1.1                          A bill for an act 
  1.2             relating to the operation of state government; making 
  1.3             changes to health and human services programs; 
  1.4             changing licensing and state-operated services 
  1.5             provisions; changing provisions in state health care 
  1.6             programs, changing MinnesotaCare to a forecasted 
  1.7             program and changing eligibility requirements and 
  1.8             payments, allowing transfer of excess health care 
  1.9             access funds to the general fund, allowing the 
  1.10            commissioner to withhold for delinquent nursing home 
  1.11            provider surcharges, allowing reduction of excess 
  1.12            assets for MA and changing other MA provisions, 
  1.13            reducing payments to managed care plans, establishing 
  1.14            medical necessity standards for state health care 
  1.15            programs, allowing the state to recover payment for 
  1.16            long-term care from trusts and life estates or joint 
  1.17            tenancy interests, and establishing a health services 
  1.18            policy committee and medication therapy management; 
  1.19            establishing a value-based nursing facility 
  1.20            reimbursement system and changing other provisions for 
  1.21            nursing facilities; changing continuing care for the 
  1.22            elderly and disabled provisions and establishing the 
  1.23            Minnesota partnership for long-term care programs, 
  1.24            increasing rate reimbursement for ICF/MR facilities, 
  1.25            health care services, and provider rate increases, 
  1.26            requiring a study for dental access, establishing an 
  1.27            interagency work group on disability services; 
  1.28            changing provisions for mental health services, 
  1.29            allowing payment for mental health telemedicine, 
  1.30            providing treatment foster care services and 
  1.31            transitional youth intensive rehabilitative mental 
  1.32            health services; modifying health policy, establishing 
  1.33            a Health Information Technology and Infrastructure 
  1.34            Advisory Committee, establishing a rural pharmacy 
  1.35            planning and transition grant program, requiring a 
  1.36            report from physicians and facilities performing 
  1.37            abortions, classifying data in abortion notification 
  1.38            reports, providing education on shaking infants and 
  1.39            children, establishing a voluntary trauma system, 
  1.40            trauma registry, and trauma advisory council, 
  1.41            establishing a cancer drug repository program, 
  1.42            prohibiting family grant funds to subsidize abortion 
  1.43            services, promoting positive abortion alternatives, 
  1.44            establishing the unborn child pain prevention act, 
  1.45            providing education on postpartum depression, 
  1.46            adjusting certain fees, providing civil and criminal 
  2.1             penalties; making forecast adjustments; appropriating 
  2.2             money; and providing for alternative funding; amending 
  2.3             Minnesota Statutes 2004, sections 13.3806, by adding a 
  2.4             subdivision; 16A.724; 103I.101, subdivision 6; 
  2.5             103I.208, subdivisions 1, 2; 103I.235, subdivision 1; 
  2.6             103I.601, subdivision 2; 144.122; 144.147, 
  2.7             subdivisions 1, 2; 144.148, subdivision 1; 144.1483; 
  2.8             144.1501, subdivisions 1, 2, 3, 4; 144.226, 
  2.9             subdivisions 1, 4, by adding subdivisions; 144.3831, 
  2.10            subdivision 1; 144.551, subdivision 1; 144.562, 
  2.11            subdivision 2; 144.9504, subdivision 2; 144.98, 
  2.12            subdivision 3; 144A.071, subdivision 4a; 144A.073, by 
  2.13            adding a subdivision; 144E.101, by adding a 
  2.14            subdivision; 145.56, subdivisions 2, 5; 145.924; 
  2.15            145.9268; 146A.11, subdivision 1; 147A.08; 150A.22; 
  2.16            157.15, by adding a subdivision; 157.16, subdivisions 
  2.17            2, 3, by adding subdivisions; 157.20, subdivisions 2, 
  2.18            2a; 214.01, subdivision 2; 214.06, subdivision 1, by 
  2.19            adding a subdivision; 245.4661, subdivisions 2, 6; 
  2.20            245.4885, subdivisions 1, 2, by adding a subdivision; 
  2.21            245A.10, subdivision 5; 245C.10, subdivisions 2, 3; 
  2.22            245C.32, subdivision 2; 246.0136, subdivision 1; 
  2.23            252.27, subdivision 2a; 253.20; 253B.02, subdivision 
  2.24            7; 256.01, subdivision 2, by adding subdivisions; 
  2.25            256.019, subdivision 1; 256.045, subdivisions 3, 3a; 
  2.26            256.046, subdivision 1; 256.9657, by adding a 
  2.27            subdivision; 256.969, subdivision 3a; 256B.02, 
  2.28            subdivision 12; 256B.04, by adding a subdivision; 
  2.29            256B.056, subdivisions 5, 5a, 5b, 7, by adding 
  2.30            subdivisions; 256B.057, subdivision 9; 256B.0575; 
  2.31            256B.0595, subdivision 2; 256B.06, subdivision 4; 
  2.32            256B.0621, subdivisions 2, 3, 4, 5, 6, 7, by adding a 
  2.33            subdivision; 256B.0625, subdivisions 2, 3a, 13, 13a, 
  2.34            13c, 13e, 13f, 17, by adding subdivisions; 256B.0644; 
  2.35            256B.075, subdivision 2; 256B.0913, subdivisions 2, 4; 
  2.36            256B.0916, by adding a subdivision; 256B.095; 
  2.37            256B.0951, subdivision 1; 256B.0952, subdivision 5; 
  2.38            256B.0953, subdivision 1; 256B.15, subdivision 1; 
  2.39            256B.19, subdivision 1; 256B.32, subdivision 1; 
  2.40            256B.431, subdivisions 28, 29, 35, by adding 
  2.41            subdivisions; 256B.432, subdivisions 1, 2, 5, by 
  2.42            adding subdivisions; 256B.434, subdivisions 3, 4, 4a, 
  2.43            4b, 4c, 4d, by adding a subdivision; 256B.438, 
  2.44            subdivision 3; 256B.47, subdivision 2; 256B.49, 
  2.45            subdivision 16; 256B.5012, by adding a subdivision; 
  2.46            256B.69, subdivisions 4, 23, by adding a subdivision; 
  2.47            256B.75; 256B.765; 256D.03, subdivisions 3, 4, by 
  2.48            adding subdivisions; 256D.045; 256L.01, subdivisions 
  2.49            1a, 4, 5; 256L.03, subdivisions 1, 3, 5, by adding a 
  2.50            subdivision; 256L.04, subdivisions 1, 2, 8, by adding 
  2.51            subdivisions; 256L.05, subdivisions 2, 3, 3a, 5; 
  2.52            256L.06, subdivision 3; 256L.07, subdivisions 1, 3, by 
  2.53            adding a subdivision; 256L.09, subdivision 2; 256L.11, 
  2.54            subdivision 6; 256L.12, subdivision 6, by adding a 
  2.55            subdivision; 256L.15, subdivisions 2, 3; 326.42, 
  2.56            subdivision 2; 471.61, by adding a subdivision; 
  2.57            514.981, subdivision 6; Laws 2003, First Special 
  2.58            Session chapter 14, article 12, section 93; Laws 2004, 
  2.59            chapter 267, article 12, section 4; proposing coding 
  2.60            for new law in Minnesota Statutes, chapters 62J; 144; 
  2.61            145; 245A; 256B; 501B; repealing Minnesota Statutes 
  2.62            2004, sections 13.383, subdivision 3; 13.411, 
  2.63            subdivision 3; 144.1486; 144.1502; 145.925; 146A.01, 
  2.64            subdivisions 2, 5; 146A.02; 146A.03; 146A.04; 146A.05; 
  2.65            146A.06; 146A.07; 146A.08; 146A.09; 146A.10; 157.215; 
  2.66            256.955; 256B.075, subdivision 5; 256L.035; 256L.04, 
  2.67            subdivisions 7, 11; 256L.09, subdivisions 1, 4, 5, 6, 
  2.68            7; 295.581; Minnesota Rules, parts 4700.1900; 
  2.69            4700.2000; 4700.2100; 4700.2200; 4700.2210; 4700.2300; 
  2.70            4700.2400; 4700.2410; 4700.2420; 4700.2500. 
  3.1   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  3.2                              ARTICLE 1 
  3.3                              LICENSING 
  3.4      Section 1.  Minnesota Statutes 2004, section 245A.10, 
  3.5   subdivision 5, is amended to read: 
  3.6      Subd. 5.  [ANNUAL LICENSE OR CERTIFICATION FEE FOR PROGRAMS 
  3.7   WITHOUT A LICENSED CAPACITY.] (a) Except as provided 
  3.8   in paragraph paragraphs (b) and (c), a program without a stated 
  3.9   licensed capacity shall pay a license or certification fee of 
  3.10  $400.  
  3.11     (b) A mental health center or mental health clinic 
  3.12  requesting certification for purposes of insurance and 
  3.13  subscriber contract reimbursement under Minnesota Rules, parts 
  3.14  9520.0750 to 9520.0870, shall pay a certification fee of $1,000 
  3.15  per year.  If the mental health center or mental health clinic 
  3.16  provides services at a primary location with satellite 
  3.17  facilities, the satellite facilities shall be certified with the 
  3.18  primary location without an additional charge. 
  3.19     (c) A program licensed to provide residential-based 
  3.20  habilitation services under the home and community-based waiver 
  3.21  for persons with developmental disabilities shall pay an annual 
  3.22  license fee that includes a base rate of $250 plus $38 times the 
  3.23  number of clients served on the first day of August of the 
  3.24  current license year.  State-operated programs are exempt from 
  3.25  the license fee under this paragraph. 
  3.26     Sec. 2.  Minnesota Statutes 2004, section 245C.10, 
  3.27  subdivision 2, is amended to read: 
  3.28     Subd. 2.  [SUPPLEMENTAL NURSING SERVICES AGENCIES.] The 
  3.29  commissioner shall recover the cost of the background studies 
  3.30  initiated by supplemental nursing services agencies registered 
  3.31  under section 144A.71, subdivision 1, through a fee of no more 
  3.32  than $8 $20 per study charged to the agency.  The fees collected 
  3.33  under this subdivision are appropriated to the commissioner for 
  3.34  the purpose of conducting background studies. 
  3.35     Sec. 3.  Minnesota Statutes 2004, section 245C.10, 
  3.36  subdivision 3, is amended to read: 
  4.1      Subd. 3.  [PERSONAL CARE PROVIDER ORGANIZATIONS.] The 
  4.2   commissioner shall recover the cost of background studies 
  4.3   initiated by a personal care provider organization under section 
  4.4   256B.0627 through a fee of no more than $12 $20 per study 
  4.5   charged to the organization responsible for submitting the 
  4.6   background study form.  The fees collected under this 
  4.7   subdivision are appropriated to the commissioner for the purpose 
  4.8   of conducting background studies. 
  4.9      Sec. 4.  Minnesota Statutes 2004, section 245C.32, 
  4.10  subdivision 2, is amended to read: 
  4.11     Subd. 2.  [USE.] (a) The commissioner may also use these 
  4.12  systems and records to obtain and provide criminal history data 
  4.13  from the Bureau of Criminal Apprehension, criminal history data 
  4.14  held by the commissioner, and data about substantiated 
  4.15  maltreatment under section 626.556 or 626.557, for other 
  4.16  purposes, provided that: 
  4.17     (1) the background study is specifically authorized in 
  4.18  statute; or 
  4.19     (2) the request is made with the informed consent of the 
  4.20  subject of the study as provided in section 13.05, subdivision 4.
  4.21     (b) An individual making a request under paragraph (a), 
  4.22  clause (2), must agree in writing not to disclose the data to 
  4.23  any other individual without the consent of the subject of the 
  4.24  data. 
  4.25     (c) The commissioner may recover the cost of obtaining and 
  4.26  providing background study data by charging the individual or 
  4.27  entity requesting the study a fee of no more than $12 $20 per 
  4.28  study.  The fees collected under this paragraph are appropriated 
  4.29  to the commissioner for the purpose of conducting background 
  4.30  studies. 
  4.31                             ARTICLE 2
  4.32                      STATE-OPERATED SERVICES 
  4.33     Section 1.  Minnesota Statutes 2004, section 245.4661, 
  4.34  subdivision 2, is amended to read: 
  4.35     Subd. 2.  [PROGRAM DESIGN AND IMPLEMENTATION.] (a) The 
  4.36  pilot projects shall be established to design, plan, and improve 
  5.1   the mental health service delivery system for adults with 
  5.2   serious and persistent mental illness that would: 
  5.3      (1) provide an expanded array of services from which 
  5.4   clients can choose services appropriate to their needs; 
  5.5      (2) be based on purchasing strategies that improve access 
  5.6   and coordinate services without cost shifting; 
  5.7      (3) incorporate existing state facilities and resources 
  5.8   into the community mental health infrastructure through creative 
  5.9   partnerships with local vendors; and 
  5.10     (4) utilize existing categorical funding streams and 
  5.11  reimbursement sources in combined and creative ways, except 
  5.12  appropriations to regional treatment centers and all funds that 
  5.13  are attributable to the operation of state-operated services are 
  5.14  excluded unless appropriated specifically by the legislature for 
  5.15  a purpose consistent with this section or section 246.0136, 
  5.16  subdivision 1. 
  5.17     (b) All projects funded by January 1, 1997, must complete 
  5.18  the planning phase and be operational by June 30, 1997; all 
  5.19  projects funded by January 1, 1998, must be operational by June 
  5.20  30, 1998.  
  5.21     Sec. 2.  Minnesota Statutes 2004, section 245.4661, 
  5.22  subdivision 6, is amended to read: 
  5.23     Subd. 6.  [DUTIES OF COMMISSIONER.] (a) For purposes of the 
  5.24  pilot projects, the commissioner shall facilitate integration of 
  5.25  funds or other resources as needed and requested by each 
  5.26  project.  These resources may include: 
  5.27     (1) residential services funds administered under Minnesota 
  5.28  Rules, parts 9535.2000 to 9535.3000, in an amount to be 
  5.29  determined by mutual agreement between the project's managing 
  5.30  entity and the commissioner of human services after an 
  5.31  examination of the county's historical utilization of facilities 
  5.32  located both within and outside of the county and licensed under 
  5.33  Minnesota Rules, parts 9520.0500 to 9520.0690; 
  5.34     (2) community support services funds administered under 
  5.35  Minnesota Rules, parts 9535.1700 to 9535.1760; 
  5.36     (3) other mental health special project funds; 
  6.1      (4) medical assistance, general assistance medical care, 
  6.2   MinnesotaCare and group residential housing if requested by the 
  6.3   project's managing entity, and if the commissioner determines 
  6.4   this would be consistent with the state's overall health care 
  6.5   reform efforts; and 
  6.6      (5) regional treatment center nonfiscal resources to the 
  6.7   extent agreed to by the project's managing entity and the 
  6.8   regional treatment center consistent with section 246.0136, 
  6.9   subdivision 1. 
  6.10     (b) The commissioner shall consider the following criteria 
  6.11  in awarding start-up and implementation grants for the pilot 
  6.12  projects: 
  6.13     (1) the ability of the proposed projects to accomplish the 
  6.14  objectives described in subdivision 2; 
  6.15     (2) the size of the target population to be served; and 
  6.16     (3) geographical distribution. 
  6.17     (c) The commissioner shall review overall status of the 
  6.18  projects initiatives at least every two years and recommend any 
  6.19  legislative changes needed by January 15 of each odd-numbered 
  6.20  year. 
  6.21     (d) The commissioner may waive administrative rule 
  6.22  requirements which are incompatible with the implementation of 
  6.23  the pilot project. 
  6.24     (e) The commissioner may exempt the participating counties 
  6.25  from fiscal sanctions for noncompliance with requirements in 
  6.26  laws and rules which are incompatible with the implementation of 
  6.27  the pilot project. 
  6.28     (f) The commissioner may award grants to an entity 
  6.29  designated by a county board or group of county boards to pay 
  6.30  for start-up and implementation costs of the pilot project. 
  6.31     Sec. 3.  Minnesota Statutes 2004, section 246.0136, 
  6.32  subdivision 1, is amended to read: 
  6.33     Subdivision 1.  [PLANNING FOR ENTERPRISE ACTIVITIES.] The 
  6.34  commissioner of human services is directed to study and make 
  6.35  recommendations to the legislature on establishing enterprise 
  6.36  activities within state-operated services.  Before implementing 
  7.1   an enterprise activity, the commissioner must obtain statutory 
  7.2   authorization for its implementation, except that the 
  7.3   commissioner has authority to implement enterprise activities 
  7.4   for adult mental health, adolescent services, and to establish a 
  7.5   public group practice without statutory authorization.  
  7.6   Enterprise activities are defined as the range of services, 
  7.7   which are delivered by state employees, needed by people with 
  7.8   disabilities and are fully funded by public or private 
  7.9   third-party health insurance or other revenue sources available 
  7.10  to clients that provide reimbursement for the services 
  7.11  provided.  Enterprise activities within state-operated services 
  7.12  shall specialize in caring for vulnerable people for whom no 
  7.13  other providers are available or for whom state-operated 
  7.14  services may be the provider selected by the payer.  In 
  7.15  subsequent biennia after an enterprise activity is established 
  7.16  within a state-operated service, the base state appropriation 
  7.17  for that state-operated service shall be reduced proportionate 
  7.18  to the size of the enterprise activity. 
  7.19     Sec. 4.  Minnesota Statutes 2004, section 253.20, is 
  7.20  amended to read: 
  7.21     253.20 [MINNESOTA SECURITY HOSPITAL.] 
  7.22     The commissioner of human services shall erect, equip, and 
  7.23  maintain in St. Peter a and other geographic locations under the 
  7.24  control of the commissioner of human services suitable 
  7.25  building buildings to be known as the Minnesota Security 
  7.26  Hospital, for the purpose of providing a secure treatment 
  7.27  facility as defined in section 253B.02, subdivision 18a, for 
  7.28  persons who may be committed there by courts, or otherwise, or 
  7.29  transferred there by the commissioner of human services, and for 
  7.30  persons who are found to be mentally ill while confined in any 
  7.31  correctional facility, or who may be found to be mentally ill 
  7.32  and dangerous, and the commissioner shall supervise and manage 
  7.33  the same as in the case of other state hospitals. 
  7.34     Sec. 5.  [AUTHORIZATION TO CLOSE AND VACATE REGIONAL 
  7.35  TREATMENT CENTER AND STATE-OPERATED NURSING HOME CAMPUSES.] 
  7.36     Effective the day following final enactment, the 
  8.1   commissioner of human services is authorized to vacate and close 
  8.2   the regional treatment center programs and campuses and 
  8.3   state-operated nursing home programs and campuses, upon 
  8.4   notification of the chairs of the house and senate committees 
  8.5   having jurisdiction over human services, once the commissioner 
  8.6   has determined that the criteria established under Laws 2003, 
  8.7   First Special Session chapter 14, article 6, section 64, have 
  8.8   been met. 
  8.9                              ARTICLE 3 
  8.10                            HEALTH CARE 
  8.11     Section 1.  Minnesota Statutes 2004, section 16A.724, is 
  8.12  amended to read: 
  8.13     16A.724 [HEALTH CARE ACCESS FUND.] 
  8.14     Subdivision 1.  [CREATION OF FUND.] (a) A health care 
  8.15  access fund is created in the state treasury.  The fund is a 
  8.16  direct appropriated special revenue fund.  The commissioner 
  8.17  shall deposit to the credit of the fund money made available to 
  8.18  the fund.  Notwithstanding section 11A.20, after June 30, 1997, 
  8.19  all investment income and all investment losses attributable to 
  8.20  the investment of the health care access fund not currently 
  8.21  needed shall be credited to the health care access fund. 
  8.22     (b) Effective July 1, 2006, the commissioner of finance 
  8.23  shall deposit revenues collected from section 256.9657, 
  8.24  subdivisions 2 and 3, into the health care access fund. 
  8.25     Subd. 2.  [TRANSFERS.] To the extent available resources in 
  8.26  the health care access fund exceed expenditures in that fund, 
  8.27  starting in fiscal year 2005, the commissioner of finance shall 
  8.28  transfer the excess funds from the health care access fund to 
  8.29  the general fund on June 30 of each year. 
  8.30     (a) In fiscal year 2005, transfers may not exceed 
  8.31  $192,442,000.  For fiscal year 2008 and thereafter, the transfer 
  8.32  may not exceed $50,000,000. 
  8.33     (b) For fiscal years 2005 to 2007, MinnesotaCare shall be a 
  8.34  forecasted program and, if necessary, the commissioner shall 
  8.35  reduce transfers to meet expenditures and shall transfer 
  8.36  sufficient funds from the general fund to the health care access 
  9.1   fund to meet annual expenditures. 
  9.2      <b>[EFFECTIVE DATE.]</b> This section is effective the day 
  9.3   following final enactment. 
  9.4      Sec. 2.  Minnesota Statutes 2004, section 256.01, 
  9.5   subdivision 2, is amended to read: 
  9.6      Subd. 2.  [SPECIFIC POWERS.] Subject to the provisions of 
  9.7   section 241.021, subdivision 2, the commissioner of human 
  9.8   services shall carry out the specific duties in paragraphs (a) 
  9.9   through (aa) (cc): 
  9.10     (a) Administer and supervise all forms of public assistance 
  9.11  provided for by state law and other welfare activities or 
  9.12  services as are vested in the commissioner.  Administration and 
  9.13  supervision of human services activities or services includes, 
  9.14  but is not limited to, assuring timely and accurate distribution 
  9.15  of benefits, completeness of service, and quality program 
  9.16  management.  In addition to administering and supervising human 
  9.17  services activities vested by law in the department, the 
  9.18  commissioner shall have the authority to: 
  9.19     (1) require county agency participation in training and 
  9.20  technical assistance programs to promote compliance with 
  9.21  statutes, rules, federal laws, regulations, and policies 
  9.22  governing human services; 
  9.23     (2) monitor, on an ongoing basis, the performance of county 
  9.24  agencies in the operation and administration of human services, 
  9.25  enforce compliance with statutes, rules, federal laws, 
  9.26  regulations, and policies governing welfare services and promote 
  9.27  excellence of administration and program operation; 
  9.28     (3) develop a quality control program or other monitoring 
  9.29  program to review county performance and accuracy of benefit 
  9.30  determinations; 
  9.31     (4) require county agencies to make an adjustment to the 
  9.32  public assistance benefits issued to any individual consistent 
  9.33  with federal law and regulation and state law and rule and to 
  9.34  issue or recover benefits as appropriate; 
  9.35     (5) delay or deny payment of all or part of the state and 
  9.36  federal share of benefits and administrative reimbursement 
 10.1   according to the procedures set forth in section 256.017; 
 10.2      (6) make contracts with and grants to public and private 
 10.3   agencies and organizations, both profit and nonprofit, and 
 10.4   individuals, using appropriated funds; and 
 10.5      (7) enter into contractual agreements with federally 
 10.6   recognized Indian tribes with a reservation in Minnesota to the 
 10.7   extent necessary for the tribe to operate a federally approved 
 10.8   family assistance program or any other program under the 
 10.9   supervision of the commissioner.  The commissioner shall consult 
 10.10  with the affected county or counties in the contractual 
 10.11  agreement negotiations, if the county or counties wish to be 
 10.12  included, in order to avoid the duplication of county and tribal 
 10.13  assistance program services.  The commissioner may establish 
 10.14  necessary accounts for the purposes of receiving and disbursing 
 10.15  funds as necessary for the operation of the programs. 
 10.16     (b) Inform county agencies, on a timely basis, of changes 
 10.17  in statute, rule, federal law, regulation, and policy necessary 
 10.18  to county agency administration of the programs. 
 10.19     (c) Administer and supervise all child welfare activities; 
 10.20  promote the enforcement of laws protecting handicapped, 
 10.21  dependent, neglected and delinquent children, and children born 
 10.22  to mothers who were not married to the children's fathers at the 
 10.23  times of the conception nor at the births of the children; 
 10.24  license and supervise child-caring and child-placing agencies 
 10.25  and institutions; supervise the care of children in boarding and 
 10.26  foster homes or in private institutions; and generally perform 
 10.27  all functions relating to the field of child welfare now vested 
 10.28  in the State Board of Control. 
 10.29     (d) Administer and supervise all noninstitutional service 
 10.30  to handicapped persons, including those who are visually 
 10.31  impaired, hearing impaired, or physically impaired or otherwise 
 10.32  handicapped.  The commissioner may provide and contract for the 
 10.33  care and treatment of qualified indigent children in facilities 
 10.34  other than those located and available at state hospitals when 
 10.35  it is not feasible to provide the service in state hospitals. 
 10.36     (e) Assist and actively cooperate with other departments, 
 11.1   agencies and institutions, local, state, and federal, by 
 11.2   performing services in conformity with the purposes of Laws 
 11.3   1939, chapter 431. 
 11.4      (f) Act as the agent of and cooperate with the federal 
 11.5   government in matters of mutual concern relative to and in 
 11.6   conformity with the provisions of Laws 1939, chapter 431, 
 11.7   including the administration of any federal funds granted to the 
 11.8   state to aid in the performance of any functions of the 
 11.9   commissioner as specified in Laws 1939, chapter 431, and 
 11.10  including the promulgation of rules making uniformly available 
 11.11  medical care benefits to all recipients of public assistance, at 
 11.12  such times as the federal government increases its participation 
 11.13  in assistance expenditures for medical care to recipients of 
 11.14  public assistance, the cost thereof to be borne in the same 
 11.15  proportion as are grants of aid to said recipients. 
 11.16     (g) Establish and maintain any administrative units 
 11.17  reasonably necessary for the performance of administrative 
 11.18  functions common to all divisions of the department. 
 11.19     (h) Act as designated guardian of both the estate and the 
 11.20  person of all the wards of the state of Minnesota, whether by 
 11.21  operation of law or by an order of court, without any further 
 11.22  act or proceeding whatever, except as to persons committed as 
 11.23  mentally retarded.  For children under the guardianship of the 
 11.24  commissioner whose interests would be best served by adoptive 
 11.25  placement, the commissioner may contract with a licensed 
 11.26  child-placing agency or a Minnesota tribal social services 
 11.27  agency to provide adoption services.  A contract with a licensed 
 11.28  child-placing agency must be designed to supplement existing 
 11.29  county efforts and may not replace existing county programs, 
 11.30  unless the replacement is agreed to by the county board and the 
 11.31  appropriate exclusive bargaining representative or the 
 11.32  commissioner has evidence that child placements of the county 
 11.33  continue to be substantially below that of other counties.  
 11.34  Funds encumbered and obligated under an agreement for a specific 
 11.35  child shall remain available until the terms of the agreement 
 11.36  are fulfilled or the agreement is terminated. 
 12.1      (i) Act as coordinating referral and informational center 
 12.2   on requests for service for newly arrived immigrants coming to 
 12.3   Minnesota. 
 12.4      (j) The specific enumeration of powers and duties as 
 12.5   hereinabove set forth shall in no way be construed to be a 
 12.6   limitation upon the general transfer of powers herein contained. 
 12.7      (k) Establish county, regional, or statewide schedules of 
 12.8   maximum fees and charges which may be paid by county agencies 
 12.9   for medical, dental, surgical, hospital, nursing and nursing 
 12.10  home care and medicine and medical supplies under all programs 
 12.11  of medical care provided by the state and for congregate living 
 12.12  care under the income maintenance programs. 
 12.13     (l) Have the authority to conduct and administer 
 12.14  experimental projects to test methods and procedures of 
 12.15  administering assistance and services to recipients or potential 
 12.16  recipients of public welfare.  To carry out such experimental 
 12.17  projects, it is further provided that the commissioner of human 
 12.18  services is authorized to waive the enforcement of existing 
 12.19  specific statutory program requirements, rules, and standards in 
 12.20  one or more counties.  The order establishing the waiver shall 
 12.21  provide alternative methods and procedures of administration, 
 12.22  shall not be in conflict with the basic purposes, coverage, or 
 12.23  benefits provided by law, and in no event shall the duration of 
 12.24  a project exceed four years.  It is further provided that no 
 12.25  order establishing an experimental project as authorized by the 
 12.26  provisions of this section shall become effective until the 
 12.27  following conditions have been met: 
 12.28     (1) the secretary of health and human services of the 
 12.29  United States has agreed, for the same project, to waive state 
 12.30  plan requirements relative to statewide uniformity; and 
 12.31     (2) a comprehensive plan, including estimated project 
 12.32  costs, shall be approved by the Legislative Advisory Commission 
 12.33  and filed with the commissioner of administration.  
 12.34     (m) According to federal requirements, establish procedures 
 12.35  to be followed by local welfare boards in creating citizen 
 12.36  advisory committees, including procedures for selection of 
 13.1   committee members. 
 13.2      (n) Allocate federal fiscal disallowances or sanctions 
 13.3   which are based on quality control error rates for the aid to 
 13.4   families with dependent children program formerly codified in 
 13.5   sections 256.72 to 256.87, medical assistance, or food stamp 
 13.6   program in the following manner:  
 13.7      (1) one-half of the total amount of the disallowance shall 
 13.8   be borne by the county boards responsible for administering the 
 13.9   programs.  For the medical assistance and the AFDC program 
 13.10  formerly codified in sections 256.72 to 256.87, disallowances 
 13.11  shall be shared by each county board in the same proportion as 
 13.12  that county's expenditures for the sanctioned program are to the 
 13.13  total of all counties' expenditures for the AFDC program 
 13.14  formerly codified in sections 256.72 to 256.87, and medical 
 13.15  assistance programs.  For the food stamp program, sanctions 
 13.16  shall be shared by each county board, with 50 percent of the 
 13.17  sanction being distributed to each county in the same proportion 
 13.18  as that county's administrative costs for food stamps are to the 
 13.19  total of all food stamp administrative costs for all counties, 
 13.20  and 50 percent of the sanctions being distributed to each county 
 13.21  in the same proportion as that county's value of food stamp 
 13.22  benefits issued are to the total of all benefits issued for all 
 13.23  counties.  Each county shall pay its share of the disallowance 
 13.24  to the state of Minnesota.  When a county fails to pay the 
 13.25  amount due hereunder, the commissioner may deduct the amount 
 13.26  from reimbursement otherwise due the county, or the attorney 
 13.27  general, upon the request of the commissioner, may institute 
 13.28  civil action to recover the amount due; and 
 13.29     (2) notwithstanding the provisions of clause (1), if the 
 13.30  disallowance results from knowing noncompliance by one or more 
 13.31  counties with a specific program instruction, and that knowing 
 13.32  noncompliance is a matter of official county board record, the 
 13.33  commissioner may require payment or recover from the county or 
 13.34  counties, in the manner prescribed in clause (1), an amount 
 13.35  equal to the portion of the total disallowance which resulted 
 13.36  from the noncompliance, and may distribute the balance of the 
 14.1   disallowance according to clause (1).  
 14.2      (o) Develop and implement special projects that maximize 
 14.3   reimbursements and result in the recovery of money to the 
 14.4   state.  For the purpose of recovering state money, the 
 14.5   commissioner may enter into contracts with third parties.  Any 
 14.6   recoveries that result from projects or contracts entered into 
 14.7   under this paragraph shall be deposited in the state treasury 
 14.8   and credited to a special account until the balance in the 
 14.9   account reaches $1,000,000.  When the balance in the account 
 14.10  exceeds $1,000,000, the excess shall be transferred and credited 
 14.11  to the general fund.  All money in the account is appropriated 
 14.12  to the commissioner for the purposes of this paragraph. 
 14.13     (p) Have the authority to make direct payments to 
 14.14  facilities providing shelter to women and their children 
 14.15  according to section 256D.05, subdivision 3.  Upon the written 
 14.16  request of a shelter facility that has been denied payments 
 14.17  under section 256D.05, subdivision 3, the commissioner shall 
 14.18  review all relevant evidence and make a determination within 30 
 14.19  days of the request for review regarding issuance of direct 
 14.20  payments to the shelter facility.  Failure to act within 30 days 
 14.21  shall be considered a determination not to issue direct payments.
 14.22     (q) Have the authority to establish and enforce the 
 14.23  following county reporting requirements:  
 14.24     (1) the commissioner shall establish fiscal and statistical 
 14.25  reporting requirements necessary to account for the expenditure 
 14.26  of funds allocated to counties for human services programs.  
 14.27  When establishing financial and statistical reporting 
 14.28  requirements, the commissioner shall evaluate all reports, in 
 14.29  consultation with the counties, to determine if the reports can 
 14.30  be simplified or the number of reports can be reduced; 
 14.31     (2) the county board shall submit monthly or quarterly 
 14.32  reports to the department as required by the commissioner.  
 14.33  Monthly reports are due no later than 15 working days after the 
 14.34  end of the month.  Quarterly reports are due no later than 30 
 14.35  calendar days after the end of the quarter, unless the 
 14.36  commissioner determines that the deadline must be shortened to 
 15.1   20 calendar days to avoid jeopardizing compliance with federal 
 15.2   deadlines or risking a loss of federal funding.  Only reports 
 15.3   that are complete, legible, and in the required format shall be 
 15.4   accepted by the commissioner; 
 15.5      (3) if the required reports are not received by the 
 15.6   deadlines established in clause (2), the commissioner may delay 
 15.7   payments and withhold funds from the county board until the next 
 15.8   reporting period.  When the report is needed to account for the 
 15.9   use of federal funds and the late report results in a reduction 
 15.10  in federal funding, the commissioner shall withhold from the 
 15.11  county boards with late reports an amount equal to the reduction 
 15.12  in federal funding until full federal funding is received; 
 15.13     (4) a county board that submits reports that are late, 
 15.14  illegible, incomplete, or not in the required format for two out 
 15.15  of three consecutive reporting periods is considered 
 15.16  noncompliant.  When a county board is found to be noncompliant, 
 15.17  the commissioner shall notify the county board of the reason the 
 15.18  county board is considered noncompliant and request that the 
 15.19  county board develop a corrective action plan stating how the 
 15.20  county board plans to correct the problem.  The corrective 
 15.21  action plan must be submitted to the commissioner within 45 days 
 15.22  after the date the county board received notice of 
 15.23  noncompliance; 
 15.24     (5) the final deadline for fiscal reports or amendments to 
 15.25  fiscal reports is one year after the date the report was 
 15.26  originally due.  If the commissioner does not receive a report 
 15.27  by the final deadline, the county board forfeits the funding 
 15.28  associated with the report for that reporting period and the 
 15.29  county board must repay any funds associated with the report 
 15.30  received for that reporting period; 
 15.31     (6) the commissioner may not delay payments, withhold 
 15.32  funds, or require repayment under clause (3) or (5) if the 
 15.33  county demonstrates that the commissioner failed to provide 
 15.34  appropriate forms, guidelines, and technical assistance to 
 15.35  enable the county to comply with the requirements.  If the 
 15.36  county board disagrees with an action taken by the commissioner 
 16.1   under clause (3) or (5), the county board may appeal the action 
 16.2   according to sections 14.57 to 14.69; and 
 16.3      (7) counties subject to withholding of funds under clause 
 16.4   (3) or forfeiture or repayment of funds under clause (5) shall 
 16.5   not reduce or withhold benefits or services to clients to cover 
 16.6   costs incurred due to actions taken by the commissioner under 
 16.7   clause (3) or (5). 
 16.8      (r) Allocate federal fiscal disallowances or sanctions for 
 16.9   audit exceptions when federal fiscal disallowances or sanctions 
 16.10  are based on a statewide random sample for the foster care 
 16.11  program under title IV-E of the Social Security Act, United 
 16.12  States Code, title 42, in direct proportion to each county's 
 16.13  title IV-E foster care maintenance claim for that period. 
 16.14     (s) Be responsible for ensuring the detection, prevention, 
 16.15  investigation, and resolution of fraudulent activities or 
 16.16  behavior by applicants, recipients, and other participants in 
 16.17  the human services programs administered by the department. 
 16.18     (t) Require county agencies to identify overpayments, 
 16.19  establish claims, and utilize all available and cost-beneficial 
 16.20  methodologies to collect and recover these overpayments in the 
 16.21  human services programs administered by the department. 
 16.22     (u) Have the authority to administer a drug rebate program 
 16.23  for drugs purchased pursuant to the prescription drug program 
 16.24  established under section 256.955 after the beneficiary's 
 16.25  satisfaction of any deductible established in the program.  The 
 16.26  commissioner shall require a rebate agreement from all 
 16.27  manufacturers of covered drugs as defined in section 256B.0625, 
 16.28  subdivision 13.  Rebate agreements for prescription drugs 
 16.29  delivered on or after July 1, 2002, must include rebates for 
 16.30  individuals covered under the prescription drug program who are 
 16.31  under 65 years of age.  For each drug, the amount of the rebate 
 16.32  shall be equal to the rebate as defined for purposes of the 
 16.33  federal rebate program in United States Code, title 42, section 
 16.34  1396r-8.  The manufacturers must provide full payment within 30 
 16.35  days of receipt of the state invoice for the rebate within the 
 16.36  terms and conditions used for the federal rebate program 
 17.1   established pursuant to section 1927 of title XIX of the Social 
 17.2   Security Act.  The manufacturers must provide the commissioner 
 17.3   with any information necessary to verify the rebate determined 
 17.4   per drug.  The rebate program shall utilize the terms and 
 17.5   conditions used for the federal rebate program established 
 17.6   pursuant to section 1927 of title XIX of the Social Security Act.
 17.7      (v) Have the authority to administer the federal drug 
 17.8   rebate program for drugs purchased under the medical assistance 
 17.9   program as allowed by section 1927 of title XIX of the Social 
 17.10  Security Act and according to the terms and conditions of 
 17.11  section 1927.  Rebates shall be collected for all drugs that 
 17.12  have been dispensed or administered in an outpatient setting and 
 17.13  that are from manufacturers who have signed a rebate agreement 
 17.14  with the United States Department of Health and Human Services. 
 17.15     (w) Have the authority to administer a supplemental drug 
 17.16  rebate program for drugs purchased under the medical assistance 
 17.17  program.  The commissioner may enter into supplemental rebate 
 17.18  contracts with pharmaceutical manufacturers and may require 
 17.19  prior authorization for drugs that are from manufacturers that 
 17.20  have not signed a supplemental rebate contract.  Prior 
 17.21  authorization of drugs shall be subject to the provisions of 
 17.22  section 256B.0625, subdivision 13. 
 17.23     (x) Operate the department's communication systems account 
 17.24  established in Laws 1993, First Special Session chapter 1, 
 17.25  article 1, section 2, subdivision 2, to manage shared 
 17.26  communication costs necessary for the operation of the programs 
 17.27  the commissioner supervises.  A communications account may also 
 17.28  be established for each regional treatment center which operates 
 17.29  communications systems.  Each account must be used to manage 
 17.30  shared communication costs necessary for the operations of the 
 17.31  programs the commissioner supervises.  The commissioner may 
 17.32  distribute the costs of operating and maintaining communication 
 17.33  systems to participants in a manner that reflects actual usage. 
 17.34  Costs may include acquisition, licensing, insurance, 
 17.35  maintenance, repair, staff time and other costs as determined by 
 17.36  the commissioner.  Nonprofit organizations and state, county, 
 18.1   and local government agencies involved in the operation of 
 18.2   programs the commissioner supervises may participate in the use 
 18.3   of the department's communications technology and share in the 
 18.4   cost of operation.  The commissioner may accept on behalf of the 
 18.5   state any gift, bequest, devise or personal property of any 
 18.6   kind, or money tendered to the state for any lawful purpose 
 18.7   pertaining to the communication activities of the department.  
 18.8   Any money received for this purpose must be deposited in the 
 18.9   department's communication systems accounts.  Money collected by 
 18.10  the commissioner for the use of communication systems must be 
 18.11  deposited in the state communication systems account and is 
 18.12  appropriated to the commissioner for purposes of this section. 
 18.13     (y) Receive any federal matching money that is made 
 18.14  available through the medical assistance program for the 
 18.15  consumer satisfaction survey.  Any federal money received for 
 18.16  the survey is appropriated to the commissioner for this 
 18.17  purpose.  The commissioner may expend the federal money received 
 18.18  for the consumer satisfaction survey in either year of the 
 18.19  biennium. 
 18.20     (z) Designate community information and referral call 
 18.21  centers and incorporate cost reimbursement claims from the 
 18.22  designated community information and referral call centers into 
 18.23  the federal cost reimbursement claiming processes of the 
 18.24  department according to federal law, rule, and regulations.  
 18.25  Existing information and referral centers provided by Greater 
 18.26  Twin Cities United Way or existing call centers for which 
 18.27  Greater Twin Cities United Way has legal authority to represent, 
 18.28  shall be included in these designations upon review by the 
 18.29  commissioner and assurance that these services are accredited 
 18.30  and in compliance with national standards.  Any reimbursement is 
 18.31  appropriated to the commissioner and all designated information 
 18.32  and referral centers shall receive payments according to normal 
 18.33  department schedules established by the commissioner upon final 
 18.34  approval of allocation methodologies from the United States 
 18.35  Department of Health and Human Services Division of Cost 
 18.36  Allocation or other appropriate authorities. 
 19.1      (aa) Develop recommended standards for foster care homes 
 19.2   that address the components of specialized therapeutic services 
 19.3   to be provided by foster care homes with those services. 
 19.4      (bb) Have the authority to administer a drug rebate program 
 19.5   for drugs purchased for persons eligible for general assistance 
 19.6   medical care under section 256D.03, subdivision 3.  The 
 19.7   commissioner shall require a rebate agreement from all 
 19.8   manufacturers of covered drugs as defined in section 256B.0625, 
 19.9   subdivisions 13 and 13d.  For each drug, the amount of the 
 19.10  rebate shall be equal to the rebate as defined for purposes of 
 19.11  the federal rebate program in United States Code, title 42, 
 19.12  section 1396r-8.  The manufacturers must provide payment within 
 19.13  the terms and conditions used for the federal rebate program 
 19.14  established under section 1927 of title XIX of the Social 
 19.15  Security Act.  The manufacturers must provide the commissioner 
 19.16  with any information necessary to verify the rebate determined 
 19.17  per drug.  The rebate program shall utilize the terms and 
 19.18  conditions used for the federal rebate program established under 
 19.19  section 1927 of title XIX of the Social Security Act. 
 19.20     Effective January 1, 2006, drug coverage under general 
 19.21  assistance medical care shall be limited to those prescription 
 19.22  drugs that: 
 19.23     (1) are covered under the medical assistance program as 
 19.24  described in section 256B.0625, subdivisions 13 and 13d; and 
 19.25     (2) are provided by manufacturers that have fully executed 
 19.26  general assistance medical care rebate agreements with the 
 19.27  commissioner and comply with such agreements.  Prescription drug 
 19.28  coverage under general assistance medical care shall conform to 
 19.29  coverage under the medical assistance program according to 
 19.30  section 256B.0625, subdivisions 13 to 13g. 
 19.31     The rebate revenues collected under the drug rebate program 
 19.32  are dedicated to funding the pharmaceutical assistance program 
 19.33  established under paragraph (cc). 
 19.34     (cc) Have the authority to administer a pharmaceutical 
 19.35  assistance program.  The pharmaceutical assistance program may 
 19.36  include: 
 20.1      (1) a drug discount card; 
 20.2      (2) assistance to the program administered by the Minnesota 
 20.3   Board on Aging under section 256.975, subdivision 9; and 
 20.4      (3) other efforts designed to assist citizens of the state 
 20.5   who are not eligible for prescription drug coverage to obtain 
 20.6   free or discounted prescription drugs. 
 20.7      The commissioner shall have authority to administer a drug 
 20.8   rebate program for any discount card program established under 
 20.9   this paragraph.  The rebates collected under this paragraph 
 20.10  shall be used to provide a discount on the prescription drugs 
 20.11  dispensed to enrollees of the discount card program. 
 20.12     Sec. 3.  Minnesota Statutes 2004, section 256.01, is 
 20.13  amended by adding a subdivision to read: 
 20.14     Subd. 2a.  [AUTHORIZATION FOR TEST SITES FOR HEALTH CARE 
 20.15  PROGRAMS.] In coordination with the development and 
 20.16  implementation of HealthMatch, an automated eligibility system 
 20.17  for medical assistance, general assistance medical care, and 
 20.18  MinnesotaCare, the commissioner, in cooperation with county 
 20.19  agencies, is authorized to test and compare a variety of 
 20.20  administrative models to demonstrate and evaluate outcomes of 
 20.21  integrating health care program business processes and points of 
 20.22  access.  The models will be evaluated for ease of enrollment for 
 20.23  health care program applicants and recipients and administrative 
 20.24  efficiencies.  Test sites will combine the administration of all 
 20.25  three programs and will include both local county and 
 20.26  centralized statewide customer assistance.  The duration of each 
 20.27  approved test site shall be no more than one year.  Based on the 
 20.28  evaluation, the commissioner shall recommend the most efficient 
 20.29  and effective administrative model for statewide implementation. 
 20.30     Sec. 4.  Minnesota Statutes 2004, section 256.019, 
 20.31  subdivision 1, is amended to read: 
 20.32     Subdivision 1.  [RETENTION RATES.] When an assistance 
 20.33  recovery amount is collected and posted by a county agency under 
 20.34  the provisions governing public assistance programs including 
 20.35  general assistance medical care, general assistance, and 
 20.36  Minnesota supplemental aid, the county may keep one-half of the 
 21.1   recovery made by the county agency using any method other than 
 21.2   recoupment.  For medical assistance, if the recovery is made by 
 21.3   a county agency using any method other than recoupment, the 
 21.4   county may keep one-half of the nonfederal share of the recovery.
 21.5   For MinnesotaCare, if the recovery is collected and posted by 
 21.6   the county agency, the county may keep one-half of the 
 21.7   nonfederal share of the recovery. 
 21.8      This does not apply to recoveries from medical providers or 
 21.9   to recoveries begun by the Department of Human Services' 
 21.10  Surveillance and Utilization Review Division, State Hospital 
 21.11  Collections Unit, and the Benefit Recoveries Division or, by the 
 21.12  attorney general's office, or child support collections.  In the 
 21.13  food stamp or food support program, the nonfederal share of 
 21.14  recoveries in the federal tax offset program only will be 
 21.15  divided equally between the state agency and the involved county 
 21.16  agency. 
 21.17     Sec. 5.  Minnesota Statutes 2004, section 256.045, 
 21.18  subdivision 3, is amended to read: 
 21.19     Subd. 3.  [STATE AGENCY HEARINGS.] (a) State agency 
 21.20  hearings are available for the following:  (1) any person 
 21.21  applying for, receiving or having received public assistance, 
 21.22  medical care, or a program of social services granted by the 
 21.23  state agency or a county agency or the federal Food Stamp Act 
 21.24  whose application for assistance is denied, not acted upon with 
 21.25  reasonable promptness, or whose assistance is suspended, 
 21.26  reduced, terminated, or claimed to have been incorrectly paid; 
 21.27  (2) any patient or relative aggrieved by an order of the 
 21.28  commissioner under section 252.27; (3) a party aggrieved by a 
 21.29  ruling of a prepaid health plan; (4) except as provided under 
 21.30  chapter 245C, any individual or facility determined by a lead 
 21.31  agency to have maltreated a vulnerable adult under section 
 21.32  626.557 after they have exercised their right to administrative 
 21.33  reconsideration under section 626.557; (5) any person whose 
 21.34  claim for foster care payment according to a placement of the 
 21.35  child resulting from a child protection assessment under section 
 21.36  626.556 is denied or not acted upon with reasonable promptness, 
 22.1   regardless of funding source; (6) any person to whom a right of 
 22.2   appeal according to this section is given by other provision of 
 22.3   law; (7) an applicant aggrieved by an adverse decision to an 
 22.4   application for a hardship waiver under section 256B.15; (8) an 
 22.5   applicant aggrieved by an adverse decision to an application or 
 22.6   redetermination for a Medicare Part D prescription drug subsidy 
 22.7   under section 256B.04, subdivision 4a; (9) except as provided 
 22.8   under chapter 245A, an individual or facility determined to have 
 22.9   maltreated a minor under section 626.556, after the individual 
 22.10  or facility has exercised the right to administrative 
 22.11  reconsideration under section 626.556; or (9) (10) except as 
 22.12  provided under chapter 245C, an individual disqualified under 
 22.13  sections 245C.14 and 245C.15, on the basis of serious or 
 22.14  recurring maltreatment; a preponderance of the evidence that the 
 22.15  individual has committed an act or acts that meet the definition 
 22.16  of any of the crimes listed in section 245C.15, subdivisions 1 
 22.17  to 4; or for failing to make reports required under section 
 22.18  626.556, subdivision 3, or 626.557, subdivision 3.  Hearings 
 22.19  regarding a maltreatment determination under clause (4) 
 22.20  or (8) (9) and a disqualification under this clause in which the 
 22.21  basis for a disqualification is serious or recurring 
 22.22  maltreatment, which has not been set aside under sections 
 22.23  245C.22 and 245C.23, shall be consolidated into a single fair 
 22.24  hearing.  In such cases, the scope of review by the human 
 22.25  services referee shall include both the maltreatment 
 22.26  determination and the disqualification.  The failure to exercise 
 22.27  the right to an administrative reconsideration shall not be a 
 22.28  bar to a hearing under this section if federal law provides an 
 22.29  individual the right to a hearing to dispute a finding of 
 22.30  maltreatment.  Individuals and organizations specified in this 
 22.31  section may contest the specified action, decision, or final 
 22.32  disposition before the state agency by submitting a written 
 22.33  request for a hearing to the state agency within 30 days after 
 22.34  receiving written notice of the action, decision, or final 
 22.35  disposition, or within 90 days of such written notice if the 
 22.36  applicant, recipient, patient, or relative shows good cause why 
 23.1   the request was not submitted within the 30-day time limit. 
 23.2      The hearing for an individual or facility under clause (4), 
 23.3   (8) (9), or (9) (10) is the only administrative appeal to the 
 23.4   final agency determination specifically, including a challenge 
 23.5   to the accuracy and completeness of data under section 13.04.  
 23.6   Hearings requested under clause (4) apply only to incidents of 
 23.7   maltreatment that occur on or after October 1, 1995.  Hearings 
 23.8   requested by nursing assistants in nursing homes alleged to have 
 23.9   maltreated a resident prior to October 1, 1995, shall be held as 
 23.10  a contested case proceeding under the provisions of chapter 14.  
 23.11  Hearings requested under clause (8) (9) apply only to incidents 
 23.12  of maltreatment that occur on or after July 1, 1997.  A hearing 
 23.13  for an individual or facility under clause (8) (9) is only 
 23.14  available when there is no juvenile court or adult criminal 
 23.15  action pending.  If such action is filed in either court while 
 23.16  an administrative review is pending, the administrative review 
 23.17  must be suspended until the judicial actions are completed.  If 
 23.18  the juvenile court action or criminal charge is dismissed or the 
 23.19  criminal action overturned, the matter may be considered in an 
 23.20  administrative hearing. 
 23.21     For purposes of this section, bargaining unit grievance 
 23.22  procedures are not an administrative appeal. 
 23.23     The scope of hearings involving claims to foster care 
 23.24  payments under clause (5) shall be limited to the issue of 
 23.25  whether the county is legally responsible for a child's 
 23.26  placement under court order or voluntary placement agreement 
 23.27  and, if so, the correct amount of foster care payment to be made 
 23.28  on the child's behalf and shall not include review of the 
 23.29  propriety of the county's child protection determination or 
 23.30  child placement decision. 
 23.31     (b) A vendor of medical care as defined in section 256B.02, 
 23.32  subdivision 7, or a vendor under contract with a county agency 
 23.33  to provide social services is not a party and may not request a 
 23.34  hearing under this section, except if assisting a recipient as 
 23.35  provided in subdivision 4. 
 23.36     (c) An applicant or recipient is not entitled to receive 
 24.1   social services beyond the services included in the amended 
 24.2   community social services plan. 
 24.3      (d) The commissioner may summarily affirm the county or 
 24.4   state agency's proposed action without a hearing when the sole 
 24.5   issue is an automatic change due to a change in state or federal 
 24.6   law. 
 24.7      Sec. 6.  Minnesota Statutes 2004, section 256.045, 
 24.8   subdivision 3a, is amended to read: 
 24.9      Subd. 3a.  [PREPAID HEALTH PLAN APPEALS.] (a) All prepaid 
 24.10  health plans under contract to the commissioner under chapter 
 24.11  256B or 256D must provide for a complaint system according to 
 24.12  section 62D.11.  When a prepaid health plan denies, reduces, or 
 24.13  terminates a health service or denies a request to authorize a 
 24.14  previously authorized health service, the prepaid health plan 
 24.15  must notify the recipient of the right to file a complaint or an 
 24.16  appeal.  The notice must include the name and telephone number 
 24.17  of the ombudsman and notice of the recipient's right to request 
 24.18  a hearing under paragraph (b).  When a complaint is filed, the 
 24.19  prepaid health plan must notify the ombudsman within three 
 24.20  working days.  Recipients may request the assistance of the 
 24.21  ombudsman in the complaint system process.  The prepaid health 
 24.22  plan must issue a written resolution of the complaint to the 
 24.23  recipient within 30 days after the complaint is filed with the 
 24.24  prepaid health plan.  A recipient is not required to exhaust the 
 24.25  complaint system procedures in order to request a hearing under 
 24.26  paragraph (b). 
 24.27     (b) Recipients enrolled in a prepaid health plan under 
 24.28  chapter 256B or 256D may contest a prepaid health plan's denial, 
 24.29  reduction, or termination of health services, a prepaid health 
 24.30  plan's denial of a request to authorize a previously authorized 
 24.31  health service, or the prepaid health plan's written resolution 
 24.32  of a complaint by submitting a written request for a hearing 
 24.33  according to subdivision 3.  A state human services referee 
 24.34  shall conduct a hearing on the matter and shall recommend an 
 24.35  order to the commissioner of human services.  The commissioner 
 24.36  need not grant a hearing if the sole issue raised by a recipient 
 25.1   is the commissioner's authority to require mandatory enrollment 
 25.2   in a prepaid health plan in a county where prepaid health plans 
 25.3   are under contract with the commissioner.  The state human 
 25.4   services referee may order a second medical opinion from the 
 25.5   prepaid health plan or may order a second medical opinion from a 
 25.6   nonprepaid health plan provider at the expense of the prepaid 
 25.7   health plan.  Recipients may request the assistance of the 
 25.8   ombudsman in the appeal process. 
 25.9      (c) In the written request for a hearing to appeal from a 
 25.10  prepaid health plan's denial, reduction, or termination of a 
 25.11  health service, a prepaid health plan's denial of a request to 
 25.12  authorize a previously authorized service, or the prepaid health 
 25.13  plan's written resolution to a complaint, a recipient may 
 25.14  request an expedited hearing.  If an expedited appeal is 
 25.15  warranted, the state human services referee shall hear the 
 25.16  appeal and render a decision within a time commensurate with the 
 25.17  level of urgency involved, based on the individual circumstances 
 25.18  of the case. 
 25.19     Sec. 7.  Minnesota Statutes 2004, section 256.046, 
 25.20  subdivision 1, is amended to read: 
 25.21     Subdivision 1.  [HEARING AUTHORITY.] A local agency must 
 25.22  initiate an administrative fraud disqualification hearing for 
 25.23  individuals, including child care providers caring for children 
 25.24  receiving child care assistance, accused of wrongfully obtaining 
 25.25  assistance or intentional program violations, in lieu of a 
 25.26  criminal action when it has not been pursued, in the aid to 
 25.27  families with dependent children program formerly codified in 
 25.28  sections 256.72 to 256.87, MFIP, the diversionary work program, 
 25.29  child care assistance programs, general assistance, family 
 25.30  general assistance program formerly codified in section 256D.05, 
 25.31  subdivision 1, clause (15), Minnesota supplemental aid, food 
 25.32  stamp programs, general assistance medical care, MinnesotaCare 
 25.33  for adults without children, and upon federal approval, all 
 25.34  categories of medical assistance and remaining categories of 
 25.35  MinnesotaCare except for children through age 18.  The 
 25.36  Department of Human Services, in lieu of a local agency, may 
 26.1   initiate an administrative fraud disqualification hearing when 
 26.2   the state agency is directly responsible for administration of 
 26.3   the health care program for which benefits were wrongfully 
 26.4   obtained.  The hearing is subject to the requirements of section 
 26.5   256.045 and the requirements in Code of Federal Regulations, 
 26.6   title 7, section 273.16, for the food stamp program and title 
 26.7   45, section 235.112, as of September 30, 1995, for the cash 
 26.8   grant, medical care programs, and child care assistance under 
 26.9   chapter 119B. 
 26.10     Sec. 8.  Minnesota Statutes 2004, section 256.9657, is 
 26.11  amended by adding a subdivision to read: 
 26.12     Subd. 7a.  [WITHHOLDING.] If any provider obligated to pay 
 26.13  an annual surcharge under this section is more than two months 
 26.14  delinquent in the timely payment of a monthly surcharge 
 26.15  installment payment, the provisions in paragraphs (a) to (f) 
 26.16  apply. 
 26.17     (a) The department may withhold some or all of the amount 
 26.18  of the delinquent surcharge, together with any interest and 
 26.19  penalties due and owing on those amounts, from any money the 
 26.20  department owes to the provider.  The department may, at its 
 26.21  discretion, also withhold future surcharge installment payments 
 26.22  from any money the department owes the provider as those 
 26.23  installments become due and owing.  The department may continue 
 26.24  this withholding until the department determines there in no 
 26.25  longer any need to do so. 
 26.26     (b) The department shall give prior notice of the 
 26.27  department's intention to withhold by mailing a written notice 
 26.28  to the provider at the address to which remittance advices are 
 26.29  mailed or faxing a copy of the notice to the provider at least 
 26.30  ten business days before the date of the first payment period 
 26.31  for which the withholding begins.  The notice may be sent by 
 26.32  ordinary or certified mail, or facsimile, and shall be deemed 
 26.33  received as of the date of mailing or receipt of the facsimile.  
 26.34  The notice shall: 
 26.35     (i) state the amount of the delinquent surcharge; 
 26.36     (ii) state the amount of the withholding per payment 
 27.1   period; 
 27.2      (iii) state the date on which the withholding is to begin; 
 27.3      (iv) state whether the department intends to withhold 
 27.4   future installments of the provider's surcharge payments; 
 27.5      (v) inform the provider of their rights to informally 
 27.6   object to the proposed withholding and to appeal the withholding 
 27.7   as provided for in this subdivision; 
 27.8      (vi) state that the provider may prevent the withholding 
 27.9   during the pendancy of their appeal by posting a bond; and 
 27.10     (vii) state other contents as the department deems 
 27.11  appropriate. 
 27.12     (c) The provider may informally object to the withholding 
 27.13  in writing anytime before the withholding begins.  An informal 
 27.14  objection shall not stay or delay the commencement of the 
 27.15  withholding.  The department may postpone the commencement of 
 27.16  the withholding as deemed appropriate and shall not be required 
 27.17  to give another notice at the end of the postponement and before 
 27.18  commencing the withholding.  The provider shall have the right 
 27.19  to appeal any withholding from remittances by filing an appeal 
 27.20  with Ramsey County District Court and serving notice of the 
 27.21  appeal on the department within 30 days of the date of the 
 27.22  written notice of the withholding.  Notice shall be given and 
 27.23  the appeal shall be heard no later than 45 days after the appeal 
 27.24  is filed.  In a hearing of the appeal, the department's action 
 27.25  shall be sustained if the department proves the amount of the 
 27.26  delinquent surcharges or overpayment the provider owes, plus any 
 27.27  accrued interest and penalties, has not been repaid.  The 
 27.28  department may continue withholding for delinquent and current 
 27.29  surcharge installment payments during the pendancy of an appeal 
 27.30  unless the provider posts a bond from a surety company licensed 
 27.31  to do business in Minnesota in favor of the department in an 
 27.32  amount equal to two times the provider's total annual surcharge 
 27.33  payment for the fiscal year in which the appeal is filed with 
 27.34  the department. 
 27.35     (d) The department shall refund any amounts due to the 
 27.36  provider under any final administrative or judicial order or 
 28.1   decree which fully and finally resolves the appeal together with 
 28.2   interest on those amounts at the rate of three percent per annum 
 28.3   simple interest computed from the date of each withholding, as 
 28.4   soon as practical after entry of the order or decree. 
 28.5      (e) The commissioner, or the commissioner's designee, may 
 28.6   enter into written settlement agreements with a provider to 
 28.7   resolve disputes and other matters involving unpaid surcharge 
 28.8   installment payments or future surcharge installment payments. 
 28.9      (f) Notwithstanding any law to the contrary, all unpaid 
 28.10  surcharges, plus any accrued interest and penalties, shall be 
 28.11  overpayments for purposes of section 256B.0641. 
 28.12     Sec. 9.  Minnesota Statutes 2004, section 256.969, 
 28.13  subdivision 3a, is amended to read: 
 28.14     Subd. 3a.  [PAYMENTS.] (a) Acute care hospital billings 
 28.15  under the medical assistance program must not be submitted until 
 28.16  the recipient is discharged.  However, the commissioner shall 
 28.17  establish monthly interim payments for inpatient hospitals that 
 28.18  have individual patient lengths of stay over 30 days regardless 
 28.19  of diagnostic category.  Except as provided in section 256.9693, 
 28.20  medical assistance reimbursement for treatment of mental illness 
 28.21  shall be reimbursed based on diagnostic classifications.  
 28.22  Individual hospital payments established under this section and 
 28.23  sections 256.9685, 256.9686, and 256.9695, in addition to third 
 28.24  party and recipient liability, for discharges occurring during 
 28.25  the rate year shall not exceed, in aggregate, the charges for 
 28.26  the medical assistance covered inpatient services paid for the 
 28.27  same period of time to the hospital.  This payment limitation 
 28.28  shall be calculated separately for medical assistance and 
 28.29  general assistance medical care services.  The limitation on 
 28.30  general assistance medical care shall be effective for 
 28.31  admissions occurring on or after July 1, 1991.  Services that 
 28.32  have rates established under subdivision 11 or 12, must be 
 28.33  limited separately from other services.  After consulting with 
 28.34  the affected hospitals, the commissioner may consider related 
 28.35  hospitals one entity and may merge the payment rates while 
 28.36  maintaining separate provider numbers.  The operating and 
 29.1   property base rates per admission or per day shall be derived 
 29.2   from the best Medicare and claims data available when rates are 
 29.3   established.  The commissioner shall determine the best Medicare 
 29.4   and claims data, taking into consideration variables of recency 
 29.5   of the data, audit disposition, settlement status, and the 
 29.6   ability to set rates in a timely manner.  The commissioner shall 
 29.7   notify hospitals of payment rates by December 1 of the year 
 29.8   preceding the rate year.  The rate setting data must reflect the 
 29.9   admissions data used to establish relative values.  Base year 
 29.10  changes from 1981 to the base year established for the rate year 
 29.11  beginning January 1, 1991, and for subsequent rate years, shall 
 29.12  not be limited to the limits ending June 30, 1987, on the 
 29.13  maximum rate of increase under subdivision 1.  The commissioner 
 29.14  may adjust base year cost, relative value, and case mix index 
 29.15  data to exclude the costs of services that have been 
 29.16  discontinued by the October 1 of the year preceding the rate 
 29.17  year or that are paid separately from inpatient services.  
 29.18  Inpatient stays that encompass portions of two or more rate 
 29.19  years shall have payments established based on payment rates in 
 29.20  effect at the time of admission unless the date of admission 
 29.21  preceded the rate year in effect by six months or more.  In this 
 29.22  case, operating payment rates for services rendered during the 
 29.23  rate year in effect and established based on the date of 
 29.24  admission shall be adjusted to the rate year in effect by the 
 29.25  hospital cost index. 
 29.26     (b) For fee-for-service admissions occurring on or after 
 29.27  July 1, 2002, the total payment, before third-party liability 
 29.28  and spenddown, made to hospitals for inpatient services is 
 29.29  reduced by .5 percent from the current statutory rates.  
 29.30     (c) In addition to the reduction in paragraph (b), the 
 29.31  total payment for fee-for-service admissions occurring on or 
 29.32  after July 1, 2003, made to hospitals for inpatient services 
 29.33  before third-party liability and spenddown, is reduced five 
 29.34  percent from the current statutory rates.  Mental health 
 29.35  services within diagnosis related groups 424 to 432, and 
 29.36  facilities defined under subdivision 16 are excluded from this 
 30.1   paragraph. 
 30.2      (d) In addition to the reduction in paragraphs (b) and (c) 
 30.3   and section 256D.03, subdivision 4, paragraph (k), the total 
 30.4   payment for fee-for-service admissions occurring on or after 
 30.5   July 1, 2005, made to hospitals for inpatient services before 
 30.6   third-party liability and spenddown, is reduced five percent 
 30.7   from the current statutory rates.  Mental health services within 
 30.8   diagnosis related groups 424 to 432 and facilities defined under 
 30.9   subdivision 16 are excluded from this paragraph. 
 30.10     Sec. 10.  Minnesota Statutes 2004, section 256B.02, 
 30.11  subdivision 12, is amended to read: 
 30.12     Subd. 12.  [THIRD-PARTY PAYER.] "Third-party payer" means a 
 30.13  person, entity, or agency or government program that has a 
 30.14  probable obligation to pay all or part of the costs of a medical 
 30.15  assistance recipient's health services.  Third-party payer 
 30.16  includes an entity under contract with the recipient to cover 
 30.17  all or part of the recipient's medical costs. 
 30.18     Sec. 11.  Minnesota Statutes 2004, section 256B.04, is 
 30.19  amended by adding a subdivision to read: 
 30.20     Subd. 4a.  [MEDICARE PRESCRIPTION DRUG SUBSIDY.] The 
 30.21  commissioner shall perform all duties necessary to administer 
 30.22  eligibility determinations for the Medicare Part D prescription 
 30.23  drug subsidy and facilitate the enrollment of eligible medical 
 30.24  assistance recipients into Medicare prescription drug plans as 
 30.25  required by the Medicare Prescription Drug, Improvement and 
 30.26  Modernization Act of 2003 (MMA), Public Law 108-173, and Code of 
 30.27  Federal Regulations, title 42, sections 423.30 through 423.56 
 30.28  and 423.771 through 423.800. 
 30.29     Sec. 12.  Minnesota Statutes 2004, section 256B.056, is 
 30.30  amended by adding a subdivision to read: 
 30.31     Subd. 3d.  [REDUCTION OF EXCESS ASSETS.] Assets in excess 
 30.32  of the limits set forth in subdivisions 3 to 3c may be reduced 
 30.33  to allowable limits as follows: 
 30.34     (a) Assets may be reduced in any of the three calendar 
 30.35  months before the month of application in which the applicant 
 30.36  seeks coverage by: 
 31.1      (1) designating burial funds up to $1500 for each 
 31.2   applicant, spouse, and MA-eligible dependent child; and 
 31.3      (2) paying health service bills incurred in the retroactive 
 31.4   period for which the applicant seeks eligibility, starting with 
 31.5   the oldest bill.  After assets are reduced to allowable limits, 
 31.6   eligibility begins with the next dollar of MA-covered health 
 31.7   services incurred in the retroactive period.  Applicants 
 31.8   reducing assets under this subdivision who also have excess 
 31.9   income shall first spend excess assets to pay health service 
 31.10  bills and may meet the income spenddown on remaining bills. 
 31.11     (b) Assets may be reduced beginning the month of 
 31.12  application by: 
 31.13     (1) paying bills for health services that would otherwise 
 31.14  be paid by medical assistance; and 
 31.15     (2) using any means other than a transfer of assets for 
 31.16  less than fair market value as defined in section 256B.0595, 
 31.17  subdivision 1, paragraph (b). 
 31.18     Sec. 13.  Minnesota Statutes 2004, section 256B.056, 
 31.19  subdivision 5, is amended to read: 
 31.20     Subd. 5.  [EXCESS INCOME.] A person who has excess income 
 31.21  is eligible for medical assistance if the person has expenses 
 31.22  for medical care that are more than the amount of the person's 
 31.23  excess income, computed by deducting incurred medical expenses 
 31.24  from the excess income to reduce the excess to the income 
 31.25  standard specified in subdivision 5c.  The person shall elect to 
 31.26  have the medical expenses deducted at the beginning of a 
 31.27  one-month budget period or at the beginning of a six-month 
 31.28  budget period.  The commissioner shall allow persons eligible 
 31.29  for assistance on a one-month spenddown basis under this 
 31.30  subdivision to elect to pay the monthly spenddown amount in 
 31.31  advance of the month of eligibility to the state agency in order 
 31.32  to maintain eligibility on a continuous basis.  If the recipient 
 31.33  does not pay the spenddown amount on or before the 20th last 
 31.34  business day of the month, the recipient is ineligible for this 
 31.35  option for the following month.  The local agency shall code the 
 31.36  Medicaid Management Information System (MMIS) to indicate that 
 32.1   the recipient has elected this option.  The state agency shall 
 32.2   convey recipient eligibility information relative to the 
 32.3   collection of the spenddown to providers through the Electronic 
 32.4   Verification System (EVS).  A recipient electing advance payment 
 32.5   must pay the state agency the monthly spenddown amount on or 
 32.6   before noon on the 20th last business day of the month in order 
 32.7   to be eligible for this option in the following month.  
 32.8      <b>[EFFECTIVE DATE.]</b> This section is effective March 1, 2006, 
 32.9   or upon HealthMatch implementation, whichever is later. 
 32.10     Sec. 14.  Minnesota Statutes 2004, section 256B.056, 
 32.11  subdivision 5a, is amended to read: 
 32.12     Subd. 5a.  [INDIVIDUALS ON FIXED OR EXCLUDED INCOME.] 
 32.13  Recipients of medical assistance who receive only fixed unearned 
 32.14  or excluded income, when that income is excluded from 
 32.15  consideration as income or unvarying in amount and timing of 
 32.16  receipt throughout the year, shall report and verify their 
 32.17  income annually every 12 months.  The 12-month period begins 
 32.18  with the month of application. 
 32.19     <b>[EFFECTIVE DATE.]</b> This section is effective March 1, 2006, 
 32.20  or upon HealthMatch implementation, whichever is later. 
 32.21     Sec. 15.  Minnesota Statutes 2004, section 256B.056, 
 32.22  subdivision 5b, is amended to read: 
 32.23     Subd. 5b.  [INDIVIDUALS WITH LOW INCOME.] Recipients of 
 32.24  medical assistance not residing in a long-term care facility who 
 32.25  have slightly fluctuating income which is below the medical 
 32.26  assistance income limit shall report and verify their income on 
 32.27  a semiannual basis every six months.  The six-month period 
 32.28  begins the month of application. 
 32.29     <b>[EFFECTIVE DATE.]</b> This section is effective March 1, 2006, 
 32.30  or upon HealthMatch implementation, whichever is later. 
 32.31     Sec. 16.  Minnesota Statutes 2004, section 256B.056, 
 32.32  subdivision 7, is amended to read: 
 32.33     Subd. 7.  [PERIOD OF ELIGIBILITY.] Eligibility is available 
 32.34  for the month of application and for three months prior to 
 32.35  application if the person was eligible in those prior 
 32.36  months.  Eligibility for months prior to application is 
 33.1   determined independently from eligibility for the month of 
 33.2   application and future months.  A redetermination of eligibility 
 33.3   must occur every 12 months.  The 12-month period begins with the 
 33.4   month of application. 
 33.5      <b>[EFFECTIVE DATE.]</b> This section is effective March 1, 2006, 
 33.6   or upon HealthMatch implementation, whichever is later. 
 33.7      Sec. 17.  Minnesota Statutes 2004, section 256B.056, is 
 33.8   amended by adding a subdivision to read: 
 33.9      Subd. 9.  [NOTICE.] The state agency must be given notice 
 33.10  of monetary claims against a person, entity, or corporation that 
 33.11  may be liable to pay all or part of the cost of medical care 
 33.12  when the state agency has paid or becomes liable for the cost of 
 33.13  that care.  Notice must be given according to paragraphs (a) to 
 33.14  (d). 
 33.15     (a) An applicant for medical assistance shall notify the 
 33.16  state or local agency of any possible claims when the applicant 
 33.17  submits the application.  A recipient of medical assistance 
 33.18  shall notify the state or local agency of any possible claims 
 33.19  when those claims arise. 
 33.20     (b) A person providing medical care services to a recipient 
 33.21  of medical assistance shall notify the state agency when the 
 33.22  person has reason to believe that a third party may be liable 
 33.23  for payment of the cost of medical care. 
 33.24     (c) A party to a claim that may be assigned to the state 
 33.25  agency under this section shall notify the state agency of its 
 33.26  potential assignment claim in writing at each of the following 
 33.27  stages of a claim: 
 33.28     (1) when a claim is filed; 
 33.29     (2) when an action is commenced; and 
 33.30     (3) when a claim is concluded by payment, award, judgment, 
 33.31  settlement, or otherwise.  
 33.32     (d) Every party involved in any stage of a claim under this 
 33.33  subdivision is required to provide notice to the state agency at 
 33.34  that stage of the claim.  However, when one of the parties to 
 33.35  the claim provides notice at that stage, every other party to 
 33.36  the claim is deemed to have provided the required notice for 
 34.1   that stage of the claim.  If the required notice under this 
 34.2   paragraph is not provided to the state agency, all parties to 
 34.3   the claim are deemed to have failed to provide the required 
 34.4   notice.  A party to the claim includes the injured person or the 
 34.5   person's legal representative, the plaintiff, the defendants, or 
 34.6   persons alleged to be responsible for compensating the injured 
 34.7   person or plaintiff, and any other party to the cause of action 
 34.8   or claim, regardless of whether the party knows the state agency 
 34.9   has a potential or actual assignment claim. 
 34.10     Sec. 18.  Minnesota Statutes 2004, section 256B.056, is 
 34.11  amended by adding a subdivision to read: 
 34.12     Subd. 10.  [ELIGIBILITY VERIFICATION.] (a) The commissioner 
 34.13  shall require women who are applying for the continuation of 
 34.14  medical assistance coverage following the end of the 60-day 
 34.15  postpartum period to complete a renewal form and verify assets. 
 34.16     (b) The commissioner shall determine the eligibility of 
 34.17  private-sector health care coverage for infants less than one 
 34.18  year of age eligible under section 256B.055, subdivision 10, or 
 34.19  256B.057, subdivision 1, paragraph (d), and shall pay for 
 34.20  private-sector coverage if this is determined to be 
 34.21  cost-effective. 
 34.22     (c) The commissioner shall modify the application for 
 34.23  Minnesota health care programs to require more detailed 
 34.24  information related to verification of assets and income, and 
 34.25  shall verify assets and income for all applicants, and for all 
 34.26  recipients upon renewal. 
 34.27     (d) The commissioner shall require recipients to report and 
 34.28  verify new employment income within ten days of the change, and 
 34.29  shall disenroll recipients who fail to provide verification. 
 34.30     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2005.  
 34.31  Prior to the implementation of HealthMatch, the commissioner 
 34.32  shall implement this section to the fullest extent possible, 
 34.33  including the use of manual processing.  Upon implementation of 
 34.34  HealthMatch, the commissioner shall implement this section in a 
 34.35  manner consistent with the procedures and requirements of 
 34.36  HealthMatch. 
 35.1      Sec. 19.  Minnesota Statutes 2004, section 256B.0575, is 
 35.2   amended to read: 
 35.3      256B.0575 [AVAILABILITY OF INCOME FOR INSTITUTIONALIZED 
 35.4   PERSONS.] 
 35.5      When an institutionalized person is determined eligible for 
 35.6   medical assistance, the income that exceeds the deductions in 
 35.7   paragraphs (a) and (b) must be applied to the cost of 
 35.8   institutional care.  
 35.9      (a) The following amounts must be deducted from the 
 35.10  institutionalized person's income in the following order: 
 35.11     (1) the personal needs allowance under section 256B.35 or, 
 35.12  for a veteran who does not have a spouse or child, or a 
 35.13  surviving spouse of a veteran having no child, the amount of an 
 35.14  improved pension received from the veteran's administration not 
 35.15  exceeding $90 per month; 
 35.16     (2) the personal allowance for disabled individuals under 
 35.17  section 256B.36; 
 35.18     (3) if the institutionalized person has a legally appointed 
 35.19  guardian or conservator, five percent of the recipient's gross 
 35.20  monthly income up to $100 as reimbursement for guardianship or 
 35.21  conservatorship services; 
 35.22     (4) a monthly income allowance determined under section 
 35.23  256B.058, subdivision 2, but only to the extent income of the 
 35.24  institutionalized spouse is made available to the community 
 35.25  spouse; 
 35.26     (5) a monthly allowance for children under age 18 which, 
 35.27  together with the net income of the children, would provide 
 35.28  income equal to the medical assistance standard for families and 
 35.29  children according to section 256B.056, subdivision 4, for a 
 35.30  family size that includes only the minor children.  This 
 35.31  deduction applies only if the children do not live with the 
 35.32  community spouse and only to the extent that the deduction is 
 35.33  not included in the personal needs allowance under section 
 35.34  256B.35, subdivision 1, as child support garnished under a court 
 35.35  order; 
 35.36     (6) a monthly family allowance for other family members, 
 36.1   equal to one-third of the difference between 122 percent of the 
 36.2   federal poverty guidelines and the monthly income for that 
 36.3   family member; 
 36.4      (7) reparations payments made by the Federal Republic of 
 36.5   Germany and reparations payments made by the Netherlands for 
 36.6   victims of Nazi persecution between 1940 and 1945; 
 36.7      (8) all other exclusions from income for institutionalized 
 36.8   persons as mandated by federal law; and 
 36.9      (9) amounts for reasonable expenses incurred for necessary 
 36.10  medical or remedial care for the institutionalized person that 
 36.11  are not medical assistance covered expenses and that are not 
 36.12  subject to payment by a third party.  
 36.13     Reasonable expenses are limited to expenses that have not 
 36.14  been previously used as a deduction from income and are incurred 
 36.15  during the enrollee's current period of eligibility, including 
 36.16  retroactive months associated with the current period of 
 36.17  eligibility, for medical assistance payment of long-term care 
 36.18  services. 
 36.19     For purposes of clause (6), "other family member" means a 
 36.20  person who resides with the community spouse and who is a minor 
 36.21  or dependent child, dependent parent, or dependent sibling of 
 36.22  either spouse.  "Dependent" means a person who could be claimed 
 36.23  as a dependent for federal income tax purposes under the 
 36.24  Internal Revenue Code. 
 36.25     (b) Income shall be allocated to an institutionalized 
 36.26  person for a period of up to three calendar months, in an amount 
 36.27  equal to the medical assistance standard for a family size of 
 36.28  one if:  
 36.29     (1) a physician certifies that the person is expected to 
 36.30  reside in the long-term care facility for three calendar months 
 36.31  or less; 
 36.32     (2) if the person has expenses of maintaining a residence 
 36.33  in the community; and 
 36.34     (3) if one of the following circumstances apply:  
 36.35     (i) the person was not living together with a spouse or a 
 36.36  family member as defined in paragraph (a) when the person 
 37.1   entered a long-term care facility; or 
 37.2      (ii) the person and the person's spouse become 
 37.3   institutionalized on the same date, in which case the allocation 
 37.4   shall be applied to the income of one of the spouses.  
 37.5   For purposes of this paragraph, a person is determined to be 
 37.6   residing in a licensed nursing home, regional treatment center, 
 37.7   or medical institution if the person is expected to remain for a 
 37.8   period of one full calendar month or more. 
 37.9      Sec. 20.  Minnesota Statutes 2004, section 256B.0595, 
 37.10  subdivision 2, is amended to read: 
 37.11     Subd. 2.  [PERIOD OF INELIGIBILITY.] (a) For any 
 37.12  uncompensated transfer occurring on or before August 10, 1993, 
 37.13  the number of months of ineligibility for long-term care 
 37.14  services shall be the lesser of 30 months, or the uncompensated 
 37.15  transfer amount divided by the average medical assistance rate 
 37.16  for nursing facility services in the state in effect on the date 
 37.17  of application.  The amount used to calculate the average 
 37.18  medical assistance payment rate shall be adjusted each July 1 to 
 37.19  reflect payment rates for the previous calendar year.  The 
 37.20  period of ineligibility begins with the month in which the 
 37.21  assets were transferred.  If the transfer was not reported to 
 37.22  the local agency at the time of application, and the applicant 
 37.23  received long-term care services during what would have been the 
 37.24  period of ineligibility if the transfer had been reported, a 
 37.25  cause of action exists against the transferee for the cost of 
 37.26  long-term care services provided during the period of 
 37.27  ineligibility, or for the uncompensated amount of the transfer, 
 37.28  whichever is less.  The action may be brought by the state or 
 37.29  the local agency responsible for providing medical assistance 
 37.30  under chapter 256G.  The uncompensated transfer amount is the 
 37.31  fair market value of the asset at the time it was given away, 
 37.32  sold, or disposed of, less the amount of compensation received.  
 37.33     (b) For uncompensated transfers made after August 10, 1993, 
 37.34  the number of months of ineligibility for long-term care 
 37.35  services shall be the total uncompensated value of the resources 
 37.36  transferred divided by the average medical assistance rate for 
 38.1   nursing facility services in the state in effect on the date of 
 38.2   application.  The amount used to calculate the average medical 
 38.3   assistance payment rate shall be adjusted each July 1 to reflect 
 38.4   payment rates for the previous calendar year.  The period of 
 38.5   ineligibility begins with the first day of the month after the 
 38.6   month in which the assets were transferred except that if one or 
 38.7   more uncompensated transfers are made during a period of 
 38.8   ineligibility, the total assets transferred during the 
 38.9   ineligibility period shall be combined and a penalty period 
 38.10  calculated to begin on the first day of the month after the 
 38.11  month in which the first uncompensated transfer was made.  If 
 38.12  the transfer was reported to the local agency after the date 
 38.13  that advance notice of a period of ineligibility that affects 
 38.14  the next month could be provided to the recipient and the 
 38.15  recipient received medical assistance services or the transfer 
 38.16  was not reported to the local agency, and the applicant or 
 38.17  recipient received medical assistance services during what would 
 38.18  have been the period of ineligibility if the transfer had been 
 38.19  reported, a cause of action exists against the transferee for 
 38.20  the cost of medical assistance services provided during the 
 38.21  period of ineligibility, or for the uncompensated amount of the 
 38.22  transfer, whichever is less.  The action may be brought by the 
 38.23  state or the local agency responsible for providing medical 
 38.24  assistance under chapter 256G.  The uncompensated transfer 
 38.25  amount is the fair market value of the asset at the time it was 
 38.26  given away, sold, or disposed of, less the amount of 
 38.27  compensation received.  Effective for transfers made on or after 
 38.28  March 1, 1996, involving persons who apply for medical 
 38.29  assistance on or after April 13, 1996, no cause of action exists 
 38.30  for a transfer unless: 
 38.31     (1) the transferee knew or should have known that the 
 38.32  transfer was being made by a person who was a resident of a 
 38.33  long-term care facility or was receiving that level of care in 
 38.34  the community at the time of the transfer; 
 38.35     (2) the transferee knew or should have known that the 
 38.36  transfer was being made to assist the person to qualify for or 
 39.1   retain medical assistance eligibility; or 
 39.2      (3) the transferee actively solicited the transfer with 
 39.3   intent to assist the person to qualify for or retain eligibility 
 39.4   for medical assistance.  
 39.5      (c) If a calculation of a penalty period results in a 
 39.6   partial month, payments for long-term care services shall be 
 39.7   reduced in an amount equal to the fraction, except that in 
 39.8   calculating the value of uncompensated transfers, if the total 
 39.9   value of all uncompensated transfers made in a month not 
 39.10  included in an existing penalty period does not exceed $200, 
 39.11  then such transfers shall be disregarded for each month prior to 
 39.12  the month of application for or during receipt of medical 
 39.13  assistance. 
 39.14     <b>[EFFECTIVE DATE.]</b> This section is effective for transfers 
 39.15  occurring on or after July 1, 2005. 
 39.16     Sec. 21.  Minnesota Statutes 2004, section 256B.06, 
 39.17  subdivision 4, is amended to read: 
 39.18     Subd. 4.  [CITIZENSHIP REQUIREMENTS.] (a) Eligibility for 
 39.19  medical assistance is limited to citizens of the United States, 
 39.20  qualified noncitizens as defined in this subdivision, and other 
 39.21  persons residing lawfully in the United States. 
 39.22     (b) "Qualified noncitizen" means a person who meets one of 
 39.23  the following immigration criteria: 
 39.24     (1) admitted for lawful permanent residence according to 
 39.25  United States Code, title 8; 
 39.26     (2) admitted to the United States as a refugee according to 
 39.27  United States Code, title 8, section 1157; 
 39.28     (3) granted asylum according to United States Code, title 
 39.29  8, section 1158; 
 39.30     (4) granted withholding of deportation according to United 
 39.31  States Code, title 8, section 1253(h); 
 39.32     (5) paroled for a period of at least one year according to 
 39.33  United States Code, title 8, section 1182(d)(5); 
 39.34     (6) granted conditional entrant status according to United 
 39.35  States Code, title 8, section 1153(a)(7); 
 39.36     (7) determined to be a battered noncitizen by the United 
 40.1   States Attorney General according to the Illegal Immigration 
 40.2   Reform and Immigrant Responsibility Act of 1996, title V of the 
 40.3   Omnibus Consolidated Appropriations Bill, Public Law 104-200; 
 40.4      (8) is a child of a noncitizen determined to be a battered 
 40.5   noncitizen by the United States Attorney General according to 
 40.6   the Illegal Immigration Reform and Immigrant Responsibility Act 
 40.7   of 1996, title V, of the Omnibus Consolidated Appropriations 
 40.8   Bill, Public Law 104-200; or 
 40.9      (9) determined to be a Cuban or Haitian entrant as defined 
 40.10  in section 501(e) of Public Law 96-422, the Refugee Education 
 40.11  Assistance Act of 1980. 
 40.12     (c) All qualified noncitizens who were residing in the 
 40.13  United States before August 22, 1996, who otherwise meet the 
 40.14  eligibility requirements of this chapter, are eligible for 
 40.15  medical assistance with federal financial participation. 
 40.16     (d) All qualified noncitizens who entered the United States 
 40.17  on or after August 22, 1996, and who otherwise meet the 
 40.18  eligibility requirements of this chapter, are eligible for 
 40.19  medical assistance with federal financial participation through 
 40.20  November 30, 1996. 
 40.21     Beginning December 1, 1996, qualified noncitizens who 
 40.22  entered the United States on or after August 22, 1996, and who 
 40.23  otherwise meet the eligibility requirements of this chapter are 
 40.24  eligible for medical assistance with federal participation for 
 40.25  five years if they meet one of the following criteria: 
 40.26     (i) refugees admitted to the United States according to 
 40.27  United States Code, title 8, section 1157; 
 40.28     (ii) persons granted asylum according to United States 
 40.29  Code, title 8, section 1158; 
 40.30     (iii) persons granted withholding of deportation according 
 40.31  to United States Code, title 8, section 1253(h); 
 40.32     (iv) veterans of the United States armed forces with an 
 40.33  honorable discharge for a reason other than noncitizen status, 
 40.34  their spouses and unmarried minor dependent children; or 
 40.35     (v) persons on active duty in the United States armed 
 40.36  forces, other than for training, their spouses and unmarried 
 41.1   minor dependent children. 
 41.2      Beginning December 1, 1996, qualified noncitizens who do 
 41.3   not meet one of the criteria in items (i) to (v) are eligible 
 41.4   for medical assistance without federal financial participation 
 41.5   as described in paragraph (j). 
 41.6      (e) Noncitizens who are not qualified noncitizens as 
 41.7   defined in paragraph (b), who are lawfully residing in the 
 41.8   United States and who otherwise meet the eligibility 
 41.9   requirements of this chapter, are eligible for medical 
 41.10  assistance under clauses (1) to (3).  These individuals must 
 41.11  cooperate with the Immigration and Naturalization Service to 
 41.12  pursue any applicable immigration status, including citizenship, 
 41.13  that would qualify them for medical assistance with federal 
 41.14  financial participation. 
