1.1                          A bill for an act 
  1.2             relating to state government; modifying licensing 
  1.3             fees; expanding health care program eligibility; 
  1.4             enacting health care cost containment measures; 
  1.5             modifying mental and chemical health programs; 
  1.6             adjusting family support programs; reducing certain 
  1.7             parental fees; providing a cost-of-living adjustment 
  1.8             for certain human services program employees; 
  1.9             modifying long-term care programs; modifying 
  1.10            continuing care programs; allowing penalties; 
  1.11            appropriating money; amending Minnesota Statutes 2004, 
  1.12            sections 62A.65, subdivision 3; 62D.12, subdivision 
  1.13            19; 62J.04, subdivision 3, by adding a subdivision; 
  1.14            62J.041; 62J.301, subdivision 3; 62J.38; 62J.692, 
  1.15            subdivision 3; 62L.08, subdivision 8; 62M.06, 
  1.16            subdivisions 2, 3; 62Q.37, subdivision 7; 103I.101, 
  1.17            subdivision 6; 103I.208, subdivisions 1, 2; 103I.235, 
  1.18            subdivision 1; 103I.601, subdivision 2; 119B.011, by 
  1.19            adding a subdivision; 119B.05, subdivision 1; 144.122; 
  1.20            144.147, subdivisions 1, 2; 144.148, subdivision 1; 
  1.21            144.1483; 144.1501, subdivisions 1, 2, 3, 4; 144.226, 
  1.22            subdivision 1, by adding subdivisions; 144.3831, 
  1.23            subdivision 1; 144.551, subdivision 1; 144.562, 
  1.24            subdivision 2; 144.9504, subdivision 2; 144.98, 
  1.25            subdivision 3; 144A.073, subdivision 10, by adding a 
  1.26            subdivision; 144E.101, by adding a subdivision; 
  1.27            145.9268; 157.15, by adding a subdivision; 157.16, 
  1.28            subdivisions 2, 3, by adding subdivisions; 157.20, 
  1.29            subdivisions 2, 2a; 241.01, by adding a subdivision; 
  1.30            244.054; 245.4661, by adding subdivisions; 245.4874; 
  1.31            245.4885, subdivisions 1, 2, by adding a subdivision; 
  1.32            252.27, subdivision 2a; 252.291, by adding a 
  1.33            subdivision; 254B.03, subdivision 4; 256.01, by adding 
  1.34            a subdivision; 256.045, subdivisions 3, 3a; 256.741, 
  1.35            subdivision 4; 256.9365; 256.969, by adding a 
  1.36            subdivision; 256B.02, subdivision 12; 256B.04, by 
  1.37            adding a subdivision; 256B.055, by adding a 
  1.38            subdivision; 256B.056, subdivisions 5, 5a, 5b, 7, by 
  1.39            adding subdivisions; 256B.057, subdivision 1; 
  1.40            256B.0621, subdivisions 2, 3, 4, 5, 6, 7; 256B.0622, 
  1.41            subdivision 2; 256B.0625, subdivisions 2, 9, 13e, as 
  1.42            amended, 13f, 19c, by adding subdivisions; 256B.0627, 
  1.43            subdivisions 1, 4, 5, 9, by adding a subdivision; 
  1.44            256B.0916, by adding a subdivision; 256B.15, 
  1.45            subdivisions 1, 1a, 2; 256B.19, subdivision 1; 
  1.46            256B.431, by adding subdivisions; 256B.434, 
  2.1             subdivision 4, by adding a subdivision; 256B.440, by 
  2.2             adding a subdivision; 256B.5012, by adding a 
  2.3             subdivision; 256B.69, subdivisions 4, 23; 256D.03, 
  2.4             subdivision 4; 256D.045; 256D.44, subdivision 5; 
  2.5             256J.021; 256J.08, subdivision 65; 256J.21, 
  2.6             subdivision 2; 256J.521, subdivision 1; 256J.53, 
  2.7             subdivision 2; 256J.626, subdivisions 1, 2, 3, 4, 7; 
  2.8             256J.95, subdivisions 3, 9; 256L.01, subdivisions 4, 
  2.9             5; 256L.03, subdivisions 1, 1b, 5; 256L.04, 
  2.10            subdivisions 2, 7, by adding subdivisions; 256L.05, 
  2.11            subdivisions 3, 3a; 256L.07, subdivisions 1, 3, by 
  2.12            adding a subdivision; 256L.12, subdivision 6; 256L.15, 
  2.13            subdivisions 2, 3; 295.582; 326.01, by adding a 
  2.14            subdivision; 326.37, subdivision 1, by adding a 
  2.15            subdivision; 326.38; 326.40, subdivision 1; 326.42, 
  2.16            subdivision 2; 514.981, subdivision 6; 524.3-805; 
  2.17            549.02, by adding a subdivision; 549.04; 641.15, 
  2.18            subdivision 2; Laws 2003, First Special Session 
  2.19            chapter 14, article 13C, section 2, subdivision 6; 
  2.20            proposing coding for new law in Minnesota Statutes, 
  2.21            chapters 62J; 144; 151; 256; 256B; 256J; 256L; 326; 
  2.22            501B; 641; repealing Minnesota Statutes 2004, sections 
  2.23            119B.074; 144.1486; 157.215; 256B.0631; 256J.37, 
  2.24            subdivisions 3a, 3b; 256L.035; 326.45; 514.991; 
  2.25            514.992; 514.993; 514.994; 514.995. 
  2.26  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  2.27                             ARTICLE 1 
  2.28                         HEALTH DEPARTMENT
  2.29     Section 1.  [62J.495] [HEALTH INFORMATION TECHNOLOGY AND 
  2.30  INFRASTRUCTURE ADVISORY COMMITTEE.] 
  2.31     Subdivision 1.  [ESTABLISHMENT; MEMBERS; DUTIES.] (a) The 
  2.32  commissioner shall establish a Health Information Technology and 
  2.33  Infrastructure Advisory Committee governed by section 15.059 to 
  2.34  advise the commissioner on the following matters: 
  2.35     (1) assessment of the use of health information technology 
  2.36  by the state, licensed health care providers and facilities, and 
  2.37  local public health agencies; 
  2.38     (2) recommendations for implementing a statewide 
  2.39  interoperable health information infrastructure, to include 
  2.40  estimates of necessary resources, and for determining standards 
  2.41  for administrative data exchange, clinical support programs, and 
  2.42  maintenance of the security and confidentiality of individual 
  2.43  patient data; and 
  2.44     (3) other related issues as requested by the commissioner. 
  2.45     (b) The members of the Health Information Technology and 
  2.46  Infrastructure Advisory Committee shall include the 
  2.47  commissioners, or commissioners' designees, of health, human 
  2.48  services, and commerce and additional members to be appointed by 
  3.1   the commissioner to include persons representing Minnesota's 
  3.2   local public health agencies, licensed hospitals and other 
  3.3   licensed facilities and providers, the medical and nursing 
  3.4   professions, health insurers and health plans, the state quality 
  3.5   improvement organization, academic and research institutions, 
  3.6   consumer advisory organizations with an interest and expertise 
  3.7   in health information technology, and other stakeholders as 
  3.8   identified by the Health Information Technology and 
  3.9   Infrastructure Advisory Committee. 
  3.10     Subd. 2.  [ANNUAL REPORT.] The commissioner shall prepare 
  3.11  and issue an annual report not later than January 30 of each 
  3.12  year outlining progress to date in implementing a statewide 
  3.13  health information infrastructure and recommending future 
  3.14  projects. 
  3.15     Subd. 3.  [EXPIRATION.] Notwithstanding section 15.059, 
  3.16  this section expires June 30, 2009. 
  3.17     Sec. 2.  Minnesota Statutes 2004, section 103I.101, 
  3.18  subdivision 6, is amended to read: 
  3.19     Subd. 6.  [FEES FOR VARIANCES.] The commissioner shall 
  3.20  charge a nonrefundable application fee of $150 $175 to cover the 
  3.21  administrative cost of processing a request for a variance or 
  3.22  modification of rules adopted by the commissioner under this 
  3.23  chapter. 
  3.24     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2006.  
  3.25     Sec. 3.  Minnesota Statutes 2004, section 103I.208, 
  3.26  subdivision 1, is amended to read: 
  3.27     Subdivision 1.  [WELL NOTIFICATION FEE.] The well 
  3.28  notification fee to be paid by a property owner is:  
  3.29     (1) for a new well, $150 $175, which includes the state 
  3.30  core function fee; 
  3.31     (2) for a well sealing, $30 $35 for each well, which 
  3.32  includes the state core function fee, except that for monitoring 
  3.33  wells constructed on a single property, having depths within a 
  3.34  25 foot range, and sealed within 48 hours of start of 
  3.35  construction, a single fee of $30 $35; and 
  3.36     (3) for construction of a dewatering well, $150 $175, which 
  4.1   includes the state core function fee, for each well except a 
  4.2   dewatering project comprising five or more wells shall be 
  4.3   assessed a single fee of $750 $875 for the wells recorded on the 
  4.4   notification. 
  4.5      <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2006.  
  4.6      Sec. 4.  Minnesota Statutes 2004, section 103I.208, 
  4.7   subdivision 2, is amended to read: 
  4.8      Subd. 2.  [PERMIT FEE.] The permit fee to be paid by a 
  4.9   property owner is:  
  4.10     (1) for a well that is not in use under a maintenance 
  4.11  permit, $125 $150 annually; 
  4.12     (2) for construction of a monitoring well, $150 $175, which 
  4.13  includes the state core function fee; 
  4.14     (3) for a monitoring well that is unsealed under a 
  4.15  maintenance permit, $125 $150 annually; 
  4.16     (4) for monitoring wells used as a leak detection device at 
  4.17  a single motor fuel retail outlet, a single petroleum bulk 
  4.18  storage site excluding tank farms, or a single agricultural 
  4.19  chemical facility site, the construction permit fee 
  4.20  is $150 $175, which includes the state core function fee, per 
  4.21  site regardless of the number of wells constructed on the site, 
  4.22  and the annual fee for a maintenance permit for unsealed 
  4.23  monitoring wells is $125 $150 per site regardless of the number 
  4.24  of monitoring wells located on site; 
  4.25     (5) for a groundwater thermal exchange device, in addition 
  4.26  to the notification fee for wells, $150 $175, which includes the 
  4.27  state core function fee; 
  4.28     (6) for a vertical heat exchanger, $150 $175; 
  4.29     (7) for a dewatering well that is unsealed under a 
  4.30  maintenance permit, $125 $150 annually for each well, except a 
  4.31  dewatering project comprising more than five wells shall be 
  4.32  issued a single permit for $625 $750 annually for wells recorded 
  4.33  on the permit; and 
  4.34     (8) for excavating holes for the purpose of installing 
  4.35  elevator shafts, $150 $175 for each hole. 
  4.36     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2006.  
  5.1      Sec. 5.  Minnesota Statutes 2004, section 103I.235, 
  5.2   subdivision 1, is amended to read: 
  5.3      Subdivision 1.  [DISCLOSURE OF WELLS TO BUYER.] (a) Before 
  5.4   signing an agreement to sell or transfer real property, the 
  5.5   seller must disclose in writing to the buyer information about 
  5.6   the status and location of all known wells on the property, by 
  5.7   delivering to the buyer either a statement by the seller that 
  5.8   the seller does not know of any wells on the property, or a 
  5.9   disclosure statement indicating the legal description and 
  5.10  county, and a map drawn from available information showing the 
  5.11  location of each well to the extent practicable.  In the 
  5.12  disclosure statement, the seller must indicate, for each well, 
  5.13  whether the well is in use, not in use, or sealed.  
  5.14     (b) At the time of closing of the sale, the disclosure 
  5.15  statement information, name and mailing address of the buyer, 
  5.16  and the quartile, section, township, and range in which each 
  5.17  well is located must be provided on a well disclosure 
  5.18  certificate signed by the seller or a person authorized to act 
  5.19  on behalf of the seller. 
  5.20     (c) A well disclosure certificate need not be provided if 
  5.21  the seller does not know of any wells on the property and the 
  5.22  deed or other instrument of conveyance contains the statement:  
  5.23  "The Seller certifies that the Seller does not know of any wells 
  5.24  on the described real property."  
