1.1                          A bill for an act 
  1.2             relating to human services; changing continuing care 
  1.3             provisions; reducing duplicative licensing activities; 
  1.4             providing alternative placement for certain offenders 
  1.5             with serious and persistent mental illness; modifying 
  1.6             medical assistance eligibility standards; modifying 
  1.7             pharmaceutical drug reimbursement provisions; 
  1.8             establishing a list of health services not eligible 
  1.9             for coverage; establishing an employer-subsidized 
  1.10            coverage exemption under MinnesotaCare; strengthening 
  1.11            provisions on prohibited transfers of certain assets 
  1.12            and income; modifying lien provisions; modifying 
  1.13            estate claims provisions; establishing a 
  1.14            pharmaceutical care demonstration project; modifying 
  1.15            reimbursement of transportation costs; modifying child 
  1.16            care assistance; modifying children's mental health 
  1.17            screening; modifying human services licensing 
  1.18            provisions; amending Minnesota Statutes 2002, sections 
  1.19            62J.692, subdivision 8; 119B.011, subdivisions 5, 6, 
  1.20            15, 19, by adding a subdivision; 119B.02, subdivision 
  1.21            1; 119B.03, subdivision 9; 119B.05, subdivision 1; 
  1.22            119B.08, subdivision 3; 119B.09, subdivision 7; 
  1.23            119B.11, subdivision 2a; 119B.12, subdivision 2; 
  1.24            119B.13, subdivisions 2, 6, by adding a subdivision; 
  1.25            119B.19, subdivision 7; 119B.21, subdivision 11; 
  1.26            119B.23, subdivision 3; 144.057, subdivision 1; 
  1.27            144.50, subdivision 6; 244.05, by adding a 
  1.28            subdivision; 245.4874; 245A.02, subdivision 14, by 
  1.29            adding a subdivision; 245A.03, subdivision 2, by 
  1.30            adding a subdivision; 245A.09, subdivision 7; 245A.10; 
  1.31            245A.11, by adding a subdivision; 245B.01; 245B.02, 
  1.32            subdivision 13; 245B.03, subdivisions 1, 2, by adding 
  1.33            a subdivision; 245B.06, subdivisions 2, 5; 245B.07, 
  1.34            subdivisions 6, 9; 245B.08, subdivision 1; 252.27, 
  1.35            subdivision 1; 252.28, subdivision 2; 252.291, 
  1.36            subdivisions 1, 2a; 252.32, subdivisions 1, 1a, 3, 3c; 
  1.37            253B.05, by adding a subdivision; 256.01, subdivision 
  1.38            2; 256.046, subdivision 1; 256.0471, subdivision 1; 
  1.39            256.98, subdivision 8; 256B.055, subdivision 12; 
  1.40            256B.057, subdivision 2; 256B.0595, subdivisions 1, 2, 
  1.41            by adding subdivisions; 256B.0621, subdivision 4; 
  1.42            256B.0623, subdivisions 2, 4, 5, 6, 8; 256B.0625, 
  1.43            subdivisions 13, 17, 19c, by adding subdivisions; 
  1.44            256B.0627, subdivisions 1, 4, 9; 256B.0911, 
  1.45            subdivision 4d; 256B.0915, by adding a subdivision; 
  1.46            256B.092, subdivision 5; 256B.15, subdivisions 1, 1a, 
  2.1             2, 3, 4, by adding subdivisions; 256B.195, subdivision 
  2.2             4; 256B.47, subdivision 2; 256B.69, subdivision 5a; 
  2.3             256L.06, subdivision 3; 256L.07, subdivisions 1, 3, by 
  2.4             adding a subdivision; 256L.12, subdivision 9; 256L.15, 
  2.5             subdivision 3, by adding a subdivision; 257.0769; 
  2.6             259.21, subdivision 6; 259.67, subdivision 7; 
  2.7             260B.157, subdivision 1; 260B.176, subdivision 2; 
  2.8             260B.178, subdivision 1; 260B.193, subdivision 2; 
  2.9             260B.235, subdivision 6; 295.53, subdivision 1; 
  2.10            297I.15, subdivisions 1, 4; 514.981, subdivision 6; 
  2.11            524.3-805; 626.5572, subdivisions 6, 13; proposing 
  2.12            coding for new law in Minnesota Statutes, chapters 
  2.13            119B; 144; 245; 245A; 256B; 514; 609; repealing 
  2.14            Minnesota Statutes 2002, sections 119B.061; 252.32, 
  2.15            subdivision 2; Laws 2001, First Special Session 
  2.16            chapter 3, article 1, section 16; Minnesota Rules, 
  2.17            parts 9520.0660, subpart 3; 9520.0670, subpart 3; 
  2.18            9530.4120, subpart 5. 
  2.19  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  2.20                             ARTICLE 1
  2.21                     CONTINUING CARE PROVISIONS
  2.22     Section 1.  Minnesota Statutes 2002, section 252.32, 
  2.23  subdivision 1, is amended to read: 
  2.24     Subdivision 1.  [PROGRAM ESTABLISHED.] In accordance with 
  2.25  state policy established in section 256F.01 that all children 
  2.26  are entitled to live in families that offer safe, nurturing, 
  2.27  permanent relationships, and that public services be directed 
  2.28  toward preventing the unnecessary separation of children from 
  2.29  their families, and because many families who have children with 
  2.30  mental retardation or related conditions disabilities have 
  2.31  special needs and expenses that other families do not have, the 
  2.32  commissioner of human services shall establish a program to 
  2.33  assist families who have dependents dependent children with 
  2.34  mental retardation or related conditions disabilities living in 
  2.35  their home.  The program shall make support grants available to 
  2.36  the families. 
  2.37     Sec. 2.  Minnesota Statutes 2002, section 252.32, 
  2.38  subdivision 1a, is amended to read: 
  2.39     Subd. 1a.  [SUPPORT GRANTS.] (a) Provision of support 
  2.40  grants must be limited to families who require support and whose 
  2.41  dependents are under the age of 22 and who have mental 
  2.42  retardation or who have a related condition 21 and who have been 
  2.43  determined by a screening team established certified disabled 
  2.44  under section 256B.092 to be at risk of 
  3.1   institutionalization 256B.055, subdivision 12, paragraphs (a), 
  3.2   (b), (c), (d), and (e).  Families who are receiving home and 
  3.3   community-based waivered services for persons with mental 
  3.4   retardation or related conditions are not eligible for support 
  3.5   grants. 
  3.6      Families receiving grants who will be receiving home and 
  3.7   community-based waiver services for persons with mental 
  3.8   retardation or a related condition for their family member 
  3.9   within the grant year, and who have ongoing payments for 
  3.10  environmental or vehicle modifications which have been approved 
  3.11  by the county as a grant expense and would have qualified for 
  3.12  payment under this waiver may receive a onetime grant payment 
  3.13  from the commissioner to reduce or eliminate the principal of 
  3.14  the remaining debt for the modifications, not to exceed the 
  3.15  maximum amount allowable for the remaining years of eligibility 
  3.16  for a family support grant.  The commissioner is authorized to 
  3.17  use up to $20,000 annually from the grant appropriation for this 
  3.18  purpose.  Any amount unexpended at the end of the grant year 
  3.19  shall be allocated by the commissioner in accordance with 
  3.20  subdivision 3a, paragraph (b), clause (2).  Families whose 
  3.21  annual adjusted gross income is $60,000 or more are not eligible 
  3.22  for support grants except in cases where extreme hardship is 
  3.23  demonstrated.  Beginning in state fiscal year 1994, the 
  3.24  commissioner shall adjust the income ceiling annually to reflect 
  3.25  the projected change in the average value in the United States 
  3.26  Department of Labor Bureau of Labor Statistics consumer price 
  3.27  index (all urban) for that year. 
  3.28     (b) Support grants may be made available as monthly subsidy 
  3.29  grants and lump sum grants. 
  3.30     (c) Support grants may be issued in the form of cash, 
  3.31  voucher, and direct county payment to a vendor.  
  3.32     (d) Applications for the support grant shall be made by the 
  3.33  legal guardian to the county social service agency.  The 
  3.34  application shall specify the needs of the families, the form of 
  3.35  the grant requested by the families, and that the families have 
  3.36  agreed to use the support grant for items and services within 
  4.1   the designated reimbursable expense categories and 
  4.2   recommendations of the county to be reimbursed.  
  4.3      (e) Families who were receiving subsidies on the date of 
  4.4   implementation of the $60,000 income limit in paragraph (a) 
  4.5   continue to be eligible for a family support grant until 
  4.6   December 31, 1991, if all other eligibility criteria are met.  
  4.7   After December 31, 1991, these families are eligible for a grant 
  4.8   in the amount of one-half the grant they would otherwise 
  4.9   receive, for as long as they remain eligible under other 
  4.10  eligibility criteria.  
  4.11     Sec. 3.  Minnesota Statutes 2002, section 252.32, 
  4.12  subdivision 3, is amended to read: 
  4.13     Subd. 3.  [AMOUNT OF SUPPORT GRANT; USE.] Support grant 
  4.14  amounts shall be determined by the county social service 
  4.15  agency.  Each service Services and item items purchased with a 
  4.16  support grant must: 
  4.17     (1) be over and above the normal costs of caring for the 
  4.18  dependent if the dependent did not have a disability; 
  4.19     (2) be directly attributable to the dependent's disabling 
  4.20  condition; and 
  4.21     (3) enable the family to delay or prevent the out-of-home 
  4.22  placement of the dependent. 
  4.23     The design and delivery of services and items purchased 
  4.24  under this section must suit the dependent's chronological age 
  4.25  and be provided in the least restrictive environment possible, 
  4.26  consistent with the needs identified in the individual service 
  4.27  plan. 
  4.28     Items and services purchased with support grants must be 
  4.29  those for which there are no other public or private funds 
  4.30  available to the family.  Fees assessed to parents for health or 
  4.31  human services that are funded by federal, state, or county 
  4.32  dollars are not reimbursable through this program. 
  4.33     In approving or denying applications, the county shall 
  4.34  consider the following factors:  
  4.35     (1) the extent and areas of the functional limitations of 
  4.36  the disabled child; 
  5.1      (2) the degree of need in the home environment for 
  5.2   additional support; and 
  5.3      (3) the potential effectiveness of the grant to maintain 
  5.4   and support the person in the family environment. 
  5.5      The maximum monthly grant amount shall be $250 per eligible 
  5.6   dependent, or $3,000 per eligible dependent per state fiscal 
  5.7   year, within the limits of available funds.  The county social 
  5.8   service agency may consider the dependent's supplemental 
  5.9   security income in determining the amount of the support grant.  
  5.10  The county social service agency may exceed $3,000 per state 
  5.11  fiscal year per eligible dependent for emergency circumstances 
  5.12  in cases where exceptional resources of the family are required 
  5.13  to meet the health, welfare-safety needs of the child.  
  5.14     County social service agencies shall continue to provide 
  5.15  funds to families receiving state grants on June 30, 1997, if 
  5.16  eligibility criteria continue to be met.  Any adjustments to 
  5.17  their monthly grant amount must be based on the needs of the 
  5.18  family and funding availability. 
  5.19     Sec. 4.  Minnesota Statutes 2002, section 252.32, 
  5.20  subdivision 3c, is amended to read: 
  5.21     Subd. 3c.  [COUNTY BOARD RESPONSIBILITIES.] County boards 
  5.22  receiving funds under this section shall:  
  5.23     (1) determine the needs of families for services in 
  5.24  accordance with section 256B.092 or 256E.08 and any rules 
  5.25  adopted under those sections submit a plan to the department for 
  5.26  the management of the family support grant program.  The plan 
  5.27  must include the projected number of families the county will 
  5.28  serve and policies and procedures for:  
  5.29     (i) identifying potential families for the program; 
  5.30     (ii) grant distribution; 
  5.31     (iii) waiting list procedures; and 
  5.32     (iv) prioritization of families to receive grants; 
  5.33     (2) determine the eligibility of all persons proposed for 
  5.34  program participation; 
  5.35     (3) approve a plan for items and services to be reimbursed 
  5.36  and inform families of the county's approval decision; 
  6.1      (4) issue support grants directly to, or on behalf of, 
  6.2   eligible families; 
  6.3      (5) inform recipients of their right to appeal under 
  6.4   subdivision 3e; 
  6.5      (6) submit quarterly financial reports under subdivision 3b 
  6.6   and indicate on the screening documents the annual grant level 
  6.7   for each family, the families denied grants, and the families 
  6.8   eligible but waiting for funding; and 
  6.9      (7) coordinate services with other programs offered by the 
  6.10  county. 
  6.11     Sec. 5.  Minnesota Statutes 2002, section 256B.0621, 
  6.12  subdivision 4, is amended to read: 
  6.13     Subd. 4.  [RELOCATION TARGETED CASE MANAGEMENT PROVIDER 
  6.14  QUALIFICATIONS.] The following qualifications and certification 
  6.15  standards must be met by providers of relocation targeted case 
  6.16  management: 
  6.17     (a) The commissioner must certify each provider of 
  6.18  relocation targeted case management before enrollment.  The 
  6.19  certification process shall examine the provider's ability to 
  6.20  meet the requirements in this subdivision and other federal and 
  6.21  state requirements of this service.  A certified relocation 
  6.22  targeted case management provider may subcontract with another 
  6.23  provider to deliver relocation targeted case management 
  6.24  services.  Subcontracted providers must demonstrate the ability 
  6.25  to provide the services outlined in subdivision 6. 
  6.26     (b) (a) A relocation targeted case management provider is 
  6.27  an enrolled medical assistance provider who is determined by the 
  6.28  commissioner to have all of the following characteristics: 
  6.29     (1) the legal authority to provide public welfare under 
  6.30  sections 393.01, subdivision 7; and 393.07; or a federally 
  6.31  recognized Indian tribe; 
  6.32     (2) the demonstrated capacity and experience to provide the 
  6.33  components of case management to coordinate and link community 
  6.34  resources needed by the eligible population; 
  6.35     (3) the administrative capacity and experience to serve the 
  6.36  target population for whom it will provide services and ensure 
  7.1   quality of services under state and federal requirements; 
  7.2      (4) the legal authority to provide complete investigative 
  7.3   and protective services under section 626.556, subdivision 10; 
  7.4   and child welfare and foster care services under section 393.07, 
  7.5   subdivisions 1 and 2; or a federally recognized Indian tribe; 
  7.6      (5) a financial management system that provides accurate 
  7.7   documentation of services and costs under state and federal 
  7.8   requirements; and 
  7.9      (6) the capacity to document and maintain individual case 
  7.10  records under state and federal requirements. 
  7.11     (b) A provider of targeted case management under section 
  7.12  256B.0625, subdivision 20, may be deemed a certified provider of 
  7.13  relocation targeted case management. 
  7.14     (c) A relocation targeted case management provider may 
  7.15  subcontract with another provider to deliver relocation targeted 
  7.16  case management services.  Subcontracted providers must 
  7.17  demonstrate the ability to provide the services outlined in 
  7.18  subdivision 6, and have a procedure in place that notifies the 
  7.19  recipient and the recipient's legal representative of any 
  7.20  conflict of interest if the contracted targeted case management 
  7.21  provider also provides, or will provide, the recipient's 
  7.22  services and supports.  Contracted providers must provide 
  7.23  information on all conflicts of interest and obtain the 
  7.24  recipient's informed consent or provide the recipient with 
  7.25  alternatives. 
  7.26     Sec. 6.  Minnesota Statutes 2002, section 256B.0623, 
  7.27  subdivision 2, is amended to read: 
  7.28     Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
  7.29  following terms have the meanings given them. 
  7.30     (a) "Adult rehabilitative mental health services" means 
  7.31  mental health services which are rehabilitative and enable the 
  7.32  recipient to develop and enhance psychiatric stability, social 
  7.33  competencies, personal and emotional adjustment, and independent 
  7.34  living and community skills, when these abilities are impaired 
  7.35  by the symptoms of mental illness.  Adult rehabilitative mental 
  7.36  health services are also appropriate when provided to enable a 
  8.1   recipient to retain stability and functioning, if the recipient 
  8.2   would be at risk of significant functional decompensation or 
  8.3   more restrictive service settings without these services. 
  8.4      (1) Adult rehabilitative mental health services instruct, 
  8.5   assist, and support the recipient in areas such as:  
  8.6   interpersonal communication skills, community resource 
  8.7   utilization and integration skills, crisis assistance, relapse 
  8.8   prevention skills, health care directives, budgeting and 
  8.9   shopping skills, healthy lifestyle skills and practices, cooking 
  8.10  and nutrition skills, transportation skills, medication 
  8.11  education and monitoring, mental illness symptom management 
  8.12  skills, household management skills, employment-related skills, 
  8.13  and transition to community living services. 
  8.14     (2) These services shall be provided to the recipient on a 
  8.15  one-to-one basis in the recipient's home or another community 
  8.16  setting or in groups. 
  8.17     (b) "Medication education services" means services provided 
  8.18  individually or in groups which focus on educating the recipient 
  8.19  about mental illness and symptoms; the role and effects of 
  8.20  medications in treating symptoms of mental illness; and the side 
  8.21  effects of medications.  Medication education is coordinated 
  8.22  with medication management services and does not duplicate it.  
  8.23  Medication education services are provided by physicians, 
  8.24  pharmacists, physician's assistants, or registered nurses. 
  8.25     (c) "Transition to community living services" means 
  8.26  services which maintain continuity of contact between the 
  8.27  rehabilitation services provider and the recipient and which 
  8.28  facilitate discharge from a hospital, residential treatment 
  8.29  program under Minnesota Rules, chapter 9505, board and lodging 
  8.30  facility, or nursing home.  Transition to community living 
  8.31  services are not intended to provide other areas of adult 
  8.32  rehabilitative mental health services.  
  8.33     Sec. 7.  Minnesota Statutes 2002, section 256B.0623, 
  8.34  subdivision 4, is amended to read: 
  8.35     Subd. 4.  [PROVIDER ENTITY STANDARDS.] (a) The provider 
  8.36  entity must be: 
  9.1      (1) a county operated entity certified by the state; or 
  9.2      (2) a noncounty entity certified by the entity's host 
  9.3   county certified by the state following the certification 
  9.4   process and procedures developed by the commissioner. 
  9.5      (b) The certification process is a determination as to 
  9.6   whether the entity meets the standards in this subdivision.  The 
  9.7   certification must specify which adult rehabilitative mental 
  9.8   health services the entity is qualified to provide. 
  9.9      (c) If an entity seeks to provide services outside its host 
  9.10  county, it A noncounty provider entity must obtain additional 
  9.11  certification from each county in which it will provide 
  9.12  services.  The additional certification must be based on the 
  9.13  adequacy of the entity's knowledge of that county's local health 
  9.14  and human service system, and the ability of the entity to 
  9.15  coordinate its services with the other services available in 
  9.16  that county.  A county-operated entity must obtain this 
  9.17  additional certification from any other county in which it will 
  9.18  provide services. 
  9.19     (d) Recertification must occur at least every two three 
  9.20  years. 
  9.21     (e) The commissioner may intervene at any time and 
  9.22  decertify providers with cause.  The decertification is subject 
  9.23  to appeal to the state.  A county board may recommend that the 
  9.24  state decertify a provider for cause. 
  9.25     (f) The adult rehabilitative mental health services 
  9.26  provider entity must meet the following standards: 
  9.27     (1) have capacity to recruit, hire, manage, and train 
  9.28  mental health professionals, mental health practitioners, and 
  9.29  mental health rehabilitation workers; 
  9.30     (2) have adequate administrative ability to ensure 
  9.31  availability of services; 
  9.32     (3) ensure adequate preservice and inservice and ongoing 
  9.33  training for staff; 
  9.34     (4) ensure that mental health professionals, mental health 
  9.35  practitioners, and mental health rehabilitation workers are 
  9.36  skilled in the delivery of the specific adult rehabilitative 
 10.1   mental health services provided to the individual eligible 
 10.2   recipient; 
 10.3      (5) ensure that staff is capable of implementing culturally 
 10.4   specific services that are culturally competent and appropriate 
 10.5   as determined by the recipient's culture, beliefs, values, and 
 10.6   language as identified in the individual treatment plan; 
 10.7      (6) ensure enough flexibility in service delivery to 
 10.8   respond to the changing and intermittent care needs of a 
 10.9   recipient as identified by the recipient and the individual 
 10.10  treatment plan; 
 10.11     (7) ensure that the mental health professional or mental 
 10.12  health practitioner, who is under the clinical supervision of a 
 10.13  mental health professional, involved in a recipient's services 
 10.14  participates in the development of the individual treatment 
 10.15  plan; 
 10.16     (8) assist the recipient in arranging needed crisis 
 10.17  assessment, intervention, and stabilization services; 
 10.18     (9) ensure that services are coordinated with other 
 10.19  recipient mental health services providers and the county mental 
 10.20  health authority and the federally recognized American Indian 
 10.21  authority and necessary others after obtaining the consent of 
 10.22  the recipient.  Services must also be coordinated with the 
 10.23  recipient's case manager or care coordinator if the recipient is 
 10.24  receiving case management or care coordination services; 
 10.25     (10) develop and maintain recipient files, individual 
 10.26  treatment plans, and contact charting; 
 10.27     (11) develop and maintain staff training and personnel 
 10.28  files; 
 10.29     (12) submit information as required by the state; 
 10.30     (13) establish and maintain a quality assurance plan to 
 10.31  evaluate the outcome of services provided; 
 10.32     (14) keep all necessary records required by law; 
 10.33     (15) deliver services as required by section 245.461; 
 10.34     (16) comply with all applicable laws; 
 10.35     (17) be an enrolled Medicaid provider; 
 10.36     (18) maintain a quality assurance plan to determine 
 11.1   specific service outcomes and the recipient's satisfaction with 
 11.2   services; and 
 11.3      (19) develop and maintain written policies and procedures 
 11.4   regarding service provision and administration of the provider 
 11.5   entity. 
 11.6      (g) The commissioner shall develop statewide procedures for 
 11.7   provider certification, including timelines for counties to 
 11.8   certify qualified providers. 
 11.9      Sec. 8.  Minnesota Statutes 2002, section 256B.0623, 
 11.10  subdivision 5, is amended to read: 
 11.11     Subd. 5.  [QUALIFICATIONS OF PROVIDER STAFF.] Adult 
 11.12  rehabilitative mental health services must be provided by 
 11.13  qualified individual provider staff of a certified provider 
 11.14  entity.  Individual provider staff must be qualified under one 
 11.15  of the following criteria: 
 11.16     (1) a mental health professional as defined in section 
 11.17  245.462, subdivision 18, clauses (1) to (5); 
 11.18     (2) a mental health practitioner as defined in section 
 11.19  245.462, subdivision 17.  The mental health practitioner must 
 11.20  work under the clinical supervision of a mental health 
 11.21  professional; or 
 11.22     (3) a mental health rehabilitation worker.  A mental health 
 11.23  rehabilitation worker means a staff person working under the 
 11.24  direction of a mental health practitioner or mental health 
 11.25  professional and under the clinical supervision of a mental 
 11.26  health professional in the implementation of rehabilitative 
 11.27  mental health services as identified in the recipient's 
 11.28  individual treatment plan who: 
 11.29     (i) is at least 21 years of age; 
 11.30     (ii) has a high school diploma or equivalent; 
 11.31     (iii) has successfully completed 30 hours of training 
 11.32  during the past two years in all of the following areas:  
 11.33  recipient rights, recipient-centered individual treatment 
 11.34  planning, behavioral terminology, mental illness, co-occurring 
 11.35  mental illness and substance abuse, psychotropic medications and 
 11.36  side effects, functional assessment, local community resources, 
 12.1   adult vulnerability, recipient confidentiality; and 
 12.2      (iv) meets the qualifications in subitem (A) or (B): 
 12.3      (A) has an associate of arts degree in one of the 
 12.4   behavioral sciences or human services, or is a registered nurse 
 12.5   without a bachelor's degree, or who within the previous ten 
 12.6   years has:  
 12.7      (1) three years of personal life experience with serious 
 12.8   and persistent mental illness; 
 12.9      (2) three years of life experience as a primary caregiver 
 12.10  to an adult with a serious mental illness or traumatic brain 
 12.11  injury; or 
 12.12     (3) 4,000 hours of supervised paid work experience in the 
 12.13  delivery of mental health services to adults with a serious 
 12.14  mental illness or traumatic brain injury; or 
 12.15     (B)(1) is fluent in the non-English language or competent 
 12.16  in the culture of the ethnic group to which at least 50 20 
 12.17  percent of the mental health rehabilitation worker's clients 
 12.18  belong; 
 12.19     (2) receives during the first 2,000 hours of work, monthly 
 12.20  documented individual clinical supervision by a mental health 
 12.21  professional; 
 12.22     (3) has 18 hours of documented field supervision by a 
 12.23  mental health professional or practitioner during the first 160 
 12.24  hours of contact work with recipients, and at least six hours of 
 12.25  field supervision quarterly during the following year; 
 12.26     (4) has review and cosignature of charting of recipient 
 12.27  contacts during field supervision by a mental health 
 12.28  professional or practitioner; and 
 12.29     (5) has 40 hours of additional continuing education on 
 12.30  mental health topics during the first year of employment. 
 12.31     Sec. 9.  Minnesota Statutes 2002, section 256B.0623, 
 12.32  subdivision 6, is amended to read: 
 12.33     Subd. 6.  [REQUIRED TRAINING AND SUPERVISION.] (a) Mental 
 12.34  health rehabilitation workers must receive ongoing continuing 
 12.35  education training of at least 30 hours every two years in areas 
 12.36  of mental illness and mental health services and other areas 
 13.1   specific to the population being served.  Mental health 
 13.2   rehabilitation workers must also be subject to the ongoing 
 13.3   direction and clinical supervision standards in paragraphs (c) 
 13.4   and (d). 
 13.5      (b) Mental health practitioners must receive ongoing 
 13.6   continuing education training as required by their professional 
 13.7   license; or if the practitioner is not licensed, the 
 13.8   practitioner must receive ongoing continuing education training 
 13.9   of at least 30 hours every two years in areas of mental illness 
 13.10  and mental health services.  Mental health practitioners must 
 13.11  meet the ongoing clinical supervision standards in paragraph (c).
 13.12     (c) Clinical supervision may be provided by a full- or 
 13.13  part-time qualified professional employed by or under contract 
 13.14  with the provider entity.  Clinical supervision may be provided 
 13.15  by interactive videoconferencing according to procedures 
 13.16  developed by the commissioner.  A mental health professional 
 13.17  providing clinical supervision of staff delivering adult 
 13.18  rehabilitative mental health services must provide the following 
 13.19  guidance: 
 13.20     (1) review the information in the recipient's file; 
 13.21     (2) review and approve initial and updates of individual 
 13.22  treatment plans; 
 13.23     (3) meet with mental health rehabilitation workers and 
 13.24  practitioners, individually or in small groups, at least monthly 
 13.25  to discuss treatment topics of interest to the workers and 
 13.26  practitioners; 
 13.27     (4) meet with mental health rehabilitation workers and 
 13.28  practitioners, individually or in small groups, at least monthly 
 13.29  to discuss treatment plans of recipients, and approve by 
 13.30  signature and document in the recipient's file any resulting 
 13.31  plan updates; 
 13.32     (5) meet at least twice a month monthly with the directing 
 13.33  mental health practitioner, if there is one, to review needs of 
 13.34  the adult rehabilitative mental health services program, review 
 13.35  staff on-site observations and evaluate mental health 
 13.36  rehabilitation workers, plan staff training, review program 
 14.1   evaluation and development, and consult with the directing 
 14.2   practitioner; and 
 14.3      (6) be available for urgent consultation as the individual 
 14.4   recipient needs or the situation necessitates; and 
 14.5      (7) provide clinical supervision by full- or part-time 
 14.6   mental health professionals employed by or under contract with 
 14.7   the provider entity. 
 14.8      (d) An adult rehabilitative mental health services provider 
 14.9   entity must have a treatment director who is a mental health 
 14.10  practitioner or mental health professional.  The treatment 
 14.11  director must ensure the following: 
 14.12     (1) while delivering direct services to recipients, a newly 
 14.13  hired mental health rehabilitation worker must be directly 
 14.14  observed delivering services to recipients by the a mental 
 14.15  health practitioner or mental health professional for at least 
 14.16  six hours per 40 hours worked during the first 160 hours that 
 14.17  the mental health rehabilitation worker works; 
 14.18     (2) the mental health rehabilitation worker must receive 
 14.19  ongoing on-site direct service observation by a mental health 
 14.20  professional or mental health practitioner for at least six 
 14.21  hours for every six months of employment; 
 14.22     (3) progress notes are reviewed from on-site service 
 14.23  observation prepared by the mental health rehabilitation worker 
 14.24  and mental health practitioner for accuracy and consistency with 
 14.25  actual recipient contact and the individual treatment plan and 
 14.26  goals; 
 14.27     (4) immediate availability by phone or in person for 
 14.28  consultation by a mental health professional or a mental health 
 14.29  practitioner to the mental health rehabilitation services worker 
 14.30  during service provision; 
 14.31     (5) oversee the identification of changes in individual 
 14.32  recipient treatment strategies, revise the plan, and communicate 
 14.33  treatment instructions and methodologies as appropriate to 
 14.34  ensure that treatment is implemented correctly; 
 14.35     (6) model service practices which:  respect the recipient, 
 14.36  include the recipient in planning and implementation of the 
 15.1   individual treatment plan, recognize the recipient's strengths, 
 15.2   collaborate and coordinate with other involved parties and 
 15.3   providers; 
 15.4      (7) ensure that mental health practitioners and mental 
 15.5   health rehabilitation workers are able to effectively 
 15.6   communicate with the recipients, significant others, and 
 15.7   providers; and 
 15.8      (8) oversee the record of the results of on-site 
 15.9   observation and charting evaluation and corrective actions taken 
 15.10  to modify the work of the mental health practitioners and mental 
 15.11  health rehabilitation workers. 
 15.12     (e) A mental health practitioner who is providing treatment 
 15.13  direction for a provider entity must receive supervision at 
 15.14  least monthly from a mental health professional to: 
 15.15     (1) identify and plan for general needs of the recipient 
 15.16  population served; 
 15.17     (2) identify and plan to address provider entity program 
 15.18  needs and effectiveness; 
 15.19     (3) identify and plan provider entity staff training and 
 15.20  personnel needs and issues; and 
 15.21     (4) plan, implement, and evaluate provider entity quality 
 15.22  improvement programs.  
 15.23     Sec. 10.  Minnesota Statutes 2002, section 256B.0623, 
 15.24  subdivision 8, is amended to read: 
 15.25     Subd. 8.  [DIAGNOSTIC ASSESSMENT.] Providers of adult 
 15.26  rehabilitative mental health services must complete a diagnostic 
 15.27  assessment as defined in section 245.462, subdivision 9, within 
 15.28  five days after the recipient's second visit or within 30 days 
 15.29  after intake, whichever occurs first.  In cases where a 
 15.30  diagnostic assessment is available that reflects the recipient's 
 15.31  current status, and has been completed within 180 days preceding 
 15.32  admission, an update must be completed.  An update shall include 
 15.33  a written summary by a mental health professional of the 
 15.34  recipient's current mental health status and service needs.  If 
 15.35  the recipient's mental health status has changed significantly 
 15.36  since the adult's most recent diagnostic assessment, a new 
 16.1   diagnostic assessment is required. For initial implementation of 
 16.2   adult rehabilitative mental health services, until June 30, 
 16.3   2005, a diagnostic assessment that reflects the recipient's 
 16.4   current status and has been completed within the past three 
 16.5   years preceding admission is acceptable. 
 16.6      Sec. 11.  Minnesota Statutes 2002, section 256B.0625, is 
 16.7   amended by adding a subdivision to read: 
 16.8      Subd. 13c.  [PHARMACEUTICAL CARE DEMONSTRATION PROJECT.] (a)
 16.9   The commissioner of human services shall seek federal approval 
 16.10  to implement a medical assistance demonstration project to 
 16.11  provide culturally specific pharmaceutical care to American 
 16.12  Indian recipients who are age 55 and older.  In developing the 
 16.13  demonstration project, the commissioner shall consult with 
 16.14  organizations and health care providers experienced in 
 16.15  developing and implementing culturally competent intervention 
 16.16  strategies to manage the use of prescription drugs, 
 16.17  over-the-counter drugs, other drug products, and native 
 16.18  therapies by American Indian elders. 
 16.19     (b) For purposes of this subdivision, "pharmaceutical care" 
 16.20  means the responsible provision of drug therapy and native 
 16.21  therapy for the purpose of improving a patient's quality of life 
 16.22  by:  (1) curing a disease; (2) eliminating or reducing a 
 16.23  patient's symptoms; (3) arresting or slowing a disease process; 
 16.24  or (4) preventing a disease or a symptom.  Pharmaceutical care 
 16.25  involves the documented process through which a pharmacist 
 16.26  cooperates with a patient and other professionals in designing, 
 16.27  implementing, and monitoring a therapeutic plan that is expected 
 16.28  to produce specific therapeutic outcomes, through the 
 16.29  identification, resolution, and prevention of drug-related 
 16.30  problems. 
 16.31     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2003, 
 16.32  or upon federal approval, whichever is later. 
 16.33     Sec. 12.  Minnesota Statutes 2002, section 256B.0625, 
 16.34  subdivision 19c, is amended to read: 
 16.35     Subd. 19c.  [PERSONAL CARE.] Medical assistance covers 
 16.36  personal care assistant services provided by an individual who 
 17.1   is qualified to provide the services according to subdivision 
 17.2   19a and section 256B.0627, where the services are prescribed by 
 17.3   a physician in accordance with a plan of treatment and are 
 17.4   supervised by the recipient or a qualified professional.  
 17.5   "Qualified professional" means a mental health professional as 
 17.6   defined in section 245.462, subdivision 18, or 245.4871, 
 17.7   subdivision 27; or a registered nurse as defined in sections 
 17.8   148.171 to 148.285, or a licensed social worker as defined in 
 17.9   section 148B.21.  As part of the assessment, the county public 
 17.10  health nurse will assist the recipient or responsible party to 
 17.11  identify the most appropriate person to provide supervision of 
 17.12  the personal care assistant.  The qualified professional shall 
 17.13  perform the duties described in Minnesota Rules, part 9505.0335, 
 17.14  subpart 4.  
 17.15     Sec. 13.  Minnesota Statutes 2002, section 256B.0627, 
 17.16  subdivision 1, is amended to read: 
 17.17     Subdivision 1.  [DEFINITION.] (a) "Activities of daily 
 17.18  living" includes eating, toileting, grooming, dressing, bathing, 
 17.19  transferring, mobility, and positioning.  
 17.20     (b) "Assessment" means a review and evaluation of a 
 17.21  recipient's need for home care services conducted in person.  
 17.22  Assessments for private duty nursing shall be conducted by a 
 17.23  registered private duty nurse.  Assessments for home health 
 17.24  agency services shall be conducted by a home health agency 
 17.25  nurse.  Assessments for personal care assistant services shall 
 17.26  be conducted by the county public health nurse or a certified 
 17.27  public health nurse under contract with the county.  A 
 17.28  face-to-face assessment must include:  documentation of health 
 17.29  status, determination of need, evaluation of service 
 17.30  effectiveness, identification of appropriate services, service 
 17.31  plan development or modification, coordination of services, 
 17.32  referrals and follow-up to appropriate payers and community 
 17.33  resources, completion of required reports, recommendation of 
 17.34  service authorization, and consumer education.  Once the need 
 17.35  for personal care assistant services is determined under this 
 17.36  section, the county public health nurse or certified public 
 18.1   health nurse under contract with the county is responsible for 
 18.2   communicating this recommendation to the commissioner and the 
 18.3   recipient.  A face-to-face assessment for personal care 
 18.4   assistant services is conducted on those recipients who have 
 18.5   never had a county public health nurse assessment.  A 
 18.6   face-to-face assessment must occur at least annually or when 
 18.7   there is a significant change in the recipient's condition or 
 18.8   when there is a change in the need for personal care assistant 
 18.9   services.  A service update may substitute for the annual 
 18.10  face-to-face assessment when there is not a significant change 
 18.11  in recipient condition or a change in the need for personal care 
 18.12  assistant service.  A service update or review for temporary 
 18.13  increase includes a review of initial baseline data, evaluation 
 18.14  of service effectiveness, redetermination of service need, 
 18.15  modification of service plan and appropriate referrals, update 
 18.16  of initial forms, obtaining service authorization, and on going 
 18.17  consumer education.  Assessments for medical assistance home 
 18.18  care services for mental retardation or related conditions and 
 18.19  alternative care services for developmentally disabled home and 
 18.20  community-based waivered recipients may be conducted by the 
 18.21  county public health nurse to ensure coordination and avoid 
 18.22  duplication.  Assessments must be completed on forms provided by 
 18.23  the commissioner within 30 days of a request for home care 
 18.24  services by a recipient or responsible party. 
 18.25     (c) "Care plan" means a written description of personal 
 18.26  care assistant services developed by the qualified professional 
 18.27  or the recipient's physician with the recipient or responsible 
 18.28  party to be used by the personal care assistant with a copy 
 18.29  provided to the recipient or responsible party. 
 18.30     (d) "Complex and regular private duty nursing care" means: 
 18.31     (1) complex care is private duty nursing provided to 
 18.32  recipients who are ventilator dependent or for whom a physician 
 18.33  has certified that were it not for private duty nursing the 
 18.34  recipient would meet the criteria for inpatient hospital 
 18.35  intensive care unit (ICU) level of care; and 
 18.36     (2) regular care is private duty nursing provided to all 
 19.1   other recipients. 
 19.2      (e) "Health-related functions" means functions that can be 
 19.3   delegated or assigned by a licensed health care professional 
 19.4   under state law to be performed by a personal care attendant. 
 19.5      (f) "Home care services" means a health service, determined 
 19.6   by the commissioner as medically necessary, that is ordered by a 
 19.7   physician and documented in a service plan that is reviewed by 
 19.8   the physician at least once every 60 days for the provision of 
 19.9   home health services, or private duty nursing, or at least once 
 19.10  every 365 days for personal care.  Home care services are 
 19.11  provided to the recipient at the recipient's residence that is a 
 19.12  place other than a hospital or long-term care facility or as 
 19.13  specified in section 256B.0625.  
 19.14     (g) "Instrumental activities of daily living" includes meal 
 19.15  planning and preparation, managing finances, shopping for food, 
 19.16  clothing, and other essential items, performing essential 
 19.17  household chores, communication by telephone and other media, 
 19.18  and getting around and participating in the community. 
 19.19     (h) "Medically necessary" has the meaning given in 
 19.20  Minnesota Rules, parts 9505.0170 to 9505.0475.  
 19.21     (i) "Personal care assistant" means a person who:  
 19.22     (1) is at least 18 years old, except for persons 16 to 18 
 19.23  years of age who participated in a related school-based job 
 19.24  training program or have completed a certified home health aide 
 19.25  competency evaluation; 
 19.26     (2) is able to effectively communicate with the recipient 
 19.27  and personal care provider organization; 
 19.28     (3) effective July 1, 1996, has completed one of the 
 19.29  training requirements as specified in Minnesota Rules, part 
 19.30  9505.0335, subpart 3, items A to D; 
 19.31     (4) has the ability to, and provides covered personal care 
 19.32  assistant services according to the recipient's care plan, 
 19.33  responds appropriately to recipient needs, and reports changes 
 19.34  in the recipient's condition to the supervising qualified 
 19.35  professional or physician; 
 19.36     (5) is not a consumer of personal care assistant services; 
 20.1   and 
 20.2      (6) is subject to criminal background checks and procedures 
 20.3   specified in section 245A.04.  
 20.4      (j) "Personal care provider organization" means an 
 20.5   organization enrolled to provide personal care assistant 
 20.6   services under the medical assistance program that complies with 
 20.7   the following:  (1) owners who have a five percent interest or 
 20.8   more, and managerial officials are subject to a background study 
 20.9   as provided in section 245A.04.  This applies to currently 
 20.10  enrolled personal care provider organizations and those agencies 
 20.11  seeking enrollment as a personal care provider organization.  An 
 20.12  organization will be barred from enrollment if an owner or 
 20.13  managerial official of the organization has been convicted of a 
 20.14  crime specified in section 245A.04, or a comparable crime in 
 20.15  another jurisdiction, unless the owner or managerial official 
 20.16  meets the reconsideration criteria specified in section 245A.04; 
 20.17  (2) the organization must maintain a surety bond and liability 
 20.18  insurance throughout the duration of enrollment and provides 
 20.19  proof thereof.  The insurer must notify the department of human 
 20.20  services of the cancellation or lapse of policy; and (3) the 
 20.21  organization must maintain documentation of services as 
 20.22  specified in Minnesota Rules, part 9505.2175, subpart 7, as well 
 20.23  as evidence of compliance with personal care assistant training 
 20.24  requirements. 
 20.25     (k) "Responsible party" means an individual residing with a 
 20.26  recipient of personal care assistant services who is capable of 
 20.27  providing the supportive care support necessary to assist the 
 20.28  recipient to live in the community, is at least 18 years 
 20.29  old, actively participates in planning and directing of personal 
 20.30  care assistant services, and is not a the personal care 
 20.31  assistant.  The responsible party must be accessible to the 
 20.32  recipient and the personal care assistant when personal care 
 20.33  services are being provided and monitor the services at least 
 20.34  weekly according to the plan of care.  The responsible party 
 20.35  must be identified at the time of assessment and listed on the 
 20.36  recipient's service agreement and care plan.  Responsible 
 21.1   parties who are parents of minors or guardians of minors or 
 21.2   incapacitated persons may delegate the responsibility to another 
 21.3   adult during a temporary absence of at least 24 hours but not 
 21.4   more than six months.  The person delegated as a responsible 
 21.5   party must be able to meet the definition of responsible party, 
 21.6   except that the delegated responsible party is required to 
 21.7   reside with the recipient only while serving as the responsible 
 21.8   party who is not the personal care assistant.  The responsible 
 21.9   party must assure that the delegate performs the functions of 
 21.10  the responsible party, is identified at the time of the 
 21.11  assessment, and is listed on the service agreement and the care 
 21.12  plan.  Foster care license holders may be designated the 
 21.13  responsible party for residents of the foster care home if case 
 21.14  management is provided as required in section 256B.0625, 
 21.15  subdivision 19a.  For persons who, as of April 1, 1992, are 
 21.16  sharing personal care assistant services in order to obtain the 
 21.17  availability of 24-hour coverage, an employee of the personal 
 21.18  care provider organization may be designated as the responsible 
 21.19  party if case management is provided as required in section 
 21.20  256B.0625, subdivision 19a. 
 21.21     (l) "Service plan" means a written description of the 
 21.22  services needed based on the assessment developed by the nurse 
 21.23  who conducts the assessment together with the recipient or 
 21.24  responsible party.  The service plan shall include a description 
 21.25  of the covered home care services, frequency and duration of 
 21.26  services, and expected outcomes and goals.  The recipient and 
 21.27  the provider chosen by the recipient or responsible party must 
 21.28  be given a copy of the completed service plan within 30 calendar 
 21.29  days of the request for home care services by the recipient or 
 21.30  responsible party. 
 21.31     (m) "Skilled nurse visits" are provided in a recipient's 
 21.32  residence under a plan of care or service plan that specifies a 
 21.33  level of care which the nurse is qualified to provide.  These 
 21.34  services are: 
 21.35     (1) nursing services according to the written plan of care 
 21.36  or service plan and accepted standards of medical and nursing 
 22.1   practice in accordance with chapter 148; 
 22.2      (2) services which due to the recipient's medical condition 
 22.3   may only be safely and effectively provided by a registered 
 22.4   nurse or a licensed practical nurse; 
 22.5      (3) assessments performed only by a registered nurse; and 
 22.6      (4) teaching and training the recipient, the recipient's 
 22.7   family, or other caregivers requiring the skills of a registered 
 22.8   nurse or licensed practical nurse. 
 22.9      (n) "Telehomecare" means the use of telecommunications 
 22.10  technology by a home health care professional to deliver home 
 22.11  health care services, within the professional's scope of 
 22.12  practice, to a patient located at a site other than the site 
 22.13  where the practitioner is located. 
 22.14     Sec. 14.  Minnesota Statutes 2002, section 256B.0627, 
 22.15  subdivision 4, is amended to read: 
 22.16     Subd. 4.  [PERSONAL CARE ASSISTANT SERVICES.] (a) The 
 22.17  personal care assistant services that are eligible for payment 
 22.18  are services and supports furnished to an individual, as needed, 
 22.19  to assist in accomplishing activities of daily living; 
 22.20  instrumental activities of daily living; health-related 
 22.21  functions through hands-on assistance, supervision, and cuing; 
 22.22  and redirection and intervention for behavior including 
 22.23  observation and monitoring.  
 22.24     (b) Payment for services will be made within the limits 
 22.25  approved using the prior authorized process established in 
 22.26  subdivision 5. 
 22.27     (c) The amount and type of services authorized shall be 
 22.28  based on an assessment of the recipient's needs in these areas: 
 22.29     (1) bowel and bladder care; 
 22.30     (2) skin care to maintain the health of the skin; 
 22.31     (3) repetitive maintenance range of motion, muscle 
 22.32  strengthening exercises, and other tasks specific to maintaining 
 22.33  a recipient's optimal level of function; 
 22.34     (4) respiratory assistance; 
 22.35     (5) transfers and ambulation; 
 22.36     (6) bathing, grooming, and hairwashing necessary for 
 23.1   personal hygiene; 
 23.2      (7) turning and positioning; 
 23.3      (8) assistance with furnishing medication that is 
 23.4   self-administered; 
 23.5      (9) application and maintenance of prosthetics and 
 23.6   orthotics; 
 23.7      (10) cleaning medical equipment; 
 23.8      (11) dressing or undressing; 
 23.9      (12) assistance with eating and meal preparation and 
 23.10  necessary grocery shopping; 
 23.11     (13) accompanying a recipient to obtain medical diagnosis 
 23.12  or treatment; 
 23.13     (14) assisting, monitoring, or prompting the recipient to 
 23.14  complete the services in clauses (1) to (13); 
 23.15     (15) redirection, monitoring, and observation that are 
 23.16  medically necessary and an integral part of completing the 
 23.17  personal care assistant services described in clauses (1) to 
 23.18  (14); 
 23.19     (16) redirection and intervention for behavior, including 
 23.20  observation and monitoring; 
 23.21     (17) interventions for seizure disorders, including 
 23.22  monitoring and observation if the recipient has had a seizure 
 23.23  that requires intervention within the past three months; 
 23.24     (18) tracheostomy suctioning using a clean procedure if the 
 23.25  procedure is properly delegated by a registered nurse.  Before 
 23.26  this procedure can be delegated to a personal care assistant, a 
 23.27  registered nurse must determine that the tracheostomy suctioning 
 23.28  can be accomplished utilizing a clean rather than a sterile 
 23.29  procedure and must ensure that the personal care assistant has 
 23.30  been taught the proper procedure; and 
 23.31     (19) incidental household services that are an integral 
 23.32  part of a personal care service described in clauses (1) to (18).
 23.33  For purposes of this subdivision, monitoring and observation 
 23.34  means watching for outward visible signs that are likely to 
 23.35  occur and for which there is a covered personal care service or 
 23.36  an appropriate personal care intervention.  For purposes of this 
 24.1   subdivision, a clean procedure refers to a procedure that 
 24.2   reduces the numbers of microorganisms or prevents or reduces the 
 24.3   transmission of microorganisms from one person or place to 
 24.4   another.  A clean procedure may be used beginning 14 days after 
 24.5   insertion. 
 24.6      (d) The personal care assistant services that are not 
 24.7   eligible for payment are the following:  
 24.8      (1) services not ordered by the physician; 
 24.9      (2) assessments by personal care assistant provider 
 24.10  organizations or by independently enrolled registered nurses; 
 24.11     (3) services that are not in the service plan; 
 24.12     (4) services provided by the recipient's spouse, legal 
 24.13  guardian for an adult or child recipient, or parent of a 
 24.14  recipient under age 18; 
 24.15     (5) services provided by a foster care provider of a 
 24.16  recipient who cannot direct the recipient's own care, unless 
 24.17  monitored by a county or state case manager under section 
 24.18  256B.0625, subdivision 19a; 
 24.19     (6) services provided by the residential or program license 
 24.20  holder in a residence for more than four persons; 
 24.21     (7) services that are the responsibility of a residential 
 24.22  or program license holder under the terms of a service agreement 
 24.23  and administrative rules; 
 24.24     (8) sterile procedures; 
 24.25     (9) injections of fluids into veins, muscles, or skin; 
 24.26     (10) services provided by parents of adult recipients, 
 24.27  adult children, or siblings of the recipient, unless these 
 24.28  relatives meet one of the following hardship criteria and the 
 24.29  commissioner waives this requirement: 
 24.30     (i) the relative resigns from a part-time or full-time job 
 24.31  to provide personal care for the recipient; 
 24.32     (ii) the relative goes from a full-time to a part-time job 
 24.33  with less compensation to provide personal care for the 
 24.34  recipient; 
 24.35     (iii) the relative takes a leave of absence without pay to 
 24.36  provide personal care for the recipient; 
 25.1      (iv) the relative incurs substantial expenses by providing 
 25.2   personal care for the recipient; or 
 25.3      (v) because of labor conditions, special language needs, or 
 25.4   intermittent hours of care needed, the relative is needed in 
 25.5   order to provide an adequate number of qualified personal care 
 25.6   assistants to meet the medical needs of the recipient; 
 25.7      (11) homemaker services that are not an integral part of a 
 25.8   personal care assistant services; 
 25.9      (12) (11) home maintenance, or chore services; 
 25.10     (13) (12) services not specified under paragraph (a); and 
 25.11     (14) (13) services not authorized by the commissioner or 
 25.12  the commissioner's designee. 
 25.13     (e) The recipient or responsible party may choose to 
 25.14  supervise the personal care assistant or to have a qualified 
 25.15  professional, as defined in section 256B.0625, subdivision 19c, 
 25.16  provide the supervision.  As required under section 256B.0625, 
 25.17  subdivision 19c, the county public health nurse, as a part of 
 25.18  the assessment, will assist the recipient or responsible party 
 25.19  to identify the most appropriate person to provide supervision 
 25.20  of the personal care assistant.  Health-related delegated tasks 
 25.21  performed by the personal care assistant will be under the 
 25.22  supervision of a qualified professional or the direction of the 
 25.23  recipient's physician.  If the recipient has a qualified 
 25.24  professional, Minnesota Rules, part 9505.0335, subpart 4, 
 25.25  applies. 
 25.26     Sec. 15.  Minnesota Statutes 2002, section 256B.0627, 
 25.27  subdivision 9, is amended to read: 
 25.28     Subd. 9.  [FLEXIBLE USE OF PERSONAL CARE ASSISTANT HOURS.] 
 25.29  (a) The commissioner may allow for the flexible use of personal 
 25.30  care assistant hours.  "Flexible use" means the scheduled use of 
 25.31  authorized hours of personal care assistant services, which vary 
 25.32  within the length of the service authorization in order to more 
 25.33  effectively meet the needs and schedule of the recipient.  
 25.34  Recipients may use their approved hours flexibly within the 
 25.35  service authorization period for medically necessary covered 
 25.36  services specified in the assessment required in subdivision 1.  
 26.1   The flexible use of authorized hours does not increase the total 
 26.2   amount of authorized hours available to a recipient as 
 26.3   determined under subdivision 5.  The commissioner shall not 
 26.4   authorize additional personal care assistant services to 
 26.5   supplement a service authorization that is exhausted before the 
 26.6   end date under a flexible service use plan, unless the county 
 26.7   public health nurse determines a change in condition and a need 
 26.8   for increased services is established. 