 41.15     (1) Persons who were medical assistance recipients on 
 41.16  August 22, 1996, are eligible for medical assistance with 
 41.17  federal financial participation through December 31, 1996. 
 41.18     (2) Beginning January 1, 1997, persons described in clause 
 41.19  (1) are eligible for medical assistance without federal 
 41.20  financial participation as described in paragraph (j). 
 41.21     (3) Beginning December 1, 1996, persons residing in the 
 41.22  United States prior to August 22, 1996, who were not receiving 
 41.23  medical assistance and persons who arrived on or after August 
 41.24  22, 1996, are eligible for medical assistance without federal 
 41.25  financial participation as described in paragraph (j). 
 41.26     (f) Nonimmigrants who otherwise meet the eligibility 
 41.27  requirements of this chapter are eligible for the benefits as 
 41.28  provided in paragraphs (g) to (i).  For purposes of this 
 41.29  subdivision, a "nonimmigrant" is a person in one of the classes 
 41.30  listed in United States Code, title 8, section 1101(a)(15). 
 41.31     (g) Payment shall also be made for care and services that 
 41.32  are furnished to noncitizens, regardless of immigration status, 
 41.33  who otherwise meet the eligibility requirements of this chapter, 
 41.34  if such care and services are necessary for the treatment of an 
 41.35  emergency medical condition, except for organ transplants and 
 41.36  related care and services and routine prenatal care.  
 42.1      (h) For purposes of this subdivision, the term "emergency 
 42.2   medical condition" means a medical condition that meets the 
 42.3   requirements of United States Code, title 42, section 1396b(v). 
 42.4      (i) Pregnant noncitizens who are undocumented or, 
 42.5   nonimmigrants, or eligible for medical assistance as described 
 42.6   in paragraph (j), and who are not covered by a group health plan 
 42.7   or health insurance coverage according to Code of Federal 
 42.8   Regulations, title 42, section 457.310, and who otherwise meet 
 42.9   the eligibility requirements of this chapter, are eligible for 
 42.10  medical assistance payment without federal financial 
 42.11  participation for care and services through the period of 
 42.12  pregnancy, and including labor and delivery, to the extent 
 42.13  federal funds are available under Title XXI of the Social 
 42.14  Security Act, and the state children's health insurance program, 
 42.15  followed by 60 days postpartum, except for labor and 
 42.16  delivery without federal financial participation.  
 42.17     (j) Qualified noncitizens as described in paragraph (d), 
 42.18  and all other noncitizens lawfully residing in the United States 
 42.19  as described in paragraph (e), who are ineligible for medical 
 42.20  assistance with federal financial participation and who 
 42.21  otherwise meet the eligibility requirements of chapter 256B and 
 42.22  of this paragraph, are eligible for medical assistance without 
 42.23  federal financial participation.  Qualified noncitizens as 
 42.24  described in paragraph (d) are only eligible for medical 
 42.25  assistance without federal financial participation for five 
 42.26  years from their date of entry into the United States.  
 42.27     (k) Beginning October 1, 2003, persons who are receiving 
 42.28  care and rehabilitation services from a nonprofit center 
 42.29  established to serve victims of torture and are otherwise 
 42.30  ineligible for medical assistance under this chapter are 
 42.31  eligible for medical assistance without federal financial 
 42.32  participation.  These individuals are eligible only for the 
 42.33  period during which they are receiving services from the 
 42.34  center.  Individuals eligible under this paragraph shall not be 
 42.35  required to participate in prepaid medical assistance. 
 42.36     Sec. 22.  Minnesota Statutes 2004, section 256B.0625, is 
 43.1   amended by adding a subdivision to read: 
 43.2      Subd. 1a.  [SERVICES PROVIDED IN A HOSPITAL EMERGENCY 
 43.3   ROOM.] Medical assistance does not cover visits to a hospital 
 43.4   emergency room that are not for emergency and emergency 
 43.5   poststabilization care or urgent care, and does not pay for any 
 43.6   services provided in a hospital emergency room that are not for 
 43.7   emergency and emergency poststabilization care or urgent care. 
 43.8      Sec. 23.  Minnesota Statutes 2004, section 256B.0625, 
 43.9   subdivision 3a, is amended to read: 
 43.10     Subd. 3a.  [GENDER SEX REASSIGNMENT SURGERY.] Gender Sex 
 43.11  reassignment surgery and other gender reassignment medical 
 43.12  procedures including drug therapy for gender reassignment are is 
 43.13  not covered unless the individual began receiving gender 
 43.14  reassignment services prior to July 1, 1998. 
 43.15     Sec. 24.  Minnesota Statutes 2004, section 256B.0625, is 
 43.16  amended by adding a subdivision to read: 
 43.17     Subd. 3c.  [CIRCUMCISION FOR NEWBORNS.] Newborn 
 43.18  circumcision is not covered, unless the procedure is medically 
 43.19  necessary or required because of a well-established religious 
 43.20  practice. 
 43.21     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2005, 
 43.22  and applies to services provided on or after that date. 
 43.23     Sec. 25.  Minnesota Statutes 2004, section 256B.0625, is 
 43.24  amended by adding a subdivision to read: 
 43.25     Subd. 3d.  [HEALTH SERVICES POLICY COMMITTEE.] The 
 43.26  commissioner, after receiving recommendations from professional 
 43.27  physician associations, professional associations representing 
 43.28  licensed nonphysician health care professionals, and consumer 
 43.29  groups, shall establish an 11-member Health Services Policy 
 43.30  Committee which will consist of ten voting members and one 
 43.31  nonvoting member.  The Health Services Policy Committee will 
 43.32  advise the commissioner regarding health services issues 
 43.33  pertaining to the administration of health care benefits covered 
 43.34  under the medical assistance, general assistance medical care, 
 43.35  and MinnesotaCare programs.  The Health Services Policy 
 43.36  Committee shall meet at least quarterly.  The Health Services 
 44.1   Policy Committee shall annually elect a physician chair from 
 44.2   among its members, who will work directly with the 
 44.3   commissioner's medical director, to establish the agenda for 
 44.4   each meeting. 
 44.5      Sec. 26.  Minnesota Statutes 2004, section 256B.0625, is 
 44.6   amended by adding a subdivision to read: 
 44.7      Subd. 3e.  [HEALTH SERVICES POLICY COMMITTEE MEMBERS.] The 
 44.8   Health Services Policy Committee shall be comprised of: 
 44.9      (1) six voting members who are licensed physicians actively 
 44.10  engaged in the practice of medicine in Minnesota, one of whom 
 44.11  must be actively engaged in the treatment of persons with mental 
 44.12  illness and three of whom must represent health plans currently 
 44.13  under contract to serve medical assistance recipients; 
 44.14     (2) three voting members who are nonphysician health care 
 44.15  professionals licensed in their profession and actively engaged 
 44.16  in the practice of their profession in Minnesota; 
 44.17     (3) the commissioner's medical director who will serve as a 
 44.18  nonvoting member; and 
 44.19     (4) one consumer who shall serve as a voting member. 
 44.20     Members of the Health Services Policy Committee shall not 
 44.21  be employed by the Department of Human Services, except for the 
 44.22  medical director. 
 44.23     Sec. 27.  Minnesota Statutes 2004, section 256B.0625, is 
 44.24  amended by adding a subdivision to read: 
 44.25     Subd. 3f.  [HEALTH SERVICES POLICY COMMITTEE TERMS AND 
 44.26  COMPENSATION.] Committee members shall serve staggered 
 44.27  three-year terms, with one-third of the voting members' terms 
 44.28  expiring annually.  Members may be reappointed by the 
 44.29  commissioner.  The commissioner may require more frequent Health 
 44.30  Services Policy Committee meetings as needed.  An honorarium of 
 44.31  $200 per meeting and reimbursement for mileage and parking shall 
 44.32  be paid to each committee member in attendance except the 
 44.33  medical director.  The Health Services Policy Committee does not 
 44.34  expire as provided in section 15.059, subdivision 6. 
 44.35     Sec. 28.  Minnesota Statutes 2004, section 256B.0625, 
 44.36  subdivision 13, is amended to read: 
 45.1      Subd. 13.  [DRUGS.] (a) Medical assistance covers drugs, 
 45.2   except for fertility drugs when specifically used to enhance 
 45.3   fertility, if prescribed by a licensed practitioner and 
 45.4   dispensed by a licensed pharmacist, by a physician enrolled in 
 45.5   the medical assistance program as a dispensing physician, or by 
 45.6   a physician or a nurse practitioner employed by or under 
 45.7   contract with a community health board as defined in section 
 45.8   145A.02, subdivision 5, for the purposes of communicable disease 
 45.9   control.  
 45.10     (b) The dispensed quantity of a prescription drug must not 
 45.11  exceed a 34-day supply, unless authorized by the commissioner.  
 45.12     (c) Medical assistance covers the following 
 45.13  over-the-counter drugs when prescribed by a licensed 
 45.14  practitioner or by a licensed pharmacist who meets standards 
 45.15  established by the commissioner, in consultation with the board 
 45.16  of pharmacy:  antacids, acetaminophen, family planning products, 
 45.17  aspirin, insulin, products for the treatment of lice, vitamins 
 45.18  for adults with documented vitamin deficiencies, vitamins for 
 45.19  children under the age of seven and pregnant or nursing women, 
 45.20  and any other over-the-counter drug identified by the 
 45.21  commissioner, in consultation with the formulary committee, as 
 45.22  necessary, appropriate, and cost-effective for the treatment of 
 45.23  certain specified chronic diseases, conditions, or disorders, 
 45.24  and this determination shall not be subject to the requirements 
 45.25  of chapter 14.  A pharmacist may prescribe over-the-counter 
 45.26  medications as provided under this paragraph for purposes of 
 45.27  receiving reimbursement under Medicaid.  When prescribing 
 45.28  over-the-counter drugs under this paragraph, licensed 
 45.29  pharmacists must consult with the recipient to determine 
 45.30  necessity, provide drug counseling, review drug therapy for 
 45.31  potential adverse interactions, and make referrals as needed to 
 45.32  other health care professionals. 
 45.33     (d) Effective January 1, 2006, medical assistance shall not 
 45.34  cover drugs that are coverable under Medicare Part D as defined 
 45.35  in the Medicare Prescription Drug, Improvement, and 
 45.36  Modernization Act of 2003, Public Law 108-173, section 
 46.1   1860D-2(e), for individuals eligible for drug coverage as 
 46.2   defined in the Medicare Prescription Drug, Improvement, and 
 46.3   Modernization Act of 2003, Public Law 108-173, section 
 46.4   1860D-1(a)(3)(A).  For such individuals, medical assistance may 
 46.5   cover drugs from the drug classes listed in United States Code, 
 46.6   title 42, section 1396r-8(d)(2), subject to the provisions of 
 46.7   this subdivision and subdivisions 13a to 13g, except that drugs 
 46.8   listed in United States Code, title 42, section 
 46.9   1396r-8(d)(2)(E), shall not be covered. 
 46.10     Sec. 29.  Minnesota Statutes 2004, section 256B.0625, 
 46.11  subdivision 13a, is amended to read: 
 46.12     Subd. 13a.  [DRUG UTILIZATION REVIEW BOARD.] The 
 46.13  commissioner, after receiving recommendations from professional 
 46.14  medical associations, professional pharmacy associations, and 
 46.15  consumer groups shall designate a nine-member Drug Utilization 
 46.16  Review Board is established.  The board is shall be comprised of 
 46.17  at least three but no more than four licensed physicians 
 46.18  actively engaged in the practice of medicine in Minnesota; at 
 46.19  least three licensed pharmacists actively engaged in the 
 46.20  practice of pharmacy in Minnesota; and one consumer 
 46.21  representative; the remainder to be made up of health care 
 46.22  professionals who are licensed in their field and have 
 46.23  recognized knowledge in the clinically appropriate prescribing, 
 46.24  dispensing, and monitoring of covered outpatient drugs.  The 
 46.25  board shall be staffed by an employee of the department who 
 46.26  shall serve as an ex officio nonvoting member of the board.  The 
 46.27  department's medical director shall also serve as an ex officio, 
 46.28  nonvoting member of the board.  The members of the board shall 
 46.29  be appointed by the commissioner and shall serve three-year 
 46.30  terms.  The members shall be selected from lists submitted by 
 46.31  professional associations.  The commissioner shall appoint the 
 46.32  initial members of the board for terms expiring as follows:  
 46.33  three members for terms expiring June 30, 1996; three members 
 46.34  for terms expiring June 30, 1997; and three members for terms 
 46.35  expiring June 30, 1998.  Members may be reappointed once by the 
 46.36  commissioner.  The board shall annually elect a chair from among 
 47.1   the members. 
 47.2      The commissioner shall, with the advice of the board: 
 47.3      (1) implement a medical assistance retrospective and 
 47.4   prospective drug utilization review program as required by 
 47.5   United States Code, title 42, section 1396r-8(g)(3); 
 47.6      (2) develop and implement the predetermined criteria and 
 47.7   practice parameters for appropriate prescribing to be used in 
 47.8   retrospective and prospective drug utilization review; 
 47.9      (3) develop, select, implement, and assess interventions 
 47.10  for physicians, pharmacists, and patients that are educational 
 47.11  and not punitive in nature; 
 47.12     (4) establish a grievance and appeals process for 
 47.13  physicians and pharmacists under this section; 
 47.14     (5) publish and disseminate educational information to 
 47.15  physicians and pharmacists regarding the board and the review 
 47.16  program; 
 47.17     (6) adopt and implement procedures designed to ensure the 
 47.18  confidentiality of any information collected, stored, retrieved, 
 47.19  assessed, or analyzed by the board, staff to the board, or 
 47.20  contractors to the review program that identifies individual 
 47.21  physicians, pharmacists, or recipients; 
 47.22     (7) establish and implement an ongoing process to (i) 
 47.23  receive public comment regarding drug utilization review 
 47.24  criteria and standards, and (ii) consider the comments along 
 47.25  with other scientific and clinical information in order to 
 47.26  revise criteria and standards on a timely basis; and 
 47.27     (8) adopt any rules necessary to carry out this section. 
 47.28     The board may establish advisory committees.  The 
 47.29  commissioner may contract with appropriate organizations to 
 47.30  assist the board in carrying out the board's duties.  The 
 47.31  commissioner may enter into contracts for services to develop 
 47.32  and implement a retrospective and prospective review program. 
 47.33     The board shall report to the commissioner annually on the 
 47.34  date the Drug Utilization Review Annual Report is due to the 
 47.35  Centers for Medicare and Medicaid Services.  This report is to 
 47.36  cover the preceding federal fiscal year.  The commissioner shall 
 48.1   make the report available to the public upon request.  The 
 48.2   report must include information on the activities of the board 
 48.3   and the program; the effectiveness of implemented interventions; 
 48.4   administrative costs; and any fiscal impact resulting from the 
 48.5   program.  An honorarium of $100 per meeting and reimbursement 
 48.6   for mileage shall be paid to each board member in attendance. 
 48.7      Sec. 30.  Minnesota Statutes 2004, section 256B.0625, 
 48.8   subdivision 13c, is amended to read: 
 48.9      Subd. 13c.  [FORMULARY COMMITTEE.] The commissioner, after 
 48.10  receiving recommendations from professional medical associations 
 48.11  and professional pharmacy associations, and consumer groups 
 48.12  shall designate a Formulary Committee to carry out duties as 
 48.13  described in subdivisions 13 to 13g.  The Formulary Committee 
 48.14  shall be comprised of four licensed physicians actively engaged 
 48.15  in the practice of medicine in Minnesota one of whom must be 
 48.16  actively engaged in the treatment of persons with mental 
 48.17  illness; at least three licensed pharmacists actively engaged in 
 48.18  the practice of pharmacy in Minnesota; and one consumer 
 48.19  representative; the remainder to be made up of health care 
 48.20  professionals who are licensed in their field and have 
 48.21  recognized knowledge in the clinically appropriate prescribing, 
 48.22  dispensing, and monitoring of covered outpatient drugs.  Members 
 48.23  of the Formulary Committee shall not be employed by the 
 48.24  Department of Human Services, but the committee shall be staffed 
 48.25  by an employee of the department who shall serve as an ex 
 48.26  officio, nonvoting member of the board.  The department's 
 48.27  medical director shall also serve as an ex officio, nonvoting 
 48.28  member for the committee.  Committee members shall serve 
 48.29  three-year terms and may be reappointed by the commissioner.  
 48.30  The Formulary Committee shall meet at least quarterly.  The 
 48.31  commissioner may require more frequent Formulary Committee 
 48.32  meetings as needed.  An honorarium of $100 per meeting and 
 48.33  reimbursement for mileage shall be paid to each committee member 
 48.34  in attendance.  
 48.35     Sec. 31.  Minnesota Statutes 2004, section 256B.0625, 
 48.36  subdivision 13e, is amended to read: 
 49.1      Subd. 13e.  [PAYMENT RATES.] (a) The basis for determining 
 49.2   the amount of payment shall be the lower of the actual 
 49.3   acquisition costs of the drugs plus a fixed dispensing fee; the 
 49.4   maximum allowable cost set by the federal government or by the 
 49.5   commissioner plus the fixed dispensing fee; or the usual and 
 49.6   customary price charged to the public.  The amount of payment 
 49.7   basis must be reduced to reflect all discount amounts applied to 
 49.8   the charge by any provider/insurer agreement or contract for 
 49.9   submitted charges to medical assistance programs.  The net 
 49.10  submitted charge may not be greater than the patient liability 
 49.11  for the service.  The pharmacy dispensing fee shall be $3.65, 
 49.12  except that the dispensing fee for intravenous solutions which 
 49.13  must be compounded by the pharmacist shall be $8 per bag, $14 
 49.14  per bag for cancer chemotherapy products, and $30 per bag for 
 49.15  total parenteral nutritional products dispensed in one liter 
 49.16  quantities, or $44 per bag for total parenteral nutritional 
 49.17  products dispensed in quantities greater than one liter.  Actual 
 49.18  acquisition cost includes quantity and other special discounts 
 49.19  except time and cash discounts.  The actual acquisition cost of 
 49.20  a drug shall be estimated by the commissioner, at average 
 49.21  wholesale price minus 11.5 12 percent, except that where a drug 
 49.22  has had its wholesale price reduced as a result of the actions 
 49.23  of the National Association of Medicaid Fraud Control Units, the 
 49.24  estimated actual acquisition cost shall be the reduced average 
 49.25  wholesale price, without the 11.5 percent deduction.  The 
 49.26  maximum allowable cost of a multisource drug may be set by the 
 49.27  commissioner and it shall be comparable to, but no higher than, 
 49.28  the maximum amount paid by other third-party payors in this 
 49.29  state who have maximum allowable cost programs.  Establishment 
 49.30  of the amount of payment for drugs shall not be subject to the 
 49.31  requirements of the Administrative Procedure Act.  
 49.32     (b) An additional dispensing fee of $.30 may be added to 
 49.33  the dispensing fee paid to pharmacists for legend drug 
 49.34  prescriptions dispensed to residents of long-term care 
 49.35  facilities when a unit dose blister card system, approved by the 
 49.36  department, is used.  Under this type of dispensing system, the 
 50.1   pharmacist must dispense a 30-day supply of drug.  The National 
 50.2   Drug Code (NDC) from the drug container used to fill the blister 
 50.3   card must be identified on the claim to the department.  The 
 50.4   unit dose blister card containing the drug must meet the 
 50.5   packaging standards set forth in Minnesota Rules, part 
 50.6   6800.2700, that govern the return of unused drugs to the 
 50.7   pharmacy for reuse.  The pharmacy provider will be required to 
 50.8   credit the department for the actual acquisition cost of all 
 50.9   unused drugs that are eligible for reuse.  Over-the-counter 
 50.10  medications must be dispensed in the manufacturer's unopened 
 50.11  package.  The commissioner may permit the drug clozapine to be 
 50.12  dispensed in a quantity that is less than a 30-day supply.  
 50.13     (c) Whenever a generically equivalent product is available, 
 50.14  payment shall be on the basis of the actual acquisition cost of 
 50.15  the generic drug, or on the maximum allowable cost established 
 50.16  by the commissioner. 
 50.17     (d) The basis for determining the amount of payment for 
 50.18  drugs administered in an outpatient setting shall be the lower 
 50.19  of the usual and customary cost submitted by the provider, the 
 50.20  average wholesale price minus five percent, or the maximum 
 50.21  allowable cost set by the federal government under United States 
 50.22  Code, title 42, chapter 7, section 1396r-8(e), and Code of 
 50.23  Federal Regulations, title 42, section 447.332, or by the 
 50.24  commissioner under paragraphs (a) to (c) or the amount 
 50.25  established for Medicare by the United States Department of 
 50.26  Health and Human Services pursuant to the Social Security Act, 
 50.27  title XVIII, section 1847a. 
 50.28     (e) The commissioner may negotiate lower reimbursement 
 50.29  rates for specialty pharmacy products than the rates specified 
 50.30  in paragraph (a).  The commissioner may require individuals 
 50.31  enrolled in the health care programs administered by the 
 50.32  department to obtain specialty pharmacy products from providers 
 50.33  with whom the commissioner has negotiated lower reimbursement 
 50.34  rates.  Specialty pharmacy products are defined as those used by 
 50.35  a small number of recipients or recipients with complex and 
 50.36  chronic diseases that require expensive and challenging drug 
 51.1   regimens.  Examples of such conditions include, but are not 
 51.2   limited to:  multiple sclerosis, HIV/AIDS, transplantation, 
 51.3   hepatitis C, growth hormone deficiency, Crohn's Disease, 
 51.4   rheumatoid arthritis, and certain forms of cancer.  Specialty 
 51.5   pharmaceutical products commonly include injectable and infusion 
 51.6   therapies, biotechnology drugs, high-cost therapies, and 
 51.7   therapies that require complex care.  The commissioner shall 
 51.8   consult with the formulary committee to develop a list of 
 51.9   specialty pharmacy products subject to this paragraph. 
 51.10     (f) The commissioner may require individuals enrolled in 
 51.11  the health care programs administered by the department to 
 51.12  obtain drugs used to treat hemophilia from a comprehensive 
 51.13  hemophilia diagnostic treatment center as defined in United 
 51.14  States Code, title 42, section 256b(a)(4)(G); provided that the 
 51.15  hemophilia treatment center is enrolled as a covered entity in 
 51.16  the drug pricing program, commonly known as the 340B program, 
 51.17  that is established under that section. 
 51.18     Sec. 32.  Minnesota Statutes 2004, section 256B.0625, 
 51.19  subdivision 13f, is amended to read: 
 51.20     Subd. 13f.  [PRIOR AUTHORIZATION.] (a) The Formulary 
 51.21  Committee shall review and recommend drugs which require prior 
 51.22  authorization.  The Formulary Committee shall establish general 
 51.23  criteria to be used for the prior authorization of brand-name 
 51.24  drugs for which generically equivalent drugs are available, but 
 51.25  the committee is not required to review each brand-name drug for 
 51.26  which a generically equivalent drug is available.  
 51.27     (b) Prior authorization may be required by the commissioner 
 51.28  before certain formulary drugs are eligible for payment.  The 
 51.29  Formulary Committee may recommend drugs for prior authorization 
 51.30  directly to the commissioner.  The commissioner may also request 
 51.31  that the Formulary Committee review a drug for prior 
 51.32  authorization.  Before the commissioner may require prior 
 51.33  authorization for a drug: 
 51.34     (1) the commissioner must provide information to the 
 51.35  Formulary Committee on the impact that placing the drug on prior 
 51.36  authorization may have on the quality of patient care and on 
 52.1   program costs, information regarding whether the drug is subject 
 52.2   to clinical abuse or misuse, and relevant data from the state 
 52.3   Medicaid program if such data is available; 
 52.4      (2) the Formulary Committee must review the drug, taking 
 52.5   into account medical and clinical data and the information 
 52.6   provided by the commissioner; and 
 52.7      (3) the Formulary Committee must hold a public forum and 
 52.8   receive public comment for an additional 15 days. 
 52.9   The commissioner must provide a 15-day notice period before 
 52.10  implementing the prior authorization.  
 52.11     (c) Prior authorization shall not be required or utilized 
 52.12  for any atypical antipsychotic drug prescribed for the treatment 
 52.13  of mental illness if: 
 52.14     (1) there is no generically equivalent drug available; and 
 52.15     (2) the drug was initially prescribed for the recipient 
 52.16  prior to July 1, 2003; or 
 52.17     (3) the drug is part of the recipient's current course of 
 52.18  treatment. 
 52.19  This paragraph applies to any multistate preferred drug list or 
 52.20  supplemental drug rebate program established or administered by 
 52.21  the commissioner.  Prior authorization shall automatically be 
 52.22  granted for 60 days for brand name drugs prescribed for 
 52.23  treatment of mental illness within 60 days of when a generically 
 52.24  equivalent drug becomes available. 
 52.25     (d) Prior authorization shall not be required or utilized 
 52.26  for any antihemophilic factor drug prescribed for the treatment 
 52.27  of hemophilia and blood disorders where there is no generically 
 52.28  equivalent drug available if the prior authorization is used in 
 52.29  conjunction with any supplemental drug rebate program or 
 52.30  multistate preferred drug list established or administered by 
 52.31  the commissioner.  This paragraph expires July 1, 2005. 
 52.32     (e) The commissioner may require prior authorization for 
 52.33  brand name drugs whenever a generically equivalent product is 
 52.34  available, even if the prescriber specifically indicates 
 52.35  "dispense as written-brand necessary" on the prescription as 
 52.36  required by section 151.21, subdivision 2. 
 53.1      (f) Notwithstanding the provisions of this subdivision, the 
 53.2   commissioner may automatically require prior authorization, for 
 53.3   a period not to exceed 180 days, for any drug that is approved 
 53.4   by the United States Food and Drug Administration on or after 
 53.5   July 1, 2005.  The 180-day period shall begin no later than the 
 53.6   first day that a drug is available for shipment to pharmacies 
 53.7   within the state.  The Formulary Committee shall recommend to 
 53.8   the commissioner general criteria to be used for the prior 
 53.9   authorization of such drugs, but the committee is not required 
 53.10  to review each individual drug.  In order to continue prior 
 53.11  authorizations for a drug after the 180-day period has expired, 
 53.12  the commissioner must follow the provisions of this subdivision. 
 53.13     <b>[EFFECTIVE DATE.]</b> The amendment to paragraph (d) is 
 53.14  effective June 30, 2005. 
 53.15     Sec. 33.  Minnesota Statutes 2004, section 256B.0625, is 
 53.16  amended by adding a subdivision to read: 
 53.17     Subd. 13h.  [MEDICATION THERAPY MANAGEMENT CARE.] (a) 
 53.18  Medical assistance and general assistance medical care cover 
 53.19  medication therapy management services for a recipient taking 
 53.20  four or more prescriptions to treat or prevent two or more 
 53.21  chronic medical conditions, or a recipient with a drug therapy 
 53.22  problem that is identified or prior authorized by the 
 53.23  commissioner that has resulted or is likely to result in 
 53.24  significant nondrug program costs.  The commissioner may cover 
 53.25  medical therapy management services under MinnesotaCare if the 
 53.26  commissioner determines this is cost-effective.  For purposes of 
 53.27  this subdivision, "medication therapy management" means the 
 53.28  provision of the following pharmaceutical care services by a 
 53.29  licensed pharmacist to optimize the therapeutic outcomes of the 
 53.30  patient's medications:  
 53.31     (1) performing or obtaining necessary assessments of the 
 53.32  patient's health status; 
 53.33     (2) formulating a medication treatment plan; 
 53.34     (3) monitoring and evaluating the patient's response to 
 53.35  therapy, including safety and effectiveness; 
 53.36     (4) performing a comprehensive medication review to 
 54.1   identify, resolve, and prevent medication-related problems, 
 54.2   including adverse drug events; 
 54.3      (5) documenting the care delivered and communicating 
 54.4   essential information to the patient's other primary care 
 54.5   providers; 
 54.6      (6) providing verbal education and training designed to 
 54.7   enhance patient understanding and appropriate use of the 
 54.8   patient's medications; 
 54.9      (7) providing information, support services, and resources 
 54.10  designed to enhance patient adherence with the patient's 
 54.11  therapeutic regimens; and 
 54.12     (8) coordinating and integrating medication therapy 
 54.13  management services within the broader health care management 
 54.14  services being provided to the patient.  
 54.15  Nothing in this subdivision shall be construed to expand or 
 54.16  modify the scope of practice of the pharmacist as defined in 
 54.17  section 151.01, subdivision 27. 
 54.18     (b) To be eligible for reimbursement for services under 
 54.19  this subdivision, a pharmacist must meet the following 
 54.20  requirements:  
 54.21     (1) have a valid license issued under chapter 151; 
 54.22     (2) have graduated from an accredited college of pharmacy 
 54.23  on or after May 1996, or completed a structured and 
 54.24  comprehensive education program approved by the Board of 
 54.25  Pharmacy and the American Council of Pharmaceutical Education 
 54.26  for the provision and documentation of pharmaceutical care 
 54.27  management services that has both clinical and didactic 
 54.28  elements; 
 54.29     (3) be practicing in an ambulatory care setting as part of 
 54.30  a multidisciplinary team or have developed a structured patient 
 54.31  care process that is offered in a private or semiprivate patient 
 54.32  care area that is separate from the commercial business that 
 54.33  also occurs in the setting; and 
 54.34     (4) make use of an electronic patient record system that 
 54.35  meets state standards.  
 54.36     (c) For purposes of reimbursement for medication therapy 
 55.1   management services, the commissioner may enroll individual 
 55.2   pharmacists as medical assistance and general assistance medical 
 55.3   care providers.  The commissioner may also establish contact 
 55.4   requirements between the pharmacist and recipient, including 
 55.5   limiting the number of reimbursable consultations per recipient. 
 55.6      (d) The commissioner, after receiving recommendations from 
 55.7   professional medical associations, professional pharmacy 
 55.8   associations, and consumer groups, shall convene an 11-member 
 55.9   Medication Therapy Management Advisory Committee to advise the 
 55.10  commissioner on the implementation and administration of 
 55.11  medication therapy management services.  The committee shall be 
 55.12  comprised of:  two licensed physicians; two licensed 
 55.13  pharmacists; two consumer representatives; two health plan 
 55.14  company representatives; and three members with expertise in the 
 55.15  area of medication therapy management, who may be licensed 
 55.16  physicians or licensed pharmacists.  The committee is governed 
 55.17  by section 15.059, except that committee members do not receive 
 55.18  compensation or reimbursement for expenses.  The advisory 
 55.19  committee expires on June 30, 2007. 
 55.20     (e) The commissioner shall evaluate the effect of 
 55.21  medication therapy management on quality of care, patient 
 55.22  outcomes, and program costs, and shall include a description of 
 55.23  any savings generated in the medical assistance and general 
 55.24  assistance medical care programs that can be attributable to 
 55.25  this coverage.  The evaluation shall be submitted to the 
 55.26  legislature by December 15, 2007.  The commissioner may contract 
 55.27  with a vendor or an academic institution that has expertise in 
 55.28  evaluating health care outcomes for the purpose of completing 
 55.29  the evaluation. 
 55.30     Sec. 34.  Minnesota Statutes 2004, section 256B.0625, 
 55.31  subdivision 17, is amended to read: 
 55.32     Subd. 17.  [TRANSPORTATION COSTS.] (a) Medical assistance 
 55.33  covers transportation costs incurred solely for obtaining 
 55.34  emergency medical care or transportation costs incurred by 
 55.35  eligible persons in obtaining emergency or nonemergency medical 
 55.36  care when paid directly to an ambulance company, common carrier, 
 56.1   or other recognized providers of transportation services.  
 56.2      (b) Medical assistance covers special transportation, as 
 56.3   defined in Minnesota Rules, part 9505.0315, subpart 1, item F, 
 56.4   if the recipient has a physical or mental impairment that would 
 56.5   prohibit the recipient from safely accessing and using a bus, 
 56.6   taxi, other commercial transportation, or private automobile.  
 56.7   The commissioner may use an order by the recipient's attending 
 56.8   physician to certify that the recipient requires special 
 56.9   transportation services.  Special transportation includes 
 56.10  driver-assisted service to eligible individuals.  
 56.11  Driver-assisted service includes passenger pickup at and return 
 56.12  to the individual's residence or place of business, assistance 
 56.13  with admittance of the individual to the medical facility, and 
 56.14  assistance in passenger securement or in securing of wheelchairs 
 56.15  or stretchers in the vehicle.  Special transportation providers 
 56.16  must obtain written documentation from the health care service 
 56.17  provider who is serving the recipient being transported, 
 56.18  identifying the time that the recipient arrived.  Special 
 56.19  transportation providers may not bill for separate base rates 
 56.20  for the continuation of a trip beyond the original destination.  
 56.21  Special transportation providers must take recipients to the 
 56.22  nearest appropriate health care provider, using the most direct 
 56.23  route available.  The maximum medical assistance reimbursement 
 56.24  rates for special transportation services are: 
 56.25     (1) $18 for the base rate and $1.40 per mile for services 
 56.26  to eligible persons who need a wheelchair-accessible van; 
 56.27     (2) $12 for the base rate and $1.35 per mile for services 
 56.28  to eligible persons who do not need a wheelchair-accessible van; 
 56.29  and 
 56.30     (3) $36 $60 for the base rate and $1.40 $2.40 per mile, and 
 56.31  an attendant rate of $9 per trip, for services to eligible 
 56.32  persons who need a stretcher-accessible vehicle. 
 56.33     Sec. 35.  [256B.0632] [MEDICALLY NECESSARY ITEMS AND 
 56.34  SERVICES.] 
 56.35     Subdivision 1.  [GENERAL REQUIREMENT FOR 
 56.36  COVERAGE.] Enrollees under the medical assistance program are 
 57.1   eligible to receive, and medical assistance shall provide 
 57.2   payment for, only those medical items and services that are: 
 57.3      (1) within the scope of defined benefits for which the 
 57.4   enrollee is eligible under the medical assistance program; and 
 57.5      (2) determined by the medical assistance program to be 
 57.6   medically necessary. 
 57.7      Subd. 2.  [MEDICAL NECESSITY.] (a) To be determined to be 
 57.8   medically necessary, a medical item or service must be 
 57.9   recommended by a physician who is treating the enrollee or other 
 57.10  licensed health care provider practicing within the scope of the 
 57.11  physician's license who is treating the enrollee and must 
 57.12  satisfy each of the criteria in this section. 
 57.13     (b) It must be required in order to diagnose or treat an 
 57.14  enrollee's medical condition.  The convenience of an enrollee, 
 57.15  the enrollee's family, or a provider, shall not be a factor or 
 57.16  justification in determining that a medical item or service is 
 57.17  medically necessary. 
 57.18     (c) It must be safe and effective.  To qualify as safe and 
 57.19  effective, the type and level of medical item or service must be 
 57.20  consistent with the symptoms or diagnosis and treatment of the 
 57.21  particular medical condition, and the reasonably anticipated 
 57.22  medical benefits of the item or service must outweigh the 
 57.23  reasonably anticipated medical risks based on the enrollee's 
 57.24  condition and scientifically supported evidence. 
 57.25     (d) It must be the least costly alternative course of 
 57.26  diagnosis or treatment that is adequate for the medical 
 57.27  condition of the enrollee.  When applied to medical items or 
 57.28  services delivered in an inpatient setting, it further means 
 57.29  that the medical item or service cannot be safely provided for 
 57.30  the same or lesser cost to the person in an outpatient setting.  
 57.31  Where there are less costly alternative courses of diagnosis or 
 57.32  treatment, including less costly alternative settings, that are 
 57.33  adequate for the medical condition of the enrollee, more costly 
 57.34  alternative courses of diagnosis or treatment are not medically 
 57.35  necessary.  An alternative course of diagnosis or treatment may 
 57.36  include observation, lifestyle or behavioral changes, or where 
 58.1   appropriate, no treatment at all. 
 58.2      Subd. 3.  [DETERMINATION OF COMMISSIONER.] It is the 
 58.3   responsibility of the commissioner ultimately to determine what 
 58.4   medical items and services are medically necessary for the 
 58.5   medical assistance program.  The fact that a provider has 
 58.6   prescribed, recommended, or approved a medical item or service 
 58.7   does not, in itself, make such item or service medically 
 58.8   necessary. 
 58.9      Subd. 4.  [APPLICABILITY.] The medical necessity standard 
 58.10  in this section shall govern the delivery of all services and 
 58.11  items to all enrollees or classes of beneficiaries in the 
 58.12  medical assistance program.  The commissioner is authorized to 
 58.13  make limited special provisions for particular items or 
 58.14  services, such as long-term care, or such as may be required for 
 58.15  compliance with federal law. 
 58.16     Subd. 5.  [MEDICAL PROTOCOLS.] Medical protocols developed 
 58.17  using evidence-based medicine that are authorized by the 
 58.18  commissioner shall satisfy the standard of medical necessity. 
 58.19  Such protocols shall be appropriately published to all medical 
 58.20  assistance providers and managed care organizations. 
 58.21     Subd. 6.  [RULEMAKING.] The commissioner is authorized to 
 58.22  adopt any rules necessary to implement this section. 
 58.23     Sec. 36.  [256B.0633] [LIMITING COVERAGE OF HEALTH CARE 
 58.24  SERVICES FOR PUBLIC PROGRAMS.] 
 58.25     Subdivision 1.  [PRIOR AUTHORIZATION OF SERVICES.] (a) 
 58.26  Effective July 1, 2005, prior authorization is required for the 
 58.27  services described in subdivision 2 for reimbursement under 
 58.28  chapters 256B, 256D, and 256L.  Effective July 1, 2005, prepaid 
 58.29  health plans shall use prior authorization for the services 
 58.30  described in subdivision 2 unless the prepaid health plan is 
 58.31  otherwise using evidence-based practices to address these 
 58.32  services. 
 58.33     (b) Prior authorization shall be conducted by the medical 
 58.34  director of the Department of Human Services in conjunction with 
 58.35  a medical policy advisory council.  To the extent available, the 
 58.36  medical director shall use publicly available evidence-based 
 59.1   guidelines developed by an independent, nonprofit organization 
 59.2   or by the professional association of the specialty that 
 59.3   typically provides the service or by a multistate Medicaid 
 59.4   evidence-based practice center.  If the commissioner does not 
 59.5   have a medical director and medical policy in place, the 
 59.6   commissioner shall contract prior authorization to a 
 59.7   Minnesota-licensed utilization review organization. 
 59.8      Subd. 2.  [SERVICES REQUIRING PRIOR AUTHORIZATION.] The 
 59.9   following services require prior authorization: 
 59.10     (1) elective outpatient high technology imaging to include 
 59.11  positive emission tomography (PET) scans, magnetic resonance 
 59.12  imaging (MRI), computed tomography (CT), and nuclear cardiology; 
 59.13     (2) spinal fusion, unless in an emergency situation related 
 59.14  to trauma; 
 59.15     (3) bariatric surgery; 
 59.16     (4) orthodontia; 
 59.17     (5) cesarean section or insertion of tympanostomy tubes 
 59.18  except in an emergency situation; and 
 59.19     (6) hysterectomy. 
 59.20     Sec. 37.  Minnesota Statutes 2004, section 256B.0644, is 
 59.21  amended to read: 
 59.22     256B.0644 [PARTICIPATION REQUIRED FOR REIMBURSEMENT UNDER 
 59.23  OTHER STATE HEALTH CARE PROGRAMS.] 
 59.24     A vendor of medical care, as defined in section 256B.02, 
 59.25  subdivision 7, and a health maintenance organization, as defined 
 59.26  in chapter 62D, must participate as a provider or contractor in 
 59.27  the medical assistance program, general assistance medical care 
 59.28  program, and MinnesotaCare as a condition of participating as a 
 59.29  provider in health insurance plans and programs or contractor 
 59.30  for state employees established under section 43A.18, the public 
 59.31  employees insurance program under section 43A.316, for health 
 59.32  insurance plans offered to local statutory or home rule charter 
 59.33  city, county, and school district employees, the workers' 
 59.34  compensation system under section 176.135, and insurance plans 
 59.35  provided through the Minnesota Comprehensive Health Association 
 59.36  under sections 62E.01 to 62E.19.  This section does not apply to 
 60.1   any person providing dental services.  The limitations on 
 60.2   insurance plans offered to local government employees shall not 
 60.3   be applicable in geographic areas where provider participation 
 60.4   is limited by managed care contracts with the Department of 
 60.5   Human Services.  For providers other than health maintenance 
 60.6   organizations, participation in the medical assistance program 
 60.7   means that (1) the provider accepts new medical assistance, 
 60.8   general assistance medical care, and MinnesotaCare patients or 
 60.9   (2) for providers other than dental service providers, and at 
 60.10  least 20 percent of the provider's patients are covered by 
 60.11  medical assistance, general assistance medical care, and 
 60.12  MinnesotaCare as their primary source of coverage, or (3) for 
 60.13  dental service providers, at least ten percent of the provider's 
 60.14  patients are covered by medical assistance, general assistance 
 60.15  medical care, and MinnesotaCare as their primary source of 
 60.16  coverage.  Patients seen on a volunteer basis by the provider at 
 60.17  a location other than the provider's usual place of practice may 
 60.18  be considered in meeting this participation requirement.  The 
 60.19  commissioner shall establish participation requirements for 
 60.20  health maintenance organizations.  The commissioner shall 
 60.21  provide lists of participating medical assistance providers on a 
 60.22  quarterly basis to the commissioner of employee relations, the 
 60.23  commissioner of labor and industry, and the commissioner of 
 60.24  commerce.  Each of the commissioners shall develop and implement 
 60.25  procedures to exclude as participating providers in the program 
 60.26  or programs under their jurisdiction those providers who do not 
 60.27  participate in the medical assistance program.  The commissioner 
 60.28  of employee relations shall implement this section through 
 60.29  contracts with participating health and dental carriers. 
 60.30     Sec. 38.  Minnesota Statutes 2004, section 256B.075, 
 60.31  subdivision 2, is amended to read: 
 60.32     Subd. 2.  [FEE-FOR-SERVICE.] (a) The commissioner shall 
 60.33  develop and implement a disease management program for medical 
 60.34  assistance and general assistance medical care recipients who 
 60.35  are not enrolled in the prepaid medical assistance or prepaid 
 60.36  general assistance medical care programs and who are receiving 
 61.1   services on a fee-for-service basis.  The commissioner may 
 61.2   contract with an outside organization to provide these services. 
 61.3      (b) The commissioner shall seek any federal approval 
 61.4   necessary to implement this section and to obtain federal 
 61.5   matching funds. 
 61.6      (c) The commissioner shall develop and implement a pilot 
 61.7   intensive care management program for medical assistance 
 61.8   children with complex and chronic medical issues who are not 
 61.9   able to participate in the metro-based U Special Kids program 
 61.10  due to geographic distance. 
 61.11     Sec. 39.  Minnesota Statutes 2004, section 256B.15, 
 61.12  subdivision 1, is amended to read: 
 61.13     Subdivision 1.  [POLICY, APPLICABILITY, PURPOSE, AND 
 61.14  CONSTRUCTION; DEFINITION.] (a) It is the policy of this state 
 61.15  that individuals or couples, either or both of whom participate 
 61.16  in the medical assistance program, use their own assets to pay 
 61.17  their share of the total cost of their care during or after 
 61.18  their enrollment in the program according to applicable federal 
 61.19  law and the laws of this state.  The following provisions apply: 
 61.20     (1) subdivisions 1c to 1k shall not apply to claims arising 
 61.21  under this section which are presented under section 525.313; 
 61.22     (2) the provisions of subdivisions 1c to 1k expanding the 
 61.23  interests included in an estate for purposes of recovery under 
 61.24  this section give effect to the provisions of United States 
 61.25  Code, title 42, section 1396p, governing recoveries, but do not 
 61.26  give rise to any express or implied liens in favor of any other 
 61.27  parties not named in these provisions; 
 61.28     (3) the continuation of a recipient's life estate or joint 
 61.29  tenancy interest in real property after the recipient's death 
 61.30  for the purpose of recovering medical assistance under this 
 61.31  section modifies common law principles holding that these 
 61.32  interests terminate on the death of the holder; 
 61.33     (4) all laws, rules, and regulations governing or involved 
 61.34  with a recovery of medical assistance shall be liberally 
 61.35  construed to accomplish their intended purposes; 
 61.36     (5) a deceased recipient's life estate and joint tenancy 
 62.1   interests continued under this section shall be owned by the 
 62.2   remaindermen or surviving joint tenants as their interests may 
 62.3   appear on the date of the recipient's death.  They shall not be 
 62.4   merged into the remainder interest or the interests of the 
 62.5   surviving joint tenants by reason of ownership.  They shall be 
 62.6   subject to the provisions of this section.  Any conveyance, 
 62.7   transfer, sale, assignment, or encumbrance by a remainderman, a 
 62.8   surviving joint tenant, or their heirs, successors, and assigns 
 62.9   shall be deemed to include all of their interest in the deceased 
 62.10  recipient's life estate or joint tenancy interest continued 
 62.11  under this section; and 
 62.12     (6) the provisions of subdivisions 1c to 1k continuing a 
 62.13  recipient's joint tenancy interests in real property after the 
 62.14  recipient's death do not apply to a homestead owned of record, 
 62.15  on the date the recipient dies, by the recipient and the 
 62.16  recipient's spouse as joint tenants with a right of 
 62.17  survivorship.  Homestead means the real property occupied by the 
 62.18  surviving joint tenant spouse as their sole residence on the 
 62.19  date the recipient dies and classified and taxed to the 
 62.20  recipient and surviving joint tenant spouse as homestead 
 62.21  property for property tax purposes in the calendar year in which 
 62.22  the recipient dies.  For purposes of this exemption, real 
 62.23  property the recipient and their surviving joint tenant spouse 
 62.24  purchase solely with the proceeds from the sale of their prior 
 62.25  homestead, own of record as joint tenants, and qualify as 
 62.26  homestead property under section 273.124 in the calendar year in 
 62.27  which the recipient dies and prior to the recipient's death 
 62.28  shall be deemed to be real property classified and taxed to the 
 62.29  recipient and their surviving joint tenant spouse as homestead 
 62.30  property in the calendar year in which the recipient dies.  The 
 62.31  surviving spouse, or any person with personal knowledge of the 
 62.32  facts, may provide an affidavit describing the homestead 
 62.33  property affected by this clause and stating facts showing 
 62.34  compliance with this clause.  The affidavit shall be prima facie 
 62.35  evidence of the facts it states. 
 62.36     (b) For purposes of this section, "medical assistance" 
 63.1   includes the medical assistance program under this chapter and 
 63.2   the general assistance medical care program under chapter 256D 
 63.3   and alternative care for nonmedical assistance recipients under 
 63.4   section 256B.0913. 
 63.5      (c) All provisions in this subdivision, and subdivisions 
 63.6   1d, 1f, 1g, 1h, 1i, and 1j, related to the continuation of a 
 63.7   recipient's life estate or joint tenancy interests in real 
 63.8   property after the recipient's death for the purpose of 
 63.9   recovering medical assistance, are effective only for life 
 63.10  estates and joint tenancy interests established on or after 
 63.11  August 1, 2003. 
 63.12     <b>[EFFECTIVE DATE.]</b> This section is effective retroactively 
 63.13  from August 1, 2003. 
 63.14     Sec. 40.  Minnesota Statutes 2004, section 256B.32, 
 63.15  subdivision 1, is amended to read: 
 63.16     Subdivision 1.  [FACILITY FEE PAYMENT.] (a) The 
 63.17  commissioner shall establish a facility fee payment mechanism 
 63.18  that will pay a facility fee to all enrolled outpatient 
 63.19  hospitals for each emergency room or outpatient clinic visit 
 63.20  provided on or after July 1, 1989.  This payment mechanism may 
 63.21  not result in an overall increase in outpatient payment rates.  
 63.22  This section does not apply to federally mandated maximum 
 63.23  payment limits, department-approved program packages, or 
 63.24  services billed using a nonoutpatient hospital provider number. 
 63.25     (b) For fee-for-service services provided on or after July 
 63.26  1, 2002, the total payment, before third-party liability and 
 63.27  spenddown, made to hospitals for outpatient hospital facility 
 63.28  services is reduced by .5 percent from the current statutory 
 63.29  rates. 
 63.30     (c) In addition to the reduction in paragraph (b), the 
 63.31  total payment for fee-for-service services provided on or after 
 63.32  July 1, 2003, made to hospitals for outpatient hospital facility 
 63.33  services before third-party liability and spenddown, is reduced 
 63.34  five percent from the current statutory rates.  Facilities 
 63.35  defined under section 256.969, subdivision 16, are excluded from 
 63.36  this paragraph. 
 64.1      (d) In addition to the reduction in paragraphs (b) and (c) 
 64.2   and section 256D.03, subdivision 4, paragraph (k), the total 
 64.3   payment for fee-for-service services provided on or after July 
 64.4   1, 2005, made to hospitals for outpatient hospital facility 
 64.5   services before third-party liability and spenddown, is reduced 
 64.6   five percent from the current statutory rates.  Facilities 
 64.7   defined under section 256.969, subdivision 16, are excluded from 
 64.8   this paragraph. 
 64.9      Sec. 41.  Minnesota Statutes 2004, section 256B.69, 
 64.10  subdivision 4, is amended to read: 
 64.11     Subd. 4.  [LIMITATION OF CHOICE.] (a) The commissioner 
 64.12  shall develop criteria to determine when limitation of choice 
 64.13  may be implemented in the experimental counties.  The criteria 
 64.14  shall ensure that all eligible individuals in the county have 
 64.15  continuing access to the full range of medical assistance 
 64.16  services as specified in subdivision 6.  
 64.17     (b) The commissioner shall exempt the following persons 
 64.18  from participation in the project, in addition to those who do 
 64.19  not meet the criteria for limitation of choice:  
 64.20     (1) persons eligible for medical assistance according to 
 64.21  section 256B.055, subdivision 1; 
 64.22     (2) persons eligible for medical assistance due to 
 64.23  blindness or disability as determined by the Social Security 
 64.24  Administration or the state medical review team, unless:  
 64.25     (i) they are 65 years of age or older; or 
 64.26     (ii) they reside in Itasca County or they reside in a 
 64.27  county in which the commissioner conducts a pilot project under 
 64.28  a waiver granted pursuant to section 1115 of the Social Security 
 64.29  Act; 
 64.30     (3) recipients who currently have private coverage through 
 64.31  a health maintenance organization; 
 64.32     (4) recipients who are eligible for medical assistance by 
 64.33  spending down excess income for medical expenses other than the 
 64.34  nursing facility per diem expense; 
 64.35     (5) recipients who receive benefits under the Refugee 
 64.36  Assistance Program, established under United States Code, title 
 65.1   8, section 1522(e); 
 65.2      (6) children who are both determined to be severely 
 65.3   emotionally disturbed and receiving case management services 
 65.4   according to section 256B.0625, subdivision 20; 
 65.5      (7) adults who are both determined to be seriously and 
 65.6   persistently mentally ill and received case management services 
 65.7   according to section 256B.0625, subdivision 20; 
 65.8      (8) persons eligible for medical assistance according to 
 65.9   section 256B.057, subdivision 10; and 
 65.10     (9) persons with access to cost-effective 
 65.11  employer-sponsored private health insurance or persons enrolled 
 65.12  in an a non-Medicare individual health plan determined to be 
 65.13  cost-effective according to section 256B.0625, subdivision 15.  
 65.14  Children under age 21 who are in foster placement may enroll in 
 65.15  the project on an elective basis.  Individuals excluded under 
 65.16  clauses (1), (6), and (7) may choose to enroll on an elective 
 65.17  basis.  The commissioner may enroll recipients in the prepaid 
 65.18  medical assistance program for seniors who are (1) age 65 and 
 65.19  over, and (2) eligible for medical assistance by spending down 
 65.20  excess income. 
 65.21     (c) The commissioner may allow persons with a one-month 
 65.22  spenddown who are otherwise eligible to enroll to voluntarily 
 65.23  enroll or remain enrolled, if they elect to prepay their monthly 
 65.24  spenddown to the state.  
 65.25     (d) The commissioner may require those individuals to 
 65.26  enroll in the prepaid medical assistance program who otherwise 
 65.27  would have been excluded under paragraph (b), clauses (1), (3), 
 65.28  and (8), and under Minnesota Rules, part 9500.1452, subpart 2, 
 65.29  items H, K, and L.  
 65.30     (e) Before limitation of choice is implemented, eligible 
 65.31  individuals shall be notified and after notification, shall be 
 65.32  allowed to choose only among demonstration providers.  The 
 65.33  commissioner may assign an individual with private coverage 
 65.34  through a health maintenance organization, to the same health 
 65.35  maintenance organization for medical assistance coverage, if the 
 65.36  health maintenance organization is under contract for medical 
 66.1   assistance in the individual's county of residence.  After 
 66.2   initially choosing a provider, the recipient is allowed to 
 66.3   change that choice only at specified times as allowed by the 
 66.4   commissioner.  If a demonstration provider ends participation in 
 66.5   the project for any reason, a recipient enrolled with that 
 66.6   provider must select a new provider but may change providers 
 66.7   without cause once more within the first 60 days after 
 66.8   enrollment with the second provider. 
 66.9      (f) An infant born to a woman who is eligible for and 
 66.10  receiving medical assistance and who is enrolled in the prepaid 
 66.11  medical assistance program shall be retroactively enrolled to 
 66.12  the month of birth in the same managed care plan as the mother 
 66.13  once the child is enrolled in medical assistance unless the 
 66.14  child is determined to be excluded from enrollment in a prepaid 
 66.15  plan under this section. 
 66.16     Sec. 42.  Minnesota Statutes 2004, section 256B.69, is 
 66.17  amended by adding a subdivision to read: 
 66.18     Subd. 5i.  [PAYMENT REDUCTION.] In addition to the 
 66.19  reduction in subdivisions 5g and 5h and section 256D.03, 
 66.20  subdivision 4, paragraph (m), the total payment made to managed 
 66.21  care plans is reduced 2.01 percent under the medical assistance 
 66.22  program and 2.20 percent under the general assistance medical 
 66.23  care program for services provided on or after January 1, 2006.  
 66.24  This provision excludes payments for nursing home services, home 
 66.25  and community-based waivers, and payments to demonstration 
 66.26  projects for persons with disabilities. 
 66.27     Sec. 43.  Minnesota Statutes 2004, section 256B.75, is 
 66.28  amended to read: 
 66.29     256B.75 [HOSPITAL OUTPATIENT REIMBURSEMENT.] 
 66.30     (a) For outpatient hospital facility fee payments for 
 66.31  services rendered on or after October 1, 1992, the commissioner 
 66.32  of human services shall pay the lower of (1) submitted charge, 
 66.33  or (2) 32 percent above the rate in effect on June 30, 1992, 
 66.34  except for those services for which there is a federal maximum 
 66.35  allowable payment.  Effective for services rendered on or after 
 66.36  January 1, 2000, payment rates for nonsurgical outpatient 
 67.1   hospital facility fees and emergency room facility fees shall be 
 67.2   increased by eight percent over the rates in effect on December 
 67.3   31, 1999, except for those services for which there is a federal 
 67.4   maximum allowable payment.  Services for which there is a 
 67.5   federal maximum allowable payment shall be paid at the lower of 
 67.6   (1) submitted charge, or (2) the federal maximum allowable 
 67.7   payment.  Total aggregate payment for outpatient hospital 
 67.8   facility fee services shall not exceed the Medicare upper 
 67.9   limit.  If it is determined that a provision of this section 
 67.10  conflicts with existing or future requirements of the United 
 67.11  States government with respect to federal financial 
 67.12  participation in medical assistance, the federal requirements 
 67.13  prevail.  The commissioner may, in the aggregate, prospectively 
 67.14  reduce payment rates to avoid reduced federal financial 
 67.15  participation resulting from rates that are in excess of the 
 67.16  Medicare upper limitations. 
 67.17     (b) Notwithstanding paragraph (a), payment for outpatient, 
 67.18  emergency, and ambulatory surgery hospital facility fee services 
 67.19  for critical access hospitals designated under section 144.1483, 
 67.20  clause (11), shall be paid on a cost-based payment system that 
 67.21  is based on the cost-finding methods and allowable costs of the 
 67.22  Medicare program. 
 67.23     (c) Effective for services provided on or after July 1, 
 67.24  2003, rates that are based on the Medicare outpatient 
 67.25  prospective payment system shall be replaced by a budget neutral 
 67.26  prospective payment system that is derived using medical 
 67.27  assistance data.  The commissioner shall provide a proposal to 
 67.28  the 2003 legislature to define and implement this provision. 
 67.29     (d) For fee-for-service services provided on or after July 
 67.30  1, 2002, the total payment, before third-party liability and 
 67.31  spenddown, made to hospitals for outpatient hospital facility 
 67.32  services is reduced by .5 percent from the current statutory 
 67.33  rate. 
 67.34     (e) In addition to the reduction in paragraph (d), the 
 67.35  total payment for fee-for-service services provided on or after 
 67.36  July 1, 2003, made to hospitals for outpatient hospital facility 
 68.1   services before third-party liability and spenddown, is reduced 
 68.2   five percent from the current statutory rates.  Facilities 
 68.3   defined under section 256.969, subdivision 16, are excluded from 
 68.4   this paragraph. 
 68.5      (f) In addition to the reduction in paragraphs (d) and (e) 
 68.6   and section 256D.03, subdivision 4, paragraph (k), the total 
 68.7   payment for fee-for-service services provided on or after July 
 68.8   1, 2005, made to hospitals for outpatient hospital facility 
 68.9   services before third-party liability and spenddown, is reduced 
 68.10  five percent from the current statutory rates.  Facilities 
 68.11  defined under section 256.969, subdivision 16, are excluded from 
 68.12  this paragraph. 
 68.13     Sec. 44.  Minnesota Statutes 2004, section 256D.03, 
 68.14  subdivision 3, is amended to read: 
 68.15     Subd. 3.  [GENERAL ASSISTANCE MEDICAL CARE; ELIGIBILITY.] 
 68.16  (a) General assistance medical care may be paid for any person 
 68.17  who is not eligible for medical assistance under chapter 256B, 
 68.18  including eligibility for medical assistance based on a 
 68.19  spenddown of excess income according to section 256B.056, 
 68.20  subdivision 5, or MinnesotaCare as defined in paragraph (b), 
 68.21  except as provided in paragraph (c), and: 
 68.22     (1) who is receiving assistance under section 256D.05, 
 68.23  except for families with children who are eligible under 
 68.24  Minnesota family investment program (MFIP), or who is having a 
 68.25  payment made on the person's behalf under sections 256I.01 to 
 68.26  256I.06, or who resides in group residential housing as defined 
 68.27  in chapter 256I and can meet a spenddown using the cost of 
 68.28  remedial services received through group residential housing; or 
 68.29     (2)(i) who is a resident of Minnesota; and 
 68.30     (i) who has gross countable income not in excess of 75 
 68.31  percent of the federal poverty guidelines for the family size, 
 68.32  using a six-month budget period and whose equity in assets is 
 68.33  not in excess of $1,000 per assistance unit.  Exempt assets, the 
 68.34  reduction of excess assets, and the waiver of excess assets must 
 68.35  conform to the medical assistance program in section 256B.056, 
 68.36  subdivision 3, with the following exception:  the maximum amount 
 69.1   of undistributed funds in a trust that could be distributed to 
 69.2   or on behalf of the beneficiary by the trustee, assuming the 
 69.3   full exercise of the trustee's discretion under the terms of the 
 69.4   trust, must be applied toward the asset maximum; or and 
 69.5      (ii) who has gross countable income above 75 percent not in 
 69.6   excess of 75 percent of the federal poverty guidelines but not 
 69.7   in excess of 175 percent of the federal poverty guidelines for 
 69.8   the family size, using a six-month budget period, or whose 
 69.9   equity in assets is not in excess of the limits in section 
 69.10  256B.056, subdivision 3c, and who applies during an inpatient 
 69.11  hospitalization excess income is spent down to 50 percent of the 
 69.12  federal poverty guidelines using a six-month budget period. 
 69.13     (b) General assistance medical care may not be paid for 
 69.14  applicants or recipients who meet all eligibility requirements 
 69.15  of MinnesotaCare as defined in sections 256L.01 to 256L.16, and 
 69.16  are adults with dependent children under 21 whose gross family 
 69.17  income is equal to or less than 275 175 percent of the federal 
 69.18  poverty guidelines. 
 69.19     (c) For applications received on or after October 1, 2003, 
 69.20  Eligibility may begin no earlier than the date of application.  
 69.21  For individuals eligible under paragraph (a), clause (2), item 
 69.22  (i), a redetermination of eligibility must occur every 12 
 69.23  months.  Individuals are eligible under paragraph (a), clause 
 69.24  (2), item (ii), only during inpatient hospitalization but may 
 69.25  reapply if there is a subsequent period of inpatient 
 69.26  hospitalization.  Beginning January 1, 2000, Minnesota health 
 69.27  care program applications completed by recipients and applicants 
 69.28  who are persons described in paragraph (b), may be returned to 
 69.29  the county agency to be forwarded to the Department of Human 
 69.30  Services or sent directly to the Department of Human Services 
 69.31  for enrollment in MinnesotaCare.  If all other eligibility 
 69.32  requirements of this subdivision are met, eligibility for 
 69.33  general assistance medical care shall be available in any month 
 69.34  during which a MinnesotaCare eligibility determination and 
 69.35  enrollment are pending.  Upon notification of eligibility for 
 69.36  MinnesotaCare, notice of termination for eligibility for general 
 70.1   assistance medical care shall be sent to an applicant or 
 70.2   recipient.  If all other eligibility requirements of this 
 70.3   subdivision are met, eligibility for general assistance medical 
 70.4   care shall be available until enrollment in MinnesotaCare 
 70.5   subject to the provisions of paragraph (e). 
 70.6      (d) The date of an initial Minnesota health care program 
 70.7   application necessary to begin a determination of eligibility 
 70.8   shall be the date the applicant has provided a name, address, 
 70.9   and Social Security number, signed and dated, to the county 
 70.10  agency or the Department of Human Services.  If the applicant is 
 70.11  unable to provide a name, address, Social Security number, and 
 70.12  signature when health care is delivered due to a medical 
 70.13  condition or disability, a health care provider may act on an 
 70.14  applicant's behalf to establish the date of an initial Minnesota 
 70.15  health care program application by providing the county agency 
 70.16  or Department of Human Services with provider identification and 
 70.17  a temporary unique identifier for the applicant.  The applicant 
 70.18  must complete the remainder of the application and provide 
 70.19  necessary verification before eligibility can be determined.  
 70.20  The county agency must assist the applicant in obtaining 
 70.21  verification if necessary.  
 70.22     (e) County agencies are authorized to use all automated 
 70.23  databases containing information regarding recipients' or 
 70.24  applicants' income in order to determine eligibility for general 
 70.25  assistance medical care or MinnesotaCare.  Such use shall be 
 70.26  considered sufficient in order to determine eligibility and 
 70.27  premium payments by the county agency. 
 70.28     (f) General assistance medical care is not available for a 
 70.29  person in a correctional facility unless the person is detained 
 70.30  by law for less than one year in a county correctional or 
 70.31  detention facility as a person accused or convicted of a crime, 
 70.32  or admitted as an inpatient to a hospital on a criminal hold 
 70.33  order, and the person is a recipient of general assistance 
 70.34  medical care at the time the person is detained by law or 
 70.35  admitted on a criminal hold order and as long as the person 
 70.36  continues to meet other eligibility requirements of this 
 71.1   subdivision.  
 71.2      (g) General assistance medical care is not available for 
 71.3   applicants or recipients who do not cooperate with the county 
 71.4   agency to meet the requirements of medical assistance.  
 71.5      (h) In determining the amount of assets of an individual 
 71.6   eligible under paragraph (a), clause (2), item (i), there shall 
 71.7   be included any asset or interest in an asset, including an 
 71.8   asset excluded under paragraph (a), that was given away, sold, 
 71.9   or disposed of for less than fair market value within the 60 
 71.10  months preceding application for general assistance medical care 
 71.11  or during the period of eligibility.  Any transfer described in 
 71.12  this paragraph shall be presumed to have been for the purpose of 
 71.13  establishing eligibility for general assistance medical care, 
 71.14  unless the individual furnishes convincing evidence to establish 
 71.15  that the transaction was exclusively for another purpose.  For 
 71.16  purposes of this paragraph, the value of the asset or interest 
 71.17  shall be the fair market value at the time it was given away, 
 71.18  sold, or disposed of, less the amount of compensation received.  
 71.19  For any uncompensated transfer, the number of months of 
 71.20  ineligibility, including partial months, shall be calculated by 
 71.21  dividing the uncompensated transfer amount by the average 
 71.22  monthly per person payment made by the medical assistance 
 71.23  program to skilled nursing facilities for the previous calendar 
 71.24  year.  The individual shall remain ineligible until this fixed 
 71.25  period has expired.  The period of ineligibility may exceed 30 
 71.26  months, and a reapplication for benefits after 30 months from 
 71.27  the date of the transfer shall not result in eligibility unless 
 71.28  and until the period of ineligibility has expired.  The period 
 71.29  of ineligibility begins in the month the transfer was reported 
 71.30  to the county agency, or if the transfer was not reported, the 
 71.31  month in which the county agency discovered the transfer, 
 71.32  whichever comes first.  For applicants, the period of 
 71.33  ineligibility begins on the date of the first approved 
 71.34  application. 
 71.35     (i) When determining eligibility for any state benefits 
 71.36  under this subdivision, the income and resources of all 
 72.1   noncitizens shall be deemed to include their sponsor's income 
 72.2   and resources as defined in the Personal Responsibility and Work 
 72.3   Opportunity Reconciliation Act of 1996, title IV, Public Law 
 72.4   104-193, sections 421 and 422, and subsequently set out in 
 72.5   federal rules. 
 72.6      (j) Undocumented noncitizens and nonimmigrants are 
 72.7   ineligible for general assistance medical care.  For purposes of 
 72.8   this subdivision, a nonimmigrant is an individual in one or more 
 72.9   of the classes listed in United States Code, title 8, section 
 72.10  1101(a)(15), and an undocumented noncitizen is an individual who 
 72.11  resides in the United States without the approval or 
 72.12  acquiescence of the Immigration and Naturalization Service. 
 72.13     (k) Notwithstanding any other provision of law, a 
 72.14  noncitizen who is ineligible for medical assistance due to the 
 72.15  deeming of a sponsor's income and resources, is ineligible for 
 72.16  general assistance medical care. 
 72.17     (l) Effective July 1, 2003, general assistance medical care 
 72.18  emergency services end.  
 72.19     <b>[EFFECTIVE DATE.]</b> This section is effective October 1, 2005.
 72.20     Sec. 45.  Minnesota Statutes 2004, section 256D.03, 
 72.21  subdivision 4, is amended to read: 
 72.22     Subd. 4.  [GENERAL ASSISTANCE MEDICAL CARE; SERVICES.] 
 72.23  (a)(i) For a person who is eligible under subdivision 3, 
 72.24  paragraph (a), clause (2), item (i), general assistance medical 
 72.25  care covers, except as provided in paragraph (c): 
 72.26     (1) inpatient hospital services; 
 72.27     (2) outpatient hospital services; 
 72.28     (3) services provided by Medicare certified rehabilitation 
 72.29  agencies; 
 72.30     (4) prescription drugs and other products recommended 
 72.31  through the process established in section 256B.0625, 
 72.32  subdivision 13; 
 72.33     (5) equipment necessary to administer insulin and 
 72.34  diagnostic supplies and equipment for diabetics to monitor blood 
 72.35  sugar level; 
 72.36     (6) eyeglasses and eye examinations provided by a physician 
 73.1   or optometrist; 
 73.2      (7) hearing aids; 
 73.3      (8) prosthetic devices; 
 73.4      (9) laboratory and X-ray services; 
 73.5      (10) physician's services; 
 73.6      (11) medical transportation except special transportation; 
 73.7      (12) chiropractic services as covered under the medical 
 73.8   assistance program; 
 73.9      (13) podiatric services; 
 73.10     (14) dental services and dentures, subject to the 
 73.11  limitations specified in section 256B.0625, subdivision 9; 
 73.12     (15) outpatient services provided by a mental health center 
 73.13  or clinic that is under contract with the county board and is 
 73.14  established under section 245.62; 
 73.15     (16) day treatment services for mental illness provided 
 73.16  under contract with the county board; 
 73.17     (17) prescribed medications for persons who have been 
 73.18  diagnosed as mentally ill as necessary to prevent more 
 73.19  restrictive institutionalization; 
 73.20     (18) psychological services, medical supplies and 
 73.21  equipment, and Medicare premiums, coinsurance and deductible 
 73.22  payments; 
 73.23     (19) medical equipment not specifically listed in this 
 73.24  paragraph when the use of the equipment will prevent the need 
 73.25  for costlier services that are reimbursable under this 
 73.26  subdivision; 
 73.27     (20) services performed by a certified pediatric nurse 
 73.28  practitioner, a certified family nurse practitioner, a certified 
 73.29  adult nurse practitioner, a certified obstetric/gynecological 
 73.30  nurse practitioner, a certified neonatal nurse practitioner, or 
 73.31  a certified geriatric nurse practitioner in independent 
 73.32  practice, if (1) the service is otherwise covered under this 
 73.33  chapter as a physician service, (2) the service provided on an 
 73.34  inpatient basis is not included as part of the cost for 
 73.35  inpatient services included in the operating payment rate, and 
 73.36  (3) the service is within the scope of practice of the nurse 
 74.1   practitioner's license as a registered nurse, as defined in 
 74.2   section 148.171; 
 74.3      (21) services of a certified public health nurse or a 
 74.4   registered nurse practicing in a public health nursing clinic 
 74.5   that is a department of, or that operates under the direct 
 74.6   authority of, a unit of government, if the service is within the 
 74.7   scope of practice of the public health nurse's license as a 
 74.8   registered nurse, as defined in section 148.171; and 
 74.9      (22) telemedicine consultations, to the extent they are 
 74.10  covered under section 256B.0625, subdivision 3b.  
 74.11     (ii) Effective October 1, 2003, for a person who is 
 74.12  eligible under subdivision 3, paragraph (a), clause (2), item 
 74.13  (ii), general assistance medical care coverage is limited to 
 74.14  inpatient hospital services, including physician services 
 74.15  provided during the inpatient hospital stay.  A $1,000 
 74.16  deductible is required for each inpatient hospitalization.  
 74.17     (b) Gender Sex reassignment surgery and related services 
 74.18  are is not covered services under this subdivision unless the 
 74.19  individual began receiving gender reassignment services prior to 
 74.20  July 1, 1995.  
 74.21     (c) In order to contain costs, the commissioner of human 
 74.22  services shall select vendors of medical care who can provide 
 74.23  the most economical care consistent with high medical standards 
 74.24  and shall where possible contract with organizations on a 
 74.25  prepaid capitation basis to provide these services.  The 
 74.26  commissioner shall consider proposals by counties and vendors 
 74.27  for prepaid health plans, competitive bidding programs, block 
 74.28  grants, or other vendor payment mechanisms designed to provide 
 74.29  services in an economical manner or to control utilization, with 
 74.30  safeguards to ensure that necessary services are provided.  
 74.31  Before implementing prepaid programs in counties with a county 
 74.32  operated or affiliated public teaching hospital or a hospital or 
 74.33  clinic operated by the University of Minnesota, the commissioner 
 74.34  shall consider the risks the prepaid program creates for the 
 74.35  hospital and allow the county or hospital the opportunity to 
 74.36  participate in the program in a manner that reflects the risk of 
 75.1   adverse selection and the nature of the patients served by the 
 75.2   hospital, provided the terms of participation in the program are 
 75.3   competitive with the terms of other participants considering the 
 75.4   nature of the population served.  Payment for services provided 
 75.5   pursuant to this subdivision shall be as provided to medical 
 75.6   assistance vendors of these services under sections 256B.02, 
 75.7   subdivision 8, and 256B.0625.  For payments made during fiscal 
 75.8   year 1990 and later years, the commissioner shall consult with 
 75.9   an independent actuary in establishing prepayment rates, but 
 75.10  shall retain final control over the rate methodology.  
 75.11     (d) Recipients eligible under subdivision 3, paragraph (a), 
 75.12  clause (2), item (i), shall pay the following co-payments for 
 75.13  services provided on or after October 1, 2003: 
 75.14     (1) $3 per nonpreventive visit.  For purposes of this 
 75.15  subdivision, a visit means an episode of service which is 
 75.16  required because of a recipient's symptoms, diagnosis, or 
 75.17  established illness, and which is delivered in an ambulatory 
 75.18  setting by a physician or physician ancillary, chiropractor, 
 75.19  podiatrist, nurse midwife, advanced practice nurse, audiologist, 
 75.20  optician, or optometrist; 
 75.21     (2) $25 for eyeglasses; 
 75.22     (3) $25 for nonemergency visits to a hospital-based 
 75.23  emergency room; 
 75.24     (4) $3 per brand-name drug prescription and $1 per generic 
 75.25  drug prescription, subject to a $20 per month maximum for 
 75.26  prescription drug co-payments.  No co-payments shall apply to 
 75.27  antipsychotic drugs when used for the treatment of mental 
 75.28  illness; and 
 75.29     (5) 50 percent coinsurance on restorative dental services.  
 75.30     (e) Co-payments shall be limited to one per day per 
 75.31  provider for nonpreventive visits, eyeglasses, and nonemergency 
 75.32  visits to a hospital-based emergency room.  Recipients of 
 75.33  general assistance medical care are responsible for all 
 75.34  co-payments in this subdivision.  The general assistance medical 
 75.35  care reimbursement to the provider shall be reduced by the 
 75.36  amount of the co-payment, except that reimbursement for 
 76.1   prescription drugs shall not be reduced once a recipient has 
 76.2   reached the $20 per month maximum for prescription drug 
 76.3   co-payments.  The provider collects the co-payment from the 
 76.4   recipient.  Providers may not deny services to recipients who 
 76.5   are unable to pay the co-payment, except as provided in 
 76.6   paragraph (f). 
 76.7      (f) If it is the routine business practice of a provider to 
 76.8   refuse service to an individual with uncollected debt, the 
 76.9   provider may include uncollected co-payments under this 
 76.10  section.  A provider must give advance notice to a recipient 
 76.11  with uncollected debt before services can be denied. 
 76.12     (g) Any county may, from its own resources, provide medical 
 76.13  payments for which state payments are not made. 
 76.14     (h) Chemical dependency services that are reimbursed under 
 76.15  chapter 254B must not be reimbursed under general assistance 
 76.16  medical care. 
 76.17     (i) The maximum payment for new vendors enrolled in the 
 76.18  general assistance medical care program after the base year 
 76.19  shall be determined from the average usual and customary charge 
 76.20  of the same vendor type enrolled in the base year. 
 76.21     (j) The conditions of payment for services under this 
 76.22  subdivision are the same as the conditions specified in rules 
 76.23  adopted under chapter 256B governing the medical assistance 
 76.24  program, unless otherwise provided by statute or rule. 
 76.25     (k) Inpatient and outpatient payments shall be reduced by 
 76.26  five percent, effective July 1, 2003.  This reduction is in 
 76.27  addition to the five percent reduction effective July 1, 2003, 
 76.28  and incorporated by reference in paragraph (i).  
 76.29     (l) Payments for all other health services except 
 76.30  inpatient, outpatient, and pharmacy services shall be reduced by 
 76.31  five percent, effective July 1, 2003.  
 76.32     (m) Payments to managed care plans shall be reduced by five 
 76.33  percent for services provided on or after October 1, 2003. 
 76.34     (n) A hospital receiving a reduced payment as a result of 
 76.35  this section may apply the unpaid balance toward satisfaction of 
 76.36  the hospital's bad debts. 
 77.1      <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2005, 
 77.2   except the amendment to paragraph (a), item (ii), is effective 
 77.3   October 1, 2005. 
 77.4      Sec. 46.  Minnesota Statutes 2004, section 256D.03, is 
 77.5   amended by adding a subdivision to read: 
 77.6      Subd. 4a.  [GENERAL ASSISTANCE MEDICAL CARE; MEDICAL 
 77.7   NECESSITY.] In order to be covered under general assistance 
 77.8   medical care, a medical item or service must meet the medical 
 77.9   necessity standards in section 256B.0632. 
 77.10     Sec. 47.  Minnesota Statutes 2004, section 256D.03, is 
 77.11  amended by adding a subdivision to read: 
 77.12     Subd. 10.  [PAYMENTS AFTER OCTOBER 1, 2005.] General 
 77.13  assistance medical care payments made on or after October 1, 
 77.14  2005, shall be made from the health care access fund. 
 77.15     Sec. 48.  Minnesota Statutes 2004, section 256D.045, is 
 77.16  amended to read: 
 77.17     256D.045 [SOCIAL SECURITY NUMBER REQUIRED.] 
 77.18     To be eligible for general assistance under sections 
 77.19  256D.01 to 256D.21, an individual must provide the individual's 
 77.20  Social Security number to the county agency or submit proof that 
 77.21  an application has been made.  An individual who refuses to 
 77.22  provide a Social Security number because of a well-established 
 77.23  religious objection as described in Code of Federal Regulations, 
 77.24  title 42, section 435.910, may be eligible for general 
 77.25  assistance medical care under section 256D.03.  The provisions 
 77.26  of this section do not apply to the determination of eligibility 
 77.27  for emergency general assistance under section 256D.06, 
 77.28  subdivision 2.  This provision applies to eligible children 
 77.29  under the age of 18 effective July 1, 1997.  
 77.30     <b>[EFFECTIVE DATE.]</b> This section is effective March 1, 2006, 
 77.31  or upon HealthMatch implementation, whichever is later. 
 77.32     Sec. 49.  Minnesota Statutes 2004, section 256L.01, 
 77.33  subdivision 1a, is amended to read: 
 77.34     Subd. 1a.  [CHILD.] (a) "Child" means an individual under 
 77.35  21 years of age who is not enrolled in a program of study at a 
 77.36  postsecondary education institution, including the unborn child 
 78.1   of a pregnant woman, an emancipated minor, and an emancipated 
 78.2   minor's spouse. 
 78.3      (b) For an individual enrolled in a program of study at a 
 78.4   postsecondary education institution, child means an individual 
 78.5   under 19 years of age, including an emancipated minor, and an 
 78.6   emancipated minor's spouse, except that an individual with 
 78.7   access to health coverage through the postsecondary education 
 78.8   institution or the individual's parent does not qualify as a 
 78.9   child under this paragraph. 
 78.10     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2005, 
 78.11  or upon federal approval, whichever is later.  Prior to the 
 78.12  implementation of HealthMatch, the commissioner shall implement 
 78.13  this section to the fullest extent possible, including the use 
 78.14  of manual processing.  Upon implementation of HealthMatch, the 
 78.15  commissioner shall implement this section in a manner consistent 
 78.16  with the procedures and requirements of HealthMatch.  
 78.17     Sec. 50.  Minnesota Statutes 2004, section 256L.01, 
 78.18  subdivision 4, is amended to read: 
 78.19     Subd. 4.  [GROSS INDIVIDUAL OR GROSS FAMILY INCOME.] (a) 
 78.20  "Gross individual or gross family income" for nonfarm 
 78.21  self-employed means income calculated for the six-month period 
 78.22  of eligibility using as the baseline the adjusted gross income 
 78.23  reported on the applicant's federal income tax form for the 
 78.24  previous year and adding back in reported depreciation, 
 78.25  carryover loss, and net operating loss amounts that apply to the 
 78.26  business in which the family is currently engaged using medical 
 78.27  assistance methodology for determining allowable and 
 78.28  nonallowable expenses and countable income.  
 78.29     (b) "Gross individual or gross family income" for farm 
 78.30  self-employed means income calculated for the six-month period 
 78.31  of eligibility using as the baseline the adjusted gross income 
 78.32  reported on the applicant's federal income tax form for the 
 78.33  previous year and adding back in reported depreciation amounts 
 78.34  that apply to the business in which the family is currently 
 78.35  engaged.  
 78.36     (c) Applicants shall report the most recent financial 
 79.1   situation of the family if it has changed from the period of 
 79.2   time covered by the federal income tax form.  The report may be 
 79.3   in the form of percentage increase or decrease "Gross individual 
 79.4   or gross family income" means the total income for all family 
 79.5   members, calculated for the six-month period of eligibility. 
 79.6      <b>[EFFECTIVE DATE.]</b> This section is effective March 1, 2006, 
 79.7   or upon HealthMatch implementation, whichever is later. 
 79.8      Sec. 51.  Minnesota Statutes 2004, section 256L.01, 
 79.9   subdivision 5, is amended to read: 
 79.10     Subd. 5.  [INCOME.] (a) "Income" has the meaning given for 
 79.11  earned and unearned income for families and children in the 
 79.12  medical assistance program, according to the state's aid to 
 79.13  families with dependent children plan in effect as of July 16, 
 79.14  1996.  The definition does not include medical assistance income 
 79.15  methodologies and deeming requirements.  The earned income of 
 79.16  full-time and part-time students under age 19 is not counted as 
 79.17  income.  Household and family income includes the earned and 
 79.18  unearned income of all persons residing in the household or 
 79.19  family, including unrelated persons.  Public assistance payments 
 79.20  and supplemental security income are not excluded income. 
 79.21     (b) For purposes of this subdivision, and unless otherwise 
 79.22  specified in this section, the commissioner shall use reasonable 
 79.23  methods to calculate gross earned and unearned income including, 
 79.24  but not limited to, projecting income based on income received 
 79.25  within the past 30 days, the last 90 days, or the last 12 months.
 79.26     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2005, 
 79.27  except that the amendment to paragraph (a) is effective July 1, 
 79.28  2005, or upon federal approval, whichever is later.  Prior to 
 79.29  the implementation of HealthMatch, the commissioner shall 
 79.30  implement this section to the fullest extent possible, including 
 79.31  the use of manual processing.  Upon completion of HealthMatch 
 79.32  conversion, the commissioner shall implement this section in a 
 79.33  manner consistent with the procedures and requirements of 
 79.34  HealthMatch. 
 79.35     Sec. 52.  Minnesota Statutes 2004, section 256L.03, 
 79.36  subdivision 1, is amended to read: 
 80.1      Subdivision 1.  [COVERED HEALTH SERVICES.] For individuals 
 80.2   under section 256L.04, subdivision 7, with income no greater 
 80.3   than 75 percent of the federal poverty guidelines or For 
 80.4   families with children under section 256L.04, subdivision 1, all 
 80.5   subdivisions of this section apply.  "Covered health services" 
 80.6   means the health services reimbursed under chapter 256B, with 
 80.7   the exception of inpatient hospital services, special education 
 80.8   services, private duty nursing services, adult dental care 
 80.9   services other than services covered under section 256B.0625, 
 80.10  subdivision 9, paragraph (b), orthodontic services, nonemergency 
 80.11  medical transportation services, personal care assistant and 
 80.12  case management services, nursing home or intermediate care 
 80.13  facilities services, inpatient mental health services, and 
 80.14  chemical dependency services.  Outpatient mental health services 
 80.15  covered under the MinnesotaCare program are limited to 
 80.16  diagnostic assessments, psychological testing, explanation of 
 80.17  findings, medication management by a physician, day treatment, 
 80.18  partial hospitalization, and individual, family, and group 
 80.19  psychotherapy. 
 80.20     No public funds shall be used for coverage of abortion 
 80.21  under MinnesotaCare except where the life of the female would be 
 80.22  endangered or substantial and irreversible impairment of a major 
 80.23  bodily function would result if the fetus were carried to term; 
 80.24  or where the pregnancy is the result of rape or incest. 
 80.25     Covered health services shall be expanded as provided in 
 80.26  this section. 
 80.27     <b>[EFFECTIVE DATE.]</b> This section is effective October 1, 2005.
 80.28     Sec. 53.  Minnesota Statutes 2004, section 256L.03, 
 80.29  subdivision 3, is amended to read: 
 80.30     Subd. 3.  [INPATIENT HOSPITAL SERVICES.] (a) Covered health 
 80.31  services shall include inpatient hospital services, including 
 80.32  inpatient hospital mental health services and inpatient hospital 
 80.33  and residential chemical dependency treatment, subject to those 
 80.34  limitations necessary to coordinate the provision of these 
 80.35  services with eligibility under the medical assistance 
 80.36  spenddown.  Prior to July 1, 1997, the inpatient hospital 
 81.1   benefit for adult enrollees is subject to an annual benefit 
 81.2   limit of $10,000.  The inpatient hospital benefit for adult 
 81.3   enrollees who qualify under section 256L.04, subdivision 7, or 
 81.4   who qualify under section 256L.04, subdivisions 1 and 2, with 
 81.5   family gross income that exceeds 175 percent of the federal 
 81.6   poverty guidelines and who are not pregnant, is subject to an 
 81.7   annual limit of $10,000.  
 81.8      (b) Admissions for inpatient hospital services paid for 
 81.9   under section 256L.11, subdivision 3, must be certified as 
 81.10  medically necessary in accordance with Minnesota Rules, parts 
 81.11  9505.0500 to 9505.0540, except as provided in clauses (1) and 
 81.12  (2): 
 81.13     (1) all admissions must be certified, except those 
 81.14  authorized under rules established under section 254A.03, 
 81.15  subdivision 3, or approved under Medicare; and 
 81.16     (2) payment under section 256L.11, subdivision 3, shall be 
 81.17  reduced by five percent for admissions for which certification 
 81.18  is requested more than 30 days after the day of admission.  The 
 81.19  hospital may not seek payment from the enrollee for the amount 
 81.20  of the payment reduction under this clause. 
 81.21     <b>[EFFECTIVE DATE.]</b> This section is effective October 1, 2005.
 81.22     Sec. 54.  Minnesota Statutes 2004, section 256L.03, 
 81.23  subdivision 5, is amended to read: 
 81.24     Subd. 5.  [CO-PAYMENTS AND COINSURANCE.] (a) Except as 
 81.25  provided in paragraphs (b) and (c), the MinnesotaCare benefit 
 81.26  plan shall include the following co-payments and coinsurance 
 81.27  requirements for all enrollees:  
 81.28     (1) ten percent of the paid charges for inpatient hospital 
 81.29  services for adult enrollees, subject to an annual inpatient 
 81.30  out-of-pocket maximum of $1,000 per individual and $3,000 per 
 81.31  family; 
 81.32     (2) $3 per prescription for adult enrollees; 
 81.33     (3) $25 for eyeglasses for adult enrollees; and 
 81.34     (4) $3 per nonpreventive visit.  For purposes of this 
 81.35  subdivision, a visit means an episode of service which is 
 81.36  required because of an enrollee's symptoms, diagnosis, or 
 82.1   established illness, and which is delivered in an ambulatory 
 82.2   setting by a physician or physician ancillary, chiropractor, 
 82.3   podiatrist, advanced practice nurse, audiologist, optician, or 
 82.4   optometrist; 
 82.5      (5) $6 for nonemergency visits to a hospital-based 
 82.6   emergency room; and 
 82.7      (6) 50 percent of the fee-for-service rate for adult dental 
 82.8   care services other than preventive care services for persons 
 82.9   eligible under section 256L.04, subdivisions 1 to 7, with income 
 82.10  equal to or less than 175 percent of the federal poverty 
 82.11  guidelines. 
 82.12     (b) Paragraph (a), clause (1), does not apply to parents 
 82.13  and relative caretakers of children under the age of 21 in 
 82.14  households with family income equal to or less than 175 percent 
 82.15  of the federal poverty guidelines.  Paragraph (a), clause (1), 
 82.16  does not apply to parents and relative caretakers of children 
 82.17  under the age of 21 in households with family income greater 
 82.18  than 175 percent of the federal poverty guidelines for inpatient 
 82.19  hospital admissions occurring on or after January 1, 2001.  
