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 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.15 	Section 1. Minnesota Statutes 2004, section 252.27,
1.16 	subdivision 2a, is amended to read:
1.17 		Subd. 2a.Contribution amount.  (a) The natural or
1.18 	adoptive parents of a minor child, including a child determined
1.19 	eligible for medical assistance without consideration of
1.20 	parental income, must contribute to the cost of services used by
1.21 	making monthly payments on a sliding scale based on income,
1.22 	unless the child is married or has been married, parental rights
1.23 	have been terminated, or the child's adoption is subsidized
1.24 	according to section 259.67 or through title IV-E of the Social
1.25 	Security Act.
1.26 	(b) For households with adjusted gross income equal to or
1.27 	greater than 100 percent of federal poverty guidelines, the
1.28 	parental contribution shall be computed by applying the
1.29 	following schedule of rates to the adjusted gross income of the
2.1 	natural or adoptive parents:
2.2 	(1) if the adjusted gross income is equal to or greater
2.3 	than 100 percent of federal poverty guidelines and less than 175
2.4 	percent of federal poverty guidelines, the parental contribution
2.5 	is $4 per month;
2.6 	(2) if the adjusted gross income is equal to or greater
2.7 	than 175 percent of federal poverty guidelines and less than or
2.8 	equal to 375 545 percent of federal poverty guidelines, the
2.9 	parental contribution shall be determined using a sliding fee
2.10 	scale established by the commissioner of human services which
2.11 	begins at one percent of adjusted gross income at 175 percent of
2.12 	federal poverty guidelines and increases to 7.5 percent of
2.13 	adjusted gross income for those with adjusted gross income up to
2.14 	375 545 percent of federal poverty guidelines;
2.15 	(3) if the adjusted gross income is greater than 375 545 
2.16 	percent of federal poverty guidelines and less than 675 percent
2.17 	of federal poverty guidelines, the parental contribution shall
2.18 	be 7.5 percent of adjusted gross income;
2.19 	(4) if the adjusted gross income is equal to or greater
2.20 	than 675 percent of federal poverty guidelines and less than 975
2.21 	percent of federal poverty guidelines, the parental contribution
2.22 	shall be determined using a sliding fee scale established by the
2.23 	commissioner of human services which begins at 7.5 percent of
2.24 	adjusted gross income at 675 percent of federal poverty
2.25 	guidelines and increases to ten percent of adjusted gross income
2.26 	for those with adjusted gross income up to 975 percent of
2.27 	federal poverty guidelines; and
2.28 	(5) if the adjusted gross income is equal to or greater
2.29 	than 975 percent of federal poverty guidelines, the parental
2.30 	contribution shall be 12.5 percent of adjusted gross income.
2.31 	If the child lives with the parent, the annual adjusted
2.32 	gross income is reduced by $2,400 prior to calculating the
2.33 	parental contribution.  If the child resides in an institution
2.34 	specified in section 256B.35, the parent is responsible for the
2.35 	personal needs allowance specified under that section in
2.36 	addition to the parental contribution determined under this
3.1 	section.  The parental contribution is reduced by any amount
3.2 	required to be paid directly to the child pursuant to a court
3.3 	order, but only if actually paid.
3.4 	(c) The household size to be used in determining the amount
3.5 	of contribution under paragraph (b) includes natural and
3.6 	adoptive parents and their dependents, including the child
3.7 	receiving services.  Adjustments in the contribution amount due
3.8 	to annual changes in the federal poverty guidelines shall be
3.9 	implemented on the first day of July following publication of
3.10 	the changes.
3.11 	(d) For purposes of paragraph (b), "income" means the
3.12 	adjusted gross income of the natural or adoptive parents
3.13 	determined according to the previous year's federal tax form,
3.14 	except, effective retroactive to July 1, 2003, taxable capital
3.15 	gains to the extent the funds have been used to purchase a home
3.16 	shall not be counted as income.
3.17 	(e) The contribution shall be explained in writing to the
3.18 	parents at the time eligibility for services is being
3.19 	determined.  The contribution shall be made on a monthly basis
3.20 	effective with the first month in which the child receives
3.21 	services.  Annually upon redetermination or at termination of
3.22 	eligibility, if the contribution exceeded the cost of services
3.23 	provided, the local agency or the state shall reimburse that
3.24 	excess amount to the parents, either by direct reimbursement if
3.25 	the parent is no longer required to pay a contribution, or by a
3.26 	reduction in or waiver of parental fees until the excess amount
3.27 	is exhausted.
3.28 	(f) The monthly contribution amount must be reviewed at
3.29 	least every 12 months; when there is a change in household size;
3.30 	and when there is a loss of or gain in income from one month to
3.31 	another in excess of ten percent.  The local agency shall mail a
3.32 	written notice 30 days in advance of the effective date of a
3.33 	change in the contribution amount.  A decrease in the
3.34 	contribution amount is effective in the month that the parent
3.35 	verifies a reduction in income or change in household size.
3.36 	(g) Parents of a minor child who do not live with each
4.1 	other shall each pay the contribution required under paragraph
4.2 	(a).  An amount equal to the annual court-ordered child support
4.3 	payment actually paid on behalf of the child receiving services
4.4 	shall be deducted from the adjusted gross income of the parent
4.5 	making the payment prior to calculating the parental
4.6 	contribution under paragraph (b).
4.7 	(h) The contribution under paragraph (b) shall be increased
4.8 	by an additional five percent if the local agency determines
4.9 	that insurance coverage is available but not obtained for the
4.10 	child.  For purposes of this section, "available" means the
4.11 	insurance is a benefit of employment for a family member at an
4.12 	annual cost of no more than five percent of the family's annual
4.13 	income.  For purposes of this section, "insurance" means health
4.14 	and accident insurance coverage, enrollment in a nonprofit
4.15 	health service plan, health maintenance organization,
4.16 	self-insured plan, or preferred provider organization.
4.17 	Parents who have more than one child receiving services
4.18 	shall not be required to pay more than the amount for the child
4.19 	with the highest expenditures.  There shall be no resource
4.20 	contribution from the parents.  The parent shall not be required
4.21 	to pay a contribution in excess of the cost of the services
4.22 	provided to the child, not counting payments made to school
4.23 	districts for education-related services.  Notice of an increase
4.24 	in fee payment must be given at least 30 days before the
4.25 	increased fee is due.
4.26 	(i) The contribution under paragraph (b) shall be reduced
4.27 	by $300 per fiscal year if, in the 12 months prior to July 1:
4.28 	(1) the parent applied for insurance for the child;
4.29 	(2) the insurer denied insurance;
4.30 	(3) the parents submitted a complaint or appeal, in writing
4.31 	to the insurer, submitted a complaint or appeal, in writing, to
4.32 	the commissioner of health or the commissioner of commerce, or
4.33 	litigated the complaint or appeal; and
4.34 	(4) as a result of the dispute, the insurer reversed its
4.35 	decision and granted insurance.
4.36 	For purposes of this section, "insurance" has the meaning
5.1 	given in paragraph (h).
5.2 	A parent who has requested a reduction in the contribution
5.3 	amount under this paragraph shall submit proof in the form and
5.4 	manner prescribed by the commissioner or county agency,
5.5 	including, but not limited to, the insurer's denial of
5.6 	insurance, the written letter or complaint of the parents, court
5.7 	documents, and the written response of the insurer approving
5.8 	insurance.  The determinations of the commissioner or county
5.9 	agency under this paragraph are not rules subject to chapter 14.

5.10 	Sec. 2. Minnesota Statutes 2004, section 256B.04, is
5.11 	amended by adding a subdivision to read:
5.12 		Subd. 20.Incentive for wellness visits. The
5.13 	commissioner of human services shall consult with private sector
5.14 	health plan companies and shall develop an incentive program to
5.15 	encourage medical assistance enrollees with disabilities to have
5.16 	regular wellness exams conducted by a primary care physician.
5.17 	The commissioner shall implement the incentive program beginning
5.18 	January 1, 2006.

