1.1                          A bill for an act
  1.2             relating to human services; modifying programs and 
  1.3             services for persons with disabilities; amending 
  1.4             Minnesota Statutes 2004, sections 252.27, subdivision 
  1.5             2a; 256B.04, by adding a subdivision; 256B.056, 
  1.6             subdivisions 3, 5c; 256B.057, subdivision 9; 
  1.7             256B.0575; 256B.0621, subdivisions 4, 6, by adding a 
  1.8             subdivision; 256B.0625, subdivision 9; 256B.0916, by 
  1.9             adding a subdivision; 256B.092, subdivisions 2a, 4b; 
  1.10            256B.35, subdivision 1; 256B.49, subdivisions 13, 16; 
  1.11            256B.5012, by adding a subdivision; 256B.69, 
  1.12            subdivision 23; 256B.765; 256D.03, subdivision 4; 
  1.13            256L.03, subdivisions 1, 5, by adding a subdivision; 
  1.14            proposing coding for new law in Minnesota Statutes, 
  1.15            chapter 256. 
  1.16  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.17     Section 1.  Minnesota Statutes 2004, section 252.27, 
  1.18  subdivision 2a, is amended to read: 
  1.19     Subd. 2a.  [CONTRIBUTION AMOUNT.] (a) The natural or 
  1.20  adoptive parents of a minor child, including a child determined 
  1.21  eligible for medical assistance without consideration of 
  1.22  parental income, must contribute to the cost of services used by 
  1.23  making monthly payments on a sliding scale based on income, 
  1.24  unless the child is married or has been married, parental rights 
  1.25  have been terminated, or the child's adoption is subsidized 
  1.26  according to section 259.67 or through title IV-E of the Social 
  1.27  Security Act. 
  1.28     (b) For households with adjusted gross income equal to or 
  1.29  greater than 100 percent of federal poverty guidelines, the 
  1.30  parental contribution shall be computed by applying the 
  2.1   following schedule of rates to the adjusted gross income of the 
  2.2   natural or adoptive parents: 
  2.3      (1) if the adjusted gross income is equal to or greater 
  2.4   than 100 percent of federal poverty guidelines and less than 175 
  2.5   percent of federal poverty guidelines, the parental contribution 
  2.6   is $4 per month; 
  2.7      (2) if the adjusted gross income is equal to or greater 
  2.8   than 175 percent of federal poverty guidelines and less than or 
  2.9   equal to 375 545 percent of federal poverty guidelines, the 
  2.10  parental contribution shall be determined using a sliding fee 
  2.11  scale established by the commissioner of human services which 
  2.12  begins at one percent of adjusted gross income at 175 percent of 
  2.13  federal poverty guidelines and increases to 7.5 percent of 
  2.14  adjusted gross income for those with adjusted gross income up to 
  2.15  375 545 percent of federal poverty guidelines; 
  2.16     (3) if the adjusted gross income is greater than 375 545 
  2.17  percent of federal poverty guidelines and less than 675 percent 
  2.18  of federal poverty guidelines, the parental contribution shall 
  2.19  be 7.5 percent of adjusted gross income; 
  2.20     (4) if the adjusted gross income is equal to or greater 
  2.21  than 675 percent of federal poverty guidelines and less than 975 
  2.22  percent of federal poverty guidelines, the parental contribution 
  2.23  shall be determined using a sliding fee scale established by the 
  2.24  commissioner of human services which begins at 7.5 percent of 
  2.25  adjusted gross income at 675 percent of federal poverty 
  2.26  guidelines and increases to ten percent of adjusted gross income 
  2.27  for those with adjusted gross income up to 975 percent of 
  2.28  federal poverty guidelines; and 
  2.29     (5) if the adjusted gross income is equal to or greater 
  2.30  than 975 percent of federal poverty guidelines, the parental 
  2.31  contribution shall be 12.5 percent of adjusted gross income. 
  2.32     If the child lives with the parent, the annual adjusted 
  2.33  gross income is reduced by $2,400 prior to calculating the 
  2.34  parental contribution.  If the child resides in an institution 
  2.35  specified in section 256B.35, the parent is responsible for the 
  2.36  personal needs allowance specified under that section in 
  3.1   addition to the parental contribution determined under this 
  3.2   section.  The parental contribution is reduced by any amount 
  3.3   required to be paid directly to the child pursuant to a court 
  3.4   order, but only if actually paid. 
  3.5      (c) The household size to be used in determining the amount 
  3.6   of contribution under paragraph (b) includes natural and 
  3.7   adoptive parents and their dependents, including the child 
  3.8   receiving services.  Adjustments in the contribution amount due 
  3.9   to annual changes in the federal poverty guidelines shall be 
  3.10  implemented on the first day of July following publication of 
  3.11  the changes. 
  3.12     (d) For purposes of paragraph (b), "income" means the 
  3.13  adjusted gross income of the natural or adoptive parents 
  3.14  determined according to the previous year's federal tax form, 
  3.15  except, effective retroactive to July 1, 2003, taxable capital 
  3.16  gains to the extent the funds have been used to purchase a home 
  3.17  shall not be counted as income. 
  3.18     (e) The contribution shall be explained in writing to the 
  3.19  parents at the time eligibility for services is being 
  3.20  determined.  The contribution shall be made on a monthly basis 
  3.21  effective with the first month in which the child receives 
  3.22  services.  Annually upon redetermination or at termination of 
  3.23  eligibility, if the contribution exceeded the cost of services 
  3.24  provided, the local agency or the state shall reimburse that 
  3.25  excess amount to the parents, either by direct reimbursement if 
  3.26  the parent is no longer required to pay a contribution, or by a 
  3.27  reduction in or waiver of parental fees until the excess amount 
  3.28  is exhausted. 
  3.29     (f) The monthly contribution amount must be reviewed at 
  3.30  least every 12 months; when there is a change in household size; 
  3.31  and when there is a loss of or gain in income from one month to 
  3.32  another in excess of ten percent.  The local agency shall mail a 
  3.33  written notice 30 days in advance of the effective date of a 
  3.34  change in the contribution amount.  A decrease in the 
  3.35  contribution amount is effective in the month that the parent 
  3.36  verifies a reduction in income or change in household size. 
  4.1      (g) Parents of a minor child who do not live with each 
  4.2   other shall each pay the contribution required under paragraph 
  4.3   (a).  An amount equal to the annual court-ordered child support 
  4.4   payment actually paid on behalf of the child receiving services 
  4.5   shall be deducted from the adjusted gross income of the parent 
  4.6   making the payment prior to calculating the parental 
  4.7   contribution under paragraph (b). 
  4.8      (h) The contribution under paragraph (b) shall be increased 
  4.9   by an additional five percent if the local agency determines 
  4.10  that insurance coverage is available but not obtained for the 
  4.11  child.  For purposes of this section, "available" means the 
  4.12  insurance is a benefit of employment for a family member at an 
  4.13  annual cost of no more than five percent of the family's annual 
  4.14  income.  For purposes of this section, "insurance" means health 
  4.15  and accident insurance coverage, enrollment in a nonprofit 
  4.16  health service plan, health maintenance organization, 
  4.17  self-insured plan, or preferred provider organization. 
  4.18     Parents who have more than one child receiving services 
  4.19  shall not be required to pay more than the amount for the child 
  4.20  with the highest expenditures.  There shall be no resource 
  4.21  contribution from the parents.  The parent shall not be required 
  4.22  to pay a contribution in excess of the cost of the services 
  4.23  provided to the child, not counting payments made to school 
  4.24  districts for education-related services.  Notice of an increase 
  4.25  in fee payment must be given at least 30 days before the 
  4.26  increased fee is due.  
  4.27     (i) The contribution under paragraph (b) shall be reduced 
  4.28  by $300 per fiscal year if, in the 12 months prior to July 1: 
  4.29     (1) the parent applied for insurance for the child; 
  4.30     (2) the insurer denied insurance; 
  4.31     (3) the parents submitted a complaint or appeal, in writing 
  4.32  to the insurer, submitted a complaint or appeal, in writing, to 
  4.33  the commissioner of health or the commissioner of commerce, or 
  4.34  litigated the complaint or appeal; and 
  4.35     (4) as a result of the dispute, the insurer reversed its 
  4.36  decision and granted insurance. 
  5.1      For purposes of this section, "insurance" has the meaning 
  5.2   given in paragraph (h). 
  5.3      A parent who has requested a reduction in the contribution 
  5.4   amount under this paragraph shall submit proof in the form and 
  5.5   manner prescribed by the commissioner or county agency, 
  5.6   including, but not limited to, the insurer's denial of 
  5.7   insurance, the written letter or complaint of the parents, court 
  5.8   documents, and the written response of the insurer approving 
  5.9   insurance.  The determinations of the commissioner or county 
  5.10  agency under this paragraph are not rules subject to chapter 14. 
