43.33  Foundation in the city of St. Paul to a new unit at the same 
 43.34  location as the existing facility that will serve persons with 
 43.35  Alzheimer's disease and other related disorders.  The transfer 
 43.36  of beds may occur gradually or in stages, provided the total 
 44.1   number of beds transferred does not exceed 40.  At the time of 
 44.2   licensure and certification of a bed or beds in the new unit, 
 44.3   the commissioner of health shall delicense and decertify the 
 44.4   same number of beds in the existing facility.  As a condition of 
 44.5   receiving a license or certification under this clause, the 
 44.6   facility must make a written commitment to the commissioner of 
 44.7   human services that it will not seek to receive an increase in 
 44.8   its property-related payment rate as a result of the transfers 
 44.9   allowed under this paragraph; 
 44.10     (g) to license and certify nursing home beds to replace 
 44.11  currently licensed and certified boarding care beds which may be 
 44.12  located either in a remodeled or renovated boarding care or 
 44.13  nursing home facility or in a remodeled, renovated, newly 
 44.14  constructed, or replacement nursing home facility within the 
 44.15  identifiable complex of health care facilities in which the 
 44.16  currently licensed boarding care beds are presently located, 
 44.17  provided that the number of boarding care beds in the facility 
 44.18  or complex are decreased by the number to be licensed as nursing 
 44.19  home beds and further provided that, if the total costs of new 
 44.20  construction, replacement, remodeling, or renovation exceed ten 
 44.21  percent of the appraised value of the facility or $200,000, 
 44.22  whichever is less, the facility makes a written commitment to 
 44.23  the commissioner of human services that it will not seek to 
 44.24  receive an increase in its property-related payment rate by 
 44.25  reason of the new construction, replacement, remodeling, or 
 44.26  renovation.  The provisions contained in section 144A.073 
 44.27  regarding the upgrading of facilities do not apply to facilities 
 44.28  that satisfy these requirements; 
 44.29     (h) to license as a nursing home and certify as a nursing 
 44.30  facility a facility that is licensed as a boarding care facility 
 44.31  but not certified under the medical assistance program, but only 
 44.32  if the commissioner of human services certifies to the 
 44.33  commissioner of health that licensing the facility as a nursing 
 44.34  home and certifying the facility as a nursing facility will 
 44.35  result in a net annual savings to the state general fund of 
 44.36  $200,000 or more; 
 45.1      (i) to certify, after September 30, 1992, and prior to July 
 45.2   1, 1993, existing nursing home beds in a facility that was 
 45.3   licensed and in operation prior to January 1, 1992; 
 45.4      (j) to license and certify new nursing home beds to replace 
 45.5   beds in a facility condemned as part of an economic 
 45.6   redevelopment plan in a city of the first class, provided the 
 45.7   new facility is located within one mile of the site of the old 
 45.8   facility.  Operating and property costs for the new facility 
 45.9   must be determined and allowed under existing reimbursement 
 45.10  rules; 
 45.11     (k) to license and certify up to 20 new nursing home beds 
 45.12  in a community-operated hospital and attached convalescent and 
 45.13  nursing care facility with 40 beds on April 21, 1991, that 
 45.14  suspended operation of the hospital in April 1986.  The 
 45.15  commissioner of human services shall provide the facility with 
 45.16  the same per diem property-related payment rate for each 
 45.17  additional licensed and certified bed as it will receive for its 
 45.18  existing 40 beds; 
 45.19     (l) to license or certify beds in renovation, replacement, 
 45.20  or upgrading projects as defined in section 144A.073, 
 45.21  subdivision 1, so long as the cumulative total costs of the 
 45.22  facility's remodeling projects do not exceed 25 percent of the 
 45.23  appraised value of the facility or $500,000, whichever is less; 
 45.24     (m) to license and certify beds that are moved from one 
 45.25  location to another for the purposes of converting up to five 
 45.26  four-bed wards to single or double occupancy rooms in a nursing 
 45.27  home that, as of January 1, 1993, was county-owned and had a 
 45.28  licensed capacity of 115 beds; 
 45.29     (n) to allow a facility that on April 16, 1993, was a 
 45.30  106-bed licensed and certified nursing facility located in 
 45.31  Minneapolis to layaway all of its licensed and certified nursing 
 45.32  home beds.  These beds may be relicensed and recertified in a 
 45.33  newly-constructed teaching nursing home facility affiliated with 
 45.34  a teaching hospital upon approval by the legislature.  The 
 45.35  proposal must be developed in consultation with the interagency 
 45.36  committee on long-term care planning.  The beds on layaway 
 46.1   status shall have the same status as voluntarily delicensed and 
 46.2   decertified beds, except that beds on layaway status remain 
 46.3   subject to the surcharge in section 256.9657.  This layaway 
 46.4   provision expires July 1, 1995; 
 46.5      (o) to allow a project which will be completed in 
 46.6   conjunction with an approved moratorium exception project for a 
 46.7   nursing home in southern Cass county and which is directly 
 46.8   related to that portion of the facility that must be repaired, 
 46.9   renovated, or replaced, to correct an emergency plumbing problem 
 46.10  for which a state correction order has been issued and which 
 46.11  must be corrected by August 31, 1993; 
 46.12     (p) to allow a facility that on April 16, 1993, was a 
 46.13  368-bed licensed and certified nursing facility located in 
 46.14  Minneapolis to layaway, upon 30 days prior written notice to the 
 46.15  commissioner, up to 30 of the facility's licensed and certified 
 46.16  beds by converting three-bed wards to single or double 
 46.17  occupancy.  Beds on layaway status shall have the same status as 
 46.18  voluntarily delicensed and decertified beds except that beds on 
 46.19  layaway status remain subject to the surcharge in section 
 46.20  256.9657, remain subject to the license application and renewal 
 46.21  fees under section 144A.07 and shall be subject to a $100 per 
 46.22  bed reactivation fee.  In addition, at any time within three 
 46.23  years of the effective date of the layaway, the beds on layaway 
 46.24  status may be: 
 46.25     (1) relicensed and recertified upon relocation and 
 46.26  reactivation of some or all of the beds to an existing licensed 
 46.27  and certified facility or facilities located in Pine River, 
 46.28  Brainerd, or International Falls; provided that the total 
 46.29  project construction costs related to the relocation of beds 
 46.30  from layaway status for any facility receiving relocated beds 
 46.31  may not exceed the dollar threshold provided in subdivision 2 
 46.32  unless the construction project has been approved through the 
 46.33  moratorium exception process under section 144A.073; 
 46.34     (2) relicensed and recertified, upon reactivation of some 
 46.35  or all of the beds within the facility which placed the beds in 
 46.36  layaway status, if the commissioner has determined a need for 
 47.1   the reactivation of the beds on layaway status. 
 47.2      The property-related payment rate of a facility placing 
 47.3   beds on layaway status must be adjusted by the incremental 
 47.4   change in its rental per diem after recalculating the rental per 
 47.5   diem as provided in section 256B.431, subdivision 3a, paragraph 
 47.6   (d).  The property-related payment rate for a facility 
 47.7   relicensing and recertifying beds from layaway status must be 
 47.8   adjusted by the incremental change in its rental per diem after 
 47.9   recalculating its rental per diem using the number of beds after 
 47.10  the relicensing to establish the facility's capacity day 
 47.11  divisor, which shall be effective the first day of the month 
 47.12  following the month in which the relicensing and recertification 
 47.13  became effective.  Any beds remaining on layaway status more 
 47.14  than three years after the date the layaway status became 
 47.15  effective must be removed from layaway status and immediately 
 47.16  delicensed and decertified; 
 47.17     (q) to license and certify beds in a renovation and 
 47.18  remodeling project to convert 13 three-bed wards into 13 two-bed 
 47.19  rooms and 13 single-bed rooms, expand space, and add 
 47.20  improvements in a nursing home that, as of January 1, 1994, met 
 47.21  the following conditions:  the nursing home was located in 
 47.22  Ramsey county; was not owned by a hospital corporation; had a 
 47.23  licensed capacity of 64 beds; and had been ranked among the top 
 47.24  15 applicants by the 1993 moratorium exceptions advisory review 
 47.25  panel.  The total project construction cost estimate for this 
 47.26  project must not exceed the cost estimate submitted in 
 47.27  connection with the 1993 moratorium exception process; or 
 47.28     (r) to license and certify beds in a renovation and 
 47.29  remodeling project to convert 12 four-bed wards into 24 two-bed 
 47.30  rooms, expand space, and add improvements in a nursing home 
 47.31  that, as of January 1, 1994, met the following conditions:  the 
 47.32  nursing home was located in Ramsey county; had a licensed 
 47.33  capacity of 154 beds; and had been ranked among the top 15 
 47.34  applicants by the 1993 moratorium exceptions advisory review 
 47.35  panel.  The total project construction cost estimate for this 
 47.36  project must not exceed the cost estimate submitted in 
 48.1   connection with the 1993 moratorium exception process. 
 48.2      Sec. 3.  Minnesota Statutes 1994, section 144A.071, is 
 48.3   amended by adding a subdivision to read: 
 48.4      Subd. 5a.  [COST ESTIMATE OF A MORATORIUM EXCEPTION 
 48.5   PROJECT.] For the purposes of this section and section 144A.073, 
 48.6   the cost estimate of a moratorium exception project shall 
 48.7   include the effects of the proposed project on the costs of the 
 48.8   state subsidy for community-based services, nursing services, 
 48.9   and housing in institutional and noninstitutional settings.  The 
 48.10  commissioner of health, in cooperation with the commissioner of 
 48.11  human services, shall define the method for estimating these 
 48.12  costs in the permanent rule implementing section 144A.073.  The 
 48.13  commissioner of human services shall prepare an estimate of the 
 48.14  total state annual long-term costs of each moratorium exception 
 48.15  proposal. 
 48.16     Sec. 4.  Minnesota Statutes 1994, section 144A.073, 
 48.17  subdivision 1, is amended to read: 
 48.18     Subdivision 1.  [DEFINITIONS.] For purposes of this 
 48.19  section, the following terms have the meanings given them: 
 48.20     (a) "Conversion" means the relocation of a nursing home bed 
 48.21  from a nursing home to an attached hospital. 
 48.22     (b) "Relocation" means the movement of licensed nursing 
 48.23  home beds or certified boarding care beds as permitted under 
 48.24  subdivision 4, clause (3), and subdivision 5. 
 48.25     (c) "Renovation" means extensive remodeling of, or 
 48.26  construction of an addition to, a facility on an existing site 
 48.27  with a total cost exceeding ten percent of the appraised value 
 48.28  of the facility or $200,000, whichever is less. 
 48.29     (c) (d) "Replacement" means the demolition or, delicensure, 
 48.30  reconstruction, or construction of an addition to all or part of 
 48.31  an existing facility. 
 48.32     (d) (e) "Upgrading" means a change in the level of 
 48.33  licensure of a bed from a boarding care bed to a nursing home 
 48.34  bed in a certified boarding care facility. 
 48.35     Sec. 5.  Minnesota Statutes 1994, section 144A.073, 
 48.36  subdivision 2, is amended to read: 
 49.1      Subd. 2.  [REQUEST FOR PROPOSALS.] At the intervals 
 49.2   specified in rules authorization by the legislature of 
 49.3   additional medical assistance expenditures for exceptions to the 
 49.4   moratorium on nursing homes, the interagency committee shall 
 49.5   publish in the State Register a request for proposals for 
 49.6   nursing home projects to be licensed or certified under section 
 49.7   144A.071, subdivision 4a, clause (c).  The public notice of this 
 49.8   funding and the request for proposals must specify how the 
 49.9   approval criteria will be prioritized by the advisory review 
 49.10  panel, the interagency long-term care planning committee, and 
 49.11  the commissioner.  The notice must describe the information that 
 49.12  must accompany a request and state that proposals must be 
 49.13  submitted to the interagency committee within 90 days of the 
 49.14  date of publication.  The notice must include the amount of the 
 49.15  legislative appropriation available for the additional costs to 
 49.16  the medical assistance program of projects approved under this 
 49.17  section.  If no money is appropriated for a year, the notice for 
 49.18  that year must state that proposals will not be requested 
 49.19  because no appropriations were made the interagency committee 
 49.20  shall publish a notice to that effect, and no proposals shall be 
 49.21  requested.  If money is appropriated, the interagency committee 
 49.22  shall initiate the application and review process described in 
 49.23  this section at least twice each biennium and up to four times 
 49.24  each biennium, according to dates established by rule.  
 49.25  Authorized funds shall be allocated proportionally to the number 
 49.26  of processes.  Funds not encumbered by an earlier process within 
 49.27  a biennium shall carry forward to subsequent iterations of the 
 49.28  process.  Authorization for expenditures does not carry forward 
 49.29  into the following biennium.  To be considered for approval, a 
 49.30  proposal must include the following information: 
 49.31     (1) whether the request is for renovation, replacement, 
 49.32  upgrading, or conversion, or relocation; 
 49.33     (2) a description of the problem the project is designed to 
 49.34  address; 
 49.35     (3) a description of the proposed project; 
 49.36     (4) an analysis of projected costs of the nursing facility 
 50.1   proposal, including initial construction and remodeling costs,; 
 50.2   site preparation costs,; financing costs, including the current 
 50.3   estimated long-term financing costs of the proposal, which 
 50.4   consists of the amount and sources of money, reserves if 
 50.5   required under the proposed funding mechanism, annual payments 
 50.6   scheduled, interest rates, length of term, closing costs and 
 50.7   fees, insurance costs, and any completed marketing study or 
 50.8   underwriting review; and estimated operating costs during the 
 50.9   first two years after completion of the project; 
 50.10     (5) for proposals involving replacement of all or part of a 
 50.11  facility, the proposed location of the replacement facility and 
 50.12  an estimate of the cost of addressing the problem through 
 50.13  renovation; 
 50.14     (6) for proposals involving renovation, an estimate of the 
 50.15  cost of addressing the problem through replacement; 
 50.16     (7) the proposed timetable for commencing construction and 
 50.17  completing the project; and 
 50.18     (8) a statement of any licensure or certification issues, 
 50.19  such as certification survey deficiencies; 
 50.20     (9) the proposed alternative disposition of current 
 50.21  residents if beds are to be closed so that the department of 
 50.22  human services can estimate the total costs of a proposal; and 
 50.23     (10) other information required by permanent rule of the 
 50.24  commissioner of health in accordance with subdivisions 4 and 8. 