5.19 	Sec. 3. Minnesota Statutes 2004, section 256B.056,
5.20 	subdivision 3, is amended to read:
5.21 		Subd. 3.Asset limitations for individuals and
5.22 	families the aged, blind, or disabled.  To be eligible for
5.23 	medical assistance, a person eligible under section 256B.055,
5.24 	subdivision 7, 7a, or 12 must not individually own more
5.25 	than $3,000 $10,000 in assets, or if a member of a household
5.26 	with two family members, husband and wife, or parent and
5.27 	child or more persons, the household must not own more
5.28 	than $6,000 $18,000 in assets, plus $200 for each additional
5.29 	legal dependent.  In addition to these maximum amounts, an
5.30 	eligible individual or family may accrue interest on these
5.31 	amounts, but they must be reduced to the maximum at the time of
5.32 	an eligibility redetermination.  The accumulation of the
5.33 	clothing and personal needs allowance according to section
5.34 	256B.35 must also be reduced to the maximum at the time of the
5.35 	eligibility redetermination.  The value of assets that are not
5.36 	considered in determining eligibility for medical assistance is
6.1 	the value of those assets excluded under the supplemental
6.2 	security income program for aged, blind, and disabled persons,
6.3 	with the following exceptions:
6.4 	(a) Household goods and personal effects are not considered.
6.5 	(b) Capital and operating assets of a trade or business
6.6 	that the local agency determines are necessary to the person's
6.7 	ability to earn an income are not considered.
6.8 	(c) Motor vehicles are excluded to the same extent excluded
6.9 	by the supplemental security income program.
6.10 	(d) Assets designated as burial expenses are excluded to
6.11 	the same extent excluded by the supplemental security income
6.12 	program.  Burial expenses funded by annuity contracts or life
6.13 	insurance policies must irrevocably designate the individual's
6.14 	estate as contingent beneficiary to the extent proceeds are not
6.15 	used for payment of selected burial expenses.
6.16 	(e) Effective upon federal approval, for a person who no
6.17 	longer qualifies as an employed person with a disability due to
6.18 	loss of earnings, assets allowed while eligible for medical
6.19 	assistance under section 256B.057, subdivision 9, are not
6.20 	considered for 12 months, beginning with the first month of
6.21 	ineligibility as an employed person with a disability, to the
6.22 	extent that the person's total assets remain within the allowed
6.23 	limits of section 256B.057, subdivision 9, paragraph (b).

6.24 	Sec. 4. Minnesota Statutes 2004, section 256B.056,
6.25 	subdivision 5c, is amended to read:
6.26 		Subd. 5c.Excess income standard.  (a) The excess income
6.27 	standard for families with children is the standard specified in
6.28 	subdivision 4.
6.29 	(b) The excess income standard for a person whose
6.30 	eligibility is based on blindness, disability, or age of 65 or
6.31 	more years is 70 100 percent of the federal poverty guidelines
6.32 	for the family size. Effective July 1, 2002, the excess income
6.33 	standard for this paragraph shall equal 75 percent of the
6.34 	federal poverty guidelines.

6.35 	Sec. 5. Minnesota Statutes 2004, section 256B.057,
6.36 	subdivision 9, is amended to read:
7.1 		Subd. 9.Employed persons with disabilities.  (a) Medical
7.2 	assistance may be paid for a person who is employed and who:
7.3 	(1) meets the definition of disabled under the supplemental
7.4 	security income program;
7.5 	(2) is at least 16 but less than 65 years of age;
7.6 	(3) meets the asset limits in paragraph (b); and
7.7 	(4) effective November 1, 2003, pays a premium and other
7.8 	obligations under paragraph (d).
7.9 	Any spousal income or assets shall be disregarded for purposes
7.10 	of eligibility and premium determinations.
7.11 	After the month of enrollment, a person enrolled in medical
7.12 	assistance under this subdivision who:
7.13 	(1) is temporarily unable to work and without receipt of
7.14 	earned income due to a medical condition, as verified by a
7.15 	physician, may retain eligibility for up to four calendar
7.16 	months; or
7.17 	(2) effective January 1, 2004, loses employment for reasons
7.18 	not attributable to the enrollee, may retain eligibility for up
7.19 	to four consecutive months after the month of job loss.  To
7.20 	receive a four-month extension, enrollees must verify the
7.21 	medical condition or provide notification of job loss.  All
7.22 	other eligibility requirements must be met and the enrollee must
7.23 	pay all calculated premium costs for continued eligibility.
7.24 	(b) For purposes of determining eligibility under this
7.25 	subdivision, a person's assets must not exceed $20,000,
7.26 	excluding:
7.27 	(1) all assets excluded under section 256B.056;
7.28 	(2) retirement accounts, including individual accounts,
7.29 	401(k) plans, 403(b) plans, Keogh plans, and pension plans; and
7.30 	(3) medical expense accounts set up through the person's
7.31 	employer.
7.32 	(c)(1) Effective January 1, 2004, for purposes of
7.33 	eligibility, there will be a $65 earned income disregard.  To be
7.34 	eligible, a person applying for medical assistance under this
7.35 	subdivision must have earned income above the disregard level.
7.36 	(2) Effective January 1, 2004, to be considered earned
8.1 	income, Medicare, Social Security, and applicable state and
8.2 	federal income taxes must be withheld.  To be eligible, a person
8.3 	must document earned income tax withholding.
8.4 	(d)(1) A person whose earned and unearned income is equal
8.5 	to or greater than 100 percent of federal poverty guidelines for
8.6 	the applicable family size must pay a premium to be eligible for
8.7 	medical assistance under this subdivision.  The premium shall be
8.8 	based on the person's gross earned and unearned income and the
8.9 	applicable family size using a sliding fee scale established by
8.10 	the commissioner, which begins at one percent of income at 100
8.11 	percent of the federal poverty guidelines and increases to 7.5
8.12 	percent of income for those with incomes at or above 300 percent
8.13 	of the federal poverty guidelines.  Annual adjustments in the
8.14 	premium schedule based upon changes in the federal poverty
8.15 	guidelines shall be effective for premiums due in July of each
8.16 	year.
8.17 	(2) Effective January 1, 2004, all enrollees must pay a
8.18 	premium to be eligible for medical assistance under this
8.19 	subdivision.  An enrollee shall pay the greater of a $35 premium
8.20 	or the premium calculated in clause (1).
8.21 	(3) Effective November 1, 2003, all enrollees who receive
8.22 	unearned income must pay one-half of one percent of unearned
8.23 	income in addition to the premium amount.
8.24 	(4) Effective November 1, 2003 July 1, 2005, for
8.25 	enrollees whose income does not exceed 200 percent of the
8.26 	federal poverty guidelines and who are also enrolled in
8.27 	Medicare, the commissioner must reimburse the enrollee for
8.28 	Medicare Part B premiums under section 256B.0625, subdivision
8.29 	15, paragraph (a).
8.30 	(5) Increases in benefits under title II of the Social
8.31 	Security Act shall not be counted as income for purposes of this
8.32 	subdivision until July 1 of each year.
8.33 	(e) A person's eligibility and premium shall be determined
8.34 	by the local county agency.  Premiums must be paid to the
8.35 	commissioner.  All premiums are dedicated to the commissioner.
8.36 	(f) Any required premium shall be determined at application
9.1 	and redetermined at the enrollee's six-month income review or
9.2 	when a change in income or household size is reported.
9.3 	Enrollees must report any change in income or household size
9.4 	within ten days of when the change occurs.  A decreased premium
9.5 	resulting from a reported change in income or household size
9.6 	shall be effective the first day of the next available billing
9.7 	month after the change is reported.  Except for changes
9.8 	occurring from annual cost-of-living increases, a change
9.9 	resulting in an increased premium shall not affect the premium
9.10 	amount until the next six-month review.
9.11 	(g) Premium payment is due upon notification from the
9.12 	commissioner of the premium amount required.  Premiums may be
9.13 	paid in installments at the discretion of the commissioner.
9.14 	(h) Nonpayment of the premium shall result in denial or
9.15 	termination of medical assistance unless the person demonstrates
9.16 	good cause for nonpayment.  Good cause exists if the
9.17 	requirements specified in Minnesota Rules, part 9506.0040,
9.18 	subpart 7, items B to D, are met.  Except when an installment
9.19 	agreement is accepted by the commissioner, all persons
9.20 	disenrolled for nonpayment of a premium must pay any past due
9.21 	premiums as well as current premiums due prior to being
9.22 	reenrolled.  Nonpayment shall include payment with a returned,
9.23 	refused, or dishonored instrument.  The commissioner may require
9.24 	a guaranteed form of payment as the only means to replace a
9.25 	returned, refused, or dishonored instrument.