  5.11     Sec. 2.  [256.4825] [DISABILITY SERVICES COORDINATION 
  5.12  COMMISSION.] 
  5.13     Subdivision 1.  [PURPOSE.] The Disability Services 
  5.14  Coordination Commission is established for the purposes of 
  5.15  coordinating services and funding needed by persons with 
  5.16  disabilities to live as independently as possible in the 
  5.17  community.  The commission's objectives include, but are not 
  5.18  limited to: 
  5.19     (1) promoting the development of affordable and accessible 
  5.20  housing; 
  5.21     (2) improving the recruitment and retention of direct 
  5.22  support staff; 
  5.23     (3) assuring that funding follows the individual, rather 
  5.24  than service providers; 
  5.25     (4) reducing the delay for obtaining home and 
  5.26  community-based services for eligible persons; 
  5.27     (5) increasing employment opportunities for persons with 
  5.28  disabilities; 
  5.29     (6) enhancing data collection activities and agency 
  5.30  accountability; 
  5.31     (7) improving transportation consistent with the Americans 
  5.32  with Disabilities Act (ADA); and 
  5.33     (8) assuring quality of services based on outcomes for 
  5.34  persons with disabilities. 
  5.35     Subd. 2.  [MEMBERSHIP.] The governor must appoint the 
  5.36  members of the Disability Services Coordination Commission.  The 
  6.1   speaker of the house of representatives must appoint two members 
  6.2   of the house of representatives to the commission.  The 
  6.3   president of the senate must appoint two members of the senate 
  6.4   to the commission.  The commission membership appointed by the 
  6.5   governor must include the following individuals: 
  6.6      (1) the commissioner of the Department of Human Services; 
  6.7      (2) the commissioner of the Department of Health; 
  6.8      (3) the commissioner of the Department of Finance; 
  6.9      (4) the commissioner of the Department of Employment And 
  6.10  Economic Development; 
  6.11     (5) the commissioner of the Minnesota Housing Finance 
  6.12  Agency; 
  6.13     (6) a Metropolitan Council housing planner; 
  6.14     (7) a representative of a public housing authority; 
  6.15     (8) a representative of the counties; and 
  6.16     (9) a consumer representative selected by the Minnesota 
  6.17  Consortium for Citizens with Disabilities. 
  6.18     Subd. 3.  [COMMISSION DUTIES.] The duties of the Disability 
  6.19  Services Coordination Commission include, but are not limited to:
  6.20     (1) setting statewide goals, including specific timelines 
  6.21  and targets for providing community services to those who want 
  6.22  to relocate from institutional settings; 
  6.23     (2) monitoring activities and outcomes under various 
  6.24  federal grants provided to support persons with disabilities 
  6.25  living more independently in community settings in Minnesota; 
  6.26     (3) integrating state agency work plans to assure a 
  6.27  coordinated effort; 
  6.28     (4) ensuring open, regular, public discussion of state 
  6.29  agency efforts; 
  6.30     (5) improving the supply of affordable, accessible housing, 
  6.31  supportive housing, services, and employment options for 
  6.32  individuals with disabilities transitioning from institutional 
  6.33  to community settings; and 
  6.34     (6) annually reviewing Minnesota's progress in providing 
  6.35  needed community services for persons with disabilities and 
  6.36  reporting each January 15 on progress and specific 
  7.1   recommendations for changes necessary to assure that persons 
  7.2   with disabilities in Minnesota can live and work as 
  7.3   independently as possible in the community. 
  7.4      Subd. 4.  [MEETINGS.] At a minimum, meetings of the 
  7.5   commission must be conducted each quarter and in accordance with 
  7.6   chapter 13D. 
  7.7      Subd. 5.  [COMMISSION STAFF.] Staff support must be 
  7.8   provided by the Minnesota Council on Disability under section 
  7.9   256.482. 
  7.10     Sec. 3.  Minnesota Statutes 2004, section 256B.04, is 
  7.11  amended by adding a subdivision to read: 
  7.12     Subd. 20.  [INCENTIVE FOR WELLNESS VISITS.] The 
  7.13  commissioner of human services shall consult with private sector 
  7.14  health plan companies and shall develop an incentive program to 
  7.15  encourage medical assistance enrollees with disabilities to have 
  7.16  regular wellness exams conducted by a primary care physician.  
  7.17  The commissioner shall implement the incentive program beginning 
  7.18  January 1, 2006.  
  7.19     Sec. 4.  Minnesota Statutes 2004, section 256B.056, 
  7.20  subdivision 3, is amended to read: 
  7.21     Subd. 3.  [ASSET LIMITATIONS FOR INDIVIDUALS AND 
  7.22  FAMILIES THE AGED, BLIND, OR DISABLED.] To be eligible for 
  7.23  medical assistance, a person eligible under section 256B.055, 
  7.24  subdivision 7, 7a, or 12 must not individually own more 
  7.25  than $3,000 $10,000 in assets, or if a member of a household 
  7.26  with two family members, husband and wife, or parent and 
  7.27  child or more persons, the household must not own more 
  7.28  than $6,000 $18,000 in assets, plus $200 for each additional 
  7.29  legal dependent.  In addition to these maximum amounts, an 
  7.30  eligible individual or family may accrue interest on these 
  7.31  amounts, but they must be reduced to the maximum at the time of 
  7.32  an eligibility redetermination.  The accumulation of the 
  7.33  clothing and personal needs allowance according to section 
  7.34  256B.35 must also be reduced to the maximum at the time of the 
  7.35  eligibility redetermination.  The value of assets that are not 
  7.36  considered in determining eligibility for medical assistance is 
  8.1   the value of those assets excluded under the supplemental 
  8.2   security income program for aged, blind, and disabled persons, 
  8.3   with the following exceptions: 
  8.4      (a) Household goods and personal effects are not considered.
  8.5      (b) Capital and operating assets of a trade or business 
  8.6   that the local agency determines are necessary to the person's 
  8.7   ability to earn an income are not considered. 
  8.8      (c) Motor vehicles are excluded to the same extent excluded 
  8.9   by the supplemental security income program. 
  8.10     (d) Assets designated as burial expenses are excluded to 
  8.11  the same extent excluded by the supplemental security income 
  8.12  program.  Burial expenses funded by annuity contracts or life 
  8.13  insurance policies must irrevocably designate the individual's 
  8.14  estate as contingent beneficiary to the extent proceeds are not 
  8.15  used for payment of selected burial expenses. 
  8.16     (e) Effective upon federal approval, for a person who no 
  8.17  longer qualifies as an employed person with a disability due to 
  8.18  loss of earnings, assets allowed while eligible for medical 
  8.19  assistance under section 256B.057, subdivision 9, are not 
  8.20  considered for 12 months, beginning with the first month of 
  8.21  ineligibility as an employed person with a disability, to the 
  8.22  extent that the person's total assets remain within the allowed 
  8.23  limits of section 256B.057, subdivision 9, paragraph (b). 
  8.24     Sec. 5.  Minnesota Statutes 2004, section 256B.056, 
  8.25  subdivision 5c, is amended to read: 
  8.26     Subd. 5c.  [EXCESS INCOME STANDARD.] (a) The excess income 
  8.27  standard for families with children is the standard specified in 
  8.28  subdivision 4. 
  8.29     (b) The excess income standard for a person whose 
  8.30  eligibility is based on blindness, disability, or age of 65 or 
  8.31  more years is 70 100 percent of the federal poverty guidelines 
  8.32  for the family size.  Effective July 1, 2002, the excess income 
  8.33  standard for this paragraph shall equal 75 percent of the 
  8.34  federal poverty guidelines. 
  8.35     Sec. 6.  Minnesota Statutes 2004, section 256B.057, 
  8.36  subdivision 9, is amended to read: 
  9.1      Subd. 9.  [EMPLOYED PERSONS WITH DISABILITIES.] (a) Medical 
  9.2   assistance may be paid for a person who is employed and who: 
  9.3      (1) meets the definition of disabled under the supplemental 
  9.4   security income program; 
  9.5      (2) is at least 16 but less than 65 years of age; 
  9.6      (3) meets the asset limits in paragraph (b); and 
  9.7      (4) effective November 1, 2003, pays a premium and other 
  9.8   obligations under paragraph (d).  
  9.9   Any spousal income or assets shall be disregarded for purposes 
  9.10  of eligibility and premium determinations. 
  9.11     After the month of enrollment, a person enrolled in medical 
  9.12  assistance under this subdivision who: 
  9.13     (1) is temporarily unable to work and without receipt of 
  9.14  earned income due to a medical condition, as verified by a 
  9.15  physician, may retain eligibility for up to four calendar 
  9.16  months; or 
  9.17     (2) effective January 1, 2004, loses employment for reasons 
  9.18  not attributable to the enrollee, may retain eligibility for up 
  9.19  to four consecutive months after the month of job loss.  To 
  9.20  receive a four-month extension, enrollees must verify the 
  9.21  medical condition or provide notification of job loss.  All 
  9.22  other eligibility requirements must be met and the enrollee must 
  9.23  pay all calculated premium costs for continued eligibility. 