 26.9      (b) The recipient or responsible party, together with the 
 26.10  county public health nurse, shall determine whether flexible use 
 26.11  is an appropriate option based on the needs and preferences of 
 26.12  the recipient or responsible party, and, if appropriate, must 
 26.13  ensure that the allocation of hours covers the ongoing needs of 
 26.14  the recipient over the entire service authorization period.  As 
 26.15  part of the assessment and service planning process, the 
 26.16  recipient or responsible party must work with the county public 
 26.17  health nurse to develop a written month-to-month plan of the 
 26.18  projected use of personal care assistant services that is part 
 26.19  of the service plan and ensures that the: 
 26.20     (1) health and safety needs of the recipient will be met; 
 26.21     (2) total annual authorization will not exceed before the 
 26.22  end date; and 
 26.23     (3) how actual use of hours will be monitored.  
 26.24     (c) If the actual use of personal care assistant service 
 26.25  varies significantly from the use projected in the plan, the 
 26.26  written plan must be promptly updated by the recipient or 
 26.27  responsible party and the county public health nurse. 
 26.28     (d) The recipient or responsible party, together with the 
 26.29  provider, must work to monitor and document the use of 
 26.30  authorized hours and ensure that a recipient is able to manage 
 26.31  services effectively throughout the authorized period.  The 
 26.32  provider must ensure that the month-to-month plan is 
 26.33  incorporated into the care plan.  Upon request of the recipient 
 26.34  or responsible party, the provider must furnish regular updates 
 26.35  to the recipient or responsible party on the amount of personal 
 26.36  care assistant services used.  
 27.1      (e) The recipient or responsible party may revoke the 
 27.2   authorization for flexible use of hours by notifying the 
 27.3   provider and county public health nurse in writing. 
 27.4      (f) If the requirements in paragraphs (a) to (e) have not 
 27.5   substantially been met, the commissioner shall deny, revoke, or 
 27.6   suspend the authorization to use authorized hours flexibly.  The 
 27.7   recipient or responsible party may appeal the commissioner's 
 27.8   action according to section 256.045.  The denial, revocation, or 
 27.9   suspension to use the flexible hours option shall not affect the 
 27.10  recipient's authorized level of personal care assistant services 
 27.11  as determined under subdivision 5. 
 27.12     Sec. 16.  Minnesota Statutes 2002, section 256B.0911, 
 27.13  subdivision 4d, is amended to read: 
 27.14     Subd. 4d.  [PREADMISSION SCREENING OF INDIVIDUALS UNDER 65 
 27.15  YEARS OF AGE.] (a) It is the policy of the state of Minnesota to 
 27.16  ensure that individuals with disabilities or chronic illness are 
 27.17  served in the most integrated setting appropriate to their needs 
 27.18  and have the necessary information to make informed choices 
 27.19  about home and community-based service options. 
 27.20     (b) Individuals under 65 years of age who are admitted to a 
 27.21  nursing facility from a hospital must be screened prior to 
 27.22  admission as outlined in subdivisions 4a through 4c. 
 27.23     (c) Individuals under 65 years of age who are admitted to 
 27.24  nursing facilities with only a telephone screening must receive 
 27.25  a face-to-face assessment from the long-term care consultation 
 27.26  team member of the county in which the facility is located or 
 27.27  from the recipient's county case manager within 20 working 40 
 27.28  calendar days of admission. 
 27.29     (d) Individuals under 65 years of age who are admitted to a 
 27.30  nursing facility without preadmission screening according to the 
 27.31  exemption described in subdivision 4b, paragraph (a), clause 
 27.32  (3), and who remain in the facility longer than 30 days must 
 27.33  receive a face-to-face assessment within 40 days of admission.  
 27.34     (e) At the face-to-face assessment, the long-term care 
 27.35  consultation team member or county case manager must perform the 
 27.36  activities required under subdivision 3b. 
 28.1      (f) For individuals under 21 years of age, a screening 
 28.2   interview which recommends nursing facility admission must be 
 28.3   face-to-face and approved by the commissioner before the 
 28.4   individual is admitted to the nursing facility. 
 28.5      (g) In the event that an individual under 65 years of age 
 28.6   is admitted to a nursing facility on an emergency basis, the 
 28.7   county must be notified of the admission on the next working 
 28.8   day, and a face-to-face assessment as described in paragraph (c) 
 28.9   must be conducted within 20 working days 40 calendar days of 
 28.10  admission. 
 28.11     (h) At the face-to-face assessment, the long-term care 
 28.12  consultation team member or the case manager must present 
 28.13  information about home and community-based options so the 
 28.14  individual can make informed choices.  If the individual chooses 
 28.15  home and community-based services, the long-term care 
 28.16  consultation team member or case manager must complete a written 
 28.17  relocation plan within 20 working days of the visit.  The plan 
 28.18  shall describe the services needed to move out of the facility 
 28.19  and a time line for the move which is designed to ensure a 
 28.20  smooth transition to the individual's home and community. 
 28.21     (i) An individual under 65 years of age residing in a 
 28.22  nursing facility shall receive a face-to-face assessment at 
 28.23  least every 12 months to review the person's service choices and 
 28.24  available alternatives unless the individual indicates, in 
 28.25  writing, that annual visits are not desired.  In this case, the 
 28.26  individual must receive a face-to-face assessment at least once 
 28.27  every 36 months for the same purposes. 
 28.28     (j) Notwithstanding the provisions of subdivision 6, the 
 28.29  commissioner may pay county agencies directly for face-to-face 
 28.30  assessments for individuals under 65 years of age who are being 
 28.31  considered for placement or residing in a nursing facility. 
 28.32     Sec. 17.  Minnesota Statutes 2002, section 256B.0915, is 
 28.33  amended by adding a subdivision to read: 
 28.34     Subd. 9.  [TRIBAL MANAGEMENT OF ELDERLY WAIVER.] 
 28.35  Notwithstanding contrary provisions of this section, or those in 
 28.36  other state laws or rules, the commissioner and White Earth 
 29.1   Reservation may develop a model for tribal management of the 
 29.2   elderly waiver program and implement this model through a 
 29.3   contract between the state and White Earth Reservation.  The 
 29.4   model shall include the provision of tribal waiver case 
 29.5   management, assessment for personal care assistance, and 
 29.6   administrative requirements otherwise carried out by counties 
 29.7   but shall not include tribal financial eligibility determination 
 29.8   for medical assistance. 
 29.9      Sec. 18.  Minnesota Statutes 2002, section 256B.47, 
 29.10  subdivision 2, is amended to read: 
 29.11     Subd. 2.  [NOTICE TO RESIDENTS.] (a) No increase in nursing 
 29.12  facility rates for private paying residents shall be effective 
 29.13  unless the nursing facility notifies the resident or person 
 29.14  responsible for payment of the increase in writing 30 days 
 29.15  before the increase takes effect.  
 29.16     A nursing facility may adjust its rates without giving the 
 29.17  notice required by this subdivision when the purpose of the rate 
 29.18  adjustment is to reflect a necessary change in the level of care 
 29.19  provided to a case-mix classification of the resident.  If the 
 29.20  state fails to set rates as required by section 
 29.21  256B.431, subdivision 1, the time required for giving notice is 
 29.22  decreased by the number of days by which the state was late in 
 29.23  setting the rates. 
 29.24     (b) If the state does not set rates by the date required in 
 29.25  section 256B.431, subdivision 1, nursing facilities shall meet 
 29.26  the requirement for advance notice by informing the resident or 
 29.27  person responsible for payments, on or before the effective date 
 29.28  of the increase, that a rate increase will be effective on that 
 29.29  date.  If the exact amount has not yet been determined, the 
 29.30  nursing facility may raise the rates by the amount anticipated 
 29.31  to be allowed.  Any amounts collected from private pay residents 
 29.32  in excess of the allowable rate must be repaid to private pay 
 29.33  residents with interest at the rate used by the commissioner of 
 29.34  revenue for the late payment of taxes and in effect on the date 
 29.35  the rate increase is effective. 
 29.36     Sec. 19.  Minnesota Statutes 2002, section 256B.69, 
 30.1   subdivision 5a, is amended to read: 
 30.2      Subd. 5a.  [MANAGED CARE CONTRACTS.] (a) Managed care 
 30.3   contracts under this section and sections 256L.12 and 256D.03, 
 30.4   shall be entered into or renewed on a calendar year basis 
 30.5   beginning January 1, 1996.  Managed care contracts which were in 
 30.6   effect on June 30, 1995, and set to renew on July 1, 1995, shall 
 30.7   be renewed for the period July 1, 1995 through December 31, 1995 
 30.8   at the same terms that were in effect on June 30, 1995. 
 30.9      (b) A prepaid health plan providing covered health services 
 30.10  for eligible persons pursuant to chapters 256B, 256D, and 256L, 
 30.11  is responsible for complying with the terms of its contract with 
 30.12  the commissioner.  Requirements applicable to managed care 
 30.13  programs under chapters 256B, 256D, and 256L, established after 
 30.14  the effective date of a contract with the commissioner take 
 30.15  effect when the contract is next issued or renewed. 
 30.16     (c) Effective for services rendered on or after January 1, 
 30.17  2003, the commissioner shall withhold five percent of managed 
 30.18  care plan payments under this section for the prepaid medical 
 30.19  assistance and general assistance medical care programs pending 
 30.20  completion of performance targets.  The withheld funds must be 
 30.21  returned no sooner than July of the following year if 
 30.22  performance targets in the contract are achieved.  The 
 30.23  commissioner may exclude special demonstration projects under 
 30.24  subdivision 23.  A managed care plan may include as admitted 
 30.25  assets under section 62D.044 any amount withheld under this 
 30.26  paragraph that is reasonably expected to be returned.  
 30.27     (d) The commissioner shall exempt from paragraph (c) a 
 30.28  managed care plan that has entered into a managed care contract 
 30.29  with the commissioner in accordance with this section if the 
 30.30  contract was the initial contract between the managed care plan 
 30.31  and the commissioner, and it was entered into after January 1, 
 30.32  2000.  This exemption shall apply for the first five years of 
 30.33  operation of the managed care plan. 
 30.34     <b>[EFFECTIVE DATE.]</b> This section is effective for services 
 30.35  rendered on or after July 1, 2003.  
 30.36     Sec. 20.  Minnesota Statutes 2002, section 256L.12, 
 31.1   subdivision 9, is amended to read: 
 31.2      Subd. 9.  [RATE SETTING; PERFORMANCE WITHHOLDS.] (a) Rates 
 31.3   will be prospective, per capita, where possible.  The 
 31.4   commissioner may allow health plans to arrange for inpatient 
 31.5   hospital services on a risk or nonrisk basis.  The commissioner 
 31.6   shall consult with an independent actuary to determine 
 31.7   appropriate rates. 
 31.8      (b) For services rendered on or after January 1, 2003, the 
 31.9   commissioner shall withhold .5 percent of managed care plan 
 31.10  payments under this section pending completion of performance 
 31.11  targets.  The withheld funds must be returned no sooner than 
 31.12  July 1 and no later than July 31 of the following year if 
 31.13  performance targets in the contract are achieved.  A managed 
 31.14  care plan may include as admitted assets under section 62D.044 
 31.15  any amount withheld under this paragraph that is reasonably 
 31.16  expected to be returned.  
 31.17     (c) The commissioner shall exempt from paragraph (b) a 
 31.18  managed care plan that has entered into a managed care contract 
 31.19  with the commissioner in accordance with this section if the 
 31.20  contract was the initial contract between the managed care plan 
 31.21  and the commissioner, and it was entered into after January 1, 
 31.22  2000.  This exemption shall apply for five years after the 
 31.23  initial contract was entered into by the managed care plan. 
 31.24     <b>[EFFECTIVE DATE.]</b> This section is effective for services 
 31.25  rendered on or after July 1, 2003. 
 31.26     Sec. 21.  [REPEALER.] 
 31.27     Minnesota Statutes 2002, section 252.32, subdivision 2, is 
 31.28  repealed. 
 31.29                             ARTICLE 2
 31.30             DEPARTMENT OF HUMAN SERVICES MISCELLANEOUS
 31.31     Section 1.  [245.945] [REIMBURSEMENT TO OMBUDSMAN FOR 
 31.32  MENTAL HEALTH AND MENTAL RETARDATION.] 
 31.33     The commissioner shall obtain federal financial 
 31.34  participation for eligible activity by the ombudsman for mental 
 31.35  health and mental retardation.  The ombudsman shall maintain and 
 31.36  transmit to the department of human services documentation that 
 32.1   is necessary in order to obtain federal funds. 
 32.2      Sec. 2.  Minnesota Statutes 2002, section 253B.05, is 
 32.3   amended by adding a subdivision to read: 
 32.4      Subd. 5.  [DETOXIFICATION.] If a person is intoxicated in 
 32.5   public and held under this section for detoxification, a 
 32.6   treatment facility may release the person without providing 
 32.7   notice under subdivision 3, paragraph (c), as soon as the 
 32.8   treatment facility determines the person is no longer 
 32.9   intoxicated.  Notice must be provided to the peace officer or 
 32.10  health officer who transported the person, or the appropriate 
 32.11  law enforcement agency, if the officer or agency requests 
 32.12  notification. 
 32.13     <b>[EFFECTIVE DATE.]</b> This section is effective the day 
 32.14  following final enactment. 
 32.15     Sec. 3.  Minnesota Statutes 2002, section 256B.092, 
 32.16  subdivision 5, is amended to read: 
 32.17     Subd. 5.  [FEDERAL WAIVERS.] (a) The commissioner shall 
 32.18  apply for any federal waivers necessary to secure, to the extent 
 32.19  allowed by law, federal financial participation under United 
 32.20  States Code, title 42, sections 1396 et seq., as amended, for 
 32.21  the provision of services to persons who, in the absence of the 
 32.22  services, would need the level of care provided in a regional 
 32.23  treatment center or a community intermediate care facility for 
 32.24  persons with mental retardation or related conditions.  The 
 32.25  commissioner may seek amendments to the waivers or apply for 
 32.26  additional waivers under United States Code, title 42, sections 
 32.27  1396 et seq., as amended, to contain costs.  The commissioner 
 32.28  shall ensure that payment for the cost of providing home and 
 32.29  community-based alternative services under the federal waiver 
 32.30  plan shall not exceed the cost of intermediate care services 
 32.31  including day training and habilitation services that would have 
 32.32  been provided without the waivered services.  
 32.33     The commissioner shall apply for a federal waiver to allow 
 32.34  properly licensed adult foster care homes to provide residential 
 32.35  services to up to five individuals with mental retardation or 
 32.36  related conditions.  If the waiver is approved, adult foster 
 33.1   care providers that can accommodate five individuals shall 
 33.2   increase their capacity to five beds, provided the providers 
 33.3   continue to meet all applicable licensing requirements. 
 33.4      (b) The commissioner, in administering home and 
 33.5   community-based waivers for persons with mental retardation and 
 33.6   related conditions, shall ensure that day services for eligible 
 33.7   persons are not provided by the person's residential service 
 33.8   provider, unless the person or the person's legal representative 
 33.9   is offered a choice of providers and agrees in writing to 
 33.10  provision of day services by the residential service provider.  
 33.11  The individual service plan for individuals who choose to have 
 33.12  their residential service provider provide their day services 
 33.13  must describe how health, safety, and protection needs will be 
 33.14  met by frequent and regular contact with persons other than the 
 33.15  residential service provider. 
 33.16     Sec. 4.  Minnesota Statutes 2002, section 257.0769, is 
 33.17  amended to read: 
 33.18     257.0769 [FUNDING FOR THE OMBUDSPERSON PROGRAM.] 
 33.19     Subdivision 1.  [APPROPRIATIONS.] (a) Money is appropriated 
 33.20  from the special fund authorized by section 256.01, subdivision 
 33.21  2, clause (15), to the Indian affairs council for the purposes 
 33.22  of sections 257.0755 to 257.0768. 
 33.23     (b) Money is appropriated from the special fund authorized 
 33.24  by section 256.01, subdivision 2, clause (15), to the council on 
 33.25  affairs of Chicano/Latino people for the purposes of sections 
 33.26  257.0755 to 257.0768. 
 33.27     (c) Money is appropriated from the special fund authorized 
 33.28  by section 256.01, subdivision 2, clause (15), to the Council of 
 33.29  Black Minnesotans for the purposes of sections 257.0755 to 
 33.30  257.0768. 
 33.31     (d) Money is appropriated from the special fund authorized 
 33.32  by section 256.01, subdivision 2, clause (15), to the Council on 
 33.33  Asian-Pacific Minnesotans for the purposes of sections 257.0755 
 33.34  to 257.0768. 
 33.35     Subd. 2.  [TITLE IV-E REIMBURSEMENT.] The commissioner 
 33.36  shall obtain federal title IV-E financial participation for 
 34.1   eligible activity by the ombudsperson for families under section 
 34.2   257.0755.  The ombudsperson for families shall maintain and 
 34.3   transmit to the department of human services documentation that 
 34.4   is necessary in order to obtain federal funds. 
 34.5      Sec. 5.  [256B.0622] [MENTAL HEALTH CASE MANAGEMENT.] 
 34.6      Counties shall contract with eligible providers willing to 
 34.7   provide mental health case management services under section 
 34.8   256B.0625, subdivision 20.  In order to be eligible, in addition 
 34.9   to general provider requirements under this chapter, the 
 34.10  provider must: 
 34.11     (1) be willing to provide the mental health case management 
 34.12  services; and 
 34.13     (2) have a minimum of at least one contact with the client 
 34.14  per week. 
 34.15     Sec. 6.  Minnesota Statutes 2002, section 259.21, 
 34.16  subdivision 6, is amended to read: 
 34.17     Subd. 6.  [AGENCY.] "Agency" means an organization or 
 34.18  department of government designated or authorized by law to 
 34.19  place children for adoption or any person, group of persons, 
 34.20  organization, association or society licensed or certified by 
 34.21  the commissioner of human services to place children for 
 34.22  adoption, including a Minnesota federally recognized tribe.  
 34.23     Sec. 7.  Minnesota Statutes 2002, section 259.67, 
 34.24  subdivision 7, is amended to read: 
 34.25     Subd. 7.  [REIMBURSEMENT OF COSTS.] (a) Subject to rules of 
 34.26  the commissioner, and the provisions of this subdivision a 
 34.27  child-placing agency licensed in Minnesota or any other state, 
 34.28  or local or tribal social services agency shall receive a 
 34.29  reimbursement from the commissioner equal to 100 percent of the 
 34.30  reasonable and appropriate cost of providing adoption services 
 34.31  for a child certified as eligible for adoption assistance under 
 34.32  subdivision 4.  Such assistance may include adoptive family 
 34.33  recruitment, counseling, and special training when needed.  A 
 34.34  child-placing agency licensed in Minnesota or any other state 
 34.35  shall receive reimbursement for adoption services it purchases 
 34.36  for or directly provides to an eligible child.  A local or 
 35.1   tribal social services agency shall receive such reimbursement 
 35.2   only for adoption services it purchases for an eligible child. 
 35.3      (b) A child-placing agency licensed in Minnesota or any 
 35.4   other state or local or tribal social services agency seeking 
 35.5   reimbursement under this subdivision shall enter into a 
 35.6   reimbursement agreement with the commissioner before providing 
 35.7   adoption services for which reimbursement is sought.  No 
 35.8   reimbursement under this subdivision shall be made to an agency 
 35.9   for services provided prior to entering a reimbursement 
 35.10  agreement.  Separate reimbursement agreements shall be made for 
 35.11  each child and separate records shall be kept on each child for 
 35.12  whom a reimbursement agreement is made.  Funds encumbered and 
 35.13  obligated under such an agreement for the child remain available 
 35.14  until the terms of the agreement are fulfilled or the agreement 
 35.15  is terminated. 
 35.16     (c) When a local or tribal social services agency uses a 
 35.17  purchase of service agreement to provide services reimbursable 
 35.18  under a reimbursement agreement, the commissioner may make 
 35.19  reimbursement payments directly to the agency providing the 
 35.20  service if direct reimbursement is specified by the purchase of 
 35.21  service agreement, and if the request for reimbursement is 
 35.22  submitted by the local or tribal social services agency along 
 35.23  with a verification that the service was provided.  
 35.24     Sec. 8.  [DEMONSTRATION GRANT TO MAINTAIN INDEPENDENCE AND 
 35.25  EMPLOYMENT.] 
 35.26     The commissioner of human services shall seek federal 
 35.27  funding to participate in a demonstration grant authorized under 
 35.28  section 204 of the Ticket to Work and Work Incentives 
 35.29  Improvement Act of 1999, Public Law 106-170.  The purpose of the 
 35.30  demonstration is to assist workers with physical or mental 
 35.31  impairments that would result in a disability to maintain 
 35.32  independence and employment by offering health care coverage to 
 35.33  them. 
 35.34     The commissioner is authorized to work with interested 
 35.35  stakeholders to identify the population that will be served by 
 35.36  the demonstration.  The commissioner is also authorized to take 
 36.1   necessary administrative actions to implement this demonstration 
 36.2   within 180 days of receiving formal notice from the center for 
 36.3   Medicare and Medicaid services that a grant has been awarded. 
 36.4      Sec. 9.  [MEDICAL ASSISTANCE FOR MENTAL HEALTH SERVICES 
 36.5   PROVIDED IN OUT-OF-HOME PLACEMENT SETTINGS.] 
 36.6      The commissioner of human services shall develop a plan in 
 36.7   conjunction with the commissioner of corrections and 
 36.8   representatives from counties, provider groups, and other 
 36.9   stakeholders, to secure medical assistance funding for mental 
 36.10  health-related services provided in out-of-home placement 
 36.11  settings, including treatment foster care, group homes, and 
 36.12  residential programs licensed under Minnesota Statutes, chapters 
 36.13  241 and 245A.  The plan must include proposed legislation, 
 36.14  fiscal implications, and other pertinent information. 
 36.15     Treatment foster care services must be provided by a child 
 36.16  placing agency licensed under Minnesota Rules, parts 9543.0010 
 36.17  to 9543.0150 or 9545.0755 to 9545.0845.  
 36.18     The commissioner shall report to the legislature by January 
 36.19  15, 2004. 
 36.20                             ARTICLE 3
 36.21                      CHILDREN'S MENTAL HEALTH
 36.22     Section 1.  Minnesota Statutes 2002, section 245.4874, is 
 36.23  amended to read: 
 36.24     245.4874 [DUTIES OF COUNTY BOARD.] 
 36.25     The county board in each county shall use its share of 
 36.26  mental health and Community Social Services Act funds allocated 
 36.27  by the commissioner according to a biennial children's mental 
 36.28  health component of the community social services plan required 
 36.29  under section 245.4888, and approved by the commissioner.  The 
 36.30  county board must: 
 36.31     (1) develop a system of affordable and locally available 
 36.32  children's mental health services according to sections 245.487 
 36.33  to 245.4888; 
 36.34     (2) establish a mechanism providing for interagency 
 36.35  coordination as specified in section 245.4875, subdivision 6; 
 36.36     (3) develop a biennial children's mental health component 
 37.1   of the community social services plan required under section 
 37.2   256E.09 which considers the assessment of unmet needs in the 
 37.3   county as reported by the local children's mental health 
 37.4   advisory council under section 245.4875, subdivision 5, 
 37.5   paragraph (b), clause (3).  The county shall provide, upon 
 37.6   request of the local children's mental health advisory council, 
 37.7   readily available data to assist in the determination of unmet 
 37.8   needs; 
 37.9      (4) assure that parents and providers in the county receive 
 37.10  information about how to gain access to services provided 
 37.11  according to sections 245.487 to 245.4888; 
 37.12     (5) coordinate the delivery of children's mental health 
 37.13  services with services provided by social services, education, 
 37.14  corrections, health, and vocational agencies to improve the 
 37.15  availability of mental health services to children and the 
 37.16  cost-effectiveness of their delivery; 
 37.17     (6) assure that mental health services delivered according 
 37.18  to sections 245.487 to 245.4888 are delivered expeditiously and 
 37.19  are appropriate to the child's diagnostic assessment and 
 37.20  individual treatment plan; 
 37.21     (7) provide the community with information about predictors 
 37.22  and symptoms of emotional disturbances and how to access 
 37.23  children's mental health services according to sections 245.4877 
 37.24  and 245.4878; 
 37.25     (8) provide for case management services to each child with 
 37.26  severe emotional disturbance according to sections 245.486; 
 37.27  245.4871, subdivisions 3 and 4; and 245.4881, subdivisions 1, 3, 
 37.28  and 5; 
 37.29     (9) provide for screening of each child under section 
 37.30  245.4885 upon admission to a residential treatment facility, 
 37.31  acute care hospital inpatient treatment, or informal admission 
 37.32  to a regional treatment center; 
 37.33     (10) prudently administer grants and purchase-of-service 
 37.34  contracts that the county board determines are necessary to 
 37.35  fulfill its responsibilities under sections 245.487 to 245.4888; 
 37.36     (11) assure that mental health professionals, mental health 
 38.1   practitioners, and case managers employed by or under contract 
 38.2   to the county to provide mental health services are qualified 
 38.3   under section 245.4871; 
 38.4      (12) assure that children's mental health services are 
 38.5   coordinated with adult mental health services specified in 
 38.6   sections 245.461 to 245.486 so that a continuum of mental health 
 38.7   services is available to serve persons with mental illness, 
 38.8   regardless of the person's age; and 
 38.9      (13) assure that culturally informed mental health 
 38.10  consultants are used as necessary to assist the county board in 
 38.11  assessing and providing appropriate treatment for children of 
 38.12  cultural or racial minority heritage; and 
 38.13     (14) arrange for or provide a children's mental health 
 38.14  screening to a child receiving child protective services or a 
 38.15  child in out-of-home placement, a child for whom parental rights 
 38.16  have been terminated, a child alleged or found to be delinquent, 
 38.17  and a child found to have committed a juvenile petty offense for 
 38.18  the third or subsequent time, unless a screening has been 
 38.19  performed within the previous 180 days, or the child is 
 38.20  currently under the care of a mental health professional.  The 
 38.21  screening shall be conducted with a screening instrument 
 38.22  approved by the commissioner of human services and shall be 
 38.23  conducted by a mental health practitioner as defined in section 
 38.24  245.4871, subdivision 26, or a probation officer or local social 
 38.25  services agency staff person who is trained in the use of the 
 38.26  screening instrument.  If the screen indicates a need for 
 38.27  assessment, the child's family, or if the family lacks mental 
 38.28  health insurance, the local social services agency, in 
 38.29  consultation with the child's family, shall have conducted a 
 38.30  diagnostic assessment, including a functional assessment, as 
 38.31  defined in section 245.4871. 
 38.32     Sec. 2.  Minnesota Statutes 2002, section 260B.157, 
 38.33  subdivision 1, is amended to read: 
 38.34     Subdivision 1.  [INVESTIGATION.] Upon request of the court 
 38.35  the local social services agency or probation officer shall 
 38.36  investigate the personal and family history and environment of 
 39.1   any minor coming within the jurisdiction of the court under 
 39.2   section 260B.101 and shall report its findings to the court.  
 39.3   The court may order any minor coming within its jurisdiction to 
 39.4   be examined by a duly qualified physician, psychiatrist, or 
 39.5   psychologist appointed by the court.  
 39.6      The court shall have a chemical use assessment conducted 
 39.7   when a child is (1) found to be delinquent for violating a 
 39.8   provision of chapter 152, or for committing a felony-level 
 39.9   violation of a provision of chapter 609 if the probation officer 
 39.10  determines that alcohol or drug use was a contributing factor in 
 39.11  the commission of the offense, or (2) alleged to be delinquent 
 39.12  for violating a provision of chapter 152, if the child is being 
 39.13  held in custody under a detention order.  The assessor's 
 39.14  qualifications and the assessment criteria shall comply with 
 39.15  Minnesota Rules, parts 9530.6600 to 9530.6655.  If funds under 
 39.16  chapter 254B are to be used to pay for the recommended 
 39.17  treatment, the assessment and placement must comply with all 
 39.18  provisions of Minnesota Rules, parts 9530.6600 to 9530.6655 and 
 39.19  9530.7000 to 9530.7030.  The commissioner of human services 
 39.20  shall reimburse the court for the cost of the chemical use 
 39.21  assessment, up to a maximum of $100. 
 39.22     The court shall have a children's mental health screening 
 39.23  conducted when a child is alleged to be delinquent or is found 
 39.24  to be delinquent.  The screening shall be conducted with a 
 39.25  screening instrument approved by the commissioner of human 
 39.26  services and shall be conducted by a mental health practitioner 
 39.27  as defined in section 245.4871, subdivision 26, or a probation 
 39.28  officer who is trained in the use of the screening instrument.  
 39.29  If the screening indicates a need for assessment, the local 
 39.30  social services agency, in consultation with the child's family, 
 39.31  shall have a diagnostic assessment conducted, including a 
 39.32  functional assessment, as defined in section 245.4871. 
 39.33     With the consent of the commissioner of corrections and 
 39.34  agreement of the county to pay the costs thereof, the court may, 
 39.35  by order, place a minor coming within its jurisdiction in an 
 39.36  institution maintained by the commissioner for the detention, 
 40.1   diagnosis, custody and treatment of persons adjudicated to be 
 40.2   delinquent, in order that the condition of the minor be given 
 40.3   due consideration in the disposition of the case.  Any funds 
 40.4   received under the provisions of this subdivision shall not 
 40.5   cancel until the end of the fiscal year immediately following 
 40.6   the fiscal year in which the funds were received.  The funds are 
 40.7   available for use by the commissioner of corrections during that 
 40.8   period and are hereby appropriated annually to the commissioner 
 40.9   of corrections as reimbursement of the costs of providing these 
 40.10  services to the juvenile courts.  
 40.11     Sec. 3.  Minnesota Statutes 2002, section 260B.176, 
 40.12  subdivision 2, is amended to read: 
 40.13     Subd. 2.  [REASONS FOR DETENTION.] (a) If the child is not 
 40.14  released as provided in subdivision 1, the person taking the 
 40.15  child into custody shall notify the court as soon as possible of 
 40.16  the detention of the child and the reasons for detention.  
 40.17     (b) No child may be detained in a juvenile secure detention 
 40.18  facility or shelter care facility longer than 36 hours, 
 40.19  excluding Saturdays, Sundays, and holidays, after being taken 
 40.20  into custody for a delinquent act as defined in section 
 40.21  260B.007, subdivision 6, unless a petition has been filed and 
 40.22  the judge or referee determines pursuant to section 260B.178 
 40.23  that the child shall remain in detention.  
 40.24     (c) No child may be detained in an adult jail or municipal 
 40.25  lockup longer than 24 hours, excluding Saturdays, Sundays, and 
 40.26  holidays, or longer than six hours in an adult jail or municipal 
 40.27  lockup in a standard metropolitan statistical area, after being 
 40.28  taken into custody for a delinquent act as defined in section 
 40.29  260B.007, subdivision 6, unless: 
 40.30     (1) a petition has been filed under section 260B.141; and 
 40.31     (2) a judge or referee has determined under section 
 40.32  260B.178 that the child shall remain in detention. 
 40.33     After August 1, 1991, no child described in this paragraph 
 40.34  may be detained in an adult jail or municipal lockup longer than 
 40.35  24 hours, excluding Saturdays, Sundays, and holidays, or longer 
 40.36  than six hours in an adult jail or municipal lockup in a 
 41.1   standard metropolitan statistical area, unless the requirements 
 41.2   of this paragraph have been met and, in addition, a motion to 
 41.3   refer the child for adult prosecution has been made under 
 41.4   section 260B.125.  Notwithstanding this paragraph, continued 
 41.5   detention of a child in an adult detention facility outside of a 
 41.6   standard metropolitan statistical area county is permissible if: 
 41.7      (i) the facility in which the child is detained is located 
 41.8   where conditions of distance to be traveled or other ground 
 41.9   transportation do not allow for court appearances within 24 
 41.10  hours.  A delay not to exceed 48 hours may be made under this 
 41.11  clause; or 
 41.12     (ii) the facility is located where conditions of safety 
 41.13  exist.  Time for an appearance may be delayed until 24 hours 
 41.14  after the time that conditions allow for reasonably safe 
 41.15  travel.  "Conditions of safety" include adverse life-threatening 
 41.16  weather conditions that do not allow for reasonably safe travel. 
 41.17     The continued detention of a child under clause (i) or (ii) 
 41.18  must be reported to the commissioner of corrections. 
 41.19     (d) If a child described in paragraph (c) is to be detained 
 41.20  in a jail beyond 24 hours, excluding Saturdays, Sundays, and 
 41.21  holidays, the judge or referee, in accordance with rules and 
 41.22  procedures established by the commissioner of corrections, shall 
 41.23  notify the commissioner of the place of the detention and the 
 41.24  reasons therefor.  The commissioner shall thereupon assist the 
 41.25  court in the relocation of the child in an appropriate juvenile 
 41.26  secure detention facility or approved jail within the county or 
 41.27  elsewhere in the state, or in determining suitable 
 41.28  alternatives.  The commissioner shall direct that a child 
 41.29  detained in a jail be detained after eight days from and 
 41.30  including the date of the original detention order in an 
 41.31  approved juvenile secure detention facility with the approval of 
 41.32  the administrative authority of the facility.  If the court 
 41.33  refers the matter to the prosecuting authority pursuant to 
 41.34  section 260B.125, notice to the commissioner shall not be 
 41.35  required.  
 41.36     (e) When a child is detained for an alleged delinquent act 
 42.1   in a state licensed juvenile facility or program, or when a 
 42.2   child is detained in an adult jail or municipal lockup as 
 42.3   provided in paragraph (c), the supervisor of the facility shall, 
 42.4   if the child's parent or legal guardian consents, have a 
 42.5   children's mental health screening conducted with a screening 
 42.6   instrument approved by the commissioner of human services, 
 42.7   unless a screening has been performed within the previous 180 
 42.8   days or the child is currently under the care of a mental health 
 42.9   professional.  The screening shall be conducted by a mental 
 42.10  health practitioner as defined in section 245.4871, subdivision 
 42.11  26, or a probation officer who is trained in the use of the 
 42.12  screening instrument.  The screening shall be conducted after 
 42.13  the initial detention hearing has been held and the court has 
 42.14  ordered the child continued in detention.  The results of the 
 42.15  screening may only be presented to the court at the 
 42.16  dispositional phase of the court proceedings on the matter 
 42.17  unless the parent or legal guardian consents to presentation at 
 42.18  a different time.  If the screening indicates a need for 
 42.19  assessment, the local social services agency or probation 
 42.20  officer, with the approval of the child's parent or legal 
 42.21  guardian, shall have a diagnostic assessment conducted, 
 42.22  including a functional assessment, as defined in section 
 42.23  245.4871. 
 42.24     Sec. 4.  Minnesota Statutes 2002, section 260B.178, 
 42.25  subdivision 1, is amended to read: 
 42.26     Subdivision 1.  [HEARING AND RELEASE REQUIREMENTS.] (a) The 
 42.27  court shall hold a detention hearing: 
 42.28     (1) within 36 hours of the time the child was taken into 
 42.29  custody, excluding Saturdays, Sundays, and holidays, if the 
 42.30  child is being held at a juvenile secure detention facility or 
 42.31  shelter care facility; or 
 42.32     (2) within 24 hours of the time the child was taken into 
 42.33  custody, excluding Saturdays, Sundays, and holidays, if the 
 42.34  child is being held at an adult jail or municipal lockup.  
 42.35     (b) Unless there is reason to believe that the child would 
 42.36  endanger self or others, not return for a court hearing, run 
 43.1   away from the child's parent, guardian, or custodian or 
 43.2   otherwise not remain in the care or control of the person to 
 43.3   whose lawful custody the child is released, or that the child's 
 43.4   health or welfare would be immediately endangered, the child 
 43.5   shall be released to the custody of a parent, guardian, 
 43.6   custodian, or other suitable person, subject to reasonable 
 43.7   conditions of release including, but not limited to, a 
 43.8   requirement that the child undergo a chemical use assessment as 
 43.9   provided in section 260B.157, subdivision 1, and a children's 
 43.10  mental health screening as provided in section 260B.176, 
 43.11  subdivision 2, paragraph (e).  In determining whether the 
 43.12  child's health or welfare would be immediately endangered, the 
 43.13  court shall consider whether the child would reside with a 
 43.14  perpetrator of domestic child abuse.  
 43.15     Sec. 5.  Minnesota Statutes 2002, section 260B.193, 
 43.16  subdivision 2, is amended to read: 
 43.17     Subd. 2.  [CONSIDERATION OF REPORTS.] Before making a 
 43.18  disposition in a case, or appointing a guardian for a child, the 
 43.19  court may consider any report or recommendation made by the 
 43.20  local social services agency, probation officer, licensed 
 43.21  child-placing agency, foster parent, guardian ad litem, tribal 
 43.22  representative, or other authorized advocate for the child or 
 43.23  child's family, a school district concerning the effect on 
 43.24  student transportation of placing a child in a school district 
 43.25  in which the child is not a resident, or any other information 
 43.26  deemed material by the court.  In addition, the court may 
 43.27  consider the results of the children's mental health screening 
 43.28  provided in section 260B.157, subdivision 1. 
 43.29     Sec. 6.  Minnesota Statutes 2002, section 260B.235, 
 43.30  subdivision 6, is amended to read: 
 43.31     Subd. 6.  [ALTERNATIVE DISPOSITION.] In addition to 
 43.32  dispositional alternatives authorized by subdivision 3 4, in the 
 43.33  case of a third or subsequent finding by the court pursuant to 
 43.34  an admission in court or after trial that a child has committed 
 43.35  a juvenile alcohol or controlled substance offense, the juvenile 
 43.36  court shall order a chemical dependency evaluation of the child 
 44.1   and if warranted by the evaluation, the court may order 
 44.2   participation by the child in an inpatient or outpatient 
 44.3   chemical dependency treatment program, or any other treatment 
 44.4   deemed appropriate by the court.  In the case of a third or 
 44.5   subsequent finding that a child has committed any juvenile petty 
 44.6   offense, the court shall order a children's mental health 
 44.7   screening be conducted as provided in section 260B.157, 
 44.8   subdivision 1, and if indicated by the screening, to undergo a 
 44.9   diagnostic assessment, including a functional assessment, as 
 44.10  defined in section 245.4871. 
 44.11     Sec. 7.  [EFFECTIVE DATE.] 
 44.12     This article is effective July 1, 2004. 
 44.13                             ARTICLE 4
 44.14               DEPARTMENT OF HUMAN SERVICES LICENSING
 44.15     Section 1.  Minnesota Statutes 2002, section 245A.09, 
 44.16  subdivision 7, is amended to read: 
 44.17     Subd. 7.  [REGULATORY METHODS.] (a) Where appropriate and 
 44.18  feasible the commissioner shall identify and implement 
 44.19  alternative methods of regulation and enforcement to the extent 
 44.20  authorized in this subdivision.  These methods shall include: 
 44.21     (1) expansion of the types and categories of licenses that 
 44.22  may be granted; 
 44.23     (2) when the standards of another state or federal 
 44.24  governmental agency or an independent accreditation body have 
 44.25  been shown to predict compliance with the rules require the same 
 44.26  standards, methods, or alternative methods to achieve 
 44.27  substantially the same intended outcomes as the licensing 
 44.28  standards, the commissioner shall consider compliance with the 
 44.29  governmental or accreditation standards to be equivalent to 
 44.30  partial compliance with the rules licensing standards; and 
 44.31     (3) use of an abbreviated inspection that employs key 
 44.32  standards that have been shown to predict full compliance with 
 44.33  the rules. 
 44.34     (b) If the commissioner accepts accreditation as 
 44.35  documentation of compliance with a licensing standard under 
 44.36  paragraph (a), the commissioner shall continue to investigate 
 45.1   complaints related to noncompliance with all licensing standards.
 45.2   The commissioner may take a licensing action for noncompliance 
 45.3   under this chapter and shall recognize all existing appeal 
 45.4   rights regarding any licensing actions taken under this chapter. 
 45.5      (c) The commissioner shall work with the commissioners of 
 45.6   health, public safety, administration, and children, families, 
 45.7   and learning in consolidating duplicative licensing and 
 45.8   certification rules and standards if the commissioner determines 
 45.9   that consolidation is administratively feasible, would 
 45.10  significantly reduce the cost of licensing, and would not reduce 
 45.11  the protection given to persons receiving services in licensed 
 45.12  programs.  Where administratively feasible and appropriate, the 
 45.13  commissioner shall work with the commissioners of health, public 
 45.14  safety, administration, and children, families, and learning in 
 45.15  conducting joint agency inspections of programs. 
 45.16     (c) (d) The commissioner shall work with the commissioners 
 45.17  of health, public safety, administration, and children, 
 45.18  families, and learning in establishing a single point of 
 45.19  application for applicants who are required to obtain concurrent 
 45.20  licensure from more than one of the commissioners listed in this 
 45.21  clause. 
 45.22     (d) (e) Unless otherwise specified in statute, the 
 45.23  commissioner may specify in rule periods of licensure up to two 
 45.24  years conduct routine inspections biennially. 
 45.25     Sec. 2.  Minnesota Statutes 2002, section 245A.10, is 
 45.26  amended to read: 
 45.27     245A.10 [FEES.] 
 45.28     The commissioner shall charge a fee for evaluation of 
 45.29  applications and inspection of programs, other than family day 
 45.30  care and foster care, which are licensed under this chapter.  
 45.31  The commissioner may charge a fee for the licensing of school 
 45.32  age child care programs, in an amount sufficient to cover the 
 45.33  cost to the state agency of processing the license. 
 45.34     A county agency may charge a fee to an applicant or license 
 45.35  holder in an amount not to exceed $100 to cover the county 
 45.36  agency's costs for evaluating applications and inspecting family 
 46.1   child care and group family child care programs that are 
 46.2   licensed under this chapter. 
 46.3      Sec. 3.  Minnesota Statutes 2002, section 245A.11, is 
 46.4   amended by adding a subdivision to read: 
 46.5      Subd. 7.  [ADULT FOSTER CARE; VARIANCE FOR ALTERNATE 
 46.6   OVERNIGHT SUPERVISION.] (a) The commissioner may grant a 
 46.7   variance under section 245A.04, subdivision 9, to rule parts 
 46.8   requiring a caregiver to be present in an adult foster care home 
 46.9   during normal sleeping hours to allow for alternative methods of 
 46.10  overnight supervision.  The commissioner may grant the variance 
 46.11  if the local county licensing agency recommends the variance and 
 46.12  the county recommendation includes documentation verifying that: 
 46.13     (1) the county has approved the license holder's plan for 
 46.14  alternative methods of providing overnight supervision and 
 46.15  determined the plan protects the residents' health, safety, and 
 46.16  rights; 
 46.17     (2) the license holder has obtained written and signed 
 46.18  informed consent from each resident or each resident's legal 
 46.19  representative documenting the resident's or legal 
 46.20  representative's agreement with the alternative method of 
 46.21  overnight supervision; and 
 46.22     (3) the alternative method of providing overnight 
 46.23  supervision is specified for each resident in the resident's: 
 46.24  (i) individualized plan of care; (ii) individual service plan 
 46.25  under section 256B.092, subdivision 1b, if required; or (iii) 
 46.26  individual resident placement agreement under Minnesota Rules, 
 46.27  part 9555.5105, subpart 19, if required. 
 46.28     (b) To be eligible for a variance under paragraph (a), the 
 46.29  adult foster care license holder must not have had a licensing 
 46.30  action under section 245A.06 or 245A.07 during the prior 24 
 46.31  months based on failure to provide adequate supervision, health 
 46.32  care services, or resident safety in the adult foster care home. 
 46.33     Sec. 4.  Minnesota Statutes 2002, section 245B.03, is 
 46.34  amended by adding a subdivision to read: 
 46.35     Subd. 3.  [CONTINUITY OF CARE.] (a) When a consumer changes 
 46.36  service to the same type of service provided under a different 
 47.1   license held by the same license holder and the policies and 
 47.2   procedures under section 245B.07, subdivision 8, are 
 47.3   substantially similar, the license holder is exempt from the 
 47.4   requirements in sections 245B.06, subdivisions 2, paragraphs (e) 
 47.5   and (f), and 4; and 245B.07, subdivision 9, clause (2). 
 47.6      (b) When a direct service staff person begins providing 
 47.7   direct service under one or more licenses other than the license 
 47.8   for which the staff person initially received the staff 
 47.9   orientation requirements under section 245B.07, subdivision 5, 
 47.10  the license holder is exempt from all staff orientation 
 47.11  requirements under section 245B.07, subdivision 5, except that: 
 47.12     (1) if the service provision location changes, the staff 
 47.13  person must receive orientation regarding any policies or 
 47.14  procedures under section 245B.07, subdivision 8, that are 
 47.15  specific to the service provision location; and 
 47.16     (2) if the staff person provides direct service to one or 
 47.17  more consumers to whom the staff person has not previously 
 47.18  provided direct service, the staff person must review each 
 47.19  consumer's:  (i) service plans and risk management plan in 
 47.20  accordance with section 245B.07, subdivision 5, paragraph (b), 
 47.21  clause (1); and (ii) medication administration in accordance 
 47.22  with section 245B.07, subdivision 5, paragraph (b), clause (6). 
 47.23     Sec. 5.  Minnesota Statutes 2002, section 245B.06, 
 47.24  subdivision 2, is amended to read: 
 47.25     Subd. 2.  [RISK MANAGEMENT PLAN.] (a) The license holder 
 47.26  must develop and, document in writing, and implement a risk 
 47.27  management plan that incorporates the individual abuse 
 47.28  prevention plan as required in section 245A.65 meets the 
 47.29  requirements of this subdivision.  License holders licensed 
 47.30  under this chapter are exempt from sections 245A.65, subdivision 
 47.31  2, and 626.557, subdivision 14, if the requirements of this 
 47.32  subdivision are met.  
 47.33     (b) The risk management plan must identify areas in which 
 47.34  the consumer is vulnerable, based on an assessment, at a 
 47.35  minimum, of the following areas: 
 47.36     (1) an adult consumer's susceptibility to physical, 
 48.1   emotional, and sexual abuse as defined in section 626.5572, 
 48.2   subdivision 2, and financial exploitation as defined in section 
 48.3   626.5572, subdivision 9; a minor consumer's susceptibility to 
 48.4   sexual and physical abuse as defined in section 626.556, 
 48.5   subdivision 2; and a consumer's susceptibility to self-abuse, 
 48.6   regardless of age; 
 48.7      (2) the consumer's health needs, considering the consumer's 
 48.8   physical disabilities; allergies; sensory impairments; seizures; 
 48.9   diet; need for medications; and ability to obtain medical 
 48.10  treatment; 
 48.11     (3) the consumer's safety needs, considering the consumer's 
 48.12  ability to take reasonable safety precautions; community 
 48.13  survival skills; water survival skills; ability to seek 
 48.14  assistance or provide medical care; and access to toxic 
 48.15  substances or dangerous items; 
 48.16     (4) environmental issues, considering the program's 
 48.17  location in a particular neighborhood or community; the type of 
 48.18  grounds and terrain surrounding the building; and the consumer's 
 48.19  ability to respond to weather-related conditions, open locked 
 48.20  doors, and remain alone in any environment; and 
 48.21     (5) the consumer's behavior, including behaviors that may 
 48.22  increase the likelihood of physical aggression between consumers 
 48.23  or sexual activity between consumers involving force or 
 48.24  coercion, as defined under section 245B.02, subdivision 10, 
 48.25  clauses (6) and (7). 
 48.26     (c) When assessing a consumer's vulnerability, the license 
 48.27  holder must consider only the consumer's skills and abilities, 
 48.28  independent of staffing patterns, supervision plans, the 
 48.29  environment, or other situational elements.  
 48.30     (d) License holders jointly providing services to a 
 48.31  consumer shall coordinate and use the resulting assessment of 
 48.32  risk areas for the development of this each license holder's 
 48.33  risk management or the shared risk management plan.  Upon 
 48.34  initiation of services, the license holder will have in place an 
 48.35  initial risk management plan that identifies areas in which the 
 48.36  consumer is vulnerable, including health, safety, and 
 49.1   environmental issues and the supports the provider will have in 
 49.2   place to protect the consumer and to minimize these risks.  The 
 49.3   plan must be changed based on the needs of the individual 
 49.4   consumer and reviewed at least annually.  The license holder's 
 49.5   plan must include the specific actions a staff person will take 
 49.6   to protect the consumer and minimize risks for the identified 
 49.7   vulnerability areas.  The specific actions must include the 
 49.8   proactive measures being taken, training being provided, or a 
 49.9   detailed description of actions a staff person will take when 
 49.10  intervention is needed. 
 49.11     (e) Prior to or upon initiating services, a license holder 
 49.12  must develop an initial risk management plan that is, at a 
 49.13  minimum, verbally approved by the consumer or consumer's legal 
 49.14  representative and case manager.  The license holder must 
 49.15  document the date the license holder receives the consumer's or 
 49.16  consumer's legal representative's and case manager's verbal 
 49.17  approval of the initial plan. 
 49.18     (f) As part of the meeting held within 45 days of 
 49.19  initiating service, as required under section 245B.06, 
 49.20  subdivision 4, the license holder must review the initial risk 
 49.21  management plan for accuracy and revise the plan if necessary.  
 49.22  The license holder must give the consumer or consumer's legal 
 49.23  representative and case manager an opportunity to participate in 
 49.24  this plan review.  If the license holder revises the plan, or if 
 49.25  the consumer or consumer's legal representative and case manager 
 49.26  have not previously signed and dated the plan, the license 
 49.27  holder must obtain dated signatures to document the plan's 
 49.28  approval. 
 49.29     (g) After plan approval, the license holder must review the 
 49.30  plan at least annually and update the plan based on the 
 49.31  individual consumer's needs and changes to the environment.  The 
 49.32  license holder must give the consumer or consumer's legal 
 49.33  representative and case manager an opportunity to participate in 
 49.34  the ongoing plan development.  The license holder shall obtain 
 49.35  dated signatures from the consumer or consumer's legal 
 49.36  representative and case manager to document completion of the 
 50.1   annual review and approval of plan changes. 
 50.2      Sec. 6.  Minnesota Statutes 2002, section 245B.06, 
 50.3   subdivision 5, is amended to read: 
 50.4      Subd. 5.  [PROGRESS REVIEWS.] The license holder must 
 50.5   participate in progress review meetings following stated time 
 50.6   lines established in the consumer's individual service plan or 
 50.7   as requested in writing by the consumer, the consumer's legal 
 50.8   representative, or the case manager, at a minimum of once a 
 50.9   year.  The license holder must summarize the progress toward 
 50.10  achieving the desired outcomes and make recommendations in a 
 50.11  written report sent to the consumer or the consumer's legal 
 50.12  representative and case manager prior to the review meeting.  
 50.13  For consumers under public guardianship, the license holder is 
 50.14  required to provide quarterly written progress review reports to 
 50.15  the consumer, designated family member, and case manager.  
 50.16     Sec. 7.  Minnesota Statutes 2002, section 245B.07, 
 50.17  subdivision 6, is amended to read: 
 50.18     Subd. 6.  [STAFF TRAINING.] (a) The license holder shall 
 50.19  ensure that direct service staff annually complete hours of 
 50.20  training equal to two percent of the number of hours the staff 
 50.21  person worked or one percent for license holders providing 
 50.22  semi-independent living services.  Direct service staff who have 
 50.23  worked for the license holder for an average of at least 30 
 50.24  hours per week for 24 or more months must annually complete 
 50.25  hours of training equal to one percent of the number of hours 
 50.26  the staff person worked.  If direct service staff has received 
 50.27  training from a license holder licensed under a program rule 
 50.28  identified in this chapter or completed course work regarding 
 50.29  disability-related issues from a post-secondary educational 
 50.30  institute, that training may also count toward training 
 50.31  requirements for other services and for other license holders. 