 82.20     (c) Paragraph (a), clauses (1) to (4) (6), do not apply to 
 82.21  pregnant women and children under the age of 21.  
 82.22     (d) Adult enrollees with family gross income that exceeds 
 82.23  175 percent of the federal poverty guidelines and who are not 
 82.24  pregnant shall be financially responsible for the coinsurance 
 82.25  amount, if applicable, and amounts which exceed the $10,000 
 82.26  inpatient hospital benefit limit. 
 82.27     (e) When a MinnesotaCare enrollee becomes a member of a 
 82.28  prepaid health plan, or changes from one prepaid health plan to 
 82.29  another during a calendar year, any charges submitted towards 
 82.30  the $10,000 annual inpatient benefit limit, and any 
 82.31  out-of-pocket expenses incurred by the enrollee for inpatient 
 82.32  services, that were submitted or incurred prior to enrollment, 
 82.33  or prior to the change in health plans, shall be disregarded. 
 82.34     (f) Paragraph (a), clauses (4) and (5), are limited to one 
 82.35  co-payment per day per provider.  
 82.36     <b>[EFFECTIVE DATE.]</b> This section is effective January 1, 
 83.1   2006, except the amendment to paragraph (b) is effective October 
 83.2   1, 2005. 
 83.3      Sec. 55.  Minnesota Statutes 2004, section 256L.03, is 
 83.4   amended by adding a subdivision to read: 
 83.5      Subd. 7.  [MEDICAL NECESSITY.] In order to be covered under 
 83.6   MinnesotaCare, a medical item or service must meet the medical 
 83.7   necessity standards in section 256B.0632. 
 83.8      Sec. 56.  Minnesota Statutes 2004, section 256L.04, 
 83.9   subdivision 1, is amended to read: 
 83.10     Subdivision 1.  [FAMILIES WITH CHILDREN.] (a) Through 
 83.11  September 30, 2005, families with children with family income 
 83.12  equal to or less than 275 percent of the federal poverty 
 83.13  guidelines for the applicable family size shall be eligible for 
 83.14  MinnesotaCare according to this section.  Beginning October 1, 
 83.15  2005, children and pregnant women with family income equal to or 
 83.16  less than 275 percent of the federal poverty guidelines for the 
 83.17  applicable family size shall be eligible for MinnesotaCare 
 83.18  according to this section.  Beginning October 1, 2005, parents, 
 83.19  grandparents, foster parents, relative caretakers, and legal 
 83.20  guardians ages 21 and over are not eligible for MinnesotaCare if 
 83.21  their gross income exceeds 175 percent of the federal poverty 
 83.22  guidelines for the applicable family size.  All other provisions 
 83.23  of sections 256L.01 to 256L.18, including the insurance-related 
 83.24  barriers to enrollment under section 256L.07, shall apply unless 
 83.25  otherwise specified. 
 83.26     (b) Parents who enroll in the MinnesotaCare program must 
 83.27  also enroll their children, if the children are eligible.  
 83.28  Children may be enrolled separately without enrollment by 
 83.29  parents.  However, if one parent in the household enrolls, both 
 83.30  parents must enroll, unless other insurance is available.  If 
 83.31  one child from a family is enrolled, all children must be 
 83.32  enrolled, unless other insurance is available.  If one spouse in 
 83.33  a household enrolls, the other spouse in the household must also 
 83.34  enroll, unless other insurance is available.  Families cannot 
 83.35  choose to enroll only certain uninsured members.  
 83.36     (c) Beginning October 1, 2003, the dependent sibling 
 84.1   definition no longer applies to the MinnesotaCare program.  
 84.2   These persons are no longer counted in the parental household 
 84.3   and may apply as a separate household. 
 84.4      (d) Beginning July 1, 2003, or upon federal approval, 
 84.5   whichever is later, parents are not eligible for MinnesotaCare 
 84.6   if their gross income exceeds $50,000. 
 84.7      Sec. 57.  Minnesota Statutes 2004, section 256L.04, is 
 84.8   amended by adding a subdivision to read: 
 84.9      Subd. 1a.  [SOCIAL SECURITY NUMBER REQUIRED.] (a) 
 84.10  Individuals and families applying for MinnesotaCare coverage 
 84.11  must provide a Social Security number. 
 84.12     (b) The commissioner shall not deny eligibility to an 
 84.13  otherwise eligible applicant who has applied for a Social 
 84.14  Security number and is awaiting issuance of that Social Security 
 84.15  number. 
 84.16     (c) Newborns enrolled under section 256L.05, subdivision 3, 
 84.17  are exempt from the requirements of this subdivision. 
 84.18     (d) Individuals who refuse to provide a Social Security 
 84.19  number because of well-established religious objections are 
 84.20  exempt from the requirements of this subdivision.  The term 
 84.21  "well-established religious objections" has the meaning given in 
 84.22  Code of Federal Regulations, title 42, section 435.910. 
 84.23     <b>[EFFECTIVE DATE.]</b> This section is effective March 1, 2006, 
 84.24  or upon HealthMatch implementation, whichever is later. 
 84.25     Sec. 58.  Minnesota Statutes 2004, section 256L.04, 
 84.26  subdivision 2, is amended to read: 
 84.27     Subd. 2.  [COOPERATION IN ESTABLISHING THIRD-PARTY 
 84.28  LIABILITY, PATERNITY, AND OTHER MEDICAL SUPPORT.] (a) To be 
 84.29  eligible for MinnesotaCare, individuals and families must 
 84.30  cooperate with the state agency to identify potentially liable 
 84.31  third-party payers and assist the state in obtaining third-party 
 84.32  payments.  "Cooperation" includes, but is not limited 
 84.33  to, complying with the notice requirements in section 256B.056, 
 84.34  subdivision 9, identifying any third party who may be liable for 
 84.35  care and services provided under MinnesotaCare to the enrollee, 
 84.36  providing relevant information to assist the state in pursuing a 
 85.1   potentially liable third party, and completing forms necessary 
 85.2   to recover third-party payments. 
 85.3      (b) A parent, guardian, relative caretaker, or child 
 85.4   enrolled in the MinnesotaCare program must cooperate with the 
 85.5   Department of Human Services and the local agency in 
 85.6   establishing the paternity of an enrolled child and in obtaining 
 85.7   medical care support and payments for the child and any other 
 85.8   person for whom the person can legally assign rights, in 
 85.9   accordance with applicable laws and rules governing the medical 
 85.10  assistance program.  A child shall not be ineligible for or 
 85.11  disenrolled from the MinnesotaCare program solely because the 
 85.12  child's parent, relative caretaker, or guardian fails to 
 85.13  cooperate in establishing paternity or obtaining medical support.
 85.14     Sec. 59.  Minnesota Statutes 2004, section 256L.04, is 
 85.15  amended by adding a subdivision to read: 
 85.16     Subd. 2a.  [APPLICATIONS FOR OTHER BENEFITS.] To be 
 85.17  eligible for MinnesotaCare, individuals and families must take 
 85.18  all necessary steps to obtain other benefits as described in 
 85.19  Code of Federal Regulations, title 42, section 435.608.  
 85.20  Applicants and enrollees must apply for other benefits within 30 
 85.21  days. 
 85.22     <b>[EFFECTIVE DATE.]</b> This section is effective March 1, 2006, 
 85.23  or upon HealthMatch implementation, whichever is later. 
 85.24     Sec. 60.  Minnesota Statutes 2004, section 256L.04, 
 85.25  subdivision 8, is amended to read: 
 85.26     Subd. 8.  [APPLICANTS POTENTIALLY ELIGIBLE FOR MEDICAL 
 85.27  ASSISTANCE.] (a) Individuals who receive supplemental security 
 85.28  income or retirement, survivors, or disability benefits due to a 
 85.29  disability, or other disability-based pension, who qualify under 
 85.30  subdivision 7, but who are potentially eligible for medical 
 85.31  assistance without a spenddown shall be allowed to enroll in 
 85.32  MinnesotaCare for a period of 60 days, so long as the applicant 
 85.33  meets all other conditions of eligibility.  The commissioner 
 85.34  shall identify and refer the applications of such individuals to 
 85.35  their county social service agency.  The county and the 
 85.36  commissioner shall cooperate to ensure that the individuals 
 86.1   obtain medical assistance coverage for any months for which they 
 86.2   are eligible. 
 86.3      (b) The enrollee must cooperate with the county social 
 86.4   service agency in determining medical assistance eligibility 
 86.5   within the 60-day enrollment period.  Enrollees who do not 
 86.6   cooperate with medical assistance within the 60-day enrollment 
 86.7   period shall be disenrolled from the plan within one calendar 
 86.8   month.  Persons disenrolled for nonapplication for medical 
 86.9   assistance may not reenroll until they have obtained a medical 
 86.10  assistance eligibility determination.  Persons disenrolled for 
 86.11  noncooperation with medical assistance may not reenroll until 
 86.12  they have cooperated with the county agency and have obtained a 
 86.13  medical assistance eligibility determination. 
 86.14     (c) Beginning January 1, 2000, counties that choose to 
 86.15  become MinnesotaCare enrollment sites shall consider 
 86.16  MinnesotaCare applications to also be applications for medical 
 86.17  assistance.  Applicants who are potentially eligible for medical 
 86.18  assistance, except for those described in paragraph (a), may 
 86.19  choose to enroll in either MinnesotaCare or medical assistance. 
 86.20     (d) The commissioner shall redetermine provider payments 
 86.21  made under MinnesotaCare to the appropriate medical assistance 
 86.22  payments for those enrollees who subsequently become eligible 
 86.23  for medical assistance. 
 86.24     <b>[EFFECTIVE DATE.]</b> This section is effective October 1, 2005.
 86.25     Sec. 61.  Minnesota Statutes 2004, section 256L.05, 
 86.26  subdivision 2, is amended to read: 
 86.27     Subd. 2.  [COMMISSIONER'S DUTIES.] (a) The commissioner or 
 86.28  county agency shall use electronic verification as the primary 
 86.29  method of income verification.  If there is a discrepancy 
 86.30  between reported income and electronically verified income, an 
 86.31  individual may be required to submit additional verification.  
 86.32  In addition, the commissioner shall perform random audits to 
 86.33  verify reported income and eligibility.  The commissioner may 
 86.34  execute data sharing arrangements with the Department of Revenue 
 86.35  and any other governmental agency in order to perform income 
 86.36  verification related to eligibility and premium payment under 
 87.1   the MinnesotaCare program. 
 87.2      (b) In determining eligibility for MinnesotaCare, the 
 87.3   commissioner shall require applicants and enrollees seeking 
 87.4   renewal of eligibility to verify both earned and unearned 
 87.5   income.  The commissioner shall also require applicants and 
 87.6   enrollees to submit to their employers, if employed, a form to 
 87.7   verify whether the applicant or enrollee, and any dependents, 
 87.8   are eligible for employer subsidized coverage.  
 87.9      <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2005.  
 87.10  Prior to the implementation of HealthMatch, the commissioner 
 87.11  shall implement this section to the fullest extent possible, 
 87.12  including the use of manual processing.  Upon implementation of 
 87.13  HealthMatch, the commissioner shall implement this section in a 
 87.14  manner consistent with the procedures and requirements of 
 87.15  HealthMatch.  
 87.16     Sec. 62.  Minnesota Statutes 2004, section 256L.05, 
 87.17  subdivision 3, is amended to read: 
 87.18     Subd. 3.  [EFFECTIVE DATE OF COVERAGE.] (a) The effective 
 87.19  date of coverage is the first day of the month following the 
 87.20  month in which eligibility is approved and the first premium 
 87.21  payment has been received.  As provided in section 256B.057, 
 87.22  coverage for newborns is automatic from the date of birth and 
 87.23  must be coordinated with other health coverage.  The effective 
 87.24  date of coverage for eligible newly adoptive children added to a 
 87.25  family receiving covered health services is the date of entry 
 87.26  into the family month of placement or the month placement is 
 87.27  reported, whichever is later.  The effective date of coverage 
 87.28  for other new recipients members added to the family receiving 
 87.29  covered health services is the first day of the month following 
 87.30  the month in which eligibility is approved or at renewal, 
 87.31  whichever the family receiving covered health services 
 87.32  prefers the change is reported.  All eligibility criteria must 
 87.33  be met by the family at the time the new family member is 
 87.34  added.  The income of the new family member is included with the 
 87.35  family's gross income and the adjusted premium begins in the 
 87.36  month the new family member is added.  
 88.1      (b) The initial premium must be received by the last 
 88.2   working day of the month for coverage to begin the first day of 
 88.3   the following month.  
 88.4      (c) Benefits are not available until the day following 
 88.5   discharge if an enrollee is hospitalized on the first day of 
 88.6   coverage.  
 88.7      (d) Notwithstanding any other law to the contrary, benefits 
 88.8   under sections 256L.01 to 256L.18 are secondary to a plan of 
 88.9   insurance or benefit program under which an eligible person may 
 88.10  have coverage and the commissioner shall use cost avoidance 
 88.11  techniques to ensure coordination of any other health coverage 
 88.12  for eligible persons.  The commissioner shall identify eligible 
 88.13  persons who may have coverage or benefits under other plans of 
 88.14  insurance or who become eligible for medical assistance. 
 88.15     <b>[EFFECTIVE DATE.]</b> This section is effective March 1, 2006, 
 88.16  or upon HealthMatch implementation, whichever is later. 
 88.17     Sec. 63.  Minnesota Statutes 2004, section 256L.05, 
 88.18  subdivision 3a, is amended to read: 
 88.19     Subd. 3a.  [RENEWAL OF ELIGIBILITY.] (a) Beginning January 
 88.20  1, 1999, an enrollee's eligibility must be renewed every 12 
 88.21  months.  The 12-month period begins in the month after the month 
 88.22  the application is approved.  
 88.23     (b) Beginning October 1, 2004, an enrollee's eligibility 
 88.24  must be renewed every six months.  The first six-month period of 
 88.25  eligibility begins in the month after the month the application 
 88.26  is approved received by the commissioner.  The effective date of 
 88.27  coverage within the first six-month period of eligibility is as 
 88.28  provided in section 256L.05, subdivision 3.  Each new period of 
 88.29  eligibility must take into account any changes in circumstances 
 88.30  that impact eligibility and premium amount.  An enrollee must 
 88.31  provide all the information needed to redetermine eligibility by 
 88.32  the first day of the month that ends the eligibility period.  
 88.33  The premium for the new period of eligibility must be received 
 88.34  as provided in section 256L.06 in order for eligibility to 
 88.35  continue. 
 88.36     <b>[EFFECTIVE DATE.]</b> This section is effective March 1, 2006, 
 89.1   or upon HealthMatch implementation, whichever is later. 
 89.2      Sec. 64.  Minnesota Statutes 2004, section 256L.05, 
 89.3   subdivision 5, is amended to read: 
 89.4      Subd. 5.  [AVAILABILITY OF PRIVATE INSURANCE.] The 
 89.5   commissioner, in consultation with the commissioners of health 
 89.6   and commerce, shall provide information regarding the 
 89.7   availability of private health insurance coverage and the 
 89.8   possibility of disenrollment under section 256L.07, subdivision 
 89.9   1, paragraphs (b) and (c), to all:  (1) to families enrolled in 
 89.10  the MinnesotaCare program whose gross family income is equal to 
 89.11  or more than 225 percent of the federal poverty guidelines; and 
 89.12  (2) single adults and households without children enrolled in 
 89.13  the MinnesotaCare program whose gross family income is equal to 
 89.14  or more than 165 percent of the federal poverty guidelines.  
 89.15  This information must be provided upon initial enrollment and 
 89.16  annually thereafter.  The commissioner shall also include 
 89.17  information regarding the availability of private health 
 89.18  insurance coverage in the notice of ineligibility provided to 
 89.19  persons subject to disenrollment under section 256L.07, 
 89.20  subdivision 1, paragraphs (b) and (c). 
 89.21     <b>[EFFECTIVE DATE.]</b> This section is effective October 1, 2005.
 89.22     Sec. 65.  Minnesota Statutes 2004, section 256L.06, 
 89.23  subdivision 3, is amended to read: 
 89.24     Subd. 3.  [COMMISSIONER'S DUTIES AND PAYMENT.] (a) Premiums 
 89.25  are dedicated to the commissioner for MinnesotaCare. 
 89.26     (b) The commissioner shall develop and implement procedures 
 89.27  to:  (1) require enrollees to report changes in income; (2) 
 89.28  adjust sliding scale premium payments, based upon changes both 
 89.29  increases and decreases in enrollee income, at the time the 
 89.30  change in income is reported; and (3) disenroll enrollees from 
 89.31  MinnesotaCare for failure to pay required premiums.  Failure to 
 89.32  pay includes payment with a dishonored check, a returned 
 89.33  automatic bank withdrawal, or a refused credit card or debit 
 89.34  card payment.  The commissioner may demand a guaranteed form of 
 89.35  payment, including a cashier's check or a money order, as the 
 89.36  only means to replace a dishonored, returned, or refused payment.
 90.1      (c) Premiums are calculated on a calendar month basis and 
 90.2   may be paid on a monthly, quarterly, or semiannual basis, with 
 90.3   the first payment due upon notice from the commissioner of the 
 90.4   premium amount required.  The commissioner shall inform 
 90.5   applicants and enrollees of these premium payment options. 
 90.6   Premium payment is required before enrollment is complete and to 
 90.7   maintain eligibility in MinnesotaCare.  Premium payments 
 90.8   received before noon are credited the same day.  Premium 
 90.9   payments received after noon are credited on the next working 
 90.10  day.  
 90.11     (d) Nonpayment of the premium will result in disenrollment 
 90.12  from the plan effective for the calendar month for which the 
 90.13  premium was due.  Persons disenrolled for nonpayment or who 
 90.14  voluntarily terminate coverage from the program may not reenroll 
 90.15  until four calendar months have elapsed.  Persons disenrolled 
 90.16  for nonpayment who pay all past due premiums as well as current 
 90.17  premiums due, including premiums due for the period of 
 90.18  disenrollment, within 20 days of disenrollment, shall be 
 90.19  reenrolled retroactively to the first day of disenrollment.  
 90.20  Persons disenrolled for nonpayment or who voluntarily terminate 
 90.21  coverage from the program may not reenroll for four calendar 
 90.22  months unless the person demonstrates good cause for 
 90.23  nonpayment.  Good cause does not exist if a person chooses to 
 90.24  pay other family expenses instead of the premium.  The 
 90.25  commissioner shall define good cause in rule. 
 90.26     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2005.  
 90.27  Prior to the implementation of HealthMatch, the commissioner 
 90.28  shall implement this section to the fullest extent possible, 
 90.29  including the use of manual processing.  Upon implementation of 
 90.30  HealthMatch, the commissioner shall implement this section in a 
 90.31  manner consistent with the procedures and requirements of 
 90.32  HealthMatch.  
 90.33     Sec. 66.  Minnesota Statutes 2004, section 256L.07, 
 90.34  subdivision 1, is amended to read: 
 90.35     Subdivision 1.  [GENERAL REQUIREMENTS.] (a) Children 
 90.36  enrolled in the original children's health plan as of September 
 91.1   30, 1992, children who enrolled in the MinnesotaCare program 
 91.2   after September 30, 1992, pursuant to Laws 1992, chapter 549, 
 91.3   article 4, section 17, and children who have family gross 
 91.4   incomes that are equal to or less than 150 percent of the 
 91.5   federal poverty guidelines are eligible without meeting the 
 91.6   requirements of subdivision 2 and the four-month requirement in 
 91.7   subdivision 3, as long as they maintain continuous coverage in 
 91.8   the MinnesotaCare program or medical assistance.  Children who 
 91.9   apply for MinnesotaCare on or after the implementation date of 
 91.10  the employer-subsidized health coverage program as described in 
 91.11  Laws 1998, chapter 407, article 5, section 45, who have family 
 91.12  gross incomes that are equal to or less than 150 percent of the 
 91.13  federal poverty guidelines, must meet the requirements of 
 91.14  subdivision 2 to be eligible for MinnesotaCare. 
 91.15     (b) Through September 30, 2005, families enrolled in 
 91.16  MinnesotaCare under section 256L.04, subdivision 1, whose income 
 91.17  increases above 275 percent of the federal poverty guidelines, 
 91.18  are no longer eligible for the program and shall be disenrolled 
 91.19  by the commissioner.  Individuals Beginning October 1, 2005, 
 91.20  children enrolled in MinnesotaCare under section 256L.04, 
 91.21  subdivision 7 1, whose income increases above 175 275 percent of 
 91.22  the federal poverty guidelines, are no longer eligible for the 
 91.23  program and shall be disenrolled by the commissioner.  Pregnant 
 91.24  women enrolled in MinnesotaCare whose income increases above 275 
 91.25  percent of the federal poverty guidelines remain eligible 
 91.26  through the end of the 60-day postpartum period.  Beginning 
 91.27  October 1, 2005, parents, grandparents, foster parents, relative 
 91.28  caretakers, and legal guardians ages 21 and over are no longer 
 91.29  eligible for MinnesotaCare if their gross income exceeds 175 
 91.30  percent of the federal poverty guidelines for the applicable 
 91.31  family size.  For persons disenrolled under this subdivision, 
 91.32  MinnesotaCare coverage terminates the last day of the calendar 
 91.33  month following the month in which the commissioner determines 
 91.34  that the income of a family or individual exceeds program income 
 91.35  limits.  
 91.36     (c)(1) Notwithstanding paragraph (b), families enrolled in 
 92.1   MinnesotaCare under section 256L.04, subdivision 1, may remain 
 92.2   enrolled in MinnesotaCare if ten percent of their annual income 
 92.3   is less than the annual premium for a policy with a $500 
 92.4   deductible available through the Minnesota Comprehensive Health 
 92.5   Association.  Families who are no longer eligible for 
 92.6   MinnesotaCare under this subdivision shall be given an 18-month 
 92.7   notice period from the date that ineligibility is determined 
 92.8   before disenrollment.  This clause expires February 1, 2004. 
 92.9      (2) Effective February 1, 2004, notwithstanding paragraph 
 92.10  (b), children may remain enrolled in MinnesotaCare if ten 
 92.11  percent of their annual gross individual or gross family income 
 92.12  as defined in section 256L.01, subdivision 4, is less than the 
 92.13  annual premium for a six-month policy with a $500 deductible 
 92.14  available through the Minnesota Comprehensive Health 
 92.15  Association.  Children who are no longer eligible for 
 92.16  MinnesotaCare under this clause shall be given a 12-month 
 92.17  six-month notice period from the date that ineligibility is 
 92.18  determined before disenrollment.  The premium for children 
 92.19  remaining eligible under this clause shall be the maximum 
 92.20  premium determined under section 256L.15, subdivision 2, 
 92.21  paragraph (b). 
 92.22     (d) Effective July 1, 2003, notwithstanding paragraphs (b) 
 92.23  and (c), parents are no longer eligible for MinnesotaCare if 
 92.24  gross household income exceeds $50,000 $25,000 for the six-month 
 92.25  period of eligibility. 
 92.26     <b>[EFFECTIVE DATE.]</b> This section is effective March 1, 2006, 
 92.27  or upon HealthMatch implementation, whichever is later. 
 92.28     Sec. 67.  Minnesota Statutes 2004, section 256L.07, 
 92.29  subdivision 3, is amended to read: 
 92.30     Subd. 3.  [OTHER HEALTH COVERAGE.] (a) Families and 
 92.31  individuals enrolled in the MinnesotaCare program must have no 
 92.32  health coverage while enrolled or for at least four months prior 
 92.33  to application and renewal.  Children enrolled in the original 
 92.34  children's health plan and children in families with income 
 92.35  equal to or less than 150 percent of the federal poverty 
 92.36  guidelines, who have other health insurance, are eligible if the 
 93.1   coverage: 
 93.2      (1) lacks two or more of the following: 
 93.3      (i) basic hospital insurance; 
 93.4      (ii) medical-surgical insurance; 
 93.5      (iii) prescription drug coverage; 
 93.6      (iv) dental coverage; or 
 93.7      (v) vision coverage; 
 93.8      (2) requires a deductible of $100 or more per person per 
 93.9   year; or 
 93.10     (3) lacks coverage because the child has exceeded the 
 93.11  maximum coverage for a particular diagnosis or the policy 
 93.12  excludes a particular diagnosis. 
 93.13     The commissioner may change this eligibility criterion for 
 93.14  sliding scale premiums in order to remain within the limits of 
 93.15  available appropriations.  The requirement of no health coverage 
 93.16  does not apply to newborns.  
 93.17     (b) Medical assistance, general assistance medical care, 
 93.18  and the Civilian Health and Medical Program of the Uniformed 
 93.19  Service, CHAMPUS, or other coverage provided under United States 
 93.20  Code, title 10, subtitle A, part II, chapter 55, are not 
 93.21  considered insurance or health coverage for purposes of the 
 93.22  four-month requirement described in this subdivision. 
 93.23     (c) For purposes of this subdivision, an applicant or 
 93.24  enrollee who is entitled to Medicare Part A or enrolled in 
 93.25  Medicare Part B coverage under title XVIII of the Social 
 93.26  Security Act, United States Code, title 42, sections 1395c 
 93.27  to 1395w-4 1395w-152, is considered to have health coverage.  An 
 93.28  applicant or enrollee who is entitled to premium free Medicare 
 93.29  Part A may not refuse to apply for or enroll in Medicare 
 93.30  coverage to establish eligibility for MinnesotaCare. 
 93.31     (d) Applicants who were recipients of medical assistance or 
 93.32  general assistance medical care within one month of application 
 93.33  must meet the provisions of this subdivision and subdivision 2. 
 93.34     (e) Effective October 1, 2003, applicants who were 
 93.35  recipients of medical assistance and had Cost-effective health 
 93.36  insurance which that was paid for by medical assistance are 
 94.1   exempt from is not considered health coverage for purposes of 
 94.2   the four-month requirement under this section, except if the 
 94.3   insurance continued after medical assistance no longer 
 94.4   considered it cost-effective or after medical assistance closed. 
 94.5      Sec. 68.  Minnesota Statutes 2004, section 256L.07, is 
 94.6   amended by adding a subdivision to read: 
 94.7      Subd. 5.  [VOLUNTARY DISENROLLMENT FOR MEMBERS OF 
 94.8   MILITARY.] Notwithstanding section 256L.05, subdivision 3b, 
 94.9   MinnesotaCare enrollees who are members of the military and 
 94.10  their families, who choose to voluntarily disenroll from the 
 94.11  program when one or more family members are called to active 
 94.12  duty, may reenroll during or following that member's tour of 
 94.13  active duty.  Those individuals and families shall be considered 
 94.14  to have good cause for voluntary termination under section 
 94.15  256L.06, subdivision 3, paragraph (d).  Income and asset 
 94.16  increases reported at the time of reenrollment shall be 
 94.17  disregarded.  All provisions of sections 256L.01 to 256L.18, 
 94.18  shall apply to individuals and families enrolled under this 
 94.19  subdivision upon six-month renewal. 
 94.20     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2005. 
 94.21     Sec. 69.  Minnesota Statutes 2004, section 256L.09, 
 94.22  subdivision 2, is amended to read: 
 94.23     Subd. 2.  [RESIDENCY REQUIREMENT.] (a) To be eligible for 
 94.24  health coverage under the MinnesotaCare program, adults without 
 94.25  children must be permanent residents of Minnesota. 
 94.26     (b) To be eligible for health coverage under the 
 94.27  MinnesotaCare program, pregnant women, families, and children 
 94.28  must meet the residency requirements as provided by Code of 
 94.29  Federal Regulations, title 42, section 435.403, except that the 
 94.30  provisions of section 256B.056, subdivision 1, shall apply upon 
 94.31  receipt of federal approval. 
 94.32     <b>[EFFECTIVE DATE.]</b> This section is effective October 1, 2005.
 94.33     Sec. 70.  Minnesota Statutes 2004, section 256L.11, 
 94.34  subdivision 6, is amended to read: 
 94.35     Subd. 6.  [ENROLLEES 18 OR OLDER.] Payment by the 
 94.36  MinnesotaCare program for inpatient hospital services provided 
 95.1   to MinnesotaCare enrollees eligible under section 256L.04, 
 95.2   subdivision 7, or who qualify under section 256L.04, 
 95.3   subdivisions 1 and 2, with family gross income that exceeds 175 
 95.4   percent of the federal poverty guidelines and who are not 
 95.5   pregnant, who are 18 years old or older on the date of admission 
 95.6   to the inpatient hospital must be in accordance with paragraphs 
 95.7   (a) and (b).  Payment for adults who are not pregnant and are 
 95.8   eligible under section 256L.04, subdivisions 1 and 2, and whose 
 95.9   incomes are equal to or less than 175 percent of the federal 
 95.10  poverty guidelines, shall be as provided for under paragraph (c) 
 95.11  this subdivision. 
 95.12     (a) If the medical assistance rate minus any co-payment 
 95.13  required under section 256L.03, subdivision 4, is less than or 
 95.14  equal to the amount remaining in the enrollee's benefit limit 
 95.15  under section 256L.03, subdivision 3, payment must be the 
 95.16  medical assistance rate minus any co-payment required under 
 95.17  section 256L.03, subdivision 4.  The hospital must not seek 
 95.18  payment from the enrollee in addition to the co-payment.  The 
 95.19  MinnesotaCare payment plus the co-payment must be treated as 
 95.20  payment in full. 
 95.21     (b) If the medical assistance rate minus any co-payment 
 95.22  required under section 256L.03, subdivision 4, is greater than 
 95.23  the amount remaining in the enrollee's benefit limit under 
 95.24  section 256L.03, subdivision 3, payment must be the lesser of: 
 95.25     (1) the amount remaining in the enrollee's benefit limit; 
 95.26  or 
 95.27     (2) charges submitted for the inpatient hospital services 
 95.28  less any co-payment established under section 256L.03, 
 95.29  subdivision 4. 
 95.30     The hospital may seek payment from the enrollee for the 
 95.31  amount by which usual and customary charges exceed the payment 
 95.32  under this paragraph.  If payment is reduced under section 
 95.33  256L.03, subdivision 3, paragraph (b), the hospital may not seek 
 95.34  payment from the enrollee for the amount of the reduction. 
 95.35     (c) For admissions occurring during the period of July 1, 
 95.36  1997, through June 30, 1998, for adults who are not pregnant and 
 96.1   are eligible under section 256L.04, subdivisions 1 and 2, and 
 96.2   whose incomes are equal to or less than 175 percent of the 
 96.3   federal poverty guidelines, the commissioner shall pay hospitals 
 96.4   directly, up to the medical assistance payment rate, for 
 96.5   inpatient hospital benefits in excess of the $10,000 annual 
 96.6   inpatient benefit limit. 
 96.7      <b>[EFFECTIVE DATE.]</b> This section is effective October 1, 2005.
 96.8      Sec. 71.  Minnesota Statutes 2004, section 256L.12, 
 96.9   subdivision 6, is amended to read: 
 96.10     Subd. 6.  [CO-PAYMENTS AND BENEFIT LIMITS.] Enrollees are 
 96.11  responsible for all co-payments in sections section 256L.03, 
 96.12  subdivision 5, and 256L.035, and shall pay co-payments to the 
 96.13  managed care plan or to its participating providers.  The 
 96.14  enrollee is also responsible for payment of inpatient hospital 
 96.15  charges which exceed the MinnesotaCare benefit limit. 
 96.16     <b>[EFFECTIVE DATE.]</b> This section is effective October 1, 2005.
 96.17     Sec. 72.  Minnesota Statutes 2004, section 256L.12, is 
 96.18  amended by adding a subdivision to read: 
 96.19     Subd. 9b.  [RATE SETTING; RATABLE REDUCTION.] In addition 
 96.20  to the reduction in subdivision 9a, the total payment made to 
 96.21  managed care plans under the MinnesotaCare program is reduced 
 96.22  1.83 percent for services provided on or after January 1, 2006. 
 96.23     Sec. 73.  Minnesota Statutes 2004, section 256L.15, 
 96.24  subdivision 2, is amended to read: 
 96.25     Subd. 2.  [SLIDING FEE SCALE TO DETERMINE PERCENTAGE OF 
 96.26  MONTHLY GROSS INDIVIDUAL OR FAMILY INCOME.] (a) The commissioner 
 96.27  shall establish a sliding fee scale to determine the percentage 
 96.28  of monthly gross individual or family income that households at 
 96.29  different income levels must pay to obtain coverage through the 
 96.30  MinnesotaCare program.  The sliding fee scale must be based on 
 96.31  the enrollee's monthly gross individual or family income.  The 
 96.32  sliding fee scale must contain separate tables based on 
 96.33  enrollment of one, two, or three or more persons.  The sliding 
 96.34  fee scale begins with a premium of 1.5 percent of monthly gross 
 96.35  individual or family income for individuals or families with 
 96.36  incomes below the limits for the medical assistance program for 
 97.1   families and children in effect on January 1, 1999, and proceeds 
 97.2   through the following evenly spaced steps:  1.8, 2.3, 3.1, 3.8, 
 97.3   4.8, 5.9, 7.4, and 8.8 percent.  These percentages are matched 
 97.4   to evenly spaced income steps ranging from the medical 
 97.5   assistance income limit for families and children in effect on 
 97.6   January 1, 1999, to 275 percent of the federal poverty 
 97.7   guidelines for the applicable family size, up to a family size 
 97.8   of five.  The sliding fee scale for a family of five must be 
 97.9   used for families of more than five.  Effective October 1, 2003, 
 97.10  the commissioner shall increase each percentage by 0.5 
 97.11  percentage points for enrollees with income greater than 100 
 97.12  percent but not exceeding 200 percent of the federal poverty 
 97.13  guidelines and shall increase each percentage by 1.0 percentage 
 97.14  points for families and children with incomes greater than 200 
 97.15  percent of the federal poverty guidelines.  The sliding fee 
 97.16  scale and percentages are not subject to the provisions of 
 97.17  chapter 14.  If a family or individual reports increased income 
 97.18  after enrollment, premiums shall not be adjusted until 
 97.19  eligibility renewal at the time the change in income is reported.
 97.20     (b)(1) Enrolled families whose gross annual income 
 97.21  increases above 275 percent of the federal poverty guideline 
 97.22  shall pay the maximum premium.  This clause expires effective 
 97.23  February 1, 2004.  
 97.24     (2) Effective February 1, 2004, children in families whose 
 97.25  gross income is above 275 percent of the federal poverty 
 97.26  guidelines shall pay the maximum premium.  
 97.27     (3) The maximum premium is defined as a base charge for 
 97.28  one, two, or three or more enrollees so that if all 
 97.29  MinnesotaCare cases paid the maximum premium, the total revenue 
 97.30  would equal the total cost of MinnesotaCare medical coverage and 
 97.31  administration.  In this calculation, administrative costs shall 
 97.32  be assumed to equal ten percent of the total.  The costs of 
 97.33  medical coverage for pregnant women and children under age two 
 97.34  and the enrollees in these groups shall be excluded from the 
 97.35  total.  The maximum premium for two enrollees shall be twice the 
 97.36  maximum premium for one, and the maximum premium for three or 
 98.1   more enrollees shall be three times the maximum premium for one. 
 98.2      (c) After calculating the percentage of premium each 
 98.3   enrollee shall pay under paragraph (a), ten percent shall be 
 98.4   added to the premium effective July 1, 2005. 
 98.5      <b>[EFFECTIVE DATE.]</b> The amendment to paragraph (a) changing 
 98.6   gross family or individual income to monthly gross family or 
 98.7   individual income is effective March 1, 2006, or upon 
 98.8   implementation of HealthMatch, whichever is later.  The 
 98.9   amendment to paragraph (a) related to premium adjustments and 
 98.10  changes of income is effective July 1, 2005.  Prior to the 
 98.11  implementation of HealthMatch, the commissioner shall implement 
 98.12  this section to the fullest extent possible, including the use 
 98.13  of manual processing.  Upon implementation of HealthMatch, the 
 98.14  commissioner shall implement this section in a manner consistent 
 98.15  with the procedures and requirements of HealthMatch. 
 98.16     Sec. 74.  Minnesota Statutes 2004, section 256L.15, 
 98.17  subdivision 3, is amended to read: 
 98.18     Subd. 3.  [EXCEPTIONS TO SLIDING SCALE.] An annual premium 
 98.19  of $48 is required for all Children in families with income at 
 98.20  or less than below 150 percent of the federal poverty guidelines 
 98.21  pay a monthly premium of $5. 
 98.22     <b>[EFFECTIVE DATE.]</b> This section is effective March 1, 2006, 
 98.23  or upon implementation of HealthMatch, whichever is later. 
 98.24     Sec. 75.  [501B.895] [PUBLIC HEALTH CARE PROGRAMS AND 
 98.25  CERTAIN TRUSTS.] 
 98.26     (a) It is the public policy of this state that individuals 
 98.27  use all available resources to pay for the cost of long-term 
 98.28  care services, as defined in section 256B.0595, before turning 
 98.29  to Minnesota health care program funds, and that trust 
 98.30  instruments should not be permitted to shield available 
 98.31  resources of an individual or an individual's spouse from such 
 98.32  use.  Any irrevocable inter-vivos trust or any legal instrument, 
 98.33  device, or arrangement similar to an irrevocable inter-vivos 
 98.34  trust created on or after July 1, 2005, containing assets or 
 98.35  income of an individual or an individual's spouse, including 
 98.36  those created by a person, court, or administrative body with 
 99.1   legal authority to act in place of, at the direction of, upon 
 99.2   the request of, or on behalf of the individual or individual's 
 99.3   spouse, becomes revocable by operation of law for the sole 
 99.4   purpose of a state or local human services agency determination 
 99.5   on an application by the individual or the individual's spouse 
 99.6   for payment of long-term care services through a Minnesota 
 99.7   public health care program pursuant to chapter 256B.  For 
 99.8   purposes of this section, any inter-vivos trust and any legal 
 99.9   instrument, device, or arrangement similar to an inter-vivos 
 99.10  trust: 
 99.11     (1) shall be deemed to be located in and subject to the 
 99.12  laws of this state; and 
 99.13     (2) is created as of the date it is fully executed by or on 
 99.14  behalf of all of the settlors or others.  
 99.15     (b) For purposes of this section, a legal instrument, 
 99.16  device, or arrangement similar to an irrevocable inter-vivos 
 99.17  trust means any instrument, device, or arrangement which 
 99.18  involves a grantor who transfers or whose property is 
 99.19  transferred by another including, but not limited to, any court, 
 99.20  administrative body, or anyone else with authority to act on 
 99.21  their behalf or at their direction, to an individual or entity 
 99.22  with fiduciary, contractual, or legal obligations to the grantor 
 99.23  or others to be held, managed, or administered by the individual 
 99.24  or entity for the benefit of the grantor or others.  These legal 
 99.25  instruments, devices, or other arrangements are irrevocable 
 99.26  inter-vivos trusts for purposes of this section. 
 99.27     (c) In the event of a conflict between this section and the 
 99.28  provisions of an irrevocable trust created on or after July 1, 
 99.29  2005, this section shall control. 
 99.30     (d) This section does not apply to trusts that qualify as 
 99.31  supplemental needs trusts under section 501B.89 or to trusts 
 99.32  meeting the criteria of United States Code, title 42, section 
 99.33  1396p (d)(4)(a) and (c) for purposes of eligibility for medical 
 99.34  assistance. 
 99.35     (e) This section applies to all trusts first created on or 
 99.36  after July 1, 2005, and to all interests in real or personal 
100.1   property regardless of the date on which the interest was 
100.2   created, reserved, or acquired.  
100.3      Sec. 76.  Minnesota Statutes 2004, section 514.981, 
100.4   subdivision 6, is amended to read: 
100.5      Subd. 6.  [TIME LIMITS; CLAIM LIMITS; LIENS ON LIFE ESTATES 
100.6   AND JOINT TENANCIES.] (a) A medical assistance lien is a lien on 
100.7   the real property it describes for a period of ten years from 
100.8   the date it attaches according to section 514.981, subdivision 
100.9   2, paragraph (a), except as otherwise provided for in sections 
100.10  514.980 to 514.985.  The agency may renew a medical assistance 
100.11  lien for an additional ten years from the date it would 
100.12  otherwise expire by recording or filing a certificate of renewal 
100.13  before the lien expires.  The certificate shall be recorded or 
100.14  filed in the office of the county recorder or registrar of 
100.15  titles for the county in which the lien is recorded or filed.  
100.16  The certificate must refer to the recording or filing data for 
100.17  the medical assistance lien it renews.  The certificate need not 
100.18  be attested, certified, or acknowledged as a condition for 
100.19  recording or filing.  The registrar of titles or the recorder 
100.20  shall file, record, index, and return the certificate of renewal 
100.21  in the same manner as provided for medical assistance liens in 
100.22  section 514.982, subdivision 2. 
100.23     (b) A medical assistance lien is not enforceable against 
100.24  the real property of an estate to the extent there is a 
100.25  determination by a court of competent jurisdiction, or by an 
100.26  officer of the court designated for that purpose, that there are 
100.27  insufficient assets in the estate to satisfy the agency's 
100.28  medical assistance lien in whole or in part because of the 
100.29  homestead exemption under section 256B.15, subdivision 4, the 
100.30  rights of the surviving spouse or minor children under section 
100.31  524.2-403, paragraphs (a) and (b), or claims with a priority 
100.32  under section 524.3-805, paragraph (a), clauses (1) to (4).  For 
100.33  purposes of this section, the rights of the decedent's adult 
100.34  children to exempt property under section 524.2-403, paragraph 
100.35  (b), shall not be considered costs of administration under 
100.36  section 524.3-805, paragraph (a), clause (1). 
101.1      (c) Notwithstanding any law or rule to the contrary, the 
101.2   provisions in clauses (1) to (7) apply if a life estate subject 
101.3   to a medical assistance lien ends according to its terms, or if 
101.4   a medical assistance recipient who owns a life estate or any 
101.5   interest in real property as a joint tenant that is subject to a 
101.6   medical assistance lien dies. 
101.7      (1) The medical assistance recipient's life estate or joint 
101.8   tenancy interest in the real property shall not end upon the 
101.9   recipient's death but shall merge into the remainder interest or 
101.10  other interest in real property the medical assistance recipient 
101.11  owned in joint tenancy with others.  The medical assistance lien 
101.12  shall attach to and run with the remainder or other interest in 
101.13  the real property to the extent of the medical assistance 
101.14  recipient's interest in the property at the time of the 
101.15  recipient's death as determined under this section. 
101.16     (2) If the medical assistance recipient's interest was a 
101.17  life estate in real property, the lien shall be a lien against 
101.18  the portion of the remainder equal to the percentage factor for 
101.19  the life estate of a person the medical assistance recipient's 
101.20  age on the date the life estate ended according to its terms or 
101.21  the date of the medical assistance recipient's death as listed 
101.22  in the Life Estate Mortality Table in the health care program's 
101.23  manual. 
101.24     (3) If the medical assistance recipient owned the interest 
101.25  in real property in joint tenancy with others, the lien shall be 
101.26  a lien against the portion of that interest equal to the 
101.27  fractional interest the medical assistance recipient would have 
101.28  owned in the jointly owned interest had the medical assistance 
101.29  recipient and the other owners held title to that interest as 
101.30  tenants in common on the date the medical assistance recipient 
101.31  died. 
101.32     (4) The medical assistance lien shall remain a lien against 
101.33  the remainder or other jointly owned interest for the length of 
101.34  time and be renewable as provided in paragraph (a). 
101.35     (5) Subdivision 5, paragraph (a), clause (4), paragraph 
101.36  (b), clauses (1) and (2); and subdivision 6, paragraph (b), do 
102.1   not apply to medical assistance liens which attach to interests 
102.2   in real property as provided under this subdivision. 
102.3      (6) The continuation of a medical assistance recipient's 
102.4   life estate or joint tenancy interest in real property after the 
102.5   medical assistance recipient's death for the purpose of 
102.6   recovering medical assistance provided for in sections 514.980 
102.7   to 514.985 modifies common law principles holding that these 
102.8   interests terminate on the death of the holder. 
102.9      (7) Notwithstanding any law or rule to the contrary, no 
102.10  release, satisfaction, discharge, or affidavit under section 
102.11  256B.15 shall extinguish or terminate the life estate or joint 
102.12  tenancy interest of a medical assistance recipient subject to a 
102.13  lien under sections 514.980 to 514.985 on the date the recipient 
102.14  dies. 
102.15     (8) The provisions of clauses (1) to (7) do not apply to a 
102.16  homestead owned of record, on the date the recipient dies, by 
102.17  the recipient and the recipient's spouse as joint tenants with a 
102.18  right of survivorship.  Homestead means the real property 
102.19  occupied by the surviving joint tenant spouse as their sole 
102.20  residence on the date the recipient dies and classified and 
102.21  taxed to the recipient and surviving joint tenant spouse as 
102.22  homestead property for property tax purposes in the calendar 
102.23  year in which the recipient dies.  For purposes of this 
102.24  exemption, real property the recipient and their surviving joint 
102.25  tenant spouse purchase solely with the proceeds from the sale of 
102.26  their prior homestead, own of record as joint tenants, and 
102.27  qualify as homestead property under section 273.124 in the 
102.28  calendar year in which the recipient dies and prior to the 
102.29  recipient's death shall be deemed to be real property classified 
102.30  and taxed to the recipient and their surviving joint tenant 
102.31  spouse as homestead property in the calendar year in which the 
102.32  recipient dies.  The surviving spouse, or any person with 
102.33  personal knowledge of the facts, may provide an affidavit 
102.34  describing the homestead property affected by this clause and 
102.35  stating facts showing compliance with this clause.  The 
102.36  affidavit shall be prima facie evidence of the facts it states. 
103.1   All provisions in this paragraph related to the continuation of 
103.2   a recipient's life estate or joint tenancy interests in real 
103.3   property after the recipient's death, for the purpose of 
103.4   recovering medical assistance, are effective only for life 
103.5   estates and joint tenancy interests established on or after 
103.6   August 1, 2003. 
103.7      <b>[EFFECTIVE DATE.]</b> This section is effective retroactively 
103.8   from August 1, 2003. 
103.9      Sec. 77.  Laws 2003, First Special Session chapter 14, 
103.10  article 12, section 93, is amended to read: 
103.11     Sec. 93.  [REVIEW OF SPECIAL TRANSPORTATION ELIGIBILITY 
103.12  CRITERIA AND POTENTIAL COST SAVINGS USE OF A BROKER TO MANAGE 
103.13  SPECIAL TRANSPORTATION SERVICES.] 
103.14     The commissioner of human services, in consultation with 
103.15  the commissioner of transportation and special transportation 
103.16  service providers, shall review eligibility criteria for medical 
103.17  assistance special transportation services and shall evaluate 
103.18  whether the level of special transportation services provided 
103.19  should be based on the degree of impairment of the client, as 
103.20  well as the medical diagnosis.  The commissioner shall also 
103.21  evaluate methods for reducing the cost of special transportation 
103.22  services, including, but not limited to: 
103.23     (1) requiring providers to maintain a daily log book 
103.24  confirming delivery of clients to medical facilities; 
103.25     (2) requiring providers to implement commercially available 
103.26  computer mapping programs to calculate mileage for purposes of 
103.27  reimbursement; 
103.28     (3) restricting special transportation service from being 
103.29  provided solely for trips to pharmacies; 
103.30     (4) modifying eligibility for special transportation; 
103.31     (5) expanding alternatives to the use of special 
103.32  transportation services; 
103.33     (6) improving the process of certifying persons as eligible 
103.34  for special transportation services; and 
103.35     (7) examining the feasibility and benefits of licensing 
103.36  special transportation providers. 
104.1      The commissioner shall present recommendations for changes 
104.2   in the eligibility criteria and potential cost-savings for 
104.3   special transportation services to the chairs and ranking 
104.4   minority members of the house and senate committees having 
104.5   jurisdiction over health and human services spending by January 
104.6   15, 2004.  The commissioner is prohibited from using a broker or 
104.7   coordinator to manage special transportation services for 
104.8   fee-for-service enrollees residing in a nursing home licensed 
104.9   under Minnesota Statutes, chapter 144A, until July 1, 2006, and 
104.10  for all other fee-for-service enrollees until July 1, 2005, 
104.11  except for the purposes of checking for recipient eligibility, 
104.12  authorizing recipients for appropriate level of transportation, 
104.13  and monitoring provider compliance with Minnesota Statutes, 
104.14  section 256B.0625, subdivision 17.  This prohibition does not 
104.15  apply to the purchase or management of common carrier 
104.16  transportation. 
104.17     Sec. 78.  [ADVISORY COMMITTEE ON NONEMERGENCY 
104.18  TRANSPORTATION SERVICES.] 
104.19     The commissioner of human services shall establish a 
104.20  seven-member advisory committee on medical assistance 
104.21  nonemergency transportation services.  The committee shall 
104.22  consist of:  a representative of the commissioner of human 
104.23  services, who shall serve as chair; two special transportation 
104.24  service providers, appointed by the trade associations 
104.25  representing special transportation service providers; one 
104.26  representative of nursing facilities; one representative of the 
104.27  disability community; and one house and one senate member, 
104.28  appointed respectively by the chairs of the house and senate 
104.29  committees with jurisdiction over medical assistance funding.  
104.30  The advisory committee shall monitor and evaluate the provision 
104.31  of medical assistance nonemergency medical transportation 
104.32  services, and present recommendations for any necessary changes 
104.33  to the commissioner. 
104.34     Sec. 79.  [PLANNING PROCESS FOR MANAGED CARE.] 
104.35     The commissioner of human services shall develop a planning 
104.36  process for the purposes of implementing at least one additional 
105.1   managed care arrangement to provide medical assistance services, 
105.2   excluding continuing care services, to recipients enrolled in 
105.3   the medical assistance fee-for-service program, effective 
105.4   January 1, 2007.  This planning process shall include an 
105.5   advisory committee composed of current fee-for-service 
105.6   consumers, consumer advocates, and providers, as well as 
105.7   representatives of health plans and other provider organizations 
105.8   qualified to provide basic health care services to persons with 
105.9   disabilities.  The department shall seek any additional federal 
105.10  authority necessary to provide basic health care services 
105.11  through contracted managed care arrangements. 
105.12     Sec. 80.  [FEDERAL APPROVAL RELATED TO MEDICAL ASSISTANCE 
105.13  INCOME LIMIT FOR PREGNANT WOMEN AND SPECIAL WORK EXPENSE 
105.14  DEDUCTION.] 
105.15     The commissioner of human services, by July 1, 2005, shall 
105.16  apply for any federal waivers and approvals necessary to retain 
105.17  the medical assistance income limit for pregnant women at 200 
105.18  percent of the federal poverty guidelines, and to not apply the 
105.19  special work expense deductions for infants and pregnant women.  
105.20  The commissioner shall update the chairs and ranking minority 
105.21  members of the house and senate committees with jurisdiction 
105.22  over the medical assistance program of the status of the request 
105.23  for federal waivers and approvals. 
105.24     Sec. 81.  [FEDERAL APPROVAL.] 
105.25     (a) The commissioner of human services shall seek federal 
105.26  waivers and approvals necessary to allow the commissioner to 
105.27  charge medical assistance recipients sliding scale premiums, 
105.28  based on the sliding scale used for the MinnesotaCare program 
105.29  under Minnesota Statutes, section 256L.15. 
105.30     (b) The commissioner of human services shall seek federal 
105.31  approval to fully implement the amendments to Minnesota 
105.32  Statutes, section 256L.01, subdivision 5. 
105.33     Sec. 82.  [HEALTH CARE FINANCING REPORT.] 
105.34     The commissioner of human services shall develop 
105.35  recommendations on simplifying publicly funded health care 
105.36  program financing.  The commissioner shall report the 
106.1   recommendations to the chairs of the house and senate committees 
106.2   with jurisdiction over health care financing during the 2007 
106.3   legislative session. 
106.4      Sec. 83.  [GENERAL PROVISIONS GOVERNING CHANGE IN EFFECTIVE 
106.5   DATE FOR LIFE ESTATE AND JOINT TENANCY INTEREST PROVISIONS.] 
106.6      Subdivision 1.  [ESTABLISHMENT OF LIFE ESTATE OR JOINT 
106.7   TENANCY INTEREST.] For purposes of the amendments to Minnesota 
106.8   Statutes, sections 256B.15, subdivision 1, and 514.981, 
106.9   subdivision 6, a life estate or joint tenancy interest is 
106.10  established upon the earlier of: 
106.11     (1) the date the instrument creating the interest is 
106.12  recorded or filed in the office of the county recorder or 
106.13  registrar of titles where the real estate interest it describes 
106.14  is located; 
106.15     (2) the date of delivery by the grantor to the grantee of 
106.16  the signed instrument as stated in an affidavit made by a person 
106.17  with knowledge of the facts; 
106.18     (3) the date on which the judicial order creating the 
106.19  interest was issued by the court; or 
106.20     (4) the date upon which the interest devolves under 
106.21  Minnesota Statutes, section 524.3-101. 
106.22     Subd. 2.  [MEDICAL ASSISTANCE.] For purposes of the 
106.23  amendments to Minnesota Statutes, sections 256B.15, subdivision 
106.24  1, and 514.981, subdivision 6, the term medical assistance means 
106.25  medical assistance as defined in Minnesota Statutes 2004, 
106.26  section 256B.15, subdivision 1. 
106.27     Subd. 3.  [LIEN NOTICES.] Medical assistance liens and 
106.28  liens under notices of potential claims that are of record 
106.29  against life estate or joint tenancy interests established prior 
106.30  to August 1, 2003, shall end and become unenforceable upon the 
106.31  death of the person named in the lien, or a notice of potential 
106.32  claim shall be disregarded by examiners of title after the death 
106.33  of the life tenant or joint tenant, and shall not be carried 
106.34  forward to a subsequent certificate of title.  This subdivision 
106.35  shall not apply to life estates that continue to exist after the 
106.36  death of the person named in the lien or notice of potential 
107.1   claim under the terms of the instrument creating or reserving 
107.2   the life estate until the life estate ends as provided for in 
107.3   the instrument. 
107.4      <b>[EFFECTIVE DATE.]</b> This section is effective retroactively 
107.5   from August 1, 2003. 
107.6      Sec. 84.  [COMMISSIONER'S DUTIES RELATED TO CHANGE IN 
107.7   EFFECTIVE DATE FOR LIFE ESTATE AND JOINT TENANCY INTEREST 
107.8   PROVISIONS.] 
107.9      (a) The commissioner of human services or a county agency 
107.10  that has recovered medical assistance or alternative care 
107.11  payments for recipients after they die from their life estates 
107.12  or jointly owned interests in real property that were 
107.13  established prior to August 1, 2003, and that were continued in 
107.14  existence or merged into another interest in real property after 
107.15  their death due solely to the provisions of section 256B.15 or 
107.16  514.981, subdivision 6, paragraph (c), as those provisions 
107.17  existed prior to the amendments in this act, shall refund those 
107.18  recoveries, without interest.  The refunds shall be paid to the 
107.19  surviving record owners of the real property in which the 
107.20  recipient had a life estate or a jointly owned interest on the 
107.21  date of the recipient's death in proportion to their record 
107.22  interests on that date.  The commissioner and a county agency 
107.23  are not required to refund any other recoveries attributable to 
107.24  any other interests or assets of the deceased recipient. 
107.25     (b) If the commissioner of human services or a county 
107.26  agency determines a person entitled to any refund under this act 
107.27  is dead, they may pay the refund due that person to their estate 
107.28  if it is still open.  If the person's estate is closed or if a 
107.29  court has entered a decree of distribution for that person under 
107.30  section 525.312 that is a final decree, the commissioner or the 
107.31  county agency may, in their absolute discretion, pay the 
107.32  person's refund to their heirs or devisees as finally determined 
107.33  in any completed probate or under any final decree of 
107.34  distribution.  In all other cases including, but not limited to, 
107.35  those in which the commissioner or a county agency determines 
107.36  they cannot identify or locate a person entitled to a refund 
108.1   under this section, they may, at their discretion, declare such 
108.2   person's refund to be abandoned property and pay and deliver it 
108.3   to the commissioner of commerce.  The commissioner of commerce 
108.4   shall administer and dispose of the refunds according to 
108.5   sections 345.31 to 345.60.  Neither the commissioner of human 
108.6   services, the Department of Human Services, a county agency, or 
108.7   the employees of the department or agency, shall be liable to 
108.8   anyone with respect to the refund after paying or delivering the 
108.9   refund as provided for in this section. 
108.10     <b>[EFFECTIVE DATE.]</b> This section is effective retroactively 
108.11  from August 1, 2003. 
108.12     Sec. 85.  [IMMUNITY.] 
108.13     The commissioner of human services, county agencies, and 
108.14  elected officials and their employees are immune from all 
108.15  liability for any action taken implementing Laws 2003, First 
108.16  Special Session chapter 14, article 12, sections 40 to 52 and 
108.17  90, as those laws existed at the time the action was taken, and 
108.18  sections 1 to 4 of this act. 
108.19     <b>[EFFECTIVE DATE.]</b> This section is effective retroactively 
108.20  from August 1, 2003. 
108.21     Sec. 86.  [REPEALER.] 
108.22     (a) Minnesota Statutes 2004, sections 256L.035; 256L.04, 
108.23  subdivision 7; and 256L.09, subdivisions 1, 4, 5, 6, and 7, are 
108.24  repealed effective October 1, 2005. 
108.25     (b) Minnesota Statutes 2004, section 256.955, is repealed 
108.26  effective January 1, 2006. 
108.27     (c) Minnesota Statutes 2004, sections 256B.075, subdivision 
108.28  5, and 295.581, are repealed the day following final enactment. 
108.29     (d) Minnesota Statutes 2004, section 256L.04, subdivision 
108.30  11, MinnesotaCare outreach grants, is repealed effective July 1, 
108.31  2005. 
108.32                             ARTICLE 4 
108.33               NURSING FACILITY REIMBURSEMENT SYSTEM 
108.34                        AND OTHER PROVISIONS 
108.35     Section 1.  Minnesota Statutes 2004, section 144A.071, 
108.36  subdivision 4a, is amended to read: 
109.1      Subd. 4a.  [EXCEPTIONS FOR REPLACEMENT BEDS.] It is in the 
109.2   best interest of the state to ensure that nursing homes and 
109.3   boarding care homes continue to meet the physical plant 
109.4   licensing and certification requirements by permitting certain 
109.5   construction projects.  Facilities should be maintained in 
109.6   condition to satisfy the physical and emotional needs of 
109.7   residents while allowing the state to maintain control over 
109.8   nursing home expenditure growth. 
109.9      The commissioner of health in coordination with the 
109.10  commissioner of human services, may approve the renovation, 
109.11  replacement, upgrading, or relocation of a nursing home or 
109.12  boarding care home, under the following conditions: 
109.13     (a) to license or certify beds in a new facility 
109.14  constructed to replace a facility or to make repairs in an 
109.15  existing facility that was destroyed or damaged after June 30, 
109.16  1987, by fire, lightning, or other hazard provided:  
109.17     (i) destruction was not caused by the intentional act of or 
109.18  at the direction of a controlling person of the facility; 
109.19     (ii) at the time the facility was destroyed or damaged the 
109.20  controlling persons of the facility maintained insurance 
109.21  coverage for the type of hazard that occurred in an amount that 
109.22  a reasonable person would conclude was adequate; 
109.23     (iii) the net proceeds from an insurance settlement for the 
109.24  damages caused by the hazard are applied to the cost of the new 
109.25  facility or repairs; 
109.26     (iv) the new facility is constructed on the same site as 
109.27  the destroyed facility or on another site subject to the 
109.28  restrictions in section 144A.073, subdivision 5; 
109.29     (v) the number of licensed and certified beds in the new 
109.30  facility does not exceed the number of licensed and certified 
109.31  beds in the destroyed facility; and 
109.32     (vi) the commissioner determines that the replacement beds 
109.33  are needed to prevent an inadequate supply of beds. 
109.34  Project construction costs incurred for repairs authorized under 
109.35  this clause shall not be considered in the dollar threshold 
109.36  amount defined in subdivision 2; 
110.1      (b) to license or certify beds that are moved from one 
110.2   location to another within a nursing home facility, provided the 
110.3   total costs of remodeling performed in conjunction with the 
110.4   relocation of beds does not exceed $1,000,000; 
110.5      (c) to license or certify beds in a project recommended for 
110.6   approval under section 144A.073; 
110.7      (d) to license or certify beds that are moved from an 
110.8   existing state nursing home to a different state facility, 
110.9   provided there is no net increase in the number of state nursing 
110.10  home beds; 
110.11     (e) to certify and license as nursing home beds boarding 
110.12  care beds in a certified boarding care facility if the beds meet 
110.13  the standards for nursing home licensure, or in a facility that 
110.14  was granted an exception to the moratorium under section 
110.15  144A.073, and if the cost of any remodeling of the facility does 
110.16  not exceed $1,000,000.  If boarding care beds are licensed as 
110.17  nursing home beds, the number of boarding care beds in the 
110.18  facility must not increase beyond the number remaining at the 
110.19  time of the upgrade in licensure.  The provisions contained in 
110.20  section 144A.073 regarding the upgrading of the facilities do 
110.21  not apply to facilities that satisfy these requirements; 
110.22     (f) to license and certify up to 40 beds transferred from 
110.23  an existing facility owned and operated by the Amherst H. Wilder 
110.24  Foundation in the city of St. Paul to a new unit at the same 
110.25  location as the existing facility that will serve persons with 
110.26  Alzheimer's disease and other related disorders.  The transfer 
110.27  of beds may occur gradually or in stages, provided the total 
110.28  number of beds transferred does not exceed 40.  At the time of 
110.29  licensure and certification of a bed or beds in the new unit, 
110.30  the commissioner of health shall delicense and decertify the 
110.31  same number of beds in the existing facility.  As a condition of 
110.32  receiving a license or certification under this clause, the 
110.33  facility must make a written commitment to the commissioner of 
110.34  human services that it will not seek to receive an increase in 
110.35  its property-related payment rate as a result of the transfers 
110.36  allowed under this paragraph; 
111.1      (g) to license and certify nursing home beds to replace 
111.2   currently licensed and certified boarding care beds which may be 
111.3   located either in a remodeled or renovated boarding care or 
111.4   nursing home facility or in a remodeled, renovated, newly 
111.5   constructed, or replacement nursing home facility within the 
111.6   identifiable complex of health care facilities in which the 
111.7   currently licensed boarding care beds are presently located, 
111.8   provided that the number of boarding care beds in the facility 
111.9   or complex are decreased by the number to be licensed as nursing 
111.10  home beds and further provided that, if the total costs of new 
111.11  construction, replacement, remodeling, or renovation exceed ten 
111.12  percent of the appraised value of the facility or $200,000, 
111.13  whichever is less, the facility makes a written commitment to 
111.14  the commissioner of human services that it will not seek to 
111.15  receive an increase in its property-related payment rate by 
111.16  reason of the new construction, replacement, remodeling, or 
111.17  renovation.  The provisions contained in section 144A.073 
111.18  regarding the upgrading of facilities do not apply to facilities 
111.19  that satisfy these requirements; 
111.20     (h) to license as a nursing home and certify as a nursing 
111.21  facility a facility that is licensed as a boarding care facility 
111.22  but not certified under the medical assistance program, but only 
111.23  if the commissioner of human services certifies to the 
111.24  commissioner of health that licensing the facility as a nursing 
111.25  home and certifying the facility as a nursing facility will 
111.26  result in a net annual savings to the state general fund of 
111.27  $200,000 or more; 
111.28     (i) to certify, after September 30, 1992, and prior to July 
111.29  1, 1993, existing nursing home beds in a facility that was 
111.30  licensed and in operation prior to January 1, 1992; 
111.31     (j) to license and certify new nursing home beds to replace 
111.32  beds in a facility acquired by the Minneapolis Community 
111.33  Development Agency as part of redevelopment activities in a city 
111.34  of the first class, provided the new facility is located within 
111.35  three miles of the site of the old facility.  Operating and 
111.36  property costs for the new facility must be determined and 
112.1   allowed under section 256B.431 or 256B.434; 
112.2      (k) to license and certify up to 20 new nursing home beds 
112.3   in a community-operated hospital and attached convalescent and 
112.4   nursing care facility with 40 beds on April 21, 1991, that 
112.5   suspended operation of the hospital in April 1986.  The 
112.6   commissioner of human services shall provide the facility with 
112.7   the same per diem property-related payment rate for each 
112.8   additional licensed and certified bed as it will receive for its 
112.9   existing 40 beds; 
112.10     (l) to license or certify beds in renovation, replacement, 
112.11  or upgrading projects as defined in section 144A.073, 
112.12  subdivision 1, so long as the cumulative total costs of the 
112.13  facility's remodeling projects do not exceed $1,000,000; 
112.14     (m) to license and certify beds that are moved from one 
112.15  location to another for the purposes of converting up to five 
112.16  four-bed wards to single or double occupancy rooms in a nursing 
112.17  home that, as of January 1, 1993, was county-owned and had a 
112.18  licensed capacity of 115 beds; 
112.19     (n) to allow a facility that on April 16, 1993, was a 
112.20  106-bed licensed and certified nursing facility located in 
112.21  Minneapolis to layaway all of its licensed and certified nursing 
112.22  home beds.  These beds may be relicensed and recertified in a 
112.23  newly constructed teaching nursing home facility affiliated with 
112.24  a teaching hospital upon approval by the legislature.  The 
112.25  proposal must be developed in consultation with the interagency 
112.26  committee on long-term care planning.  The beds on layaway 
112.27  status shall have the same status as voluntarily delicensed and 
112.28  decertified beds, except that beds on layaway status remain 
112.29  subject to the surcharge in section 256.9657.  This layaway 
112.30  provision expires July 1, 1998; 
112.31     (o) to allow a project which will be completed in 
112.32  conjunction with an approved moratorium exception project for a 
112.33  nursing home in southern Cass County and which is directly 
112.34  related to that portion of the facility that must be repaired, 
112.35  renovated, or replaced, to correct an emergency plumbing problem 
112.36  for which a state correction order has been issued and which 
113.1   must be corrected by August 31, 1993; 
113.2      (p) to allow a facility that on April 16, 1993, was a 
113.3   368-bed licensed and certified nursing facility located in 
113.4   Minneapolis to layaway, upon 30 days prior written notice to the 
113.5   commissioner, up to 30 of the facility's licensed and certified 
113.6   beds by converting three-bed wards to single or double 
113.7   occupancy.  Beds on layaway status shall have the same status as 
113.8   voluntarily delicensed and decertified beds except that beds on 
113.9   layaway status remain subject to the surcharge in section 
113.10  256.9657, remain subject to the license application and renewal 
113.11  fees under section 144A.07 and shall be subject to a $100 per 
113.12  bed reactivation fee.  In addition, at any time within three 
113.13  years of the effective date of the layaway, the beds on layaway 
113.14  status may be: 
113.15     (1) relicensed and recertified upon relocation and 
113.16  reactivation of some or all of the beds to an existing licensed 
113.17  and certified facility or facilities located in Pine River, 
113.18  Brainerd, or International Falls; provided that the total 
113.19  project construction costs related to the relocation of beds 
113.20  from layaway status for any facility receiving relocated beds 
113.21  may not exceed the dollar threshold provided in subdivision 2 
113.22  unless the construction project has been approved through the 
113.23  moratorium exception process under section 144A.073; 
113.24     (2) relicensed and recertified, upon reactivation of some 
113.25  or all of the beds within the facility which placed the beds in 
113.26  layaway status, if the commissioner has determined a need for 
113.27  the reactivation of the beds on layaway status. 
113.28     The property-related payment rate of a facility placing 
113.29  beds on layaway status must be adjusted by the incremental 
113.30  change in its rental per diem after recalculating the rental per 
113.31  diem as provided in section 256B.431, subdivision 3a, paragraph 
113.32  (c).  The property-related payment rate for a facility 
113.33  relicensing and recertifying beds from layaway status must be 
113.34  adjusted by the incremental change in its rental per diem after 
113.35  recalculating its rental per diem using the number of beds after 
113.36  the relicensing to establish the facility's capacity day 
114.1   divisor, which shall be effective the first day of the month 
114.2   following the month in which the relicensing and recertification 
114.3   became effective.  Any beds remaining on layaway status more 
114.4   than three years after the date the layaway status became 
114.5   effective must be removed from layaway status and immediately 
114.6   delicensed and decertified; 
114.7      (q) to license and certify beds in a renovation and 
114.8   remodeling project to convert 12 four-bed wards into 24 two-bed 
114.9   rooms, expand space, and add improvements in a nursing home 
114.10  that, as of January 1, 1994, met the following conditions:  the 
114.11  nursing home was located in Ramsey County; had a licensed 
114.12  capacity of 154 beds; and had been ranked among the top 15 
114.13  applicants by the 1993 moratorium exceptions advisory review 
114.14  panel.  The total project construction cost estimate for this 
114.15  project must not exceed the cost estimate submitted in 
114.16  connection with the 1993 moratorium exception process; 
114.17     (r) to license and certify up to 117 beds that are 
114.18  relocated from a licensed and certified 138-bed nursing facility 
114.19  located in St. Paul to a hospital with 130 licensed hospital 
114.20  beds located in South St. Paul, provided that the nursing 
114.21  facility and hospital are owned by the same or a related 
114.22  organization and that prior to the date the relocation is 
114.23  completed the hospital ceases operation of its inpatient 
114.24  hospital services at that hospital.  After relocation, the 
114.25  nursing facility's status under section 256B.431, subdivision 
114.26  2j, shall be the same as it was prior to relocation.  The 
114.27  nursing facility's property-related payment rate resulting from 
114.28  the project authorized in this paragraph shall become effective 
114.29  no earlier than April 1, 1996.  For purposes of calculating the 
114.30  incremental change in the facility's rental per diem resulting 
114.31  from this project, the allowable appraised value of the nursing 
114.32  facility portion of the existing health care facility physical 
114.33  plant prior to the renovation and relocation may not exceed 
114.34  $2,490,000; 
114.35     (s) to license and certify two beds in a facility to 
114.36  replace beds that were voluntarily delicensed and decertified on 
115.1   June 28, 1991; 
115.2      (t) to allow 16 licensed and certified beds located on July 
115.3   1, 1994, in a 142-bed nursing home and 21-bed boarding care home 
115.4   facility in Minneapolis, notwithstanding the licensure and 
115.5   certification after July 1, 1995, of the Minneapolis facility as 
115.6   a 147-bed nursing home facility after completion of a 
115.7   construction project approved in 1993 under section 144A.073, to 
115.8   be laid away upon 30 days' prior written notice to the 
115.9   commissioner.  Beds on layaway status shall have the same status 
115.10  as voluntarily delicensed or decertified beds except that they 
115.11  shall remain subject to the surcharge in section 256.9657.  The 
115.12  16 beds on layaway status may be relicensed as nursing home beds 
115.13  and recertified at any time within five years of the effective 
115.14  date of the layaway upon relocation of some or all of the beds 
115.15  to a licensed and certified facility located in Watertown, 
115.16  provided that the total project construction costs related to 
115.17  the relocation of beds from layaway status for the Watertown 
115.18  facility may not exceed the dollar threshold provided in 
115.19  subdivision 2 unless the construction project has been approved 
115.20  through the moratorium exception process under section 144A.073. 
115.21     The property-related payment rate of the facility placing 
115.22  beds on layaway status must be adjusted by the incremental 
115.23  change in its rental per diem after recalculating the rental per 
115.24  diem as provided in section 256B.431, subdivision 3a, paragraph 
115.25  (c).  The property-related payment rate for the facility 
115.26  relicensing and recertifying beds from layaway status must be 
115.27  adjusted by the incremental change in its rental per diem after 
115.28  recalculating its rental per diem using the number of beds after 
115.29  the relicensing to establish the facility's capacity day 
115.30  divisor, which shall be effective the first day of the month 
115.31  following the month in which the relicensing and recertification 
115.32  became effective.  Any beds remaining on layaway status more 
115.33  than five years after the date the layaway status became 
115.34  effective must be removed from layaway status and immediately 
115.35  delicensed and decertified; 
115.36     (u) to license and certify beds that are moved within an 
116.1   existing area of a facility or to a newly constructed addition 
116.2   which is built for the purpose of eliminating three- and 
116.3   four-bed rooms and adding space for dining, lounge areas, 
116.4   bathing rooms, and ancillary service areas in a nursing home 
116.5   that, as of January 1, 1995, was located in Fridley and had a 
116.6   licensed capacity of 129 beds; 
116.7      (v) to relocate 36 beds in Crow Wing County and four beds 
116.8   from Hennepin County to a 160-bed facility in Crow Wing County, 
116.9   provided all the affected beds are under common ownership; 
116.10     (w) to license and certify a total replacement project of 
116.11  up to 49 beds located in Norman County that are relocated from a 
116.12  nursing home destroyed by flood and whose residents were 
116.13  relocated to other nursing homes.  The operating cost payment 
116.14  rates for the new nursing facility shall be determined based on 
116.15  the interim and settle-up payment provisions of Minnesota Rules, 
116.16  part 9549.0057, and the reimbursement provisions of section 
116.17  256B.431, except that subdivision 26, paragraphs (a) and (b), 
116.18  shall not apply until the second rate year after the settle-up 
116.19  cost report is filed.  Property-related reimbursement rates 
116.20  shall be determined under section 256B.431, taking into account 
116.21  any federal or state flood-related loans or grants provided to 
116.22  the facility; 
116.23     (x) to license and certify a total replacement project of 
116.24  up to 129 beds located in Polk County that are relocated from a 
116.25  nursing home destroyed by flood and whose residents were 
116.26  relocated to other nursing homes.  The operating cost payment 
116.27  rates for the new nursing facility shall be determined based on 
116.28  the interim and settle-up payment provisions of Minnesota Rules, 
116.29  part 9549.0057, and the reimbursement provisions of section 
116.30  256B.431, except that subdivision 26, paragraphs (a) and (b), 
116.31  shall not apply until the second rate year after the settle-up 
116.32  cost report is filed.  Property-related reimbursement rates 
116.33  shall be determined under section 256B.431, taking into account 
116.34  any federal or state flood-related loans or grants provided to 
116.35  the facility; 
116.36     (y) to license and certify beds in a renovation and 
117.1   remodeling project to convert 13 three-bed wards into 13 two-bed 
117.2   rooms and 13 single-bed rooms, expand space, and add 
117.3   improvements in a nursing home that, as of January 1, 1994, met 
117.4   the following conditions:  the nursing home was located in 
117.5   Ramsey County, was not owned by a hospital corporation, had a 
117.6   licensed capacity of 64 beds, and had been ranked among the top 
117.7   15 applicants by the 1993 moratorium exceptions advisory review 
117.8   panel.  The total project construction cost estimate for this 
117.9   project must not exceed the cost estimate submitted in 
117.10  connection with the 1993 moratorium exception process; 
117.11     (z) to license and certify up to 150 nursing home beds to 
117.12  replace an existing 285 bed nursing facility located in St. 
117.13  Paul.  The replacement project shall include both the renovation 
117.14  of existing buildings and the construction of new facilities at 
117.15  the existing site.  The reduction in the licensed capacity of 
117.16  the existing facility shall occur during the construction 
117.17  project as beds are taken out of service due to the construction 
117.18  process.  Prior to the start of the construction process, the 
117.19  facility shall provide written information to the commissioner 
117.20  of health describing the process for bed reduction, plans for 
117.21  the relocation of residents, and the estimated construction 
117.22  schedule.  The relocation of residents shall be in accordance 
117.23  with the provisions of law and rule; 
117.24     (aa) to allow the commissioner of human services to license 
117.25  an additional 36 beds to provide residential services for the 
117.26  physically handicapped under Minnesota Rules, parts 9570.2000 to 
117.27  9570.3400, in a 198-bed nursing home located in Red Wing, 
117.28  provided that the total number of licensed and certified beds at 
117.29  the facility does not increase; 
117.30     (bb) to license and certify a new facility in St. Louis 
117.31  county with 44 beds constructed to replace an existing facility 
117.32  in St. Louis County with 31 beds, which has resident rooms on 
117.33  two separate floors and an antiquated elevator that creates 
117.34  safety concerns for residents and prevents nonambulatory 
117.35  residents from residing on the second floor.  The project shall 
117.36  include the elimination of three- and four-bed rooms; 
118.1      (cc) to license and certify four beds in a 16-bed certified 
118.2   boarding care home in Minneapolis to replace beds that were 
118.3   voluntarily delicensed and decertified on or before March 31, 
118.4   1992.  The licensure and certification is conditional upon the 
118.5   facility periodically assessing and adjusting its resident mix 
118.6   and other factors which may contribute to a potential 
118.7   institution for mental disease declaration.  The commissioner of 
118.8   human services shall retain the authority to audit the facility 
118.9   at any time and shall require the facility to comply with any 
118.10  requirements necessary to prevent an institution for mental 
118.11  disease declaration, including delicensure and decertification 
118.12  of beds, if necessary; 
118.13     (dd) to license and certify 72 beds in an existing facility 
118.14  in Mille Lacs County with 80 beds as part of a renovation 
118.15  project.  The renovation must include construction of an 
118.16  addition to accommodate ten residents with beginning and 
118.17  midstage dementia in a self-contained living unit; creation of 
118.18  three resident households where dining, activities, and support 
118.19  spaces are located near resident living quarters; designation of 
118.20  four beds for rehabilitation in a self-contained area; 
118.21  designation of 30 private rooms; and other improvements; 
118.22     (ee) to license and certify beds in a facility that has 
118.23  undergone replacement or remodeling as part of a planned closure 
118.24  under section 256B.437; 
118.25     (ff) to license and certify a total replacement project of 
118.26  up to 124 beds located in Wilkin County that are in need of 
118.27  relocation from a nursing home significantly damaged by flood.  
118.28  The operating cost payment rates for the new nursing facility 
118.29  shall be determined based on the interim and settle-up payment 
118.30  provisions of Minnesota Rules, part 9549.0057, and the 
118.31  reimbursement provisions of section 256B.431, except that 
118.32  section 256B.431, subdivision 26, paragraphs (a) and (b), shall 
118.33  not apply until the second rate year after the settle-up cost 
118.34  report is filed.  Property-related reimbursement rates shall be 
118.35  determined under section 256B.431, taking into account any 
118.36  federal or state flood-related loans or grants provided to the 
119.1   facility; 
119.2      (gg) to allow the commissioner of human services to license 
119.3   an additional nine beds to provide residential services for the 
119.4   physically handicapped under Minnesota Rules, parts 9570.2000 to 
119.5   9570.3400, in a 240-bed nursing home located in Duluth, provided 
119.6   that the total number of licensed and certified beds at the 
119.7   facility does not increase; 
119.8      (hh) to license and certify up to 120 new nursing facility 
119.9   beds to replace beds in a facility in Anoka County, which was 
119.10  licensed for 98 beds as of July 1, 2000, provided the new 
119.11  facility is located within four miles of the existing facility 
119.12  and is in Anoka County.  Operating and property rates shall be 
119.13  determined and allowed under section 256B.431 and Minnesota 
119.14  Rules, parts 9549.0010 to 9549.0080, or section 256B.434 or 
119.15  256B.435.  The provisions of section 256B.431, subdivision 26, 
119.16  paragraphs (a) and (b), do not apply until the second rate year 
119.17  following settle-up; or 
119.18     (ii) to transfer up to 98 beds of a 129-licensed bed 
119.19  facility located in Anoka County that, as of March 25, 2001, is 
119.20  in the active process of closing, to a 122-licensed bed 
119.21  nonprofit nursing facility located in the city of Columbia 
119.22  Heights or its affiliate.  The transfer is effective when the 
119.23  receiving facility notifies the commissioner in writing of the 
119.24  number of beds accepted.  The commissioner shall place all 
119.25  transferred beds on layaway status held in the name of the 
119.26  receiving facility.  The layaway adjustment provisions of 
119.27  section 256B.431, subdivision 30, do not apply to this layaway.  
119.28  The receiving facility may only remove the beds from layaway for 
119.29  recertification and relicensure at the receiving facility's 
119.30  current site, or at a newly constructed facility located in 
119.31  Anoka County.  The receiving facility must receive statutory 
119.32  authorization before removing these beds from layaway status. 
119.33     (jj)(1) A facility in Columbia Heights with 122 beds on 
119.34  January 1, 2005, may remove from layaway status up to 35 of 98 
119.35  beds placed in layaway status in paragraph (ii), and relicense 
119.36  and recertify these beds in stages in a newly constructed 
120.1   nursing facility in Ramsey located on a long-term care campus 
120.2   that provides a continuum of housing and health care options and 
120.3   services, ranging from independent living to skilled nursing 
120.4   services.  The beds may be relicensed and recertified in two 
120.5   stages. 
120.6      (2) A facility in Anoka with 57 beds on January 1, 2005, 
120.7   may remove from layaway status an additional 33 of the 98 beds 
120.8   placed in layaway status in paragraph (ii) and relicense and 
120.9   recertify these beds in a newly constructed nursing facility 
120.10  located in Anoka County, north of State Highway 242 and at a 
120.11  site not closer than five miles from any other licensed and 
120.12  certified nursing facility, along with up to 57 beds that may be 
120.13  relocated from the facility in Anoka. 
120.14     (3) Notwithstanding the five-year duration after which beds 
120.15  may no longer remain in layaway and still be placed in active 
120.16  service, as specified in subdivision 4b, the beds must be 
120.17  relicensed and recertified prior to June 30, 2009. 
120.18     (4) For the facility in clause (1), the total payment rates 
120.19  shall be equal to those of the 122-bed facility in Columbia 
120.20  Heights.  For the facility in clause (2), the total payment 
120.21  rates shall be equal to those of the 57-bed facility in Anoka. 
120.22     (5) The facilities in clauses (1) and (2) may annually 
120.23  certify to the commissioner of human services, on a form and in 
120.24  a manner specified by the commissioner, beginning no later than 
120.25  one year after they are licensed and certified, that they are 
120.26  discharging eight or more individuals per year for each newly 
120.27  licensed bed.  If, in the certification, the facility reports 
120.28  that they are discharging fewer than eight individuals per year 
120.29  for each newly licensed bed, the commissioner shall reduce the 
120.30  facility's payment rates under medical assistance by three 
120.31  percent for each one discharge per year for each newly licensed 
120.32  bed, or portion thereof, less than eight, times the portion of 
120.33  the facility's licensed and certified beds that are newly 
120.34  licensed and certified.  If the facility fails to provide this 
120.35  annual certification, the commissioner shall assume two 
120.36  discharges per year for each newly licensed bed and reduce the 
121.1   facility's payment rates under medical assistance by three 
121.2   percent for each one discharge per year for each newly licensed 
121.3   bed, less than eight. 
121.4      Sec. 2.  Minnesota Statutes 2004, section 144A.073, is 
121.5   amended by adding a subdivision to read: 
121.6      Subd. 10a.  [EXTENSION OF APPROVAL FOR A FACILITY IN OTTER 
121.7   TAIL COUNTY.] Notwithstanding subdivisions 3 and 10, the 
121.8   commissioner of health shall extend project approval for an 
121.9   additional 24 months for an exception to the nursing home 
121.10  licensure and certification moratorium proposed by a nursing 
121.11  facility in Otter Tail County and originally approved by the 
121.12  commissioner on December 20, 2002. 
121.13     Sec. 3.  Minnesota Statutes 2004, section 256B.431, 
121.14  subdivision 28, is amended to read: 
121.15     Subd. 28.  [NURSING FACILITY RATE INCREASES BEGINNING JULY 
121.16  1, 1999, AND JULY 1, 2000.] (a) For the rate years beginning 
121.17  July 1, 1999, and July 1, 2000, the commissioner shall make 
121.18  available to each nursing facility reimbursed under this section 
121.19  or section 256B.434 an adjustment to the total operating payment 
121.20  rate.  For nursing facilities reimbursed under this section or 
121.21  section 256B.434, the July 1, 2000, operating payment rate 
121.22  increases provided in this subdivision shall be applied to each 
121.23  facility's June 30, 2000, operating payment rate.  For each 
121.24  facility, total operating costs shall be separated into costs 
121.25  that are compensation related and all other costs.  
121.26  Compensation-related costs include salaries, payroll taxes, and 
121.27  fringe benefits for all employees except management fees, the 
121.28  administrator, and central office staff. 
121.29     (b) For the rate year beginning July 1, 1999, the 
121.30  commissioner shall make available a rate increase for 
121.31  compensation-related costs of 4.843 percent and a rate increase 
121.32  for all other operating costs of 3.446 percent. 
121.33     (c) For the rate year beginning July 1, 2000, the 
121.34  commissioner shall make available: 
121.35     (1) a rate increase for compensation-related costs of 3.632 
121.36  percent; 
122.1      (2) an additional rate increase for each case mix payment 
122.2   rate which must be used to increase the per-hour pay rate of all 
122.3   employees except management fees, the administrator, and central 
122.4   office staff by an equal dollar amount and to pay associated 
122.5   costs for FICA, the Medicare tax, workers' compensation 
122.6   premiums, and federal and state unemployment insurance, to be 
122.7   calculated according to clauses (i) to (iii): 
122.8      (i) the commissioner shall calculate the arithmetic mean of 
122.9   the 11 June 30, 2000, operating rates for each facility; 
122.10     (ii) the commissioner shall construct an array of nursing 
122.11  facilities from highest to lowest, according to the arithmetic 
122.12  mean calculated in clause (i).  A numerical rank shall be 
122.13  assigned to each facility in the array.  The facility with the 
122.14  highest mean shall be assigned a numerical rank of one.  The 
122.15  facility with the lowest mean shall be assigned a numerical rank 
122.16  equal to the total number of nursing facilities in the array.  
122.17  All other facilities shall be assigned a numerical rank in 
122.18  accordance with their position in the array; 
122.19     (iii) the amount of the additional rate increase shall be 
122.20  $1 plus an amount equal to $3.13 multiplied by the ratio of the 
122.21  facility's numeric rank divided by the number of facilities in 
122.22  the array; and 
122.23     (3) a rate increase for all other operating costs of 2.585 
122.24  percent.  
122.25     Money received by a facility as a result of the additional 
122.26  rate increase provided under clause (2) shall be used only for 
122.27  wage increases implemented on or after July 1, 2000, and shall 
122.28  not be used for wage increases implemented prior to that date. 
122.29     (d) The payment rate adjustment for each nursing facility 
122.30  must be determined under clause (1) or (2): 
122.31     (1) for each nursing facility that reports salaries for 
122.32  registered nurses, licensed practical nurses, aides, orderlies, 
122.33  and attendants separately, the commissioner shall determine the 
122.34  payment rate adjustment using the categories specified in 
122.35  paragraph (a) multiplied by the rate increases specified in 
122.36  paragraph (b) or (c), and then dividing the resulting amount by 
123.1   the nursing facility's actual resident days.  In determining the 
123.2   amount of a payment rate adjustment for a nursing facility 
123.3   reimbursed under section 256B.434, the commissioner shall 
123.4   determine the proportions of the facility's rates that are 
123.5   compensation-related costs and all other operating costs based 
123.6   on the facility's most recent cost report; and 
123.7      (2) for each nursing facility that does not report salaries 
123.8   for registered nurses, licensed practical nurses, aides, 
123.9   orderlies, and attendants separately, the payment rate 
123.10  adjustment shall be computed using the facility's total 
123.11  operating costs, separated into the categories specified in 
123.12  paragraph (a) in proportion to the weighted average of all 
123.13  facilities determined under clause (1), multiplied by the rate 
123.14  increases specified in paragraph (b) or (c), and then dividing 
123.15  the resulting amount by the nursing facility's actual resident 
123.16  days. 