  9.24     (b) For purposes of determining eligibility under this 
  9.25  subdivision, a person's assets must not exceed $20,000, 
  9.26  excluding: 
  9.27     (1) all assets excluded under section 256B.056; 
  9.28     (2) retirement accounts, including individual accounts, 
  9.29  401(k) plans, 403(b) plans, Keogh plans, and pension plans; and 
  9.30     (3) medical expense accounts set up through the person's 
  9.31  employer. 
  9.32     (c)(1) Effective January 1, 2004, for purposes of 
  9.33  eligibility, there will be a $65 earned income disregard.  To be 
  9.34  eligible, a person applying for medical assistance under this 
  9.35  subdivision must have earned income above the disregard level. 
  9.36     (2) Effective January 1, 2004, to be considered earned 
 10.1   income, Medicare, Social Security, and applicable state and 
 10.2   federal income taxes must be withheld.  To be eligible, a person 
 10.3   must document earned income tax withholding. 
 10.4      (d)(1) A person whose earned and unearned income is equal 
 10.5   to or greater than 100 percent of federal poverty guidelines for 
 10.6   the applicable family size must pay a premium to be eligible for 
 10.7   medical assistance under this subdivision.  The premium shall be 
 10.8   based on the person's gross earned and unearned income and the 
 10.9   applicable family size using a sliding fee scale established by 
 10.10  the commissioner, which begins at one percent of income at 100 
 10.11  percent of the federal poverty guidelines and increases to 7.5 
 10.12  percent of income for those with incomes at or above 300 percent 
 10.13  of the federal poverty guidelines.  Annual adjustments in the 
 10.14  premium schedule based upon changes in the federal poverty 
 10.15  guidelines shall be effective for premiums due in July of each 
 10.16  year.  
 10.17     (2) Effective January 1, 2004, all enrollees must pay a 
 10.18  premium to be eligible for medical assistance under this 
 10.19  subdivision.  An enrollee shall pay the greater of a $35 premium 
 10.20  or the premium calculated in clause (1). 
 10.21     (3) Effective November 1, 2003, all enrollees who receive 
 10.22  unearned income must pay one-half of one percent of unearned 
 10.23  income in addition to the premium amount. 
 10.24     (4) Effective November 1, 2003 July 1, 2005, for 
 10.25  enrollees whose income does not exceed 200 percent of the 
 10.26  federal poverty guidelines and who are also enrolled in 
 10.27  Medicare, the commissioner must reimburse the enrollee for 
 10.28  Medicare Part B premiums under section 256B.0625, subdivision 
 10.29  15, paragraph (a).  
 10.30     (5) Increases in benefits under title II of the Social 
 10.31  Security Act shall not be counted as income for purposes of this 
 10.32  subdivision until July 1 of each year.  
 10.33     (e) A person's eligibility and premium shall be determined 
 10.34  by the local county agency.  Premiums must be paid to the 
 10.35  commissioner.  All premiums are dedicated to the commissioner. 
 10.36     (f) Any required premium shall be determined at application 
 11.1   and redetermined at the enrollee's six-month income review or 
 11.2   when a change in income or household size is reported.  
 11.3   Enrollees must report any change in income or household size 
 11.4   within ten days of when the change occurs.  A decreased premium 
 11.5   resulting from a reported change in income or household size 
 11.6   shall be effective the first day of the next available billing 
 11.7   month after the change is reported.  Except for changes 
 11.8   occurring from annual cost-of-living increases, a change 
 11.9   resulting in an increased premium shall not affect the premium 
 11.10  amount until the next six-month review. 
 11.11     (g) Premium payment is due upon notification from the 
 11.12  commissioner of the premium amount required.  Premiums may be 
 11.13  paid in installments at the discretion of the commissioner. 
 11.14     (h) Nonpayment of the premium shall result in denial or 
 11.15  termination of medical assistance unless the person demonstrates 
 11.16  good cause for nonpayment.  Good cause exists if the 
 11.17  requirements specified in Minnesota Rules, part 9506.0040, 
 11.18  subpart 7, items B to D, are met.  Except when an installment 
 11.19  agreement is accepted by the commissioner, all persons 
 11.20  disenrolled for nonpayment of a premium must pay any past due 
 11.21  premiums as well as current premiums due prior to being 
 11.22  reenrolled.  Nonpayment shall include payment with a returned, 
 11.23  refused, or dishonored instrument.  The commissioner may require 
 11.24  a guaranteed form of payment as the only means to replace a 
 11.25  returned, refused, or dishonored instrument. 
 11.26     Sec. 7.  Minnesota Statutes 2004, section 256B.0575, is 
 11.27  amended to read: 
 11.28     256B.0575 [AVAILABILITY OF INCOME FOR INSTITUTIONALIZED 
 11.29  PERSONS.] 
 11.30     When an institutionalized person is determined eligible for 
 11.31  medical assistance, the income that exceeds the deductions in 
 11.32  paragraphs (a) and (b) must be applied to the cost of 
 11.33  institutional care.  
 11.34     (a) The following amounts must be deducted from the 
 11.35  institutionalized person's income in the following order: 
 11.36     (1) the personal needs allowance under section 256B.35 or, 
 12.1   for a veteran who does not have a spouse or child, or a 
 12.2   surviving spouse of a veteran having no child, the amount of an 
 12.3   improved pension received from the veteran's administration not 
 12.4   exceeding $90 per month; 
 12.5      (2) the personal allowance for disabled individuals under 
 12.6   section 256B.36; 
 12.7      (3) if the institutionalized person has a legally appointed 
 12.8   guardian or conservator, five percent of the recipient's gross 
 12.9   monthly income up to $100 as reimbursement for guardianship or 
 12.10  conservatorship services; 
 12.11     (4) a monthly income allowance determined under section 
 12.12  256B.058, subdivision 2, but only to the extent income of the 
 12.13  institutionalized spouse is made available to the community 
 12.14  spouse; 
 12.15     (5) a monthly allowance for children under age 18 which, 
 12.16  together with the net income of the children, would provide 
 12.17  income equal to the medical assistance standard for families and 
 12.18  children according to section 256B.056, subdivision 4, for a 
 12.19  family size that includes only the minor children.  This 
 12.20  deduction applies only if the children do not live with the 
 12.21  community spouse and only to the extent that the deduction is 
 12.22  not included in the personal needs allowance under section 
 12.23  256B.35, subdivision 1, as child support garnished under a court 
 12.24  order; 
 12.25     (6) a monthly family allowance for other family members, 
 12.26  equal to one-third of the difference between 122 percent of the 
 12.27  federal poverty guidelines and the monthly income for that 
 12.28  family member; 
 12.29     (7) reparations payments made by the Federal Republic of 
 12.30  Germany and reparations payments made by the Netherlands for 
 12.31  victims of Nazi persecution between 1940 and 1945; 
 12.32     (8) all other exclusions from income for institutionalized 
 12.33  persons as mandated by federal law; and 
 12.34     (9) amounts for reasonable expenses incurred for necessary 
 12.35  medical or remedial care for the institutionalized person that 
 12.36  are not medical assistance covered expenses and that are not 
 13.1   subject to payment by a third party.  
 13.2      For purposes of clause (6), "other family member" means a 
 13.3   person who resides with the community spouse and who is a minor 
 13.4   or dependent child, dependent parent, or dependent sibling of 
 13.5   either spouse.  "Dependent" means a person who could be claimed 
 13.6   as a dependent for federal income tax purposes under the 
 13.7   Internal Revenue Code. 
 13.8      (b) Income shall be allocated to an institutionalized 
 13.9   person for a period of up to three six calendar months, in an 
 13.10  amount equal to 100 percent of the medical assistance standard 
 13.11  federal poverty guidelines for a family size of one if:  
 13.12     (1) a physician certifies that the person is expected to 
 13.13  reside in the long-term care facility for three six calendar 
 13.14  months or less; 
 13.15     (2) if the person has expenses of maintaining a residence 
 13.16  in the community; and 
 13.17     (3) if one of the following circumstances apply:  
 13.18     (i) the person was not living together with a spouse or a 
 13.19  family member as defined in paragraph (a) when the person 
 13.20  entered a long-term care facility; or 
 13.21     (ii) the person and the person's spouse become 
 13.22  institutionalized on the same date, in which case the allocation 
 13.23  shall be applied to the income of one of the spouses.  