9.26 	Sec. 6. Minnesota Statutes 2004, section 256B.0575, is
9.27 	amended to read:
9.28 	256B.0575 AVAILABILITY OF INCOME FOR INSTITUTIONALIZED
9.29 	PERSONS.
9.30 	When an institutionalized person is determined eligible for
9.31 	medical assistance, the income that exceeds the deductions in
9.32 	paragraphs (a) and (b) must be applied to the cost of
9.33 	institutional care.
9.34 	(a) The following amounts must be deducted from the
9.35 	institutionalized person's income in the following order:
9.36 	(1) the personal needs allowance under section 256B.35 or,
10.1 	for a veteran who does not have a spouse or child, or a
10.2 	surviving spouse of a veteran having no child, the amount of an
10.3 	improved pension received from the veteran's administration not
10.4 	exceeding $90 per month;
10.5 	(2) the personal allowance for disabled individuals under
10.6 	section 256B.36;
10.7 	(3) if the institutionalized person has a legally appointed
10.8 	guardian or conservator, five percent of the recipient's gross
10.9 	monthly income up to $100 as reimbursement for guardianship or
10.10 	conservatorship services;
10.11 	(4) a monthly income allowance determined under section
10.12 	256B.058, subdivision 2, but only to the extent income of the
10.13 	institutionalized spouse is made available to the community
10.14 	spouse;
10.15 	(5) a monthly allowance for children under age 18 which,
10.16 	together with the net income of the children, would provide
10.17 	income equal to the medical assistance standard for families and
10.18 	children according to section 256B.056, subdivision 4, for a
10.19 	family size that includes only the minor children.  This
10.20 	deduction applies only if the children do not live with the
10.21 	community spouse and only to the extent that the deduction is
10.22 	not included in the personal needs allowance under section
10.23 	256B.35, subdivision 1, as child support garnished under a court
10.24 	order;
10.25 	(6) a monthly family allowance for other family members,
10.26 	equal to one-third of the difference between 122 percent of the
10.27 	federal poverty guidelines and the monthly income for that
10.28 	family member;
10.29 	(7) reparations payments made by the Federal Republic of
10.30 	Germany and reparations payments made by the Netherlands for
10.31 	victims of Nazi persecution between 1940 and 1945;
10.32 	(8) all other exclusions from income for institutionalized
10.33 	persons as mandated by federal law; and
10.34 	(9) amounts for reasonable expenses incurred for necessary
10.35 	medical or remedial care for the institutionalized person that
10.36 	are not medical assistance covered expenses and that are not
11.1 	subject to payment by a third party.
11.2 	For purposes of clause (6), "other family member" means a
11.3 	person who resides with the community spouse and who is a minor
11.4 	or dependent child, dependent parent, or dependent sibling of
11.5 	either spouse.  "Dependent" means a person who could be claimed
11.6 	as a dependent for federal income tax purposes under the
11.7 	Internal Revenue Code.
11.8 	(b) Income shall be allocated to an institutionalized
11.9 	person for a period of up to three six calendar months, in an
11.10 	amount equal to 100 percent of the medical assistance standard 
11.11 	federal poverty guidelines for a family size of one if:
11.12 	(1) a physician certifies that the person is expected to
11.13 	reside in the long-term care facility for three six calendar
11.14 	months or less;
11.15 	(2) if the person has expenses of maintaining a residence
11.16 	in the community; and
11.17 	(3) if one of the following circumstances apply:
11.18 	(i) the person was not living together with a spouse or a
11.19 	family member as defined in paragraph (a) when the person
11.20 	entered a long-term care facility; or
11.21 	(ii) the person and the person's spouse become
11.22 	institutionalized on the same date, in which case the allocation
11.23 	shall be applied to the income of one of the spouses.
11.24 	For purposes of this paragraph, a person is determined to be
11.25 	residing in a licensed nursing home, regional treatment center,
11.26 	or medical institution if the person is expected to remain for a
11.27 	period of one full calendar month or more.

11.28 	Sec. 7. Minnesota Statutes 2004, section 256B.0621,
11.29 	subdivision 4, is amended to read:
11.30 		Subd. 4.Relocation targeted case management provider
11.31 	qualifications.  (a) A relocation targeted case management
11.32 	provider is an enrolled medical assistance provider who is
11.33 	determined by the commissioner to have all of the following
11.34 	characteristics:
11.35 	(1) the legal authority to provide public welfare under
11.36 	sections 393.01, subdivision 7; and 393.07; or a federally
12.1 	recognized Indian tribe;
12.2 	(2) the demonstrated capacity and experience to provide the
12.3 	components of case management to coordinate and link community
12.4 	resources needed by the eligible population;
12.5 	(3) the administrative capacity and experience to serve the
12.6 	target population for whom it will provide services and ensure
12.7 	quality of services under state and federal requirements;
12.8 	(4) the legal authority to provide complete investigative
12.9 	and protective services under section 626.556, subdivision 10;
12.10 	and child welfare and foster care services under section 393.07,
12.11 	subdivisions 1 and 2; or a federally recognized Indian tribe;
12.12 	(5) a financial management system that provides accurate
12.13 	documentation of services and costs under state and federal
12.14 	requirements; and
12.15 	(6) the capacity to document and maintain individual case
12.16 	records under state and federal requirements.
12.17 	(b) The commissioner shall ensure that each eligible person
12.18 	is given a choice of county and private agency relocation
12.19 	targeted case management service providers.
12.20 	(c) A provider of targeted case management under section
12.21 	256B.0625, subdivision 20, may be deemed a certified provider of
12.22 	relocation targeted case management.
12.23 	(c) (d) A relocation targeted case management provider may
12.24 	subcontract with another provider to deliver relocation targeted
12.25 	case management services.  Subcontracted providers must
12.26 	demonstrate the ability to provide the services outlined in
12.27 	subdivision 6, and have a procedure in place that notifies 
12.28 	provides full disclosure to the recipient and the recipient's
12.29 	legal representative of any conflict of interest if the
12.30 	contracted targeted case management provider also provides, or
12.31 	will provide, the recipient's housing,services and , or 
12.32 	supports.  Contracted providers must provide information on all
12.33 	conflicts of interest and obtain the recipient's informed
12.34 	consent or provide the recipient with alternatives.
12.35 	
EFFECTIVE DATE. This section is effective July 1, 2005,
12.36 	or, if a federal waiver is required, on the date the federal
13.1 	waiver is granted.