 50.25     Sec. 6.  Minnesota Statutes 1994, section 144A.073, 
 50.26  subdivision 3, is amended to read: 
 50.27     Subd. 3.  [REVIEW AND APPROVAL OF PROPOSALS.] Within the 
 50.28  limits of money specifically appropriated to the medical 
 50.29  assistance program for this purpose, the interagency long-term 
 50.30  care planning committee may recommend that the commissioner of 
 50.31  health grant exceptions to the nursing home licensure or 
 50.32  certification moratorium for proposals that satisfy the 
 50.33  requirements of this section.  The interagency committee shall 
 50.34  appoint an advisory review panel composed of representatives of 
 50.35  consumers and providers to review proposals and provide comments 
 50.36  and recommendations to the committee.  The commissioners of 
 51.1   human services and health shall provide staff and technical 
 51.2   assistance to the committee for the review and analysis of 
 51.3   proposals.  The interagency committee shall hold a public 
 51.4   hearing before submitting recommendations to the commissioner of 
 51.5   health on project requests.  The committee shall submit 
 51.6   recommendations within 150 days of the date of the publication 
 51.7   of the notice, based on a comparison and ranking of proposals 
 51.8   using the criteria in subdivision 4.  The commissioner of health 
 51.9   shall approve or disapprove a project within 30 days after 
 51.10  receiving the committee's recommendations.  The advisory review 
 51.11  panel, the committee, and the commissioner of health shall base 
 51.12  their recommendations, approvals, or disapprovals on a 
 51.13  comparison and ranking of proposals using only the criteria in 
 51.14  subdivision 4 and in emergency and permanent rules adopted by 
 51.15  the commissioner.  The cost to the medical assistance program of 
 51.16  the proposals approved must be within the limits of the 
 51.17  appropriations specifically made for this purpose.  Approval of 
 51.18  a proposal expires 18 months after approval by the commissioner 
 51.19  of health unless the facility has commenced construction as 
 51.20  defined in section 144A.071, subdivision 1a, paragraph (d).  The 
 51.21  committee's report to the legislature, as required under section 
 51.22  144A.31, must include the projects approved, the criteria used 
 51.23  to recommend proposals for approval, and the estimated costs of 
 51.24  the projects, including the costs of initial construction and 
 51.25  remodeling, and the estimated operating costs during the first 
 51.26  two years after the project is completed. 
 51.27     Sec. 7.  Minnesota Statutes 1994, section 144A.073, is 
 51.28  amended by adding a subdivision to read: 
 51.29     Subd. 3c.  [COST NEUTRAL RELOCATION 
 51.30  PROJECTS.] Notwithstanding subdivision 3, the interagency 
 51.31  committee may at any time accept proposals or amendments to 
 51.32  proposals previously approved under this section for relocations 
 51.33  that are cost neutral with respect to state costs as defined in 
 51.34  section 144A.071, subdivision 5a.  The committee shall review 
 51.35  these applications and make recommendations to the commissioner 
 51.36  within 90 days.  The committee must evaluate proposals according 
 52.1   to subdivision 4, clauses (1), (2), and (3), and other criteria 
 52.2   established in rule.  The commissioner shall approve or 
 52.3   disapprove a project within 30 days of receiving the committee's 
 52.4   recommendation.  Proposals and amendments approved under this 
 52.5   subdivision are not subject to the six-mile limit in subdivision 
 52.6   5, paragraph (e), and an amendment under this section to a 
 52.7   proposal originally approved before April 1, 1995, involving the 
 52.8   replacement of 102 licensed and certified beds may include the 
 52.9   relocation of 50 percent of the beds to each of two other 
 52.10  locations.  A project previously approved under this section 
 52.11  that applies for and is granted an amendment under this 
 52.12  subdivision prior to July 1, 1995, shall have an additional six 
 52.13  months to commence construction beyond the limit established in 
 52.14  subdivision 3b. 
 52.15     Sec. 8.  Minnesota Statutes 1994, section 144A.073, 
 52.16  subdivision 4, is amended to read: 
 52.17     Subd. 4.  [CRITERIA FOR REVIEW.] (a) The following criteria 
 52.18  must shall be used in a consistent manner to compare and, 
 52.19  evaluate, and rank all proposals submitted.  Except for the 
 52.20  criteria specified in clause (3), the application of criteria 
 52.21  listed under this subdivision shall not reflect any distinction 
 52.22  based on the geographic location of the proposed project: 
 52.23     (1) the extent to which the average occupancy rate of the 
 52.24  facility supports the need for the proposed project; 
 52.25     (2) the extent to which the average occupancy rate of all 
 52.26  facilities in the county in which the applicant is located, 
 52.27  together with all contiguous Minnesota counties, supports the 
 52.28  need for the proposed project; 
 52.29     (3) the extent to which the proposal furthers state 
 52.30  long-term care goals, including the goals stated in section 
 52.31  144A.31, and including the goal of enhancing the availability 
 52.32  and use of alternative care services and the goal of reducing 
 52.33  the number of long-term care resident rooms with more than two 
 52.34  beds; 
 52.35     (4) the cost-effectiveness of the proposal, including (2) 
 52.36  the proposal's long-term effects on the state costs of the 
 53.1   medical assistance program, as determined by the commissioner of 
 53.2   human services; and including the cost estimate of the project 
 53.3   according to section 144A.071, subdivision 5a; 
 53.4      (5) other factors developed in rule by the commissioner of 
 53.5   health that evaluate and assess how the proposed project will 
 53.6   further promote or protect the health, safety, comfort, 
 53.7   treatment, or well-being of the facility's residents. 
 53.8      (b) In addition to the criteria in paragraph (a), the 
 53.9   following criteria must be used to evaluate, compare, and rank 
 53.10  proposals involving renovation or replacement: 
 53.11     (3) the extent to which the proposal promotes equitable 
 53.12  access to long-term care services in nursing homes through 
 53.13  redistribution of the nursing home bed supply, as measured by 
 53.14  the number of beds relative to the population 85 or older, 
 53.15  projected to the year 2000 by the state demographer, and 
 53.16  according to items (i) through (iv): 
 53.17     (i) reduce beds in counties where the supply is relatively 
 53.18  high, and increase beds in counties where the supply is 
 53.19  relatively low; 
 53.20     (ii) adjust the bed supply so as to create the greatest 
 53.21  benefits in improving the distribution of beds; 
 53.22     (iii) adjust the existing bed supply (A) in counties in the 
 53.23  seven-county metropolitan area so that the bed supply in the 
 53.24  counties, together with all contiguous Minnesota counties, moves 
 53.25  toward the statewide mean and (B) in other counties so that the 
 53.26  supply in the 50-mile radius surrounding the project under 
 53.27  review moves toward the statewide mean; and 
 53.28     (iv) adjust the existing bed supply so that the 
 53.29  distribution of beds as projected for the year 2020 would be 
 53.30  consistent with projected need; 
 53.31     (1) (4) the extent to which the project improves conditions 
 53.32  that affect the health or safety of residents, such as narrow 
 53.33  corridors, narrow door frames, unenclosed fire exits, and wood 
 53.34  frame construction, and similar provisions contained in fire and 
 53.35  life safety codes and licensure and certification rules; 
 53.36     (2) (5) the extent to which the project improves conditions 
 54.1   that affect the comfort or quality of life of residents in a 
 54.2   facility or the ability of the facility to provide efficient 
 54.3   care, such as a relatively high number of residents in a room; 
 54.4   inadequate lighting or ventilation; poor access to bathing or 
 54.5   toilet facilities; a lack of available ancillary space for 
 54.6   dining rooms, day rooms, or rooms used for other activities; 
 54.7   problems relating to heating, cooling, or energy efficiency; 
 54.8   inefficient location of nursing stations; narrow corridors; or 
 54.9   other provisions contained in the licensure and certification 
 54.10  rules; 
 54.11     (6) the extent to which the applicant demonstrates the 
 54.12  delivery of quality care to residents as evidenced by the two 
 54.13  most recent state agency certification surveys and the 
 54.14  applicants' response to those surveys; 
 54.15     (7) the extent to which the project removes the need for 
 54.16  waivers or variances previously granted by either the licensing 
 54.17  agency, certifying agency, fire marshal, or local government 
 54.18  entity; and 
 54.19     (8) other factors that may be developed in permanent rule 
 54.20  by the commissioner of health that evaluate and assess how the 
 54.21  proposed project will further promote or protect the health, 
 54.22  safety, comfort, treatment, or well-being of the facility's 
 54.23  residents. 
 54.24     Sec. 9.  Minnesota Statutes 1994, section 144A.073, 
 54.25  subdivision 8, is amended to read: 
 54.26     Subd. 8.  [RULEMAKING.] The commissioner of health shall 
 54.27  adopt emergency or permanent rules to implement this 
 54.28  section.  The permanent rules must be in accordance with and 
 54.29  implement only the criteria listed in this section.  The 
 54.30  authority to adopt emergency permanent rules continues until 
 54.31  December 30, 1988 July 1, 1996. 
 54.32     Sec. 10.  Minnesota Statutes 1994, section 256.015, 
 54.33  subdivision 1, is amended to read: 
 54.34     Subdivision 1.  [STATE AGENCY HAS LIEN.] When the state 
 54.35  agency provides, pays for, or becomes liable for medical care or 
 54.36  furnishes subsistence or other payments to a person, the agency 
 55.1   has a lien for the cost of the care and payments on all causes 
 55.2   of action that accrue to the person to whom the care or payments 
 55.3   were furnished, or to the person's legal representatives, as a 
 55.4   result of the occurrence that necessitated the medical care, 
 55.5   subsistence, or other payments.  For purposes of this section, 
 55.6   "state agency" includes authorized agents of the state agency. 
 55.7      Sec. 11.  Minnesota Statutes 1994, section 256.015, 
 55.8   subdivision 2, is amended to read: 
 55.9      Subd. 2.  [PERFECTION; ENFORCEMENT.] The state agency may 
 55.10  perfect and enforce its lien under sections 514.69, 514.70, and 
 55.11  514.71, and must file the verified lien statement with the 
 55.12  appropriate court administrator in the county of financial 
 55.13  responsibility.  The verified lien statement must contain the 
 55.14  following:  the name and address of the person to whom medical 
 55.15  care, subsistence, or other payment was furnished; the date of 
 55.16  injury; the name and address of vendors furnishing medical care; 
 55.17  the dates of the service or payment; the amount claimed to be 
 55.18  due for the care or payment; and to the best of the state 
 55.19  agency's knowledge, the names and addresses of all persons, 
 55.20  firms, or corporations claimed to be liable for damages arising 
 55.21  from the injuries.  
 55.22     This section does not affect the priority of any attorney's 
 55.23  lien.  The state agency is not subject to any limitations period 
 55.24  referred to in section 514.69 or 514.71 and has one year from 
 55.25  the date notice is first received by it under subdivision 4, 
 55.26  paragraph (c), even if the notice is untimely, or one year from 
 55.27  the date medical bills are first paid by the state agency, 
 55.28  whichever is later, to file its verified lien statement.  The 
 55.29  state agency may commence an action to enforce the lien within 
 55.30  one year of (1) the date the notice required by subdivision 4, 
 55.31  paragraph (c), is received, or (2) the date the person's cause 
 55.32  of action is concluded by judgment, award, settlement, or 
 55.33  otherwise, whichever is later. 
 55.34     Sec. 12.  Minnesota Statutes 1994, section 256.9353, 
 55.35  subdivision 8, is amended to read: 
 55.36     Subd. 8.  [LIEN.] When the state agency provides, pays for, 
 56.1   or becomes liable for covered health services, the agency shall 
 56.2   have a lien for the cost of the covered health services upon any 
 56.3   and all causes of action accruing to the enrollee, or to the 
 56.4   enrollee's legal representatives, as a result of the occurrence 
 56.5   that necessitated the payment for the covered health services.  
 56.6   All liens under this section shall be subject to the provisions 
 56.7   of section 256.015.  For purposes of this subdivision, "state 
 56.8   agency" includes authorized agents of the state agency. 
 56.9      Sec. 13.  Minnesota Statutes 1994, section 256.969, 
 56.10  subdivision 10, is amended to read: 
 56.11     Subd. 10.  [SEPARATE BILLING BY CERTIFIED REGISTERED NURSE 
 56.12  ANESTHETISTS.] Hospitals may exclude certified registered nurse 
 56.13  anesthetist costs from the operating payment rate as allowed by 
 56.14  section 256B.0625, subdivision 11.  To be eligible, a hospital 
 56.15  must notify the commissioner in writing by October 1 of the year 
 56.16  preceding the rate year of the request to exclude certified 
 56.17  registered nurse anesthetist costs.  The hospital must agree 
 56.18  that all hospital claims for the cost and charges of certified 
 56.19  registered nurse anesthetist services will not be included as 
 56.20  part of the rates for inpatient services provided during the 
 56.21  rate year.  In this case, the operating payment rate shall be 
 56.22  adjusted to exclude the cost of certified registered nurse 
 56.23  anesthetist services.  Payments made through separate claims for 
 56.24  certified registered nurse anesthetist services shall not be 
 56.25  paid directly through the hospital provider number or indirectly 
 56.26  by the certified registered nurse anesthetist to the hospital or 
 56.27  related organizations. 
 56.28     For admissions occurring on or after July 1, 1991, and 
 56.29  until the expiration date of section 256.9695, subdivision 3, 
 56.30  services of certified registered nurse anesthetists provided on 
 56.31  an inpatient basis may be paid as allowed by section 256B.0625, 
 56.32  subdivision 11, when the hospital's base year did not include 
 56.33  the cost of these services.  To be eligible, a hospital must 
 56.34  notify the commissioner in writing by July 1, 1991, of the 
 56.35  request and must comply with all other requirements of this 
 56.36  subdivision. 
 57.1      Sec. 14.  Minnesota Statutes 1994, section 256.969, 
 57.2   subdivision 16, is amended to read: 
 57.3      Subd. 16.  [INDIAN HEALTH SERVICE FACILITIES.] Indian 
 57.4   health service facilities are exempt from the rate establishment 
 57.5   methods required by this section and shall be reimbursed at 
 57.6   charges as limited to the amount allowed under federal law.  
 57.7   This exemption is not effective for payments under general 
 57.8   assistance medical care. 