 13.24  For purposes of this paragraph, a person is determined to be 
 13.25  residing in a licensed nursing home, regional treatment center, 
 13.26  or medical institution if the person is expected to remain for a 
 13.27  period of one full calendar month or more. 
 13.28     Sec. 8.  Minnesota Statutes 2004, section 256B.0621, 
 13.29  subdivision 4, is amended to read: 
 13.30     Subd. 4.  [RELOCATION TARGETED CASE MANAGEMENT PROVIDER 
 13.31  QUALIFICATIONS.] (a) A relocation targeted case management 
 13.32  provider is an enrolled medical assistance provider who is 
 13.33  determined by the commissioner to have all of the following 
 13.34  characteristics: 
 13.35     (1) the legal authority to provide public welfare under 
 13.36  sections 393.01, subdivision 7; and 393.07; or a federally 
 14.1   recognized Indian tribe; 
 14.2      (2) the demonstrated capacity and experience to provide the 
 14.3   components of case management to coordinate and link community 
 14.4   resources needed by the eligible population; 
 14.5      (3) the administrative capacity and experience to serve the 
 14.6   target population for whom it will provide services and ensure 
 14.7   quality of services under state and federal requirements; 
 14.8      (4) the legal authority to provide complete investigative 
 14.9   and protective services under section 626.556, subdivision 10; 
 14.10  and child welfare and foster care services under section 393.07, 
 14.11  subdivisions 1 and 2; or a federally recognized Indian tribe; 
 14.12     (5) a financial management system that provides accurate 
 14.13  documentation of services and costs under state and federal 
 14.14  requirements; and 
 14.15     (6) the capacity to document and maintain individual case 
 14.16  records under state and federal requirements. 
 14.17     (b) The commissioner shall ensure that each eligible person 
 14.18  is given a choice of county and private agency relocation 
 14.19  targeted case management service providers. 
 14.20     (c) A provider of targeted case management under section 
 14.21  256B.0625, subdivision 20, may be deemed a certified provider of 
 14.22  relocation targeted case management. 
 14.23     (c) (d) A relocation targeted case management provider may 
 14.24  subcontract with another provider to deliver relocation targeted 
 14.25  case management services.  Subcontracted providers must 
 14.26  demonstrate the ability to provide the services outlined in 
 14.27  subdivision 6, and have a procedure in place that notifies 
 14.28  provides full disclosure to the recipient and the recipient's 
 14.29  legal representative of any conflict of interest if the 
 14.30  contracted targeted case management provider also provides, or 
 14.31  will provide, the recipient's housing, services and, or 
 14.32  supports.  Contracted providers must provide information on all 
 14.33  conflicts of interest and obtain the recipient's informed 
 14.34  consent or provide the recipient with alternatives.  
 14.35     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2005, 
 14.36  or, if a federal waiver is required, on the date the federal 
 15.1   waiver is granted. 
 15.2      Sec. 9.  Minnesota Statutes 2004, section 256B.0621, 
 15.3   subdivision 6, is amended to read: 
 15.4      Subd. 6.  [ELIGIBLE SERVICES.] (a) Services eligible for 
 15.5   medical assistance reimbursement as targeted case management 
 15.6   service coordination include: 
 15.7      (1) assessment of the recipient's need for targeted case 
 15.8   management services; 
 15.9      (2) development, completion, and regular review of a 
 15.10  written individual service plan, which is based upon the 
 15.11  assessment of the recipient's needs and choices, and which will 
 15.12  ensure access to medical, social, educational, and other related 
 15.13  services and supports; 
 15.14     (3) (2) routine contact or communication with the 
 15.15  recipient, recipient's family, primary caregiver, legal 
 15.16  representative, substitute care provider, service providers, or 
 15.17  other relevant persons identified as necessary to the 
 15.18  development or implementation of the goals of the individual 
 15.19  service plan; 
 15.20     (4) (3) coordinating referrals for, and the provision of, 
 15.21  case management services for the recipient with appropriate 
 15.22  service providers, consistent with section 1902(a)(23) of the 
 15.23  Social Security Act; 
 15.24     (5) (4) coordinating and monitoring the overall service 
 15.25  delivery to ensure quality of services, appropriateness, and 
 15.26  continued need; 
 15.27     (6) (5) completing and maintaining necessary documentation 
 15.28  that supports and verifies the activities in this subdivision; 
 15.29     (7) (6) traveling to conduct a visit with the recipient or 
 15.30  other relevant person necessary to develop or implement the 
 15.31  goals of the individual service plan; and 
 15.32     (8) (7) coordinating with the institution discharge planner 
 15.33  in the 180-day period before the recipient's discharge. 
 15.34     (b) Targeted relocation case management administrative 
 15.35  activities are the responsibility of the county or the agency 
 15.36  under contract.  Targeted relocation case management 
 16.1   administrative activities include: 
 16.2      (1) assessment of the recipient's need for targeted case 
 16.3   management services; 
 16.4      (2) eligibility determination; 
 16.5      (3) providing information and assistance to the recipient 
 16.6   or their legal representative sufficient to allow the recipient 
 16.7   to choose a provider of targeted case management services; 
 16.8      (4) approval of service plans and necessary contracts; and 
 16.9      (5) monitoring spending and evaluating health, safety, 
 16.10  welfare, and service outcomes. 
 16.11     Sec. 10.  Minnesota Statutes 2004, section 256B.0621, is 
 16.12  amended by adding a subdivision to read: 
 16.13     Subd. 11.  [NOTICE OF RELOCATION TARGETED CASE MANAGEMENT 
 16.14  AVAILABILITY.] Upon admission and annually thereafter, the 
 16.15  commissioner shall provide notification to medical assistance 
 16.16  eligible persons who are residing in institutions of the 
 16.17  availability of relocation targeted case management services. 
 16.18     Sec. 11.  Minnesota Statutes 2004, section 256B.0625, 
 16.19  subdivision 9, is amended to read: 
 16.20     Subd. 9.  [DENTAL SERVICES.] (a) Medical assistance covers 
 16.21  dental services.  Dental services include, with prior 
 16.22  authorization, fixed bridges that are cost-effective for persons 
 16.23  who cannot use removable dentures because of their medical 
 16.24  condition.  
 16.25     (b) Coverage of dental services for adults age 21 and over 
 16.26  who are not pregnant is subject to a $500 annual benefit limit 
 16.27  and covered services are limited to:  
 16.28     (1) diagnostic and preventative services; 
 16.29     (2) restorative services; and 
 16.30     (3) emergency services. 
 16.31     Emergency services, dentures, and extractions related to 
 16.32  dentures are not included in the $500 annual benefit limit. 
 16.33     Sec. 12.  Minnesota Statutes 2004, section 256B.0916, is 
 16.34  amended by adding a subdivision to read: 
 16.35     Subd. 10.  [TRANSITIONAL SUPPORTS ALLOWANCE.] A 
 16.36  transitional supports allowance shall be available to all 
 17.1   persons under a home and community-based waiver who are moving 
 17.2   from a licensed setting to a community setting.  "Transitional 
 17.3   supports allowance" means a onetime payment of up to $3,000, to 
 17.4   cover the costs, not covered by other sources, associated with 
 17.5   moving from a licensed setting to a community setting.  Covered 
 17.6   costs include: 
 17.7      (1) lease or rent deposits; 
 17.8      (2) security deposits; 
 17.9      (3) utilities set-up costs, including telephone; 
 17.10     (4) essential furnishings and supplies; and 
 17.11     (5) personal supports and transports needed to locate and 
 17.12  transition to community settings. 
 17.13     <b>[EFFECTIVE DATE.]</b> This section is effective upon federal 
 17.14  approval and to the extent approved as a federal waiver 
 17.15  amendment. 
 17.16     Sec. 13.  Minnesota Statutes 2004, section 256B.092, 
 17.17  subdivision 2a, is amended to read: 
 17.18     Subd. 2a.  [MEDICAL ASSISTANCE FOR CASE MANAGEMENT 
 17.19  ACTIVITIES UNDER THE STATE PLAN MEDICAID OPTION.] (a) Upon 
 17.20  receipt of federal approval, the commissioner shall make 
 17.21  payments to approved vendors of case management services 
 17.22  participating in the medical assistance program to reimburse 
 17.23  costs for providing case management service activities to 
 17.24  medical assistance eligible persons with mental retardation or a 
 17.25  related condition, in accordance with the state Medicaid plan 
 17.26  and federal requirements and limitations. 
 17.27     (b) The commissioner shall ensure that each eligible person 
 17.28  is given a choice of county and private agency case management 
 17.29  service coordination vendors. 
 17.30     (c) The commissioner shall, with consumer input, develop 
 17.31  standards, notice requirements, and basic consumer rights so 
 17.32  that full disclosure is provided in cases in which a case 
 17.33  manager may be providing relocation services, housing, or other 
 17.34  support services to the same individual. 