123.17     (e) A nursing facility may apply for the 
123.18  compensation-related payment rate adjustment calculated under 
123.19  this subdivision.  The application must be made to the 
123.20  commissioner and contain a plan by which the nursing facility 
123.21  will distribute the compensation-related portion of the payment 
123.22  rate adjustment to employees of the nursing facility.  For 
123.23  nursing facilities in which the employees are represented by an 
123.24  exclusive bargaining representative, an agreement negotiated and 
123.25  agreed to by the employer and the exclusive bargaining 
123.26  representative constitutes the plan.  For the second rate year, 
123.27  a negotiated agreement constitutes the plan only if the 
123.28  agreement is finalized after the date of enactment of all rate 
123.29  increases for the second rate year.  The commissioner shall 
123.30  review the plan to ensure that the payment rate adjustment per 
123.31  diem is used as provided in paragraphs (a) to (c).  To be 
123.32  eligible, a facility must submit its plan for the compensation 
123.33  distribution by December 31 each year.  A facility may amend its 
123.34  plan for the second rate year by submitting a revised plan by 
123.35  December 31, 2000.  If a facility's plan for compensation 
123.36  distribution is effective for its employees after July 1 of the 
124.1   year that the funds are available, the payment rate adjustment 
124.2   per diem shall be effective the same date as its plan. 
124.3      (f) A copy of the approved distribution plan must be made 
124.4   available to all employees.  This must be done by giving each 
124.5   employee a copy or by posting it in an area of the nursing 
124.6   facility to which all employees have access.  If an employee 
124.7   does not receive the compensation adjustment described in their 
124.8   facility's approved plan and is unable to resolve the problem 
124.9   with the facility's management or through the employee's union 
124.10  representative, the employee may contact the commissioner at an 
124.11  address or phone number provided by the commissioner and 
124.12  included in the approved plan.  
124.13     (g) If the reimbursement system under section 256B.435 is 
124.14  not implemented until July 1, 2001, the salary adjustment per 
124.15  diem authorized in subdivision 2i, paragraph (c), shall continue 
124.16  until June 30, 2001.  
124.17     (h) For the rate year beginning July 1, 1999, the following 
124.18  nursing facilities shall be allowed a rate increase equal to 67 
124.19  percent of the rate increase that would be allowed if 
124.20  subdivision 26, paragraph (a), was not applied: 
124.21     (1) a nursing facility in Carver County licensed for 33 
124.22  nursing home beds and four boarding care beds; 
124.23     (2) a nursing facility in Faribault County licensed for 159 
124.24  nursing home beds on September 30, 1998; and 
124.25     (3) a nursing facility in Houston County licensed for 68 
124.26  nursing home beds on September 30, 1998. 
124.27     (i) For the rate year beginning July 1, 1999, the following 
124.28  nursing facilities shall be allowed a rate increase equal to 67 
124.29  percent of the rate increase that would be allowed if 
124.30  subdivision 26, paragraphs (a) and (b), were not applied: 
124.31     (1) a nursing facility in Chisago County licensed for 135 
124.32  nursing home beds on September 30, 1998; and 
124.33     (2) a nursing facility in Murray County licensed for 62 
124.34  nursing home beds on September 30, 1998. 
124.35     (j) For the rate year beginning July 1, 1999, a nursing 
124.36  facility in Hennepin County licensed for 134 beds on September 
125.1   30, 1998, shall: 
125.2      (1) have the prior year's allowable care-related per diem 
125.3   increased by $3.93 and the prior year's other operating cost per 
125.4   diem increased by $1.69 before adding the inflation in 
125.5   subdivision 26, paragraph (d), clause (2); and 
125.6      (2) be allowed a rate increase equal to 67 percent of the 
125.7   rate increase that would be allowed if subdivision 26, 
125.8   paragraphs (a) and (b), were not applied. 
125.9      The increases provided in paragraphs (h), (i), and (j) 
125.10  shall be included in the facility's total payment rates for the 
125.11  purposes of determining future rates under this section or any 
125.12  other section. 
125.13     (k) For the rate years beginning on or after July 1, 2000, 
125.14  a nursing home facility in Goodhue County that was licensed for 
125.15  104 beds on February 1, 2000, shall have its employee pension 
125.16  benefit costs reported on its Rule 50 cost report treated as 
125.17  PERA contributions for the purpose of computing its payment 
125.18  rates. 
125.19     Sec. 4.  Minnesota Statutes 2004, section 256B.431, 
125.20  subdivision 29, is amended to read: 
125.21     Subd. 29.  [FACILITY RATE INCREASES EFFECTIVE JULY 1, 
125.22  2000.] Following the determination under subdivision 28 of the 
125.23  payment rate for the rate year beginning July 1, 2000, for a 
125.24  facility in Roseau County licensed for 49 beds, the facility's 
125.25  operating cost per diem shall be increased by the following 
125.26  amounts: 
125.27     (1) case mix class A, $1.97; 
125.28     (2) case mix class B, $2.11; 
125.29     (3) case mix class C, $2.26; 
125.30     (4) case mix class D, $2.39; 
125.31     (5) case mix class E, $2.54; 
125.32     (6) case mix class F, $2.55; 
125.33     (7) case mix class G, $2.66; 
125.34     (8) case mix class H, $2.90; 
125.35     (9) case mix class I, $2.97; 
125.36     (10) case mix class J, $3.10; and 
126.1      (11) case mix class K, $3.36. 
126.2   These increases shall be included in the facility's total 
126.3   payment rates for the purpose of determining future rates under 
126.4   this section or any other section. 
126.5      Sec. 5.  Minnesota Statutes 2004, section 256B.431, 
126.6   subdivision 35, is amended to read: 
126.7      Subd. 35.  [EXCLUSION OF RAW FOOD COST ADJUSTMENT.] For 
126.8   rate years beginning on or after July 1, 2001, in calculating a 
126.9   nursing facility's operating cost per diem for the purposes of 
126.10  constructing an array, determining a median, or otherwise 
126.11  performing a statistical measure of nursing facility payment 
126.12  rates to be used to determine future rate increases under this 
126.13  section, section 256B.434, or any other section, the 
126.14  commissioner shall exclude adjustments for raw food costs under 
126.15  subdivision 2b, paragraph (h), that are related to providing 
126.16  special diets based on religious beliefs.  For rates determined 
126.17  under section 256B.441, the amount determined under subdivision 
126.18  2b, paragraph (h), shall not be included in the support services 
126.19  per diem cost determined in section 256B.441, subdivision 45, 
126.20  and shall be added to the external fixed cost costs payment rate 
126.21  determined in section 256B.441, subdivision 52, paragraph (i). 
126.22     Sec. 6.  Minnesota Statutes 2004, section 256B.431, is 
126.23  amended by adding a subdivision to read: 
126.24     Subd. 41.  [NURSING FACILITY RATE INCREASES BEGINNING 
126.25  OCTOBER 1, 2005, AND OCTOBER 1, 2006.] (a) For the rate years 
126.26  beginning October 1, 2005, and October 1, 2006, the commissioner 
126.27  shall provide nursing facilities reimbursed under this section 
126.28  or section 256B.434 and for rates determined under section 
126.29  256B.441 with an adjustment to the total operating payment rate 
126.30  of two percent.  At least two-thirds of each year's adjustment 
126.31  must be used for increased costs of employee salaries and 
126.32  benefits and associated costs for FICA, the Medicare tax, 
126.33  workers' compensation premiums, and federal and state 
126.34  unemployment insurance.  Each facility receiving an adjustment 
126.35  shall report to the commissioner, in the form and manner 
126.36  specified by the commissioner, on how the additional funding was 
127.1   used. 
127.2      (b) Costs for salary and employee benefits increases 
127.3   incurred by nursing facilities since July 1, 2003, can be 
127.4   counted towards the amount required to be spent on salaries and 
127.5   benefits under paragraph (a).  These costs should be reported in 
127.6   the form and manner specified by the commissioner along with the 
127.7   information required under paragraph (a). 
127.8      Sec. 7.  Minnesota Statutes 2004, section 256B.431, is 
127.9   amended by adding a subdivision to read: 
127.10     Subd. 42.  [RATE INCREASE FOR FACILITIES IN STEARNS, 
127.11  SHERBURNE, AND BENTON COUNTIES.] Effective October 1, 2005, 
127.12  before determining any other rate adjustment effective on that 
127.13  date, operating payment rates of nursing facilities in Stearns 
127.14  County, Sherburne County, and Benton County, reimbursed under 
127.15  this section or section 256B.434, shall be increased to be 
127.16  equal, for a RUGs rate with a weight of 1.00, to the 30th 
127.17  percentile of the geographic group III rate for the same RUGs 
127.18  weight.  The percentage of the operating payment rate for each 
127.19  facility to be case-mix adjusted shall be equal to the 
127.20  percentage that is case-mix adjusted in that facility's 
127.21  September 30, 2005, operating payment rate.  This subdivision 
127.22  shall apply only if it results in a rate increase.  Increases 
127.23  provided by this subdivision shall be added to the rate 
127.24  determined under any new reimbursement system established under 
127.25  section 256B.440.  
127.26     Sec. 8.  Minnesota Statutes 2004, section 256B.432, 
127.27  subdivision 1, is amended to read: 
127.28     Subdivision 1.  [DEFINITIONS.] For purposes of this 
127.29  section, the following terms have the meanings given them. 
127.30     (a) "Management agreement" means an agreement in which one 
127.31  or more of the following criteria exist:  
127.32     (1) the central, affiliated, or corporate office has or is 
127.33  authorized to assume day-to-day operational control of the 
127.34  nursing facility for any six-month period within a 24-month 
127.35  period.  "Day-to-day operational control" means that the 
127.36  central, affiliated, or corporate office has the authority to 
128.1   require, mandate, direct, or compel the employees of the nursing 
128.2   facility to perform or refrain from performing certain acts, or 
128.3   to supplant or take the place of the top management of the 
128.4   nursing facility.  "Day-to-day operational control" includes the 
128.5   authority to hire or terminate employees or to provide an 
128.6   employee of the central, affiliated, or corporate office to 
128.7   serve as administrator of the nursing facility; 
128.8      (2) the central, affiliated, or corporate office performs 
128.9   or is authorized to perform two or more of the following:  the 
128.10  execution of contracts; authorization of purchase orders; 
128.11  signature authority for checks, notes, or other financial 
128.12  instruments; requiring the nursing facility to use the group or 
128.13  volume purchasing services of the central, affiliated, or 
128.14  corporate office; or the authority to make annual capital 
128.15  expenditures for the nursing facility exceeding $50,000, or $500 
128.16  per licensed bed, whichever is less, without first securing the 
128.17  approval of the nursing facility board of directors; 
128.18     (3) the central, affiliated, or corporate office becomes or 
128.19  is required to become the licensee under applicable state law; 
128.20     (4) the agreement provides that the compensation for 
128.21  services provided under the agreement is directly related to any 
128.22  profits made by the nursing facility; or 
128.23     (5) the nursing facility entering into the agreement is 
128.24  governed by a governing body that meets fewer than four times a 
128.25  year, that does not publish notice of its meetings, or that does 
128.26  not keep formal records of its proceedings.  
128.27     (b) "Consulting agreement" means any agreement the purpose 
128.28  of which is for a central, affiliated, or corporate office to 
128.29  advise, counsel, recommend, or suggest to the owner or operator 
128.30  of the nonrelated nursing facility measures and methods for 
128.31  improving the operations of the nursing facility.  
128.32     (c) "Nursing facility" means a nursing facility whose 
128.33  medical assistance rates are determined according to section 
128.34  256B.431 with a medical assistance provider agreement that is 
128.35  licensed as a nursing home under chapter 144A or as a boarding 
128.36  care home under sections 144.50 to 144.56. 
129.1      Sec. 9.  Minnesota Statutes 2004, section 256B.432, 
129.2   subdivision 2, is amended to read: 
129.3      Subd. 2.  [EFFECTIVE DATE.] For rate years beginning on or 
129.4   after July 1, 1990, the central, affiliated, or corporate office 
129.5   cost allocations in subdivisions 3 to 6 must be used when 
129.6   determining medical assistance rates under section 256B.431, 
129.7   256B.434, or 256B.441.  
129.8      Sec. 10.  Minnesota Statutes 2004, section 256B.432, is 
129.9   amended by adding a subdivision to read: 
129.10     Subd. 4a.  [ALLOCATION; COSTS ALLOCABLE ON A FUNCTIONAL 
129.11  BASIS.] (a) Costs that have not been directly identified must be 
129.12  allocated to nursing facilities on a basis designed to equitably 
129.13  allocate the costs to the nursing facilities or activities 
129.14  receiving the benefits of the costs.  This allocation must be 
129.15  made in a manner reasonably related to the services received by 
129.16  the nursing facilities.  Where practical and the amounts are 
129.17  material, these costs must be allocated on a functional basis.  
129.18  The functions, or cost centers used to allocate central office 
129.19  costs, and the unit bases used to allocate the costs, including 
129.20  those central office costs allocated according to subdivision 5, 
129.21  must be used consistently from one central office accounting 
129.22  period to another. 
129.23     (b) If the central office wishes to change its allocation 
129.24  bases and believes the change will result in more appropriate 
129.25  and more accurate allocations, the central office must make a 
129.26  written request, with its justification, to the commissioner for 
129.27  approval of the change no later than 120 days after the 
129.28  beginning of the central office accounting period to which the 
129.29  change is to apply.  The commissioner's approval of a central 
129.30  office request will be furnished to the central office in 
129.31  writing.  Where the commissioner approves the central office 
129.32  request, the change must be applied to the accounting period for 
129.33  which the request was made, and to all subsequent central office 
129.34  accounting periods unless the commissioner approves a subsequent 
129.35  request for change by the central office.  The effective date of 
129.36  the change will be the beginning of the accounting period for 
130.1   which the request was made. 
130.2      Sec. 11.  Minnesota Statutes 2004, section 256B.432, 
130.3   subdivision 5, is amended to read: 
130.4      Subd. 5.  [ALLOCATION OF REMAINING COSTS; ALLOCATION 
130.5   RATIO.] (a) After the costs that can be directly identified 
130.6   according to subdivisions 3 and 4 have been allocated, the 
130.7   remaining central, affiliated, or corporate office costs must be 
130.8   allocated between the nursing facility operations and the other 
130.9   activities or facilities unrelated to the nursing facility 
130.10  operations based on the ratio of total operating 
130.11  costs.  However, in the event that these remaining costs are 
130.12  partially attributable to the start-up of home and 
130.13  community-based services intended to fill a gap identified by 
130.14  the local agency, the facility may assign these remaining costs 
130.15  to the appropriate cost category of the facility for a period 
130.16  not to exceed two years. 
130.17     (b) For purposes of allocating these remaining central, 
130.18  affiliated, or corporate office costs, the numerator for the 
130.19  allocation ratio shall be determined as follows:  
130.20     (1) for nursing facilities that are related organizations 
130.21  or are controlled by a central, affiliated, or corporate office 
130.22  under a management agreement, the numerator of the allocation 
130.23  ratio shall be equal to the sum of the total operating costs 
130.24  incurred by each related organization or controlled nursing 
130.25  facility; 
130.26     (2) for a central, affiliated, or corporate office 
130.27  providing goods or services to related organizations that are 
130.28  not nursing facilities, the numerator of the allocation ratio 
130.29  shall be equal to the sum of the total operating costs incurred 
130.30  by the nonnursing facility related organizations; 
130.31     (3) for a central, affiliated, or corporate office 
130.32  providing goods or services to unrelated nursing facilities 
130.33  under a consulting agreement, the numerator of the allocation 
130.34  ratio shall be equal to the greater of directly identified 
130.35  central, affiliated, or corporate costs or the contracted 
130.36  amount; or 
131.1      (4) for business activities that involve the providing of 
131.2   goods or services to unrelated parties which are not nursing 
131.3   facilities, the numerator of the allocation ratio shall be equal 
131.4   to the greater of directly identified costs or revenues 
131.5   generated by the activity or function.  
131.6      (c) The denominator for the allocation ratio is the sum of 
131.7   the numerators in paragraph (b), clauses (1) to (4). 
131.8      Sec. 12.  Minnesota Statutes 2004, section 256B.432, is 
131.9   amended by adding a subdivision to read: 
131.10     Subd. 6a.  [RELATED ORGANIZATION COSTS.] (a) Costs 
131.11  applicable to services, capital assets, and supplies directly or 
131.12  indirectly furnished to the nursing facility by any related 
131.13  organization are includable in the allowable cost of the nursing 
131.14  facility at the purchase price paid by the related organization 
131.15  for capital assets or supplies and at the cost incurred by the 
131.16  related organization for the provision of services to the 
131.17  nursing facility if these prices or costs do not exceed the 
131.18  price of comparable services, capital assets, or supplies that 
131.19  could be purchased elsewhere.  For this purpose, the related 
131.20  organization's costs must not include an amount for markup or 
131.21  profit. 
131.22     (b) If the related organization in the normal course of 
131.23  business sells services, capital assets, or supplies to 
131.24  nonrelated organizations, the cost to the nursing facility shall 
131.25  be the nonrelated organization's price provided that sales to 
131.26  nonrelated organizations constitute at least 50 percent of total 
131.27  annual sales of similar services, capital assets, or supplies. 
131.28     Sec. 13.  Minnesota Statutes 2004, section 256B.434, 
131.29  subdivision 3, is amended to read: 
131.30     Subd. 3.  [DURATION AND TERMINATION OF CONTRACTS.] (a) 
131.31  Subject to available resources, the commissioner may begin to 
131.32  execute contracts with nursing facilities November 1, 1995. 
131.33     (b) All contracts entered into under this section are for a 
131.34  term of one year not to exceed four years.  Either party may 
131.35  terminate a contract at any time without cause by providing 90 
131.36  calendar days advance written notice to the other party.  The 
132.1   decision to terminate a contract is not appealable.  
132.2   Notwithstanding section 16C.05, subdivision 2, paragraph (a), 
132.3   clause (5), the contract shall be renegotiated for 
132.4   additional one-year four-year terms, unless either party 
132.5   provides written notice of termination.  The provisions of the 
132.6   contract shall be renegotiated annually at a minimum of every 
132.7   four years by the parties prior to the expiration date of the 
132.8   contract.  The parties may voluntarily renegotiate the terms of 
132.9   the contract at any time by mutual agreement. 
132.10     (c) If a nursing facility fails to comply with the terms of 
132.11  a contract, the commissioner shall provide reasonable notice 
132.12  regarding the breach of contract and a reasonable opportunity 
132.13  for the facility to come into compliance.  If the facility fails 
132.14  to come into compliance or to remain in compliance, the 
132.15  commissioner may terminate the contract.  If a contract is 
132.16  terminated, the contract payment remains in effect for the 
132.17  remainder of the rate year in which the contract was terminated, 
132.18  but in all other respects the provisions of this section do not 
132.19  apply to that facility effective the date the contract is 
132.20  terminated.  The contract shall contain a provision governing 
132.21  the transition back to the cost-based reimbursement system 
132.22  established under section 256B.431 and Minnesota Rules, parts 
132.23  9549.0010 to 9549.0080.  A contract entered into under this 
132.24  section may be amended by mutual agreement of the parties. 
132.25     Sec. 14.  Minnesota Statutes 2004, section 256B.434, 
132.26  subdivision 4, is amended to read: 
132.27     Subd. 4.  [ALTERNATE RATES FOR NURSING FACILITIES.] (a) For 
132.28  nursing facilities which have their payment rates determined 
132.29  under this section rather than section 256B.431, the 
132.30  commissioner shall establish a rate under this subdivision.  The 
132.31  nursing facility must enter into a written contract with the 
132.32  commissioner. 
132.33     (b) A nursing facility's case mix payment rate for the 
132.34  first rate year of a facility's contract under this section is 
132.35  the payment rate the facility would have received under section 
132.36  256B.431. 
133.1      (c) A nursing facility's case mix payment rates for the 
133.2   second and subsequent years of a facility's contract under this 
133.3   section are the previous rate year's contract payment rates plus 
133.4   an inflation adjustment and, for facilities reimbursed under 
133.5   this section or section 256B.431, an adjustment to include the 
133.6   cost of any increase in Health Department licensing fees for the 
133.7   facility taking effect on or after July 1, 2001.  The index for 
133.8   the inflation adjustment must be based on the change in the 
133.9   Consumer Price Index-All Items (United States City average) 
133.10  (CPI-U) forecasted by the commissioner of finance's national 
133.11  economic consultant, as forecasted in the fourth quarter of the 
133.12  calendar year preceding the rate year.  The inflation adjustment 
133.13  must be based on the 12-month period from the midpoint of the 
133.14  previous rate year to the midpoint of the rate year for which 
133.15  the rate is being determined.  For the rate years beginning on 
133.16  July 1, 1999, July 1, 2000, July 1, 2001, July 1, 2002, July 1, 
133.17  2003, and July 1, 2004, July 1, 2005, July 1, 2006, July 1, 
133.18  2007, July 1, 2008, and July 1, 2009, this paragraph shall apply 
133.19  only to the property-related payment rate, except that 
133.20  adjustments to include the cost of any increase in Health 
133.21  Department licensing fees taking effect on or after July 1, 
133.22  2001, shall be provided.  Beginning in 2005, adjustment to the 
133.23  property payment rate under this section and section 256B.431 
133.24  shall be effective on October 1.  In determining the amount of 
133.25  the property-related payment rate adjustment under this 
133.26  paragraph, the commissioner shall determine the proportion of 
133.27  the facility's rates that are property-related based on the 
133.28  facility's most recent cost report. 
133.29     (d) The commissioner shall develop additional 
133.30  incentive-based payments of up to five percent above the 
133.31  standard contract rate for achieving outcomes specified in each 
133.32  contract.  The specified facility-specific outcomes must be 
133.33  measurable and approved by the commissioner.  The commissioner 
133.34  may establish, for each contract, various levels of achievement 
133.35  within an outcome.  After the outcomes have been specified the 
133.36  commissioner shall assign various levels of payment associated 
134.1   with achieving the outcome.  Any incentive-based payment cancels 
134.2   if there is a termination of the contract.  In establishing the 
134.3   specified outcomes and related criteria the commissioner shall 
134.4   consider the following state policy objectives: 
134.5      (1) improved cost effectiveness and quality of life as 
134.6   measured by improved clinical outcomes; 
134.7      (2) successful diversion or discharge to community 
134.8   alternatives; 
134.9      (3) decreased acute care costs; 
134.10     (4) improved consumer satisfaction; 
134.11     (5) the achievement of quality; or 
134.12     (6) any additional outcomes proposed by a nursing facility 
134.13  that the commissioner finds desirable. 
134.14     Sec. 15.  Minnesota Statutes 2004, section 256B.434, 
134.15  subdivision 4a, is amended to read: 
134.16     Subd. 4a.  [FACILITY RATE INCREASES.] For the rate year 
134.17  beginning July 1, 1999, the nursing facilities described in 
134.18  clauses (1) to (5) shall receive the rate increases indicated.  
134.19  The increases provided under this subdivision shall be included 
134.20  in the facility's total payment rates for the purpose of 
134.21  determining future rates under this section or any other section:
134.22     (1) a nursing facility in Becker County licensed for 102 
134.23  nursing home beds on September 30, 1998, shall receive an 
134.24  increase of $1.30 in its case mix class A payment rate; an 
134.25  increase of $1.33 in its case mix class B payment rate; an 
134.26  increase of $1.36 in its case mix class C payment rate; an 
134.27  increase of $1.39 in its case mix class D payment rate; an 
134.28  increase of $1.42 in its case mix class E payment rate; an 
134.29  increase of $1.42 in its case mix class F payment rate; an 
134.30  increase of $1.45 in its case mix class G payment rate; an 
134.31  increase of $1.49 in its case mix class H payment rate; an 
134.32  increase of $1.51 in its case mix class I payment rate; an 
134.33  increase of $1.54 in its case mix class J payment rate; and an 
134.34  increase of $1.59 in its case mix class K payment rate; 
134.35     (2) a nursing facility in Chisago County licensed for 101 
134.36  nursing home beds on September 30, 1998, shall receive an 
135.1   increase of $3.67 in each case mix payment rate; 
135.2      (3) a nursing facility in Canby, licensed for 75 beds shall 
135.3   have its property-related per diem rate increased by $1.21.  
135.4   This increase shall be recognized in the facility's contract 
135.5   payment rate under this section; 
135.6      (4) a nursing facility in Golden Valley with all its beds 
135.7   licensed to provide residential rehabilitative services to young 
135.8   adults under Minnesota Rules, parts 9570.2000 to 9570.3400, 
135.9   shall have the payment rate computed according to this section 
135.10  increased by $14.83; and 
135.11     (5) a county-owned 130-bed nursing facility in Park Rapids 
135.12  shall have its per diem contract payment rate increased by $1.02 
135.13  for costs related to compliance with comparable worth 
135.14  requirements.  
135.15     Sec. 16.  Minnesota Statutes 2004, section 256B.434, 
135.16  subdivision 4b, is amended to read: 
135.17     Subd. 4b.  [FACILITY RATE INCREASES EFFECTIVE JULY 1, 
135.18  2000.] For the rate year beginning July 1, 2000, the nursing 
135.19  facilities described in clauses (1) to (6) shall receive the 
135.20  rate increases indicated.  The increases under this subdivision 
135.21  shall be added following the determination under section 
135.22  256B.431, subdivision 28, of the payment rate for the rate year 
135.23  beginning July 1, 2000, and shall be included in the facility's 
135.24  total payment rates for the purposes of determining future rates 
135.25  under this section or any other section: 
135.26     (1) a nursing facility in Hennepin County licensed for 290 
135.27  beds shall receive an operating cost per diem increase of 5.9 
135.28  percent, provided that the facility delicenses, decertifies, or 
135.29  places on layaway status, if that status is otherwise permitted 
135.30  by law, 70 beds; 
135.31     (2) a nursing facility in Goodhue County licensed for 84 
135.32  beds shall receive an increase of $1.54 in each case mix payment 
135.33  rate; 
135.34     (3) a nursing facility located in Rochester and licensed 
135.35  for 103 beds on January 1, 2000, shall receive an increase in 
135.36  its case mix resident class A payment of $3.78, and an increase 
136.1   in the payment rate for all other case mix classes of that 
136.2   amount multiplied by the class weight for that case mix class 
136.3   established in Minnesota Rules, part 9549.0058, subpart 3; 
136.4      (4) a nursing facility in Wright County licensed for 154 
136.5   beds shall receive an increase of $2.03 in each case mix payment 
136.6   rate to be used for employee wage and benefit enhancements; 
136.7      (5) a facility in Todd County licensed for 78 beds, shall 
136.8   have its operating cost per diem increased by the following 
136.9   amounts: 
136.10     (i) case mix class A, $1.16; 
136.11     (ii) case mix class B, $1.50; 
136.12     (iii) case mix class C, $1.89; 
136.13     (iv) case mix class D, $2.26; 
136.14     (v) case mix class E, $2.63; 
136.15     (vi) case mix class F, $2.65; 
136.16     (vii) case mix class G, $2.96; 
136.17     (viii) case mix class H, $3.55; 
136.18     (ix) case mix class I, $3.76; 
136.19     (x) case mix class J, $4.08; and 
136.20     (xi) case mix class K, $4.76; and 
136.21     (6) a nursing facility in Pine City that decertified 22 
136.22  beds in calendar year 1999 shall have its property-related per 
136.23  diem payment rate increased by $1.59. 
136.24     Sec. 17.  Minnesota Statutes 2004, section 256B.434, 
136.25  subdivision 4c, is amended to read: 
136.26     Subd. 4c.  [FACILITY RATE INCREASES EFFECTIVE JANUARY 1, 
136.27  2002.] For the rate period beginning January 1, 2002, and for 
136.28  the rate year beginning July 1, 2002, a nursing facility in 
136.29  Morrison County licensed for 83 beds as of March 1, 2001, shall 
136.30  receive an increase of $2.54 in each case mix payment rate to 
136.31  offset property tax payments due as a result of the facility's 
136.32  conversion from nonprofit to for-profit status.  The increase 
136.33  under this subdivision shall be added following the 
136.34  determination under this chapter of the payment rate for the 
136.35  rate year beginning July 1, 2001, and shall be included in the 
136.36  facility's total payment rates for the purposes of determining 
137.1   future rates under this section or any other section. 
137.2      Sec. 18.  Minnesota Statutes 2004, section 256B.434, 
137.3   subdivision 4d, is amended to read: 
137.4      Subd. 4d.  [FACILITY RATE INCREASES EFFECTIVE JULY 1, 
137.5   2001.] For the rate year beginning July 1, 2001, a nursing 
137.6   facility in Hennepin County licensed for 302 beds shall receive 
137.7   an increase of 29 cents in each case mix payment rate to correct 
137.8   an error in the cost-reporting system that occurred prior to the 
137.9   date that the facility entered the alternative payment 
137.10  demonstration project.  The increase under this subdivision 
137.11  shall be added following the determination under this chapter of 
137.12  the payment rate for the rate year beginning July 1, 2001, and 
137.13  shall be included in the facility's total payment rates for the 
137.14  purposes of determining future rates under this section or any 
137.15  other section. 
137.16     Sec. 19.  Minnesota Statutes 2004, section 256B.434, is 
137.17  amended by adding a subdivision to read: 
137.18     Subd. 18.  [PHASE-OUT OF ALTERNATIVE PAYMENT SYSTEM 
137.19  CONTRACTS.] Nursing facilities that have entered into a contract 
137.20  with the commissioner under the provisions of this section will 
137.21  cease their contractual agreement with the commissioner 
137.22  effective October 1, 2009.  Nursing facilities with a contract 
137.23  in effect on September 30, 2006, shall be paid the contract 
137.24  payment rate for the remainder of the phase-in period according 
137.25  to the provisions of section 256B.441, subdivision 53.  
137.26     Sec. 20.  Minnesota Statutes 2004, section 256B.438, 
137.27  subdivision 3, is amended to read: 
137.28     Subd. 3.  [CASE MIX INDICES.] (a) The commissioner of human 
137.29  services shall assign a case mix index to each resident class 
137.30  based on the Centers for Medicare and Medicaid Services staff 
137.31  time measurement study and adjusted for Minnesota-specific wage 
137.32  indices.  The case mix indices assigned to each resident class 
137.33  shall be published in the Minnesota State Register at least 120 
137.34  days prior to the implementation of the 34 group, RUG-III 
137.35  resident classification system. 
137.36     (b) An index maximization approach shall be used to 
138.1   classify residents. 
138.2      (c) After implementation of the revised case mix system, 
138.3   the commissioner of human services may annually rebase case mix 
138.4   indices and base rates using more current data on average wage 
138.5   rates and staff time measurement studies.  This rebasing shall 
138.6   be calculated under subdivision 7, paragraph (b).  The 
138.7   commissioner shall publish in the Minnesota State Register 
138.8   adjusted case mix indices at least 45 days prior to the 
138.9   effective date of the adjusted case mix indices.  In the event 
138.10  that new case mix indices are implemented together with a new 
138.11  payment system, rebasing of rates under subdivision 7, paragraph 
138.12  (b), shall not apply. 
138.13     Sec. 21.  [256B.441] [NURSING FACILITY REIMBURSEMENT SYSTEM 
138.14  EFFECTIVE OCTOBER 1, 2005.] 
138.15     Subdivision 1.  [IN GENERAL.] (a) The commissioner shall 
138.16  establish a value-based nursing facility reimbursement system 
138.17  which will provide facility-specific, prospective rates for 
138.18  nursing facilities participating in the medical assistance 
138.19  program.  The rates shall be determined using an annual 
138.20  statistical and cost report filed by each nursing facility.  The 
138.21  total payment rate shall be composed of four rate components:  
138.22  direct care services, support services, external fixed, and 
138.23  property-related rate components.  The payment rate shall be 
138.24  derived from statistical measures of actual costs incurred in 
138.25  facility operation of nursing facilities.  From this cost basis, 
138.26  the components of the total payment rate shall be adjusted for 
138.27  quality of services provided, recognition of staffing levels, 
138.28  geographic variation in labor costs, and resident acuity. 
138.29     (b) Rates shall be rebased annually.  Each cost reporting 
138.30  year shall begin on October 1 and end on the following September 
138.31  30.  Beginning in 2006, a statistical and cost report shall be 
138.32  filed by each nursing facility by January 15.  Notice of rates 
138.33  shall be distributed by August 15 and the rates shall go into 
138.34  effect on October 1 for one year. 
138.35     (c)  The commissioner shall begin to phase in the new 
138.36  reimbursement system beginning October 1, 2006.  Full phase-in 
139.1   shall be completed by October 1, 2010. 
139.2      Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
139.3   terms in subdivisions 3 to 42 have the meanings given unless 
139.4   otherwise provided for in this section. 
139.5      Subd. 3.  [ACTIVE BEDS.] "Active beds" means licensed beds 
139.6   that are not currently in layaway status. 
139.7      Subd. 4.  [ACTIVITIES COSTS.] "Activities costs" means the 
139.8   costs for the salaries and wages of the supervisor and other 
139.9   activities workers, associated fringe benefits and payroll 
139.10  taxes, supplies, services, and consultants. 
139.11     Subd. 5.  [ADMINISTRATIVE COSTS.] "Administrative costs" 
139.12  means the direct costs for administering the overall activities 
139.13  of the nursing home.  These costs include salaries and wages of 
139.14  the administrator, assistant administrator, business office 
139.15  employees, security guards, and associated fringe benefits and 
139.16  payroll taxes, fees, contracts, or purchases related to business 
139.17  office functions, licenses, and permits except as provided in 
139.18  the external fixed costs category, employee recognition, travel 
139.19  including meals and lodging, training, voice and data 
139.20  communication or transmission, office supplies, liability 
139.21  insurance and other forms of insurance not designated to other 
139.22  areas, personnel recruitment, legal services, accounting 
139.23  services, management or business consultants, data processing, 
139.24  central or home office costs, business meetings and seminars, 
139.25  postage, fees for professional organizations, subscriptions, 
139.26  security services, advertising, board of director's fees, 
139.27  working capital interest expense, and bad debts and bad debt 
139.28  collection fees. 
139.29     Subd. 6.  [ALLOWED COSTS.] "Allowed costs" means the 
139.30  amounts reported by the facility which are necessary for the 
139.31  operation of the facility and the care of residents and which 
139.32  are reviewed by the department for accuracy, reasonableness, and 
139.33  compliance with this section and generally accepted accounting 
139.34  principles. 
139.35     Subd. 7.  [CENTER FOR MEDICARE AND MEDICAID 
139.36  SERVICES.] "Center for Medicare and Medicaid services" means the 
140.1   federal agency, in the United States Department of Health and 
140.2   Human Services that administers Medicaid, also referred to as 
140.3   "CMS." 
140.4      Subd. 8.  [COMMISSIONER.] "Commissioner" means the 
140.5   commissioner of human services unless specified otherwise. 
140.6      Subd. 9.  [DESK AUDIT.] "Desk audit" means the 
140.7   establishment of the payment rate based on the commissioner's 
140.8   review and analysis of required reports, supporting 
140.9   documentation, and work sheets submitted by the nursing facility.
140.10     Subd. 10.  [DIETARY COSTS.] "Dietary costs" means the costs 
140.11  for the salaries and wages of the dietary supervisor, 
140.12  dietitians, chefs, cooks, dishwashers, and other employees 
140.13  assigned to the kitchen and dining room, and associated fringe 
140.14  benefits and payroll taxes.  Dietary costs also includes the 
140.15  salaries or fees of dietary consultants, direct costs of raw 
140.16  food (both normal and special diet food), dietary supplies, and 
140.17  food preparation and serving.  Also included are special dietary 
140.18  supplements used for tube feeding or oral feeding, such as 
140.19  elemental high nitrogen diet, even if written as a prescription 
140.20  item by a physician. 
140.21     Subd. 11.  [DIRECT CARE COSTS CATEGORY.] "Direct care costs 
140.22  category" means costs for nursing services, activities, and 
140.23  social services. 
140.24     Subd. 12.  [ECONOMIC DEVELOPMENT REGIONS.] "Economic 
140.25  development regions" are as defined in section 462.385, 
140.26  subdivision 1. 
140.27     Subd. 13.  [EXTERNAL FIXED COSTS CATEGORY.] "External fixed 
140.28  costs category" means costs related to the nursing home 
140.29  surcharge under section 256.9657, subdivision 1; licensure fees 
140.30  under section 144.122; long-term care consultation fees under 
140.31  section 256B.0911, subdivision 6; family advisory council fee 
140.32  under section 144A.35; scholarships under section 256B.431, 
140.33  subdivision 36; planned closure rate adjustments under section 
140.34  256B.437; property taxes and property insurance; and PERA. 
140.35     Subd. 14.  [FACILITY AVERAGE CASE MIX INDEX 
140.36  (CMI).] "Facility average case mix index" or "CMI" means a 
141.1   numerical value score that describes the relative resource use 
141.2   for all residents within the groups under the resource 
141.3   utilization group (RUG-III) classification system prescribed by 
141.4   the commissioner based on an assessment of each resident.  The 
141.5   facility average CMI shall be computed as the standardized days 
141.6   divided by total days for all residents in the facility. 
141.7      Subd. 15.  [FIELD AUDIT.] "Field audit" means the 
141.8   examination, verification, and review of the financial records, 
141.9   statistical records, and related supporting documentation on the 
141.10  nursing home and any related organization. 
141.11     Subd. 16.  [FINAL RATE.] "Final rate" means the rate 
141.12  established after any adjustment by the commissioner, including, 
141.13  but not limited to, adjustments resulting from audits. 
141.14     Subd. 17.  [FRINGE BENEFIT COSTS.] "Fringe benefit costs" 
141.15  means the costs for group life, health, dental, workers' 
141.16  compensation, and other employee insurances and pension, 
141.17  profit-sharing, and retirement plans for which the employer pays 
141.18  all or a portion of the costs and that are available to at least 
141.19  all employees who work at least 20 hours per week. 
141.20     Subd. 18.  [GENERALLY ACCEPTED ACCOUNTING PRINCIPLES.] 
141.21  "Generally Accepted Accounting Principles" means the body of 
141.22  pronouncements adopted by the American Institute of Certified 
141.23  Public Accountants regarding proper accounting procedures, 
141.24  guidelines, and rules. 
141.25     Subd. 19.  [HOSPITAL-ATTACHED NURSING FACILITY STATUS.] (a) 
141.26  For the purpose of setting rates under this section, for rate 
141.27  years beginning after September 30, 2006, "hospital-attached 
141.28  nursing facility" means a nursing facility which meets the 
141.29  requirements of clauses (1) and (2); or (3); or (4), or had 
141.30  hospital-attached status prior to January 1, 1995, and has been 
141.31  recognized as having hospital-attached status by CMS 
141.32  continuously since that date: 
141.33     (1) the nursing facility is recognized by the federal 
141.34  Medicare program to be a hospital-based nursing facility; 
141.35     (2) the hospital and nursing facility are physically 
141.36  attached or connected by a corridor; 
142.1      (3) a nursing facility and hospital, which have applied for 
142.2   hospital-based nursing facility status under the federal 
142.3   Medicare program during the reporting year, shall be considered 
142.4   a hospital-attached nursing facility for purposes of setting 
142.5   payment rates under this section.  The nursing facility must 
142.6   file its cost report for that reporting year using Medicare 
142.7   principles and Medicare's recommended cost allocation methods 
142.8   had the Medicare program's hospital-based nursing facility 
142.9   status been granted to the nursing facility.  For each 
142.10  subsequent rate year, the nursing facility must meet the 
142.11  definition requirements in clauses (1) and (2).  If the nursing 
142.12  facility is denied hospital-based nursing facility status under 
142.13  the Medicare program, the nursing facility's payment rates for 
142.14  the rate years the nursing facility was considered to be a 
142.15  hospital-attached nursing facility according to this paragraph 
142.16  shall be recalculated treating the nursing facility as a 
142.17  non-hospital-attached nursing facility; 
142.18     (4) if a nonprofit or community-operated hospital and 
142.19  attached nursing facility suspend operation of the hospital, the 
142.20  remaining nursing facility must be allowed to continue its 
142.21  status as hospital-attached for rate calculations in the three 
142.22  rate years subsequent to the one in which the hospital ceased 
142.23  operations. 
142.24     (b) The nursing facility's cost report filed as 
142.25  hospital-attached facility shall use the same cost allocation 
142.26  principles and methods used in the reports filed for the 
142.27  Medicare program.  Direct identification of costs to the nursing 
142.28  facility cost center will be permitted only when the comparable 
142.29  hospital costs have also been directly identified to a cost 
142.30  center which is not allocated to the nursing facility. 
142.31     Subd. 20.  [HOUSEKEEPING COSTS.] "Housekeeping costs" means 
142.32  the costs for the salaries and wages of the housekeeping 
142.33  supervisor, housekeepers, and other cleaning employees and 
142.34  associated fringe benefits and payroll taxes.  It also includes 
142.35  the cost of housekeeping supplies, including cleaning and 
142.36  lavatory supplies and contract services.  
143.1      Subd. 21.  [LABOR-RELATED PORTION.] The "labor-related 
143.2   portion" of direct care costs and of support service costs shall 
143.3   be that portion of costs that is attributable to wages for all 
143.4   compensated hours, payroll taxes, and fringe benefits. 
143.5      Subd. 22.  [LAUNDRY COSTS.] "Laundry costs" means the costs 
143.6   for the salaries and wages of the laundry supervisor and other 
143.7   laundry employees, associated fringe benefits, and payroll 
143.8   taxes.  It also includes the costs of linen and bedding, the 
143.9   laundering of resident clothing, laundry supplies, and contract 
143.10  services. 
143.11     Subd. 23.  [LICENSEE.] "Licensee" means the individual or 
143.12  organization listed on the form issued by the Minnesota 
143.13  Department of Health under chapter 144A or sections 144.50 to 
143.14  144.56. 
143.15     Subd. 24.  [MAINTENANCE AND PLANT OPERATIONS 
143.16  COSTS.] "Maintenance and plant operations costs" means the costs 
143.17  for the salaries and wages of the maintenance supervisor, 
143.18  engineers, heating-plant employees, and other maintenance 
143.19  employees and associated fringe benefits and payroll taxes.  It 
143.20  also includes direct costs for maintenance and operation of the 
143.21  building and grounds, including fuel, electricity, medical waste 
143.22  and garbage removal, water, sewer, supplies, tools, and repairs. 
143.23     Subd. 25.  [NORMALIZED DIRECT CARE COSTS PER 
143.24  DAY.] "Normalized direct care costs per day" means direct care 
143.25  costs divided by standardized days.  It is the costs per day for 
143.26  direct care services associated with a RUG's index of 1.00. 
143.27     Subd. 26.  [NURSING COSTS.] "Nursing costs" means the costs 
143.28  for the wages of nursing administration, staff education, and 
143.29  direct care registered nurses, licensed practical nurses, 
143.30  certified nursing assistants, and trained medication aides; 
143.31  mental health workers and other direct care employees, and 
143.32  associated fringe benefits and payroll taxes; services from a 
143.33  supplemental nursing services agency and supplies that are 
143.34  stocked at nursing stations or on the floor and distributed or 
143.35  used individually, including:  alcohol, applicators, cotton 
143.36  balls, incontinence pads, disposable ice bags, dressings, 
144.1   bandages, water pitchers, tongue depressors, disposable gloves, 
144.2   enemas, enema equipment, soap, medication cups, diapers, plastic 
144.3   waste bags, sanitary products, thermometers, hypodermic needles 
144.4   and syringes, and clinical reagents or similar diagnostic 
144.5   agents, and drugs which are not paid on a separate fee schedule 
144.6   by the medical assistance program or any other payer. 
144.7      Subd. 27.  [NURSING FACILITY.] "Nursing facility" means a 
144.8   facility with a medical assistance provider agreement that is 
144.9   licensed as a nursing home under chapter 144A or as a boarding 
144.10  care home under sections 144.50 to 144.56. 
144.11     Subd. 28.  [OPERATING COSTS.] "Operating costs" means costs 
144.12  associated with the direct care costs category and the support 
144.13  services costs category. 
144.14     Subd. 29.  [PAYROLL TAXES.] "Payroll taxes" means the costs 
144.15  for the employer's share of the FICA and Medicare withholding 
144.16  tax, and state and federal unemployment compensation taxes.  
144.17     Subd. 30.  [PEER GROUPS.] Facilities shall be classified 
144.18  into three groups, called "peer groups," which shall consist of: 
144.19     (1) C&NC/Short Stay/R80 - facilities that have three or 
144.20  more admissions per bed per year, are hospital-attached, or are 
144.21  licensed under Minnesota Rules, parts 9570.2000 to 9570.3600; 
144.22     (2) boarding care homes - facilities that have more than 50 
144.23  percent of their beds licensed as boarding care homes; and 
144.24     (3) standard - all other facilities. 
144.25     Subd. 31.  [PRIOR RATE-SETTING METHOD.] "Prior rate-setting 
144.26  method" means the rate determination process in effect prior to 
144.27  October 1, 2006, under Minnesota Rules and Minnesota Statutes. 
144.28     Subd. 32.  [PRIVATE PAYING RESIDENT.] "Private paying 
144.29  resident" means a nursing facility resident who is not a medical 
144.30  assistance recipient and whose payment rate is not established 
144.31  by another third party, including the veterans administration or 
144.32  Medicare. 
144.33     Subd. 33.  [RATE YEAR.] "Rate year" means the 12-month 
144.34  period beginning on October 1 following the second most recent 
144.35  reporting year. 
144.36     Subd. 34.  [RELATED ORGANIZATION.] "Related organization" 
145.1   means a person that furnishes goods or services to a nursing 
145.2   facility and that is a close relative of a nursing facility, an 
145.3   affiliate of a nursing facility, a close relative of an 
145.4   affiliate of a nursing facility, or an affiliate of a close 
145.5   relative of an affiliate of a nursing facility.  As used in this 
145.6   subdivision, paragraphs (a) to (d) apply: 
145.7      (a) "Affiliate" means a person that directly, or indirectly 
145.8   through one or more intermediaries, controls or is controlled 
145.9   by, or is under common control with another person. 
145.10     (b) "Person" means an individual, a corporation, a 
145.11  partnership, an association, a trust, an unincorporated 
145.12  organization, or a government or political subdivision. 
145.13     (c) "Close relative of an affiliate of a nursing facility" 
145.14  means an individual whose relationship by blood, marriage, or 
145.15  adoption to an individual who is an affiliate of a nursing 
145.16  facility is no more remote than first cousin. 
145.17     (d) "Control" including the terms "controlling," 
145.18  "controlled by," and "under common control with" means the 
145.19  possession, direct or indirect, of the power to direct or cause 
145.20  the direction of the management, operations, or policies of a 
145.21  person, whether through the ownership of voting securities, by 
145.22  contract, or otherwise, or to influence in any manner other than 
145.23  through an arms length, legal transaction. 
145.24     Subd. 35.  [REPORTING PERIOD.] "Reporting period" means the 
145.25  one-year period beginning on October 1 and ending on the 
145.26  following September 30 during which incurred costs are 
145.27  accumulated and then reported on the statistical and cost report.
145.28     Subd. 36.  [RESIDENT DAY OR ACTUAL RESIDENT DAY.] "Resident 
145.29  day" or "actual resident day" means a day for which nursing 
145.30  services are rendered and billable, or a day for which a bed is 
145.31  held and billed.  The day of admission is considered a resident 
145.32  day, regardless of the time of admission.  The day of discharge 
145.33  is not considered a resident day, regardless of the time of 
145.34  discharge. 
145.35     Subd. 37.  [SALARIES AND WAGES.] "Salaries and wages" means 
145.36  amounts earned by and paid to employees or on behalf of 
146.1   employees to compensate for necessary services provided.  
146.2   Salaries and wages include accrued vested vacation and accrued 
146.3   vested sick leave pay.  Salaries and wages must be paid within 
146.4   30 days of the end of the reporting period in order to be 
146.5   allowable costs of the reporting period. 
146.6      Subd. 38.  [SOCIAL SERVICES COSTS.] "Social services costs" 
146.7   means the costs for the salaries and wages of the supervisor and 
146.8   other social work employees, associated fringe benefits and 
146.9   payroll taxes, supplies, services, and consultants. 
146.10     Subd. 39.  [STAKEHOLDERS.] "Stakeholders" means individuals 
146.11  and representatives of organizations interested in long-term 
146.12  care, including nursing homes, consumers, and labor unions. 
146.13     Subd. 40.  [STANDARDIZED DAYS.] "Standardized days" means 
146.14  the sum of resident days by case mix category multiplied by the 
146.15  RUG index for each category. 
146.16     Subd. 41.  [STATISTICAL AND COST REPORT.] "Statistical and 
146.17  cost report" means the forms supplied by the commissioner for 
146.18  annual reporting of nursing facility expenses and statistics, 
146.19  including instructions and definitions of items in the report. 
146.20     Subd. 42.  [SUPPORT SERVICES COSTS CATEGORY.] "Support 
146.21  services costs category" means the costs for dietary, 
146.22  housekeeping, laundry, maintenance, and administration. 
146.23     Subd. 43.  [REPORTING OF STATISTICAL AND COST 
146.24  INFORMATION.] (a) Beginning in 2006, all nursing facilities 
146.25  shall provide information annually to the commissioner on a form 
146.26  and in a manner determined by the commissioner.  The 
146.27  commissioner may also require nursing facilities to provide 
146.28  statistical and cost information for a subset of the items in 
146.29  the annual report on a semiannual basis.  Nursing facilities 
146.30  shall report only costs directly related to the operation of the 
146.31  nursing facility.  The facility shall not include costs which 
146.32  are separately reimbursed by residents, medical assistance, or 
146.33  other payors.  Allocations of costs from central, affiliated, or 
146.34  corporate office and related organization transactions shall be 
146.35  reported according to section 256B.432.  The commissioner may 
146.36  grant to facilities one extension of up to 15 days for the 
147.1   filing of this report if the extension is requested by December 
147.2   15 and the commissioner determines that the extension will not 
147.3   prevent the commissioner from establishing rates in a timely 
147.4   manner required by law.  The commissioner may separately require 
147.5   facilities to submit in a manner specified by the commissioner 
147.6   documentation of statistical and cost information included in 
147.7   the report to ensure accuracy in establishing payment rates and 
147.8   to perform audit and appeal review functions under this section. 
147.9   Facilities shall retain all records necessary to document 
147.10  statistical and cost information on the report for a period of 
147.11  no less than seven years.  The commissioner may amend 
147.12  information in the report according to subdivision 54.  The 
147.13  commissioner may reject a report filed by a nursing facility 
147.14  under this section if the commissioner determines that the 
147.15  report has been filed in a form that is incomplete or inaccurate 
147.16  and the information is insufficient to establish accurate 
147.17  payment rates.  In the event that a complete report is not 
147.18  submitted in a timely manner, the commissioner shall reduce the 
147.19  reimbursement payments to a nursing facility to 85 percent of 
147.20  amounts due until the information is filed.  The release of 
147.21  withheld payments shall be retroactive for no more than 90 
147.22  days.  A nursing facility that does not submit a report or whose 
147.23  report is filed in a timely manner but determined to be 
147.24  incomplete shall be given written notice that a payment 
147.25  reduction is to be implemented and allowed ten days to complete 
147.26  the report prior to any payment reduction.  The commissioner may 
147.27  delay the payment withhold under exceptional circumstances to be 
147.28  determined at the sole discretion of the commissioner. 
147.29     (b) Nursing facilities may, within 12 months of the due 
147.30  date of a statistical and cost report, file an amendment when 
147.31  errors or omissions in the annual statistical and cost report 
147.32  are discovered and an amendment would result in a rate increase 
147.33  of at least 0.15 percent of the statewide weighted average 
147.34  operating payment rate and shall, at any time, file an amendment 
147.35  which would result in a rate reduction of at least 0.15 percent 
147.36  of the statewide weighted average operating payment rate.  The 
148.1   commissioner shall make retroactive adjustments to the total 
148.2   payment rate of a nursing facility if an amendment is accepted.  
148.3   Where a retroactive adjustment is to be made as a result of an 
148.4   amended report, audit findings, or other determination of an 
148.5   incorrect payment rate, the commissioner may settle the payment 
148.6   error through a negotiated agreement with the facility and a 
148.7   gross adjustment of the payments to the facility.  Retroactive 
148.8   adjustments shall not be applied to private pay residents.  An 
148.9   error or omission for purposes of this item does not include a 
148.10  nursing facility's determination that an election between 
148.11  permissible alternatives was not advantageous and should be 
148.12  changed. 
148.13     (c) If the commissioner determines that a nursing facility 
148.14  knowingly supplied inaccurate or false information or failed to 
148.15  file an amendment to a statistical and cost report that resulted 
148.16  in or would result in an overpayment, the commissioner shall 
148.17  immediately adjust the nursing facility's payment rate and 
148.18  recover the entire overpayment.  The commissioner may also 
148.19  terminate the commissioner's agreement with the nursing facility 
148.20  and prosecute under applicable state or federal law. 
148.21     Subd. 44.  [CALCULATION OF DIRECT CARE PER DIEM COSTS.] The 
148.22  commissioner shall calculate, for each nursing facility, the 
148.23  normalized per diem cost for direct care services by dividing 
148.24  the total allowable reported costs for direct care services by 
148.25  the number of standardized days for the same reporting period.  
148.26     Subd. 45.  [CALCULATION OF SUPPORT SERVICES PER DIEM 
148.27  COSTS.] The commissioner shall calculate, for each nursing 
148.28  facility, the per diem cost for support services by dividing the 
148.29  total allowable reported costs for support services by the 
148.30  number of resident days for the same reporting period. 
148.31     Subd. 46.  [CALCULATION OF A QUALITY SCORE.] (a) The 
148.32  commissioner shall determine a quality score for each nursing 
148.33  facility using quality measures established in section 256B.439, 
148.34  according to methods determined by the commissioner in 
148.35  consultation with stakeholders and experts.  These methods shall 
148.36  be exempt from the rulemaking requirements under chapter 14.  
149.1      (b) For each quality measure, a score shall be determined 
149.2   with a maximum number of points available and number of points 
149.3   assigned as determined by the commissioner using the methodology 
149.4   established according to this subdivision.  The scores 
149.5   determined for all quality measures shall be totaled.  The 
149.6   determination of the quality measures to be used and the methods 
149.7   of calculating scores may be revised annually by the 
149.8   commissioner.  
149.9      (c) For the initial rate year under the new payment system, 
149.10  the quality measures shall include: 
149.11     (1) staff turnover; 
149.12     (2) staff retention; 
149.13     (3) use of pool staff; 
149.14     (4) quality indicators from the minimum data set; and 
149.15     (5) survey deficiencies. 
149.16     (d) For rate years beginning after October 1, 2006, when 
149.17  making revisions to the quality measures or method for 
149.18  calculating scores, the commissioner shall publish the 
149.19  methodology in the State Register at least 15 months prior to 
149.20  the start of the rate year for which the revised methodology is 
149.21  to be used for rate-setting purposes.  The quality score used to 
149.22  determine payment rates shall be established for a rate year 
149.23  using data submitted in the statistical and cost report from the 
149.24  associated reporting year, and using data from other sources 
149.25  related to a period beginning no more than six months prior to 
149.26  the associated reporting year. 
149.27     Subd. 47.  [CALCULATION OF PAYMENT RATE FOR DIRECT CARE 
149.28  SERVICES.] For each rate year, the payment rate for direct care 
149.29  services shall be a variable amount, determined annually, based 
149.30  on the facility's staffing level in the reporting year, adjusted 
149.31  for peer group, geography, and case mix. 
149.32     (a) For each facility, determine the geographic normalized 
149.33  direct care costs per standardized day according to clauses (1) 
149.34  to (7):  
149.35     (1) for the costs determined in subdivision 44, for each 
149.36  facility, determine the portion, as a percent, that is 
150.1   labor-related; 
150.2      (2) array the values in clause (1) by peer group and select 
150.3   the median for each peer group; 
150.4      (3) for each facility, multiply the costs determined in 
150.5   subdivision 44 by the value determined in clause (2) for its 
150.6   peer group; 
150.7      (4) divide the value determined in clause (3) by the 
150.8   geographic adjuster determined in subdivision 50; 
150.9      (5) for each facility, multiply the costs determined in 
150.10  subdivision 44 by the value of one minus the value determined in 
150.11  clause (2) for its peer group; 
150.12     (6) add the value determined in clause (4) to the value 
150.13  determined in clause (5); and 
150.14     (7) divide the value determined in clause (6) by the 
150.15  average RUG's index for the facility.  This value is the 
150.16  geographic normalized direct care costs per standardized day. 
150.17     (b) For each facility, determine the wage adjusted direct 
150.18  care hours per standardized day according to clauses (1) to (4): 
150.19     (1) determine the statewide average wage rate for each 
150.20  category of direct care worker; 
150.21     (2) for each category of direct care worker, determine the 
150.22  ratio of its weighted average hourly wage rate to the weighted 
150.23  average hourly wage rate of certified nursing assistants; 
150.24     (3) for each facility, determine the sum of the compensated 
150.25  hours for each category of direct care worker times the ratio 
150.26  determined in clause (2) for that category of direct care 
150.27  worker; and 
150.28     (4) divide the value in clause (3) by the number of 
150.29  standardized days in the facility during the reporting period.  
150.30  This value is the wage adjusted direct care hours per 
150.31  standardized day.  If this value exceeds the value determined in 
150.32  the prior year, the value to be used shall be the value that was 
150.33  used in the prior year, except to the extent an appropriation is 
150.34  made to allow an increase in the value. 
150.35     (c) For each peer group, array the values determined in 
150.36  paragraph (b).  
151.1      (d) In each of the arrays determined in paragraph (c), 
151.2   select the facilities between the tenth and 20th percentiles 
151.3   inclusive and determine the average, for these facilities, of 
151.4   the geographic normalized direct care costs per standardized day 
151.5   determined in paragraph (a), clause (7).  This is the minimum 
151.6   unadjusted direct care price.  
151.7      (e) In each of the arrays determined in paragraph (c), 
151.8   select the facilities between the 80th and the 90th percentiles 
151.9   inclusive and determine the average, for these facilities, of 
151.10  the geographic normalized direct care costs per standardized day 
151.11  determined in paragraph (a), clause (7).  This is the maximum 
151.12  unadjusted direct care price.  
151.13     (f) The commissioner is authorized to apply multipliers to 
151.14  the values determined in paragraphs (d) and (e) to assure that 
151.15  expenditures are within the limits of the appropriation and that 
151.16  funds are not shifted between peer groups.  
151.17     (g) Determine the unadjusted direct care price for each 
151.18  facility according to clauses (1) to (3):  
151.19     (1) for each facility at the 20th percentile or less in the 
151.20  arrays in paragraph (c), the unadjusted direct care price shall 
151.21  be the unadjusted minimum direct care price for that peer group 
151.22  determined in paragraph (d) as adjusted according to paragraph 
151.23  (f); 
151.24     (2) for each facility above the 20th percentile and not 
151.25  above the 80th percentile in the arrays in paragraph (c), the 
151.26  unadjusted direct care price shall be prorated between the 
151.27  minimum and maximum unadjusted direct care prices for that peer 
151.28  group as adjusted according to paragraph (f); and 
151.29     (3) for each facility above the 80th percentile in the 
151.30  arrays in paragraph (c), the unadjusted direct care price shall 
151.31  be the unadjusted maximum direct care price for that peer group 
151.32  determined in paragraph (e), as adjusted according to paragraph 
151.33  (f). 
151.34     (h) The direct care price for each facility shall be the 
151.35  value determined in paragraph (g) adjusted for the geographic 
151.36  adjuster of the facility according to clauses (1) to (4): 
152.1      (1) the value determined in paragraph (g) shall be 
152.2   multiplied by the value determined in paragraph (a), clause (2), 
152.3   for the facility's peer group; 
152.4      (2) multiply the value determined in clause (1) by the 
152.5   geographic adjuster determined in subdivision 50; 
152.6      (3) for each facility, multiply the value determined in 
152.7   paragraph (g) by the value of one minus the value determined in 
152.8   paragraph (a), clause (2), for the facility's peer group; and 
152.9      (4) add the value determined in clause (2) to the value 
152.10  determined in clause (3).  This value shall be multiplied by the 
152.11  index associated with each RUG's group to determine the direct 
152.12  care services payment rate for each RUG's group. 
152.13     Subd. 48.  [CALCULATION OF PAYMENT RATE FOR SUPPORT 
152.14  SERVICES.] The payment rate for support services shall be a 
152.15  fixed amount adjusted for the facility's peer group and 
152.16  geography. 
152.17     (a) For each facility, determine the geographic normalized 
152.18  support services costs per standardized day according to clauses 
152.19  (1) to (7): 
152.20     (1) for the costs determined in subdivision 45, for each 
152.21  facility, determine the portion, as a percent, that is 
152.22  labor-related; 
152.23     (2) array the values in clause (1) by peer group and select 
152.24  the median for each peer group; 
152.25     (3) for each facility, multiply the costs determined in 
152.26  subdivision 45 by the value determined in clause (2) for its 
152.27  peer group; 
152.28     (4) divide the value determined in clause (3) by the 
152.29  geographic adjuster determined in subdivision 50; 
152.30     (5) for each facility, multiply the costs determined in 
152.31  subdivision 45 by the value of one minus the value determined in 
152.32  clause (2) for its peer group; 
152.33     (6) add the value determined in clause (4) to the value 
152.34  determined in clause (5); 
152.35     (7) array the values determined in clause (6) for each peer 
152.36  group, and select the 40th percentile; and 
153.1      (8) the commissioner is authorized to apply multipliers to 
153.2   the values determined in clause (7) to assure that expenditures 
153.3   are within the limits of the appropriation and that funds are 
153.4   not shifted between peer groups.  These values shall be the 
153.5   unadjusted support services payment rate for the three peer 
153.6   groups. 
153.7      (b) The support services price for each facility shall be 
153.8   the value determined in paragraph (a), clause (8), adjusted by 
153.9   the geographic adjuster of the facility according to clauses (1) 
153.10  to (4): 
153.11     (1) the value determined in paragraph (a), clause (8), 
153.12  shall be multiplied by the value determined in paragraph (a), 
153.13  clause (2), for the facility's peer group; 
153.14     (2) multiply the value determined in clause (1) by the 
153.15  geographic adjuster determined in subdivision 50; 
153.16     (3) for each facility, multiply the value determined in 
153.17  paragraph (a), clause (8), by the value of one minus the value 
153.18  determined in paragraph (a), clause (2), for the facility's peer 
153.19  group; 
153.20     (4) add the value determined in clause (2) to the value 
153.21  determined in clause (3).  This value shall be the support 
153.22  services payment rate for each facility; and 
153.23     (c) For rate years beginning on or after October 1, 2007, 
153.24  the value determined in paragraph (b), clause (4), shall not be 
153.25  less than the value used for the rate year beginning October 1, 
153.26  2006.  
153.27     Subd. 49.  [CALCULATION OF QUALITY ADD-ON.] The payment 
153.28  rate for the quality add-on shall be a variable amount based on 
153.29  each facility's quality score. 
153.30     (a) For the rate year beginning October 1, 2006, the 
153.31  maximum quality add-on percent shall be five percent.  When new 
153.32  quality measures are incorporated into the quality score 
153.33  methodology and when existing quality measures are updated or 
153.34  improved, the commissioner may increase the maximum quality 
153.35  add-on percent. 
153.36     (b) For each facility, determine the sum of the values 
154.1   determined in subdivisions 47 and 48.  
154.2      (c) For each facility determine a ratio of the quality 
154.3   score of the facility determined in subdivision 46, less 40 and 
154.4   then divided by 60.  If this value is less than zero, use the 
154.5   value zero. 
154.6      (d) For each facility, the quality add-on shall be the 
154.7   value determined in paragraph (b) times the value determined in 
154.8   paragraph (c) times the maximum quality add-on percent. 
154.9      Subd. 50.  [GEOGRAPHIC ADJUSTMENTS OF LABOR-RELATED COSTS.] 
154.10  The commissioner shall determine adjusters for the labor-related 
154.11  share of the operating rate which shall be the ratio calculated 
154.12  in paragraphs (a) to (c), using data reported under subdivision 
154.13  43.  In paragraphs (a) and (b), use direct care costs and direct 
154.14  care compensated hours and use only facilities that have 
154.15  reported both. 
154.16     (a) Calculate the sum of compensation for all facilities in 
154.17  each economic development region divided by the facilities total 
154.18  compensated hours. 
154.19     (b) Calculate the sum of compensation for all facilities in 
154.20  the state divided by total reported compensated hours of all 
154.21  facilities in the state. 
154.22     (c) For each economic development region, divide the value 
154.23  in paragraph (a) by the value in paragraph (b).  These ratios 
154.24  shall be the geographic adjusters for the economic development 
154.25  regions.  
154.26     Subd. 51.  [ADJUSTER FOR OPERATING PAYMENT RATES.] (a) The 
154.27  commissioner shall provide information to the appropriate 
154.28  committee chairs of the legislature by January 15 of each year 
154.29  specifying adjusters that may be multiplied by the uninflated 
154.30  payment rates, or by any other factor the commissioner deems 
154.31  appropriate, for direct care and support service costs 
154.32  determined in subdivisions 47 and 48.  The information shall 
154.33  include: 
154.34     (1) the projected change in the CPI-U, between the midpoint 
154.35  of the reporting year and the midpoint of the rate year, as 
154.36  determined by the national economic consultant used by the 
155.1   commissioner of finance, for the next rate year; and 
155.2      (2) the costs or savings to the state of adjusting payment 
155.3   rates according to clause (1).  
155.4      (b) The commissioner may also describe other factors or 
155.5   methods that may be considered in adjusting rates.  
155.6      Subd. 52.  [CALCULATION OF PAYMENT RATE FOR EXTERNAL FIXED 
155.7   COSTS.] The commissioner shall calculate a payment rate for 
155.8   external fixed costs. 
155.9      (a) For facilities licensed as nursing homes, the portion 
155.10  related to section 256.9657 shall be equal to $8.86.  For 
155.11  facilities licensed as both nursing homes and boarding care 
155.12  homes, the portion related to section 256.9657 shall be equal to 
155.13  $8.86 multiplied by the ratio of their number of nursing home 
155.14  beds divided by their total number of active licensed and 
155.15  certified nursing home and boarding care beds. 
155.16     (b) The portion related to the licensure fee under section 
155.17  144.122, paragraph (d), shall be the amount of the fee divided 
155.18  by actual resident days. 
155.19     (c) The portion related to scholarships shall be determined 
155.20  under section 256B.431, subdivision 36. 
155.21     (d) The portion related to long-term care consultation 
155.22  shall be determined according to section 256B.0911, subdivision 
155.23  6. 
155.24     (e) The portion related to development and education of 
155.25  resident and family advisory councils under section 144A.33 
155.26  shall be $5 divided by 365. 
155.27     (f) The portion related to planned closure rate adjustments 
155.28  shall be as determined under section 256B.437. 
155.29     (g) The portions related to property insurance, real estate 
155.30  taxes, special assessments, and payments made in lieu of real 
155.31  estate taxes directly identified or allocated to the nursing 
155.32  facility shall be the actual amounts divided by actual resident 
155.33  days. 
155.34     (h) The portion related to PERA shall be actual costs 
155.35  divided by actual resident days. 
155.36     (i) The payment rate for external fixed costs shall be the 
156.1   sum of the amounts in paragraphs (a) to (h). 
156.2      Subd. 53.  [PHASE-IN.] The commissioner shall implement the 
156.3   operating payment rate-setting methods in this section according 
156.4   to paragraphs (a) to (j). 
156.5      (a) Total payment rates effective on June 30, 2006, shall 
156.6   remain in effect through September 30, 2006. 
156.7      (b) By August 15 of 2006, 2007, and 2008, the commissioner 
156.8   shall notify nursing facilities of the operating payment rates 
156.9   they will receive under both this section and under the prior 
156.10  rate-setting method, of the blended operating payment rates that 
156.11  will apply based on paragraphs (c) to (i), and the actual 
156.12  operating payment rate that will result from application of 
156.13  paragraph (j).  For purposes of determining payment rates under 
156.14  the prior rate-setting method, the RUG's indices determined 
156.15  under section 256B.438, subdivision 3, paragraph (a), shall be 
156.16  used.  For purposes of determining payment rates under the new 
156.17  rate-setting method, the RUG's indices determined under section 
156.18  256B.438, subdivision 3, paragraph (c), shall be used. 
156.19     (c) For facilities reimbursed under section 256B.434 on 
156.20  September 30, 2006, for purposes of determining payment rates 
156.21  under the prior rate-setting method, and under this section for 
156.22  rate years beginning after June 30, 2006, the rate adjustment 
156.23  under section 256B.434, subdivision 4, paragraph (c), shall 
156.24  apply only to the property-related payment rate.  For facilities 
156.25  reimbursed under section 256B.431 on September 30, 2006, for 
156.26  rate years beginning on and after October 1, 2006, property 
156.27  rates shall continue to be determined under Minnesota Rules, 
156.28  parts 9549.0010 to 9549.0080. 
156.29     (d) For the rate year beginning October 1, 2006, for the 
156.30  operating rate components under the prior rate-setting method, 
156.31  the commissioner shall use the amounts in effect on June 30, 
156.32  2006.  For the rate years beginning on October 1, 2007, and 
156.33  October 1, 2008, the commissioner shall use the amounts in 
156.34  effect on the prior September 30. 
156.35     (e) For RUG's classifications with an effective date prior 
156.36  to October 1, 2007, the commissioner of health shall apply index 
157.1   maximization using the indices determined under section 
157.2   256B.438, subdivision 3, paragraph (a).  For RUG's 
157.3   classifications with an effective date on or after October 1, 
157.4   2007, the commissioner of health shall apply index maximization 
157.5   using the indices determined under section 256B.438, subdivision 
157.6   3, paragraph (c). 
157.7      (f) The blended total payment rate that will apply on 
157.8   October 1, 2006, shall consist of ten percent of the amount 
157.9   determined under this section and 90 percent of the amount 
157.10  determined under the prior rate-setting method. 
157.11     (g) The blended total payment rate that will apply on 
157.12  October 1, 2007, shall consist of 40 percent of the amount 
157.13  determined under this section and 60 percent of the amount 
157.14  determined under the prior rate-setting method. 
157.15     (h) The blended total payment rate that will apply on 
157.16  October 1, 2008, shall consist of 70 percent of the amount 
157.17  determined under this section and 30 percent of the amount 
157.18  determined under the prior rate-setting method. 
157.19     (i) The blended total payment rate that will apply on 
157.20  October 1, 2009, shall be the amount determined under this 
157.21  section. 
157.22     (j) For rate years beginning October 1 of 2006, 2007, and 
157.23  2008, for facilities for which the rate determined under this 
157.24  subdivision as adjusted according to section 256B.431, 
157.25  subdivision 41, is less than the rate that was in effect on 
157.26  September 30, 2006, the actual operating payment rate shall be 
157.27  the rate that was in effect on September 30, 2006.  For the rate 
157.28  year beginning October 1, 2009, for facilities for which the 
157.29  rate determined under this section is less than the rate 
157.30  determined under the prior rate-setting method, the actual 
157.31  operating payment rate shall be the rate determined under this 
157.32  section but shall be no more than $10 less than the rate that 
157.33  was in effect on September 30, 2006.  For rate years beginning 
157.34  on or after October 1, 2010, for facilities for which the rate 
157.35  determined under this section is less than the rate that was in 
157.36  effect on September 30, 2010, the actual operating payment rate 
158.1   shall be the rate determined under this section.  
158.2      Subd. 54.  [AUDIT AUTHORITY.] (a) The commissioner may 
158.3   subject reports and supporting documentation to desk and field 
158.4   audits to determine compliance with this section.  Retroactive 
158.5   adjustments shall be made as a result of desk or field audit 
158.6   findings if the cumulative impact of the finding would result in 
158.7   a rate adjustment of at least 0.15 percent of the statewide 
158.8   weighted average operating payment rate.  If a field audit 
158.9   reveals inadequacies in a nursing facility's record keeping or 
158.10  accounting practices, the commissioner may require the nursing 
158.11  facility to engage competent professional assistance to correct 
158.12  those inadequacies within 90 days so that the field audit may 
158.13  proceed. 
158.14     (b) Field audits may cover the four most recent annual 
158.15  statistical and cost reports for which desk audits have been 
158.16  completed and payment rates have been established.  The field 
158.17  audit must be an independent review of the nursing facility's 
158.18  statistical and cost report.  All transactions, invoices, or 
158.19  other documentation that support or relate to the statistics and 
158.20  costs claimed on the annual statistical and cost reports are 
158.21  subject to review by the field auditor.  If the provider fails 
158.22  to provide the field auditor access to supporting documentation 
158.23  related to the information reported on the statistical and cost 
158.24  report within the time period specified by the commissioner, the 
158.25  commissioner shall calculate the total payment rate by 
158.26  disallowing the cost of the items for which access to the 
158.27  supporting documentation is not provided. 
158.28     (c) Changes in the total payment rate which result from 
158.29  desk or field audit adjustments to statistical and cost reports 
158.30  for reporting years earlier than the four most recent annual 
158.31  cost reports must be made to the four most recent annual 
158.32  statistical and cost reports, the current statistical and cost 
158.33  report, and future statistical and cost reports to the extent 
158.34  that those adjustments affect the total payment rate established 
158.35  by those reporting years. 
158.36     (d) The commissioner shall extend the period for retention 
159.1   of records under subdivision 43 for purposes of performing field 
159.2   audits as necessary to enforce section 256B.48 with written 
159.3   notice to the facility postmarked no later than 90 days prior to 
159.4   the expiration of the record retention requirement. 
159.5      Subd. 55.  [REMEDIES FOR DISPUTES.] The commissioner shall 
159.6   provide remedies for disputes under this section. 
159.7      (a) A provider may appeal a determination of a payment rate 
159.8   established under this section if the appeal, if successful, 
159.9   would result in a change to the provider's payment rate of at 
159.10  least 0.15 percent of the statewide weighted average operating 
159.11  payment rate.  Appeals must be filed according to procedures in 
159.12  this subdivision. 
159.13     (b) To appeal, the provider shall file with the 
159.14  commissioner a written notice of appeal and the appeal must be 
159.15  postmarked or received by the commissioner within 60 days of the 
159.16  date the determination of the payment rate was mailed or 
159.17  personally received by a provider, whichever is earlier. 
159.18     (c) The notice of appeal must specify: 
159.19     (1) each disputed item; 
159.20     (2) the reason for the dispute; 
159.21     (3) the computation that the provider believes is correct; 
159.22     (4) the impact upon the facility's payment rate if the 
159.23  appeal is successful; 
159.24     (5) the authority in statute or rule upon which the 
159.25  provider relies for each disputed item; 
159.26     (6) the name and address of the person or firm with whom 
159.27  contacts may be made regarding the appeal; and 
159.28     (7) additional information the provider wishes to offer 
159.29  with the appeal to support the provider's position.  The 
159.30  commissioner may request additional information to clarify the 
159.31  provider's position. 
159.32     (d) The commissioner shall review appeals and issue a 
159.33  written appeal determination on each appealed item within 180 
159.34  days of the due date of the appeal.  Upon mutual agreement, the 
159.35  commissioner and the provider may extend the time for issuing a 
159.36  determination for a specified period.  The appeal determination 
160.1   takes effect 30 days following the date of issuance specified in 
160.2   the determination. 
160.3      (e) For an appeal item on which the provider disagrees with 
160.4   the appeal determination, the provider may request 
160.5   reconsideration.  A request for reconsideration must be 
160.6   postmarked or received by the commissioner within 30 days of the 
160.7   date of issuance of the determination.  A request for 
160.8   reconsideration delays the date on which the determination takes 
160.9   effect.  The appeal determination and any changes resulting from 
160.10  reconsideration shall be implemented 30 days following the 
160.11  issuance of the reconsideration response. 
160.12     (f) For an appeal item on which the provider disagrees with 
160.13  the appeal determination and the reconsideration response, if 
160.14  any, the provider may file with the commissioner a written 
160.15  demand for a contested case hearing to determine the proper 
160.16  resolution of specified appeal items.  The demand must be 
160.17  postmarked or received by the commissioner within 30 days of the 
160.18  date of issuance specified in the determination or within 30 
160.19  days of the issuance of the reconsideration response, if 
160.20  reconsideration was requested.  A demand for a contested case 
160.21  hearing for an appeal item nullifies the written appeal 
160.22  determination issued by the commissioner for that appeal item.  
160.23  The commissioner shall refer any demand for a contested case 
160.24  hearing to the Office of the Attorney General. 
160.25     (g) A contested case hearing shall be heard by an 
160.26  administrative law judge according to sections 14.48 to 14.56.  
160.27  In any proceeding under this section, the appealing party must 
160.28  demonstrate by a preponderance of the evidence that the 
160.29  determination of a payment rate is incorrect. 
160.30     (h) Regardless of any rate appeal, the rate established 
160.31  must be the rate paid and must remain in effect until final 
160.32  resolution of the appeal or a subsequent rate determination. 
160.33     (i) A provider shall not use this process to challenge the 
160.34  method of determining a quality score under subdivision 46; or 
160.35  the commissioner's determination under subdivision 56 to 
160.36  negotiate rates.  This process does not apply to a request from 
161.1   a resident or nursing facility for reconsideration of the 
161.2   classification of a resident under section 144.0722 or 144.0724. 
161.3      Subd. 56.  [INTERIM RATES.] (a) The commissioner shall 
161.4   determine interim payment rates for nursing facilities that have 
161.5   no cost history.  The facilities shall provide statistical and 
161.6   cost information, according to subdivision 43, on a prospective 
161.7   basis.  The commissioner shall establish an interim rate using 
161.8   the quality score of the nursing facility at the 60th 
161.9   percentile, direct care costs according to a budget negotiated 
161.10  with the provider and the methods provided in subdivision 47.  
161.11  The interim rate shall apply until a rate can be established 
161.12  under this section.  Upon providing final information under 
161.13  subdivision 43 for the interim rate period, the commissioner 
161.14  shall determine that an overpayment has occurred if the interim 
161.15  payment rate for direct care costs exceeded the final rate for 
161.16  direct care costs by an amount greater than four percent, and 
161.17  shall recover any overpayment.  
161.18     In the event of an overpayment, the commissioner may allow 
161.19  up to six months for complete repayment if the provider 
161.20  demonstrates that immediate repayment of the overpayment would 
161.21  result in an undue hardship to the operation of the facility. 
161.22     (b) The commissioner may negotiate an interim rate with a 
161.23  nursing facility, according to the process in paragraph (a), 
161.24  when that facility has been purchased by an unrelated party 
161.25  within the last six months.  In determining if negotiations 
161.26  shall be initiated, the commissioner shall consider: 
161.27     (1) the potential inadequacy of current rates as evidenced 
161.28  by the position in the arrays of operating costs of the rates of 
161.29  the requesting facility; 
161.30     (2) preventing closure of facilities in under-bedded areas 
161.31  of the state, as measured by the number of beds per 1,000 
161.32  elderly in the county or in contiguous counties in which the 
161.33  facility is located; 
161.34     (3) the ability of the purchaser to provide high quality 
161.35  services as evidenced by high quality scores of any other 
161.36  facility under the control of the purchaser operating in 
162.1   Minnesota; 
162.2      (4) the ability of the purchasing entity to operate 
162.3   efficiently as evidenced by the difference between the operating 
162.4   costs and target prices of the other facility or facilities 
162.5   under the control of the purchaser operating in Minnesota; 
162.6      (5) previous success of the purchaser with negotiated 
162.7   interim rates; 
162.8      (6) the financial soundness of the purchaser; 
162.9      (7) avoiding negotiating interim rates with purchasers who 
162.10  have sold facilities that then requested interim rate 
162.11  negotiation; and 
162.12     (8) avoiding too much consolidation of the nursing facility 
162.13  industry within any small number of providers. 
162.14     Sec. 22.  Minnesota Statutes 2004, section 256B.47, 
162.15  subdivision 2, is amended to read: 
162.16     Subd. 2.  [NOTICE TO RESIDENTS.] (a) No increase in nursing 
162.17  facility rates for private paying residents shall be effective 
162.18  unless the nursing facility notifies the resident or person 
162.19  responsible for payment of the increase in writing 30 days 
162.20  before the increase takes effect.  
162.21     A nursing facility may adjust its rates without giving the 
162.22  notice required by this subdivision when the purpose of the rate 
162.23  adjustment is to reflect a change in the case-mix classification 
162.24  of the resident.  If the state fails to set rates as required by 
162.25  section 256B.431 256B.441, subdivision 1, the time required for 
162.26  giving notice is decreased by the number of days by which the 
162.27  state was late in setting the rates. 
162.28     (b) If the state does not set rates by the date required in 
162.29  section 256B.431 256B.441, subdivision 1, nursing facilities 
162.30  shall meet the requirement for advance notice by informing the 
162.31  resident or person responsible for payments, on or before the 
162.32  effective date of the increase, that a rate increase will be 
162.33  effective on that date.  If the exact amount has not yet been 
162.34  determined, the nursing facility may raise the rates by the 
162.35  amount anticipated to be allowed.  Any amounts collected from 
162.36  private pay residents in excess of the allowable rate must be 
163.1   repaid to private pay residents with interest at the rate used 
163.2   by the commissioner of revenue for the late payment of taxes and 
163.3   in effect on the date the rate increase is effective. 
163.4      Sec. 23.  Laws 2004, chapter 267, article 12, section 4, is 
163.5   amended to read:  
163.6      Sec. 4.  [EFFECTIVE DATE.] 
163.7      (a) Section 1, relating to the Fair Oaks Lodge, Wadena, is 
163.8   effective upon the latter of: 
163.9      (1) the day after the governing body of Todd County and its 
163.10  chief clerical officer timely complete their compliance with 
163.11  Minnesota Statutes, section 645.021, subdivisions 2 and 3; and 
163.12     (2) the day after the governing body of Wadena County and 
163.13  its chief clerical officer timely complete their compliance with 
163.14  Minnesota Statutes, section 645.021, subdivisions 2 and 3. 
163.15     (b) Section 1, relating to the RenVilla Nursing Home, is 
163.16  effective upon the latter of: 
163.17     (1) the day after the governing body of the city of 
163.18  Renville and its chief clerical officer timely complete their 
163.19  compliance with Minnesota Statutes, section 645.021, 
163.20  subdivisions 2 and 3, except that the certificate of approval 
163.21  must be filed before January 1, 2006; and 
163.22     (2) the first day of the month next following certification 
163.23  to the governing body of the city of Renville by the executive 
163.24  director of the Public Employees Retirement Association that the 
163.25  actuarial accrued liability of the special benefit coverage 
163.26  proposed for extension to the privatized RenVilla Nursing Home 
163.27  employees under section 1 does not exceed the actuarial gain 
163.28  otherwise to be accrued by the Public Employees Retirement 
163.29  Association, as calculated by the consulting actuary retained by 
163.30  the Legislative Commission on Pensions and Retirement, or the 
163.31  actuary retained under Minnesota Statutes, section 356.214, 
163.32  whichever is applicable. 
163.33     (c) The cost of the actuarial calculations must be borne by 
163.34  the city of Renville or the purchaser of the RenVilla Nursing 
163.35  Home. 
163.36     (d) Section 1, relating to the St. Peter Community 
164.1   Healthcare Center, is effective upon the latter of: 
164.2      (1) the day after the governing body of the city of St. 
164.3   Peter and its chief clerical officer timely complete their 
164.4   compliance with Minnesota Statutes, section 645.021, 
164.5   subdivisions 2 and 3; and 
164.6      (2) the first day of the month next following certification 
164.7   to the governing body of the city of St. Peter by the executive 
164.8   director of the Public Employees Retirement Association that the 
164.9   actuarial accrued liability of the special benefit coverage 
164.10  proposed for extension to the privatized St. Peter Community 
164.11  Healthcare Center employees under section 1 does not exceed the 
164.12  actuarial gain otherwise to be accrued by the Public Employees 
164.13  Retirement Association, as calculated by the consulting actuary 
164.14  retained by the Legislative Commission on Pensions and 
164.15  Retirement, or the actuary retained under Minnesota Statutes, 
164.16  section 356.214, whichever is applicable. 
164.17     (e) The cost of the actuarial calculations must be borne by 
164.18  the city of St. Peter or the purchaser of the St. Peter 
164.19  Community Healthcare Center. 
164.20     (f) If the required actions under paragraphs (b) and (c) 
164.21  occur, section 1 applies retroactively to the RenVilla Nursing 
164.22  Home as of the date of privatization. 
164.23     (g) If the required actions under paragraph (a) occur, 
164.24  section 1 applies retroactively to Fair Oaks Lodge, Wadena, as 
164.25  of January 1, 2004. 
164.26     (h) Sections 2 and 3 are effective on the day following 
164.27  final enactment. 
164.28     Sec. 24.  [MORATORIUM PROJECT DEADLINE EXTENSION IN AITKIN 
164.29  COUNTY.] 
164.30     Notwithstanding Minnesota Statutes, section 144A.073, 
164.31  subdivisions 3 and 10, the commissioner of health shall extend 
164.32  the project approval until December 31, 2006, for a nursing home 
164.33  moratorium exception project that was approved under Minnesota 
164.34  Statutes, section 144A.073, in 2002 to remodel a 48-bed facility 
164.35  in Aitkin County. 
164.36     Sec. 25.  [MORATORIUM PROJECT DEADLINE EXTENSION IN 
165.1   RENVILLE COUNTY.] 
165.2      Notwithstanding Minnesota Statutes, section 144A.073, 
165.3   subdivisions 3 and 10, the commissioner of health shall extend 
165.4   the project approval until December 31, 2006, for a nursing home 
165.5   moratorium exception project that was approved under Minnesota 
165.6   Statutes, section 144A.073, in 2002 to remodel a 60-bed facility 
165.7   in Renville County.  
165.8      Sec. 26.  [RECOMMENDATIONS ON CRITERIA AND RATE 
165.9   NEGOTIATIONS FOR NURSING FACILITIES.] 
165.10     The commissioner of human services shall provide 
165.11  recommendations to the legislature by December 15, 2006, 
165.12  defining criteria and rate negotiations for nursing facilities 
165.13  that provide specialized care or that have extenuating 
165.14  circumstances requiring a negotiated rate.  The commissioner 
165.15  shall also provide recommendations to the legislature on changes 
165.16  to the current nursing facility property system by December 15, 
165.17  2006. 