 57.9      Sec. 15.  Minnesota Statutes 1994, section 256B.042, 
 57.10  subdivision 2, is amended to read: 
 57.11     Subd. 2.  [LIEN ENFORCEMENT.] The state agency may perfect 
 57.12  and enforce its lien by following the procedures set forth in 
 57.13  sections 514.69, 514.70 and 514.71, and its verified lien 
 57.14  statement shall be filed with the appropriate court 
 57.15  administrator in the county of financial responsibility.  The 
 57.16  verified lien statement shall contain the following:  the name 
 57.17  and address of the person to whom medical care was furnished, 
 57.18  the date of injury, the name and address of the vendor or 
 57.19  vendors furnishing medical care, the dates of the service, the 
 57.20  amount claimed to be due for the care, and, to the best of the 
 57.21  state agency's knowledge, the names and addresses of all 
 57.22  persons, firms, or corporations claimed to be liable for damages 
 57.23  arising from the injuries.  This section shall not affect the 
 57.24  priority of any attorney's lien.  The state agency is not 
 57.25  subject to any limitations period referred to in section 514.69 
 57.26  or 514.71 and has one year from the date notice is first 
 57.27  received by it under subdivision 4, paragraph (c), even if the 
 57.28  notice is untimely, or one year from the date medical bills are 
 57.29  first paid by the state agency, whichever is later, to file its 
 57.30  verified lien statement.  The state agency may commence an 
 57.31  action to enforce the lien within one year of (1) the date the 
 57.32  notice required by subdivision 4, paragraph (c), is received or 
 57.33  (2) the date the recipient's cause of action is concluded by 
 57.34  judgment, award, settlement, or otherwise, whichever is 
 57.35  later.  For purposes of this section, "state agency" includes 
 57.36  authorized agents of the state agency. 
 58.1      Sec. 16.  Minnesota Statutes 1994, section 256B.056, 
 58.2   subdivision 4, is amended to read: 
 58.3      Subd. 4.  [INCOME.] To be eligible for medical assistance, 
 58.4   a person must not have, or anticipate receiving, semiannual 
 58.5   income in excess of 120 percent of the income standards by 
 58.6   family size used in the aid to families with dependent children 
 58.7   program, except that families and children may have an income up 
 58.8   to 133-1/3 percent of the AFDC income standard.  In computing 
 58.9   income to determine eligibility of persons who are not residents 
 58.10  of long-term care facilities, the commissioner shall disregard 
 58.11  increases in income as required by Public Law Numbers 94-566, 
 58.12  section 503; 99-272; and 99-509.  Veterans aid and attendance 
 58.13  benefits are considered income to the recipient. 
 58.14     Sec. 17.  Minnesota Statutes 1994, section 256B.0575, is 
 58.15  amended to read: 
 58.16     256B.0575 [AVAILABILITY OF INCOME FOR INSTITUTIONALIZED 
 58.17  PERSONS.] 
 58.18     When an institutionalized person is determined eligible for 
 58.19  medical assistance, the income that exceeds the deductions in 
 58.20  paragraphs (a) and (b) must be applied to the cost of 
 58.21  institutional care.  
 58.22     (a) The following amounts must be deducted from the 
 58.23  institutionalized person's income in the following order: 
 58.24     (1) the personal needs allowance under section 256B.35 or, 
 58.25  for a veteran who does not have a spouse or child, or a 
 58.26  surviving spouse of a veteran having no child, the amount of an 
 58.27  improved pension received from the veteran's administration not 
 58.28  exceeding $90 per month; 
 58.29     (2) the personal allowance for disabled individuals under 
 58.30  section 256B.36; 
 58.31     (3) if the institutionalized person has a legally appointed 
 58.32  guardian or conservator, five percent of the recipient's gross 
 58.33  monthly income up to $100 as reimbursement for guardianship or 
 58.34  conservatorship services; 
 58.35     (4) a monthly income allowance determined under section 
 58.36  256B.058, subdivision 2, but only to the extent income of the 
 59.1   institutionalized spouse is made available to the community 
 59.2   spouse; 
 59.3      (5) a monthly allowance for children under age 18 which, 
 59.4   together with the net income of the children, would provide 
 59.5   income equal to the medical assistance standard for families and 
 59.6   children according to section 256B.056, subdivision 4, for a 
 59.7   family size that includes only the minor children.  This 
 59.8   deduction applies only if the children do not live with the 
 59.9   community spouse and only if the children resided with the 
 59.10  institutionalized person immediately prior to admission; 
 59.11     (6) a monthly family allowance for other family members, 
 59.12  equal to one-third of the difference between 122 percent of the 
 59.13  federal poverty guidelines and the monthly income for that 
 59.14  family member; 
 59.15     (7) reparations payments made by the Federal Republic of 
 59.16  Germany and reparations payments made by the Netherlands for 
 59.17  victims of Nazi persecution between 1940 and 1945; and 
 59.18     (8) amounts for reasonable expenses incurred for necessary 
 59.19  medical or remedial care for the institutionalized spouse that 
 59.20  are not medical assistance covered expenses and that are not 
 59.21  subject to payment by a third party.  
 59.22     For purposes of clause (6), "other family member" means a 
 59.23  person who resides with the community spouse and who is a minor 
 59.24  or dependent child, dependent parent, or dependent sibling of 
 59.25  either spouse.  "Dependent" means a person who could be claimed 
 59.26  as a dependent for federal income tax purposes under the 
 59.27  Internal Revenue Code. 
 59.28     (b) Income shall be allocated to an institutionalized 
 59.29  person for a period of up to three calendar months, in an amount 
 59.30  equal to the medical assistance standard for a family size of 
 59.31  one if:  
 59.32     (1) a physician certifies that the person is expected to 
 59.33  reside in the long-term care facility for three calendar months 
 59.34  or less; 
 59.35     (2) if the person has expenses of maintaining a residence 
 59.36  in the community; and 
 60.1      (3) if one of the following circumstances apply:  
 60.2      (i) the person was not living together with a spouse or a 
 60.3   family member as defined in paragraph (a) when the person 
 60.4   entered a long-term care facility; or 
 60.5      (ii) the person and the person's spouse become 
 60.6   institutionalized on the same date, in which case the allocation 
 60.7   shall be applied to the income of one of the spouses.  
 60.8   For purposes of this paragraph, a person is determined to be 
 60.9   residing in a licensed nursing home, regional treatment center, 
 60.10  or medical institution if the person is expected to remain for a 
 60.11  period of one full calendar month or more. 
 60.12     Sec. 18.  Minnesota Statutes 1994, section 256B.059, 
 60.13  subdivision 1, is amended to read: 
 60.14     Subdivision 1.  [DEFINITIONS.] (a) For purposes of this 
 60.15  section, the terms defined in this subdivision have the meanings 
 60.16  given them. 
 60.17     (b) "Community spouse" means the spouse of an 
 60.18  institutionalized person spouse. 
 60.19     (c) "Spousal share" means one-half of the total value of 
 60.20  all assets, to the extent that either the institutionalized 
 60.21  spouse or the community spouse had an ownership interest at the 
 60.22  time of institutionalization. 
 60.23     (d) "Assets otherwise available to the community spouse" 
 60.24  means assets individually or jointly owned by the community 
 60.25  spouse, other than assets excluded by subdivision 5, paragraph 
 60.26  (c). 
 60.27     (e) "Community spouse asset allowance" is the value of 
 60.28  assets that can be transferred under subdivision 3. 
 60.29     (f) "Institutionalized spouse" means a person who is: 
 60.30     (1) in a hospital, nursing facility, or intermediate care 
 60.31  facility for persons with mental retardation, or receiving home 
 60.32  and community-based services under section 256B.0915 or 256B.49, 
 60.33  and is expected to remain in the facility or institution or 
 60.34  receive the home and community-based services for at least 30 
 60.35  consecutive days; and 
 60.36     (2) married to a person who is not in a hospital, nursing 
 61.1   facility, or intermediate care facility for persons with mental 
 61.2   retardation, and is not receiving home and community-based 
 61.3   services under section 256B.0915 or 256B.49. 
 61.4      Sec. 19.  Minnesota Statutes 1994, section 256B.059, 
 61.5   subdivision 3, is amended to read: 
 61.6      Subd. 3.  [COMMUNITY SPOUSE ASSET ALLOWANCE.] An 
 61.7   institutionalized spouse may transfer assets to the community 
 61.8   spouse solely for the benefit of the community spouse.  Except 
 61.9   for increased amounts allowable under subdivision 4, the maximum 
 61.10  amount of assets allowed to be transferred is the amount which, 
 61.11  when added to the assets otherwise available to the community 
 61.12  spouse, is as follows:  
 61.13     (1) prior to July 1, 1994, the greater of: 
 61.14     (i) $14,148; 
 61.15     (ii) the lesser of the spousal share or $70,740; or 
 61.16     (iii) the amount required by court order to be paid to the 
 61.17  community spouse; and 
 61.18     (2) for persons who begin whose date of initial 
 61.19  determination of eligibility for medical assistance following 
 61.20  their first continuous period of institutionalization occurs on 
 61.21  or after July 1, 1994, the greater of: 
 61.22     (i) $20,000; 
 61.23     (ii) the lesser of the spousal share or $70,740; or 
 61.24     (iii) the amount required by court order to be paid to the 
 61.25  community spouse. 
 61.26     If the assets available to the community spouse are already 
 61.27  at the limit permissible under this section, or the higher limit 
 61.28  attributable to increases under subdivision 4, no assets may be 
 61.29  transferred from the institutionalized spouse to the community 
 61.30  spouse.  The transfer must be made as soon as practicable after 
 61.31  the date the institutionalized spouse is determined eligible for 
 61.32  medical assistance, or within the amount of time needed for any 
 61.33  court order required for the transfer.  On January 1, 1994, and 
 61.34  every January 1 thereafter, the limits in this subdivision shall 
 61.35  be adjusted by the same percentage change in the consumer price 
 61.36  index for all urban consumers (all items; United States city 
 62.1   average) between the two previous Septembers.  These adjustments 
 62.2   shall also be applied to the limits in subdivision 5. 
 62.3      Sec. 20.  Minnesota Statutes 1994, section 256B.059, 
 62.4   subdivision 5, is amended to read: 
 62.5      Subd. 5.  [ASSET AVAILABILITY.] (a) At the time of 
 62.6   application initial determination of eligibility for medical 
 62.7   assistance benefits following the first continuous period of 
 62.8   institutionalization, assets considered available to the 
 62.9   institutionalized spouse shall be the total value of all assets 
 62.10  in which either spouse has an ownership interest, reduced by the 
 62.11  following: 
 62.12     (1) prior to July 1, 1994, the greater of:  
 62.13     (i) $14,148; 
 62.14     (ii) the lesser of the spousal share or $70,740; or 
 62.15     (iii) the amount required by court order to be paid to the 
 62.16  community spouse; 
 62.17     (2) for persons who begin whose date of initial 
 62.18  determination of eligibility for medical assistance following 
 62.19  their first continuous period of institutionalization occurs on 
 62.20  or after July 1, 1994, the greater of:  
 62.21     (i) $20,000; 
 62.22     (ii) the lesser of the spousal share or $70,740; or 
 62.23     (iii) the amount required by court order to be paid to the 
 62.24  community spouse.  If the community spouse asset allowance has 
 62.25  been increased under subdivision 4, then the assets considered 
 62.26  available to the institutionalized spouse under this subdivision 
 62.27  shall be further reduced by the value of additional amounts 
 62.28  allowed under subdivision 4. 
 62.29     (b) An institutionalized spouse may be found eligible for 
 62.30  medical assistance even though assets in excess of the allowable 
 62.31  amount are found to be available under paragraph (a) if the 
 62.32  assets are owned jointly or individually by the community 
 62.33  spouse, and the institutionalized spouse cannot use those assets 
 62.34  to pay for the cost of care without the consent of the community 
 62.35  spouse, and if:  (i) the institutionalized spouse assigns to the 
 62.36  commissioner the right to support from the community spouse 
 63.1   under section 256B.14, subdivision 3; (ii) the institutionalized 
 63.2   spouse lacks the ability to execute an assignment due to a 
 63.3   physical or mental impairment; or (iii) the denial of 
 63.4   eligibility would cause an imminent threat to the 
 63.5   institutionalized spouse's health and well-being. 
 63.6      (c) After the month in which the institutionalized spouse 
 63.7   is determined eligible for medical assistance, during the 
 63.8   continuous period of institutionalization, no assets of the 
 63.9   community spouse are considered available to the 
 63.10  institutionalized spouse, unless the institutionalized spouse 
 63.11  has been found eligible under clause paragraph (b). 
 63.12     (d) Assets determined to be available to the 
 63.13  institutionalized spouse under this section must be used for the 
 63.14  health care or personal needs of the institutionalized spouse. 
 63.15     (e) For purposes of this section, assets do not include 
 63.16  assets excluded under section 256B.056, without regard to the 
 63.17  limitations on total value in that section the supplemental 
 63.18  security income program. 
 63.19     Sec. 21.  Minnesota Statutes 1994, section 256B.0595, 
 63.20  subdivision 1, is amended to read: 
 63.21     Subdivision 1.  [PROHIBITED TRANSFERS.] (a) For transfers 
 63.22  of assets made on or before August 10, 1993, if a person or the 
 63.23  person's spouse has given away, sold, or disposed of, for less 
 63.24  than fair market value, any asset or interest therein, except 
 63.25  assets other than the homestead that are excluded under section 
 63.26  256B.056, subdivision 3 the supplemental security program, 
 63.27  within 30 months before or any time after the date of 
 63.28  institutionalization if the person has been determined eligible 
 63.29  for medical assistance, or within 30 months before or any time 
 63.30  after the date of the first approved application for medical 
 63.31  assistance if the person has not yet been determined eligible 
 63.32  for medical assistance, the person is ineligible for long-term 
 63.33  care services for the period of time determined under 
 63.34  subdivision 2.  
 63.35     (b) Effective for transfers made on or after July 1, 1993, 
 63.36  or upon federal approval, whichever is later August 10, 1993, a 
 64.1   person, a person's spouse, or a person's authorized 
 64.2   representative any person, court, or administrative body with 
 64.3   legal authority to act in place of, on behalf of, at the 
 64.4   direction of, or upon the request of the person or person's 
 64.5   spouse, may not give away, sell, or dispose of, for less than 
 64.6   fair market value, any asset or interest therein, except assets 
 64.7   other than the homestead that are excluded under the 
 64.8   supplemental security income program, for the purpose of 
 64.9   establishing or maintaining medical assistance eligibility.  For 
 64.10  purposes of determining eligibility for medical assistance 
 64.11  long-term care services, any transfer of an asset such assets 
 64.12  within 60 36 months preceding application before or any time 
 64.13  after an institutionalized person applies for medical assistance 
 64.14  or during the period of medical assistance eligibility, 
 64.15  including assets excluded under section 256B.056, subdivision 3, 
 64.16  or 36 months before or any time after a medical assistance 
 64.17  recipient becomes institutionalized, for less than fair market 
 64.18  value may be considered.  Any such transfer for less than fair 
 64.19  market value made within 60 months preceding application for 
 64.20  medical assistance or during the period of medical assistance 
 64.21  eligibility is presumed to have been made for the purpose of 
 64.22  establishing or maintaining medical assistance eligibility and 
 64.23  the person is ineligible for medical assistance long-term care 
 64.24  services for the period of time determined under subdivision 2, 
 64.25  unless the person furnishes convincing evidence to establish 
 64.26  that the transaction was exclusively for another purpose, or 
 64.27  unless the transfer is permitted under subdivisions subdivision 
 64.28  3 or 4.  Notwithstanding the provisions of this paragraph, in 
 64.29  the case of payments from a trust or portions of a trust that 
 64.30  are considered transfers of assets under federal law, any 
 64.31  transfers made within 60 months before or any time after an 
 64.32  institutionalized person applies for medical assistance and 
 64.33  within 60 months before or any time after a medical assistance 
 64.34  recipient becomes institutionalized, may be considered. 