 17.35     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2005, 
 17.36  or, if a federal waiver is required, on the date the federal 
 18.1   waiver is granted. 
 18.2      Sec. 14.  Minnesota Statutes 2004, section 256B.092, 
 18.3   subdivision 4b, is amended to read: 
 18.4      Subd. 4b.  [CASE MANAGEMENT FOR PERSONS RECEIVING HOME AND 
 18.5   COMMUNITY-BASED SERVICES.] (a) Persons authorized for and 
 18.6   receiving home and community-based services may select from 
 18.7   public and private vendors of case management which have 
 18.8   provider agreements with the state to provide home and 
 18.9   community-based case management service activities.  This 
 18.10  subdivision becomes effective July 1, 1992, only if the state 
 18.11  agency is unable to secure federal approval for limiting choice 
 18.12  of case management vendors to the county of financial 
 18.13  responsibility.  
 18.14     (b) The commissioner shall ensure that each eligible person 
 18.15  is given a choice of county and private agency case management 
 18.16  service coordination vendors. 
 18.17     (c) The commissioner shall, with consumer input, develop 
 18.18  standards, notice requirements, and basic consumer rights so 
 18.19  that full disclosure is provided in cases in which a case 
 18.20  manager may be providing relocation services, housing, or other 
 18.21  support services to the same individual. 
 18.22     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2005, 
 18.23  or, if a federal waiver is required, on the date the federal 
 18.24  waiver is granted. 
 18.25     Sec. 15.  Minnesota Statutes 2004, section 256B.35, 
 18.26  subdivision 1, is amended to read: 
 18.27     Subdivision 1.  [PERSONAL NEEDS ALLOWANCE.] (a) 
 18.28  Notwithstanding any law to the contrary, welfare allowances for 
 18.29  clothing and personal needs for individuals receiving medical 
 18.30  assistance while residing in any skilled nursing home, 
 18.31  intermediate care facility, or medical institution including 
 18.32  recipients of supplemental security income, in this state shall 
 18.33  not be less than $45 $150 per month from all sources.  When 
 18.34  benefit amounts for Social Security or supplemental security 
 18.35  income recipients are increased pursuant to United States Code, 
 18.36  title 42, sections 415(i) and 1382f, the commissioner shall, 
 19.1   effective in the month in which the increase takes effect, 
 19.2   increase by the same percentage to the nearest whole dollar the 
 19.3   clothing and personal needs allowance for individuals receiving 
 19.4   medical assistance while residing in any skilled nursing home, 
 19.5   medical institution, or intermediate care facility.  The 
 19.6   commissioner shall provide timely notice to local agencies, 
 19.7   providers, and recipients of increases under this provision. 
 19.8      (b) The personal needs allowance may be paid as part of the 
 19.9   Minnesota supplemental aid program, notwithstanding the 
 19.10  provisions of section 256D.37, subdivision 2, and payments to 
 19.11  recipients of Minnesota supplemental aid may be made once each 
 19.12  three months covering liabilities that accrued during the 
 19.13  preceding three months. 
 19.14     (c) The personal needs allowance shall be increased to 
 19.15  include income garnished for child support under a court order, 
 19.16  up to a maximum of $250 per month but only to the extent that 
 19.17  the amount garnished is not deducted as a monthly allowance for 
 19.18  children under section 256B.0575, paragraph (a), clause (5). 
 19.19     Sec. 16.  Minnesota Statutes 2004, section 256B.49, 
 19.20  subdivision 13, is amended to read: 
 19.21     Subd. 13.  [CASE MANAGEMENT SERVICE COORDINATION AND 
 19.22  ADMINISTRATIVE ACTIVITIES.] (a) Each recipient of a home and 
 19.23  community-based waiver shall be provided choose a vendor of case 
 19.24  management services by service coordination from among qualified 
 19.25  public and private vendors as described in the federally 
 19.26  approved waiver application.  The case management 
 19.27  service coordination activities provided will include: 
 19.28     (1) assessing the needs of the individual within 20 working 
 19.29  days of a recipient's request as changes occur, but at least 
 19.30  annually; 
 19.31     (2) developing the written individual service plan within 
 19.32  ten working days after the assessment is completed; 
 19.33     (3) informing the recipient or the recipient's legal 
 19.34  guardian or conservator of service options; 
 19.35     (4) assisting the recipient in the identification of 
 19.36  potential service providers; 
 20.1      (5) assisting the recipient to access services; 
 20.2      (6) coordinating, evaluating, and monitoring of the 
 20.3   services identified in the service plan; 
 20.4      (7) completing the annual reviews of the service plan; and 
 20.5      (8) informing the recipient or legal representative of the 
 20.6   right to have assessments completed and service plans developed 
 20.7   within specified time periods, and to appeal county action or 
 20.8   inaction under section 256.045, subdivision 3. 
 20.9      (b) Case management administrative activities are the 
 20.10  responsibility of the county or agency under contract.  Case 
 20.11  management administrative functions include: 
 20.12     (1) screening; 
 20.13     (2) assistance with obtaining diagnoses and necessary 
 20.14  medical or health reports; 
 20.15     (3) eligibility determination; 
 20.16     (4) initial assessment within 20 days of a request for 
 20.17  waiver services; 
 20.18     (5) providing information and assistance to the person or 
 20.19  their legal representative sufficient to allow the person to 
 20.20  choose a vendor of case management service coordination; 
 20.21     (6) determination of resources needed to meet assessed 
 20.22  needs; 
 20.23     (7) approval of service plans and necessary contracts; and 
 20.24     (8) monitoring spending and evaluating health, safety, 
 20.25  welfare, and service outcomes. 
 20.26     (c) The case manager may delegate certain aspects of the 
 20.27  case management service activities to another individual 
 20.28  provided there is oversight by the case manager.  The case 
 20.29  manager may not delegate those aspects which require 
 20.30  professional judgment including assessments, reassessments, and 
 20.31  care plan development. 
 20.32     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2005, 
 20.33  or, if a federal waiver is required, on the date the federal 
 20.34  waiver is granted. 
 20.35     Sec. 17.  Minnesota Statutes 2004, section 256B.49, 
 20.36  subdivision 16, is amended to read: 
 21.1      Subd. 16.  [SERVICES AND SUPPORTS.] (a) Services and 
 21.2   supports included in the home and community-based waivers for 
 21.3   persons with disabilities shall meet the requirements set out in 
 21.4   United States Code, title 42, section 1396n.  The services and 
 21.5   supports, which are offered as alternatives to institutional 
 21.6   care, shall promote consumer choice, community inclusion, 
 21.7   self-sufficiency, and self-determination. 
 21.8      (b) Beginning January 1, 2003, the commissioner shall 
 21.9   simplify and improve access to home and community-based waivered 
 21.10  services, to the extent possible, through the establishment of a 
 21.11  common service menu that is available to eligible recipients 
 21.12  regardless of age, disability type, or waiver program. 
 21.13     (c) Consumer directed community support services shall be 
 21.14  offered as an option to all persons eligible for services under 
 21.15  subdivision 11, by January 1, 2002. 
 21.16     (d) Services and supports shall be arranged and provided 
 21.17  consistent with individualized written plans of care for 
 21.18  eligible waiver recipients. 
 21.19     (e) A transitional supports allowance shall be available to 
 21.20  all persons under a home and community-based waiver who are 
 21.21  moving from a licensed setting to a community setting. 
 21.22  "Transitional supports allowance" means a onetime payment of up 
 21.23  to $3,000, to cover the costs, not covered by other sources, 
 21.24  associated with moving from a licensed setting to a community 
 21.25  setting.  Covered costs include: 
 21.26     (1) lease or rent deposits; 
 21.27     (2) security deposits; 
 21.28     (3) utilities set-up costs, including telephone; 
 21.29     (4) essential furnishings and supplies; and 
 21.30     (5) personal supports and transports needed to locate and 
 21.31  transition to community settings. 
 21.32     (f) The state of Minnesota and county agencies that 
 21.33  administer home and community-based waivered services for 
 21.34  persons with disabilities, shall not be liable for damages, 
 21.35  injuries, or liabilities sustained through the purchase of 
 21.36  supports by the individual, the individual's family, legal 
 22.1   representative, or the authorized representative with funds 
 22.2   received through the consumer-directed community support service 
 22.3   under this section.  Liabilities include but are not limited 
 22.4   to:  workers' compensation liability, the Federal Insurance 
 22.5   Contributions Act (FICA), or the Federal Unemployment Tax Act 
 22.6   (FUTA). 
 22.7      <b>[EFFECTIVE DATE.]</b> This section is effective upon federal 
 22.8   approval and to the extent approved as a federal waiver 
 22.9   amendment. 