13.2 	Sec. 8. Minnesota Statutes 2004, section 256B.0621,
13.3 	subdivision 6, is amended to read:
13.4 		Subd. 6.Eligible services. (a) Services eligible for
13.5 	medical assistance reimbursement as targeted case management
13.6 	service coordination include:
13.7 	(1) assessment of the recipient's need for targeted case
13.8 	management services;
13.9 	(2) development, completion, and regular review of a
13.10 	written individual service plan, which is based upon the
13.11 	assessment of the recipient's needs and choices, and which will
13.12 	ensure access to medical, social, educational, and other related
13.13 	services and supports;
13.14 	(3) (2) routine contact or communication with the
13.15 	recipient, recipient's family, primary caregiver, legal
13.16 	representative, substitute care provider, service providers, or
13.17 	other relevant persons identified as necessary to the
13.18 	development or implementation of the goals of the individual
13.19 	service plan;
13.20 	(4) (3) coordinating referrals for, and the provision of,
13.21 	case management services for the recipient with appropriate
13.22 	service providers, consistent with section 1902(a)(23) of the
13.23 	Social Security Act;
13.24 	(5) (4) coordinating and monitoring the overall service
13.25 	delivery to ensure quality of services, appropriateness, and
13.26 	continued need;
13.27 	(6) (5) completing and maintaining necessary documentation
13.28 	that supports and verifies the activities in this subdivision;
13.29 	(7) (6) traveling to conduct a visit with the recipient or
13.30 	other relevant person necessary to develop or implement the
13.31 	goals of the individual service plan; and
13.32 	(8) (7) coordinating with the institution discharge planner
13.33 	in the 180-day period before the recipient's discharge.
13.34 	(b) Targeted relocation case management administrative
13.35 	activities are the responsibility of the county or the agency
13.36 	under contract.  Targeted relocation case management
14.1 	administrative activities include:
14.2 	(1) assessment of the recipient's need for targeted case
14.3 	management services;
14.4 	(2) eligibility determination;
14.5 	(3) providing information and assistance to the recipient
14.6 	or their legal representative sufficient to allow the recipient
14.7 	to choose a provider of targeted case management services;
14.8 	(4) approval of service plans and necessary contracts; and 
14.9 	(5) monitoring spending and evaluating health, safety,
14.10 	welfare, and service outcomes.

14.11 	Sec. 9. Minnesota Statutes 2004, section 256B.0621, is
14.12 	amended by adding a subdivision to read:
14.13 		Subd. 11.Notice of relocation targeted case management
14.14 	availability. Upon admission and annually thereafter, the
14.15 	commissioner shall provide notification to medical assistance
14.16 	eligible persons who are residing in institutions of the
14.17 	availability of relocation targeted case management services.

14.18 	Sec. 10. Minnesota Statutes 2004, section 256B.0625,
14.19 	subdivision 9, is amended to read:
14.20 		Subd. 9.Dental services. (a) Medical assistance covers
14.21 	dental services.  Dental services include, with prior
14.22 	authorization, fixed bridges that are cost-effective for persons
14.23 	who cannot use removable dentures because of their medical
14.24 	condition.
14.25 	(b) Coverage of dental services for adults age 21 and over
14.26 	who are not pregnant is subject to a $500 annual benefit limit
14.27 	and covered services are limited to:
14.28 	(1) diagnostic and preventative services;
14.29 	(2) restorative services; and 
14.30 	(3) emergency services.
14.31 	Emergency services, dentures, and extractions related to
14.32 	dentures are not included in the $500 annual benefit limit.

14.33 	Sec. 11. Minnesota Statutes 2004, section 256B.0916, is
14.34 	amended by adding a subdivision to read:
14.35 		Subd. 10.Transitional supports allowance. A
14.36 	transitional supports allowance shall be available to all
15.1 	persons under a home and community-based waiver who are moving
15.2 	from a licensed setting to a community setting.  "Transitional
15.3 	supports allowance" means a onetime payment of up to $3,000, to
15.4 	cover the costs, not covered by other sources, associated with
15.5 	moving from a licensed setting to a community setting.  Covered
15.6 	costs include:
15.7 	(1) lease or rent deposits;
15.8 	(2) security deposits;
15.9 	(3) utilities set-up costs, including telephone;
15.10 	(4) essential furnishings and supplies; and 
15.11 	(5) personal supports and transports needed to locate and
15.12 	transition to community settings.
15.13 	
EFFECTIVE DATE. This section is effective upon federal
15.14 	approval and to the extent approved as a federal waiver
15.15 	amendment.

15.16 	Sec. 12. Minnesota Statutes 2004, section 256B.092,
15.17 	subdivision 2a, is amended to read:
15.18 		Subd. 2a.Medical assistance for case management
15.19 	activities under the state plan medicaid option. (a) Upon
15.20 	receipt of federal approval, the commissioner shall make
15.21 	payments to approved vendors of case management services
15.22 	participating in the medical assistance program to reimburse
15.23 	costs for providing case management service activities to
15.24 	medical assistance eligible persons with mental retardation or a
15.25 	related condition, in accordance with the state Medicaid plan
15.26 	and federal requirements and limitations.
15.27 	(b) The commissioner shall ensure that each eligible person
15.28 	is given a choice of county and private agency case management
15.29 	service coordination vendors.
15.30 	(c) The commissioner shall, with consumer input, develop
15.31 	standards, notice requirements, and basic consumer rights so
15.32 	that full disclosure is provided in cases in which a case
15.33 	manager may be providing relocation services, housing, or other
15.34 	support services to the same individual.
15.35 	
EFFECTIVE DATE. This section is effective July 1, 2005,
15.36 	or, if a federal waiver is required, on the date the federal
16.1 	waiver is granted.

16.2 	Sec. 13. Minnesota Statutes 2004, section 256B.092,
16.3 	subdivision 4b, is amended to read:
16.4 		Subd. 4b.Case management for persons receiving home and
16.5 	community-based services. (a) Persons authorized for and
16.6 	receiving home and community-based services may select from
16.7 	public and private vendors of case management which have
16.8 	provider agreements with the state to provide home and
16.9 	community-based case management service activities. This
16.10 	subdivision becomes effective July 1, 1992, only if the state
16.11 	agency is unable to secure federal approval for limiting choice
16.12 	of case management vendors to the county of financial
16.13 	responsibility.
16.14 	(b) The commissioner shall ensure that each eligible person
16.15 	is given a choice of county and private agency case management
16.16 	service coordination vendors.
16.17 	(c) The commissioner shall, with consumer input, develop
16.18 	standards, notice requirements, and basic consumer rights so
16.19 	that full disclosure is provided in cases in which a case
16.20 	manager may be providing relocation services, housing, or other
16.21 	support services to the same individual.
16.22 	
EFFECTIVE DATE. This section is effective July 1, 2005,
16.23 	or, if a federal waiver is required, on the date the federal
16.24 	waiver is granted.

16.25 	Sec. 14. Minnesota Statutes 2004, section 256B.35,
16.26 	subdivision 1, is amended to read:
16.27 		Subdivision 1.Personal needs allowance.  (a)
16.28 	Notwithstanding any law to the contrary, welfare allowances for
16.29 	clothing and personal needs for individuals receiving medical
16.30 	assistance while residing in any skilled nursing home,
16.31 	intermediate care facility, or medical institution including
16.32 	recipients of supplemental security income, in this state shall
16.33 	not be less than $45 $150 per month from all sources.  When
16.34 	benefit amounts for Social Security or supplemental security
16.35 	income recipients are increased pursuant to United States Code,
16.36 	title 42, sections 415(i) and 1382f, the commissioner shall,
17.1 	effective in the month in which the increase takes effect,
17.2 	increase by the same percentage to the nearest whole dollar the
17.3 	clothing and personal needs allowance for individuals receiving
17.4 	medical assistance while residing in any skilled nursing home,
17.5 	medical institution, or intermediate care facility.  The
17.6 	commissioner shall provide timely notice to local agencies,
17.7 	providers, and recipients of increases under this provision.
17.8 	(b) The personal needs allowance may be paid as part of the
17.9 	Minnesota supplemental aid program, notwithstanding the
17.10 	provisions of section 256D.37, subdivision 2, and payments to
17.11 	recipients of Minnesota supplemental aid may be made once each
17.12 	three months covering liabilities that accrued during the
17.13 	preceding three months.
17.14 	(c) The personal needs allowance shall be increased to
17.15 	include income garnished for child support under a court order,
17.16 	up to a maximum of $250 per month but only to the extent that
17.17 	the amount garnished is not deducted as a monthly allowance for
17.18 	children under section 256B.0575, paragraph (a), clause (5).

