1.1                          A bill for an act 
  1.2             relating to human services; changing continuing care 
  1.3             provisions; reducing duplicative health and human 
  1.4             services licensing activities; appropriating money; 
  1.5             amending Minnesota Statutes 2002, sections 144.057, 
  1.6             subdivision 1; 144.50, subdivision 6; 174.30, 
  1.7             subdivision 1; 245A.02, subdivision 14, by adding a 
  1.8             subdivision; 245A.03, subdivision 2, by adding a 
  1.9             subdivision; 245B.01; 245B.02, subdivision 13; 
  1.10            245B.03, subdivisions 1, 2; 245B.07, subdivision 11; 
  1.11            252.27, subdivisions 1, 2a; 252.28, subdivision 2; 
  1.12            252.291, subdivisions 1, 2a; 252.32, subdivisions 1, 
  1.13            1a, 3, 3c; 252.41, subdivision 3; 252.46, subdivision 
  1.14            1; 256.045, subdivisions 3, 5, by adding a 
  1.15            subdivision; 256B.055, subdivision 12; 256B.057, 
  1.16            subdivision 9; 256B.0625, subdivision 17; 256B.092, 
  1.17            subdivisions 1a, 5; 256B.501, subdivision 1, by adding 
  1.18            a subdivision; 256B.5013, subdivision 4; 256B.5015; 
  1.19            626.5572, subdivisions 6, 13; proposing coding for new 
  1.20            law in Minnesota Statutes, chapters 144; 245A; 256B; 
  1.21            proposing coding for new law as Minnesota Statutes, 
  1.22            chapter 256M; repealing Minnesota Statutes 2002, 
  1.23            sections 245.4886; 245.496; 252.32, subdivision 2; 
  1.24            254A.17; 256B.0945, subdivisions 6, 7, 8, 9, 10; 
  1.25            256E.01; 256E.02; 256E.03; 256E.04; 256E.05; 256E.06; 
  1.26            256E.07; 256E.09; 256E.10; 256E.11; 256E.115; 256E.12; 
  1.27            256E.13; 256E.14; 256E.15; 256F.01; 256F.02; 256F.03; 
  1.28            256F.04; 256F.05; 256F.06; 256F.07; 256F.08; 256F.11; 
  1.29            256F.12; 256F.14; 257.075; 257.81; 260.152; 626.562; 
  1.30            Minnesota Rules, parts 9520.0660, subpart 3; 
  1.31            9520.0670, subpart 3; 9530.4120, subpart 5; 9550.0010; 
  1.32            9550.0020; 9550.0030; 9550.0040; 9550.0050; 9550.0060; 
  1.33            9550.0070; 9550.0080; 9550.0090; 9550.0091; 9550.0092; 
  1.34            9550.0093. 
  1.35  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.36                             ARTICLE 1 
  1.37                          CONTINUING CARE 
  1.38     Section 1.  Minnesota Statutes 2002, section 174.30, 
  1.39  subdivision 1, is amended to read: 
  1.40     Subdivision 1.  [APPLICABILITY.] (a) The operating 
  2.1   standards for special transportation service adopted under this 
  2.2   section do not apply to special transportation provided by:  
  2.3      (1) a common carrier operating on fixed routes and 
  2.4   schedules; 
  2.5      (2) a volunteer driver using a private automobile; 
  2.6      (3) a school bus as defined in section 169.01, subdivision 
  2.7   6; or 
  2.8      (4) an emergency ambulance regulated under chapter 144. 
  2.9      (b) The operating standards adopted under this section only 
  2.10  apply to providers of special transportation service who receive 
  2.11  grants or other financial assistance from either the state or 
  2.12  the federal government, or both, to provide or assist in 
  2.13  providing that service; except that the operating standards 
  2.14  adopted under this section do not apply to any nursing home 
  2.15  licensed under section 144A.02, to any board and care facility 
  2.16  licensed under section 144.50, or to any day training and 
  2.17  habilitation services, day care, or group home facility licensed 
  2.18  under sections 245A.01 to 245A.19 unless the facility or program 
  2.19  provides transportation to nonresidents on a regular basis and 
  2.20  the facility receives reimbursement, other than per diem 
  2.21  payments, for that service under rules promulgated by the 
  2.22  commissioner of human services.  
  2.23     (c) Notwithstanding paragraph (b), the operating standards 
  2.24  adopted under this section do not apply to any vendor of 
  2.25  services licensed under chapter 245B that provides 
  2.26  transportation services to consumers or residents of other 
  2.27  vendors licensed under chapter 245B. 
  2.28     Sec. 2.  Minnesota Statutes 2002, section 245B.07, 
  2.29  subdivision 11, is amended to read: 
  2.30     Subd. 11.  [TRAVEL TIME TO AND FROM A DAY TRAINING AND 
  2.31  HABILITATION SITE.] Except in unusual circumstances, the license 
  2.32  holder must not transport a consumer receiving services for 
  2.33  longer than one hour 90 minutes per one-way trip. 
  2.34     Sec. 3.  Minnesota Statutes 2002, section 252.27, 
  2.35  subdivision 2a, is amended to read: 
  2.36     Subd. 2a.  [CONTRIBUTION AMOUNT; PARENTAL COINSURANCE 
  3.1   PAYMENTS.] (a) The natural or adoptive parents of a minor child, 
  3.2   including a child determined eligible for medical assistance 
  3.3   without consideration of parental income, must contribute 
  3.4   monthly to the cost of services through parental coinsurance 
  3.5   payments or a fixed monthly contribution, unless the child is 
  3.6   married or has been married, parental rights have been 
  3.7   terminated, or the child's adoption is subsidized according to 
  3.8   section 259.67 or through title IV-E of the Social Security Act. 
  3.9   Parental coinsurance payments are set at a percentage that is 
  3.10  equal to the ratio between the parental contribution calculated 
  3.11  under paragraph (b) and the projected cost of services under the 
  3.12  child's care plan.  Parental coinsurance payments apply each 
  3.13  time a service is accessed, subject to a monthly coinsurance 
  3.14  limit equal to the monthly parental contribution calculated 
  3.15  under paragraph (b).  Households that meet the criteria in 
  3.16  paragraph (b), clause (1), are exempt from parental coinsurance 
  3.17  payments and instead pay the fixed monthly contribution 
  3.18  specified in that provision. 
  3.19     (b) For households with adjusted gross income equal to or 
  3.20  greater than 100 percent of federal poverty guidelines, the 
  3.21  parental contribution or fixed monthly contribution shall be the 
  3.22  greater of a minimum monthly fee of $25 for households with 
  3.23  adjusted gross income of $30,000 and over, or an amount to be 
  3.24  computed by applying the following schedule of rates to the 
  3.25  adjusted gross income of the natural or adoptive parents that 
  3.26  exceeds 150 percent of the federal poverty guidelines for the 
  3.27  applicable household size, the following schedule of rates: 
  3.28     (1) on the amount of adjusted gross income over 150 percent 
  3.29  of poverty, but not over $50,000, ten percent if the adjusted 
  3.30  gross income is equal to or greater than 100 percent of federal 
  3.31  poverty guidelines and less than 175 percent of federal poverty 
  3.32  guidelines, the fixed monthly contribution is $4 per month; 
  3.33     (2) on if the amount of adjusted gross income over 150 
  3.34  percent of poverty and over $50,000 but not over $60,000, 12 
  3.35  percent is equal to or greater than 175 percent of federal 
  3.36  poverty guidelines and less than or equal to 375 percent of 
  4.1   federal poverty guidelines, the parental contribution shall be 
  4.2   determined using a sliding fee scale established by the 
  4.3   commissioner of human services which begins at one percent of 
  4.4   adjusted gross income at 175 percent of federal poverty 
  4.5   guidelines and increases to 7.5 percent of adjusted gross income 
  4.6   for those with adjusted gross income up to 375 percent of 
  4.7   federal poverty guidelines; 
  4.8      (3) on if the amount of adjusted gross income over 150 is 
  4.9   greater than 375 percent of federal poverty, and over $60,000 
  4.10  but not over $75,000, 14 percent guidelines and less than 675 
  4.11  percent of federal poverty guidelines, the parental contribution 
  4.12  shall be 7.5 percent of adjusted gross income; and 
  4.13     (4) on all if the adjusted gross income amounts over 150 is 
  4.14  equal to or greater than 675 percent of federal poverty, and 
  4.15  over $75,000, 15 percent guidelines and less than 975 percent of 
  4.16  federal poverty guidelines, the parental contribution shall be 
  4.17  ten percent of adjusted gross income; and 
  4.18     (5) if the adjusted gross income is equal to or greater 
  4.19  than 975 percent of federal poverty guidelines, the parental 
  4.20  contribution shall be 12.5 percent of adjusted gross income. 
  4.21     If the child lives with the parent, the parental 
  4.22  contribution annual adjusted gross income is reduced by $200, 
  4.23  except that the parent must pay the minimum monthly $25 fee 
  4.24  under this paragraph $2,400 prior to calculating the parental 
  4.25  contribution.  If the child resides in an institution specified 
  4.26  in section 256B.35, the parent is responsible for the personal 
  4.27  needs allowance specified under that section in addition to the 
  4.28  parental contribution determined under this section.  The 
  4.29  parental contribution is reduced by any amount required to be 
  4.30  paid directly to the child pursuant to a court order, but only 
  4.31  if actually paid. 
  4.32     (c) The household size to be used in determining the amount 
  4.33  of contribution under paragraph (b) includes natural and 
  4.34  adoptive parents and their dependents under age 21, including 
  4.35  the child receiving services.  Adjustments in the contribution 
  4.36  amount due to annual changes in the federal poverty guidelines 
  5.1   shall be implemented on the first day of July following 
  5.2   publication of the changes. 
  5.3      (d) For purposes of paragraph (b), "income" means the 
  5.4   adjusted gross income of the natural or adoptive parents 
  5.5   determined according to the previous year's federal tax form. 
  5.6      (e) The contribution shall be explained in writing to the 
  5.7   parents at the time eligibility for services is being 
  5.8   determined.  The contribution shall be made on a monthly basis 
  5.9   effective with the first month in which the child receives 
  5.10  services.  Annually upon redetermination or at termination of 
  5.11  eligibility, if the contribution exceeded the cost of services 
  5.12  provided, the local agency or the state shall reimburse that 
  5.13  excess amount to the parents, either by direct reimbursement if 
  5.14  the parent is no longer required to pay a contribution, or by a 
  5.15  reduction in or waiver of parental fees until the excess amount 
  5.16  is exhausted. 
  5.17     (f) The monthly contribution amount must be reviewed at 
  5.18  least every 12 months; when there is a change in household size; 
  5.19  and when there is a loss of or gain in income from one month to 
  5.20  another in excess of ten percent.  The local agency shall mail a 
  5.21  written notice 30 days in advance of the effective date of a 
  5.22  change in the contribution amount.  A decrease in the 
  5.23  contribution amount is effective in the month that the parent 
  5.24  verifies a reduction in income or change in household size. 
  5.25     (g) Parents of a minor child who do not live with each 
  5.26  other shall each pay the contribution required under paragraph 
  5.27  (a), except that a.  An amount equal to the annual court-ordered 
  5.28  child support payment actually paid on behalf of the child 
  5.29  receiving services shall be deducted from the contribution 
  5.30  adjusted gross income of the parent making the payment prior to 
  5.31  calculating the parental contribution under paragraph (b). 
  5.32     (h) The contribution under paragraph (b) shall be increased 
  5.33  by an additional five percent if the local agency determines 
  5.34  that insurance coverage is available but not obtained for the 
  5.35  child.  For purposes of this section, "available" means the 
  5.36  insurance is a benefit of employment for a family member at an 
  6.1   annual cost of no more than five percent of the family's annual 
  6.2   income.  For purposes of this section, "insurance" means health 
  6.3   and accident insurance coverage, enrollment in a nonprofit 
  6.4   health service plan, health maintenance organization, 
  6.5   self-insured plan, or preferred provider organization. 
  6.6      Parents who have more than one child receiving services 
  6.7   shall not be required to pay more than the amount for the child 
  6.8   with the highest expenditures.  There shall be no resource 
  6.9   contribution from the parents.  The parent shall not be required 
  6.10  to pay a contribution in excess of the cost of the services 
  6.11  provided to the child, not counting payments made to school 
  6.12  districts for education-related services.  Notice of an increase 
  6.13  in fee payment must be given at least 30 days before the 
  6.14  increased fee is due.  
  6.15     (i) The contribution under paragraph (b) shall be reduced 
  6.16  by $300 per fiscal year if, in the 12 months prior to July 1: 
  6.17     (1) the parent applied for insurance for the child; 
  6.18     (2) the insurer denied insurance; 
  6.19     (3) the parents submitted a complaint or appeal, in writing 
  6.20  to the insurer, submitted a complaint or appeal, in writing, to 
  6.21  the commissioner of health or the commissioner of commerce, or 
  6.22  litigated the complaint or appeal; and 
  6.23     (4) as a result of the dispute, the insurer reversed its 
  6.24  decision and granted insurance. 
  6.25     For purposes of this section, "insurance" has the meaning 
  6.26  given in paragraph (h). 
  6.27     A parent who has requested a reduction in the contribution 
  6.28  amount under this paragraph shall submit proof in the form and 
  6.29  manner prescribed by the commissioner or county agency, 
  6.30  including, but not limited to, the insurer's denial of 
  6.31  insurance, the written letter or complaint of the parents, court 
  6.32  documents, and the written response of the insurer approving 
  6.33  insurance.  The determinations of the commissioner or county 
  6.34  agency under this paragraph are not rules subject to chapter 14. 
  6.35     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2004. 
  6.36     Sec. 4.  Minnesota Statutes 2002, section 252.32, 
  7.1   subdivision 1, is amended to read: 
  7.2      Subdivision 1.  [PROGRAM ESTABLISHED.] In accordance with 
  7.3   state policy established in section 256F.01 that all children 
  7.4   are entitled to live in families that offer safe, nurturing, 
  7.5   permanent relationships, and that public services be directed 
  7.6   toward preventing the unnecessary separation of children from 
  7.7   their families, and because many families who have children with 
  7.8   mental retardation or related conditions disabilities have 
  7.9   special needs and expenses that other families do not have, the 
  7.10  commissioner of human services shall establish a program to 
  7.11  assist families who have dependents dependent children with 
  7.12  mental retardation or related conditions disabilities living in 
  7.13  their home.  The program shall make support grants available to 
  7.14  the families. 
  7.15     Sec. 5.  Minnesota Statutes 2002, section 252.32, 
  7.16  subdivision 1a, is amended to read: 
  7.17     Subd. 1a.  [SUPPORT GRANTS.] (a) Provision of support 
  7.18  grants must be limited to families who require support and whose 
  7.19  dependents are under the age of 22 21 and who have mental 
  7.20  retardation or who have a related condition and who have been 
  7.21  determined by a screening team established certified disabled 
  7.22  under Minnesota Statutes, section 256B.092 to be at risk of 
  7.23  institutionalization 256B.055, subdivision 12, paragraphs (a), 
  7.24  (b), (c), (d), and (e).  Families who are receiving home and 
  7.25  community-based waivered services for persons with mental 
  7.26  retardation or related conditions under United States Code, 
  7.27  title 42, section 1396n(c), are not eligible for support grants. 
  7.28     Families receiving grants who will be receiving home and 
  7.29  community-based waiver services for persons with mental 
  7.30  retardation or a related condition for their family member 
  7.31  within the grant year, and who have ongoing payments for 
  7.32  environmental or vehicle modifications which have been approved 
  7.33  by the county as a grant expense and would have qualified for 
  7.34  payment under this waiver may receive a onetime grant payment 
  7.35  from the commissioner to reduce or eliminate the principal of 
  7.36  the remaining debt for the modifications, not to exceed the 
  8.1   maximum amount allowable for the remaining years of eligibility 
  8.2   for a family support grant.  The commissioner is authorized to 
  8.3   use up to $20,000 annually from the grant appropriation for this 
  8.4   purpose.  Any amount unexpended at the end of the grant year 
  8.5   shall be allocated by the commissioner in accordance with 
  8.6   subdivision 3a, paragraph (b), clause (2).  Families whose 
  8.7   annual adjusted gross income is $60,000 or more are not eligible 
  8.8   for support grants except in cases where extreme hardship is 
  8.9   demonstrated.  Beginning in state fiscal year 1994, the 
  8.10  commissioner shall adjust the income ceiling annually to reflect 
  8.11  the projected change in the average value in the United States 
  8.12  Department of Labor Bureau of Labor Statistics consumer price 
  8.13  index (all urban) for that year. 
  8.14     (b) Support grants may be made available as monthly subsidy 
  8.15  grants and lump sum grants. 
  8.16     (c) Support grants may be issued in the form of cash, 
  8.17  voucher, and direct county payment to a vendor.  
  8.18     (d) Applications for the support grant shall be made by the 
  8.19  legal guardian to the county social service agency.  The 
  8.20  application shall specify the needs of the families, the form of 
  8.21  the grant requested by the families, and that the families have 
  8.22  agreed to use the support grant for items and services within 
  8.23  the designated reimbursable expense categories and 
  8.24  recommendations of the county to be reimbursed.  
  8.25     (e) Families who were receiving subsidies on the date of 
  8.26  implementation of the $60,000 income limit in paragraph (a) 
  8.27  continue to be eligible for a family support grant until 
  8.28  December 31, 1991, if all other eligibility criteria are met.  
  8.29  After December 31, 1991, these families are eligible for a grant 
  8.30  in the amount of one-half the grant they would otherwise 
  8.31  receive, for as long as they remain eligible under other 
  8.32  eligibility criteria. Families cannot concurrently receive the 
  8.33  consumer support grant under section 256.476. 