  5.25     (d) If a deed is given pursuant to a contract for deed, the 
  5.26  well disclosure certificate required by this subdivision shall 
  5.27  be signed by the buyer or a person authorized to act on behalf 
  5.28  of the buyer.  If the buyer knows of no wells on the property, a 
  5.29  well disclosure certificate is not required if the following 
  5.30  statement appears on the deed followed by the signature of the 
  5.31  grantee or, if there is more than one grantee, the signature of 
  5.32  at least one of the grantees:  "The Grantee certifies that the 
  5.33  Grantee does not know of any wells on the described real 
  5.34  property."  The statement and signature of the grantee may be on 
  5.35  the front or back of the deed or on an attached sheet and an 
  5.36  acknowledgment of the statement by the grantee is not required 
  6.1   for the deed to be recordable. 
  6.2      (e) This subdivision does not apply to the sale, exchange, 
  6.3   or transfer of real property:  
  6.4      (1) that consists solely of a sale or transfer of severed 
  6.5   mineral interests; or 
  6.6      (2) that consists of an individual condominium unit as 
  6.7   described in chapters 515 and 515B. 
  6.8      (f) For an area owned in common under chapter 515 or 515B 
  6.9   the association or other responsible person must report to the 
  6.10  commissioner by July 1, 1992, the location and status of all 
  6.11  wells in the common area.  The association or other responsible 
  6.12  person must notify the commissioner within 30 days of any change 
  6.13  in the reported status of wells. 
  6.14     (g) For real property sold by the state under section 
  6.15  92.67, the lessee at the time of the sale is responsible for 
  6.16  compliance with this subdivision. 
  6.17     (h) If the seller fails to provide a required well 
  6.18  disclosure certificate, the buyer, or a person authorized to act 
  6.19  on behalf of the buyer, may sign a well disclosure certificate 
  6.20  based on the information provided on the disclosure statement 
  6.21  required by this section or based on other available information.
  6.22     (i) A county recorder or registrar of titles may not record 
  6.23  a deed or other instrument of conveyance dated after October 31, 
  6.24  1990, for which a certificate of value is required under section 
  6.25  272.115, or any deed or other instrument of conveyance dated 
  6.26  after October 31, 1990, from a governmental body exempt from the 
  6.27  payment of state deed tax, unless the deed or other instrument 
  6.28  of conveyance contains the statement made in accordance with 
  6.29  paragraph (c) or (d) or is accompanied by the well disclosure 
  6.30  certificate containing all the information required by paragraph 
  6.31  (b) or (d).  The county recorder or registrar of titles must not 
  6.32  accept a certificate unless it contains all the required 
  6.33  information.  The county recorder or registrar of titles shall 
  6.34  note on each deed or other instrument of conveyance accompanied 
  6.35  by a well disclosure certificate that the well disclosure 
  6.36  certificate was received.  The notation must include the 
  7.1   statement "No wells on property" if the disclosure certificate 
  7.2   states there are no wells on the property.  The well disclosure 
  7.3   certificate shall not be filed or recorded in the records 
  7.4   maintained by the county recorder or registrar of titles.  After 
  7.5   noting "No wells on property" on the deed or other instrument of 
  7.6   conveyance, the county recorder or registrar of titles shall 
  7.7   destroy or return to the buyer the well disclosure certificate.  
  7.8   The county recorder or registrar of titles shall collect from 
  7.9   the buyer or the person seeking to record a deed or other 
  7.10  instrument of conveyance, a fee of $30 $40 for receipt of a 
  7.11  completed well disclosure certificate.  By the tenth day of each 
  7.12  month, the county recorder or registrar of titles shall transmit 
  7.13  the well disclosure certificates to the commissioner of health.  
  7.14  By the tenth day after the end of each calendar quarter, the 
  7.15  county recorder or registrar of titles shall transmit to the 
  7.16  commissioner of health $27.50 $32.50 of the fee for each well 
  7.17  disclosure certificate received during the quarter.  The 
  7.18  commissioner shall maintain the well disclosure certificate for 
  7.19  at least six years.  The commissioner may store the certificate 
  7.20  as an electronic image.  A copy of that image shall be as valid 
  7.21  as the original. 
  7.22     (j) No new well disclosure certificate is required under 
  7.23  this subdivision if the buyer or seller, or a person authorized 
  7.24  to act on behalf of the buyer or seller, certifies on the deed 
  7.25  or other instrument of conveyance that the status and number of 
  7.26  wells on the property have not changed since the last previously 
  7.27  filed well disclosure certificate.  The following statement, if 
  7.28  followed by the signature of the person making the statement, is 
  7.29  sufficient to comply with the certification requirement of this 
  7.30  paragraph:  "I am familiar with the property described in this 
  7.31  instrument and I certify that the status and number of wells on 
  7.32  the described real property have not changed since the last 
  7.33  previously filed well disclosure certificate."  The 
  7.34  certification and signature may be on the front or back of the 
  7.35  deed or on an attached sheet and an acknowledgment of the 
  7.36  statement is not required for the deed or other instrument of 
  8.1   conveyance to be recordable. 
  8.2      (k) The commissioner in consultation with county recorders 
  8.3   shall prescribe the form for a well disclosure certificate and 
  8.4   provide well disclosure certificate forms to county recorders 
  8.5   and registrars of titles and other interested persons. 
  8.6      (l) Failure to comply with a requirement of this 
  8.7   subdivision does not impair: 
  8.8      (1) the validity of a deed or other instrument of 
  8.9   conveyance as between the parties to the deed or instrument or 
  8.10  as to any other person who otherwise would be bound by the deed 
  8.11  or instrument; or 
  8.12     (2) the record, as notice, of any deed or other instrument 
  8.13  of conveyance accepted for filing or recording contrary to the 
  8.14  provisions of this subdivision. 
  8.15     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2006.  
  8.16     Sec. 6.  Minnesota Statutes 2004, section 103I.601, 
  8.17  subdivision 2, is amended to read: 
  8.18     Subd. 2.  [LICENSE REQUIRED TO MAKE BORINGS.] (a) Except as 
  8.19  provided in paragraph (b) (d), a person may must not make an 
  8.20  exploratory boring without an exploratory borer's explorer's 
  8.21  license.  The fee for an explorer's license is $75.  The 
  8.22  explorer's license is valid until the date prescribed in the 
  8.23  license by the commissioner. 
  8.24     (b) A person must file an application and renewal 
  8.25  application fee to renew the explorer's license by the date 
  8.26  stated in the license.  The renewal application fee is $75. 
  8.27     (c) If the licensee submits an application fee after the 
  8.28  required renewal date, the licensee: 
  8.29     (1) must include a late fee of $75; and 
  8.30     (2) may not conduct activities authorized by an explorer's 
  8.31  license until the renewal application, renewal application fee, 
  8.32  late fee, and sealing reports required in subdivision 9 are 
  8.33  submitted. 
  8.34     (d) An explorer may must designate a responsible individual 
  8.35  to supervise and oversee the making of exploratory borings.  
  8.36  Before an individual supervises or oversees an exploratory 
  9.1   boring, the individual must file an application and application 
  9.2   fee of $75 to qualify as a responsible individual.  The 
  9.3   individual must take and pass an examination relating to 
  9.4   construction, location, and sealing of exploratory borings.  A 
  9.5   professional engineer registered or geoscientist licensed under 
  9.6   sections 326.02 to 326.15 or a certified professional geologist 
  9.7   certified by the American Institute of Professional Geologists 
  9.8   is not required to take the examination required in this 
  9.9   subdivision, but must be licensed certified as a responsible 
  9.10  individual to make supervise an exploratory boring. 
  9.11     Sec. 7.  Minnesota Statutes 2004, section 144.122, is 
  9.12  amended to read: 
  9.13     144.122 [LICENSE, PERMIT, AND SURVEY FEES.] 
  9.14     (a) The state commissioner of health, by rule, may 
  9.15  prescribe reasonable procedures and fees for filing with the 
  9.16  commissioner as prescribed by statute and for the issuance of 
  9.17  original and renewal permits, licenses, registrations, and 
  9.18  certifications issued under authority of the commissioner.  The 
  9.19  expiration dates of the various licenses, permits, 
  9.20  registrations, and certifications as prescribed by the rules 
  9.21  shall be plainly marked thereon.  Fees may include application 
  9.22  and examination fees and a penalty fee for renewal applications 
  9.23  submitted after the expiration date of the previously issued 
  9.24  permit, license, registration, and certification.  The 
  9.25  commissioner may also prescribe, by rule, reduced fees for 
  9.26  permits, licenses, registrations, and certifications when the 
  9.27  application therefor is submitted during the last three months 
  9.28  of the permit, license, registration, or certification period.  
  9.29  Fees proposed to be prescribed in the rules shall be first 
  9.30  approved by the Department of Finance.  All fees proposed to be 
  9.31  prescribed in rules shall be reasonable.  The fees shall be in 
  9.32  an amount so that the total fees collected by the commissioner 
  9.33  will, where practical, approximate the cost to the commissioner 
  9.34  in administering the program.  All fees collected shall be 
  9.35  deposited in the state treasury and credited to the state 
  9.36  government special revenue fund unless otherwise specifically 
 10.1   appropriated by law for specific purposes. 
 10.2      (b) The commissioner shall adopt rules establishing 
 10.3   criteria and procedures for refusal to grant or renew licenses 
 10.4   and registrations, and for suspension and revocation of licenses 
 10.5   and registrations.  
 10.6      (c) The commissioner may refuse to grant or renew licenses 
 10.7   and registrations, or suspend or revoke licenses and 
 10.8   registrations, according to the commissioner's criteria and 
 10.9   procedures as adopted by rule.  
 10.10     (d) The commissioner may charge a fee for voluntary 
 10.11  certification of medical laboratories and environmental 
 10.12  laboratories, and for environmental and medical laboratory 
 10.13  services provided by the department, without complying with 
 10.14  paragraph (a) or chapter 14.  Fees charged for environment and 
 10.15  medical laboratory services provided by the department must be 
 10.16  approximately equal to the costs of providing the services.  
 10.17     (c) (e) The commissioner may develop a schedule of fees for 
 10.18  diagnostic evaluations conducted at clinics held by the services 
 10.19  for children with handicaps program.  All receipts generated by 
 10.20  the program are annually appropriated to the commissioner for 
 10.21  use in the maternal and child health program. 
 10.22     (d) (f) The commissioner shall set license fees for 
 10.23  hospitals and nursing homes that are not boarding care homes at 
 10.24  the following levels: 
 10.25  Joint Commission on Accreditation of Healthcare 
 10.26  Organizations (JCAHO hospitals)  $7,055 $7,555 plus $13 per bed
 10.27  Non-JCAHO hospitals              $4,680 $5,180 plus $234
 10.28                                              $247 per bed
 10.29  Nursing home                     $183 plus $91 per bed
 10.30     The commissioner shall set license fees for outpatient 
 10.31  surgical centers, boarding care homes, and supervised living 
 10.32  facilities at the following levels: 
 10.33  Outpatient surgical centers      $1,512 $3,349
 10.34  Boarding care homes              $183 plus $91 per bed
 10.35  Supervised living facilities     $183 plus $91 per bed.
 10.36     (e) (g) Unless prohibited by federal law, the commissioner 
 11.1   of health shall charge applicants the following fees to cover 
 11.2   the cost of any initial certification surveys required to 
 11.3   determine a provider's eligibility to participate in the 
 11.4   Medicare or Medicaid program: 
 11.5   Prospective payment surveys for          $  900
 11.6   hospitals
 11.8   Swing bed surveys for nursing homes      $1,200
 11.10  Psychiatric hospitals                    $1,400
 11.12  Rural health facilities                  $1,100
 11.14  Portable x-ray providers                 $  500
 11.16  Home health agencies                     $1,800
 11.18  Outpatient therapy agencies              $  800
 11.20  End stage renal dialysis providers       $2,100
 11.22  Independent therapists                   $  800
 11.24  Comprehensive rehabilitation             $1,200
 11.25  outpatient facilities
 11.27  Hospice providers                        $1,700
 11.29  Ambulatory surgical providers            $1,800
 11.31  Hospitals                                $4,200
 11.33  Other provider categories or             Actual surveyor costs:
 11.34  additional resurveys required            average surveyor cost x
 11.35  to complete initial certification        number of hours for the
 11.36                                           survey process.