17.19 	Sec. 15. Minnesota Statutes 2004, section 256B.49,
17.20 	subdivision 13, is amended to read:
17.21 		Subd. 13.Case management service coordination and
17.22 	administrative activities.  (a) Each recipient of a home and
17.23 	community-based waiver shall be provided choose a vendor of case
17.24 	management services by service coordination from among qualified
17.25 	public and private vendors as described in the federally
17.26 	approved waiver application.  The case management
17.27 	service coordination activities provided will include:
17.28 	(1) assessing the needs of the individual within 20 working
17.29 	days of a recipient's request as changes occur, but at least
17.30 	annually;
17.31 	(2) developing the written individual service plan within
17.32 	ten working days after the assessment is completed;
17.33 	(3) informing the recipient or the recipient's legal
17.34 	guardian or conservator of service options;
17.35 	(4) assisting the recipient in the identification of
17.36 	potential service providers;
18.1 	(5) assisting the recipient to access services;
18.2 	(6) coordinating, evaluating, and monitoring of the
18.3 	services identified in the service plan;
18.4 	(7) completing the annual reviews of the service plan; and
18.5 	(8) informing the recipient or legal representative of the
18.6 	right to have assessments completed and service plans developed
18.7 	within specified time periods, and to appeal county action or
18.8 	inaction under section 256.045, subdivision 3.
18.9 	(b) Case management administrative activities are the
18.10 	responsibility of the county or agency under contract.  Case
18.11 	management administrative functions include:
18.12 	(1) screening;
18.13 	(2) assistance with obtaining diagnoses and necessary
18.14 	medical or health reports;
18.15 	(3) eligibility determination;
18.16 	(4) initial assessment within 20 days of a request for
18.17 	waiver services;
18.18 	(5) providing information and assistance to the person or
18.19 	their legal representative sufficient to allow the person to
18.20 	choose a vendor of case management service coordination;
18.21 	(6) determination of resources needed to meet assessed
18.22 	needs;
18.23 	(7) approval of service plans and necessary contracts; and 
18.24 	(8) monitoring spending and evaluating health, safety,
18.25 	welfare, and service outcomes.
18.26 	(c) The case manager may delegate certain aspects of the
18.27 	case management service activities to another individual
18.28 	provided there is oversight by the case manager.  The case
18.29 	manager may not delegate those aspects which require
18.30 	professional judgment including assessments, reassessments, and
18.31 	care plan development.
18.32 	
EFFECTIVE DATE. This section is effective July 1, 2005,
18.33 	or, if a federal waiver is required, on the date the federal
18.34 	waiver is granted.

18.35 	Sec. 16. Minnesota Statutes 2004, section 256B.49,
18.36 	subdivision 16, is amended to read:
19.1 		Subd. 16.Services and supports.  (a) Services and
19.2 	supports included in the home and community-based waivers for
19.3 	persons with disabilities shall meet the requirements set out in
19.4 	United States Code, title 42, section 1396n.  The services and
19.5 	supports, which are offered as alternatives to institutional
19.6 	care, shall promote consumer choice, community inclusion,
19.7 	self-sufficiency, and self-determination.
19.8 	(b) Beginning January 1, 2003, the commissioner shall
19.9 	simplify and improve access to home and community-based waivered
19.10 	services, to the extent possible, through the establishment of a
19.11 	common service menu that is available to eligible recipients
19.12 	regardless of age, disability type, or waiver program.
19.13 	(c) Consumer directed community support services shall be
19.14 	offered as an option to all persons eligible for services under
19.15 	subdivision 11, by January 1, 2002.
19.16 	(d) Services and supports shall be arranged and provided
19.17 	consistent with individualized written plans of care for
19.18 	eligible waiver recipients.
19.19 	(e) A transitional supports allowance shall be available to
19.20 	all persons under a home and community-based waiver who are
19.21 	moving from a licensed setting to a community setting.
19.22 	"Transitional supports allowance" means a onetime payment of up
19.23 	to $3,000, to cover the costs, not covered by other sources,
19.24 	associated with moving from a licensed setting to a community
19.25 	setting.  Covered costs include:
19.26 	(1) lease or rent deposits;
19.27 	(2) security deposits;
19.28 	(3) utilities set-up costs, including telephone;
19.29 	(4) essential furnishings and supplies; and 
19.30 	(5) personal supports and transports needed to locate and
19.31 	transition to community settings.
19.32 	(f) The state of Minnesota and county agencies that
19.33 	administer home and community-based waivered services for
19.34 	persons with disabilities, shall not be liable for damages,
19.35 	injuries, or liabilities sustained through the purchase of
19.36 	supports by the individual, the individual's family, legal
20.1 	representative, or the authorized representative with funds
20.2 	received through the consumer-directed community support service
20.3 	under this section.  Liabilities include but are not limited
20.4 	to:  workers' compensation liability, the Federal Insurance
20.5 	Contributions Act (FICA), or the Federal Unemployment Tax Act
20.6 	(FUTA).
20.7 	
EFFECTIVE DATE. This section is effective upon federal
20.8 	approval and to the extent approved as a federal waiver
20.9 	amendment.

20.10 	Sec. 17. Minnesota Statutes 2004, section 256B.5012, is
20.11 	amended by adding a subdivision to read:
20.12 		Subd. 6.Icf/mr rate increases beginning january 1, 2006,
20.13 	and january 1, 2007. For the rate years beginning January 1,
20.14 	2006, and January 1, 2007, the commissioner shall provide
20.15 	facilities reimbursed under this section an adjustment to the
20.16 	total operating payment rate of ..... percent.  At least
20.17 	two-thirds of each year's adjustment must be used for increased
20.18 	costs of employee salaries and benefits and associated costs for
20.19 	FICA, the Medicare tax, workers' compensation premiums, and
20.20 	federal and state unemployment insurance.  Each facility
20.21 	receiving an adjustment shall report to the commissioner, in the
20.22 	form and manner specified by the commissioner, on how the
20.23 	additional funding was used.