 64.35     (c) This section applies to transfers, for less than fair 
 64.36  market value, of income or assets, including assets that are 
 65.1   considered income in the month received, such as inheritances, 
 65.2   court settlements, and retroactive benefit payments or income to 
 65.3   which the person or the person's spouse is entitled but does not 
 65.4   receive due to action by the person, the person's spouse, or any 
 65.5   person, court, or administrative body with legal authority to 
 65.6   act in place of, on behalf of, at the direction of, or upon the 
 65.7   request of the person or the person's spouse.  
 65.8      (d) This section applies to payments for care or personal 
 65.9   services provided by a relative, unless the compensation was 
 65.10  stipulated in a notarized, written agreement which was in 
 65.11  existence when the service was performed, the care or services 
 65.12  directly benefited the person, and the payments made represented 
 65.13  reasonable compensation for the care or services provided.  A 
 65.14  notarized written agreement is not required if payment for the 
 65.15  services was made within 60 days after the service was provided. 
 65.16     (e) This section applies to the portion of any asset or 
 65.17  interest that a person or, a person's spouse transfers, or any 
 65.18  person, court, or administrative body with legal authority to 
 65.19  act in place of, on behalf of, at the direction of, or upon the 
 65.20  request of the person or the person's spouse, to an 
 65.21  irrevocable any trust, annuity, or other instrument, that 
 65.22  exceeds the value of the benefit likely to be returned to the 
 65.23  person or spouse while alive, based on estimated life expectancy 
 65.24  using the life expectancy tables employed by the supplemental 
 65.25  security income program to determine the value of an agreement 
 65.26  for services for life.  The commissioner may adopt rules 
 65.27  reducing life expectancies based on the need for long-term care. 
 65.28     (f) For purposes of this section, long-term care services 
 65.29  include services in a nursing facility, services that are 
 65.30  eligible for payment according to section 256B.0625, subdivision 
 65.31  2, because they are provided in a swing bed, intermediate care 
 65.32  facility for persons with mental retardation, and home and 
 65.33  community-based services provided pursuant to section 256B.491 
 65.34  sections 256B.0915, 256B.092, and 256B.49.  For purposes of this 
 65.35  subdivision and subdivisions 2, 3, and 4, "institutionalized 
 65.36  person" includes a person who is an inpatient in a nursing 
 66.1   facility, or in a swing bed, or intermediate care facility for 
 66.2   persons with mental retardation or who is receiving home and 
 66.3   community-based services under section 256B.491 sections 
 66.4   256B.0915, 256B.092, and 256B.49. 
 66.5      Sec. 22.  Minnesota Statutes 1994, section 256B.0595, 
 66.6   subdivision 2, is amended to read: 
 66.7      Subd. 2.  [PERIOD OF INELIGIBILITY.] (a) For any 
 66.8   uncompensated transfer occurring on or before August 10, 1993, 
 66.9   the number of months of ineligibility for long-term care 
 66.10  services shall be the lesser of 30 months, or the uncompensated 
 66.11  transfer amount divided by the average medical assistance rate 
 66.12  for nursing facility services in the state in effect on the date 
 66.13  of application.  The amount used to calculate the average 
 66.14  medical assistance payment rate shall be adjusted each July 1 to 
 66.15  reflect payment rates for the previous calendar year.  The 
 66.16  period of ineligibility begins with the month in which the 
 66.17  assets were transferred.  If the transfer was not reported to 
 66.18  the local agency at the time of application, and the applicant 
 66.19  received long-term care services during what would have been the 
 66.20  period of ineligibility if the transfer had been reported, a 
 66.21  cause of action exists against the transferee for the cost of 
 66.22  long-term care services provided during the period of 
 66.23  ineligibility, or for the uncompensated amount of the transfer, 
 66.24  whichever is less.  The action may be brought by the state or 
 66.25  the local agency responsible for providing medical assistance 
 66.26  under chapter 256G.  The uncompensated transfer amount is the 
 66.27  fair market value of the asset at the time it was given away, 
 66.28  sold, or disposed of, less the amount of compensation received.  
 66.29     (b) For uncompensated transfers made on or after July 1, 
 66.30  August 10, 1993, or upon federal approval, whichever is later, 
 66.31  the number of months of ineligibility, including partial months, 
 66.32  for medical assistance long-term care services shall be the 
 66.33  total uncompensated value of the resources transferred divided 
 66.34  by the average medical assistance rate for nursing facility 
 66.35  services in the state in effect on the date of application.  If 
 66.36  a calculation of a penalty period results in a partial month, 
 67.1   payments for medical assistance services will be reduced in an 
 67.2   amount equal to the fraction, except that in calculating the 
 67.3   value of uncompensated transfers, uncompensated transfers not to 
 67.4   exceed $1,000 in total value per month shall be disregarded for 
 67.5   each month prior to the month of application for medical 
 67.6   assistance.  The amount used to calculate the average medical 
 67.7   assistance payment rate shall be adjusted each July 1 to reflect 
 67.8   payment rates for the previous calendar year.  The period of 
 67.9   ineligibility begins with the month in which the assets were 
 67.10  transferred except that if one or more uncompensated transfers 
 67.11  are made during a period of ineligibility, the total assets 
 67.12  transferred during the ineligibility period shall be combined 
 67.13  and a penalty period calculated to begin in the month the first 
 67.14  uncompensated transfer was made.  The penalty in this paragraph 
 67.15  shall not apply to uncompensated transfers of assets not to 
 67.16  exceed a total of $1,000 per month during a medical assistance 
 67.17  eligibility certification period.  If the transfer was not 
 67.18  reported to the local agency at the time of application, and the 
 67.19  applicant received medical assistance services during what would 
 67.20  have been the period of ineligibility if the transfer had been 
 67.21  reported, a cause of action exists against the transferee for 
 67.22  the cost of medical assistance services provided during the 
 67.23  period of ineligibility, or for the uncompensated amount of the 
 67.24  transfer, whichever is less.  The action may be brought by the 
 67.25  state or the local agency responsible for providing medical 
 67.26  assistance under chapter 256G.  The uncompensated transfer 
 67.27  amount is the fair market value of the asset at the time it was 
 67.28  given away, sold, or disposed of, less the amount of 
 67.29  compensation received.  
 67.30     (c) If the total value of all uncompensated transfers made 
 67.31  in a month exceeds $1,000, the disregards allowed under 
 67.32  paragraph (b) do not apply.  If a calculation of a penalty 
 67.33  period results in a partial month, payments for long-term care 
 67.34  services shall be reduced in an amount equal to the fraction, 
 67.35  except that in calculating the value of uncompensated transfers, 
 67.36  if the total value of all uncompensated transfers made in a 
 68.1   month does not exceed $1,000, then such transfers shall be 
 68.2   disregarded for each month prior to the month of application for 
 68.3   or during receipt of medical assistance. 
 68.4      Sec. 23.  Minnesota Statutes 1994, section 256B.0595, 
 68.5   subdivision 3, is amended to read: 
 68.6      Subd. 3.  [HOMESTEAD EXCEPTION TO TRANSFER PROHIBITION.] 
 68.7   (a) An institutionalized person is not ineligible for long-term 
 68.8   care services due to a transfer of assets for less than fair 
 68.9   market value if the asset transferred was a homestead and: 
 68.10     (1) title to the homestead was transferred to the 
 68.11  individual's 
 68.12     (i) spouse; 
 68.13     (ii) child who is under age 21; 
 68.14     (iii) blind or permanently and totally disabled child as 
 68.15  defined in the supplemental security income program; 
 68.16     (iv) sibling who has equity interest in the home and who 
 68.17  was residing in the home for a period of at least one year 
 68.18  immediately before the date of the individual's admission to the 
 68.19  facility; or 
 68.20     (v) son or daughter who was residing in the individual's 
 68.21  home for a period of at least two years immediately before the 
 68.22  date of the individual's admission to the facility, and who 
 68.23  provided care to the individual that permitted the individual to 
 68.24  reside at home rather than in an institution or facility; 
 68.25     (2) a satisfactory showing is made that the individual 
 68.26  intended to dispose of the homestead at fair market value or for 
 68.27  other valuable consideration; or 
 68.28     (3) the local agency grants a waiver of the excess 
 68.29  resources created by the uncompensated transfer because denial 
 68.30  of eligibility would cause undue hardship for the individual, 
 68.31  based on imminent threat to the individual's health and 
 68.32  well-being.  
 68.33     (b) When a waiver is granted under paragraph (a), clause 
 68.34  (3), a cause of action exists against the person to whom the 
 68.35  homestead was transferred for that portion of long-term care 
 68.36  services granted within: 
 69.1      (1) 30 months of the a transfer made on or before August 
 69.2   10, 1993; 
 69.3      (2) 60 months if the homestead was transferred after August 
 69.4   10, 1993, to a trust or portion of a trust that is considered a 
 69.5   transfer of assets under federal law; or 
 69.6      (3) 36 months if transferred in any other manner after 
 69.7   August 10, 1993, 
 69.8   or the amount of the uncompensated transfer, whichever is less, 
 69.9   together with the costs incurred due to the action.  The action 
 69.10  may be brought by the state or the local agency responsible for 
 69.11  providing medical assistance under chapter 256G.  
 69.12     (c) Effective for transfers made on or after July 1, 1993, 
 69.13  or upon federal approval, whichever is later, an 
 69.14  institutionalized person is not ineligible for medical 
 69.15  assistance services due to a transfer of assets for less than 
 69.16  fair market value if the asset transferred was a homestead and: 
 69.17     (1) title to the homestead was transferred to the 
 69.18  individual's 
 69.19     (i) spouse; 
 69.20     (ii) child who is under age 21; 
 69.21     (iii) blind or permanently and totally disabled child as 
 69.22  defined in the supplemental security income program; 
 69.23     (iv) sibling who has equity interest in the home and who 
 69.24  was residing in the home for a period of at least one year 
 69.25  immediately before the date of the individual's admission to the 
 69.26  facility; or 
 69.27     (v) son or daughter who was residing in the individual's 
 69.28  home for a period of at least two years immediately before the 
 69.29  date of the individual's admission to the facility, and who 
 69.30  provided care to the individual that permitted the individual to 
 69.31  reside at home rather than in an institution or facility; 
 69.32     (2) a satisfactory showing is made that the individual 
 69.33  intended to dispose of the homestead at fair market value or for 
 69.34  other valuable consideration; or 
 69.35     (3) the local agency grants a waiver of the excess 
 69.36  resources created by the uncompensated transfer because denial 
 70.1   of eligibility would cause undue hardship for the individual, 
 70.2   based on imminent threat to the individual's health and 
 70.3   well-being.  
 70.4      (d) When a waiver is granted under paragraph (c), clause 
 70.5   (3), a cause of action exists against the person to whom the 
 70.6   homestead was transferred for that portion of medical assistance 
 70.7   services granted during the period of ineligibility under 
 70.8   subdivision 2, or the amount of the uncompensated transfer, 
 70.9   whichever is less, together with the costs incurred due to the 
 70.10  action.  The action may be brought by the state or the local 
 70.11  agency responsible for providing medical assistance under 
 70.12  chapter 256G.  
 70.13     Sec. 24.  Minnesota Statutes 1994, section 256B.0595, 
 70.14  subdivision 4, is amended to read: 
 70.15     Subd. 4.  [OTHER EXCEPTIONS TO TRANSFER PROHIBITION.] (a) 
 70.16  An institutionalized person who has made, or whose spouse has 
 70.17  made a transfer prohibited by subdivision 1, is not ineligible 
 70.18  for long-term care services if one of the following conditions 
 70.19  applies: 
 70.20     (1) the assets were transferred to the community 
 70.21  individual's spouse, as defined in section 256B.059 or to 
 70.22  another for the sole benefit of the spouse; or 
 70.23     (2) the institutionalized spouse, prior to being 
 70.24  institutionalized, transferred assets to a spouse, provided that 
 70.25  the spouse to whom the assets were transferred does not then 
 70.26  transfer those assets to another person for less than fair 
 70.27  market value.  (At the time when one spouse is 
 70.28  institutionalized, assets must be allocated between the spouses 
 70.29  as provided under section 256B.059); or 
 70.30     (3) the assets were transferred to the individual's child 
 70.31  who is blind or permanently and totally disabled as determined 
 70.32  in the supplemental security income program; or 
 70.33     (4) a satisfactory showing is made that the individual 
 70.34  intended to dispose of the assets either at fair market value or 
 70.35  for other valuable consideration; or 
 70.36     (5) the local agency determines that denial of eligibility 
 71.1   for long-term care services would work an undue hardship and 
 71.2   grants a waiver of excess assets.  When a waiver is granted, a 
 71.3   cause of action exists against the person to whom the assets 
 71.4   were transferred for that portion of long-term care services 
 71.5   granted within 30 months of the transfer, or the amount of the 
 71.6   uncompensated transfer, whichever is less, together with the 
 71.7   costs incurred due to the action.  The action may be brought by 
 71.8   the state or the local agency responsible for providing medical 
 71.9   assistance under this chapter.; or 
 71.10     (6) for transfers occurring after August 10, 1993, the 
 71.11  assets were transferred by the person or person's spouse:  (i) 
 71.12  into a trust established solely for the benefit of a son or 
 71.13  daughter of any age who is blind or disabled as defined by the 
 71.14  Supplemental Security Income program; or (ii) into a trust 
 71.15  established solely for the benefit of an individual who is under 
 71.16  65 years of age who is disabled as defined by the Supplemental 
 71.17  Security Income program. 
 71.18     (b) Effective for transfers made on or after July 1, 1993, 
 71.19  or upon federal approval, whichever is later, an 
 71.20  institutionalized person who has made, or whose spouse has made 
 71.21  a transfer prohibited by subdivision 1, is not ineligible for 
 71.22  medical assistance services if one of the following conditions 
 71.23  applies: 
 71.24     (1) the assets were transferred to the community spouse, as 
 71.25  defined in section 256B.059; or 
 71.26     (2) the institutionalized spouse, prior to being 
 71.27  institutionalized, transferred assets to a spouse, provided that 
 71.28  the spouse to whom the assets were transferred does not then 
 71.29  transfer those assets to another person for less than fair 
 71.30  market value.  (At the time when one spouse is 
 71.31  institutionalized, assets must be allocated between the spouses 
 71.32  as provided under section 256B.059); or 
 71.33     (3) the assets were transferred to the individual's child 
 71.34  who is blind or permanently and totally disabled as determined 
 71.35  in the supplemental security income program; or 
 71.36     (4) a satisfactory showing is made that the individual 
 72.1   intended to dispose of the assets either at fair market value or 
 72.2   for other valuable consideration; or 
 72.3      (5) the local agency determines that denial of eligibility 
 72.4   for medical assistance services would work an undue hardship and 
 72.5   grants a waiver of excess assets.  When a waiver is granted, a 
 72.6   cause of action exists against the person to whom the assets 
 72.7   were transferred for that portion of medical assistance services 
 72.8   granted during the period of ineligibility determined under 
 72.9   subdivision 2 or the amount of the uncompensated transfer, 
 72.10  whichever is less, together with the costs incurred due to the 
 72.11  action.  The action may be brought by the state or the local 
 72.12  agency responsible for providing medical assistance under this 
 72.13  chapter. 