 50.32     (b) The license holder must document the training completed 
 50.33  by each employee. 
 50.34     (c) Training shall address staff competencies necessary to 
 50.35  address the consumer needs as identified in the consumer's 
 50.36  individual service plan and ensure consumer health, safety, and 
 51.1   protection of rights.  Training may also include other areas 
 51.2   identified by the license holder. 
 51.3      (d) For consumers requiring a 24-hour plan of care, the 
 51.4   license holder shall provide training in cardiopulmonary 
 51.5   resuscitation, from a qualified source determined by the 
 51.6   commissioner, if the consumer's health needs as determined by 
 51.7   the consumer's physician indicate trained staff would be 
 51.8   necessary to the consumer. 
 51.9      Sec. 8.  Minnesota Statutes 2002, section 245B.07, 
 51.10  subdivision 9, is amended to read: 
 51.11     Subd. 9.  [AVAILABILITY OF CURRENT WRITTEN POLICIES AND 
 51.12  PROCEDURES.] The license holder shall: 
 51.13     (1) review and update, as needed, the written policies and 
 51.14  procedures in this chapter and inform all consumers or the 
 51.15  consumer's legal representatives, case managers, and employees 
 51.16  of the revised policies and procedures when they affect the 
 51.17  service provision; 
 51.18     (2) inform consumers or the consumer's legal 
 51.19  representatives of the written policies and procedures in this 
 51.20  chapter upon service initiation.  Copies must be available to 
 51.21  consumers or the consumer's legal representatives, case 
 51.22  managers, the county where services are located, and the 
 51.23  commissioner upon request; and 
 51.24     (3) provide all consumers or the consumers' legal 
 51.25  representatives and case managers a copy and explanation of 
 51.26  revisions to policies and procedures that affect consumers' 
 51.27  service-related or protection-related rights under section 
 51.28  245B.04.  Unless there is reasonable cause, the license holder 
 51.29  must provide this notice at least 30 days before implementing 
 51.30  the revised policy and procedure.  The license holder must 
 51.31  document the reason for not providing the notice at least 30 
 51.32  days before implementing the revisions; 
 51.33     (4) annually notify all consumers or the consumers' legal 
 51.34  representatives and case managers of any revised policies and 
 51.35  procedures under this chapter, other than those in clause (3).  
 51.36  Upon request, the license holder must provide the consumer or 
 52.1   consumer's legal representative and case manager copies of the 
 52.2   revised policies and procedures; 
 52.3      (5) before implementing revisions to policies and 
 52.4   procedures under this chapter, inform all employees of the 
 52.5   revised policies and procedures; and 
 52.6      (6) document and maintain relevant information related to 
 52.7   the policies and procedures in this chapter. 
 52.8      Sec. 9.  Minnesota Statutes 2002, section 245B.08, 
 52.9   subdivision 1, is amended to read: 
 52.10     Subdivision 1.  [ALTERNATIVE METHODS OF DETERMINING 
 52.11  COMPLIANCE.] (a) In addition to methods specified in chapter 
 52.12  245A, the commissioner may use alternative methods and new 
 52.13  regulatory strategies to determine compliance with this 
 52.14  section.  The commissioner may use sampling techniques to ensure 
 52.15  compliance with this section.  Notwithstanding section 245A.09, 
 52.16  subdivision 7, paragraph (d) (e), the commissioner may also 
 52.17  extend periods of licensure, not to exceed five years, for 
 52.18  license holders who have demonstrated substantial and consistent 
 52.19  compliance with sections 245B.02 to 245B.07 and have 
 52.20  consistently maintained the health and safety of consumers and 
 52.21  have demonstrated by alternative methods in paragraph (b) that 
 52.22  they meet or exceed the requirements of this section.  For 
 52.23  purposes of this section, "substantial and consistent 
 52.24  compliance" means that during the current licensing period: 
 52.25     (1) the license holder's license has not been made 
 52.26  conditional, suspended, or revoked; 
 52.27     (2) there have been no substantiated allegations of 
 52.28  maltreatment against the license holder; 
 52.29     (3) there have been no program deficiencies that have been 
 52.30  identified that would jeopardize the health or safety of 
 52.31  consumers being served; and 
 52.32     (4) the license holder is in substantial compliance with 
 52.33  the other requirements of chapter 245A and other applicable laws 
 52.34  and rules. 
 52.35     (b) To determine the length of a license, the commissioner 
 52.36  shall consider: 
 53.1      (1) information from affected consumers, and the license 
 53.2   holder's responsiveness to consumers' concerns and 
 53.3   recommendations; 
 53.4      (2) self assessments and peer reviews of the standards of 
 53.5   this section, corrective actions taken by the license holder, 
 53.6   and sharing the results of the inspections with consumers, the 
 53.7   consumers' families, and others, as requested; 
 53.8      (3) length of accreditation by an independent accreditation 
 53.9   body, if applicable; 
 53.10     (4) information from the county where the license holder is 
 53.11  located; and 
 53.12     (5) information from the license holder demonstrating 
 53.13  performance that meets or exceeds the minimum standards of this 
 53.14  chapter. 
 53.15     (c) The commissioner may reduce the length of the license 
 53.16  if the license holder fails to meet the criteria in paragraph 
 53.17  (a) and the conditions specified in paragraph (b). 
 53.18                             ARTICLE 5 
 53.19         REDUCTION OF DUPLICATIVE HEALTH AND HUMAN SERVICES 
 53.20                        LICENSING ACTIVITIES 
 53.21     Section 1.  Minnesota Statutes 2002, section 144.057, 
 53.22  subdivision 1, is amended to read: 
 53.23     Subdivision 1.  [BACKGROUND STUDIES REQUIRED.] The 
 53.24  commissioner of health shall contract with the commissioner of 
 53.25  human services to conduct background studies of: 
 53.26     (1) individuals providing services which have direct 
 53.27  contact, as defined under section 245A.04, subdivision 3, with 
 53.28  patients and residents in hospitals, boarding care homes, 
 53.29  outpatient surgical centers licensed under sections 144.50 to 
 53.30  144.58; nursing homes and home care agencies licensed under 
 53.31  chapter 144A; ICFs/MR certified by the commissioner of health as 
 53.32  intermediate care facilities that provide services for persons 
 53.33  with mental retardation or related conditions under Code of 
 53.34  Federal Regulations, title 42, section 483; residential care 
 53.35  homes licensed under chapter 144B, and board and lodging 
 53.36  establishments that are registered to provide supportive or 
 54.1   health supervision services under section 157.17; 
 54.2      (2) individuals specified in section 245A.04, subdivision 
 54.3   3, paragraph (c), who perform direct contact services in a 
 54.4   nursing home or a home care agency licensed under chapter 144A 
 54.5   or a boarding care home licensed under sections 144.50 to 
 54.6   144.58, and if the individual under study resides outside 
 54.7   Minnesota, the study must be at least as comprehensive as that 
 54.8   of a Minnesota resident and include a search of information from 
 54.9   the criminal justice data communications network in the state 
 54.10  where the subject of the study resides; 
 54.11     (3) beginning July 1, 1999, all other employees in nursing 
 54.12  homes licensed under chapter 144A, and boarding care homes 
 54.13  licensed under sections 144.50 to 144.58.  A disqualification of 
 54.14  an individual in this section shall disqualify the individual 
 54.15  from positions allowing direct contact or access to patients or 
 54.16  residents receiving services.  "Access" means physical access to 
 54.17  a client or the client's personal property without continuous, 
 54.18  direct supervision as defined in section 245A.04, subdivision 3, 
 54.19  paragraph (b), clause (2), when the employee's employment 
 54.20  responsibilities do not include providing direct contact 
 54.21  services; 
 54.22     (4) individuals employed by a supplemental nursing services 
 54.23  agency, as defined under section 144A.70, who are providing 
 54.24  services in health care facilities; and 
 54.25     (5) controlling persons of a supplemental nursing services 
 54.26  agency, as defined under section 144A.70. 
 54.27     If a facility or program is licensed by the department of 
 54.28  human services and subject to the background study provisions of 
 54.29  chapter 245A and is also licensed by the department of health, 
 54.30  the department of human services is solely responsible for the 
 54.31  background studies of individuals in the jointly licensed 
 54.32  programs. 
 54.33     Sec. 2.  Minnesota Statutes 2002, section 144.50, 
 54.34  subdivision 6, is amended to read: 
 54.35     Subd. 6.  [SUPERVISED LIVING FACILITY LICENSES.] (a) The 
 54.36  commissioner may license as a supervised living facility a 
 55.1   facility seeking medical assistance certification as an 
 55.2   intermediate care facility for persons with mental retardation 
 55.3   or related conditions for four or more persons as authorized 
 55.4   under section 252.291. 
 55.5      (b) Class B supervised living facilities shall be 
 55.6   classified as follows for purposes of the State Building Code: 
 55.7      (1) Class B supervised living facilities for six or less 
 55.8   persons must meet Group R, Division 3, occupancy requirements; 
 55.9   and 
 55.10     (2) Class B supervised living facilities for seven to 16 
 55.11  persons must meet Group R, Division 1, occupancy requirements. 
 55.12     (c) Class B facilities classified under paragraph (b), 
 55.13  clauses (1) and (2), must meet the fire protection provisions of 
 55.14  chapter 21 of the 1985 Life Safety Code, NFPA 101, for 
 55.15  facilities housing persons with impractical evacuation 
 55.16  capabilities, except that Class B facilities licensed prior to 
 55.17  July 1, 1990, need only continue to meet institutional fire 
 55.18  safety provisions.  Class B supervised living facilities shall 
 55.19  provide the necessary physical plant accommodations to meet the 
 55.20  needs and functional disabilities of the residents.  For Class B 
 55.21  supervised living facilities licensed after July 1, 1990, and 
 55.22  housing nonambulatory or nonmobile persons, the corridor access 
 55.23  to bedrooms, common spaces, and other resident use spaces must 
 55.24  be at least five feet in clear width, except that a waiver may 
 55.25  be requested in accordance with Minnesota Rules, part 4665.0600. 
 55.26     (d) The commissioner may license as a Class A supervised 
 55.27  living board and lodge facility under chapter 157 as a 
 55.28  residential program for chemically dependent individuals that 
 55.29  allows children to reside with the parent receiving treatment in 
 55.30  the facility.  The licensee of the program shall be responsible 
 55.31  for the health, safety, and welfare of the children residing in 
 55.32  the facility.  The facility in which the program is located must 
 55.33  be provided with a sprinkler system approved by the state fire 
 55.34  marshal.  The licensee shall also provide additional space and 
 55.35  physical plant accommodations appropriate for the number and age 
 55.36  of children residing in the facility.  For purposes of license 
 56.1   capacity, each child residing in the facility shall be 
 56.2   considered to be a resident.  
 56.3      Sec. 3.  [144.601] [ICFs/MR; LICENSURE.] 
 56.4      Subdivision 1.  [REQUIREMENTS GOVERNING ICFs/MR.] (a) When 
 56.5   certifying an intermediate care facility for persons with mental 
 56.6   retardation or related conditions or ICF/MR, the commissioner 
 56.7   shall: 
 56.8      (1) license the facility as a supervised living facility 
 56.9   under sections 144.50 to 144.58; 
 56.10     (2) assure compliance with requirements set forth in the 
 56.11  code of federal regulations governing intermediate care 
 56.12  facilities for persons with mental retardation or related 
 56.13  conditions; 
 56.14     (3) enforce requirements governing the use of aversive and 
 56.15  deprivation procedures set forth in Minnesota Rules, parts 
 56.16  9525.2700 to 9525.2810; and 
 56.17     (4) assure compliance with the psychotropic medication use 
 56.18  checklist defined under section 245B.02, subdivision 19. 
 56.19     (b) The commissioner of health may not grant a variance to 
 56.20  any requirements governing use of aversive and deprivation 
 56.21  procedures under Minnesota Rules, parts 9525.2700 to 9525.2810; 
 56.22  compliance with the psychotropic medication use checklist; or 
 56.23  provisions governing data practices. 
 56.24     (c) The commissioner of health shall monitor compliance 
 56.25  with the requirements governing ICFs/MR in subdivisions 2 to 14. 
 56.26     Subd. 2.  [CONSUMER HEALTH.] The license holder is 
 56.27  responsible for meeting a consumer's health service needs 
 56.28  assigned to the license holder in the individual service plan 
 56.29  and for bringing a consumer's health needs, as discovered by the 
 56.30  license holder, promptly to the attention of the consumer, the 
 56.31  consumer's legal representative, and the case manager. 
 56.32     Subd. 3.  [FIRST AID.] When the license holder is providing 
 56.33  direct service and supervision to a consumer who requires a 
 56.34  24-hour plan of care and receives services at an ICF/MR, the 
 56.35  license holder must have available a staff person trained in 
 56.36  first aid and cardiopulmonary resuscitation from a qualified 
 57.1   source, as determined by the commissioner. 
 57.2      Subd. 4.  [REPORTING INCIDENTS.] (a) The license holder 
 57.3   must maintain information about and report incidents to a 
 57.4   consumer's legal representative, other licensed caregiver, if 
 57.5   any, and case manager within 24 hours of the occurrence, or 
 57.6   within 24 hours of receipt of the information unless the 
 57.7   incident has been reported by another license holder. 
 57.8      (b) When the incident involves more than one consumer, the 
 57.9   license holder must not disclose personally identifiable 
 57.10  information about any other consumer when making the report to 
 57.11  each consumer's legal representative, other licensed caregiver, 
 57.12  if any, and case manager, unless the license holder has the 
 57.13  consent of a consumer or a consumer's legal representative. 
 57.14     (c) Within 24 hours of reporting maltreatment as required 
 57.15  under section 626.556 or 626.557, the license holder must inform 
 57.16  the consumer's legal representative and case manager of the 
 57.17  report unless there is reason to believe that the legal 
 57.18  representative or case manager is involved in the suspected 
 57.19  maltreatment.  The information the license holder must disclose 
 57.20  is the nature of the activity or occurrence reported, the agency 
 57.21  that received the report, and the telephone number of the 
 57.22  commissioner of health's office of health facility complaints. 
 57.23     (d) The license holder must report a consumer's death or 
 57.24  serious injury to the commissioner of health and the ombudsman, 
 57.25  as required under sections 245.91 and 245.94, subdivision 2a. 
 57.26     (e) For purposes of this subdivision, "incident" means any 
 57.27  of the following: 
 57.28     (1) serious injury as determined by section 245.91, 
 57.29  subdivision 6; 
 57.30     (2) a consumer's death; 
 57.31     (3) any medical emergencies, unexpected serious illnesses, 
 57.32  or accidents that require physician treatment or 
 57.33  hospitalization; 
 57.34     (4) a consumer's unauthorized absence; 
 57.35     (5) any fires or other circumstances involving a law 
 57.36  enforcement agency; 
 58.1      (6) physical aggression by a consumer against another 
 58.2   consumer that causes physical pain, injury, or persistent 
 58.3   emotional distress, including, but not limited to, hitting, 
 58.4   slapping, kicking, scratching, pinching, biting, pushing, and 
 58.5   spitting; 
 58.6      (7) any sexual activity between consumers involving force 
 58.7   or coercion as defined under section 609.341, subdivisions 3 and 
 58.8   14; or 
 58.9      (8) a report of child or vulnerable adult maltreatment 
 58.10  under section 626.556 or 626.557. 
 58.11     Subd. 5.  [PROGRESS REVIEWS.] The license holder must 
 58.12  participate in progress review meetings following stated time 
 58.13  lines established in the consumer's individual service plan or 
 58.14  as requested in writing by the consumer, the consumer's legal 
 58.15  representative, or the case manager, at a minimum of once a 
 58.16  year.  The license holder must summarize the progress toward 
 58.17  achieving the desired outcomes and make recommendations in a 
 58.18  written report sent to the consumer or the consumer's legal 
 58.19  representative and case manager before the review meeting. 
 58.20     Subd. 6.  [LEAVING THE RESIDENCE.] As specified in each 
 58.21  consumer's individual service plan, each consumer requiring a 
 58.22  24-hour plan of care must leave the residence to participate in 
 58.23  regular education, employment, or community activities.  License 
 58.24  holders providing services to consumers living in a licensed 
 58.25  site must ensure that they are prepared to care for consumers 
 58.26  whenever they are at the residence during the day because of 
 58.27  illness, work schedules, or other reasons. 
 58.28     Subd. 7.  [PROHIBITION.] The license holder must not use 
 58.29  psychotropic medication and the use of aversive and deprivation 
 58.30  procedures, as referenced in section 245.825 and rules 
 58.31  promulgated under that section, as a substitute for adequate 
 58.32  staffing, as punishment, or for staff convenience. 
 58.33     Subd. 8.  [CONSUMER DATA FILE.] The license holder must 
 58.34  maintain the following information for each consumer: 
 58.35     (1) identifying information that includes date of birth, 
 58.36  medications, legal representative, history, medical, and other 
 59.1   individual-specific information, and names and telephone numbers 
 59.2   of contacts; 
 59.3      (2) consumer health information, including individual 
 59.4   medication administration and monitoring information; 
 59.5      (3) the consumer's individual service plan.  When a 
 59.6   consumer's case manager does not provide a current individual 
 59.7   service plan, the license holder must make a written request to 
 59.8   the case manager to provide a copy of the individual service 
 59.9   plan and inform the consumer or the consumer's legal 
 59.10  representative of the right to an individual service plan and 
 59.11  the right to appeal under section 256.045; 
 59.12     (4) copies of assessments, analyses, summaries, and 
 59.13  recommendations; 
 59.14     (5) progress review reports; 
 59.15     (6) incidents involving the consumer; 
 59.16     (7) reports required under subdivision 4; 
 59.17     (8) discharge summary, when applicable; 
 59.18     (9) record of other license holders serving the consumer 
 59.19  that includes a contact person and telephone numbers, services 
 59.20  being provided, services that require coordination between two 
 59.21  license holders, and name of staff responsible for coordination; 
 59.22     (10) information about verbal aggression directed at the 
 59.23  consumer by another consumer; and 
 59.24     (11) information about self-abuse. 
 59.25     Subd. 9.  [ACCESS TO RECORDS.] The license holder must 
 59.26  ensure that the following people have access to the information 
 59.27  in subdivision 8: 
 59.28     (1) the consumer, the consumer's legal representative, and 
 59.29  anyone properly authorized by the consumer or legal 
 59.30  representative; 
 59.31     (2) the consumer's case manager; and 
 59.32     (3) staff providing direct services to the consumer unless 
 59.33  the information is not relevant to carrying out the individual 
 59.34  service plan. 
 59.35     Subd. 10.  [RETENTION OF CONSUMER'S RECORDS.] The license 
 59.36  holder must retain the records required for consumers for at 
 60.1   least three years following termination of services. 
 60.2      Subd. 11.  [STAFF ORIENTATION.] (a) Within 60 days of 
 60.3   hiring staff who provide direct service, the license holder must 
 60.4   provide 30 hours of staff orientation.  Direct care staff must 
 60.5   complete 15 of the 30 hours of orientation before providing any 
 60.6   unsupervised direct service to a consumer. 
 60.7      (b) The 30 hours of orientation must combine supervised 
 60.8   on-the-job training with coverage of the following material: 
 60.9      (1) review of the consumer's service plans and risk 
 60.10  management plan to achieve an understanding of the consumer as a 
 60.11  unique individual; 
 60.12     (2) review and instruction on the license holder's policies 
 60.13  and procedures, including their location and access; 
 60.14     (3) emergency procedures; 
 60.15     (4) explanation of specific job functions, including 
 60.16  implementing objectives from the consumer's individual service 
 60.17  plan; 
 60.18     (5) explanation of responsibilities related to sections 
 60.19  626.556 and 626.557, governing maltreatment reporting and 
 60.20  service planning for children and vulnerable adults, and section 
 60.21  245.825, governing use of aversive and deprivation procedures; 
 60.22     (6) medication administration as it applies to the 
 60.23  individual consumer, and when the consumer meets the criteria of 
 60.24  having overriding health care needs, then medication 
 60.25  administration taught by a health services professional.  Staff 
 60.26  may administer medications only after they demonstrate the 
 60.27  ability, as defined in the license holder's medication 
 60.28  administration policy and procedures.  Once a consumer with 
 60.29  overriding health care needs is admitted, the license holder 
 60.30  must provide staff with remedial training as deemed necessary by 
 60.31  the license holder and the health professional to meet the needs 
 60.32  of that consumer.  For purposes of this requirement, overriding 
 60.33  health care needs means a health care condition that affects the 
 60.34  service options available to the consumer because the condition 
 60.35  requires:  (i) specialized or intensive medical or nursing 
 60.36  supervision; and (ii) nonmedical service providers to adapt 
 61.1   their services to accommodate the health and safety needs of the 
 61.2   consumer; 
 61.3      (7) consumer rights; and 
 61.4      (8) other topics necessary as determined by the consumer's 
 61.5   individual service plan or other areas identified by the license 
 61.6   holder. 
 61.7      (c) The license holder must document the orientation each 
 61.8   employee receives. 
 61.9      Subd. 12.  [STAFF TRAINING.] (a) The license holder must 
 61.10  ensure that direct service staff annually complete hours of 
 61.11  training equal to two percent of the number of hours the staff 
 61.12  person worked.  Direct service staff who have worked for the 
 61.13  license holder for an average of at least 30 hours per week for 
 61.14  24 or more months must annually complete hours of training equal 
 61.15  to one percent of the number of hours the staff person worked. 
 61.16     (b) The license holder must document the training completed 
 61.17  by each employee. 
 61.18     (c) Training must address staff competencies necessary to 
 61.19  address the consumer's needs as identified in the consumer's 
 61.20  individual service plan and ensure consumer health, safety, and 
 61.21  protection of rights.  Training may also include other areas 
 61.22  identified by the license holder. 
 61.23     (d) For consumers requiring a 24-hour plan of care, the 
 61.24  license holder must provide training in cardiopulmonary 
 61.25  resuscitation, from a qualified source determined by the 
 61.26  commissioner, if the consumer's health needs as determined by 
 61.27  the consumer's physician indicate trained staff would be 
 61.28  necessary to the consumer. 
 61.29     Subd. 13.  [POLICIES AND PROCEDURES.] The license holder 
 61.30  must develop and implement the following policies and procedures:
 61.31     (1) psychotropic medication monitoring when the consumer is 
 61.32  prescribed a psychotropic medication, including the use of the 
 61.33  psychotropic medication use checklist.  If the responsibility 
 61.34  for implementing the psychotropic medication use checklist has 
 61.35  not been assigned in the individual service plan and the 
 61.36  consumer lives in a licensed site, the residential license 
 62.1   holder must be designated; 
 62.2      (2) criteria for admission or service initiation developed 
 62.3   by the license holder; 
 62.4      (3) policies and procedures that promote continuity and 
 62.5   quality of consumer supports by ensuring: 
 62.6      (i) continuity of care and service coordination, including 
 62.7   provisions for service termination, temporary service 
 62.8   suspension, and efforts made by the license holder to coordinate 
 62.9   services with other vendors who also provide support to the 
 62.10  consumer.  The policy must include the following requirements: 
 62.11     (A) the license holder must notify the consumer or 
 62.12  consumer's legal representative and the consumer's case manager 
 62.13  in writing of the intended termination or temporary service 
 62.14  suspension and the consumer's right to seek a temporary order 
 62.15  staying the termination or suspension of service according to 
 62.16  the procedures in section 256.045, subdivision 4a or subdivision 
 62.17  6, paragraph (c); 
 62.18     (B) notice of the proposed termination of services, 
 62.19  including those situations that began with a temporary service 
 62.20  suspension, must be given at least 60 days before the proposed 
 62.21  termination is to become effective; 
 62.22     (C) the license holder must provide information requested 
 62.23  by the consumer or consumer's legal representative or case 
 62.24  manager when services are temporarily suspended or upon notice 
 62.25  of termination; 
 62.26     (D) use of temporary service suspension procedures are 
 62.27  restricted to situations in which the consumer's behavior causes 
 62.28  immediate and serious danger to the health and safety of the 
 62.29  individual or others; 
 62.30     (E) prior to giving notice of service termination or 
 62.31  temporary service suspension, the license holder must document 
 62.32  actions taken to minimize or eliminate the need for service 
 62.33  termination or temporary service suspension; and 
 62.34     (F) during the period of temporary service suspension, the 
 62.35  license holder will work with the appropriate county agency to 
 62.36  develop reasonable alternatives to protect the individual and 
 63.1   others; and 
 63.2      (ii) quality services measured through a program evaluation 
 63.3   process including regular evaluations of consumer satisfaction 
 63.4   and sharing the results of the evaluations with the consumers 
 63.5   and legal representatives. 
 63.6      Subd. 14.  [CONSUMER FUNDS.] (a) The license holder must 
 63.7   ensure that consumers retain the use and availability of 
 63.8   personal funds or property unless restrictions are justified in 
 63.9   the consumer's individual service plan. 
 63.10     (b) The license holder must ensure separation of consumer 
 63.11  funds from funds of the license holder, the program, or program 
 63.12  staff. 
 63.13     (c) Whenever the license holder assists a consumer with the 
 63.14  safekeeping of funds or other property, the license holder must 
 63.15  have written authorization to do so by the consumer or the 
 63.16  consumer's legal representative, and the case manager.  In 
 63.17  addition, the license holder must: 
 63.18     (1) document receipt and disbursement of the consumer's 
 63.19  funds or the property; 
 63.20     (2) annually survey, document, and implement the 
 63.21  preferences of the consumer, consumer's legal representative, 
 63.22  and the case manager for frequency of receiving a statement that 
 63.23  itemizes receipts and disbursements of consumer funds or other 
 63.24  property; and 
 63.25     (3) return to the consumer, upon the consumer's request, 
 63.26  funds and property in the license holder's possession subject to 
 63.27  restrictions in the consumer's individual service plan, as soon 
 63.28  as possible, but no later than three working days after the date 
 63.29  of the request. 
 63.30     (d) License holders and program staff must not: 
 63.31     (1) borrow money from a consumer; 
 63.32     (2) purchase personal items from a consumer; 
 63.33     (3) sell merchandise or personal services to a consumer; 
 63.34     (4) require a consumer to purchase items for which the 
 63.35  license holder is eligible for reimbursement; or 
 63.36     (5) use consumer funds in a manner that would violate 
 64.1   requirements under this subdivision. 
 64.2      Sec. 4.  Minnesota Statutes 2002, section 245A.02, 
 64.3   subdivision 14, is amended to read: 
 64.4      Subd. 14.  [RESIDENTIAL PROGRAM.] "Residential program" 
 64.5   means a program that provides 24-hour-a-day care, supervision, 
 64.6   food, lodging, rehabilitation, training, education, 
 64.7   habilitation, or treatment outside a person's own home, 
 64.8   including a nursing home or hospital that receives public funds, 
 64.9   administered by the commissioner, to provide services for five 
 64.10  or more persons whose primary diagnosis is mental retardation or 
 64.11  a related condition or mental illness and who do not have a 
 64.12  significant physical or medical problem that necessitates 
 64.13  nursing home care; a program in an intermediate care facility a 
 64.14  board and lodging or supervised living facility for four or more 
 64.15  persons with mental retardation or a related condition that is 
 64.16  not an ICF/MR; a nursing home or hospital that was licensed by 
 64.17  the commissioner on July 1, 1987, to provide a program for 
 64.18  persons with a physical handicap that is not the result of the 
 64.19  normal aging process and considered to be a chronic condition; 
 64.20  and chemical dependency or chemical abuse programs that are 
 64.21  located in a hospital or nursing home and receive public funds 
 64.22  for providing chemical abuse or chemical dependency treatment 
 64.23  services under chapter 254B.  Residential programs include home 
 64.24  and community-based services for persons with mental retardation 
 64.25  or a related condition that are provided in or outside of a 
 64.26  person's own home. 
 64.27     Sec. 5.  Minnesota Statutes 2002, section 245A.02, is 
 64.28  amended by adding a subdivision to read: 
 64.29     Subd. 20.  [ICF/MR.] For purposes of this chapter, ICF/MR 
 64.30  means an intermediate care facility for persons with mental 
 64.31  retardation or related conditions as defined in section 
 64.32  256B.055, subdivision 12, paragraph (d). 
 64.33     Sec. 6.  Minnesota Statutes 2002, section 245A.03, is 
 64.34  amended by adding a subdivision to read: 
 64.35     Subd. 1a.  [LICENSING JURISDICTION; MINIMIZING DUPLICATION 
 64.36  OF AGENCY LICENSING ACTIVITIES.] (a) To minimize the duplication 
 65.1   of licensing activities between the commissioners of human 
 65.2   services and health related to ICFs/MR and residential programs 
 65.3   licensed by the commissioner of human services that also have a 
 65.4   supervised living facility class A license issued by the 
 65.5   commissioner of health, the commissioners' jurisdiction over 
 65.6   licensing activities is determined under this subdivision. 
 65.7      (b) The commissioner of health shall have sole 
 65.8   responsibility for licensing ICFs/MR, including investigating 
 65.9   allegations of maltreatment in the facilities and contracting 
 65.10  with the commissioner of human services under section 144.057, 
 65.11  subdivision 1, for the required background studies.  In addition 
 65.12  to enforcement of ICF/MR standards and supervised living 
 65.13  facility standards, the commissioner of health shall enforce 
 65.14  Minnesota Rules, parts 9525.2700 to 9525.2810, regarding use of 
 65.15  aversive and deprivation procedures, and requirements related to 
 65.16  the psychotropic medication use checklist defined in section 
 65.17  245B.02, subdivision 19. 
 65.18     (c) The commissioner of human services shall enforce 
 65.19  licensure requirements for residential mental health treatment 
 65.20  facilities and residential chemical dependency treatment 
 65.21  facilities.  Except for chemical dependency detoxification 
 65.22  programs that also have a supervised living facility license 
 65.23  class B under sections 144.50 to 144.56, programs licensed under 
 65.24  Minnesota Rules, parts 9530.4100 to 9530.4450 and parts 
 65.25  9520.0500 to 9520.0690, shall be licensed as board and lodge 
 65.26  under chapter 157. 
 65.27     (d) Residential programs licensed by the commissioner of 
 65.28  human services under chapter 245A that are also licensed by the 
 65.29  commissioner of health as class B supervised living facilities 
 65.30  under sections 144.50 to 144.601, on March 1, 2003, shall 
 65.31  continue to be licensed as class B supervised living facilities 
 65.32  until such time as the commissioners of health, human services, 
 65.33  public safety, and administration determine whether the 
 65.34  international building code and fire code to become effective in 
 65.35  2003 will provide adequate safety, when combined with a board 
 65.36  and lodging license for these programs. 
 66.1      Sec. 7.  Minnesota Statutes 2002, section 245A.03, 
 66.2   subdivision 2, is amended to read: 
 66.3      Subd. 2.  [EXCLUSION FROM LICENSURE.] (a) This chapter does 
 66.4   not apply to: 
 66.5      (1) residential or nonresidential programs that are 
 66.6   provided to a person by an individual who is related unless the 
 66.7   residential program is a child foster care placement made by a 
 66.8   local social services agency or a licensed child-placing agency, 
 66.9   except as provided in subdivision 2a; 
 66.10     (2) nonresidential programs that are provided by an 
 66.11  unrelated individual to persons from a single related family; 
 66.12     (3) residential or nonresidential programs that are 
 66.13  provided to adults who do not abuse chemicals or who do not have 
 66.14  a chemical dependency, a mental illness, mental retardation or a 
 66.15  related condition, a functional impairment, or a physical 
 66.16  handicap; 
 66.17     (4) sheltered workshops or work activity programs that are 
 66.18  certified by the commissioner of economic security; 
 66.19     (5) programs for children enrolled in kindergarten to the 
 66.20  12th grade and prekindergarten special education in a school as 
 66.21  defined in section 120A.22, subdivision 4, and programs serving 
 66.22  children in combined special education and regular 
 66.23  prekindergarten programs that are operated or assisted by the 
 66.24  commissioner of children, families, and learning; 
 66.25     (6) nonresidential programs primarily for children that 
 66.26  provide care or supervision, without charge for ten or fewer 
 66.27  days a year, and for periods of less than three hours a day 
 66.28  while the child's parent or legal guardian is in the same 
 66.29  building as the nonresidential program or present within another 
 66.30  building that is directly contiguous to the building in which 
 66.31  the nonresidential program is located; 
 66.32     (7) nursing homes or hospitals licensed by the commissioner 
 66.33  of health except as specified under section 245A.02; 
 66.34     (8) board and lodge facilities licensed by the commissioner 
 66.35  of health that provide services for five or more persons whose 
 66.36  primary diagnosis is mental illness who have refused an 
 67.1   appropriate residential program offered by a county agency; 
 67.2      (9) homes providing programs for persons placed there by a 
 67.3   licensed agency for legal adoption, unless the adoption is not 
 67.4   completed within two years; 
 67.5      (10) programs licensed by the commissioner of corrections; 
 67.6      (11) recreation programs for children or adults that 
 67.7   operate for fewer than 40 calendar days in a calendar year or 
 67.8   programs operated by a park and recreation board of a city of 
 67.9   the first class whose primary purpose is to provide social and 
 67.10  recreational activities to school age children, provided the 
 67.11  program is approved by the park and recreation board; 
 67.12     (12) programs operated by a school as defined in section 
 67.13  120A.22, subdivision 4, whose primary purpose is to provide 
 67.14  child care to school-age children, provided the program is 
 67.15  approved by the district's school board; 
 67.16     (13) Head Start nonresidential programs which operate for 
 67.17  less than 31 days in each calendar year; 
 67.18     (14) noncertified boarding care homes unless they provide 
 67.19  services for five or more persons whose primary diagnosis is 
 67.20  mental illness or mental retardation; 
 67.21     (15) nonresidential programs for nonhandicapped children 
 67.22  provided for a cumulative total of less than 30 days in any 
 67.23  12-month period; 
 67.24     (16) residential programs for persons with mental illness, 
 67.25  that are located in hospitals, until the commissioner adopts 
 67.26  appropriate rules; 
 67.27     (17) the religious instruction of school-age children; 
 67.28  Sabbath or Sunday schools; or the congregate care of children by 
 67.29  a church, congregation, or religious society during the period 
 67.30  used by the church, congregation, or religious society for its 
 67.31  regular worship; 
 67.32     (18) camps licensed by the commissioner of health under 
 67.33  Minnesota Rules, chapter 4630; 
 67.34     (19) mental health outpatient services for adults with 
 67.35  mental illness or children with emotional disturbance; 
 67.36     (20) residential programs serving school-age children whose 
 68.1   sole purpose is cultural or educational exchange, until the 
 68.2   commissioner adopts appropriate rules; 
 68.3      (21) unrelated individuals who provide out-of-home respite 
 68.4   care services to persons with mental retardation or related 
 68.5   conditions from a single related family for no more than 90 days 
 68.6   in a 12-month period and the respite care services are for the 
 68.7   temporary relief of the person's family or legal representative; 
 68.8      (22) respite care services provided as a home and 
 68.9   community-based service to a person with mental retardation or a 
 68.10  related condition, in the person's primary residence; 
 68.11     (23) community support services programs as defined in 
 68.12  section 245.462, subdivision 6, and family community support 
 68.13  services as defined in section 245.4871, subdivision 17; 
 68.14     (24) the placement of a child by a birth parent or legal 
 68.15  guardian in a preadoptive home for purposes of adoption as 
 68.16  authorized by section 259.47; 
 68.17     (25) settings registered under chapter 144D which provide 
 68.18  home care services licensed by the commissioner of health to 
 68.19  fewer than seven adults; or 
 68.20     (26) ICFs/MR; or 
 68.21     (27) consumer-directed community support service funded 
 68.22  under the Medicaid waiver for persons with mental retardation 
 68.23  and related conditions when the individual who provided the 
 68.24  service is:  
 68.25     (i) the same individual who is the direct payee of these 
 68.26  specific waiver funds or paid by a fiscal agent, fiscal 
 68.27  intermediary, or employer of record; and 
 68.28     (ii) not otherwise under the control of a residential or 
 68.29  nonresidential program that is required to be licensed under 
 68.30  this chapter when providing the service. 
 68.31     (b) For purposes of paragraph (a), clause (6), a building 
 68.32  is directly contiguous to a building in which a nonresidential 
 68.33  program is located if it shares a common wall with the building 
 68.34  in which the nonresidential program is located or is attached to 
 68.35  that building by skyway, tunnel, atrium, or common roof. 
 68.36     (c) Nothing in this chapter shall be construed to require 
 69.1   licensure for any services provided and funded according to an 
 69.2   approved federal waiver plan where licensure is specifically 
 69.3   identified as not being a condition for the services and funding.
 69.4      Sec. 8.  [245A.157] [ADDITIONAL LICENSING STANDARDS FOR 
 69.5   CERTAIN RESIDENTIAL PROGRAMS.] 
 69.6      Subdivision 1.  [COMPANION LICENSE 
 69.7   REQUIREMENT.] Notwithstanding any law or rule to the contrary, a 
 69.8   residential program: 
 69.9      (1) serving persons with mental retardation or related 
 69.10  conditions that is not foster care and is not an ICF/MR, must 
 69.11  have at least a board and lodge license issued by the 
 69.12  commissioner of health under chapter 157 in accordance with 
 69.13  Minnesota Rules, parts 4625.0100 to 4625.2355 and 4626.0010 to 
 69.14  4626.1825; 
 69.15     (2) licensed to provide category I or II services to 
 69.16  persons with mental illness under Minnesota Rules, parts 
 69.17  9520.0500 to 9520.0690, must have at least a board and lodge 
 69.18  license issued by the commissioner of health under chapter 157 
 69.19  in accordance with Minnesota Rules, parts 4625.0100 to 4625.2355 
 69.20  and 4626.0010 to 4626.1825; 
 69.21     (3) licensed to provide category I chemical dependency 
 69.22  services under Minnesota Rules, parts 9530.4100 to 9530.4450, 
 69.23  must have at least a supervised living facility class B license 
 69.24  issued by the commissioner of health under sections 144.50 to 
 69.25  144.58; and 
 69.26     (4) licensed to provide category II, III, or IV chemical 
 69.27  dependency services under Minnesota Rules, parts 9530.4100 to 
 69.28  9530.4450, must have at least a board and lodge license issued 
 69.29  by the commissioner of health under chapter 157 in accordance 
 69.30  with Minnesota Rules, parts 4625.0100 to 4625.2355 and 4626.0010 
 69.31  to 4626.1825. 
 69.32     Subd. 2.  [ADDITIONAL LICENSING REQUIREMENTS FOR MENTAL 
 69.33  HEALTH AND CHEMICAL DEPENDENCY TREATMENT PROGRAMS.] (a) In 
 69.34  addition to licensing requirements set forth in Minnesota Rules, 
 69.35  parts 9520.0500 to 9520.0690, for programs serving persons with 
 69.36  mental illness, and Minnesota Rules, parts 9530.4100 to 
 70.1   9530.4450, for programs serving persons with a chemical 
 70.2   dependency, the commissioner of human services shall ensure 
 70.3   compliance with the requirements under this subdivision. 
 70.4      (b) Before providing medication assistance to a person 
 70.5   served by a program, an employee, other than a physician, 
 70.6   registered nurse, or licensed practical nurse, who is 
 70.7   responsible for medication assistance must provide a certificate 
 70.8   verifying successful completion of a formalized training program 
 70.9   offered by the license holder.  The training program must be 
 70.10  taught and supervised by a registered nurse.  The training must 
 70.11  include, but is not limited to, the proper storage, dispensing, 
 70.12  and recording of medications.  The license holder must document 
 70.13  the medication administration training provided by a registered 
 70.14  nurse to unlicensed personnel and place the documentation in the 
 70.15  unlicensed employees' personnel records.  A registered nurse 
 70.16  must provide consultation and review of the license holder's 
 70.17  administration of medications, including a timely review of all 
 70.18  medication errors. 
 70.19     (c) A facility must have a written plan that specifies 
 70.20  actions and procedures for responding to fire, serious illness, 
 70.21  severe weather, missing persons, and other emergencies.  The 
 70.22  program administrator must review the plan with staff and 
 70.23  residents.  The license holder must develop the plan with the 
 70.24  advice of the local fire and rescue authority or other emergency 
 70.25  response authorities.  The plan must specify responsibilities 
 70.26  assumed by the license holder for assisting residents who 
 70.27  require emergency care or special assistance in emergencies.  
 70.28  The license holder must ensure that all staff providing program 
 70.29  services review the following at least quarterly: 
 70.30     (1) assignment of persons to specific tasks and 
 70.31  responsibilities in an emergency situation; 
 70.32     (2) instructions on using alarm systems and emergency 
 70.33  equipment; 
 70.34     (3) when and how to notify appropriate persons outside the 
 70.35  facility; and 
 70.36     (4) evacuation routes and procedures. 
 71.1      (d) Clients and residents have the right to: 
 71.2      (1) be treated with courtesy and respect for their 
 71.3   individuality by employees of or persons providing service in a 
 71.4   health care facility; 
 71.5      (2) refuse treatment.  A license holder must inform 
 71.6   residents or clients who refuse treatment, medication, or 
 71.7   dietary restrictions of the likely medical or major 
 71.8   psychological results of the refusal, and put documentation of 
 71.9   the refusal in the individual client record; 
 71.10     (3) be free from maltreatment as defined under sections 
 71.11  626.5572 and 626.556; 
 71.12     (4) confidential treatment of the client's or resident's 
 71.13  personal and medical records.  The client or resident may 
 71.14  approve or refuse the release of personal and medical records to 
 71.15  any individual outside the facility; 
 71.16     (5) retain and use their personal clothing and possessions 
 71.17  as space permits, unless doing so infringes upon the rights of 
 71.18  other clients or residents or is medically or programmatically 
 71.19  contraindicated for documented medical, safety, or programmatic 
 71.20  reasons.  The facility must maintain a central locked depository 
 71.21  or provide individual locked storage areas in which clients or 
 71.22  residents may store valuables for safekeeping.  The facility 
 71.23  may, but is not required to, provide compensation for or 
 71.24  replacement of lost or stolen items; and 
 71.25     (6) not perform labor or services for the facility unless 
 71.26  the activities are included for therapeutic purposes and 
 71.27  appropriately goal-related in their individual medical record. 
 71.28     Sec. 9.  Minnesota Statutes 2002, section 245B.01, is 
 71.29  amended to read: 
 71.30     245B.01 [RULE CONSOLIDATION.] 
 71.31     This chapter establishes new methods to ensure the quality 
 71.32  of services to persons with mental retardation or related 
 71.33  conditions, and streamlines and simplifies regulation of 
 71.34  services and supports for persons with mental retardation or 
 71.35  related conditions.  Sections 245B.02 to 245B.07 establishes new 
 71.36  standards that eliminate duplication and overlap of regulatory 
 72.1   requirements by consolidating and replacing rule parts from four 
 72.2   program rules.  Section 245B.08 authorizes the commissioner of 
 72.3   human services to develop and use new regulatory strategies to 
 72.4   maintain compliance with the streamlined requirements.  This 
 72.5   chapter does not apply to ICFs/MR. 
 72.6      Sec. 10.  Minnesota Statutes 2002, section 245B.02, 
 72.7   subdivision 13, is amended to read: 
 72.8      Subd. 13.  [INTERMEDIATE CARE FACILITY FOR PERSONS WITH 
 72.9   MENTAL RETARDATION OR RELATED CONDITIONS OR ICF/MR.] 
 72.10  "Intermediate care facility" for persons with mental retardation 
 72.11  or related conditions or ICF/MR means a residential program 
 72.12  licensed to provide services to persons with mental retardation 
 72.13  or related conditions under section 252.28 and chapter 245A and 
 72.14  a physical facility licensed as a supervised living facility 
 72.15  under chapter 144, which together are certified by the 
 72.16  department of health as an intermediate care facility for 
 72.17  persons with mental retardation or related conditions. 
 72.18     Sec. 11.  Minnesota Statutes 2002, section 245B.03, 
 72.19  subdivision 1, is amended to read: 
 72.20     Subdivision 1.  [APPLICABILITY.] The standards in this 
 72.21  chapter govern services to persons with mental retardation or 
 72.22  related conditions receiving services from license holders 
 72.23  providing residential-based habilitation; day training and 
 72.24  habilitation services for adults; supported employment; 
 72.25  semi-independent living services; residential programs that 
 72.26  serve more than four consumers, including intermediate care 
 72.27  facilities for persons with mental retardation for persons with 
 72.28  mental retardation or related conditions that are not licensed 
 72.29  as foster care programs and are not ICFs/MR; and respite care 
 72.30  provided outside the consumer's home for more than four 
 72.31  consumers at the same time at a single site. 
 72.32     Sec. 12.  Minnesota Statutes 2002, section 245B.03, 
 72.33  subdivision 2, is amended to read: 
 72.34     Subd. 2.  [RELATIONSHIP TO OTHER STANDARDS GOVERNING 
 72.35  SERVICES FOR PERSONS WITH MENTAL RETARDATION OR RELATED 
 72.36  CONDITIONS.] (a) ICFs/MR are exempt from: 
 73.1      (1) section 245B.04; 
 73.2      (2) section 245B.06, subdivisions 4 and 6; and 
 73.3      (3) section 245B.07, subdivisions 4, paragraphs (b) and 
 73.4   (c); 7; and 8, paragraphs (1), clause (iv), and (2). 
 73.5      (b) License holders also licensed under chapter 144 as a 
 73.6   supervised living facility are exempt from section 245B.04. 
 73.7      (c) (b) Residential service sites controlled by license 
 73.8   holders licensed under chapter 245B for home and community-based 
 73.9   waivered services for four or fewer adults are exempt from 
 73.10  compliance with Minnesota Rules, parts 9543.0040, subpart 2, 
 73.11  item C; 9555.5505; 9555.5515, items B and G; 9555.5605; 
 73.12  9555.5705; 9555.6125, subparts 3, item C, subitem (2), and 4 to 
 73.13  6; 9555.6185; 9555.6225, subpart 8; 9555.6245; 9555.6255; and 
 73.14  9555.6265.  The commissioner may approve alternative methods of 
 73.15  providing overnight supervision using the process and criteria 
 73.16  for granting a variance in section 245A.04, subdivision 9.  This 
 73.17  chapter does not apply to foster care homes that do not provide 
 73.18  residential habilitation services funded under the home and 
 73.19  community-based waiver programs defined in section 256B.092. 
 73.20     (d) (c) The commissioner may exempt license holders from 
 73.21  applicable standards of this chapter when the license holder 
 73.22  meets the standards under section 245A.09, subdivision 7.  
 73.23  License holders that are accredited by an independent 
 73.24  accreditation body shall continue to be licensed under this 
 73.25  chapter. 
 73.26     (e) (d) License holders governed by sections 245B.02 to 
 73.27  245B.07 must also meet the licensure requirements in chapter 
 73.28  245A.  
 73.29     (f) (e) Nothing in this chapter prohibits license holders 
 73.30  from concurrently serving consumers with and without mental 
 73.31  retardation or related conditions provided this chapter's 
 73.32  standards are met as well as other relevant standards. 
 73.33     (g) (f) The documentation that sections 245B.02 to 245B.07 
 73.34  require of the license holder meets the individual program plan 
 73.35  required in section 256B.092 or successor provisions.  
 73.36     Sec. 13.  Minnesota Statutes 2002, section 252.27, 
 74.1   subdivision 1, is amended to read: 
 74.2      Subdivision 1.  [COUNTY OF FINANCIAL RESPONSIBILITY.] 
 74.3   Whenever any child who has mental retardation or a related 
 74.4   condition, or a physical disability or emotional disturbance is 
 74.5   in 24-hour care outside the home including respite care, in an 
 74.6   ICF/MR or a facility licensed by the commissioner of human 
 74.7   services, the cost of services shall be paid by the county of 
 74.8   financial responsibility determined pursuant to chapter 256G.  
 74.9   If the child's parents or guardians do not reside in this state, 
 74.10  the cost shall be paid by the responsible governmental agency in 
 74.11  the state from which the child came, by the parents or guardians 
 74.12  of the child if they are financially able, or, if no other 
 74.13  payment source is available, by the commissioner of human 
 74.14  services. 
 74.15     Sec. 14.  Minnesota Statutes 2002, section 252.28, 
 74.16  subdivision 2, is amended to read: 
 74.17     Subd. 2.  [RULES; PROGRAM STANDARDS; LICENSES.] The 
 74.18  commissioner of human services shall: 
 74.19     (1) Establish uniform rules and program standards for each 
 74.20  type of residential and day facility or service for persons with 
 74.21  mental retardation or related conditions, including state 
 74.22  hospitals under control of the commissioner and serving persons 
 74.23  with mental retardation or related conditions, and excluding 
 74.24  persons with mental retardation or related conditions residing 
 74.25  with their families or in ICFs/MR. 
 74.26     (2) Grant licenses according to the provisions of Laws 
 74.27  1976, chapter 243, sections 2 to 13. 
 74.28     Sec. 15.  Minnesota Statutes 2002, section 252.291, 
 74.29  subdivision 1, is amended to read: 
 74.30     Subdivision 1.  [MORATORIUM.] Notwithstanding section 
 74.31  252.28, subdivision 1, or any other law or rule to the contrary, 
 74.32  the commissioner of human services shall deny any request for a 
 74.33  determination of need and refuse to grant a license pursuant to 
 74.34  section 245A.02 for any new intermediate care facility for 
 74.35  persons with mental retardation or related conditions or for an 
 74.36  increase in the licensed capacity of an existing facility except 
 75.1   as provided in this subdivision and subdivision 2.  The total 
 75.2   number of certified intermediate care beds for persons with 
 75.3   mental retardation or related conditions in community facilities 
 75.4   and state hospitals shall not exceed 7,000 beds except that, to 
 75.5   the extent that federal authorities disapprove any applications 
 75.6   of the commissioner for home and community-based waivers under 
 75.7   United States Code, title 42, section 1396n, as amended through 
 75.8   December 31, 1987, the commissioner may authorize new 
 75.9   intermediate care beds, as necessary, to serve persons with 
 75.10  mental retardation or related conditions who would otherwise 
 75.11  have been served under a proposed waiver.  "Certified bed" means 
 75.12  an intermediate care bed for persons with mental retardation or 
 75.13  related conditions certified by the commissioner of health for 
 75.14  the purposes of the medical assistance program under United 
 75.15  States Code, title 42, sections 1396 to 1396p, as amended 
 75.16  through December 31, 1987.  
 75.17     Sec. 16.  Minnesota Statutes 2002, section 252.291, 
 75.18  subdivision 2a, is amended to read: 
 75.19     Subd. 2a.  [EXCEPTION FOR LAKE OWASSO PROJECT.] (a) The 
 75.20  commissioner shall authorize and grant a license under chapter 
 75.21  245A to a new intermediate care facility for persons with mental 
 75.22  retardation effective January 1, 2000, under the following 
 75.23  circumstances: 
 75.24     (1) the new facility replaces an existing 64-bed 
 75.25  intermediate care facility for the mentally retarded located in 
 75.26  Ramsey county; 
 75.27     (2) the new facility is located upon a parcel of land 
 75.28  contiguous to the parcel upon which the existing 64-bed facility 
 75.29  is located; 
 75.30     (3) the new facility is comprised of no more than eight 
 75.31  twin home style buildings and an administration building; 
 75.32     (4) the total licensed bed capacity of the facility does 
 75.33  not exceed 64 beds; and 
 75.34     (5) the existing 64-bed facility is demolished. 
 75.35     (b) The medical assistance payment rate for the new 
 75.36  facility shall be the higher of the rate specified in paragraph 
 76.1   (c) or as otherwise provided by law. 