 11.37     These fees shall be submitted at the time of the 
 11.38  application for federal certification and shall not be 
 11.39  refunded.  All fees collected after the date that the imposition 
 11.40  of fees is not prohibited by federal law shall be deposited in 
 11.41  the state treasury and credited to the state government special 
 11.42  revenue fund. 
 11.43     (h) The commissioner shall charge the following fees for 
 11.44  examinations, registrations, licenses, and inspections: 
 11.45  Plumbing examination                         $ 50 
 11.46  Water conditioning examination               $ 50 
 11.47  Plumbing bond registration fee               $ 40 
 11.48  Water conditioning bond registration fee     $ 40 
 11.49  Master plumber's license                     $120 
 11.50  Restricted plumbing contractor license       $ 90 
 11.51  Journeyman plumber's license                 $ 55 
 12.1   Apprentice registration                      $ 25 
 12.2   Water conditioning contractor license        $ 70 
 12.3   Water conditioning installer license         $ 35 
 12.4   Residential inspection fee (each visit)      $ 50 
 12.5   Public, commercial, and       Inspection fee 
 12.6   industrial inspections 
 12.7      25 or fewer drainage 
 12.8      fixture units                   $  300 
 12.9      26 to 50 drainage 
 12.10     fixture units                   $  900 
 12.11     51 to 150 drainage 
 12.12     fixture units                   $1,200 
 12.13     151 to 249 drainage 
 12.14     fixture units                   $1,500 
 12.15     250 or more drainage 
 12.16     fixture units                   $1,800 
 12.17     Callback fee (each visit)       $  100
 12.18     Sec. 8.  Minnesota Statutes 2004, section 144.147, 
 12.19  subdivision 1, is amended to read: 
 12.20     Subdivision 1.  [DEFINITION.] "Eligible rural hospital" 
 12.21  means any nonfederal, general acute care hospital that: 
 12.22     (1) is either located in a rural area, as defined in the 
 12.23  federal Medicare regulations, Code of Federal Regulations, title 
 12.24  42, section 405.1041, or located in a community with a 
 12.25  population of less than 10,000 15,000, according to United 
 12.26  States Census Bureau statistics, outside the seven-county 
 12.27  metropolitan area; 
 12.28     (2) has 50 or fewer beds; and 
 12.29     (3) is not for profit. 
 12.30     Sec. 9.  Minnesota Statutes 2004, section 144.147, 
 12.31  subdivision 2, is amended to read: 
 12.32     Subd. 2.  [GRANTS AUTHORIZED.] The commissioner shall 
 12.33  establish a program of grants to assist eligible rural 
 12.34  hospitals.  The commissioner shall award grants to hospitals and 
 12.35  communities for the purposes set forth in paragraphs (a) and (b).
 12.36     (a) Grants may be used by hospitals and their communities 
 13.1   to develop strategic plans for preserving or enhancing access to 
 13.2   health services.  At a minimum, a strategic plan must consist of:
 13.3      (1) a needs assessment to determine what health services 
 13.4   are needed and desired by the community.  The assessment must 
 13.5   include interviews with or surveys of area health professionals, 
 13.6   local community leaders, and public hearings; 
 13.7      (2) an assessment of the feasibility of providing needed 
 13.8   health services that identifies priorities and timeliness for 
 13.9   potential changes; and 
 13.10     (3) an implementation plan.  
 13.11     The strategic plan must be developed by a committee that 
 13.12  includes representatives from the hospital, local public health 
 13.13  agencies, other health providers, and consumers from the 
 13.14  community.  
 13.15     (b) The grants may also be used by eligible rural hospitals 
 13.16  that have developed strategic plans to implement transition 
 13.17  projects to modify the type and extent of services provided, in 
 13.18  order to reflect the needs of that plan.  Grants may be used by 
 13.19  hospitals under this paragraph to develop hospital-based 
 13.20  physician practices that integrate hospital and existing medical 
 13.21  practice facilities that agree to transfer their practices, 
 13.22  equipment, staffing, and administration to the hospital.  The 
 13.23  grants may also be used by the hospital to establish a health 
 13.24  provider cooperative, a telemedicine system, an electronic 
 13.25  health records system, or a rural health care system or to cover 
 13.26  expenses associated with being designated as a critical access 
 13.27  hospital for the Medicare rural hospital flexibility program.  
 13.28  Not more than one-third of any grant shall be used to offset 
 13.29  losses incurred by physicians agreeing to transfer their 
 13.30  practices to hospitals.  The commissioner shall give priority to 
 13.31  grant applications for projects involving electronic health 
 13.32  records systems. 
 13.33     Sec. 10.  [144.1476] [RURAL PHARMACY PLANNING AND 
 13.34  TRANSITION GRANT PROGRAM.] 
 13.35     Subdivision 1.  [DEFINITIONS.] (a) For the purposes of this 
 13.36  section, the following definitions apply. 
 14.1      (b) "Eligible rural community" means: 
 14.2      (1) a Minnesota community that is located in a rural area, 
 14.3   as defined in the federal Medicare regulations, Code of Federal 
 14.4   Regulations, title 42, section 405.1041; or 
 14.5      (2) a Minnesota community that has a population of less 
 14.6   than 10,000, according to the United States Bureau of 
 14.7   Statistics, and that is outside the seven-county metropolitan 
 14.8   area, excluding the cities of Duluth, Mankato, Moorhead, 
 14.9   Rochester, and St. Cloud. 
 14.10     (c) "Health care provider" means a hospital, clinic, 
 14.11  pharmacy, long-term care institution, or other health care 
 14.12  facility that is licensed, certified, or otherwise authorized by 
 14.13  the laws of this state to provide health care. 
 14.14     (d) "Pharmacist" means an individual with a valid license 
 14.15  issued under chapter 151 to practice pharmacy. 
 14.16     (e) "Pharmacy" has the meaning given under section 151.01, 
 14.17  subdivision 2. 
 14.18     Subd. 2.  [GRANTS AUTHORIZED; ELIGIBILITY.] (a) The 
 14.19  commissioner of health shall establish a program to award grants 
 14.20  to eligible rural communities or health care providers in 
 14.21  eligible rural communities for planning, establishing, keeping 
 14.22  in operation, or providing health care services that preserve 
 14.23  access to prescription medications and the skills of a 
 14.24  pharmacist according to sections 151.01 to 151.40. 
 14.25     (b) To be eligible for a grant, an applicant must develop a 
 14.26  strategic plan for preserving or enhancing access to 
 14.27  prescription medications and the skills of a pharmacist.  At a 
 14.28  minimum, a strategic plan must consist of: 
 14.29     (1) a needs assessment to determine what pharmacy services 
 14.30  are needed and desired by the community.  The assessment must 
 14.31  include interviews with or surveys of area and local health 
 14.32  professionals, local community leaders, and public officials; 
 14.33     (2) an assessment of the feasibility of providing needed 
 14.34  pharmacy services that identifies priorities and timelines for 
 14.35  potential changes; and 
 14.36     (3) an implementation plan. 
 15.1      (c) A grant may be used by a recipient that has developed a 
 15.2   strategic plan to implement transition projects to modify the 
 15.3   type and extent of pharmacy services provided, in order to 
 15.4   reflect the needs of the community.  Grants may also be used by 
 15.5   recipients: 
 15.6      (1) to develop pharmacy practices that integrate pharmacy 
 15.7   and existing health care provider facilities; or 
 15.8      (2) to establish a pharmacy provider cooperative or 
 15.9   initiatives that maintain local access to prescription 
 15.10  medications and the skills of a pharmacist. 
 15.11     Subd. 3.  [CONSIDERATION OF GRANTS.] In determining which 
 15.12  applicants shall receive grants under this section, the 
 15.13  commissioner of health shall appoint a committee comprised of 
 15.14  members with experience and knowledge about rural pharmacy 
 15.15  issues, including, but not limited to, two rural pharmacists 
 15.16  with a community pharmacy background, two health care providers 
 15.17  from rural communities, one representative from a statewide 
 15.18  pharmacist organization, and one representative of the Board of 
 15.19  Pharmacy.  A representative of the commissioner may serve on the 
 15.20  committee in an ex officio status.  In determining who shall 
 15.21  receive a grant, the committee shall take into account: 
 15.22     (1) improving or maintaining access to prescription 
 15.23  medications and the skills of a pharmacist; 
 15.24     (2) changes in service populations; 
 15.25     (3) the extent community pharmacy needs are not currently 
 15.26  met by other providers in the area; 
 15.27     (4) the financial condition of the applicant; 
 15.28     (5) the integration of pharmacy services into existing 
 15.29  health care services; and 
 15.30     (6) community support. 
 15.31     The commissioner may also take into account other relevant 
 15.32  factors. 
 15.33     Subd. 4.  [ALLOCATION OF GRANTS.] (a) The commissioner 
 15.34  shall establish a deadline for receiving applications and must 
 15.35  make a final decision on the funding of each application within 
 15.36  60 days of the deadline.  An applicant must apply no later than 
 16.1   March 1 of each fiscal year for grants awarded for that fiscal 
 16.2   year. 
 16.3      (b) Any grant awarded must not exceed $50,000 a year and 
 16.4   may not exceed a one-year term. 
 16.5      (c) Applicants may apply to the program each year they are 
 16.6   eligible. 
 16.7      (d) Project grants may not be used to retire debt incurred 
 16.8   with respect to any capitol expenditure made prior to the date 
 16.9   on which the project is initiated. 
 16.10     Subd. 5.  [EVALUATION.] The commissioner shall evaluate the 
 16.11  overall effectiveness of the grant program and may collect 
 16.12  progress reports and other information from grantees needed for 
 16.13  program evaluation.  An academic institution that has the 
 16.14  expertise in evaluating rural pharmacy outcomes may participate 
 16.15  in the program evaluation if asked by a grantee or the 
 16.16  commissioner.  The commissioner shall compile summaries of 
 16.17  successful grant projects and other model community efforts to 
 16.18  preserve access to prescription medications and the skills of a 
 16.19  pharmacist, and make this information available to Minnesota 
 16.20  communities seeking to address local pharmacy issues. 
 16.21     Sec. 11.  Minnesota Statutes 2004, section 144.148, 
 16.22  subdivision 1, is amended to read: 
 16.23     Subdivision 1.  [DEFINITION.] (a) For purposes of this 
 16.24  section, the following definitions apply. 
 16.25     (b) "Eligible rural hospital" means any nonfederal, general 
 16.26  acute care hospital that: 
 16.27     (1) is either located in a rural area, as defined in the 
 16.28  federal Medicare regulations, Code of Federal Regulations, title 
 16.29  42, section 405.1041, or located in a community with a 
 16.30  population of less than 10,000 15,000, according to United 
 16.31  States Census Bureau statistics, outside the seven-county 
 16.32  metropolitan area; 
 16.33     (2) has 50 or fewer beds; and 
 16.34     (3) is not for profit. 
 16.35     (c) "Eligible project" means a modernization project to 
 16.36  update, remodel, or replace aging hospital facilities and 
 17.1   equipment necessary to maintain the operations of a hospital, 
 17.2   including establishing an electronic health records system.  The 
 17.3   commissioner shall give priority to grant applications for 
 17.4   projects involving electronic health records systems. 
 17.5      Sec. 12.  Minnesota Statutes 2004, section 144.1483, is 
 17.6   amended to read: 
 17.7      144.1483 [RURAL HEALTH INITIATIVES.] 