 72.14     Sec. 25.  Minnesota Statutes 1994, section 256B.06, 
 72.15  subdivision 4, is amended to read: 
 72.16     Subd. 4.  [CITIZENSHIP REQUIREMENTS.] Eligibility for 
 72.17  medical assistance is limited to citizens of the United States 
 72.18  and aliens lawfully admitted for permanent residence or 
 72.19  otherwise permanently residing in the United States under the 
 72.20  color of law.  Aliens who are seeking legalization under the 
 72.21  Immigration Reform and Control Act of 1986, Public Law Number 
 72.22  99-603, who are under age 18, over age 65, blind, disabled, or 
 72.23  Cuban or Haitian, and who meet the eligibility requirements of 
 72.24  medical assistance under subdivision 1 and sections 256B.055 to 
 72.25  256B.062 are eligible to receive medical assistance.  Pregnant 
 72.26  women who are aliens seeking legalization under the Immigration 
 72.27  Reform and Control Act of 1986, Public Law Number 99-603, and 
 72.28  who meet the eligibility requirements of medical assistance 
 72.29  under subdivision 1 are eligible for payment of care and 
 72.30  services through the period of pregnancy and six weeks 
 72.31  postpartum.  Payment shall also be made for care and services 
 72.32  that are furnished to an alien, regardless of immigration 
 72.33  status, who otherwise meets the eligibility requirements of this 
 72.34  section if such care and services are necessary for the 
 72.35  treatment of an emergency medical condition, except for organ 
 72.36  transplants and related care and services.  For purposes of this 
 73.1   subdivision, the term "emergency medical condition" means a 
 73.2   medical condition, including labor and delivery, that if not 
 73.3   immediately treated could cause a person physical or mental 
 73.4   disability, continuation of severe pain, or death. 
 73.5      Sec. 26.  Minnesota Statutes 1994, section 256B.0625, 
 73.6   subdivision 5, is amended to read: 
 73.7      Subd. 5.  [COMMUNITY MENTAL HEALTH CENTER SERVICES.] 
 73.8   Medical assistance covers community mental health center 
 73.9   services, as defined in rules adopted by the commissioner 
 73.10  pursuant to section 256B.04, subdivision 2, and provided by a 
 73.11  community mental health center as defined in section 245.62, 
 73.12  subdivision 2 that meets the requirements in paragraphs (a) to 
 73.13  (j). 
 73.14     (a) The provider is licensed under Minnesota Rules, parts 
 73.15  9520.0750 to 9520.0870.  
 73.16     (b) The provider provides mental health services under the 
 73.17  clinical supervision of a mental health professional who is 
 73.18  licensed for independent practice at the doctoral level or by a 
 73.19  board-certified psychiatrist or a psychiatrist who is eligible 
 73.20  for board certification.  Clinical supervision has the meaning 
 73.21  given in Minnesota Rules, part 9505.0323, subpart 1, item F.  
 73.22     (c) The provider must be a private nonprofit corporation or 
 73.23  a governmental agency and have a community board of directors as 
 73.24  specified by section 245.66.  
 73.25     (d) The provider must have a sliding fee scale that meets 
 73.26  the requirements in Minnesota Rules, part 9550.0060, and agree 
 73.27  to serve within the limits of its capacity, all individuals 
 73.28  residing in its service delivery area.  
 73.29     (e) At a minimum, the provider must provide the following 
 73.30  outpatient mental health services:  diagnostic assessment; 
 73.31  explanation of findings; family, group, and individual 
 73.32  psychotherapy, including crisis intervention psychotherapy 
 73.33  services, multiple family group psychotherapy, psychological 
 73.34  testing, and medication management.  In addition, the provider 
 73.35  must provide or be capable of providing upon request of the 
 73.36  local mental health authority day treatment services and 
 74.1   professional home-based mental health services.  The provider 
 74.2   must have the capacity to provide such services to specialized 
 74.3   populations such as the elderly, families with children, persons 
 74.4   who are seriously and persistently mentally ill, and children 
 74.5   who are seriously emotionally disturbed.  
 74.6      (f) The provider must be capable of providing the services 
 74.7   specified in paragraph (e) to individuals who are diagnosed with 
 74.8   both mental illness or emotional disturbance, and chemical 
 74.9   dependency, and to individuals dually diagnosed with a mental 
 74.10  illness or emotional disturbance and mental retardation or a 
 74.11  related condition.  
 74.12     (g) The provider must provide 24-hour emergency care 
 74.13  services or demonstrate the capacity to assist recipients in 
 74.14  need of such services to access such services on a 24-hour basis.
 74.15     (h) The provider must have a contract with the local mental 
 74.16  health authority to provide one or more of the services 
 74.17  specified in paragraph (e).  
 74.18     (i) The provider must agree, upon request of the local 
 74.19  mental health authority, to enter into a contract with the 
 74.20  county to provide mental health services not reimbursable under 
 74.21  the medical assistance program.  
 74.22     (j) The provider may not be enrolled with the medical 
 74.23  assistance program as both a hospital and a community mental 
 74.24  health center.  The community mental health center's 
 74.25  administrative, organizational, and financial structure must be 
 74.26  separate and distinct from that of the hospital. 
 74.27     Sec. 27.  Minnesota Statutes 1994, section 256B.0625, 
 74.28  subdivision 13a, is amended to read: 
 74.29     Subd. 13a.  [DRUG UTILIZATION REVIEW BOARD.] A 
 74.30  12-member nine-member drug utilization review board is 
 74.31  established.  The board is comprised of six at least three but 
 74.32  no more than four licensed physicians actively engaged in the 
 74.33  practice of medicine in Minnesota; five at least three licensed 
 74.34  pharmacists actively engaged in the practice of pharmacy in 
 74.35  Minnesota; and one consumer representative; the remainder to be 
 74.36  made up of health care professionals who are licensed in their 
 75.1   field and have recognized knowledge in the clinically 
 75.2   appropriate prescribing, dispensing, and monitoring of covered 
 75.3   outpatient drugs.  The board shall be staffed by an employee of 
 75.4   the department who shall serve as an ex officio nonvoting member 
 75.5   of the board.  The members of the board shall be appointed by 
 75.6   the commissioner and shall serve three-year terms.  
 75.7   The physician members shall be selected from lists submitted by 
 75.8   professional medical associations.  The pharmacist members shall 
 75.9   be selected from lists submitted by professional pharmacist 
 75.10  associations.  The commissioner shall appoint the initial 
 75.11  members of the board for terms expiring as follows:  four three 
 75.12  members for terms expiring June 30, 1995 1996; four three 
 75.13  members for terms expiring June 30, 1994 1997; and four three 
 75.14  members for terms expiring June 30, 1993 1998.  Members may be 
 75.15  reappointed once.  The board shall annually elect a chair from 
 75.16  among the members. 
 75.17     The commissioner shall, with the advice of the board: 
 75.18     (1) implement a medical assistance retrospective and 
 75.19  prospective drug utilization review program as required by 
 75.20  United States Code, title 42, section 1396r-8(g)(3); 
 75.21     (2) develop and implement the predetermined criteria and 
 75.22  practice parameters for appropriate prescribing to be used in 
 75.23  retrospective and prospective drug utilization review; 
 75.24     (3) develop, select, implement, and assess interventions 
 75.25  for physicians, pharmacists, and patients that are educational 
 75.26  and not punitive in nature; 
 75.27     (4) establish a grievance and appeals process for 
 75.28  physicians and pharmacists under this section; 
 75.29     (5) publish and disseminate educational information to 
 75.30  physicians and pharmacists regarding the board and the review 
 75.31  program; 
 75.32     (6) adopt and implement procedures designed to ensure the 
 75.33  confidentiality of any information collected, stored, retrieved, 
 75.34  assessed, or analyzed by the board, staff to the board, or 
 75.35  contractors to the review program that identifies individual 
 75.36  physicians, pharmacists, or recipients; 
 76.1      (7) establish and implement an ongoing process to (i) 
 76.2   receive public comment regarding drug utilization review 
 76.3   criteria and standards, and (ii) consider the comments along 
 76.4   with other scientific and clinical information in order to 
 76.5   revise criteria and standards on a timely basis; and 
 76.6      (8) adopt any rules necessary to carry out this section. 
 76.7      The board may establish advisory committees.  The 
 76.8   commissioner may contract with appropriate organizations to 
 76.9   assist the board in carrying out the board's duties.  The 
 76.10  commissioner may enter into contracts for services to develop 
 76.11  and implement a retrospective and prospective review program. 
 76.12     The board shall report to the commissioner annually on 
 76.13  December 1 the date the Drug Utilization Review Annual Report is 
 76.14  due to the Health Care Financing Administration.  This report is 
 76.15  to cover the preceding federal fiscal year.  The commissioner 
 76.16  shall make the report available to the public upon request.  The 
 76.17  report must include information on the activities of the board 
 76.18  and the program; the effectiveness of implemented interventions; 
 76.19  administrative costs; and any fiscal impact resulting from the 
 76.20  program.  An honorarium of $50 per meeting shall be paid to each 
 76.21  board member in attendance.  
 76.22     Sec. 28.  Minnesota Statutes 1994, section 256B.0625, 
 76.23  subdivision 18, is amended to read: 
 76.24     Subd. 18.  [BUS OR TAXICAB TRANSPORTATION.] To the extent 
 76.25  authorized by rule of the state agency, medical assistance 
 76.26  covers costs of bus or taxicab the most appropriate and 
 76.27  cost-effective form of transportation incurred by any ambulatory 
 76.28  eligible person for obtaining nonemergency medical care. 
 76.29     Sec. 29.  Minnesota Statutes 1994, section 256B.0628, 
 76.30  subdivision 2, is amended to read: 
 76.31     Subd. 2.  [DUTIES.] (a) The commissioner may contract with 
 76.32  or employ qualified registered nurses and necessary support 
 76.33  staff, or contract with qualified agencies, to provide home care 
 76.34  prior authorization and review services for medical assistance 
 76.35  recipients who are receiving home care services. 
 76.36     (b) Reimbursement for the prior authorization function 
 77.1   shall be made through the medical assistance administrative 
 77.2   authority.  The state shall pay the nonfederal share.  The 
 77.3   functions will be to: 
 77.4      (1) assess the recipient's individual need for services 
 77.5   required to be cared for safely in the community; 
 77.6      (2) ensure that a care plan that meets the recipient's 
 77.7   needs is developed by the appropriate agency or individual; 
 77.8      (3) ensure cost-effectiveness of medical assistance home 
 77.9   care services; 
 77.10     (4) recommend the approval or denial of the use of medical 
 77.11  assistance funds to pay for home care services when home care 
 77.12  services exceed thresholds established by the commissioner under 
 77.13  Minnesota Rules, parts 9505.0170 to 9505.0475; 
 77.14     (5) reassess the recipient's need for and level of home 
 77.15  care services at a frequency determined by the commissioner; and 
 77.16     (6) conduct on-site assessments when determined necessary 
 77.17  by the commissioner and recommend changes to care plans that 
 77.18  will provide more efficient and appropriate home care. 
 77.19     (c) In addition, the commissioner or the commissioner's 
 77.20  designee may: 
 77.21     (1) review care plans and reimbursement data for 
 77.22  utilization of services that exceed community-based standards 
 77.23  for home care, inappropriate home care services, medical 
 77.24  necessity, home care services that do not meet quality of care 
 77.25  standards, or unauthorized services and make appropriate 
 77.26  referrals within the department or to other appropriate entities 
 77.27  based on the findings; 
 77.28     (2) assist the recipient in obtaining services necessary to 
 77.29  allow the recipient to remain safely in or return to the 
 77.30  community; 
 77.31     (3) coordinate home care services with other medical 
 77.32  assistance services under section 256B.0625; 
 77.33     (4) assist the recipient with problems related to the 
 77.34  provision of home care services; and 
 77.35     (5) assure the quality of home care services. 
 77.36     (d) For the purposes of this section, "home care services"  
 78.1   means medical assistance services defined under section 
 78.2   256B.0625, subdivisions 6a, 7, and 19a. 
 78.3      Sec. 30.  Minnesota Statutes 1994, section 256B.0911, 
 78.4   subdivision 2, is amended to read: 
 78.5      Subd. 2.  [PERSONS REQUIRED TO BE SCREENED; EXEMPTIONS.] 
 78.6   All applicants to Medicaid certified nursing facilities must be 
 78.7   screened prior to admission, regardless of income, assets, or 
 78.8   funding sources, except the following: 
 78.9      (1) patients who, having entered acute care facilities from 
 78.10  certified nursing facilities, are returning to a certified 
 78.11  nursing facility; 
 78.12     (2) residents transferred from other certified nursing 
 78.13  facilities located within the state of Minnesota; 
 78.14     (3) individuals who have a contractual right to have their 
 78.15  nursing facility care paid for indefinitely by the veteran's 
 78.16  administration; or 
 78.17     (4) individuals who are enrolled in the Ebenezer/Group 
 78.18  Health social health maintenance organization project, or 
 78.19  enrolled in a demonstration project under section 256B.69, 
 78.20  subdivision 18, at the time of application to a nursing home; or 
 78.21     (5) individuals previously screened and currently being 
 78.22  served under the alternative care program or under a home- and 
 78.23  community-based services waiver authorized under section 1915(c) 
 78.24  of the Social Security Act. 