 76.2      (c) The new facility shall be considered a newly 
 76.3   established facility for rate setting purposes and shall be 
 76.4   eligible for the investment per bed limit specified in section 
 76.5   256B.501, subdivision 11, paragraph (c), and the interest 
 76.6   expense limitation specified in section 256B.501, subdivision 
 76.7   11, paragraph (d).  Notwithstanding section 256B.5011, the newly 
 76.8   established facility's initial payment rate shall be set 
 76.9   according to Minnesota Rules, part 9553.0075, and shall not be 
 76.10  subject to the provisions of section 256B.501, subdivision 5b. 
 76.11     (d) During the construction of the new facility, Ramsey 
 76.12  county shall work with residents, families, and service 
 76.13  providers to explore all service options open to current 
 76.14  residents of the facility. 
 76.15     Sec. 17.  Minnesota Statutes 2002, section 256B.055, 
 76.16  subdivision 12, is amended to read: 
 76.17     Subd. 12.  [DISABLED CHILDREN.] (a) A person is eligible 
 76.18  for medical assistance if the person is under age 19 and 
 76.19  qualifies as a disabled individual under United States Code, 
 76.20  title 42, section 1382c(a), and would be eligible for medical 
 76.21  assistance under the state plan if residing in a medical 
 76.22  institution, and the child requires a level of care provided in 
 76.23  a hospital, nursing facility, or intermediate care facility for 
 76.24  persons with mental retardation or related conditions, for whom 
 76.25  home care is appropriate, provided that the cost to medical 
 76.26  assistance under this section is not more than the amount that 
 76.27  medical assistance would pay for if the child resides in an 
 76.28  institution.  After the child is determined to be eligible under 
 76.29  this section, the commissioner shall review the child's 
 76.30  disability under United States Code, title 42, section 1382c(a) 
 76.31  and level of care defined under this section no more often than 
 76.32  annually and may elect, based on the recommendation of health 
 76.33  care professionals under contract with the state medical review 
 76.34  team, to extend the review of disability and level of care up to 
 76.35  a maximum of four years.  The commissioner's decision on the 
 76.36  frequency of continuing review of disability and level of care 
 77.1   is not subject to administrative appeal under section 256.045.  
 77.2   Nothing in this subdivision shall be construed as affecting 
 77.3   other redeterminations of medical assistance eligibility under 
 77.4   this chapter and annual cost-effective reviews under this 
 77.5   section.  
 77.6      (b) For purposes of this subdivision, "hospital" means an 
 77.7   institution as defined in section 144.696, subdivision 3, 
 77.8   144.55, subdivision 3, or Minnesota Rules, part 4640.3600, and 
 77.9   licensed pursuant to sections 144.50 to 144.58.  For purposes of 
 77.10  this subdivision, a child requires a level of care provided in a 
 77.11  hospital if the child is determined by the commissioner to need 
 77.12  an extensive array of health services, including mental health 
 77.13  services, for an undetermined period of time, whose health 
 77.14  condition requires frequent monitoring and treatment by a health 
 77.15  care professional or by a person supervised by a health care 
 77.16  professional, who would reside in a hospital or require frequent 
 77.17  hospitalization if these services were not provided, and the 
 77.18  daily care needs are more complex than a nursing facility level 
 77.19  of care.  
 77.20     A child with serious emotional disturbance requires a level 
 77.21  of care provided in a hospital if the commissioner determines 
 77.22  that the individual requires 24-hour supervision because the 
 77.23  person exhibits recurrent or frequent suicidal or homicidal 
 77.24  ideation or behavior, recurrent or frequent psychosomatic 
 77.25  disorders or somatopsychic disorders that may become life 
 77.26  threatening, recurrent or frequent severe socially unacceptable 
 77.27  behavior associated with psychiatric disorder, ongoing and 
 77.28  chronic psychosis or severe, ongoing and chronic developmental 
 77.29  problems requiring continuous skilled observation, or severe 
 77.30  disabling symptoms for which office-centered outpatient 
 77.31  treatment is not adequate, and which overall severely impact the 
 77.32  individual's ability to function. 
 77.33     (c) For purposes of this subdivision, "nursing facility" 
 77.34  means a facility which provides nursing care as defined in 
 77.35  section 144A.01, subdivision 5, licensed pursuant to sections 
 77.36  144A.02 to 144A.10, which is appropriate if a person is in 
 78.1   active restorative treatment; is in need of special treatments 
 78.2   provided or supervised by a licensed nurse; or has unpredictable 
 78.3   episodes of active disease processes requiring immediate 
 78.4   judgment by a licensed nurse.  For purposes of this subdivision, 
 78.5   a child requires the level of care provided in a nursing 
 78.6   facility if the child is determined by the commissioner to meet 
 78.7   the requirements of the preadmission screening assessment 
 78.8   document under section 256B.0911 and the home care independent 
 78.9   rating document under section 256B.0627, subdivision 5, 
 78.10  paragraph (f), item (iii), adjusted to address age-appropriate 
 78.11  standards for children age 18 and under, pursuant to section 
 78.12  256B.0627, subdivision 5, paragraph (d), clause (2). 
 78.13     (d) For purposes of this subdivision, "intermediate care 
 78.14  facility for persons with mental retardation or related 
 78.15  conditions" or "ICF/MR" means a program licensed to provide 
 78.16  services to persons with mental retardation under section 
 78.17  252.28, and chapter 245A, and a physical plant licensed as a 
 78.18  supervised living facility under chapter 144, which together are 
 78.19  certified by the Minnesota department of health as meeting the 
 78.20  standards in Code of Federal Regulations, title 42, part 483, 
 78.21  for an intermediate care facility which provides services for 
 78.22  persons with mental retardation or persons with related 
 78.23  conditions who require 24-hour supervision and active treatment 
 78.24  for medical, behavioral, or habilitation needs.  For purposes of 
 78.25  this subdivision, a child requires a level of care provided in 
 78.26  an ICF/MR if the commissioner finds that the child has mental 
 78.27  retardation or a related condition in accordance with section 
 78.28  256B.092, is in need of a 24-hour plan of care and active 
 78.29  treatment similar to persons with mental retardation, and there 
 78.30  is a reasonable indication that the child will need ICF/MR 
 78.31  services. 
 78.32     (e) For purposes of this subdivision, a person requires the 
 78.33  level of care provided in a nursing facility if the person 
 78.34  requires 24-hour monitoring or supervision and a plan of mental 
 78.35  health treatment because of specific symptoms or functional 
 78.36  impairments associated with a serious mental illness or disorder 
 79.1   diagnosis, which meet severity criteria for mental health 
 79.2   established by the commissioner and published in March 1997 as 
 79.3   the Minnesota Mental Health Level of Care for Children and 
 79.4   Adolescents with Severe Emotional Disorders. 
 79.5      (f) The determination of the level of care needed by the 
 79.6   child shall be made by the commissioner based on information 
 79.7   supplied to the commissioner by the parent or guardian, the 
 79.8   child's physician or physicians, and other professionals as 
 79.9   requested by the commissioner.  The commissioner shall establish 
 79.10  a screening team to conduct the level of care determinations 
 79.11  according to this subdivision. 
 79.12     (g) If a child meets the conditions in paragraph (b), (c), 
 79.13  (d), or (e), the commissioner must assess the case to determine 
 79.14  whether: 
 79.15     (1) the child qualifies as a disabled individual under 
 79.16  United States Code, title 42, section 1382c(a), and would be 
 79.17  eligible for medical assistance if residing in a medical 
 79.18  institution; and 
 79.19     (2) the cost of medical assistance services for the child, 
 79.20  if eligible under this subdivision, would not be more than the 
 79.21  cost to medical assistance if the child resides in a medical 
 79.22  institution to be determined as follows: 
 79.23     (i) for a child who requires a level of care provided in an 
 79.24  ICF/MR, the cost of care for the child in an institution shall 
 79.25  be determined using the average payment rate established for the 
 79.26  regional treatment centers that are certified as ICFs/MR; 
 79.27     (ii) for a child who requires a level of care provided in 
 79.28  an inpatient hospital setting according to paragraph (b), 
 79.29  cost-effectiveness shall be determined according to Minnesota 
 79.30  Rules, part 9505.3520, items F and G; and 
 79.31     (iii) for a child who requires a level of care provided in 
 79.32  a nursing facility according to paragraph (c) or (e), 
 79.33  cost-effectiveness shall be determined according to Minnesota 
 79.34  Rules, part 9505.3040, except that the nursing facility average 
 79.35  rate shall be adjusted to reflect rates which would be paid for 
 79.36  children under age 16.  The commissioner may authorize an amount 
 80.1   up to the amount medical assistance would pay for a child 
 80.2   referred to the commissioner by the preadmission screening team 
 80.3   under section 256B.0911. 
 80.4      (h) Children eligible for medical assistance services under 
 80.5   section 256B.055, subdivision 12, as of June 30, 1995, must be 
 80.6   screened according to the criteria in this subdivision prior to 
 80.7   January 1, 1996.  Children found to be ineligible may not be 
 80.8   removed from the program until January 1, 1996.  
 80.9      Sec. 18.  Minnesota Statutes 2002, section 626.5572, 
 80.10  subdivision 6, is amended to read: 
 80.11     Subd. 6.  [FACILITY.] (a) "Facility" means a hospital or 
 80.12  other entity required to be licensed under sections 144.50 to 
 80.13  144.58; a nursing home required to be licensed to serve adults 
 80.14  under section 144A.02; a residential or nonresidential facility 
 80.15  required to be licensed to serve adults under sections 245A.01 
 80.16  to 245A.16 chapter 245A; an ICF/MR as defined in section 
 80.17  256B.055, subdivision 12; a home care provider licensed or 
 80.18  required to be licensed under section 144A.46; a hospice 
 80.19  provider licensed under sections 144A.75 to 144A.755; or a 
 80.20  person or organization that exclusively offers, provides, or 
 80.21  arranges for personal care assistant services under the medical 
 80.22  assistance program as authorized under sections 256B.04, 
 80.23  subdivision 16, 256B.0625, subdivision 19a, and 256B.0627.  
 80.24     (b) For home care providers and personal care attendants, 
 80.25  the term "facility" refers to the provider or person or 
 80.26  organization that exclusively offers, provides, or arranges for 
 80.27  personal care services, and does not refer to the client's home 
 80.28  or other location at which services are rendered. 
 80.29     Sec. 19.  Minnesota Statutes 2002, section 626.5572, 
 80.30  subdivision 13, is amended to read: 
 80.31     Subd. 13.  [LEAD AGENCY.] "Lead agency" is the primary 
 80.32  administrative agency responsible for investigating reports made 
 80.33  under section 626.557. 
 80.34     (a) The department of health is the lead agency for the 
 80.35  facilities which are licensed or are required to be licensed as: 
 80.36  hospitals, including mental health and chemical dependency 
 81.1   treatment programs licensed as hospitals; ICFs/MR; home care 
 81.2   providers, including home care services provided in adult foster 
 81.3   care settings; nursing homes,; residential care homes,; or 
 81.4   boarding care homes. 
 81.5      (b) The department of human services is the lead agency for 
 81.6   the programs licensed or required to be licensed as:  adult day 
 81.7   care,; adult foster care, except services provided in a foster 
 81.8   setting by a home health care provider or an unlicensed home 
 81.9   care provider; programs for people with developmental 
 81.10  disabilities, except ICFs/MR; and mental health programs, and 
 81.11  chemical health programs, or personal care provider 
 81.12  organizations except programs licensed as a hospital. 
 81.13     (c) The county social service agency or its designee is the 
 81.14  lead agency for all other reports. 
 81.15     Sec. 20.  [REPEALER.] 
 81.16     Minnesota Rules, parts 9520.0660, subpart 3; 9520.0670, 
 81.17  subpart 3; and 9530.4120, subpart 5, are repealed. 
 81.18     Sec. 21.  [EFFECTIVE DATE.] 
 81.19     Sections 1 to 20 are effective January 1, 2004. 
 81.20                             ARTICLE 6
 81.21                            CORRECTIONS 
 81.22     Section 1.  Minnesota Statutes 2002, section 244.05, is 
 81.23  amended by adding a subdivision to read: 
 81.24     Subd. 3a.  [SANCTIONS FOR VIOLATIONS; INMATES WITH SERIOUS 
 81.25  AND PERSISTENT MENTAL ILLNESS.] When an inmate with a serious 
 81.26  and persistent mental illness, as defined in section 245.462, 
 81.27  subdivision 20, paragraph (c), violates the conditions of the 
 81.28  inmate's supervised release and the commissioner intends to 
 81.29  revoke the release and reimprison the inmate, the commissioner, 
 81.30  when consistent with public safety, may continue the inmate's 
 81.31  supervised release term and require the inmate to successfully 
 81.32  complete an appropriate supervised alternative living program 
 81.33  having a mental health treatment component.  
 81.34     Sec. 2.  [609.1055] [OFFENDERS WITH SERIOUS AND PERSISTENT 
 81.35  MENTAL ILLNESS; ALTERNATIVE PLACEMENT.] 
 81.36     When a court intends to commit an offender with a serious 
 82.1   and persistent mental illness, as defined in section 245.462, 
 82.2   subdivision 20, paragraph (c), to the custody of the 
 82.3   commissioner of corrections for imprisonment at a state 
 82.4   correctional facility, either when initially pronouncing a 
 82.5   sentence or when revoking an offender's probation, the court, 
 82.6   when consistent with public safety, may instead place the 
 82.7   offender on probation or continue the offender's probation and 
 82.8   require as a condition of the probation that the offender 
 82.9   successfully complete an appropriate supervised alternative 
 82.10  living program having a mental health treatment component.  This 
 82.11  section applies only to offenders who would have a remaining 
 82.12  term of imprisonment after adjusting for credit for prior 
 82.13  imprisonment, if any, of more than one year. 
 82.14     Sec. 3.  [ALTERNATIVE LIVING PROGRAMS FOR CERTAIN OFFENDERS 
 82.15  WITH MENTAL ILLNESS.] 
 82.16     The commissioner of corrections shall cooperate with 
 82.17  nonprofit entities to establish supervised alternative living 
 82.18  programs for offenders with serious and persistent mental 
 82.19  illness, as defined in Minnesota Statutes, section 245.462, 
 82.20  subdivision 20, paragraph (c).  Each program must be structured 
 82.21  to accommodate between eight and 13 offenders who are required 
 82.22  to successfully complete the program as a sanction for violating 
 82.23  their supervised release or as a condition of probation.  Each 
 82.24  program must provide a residential component and include mental 
 82.25  health treatment and counseling, living and employment skills 
 82.26  development, and supported employment.  Program directors shall 
 82.27  report program violations by participating offenders to the 
 82.28  offender's correctional agent.  
 82.29     Sec. 4.  [RULE 36, MINNESOTA RULES, PARTS 9520.0500 TO 
 82.30  9520.0690, LICENSURE FOR ALTERNATIVE LIVING PROGRAMS FOR CERTAIN 
 82.31  OFFENDERS WITH MENTAL ILLNESS.] 
 82.32     The commissioner of human services shall approve additional 
 82.33  Rule 36 licenses in order to accommodate alternative living 
 82.34  programs for certain offenders with mental illness if: 
 82.35     (1) the provider meets applicable licensing standards; and 
 82.36     (2) additional Rule 36 programs are necessary to meet the 
 83.1   demand for alternative living programs for certain offenders 
 83.2   with mental illness. 
 83.3      Sec. 5.  [FINANCING FOR RULE 36 PROGRAMS FOR ALTERNATIVE 
 83.4   LIVING PROGRAMS FOR CERTAIN OFFENDERS WITH MENTAL ILLNESS.] 
 83.5      Applicants for licensure of a Rule 36 program to provide an 
 83.6   alternative living program for certain offenders with mental 
 83.7   illness must be given special consideration and priority from 
 83.8   the Minnesota housing finance agency, as allowed, in order to 
 83.9   secure home loans for an alternative living program for certain 
 83.10  offenders with mental illness. 
 83.11                             ARTICLE 7
 83.12             PROHIBITED TRANSFERS; LIENS; ESTATE CLAIMS
 83.13     Section 1.  Minnesota Statutes 2002, section 256B.0595, 
 83.14  subdivision 1, is amended to read: 
 83.15     Subdivision 1.  [PROHIBITED TRANSFERS.] (a) For transfers 
 83.16  of assets made on or before August 10, 1993, if a person or the 
 83.17  person's spouse has given away, sold, or disposed of, for less 
 83.18  than fair market value, any asset or interest therein, except 
 83.19  assets other than the homestead that are excluded under the 
 83.20  supplemental security program, within 30 months before or any 
 83.21  time after the date of institutionalization if the person has 
 83.22  been determined eligible for medical assistance, or within 30 
 83.23  months before or any time after the date of the first approved 
 83.24  application for medical assistance if the person has not yet 
 83.25  been determined eligible for medical assistance, the person is 
 83.26  ineligible for long-term care services for the period of time 
 83.27  determined under subdivision 2.  
 83.28     (b) Effective for transfers made after August 10, 1993, a 
 83.29  person, a person's spouse, or any person, court, or 
 83.30  administrative body with legal authority to act in place of, on 
 83.31  behalf of, at the direction of, or upon the request of the 
 83.32  person or person's spouse, may not give away, sell, or dispose 
 83.33  of, for less than fair market value, any asset or interest 
 83.34  therein, except assets other than the homestead that are 
 83.35  excluded under the supplemental security income program, for the 
 83.36  purpose of establishing or maintaining medical assistance 
 84.1   eligibility.  This applies to all transfers, including those 
 84.2   made by a community spouse after the month in which the 
 84.3   institutionalized spouse is determined eligible for medical 
 84.4   assistance.  For purposes of determining eligibility for 
 84.5   long-term care services, any transfer of such assets within 36 
 84.6   months before or any time after an institutionalized person 
 84.7   applies for medical assistance, or 36 months before or any time 
 84.8   after a medical assistance recipient becomes institutionalized, 
 84.9   for less than fair market value may be considered.  Any such 
 84.10  transfer is presumed to have been made for the purpose of 
 84.11  establishing or maintaining medical assistance eligibility and 
 84.12  the person is ineligible for long-term care services for the 
 84.13  period of time determined under subdivision 2, unless the person 
 84.14  furnishes convincing evidence to establish that the transaction 
 84.15  was exclusively for another purpose, or unless the transfer is 
 84.16  permitted under subdivision 3 or 4.  Notwithstanding the 
 84.17  provisions of this paragraph, in the case of payments from a 
 84.18  trust or portions of a trust that are considered transfers of 
 84.19  assets under federal law, any transfers made within 60 months 
 84.20  before or any time after an institutionalized person applies for 
 84.21  medical assistance and within 60 months before or any time after 
 84.22  a medical assistance recipient becomes institutionalized, may be 
 84.23  considered. 
 84.24     (c) This section applies to transfers, for less than fair 
 84.25  market value, of income or assets, including assets that are 
 84.26  considered income in the month received, such as inheritances, 
 84.27  court settlements, and retroactive benefit payments or income to 
 84.28  which the person or the person's spouse is entitled but does not 
 84.29  receive due to action by the person, the person's spouse, or any 
 84.30  person, court, or administrative body with legal authority to 
 84.31  act in place of, on behalf of, at the direction of, or upon the 
 84.32  request of the person or the person's spouse.  
 84.33     (d) This section applies to payments for care or personal 
 84.34  services provided by a relative, unless the compensation was 
 84.35  stipulated in a notarized, written agreement which was in 
 84.36  existence when the service was performed, the care or services 
 85.1   directly benefited the person, and the payments made represented 
 85.2   reasonable compensation for the care or services provided.  A 
 85.3   notarized written agreement is not required if payment for the 
 85.4   services was made within 60 days after the service was provided. 
 85.5      (e) This section applies to the portion of any asset or 
 85.6   interest that a person, a person's spouse, or any person, court, 
 85.7   or administrative body with legal authority to act in place of, 
 85.8   on behalf of, at the direction of, or upon the request of the 
 85.9   person or the person's spouse, transfers to any annuity that 
 85.10  exceeds the value of the benefit likely to be returned to the 
 85.11  person or spouse while alive, based on estimated life expectancy 
 85.12  using the life expectancy tables employed by the supplemental 
 85.13  security income program to determine the value of an agreement 
 85.14  for services for life.  The commissioner may adopt rules 
 85.15  reducing life expectancies based on the need for long-term 
 85.16  care.  This section applies to an annuity described in this 
 85.17  paragraph purchased on or after March 1, 2002, that: 
 85.18     (1) is not purchased from an insurance company or financial 
 85.19  institution that is subject to licensing or regulation by the 
 85.20  Minnesota department of commerce or a similar regulatory agency 
 85.21  of another state; 
 85.22     (2) does not pay out principal and interest in equal 
 85.23  monthly installments; or 
 85.24     (3) does not begin payment at the earliest possible date 
 85.25  after annuitization.  
 85.26     (f) For purposes of this section, long-term care services 
 85.27  include services in a nursing facility, services that are 
 85.28  eligible for payment according to section 256B.0625, subdivision 
 85.29  2, because they are provided in a swing bed, intermediate care 
 85.30  facility for persons with mental retardation, and home and 
 85.31  community-based services provided pursuant to sections 
 85.32  256B.0915, 256B.092, and 256B.49.  For purposes of this 
 85.33  subdivision and subdivisions 2, 3, and 4, "institutionalized 
 85.34  person" includes a person who is an inpatient in a nursing 
 85.35  facility or in a swing bed, or intermediate care facility for 
 85.36  persons with mental retardation or who is receiving home and 
 86.1   community-based services under sections 256B.0915, 256B.092, and 
 86.2   256B.49. 
 86.3      <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2003.  
 86.4      Sec. 2.  Minnesota Statutes 2002, section 256B.0595, is 
 86.5   amended by adding a subdivision to read: 
 86.6      Subd. 1b.  [PROHIBITED TRANSFERS.] (a) Notwithstanding any 
 86.7   contrary provisions of this section, this subdivision applies to 
 86.8   transfers involving recipients of medical assistance that are 
 86.9   made on or after its effective date and to all transfers 
 86.10  involving persons who apply for medical assistance on or after 
 86.11  its effective date if the transfer occurred within 72 months 
 86.12  before the person applies for medical assistance, except that 
 86.13  this subdivision does not apply to transfers made prior to July 
 86.14  1, 2003.  A person, a person's spouse, or any person, court, or 
 86.15  administrative body with legal authority to act in place of, on 
 86.16  behalf of, at the direction of, or upon the request of the 
 86.17  person or the person's spouse, may not give away, sell, dispose 
 86.18  of, or reduce ownership or control of any income, asset, or 
 86.19  interest therein for less than fair market value for the purpose 
 86.20  of establishing or maintaining medical assistance eligibility.  
 86.21  This applies to all transfers, including those made by a 
 86.22  community spouse after the month in which the institutionalized 
 86.23  spouse is determined eligible for medical assistance.  For 
 86.24  purposes of determining eligibility for medical assistance 
 86.25  services, any transfer of such income or assets for less than 
 86.26  fair market value within 72 months before or any time after a 
 86.27  person applies for medical assistance may be considered.  Any 
 86.28  such transfer is presumed to have been made for the purpose of 
 86.29  establishing or maintaining medical assistance eligibility, and 
 86.30  the person is ineligible for medical assistance services for the 
 86.31  period of time determined under subdivision 2b, unless the 
 86.32  person furnishes convincing evidence to establish that the 
 86.33  transaction was exclusively for another purpose or unless the 
 86.34  transfer is permitted under subdivision 3b or 4b. 
 86.35     (b) This section applies to transfers to trusts.  The 
 86.36  commissioner shall determine valid trust purposes under this 
 87.1   section.  Assets placed into a trust that is not for a valid 
 87.2   purpose shall always be considered available for the purposes of 
 87.3   medical assistance eligibility, regardless of when the trust is 
 87.4   established. 
 87.5      (c) This section applies to transfers of income or assets 
 87.6   for less than fair market value, including assets that are 
 87.7   considered income in the month received, such as inheritances, 
 87.8   court settlements, and retroactive benefit payments or income to 
 87.9   which the person or the person's spouse is entitled but does not 
 87.10  receive due to action by the person, the person's spouse, or any 
 87.11  person, court, or administrative body with legal authority to 
 87.12  act in place of, on behalf of, at the direction of, or upon the 
 87.13  request of the person or the person's spouse. 
 87.14     (d) This section applies to payments for care or personal 
 87.15  services provided by a relative, unless the compensation was 
 87.16  stipulated in a notarized written agreement that was in 
 87.17  existence when the service was performed, the care or services 
 87.18  directly benefited the person, and the payments made represented 
 87.19  reasonable compensation for the care or services provided.  A 
 87.20  notarized written agreement is not required if payment for the 
 87.21  services was made within 60 days after the service was provided. 
 87.22     (e) This section applies to the portion of any income, 
 87.23  asset, or interest therein that a person, a person's spouse, or 
 87.24  any person, court, or administrative body with legal authority 
 87.25  to act in place of, on behalf of, at the direction of, or upon 
 87.26  the request of the person or the person's spouse, transfers to 
 87.27  any annuity that exceeds the value of the benefit likely to be 
 87.28  returned to the person or the person's spouse while alive, based 
 87.29  on estimated life expectancy, using the life expectancy tables 
 87.30  employed by the supplemental security income program, or based 
 87.31  on a shorter life expectancy if the annuitant had a medical 
 87.32  condition that would shorten his or her life expectancy and that 
 87.33  was diagnosed before funds were placed into the annuity.  The 
 87.34  agency may request and receive a physician's statement to 
 87.35  determine if the annuitant had a diagnosed medical condition 
 87.36  that would shorten his or her life expectancy.  If so, the 
 88.1   agency shall determine the expected value of the benefits based 
 88.2   upon the physician's statement instead of using a life 
 88.3   expectancy table.  This section applies to an annuity described 
 88.4   in this paragraph purchased on or after March 1, 2002, that: 
 88.5      (1) is not purchased from an insurance company or financial 
 88.6   institution that is subject to licensing or regulation by the 
 88.7   Minnesota department of commerce or a similar regulatory agency 
 88.8   of another state; 
 88.9      (2) does not pay out principal and interest in equal 
 88.10  monthly installments; or 
 88.11     (3) does not begin payment at the earliest possible date 
 88.12  after annuitization. 
 88.13     (f) Transfers under this section shall affect 
 88.14  determinations of eligibility for all medical assistance 
 88.15  services or long-term care services, whichever receives federal 
 88.16  approval. 
 88.17     <b>[EFFECTIVE DATE.]</b> (a) This section is effective July 1, 
 88.18  2003, to the extent permitted by federal law.  If any provision 
 88.19  of this section is prohibited by federal law, the provision 
 88.20  shall become effective when federal law is changed to permit its 
 88.21  application or a waiver is received.  The commissioner of human 
 88.22  services shall notify the revisor of statutes when federal law 
 88.23  is enacted or a waiver or other federal approval is received and 
 88.24  publish a notice in the State Register.  The commissioner must 
 88.25  include the notice in the first State Register published after 
 88.26  the effective date of the federal changes. 
 88.27     (b) If, by July 1, 2003, any provision of this section is 
 88.28  not effective because of prohibitions in federal law, the 
 88.29  commissioner of human services shall apply to the federal 
 88.30  government by August 1, 2003, for a waiver of those prohibitions 
 88.31  or other federal authority, and that provision shall become 
 88.32  effective upon receipt of a federal waiver or other federal 
 88.33  approval, notification to the revisor of statutes, and 
 88.34  publication of a notice in the State Register to that effect.  
 88.35  In applying for federal approval to extend the lookback period, 
 88.36  the commissioner shall seek the longest lookback period the 
 89.1   federal government will approve, not to exceed 72 months. 
 89.2      Sec. 3.  Minnesota Statutes 2002, section 256B.0595, 
 89.3   subdivision 2, is amended to read: 
 89.4      Subd. 2.  [PERIOD OF INELIGIBILITY.] (a) For any 
 89.5   uncompensated transfer occurring on or before August 10, 1993, 
 89.6   the number of months of ineligibility for long-term care 
 89.7   services shall be the lesser of 30 months, or the uncompensated 
 89.8   transfer amount divided by the average medical assistance rate 
 89.9   for nursing facility services in the state in effect on the date 
 89.10  of application.  The amount used to calculate the average 
 89.11  medical assistance payment rate shall be adjusted each July 1 to 
 89.12  reflect payment rates for the previous calendar year.  The 
 89.13  period of ineligibility begins with the month in which the 
 89.14  assets were transferred.  If the transfer was not reported to 
 89.15  the local agency at the time of application, and the applicant 
 89.16  received long-term care services during what would have been the 
 89.17  period of ineligibility if the transfer had been reported, a 
 89.18  cause of action exists against the transferee for the cost of 
 89.19  long-term care services provided during the period of 
 89.20  ineligibility, or for the uncompensated amount of the transfer, 
 89.21  whichever is less.  The action may be brought by the state or 
 89.22  the local agency responsible for providing medical assistance 
 89.23  under chapter 256G.  The uncompensated transfer amount is the 
 89.24  fair market value of the asset at the time it was given away, 
 89.25  sold, or disposed of, less the amount of compensation received.  
 89.26     (b) For uncompensated transfers made after August 10, 1993, 
 89.27  the number of months of ineligibility for long-term care 
 89.28  services shall be the total uncompensated value of the resources 
 89.29  transferred divided by the average medical assistance rate for 
 89.30  nursing facility services in the state in effect on the date of 
 89.31  application.  The amount used to calculate the average medical 
 89.32  assistance payment rate shall be adjusted each July 1 to reflect 
 89.33  payment rates for the previous calendar year.  The period of 
 89.34  ineligibility begins with the first day of the month after the 
 89.35  month in which the assets were transferred except that if one or 
 89.36  more uncompensated transfers are made during a period of 
 90.1   ineligibility, the total assets transferred during the 
 90.2   ineligibility period shall be combined and a penalty period 
 90.3   calculated to begin in on the first day of the month after the 
 90.4   month in which the first uncompensated transfer was made.  If 
 90.5   the transfer was not reported to the local agency at the time of 
 90.6   application, and the applicant received medical assistance 
 90.7   services during what would have been the period of ineligibility 
 90.8   if the transfer had been reported, a cause of action exists 
 90.9   against the transferee for the cost of medical assistance 
 90.10  services provided during the period of ineligibility, or for the 
 90.11  uncompensated amount of the transfer, whichever is less.  The 
 90.12  action may be brought by the state or the local agency 
 90.13  responsible for providing medical assistance under chapter 
 90.14  256G.  The uncompensated transfer amount is the fair market 
 90.15  value of the asset at the time it was given away, sold, or 
 90.16  disposed of, less the amount of compensation received.  
 90.17  Effective for transfers made on or after March 1, 1996, 
 90.18  involving persons who apply for medical assistance on or after 
 90.19  April 13, 1996, no cause of action exists for a transfer unless: 
 90.20     (1) the transferee knew or should have known that the 
 90.21  transfer was being made by a person who was a resident of a 
 90.22  long-term care facility or was receiving that level of care in 
 90.23  the community at the time of the transfer; 
 90.24     (2) the transferee knew or should have known that the 
 90.25  transfer was being made to assist the person to qualify for or 
 90.26  retain medical assistance eligibility; or 
 90.27     (3) the transferee actively solicited the transfer with 
 90.28  intent to assist the person to qualify for or retain eligibility 
 90.29  for medical assistance.  
 90.30     (c) If a calculation of a penalty period results in a 
 90.31  partial month, payments for long-term care services shall be 
 90.32  reduced in an amount equal to the fraction, except that in 
 90.33  calculating the value of uncompensated transfers, if the total 
 90.34  value of all uncompensated transfers made in a month not 
 90.35  included in an existing penalty period does not exceed $200, 
 90.36  then such transfers shall be disregarded for each month prior to 
 91.1   the month of application for or during receipt of medical 
 91.2   assistance. 
 91.3      <b>[EFFECTIVE DATE.]</b> Paragraph (b) of this section is 
 91.4   effective July 1, 2003. 
 91.5      Sec. 4.  Minnesota Statutes 2002, section 256B.0595, is 
 91.6   amended by adding a subdivision to read: 
 91.7      Subd. 2b.  [PERIOD OF INELIGIBILITY.] (a) Notwithstanding 
 91.8   any contrary provisions of this section, this subdivision 
 91.9   applies to transfers, including transfers to trusts, involving 
 91.10  recipients of medical assistance that are made on or after its 
 91.11  effective date and to all transfers involving persons who apply 
 91.12  for medical assistance on or after its effective date, 
 91.13  regardless of when the transfer occurred, except that this 
 91.14  subdivision does not apply to transfers made prior to July 1, 
 91.15  2003.  For any uncompensated transfer occurring within 72 months 
 91.16  prior to the date of application, at any time after application, 
 91.17  or while eligible, the number of months of cumulative 
 91.18  ineligibility for medical assistance services shall be the total 
 91.19  uncompensated value of the assets and income transferred divided 
 91.20  by the statewide average per-person nursing facility payment 
 91.21  made by the state in effect at the time a penalty for a transfer 
 91.22  is determined.  The amount used to calculate the average 
 91.23  per-person nursing facility payment shall be adjusted each July 
 91.24  1 to reflect average payments for the previous calendar year.  
 91.25  For applicants, the period of ineligibility begins with the 
 91.26  month in which the person applied for medical assistance and 
 91.27  satisfied all other requirements for eligibility, or the first 
 91.28  month the local agency becomes aware of the transfer and can 
 91.29  give proper notice, if later.  For recipients, the period of 
 91.30  ineligibility begins in the first month after the month the 
 91.31  agency becomes aware of the transfer and can give proper notice, 
 91.32  except that penalty periods for transfers made during a period 
 91.33  of ineligibility as determined under this section shall begin in 
 91.34  the month following the existing period of ineligibility.  If 
 91.35  the transfer was not reported to the local agency, and the 
 91.36  applicant received medical assistance services during what would 
 92.1   have been the period of ineligibility if the transfer had been 
 92.2   reported, a cause of action exists against the transferee for 
 92.3   the cost of medical assistance services provided during the 
 92.4   period of ineligibility or for the uncompensated amount of the 
 92.5   transfer that was not recovered from the transferor through the 
 92.6   implementation of a penalty period under this subdivision, 
 92.7   whichever is less.  Recovery shall include the costs incurred 
 92.8   due to the action.  The action may be brought by the state or 
 92.9   the local agency responsible for providing medical assistance 
 92.10  under chapter 256B.  The total uncompensated value is the fair 
 92.11  market value of the income or asset at the time it was given 
 92.12  away, sold, or disposed of, less the amount of compensation 
 92.13  received.  No cause of action exists for a transfer unless: 
 92.14     (1) the transferee knew or should have known that the 
 92.15  transfer was being made by a person who was a resident of a 
 92.16  long-term care facility or was receiving that level of care in 
 92.17  the community at the time of the transfer; 
 92.18     (2) the transferee knew or should have known that the 
 92.19  transfer was being made to assist the person to qualify for or 
 92.20  retain medical assistance eligibility; or 
 92.21     (3) the transferee actively solicited the transfer with 
 92.22  intent to assist the person to qualify for or retain eligibility 
 92.23  for medical assistance. 
 92.24     (b) If a calculation of a penalty period results in a 
 92.25  partial month, payments for medical assistance services shall be 
 92.26  reduced in an amount equal to the fraction, except that in 
 92.27  calculating the value of uncompensated transfers, if the total 
 92.28  value of all uncompensated transfers made in a month not 
 92.29  included in an existing penalty period does not exceed $200, 
 92.30  then such transfers shall be disregarded for each month prior to 
 92.31  the month of application for or during receipt of medical 
 92.32  assistance. 
 92.33     (c) Ineligibility under this section shall apply to medical 
 92.34  assistance services or long-term care services, whichever 
 92.35  receives federal approval. 
 92.36     <b>[EFFECTIVE DATE.]</b> (a) This section is effective July 1, 
 93.1   2003, to the extent permitted by federal law.  If any provision 
 93.2   of this section is prohibited by federal law, the provision 
 93.3   shall become effective when federal law is changed to permit its 
 93.4   application or a waiver is received.  The commissioner of human 
 93.5   services shall notify the revisor of statutes when federal law 
 93.6   is enacted or a waiver or other federal approval is received and 
 93.7   publish a notice in the State Register.  The commissioner must 
 93.8   include the notice in the first State Register published after 
 93.9   the effective date of the federal changes. 
 93.10     (b) If, by July 1, 2003, any provision of this section is 
 93.11  not effective because of prohibitions in federal law, the 
 93.12  commissioner of human services shall apply to the federal 
 93.13  government by August 1, 2003, for a waiver of those prohibitions 
 93.14  or other federal authority, and that provision shall become 
 93.15  effective upon receipt of a federal waiver or other federal 
 93.16  approval, notification to the revisor of statutes, and 
 93.17  publication of a notice in the State Register to that effect.  
 93.18  In applying for federal approval to extend the lookback period, 
 93.19  the commissioner shall seek the longest lookback period the 
 93.20  federal government will approve, not to exceed 72 months. 
 93.21     Sec. 5.  Minnesota Statutes 2002, section 256B.0595, is 
 93.22  amended by adding a subdivision to read: 
 93.23     Subd. 3b.  [HOMESTEAD EXCEPTION TO TRANSFER 
 93.24  PROHIBITION.] (a) This subdivision applies to transfers 
 93.25  involving recipients of medical assistance that are made on or 
 93.26  after its effective date and to all transfers involving persons 
 93.27  who apply for medical assistance on or after its effective date, 
 93.28  regardless of when the transfer occurred, except that this 
 93.29  subdivision does not apply to transfers made prior to July 1, 
 93.30  2003.  A person is not ineligible for medical assistance 
 93.31  services due to a transfer of assets for less than fair market 
 93.32  value as described in subdivision 1b, if the asset transferred 
 93.33  was a homestead, and: 
 93.34     (1) a satisfactory showing is made that the individual 
 93.35  intended to dispose of the homestead at fair market value or for 
 93.36  other valuable consideration; or 
 94.1      (2) the local agency grants a waiver of a penalty resulting 
 94.2   from a transfer for less than fair market value because denial 
 94.3   of eligibility would cause undue hardship for the individual and 
 94.4   there exists an imminent threat to the individual's health and 
 94.5   well-being.  Whenever an applicant or recipient is denied 
 94.6   eligibility because of a transfer for less than fair market 
 94.7   value, the local agency shall notify the applicant or recipient 
 94.8   that the applicant or recipient may request a waiver of the 
 94.9   penalty if the denial of eligibility will cause undue hardship.  
 94.10  In evaluating a waiver, the local agency shall take into account 
 94.11  whether the individual was the victim of financial exploitation, 
 94.12  whether the individual has made reasonable efforts to recover 
 94.13  the transferred property or resource, and other factors relevant 
 94.14  to a determination of hardship.  If the local agency does not 
 94.15  approve a hardship waiver, the local agency shall issue a 
 94.16  written notice to the individual stating the reasons for the 
 94.17  denial and the process for appealing the local agency's decision.
 94.18     (b) When a waiver is granted under paragraph (a), clause 
 94.19  (2), a cause of action exists against the person to whom the 
 94.20  homestead was transferred for that portion of medical assistance 
 94.21  services granted within 72 months of the date the transferor 
 94.22  applied for medical assistance and satisfied all other 
 94.23  requirements for eligibility or the amount of the uncompensated 
 94.24  transfer, whichever is less, together with the costs incurred 
 94.25  due to the action.  The action shall be brought by the state 
 94.26  unless the state delegates this responsibility to the local 
 94.27  agency responsible for providing medical assistance under 
 94.28  chapter 256B. 
 94.29     <b>[EFFECTIVE DATE.]</b> (a) This section is effective July 1, 
 94.30  2003, to the extent permitted by federal law.  If any provision 
 94.31  of this section is prohibited by federal law, the provision 
 94.32  shall become effective when federal law is changed to permit its 
 94.33  application or a waiver is received.  The commissioner of human 
 94.34  services shall notify the revisor of statutes when federal law 
 94.35  is enacted or a waiver or other federal approval is received and 
 94.36  publish a notice in the State Register.  The commissioner must 
 95.1   include the notice in the first State Register published after 
 95.2   the effective date of the federal changes. 
 95.3      (b) If, by July 1, 2003, any provision of this section is 
 95.4   not effective because of prohibitions in federal law, the 
 95.5   commissioner of human services shall apply to the federal 
 95.6   government by August 1, 2003, for a waiver of those prohibitions 
 95.7   or other federal authority, and that provision shall become 
 95.8   effective upon receipt of a federal waiver or other federal 
 95.9   approval, notification to the revisor of statutes, and 
 95.10  publication of a notice in the State Register to that effect.  
 95.11  In applying for federal approval to extend the lookback period, 
 95.12  the commissioner shall seek the longest lookback period the 
 95.13  federal government will approve, not to exceed 72 months. 
 95.14     Sec. 6.  Minnesota Statutes 2002, section 256B.0595, is 
 95.15  amended by adding a subdivision to read: 
 95.16     Subd. 4b.  [OTHER EXCEPTIONS TO TRANSFER PROHIBITION.] This 
 95.17  subdivision applies to transfers involving recipients of medical 
 95.18  assistance that are made on or after its effective date and to 
 95.19  all transfers involving persons who apply for medical assistance 
 95.20  on or after its effective date regardless of when the transfer 
 95.21  occurred, except that this subdivision does not apply to 
 95.22  transfers made prior to July 1, 2003.  A person or a person's 
 95.23  spouse who made a transfer prohibited by subdivision 1b is not 
 95.24  ineligible for medical assistance services if one of the 
 95.25  following conditions applies: 
 95.26     (1) the assets or income were transferred to the 
 95.27  individual's spouse or to another for the sole benefit of the 
 95.28  spouse, except that after eligibility is established and the 
 95.29  assets have been divided between the spouses as part of the 
 95.30  asset allowance under section 256B.059, no further transfers 
 95.31  between spouses may be made; 
 95.32     (2) the institutionalized spouse, prior to being 
 95.33  institutionalized, transferred assets or income to a spouse, 
 95.34  provided that the spouse to whom the assets or income were 
 95.35  transferred does not then transfer those assets or income to 
 95.36  another person for less than fair market value.  At the time 
 96.1   when one spouse is institutionalized, assets must be allocated 
 96.2   between the spouses as provided under section 256B.059; 
 96.3      (3) the assets or income were transferred to a trust for 
 96.4   the sole benefit of the individual's child who is blind or 
 96.5   permanently and totally disabled as determined in the 
 96.6   supplemental security income program and the trust reverts to 
 96.7   the state upon the disabled child's death to the extent the 
 96.8   medical assistance has paid for services for the grantor or 
 96.9   beneficiary of the trust.  This clause applies to a trust 
 96.10  established after the commissioner publishes a notice in the 
 96.11  State Register that the commissioner has been authorized to 
 96.12  implement this clause due to a change in federal law or the 
 96.13  approval of a federal waiver; 
 96.14     (4) a satisfactory showing is made that the individual 
 96.15  intended to dispose of the assets or income either at fair 
 96.16  market value or for other valuable consideration; or 
 96.17     (5) the local agency determines that denial of eligibility 
 96.18  for medical assistance services would cause undue hardship and 
 96.19  grants a waiver of a penalty resulting from a transfer for less 
 96.20  than fair market value because there exists an imminent threat 
 96.21  to the individual's health and well-being.  Whenever an 
 96.22  applicant or recipient is denied eligibility because of a 
 96.23  transfer for less than fair market value, the local agency shall 
 96.24  notify the applicant or recipient that the applicant or 
 96.25  recipient may request a waiver of the penalty if the denial of 
 96.26  eligibility will cause undue hardship.  In evaluating a waiver, 
 96.27  the local agency shall take into account whether the individual 
 96.28  was the victim of financial exploitation, whether the individual 
 96.29  has made reasonable efforts to recover the transferred property 
 96.30  or resource, and other factors relevant to a determination of 
 96.31  hardship.  If the local agency does not approve a hardship 
 96.32  waiver, the local agency shall issue a written notice to the 
 96.33  individual stating the reasons for the denial and the process 
 96.34  for appealing the local agency's decision.  When a waiver is 
 96.35  granted, a cause of action exists against the person to whom the 
 96.36  assets were transferred for that portion of medical assistance 
 97.1   services granted within 72 months of the date the transferor 
 97.2   applied for medical assistance and satisfied all other 
 97.3   requirements for eligibility, or the amount of the uncompensated 
 97.4   transfer, whichever is less, together with the costs incurred 
 97.5   due to the action.  The action shall be brought by the state 
 97.6   unless the state delegates this responsibility to the local 
 97.7   agency responsible for providing medical assistance under this 
 97.8   chapter. 
 97.9      <b>[EFFECTIVE DATE.]</b> (a) This section is effective July 1, 
 97.10  2003, to the extent permitted by federal law.  If any provision 
 97.11  of this section is prohibited by federal law, the provision 
 97.12  shall become effective when federal law is changed to permit its 
 97.13  application or a waiver is received.  The commissioner of human 
 97.14  services shall notify the revisor of statutes when federal law 
 97.15  is enacted or a waiver or other federal approval is received and 
 97.16  publish a notice in the State Register.  The commissioner must 
 97.17  include the notice in the first State Register published after 
 97.18  the effective date of the federal changes. 
 97.19     (b) If, by July 1, 2003, any provision of this section is 
 97.20  not effective because of prohibitions in federal law, the 
 97.21  commissioner of human services shall apply to the federal 
 97.22  government by August 1, 2003, for a waiver of those prohibitions 
 97.23  or other federal authority, and that provision shall become 
 97.24  effective upon receipt of a federal waiver or other federal 
 97.25  approval, notification to the revisor of statutes, and 
 97.26  publication of a notice in the State Register to that effect.  
 97.27  In applying for federal approval to extend the lookback period, 
 97.28  the commissioner shall seek the longest lookback period the 
 97.29  federal government will approve, not to exceed 72 months. 
 97.30     Sec. 7.  Minnesota Statutes 2002, section 256B.15, 
 97.31  subdivision 1, is amended to read: 
 97.32     Subdivision 1.  [POLICY, APPLICABILITY, PURPOSE, AND 
 97.33  CONSTRUCTION; DEFINITION.] (a) It is the policy of this state 
 97.34  that individuals or couples, either or both of whom participate 
 97.35  in the medical assistance program, use their own assets to pay 
 97.36  their share of the total cost of their care during or after 
 98.1   their enrollment in the program according to applicable federal 
 98.2   law and the laws of this state.  The following provisions apply: 
 98.3      (1) subdivisions 1c to 1k shall not apply to claims arising 
 98.4   under this section which are presented under section 525.313; 
 98.5      (2) the provisions of subdivisions 1c to 1k expanding the 
 98.6   interests included in an estate for purposes of recovery under 
 98.7   this section give effect to the provisions of United States 
 98.8   Code, title 42, section 1396p, governing recoveries, but do not 
 98.9   give rise to any express or implied liens in favor of any other 
 98.10  parties not named in these provisions; 
 98.11     (3) the continuation of a recipient's life estate or joint 
 98.12  tenancy interest in real property after the recipient's death 
 98.13  for the purpose of recovering medical assistance under this 
 98.14  section modifies common law principles holding that these 
 98.15  interests terminate on the death of the holder; 
 98.16     (4) all laws, rules, and regulations governing or involved 
 98.17  with a recovery of medical assistance shall be liberally 
 98.18  construed to accomplish their intended purposes; and 
 98.19     (5) a deceased recipient's life estate and joint tenancy 
 98.20  interests continued under this section shall be owned by the 
 98.21  remaindermen or surviving joint tenants as their interests may 
 98.22  appear on the date of the recipient's death.  They shall not be 
 98.23  merged into the remainder interest or the interests of the 
 98.24  surviving joint tenants by reason of ownership.  They shall be 
 98.25  subject to the provisions of this section.  Any conveyance, 
 98.26  transfer, sale, assignment, or encumbrance by a remainderman, a 
 98.27  surviving joint tenant, or their heirs, successors, and assigns 
 98.28  shall be deemed to include all of their interest in the deceased 
 98.29  recipient's life estate or joint tenancy interest continued 
 98.30  under this section. 
 98.31     (b) For purposes of this section, "medical assistance" 
 98.32  includes the medical assistance program under this chapter and, 
 98.33  the general assistance medical care program under chapter 256D, 
 98.34  but does not include and the alternative care program for 
 98.35  nonmedical assistance recipients under section 256B.0913, 
 98.36  subdivision 4. 
 99.1      <b>[EFFECTIVE DATE.]</b> This section is effective August 1, 2003, 
 99.2   and applies to estates of decedents who die on or after that 
 99.3   date. 
 99.4      Sec. 8.  Minnesota Statutes 2002, section 256B.15, 
 99.5   subdivision 1a, is amended to read: 
 99.6      Subd. 1a.  [ESTATES SUBJECT TO CLAIMS.] If a person 
 99.7   receives any medical assistance hereunder, on the person's 
 99.8   death, if single, or on the death of the survivor of a married 
 99.9   couple, either or both of whom received medical assistance, or 
 99.10  as otherwise provided for in this section, the total amount paid 
 99.11  for medical assistance rendered for the person and spouse shall 
 99.12  be filed as a claim against the estate of the person or the 
 99.13  estate of the surviving spouse in the court having jurisdiction 
 99.14  to probate the estate or to issue a decree of descent according 
 99.15  to sections 525.31 to 525.313.  
 99.16     A claim shall be filed if medical assistance was rendered 
 99.17  for either or both persons under one of the following 
 99.18  circumstances: 
 99.19     (a) the person was over 55 years of age, and received 
 99.20  services under this chapter, excluding alternative care; 
 99.21     (b) the person resided in a medical institution for six 
 99.22  months or longer, received services under this chapter excluding 
 99.23  alternative care, and, at the time of institutionalization or 
 99.24  application for medical assistance, whichever is later, the 
 99.25  person could not have reasonably been expected to be discharged 
 99.26  and returned home, as certified in writing by the person's 
 99.27  treating physician.  For purposes of this section only, a 
 99.28  "medical institution" means a skilled nursing facility, 
 99.29  intermediate care facility, intermediate care facility for 
 99.30  persons with mental retardation, nursing facility, or inpatient 
 99.31  hospital; or 
 99.32     (c) the person received general assistance medical care 
 99.33  services under chapter 256D.  
 99.34     The claim shall be considered an expense of the last 
 99.35  illness of the decedent for the purpose of section 524.3-805.  
 99.36  Any statute of limitations that purports to limit any county 
100.1   agency or the state agency, or both, to recover for medical 
100.2   assistance granted hereunder shall not apply to any claim made 
100.3   hereunder for reimbursement for any medical assistance granted 
100.4   hereunder.  Notice of the claim shall be given to all heirs and 
100.5   devisees of the decedent whose identity can be ascertained with 
100.6   reasonable diligence.  The notice must include procedures and 
100.7   instructions for making an application for a hardship waiver 
100.8   under subdivision 5; time frames for submitting an application 
100.9   and determination; and information regarding appeal rights and 
100.10  procedures.  Counties are entitled to one-half of the nonfederal 
100.11  share of medical assistance collections from estates that are 
100.12  directly attributable to county effort.  Counties are entitled 
100.13  to ten percent of the collections for alternative care directly 
100.14  attributable to county effort. 
100.15     <b>[EFFECTIVE DATE.]</b> This section is effective August 1, 2003, 
100.16  and applies to the estates of decedents who die on and after 
100.17  that date. 
100.18     Sec. 9.  Minnesota Statutes 2002, section 256B.15, is 
100.19  amended by adding a subdivision to read: 
100.20     Subd. 1c.  [NOTICE OF POTENTIAL CLAIM.] (a) A state agency 
100.21  with a claim or potential claim under this section may file a 
100.22  notice of potential claim under this subdivision anytime before 
100.23  or within one year after a medical assistance recipient dies.  