165.18                             ARTICLE 5 
165.19            CONTINUING CARE FOR THE ELDERLY AND DISABLED 
165.20     Section 1.  Minnesota Statutes 2004, section 252.27, 
165.21  subdivision 2a, is amended to read: 
165.22     Subd. 2a.  [CONTRIBUTION AMOUNT.] (a) The natural or 
165.23  adoptive parents of a minor child, including a child determined 
165.24  eligible for medical assistance without consideration of 
165.25  parental income, must contribute to the cost of services used by 
165.26  making monthly payments on a sliding scale based on income, 
165.27  unless the child is married or has been married, parental rights 
165.28  have been terminated, or the child's adoption is subsidized 
165.29  according to section 259.67 or through title IV-E of the Social 
165.30  Security Act. 
165.31     (b) For households with adjusted gross income equal to or 
165.32  greater than 100 percent of federal poverty guidelines, the 
165.33  parental contribution shall be computed by applying the 
165.34  following schedule of rates to the adjusted gross income of the 
165.35  natural or adoptive parents: 
165.36     (1) if the adjusted gross income is equal to or greater 
166.1   than 100 percent of federal poverty guidelines and less than 175 
166.2   percent of federal poverty guidelines, the parental contribution 
166.3   is $4 per month; 
166.4      (2) if the adjusted gross income is equal to or greater 
166.5   than 175 percent of federal poverty guidelines and less than or 
166.6   equal to 375 545 percent of federal poverty guidelines, the 
166.7   parental contribution shall be determined using a sliding fee 
166.8   scale established by the commissioner of human services which 
166.9   begins at one percent of adjusted gross income at 175 percent of 
166.10  federal poverty guidelines and increases to 7.5 percent of 
166.11  adjusted gross income for those with adjusted gross income up to 
166.12  375 545 percent of federal poverty guidelines; 
166.13     (3) if the adjusted gross income is greater than 375 545 
166.14  percent of federal poverty guidelines and less than 675 percent 
166.15  of federal poverty guidelines, the parental contribution shall 
166.16  be 7.5 percent of adjusted gross income; 
166.17     (4) if the adjusted gross income is equal to or greater 
166.18  than 675 percent of federal poverty guidelines and less than 975 
166.19  percent of federal poverty guidelines, the parental contribution 
166.20  shall be determined using a sliding fee scale established by the 
166.21  commissioner of human services which begins at 7.5 percent of 
166.22  adjusted gross income at 675 percent of federal poverty 
166.23  guidelines and increases to ten percent of adjusted gross income 
166.24  for those with adjusted gross income up to 975 percent of 
166.25  federal poverty guidelines; and 
166.26     (5) if the adjusted gross income is equal to or greater 
166.27  than 975 percent of federal poverty guidelines, the parental 
166.28  contribution shall be 12.5 percent of adjusted gross income. 
166.29     If the child lives with the parent, the annual adjusted 
166.30  gross income is reduced by $2,400 prior to calculating the 
166.31  parental contribution.  If the child resides in an institution 
166.32  specified in section 256B.35, the parent is responsible for the 
166.33  personal needs allowance specified under that section in 
166.34  addition to the parental contribution determined under this 
166.35  section.  The parental contribution is reduced by any amount 
166.36  required to be paid directly to the child pursuant to a court 
167.1   order, but only if actually paid. 
167.2      (c) The household size to be used in determining the amount 
167.3   of contribution under paragraph (b) includes natural and 
167.4   adoptive parents and their dependents, including the child 
167.5   receiving services.  Adjustments in the contribution amount due 
167.6   to annual changes in the federal poverty guidelines shall be 
167.7   implemented on the first day of July following publication of 
167.8   the changes. 
167.9      (d) For purposes of paragraph (b), "income" means the 
167.10  adjusted gross income of the natural or adoptive parents 
167.11  determined according to the previous year's federal tax form, 
167.12  except, effective retroactive to July 1, 2003, taxable capital 
167.13  gains to the extent the funds have been used to purchase a home 
167.14  shall not be counted as income. 
167.15     (e) The contribution shall be explained in writing to the 
167.16  parents at the time eligibility for services is being 
167.17  determined.  The contribution shall be made on a monthly basis 
167.18  effective with the first month in which the child receives 
167.19  services.  Annually upon redetermination or at termination of 
167.20  eligibility, if the contribution exceeded the cost of services 
167.21  provided, the local agency or the state shall reimburse that 
167.22  excess amount to the parents, either by direct reimbursement if 
167.23  the parent is no longer required to pay a contribution, or by a 
167.24  reduction in or waiver of parental fees until the excess amount 
167.25  is exhausted. 
167.26     (f) The monthly contribution amount must be reviewed at 
167.27  least every 12 months; when there is a change in household size; 
167.28  and when there is a loss of or gain in income from one month to 
167.29  another in excess of ten percent.  The local agency shall mail a 
167.30  written notice 30 days in advance of the effective date of a 
167.31  change in the contribution amount.  A decrease in the 
167.32  contribution amount is effective in the month that the parent 
167.33  verifies a reduction in income or change in household size. 
167.34     (g) Parents of a minor child who do not live with each 
167.35  other shall each pay the contribution required under paragraph 
167.36  (a).  An amount equal to the annual court-ordered child support 
168.1   payment actually paid on behalf of the child receiving services 
168.2   shall be deducted from the adjusted gross income of the parent 
168.3   making the payment prior to calculating the parental 
168.4   contribution under paragraph (b). 
168.5      (h) The contribution under paragraph (b) shall be increased 
168.6   by an additional five percent if the local agency determines 
168.7   that insurance coverage is available but not obtained for the 
168.8   child.  For purposes of this section, "available" means the 
168.9   insurance is a benefit of employment for a family member at an 
168.10  annual cost of no more than five percent of the family's annual 
168.11  income.  For purposes of this section, "insurance" means health 
168.12  and accident insurance coverage, enrollment in a nonprofit 
168.13  health service plan, health maintenance organization, 
168.14  self-insured plan, or preferred provider organization. 
168.15     Parents who have more than one child receiving services 
168.16  shall not be required to pay more than the amount for the child 
168.17  with the highest expenditures.  There shall be no resource 
168.18  contribution from the parents.  The parent shall not be required 
168.19  to pay a contribution in excess of the cost of the services 
168.20  provided to the child, not counting payments made to school 
168.21  districts for education-related services.  Notice of an increase 
168.22  in fee payment must be given at least 30 days before the 
168.23  increased fee is due.  
168.24     (i) The contribution under paragraph (b) shall be reduced 
168.25  by $300 per fiscal year if, in the 12 months prior to July 1: 
168.26     (1) the parent applied for insurance for the child; 
168.27     (2) the insurer denied insurance; 
168.28     (3) the parents submitted a complaint or appeal, in writing 
168.29  to the insurer, submitted a complaint or appeal, in writing, to 
168.30  the commissioner of health or the commissioner of commerce, or 
168.31  litigated the complaint or appeal; and 
168.32     (4) as a result of the dispute, the insurer reversed its 
168.33  decision and granted insurance. 
168.34     For purposes of this section, "insurance" has the meaning 
168.35  given in paragraph (h). 
168.36     A parent who has requested a reduction in the contribution 
169.1   amount under this paragraph shall submit proof in the form and 
169.2   manner prescribed by the commissioner or county agency, 
169.3   including, but not limited to, the insurer's denial of 
169.4   insurance, the written letter or complaint of the parents, court 
169.5   documents, and the written response of the insurer approving 
169.6   insurance.  The determinations of the commissioner or county 
169.7   agency under this paragraph are not rules subject to chapter 14. 
169.8      Sec. 2.  [256B.0185] [REQUIRED REPORT.] 
169.9      Subdivision 1.  [PENDING APPLICATION.] By December 15 of 
169.10  both 2005 and 2006, the commissioner must deliver to the 
169.11  legislature a report that identifies: 
169.12     (1) each county in which an application for medical 
169.13  assistance from a person identified as residing in a long-term 
169.14  care facility is or was pending, at any time between January 1 
169.15  and December 1 of the calendar year to which the report relates, 
169.16  for more than 60 days in the case of a person who is disabled, 
169.17  or for more than 45 days in the case of a person who is age 65 
169.18  or older; and 
169.19     (2) for each of the identified counties:  the number of 
169.20  applications described in clause (1), the average number of days 
169.21  the applications were pending, the distribution of days for 
169.22  applications that were pending, and what percentage of the 
169.23  applications, respectively, the county approved and denied. 
169.24     Subd. 2.  [TIME TO PROCESS APPLICATION.] The report must 
169.25  include specific recommendations for how counties, as a group, 
169.26  could shorten the time it takes to act on the applications 
169.27  described in subdivision 1, clause (1). 
169.28     Sec. 3.  Minnesota Statutes 2004, section 256B.057, 
169.29  subdivision 9, is amended to read: 
169.30     Subd. 9.  [EMPLOYED PERSONS WITH DISABILITIES.] (a) Medical 
169.31  assistance may be paid for a person who is employed and who: 
169.32     (1) meets the definition of disabled under the supplemental 
169.33  security income program; 
169.34     (2) is at least 16 but less than 65 years of age; 
169.35     (3) meets the asset limits in paragraph (b); and 
169.36     (4) effective November 1, 2003, pays a premium and other 
170.1   obligations under paragraph (d).  
170.2   Any spousal income or assets shall be disregarded for purposes 
170.3   of eligibility and premium determinations. 
170.4      After the month of enrollment, a person enrolled in medical 
170.5   assistance under this subdivision who: 
170.6      (1) is temporarily unable to work and without receipt of 
170.7   earned income due to a medical condition, as verified by a 
170.8   physician, may retain eligibility for up to four calendar 
170.9   months; or 
170.10     (2) effective January 1, 2004, loses employment for reasons 
170.11  not attributable to the enrollee, may retain eligibility for up 
170.12  to four consecutive months after the month of job loss.  To 
170.13  receive a four-month extension, enrollees must verify the 
170.14  medical condition or provide notification of job loss.  All 
170.15  other eligibility requirements must be met and the enrollee must 
170.16  pay all calculated premium costs for continued eligibility. 
170.17     (b) For purposes of determining eligibility under this 
170.18  subdivision, a person's assets must not exceed $20,000, 
170.19  excluding: 
170.20     (1) all assets excluded under section 256B.056; 
170.21     (2) retirement accounts, including individual accounts, 
170.22  401(k) plans, 403(b) plans, Keogh plans, and pension plans; and 
170.23     (3) medical expense accounts set up through the person's 
170.24  employer. 
170.25     (c)(1) Effective January 1, 2004, for purposes of 
170.26  eligibility, there will be a $65 earned income disregard.  To be 
170.27  eligible, a person applying for medical assistance under this 
170.28  subdivision must have earned income above the disregard level. 
170.29     (2) Effective January 1, 2004, to be considered earned 
170.30  income, Medicare, Social Security, and applicable state and 
170.31  federal income taxes must be withheld.  To be eligible, a person 
170.32  must document earned income tax withholding. 
170.33     (d)(1) A person whose earned and unearned income is equal 
170.34  to or greater than 100 percent of federal poverty guidelines for 
170.35  the applicable family size must pay a premium to be eligible for 
170.36  medical assistance under this subdivision.  The premium shall be 
171.1   based on the person's gross earned and unearned income and the 
171.2   applicable family size using a sliding fee scale established by 
171.3   the commissioner, which begins at one percent of income at 100 
171.4   percent of the federal poverty guidelines and increases to 7.5 
171.5   percent of income for those with incomes at or above 300 percent 
171.6   of the federal poverty guidelines.  Annual adjustments in the 
171.7   premium schedule based upon changes in the federal poverty 
171.8   guidelines shall be effective for premiums due in July of each 
171.9   year.  
171.10     (2) Effective January 1, 2004, all enrollees must pay a 
171.11  premium to be eligible for medical assistance under this 
171.12  subdivision.  An enrollee shall pay the greater of a $35 premium 
171.13  or the premium calculated in clause (1). 
171.14     (3) Effective November 1, 2003, all enrollees who receive 
171.15  unearned income must pay one-half of one percent of unearned 
171.16  income in addition to the premium amount. 
171.17     (4) Effective November 1, 2003 July 1, 2005, for 
171.18  enrollees whose income does not exceed 200 percent of the 
171.19  federal poverty guidelines and who are also enrolled in 
171.20  Medicare, the commissioner must reimburse the enrollee for 
171.21  Medicare Part B premiums under section 256B.0625, subdivision 
171.22  15, paragraph (a).  
171.23     (5) Increases in benefits under title II of the Social 
171.24  Security Act shall not be counted as income for purposes of this 
171.25  subdivision until July 1 of each year.  
171.26     (e) A person's eligibility and premium shall be determined 
171.27  by the local county agency.  Premiums must be paid to the 
171.28  commissioner.  All premiums are dedicated to the commissioner. 
171.29     (f) Any required premium shall be determined at application 
171.30  and redetermined at the enrollee's six-month income review or 
171.31  when a change in income or household size is reported.  
171.32  Enrollees must report any change in income or household size 
171.33  within ten days of when the change occurs.  A decreased premium 
171.34  resulting from a reported change in income or household size 
171.35  shall be effective the first day of the next available billing 
171.36  month after the change is reported.  Except for changes 
172.1   occurring from annual cost-of-living increases, a change 
172.2   resulting in an increased premium shall not affect the premium 
172.3   amount until the next six-month review. 
172.4      (g) Premium payment is due upon notification from the 
172.5   commissioner of the premium amount required.  Premiums may be 
172.6   paid in installments at the discretion of the commissioner. 
172.7      (h) Nonpayment of the premium shall result in denial or 
172.8   termination of medical assistance unless the person demonstrates 
172.9   good cause for nonpayment.  Good cause exists if the 
172.10  requirements specified in Minnesota Rules, part 9506.0040, 
172.11  subpart 7, items B to D, are met.  Except when an installment 
172.12  agreement is accepted by the commissioner, all persons 
172.13  disenrolled for nonpayment of a premium must pay any past due 
172.14  premiums as well as current premiums due prior to being 
172.15  reenrolled.  Nonpayment shall include payment with a returned, 
172.16  refused, or dishonored instrument.  The commissioner may require 
172.17  a guaranteed form of payment as the only means to replace a 
172.18  returned, refused, or dishonored instrument. 
172.19     Sec. 4.  [256B.0571] [LONG-TERM CARE PARTNERSHIP.] 
172.20     Subdivision 1.  [DEFINITIONS.] For purposes of this 
172.21  section, the following terms have the meanings given them. 
172.22     Subd. 2.  [HOME CARE SERVICE.] "Home care service" means 
172.23  care described in section 144A.43. 
172.24     Subd. 3.  [LONG-TERM CARE INSURANCE.] "Long-term care 
172.25  insurance" means a policy described in section 62S.01. 
172.26     Subd. 4.  [MEDICAL ASSISTANCE.] "Medical assistance" means 
172.27  the program of medical assistance established under section 
172.28  256B.01. 
172.29     Subd. 5.  [NURSING HOME.] "Nursing home" means a nursing 
172.30  home as described in section 144A.01. 
172.31     Subd. 6.  [PARTNERSHIP POLICY.] "Partnership policy" means 
172.32  a long-term care insurance policy that meets the requirements 
172.33  under subdivision 10. 
172.34     Subd. 7.  [PARTNERSHIP PROGRAM.] "Partnership program" 
172.35  means the Minnesota partnership for long-term care program 
172.36  established under this section. 
173.1      Subd. 8.  [PROGRAM ESTABLISHED.] (a) The commissioner, in 
173.2   cooperation with the commissioner of commerce, shall establish 
173.3   the Minnesota partnership for long-term care program to provide 
173.4   for the financing of long-term care through a combination of 
173.5   private insurance and medical assistance. 
173.6      (b) An individual who meets the requirements in this 
173.7   paragraph is eligible to participate in the partnership 
173.8   program.  The individual must: 
173.9      (1) be a Minnesota resident; 
173.10     (2) purchase a partnership policy that is delivered, issued 
173.11  for delivery, or renewed on or after the effective date of this 
173.12  section, and maintain the partnership policy in effect 
173.13  throughout the period of participation in the partnership 
173.14  program; and 
173.15     (3) exhaust the minimum benefits under the partnership 
173.16  policy as described in this section.  Benefits received under a 
173.17  long-term care insurance policy before the effective date of 
173.18  this section do not count toward the exhaustion of benefits 
173.19  required in this subdivision. 
173.20     Subd. 9.  [MEDICAL ASSISTANCE ELIGIBILITY.] (a) Upon 
173.21  application of an individual who meets the requirements 
173.22  described in subdivision 8, the commissioner shall determine the 
173.23  individual's eligibility for medical assistance according to 
173.24  paragraphs (b) and (c). 
173.25     (b) After disregarding financial assets exempted under 
173.26  medical assistance eligibility requirements, the commissioner 
173.27  shall disregard an additional amount of financial assets equal 
173.28  to the dollar amount of coverage utilized under the partnership 
173.29  policy. 
173.30     (c) The commissioner shall consider the individual's income 
173.31  according to medical assistance eligibility requirements. 
173.32     Subd. 10.  [APPROVED POLICIES.] (a) A partnership policy 
173.33  must meet all of the requirements in paragraphs (b) to (h).  
173.34     (b) Minimum coverage shall be for a period of not less than 
173.35  three years and for a dollar amount equal to 36 months of 
173.36  nursing home care at the minimum daily benefit rate determined 
174.1   and adjusted under paragraph (c).  The policy shall provide for 
174.2   home health care benefits to be substituted for nursing home 
174.3   care benefits on the basis of two home health care days for one 
174.4   nursing home care day. 
174.5      (c) Minimum daily benefits shall be $150 for nursing home 
174.6   care or $75 for home care, with inflation protection provided in 
174.7   the policy as described in section 62S.23, subdivision 1, clause 
174.8   (1).  These minimum daily benefit amounts shall also be adjusted 
174.9   by the commissioner on October 1 of each year by a percentage 
174.10  equal to the inflation protection feature described in section 
174.11  62S.23, subdivision 1, clause (1), for purposes of setting 
174.12  minimum requirements that a policy must meet in future years in 
174.13  order to initially qualify as an approved policy under this 
174.14  subdivision.  Adjusted minimum daily benefit amounts shall be 
174.15  rounded to the nearest whole dollar.  
174.16     (d) A third party designated by the insured shall be 
174.17  entitled to receive notice if the policy is about to lapse for 
174.18  nonpayment of premium, and an additional 30-day grace period for 
174.19  payment of premium shall be granted following notification to 
174.20  that person. 
174.21     (e) The policy must cover all of the following services: 
174.22     (1) nursing home stay; 
174.23     (2) home care service; 
174.24     (3) care management; and 
174.25     (4) up to 14 days of nursing care in a hospital while the 
174.26  individual is waiting for long-term care placement. 
174.27     (f) Payment for service under paragraph (e), clause (4), 
174.28  must not exceed the daily benefit amount for nursing home care. 
174.29     (g) A partnership policy must offer, as an option for an 
174.30  adjusted premium, an elimination period of not more than 180 
174.31  days. 
174.32     (h) An issuer of a partnership policy must comply with any 
174.33  federal law authorizing partnership policies in Minnesota, 
174.34  including any federal regulations, as amended, adopted under 
174.35  that law.  This paragraph does not require compliance with any 
174.36  provision of this federal law until the date upon which the law 
175.1   requires compliance with the provision.  The commissioner has 
175.2   authority to enforce this paragraph. 
175.3      Subd. 11.  [LIMITATIONS ON ESTATE RECOVERY.] For an 
175.4   individual determined eligible for medical assistance under 
175.5   subdivision 9, the state shall not seek recovery under the 
175.6   provisions of section 256B.15 against the estate of the 
175.7   individual or individual's spouse for medical assistance 
175.8   benefits received by that individual. 
175.9      Subd. 12.  [EFFECTIVE DATE.] (a) If any provision of this 
175.10  section is prohibited by federal law, no provision shall become 
175.11  effective until federal law is changed to permit its full 
175.12  implementation.  The commissioner of human services shall notify 
175.13  the revisor of statutes when federal law is enacted or other 
175.14  federal approval is received and publish a notice in the State 
175.15  Register.  The commissioner must include the notice in the first 
175.16  State Register published after the effective date of the federal 
175.17  changes. 
175.18     (b) If federal law is changed to permit a waiver of any 
175.19  provisions prohibited by federal law, the commissioner of human 
175.20  services shall apply to the federal government for a waiver of 
175.21  those prohibitions or other federal authority, and that 
175.22  provision shall become effective upon receipt of a federal 
175.23  waiver or other federal approval, notification to the revisor of 
175.24  statutes, and publication of a notice in the State Register to 
175.25  that effect. 
175.26     Sec. 5.  Minnesota Statutes 2004, section 256B.0621, 
175.27  subdivision 2, is amended to read: 
175.28     Subd. 2.  [TARGETED CASE MANAGEMENT; DEFINITIONS.] For 
175.29  purposes of subdivisions 3 to 10, the following terms have the 
175.30  meanings given them: 
175.31     (1) "home care service recipients" means those individuals 
175.32  receiving the following services under section 256B.0627:  
175.33  skilled nursing visits, home health aide visits, private duty 
175.34  nursing, personal care assistants, or therapies provided through 
175.35  a home health agency; 
175.36     (2) "home care targeted case management" means the 
176.1   provision of targeted case management services for the purpose 
176.2   of assisting home care service recipients to gain access to 
176.3   needed services and supports so that they may remain in the 
176.4   community; 
176.5      (3) "institutions" means hospitals, consistent with Code of 
176.6   Federal Regulations, title 42, section 440.10; regional 
176.7   treatment center inpatient services, consistent with section 
176.8   245.474; nursing facilities; and intermediate care facilities 
176.9   for persons with mental retardation; 
176.10     (4) "relocation targeted case management" means includes 
176.11  the provision of both county targeted case management and public 
176.12  or private vendor service coordination services for the purpose 
176.13  of assisting recipients to gain access to needed services and 
176.14  supports if they choose to move from an institution to the 
176.15  community.  Relocation targeted case management may be provided 
176.16  during the last 180 consecutive days of an eligible recipient's 
176.17  institutional stay; and 
176.18     (5) "targeted case management" means case management 
176.19  services provided to help recipients gain access to needed 
176.20  medical, social, educational, and other services and supports. 
176.21     Sec. 6.  Minnesota Statutes 2004, section 256B.0621, 
176.22  subdivision 3, is amended to read: 
176.23     Subd. 3.  [ELIGIBILITY.] The following persons are eligible 
176.24  for relocation targeted case management or home care-targeted 
176.25  care targeted case management: 
176.26     (1) medical assistance eligible persons residing in 
176.27  institutions who choose to move into the community are eligible 
176.28  for relocation targeted case management services; and 
176.29     (2) medical assistance eligible persons receiving home care 
176.30  services, who are not eligible for any other medical assistance 
176.31  reimbursable case management service, are eligible for home 
176.32  care-targeted care targeted case management services beginning 
176.33  January 1, 2003 July 1, 2005. 
176.34     Sec. 7.  Minnesota Statutes 2004, section 256B.0621, 
176.35  subdivision 4, is amended to read: 
176.36     Subd. 4.  [RELOCATION TARGETED COUNTY CASE MANAGEMENT 
177.1   PROVIDER QUALIFICATIONS.] (a) A relocation targeted county case 
177.2   management provider is an enrolled medical assistance provider 
177.3   who is determined by the commissioner to have all of the 
177.4   following characteristics: 
177.5      (1) the legal authority to provide public welfare under 
177.6   sections 393.01, subdivision 7; and 393.07; or a federally 
177.7   recognized Indian tribe; 
177.8      (2) the demonstrated capacity and experience to provide the 
177.9   components of case management to coordinate and link community 
177.10  resources needed by the eligible population; 
177.11     (3) the administrative capacity and experience to serve the 
177.12  target population for whom it will provide services and ensure 
177.13  quality of services under state and federal requirements; 
177.14     (4) the legal authority to provide complete investigative 
177.15  and protective services under section 626.556, subdivision 10; 
177.16  and child welfare and foster care services under section 393.07, 
177.17  subdivisions 1 and 2; or a federally recognized Indian tribe; 
177.18     (5) a financial management system that provides accurate 
177.19  documentation of services and costs under state and federal 
177.20  requirements; and 
177.21     (6) the capacity to document and maintain individual case 
177.22  records under state and federal requirements. 
177.23     (b) A provider of targeted case management under section 
177.24  256B.0625, subdivision 20, may be deemed a certified provider of 
177.25  relocation targeted case management. 
177.26     (c) A relocation targeted county case management provider 
177.27  may subcontract with another provider to deliver relocation 
177.28  targeted case management services.  Subcontracted providers must 
177.29  demonstrate the ability to provide the services outlined in 
177.30  subdivision 6, and have a procedure in place that notifies the 
177.31  recipient and the recipient's legal representative of any 
177.32  conflict of interest if the contracted targeted case management 
177.33  provider also provides, or will provide, the recipient's 
177.34  services and supports.  Counties must require that contracted 
177.35  providers must provide information on all conflicts of interest 
177.36  and obtain the recipient's informed consent or provide the 
178.1   recipient with alternatives. 
178.2      Sec. 8.  Minnesota Statutes 2004, section 256B.0621, 
178.3   subdivision 5, is amended to read: 
178.4      Subd. 5.  [HOME CARE TARGETED CASE MANAGEMENT AND 
178.5   RELOCATION SERVICE COORDINATION PROVIDER QUALIFICATIONS.] The 
178.6   following qualifications and certification standards must be met 
178.7   by Providers of home care targeted case management and 
178.8   relocation service coordination must meet the qualifications 
178.9   under subdivision 4 for county vendors or the qualifications and 
178.10  certification standards under paragraphs (a) and (b) for private 
178.11  vendors. 
178.12     (a) The commissioner must certify each provider of home 
178.13  care targeted case management and relocation service 
178.14  coordination before enrollment.  The certification process shall 
178.15  examine the provider's ability to meet the requirements in this 
178.16  subdivision and other state and federal requirements of this 
178.17  service. 
178.18     (b) A Both home care targeted case management provider is 
178.19  an providers and relocation service coordination providers are 
178.20  enrolled medical assistance provider providers who has have a 
178.21  minimum of a bachelor's degree or a license in a health or human 
178.22  services field, or comparable training and two years of 
178.23  experience in human services, and is have been determined by the 
178.24  commissioner to have all of the following characteristics: 
178.25     (1) the demonstrated capacity and experience to provide the 
178.26  components of case management to coordinate and link community 
178.27  resources needed by the eligible population; 
178.28     (2) the administrative capacity and experience to serve the 
178.29  target population for whom it will provide services and ensure 
178.30  quality of services under state and federal requirements; 
178.31     (3) a financial management system that provides accurate 
178.32  documentation of services and costs under state and federal 
178.33  requirements; 
178.34     (4) the capacity to document and maintain individual case 
178.35  records under state and federal requirements; and 
178.36     (5) the capacity to coordinate with county administrative 
179.1   functions; 
179.2      (6) have no financial interest in the provision of 
179.3   out-of-home residential services to persons for whom home care 
179.4   targeted case management or relocation service coordination is 
179.5   provided; and 
179.6      (7) if a provider has a financial interest in services 
179.7   other than out-of-home residential services provided to persons 
179.8   for whom home care targeted case management or relocation 
179.9   service coordination is also provided, the county must determine 
179.10  each year that: 
179.11     (i) any possible conflict of interest is explained annually 
179.12  at a face-to-face meeting and in writing and the person provides 
179.13  written informed consent consistent with section 256B.77, 
179.14  subdivision 2, paragraph (p); and 
179.15     (ii) information on a range of other feasible service 
179.16  provider options has been provided. 
179.17     Sec. 9.  Minnesota Statutes 2004, section 256B.0621, 
179.18  subdivision 6, is amended to read: 
179.19     Subd. 6.  [ELIGIBLE SERVICES.] (a) Services eligible for 
179.20  medical assistance reimbursement as targeted case management 
179.21  include: 
179.22     (1) assessment of the recipient's need for targeted case 
179.23  management services and for persons choosing to relocate, the 
179.24  county must provide service coordination provider options at the 
179.25  first contact and upon request; 
179.26     (2) development, completion, and regular review of a 
179.27  written individual service plan, which is based upon the 
179.28  assessment of the recipient's needs and choices, and which will 
179.29  ensure access to medical, social, educational, and other related 
179.30  services and supports; 
179.31     (3) routine contact or communication with the recipient, 
179.32  recipient's family, primary caregiver, legal representative, 
179.33  substitute care provider, service providers, or other relevant 
179.34  persons identified as necessary to the development or 
179.35  implementation of the goals of the individual service plan; 
179.36     (4) coordinating referrals for, and the provision of, case 
180.1   management services for the recipient with appropriate service 
180.2   providers, consistent with section 1902(a)(23) of the Social 
180.3   Security Act; 
180.4      (5) coordinating and monitoring the overall service 
180.5   delivery and engaging in advocacy as needed to ensure quality of 
180.6   services, appropriateness, and continued need; 
180.7      (6) completing and maintaining necessary documentation that 
180.8   supports and verifies the activities in this subdivision; 
180.9      (7) traveling assisting individuals in order to access 
180.10  needed services, including travel to conduct a visit with the 
180.11  recipient or other relevant person necessary to develop or 
180.12  implement the goals of the individual service plan; and 
180.13     (8) coordinating with the institution discharge planner in 
180.14  the 180-day period before the recipient's discharge. 
180.15     (b) Relocation targeted county case management includes 
180.16  services under paragraph (a), clauses (1), (2), and (4).  
180.17  Relocation service coordination includes services under 
180.18  paragraph (a), clauses (3) and (5) to (8).  Home care targeted 
180.19  case management includes services under paragraph (a), clauses 
180.20  (1) to (8). 
180.21     Sec. 10.  Minnesota Statutes 2004, section 256B.0621, 
180.22  subdivision 7, is amended to read: 
180.23     Subd. 7.  [TIME LINES.] The following time lines must be 
180.24  met for assigning a case manager: 
180.25     (a) For relocation targeted case management, an eligible 
180.26  recipient must be assigned a county case manager who visits the 
180.27  person within 20 working days of requesting a case manager from 
180.28  their county of financial responsibility as determined under 
180.29  chapter 256G. 
180.30     (1) If a county agency, its contractor, or federally 
180.31  recognized tribe does not provide case management services as 
180.32  required, the recipient may obtain targeted relocation case 
180.33  management services relocation service coordination from an 
180.34  alternative a provider of targeted case management services 
180.35  enrolled by the commissioner qualified under subdivision 5. 
180.36     (2) The commissioner may waive the provider requirements in 
181.1   subdivision 4, paragraph (a), clauses (1) and (4), to ensure 
181.2   recipient access to the assistance necessary to move from an 
181.3   institution to the community.  The recipient or the recipient's 
181.4   legal guardian shall provide written notice to the county or 
181.5   tribe of the decision to obtain services from an alternative 
181.6   provider. 
181.7      (3) Providers of relocation targeted case management 
181.8   enrolled under this subdivision shall: 
181.9      (i) meet the provider requirements under subdivision 4 that 
181.10  are not waived by the commissioner; 
181.11     (ii) be qualified to provide the services specified in 
181.12  subdivision 6; 
181.13     (iii) coordinate efforts with local social service agencies 
181.14  and tribes; and 
181.15     (iv) comply with the conflict of interest provisions 
181.16  established under subdivision 4, paragraph (c). 
181.17     (4) Local social service agencies and federally recognized 
181.18  tribes shall cooperate with providers certified by the 
181.19  commissioner under this subdivision to facilitate the 
181.20  recipient's successful relocation from an institution to the 
181.21  community. 
181.22     (b) For home care targeted case management, an eligible 
181.23  recipient must be assigned a case manager within 20 working days 
181.24  of requesting a case manager from a home care targeted case 
181.25  management provider, as defined in subdivision 5. 
181.26     Sec. 11.  Minnesota Statutes 2004, section 256B.0621, is 
181.27  amended by adding a subdivision to read: 
181.28     Subd. 11.  [DATA USE AGREEMENT AND NOTICE OF RELOCATION 
181.29  TARGETED CASE MANAGEMENT AVAILABILITY.] The commissioner shall 
181.30  execute a data use agreement with the Centers for Medicare and 
181.31  Medicaid Services to obtain the long-term care minimum data set 
181.32  data to assist residents of nursing facilities who have 
181.33  indicated a desire to live in the community.  The commissioner 
181.34  shall in turn enter into agreements with the Centers for 
181.35  Independent Living to provide information about assistance for 
181.36  persons who want to move to the community. 
182.1      Sec. 12.  Minnesota Statutes 2004, section 256B.0625, 
182.2   subdivision 2, is amended to read: 
182.3      Subd. 2.  [SKILLED AND INTERMEDIATE NURSING CARE.] Medical 
182.4   assistance covers skilled nursing home services and services of 
182.5   intermediate care facilities, including training and 
182.6   habilitation services, as defined in section 252.41, subdivision 
182.7   3, for persons with mental retardation or related conditions who 
182.8   are residing in intermediate care facilities for persons with 
182.9   mental retardation or related conditions.  Medical assistance 
182.10  must not be used to pay the costs of nursing care provided to a 
182.11  patient in a swing bed as defined in section 144.562, unless (a) 
182.12  the facility in which the swing bed is located is eligible as a 
182.13  sole community provider, as defined in Code of Federal 
182.14  Regulations, title 42, section 412.92, or the facility is a 
182.15  public hospital owned by a governmental entity with 15 or fewer 
182.16  licensed acute care beds; (b) the Centers for Medicare and 
182.17  Medicaid Services approves the necessary state plan amendments; 
182.18  (c) the patient was screened as provided by law; (d) the patient 
182.19  no longer requires acute care services; and (e) no nursing home 
182.20  beds are available within 25 miles of the facility.  The 
182.21  commissioner shall exempt a facility from compliance with the 
182.22  sole community provider requirement in clause (a) if, as of 
182.23  January 1, 2004, the facility had an agreement with the 
182.24  commissioner to provide medical assistance swing bed services.  
182.25  Medical assistance also covers up to ten days of nursing care 
182.26  provided to a patient in a swing bed if:  (1) the patient's 
182.27  physician certifies that the patient has a terminal illness or 
182.28  condition that is likely to result in death within 30 days and 
182.29  that moving the patient would not be in the best interests of 
182.30  the patient and patient's family; (2) no open nursing home beds 
182.31  are available within 25 miles of the facility; and (3) no open 
182.32  beds are available in any Medicare hospice program within 50 
182.33  miles of the facility.  The daily medical assistance payment for 
182.34  nursing care for the patient in the swing bed is the statewide 
182.35  average medical assistance skilled nursing care per diem as 
182.36  computed annually by the commissioner on July 1 of each year. 
183.1      <b>[EFFECTIVE DATE.]</b> This section is effective the day 
183.2   following final enactment and applies to medical assistance 
183.3   payments for swing bed services provided on or after March 5, 
183.4   2005. 
183.5      Sec. 13.  Minnesota Statutes 2004, section 256B.0913, 
183.6   subdivision 2, is amended to read: 
183.7      Subd. 2.  [ELIGIBILITY FOR SERVICES.] Alternative care 
183.8   services are available to Minnesotans age 65 or older who would 
183.9   be eligible for medical assistance within 180 120 days of 
183.10  admission to a nursing facility and subject to subdivisions 4 to 
183.11  13. 
183.12     Sec. 14.  Minnesota Statutes 2004, section 256B.0913, 
183.13  subdivision 4, is amended to read: 
183.14     Subd. 4.  [ELIGIBILITY FOR FUNDING FOR SERVICES FOR 
183.15  NONMEDICAL ASSISTANCE RECIPIENTS.] (a) Funding for services 
183.16  under the alternative care program is available to persons who 
183.17  meet the following criteria: 
183.18     (1) the person has been determined by a community 
183.19  assessment under section 256B.0911 to be a person who would 
183.20  require the level of care provided in a nursing facility, but 
183.21  for the provision of services under the alternative care 
183.22  program; 
183.23     (2) the person is age 65 or older; 
183.24     (3) the person would be eligible for medical assistance 
183.25  within 180 120 days of admission to a nursing facility; 
183.26     (4) the person is not ineligible for the medical assistance 
183.27  program due to an asset transfer penalty; 
183.28     (5) the person needs services that are not funded through 
183.29  other state or federal funding; 
183.30     (6) the monthly cost of the alternative care services 
183.31  funded by the program for this person does not exceed 75 percent 
183.32  of the monthly limit described under section 256B.0915, 
183.33  subdivision 3a.  This monthly limit does not prohibit the 
183.34  alternative care client from payment for additional services, 
183.35  but in no case may the cost of additional services purchased 
183.36  under this section exceed the difference between the client's 
184.1   monthly service limit defined under section 256B.0915, 
184.2   subdivision 3, and the alternative care program monthly service 
184.3   limit defined in this paragraph.  If medical supplies and 
184.4   equipment or environmental modifications are or will be 
184.5   purchased for an alternative care services recipient, the costs 
184.6   may be prorated on a monthly basis for up to 12 consecutive 
184.7   months beginning with the month of purchase.  If the monthly 
184.8   cost of a recipient's other alternative care services exceeds 
184.9   the monthly limit established in this paragraph, the annual cost 
184.10  of the alternative care services shall be determined.  In this 
184.11  event, the annual cost of alternative care services shall not 
184.12  exceed 12 times the monthly limit described in this paragraph; 
184.13  and 
184.14     (7) the person is making timely payments of the assessed 
184.15  monthly fee. 
184.16  A person is ineligible if payment of the fee is over 60 days 
184.17  past due, unless the person agrees to: 
184.18     (i) the appointment of a representative payee; 
184.19     (ii) automatic payment from a financial account; 
184.20     (iii) the establishment of greater family involvement in 
184.21  the financial management of payments; or 
184.22     (iv) another method acceptable to the county to ensure 
184.23  prompt fee payments. 
184.24     The county shall extend the client's eligibility as 
184.25  necessary while making arrangements to facilitate payment of 
184.26  past-due amounts and future premium payments.  Following 
184.27  disenrollment due to nonpayment of a monthly fee, eligibility 
184.28  shall not be reinstated for a period of 30 days. 
184.29     (b) Alternative care funding under this subdivision is not 
184.30  available for a person who is a medical assistance recipient or 
184.31  who would be eligible for medical assistance without a spenddown 
184.32  or waiver obligation.  A person whose initial application for 
184.33  medical assistance and the elderly waiver program is being 
184.34  processed may be served under the alternative care program for a 
184.35  period up to 60 days.  If the individual is found to be eligible 
184.36  for medical assistance, medical assistance must be billed for 
185.1   services payable under the federally approved elderly waiver 
185.2   plan and delivered from the date the individual was found 
185.3   eligible for the federally approved elderly waiver plan.  
185.4   Notwithstanding this provision, alternative care funds may not 
185.5   be used to pay for any service the cost of which:  (i) is 
185.6   payable by medical assistance; (ii) is used by a recipient to 
185.7   meet a waiver obligation; or (iii) is used to pay a medical 
185.8   assistance income spenddown for a person who is eligible to 
185.9   participate in the federally approved elderly waiver program 
185.10  under the special income standard provision. 
185.11     (c) Alternative care funding is not available for a person 
185.12  who resides in a licensed nursing home, certified boarding care 
185.13  home, hospital, or intermediate care facility, except for case 
185.14  management services which are provided in support of the 
185.15  discharge planning process for a nursing home resident or 
185.16  certified boarding care home resident to assist with a 
185.17  relocation process to a community-based setting. 
185.18     (d) Alternative care funding is not available for a person 
185.19  whose income is greater than the maintenance needs allowance 
185.20  under section 256B.0915, subdivision 1d, but equal to or less 
185.21  than 120 percent of the federal poverty guideline effective July 
185.22  1 in the year for which alternative care eligibility is 
185.23  determined, who would be eligible for the elderly waiver with a 
185.24  waiver obligation. 
185.25     Sec. 15.  Minnesota Statutes 2004, section 256B.0916, is 
185.26  amended by adding a subdivision to read: 
185.27     Subd. 10.  [TRANSITIONAL SUPPORTS ALLOWANCE.] A 
185.28  transitional supports allowance shall be available to all 
185.29  persons under a home and community-based waiver who are moving 
185.30  from a licensed setting to a community setting.  "Transitional 
185.31  supports allowance" means a onetime payment of up to $3,000, to 
185.32  cover the costs, not covered by other sources, associated with 
185.33  moving from a licensed setting to a community setting.  Covered 
185.34  costs include: 
185.35     (1) lease or rent deposits; 
185.36     (2) security deposits; 
186.1      (3) utilities set-up costs, including telephone; 
186.2      (4) essential furnishings and supplies; and 
186.3      (5) personal supports and transports needed to locate and 
186.4   transition to community settings. 
186.5      <b>[EFFECTIVE DATE.]</b> This section is effective upon federal 
186.6   approval and to the extent approved as a federal waiver 
186.7   amendment. 
186.8      Sec. 16.  Minnesota Statutes 2004, section 256B.095, is 
186.9   amended to read: 
186.10     256B.095 [QUALITY ASSURANCE SYSTEM ESTABLISHED.] 
186.11     (a) Effective July 1, 1998, a quality assurance system for 
186.12  persons with developmental disabilities, which includes an 
186.13  alternative quality assurance licensing system for programs, is 
186.14  established in Dodge, Fillmore, Freeborn, Goodhue, Houston, 
186.15  Mower, Olmsted, Rice, Steele, Wabasha, and Winona Counties for 
186.16  the purpose of improving the quality of services provided to 
186.17  persons with developmental disabilities.  A county, at its 
186.18  option, may choose to have all programs for persons with 
186.19  developmental disabilities located within the county licensed 
186.20  under chapter 245A using standards determined under the 
186.21  alternative quality assurance licensing system or may continue 
186.22  regulation of these programs under the licensing system operated 
186.23  by the commissioner.  The project expires on June 30, 2007 2009. 
186.24     (b) Effective July 1, 2003, a county not listed in 
186.25  paragraph (a) may apply to participate in the quality assurance 
186.26  system established under paragraph (a).  The commission 
186.27  established under section 256B.0951 may, at its option, allow 
186.28  additional counties to participate in the system. 
186.29     (c) Effective July 1, 2003, any county or group of counties 
186.30  not listed in paragraph (a) may establish a quality assurance 
186.31  system under this section.  A new system established under this 
186.32  section shall have the same rights and duties as the system 
186.33  established under paragraph (a).  A new system shall be governed 
186.34  by a commission under section 256B.0951.  The commissioner shall 
186.35  appoint the initial commission members based on recommendations 
186.36  from advocates, families, service providers, and counties in the 
187.1   geographic area included in the new system.  Counties that 
187.2   choose to participate in a new system shall have the duties 
187.3   assigned under section 256B.0952.  The new system shall 
187.4   establish a quality assurance process under section 256B.0953.  
187.5   The provisions of section 256B.0954 shall apply to a new system 
187.6   established under this paragraph.  The commissioner shall 
187.7   delegate authority to a new system established under this 
187.8   paragraph according to section 256B.0955. 
187.9      Sec. 17.  Minnesota Statutes 2004, section 256B.0951, 
187.10  subdivision 1, is amended to read: 
187.11     Subdivision 1.  [MEMBERSHIP.] The Quality Assurance 
187.12  Commission is established.  The commission consists of at least 
187.13  14 but not more than 21 members as follows:  at least three but 
187.14  not more than five members representing advocacy organizations; 
187.15  at least three but not more than five members representing 
187.16  consumers, families, and their legal representatives; at least 
187.17  three but not more than five members representing service 
187.18  providers; at least three but not more than five members 
187.19  representing counties; and the commissioner of human services or 
187.20  the commissioner's designee.  The first commission shall 
187.21  establish membership guidelines for the transition and 
187.22  recruitment of membership for the commission's ongoing 
187.23  existence.  Members of the commission who do not receive a 
187.24  salary or wages from an employer for time spent on commission 
187.25  duties may receive a per diem payment when performing commission 
187.26  duties and functions.  All members may be reimbursed for 
187.27  expenses related to commission activities.  Notwithstanding the 
187.28  provisions of section 15.059, subdivision 5, the commission 
187.29  expires on June 30, 2007 2009. 
187.30     Sec. 18.  Minnesota Statutes 2004, section 256B.0952, 
187.31  subdivision 5, is amended to read: 
187.32     Subd. 5.  [QUALITY ASSURANCE TEAMS.] Quality assurance 
187.33  teams shall be comprised of county staff; providers; consumers, 
187.34  families, and their legal representatives; members of advocacy 
187.35  organizations; and other involved community members.  Team 
187.36  members must satisfactorily complete the training program 
188.1   approved by the commission and must demonstrate 
188.2   performance-based competency.  Team members are not considered 
188.3   to be county employees for purposes of workers' compensation, 
188.4   unemployment insurance, or state retirement laws solely on the 
188.5   basis of participation on a quality assurance team.  The county 
188.6   may pay a per diem to team members who do not receive a salary 
188.7   or wages from an employer for time spent on alternative quality 
188.8   assurance process matters.  All team members may be reimbursed 
188.9   for expenses related to their participation in the alternative 
188.10  process. 
188.11     Sec. 19.  Minnesota Statutes 2004, section 256B.0953, 
188.12  subdivision 1, is amended to read: 
188.13     Subdivision 1.  [PROCESS COMPONENTS.] (a) The quality 
188.14  assurance licensing process consists of an evaluation by a 
188.15  quality assurance team of the facility, program, or service 
188.16  according to outcome-based measurements.  The process must 
188.17  include an evaluation of a random sample of program consumers.  
188.18  The sample must be representative of each service provided.  The 
188.19  sample size must be at least five percent of consumers but not 
188.20  less than three two consumers.  
188.21     (b) All consumers must be given the opportunity to be 
188.22  included in the quality assurance process in addition to those 
188.23  chosen for the random sample. 
188.24     Sec. 20.  Minnesota Statutes 2004, section 256B.19, 
188.25  subdivision 1, is amended to read: 
188.26     Subdivision 1.  [DIVISION OF COST.] The state and county 
188.27  share of medical assistance costs not paid by federal funds 
188.28  shall be as follows:  
188.29     (1) beginning January 1, 1992, 50 percent state funds and 
188.30  50 percent county funds for the cost of placement of severely 
188.31  emotionally disturbed children in regional treatment centers; 
188.32     (2) beginning January 1, 2003, 80 percent state funds and 
188.33  20 percent county funds for the costs of nursing facility 
188.34  placements of persons with disabilities under the age of 65 that 
188.35  have exceeded 90 days.  This clause shall be subject to chapter 
188.36  256G and shall not apply to placements in facilities not 
189.1   certified to participate in medical assistance; 
189.2      (3) beginning July 1, 2004, 80 95 percent state funds and 
189.3   20 five percent county funds for the costs of placements that 
189.4   have exceeded 90 days in intermediate care facilities for 
189.5   persons with mental retardation or a related condition that have 
189.6   seven or more beds.  This provision includes pass-through 
189.7   payments made under section 256B.5015; and 
189.8      (4) beginning July 1, 2004, when state funds are used to 
189.9   pay for a nursing facility placement due to the facility's 
189.10  status as an institution for mental diseases (IMD), the county 
189.11  shall pay 20 percent of the nonfederal share of costs that have 
189.12  exceeded 90 days.  This clause is subject to chapter 256G. 
189.13     For counties that participate in a Medicaid demonstration 
189.14  project under sections 256B.69 and 256B.71, the division of the 
189.15  nonfederal share of medical assistance expenses for payments 
189.16  made to prepaid health plans or for payments made to health 
189.17  maintenance organizations in the form of prepaid capitation 
189.18  payments, this division of medical assistance expenses shall be 
189.19  95 percent by the state and five percent by the county of 
189.20  financial responsibility.  
189.21     In counties where prepaid health plans are under contract 
189.22  to the commissioner to provide services to medical assistance 
189.23  recipients, the cost of court ordered treatment ordered without 
189.24  consulting the prepaid health plan that does not include 
189.25  diagnostic evaluation, recommendation, and referral for 
189.26  treatment by the prepaid health plan is the responsibility of 
189.27  the county of financial responsibility. 
189.28     <b>[EFFECTIVE DATE.]</b> This section is effective the day 
189.29  following final enactment.  
189.30     Sec. 21.  Minnesota Statutes 2004, section 256B.49, 
189.31  subdivision 16, is amended to read: 
189.32     Subd. 16.  [SERVICES AND SUPPORTS.] (a) Services and 
189.33  supports included in the home and community-based waivers for 
189.34  persons with disabilities shall meet the requirements set out in 
189.35  United States Code, title 42, section 1396n.  The services and 
189.36  supports, which are offered as alternatives to institutional 
190.1   care, shall promote consumer choice, community inclusion, 
190.2   self-sufficiency, and self-determination. 
190.3      (b) Beginning January 1, 2003, the commissioner shall 
190.4   simplify and improve access to home and community-based waivered 
190.5   services, to the extent possible, through the establishment of a 
190.6   common service menu that is available to eligible recipients 
190.7   regardless of age, disability type, or waiver program. 
190.8      (c) Consumer directed community support services shall be 
190.9   offered as an option to all persons eligible for services under 
190.10  subdivision 11, by January 1, 2002. 
190.11     (d) Services and supports shall be arranged and provided 
190.12  consistent with individualized written plans of care for 
190.13  eligible waiver recipients. 
190.14     (e) A transitional supports allowance shall be available to 
190.15  all persons under a home and community-based waiver who are 
190.16  moving from a licensed setting to a community setting. 
190.17  "Transitional supports allowance" means a onetime payment of up 
190.18  to $3,000, to cover the costs, not covered by other sources, 
190.19  associated with moving from a licensed setting to a community 
190.20  setting.  Covered costs include: 
190.21     (1) lease or rent deposits; 
190.22     (2) security deposits; 
190.23     (3) utilities set-up costs, including telephone; 
190.24     (4) essential furnishings and supplies; and 
190.25     (5) personal supports and transports needed to locate and 
190.26  transition to community settings. 
190.27     (f) The state of Minnesota and county agencies that 
190.28  administer home and community-based waivered services for 
190.29  persons with disabilities, shall not be liable for damages, 
190.30  injuries, or liabilities sustained through the purchase of 
190.31  supports by the individual, the individual's family, legal 
190.32  representative, or the authorized representative with funds 
190.33  received through the consumer-directed community support service 
190.34  under this section.  Liabilities include but are not limited 
190.35  to:  workers' compensation liability, the Federal Insurance 
190.36  Contributions Act (FICA), or the Federal Unemployment Tax Act 
191.1   (FUTA). 
191.2      <b>[EFFECTIVE DATE.]</b> This section is effective upon federal 
191.3   approval and to the extent approved as a federal waiver 
191.4   amendment. 
191.5      Sec. 22.  Minnesota Statutes 2004, section 256B.5012, is 
191.6   amended by adding a subdivision to read: 
191.7      Subd. 6.  [ICF/MR RATE INCREASES BEGINNING OCTOBER 1, 2005, 
191.8   AND OCTOBER 1, 2006.] For the rate years beginning October 1, 
191.9   2005, and October 1, 2006, the commissioner shall provide 
191.10  facilities reimbursed under this section an adjustment to the 
191.11  total operating payment rate of two percent.  At least 
191.12  two-thirds of each year's adjustment must be used for increased 
191.13  costs of employee salaries and benefits and associated costs for 
191.14  FICA, the Medicare tax, workers' compensation premiums, and 
191.15  federal and state unemployment insurance.  Each facility 
191.16  receiving an adjustment shall report to the commissioner, in the 
191.17  form and manner specified by the commissioner, on how the 
191.18  additional funding was used. 
191.19     Sec. 23.  Minnesota Statutes 2004, section 256B.69, 
191.20  subdivision 23, is amended to read: 
191.21     Subd. 23.  [ALTERNATIVE INTEGRATED LONG-TERM CARE SERVICES; 
191.22  ELDERLY AND DISABLED PERSONS.] (a) The commissioner may 
191.23  implement demonstration projects to create alternative 
191.24  integrated delivery systems for acute and long-term care 
191.25  services to elderly persons and persons with disabilities as 
191.26  defined in section 256B.77, subdivision 7a, that provide 
191.27  increased coordination, improve access to quality services, and 
191.28  mitigate future cost increases.  The commissioner may seek 
191.29  federal authority to combine Medicare and Medicaid capitation 
191.30  payments for the purpose of such demonstrations.  Medicare funds 
191.31  and services shall be administered according to the terms and 
191.32  conditions of the federal waiver and demonstration provisions.  
191.33  For the purpose of administering medical assistance funds, 
191.34  demonstrations under this subdivision are subject to 
191.35  subdivisions 1 to 22.  The provisions of Minnesota Rules, parts 
191.36  9500.1450 to 9500.1464, apply to these demonstrations, with the 
192.1   exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457, 
192.2   subpart 1, items B and C, which do not apply to persons 
192.3   enrolling in demonstrations under this section.  An initial open 
192.4   enrollment period may be provided.  Persons who disenroll from 
192.5   demonstrations under this subdivision remain subject to 
192.6   Minnesota Rules, parts 9500.1450 to 9500.1464.  When a person is 
192.7   enrolled in a health plan under these demonstrations and the 
192.8   health plan's participation is subsequently terminated for any 
192.9   reason, the person shall be provided an opportunity to select a 
192.10  new health plan and shall have the right to change health plans 
192.11  within the first 60 days of enrollment in the second health 
192.12  plan.  Persons required to participate in health plans under 
192.13  this section who fail to make a choice of health plan shall not 
192.14  be randomly assigned to health plans under these demonstrations. 
192.15  Notwithstanding section 256L.12, subdivision 5, and Minnesota 
192.16  Rules, part 9505.5220, subpart 1, item A, if adopted, for the 
192.17  purpose of demonstrations under this subdivision, the 
192.18  commissioner may contract with managed care organizations, 
192.19  including counties, to serve only elderly persons eligible for 
192.20  medical assistance, elderly and disabled persons, or disabled 
192.21  persons only.  For persons with primary diagnoses of mental 
192.22  retardation or a related condition, serious and persistent 
192.23  mental illness, or serious emotional disturbance, the 
192.24  commissioner must ensure that the county authority has approved 
192.25  the demonstration and contracting design.  Enrollment in these 
192.26  projects for persons with disabilities shall be voluntary.  The 
192.27  commissioner shall not implement any demonstration project under 
192.28  this subdivision for persons with primary diagnoses of mental 
192.29  retardation or a related condition, serious and persistent 
192.30  mental illness, or serious emotional disturbance, without 
192.31  approval of the county board of the county in which the 
192.32  demonstration is being implemented.  
192.33     (b) Notwithstanding chapter 245B, sections 252.40 to 
192.34  252.46, 256B.092, 256B.501 to 256B.5015, and Minnesota Rules, 
192.35  parts 9525.0004 to 9525.0036, 9525.1200 to 9525.1330, 9525.1580, 
192.36  and 9525.1800 to 9525.1930, the commissioner may implement under 
193.1   this section projects for persons with developmental 
193.2   disabilities.  The commissioner may capitate payments for ICF/MR 
193.3   services, waivered services for mental retardation or related 
193.4   conditions, including case management services, day training and 
193.5   habilitation and alternative active treatment services, and 
193.6   other services as approved by the state and by the federal 
193.7   government.  Case management and active treatment must be 
193.8   individualized and developed in accordance with a 
193.9   person-centered plan.  Costs under these projects may not exceed 
193.10  costs that would have been incurred under fee-for-service. 
193.11  Beginning July 1, 2003, and until two years after the pilot 
193.12  project implementation date, subcontractor participation in the 
193.13  long-term care developmental disability pilot is limited to a 
193.14  nonprofit long-term care system providing ICF/MR services, home 
193.15  and community-based waiver services, and in-home services to no 
193.16  more than 120 consumers with developmental disabilities in 
193.17  Carver, Hennepin, and Scott Counties.  The commissioner shall 
193.18  report to the legislature prior to expansion of the 
193.19  developmental disability pilot project.  This paragraph expires 
193.20  two years after the implementation date of the pilot project.  
193.21     (c) Before implementation of a demonstration project for 
193.22  disabled persons, the commissioner must provide information to 
193.23  appropriate committees of the house of representatives and 
193.24  senate and must involve representatives of affected disability 
193.25  groups in the design of the demonstration projects. 
193.26     (d) A nursing facility reimbursed under the alternative 
193.27  reimbursement methodology in section 256B.434 may, in 
193.28  collaboration with a hospital, clinic, or other health care 
193.29  entity provide services under paragraph (a).  The commissioner 
193.30  shall amend the state plan and seek any federal waivers 
193.31  necessary to implement this paragraph. 
193.32     (e) The commissioner, in consultation with the 
193.33  commissioners of commerce and health, may approve and implement 
193.34  programs for all-inclusive care for the elderly (PACE) according 
193.35  to federal laws and regulations governing that program and state 
193.36  laws or rules applicable to participating providers.  The 
194.1   process for approval of these programs shall begin only after 
194.2   the commissioner receives grant money in an amount sufficient to 
194.3   cover the state share of the administrative and actuarial costs 
194.4   to implement the programs during state fiscal years 2006 through 
194.5   2009.  Grants for this purpose shall be deposited in an account 
194.6   in the special revenue fund and are appropriated to the 
194.7   commissioner to be used solely for the purpose of PACE 
194.8   administrative and actuarial costs.  A PACE provider is not 
194.9   required to be licensed or certified as a health plan company as 
194.10  defined in section 62Q.01, subdivision 4.  Persons age 55 and 
194.11  older who have been screened by the county and found to be 
194.12  eligible for services under the elderly waiver or community 
194.13  alternatives for disabled individuals or who are already 
194.14  eligible for Medicaid but meet level of care criteria for 
194.15  receipt of waiver services may choose to enroll in the PACE 
194.16  program.  Medicare and Medicaid services will be provided 
194.17  according to this subdivision and federal Medicare and Medicaid 
194.18  requirements governing PACE providers and programs.  PACE 
194.19  enrollees will receive Medicaid home and community-based 
194.20  services through the PACE provider as an alternative to services 
194.21  for which they would otherwise be eligible through home and 
194.22  community-based waiver programs and Medicaid State Plan 
194.23  Services.  The commissioner shall establish Medicaid rates for 
194.24  PACE providers that do not exceed costs that would have been 
194.25  incurred under fee-for-service or other relevant managed care 
194.26  programs operated by the state. 
194.27     (f) The commissioner shall seek federal approval to expand 
194.28  the Minnesota disability health options (MnDHO) program 
194.29  established under this subdivision in stages, first to regional 
194.30  population centers outside the seven-county metro area and then 
194.31  to all areas of the state. 
194.32     (g) Notwithstanding section 256B.0261, health plans 
194.33  providing services under this section are responsible for home 
194.34  care targeted case management and relocation targeted case 
194.35  management.  Services must be provided according to the terms of 
194.36  the waivers and contracts approved by the federal government. 
195.1      Sec. 24.  [256B.762] [REIMBURSEMENT FOR HEALTH CARE 
195.2   SERVICES.] 
195.3      Effective for services provided on or after October 1, 
195.4   2005, payment rates for the following services shall be 
195.5   increased by five percent over the rates in effect on September 
195.6   30, 2005, when these services are provided as home health 
195.7   services under section 256B.0625, subdivision 6a: 
195.8      (1) skilled nursing visit; 
195.9      (2) physical therapy visit; 
195.10     (3) occupational therapy visit; 
195.11     (4) speech therapy visit; and 
195.12     (5) home health aide visit. 
195.13     Sec. 25.  Minnesota Statutes 2004, section 256B.765, is 
195.14  amended to read: 
195.15     256B.765 [PROVIDER RATE INCREASES.] 
195.16     Subdivision 1.  [ANNUAL INFLATION ADJUSTMENTS.] (a) 
195.17  Effective July 1, 2001, within the limits of appropriations 
195.18  specifically for this purpose, the commissioner shall provide an 
195.19  annual inflation adjustment for the providers listed 
195.20  in paragraph (c) subdivision 2.  The index for the inflation 
195.21  adjustment must be based on the change in the Employment Cost 
195.22  Index for Private Industry Workers - Total Compensation 
195.23  forecasted by Data Resources, Inc., as forecasted in the fourth 
195.24  quarter of the calendar year preceding the fiscal year.  The 
195.25  commissioner shall increase reimbursement or allocation rates by 
195.26  the percentage of this adjustment, and county boards shall 
195.27  adjust provider contracts as needed. 
195.28     (b) The commissioner of finance shall include an annual 
195.29  inflationary adjustment in reimbursement rates for the providers 
195.30  listed in paragraph (c) subdivision 2 using the inflation factor 
195.31  specified in paragraph (a) as a budget change request in each 
195.32  biennial detailed expenditure budget submitted to the 
195.33  legislature under section 16A.11. 
195.34     (c) Subd. 2.  [ELIGIBLE PROVIDERS.] The annual adjustment 
195.35  under subdivision 1, paragraph (a), shall be provided for home 
195.36  and community-based waiver services for persons with mental 
196.1   retardation or related conditions under section 256B.501; home 
196.2   and community-based waiver services for the elderly under 
196.3   section 256B.0915; waivered services under community 
196.4   alternatives for disabled individuals under section 256B.49; 
196.5   community alternative care waivered services under section 
196.6   256B.49; traumatic brain injury waivered services under section 
196.7   256B.49; nursing services and home health services under section 
196.8   256B.0625, subdivision 6a; personal care services and nursing 
196.9   supervision of personal care services under section 256B.0625, 
196.10  subdivision 19a; private duty nursing services under section 
196.11  256B.0625, subdivision 7; day training and habilitation services 
196.12  for adults with mental retardation or related conditions under 
196.13  sections 252.40 to 252.46; physical therapy services under 
196.14  sections 256B.0625, subdivision 8, and 256D.03, subdivision 4; 
196.15  occupational therapy services under sections 256B.0625, 
196.16  subdivision 8a, and 256D.03, subdivision 4; speech-language 
196.17  therapy services under section 256D.03, subdivision 4, and 
196.18  Minnesota Rules, part 9505.0390; respiratory therapy services 
196.19  under section 256D.03, subdivision 4, and Minnesota Rules, part 
196.20  9505.0295; alternative care services under section 256B.0913; 
196.21  adult residential program grants under Minnesota Rules, parts 
196.22  9535.2000 to 9535.3000; adult and family community support 
196.23  grants under Minnesota Rules, parts 9535.1700 to 9535.1760; 
196.24  semi-independent living services under section 252.275 including 
196.25  SILS funding under county social services grants formerly funded 
196.26  under chapter 256I; and community support services for deaf and 
196.27  hard-of-hearing adults with mental illness who use or wish to 
196.28  use sign language as their primary means of communication. 
196.29     Subd. 3.  [RATE INCREASE FOR RATE PERIODS BEGINNING OCTOBER 
196.30  1, 2005.] For the rate periods beginning October 1, 2005, and 
196.31  October 1, 2006, the commissioner shall increase reimbursement 
196.32  rates for the providers listed in subdivision 2 by two percent.  
196.33  At least two-thirds of each year's adjustment must be used for 
196.34  increased costs of employee salaries and benefits and associated 
196.35  costs for FICA, the Medicare tax, workers' compensation 
196.36  premiums, and federal and state unemployment insurance.  Each 
197.1   provider receiving an adjustment shall report to the 
197.2   commissioner, in the form and manner specified by the 
197.3   commissioner, on how the additional funding was used. 
197.4      Sec. 26.  [ICF/MR PLAN.] 
197.5      The commissioner of human services shall consult with 
197.6   ICF/MR providers, advocates, counties, and consumer families to 
197.7   develop recommendations and legislation concerning the future 
197.8   services provided to people now served in ICFs/MR.  The 
197.9   recommendations shall be reported to the house and senate 
197.10  committees with jurisdiction over health and human services 
197.11  policy and finance issues by January 15, 2006.  In preparing the 
197.12  recommendations, the commissioner shall consider: 
197.13     (1) consumer choice of services; 
197.14     (2) consumers' service needs, including, but not limited 
197.15  to, active treatment; 
197.16     (3) the total cost of providing services in ICFs/MR and 
197.17  alternative delivery systems for individuals currently residing 
197.18  in ICFs/MR; 
197.19     (4) whether it is the policy of the state to maintain an 
197.20  ICF/MR system and, if so, the recommendations shall: 
197.21     (i) define the purpose, types of services, and intended 
197.22  recipients of ICF/MR services; 
197.23     (ii) define the capacity needed to maintain ICF/MR services 
197.24  for designated populations; and 
197.25     (iii) assure that mechanisms are provided to adequately 
197.26  fund the transition to the defined services, maintain the 
197.27  designated capacity, and are adjustable to meet increased 
197.28  service demands; and 
197.29     (5) if alternative services are recommended to support the 
197.30  people now receiving services in an ICF/MR, the recommendations 
197.31  shall provide for transition planning and ensure adequate state 
197.32  and federal financial resources are available to meet the needs 
197.33  of ICF/MR recipients. 
197.34     <b>[EFFECTIVE DATE.]</b> This section is effective the day 
197.35  following final enactment. 
197.36     Sec. 27.  [DIRECTION TO THE COMMISSIONER; LICENSING AND 
198.1   ALTERNATIVE QUALITY ASSURANCE STUDY.] 
198.2      The commissioner of human services shall arrange for a 
198.3   study, including recommendations for statewide development and 
198.4   implementation of regional or local quality assurance models for 
198.5   disability services.  The study shall include a review of 
198.6   current projects or models; make findings regarding the best 
198.7   components, role, and function of such models within a statewide 
198.8   quality assurance system; and shall estimate the cost and 
198.9   sources of funding for regional and local quality assurance 
198.10  models on a statewide basis.  The study shall be done in 
198.11  consultation with counties, consumers of service, providers, and 
198.12  representatives of the Quality Assurance Commission under 
198.13  Minnesota Statutes, section 256B.0951, subdivision 1. 
198.14     The study shall be submitted to the chairs of the 
198.15  legislative committees with jurisdiction over health and human 
198.16  services with recommendations on implementation of a statewide 
198.17  system of quality assurance and licensing by July 1, 2006.  The 
198.18  commissioner shall submit proposed legislation for 
198.19  implementation of a statewide system of quality assurance to the 
198.20  chairs of the legislative committees with jurisdiction over 
198.21  health and human services by December 15, 2006. 
198.22     Sec. 28.  [CONSUMER-DIRECTED COMMUNITY SUPPORTS EXCEPTION.] 
198.23     (a) Effective upon federal approval, for persons using the 
198.24  home and community-based waiver for persons with developmental 
198.25  disabilities consumer-directed community supports option whose 
198.26  budgets were reduced by the October 2004 state set budget 
198.27  methodology, the commissioner must allow exceptions to exceed 
198.28  the state set budget formula amount up to the daily average cost 
198.29  during calendar year 2004 or for persons who graduated from 
198.30  school during 2004, the average daily cost during July through 
198.31  December 2004, less one-half case management and home 
198.32  modifications over $5,000, when the person's county of financial 
198.33  responsibility determines that:  (1) necessary alternative 
198.34  services will cost the same or more than the person's current 
198.35  budget, and (2) administrative expenses or provider rates will 
198.36  result in fewer hours of needed staffing for the person than 
199.1   under the consumer-directed community supports option.  Any 
199.2   exceptions the county grants must be within the county's 
199.3   allowable aggregate amount for the home and community-based 
199.4   waiver for persons with developmental disabilities. 
199.5      (b) This section expires on the date the Department of 
199.6   Human Services implements a new consumer-directed community 
199.7   supports budget methodology that is based on reliable and 
199.8   accurate information about the services and supports intensity 
199.9   needs of persons using the option which adequately accounts for 
199.10  the increased costs of adults who graduate from school and need 
199.11  services funded by the waiver during the day. 
199.12     Sec. 29.  [COSTS ASSOCIATED WITH PHYSICAL ACTIVITIES.] 
199.13     Effective upon federal approval, the expenses allowed for 
199.14  adults under the consumer-directed community supports option 
199.15  shall include the costs at the lowest rate available considering 
199.16  daily, monthly, semi-annual, annual, or membership rates, 
199.17  including transportation, associated with physical exercise or 
199.18  other physical activities to maintain or improve the person's 
199.19  health and functioning. 
199.20     Sec. 30.  [WAIVER AMENDMENT.] 
199.21     The commissioner of human services shall submit an 
199.22  amendment to the Centers for Medicare and Medicaid Services 
199.23  consistent with sections 28 and 29 by August 1, 2005. 
199.24     <b>[EFFECTIVE DATE.]</b> This section is effective the day 
199.25  following final enactment. 
199.26     Sec. 31.  [INDEPENDENT EVALUATION AND REVIEW OF UNALLOWABLE 
199.27  ITEMS.] 
199.28     The commissioner of human services shall include in the 
199.29  independent evaluation of the consumer-directed community 
199.30  supports option provided through the home and community-based 
199.31  services waivers for persons with disabilities under 65 years of 
199.32  age:  (1) provisions for ongoing, regular stakeholder 
199.33  representatives participation through June 30, 2007; (2) 
199.34  recommendations to the legislative committees with jurisdiction 
199.35  over human services policy and finance issues by January 15, 
199.36  2006, on whether changes to the unallowable items should be made 
200.1   to meet the health, safety, or welfare needs of participants in 
200.2   the consumer-directed community supports option within the 
200.3   allowed budget amounts; and (3) a review of the statewide 
200.4   caseload changes for the disability waiver programs for persons 
200.5   under 65 years of age, which occurred after the state set budget 
200.6   methodology implementation on October 1, 2004, and 
200.7   recommendations on the fiscal impact of the budget methodology 
200.8   on use of the consumer-directed community supports option. 
200.9      <b>[EFFECTIVE DATE.]</b> This section is effective the day 
200.10  following final enactment. 
200.11     Sec. 32.  [FEDERAL APPROVAL.] 
200.12     By August 1, 2005, the commissioner of human services shall 
200.13  request any federal approval and plan amendments necessary to 
200.14  implement (1) the transitional supports allowance under 
200.15  Minnesota Statutes, sections 256B.0916, subdivision 10, and 
200.16  256B.49, subdivision 16; and (2) the choice of case management 
200.17  service coordination provisions under Minnesota Statutes, 
200.18  section 256B.0621, subdivisions 4, 5, 6, and 7. 
200.19     Sec. 33.  [DENTAL ACCESS FOR PERSONS WITH DISABILITIES.] 
200.20     The commissioner of human services shall study access to 
200.21  dental services for persons with disabilities and shall present 
200.22  recommendations for improving access to dental services to the 
200.23  legislature by January 15, 2006.  The study must examine 
200.24  physical and geographic access, the willingness of dentists to 
200.25  serve persons with disabilities enrolled in state health care 
200.26  programs, reimbursement rates for dental service providers, and 
200.27  other factors identified by the commissioner as potential 
200.28  barriers to accessing dental services.  The commissioner shall 
200.29  direct the Dental Access Advisory Committee, established under 
200.30  Minnesota Statutes, section 256B.55, to assist in this study. 
200.31     Sec. 34.  [DISABILITY SERVICES INTERAGENCY WORK GROUP.] 
200.32     Subdivision 1.  [MEMBERSHIP.] The Department of Human 
200.33  Services, the Minnesota Housing Finance Agency, and the 
200.34  Minnesota State Council on Disability shall convene an 
200.35  interagency work group which includes interested stakeholders 
200.36  including other state agencies, counties, public housing 
201.1   authorities, the Metropolitan Council, disability service 
201.2   providers, and representatives from disability advocacy 
201.3   organizations to identify barriers, strengthen coordination, 
201.4   recommend policy and funding changes, and pursue federal 
201.5   financing that will assist Minnesotans with disabilities who are 
201.6   attempting to relocate from or avoid placement in institutional 
201.7   settings. 
201.8      Subd. 2.  [WORK GROUP ACTIVITIES.] The work group shall 
201.9   make recommendations to the state agencies and the legislature 
201.10  related to: 
201.11     (1) coordinating the availability of housing, 
201.12  transportation, and support services needed to discharge persons 
201.13  with disabilities from institutions; 
201.14     (2) improving information and assistance needed to make an 
201.15  informed choice about relocating from an institutional placement 
201.16  to community-based services; 
201.17     (3) identifying gaps in human services, transportation, or 
201.18  housing access which are barriers to moving to community 
201.19  services; 
201.20     (4) identifying strategies which would result in earlier 
201.21  identification of persons most at risk of institutional 
201.22  placement in order to promote diversion to community service or 
201.23  reduce length of stay in an institutional facility; 
201.24     (5) identifying funding mechanisms and financial strategies 
201.25  to assure a financially sustainable community support system 
201.26  that diverts and relocates individuals from institutional 
201.27  placement; and 
201.28     (6) identifying state changes needed to address any federal 
201.29  changes affecting policies, benefits, or funding used to support 
201.30  persons with disabilities to avoid institutional placement.  
201.31     Subd. 3.  [RECOMMENDATIONS.] Recommendations of the work 
201.32  group will be submitted to each participating state agency and 
201.33  to the chairs of the health and human services policy and 
201.34  finance committees of the senate and house of representatives by 
201.35  October 15, 2006.  This section expires October 15, 2006. 
201.36     Sec. 35.  [REPORT TO LEGISLATURE.] 
202.1      The commissioner shall report to the legislature on the 
202.2   redesign of case management services.  In preparing the report, 
202.3   the commissioner shall consult with representatives for 
202.4   consumers, consumer advocates, counties, and service providers.  
202.5   The report shall include draft legislation for case management 
202.6   changes that will: 
202.7      (1) streamline administration; 
202.8      (2) improve consumer access to case management services; 
202.9      (3) address the use of a comprehensive universal assessment 
202.10  protocol for persons seeking community supports; 
202.11     (4) establish case management performance measures; 
202.12     (5) provide for consumer choice of the case management 
202.13  service vendor; and 
202.14     (6) provide a method of payment for case management 
202.15  services that is cost-effective and best supports the draft 
202.16  legislation in clauses (1) to (5). 
202.17                             ARTICLE 6 
202.18                           MISCELLANEOUS 
202.19     Section 1.  Minnesota Statutes 2004, section 256.01, 
202.20  subdivision 2, is amended to read: 
202.21     Subd. 2.  [SPECIFIC POWERS.] Subject to the provisions of 
202.22  section 241.021, subdivision 2, the commissioner of human 
202.23  services shall carry out the specific duties in paragraphs (a) 
202.24  through (aa) (bb): 
202.25     (a) Administer and supervise all forms of public assistance 
202.26  provided for by state law and other welfare activities or 
202.27  services as are vested in the commissioner.  Administration and 
202.28  supervision of human services activities or services includes, 
202.29  but is not limited to, assuring timely and accurate distribution 
202.30  of benefits, completeness of service, and quality program 
202.31  management.  In addition to administering and supervising human 
202.32  services activities vested by law in the department, the 
202.33  commissioner shall have the authority to: 
202.34     (1) require county agency participation in training and 
202.35  technical assistance programs to promote compliance with 
202.36  statutes, rules, federal laws, regulations, and policies 
203.1   governing human services; 
203.2      (2) monitor, on an ongoing basis, the performance of county 
203.3   agencies in the operation and administration of human services, 
203.4   enforce compliance with statutes, rules, federal laws, 
203.5   regulations, and policies governing welfare services and promote 
203.6   excellence of administration and program operation; 
203.7      (3) develop a quality control program or other monitoring 
203.8   program to review county performance and accuracy of benefit 
203.9   determinations; 
203.10     (4) require county agencies to make an adjustment to the 
203.11  public assistance benefits issued to any individual consistent 
203.12  with federal law and regulation and state law and rule and to 
203.13  issue or recover benefits as appropriate; 
203.14     (5) delay or deny payment of all or part of the state and 
203.15  federal share of benefits and administrative reimbursement 
203.16  according to the procedures set forth in section 256.017; 
203.17     (6) make contracts with and grants to public and private 
203.18  agencies and organizations, both profit and nonprofit, and 
203.19  individuals, using appropriated funds; and 
203.20     (7) enter into contractual agreements with federally 
203.21  recognized Indian tribes with a reservation in Minnesota to the 
203.22  extent necessary for the tribe to operate a federally approved 
203.23  family assistance program or any other program under the 
203.24  supervision of the commissioner.  The commissioner shall consult 
203.25  with the affected county or counties in the contractual 
203.26  agreement negotiations, if the county or counties wish to be 
203.27  included, in order to avoid the duplication of county and tribal 
203.28  assistance program services.  The commissioner may establish 
203.29  necessary accounts for the purposes of receiving and disbursing 
203.30  funds as necessary for the operation of the programs. 
203.31     (b) Inform county agencies, on a timely basis, of changes 
203.32  in statute, rule, federal law, regulation, and policy necessary 
203.33  to county agency administration of the programs. 
203.34     (c) Administer and supervise all child welfare activities; 
203.35  promote the enforcement of laws protecting handicapped, 
203.36  dependent, neglected and delinquent children, and children born 
204.1   to mothers who were not married to the children's fathers at the 
204.2   times of the conception nor at the births of the children; 
204.3   license and supervise child-caring and child-placing agencies 
204.4   and institutions; supervise the care of children in boarding and 
204.5   foster homes or in private institutions; and generally perform 
204.6   all functions relating to the field of child welfare now vested 
204.7   in the State Board of Control. 
204.8      (d) Administer and supervise all noninstitutional service 
204.9   to handicapped persons, including those who are visually 
204.10  impaired, hearing impaired, or physically impaired or otherwise 
204.11  handicapped.  The commissioner may provide and contract for the 
204.12  care and treatment of qualified indigent children in facilities 
204.13  other than those located and available at state hospitals when 
204.14  it is not feasible to provide the service in state hospitals. 
204.15     (e) Assist and actively cooperate with other departments, 
204.16  agencies and institutions, local, state, and federal, by 
204.17  performing services in conformity with the purposes of Laws 
204.18  1939, chapter 431. 
204.19     (f) Act as the agent of and cooperate with the federal 
204.20  government in matters of mutual concern relative to and in 
204.21  conformity with the provisions of Laws 1939, chapter 431, 
204.22  including the administration of any federal funds granted to the 
204.23  state to aid in the performance of any functions of the 
204.24  commissioner as specified in Laws 1939, chapter 431, and 
204.25  including the promulgation of rules making uniformly available 
204.26  medical care benefits to all recipients of public assistance, at 
204.27  such times as the federal government increases its participation 
204.28  in assistance expenditures for medical care to recipients of 
204.29  public assistance, the cost thereof to be borne in the same 
204.30  proportion as are grants of aid to said recipients. 
204.31     (g) Establish and maintain any administrative units 
204.32  reasonably necessary for the performance of administrative 
204.33  functions common to all divisions of the department. 
204.34     (h) Act as designated guardian of both the estate and the 
204.35  person of all the wards of the state of Minnesota, whether by 
204.36  operation of law or by an order of court, without any further 
205.1   act or proceeding whatever, except as to persons committed as 
205.2   mentally retarded.  For children under the guardianship of the 
205.3   commissioner whose interests would be best served by adoptive 
205.4   placement, the commissioner may contract with a licensed 
205.5   child-placing agency or a Minnesota tribal social services 
205.6   agency to provide adoption services.  A contract with a licensed 
205.7   child-placing agency must be designed to supplement existing 
205.8   county efforts and may not replace existing county programs, 
205.9   unless the replacement is agreed to by the county board and the 
205.10  appropriate exclusive bargaining representative or the 
205.11  commissioner has evidence that child placements of the county 
205.12  continue to be substantially below that of other counties.  
205.13  Funds encumbered and obligated under an agreement for a specific 
205.14  child shall remain available until the terms of the agreement 
205.15  are fulfilled or the agreement is terminated. 
205.16     (i) Act as coordinating referral and informational center 
205.17  on requests for service for newly arrived immigrants coming to 
205.18  Minnesota. 
205.19     (j) The specific enumeration of powers and duties as 
205.20  hereinabove set forth shall in no way be construed to be a 
205.21  limitation upon the general transfer of powers herein contained. 
205.22     (k) Establish county, regional, or statewide schedules of 
205.23  maximum fees and charges which may be paid by county agencies 
205.24  for medical, dental, surgical, hospital, nursing and nursing 
205.25  home care and medicine and medical supplies under all programs 
205.26  of medical care provided by the state and for congregate living 
205.27  care under the income maintenance programs. 
205.28     (l) Have the authority to conduct and administer 
205.29  experimental projects to test methods and procedures of 
205.30  administering assistance and services to recipients or potential 
205.31  recipients of public welfare.  To carry out such experimental 
205.32  projects, it is further provided that the commissioner of human 
205.33  services is authorized to waive the enforcement of existing 
205.34  specific statutory program requirements, rules, and standards in 
205.35  one or more counties.  The order establishing the waiver shall 
205.36  provide alternative methods and procedures of administration, 
206.1   shall not be in conflict with the basic purposes, coverage, or 
206.2   benefits provided by law, and in no event shall the duration of 
206.3   a project exceed four years.  It is further provided that no 
206.4   order establishing an experimental project as authorized by the 
206.5   provisions of this section shall become effective until the 
206.6   following conditions have been met: 
206.7      (1) the secretary of health and human services of the 
206.8   United States has agreed, for the same project, to waive state 
206.9   plan requirements relative to statewide uniformity; and 
206.10     (2) a comprehensive plan, including estimated project 
206.11  costs, shall be approved by the Legislative Advisory Commission 
206.12  and filed with the commissioner of administration.  
206.13     (m) According to federal requirements, establish procedures 
206.14  to be followed by local welfare boards in creating citizen 
206.15  advisory committees, including procedures for selection of 
206.16  committee members. 
206.17     (n) Allocate federal fiscal disallowances or sanctions 
206.18  which are based on quality control error rates for the aid to 
206.19  families with dependent children program formerly codified in 
206.20  sections 256.72 to 256.87, medical assistance, or food stamp 
206.21  program in the following manner:  
206.22     (1) one-half of the total amount of the disallowance shall 
206.23  be borne by the county boards responsible for administering the 
206.24  programs.  For the medical assistance and the AFDC program 
206.25  formerly codified in sections 256.72 to 256.87, disallowances 
206.26  shall be shared by each county board in the same proportion as 
206.27  that county's expenditures for the sanctioned program are to the 
206.28  total of all counties' expenditures for the AFDC program 
206.29  formerly codified in sections 256.72 to 256.87, and medical 
206.30  assistance programs.  For the food stamp program, sanctions 
206.31  shall be shared by each county board, with 50 percent of the 
206.32  sanction being distributed to each county in the same proportion 
206.33  as that county's administrative costs for food stamps are to the 
206.34  total of all food stamp administrative costs for all counties, 
206.35  and 50 percent of the sanctions being distributed to each county 
206.36  in the same proportion as that county's value of food stamp 
207.1   benefits issued are to the total of all benefits issued for all 
207.2   counties.  Each county shall pay its share of the disallowance 
207.3   to the state of Minnesota.  When a county fails to pay the 
207.4   amount due hereunder, the commissioner may deduct the amount 
207.5   from reimbursement otherwise due the county, or the attorney 
207.6   general, upon the request of the commissioner, may institute 
207.7   civil action to recover the amount due; and 
207.8      (2) notwithstanding the provisions of clause (1), if the 
207.9   disallowance results from knowing noncompliance by one or more 
207.10  counties with a specific program instruction, and that knowing 
207.11  noncompliance is a matter of official county board record, the 
207.12  commissioner may require payment or recover from the county or 
207.13  counties, in the manner prescribed in clause (1), an amount 
207.14  equal to the portion of the total disallowance which resulted 
207.15  from the noncompliance, and may distribute the balance of the 
207.16  disallowance according to clause (1).  
207.17     (o) Develop and implement special projects that maximize 
207.18  reimbursements and result in the recovery of money to the 
207.19  state.  For the purpose of recovering state money, the 
207.20  commissioner may enter into contracts with third parties.  Any 
207.21  recoveries that result from projects or contracts entered into 
207.22  under this paragraph shall be deposited in the state treasury 
207.23  and credited to a special account until the balance in the 
207.24  account reaches $1,000,000.  When the balance in the account 
207.25  exceeds $1,000,000, the excess shall be transferred and credited 
207.26  to the general fund.  All money in the account is appropriated 
207.27  to the commissioner for the purposes of this paragraph. 
207.28     (p) Have the authority to make direct payments to 
207.29  facilities providing shelter to women and their children 
207.30  according to section 256D.05, subdivision 3.  Upon the written 
207.31  request of a shelter facility that has been denied payments 
207.32  under section 256D.05, subdivision 3, the commissioner shall 
207.33  review all relevant evidence and make a determination within 30 
207.34  days of the request for review regarding issuance of direct 
207.35  payments to the shelter facility.  Failure to act within 30 days 
207.36  shall be considered a determination not to issue direct payments.
208.1      (q) Have the authority to establish and enforce the 
208.2   following county reporting requirements:  
208.3      (1) the commissioner shall establish fiscal and statistical 
208.4   reporting requirements necessary to account for the expenditure 
208.5   of funds allocated to counties for human services programs.  
208.6   When establishing financial and statistical reporting 
208.7   requirements, the commissioner shall evaluate all reports, in 
208.8   consultation with the counties, to determine if the reports can 
208.9   be simplified or the number of reports can be reduced; 
208.10     (2) the county board shall submit monthly or quarterly 
208.11  reports to the department as required by the commissioner.  
208.12  Monthly reports are due no later than 15 working days after the 
208.13  end of the month.  Quarterly reports are due no later than 30 
208.14  calendar days after the end of the quarter, unless the 
208.15  commissioner determines that the deadline must be shortened to 
208.16  20 calendar days to avoid jeopardizing compliance with federal 
208.17  deadlines or risking a loss of federal funding.  Only reports 
208.18  that are complete, legible, and in the required format shall be 
208.19  accepted by the commissioner; 
208.20     (3) if the required reports are not received by the 
208.21  deadlines established in clause (2), the commissioner may delay 
208.22  payments and withhold funds from the county board until the next 
208.23  reporting period.  When the report is needed to account for the 
208.24  use of federal funds and the late report results in a reduction 
208.25  in federal funding, the commissioner shall withhold from the 
208.26  county boards with late reports an amount equal to the reduction 
208.27  in federal funding until full federal funding is received; 
208.28     (4) a county board that submits reports that are late, 
208.29  illegible, incomplete, or not in the required format for two out 
208.30  of three consecutive reporting periods is considered 
208.31  noncompliant.  When a county board is found to be noncompliant, 
208.32  the commissioner shall notify the county board of the reason the 
208.33  county board is considered noncompliant and request that the 
208.34  county board develop a corrective action plan stating how the 
208.35  county board plans to correct the problem.  The corrective 
208.36  action plan must be submitted to the commissioner within 45 days 
209.1   after the date the county board received notice of 
209.2   noncompliance; 
209.3      (5) the final deadline for fiscal reports or amendments to 
209.4   fiscal reports is one year after the date the report was 
209.5   originally due.  If the commissioner does not receive a report 
209.6   by the final deadline, the county board forfeits the funding 
209.7   associated with the report for that reporting period and the 
209.8   county board must repay any funds associated with the report 
209.9   received for that reporting period; 
209.10     (6) the commissioner may not delay payments, withhold 
209.11  funds, or require repayment under clause (3) or (5) if the 
209.12  county demonstrates that the commissioner failed to provide 
209.13  appropriate forms, guidelines, and technical assistance to 
209.14  enable the county to comply with the requirements.  If the 
209.15  county board disagrees with an action taken by the commissioner 
209.16  under clause (3) or (5), the county board may appeal the action 
209.17  according to sections 14.57 to 14.69; and 
209.18     (7) counties subject to withholding of funds under clause 
209.19  (3) or forfeiture or repayment of funds under clause (5) shall 
209.20  not reduce or withhold benefits or services to clients to cover 
209.21  costs incurred due to actions taken by the commissioner under 
209.22  clause (3) or (5). 
209.23     (r) Allocate federal fiscal disallowances or sanctions for 
209.24  audit exceptions when federal fiscal disallowances or sanctions 
209.25  are based on a statewide random sample for the foster care 
209.26  program under title IV-E of the Social Security Act, United 
209.27  States Code, title 42, in direct proportion to each county's 
209.28  title IV-E foster care maintenance claim for that period. 
209.29     (s) Be responsible for ensuring the detection, prevention, 
209.30  investigation, and resolution of fraudulent activities or 
209.31  behavior by applicants, recipients, and other participants in 
209.32  the human services programs administered by the department. 
209.33     (t) Require county agencies to identify overpayments, 
209.34  establish claims, and utilize all available and cost-beneficial 
209.35  methodologies to collect and recover these overpayments in the 
209.36  human services programs administered by the department. 