 78.25     Regardless of the exemptions in clauses (2) to (4), persons 
 78.26  who have a diagnosis or possible diagnosis of mental illness, 
 78.27  mental retardation, or a related condition must be screened 
 78.28  before admission unless the admission prior to screening is 
 78.29  authorized by the local mental health authority or the local 
 78.30  developmental disabilities case manager, or unless authorized by 
 78.31  the county agency according to Public Law Number 101-508. 
 78.32     Before admission to a Medicaid certified nursing home or 
 78.33  boarding care home, all persons must be screened and approved 
 78.34  for admission through an assessment process.  The nursing 
 78.35  facility is authorized to conduct case mix assessments which are 
 78.36  not conducted by the county public health nurse under Minnesota 
 79.1   Rules, part 9549.0059.  The designated county agency is 
 79.2   responsible for distributing the quality assurance and review 
 79.3   form for all new applicants to nursing homes. 
 79.4      Other persons who are not applicants to nursing facilities 
 79.5   must be screened if a request is made for a screening. 
 79.6      Sec. 31.  Minnesota Statutes 1994, section 256B.0911, 
 79.7   subdivision 2a, is amended to read: 
 79.8      Subd. 2a.  [SCREENING REQUIREMENTS.] Persons may be 
 79.9   screened by telephone or in a face-to-face consultation.  The 
 79.10  screener will identify each individual's needs according to the 
 79.11  following categories:  (1) needs no face-to-face screening; (2) 
 79.12  needs an immediate face-to-face screening interview; or (3) 
 79.13  needs a face-to-face screening interview after admission to a 
 79.14  certified nursing facility or after a return home.  The screener 
 79.15  shall confer with the screening team to assure that the health 
 79.16  and social needs of the individual are assessed.  Persons who 
 79.17  are not admitted to a Medicaid certified nursing facility must 
 79.18  be screened within ten working days after the date of referral.  
 79.19  Persons admitted on a nonemergency basis to a Medicaid certified 
 79.20  nursing facility must be screened prior to the certified nursing 
 79.21  facility admission.  Persons admitted to the Medicaid certified 
 79.22  nursing facility from the community on an emergency basis or 
 79.23  from an acute care facility on a nonworking day must be screened 
 79.24  the first working day after admission and the reason for the 
 79.25  emergency admission must be certified by the attending physician 
 79.26  in the person's medical record. 
 79.27     Sec. 32.  Minnesota Statutes 1994, section 256B.0911, 
 79.28  subdivision 3, is amended to read: 
 79.29     Subd. 3.  [PERSONS RESPONSIBLE FOR CONDUCTING THE 
 79.30  PREADMISSION SCREENING.] (a) A local screening team shall be 
 79.31  established by the county board of commissioners.  Each local 
 79.32  screening team shall consist of screeners who are a social 
 79.33  worker and a public health nurse from their respective county 
 79.34  agencies.  If a county does not have a public health nurse 
 79.35  available, it may request approval from the commissioner to 
 79.36  assign a county registered nurse with at least one year 
 80.1   experience in home care to participate on the team.  The 
 80.2   screening team members must confer regarding the most 
 80.3   appropriate care for each individual screened.  Two or more 
 80.4   counties may collaborate to establish a joint local screening 
 80.5   team or teams. 
 80.6      (b) In assessing a person's needs, screeners shall have a 
 80.7   physician available for consultation and shall consider the 
 80.8   assessment of the individual's attending physician, if any.  The 
 80.9   individual's physician shall be included if the physician 
 80.10  chooses to participate.  Other personnel may be included on the 
 80.11  team as deemed appropriate by the county agencies. 
 80.12     Sec. 33.  [256B.0912] [ALTERNATIVE CARE AND WAIVERED 
 80.13  SERVICE PROGRAMS.] 
 80.14     Subdivision 1.  [RESTRUCTURING PLAN.] By January 1, 1996, 
 80.15  the commissioner shall present a plan to the legislature to 
 80.16  restructure administration of the alternative care, elderly 
 80.17  waiver, and disabled waiver programs.  The plan must demonstrate 
 80.18  cost neutrality and provide counties with the flexibility, 
 80.19  authority, and accountability to administer home- and 
 80.20  community-based service programs within predetermined fixed 
 80.21  budgets.  To support this local program administration, the 
 80.22  commissioner shall explore options with the health care 
 80.23  financing administration to assure flexibility to expand core 
 80.24  services within the elderly and disabled waivers as long as cost 
 80.25  neutrality is maintained. 
 80.26     Subd. 2.  [WAIVER PROGRAM MODIFICATIONS.] The commissioner 
 80.27  of human services shall make the following modifications in 
 80.28  medical assistance waiver programs, effective for services 
 80.29  rendered after June 30, 1995, or, if necessary, after federal 
 80.30  approval is granted: 
 80.31     (a) The community alternatives for disabled individuals 
 80.32  waiver shall: 
 80.33     (1) if medical supplies and equipment or adaptations are or 
 80.34  will be purchased for a waiver services recipient, allow the 
 80.35  prorating of costs on a monthly basis throughout the year in 
 80.36  which they are purchased.  If the monthly cost of a recipient's 
 81.1   other waivered services exceeds the monthly limit established in 
 81.2   this paragraph, the annual cost of the waivered services shall 
 81.3   be determined.  In this event, the annual cost of waivered 
 81.4   services shall not exceed 12 times the monthly limit calculated 
 81.5   in this paragraph; 
 81.6      (2) require client reassessments once every 12 months; 
 81.7      (3) permit the purchase of supplies and equipment costing 
 81.8   $150 or less without prior approval of the commissioner of human 
 81.9   services.  A county is not required to contract with a provider 
 81.10  of supplies and equipment if the monthly cost of supplies and 
 81.11  equipment is less than $250; and 
 81.12     (4) allow the implementation of care plans without the 
 81.13  approval of the county of financial responsibility when the 
 81.14  client receives services from another county. 
 81.15     (b) The traumatic brain injury waiver shall: 
 81.16     (1) require client reassessments once every 12 months; 
 81.17     (2) permit the purchase of supplies and equipment costing 
 81.18  $250 or less without having a contract with the supplier; and 
 81.19     (3) allow the implementation of care plans without the 
 81.20  approval of the county of financial responsibility when the 
 81.21  client receives services from another county. 
 81.22     Sec. 34.  Minnesota Statutes 1994, section 256B.0913, 
 81.23  subdivision 4, is amended to read: 
 81.24     Subd. 4.  [ELIGIBILITY FOR FUNDING FOR SERVICES FOR 
 81.25  NONMEDICAL ASSISTANCE RECIPIENTS.] (a) Funding for services 
 81.26  under the alternative care program is available to persons who 
 81.27  meet the following criteria: 
 81.28     (1) the person has been screened by the county screening 
 81.29  team or, if previously screened and served under the alternative 
 81.30  care program, assessed by the local county social worker or 
 81.31  public health nurse; 
 81.32     (2) the person is age 65 or older; 
 81.33     (3) the person would be financially eligible for medical 
 81.34  assistance within 180 days of admission to a nursing facility; 
 81.35     (4) the person meets the asset transfer requirements of the 
 81.36  medical assistance program; 
 82.1      (5) the screening team would recommend nursing facility 
 82.2   admission or continued stay for the person if alternative care 
 82.3   services were not available; 
 82.4      (6) the person needs services that are not available at 
 82.5   that time in the county through other county, state, or federal 
 82.6   funding sources; and 
 82.7      (7) the monthly cost of the alternative care services 
 82.8   funded by the program for this person does not exceed 75 percent 
 82.9   of the statewide average monthly medical assistance payment for 
 82.10  nursing facility care at the individual's case mix 
 82.11  classification to which the individual would be assigned under 
 82.12  Minnesota Rules, parts 9549.0050 to 9549.0059.  If medical 
 82.13  supplies and equipment or adaptations are or will be purchased 
 82.14  for an alternative care services recipient, the costs may be 
 82.15  prorated on a monthly basis throughout the year in which they 
 82.16  are purchased.  If the monthly cost of a recipient's other 
 82.17  alternative care services exceeds the monthly limit established 
 82.18  in this paragraph, the annual cost of the alternative care 
 82.19  services shall be determined.  In this event, the annual cost of 
 82.20  alternative care services shall not exceed 12 times the monthly 
 82.21  limit calculated in this paragraph. 
 82.22     (b) Individuals who meet the criteria in paragraph (a) and 
 82.23  who have been approved for alternative care funding are called 
 82.24  180-day eligible clients. 
 82.25     (c) The statewide average payment for nursing facility care 
 82.26  is the statewide average monthly nursing facility rate in effect 
 82.27  on July 1 of the fiscal year in which the cost is incurred, less 
 82.28  the statewide average monthly income of nursing facility 
 82.29  residents who are age 65 or older and who are medical assistance 
 82.30  recipients in the month of March of the previous fiscal year. 
 82.31  This monthly limit does not prohibit the 180-day eligible client 
 82.32  from paying for additional services needed or desired.  
 82.33     (d) In determining the total costs of alternative care 
 82.34  services for one month, the costs of all services funded by the 
 82.35  alternative care program, including supplies and equipment, must 
 82.36  be included. 
 83.1      (e) Alternative care funding under this subdivision is not 
 83.2   available for a person who is a medical assistance recipient or 
 83.3   who would be eligible for medical assistance without a spenddown 
 83.4   if the person applied, unless authorized by the commissioner.  A 
 83.5   person whose application for medical assistance is being 
 83.6   processed may be served under the alternative care program for a 
 83.7   period up to 60 days.  If the individual is found to be eligible 
 83.8   for medical assistance, the county must bill medical assistance 
 83.9   from the date the individual was found eligible for the medical 
 83.10  assistance services provided that are reimbursable under the 
 83.11  elderly waiver program.  
 83.12     (f) Alternative care funding is not available for a person 
 83.13  who resides in a licensed nursing home or boarding care home, 
 83.14  except for case management services which are being provided in 
 83.15  support of the discharge planning process.  
 83.16     Sec. 35.  Minnesota Statutes 1994, section 256B.0913, 
 83.17  subdivision 5, is amended to read: 
 83.18     Subd. 5.  [SERVICES COVERED UNDER ALTERNATIVE CARE.] (a) 
 83.19  Alternative care funding may be used for payment of costs of: 
 83.20     (1) adult foster care; 
 83.21     (2) adult day care; 
 83.22     (3) home health aide; 
 83.23     (4) homemaker services; 
 83.24     (5) personal care; 
 83.25     (6) case management; 
 83.26     (7) respite care; 
 83.27     (8) assisted living; 
 83.28     (9) residential care services; 
 83.29     (10) care-related supplies and equipment; 
 83.30     (11) meals delivered to the home; 
 83.31     (12) transportation; 
 83.32     (13) skilled nursing; 
 83.33     (14) chore services; 
 83.34     (15) companion services; 
 83.35     (16) nutrition services; and 
 83.36     (17) training for direct informal caregivers. 
 84.1      (b) The county agency must ensure that the funds are used 
 84.2   only to supplement and not supplant services available through 
 84.3   other public assistance or services programs. 
 84.4      (c) Unless specified in statute, the service standards for 
 84.5   alternative care services shall be the same as the service 
 84.6   standards defined in the elderly waiver.  Persons or agencies 
 84.7   must be employed by or under a contract with the county agency 
 84.8   or the public health nursing agency of the local board of health 
 84.9   in order to receive funding under the alternative care program. 
 84.10     (d) The adult foster care rate shall be considered a 
 84.11  difficulty of care payment and shall not include room and 
 84.12  board.  The adult foster care daily rate shall be negotiated 
 84.13  between the county agency and the foster care provider.  The 
 84.14  rate established under this section shall not exceed 75 percent 
 84.15  of the state average monthly nursing home payment for the case 
 84.16  mix classification to which the individual receiving foster care 
 84.17  is assigned, and it must allow for other alternative care 
 84.18  services to be authorized by the case manager. 
 84.19     (e) Personal care services may be provided by a personal 
 84.20  care provider organization.  A county agency may contract with a 
 84.21  relative of the client to provide personal care services, but 
 84.22  must ensure nursing supervision.  Covered personal care services 
 84.23  defined in section 256B.0627, subdivision 4, must meet 
 84.24  applicable standards in Minnesota Rules, part 9505.0335. 
 84.25     (f) Costs for supplies and equipment that exceed $150 per 
 84.26  item per month must have prior approval from the commissioner.  
 84.27  A county may use alternative care funds to purchase supplies and 
 84.28  equipment from a non-Medicaid certified vendor if the cost for 
 84.29  the items is less than that of a Medicaid vendor.  A county is 
 84.30  not required to contract with a provider of supplies and 
 84.31  equipment if the monthly cost of the supplies and equipment is 
 84.32  less than $250. 
 84.33     (g) For purposes of this section, residential care services 
 84.34  are services which are provided to individuals living in 
 84.35  residential care homes.  Residential care homes are currently 
 84.36  licensed as board and lodging establishments and are registered 
 85.1   with the department of health as providing special services.  
 85.2   Residential care services are defined as "supportive services" 
 85.3   and "health-related services."  "Supportive services" means the 
 85.4   provision of up to 24-hour supervision and oversight.  
 85.5   Supportive services includes:  (1) transportation, when provided 
 85.6   by the residential care center only; (2) socialization, when 
 85.7   socialization is part of the plan of care, has specific goals 
 85.8   and outcomes established, and is not diversional or recreational 
 85.9   in nature; (3) assisting clients in setting up meetings and 
 85.10  appointments; (4) assisting clients in setting up medical and 
 85.11  social services; (5) providing assistance with personal laundry, 
 85.12  such as carrying the client's laundry to the laundry room.  
 85.13  Assistance with personal laundry does not include any laundry, 
 85.14  such as bed linen, that is included in the room and board rate.  
 85.15  Health-related services are limited to minimal assistance with 
 85.16  dressing, grooming, and bathing and providing reminders to 
 85.17  residents to take medications that are self-administered or 
 85.18  providing storage for medications, if requested.  Individuals 
 85.19  receiving residential care services cannot receive both personal 
 85.20  care services and residential care services.  
 85.21     (h) For the purposes of this section, "assisted living" 
 85.22  refers to supportive services provided by a single vendor to 
 85.23  clients who reside in the same apartment building of three or 
 85.24  more units.  Assisted living services are defined as up to 
 85.25  24-hour supervision, and oversight, supportive services as 
 85.26  defined in clause (1), individualized home care aide tasks as 
 85.27  defined in clause (2), and individualized home management tasks 
 85.28  as defined in clause (3) provided to residents of a residential 
 85.29  center living in their units or apartments with a full kitchen 
 85.30  and bathroom.  A full kitchen includes a stove, oven, 
 85.31  refrigerator, food preparation counter space, and a kitchen 
 85.32  utensil storage compartment.  Assisted living services must be 
 85.33  provided by the management of the residential center or by 
 85.34  providers under contract with the management or with the county. 
