1.1                          A bill for an act 
  1.2             relating to human services; providing annual rate 
  1.3             increases for certain providers; terminating a rate 
  1.4             reduction for certain providers; appropriating money; 
  1.5             amending Minnesota Statutes 2002, section 256B.5012, 
  1.6             by adding a subdivision; Laws 2003, First Special 
  1.7             Session chapter 14, article 13C, section 2, 
  1.8             subdivision 9; proposing coding for new law in 
  1.9             Minnesota Statutes, chapter 256B. 
  1.10  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.11     Section 1.  Minnesota Statutes 2002, section 256B.5012, is 
  1.12  amended by adding a subdivision to read: 
  1.13     Subd. 6.  [ICF/MR RATE INCREASES BEGINNING JULY 1, 
  1.14  2004.] (a) For the rate years beginning on or after July 1, 
  1.15  2004, the commissioner shall make available to each facility 
  1.16  reimbursed under this section an adjustment to the total 
  1.17  operating payment rate of two percent.  Of this adjustment, 
  1.18  two-thirds must be used as provided under paragraph (b) and 
  1.19  one-third must be used for operating costs. 
  1.20     (b) The adjustment under this paragraph must be used to 
  1.21  increase the wages and benefits and pay associated costs of all 
  1.22  employees except administrative and central office employees, 
  1.23  provided that this increase must be used only for wage and 
  1.24  benefit increases implemented on or after the first day of the 
  1.25  rate year and must not be used for increases implemented prior 
  1.26  to that date. 
  1.27     (c) For each facility, the commissioner shall make 
  2.1   available an adjustment using the percentage specified in 
  2.2   paragraph (a) multiplied by the total payment rate, excluding 
  2.3   the property-related payment rate, in effect on the preceding 
  2.4   June 30.  The total payment rate shall include the adjustment 
  2.5   provided in section 256B.501, subdivision 12. 
  2.6      (d) A facility whose payment rates are governed by closure 
  2.7   agreements, receivership agreements, or Minnesota Rules, part 
  2.8   9553.0075, is not eligible for an adjustment otherwise granted 
  2.9   under this subdivision.  
  2.10     (e) A facility may apply for the payment rate adjustment 
  2.11  provided under paragraph (b).  The application must be made to 
  2.12  the commissioner and contain a plan by which the facility will 
  2.13  distribute the adjustment in paragraph (b) to employees of the 
  2.14  facility.  For facilities in which the employees are represented 
  2.15  by an exclusive bargaining representative, an agreement 
  2.16  negotiated and agreed to by the employer and the exclusive 
  2.17  bargaining representative constitutes the plan.  A negotiated 
  2.18  agreement may constitute the plan only if the agreement is 
  2.19  finalized after the date of enactment of all rate increases for 
  2.20  the rate year.  The commissioner shall review the plan to ensure 
  2.21  that the payment rate adjustment per diem is used as provided in 
  2.22  this subdivision.  To be eligible, a facility must submit its 
  2.23  plan by March 31, 2005, and March 31 of each following year.  If 
  2.24  a facility's plan is effective for its employees after the first 
  2.25  day of the applicable rate year that the funds are available, 
  2.26  the payment rate adjustment per diem is effective the same date 
  2.27  as its plan. 
  2.28     (f) A copy of the approved distribution plan must be made 
  2.29  available to all employees by giving each employee a copy or by 
  2.30  posting it in an area of the facility to which all employees 
  2.31  have access.  If an employee does not receive the wage and 
  2.32  benefit adjustment described in the facility's approved plan and 
  2.33  is unable to resolve the problem with the facility's management 
  2.34  or through the employee's union representative, the employee may 
  2.35  contact the commissioner at an address or telephone number 
  2.36  provided by the commissioner and included in the approved plan. 
  3.1      Sec. 2.  [256B.766] [RATE INCREASES FOR CERTAIN PROVIDERS.] 
  3.2      (a) The commissioner shall provide an annual two percent 
  3.3   rate adjustment for the providers listed in paragraph (b).  The 
  3.4   increases are effective for services rendered on or after July 1 
  3.5   of each year. 