  8.34     Sec. 6.  Minnesota Statutes 2002, section 252.32, 
  8.35  subdivision 3, is amended to read: 
  8.36     Subd. 3.  [AMOUNT OF SUPPORT GRANT; USE.] Support grant 
  9.1   amounts shall be determined by the county social service 
  9.2   agency.  Each service Services and item items purchased with a 
  9.3   support grant must: 
  9.4      (1) be over and above the normal costs of caring for the 
  9.5   dependent if the dependent did not have a disability; 
  9.6      (2) be directly attributable to the dependent's disabling 
  9.7   condition; and 
  9.8      (3) enable the family to delay or prevent the out-of-home 
  9.9   placement of the dependent. 
  9.10     The design and delivery of services and items purchased 
  9.11  under this section must suit the dependent's chronological age 
  9.12  and be provided in the least restrictive environment possible, 
  9.13  consistent with the needs identified in the individual service 
  9.14  plan. 
  9.15     Items and services purchased with support grants must be 
  9.16  those for which there are no other public or private funds 
  9.17  available to the family.  Fees assessed to parents for health or 
  9.18  human services that are funded by federal, state, or county 
  9.19  dollars are not reimbursable through this program. 
  9.20     In approving or denying applications, the county shall 
  9.21  consider the following factors:  
  9.22     (1) the extent and areas of the functional limitations of 
  9.23  the disabled child; 
  9.24     (2) the degree of need in the home environment for 
  9.25  additional support; and 
  9.26     (3) the potential effectiveness of the grant to maintain 
  9.27  and support the person in the family environment. 
  9.28     The maximum monthly grant amount shall be $250 per eligible 
  9.29  dependent, or $3,000 per eligible dependent per state fiscal 
  9.30  year, within the limits of available funds.  The county social 
  9.31  service agency may consider the dependent's supplemental 
  9.32  security income in determining the amount of the support grant.  
  9.33  The county social service agency may exceed $3,000 per state 
  9.34  fiscal year per eligible dependent for emergency circumstances 
  9.35  in cases where exceptional resources of the family are required 
  9.36  to meet the health, welfare-safety needs of the child.  
 10.1      County social service agencies shall continue to provide 
 10.2   funds to families receiving state grants on June 30, 1997, if 
 10.3   eligibility criteria continue to be met.  Any adjustments to 
 10.4   their monthly grant amount must be based on the needs of the 
 10.5   family and funding availability. 
 10.6      Sec. 7.  Minnesota Statutes 2002, section 252.32, 
 10.7   subdivision 3c, is amended to read: 
 10.8      Subd. 3c.  [COUNTY BOARD RESPONSIBILITIES.] County boards 
 10.9   receiving funds under this section shall:  
 10.10     (1) determine the needs of families for services in 
 10.11  accordance with section 256B.092 or 256E.08 and any rules 
 10.12  adopted under those sections; submit a plan to the department 
 10.13  for the management of the family support grant program.  The 
 10.14  plan must include the projected number of families the county 
 10.15  will serve and policies and procedures for:  
 10.16     (i) identifying potential families for the program; 
 10.17     (ii) grant distribution; 
 10.18     (iii) waiting list procedures; and 
 10.19     (iv) prioritization of families to receive grants; 
 10.20     (2) determine the eligibility of all persons proposed for 
 10.21  program participation; 
 10.22     (3) approve a plan for items and services to be reimbursed 
 10.23  and inform families of the county's approval decision; 
 10.24     (4) issue support grants directly to, or on behalf of, 
 10.25  eligible families; 
 10.26     (5) inform recipients of their right to appeal under 
 10.27  subdivision 3e; 
 10.28     (6) submit quarterly financial reports under subdivision 3b 
 10.29  and indicate on the screening documents the annual grant level 
 10.30  for each family, the families denied grants, and the families 
 10.31  eligible but waiting for funding; and 
 10.32     (7) coordinate services with other programs offered by the 
 10.33  county. 
 10.34     Sec. 8.  Minnesota Statutes 2002, section 252.41, 
 10.35  subdivision 3, is amended to read: 
 10.36     Subd. 3.  [DAY TRAINING AND HABILITATION SERVICES FOR 
 11.1   ADULTS WITH MENTAL RETARDATION, RELATED CONDITIONS.] "Day 
 11.2   training and habilitation services for adults with mental 
 11.3   retardation and related conditions" means services that: 
 11.4      (1) include supervision, training, assistance, and 
 11.5   supported employment, work-related activities, or other 
 11.6   community-integrated activities designed and implemented in 
 11.7   accordance with the individual service and individual 
 11.8   habilitation plans required under Minnesota Rules, parts 
 11.9   9525.0015 to 9525.0165, to help an adult reach and maintain the 
 11.10  highest possible level of independence, productivity, and 
 11.11  integration into the community; and 
 11.12     (2) are provided under contract with the county where the 
 11.13  services are delivered by a vendor licensed under sections 
 11.14  245A.01 to 245A.16 and 252.28, subdivision 2, to provide day 
 11.15  training and habilitation services; and 
 11.16     (3) are regularly provided to one or more adults with 
 11.17  mental retardation or related conditions in a place other than 
 11.18  the adult's own home or residence unless medically 
 11.19  contraindicated. 
 11.20     Day training and habilitation services reimbursable under 
 11.21  this section do not include special education and related 
 11.22  services as defined in the Education of the Handicapped Act, 
 11.23  United States Code, title 20, chapter 33, section 1401, clauses 
 11.24  (6) and (17), or vocational services funded under section 110 of 
 11.25  the Rehabilitation Act of 1973, United States Code, title 29, 
 11.26  section 720, as amended. 
 11.27     Sec. 9.  Minnesota Statutes 2002, section 252.46, 
 11.28  subdivision 1, is amended to read: 
 11.29     Subdivision 1.  [RATES.] (a) Payment rates to vendors, 
 11.30  except regional centers, for county-funded day training and 
 11.31  habilitation services and transportation provided to persons 
 11.32  receiving day training and habilitation services established by 
 11.33  a county board are governed by subdivisions 2 to 19.  The 
 11.34  commissioner shall approve the following three payment rates for 
 11.35  services provided by a vendor: 
 11.36     (1) a full-day service rate for persons who receive at 
 12.1   least six service hours a day, including the time it takes to 
 12.2   transport the person to and from the service site; 
 12.3      (2) a partial-day service rate that must not exceed 75 
 12.4   percent of the full-day service rate for persons who receive 
 12.5   less than a full day of service; and 
 12.6      (3) a transportation rate for providing, or arranging and 
 12.7   paying for, transportation of a person to and from the person's 
 12.8   residence to the service site.  
 12.9      (b) The commissioner may also approve an hourly job-coach, 
 12.10  follow-along rate for services provided by one employee at or en 
 12.11  route to or from community locations to supervise, support, and 
 12.12  assist one person receiving the vendor's services to learn 
 12.13  job-related skills necessary to obtain or retain employment when 
 12.14  and where no other persons receiving services are present and 
 12.15  when all the following criteria are met: 
 12.16     (1) the vendor requests and the county recommends the 
 12.17  optional rate; 
 12.18     (2) the service is prior authorized by the county on the 
 12.19  Medicaid Management Information System for no more than 414 
 12.20  hours in a 12-month period and the daily per person charge to 
 12.21  medical assistance does not exceed the vendor's approved full 
 12.22  day plus transportation rates; 
 12.23     (3) separate full day, partial day, and transportation 
 12.24  rates are not billed for the same person on the same day; 
 12.25     (4) the approved hourly rate does not exceed the sum of the 
 12.26  vendor's current average hourly direct service wage, including 
 12.27  fringe benefits and taxes, plus a component equal to the 
 12.28  vendor's average hourly nondirect service wage expenses; and 
 12.29     (5) the actual revenue received for provision of hourly 
 12.30  job-coach, follow-along services is subtracted from the vendor's 
 12.31  total expenses for the same time period and those adjusted 
 12.32  expenses are used for determining recommended full day and 
 12.33  transportation payment rates under subdivision 5 in accordance 
 12.34  with the limitations in subdivision 3. 
 12.35     (b) Notwithstanding any law or rule to the contrary, the 
 12.36  commissioner may authorize county participation in a voluntary 
 13.1   individualized payment rate structure for day training and 
 13.2   habilitation services to allow a county the flexibility to 
 13.3   change, after consulting with providers, from a site-based 
 13.4   payment rate structure to an individual payment rate structure 
 13.5   for the providers of day training and habilitation services in 
 13.6   the county.  The commissioner shall seek input from providers 
 13.7   and consumers in establishing procedures for determining the 
 13.8   structure of voluntary individualized payment rates to ensure 
 13.9   that there is no additional cost to the state and that the rate 
 13.10  structure is cost-neutral to providers of day training and 
 13.11  habilitation services. 
 13.12     (c) Medical assistance rates for home and community-based 
 13.13  service provided under section 256B.501, subdivision 4, by 
 13.14  licensed vendors of day training and habilitation services must 
 13.15  not be greater than the rates for the same services established 
 13.16  by counties under sections 252.40 to 252.46.  For very dependent 
 13.17  persons with special needs the commissioner may approve an 
 13.18  exception to the approved payment rate under section 256B.501, 
 13.19  subdivision 4 or 8. 
 13.20     Sec. 10.  Minnesota Statutes 2002, section 256.045, 
 13.21  subdivision 3, is amended to read: 
 13.22     Subd. 3.  [STATE AGENCY HEARINGS.] (a) State agency 
 13.23  hearings are available for the following:  (1) any person 
 13.24  applying for, receiving or having received public assistance, 
 13.25  medical care, or a program of social services granted by the 
 13.26  state agency or a county agency or the federal Food Stamp Act 
 13.27  whose application for assistance is denied, not acted upon with 
 13.28  reasonable promptness, or whose assistance is suspended, 
 13.29  reduced, terminated, or claimed to have been incorrectly paid; 
 13.30  (2) any patient or relative aggrieved by an order of the 
 13.31  commissioner under section 252.27; (3) a party aggrieved by a 
 13.32  ruling of a prepaid health plan; (4) except as provided under 
 13.33  chapter 245A, any individual or facility determined by a lead 
 13.34  agency to have maltreated a vulnerable adult under section 
 13.35  626.557 after they have exercised their right to administrative 
 13.36  reconsideration under section 626.557; (5) any person whose 
 14.1   claim for foster care payment according to a placement of the 
 14.2   child resulting from a child protection assessment under section 
 14.3   626.556 is denied or not acted upon with reasonable promptness, 
 14.4   regardless of funding source; (6) any person to whom a right of 
 14.5   appeal according to this section is given by other provision of 
 14.6   law; (7) an applicant aggrieved by an adverse decision to an 
 14.7   application for a hardship waiver under section 256B.15; (8) 
 14.8   except as provided under chapter 245A, an individual or facility 
 14.9   determined to have maltreated a minor under section 626.556, 
 14.10  after the individual or facility has exercised the right to 
 14.11  administrative reconsideration under section 626.556; or (9) 
 14.12  except as provided under chapter 245A, an individual 
 14.13  disqualified under section 245A.04, subdivision 3d, on the basis 
 14.14  of serious or recurring maltreatment; a preponderance of the 
 14.15  evidence that the individual has committed an act or acts that 
 14.16  meet the definition of any of the crimes listed in section 
 14.17  245A.04, subdivision 3d, paragraph (a), clauses (1) to (4); or 
 14.18  for failing to make reports required under section 626.556, 
 14.19  subdivision 3, or 626.557, subdivision 3; or (10) a vendor of 
 14.20  medical care as defined in section 256B.02, subdivision 7, or a 
 14.21  vendor under contract to provide social services under section 
 14.22  256E.08, subdivision 4, to the extent permitted under 
 14.23  subdivision 11.  Hearings regarding a maltreatment determination 
 14.24  under clause (4) or (8) and a disqualification under this clause 
 14.25  in which the basis for a disqualification is serious or 
 14.26  recurring maltreatment, which has not been set aside or 
 14.27  rescinded under section 245A.04, subdivision 3b, shall be 
 14.28  consolidated into a single fair hearing.  In such cases, the 
 14.29  scope of review by the human services referee shall include both 
 14.30  the maltreatment determination and the disqualification.  The 
 14.31  failure to exercise the right to an administrative 
 14.32  reconsideration shall not be a bar to a hearing under this 
 14.33  section if federal law provides an individual the right to a 
 14.34  hearing to dispute a finding of maltreatment.  Individuals and 
 14.35  organizations specified in this section may contest the 
 14.36  specified action, decision, or final disposition before the 
 15.1   state agency by submitting a written request for a hearing to 
 15.2   the state agency within 30 days after receiving written notice 
 15.3   of the action, decision, or final disposition, or within 90 days 
 15.4   of such written notice if the applicant, recipient, patient, or 
 15.5   relative shows good cause why the request was not submitted 
 15.6   within the 30-day time limit. 
 15.7      The hearing for an individual or facility under clause (4), 
 15.8   (8), or (9) is the only administrative appeal to the final 
 15.9   agency determination specifically, including a challenge to the 
 15.10  accuracy and completeness of data under section 13.04.  Hearings 
 15.11  requested under clause (4) apply only to incidents of 
 15.12  maltreatment that occur on or after October 1, 1995.  Hearings 
 15.13  requested by nursing assistants in nursing homes alleged to have 
 15.14  maltreated a resident prior to October 1, 1995, shall be held as 
 15.15  a contested case proceeding under the provisions of chapter 14.  
 15.16  Hearings requested under clause (8) apply only to incidents of 
 15.17  maltreatment that occur on or after July 1, 1997.  A hearing for 
 15.18  an individual or facility under clause (8) is only available 
 15.19  when there is no juvenile court or adult criminal action 
 15.20  pending.  If such action is filed in either court while an 
 15.21  administrative review is pending, the administrative review must 
 15.22  be suspended until the judicial actions are completed.  If the 
 15.23  juvenile court action or criminal charge is dismissed or the 
 15.24  criminal action overturned, the matter may be considered in an 
 15.25  administrative hearing. 
 15.26     For purposes of this section, bargaining unit grievance 
 15.27  procedures are not an administrative appeal. 
 15.28     The scope of hearings involving claims to foster care 
 15.29  payments under clause (5) shall be limited to the issue of 
 15.30  whether the county is legally responsible for a child's 
 15.31  placement under court order or voluntary placement agreement 
 15.32  and, if so, the correct amount of foster care payment to be made 
 15.33  on the child's behalf and shall not include review of the 
 15.34  propriety of the county's child protection determination or 
 15.35  child placement decision. 
 15.36     (b) A vendor of medical care as defined in section 256B.02, 
 16.1   subdivision 7, or a vendor under contract with a county agency 
 16.2   to provide social services under section 256E.08, subdivision 4, 
 16.3   is not a party and may not request a hearing under this section, 
 16.4   except if assisting a recipient as provided in subdivision 4 or 
 16.5   as provided under subdivision 11. 
 16.6      (c) An applicant or recipient is not entitled to receive 
 16.7   social services beyond the services included in the amended 
 16.8   community social services plan developed under section 256E.081, 
 16.9   subdivision 3, if the county agency has met the requirements in 
 16.10  section 256E.081. 
 16.11     (d) The commissioner may summarily affirm the county or 
 16.12  state agency's proposed action without a hearing when the sole 
 16.13  issue is an automatic change due to a change in state or federal 
 16.14  law. 
 16.15     Sec. 11.  Minnesota Statutes 2002, section 256.045, 
 16.16  subdivision 5, is amended to read: 
 16.17     Subd. 5.  [ORDERS OF THE COMMISSIONER OF HUMAN SERVICES.] A 
 16.18  state human services referee shall conduct a hearing on the 
 16.19  appeal and shall recommend an order to the commissioner of human 
 16.20  services.  The recommended order must be based on all relevant 
 16.21  evidence and must not be limited to a review of the propriety of 
 16.22  the state or county agency's action.  A referee may take 
 16.23  official notice of adjudicative facts.  The commissioner of 
 16.24  human services may accept the recommended order of a state human 
 16.25  services referee and issue the order to the county agency and 
 16.26  the applicant, recipient, former recipient, or prepaid health 
 16.27  plan.  The commissioner on refusing to accept the recommended 
 16.28  order of the state human services referee, shall notify the 
 16.29  petitioner, the agency, or prepaid health plan of that fact and 
 16.30  shall state reasons therefor and shall allow each party ten 
 16.31  days' time to submit additional written argument on the matter.  
 16.32  After the expiration of the ten-day period, the commissioner 
 16.33  shall issue an order on the matter to the petitioner, the 
 16.34  agency, or prepaid health plan. 
 16.35     A party aggrieved by an order of the commissioner may 
 16.36  appeal under subdivision 7, or request reconsideration by the 
 17.1   commissioner within 30 days after the date the commissioner 
 17.2   issues the order.  The commissioner may reconsider an order upon 
 17.3   request of any party or on the commissioner's own motion.  A 
 17.4   request for reconsideration does not stay implementation of the 
 17.5   commissioner's order.  Upon reconsideration, the commissioner 
 17.6   may issue an amended order or an order affirming the original 
 17.7   order. 