 17.8      The commissioner of health, through the Office of Rural 
 17.9   Health, and consulting as necessary with the commissioner of 
 17.10  human services, the commissioner of commerce, the Higher 
 17.11  Education Services Office, and other state agencies, shall: 
 17.12     (1) develop a detailed plan regarding the feasibility of 
 17.13  coordinating rural health care services by organizing individual 
 17.14  medical providers and smaller hospitals and clinics into 
 17.15  referral networks with larger rural hospitals and clinics that 
 17.16  provide a broader array of services; 
 17.17     (2) develop and implement a program to assist rural 
 17.18  communities in establishing community health centers, as 
 17.19  required by section 144.1486; 
 17.20     (3) develop recommendations regarding health education and 
 17.21  training programs in rural areas, including but not limited to a 
 17.22  physician assistants' training program, continuing education 
 17.23  programs for rural health care providers, and rural outreach 
 17.24  programs for nurse practitioners within existing training 
 17.25  programs; 
 17.26     (4) (3) develop a statewide, coordinated recruitment 
 17.27  strategy for health care personnel and maintain a database on 
 17.28  health care personnel as required under section 144.1485; 
 17.29     (5) (4) develop and administer technical assistance 
 17.30  programs to assist rural communities in:  (i) planning and 
 17.31  coordinating the delivery of local health care services; and 
 17.32  (ii) hiring physicians, nurse practitioners, public health 
 17.33  nurses, physician assistants, and other health personnel; 
 17.34     (6) (5) study and recommend changes in the regulation of 
 17.35  health care personnel, such as nurse practitioners and physician 
 17.36  assistants, related to scope of practice, the amount of on-site 
 18.1   physician supervision, and dispensing of medication, to address 
 18.2   rural health personnel shortages; 
 18.3      (7) (6) support efforts to ensure continued funding for 
 18.4   medical and nursing education programs that will increase the 
 18.5   number of health professionals serving in rural areas; 
 18.6      (8) (7) support efforts to secure higher reimbursement for 
 18.7   rural health care providers from the Medicare and medical 
 18.8   assistance programs; 
 18.9      (9) (8) coordinate the development of a statewide plan for 
 18.10  emergency medical services, in cooperation with the Emergency 
 18.11  Medical Services Advisory Council; 
 18.12     (10) (9) establish a Medicare rural hospital flexibility 
 18.13  program pursuant to section 1820 of the federal Social Security 
 18.14  Act, United States Code, title 42, section 1395i-4, by 
 18.15  developing a state rural health plan and designating, consistent 
 18.16  with the rural health plan, rural nonprofit or public hospitals 
 18.17  in the state as critical access hospitals.  Critical access 
 18.18  hospitals shall include facilities that are certified by the 
 18.19  state as necessary providers of health care services to 
 18.20  residents in the area.  Necessary providers of health care 
 18.21  services are designated as critical access hospitals on the 
 18.22  basis of being more than 20 miles, defined as official mileage 
 18.23  as reported by the Minnesota Department of Transportation, from 
 18.24  the next nearest hospital, being the sole hospital in the 
 18.25  county, being a hospital located in a county with a designated 
 18.26  medically underserved area or health professional shortage area, 
 18.27  or being a hospital located in a county contiguous to a county 
 18.28  with a medically underserved area or health professional 
 18.29  shortage area.  A critical access hospital located in a county 
 18.30  with a designated medically underserved area or a health 
 18.31  professional shortage area or in a county contiguous to a county 
 18.32  with a medically underserved area or health professional 
 18.33  shortage area shall continue to be recognized as a critical 
 18.34  access hospital in the event the medically underserved area or 
 18.35  health professional shortage area designation is subsequently 
 18.36  withdrawn; and 
 19.1      (11) (10) carry out other activities necessary to address 
 19.2   rural health problems. 
 19.3      Sec. 13.  Minnesota Statutes 2004, section 144.1501, 
 19.4   subdivision 1, is amended to read: 
 19.5      Subdivision 1.  [DEFINITIONS.] (a) For purposes of this 
 19.6   section, the following definitions apply.  
 19.7      (b) "Designated rural area" means:  
 19.8      (1) an area in Minnesota outside the counties of Anoka, 
 19.9   Carver, Dakota, Hennepin, Ramsey, Scott, and Washington, 
 19.10  excluding the cities of Duluth, Mankato, Moorhead, Rochester, 
 19.11  and St. Cloud; or 
 19.12     (2) a municipal corporation, as defined under section 
 19.13  471.634, that is physically located, in whole or in part, in an 
 19.14  area defined as a designated rural area under clause (1).  
 19.15     (c) "Emergency circumstances" means those conditions that 
 19.16  make it impossible for the participant to fulfill the service 
 19.17  commitment, including death, total and permanent disability, or 
 19.18  temporary disability lasting more than two years. 
 19.19     (d) "Medical resident" means an individual participating in 
 19.20  a medical residency in family practice, internal medicine, 
 19.21  obstetrics and gynecology, pediatrics, or psychiatry.  
 19.22     (e) "Midlevel practitioner" means a nurse practitioner, 
 19.23  nurse-midwife, nurse anesthetist, advanced clinical nurse 
 19.24  specialist, or physician assistant.  
 19.25     (f) "Nurse" means an individual who has completed training 
 19.26  and received all licensing or certification necessary to perform 
 19.27  duties as a licensed practical nurse or registered nurse.  
 19.28     (g) "Nurse-midwife" means a registered nurse who has 
 19.29  graduated from a program of study designed to prepare registered 
 19.30  nurses for advanced practice as nurse-midwives.  
 19.31     (h) "Nurse practitioner" means a registered nurse who has 
 19.32  graduated from a program of study designed to prepare registered 
 19.33  nurses for advanced practice as nurse practitioners.  
 19.34     (i) "Pharmacist" means an individual with a valid license 
 19.35  issued under chapter 151 to practice pharmacy. 
 19.36     (j) "Physician" means an individual who is licensed to 
 20.1   practice medicine in the areas of family practice, internal 
 20.2   medicine, obstetrics and gynecology, pediatrics, or psychiatry.  
 20.3      (j) (k) "Physician assistant" means a person registered 
 20.4   under chapter 147A.  
 20.5      (k) (l) "Qualified educational loan" means a government, 
 20.6   commercial, or foundation loan for actual costs paid for 
 20.7   tuition, reasonable education expenses, and reasonable living 
 20.8   expenses related to the graduate or undergraduate education of a 
 20.9   health care professional.  
 20.10     (l) (m) "Underserved urban community" means a Minnesota 
 20.11  urban area or population included in the list of designated 
 20.12  primary medical care health professional shortage areas (HPSAs), 
 20.13  medically underserved areas (MUAs), or medically underserved 
 20.14  populations (MUPs) maintained and updated by the United States 
 20.15  Department of Health and Human Services.  
 20.16     Sec. 14.  Minnesota Statutes 2004, section 144.1501, 
 20.17  subdivision 2, is amended to read: 
 20.18     Subd. 2.  [CREATION OF ACCOUNT.] (a) A health professional 
 20.19  education loan forgiveness program account is established.  The 
 20.20  commissioner of health shall use money from the account to 
 20.21  establish a loan forgiveness program: 
 20.22     (1) for medical residents agreeing to practice in 
 20.23  designated rural areas or underserved urban communities, or 
 20.24  specializing in the area of pediatric psychiatry; 
 20.25     (2) for midlevel practitioners agreeing to practice in 
 20.26  designated rural areas, and or to teach for at least 20 hours 
 20.27  per week in the nursing field in a postsecondary program; 
 20.28     (3) for nurses who agree to practice in a Minnesota nursing 
 20.29  home or intermediate care facility for persons with mental 
 20.30  retardation or related conditions or to teach for at least 20 
 20.31  hours per week in the nursing field in a postsecondary program; 
 20.32     (4) for other health care technicians agreeing to teach for 
 20.33  at least 20 hours per week in their designated field in a 
 20.34  postsecondary program.  The commissioner, in consultation with 
 20.35  the Healthcare Education-Industry Partnership, shall determine 
 20.36  the health care fields where the need is the greatest, 
 21.1   including, but not limited to, respiratory therapy, clinical 
 21.2   laboratory technology, radiologic technology, and surgical 
 21.3   technology; and 
 21.4      (5) for pharmacists who agree to practice in designated 
 21.5   rural areas. 
 21.6      (b) Appropriations made to the account do not cancel and 
 21.7   are available until expended, except that at the end of each 
 21.8   biennium, any remaining balance in the account that is not 
 21.9   committed by contract and not needed to fulfill existing 
 21.10  commitments shall cancel to the fund. 
 21.11     Sec. 15.  Minnesota Statutes 2004, section 144.1501, 
 21.12  subdivision 3, is amended to read: 
 21.13     Subd. 3.  [ELIGIBILITY.] (a) To be eligible to participate 
 21.14  in the loan forgiveness program, an individual must: 
 21.15     (1) be a medical resident or a licensed pharmacist or be 
 21.16  enrolled in a midlevel practitioner, registered nurse, or a 
 21.17  licensed practical nurse training program; and 
 21.18     (2) submit an application to the commissioner of health.  
 21.19     (b) An applicant selected to participate must sign a 
 21.20  contract to agree to serve a minimum three-year full-time 
 21.21  service obligation according to subdivision 2, which shall begin 
 21.22  no later than March 31 following completion of required training.
 21.23     Sec. 16.  Minnesota Statutes 2004, section 144.1501, 
 21.24  subdivision 4, is amended to read: 
 21.25     Subd. 4.  [LOAN FORGIVENESS.] The commissioner of health 
 21.26  may select applicants each year for participation in the loan 
 21.27  forgiveness program, within the limits of available funding. The 
 21.28  commissioner shall distribute available funds for loan 
 21.29  forgiveness proportionally among the eligible professions 
 21.30  according to the vacancy rate for each profession in the 
 21.31  required geographic area or, facility type, teaching area, or 
 21.32  specialty type specified in subdivision 2.  The commissioner 
 21.33  shall allocate funds for physician loan forgiveness so that 75 
 21.34  percent of the funds available are used for rural physician loan 
 21.35  forgiveness and 25 percent of the funds available are used for 
 21.36  underserved urban communities and pediatric psychiatry loan 
 22.1   forgiveness.  If the commissioner does not receive enough 
 22.2   qualified applicants each year to use the entire allocation of 
 22.3   funds for urban underserved communities or pediatric psychiatry, 
 22.4   the remaining funds may be allocated for rural physician loan 
 22.5   forgiveness.  Applicants are responsible for securing their own 
 22.6   qualified educational loans.  The commissioner shall select 
 22.7   participants based on their suitability for practice serving the 
 22.8   required geographic area or facility type specified in 
 22.9   subdivision 2, as indicated by experience or training.  The 
 22.10  commissioner shall give preference to applicants closest to 
 22.11  completing their training.  For each year that a participant 
 22.12  meets the service obligation required under subdivision 3, up to 
 22.13  a maximum of four years, the commissioner shall make annual 
 22.14  disbursements directly to the participant equivalent to 15 
 22.15  percent of the average educational debt for indebted graduates 
 22.16  in their profession in the year closest to the applicant's 
 22.17  selection for which information is available, not to exceed the 
 22.18  balance of the participant's qualifying educational loans.  
 22.19  Before receiving loan repayment disbursements and as requested, 
 22.20  the participant must complete and return to the commissioner an 
 22.21  affidavit of practice form provided by the commissioner 
 22.22  verifying that the participant is practicing as required under 
 22.23  subdivisions 2 and 3.  The participant must provide the 
 22.24  commissioner with verification that the full amount of loan 
 22.25  repayment disbursement received by the participant has been 
 22.26  applied toward the designated loans.  After each disbursement, 
 22.27  verification must be received by the commissioner and approved 
 22.28  before the next loan repayment disbursement is made.  
 22.29  Participants who move their practice remain eligible for loan 
 22.30  repayment as long as they practice as required under subdivision 
 22.31  2.  
 22.32     Sec. 17.  Minnesota Statutes 2004, section 144.226, 
 22.33  subdivision 1, is amended to read: 
 22.34     Subdivision 1.  [WHICH SERVICES ARE FOR FEE.] The fees for 
 22.35  the following services shall be the following or an amount 
 22.36  prescribed by rule of the commissioner: 
 23.1      (a) The fee for the issuance of a certified vital record or 
 23.2   a certification that the vital record cannot be found is $8 $9.  
 23.3   No fee shall be charged for a certified birth or death record 
 23.4   that is reissued within one year of the original issue, if an 
 23.5   amendment is made to the vital record and if the previously 
 23.6   issued vital record is surrendered.  The fee is nonrefundable. 
 23.7      (b) The fee for processing a request for the replacement of 
 23.8   a birth record for all events, except when filing a recognition 
 23.9   of parentage pursuant to section 257.73, subdivision 1, 
 23.10  is $20 $40.  The fee is payable at the time of application and 
 23.11  is nonrefundable. 