  3.6      (b) The rate increases described in this section must be 
  3.7   provided to: 
  3.8      (1) home and community-based waivered services for persons 
  3.9   with mental retardation or related conditions under section 
  3.10  256B.501; 
  3.11     (2) home and community-based waivered services for the 
  3.12  elderly under section 256B.0915; 
  3.13     (3) waivered services under community alternatives for 
  3.14  disabled individuals under section 256B.49; 
  3.15     (4) community alternative care waivered services under 
  3.16  section 256B.49; 
  3.17     (5) traumatic brain injury waivered services under section 
  3.18  256B.49; 
  3.19     (6) nursing services and home health services under section 
  3.20  256B.0625, subdivision 6a; 
  3.21     (7) personal care services and nursing supervision of 
  3.22  personal care services under section 256B.0625, subdivision 19a; 
  3.23     (8) private duty nursing services under section 256B.0625, 
  3.24  subdivision 7; 
  3.25     (9) day training and habilitation services for adults with 
  3.26  mental retardation or related conditions under sections 252.40 
  3.27  to 252.46; 
  3.28     (10) day training and habilitation services under chapter 
  3.29  256B; 
  3.30     (11) alternative care services under section 256B.0913; 
  3.31     (12) adult residential program grants under Minnesota 
  3.32  Rules, parts 9535.2000 to 9535.3000; 
  3.33     (13) adult and family community support grants under 
  3.34  section 256.476 and Minnesota Rules, parts 9535.1700 to 
  3.35  9535.1760; 
  3.36     (14) the group residential housing supplementary service 
  4.1   rate under section 256I.05, subdivision 1a; 
  4.2      (15) adult mental health integrated fund grants under 
  4.3   section 245.4661; 
  4.4      (16) semi-independent living services under section 
  4.5   252.275, including SILS funding under county social services 
  4.6   grants formerly funded under chapter 256I; 
  4.7      (17) deaf and hard-of-hearing grants; 
  4.8      (18) living skills training programs for persons with 
  4.9   intractable epilepsy who need assistance in the transition to 
  4.10  independent living; 
  4.11     (19) chemical dependency residential and nonresidential 
  4.12  service rates under section 245B.03; 
  4.13     (20) physical therapy services under sections 256B.0625, 
  4.14  subdivision 8, and 256D.03, subdivision 4; 
  4.15     (21) occupational therapy services under sections 
  4.16  256B.0625, subdivision 8a, and 256D.03, subdivision 4; 
  4.17     (22) speech-language therapy services under section 
  4.18  256D.03, subdivision 4, and Minnesota Rules, part 9505.0390; 
  4.19     (23) respiratory therapy services under section 256D.03, 
  4.20  subdivision 4, and Minnesota Rules, part 9505.0295; and 
  4.21     (24) nursing facilities under sections 256B.431 and 
  4.22  256B.434. 
  4.23     (c) Providers that receive a rate increase under this 
  4.24  section shall use one-third of the additional revenue for 
  4.25  operating cost increases and two-thirds of the additional 
  4.26  revenue to increase wages and benefits and pay associated costs 
  4.27  for all employees other than the administrator and central 
  4.28  office staff.  For public employees, the portion of this 
  4.29  increase reserved to increase wages and benefits for certain 
  4.30  staff is available and pay rates shall be increased only to the 
  4.31  extent that they comply with laws governing public employees 
  4.32  collective bargaining.  Money received by a provider for pay 
  4.33  increases under this section must be used only for increases 
  4.34  implemented on or after the first day of the state fiscal year 
  4.35  in which the increase is available and must not be used for 
  4.36  increases implemented prior to that date. 
  5.1      (d) A copy of the provider's plan for complying with 
  5.2   paragraph (c) must be made available to all employees by giving 
  5.3   each employee a copy or by posting it in an area of the 
  5.4   provider's operation to which all employees have access.  If an 
  5.5   employee does not receive the adjustment described in the plan 
  5.6   and is unable to resolve the problem with the provider, the 
  5.7   employee may contact the employee's union representative.  If 
  5.8   the employee is not covered by a collective bargaining 
  5.9   agreement, the employee may contact the commissioner at a 
  5.10  telephone number provided by the commissioner and included in 
  5.11  the provider's plan. 