 17.8      Any order of the commissioner issued under this subdivision 
 17.9   shall be conclusive upon the parties unless appeal is taken in 
 17.10  the manner provided by subdivision 7.  Any order of the 
 17.11  commissioner is binding on the parties and must be implemented 
 17.12  by the state agency, a county agency, or a prepaid health plan 
 17.13  according to subdivision 3a, until the order is reversed by the 
 17.14  district court, or unless the commissioner or a district court 
 17.15  orders monthly assistance or aid or services paid or provided 
 17.16  under subdivision 10. 
 17.17     A vendor of medical care as defined in section 256B.02, 
 17.18  subdivision 7, or a vendor under contract with a county agency 
 17.19  to provide social services under section 256E.08, subdivision 4, 
 17.20  is not a party and may not request a hearing or seek judicial 
 17.21  review of an order issued under this section, unless assisting a 
 17.22  recipient as provided in subdivision 4 or as provided in 
 17.23  subdivision 11.  A prepaid health plan is a party to an appeal 
 17.24  under subdivision 3a, but cannot seek judicial review of an 
 17.25  order issued under this section. 
 17.26     Sec. 12.  Minnesota Statutes 2002, section 256.045, is 
 17.27  amended by adding a subdivision to read: 
 17.28     Subd. 11.  [VENDOR APPEAL PROCESS.] A vendor of medical 
 17.29  care as defined in section 256B.02, subdivision 7, or a vendor 
 17.30  under contract to provide social services under section 256E.08, 
 17.31  subdivision 4, may appeal an action of a county board arising 
 17.32  from the terms of a purchase of service agreement between the 
 17.33  vendor and the county that is proposed or in effect, if the 
 17.34  agreement: 
 17.35     (1) contains unreasonable or discriminatory outcome 
 17.36  requirements, performance criteria, or program objectives; or 
 18.1      (2) provides a rate of reimbursement that is unfair or 
 18.2   discriminatory when compared to the rates of reimbursement for 
 18.3   other vendors in the county providing similar services. 
 18.4      Sec. 13.  Minnesota Statutes 2002, section 256B.057, 
 18.5   subdivision 9, is amended to read: 
 18.6      Subd. 9.  [EMPLOYED PERSONS WITH DISABILITIES.] (a) Medical 
 18.7   assistance may be paid for a person who is employed and who: 
 18.8      (1) meets the definition of disabled under the supplemental 
 18.9   security income program; 
 18.10     (2) is at least 16 but less than 65 years of age; 
 18.11     (3) meets the asset limits in paragraph (b); and 
 18.12     (4) effective November 1, 2003, pays a premium, if 
 18.13  required, and other obligations under paragraph (c) (d).  
 18.14  Any spousal income or assets shall be disregarded for purposes 
 18.15  of eligibility and premium determinations. 
 18.16     After the month of enrollment, a person enrolled in medical 
 18.17  assistance under this subdivision who: 
 18.18     (1) is temporarily unable to work and without receipt of 
 18.19  earned income due to a medical condition, as verified by a 
 18.20  physician, may retain eligibility for up to four calendar 
 18.21  months; or 
 18.22     (2) effective January 1, 2004, loses employment for reasons 
 18.23  not attributable to the enrollee, may retain eligibility for up 
 18.24  to four consecutive months after the month of job loss.  To 
 18.25  receive a four-month extension, enrollees must verify the 
 18.26  medical condition or provide notification of job loss.  All 
 18.27  other eligibility requirements must be met and the enrollee must 
 18.28  pay all calculated premium costs for continued eligibility. 
 18.29     (b) For purposes of determining eligibility under this 
 18.30  subdivision, a person's assets must not exceed $20,000, 
 18.31  excluding: 
 18.32     (1) all assets excluded under section 256B.056; 
 18.33     (2) retirement accounts, including individual accounts, 
 18.34  401(k) plans, 403(b) plans, Keogh plans, and pension plans; and 
 18.35     (3) medical expense accounts set up through the person's 
 18.36  employer. 
 19.1      (c)(1) Effective January 1, 2004, for purposes of 
 19.2   eligibility, there will be a $65 earned income disregard.  To be 
 19.3   eligible, a person applying for medical assistance under this 
 19.4   subdivision must have earned income above the disregard level. 
 19.5      (2) Effective January 1, 2004, to be considered earned 
 19.6   income, Medicare, social security, and applicable state and 
 19.7   federal income taxes must be withheld.  To be eligible, a person 
 19.8   must document earned income tax withholding. 
 19.9      (d)(1) A person whose earned and unearned income is equal 
 19.10  to or greater than 100 percent of federal poverty guidelines for 
 19.11  the applicable family size must pay a premium to be eligible for 
 19.12  medical assistance under this subdivision.  The premium shall be 
 19.13  based on the person's gross earned and unearned income and the 
 19.14  applicable family size using a sliding fee scale established by 
 19.15  the commissioner, which begins at one five percent of income at 
 19.16  for a person whose income is equal to or greater than 100 
 19.17  percent but does not exceed 175 percent of the federal poverty 
 19.18  guidelines and increases to 7.5 percent of income for those with 
 19.19  incomes at or above 300 225 percent of the federal poverty 
 19.20  guidelines.  Annual adjustments in the premium schedule based 
 19.21  upon changes in the federal poverty guidelines shall be 
 19.22  effective for premiums due in July of each year.  
 19.23     (2) Effective January 1, 2004, all enrollees must pay a 
 19.24  premium to be eligible for medical assistance under this 
 19.25  subdivision.  An enrollee shall pay the greater of a $35 premium 
 19.26  or the premium calculated in clause (1). 
 19.27     (3) Effective November 1, 2003, notwithstanding section 
 19.28  256B.0625, subdivision 15, paragraph (a), the commissioner shall 
 19.29  require enrollees with incomes greater than 150 percent of the 
 19.30  federal poverty guidelines who are also enrolled in Medicare to 
 19.31  pay the full cost of Medicare Part B premiums. 
 19.32     (d) (e) A person's eligibility and premium shall be 
 19.33  determined by the local county agency.  Premiums must be paid to 
 19.34  the commissioner.  All premiums are dedicated to the 
 19.35  commissioner. 
 19.36     (e) (f) Any required premium shall be determined at 
 20.1   application and redetermined annually at recertification at the 
 20.2   enrollee's six-month income review or when a change in income or 
 20.3   family household size occurs is reported.  Enrollees must report 
 20.4   any change in income or household size within ten days of when 
 20.5   the change occurs.  A decreased premium resulting from a 
 20.6   reported change in income or household size shall be effective 
 20.7   the first day of the next available billing month after the 
 20.8   change is reported.  Except for changes occurring from annual 
 20.9   cost-of-living increases or verification of income under section 
 20.10  256B.061, paragraph (b), a change resulting in an increased 
 20.11  premium shall not affect the premium amount until the next 
 20.12  six-month review. 
 20.13     (f) (g) Premium payment is due upon notification from the 
 20.14  commissioner of the premium amount required.  Premiums may be 
 20.15  paid in installments at the discretion of the commissioner. 
 20.16     (g) (h) Nonpayment of the premium shall result in denial or 
 20.17  termination of medical assistance unless the person demonstrates 
 20.18  good cause for nonpayment.  Good cause exists if the 
 20.19  requirements specified in Minnesota Rules, part 9506.0040, 
 20.20  subpart 7, items B to D, are met.  Except when an installment 
 20.21  agreement is accepted by the commissioner, all persons 
 20.22  disenrolled for nonpayment of a premium must pay any past due 
 20.23  premiums as well as current premiums due prior to being 
 20.24  reenrolled.  Nonpayment shall include payment with a returned, 
 20.25  refused, or dishonored instrument.  The commissioner may require 
 20.26  a guaranteed form of payment as the only means to replace a 
 20.27  returned, refused, or dishonored instrument. 
 20.28     <b>[EFFECTIVE DATE.]</b> This section is effective November 1, 
 20.29  2003, except the amendment to Minnesota Statutes 2002, section 
 20.30  256B.057, subdivision 9, paragraph (d), is effective January 1, 
 20.31  2004, and the amendments to Minnesota Statutes 2002, section 
 20.32  256B.057, subdivision 9, paragraphs (f) and (h), are effective 
 20.33  July 1, 2003. 
 20.34     Sec. 14.  Minnesota Statutes 2002, section 256B.0625, 
 20.35  subdivision 17, is amended to read: 
 20.36     Subd. 17.  [TRANSPORTATION COSTS.] (a) Medical assistance 
 21.1   covers transportation costs incurred solely for obtaining 
 21.2   emergency medical care or transportation costs incurred by 
 21.3   nonambulatory persons in obtaining emergency or nonemergency 
 21.4   medical care when paid directly to an ambulance company, common 
 21.5   carrier, or other recognized providers of transportation 
 21.6   services.  For the purpose of this subdivision, a person who is 
 21.7   incapable of transport by taxicab or bus shall be considered to 
 21.8   be nonambulatory. 
 21.9      (b) Medical assistance covers special transportation, as 
 21.10  defined in Minnesota Rules, part 9505.0315, subpart 1, item F, 
 21.11  if the provider receives and maintains a current physician's 
 21.12  order by the recipient's attending physician certifying that the 
 21.13  recipient has a physical or mental impairment that would 
 21.14  prohibit the recipient from safely accessing and using a bus, 
 21.15  taxi, other commercial transportation, or private 
 21.16  automobile. and the recipient: 
 21.17     (1) requires a wheelchair-accessible van or a 
 21.18  stretcher-accessible vehicle; or 
 21.19     (2) does not require a wheelchair-accessible van or a 
 21.20  stretcher-accessible vehicle but: 
 21.21     (i) resides in a facility licensed by or registered with 
 21.22  the commissioner of human services or the commissioner of 
 21.23  health; or 
 21.24     (ii) needs special transportation service to access 
 21.25  dialysis or radiation therapy services.  Individuals certified 
 21.26  as needing a wheelchair-accessible van or a stretcher-accessible 
 21.27  vehicle must have the physician certification renewed every 
 21.28  three years.  All other individuals must have the physician 
 21.29  certification renewed annually.  Special transportation includes 
 21.30  driver-assisted service to eligible individuals.  
 21.31  Driver-assisted service includes passenger pickup at and return 
 21.32  to the individual's residence or place of business, assistance 
 21.33  with admittance of the individual to the medical facility, and 
 21.34  assistance in passenger securement or in securing of wheelchairs 
 21.35  or stretchers in the vehicle.  The commissioner shall establish 
 21.36  maximum medical assistance reimbursement rates for special 
 22.1   transportation services for persons who need a 
 22.2   wheelchair-accessible van or stretcher-accessible vehicle and 
 22.3   for those who do not need a wheelchair-accessible van or 
 22.4   stretcher-accessible vehicle.  The average of these two rates 
 22.5   per trip must not exceed $15 for the base rate and $1.40 per 
 22.6   mile.  Special transportation provided to nonambulatory persons 
 22.7   who do not need a wheelchair-accessible van or 
 22.8   stretcher-accessible vehicle, may be reimbursed at a lower rate 
 22.9   than special transportation provided to persons who need a 
 22.10  wheelchair-accessible van or stretcher-accessible vehicle.  
 22.11     (c) The maximum medical assistance reimbursement rates for 
 22.12  special transportation services are: 
 22.13     (1) $18 for the base rate and $1.40 per mile for services 
 22.14  to persons who need a wheelchair-accessible van; 
 22.15     (2) $36 for the base rate and $1.40 per mile for services 
 22.16  to persons who need a stretcher-accessible vehicle; 
 22.17     (3) $9 per trip for the attendant rate for 
 22.18  wheelchair-accessible vans or stretcher accessible vehicles; and 
 22.19     (4) $12 for the base rate and $1.40 per mile for services 
 22.20  provided to persons who do not need a wheelchair-accessible van 
 22.21  or stretcher-accessible vehicle. 
 22.22     (d) In order to receive reimbursement under this 
 22.23  subdivision, all providers must maintain a daily log book that 
 22.24  is signed by an authorized representative of the emergency or 
 22.25  nonemergency medical facility to which an individual is 
 22.26  transported.  The log book must list the date and time the 
 22.27  nonambulatory person is received at the medical facility.  All 
 22.28  log books must be retained for at least five years.  All 
 22.29  providers of special transportation services must use a 
 22.30  commercially available computer mapping software program 
 22.31  selected by the commissioner to calculate mileage for purposes 
 22.32  of reimbursement under this subdivision. 
 22.33     (e) A provider may not receive reimbursement under this 
 22.34  subdivision for providing transportation solely for the purpose 
 22.35  of transporting an individual to a pharmacy.  A provider may 
 22.36  receive reimbursement for transporting an individual to a 
 23.1   pharmacy if the visit occurs following a visit to a medical 
 23.2   facility at which a prescription was provided.  A special 
 23.3   transportation provider may not receive reimbursement under this 
 23.4   subdivision for transporting a child to school, unless the 
 23.5   special transportation service is needed to obtain nonemergency 
 23.6   medical care at the school and a less costly alternative form of 
 23.7   transportation is not available. 
 23.8      (f) The medical assistance benefit plan shall include a $1 
 23.9   co-payment for special transportation services provided to 
 23.10  individuals who do not need a wheelchair-accessible van or 
 23.11  stretcher-accessible vehicle, effective for services provided on 
 23.12  or after October 1, 2003.  Recipients of medical assistance are 
 23.13  responsible for all co-payments in this subdivision.  
 23.14  Co-payments shall be subject to the following exceptions: 
 23.15     (1) children under the age of 21; 
 23.16     (2) pregnant women for services that relate to the 
 23.17  pregnancy or any other medical condition that may complicate the 
 23.18  pregnancy; 
 23.19     (3) recipients expected to reside for at least 30 days in a 
 23.20  hospital, nursing home, or intermediate care facility for the 
 23.21  mentally retarded; 
 23.22     (4) recipients receiving hospice care; 
 23.23     (5) 100 percent federally funded services provided by an 
 23.24  Indian health service; 
 23.25     (6) services that are paid by Medicare, resulting in the 
 23.26  medical assistance program paying for the coinsurance and 
 23.27  deductible; and 
 23.28     (7) co-payments that exceed one per day per provider. 
 23.29     The medical assistance reimbursement to the provider shall 
 23.30  be reduced by the amount of the co-payment.  The provider 
 23.31  collects the co-payment from the recipient.  Providers may not 
 23.32  deny services to individuals who are unable to pay the 
 23.33  co-payment.  Providers must accept an assertion from the 
 23.34  recipient that they are unable to pay. 
 23.35     (f) The commissioner is prohibited from using a broker or 
 23.36  coordinator to manage special transportation services. 
 24.1      Sec. 15.  Minnesota Statutes 2002, section 256B.092, 
 24.2   subdivision 1a, is amended to read: 
 24.3      Subd. 1a.  [CASE MANAGEMENT ADMINISTRATION AND SERVICES.] 
 24.4   (a) The administrative functions of case management provided to 
 24.5   or arranged for a person include: 
 24.6      (1) intake review of eligibility for services; 
 24.7      (2) diagnosis screening; 
 24.8      (3) screening intake; 
 24.9      (4) service authorization diagnosis; 
 24.10     (5) review of eligibility for services individualized 
 24.11  service plan development; 
 24.12     (6) service authorization; and 
 24.13     (6) (7) responding to requests for conciliation conferences 
 24.14  and appeals according to section 256.045 made by the person, the 
 24.15  person's legal guardian or conservator, or the parent if the 
 24.16  person is a minor. 
 24.17     (b) Case management service activities provided to or 
 24.18  arranged for a person include: 
 24.19     (1) development of the individual service plan; 
 24.20     (2) informing in consultation with the individual or and 
 24.21  the individual's legal guardian or conservator, or parent if the 
 24.22  person is a minor, of service options medical experts, and 
 24.23  service providers; 
 24.24     (3) (2) assisting the person in the identification of 
 24.25  potential providers; 
 24.26     (4) assisting the person to access services; 
 24.27     (5) (3) coordination of services, if coordination is not 
 24.28  provided by the service provider; 
 24.29     (6) evaluation and monitoring of the services identified in 
 24.30  the plan; and 
 24.31     (7) (4) annual reviews of service plans and services 
 24.32  provided. 
 24.33     (c) Case management administration and service activities 
 24.34  that are provided to the person with mental retardation or a 
 24.35  related condition shall be provided directly by county agencies 
 24.36  or under contract.  
 25.1      (d) Case managers are responsible for the administrative 
 25.2   duties and service provisions listed in paragraphs (a) and (b).  
 25.3   Case managers shall work with consumers, families, legal 
 25.4   representatives, and relevant service providers in the 
 25.5   development and annual review of the individualized service and 
 25.6   habilitation plans. 
 25.7      (e) The department of human services shall offer ongoing 
 25.8   education in case management to case managers.  Case managers 
 25.9   shall receive no less than ten hours of case management 
 25.10  education and training each year. 
 25.11     Sec. 16.  Minnesota Statutes 2002, section 256B.092, 
 25.12  subdivision 5, is amended to read: 
 25.13     Subd. 5.  [FEDERAL WAIVERS.] (a) The commissioner shall 
 25.14  apply for any federal waivers necessary to secure, to the extent 
 25.15  allowed by law, federal financial participation under United 
 25.16  States Code, title 42, sections 1396 et seq., as amended, for 
 25.17  the provision of services to persons who, in the absence of the 
 25.18  services, would need the level of care provided in a regional 
 25.19  treatment center or a community intermediate care facility for 
 25.20  persons with mental retardation or related conditions.  The 
 25.21  commissioner may seek amendments to the waivers or apply for 
 25.22  additional waivers under United States Code, title 42, sections 
 25.23  1396 et seq., as amended, to contain costs.  The commissioner 
 25.24  shall ensure that payment for the cost of providing home and 
 25.25  community-based alternative services under the federal waiver 
 25.26  plan shall not exceed the cost of intermediate care services 
 25.27  including day training and habilitation services that would have 
 25.28  been provided without the waivered services.  