210.1      (u) Have the authority to administer a drug rebate program 
210.2   for drugs purchased pursuant to the prescription drug program 
210.3   established under section 256.955 after the beneficiary's 
210.4   satisfaction of any deductible established in the program.  The 
210.5   commissioner shall require a rebate agreement from all 
210.6   manufacturers of covered drugs as defined in section 256B.0625, 
210.7   subdivision 13.  Rebate agreements for prescription drugs 
210.8   delivered on or after July 1, 2002, must include rebates for 
210.9   individuals covered under the prescription drug program who are 
210.10  under 65 years of age.  For each drug, the amount of the rebate 
210.11  shall be equal to the rebate as defined for purposes of the 
210.12  federal rebate program in United States Code, title 42, section 
210.13  1396r-8.  The manufacturers must provide full payment within 30 
210.14  days of receipt of the state invoice for the rebate within the 
210.15  terms and conditions used for the federal rebate program 
210.16  established pursuant to section 1927 of title XIX of the Social 
210.17  Security Act.  The manufacturers must provide the commissioner 
210.18  with any information necessary to verify the rebate determined 
210.19  per drug.  The rebate program shall utilize the terms and 
210.20  conditions used for the federal rebate program established 
210.21  pursuant to section 1927 of title XIX of the Social Security Act.
210.22     (v) Have the authority to administer the federal drug 
210.23  rebate program for drugs purchased under the medical assistance 
210.24  program as allowed by section 1927 of title XIX of the Social 
210.25  Security Act and according to the terms and conditions of 
210.26  section 1927.  Rebates shall be collected for all drugs that 
210.27  have been dispensed or administered in an outpatient setting and 
210.28  that are from manufacturers who have signed a rebate agreement 
210.29  with the United States Department of Health and Human Services. 
210.30     (w) Have the authority to administer a supplemental drug 
210.31  rebate program for drugs purchased under the medical assistance 
210.32  program.  The commissioner may enter into supplemental rebate 
210.33  contracts with pharmaceutical manufacturers and may require 
210.34  prior authorization for drugs that are from manufacturers that 
210.35  have not signed a supplemental rebate contract.  Prior 
210.36  authorization of drugs shall be subject to the provisions of 
211.1   section 256B.0625, subdivision 13. 
211.2      (x) Operate the department's communication systems account 
211.3   established in Laws 1993, First Special Session chapter 1, 
211.4   article 1, section 2, subdivision 2, to manage shared 
211.5   communication costs necessary for the operation of the programs 
211.6   the commissioner supervises.  A communications account may also 
211.7   be established for each regional treatment center which operates 
211.8   communications systems.  Each account must be used to manage 
211.9   shared communication costs necessary for the operations of the 
211.10  programs the commissioner supervises.  The commissioner may 
211.11  distribute the costs of operating and maintaining communication 
211.12  systems to participants in a manner that reflects actual usage. 
211.13  Costs may include acquisition, licensing, insurance, 
211.14  maintenance, repair, staff time and other costs as determined by 
211.15  the commissioner.  Nonprofit organizations and state, county, 
211.16  and local government agencies involved in the operation of 
211.17  programs the commissioner supervises may participate in the use 
211.18  of the department's communications technology and share in the 
211.19  cost of operation.  The commissioner may accept on behalf of the 
211.20  state any gift, bequest, devise or personal property of any 
211.21  kind, or money tendered to the state for any lawful purpose 
211.22  pertaining to the communication activities of the department.  
211.23  Any money received for this purpose must be deposited in the 
211.24  department's communication systems accounts.  Money collected by 
211.25  the commissioner for the use of communication systems must be 
211.26  deposited in the state communication systems account and is 
211.27  appropriated to the commissioner for purposes of this section. 
211.28     (y) Receive any federal matching money that is made 
211.29  available through the medical assistance program for the 
211.30  consumer satisfaction survey.  Any federal money received for 
211.31  the survey is appropriated to the commissioner for this 
211.32  purpose.  The commissioner may expend the federal money received 
211.33  for the consumer satisfaction survey in either year of the 
211.34  biennium. 
211.35     (z) Designate community information and referral call 
211.36  centers and incorporate cost reimbursement claims from the 
212.1   designated community information and referral call centers into 
212.2   the federal cost reimbursement claiming processes of the 
212.3   department according to federal law, rule, and regulations.  
212.4   Existing information and referral centers provided by Greater 
212.5   Twin Cities United Way or existing call centers for which 
212.6   Greater Twin Cities United Way has legal authority to represent, 
212.7   shall be included in these designations upon review by the 
212.8   commissioner and assurance that these services are accredited 
212.9   and in compliance with national standards.  Any reimbursement is 
212.10  appropriated to the commissioner and all designated information 
212.11  and referral centers shall receive payments according to normal 
212.12  department schedules established by the commissioner upon final 
212.13  approval of allocation methodologies from the United States 
212.14  Department of Health and Human Services Division of Cost 
212.15  Allocation or other appropriate authorities. 
212.16     (aa) Develop recommended standards for foster care homes 
212.17  that address the components of specialized therapeutic services 
212.18  to be provided by foster care homes with those services. 
212.19     (bb) Authorize the method of payment to or from the 
212.20  department as part of the human services programs administered 
212.21  by the department.  This authorization includes the receipt or 
212.22  disbursement of funds held by the department in a fiduciary 
212.23  capacity as part of the human services programs administered by 
212.24  the department. 
212.25     Sec. 2.  Minnesota Statutes 2004, section 256.01, is 
212.26  amended by adding a subdivision to read: 
212.27     Subd. 23.  [ANNUAL REPORT.] Effective August 1, 2006, or on 
212.28  the date HealthMatch is fully implemented, whichever is later, 
212.29  the commissioner shall prepare an annual report of the number of 
212.30  eligible applicants who applied in the prior calendar year for 
212.31  Minnesota health care programs under chapters 256B, 256D, and 
212.32  256L, and had not lived in Minnesota for the 12 months prior to 
212.33  the application month.  The report shall indicate the number of 
212.34  applicants by state of prior residence or by the general 
212.35  category of foreign country. 
212.36     Sec. 3.  [DIRECTION TO COMMISSIONER; STUDY ON DEEMED INCOME 
213.1   OF SPONSORS OF NONCITIZENS.] 
213.2      The commissioner of human services shall assess county 
213.3   compliance with deeming the income and assets of sponsors of 
213.4   noncitizens under Minnesota Statutes, sections 256B.06, 
213.5   subdivision 5; 256D.03, subdivision 3, paragraph (i); 256D.05, 
213.6   subdivision 3; 256J.37, subdivision 2; and 256L.04, subdivision 
213.7   10a.  The commissioner shall report findings on county 
213.8   compliance with these provisions and make recommendations to 
213.9   ensure compliance to the legislative committees with 
213.10  jurisdiction over human services by January 15, 2006. 
213.11                             ARTICLE 7 
213.12                       MENTAL HEALTH SERVICES 
213.13     Section 1.  Minnesota Statutes 2004, section 245.4885, 
213.14  subdivision 1, is amended to read: 
213.15     Subdivision 1.  [SCREENING REQUIRED ADMISSION CRITERIA.] 
213.16  The county board shall, prior to admission, except in the case 
213.17  of emergency admission, screen determine the needed level of 
213.18  care for all children referred for treatment of severe emotional 
213.19  disturbance to in a treatment foster care setting, residential 
213.20  treatment facility, or informally admitted to a regional 
213.21  treatment center if public funds are used to pay for the 
213.22  services.  The county board shall also screen determine the 
213.23  needed level of care for all children admitted to an acute care 
213.24  hospital for treatment of severe emotional disturbance if public 
213.25  funds other than reimbursement under chapters 256B and 256D are 
213.26  used to pay for the services.  If a child is admitted to a 
213.27  residential treatment facility or acute care hospital for 
213.28  emergency treatment or held for emergency care by a regional 
213.29  treatment center under section 253B.05, subdivision 1, screening 
213.30  must occur within three working days of admission.  
213.31  Screening The level of care determination shall determine 
213.32  whether the proposed treatment:  
213.33     (1) is necessary; 
213.34     (2) is appropriate to the child's individual treatment 
213.35  needs; 
213.36     (3) cannot be effectively provided in the child's home; and 
214.1      (4) provides a length of stay as short as possible 
214.2   consistent with the individual child's need. 
214.3      When a screening level of care determination is conducted, 
214.4   the county board may not determine that referral or admission to 
214.5   a treatment foster care setting, residential treatment facility, 
214.6   or acute care hospital is not appropriate solely because 
214.7   services were not first provided to the child in a less 
214.8   restrictive setting and the child failed to make progress toward 
214.9   or meet treatment goals in the less restrictive 
214.10  setting.  Screening shall include both The level of care 
214.11  determination must be based on a diagnostic assessment and that 
214.12  includes a functional assessment which evaluates family, school, 
214.13  and community living situations; and an assessment of the 
214.14  child's need for care out of the home using a validated tool 
214.15  which assesses a child's functional status and assigns an 
214.16  appropriate level of care.  The validated tool must be approved 
214.17  by the commissioner of human services.  If a diagnostic 
214.18  assessment or including a functional assessment has been 
214.19  completed by a mental health professional within the past 180 
214.20  days, a new diagnostic or functional assessment need not be 
214.21  completed unless in the opinion of the current treating mental 
214.22  health professional the child's mental health status has changed 
214.23  markedly since the assessment was completed.  The child's parent 
214.24  shall be notified if an assessment will not be completed and of 
214.25  the reasons.  A copy of the notice shall be placed in the 
214.26  child's file.  Recommendations developed as part of 
214.27  the screening level of care determination process shall include 
214.28  specific community services needed by the child and, if 
214.29  appropriate, the child's family, and shall indicate whether or 
214.30  not these services are available and accessible to the child and 
214.31  family.  
214.32     During the screening level of care determination process, 
214.33  the child, child's family, or child's legal representative, as 
214.34  appropriate, must be informed of the child's eligibility for 
214.35  case management services and family community support services 
214.36  and that an individual family community support plan is being 
215.1   developed by the case manager, if assigned.  
215.2      Screening The level of care determination shall be in 
215.3   compliance comply with section 260C.212.  Wherever possible, the 
215.4   parent shall be consulted in the screening process, unless 
215.5   clinically inappropriate.  
215.6      The screening process level of care determination, and 
215.7   placement decision, and recommendations for mental health 
215.8   services must be documented in the child's record.  
215.9      An alternate review process may be approved by the 
215.10  commissioner if the county board demonstrates that an alternate 
215.11  review process has been established by the county board and the 
215.12  times of review, persons responsible for the review, and review 
215.13  criteria are comparable to the standards in clauses (1) to (4). 
215.14     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2006. 
215.15     Sec. 2.  Minnesota Statutes 2004, section 245.4885, is 
215.16  amended by adding a subdivision to read: 
215.17     Subd. 1a.  [EMERGENCY ADMISSION.] Effective July 1, 2006, 
215.18  if a child is admitted to a treatment foster care setting, 
215.19  residential treatment facility, or acute care hospital for 
215.20  emergency treatment or held for emergency care by a regional 
215.21  treatment center under section 253B.05, subdivision 1, the level 
215.22  of care determination must occur within three working days of 
215.23  admission. 
215.24     Sec. 3.  Minnesota Statutes 2004, section 245.4885, 
215.25  subdivision 2, is amended to read: 
215.26     Subd. 2.  [QUALIFICATIONS.] No later than July 1, 1991, 
215.27  Screening Level of care determination of children for treatment 
215.28  foster care, residential, and inpatient services must be 
215.29  conducted by a mental health professional.  Where appropriate 
215.30  and available, culturally informed mental health consultants 
215.31  must participate in the screening level of care determination.  
215.32  Mental health professionals providing screening level of care 
215.33  determination for treatment foster care, inpatient, and 
215.34  residential services must not be financially affiliated with any 
215.35  acute care inpatient hospital, residential treatment facility, 
215.36  or regional treatment center nongovernment entity which may be 
216.1   providing those services.  The commissioner may waive this 
216.2   requirement for mental health professional participation after 
216.3   July 1, 1991, if the county documents that: 
216.4      (1) mental health professionals or mental health 
216.5   practitioners are unavailable to provide this service; and 
216.6      (2) services are provided by a designated person with 
216.7   training in human services who receives clinical supervision 
216.8   from a mental health professional. 
216.9      <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2006. 
216.10     Sec. 4.  Minnesota Statutes 2004, section 253B.02, 
216.11  subdivision 7, is amended to read: 
216.12     Subd. 7.  [EXAMINER.] "Examiner" means a person who is 
216.13  knowledgeable, trained, and practicing in the diagnosis and 
216.14  assessment or in the treatment of the alleged impairment, and 
216.15  who is: 
216.16     (1) a licensed physician; or 
216.17     (2) a licensed psychologist who has a doctoral degree in 
216.18  psychology or who became a licensed consulting psychologist 
216.19  before July 2, 1975; or 
216.20     (3) an advanced practice registered nurse certified in 
216.21  mental health, except that only a physician or psychologist 
216.22  meeting these requirements may be appointed by the court to 
216.23  conduct an evaluation. 
216.24     Sec. 5.  Minnesota Statutes 2004, section 256B.0625, is 
216.25  amended by adding a subdivision to read: 
216.26     Subd. 46.  [MENTAL HEALTH TELEMEDICINE.] Effective January 
216.27  1, 2006, and subject to federal approval, mental health services 
216.28  that are otherwise covered by medical assistance as direct 
216.29  face-to-face services may be provided via two-way interactive 
216.30  video.  Use of two-way interactive video must be medically 
216.31  appropriate to the condition and needs of the person being 
216.32  served.  Reimbursement is at the same rates and under the same 
216.33  conditions that would otherwise apply to the service.  The 
216.34  interactive video equipment and connection must comply with 
216.35  Medicare standards in effect at the time the service is provided.
216.36     Sec. 6.  Minnesota Statutes 2004, section 256B.0625, is 
217.1   amended by adding a subdivision to read: 
217.2      Subd. 47.  [TREATMENT FOSTER CARE SERVICES.] Effective July 
217.3   1, 2006, and subject to federal approval, medical assistance 
217.4   covers treatment foster care services according to section 
217.5   256B.0946. 
217.6      Sec. 7.  Minnesota Statutes 2004, section 256B.0625, is 
217.7   amended by adding a subdivision to read: 
217.8      Subd. 48.  [PSYCHIATRIC CONSULTATION TO PRIMARY CARE 
217.9   PRACTITIONERS.] Effective January 1, 2006, medical assistance 
217.10  covers consultation provided by a psychiatrist via telephone, 
217.11  e-mail, facsimile, or other means of communication to primary 
217.12  care practitioners, including pediatricians.  The need for 
217.13  consultation and the receipt of the consultation must be 
217.14  documented in the patient record maintained by the primary care 
217.15  practitioner.  If the patient consents, and subject to federal 
217.16  limitations and data privacy provisions, the consultation may be 
217.17  provided without the patient present. 
217.18     Sec. 8.  [256B.0946] [TREATMENT FOSTER CARE.] 
217.19     Subdivision 1.  [COVERED SERVICE.] (a) Effective July 1, 
217.20  2006, and subject to federal approval, medical assistance covers 
217.21  medically necessary services described under paragraph (b) that 
217.22  are provided by a provider entity eligible under subdivision 3 
217.23  to a client eligible under subdivision 2 who is placed in a 
217.24  treatment foster home licensed under Minnesota Rules, parts 
217.25  2960.3000 to 2960.3340. 
217.26     (b) Services to children with severe emotional disturbance 
217.27  residing in treatment foster care settings must meet the 
217.28  relevant standards for mental health services under sections 
217.29  245.487 to 245.4887.  In addition, specific service components 
217.30  reimbursed by medical assistance must meet the following 
217.31  standards: 
217.32     (1) case management service component must meet the 
217.33  standards in Minnesota Rules, parts 9520.0900 to 9520.0926 and 
217.34  9505.0322, excluding subparts 6 and 10; 
217.35     (2) psychotherapy and skills training components must meet 
217.36  the standards for children's therapeutic services and supports 
218.1   in section 256B.0943; and 
218.2      (3) family psychoeducation services under supervision of a 
218.3   mental health professional. 
218.4      Subd. 2.  [DETERMINATION OF CLIENT ELIGIBILITY.] A client's 
218.5   eligibility to receive treatment foster care under this section 
218.6   shall be determined by a diagnostic assessment, an evaluation of 
218.7   level of care needed, and development of an individual treatment 
218.8   plan, as defined in paragraphs (a) to (c). 
218.9      (a) The diagnostic assessment must: 
218.10     (1) be conducted by a psychiatrist, licensed psychologist, 
218.11  or licensed independent clinical social worker that is performed 
218.12  within 180 days prior to the start of service; 
218.13     (2) include current diagnoses on all five axes of the 
218.14  client's current mental health status; 
218.15     (3) determine whether or not a child meets the criteria for 
218.16  severe emotional disturbance in section 245.4871, subdivision 6, 
218.17  or for serious and persistent mental illness in section 245.462, 
218.18  subdivision 20; and 
218.19     (4) be completed annually until age 18.  For individuals 
218.20  between age 18 and 21, unless a client's mental health condition 
218.21  has changed markedly since the client's most recent diagnostic 
218.22  assessment, annual updating is necessary.  For the purpose of 
218.23  this section, "updating" means a written summary, including 
218.24  current diagnoses on all five axes, by a mental health 
218.25  professional of the client's current mental status and service 
218.26  needs. 
218.27     (b) The evaluation of level of care must be conducted by 
218.28  the placing county with an instrument approved by the 
218.29  commissioner of human services.  The commissioner shall update 
218.30  the list of approved level of care instruments annually. 
218.31     (c) The individual treatment plan must be: 
218.32     (1) based on the information in the client's diagnostic 
218.33  assessment; 
218.34     (2) developed through a child-centered, family driven 
218.35  planning process that identifies service needs and 
218.36  individualized, planned, and culturally appropriate 
219.1   interventions that contain specific measurable treatment goals 
219.2   and objectives for the client and treatment strategies for the 
219.3   client's family and foster family; 
219.4      (3) reviewed at least once every 90 days and revised; and 
219.5      (4) signed by the client or, if appropriate, by the 
219.6   client's parent or other person authorized by statute to consent 
219.7   to mental health services for the client. 
219.8      Subd. 3.  [ELIGIBLE PROVIDERS.] For purposes of this 
219.9   section, a provider agency must have an individual placement 
219.10  agreement for each recipient and must be a licensed child 
219.11  placing agency, under Minnesota Rules, parts 9543.0010 to 
219.12  9543.0150, and either: 
219.13     (1) a county; 
219.14     (2) an Indian Health Services facility operated by a tribe 
219.15  or tribal organization under funding authorized by United States 
219.16  Code, title 25, sections 450f to 450n, or title 3 of the Indian 
219.17  Self-Determination Act, Public Law 93-638, section 638 
219.18  (facilities or providers); or 
219.19     (3) a noncounty entity under contract with a county board. 
219.20     Subd. 4.  [ELIGIBLE PROVIDER RESPONSIBILITIES.] (a) To be 
219.21  an eligible provider under this section, a provider must develop 
219.22  written policies and procedures for treatment foster care 
219.23  services consistent with subdivision 1, paragraph (b), clauses 
219.24  (1), (2), and (3). 
219.25     (b) In delivering services under this section, a treatment 
219.26  foster care provider must ensure that staff caseload size 
219.27  reasonably enables the provider to play an active role in 
219.28  service planning, monitoring, delivering, and reviewing for 
219.29  discharge planning to meet the needs of the client, the client's 
219.30  foster family, and the birth family, as specified in each 
219.31  client's individual treatment plan. 
219.32     Subd. 5.  [SERVICE AUTHORIZATION.] The commissioner will 
219.33  administer authorizations for services under this section in 
219.34  compliance with section 256B.0625, subdivision 25. 
219.35     Subd. 6.  [EXCLUDED SERVICES.] (a) Services in clauses (1) 
219.36  to (4) are not eligible as components of treatment foster care 
220.1   services: 
220.2      (1) treatment foster care services provided in violation of 
220.3   medical assistance policy in Minnesota Rules, part 9505.0220; 
220.4      (2) service components of children's therapeutic services 
220.5   and supports simultaneously provided by more than one treatment 
220.6   foster care provider; 
220.7      (3) home and community-based waiver services; and 
220.8      (4) treatment foster care services provided to a child 
220.9   without a level of care determination according to section 
220.10  245.4885, subdivision 1. 
220.11     (b) Children receiving treatment foster care services are 
220.12  not eligible for medical assistance reimbursement for the 
220.13  following services while receiving treatment foster care: 
220.14     (1) mental health case management services under section 
220.15  256B.0625, subdivision 20; and 
220.16     (2) psychotherapy and skill training components of 
220.17  children's therapeutic services and supports under section 
220.18  256B.0625, subdivision 35b. 
220.19     Sec. 9.  [256B.0947] [TRANSITIONAL YOUTH INTENSIVE 
220.20  REHABILITATIVE MENTAL HEALTH SERVICES.] 
220.21     Subdivision 1.  [SCOPE.] Subject to federal approval, 
220.22  medical assistance covers medically necessary, intensive 
220.23  nonresidential rehabilitative mental health services as defined 
220.24  in subdivision 2, for recipients as defined in subdivision 3, 
220.25  when the services are provided by an entity meeting the 
220.26  standards in this section. 
220.27     Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
220.28  following terms have the meanings given them. 
220.29     (a) "Intensive nonresidential rehabilitative mental health 
220.30  services" means child rehabilitative mental health services as 
220.31  defined in section 256B.0943, except that these services are 
220.32  provided by a multidisciplinary staff using a total team 
220.33  approach consistent with assertive community treatment, or other 
220.34  evidence-based practices, and directed to recipients with a 
220.35  serious mental illness who require intensive services. 
220.36     (b) "Evidence-based practices" are nationally recognized 
221.1   mental health services that are proven by substantial research 
221.2   to be effective in helping individuals with serious mental 
221.3   illness obtain specific treatment goals. 
221.4      (c) "Treatment team" means all staff who provide services 
221.5   to recipients under this section.  At a minimum, this includes 
221.6   the clinical supervisor, mental health professionals, mental 
221.7   health practitioners, mental health behavioral aides, and a 
221.8   school representative familiar with the recipient's individual 
221.9   education plan (IEP) if applicable. 
221.10     Subd. 3.  [ELIGIBILITY FOR TRANSITIONAL YOUTH.] An eligible 
221.11  recipient under the age of 18 is an individual who: 
221.12     (1) is age 16 or 17; 
221.13     (2) is diagnosed with a medical condition, such as an 
221.14  emotional disturbance or traumatic brain injury, for which 
221.15  intensive nonresidential rehabilitative mental health services 
221.16  are needed; 
221.17     (3) has substantial disability and functional impairment in 
221.18  three or more of the areas listed in section 245.462, 
221.19  subdivision 11a, so that self-sufficiency upon adulthood or 
221.20  emancipation is unlikely; and 
221.21     (4) has had a recent diagnostic assessment by a qualified 
221.22  professional that documents that intensive nonresidential 
221.23  rehabilitative mental health services are medically necessary to 
221.24  address identified disability and functional impairments and 
221.25  individual recipient goals. 
221.26     Subd. 4.  [PROVIDER CERTIFICATION AND CONTRACT 
221.27  REQUIREMENTS.] (a) The intensive nonresidential rehabilitative 
221.28  mental health services provider must: 
221.29     (1) have a contract with the host county to provide 
221.30  intensive transition youth rehabilitative mental health 
221.31  services; and 
221.32     (2) be certified by the commissioner as being in compliance 
221.33  with this section and section 256B.0943. 
221.34     (b) The commissioner shall develop procedures for counties 
221.35  and providers to submit contracts and other documentation as 
221.36  needed to allow the commissioner to determine whether the 
222.1   standards in this section are met. 
222.2      Subd. 5.  [STANDARDS APPLICABLE TO NONRESIDENTIAL 
222.3   PROVIDERS.] (a) Services must be provided by a certified 
222.4   provider entity as defined in section 256B.0943, subdivision 4 
222.5   that meets the requirements in section 245B.0943, subdivisions 5 
222.6   and 6. 
222.7      (b) The clinical supervisor must be an active member of the 
222.8   treatment team.  The treatment team must meet with the clinical 
222.9   supervisor at least weekly to discuss recipients' progress and 
222.10  make rapid adjustments to meet recipients' needs.  The team 
222.11  meeting shall include recipient-specific case reviews and 
222.12  general treatment discussions among team members.  
222.13  Recipient-specific case reviews and planning must be documented 
222.14  in the individual recipient's treatment record. 
222.15     (c) Treatment staff must have prompt access in person or by 
222.16  telephone to a mental health practitioner or mental health 
222.17  professional.  The provider must have the capacity to promptly 
222.18  and appropriately respond to emergent needs and make any 
222.19  necessary staffing adjustments to assure the health and safety 
222.20  of recipients. 
222.21     (d) The initial functional assessment must be completed 
222.22  within ten days of intake and updated at least every three 
222.23  months or prior to discharge from the service, whichever comes 
222.24  first. 
222.25     (e) The initial individual treatment plan must be completed 
222.26  within ten days of intake and reviewed and updated at least 
222.27  monthly with the recipient. 
222.28     Subd. 6.  [ADDITIONAL STANDARDS FOR NONRESIDENTIAL 
222.29  SERVICES.] The standards in this subdivision apply to intensive 
222.30  nonresidential rehabilitative mental health services. 
222.31     (1) The treatment team must use team treatment, not an 
222.32  individual treatment model. 
222.33     (2) The clinical supervisor must function as a practicing 
222.34  clinician at least on a part-time basis. 
222.35     (3) The staffing ratio must not exceed ten recipients to 
222.36  one full-time equivalent treatment team position. 
223.1      (4) Services must be available at times that meet client 
223.2   needs. 
223.3      (5) The treatment team must actively and assertively engage 
223.4   and reach out to the recipient's family members and significant 
223.5   others, after obtaining the recipient's permission. 
223.6      (6) The treatment team must establish ongoing communication 
223.7   and collaboration between the team, family, and significant 
223.8   others and educate the family and significant others about 
223.9   mental illness, symptom management, and the family's role in 
223.10  treatment. 
223.11     (7) The treatment team must provide interventions to 
223.12  promote positive interpersonal relationships. 
223.13     Subd. 7.  [MEDICAL ASSISTANCE PAYMENT FOR INTENSIVE 
223.14  REHABILITATIVE MENTAL HEALTH SERVICES.] (a) Payment for 
223.15  nonresidential services in this section shall be based on one 
223.16  daily rate per provider inclusive of the following services 
223.17  received by an eligible recipient in a given calendar day: all 
223.18  rehabilitative services under this section, staff travel time to 
223.19  provide rehabilitative services under this section, and 
223.20  nonresidential crisis stabilization services under section 
223.21  256B.0944. 
223.22     (b) Except as indicated in paragraph (c), payment will not 
223.23  be made to more than one entity for each recipient for services 
223.24  provided under this section on a given day.  If services under 
223.25  this section are provided by a team that includes staff from 
223.26  more than one entity, the team must determine how to distribute 
223.27  the payment among the members. 
223.28     (c) The host county shall recommend to the commissioner one 
223.29  rate for each entity that will bill medical assistance for 
223.30  nonresidential intensive rehabilitative mental health services.  
223.31  In developing these rates, the host county shall consider and 
223.32  document: 
223.33     (1) the cost for similar services in the local trade area; 
223.34     (2) actual costs incurred by entities providing the 
223.35  services; 
223.36     (3) the intensity and frequency of services to be provided 
224.1   to each recipient; 
224.2      (4) the degree to which recipients will receive services 
224.3   other than services under this section; and 
224.4      (5) the costs of other services that will be separately 
224.5   reimbursed. 
224.6      (d) The rate for intensive rehabilitative mental health 
224.7   services must exclude medical assistance room and board rate, as 
224.8   defined in section 256I.03, subdivision 6, and services not 
224.9   covered under this section, such as partial hospitalization and 
224.10  inpatient services.  Physician services are not a component of 
224.11  the treatment team and may be billed separately.  The county's 
224.12  recommendation shall specify the period for which the rate will 
224.13  be applicable, not to exceed two years. 
224.14     (e) When services under this section are provided by an 
224.15  assertive community team, case management functions must be an 
224.16  integral part of the team. 
224.17     (f) The rate for a provider must not exceed the rate 
224.18  charged by that provider for the same service to other payors. 
224.19     (g) The commissioner shall approve or reject the county's 
224.20  rate recommendation, based on the commissioner's own analysis of 
224.21  the criteria in paragraph (c). 
224.22     Subd. 8.  [PROVIDER ENROLLMENT; RATE SETTING FOR 
224.23  COUNTY-OPERATED ENTITIES.] Effective July 1, 2006, counties that 
224.24  employ their own staff to provide services under this section 
224.25  shall apply directly to the commissioner for enrollment and rate 
224.26  setting.  In this case, a county contract is not required and 
224.27  the commissioner shall perform the program review and rate 
224.28  setting duties which would otherwise be required of counties 
224.29  under this section. 
224.30     Sec. 10.  Minnesota Statutes 2004, section 256D.03, 
224.31  subdivision 4, is amended to read: 
224.32     Subd. 4.  [GENERAL ASSISTANCE MEDICAL CARE; SERVICES.] 
224.33  (a)(i) For a person who is eligible under subdivision 3, 
224.34  paragraph (a), clause (2), item (i), general assistance medical 
224.35  care covers, except as provided in paragraph (c): 
224.36     (1) inpatient hospital services; 
225.1      (2) outpatient hospital services; 
225.2      (3) services provided by Medicare certified rehabilitation 
225.3   agencies; 
225.4      (4) prescription drugs and other products recommended 
225.5   through the process established in section 256B.0625, 
225.6   subdivision 13; 
225.7      (5) equipment necessary to administer insulin and 
225.8   diagnostic supplies and equipment for diabetics to monitor blood 
225.9   sugar level; 
225.10     (6) eyeglasses and eye examinations provided by a physician 
225.11  or optometrist; 
225.12     (7) hearing aids; 
225.13     (8) prosthetic devices; 
225.14     (9) laboratory and X-ray services; 
225.15     (10) physician's services; 
225.16     (11) medical transportation except special transportation; 
225.17     (12) chiropractic services as covered under the medical 
225.18  assistance program; 
225.19     (13) podiatric services; 
225.20     (14) dental services and dentures, subject to the 
225.21  limitations specified in section 256B.0625, subdivision 9; 
225.22     (15) outpatient services provided by a mental health center 
225.23  or clinic that is under contract with the county board and is 
225.24  established under section 245.62; 
225.25     (16) day treatment services for mental illness provided 
225.26  under contract with the county board; 
225.27     (17) prescribed medications for persons who have been 
225.28  diagnosed as mentally ill as necessary to prevent more 
225.29  restrictive institutionalization; 
225.30     (18) psychological services, medical supplies and 
225.31  equipment, and Medicare premiums, coinsurance and deductible 
225.32  payments; 
225.33     (19) medical equipment not specifically listed in this 
225.34  paragraph when the use of the equipment will prevent the need 
225.35  for costlier services that are reimbursable under this 
225.36  subdivision; 
226.1      (20) services performed by a certified pediatric nurse 
226.2   practitioner, a certified family nurse practitioner, a certified 
226.3   adult nurse practitioner, a certified obstetric/gynecological 
226.4   nurse practitioner, a certified neonatal nurse practitioner, or 
226.5   a certified geriatric nurse practitioner in independent 
226.6   practice, if (1) the service is otherwise covered under this 
226.7   chapter as a physician service, (2) the service provided on an 
226.8   inpatient basis is not included as part of the cost for 
226.9   inpatient services included in the operating payment rate, and 
226.10  (3) the service is within the scope of practice of the nurse 
226.11  practitioner's license as a registered nurse, as defined in 
226.12  section 148.171; 
226.13     (21) services of a certified public health nurse or a 
226.14  registered nurse practicing in a public health nursing clinic 
226.15  that is a department of, or that operates under the direct 
226.16  authority of, a unit of government, if the service is within the 
226.17  scope of practice of the public health nurse's license as a 
226.18  registered nurse, as defined in section 148.171; and 
226.19     (22) telemedicine consultations, to the extent they are 
226.20  covered under section 256B.0625, subdivision 3b; and 
226.21     (23) mental health telemedicine and psychiatric 
226.22  consultation as covered under section 256B.0625, subdivisions 46 
226.23  and 48. 
226.24     (ii) Effective October 1, 2003, for a person who is 
226.25  eligible under subdivision 3, paragraph (a), clause (2), item 
226.26  (ii), general assistance medical care coverage is limited to 
226.27  inpatient hospital services, including physician services 
226.28  provided during the inpatient hospital stay.  A $1,000 
226.29  deductible is required for each inpatient hospitalization.  
226.30     (b) Gender reassignment surgery and related services are 
226.31  not covered services under this subdivision unless the 
226.32  individual began receiving gender reassignment services prior to 
226.33  July 1, 1995.  
226.34     (c) In order to contain costs, the commissioner of human 
226.35  services shall select vendors of medical care who can provide 
226.36  the most economical care consistent with high medical standards 
227.1   and shall where possible contract with organizations on a 
227.2   prepaid capitation basis to provide these services.  The 
227.3   commissioner shall consider proposals by counties and vendors 
227.4   for prepaid health plans, competitive bidding programs, block 
227.5   grants, or other vendor payment mechanisms designed to provide 
227.6   services in an economical manner or to control utilization, with 
227.7   safeguards to ensure that necessary services are provided.  
227.8   Before implementing prepaid programs in counties with a county 
227.9   operated or affiliated public teaching hospital or a hospital or 
227.10  clinic operated by the University of Minnesota, the commissioner 
227.11  shall consider the risks the prepaid program creates for the 
227.12  hospital and allow the county or hospital the opportunity to 
227.13  participate in the program in a manner that reflects the risk of 
227.14  adverse selection and the nature of the patients served by the 
227.15  hospital, provided the terms of participation in the program are 
227.16  competitive with the terms of other participants considering the 
227.17  nature of the population served.  Payment for services provided 
227.18  pursuant to this subdivision shall be as provided to medical 
227.19  assistance vendors of these services under sections 256B.02, 
227.20  subdivision 8, and 256B.0625.  For payments made during fiscal 
227.21  year 1990 and later years, the commissioner shall consult with 
227.22  an independent actuary in establishing prepayment rates, but 
227.23  shall retain final control over the rate methodology.  
227.24     (d) Recipients eligible under subdivision 3, paragraph (a), 
227.25  clause (2), item (i), shall pay the following co-payments for 
227.26  services provided on or after October 1, 2003: 
227.27     (1) $3 per nonpreventive visit.  For purposes of this 
227.28  subdivision, a visit means an episode of service which is 
227.29  required because of a recipient's symptoms, diagnosis, or 
227.30  established illness, and which is delivered in an ambulatory 
227.31  setting by a physician or physician ancillary, chiropractor, 
227.32  podiatrist, nurse midwife, advanced practice nurse, audiologist, 
227.33  optician, or optometrist; 
227.34     (2) $25 for eyeglasses; 
227.35     (3) $25 for nonemergency visits to a hospital-based 
227.36  emergency room; 
228.1      (4) $3 per brand-name drug prescription and $1 per generic 
228.2   drug prescription, subject to a $20 per month maximum for 
228.3   prescription drug co-payments.  No co-payments shall apply to 
228.4   antipsychotic drugs when used for the treatment of mental 
228.5   illness; and 
228.6      (5) 50 percent coinsurance on restorative dental services.  
228.7      (e) Co-payments shall be limited to one per day per 
228.8   provider for nonpreventive visits, eyeglasses, and nonemergency 
228.9   visits to a hospital-based emergency room.  Recipients of 
228.10  general assistance medical care are responsible for all 
228.11  co-payments in this subdivision.  The general assistance medical 
228.12  care reimbursement to the provider shall be reduced by the 
228.13  amount of the co-payment, except that reimbursement for 
228.14  prescription drugs shall not be reduced once a recipient has 
228.15  reached the $20 per month maximum for prescription drug 
228.16  co-payments.  The provider collects the co-payment from the 
228.17  recipient.  Providers may not deny services to recipients who 
228.18  are unable to pay the co-payment, except as provided in 
228.19  paragraph (f). 
228.20     (f) If it is the routine business practice of a provider to 
228.21  refuse service to an individual with uncollected debt, the 
228.22  provider may include uncollected co-payments under this 
228.23  section.  A provider must give advance notice to a recipient 
228.24  with uncollected debt before services can be denied. 
228.25     (g) Any county may, from its own resources, provide medical 
228.26  payments for which state payments are not made. 
228.27     (h) Chemical dependency services that are reimbursed under 
228.28  chapter 254B must not be reimbursed under general assistance 
228.29  medical care. 
228.30     (i) The maximum payment for new vendors enrolled in the 
228.31  general assistance medical care program after the base year 
228.32  shall be determined from the average usual and customary charge 
228.33  of the same vendor type enrolled in the base year. 
228.34     (j) The conditions of payment for services under this 
228.35  subdivision are the same as the conditions specified in rules 
228.36  adopted under chapter 256B governing the medical assistance 
229.1   program, unless otherwise provided by statute or rule. 
229.2      (k) Inpatient and outpatient payments shall be reduced by 
229.3   five percent, effective July 1, 2003.  This reduction is in 
229.4   addition to the five percent reduction effective July 1, 2003, 
229.5   and incorporated by reference in paragraph (i).  
229.6      (l) Payments for all other health services except 
229.7   inpatient, outpatient, and pharmacy services shall be reduced by 
229.8   five percent, effective July 1, 2003.  
229.9      (m) Payments to managed care plans shall be reduced by five 
229.10  percent for services provided on or after October 1, 2003. 
229.11     (n) A hospital receiving a reduced payment as a result of 
229.12  this section may apply the unpaid balance toward satisfaction of 
229.13  the hospital's bad debts. 
229.14     <b>[EFFECTIVE DATE.]</b> This section is effective January 1, 2006.
229.15     Sec. 11.  Minnesota Statutes 2004, section 256L.03, 
229.16  subdivision 1, is amended to read: 
229.17     Subdivision 1.  [COVERED HEALTH SERVICES.] For individuals 
229.18  under section 256L.04, subdivision 7, with income no greater 
229.19  than 75 percent of the federal poverty guidelines or for 
229.20  families with children under section 256L.04, subdivision 1, all 
229.21  subdivisions of this section apply.  "Covered health services" 
229.22  means the health services reimbursed under chapter 256B, with 
229.23  the exception of inpatient hospital services, special education 
229.24  services, private duty nursing services, adult dental care 
229.25  services other than services covered under section 256B.0625, 
229.26  subdivision 9, paragraph (b), orthodontic services, nonemergency 
229.27  medical transportation services, personal care assistant and 
229.28  case management services, nursing home or intermediate care 
229.29  facilities services, inpatient mental health services, and 
229.30  chemical dependency services.  Outpatient mental health services 
229.31  covered under the MinnesotaCare program are limited to 
229.32  diagnostic assessments, psychological testing, explanation of 
229.33  findings, mental health telemedicine, psychiatric consultation, 
229.34  medication management by a physician, day treatment, partial 
229.35  hospitalization, and individual, family, and group psychotherapy.
229.36     No public funds shall be used for coverage of abortion 
230.1   under MinnesotaCare except where the life of the female would be 
230.2   endangered or substantial and irreversible impairment of a major 
230.3   bodily function would result if the fetus were carried to term; 
230.4   or where the pregnancy is the result of rape or incest. 
230.5      Covered health services shall be expanded as provided in 
230.6   this section. 
230.7      <b>[EFFECTIVE DATE.]</b> This section is effective January 1, 2006.
230.8                              ARTICLE 8
230.9                            HEALTH POLICY 
230.10     Section 1.  Minnesota Statutes 2004, section 13.3806, is 
230.11  amended by adding a subdivision to read: 
230.12     Subd. 21.  [ABORTION NOTIFICATION DATA.] Classification of 
230.13  data in abortion notification reports is governed by section 
230.14  144.3431. 
230.15     Sec. 2.  [62J.495] [HEALTH INFORMATION TECHNOLOGY AND 
230.16  INFRASTRUCTURE ADVISORY COMMITTEE.] 
230.17     Subdivision 1.  [LEGISLATIVE FINDINGS AND PURPOSE.] There 
230.18  is a need for coordination and collaboration among health care 
230.19  payers, providers, consumers, and government in designing and 
230.20  implementing a statewide interoperable health information 
230.21  infrastructure that includes standards for administrative data 
230.22  exchange, clinical support programs, quality performance 
230.23  measures, and maintenance of the security and confidentiality of 
230.24  individual patient data. 
230.25     Subd. 2.  [ESTABLISHMENT; MEMBERS; DUTIES.] (a) The 
230.26  commissioner shall establish a Health Information Technology and 
230.27  Infrastructure Advisory Committee governed by section 15.059 to 
230.28  advise the commissioner on the following matters: 
230.29     (1) assessment of the use of health information technology 
230.30  by the state, licensed health care providers and facilities, and 
230.31  local public health agencies; 
230.32     (2) recommendations for implementing a statewide 
230.33  interoperable health information infrastructure, to include 
230.34  estimates of necessary resources, and for determining standards 
230.35  for administrative data exchange, clinical support programs, and 
230.36  maintenance of the security and confidentiality of individual 
231.1   patient data; and 
231.2      (3) other related issues as requested by the commissioner. 
231.3      (b) The members of the Health Information Technology and 
231.4   Infrastructure Advisory Committee shall include the 
231.5   commissioners, or commissioners' designees, of health, human 
231.6   services, and commerce and additional members to be appointed by 
231.7   the commissioner to include persons representing Minnesota's 
231.8   local public health agencies, licensed hospitals and other 
231.9   licensed facilities and providers, private purchasers, the 
231.10  medical and nursing professions, health insurers and health 
231.11  plans, the state quality improvement organization, academic and 
231.12  research institutions, consumer advisory organizations with an 
231.13  interest and expertise in health information technology, and 
231.14  other stakeholders as identified by the Health Information 
231.15  Technology and Infrastructure Advisory Committee. 
231.16     Subd. 3.  [ANNUAL REPORT.] The commissioner shall prepare 
231.17  and issue an annual report not later than January 30 of each 
231.18  year outlining progress to date in implementing a statewide 
231.19  health information infrastructure and recommending future 
231.20  projects. 
231.21     Subd. 4.  [EXPIRATION.] Notwithstanding section 15.059, 
231.22  this section expires June 30, 2009. 
231.23     Sec. 3.  Minnesota Statutes 2004, section 103I.101, 
231.24  subdivision 6, is amended to read: 
231.25     Subd. 6.  [FEES FOR VARIANCES.] The commissioner shall 
231.26  charge a nonrefundable application fee of $150 $175 to cover the 
231.27  administrative cost of processing a request for a variance or 
231.28  modification of rules adopted by the commissioner under this 
231.29  chapter. 
231.30     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2006. 
231.31     Sec. 4.  Minnesota Statutes 2004, section 103I.208, 
231.32  subdivision 1, is amended to read: 
231.33     Subdivision 1.  [WELL NOTIFICATION FEE.] The well 
231.34  notification fee to be paid by a property owner is:  
231.35     (1) for a new well, $150 $175, which includes the state 
231.36  core function fee; 
232.1      (2) for a well sealing, $30 $35 for each well, which 
232.2   includes the state core function fee, except that for monitoring 
232.3   wells constructed on a single property, having depths within a 
232.4   25 foot range, and sealed within 48 hours of start of 
232.5   construction, a single fee of $30 $35; and 
232.6      (3) for construction of a dewatering well, $150 $175, which 
232.7   includes the state core function fee, for each well except a 
232.8   dewatering project comprising five or more wells shall be 
232.9   assessed a single fee of $750 $875 for the wells recorded on the 
232.10  notification. 
232.11     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2006.  
232.12     Sec. 5.  Minnesota Statutes 2004, section 103I.208, 
232.13  subdivision 2, is amended to read: 
232.14     Subd. 2.  [PERMIT FEE.] The permit fee to be paid by a 
232.15  property owner is:  
232.16     (1) for a well that is not in use under a maintenance 
232.17  permit, $125 $150 annually; 
232.18     (2) for construction of a monitoring well, $150 $175, which 
232.19  includes the state core function fee; 
232.20     (3) for a monitoring well that is unsealed under a 
232.21  maintenance permit, $125 $150 annually; 
232.22     (4) for monitoring wells used as a leak detection device at 
232.23  a single motor fuel retail outlet, a single petroleum bulk 
232.24  storage site excluding tank farms, or a single agricultural 
232.25  chemical facility site, the construction permit fee 
232.26  is $150 $175, which includes the state core function fee, per 
232.27  site regardless of the number of wells constructed on the site, 
232.28  and the annual fee for a maintenance permit for unsealed 
232.29  monitoring wells is $125 $150 per site regardless of the number 
232.30  of monitoring wells located on site; 
232.31     (5) for a groundwater thermal exchange device, in addition 
232.32  to the notification fee for wells, $150 $175, which includes the 
232.33  state core function fee; 
232.34     (6) for a vertical heat exchanger, $150 $175; 
232.35     (7) for a dewatering well that is unsealed under a 
232.36  maintenance permit, $125 $150 annually for each well, except a 
233.1   dewatering project comprising more than five wells shall be 
233.2   issued a single permit for $625 $750 annually for wells recorded 
233.3   on the permit; and 
233.4      (8) for excavating holes for the purpose of installing 
233.5   elevator shafts, $150 $175 for each hole. 
233.6      <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2006.  
233.7      Sec. 6.  Minnesota Statutes 2004, section 103I.235, 
233.8   subdivision 1, is amended to read: 
233.9      Subdivision 1.  [DISCLOSURE OF WELLS TO BUYER.] (a) Before 
233.10  signing an agreement to sell or transfer real property, the 
233.11  seller must disclose in writing to the buyer information about 
233.12  the status and location of all known wells on the property, by 
233.13  delivering to the buyer either a statement by the seller that 
233.14  the seller does not know of any wells on the property, or a 
233.15  disclosure statement indicating the legal description and 
233.16  county, and a map drawn from available information showing the 
233.17  location of each well to the extent practicable.  In the 
233.18  disclosure statement, the seller must indicate, for each well, 
233.19  whether the well is in use, not in use, or sealed.  
233.20     (b) At the time of closing of the sale, the disclosure 
233.21  statement information, name and mailing address of the buyer, 
233.22  and the quartile, section, township, and range in which each 
233.23  well is located must be provided on a well disclosure 
233.24  certificate signed by the seller or a person authorized to act 
233.25  on behalf of the seller. 
233.26     (c) A well disclosure certificate need not be provided if 
233.27  the seller does not know of any wells on the property and the 
233.28  deed or other instrument of conveyance contains the statement:  
233.29  "The Seller certifies that the Seller does not know of any wells 
233.30  on the described real property."  
233.31     (d) If a deed is given pursuant to a contract for deed, the 
233.32  well disclosure certificate required by this subdivision shall 
233.33  be signed by the buyer or a person authorized to act on behalf 
233.34  of the buyer.  If the buyer knows of no wells on the property, a 
233.35  well disclosure certificate is not required if the following 
233.36  statement appears on the deed followed by the signature of the 
234.1   grantee or, if there is more than one grantee, the signature of 
234.2   at least one of the grantees:  "The Grantee certifies that the 
234.3   Grantee does not know of any wells on the described real 
234.4   property."  The statement and signature of the grantee may be on 
234.5   the front or back of the deed or on an attached sheet and an 
234.6   acknowledgment of the statement by the grantee is not required 
234.7   for the deed to be recordable. 
234.8      (e) This subdivision does not apply to the sale, exchange, 
234.9   or transfer of real property:  
234.10     (1) that consists solely of a sale or transfer of severed 
234.11  mineral interests; or 
234.12     (2) that consists of an individual condominium unit as 
234.13  described in chapters 515 and 515B. 
234.14     (f) For an area owned in common under chapter 515 or 515B 
234.15  the association or other responsible person must report to the 
234.16  commissioner by July 1, 1992, the location and status of all 
234.17  wells in the common area.  The association or other responsible 
234.18  person must notify the commissioner within 30 days of any change 
234.19  in the reported status of wells. 
234.20     (g) For real property sold by the state under section 
234.21  92.67, the lessee at the time of the sale is responsible for 
234.22  compliance with this subdivision. 
234.23     (h) If the seller fails to provide a required well 
234.24  disclosure certificate, the buyer, or a person authorized to act 
234.25  on behalf of the buyer, may sign a well disclosure certificate 
234.26  based on the information provided on the disclosure statement 
234.27  required by this section or based on other available information.
234.28     (i) A county recorder or registrar of titles may not record 
234.29  a deed or other instrument of conveyance dated after October 31, 
234.30  1990, for which a certificate of value is required under section 
234.31  272.115, or any deed or other instrument of conveyance dated 
234.32  after October 31, 1990, from a governmental body exempt from the 
234.33  payment of state deed tax, unless the deed or other instrument 
234.34  of conveyance contains the statement made in accordance with 
234.35  paragraph (c) or (d) or is accompanied by the well disclosure 
234.36  certificate containing all the information required by paragraph 
235.1   (b) or (d).  The county recorder or registrar of titles must not 
235.2   accept a certificate unless it contains all the required 
235.3   information.  The county recorder or registrar of titles shall 
235.4   note on each deed or other instrument of conveyance accompanied 
235.5   by a well disclosure certificate that the well disclosure 
235.6   certificate was received.  The notation must include the 
235.7   statement "No wells on property" if the disclosure certificate 
235.8   states there are no wells on the property.  The well disclosure 
235.9   certificate shall not be filed or recorded in the records 
235.10  maintained by the county recorder or registrar of titles.  After 
235.11  noting "No wells on property" on the deed or other instrument of 
235.12  conveyance, the county recorder or registrar of titles shall 
235.13  destroy or return to the buyer the well disclosure certificate.  
235.14  The county recorder or registrar of titles shall collect from 
235.15  the buyer or the person seeking to record a deed or other 
235.16  instrument of conveyance, a fee of $30 $40 for receipt of a 
235.17  completed well disclosure certificate.  By the tenth day of each 
235.18  month, the county recorder or registrar of titles shall transmit 
235.19  the well disclosure certificates to the commissioner of health.  
235.20  By the tenth day after the end of each calendar quarter, the 
235.21  county recorder or registrar of titles shall transmit to the 
235.22  commissioner of health $27.50 $32.50 of the fee for each well 
235.23  disclosure certificate received during the quarter.  The 
235.24  commissioner shall maintain the well disclosure certificate for 
235.25  at least six years.  The commissioner may store the certificate 
235.26  as an electronic image.  A copy of that image shall be as valid 
235.27  as the original. 
235.28     (j) No new well disclosure certificate is required under 
235.29  this subdivision if the buyer or seller, or a person authorized 
235.30  to act on behalf of the buyer or seller, certifies on the deed 
235.31  or other instrument of conveyance that the status and number of 
235.32  wells on the property have not changed since the last previously 
235.33  filed well disclosure certificate.  The following statement, if 
235.34  followed by the signature of the person making the statement, is 
235.35  sufficient to comply with the certification requirement of this 
235.36  paragraph:  "I am familiar with the property described in this 
236.1   instrument and I certify that the status and number of wells on 
236.2   the described real property have not changed since the last 
236.3   previously filed well disclosure certificate."  The 
236.4   certification and signature may be on the front or back of the 
236.5   deed or on an attached sheet and an acknowledgment of the 
236.6   statement is not required for the deed or other instrument of 
236.7   conveyance to be recordable. 
236.8      (k) The commissioner in consultation with county recorders 
236.9   shall prescribe the form for a well disclosure certificate and 
236.10  provide well disclosure certificate forms to county recorders 
236.11  and registrars of titles and other interested persons. 
236.12     (l) Failure to comply with a requirement of this 
236.13  subdivision does not impair: 
236.14     (1) the validity of a deed or other instrument of 
236.15  conveyance as between the parties to the deed or instrument or 
236.16  as to any other person who otherwise would be bound by the deed 
236.17  or instrument; or 
236.18     (2) the record, as notice, of any deed or other instrument 
236.19  of conveyance accepted for filing or recording contrary to the 
236.20  provisions of this subdivision. 
236.21     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2006. 
236.22     Sec. 7.  Minnesota Statutes 2004, section 103I.601, 
236.23  subdivision 2, is amended to read: 
236.24     Subd. 2.  [LICENSE REQUIRED TO MAKE BORINGS.] (a) Except as 
236.25  provided in paragraph (b) (d), a person may must not make an 
236.26  exploratory boring without an exploratory borer's explorer's 
236.27  license.  The fee for an explorer's license is $75.  The 
236.28  explorer's license is valid until the date prescribed in the 
236.29  license by the commissioner. 
236.30     (b) A person must file an application and renewal 
236.31  application fee to renew the explorer's license by the date 
236.32  stated in the license.  The renewal application fee is $75. 
236.33     (c) If the licensee submits an application fee after the 
236.34  required renewal date, the licensee: 
236.35     (1) must include a late fee of $75; and 
236.36     (2) may not conduct activities authorized by an explorer's 
237.1   license until the renewal application, renewal application fee, 
237.2   late fee, and sealing reports required in subdivision 9 are 
237.3   submitted. 
237.4      (d) An explorer may must designate a responsible individual 
237.5   to supervise and oversee the making of exploratory borings.  
237.6   Before an individual supervises or oversees an exploratory 
237.7   boring, the individual must file an application and application 
237.8   fee of $75 to qualify as a responsible individual.  The 
237.9   individual must take and pass an examination relating to 
237.10  construction, location, and sealing of exploratory borings.  A 
237.11  professional engineer registered or geoscientist licensed under 
237.12  sections 326.02 to 326.15 or a certified professional geologist 
237.13  certified by the American Institute of Professional Geologists 
237.14  is not required to take the examination required in this 
237.15  subdivision, but must be licensed certified as a responsible 
237.16  individual to make supervise an exploratory boring. 
237.17     Sec. 8.  Minnesota Statutes 2004, section 144.122, is 
237.18  amended to read: 
237.19     144.122 [LICENSE, PERMIT, AND SURVEY FEES.] 
237.20     (a) The state commissioner of health, by rule, may 
237.21  prescribe reasonable procedures and fees for filing with the 
237.22  commissioner as prescribed by statute and for the issuance of 
237.23  original and renewal permits, licenses, registrations, and 
237.24  certifications issued under authority of the commissioner.  The 
237.25  expiration dates of the various licenses, permits, 
237.26  registrations, and certifications as prescribed by the rules 
237.27  shall be plainly marked thereon.  Fees may include application 
237.28  and examination fees and a penalty fee for renewal applications 
237.29  submitted after the expiration date of the previously issued 
237.30  permit, license, registration, and certification.  The 
237.31  commissioner may also prescribe, by rule, reduced fees for 
237.32  permits, licenses, registrations, and certifications when the 
237.33  application therefor is submitted during the last three months 
237.34  of the permit, license, registration, or certification period.  
237.35  Fees proposed to be prescribed in the rules shall be first 
237.36  approved by the Department of Finance.  All fees proposed to be 
238.1   prescribed in rules shall be reasonable.  The fees shall be in 
238.2   an amount so that the total fees collected by the commissioner 
238.3   will, where practical, approximate the cost to the commissioner 
238.4   in administering the program.  All fees collected shall be 
238.5   deposited in the state treasury and credited to the state 
238.6   government special revenue fund unless otherwise specifically 
238.7   appropriated by law for specific purposes. 
238.8      (b) The commissioner may charge a fee for voluntary 
238.9   certification of medical laboratories and environmental 
238.10  laboratories, and for environmental and medical laboratory 
238.11  services provided by the department, without complying with 
238.12  paragraph (a) or chapter 14.  Fees charged for environment and 
238.13  medical laboratory services provided by the department must be 
238.14  approximately equal to the costs of providing the services.  
238.15     (c) The commissioner may develop a schedule of fees for 
238.16  diagnostic evaluations conducted at clinics held by the services 
238.17  for children with handicaps program.  All receipts generated by 
238.18  the program are annually appropriated to the commissioner for 
238.19  use in the maternal and child health program. 
238.20     (d) The commissioner shall set license fees for hospitals 
238.21  and nursing homes that are not boarding care homes at the 
238.22  following levels: 
238.23  Joint Commission on Accreditation of Healthcare 
238.24  Organizations (JCAHO hospitals)  $7,055 $7,555 plus $13 per bed
238.25  Non-JCAHO hospitals              $4,680 $5,180 plus $234
238.26                                              $247 per bed
238.27  Nursing home                     $183 plus $91 per bed
238.28     The commissioner shall set license fees for outpatient 
238.29  surgical centers, boarding care homes, and supervised living 
238.30  facilities at the following levels: 
238.31  Outpatient surgical centers      $1,512 $3,349
238.32  Boarding care homes              $183 plus $91 per bed
238.33  Supervised living facilities     $183 plus $91 per bed.
238.34     (e) Unless prohibited by federal law, the commissioner of 
238.35  health shall charge applicants the following fees to cover the 
238.36  cost of any initial certification surveys required to determine 
239.1   a provider's eligibility to participate in the Medicare or 
239.2   Medicaid program: 
239.3   Prospective payment surveys for          $  900
239.4   hospitals
239.6   Swing bed surveys for nursing homes      $1,200
239.8   Psychiatric hospitals                    $1,400
239.10  Rural health facilities                  $1,100
239.12  Portable x-ray providers                 $  500
239.14  Home health agencies                     $1,800
239.16  Outpatient therapy agencies              $  800
239.18  End stage renal dialysis providers       $2,100
239.20  Independent therapists                   $  800
239.22  Comprehensive rehabilitation             $1,200
239.23  outpatient facilities
239.25  Hospice providers                        $1,700
239.27  Ambulatory surgical providers            $1,800
239.29  Hospitals                                $4,200
239.31  Other provider categories or             Actual surveyor costs:
239.32  additional resurveys required            average surveyor cost x
239.33  to complete initial certification        number of hours for the
239.34                                           survey process.
239.35     These fees shall be submitted at the time of the 
239.36  application for federal certification and shall not be 
239.37  refunded.  All fees collected after the date that the imposition 
239.38  of fees is not prohibited by federal law shall be deposited in 
239.39  the state treasury and credited to the state government special 
239.40  revenue fund. 
239.41     Sec. 9.  Minnesota Statutes 2004, section 144.147, 
239.42  subdivision 1, is amended to read: 
239.43     Subdivision 1.  [DEFINITION.] "Eligible rural hospital" 
239.44  means any nonfederal, general acute care hospital that: 
239.45     (1) is either located in a rural area, as defined in the 
239.46  federal Medicare regulations, Code of Federal Regulations, title 
239.47  42, section 405.1041, or located in a community with a 
239.48  population of less than 10,000 15,000, according to United 
239.49  States Census Bureau statistics, outside the seven-county 
239.50  metropolitan area; 
239.51     (2) has 50 or fewer beds; and 
240.1      (3) is not for profit. 
240.2      Sec. 10.  Minnesota Statutes 2004, section 144.147, 
240.3   subdivision 2, is amended to read: 
240.4      Subd. 2.  [GRANTS AUTHORIZED.] The commissioner shall 
240.5   establish a program of grants to assist eligible rural 
240.6   hospitals.  The commissioner shall award grants to hospitals and 
240.7   communities for the purposes set forth in paragraphs (a) and (b).
240.8      (a) Grants may be used by hospitals and their communities 
240.9   to develop strategic plans for preserving or enhancing access to 
240.10  health services.  At a minimum, a strategic plan must consist of:
240.11     (1) a needs assessment to determine what health services 
240.12  are needed and desired by the community.  The assessment must 
240.13  include interviews with or surveys of area health professionals, 
240.14  local community leaders, and public hearings; 
240.15     (2) an assessment of the feasibility of providing needed 
240.16  health services that identifies priorities and timeliness for 
240.17  potential changes; and 
240.18     (3) an implementation plan.  
240.19     The strategic plan must be developed by a committee that 
240.20  includes representatives from the hospital, local public health 
240.21  agencies, other health providers, and consumers from the 
240.22  community.  
240.23     (b) The grants may also be used by eligible rural hospitals 
240.24  that have developed strategic plans to implement transition 
240.25  projects to modify the type and extent of services provided, in 
240.26  order to reflect the needs of that plan.  Grants may be used by 
240.27  hospitals under this paragraph to develop hospital-based 
240.28  physician practices that integrate hospital and existing medical 
240.29  practice facilities that agree to transfer their practices, 
240.30  equipment, staffing, and administration to the hospital.  The 
240.31  grants may also be used by the hospital to establish a health 
240.32  provider cooperative, a telemedicine system, an electronic 
240.33  health records system, or a rural health care system or to cover 
240.34  expenses associated with being designated as a critical access 
240.35  hospital for the Medicare rural hospital flexibility program.  
240.36  Not more than one-third of any grant shall be used to offset 
241.1   losses incurred by physicians agreeing to transfer their 
241.2   practices to hospitals.  
241.3      Sec. 11.  [144.1476] [RURAL PHARMACY PLANNING AND 
241.4   TRANSITION GRANT PROGRAM.] 
241.5      Subdivision 1.  [DEFINITIONS.] (a) For the purposes of this 
241.6   section, the following definitions apply. 
241.7      (b) "Eligible rural community" means: 
241.8      (1) a Minnesota community that is located in a rural area, 
241.9   as defined in the federal Medicare regulations, Code of Federal 
241.10  Regulations, title 42, section 405.1041; or 
241.11     (2) a Minnesota community that has a population of less 
241.12  than 10,000, according to the United States Bureau of 
241.13  Statistics, and that is outside the seven-county metropolitan 
241.14  area, excluding the cities of Duluth, Mankato, Moorhead, 
241.15  Rochester, and St. Cloud. 
241.16     (c) "Health care provider" means a hospital, clinic, 
241.17  pharmacy, long-term care institution, or other health care 
241.18  facility that is licensed, certified, or otherwise authorized by 
241.19  the laws of this state to provide health care. 
241.20     (d) "Pharmacist" means an individual with a valid license 
241.21  issued under chapter 151 to practice pharmacy. 
241.22     (e) "Pharmacy" has the meaning given under section 151.01, 
241.23  subdivision 2. 
241.24     Subd. 2.  [GRANTS AUTHORIZED; ELIGIBILITY.] (a) The 
241.25  commissioner of health shall establish a program to award grants 
241.26  to eligible rural communities or health care providers in 
241.27  eligible rural communities for planning, establishing, keeping 
241.28  in operation, or providing health care services that preserve 
241.29  access to prescription medications and the skills of a 
241.30  pharmacist according to sections 151.01 to 151.40. 
241.31     (b) To be eligible for a grant, an applicant must develop a 
241.32  strategic plan for preserving or enhancing access to 
241.33  prescription medications and the skills of a pharmacist.  At a 
241.34  minimum, a strategic plan must consist of: 
241.35     (1) a needs assessment to determine what pharmacy services 
241.36  are needed and desired by the community.  The assessment must 
242.1   include interviews with or surveys of area and local health 
242.2   professionals, local community leaders, and public officials; 
242.3      (2) an assessment of the feasibility of providing needed 
242.4   pharmacy services that identifies priorities and timelines for 
242.5   potential changes; and 
242.6      (3) an implementation plan. 
242.7      (c) A grant may be used by a recipient that has developed a 
242.8   strategic plan to implement transition projects to modify the 
242.9   type and extent of pharmacy services provided, in order to 
242.10  reflect the needs of the community.  Grants may also be used by 
242.11  recipients: 
242.12     (1) to develop pharmacy practices that integrate pharmacy 
242.13  and existing health care provider facilities; or 
242.14     (2) to establish a pharmacy provider cooperative or 
242.15  initiatives that maintain local access to prescription 
242.16  medications and the skills of a pharmacist. 
242.17     Subd. 3.  [FUNDING.] In accordance with section 214.06, fee 
242.18  revenues collected by the Board of Pharmacy shall pay for: 
242.19     (1) anticipated operating expenditures during the fiscal 
242.20  biennium; and 
242.21     (2) appropriations for the rural pharmacy grant program 
242.22  administered by the Department of Health. 
242.23  The commissioner of finance shall make available money in the 
242.24  state government special revenue fund for the operation and 
242.25  administration of the rural pharmacy grant program.  No more 
242.26  than ten percent of the money appropriated for the rural 
242.27  pharmacy grant program may be used for administrative expenses. 
242.28     Subd. 4.  [CONSIDERATION OF GRANTS.] In determining which 
242.29  applicants shall receive grants under this section, the 
242.30  commissioner of health shall appoint a committee comprised of 
242.31  members with experience and knowledge about rural pharmacy 
242.32  issues including two rural pharmacists with a community pharmacy 
242.33  background, two health care providers from rural communities, 
242.34  one representative from a statewide pharmacist organization, and 
242.35  one representative of the Board of Pharmacy.  A representative 
242.36  of the commissioner may serve on the committee in an ex officio 
243.1   status.  In determining who shall receive a grant, the committee 
243.2   shall take into account: 
243.3      (1) improving or maintaining access to prescription 
243.4   medications and the skills of a pharmacist; 
243.5      (2) changes in service populations; 
243.6      (3) the extent community pharmacy needs are not currently 
243.7   met by other providers in the area; 
243.8      (4) the financial condition of the applicant; 
243.9      (5) the integration of pharmacy services into existing 
243.10  health care services; and 
243.11     (6) community support. 
243.12     Subd. 5.  [ALLOCATION OF GRANTS.] (a) The commissioner 
243.13  shall establish a deadline for receiving applications and must 
243.14  make a final decision on the funding of each application within 
243.15  60 days of the deadline.  An applicant must apply no later than 
243.16  March 1 of each fiscal year for grants awarded for that fiscal 
243.17  year.  Each relevant community board has 30 days in which to 
243.18  review and comment to the commissioner on eligible applications. 
243.19     (b) Any grant awarded must not exceed $50,000 a year and 
243.20  may not exceed a one-year term. 
243.21     (c) Applicants may apply to the program each year they are 
243.22  eligible. 
243.23     (d) Project grants may not be used to retire debt incurred 
243.24  with respect to any capitol expenditure made prior to the date 
243.25  on which the project is initiated. 
243.26     Subd. 6.  [EVALUATION.] The grant program shall be 
243.27  evaluated annually in reports by the recipients of the grants.  
243.28  An academic institution that has the expertise in evaluating 
243.29  rural pharmacy outcomes may participate in the program 
243.30  evaluation if asked by a recipient or the commissioner. 
243.31     Sec. 12.  Minnesota Statutes 2004, section 144.148, 
243.32  subdivision 1, is amended to read: 
243.33     Subdivision 1.  [DEFINITION.] (a) For purposes of this 
243.34  section, the following definitions apply. 
243.35     (b) "Eligible rural hospital" means any nonfederal, general 
243.36  acute care hospital that: 
244.1      (1) is either located in a rural area, as defined in the 
244.2   federal Medicare regulations, Code of Federal Regulations, title 
244.3   42, section 405.1041, or located in a community with a 
244.4   population of less than 10,000 15,000, according to United 
244.5   States Census Bureau statistics, outside the seven-county 
244.6   metropolitan area; 
244.7      (2) has 50 or fewer beds; and 
244.8      (3) is not for profit. 
244.9      (c) "Eligible project" means a modernization project to 
244.10  update, remodel, or replace aging hospital facilities and 
244.11  equipment necessary to maintain the operations of a hospital, 
244.12  including establishing an electronic health records system. 
244.13     Sec. 13.  Minnesota Statutes 2004, section 144.1483, is 
244.14  amended to read: 
244.15     144.1483 [RURAL HEALTH INITIATIVES.] 
244.16     The commissioner of health, through the Office of Rural 
244.17  Health, and consulting as necessary with the commissioner of 
244.18  human services, the commissioner of commerce, the Higher 
244.19  Education Services Office, and other state agencies, shall: 
244.20     (1) develop a detailed plan regarding the feasibility of 
244.21  coordinating rural health care services by organizing individual 
244.22  medical providers and smaller hospitals and clinics into 
244.23  referral networks with larger rural hospitals and clinics that 
244.24  provide a broader array of services; 
244.25     (2) develop and implement a program to assist rural 
244.26  communities in establishing community health centers, as 
244.27  required by section 144.1486; 
244.28     (3) develop recommendations regarding health education and 
244.29  training programs in rural areas, including but not limited to a 
244.30  physician assistants' training program, continuing education 
244.31  programs for rural health care providers, and rural outreach 
244.32  programs for nurse practitioners within existing training 
244.33  programs; 
244.34     (4) (3) develop a statewide, coordinated recruitment 
244.35  strategy for health care personnel and maintain a database on 
244.36  health care personnel as required under section 144.1485; 
245.1      (5) (4) develop and administer technical assistance 
245.2   programs to assist rural communities in:  (i) planning and 
245.3   coordinating the delivery of local health care services; and 
245.4   (ii) hiring physicians, nurse practitioners, public health 
245.5   nurses, physician assistants, and other health personnel; 
245.6      (6) (5) study and recommend changes in the regulation of 
245.7   health care personnel, such as nurse practitioners and physician 
245.8   assistants, related to scope of practice, the amount of on-site 
245.9   physician supervision, and dispensing of medication, to address 
245.10  rural health personnel shortages; 
245.11     (7) (6) support efforts to ensure continued funding for 
245.12  medical and nursing education programs that will increase the 
245.13  number of health professionals serving in rural areas; 
245.14     (8) (7) support efforts to secure higher reimbursement for 
245.15  rural health care providers from the Medicare and medical 
245.16  assistance programs; 
245.17     (9) (8) coordinate the development of a statewide plan for 
245.18  emergency medical services, in cooperation with the Emergency 
245.19  Medical Services Advisory Council; 
245.20     (10) (9) establish a Medicare rural hospital flexibility 
245.21  program pursuant to section 1820 of the federal Social Security 
245.22  Act, United States Code, title 42, section 1395i-4, by 
245.23  developing a state rural health plan and designating, consistent 
245.24  with the rural health plan, rural nonprofit or public hospitals 
245.25  in the state as critical access hospitals.  Critical access 
245.26  hospitals shall include facilities that are certified by the 
245.27  state as necessary providers of health care services to 
245.28  residents in the area.  Necessary providers of health care 
245.29  services are designated as critical access hospitals on the 
245.30  basis of being more than 20 miles, defined as official mileage 
245.31  as reported by the Minnesota Department of Transportation, from 
245.32  the next nearest hospital, being the sole hospital in the 
245.33  county, being a hospital located in a county with a designated 
245.34  medically underserved area or health professional shortage area, 
245.35  or being a hospital located in a county contiguous to a county 
245.36  with a medically underserved area or health professional 
246.1   shortage area.  A critical access hospital located in a county 
246.2   with a designated medically underserved area or a health 
246.3   professional shortage area or in a county contiguous to a county 
246.4   with a medically underserved area or health professional 
246.5   shortage area shall continue to be recognized as a critical 
246.6   access hospital in the event the medically underserved area or 
246.7   health professional shortage area designation is subsequently 
246.8   withdrawn; and 
246.9      (11) (10) carry out other activities necessary to address 
246.10  rural health problems. 
246.11     Sec. 14.  Minnesota Statutes 2004, section 144.1501, 
246.12  subdivision 1, is amended to read: 
246.13     Subdivision 1.  [DEFINITIONS.] (a) For purposes of this 
246.14  section, the following definitions apply.  
246.15     (b) "Dentist" means an individual who is licensed to 
246.16  practice dentistry. 
246.17     (c) "Designated rural area" means:  
246.18     (1) an area in Minnesota outside the counties of Anoka, 
246.19  Carver, Dakota, Hennepin, Ramsey, Scott, and Washington, 
246.20  excluding the cities of Duluth, Mankato, Moorhead, Rochester, 
246.21  and St. Cloud; or 
246.22     (2) a municipal corporation, as defined under section 
246.23  471.634, that is physically located, in whole or in part, in an 
246.24  area defined as a designated rural area under clause (1).  
246.25     (c) (d) "Emergency circumstances" means those conditions 
246.26  that make it impossible for the participant to fulfill the 
246.27  service commitment, including death, total and permanent 
246.28  disability, or temporary disability lasting more than two years. 
246.29     (d) (e) "Medical resident" means an individual 
246.30  participating in a medical residency in family practice, 
246.31  internal medicine, obstetrics and gynecology, pediatrics, or 
246.32  psychiatry.  
246.33     (e) (f) "Midlevel practitioner" means a nurse practitioner, 
246.34  nurse-midwife, nurse anesthetist, advanced clinical nurse 
246.35  specialist, or physician assistant.  
246.36     (f) (g) "Nurse" means an individual who has completed 
247.1   training and received all licensing or certification necessary 
247.2   to perform duties as a licensed practical nurse or registered 
247.3   nurse.  
247.4      (g) (h) "Nurse-midwife" means a registered nurse who has 
247.5   graduated from a program of study designed to prepare registered 
247.6   nurses for advanced practice as nurse-midwives.  
247.7      (h) (i) "Nurse practitioner" means a registered nurse who 
247.8   has graduated from a program of study designed to prepare 
247.9   registered nurses for advanced practice as nurse practitioners.  
247.10     (i) (j) "Pharmacist" means an individual with a valid 
247.11  license to practice pharmacy issued under chapter 151. 
247.12     (k) "Physician" means an individual who is licensed to 
247.13  practice medicine in the areas of family practice, internal 
247.14  medicine, obstetrics and gynecology, pediatrics, or psychiatry.  
247.15     (j) (l) "Physician assistant" means a person registered 
247.16  under chapter 147A.  
247.17     (k) (m) "Qualified educational loan" means a government, 
247.18  commercial, or foundation loan for actual costs paid for 
247.19  tuition, reasonable education expenses, and reasonable living 
247.20  expenses related to the graduate or undergraduate education of a 
247.21  health care professional.  
247.22     (l) (n) "Underserved urban community" means a Minnesota 
247.23  urban area or population included in the list of designated 
247.24  primary medical care health professional shortage areas (HPSAs), 
247.25  medically underserved areas (MUAs), or medically underserved 
247.26  populations (MUPs) maintained and updated by the United States 
247.27  Department of Health and Human Services.  
247.28     Sec. 15.  Minnesota Statutes 2004, section 144.1501, 
247.29  subdivision 2, is amended to read: 
247.30     Subd. 2.  [CREATION OF ACCOUNT.] A health professional 
247.31  education loan forgiveness program account is established.  The 
247.32  commissioner of health shall use money from the account to 
247.33  establish a loan forgiveness program for medical residents 
247.34  agreeing to practice in designated rural areas or underserved 
247.35  urban communities,; for dentists agreeing to deliver at least 25 
247.36  percent of the dentist's yearly patient encounters to state 
248.1   public program enrollees or patients receiving sliding fee 
248.2   schedule discounts through a formal sliding fee schedule meeting 
248.3   the standards established by the United States Department of 
248.4   Health and Human Services under Code of Federal Regulations, 
248.5   title 42, section 51, chapter 303; for midlevel practitioners 
248.6   agreeing to practice in designated rural areas, and for nurses 
248.7   who agree to practice in a Minnesota nursing home or 
248.8   intermediate care facility for persons with mental retardation 
248.9   or related conditions, and for pharmacists who agree to practice 
248.10  in designated rural areas.  Appropriations made to the account 
248.11  do not cancel and are available until expended, except that at 
248.12  the end of each biennium, any remaining balance in the account 
248.13  that is not committed by contract and not needed to fulfill 
248.14  existing commitments shall cancel to the fund. 
248.15     Sec. 16.  Minnesota Statutes 2004, section 144.1501, 
248.16  subdivision 3, is amended to read: 
248.17     Subd. 3.  [ELIGIBILITY.] (a) To be eligible to participate 
248.18  in the loan forgiveness program, an individual must: 
248.19     (1) be a medical or dental resident or a licensed 
248.20  pharmacist or be enrolled in a dentist, midlevel practitioner, 
248.21  registered nurse, or a licensed practical nurse training 
248.22  program; and 
248.23     (2) submit an application to the commissioner of 
248.24  health.  If fewer applications are submitted by dental students 
248.25  or residents than there are dentist participant slots available, 
248.26  the commissioner may consider applications submitted by dental 
248.27  program graduates who are licensed dentists. 
248.28     (b) An applicant selected to participate must sign a 
248.29  contract to agree to serve a minimum three-year full-time 
248.30  service obligation according to subdivision 2, which shall begin 
248.31  no later than March 31 following completion of required training.
248.32     Sec. 17.  Minnesota Statutes 2004, section 144.1501, 
248.33  subdivision 4, is amended to read: 
248.34     Subd. 4.  [LOAN FORGIVENESS.] The commissioner of health 
248.35  may select applicants each year for participation in the loan 
248.36  forgiveness program, within the limits of available funding. The 
249.1   commissioner shall distribute available funds for loan 
249.2   forgiveness proportionally among the eligible professions 
249.3   according to the vacancy rate for each profession in the 
249.4   required geographic area, patient group, or facility type 
249.5   specified in subdivision 2.  The commissioner shall allocate 
249.6   funds for physician loan forgiveness so that 75 percent of the 
249.7   funds available are used for rural physician loan forgiveness 
249.8   and 25 percent of the funds available are used for underserved 
249.9   urban communities loan forgiveness.  If the commissioner does 
249.10  not receive enough qualified applicants each year to use the 
249.11  entire allocation of funds for urban underserved communities any 
249.12  eligible profession, the remaining funds may be allocated for 
249.13  rural physician loan forgiveness proportionally among the other 
249.14  eligible professions according to the vacancy rate for each 
249.15  profession in the required geographic area, patient group, or 
249.16  facility type specified in subdivision 2.  Applicants are 
249.17  responsible for securing their own qualified educational loans.  
249.18  The commissioner shall select participants based on their 
249.19  suitability for practice serving the required geographic area or 
249.20  facility type specified in subdivision 2, as indicated by 
249.21  experience or training.  The commissioner shall give preference 
249.22  to applicants closest to completing their training.  For each 
249.23  year that a participant meets the service obligation required 
249.24  under subdivision 3, up to a maximum of four years, the 
249.25  commissioner shall make annual disbursements directly to the 
249.26  participant equivalent to 15 percent of the average educational 
249.27  debt for indebted graduates in their profession in the year 
249.28  closest to the applicant's selection for which information is 
249.29  available, not to exceed the balance of the participant's 
249.30  qualifying educational loans.  Before receiving loan repayment 
249.31  disbursements and as requested, the participant must complete 
249.32  and return to the commissioner an affidavit of practice form 
249.33  provided by the commissioner verifying that the participant is 
249.34  practicing as required under subdivisions 2 and 3.  The 
249.35  participant must provide the commissioner with verification that 
249.36  the full amount of loan repayment disbursement received by the 
250.1   participant has been applied toward the designated loans.  After 
250.2   each disbursement, verification must be received by the 
250.3   commissioner and approved before the next loan repayment 
250.4   disbursement is made.  Participants who move their practice 
250.5   remain eligible for loan repayment as long as they practice as 
250.6   required under subdivision 2.  
250.7      Sec. 18.  Minnesota Statutes 2004, section 144.226, 
250.8   subdivision 1, is amended to read: 
250.9      Subdivision 1.  [WHICH SERVICES ARE FOR FEE.] The fees for 
250.10  the following services shall be the following or an amount 
250.11  prescribed by rule of the commissioner: 
250.12     (a) The fee for the issuance of a certified vital record or 
250.13  a certification that the vital record cannot be found is $8 $9.  
250.14  No fee shall be charged for a certified birth or death record 
250.15  that is reissued within one year of the original issue, if an 
250.16  amendment is made to the vital record and if the previously 
250.17  issued vital record is surrendered.  The fee is nonrefundable. 
250.18     (b) The fee for processing a request for the replacement of 
250.19  a birth record for all events, except when filing a recognition 
250.20  of parentage pursuant to section 257.73, subdivision 1, 
250.21  is $20 $40.  The fee is payable at the time of application and 
250.22  is nonrefundable. 
250.23     (c) The fee for processing a request for the filing of a 
250.24  delayed registration of birth or death is $20 $40.  The fee is 
250.25  payable at the time of application and is nonrefundable.  This 
250.26  fee includes one subsequent review of the request if the request 
250.27  is not acceptable upon the initial receipt. 
250.28     (d) The fee for processing a request for the amendment of 
250.29  any vital record when requested more than 45 days after the 
250.30  filing of the vital record is $20 $40.  No fee shall be charged 
250.31  for an amendment requested within 45 days after the filing of 
250.32  the vital record.  The fee is payable at the time of application 
250.33  and is nonrefundable.  This fee includes one subsequent review 
250.34  of the request if the request is not acceptable upon the initial 
250.35  receipt. 
250.36     (e) The fee for processing a request for the verification 
251.1   of information from vital records is $8 $9 when the applicant 
251.2   furnishes the specific information to locate the vital record.  
251.3   When the applicant does not furnish specific information, the 
251.4   fee is $20 per hour for staff time expended.  Specific 
251.5   information includes the correct date of the event and the 
251.6   correct name of the registrant.  Fees charged shall approximate 
251.7   the costs incurred in searching and copying the vital records.  
251.8   The fee shall be is payable at the time of application and is 
251.9   nonrefundable. 
251.10     (f) The fee for processing a request for the issuance of a 
251.11  copy of any document on file pertaining to a vital record or 
251.12  statement that a related document cannot be found is $8 $9.  The 
251.13  fee is payable at the time of application and is nonrefundable. 
251.14     Sec. 19.  Minnesota Statutes 2004, section 144.226, 
251.15  subdivision 4, is amended to read: 
251.16     Subd. 4.  [VITAL RECORDS SURCHARGE.] In addition to any fee 
251.17  prescribed under subdivision 1, there is a nonrefundable 
251.18  surcharge of $2 $4 for each certified and noncertified birth or 
251.19  death record, and for a certification that the record cannot be 
251.20  found.  The local or state registrar shall forward this amount 
251.21  to the commissioner of finance to be deposited into the state 
251.22  government special revenue fund.  This surcharge shall not be 
251.23  charged under those circumstances in which no fee for a birth or 
251.24  death record is permitted under subdivision 1, paragraph (a).  
251.25     Sec. 20.  Minnesota Statutes 2004, section 144.226, is 
251.26  amended by adding a subdivision to read: 
251.27     Subd. 5.  [ELECTRONIC VERIFICATION.] A fee for the 
251.28  electronic verification of a vital event, when the information 
251.29  being verified is obtained from a certified birth or death 
251.30  record, shall be established through contractual or interagency 
251.31  agreements with interested local, state, or federal government 
251.32  agencies. 
251.33     Sec. 21.  Minnesota Statutes 2004, section 144.226, is 
251.34  amended by adding a subdivision to read: 
251.35     Subd. 6.  [ALTERNATIVE PAYMENT METHODS.] Notwithstanding 
251.36  subdivision 1, alternative payment methods may be approved and 
252.1   implemented by the state registrar or a local registrar. 
252.2      Sec. 22.  [144.3431] [ABORTION NOTIFICATION DATA.] 
252.3      Subdivision 1.  [REPORTING FORM.] (a) Within 90 days of the 
252.4   effective date of this section, the commissioner of health shall 
252.5   prepare a reporting form for use by physicians and facilities 
252.6   performing abortions. 
252.7      (b) The form shall require the following information: 
252.8      (1) the number of minors or women for whom a guardian has 
252.9   been appointed under sections 524.5-301 to 524.5-317 because of 
252.10  a finding of incompetency for whom the physician or an agent of 
252.11  the physician provided the notice described in section 144.343, 
252.12  subdivision 2; of that number, the number of notices provided 
252.13  personally as described in section 144.343, subdivision 2, 
252.14  paragraph (a), and the number of notices provided by mail as 
252.15  described in section 144.343, subdivision 2, paragraph (b); and 
252.16  of each of those numbers, the number who, to the best of the 
252.17  reporting physician's or reporting facility's information and 
252.18  belief, went on to obtain the abortion from the reporting 
252.19  physician or reporting physician's facility, or from the 
252.20  reporting facility; 
252.21     (2) the number of minors or women for whom a guardian has 
252.22  been appointed under sections 524.5-301 to 524.5-317 because of 
252.23  a finding of incompetency upon whom the physician performed an 
252.24  abortion without providing the notice described in section 
252.25  144.343, subdivision 2; and of that number, the number who were 
252.26  emancipated minors, and the number for whom section 144.343, 
252.27  subdivision 4, was applicable, itemized by each of the 
252.28  limitations identified in paragraphs (a), (b), and (c) of that 
252.29  subdivision; 
252.30     (3) the number of abortions performed by the physician for 
252.31  which judicial authorization was received and for which the 
252.32  notification described in section 144.343, subdivision 2, was 
252.33  not provided; 
252.34     (4) the county the female resides in; the county where the 
252.35  abortion was performed, if different from the female's 
252.36  residence; and, if a judicial bypass was obtained, the county it 
253.1   was obtained in, if different from the female's residence; 
253.2      (5) the age of the female; 
253.3      (6) the race of the female; 
253.4      (7) the process the physician or the physician's agent used 
253.5   to inform the female of the judicial bypass; whether court forms 
253.6   were provided to her; and whether the physician or the 
253.7   physician's agent made the court arrangement for the female; and 
253.8      (8) how soon after visiting the abortion facility the 
253.9   female went to court to obtain a judicial bypass. 
253.10     Subd. 2.  [FORMS TO PHYSICIANS AND FACILITIES.] Physicians 
253.11  and facilities required to report under subdivision 3 shall 
253.12  obtain reporting forms from the commissioner. 
253.13     Subd. 3.  [SUBMISSION.] (a) The following physicians or 
253.14  facilities must submit the forms to the commissioner no later 
253.15  than April 1 for abortions performed in the previous calendar 
253.16  year: 
253.17     (1) a physician who provides, or whose agent provides, the 
253.18  notice described in section 144.343, subdivision 2, or the 
253.19  facility at which such notice is provided; and 
253.20     (2) a physician who knowingly performs an abortion upon a 
253.21  minor or a woman for whom a guardian has been appointed 
253.22  according to sections 524.5-301 to 524.5-317 because of a 
253.23  finding of incompetency, or a facility at which such an abortion 
253.24  is performed. 
253.25     (b) The commissioner shall maintain as confidential data 
253.26  which alone or in combination may constitute information that 
253.27  would reasonably lead, using epidemiologic principles, to the 
253.28  identification of: 
253.29     (1) an individual who has had an abortion, who has received 
253.30  judicial authorization for an abortion, or to whom the notice 
253.31  described in section 144.343, subdivision 2, has been provided; 
253.32  or 
253.33     (2) a physician or facility required to report under 
253.34  paragraph (a). 
253.35     Subd. 4.  [FAILURE TO REPORT AS REQUIRED.] (a) Reports that 
253.36  are not submitted more than 30 days following the due date shall 
254.1   be subject to a late fee of $500 for each additional 30-day 
254.2   period or portion of a 30-day period overdue.  If a physician or 
254.3   facility required to report under this section has not submitted 
254.4   a report, or has submitted only an incomplete report, more than 
254.5   one year following the due date, the commissioner of health 
254.6   shall bring an action in a court of competent jurisdiction for 
254.7   an order directing the physician or facility to submit a 
254.8   complete report within a period stated by court order or be 
254.9   subject to sanctions.  If the commissioner brings such an action 
254.10  for an order directing a physician or facility to submit a 
254.11  complete report, the court may assess reasonable attorney fees 
254.12  and costs against the noncomplying party. 
254.13     (b) Notwithstanding section 13.39, data related to actions 
254.14  taken by the commissioner to enforce any provision of this 
254.15  section is private data if the data, alone or in combination, 
254.16  may constitute information that would reasonably lead, using 
254.17  epidemiologic principles, to the identification of: 
254.18     (1) an individual who has had an abortion, who has received 
254.19  judicial authorization for an abortion, or to whom the notice 
254.20  described in section 144.343, subdivision 2, has been provided; 
254.21  or 
254.22     (2) a physician or facility required to report under 
254.23  subdivision 3. 