100.24  The claimant shall be the state agency.  A notice filed prior to 
100.25  the recipient's death shall not take effect and shall not be 
100.26  effective as notice until the recipient dies.  A notice filed 
100.27  after a recipient dies shall be effective from the time of 
100.28  filing.  
100.29     (b) The notice of claim shall be filed or recorded in the 
100.30  real estate records in the office of the county recorder or 
100.31  registrar of titles for each county in which any part of the 
100.32  property is located.  The recorder shall accept the notice for 
100.33  recording or filing.  The registrar of titles shall accept the 
100.34  notice for filing if the recipient has a recorded interest in 
100.35  the property.  The registrar of titles shall not carry forward 
100.36  to a new certificate of title any notice filed more than one 
101.1   year from the date of the recipient's death. 
101.2      (c) The notice must be dated, state the name of the 
101.3   claimant, the medical assistance recipient's name and social 
101.4   security number if filed before their death and their date of 
101.5   death if filed after they die, the name and date of death of any 
101.6   predeceased spouse of the medical assistance recipient for whom 
101.7   a claim may exist, a statement that the claimant may have a 
101.8   claim arising under this section, generally identify the 
101.9   recipient's interest in the property, contain a legal 
101.10  description for the property and whether it is abstract or 
101.11  registered property, a statement of when the notice becomes 
101.12  effective and the effect of the notice, be signed by an 
101.13  authorized representative of the state agency, and may include 
101.14  such other contents as the state agency may deem appropriate. 
101.15     <b>[EFFECTIVE DATE.]</b> This section is effective August 1, 2003, 
101.16  and applies to the estates of decedents who die on or after that 
101.17  date. 
101.18     Sec. 10.  Minnesota Statutes 2002, section 256B.15, is 
101.19  amended by adding a subdivision to read: 
101.20     Subd. 1d.  [EFFECT OF NOTICE.] From the time it takes 
101.21  effect, the notice shall be notice to remaindermen, joint 
101.22  tenants, or to anyone else owning or acquiring an interest in or 
101.23  encumbrance against the property described in the notice that 
101.24  the medical assistance recipient's life estate, joint tenancy, 
101.25  or other interests in the real estate described in the notice: 
101.26     (1) shall, in the case of life estate and joint tenancy 
101.27  interests, continue to exist for purposes of this section, and 
101.28  be subject to liens and claims as provided in this section; 
101.29     (2) shall be subject to a lien in favor of the claimant 
101.30  effective upon the death of the recipient and dealt with as 
101.31  provided in this section; 
101.32     (3) may be included in the recipient's estate, as defined 
101.33  in this section; and 
101.34     (4) may be subject to administration and all other 
101.35  provisions of chapter 524 and may be sold, assigned, 
101.36  transferred, or encumbered free and clear of their interest or 
102.1   encumbrance to satisfy claims under this section. 
102.2      <b>[EFFECTIVE DATE.]</b> This section is effective August 1, 2003, 
102.3   and applies to the estates of decedents who die on or after that 
102.4   date. 
102.5      Sec. 11.  Minnesota Statutes 2002, section 256B.15, is 
102.6   amended by adding a subdivision to read: 
102.7      Subd. 1e.  [FULL OR PARTIAL RELEASE OF NOTICE.] (a) The 
102.8   claimant may fully or partially release the notice and the lien 
102.9   arising out of the notice of record in the real estate records 
102.10  where the notice is filed or recorded at any time.  The claimant 
102.11  may give a full or partial release to extinguish any life 
102.12  estates or joint tenancy interests which are or may be continued 
102.13  under this section or whose existence or nonexistence may create 
102.14  a cloud on the title to real property at any time whether or not 
102.15  a notice has been filed.  The recorder or registrar of titles 
102.16  shall accept the release for recording or filing.  If the 
102.17  release is a partial release, it must include a legal 
102.18  description of the property being released. 
102.19     (b) At any time, the claimant may, at the claimant's 
102.20  discretion, wholly or partially release, subordinate, modify, or 
102.21  amend the recorded notice and the lien arising out of the notice.
102.22     <b>[EFFECTIVE DATE.]</b> This section is effective August 1, 2003, 
102.23  and applies to the estates of decedents who die on or after that 
102.24  date. 
102.25     Sec. 12.  Minnesota Statutes 2002, section 256B.15, is 
102.26  amended by adding a subdivision to read: 
102.27     Subd. 1f.  [AGENCY LIEN.] (a) The notice shall constitute a 
102.28  lien in favor of the department of human services against the 
102.29  recipient's interests in the real estate it describes for a 
102.30  period of 20 years from the date of filing or the date of the 
102.31  recipient's death, whichever is later.  Notwithstanding any law 
102.32  or rule to the contrary, a recipient's life estate and joint 
102.33  tenancy interests shall not end upon the recipient's death but 
102.34  shall continue according to subdivisions 1h, 1i, and 1j.  The 
102.35  amount of the lien shall be equal to the total amount of the 
102.36  claims that could be presented in the recipient's estate under 
103.1   this section. 
103.2      (b) If no estate has been opened for the deceased 
103.3   recipient, any holder of an interest in the property may apply 
103.4   to the lienholder for a statement of the amount of the lien or 
103.5   for a full or partial release of the lien.  The application 
103.6   shall include the applicant's name, current mailing address, 
103.7   current home and work telephone numbers, and a description of 
103.8   their interest in the property, a legal description of the 
103.9   recipient's interest in the property, and the deceased 
103.10  recipient's name, date of birth, and social security number.  
103.11  The lienholder shall send the applicant by certified mail, 
103.12  return receipt requested, a written statement showing the amount 
103.13  of the lien, whether the lienholder is willing to release the 
103.14  lien and under what conditions, and inform them of the right to 
103.15  a hearing under section 256.045.  The lienholder shall have the 
103.16  discretion to compromise and settle the lien upon any terms and 
103.17  conditions the lienholder deems appropriate. 
103.18     (c) Any holder of an interest in property subject to the 
103.19  lien has a right to request a hearing under section 256.045 to 
103.20  determine the validity, extent, or amount of the lien.  The 
103.21  request must be in writing, and must include the names, current 
103.22  addresses, and home and business telephone numbers for all other 
103.23  parties holding an interest in the property.  A request for a 
103.24  hearing by any holder of an interest in the property shall be 
103.25  deemed to be a request for a hearing by all parties owning 
103.26  interests in the property.  Notice of the hearing shall be given 
103.27  to the lienholder, the party filing the appeal, and all of the 
103.28  other holders of interests in the property at the addresses 
103.29  listed in the appeal by certified mail, return receipt 
103.30  requested, or by ordinary mail.  Any owner of an interest in the 
103.31  property to whom notice of the hearing is mailed shall be deemed 
103.32  to have waived any and all claims or defenses in respect to the 
103.33  lien unless they appear and assert any claims or defenses at the 
103.34  hearing. 
103.35     (d) If the claim the lien secures could be filed under 
103.36  subdivision 1h, the lienholder may collect, compromise, settle, 
104.1   or release the lien upon any terms and conditions it deems 
104.2   appropriate.  If the claim the lien secures could be filed under 
104.3   subdivision 1i or 1j, the lien may be adjusted or enforced to 
104.4   the same extent had it been filed under subdivisions 1i and 1j, 
104.5   and the provisions of subdivisions 1i, clause (f), and lj, 
104.6   clause (d), shall apply to voluntary payment, settlement, or 
104.7   satisfaction of the lien. 
104.8      (e) If no probate proceedings have been commenced for the 
104.9   recipient as of the date the lienholder executes a release of 
104.10  the lien on a recipient's life estate or joint tenancy interest, 
104.11  created for purposes of this section, the release shall 
104.12  terminate the life estate or joint tenancy interest created 
104.13  under this section as of the date it is recorded or filed to the 
104.14  extent of the release.  If the claimant executes a release for 
104.15  purposes of extinguishing a life estate or a joint tenancy 
104.16  interest created under this section to remove a cloud on title 
104.17  to real property, the release shall have the effect of 
104.18  extinguishing any life estate or joint tenancy interests in the 
104.19  property it describes which may have been continued by reason of 
104.20  this section retroactive to the date of death of the deceased 
104.21  life tenant or joint tenant except as provided for in section 
104.22  514.981, subdivision 6. 
104.23     (f) If the deceased recipient's estate is probated, a claim 
104.24  shall be filed under this section.  The amount of the lien shall 
104.25  be limited to the amount of the claim as finally allowed.  If 
104.26  the claim the lien secures is filed under subdivision 1h, the 
104.27  lien may be released in full after any allowance of the claim 
104.28  becomes final or according to any agreement to settle and 
104.29  satisfy the claim.  The release shall release the lien but shall 
104.30  not extinguish or terminate the interest being released.  If the 
104.31  claim the lien secures is filed under subdivision 1i or 1j, the 
104.32  lien shall be released after the lien under subdivision 1i or 1j 
104.33  is filed or recorded, or settled according to any agreement to 
104.34  settle and satisfy the claim.  The release shall not extinguish 
104.35  or terminate the interest being released.  If the claim is 
104.36  finally disallowed in full, the claimant shall release the 
105.1   claimant's lien at the claimant's expense. 
105.2      <b>[EFFECTIVE DATE.]</b> This section takes effect on August 1, 
105.3   2003, and applies to the estates of decedents who die on or 
105.4   after that date. 
105.5      Sec. 13.  Minnesota Statutes 2002, section 256B.15, is 
105.6   amended by adding a subdivision to read: 
105.7      Subd. 1g.  [ESTATE PROPERTY.] Notwithstanding any law or 
105.8   rule to the contrary, if a claim is presented under this 
105.9   section, interests or the proceeds of interests in real property 
105.10  a decedent owned as a life tenant or a joint tenant with a right 
105.11  of survivorship shall be part of the decedent's estate, subject 
105.12  to administration, and shall be dealt with as provided in this 
105.13  section. 
105.14     <b>[EFFECTIVE DATE.]</b> This section takes effect on August 1, 
105.15  2003, and applies to the estates of decedents who die on or 
105.16  after that date. 
105.17     Sec. 14.  Minnesota Statutes 2002, section 256B.15, is 
105.18  amended by adding a subdivision to read: 
105.19     Subd. 1h.  [ESTATES OF SPECIFIC PERSONS RECEIVING MEDICAL 
105.20  ASSISTANCE.] (a) For purposes of this section, paragraphs (b) to 
105.21  (k) apply if a person received medical assistance for which a 
105.22  claim may be filed under this section and died single, or the 
105.23  surviving spouse of the couple and was not survived by any of 
105.24  the persons described in subdivisions 3 and 4. 
105.25     (b) For purposes of this section, the person's estate 
105.26  consists of:  (1) their probate estate; (2) all of the person's 
105.27  interests or proceeds of those interests in real property the 
105.28  person owned as a life tenant or as a joint tenant with a right 
105.29  of survivorship at the time of the person's death; (3) all of 
105.30  the person's interests or proceeds of those interests in 
105.31  securities the person owned in beneficiary form as provided 
105.32  under sections 524.6-301 to 524.6-311 at the time of the 
105.33  person's death, to the extent they become part of the probate 
105.34  estate under section 524.6-307; and (4) all of the person's 
105.35  interests in joint accounts, multiple party accounts, and pay on 
105.36  death accounts, or the proceeds of those accounts, as provided 
106.1   under sections 524.6-201 to 524.6-214 at the time of the 
106.2   person's death to the extent they become part of the probate 
106.3   estate under section 524.6-207.  Notwithstanding any law or rule 
106.4   to the contrary, a state or county agency with a claim under 
106.5   this section shall be a creditor under section 524.6-307. 
106.6      (c) Notwithstanding any law or rule to the contrary, the 
106.7   person's life estate or joint tenancy interest in real property 
106.8   not subject to a medical assistance lien under sections 514.980 
106.9   to 514.985 on the date of the person's death shall not end upon 
106.10  the person's death and shall continue as provided in this 
106.11  subdivision.  The life estate in the person's estate shall be 
106.12  that portion of the interest in the real property subject to the 
106.13  life estate that is equal to the life estate percentage factor 
106.14  for the life estate as listed in the Life Estate Mortality Table 
106.15  of the health care program's manual for a person who was the age 
106.16  of the medical assistance recipient on the date of the person's 
106.17  death.  The joint tenancy interest in real property in the 
106.18  estate shall be equal to the fractional interest the person 
106.19  would have owned in the jointly held interest in the property 
106.20  had they and the other owners held title to the property as 
106.21  tenants in common on the date the person died. 
106.22     (d) The court upon its own motion, or upon motion by the 
106.23  personal representative or any interested party, may enter an 
106.24  order directing the remaindermen or surviving joint tenants and 
106.25  their spouses, if any, to sign all documents, take all actions, 
106.26  and otherwise fully cooperate with the personal representative 
106.27  and the court to liquidate the decedent's life estate or joint 
106.28  tenancy interests in the estate and deliver the cash or the 
106.29  proceeds of those interests to the personal representative and 
106.30  provide for any legal and equitable sanctions as the court deems 
106.31  appropriate to enforce and carry out the order, including an 
106.32  award of reasonable attorney fees. 
106.33     (e) The personal representative may make, execute, and 
106.34  deliver any conveyances or other documents necessary to convey 
106.35  the decedent's life estate or joint tenancy interest in the 
106.36  estate that are necessary to liquidate and reduce to cash the 
107.1   decedent's interest or for any other purposes. 
107.2      (f) Subject to administration, all costs, including 
107.3   reasonable attorney fees, directly and immediately related to 
107.4   liquidating the decedent's life estate or joint tenancy interest 
107.5   in the decedent's estate, shall be paid from the gross proceeds 
107.6   of the liquidation allocable to the decedent's interest and the 
107.7   net proceeds shall be turned over to the personal representative 
107.8   and applied to payment of the claim presented under this section.
107.9      (g) The personal representative shall bring a motion in the 
107.10  district court in which the estate is being probated to compel 
107.11  the remaindermen or surviving joint tenants to account for and 
107.12  deliver to the personal representative all or any part of the 
107.13  proceeds of any sale, mortgage, transfer, conveyance, or any 
107.14  disposition of real property allocable to the decedent's life 
107.15  estate or joint tenancy interest in the decedent's estate, and 
107.16  do everything necessary to liquidate and reduce to cash the 
107.17  decedent's interest and turn the proceeds of the sale or other 
107.18  disposition over to the personal representative.  The court may 
107.19  grant any legal or equitable relief including, but not limited 
107.20  to, ordering a partition of real estate under chapter 558 
107.21  necessary to make the value of the decedent's life estate or 
107.22  joint tenancy interest available to the estate for payment of a 
107.23  claim under this section. 
107.24     (h) Subject to administration, the personal representative 
107.25  shall use all of the cash or proceeds of interests to pay an 
107.26  allowable claim under this section.  The remaindermen or 
107.27  surviving joint tenants and their spouses, if any, may enter 
107.28  into a written agreement with the personal representative or the 
107.29  claimant to settle and satisfy obligations imposed at any time 
107.30  before or after a claim is filed. 
107.31     (i) The personal representative may provide any or all of 
107.32  the other owners, remaindermen, or surviving joint tenants with 
107.33  an affidavit terminating the decedent's estate's interest in 
107.34  real property the decedent owned as a life tenant or as a joint 
107.35  tenant with others, if the personal representative determines 
107.36  that neither the decedent nor any of the decedent's predeceased 
108.1   spouses received any medical assistance for which a claim could 
108.2   be filed under this section, or if the personal representative 
108.3   has filed an affidavit with the court that the estate has other 
108.4   assets sufficient to pay a claim, as presented, or if there is a 
108.5   written agreement under paragraph (h), or if the claim, as 
108.6   allowed, has been paid in full or to the full extent of the 
108.7   assets the estate has available to pay it.  The affidavit may be 
108.8   recorded in the office of the county recorder or filed in the 
108.9   office of the registrar of titles for the county in which the 
108.10  real property is located.  Except as provided in section 
108.11  514.981, subdivision 6, when recorded or filed, the affidavit 
108.12  shall terminate the decedent's interest in real estate the 
108.13  decedent owned as a life tenant or a joint tenant with others.  
108.14  The affidavit shall:  (1) be signed by the personal 
108.15  representative; (2) identify the decedent and the interest being 
108.16  terminated; (3) give recording information sufficient to 
108.17  identify the instrument that created the interest in real 
108.18  property being terminated; (4) legally describe the affected 
108.19  real property; (5) state that the personal representative has 
108.20  determined that neither the decedent nor any of the decedent's 
108.21  predeceased spouses received any medical assistance for which a 
108.22  claim could be filed under this section; (6) state that the 
108.23  decedent's estate has other assets sufficient to pay the claim, 
108.24  as presented, or that there is a written agreement between the 
108.25  personal representative and the claimant and the other owners or 
108.26  remaindermen or other joint tenants to satisfy the obligations 
108.27  imposed under this subdivision; and (7) state that the affidavit 
108.28  is being given to terminate the estate's interest under this 
108.29  subdivision, and any other contents as may be appropriate.  
108.30  The recorder or registrar of titles shall accept the affidavit 
108.31  for recording or filing.  The affidavit shall be effective as 
108.32  provided in this section and shall constitute notice even if it 
108.33  does not include recording information sufficient to identify 
108.34  the instrument creating the interest it terminates.  The 
108.35  affidavit shall be conclusive evidence of the stated facts. 
108.36     (j) The holder of a lien arising under subdivision 1c shall 
109.1   release the lien at the holder's expense against an interest 
109.2   terminated under paragraph (h) to the extent of the termination. 
109.3      (k) If a lien arising under subdivision 1c is not released 
109.4   under paragraph (j), prior to closing the estate, the personal 
109.5   representative shall deed the interest subject to the lien to 
109.6   the remaindermen or surviving joint tenants as their interests 
109.7   may appear.  Upon recording or filing, the deed shall work a 
109.8   merger of the recipient's life estate or joint tenancy interest, 
109.9   subject to the lien, into the remainder interest or interest the 
109.10  decedent and others owned jointly.  The lien shall attach to and 
109.11  run with the property to the extent of the decedent's interest 
109.12  at the time of the decedent's death. 
109.13     <b>[EFFECTIVE DATE.]</b> This section takes effect on August 1, 
109.14  2003, and applies to the estates of decedents who die on or 
109.15  after that date. 
109.16     Sec. 15.  Minnesota Statutes 2002, section 256B.15, is 
109.17  amended by adding a subdivision to read: 
109.18     Subd. 1i.  [ESTATES OF PERSONS RECEIVING MEDICAL ASSISTANCE 
109.19  AND SURVIVED BY OTHERS.] (a) For purposes of this subdivision, 
109.20  the person's estate consists of the person's probate estate and 
109.21  all of the person's interests in real property the person owned 
109.22  as a life tenant or a joint tenant at the time of the person's 
109.23  death. 
109.24     (b) Notwithstanding any law or rule to the contrary, this 
109.25  subdivision applies if a person received medical assistance for 
109.26  which a claim could be filed under this section but for the fact 
109.27  the person was survived by a spouse or by a person listed in 
109.28  subdivision 3, or if subdivision 4 applies to a claim arising 
109.29  under this section. 
109.30     (c) The person's life estate or joint tenancy interests in 
109.31  real property not subject to a medical assistance lien under 
109.32  sections 514.980 to 514.985 on the date of the person's death 
109.33  shall not end upon death and shall continue as provided in this 
109.34  subdivision.  The life estate in the estate shall be the portion 
109.35  of the interest in the property subject to the life estate that 
109.36  is equal to the life estate percentage factor for the life 
110.1   estate as listed in the Life Estate Mortality Table of the 
110.2   health care program's manual for a person who was the age of the 
110.3   medical assistance recipient on the date of the person's death.  
110.4   The joint tenancy interest in the estate shall be equal to the 
110.5   fractional interest the medical assistance recipient would have 
110.6   owned in the jointly held interest in the property had they and 
110.7   the other owners held title to the property as tenants in common 
110.8   on the date the medical assistance recipient died. 
110.9      (d) The county agency shall file a claim in the estate 
110.10  under this section on behalf of the claimant who shall be the 
110.11  commissioner of human services, notwithstanding that the 
110.12  decedent is survived by a spouse or a person listed in 
110.13  subdivision 3.  The claim, as allowed, shall not be paid by the 
110.14  estate and shall be disposed of as provided in this paragraph.  
110.15  The personal representative or the court shall make, execute, 
110.16  and deliver a lien in favor of the claimant on the decedent's 
110.17  interest in real property in the estate in the amount of the 
110.18  allowed claim on forms provided by the commissioner to the 
110.19  county agency filing the lien.  The lien shall bear interest as 
110.20  provided under section 524.3-806, shall attach to the property 
110.21  it describes upon filing or recording, and shall remain a lien 
110.22  on the real property it describes for a period of 20 years from 
110.23  the date it is filed or recorded.  The lien shall be a 
110.24  disposition of the claim sufficient to permit the estate to 
110.25  close. 
110.26     (e) The state or county agency shall file or record the 
110.27  lien in the office of the county recorder or registrar of titles 
110.28  for each county in which any of the real property is located.  
110.29  The recorder or registrar of titles shall accept the lien for 
110.30  filing or recording.  All recording or filing fees shall be paid 
110.31  by the department of human services.  The recorder or registrar 
110.32  of titles shall mail the recorded lien to the department of 
110.33  human services.  The lien need not be attested, certified, or 
110.34  acknowledged as a condition of recording or filing.  Upon 
110.35  recording or filing of a lien against a life estate or a joint 
110.36  tenancy interest, the interest subject to the lien shall merge 
111.1   into the remainder interest or the interest the recipient and 
111.2   others owned jointly.  The lien shall attach to and run with the 
111.3   property to the extent of the decedent's interest in the 
111.4   property at the time of the decedent's death as determined under 
111.5   this section.  
111.6      (f) The department shall make no adjustment or recovery 
111.7   under the lien until after the decedent's spouse, if any, has 
111.8   died, and only at a time when the decedent has no surviving 
111.9   child described in subdivision 3.  The estate, any owner of an 
111.10  interest in the property which is or may be subject to the lien, 
111.11  or any other interested party, may voluntarily pay off, settle, 
111.12  or otherwise satisfy the claim secured or to be secured by the 
111.13  lien at any time before or after the lien is filed or recorded.  
111.14  Such payoffs, settlements, and satisfactions shall be deemed to 
111.15  be voluntary repayments of past medical assistance payments for 
111.16  the benefit of the deceased recipient, and neither the process 
111.17  of settling the claim, the payment of the claim, or the 
111.18  acceptance of a payment shall constitute an adjustment or 
111.19  recovery that is prohibited under this subdivision. 
111.20     (g) The lien under this subdivision may be enforced or 
111.21  foreclosed in the manner provided by law for the enforcement of 
111.22  judgment liens against real estate or by a foreclosure by action 
111.23  under chapter 581.  When the lien is paid, satisfied, or 
111.24  otherwise discharged, the state or county agency shall prepare 
111.25  and file a release of lien at its own expense.  No action to 
111.26  foreclose the lien shall be commenced unless the lienholder has 
111.27  first given 30 days' prior written notice to pay the lien to the 
111.28  owners and parties in possession of the property subject to the 
111.29  lien.  The notice shall:  (1) include the name, address, and 
111.30  telephone number of the lienholder; (2) describe the lien; (3) 
111.31  give the amount of the lien; (4) inform the owner or party in 
111.32  possession that payment of the lien in full must be made to the 
111.33  lienholder within 30 days after service of the notice or the 
111.34  lienholder may begin proceedings to foreclose the lien; and (5) 
111.35  be served by personal service, certified mail, return receipt 
111.36  requested, ordinary first class mail, or by publishing it once 
112.1   in a newspaper of general circulation in the county in which any 
112.2   part of the property is located.  Service of the notice shall be 
112.3   complete upon mailing or publication. 
112.4      <b>[EFFECTIVE DATE.]</b> This section takes effect August 1, 2003, 
112.5   and applies to estates of decedents who die on and after that 
112.6   date. 
112.7      Sec. 16.  Minnesota Statutes 2002, section 256B.15, is 
112.8   amended by adding a subdivision to read: 
112.9      Subd. 1j.  [CLAIMS IN ESTATES OF DECEDENTS SURVIVED BY 
112.10  OTHER SURVIVORS.] For purposes of this subdivision, the 
112.11  provisions in subdivision 1i, paragraphs (a) to (c) apply. 
112.12     (a) If payment of a claim filed under this section is 
112.13  limited as provided in subdivision 4, and if the estate does not 
112.14  have other assets sufficient to pay the claim in full, as 
112.15  allowed, the personal representative or the court shall make, 
112.16  execute, and deliver a lien on the property in the estate that 
112.17  is exempt from the claim under subdivision 4 in favor of the 
112.18  commissioner of human services on forms provided by the 
112.19  commissioner to the county agency filing the claim.  If the 
112.20  estate pays a claim filed under this section in full from other 
112.21  assets of the estate, no lien shall be filed against the 
112.22  property described in subdivision 4. 
112.23     (b) The lien shall be in an amount equal to the unpaid 
112.24  balance of the allowed claim under this section remaining after 
112.25  the estate has applied all other available assets of the estate 
112.26  to pay the claim.  The property exempt under subdivision 4 shall 
112.27  not be sold, assigned, transferred, conveyed, encumbered, or 
112.28  distributed until after the personal representative has 
112.29  determined the estate has other assets sufficient to pay the 
112.30  allowed claim in full, or until after the lien has been filed or 
112.31  recorded.  The lien shall bear interest as provided under 
112.32  section 524.3-806, shall attach to the property it describes 
112.33  upon filing or recording, and shall remain a lien on the real 
112.34  property it describes for a period of 20 years from the date it 
112.35  is filed or recorded.  The lien shall be a disposition of the 
112.36  claim sufficient to permit the estate to close. 
113.1      (c) The state or county agency shall file or record the 
113.2   lien in the office of the county recorder or registrar of titles 
113.3   in each county in which any of the real property is located.  
113.4   The department shall pay the filing fees.  The lien need not be 
113.5   attested, certified, or acknowledged as a condition of recording 
113.6   or filing.  The recorder or registrar of titles shall accept the 
113.7   lien for filing or recording. 
113.8      (d) The commissioner shall make no adjustment or recovery 
113.9   under the lien until none of the persons listed in subdivision 4 
113.10  are residing on the property or until the property is sold or 
113.11  transferred.  The estate or any owner of an interest in the 
113.12  property that is or may be subject to the lien, or any other 
113.13  interested party, may voluntarily pay off, settle, or otherwise 
113.14  satisfy the claim secured or to be secured by the lien at any 
113.15  time before or after the lien is filed or recorded.  The 
113.16  payoffs, settlements, and satisfactions shall be deemed to be 
113.17  voluntary repayments of past medical assistance payments for the 
113.18  benefit of the deceased recipient and neither the process of 
113.19  settling the claim, the payment of the claim, or acceptance of a 
113.20  payment shall constitute an adjustment or recovery that is 
113.21  prohibited under this subdivision. 
113.22     (e) A lien under this subdivision may be enforced or 
113.23  foreclosed in the manner provided for by law for the enforcement 
113.24  of judgment liens against real estate or by a foreclosure by 
113.25  action under chapter 581.  When the lien has been paid, 
113.26  satisfied, or otherwise discharged, the claimant shall prepare 
113.27  and file a release of lien at the claimant's expense.  No action 
113.28  to foreclose the lien shall be commenced unless the lienholder 
113.29  has first given 30 days prior written notice to pay the lien to 
113.30  the record owners of the property and the parties in possession 
113.31  of the property subject to the lien.  The notice shall:  (1) 
113.32  include the name, address, and telephone number of the 
113.33  lienholder; (2) describe the lien; (3) give the amount of the 
113.34  lien; (4) inform the owner or party in possession that payment 
113.35  of the lien in full must be made to the lienholder within 30 
113.36  days after service of the notice or the lienholder may begin 
114.1   proceedings to foreclose the lien; and (5) be served by personal 
114.2   service, certified mail, return receipt requested, ordinary 
114.3   first class mail, or by publishing it once in a newspaper of 
114.4   general circulation in the county in which any part of the 
114.5   property is located.  Service shall be complete upon mailing or 
114.6   publication. 
114.7      (f) Upon filing or recording of a lien against a life 
114.8   estate or joint tenancy interest under this subdivision, the 
114.9   interest subject to the lien shall merge into the remainder 
114.10  interest or the interest the decedent and others owned jointly, 
114.11  effective on the date of recording and filing.  The lien shall 
114.12  attach to and run with the property to the extent of the 
114.13  decedent's interest in the property at the time of the 
114.14  decedent's death as determined under this section. 
114.15     (g)(1) An affidavit may be provided by a personal 
114.16  representative stating the personal representative has 
114.17  determined in good faith that a decedent survived by a spouse or 
114.18  a person listed in subdivision 3, or by a person listed in 
114.19  subdivision 4, or the decedent's predeceased spouse did not 
114.20  receive any medical assistance giving rise to a claim under this 
114.21  section, or that the real property described in subdivision 4 is 
114.22  not needed to pay in full a claim arising under this section. 
114.23     (2) The affidavit shall:  (i) describe the property and the 
114.24  interest being extinguished; (ii) name the decedent and give the 
114.25  date of death; (iii) state the facts listed in clause (1); (iv) 
114.26  state that the affidavit is being filed to terminate the life 
114.27  estate or joint tenancy interest created under this subdivision; 
114.28  (v) be signed by the personal representative; and (vi) contain 
114.29  any other information that the affiant deems appropriate. 
114.30     (3) Except as provided in section 514.981, subdivision 6, 
114.31  when the affidavit is filed or recorded, the life estate or 
114.32  joint tenancy interest in real property that the affidavit 
114.33  describes shall be terminated effective as of the date of filing 
114.34  or recording.  The termination shall be final and may not be set 
114.35  aside for any reason. 
114.36     <b>[EFFECTIVE DATE.]</b> This section takes effect on August 1, 
115.1   2003, and applies to the estates of decedents who die on or 
115.2   after that date. 
115.3      Sec. 17.  Minnesota Statutes 2002, section 256B.15, is 
115.4   amended by adding a subdivision to read: 
115.5      Subd. 1k.  [FILING.] Any notice, lien, release, or other 
115.6   document filed under subdivisions 1c to 1l, and any lien, 
115.7   release of lien, or other documents relating to a lien filed 
115.8   under subdivisions 1h, 1i, and 1j must be filed or recorded in 
115.9   the office of the county recorder or registrar of titles, as 
115.10  appropriate, in the county where the affected real property is 
115.11  located.  Notwithstanding section 386.77, the state or county 
115.12  agency shall pay any applicable filing fee.  An attestation, 
115.13  certification, or acknowledgment is not required as a condition 
115.14  of filing.  If the property described in the filing is 
115.15  registered property, the registrar of titles shall record the 
115.16  filing on the certificate of title for each parcel of property 
115.17  described in the filing.  If the property described in the 
115.18  filing is abstract property, the recorder shall file and index 
115.19  the property in the county's grantor-grantee indexes and any 
115.20  tract indexes the county maintains for each parcel of property 
115.21  described in the filing.  The recorder or registrar of titles 
115.22  shall return the filed document to the party filing it at no 
115.23  cost.  If the party making the filing provides a duplicate copy 
115.24  of the filing, the recorder or registrar of titles shall show 
115.25  the recording or filing data on the copy and return it to the 
115.26  party at no extra cost. 
115.27     <b>[EFFECTIVE DATE.]</b> This section takes effect on August 1, 
115.28  2003, and applies to the estates of decedents who die on or 
115.29  after that date. 
115.30     Sec. 18.  Minnesota Statutes 2002, section 256B.15, 
115.31  subdivision 2, is amended to read: 
115.32     Subd. 2.  [LIMITATIONS ON CLAIMS.] The claim shall include 
115.33  only the total amount of medical assistance rendered after age 
115.34  55 or during a period of institutionalization described in 
115.35  subdivision 1a, clause (b), and the total amount of general 
115.36  assistance medical care rendered, and shall not include 
116.1   interest.  Claims that have been allowed but not paid shall bear 
116.2   interest according to section 524.3-806, paragraph (d).  A claim 
116.3   against the estate of a surviving spouse who did not receive 
116.4   medical assistance, for medical assistance rendered for the 
116.5   predeceased spouse, is limited to the value of the assets of the 
116.6   estate that were marital property or jointly owned property at 
116.7   any time during the marriage.  Claims for alternative care shall 
116.8   be net of all premiums paid under section 256B.0913, subdivision 
116.9   12, on or after July 1, 2003, and shall be limited to services 
116.10  provided on or after July 1, 2003. 
116.11     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2003, 
116.12  for decedents dying on or after that date. 
116.13     Sec. 19.  Minnesota Statutes 2002, section 256B.15, 
116.14  subdivision 3, is amended to read: 
116.15     Subd. 3.  [SURVIVING SPOUSE, MINOR, BLIND, OR DISABLED 
116.16  CHILDREN.] If a decedent who is survived by a spouse, or was 
116.17  single, or who was the surviving spouse of a married couple, and 
116.18  is survived by a child who is under age 21 or blind or 
116.19  permanently and totally disabled according to the supplemental 
116.20  security income program criteria, no a claim shall be filed 
116.21  against the estate according to this section. 
116.22     <b>[EFFECTIVE DATE.]</b> This section is effective August 1, 2003, 
116.23  and applies to decedents who die on or after that date. 
116.24     Sec. 20.  Minnesota Statutes 2002, section 256B.15, 
116.25  subdivision 4, is amended to read: 
116.26     Subd. 4.  [OTHER SURVIVORS.] If the decedent who was single 
116.27  or the surviving spouse of a married couple is survived by one 
116.28  of the following persons, a claim exists against the estate in 
116.29  an amount not to exceed the value of the nonhomestead property 
116.30  included in the estate and the personal representative shall 
116.31  make, execute, and deliver to the county agency a lien against 
116.32  the homestead property in the estate for any unpaid balance of 
116.33  the claim to the claimant as provided under this section: 
116.34     (a) a sibling who resided in the decedent medical 
116.35  assistance recipient's home at least one year before the 
116.36  decedent's institutionalization and continuously since the date 
117.1   of institutionalization; or 
117.2      (b) a son or daughter or a grandchild who resided in the 
117.3   decedent medical assistance recipient's home for at least two 
117.4   years immediately before the parent's or grandparent's 
117.5   institutionalization and continuously since the date of 
117.6   institutionalization, and who establishes by a preponderance of 
117.7   the evidence having provided care to the parent or grandparent 
117.8   who received medical assistance, that the care was provided 
117.9   before institutionalization, and that the care permitted the 
117.10  parent or grandparent to reside at home rather than in an 
117.11  institution. 
117.12     <b>[EFFECTIVE DATE.]</b> This section is effective August 1, 2003, 
117.13  and applies to decedents who die on or after that date. 
117.14     Sec. 21.  Minnesota Statutes 2002, section 514.981, 
117.15  subdivision 6, is amended to read: 
117.16     Subd. 6.  [TIME LIMITS; CLAIM LIMITS; LIENS ON LIFE ESTATES 
117.17  AND JOINT TENANCIES.] (a) A medical assistance lien is a lien on 
117.18  the real property it describes for a period of ten years from 
117.19  the date it attaches according to section 514.981, subdivision 
117.20  2, paragraph (a), except as otherwise provided for in sections 
117.21  514.980 to 514.985.  The agency may renew a medical assistance 
117.22  lien for an additional ten years from the date it would 
117.23  otherwise expire by recording or filing a certificate of renewal 
117.24  before the lien expires.  The certificate shall be recorded or 
117.25  filed in the office of the county recorder or registrar of 
117.26  titles for the county in which the lien is recorded or filed.  
117.27  The certificate must refer to the recording or filing data for 
117.28  the medical assistance lien it renews.  The certificate need not 
117.29  be attested, certified, or acknowledged as a condition for 
117.30  recording or filing.  The registrar of titles or the recorder 
117.31  shall file, record, index, and return the certificate of renewal 
117.32  in the same manner as provided for medical assistance liens in 
117.33  section 514.982, subdivision 2. 
117.34     (b) A medical assistance lien is not enforceable against 
117.35  the real property of an estate to the extent there is a 
117.36  determination by a court of competent jurisdiction, or by an 
118.1   officer of the court designated for that purpose, that there are 
118.2   insufficient assets in the estate to satisfy the agency's 
118.3   medical assistance lien in whole or in part because of the 
118.4   homestead exemption under section 256B.15, subdivision 4, the 
118.5   rights of the surviving spouse or minor children under section 
118.6   524.2-403, paragraphs (a) and (b), or claims with a priority 
118.7   under section 524.3-805, paragraph (a), clauses (1) to (4).  For 
118.8   purposes of this section, the rights of the decedent's adult 
118.9   children to exempt property under section 524.2-403, paragraph 
118.10  (b), shall not be considered costs of administration under 
118.11  section 524.3-805, paragraph (a), clause (1). 
118.12     (c) Notwithstanding any law or rule to the contrary, the 
118.13  provisions in clauses (1) to (7) apply if a life estate subject 
118.14  to a medical assistance lien ends according to its terms, or if 
118.15  a medical assistance recipient who owns a life estate or any 
118.16  interest in real property as a joint tenant that is subject to a 
118.17  medical assistance lien dies. 
118.18     (1) The medical assistance recipient's life estate or joint 
118.19  tenancy interest in the real property shall not end upon the 
118.20  recipient's death but shall merge into the remainder interest or 
118.21  other interest in real property the medical assistance recipient 
118.22  owned in joint tenancy with others.  The medical assistance lien 
118.23  shall attach to and run with the remainder or other interest in 
118.24  the real property to the extent of the medical assistance 
118.25  recipient's interest in the property at the time of the 
118.26  recipient's death as determined under this section. 
118.27     (2) If the medical assistance recipient's interest was a 
118.28  life estate in real property, the lien shall be a lien against 
118.29  the portion of the remainder equal to the percentage factor for 
118.30  the life estate of a person the medical assistance recipient's 
118.31  age on the date the life estate ended according to its terms or 
118.32  the date of the medical assistance recipient's death as listed 
118.33  in the Life Estate Mortality Table in the health care program's 
118.34  manual. 
118.35     (3) If the medical assistance recipient owned the interest 
118.36  in real property in joint tenancy with others, the lien shall be 
119.1   a lien against the portion of that interest equal to the 
119.2   fractional interest the medical assistance recipient would have 
119.3   owned in the jointly owned interest had the medical assistance 
119.4   recipient and the other owners held title to that interest as 
119.5   tenants in common on the date the medical assistance recipient 
119.6   died. 
119.7      (4) The medical assistance lien shall remain a lien against 
119.8   the remainder or other jointly owned interest for the length of 
119.9   time and be renewable as provided in paragraph (a). 
119.10     (5) Subdivision 5, paragraphs (a), clause (4), (b), clauses 
119.11  (1) and (2); and subdivision 6, paragraph (b), do not apply to 
119.12  medical assistance liens which attach to interests in real 
119.13  property as provided under this subdivision. 
119.14     (6) The continuation of a medical assistance recipient's 
119.15  life estate or joint tenancy interest in real property after the 
119.16  medical assistance recipient's death for the purpose of 
119.17  recovering medical assistance provided for in sections 514.980 
119.18  to 514.985 modifies common law principles holding that these 
119.19  interests terminate on the death of the holder. 
119.20     (7) Notwithstanding any law or rule to the contrary, no 
119.21  release, satisfaction, discharge, or affidavit under section 
119.22  256B.15 shall extinguish or terminate the life estate or joint 
119.23  tenancy interest of a medical assistance recipient subject to a 
119.24  lien under sections 514.980 to 514.985 on the date the recipient 
119.25  dies. 
119.26     <b>[EFFECTIVE DATE.]</b> This section is effective August 1, 2003, 
119.27  and applies to all medical assistance liens recorded or filed on 
119.28  or after that date. 
119.29     Sec. 22.  [514.991] [ALTERNATIVE CARE LIENS; DEFINITIONS.] 
119.30     Subdivision 1.  [APPLICABILITY.] The definitions in this 
119.31  section apply to sections 514.991 to 514.995. 
119.32     Subd. 2.  [ALTERNATIVE CARE AGENCY, AGENCY, OR 
119.33  DEPARTMENT.] "Alternative care agency," "agency," or "department"
119.34  means the department of human services when it pays for or 
119.35  provides alternative care benefits for a nonmedical assistance 
119.36  recipient directly or through a county social services agency 
120.1   under chapter 256B according to section 256B.0913. 
120.2      Subd. 3.  [ALTERNATIVE CARE BENEFIT OR 
120.3   BENEFITS.] "Alternative care benefit" or "benefits" means a 
120.4   benefit provided to a nonmedical assistance recipient under 
120.5   chapter 256B according to section 256B.0913. 
120.6      Subd. 4.  [ALTERNATIVE CARE RECIPIENT OR 
120.7   RECIPIENT.] "Alternative care recipient" or "recipient" means a 
120.8   person who receives alternative care grant benefits. 
120.9      Subd. 5.  [ALTERNATIVE CARE LIEN OR LIEN.] "Alternative 
120.10  care lien" or "lien" means a lien filed under sections 514.992 
120.11  to 514.995. 
120.12     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2003, 
120.13  for services for persons first enrolling in the alternative care 
120.14  program on or after that date and on the first day of the first 
120.15  eligibility renewal period for persons enrolled in the 
120.16  alternative care program prior to July 1, 2003. 
120.17     Sec. 23.  [514.992] [ALTERNATIVE CARE LIEN.] 
120.18     Subdivision 1.  [PROPERTY SUBJECT TO LIEN; LIEN AMOUNT.] (a)
120.19  Subject to sections 514.991 to 514.995, payments made by an 
120.20  alternative care agency to provide benefits to a recipient or to 
120.21  the recipient's spouse who owns property in this state 
120.22  constitute a lien in favor of the agency on all real property 
120.23  the recipient owns at and after the time the benefits are first 
120.24  paid. 
120.25     (b) The amount of the lien is limited to benefits paid for 
120.26  services provided to recipients over 55 years of age and 
120.27  provided on and after July 1, 2003. 
120.28     Subd. 2.  [ATTACHMENT.] (a) A lien attaches to and becomes 
120.29  enforceable against specific real property as of the date when 
120.30  all of the following conditions are met: 
120.31     (1) the agency has paid benefits for a recipient; 
120.32     (2) the recipient has been given notice and an opportunity 
120.33  for a hearing under paragraph (b); 
120.34     (3) the lien has been filed as provided for in section 
120.35  514.993 or memorialized on the certificate of title for the 
120.36  property it describes; and 
121.1      (4) all restrictions against enforcement have ceased to 
121.2   apply. 
121.3      (b) An agency may not file a lien until it has sent the 
121.4   recipient, their authorized representative, or their legal 
121.5   representative written notice of its lien rights by certified 
121.6   mail, return receipt requested, or registered mail and there has 
121.7   been an opportunity for a hearing under section 256.045.  No 
121.8   person other than the recipient shall have a right to a hearing 
121.9   under section 256.045 prior to the time the lien is filed.  The 
121.10  hearing shall be limited to whether the agency has met all of 
121.11  the prerequisites for filing the lien and whether any of the 
121.12  exceptions in this section apply. 
121.13     (c) An agency may not file a lien against the recipient's 
121.14  homestead when any of the following exceptions apply: 
121.15     (1) while the recipient's spouse is also physically present 
121.16  and lawfully and continuously residing in the homestead; 
121.17     (2) a child of the recipient who is under age 21 or who is 
121.18  blind or totally and permanently disabled according to 
121.19  supplemental security income criteria is also physically present 
121.20  on the property and lawfully and continuously residing on the 
121.21  property from and after the date the recipient first receives 
121.22  benefits; 
121.23     (3) a child of the recipient who has also lawfully and 
121.24  continuously resided on the property for a period beginning at 
121.25  least two years before the first day of the month in which the 
121.26  recipient began receiving alternative care, and who provided 
121.27  uncompensated care to the recipient which enabled the recipient 
121.28  to live without alternative care services for the two-year 
121.29  period; 
121.30     (4) a sibling of the recipient who has an ownership 
121.31  interest in the property of record in the office of the county 
121.32  recorder or registrar of titles for the county in which the real 
121.33  property is located and who has also continuously occupied the 
121.34  homestead for a period of at least one year immediately prior to 
121.35  the first day of the first month in which the recipient received 
121.36  benefits and continuously since that date. 
122.1      (d) A lien only applies to the real property it describes. 
122.2      Subd. 3.  [CONTINUATION OF LIEN.] A lien remains effective 
122.3   from the time it is filed until it is paid, satisfied, 
122.4   discharged, or becomes unenforceable under sections 514.991 to 
122.5   514.995. 
122.6      Subd. 4.  [PRIORITY OF LIEN.] (a) A lien which attaches to 
122.7   the real property it describes is subject to the rights of 
122.8   anyone else whose interest in the real property is perfected of 
122.9   record before the lien has been recorded or filed under section 
122.10  514.993, including: 
122.11     (1) an owner, other than the recipient or the recipient's 
122.12  spouse; 
122.13     (2) a good faith purchaser for value without notice of the 
122.14  lien; 
122.15     (3) a holder of a mortgage or security interest; or 
122.16     (4) a judgment lien creditor whose judgment lien has 
122.17  attached to the recipient's interest in the real property. 
122.18     (b) The rights of the other person have the same 
122.19  protections against an alternative care lien as are afforded 
122.20  against a judgment lien that arises out of an unsecured 
122.21  obligation and arises as of the time of the filing of an 
122.22  alternative care grant lien under section 514.993.  The lien 
122.23  shall be inferior to a lien for property taxes and special 
122.24  assessments and shall be superior to all other matters first 
122.25  appearing of record after the time and date the lien is filed or 
122.26  recorded. 
122.27     Subd. 5.  [SETTLEMENT, SUBORDINATION, AND RELEASE.] (a) An 
122.28  agency may, with absolute discretion, settle or subordinate the 
122.29  lien to any other lien or encumbrance of record upon the terms 
122.30  and conditions it deems appropriate. 
122.31     (b) The agency filing the lien shall release and discharge 
122.32  the lien: 
122.33     (1) if it has been paid, discharged, or satisfied; 
122.34     (2) if it has received reimbursement for the amounts 
122.35  secured by the lien, has entered into a binding and legally 
122.36  enforceable agreement under which it is reimbursed for the 
123.1   amount of the lien, or receives other collateral sufficient to 
123.2   secure payment of the lien; 
123.3      (3) against some, but not all, of the property it describes 
123.4   upon the terms, conditions, and circumstances the agency deems 
123.5   appropriate; 
123.6      (4) to the extent it cannot be lawfully enforced against 
123.7   the property it describes because of an error, omission, or 
123.8   other material defect in the legal description contained in the 
123.9   lien or a necessary prerequisite to enforcement of the lien; and 
123.10     (5) if, in its discretion, it determines the filing or 
123.11  enforcement of the lien is contrary to the public interest. 
123.12     (c) The agency executing the lien shall execute and file 
123.13  the release as provided for in section 514.993, subdivision 2. 
123.14     Subd. 6.  [LENGTH OF LIEN.] (a) A lien shall be a lien on 
123.15  the real property it describes for a period of ten years from 
123.16  the date it attaches according to subdivision 2, paragraph (a), 
123.17  except as otherwise provided for in sections 514.992 to 
123.18  514.995.  The agency filing the lien may renew the lien for one 
123.19  additional ten-year period from the date it would otherwise 
123.20  expire by recording or filing a certificate of renewal before 
123.21  the lien expires.  The certificate of renewal shall be recorded 
123.22  or filed in the office of the county recorder or registrar of 
123.23  titles for the county in which the lien is recorded or filed.  
123.24  The certificate must refer to the recording or filing data for 
123.25  the lien it renews.  The certificate need not be attested, 
123.26  certified, or acknowledged as a condition for recording or 
123.27  filing.  The recorder or registrar of titles shall record, file, 
123.28  index, and return the certificate of renewal in the same manner 
123.29  provided for liens in section 514.993, subdivision 2. 
123.30     (b) An alternative care lien is not enforceable against the 
123.31  real property of an estate to the extent there is a 
123.32  determination by a court of competent jurisdiction, or by an 
123.33  officer of the court designated for that purpose, that there are 
123.34  insufficient assets in the estate to satisfy the lien in whole 
123.35  or in part because of the homestead exemption under section 
123.36  256B.15, subdivision 4, the rights of a surviving spouse or a 
124.1   minor child under section 524.2-403, paragraphs (a) and (b), or 
124.2   claims with a priority under section 524.3-805, paragraph (a), 
124.3   clauses (1) to (4).  For purposes of this section, the rights of 
124.4   the decedent's adult children to exempt property under section 
124.5   524.2-403, paragraph (b), shall not be considered costs of 
124.6   administration under section 524.3-805, paragraph (a), clause 
124.7   (1). 
124.8      <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2003, 
124.9   for services for persons first enrolling in the alternative care 
124.10  program on or after that date and on the first day of the first 
124.11  eligibility renewal period for persons enrolled in the 
124.12  alternative care program prior to July 1, 2003. 
124.13     Sec. 24.  [514.993] [LIEN; CONTENTS AND FILING.] 
124.14     Subdivision 1.  [CONTENTS.] A lien shall be dated and must 
124.15  contain: 
124.16     (1) the recipient's full name, last known address, and 
124.17  social security number; 
124.18     (2) a statement that benefits have been paid to or for the 
124.19  recipient's benefit; 
124.20     (3) a statement that all of the recipient's interests in 
124.21  the real property described in the lien may be subject to or 
124.22  affected by the agency's right to reimbursement for benefits; 
124.23     (4) a legal description of the real property subject to the 
124.24  lien and whether it is registered or abstract property; and 
124.25     (5) such other contents, if any, as the agency deems 
124.26  appropriate. 
124.27     Subd. 2.  [FILING.] Any lien, release, or other document 
124.28  required or permitted to be filed under sections 514.991 to 
124.29  514.995 must be recorded or filed in the office of the county 
124.30  recorder or registrar of titles, as appropriate, in the county 
124.31  where the real property is located.  Notwithstanding section 
124.32  386.77, the agency shall pay the applicable filing fee for any 
124.33  documents filed under sections 514.991 to 514.995.  An 
124.34  attestation, certification, or acknowledgment is not required as 
124.35  a condition of filing.  If the property described in the lien is 
124.36  registered property, the registrar of titles shall record it on 
125.1   the certificate of title for each parcel of property described 
125.2   in the lien.  If the property described in the lien is abstract 
125.3   property, the recorder shall file the lien in the county's 
125.4   grantor-grantee indexes and any tract indexes the county 
125.5   maintains for each parcel of property described in the lien.  
125.6   The recorder or registrar shall return the recorded or filed 
125.7   lien to the agency at no cost.  If the agency provides a 
125.8   duplicate copy of the lien, the recorder or registrar of titles 
125.9   shall show the recording or filing data on the copy and return 
125.10  it to the agency at no cost.  The agency is responsible for 
125.11  filing any lien, release, or other documents under sections 
125.12  514.991 to 514.995. 
125.13     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2003, 
125.14  for services for persons first enrolling in the alternative care 
125.15  program on or after that date and on the first day of the first 
125.16  eligibility renewal period for persons enrolled in the 
125.17  alternative care program prior to July 1, 2003. 
125.18     Sec. 25.  [514.994] [ENFORCEMENT; OTHER REMEDIES.] 
125.19     Subdivision 1.  [FORECLOSURE OR ENFORCEMENT OF LIEN.] The 
125.20  agency may enforce or foreclose a lien filed under sections 
125.21  514.991 to 514.995 in the manner provided for by law for 
125.22  enforcement of judgment liens against real estate or by a 
125.23  foreclosure by action under chapter 581.  The lien shall remain 
125.24  enforceable as provided for in sections 514.991 to 514.995 
125.25  notwithstanding any laws limiting the enforceability of 
125.26  judgments. 