 25.29     (b) The commissioner, in administering home and 
 25.30  community-based waivers for persons with mental retardation and 
 25.31  related conditions, shall ensure that day services for eligible 
 25.32  persons are not provided by the person's residential service 
 25.33  provider, unless the person or the person's legal representative 
 25.34  is offered a choice of providers and agrees in writing to 
 25.35  provision of day services by the residential service provider.  
 25.36  The individual service plan for individuals who choose to have 
 26.1   their residential service provider provide their day services 
 26.2   must describe how health, safety, and protection, and 
 26.3   habilitation needs will be met by, including how frequent and 
 26.4   regular contact with persons other than the residential service 
 26.5   provider will occur.  The individualized service plan must 
 26.6   address the appropriateness of receiving habilitative services 
 26.7   outside the residence on weekdays.  
 26.8      Sec. 17.  [256B.492] [REGIONAL MANAGEMENT OF HOME AND 
 26.9   COMMUNITY-BASED WAIVER SERVICES.] 
 26.10     Subdivision 1.  [REGION.] For the purposes of this section, 
 26.11  "region" means a county or a group of counties, with a 
 26.12  population of 100,000 or more, that have formed a joint powers 
 26.13  agreement to manage the home and community-based waiver services.
 26.14     Subd. 2.  [PURPOSE.] Counties may form joint powers 
 26.15  agreements for the purpose of regionally managing the home and 
 26.16  community-based waiver services under sections 256B.0916 and 
 26.17  256B.49.  Counties with a population of less than 100,000 are 
 26.18  encouraged to form joint powers agreements with other counties 
 26.19  to regionally manage the home and community-based waiver 
 26.20  services under sections 256B.0916 and 256B.49. 
 26.21     Subd. 3.  [REGIONAL WAIVER AUTHORITY.] One of the parties 
 26.22  to the joint powers agreement shall be designated the regional 
 26.23  waiver authority and shall monitor regional authorizations and 
 26.24  expenditures.  The joint powers agreement shall specify how 
 26.25  decisions are made on authorizations and expenditures from the 
 26.26  home and community-based waiver allocation. 
 26.27     Subd. 4.  [FISCAL MANAGEMENT.] A region may expend up to 
 26.28  two percent more than its home and community-based allocation in 
 26.29  a given fiscal year if the region underspends by the same amount 
 26.30  the following fiscal year.  A region may carry forward a 
 26.31  resource allocation of unspent resources within its home and 
 26.32  community-based waiver services allocation from year to year. 
 26.33     Subd. 5.  [COMMISSIONER'S AUTHORITY.] When waiver resources 
 26.34  are distributed to a group of counties, the commissioner may (1) 
 26.35  require a joint powers agreement; (2) contract with a public or 
 26.36  private agency; or (3) require both to administer the waiver 
 27.1   program for that geographic area.  The commissioner is 
 27.2   responsible for assuring that funds are used properly within the 
 27.3   amount allocated. 
 27.4      Sec. 18.  Minnesota Statutes 2002, section 256B.501, 
 27.5   subdivision 1, is amended to read: 
 27.6      Subdivision 1.  [DEFINITIONS.] For the purposes of this 
 27.7   section, the following terms have the meaning given them.  
 27.8      (a) "Commissioner" means the commissioner of human services.
 27.9      (b) "Facility" means a facility licensed as a mental 
 27.10  retardation residential facility under section 252.28, licensed 
 27.11  as a supervised living facility under chapter 144, and certified 
 27.12  as an intermediate care facility for persons with mental 
 27.13  retardation or related conditions.  The term does not include a 
 27.14  state regional treatment center. 
 27.15     (c) "Habilitation services" means health and social 
 27.16  services directed toward increasing and maintaining the 
 27.17  physical, intellectual, emotional, and social functioning of 
 27.18  persons with mental retardation or related conditions.  
 27.19  Habilitation services include therapeutic activities, 
 27.20  assistance, training, supervision, and monitoring in the areas 
 27.21  of self-care, sensory and motor development, interpersonal 
 27.22  skills, communication, socialization, reduction or elimination 
 27.23  of maladaptive behavior, community living and mobility, health 
 27.24  care, leisure and recreation, money management, and household 
 27.25  chores. 
 27.26     (d) "Services during the day" means services or supports 
 27.27  provided to a person that enables the person to be fully 
 27.28  integrated into the community.  Services during the day must 
 27.29  include habilitation services, and may include a variety of 
 27.30  supports to enable the person to exercise choices for community 
 27.31  integration and inclusion activities.  Services during the day 
 27.32  may include, but are not limited to:  supported work, support 
 27.33  during community activities, community volunteer opportunities, 
 27.34  adult day care, recreational activities, and other 
 27.35  individualized integrated supports. 
 27.36     (e) "Waivered service" means home or community-based 
 28.1   service authorized under United States Code, title 42, section 
 28.2   1396n(c), as amended through December 31, 1987, and defined in 
 28.3   the Minnesota state plan for the provision of medical assistance 
 28.4   services.  Waivered services include, at a minimum, case 
 28.5   management, family training and support, developmental training 
 28.6   homes, supervised living arrangements, semi-independent living 
 28.7   services, respite care, and training and habilitation services. 
 28.8      Sec. 19.  Minnesota Statutes 2002, section 256B.501, is 
 28.9   amended by adding a subdivision to read: 
 28.10     Subd. 3m.  [SERVICES DURING THE DAY.] When establishing a 
 28.11  rate for services during the day, the commissioner shall ensure 
 28.12  that these services comply with active treatment requirements 
 28.13  for persons residing in an ICF/MR as defined under federal 
 28.14  regulations and shall ensure that day services for eligible 
 28.15  persons are not provided by the person's residential service 
 28.16  provider, unless the person or the person's legal representative 
 28.17  is offered a choice of providers and agrees in writing to 
 28.18  provision of day services by the residential service provider, 
 28.19  consistent with the individual service plan.  The individual 
 28.20  service plan for individuals who choose to have their 
 28.21  residential service provider provide their day services must 
 28.22  describe how health, safety, protection, and habilitation needs 
 28.23  will be met, including how frequent and regular contact with 
 28.24  persons other than the residential service provider will occur.  
 28.25     Sec. 20.  Minnesota Statutes 2002, section 256B.5013, 
 28.26  subdivision 4, is amended to read: 
 28.27     Subd. 4.  [TEMPORARY RATE ADJUSTMENTS TO ADDRESS OCCUPANCY 
 28.28  AND ACCESS.] Beginning July 1, 2002, the commissioner shall 
 28.29  adjust the total payment rate for up to 75 days for the 
 28.30  remaining recipients for facilities in which the monthly 
 28.31  occupancy rate of licensed beds is 75 percent or greater, if the 
 28.32  vacancy or vacancies are due to a facility reserving beds for 
 28.33  crisis respite care or respite care for medically fragile 
 28.34  individuals.  This mechanism shall not be used to pay for 
 28.35  hospital or therapeutic leave days beyond the maximums allowed. 
 28.36     Sec. 21.  Minnesota Statutes 2002, section 256B.5015, is 
 29.1   amended to read: 
 29.2      256B.5015 [PASS-THROUGH OF TRAINING AND HABILITATION OTHER 
 29.3   SERVICES COSTS.] 
 29.4      Subdivision 1.  [DAY TRAINING AND HABILITATION SERVICES.] 
 29.5   Day training and habilitation services costs shall be paid as a 
 29.6   pass-through payment at the lowest rate paid for the comparable 
 29.7   services at that site under sections 252.40 to 252.46.  The 
 29.8   pass-through payments for training and habilitation services 
 29.9   shall be paid separately by the commissioner and shall not be 
 29.10  included in the computation of the ICF/MR facility total payment 
 29.11  rate. 
 29.12     Subd. 2.  [SERVICES DURING THE DAY.] Services during the 
 29.13  day, as defined in section 256B.501, but excluding day training 
 29.14  and habilitation services, shall be paid as a pass-through 
 29.15  payment no later than January 1, 2004.  The commissioner shall 
 29.16  establish rates for these services, other than day training and 
 29.17  habilitation services, at levels that do not exceed 60 percent 
 29.18  of a recipient's day training and habilitation costs prior to 
 29.19  the service change. 
 29.20     When establishing a rate for these services, the 
 29.21  commissioner shall also consider an individual recipient's needs 
 29.22  as identified in the individualized service plan and the 
 29.23  person's need for active treatment as defined under federal 
 29.24  regulations.  The pass-through payments for services during the 
 29.25  day shall be paid separately by the commissioner and may be 
 29.26  included in the computation of the ICF/MR facility total payment 
 29.27  rate.  
 29.28     Sec. 22.  [256M.01] [CITATION.] 
 29.29     Sections 256M.01 to 256M.80 may be cited as the "Children 
 29.30  and Community Services Act."  This act establishes a fund to 
 29.31  address the needs of children, adolescents, and young adults 
 29.32  within each county in accordance with a service agreement 
 29.33  entered into by the board of county commissioners of each county 
 29.34  and the commissioner of human services.  The service agreement 
 29.35  shall specify the outcomes to be achieved, the general 
 29.36  strategies to be employed, and the respective state and county 
 30.1   roles.  The service agreement shall be reviewed and updated 
 30.2   every two years, or sooner if both the state and the county deem 
 30.3   it necessary.  Nothing in this act is intended to limit the 
 30.4   ability of counties to provide services to adults over age 25. 
 30.5      Sec. 23.  [256M.10] [DEFINITIONS.] 
 30.6      Subdivision 1.  [SCOPE.] For the purposes of sections 
 30.7   256M.01 to 256M.80, the terms defined in this section have the 
 30.8   meanings given them. 
 30.9      Subd. 2.  [CHILDREN AND COMMUNITY SERVICES.] (a) "Children 
 30.10  and community services" means services provided or arranged for 
 30.11  by county boards for children, adolescents, and adults who 
 30.12  experience dependency, abuse, neglect, poverty, disability, 
 30.13  chronic health conditions, or other factors, including ethnicity 
 30.14  and race, that may result in poor outcomes or disparities, as 
 30.15  well as services for family members to support those individuals.
 30.16     (b) Services eligible as allowable expenditures under 
 30.17  sections 256M.01 to 256M.80 include, but are not limited to, 
 30.18  services that: 
 30.19     (1) protect a person from harm; 
 30.20     (2) support permanent living arrangements; 
 30.21     (3) provide treatment; 
 30.22     (4) maintain family relationships; 
 30.23     (5) increase parenting skills; 
 30.24     (6) reduce substance abuse; and 
 30.25     (7) reduce domestic violence.  
 30.26  These services may be provided by professionals or 
 30.27  nonprofessionals, including the person's natural supports in the 
 30.28  community.  
 30.29     (c) Services shall, to the extent possible: 
 30.30     (1) build on family and community strengths; 
 30.31     (2) help prevent crisis by meeting needs early; 
 30.32     (3) provide transitional supports to adolescents and young 
 30.33  adults making the transition to adulthood; 
 30.34     (4) offer help in basic needs, special needs, and 
 30.35  referrals; 
 30.36     (5) respond flexibly to the needs of the person and the 
 31.1   family; 
 31.2      (6) be culturally sensitive and responsive to the needs of 
 31.3   the person; and 
 31.4      (7) be offered in the family home as well as in other 
 31.5   settings. 
 31.6      (d) Children and community services do not include services 
 31.7   under the public assistance programs known as the Minnesota 
 31.8   family investment program, Minnesota supplemental aid, medical 
 31.9   assistance, general assistance, general assistance medical care, 
 31.10  MinnesotaCare, or community health services. 
 31.11     Subd. 3.  [COMMISSIONER.] "Commissioner" means the 
 31.12  commissioner of human services. 
 31.13     Subd. 4.  [COUNTY BOARD.] "County board" means the board of 
 31.14  county commissioners in each county. 
 31.15     Subd. 5.  [FORMER CHILDREN'S SERVICES AND COMMUNITY SERVICE 
 31.16  GRANTS.] "Former children's services and community service 
 31.17  grants" means allocations for the following grants: 
 31.18     (1) community social service grants under sections 252.24, 
 31.19  256E.06, and 256E.14; 
 31.20     (2) family preservation grants under section 256F.05, 
 31.21  subdivision 3; 
 31.22     (3) concurrent permanency planning grants under section 
 31.23  260C.213, subdivision 5; 
 31.24     (4) social service block grants (Title XX) under section 
 31.25  256E.07; and 
 31.26     (5) children's mental health grants under sections 245.4886 
 31.27  and 260.152. 
 31.28     Subd. 6.  [HUMAN SERVICES BOARD.] "Human services board" 
 31.29  means a board established under section 402.02; Laws 1974, 
 31.30  chapter 293; or Laws 1976, chapter 340.  
 31.31     Subd. 7.  [YOUNG ADULT.] "Young adult" means a person 
 31.32  between the ages of 18 and 25. 
 31.33     Sec. 24.  [256M.70] [FISCAL LIMITATIONS.] 
 31.34     Subdivision 1.  [SERVICE LIMITATION.] If the county has met 
 31.35  the requirements in subdivisions 2 to 4, the county shall not be 
 31.36  required to provide children and community services beyond 
 32.1   requirements in federal or state law. 
 32.2      Subd. 2.  [DEMONSTRATION OF REASONABLE EFFORT.] The county 
 32.3   shall make reasonable efforts to comply with all children and 
 32.4   community services requirements.  For the purposes of this 
 32.5   section, a county is making reasonable efforts if the county has 
 32.6   made efforts to comply with requirements within the limits of 
 32.7   available funding, including efforts to identify and apply for 
 32.8   commonly available state and federal funding for services. 
 32.9      Subd. 3.  [IDENTIFICATION OF SERVICES TO BE PROVIDED.] If a 
 32.10  county has made reasonable efforts to comply with all applicable 
 32.11  administrative rule requirements and is unable to meet all 
 32.12  requirements, the county must provide services using the 
 32.13  following considerations: 
 32.14     (1) providing services needed to protect individuals from 
 32.15  maltreatment, abuse, and neglect; 
 32.16     (2) providing emergency and crisis services needed to 
 32.17  protect clients from physical, emotional, or psychological harm; 
 32.18     (3) assessing and documenting the needs of persons applying 
 32.19  for services and referring to appropriate services when 
 32.20  necessary; 
 32.21     (4) providing public guardianship services; 
 32.22     (5) fulfilling licensing responsibilities delegated to the 
 32.23  county by the commissioner under section 245A.16; 
 32.24     (6) providing day training and habilitation services for 
 32.25  children, adolescents, young adults, and adults over age 25 with 
 32.26  developmental disabilities; and 
 32.27     (7) providing case management for persons with 
 32.28  developmental disabilities, children with serious emotional 
 32.29  disturbances, and adults with serious and persistent mental 
 32.30  illness. 
 32.31     Subd. 4.  [DENIAL, REDUCTION, OR TERMINATION OF SERVICES 
 32.32  DUE TO FISCAL LIMITATIONS.] Before a county denies, reduces, or 
 32.33  terminates services to an individual due to fiscal limitations, 
 32.34  the county must meet the requirements in subdivisions 2 and 3.  
 32.35  The county must notify the individual and the individual's 
 32.36  guardian in writing of the reason for the denial, reduction, or 
 33.1   termination of services and must inform the individual and the 
 33.2   individual's guardian in writing that the county will, upon 
 33.3   request, meet to discuss alternatives before services are 
 33.4   terminated or reduced. 
 33.5      Subd. 5.  [APPEAL RIGHTS.] An individual who applies for or 
 33.6   receives children and community services under this chapter, 
 33.7   whose application is denied, or whose services are reduced or 
 33.8   terminated has the right to a fair hearing under section 256.045.
 33.9      Subd. 6.  [RIGHT TO PETITION FOR REVIEW.] Any individual 
 33.10  who applies for or receives children and community services 
 33.11  under this chapter, whose application is denied, or whose 
 33.12  services are reduced or terminated may petition the commissioner 
 33.13  to review the county's performance under the county service 
 33.14  agreement.  The petition must be in writing and must be specific 
 33.15  as to what action the individual believes is inconsistent with 
 33.16  the county service agreement, and what action the individual 
 33.17  believes should be required.  Upon receiving a petition, the 
 33.18  commissioner shall have 60 days in which to make a reply in 
 33.19  writing as to its determination and any corrective action 
 33.20  required.  Notwithstanding any state law to the contrary, and 
 33.21  subject to provisions of federal law, during this time period, 
 33.22  the denial of eligibility or reduction or termination of 
 33.23  services shall take effect, unless the commissioner determines 
 33.24  this would endanger the life or safety of the individual.  
 33.25     Sec. 25.  [COST MANAGEMENT OF HOME AND COMMUNITY-BASED 
 33.26  WAIVERED SERVICES.] 
 33.27     (a) The commissioner of human services shall efficiently 
 33.28  allocate and manage limited home and community-based waiver 
 33.29  services program resources to achieve the following outcomes: 
 33.30     (1) the establishment of feasible and viable alternatives 
 33.31  for persons in institutional or hospital settings to relocate to 
 33.32  home and community-based settings; 
 33.33     (2) the availability of timely assistance to persons at 
 33.34  imminent risk of institutional or hospital placement or whose 
 33.35  health and safety is at immediate risk; and 
 33.36     (3) the maximum provision of essential community supports 
 34.1   to eligible persons in need of and waiting for home and 
 34.2   community-based service alternatives. 