254.24     Subd. 5.  [PUBLIC RECORDS.] (a) By September 30 of each 
254.25  year, the commissioner of health shall issue a public report 
254.26  providing statistics for each item listed in subdivision 1 for 
254.27  the previous calendar year compiled from reports submitted 
254.28  according to this section.  The report shall also include 
254.29  statistics, which shall be obtained from court administrators, 
254.30  that include: 
254.31     (1) the total number of petitions or motions filed under 
254.32  section 144.343, subdivision 6, paragraph (c), clause (i); 
254.33     (2) the number of cases in which the court appointed a 
254.34  guardian ad litem; 
254.35     (3) the number of cases in which the court appointed 
254.36  counsel; 
255.1      (4) the number of cases in which the judge issued an order 
255.2   authorizing an abortion without notification, including: 
255.3      (i) the number of petitions or motions granted by the court 
255.4   because of a finding of maturity and the basis for that finding; 
255.5   and 
255.6      (ii) the number of petitions or motions granted because of 
255.7   a finding that the abortion would be in the best interest of the 
255.8   minor and the basis for that finding; 
255.9      (5) the number of denials from which an appeal was filed; 
255.10     (6) the number of appeals that resulted in a denial being 
255.11  affirmed; and 
255.12     (7) the number of appeals that resulted in reversal of a 
255.13  denial. 
255.14     (b) The report shall provide the statistics for all 
255.15  previous calendar years for which a public report was required 
255.16  to be issued, adjusted to reflect any additional information 
255.17  from late or corrected reports. 
255.18     (c) The commissioner shall ensure that all statistical 
255.19  information included in the public reports are presented so that 
255.20  the data cannot reasonably lead, using epidemiologic principles, 
255.21  to the identification of: 
255.22     (1) an individual who has had an abortion, who has received 
255.23  judicial authorization for an abortion, or to whom the notice 
255.24  described in section 144.343, subdivision 2, has been provided; 
255.25  or 
255.26     (2) a physician or facility who has submitted a form to the 
255.27  commissioner under subdivision 3. 
255.28     Subd. 6.  [MODIFICATION OF REQUIREMENTS.] The commissioner 
255.29  of health may, by administrative rule, alter the dates 
255.30  established in subdivisions 3 and 5, consolidate the forms 
255.31  created according to subdivision 1 with the reporting form 
255.32  created according to section 145.4131, or consolidate reports to 
255.33  achieve administrative convenience or fiscal savings, to allow 
255.34  physicians and facilities to submit all information collected by 
255.35  the commissioner regarding abortions at one time, or to reduce 
255.36  the burden of the data collection, so long as the report 
256.1   described in subdivision 5 is issued at least once a year. 
256.2      Subd. 7.  [SUIT TO COMPEL STATISTICAL REPORT.] If the 
256.3   commissioner of health fails to issue the public report required 
256.4   under subdivision 5, any group of ten or more citizens of the 
256.5   state may seek an injunction in a court of competent 
256.6   jurisdiction against the commissioner, requiring that a complete 
256.7   report be issued within a period stated by court order.  Failure 
256.8   to abide by the injunction shall subject the commissioner to 
256.9   sanctions for civil contempt. 
256.10     Subd. 8.  [ATTORNEY FEES.] If judgment is rendered in favor 
256.11  of the plaintiff in any action described in this section, the 
256.12  court shall also render judgment for a reasonable attorney fee 
256.13  in favor of the plaintiff against the defendant.  If the 
256.14  judgment is rendered in favor of the defendant and the court 
256.15  finds that plaintiff's suit was frivolous and brought in bad 
256.16  faith, the court shall render judgment for a reasonable attorney 
256.17  fee in favor of the defendant against the plaintiff.  
256.18     Subd. 9.  [SEVERABILITY.] If any one or more provision, 
256.19  section, subdivision, sentence, clause, phrase, or word of this 
256.20  section or the application thereof to any person or circumstance 
256.21  is found to be unconstitutional, the same is hereby declared to 
256.22  be severable and the balance of this section shall remain 
256.23  effective notwithstanding such unconstitutionality.  The 
256.24  legislature hereby declares that it would have passed this 
256.25  section, and each provision, section, subdivision, sentence, 
256.26  clause, phrase, or word thereof irrespective of the fact that 
256.27  any one provision, section, subdivision, sentence, clause, 
256.28  phrase, or word be declared unconstitutional. 
256.29     Sec. 23.  Minnesota Statutes 2004, section 144.3831, 
256.30  subdivision 1, is amended to read: 
256.31     Subdivision 1.  [FEE SETTING.] The commissioner of health 
256.32  may assess an annual fee of $5.21 $6.36 for every service 
256.33  connection to a public water supply that is owned or operated by 
256.34  a home rule charter city, a statutory city, a city of the first 
256.35  class, or a town.  The commissioner of health may also assess an 
256.36  annual fee for every service connection served by a water user 
257.1   district defined in section 110A.02. 
257.2      <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2006. 
257.3      Sec. 24.  Minnesota Statutes 2004, section 144.551, 
257.4   subdivision 1, is amended to read: 
257.5      Subdivision 1.  [RESTRICTED CONSTRUCTION OR MODIFICATION.] 
257.6   (a) The following construction or modification may not be 
257.7   commenced:  
257.8      (1) any erection, building, alteration, reconstruction, 
257.9   modernization, improvement, extension, lease, or other 
257.10  acquisition by or on behalf of a hospital that increases the bed 
257.11  capacity of a hospital, relocates hospital beds from one 
257.12  physical facility, complex, or site to another, or otherwise 
257.13  results in an increase or redistribution of hospital beds within 
257.14  the state; and 
257.15     (2) the establishment of a new hospital.  
257.16     (b) This section does not apply to:  
257.17     (1) construction or relocation within a county by a 
257.18  hospital, clinic, or other health care facility that is a 
257.19  national referral center engaged in substantial programs of 
257.20  patient care, medical research, and medical education meeting 
257.21  state and national needs that receives more than 40 percent of 
257.22  its patients from outside the state of Minnesota; 
257.23     (2) a project for construction or modification for which a 
257.24  health care facility held an approved certificate of need on May 
257.25  1, 1984, regardless of the date of expiration of the 
257.26  certificate; 
257.27     (3) a project for which a certificate of need was denied 
257.28  before July 1, 1990, if a timely appeal results in an order 
257.29  reversing the denial; 
257.30     (4) a project exempted from certificate of need 
257.31  requirements by Laws 1981, chapter 200, section 2; 
257.32     (5) a project involving consolidation of pediatric 
257.33  specialty hospital services within the Minneapolis-St. Paul 
257.34  metropolitan area that would not result in a net increase in the 
257.35  number of pediatric specialty hospital beds among the hospitals 
257.36  being consolidated; 
258.1      (6) a project involving the temporary relocation of 
258.2   pediatric-orthopedic hospital beds to an existing licensed 
258.3   hospital that will allow for the reconstruction of a new 
258.4   philanthropic, pediatric-orthopedic hospital on an existing site 
258.5   and that will not result in a net increase in the number of 
258.6   hospital beds.  Upon completion of the reconstruction, the 
258.7   licenses of both hospitals must be reinstated at the capacity 
258.8   that existed on each site before the relocation; 
258.9      (7) the relocation or redistribution of hospital beds 
258.10  within a hospital building or identifiable complex of buildings 
258.11  provided the relocation or redistribution does not result in: 
258.12  (i) an increase in the overall bed capacity at that site; (ii) 
258.13  relocation of hospital beds from one physical site or complex to 
258.14  another; or (iii) redistribution of hospital beds within the 
258.15  state or a region of the state; 
258.16     (8) relocation or redistribution of hospital beds within a 
258.17  hospital corporate system that involves the transfer of beds 
258.18  from a closed facility site or complex to an existing site or 
258.19  complex provided that:  (i) no more than 50 percent of the 
258.20  capacity of the closed facility is transferred; (ii) the 
258.21  capacity of the site or complex to which the beds are 
258.22  transferred does not increase by more than 50 percent; (iii) the 
258.23  beds are not transferred outside of a federal health systems 
258.24  agency boundary in place on July 1, 1983; and (iv) the 
258.25  relocation or redistribution does not involve the construction 
258.26  of a new hospital building; 
258.27     (9) a construction project involving up to 35 new beds in a 
258.28  psychiatric hospital in Rice County that primarily serves 
258.29  adolescents and that receives more than 70 percent of its 
258.30  patients from outside the state of Minnesota; 
258.31     (10) a project to replace a hospital or hospitals with a 
258.32  combined licensed capacity of 130 beds or less if:  (i) the new 
258.33  hospital site is located within five miles of the current site; 
258.34  and (ii) the total licensed capacity of the replacement 
258.35  hospital, either at the time of construction of the initial 
258.36  building or as the result of future expansion, will not exceed 
259.1   70 licensed hospital beds, or the combined licensed capacity of 
259.2   the hospitals, whichever is less; 
259.3      (11) the relocation of licensed hospital beds from an 
259.4   existing state facility operated by the commissioner of human 
259.5   services to a new or existing facility, building, or complex 
259.6   operated by the commissioner of human services; from one 
259.7   regional treatment center site to another; or from one building 
259.8   or site to a new or existing building or site on the same 
259.9   campus; 
259.10     (12) the construction or relocation of hospital beds 
259.11  operated by a hospital having a statutory obligation to provide 
259.12  hospital and medical services for the indigent that does not 
259.13  result in a net increase in the number of hospital beds; 
259.14     (13) a construction project involving the addition of up to 
259.15  31 new beds in an existing nonfederal hospital in Beltrami 
259.16  County; 
259.17     (14) a construction project involving the addition of up to 
259.18  eight new beds in an existing nonfederal hospital in Otter Tail 
259.19  County with 100 licensed acute care beds; 
259.20     (15) a construction project involving the addition of 20 
259.21  new hospital beds used for rehabilitation services in an 
259.22  existing hospital in Carver County serving the southwest 
259.23  suburban metropolitan area.  Beds constructed under this clause 
259.24  shall not be eligible for reimbursement under medical 
259.25  assistance, general assistance medical care, or MinnesotaCare; 
259.26     (16) a project for the construction or relocation of up to 
259.27  20 hospital beds for the operation of up to two psychiatric 
259.28  facilities or units for children provided that the operation of 
259.29  the facilities or units have received the approval of the 
259.30  commissioner of human services; 
259.31     (17) a project involving the addition of 14 new hospital 
259.32  beds to be used for rehabilitation services in an existing 
259.33  hospital in Itasca County; or 
259.34     (18) a project to add 20 licensed beds in existing space at 
259.35  a hospital in Hennepin County that closed 20 rehabilitation beds 
259.36  in 2002, provided that the beds are used only for rehabilitation 
260.1   in the hospital's current rehabilitation building.  If the beds 
260.2   are used for another purpose or moved to another location, the 
260.3   hospital's licensed capacity is reduced by 20 beds; or 
260.4      (19) a critical access hospital established under section 
260.5   144.1483, clause (10), and section 1820 of the federal Social 
260.6   Security Act, United States Code, title 42, section 1395i-4, 
260.7   that delicensed beds since enactment of the Balanced Budget Act 
260.8   of 1997, Public Law 105-33, to the extent that the critical 
260.9   access hospital does not seek to exceed the maximum number of 
260.10  beds permitted such hospital under federal law. 
260.11     Sec. 25.  Minnesota Statutes 2004, section 144.562, 
260.12  subdivision 2, is amended to read: 
260.13     Subd. 2.  [ELIGIBILITY FOR LICENSE CONDITION.] (a) A 
260.14  hospital is not eligible to receive a license condition for 
260.15  swing beds unless (1) it either has a licensed bed capacity of 
260.16  less than 50 beds defined in the federal Medicare regulations, 
260.17  Code of Federal Regulations, title 42, section 482.66, or it has 
260.18  a licensed bed capacity of 50 beds or more and has swing beds 
260.19  that were approved for Medicare reimbursement before May 1, 
260.20  1985, or it has a licensed bed capacity of less than 65 beds and 
260.21  the available nursing homes within 50 miles have had, in the 
260.22  aggregate, an average occupancy rate of 96 percent or higher in 
260.23  the most recent two years as documented on the statistical 
260.24  reports to the Department of Health; and (2) it is located in a 
260.25  rural area as defined in the federal Medicare regulations, Code 
260.26  of Federal Regulations, title 42, section 482.66.  
260.27     (b) Except for those critical access hospitals established 
260.28  under section 144.1483, clause (10), and section 1820 of the 
260.29  federal Social Security Act, United States Code, title 42, 
260.30  section 1395i-4, that have an attached nursing home, eligible 
260.31  hospitals are allowed a total of 1,460 2,000 days of swing bed 
260.32  use per year, provided that no more than ten hospital beds are 
260.33  used as swing beds at any one time.  Critical access hospitals 
260.34  that have an attached nursing home are allowed swing bed use as 
260.35  provided in federal law.  
260.36     (c) Except for critical access hospitals that have an 
261.1   attached nursing home, the commissioner of health must may 
261.2   approve swing bed use beyond 1,460 2,000 days as long as there 
261.3   are no Medicare certified skilled nursing facility beds 
261.4   available within 25 miles of that hospital that are willing to 
261.5   admit the patient.  Critical access hospitals exceeding 2,000 
261.6   swing bed days must maintain documentation that they have 
261.7   contacted skilled nursing facilities within 25 miles to 
261.8   determine if any skilled nursing facility beds are available 
261.9   that are willing to admit the patient. 
261.10     (d) After reaching 2,000 days of swing bed use in a year, 
261.11  an eligible hospital to which this limit applies may admit six 
261.12  additional patients to swing beds each year without seeking 
261.13  approval from the commissioner or being in violation of this 
261.14  subdivision.  These six swing bed admissions are exempt from the 
261.15  limit of 2,000 annual swing bed days for hospitals subject to 
261.16  this limit. 
261.17     (e) A health care system that is in full compliance with 
261.18  this subdivision may allocate its total limit of swing bed days 
261.19  among the hospitals within the system, provided that no hospital 
261.20  in the system without an attached nursing home may exceed 2,000 
261.21  swing bed days per year. 
261.22     Sec. 26.  [144.574] [EDUCATION ABOUT THE DANGERS OF SHAKING 
261.23  INFANTS AND YOUNG CHILDREN.] 
261.24     Subdivision 1.  [EDUCATION BY HOSPITALS.] (a) A hospital 
261.25  licensed under sections 144.50 to 144.56 shall make available 
261.26  for viewing by the parents of each newborn baby delivered in the 
261.27  hospital a video presentation on the dangers associated with 
261.28  shaking infants and young children. 
261.29     (b) A hospital shall use a video obtained from the 
261.30  commissioner or approved by the commissioner.  The commissioner 
261.31  shall provide to a hospital at cost copies of an approved 
261.32  video.  The commissioner shall review other video presentations 
261.33  for possible approval upon the request of a hospital.  The 
261.34  commissioner shall not require a hospital to use videos that 
261.35  would require the hospital to pay royalties for use of the 
261.36  video, restrict viewing in order to comply with public viewing 
262.1   or other restrictions, or be subject to other costs or 
262.2   restrictions associated with copyrights. 
262.3      (c) A hospital shall, whenever possible, request both 
262.4   parents to view the video. 
262.5      (d) The showing or distribution of the video shall not 
262.6   subject any person or facility to any action for damages or 
262.7   other relief provided the person or facility acted in good faith.
262.8      Subd. 2.  [EDUCATION BY HEALTH CARE PROVIDERS.] The 
262.9   commissioner shall establish a protocol for health care 
262.10  providers to educate parents and primary caregivers about the 
262.11  dangers associated with shaking infants and young children.  The 
262.12  commissioner shall request family practice physicians, 
262.13  pediatricians, and other pediatric health care providers to 
262.14  review these dangers with the parents and primary caregivers of 
262.15  infants and young children up to the age of three at each 
262.16  well-baby visit. 
262.17     Sec. 27.  [144.601] [ESTABLISHING A VOLUNTARY TRAUMA 
262.18  SYSTEM.] 
262.19     The legislature finds that death and disability from major 
262.20  trauma among Minnesotans can be reduced by implementing a 
262.21  statewide trauma system designed to provide that each severely 
262.22  injured person is promptly transported and treated at facilities 
262.23  appropriate to the severity of injury.  The legislature further 
262.24  finds that the most effective way to ensure this outcome is 
262.25  through a system of voluntary participation, based on criteria 
262.26  issued by the commissioner of health.  
262.27     Sec. 28.  [144.602] [DEFINITIONS.] 
262.28     Subdivision 1.  [APPLICABILITY.] For purposes of sections 
262.29  144.601 to 144.608, the terms defined in this section have the 
262.30  meanings given them. 
262.31     Subd. 2.  [COMMISSIONER.] "Commissioner" means the 
262.32  commissioner of health.  
262.33     Subd. 3.  [MAJOR TRAUMA.] "Major trauma" means a sudden 
262.34  severe injury or damage to the body caused by an external force 
262.35  that results in potentially life-threatening injuries or that 
262.36  could result in the following disabilities:  
263.1      (1) impairment of cognitive or mental abilities; 
263.2      (2) impairment of physical functioning; or 
263.3      (3) disturbance of behavioral or emotional functioning. 
263.4      Subd. 4.  [TRAUMA HOSPITAL.] "Trauma hospital" means a 
263.5   hospital that voluntarily meets the commissioner's criteria 
263.6   under section 144.603 and that has been designated as a trauma 
263.7   hospital under section 144.605. 
263.8      Sec. 29.  [144.603] [STATEWIDE TRAUMA SYSTEM CRITERIA.] 
263.9      Subdivision 1.  [CRITERIA ESTABLISHED.] The commissioner 
263.10  shall adopt criteria to ensure that severely injured people are 
263.11  promptly transported and treated at trauma hospitals appropriate 
263.12  to the severity of injury.  Minimum criteria shall address 
263.13  emergency medical service trauma triage and transportation 
263.14  guidelines as approved under section 144E.102, subdivision 14, 
263.15  designation of hospitals as trauma hospitals, interhospital 
263.16  transfers, a trauma registry, and a trauma system governance 
263.17  structure.  
263.18     Subd. 2.  [BASIS; VERIFICATION.] The commissioner shall 
263.19  base the establishment, implementation, and modifications to the 
263.20  criteria under subdivision 1 on the department-published 
263.21  Minnesota comprehensive statewide trauma system plan.  The 
263.22  commissioner shall seek the advice of the Trauma Advisory 
263.23  Council in implementing and updating the criteria, using 
263.24  accepted and prevailing trauma transport, treatment, and 
263.25  referral standards of the American College of Surgeons, the 
263.26  American College of Emergency Physicians, the Minnesota 
263.27  Emergency Medical Services Regulatory Board, the national Trauma 
263.28  Resources Network, and other widely recognized trauma experts.  
263.29  The commissioner shall adapt and modify the standards as 
263.30  appropriate to accommodate Minnesota's unique geography and the 
263.31  state's hospital and health professional distribution and shall 
263.32  verify that the criteria are met by each hospital voluntarily 
263.33  participating in the statewide trauma system.  
263.34     Subd. 3.  [RULE EXEMPTION AND REPORT TO THE 
263.35  LEGISLATURE.] In developing and adopting the criteria under this 
263.36  section, the commissioner of health is exempt from chapter 14, 
264.1   including section 14.386.  By September 1, 2009, the 
264.2   commissioner must report to the legislature on implementation of 
264.3   the voluntary trauma system, including recommendations on the 
264.4   need for including the trauma system criteria in rule. 
264.5      Sec. 30.  [144.604] [TRAUMA TRIAGE AND TRANSPORTATION.] 
264.6      Subdivision 1.  [TRANSPORT REQUIREMENT.] Unless the 
264.7   Emergency Medical Services Regulatory Board has approved a 
264.8   licensed ambulance service's deviation from the guidelines under 
264.9   section 144E.101, subdivision 14, the ambulance service must 
264.10  transport major trauma patients from the scene to the highest 
264.11  state-designated trauma hospital within 30 minutes' transport 
264.12  time.  
264.13     Subd. 2.  [GROUND AMBULANCE EXCEPTIONS.] Notwithstanding 
264.14  subdivision 1, ground ambulances must comply with the following: 
264.15     (1) patients with compromised airways must be transported 
264.16  immediately to the nearest designated trauma hospital; and 
264.17     (2) level II trauma hospitals capable of providing 
264.18  definitive trauma care must not be bypassed to reach a level I 
264.19  trauma hospital.  
264.20     Subd. 3.  [UNDESIGNATED HOSPITALS.] No major trauma patient 
264.21  shall be transported to a hospital not participating in the 
264.22  statewide trauma system unless no trauma hospital is available 
264.23  within 30 minutes' transport time. 
264.24     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2009. 
264.25     Sec. 31.  [144.605] [DESIGNATING TRAUMA HOSPITALS.] 
264.26     Subdivision 1.  [NAMING PRIVILEGES.] Unless it has been 
264.27  designated a trauma hospital by the commissioner, no hospital 
264.28  shall use the term trauma center or trauma hospital in its name 
264.29  or its advertising or shall otherwise indicate it has trauma 
264.30  treatment capabilities. 
264.31     Subd. 2.  [DESIGNATION; REVERIFICATION.] The commissioner 
264.32  shall designate four levels of trauma hospitals.  A hospital 
264.33  that voluntarily meets the criteria for a particular level of 
264.34  trauma hospital shall apply to the commissioner for designation 
264.35  and, upon the commissioner's verifying the hospital meets the 
264.36  criteria, be designated a trauma hospital at the appropriate 
265.1   level for a three-year period.  Prior to the expiration of the 
265.2   three-year designation, a hospital seeking to remain part of the 
265.3   voluntary system must apply for and successfully complete a 
265.4   reverification process, be awaiting the site visit for the 
265.5   reverification, or be awaiting the results of the site visit.  
265.6   The commissioner may extend a hospital's existing designation 
265.7   for up to 18 months on a provisional basis if the hospital has 
265.8   applied for reverification in a timely manner but has not yet 
265.9   completed the reverification process within the expiration of 
265.10  the three-year designation and the extension is in the best 
265.11  interest of trauma system patient safety.  To be granted a 
265.12  provisional extension, the hospital must be:  
265.13     (1) scheduled and awaiting the site visit for 
265.14  reverification; 
265.15     (2) awaiting the results of the site visit; or 
265.16     (3) responding to and correcting identified deficiencies 
265.17  identified in the site visit. 
265.18     Subd. 3.  [ACS VERIFICATION.] The commissioner shall grant 
265.19  the appropriate level I, II, or III trauma hospital designation 
265.20  to a hospital that successfully completes and passes the 
265.21  American College of Surgeons (ACS) verification standards at the 
265.22  hospital's cost, submits verification documentation to the 
265.23  Trauma Advisory Council, and formally notifies the Trauma 
265.24  Advisory Council of ACS verification.  
265.25     Subd. 4.  [LEVEL III DESIGNATION; NOT ACS VERIFIED.] (a) 
265.26  The commissioner shall grant the appropriate level III trauma 
265.27  hospital designation to a hospital that is not ACS verified but 
265.28  that successfully completes the designation process under 
265.29  paragraph (b).  
265.30     (b) The hospital must complete and submit a self-reported 
265.31  survey and application to the Trauma Advisory Council for 
265.32  review, verifying that the hospital meets the criteria as a 
265.33  level III trauma hospital.  When the Trauma Advisory Council is 
265.34  satisfied the application is complete, the commissioner shall 
265.35  arrange a site review visit.  Upon successful completion of the 
265.36  site review, the review team shall make written recommendations 
266.1   to the Trauma Advisory Council.  If approved by the Trauma 
266.2   Advisory Council, a letter of recommendation shall be sent to 
266.3   the commissioner for final approval and designation.  
266.4      Subd. 5.  [LEVEL IV DESIGNATION.] (a) The commissioner 
266.5   shall grant the appropriate level IV trauma hospital designation 
266.6   to a hospital that successfully completes the designation 
266.7   process under paragraph (b).  
266.8      (b) The hospital must complete and submit a self-reported 
266.9   survey and application to the Trauma Advisory Council for 
266.10  review, verifying that the hospital meets the criteria as a 
266.11  level IV trauma hospital.  When the Trauma Advisory Council is 
266.12  satisfied the application is complete, the council shall review 
266.13  the application and, if the council approves the application, 
266.14  send a letter of recommendation to the commissioner for final 
266.15  approval and designation.  The commissioner shall grant a level 
266.16  IV designation and shall arrange a site review visit within 
266.17  three years of the designation and every three years thereafter, 
266.18  to coincide with the three-year reverification process.  
266.19     Subd. 6.  [CHANGES IN DESIGNATION.] Changes in a trauma 
266.20  hospital's ability to meet the criteria for the hospital's level 
266.21  of designation must be self-reported to the Trauma Advisory 
266.22  Council and to other regional hospitals and local emergency 
266.23  medical services providers and authorities.  If the hospital 
266.24  cannot correct its ability to meet the criteria for its level 
266.25  within six months, the hospital may apply for redesignation at a 
266.26  different level.  
266.27     Subd. 7.  [HIGHER DESIGNATION.] A trauma hospital may apply 
266.28  for a higher trauma hospital designation one time during the 
266.29  hospital's three-year designation by completing the designation 
266.30  process for that level of trauma hospital.  
266.31     Subd. 8.  [LOSS OF DESIGNATION.] The commissioner may 
266.32  refuse to designate or redesignate or may revoke a previously 
266.33  issued trauma hospital designation if a hospital does not meet 
266.34  the criteria of the statewide trauma plan, in the interests of 
266.35  patient safety, or if a hospital denies or refuses a reasonable 
266.36  request by the commissioner or the commissioner's designee to 
267.1   verify information by correspondence or an on-site visit. 
267.2      Sec. 32.  [144.606] [INTERHOSPITAL TRANSFERS.] 
267.3      Subdivision 1.  [WRITTEN PROCEDURES REQUIRED.] A level III 
267.4   or IV trauma hospital must have predetermined, written 
267.5   procedures that direct the internal process for rapidly and 
267.6   efficiently transferring a major trauma patient to definitive 
267.7   care, including: 
267.8      (1) clearly identified anatomic and physiologic criteria 
267.9   that, if met, will immediately initiate transfer to definitive 
267.10  care; 
267.11     (2) a listing of appropriate ground and air transport 
267.12  services, including primary and secondary telephone contact 
267.13  numbers; and 
267.14     (3) immediately available supplies, records, or other 
267.15  necessary resources that will accompany a patient.  
267.16     Subd. 2.  [TRANSFER AGREEMENTS.] (a) A level III or IV 
267.17  trauma hospital may transfer patients to a hospital with which 
267.18  the trauma hospital has a written transfer agreement. 
267.19     (b) Each agreement must be current and with a trauma 
267.20  hospital or trauma hospitals capable of caring for major trauma 
267.21  injuries.  
267.22     (c) A level III or IV trauma hospital must have a current 
267.23  transfer agreement with a hospital that has special capabilities 
267.24  in the treatment of burn injuries and a transfer agreement with 
267.25  a second hospital that has special capabilities in the treatment 
267.26  of burn injuries, should the primary transfer hospital be unable 
267.27  to accept a burn patient. 
267.28     Sec. 33.  [144.607] [TRAUMA REGISTRY.] 
267.29     Subdivision 1.  [REGISTRY PARTICIPATION REQUIRED.] A trauma 
267.30  hospital must participate in the statewide trauma registry.  
267.31     Subd. 2.  [TRAUMA REPORTING.] A trauma hospital must report 
267.32  major trauma injuries as part of the reporting for the traumatic 
267.33  brain injury and spinal cord injury registry required in 
267.34  sections 144.661 to 144.665.  
267.35     Subd. 3.  [APPLICATION OF OTHER LAW.] Sections 144.661 to 
267.36  144.665 apply to a major trauma reported to the statewide trauma 
268.1   registry, with the exception of sections 144.662, clause (2), 
268.2   and 144.664, subdivision 3.  
268.3      Sec. 34.  [144.608] [TRAUMA ADVISORY COUNCIL.] 
268.4      Subdivision 1.  [TRAUMA ADVISORY COUNCIL ESTABLISHED.] (a) 
268.5   A Trauma Advisory Council is established to advise, consult 
268.6   with, and make recommendations to the commissioner on the 
268.7   development, maintenance, and improvement of a statewide trauma 
268.8   system.  
268.9      (b) The council shall consist of the following members:  
268.10     (1) a trauma surgeon certified by the American College of 
268.11  Surgeons who practices in a level I or II trauma hospital; 
268.12     (2) a general surgeon certified by the American College of 
268.13  Surgeons whose practice includes trauma and who practices in a 
268.14  designated rural area as defined under section 144.1501, 
268.15  subdivision 1, paragraph (b); 
268.16     (3) a neurosurgeon certified by the American Board of 
268.17  Neurological Surgery who practices in a level I or II trauma 
268.18  hospital; 
268.19     (4) a trauma program nurse manager or coordinator 
268.20  practicing in a level I or II trauma hospital; 
268.21     (5) an emergency physician certified by the American 
268.22  College of Emergency Physicians whose practice includes 
268.23  emergency room care in a level I, II, III, or IV trauma 
268.24  hospital; 
268.25     (6) an emergency room nurse manager who practices in a 
268.26  level III or IV trauma hospital; 
268.27     (7) a family practice physician whose practice includes 
268.28  emergency room care in a level III or IV trauma hospital located 
268.29  in a designated rural area as defined under section 144.1501, 
268.30  subdivision 1, paragraph (b); 
268.31     (8) a nurse practitioner, as defined under section 
268.32  144.1501, subdivision 1, paragraph (h), or a physician 
268.33  assistant, as defined under section 144.1501, subdivision 1, 
268.34  paragraph (j), whose practice includes emergency room care in a 
268.35  level IV trauma hospital located in a designated rural area as 
268.36  defined under section 144.1501, subdivision 1, paragraph (b); 
269.1      (9) a pediatrician certified by the American Academy of 
269.2   Pediatrics whose practice includes emergency room care in a 
269.3   level I, II, III, or IV trauma hospital; 
269.4      (10) an orthopedic surgeon certified by the American Board 
269.5   of Orthopaedic Surgery whose practice includes trauma and who 
269.6   practices in a level I, II, or III trauma hospital; 
269.7      (11) the state emergency medical services medical director 
269.8   appointed by the Emergency Medical Services Regulatory Board; 
269.9      (12) a hospital administrator of a level III or IV trauma 
269.10  hospital located in a designated rural area as defined under 
269.11  section 144.1501, subdivision 1, paragraph (b); 
269.12     (13) a rehabilitation specialist whose practice includes 
269.13  rehabilitation of patients with major trauma injuries or 
269.14  traumatic brain injuries and spinal cord injuries as defined 
269.15  under section 144.661; 
269.16     (14) an attendant or ambulance director who is an EMT, 
269.17  EMT-I, or EMT-P within the meaning of section 144E.001 and who 
269.18  actively practices with a licensed ambulance service in a 
269.19  primary service area located in a designated rural area as 
269.20  defined under section 144.1501, subdivision 1, paragraph (b); 
269.21  and 
269.22     (15) the commissioner of public safety or the 
269.23  commissioner's designee. 
269.24     (c) Council members whose appointment is dependent on 
269.25  practice in a level III or IV trauma hospital may be appointed 
269.26  to an initial term based upon their statements that the hospital 
269.27  intends to become a level III or IV facility by July 1, 2009.  
269.28     Subd. 2.  [COUNCIL ADMINISTRATION.] (a) The council must 
269.29  meet at least twice a year but may meet more frequently at the 
269.30  call of the chair, a majority of the council members, or the 
269.31  commissioner.  
269.32     (b) The terms, compensation, and removal of members of the 
269.33  council are governed by section 15.059, except that the council 
269.34  expires June 30, 2015. 
269.35     (c) The council may appoint subcommittees and workgroups.  
269.36  Subcommittees shall consist of council members.  Workgroups may 
270.1   include noncouncil members.  Noncouncil members shall be 
270.2   compensated for workgroup activities under section 15.059, 
270.3   subdivision 3, but shall receive expenses only.  
270.4      Subd. 3.  [REGIONAL TRAUMA ADVISORY COUNCILS.] (a) Up to 
270.5   eight regional trauma advisory councils may be formed as needed. 
270.6      (b) Regional trauma advisory councils shall advise, consult 
270.7   with, and make recommendation to the state Trauma Advisory 
270.8   Council on suggested regional modifications to the statewide 
270.9   trauma criteria that will improve patient care and accommodate 
270.10  specific regional needs.  
270.11     (c) Each regional advisory council must have no more than 
270.12  15 members.  The commissioner, in consultation with the 
270.13  Emergency Medical Services Regulatory Board, shall name the 
270.14  council members. 
270.15     (d) Regional council members may receive expenses in the 
270.16  same manner and amount as authorized by the plan adopted under 
270.17  section 43A.18, subdivision 2. 
270.18     Sec. 35.  [144.707] [CANCER DRUG REPOSITORY PROGRAM.] 
270.19     Subdivision 1.  [DEFINITIONS.] (a) For the purposes of this 
270.20  section, the terms defined in this subdivision have the meanings 
270.21  given. 
270.22     (b) "Cancer drug" means a prescription drug that is used to 
270.23  treat:  
270.24     (1) cancer or the side effects of cancer; or 
270.25     (2) the side effects of any prescription drug that is used 
270.26  to treat cancer or the side effects of cancer.  
270.27     (c) "Cancer drug repository" means a medical facility or 
270.28  pharmacy that has notified the Board of Pharmacy of its election 
270.29  to participate in the cancer drug repository program.  
270.30     (d) "Cancer supply" or "cancer supplies" means prescription 
270.31  and nonprescription cancer supplies needed to administer a 
270.32  cancer drug.  
270.33     (e) "Board of Pharmacy" means the Minnesota State Board of 
270.34  Pharmacy.  
270.35     (f) "Dispense" has the meaning given in section 151.01, 
270.36  subdivision 30.  
271.1      (g) "Distribute" means to deliver, other than by 
271.2   administering or dispensing.  
271.3      (h) "Donor" means an individual and not a manufacturer or 
271.4   wholesale drug distributor. 
271.5      (i) "Medical facility" means an institution defined in 
271.6   section 144.50, subdivision 2.  
271.7      (j) "Medical supplies" means any prescription and 
271.8   nonprescription medical supply needed to administer a cancer 
271.9   drug.  
271.10     (k) "Pharmacist" has the meaning given in section 151.01, 
271.11  subdivision 3.  
271.12     (l) "Pharmacy" means any pharmacy registered with the Board 
271.13  of Pharmacy according to section 151.19, subdivision 1.  
271.14     (m) "Practitioner" has the meaning given in section 151.01, 
271.15  subdivision 23.  
271.16     (n) "Prescription drug" means a legend drug as defined in 
271.17  section 151.01, subdivision 17.  
271.18     (o) "Side effects of cancer" means symptoms of cancer.  
271.19     (p) "Single-unit-dose packaging" means a single-unit 
271.20  container for articles intended for administration as a single 
271.21  dose, direct from the container. 
271.22     (q) "Tamper-evident unit dose packaging" means a container 
271.23  within which a drug is sealed so that the contents cannot be 
271.24  opened without obvious destruction of the seal.  
271.25     Subd. 2.  [ESTABLISHMENT.] The Board of Pharmacy shall 
271.26  establish and maintain a cancer drug repository program under 
271.27  which any person may donate a cancer drug or supply for use by 
271.28  an individual who meets the eligibility criteria specified under 
271.29  subdivision 4.  Under the program, donations may be made on the 
271.30  premises of a medical facility or pharmacy that elects to 
271.31  participate in the program and meets the requirements specified 
271.32  under subdivision 3.  
271.33     Subd. 3.  [REQUIREMENTS FOR PARTICIPATION BY PHARMACIES AND 
271.34  MEDICAL FACILITIES.] (a) To be eligible for participation in the 
271.35  cancer drug repository program, a pharmacy or medical facility 
271.36  must be licensed and in compliance with all applicable federal 
272.1   and state laws and administrative rules.  
272.2      (b) Participation in the cancer drug repository program is 
272.3   voluntary.  A pharmacy or medical facility may elect to 
272.4   participate in the cancer drug repository program by submitting 
272.5   the following information to the Board of Pharmacy, in a form 
272.6   provided by the Board of Pharmacy:  
272.7      (1) the name, street address, and telephone number of the 
272.8   pharmacy or medical facility; 
272.9      (2) the name and telephone number of a pharmacist who is 
272.10  employed by or under contract with the pharmacy or medical 
272.11  facility, or other contact person who is familiar with the 
272.12  pharmacy's or medical facility's participation in the cancer 
272.13  drug repository program; and 
272.14     (3) a statement indicating that the pharmacy or medical 
272.15  facility meets the eligibility requirements under paragraph (a) 
272.16  and the chosen level of participation under paragraph (c). 
272.17     (c) A pharmacy or medical facility may fully participate in 
272.18  the cancer drug repository program by accepting, storing, and 
272.19  dispensing donated drugs and supplies, or may limit its 
272.20  participation to only accepting and storing donated drugs and 
272.21  supplies.  If a pharmacy or facility chooses to limit its 
272.22  participation, the pharmacy or facility shall distribute any 
272.23  donated drugs to a fully participating cancer drug repository 
272.24  according to subdivision 8.  
272.25     (d) A pharmacy or medical facility may withdraw from 
272.26  participation in the cancer drug repository program at any time 
272.27  upon notification to the Board of Pharmacy.  A notice to 
272.28  withdraw from participation may be given by telephone or U.S.  
272.29  mail.  
272.30     Subd. 4.  [INDIVIDUAL ELIGIBILITY REQUIREMENTS.] Any 
272.31  Minnesota resident who is diagnosed with cancer is eligible to 
272.32  receive drugs or supplies under the cancer drug repository 
272.33  program.  Drugs and supplies shall be dispensed according to the 
272.34  priority given under subdivision 6.  
272.35     Subd. 5.  [DONATIONS OF CANCER DRUGS AND SUPPLIES.] (a) Any 
272.36  one of the following persons may donate legally obtained cancer 
273.1   drugs or supplies to a cancer drug repository if the drugs or 
273.2   supplies meet the requirements under paragraph (b) or (c) as 
273.3   determined by a pharmacist who is employed by or under contract 
273.4   with a cancer drug repository:  
273.5      (1) an individual who is 18 years of age or older; or 
273.6      (2) a pharmacy, medical facility, drug manufacturer, or 
273.7   wholesale drug distributor, if the donated drugs have not been 
273.8   previously dispensed.  
273.9      (b) A cancer drug is eligible for donation under the cancer 
273.10  drug repository program only if the following requirements are 
273.11  met:  
273.12     (1) the donation is accompanied by a cancer drug repository 
273.13  donor form described under paragraph (d) that is signed by the 
273.14  person making the donation or that person's authorized 
273.15  representative; 
273.16     (2) the drug's expiration date is at least six months later 
273.17  than the date that the drug was donated; 
273.18     (3) the drug is in its original, unopened, tamper-evident 
273.19  unit dose packaging that includes the drug's lot number and 
273.20  expiration date.  Single-unit dose drugs may be accepted if the 
273.21  single-unit-dose packaging is unopened; and 
273.22     (4) the drug is not adulterated or misbranded.  
273.23     (c) Cancer supplies are eligible for donation under the 
273.24  cancer drug repository program only if the following 
273.25  requirements are met:  
273.26     (1) the supplies are not adulterated or misbranded; 
273.27     (2) the supplies are in their original, unopened, sealed 
273.28  packaging; and 
273.29     (3) the donation is accompanied by a cancer drug repository 
273.30  donor form described under paragraph (d) that is signed by the 
273.31  person making the donation or that person's authorized 
273.32  representative.  
273.33     (d) The cancer drug repository donor form must be provided 
273.34  by the Board of Pharmacy and shall state that to the best of the 
273.35  donor's knowledge the donated drug or supply has been properly 
273.36  stored and that the drug or supply has never been opened, used, 
274.1   tampered with, adulterated, or misbranded.  The Board of 
274.2   Pharmacy shall make the cancer drug repository donor form 
274.3   available on the Board of Pharmacy's Web site.  
274.4      (e) Controlled substances and drugs and supplies that do 
274.5   not meet the criteria under this subdivision are not eligible 
274.6   for donation or acceptance under the cancer drug repository 
274.7   program. 
274.8      (f) Drugs and supplies may be donated on the premises of a 
274.9   cancer drug repository to a pharmacist designated by the 
274.10  repository.  A drop box may not be used to deliver or accept 
274.11  donations.  
274.12     (g) Cancer drugs and supplies donated under the cancer drug 
274.13  repository program must be stored in a secure storage area under 
274.14  environmental conditions appropriate for the drugs or supplies 
274.15  being stored.  Donated drugs and supplies may not be stored with 
274.16  nondonated inventory.  
274.17     Subd. 6.  [DISPENSING REQUIREMENTS.] (a) Drugs and supplies 
274.18  must be dispensed by a licensed pharmacist pursuant to a 
274.19  prescription by a practitioner and according to the requirements 
274.20  of chapter 151.  
274.21     (b) Before being dispensed, cancer drugs and supplies shall 
274.22  be visually inspected by the pharmacist for adulteration, 
274.23  misbranding, and date of expiration.  Drugs or supplies that 
274.24  have expired or appear upon visual inspection to be adulterated, 
274.25  misbranded, or tampered with in any way may not be dispensed.  
274.26     (c) Before a cancer drug or supply may be dispensed to an 
274.27  individual, the individual must sign a cancer drug repository 
274.28  recipient form provided by the Board of Pharmacy acknowledging 
274.29  that the individual understands the information stated on the 
274.30  form.  The form shall include the following information:  
274.31     (1) that the drug or supply being dispensed has been 
274.32  donated and may have been previously dispensed; 
274.33     (2) that a visual inspection has been conducted by the 
274.34  pharmacist to ensure that the drug has not expired, has not been 
274.35  adulterated or misbranded, and is in its original, unopened 
274.36  packaging; and 
275.1      (3) that the dispensing pharmacist, the cancer drug 
275.2   repository, the Board of Pharmacy, and any other participant in 
275.3   the cancer drug repository program cannot guarantee the safety 
275.4   of the drug or supply being dispensed and that the pharmacist 
275.5   has determined that the drug or supply is safe to dispense based 
275.6   on the accuracy of the donor's form submitted with the donated 
275.7   drug or supply and the visual inspection required to be 
275.8   performed by the pharmacist before dispensing.  
275.9   The Board of Pharmacy shall make the cancer drug repository form 
275.10  available on the Board of Pharmacy's Web site.  
275.11     (d) Drugs and supplies shall only be dispensed to 
275.12  individuals who meet the eligibility requirements in subdivision 
275.13  4 and in the following order of priority:  
275.14     (1) individuals who are uninsured; 
275.15     (2) individuals who are enrolled in medical assistance, 
275.16  general assistance medical care, MinnesotaCare, Medicare, or 
275.17  other public assistance health care; and 
275.18     (3) all other individuals who are otherwise eligible under 
275.19  subdivision 4 to receive drugs or supplies from a cancer drug 
275.20  repository.  
275.21     Subd. 7.  [HANDLING FEES.] A cancer drug repository may 
275.22  charge the individual receiving a drug or supply a handling fee 
275.23  of no more than 250 percent of the medical assistance program 
275.24  dispensing fee for each cancer drug or supply dispensed.  
275.25     Subd. 8.  [DISTRIBUTION OF DONATED CANCER DRUGS AND 
275.26  SUPPLIES.] (a) Cancer drug repositories may distribute drugs and 
275.27  supplies donated under the cancer drug repository program to 
275.28  other repositories if requested by a participating repository.  
275.29     (b) A cancer drug repository that has elected not to 
275.30  dispense donated drugs or supplies shall distribute any donated 
275.31  drugs and supplies to a participating repository upon request of 
275.32  the repository.  
275.33     (c) If a cancer drug repository distributes drugs or 
275.34  supplies under paragraph (a) or (b), the repository shall 
275.35  complete a cancer drug repository donor form provided by the 
275.36  Board of Pharmacy.  The completed form and a copy of the donor 
276.1   form that was completed by the original donor under subdivision 
276.2   5 shall be provided to the fully participating cancer drug 
276.3   repository at the time of distribution. 
276.4      Subd. 9.  [RESALE OF DONATED DRUGS AND SUPPLIES.] Donated 
276.5   drugs and supplies may not be resold.  
276.6      Subd. 10.  [RECORD KEEPING REQUIREMENTS.] (a) Cancer drug 
276.7   repository donor and recipient forms shall be maintained for at 
276.8   least five years.  
276.9      (b) A record of destruction of donated drugs and supplies 
276.10  that are not dispensed under subdivision 6 shall be maintained 
276.11  by the dispensing repository for at least five years.  For each 
276.12  drug or supply destroyed, the record shall include the following 
276.13  information:  
276.14     (1) the date of destruction; 
276.15     (2) the name, strength, and quantity of the cancer drug 
276.16  destroyed; 
276.17     (3) the name of the person or firm that destroyed the drug; 
276.18  and 
276.19     (4) the source of the drugs or supplies destroyed.  
276.20     Subd. 11.  [LIABILITY.] (a) The manufacturer of a drug or 
276.21  supply is not subject to criminal or civil liability for injury, 
276.22  death, or loss to a person or to property due to participation 
276.23  in the cancer drug repository program.  Manufacturers are not 
276.24  liable for: 
276.25     (1) the intentional or unintentional alteration of the drug 
276.26  or supply by a party not under the control of the manufacturer; 
276.27  or 
276.28     (2) failure of a party not under the control of the 
276.29  manufacturer to transfer or communicate product or consumer 
276.30  information or the expiration date of the donated drug or supply.
276.31     (b) A medical facility or pharmacy participating in the 
276.32  program, a pharmacist dispensing a drug or supply pursuant to 
276.33  the program, a practitioner administering a drug or supply 
276.34  pursuant to the program, or the donor of a cancer drug or supply 
276.35  is immune from civil liability for an act or omission that 
276.36  causes injury to or the death of an individual to whom the 
277.1   cancer drug or supply is dispensed and no disciplinary action 
277.2   shall be taken against a pharmacist or practitioner so long as 
277.3   the drug or supply is donated, accepted, distributed, and 
277.4   dispensed according to the requirements of this section.  This 
277.5   immunity does not apply if the act or omission involves 
277.6   reckless, wanton, or intentional misconduct, or malpractice 
277.7   unrelated to the quality of the cancer drug or supply. 
277.8      Sec. 36.  Minnesota Statutes 2004, section 144.9504, 
277.9   subdivision 2, is amended to read: 
277.10     Subd. 2.  [LEAD RISK ASSESSMENT.] (a) An assessing agency 
277.11  shall conduct a lead risk assessment of a residence according to 
277.12  the venous blood lead level and time frame set forth in clauses 
277.13  (1) to (5) (4) for purposes of secondary prevention: 
277.14     (1) within 48 hours of a child or pregnant female in the 
277.15  residence being identified to the agency as having a venous 
277.16  blood lead level equal to or greater than 70 60 micrograms of 
277.17  lead per deciliter of whole blood; 
277.18     (2) within five working days of a child or pregnant female 
277.19  in the residence being identified to the agency as having a 
277.20  venous blood lead level equal to or greater than 45 micrograms 
277.21  of lead per deciliter of whole blood; 
277.22     (3) within ten working days of a child in the residence 
277.23  being identified to the agency as having a venous blood lead 
277.24  level equal to or greater than 20 15 micrograms of lead per 
277.25  deciliter of whole blood; 
277.26     (4) within ten working days of a child in the residence 
277.27  being identified to the agency as having a venous blood lead 
277.28  level that persists in the range of 15 to 19 micrograms of lead 
277.29  per deciliter of whole blood for 90 days after initial 
277.30  identification; or 
277.31     (5) within ten working days of a pregnant female in the 
277.32  residence being identified to the agency as having a venous 
277.33  blood lead level equal to or greater than ten micrograms of lead 
277.34  per deciliter of whole blood.  
277.35     (b) Within the limits of available local, state, and 
277.36  federal appropriations, an assessing agency may also conduct a 
278.1   lead risk assessment for children with any elevated blood lead 
278.2   level.  
278.3      (c) In a building with two or more dwelling units, an 
278.4   assessing agency shall assess the individual unit in which the 
278.5   conditions of this section are met and shall inspect all common 
278.6   areas accessible to a child.  If a child visits one or more 
278.7   other sites such as another residence, or a residential or 
278.8   commercial child care facility, playground, or school, the 
278.9   assessing agency shall also inspect the other sites.  The 
278.10  assessing agency shall have one additional day added to the time 
278.11  frame set forth in this subdivision to complete the lead risk 
278.12  assessment for each additional site.  
278.13     (d) Within the limits of appropriations, the assessing 
278.14  agency shall identify the known addresses for the previous 12 
278.15  months of the child or pregnant female with venous blood lead 
278.16  levels of at least 20 15 micrograms per deciliter for the child 
278.17  or at least ten micrograms per deciliter for the pregnant 
278.18  female; notify the property owners, landlords, and tenants at 
278.19  those addresses that an elevated blood lead level was found in a 
278.20  person who resided at the property; and give them primary 
278.21  prevention information.  Within the limits of appropriations, 
278.22  the assessing agency may perform a risk assessment and issue 
278.23  corrective orders in the properties, if it is likely that the 
278.24  previous address contributed to the child's or pregnant female's 
278.25  blood lead level.  The assessing agency shall provide the notice 
278.26  required by this subdivision without identifying the child or 
278.27  pregnant female with the elevated blood lead level.  The 
278.28  assessing agency is not required to obtain the consent of the 
278.29  child's parent or guardian or the consent of the pregnant female 
278.30  for purposes of this subdivision.  This information shall be 
278.31  classified as private data on individuals as defined under 
278.32  section 13.02, subdivision 12.  
278.33     (e) The assessing agency shall conduct the lead risk 
278.34  assessment according to rules adopted by the commissioner under 
278.35  section 144.9508.  An assessing agency shall have lead risk 
278.36  assessments performed by lead risk assessors licensed by the 
279.1   commissioner according to rules adopted under section 144.9508.  
279.2   If a property owner refuses to allow a lead risk assessment, the 
279.3   assessing agency shall begin legal proceedings to gain entry to 
279.4   the property and the time frame for conducting a lead risk 
279.5   assessment set forth in this subdivision no longer applies.  A 
279.6   lead risk assessor or assessing agency may observe the 
279.7   performance of lead hazard reduction in progress and shall 
279.8   enforce the provisions of this section under section 144.9509.  
279.9   Deteriorated painted surfaces, bare soil, and dust must be 
279.10  tested with appropriate analytical equipment to determine the 
279.11  lead content, except that deteriorated painted surfaces or bare 
279.12  soil need not be tested if the property owner agrees to engage 
279.13  in lead hazard reduction on those surfaces.  The lead content of 
279.14  drinking water must be measured if another probable source of 
279.15  lead exposure is not identified.  Within a standard metropolitan 
279.16  statistical area, an assessing agency may order lead hazard 
279.17  reduction of bare soil without measuring the lead content of the 
279.18  bare soil if the property is in a census tract in which soil 
279.19  sampling has been performed according to rules established by 
279.20  the commissioner and at least 25 percent of the soil samples 
279.21  contain lead concentrations above the standard in section 
279.22  144.9508. 
279.23     (f) Each assessing agency shall establish an administrative 
279.24  appeal procedure which allows a property owner to contest the 
279.25  nature and conditions of any lead order issued by the assessing 
279.26  agency.  Assessing agencies must consider appeals that propose 
279.27  lower cost methods that make the residence lead safe.  The 
279.28  commissioner shall use the authority and appeal procedure 
279.29  granted under sections 144.989 to 144.993. 
279.30     (g) Sections 144.9501 to 144.9509 neither authorize nor 
279.31  prohibit an assessing agency from charging a property owner for 
279.32  the cost of a lead risk assessment. 
279.33     Sec. 37.  Minnesota Statutes 2004, section 144.98, 
279.34  subdivision 3, is amended to read: 
279.35     Subd. 3.  [FEES.] (a) An application for certification 
279.36  under subdivision 1 must be accompanied by the biennial fee 
280.1   specified in this subdivision.  The fees are for: 
280.2      (1) nonrefundable base certification fee, $1,200 
280.3   $1,600; and 
280.4      (2) sample preparation techniques fees, $100 per technique; 
280.5   and 
280.6      (3) test category certification fees: 
280.7   Test Category                                   Certification Fee
280.8   Clean water program bacteriology                        $600 $800
280.9   Safe drinking water program bacteriology                $600 $800
280.10  Clean water program inorganic chemistry                 $600 $800
280.11  Safe drinking water program inorganic chemistry         $600 $800
280.12  Clean water program chemistry metals                  $800 $1,200
280.13  Safe drinking water program chemistry metals          $800 $1,200
280.14  Resource conservation and recovery program 
280.15    chemistry metals                                    $800 $1,200
280.16  Clean water program volatile organic compounds      $1,200 $1,500
280.17  Safe drinking water program 
280.18    volatile organic compounds                        $1,200 $1,500
280.19  Resource conservation and recovery program 
280.20    volatile organic compounds                        $1,200 $1,500
280.21  Underground storage tank program
280.22    volatile organic compounds                        $1,200 $1,500
280.23  Clean water program other organic compounds         $1,200 $1,500
280.24  Safe drinking water program other organic compounds $1,200 $1,500
280.25  Resource conservation and recovery program
280.26    other organic compounds                           $1,200 $1,500
280.27  Clean water program radiochemistry                         $2,500
280.28  Safe drinking water program radiochemistry                 $2,500
280.29  Resource conservation and recovery program
280.30    agricultural contaminants                                $2,500
280.31  Resource conservation and recovery program
280.32    emerging contaminants                                    $2,500
280.33     (b) The total biennial certification fee is the base fee 
280.34  plus the applicable test category fees.  
280.35     (c) Laboratories located outside of this state that require 
280.36  an on-site survey will inspection shall be assessed an 
281.1   additional $2,500 $3,750 fee. 
281.2      (c) The total biennial certification fee includes the base 
281.3   fee, the sample preparation techniques fees, the test category 
281.4   fees, and, when applicable, the on-site inspection fee. 
281.5      (d) Fees must be set so that the total fees support the 
281.6   laboratory certification program.  Direct costs of the 
281.7   certification service include program administration, 
281.8   inspections, the agency's general support costs, and attorney 
281.9   general costs attributable to the fee function. 
281.10     (e) A change fee shall be assessed if a laboratory requests 
281.11  additional analytes or methods at any time other than when 
281.12  applying for or renewing its certification.  The change fee is 
281.13  equal to the test category certification fee for the analyte.  
281.14     (f) A variance fee shall be assessed if a laboratory 
281.15  requests and is granted a variance from a rule adopted under 
281.16  this section.  The variance fee is $500 per variance. 
281.17     (g) Refunds or credits shall not be made for analytes or 
281.18  methods requested but not approved.  
281.19     (h) Certification of a laboratory shall not be awarded 
281.20  until all fees are paid. 
281.21     Sec. 38.  Minnesota Statutes 2004, section 144E.101, is 
281.22  amended by adding a subdivision to read: 
281.23     Subd. 14.  [TRAUMA TRIAGE AND TRANSPORT GUIDELINES.] By 
281.24  July 1, 2009, a licensee shall have written age appropriate 
281.25  trauma triage and transport guidelines consistent with the 
281.26  criteria issued by the Trauma Advisory Council and approved by 
281.27  the board.  The board may approve a licensee's requested 
281.28  deviations to the guidelines due to the availability of local or 
281.29  regional trauma resources if the changes are in the best 
281.30  interest of the patient's health. 
281.31     Sec. 39.  [145.417] [FAMILY PLANNING GRANT FUNDS NOT USED 
281.32  TO SUBSIDIZE ABORTION SERVICES.] 
281.33     Subdivision 1.  [DEFINITIONS.] (a) For purposes of this 
281.34  section, the following definitions apply. 
281.35     (b) "Abortion" means the use or prescription of any 
281.36  instrument, medicine, drug, or any other substance or device to 
282.1   intentionally terminate the pregnancy of a female known to be 
282.2   pregnant, with an intention other than to prevent the death of 
282.3   the female, increase the probability of a live birth, preserve 
282.4   the life or health of the child after live birth, or remove a 
282.5   dead fetus. 
282.6      (c) "Family planning grant funds" means funds distributed 
282.7   through the family planning special projects grant program under 
282.8   section 145.925, or any other state grant program whose funds 
282.9   are or may be used to fund family planning services.  Family 
282.10  planning grant funds shall not mean medical education funds 
282.11  awarded under section 62J.692 to the University of Minnesota, 
282.12  Mayo Clinic, or any other clinical medical education program in 
282.13  the state.  
282.14     (d) "Family planning services" means preconception services 
282.15  that limit or enhance fertility, including methods of 
282.16  contraception, the management of infertility, preconception 
282.17  counseling, education, and general reproductive health care. 
282.18     (e) "Nondirective counseling" means providing patients with:
282.19     (1) a list of health care providers and social service 
282.20  providers that provide prenatal care, childbirth care, infant 
282.21  care, foster care, adoption services, alternatives to abortion, 
282.22  or abortion services; and 
282.23     (2) nondirective, nonmarketing information regarding such 
282.24  providers. 
282.25     (f) "Public advocacy" means engaging in one or more of the 
282.26  following: 
282.27     (1) regularly engaging in efforts to encourage the passage 
282.28  or defeat of legislation pertaining to the continued or expanded 
282.29  availability of abortion; 
282.30     (2) publicly endorsing or recommending the election or 
282.31  defeat of a candidate for public office based on the candidate's 
282.32  position on the legality of abortion; or 
282.33     (3) engaging in civil litigation against a unit of 
282.34  government as a plaintiff seeking to enjoin or otherwise 
282.35  prohibit enforcement of a statute, ordinance, rule, or 
282.36  regulation pertaining to abortion. 
283.1      Subd. 2.  [USES OF FAMILY PLANNING GRANT FUNDS.] No family 
283.2   planning grant funds may be: 
283.3      (1) expended to directly or indirectly subsidize abortion 
283.4   services or administrative expenses; 
283.5      (2) paid or granted to an organization or an affiliate of 
283.6   an organization that provides abortion services, unless the 
283.7   affiliate is independent as provided in subdivision 4; or 
283.8      (3) paid or granted to an organization that has adopted or 
283.9   maintains a policy in writing or through oral public statements 
283.10  that abortion is considered part of a continuum of family 
283.11  planning services, reproductive health services, or both. 
283.12     Subd. 3.  [ORGANIZATIONS RECEIVING FAMILY PLANNING GRANT 
283.13  FUNDS.] An organization that receives family planning grant 
283.14  funds:  
283.15     (1) may provide nondirective counseling relating to 
283.16  pregnancy but may not directly refer patients who seek abortion 
283.17  services to any organization that provides abortion services, 
283.18  including an independent affiliate of the organization receiving 
283.19  family planning grant funds.  For purposes of this clause, an 
283.20  affiliate is independent if it satisfies the criteria in 
283.21  subdivision 4, paragraph (a); 
283.22     (2) may not display or distribute marketing materials about 
283.23  abortion services to patients; 
283.24     (3) may not engage in public advocacy promoting the 
283.25  legality or accessibility of abortion; and 
283.26     (4) must be separately incorporated from any affiliated 
283.27  organization that provides abortion services. 
283.28     Subd. 4.  [INDEPENDENT AFFILIATES THAT PROVIDE ABORTION 
283.29  SERVICES.] (a) To ensure that the state does not lend its 
283.30  imprimatur to abortion services and to ensure that an 
283.31  organization that provides abortion services does not receive a 
283.32  direct or indirect economic or marketing benefit from family 
283.33  planning grant funds, an organization that receives family 
283.34  planning grant funds may not be affiliated with an organization 
283.35  that provides abortion services unless the organizations are 
283.36  independent from each other.  To be independent, the 
284.1   organizations may not share any of the following: 
284.2      (1) the same or a similar name; 
284.3      (2) medical facilities or nonmedical facilities, including 
284.4   but not limited to, business offices, treatment rooms, 
284.5   consultation rooms, examination rooms, and waiting rooms; 
284.6      (3) expenses; 
284.7      (4) employee wages or salaries; or 
284.8      (5) equipment or supplies, including but not limited to, 
284.9   computers, telephone systems, telecommunications equipment, and 
284.10  office supplies. 
284.11     (b) An organization that receives family planning grant 
284.12  funds and that is affiliated with an organization that provides 
284.13  abortion services must maintain financial records that 
284.14  demonstrate strict compliance with this subdivision and that 
284.15  demonstrate that its independent affiliate that provides 
284.16  abortion services receives no direct or indirect economic or 
284.17  marketing benefit from the family planning grant funds. 
284.18     Subd. 5.  [INDEPENDENT AUDIT.] When an organization applies 
284.19  for family planning grant funds, the organization must submit 
284.20  with the grant application a copy of the organization's most 
284.21  recent independent audit to ensure the organization is in 
284.22  compliance with this section.  The independent audit must have 
284.23  been conducted no more than two years before the organization 
284.24  submits its grant application. 
284.25     Subd. 6.  [ORGANIZATIONS RECEIVING TITLE X FUNDS.] Nothing 
284.26  in this section requires an organization that receives federal 
284.27  funds under title X of the Public Health Service Act to refrain 
284.28  from performing any service that is required to be provided as a 
284.29  condition of receiving title X funds, as specified by the 
284.30  provisions of title X or the title X program guidelines for 
284.31  project grants for family planning services published by the 
284.32  United States Department of Health and Human Services. 
284.33     Subd. 7.  [SEVERABILITY.] If any one or more provision, 
284.34  word, phrase, clause, sentence, or subdivision of this section, 
284.35  or the application to any person or circumstance, is found to be 
284.36  unconstitutional, it is declared to be severable and the balance 
285.1   of this section shall remain effective notwithstanding such 
285.2   unconstitutionality.  The legislature hereby declares that it 
285.3   would have passed this section, and each provision, word, 
285.4   phrase, clause, sentence, or subdivision of it, regardless of 
285.5   the fact that any one or more provision, word, phrase, clause, 
285.6   sentence, or subdivision be declared unconstitutional. 
285.7      Sec. 40.  [145.4231] [POSITIVE ABORTION ALTERNATIVES.] 
285.8      Subdivision 1.  [DEFINITIONS.] For purposes of this 
285.9   section, the following terms have the meanings given: 
285.10     (1) "abortion" means the use of any means to terminate the 
285.11  pregnancy of a woman known to be pregnant with knowledge that 
285.12  the termination with those means will, with reasonable 
285.13  likelihood, cause the death of the unborn child.  For purposes 
285.14  of this section, abortion does not include an abortion necessary 
285.15  to prevent the death of the mother; and 
285.16     (2) "unborn child" means an individual organism of the 
285.17  species Homo sapiens from fertilization until birth. 
285.18     Subd. 2.  [ELIGIBILITY FOR GRANTS.] (a) The commissioner of 
285.19  health shall award grants to eligible applicants under paragraph 
285.20  (c) for the reasonable expenses of programs to support, 
285.21  encourage, and assist women in carrying their pregnancies to 
285.22  term by providing information on, referral to, and assistance 
285.23  with securing necessary services that enable women to carry 
285.24  their pregnancies to term.  Necessary services include, but are 
285.25  not limited to: 
285.26     (1) medical care; 
285.27     (2) nutritional services; 
285.28     (3) housing assistance; 
285.29     (4) adoption services; 
285.30     (5) education and employment assistance; 
285.31     (6) parenting education and support services; and 
285.32     (7) child care assistance. 
285.33     (b) In addition to providing information and referral under 
285.34  paragraph (a), an eligible program may provide one or more of 
285.35  the necessary services under paragraph (a) that assists women in 
285.36  carrying their pregnancies to term.  To avoid duplication of 
286.1   efforts, grantees may refer to other public or private programs, 
286.2   rather than provide the care directly, if a woman meets 
286.3   eligibility criteria for the other programs. 
286.4      (c) To be eligible for a grant, an agency or organization 
286.5   must: 
286.6      (1) be a private, nonprofit organization; 
286.7      (2) demonstrate that the program is conducted under 
286.8   appropriate supervision; 
286.9      (3) not charge women for services provided under the 
286.10  program; 
286.11     (4) provide each pregnant woman counseled with accurate 
286.12  information on the developmental characteristics of unborn 
286.13  children, including offering the printed information described 
286.14  in section 145.4243; 
286.15     (5) ensure that the alternatives to abortion program's sole 
286.16  purposes are to assist and encourage women in carrying their 
286.17  pregnancies to term and to maximize their potentials thereafter; 
286.18     (6) ensure that none of the funds provided are used to 
286.19  encourage or counsel a woman to have an abortion not necessary 
286.20  to prevent her death, to provide her such an abortion, or to 
286.21  refer her for such an abortion; and 
286.22     (7) have had the alternatives to abortion program in 
286.23  existence for at least one year as of July 1, 2005. 
286.24     (d) The provisions, words, phrases, and clauses of 
286.25  paragraph (c) are inseverable from this subdivision, and if any 
286.26  provision, word, phrase, or clause of paragraph (c) or the 
286.27  application thereof to any person or circumstance is held 
286.28  invalid, such invalidity shall apply to all of this subdivision. 
286.29     (e) An organization that provides abortions, promotes 
286.30  abortions, or directly refers for abortions is ineligible to 
286.31  receive a grant under this program.  An affiliate of an 
286.32  organization that provides abortions, promotes abortions, or 
286.33  directly refers for abortions is ineligible to receive a grant 
286.34  under this section unless the organizations are separately 
286.35  incorporated and independent from each other.  To be 
286.36  independent, the organizations may not share any of the 
287.1   following: 
287.2      (1) the same or a similar name; 
287.3      (2) medical facilities or nonmedical facilities, including, 
287.4   but not limited to, business offices, treatment rooms, 
287.5   consultation rooms, examination rooms, and waiting rooms; 
287.6      (3) expenses; 
287.7      (4) employee wages or salaries; or 
287.8      (5) equipment or supplies, including, but not limited to, 
287.9   computers, telephone systems, telecommunications equipment, and 
287.10  office supplies. 
287.11     (f) An organization that receives a grant under this 
287.12  section and that is affiliated with an organization that 
287.13  provides abortion services must maintain financial records that 
287.14  demonstrate strict compliance with this subdivision and that 
287.15  demonstrate that its independent affiliate that provides 
287.16  abortion services receives no direct or indirect economic or 
287.17  marketing benefit from the grant under this section. 
287.18     (g) The following data on participants is private data on 
287.19  individuals under section 13.02, subdivision 12:  all data 
287.20  collected, received, maintained, or disseminated by the grantee 
287.21  using grant funds awarded by the commissioner under this section.
287.22     Subd. 3.  [DUTIES OF COMMISSIONER.] The commissioner of 
287.23  health shall make grants under subdivision 2 beginning no later 
287.24  than July 1, 2006.  The commissioner shall monitor and review 
287.25  the programs of each grantee to ensure that the grantee 
287.26  carefully adheres to the purposes and requirements of 
287.27  subdivision 2 and shall cease funding a grantee that fails to do 
287.28  so. 
287.29     Subd. 4.  [SEVERABILITY.] Except as provided in subdivision 
287.30  2, paragraph (d), if any provision, word, phrase, or clause of 
287.31  this section or the application thereof to any person or 
287.32  circumstance is held invalid, such invalidity shall not affect 
287.33  the provisions, words, phrases, clauses, or applications of this 
287.34  section that can be given effect without the invalid provision, 
287.35  word, phrase, clause, or application and to this end, the 
287.36  provisions, words, phrases, and clauses of this section are 
288.1   declared to be severable. 
288.2      Subd. 5.  [SUPREME COURT JURISDICTION.] The Minnesota 
288.3   Supreme Court has original jurisdiction over an action 
288.4   challenging the constitutionality of this section and shall 
288.5   expedite the resolution of the action. 
288.6      Sec. 41.  [145.4232] [UNBORN CHILD PAIN PREVENTION.] 
288.7      Subdivision 1.  [SHORT TITLE.] This act shall be known and 
288.8   may be cited as the "Unborn Child Pain Prevention Act." 
288.9      Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
288.10  terms used have the meanings given: 
288.11     (1) "abortion" means the use of any means to terminate the 
288.12  pregnancy of a female known to be pregnant with knowledge that 
288.13  the termination with those means will, with reasonable 
288.14  likelihood, cause the death of the unborn child; 
288.15     (2) "attempt to perform an abortion" means an act, or an 
288.16  omission of a statutorily required act, that, under the 
288.17  circumstances as the actor believes them to be, constitutes a 
288.18  substantial step in a course of conduct planned to culminate in 
288.19  the performance of an abortion in violation of this section; 
288.20     (3) "unborn child" means a member of the species Homo 
288.21  sapiens from fertilization until birth; 
288.22     (4) "medical emergency" means any condition that, on the 
288.23  basis of the physician's good faith clinical judgment, so 
288.24  complicates the medical condition of a pregnant female as to 
288.25  necessitate the immediate abortion of her pregnancy to avert her 
288.26  death or for which a delay will create serious risk of 
288.27  substantial and irreversible impairment of a major bodily 
288.28  function; and 
288.29     (5) "physician" means a person licensed as a physician or 
288.30  osteopath under chapter 147. 
288.31     Subd. 3.  [UNBORN CHILD PAIN PREVENTION.] Except in the 
288.32  case of a medical emergency, before an abortion is performed on 
288.33  an unborn child who is 20 weeks gestational age or more, the 
288.34  physician performing the abortion or the physician's agent shall 
288.35  inform the female if an anesthetic or analgesic would eliminate 
288.36  or alleviate organic pain to the unborn child caused by the 
289.1   particular method of abortion to be employed and inform her of 
289.2   the particular medical risks associated with the particular 
289.3   anesthetic or analgesic.  With her consent, the physician shall 
289.4   administer such anesthetic or analgesic. 
289.5      Subd. 4.  [CRIMINAL PENALTIES.] Any person who knowingly or 
289.6   recklessly performs or attempts to perform an abortion in 
289.7   violation of this section is guilty of a felony.  No penalty may 
289.8   be assessed against the female upon whom the abortion is 
289.9   performed or attempted to be performed. 
289.10     Subd. 5.  [CIVIL REMEDIES.] (a) Any person upon whom an 
289.11  abortion has been performed in violation of this section or the 
289.12  father or a grandparent of the unborn child who was the subject 
289.13  of such an abortion may maintain an action against the person 
289.14  who performed the abortion in knowing or reckless violation of 
289.15  this section for actual and punitive damages.  Any person upon 
289.16  whom an abortion has been attempted in violation of this section 
289.17  may maintain an action against the person who attempted to 
289.18  perform the abortion in knowing or reckless violation of this 
289.19  section for actual and punitive damages. 
289.20     (b) If judgment is rendered in favor of the plaintiff in 
289.21  any action described in this subdivision, the court shall render 
289.22  judgment for a reasonable attorney's fee in favor of the 
289.23  plaintiff against the defendant.  If judgment is rendered in 
289.24  favor of the defendant and the court finds that the plaintiff's 
289.25  suit was frivolous and brought in bad faith, the court shall 
289.26  render judgment for a reasonable attorney's fee in favor of the 
289.27  defendant against the plaintiff. 
289.28     Subd. 6.  [PROTECTION OF PRIVACY.] In every civil or 
289.29  criminal proceeding or action brought under this section, the 
289.30  court shall rule whether the anonymity of any female upon whom 
289.31  an abortion has been performed or attempted shall be preserved 
289.32  from public disclosure if she does not give her consent to such 
289.33  disclosure.  The court, upon motion or sua sponte, shall make 
289.34  such a ruling and, upon determining that her anonymity should be 
289.35  preserved, shall issue orders to the parties, witnesses, and 
289.36  counsel and shall direct the sealing of the record and exclusion 
290.1   of individuals from courtrooms or hearing rooms to the extent 
290.2   necessary to safeguard her identity from public disclosure.  The 
290.3   order shall be accompanied by specific written findings 
290.4   explaining why the anonymity of the female should be preserved 
290.5   from public disclosure, why the order is essential to that end, 
290.6   how the order is narrowly tailored to serve that interest, and 
290.7   why no reasonable, less restrictive alternative exists.  In the 
290.8   absence of written consent of the female upon whom an abortion 
290.9   has been performed or attempted, anyone, other than a public 
290.10  official, who brings an action under subdivision 4, paragraph 
290.11  (a), shall do so under a pseudonym.  This subdivision may not be 
290.12  construed to conceal the identity of the plaintiff or of 
290.13  witnesses from the defendant. 
290.14     Subd. 7.  [SEVERABILITY.] If any one or more provision, 
290.15  section, subsection, sentence, clause, phrase, or word of this 
290.16  section or the application thereof to any person or circumstance 
290.17  is found to be unconstitutional, the same is hereby declared to 
290.18  be severable and the balance of this section shall remain 
290.19  effective notwithstanding such unconstitutionality.  The 
290.20  legislature hereby declares that it would have passed this 
290.21  section, and each provision, section, subsection, sentence, 
290.22  clause, phrase, or word thereof, irrespective of the fact that 
290.23  any one or more provision, section, subsection, sentence, 
290.24  clause, phrase, or word be declared unconstitutional. 
290.25     Sec. 42.  Minnesota Statutes 2004, section 145.56, 
290.26  subdivision 2, is amended to read: 
290.27     Subd. 2.  [COMMUNITY-BASED PROGRAMS.] (a) To the extent 
290.28  funds are appropriated for the purposes of this subdivision, the 
290.29  commissioner shall establish a grant program to fund: 
290.30     (1) community-based programs to provide education, 
290.31  outreach, and advocacy services to populations who may be at 
290.32  risk for suicide; 
290.33     (2) community-based programs that educate community helpers 
290.34  and gatekeepers, such as family members, spiritual leaders, 
290.35  coaches, and business owners, employers, and coworkers on how to 
290.36  prevent suicide by encouraging help-seeking behaviors; 
291.1      (3) community-based programs that educate populations at 
291.2   risk for suicide and community helpers and gatekeepers that must 
291.3   include information on the symptoms of depression and other 
291.4   psychiatric illnesses, the warning signs of suicide, skills for 
291.5   preventing suicides, and making or seeking effective referrals 
291.6   to intervention and community resources; and 
291.7      (4) community-based programs to provide evidence-based 
291.8   suicide prevention and intervention education to school staff, 
291.9   parents, and students in grades kindergarten through 12.  
291.10     Sec. 43.  Minnesota Statutes 2004, section 145.56, 
291.11  subdivision 5, is amended to read: 
291.12     Subd. 5.  [PERIODIC EVALUATIONS; BIENNIAL REPORTS.] To the 
291.13  extent funds are appropriated for the purposes of this 
291.14  subdivision, the commissioner shall conduct periodic evaluations 
291.15  of the impact of and outcomes from implementation of the state's 
291.16  suicide prevention plan and each of the activities specified in 
291.17  this section.  By July 1, 2002, and July 1 of each even-numbered 
291.18  year thereafter, the commissioner shall report the results of 
291.19  these evaluations to the chairs of the policy and finance 
291.20  committees in the house and senate with jurisdiction over health 
291.21  and human services issues. 
291.22     Sec. 44.  [145.906] [POSTPARTUM DEPRESSION EDUCATION AND 
291.23  INFORMATION.] 
291.24     (a) The commissioner of health shall work with health care 
291.25  facilities, licensed health and mental health care 
291.26  professionals, mental health advocates, consumers, and families 
291.27  in the state to develop materials and information about 
291.28  postpartum depression including treatment resources and develop 
291.29  policies and procedures to comply with this section. 
291.30     (b) Physicians, traditional midwives, and other licensed 
291.31  health care professionals providing prenatal care to women must 
291.32  make available to women and their families information about 
291.33  postpartum depression. 
291.34     (c) Hospitals and other health care facilities in the state 
291.35  must provide departing new mothers and fathers and other family 
291.36  members, as appropriate, with written information about 
292.1   postpartum depression, including its symptoms, methods of coping 
292.2   with the illness, and treatment resources. 
292.3      Sec. 45.  Minnesota Statutes 2004, section 145.924, is 
292.4   amended to read: 
292.5      145.924 [AIDS PREVENTION GRANTS.] 
292.6      (a) The commissioner may award grants to boards of health 
292.7   as defined in section 145A.02, subdivision 2, state agencies, 
292.8   state councils, or nonprofit corporations to provide evaluation 
292.9   and counseling services to populations at risk for acquiring 
292.10  human immunodeficiency virus infection, including, but not 
292.11  limited to, minorities, adolescents, intravenous drug users, and 
292.12  homosexual men. 
292.13     (b) The commissioner may award grants to agencies 
292.14  experienced in providing services to communities of color, for 
292.15  the design of innovative outreach and education programs for 
292.16  targeted groups within the community who may be at risk of 
292.17  acquiring the human immunodeficiency virus infection, including 
292.18  intravenous drug users and their partners, adolescents, gay and 
292.19  bisexual individuals and women.  Grants shall be awarded on a 
292.20  request for proposal basis and shall include funds for 
292.21  administrative costs.  Priority for grants shall be given to 
292.22  agencies or organizations that have experience in providing 
292.23  service to the particular community which the grantee proposes 
292.24  to serve; that have policy makers representative of the targeted 
292.25  population; that have experience in dealing with issues relating 
292.26  to HIV/AIDS; and that have the capacity to deal effectively with 
292.27  persons of differing sexual orientations.  For purposes of this 
292.28  paragraph, the "communities of color" are:  the American-Indian 
292.29  community; the Hispanic community; the African-American 
292.30  community; and the Asian-Pacific community. 
292.31     (c) All state grants awarded under this section for 
292.32  programs targeted to adolescents shall include the promotion of 
292.33  abstinence from sexual activity and drug use. 
292.34     (d) No state grant monies awarded under this section shall 
292.35  be used for web sites, pamphlets, or other communications that 
292.36  contain sexually explicit images or language. 
293.1      Sec. 46.  Minnesota Statutes 2004, section 145.9268, is 
293.2   amended to read: 
293.3      145.9268 [COMMUNITY CLINIC GRANTS.] 
293.4      Subdivision 1.  [DEFINITION.] For purposes of this section, 
293.5   "eligible community clinic" means: 
293.6      (1) a nonprofit clinic that provides is established to 
293.7   provide health services under conditions as defined in Minnesota 
293.8   Rules, part 9505.0255, to low income or rural population groups; 
293.9   provides medical, preventive, dental, or mental health primary 
293.10  care services; and utilizes a sliding fee scale or other 
293.11  procedure to determine eligibility for charity care or to ensure 
293.12  that no person will be denied services because of inability to 
293.13  pay; 
293.14     (2) a governmental entity or an Indian tribal government or 
293.15  Indian health service unit that provides services and utilizes a 
293.16  sliding fee scale or other procedure as described under clause 
293.17  (1); or 
293.18     (3) a consortium of clinics comprised of entities under 
293.19  clause (1) or (2); or 
293.20     (4) a nonprofit, tribal, or governmental entity proposing 
293.21  the establishment of a clinic that will provide services and 
293.22  utilize a sliding fee scale or other procedure as described 
293.23  under clause (1). 
293.24     Subd. 2.  [GRANTS AUTHORIZED.] The commissioner of health 
293.25  shall award grants to eligible community clinics to plan, 
293.26  establish, or operate services to improve the ongoing viability 
293.27  of Minnesota's clinic-based safety net providers.  Grants shall 
293.28  be awarded to support the capacity of eligible community clinics 
293.29  to serve low-income populations, reduce current or future 
293.30  uncompensated care burdens, or provide for improved care 
293.31  delivery infrastructure.  The commissioner shall award grants to 
293.32  community clinics in metropolitan and rural areas of the state, 
293.33  and shall ensure geographic representation in grant awards among 
293.34  all regions of the state. 
293.35     Subd. 3.  [ALLOCATION OF GRANTS.] (a) To receive a grant 
293.36  under this section, an eligible community clinic must submit an 
294.1   application to the commissioner of health by the deadline 
294.2   established by the commissioner.  A grant may be awarded upon 
294.3   the signing of a grant contract.  Community clinics may apply 
294.4   for and the commissioner may award grants for one-year or 
294.5   two-year periods. 
294.6      (b) An application must be on a form and contain 
294.7   information as specified by the commissioner but at a minimum 
294.8   must contain: 
294.9      (1) a description of the purpose or project for which grant 
294.10  funds will be used; 
294.11     (2) a description of the problem or problems the grant 
294.12  funds will be used to address; and 
294.13     (3) a description of achievable objectives, a workplan, and 
294.14  a timeline for implementation and completion of processes or 
294.15  projects enabled by the grant; and 
294.16     (4) a process for documenting and evaluating results of the 
294.17  grant. 
294.18     (c) The commissioner shall review each application to 
294.19  determine whether the application is complete and whether the 
294.20  applicant and the project are eligible for a grant.  In 
294.21  evaluating applications according to paragraph (d), the 
294.22  commissioner shall establish criteria including, but not limited 
294.23  to:  the priority level eligibility of the project; the 
294.24  applicant's thoroughness and clarity in describing the problem 
294.25  grant funds are intended to address; a description of the 
294.26  applicant's proposed project; a description of the population 
294.27  demographics and service area of the proposed project; the 
294.28  manner in which the applicant will demonstrate the effectiveness 
294.29  of any projects undertaken; and evidence of efficiencies and 
294.30  effectiveness gained through collaborative efforts.  The 
294.31  commissioner may also take into account other relevant factors, 
294.32  including, but not limited to, the percentage for which 
294.33  uninsured patients represent the applicant's patient base and 
294.34  the degree to which grant funds will be used to support services 
294.35  increasing or maintaining access to health care services.  
294.36  During application review, the commissioner may request 
295.1   additional information about a proposed project, including 
295.2   information on project cost.  Failure to provide the information 
295.3   requested disqualifies an applicant.  The commissioner has 
295.4   discretion over the number of grants awarded. 
295.5      (d) In determining which eligible community clinics will 
295.6   receive grants under this section, the commissioner shall give 
295.7   preference to those grant applications that show evidence of 
295.8   collaboration with other eligible community clinics, hospitals, 
295.9   health care providers, or community organizations.  In addition, 
295.10  the commissioner shall give priority, in declining order, to 
295.11  grant applications for projects that: 
295.12     Subd. 3a.  [AWARDING GRANTS.] (a) The commissioner may 
295.13  award grants for activities to: 
295.14     (1) provide a direct offset to expenses incurred for 
295.15  services provided to the clinic's target population; 
295.16     (2) establish, update, or improve information, data 
295.17  collection, or billing systems, including electronic health 
295.18  records systems; 
295.19     (3) procure, modernize, remodel, or replace equipment used 
295.20  in the delivery of direct patient care at a clinic; 
295.21     (4) provide improvements for care delivery, such as 
295.22  increased translation and interpretation services; or 
295.23     (5) build a new clinic or expand an existing facility; or 
295.24     (6) other projects determined by the commissioner to 
295.25  improve the ability of applicants to provide care to the 
295.26  vulnerable populations they serve. 
295.27     (e) (b) A grant awarded to an eligible community clinic may 
295.28  not exceed $300,000 per eligible community clinic.  For an 
295.29  applicant applying as a consortium of clinics, a grant may not 
295.30  exceed $300,000 per clinic included in the consortium.  The 
295.31  commissioner has discretion over the number of grants awarded.  
295.32     Subd. 4.  [EVALUATION AND REPORT.] The commissioner of 
295.33  health shall evaluate the overall effectiveness of the grant 
295.34  program.  The commissioner shall collect progress reports to 
295.35  evaluate the grant program from the eligible community clinics 
295.36  receiving grants.  Every two years, as part of this evaluation, 
296.1   the commissioner shall report to the legislature on priority 
296.2   areas for grants set under subdivision 3 the needs of community 
296.3   clinics and provide any recommendations for adding or 
296.4   changing priority areas eligible activities. 
296.5      Sec. 47.  Minnesota Statutes 2004, section 146A.11, 
296.6   subdivision 1, is amended to read: 
296.7      Subdivision 1.  [SCOPE.] All unlicensed complementary and 
296.8   alternative health care practitioners shall provide to each 
296.9   complementary and alternative health care client prior to 
296.10  providing treatment a written copy of the complementary and 
296.11  alternative health care client bill of rights.  A copy must also 
296.12  be posted in a prominent location in the office of the 
296.13  unlicensed complementary and alternative health care 
296.14  practitioner.  Reasonable accommodations shall be made for those 
296.15  clients who cannot read or who have communication impairments 
296.16  and those who do not read or speak English.  The complementary 
296.17  and alternative health care client bill of rights shall include 
296.18  the following: 
296.19     (1) the name, complementary and alternative health care 
296.20  title, business address, and telephone number of the unlicensed 
296.21  complementary and alternative health care practitioner; 
296.22     (2) the degrees, training, experience, or other 
296.23  qualifications of the practitioner regarding the complimentary 
296.24  and alternative health care being provided, followed by the 
296.25  following statement in bold print: 
296.26     "THE STATE OF MINNESOTA HAS NOT ADOPTED ANY EDUCATIONAL AND 
296.27  TRAINING STANDARDS FOR UNLICENSED COMPLEMENTARY AND ALTERNATIVE 
296.28  HEALTH CARE PRACTITIONERS.  THIS STATEMENT OF CREDENTIALS IS FOR 
296.29  INFORMATION PURPOSES ONLY. 
296.30     Under Minnesota law, an unlicensed complementary and 
296.31  alternative health care practitioner may not provide a medical 
296.32  diagnosis or recommend discontinuance of medically prescribed 
296.33  treatments.  If a client desires a diagnosis from a licensed 
296.34  physician, chiropractor, or acupuncture practitioner, or 
296.35  services from a physician, chiropractor, nurse, osteopath, 
296.36  physical therapist, dietitian, nutritionist, acupuncture 
297.1   practitioner, athletic trainer, or any other type of health care 
297.2   provider, the client may seek such services at any time."; 
297.3      (3) the name, business address, and telephone number of the 
297.4   practitioner's supervisor, if any; 
297.5      (4) notice that a complementary and alternative health care 
297.6   client has the right to file a complaint with the practitioner's 
297.7   supervisor, if any, and the procedure for filing complaints; 
297.8      (5) the name, address, and telephone number of the office 
297.9   of unlicensed complementary and alternative health care practice 
297.10  the attorney general and notice that a the office of the 
297.11  attorney general is the point of contact for purposes of 
297.12  referring client may file complaints with the office to the 
297.13  proper health care board, agency, or law enforcement; 
297.14     (6) the practitioner's fees per unit of service, the 
297.15  practitioner's method of billing for such fees, the names of any 
297.16  insurance companies that have agreed to reimburse the 
297.17  practitioner, or health maintenance organizations with whom the 
297.18  practitioner contracts to provide service, whether the 
297.19  practitioner accepts Medicare, medical assistance, or general 
297.20  assistance medical care, and whether the practitioner is willing 
297.21  to accept partial payment, or to waive payment, and in what 
297.22  circumstances; 
297.23     (7) a statement that the client has a right to reasonable 
297.24  notice of changes in services or charges; 
297.25     (8) a brief summary, in plain language, of the theoretical 
297.26  approach used by the practitioner in providing services to 
297.27  clients; 
297.28     (9) notice that the client has a right to complete and 
297.29  current information concerning the practitioner's assessment and 
297.30  recommended service that is to be provided, including the 
297.31  expected duration of the service to be provided; 
297.32     (10) a statement that clients may expect courteous 
297.33  treatment and to be free from verbal, physical, or sexual abuse 
297.34  by the practitioner; 
297.35     (11) a statement that client records and transactions with 
297.36  the practitioner are confidential, unless release of these 
298.1   records is authorized in writing by the client, or otherwise 
298.2   provided by law; 
298.3      (12) a statement of the client's right to be allowed access 
298.4   to records and written information from records in accordance 
298.5   with section 144.335; 
298.6      (13) a statement that other services may be available in 
298.7   the community, including where information concerning services 
298.8   is available; 
298.9      (14) a statement that the client has the right to choose 
298.10  freely among available practitioners and to change practitioners 
298.11  after services have begun, within the limits of health 
298.12  insurance, medical assistance, or other health programs; 
298.13     (15) a statement that the client has a right to coordinated 
298.14  transfer when there will be a change in the provider of 
298.15  services; 
298.16     (16) a statement that the client may refuse services or 
298.17  treatment, unless otherwise provided by law; and 
298.18     (17) a statement that the client may assert the client's 
298.19  rights without retaliation. 