20.24 	Sec. 18. Minnesota Statutes 2004, section 256B.69,
20.25 	subdivision 23, is amended to read:
20.26 		Subd. 23.Alternative integrated long-term care services;
20.27 	elderly and disabled persons.  (a) The commissioner may
20.28 	implement demonstration projects to create alternative
20.29 	integrated delivery systems for acute and long-term care
20.30 	services to elderly persons and persons with disabilities as
20.31 	defined in section 256B.77, subdivision 7a, that provide
20.32 	increased coordination, improve access to quality services, and
20.33 	mitigate future cost increases.  The commissioner may seek
20.34 	federal authority to combine Medicare and Medicaid capitation
20.35 	payments for the purpose of such demonstrations.  Medicare funds
20.36 	and services shall be administered according to the terms and
21.1 	conditions of the federal waiver and demonstration provisions.
21.2 	For the purpose of administering medical assistance funds,
21.3 	demonstrations under this subdivision are subject to
21.4 	subdivisions 1 to 22.  The provisions of Minnesota Rules, parts
21.5 	9500.1450 to 9500.1464, apply to these demonstrations, with the
21.6 	exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457,
21.7 	subpart 1, items B and C, which do not apply to persons
21.8 	enrolling in demonstrations under this section.  An initial open
21.9 	enrollment period may be provided.  Persons who disenroll from
21.10 	demonstrations under this subdivision remain subject to
21.11 	Minnesota Rules, parts 9500.1450 to 9500.1464.  When a person is
21.12 	enrolled in a health plan under these demonstrations and the
21.13 	health plan's participation is subsequently terminated for any
21.14 	reason, the person shall be provided an opportunity to select a
21.15 	new health plan and shall have the right to change health plans
21.16 	within the first 60 days of enrollment in the second health
21.17 	plan.  Persons required to participate in health plans under
21.18 	this section who fail to make a choice of health plan shall not
21.19 	be randomly assigned to health plans under these demonstrations.
21.20 	Notwithstanding section 256L.12, subdivision 5, and Minnesota
21.21 	Rules, part 9505.5220, subpart 1, item A, if adopted, for the
21.22 	purpose of demonstrations under this subdivision, the
21.23 	commissioner may contract with managed care organizations,
21.24 	including counties, to serve only elderly persons eligible for
21.25 	medical assistance, elderly and disabled persons, or disabled
21.26 	persons only.  For persons with primary diagnoses of mental
21.27 	retardation or a related condition, serious and persistent
21.28 	mental illness, or serious emotional disturbance, the
21.29 	commissioner must ensure that the county authority has approved
21.30 	the demonstration and contracting design.  Enrollment in these
21.31 	projects for persons with disabilities shall be voluntary.  The
21.32 	commissioner shall not implement any demonstration project under
21.33 	this subdivision for persons with primary diagnoses of mental
21.34 	retardation or a related condition, serious and persistent
21.35 	mental illness, or serious emotional disturbance, without
21.36 	approval of the county board of the county in which the
22.1 	demonstration is being implemented.
22.2 	(b) Notwithstanding chapter 245B, sections 252.40 to
22.3 	252.46, 256B.092, 256B.501 to 256B.5015, and Minnesota Rules,
22.4 	parts 9525.0004 to 9525.0036, 9525.1200 to 9525.1330, 9525.1580,
22.5 	and 9525.1800 to 9525.1930, the commissioner may implement under
22.6 	this section projects for persons with developmental
22.7 	disabilities.  The commissioner may capitate payments for ICF/MR
22.8 	services, waivered services for mental retardation or related
22.9 	conditions, including case management services, day training and
22.10 	habilitation and alternative active treatment services, and
22.11 	other services as approved by the state and by the federal
22.12 	government.  Case management and active treatment must be
22.13 	individualized and developed in accordance with a
22.14 	person-centered plan.  Costs under these projects may not exceed
22.15 	costs that would have been incurred under fee-for-service.
22.16 	Beginning July 1, 2003, and until two years after the pilot
22.17 	project implementation date, subcontractor participation in the
22.18 	long-term care developmental disability pilot is limited to a
22.19 	nonprofit long-term care system providing ICF/MR services, home
22.20 	and community-based waiver services, and in-home services to no
22.21 	more than 120 consumers with developmental disabilities in
22.22 	Carver, Hennepin, and Scott Counties.  The commissioner shall
22.23 	report to the legislature prior to expansion of the
22.24 	developmental disability pilot project.  This paragraph expires
22.25 	two years after the implementation date of the pilot project.
22.26 	(c) Before implementation of a demonstration project for
22.27 	disabled persons, the commissioner must provide information to
22.28 	appropriate committees of the house of representatives and
22.29 	senate and must involve representatives of affected disability
22.30 	groups in the design of the demonstration projects.
22.31 	(d) A nursing facility reimbursed under the alternative
22.32 	reimbursement methodology in section 256B.434 may, in
22.33 	collaboration with a hospital, clinic, or other health care
22.34 	entity provide services under paragraph (a).  The commissioner
22.35 	shall amend the state plan and seek any federal waivers
22.36 	necessary to implement this paragraph.
23.1 	(e) The commissioner shall seek federal approval to expand
23.2 	the Minnesota disability health options (MnDHO) program
23.3 	established under this subdivision in stages, first to regional
23.4 	population centers outside the seven-county metro area and then
23.5 	to all areas of the state.

23.6 	Sec. 19. Minnesota Statutes 2004, section 256B.765, is
23.7 	amended to read:
23.8 	256B.765 PROVIDER RATE INCREASES.
23.9 		Subdivision 1.Annual inflation adjustments. (a)
23.10 	Effective July 1, 2001, within the limits of appropriations
23.11 	specifically for this purpose, the commissioner shall provide an
23.12 	annual inflation adjustment for the providers listed
23.13 	in paragraph (c) subdivision 2.  The index for the inflation
23.14 	adjustment must be based on the change in the Employment Cost
23.15 	Index for Private Industry Workers - Total Compensation
23.16 	forecasted by Data Resources, Inc., as forecasted in the fourth
23.17 	quarter of the calendar year preceding the fiscal year.  The
23.18 	commissioner shall increase reimbursement or allocation rates by
23.19 	the percentage of this adjustment, and county boards shall
23.20 	adjust provider contracts as needed.
23.21 	(b) The commissioner of finance shall include an annual
23.22 	inflationary adjustment in reimbursement rates for the providers
23.23 	listed in paragraph (c) subdivision 2 using the inflation factor
23.24 	specified in paragraph (a) as a budget change request in each
23.25 	biennial detailed expenditure budget submitted to the
23.26 	legislature under section 16A.11.
23.27 	(c) Subd. 2.[ELIGIBLE PROVIDERS.] The annual adjustment
23.28 	under subdivision 1,paragraph (a),shall be provided for home
23.29 	and community-based waiver services for persons with mental
23.30 	retardation or related conditions under section 256B.501; home
23.31 	and community-based waiver services for the elderly under
23.32 	section 256B.0915; waivered services under community
23.33 	alternatives for disabled individuals under section 256B.49;
23.34 	community alternative care waivered services under section
23.35 	256B.49; traumatic brain injury waivered services under section
23.36 	256B.49; nursing services and home health services under section
24.1 	256B.0625, subdivision 6a; personal care services and nursing
24.2 	supervision of personal care services under section 256B.0625,
24.3 	subdivision 19a; private duty nursing services under section
24.4 	256B.0625, subdivision 7; day training and habilitation services
24.5 	for adults with mental retardation or related conditions under
24.6 	sections 252.40 to 252.46; physical therapy services under
24.7 	sections 256B.0625, subdivision 8, and 256D.03, subdivision 4;
24.8 	occupational therapy services under sections 256B.0625,
24.9 	subdivision 8a, and 256D.03, subdivision 4; speech-language
24.10 	therapy services under section 256D.03, subdivision 4, and
24.11 	Minnesota Rules, part 9505.0390; respiratory therapy services
24.12 	under section 256D.03, subdivision 4, and Minnesota Rules, part
24.13 	9505.0295; alternative care services under section 256B.0913;
24.14 	adult residential program grants under Minnesota Rules, parts
24.15 	9535.2000 to 9535.3000; adult and family community support
24.16 	grants under Minnesota Rules, parts 9535.1700 to 9535.1760;
24.17 	semi-independent living services under section 252.275 including
24.18 	SILS funding under county social services grants formerly funded
24.19 	under chapter 256I; and community support services for deaf and
24.20 	hard-of-hearing adults with mental illness who use or wish to
24.21 	use sign language as their primary means of communication.
24.22 		Subd. 3.Rate increase for biennium beginning july 1,
24.23 	2005. For the fiscal years beginning July 1, 2005, and July 1,
24.24 	2006, the commissioner shall increase reimbursement rates for
24.25 	the providers listed in subdivision 2 by ..... percent.  At
24.26 	least two-thirds of each year's adjustment must be used for
24.27 	increased costs of employee salaries and benefits and associated
24.28 	costs for FICA, the Medicare tax, workers' compensation
24.29 	premiums, and federal and state unemployment insurance.  Each
24.30 	provider receiving an adjustment shall report to the
24.31 	commissioner, in the form and manner specified by the
24.32 	commissioner, on how the additional funding was used.