  5.12     Sec. 3.  Laws 2003, First Special Session chapter 14, 
  5.13  article 13C, section 2, subdivision 9, is amended to read: 
  5.14  Subd. 9.  Continuing Care Grants 
  5.15                Summary by Fund
  5.16  General           1,504,933,000 1,490,958,000
  5.17  Lottery Prize Fund    1,408,000     1,408,000
  5.18  The amounts that may be spent from this 
  5.19  appropriation for each purpose are as 
  5.20  follows: 
  5.21  (a) Community Social Services
  5.22  General                 496,000       371,000
  5.23  (b) Aging and Adult Service Grant 
  5.24  General              12,998,000    13,951,000
  5.25  [LONG-TERM CARE PROGRAM REDUCTIONS.] 
  5.26  For the biennium ending June 30, 2005, 
  5.27  state funding for the following state 
  5.28  long-term care programs is reduced by 
  5.29  15 percent from the level of state 
  5.30  funding provided on June 30, 2003:  
  5.31  SAIL project grants under Minnesota 
  5.32  Statutes, section 256B.0917; senior 
  5.33  nutrition programs under Minnesota 
  5.34  Statutes, section 256.9752; foster 
  5.35  grandparents program under Minnesota 
  5.36  Statutes, section 256.976; retired 
  5.37  senior volunteer program under 
  5.38  Minnesota Statutes, section 256.9753; 
  5.39  and the senior companion program under 
  5.40  Minnesota Statutes, section 256.977. 
  5.41  (c) Deaf and Hard-of-hearing 
  5.42  Service Grants 
  5.43  General               1,719,000     1,490,000
  5.44  (d) Mental Health Grants 
  5.45  General              53,479,000    34,690,000
  6.1   Lottery Prize Fund    1,408,000     1,408,000
  6.2   [RESTRUCTURING OF ADULT MENTAL HEALTH 
  6.3   SERVICES.] The commissioner may make 
  6.4   transfers that do not increase the 
  6.5   state share of costs to effectively 
  6.6   implement the restructuring of adult 
  6.7   mental health services.  
  6.8   [COMPULSIVE GAMBLING.] Of the 
  6.9   appropriation from the lottery prize 
  6.10  fund, $250,000 each year is for the 
  6.11  following purposes: 
  6.12  (1) $100,000 each year is for a grant 
  6.13  to the Southeast Asian Problem Gambling 
  6.14  Consortium.  The consortium must 
  6.15  provide statewide compulsive gambling 
  6.16  prevention and treatment services for 
  6.17  Lao, Hmong, Vietnamese, and Cambodian 
  6.18  families, adults, and adolescents.  The 
  6.19  appropriation in this clause shall not 
  6.20  become part of base level funding for 
  6.21  the biennium beginning July 1, 2005.  
  6.22  Any unencumbered balance of the 
  6.23  appropriation in the first year does 
  6.24  not cancel but is available for the 
  6.25  second year; and 
  6.26  (2) $150,000 each year is for a grant 
  6.27  to a compulsive gambling council 
  6.28  located in St. Louis county.  The 
  6.29  gambling council must provide a 
  6.30  statewide compulsive gambling 
  6.31  prevention and education project for 
  6.32  adolescents.  Any unencumbered balance 
  6.33  of the appropriation in the first year 
  6.34  of the biennium does not cancel but is 
  6.35  available for the second year. 
  6.36  (e) Community Support Grants 
  6.37  General               12,523,000    9,093,000
  6.38  [CENTERS FOR INDEPENDENT LIVING STUDY.] 
  6.39  The commissioner of human services, in 
  6.40  consultation with the commissioner of 
  6.41  economic security, the centers for 
  6.42  independent living, and consumer 
  6.43  representatives, shall study the 
  6.44  financing of the centers for 
  6.45  independent living authorized under 
  6.46  Minnesota Statutes, section 268A.11, 
  6.47  and make recommendations on options to 
  6.48  maximize federal financial 
  6.49  participation.  Study components shall 
  6.50  include: 
  6.51  (1) the demographics of individuals 
  6.52  served by the centers for independent 
  6.53  living; 
  6.54  (2) the range of services the centers 
  6.55  for independent living provide to these 
  6.56  individuals; 
  6.57  (3) other publicly funded services 
  6.58  received by individuals supported by 
  6.59  the centers; and 
  6.60  (4) strategies for maximizing federal 
  7.1   financial participation for eligible 
  7.2   activities carried out by centers for 
  7.3   independent living. 