298.20     Sec. 48.  Minnesota Statutes 2004, section 147A.08, is 
298.21  amended to read: 
298.22     147A.08 [EXEMPTIONS.] 
298.23     (a) This chapter does not apply to, control, prevent, or 
298.24  restrict the practice, service, or activities of persons listed 
298.25  in section 147.09, clauses (1) to (6) and (8) to (13), persons 
298.26  regulated under section 214.01, subdivision 2, or persons 
298.27  defined in section 144.1501, subdivision 1, paragraphs 
298.28  (e) (f), (g) (h), and (h) (i). 
298.29     (b) Nothing in this chapter shall be construed to require 
298.30  registration of: 
298.31     (1) a physician assistant student enrolled in a physician 
298.32  assistant or surgeon assistant educational program accredited by 
298.33  the Committee on Allied Health Education and Accreditation or by 
298.34  its successor agency approved by the board; 
298.35     (2) a physician assistant employed in the service of the 
298.36  federal government while performing duties incident to that 
299.1   employment; or 
299.2      (3) technicians, other assistants, or employees of 
299.3   physicians who perform delegated tasks in the office of a 
299.4   physician but who do not identify themselves as a physician 
299.5   assistant. 
299.6      Sec. 49.  Minnesota Statutes 2004, section 150A.22, is 
299.7   amended to read: 
299.8      150A.22 [DONATED DENTAL SERVICES.] 
299.9      (a) The Board of Dentistry commissioner of health shall 
299.10  contract with the Minnesota Dental Association, or another 
299.11  appropriate and qualified organization to develop and operate a 
299.12  donated dental services program to provide dental care to public 
299.13  program recipients and the uninsured through dentists who 
299.14  volunteer their services without compensation.  As part of the 
299.15  contract, the board commissioner shall include specific 
299.16  performance and outcome measures that the contracting 
299.17  organization must meet.  The donated dental services program 
299.18  shall: 
299.19     (1) establish a network of volunteer dentists, including 
299.20  dental specialties, to donate dental services to eligible 
299.21  individuals; 
299.22     (2) establish a system to refer eligible individuals to the 
299.23  appropriate volunteer dentists; and 
299.24     (3) develop and implement a public awareness campaign to 
299.25  educate eligible individuals about the availability of the 
299.26  program. 
299.27     (b) Funding for the program may be used for administrative 
299.28  or technical support.  The organization contracting with the 
299.29  board commissioner shall provide an annual report that accounts 
299.30  for funding appropriated to the program by the state, documents 
299.31  the number of individuals served by the program and the number 
299.32  of dentists participating as program providers, and provides 
299.33  data on meeting the specific performance and outcome measures 
299.34  identified by the board commissioner.  
299.35     Sec. 50.  Minnesota Statutes 2004, section 157.15, is 
299.36  amended by adding a subdivision to read: 
300.1      Subd. 19.  [STATEWIDE HOSPITALITY FEE.] "Statewide 
300.2   hospitality fee" means a fee to fund statewide food, beverage, 
300.3   and lodging program development activities, including training 
300.4   for inspection staff, technical assistance, maintenance of a 
300.5   statewide integrated food safety and security information 
300.6   system, and other related statewide activities that support the 
300.7   food, beverage, and lodging program activities. 
300.8      Sec. 51.  Minnesota Statutes 2004, section 157.16, 
300.9   subdivision 2, is amended to read: 
300.10     Subd. 2.  [LICENSE RENEWAL.] Initial and renewal licenses 
300.11  for all food and beverage service establishments, hotels, 
300.12  motels, lodging establishments, and resorts shall be issued for 
300.13  the calendar year for which application is made and shall expire 
300.14  on December 31 of such year.  Any person who operates a place of 
300.15  business after the expiration date of a license or without 
300.16  having submitted an application and paid the fee shall be deemed 
300.17  to have violated the provisions of this chapter and shall be 
300.18  subject to enforcement action, as provided in the Health 
300.19  Enforcement Consolidation Act, sections 144.989 to 144.993.  In 
300.20  addition, a penalty of $25 $50 shall be added to the total of 
300.21  the license fee for any food and beverage service establishment 
300.22  operating without a license as a mobile food unit, a seasonal 
300.23  temporary or seasonal permanent food stand, or a special event 
300.24  food stand, and a penalty of $50 $100 shall be added to the 
300.25  total of the license fee for all restaurants, food carts, 
300.26  hotels, motels, lodging establishments, and resorts operating 
300.27  without a license for a period of up to 30 days.  A late fee of 
300.28  $300 shall be added to the license fee for establishments 
300.29  operating more than 30 days without a license. 
300.30     Sec. 52.  Minnesota Statutes 2004, section 157.16, is 
300.31  amended by adding a subdivision to read: 
300.32     Subd. 2a.  [FOOD MANAGER CERTIFICATION.] An applicant for 
300.33  certification or certification renewal as a food manager must 
300.34  submit to the commissioner a $28 nonrefundable certification fee 
300.35  payable to the Department of Health. 
300.36     Sec. 53.  Minnesota Statutes 2004, section 157.16, 
301.1   subdivision 3, is amended to read: 
301.2      Subd. 3.  [ESTABLISHMENT FEES; DEFINITIONS.] (a) The 
301.3   following fees are required for food and beverage service 
301.4   establishments, hotels, motels, lodging establishments, and 
301.5   resorts licensed under this chapter.  Food and beverage service 
301.6   establishments must pay the highest applicable fee under 
301.7   paragraph (e) (d), clause (1), (2), (3), or (4), and 
301.8   establishments serving alcohol must pay the highest applicable 
301.9   fee under paragraph (e) (d), clause (6) or (7).  The license fee 
301.10  for new operators previously licensed under this chapter for the 
301.11  same calendar year is one-half of the appropriate annual license 
301.12  fee, plus any penalty that may be required.  The license fee for 
301.13  operators opening on or after October 1 is one-half of the 
301.14  appropriate annual license fee, plus any penalty that may be 
301.15  required. 
301.16     (b) All food and beverage service establishments, except 
301.17  special event food stands, and all hotels, motels, lodging 
301.18  establishments, and resorts shall pay an annual base fee of 
301.19  $145 $150. 
301.20     (c) A special event food stand shall pay a flat fee 
301.21  of $35 $40 annually.  "Special event food stand" means a fee 
301.22  category where food is prepared or served in conjunction with 
301.23  celebrations, county fairs, or special events from a special 
301.24  event food stand as defined in section 157.15. 
301.25     (d) In addition to the base fee in paragraph (b), each food 
301.26  and beverage service establishment, other than a special event 
301.27  food stand, and each hotel, motel, lodging establishment, and 
301.28  resort shall pay an additional annual fee for each fee category 
301.29  as, additional food service, or required additional inspection 
301.30  specified in this paragraph: 
301.31     (1) Limited food menu selection, $40 $50.  "Limited food 
301.32  menu selection" means a fee category that provides one or more 
301.33  of the following: 
301.34     (i) prepackaged food that receives heat treatment and is 
301.35  served in the package; 
301.36     (ii) frozen pizza that is heated and served; 
302.1      (iii) a continental breakfast such as rolls, coffee, juice, 
302.2   milk, and cold cereal; 
302.3      (iv) soft drinks, coffee, or nonalcoholic beverages; or 
302.4      (v) cleaning for eating, drinking, or cooking utensils, 
302.5   when the only food served is prepared off site. 
302.6      (2) Small establishment, including boarding establishments, 
302.7   $75 $100.  "Small establishment" means a fee category that has 
302.8   no salad bar and meets one or more of the following: 
302.9      (i) possesses food service equipment that consists of no 
302.10  more than a deep fat fryer, a grill, two hot holding containers, 
302.11  and one or more microwave ovens; 
302.12     (ii) serves dipped ice cream or soft serve frozen desserts; 
302.13     (iii) serves breakfast in an owner-occupied bed and 
302.14  breakfast establishment; 
302.15     (iv) is a boarding establishment; or 
302.16     (v) meets the equipment criteria in clause (3), item (i) or 
302.17  (ii), and has a maximum patron seating capacity of not more than 
302.18  50.  
302.19     (3) Medium establishment, $210 $260.  "Medium establishment"
302.20  means a fee category that meets one or more of the following: 
302.21     (i) possesses food service equipment that includes a range, 
302.22  oven, steam table, salad bar, or salad preparation area; 
302.23     (ii) possesses food service equipment that includes more 
302.24  than one deep fat fryer, one grill, or two hot holding 
302.25  containers; or 
302.26     (iii) is an establishment where food is prepared at one 
302.27  location and served at one or more separate locations. 
302.28     Establishments meeting criteria in clause (2), item (v), 
302.29  are not included in this fee category.  
302.30     (4) Large establishment, $350 $460.  "Large establishment" 
302.31  means either: 
302.32     (i) a fee category that (A) meets the criteria in clause 
302.33  (3), items (i) or (ii), for a medium establishment, (B) seats 
302.34  more than 175 people, and (C) offers the full menu selection an 
302.35  average of five or more days a week during the weeks of 
302.36  operation; or 
303.1      (ii) a fee category that (A) meets the criteria in clause 
303.2   (3), item (iii), for a medium establishment, and (B) prepares 
303.3   and serves 500 or more meals per day. 
303.4      (5) Other food and beverage service, including food carts, 
303.5   mobile food units, seasonal temporary food stands, and seasonal 
303.6   permanent food stands, $40 $50. 
303.7      (6) Beer or wine table service, $40 $50.  "Beer or wine 
303.8   table service" means a fee category where the only alcoholic 
303.9   beverage service is beer or wine, served to customers seated at 
303.10  tables. 
303.11     (7) Alcoholic beverage service, other than beer or wine 
303.12  table service, $105 $135. 
303.13     "Alcohol beverage service, other than beer or wine table 
303.14  service" means a fee category where alcoholic mixed drinks are 
303.15  served or where beer or wine are served from a bar. 
303.16     (8) Lodging per sleeping accommodation unit, $6 $8, 
303.17  including hotels, motels, lodging establishments, and resorts, 
303.18  up to a maximum of $600 $800.  "Lodging per sleeping 
303.19  accommodation unit" means a fee category including the number of 
303.20  guest rooms, cottages, or other rental units of a hotel, motel, 
303.21  lodging establishment, or resort; or the number of beds in a 
303.22  dormitory. 
303.23     (9) First public swimming pool, $140 $180; each additional 
303.24  public swimming pool, $80 $100.  "Public swimming pool" means a 
303.25  fee category that has the meaning given in Minnesota Rules, part 
303.26  4717.0250, subpart 8. 
303.27     (10) First spa, $80 $110; each additional spa, $40 $50.  
303.28  "Spa pool" means a fee category that has the meaning given in 
303.29  Minnesota Rules, part 4717.0250, subpart 9. 
303.30     (11) Private sewer or water, $40 $50.  "Individual private 
303.31  water" means a fee category with a water supply other than a 
303.32  community public water supply as defined in Minnesota Rules, 
303.33  chapter 4720.  "Individual private sewer" means a fee category 
303.34  with an individual sewage treatment system which uses subsurface 
303.35  treatment and disposal. 
303.36     (12) Additional food service, $130.  "Additional food 
304.1   service" means a location at a food service establishment, other 
304.2   than the primary food preparation and service area, used to 
304.3   prepare or serve food to the public. 
304.4      (13) Additional inspection fee, $300.  "Additional 
304.5   inspection fee" means a fee to conduct the second inspection 
304.6   each year for elementary and secondary education facility school 
304.7   lunch programs when required by the Richard B. Russell National 
304.8   School Lunch Act. 
304.9      (e) A fee of $150 $350 for review of the construction plans 
304.10  must accompany the initial license application for food and 
304.11  beverage service establishments restaurants, hotels, motels, 
304.12  lodging establishments, or resorts with five or more sleeping 
304.13  units. 
304.14     (f) When existing food and beverage service establishments, 
304.15  hotels, motels, lodging establishments, or resorts are 
304.16  extensively remodeled, a fee of $150 $250 must be submitted with 
304.17  the remodeling plans.  A fee of $250 must be submitted for new 
304.18  construction or remodeling for a restaurant with a limited food 
304.19  menu selection, a seasonal permanent food stand, a mobile food 
304.20  unit, or a food cart, or for a hotel, motel, resort, or lodging 
304.21  establishment addition of less than five sleeping units. 
304.22     (g) Seasonal temporary food stands and special event food 
304.23  stands are not required to submit construction or remodeling 
304.24  plans for review. 
304.25     Sec. 54.  Minnesota Statutes 2004, section 157.16, is 
304.26  amended by adding a subdivision to read: 
304.27     Subd. 3a.  [STATEWIDE HOSPITALITY FEE.] Every person, firm, 
304.28  or corporation that operates a licensed boarding establishment, 
304.29  food and beverage service establishment, seasonal temporary or 
304.30  permanent food stand, special event food stand, mobile food 
304.31  unit, food cart, resort, hotel, motel, or lodging establishment 
304.32  in Minnesota must submit to the commissioner a $35 annual 
304.33  statewide hospitality fee for each licensed activity.  The fee 
304.34  for establishments licensed by the Department of Health is 
304.35  required at the same time the licensure fee is due.  For 
304.36  establishments licensed by local governments, the fee is due by 
305.1   July 1 of each year.  
305.2      Sec. 55.  Minnesota Statutes 2004, section 157.20, 
305.3   subdivision 2, is amended to read: 
305.4      Subd. 2.  [INSPECTION FREQUENCY.] The frequency of 
305.5   inspections of the establishments shall be based on the degree 
305.6   of health risk. 
305.7      (a) High-risk establishments must be inspected at least 
305.8   once a year every 12 months. 
305.9      (b) Medium-risk establishments must be inspected at least 
305.10  once every 18 months. 
305.11     (c) Low-risk establishments must be inspected at least once 
305.12  every two years 24 months. 
305.13     Sec. 56.  Minnesota Statutes 2004, section 157.20, 
305.14  subdivision 2a, is amended to read: 
305.15     Subd. 2a.  [RISK CATEGORIES.] (a)  [HIGH-RISK 
305.16  ESTABLISHMENT.] "High-risk establishment" means any food and 
305.17  beverage service establishment, hotel, motel, lodging 
305.18  establishment, or resort that: 
305.19     (1) serves potentially hazardous foods that require 
305.20  extensive processing on the premises, including manual handling, 
305.21  cooling, reheating, or holding for service; 
305.22     (2) prepares foods several hours or days before service; 
305.23     (3) serves menu items that epidemiologic experience has 
305.24  demonstrated to be common vehicles of food-borne illness; 
305.25     (4) has a public swimming pool; or 
305.26     (5) draws its drinking water from a surface water supply. 
305.27     (b)  [MEDIUM-RISK ESTABLISHMENT.] "Medium-risk 
305.28  establishment" means a food and beverage service establishment, 
305.29  hotel, motel, lodging establishment, or resort that: 
305.30     (1) serves potentially hazardous foods but with minimal 
305.31  holding between preparation and service; or 
305.32     (2) serves foods, such as pizza, that require extensive 
305.33  handling followed by heat treatment. 
305.34     (c)  [LOW-RISK ESTABLISHMENT.] "Low-risk establishment" 
305.35  means a food and beverage service establishment, hotel, motel, 
305.36  lodging establishment, or resort that is not a high-risk or 
306.1   medium-risk establishment. 
306.2      (d)  [RISK EXCEPTIONS.] Mobile food units, seasonal 
306.3   permanent and seasonal temporary food stands, food carts, and 
306.4   special event food stands are not inspected on an established 
306.5   schedule and therefore are not defined as high-risk, 
306.6   medium-risk, or low-risk establishments. 
306.7      (e)  [SCHOOL INSPECTION FREQUENCY.] Elementary and 
306.8   secondary school food service establishments must be inspected 
306.9   according to the assigned risk category or by the frequency 
306.10  required in the Richard B. Russell National School Lunch Act, 
306.11  whichever frequency is more restrictive. 
306.12     Sec. 57.  Minnesota Statutes 2004, section 214.01, 
306.13  subdivision 2, is amended to read: 
306.14     Subd. 2.  [HEALTH-RELATED LICENSING BOARD.] "Health-related 
306.15  licensing board" means the Board of Examiners of Nursing Home 
306.16  Administrators established pursuant to section 144A.19, the 
306.17  Office of Unlicensed Complementary and Alternative Health Care 
306.18  Practice established pursuant to section 146A.02, the Board of 
306.19  Medical Practice created pursuant to section 147.01, the Board 
306.20  of Nursing created pursuant to section 148.181, the Board of 
306.21  Chiropractic Examiners established pursuant to section 148.02, 
306.22  the Board of Optometry established pursuant to section 148.52, 
306.23  the Board of Physical Therapy established pursuant to section 
306.24  148.67, the Board of Psychology established pursuant to section 
306.25  148.90, the Board of Social Work pursuant to section 148B.19, 
306.26  the Board of Marriage and Family Therapy pursuant to section 
306.27  148B.30, the Office of Mental Health Practice established 
306.28  pursuant to section 148B.61, the Board of Behavioral Health and 
306.29  Therapy established by section 148B.51, the Alcohol and Drug 
306.30  Counselors Licensing Advisory Council established pursuant to 
306.31  section 148C.02, the Board of Dietetics and Nutrition Practice 
306.32  established under section 148.622, the Board of Dentistry 
306.33  established pursuant to section 150A.02, the Board of Pharmacy 
306.34  established pursuant to section 151.02, the Board of Podiatric 
306.35  Medicine established pursuant to section 153.02, and the Board 
306.36  of Veterinary Medicine, established pursuant to section 156.01. 
307.1      Sec. 58.  Minnesota Statutes 2004, section 214.06, 
307.2   subdivision 1, is amended to read: 
307.3      Subdivision 1.  [FEE ADJUSTMENT.] Notwithstanding any law 
307.4   to the contrary, the commissioner of health as authorized by 
307.5   section 214.13, all health-related licensing boards and all 
307.6   non-health-related licensing boards shall by rule, with the 
307.7   approval of the commissioner of finance, adjust, as needed, any 
307.8   fee which the commissioner of health or the board is empowered 
307.9   to assess.  As provided in section 16A.1285, the adjustment 
307.10  shall be an amount sufficient so that the total fees collected 
307.11  by each board will as closely as possible equal be based on 
307.12  anticipated expenditures during the fiscal biennium, including 
307.13  expenditures for the programs authorized by sections 214.17 to 
307.14  214.25 and 214.31 to 214.37. 144.1476, 214.10, 214.103, 214.11, 
307.15  214.17 to 214.24, 214.28 to 214.37, and 214.40, except that a 
307.16  health-related licensing board may have anticipated expenditures 
307.17  in excess of anticipated revenues in a biennium by using 
307.18  accumulated surplus revenues from fees collected by that board 
307.19  in previous bienniums.  A health-related licensing board shall 
307.20  not spend more money than the amount appropriated by the 
307.21  legislature for a biennium.  For members of an occupation 
307.22  registered after July 1, 1984, by the commissioner of health 
307.23  under the provisions of section 214.13, the fee established must 
307.24  include an amount necessary to recover, over a five-year period, 
307.25  the commissioner's direct expenditures for adoption of the rules 
307.26  providing for registration of members of the occupation.  All 
307.27  fees received shall be deposited in the state treasury.  Fees 
307.28  received by the commissioner of health or health-related 
307.29  licensing boards must be credited to the health occupations 
307.30  licensing account in the state government special revenue fund.  
307.31     Sec. 59.  Minnesota Statutes 2004, section 214.06, is 
307.32  amended by adding a subdivision to read: 
307.33     Subd. 1a.  [HEALTH OCCUPATIONS LICENSING ACCOUNT.] Fees 
307.34  received by the commissioner of health or health-related 
307.35  licensing boards must be credited to the health occupations 
307.36  licensing account in the state government special revenue fund.  
308.1   The commissioner of finance shall ensure that the revenues and 
308.2   expenditures of each health-related licensing board are tracked 
308.3   separately in the health occupations licensing account. 
308.4      Sec. 60.  [245A.034] [CHILD CARE PROVIDER TRAINING; DANGERS 
308.5   OF SHAKING INFANTS AND YOUNG CHILDREN.] 
308.6      The commissioner shall make available for viewing by all 
308.7   licensed and legal nonlicensed child care providers a video 
308.8   presentation on the dangers associated with shaking infants and 
308.9   young children.  The video presentation shall be part of the 
308.10  initial and ongoing training of licensed child care providers.  
308.11  Legal nonlicensed child care providers may participate at their 
308.12  option in a video presentation session offered under this 
308.13  section.  The commissioner shall provide to child care providers 
308.14  at cost copies of a video approved by the commissioner of health 
308.15  under section 144.574 on the dangers associated with shaking 
308.16  infants and young children. 
308.17     Sec. 61.  Minnesota Statutes 2004, section 326.42, 
308.18  subdivision 2, is amended to read: 
308.19     Subd. 2.  [FEES.] Plumbing system plans and specifications 
308.20  that are submitted to the commissioner for review shall be 
308.21  accompanied by the appropriate plan examination fees.  If the 
308.22  commissioner determines, upon review of the plans, that 
308.23  inadequate fees were paid, the necessary additional fees shall 
308.24  be paid prior to plan approval.  The commissioner shall charge 
308.25  the following fees for plan reviews and audits of plumbing 
308.26  installations for public, commercial, and industrial buildings:  
308.27     (1) systems with both water distribution and drain, waste, 
308.28  and vent systems and having:  
308.29     (i) 25 or fewer drainage fixture units, $150; 
308.30     (ii) 26 to 50 drainage fixture units, $250; 
308.31     (iii) 51 to 150 drainage fixture units, $350; 
308.32     (iv) 151 to 249 drainage fixture units, $500; 
308.33     (v) 250 or more drainage fixture units, $3 per drainage 
308.34  fixture unit to a maximum of $4,000; and 
308.35     (vi) interceptors, separators, or catch basins, $70 per 
308.36  interceptor, separator, or catch basin design; 
309.1      (2) building sewer service only, $150; 
309.2      (3) building water service only, $150; 
309.3      (4) building water distribution system only, no drainage 
309.4   system, $5 per supply fixture unit or $150, whichever is 
309.5   greater; 
309.6      (5) storm drainage system, a minimum fee of $150 or: 
309.7      (i) $50 per drain opening, up to a maximum of $500; and 
309.8      (ii) $70 per interceptor, separator, or catch basin design; 
309.9      (6) manufactured home park or campground, one to 25 sites, 
309.10  $300; 
309.11     (7) manufactured home park or campground, 26 to 50 sites, 
309.12  $350; 
309.13     (8) manufactured home park or campground, 51 to 125 sites, 
309.14  $400; 
309.15     (9) manufactured home park or campground, more than 125 
309.16  sites, $500; 
309.17     (10) accelerated review, double the regular fee, one-half 
309.18  to be refunded if no response from the commissioner within 15 
309.19  business days; and 
309.20     (11) revision to previously reviewed or incomplete plans: 
309.21     (i) review of plans for which commissioner has issued two 
309.22  or more requests for additional information, per review, $100 or 
309.23  ten percent of the original fee, whichever is greater; 
309.24     (ii) proposer-requested revision with no increase in 
309.25  project scope, $50 or ten percent of original fee, whichever is 
309.26  greater; and 
309.27     (iii) proposer-requested revision with an increase in 
309.28  project scope, $50 plus the difference between the original 
309.29  project fee and the revised project fee. 
309.30     Sec. 62.  Minnesota Statutes 2004, section 471.61, is 
309.31  amended by adding a subdivision to read: 
309.32     Subd. 5.  [PROVISION OF LONG-TERM CARE INSURANCE.] Any 
309.33  political subdivision, or any two or more political subdivisions 
309.34  acting jointly, may contract with an insurance company licensed 
309.35  to do business in this state for the voluntary purchase of 
309.36  long-term care insurance by the employees and their dependents 
310.1   of the political subdivision or subdivisions.  The coverage may 
310.2   be through a group policy or through individual coverage. 
310.3      Sec. 63.  [RULE AMENDMENT.] 
310.4      The commissioner of health shall amend Minnesota Rules, 
310.5   part 4626.2015, subparts 3, item C; and 6, item B, to conform 
310.6   with section 52.  The commissioner may use the good cause 
310.7   exemption under Minnesota Statutes, section 14.388, subdivision 
310.8   1, clause (3).  Minnesota Statutes, section 14.386, does not 
310.9   apply, except to the extent provided under Minnesota Statutes, 
310.10  section 14.388. 
310.11     Sec. 64.  [DIRECTION TO COMMISSIONER; DENTAL REVIEW.] 
310.12     The commissioner of health, in consultation with the 
310.13  relevant dental associations, licensed dental and public health 
310.14  professionals, and others, shall review the leadership and 
310.15  advisory role of the Department of Health relative to dental 
310.16  health including the usefulness of utilizing a dental director.  
310.17  The review shall include prevention, health disparities, and 
310.18  critical access issues and shall be reported to the legislative 
310.19  committees with jurisdiction over health policy by January 15, 
310.20  2006. 
310.21     Sec. 65.  [REPEALER.] 
310.22     (a) Minnesota Statutes 2004, sections 13.383, subdivision 
310.23  3; 13.411, subdivision 3; 144.1486; 144.1502; 146A.01, 
310.24  subdivisions 2 and 5; 146A.02; 146A.03; 146A.04; 146A.05; 
310.25  146A.06; 146A.07; 146A.08; 146A.09; 146A.10; and 157.215, are 
310.26  repealed. 
310.27     (b) Minnesota Statutes 2004, section 145.925, and Minnesota 
310.28  Rules, parts 4700.1900, 4700.2000, 4700.2100, 4700.2200, 
310.29  4700.2210, 4700.2300, 4700.2400, 4700.2410, 4700.2420, and 
310.30  4700.2500, are repealed. 
310.31     <b>[EFFECTIVE DATE.]</b> Paragraph (b) of this section is 
310.32  effective July 1, 2006, or upon implementation of the Family 
310.33  Planning Project section 1115 waiver, whichever is later. 
310.34                             ARTICLE 9 
310.35          DEPARTMENT OF HUMAN SERVICES FORECAST ADJUSTMENT 
310.36  Section 1.  [ADJUSTMENT.] 
311.1      The dollar amounts shown are added to or, if shown in 
311.2   parentheses, are subtracted from the appropriations in Laws 
311.3   2003, First Special Session chapter 14, as amended by Laws 2004, 
311.4   chapter 272, or other law, and are appropriated from the general 
311.5   fund, or any other fund named, to the Department of Human 
311.6   Services for the purposes specified in this article, to be 
311.7   available for the fiscal year indicated for each purpose.  The 
311.8   figure "2005" used in this article means that the appropriation 
311.9   or appropriations listed are available for the fiscal year 
311.10  ending June 30, 2005. 
311.11                          SUMMARY BY FUND
311.12                                                            2005  
311.13  General Fund                                          25,517,000 
311.14  Health Care Access                                   (33,947,000)
311.15  TANF                                                    (814,000)
311.16  TOTAL                                                 (9,244,000)
311.17  Sec. 2.  COMMISSIONER OF HUMAN SERVICES 
311.18  Subdivision 1.  Total
311.19  Appropriation                                         (9,244,000)
311.20                          Summary by Fund
311.21  General                                25,517,000 
311.22  Health Care Access                    (33,947,000)
311.23  TANF                                     (814,000)
311.24  Subd. 2.  Revenue and Pass-Through 
311.25  TANF                                                    (814,000)
311.26  Subd. 3.  Basic Health Care Grants 
311.27  General                                               44,502,000 
311.28  Health Care Access                                   (33,947,000)
311.29  The amount that may be spent from this 
311.30  appropriation for each purpose is as 
311.31  follows: 
311.32  (a) MinnesotaCare   
311.33  Health Care Access                                   (33,947,000)
311.34  (b) MA Basic Health Care - Families and Children
311.35  General                                               39,343,000
311.36  (c) MA Basic Health Care - Elderly and Disabled 
311.37  General                                              (20,641,000)
312.1   (d) General Assistance Medical Care 
312.2   General                                               25,800,000
312.3   Subd. 4.  Continuing Care Grants 
312.4   General                                              (18,985,000)
312.5   The amount that may be spent from this 
312.6   appropriation for each purpose is as 
312.7   follows: 
312.8   (a) MA Long-Term Care Waivers
312.9   General                                               (6,218,000)
312.10  (b) MA Long-Term Care Facilities
312.11  General                                              (15,645,000)
312.12  (c) Chemical Dependency Entitlement Grants
312.13  General                                               (2,878,000)
312.14                             ARTICLE 10 
312.15                           APPROPRIATIONS 
312.16  Section 1.  [HEALTH AND HUMAN SERVICES APPROPRIATIONS.] 
312.17     The sums shown in the columns marked "APPROPRIATIONS" are 
312.18  appropriated from the general fund, or any other fund named, to 
312.19  the agencies and for the purposes specified in the sections of 
312.20  this article, to be available for the fiscal years indicated for 
312.21  each purpose.  The figures "2006" and "2007" where used in this 
312.22  article, mean that the appropriation or appropriations listed 
312.23  under them are available for the fiscal year ending June 30, 
312.24  2006, or June 30, 2007, respectively.  
312.25                          SUMMARY BY FUND
312.26                                                       BIENNIAL
312.27                             2006          2007           TOTAL
312.28  General            $3,489,795,000 $3,638,825,000 $7,128,620,000
312.29  State Government
312.30  Special Revenue        49,893,000     50,307,000    100,200,000
312.31  Health Care 
312.32  Access                461,575,000    552,394,000  1,013,969,000
312.33  Federal TANF           66,989,000     64,446,000    131,435,000
312.34  Lottery Prize 
312.35  Fund                    1,456,000      1,456,000      2,912,000
312.36  TOTAL              $4,069,708,000 $4,307,428,000 $8,377,136,000
312.37                                             APPROPRIATIONS 
312.38                                         Available for the Year 
312.39                                             Ending June 30 
312.40                                            2006         2007 
313.1   Sec. 2.  COMMISSIONER OF
313.2   HUMAN SERVICES
313.3   Subdivision 1.  Total
313.4   Appropriation                     $3,908,881,000 $4,145,724,000
313.5                 Summary by Fund
313.6   General           3,390,600,000 3,539,173,000
313.7   State Government 
313.8   Special Revenue         534,000       534,000
313.9   Health Care
313.10  Access              455,302,000   546,115,000
313.11  Federal TANF         60,989,000    58,446,000
313.12  Lottery Cash
313.13  Flow                  1,456,000     1,456,000
313.14  [RECEIPTS FOR SYSTEMS PROJECTS.] 
313.15  Appropriations and federal receipts for 
313.16  information system projects for MAXIS, 
313.17  PRISM, MMIS, AND SSIS must be deposited 
313.18  in the state system account authorized 
313.19  in Minnesota Statutes, section 
313.20  256.014.  Money appropriated for 
313.21  computer projects approved by the 
313.22  Minnesota Office of Technology, funded 
313.23  by the legislature, and approved by the 
313.24  commissioner of finance, may be 
313.25  transferred from one project to another 
313.26  and from development to operations as 
313.27  the commissioner of human services 
313.28  considers necessary.  Any unexpended 
313.29  balance in the appropriation for these 
313.30  projects does not cancel but is 
313.31  available for ongoing development and 
313.32  operations. 
313.33  [SYSTEMS CONTINUITY.] In the event of 
313.34  disruption of technical systems or 
313.35  computer operations, the commissioner 
313.36  may use available grant appropriations 
313.37  to ensure continuity of payments for 
313.38  maintaining the health, safety, and 
313.39  well-being of clients served by 
313.40  programs administered by the Department 
313.41  of Human Services.  Grant funds must be 
313.42  used in a manner consistent with the 
313.43  original intent of the appropriation. 
313.44  [NONFEDERAL SHARE TRANSFERS.] The 
313.45  nonfederal share of activities for 
313.46  which federal administrative 
313.47  reimbursement is appropriated to the 
313.48  commissioner may be transferred to the 
313.49  special revenue fund. 
313.50  [GIFTS.] Notwithstanding Minnesota 
313.51  Statutes, chapter 7, the commissioner 
313.52  may accept, on behalf of the state, 
313.53  additional funding from sources other 
313.54  than state funds for the purpose of 
313.55  financing the cost of assistance 
313.56  program grants or nongrant 
313.57  administration.  All additional funding 
313.58  is appropriated to the commissioner for 
313.59  use as designated by the grantor of 
313.60  funding. 
314.1   [TANF FUNDS APPROPRIATED TO OTHER 
314.2   ENTITIES.] Any expenditures from the 
314.3   TANF block grant shall be expended in 
314.4   accordance with the requirements and 
314.5   limitations of part A of title IV of 
314.6   the Social Security Act, as amended, 
314.7   and any other applicable federal 
314.8   requirement or limitation.  Prior to 
314.9   any expenditure of these funds, the 
314.10  commissioner shall assure that funds 
314.11  are expended in compliance with the 
314.12  requirements and limitations of federal 
314.13  law and that any reporting requirements 
314.14  of federal law are met.  It shall be 
314.15  the responsibility of any entity to 
314.16  which these funds are appropriated to 
314.17  implement a memorandum of understanding 
314.18  with the commissioner that provides the 
314.19  necessary assurance of compliance prior 
314.20  to any expenditure of funds.  The 
314.21  commissioner shall receipt TANF funds 
314.22  appropriated to other state agencies 
314.23  and coordinate all related interagency 
314.24  accounting transactions necessary to 
314.25  implement these appropriations.  
314.26  Unexpended TANF funds appropriated to 
314.27  any state, local, or nonprofit entity 
314.28  cancel at the end of the state fiscal 
314.29  year unless appropriating language 
314.30  permits otherwise. 
314.31  [CAPITATION RATE INCREASE.] Of the 
314.32  health care access fund appropriations 
314.33  to the University of Minnesota in the 
314.34  higher education omnibus appropriation 
314.35  bill, $2,157,000 in fiscal year 2006 
314.36  and $2,157,000 in fiscal year 2007 are 
314.37  to be used to increase the capitation 
314.38  payments under Minnesota Statutes, 
314.39  section 256B.69.  Notwithstanding 
314.40  section 12, this provision shall not 
314.41  expire. 
314.42  Subd. 2.  Agency Management        
314.43                Summary by Fund
314.44  General              46,899,000    46,782,000
314.45  State Government                             
314.46  Special Revenue         415,000       415,000
314.47  Health Care Access    5,565,000     5,200,000
314.48  Federal TANF            222,000       222,000
314.49  The amounts that may be spent from the 
314.50  appropriation for each purpose are as 
314.51  follows: 
314.52  (a) Financial Operations 
314.53  General              10,473,000    10,473,000
314.54  Health Care Access      813,000       837,000
314.55  Federal TANF            122,000       122,000
314.56  [ADMINISTRATIVE BASE ADJUSTMENT - WEB 
314.57  PAYMENT.] The health care access fund 
314.58  base is increased by $28,000 in fiscal 
315.1   year 2008 and $61,000 in fiscal year 
315.2   2009 for fees associated with web-based 
315.3   payment collections. 
315.4   (b) Legal and
315.5   Regulation Operations 
315.6   General               9,983,000     9,636,000
315.7   State Government                             
315.8   Special Revenue         415,000       415,000
315.9   Health Care Access      755,000       319,000
315.10  Federal TANF            100,000       100,000
315.11  (c) Management Operations 
315.12  General               3,281,000     3,281,000
315.13  Health Care Access       68,000        68,000
315.14  (d) Information Technology
315.15  Operations 
315.16  General              23,162,000    23,392,000
315.17  Health Care Access    3,929,000     3,976,000
315.18  Subd. 3.  Revenue and Pass-Through Expenditures 
315.19                Summary by Fund
315.20  Federal TANF         60,767,000    58,224,000
315.21  Subd. 4.  Children and Economic 
315.22  Assistance Grants 
315.23                Summary by Fund
315.24  General                  37,000       177,000
315.25  (a) Children's Services Grants 
315.26  General                  34,000       166,000
315.27  [CHILDREN'S MENTAL HEALTH GRANTS BASE 
315.28  ADJUSTMENT.] The general fund base is 
315.29  increased by $41,000 in fiscal year 
315.30  2008 and fiscal year 2009 for costs 
315.31  associated with the long-term care 
315.32  provider cost-of-living adjustment. 
315.33  (b) Children and Community 
315.34  Services Grants 
315.35  General                   3,000        11,000
315.36  [CHILDREN'S COMMUNITY SERVICE GRANTS 
315.37  BASE ADJUSTMENT.] The general fund base 
315.38  is increased by $2,000 in fiscal year 
315.39  2008 and fiscal year 2009 for costs 
315.40  associated with the long-term care 
315.41  provider cost-of-living adjustment. 
315.42  Subd. 5.  Basic Health Care Grants 
315.43                Summary by Fund
315.44  General           1,523,140,000 1,600,826,000
316.1   Health Care Access  429,897,000   523,265,000
316.2   [UPDATING FEDERAL POVERTY GUIDELINES.] 
316.3   Annual updates to the federal poverty 
316.4   guidelines are effective each July 1, 
316.5   following publication by the United 
316.6   States Department of Health and Human 
316.7   Services for health care programs under 
316.8   Minnesota Statutes, chapters 256, 256B, 
316.9   256D, and 256L. 
316.10  [HEALTH CARE ACCESS FUND SPENDING 
316.11  AUTHORITY.] The commissioner of human 
316.12  services, with the approval of the 
316.13  commissioner of finance, and after 
316.14  notification of the chairs of the 
316.15  relevant house finance committee and 
316.16  senate budget division, may expend 
316.17  money appropriated from the health care 
316.18  access fund for MinnesotaCare and 
316.19  general assistance medical care in 
316.20  either fiscal year of the biennium and 
316.21  transfer unencumbered appropriation 
316.22  balances between these two programs 
316.23  within or between fiscal years for the 
316.24  biennium ending June 30, 2007. 
316.25  The amounts that may be spent from the 
316.26  appropriation for each purpose are as 
316.27  follows: 
316.28  (a) MinnesotaCare Grants 
316.29  Health Care Access  194,312,000   124,655,000
316.30  [MINNESOTACARE FEDERAL RECEIPTS.] 
316.31  Receipts received as a result of 
316.32  federal participation pertaining to 
316.33  administrative costs of the Minnesota 
316.34  health care reform waiver shall be 
316.35  deposited as nondedicated revenue in 
316.36  the health care access fund.  Receipts 
316.37  received as a result of federal 
316.38  participation pertaining to grants 
316.39  shall be deposited in the federal fund 
316.40  and shall offset health care access 
316.41  funds for payments to providers. 
316.42  (b) MA Basic Health Care - 
316.43  Families and Children 
316.44  General             618,601,000   735,325,000
316.45  (c) MA Basic Health Care - 
316.46  Elderly and Disabled 
316.47  General             807,585,000   862,804,000
316.48  (d) General Assistance Medical Care 
316.49  Grants 
316.50  General              87,416,000       318,000
316.51  [GAMC DRUG REBATE REVENUES.] 
316.52  Notwithstanding Minnesota Statutes, 
316.53  section 256.01, subdivision 2, drug 
316.54  rebate revenues collected for general 
316.55  assistance medical care claims with a 
316.56  warrant date prior to June 30, 2007, 
316.57  shall be deposited in the general fund 
316.58  and the pharmaceutical discount program 
317.1   implementation is delayed until July 1, 
317.2   2007.  Notwithstanding section 12, this 
317.3   provision will not expire. 
317.4   Health Care Access  235,585,000   398,610,000
317.5   (e) Prescription Drug Program Grants 
317.6   General               4,318,000       -0-    
317.7   [PDP TO MEDICARE PART D TRANSITION.] 
317.8   The commissioner of human services, 
317.9   with the approval of the commissioner 
317.10  of finance, and after notification of 
317.11  the chair of the senate Health and 
317.12  Human Services Budget Division and the 
317.13  chair of the house Health Policy and 
317.14  Finance Committee, may transfer fiscal 
317.15  year 2006 appropriations between the 
317.16  medical assistance program and the 
317.17  prescription drug program. 
317.18  (f) Health Care Grants - 
317.19  Other Assistance 
317.20  General               5,467,000     3,059,000
317.21  Subd. 6.  Health Care Management 
317.22                Summary by Fund
317.23  General              25,613,000    26,371,000
317.24  Health Care Access   19,840,000    17,650,000
317.25  The amounts that may be spent from the 
317.26  appropriation for each purpose are as 
317.27  follows: 
317.28  (a) Health Care Policy Administration 
317.29  General               8,976,000     9,176,000
317.30  Health Care Access    3,482,000     2,630,000
317.31  [HEALTH CARE ACCESS FUND TRANSFERS 
317.32  EXPIRATION.] Notwithstanding Laws 2003, 
317.33  First Special Session chapter 14, 
317.34  article 13C, section 2, subdivision 6, 
317.35  paragraph (b), designating funds 
317.36  available for transfer to the general 
317.37  fund, the commissioner of finance's 
317.38  authorization to transfer those 
317.39  designated funds from the health care 
317.40  access fund shall expire July 1, 2005. 
317.41  [HEALTH CARE ACCESS FUND TRANSFERS.] 
317.42  Transfers of funds between the health 
317.43  care access fund and the general fund 
317.44  authorized under Minnesota Statutes, 
317.45  section 16A.724, supersede the 
317.46  transfers authorized in Laws 2003, 
317.47  First Special Session chapter 14, 
317.48  article 13C, section 2, subdivision 7, 
317.49  paragraph (a).  This provision is 
317.50  effective the day following final 
317.51  enactment. 
317.52  [ADMINISTRATIVE BASE ADJUSTMENT.] The 
317.53  health care access fund base is 
317.54  increased by $1,868,000 in fiscal year 
318.1   2008 and $1,874,000 in fiscal year 
318.2   2009, for implementation of business 
318.3   process redesign in health care. 
318.4   [MINNESOTA SENIOR HEALTH OPTIONS 
318.5   REIMBURSEMENT.] Federal administrative 
318.6   reimbursement resulting from the 
318.7   Minnesota senior health options project 
318.8   is appropriated to the commissioner for 
318.9   this activity. 
318.10  [UTILIZATION REVIEW.] Federal 
318.11  administrative reimbursement resulting 
318.12  from prior authorization and inpatient 
318.13  admission certification by a 
318.14  professional review organization shall 
318.15  be dedicated to the commissioner for 
318.16  these purposes.  A portion of these 
318.17  funds must be used for activities to 
318.18  decrease unnecessary pharmaceutical 
318.19  costs in medical assistance. 
318.20  (b) Health Care Operations 
318.21  General              16,637,000    17,195,000
318.22  Health Care Access   16,358,000    15,020,000
318.23  Subd. 7.  Continuing Care Grants 
318.24                Summary by Fund
318.25  General           1,556,346,000 1,649,445,000
318.26  Lottery Prize         1,308,000     1,308,000
318.27  The amounts that may be spent from the 
318.28  appropriation for each purpose are as 
318.29  follows: 
318.30  (a) Aging and Adult Services Grant 
318.31  General              15,375,000    14,323,000
318.32  [MEDICARE PART D.] Of the general fund 
318.33  appropriation for the biennium, 
318.34  $4,697,000 shall be used for grants to 
318.35  the Board on Aging for information and 
318.36  assistance for Medicare Part D 
318.37  implementation.  This money can be used 
318.38  in either year of the biennium.  
318.39  Beginning in fiscal 2008, base level 
318.40  funding is $3,417,000 per year. 
318.41  (b) Alternative Care Grants 
318.42  General              57,896,000    49,492,000
318.43  [ALTERNATIVE CARE TRANSFER.] Any money 
318.44  allocated to the alternative care 
318.45  program that is not spent for the 
318.46  purposes indicated does not cancel but 
318.47  shall be transferred to the medical 
318.48  assistance account. 
318.49  [ALTERNATIVE CARE BASE.] Base level 
318.50  funding for alternative care grants is 
318.51  increased by $563,000 in fiscal year 
318.52  2008 and by $575,000 in fiscal year 
318.53  2009. 
319.1   [ALTERNATIVE CARE IMPLEMENTATION OF 
319.2   CHANGES TO ELIGIBILITY.] Changes to 
319.3   Minnesota Statutes, section 256B.0913, 
319.4   subdivisions 2 and 4, paragraph (a), 
319.5   are effective July 1, 2005, for all 
319.6   persons found eligible for the 
319.7   alternative care program on and after 
319.8   July 1, 2005.  All persons who are 
319.9   alternative care clients as of June 30, 
319.10  2005, must be subject to Minnesota 
319.11  Statutes, section 256B.0913, 
319.12  subdivisions 2 and 4, paragraph (a), on 
319.13  the annual redetermination of program 
319.14  eligibility due after June 30, 2005, 
319.15  but no later than January 1, 2006. 
319.16  (c) Medical Assistance Grants - 
319.17  Long-term Care Facilities 
319.18  General             522,134,000   524,987,000
319.19  (d) Medical Assistance Grants - 
319.20  Long-Term Care Waivers and 
319.21  Home Care Grants 
319.22  General             834,007,000   926,510,000
319.23  [LONG-TERM CARE PROVIDER RATE 
319.24  INCREASE.] The long-term care provider 
319.25  rate increase in Minnesota Statutes, 
319.26  sections 256B.431, subdivision 41; 
319.27  256B.5012, subdivision 6; and 256B.765, 
319.28  subdivision 3, shall be adjusted to 
319.29  reflect an additional 3.37 percent 
319.30  increase effective October 1, 2007.  
319.31  This new rate shall become part of 
319.32  base-level funding for fiscal years 
319.33  2008 and 2009.  
319.34  [LIMITING GROWTH IN COMMUNITY 
319.35  ALTERNATIVES FOR DISABLED INDIVIDUALS 
319.36  WAIVER.] For each year of the biennium 
319.37  ending June 30, 2007, the commissioner 
319.38  shall make available additional 
319.39  allocations for home and 
319.40  community-based services covered under 
319.41  Minnesota Statutes, section 256B.49, at 
319.42  a rate of 95 per month or 1,140 per 
319.43  year, plus any additional legislatively 
319.44  authorized growth.  Priorities for the 
319.45  allocation of funds shall be for 
319.46  individuals anticipated to be 
319.47  discharged from institutional settings 
319.48  or who are at imminent risk of a 
319.49  placement in an institutional setting. 
319.50  [LIMITING GROWTH IN TBI WAIVER.] For 
319.51  each year of the biennium ending June 
319.52  30, 2007, the commissioner shall make 
319.53  available additional allocations for 
319.54  home and community-based services 
319.55  covered under Minnesota Statutes, 
319.56  section 256B.49, at a rate of 150 per 
319.57  year.  Priorities for the allocation of 
319.58  funds shall be for individuals 
319.59  anticipated to be discharged from 
319.60  institutional settings or who are at 
319.61  imminent risk of a placement in an 
319.62  institutional setting. 
319.63  [LIMITING GROWTH IN MR/RC WAIVER.] For 
320.1   each year of the biennium ending June 
320.2   30, 2007, the commissioner shall limit 
320.3   the new diversion caseload growth in 
320.4   the MR/RC waiver to 50 additional 
320.5   allocations.  Notwithstanding Minnesota 
320.6   Statutes, section 256B.0916, 
320.7   subdivision 5, paragraph (b), the 
320.8   available diversion allocations shall 
320.9   be awarded to support individuals whose 
320.10  health and safety needs result in an 
320.11  imminent risk of an institutional 
320.12  placement at any time during the fiscal 
320.13  year. 
320.14  [QUALITY ASSURANCE COMMISSION.] Of the 
320.15  general fund appropriation, $299,000 in 
320.16  fiscal year 2006 and $450,000 in fiscal 
320.17  year 2007 is for the Quality Assurance 
320.18  Commission under Minnesota Statutes, 
320.19  section 256B.0951. 
320.20  (e) Mental Health Grants 
320.21  General              46,665,000    47,726,000
320.22  Lottery Prize         1,308,000     1,308,000
320.23  [MENTAL HEALTH GRANT BASE.] Base level 
320.24  funding for mental health grants is 
320.25  increased by $388,000 in fiscal year 
320.26  2008 and by $395,000 in fiscal year 
320.27  2009. 
320.28  [RESTRUCTURING OF ADULT MENTAL HEALTH 
320.29  SERVICES.] The commissioner may make 
320.30  transfers that do not increase the 
320.31  state share of costs to effectively 
320.32  implement the restructuring of adult 
320.33  mental health services. 
320.34  [COMPULSIVE GAMBLING PREVENTION AND 
320.35  EDUCATION.] $150,000 is appropriated 
320.36  from the lottery prize fund for the 
320.37  fiscal year ending June 30, 2006, and 
320.38  $150,000 is appropriated from the 
320.39  lottery prize fund for the fiscal year 
320.40  ending June 30, 2007, to the 
320.41  commissioner of human services for a 
320.42  grant to the Northstar Problem Gambling 
320.43  Alliance in Arlington, Minnesota.  Of 
320.44  this appropriation, $75,000 in the 
320.45  fiscal year ending June 30, 2006, and 
320.46  $75,000 in the fiscal year ending June 
320.47  30, 2007, is contingent on 
320.48  demonstration of nonstate matching 
320.49  funds.  The commissioner of finance may 
320.50  disburse the state portion of the 
320.51  matching funds in increments of $37,500 
320.52  upon receipt of a commitment for an 
320.53  equal amount of matching nonstate 
320.54  funds.  These funds shall be used to 
320.55  increase public awareness of problem 
320.56  gambling, education, training, and 
320.57  research. 
320.58  (f) Deaf and Hard-of-Hearing 
320.59  Grants 
320.60  General               1,453,000     1,479,000
320.61  [DEAF AND HARD-OF-HEARING BASE 
321.1   FUNDING.] Base level funding for the 
321.2   deaf and hard-of-hearing grants is 
321.3   increased by $4,000 in fiscal year 2008 
321.4   and $4,000 in fiscal year 2009. 
321.5   (g) Chemical Dependency
321.6   Entitlement Grants 
321.7   General              63,183,000    68,744,000
321.8   (h) Chemical Dependency Nonentitlement 
321.9   Grants 
321.10  General               1,055,000     1,055,000
321.11  (i) Other Continuing Care Grants 
321.12  General              14,578,000    15.260,000
321.13  [OTHER CONTINUING CARE GRANTS BASE 
321.14  FUNDING.] Base level funding for other 
321.15  continuing care grants is increased by 
321.16  $45,000 in fiscal year 2008 and $94,000 
321.17  in fiscal year 2009. 
321.18  Subd. 8.  Continuing Care Management 
321.19                Summary by Fund
321.20  General              14,984,000    15,122,000
321.21  State Government 
321.22  Special Revenue         119,000       119,000
321.23  Lottery Prize           148,000       148,000
321.24  [QUALITY ASSURANCE COMMISSION.] 
321.25  $151,000 in fiscal year 2007 is 
321.26  appropriated from the general fund to 
321.27  the commissioner of human services for 
321.28  the Quality Assurance Commission under 
321.29  Minnesota Statutes, section 256B.0951.  
321.30  This funding is added to the base 
321.31  appropriation for the quality assurance 
321.32  commission program for the fiscal year 
321.33  beginning July 1, 2006. 
321.34  Subd. 9.  State-Operated Services 
321.35                Summary by Fund 
321.36  General             223,581,000   200,448,000
321.37  [EVIDENCE-BASED PRACTICE FOR 
321.38  METHAMPHETAMINE TREATMENT.] $300,000 is 
321.39  appropriated from the general fund for 
321.40  the fiscal year ending June 30, 2006, 
321.41  and $300,000 is appropriated from the 
321.42  general fund for the fiscal year ending 
321.43  June 30, 2007, to the commissioner of 
321.44  human services to support development 
321.45  of evidence-based practices for the 
321.46  treatment of methamphetamine abuse at 
321.47  the state-operated services chemical 
321.48  dependency program in Willmar.  These 
321.49  funds shall be used to support research 
321.50  on evidence-based practices for the 
321.51  treatment of methamphetamine abuse, to 
321.52  disseminate the results of the 
321.53  evidence-based practice research 
321.54  statewide, and to create training for 
322.1   addiction counselors specializing in 
322.2   the treatment of methamphetamine abuse. 
322.3   [TRANSFER AUTHORITY RELATED TO 
322.4   STATE-OPERATED SERVICES.] Money 
322.5   appropriated to finance state-operated 
322.6   services programs and administrative 
322.7   services may be transferred between 
322.8   fiscal years of the biennium with the 
322.9   approval of the commissioner of finance.
322.10  [BASE ADJUSTMENT FOR STATE-OPERATED 
322.11  SERVICES UTILIZATION.] The general fund 
322.12  base is increased by $3,174,000 in 
322.13  fiscal year 2008 and $6,472,000 in 
322.14  fiscal year 2009 for state-operated 
322.15  services forensic operations, with 
322.16  corresponding adjustments to 
322.17  nondedicated revenue estimates.  
322.18  Sec. 3.  COMMISSIONER OF HEALTH
322.19  Subdivision 1.  Total
322.20  Appropriation                        113,245,000    114,094,000
322.21                Summary by Fund
322.22  General              64,452,000    64,909,000
322.23  State Government
322.24  Special Revenue      36,520,000    36,906,000
322.25  Health Care Access    6,273,000     6,279,000
322.26  Federal TANF          6,000,000     6,000,000
322.27  [TANF APPROPRIATIONS.] (a) $4,000,000 
322.28  of TANF funds is appropriated each year 
322.29  to the commissioner for home visiting 
322.30  and nutritional services listed under 
322.31  Minnesota Statutes, section 145.882, 
322.32  subdivision 7, clauses (6) and (7).  
322.33  Funding shall be distributed to 
322.34  community health boards based on 
322.35  Minnesota Statutes, section 145A.131, 
322.36  subdivision 1, and tribal governments 
322.37  based on Minnesota Statutes, section 
322.38  145A.14, subdivision 2, paragraph (b). 
322.39  (b) $2,000,000 of TANF funds is 
322.40  appropriated each year to the 
322.41  commissioner for decreasing racial and 
322.42  ethnic disparities in infant mortality 
322.43  rates under Minnesota Statutes, section 
322.44  145.928, subdivision 7. 
322.45  [TANF CARRYFORWARD.] Any unexpended 
322.46  balance of the TANF appropriation in 
322.47  the first year of the biennium does not 
322.48  cancel but is available for the second 
322.49  year. 
322.50  [MN AIDS PROJECT.] Notwithstanding any 
322.51  law to the contrary, the Minnesota AIDS 
322.52  Project is not eligible for any grants 
322.53  from the commissioner of health or 
322.54  Department of Health.  
322.55  Subd. 2.  Community and Family 
322.56  Health Promotion 
323.1                 Summary by Fund
323.2   General              40,074,000    38,670,000
323.3   State Government
323.4   Special Revenue         341,000       328,000
323.5   Health Care Access    3,510,000     3,516,000
323.6   Federal TANF          3,580,000     3,580,000
323.7   [HEALTH OCCUPATIONS LICENSING.] 
323.8   $200,000 of the appropriation in fiscal 
323.9   year 2006 and $200,000 of the 
323.10  appropriation in fiscal year 2007 from 
323.11  the health occupations licensing 
323.12  account in the state government special 
323.13  revenue fund are for the rural pharmacy 
323.14  planning and transition grant program. 
323.15  [SHAKEN BABY VIDEO.] Of the state 
323.16  government special revenue fund 
323.17  appropriation, $13,000 in 2006 is 
323.18  appropriated to the commissioner of 
323.19  health to provide a video to hospitals 
323.20  on shaken baby syndrome.  The 
323.21  commissioner of health shall assess a 
323.22  fee to hospitals to cover the cost of 
323.23  the approved shaken baby video and the 
323.24  revenue received is to be deposited in 
323.25  the state government special revenue 
323.26  fund. 
323.27  [POSITIVE ABORTION ALTERNATIVES.] 
323.28  $50,000 in fiscal year 2006 is for 
323.29  administrative costs of the positive 
323.30  abortion alternatives program 
323.31  implementation.  
323.32  $2,500,000 in fiscal year 2007 is for 
323.33  positive abortion alternatives under 
323.34  Minnesota Statutes, section 145.4231.  
323.35  Of this amount, $100,000 may be used 
323.36  for administrative costs of 
323.37  implementing the grant program. 
323.38  Subd. 3.  Policy Quality and 
323.39  Compliance 
323.40                Summary by Fund
323.41  General               3,668,000     3,668,000
323.42  State Government
323.43  Special Revenue      11,528,000    11,428,000
323.44  Health Care Access    2,763,000     2,763,000
323.45  [OCCUPATIONAL THERAPY FEE HOLIDAY.] The 
323.46  commissioner's authority to collect the 
323.47  license renewal fee from occupational 
323.48  therapy practitioners under Minnesota 
323.49  Statutes, section 148.6445, subdivision 
323.50  2, is suspended for fiscal years 2006 
323.51  and 2007. 
323.52  Subd. 4.  Health Protection 
323.53                Summary by Fund
323.54  General               9,118,000     9,118,000
324.1   State Government
324.2   Special Revenue      24,316,000    24,815,000
324.3   Subd. 5.  Minority and 
324.4   Multicultural Health 
324.5                Summary by Fund 
324.6   General               6,190,000     8,051,000
324.7   Federal TANF          2,420,000     2,420,000
324.8   Subd. 6.  Administrative 
324.9   Support Services 
324.10               Summary by Fund 
324.11  General               5,402,000     5,402,000 
324.12  State Government 
324.13  Special Revenue         335,000       335,000 
324.14  Sec. 4.  VETERANS NURSING HOMES BOARD 
324.15  General              30,030,000    30,030,000
324.16  [VETERANS HOMES SPECIAL REVENUE 
324.17  ACCOUNT.] The general fund 
324.18  appropriations made to the board may be 
324.19  transferred to a veterans homes special 
324.20  revenue account in the special revenue 
324.21  fund in the same manner as other 
324.22  receipts are deposited according to 
324.23  Minnesota Statutes, section 198.34, and 
324.24  are appropriated to the board for the 
324.25  operation of board facilities and 
324.26  programs. 
324.27  Sec. 5.  HEALTH-RELATED BOARDS 
324.28  Subdivision 1.  Total
324.29  Appropriation                         12,268,000     12,296,000 
324.30                Summary by Fund
324.31  General                  25,000        25,000 
324.32  State Government            
324.33  Special Revenue      12,243,000    12,271,000
324.34  [STATE GOVERNMENT SPECIAL REVENUE 
324.35  FUND.] The appropriations in this 
324.36  section are from the state government 
324.37  special revenue fund, except where 
324.38  noted. 
324.39  [NO SPENDING IN EXCESS OF REVENUES.] 
324.40  The commissioner of finance shall not 
324.41  permit the allotment, encumbrance, or 
324.42  expenditure of money appropriated in 
324.43  this section in excess of the 
324.44  anticipated biennial revenues or 
324.45  accumulated surplus revenues from fees 
324.46  collected by the boards.  Neither this 
324.47  provision nor Minnesota Statutes, 
324.48  section 214.06, applies to transfers 
324.49  from the general contingent account. 
324.50  Subd. 2.  Board of Behavioral
324.51  Health and Therapy                       673,000        673,000 
325.1   Subd. 3.  Board of Chiropractic
325.2   Examiners                                414,000        414,000 
325.3   Subd. 4.  Board of Dentistry             888,000        888,000
325.4   Subd. 5.  Board of Dietetic and 
325.5   Nutrition Practice                       101,000        101,000 
325.6   The Board of Dietetic and Nutrition 
325.7   Practice may lower its fees by an 
325.8   amount not to exceed $36,000 in fiscal 
325.9   years 2006, 2007, 2008, and 2009. 
325.10  Subd. 6.  Board of Marriage and
325.11  Family Therapy                           127,000        131,000 
325.12  Subd. 7.  Board of Medical
325.13  Practice                               3,529,000      3,569,000 
325.14  Subd. 8.  Board of Nursing             2,561,000      2,567,000 
325.15  The Board of Nursing may lower its fees 
325.16  by an amount not to exceed $467,000 in 
325.17  fiscal year 2006 and $442,000 in fiscal 
325.18  years 2007, 2008, and 2009. 
325.19  Subd. 9.  Board of Nursing
325.20  Home Administrators                      616,000        629,000 
325.21  [ADMINISTRATIVE SERVICES UNIT.] Of this 
325.22  appropriation, $418,000 the first year 
325.23  and $421,000 the second year are for 
325.24  the health boards administrative 
325.25  services unit.  The administrative 
325.26  services unit may receive and expend 
325.27  reimbursements for services performed 
325.28  for other agencies. 
325.29  Subd. 10.  Board of Optometry             96,000         96,000 
325.30  Subd. 11.  Board of Pharmacy           1,289,000      1,244,000 
325.31  General Fund             25,000        25,000
325.32  State Government
325.33  Special Revenue       1,264,000     1,219,000
325.34  [CANCER DRUG REPOSITORY.] $25,000 each 
325.35  year from the general fund is for the 
325.36  Board of Pharmacy to operate the cancer 
325.37  drug repository program in Minnesota 
325.38  Statutes, section 144.707. 
325.39  Subd. 12.  Board of Physical
325.40  Therapy                                  201,000        207,000 
325.41  Subd. 13.  Board of Podiatry              49,000         53,000 
325.42  Subd. 14.  Board of Psychology           680,000        680,000 
325.43  Subd. 15.  Board of Social 
325.44  Work                                     873,000        873,000 
325.45  [TEMPORARY FEE REDUCTION.] For fiscal 
325.46  years 2006, 2007, 2008, and 2009, the 
325.47  following fee changes for fees 
325.48  specified in Minnesota Statutes, 
325.49  section 148D.175, are effective: 
325.50  (1) in subdivision 1, the application 
325.51  fee for a licensed independent social 
326.1   worker is reduced to $45; 
326.2   (2) in subdivision 1, the application 
326.3   fee for a licensed independent clinical 
326.4   social worker is reduced to $45; 
326.5   (3) in subdivision 1, the application 
326.6   fee for a licensure by endorsement is 
326.7   reduced to $85; 
326.8   (4) in subdivision 2, the license fee 
326.9   for a licensed social worker is reduced 
326.10  to $90; 
326.11  (5) in subdivision 2, the license fee 
326.12  for a licensed graduate social worker 
326.13  is reduced to $160; 
326.14  (6) in subdivision 2, the license fee 
326.15  for a licensed independent social 
326.16  worker is reduced to $240; 
326.17  (7) in subdivision 2, the license fee 
326.18  for a licensed independent clinical 
326.19  social worker is reduced to $265; 
326.20  (8) in subdivision 3, the renewal fee 
326.21  for a licensed social worker is reduced 
326.22  to $90; 
326.23  (9) in subdivision 3, the renewal fee 
326.24  for a licensed graduate social worker 
326.25  is reduced to $160; 
326.26  (10) in subdivision 3, the renewal fee 
326.27  for a licensed independent social 
326.28  worker is reduced to $240; 
326.29  (11) in subdivision 3, the renewal fee 
326.30  for a licensed independent clinical 
326.31  social worker is reduced to $265; and 
326.32  (12) in subdivision 5, the renewal late 
326.33  fee is reduced to one-third of the 
326.34  renewal fee specified in subdivision 3. 
326.35  These fee reductions expire on June 30, 
326.36  2009. 
326.37  Subd. 16.  Board of Veterinary
326.38  Medicine                                 171,000        171,000 
326.39  Sec. 6.  EMERGENCY MEDICAL SERVICES BOARD 
326.40  Subdivision 1.  Total
326.41  Appropriation                          3,077,000      3,077,000
326.42                Summary by Fund
326.43  General               2,481,000     2,481,000
326.44  State Government
326.45  Special Revenue         596,000       596,000
326.46  [HEALTH PROFESSIONAL SERVICES 
326.47  ACTIVITY.] $596,000 each year from the 
326.48  state government special revenue fund 
326.49  is for the health professional services 
326.50  activity. 
326.51  Sec. 7.  COUNCIL ON DISABILITY 
327.1   General                                  500,000        500,000
327.2   Sec. 8.  OMBUDSMAN FOR MENTAL HEALTH 
327.3   AND MENTAL RETARDATION                                          
327.4   General                                1,462,000      1,462,000 
327.5   Sec. 9.  OMBUDSMAN FOR FAMILIES
327.6   General                                  245,000        245,000 
327.7      Sec. 10.  [TRANSFERS.] 
327.8      Subdivision 1.  [GRANTS.] The commissioner of human 
327.9   services, with the approval of the commissioner of finance, and 
327.10  after notification of the chairs of the relevant senate budget 
327.11  division and house finance committee, may transfer unencumbered 
327.12  appropriation balances for the biennium ending June 30, 2007, 
327.13  within fiscal years among the MFIP, general assistance, medical 
327.14  assistance, MFIP child care assistance under Minnesota Statutes, 
327.15  section 119B.05, Minnesota supplemental aid, and group 
327.16  residential housing programs, and the entitlement portion of the 
327.17  chemical dependency consolidated treatment fund, and between 
327.18  fiscal years of the biennium. 
327.19     Subd. 2.  [ADMINISTRATION.] Positions, salary money, and 
327.20  nonsalary administrative money may be transferred within the 
327.21  departments of human services and health and within the programs 
327.22  operated by the veterans nursing homes board as the 
327.23  commissioners and the board consider necessary, with the advance 
327.24  approval of the commissioner of finance.  The commissioner or 
327.25  the board shall inform the chairs of the relevant house and 
327.26  senate health committees quarterly about transfers made under 
327.27  this provision. 
327.28     Subd. 3.  [PROHIBITED TRANSFERS.] Grant money shall not be 
327.29  transferred to operations within the departments of human 
327.30  services and health and within the programs operated by the 
327.31  veterans nursing homes board without the approval of the 
327.32  legislature. 
327.33     Sec. 11.  [INDIRECT COSTS NOT TO FUND PROGRAMS.] 
327.34     The commissioners of health and of human services shall not 
327.35  use indirect cost allocations to pay for the operational costs 
327.36  of any program for which they are responsible. 
328.1      Sec. 12.  [SUNSET OF UNCODIFIED LANGUAGE.] 
328.2      All uncodified language contained in this article expires 
328.3   on June 30, 2007, unless a different expiration date is explicit.
328.4      Sec. 13.  [EFFECTIVE DATE.] 
328.5      The provisions in this article are effective July 1, 2005, 
328.6   unless a different effective date is specified. 
328.7                              ARTICLE 11 
328.8                          OPTION B SPENDING 
328.9      Section 1.  [CONDITIONAL EFFECTIVE DATE.] 
328.10     The policies and the appropriations in this article are 
328.11  effective only if H.F. 1664 is passed by the house of 
328.12  representatives.  The amounts indicated in this article are 
328.13  appropriated to the commissioner of human services for the 
328.14  purposes indicated in the fiscal years indicated. 
328.15     Sec. 2.  Minnesota Statutes 2004, section 256D.03, 
328.16  subdivision 3, is amended to read: 
328.17     Subd. 3.  [GENERAL ASSISTANCE MEDICAL CARE; ELIGIBILITY.] 
328.18  (a) General assistance medical care may be paid for any person 
328.19  who is not eligible for medical assistance under chapter 256B, 
328.20  including eligibility for medical assistance based on a 
328.21  spenddown of excess income according to section 256B.056, 
328.22  subdivision 5, or MinnesotaCare as defined in paragraph (b), 
328.23  except as provided in paragraph (c), and: 
328.24     (1) who is receiving assistance under section 256D.05, 
328.25  except for families with children who are eligible under 
328.26  Minnesota family investment program (MFIP), or who is having a 
328.27  payment made on the person's behalf under sections 256I.01 to 
328.28  256I.06, or who resides in group residential housing as defined 
328.29  in chapter 256I and can meet a spenddown using the cost of 
328.30  remedial services received through group residential housing; or 
328.31     (2)(i) who is a resident of Minnesota; and 
328.32     (i) who has gross countable income not in excess of 75 
328.33  percent of the federal poverty guidelines for the family size, 
328.34  using a six-month budget period and whose equity in assets is 
328.35  not in excess of $1,000 per assistance unit.  Exempt assets, the 
328.36  reduction of excess assets, and the waiver of excess assets must 
329.1   conform to the medical assistance program in section 256B.056, 
329.2   subdivision 3, with the following exception:  the maximum amount 
329.3   of undistributed funds in a trust that could be distributed to 
329.4   or on behalf of the beneficiary by the trustee, assuming the 
329.5   full exercise of the trustee's discretion under the terms of the 
329.6   trust, must be applied toward the asset maximum; or and 
329.7      (ii) who has gross countable income above 75 percent not in 
329.8   excess of 75 percent of the federal poverty guidelines but not 
329.9   in excess of 175 percent of the federal poverty guidelines for 
329.10  the family size, using a six-month budget period, or whose 
329.11  equity in assets is not in excess of the limits in section 
329.12  256B.056, subdivision 3c, and who applies during an inpatient 
329.13  hospitalization excess income is spent down to 75 percent of the 
329.14  federal poverty guidelines using a six-month budget period. 
329.15     (b) General assistance medical care may not be paid for 
329.16  applicants or recipients who meet all eligibility requirements 
329.17  of MinnesotaCare as defined in sections 256L.01 to 256L.16, and 
329.18  are adults with dependent children under 21 whose gross family 
329.19  income is equal to or less than 275 175 percent of the federal 
329.20  poverty guidelines. 
329.21     (c) For applications received on or after October 1, 2003, 
329.22  Eligibility may begin no earlier than the date of application.  
329.23  For individuals eligible under paragraph (a), clause (2), item 
329.24  (i), a redetermination of eligibility must occur every 12 
329.25  months.  Individuals are eligible under paragraph (a), clause 
329.26  (2), item (ii), only during inpatient hospitalization but may 
329.27  reapply if there is a subsequent period of inpatient 
329.28  hospitalization.  Beginning January 1, 2000, Minnesota health 
329.29  care program applications completed by recipients and applicants 
329.30  who are persons described in paragraph (b), may be returned to 
329.31  the county agency to be forwarded to the Department of Human 
329.32  Services or sent directly to the Department of Human Services 
329.33  for enrollment in MinnesotaCare.  If all other eligibility 
329.34  requirements of this subdivision are met, eligibility for 
329.35  general assistance medical care shall be available in any month 
329.36  during which a MinnesotaCare eligibility determination and 
330.1   enrollment are pending.  Upon notification of eligibility for 
330.2   MinnesotaCare, notice of termination for eligibility for general 
330.3   assistance medical care shall be sent to an applicant or 
330.4   recipient.  If all other eligibility requirements of this 
330.5   subdivision are met, eligibility for general assistance medical 
330.6   care shall be available until enrollment in MinnesotaCare 
330.7   subject to the provisions of paragraph (e). 
330.8      (d) The date of an initial Minnesota health care program 
330.9   application necessary to begin a determination of eligibility 
330.10  shall be the date the applicant has provided a name, address, 
330.11  and Social Security number, signed and dated, to the county 
330.12  agency or the Department of Human Services.  If the applicant is 
330.13  unable to provide a name, address, Social Security number, and 
330.14  signature when health care is delivered due to a medical 
330.15  condition or disability, a health care provider may act on an 
330.16  applicant's behalf to establish the date of an initial Minnesota 
330.17  health care program application by providing the county agency 
330.18  or Department of Human Services with provider identification and 
330.19  a temporary unique identifier for the applicant.  The applicant 
330.20  must complete the remainder of the application and provide 
330.21  necessary verification before eligibility can be determined.  
330.22  The county agency must assist the applicant in obtaining 
330.23  verification if necessary.  
330.24     (e) County agencies are authorized to use all automated 
330.25  databases containing information regarding recipients' or 
330.26  applicants' income in order to determine eligibility for general 
330.27  assistance medical care or MinnesotaCare.  Such use shall be 
330.28  considered sufficient in order to determine eligibility and 
330.29  premium payments by the county agency. 
330.30     (f) General assistance medical care is not available for a 
330.31  person in a correctional facility unless the person is detained 
330.32  by law for less than one year in a county correctional or 
330.33  detention facility as a person accused or convicted of a crime, 
330.34  or admitted as an inpatient to a hospital on a criminal hold 
330.35  order, and the person is a recipient of general assistance 
330.36  medical care at the time the person is detained by law or 
331.1   admitted on a criminal hold order and as long as the person 
331.2   continues to meet other eligibility requirements of this 
331.3   subdivision.  
331.4      (g) General assistance medical care is not available for 
331.5   applicants or recipients who do not cooperate with the county 
331.6   agency to meet the requirements of medical assistance.  
331.7      (h) In determining the amount of assets of an individual 
331.8   eligible under paragraph (a), clause (2), item (i), there shall 
331.9   be included any asset or interest in an asset, including an 
331.10  asset excluded under paragraph (a), that was given away, sold, 
331.11  or disposed of for less than fair market value within the 60 
331.12  months preceding application for general assistance medical care 
331.13  or during the period of eligibility.  Any transfer described in 
331.14  this paragraph shall be presumed to have been for the purpose of 
331.15  establishing eligibility for general assistance medical care, 
331.16  unless the individual furnishes convincing evidence to establish 
331.17  that the transaction was exclusively for another purpose.  For 
331.18  purposes of this paragraph, the value of the asset or interest 
331.19  shall be the fair market value at the time it was given away, 
331.20  sold, or disposed of, less the amount of compensation received.  
331.21  For any uncompensated transfer, the number of months of 
331.22  ineligibility, including partial months, shall be calculated by 
331.23  dividing the uncompensated transfer amount by the average 
331.24  monthly per person payment made by the medical assistance 
331.25  program to skilled nursing facilities for the previous calendar 
331.26  year.  The individual shall remain ineligible until this fixed 
331.27  period has expired.  The period of ineligibility may exceed 30 
331.28  months, and a reapplication for benefits after 30 months from 
331.29  the date of the transfer shall not result in eligibility unless 
331.30  and until the period of ineligibility has expired.  The period 
331.31  of ineligibility begins in the month the transfer was reported 
331.32  to the county agency, or if the transfer was not reported, the 
331.33  month in which the county agency discovered the transfer, 
331.34  whichever comes first.  For applicants, the period of 
331.35  ineligibility begins on the date of the first approved 
331.36  application. 
332.1      (i) When determining eligibility for any state benefits 
332.2   under this subdivision, the income and resources of all 
332.3   noncitizens shall be deemed to include their sponsor's income 
332.4   and resources as defined in the Personal Responsibility and Work 
332.5   Opportunity Reconciliation Act of 1996, title IV, Public Law 
332.6   104-193, sections 421 and 422, and subsequently set out in 
332.7   federal rules. 
332.8      (j) Undocumented noncitizens and nonimmigrants are 
332.9   ineligible for general assistance medical care.  For purposes of 
332.10  this subdivision, a nonimmigrant is an individual in one or more 
332.11  of the classes listed in United States Code, title 8, section 
332.12  1101(a)(15), and an undocumented noncitizen is an individual who 
332.13  resides in the United States without the approval or 
332.14  acquiescence of the Immigration and Naturalization Service. 
332.15     (k) Notwithstanding any other provision of law, a 
332.16  noncitizen who is ineligible for medical assistance due to the 
332.17  deeming of a sponsor's income and resources, is ineligible for 
332.18  general assistance medical care. 
332.19     (l) Effective July 1, 2003, general assistance medical care 
332.20  emergency services end.  
332.21     <b>[EFFECTIVE DATE.]</b> This section is effective October 1, 2005.
332.22     Sec. 3.  Minnesota Statutes 2004, section 256L.03, 
332.23  subdivision 3, is amended to read: 
332.24     Subd. 3.  [INPATIENT HOSPITAL SERVICES.] (a) Covered health 
332.25  services shall include inpatient hospital services, including 
332.26  inpatient hospital mental health services and inpatient hospital 
332.27  and residential chemical dependency treatment, subject to those 
332.28  limitations necessary to coordinate the provision of these 
332.29  services with eligibility under the medical assistance 
332.30  spenddown.  Prior to July 1, 1997, the inpatient hospital 
332.31  benefit for adult enrollees is subject to an annual benefit 
332.32  limit of $10,000.  The inpatient hospital benefit for adult 
332.33  enrollees who qualify under section 256L.04, subdivision 7, or 
332.34  who qualify under section 256L.04, subdivisions 1 and 2, with 
332.35  family gross income that exceeds 175 percent of the federal 
332.36  poverty guidelines and who are not pregnant, is subject to an 
333.1   annual limit of $10,000.  
333.2      (b) Admissions for inpatient hospital services paid for 
333.3   under section 256L.11, subdivision 3, must be certified as 
333.4   medically necessary in accordance with Minnesota Rules, parts 
333.5   9505.0500 to 9505.0540, except as provided in clauses (1) and 
333.6   (2): 
333.7      (1) all admissions must be certified, except those 
333.8   authorized under rules established under section 254A.03, 
333.9   subdivision 3, or approved under Medicare; and 
333.10     (2) payment under section 256L.11, subdivision 3, shall be 
333.11  reduced by five percent for admissions for which certification 
333.12  is requested more than 30 days after the day of admission.  The 
333.13  hospital may not seek payment from the enrollee for the amount 
333.14  of the payment reduction under this clause. 
333.15     <b>[EFFECTIVE DATE.]</b> This section is effective October 1, 2005.
333.16     Sec. 4.  Minnesota Statutes 2004, section 256L.03, 
333.17  subdivision 5, is amended to read: 
333.18     Subd. 5.  [CO-PAYMENTS AND COINSURANCE.] (a) Except as 
333.19  provided in paragraphs (b) and (c), the MinnesotaCare benefit 
333.20  plan shall include the following co-payments and coinsurance 
333.21  requirements for all enrollees:  
333.22     (1) ten percent of the paid charges for inpatient hospital 
333.23  services for adult enrollees, subject to an annual inpatient 
333.24  out-of-pocket maximum of $1,000 per individual and $3,000 per 
333.25  family; 
333.26     (2) $3 per prescription for adult enrollees; 
333.27     (3) $25 for eyeglasses for adult enrollees; and 
333.28     (4) $3 per nonpreventive visit.  For purposes of this 
333.29  subdivision, a visit means an episode of service which is 
333.30  required because of an enrollee's symptoms, diagnosis, or 
333.31  established illness, and which is delivered in an ambulatory 
333.32  setting by a physician or physician ancillary, chiropractor, 
333.33  podiatrist, advanced practice nurse, audiologist, optician, or 
333.34  optometrist; 
333.35     (5) $6 for nonemergency visits to a hospital-based 
333.36  emergency room; and 
334.1      (6) 50 percent of the fee-for-service rate for adult dental 
334.2   care services other than preventive care services for persons 
334.3   eligible under section 256L.04, subdivisions 1 to 7, with income 
334.4   equal to or less than 175 percent of the federal poverty 
334.5   guidelines. 
334.6      (b) Paragraph (a), clause (1), does not apply to parents 
334.7   and relative caretakers of children under the age of 21 in 
334.8   households with family income equal to or less than 175 percent 
334.9   of the federal poverty guidelines.  Paragraph (a), clause (1), 
334.10  does not apply to parents and relative caretakers of children 
334.11  under the age of 21 in households with family income greater 
334.12  than 175 percent of the federal poverty guidelines for inpatient 
334.13  hospital admissions occurring on or after January 1, 2001.  
334.14     (c) Paragraph (a), clauses (1) to (4) (6), do not apply to 
334.15  pregnant women and children under the age of 21.  
334.16     (d) Adult enrollees with family gross income that exceeds 
334.17  175 percent of the federal poverty guidelines and who are not 
334.18  pregnant shall be financially responsible for the coinsurance 
334.19  amount, if applicable, and amounts which exceed the $10,000 
334.20  inpatient hospital benefit limit. 
334.21     (e) When a MinnesotaCare enrollee becomes a member of a 
334.22  prepaid health plan, or changes from one prepaid health plan to 
334.23  another during a calendar year, any charges submitted towards 
334.24  the $10,000 annual inpatient benefit limit, and any 
334.25  out-of-pocket expenses incurred by the enrollee for inpatient 
334.26  services, that were submitted or incurred prior to enrollment, 
334.27  or prior to the change in health plans, shall be disregarded. 
334.28     (f) Paragraph (a), clauses (4) and (5), are limited to one 
334.29  co-payment per day per provider.  
334.30     <b>[EFFECTIVE DATE.]</b> This section is effective January 1, 2006.
334.31     Sec. 5.  Minnesota Statutes 2004, section 256L.04, 
334.32  subdivision 1, is amended to read: 
334.33     Subdivision 1.  [FAMILIES WITH CHILDREN.] (a) Through 
334.34  September 30, 2005, families with children with family income 
334.35  equal to or less than 275 percent of the federal poverty 
334.36  guidelines for the applicable family size shall be eligible for 
335.1   MinnesotaCare according to this section.  Beginning October 1, 
335.2   2005, children and pregnant women with family income equal to or 
335.3   less than 275 percent of the federal poverty guidelines for the 
335.4   applicable family size shall be eligible for MinnesotaCare 
335.5   according to this section.  Beginning October 1, 2005, parents, 
335.6   grandparents, foster parents, relative caretakers, and legal 
335.7   guardians ages 21 and over are not eligible for MinnesotaCare if 
335.8   their gross income exceeds 190 percent of the federal poverty 
335.9   guidelines for the applicable family size.  All other provisions 
335.10  of sections 256L.01 to 256L.18, including the insurance-related 
335.11  barriers to enrollment under section 256L.07, shall apply unless 
335.12  otherwise specified. 
335.13     (b) Parents who enroll in the MinnesotaCare program must 
335.14  also enroll their children, if the children are eligible.  
335.15  Children may be enrolled separately without enrollment by 
335.16  parents.  However, if one parent in the household enrolls, both 
335.17  parents must enroll, unless other insurance is available.  If 
335.18  one child from a family is enrolled, all children must be 
335.19  enrolled, unless other insurance is available.  If one spouse in 
335.20  a household enrolls, the other spouse in the household must also 
335.21  enroll, unless other insurance is available.  Families cannot 
335.22  choose to enroll only certain uninsured members.  
335.23     (c) Beginning October 1, 2003, the dependent sibling 
335.24  definition no longer applies to the MinnesotaCare program.  
335.25  These persons are no longer counted in the parental household 
335.26  and may apply as a separate household. 
335.27     (d) Beginning July 1, 2003, or upon federal approval, 
335.28  whichever is later, parents are not eligible for MinnesotaCare 
335.29  if their gross income exceeds $50,000. 
335.30     Sec. 6.  Minnesota Statutes 2004, section 256L.11, 
335.31  subdivision 6, is amended to read: 
335.32     Subd. 6.  [ENROLLEES 18 OR OLDER.] Payment by the 
335.33  MinnesotaCare program for inpatient hospital services provided 
335.34  to MinnesotaCare enrollees eligible under section 256L.04, 
335.35  subdivision 7, or who qualify under section 256L.04, 
335.36  subdivisions 1 and 2, with family gross income that exceeds 175 
336.1   percent of the federal poverty guidelines and who are not 
336.2   pregnant, who are 18 years old or older on the date of admission 
336.3   to the inpatient hospital must be in accordance with paragraphs 
336.4   (a) and (b).  Payment for adults who are not pregnant and are 
336.5   eligible under section 256L.04, subdivisions 1 and 2, and whose 
336.6   incomes are equal to or less than 175 percent of the federal 
336.7   poverty guidelines, shall be as provided for under paragraph (c).
336.8      (a) If the medical assistance rate minus any co-payment 
336.9   required under section 256L.03, subdivision 4 5, is less than or 
336.10  equal to the amount remaining in the enrollee's benefit limit 
336.11  under section 256L.03, subdivision 3, payment must be the 
336.12  medical assistance rate minus any co-payment required under 
336.13  section 256L.03, subdivision 4 5.  The hospital must not seek 
336.14  payment from the enrollee in addition to the co-payment.  The 
336.15  MinnesotaCare payment plus the co-payment must be treated as 
336.16  payment in full. 
336.17     (b) If the medical assistance rate minus any co-payment 
336.18  required under section 256L.03, subdivision 4 5, is greater than 
336.19  the amount remaining in the enrollee's benefit limit under 
336.20  section 256L.03, subdivision 3, payment must be the lesser of: 
336.21     (1) the amount remaining in the enrollee's benefit limit; 
336.22  or 
336.23     (2) charges submitted for the inpatient hospital services 
336.24  less any co-payment established under section 256L.03, 
336.25  subdivision 4 5. 
336.26     The hospital may seek payment from the enrollee for the 
336.27  amount by which usual and customary charges exceed the payment 
336.28  under this paragraph.  If payment is reduced under section 
336.29  256L.03, subdivision 3, paragraph (b), the hospital may not seek 
336.30  payment from the enrollee for the amount of the reduction. 
336.31     (c) For admissions occurring during the period of July 1, 
336.32  1997, through June 30, 1998, for adults who are not pregnant and 
336.33  are eligible under section 256L.04, subdivisions 1 and 2, and 
336.34  whose incomes are equal to or less than 175 percent of the 
336.35  federal poverty guidelines, the commissioner shall pay hospitals 
336.36  directly, up to the medical assistance payment rate, for 
337.1   inpatient hospital benefits in excess of the $10,000 annual 
337.2   inpatient benefit limit. 
337.3      <b>[EFFECTIVE DATE.]</b> This section is effective October 1, 2005.
337.4      Sec. 7.  [INCREASE IN GAMC FUNDING RELATED TO SPENDDOWN 
337.5   STANDARD.] 
337.6      $3,062,000 in fiscal year 2006 and $3,964,000 in fiscal 
337.7   year 2007 are added to the appropriations in article 10, section 
337.8   2, subdivision 5, paragraph (d), to increase the general 
337.9   assistance medical care spenddown standard from 50 percent to 75 
337.10  percent of the federal poverty guidelines as provided in section 
337.11  2. 
337.12     Sec. 8.  [INCREASE IN MINNESOTACARE FUNDING RELATED TO 
337.13  INCOME STANDARD FOR PARENTS.] 
337.14     $2,191,000 in fiscal year 2006 and $6,048,000 in fiscal 
337.15  year 2007 are added to the appropriations in article 10, section 
337.16  2, subdivision 5, paragraph (a), for the purpose of sections 3 
337.17  to 6. 
337.18     Sec. 9.  [MINNESOTACARE OUTREACH GRANTS.] 
337.19     The repeal in article 3 of Minnesota Statutes 2004, section 
337.20  256L.04, subdivision 11, shall not take effect. 
337.21     Sec. 10.  [FUNDING FOR MINNESOTACARE OUTREACH GRANTS.] 
337.22     $750,000 in fiscal year 2006 and $750,000 in fiscal year 
337.23  2007 are added to the appropriations in article 10, section 2, 
337.24  subdivision 5, paragraph (f), to fund MinnesotaCare outreach 
337.25  grants under Minnesota Statutes, section 256L.04, subdivision 
337.26  11.  Federal administrative reimbursement resulting from 
337.27  MinnesotaCare outreach is appropriated to the commissioner for 
337.28  this purpose. 
337.29     Sec. 11.  [HOME CARE SERVICES REIMBURSEMENT RATES.] 
337.30     $1,261,000 in fiscal year 2006 and $1,973,000 in fiscal 
337.31  year 2007 are added to the appropriations in article 10, section 
337.32  2, subdivision 7, paragraph (d), to provide additional increases 
337.33  in reimbursement rates for home health services under Minnesota 
337.34  Statutes, section 256B.763.  The commissioner must recalculate 
337.35  the rates in Minnesota Statutes, section 256B.763, to reflect 
337.36  these additional appropriations. 
338.1      Sec. 12.  [OTHER PROVISIONS.] 
338.2      The amendments in this article to sections of law supersede 
338.3   and shall be implemented in place of the amendments or repealers 
338.4   to those sections in article 3.