 22.10     Sec. 18.  Minnesota Statutes 2004, section 256B.5012, is 
 22.11  amended by adding a subdivision to read: 
 22.12     Subd. 6.  [ICF/MR RATE INCREASES BEGINNING JANUARY 1, 2006, 
 22.13  AND JANUARY 1, 2007.] For the rate years beginning January 1, 
 22.14  2006, and January 1, 2007, the commissioner shall provide 
 22.15  facilities reimbursed under this section an adjustment to the 
 22.16  total operating payment rate of ..... percent.  At least 
 22.17  two-thirds of each year's adjustment must be used for increased 
 22.18  costs of employee salaries and benefits and associated costs for 
 22.19  FICA, the Medicare tax, workers' compensation premiums, and 
 22.20  federal and state unemployment insurance.  Each facility 
 22.21  receiving an adjustment shall report to the commissioner, in the 
 22.22  form and manner specified by the commissioner, on how the 
 22.23  additional funding was used. 
 22.24     Sec. 19.  Minnesota Statutes 2004, section 256B.69, 
 22.25  subdivision 23, is amended to read: 
 22.26     Subd. 23.  [ALTERNATIVE INTEGRATED LONG-TERM CARE SERVICES; 
 22.27  ELDERLY AND DISABLED PERSONS.] (a) The commissioner may 
 22.28  implement demonstration projects to create alternative 
 22.29  integrated delivery systems for acute and long-term care 
 22.30  services to elderly persons and persons with disabilities as 
 22.31  defined in section 256B.77, subdivision 7a, that provide 
 22.32  increased coordination, improve access to quality services, and 
 22.33  mitigate future cost increases.  The commissioner may seek 
 22.34  federal authority to combine Medicare and Medicaid capitation 
 22.35  payments for the purpose of such demonstrations.  Medicare funds 
 22.36  and services shall be administered according to the terms and 
 23.1   conditions of the federal waiver and demonstration provisions.  
 23.2   For the purpose of administering medical assistance funds, 
 23.3   demonstrations under this subdivision are subject to 
 23.4   subdivisions 1 to 22.  The provisions of Minnesota Rules, parts 
 23.5   9500.1450 to 9500.1464, apply to these demonstrations, with the 
 23.6   exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457, 
 23.7   subpart 1, items B and C, which do not apply to persons 
 23.8   enrolling in demonstrations under this section.  An initial open 
 23.9   enrollment period may be provided.  Persons who disenroll from 
 23.10  demonstrations under this subdivision remain subject to 
 23.11  Minnesota Rules, parts 9500.1450 to 9500.1464.  When a person is 
 23.12  enrolled in a health plan under these demonstrations and the 
 23.13  health plan's participation is subsequently terminated for any 
 23.14  reason, the person shall be provided an opportunity to select a 
 23.15  new health plan and shall have the right to change health plans 
 23.16  within the first 60 days of enrollment in the second health 
 23.17  plan.  Persons required to participate in health plans under 
 23.18  this section who fail to make a choice of health plan shall not 
 23.19  be randomly assigned to health plans under these demonstrations. 
 23.20  Notwithstanding section 256L.12, subdivision 5, and Minnesota 
 23.21  Rules, part 9505.5220, subpart 1, item A, if adopted, for the 
 23.22  purpose of demonstrations under this subdivision, the 
 23.23  commissioner may contract with managed care organizations, 
 23.24  including counties, to serve only elderly persons eligible for 
 23.25  medical assistance, elderly and disabled persons, or disabled 
 23.26  persons only.  For persons with primary diagnoses of mental 
 23.27  retardation or a related condition, serious and persistent 
 23.28  mental illness, or serious emotional disturbance, the 
 23.29  commissioner must ensure that the county authority has approved 
 23.30  the demonstration and contracting design.  Enrollment in these 
 23.31  projects for persons with disabilities shall be voluntary.  The 
 23.32  commissioner shall not implement any demonstration project under 
 23.33  this subdivision for persons with primary diagnoses of mental 
 23.34  retardation or a related condition, serious and persistent 
 23.35  mental illness, or serious emotional disturbance, without 
 23.36  approval of the county board of the county in which the 
 24.1   demonstration is being implemented.  
 24.2      (b) Notwithstanding chapter 245B, sections 252.40 to 
 24.3   252.46, 256B.092, 256B.501 to 256B.5015, and Minnesota Rules, 
 24.4   parts 9525.0004 to 9525.0036, 9525.1200 to 9525.1330, 9525.1580, 
 24.5   and 9525.1800 to 9525.1930, the commissioner may implement under 
 24.6   this section projects for persons with developmental 
 24.7   disabilities.  The commissioner may capitate payments for ICF/MR 
 24.8   services, waivered services for mental retardation or related 
 24.9   conditions, including case management services, day training and 
 24.10  habilitation and alternative active treatment services, and 
 24.11  other services as approved by the state and by the federal 
 24.12  government.  Case management and active treatment must be 
 24.13  individualized and developed in accordance with a 
 24.14  person-centered plan.  Costs under these projects may not exceed 
 24.15  costs that would have been incurred under fee-for-service. 
 24.16  Beginning July 1, 2003, and until two years after the pilot 
 24.17  project implementation date, subcontractor participation in the 
 24.18  long-term care developmental disability pilot is limited to a 
 24.19  nonprofit long-term care system providing ICF/MR services, home 
 24.20  and community-based waiver services, and in-home services to no 
 24.21  more than 120 consumers with developmental disabilities in 
 24.22  Carver, Hennepin, and Scott Counties.  The commissioner shall 
 24.23  report to the legislature prior to expansion of the 
 24.24  developmental disability pilot project.  This paragraph expires 
 24.25  two years after the implementation date of the pilot project.  
 24.26     (c) Before implementation of a demonstration project for 
 24.27  disabled persons, the commissioner must provide information to 
 24.28  appropriate committees of the house of representatives and 
 24.29  senate and must involve representatives of affected disability 
 24.30  groups in the design of the demonstration projects. 
 24.31     (d) A nursing facility reimbursed under the alternative 
 24.32  reimbursement methodology in section 256B.434 may, in 
 24.33  collaboration with a hospital, clinic, or other health care 
 24.34  entity provide services under paragraph (a).  The commissioner 
 24.35  shall amend the state plan and seek any federal waivers 
 24.36  necessary to implement this paragraph. 
 25.1      (e) The commissioner shall seek federal approval to expand 
 25.2   the Minnesota disability health options (MnDHO) program 
 25.3   established under this subdivision in stages, first to regional 
 25.4   population centers outside the seven-county metro area and then 
 25.5   to all areas of the state. 
 25.6      Sec. 20.  Minnesota Statutes 2004, section 256B.765, is 
 25.7   amended to read: 
 25.8      256B.765 [PROVIDER RATE INCREASES.] 
 25.9      Subdivision 1.  [ANNUAL INFLATION ADJUSTMENTS.] (a) 
 25.10  Effective July 1, 2001, within the limits of appropriations 
 25.11  specifically for this purpose, the commissioner shall provide an 
 25.12  annual inflation adjustment for the providers listed 
 25.13  in paragraph (c) subdivision 2.  The index for the inflation 
 25.14  adjustment must be based on the change in the Employment Cost 
 25.15  Index for Private Industry Workers - Total Compensation 
 25.16  forecasted by Data Resources, Inc., as forecasted in the fourth 
 25.17  quarter of the calendar year preceding the fiscal year.  The 
 25.18  commissioner shall increase reimbursement or allocation rates by 
 25.19  the percentage of this adjustment, and county boards shall 
 25.20  adjust provider contracts as needed. 
 25.21     (b) The commissioner of finance shall include an annual 
 25.22  inflationary adjustment in reimbursement rates for the providers 
 25.23  listed in paragraph (c) subdivision 2 using the inflation factor 
 25.24  specified in paragraph (a) as a budget change request in each 
 25.25  biennial detailed expenditure budget submitted to the 
 25.26  legislature under section 16A.11. 