 23.12     (c) The fee for processing a request for the filing of a 
 23.13  delayed registration of birth or death is $20 $40.  The fee is 
 23.14  payable at the time of application and is nonrefundable.  This 
 23.15  fee includes one subsequent review of the request if the request 
 23.16  is not acceptable upon the initial receipt. 
 23.17     (d) The fee for processing a request for the amendment of 
 23.18  any vital record when requested more than 45 days after the 
 23.19  filing of the vital record is $20 $40.  No fee shall be charged 
 23.20  for an amendment requested within 45 days after the filing of 
 23.21  the vital record.  The fee is payable at the time of application 
 23.22  and is nonrefundable.  This fee includes one subsequent review 
 23.23  of the request if the request is not acceptable upon the initial 
 23.24  receipt. 
 23.25     (e) The fee for processing a request for the verification 
 23.26  of information from vital records is $8 $9 when the applicant 
 23.27  furnishes the specific information to locate the vital record.  
 23.28  When the applicant does not furnish specific information, the 
 23.29  fee is $20 per hour for staff time expended.  Specific 
 23.30  information includes the correct date of the event and the 
 23.31  correct name of the registrant.  Fees charged shall approximate 
 23.32  the costs incurred in searching and copying the vital records.  
 23.33  The fee shall be is payable at the time of application and is 
 23.34  nonrefundable. 
 23.35     (f) The fee for processing a request for the issuance of a 
 23.36  copy of any document on file pertaining to a vital record or 
 24.1   statement that a related document cannot be found is $8 $9.  The 
 24.2   fee is payable at the time of application and is nonrefundable. 
 24.3      Sec. 18.  Minnesota Statutes 2004, section 144.226, is 
 24.4   amended by adding a subdivision to read: 
 24.5      Subd. 5.  [ELECTRONIC VERIFICATION.] A fee for the 
 24.6   electronic verification of a vital event, when the information 
 24.7   being verified is obtained from a certified birth or death 
 24.8   record, shall be established through contractual or interagency 
 24.9   agreements with interested local, state, or federal government 
 24.10  agencies. 
 24.11     Sec. 19.  Minnesota Statutes 2004, section 144.226, is 
 24.12  amended by adding a subdivision to read: 
 24.13     Subd. 6.  [ALTERNATIVE PAYMENT METHODS.] Notwithstanding 
 24.14  subdivision 1, alternative payment methods may be approved and 
 24.15  implemented by the state registrar or a local registrar. 
 24.16     Sec. 20.  Minnesota Statutes 2004, section 144.3831, 
 24.17  subdivision 1, is amended to read: 
 24.18     Subdivision 1.  [FEE SETTING.] The commissioner of health 
 24.19  may assess an annual fee of $5.21 $6.36 for every service 
 24.20  connection to a public water supply that is owned or operated by 
 24.21  a home rule charter city, a statutory city, a city of the first 
 24.22  class, or a town.  The commissioner of health may also assess an 
 24.23  annual fee for every service connection served by a water user 
 24.24  district defined in section 110A.02. 
 24.25     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2006. 
 24.26     Sec. 21.  Minnesota Statutes 2004, section 144.551, 
 24.27  subdivision 1, is amended to read: 
 24.28     Subdivision 1.  [RESTRICTED CONSTRUCTION OR MODIFICATION.] 
 24.29  (a) The following construction or modification may not be 
 24.30  commenced:  
 24.31     (1) any erection, building, alteration, reconstruction, 
 24.32  modernization, improvement, extension, lease, or other 
 24.33  acquisition by or on behalf of a hospital that increases the bed 
 24.34  capacity of a hospital, relocates hospital beds from one 
 24.35  physical facility, complex, or site to another, or otherwise 
 24.36  results in an increase or redistribution of hospital beds within 
 25.1   the state; and 
 25.2      (2) the establishment of a new hospital.  
 25.3      (b) This section does not apply to:  
 25.4      (1) construction or relocation within a county by a 
 25.5   hospital, clinic, or other health care facility that is a 
 25.6   national referral center engaged in substantial programs of 
 25.7   patient care, medical research, and medical education meeting 
 25.8   state and national needs that receives more than 40 percent of 
 25.9   its patients from outside the state of Minnesota; 
 25.10     (2) a project for construction or modification for which a 
 25.11  health care facility held an approved certificate of need on May 
 25.12  1, 1984, regardless of the date of expiration of the 
 25.13  certificate; 
 25.14     (3) a project for which a certificate of need was denied 
 25.15  before July 1, 1990, if a timely appeal results in an order 
 25.16  reversing the denial; 
 25.17     (4) a project exempted from certificate of need 
 25.18  requirements by Laws 1981, chapter 200, section 2; 
 25.19     (5) a project involving consolidation of pediatric 
 25.20  specialty hospital services within the Minneapolis-St. Paul 
 25.21  metropolitan area that would not result in a net increase in the 
 25.22  number of pediatric specialty hospital beds among the hospitals 
 25.23  being consolidated; 
 25.24     (6) a project involving the temporary relocation of 
 25.25  pediatric-orthopedic hospital beds to an existing licensed 
 25.26  hospital that will allow for the reconstruction of a new 
 25.27  philanthropic, pediatric-orthopedic hospital on an existing site 
 25.28  and that will not result in a net increase in the number of 
 25.29  hospital beds.  Upon completion of the reconstruction, the 
 25.30  licenses of both hospitals must be reinstated at the capacity 
 25.31  that existed on each site before the relocation; 
 25.32     (7) the relocation or redistribution of hospital beds 
 25.33  within a hospital building or identifiable complex of buildings 
 25.34  provided the relocation or redistribution does not result in: 
 25.35  (i) an increase in the overall bed capacity at that site; (ii) 
 25.36  relocation of hospital beds from one physical site or complex to 
 26.1   another; or (iii) redistribution of hospital beds within the 
 26.2   state or a region of the state; 
 26.3      (8) relocation or redistribution of hospital beds within a 
 26.4   hospital corporate system that involves the transfer of beds 
 26.5   from a closed facility site or complex to an existing site or 
 26.6   complex provided that:  (i) no more than 50 percent of the 
 26.7   capacity of the closed facility is transferred; (ii) the 
 26.8   capacity of the site or complex to which the beds are 
 26.9   transferred does not increase by more than 50 percent; (iii) the 
 26.10  beds are not transferred outside of a federal health systems 
 26.11  agency boundary in place on July 1, 1983; and (iv) the 
 26.12  relocation or redistribution does not involve the construction 
 26.13  of a new hospital building; 
 26.14     (9) a construction project involving up to 35 new beds in a 
 26.15  psychiatric hospital in Rice County that primarily serves 
 26.16  adolescents and that receives more than 70 percent of its 
 26.17  patients from outside the state of Minnesota; 
 26.18     (10) a project to replace a hospital or hospitals with a 
 26.19  combined licensed capacity of 130 beds or less if:  (i) the new 
 26.20  hospital site is located within five miles of the current site; 
 26.21  and (ii) the total licensed capacity of the replacement 
 26.22  hospital, either at the time of construction of the initial 
 26.23  building or as the result of future expansion, will not exceed 
 26.24  70 licensed hospital beds, or the combined licensed capacity of 
 26.25  the hospitals, whichever is less; 
 26.26     (11) the relocation of licensed hospital beds from an 
 26.27  existing state facility operated by the commissioner of human 
 26.28  services to a new or existing facility, building, or complex 
 26.29  operated by the commissioner of human services; from one 
 26.30  regional treatment center site to another; or from one building 
 26.31  or site to a new or existing building or site on the same 
 26.32  campus; 
 26.33     (12) the construction or relocation of hospital beds 
 26.34  operated by a hospital within or among hospitals having a 
 26.35  statutory obligation to provide hospital and medical services 
 26.36  for the indigent that does not result in a net increase in the 
 27.1   number of hospital beds; 
 27.2      (13) a construction project involving the addition of up to 
 27.3   31 new beds in an existing nonfederal hospital in Beltrami 
 27.4   County; 
 27.5      (14) a construction project involving the addition of up to 
 27.6   eight new beds in an existing nonfederal hospital in Otter Tail 
 27.7   County with 100 licensed acute care beds; 
 27.8      (15) a construction project involving the addition of 20 
 27.9   new hospital beds used for rehabilitation services in an 
 27.10  existing hospital in Carver County serving the southwest 
 27.11  suburban metropolitan area.  Beds constructed under this clause 
 27.12  shall not be eligible for reimbursement under medical 
 27.13  assistance, general assistance medical care, or MinnesotaCare; 
 27.14     (16) a project for the construction or relocation of up to 
 27.15  20 hospital beds for the operation of up to two psychiatric 
 27.16  facilities or units for children provided that the operation of 
 27.17  the facilities or units have received the approval of the 
 27.18  commissioner of human services; 
 27.19     (17) a project involving the addition of 14 new hospital 
 27.20  beds to be used for rehabilitation services in an existing 
 27.21  hospital in Itasca County; or 
 27.22     (18) a project to add 20 licensed beds in existing space at 
 27.23  a hospital in Hennepin County that closed 20 rehabilitation beds 
 27.24  in 2002, provided that the beds are used only for rehabilitation 
 27.25  in the hospital's current rehabilitation building.  If the beds 
 27.26  are used for another purpose or moved to another location, the 
 27.27  hospital's licensed capacity is reduced by 20 beds; or 
 27.28     (19) a critical access hospital established under section 
 27.29  144.1483, clause (10), and section 1820 of the federal Social 
 27.30  Security Act, United States Code, title 42, section 1395i-4, 
 27.31  that delicensed beds since enactment of the Balanced Budget Act 
 27.32  of 1997, Public Law 105-33, to the extent that the critical 
 27.33  access hospital does not seek to exceed the maximum number of 
 27.34  beds permitted such hospital under federal law. 
 27.35     Sec. 22.  Minnesota Statutes 2004, section 144.562, 
 27.36  subdivision 2, is amended to read: 
 28.1      Subd. 2.  [ELIGIBILITY FOR LICENSE CONDITION.] (a) A 
 28.2   hospital is not eligible to receive a license condition for 
 28.3   swing beds unless (1) it either has a licensed bed capacity of 
 28.4   less than 50 beds defined in the federal Medicare regulations, 
 28.5   Code of Federal Regulations, title 42, section 482.66, or it has 
 28.6   a licensed bed capacity of 50 beds or more and has swing beds 
 28.7   that were approved for Medicare reimbursement before May 1, 
 28.8   1985, or it has a licensed bed capacity of less than 65 beds and 
 28.9   the available nursing homes within 50 miles have had, in the 
 28.10  aggregate, an average occupancy rate of 96 percent or higher in 
 28.11  the most recent two years as documented on the statistical 
 28.12  reports to the Department of Health; and (2) it is located in a 
 28.13  rural area as defined in the federal Medicare regulations, Code 
 28.14  of Federal Regulations, title 42, section 482.66.  
 28.15     (b) Except for those critical access hospitals established 
 28.16  under section 144.1483, clause (10), and section 1820 of the 
 28.17  federal Social Security Act, United States Code, title 42, 
 28.18  section 1395i-4, that have an attached nursing home, eligible 
 28.19  hospitals are allowed a total of 1,460 2,000 days of swing bed 
 28.20  use per year, provided that no more than ten hospital beds are 
 28.21  used as swing beds at any one time.  Critical access hospitals 
 28.22  that have an attached nursing home are allowed swing bed use as 
 28.23  provided in federal law.  
 28.24     (c) Except for critical access hospitals that have an 
 28.25  attached nursing home, the commissioner of health must may 
 28.26  approve swing bed use beyond 1,460 2,000 days as long as there 
 28.27  are no Medicare certified skilled nursing facility beds 
 28.28  available within 25 miles of that hospital that are willing to 
 28.29  admit the patient.  Critical access hospitals exceeding 2,000 
 28.30  swing bed days must maintain documentation that they have 
 28.31  contacted skilled nursing facilities within 25 miles to 
 28.32  determine if any skilled nursing facility beds are available 
 28.33  that are willing to admit the patient. 