24.33 	Sec. 20. Minnesota Statutes 2004, section 256D.03,
24.34 	subdivision 4, is amended to read:
24.35 		Subd. 4.General assistance medical care; services.
 24.36 	(a)(i) For a person who is eligible under subdivision 3,
25.1 	paragraph (a), clause (2), item (i), general assistance medical
25.2 	care covers, except as provided in paragraph (c):
25.3 	(1) inpatient hospital services;
25.4 	(2) outpatient hospital services;
25.5 	(3) services provided by Medicare certified rehabilitation
25.6 	agencies;
25.7 	(4) prescription drugs and other products recommended
25.8 	through the process established in section 256B.0625,
25.9 	subdivision 13;
25.10 	(5) equipment necessary to administer insulin and
25.11 	diagnostic supplies and equipment for diabetics to monitor blood
25.12 	sugar level;
25.13 	(6) eyeglasses and eye examinations provided by a physician
25.14 	or optometrist;
25.15 	(7) hearing aids;
25.16 	(8) prosthetic devices;
25.17 	(9) laboratory and X-ray services;
25.18 	(10) physician's services;
25.19 	(11) medical transportation except special transportation;
25.20 	(12) chiropractic services as covered under the medical
25.21 	assistance program;
25.22 	(13) podiatric services;
25.23 	(14) dental services and dentures, subject to the
25.24 	limitations specified in section 256B.0625, subdivision 9as
25.25 	covered under the medical assistance program;
25.26 	(15) outpatient services provided by a mental health center
25.27 	or clinic that is under contract with the county board and is
25.28 	established under section 245.62;
25.29 	(16) day treatment services for mental illness provided
25.30 	under contract with the county board;
25.31 	(17) prescribed medications for persons who have been
25.32 	diagnosed as mentally ill as necessary to prevent more
25.33 	restrictive institutionalization;
25.34 	(18) psychological services, medical supplies and
25.35 	equipment, and Medicare premiums, coinsurance and deductible
25.36 	payments;
26.1 	(19) medical equipment not specifically listed in this
26.2 	paragraph when the use of the equipment will prevent the need
26.3 	for costlier services that are reimbursable under this
26.4 	subdivision;
26.5 	(20) services performed by a certified pediatric nurse
26.6 	practitioner, a certified family nurse practitioner, a certified
26.7 	adult nurse practitioner, a certified obstetric/gynecological
26.8 	nurse practitioner, a certified neonatal nurse practitioner, or
26.9 	a certified geriatric nurse practitioner in independent
26.10 	practice, if (1) the service is otherwise covered under this
26.11 	chapter as a physician service, (2) the service provided on an
26.12 	inpatient basis is not included as part of the cost for
26.13 	inpatient services included in the operating payment rate, and
26.14 	(3) the service is within the scope of practice of the nurse
26.15 	practitioner's license as a registered nurse, as defined in
26.16 	section 148.171;
26.17 	(21) services of a certified public health nurse or a
26.18 	registered nurse practicing in a public health nursing clinic
26.19 	that is a department of, or that operates under the direct
26.20 	authority of, a unit of government, if the service is within the
26.21 	scope of practice of the public health nurse's license as a
26.22 	registered nurse, as defined in section 148.171; and
26.23 	(22) telemedicine consultations, to the extent they are
26.24 	covered under section 256B.0625, subdivision 3b.
26.25 	(ii) Effective October 1, 2003, for a person who is
26.26 	eligible under subdivision 3, paragraph (a), clause (2), item
26.27 	(ii), general assistance medical care coverage is limited to
26.28 	inpatient hospital services, including physician services
26.29 	provided during the inpatient hospital stay.  A $1,000
26.30 	deductible is required for each inpatient hospitalization.
26.31 	(b) Gender reassignment surgery and related services are
26.32 	not covered services under this subdivision unless the
26.33 	individual began receiving gender reassignment services prior to
26.34 	July 1, 1995.
26.35 	(c) In order to contain costs, the commissioner of human
26.36 	services shall select vendors of medical care who can provide
27.1 	the most economical care consistent with high medical standards
27.2 	and shall where possible contract with organizations on a
27.3 	prepaid capitation basis to provide these services.  The
27.4 	commissioner shall consider proposals by counties and vendors
27.5 	for prepaid health plans, competitive bidding programs, block
27.6 	grants, or other vendor payment mechanisms designed to provide
27.7 	services in an economical manner or to control utilization, with
27.8 	safeguards to ensure that necessary services are provided.
27.9 	Before implementing prepaid programs in counties with a county
27.10 	operated or affiliated public teaching hospital or a hospital or
27.11 	clinic operated by the University of Minnesota, the commissioner
27.12 	shall consider the risks the prepaid program creates for the
27.13 	hospital and allow the county or hospital the opportunity to
27.14 	participate in the program in a manner that reflects the risk of
27.15 	adverse selection and the nature of the patients served by the
27.16 	hospital, provided the terms of participation in the program are
27.17 	competitive with the terms of other participants considering the
27.18 	nature of the population served.  Payment for services provided
27.19 	pursuant to this subdivision shall be as provided to medical
27.20 	assistance vendors of these services under sections 256B.02,
27.21 	subdivision 8, and 256B.0625.  For payments made during fiscal
27.22 	year 1990 and later years, the commissioner shall consult with
27.23 	an independent actuary in establishing prepayment rates, but
27.24 	shall retain final control over the rate methodology.
27.25 	(d) Recipients eligible under subdivision 3, paragraph (a),
27.26 	clause (2), item (i), shall pay the following co-payments for
27.27 	services provided on or after October 1, 2003:
27.28 	(1) $3 per nonpreventive visit.  For purposes of this
27.29 	subdivision, a visit means an episode of service which is
27.30 	required because of a recipient's symptoms, diagnosis, or
27.31 	established illness, and which is delivered in an ambulatory
27.32 	setting by a physician or physician ancillary, chiropractor,
27.33 	podiatrist, nurse midwife, advanced practice nurse, audiologist,
27.34 	optician, or optometrist;
27.35 	(2) $25 for eyeglasses;
27.36 	(3) $25 for nonemergency visits to a hospital-based
28.1 	emergency room; and 
28.2 	(4) $3 per brand-name drug prescription and $1 per generic
28.3 	drug prescription, subject to a $20 per month maximum for
28.4 	prescription drug co-payments.  No co-payments shall apply to
28.5 	antipsychotic drugs when used for the treatment of mental
28.6 	illness; and 
28.7 	(5) 50 percent coinsurance on restorative dental services.
28.8 	(e) Co-payments shall be limited to one per day per
28.9 	provider for nonpreventive visits, eyeglasses, and nonemergency
28.10 	visits to a hospital-based emergency room.  Recipients of
28.11 	general assistance medical care are responsible for all
28.12 	co-payments in this subdivision.  The general assistance medical
28.13 	care reimbursement to the provider shall be reduced by the
28.14 	amount of the co-payment, except that reimbursement for
28.15 	prescription drugs shall not be reduced once a recipient has
28.16 	reached the $20 per month maximum for prescription drug
28.17 	co-payments.  The provider collects the co-payment from the
28.18 	recipient.  Providers may not deny services to recipients who
28.19 	are unable to pay the co-payment, except as provided in
28.20 	paragraph (f).
28.21 	(f) If it is the routine business practice of a provider to
28.22 	refuse service to an individual with uncollected debt, the
28.23 	provider may include uncollected co-payments under this
28.24 	section.  A provider must give advance notice to a recipient
28.25 	with uncollected debt before services can be denied.
28.26 	(g) Any county may, from its own resources, provide medical
28.27 	payments for which state payments are not made.
28.28 	(h) Chemical dependency services that are reimbursed under
28.29 	chapter 254B must not be reimbursed under general assistance
28.30 	medical care.
28.31 	(i) The maximum payment for new vendors enrolled in the
28.32 	general assistance medical care program after the base year
28.33 	shall be determined from the average usual and customary charge
28.34 	of the same vendor type enrolled in the base year.
28.35 	(j) The conditions of payment for services under this
28.36 	subdivision are the same as the conditions specified in rules
29.1 	adopted under chapter 256B governing the medical assistance
29.2 	program, unless otherwise provided by statute or rule.
29.3 	(k) Inpatient and outpatient payments shall be reduced by
29.4 	five percent, effective July 1, 2003.  This reduction is in
29.5 	addition to the five percent reduction effective July 1, 2003,
29.6 	and incorporated by reference in paragraph (i).
29.7 	(l) Payments for all other health services except
29.8 	inpatient, outpatient, and pharmacy services shall be reduced by
29.9 	five percent, effective July 1, 2003.
29.10 	(m) Payments to managed care plans shall be reduced by five
29.11 	percent for services provided on or after October 1, 2003.
29.12 	(n) A hospital receiving a reduced payment as a result of
29.13 	this section may apply the unpaid balance toward satisfaction of
29.14 	the hospital's bad debts.