 34.3      (b) The commissioner shall monitor the costs of home and 
 34.4   community-based services, and may adjust home and 
 34.5   community-based service allocations, as necessary, to assure 
 34.6   that program costs are managed within available funding.  When 
 34.7   making this determination, the commissioner shall give 
 34.8   consideration to offsets that may occur in other programs as a 
 34.9   result of the availability and use of home and community-based 
 34.10  services. 
 34.11     (c) The commissioner shall allocate home and 
 34.12  community-based resources to local/regional entities in a manner 
 34.13  that considers: 
 34.14     (1) the historical costs of serving individuals in a county 
 34.15  or region; 
 34.16     (2) the individualized service plans for current recipients 
 34.17  and eligible individuals expected to enter the waiver during the 
 34.18  fiscal year; and 
 34.19     (3) the need for crisis services or other short-term 
 34.20  services required because of unforeseen circumstances. 
 34.21     (d) The commissioner may reallocate resources from one 
 34.22  county or region to another if available funding in that county 
 34.23  or region is not likely to be spent and the reallocation is 
 34.24  necessary to achieve the outcomes specified in paragraph (a). 
 34.25     Sec. 26.  [SERVICE PRIORITIES.] 
 34.26     For the 2004-2005 biennium, the commissioner shall monitor 
 34.27  all available home and community-based waiver resources to 
 34.28  support the following priorities for service for eligible 
 34.29  individuals: 
 34.30     (1) children or adults who cannot be maintained safely in 
 34.31  their current living situation without waiver services; 
 34.32     (2) children or adults in unstable living situations due to 
 34.33  significant needs, age, or incapacity of the primary caregiver; 
 34.34  and 
 34.35     (3) other persons who have been screened and are eligible, 
 34.36  including those living in an ICF/MR, who are on a waiting list 
 35.1   maintained by the date of screening document. 
 35.2      Sec. 27.  [HOME AND COMMUNITY-BASED WAIVER RESOURCE 
 35.3   MANAGEMENT STATEWIDE.] 
 35.4      The commissioner shall manage program resources during the 
 35.5   2004-2005 biennium to assure that all available funds are 
 35.6   allocated to meet the service priority needs and maintain a 
 35.7   reserve statewide of no more than three percent of available 
 35.8   funds.  In order to effectively manage available resources to 
 35.9   meet service priorities, the commissioner shall enable counties 
 35.10  to manage resources on a regional basis. 
 35.11     Sec. 28.  [DENIAL, REDUCTION, OR TERMINATION OF WAIVER 
 35.12  SERVICES.] 
 35.13     For the 2004-2005 biennium, before a county denies, 
 35.14  reduces, or terminates home and community-based services under 
 35.15  sections 256B.0916 and 256B.49 for an individual, the case 
 35.16  manager must meet with the individual or the individual's 
 35.17  guardian and prioritize service needs based on the 
 35.18  individualized service plan.  The percentage reduction in the 
 35.19  dollar value of authorized services for an individual due to 
 35.20  waiver rebasing or reductions in waiver funding may not exceed 
 35.21  twice the percentage reduction in total funding to the county 
 35.22  for that waivered service due to waiver rebasing or a reduction 
 35.23  in waiver funding. 
 35.24     Sec. 29.  [DIRECTION TO THE COMMISSIONER; HOME AND 
 35.25  COMMUNITY-BASED SERVICES RESOURCE ALLOCATION METHOD 
 35.26  DEVELOPMENT.] 
 35.27     The commissioner shall consult with representatives of 
 35.28  persons with disabilities, their families and guardians, 
 35.29  counties, service providers, and advocacy organizations to 
 35.30  develop recommendations for a statewide method of allocating 
 35.31  resources sufficient to meet the identified needs of persons 
 35.32  eligible for home and community-based waiver services under 
 35.33  Minnesota Statutes, sections 256B.0916 and 256B.49.  The 
 35.34  recommendations shall include provisions that address the 
 35.35  feasibility of offering incentives to persons with less urgent 
 35.36  service needs who are receiving services or on the waiting list 
 36.1   to postpone their access to home and community-based service 
 36.2   options.  The recommendations shall be provided to the 
 36.3   legislative committees with jurisdiction over health and human 
 36.4   services issues by January 15, 2004. 
 36.5      Sec. 30.  [HOME AND COMMUNITY-BASED SERVICES FUNDING 
 36.6   METHODOLOGY.] 
 36.7      Beginning July 1, 2003, before making significant changes 
 36.8   in the funding methodology for the home and community-based 
 36.9   waiver for persons with mental retardation or a related 
 36.10  condition, the commissioner shall consult with representatives 
 36.11  of counties, service providers, and persons with disabilities 
 36.12  and their families to provide specific information about the 
 36.13  funding formula and funding changes and the opportunity to 
 36.14  comment at least 90 days before the changes become effective. 
 36.15     Sec. 31. [CASE MANAGEMENT ACCESS FOR HOME AND 
 36.16  COMMUNITY-BASED WAIVER RECIPIENTS.] 
 36.17     For the 2004-2005 biennium, when a person requests case 
 36.18  management services under Minnesota Statutes, section 256B.092 
 36.19  or 256B.49, subdivision 13, the county must determine whether 
 36.20  the person qualifies and begin the screening process within ten 
 36.21  working days and individualized service plan development and 
 36.22  provide case management services to those eligible within a 
 36.23  reasonable time.  If a county is unable to provide case 
 36.24  management services, the county shall contract for case 
 36.25  management services to meet the obligation.  
 36.26     Sec. 32.  [DIRECTION TO THE COMMISSIONER; CASE MANAGEMENT 
 36.27  SERVICES.] 
 36.28     In consultation with representatives for consumers, 
 36.29  consumer advocates, counties, and service providers, the 
 36.30  commissioner shall develop proposed legislation for case 
 36.31  management changes that will (1) streamline administration, (2) 
 36.32  improve consumer access to case management services, (3) assess 
 36.33  the feasibility of a comprehensive universal assessment protocol 
 36.34  for persons seeking community supports, (4) establish 
 36.35  accountability for funds and performance measures, and (5) 
 36.36  provide for consumer choice of the case management service 
 37.1   vendor.  The proposed legislation shall be provided to the 
 37.2   legislative committees with jurisdiction over health and human 
 37.3   services issues by February 15, 2004. 
 37.4      Sec. 33.  [DIRECTION TO THE COMMISSIONER; SEMI-INDEPENDENT 
 37.5   LIVING SERVICES AND FAMILY SUPPORT GRANT CONSOLIDATION.] 
 37.6      The commissioner shall consolidate the semi-independent 
 37.7   living services and family support grants, under Minnesota 
 37.8   Statutes, sections 252.275 and 256.476, and require a county 
 37.9   contribution equal to 20 percent of the total amount expended on 
 37.10  the grant program, by January 1, 2004. 
 37.11     Sec. 34.  [STATE-OPERATED SERVICES STUDY.] 
 37.12     The commissioner of human services shall study alternate 
 37.13  methods of providing services to persons with developmental 
 37.14  disabilities served in state-operated community services (SOCS), 
 37.15  including, but not limited to, how the services could be 
 37.16  privatized by June 30, 2005.  The commissioner also shall study 
 37.17  the Minnesota extended treatment options, including an analysis 
 37.18  of the population served by the program and the effectiveness of 
 37.19  the program.  The commissioner shall report on the results of 
 37.20  the study under this section to the chairs of the house and 
 37.21  senate committees with jurisdiction over state-operated services 
 37.22  by January 15, 2004.  
 37.23     Sec. 35.  [VACANCY LISTINGS.] 
 37.24     The commissioner of human services shall work with 
 37.25  interested stakeholders on how provider and industry specific 
 37.26  Web sites can provide useful information to consumers on bed 
 37.27  vacancies for group residential housing providers and 
 37.28  intermediate care facilities for persons with mental retardation 
 37.29  and related conditions.  Providers and industry trade 
 37.30  organizations are responsible for all costs related to 
 37.31  maintaining Web sites listing bed vacancies. 
 37.32     Sec. 36.  [CASE MANAGEMENT SERVICES.] 
 37.33     Notwithstanding any other law or rule to the contrary, all 
 37.34  case management services provided to individuals for nonwaivered 
 37.35  services shall be paid by the state. 
 37.36     Sec. 37.  [REVIEW OF SPECIAL TRANSPORTATION ELIGIBILITY 
 38.1   CRITERIA.] 
 38.2      The commissioner of human services, in consultation with 
 38.3   the commissioner of transportation and special transportation 
 38.4   service providers, shall review eligibility criteria for medical 
 38.5   assistance special transportation services and shall evaluate 
 38.6   whether the level of special transportation services provided 
 38.7   should be based on the degree of impairment of the client, as 
 38.8   well as the medical diagnosis.  The commissioner shall present 
 38.9   recommendations for changes in the eligibility criteria for 
 38.10  special transportation services to the chairs and ranking 
 38.11  minority members of the house and senate committees with 
 38.12  jurisdiction over health and human services spending by January 
 38.13  15, 2004. 
 38.14     Sec. 38.  [HOMELESS SERVICES; STATE CONTRACTS.] 
 38.15     Nonprofit organizations providing homeless services in two 
 38.16  or more counties may apply directly to the commissioner of human 
 38.17  services for a contract to provide services.  No more than two 
 38.18  percent of Community Social Services Act funds are set aside to 
 38.19  provide for contracts under this section.  
 38.20     Sec. 39.  [REPEALER.] 
 38.21     (a) Minnesota Statutes 2002, sections 245.4886; 245.496; 
 38.22  252.32, subdivision 2; 254A.17; 256B.0945, subdivisions 6, 7, 8, 
 38.23  9, and 10; 256E.01; 256E.02; 256E.03; 256E.04; 256E.05; 256E.06; 
 38.24  256E.07; 256E.09; 256E.10; 256E.11; 256E.115; 256E.12; 256E.13; 
 38.25  256E.14; 256E.15; 256F.01; 256F.02; 256F.03; 256F.04; 256F.05; 
 38.26  256F.06; 256F.07; 256F.08; 256F.11; 256F.12; 256F.14; 257.075; 
 38.27  257.81; 260.152; and 626.562, are repealed. 
 38.28     (b) Minnesota Rules, parts 9550.0010; 9550.0020; 9550.0030; 
 38.29  9550.0040; 9550.0050; 9550.0060; 9550.0070; 9550.0080; 
 38.30  9550.0090; 9550.0091; 9550.0092; and 9550.0093, are repealed. 
 38.31                             ARTICLE 2 
 38.32         REDUCTION OF DUPLICATIVE HEALTH AND HUMAN SERVICES 
 38.33                        LICENSING ACTIVITIES 
 38.34     Section 1.  Minnesota Statutes 2002, section 144.057, 
 38.35  subdivision 1, is amended to read: 
 38.36     Subdivision 1.  [BACKGROUND STUDIES REQUIRED.] The 
 39.1   commissioner of health shall contract with the commissioner of 
 39.2   human services to conduct background studies of: 
 39.3      (1) individuals providing services which have direct 
 39.4   contact, as defined under section 245A.04, subdivision 3, with 
 39.5   patients and residents in hospitals, boarding care homes, 
 39.6   outpatient surgical centers licensed under sections 144.50 to 
 39.7   144.58; nursing homes and home care agencies licensed under 
 39.8   chapter 144A; ICF/MR certified by the commissioner of health as 
 39.9   intermediate care facilities that provide services for persons 
 39.10  with mental retardation or related conditions under Code of 
 39.11  Federal Regulations, title 42, section 483; residential care 
 39.12  homes licensed under chapter 144B, and board and lodging 
 39.13  establishments that are registered to provide supportive or 
 39.14  health supervision services under section 157.17; 
 39.15     (2) individuals specified in section 245A.04, subdivision 
 39.16  3, paragraph (c), who perform direct contact services in a 
 39.17  nursing home or a home care agency licensed under chapter 144A 
 39.18  or a boarding care home licensed under sections 144.50 to 
 39.19  144.58, and if the individual under study resides outside 
 39.20  Minnesota, the study must be at least as comprehensive as that 
 39.21  of a Minnesota resident and include a search of information from 
 39.22  the criminal justice data communications network in the state 
 39.23  where the subject of the study resides; 
 39.24     (3) beginning July 1, 1999, all other employees in nursing 
 39.25  homes licensed under chapter 144A, and boarding care homes 
 39.26  licensed under sections 144.50 to 144.58.  A disqualification of 
 39.27  an individual in this section shall disqualify the individual 
 39.28  from positions allowing direct contact or access to patients or 
 39.29  residents receiving services.  "Access" means physical access to 
 39.30  a client or the client's personal property without continuous, 
 39.31  direct supervision as defined in section 245A.04, subdivision 3, 
 39.32  paragraph (b), clause (2), when the employee's employment 
 39.33  responsibilities do not include providing direct contact 
 39.34  services; 
 39.35     (4) individuals employed by a supplemental nursing services 
 39.36  agency, as defined under section 144A.70, who are providing 
 40.1   services in health care facilities; and 
 40.2      (5) controlling persons of a supplemental nursing services 
 40.3   agency, as defined under section 144A.70. 
 40.4      If a facility or program is licensed by the department of 
 40.5   human services and subject to the background study provisions of 
 40.6   chapter 245A and is also licensed by the department of health, 
 40.7   the department of human services is solely responsible for the 
 40.8   background studies of individuals in the jointly licensed 
 40.9   programs. 
 40.10     Sec. 2.  Minnesota Statutes 2002, section 144.50, 
 40.11  subdivision 6, is amended to read: 
 40.12     Subd. 6.  [SUPERVISED LIVING FACILITY LICENSES.] (a) The 
 40.13  commissioner may license as a supervised living facility a 
 40.14  facility seeking medical assistance certification as an 
 40.15  intermediate care facility for persons with mental retardation 
 40.16  or related conditions for four or more persons as authorized 
 40.17  under section 252.291. 
 40.18     (b) Class B supervised living facilities shall be 
 40.19  classified as follows for purposes of the State Building Code: 
 40.20     (1) Class B supervised living facilities for six or less 
 40.21  persons must meet Group R, Division 3, occupancy requirements; 
 40.22  and 
 40.23     (2) Class B supervised living facilities for seven to 16 
 40.24  persons must meet Group R, Division 1, occupancy requirements. 
 40.25     (c) Class B facilities classified under paragraph (b), 
 40.26  clauses (1) and (2), must meet the fire protection provisions of 
 40.27  chapter 21 of the 1985 Life Safety Code, NFPA 101, for 
 40.28  facilities housing persons with impractical evacuation 
 40.29  capabilities, except that Class B facilities licensed prior to 
 40.30  July 1, 1990, need only continue to meet institutional fire 
 40.31  safety provisions.  Class B supervised living facilities shall 
 40.32  provide the necessary physical plant accommodations to meet the 
 40.33  needs and functional disabilities of the residents.  For Class B 
 40.34  supervised living facilities licensed after July 1, 1990, and 
 40.35  housing nonambulatory or nonmobile persons, the corridor access 
 40.36  to bedrooms, common spaces, and other resident use spaces must 
 41.1   be at least five feet in clear width, except that a waiver may 
 41.2   be requested in accordance with Minnesota Rules, part 4665.0600. 
 41.3      (d) The commissioner may license as a Class A supervised 
 41.4   living board and lodge facility under chapter 157 as a 
 41.5   residential program for chemically dependent individuals that 
 41.6   allows children to reside with the parent receiving treatment in 
 41.7   the facility.  The licensee of the program shall be responsible 
 41.8   for the health, safety, and welfare of the children residing in 
 41.9   the facility.  The facility in which the program is located must 
 41.10  be provided with a sprinkler system approved by the state fire 
 41.11  marshal.  The licensee shall also provide additional space and 
 41.12  physical plant accommodations appropriate for the number and age 
 41.13  of children residing in the facility.  For purposes of license 
 41.14  capacity, each child residing in the facility shall be 
 41.15  considered to be a resident.  
 41.16     Sec. 3.  [144.601] [ICF/MR; LICENSURE.] 
 41.17     Subdivision 1.  [REQUIREMENTS GOVERNING ICF/MR.] (a) When 
 41.18  certifying an intermediate care facility for persons with mental 
 41.19  retardation or related conditions or ICF/MR, the commissioner 
 41.20  shall: 
 41.21     (1) license the facility as a supervised living facility 
 41.22  under sections 144.50 to 144.58; 
 41.23     (2) assure compliance with requirements set forth in the 
 41.24  Code of Federal Regulations governing intermediate care 
 41.25  facilities for persons with mental retardation or related 
 41.26  conditions; 
 41.27     (3) enforce requirements governing the use of aversive and 
 41.28  deprivation procedures set forth in Minnesota Rules, parts 
 41.29  9525.2700 to 9525.2810; and 
 41.30     (4) assure compliance with the psychotropic medication use 
 41.31  checklist defined under section 245B.02, subdivision 19. 
 41.32     (b) The commissioner of health may not grant a variance to 
 41.33  any requirements governing use of aversive and deprivation 
 41.34  procedures under Minnesota Rules, parts 9525.2700 to 9525.2810; 
 41.35  compliance with the psychotropic medication use checklist; or 
 41.36  provisions governing data practices. 
 42.1      (c) The commissioner of health shall monitor compliance 
 42.2   with the requirements governing ICFs/MR in subdivisions 2 to 14. 