  7.4   The commissioner shall report with 
  7.5   fiscal and programmatic recommendations 
  7.6   to the chairs of the appropriate house 
  7.7   of representatives and senate finance 
  7.8   and policy committees by January 15, 
  7.9   2004. 
  7.10  (f) Medical Assistance Long-Term 
  7.11  Care Waivers and Home Care Grants 
  7.12  General              659,211,000  718,665,000
  7.13  [RATE AND ALLOCATION DECREASES FOR 
  7.14  CONTINUING CARE PROGRAMS.] 
  7.15  Notwithstanding any law or rule to the 
  7.16  contrary, the commissioner of human 
  7.17  services shall decrease reimbursement 
  7.18  rates or reduce allocations to assure 
  7.19  the necessary reductions in state 
  7.20  spending for the providers or programs 
  7.21  listed in paragraphs (a) to (d).  The 
  7.22  decreases are effective for services 
  7.23  rendered on or after July 1, 2003, to 
  7.24  June 30, 2004.  Effective July 1, 2004, 
  7.25  the reimbursement rates and allocations 
  7.26  in effect prior to July 1, 2003, shall 
  7.27  be reinstated. 
  7.28  (a) Effective July 1, 2003, the 
  7.29  commissioner shall reduce payment rates 
  7.30  for services and individual or service 
  7.31  limits by one percent.  The rate 
  7.32  decreases described in this section 
  7.33  must be applied to: 
  7.34  (1) home and community-based waivered 
  7.35  services for the elderly under 
  7.36  Minnesota Statutes, section 256B.0915; 
  7.37  (2) day training and habilitation 
  7.38  services for adults with mental 
  7.39  retardation or related conditions under 
  7.40  Minnesota Statutes, sections 252.40 to 
  7.41  252.46; 
  7.42  (3) the group residential housing 
  7.43  supplementary service rate under 
  7.44  Minnesota Statutes, section 256I.05, 
  7.45  subdivision 1a; 
  7.46  (4) chemical dependency residential and 
  7.47  nonresidential service rates under 
  7.48  Minnesota Statutes, section 245B.03; 
  7.49  (5) consumer support grants under 
  7.50  Minnesota Statutes, section 256.476; 
  7.51  and 
  7.52  (6) home and community-based services 
  7.53  for alternative care services under 
  7.54  Minnesota Statutes, section 256B.0913. 
  7.55  (b) The commissioner shall reduce 
  7.56  allocations made available to county 
  7.57  agencies for home and community-based 
  7.58  waivered services to assure a 
  7.59  one-percent reduction in state spending 
  8.1   for services rendered on or after July 
  8.2   1, 2003.  The commissioner shall apply 
  8.3   the allocation decreases described in 
  8.4   this section to: 
  8.5   (1) persons with mental retardation or 
  8.6   related conditions under Minnesota 
  8.7   Statutes, section 256B.501; 
  8.8   (2) waivered services under community 
  8.9   alternatives for disabled individuals 
  8.10  under Minnesota Statutes, section 
  8.11  256B.49; 
  8.12  (3) community alternative care waivered 
  8.13  services under Minnesota Statutes, 
  8.14  section 256B.49; and 
  8.15  (4) traumatic brain injury waivered 
  8.16  services under Minnesota Statutes, 
  8.17  section 256B.49. 
  8.18  County agencies will be responsible for 
  8.19  100 percent of any spending in excess 
  8.20  of the allocation made by the 
  8.21  commissioner.  Nothing in this section 
  8.22  shall be construed as reducing the 
  8.23  county's responsibility to offer and 
  8.24  make available feasible home and 
  8.25  community-based options to eligible 
  8.26  waiver recipients within the resources 
  8.27  allocated to them for that purpose. 