29.15 	Sec. 21. Minnesota Statutes 2004, section 256L.03,
29.16 	subdivision 1, is amended to read:
29.17 		Subdivision 1.Covered health services.  For individuals
29.18 	under section 256L.04, subdivision 7, with income no greater
29.19 	than 75 percent of the federal poverty guidelines or for
29.20 	families with children under section 256L.04, subdivision 1, all
29.21 	subdivisions of this section apply.  "Covered health services"
29.22 	means the health services reimbursed under chapter 256B, with
29.23 	the exception of inpatient hospital services, special education
29.24 	services, private duty nursing services, adult dental care
29.25 	services other than services except as covered under section
29.26 	256B.0625,subdivision 9, paragraph (b), orthodontic services 
29.27 	3b, nonemergency medical transportation services, personal care
29.28 	assistant and case management services, nursing home or
29.29 	intermediate care facilities services, inpatient mental health
29.30 	services, and chemical dependency services.  Outpatient mental
29.31 	health services covered under the MinnesotaCare program are
29.32 	limited to diagnostic assessments, psychological testing,
29.33 	explanation of findings, medication management by a physician,
29.34 	day treatment, partial hospitalization, and individual, family,
29.35 	and group psychotherapy.
29.36 	No public funds shall be used for coverage of abortion
30.1 	under MinnesotaCare except where the life of the female would be
30.2 	endangered or substantial and irreversible impairment of a major
30.3 	bodily function would result if the fetus were carried to term;
30.4 	or where the pregnancy is the result of rape or incest.
30.5 	Covered health services shall be expanded as provided in
30.6 	this section.

30.7 	Sec. 22. Minnesota Statutes 2004, section 256L.03, is
30.8 	amended by adding a subdivision to read:
30.9 		Subd. 3b.Dental services effective july 1, 2005. (a)
30.10 	Effective July 1, 2005, the provisions in paragraphs (b) and (c)
30.11 	apply.
30.12 	(b) For parents, grandparents, foster parents, relative
30.13 	caretakers, and legal guardians eligible under section 256L.04,
30.14 	subdivision 1, with incomes not exceeding 75 percent of the
30.15 	federal poverty guidelines, dental services are covered as
30.16 	provided under section 256B.0625, subdivision 9, except that no
30.17 	coverage is provided for orthodontic services.
30.18 	(c) For pregnant women and children under age 21, dental
30.19 	services are covered as provided under section 256B.0625,
30.20 	subdivision 9.

30.21 	Sec. 23. Minnesota Statutes 2004, section 256L.03,
30.22 	subdivision 5, is amended to read:
30.23 		Subd. 5.Co-payments and coinsurance.  (a) Except as
30.24 	provided in paragraphs (b) and (c), the MinnesotaCare benefit
30.25 	plan shall include the following co-payments and coinsurance
30.26 	requirements for all enrollees:
30.27 	(1) ten percent of the paid charges for inpatient hospital
30.28 	services for adult enrollees, subject to an annual inpatient
30.29 	out-of-pocket maximum of $1,000 per individual and $3,000 per
30.30 	family;
30.31 	(2) $3 per prescription for adult enrollees;
30.32 	(3) $25 for eyeglasses for adult enrollees; and
30.33 	(4) 50 percent of the fee-for-service rate for adult dental
30.34 	care services other than preventive care services for persons
30.35 	eligible under section 256L.04, subdivisions 1 to 7, with income
30.36 	equal to or less than 175 percent of the federal poverty
31.1 	guidelines subdivision 3b, paragraph (b).
31.2 	(b) Paragraph (a), clause (1), does not apply to parents
31.3 	and relative caretakers of children under the age of 21 in
31.4 	households with family income equal to or less than 175 percent
31.5 	of the federal poverty guidelines.  Paragraph (a), clause (1),
31.6 	does not apply to parents and relative caretakers of children
31.7 	under the age of 21 in households with family income greater
31.8 	than 175 percent of the federal poverty guidelines for inpatient
31.9 	hospital admissions occurring on or after January 1, 2001.
31.10 	(c) Paragraph (a), clauses (1) to (4), do not apply to
31.11 	pregnant women and children under the age of 21.
31.12 	(d) Adult enrollees with family gross income that exceeds
31.13 	175 percent of the federal poverty guidelines and who are not
31.14 	pregnant shall be financially responsible for the coinsurance
31.15 	amount, if applicable, and amounts which exceed the $10,000
31.16 	inpatient hospital benefit limit.
31.17 	(e) When a MinnesotaCare enrollee becomes a member of a
31.18 	prepaid health plan, or changes from one prepaid health plan to
31.19 	another during a calendar year, any charges submitted towards
31.20 	the $10,000 annual inpatient benefit limit, and any
31.21 	out-of-pocket expenses incurred by the enrollee for inpatient
31.22 	services, that were submitted or incurred prior to enrollment,
31.23 	or prior to the change in health plans, shall be disregarded.

31.24 	Sec. 24. FEDERAL APPROVAL.
 31.25 	By August 1, 2005, the commissioner of human services shall
31.26 	request any federal approval and plan amendments necessary to
31.27 	implement (1) the transitional supports allowance under
31.28 	Minnesota Statutes, sections 256B.0916, subdivision 10; and
31.29 	256B.49, subdivision 16; and (2) the choice of case management
31.30 	service coordination provisions under Minnesota Statutes,
31.31 	sections 256B.0621, subdivision 4; 256B.092, subdivisions 2a and
31.32 	4b; and 256B.49, subdivision 13.

31.33 	Sec. 25. DENTAL ACCESS FOR PERSONS WITH DISABILITIES.
 31.34 	The commissioner of human services shall study access to
31.35 	dental services for persons with disabilities, and shall present
31.36 	recommendations for improving access to dental services to the
32.1 	legislature by January 15, 2006.  The study must examine
32.2 	physical and geographic access, the willingness of dentists to
32.3 	serve persons with disabilities enrolled in state health care
32.4 	programs, reimbursement rates for dental service providers, and
32.5 	other factors identified by the commissioner as potential
32.6 	barriers to accessing dental services.

32.7 	Sec. 26. DISABILITY SERVICES INTERAGENCY WORK GROUP.
 32.8 		Subdivision 1.Membership. The Department of Human
32.9 	Services, the Minnesota Housing Finance Agency, and the
32.10 	Minnesota State Council on Disability shall convene an
32.11 	interagency work group which includes interested stakeholders
32.12 	including other state agencies, counties, public housing
32.13 	authorities, the Metropolitan Council, disability service
32.14 	providers, and representatives from disability advocacy
32.15 	organizations to identify barriers, strengthen coordination,
32.16 	recommend policy and funding changes, and pursue federal
32.17 	financing that will assist Minnesotans with disabilities who are
32.18 	attempting to relocate from or avoid placement in institutional
32.19 	settings.
32.20 		Subd. 2.Work group activities. The work group shall
32.21 	make recommendations to the state agencies and the legislature
32.22 	related to:
32.23 	(1) coordinating the availability of housing,
32.24 	transportation, and support services needed to discharge persons
32.25 	with disabilities from institutions;
32.26 	(2) improving information and assistance needed to make an
32.27 	informed choice about relocating from an institutional placement
32.28 	to community-based services;
32.29 	(3) identifying gaps in human services, transportation, or
32.30 	housing access which are barriers to moving to community
32.31 	services;
32.32 	(4) identifying strategies which would result in earlier
32.33 	identification of persons most at risk of institutional
32.34 	placement in order to promote diversion to community service or
32.35 	reduce length of stay in an institutional facility;
32.36 	(5) identifying funding mechanisms and financial strategies
33.1 	to assure a financially sustainable community support system
33.2 	that diverts and relocates individuals from institutional
33.3 	placement; and 
33.4 	(6) identifying state changes needed to address any federal
33.5 	changes affecting policies, benefits, or funding used to support
33.6 	persons with disabilities to avoid institutional placement.
33.7 		Subd. 3.Recommendations. Recommendations of the work
33.8 	group will be submitted to each participating state agency and
33.9 	to the chairs of the health and human services policy and
33.10 	finance committees of the senate and house of representatives by
33.11 	October 15, 2006.