 28.34     (d) After reaching 2,000 days of swing bed use in a year, 
 28.35  an eligible hospital to which this limit applies may admit six 
 28.36  additional patients to swing beds each year without seeking 
 29.1   approval from the commissioner or being in violation of this 
 29.2   subdivision.  These six swing bed admissions are exempt from the 
 29.3   limit of 2,000 annual swing bed days for hospitals subject to 
 29.4   this limit. 
 29.5      (e) A health care system that is in full compliance with 
 29.6   this subdivision may allocate its total limit of swing bed days 
 29.7   among the hospitals within the system, provided that no hospital 
 29.8   in the system without an attached nursing home may exceed 2,000 
 29.9   swing bed days per year. 
 29.10     Sec. 23.  [144.602] [DEFINITIONS.] 
 29.11     Subdivision 1.  [APPLICABILITY.] For purposes of sections 
 29.12  144.601 to 144.608, the terms defined in this section have the 
 29.13  meanings given them. 
 29.14     Subd. 2.  [COMMISSIONER.] "Commissioner" means the 
 29.15  commissioner of health.  
 29.16     Subd. 3.  [MAJOR TRAUMA.] "Major trauma" means a sudden 
 29.17  severe injury or damage to the body caused by an external force 
 29.18  that results in potentially life-threatening injuries or that 
 29.19  could result in the following disabilities:  
 29.20     (1) impairment of cognitive or mental abilities; 
 29.21     (2) impairment of physical functioning; or 
 29.22     (3) disturbance of behavioral or emotional functioning. 
 29.23     Subd. 4.  [TRAUMA HOSPITAL.] "Trauma hospital" means a 
 29.24  hospital that voluntarily meets the commissioner's criteria 
 29.25  under section 144.603 and that has been designated as a trauma 
 29.26  hospital under section 144.605. 
 29.27     Sec. 24.  [144.603] [STATEWIDE TRAUMA SYSTEM CRITERIA.] 
 29.28     Subdivision 1.  [CRITERIA ESTABLISHED.] The commissioner 
 29.29  shall adopt criteria to ensure that severely injured people are 
 29.30  promptly transported and treated at trauma hospitals appropriate 
 29.31  to the severity of injury.  Minimum criteria shall govern 
 29.32  emergency medical service trauma triage and transportation 
 29.33  guidelines, designation of hospitals as trauma hospitals, 
 29.34  interhospital transfers, a trauma registry, and a trauma system 
 29.35  governance structure.  
 29.36     Subd. 2.  [BASIS; VERIFICATION.] The commissioner shall 
 30.1   base the establishment, implementation, and modifications to the 
 30.2   criteria under subdivision 1 on the department-published 
 30.3   Minnesota comprehensive statewide trauma system plan.  The 
 30.4   commissioner shall seek the advice of the Trauma Advisory 
 30.5   Council in implementing and updating the criteria, using 
 30.6   accepted and prevailing trauma transport, treatment, and 
 30.7   referral standards of the American College of Surgeons, the 
 30.8   American College of Emergency Physicians, the Minnesota 
 30.9   Emergency Medical Services Regulatory Board, the national Trauma 
 30.10  Resources Network, and other widely recognized trauma experts.  
 30.11  The commissioner shall adapt and modify the standards as 
 30.12  appropriate to accommodate Minnesota's unique geography and the 
 30.13  state's hospital and health professional distribution and shall 
 30.14  verify that the criteria are met by each hospital voluntarily 
 30.15  participating in the statewide trauma system.  
 30.16     Subd. 3.  [RULE EXEMPTION AND REPORT TO LEGISLATURE.] In 
 30.17  developing and adopting the criteria under this section, the 
 30.18  commissioner of health is exempt from chapter 14, including 
 30.19  section 14.386.  By September 1, 2009, the commissioner must 
 30.20  report to the legislature on implementation of the voluntary 
 30.21  trauma system, including recommendations on the need for 
 30.22  including the trauma system criteria in rule. 
 30.23     Sec. 25.  [144.604] [TRAUMA TRIAGE AND TRANSPORTATION.] 
 30.24     Subdivision 1.  [TRANSPORT REQUIREMENT.] Unless the 
 30.25  Emergency Medical Services Regulatory Board has approved a 
 30.26  licensed ambulance service's deviation from the guidelines under 
 30.27  section 144E.101, subdivision 14, the ambulance service must 
 30.28  transport major trauma patients from the scene to the highest 
 30.29  state-designated trauma hospital within 30 minutes' transport 
 30.30  time.  
 30.31     Subd. 2.  [EXCEPTIONS.] Notwithstanding subdivision 1:  
 30.32     (1) patients with compromised airways must be transported 
 30.33  immediately to the nearest designated trauma hospital; and 
 30.34     (2) level II trauma hospitals capable of providing 
 30.35  definitive trauma care must not be bypassed to reach a level I 
 30.36  trauma hospital.  
 31.1      Subd. 3.  [UNDESIGNATED HOSPITALS.] No major trauma patient 
 31.2   shall be transported to a hospital not participating in the 
 31.3   statewide trauma system unless no trauma hospital is available 
 31.4   within 30 minutes' transport time. 
 31.5      <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2009. 
 31.6      Sec. 26.  [144.605] [DESIGNATING TRAUMA HOSPITALS.] 
 31.7      Subdivision 1.  [NAMING PRIVILEGES.] Unless it has been 
 31.8   designated a trauma hospital by the commissioner, no hospital 
 31.9   shall use the term trauma center or trauma hospital in its name 
 31.10  or its advertising or shall otherwise indicate it has trauma 
 31.11  treatment capabilities. 
 31.12     Subd. 2.  [DESIGNATION; REVERIFICATION.] The commissioner 
 31.13  shall designate four levels of trauma hospitals.  A hospital 
 31.14  that voluntarily meets the criteria for a particular level of 
 31.15  trauma hospital shall apply to the commissioner for designation 
 31.16  and, upon the commissioner's verifying the hospital meets the 
 31.17  criteria, be designated a trauma hospital at the appropriate 
 31.18  level for a three-year period.  Prior to the expiration of the 
 31.19  three-year designation, a hospital seeking to remain part of the 
 31.20  voluntary system must apply for and successfully complete a 
 31.21  reverification process, be awaiting the site visit for the 
 31.22  reverification, or be awaiting the results of the site visit.  
 31.23  The commissioner may extend a hospital's existing designation 
 31.24  for up to 18 months on a provisional basis if the hospital has 
 31.25  applied for reverification in a timely manner but has not yet 
 31.26  completed the reverification process within the expiration of 
 31.27  the three-year designation and the extension is in the best 
 31.28  interest of trauma system patient safety.  To be granted a 
 31.29  provisional extension, the hospital must be:  
 31.30     (1) scheduled and awaiting the site visit for 
 31.31  reverification; 
 31.32     (2) awaiting the results of the site visit; or 
 31.33     (3) responding to and correcting identified deficiencies 
 31.34  identified in the site visit. 
 31.35     Subd. 3.  [ACS VERIFICATION.] The commissioner shall grant 
 31.36  the appropriate level I, II, or III trauma hospital designation 
 32.1   to a hospital that successfully completes and passes the 
 32.2   American College of Surgeons (ACS) verification standards at the 
 32.3   hospital's cost, submits verification documentation to the 
 32.4   Trauma Advisory Council, and formally notifies the Trauma 
 32.5   Advisory Council of ACS verification.  
 32.6      Subd. 4.  [LEVEL III DESIGNATION; NOT ACS VERIFIED.] (a) 
 32.7   The commissioner shall grant the appropriate level III trauma 
 32.8   hospital designation to a hospital that is not ACS verified but 
 32.9   that successfully completes the designation process under 
 32.10  paragraph (b).  
 32.11     (b) The hospital must complete and submit a self-reported 
 32.12  survey and application to the Trauma Advisory Council for 
 32.13  review, verifying that the hospital meets the criteria as a 
 32.14  level III trauma hospital.  When the Trauma Advisory Council is 
 32.15  satisfied the application is complete, the commissioner shall 
 32.16  arrange a site review visit.  Upon successful completion of the 
 32.17  site review, the review team shall make written recommendations 
 32.18  to the Trauma Advisory Council.  If approved by the Trauma 
 32.19  Advisory Council, a letter of recommendation shall be sent to 
 32.20  the commissioner for final approval and designation.  
 32.21     Subd. 5.  [LEVEL IV DESIGNATION.] (a) The commissioner 
 32.22  shall grant the appropriate level IV trauma hospital designation 
 32.23  to a hospital that successfully completes the designation 
 32.24  process under paragraph (b).  
 32.25     (b) The hospital must complete and submit a self-reported 
 32.26  survey and application to the Trauma Advisory Council for 
 32.27  review, verifying that the hospital meets the criteria as a 
 32.28  level IV trauma hospital.  When the Trauma Advisory Council is 
 32.29  satisfied the application is complete, the council shall review 
 32.30  the application and, if the council approves the application, 
 32.31  send a letter of recommendation to the commissioner for final 
 32.32  approval and designation.  The commissioner shall grant a level 
 32.33  IV designation and shall arrange a site review visit within 
 32.34  three years of the designation and every three years thereafter, 
 32.35  to coincide with the three-year reverification process.  
 32.36     Subd. 6.  [CHANGES IN DESIGNATION.] Changes in a trauma 
 33.1   hospital's ability to meet the criteria for the hospital's level 
 33.2   of designation must be self-reported to the Trauma Advisory 
 33.3   Council and to other regional hospitals and local emergency 
 33.4   medical services providers and authorities.  If the hospital 
 33.5   cannot correct its ability to meet the criteria for its level 
 33.6   within six months, the hospital may apply for redesignation at a 
 33.7   different level.  
 33.8      Subd. 7.  [HIGHER DESIGNATION.] A trauma hospital may apply 
 33.9   for a higher trauma hospital designation one time during the 
 33.10  hospital's three-year designation by completing the designation 
 33.11  process for that level of trauma hospital.  
 33.12     Subd. 8.  [LOSS OF DESIGNATION.] The commissioner may 
 33.13  refuse to designate or redesignate or may revoke a previously 
 33.14  issued trauma hospital designation if a hospital does not meet 
 33.15  the criteria of the statewide trauma plan, in the interests of 
 33.16  patient safety, or if a hospital denies or refuses a reasonable 
 33.17  request by the commissioner or the commissioner's designee to 
 33.18  verify information by correspondence or an on-site visit. 
 33.19     Sec. 27.  [144.606] [INTERHOSPITAL TRANSFERS.] 
 33.20     Subdivision 1.  [WRITTEN PROCEDURES REQUIRED.] A level III 
 33.21  or IV trauma hospital must have predetermined, written 
 33.22  procedures that direct the internal process for rapidly and 
 33.23  efficiently transferring a major trauma patient to definitive 
 33.24  care, including: 
 33.25     (1) clearly identified anatomic and physiologic criteria 
 33.26  that, if met, will immediately initiate transfer to definitive 
 33.27  care; 
 33.28     (2) a listing of appropriate ground and air transport 
 33.29  services, including primary and secondary telephone contact 
 33.30  numbers; and 
 33.31     (3) immediately available supplies, records, or other 
 33.32  necessary resources that will accompany a patient.  
 33.33     Subd. 2.  [TRANSFER AGREEMENTS.] (a) A level III or IV 
 33.34  trauma hospital may transfer patients to a hospital with which 
 33.35  the trauma hospital has a written transfer agreement. 
 33.36     (b) Each agreement must be current and with a trauma 
 34.1   hospital or trauma hospitals capable of caring for major trauma 
 34.2   injuries.  
 34.3      (c) A level III or IV trauma hospital must have a current 
 34.4   transfer agreement with a hospital that has special capabilities 
 34.5   in the treatment of burn injuries and a transfer agreement with 
 34.6   a second hospital that has special capabilities in the treatment 
 34.7   of burn injuries, should the primary transfer hospital be unable 
 34.8   to accept a burn patient. 
 34.9      Sec. 28.  [144.607] [TRAUMA REGISTRY.] 
 34.10     Subdivision 1.  [REGISTRY PARTICIPATION REQUIRED.] A trauma 
 34.11  hospital must participate in the statewide trauma registry.  