 42.3      Subd. 2.  [CONSUMER HEALTH.] The license holder is 
 42.4   responsible for meeting a consumer's health service needs 
 42.5   assigned to the license holder in the individual service plan 
 42.6   and for bringing a consumer's health needs, as discovered by the 
 42.7   license holder, promptly to the attention of the consumer, the 
 42.8   consumer's legal representative, and the case manager. 
 42.9      Subd. 3.  [FIRST AID.] When the license holder is providing 
 42.10  direct service and supervision to a consumer who requires a 
 42.11  24-hour plan of care and receives services at an ICF/MR, the 
 42.12  license holder must have available a staff person trained in 
 42.13  first aid and cardiopulmonary resuscitation from a qualified 
 42.14  source, as determined by the commissioner. 
 42.15     Subd. 4.  [REPORTING INCIDENTS.] (a) The license holder 
 42.16  must maintain information about and report incidents to a 
 42.17  consumer's legal representative, other licensed caregiver, if 
 42.18  any, and case manager within 24 hours of the occurrence, or 
 42.19  within 24 hours of receipt of the information unless the 
 42.20  incident has been reported by another license holder. 
 42.21     (b) When the incident involves more than one consumer, the 
 42.22  license holder must not disclose personally identifiable 
 42.23  information about any other consumer when making the report to 
 42.24  each consumer's legal representative, other licensed caregiver, 
 42.25  if any, and case manager, unless the license holder has the 
 42.26  consent of a consumer or a consumer's legal representative. 
 42.27     (c) Within 24 hours of reporting maltreatment as required 
 42.28  under section 626.556 or 626.557, the license holder must inform 
 42.29  the consumer's legal representative and case manager of the 
 42.30  report unless there is reason to believe that the legal 
 42.31  representative or case manager is involved in the suspected 
 42.32  maltreatment.  The information the license holder must disclose 
 42.33  is the nature of the activity or occurrence reported, the agency 
 42.34  that received the report, and the telephone number of the 
 42.35  commissioner of health's office of health facility complaints. 
 42.36     (d) The license holder must report a consumer's death or 
 43.1   serious injury to the commissioner of health and the ombudsman, 
 43.2   as required under sections 245.91 and 245.94, subdivision 2a. 
 43.3      (e) For purposes of this subdivision, "incident" means any 
 43.4   of the following: 
 43.5      (1) serious injury as determined by section 245.91, 
 43.6   subdivision 6; 
 43.7      (2) a consumer's death; 
 43.8      (3) any medical emergencies, unexpected serious illnesses, 
 43.9   or accidents that require physician treatment or 
 43.10  hospitalization; 
 43.11     (4) a consumer's unauthorized absence; 
 43.12     (5) any fires or other circumstances involving a law 
 43.13  enforcement agency; 
 43.14     (6) physical aggression by a consumer against another 
 43.15  consumer that causes physical pain, injury, or persistent 
 43.16  emotional distress, including, but not limited to, hitting, 
 43.17  slapping, kicking, scratching, pinching, biting, pushing, and 
 43.18  spitting; 
 43.19     (7) any sexual activity between consumers involving force 
 43.20  or coercion as defined under section 609.341, subdivisions 3 and 
 43.21  14; or 
 43.22     (8) a report of child or vulnerable adult maltreatment 
 43.23  under section 626.556 or 626.557. 
 43.24     Subd. 5.  [PROGRESS REVIEWS.] The license holder must 
 43.25  participate in progress review meetings following stated time 
 43.26  lines established in the consumer's individual service plan or 
 43.27  as requested in writing by the consumer, the consumer's legal 
 43.28  representative, or the case manager, at a minimum of once a 
 43.29  year.  The license holder must summarize the progress toward 
 43.30  achieving the desired outcomes and make recommendations in a 
 43.31  written report sent to the consumer or the consumer's legal 
 43.32  representative and case manager before the review meeting. 
 43.33     Subd. 6.  [LEAVING THE RESIDENCE.] As specified in each 
 43.34  consumer's individual service plan, each consumer requiring a 
 43.35  24-hour plan of care must leave the residence to participate in 
 43.36  regular education, employment, or community activities.  License 
 44.1   holders providing services to consumers living in a licensed 
 44.2   site must ensure that they are prepared to care for consumers 
 44.3   whenever they are at the residence during the day because of 
 44.4   illness, work schedules, or other reasons. 
 44.5      Subd. 7.  [PROHIBITION.] The license holder must not use 
 44.6   psychotropic medication and the use of aversive and deprivation 
 44.7   procedures, as referenced in section 245.825 and rules 
 44.8   promulgated under that section, as a substitute for adequate 
 44.9   staffing, as punishment, or for staff convenience. 
 44.10     Subd. 8.  [CONSUMER DATA FILE.] The license holder must 
 44.11  maintain the following information for each consumer: 
 44.12     (1) identifying information that includes date of birth, 
 44.13  medications, legal representative, history, medical, and other 
 44.14  individual-specific information, and names and telephone numbers 
 44.15  of contacts; 
 44.16     (2) consumer health information, including individual 
 44.17  medication administration and monitoring information; 
 44.18     (3) the consumer's individual service plan.  When a 
 44.19  consumer's case manager does not provide a current individual 
 44.20  service plan, the license holder must make a written request to 
 44.21  the case manager to provide a copy of the individual service 
 44.22  plan and inform the consumer or the consumer's legal 
 44.23  representative of the right to an individual service plan and 
 44.24  the right to appeal under section 256.045; 
 44.25     (4) copies of assessments, analyses, summaries, and 
 44.26  recommendations; 
 44.27     (5) progress review reports; 
 44.28     (6) incidents involving the consumer; 
 44.29     (7) reports required under subdivision 4; 
 44.30     (8) discharge summary, when applicable; 
 44.31     (9) record of other license holders serving the consumer 
 44.32  that includes a contact person and telephone numbers, services 
 44.33  being provided, services that require coordination between two 
 44.34  license holders, and name of staff responsible for coordination; 
 44.35     (10) information about verbal aggression directed at the 
 44.36  consumer by another consumer; and 
 45.1      (11) information about self-abuse. 
 45.2      Subd. 9.  [ACCESS TO RECORDS.] The license holder must 
 45.3   ensure that the following people have access to the information 
 45.4   in subdivision 8: 
 45.5      (1) the consumer, the consumer's legal representative, and 
 45.6   anyone properly authorized by the consumer or legal 
 45.7   representative; 
 45.8      (2) the consumer's case manager; and 
 45.9      (3) staff providing direct services to the consumer unless 
 45.10  the information is not relevant to carrying out the individual 
 45.11  service plan. 
 45.12     Subd. 10.  [RETENTION OF CONSUMER'S RECORDS.] The license 
 45.13  holder must retain the records required for consumers for at 
 45.14  least three years following termination of services. 
 45.15     Subd. 11.  [STAFF ORIENTATION.] (a) Within 60 days of 
 45.16  hiring staff who provide direct service, the license holder must 
 45.17  provide 30 hours of staff orientation.  Direct care staff must 
 45.18  complete 15 of the 30 hours of orientation before providing any 
 45.19  unsupervised direct service to a consumer. 
 45.20     (b) The 30 hours of orientation must combine supervised 
 45.21  on-the-job training with coverage of the following material: 
 45.22     (1) review of the consumer's service plans and risk 
 45.23  management plan to achieve an understanding of the consumer as a 
 45.24  unique individual; 
 45.25     (2) review and instruction on the license holder's policies 
 45.26  and procedures, including their location and access; 
 45.27     (3) emergency procedures; 
 45.28     (4) explanation of specific job functions, including 
 45.29  implementing objectives from the consumer's individual service 
 45.30  plan; 
 45.31     (5) explanation of responsibilities related to sections 
 45.32  626.556 and 626.557, governing maltreatment reporting and 
 45.33  service planning for children and vulnerable adults, and section 
 45.34  245.825, governing use of aversive and deprivation procedures; 
 45.35     (6) medication administration as it applies to the 
 45.36  individual consumer, and when the consumer meets the criteria of 
 46.1   having overriding health care needs, then medication 
 46.2   administration taught by a health services professional.  Staff 
 46.3   may administer medications only after they demonstrate the 
 46.4   ability, as defined in the license holder's medication 
 46.5   administration policy and procedures.  Once a consumer with 
 46.6   overriding health care needs is admitted, the license holder 
 46.7   must provide staff with remedial training as deemed necessary by 
 46.8   the license holder and the health professional to meet the needs 
 46.9   of that consumer.  For purposes of this requirement, overriding 
 46.10  health care needs means a health care condition that affects the 
 46.11  service options available to the consumer because the condition 
 46.12  requires: 
 46.13     (i) specialized or intensive medical or nursing 
 46.14  supervision; and 
 46.15     (ii) nonmedical service providers to adapt their services 
 46.16  to accommodate the health and safety needs of the consumer; 
 46.17     (7) consumer rights; and 
 46.18     (8) other topics necessary as determined by the consumer's 
 46.19  individual service plan or other areas identified by the license 
 46.20  holder. 
 46.21     (c) The license holder must document the orientation each 
 46.22  employee receives. 
 46.23     Subd. 12.  [STAFF TRAINING.] (a) The license holder must 
 46.24  ensure that direct service staff annually complete hours of 
 46.25  training equal to two percent of the number of hours the staff 
 46.26  person worked.  Direct service staff who have worked for the 
 46.27  license holder for an average of at least 30 hours per week for 
 46.28  24 or more months must annually complete hours of training equal 
 46.29  to one percent of the number of hours the staff person worked. 
 46.30     (b) The license holder must document the training completed 
 46.31  by each employee. 
 46.32     (c) Training must address staff competencies necessary to 
 46.33  address the consumer's needs as identified in the consumer's 
 46.34  individual service plan and ensure consumer health, safety, and 
 46.35  protection of rights.  Training may also include other areas 
 46.36  identified by the license holder. 
 47.1      (d) For consumers requiring a 24-hour plan of care, the 
 47.2   license holder must provide training in cardiopulmonary 
 47.3   resuscitation from a qualified source determined by the 
 47.4   commissioner if the consumer's health needs as determined by the 
 47.5   consumer's physician indicate trained staff would be necessary 
 47.6   to the consumer. 
 47.7      Subd. 13.  [POLICIES AND PROCEDURES.] The license holder 
 47.8   must develop and implement the following policies and procedures:
 47.9      (1) psychotropic medication monitoring when the consumer is 
 47.10  prescribed a psychotropic medication, including the use of the 
 47.11  psychotropic medication use checklist.  If the responsibility 
 47.12  for implementing the psychotropic medication use checklist has 
 47.13  not been assigned in the individual service plan and the 
 47.14  consumer lives in a licensed site, the residential license 
 47.15  holder must be designated; 
 47.16     (2) criteria for admission or service initiation developed 
 47.17  by the license holder; 
 47.18     (3) policies and procedures that promote continuity and 
 47.19  quality of consumer supports by ensuring: 
 47.20     (i) continuity of care and service coordination, including 
 47.21  provisions for service termination, temporary service 
 47.22  suspension, and efforts made by the license holder to coordinate 
 47.23  services with other vendors who also provide support to the 
 47.24  consumer.  The policy must include the following requirements: 
 47.25     (A) the license holder must notify the consumer or 
 47.26  consumer's legal representative and the consumer's case manager 
 47.27  in writing of the intended termination or temporary service 
 47.28  suspension and the consumer's right to seek a temporary order 
 47.29  staying the termination or suspension of service according to 
 47.30  the procedures in section 256.045, subdivision 4a, or 
 47.31  subdivision 6, paragraph (c); 
 47.32     (B) notice of the proposed termination of services, 
 47.33  including those situations that began with a temporary service 
 47.34  suspension, must be given at least 60 days before the proposed 
 47.35  termination is to become effective; 
 47.36     (C) the license holder must provide information requested 
 48.1   by the consumer or consumer's legal representative or case 
 48.2   manager when services are temporarily suspended or upon notice 
 48.3   of termination; 
 48.4      (D) use of temporary service suspension procedures are 
 48.5   restricted to situations in which the consumer's behavior causes 
 48.6   immediate and serious danger to the health and safety of the 
 48.7   individual or others; 
 48.8      (E) prior to giving notice of service termination or 
 48.9   temporary service suspension, the license holder must document 
 48.10  actions taken to minimize or eliminate the need for service 
 48.11  termination or temporary service suspension; and 
 48.12     (F) during the period of temporary service suspension, the 
 48.13  license holder will work with the appropriate county agency to 
 48.14  develop reasonable alternatives to protect the individual and 
 48.15  others; and 
 48.16     (ii) quality services measured through a program evaluation 
 48.17  process including regular evaluations of consumer satisfaction 
 48.18  and sharing the results of the evaluations with the consumers 
 48.19  and legal representatives. 
 48.20     Subd. 14.  [CONSUMER FUNDS.] (a) The license holder must 
 48.21  ensure that consumers retain the use and availability of 
 48.22  personal funds or property unless restrictions are justified in 
 48.23  the consumer's individual service plan. 
 48.24     (b) The license holder must ensure separation of consumer 
 48.25  funds from funds of the license holder, the program, or program 
 48.26  staff. 
 48.27     (c) Whenever the license holder assists a consumer with the 
 48.28  safekeeping of funds or other property, the license holder must 
 48.29  have written authorization to do so by the consumer or the 
 48.30  consumer's legal representative, and the case manager.  In 
 48.31  addition, the license holder must: 
 48.32     (1) document receipt and disbursement of the consumer's 
 48.33  funds or the property; 
 48.34     (2) annually survey, document, and implement the 
 48.35  preferences of the consumer, consumer's legal representative, 
 48.36  and the case manager for frequency of receiving a statement that 
 49.1   itemizes receipts and disbursements of consumer funds or other 
 49.2   property; and 
 49.3      (3) return to the consumer, upon the consumer's request, 
 49.4   funds and property in the license holder's possession subject to 
 49.5   restrictions in the consumer's individual service plan, as soon 
 49.6   as possible, but no later than three working days after the date 
 49.7   of the request. 
 49.8      (d) License holders and program staff must not: 
 49.9      (1) borrow money from a consumer; 
 49.10     (2) purchase personal items from a consumer; 
 49.11     (3) sell merchandise or personal services to a consumer; 
 49.12     (4) require a consumer to purchase items for which the 
 49.13  license holder is eligible for reimbursement; or 
 49.14     (5) use consumer funds in a manner that would violate 
 49.15  requirements under this subdivision. 
 49.16     Sec. 4.  Minnesota Statutes 2002, section 245A.02, 
 49.17  subdivision 14, is amended to read: 
 49.18     Subd. 14.  [RESIDENTIAL PROGRAM.] "Residential program" 
 49.19  means a program that provides 24-hour-a-day care, supervision, 
 49.20  food, lodging, rehabilitation, training, education, 
 49.21  habilitation, or treatment outside a person's own home, 
 49.22  including a nursing home or hospital that receives public funds, 
 49.23  administered by the commissioner, to provide services for five 
 49.24  or more persons whose primary diagnosis is mental retardation or 
 49.25  a related condition or mental illness and who do not have a 
 49.26  significant physical or medical problem that necessitates 
 49.27  nursing home care; a program in an intermediate care facility a 
 49.28  board and lodging or supervised living facility for four or more 
 49.29  persons with mental retardation or a related condition that is 
 49.30  not an ICF/MR; a nursing home or hospital that was licensed by 
 49.31  the commissioner on July 1, 1987, to provide a program for 
 49.32  persons with a physical handicap that is not the result of the 
 49.33  normal aging process and considered to be a chronic condition; 
 49.34  and chemical dependency or chemical abuse programs that are 
 49.35  located in a hospital or nursing home and receive public funds 
 49.36  for providing chemical abuse or chemical dependency treatment 
 50.1   services under chapter 254B.  Residential programs include home 
 50.2   and community-based services for persons with mental retardation 
 50.3   or a related condition that are provided in or outside of a 
 50.4   person's own home. 
 50.5      Sec. 5.  Minnesota Statutes 2002, section 245A.02, is 
 50.6   amended by adding a subdivision to read: 
 50.7      Subd. 20.  [ICF/MR.] For purposes of this chapter, ICF/MR 
 50.8   means an intermediate care facility for persons with mental 
 50.9   retardation or related conditions as defined in section 
 50.10  256B.055, subdivision 12, paragraph (d). 
 50.11     Sec. 6.  Minnesota Statutes 2002, section 245A.03, is 
 50.12  amended by adding a subdivision to read: 
 50.13     Subd. 1a.  [LICENSING JURISDICTION; MINIMIZING DUPLICATION 
 50.14  OF AGENCY LICENSING ACTIVITIES.] (a) To minimize the duplication 
 50.15  of licensing activities between the commissioners of human 
 50.16  services and health related to ICFs/MR and residential programs 
 50.17  licensed by the commissioner of human services that also have a 
 50.18  supervised living facility class A license issued by the 
 50.19  commissioner of health, the commissioners' jurisdiction over 
 50.20  licensing activities is determined under this subdivision. 
 50.21     (b) The commissioner of health shall have sole 
 50.22  responsibility for licensing ICFs/MR, including investigating 
 50.23  allegations of maltreatment in the facilities and contracting 
 50.24  with the commissioner of human services under section 144.057, 
 50.25  subdivision 1, for the required background studies.  In addition 
 50.26  to enforcement of ICF/MR standards and supervised living 
 50.27  facility standards, the commissioner of health shall enforce 
 50.28  Minnesota Rules, parts 9525.2700 to 9525.2810, regarding use of 
 50.29  aversive and deprivation procedures, and requirements related to 
 50.30  the psychotropic medication use checklist defined in section 
 50.31  245B.02, subdivision 19. 