 25.27     (c) Subd. 2.  [ELIGIBLE PROVIDERS.] The annual adjustment 
 25.28  under subdivision 1, paragraph (a), shall be provided for home 
 25.29  and community-based waiver services for persons with mental 
 25.30  retardation or related conditions under section 256B.501; home 
 25.31  and community-based waiver services for the elderly under 
 25.32  section 256B.0915; waivered services under community 
 25.33  alternatives for disabled individuals under section 256B.49; 
 25.34  community alternative care waivered services under section 
 25.35  256B.49; traumatic brain injury waivered services under section 
 25.36  256B.49; nursing services and home health services under section 
 26.1   256B.0625, subdivision 6a; personal care services and nursing 
 26.2   supervision of personal care services under section 256B.0625, 
 26.3   subdivision 19a; private duty nursing services under section 
 26.4   256B.0625, subdivision 7; day training and habilitation services 
 26.5   for adults with mental retardation or related conditions under 
 26.6   sections 252.40 to 252.46; physical therapy services under 
 26.7   sections 256B.0625, subdivision 8, and 256D.03, subdivision 4; 
 26.8   occupational therapy services under sections 256B.0625, 
 26.9   subdivision 8a, and 256D.03, subdivision 4; speech-language 
 26.10  therapy services under section 256D.03, subdivision 4, and 
 26.11  Minnesota Rules, part 9505.0390; respiratory therapy services 
 26.12  under section 256D.03, subdivision 4, and Minnesota Rules, part 
 26.13  9505.0295; alternative care services under section 256B.0913; 
 26.14  adult residential program grants under Minnesota Rules, parts 
 26.15  9535.2000 to 9535.3000; adult and family community support 
 26.16  grants under Minnesota Rules, parts 9535.1700 to 9535.1760; 
 26.17  semi-independent living services under section 252.275 including 
 26.18  SILS funding under county social services grants formerly funded 
 26.19  under chapter 256I; and community support services for deaf and 
 26.20  hard-of-hearing adults with mental illness who use or wish to 
 26.21  use sign language as their primary means of communication. 
 26.22     Subd. 3.  [RATE INCREASE FOR BIENNIUM BEGINNING JULY 1, 
 26.23  2005.] For the fiscal years beginning July 1, 2005, and July 1, 
 26.24  2006, the commissioner shall increase reimbursement rates for 
 26.25  the providers listed in subdivision 2 by ..... percent.  At 
 26.26  least two-thirds of each year's adjustment must be used for 
 26.27  increased costs of employee salaries and benefits and associated 
 26.28  costs for FICA, the Medicare tax, workers' compensation 
 26.29  premiums, and federal and state unemployment insurance.  Each 
 26.30  provider receiving an adjustment shall report to the 
 26.31  commissioner, in the form and manner specified by the 
 26.32  commissioner, on how the additional funding was used. 
 26.33     Sec. 21.  Minnesota Statutes 2004, section 256D.03, 
 26.34  subdivision 4, is amended to read: 
 26.35     Subd. 4.  [GENERAL ASSISTANCE MEDICAL CARE; SERVICES.] 
 26.36  (a)(i) For a person who is eligible under subdivision 3, 
 27.1   paragraph (a), clause (2), item (i), general assistance medical 
 27.2   care covers, except as provided in paragraph (c): 
 27.3      (1) inpatient hospital services; 
 27.4      (2) outpatient hospital services; 
 27.5      (3) services provided by Medicare certified rehabilitation 
 27.6   agencies; 
 27.7      (4) prescription drugs and other products recommended 
 27.8   through the process established in section 256B.0625, 
 27.9   subdivision 13; 
 27.10     (5) equipment necessary to administer insulin and 
 27.11  diagnostic supplies and equipment for diabetics to monitor blood 
 27.12  sugar level; 
 27.13     (6) eyeglasses and eye examinations provided by a physician 
 27.14  or optometrist; 
 27.15     (7) hearing aids; 
 27.16     (8) prosthetic devices; 
 27.17     (9) laboratory and X-ray services; 
 27.18     (10) physician's services; 
 27.19     (11) medical transportation except special transportation; 
 27.20     (12) chiropractic services as covered under the medical 
 27.21  assistance program; 
 27.22     (13) podiatric services; 
 27.23     (14) dental services and dentures, subject to the 
 27.24  limitations specified in section 256B.0625, subdivision 9 as 
 27.25  covered under the medical assistance program; 
 27.26     (15) outpatient services provided by a mental health center 
 27.27  or clinic that is under contract with the county board and is 
 27.28  established under section 245.62; 
 27.29     (16) day treatment services for mental illness provided 
 27.30  under contract with the county board; 
 27.31     (17) prescribed medications for persons who have been 
 27.32  diagnosed as mentally ill as necessary to prevent more 
 27.33  restrictive institutionalization; 
 27.34     (18) psychological services, medical supplies and 
 27.35  equipment, and Medicare premiums, coinsurance and deductible 
 27.36  payments; 
 28.1      (19) medical equipment not specifically listed in this 
 28.2   paragraph when the use of the equipment will prevent the need 
 28.3   for costlier services that are reimbursable under this 
 28.4   subdivision; 
 28.5      (20) services performed by a certified pediatric nurse 
 28.6   practitioner, a certified family nurse practitioner, a certified 
 28.7   adult nurse practitioner, a certified obstetric/gynecological 
 28.8   nurse practitioner, a certified neonatal nurse practitioner, or 
 28.9   a certified geriatric nurse practitioner in independent 
 28.10  practice, if (1) the service is otherwise covered under this 
 28.11  chapter as a physician service, (2) the service provided on an 
 28.12  inpatient basis is not included as part of the cost for 
 28.13  inpatient services included in the operating payment rate, and 
 28.14  (3) the service is within the scope of practice of the nurse 
 28.15  practitioner's license as a registered nurse, as defined in 
 28.16  section 148.171; 
 28.17     (21) services of a certified public health nurse or a 
 28.18  registered nurse practicing in a public health nursing clinic 
 28.19  that is a department of, or that operates under the direct 
 28.20  authority of, a unit of government, if the service is within the 
 28.21  scope of practice of the public health nurse's license as a 
 28.22  registered nurse, as defined in section 148.171; and 
 28.23     (22) telemedicine consultations, to the extent they are 
 28.24  covered under section 256B.0625, subdivision 3b.  
 28.25     (ii) Effective October 1, 2003, for a person who is 
 28.26  eligible under subdivision 3, paragraph (a), clause (2), item 
 28.27  (ii), general assistance medical care coverage is limited to 
 28.28  inpatient hospital services, including physician services 
 28.29  provided during the inpatient hospital stay.  A $1,000 
 28.30  deductible is required for each inpatient hospitalization.  
 28.31     (b) Gender reassignment surgery and related services are 
 28.32  not covered services under this subdivision unless the 
 28.33  individual began receiving gender reassignment services prior to 
 28.34  July 1, 1995.  
 28.35     (c) In order to contain costs, the commissioner of human 
 28.36  services shall select vendors of medical care who can provide 
 29.1   the most economical care consistent with high medical standards 
 29.2   and shall where possible contract with organizations on a 
 29.3   prepaid capitation basis to provide these services.  The 
 29.4   commissioner shall consider proposals by counties and vendors 
 29.5   for prepaid health plans, competitive bidding programs, block 
 29.6   grants, or other vendor payment mechanisms designed to provide 
 29.7   services in an economical manner or to control utilization, with 
 29.8   safeguards to ensure that necessary services are provided.  
 29.9   Before implementing prepaid programs in counties with a county 
 29.10  operated or affiliated public teaching hospital or a hospital or 
 29.11  clinic operated by the University of Minnesota, the commissioner 
 29.12  shall consider the risks the prepaid program creates for the 
 29.13  hospital and allow the county or hospital the opportunity to 
 29.14  participate in the program in a manner that reflects the risk of 
 29.15  adverse selection and the nature of the patients served by the 
 29.16  hospital, provided the terms of participation in the program are 
 29.17  competitive with the terms of other participants considering the 
 29.18  nature of the population served.  Payment for services provided 
 29.19  pursuant to this subdivision shall be as provided to medical 
 29.20  assistance vendors of these services under sections 256B.02, 
 29.21  subdivision 8, and 256B.0625.  For payments made during fiscal 
 29.22  year 1990 and later years, the commissioner shall consult with 
 29.23  an independent actuary in establishing prepayment rates, but 
 29.24  shall retain final control over the rate methodology.  
 29.25     (d) Recipients eligible under subdivision 3, paragraph (a), 
 29.26  clause (2), item (i), shall pay the following co-payments for 
 29.27  services provided on or after October 1, 2003: 
 29.28     (1) $3 per nonpreventive visit.  For purposes of this 
 29.29  subdivision, a visit means an episode of service which is 
 29.30  required because of a recipient's symptoms, diagnosis, or 
 29.31  established illness, and which is delivered in an ambulatory 
 29.32  setting by a physician or physician ancillary, chiropractor, 
 29.33  podiatrist, nurse midwife, advanced practice nurse, audiologist, 
 29.34  optician, or optometrist; 
 29.35     (2) $25 for eyeglasses; 
 29.36     (3) $25 for nonemergency visits to a hospital-based 
 30.1   emergency room; and 
 30.2      (4) $3 per brand-name drug prescription and $1 per generic 
 30.3   drug prescription, subject to a $20 per month maximum for 
 30.4   prescription drug co-payments.  No co-payments shall apply to 
 30.5   antipsychotic drugs when used for the treatment of mental 
 30.6   illness; and 
 30.7      (5) 50 percent coinsurance on restorative dental services.  