 34.12     Subd. 2.  [TRAUMA REPORTING.] A trauma hospital must report 
 34.13  major trauma injuries as part of the reporting for the traumatic 
 34.14  brain injury and spinal cord injury registry required in 
 34.15  sections 144.661 to 144.665.  
 34.16     Subd. 3.  [APPLICATION OF OTHER LAW.] Sections 144.661 to 
 34.17  144.665 apply to a major trauma reported to the statewide trauma 
 34.18  registry, with the exception of sections 144.662, clause (2), 
 34.19  and 144.664, subdivision 3.  
 34.20     Sec. 29.  [144.608] [TRAUMA ADVISORY COUNCIL.] 
 34.21     Subdivision 1.  [TRAUMA ADVISORY COUNCIL ESTABLISHED.] (a) 
 34.22  A Trauma Advisory Council is established to advise, consult 
 34.23  with, and make recommendations to the commissioner on the 
 34.24  development, maintenance, and improvement of a statewide trauma 
 34.25  system.  
 34.26     (b) The council shall consist of the following members:  
 34.27     (1) a trauma surgeon certified by the American College of 
 34.28  Surgeons who practices in a level I or II trauma hospital; 
 34.29     (2) a general surgeon certified by the American College of 
 34.30  Surgeons whose practice includes trauma and who practices in a 
 34.31  designated rural area as defined under section 144.1501, 
 34.32  subdivision 1, paragraph (b); 
 34.33     (3) a neurosurgeon certified by the American Board of 
 34.34  Neurological Surgery who practices in a level I or II trauma 
 34.35  hospital; 
 34.36     (4) a trauma program nurse manager or coordinator 
 35.1   practicing in a level I or II trauma hospital; 
 35.2      (5) an emergency physician certified by the American 
 35.3   College of Emergency Physicians whose practice includes 
 35.4   emergency room care in a level I, II, III, or IV trauma 
 35.5   hospital; 
 35.6      (6) an emergency room nurse manager who practices in a 
 35.7   level III or IV trauma hospital; 
 35.8      (7) a family practice physician whose practice includes 
 35.9   emergency room care in a level III or IV trauma hospital located 
 35.10  in a designated rural area as defined under section 144.1501, 
 35.11  subdivision 1, paragraph (b); 
 35.12     (8) a nurse practitioner, as defined under section 
 35.13  144.1501, subdivision 1, paragraph (h), or a physician 
 35.14  assistant, as defined under section 144.1501, subdivision 1, 
 35.15  paragraph (j), whose practice includes emergency room care in a 
 35.16  level IV trauma hospital located in a designated rural area as 
 35.17  defined under section 144.1501, subdivision 1, paragraph (b); 
 35.18     (9) a pediatrician certified by the American Academy of 
 35.19  Pediatrics whose practice includes emergency room care in a 
 35.20  level I, II, III, or IV trauma hospital; 
 35.21     (10) an orthopedic surgeon certified by the American Board 
 35.22  of Orthopedic Surgery whose practice includes trauma and who 
 35.23  practices in a level I, II, or III trauma hospital; 
 35.24     (11) the state emergency medical services medical director 
 35.25  appointed by the Emergency Medical Services Regulatory Board; 
 35.26     (12) a hospital administrator of a level III or IV trauma 
 35.27  hospital located in a designated rural area as defined under 
 35.28  section 144.1501, subdivision 1, paragraph (b); 
 35.29     (13) a rehabilitation specialist whose practice includes 
 35.30  rehabilitation of patients with major trauma injuries or 
 35.31  traumatic brain injuries and spinal cord injuries as defined 
 35.32  under section 144.661; 
 35.33     (14) an attendant or ambulance director who is an EMT, 
 35.34  EMT-I, or EMT-P within the meaning of section 144E.001 and who 
 35.35  actively practices with a licensed ambulance service in a 
 35.36  primary service area located in a designated rural area as 
 36.1   defined under section 144.1501, subdivision 1, paragraph (b); 
 36.2   and 
 36.3      (15) the commissioner of public safety or the 
 36.4   commissioner's designee.  
 36.5      (c) Council members whose appointment is dependent on 
 36.6   practice in a level III or IV trauma hospital may be appointed 
 36.7   to an initial term based upon their statements that the hospital 
 36.8   intends to become a level III or IV facility by July 1, 2009.  
 36.9      Subd. 2.  [COUNCIL ADMINISTRATION.] (a) The council must 
 36.10  meet at least twice a year but may meet more frequently at the 
 36.11  call of the chair, a majority of the council members, or the 
 36.12  commissioner.  
 36.13     (b) The terms, compensation, and removal of members of the 
 36.14  council are governed by section 15.059, except that the council 
 36.15  expires June 30, 2015. 
 36.16     (c) The council may appoint subcommittees and workgroups.  
 36.17  Subcommittees shall consist of council members.  Workgroups may 
 36.18  include noncouncil members.  Noncouncil members shall be 
 36.19  compensated for workgroup activities under section 15.059, 
 36.20  subdivision 3, but shall receive expenses only.  
 36.21     Subd. 3.  [REGIONAL TRAUMA ADVISORY COUNCILS.] (a) Up to 
 36.22  eight regional trauma advisory councils may be formed as needed. 
 36.23     (b) Regional trauma advisory councils shall advise, consult 
 36.24  with, and make recommendation to the state Trauma Advisory 
 36.25  Council on suggested regional modifications to the statewide 
 36.26  trauma criteria that will improve patient care and accommodate 
 36.27  specific regional needs.  
 36.28     (c) Each regional advisory council must have no more than 
 36.29  15 members.  The commissioner, in consultation with the 
 36.30  Emergency Medical Services Regulatory Board and the commissioner 
 36.31  of public safety, shall name the council members. 
 36.32     (d) Regional council members may receive expenses in the 
 36.33  same manner and amount as authorized by the plan adopted under 
 36.34  section 43A.18, subdivision 2.  
 36.35     Sec. 30.  Minnesota Statutes 2004, section 144.9504, 
 36.36  subdivision 2, is amended to read: 
 37.1      Subd. 2.  [LEAD RISK ASSESSMENT.] (a) An assessing agency 
 37.2   shall conduct a lead risk assessment of a residence according to 
 37.3   the venous blood lead level and time frame set forth in clauses 
 37.4   (1) to (5) (4) for purposes of secondary prevention: 
 37.5      (1) within 48 hours of a child or pregnant female in the 
 37.6   residence being identified to the agency as having a venous 
 37.7   blood lead level equal to or greater than 70 60 micrograms of 
 37.8   lead per deciliter of whole blood; 
 37.9      (2) within five working days of a child or pregnant female 
 37.10  in the residence being identified to the agency as having a 
 37.11  venous blood lead level equal to or greater than 45 micrograms 
 37.12  of lead per deciliter of whole blood; 
 37.13     (3) within ten working days of a child in the residence 
 37.14  being identified to the agency as having a venous blood lead 
 37.15  level equal to or greater than 20 15 micrograms of lead per 
 37.16  deciliter of whole blood; or 
 37.17     (4) within ten working days of a child in the residence 
 37.18  being identified to the agency as having a venous blood lead 
 37.19  level that persists in the range of 15 to 19 micrograms of lead 
 37.20  per deciliter of whole blood for 90 days after initial 
 37.21  identification; or 
 37.22     (5) within ten working days of a pregnant female in the 
 37.23  residence being identified to the agency as having a venous 
 37.24  blood lead level equal to or greater than ten micrograms of lead 
 37.25  per deciliter of whole blood.  
 37.26     (b) Within the limits of available local, state, and 
 37.27  federal appropriations, an assessing agency may also conduct a 
 37.28  lead risk assessment for children with any elevated blood lead 
 37.29  level.  
 37.30     (c) In a building with two or more dwelling units, an 
 37.31  assessing agency shall assess the individual unit in which the 
 37.32  conditions of this section are met and shall inspect all common 
 37.33  areas accessible to a child.  If a child visits one or more 
 37.34  other sites such as another residence, or a residential or 
 37.35  commercial child care facility, playground, or school, the 
 37.36  assessing agency shall also inspect the other sites.  The 
 38.1   assessing agency shall have one additional day added to the time 
 38.2   frame set forth in this subdivision to complete the lead risk 
 38.3   assessment for each additional site.  
 38.4      (d) Within the limits of appropriations, the assessing 
 38.5   agency shall identify the known addresses for the previous 12 
 38.6   months of the child or pregnant female with venous blood lead 
 38.7   levels of at least 20 15 micrograms per deciliter for the child 
 38.8   or at least ten micrograms per deciliter for the pregnant 
 38.9   female; notify the property owners, landlords, and tenants at 
 38.10  those addresses that an elevated blood lead level was found in a 
 38.11  person who resided at the property; and give them primary 
 38.12  prevention information.  Within the limits of appropriations, 
 38.13  the assessing agency may perform a risk assessment and issue 
 38.14  corrective orders in the properties, if it is likely that the 
 38.15  previous address contributed to the child's or pregnant female's 
 38.16  blood lead level.  The assessing agency shall provide the notice 
 38.17  required by this subdivision without identifying the child or 
 38.18  pregnant female with the elevated blood lead level.  The 
 38.19  assessing agency is not required to obtain the consent of the 
 38.20  child's parent or guardian or the consent of the pregnant female 
 38.21  for purposes of this subdivision.  This information shall be 
 38.22  classified as private data on individuals as defined under 
 38.23  section 13.02, subdivision 12.  
 38.24     (e) The assessing agency shall conduct the lead risk 
 38.25  assessment according to rules adopted by the commissioner under 
 38.26  section 144.9508.  An assessing agency shall have lead risk 
 38.27  assessments performed by lead risk assessors licensed by the 
 38.28  commissioner according to rules adopted under section 144.9508.  
 38.29  If a property owner refuses to allow a lead risk assessment, the 
 38.30  assessing agency shall begin legal proceedings to gain entry to 
 38.31  the property and the time frame for conducting a lead risk 
 38.32  assessment set forth in this subdivision no longer applies.  A 
 38.33  lead risk assessor or assessing agency may observe the 
 38.34  performance of lead hazard reduction in progress and shall 
 38.35  enforce the provisions of this section under section 144.9509.  
 38.36  Deteriorated painted surfaces, bare soil, and dust must be 
 39.1   tested with appropriate analytical equipment to determine the 
 39.2   lead content, except that deteriorated painted surfaces or bare 
 39.3   soil need not be tested if the property owner agrees to engage 
 39.4   in lead hazard reduction on those surfaces.  The lead content of 
 39.5   drinking water must be measured if another probable source of 
 39.6   lead exposure is not identified.  Within a standard metropolitan 
 39.7   statistical area, an assessing agency may order lead hazard 
 39.8   reduction of bare soil without measuring the lead content of the 
 39.9   bare soil if the property is in a census tract in which soil 
 39.10  sampling has been performed according to rules established by 
 39.11  the commissioner and at least 25 percent of the soil samples 
 39.12  contain lead concentrations above the standard in section 
 39.13  144.9508. 
 39.14     (f) Each assessing agency shall establish an administrative 
 39.15  appeal procedure which allows a property owner to contest the 
 39.16  nature and conditions of any lead order issued by the assessing 
 39.17  agency.  Assessing agencies must consider appeals that propose 
 39.18  lower cost methods that make the residence lead safe.  The 
 39.19  commissioner shall use the authority and appeal procedure 
 39.20  granted under sections 144.989 to 144.993. 
 39.21     (g) Sections 144.9501 to 144.9509 neither authorize nor 
 39.22  prohibit an assessing agency from charging a property owner for 
 39.23  the cost of a lead risk assessment. 