125.27     Subd. 2.  [HOMESTEAD EXEMPTION.] The lien may not be 
125.28  enforced against the homestead property of the recipient or the 
125.29  spouse while they physically occupy it as their lawful residence.
125.30     Subd. 3.  [AGENCY CLAIM OR REMEDY.] Sections 514.992 to 
125.31  514.995 do not limit the agency's right to file a claim against 
125.32  the recipient's estate or the estate of the recipient's spouse, 
125.33  do not limit any other claims for reimbursement the agency may 
125.34  have, and do not limit the availability of any other remedy to 
125.35  the agency. 
125.36     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2003, 
126.1   for services for persons first enrolling in the alternative care 
126.2   program on or after that date and on the first day of the first 
126.3   eligibility renewal period for persons enrolled in the 
126.4   alternative care program prior to July 1, 2003. 
126.5      Sec. 26.  [514.995] [AMOUNTS RECEIVED TO SATISFY LIEN.] 
126.6      Amounts the agency receives to satisfy the lien must be 
126.7   deposited in the state treasury and credited to the fund from 
126.8   which the benefits were paid. 
126.9      <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2003, 
126.10  for services for persons first enrolling in the alternative care 
126.11  program on or after that date and on the first day of the first 
126.12  eligibility renewal period for persons enrolled in the 
126.13  alternative care program prior to July 1, 2003. 
126.14     Sec. 27.  Minnesota Statutes 2002, section 524.3-805, is 
126.15  amended to read: 
126.16     524.3-805 [CLASSIFICATION OF CLAIMS.] 
126.17     (a) If the applicable assets of the estate are insufficient 
126.18  to pay all claims in full, the personal representative shall 
126.19  make payment in the following order: 
126.20     (1) costs and expenses of administration; 
126.21     (2) reasonable funeral expenses; 
126.22     (3) debts and taxes with preference under federal law; 
126.23     (4) reasonable and necessary medical, hospital, or nursing 
126.24  home expenses of the last illness of the decedent, including 
126.25  compensation of persons attending the decedent, a claim filed 
126.26  under section 256B.15 for recovery of expenditures for 
126.27  alternative care for nonmedical assistance recipients under 
126.28  section 256B.0913, and including a claim filed pursuant to 
126.29  section 256B.15; 
126.30     (5) reasonable and necessary medical, hospital, and nursing 
126.31  home expenses for the care of the decedent during the year 
126.32  immediately preceding death; 
126.33     (6) debts with preference under other laws of this state, 
126.34  and state taxes; 
126.35     (7) all other claims. 
126.36     (b) No preference shall be given in the payment of any 
127.1   claim over any other claim of the same class, and a claim due 
127.2   and payable shall not be entitled to a preference over claims 
127.3   not due, except that if claims for expenses of the last illness 
127.4   involve only claims filed under section 256B.15 for recovery of 
127.5   expenditures for alternative care for nonmedical assistance 
127.6   recipients under section 256B.0913, section 246.53 for costs of 
127.7   state hospital care and claims filed under section 256B.15, 
127.8   claims filed to recover expenditures for alternative care for 
127.9   nonmedical assistance recipients under section 256B.0913 shall 
127.10  have preference over claims filed under both section 246.53 and 
127.11  other claims filed under section 256B.15, and claims filed under 
127.12  section 246.53 have preference over claims filed under section 
127.13  256B.15 for recovery of amounts other than those for 
127.14  expenditures for alternative care for nonmedical assistance 
127.15  recipients under section 256B.0913. 
127.16     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2003, 
127.17  for decedents dying on or after that date. 
127.18                             ARTICLE 8
127.19               PROGRAMS AND FUNDING TRANSFERRED FROM
127.20         THE DEPARTMENT OF CHILDREN, FAMILIES, AND LEARNING
127.21     Section 1.  Minnesota Statutes 2002, section 119B.011, 
127.22  subdivision 6, is amended to read: 
127.23     Subd. 6.  [CHILD CARE FUND.] "Child care fund" means a 
127.24  program under this chapter providing:  
127.25     (1) financial assistance for child care to parents engaged 
127.26  in employment, job search, or education and training leading to 
127.27  employment, or an at-home infant care subsidy; and 
127.28     (2) grants to develop, expand, and improve the access and 
127.29  availability of child care services statewide. 
127.30     Sec. 2.  Minnesota Statutes 2002, section 119B.011, 
127.31  subdivision 15, is amended to read: 
127.32     Subd. 15.  [INCOME.] "Income" means earned or unearned 
127.33  income received by all family members, including public 
127.34  assistance cash benefits and at-home infant care subsidy 
127.35  payments, unless specifically excluded and child support and 
127.36  maintenance distributed to the family under section 256.741, 
128.1   subdivision 15.  The following are excluded from income:  funds 
128.2   used to pay for health insurance premiums for family members, 
128.3   Supplemental Security Income, scholarships, work-study income, 
128.4   and grants that cover costs or reimbursement for tuition, fees, 
128.5   books, and educational supplies; student loans for tuition, 
128.6   fees, books, supplies, and living expenses; state and federal 
128.7   earned income tax credits; in-kind income such as food stamps, 
128.8   energy assistance, foster care assistance, medical assistance, 
128.9   child care assistance, and housing subsidies; earned income of 
128.10  full-time or part-time students up to the age of 19, who have 
128.11  not earned a high school diploma or GED high school equivalency 
128.12  diploma including earnings from summer employment; grant awards 
128.13  under the family subsidy program; nonrecurring lump sum income 
128.14  only to the extent that it is earmarked and used for the purpose 
128.15  for which it is paid; and any income assigned to the public 
128.16  authority according to section 256.741. 
128.17     Sec. 3.  Minnesota Statutes 2002, section 119B.09, 
128.18  subdivision 7, is amended to read: 
128.19     Subd. 7.  [DATE OF ELIGIBILITY FOR ASSISTANCE.] (a) The 
128.20  date of eligibility for child care assistance under this chapter 
128.21  is the later of the date the application was signed; the 
128.22  beginning date of employment, education, or training; or the 
128.23  date a determination has been made that the applicant is a 
128.24  participant in employment and training services under Minnesota 
128.25  Rules, part 3400.0080, subpart 2a, or chapter 256J or 256K.  The 
128.26  date of eligibility for the basic sliding fee at-home infant 
128.27  child care program is the later of the date the infant is born 
128.28  or, in a county with a basic sliding fee waiting list, the date 
128.29  the family applies for at-home infant child care.  
128.30     (b) Payment ceases for a family under the at-home infant 
128.31  child care program when a family has used a total of 12 months 
128.32  of assistance as specified under section 119B.061.  Payment of 
128.33  child care assistance for employed persons on MFIP is effective 
128.34  the date of employment or the date of MFIP eligibility, 
128.35  whichever is later.  Payment of child care assistance for MFIP 
128.36  or work first participants in employment and training services 
129.1   is effective the date of commencement of the services or the 
129.2   date of MFIP or work first eligibility, whichever is later.  
129.3   Payment of child care assistance for transition year child care 
129.4   must be made retroactive to the date of eligibility for 
129.5   transition year child care. 
129.6      Sec. 4.  Minnesota Statutes 2002, section 119B.13, is 
129.7   amended by adding a subdivision to read: 
129.8      Subd. 1a.  [LEGAL NONLICENSED FAMILY CHILD CARE PROVIDER 
129.9   RATES.] (a) Legal nonlicensed family child care providers 
129.10  receiving reimbursement under this chapter must be paid in 
129.11  hourly blocks of time for families receiving assistance. 
129.12     (b) The maximum rate paid to legal nonlicensed family child 
129.13  care providers must be 90 percent of the county maximum hourly 
129.14  rate for licensed family child care providers.  In counties 
129.15  where the maximum hourly rate for licensed family child care 
129.16  providers is higher than the maximum weekly rate for those 
129.17  providers divided by 50, the maximum hourly rate that may be 
129.18  paid to legal nonlicensed family child care providers is the 
129.19  rate equal to the maximum weekly rate for licensed family child 
129.20  care providers divided by 50 and then multiplied by 0.90. 
129.21     (c) A rate which includes a provider bonus paid under 
129.22  subdivision 2 or a special needs rate paid under subdivision 3 
129.23  may be in excess of the maximum rate allowed under this 
129.24  subdivision. 
129.25     (d) Legal nonlicensed family child care providers receiving 
129.26  reimbursement under this chapter may not be paid registration 
129.27  fees for families receiving assistance. 
129.28     Sec. 5.  Minnesota Statutes 2002, section 119B.13, 
129.29  subdivision 2, is amended to read: 
129.30     Subd. 2.  [PROVIDER RATE BONUS FOR ACCREDITATION.] A family 
129.31  child care provider or child care center shall be paid a ten 
129.32  percent bonus above the maximum rate established in subdivision 
129.33  1 or 1a, if the provider or center holds a current early 
129.34  childhood development credential approved by the commissioner, 
129.35  up to the actual provider rate.  
129.36     Sec. 6.  [CHILD CARE ASSISTANCE PARENT FEE SCHEDULE, 
130.1   RULEMAKING.] 
130.2      The parent fee schedule in Minnesota Rules, part 3400.0100, 
130.3   subpart 4, is amended as follows: 
130.4      (1) parent fees for families with incomes greater than 100 
130.5   percent of the federal poverty guidelines but less than 35.01 
130.6   percent of the state median income must equal 2.42 percent of 
130.7   adjusted gross income for families at 35 percent of the state 
130.8   median income; 
130.9      (2) parent fees for families with incomes equal to or 
130.10  greater than 35.01 percent of the state median income but less 
130.11  than 42.01 percent of the state median income must equal 2.97 
130.12  percent of adjusted gross income for families at 42 percent of 
130.13  the state median income; 
130.14     (3) parent fees for families with incomes equal to or 
130.15  greater than 42.01 percent of the state median income but less 
130.16  than 75 percent of the state median income must begin at 4.13 
130.17  percent of adjusted gross income and provide for graduated 
130.18  movement of fee increases using the fixed percentages of income 
130.19  listed in Minnesota Rules, part 3400.0100, subpart 4, increased 
130.20  by ten percent; and 
130.21     (4) parent fees for families equal to 75 percent of the 
130.22  state median income must equal 22 percent of gross annual income.
130.23     Sec. 7.  [REPEALER.] 
130.24     Minnesota Statutes 2002, section 119B.061, is repealed. 
130.25                             ARTICLE 9 
130.26                     FAMILY AND EARLY CHILDHOOD 
130.27     Section 1.  Minnesota Statutes 2002, section 119B.011, 
130.28  subdivision 5, is amended to read: 
130.29     Subd. 5.  [CHILD CARE.] "Child care" means the care of a 
130.30  child by someone other than a parent or, stepparent, legal 
130.31  guardian, eligible relative caregiver, or the spouses of any of 
130.32  the foregoing in or outside the child's own home for gain or 
130.33  otherwise, on a regular basis, for any part of a 24-hour day. 
130.34     Sec. 2.  Minnesota Statutes 2002, section 119B.011, 
130.35  subdivision 15, is amended to read: 
130.36     Subd. 15.  [INCOME.] "Income" means earned or unearned 
131.1   income received by all family members, including public 
131.2   assistance cash benefits and at-home infant care subsidy 
131.3   payments, unless specifically excluded and child support and 
131.4   maintenance distributed to the family under section 256.741, 
131.5   subdivision 15.  The following are excluded from income:  funds 
131.6   used to pay for health insurance premiums for family members, 
131.7   Supplemental Security Income, scholarships, work-study income, 
131.8   and grants that cover costs or reimbursement for tuition, fees, 
131.9   books, and educational supplies; student loans for tuition, 
131.10  fees, books, supplies, and living expenses; state and federal 
131.11  earned income tax credits; assistance specifically excluded as 
131.12  income by law; in-kind income such as food stamps, energy 
131.13  assistance, foster care assistance, medical assistance, child 
131.14  care assistance, and housing subsidies; earned income of 
131.15  full-time or part-time students up to the age of 19, who have 
131.16  not earned a high school diploma or GED high school equivalency 
131.17  diploma including earnings from summer employment; grant awards 
131.18  under the family subsidy program; nonrecurring lump sum income 
131.19  only to the extent that it is earmarked and used for the purpose 
131.20  for which it is paid; and any income assigned to the public 
131.21  authority according to section 256.741. 
131.22     Sec. 3.  Minnesota Statutes 2002, section 119B.011, 
131.23  subdivision 19, is amended to read: 
131.24     Subd. 19.  [PROVIDER.] "Provider" means (1) an individual 
131.25  or child care center or facility, either licensed or unlicensed, 
131.26  providing legal child care services as defined under section 
131.27  245A.03, or (2) an individual or child care center or facility 
131.28  holding a valid child care license issued by another state or a 
131.29  tribe and providing child care services in the licensing state 
131.30  or in the area under the licensing tribe's jurisdiction.  A 
131.31  legally unlicensed registered family child care provider must be 
131.32  at least 18 years of age, and not a member of the MFIP 
131.33  assistance unit or a member of the family receiving child care 
131.34  assistance to be authorized under this chapter.  
131.35     Sec. 4.  Minnesota Statutes 2002, section 119B.011, is 
131.36  amended by adding a subdivision to read: 
132.1      Subd. 19a.  [REGISTRATION.] "Registration" means the 
132.2   process used by a county to determine whether the provider 
132.3   selected by a family applying for or receiving child care 
132.4   assistance to care for that family's children meets the 
132.5   requirements necessary for payment of child care assistance for 
132.6   care provided by that provider. 
132.7      Sec. 5.  Minnesota Statutes 2002, section 119B.02, 
132.8   subdivision 1, is amended to read: 
132.9      Subdivision 1.  [CHILD CARE SERVICES.] The commissioner 
132.10  shall develop standards for county and human services boards to 
132.11  provide child care services to enable eligible families to 
132.12  participate in employment, training, or education programs.  
132.13  Within the limits of available appropriations, the commissioner 
132.14  shall distribute money to counties to reduce the costs of child 
132.15  care for eligible families.  The commissioner shall adopt rules 
132.16  to govern the program in accordance with this section.  The 
132.17  rules must establish a sliding schedule of fees for parents 
132.18  receiving child care services.  The rules shall provide that 
132.19  funds received as a lump sum payment of child support arrearages 
132.20  shall not be counted as income to a family in the month received 
132.21  but shall be prorated over the 12 months following receipt and 
132.22  added to the family income during those months.  In the rules 
132.23  adopted under this section, county and human services boards 
132.24  shall be authorized to establish policies for payment of child 
132.25  care spaces for absent children, when the payment is required by 
132.26  the child's regular provider.  The rules shall not set a maximum 
132.27  number of days for which absence payments can be made, but 
132.28  instead shall direct the county agency to set limits and pay for 
132.29  absences according to the prevailing market practice in the 
132.30  county.  County policies for payment of absences shall be 
132.31  subject to the approval of the commissioner.  The commissioner 
132.32  shall maximize the use of federal money under title I and title 
132.33  IV of Public Law Number 104-193, the Personal Responsibility and 
132.34  Work Opportunity Reconciliation Act of 1996, and other programs 
132.35  that provide federal or state reimbursement for child care 
132.36  services for low-income families who are in education, training, 
133.1   job search, or other activities allowed under those programs.  
133.2   Money appropriated under this section must be coordinated with 
133.3   the programs that provide federal reimbursement for child care 
133.4   services to accomplish this purpose.  Federal reimbursement 
133.5   obtained must be allocated to the county that spent money for 
133.6   child care that is federally reimbursable under programs that 
133.7   provide federal reimbursement for child care services.  The 
133.8   counties shall use the federal money to expand child care 
133.9   services.  The commissioner may adopt rules under chapter 14 to 
133.10  implement and coordinate federal program requirements. 
133.11     Sec. 6.  Minnesota Statutes 2002, section 119B.03, 
133.12  subdivision 9, is amended to read: 
133.13     Subd. 9.  [PORTABILITY POOL.] (a) The commissioner shall 
133.14  establish a pool of up to five percent of the annual 
133.15  appropriation for the basic sliding fee program to provide 
133.16  continuous child care assistance for eligible families who move 
133.17  between Minnesota counties.  At the end of each allocation 
133.18  period, any unspent funds in the portability pool must be used 
133.19  for assistance under the basic sliding fee program.  If 
133.20  expenditures from the portability pool exceed the amount of 
133.21  money available, the reallocation pool must be reduced to cover 
133.22  these shortages. 
133.23     (b) To be eligible for portable basic sliding fee 
133.24  assistance, a family that has moved from a county in which it 
133.25  was receiving basic sliding fee assistance to a county with a 
133.26  waiting list for the basic sliding fee program must: 
133.27     (1) meet the income and eligibility guidelines for the 
133.28  basic sliding fee program; and 
133.29     (2) notify the new county of residence within 30 60 days of 
133.30  moving and apply for basic sliding fee assistance in submit 
133.31  information to the new county of residence to verify eligibility 
133.32  for the basic sliding fee program. 
133.33     (c) The receiving county must: 
133.34     (1) accept administrative responsibility for applicants for 
133.35  portable basic sliding fee assistance at the end of the two 
133.36  months of assistance under the Unitary Residency Act; 
134.1      (2) continue basic sliding fee assistance for the lesser of 
134.2   six months or until the family is able to receive assistance 
134.3   under the county's regular basic sliding program; and 
134.4      (3) notify the commissioner through the quarterly reporting 
134.5   process of any family that meets the criteria of the portable 
134.6   basic sliding fee assistance pool. 
134.7      Sec. 7.  Minnesota Statutes 2002, section 119B.05, 
134.8   subdivision 1, is amended to read: 
134.9      Subdivision 1.  [ELIGIBLE PARTICIPANTS.] Families eligible 
134.10  for child care assistance under the MFIP child care program are: 
134.11     (1) MFIP participants who are employed or in job search and 
134.12  meet the requirements of section 119B.10; 
134.13     (2) persons who are members of transition year families 
134.14  under section 119B.011, subdivision 20, and meet the 
134.15  requirements of section 119B.10; 
134.16     (3) families who are participating in employment 
134.17  orientation or job search, or other employment or training 
134.18  activities that are included in an approved employability 
134.19  development plan under chapter 256K; 
134.20     (4) MFIP families who are participating in work job search, 
134.21  job support, employment, or training activities as required in 
134.22  their job search support or employment plan, or in appeals, 
134.23  hearings, assessments, or orientations according to chapter 
134.24  256J; 
134.25     (5) MFIP families who are participating in social services 
134.26  activities under chapter 256J or 256K as required in their 
134.27  employment plan approved according to chapter 256J or 256K; and 
134.28     (6) families who are participating in programs as required 
134.29  in tribal contracts under section 119B.02, subdivision 2, or 
134.30  256.01, subdivision 2. 
134.31     Sec. 8.  Minnesota Statutes 2002, section 119B.08, 
134.32  subdivision 3, is amended to read: 
134.33     Subd. 3.  [CHILD CARE FUND PLAN.] The county and designated 
134.34  administering agency shall submit a biennial child care fund 
134.35  plan to the commissioner an annual child care fund plan in its 
134.36  biennial community social services plan.  The commissioner shall 
135.1   establish the dates by which the county must submit the plans.  
135.2   The plan shall include: 
135.3      (1) a narrative of the total program for child care 
135.4   services, including all policies and procedures that affect 
135.5   eligible families and are used to administer the child care 
135.6   funds; 
135.7      (2) the methods used by the county to inform eligible 
135.8   families of the availability of child care assistance and 
135.9   related services; 
135.10     (3) the provider rates paid for all children with special 
135.11  needs by provider type; 
135.12     (4) the county prioritization policy for all eligible 
135.13  families under the basic sliding fee program; and 
135.14     (5) other a description of strategies to coordinate and 
135.15  maximize public and private community resources, including 
135.16  school districts, health care facilities, government agencies, 
135.17  neighborhood organizations, and other resources knowledgeable in 
135.18  early childhood development, in particular to coordinate child 
135.19  care assistance with existing community-based programs and 
135.20  service providers including child care resource and referral 
135.21  programs, early childhood family education, school readiness, 
135.22  Head Start, local interagency early intervention committees, 
135.23  special education services, early childhood screening, and other 
135.24  early childhood care and education services and programs to the 
135.25  extent possible, to foster collaboration among agencies and 
135.26  other community-based programs that provide flexible, 
135.27  family-focused services to families with young children and to 
135.28  facilitate the transition to kindergarten.  The county must 
135.29  describe a method by which to share information, responsibility, 
135.30  and accountability among service and program providers; 
135.31     (2) a description of procedures and methods to be used to 
135.32  make copies of the proposed state plan reasonably available to 
135.33  the public, including members of the public particularly 
135.34  interested in child care policies such as parents, child care 
135.35  providers, culturally specific service organizations, child care 
135.36  resource and referral programs, interagency early intervention 
136.1   committees, potential collaboration partners and agencies 
136.2   involved in the provision of care and education to young 
136.3   children, and allowing sufficient time for public review and 
136.4   comment; and 
136.5      (3) information as requested by the department to ensure 
136.6   compliance with the child care fund statutes and rules 
136.7   promulgated by the commissioner. 
136.8      The commissioner shall notify counties within 60 90 days of 
136.9   the date the plan is submitted whether the plan is approved or 
136.10  the corrections or information needed to approve the plan.  The 
136.11  commissioner shall withhold a county's allocation until it has 
136.12  an approved plan.  Plans not approved by the end of the second 
136.13  quarter after the plan is due may result in a 25 percent 
136.14  reduction in allocation.  Plans not approved by the end of the 
136.15  third quarter after the plan is due may result in a 100 percent 
136.16  reduction in the allocation to the county.  Counties are to 
136.17  maintain services despite any reduction in their allocation due 
136.18  to plans not being approved. 
136.19     Sec. 9.  Minnesota Statutes 2002, section 119B.11, 
136.20  subdivision 2a, is amended to read: 
136.21     Subd. 2a.  [RECOVERY OF OVERPAYMENTS.] An amount of child 
136.22  care assistance paid to a recipient in excess of the payment due 
136.23  is recoverable by the county agency.  If the family remains 
136.24  eligible for child care assistance, the overpayment must be 
136.25  recovered through recoupment as identified in Minnesota Rules, 
136.26  part 3400.0140, subpart 19, except that the overpayments must be 
136.27  calculated and collected on a service period basis.  If the 
136.28  family no longer remains eligible for child care assistance, the 
136.29  county may choose to initiate efforts to recover overpayments 
136.30  from the family for overpayment less than $50.  If the 
136.31  overpayment is greater than or equal to $50, the county shall 
136.32  seek voluntary repayment of the overpayment from the family.  If 
136.33  the county is unable to recoup the overpayment through voluntary 
136.34  repayment, the county shall initiate civil court proceedings to 
136.35  recover the overpayment unless the county's costs to recover the 
136.36  overpayment will exceed the amount of the overpayment.  A family 
137.1   with an outstanding debt under this subdivision is not eligible 
137.2   for child care assistance until:  (1) the debt is paid in full; 
137.3   or (2) satisfactory arrangements are made with the county to 
137.4   retire the debt consistent with the requirements of this chapter 
137.5   and Minnesota Rules, chapter 3400, and the family is in 
137.6   compliance with the arrangements. 
137.7      Sec. 10.  Minnesota Statutes 2002, section 119B.12, 
137.8   subdivision 2, is amended to read: 
137.9      Subd. 2.  [PARENT FEE.] A family must be assessed a parent 
137.10  fee for each service period.  A family's monthly parent fee must 
137.11  be a fixed percentage of its annual gross income.  Parent fees 
137.12  must apply to families eligible for child care assistance under 
137.13  sections 119B.03 and 119B.05.  Income must be as defined in 
137.14  section 119B.011, subdivision 15.  The fixed percent is based on 
137.15  the relationship of the family's annual gross income to 100 
137.16  percent of state median income.  Beginning January 1, 1998, 
137.17  parent fees must begin at 75 percent of the poverty level.  The 
137.18  minimum parent fees for families between 75 percent and 100 
137.19  percent of poverty level must be $5 per month service period.  
137.20  Parent fees must be established in rule and must provide for 
137.21  graduated movement to full payment. 
137.22     Sec. 11.  [119B.125] [PROVIDER REQUIREMENTS.] 
137.23     Subdivision 1.  [AUTHORIZATION.] Except as provided in 
137.24  subdivision 3, a county must authorize the provider chosen by an 
137.25  applicant or a participant before the county can authorize 
137.26  payment for care provided by that provider.  The commissioner 
137.27  must establish the requirements necessary for authorization of 
137.28  providers. 
137.29     Subd. 2.  [UNSAFE CARE.] A county may deny authorization as 
137.30  a child care provider to any applicant or rescind authorization 
137.31  of any provider when the county knows or has reason to believe 
137.32  that the provider is unsafe or that the circumstances of the 
137.33  chosen child care arrangement are unsafe.  The county must 
137.34  include the conditions under which a provider or care 
137.35  arrangement will be determined to be unsafe in the county's 
137.36  child care fund plan under section 119B.08, subdivision 3. 
138.1      Subd. 3.  [PROVISIONAL PAYMENT.] After a county receives a 
138.2   completed application from a provider, the county may issue 
138.3   provisional authorization and payment to the provider during the 
138.4   time needed to determine whether to give final authorization to 
138.5   the provider. 
138.6      Subd. 4.  [RECORD KEEPING REQUIREMENT.] All providers must 
138.7   keep daily attendance records for children receiving child care 
138.8   assistance and must make those records available immediately to 
138.9   the county upon request.  The daily attendance records must be 
138.10  retained for six years after the date of service.  A county may 
138.11  deny authorization as a child care provider to any applicant or 
138.12  rescind authorization of any provider when the county knows or 
138.13  has reason to believe that the provider has not complied with 
138.14  the record keeping requirement in this subdivision. 
138.15     Sec. 12.  Minnesota Statutes 2002, section 119B.13, 
138.16  subdivision 6, is amended to read: 
138.17     Subd. 6.  [PROVIDER PAYMENTS.] (a) Counties or the state 
138.18  shall make vendor payments to the child care provider or pay the 
138.19  parent directly for eligible child care expenses.  
138.20     (b) If payments for child care assistance are made to 
138.21  providers, the provider shall bill the county for services 
138.22  provided within ten days of the end of the month of service 
138.23  period.  If bills are submitted in accordance with the 
138.24  provisions of this subdivision within ten days of the end of the 
138.25  service period, a county or the state shall issue payment to the 
138.26  provider of child care under the child care fund within 30 days 
138.27  of receiving an invoice a bill from the provider.  Counties or 
138.28  the state may establish policies that make payments on a more 
138.29  frequent basis.  
138.30     (c) All bills must be submitted within 60 days of the last 
138.31  date of service on the bill.  A county may pay a bill submitted 
138.32  more than 60 days after the last date of service if the provider 
138.33  shows good cause why the bill was not submitted within 60 days.  
138.34  Good cause must be defined in the county's child care fund plan 
138.35  under section 119B.08, subdivision 3, and the definition of good 
138.36  cause must include county error.  A county may not pay any bill 
139.1   submitted more than a year after the last date of service on the 
139.2   bill. 
139.3      (d) A county may stop payment issued to a provider or may 
139.4   refuse to pay a bill submitted by a provider if: 
139.5      (1) the provider admits to intentionally giving the county 
139.6   false information on the provider's billing forms; or 
139.7      (2) a county finds by a preponderance of the evidence that 
139.8   the provider intentionally gave the county false information on 
139.9   the provider's billing forms. 
139.10     (e) A county's payment policies must be included in the 
139.11  county's child care plan under section 119B.08, subdivision 3.  
139.12  If payments are made by the state, in addition to being in 
139.13  compliance with this subdivision, the payments must be made in 
139.14  compliance with section 16A.124. 
139.15     Sec. 13.  Minnesota Statutes 2002, section 119B.19, 
139.16  subdivision 7, is amended to read: 
139.17     Subd. 7.  [CHILD CARE RESOURCE AND REFERRAL PROGRAMS.] 
139.18  Within each region, a child care resource and referral program 
139.19  must: 
139.20     (1) maintain one database of all existing child care 
139.21  resources and services and one database of family referrals; 
139.22     (2) provide a child care referral service for families; 
139.23     (3) develop resources to meet the child care service needs 
139.24  of families; 
139.25     (4) increase the capacity to provide culturally responsive 
139.26  child care services; 
139.27     (5) coordinate professional development opportunities for 
139.28  child care and school-age care providers; 
139.29     (6) administer and award child care services grants; 
139.30     (7) administer and provide loans for child development 
139.31  education and training; and 
139.32     (8) cooperate with the Minnesota Child Care Resource and 
139.33  Referral Network and its member programs to develop effective 
139.34  child care services and child care resources; and 
139.35     (9) assist in fostering coordination, collaboration, and 
139.36  planning among child care programs and community programs such 
140.1   as school readiness, Head Start, early childhood family 
140.2   education, local interagency early intervention committees, 
140.3   early childhood screening, special education services, and other 
140.4   early childhood care and education services and programs that 
140.5   provide flexible, family-focused services to families with young 
140.6   children to the extent possible. 
140.7      Sec. 14.  Minnesota Statutes 2002, section 119B.21, 
140.8   subdivision 11, is amended to read: 
140.9      Subd. 11.  [STATEWIDE ADVISORY TASK FORCE.] The 
140.10  commissioner may convene a statewide advisory task force to 
140.11  advise the commissioner on statewide grants or other child care 
140.12  issues.  The following groups must be represented:  family child 
140.13  care providers, child care center programs, school-age care 
140.14  providers, parents who use child care services, health services, 
140.15  social services, Head Start, public schools, school-based early 
140.16  childhood programs, special education programs, employers, and 
140.17  other citizens with demonstrated interest in child care issues.  
140.18  Additional members may be appointed by the commissioner.  The 
140.19  commissioner may compensate members for their travel, child 
140.20  care, and child care provider substitute expenses for attending 
140.21  task force meetings.  The commissioner may also pay a stipend to 
140.22  parent representatives for participating in task force meetings. 
140.23     Sec. 15.  Minnesota Statutes 2002, section 119B.23, 
140.24  subdivision 3, is amended to read: 
140.25     Subd. 3.  [BIENNIAL PLAN.] The county board shall 
140.26  biennially develop a plan for the distribution of money for 
140.27  child care services as part of the community social services 
140.28  plan described in section 256E.09 child care fund plan under 
140.29  section 119B.08.  All licensed child care programs shall be 
140.30  given written notice concerning the availability of money and 
140.31  the application process. 
140.32     Sec. 16.  Minnesota Statutes 2002, section 256.046, 
140.33  subdivision 1, is amended to read: 
140.34     Subdivision 1.  [HEARING AUTHORITY.] A local agency must 
140.35  initiate an administrative fraud disqualification hearing for 
140.36  individuals accused of wrongfully obtaining assistance or 
141.1   intentional program violations, in lieu of a criminal action 
141.2   when it has not been pursued, in the aid to families with 
141.3   dependent children program formerly codified in sections 256.72 
141.4   to 256.87, MFIP, child care assistance programs, general 
141.5   assistance, family general assistance program formerly codified 
141.6   in section 256D.05, subdivision 1, clause (15), Minnesota 
141.7   supplemental aid, medical care, or food stamp programs.  The 
141.8   hearing is subject to the requirements of section 256.045 and 
141.9   the requirements in Code of Federal Regulations, title 7, 
141.10  section 273.16, for the food stamp program and title 45, section 
141.11  235.112, as of September 30, 1995, for the cash grant, child 
141.12  care assistance administered under chapter 119B, and medical 
141.13  care programs. 
141.14     Sec. 17.  Minnesota Statutes 2002, section 256.0471, 
141.15  subdivision 1, is amended to read: 
141.16     Subdivision 1.  [QUALIFYING OVERPAYMENT.] Any overpayment 
141.17  for assistance granted under section 119B.05 chapter 119B, the 
141.18  MFIP program formerly codified under sections 256.031 to 
141.19  256.0361, and the AFDC program formerly codified under sections 
141.20  256.72 to 256.871; chapters 256B, 256D, 256I, 256J, and 256K; 
141.21  and the food stamp program, except agency error claims, become a 
141.22  judgment by operation of law 90 days after the notice of 
141.23  overpayment is personally served upon the recipient in a manner 
141.24  that is sufficient under rule 4.03(a) of the Rules of Civil 
141.25  Procedure for district courts, or by certified mail, return 
141.26  receipt requested.  This judgment shall be entitled to full 
141.27  faith and credit in this and any other state. 
141.28     Sec. 18.  Minnesota Statutes 2002, section 256.98, 
141.29  subdivision 8, is amended to read: 
141.30     Subd. 8.  [DISQUALIFICATION FROM PROGRAM.] (a) Any person 
141.31  found to be guilty of wrongfully obtaining assistance by a 
141.32  federal or state court or by an administrative hearing 
141.33  determination, or waiver thereof, through a disqualification 
141.34  consent agreement, or as part of any approved diversion plan 
141.35  under section 401.065, or any court-ordered stay which carries 
141.36  with it any probationary or other conditions, in the Minnesota 
142.1   family investment program, the food stamp program, the general 
142.2   assistance program, the group residential housing program, or 
142.3   the Minnesota supplemental aid program shall be disqualified 
142.4   from that program.  In addition, any person disqualified from 
142.5   the Minnesota family investment program shall also be 
142.6   disqualified from the food stamp program.  The needs of that 
142.7   individual shall not be taken into consideration in determining 
142.8   the grant level for that assistance unit:  
142.9      (1) for one year after the first offense; 
142.10     (2) for two years after the second offense; and 
142.11     (3) permanently after the third or subsequent offense.  
142.12     The period of program disqualification shall begin on the 
142.13  date stipulated on the advance notice of disqualification 
142.14  without possibility of postponement for administrative stay or 
142.15  administrative hearing and shall continue through completion 
142.16  unless and until the findings upon which the sanctions were 
142.17  imposed are reversed by a court of competent jurisdiction.  The 
142.18  period for which sanctions are imposed is not subject to 
142.19  review.  The sanctions provided under this subdivision are in 
142.20  addition to, and not in substitution for, any other sanctions 
142.21  that may be provided for by law for the offense involved.  A 
142.22  disqualification established through hearing or waiver shall 
142.23  result in the disqualification period beginning immediately 
142.24  unless the person has become otherwise ineligible for 
142.25  assistance.  If the person is ineligible for assistance, the 
142.26  disqualification period begins when the person again meets the 
142.27  eligibility criteria of the program from which they were 
142.28  disqualified and makes application for that program. 
142.29     (b) A family receiving assistance through child care 
142.30  assistance programs under chapter 119B with a family member who 
142.31  is found to be guilty of wrongfully obtaining child care 
142.32  assistance by a federal court, state court, or an administrative 
142.33  hearing determination or waiver, through a disqualification 
142.34  consent agreement, as part of an approved diversion plan under 
142.35  section 401.065, or a court-ordered stay with probationary or 
142.36  other conditions, is disqualified from child care assistance 
143.1   programs.  The disqualifications must be for periods of three 
143.2   months, six months, and two years for the first, second, and 
143.3   third offenses respectively.  Subsequent violations must result 
143.4   in permanent disqualification.  During the disqualification 
143.5   period, disqualification from any child care program must extend 
143.6   to all child care programs and must be immediately applied. 
143.7      (c) A provider caring for children receiving assistance 
143.8   through child care assistance programs under chapter 119B is 
143.9   disqualified from receiving payment for child care services from 
143.10  the child care assistance programs under chapter 119B when the 
143.11  provider is found to have wrongfully obtained child care 
143.12  assistance by a federal court, state court, or an administrative 
143.13  hearing determination or waiver under section 256.046, through a 
143.14  disqualification consent agreement, as part of an approved 
143.15  diversion plan under section 401.065, or a court-ordered stay 
143.16  with probationary or other conditions.  The disqualification 
143.17  must be for a period of one year for the first offense and two 
143.18  years for the second offense.  Any subsequent violation must 
143.19  result in permanent disqualification.  The disqualification 
143.20  period must be imposed immediately after a determination is made 
143.21  under this paragraph.  During the disqualification period, the 
143.22  provider is disqualified from receiving payment from any child 
143.23  care program under chapter 119B.  
143.24     Sec. 19.  [REPEALER.] 
143.25     Laws 2001, First Special Session chapter 3, article 1, 
143.26  section 16, is repealed. 
143.27                             ARTICLE 10
143.28                            HEALTH CARE
143.29     Section 1.  Minnesota Statutes 2002, section 62J.692, 
143.30  subdivision 8, is amended to read: 
143.31     Subd. 8.  [FEDERAL FINANCIAL PARTICIPATION.] (a) The 
143.32  commissioner of human services shall seek to maximize federal 
143.33  financial participation in payments for medical education and 
143.34  research costs.  If the commissioner of human services 
143.35  determines that federal financial participation is available for 
143.36  the medical education and research, the commissioner of health 
144.1   shall transfer to the commissioner of human services the amount 
144.2   of state funds necessary to maximize the federal funds 
144.3   available.  The amount transferred to the commissioner of human 
144.4   services, plus the amount of federal financial participation, 
144.5   shall be distributed to medical assistance providers in 
144.6   accordance with the distribution methodology described in 
144.7   subdivision 4. 
144.8      (b) For the purposes of paragraph (a), the commissioner 
144.9   shall use physician clinic rates where possible to maximize 
144.10  federal financial participation. 
144.11     Sec. 2.  Minnesota Statutes 2002, section 256.01, 
144.12  subdivision 2, is amended to read: 
144.13     Subd. 2.  [SPECIFIC POWERS.] Subject to the provisions of 
144.14  section 241.021, subdivision 2, the commissioner of human 
144.15  services shall: 
144.16     (1) Administer and supervise all forms of public assistance 
144.17  provided for by state law and other welfare activities or 
144.18  services as are vested in the commissioner.  Administration and 
144.19  supervision of human services activities or services includes, 
144.20  but is not limited to, assuring timely and accurate distribution 
144.21  of benefits, completeness of service, and quality program 
144.22  management.  In addition to administering and supervising human 
144.23  services activities vested by law in the department, the 
144.24  commissioner shall have the authority to: 
144.25     (a) require county agency participation in training and 
144.26  technical assistance programs to promote compliance with 
144.27  statutes, rules, federal laws, regulations, and policies 
144.28  governing human services; 
144.29     (b) monitor, on an ongoing basis, the performance of county 
144.30  agencies in the operation and administration of human services, 
144.31  enforce compliance with statutes, rules, federal laws, 
144.32  regulations, and policies governing welfare services and promote 
144.33  excellence of administration and program operation; 
144.34     (c) develop a quality control program or other monitoring 
144.35  program to review county performance and accuracy of benefit 
144.36  determinations; 
145.1      (d) require county agencies to make an adjustment to the 
145.2   public assistance benefits issued to any individual consistent 
145.3   with federal law and regulation and state law and rule and to 
145.4   issue or recover benefits as appropriate; 
145.5      (e) delay or deny payment of all or part of the state and 
145.6   federal share of benefits and administrative reimbursement 
145.7   according to the procedures set forth in section 256.017; 
145.8      (f) make contracts with and grants to public and private 
145.9   agencies and organizations, both profit and nonprofit, and 
145.10  individuals, using appropriated funds; and 
145.11     (g) enter into contractual agreements with federally 
145.12  recognized Indian tribes with a reservation in Minnesota to the 
145.13  extent necessary for the tribe to operate a federally approved 
145.14  family assistance program or any other program under the 
145.15  supervision of the commissioner.  The commissioner shall consult 
145.16  with the affected county or counties in the contractual 
145.17  agreement negotiations, if the county or counties wish to be 
145.18  included, in order to avoid the duplication of county and tribal 
145.19  assistance program services.  The commissioner may establish 
145.20  necessary accounts for the purposes of receiving and disbursing 
145.21  funds as necessary for the operation of the programs. 
145.22     (2) Inform county agencies, on a timely basis, of changes 
145.23  in statute, rule, federal law, regulation, and policy necessary 
145.24  to county agency administration of the programs. 
145.25     (3) Administer and supervise all child welfare activities; 
145.26  promote the enforcement of laws protecting handicapped, 
145.27  dependent, neglected and delinquent children, and children born 
145.28  to mothers who were not married to the children's fathers at the 
145.29  times of the conception nor at the births of the children; 
145.30  license and supervise child-caring and child-placing agencies 
145.31  and institutions; supervise the care of children in boarding and 
145.32  foster homes or in private institutions; and generally perform 
145.33  all functions relating to the field of child welfare now vested 
145.34  in the state board of control. 
145.35     (4) Administer and supervise all noninstitutional service 
145.36  to handicapped persons, including those who are visually 
146.1   impaired, hearing impaired, or physically impaired or otherwise 
146.2   handicapped.  The commissioner may provide and contract for the 
146.3   care and treatment of qualified indigent children in facilities 
146.4   other than those located and available at state hospitals when 
146.5   it is not feasible to provide the service in state hospitals. 
146.6      (5) Assist and actively cooperate with other departments, 
146.7   agencies and institutions, local, state, and federal, by 
146.8   performing services in conformity with the purposes of Laws 
146.9   1939, chapter 431. 
146.10     (6) Act as the agent of and cooperate with the federal 
146.11  government in matters of mutual concern relative to and in 
146.12  conformity with the provisions of Laws 1939, chapter 431, 
146.13  including the administration of any federal funds granted to the 
146.14  state to aid in the performance of any functions of the 
146.15  commissioner as specified in Laws 1939, chapter 431, and 
146.16  including the promulgation of rules making uniformly available 
146.17  medical care benefits to all recipients of public assistance, at 
146.18  such times as the federal government increases its participation 
146.19  in assistance expenditures for medical care to recipients of 
146.20  public assistance, the cost thereof to be borne in the same 
146.21  proportion as are grants of aid to said recipients. 
146.22     (7) Establish and maintain any administrative units 
146.23  reasonably necessary for the performance of administrative 
146.24  functions common to all divisions of the department. 
146.25     (8) Act as designated guardian of both the estate and the 
146.26  person of all the wards of the state of Minnesota, whether by 
146.27  operation of law or by an order of court, without any further 
146.28  act or proceeding whatever, except as to persons committed as 
146.29  mentally retarded.  For children under the guardianship of the 
146.30  commissioner whose interests would be best served by adoptive 
146.31  placement, the commissioner may contract with a licensed 
146.32  child-placing agency or a Minnesota tribal social services 
146.33  agency to provide adoption services.  A contract with a licensed 
146.34  child-placing agency must be designed to supplement existing 
146.35  county efforts and may not replace existing county programs, 
146.36  unless the replacement is agreed to by the county board and the 
147.1   appropriate exclusive bargaining representative or the 
147.2   commissioner has evidence that child placements of the county 
147.3   continue to be substantially below that of other counties.  
147.4   Funds encumbered and obligated under an agreement for a specific 
147.5   child shall remain available until the terms of the agreement 
147.6   are fulfilled or the agreement is terminated. 
147.7      (9) Act as coordinating referral and informational center 
147.8   on requests for service for newly arrived immigrants coming to 
147.9   Minnesota. 
147.10     (10) The specific enumeration of powers and duties as 
147.11  hereinabove set forth shall in no way be construed to be a 
147.12  limitation upon the general transfer of powers herein contained. 
147.13     (11) Establish county, regional, or statewide schedules of 
147.14  maximum fees and charges which may be paid by county agencies 
147.15  for medical, dental, surgical, hospital, nursing and nursing 
147.16  home care and medicine and medical supplies under all programs 
147.17  of medical care provided by the state and for congregate living 
147.18  care under the income maintenance programs. 
147.19     (12) Have the authority to conduct and administer 
147.20  experimental projects to test methods and procedures of 
147.21  administering assistance and services to recipients or potential 
147.22  recipients of public welfare.  To carry out such experimental 
147.23  projects, it is further provided that the commissioner of human 
147.24  services is authorized to waive the enforcement of existing 
147.25  specific statutory program requirements, rules, and standards in 
147.26  one or more counties.  The order establishing the waiver shall 
147.27  provide alternative methods and procedures of administration, 
147.28  shall not be in conflict with the basic purposes, coverage, or 
147.29  benefits provided by law, and in no event shall the duration of 
147.30  a project exceed four years.  It is further provided that no 
147.31  order establishing an experimental project as authorized by the 
147.32  provisions of this section shall become effective until the 
147.33  following conditions have been met: 
147.34     (a) The secretary of health and human services of the 
147.35  United States has agreed, for the same project, to waive state 
147.36  plan requirements relative to statewide uniformity. 
148.1      (b) A comprehensive plan, including estimated project 
148.2   costs, shall be approved by the legislative advisory commission 
148.3   and filed with the commissioner of administration.  
148.4      (13) According to federal requirements, establish 
148.5   procedures to be followed by local welfare boards in creating 
148.6   citizen advisory committees, including procedures for selection 
148.7   of committee members. 
148.8      (14) Allocate federal fiscal disallowances or sanctions 
148.9   which are based on quality control error rates for the aid to 
148.10  families with dependent children program formerly codified in 
148.11  sections 256.72 to 256.87, medical assistance, or food stamp 
148.12  program in the following manner:  
148.13     (a) One-half of the total amount of the disallowance shall 
148.14  be borne by the county boards responsible for administering the 
148.15  programs.  For the medical assistance and the AFDC program 
148.16  formerly codified in sections 256.72 to 256.87, disallowances 
148.17  shall be shared by each county board in the same proportion as 
148.18  that county's expenditures for the sanctioned program are to the 
148.19  total of all counties' expenditures for the AFDC program 
148.20  formerly codified in sections 256.72 to 256.87, and medical 
148.21  assistance programs.  For the food stamp program, sanctions 
148.22  shall be shared by each county board, with 50 percent of the 
148.23  sanction being distributed to each county in the same proportion 
148.24  as that county's administrative costs for food stamps are to the 
148.25  total of all food stamp administrative costs for all counties, 
148.26  and 50 percent of the sanctions being distributed to each county 
148.27  in the same proportion as that county's value of food stamp 
148.28  benefits issued are to the total of all benefits issued for all 
148.29  counties.  Each county shall pay its share of the disallowance 
148.30  to the state of Minnesota.  When a county fails to pay the 
148.31  amount due hereunder, the commissioner may deduct the amount 
148.32  from reimbursement otherwise due the county, or the attorney 
148.33  general, upon the request of the commissioner, may institute 
148.34  civil action to recover the amount due. 
148.35     (b) Notwithstanding the provisions of paragraph (a), if the 
148.36  disallowance results from knowing noncompliance by one or more 
149.1   counties with a specific program instruction, and that knowing 
149.2   noncompliance is a matter of official county board record, the 
149.3   commissioner may require payment or recover from the county or 
149.4   counties, in the manner prescribed in paragraph (a), an amount 
149.5   equal to the portion of the total disallowance which resulted 
149.6   from the noncompliance, and may distribute the balance of the 
149.7   disallowance according to paragraph (a).  
149.8      (15) Develop and implement special projects that maximize 
149.9   reimbursements and result in the recovery of money to the 
149.10  state.  For the purpose of recovering state money, the 
149.11  commissioner may enter into contracts with third parties.  Any 
149.12  recoveries that result from projects or contracts entered into 
149.13  under this paragraph shall be deposited in the state treasury 
149.14  and credited to a special account until the balance in the 
149.15  account reaches $1,000,000.  When the balance in the account 
149.16  exceeds $1,000,000, the excess shall be transferred and credited 
149.17  to the general fund.  All money in the account is appropriated 
149.18  to the commissioner for the purposes of this paragraph. 
149.19     (16) Have the authority to make direct payments to 
149.20  facilities providing shelter to women and their children 
149.21  according to section 256D.05, subdivision 3.  Upon the written 
149.22  request of a shelter facility that has been denied payments 
149.23  under section 256D.05, subdivision 3, the commissioner shall 
149.24  review all relevant evidence and make a determination within 30 
149.25  days of the request for review regarding issuance of direct 
149.26  payments to the shelter facility.  Failure to act within 30 days 
149.27  shall be considered a determination not to issue direct payments.
149.28     (17) Have the authority to establish and enforce the 
149.29  following county reporting requirements:  
149.30     (a) The commissioner shall establish fiscal and statistical 
149.31  reporting requirements necessary to account for the expenditure 
149.32  of funds allocated to counties for human services programs.  
149.33  When establishing financial and statistical reporting 
149.34  requirements, the commissioner shall evaluate all reports, in 
149.35  consultation with the counties, to determine if the reports can 
149.36  be simplified or the number of reports can be reduced. 
150.1      (b) The county board shall submit monthly or quarterly 
150.2   reports to the department as required by the commissioner.  
150.3   Monthly reports are due no later than 15 working days after the 
150.4   end of the month.  Quarterly reports are due no later than 30 
150.5   calendar days after the end of the quarter, unless the 
150.6   commissioner determines that the deadline must be shortened to 
150.7   20 calendar days to avoid jeopardizing compliance with federal 
150.8   deadlines or risking a loss of federal funding.  Only reports 
150.9   that are complete, legible, and in the required format shall be 
150.10  accepted by the commissioner.  
150.11     (c) If the required reports are not received by the 
150.12  deadlines established in clause (b), the commissioner may delay 
150.13  payments and withhold funds from the county board until the next 
150.14  reporting period.  When the report is needed to account for the 
150.15  use of federal funds and the late report results in a reduction 
150.16  in federal funding, the commissioner shall withhold from the 
150.17  county boards with late reports an amount equal to the reduction 
150.18  in federal funding until full federal funding is received.  
150.19     (d) A county board that submits reports that are late, 
150.20  illegible, incomplete, or not in the required format for two out 
150.21  of three consecutive reporting periods is considered 
150.22  noncompliant.  When a county board is found to be noncompliant, 
150.23  the commissioner shall notify the county board of the reason the 
150.24  county board is considered noncompliant and request that the 
150.25  county board develop a corrective action plan stating how the 
150.26  county board plans to correct the problem.  The corrective 
150.27  action plan must be submitted to the commissioner within 45 days 
150.28  after the date the county board received notice of noncompliance.
150.29     (e) The final deadline for fiscal reports or amendments to 
150.30  fiscal reports is one year after the date the report was 
150.31  originally due.  If the commissioner does not receive a report 
150.32  by the final deadline, the county board forfeits the funding 
150.33  associated with the report for that reporting period and the 
150.34  county board must repay any funds associated with the report 
150.35  received for that reporting period. 
150.36     (f) The commissioner may not delay payments, withhold 
151.1   funds, or require repayment under paragraph (c) or (e) if the 
151.2   county demonstrates that the commissioner failed to provide 
151.3   appropriate forms, guidelines, and technical assistance to 
151.4   enable the county to comply with the requirements.  If the 
151.5   county board disagrees with an action taken by the commissioner 
151.6   under paragraph (c) or (e), the county board may appeal the 
151.7   action according to sections 14.57 to 14.69. 
151.8      (g) Counties subject to withholding of funds under 
151.9   paragraph (c) or forfeiture or repayment of funds under 
151.10  paragraph (e) shall not reduce or withhold benefits or services 
151.11  to clients to cover costs incurred due to actions taken by the 
151.12  commissioner under paragraph (c) or (e). 
151.13     (18) Allocate federal fiscal disallowances or sanctions for 
151.14  audit exceptions when federal fiscal disallowances or sanctions 
151.15  are based on a statewide random sample for the foster care 
151.16  program under title IV-E of the Social Security Act, United 
151.17  States Code, title 42, in direct proportion to each county's 
151.18  title IV-E foster care maintenance claim for that period. 
151.19     (19) Be responsible for ensuring the detection, prevention, 
151.20  investigation, and resolution of fraudulent activities or 
151.21  behavior by applicants, recipients, and other participants in 
151.22  the human services programs administered by the department. 