  8.28  (c) The commissioner shall reduce deaf 
  8.29  and hard-of-hearing grants by one 
  8.30  percent on July 1, 2003. 
  8.31  (d) Effective July 1, 2003, the 
  8.32  commissioner shall reduce payment rates 
  8.33  for each facility reimbursed under 
  8.34  Minnesota Statutes, section 256B.5012, 
  8.35  by decreasing the total operating 
  8.36  payment rate for intermediate care 
  8.37  facilities for the mentally retarded by 
  8.38  one percent.  For each facility, the 
  8.39  commissioner shall multiply the 
  8.40  adjustment by the total payment rate, 
  8.41  excluding the property-related payment 
  8.42  rate, in effect on June 30, 2003.  A 
  8.43  facility whose payment rates are 
  8.44  governed by closure agreements, 
  8.45  receivership agreements, or Minnesota 
  8.46  Rules, part 9553.0075, is not subject 
  8.47  to an adjustment otherwise taken under 
  8.48  this subdivision. 
  8.49  Notwithstanding section 14, these 
  8.50  adjustments the reimbursement rates and 
  8.51  allocations effective July 1, 2004, 
  8.52  shall not expire. 
  8.53  [REDUCE GROWTH IN MR/RC WAIVER.] The 
  8.54  commissioner shall reduce the growth in 
  8.55  the MR/RC waiver by not allocating the 
  8.56  300 additional diversion allocations 
  8.57  that are included in the February 2003 
  8.58  forecast for the fiscal years that 
  8.59  begin on July 1, 2003, and July 1, 2004.
  8.60  [MANAGE THE GROWTH IN THE TBI WAIVER.] 
  8.61  During the fiscal years beginning on 
  9.1   July 1, 2003, and July 1, 2004, the 
  9.2   commissioner shall allocate money for 
  9.3   home and community-based programs 
  9.4   covered under Minnesota Statutes, 
  9.5   section 256B.49, to assure a reduction 
  9.6   in state spending that is equivalent to 
  9.7   limiting the caseload growth of the TBI 
  9.8   waiver to 150 in each year of the 
  9.9   biennium.  Priorities for the 
  9.10  allocation of funds shall be for 
  9.11  individuals anticipated to be 
  9.12  discharged from institutional settings 
  9.13  or who are at imminent risk of a 
  9.14  placement in an institutional setting. 
  9.15  [TARGETED CASE MANAGEMENT FOR HOME CARE 
  9.16  RECIPIENTS.] Implementation of the 
  9.17  targeted case management benefit for 
  9.18  home care recipients, according to 
  9.19  Minnesota Statutes, section 256B.0621, 
  9.20  subdivisions 2, 3, 5, 6, 7, 9, and 10, 
  9.21  will be delayed until July 1, 2005. 
  9.22  [COMMON SERVICE MENU.] Implementation 
  9.23  of the common service menu option 
  9.24  within the home and community-based 
  9.25  waivers, according to Minnesota 
  9.26  Statutes, section 256B.49, subdivision 
  9.27  16, will be delayed until July 1, 2005. 
  9.28  [LIMITATION ON COMMUNITY ALTERNATIVES 
  9.29  FOR DISABLED INDIVIDUALS CASELOAD 
  9.30  GROWTH.] For the biennium ending June 
  9.31  30, 2005, the commissioner shall limit 
  9.32  the allocations made available in the 
  9.33  community alternatives for disabled 
  9.34  individuals waiver program in order not 
  9.35  to exceed average caseload growth of 95 
  9.36  per month from June 2003 program 
  9.37  levels, plus any additional 
  9.38  legislatively authorized program 
  9.39  growth.  The commissioner shall 
  9.40  allocate available resources to achieve 
  9.41  the following outcomes: 
  9.42  (1) the establishment of feasible and 
  9.43  viable alternatives for persons in 
  9.44  institutional or hospital settings to 
  9.45  relocate to home and community-based 
  9.46  settings; 
  9.47  (2) the availability of timely 
  9.48  assistance to persons at imminent risk 
  9.49  of institutional or hospital placement 
  9.50  or whose health and safety is at 
  9.51  immediate risk; and 
  9.52  (3) the maximum provision of essential 
  9.53  community supports to eligible persons 
  9.54  in need of and waiting for home and 
  9.55  community-based service alternatives.  