 85.35     (1) Supportive services include:  
 85.36     (i) socialization, when socialization is part of the plan 
 86.1   of care, has specific goals and outcomes established, and is not 
 86.2   diversional or recreational in nature; 
 86.3      (ii) assisting clients in setting up meetings and 
 86.4   appointments; and 
 86.5      (iii) providing transportation, when provided by the 
 86.6   residential center only.  
 86.7      Individuals receiving assisted living services will not 
 86.8   receive both assisted living services and homemaking or personal 
 86.9   care services.  Individualized means services are chosen and 
 86.10  designed specifically for each resident's needs, rather than 
 86.11  provided or offered to all residents regardless of their 
 86.12  illnesses, disabilities, or physical conditions.  
 86.13     (2) Home care aide tasks means:  
 86.14     (i) preparing modified diets, such as diabetic or low 
 86.15  sodium diets; 
 86.16     (ii) reminding residents to take regularly scheduled 
 86.17  medications or to perform exercises; 
 86.18     (iii) household chores in the presence of technically 
 86.19  sophisticated medical equipment or episodes of acute illness or 
 86.20  infectious disease; 
 86.21     (iv) household chores when the resident's care requires the 
 86.22  prevention of exposure to infectious disease or containment of 
 86.23  infectious disease; and 
 86.24     (v) assisting with dressing, oral hygiene, hair care, 
 86.25  grooming, and bathing, if the resident is ambulatory, and if the 
 86.26  resident has no serious acute illness or infectious disease.  
 86.27  Oral hygiene means care of teeth, gums, and oral prosthetic 
 86.28  devices.  
 86.29     (3) Home management tasks means:  
 86.30     (i) housekeeping; 
 86.31     (ii) laundry; 
 86.32     (iii) preparation of regular snacks and meals; and 
 86.33     (iv) shopping.  
 86.34     A person's eligibility to reside in the building must not 
 86.35  be contingent on the person's acceptance or use of the assisted 
 86.36  living services.  Assisted living services as defined in this 
 87.1   section shall not be authorized in boarding and lodging 
 87.2   establishments licensed according to sections 157.01 to 157.031. 
 87.3      Reimbursement for assisted living services and residential 
 87.4   care services shall be made by the lead agency to the vendor as 
 87.5   a monthly rate negotiated with the county agency.  The rate 
 87.6   shall not exceed the nonfederal share of the greater of either 
 87.7   the statewide or any of the geographic groups' weighted average 
 87.8   monthly medical assistance nursing facility payment rate of the 
 87.9   case mix resident class to which the 180-day eligible client 
 87.10  would be assigned under Minnesota Rules, parts 9549.0050 to 
 87.11  9549.0059, except for alternative care assisted living projects 
 87.12  established under Laws 1988, chapter 689, article 2, section 
 87.13  256, whose rates may not exceed 65 percent of either the 
 87.14  statewide or any of the geographic groups' weighted average 
 87.15  monthly medical assistance nursing facility payment rate of the 
 87.16  case mix resident class to which the 180-day eligible client 
 87.17  would be assigned under Minnesota Rules, parts 9549.0050 to 
 87.18  9549.0059.  The rate may not cover rent and direct food costs. 
 87.19     (i) For purposes of this section, companion services are 
 87.20  defined as nonmedical care, supervision and oversight, provided 
 87.21  to a functionally impaired adult.  Companions may assist the 
 87.22  individual with such tasks as meal preparation, laundry and 
 87.23  shopping, but do not perform these activities as discrete 
 87.24  services.  The provision of companion services does not entail 
 87.25  hands-on medical care.  Providers may also perform light 
 87.26  housekeeping tasks which are incidental to the care and 
 87.27  supervision of the recipient.  This service must be approved by 
 87.28  the case manager as part of the care plan.  Companion services 
 87.29  must be provided by individuals or nonprofit organizations who 
 87.30  are under contract with the local agency to provide the 
 87.31  service.  Any person related to the waiver recipient by blood, 
 87.32  marriage or adoption cannot be reimbursed under this service.  
 87.33  Persons providing companion services will be monitored by the 
 87.34  case manager. 
 87.35     (j) For purposes of this section, training for direct 
 87.36  informal caregivers is defined as a classroom or home course of 
 88.1   instruction which may include:  transfer and lifting skills, 
 88.2   nutrition, personal and physical cares, home safety in a home 
 88.3   environment, stress reduction and management, behavioral 
 88.4   management, long-term care decision making, care coordination 
 88.5   and family dynamics.  The training is provided to an informal 
 88.6   unpaid caregiver of a 180-day eligible client which enables the 
 88.7   caregiver to deliver care in a home setting with high levels of 
 88.8   quality.  The training must be approved by the case manager as 
 88.9   part of the individual care plan.  Individuals, agencies, and 
 88.10  educational facilities which provide caregiver training and 
 88.11  education will be monitored by the case manager. 
 88.12     Sec. 36.  Minnesota Statutes 1994, section 256B.0913, 
 88.13  subdivision 8, is amended to read: 
 88.14     Subd. 8.  [REQUIREMENTS FOR INDIVIDUAL CARE PLAN.] (a) The 
 88.15  case manager shall implement the plan of care for each 180-day 
 88.16  eligible client and ensure that a client's service needs and 
 88.17  eligibility are reassessed at least every six 12 months.  The 
 88.18  plan shall include any services prescribed by the individual's 
 88.19  attending physician as necessary to allow the individual to 
 88.20  remain in a community setting.  In developing the individual's 
 88.21  care plan, the case manager should include the use of volunteers 
 88.22  from families and neighbors, religious organizations, social 
 88.23  clubs, and civic and service organizations to support the formal 
 88.24  home care services.  The county shall be held harmless for 
 88.25  damages or injuries sustained through the use of volunteers 
 88.26  under this subdivision including workers' compensation 
 88.27  liability.  The lead agency shall provide documentation to the 
 88.28  commissioner verifying that the individual's alternative care is 
 88.29  not available at that time through any other public assistance 
 88.30  or service program.  The lead agency shall provide documentation 
 88.31  in each individual's plan of care and to the commissioner that 
 88.32  the most cost-effective alternatives available have been offered 
 88.33  to the individual and that the individual was free to choose 
 88.34  among available qualified providers, both public and private. 
 88.35  The case manager must give the individual a ten-day written 
 88.36  notice of any decrease in or termination of alternative care 
 89.1   services. 
 89.2      (b) If the county administering alternative care services 
 89.3   is different than the county of financial responsibility, the 
 89.4   care plan may be implemented without the approval of the county 
 89.5   of financial responsibility. 
 89.6      Sec. 37.  Minnesota Statutes 1994, section 256B.0913, 
 89.7   subdivision 12, is amended to read: 
 89.8      Subd. 12.  [CLIENT PREMIUMS.] (a) A premium is required for 
 89.9   all 180-day eligible clients to help pay for the cost of 
 89.10  participating in the program.  The amount of the premium for the 
 89.11  alternative care client shall be determined as follows: 
 89.12     (1) when the alternative care client's income less 
 89.13  recurring and predictable medical expenses is greater than the 
 89.14  medical assistance income standard but less than 150 percent of 
 89.15  the federal poverty guideline, and total assets are less than 
 89.16  $6,000, the fee is zero; 
 89.17     (2) when the alternative care client's income less 
 89.18  recurring and predictable medical expenses is greater than 150 
 89.19  percent of the federal poverty guideline and total assets are 
 89.20  less than $6,000, the fee is 25 percent of the cost of 
 89.21  alternative care services or the difference between 150 percent 
 89.22  of the federal poverty guideline and the client's income less 
 89.23  recurring and predictable medical expenses, whichever is less; 
 89.24  and 
 89.25     (3) when the alternative care client's total assets are 
 89.26  greater than $6,000, the fee is 25 percent of the cost of 
 89.27  alternative care services.  
 89.28     For married persons, total assets are defined as the total 
 89.29  marital assets less the estimated community spouse asset 
 89.30  allowance, under section 256B.059, if applicable.  For married 
 89.31  persons, total income is defined as the client's income less the 
 89.32  monthly spousal allotment, under section 256B.058. 
 89.33     All alternative care services except case management shall 
 89.34  be included in the estimated costs for the purpose of 
 89.35  determining 25 percent of the costs. 
 89.36     The monthly premium shall be calculated and be payable in 
 90.1   the based on the cost of the first full month in which the of 
 90.2   alternative care services begin and shall continue unaltered for 
 90.3   six months until the semiannual reassessment unless the actual 
 90.4   cost of services falls below the fee until the next reassessment 
 90.5   is completed or at the end of 12 months, whichever comes first.  
 90.6   Premiums are due and payable each month alternative care 
 90.7   services are received unless the actual cost of the services is 
 90.8   less than the premium. 
 90.9      (b) The fee shall be waived by the commissioner when: 
 90.10     (1) a person who is residing in a nursing facility is 
 90.11  receiving case management only; 
 90.12     (2) a person is applying for medical assistance; 
 90.13     (3) a married couple is requesting an asset assessment 
 90.14  under the spousal impoverishment provisions; 
 90.15     (4) a person is a medical assistance recipient, but has 
 90.16  been approved for alternative care-funded assisted living 
 90.17  services; 
 90.18     (5) a person is found eligible for alternative care, but is 
 90.19  not yet receiving alternative care services; 
 90.20     (6) a person is an adult foster care resident for whom 
 90.21  alternative care funds are being used to meet a portion of the 
 90.22  person's medical assistance spenddown, as authorized in 
 90.23  subdivision 4; and 
 90.24     (7) a person's fee under paragraph (a) is less than $25. 
 90.25     (c) The county agency must collect the premium from the 
 90.26  client and forward the amounts collected to the commissioner in 
 90.27  the manner and at the times prescribed by the commissioner.  
 90.28  Money collected must be deposited in the general fund and is 
 90.29  appropriated to the commissioner for the alternative care 
 90.30  program.  The client must supply the county with the client's 
 90.31  social security number at the time of application.  If a client 
 90.32  fails or refuses to pay the premium due, the county shall supply 
 90.33  the commissioner with the client's social security number and 
 90.34  other information the commissioner requires to collect the 
 90.35  premium from the client.  The commissioner shall collect unpaid 
 90.36  premiums using the revenue recapture act in chapter 270A and 
 91.1   other methods available to the commissioner.  The commissioner 
 91.2   may require counties to inform clients of the collection 
 91.3   procedures that may be used by the state if a premium is not 
 91.4   paid.  
 91.5      (d) The commissioner shall begin to adopt emergency or 
 91.6   permanent rules governing client premiums within 30 days after 
 91.7   July 1, 1991, including criteria for determining when services 
 91.8   to a client must be terminated due to failure to pay a premium.  
 91.9      Sec. 38.  Minnesota Statutes 1994, section 256B.0913, 
 91.10  subdivision 14, is amended to read: 
 91.11     Subd. 14.  [REIMBURSEMENT AND RATE ADJUSTMENTS.] (a) 
 91.12  Reimbursement for expenditures for the alternative care services 
 91.13  as approved by the client's case manager shall be through the 
 91.14  invoice processing procedures of the department's Medicaid 
 91.15  Management Information System (MMIS), only with the approval of 
 91.16  the client's case manager.  To receive reimbursement, the county 
 91.17  or vendor must submit invoices within 120 days 12 months 
 91.18  following the month date of service.  The county agency and its 
 91.19  vendors under contract shall not be reimbursed for services 
 91.20  which exceed the county allocation. 
 91.21     (b) If a county collects less than 50 percent of the client 
 91.22  premiums due under subdivision 12, the commissioner may withhold 
 91.23  up to three percent of the county's final alternative care 
 91.24  program allocation determined under subdivisions 10 and 11. 
 91.25     (c) Beginning July 1, 1991, the state will reimburse 
 91.26  counties, up to the limits of state appropriations, according to 
 91.27  the payment schedule in section 256.025 for the county share of 
 91.28  costs incurred under this subdivision on or after January 1, 
 91.29  1991, for individuals who would be eligible for medical 
 91.30  assistance within 180 days of admission to a nursing home. 
 91.31     (d) For fiscal years beginning on or after July 1, 1993, 
 91.32  the commissioner of human services shall not provide automatic 
 91.33  annual inflation adjustments for alternative care services.  The 
 91.34  commissioner of finance shall include as a budget change request 
 91.35  in each biennial detailed expenditure budget submitted to the 
 91.36  legislature under section 16A.11 annual adjustments in 
 92.1   reimbursement rates for alternative care services based on the 
 92.2   forecasted percentage change in the Home Health Agency Market 
 92.3   Basket of Operating Costs, for the fiscal year beginning July 1, 
 92.4   compared to the previous fiscal year, unless otherwise adjusted 
 92.5   by statute.  The Home Health Agency Market Basket of Operating 
 92.6   Costs is published by Data Resources, Inc.  The forecast to be 
 92.7   used is the one published for the calendar quarter beginning 
 92.8   January 1, six months prior to the beginning of the fiscal year 
 92.9   for which rates are set. 
 92.10     (e) The county shall negotiate individual rates with 
 92.11  vendors and may be reimbursed for actual costs up to the greater 
 92.12  of the county's current approved rate or 60 percent of the 
 92.13  maximum rate in fiscal year 1994 and 65 percent of the maximum 
 92.14  rate in fiscal year 1995 for each alternative care service.  
 92.15  Notwithstanding any other rule or statutory provision to the 
 92.16  contrary, the commissioner shall not be authorized to increase 
 92.17  rates by an annual inflation factor, unless so authorized by the 
 92.18  legislature. 
 92.19     (f) On July 1, 1993, the commissioner shall increase the 
 92.20  maximum rate for home delivered meals to $4.50 per meal. 
 92.21     Sec. 39.  Minnesota Statutes 1994, section 256B.0915, 
 92.22  subdivision 3, is amended to read: 
 92.23     Subd. 3.  [LIMITS OF CASES, RATES, REIMBURSEMENT, AND 
 92.24  FORECASTING.] (a) The number of medical assistance waiver 
 92.25  recipients that a county may serve must be allocated according 
 92.26  to the number of medical assistance waiver cases open on July 1 
 92.27  of each fiscal year.  Additional recipients may be served with 
 92.28  the approval of the commissioner. 