 30.8      (e) Co-payments shall be limited to one per day per 
 30.9   provider for nonpreventive visits, eyeglasses, and nonemergency 
 30.10  visits to a hospital-based emergency room.  Recipients of 
 30.11  general assistance medical care are responsible for all 
 30.12  co-payments in this subdivision.  The general assistance medical 
 30.13  care reimbursement to the provider shall be reduced by the 
 30.14  amount of the co-payment, except that reimbursement for 
 30.15  prescription drugs shall not be reduced once a recipient has 
 30.16  reached the $20 per month maximum for prescription drug 
 30.17  co-payments.  The provider collects the co-payment from the 
 30.18  recipient.  Providers may not deny services to recipients who 
 30.19  are unable to pay the co-payment, except as provided in 
 30.20  paragraph (f). 
 30.21     (f) If it is the routine business practice of a provider to 
 30.22  refuse service to an individual with uncollected debt, the 
 30.23  provider may include uncollected co-payments under this 
 30.24  section.  A provider must give advance notice to a recipient 
 30.25  with uncollected debt before services can be denied. 
 30.26     (g) Any county may, from its own resources, provide medical 
 30.27  payments for which state payments are not made. 
 30.28     (h) Chemical dependency services that are reimbursed under 
 30.29  chapter 254B must not be reimbursed under general assistance 
 30.30  medical care. 
 30.31     (i) The maximum payment for new vendors enrolled in the 
 30.32  general assistance medical care program after the base year 
 30.33  shall be determined from the average usual and customary charge 
 30.34  of the same vendor type enrolled in the base year. 
 30.35     (j) The conditions of payment for services under this 
 30.36  subdivision are the same as the conditions specified in rules 
 31.1   adopted under chapter 256B governing the medical assistance 
 31.2   program, unless otherwise provided by statute or rule. 
 31.3      (k) Inpatient and outpatient payments shall be reduced by 
 31.4   five percent, effective July 1, 2003.  This reduction is in 
 31.5   addition to the five percent reduction effective July 1, 2003, 
 31.6   and incorporated by reference in paragraph (i).  
 31.7      (l) Payments for all other health services except 
 31.8   inpatient, outpatient, and pharmacy services shall be reduced by 
 31.9   five percent, effective July 1, 2003.  
 31.10     (m) Payments to managed care plans shall be reduced by five 
 31.11  percent for services provided on or after October 1, 2003. 
 31.12     (n) A hospital receiving a reduced payment as a result of 
 31.13  this section may apply the unpaid balance toward satisfaction of 
 31.14  the hospital's bad debts. 
 31.15     Sec. 22.  Minnesota Statutes 2004, section 256L.03, 
 31.16  subdivision 1, is amended to read: 
 31.17     Subdivision 1.  [COVERED HEALTH SERVICES.] For individuals 
 31.18  under section 256L.04, subdivision 7, with income no greater 
 31.19  than 75 percent of the federal poverty guidelines or for 
 31.20  families with children under section 256L.04, subdivision 1, all 
 31.21  subdivisions of this section apply.  "Covered health services" 
 31.22  means the health services reimbursed under chapter 256B, with 
 31.23  the exception of inpatient hospital services, special education 
 31.24  services, private duty nursing services, adult dental care 
 31.25  services other than services except as covered under section 
 31.26  256B.0625, subdivision 9, paragraph (b), orthodontic services 
 31.27  3b, nonemergency medical transportation services, personal care 
 31.28  assistant and case management services, nursing home or 
 31.29  intermediate care facilities services, inpatient mental health 
 31.30  services, and chemical dependency services.  Outpatient mental 
 31.31  health services covered under the MinnesotaCare program are 
 31.32  limited to diagnostic assessments, psychological testing, 
 31.33  explanation of findings, medication management by a physician, 
 31.34  day treatment, partial hospitalization, and individual, family, 
 31.35  and group psychotherapy. 
 31.36     No public funds shall be used for coverage of abortion 
 32.1   under MinnesotaCare except where the life of the female would be 
 32.2   endangered or substantial and irreversible impairment of a major 
 32.3   bodily function would result if the fetus were carried to term; 
 32.4   or where the pregnancy is the result of rape or incest. 
 32.5      Covered health services shall be expanded as provided in 
 32.6   this section. 
 32.7      Sec. 23.  Minnesota Statutes 2004, section 256L.03, is 
 32.8   amended by adding a subdivision to read: 
 32.9      Subd. 3b.  [DENTAL SERVICES EFFECTIVE JULY 1, 2005.] (a) 
 32.10  Effective July 1, 2005, the provisions in paragraphs (b) and (c) 
 32.11  apply. 
 32.12     (b) For parents, grandparents, foster parents, relative 
 32.13  caretakers, and legal guardians eligible under section 256L.04, 
 32.14  subdivision 1, with incomes not exceeding 75 percent of the 
 32.15  federal poverty guidelines, dental services are covered as 
 32.16  provided under section 256B.0625, subdivision 9, except that no 
 32.17  coverage is provided for orthodontic services. 
 32.18     (c) For pregnant women and children under age 21, dental 
 32.19  services are covered as provided under section 256B.0625, 
 32.20  subdivision 9. 
 32.21     Sec. 24.  Minnesota Statutes 2004, section 256L.03, 
 32.22  subdivision 5, is amended to read: 
 32.23     Subd. 5.  [CO-PAYMENTS AND COINSURANCE.] (a) Except as 
 32.24  provided in paragraphs (b) and (c), the MinnesotaCare benefit 
 32.25  plan shall include the following co-payments and coinsurance 
 32.26  requirements for all enrollees:  
 32.27     (1) ten percent of the paid charges for inpatient hospital 
 32.28  services for adult enrollees, subject to an annual inpatient 
 32.29  out-of-pocket maximum of $1,000 per individual and $3,000 per 
 32.30  family; 
 32.31     (2) $3 per prescription for adult enrollees; 
 32.32     (3) $25 for eyeglasses for adult enrollees; and 
 32.33     (4) 50 percent of the fee-for-service rate for adult dental 
 32.34  care services other than preventive care services for persons 
 32.35  eligible under section 256L.04, subdivisions 1 to 7, with income 
 32.36  equal to or less than 175 percent of the federal poverty 
 33.1   guidelines subdivision 3b, paragraph (b). 
 33.2      (b) Paragraph (a), clause (1), does not apply to parents 
 33.3   and relative caretakers of children under the age of 21 in 
 33.4   households with family income equal to or less than 175 percent 
 33.5   of the federal poverty guidelines.  Paragraph (a), clause (1), 
 33.6   does not apply to parents and relative caretakers of children 
 33.7   under the age of 21 in households with family income greater 
 33.8   than 175 percent of the federal poverty guidelines for inpatient 
 33.9   hospital admissions occurring on or after January 1, 2001.  
 33.10     (c) Paragraph (a), clauses (1) to (4), do not apply to 
 33.11  pregnant women and children under the age of 21.  
 33.12     (d) Adult enrollees with family gross income that exceeds 
 33.13  175 percent of the federal poverty guidelines and who are not 
 33.14  pregnant shall be financially responsible for the coinsurance 
 33.15  amount, if applicable, and amounts which exceed the $10,000 
 33.16  inpatient hospital benefit limit. 
 33.17     (e) When a MinnesotaCare enrollee becomes a member of a 
 33.18  prepaid health plan, or changes from one prepaid health plan to 
 33.19  another during a calendar year, any charges submitted towards 
 33.20  the $10,000 annual inpatient benefit limit, and any 
 33.21  out-of-pocket expenses incurred by the enrollee for inpatient 
 33.22  services, that were submitted or incurred prior to enrollment, 
 33.23  or prior to the change in health plans, shall be disregarded. 
 33.24     Sec. 25.  [FEDERAL APPROVAL.] 
 33.25     By August 1, 2005, the commissioner of human services shall 
 33.26  request any federal approval and plan amendments necessary to 
 33.27  implement (1) the transitional supports allowance under 
 33.28  Minnesota Statutes, sections 256B.0916, subdivision 10; and 
 33.29  256B.49, subdivision 16; and (2) the choice of case management 
 33.30  service coordination provisions under Minnesota Statutes, 
 33.31  sections 256B.0621, subdivision 4; 256B.092, subdivisions 2a and 
 33.32  4b; and 256B.49, subdivision 13. 
 33.33     Sec. 26.  [DENTAL ACCESS FOR PERSONS WITH DISABILITIES.] 
 33.34     The commissioner of human services shall study access to 
 33.35  dental services for persons with disabilities, and shall present 
 33.36  recommendations for improving access to dental services to the 
 34.1   legislature by January 15, 2006.  The study must examine 
 34.2   physical and geographic access, the willingness of dentists to 
 34.3   serve persons with disabilities enrolled in state health care 
 34.4   programs, reimbursement rates for dental service providers, and 
 34.5   other factors identified by the commissioner as potential 
 34.6   barriers to accessing dental services.