151.23     (20) Require county agencies to identify overpayments, 
151.24  establish claims, and utilize all available and cost-beneficial 
151.25  methodologies to collect and recover these overpayments in the 
151.26  human services programs administered by the department. 
151.27     (21) Have the authority to administer a drug rebate program 
151.28  for drugs purchased pursuant to the prescription drug program 
151.29  established under section 256.955 after the beneficiary's 
151.30  satisfaction of any deductible established in the program.  The 
151.31  commissioner shall require a rebate agreement from all 
151.32  manufacturers of covered drugs as defined in section 256B.0625, 
151.33  subdivision 13.  Rebate agreements for prescription drugs 
151.34  delivered on or after July 1, 2002, must include rebates for 
151.35  individuals covered under the prescription drug program who are 
151.36  under 65 years of age.  For each drug, the amount of the rebate 
152.1   shall be equal to the basic rebate as defined for purposes of 
152.2   the federal rebate program in United States Code, title 42, 
152.3   section 1396r-8(c)(1).  This basic rebate shall be applied to 
152.4   single-source and multiple-source drugs.  The manufacturers must 
152.5   provide full payment within 30 days of receipt of the state 
152.6   invoice for the rebate within the terms and conditions used for 
152.7   the federal rebate program established pursuant to section 1927 
152.8   of title XIX of the Social Security Act.  The manufacturers must 
152.9   provide the commissioner with any information necessary to 
152.10  verify the rebate determined per drug.  The rebate program shall 
152.11  utilize the terms and conditions used for the federal rebate 
152.12  program established pursuant to section 1927 of title XIX of the 
152.13  Social Security Act. 
152.14     (22) Have the authority to administer the federal drug 
152.15  rebate program for drugs purchased under the medical assistance 
152.16  program as allowed by section 1927 of title XIX of the Social 
152.17  Security Act and according to the terms and conditions of 
152.18  section 1927.  Rebates shall be collected for all drugs that 
152.19  have been dispensed or administered in an outpatient setting and 
152.20  that are from manufacturers who have signed a rebate agreement 
152.21  with the United States Department of Health and Human Services. 
152.22     (23) Have the authority to administer a supplemental drug 
152.23  rebate program for drugs purchased under the medical assistance 
152.24  program.  The commissioner may enter into supplemental rebate 
152.25  contracts with pharmaceutical manufacturers and may require 
152.26  prior authorization for drugs that are from manufacturers that 
152.27  have not signed a supplemental rebate contract.  Prior 
152.28  authorization of drugs shall be subject to the provisions of 
152.29  section 256B.0625, subdivision 13.  The commissioner shall 
152.30  evaluate whether participation in a multistate preferred drug 
152.31  list and supplemental rebate program can reduce costs or improve 
152.32  the operations of the medical assistance program.  The 
152.33  commissioner may enter into a contract with a vendor or other 
152.34  states for the purposes of participating in a multistate 
152.35  preferred drug list and supplemental rebate program.  
152.36     (24) Operate the department's communication systems account 
153.1   established in Laws 1993, First Special Session chapter 1, 
153.2   article 1, section 2, subdivision 2, to manage shared 
153.3   communication costs necessary for the operation of the programs 
153.4   the commissioner supervises.  A communications account may also 
153.5   be established for each regional treatment center which operates 
153.6   communications systems.  Each account must be used to manage 
153.7   shared communication costs necessary for the operations of the 
153.8   programs the commissioner supervises.  The commissioner may 
153.9   distribute the costs of operating and maintaining communication 
153.10  systems to participants in a manner that reflects actual usage. 
153.11  Costs may include acquisition, licensing, insurance, 
153.12  maintenance, repair, staff time and other costs as determined by 
153.13  the commissioner.  Nonprofit organizations and state, county, 
153.14  and local government agencies involved in the operation of 
153.15  programs the commissioner supervises may participate in the use 
153.16  of the department's communications technology and share in the 
153.17  cost of operation.  The commissioner may accept on behalf of the 
153.18  state any gift, bequest, devise or personal property of any 
153.19  kind, or money tendered to the state for any lawful purpose 
153.20  pertaining to the communication activities of the department.  
153.21  Any money received for this purpose must be deposited in the 
153.22  department's communication systems accounts.  Money collected by 
153.23  the commissioner for the use of communication systems must be 
153.24  deposited in the state communication systems account and is 
153.25  appropriated to the commissioner for purposes of this section. 
153.26     (25) Receive any federal matching money that is made 
153.27  available through the medical assistance program for the 
153.28  consumer satisfaction survey.  Any federal money received for 
153.29  the survey is appropriated to the commissioner for this 
153.30  purpose.  The commissioner may expend the federal money received 
153.31  for the consumer satisfaction survey in either year of the 
153.32  biennium. 
153.33     (26) Incorporate cost reimbursement claims from First Call 
153.34  Minnesota and Greater Twin Cities United Way into the federal 
153.35  cost reimbursement claiming processes of the department 
153.36  according to federal law, rule, and regulations.  Any 
154.1   reimbursement received is appropriated to the commissioner and 
154.2   shall be disbursed to First Call Minnesota and Greater Twin 
154.3   Cities United Way according to normal department payment 
154.4   schedules. 
154.5      (27) Develop recommended standards for foster care homes 
154.6   that address the components of specialized therapeutic services 
154.7   to be provided by foster care homes with those services.  
154.8      Sec. 3.  Minnesota Statutes 2002, section 256B.057, 
154.9   subdivision 2, is amended to read: 
154.10     Subd. 2.  [CHILDREN.] Except as specified in subdivision 
154.11  1b, effective July 1, 2002 2003, a child one through 18 years of 
154.12  age in a family whose countable income is no greater than 170 
154.13  150 percent of the federal poverty guidelines for the same 
154.14  family size, is eligible for medical assistance. 
154.15     Sec. 4.  Minnesota Statutes 2002, section 256B.0625, 
154.16  subdivision 13, is amended to read: 
154.17     Subd. 13.  [DRUGS.] (a) Medical assistance covers drugs, 
154.18  except for fertility drugs when specifically used to enhance 
154.19  fertility, if prescribed by a licensed practitioner and 
154.20  dispensed by a licensed pharmacist, by a physician enrolled in 
154.21  the medical assistance program as a dispensing physician, or by 
154.22  a physician or a nurse practitioner employed by or under 
154.23  contract with a community health board as defined in section 
154.24  145A.02, subdivision 5, for the purposes of communicable disease 
154.25  control.  
154.26     (b) The commissioner, after receiving recommendations from 
154.27  professional medical associations and professional 
154.28  pharmacist pharmacy associations, shall designate a formulary 
154.29  committee to advise the commissioner on the names of drugs for 
154.30  which payment is made, recommend a system for reimbursing 
154.31  providers on a set fee or charge basis rather than the present 
154.32  system, and develop methods encouraging use of generic drugs 
154.33  when they are less expensive and equally effective as trademark 
154.34  drugs.  The formulary committee shall consist of nine members, 
154.35  four of whom shall be physicians who are not employed by the 
154.36  department of human services, and a majority of whose practice 
155.1   is for persons paying privately or through health insurance, 
155.2   three of whom shall be pharmacists who are not employed by the 
155.3   department of human services, and a majority of whose practice 
155.4   is for persons paying privately or through health insurance, a 
155.5   consumer representative, and a nursing home representative carry 
155.6   out duties as described in this subdivision.  The formulary 
155.7   committee shall be comprised of four licensed physicians 
155.8   actively engaged in the practice of medicine in Minnesota; at 
155.9   least three licensed pharmacists actively engaged in the 
155.10  practice of pharmacy in Minnesota; and one consumer 
155.11  representative; the remainder to be made up of health care 
155.12  professionals who are licensed in their field and have 
155.13  recognized knowledge in the clinically appropriate prescribing, 
155.14  dispensing, and monitoring of covered outpatient drugs.  Members 
155.15  of the formulary committee shall not be employed by the 
155.16  department of human services.  Committee members shall serve 
155.17  three-year terms and shall serve without compensation.  Members 
155.18  may be reappointed once by the commissioner.  The formulary 
155.19  committee shall meet at least quarterly.  The commissioner may 
155.20  require more frequent formulary committee meetings as needed.  
155.21  An honorarium of $100 per meeting and reimbursement for mileage 
155.22  shall be paid to each committee member in attendance.  
155.23     (b) (c) The commissioner shall establish a drug formulary.  
155.24  Its establishment and publication shall not be subject to the 
155.25  requirements of the Administrative Procedure Act, but the 
155.26  formulary committee shall review and comment on the formulary 
155.27  contents.  
155.28     The formulary shall not include:  
155.29     (i) drugs or products for which there is no federal 
155.30  funding; 
155.31     (ii) over-the-counter drugs, except for antacids, 
155.32  acetaminophen, family planning products, aspirin, insulin, 
155.33  products for the treatment of lice, vitamins for adults with 
155.34  documented vitamin deficiencies, vitamins for children under the 
155.35  age of seven and pregnant or nursing women, and any other 
155.36  over-the-counter drug identified by the commissioner, in 
156.1   consultation with the drug formulary committee, as necessary, 
156.2   appropriate, and cost-effective for the treatment of certain 
156.3   specified chronic diseases, conditions or disorders, and this 
156.4   determination shall not be subject to the requirements of 
156.5   chapter 14; 
156.6      (iii) anorectics, except that medically necessary 
156.7   anorectics shall be covered for a recipient previously diagnosed 
156.8   as having pickwickian syndrome and currently diagnosed as having 
156.9   diabetes and being morbidly obese; 
156.10     (iv) drugs for which medical value has not been 
156.11  established; and 
156.12     (v) drugs from manufacturers who have not signed a rebate 
156.13  agreement with the Department of Health and Human Services 
156.14  pursuant to section 1927 of title XIX of the Social Security Act.
156.15     The commissioner shall publish conditions for prohibiting 
156.16  payment for specific drugs after considering the formulary 
156.17  committee's recommendations.  An honorarium of $100 per meeting 
156.18  and reimbursement for mileage shall be paid to each committee 
156.19  member in attendance.  
156.20     (d) Prior authorization may be required by the commissioner 
156.21  before certain formulary drugs are eligible for payment.  The 
156.22  formulary committee may recommend drugs for prior authorization 
156.23  directly to the commissioner.  The commissioner may also request 
156.24  that the formulary committee review a drug for prior 
156.25  authorization.  Before the commissioner may require prior 
156.26  authorization for a drug: 
156.27     (1) the commissioner must provide information to the 
156.28  formulary committee on the impact that placing the drug on prior 
156.29  authorization may have on the quality of patient care and on 
156.30  program costs, information regarding whether the drug is subject 
156.31  to clinical abuse or misuse, and relevant data from the state 
156.32  Medicaid program if such data is available; 
156.33     (2) the formulary committee must review the drug, taking 
156.34  into account medical and clinical data and the information 
156.35  provided by the commissioner; and 
156.36     (3) the formulary committee must hold a public forum and 
157.1   receive public comment for an additional 15 days. 
157.2   The commissioner must provide a 15-day notice period before 
157.3   implementing the prior authorization.  
157.4      (c) (e) The basis for determining the amount of payment 
157.5   shall be the lower of the actual acquisition costs of the drugs 
157.6   plus a fixed dispensing fee; the maximum allowable cost set by 
157.7   the federal government or by the commissioner plus the fixed 
157.8   dispensing fee; or the usual and customary price charged to the 
157.9   public.  The amount of payment basis must be reduced to reflect 
157.10  all discount amounts applied to the charge by any 
157.11  provider/insurer agreement or contract for submitted charges to 
157.12  medical assistance programs.  The net submitted charge may not 
157.13  be greater than the patient liability for the service.  The 
157.14  pharmacy dispensing fee shall be $3.65, except that the 
157.15  dispensing fee for intravenous solutions which must be 
157.16  compounded by the pharmacist shall be $8 per bag, $14 per bag 
157.17  for cancer chemotherapy products, and $30 per bag for total 
157.18  parenteral nutritional products dispensed in one liter 
157.19  quantities, or $44 per bag for total parenteral nutritional 
157.20  products dispensed in quantities greater than one liter.  Actual 
157.21  acquisition cost includes quantity and other special discounts 
157.22  except time and cash discounts.  The actual acquisition cost of 
157.23  a drug shall be estimated by the commissioner, at average 
157.24  wholesale price minus nine percent, except that where a drug has 
157.25  had its wholesale price reduced as a result of the actions of 
157.26  the National Association of Medicaid Fraud Control Units, the 
157.27  estimated actual acquisition cost shall be the reduced average 
157.28  wholesale price, without the nine percent deduction.  The 
157.29  maximum allowable cost of a multisource drug may be set by the 
157.30  commissioner and it shall be comparable to, but no higher than, 
157.31  the maximum amount paid by other third-party payors in this 
157.32  state who have maximum allowable cost programs.  The 
157.33  commissioner shall set maximum allowable costs for multisource 
157.34  drugs that are not on the federal upper limit list as described 
157.35  in United States Code, title 42, chapter 7, section 1396r-8(e), 
157.36  the Social Security Act, and Code of Federal Regulations, title 
158.1   42, part 447, section 447.332.  Establishment of the amount of 
158.2   payment for drugs shall not be subject to the requirements of 
158.3   the Administrative Procedure Act.  An additional dispensing fee 
158.4   of $.30 may be added to the dispensing fee paid to pharmacists 
158.5   for legend drug prescriptions dispensed to residents of 
158.6   long-term care facilities when a unit dose blister card system, 
158.7   approved by the department, is used.  Under this type of 
158.8   dispensing system, the pharmacist must dispense a 30-day supply 
158.9   of drug.  The National Drug Code (NDC) from the drug container 
158.10  used to fill the blister card must be identified on the claim to 
158.11  the department.  The unit dose blister card containing the drug 
158.12  must meet the packaging standards set forth in Minnesota Rules, 
158.13  part 6800.2700, that govern the return of unused drugs to the 
158.14  pharmacy for reuse.  The pharmacy provider will be required to 
158.15  credit the department for the actual acquisition cost of all 
158.16  unused drugs that are eligible for reuse.  Over-the-counter 
158.17  medications must be dispensed in the manufacturer's unopened 
158.18  package.  The commissioner may permit the drug clozapine to be 
158.19  dispensed in a quantity that is less than a 30-day supply.  
158.20  Whenever a generically equivalent product is available, payment 
158.21  shall be on the basis of the actual acquisition cost of the 
158.22  generic drug, unless the prescriber specifically indicates 
158.23  "dispense as written - brand necessary" on the prescription as 
158.24  required by section 151.21, subdivision 2. 
158.25     (d) (f) For purposes of this subdivision, "multisource 
158.26  drugs" means covered outpatient drugs, excluding innovator 
158.27  multisource drugs for which there are two or more drug products, 
158.28  which: 
158.29     (1) are related as therapeutically equivalent under the 
158.30  Food and Drug Administration's most recent publication of 
158.31  "Approved Drug Products with Therapeutic Equivalence 
158.32  Evaluations"; 
158.33     (2) are pharmaceutically equivalent and bioequivalent as 
158.34  determined by the Food and Drug Administration; and 
158.35     (3) are sold or marketed in Minnesota. 
158.36  "Innovator multisource drug" means a multisource drug that was 
159.1   originally marketed under an original new drug application 
159.2   approved by the Food and Drug Administration. 
159.3      (e) The formulary committee shall review and recommend 
159.4   drugs which require prior authorization.  The formulary 
159.5   committee may recommend drugs for prior authorization directly 
159.6   to the commissioner, as long as opportunity for public input is 
159.7   provided.  Prior authorization may be requested by the 
159.8   commissioner based on medical and clinical criteria and on cost 
159.9   before certain drugs are eligible for payment.  Before a drug 
159.10  may be considered for prior authorization at the request of the 
159.11  commissioner: 
159.12     (1) the drug formulary committee must develop criteria to 
159.13  be used for identifying drugs; the development of these criteria 
159.14  is not subject to the requirements of chapter 14, but the 
159.15  formulary committee shall provide opportunity for public input 
159.16  in developing criteria; 
159.17     (2) the drug formulary committee must hold a public forum 
159.18  and receive public comment for an additional 15 days; 
159.19     (3) the drug formulary committee must consider data from 
159.20  the state Medicaid program if such data is available; and 
159.21     (4) the commissioner must provide information to the 
159.22  formulary committee on the impact that placing the drug on prior 
159.23  authorization will have on the quality of patient care and on 
159.24  program costs, and information regarding whether the drug is 
159.25  subject to clinical abuse or misuse.  
159.26     Prior authorization may be required by the commissioner 
159.27  before certain formulary drugs are eligible for payment.  If 
159.28  prior authorization of a drug is required by the commissioner, 
159.29  the commissioner must provide a 30-day notice period before 
159.30  implementing the prior authorization.  If a prior authorization 
159.31  request is denied by the department, the recipient may appeal 
159.32  the denial in accordance with section 256.045.  If an appeal is 
159.33  filed, the drug must be provided without prior authorization 
159.34  until a decision is made on the appeal.  
159.35     (f) (g) The basis for determining the amount of payment for 
159.36  drugs administered in an outpatient setting shall be the lower 
160.1   of the usual and customary cost submitted by the provider; the 
160.2   average wholesale price minus five percent; or the maximum 
160.3   allowable cost set by the federal government under United States 
160.4   Code, title 42, chapter 7, section 1396r-8(e), and Code of 
160.5   Federal Regulations, title 42, section 447.332, or by the 
160.6   commissioner under paragraph (c). 
160.7      (g) Prior authorization shall not be required or utilized 
160.8   for any antipsychotic drug prescribed for the treatment of 
160.9   mental illness where there is no generically equivalent drug 
160.10  available unless the commissioner determines that prior 
160.11  authorization is necessary for patient safety.  This paragraph 
160.12  applies to any supplemental drug rebate program established or 
160.13  administered by the commissioner. 
160.14     (h) Prior authorization shall not be required or utilized 
160.15  for any antihemophilic factor drug prescribed for the treatment 
160.16  of hemophilia and blood disorders where there is no generically 
160.17  equivalent drug available unless the commissioner determines 
160.18  that prior authorization is necessary for patient safety.  This 
160.19  paragraph applies to any supplemental drug rebate program 
160.20  established or administered by the commissioner.  This paragraph 
160.21  expires July 1, 2003. 
160.22     Sec. 5.  Minnesota Statutes 2002, section 256B.0625, 
160.23  subdivision 17, is amended to read: 
160.24     Subd. 17.  [TRANSPORTATION COSTS.] (a) Medical assistance 
160.25  covers transportation costs incurred solely for obtaining 
160.26  emergency medical care or transportation costs incurred by 
160.27  nonambulatory persons in obtaining emergency or nonemergency 
160.28  medical care when paid directly to an ambulance company, common 
160.29  carrier, or other recognized providers of transportation 
160.30  services.  For the purpose of this subdivision, a person who is 
160.31  incapable of transport by taxicab or bus shall be considered to 
160.32  be nonambulatory. 
160.33     (b) Medical assistance covers special transportation, as 
160.34  defined in Minnesota Rules, part 9505.0315, subpart 1, item F, 
160.35  if the provider receives and maintains a current physician's 
160.36  order by the recipient's attending physician certifying that the 
161.1   recipient has a physical or mental impairment that would 
161.2   prohibit the recipient from safely accessing and using a bus, 
161.3   taxi, other commercial transportation, or private automobile and 
161.4   the recipient:  (1) requires a wheelchair-accessible van or a 
161.5   stretcher-accessible vehicle; or (2) does not require a 
161.6   wheelchair-accessible van or a stretcher-accessible vehicle but: 
161.7   (i) resides in a facility licensed by or registered with the 
161.8   commissioner of human services or the commissioner of health; or 
161.9   (ii) needs special transportation service to access dialysis or 
161.10  radiation therapy services.  Individuals certified as needing a 
161.11  wheelchair-accessible van or a stretcher-accessible vehicle must 
161.12  have the physician certification renewed every three years.  All 
161.13  other individuals must have the physician certification renewed 
161.14  annually.  Special transportation includes driver-assisted 
161.15  service to eligible individuals.  Driver-assisted service 
161.16  includes passenger pickup at and return to the individual's 
161.17  residence or place of business, assistance with admittance of 
161.18  the individual to the medical facility, and assistance in 
161.19  passenger securement or in securing of wheelchairs or stretchers 
161.20  in the vehicle.  The commissioner shall establish maximum 
161.21  medical assistance reimbursement rates for special 
161.22  transportation services for persons who need a 
161.23  wheelchair-accessible van or stretcher-accessible vehicle and 
161.24  for those who do not need a wheelchair-accessible van or 
161.25  stretcher-accessible vehicle.  The average of these two rates 
161.26  per trip must not exceed $15 for the base rate and $1.40 per 
161.27  mile.  Special transportation provided to nonambulatory persons 
161.28  who do not need a wheelchair-accessible van or 
161.29  stretcher-accessible vehicle, may be reimbursed at a lower rate 
161.30  than special transportation provided to persons who need a 
161.31  wheelchair-accessible van or stretcher-accessible vehicle.  The 
161.32  maximum medical assistance reimbursement rates for special 
161.33  transportation services are: 
161.34     (1) $18 for the base rate and $1.40 per mile for services 
161.35  to persons who need a wheelchair-accessible van; 
161.36     (2) $36 for the base rate and $1.40 per mile for services 
162.1   to persons who need a stretcher-accessible vehicle; 
162.2      (3) $9 per trip for the attendant rate for 
162.3   wheelchair-accessible vans or stretcher-accessible vehicles; and 
162.4      (4) $12 for the base rate and $1.40 per mile for services 
162.5   provided to persons who do not need a wheelchair-accessible van 
162.6   or stretcher-accessible vehicle. 
162.7      (c) In order to receive reimbursement under this 
162.8   subdivision, all providers must maintain a daily log book that 
162.9   is signed by an authorized representative of the emergency or 
162.10  nonemergency medical facility to which an individual is 
162.11  transported.  The log book must list the date and time the 
162.12  nonambulatory person is received at the medical facility.  All 
162.13  log books must be retained for at least five years.  All 
162.14  providers of special transportation services must use a 
162.15  commercially available computer mapping software program 
162.16  selected by the commissioner to calculate mileage for purposes 
162.17  of reimbursement under this subdivision. 
162.18     (d) A provider may not receive reimbursement under this 
162.19  subdivision for providing transportation solely for the purpose 
162.20  of transporting an individual to a pharmacy.  A provider may 
162.21  receive reimbursement for transporting an individual to a 
162.22  pharmacy if the visit occurs following a visit to a medical 
162.23  facility at which a prescription was provided.  A special 
162.24  transportation provider may not receive reimbursement under this 
162.25  subdivision for transporting a child to school, unless the 
162.26  special transportation service is needed to obtain nonemergency 
162.27  medical care at the school and a less costly alternative form of 
162.28  transportation is not available. 
162.29     (e) The medical assistance benefit plan shall include a $1 
162.30  co-payment for special transportation services provided to 
162.31  individuals who do not need a wheelchair-accessible van or 
162.32  stretcher-accessible vehicle, effective for services provided on 
162.33  or after October 1, 2003.  Recipients of medical assistance are 
162.34  responsible for all co-payments in this subdivision.  
162.35  Co-payments shall be subject to the following exceptions: 
162.36     (1) children under the age of 21; 
163.1      (2) pregnant women for services that relate to the 
163.2   pregnancy or any other medical condition that may complicate the 
163.3   pregnancy; 
163.4      (3) recipients expected to reside for at least 30 days in a 
163.5   hospital, nursing home, or intermediate care facility for the 
163.6   mentally retarded; 
163.7      (4) recipients receiving hospice care; 
163.8      (5) 100 percent federally funded services provided by an 
163.9   Indian health service; 
163.10     (6) services that are paid by Medicare, resulting in the 
163.11  medical assistance program paying for the coinsurance and 
163.12  deductible; and 
163.13     (7) co-payments that exceed one per day per provider. 
163.14     The medical assistance reimbursement to the provider shall 
163.15  be reduced by the amount of the co-payment.  The provider 
163.16  collects the co-payment from the recipient.  Providers may not 
163.17  deny services to individuals who are unable to pay the 
163.18  co-payment.  Providers must accept an assertion from the 
163.19  recipient that they are unable to pay. 
163.20     (f) The commissioner is prohibited from using a broker or 
163.21  coordinator to manage special transportation services. 
163.22     Sec. 6.  Minnesota Statutes 2002, section 256B.0625, is 
163.23  amended by adding a subdivision to read: 
163.24     Subd. 45.  [LIST OF HEALTH CARE SERVICES NOT ELIGIBLE FOR 
163.25  COVERAGE.] (a) The commissioner of human services, in 
163.26  consultation with the commissioner of health, shall biennially 
163.27  establish a list of diagnosis/treatment pairings that are not 
163.28  eligible for reimbursement under chapters 256B, 256D, and 256L, 
163.29  effective for services provided on or after July 1, 2005.  The 
163.30  commissioner shall review the list in effect for the prior 
163.31  biennium and shall make any additions or deletions from the list 
163.32  as appropriate taking into consideration the following:  
163.33     (1) scientific and medical information; 
163.34     (2) clinical assessment; 
163.35     (3) cost-effectiveness of treatment; 
163.36     (4) prevention of future costs; and 
164.1      (5) medical ineffectiveness.  
164.2      (b) The commissioner may appoint an ad hoc advisory panel 
164.3   made up of physicians, consumers, nurses, dentists, and other 
164.4   experts to assist the commissioner in reviewing and establishing 
164.5   the list.  The commissioner shall solicit comments and 
164.6   recommendations from any interested persons and organizations 
164.7   and shall schedule at least one public hearing.  
164.8      (c) The list must be established by October 1 of the 
164.9   even-numbered years beginning October 1, 2004.  The commissioner 
164.10  shall publish the list in the State Register by November 1 of 
164.11  the even-numbered years beginning November 1, 2004.  The list 
164.12  shall be submitted to the legislature by January 15 of the 
164.13  odd-numbered years beginning January 15, 2005. 
164.14     Sec. 7.  Minnesota Statutes 2002, section 256B.195, 
164.15  subdivision 4, is amended to read: 
164.16     Subd. 4.  [ADJUSTMENTS PERMITTED.] (a) The commissioner may 
164.17  adjust the intergovernmental transfers under subdivision 2 and 
164.18  the payments under subdivision 3, and payments and transfers 
164.19  under subdivision 5, based on the commissioner's determination 
164.20  of Medicare upper payment limits, hospital-specific charge 
164.21  limits, and hospital-specific limitations on disproportionate 
164.22  share payments.  Any adjustments must be made on a proportional 
164.23  basis.  If participation by a particular hospital under this 
164.24  section is limited, the commissioner shall adjust the payments 
164.25  that relate to that hospital under subdivisions 2, 3, and 5 on a 
164.26  proportional basis in order to allow the hospital to participate 
164.27  under this section to the fullest extent possible and shall 
164.28  increase other payments under subdivisions 2, 3, and 5 to the 
164.29  extent allowable to maintain the overall level of payments under 
164.30  this section.  The commissioner may make adjustments under this 
164.31  subdivision only after consultation with the counties and 
164.32  hospitals identified in subdivisions 2 and 3, and, if 
164.33  subdivision 5 receives federal approval, with the hospital and 
164.34  educational institution identified in subdivision 5. 
164.35     (b) The ratio of medical assistance payments specified in 
164.36  subdivision 3 to the intergovernmental transfers specified in 
165.1   subdivision 2 shall not be reduced except as provided under 
165.2   paragraph (a).  
165.3      (c) The increases in intergovernmental transfers and 
165.4   payments that result from section 62J.692, subdivision 8, 
165.5   paragraph (b), shall be allocated for ........ 
165.6      Sec. 8.  Minnesota Statutes 2002, section 256L.06, 
165.7   subdivision 3, is amended to read: 
165.8      Subd. 3.  [COMMISSIONER'S DUTIES AND PAYMENT.] (a) Premiums 
165.9   are dedicated to the commissioner for MinnesotaCare. 
165.10     (b) The commissioner shall develop and implement procedures 
165.11  to:  (1) require enrollees to report changes in income; (2) 
165.12  adjust sliding scale premium payments, based upon changes in 
165.13  enrollee income; and (3) disenroll enrollees from MinnesotaCare 
165.14  for failure to pay required premiums; and (4) collect the 
165.15  premiums from employers choosing to participate in the 
165.16  employer-subsidized coverage exemption as described in section 
165.17  256L.15, subdivision 4.  Failure to pay includes payment with a 
165.18  dishonored check, a returned automatic bank withdrawal, or a 
165.19  refused credit card or debit card payment.  The commissioner may 
165.20  demand a guaranteed form of payment, including a cashier's check 
165.21  or a money order, as the only means to replace a dishonored, 
165.22  returned, or refused payment. 
165.23     (c) Premiums are calculated on a calendar month basis and 
165.24  may be paid on a monthly, quarterly, or annual basis, with the 
165.25  first payment due upon notice from the commissioner of the 
165.26  premium amount required.  The commissioner shall inform 
165.27  applicants and enrollees of these premium payment options. 
165.28  Premium payment is required before enrollment is complete and to 
165.29  maintain eligibility in MinnesotaCare.  Premium payments 
165.30  received before noon are credited the same day.  Premium 
165.31  payments received after noon are credited on the next working 
165.32  day.  
165.33     (d) Nonpayment of the premium will result in disenrollment 
165.34  from the plan effective for the calendar month for which the 
165.35  premium was due.  Persons disenrolled for nonpayment or who 
165.36  voluntarily terminate coverage from the program may not reenroll 
166.1   until four calendar months have elapsed.  Persons disenrolled 
166.2   for nonpayment who pay all past due premiums as well as current 
166.3   premiums due, including premiums due for the period of 
166.4   disenrollment, within 20 days of disenrollment, shall be 
166.5   reenrolled retroactively to the first day of disenrollment.  
166.6   Persons disenrolled for nonpayment or who voluntarily terminate 
166.7   coverage from the program may not reenroll for four calendar 
166.8   months unless the person demonstrates good cause for 
166.9   nonpayment.  Good cause does not exist if a person chooses to 
166.10  pay other family expenses instead of the premium.  The 
166.11  commissioner shall define good cause in rule. 
166.12     Sec. 9.  Minnesota Statutes 2002, section 256L.07, 
166.13  subdivision 1, is amended to read: 
166.14     Subdivision 1.  [GENERAL REQUIREMENTS.] (a) Children 
166.15  enrolled in the original children's health plan as of September 
166.16  30, 1992, children who enrolled in the MinnesotaCare program 
166.17  after September 30, 1992, pursuant to Laws 1992, chapter 549, 
166.18  article 4, section 17, and children who have family gross 
166.19  incomes that are equal to or less than 175 150 percent of the 
166.20  federal poverty guidelines are eligible without meeting the 
166.21  requirements of subdivision 2, as long as they maintain 
166.22  continuous coverage in the MinnesotaCare program or medical 
166.23  assistance or they meet the requirements of subdivision 
166.24  5.  Children who apply for MinnesotaCare on or after the 
166.25  implementation date of the employer-subsidized health coverage 
166.26  program as described in Laws 1998, chapter 407, article 5, 
166.27  section 45, who have family gross incomes that are equal to or 
166.28  less than 175 percent of the federal poverty guidelines, must 
166.29  meet the requirements of subdivision 2 to be eligible for 
166.30  MinnesotaCare. 
166.31     (b) Families enrolled in MinnesotaCare under section 
166.32  256L.04, subdivision 1, whose income increases above 275 percent 
166.33  of the federal poverty guidelines, are no longer eligible for 
166.34  the program and shall be disenrolled by the commissioner.  
166.35  Individuals enrolled in MinnesotaCare under section 256L.04, 
166.36  subdivision 7, whose income increases above 175 percent of the 
167.1   federal poverty guidelines are no longer eligible for the 
167.2   program and shall be disenrolled by the commissioner.  For 
167.3   persons disenrolled under this subdivision, MinnesotaCare 
167.4   coverage terminates the last day of the calendar month following 
167.5   the month in which the commissioner determines that the income 
167.6   of a family or individual exceeds program income limits.  
167.7      (c) Notwithstanding paragraph (b), individuals and families 
167.8   may remain enrolled in MinnesotaCare if ten percent of their 
167.9   annual income is less than the annual premium for a policy with 
167.10  a $500 deductible available through the Minnesota comprehensive 
167.11  health association.  Individuals and families who are no longer 
167.12  eligible for MinnesotaCare under this subdivision shall be given 
167.13  an 18-month notice period from the date that ineligibility is 
167.14  determined before disenrollment. 
167.15     Sec. 10.  Minnesota Statutes 2002, section 256L.07, 
167.16  subdivision 3, is amended to read: 
167.17     Subd. 3.  [OTHER HEALTH COVERAGE.] (a) Families and 
167.18  individuals enrolled in the MinnesotaCare program must have no 
167.19  health coverage while enrolled or for at least four months prior 
167.20  to application and renewal.  Children enrolled in the original 
167.21  children's health plan and children in families with income 
167.22  equal to or less than 175 150 percent of the federal poverty 
167.23  guidelines, who have other health insurance, are eligible if the 
167.24  coverage: 
167.25     (1) lacks two or more of the following: 
167.26     (i) basic hospital insurance; 
167.27     (ii) medical-surgical insurance; 
167.28     (iii) prescription drug coverage; 
167.29     (iv) dental coverage; or 
167.30     (v) vision coverage; 
167.31     (2) requires a deductible of $100 or more per person per 
167.32  year; or 
167.33     (3) lacks coverage because the child has exceeded the 
167.34  maximum coverage for a particular diagnosis or the policy 
167.35  excludes a particular diagnosis. 
167.36     The commissioner may change this eligibility criterion for 
168.1   sliding scale premiums in order to remain within the limits of 
168.2   available appropriations.  The requirement of no health coverage 
168.3   does not apply to newborns. 
168.4      (b) Medical assistance, general assistance medical care, 
168.5   and the Civilian Health and Medical Program of the Uniformed 
168.6   Service, CHAMPUS, or other coverage provided under United States 
168.7   Code, title 10, subtitle A, part II, chapter 55, are not 
168.8   considered insurance or health coverage for purposes of the 
168.9   four-month requirement described in this subdivision. 
168.10     (c) For purposes of this subdivision, Medicare Part A or B 
168.11  coverage under title XVIII of the Social Security Act, United 
168.12  States Code, title 42, sections 1395c to 1395w-4, is considered 
168.13  health coverage.  An applicant or enrollee may not refuse 
168.14  Medicare coverage to establish eligibility for MinnesotaCare. 
168.15     (d) Applicants who were recipients of medical assistance or 
168.16  general assistance medical care within one month of application 
168.17  must meet the provisions of this subdivision and subdivision 2. 
168.18     Sec. 11.  Minnesota Statutes 2002, section 256L.07, is 
168.19  amended by adding a subdivision to read: 
168.20     Subd. 5.  [EMPLOYER-SUBSIDIZED COVERAGE 
168.21  EXEMPTION.] Children in families with family gross income equal 
168.22  to or less than 170 percent of the federal poverty guidelines 
168.23  who have access to employer-subsidized coverage as defined in 
168.24  subdivision 2 are eligible for MinnesotaCare without meeting the 
168.25  requirements of subdivision 2 if the following requirements are 
168.26  met:  
168.27     (1) all eligibility requirements except for the 
168.28  requirements of subdivision 2 are met by the child; 
168.29     (2) any premiums owed as determined under section 256L.15 
168.30  are paid in accordance with section 256L.06; and 
168.31     (3) the employer meets the requirements described in 
168.32  section 256L.15, subdivision 4. 
168.33     Sec. 12.  Minnesota Statutes 2002, section 256L.15, 
168.34  subdivision 3, is amended to read: 
168.35     Subd. 3.  [EXCEPTIONS TO SLIDING SCALE.] An annual premium 
168.36  of $48 is required for all children in families with income at 
169.1   or less than 175 150 percent of federal poverty guidelines. 
169.2      Sec. 13.  Minnesota Statutes 2002, section 256L.15, is 
169.3   amended by adding a subdivision to read: 
169.4      Subd. 4.  [EMPLOYER-SUBSIDIZED INSURANCE EXCEPTION.] Any 
169.5   employer of a parent of a child who may be eligible for 
169.6   MinnesotaCare under section 256L.07, subdivision 5, must choose 
169.7   to contribute 25 percent of the total cost of the coverage as 
169.8   calculated under subdivision 2 for the child to be eligible for 
169.9   MinnesotaCare in accordance with section 256L.07, subdivision 
169.10  5.  Any employer who chooses to participate must pay the premium 
169.11  owed to the commissioner in accordance with section 256L.06. 
169.12     Sec. 14.  Minnesota Statutes 2002, section 295.53, 
169.13  subdivision 1, is amended to read: 
169.14     Subdivision 1.  [EXEMPTIONS.] (a) The following payments 
169.15  are excluded from the gross revenues subject to the hospital, 
169.16  surgical center, or health care provider taxes under sections 
169.17  295.50 to 295.57: 
169.18     (1) payments received for services provided under the 
169.19  Medicare program, including payments received from the 
169.20  government, and organizations governed by sections 1833 and 1876 
169.21  of title XVIII of the federal Social Security Act, United States 
169.22  Code, title 42, section 1395, and enrollee deductibles, 
169.23  coinsurance, and co-payments, whether paid by the Medicare 
169.24  enrollee or by a Medicare supplemental coverage as defined in 
169.25  section 62A.011, subdivision 3, clause (10).  Payments for 
169.26  services not covered by Medicare are taxable; 
169.27     (2) medical assistance payments including payments received 
169.28  directly from the government or from a prepaid plan; 
169.29     (3) payments received for home health care services; 
169.30     (4) (3) payments received from hospitals or surgical 
169.31  centers for goods and services on which liability for tax is 
169.32  imposed under section 295.52 or the source of funds for the 
169.33  payment is exempt under clause (1), (2), (7), (8), 
169.34  (10) (7), (13) (10), or (20) (17); 
169.35     (5) (4) payments received from health care providers for 
169.36  goods and services on which liability for tax is imposed under 
170.1   this chapter or the source of funds for the payment is exempt 
170.2   under clause (1), (2), (7), (8), (10) (7), (13) (10), 
170.3   or (20) (17); 
170.4      (6) (5) amounts paid for legend drugs, other than 
170.5   nutritional products, to a wholesale drug distributor who is 
170.6   subject to tax under section 295.52, subdivision 3, reduced by 
170.7   reimbursements received for legend drugs otherwise exempt under 
170.8   this chapter; 
170.9      (7) payments received under the general assistance medical 
170.10  care program including payments received directly from the 
170.11  government or from a prepaid plan; 
170.12     (8) payments received for providing services under the 
170.13  MinnesotaCare program including payments received directly from 
170.14  the government or from a prepaid plan and enrollee deductibles, 
170.15  coinsurance, and copayments.  For purposes of this clause, 
170.16  coinsurance means the portion of payment that the enrollee is 
170.17  required to pay for the covered service; 
170.18     (9) (6) payments received by a health care provider or the 
170.19  wholly owned subsidiary of a health care provider for care 
170.20  provided outside Minnesota; 
170.21     (10) (7) payments received from the chemical dependency 
170.22  fund under chapter 254B; 
170.23     (11) (8) payments received in the nature of charitable 
170.24  donations that are not designated for providing patient services 
170.25  to a specific individual or group; 
170.26     (12) (9) payments received for providing patient services 
170.27  incurred through a formal program of health care research 
170.28  conducted in conformity with federal regulations governing 
170.29  research on human subjects.  Payments received from patients or 
170.30  from other persons paying on behalf of the patients are subject 
170.31  to tax; 
170.32     (13) (10) payments received from any governmental agency 
170.33  for services benefiting the public, not including payments made 
170.34  by the government in its capacity as an employer or insurer; 
170.35     (14) (11) payments received for services provided by 
170.36  community residential mental health facilities licensed under 
171.1   Minnesota Rules, parts 9520.0500 to 9520.0690, community support 
171.2   programs and family community support programs approved under 
171.3   Minnesota Rules, parts 9535.1700 to 9535.1760, and community 
171.4   mental health centers as defined in section 245.62, subdivision 
171.5   2; 
171.6      (15) (12) government payments received by a regional 
171.7   treatment center; 
171.8      (16) (13) payments received for hospice care services; 
171.9      (17) (14) payments received by a health care provider for 
171.10  hearing aids and related equipment or prescription eyewear 
171.11  delivered outside of Minnesota; 
171.12     (18) (15) payments received by an educational institution 
171.13  from student tuition, student activity fees, health care service 
171.14  fees, government appropriations, donations, or grants.  Fee for 
171.15  service payments and payments for extended coverage are taxable; 
171.16     (19) (16) payments received for services provided by:  
171.17  assisted living programs and congregate housing programs; and 
171.18     (20) (17) payments received under the federal Employees 
171.19  Health Benefits Act, United States Code, title 5, section 
171.20  8909(f), as amended by the Omnibus Reconciliation Act of 1990. 
171.21     (b) Payments received by wholesale drug distributors for 
171.22  legend drugs sold directly to veterinarians or veterinary bulk 
171.23  purchasing organizations are excluded from the gross revenues 
171.24  subject to the wholesale drug distributor tax under sections 
171.25  295.50 to 295.59. 
171.26     Sec. 15.  Minnesota Statutes 2002, section 297I.15, 
171.27  subdivision 1, is amended to read: 
171.28     Subdivision 1.  [GOVERNMENT PAYMENTS.] Premiums under 
171.29  medical assistance, general assistance medical care, the 
171.30  MinnesotaCare program, and the Minnesota comprehensive health 
171.31  insurance plan and all payments, revenues, and reimbursements 
171.32  received from the federal government for Medicare-related 
171.33  coverage as defined in section 62A.31, subdivision 3, are not 
171.34  subject to tax under this chapter. 
171.35     Sec. 16.  Minnesota Statutes 2002, section 297I.15, 
171.36  subdivision 4, is amended to read: 
172.1      Subd. 4.  [PREMIUMS PAID TO HEALTH CARRIERS BY STATE.] A 
172.2   health carrier as defined in section 62A.011 is exempt from the 
172.3   taxes imposed under this chapter on premiums paid to it by the 
172.4   state.  Premiums paid by the state under medical assistance, 
172.5   general assistance medical care, and the MinnesotaCare program 
172.6   are not exempt under this subdivision. 
172.7      Sec. 17.  [LIMITING COVERAGE OF HEALTH CARE SERVICES FOR 
172.8   MEDICAL ASSISTANCE, GENERAL ASSISTANCE MEDICAL CARE, AND 
172.9   MINNESOTACARE PROGRAMS.] 
172.10     Subdivision 1.  [GENERAL ASSISTANCE MEDICAL CARE AND 
172.11  MINNESOTACARE.] (a) Effective July 1, 2003, the 
172.12  diagnosis/treatment pairings described in subdivision 3 shall 
172.13  not be covered under the general assistance medical care program 
172.14  and under the MinnesotaCare program for persons eligible under 
172.15  Minnesota Statutes, section 256L.04, subdivision 7.  
172.16     (b) This subdivision expires July 1, 2005.  
172.17     Subd. 2.  [PRIOR AUTHORIZATION OF SERVICES FOR MEDICAL 
172.18  ASSISTANCE.] (a) Effective July 1, 2003, prior authorization 
172.19  shall be required for the diagnosis/treatment pairings described 
172.20  in subdivision 3 for reimbursement under Minnesota Statutes, 
172.21  chapter 256B, and under the MinnesotaCare program for persons 
172.22  eligible under Minnesota Statutes, section 256L.04, subdivision 
172.23  1.  
172.24     (b) This subdivision expires July 1, 2005.  