 92.29     (b) The monthly limit for the cost of waivered services to 
 92.30  an individual waiver client shall be the statewide average 
 92.31  payment rate of the case mix resident class to which the waiver 
 92.32  client would be assigned under the medical assistance case mix 
 92.33  reimbursement system.  If medical supplies and equipment or 
 92.34  adaptations are or will be purchased for an elderly waiver 
 92.35  services recipient, the costs may be prorated on a monthly basis 
 92.36  throughout the year in which they are purchased.  If the monthly 
 93.1   cost of a recipient's other waivered services exceeds the 
 93.2   monthly limit established in this paragraph, the annual cost of 
 93.3   the waivered services shall be determined.  In this event, the 
 93.4   annual cost of waivered services shall not exceed 12 times the 
 93.5   monthly limit calculated in this paragraph.  The statewide 
 93.6   average payment rate is calculated by determining the statewide 
 93.7   average monthly nursing home rate, effective July 1 of the 
 93.8   fiscal year in which the cost is incurred, less the statewide 
 93.9   average monthly income of nursing home residents who are age 65 
 93.10  or older, and who are medical assistance recipients in the month 
 93.11  of March of the previous state fiscal year.  The annual cost 
 93.12  divided by 12 of elderly or disabled waivered services for a 
 93.13  person who is a nursing facility resident at the time of 
 93.14  requesting a determination of eligibility for elderly or 
 93.15  disabled waivered services shall not exceed the monthly payment 
 93.16  for the resident class assigned under Minnesota Rules, parts 
 93.17  9549.0050 to 9549.0059, for that resident in the nursing 
 93.18  facility where the resident currently resides.  The following 
 93.19  costs must be included in determining the total monthly costs 
 93.20  for the waiver client: 
 93.21     (1) cost of all waivered services, including extended 
 93.22  medical supplies and equipment; and 
 93.23     (2) cost of skilled nursing, home health aide, and personal 
 93.24  care services reimbursable by medical assistance.  
 93.25     (c) Medical assistance funding for skilled nursing 
 93.26  services, home health aide, and personal care services for 
 93.27  waiver recipients must be approved by the case manager and 
 93.28  included in the individual care plan. 
 93.29     (d) Expenditures for extended medical supplies and 
 93.30  equipment that cost over $150 per month for both the elderly 
 93.31  waiver and the disabled waiver must have the commissioner's 
 93.32  prior approval.  A county is not required to contract with a 
 93.33  provider of supplies and equipment if the monthly cost of the 
 93.34  supplies and equipment is less than $250. 
 93.35     (e) For the fiscal year beginning on July 1, 1993, and for 
 93.36  subsequent fiscal years, the commissioner of human services 
 94.1   shall not provide automatic annual inflation adjustments for 
 94.2   home and community-based waivered services.  The commissioner of 
 94.3   finance shall include as a budget change request in each 
 94.4   biennial detailed expenditure budget submitted to the 
 94.5   legislature under section 16A.11, annual adjustments in 
 94.6   reimbursement rates for home and community-based waivered 
 94.7   services, based on the forecasted percentage change in the Home 
 94.8   Health Agency Market Basket of Operating Costs, for the fiscal 
 94.9   year beginning July 1, compared to the previous fiscal year, 
 94.10  unless otherwise adjusted by statute.  The Home Health Agency 
 94.11  Market Basket of Operating Costs is published by Data Resources, 
 94.12  Inc.  The forecast to be used is the one published for the 
 94.13  calendar quarter beginning January 1, six months prior to the 
 94.14  beginning of the fiscal year for which rates are set.  The adult 
 94.15  foster care rate shall be considered a difficulty of care 
 94.16  payment and shall not include room and board. 
 94.17     (f) The adult foster care daily rate for the elderly and 
 94.18  disabled waivers shall be negotiated between the county agency 
 94.19  and the foster care provider.  The rate established under this 
 94.20  section shall not exceed the state average monthly nursing home 
 94.21  payment for the case mix classification to which the individual 
 94.22  receiving foster care is assigned, and it; the rate must allow 
 94.23  for other waiver and medical assistance home care services to be 
 94.24  authorized by the case manager. 
 94.25     (g) The assisted living and residential care service rates 
 94.26  for elderly and disabled community alternatives for disabled 
 94.27  individuals (CADI) waivers shall be made to the vendor as a 
 94.28  monthly rate negotiated with the county agency.  The rate shall 
 94.29  not exceed the nonfederal share of the greater of either the 
 94.30  statewide or any of the geographic groups' weighted average 
 94.31  monthly medical assistance nursing facility payment rate of the 
 94.32  case mix resident class to which the elderly or disabled client 
 94.33  would be assigned under Minnesota Rules, parts 9549.0050 to 
 94.34  9549.0059, except.  For alternative care assisted living 
 94.35  projects established under Laws 1988, chapter 689, article 2, 
 94.36  section 256, whose monthly rates may not exceed 65 percent of 
 95.1   the greater of either the statewide or any of the geographic 
 95.2   groups' weighted average monthly medical assistance nursing 
 95.3   facility payment rate for the case mix resident class to which 
 95.4   the elderly or disabled client would be assigned under Minnesota 
 95.5   Rules, parts 9549.0050 to 9549.0059.  The rate may not cover 
 95.6   direct rent or food costs. 
 95.7      (h) The county shall negotiate individual rates with 
 95.8   vendors and may be reimbursed for actual costs up to the greater 
 95.9   of the county's current approved rate or 60 percent of the 
 95.10  maximum rate in fiscal year 1994 and 65 percent of the maximum 
 95.11  rate in fiscal year 1995 for each service within each program. 
 95.12     (i) On July 1, 1993, the commissioner shall increase the 
 95.13  maximum rate for home-delivered meals to $4.50 per meal. 
 95.14     (j) Reimbursement for the medical assistance recipients 
 95.15  under the approved waiver shall be made from the medical 
 95.16  assistance account through the invoice processing procedures of 
 95.17  the department's Medicaid Management Information System (MMIS), 
 95.18  only with the approval of the client's case manager.  The budget 
 95.19  for the state share of the Medicaid expenditures shall be 
 95.20  forecasted with the medical assistance budget, and shall be 
 95.21  consistent with the approved waiver.  
 95.22     (k) Beginning July 1, 1991, the state shall reimburse 
 95.23  counties according to the payment schedule in section 256.025 
 95.24  for the county share of costs incurred under this subdivision on 
 95.25  or after January 1, 1991, for individuals who are receiving 
 95.26  medical assistance. 
 95.27     Sec. 40.  Minnesota Statutes 1994, section 256B.0915, 
 95.28  subdivision 5, is amended to read: 
 95.29     Subd. 5.  [REASSESSMENTS FOR WAIVER CLIENTS.] A 
 95.30  reassessment of a client served under the elderly or disabled 
 95.31  waiver must be conducted at least every six 12 months and at 
 95.32  other times when the case manager determines that there has been 
 95.33  significant change in the client's functioning.  This may 
 95.34  include instances where the client is discharged from the 
 95.35  hospital.  
 95.36     Sec. 41.  Minnesota Statutes 1994, section 256B.0915, is 
 96.1   amended by adding a subdivision to read: 
 96.2      Subd. 6.  [IMPLEMENTATION OF CARE PLAN.] If the county 
 96.3   administering waivered services is different than the county of 
 96.4   financial responsibility, the care plan may be implemented 
 96.5   without the approval of the county of financial responsibility.  
 96.6      Sec. 42.  Minnesota Statutes 1994, section 256B.093, 
 96.7   subdivision 1, is amended to read: 
 96.8      Subdivision 1.  [STATE TRAUMATIC BRAIN INJURY PROGRAM.] The 
 96.9   commissioner of human services shall: 
 96.10     (1) establish and maintain a statewide traumatic brain 
 96.11  injury program; 
 96.12     (2) designate a full-time position to supervise and 
 96.13  coordinate services and policies for persons with traumatic 
 96.14  brain injuries; 
 96.15     (3) contract with qualified agencies or employ staff to 
 96.16  provide statewide administrative case management and 
 96.17  consultation; 
 96.18     (4) establish maintain an advisory committee to provide 
 96.19  recommendations in a report reports to the commissioner 
 96.20  regarding program and service needs of persons with traumatic 
 96.21  brain injuries.  The advisory committee shall consist of no less 
 96.22  than ten members and no more than 30 members.  The commissioner 
 96.23  shall appoint all advisory committee members to one- or two-year 
 96.24  terms and appoint one member as chair; and 
 96.25     (5) investigate the need for the development of rules or 
 96.26  statutes for:  
 96.27     (i) the traumatic brain injury home and community-based 
 96.28  services waiver; and 
 96.29     (ii) traumatic brain injury services not covered by any 
 96.30  other statute or rule (6) investigate present and potential 
 96.31  models of service coordination which can be delivered at the 
 96.32  local level.  
 96.33     Sec. 43.  Minnesota Statutes 1994, section 256B.093, 
 96.34  subdivision 2, is amended to read: 
 96.35     Subd. 2.  [ELIGIBILITY.] Persons eligible for traumatic 
 96.36  brain injury administrative case management and consultation 
 97.1   must be eligible medical assistance recipients who have 
 97.2   traumatic or certain acquired brain injury and: 
 97.3      (1) are at risk of institutionalization; or 
 97.4      (2) exceed limits established by the commissioner in 
 97.5   section 256B.0627, subdivision 5, paragraph (b). 
 97.6      Sec. 44.  Minnesota Statutes 1994, section 256B.093, 
 97.7   subdivision 3, is amended to read: 
 97.8      Subd. 3.  [TRAUMATIC BRAIN INJURY PROGRAM DUTIES.] The 
 97.9   department shall fund administrative case management under this 
 97.10  subdivision using medical assistance administrative funds.  The 
 97.11  traumatic brain injury program duties include: 
 97.12     (1) assessing the person's individual needs for services 
 97.13  required to prevent institutionalization; 
 97.14     (2) ensuring that a care plan that addresses the person's 
 97.15  needs is developed, implemented, and monitored on an ongoing 
 97.16  basis by the appropriate agency or individual; 
 97.17     (3) assisting the person in obtaining services necessary to 
 97.18  allow the person to remain in the community; 
 97.19     (4) coordinating home care services with other medical 
 97.20  assistance services under section 256B.0625; 
 97.21     (5) ensuring appropriate, accessible, and cost-effective 
 97.22  medical assistance services; 
 97.23     (6) recommending to the commissioner the approval or denial 
 97.24  of the use of medical assistance funds to pay for home care 
 97.25  services when home care services exceed thresholds established 
 97.26  by the commissioner under section 256B.0627; 
 97.27     (7) assisting the person with problems related to the 
 97.28  provision of home care services; 
 97.29     (8) ensuring the quality of home care services; 
 97.30     (9) reassessing the person's need for and level of home 
 97.31  care services at a frequency determined by the commissioner; 
 97.32     (10) (1) recommending to the commissioner the approval or 
 97.33  denial of medical assistance funds to pay for out-of-state 
 97.34  placements for traumatic brain injury services and in-state 
 97.35  traumatic brain injury services provided by designated Medicare 
 97.36  long-term care hospitals; 
 98.1      (11) (2) coordinating the traumatic brain injury home and 
 98.2   community-based waiver; and 
 98.3      (12) (3) approving traumatic brain injury waiver 
 98.4   eligibility or care plans or both; 
 98.5      (4) providing ongoing technical assistance and consultation 
 98.6   to county and facility case managers to facilitate care plan 
 98.7   development for appropriate, accessible, and cost-effective 
 98.8   medical assistance services; 
 98.9      (5) providing technical assistance to promote statewide 
 98.10  development of appropriate, accessible, and cost-effective 
 98.11  medical assistance services and related policy; 
 98.12     (6) providing training and outreach to facilitate access to 
 98.13  appropriate home and community-based services to prevent 
 98.14  institutionalization; 
 98.15     (7) facilitating appropriate admissions, continued stay 
 98.16  review, discharges, and utilization review for neurobehavioral 
 98.17  hospitals and other specialized institutions; 
 98.18     (8) providing technical assistance on the use of prior 
 98.19  authorization of home care services and coordination of these 
 98.20  services with other medical assistance services; 
 98.21     (9) developing a system for identification of nursing 
 98.22  facility and hospital residents with traumatic brain injury to 
 98.23  assist in long-term planning for medical assistance services.  
 98.24  Factors will include, but are not limited to, number of 
 98.25  individuals served, length of stay, services received, and 
 98.26  barriers to community placement; and 
 98.27     (10) providing information, referral, and case consultation 
 98.28  to access medical assistance services for recipients without a 
 98.29  county or facility case manager.  Direct access to this 
 98.30  assistance may be limited due to the regional structure of the 
 98.31  program. 
 98.32     Sec. 45.  Minnesota Statutes 1994, section 256B.093, is 
 98.33  amended by adding a subdivision to read: 
 98.34     Subd. 3a.  [TRAUMATIC BRAIN INJURY CASE MANAGEMENT 
 98.35  SERVICES.] The annual appropriation established under section 
 98.36  171.29, subdivision 2, paragraph (b), clause (5), shall be used 
 99.1   for traumatic brain injury program services that include, but 
 99.2   are not limited to: 
 99.3      (1) collaborating with counties, providers, and other 
 99.4   public and private organizations to expand and strengthen local 
 99.5   capacity for delivering needed services and supports, including 
 99.6   efforts to increase access to supportive residential housing 
 99.7   options; 
 99.8      (2) participating in planning and accessing services not 
 99.9   otherwise covered in subdivision 3 to allow individuals to 
 99.10  attain and maintain community-based services; 
 99.11     (3) providing information, referral, and case consultation 
 99.12  to access health and human services for persons with traumatic 
 99.13  brain injury not eligible for medical assistance, though direct 
 99.14  access to this assistance may be limited due to the regional 
 99.15  structure of the program; and 
 99.16     (4) collaborating on injury prevention efforts. 
 99.17     Sec. 46.  Minnesota Statutes 1994, section 256B.431, is 
 99.18  amended by adding a subdivision to read: 
 99.19     Subd. 2s.  [OPERATING COSTS AFTER JUNE 30, 1997.] (a) In 
 99.20  general, the commissioner shall establish maximum standard rates 
 99.21  for the prospective reimbursement of nursing facility costs.  
 99.22  The maximum standard rates must take into account the level of 
 99.23  reimbursement which is adequate to cover the base-level costs of 
 99.24  economically operated nursing facilities.  In determining the 
 99.25  base-level costs, the commissioner shall consider geographic 
 99.26  location, types of nursing facilities (Rule 80, 
 99.27  short-length-of-stay, hospital attached, etc.), minimum nursing 
 99.28  standards, case mix assessment of residents, and other factors 
 99.29  as determined by the commissioner. 
 99.30     The commissioner shall also develop additional 
 99.31  incentive-based payments which if achieved for specified 
 99.32  outcomes will be added to the maximum standard rates.  The 
 99.33  specified outcomes must be measurable, and shall be based on 
 99.34  criteria to be developed by the commissioner during fiscal year 
 99.35  1996.  The commissioner may establish various levels of 
 99.36  achievement within an outcome.  Once the outcomes are