 50.32     (c) The commissioner of human services shall enforce 
 50.33  licensure requirements for residential mental health treatment 
 50.34  facilities and residential chemical dependency treatment 
 50.35  facilities.  Except for chemical dependency detoxification 
 50.36  programs that also have a supervised living facility license 
 51.1   class B under sections 144.50 to 144.56, programs licensed under 
 51.2   Minnesota Rules, parts 9530.4100 to 9530.4450 and parts 
 51.3   9520.0500 to 9520.0690 shall be licensed as board and lodge 
 51.4   establishments under chapter 157. 
 51.5      (d)  Residential programs licensed by the commissioner of 
 51.6   human services under this chapter that are also licensed by the 
 51.7   commissioner of health as class B supervised living facilities 
 51.8   under sections 144.50 to 144.601, on March 1, 2003, shall 
 51.9   continue to be licensed as class B supervised living facilities 
 51.10  until such time as the commissioners of health, human services, 
 51.11  public safety, and administration determine whether the 
 51.12  International Building Code and Fire Code to become effective in 
 51.13  2003 will provide adequate safety, when combined with a board 
 51.14  and lodging license for these programs. 
 51.15     Sec. 7.  Minnesota Statutes 2002, section 245A.03, 
 51.16  subdivision 2, is amended to read: 
 51.17     Subd. 2.  [EXCLUSION FROM LICENSURE.] (a) This chapter does 
 51.18  not apply to: 
 51.19     (1) residential or nonresidential programs that are 
 51.20  provided to a person by an individual who is related unless the 
 51.21  residential program is a child foster care placement made by a 
 51.22  local social services agency or a licensed child-placing agency, 
 51.23  except as provided in subdivision 2a; 
 51.24     (2) nonresidential programs that are provided by an 
 51.25  unrelated individual to persons from a single related family; 
 51.26     (3) residential or nonresidential programs that are 
 51.27  provided to adults who do not abuse chemicals or who do not have 
 51.28  a chemical dependency, a mental illness, mental retardation or a 
 51.29  related condition, a functional impairment, or a physical 
 51.30  handicap; 
 51.31     (4) sheltered workshops or work activity programs that are 
 51.32  certified by the commissioner of economic security; 
 51.33     (5) programs for children enrolled in kindergarten to the 
 51.34  12th grade and prekindergarten special education in a school as 
 51.35  defined in section 120A.22, subdivision 4, and programs serving 
 51.36  children in combined special education and regular 
 52.1   prekindergarten programs that are operated or assisted by the 
 52.2   commissioner of children, families, and learning; 
 52.3      (6) nonresidential programs primarily for children that 
 52.4   provide care or supervision, without charge for ten or fewer 
 52.5   days a year, and for periods of less than three hours a day 
 52.6   while the child's parent or legal guardian is in the same 
 52.7   building as the nonresidential program or present within another 
 52.8   building that is directly contiguous to the building in which 
 52.9   the nonresidential program is located; 
 52.10     (7) nursing homes or hospitals licensed by the commissioner 
 52.11  of health except as specified under section 245A.02; 
 52.12     (8) board and lodge facilities licensed by the commissioner 
 52.13  of health that provide services for five or more persons whose 
 52.14  primary diagnosis is mental illness who have refused an 
 52.15  appropriate residential program offered by a county agency; 
 52.16     (9) homes providing programs for persons placed there by a 
 52.17  licensed agency for legal adoption, unless the adoption is not 
 52.18  completed within two years; 
 52.19     (10) programs licensed by the commissioner of corrections; 
 52.20     (11) recreation programs for children or adults that 
 52.21  operate for fewer than 40 calendar days in a calendar year or 
 52.22  programs operated by a park and recreation board of a city of 
 52.23  the first class whose primary purpose is to provide social and 
 52.24  recreational activities to school age children, provided the 
 52.25  program is approved by the park and recreation board; 
 52.26     (12) programs operated by a school as defined in section 
 52.27  120A.22, subdivision 4, whose primary purpose is to provide 
 52.28  child care to school-age children, provided the program is 
 52.29  approved by the district's school board; 
 52.30     (13) Head Start nonresidential programs which operate for 
 52.31  less than 31 days in each calendar year; 
 52.32     (14) noncertified boarding care homes unless they provide 
 52.33  services for five or more persons whose primary diagnosis is 
 52.34  mental illness or mental retardation; 
 52.35     (15) nonresidential programs for nonhandicapped children 
 52.36  provided for a cumulative total of less than 30 days in any 
 53.1   12-month period; 
 53.2      (16) residential programs for persons with mental illness, 
 53.3   that are located in hospitals, until the commissioner adopts 
 53.4   appropriate rules; 
 53.5      (17) the religious instruction of school-age children; 
 53.6   Sabbath or Sunday schools; or the congregate care of children by 
 53.7   a church, congregation, or religious society during the period 
 53.8   used by the church, congregation, or religious society for its 
 53.9   regular worship; 
 53.10     (18) camps licensed by the commissioner of health under 
 53.11  Minnesota Rules, chapter 4630; 
 53.12     (19) mental health outpatient services for adults with 
 53.13  mental illness or children with emotional disturbance; 
 53.14     (20) residential programs serving school-age children whose 
 53.15  sole purpose is cultural or educational exchange, until the 
 53.16  commissioner adopts appropriate rules; 
 53.17     (21) unrelated individuals who provide out-of-home respite 
 53.18  care services to persons with mental retardation or related 
 53.19  conditions from a single related family for no more than 90 days 
 53.20  in a 12-month period and the respite care services are for the 
 53.21  temporary relief of the person's family or legal representative; 
 53.22     (22) respite care services provided as a home and 
 53.23  community-based service to a person with mental retardation or a 
 53.24  related condition, in the person's primary residence; 
 53.25     (23) community support services programs as defined in 
 53.26  section 245.462, subdivision 6, and family community support 
 53.27  services as defined in section 245.4871, subdivision 17; 
 53.28     (24) the placement of a child by a birth parent or legal 
 53.29  guardian in a preadoptive home for purposes of adoption as 
 53.30  authorized by section 259.47; 
 53.31     (25) settings registered under chapter 144D which provide 
 53.32  home care services licensed by the commissioner of health to 
 53.33  fewer than seven adults; or 
 53.34     (26) ICFs/MR; or 
 53.35     (27) consumer-directed community support service funded 
 53.36  under the Medicaid waiver for persons with mental retardation 
 54.1   and related conditions when the individual who provided the 
 54.2   service is:  
 54.3      (i) the same individual who is the direct payee of these 
 54.4   specific waiver funds or paid by a fiscal agent, fiscal 
 54.5   intermediary, or employer of record; and 
 54.6      (ii) not otherwise under the control of a residential or 
 54.7   nonresidential program that is required to be licensed under 
 54.8   this chapter when providing the service. 
 54.9      (b) For purposes of paragraph (a), clause (6), a building 
 54.10  is directly contiguous to a building in which a nonresidential 
 54.11  program is located if it shares a common wall with the building 
 54.12  in which the nonresidential program is located or is attached to 
 54.13  that building by skyway, tunnel, atrium, or common roof. 
 54.14     (c) Nothing in this chapter shall be construed to require 
 54.15  licensure for any services provided and funded according to an 
 54.16  approved federal waiver plan where licensure is specifically 
 54.17  identified as not being a condition for the services and funding.
 54.18     Sec. 8.  [245A.157] [ADDITIONAL LICENSING STANDARDS FOR 
 54.19  CERTAIN RESIDENTIAL PROGRAMS.] 
 54.20     Subdivision 1.  [COMPANION LICENSE 
 54.21  REQUIREMENT.] Notwithstanding any law or rule to the contrary, a 
 54.22  residential program: 
 54.23     (1) serving persons with mental retardation or related 
 54.24  conditions that is not foster care and is not an ICF/MR, must 
 54.25  have at least a board and lodge license issued by the 
 54.26  commissioner of health under chapter 157 in accordance with 
 54.27  Minnesota Rules, parts 4625.0100 to 4625.2355 and 4626.0010 to 
 54.28  4626.1825; 
 54.29     (2) licensed to provide category I or II services to 
 54.30  persons with mental illness under Minnesota Rules, parts 
 54.31  9520.0500 to 9520.0690, must have at least a board and lodge 
 54.32  license issued by the commissioner of health under chapter 157 
 54.33  in accordance with Minnesota Rules, parts 4625.0100 to 4625.2355 
 54.34  and 4626.0010 to 4626.1825; 
 54.35     (3) licensed to provide category I chemical dependency 
 54.36  services under Minnesota Rules, parts 9530.4100 to 9530.4450, 
 55.1   must have at least a supervised living facility class B license 
 55.2   issued by the commissioner of health under sections 144.50 to 
 55.3   144.58; and 
 55.4      (4) licensed to provide category II, III, or IV chemical 
 55.5   dependency services under Minnesota Rules, parts 9530.4100 to 
 55.6   9530.4450, must have at least a board and lodge license issued 
 55.7   by the commissioner of health under chapter 157 in accordance 
 55.8   with Minnesota Rules, parts 4625.0100 to 4625.2355 and 4626.0010 
 55.9   to 4626.1825. 
 55.10     Subd. 2.  [ADDITIONAL LICENSING REQUIREMENTS FOR MENTAL 
 55.11  HEALTH AND CHEMICAL DEPENDENCY TREATMENT PROGRAMS.] (a) In 
 55.12  addition to licensing requirements set forth in Minnesota Rules, 
 55.13  parts 9520.0500 to 9520.0690, for programs serving persons with 
 55.14  mental illness, and Minnesota Rules, parts 9530.4100 to 
 55.15  9530.4450, for programs serving persons with a chemical 
 55.16  dependency, the commissioner of human services shall ensure 
 55.17  compliance with the requirements under this subdivision. 
 55.18     (b) Before providing medication assistance to a person 
 55.19  served by a program, an employee, other than a physician, 
 55.20  registered nurse, or licensed practical nurse, who is 
 55.21  responsible for medication assistance, must provide a 
 55.22  certificate verifying successful completion of a formalized 
 55.23  training program offered by the license holder.  The training 
 55.24  program must be taught and supervised by a registered nurse.  
 55.25  The training must include, but is not limited to, the proper 
 55.26  storage, dispensing, and recording of medications.  The license 
 55.27  holder must document the medication administration training 
 55.28  provided by a registered nurse to unlicensed personnel and place 
 55.29  the documentation in the unlicensed employees' personnel 
 55.30  records.  A registered nurse must provide consultation and 
 55.31  review of the license holder's administration of medications, 
 55.32  including a timely review of all medication errors. 
 55.33     (c) A facility must have a written plan that specifies 
 55.34  actions and procedures for responding to fire, serious illness, 
 55.35  severe weather, missing persons, and other emergencies.  The 
 55.36  program administrator must review the plan with staff and 
 56.1   residents.  The license holder must develop the plan with the 
 56.2   advice of the local fire and rescue authority or other emergency 
 56.3   response authorities.  The plan must specify responsibilities 
 56.4   assumed by the license holder for assisting residents who 
 56.5   require emergency care or special assistance in emergencies.  
 56.6   The license holder must ensure that all staff providing program 
 56.7   services review the following at least quarterly: 
 56.8      (1) assignment of persons to specific tasks and 
 56.9   responsibilities in an emergency situation; 
 56.10     (2) instructions on using alarm systems and emergency 
 56.11  equipment; 
 56.12     (3) when and how to notify appropriate persons outside the 
 56.13  facility; and 
 56.14     (4) evacuation routes and procedures. 
 56.15     (d) Clients and residents have the right to: 
 56.16     (1) be treated with courtesy and respect for their 
 56.17  individuality by employees of or persons providing service in a 
 56.18  health care facility; 
 56.19     (2) refuse treatment.  A license holder must inform 
 56.20  residents or clients who refuse treatment, medication, or 
 56.21  dietary restrictions of the likely medical or major 
 56.22  psychological results of the refusal, and put documentation of 
 56.23  the refusal in the individual client record; 
 56.24     (3) be free from maltreatment as defined under sections 
 56.25  626.556 and 626.5572; 
 56.26     (4) confidential treatment of the client's or resident's 
 56.27  personal and medical records.  The client or resident may 
 56.28  approve or refuse the release of personal and medical records to 
 56.29  any individual outside the facility; 
 56.30     (5) retain and use their personal clothing and possessions 
 56.31  as space permits, unless doing so infringes upon the rights of 
 56.32  other clients or residents or is medically or programmatically 
 56.33  contraindicated for documented medical, safety, or programmatic 
 56.34  reasons.  The facility must maintain a central locked depository 
 56.35  or provide individual locked storage areas in which clients or 
 56.36  residents may store valuables for safekeeping.  The facility 
 57.1   may, but is not required to, provide compensation for or 
 57.2   replacement of lost or stolen items; and 
 57.3      (6) not perform labor or services for the facility unless 
 57.4   the activities are included for therapeutic purposes and 
 57.5   appropriately goal-related in their individual medical record. 
 57.6      Sec. 9.  Minnesota Statutes 2002, section 245B.01, is 
 57.7   amended to read: 
 57.8      245B.01 [RULE CONSOLIDATION.] 
 57.9      This chapter establishes new methods to ensure the quality 
 57.10  of services to persons with mental retardation or related 
 57.11  conditions, and streamlines and simplifies regulation of 
 57.12  services and supports for persons with mental retardation or 
 57.13  related conditions.  Sections 245B.02 to 245B.07 establishes new 
 57.14  standards that eliminate duplication and overlap of regulatory 
 57.15  requirements by consolidating and replacing rule parts from four 
 57.16  program rules.  Section 245B.08 authorizes the commissioner of 
 57.17  human services to develop and use new regulatory strategies to 
 57.18  maintain compliance with the streamlined requirements.  This 
 57.19  chapter does not apply to ICFs/MR. 
 57.20     Sec. 10.  Minnesota Statutes 2002, section 245B.02, 
 57.21  subdivision 13, is amended to read: 
 57.22     Subd. 13.  [INTERMEDIATE CARE FACILITY FOR PERSONS WITH 
 57.23  MENTAL RETARDATION OR RELATED CONDITIONS OR ICF/MR.] 
 57.24  "Intermediate care facility" for persons with mental retardation 
 57.25  or related conditions or ICF/MR means a residential program 
 57.26  licensed to provide services to persons with mental retardation 
 57.27  or related conditions under section 252.28 and chapter 245A and 
 57.28  a physical facility licensed as a supervised living facility 
 57.29  under chapter 144, which together are certified by the 
 57.30  department of health as an intermediate care facility for 
 57.31  persons with mental retardation or related conditions. 
 57.32     Sec. 11.  Minnesota Statutes 2002, section 245B.03, 
 57.33  subdivision 1, is amended to read: 
 57.34     Subdivision 1.  [APPLICABILITY.] The standards in this 
 57.35  chapter govern services to persons with mental retardation or 
 57.36  related conditions receiving services from license holders 
 58.1   providing residential-based habilitation; day training and 
 58.2   habilitation services for adults; supported employment; 
 58.3   semi-independent living services; residential programs that 
 58.4   serve more than four consumers, including intermediate care 
 58.5   facilities for persons with mental retardation for persons with 
 58.6   mental retardation or related conditions that are not licensed 
 58.7   as foster care programs and are not ICFs/MR; and respite care 
 58.8   provided outside the consumer's home for more than four 
 58.9   consumers at the same time at a single site. 
 58.10     Sec. 12.  Minnesota Statutes 2002, section 245B.03, 
 58.11  subdivision 2, is amended to read: 
 58.12     Subd. 2.  [RELATIONSHIP TO OTHER STANDARDS GOVERNING 
 58.13  SERVICES FOR PERSONS WITH MENTAL RETARDATION OR RELATED 
 58.14  CONDITIONS.] (a) ICFs/MR are exempt from: 
 58.15     (1) section 245B.04; 
 58.16     (2) section 245B.06, subdivisions 4 and 6; and 
 58.17     (3) section 245B.07, subdivisions 4, paragraphs (b) and 
 58.18  (c); 7; and 8, paragraphs (1), clause (iv), and (2). 
 58.19     (b) License holders also licensed under chapter 144 as a 
 58.20  supervised living facility are exempt from section 245B.04. 
 58.21     (c) (b) Residential service sites controlled by license 
 58.22  holders licensed under chapter 245B for home and community-based 
 58.23  waivered services for four or fewer adults are exempt from 
 58.24  compliance with Minnesota Rules, parts 9543.0040, subpart 2, 
 58.25  item C; 9555.5505; 9555.5515, items B and G; 9555.5605; 
 58.26  9555.5705; 9555.6125, subparts 3, item C, subitem (2), and 4 to 
 58.27  6; 9555.6185; 9555.6225, subpart 8; 9555.6245; 9555.6255; and 
 58.28  9555.6265.  The commissioner may approve alternative methods of 
 58.29  providing overnight supervision using the process and criteria 
 58.30  for granting a variance in section 245A.04, subdivision 9.  This 
 58.31  chapter does not apply to foster care homes that do not provide 
 58.32  residential habilitation services funded under the home and 
 58.33  community-based waiver programs defined in section 256B.092. 
 58.34     (d) (c) The commissioner may exempt license holders from 
 58.35  applicable standards of this chapter when the license holder 
 58.36  meets the standards under section 245A.09, subdivision 7.  
 59.1   License holders that are accredited by an independent 
 59.2   accreditation body shall continue to be licensed under this 
 59.3   chapter. 