172.25     Subd. 3.  [LIST OF DIAGNOSIS/TREATMENT PAIRINGS.] (a)(1) 
172.26  Diagnosis:  TRIGEMINAL AND OTHER NERVE DISORDERS 
172.27  Treatment:  MEDICAL AND SURGICAL TREATMENT 
172.28  ICD-9:  350,352 
172.29     (2) Diagnosis:  DISRUPTIONS OF THE LIGAMENTS AND TENDONS OF 
172.30  THE ARMS AND LEGS, EXCLUDING THE KNEE, GRADE II AND III 
172.31  Treatment:  REPAIR 
172.32  ICD-9:  726.5, 727.59, 727.62-727.65, 727.68-727.69, 728.83, 
172.33  728.89, 840.0-840.3, 840.5-840.9, 841-843, 845.0 
172.34     (3) Diagnosis:  DISORDERS OF SHOULDER 
172.35  Treatment:  REPAIR/RECONSTRUCTION 
172.36  ICD-9:  718.01, 718.11, 718.21, 718.31, 718.41, 718.51, 718.81, 
173.1   726.0, 726.10-726.11, 726.19, 726.2, 727.61, 840.4, 840.7 
173.2      (4) Diagnosis:  INTERNAL DERANGEMENT OF KNEE AND 
173.3   LIGAMENTOUS DISRUPTIONS OF THE KNEE, GRADE II AND III 
173.4   Treatment:  REPAIR, MEDICAL THERAPY 
173.5   ICD-9:  717.0-717.4, 717.6-717.8, 718.26, 718.36, 718.46, 
173.6   718.56, 727.66, 836.0-836.2, 844 
173.7      (5) Diagnosis:  MALUNION AND NONUNION OF FRACTURE 
173.8   Treatment:  SURGICAL TREATMENT 
173.9   ICD-9:  733.8 
173.10     (6) Diagnosis:  FOREIGN BODY IN UTERUS, VULVA AND VAGINA 
173.11  Treatment:  MEDICAL AND SURGICAL TREATMENT 
173.12  ICD-9:  939.1-939.2 
173.13     (7) Diagnosis: UTERINE PROLAPSE; CYSTOCELE 
173.14  Treatment:  SURGICAL REPAIR 
173.15  ICD-9:  618 
173.16     (8) Diagnosis:  OSTEOARTHRITIS AND ALLIED DISORDERS 
173.17  Treatment:  MEDICAL THERAPY, INJECTIONS 
173.18  ICD-9:  713.5, 715, 716.0-716.1, 716.5-716.6 
173.19     (9) Diagnosis:  METABOLIC BONE DISEASE 
173.20  Treatment:  MEDICAL THERAPY 
173.21  ICD-9:  731.0, 733.0 
173.22     (10) Diagnosis:  SYMPTOMATIC IMPACTED TEETH 
173.23  Treatment:  SURGERY 
173.24  ICD-9:  520.6, 524.3-524.4 
173.25     (11) Diagnosis:  UNSPECIFIED DISEASE OF HARD TISSUES OF 
173.26  TEETH (AVULSION) 
173.27  Treatment:  INTERDENTAL WIRING 
173.28  ICD-9:  525.9 
173.29     (12) Diagnosis:  ABSCESSES AND CYSTS OF BARTHOLIN'S GLAND 
173.30  AND VULVA 
173.31  Treatment:  INCISION AND DRAINAGE, MEDICAL THERAPY 
173.32  ICD-9:  616.2-616.9 
173.33     (13) Diagnosis:  CERVICITIS, ENDOCERVICITIS, HEMATOMA OF 
173.34  VULVA, AND NONINFLAMMATORY DISORDERS OF THE VAGINA 
173.35  Treatment:  MEDICAL AND SURGICAL TREATMENT 
173.36  ICD-9:  616.0, 623.6, 623.8-623.9, 624.5 
174.1      (14) Diagnosis:  DENTAL CONDITIONS (e.g,. TOOTH LOSS) 
174.2   Treatment:  SPACE MAINTENANCE AND PERIODONTAL MAINTENANCE 
174.3   ICD-9:  V72.2 
174.4      (15) Diagnosis:  URINARY INCONTINENCE 
174.5   Treatment:  MEDICAL AND SURGICAL TREATMENT 
174.6   ICD-9:  599.81, 625.6, 788.31-788.33 
174.7      (16) Diagnosis:  HYPOSPADIAS AND EPISPADIAS 
174.8   Treatment:  REPAIR 
174.9   ICD-9:  752.6 
174.10     (17) Diagnosis:  RESIDUAL FOREIGN BODY IN SOFT TISSUE 
174.11  Treatment:  REMOVAL 
174.12  ICD-9:  374.86, 729.6, 883.1-883.2 
174.13     (18) Diagnosis:  BRANCHIAL CLEFT CYST 
174.14  Treatment:  EXCISION, MEDICAL THERAPY 
174.15  ICD-9:  744.41-744.46, 744.49, 759.2 
174.16     (19) Diagnosis:  EXFOLIATION OF TEETH DUE TO SYSTEMIC 
174.17  CAUSES; SPECIFIC DISORDERS OF THE TEETH AND SUPPORTING 
174.18  STRUCTURES 
174.19  Treatment:  EXCISION OF DENTOALVEOLAR STRUCTURE 
174.20  ICD-9:  525.0, 525.8, 525.11 
174.21     (20) Diagnosis:  PTOSIS (ACQUIRED) WITH VISION IMPAIRMENT 
174.22  Treatment:  PTOSIS REPAIR 
174.23  ICD-9:  374.2-374.3, 374.41, 374.43, 374.46 
174.24     (21) Diagnosis:  SIMPLE AND SOCIAL PHOBIAS 
174.25  Treatment:  MEDICAL/PSYCHOTHERAPY 
174.26  ICD-9:  300.23, 300.29 
174.27     (22) Diagnosis:  RETAINED DENTAL ROOT 
174.28  Treatment:  EXCISION OF DENTOALVEOLAR STRUCTURE 
174.29  ICD-9:  525.3 
174.30     (23) Diagnosis:  PERIPHERAL NERVE ENTRAPMENT 
174.31  Treatment:  MEDICAL AND SURGICAL TREATMENT 
174.32  ICD-9:  354.0, 354.2, 355.5, 723.3, 728.6 
174.33     (24) Diagnosis:  INCONTINENCE OF FECES 
174.34  Treatment:  MEDICAL AND SURGICAL TREATMENT 
174.35  ICD-9:  787.6 
174.36     (25) Diagnosis:  RECTAL PROLAPSE 
175.1   Treatment:  PARTIAL COLECTOMY 
175.2   ICD-9:  569.1-569.2 
175.3      (26) Diagnosis:  BENIGN NEOPLASM OF KIDNEY AND OTHER 
175.4   URINARY ORGANS 
175.5   Treatment:  MEDICAL AND SURGICAL TREATMENT 
175.6   ICD-9:  223 
175.7      (27) Diagnosis:  URETHRAL FISTULA 
175.8   Treatment:  EXCISION, MEDICAL THERAPY 
175.9   ICD-9:  599.1-599.2, 599.4 
175.10     (28) Diagnosis:  THROMBOSED AND COMPLICATED HEMORRHOIDS 
175.11  Treatment:  HEMORRHOIDECTOMY, INCISION 
175.12  ICD-9:  455.1-455.2, 455.4-455.5, 455.7-455.8 
175.13     (29) Diagnosis:  VAGINITIS, TRICHOMONIASIS 
175.14  Treatment:  MEDICAL THERAPY 
175.15  ICD-9:  112.1, 131, 616.1, 623.5 
175.16     (30) Diagnosis:  BALANOPOSTHITIS AND OTHER DISORDERS OF 
175.17  PENIS 
175.18  Treatment:  MEDICAL AND SURGICAL TREATMENT 
175.19  ICD-9:  607.1, 607.81-607.83, 607.89 
175.20     (31) Diagnosis:  CHRONIC ANAL FISSURE; ANAL FISTULA 
175.21  Treatment:  SPHINCTEROTOMY, FISSURECTOMY, FISTULECTOMY, MEDICAL 
175.22  THERAPY 
175.23  ICD-9:  565.0-565.1 
175.24     (32) Diagnosis:  CHRONIC OTITIS MEDIA 
175.25  Treatment:  PE TUBES/ADENOIDECTOMY/TYMPANOPLASTY, MEDICAL 
175.26  THERAPY 
175.27  ICD-9:  380.5, 381.1-381.8, 382.1-382.3, 382.9, 383.1-383.2, 
175.28  383.30-383.31, 383.9, 384.2, 384.8-384.9 
175.29     (33) Diagnosis:  ACUTE CONJUNCTIVITIS 
175.30  Treatment:  MEDICAL THERAPY 
175.31  ICD-9:  077, 372.00 
175.32     (34) Diagnosis:  CERUMEN IMPACTION, FOREIGN BODY IN EAR & 
175.33  NOSE 
175.34  Treatment:  REMOVAL OF FOREIGN BODY 
175.35  ICD-9:  380.4, 931-932 
175.36     (35) Diagnosis:  VERTIGINOUS SYNDROMES AND OTHER DISORDERS 
176.1   OF VESTIBULAR SYSTEM 
176.2   Treatment:  MEDICAL AND SURGICAL TREATMENT 
176.3   ICD-9:  379.54, 386.1-386.2, 386.4-386.9, 438.6-438.7, 
176.4   438.83-438.85 
176.5      (36) Diagnosis:  UNSPECIFIED URINARY OBSTRUCTION AND BENIGN 
176.6   PROSTATIC HYPERPLASIA WITHOUT OBSTRUCTION 
176.7   Treatment:  MEDICAL THERAPY 
176.8   ICD-9:  599.6, 600 
176.9      (37) Diagnosis:  PHIMOSIS 
176.10  Treatment:  SURGICAL TREATMENT 
176.11  ICD-9:  605 
176.12     (38) Diagnosis:  CONTACT DERMATITIS, ATOPIC DERMATITIS AND 
176.13  OTHER ECZEMA 
176.14  Treatment:  MEDICAL THERAPY 
176.15  ICD-9:  691.8, 692.0-692.6, 692.70-692.74, 692.79, 692.8-692.9 
176.16     (39) Diagnosis:  PSORIASIS AND SIMILAR DISORDERS 
176.17  Treatment:  MEDICAL THERAPY 
176.18  ICD-9:  696.1-696.2, 696.8 
176.19     (40) Diagnosis:  CYSTIC ACNE 
176.20  Treatment:  MEDICAL AND SURGICAL TREATMENT 
176.21  ICD-9:  705.83, 706.0-706.1 
176.22     (41) Diagnosis:  CLOSED FRACTURE OF GREAT TOE 
176.23  Treatment:  MEDICAL AND SURGICAL TREATMENT 
176.24  ICD-9:  826.0 
176.25     (42) Diagnosis:  SYMPTOMATIC URTICARIA 
176.26  Treatment:  MEDICAL THERAPY 
176.27  ICD-9:  708.0-708.1, 708.5, 708.8, 995.7 
176.28     (43) Diagnosis:  PERIPHERAL NERVE DISORDERS 
176.29  Treatment:  SURGICAL TREATMENT 
176.30  ICD-9:  337.2, 353, 354.1, 354.3-354.9, 355.0, 355.3, 355.4, 
176.31  355.7-355.8, 723.2 
176.32     (44) Diagnosis:  DYSFUNCTION OF NASOLACRIMAL SYSTEM; 
176.33  LACRIMAL SYSTEM LACERATION 
176.34  Treatment:  MEDICAL AND SURGICAL TREATMENT; CLOSURE 
176.35  ICD-9:  370.33, 375, 870.2 
176.36     (45) Diagnosis:  NASAL POLYPS, OTHER DISORDERS OF NASAL 
177.1   CAVITY AND SINUSES 
177.2   Treatment:  MEDICAL AND SURGICAL TREATMENT 
177.3   ICD-9:  471, 478.1, 993.1 
177.4      (46) Diagnosis:  SIALOLITHIASIS, MUCOCELE, DISTURBANCE OF 
177.5   SALIVARY SECRETION, OTHER AND UNSPECIFIED DISEASES OF SALIVARY 
177.6   GLANDS 
177.7   Treatment:  MEDICAL AND SURGICAL TREATMENT 
177.8   ICD-9:  527.5-527.9 
177.9      (47) Diagnosis:  DENTAL CONDITIONS (e.g., BROKEN APPLIANCES)
177.10  Treatment:  PERIODONTICS AND COMPLEX PROSTHETICS 
177.11  ICD-9:  522.6, 522.8, V72.2 
177.12     (48) Diagnosis:  IMPULSE DISORDERS 
177.13  Treatment:  MEDICAL/PSYCHOTHERAPY 
177.14  ICD-9:  312.31-312.39 
177.15     (49) Diagnosis:  BENIGN NEOPLASM BONE AND ARTICULAR 
177.16  CARTILAGE, INCLUDING OSTEOID OSTEOMAS; BENIGN NEOPLASM OF 
177.17  CONNECTIVE AND OTHER SOFT TISSUE 
177.18  Treatment:  MEDICAL AND SURGICAL TREATMENT 
177.19  ICD-9:  213, 215, 526.0-526.1, 526.81, 719.2, 733.2 
177.20     (50) Diagnosis: SEXUAL DYSFUNCTION 
177.21  Treatment:  MEDICAL AND SURGICAL TREATMENT, PSYCHOTHERAPY 
177.22  ICD-9: 302.7, 607.84 
177.23     (51) Diagnosis:  STOMATITIS AND DISEASES OF LIPS 
177.24  Treatment:  INCISION AND DRAINAGE/MEDICAL THERAPY 
177.25  ICD-9:  528.0, 528.5, 528.9, 529.0 
177.26     (52) Diagnosis:  BELL'S PALSY, EXPOSURE 
177.27  KERATOCONJUNCTIVITIS 
177.28  Treatment:  TARSORRHAPHY 
177.29  ICD-9:  351.0-351.1, 351.8-351.9, 370.34, 374.44, 374.45, 374.89 
177.30     (53) Diagnosis:  HORDEOLUM AND OTHER DEEP INFLAMMATION OF 
177.31  EYELID; CHALAZION 
177.32  Treatment:  INCISION AND DRAINAGE/MEDICAL THERAPY 
177.33  ICD-9:  373.11-373.12, 373.2, 374.50, 374.54, 374.56, 374.84 
177.34     (54) Diagnosis:  ECTROPION, TRICHIASIS OF EYELID, BENIGN 
177.35  NEOPLASM OF EYELID 
177.36  Treatment:  ECTROPION REPAIR 
178.1   ICD-9:  216.1, 224, 372.63, 374.1, 374.85 
178.2      (55) Diagnosis:  CHONDROMALACIA 
178.3   Treatment:  MEDICAL THERAPY 
178.4   ICD-9:  733.92 
178.5      (56) Diagnosis:  DYSMENORRHEA 
178.6   Treatment:  MEDICAL AND SURGICAL TREATMENT 
178.7   ICD-9:  625.3 
178.8      (57) Diagnosis:  SPASTIC DIPLEGIA 
178.9   Treatment:  RHIZOTOMY 
178.10  ICD-9:  343.0 
178.11     (58) Diagnosis:  ATROPHY OF EDENTULOUS ALVEOLAR RIDGE 
178.12  Treatment:  VESTIBULOPLASTY, GRAFTS, IMPLANTS 
178.13  ICD-9:  525.2 
178.14     (59) Diagnosis:  DEFORMITIES OF UPPER BODY AND ALL LIMBS 
178.15  Treatment:  REPAIR/REVISION/RECONSTRUCTION/RELOCATION/MEDICAL 
178.16  THERAPY 
178.17  ICD-9:  718.02-718.05, 718.13-718.15, 718.42-718.46, 
178.18  718.52-718.56, 718.65, 718.82-718.86, 728.79, 732.3, 732.6, 
178.19  732.8-732.9, 733.90-733.91, 736.00-736.04, 736.07, 736.09, 
178.20  736.1, 736.20, 736.29, 736.30, 736.39, 736.4, 736.6, 736.76, 
178.21  736.79, 736.89, 736.9, 738.6, 738.8, 754.42-754.44, 754.61, 
178.22  754.8, 755.50-755.53, 755.56-755.57, 755.59, 755.60, 
178.23  755.63-755.64, 755.69, 755.8, 756.82-756.83, 756.89 
178.24     (60) Diagnosis:  DEFORMITIES OF FOOT 
178.25  Treatment:  FASCIOTOMY/INCISION/REPAIR/ARTHRODESIS 
178.26  ICD-9:  718.07, 718.47, 718.57, 718.87, 727.1, 732.5, 
178.27  735.0-735.2, 735.3-735.9, 736.70-736.72, 754.50, 754.59, 754.60, 
178.28  754.69, 754.70, 754.79, 755.65-755.67 
178.29     (61) Diagnosis:  PERITONEAL ADHESION 
178.30  Treatment:  SURGICAL TREATMENT 
178.31  ICD-9:  568.0, 568.82-568.89, 568.9 
178.32     (62) Diagnosis:  PELVIC PAIN SYNDROME, DYSPAREUNIA 
178.33  Treatment:  MEDICAL AND SURGICAL TREATMENT 
178.34  ICD-9:  300.81, 614.1, 614.6, 620.6, 625.0-625.2, 625.5, 
178.35  625.8-625.9 
178.36     (63) Diagnosis:  TENSION HEADACHES 
179.1   Treatment:  MEDICAL THERAPY 
179.2   ICD-9:  307.81, 784.0 
179.3      (64) Diagnosis:  CHRONIC BRONCHITIS 
179.4   Treatment:  MEDICAL THERAPY 
179.5   ICD-9:  490, 491.0, 491.8-491.9 
179.6      (65) Diagnosis:  DISORDERS OF FUNCTION OF STOMACH AND OTHER 
179.7   FUNCTIONAL DIGESTIVE DISORDERS 
179.8   Treatment:  MEDICAL THERAPY 
179.9   ICD-9:  536.0-536.3, 536.8-536.9, 537.1-537.2, 537.5-537.6, 
179.10  537.89, 537.9, 564.0-564.7, 564.9 
179.11     (66) Diagnosis:  TMJ DISORDER 
179.12  Treatment:  TMJ SPLINTS 
179.13  ICD-9:  524.6, 848.1 
179.14     (67) Diagnosis:  URETHRITIS, NONSEXUALLY TRANSMITTED 
179.15  Treatment:  MEDICAL THERAPY 
179.16  ICD-9:  597.8, 599.3-599.5, 599.9 
179.17     (68) Diagnosis:  LESION OF PLANTAR NERVE; PLANTAR FASCIAL 
179.18  FIBROMATOSIS 
179.19  Treatment:  MEDICAL THERAPY, EXCISION 
179.20  ICD-9:  355.6, 728.71 
179.21     (69) Diagnosis:  GRANULOMA OF MUSCLE, GRANULOMA OF SKIN AND 
179.22  SUBCUTANEOUS TISSUE 
179.23  Treatment:  REMOVAL OF GRANULOMA 
179.24  ICD-9:  709.4, 728.82 
179.25     (70) Diagnosis:  DERMATOPHYTOSIS OF NAIL, GROIN, AND FOOT 
179.26  AND OTHER DERMATOMYCOSIS 
179.27  Treatment:  MEDICAL AND SURGICAL TREATMENT 
179.28  ICD-9:  110.0-110.6, 110.8-110.9, 111 
179.29     (71) Diagnosis:  INTERNAL DERANGEMENT OF JOINT OTHER THAN 
179.30  KNEE 
179.31  Treatment:  REPAIR, MEDICAL THERAPY 
179.32  ICD-9:  718.09, 718.19, 718.29, 718.48, 718.59, 718.88-718.89, 
179.33  719.81-719.85, 719.87-719.89 
179.34     (72) Diagnosis:  STENOSIS OF NASOLACRIMAL DUCT (ACQUIRED) 
179.35  Treatment:  DACRYOCYSTORHINOSTOMY 
179.36  ICD-9:  375.02, 375.30, 375.32, 375.4, 375.56-375.57, 375.61, 
180.1   771.6 
180.2      (73) Diagnosis:  PERIPHERAL NERVE DISORDERS 
180.3   Treatment:  SURGICAL TREATMENT 
180.4   ICD-9:  337.2, 353, 354.1, 354.3-354.9, 355.0, 355.3, 355.4, 
180.5   355.7-355.8, 723.2 
180.6      (74) Diagnosis:  CAVUS DEFORMITY OF FOOT; FLAT FOOT; 
180.7   POLYDACTYLY AND SYNDACTYLY OF TOES 
180.8   Treatment:  MEDICAL THERAPY, ORTHOTIC 
180.9   ICD-9:  734, 736.73, 755.00, 755.02, 755.10, 755.13-755.14 
180.10     (75) Diagnosis:  PERIPHERAL ENTHESOPATHIES 
180.11  Treatment:  SURGICAL TREATMENT 
180.12  ICD-9:  726.12, 726.3-726.9, 728.81 
180.13     (76) Diagnosis:  PERIPHERAL ENTHESOPATHIES 
180.14  Treatment:  MEDICAL THERAPY 
180.15  ICD-9:  726.12, 726.3-726.4, 726.6-726.9, 728.81 
180.16     (77) Diagnosis:  DISORDERS OF SOFT TISSUE 
180.17  Treatment:  MEDICAL THERAPY 
180.18  ICD-9:  729.0-729.2, 729.31-729.39, 729.4-729.9 
180.19     (78) Diagnosis:  ENOPHTHALMOS 
180.20  Treatment:  ORBITAL IMPLANT 
180.21  ICD-9:  372.64, 376.5 
180.22     (79) Diagnosis:  MACROMASTIA 
180.23  Treatment:  SUBCUTANEOUS TOTAL MASTECTOMY, BREAST REDUCTION 
180.24  ICD-9:  611.1 
180.25     (80) Diagnosis:  GALACTORRHEA, MASTODYNIA, ATROPHY, BENIGN 
180.26  NEOPLASMS AND UNSPECIFIED DISORDERS OF THE BREAST 
180.27  Treatment:  MEDICAL AND SURGICAL TREATMENT 
180.28  ICD-9: 217, 611.3, 611.4, 611.6, 611.71, 611.9, 757.6 
180.29     (81) Diagnosis:  ACUTE AND CHRONIC DISORDERS OF SPINE 
180.30  WITHOUT NEUROLOGIC IMPAIRMENT 
180.31  Treatment:  MEDICAL AND SURGICAL TREATMENT 
180.32  ICD-9:  721.0, 721.2-721.3, 721.7-721.8, 721.90, 722.0-722.6, 
180.33  722.8-722.9, 723.1, 723.5-723.9, 724.1-724.2, 724.5-724.9, 739, 
180.34  839.2, 847 
180.35     (82) Diagnosis:  CYSTS OF ORAL SOFT TISSUES 
180.36  Treatment:  INCISION AND DRAINAGE 
181.1   ICD-9:  527.1, 528.4, 528.8 
181.2      (83) Diagnosis:  FEMALE INFERTILITY, MALE INFERTILITY 
181.3   Treatment:  ARTIFICIAL INSEMINATION, MEDICAL THERAPY 
181.4   ICD-9:  606, 628.4-628.9, 629.9, V26.1-V26.2, V26.8-V26.9 
181.5      (84) Diagnosis:  INFERTILITY DUE TO ANNOVULATION 
181.6   Treatment:  MEDICAL THERAPY 
181.7   ICD-9:  626.0-626.1, 628.0, 628.1 
181.8      (85) Diagnosis:  POSTCONCUSSION SYNDROME 
181.9   Treatment:  MEDICAL THERAPY 
181.10  ICD-9:  310.2 
181.11     (86) Diagnosis:  SIMPLE AND UNSPECIFIED GOITER, NONTOXIC 
181.12  NODULAR GOITER 
181.13  Treatment:  MEDICAL THERAPY, THYROIDECTOMY 
181.14  ICD-9:  240-241 
181.15     (87) Diagnosis:  CONDUCTIVE HEARING LOSS 
181.16  Treatment:  AUDIANT BONE CONDUCTORS 
181.17  ICD-9:  389.0, 389.2 
181.18     (88) Diagnosis:  CANCER OF LIVER AND INTRAHEPATIC BILE 
181.19  DUCTS 
181.20  Treatment:  LIVER TRANSPLANT 
181.21  ICD-9:  155.0-155.1, 996.82 
181.22     (89) Diagnosis:  HYPOTENSION 
181.23  Treatment:  MEDICAL THERAPY 
181.24  ICD-9:  458 
181.25     (90) Diagnosis:  VIRAL HEPATITIS, EXCLUDING CHRONIC VIRAL 
181.26  HEPATITIS B AND VIRAL HEPATITIS C WITHOUT HEPATIC COMA 
181.27  Treatment:  MEDICAL THERAPY 
181.28  ICD-9:  070.0-070.2, 070.30-070.31, 070.33, 070.4, 
181.29  070.52-070.53, 070.59, 070.6-070.9 
181.30     (91) Diagnosis:  BENIGN NEOPLASMS OF SKIN AND OTHER SOFT 
181.31  TISSUES 
181.32  Treatment:  MEDICAL THERAPY 
181.33  ICD-9:  210, 214, 216, 221, 222.1, 222.4, 228.00-228.01, 228.1, 
181.34  229, 686.1, 686.9 
181.35     (92) Diagnosis:  REDUNDANT PREPUCE 
181.36  Treatment:  ELECTIVE CIRCUMCISION 
182.1   ICD-9:  605, V50.2 
182.2      (93) Diagnosis:  BENIGN NEOPLASMS OF DIGESTIVE SYSTEM 
182.3   Treatment:  SURGICAL TREATMENT 
182.4   ICD-9:  211.0-211.2, 211.5-211.6, 211.8-211.9 
182.5      (94) Diagnosis:  OTHER NONINFECTIOUS GASTROENTERITIS AND 
182.6   COLITIS 
182.7   Treatment:  MEDICAL THERAPY 
182.8   ICD-9:  558 
182.9      (95) Diagnosis:  FACTITIOUS DISORDERS 
182.10  Treatment:  CONSULTATION 
182.11  ICD-9:  300.10, 300.16, 300.19, 301.51 
182.12     (96) Diagnosis:  HYPOCHONDRIASIS; SOMATOFORM DISORDER, NOS 
182.13  AND UNDIFFERENTIATED 
182.14  Treatment:  CONSULTATION 
182.15  ICD-9:  300.7, 300.9, 306 
182.16     (97) Diagnosis:  CONVERSION DISORDER, ADULT 
182.17  Treatment:  MEDICAL/PSYCHOTHERAPY 
182.18  ICD-9:  300.11 
182.19     (97) Diagnosis:  SPINAL DEFORMITY, NOT CLINICALLY 
182.20  SIGNIFICANT 
182.21  Treatment:  ARTHRODESIS/REPAIR/RECONSTRUCTION, MEDICAL THERAPY 
182.22  ICD-9:  721.5-721.6, 723.0, 724.0, 731.0, 737.0-737.3, 
182.23  737.8-737.9, 738.4-738.5, 754.1-754.2, 756.10-756.12, 
182.24  756.13-756.17, 756.19, 756.3 
182.25     (98) Diagnosis:  ASYMPTOMATIC URTICARIA 
182.26  Treatment:  MEDICAL THERAPY 
182.27  ICD-9:  708.2-708.4, 708.9 
182.28     (99) Diagnosis:  CIRCUMSCRIBED SCLERODERMA; SENILE PURPURA 
182.29  Treatment:  MEDICAL THERAPY 
182.30  ICD-9:  287.2, 287.8-287.9, 701.0 
182.31     (100) Diagnosis:  DERMATITIS DUE TO SUBSTANCES TAKEN 
182.32  INTERNALLY 
182.33  Treatment:  MEDICAL THERAPY 
182.34  ICD-9:  693 
182.35     (101) Diagnosis:  ALLERGIC RHINITIS AND CONJUNCTIVITIS, 
182.36  CHRONIC RHINITIS 
183.1   Treatment:  MEDICAL THERAPY 
183.2   ICD-9:  372.01-372.05, 372.14, 372.54, 372.56, 472, 477, 955.3, 
183.3   V07.1 
183.4      (102) Diagnosis:  PLEURISY 
183.5   Treatment:  MEDICAL THERAPY 
183.6   ICD-9:  511.0, 511.9 
183.7      (103) Diagnosis:  CONJUNCTIVAL CYST 
183.8   Treatment:  EXCISION OF CONJUNCTIVAL CYST 
183.9   ICD-9:  372.61-372.62, 372.71-372.72, 372.74-372.75 
183.10     (104) Diagnosis:  HEMATOMA OF AURICLE OR PINNA AND HEMATOMA 
183.11  OF EXTERNAL EAR 
183.12  Treatment:  DRAINAGE 
183.13  ICD-9:  380.3, 380.8, 738.7 
183.14     (105) Diagnosis:  ACUTE NONSUPPURATIVE LABYRINTHITIS 
183.15  Treatment:  MEDICAL THERAPY 
183.16  ICD-9:  386.30-386.32, 386.34-386.35 
183.17     (106) Diagnosis:  INFECTIOUS MONONUCLEOSIS 
183.18  Treatment: MEDICAL THERAPY 
183.19  ICD-9:  075 
183.20     (107) Diagnosis:  ASEPTIC MENINGITIS 
183.21  Treatment:  MEDICAL THERAPY 
183.22  ICD-9:  047-049 
183.23     (108) Diagnosis:  CONGENITAL ANOMALIES OF FEMALE GENITAL 
183.24  ORGANS, EXCLUDING VAGINA 
183.25  Treatment:  SURGICAL TREATMENT 
183.26  ICD-9:  752.0-752.3, 752.41 
183.27     (109) Diagnosis:  CONGENITAL DEFORMITIES OF KNEE 
183.28  Treatment:  ARTHROSCOPIC REPAIR 
183.29  ICD-9:  755.64, 727.83 
183.30     (110) Diagnosis:  UNCOMPLICATED HERNIA IN ADULTS AGE 18 OR 
183.31  OVER 
183.32  Treatment:  REPAIR 
183.33  ICD-9:  550.9, 553.0-553.2, 553.8-553.9 
183.34     (111) Diagnosis:  ACUTE ANAL FISSURE 
183.35  Treatment:  FISSURECTOMY, MEDICAL THERAPY 
183.36  ICD-9:  565.0 
184.1      (112) Diagnosis:  CYST OF KIDNEY, ACQUIRED 
184.2   Treatment:  MEDICAL AND SURGICAL TREATMENT 
184.3   ICD-9:  593.2 
184.4      (113) Diagnosis:  PICA 
184.5   Treatment:  MEDICAL/PSYCHOTHERAPY 
184.6   ICD-9:  307.52 
184.7      (114) Diagnosis:  DISORDERS OF SLEEP WITHOUT SLEEP APNEA 
184.8   Treatment:  MEDICAL THERAPY 
184.9   ICD-9:  307.41-307.45, 307.47-307.49, 780.50, 780.52, 
184.10  780.54-780.56, 780.59 
184.11     (115) Diagnosis:  CYST, HEMORRHAGE, AND INFARCTION OF 
184.12  THYROID 
184.13  Treatment:  SURGERY - EXCISION 
184.14  ICD-9:  246.2, 246.3, 246.9 
184.15     (116) Diagnosis:  DEVIATED NASAL SEPTUM, ACQUIRED DEFORMITY 
184.16  OF NOSE, OTHER DISEASES OF UPPER RESPIRATORY TRACT 
184.17  Treatment:  EXCISION OF CYST/RHINECTOMY/PROSTHESIS 
184.18  ICD-9:  470, 478.0, 738.0, 754.0 
184.19     (117) Diagnosis:  ERYTHEMA MULTIFORM 
184.20  Treatment:  MEDICAL THERAPY 
184.21  ICD-9:  695.1 
184.22     (118) Diagnosis:  HERPES SIMPLEX WITHOUT COMPLICATIONS 
184.23  Treatment:  MEDICAL THERAPY 
184.24  ICD-9:  054.2, 054.6, 054.73, 054.9 
184.25     (119) Diagnosis:  CONGENITAL ANOMALIES OF THE EAR WITHOUT 
184.26  IMPAIRMENT OF HEARING; UNILATERAL ANOMALIES OF THE EAR 
184.27  Treatment:  OTOPLASTY, REPAIR AND AMPUTATION 
184.28  ICD-9:  744.00-744.04, 744.09, 744.1-744.3 
184.29     (120) Diagnosis:  BLEPHARITIS 
184.30  Treatment:  MEDICAL THERAPY 
184.31  ICD-9:  373.0, 373.8-373.9, 374.87 
184.32     (121) Diagnosis:  HYPERTELORISM OF ORBIT 
184.33  Treatment:  ORBITOTOMY 
184.34  ICD-9:  376.41 
184.35     (122) Diagnosis:  INFERTILITY DUE TO TUBAL DISEASE 
184.36  Treatment:  MICROSURGERY 
185.1   ICD-9:  608.85, 622.5, 628.2-628.3, 629.9, V26.0 
185.2      (123) Diagnosis:  KERATODERMA, ACANTHOSIS NIGRICANS, STRIAE 
185.3   ATROPHICAE, AND OTHER HYPERTROPHIC OR ATROPHIC CONDITIONS OF 
185.4   SKIN 
185.5   Treatment:  MEDICAL THERAPY 
185.6   ICD-9:  373.3, 690, 698, 701.1-701.3, 701.8, 701.9 
185.7      (124) Diagnosis:  LICHEN PLANUS 
185.8   Treatment:  MEDICAL THERAPY 
185.9   ICD-9:  697 
185.10     (125) Diagnosis: OBESITY 
185.11  Treatment:  NUTRITIONAL AND LIFE STYLE COUNSELING 
185.12  ICD-9:  278.0 
185.13     (126) Diagnosis:  MORBID OBESITY 
185.14  Treatment:  GASTROPLASTY 
185.15  ICD-9:  278.01 
185.16     (127) Diagnosis:  CHRONIC DISEASE OF TONSILS AND ADENOIDS 
185.17  Treatment:  TONSILLECTOMY AND ADENOIDECTOMY 
185.18  ICD-9:  474.0, 474.1-474.2, 474.9 
185.19     (128) Diagnosis:  HYDROCELE 
185.20  Treatment:  MEDICAL THERAPY, EXCISION 
185.21  ICD-9:  603, 608.84, 629.1, 778.6 
185.22     (129) Diagnosis:  KELOID SCAR; OTHER ABNORMAL GRANULATION 
185.23  TISSUE 
185.24  Treatment:  INTRALESIONAL INJECTIONS/DESTRUCTION/EXCISION, 
185.25  RADIATION THERAPY 
185.26  ICD-9:  701.4-701.5 
185.27     (130) Diagnosis:  NONINFLAMMATORY DISORDERS OF CERVIX; 
185.28  HYPERTROPHY OF LABIA 
185.29  Treatment:  MEDICAL THERAPY 
185.30  ICD-9:  622.4, 622.6-622.9, 623.4, 624.2-624.3, 624.6-624.9 
185.31     (131) Diagnosis:  SPRAINS OF JOINTS AND ADJACENT MUSCLES, 
185.32  GRADE I 
185.33  Treatment:  MEDICAL THERAPY 
185.34  ICD-9:  355.1-355.3, 355.9, 717, 718.26, 718.36, 718.46, 718.56, 
185.35  836.0-836.2, 840-843, 844.0-844.3, 844.8-844.9, 845.00-845.03, 
185.36  845.1, 846, 848.3, 848.40-848.42, 848.49, 848.5, 848.8-848.9, 
186.1   905.7 
186.2      (132) Diagnosis:  SYNOVITIS AND TENOSYNOVITIS 
186.3   Treatment:  MEDICAL THERAPY 
186.4   ICD-9:  726.12, 727.00, 727.03-727.09 
186.5      (133) Diagnosis:  OTHER DISORDERS OF SYNOVIUM, TENDON AND 
186.6   BURSA, COSTOCHONDRITIS, AND CHONDRODYSTROPHY 
186.7   Treatment: MEDICAL THERAPY 
186.8   ICD-9:  719.5-719.6, 719.80, 719.86, 727.2-727.3, 727.50, 
186.9   727.60, 727.82, 727.9, 733.5-733.7, 756.4 
186.10     (134) Diagnosis:  DISEASE OF NAILS, HAIR, AND HAIR 
186.11  FOLLICLES 
186.12  Treatment:  MEDICAL THERAPY 
186.13  ICD-9:  703.8-703.9, 704.0, 704.1-704.9, 706.3, 706.9, 
186.14  757.4-757.5, V50.0 
186.15     (135) Diagnosis:  CANDIDIASIS OF MOUTH, SKIN, AND NAILS 
186.16  Treatment:  MEDICAL THERAPY 
186.17  ICD-9:  112.0, 112.3, 112.9 
186.18     (136) Diagnosis:  BENIGN LESIONS OF TONGUE 
186.19  Treatment:  EXCISION 
186.20  ICD-9:  529.1-529.6, 529.8-529.9 
186.21     (137) Diagnosis:  MINOR BURNS 
186.22  Treatment:  MEDICAL THERAPY 
186.23  ICD-9:  692.76, 941.0-941.2, 942.0-942.2, 943.0-943.2, 
186.24  944.0-944.2, 945.0-945.2, 946.0-946.2, 949.0-949.1 
186.25     (138) Diagnosis:  MINOR HEAD INJURY:  HEMATOMA/EDEMA WITH 
186.26  NO LOSS OF CONSCIOUSNESS 
186.27  Treatment:  MEDICAL THERAPY 
186.28  ICD-9:  800.00-800.01, 801.00-801.01, 803.00-803.01, 850.0, 
186.29  850.9, 851.00-851.01, 851.09, 851.20-851.21, 851.29, 
186.30  851.40-851.41, 851.49, 851.60-851.61, 851.69, 851.80-851.81, 
186.31  851.89 
186.32     (139) Diagnosis:  CONGENITAL DEFORMITY OF KNEE 
186.33  Treatment:  MEDICAL THERAPY 
186.34  ICD-9:  755.64 
186.35     (140) Diagnosis:  PHLEBITIS AND THROMBOPHLEBITIS, 
186.36  SUPERFICIAL 
187.1   Treatment:  MEDICAL THERAPY 
187.2   ICD-9:  451.0, 451.2, 451.82, 451.84, 451.89, 451.9 
187.3      (141) Diagnosis:  PROLAPSED URETHRAL MUCOSA 
187.4   Treatment:  SURGICAL TREATMENT 
187.5   ICD-9:  599.3, 599.5 
187.6      (142) Diagnosis:  RUPTURE OF SYNOVIUM 
187.7   Treatment:  REMOVAL OF BAKER'S CYST 
187.8   ICD-9:  727.51 
187.9      (143) Diagnosis:  PERSONALITY DISORDERS, EXCLUDING 
187.10  BORDERLINE, SCHIZOTYPAL AND ANTISOCIAL 
187.11  Treatment:  MEDICAL/PSYCHOTHERAPY 
187.12  ICD-9:  301.0, 301.10-301.12, 301.20-301.21, 301.3-301.4, 
187.13  301.50, 301.59, 301.6, 301.81-301.82, 301.84, 301.89, 301.9 
187.14     (144) Diagnosis:  GENDER IDENTIFICATION DISORDER, 
187.15  PARAPHILIAS AND OTHER PSYCHOSEXUAL DISORDERS 
187.16  Treatment:  MEDICAL/PSYCHOTHERAPY 
187.17  ICD-9:  302.0-302.4, 302.50, 302.6, 302.85, 302.9 
187.18     (145) Diagnosis:  FINGERTIP AVULSION 
187.19  Treatment:  REPAIR WITHOUT PEDICLE GRAFT 
187.20  ICD-9:  883.0 
187.21     (146) Diagnosis:  ANOMALIES OF RELATIONSHIP OF JAW TO 
187.22  CRANIAL BASE, MAJOR ANOMALIES OF JAW SIZE, OTHER SPECIFIED AND 
187.23  UNSPECIFIED DENTOFACIAL ANOMALIES 
187.24  Treatment:  OSTEOPLASTY, MAXILLA/MANDIBLE 
187.25  ICD-9:  524.0-524.2, 524.5, 524.7-524.8, 524.9 
187.26     (147) Diagnosis:  CERVICAL RIB 
187.27  Treatment:  SURGICAL TREATMENT 
187.28  ICD-9:  756.2 
187.29     (148) Diagnosis:  GYNECOMASTIA 
187.30  Treatment:  MASTECTOMY 
187.31  ICD-9:  611.1 
187.32     (149) Diagnosis:  VIRAL, SELF-LIMITING ENCEPHALITIS, 
187.33  MYELITIS AND ENCEPHALOMYELITIS 
187.34  Treatment:  MEDICAL THERAPY 
187.35  ICD-9:  056.0, 056.71, 323.8-323.9 
187.36     (150) Diagnosis:  GALLSTONES WITHOUT CHOLECYSTITIS 
188.1   Treatment:  MEDICAL THERAPY, CHOLECYSTECTOMY 
188.2   ICD-9: 574.2, 575.8 
188.3      (151) Diagnosis:  BENIGN NEOPLASM OF NASAL CAVITIES, MIDDLE 
188.4   EAR AND ACCESSORY SINUSES 
188.5   Treatment:  EXCISION, RECONSTRUCTION 
188.6   ICD-9:  212.0 
188.7      (152) Diagnosis:  ACUTE TONSILLITIS OTHER THAN 
188.8   BETA-STREPTOCOCCAL 
188.9   Treatment:  MEDICAL THERAPY 
188.10  ICD-9:  463 
188.11     (153) Diagnosis:  EDEMA AND OTHER CONDITIONS INVOLVING THE 
188.12  INTEGUMENT OF THE FETUS AND NEWBORN 
188.13  Treatment:  MEDICAL THERAPY 
188.14  ICD-9:  778.5, 778.7-778.9 
188.15     (154) Diagnosis:  ACUTE UPPER RESPIRATORY INFECTIONS AND 
188.16  COMMON COLD 
188.17  Treatment:  MEDICAL THERAPY 
188.18  ICD-9:  460, 465 
188.19     (155) Diagnosis:  DIAPER RASH 
188.20  Treatment:  MEDICAL THERAPY 
188.21  ICD-9:  691.0 
188.22     (156) Diagnosis:  DISORDERS OF SWEAT GLANDS 
188.23  Treatment:  MEDICAL THERAPY 
188.24  ICD-9:  705.0-705.1, 705.81-705.83, 705.89, 705.9, 780.8 
188.25     (157) Diagnosis:  OTHER VIRAL INFECTIONS, EXCLUDING 
188.26  PNEUMONIA DUE TO RESPIRATORY SYNCYTIAL VIRUS IN PERSONS UNDER 
188.27  AGE 3 
188.28  Treatment:  MEDICAL THERAPY 
188.29  ICD-9:  052, 055, 056.79, 056.8-056.9, 057, 072, 074, 078.0, 
188.30  078.2, 078.4-078.8, 079.0-079.6, 079.88-079.89, 079.9, 480, 487 
188.31     (158) Diagnosis:  PHARYNGITIS AND LARYNGITIS AND OTHER 
188.32  DISEASES OF VOCAL CORDS 
188.33  Treatment:  MEDICAL THERAPY 
188.34  ICD-9:  462, 464.00, 464.50, 476, 478.5 
188.35     (159) Diagnosis:  CORNS AND CALLUSES 
188.36  Treatment:  MEDICAL THERAPY 
189.1   ICD-9:  700 
189.2      (160) Diagnosis:  VIRAL WARTS, EXCLUDING VENEREAL WARTS 
189.3   Treatment:  MEDICAL AND SURGICAL TREATMENT, CRYOSURGERY 
189.4   ICD-9:  078.0, 078.10, 078.19 
189.5      (161) Diagnosis:  OLD LACERATION OF CERVIX AND VAGINA 
189.6   Treatment:  MEDICAL THERAPY 
189.7   ICD-9:  621.5, 622.3, 624.4 
189.8      (162) Diagnosis:  TONGUE TIE AND OTHER ANOMALIES OF TONGUE 
189.9   Treatment:  FRENOTOMY, TONGUE TIE 
189.10  ICD-9:  529.5, 750.0-750.1 
189.11     (163) Diagnosis:  OPEN WOUND OF INTERNAL STRUCTURES OF 
189.12  MOUTH WITHOUT COMPLICATION 
189.13  Treatment:  REPAIR SOFT TISSUES 
189.14  ICD-9:  525.10, 525.12, 525.13, 525.19, 873.6 
189.15     (164) Diagnosis:  CENTRAL SEROUS RETINOPATHY 
189.16  Treatment:  LASER SURGERY 
189.17  ICD-9:  362.40-362.41, 362.6-362.7 
189.18     (165) Diagnosis:  SEBORRHEIC KERATOSIS, DYSCHROMIA, AND 
189.19  VASCULAR DISORDERS, SCAR CONDITIONS, AND FIBROSIS OF SKIN 
189.20  Treatment:  MEDICAL AND SURGICAL TREATMENT 
189.21  ICD-9:  278.1, 702.1-702.8, 709.1-709.3, 709.8-709.9 
189.22     (166) Diagnosis:  UNCOMPLICATED HEMORRHOIDS 
189.23  Treatment:  HEMORRHOIDECTOMY, MEDICAL THERAPY 
189.24  ICD-9:  455.0, 455.3, 455.6, 455.9 
189.25     (167) Diagnosis:  GANGLION 
189.26  Treatment:  EXCISION 
189.27  ICD-9:  727.02, 727.4 
189.28     (168) Diagnosis:  CHRONIC CONJUNCTIVITIS, 
189.29  BLEPHAROCONJUNCTIVITIS 
189.30  Treatment:  MEDICAL THERAPY 
189.31  ICD-9:  372.10-372.13, 372.2-372.3, 372.53, 372.73, 374.55 
189.32     (169) Diagnosis:  TOXIC ERYTHEMA, ACNE ROSACEA, DISCOID 
189.33  LUPUS 
189.34  Treatment:  MEDICAL THERAPY 
189.35  ICD-9:  695.0, 695.2-695.9 
189.36     (170) Diagnosis:  PERIPHERAL NERVE DISORDERS 
190.1   Treatment:  MEDICAL THERAPY 
190.2   ICD-9:  337.2, 353, 354.1, 354.3-354.9, 355.0, 355.3, 
190.3   355.7-355.8, 357.5-357.9, 723.2 
190.4      (171) Diagnosis:  OTHER COMPLICATIONS OF A PROCEDURE 
190.5   Treatment:  MEDICAL AND SURGICAL TREATMENT 
190.6   ICD-9:  371.82, 457.0, 998.81, 998.9 
190.7      (172) Diagnosis:  RAYNAUD'S SYNDROME 
190.8   Treatment:  MEDICAL THERAPY 
190.9   ICD-9:  443.0, 443.89, 443.9 
190.10     (173) Diagnosis:  TMJ DISORDERS 
190.11  Treatment:  TMJ SURGERY 
190.12  ICD-9:  524.5, 524.6, 718.08, 718.18, 718.28, 718.38, 718.58 
190.13     (174) Diagnosis:  VARICOSE VEINS OF LOWER EXTREMITIES 
190.14  WITHOUT ULCER OR INFLAMMATION 
190.15  Treatment:  STRIPPING/SCLEROTHERAPY 
190.16  ICD-9:  454.9, 459, 607.82 
190.17     (175) Diagnosis:  VULVAL VARICES 
190.18  Treatment:  VASCULAR SURGERY 
190.19  ICD-9:  456.6 
190.20     (176) Diagnosis:  CHRONIC PANCREATITIS 
190.21  Treatment:  SURGICAL TREATMENT 
190.22  ICD-9:  577.1 
190.23     (177) Diagnosis:  CHRONIC PROSTATITIS, OTHER DISORDERS OF 
190.24  PROSTATE 
190.25  Treatment:  MEDICAL THERAPY 
190.26  ICD-9:  601.1, 601.3, 601.9, 602 
190.27     (178) Diagnosis:  MUSCULAR CALCIFICATION AND OSSIFICATION 
190.28  Treatment:  MEDICAL THERAPY 
190.29  ICD-9:  728.1 
190.30     (179) Diagnosis:  CANCER OF VARIOUS SITES WHERE TREATMENT 
190.31  WILL NOT RESULT IN A FIVE PERCENT FIVE-YEAR SURVIVAL 
190.32  Treatment:  CURATIVE MEDICAL AND SURGICAL TREATMENT 
190.33  ICD-9:  140-208 
190.34     (180) Diagnosis:  AGENESIS OF LUNG 
190.35  Treatment:  MEDICAL THERAPY 
190.36  ICD-9:  748.5 
191.1      (181) Diagnosis:  DISEASE OF CAPILLARIES 
191.2   Treatment:  EXCISION 
191.3   ICD-9:  448.1-448.9 
191.4      (182) Diagnosis:  BENIGN POLYPS OF VOCAL CORDS 
191.5   Treatment:  MEDICAL THERAPY, STRIPPING 
191.6   ICD-9:  478.4 
191.7      (183) Diagnosis:  FRACTURES OF RIBS AND STERNUM, CLOSED 
191.8   Treatment:  MEDICAL THERAPY 
191.9   ICD-9:  807.0, 807.2, 805.6, 839.41 
191.10     (184) Diagnosis:  CLOSED FRACTURE OF ONE OR MORE PHALANGES 
191.11  OF THE FOOT, NOT INCLUDING THE GREAT TOE 
191.12  Treatment:  MEDICAL AND SURGICAL TREATMENT 
191.13  ICD-9:  826.0 
191.14     (185) Diagnosis:  DISEASES OF THYMUS GLAND 
191.15  Treatment:  MEDICAL THERAPY 
191.16  ICD-9:  254 
191.17     (186) Diagnosis:  DENTAL CONDITIONS WHERE TREATMENT RESULTS 
191.18  IN MARGINAL IMPROVEMENT 
191.19  Treatment:  ELECTIVE DENTAL SERVICES 
191.20  ICD-9:  520.7, V72.2 
191.21     (187) Diagnosis:  ANTISOCIAL PERSONALITY DISORDER 
191.22  Treatment:  MEDICAL/PSYCHOTHERAPY 
191.23  ICD-9:  301.7 
191.24     (188) Diagnosis:  SEBACEOUS CYST 
191.25  Treatment:  MEDICAL AND SURGICAL THERAPY 
191.26  ICD-9:  685.1, 706.2, 744.47 
191.27     (189) Diagnosis:  CENTRAL RETINAL ARTERY OCCLUSION 
191.28  Treatment:  PARACENTESIS OF AQUEOUS 
191.29  ICD-9:  362.31-362.33 
191.30     (190) Diagnosis:  ORAL APHTHAE 
191.31  Treatment:  MEDICAL THERAPY 
191.32  ICD-9:  528.2 
191.33     (191) Diagnosis:  SUBLINGUAL, SCROTAL, AND PELVIC VARICES 
191.34  Treatment:  VENOUS INJECTION, VASCULAR SURGERY 
191.35  ICD-9:  456.3-456.5 
191.36     (192) Diagnosis:  SUPERFICIAL WOUNDS WITHOUT INFECTION AND 
192.1   CONTUSIONS 
192.2   Treatment:  MEDICAL THERAPY 
192.3   ICD-9:  910.0, 910.2, 910.4, 910.6, 910.8, 911.0, 911.2, 911.4, 
192.4   91.6, 911.8, 912.0, 912.2, 912.4, 912.6, 912.8, 913.0, 913.2, 
192.5   913.4, 913.6, 913.8, 914.0, 914.2, 914.4, 914.6, 914.8, 915.0, 
192.6   915.2, 915.4, 915.6, 915.8, 916.0, 916.2, 916.4, 916.6, 916.8, 
192.7   917.0, 917.2, 917.4, 917.6, 917.8, 919.0, 919.2, 919.4, 919.6, 
192.8   919.8, 920-924, 959.0-959.8 
192.9      (193) Diagnosis:  UNSPECIFIED RETINAL VASCULAR OCCLUSION 
192.10  Treatment:  LASER SURGERY 
192.11  ICD-9:  362.30 
192.12     (194) Diagnosis:  BENIGN NEOPLASM OF EXTERNAL FEMALE 
192.13  GENITAL ORGANS 
192.14  Treatment:  EXCISION 
192.15  ICD-9:  221.1-221.9 
192.16     (195) Diagnosis:  BENIGN NEOPLASM OF MALE GENITAL ORGANS:  
192.17  TESTIS, PROSTATE, EPIDIDYMIS 
192.18  Treatment:  MEDICAL AND SURGICAL TREATMENT 
192.19  ICD-9:  222.0, 222.2, 222.3, 222.8, 222.9 
192.20     (196) Diagnosis:  XEROSIS 
192.21  Treatment:  MEDICAL THERAPY 
192.22  ICD-9:  706.8 
192.23     (197) Diagnosis:  CONGENITAL CYSTIC LUNG - SEVERE 
192.24  Treatment:  LUNG RESECTION 
192.25  ICD-9:  748.4 
192.26     (198) Diagnosis:  ICHTHYOSIS 
192.27  Treatment:  MEDICAL THERAPY 
192.28  ICD-9:  757.1 
192.29     (199) Diagnosis:  LYMPHEDEMA 
192.30  Treatment:  MEDICAL THERAPY, OTHER OPERATION ON LYMPH CHANNEL 
192.31  ICD-9:  457.1-457.9, 757.0 
192.32     (200) Diagnosis:  DERMATOLOGICAL CONDITIONS WITH NO 
192.33  EFFECTIVE TREATMENT OR NO TREATMENT NECESSARY 
192.34  Treatment:  MEDICAL AND SURGICAL TREATMENT 
192.35  ICD-9:  696.3-696.5, 709.0, 757.2-757.3, 757.8-757.9 
192.36     (201) Diagnosis:  INFECTIOUS DISEASES WITH NO EFFECTIVE 
193.1   TREATMENTS OR NO TREATMENT NECESSARY 
193.2   Treatment:  EVALUATION 
193.3   ICD-9:  071, 136.0, 136.9 
193.4      (202) Diagnosis:  RESPIRATORY CONDITIONS WITH NO EFFECTIVE 
193.5   TREATMENTS OR NO TREATMENT NECESSARY 
193.6   Treatment:  EVALUATION 
193.7   ICD-9:  519.3, 519.9, 748.60, 748.69, 748.9 
193.8      (203) Diagnosis:  GENITOURINARY CONDITIONS WITH NO 
193.9   EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY 
193.10  Treatment:  EVALUATION 
193.11  ICD-9:  593.0-593.1, 593.6, 607.9, 608.3, 608.9, 621.6, 
193.12  621.8-621.9, 626.9, 629.8, 752.9 
193.13     (204) Diagnosis:  CARDIOVASCULAR CONDITIONS WITH NO 
193.14  EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY 
193.15  Treatment:  EVALUATION 
193.16  ICD-9:  429.3, 429.81-429.82, 429.89, 429.9, 747.9 
193.17     (205) Diagnosis:  MUSCULOSKELETAL CONDITIONS WITH NO 
193.18  EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY 
193.19  Treatment:  EVALUATION 
193.20  ICD-9:  716.9, 718.00, 718.10, 718.20, 718.40, 718.50, 718.60, 
193.21  718.80, 718.9, 719.7, 719.9, 728.5, 728.84, 728.9, 731.2, 
193.22  738.2-738.3, 738.9, 744.5-744.9, 748.1, 755.9, 756.9 
193.23     (206) Diagnosis:  INTRACRANIAL CONDITIONS WITH NO EFFECTIVE 
193.24  TREATMENTS OR NO TREATMENT NECESSARY 
193.25  Treatment:  EVALUATION 
193.26  ICD-9:  348.2, 377.01, 377.02, 377.2, 377.3, 377.5, 377.7, 
193.27  437.7-437.8 
193.28     (207) Diagnosis:  SENSORY ORGAN CONDITIONS WITH NO 
193.29  EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY 
193.30  Treatment:  EVALUATION 
193.31  ICD-9:  360.30-360.31, 360.33, 362.37, 362.42-362.43, 
193.32  362.8-362.9, 363.21, 364.5, 364.60, 364.9, 371.20, 371.22, 
193.33  371.24, 371.3, 371.81, 371.89, 371.9, 372.40-372.42, 
193.34  372.44-372.45, 372.50-372.52, 372.55, 372.8-372.9, 
193.35  374.52-374.53, 374.81-374.83, 374.9, 376.82, 376.89, 376.9, 
193.36  377.03, 377.1, 377.4, 377.6, 379.24, 379.29, 379.4-379.8, 380.9, 
194.1   747.47 
194.2      (208) Diagnosis:  ENDOCRINE AND METABOLIC CONDITIONS WITH 
194.3   NO EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY 
194.4   Treatment:  EVALUATION 
194.5   ICD-9:  251.1-251.2, 259.4, 259.8-259.9, 277.3, 759.1 
194.6      (209) Diagnosis:  GASTROINTESTINAL CONDITIONS WITH NO 
194.7   EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY 
194.8   Treatment:  EVALUATION 
194.9   ICD-9:  527.0, 569.9, 573.9 
194.10     (210) Diagnosis:  MENTAL DISORDERS WITH NO EFFECTIVE 
194.11  TREATMENTS OR NO TREATMENT NECESSARY 
194.12  Treatment:  EVALUATION 
194.13  ICD-9:  313.1, 313.3, 313.83 
194.14     (211) Diagnosis:  NEUROLOGIC CONDITIONS WITH NO EFFECTIVE 
194.15  TREATMENTS OR NO TREATMENT NECESSARY 
194.16  Treatment:  EVALUATION 
194.17  ICD-9:  333.82, 333.84, 333.91, 333.93 
194.18     (212) Diagnosis:  DENTAL CONDITIONS (e.g., ORTHODONTICS) 
194.19  Treatment:  COSMETIC DENTAL SERVICES 
194.20  ICD-9:  520.0-520.5, 520.8-520.9, 521.1-521.9, 522.3, V72.2 
194.21     (213) Diagnosis:  TUBAL DYSFUNCTION AND OTHER CAUSES OF 
194.22  INFERTILITY 
194.23  Treatment:  IN-VITRO FERTILIZATION, GIFT 
194.24  ICD-9:  256 
194.25     (214) Diagnosis:  HEPATORENAL SYNDROME 
194.26  Treatment:  MEDICAL THERAPY 
194.27  ICD-9:  572.4 
194.28     (215) Diagnosis:  SPASTIC DYSPHONIA 
194.29  Treatment:  MEDICAL THERAPY 
194.30  ICD-9:  478.79 
194.31     (216) Diagnosis:  DISORDERS OF REFRACTION AND ACCOMMODATION 
194.32  Treatment:  RADIAL KERATOTOMY 
194.33  ICD-9:  367, 368.1-368.9 
194.34     (b) The commissioner of human services shall identify the 
194.35  related CPT codes that correspond with the diagnosis/treatment 
194.36  pairings described in this section.  The identification of the 
195.1   related CPT codes is not subject to the requirements of 
195.2   Minnesota Statutes, chapter 14. 
195.3      Subd. 4.  [FEDERAL APPROVAL.] The commissioner of human 
195.4   services shall seek federal approval to eliminate medical 
195.5   assistance coverage for the diagnosis/treatment pairings 
195.6   described in subdivision 3. 
195.7      Sec. 18.  [REVIEW OF SPECIAL TRANSPORTATION ELIGIBILITY 
195.8   CRITERIA.] 
195.9      The commissioner of human services, in consultation with 
195.10  the commissioner of transportation and special transportation 
195.11  service providers, shall review eligibility criteria for medical 
195.12  assistance special transportation services and shall evaluate 
195.13  whether the level of special transportation services provided 
195.14  should be based on the degree of impairment of the client, as 
195.15  well as the medical diagnosis.  The commissioner shall present 
195.16  recommendations for changes in the eligibility criteria for 
195.17  special transportation services to the chairs and ranking 
195.18  minority members of the house and senate committees with 
195.19  jurisdiction over health and human services spending by January 
195.20  15, 2004.