  9.56  The commissioner may reallocate 
  9.57  resources from one county or region to 
  9.58  another if available funding in that 
  9.59  county or region is not likely to be 
  9.60  spent and the reallocation is necessary 
  9.61  to achieve the outcomes specified in 
  9.62  this paragraph. 
  9.63  (g) Medical Assistance Long-term 
  9.64  Care Facilities Grants 
 10.1   General             543,999,000   514,483,000
 10.2   (h) Alternative Care Grants 
 10.3   General              75,206,000    66,351,000
 10.4   [ALTERNATIVE CARE TRANSFER.] Any money 
 10.5   allocated to the alternative care 
 10.6   program that is not spent for the 
 10.7   purposes indicated does not cancel but 
 10.8   shall be transferred to the medical 
 10.9   assistance account. 
 10.10  [ALTERNATIVE CARE APPROPRIATION.] The 
 10.11  commissioner may expend the money 
 10.12  appropriated for the alternative care 
 10.13  program for that purpose in either year 
 10.14  of the biennium. 
 10.15  [ALTERNATIVE CARE IMPLEMENTATION OF 
 10.16  CHANGES TO FEES AND ELIGIBILITY.] 
 10.17  Changes to Minnesota Statutes, section 
 10.18  256B.0913, subdivision 4, paragraph 
 10.19  (d), and subdivision 12, are effective 
 10.20  July 1, 2003, for all persons found 
 10.21  eligible for the alternative care 
 10.22  program on or after July 1, 2003.  All 
 10.23  recipients of alternative care funding 
 10.24  as of June 30, 2003, shall be subject 
 10.25  to Minnesota Statutes, section 
 10.26  256B.0913, subdivision 4, paragraph 
 10.27  (d), and subdivision 12, on the annual 
 10.28  reassessment and review of their 
 10.29  eligibility after July 1, 2003, but no 
 10.30  later than January 1, 2004. 
 10.31  (i) Group Residential Housing Grants 
 10.32  General              94,996,000    80,472,000
 10.33  [GROUP RESIDENTIAL HOUSING COSTS 
 10.34  REFINANCED.] (1) Effective July 1, 
 10.35  2004, the commissioner shall increase 
 10.36  the home and community-based service 
 10.37  rates and county allocations provided 
 10.38  to programs for persons with 
 10.39  disabilities established under section 
 10.40  1915(c) of the Social Security Act to 
 10.41  the extent that these programs will be 
 10.42  paying for the costs above the rate 
 10.43  established in Minnesota Statutes, 
 10.44  section 256I.05, subdivision 1. 
 10.45  (2) For persons in receipt of services 
 10.46  under Minnesota Statutes, section 
 10.47  256B.0915, who reside in licensed adult 
 10.48  foster care beds for which a 
 10.49  supplemental room and board payment was 
 10.50  being made under Minnesota Statutes, 
 10.51  section 256I.05, subdivision 1, 
 10.52  counties may request an exception to 
 10.53  the individual caps specified in 
 10.54  Minnesota Statutes, section 256B.0915, 
 10.55  subdivision 3, paragraph (b), not to 
 10.56  exceed the difference between the 
 10.57  individual cap and the client's monthly 
 10.58  service expenditures plus the amount of 
 10.59  the supplemental room and board rate.  
 10.60  The county must submit a request to 
 10.61  exceed the individual cap to the 
 11.1   commissioner for approval. 
 11.2   (j) Chemical Dependency
 11.3   Entitlement Grants 
 11.4   General              49,251,000    50,337,000
 11.5   (k) Chemical Dependency Nonentitlement 
 11.6   Grants 
 11.7   General               1,055,000     1,055,000
 11.8      Sec. 4.  [APPROPRIATION.] 
 11.9      $....... is appropriated from the general fund to the 
 11.10  commissioner of human services for the fiscal year beginning 
 11.11  July 1, 2004, for the purposes of sections 1 to 3.