 59.4      (e) (d) License holders governed by sections 245B.02 to 
 59.5   245B.07 must also meet the licensure requirements in chapter 
 59.6   245A.  
 59.7      (f) (e) Nothing in this chapter prohibits license holders 
 59.8   from concurrently serving consumers with and without mental 
 59.9   retardation or related conditions provided this chapter's 
 59.10  standards are met as well as other relevant standards. 
 59.11     (g) (f) The documentation that sections 245B.02 to 245B.07 
 59.12  require of the license holder meets the individual program plan 
 59.13  required in section 256B.092 or successor provisions.  
 59.14     Sec. 13.  Minnesota Statutes 2002, section 252.27, 
 59.15  subdivision 1, is amended to read: 
 59.16     Subdivision 1.  [COUNTY OF FINANCIAL RESPONSIBILITY.] 
 59.17  Whenever any child who has mental retardation or a related 
 59.18  condition, or a physical disability or emotional disturbance is 
 59.19  in 24-hour care outside the home including respite care, in an 
 59.20  ICF/MR or a facility licensed by the commissioner of human 
 59.21  services, the cost of services shall be paid by the county of 
 59.22  financial responsibility determined pursuant to chapter 256G.  
 59.23  If the child's parents or guardians do not reside in this state, 
 59.24  the cost shall be paid by the responsible governmental agency in 
 59.25  the state from which the child came, by the parents or guardians 
 59.26  of the child if they are financially able, or, if no other 
 59.27  payment source is available, by the commissioner of human 
 59.28  services. 
 59.29     Sec. 14.  Minnesota Statutes 2002, section 252.28, 
 59.30  subdivision 2, is amended to read: 
 59.31     Subd. 2.  [RULES; PROGRAM STANDARDS; LICENSES.] The 
 59.32  commissioner of human services shall: 
 59.33     (1) Establish uniform rules and program standards for each 
 59.34  type of residential and day facility or service for persons with 
 59.35  mental retardation or related conditions, including state 
 59.36  hospitals under control of the commissioner and serving persons 
 60.1   with mental retardation or related conditions, and excluding 
 60.2   persons with mental retardation or related conditions residing 
 60.3   with their families or in ICFs/MR. 
 60.4      (2) Grant licenses according to the provisions of Laws 
 60.5   1976, chapter 243, sections 2 to 13. 
 60.6      Sec. 15.  Minnesota Statutes 2002, section 252.291, 
 60.7   subdivision 1, is amended to read: 
 60.8      Subdivision 1.  [MORATORIUM.] Notwithstanding section 
 60.9   252.28, subdivision 1, or any other law or rule to the contrary, 
 60.10  the commissioner of human services shall deny any request for a 
 60.11  determination of need and refuse to grant a license pursuant to 
 60.12  section 245A.02 for any new intermediate care facility for 
 60.13  persons with mental retardation or related conditions or for an 
 60.14  increase in the licensed capacity of an existing facility except 
 60.15  as provided in this subdivision and subdivision 2.  The total 
 60.16  number of certified intermediate care beds for persons with 
 60.17  mental retardation or related conditions in community facilities 
 60.18  and state hospitals shall not exceed 7,000 beds except that, to 
 60.19  the extent that federal authorities disapprove any applications 
 60.20  of the commissioner for home and community-based waivers under 
 60.21  United States Code, title 42, section 1396n, as amended through 
 60.22  December 31, 1987, the commissioner may authorize new 
 60.23  intermediate care beds, as necessary, to serve persons with 
 60.24  mental retardation or related conditions who would otherwise 
 60.25  have been served under a proposed waiver.  "Certified bed" means 
 60.26  an intermediate care bed for persons with mental retardation or 
 60.27  related conditions certified by the commissioner of health for 
 60.28  the purposes of the medical assistance program under United 
 60.29  States Code, title 42, sections 1396 to 1396p, as amended 
 60.30  through December 31, 1987.  
 60.31     Sec. 16.  Minnesota Statutes 2002, section 252.291, 
 60.32  subdivision 2a, is amended to read: 
 60.33     Subd. 2a.  [EXCEPTION FOR LAKE OWASSO PROJECT.] (a) The 
 60.34  commissioner shall authorize and grant a license under chapter 
 60.35  245A to a new intermediate care facility for persons with mental 
 60.36  retardation effective January 1, 2000, under the following 
 61.1   circumstances: 
 61.2      (1) the new facility replaces an existing 64-bed 
 61.3   intermediate care facility for the mentally retarded located in 
 61.4   Ramsey county; 
 61.5      (2) the new facility is located upon a parcel of land 
 61.6   contiguous to the parcel upon which the existing 64-bed facility 
 61.7   is located; 
 61.8      (3) the new facility is comprised of no more than eight 
 61.9   twin home style buildings and an administration building; 
 61.10     (4) the total licensed bed capacity of the facility does 
 61.11  not exceed 64 beds; and 
 61.12     (5) the existing 64-bed facility is demolished. 
 61.13     (b) The medical assistance payment rate for the new 
 61.14  facility shall be the higher of the rate specified in paragraph 
 61.15  (c) or as otherwise provided by law. 
 61.16     (c) The new facility shall be considered a newly 
 61.17  established facility for rate setting purposes and shall be 
 61.18  eligible for the investment per bed limit specified in section 
 61.19  256B.501, subdivision 11, paragraph (c), and the interest 
 61.20  expense limitation specified in section 256B.501, subdivision 
 61.21  11, paragraph (d).  Notwithstanding section 256B.5011, the newly 
 61.22  established facility's initial payment rate shall be set 
 61.23  according to Minnesota Rules, part 9553.0075, and shall not be 
 61.24  subject to the provisions of section 256B.501, subdivision 5b. 
 61.25     (d) During the construction of the new facility, Ramsey 
 61.26  county shall work with residents, families, and service 
 61.27  providers to explore all service options open to current 
 61.28  residents of the facility. 
 61.29     Sec. 17.  Minnesota Statutes 2002, section 256B.055, 
 61.30  subdivision 12, is amended to read: 
 61.31     Subd. 12.  [DISABLED CHILDREN.] (a) A person is eligible 
 61.32  for medical assistance if the person is under age 19 and 
 61.33  qualifies as a disabled individual under United States Code, 
 61.34  title 42, section 1382c(a), and would be eligible for medical 
 61.35  assistance under the state plan if residing in a medical 
 61.36  institution, and the child requires a level of care provided in 
 62.1   a hospital, nursing facility, or intermediate care facility for 
 62.2   persons with mental retardation or related conditions, for whom 
 62.3   home care is appropriate, provided that the cost to medical 
 62.4   assistance under this section is not more than the amount that 
 62.5   medical assistance would pay for if the child resides in an 
 62.6   institution.  After the child is determined to be eligible under 
 62.7   this section, the commissioner shall review the child's 
 62.8   disability under United States Code, title 42, section 1382c(a) 
 62.9   and level of care defined under this section no more often than 
 62.10  annually and may elect, based on the recommendation of health 
 62.11  care professionals under contract with the state medical review 
 62.12  team, to extend the review of disability and level of care up to 
 62.13  a maximum of four years.  The commissioner's decision on the 
 62.14  frequency of continuing review of disability and level of care 
 62.15  is not subject to administrative appeal under section 256.045.  
 62.16  Nothing in this subdivision shall be construed as affecting 
 62.17  other redeterminations of medical assistance eligibility under 
 62.18  this chapter and annual cost-effective reviews under this 
 62.19  section.  
 62.20     (b) For purposes of this subdivision, "hospital" means an 
 62.21  institution as defined in section 144.696, subdivision 3, 
 62.22  144.55, subdivision 3, or Minnesota Rules, part 4640.3600, and 
 62.23  licensed pursuant to sections 144.50 to 144.58.  For purposes of 
 62.24  this subdivision, a child requires a level of care provided in a 
 62.25  hospital if the child is determined by the commissioner to need 
 62.26  an extensive array of health services, including mental health 
 62.27  services, for an undetermined period of time, whose health 
 62.28  condition requires frequent monitoring and treatment by a health 
 62.29  care professional or by a person supervised by a health care 
 62.30  professional, who would reside in a hospital or require frequent 
 62.31  hospitalization if these services were not provided, and the 
 62.32  daily care needs are more complex than a nursing facility level 
 62.33  of care.  
 62.34     A child with serious emotional disturbance requires a level 
 62.35  of care provided in a hospital if the commissioner determines 
 62.36  that the individual requires 24-hour supervision because the 
 63.1   person exhibits recurrent or frequent suicidal or homicidal 
 63.2   ideation or behavior, recurrent or frequent psychosomatic 
 63.3   disorders or somatopsychic disorders that may become life 
 63.4   threatening, recurrent or frequent severe socially unacceptable 
 63.5   behavior associated with psychiatric disorder, ongoing and 
 63.6   chronic psychosis or severe, ongoing and chronic developmental 
 63.7   problems requiring continuous skilled observation, or severe 
 63.8   disabling symptoms for which office-centered outpatient 
 63.9   treatment is not adequate, and which overall severely impact the 
 63.10  individual's ability to function. 
 63.11     (c) For purposes of this subdivision, "nursing facility" 
 63.12  means a facility which provides nursing care as defined in 
 63.13  section 144A.01, subdivision 5, licensed pursuant to sections 
 63.14  144A.02 to 144A.10, which is appropriate if a person is in 
 63.15  active restorative treatment; is in need of special treatments 
 63.16  provided or supervised by a licensed nurse; or has unpredictable 
 63.17  episodes of active disease processes requiring immediate 
 63.18  judgment by a licensed nurse.  For purposes of this subdivision, 
 63.19  a child requires the level of care provided in a nursing 
 63.20  facility if the child is determined by the commissioner to meet 
 63.21  the requirements of the preadmission screening assessment 
 63.22  document under section 256B.0911 and the home care independent 
 63.23  rating document under section 256B.0627, subdivision 5, 
 63.24  paragraph (f), item (iii), adjusted to address age-appropriate 
 63.25  standards for children age 18 and under, pursuant to section 
 63.26  256B.0627, subdivision 5, paragraph (d), clause (2). 
 63.27     (d) For purposes of this subdivision, "intermediate care 
 63.28  facility for persons with mental retardation or related 
 63.29  conditions" or "ICF/MR" means a program licensed to provide 
 63.30  services to persons with mental retardation under section 
 63.31  252.28, and chapter 245A, and a physical plant licensed as a 
 63.32  supervised living facility under chapter 144, which together are 
 63.33  certified by the Minnesota department of health as meeting the 
 63.34  standards in Code of Federal Regulations, title 42, part 483, 
 63.35  for an intermediate care facility which provides services for 
 63.36  persons with mental retardation or persons with related 
 64.1   conditions who require 24-hour supervision and active treatment 
 64.2   for medical, behavioral, or habilitation needs.  For purposes of 
 64.3   this subdivision, a child requires a level of care provided in 
 64.4   an ICF/MR if the commissioner finds that the child has mental 
 64.5   retardation or a related condition in accordance with section 
 64.6   256B.092, is in need of a 24-hour plan of care and active 
 64.7   treatment similar to persons with mental retardation, and there 
 64.8   is a reasonable indication that the child will need ICF/MR 
 64.9   services. 
 64.10     (e) For purposes of this subdivision, a person requires the 
 64.11  level of care provided in a nursing facility if the person 
 64.12  requires 24-hour monitoring or supervision and a plan of mental 
 64.13  health treatment because of specific symptoms or functional 
 64.14  impairments associated with a serious mental illness or disorder 
 64.15  diagnosis, which meet severity criteria for mental health 
 64.16  established by the commissioner and published in March 1997 as 
 64.17  the Minnesota Mental Health Level of Care for Children and 
 64.18  Adolescents with Severe Emotional Disorders. 
 64.19     (f) The determination of the level of care needed by the 
 64.20  child shall be made by the commissioner based on information 
 64.21  supplied to the commissioner by the parent or guardian, the 
 64.22  child's physician or physicians, and other professionals as 
 64.23  requested by the commissioner.  The commissioner shall establish 
 64.24  a screening team to conduct the level of care determinations 
 64.25  according to this subdivision. 
 64.26     (g) If a child meets the conditions in paragraph (b), (c), 
 64.27  (d), or (e), the commissioner must assess the case to determine 
 64.28  whether: 
 64.29     (1) the child qualifies as a disabled individual under 
 64.30  United States Code, title 42, section 1382c(a), and would be 
 64.31  eligible for medical assistance if residing in a medical 
 64.32  institution; and 
 64.33     (2) the cost of medical assistance services for the child, 
 64.34  if eligible under this subdivision, would not be more than the 
 64.35  cost to medical assistance if the child resides in a medical 
 64.36  institution to be determined as follows: 
 65.1      (i) for a child who requires a level of care provided in an 
 65.2   ICF/MR, the cost of care for the child in an institution shall 
 65.3   be determined using the average payment rate established for the 
 65.4   regional treatment centers that are certified as ICFs/MR; 
 65.5      (ii) for a child who requires a level of care provided in 
 65.6   an inpatient hospital setting according to paragraph (b), 
 65.7   cost-effectiveness shall be determined according to Minnesota 
 65.8   Rules, part 9505.3520, items F and G; and 
 65.9      (iii) for a child who requires a level of care provided in 
 65.10  a nursing facility according to paragraph (c) or (e), 
 65.11  cost-effectiveness shall be determined according to Minnesota 
 65.12  Rules, part 9505.3040, except that the nursing facility average 
 65.13  rate shall be adjusted to reflect rates which would be paid for 
 65.14  children under age 16.  The commissioner may authorize an amount 
 65.15  up to the amount medical assistance would pay for a child 
 65.16  referred to the commissioner by the preadmission screening team 
 65.17  under section 256B.0911. 
 65.18     (h) Children eligible for medical assistance services under 
 65.19  section 256B.055, subdivision 12, as of June 30, 1995, must be 
 65.20  screened according to the criteria in this subdivision prior to 
 65.21  January 1, 1996.  Children found to be ineligible may not be 
 65.22  removed from the program until January 1, 1996.  
 65.23     Sec. 18.  Minnesota Statutes 2002, section 626.5572, 
 65.24  subdivision 6, is amended to read: 
 65.25     Subd. 6.  [FACILITY.] (a) "Facility" means a hospital or 
 65.26  other entity required to be licensed under sections 144.50 to 
 65.27  144.58; a nursing home required to be licensed to serve adults 
 65.28  under section 144A.02; a residential or nonresidential facility 
 65.29  required to be licensed to serve adults under sections 245A.01 
 65.30  to 245A.16 chapter 245A; an ICF/MR as defined in section 
 65.31  256B.055, subdivision 12; a home care provider licensed or 
 65.32  required to be licensed under section 144A.46; a hospice 
 65.33  provider licensed under sections 144A.75 to 144A.755; or a 
 65.34  person or organization that exclusively offers, provides, or 
 65.35  arranges for personal care assistant services under the medical 
 65.36  assistance program as authorized under sections 256B.04, 
 66.1   subdivision 16, 256B.0625, subdivision 19a, and 256B.0627.  
 66.2      (b) For home care providers and personal care attendants, 
 66.3   the term "facility" refers to the provider or person or 
 66.4   organization that exclusively offers, provides, or arranges for 
 66.5   personal care services, and does not refer to the client's home 
 66.6   or other location at which services are rendered. 
 66.7      Sec. 19.  Minnesota Statutes 2002, section 626.5572, 
 66.8   subdivision 13, is amended to read: 
 66.9      Subd. 13.  [LEAD AGENCY.] "Lead agency" is the primary 
 66.10  administrative agency responsible for investigating reports made 
 66.11  under section 626.557. 
 66.12     (a) The department of health is the lead agency for the 
 66.13  facilities which are licensed or are required to be licensed as: 
 66.14  hospitals, including mental health and chemical dependency 
 66.15  treatment programs licensed as hospitals; home care providers, 
 66.16  including home care services provided in adult foster care 
 66.17  settings; ICFs/MR; nursing homes,; residential care homes,; or 
 66.18  boarding care homes. 
 66.19     (b) The department of human services is the lead agency for 
 66.20  the programs licensed or required to be licensed as:  adult day 
 66.21  care,; adult foster care, except services provided in a foster 
 66.22  setting by a home health care provider or an unlicensed home 
 66.23  care provider; programs for people with developmental 
 66.24  disabilities, except ICFs/MR; and mental health programs, and 
 66.25  chemical health programs, or personal care provider 
 66.26  organizations except programs licensed as a hospital. 
 66.27     (c) The county social service agency or its designee is the 
 66.28  lead agency for all other reports. 
 66.29     Sec. 20.  [APPROPRIATION.] 
 66.30     (a) $....... is appropriated in fiscal year 2004 and 
 66.31  $....... is appropriated in fiscal year 2005 from the state 
 66.32  government special revenue account to the base budget of the 
 66.33  commissioner of health to implement the provisions in this 
 66.34  article. 
 66.35     (b) $....... is appropriated in fiscal year 2004 and 
 66.36  $....... is appropriated in fiscal year 2005 from the general 
 67.1   fund to the base budget of the commissioner of human services to 
 67.2   implement the provisions of this article. 
 67.3      Sec. 21.  [REPEALER.] 
 67.4      Minnesota Rules, parts 9520.0660, subpart 3; 9520.0670, 
 67.5   subpart 3; and 9530.4120, subpart 5, are repealed. 
 67.6      Sec. 22.  [EFFECTIVE DATE.] 
 67.7      Sections 1 to 20 are effective January 1, 2004.