 39.24     Sec. 31.  Minnesota Statutes 2004, section 144.98, 
 39.25  subdivision 3, is amended to read: 
 39.26     Subd. 3.  [FEES.] (a) An application for certification 
 39.27  under subdivision 1 must be accompanied by the biennial fee 
 39.28  specified in this subdivision.  The fees are for: 
 39.29     (1) nonrefundable base certification fee, $1,200 
 39.30  $1,600; and 
 39.31     (2) sample preparation techniques fees, $100 per technique; 
 39.32  and 
 39.33     (3) test category certification fees: 
 39.34  Test Category                                   Certification Fee
 39.35  Clean water program bacteriology                        $600 $800
 39.36  Safe drinking water program bacteriology                $600 $800
 40.1   Clean water program inorganic chemistry                 $600 $800
 40.2   Safe drinking water program inorganic chemistry         $600 $800
 40.3   Clean water program chemistry metals                  $800 $1,200
 40.4   Safe drinking water program chemistry metals          $800 $1,200
 40.5   Resource conservation and recovery program 
 40.6     chemistry metals                                    $800 $1,200
 40.7   Clean water program volatile organic compounds      $1,200 $1,500
 40.8   Safe drinking water program 
 40.9     volatile organic compounds                        $1,200 $1,500
 40.10  Resource conservation and recovery program 
 40.11    volatile organic compounds                        $1,200 $1,500
 40.12  Underground storage tank program
 40.13    volatile organic compounds                        $1,200 $1,500
 40.14  Clean water program other organic compounds         $1,200 $1,500
 40.15  Safe drinking water program other organic compounds $1,200 $1,500
 40.16  Resource conservation and recovery program
 40.17    other organic compounds                           $1,200 $1,500
 40.18  Clean water program radiochemistry                         $2,500
 40.19  Safe drinking water program radiochemistry                 $2,500
 40.20  Resource conservation and recovery program
 40.21    agricultural contaminants                                $2,500
 40.22  Resource conservation and recovery program
 40.23    emerging contaminants                                    $2,500
 40.24     (b) The total biennial certification fee is the base fee 
 40.25  plus the applicable test category fees.  
 40.26     (c) Laboratories located outside of this state that require 
 40.27  an on-site survey will inspection shall be assessed an 
 40.28  additional $2,500 $3,750 fee. 
 40.29     (c) The total biennial certification fee includes the base 
 40.30  fee, the sample preparation techniques fees, the test category 
 40.31  fees, and, when applicable, the on-site inspection fee. 
 40.32     (d) Fees must be set so that the total fees support the 
 40.33  laboratory certification program.  Direct costs of the 
 40.34  certification service include program administration, 
 40.35  inspections, the agency's general support costs, and attorney 
 40.36  general costs attributable to the fee function. 
 41.1      (e) A change fee shall be assessed if a laboratory requests 
 41.2   additional analytes or methods at any time other than when 
 41.3   applying for or renewing its certification.  The change fee is 
 41.4   equal to the test category certification fee for the analyte.  
 41.5      (f) A variance fee shall be assessed if a laboratory 
 41.6   requests and is granted a variance from a rule adopted under 
 41.7   this section.  The variance fee is $500 per variance. 
 41.8      (g) Refunds or credits shall not be made for analytes or 
 41.9   methods requested but not approved.  
 41.10     (h) Certification of a laboratory shall not be awarded 
 41.11  until all fees are paid. 
 41.12     Sec. 32.  Minnesota Statutes 2004, section 144E.101, is 
 41.13  amended by adding a subdivision to read: 
 41.14     Subd. 14.  [TRAUMA TRIAGE AND TRANSPORT GUIDELINES.] A 
 41.15  licensee shall have written age appropriate trauma triage and 
 41.16  transport guidelines consistent with the criteria established by 
 41.17  the Trauma Advisory Council established under section 144.608, 
 41.18  and approved by the board.  The board may approve a licensee's 
 41.19  requested deviations to the guidelines due to the availability 
 41.20  of local or regional trauma resources if the changes are in the 
 41.21  best interest of the patient's health.  
 41.22     Sec. 33.  Minnesota Statutes 2004, section 145.9268, is 
 41.23  amended to read: 
 41.24     145.9268 [COMMUNITY CLINIC GRANTS.] 
 41.25     Subdivision 1.  [DEFINITION.] For purposes of this section, 
 41.26  "eligible community clinic" means: 
 41.27     (1) a nonprofit clinic that provides is established to 
 41.28  provide health services under conditions as defined in Minnesota 
 41.29  Rules, part 9505.0255, to low income or rural population groups; 
 41.30  provides medical, preventive, dental, or mental health primary 
 41.31  care services; and utilizes a sliding fee scale or other 
 41.32  procedure to determine eligibility for charity care or to ensure 
 41.33  that no person will be denied services because of inability to 
 41.34  pay; 
 41.35     (2) a governmental entity or an Indian tribal government or 
 41.36  Indian health service unit that provides services and utilizes a 
 42.1   sliding fee scale or other procedure as described under clause 
 42.2   (1); or 
 42.3      (3) a consortium of clinics comprised of entities under 
 42.4   clause (1) or (2); or 
 42.5      (4) a nonprofit, tribal, or governmental entity proposing 
 42.6   the establishment of a clinic that will provide services and 
 42.7   utilize a sliding fee scale or other procedure as described 
 42.8   under clause (1). 
 42.9      Subd. 2.  [GRANTS AUTHORIZED.] The commissioner of health 
 42.10  shall award grants to eligible community clinics to plan, 
 42.11  establish, or operate services to improve the ongoing viability 
 42.12  of Minnesota's clinic-based safety net providers.  Grants shall 
 42.13  be awarded to support the capacity of eligible community clinics 
 42.14  to serve low-income populations, reduce current or future 
 42.15  uncompensated care burdens, or provide for improved care 
 42.16  delivery infrastructure.  The commissioner shall award grants to 
 42.17  community clinics in metropolitan and rural areas of the state, 
 42.18  and shall ensure geographic representation in grant awards among 
 42.19  all regions of the state. 
 42.20     Subd. 3.  [ALLOCATION OF GRANTS.] (a) To receive a grant 
 42.21  under this section, an eligible community clinic must submit an 
 42.22  application to the commissioner of health by the deadline 
 42.23  established by the commissioner.  A grant may be awarded upon 
 42.24  the signing of a grant contract.  Community clinics may apply 
 42.25  for and the commissioner may award grants for one-year or 
 42.26  two-year periods. 
 42.27     (b) An application must be on a form and contain 
 42.28  information as specified by the commissioner but at a minimum 
 42.29  must contain: 
 42.30     (1) a description of the purpose or project for which grant 
 42.31  funds will be used; 
 42.32     (2) a description of the problem or problems the grant 
 42.33  funds will be used to address; and 
 42.34     (3) a description of achievable objectives, a workplan, and 
 42.35  a timeline for implementation and completion of processes or 
 42.36  projects enabled by the grant; and 
 43.1      (4) a process for documenting and evaluating results of the 
 43.2   grant. 
 43.3      (c) The commissioner shall review each application to 
 43.4   determine whether the application is complete and whether the 
 43.5   applicant and the project are eligible for a grant.  In 
 43.6   evaluating applications according to paragraph (d), the 
 43.7   commissioner shall establish criteria including, but not limited 
 43.8   to:  the priority level eligibility of the project; the 
 43.9   applicant's thoroughness and clarity in describing the problem 
 43.10  grant funds are intended to address; a description of the 
 43.11  applicant's proposed project; a description of the population 
 43.12  demographics and service area of the proposed project; the 
 43.13  manner in which the applicant will demonstrate the effectiveness 
 43.14  of any projects undertaken; and evidence of efficiencies and 
 43.15  effectiveness gained through collaborative efforts.  The 
 43.16  commissioner may also take into account other relevant factors, 
 43.17  including, but not limited to, the percentage for which 
 43.18  uninsured patients represent the applicant's patient base and 
 43.19  the degree to which grant funds will be used to support services 
 43.20  increasing or maintaining access to health care services.  
 43.21  During application review, the commissioner may request 
 43.22  additional information about a proposed project, including 
 43.23  information on project cost.  Failure to provide the information 
 43.24  requested disqualifies an applicant.  The commissioner has 
 43.25  discretion over the number of grants awarded. 
 43.26     (d) In determining which eligible community clinics will 
 43.27  receive grants under this section, the commissioner shall give 
 43.28  preference to those grant applications that show evidence of 
 43.29  collaboration with other eligible community clinics, hospitals, 
 43.30  health care providers, or community organizations.  In addition, 
 43.31  the commissioner shall give priority, in declining order, to 
 43.32  grant applications for projects that: In addition, the 
 43.33  commissioner shall give priority to grant applications for 
 43.34  projects involving electronic health records systems. 
 43.35     Subd. 3a.  [AWARDING GRANTS.] (a) The commissioner may 
 43.36  award grants for activities to: 
 44.1      (1) provide a direct offset to expenses incurred for 
 44.2   services provided to the clinic's target population; 
 44.3      (2) establish, update, or improve information, data 
 44.4   collection, or billing systems, including electronic health 
 44.5   records systems; 
 44.6      (3) procure, modernize, remodel, or replace equipment used 
 44.7   in the delivery of direct patient care at a clinic; 
 44.8      (4) provide improvements for care delivery, such as 
 44.9   increased translation and interpretation services; or 
 44.10     (5) build a new clinic or expand an existing facility; or 
 44.11     (6) other projects determined by the commissioner to 
 44.12  improve the ability of applicants to provide care to the 
 44.13  vulnerable populations they serve. 
 44.14     (e) (b) A grant awarded to an eligible community clinic may 
 44.15  not exceed $300,000 per eligible community clinic.  For an 
 44.16  applicant applying as a consortium of clinics, a grant may not 
 44.17  exceed $300,000 per clinic included in the consortium.  The 
 44.18  commissioner has discretion over the number of grants awarded.  
 44.19     Subd. 4.  [EVALUATION AND REPORT.] The commissioner of 
 44.20  health shall evaluate the overall effectiveness of the grant 
 44.21  program.  The commissioner shall collect progress reports to 
 44.22  evaluate the grant program from the eligible community clinics 
 44.23  receiving grants.  Every two years, as part of this evaluation, 
 44.24  the commissioner shall report to the legislature on priority 
 44.25  areas for grants set under subdivision 3 the needs of community 
 44.26  clinics and provide any recommendations for adding or 
 44.27  changing priority areas eligible activities. 
 44.28     Sec. 34.  Minnesota Statutes 2004, section 157.15, is 
 44.29  amended by adding a subdivision to read: 
 44.30     Subd. 19.  [STATEWIDE HOSPITALITY FEE.] "Statewide 
 44.31  hospitality fee" means a fee to fund statewide food, beverage, 
 44.32  and lodging program development activities, including training 
 44.33  for inspection staff, technical assistance, maintenance of a 
 44.34  statewide integrated food safety and security information 
 44.35  system, and other related statewide activities that support the 
 44.36  food, beverage, and lodging program activities. 
 45.1      Sec. 35.  Minnesota Statutes 2004, section 157.16, 
 45.2   subdivision 2, is amended to read: 
 45.3      Subd. 2.  [LICENSE RENEWAL.] Initial and renewal licenses 
 45.4   for all food and beverage service establishments, hotels, 
 45.5   motels, lodging establishments, and resorts shall be issued for 
 45.6   the calendar year for which application is made and shall expire 
 45.7   on December 31 of such year.  Any person who operates a place of 
 45.8   business after the expiration date of a license or without 
 45.9   having submitted an application and paid the fee shall be deemed 
 45.10  to have violated the provisions of this chapter and shall be 
 45.11  subject to enforcement action, as provided in the Health 
 45.12  Enforcement Consolidation Act, sections 144.989 to 144.993.  In 
 45.13  addition, a penalty of $25 $50 shall be added to the total of 
 45.14  the license fee for any food and beverage service establishment 
 45.15  operating without a license as a mobile food unit, a seasonal 
 45.16  temporary or seasonal permanent food stand, or a special event 
 45.17  food stand, and a penalty of $50 $100 shall be added to the 
 45.18  total of the license fee for all restaurants, food carts, 
 45.19  hotels, motels, lodging establishments, and resorts operating 
 45.20  without a license for a period of up to 30 days.  A late fee of 
 45.21  $300 shall be added to the license fee for establishments 
 45.22  operating more than 30 days without a license. 
 45.23     Sec. 36.  Minnesota Statutes 2004, section 157.16, is 
 45.24  amended by adding a subdivision to read: 
 45.25     Subd. 2a.  [FOOD MANAGER CERTIFICATION.] An applicant for 
 45.26  certification or certification renewal as a food manager must 
 45.27  submit to the commissioner a $28 nonrefundable certification fee 
 45.28  payable to the Department of Health. 
 45.29     Sec. 37.  Minnesota Statutes 2004, section 157.16, 
 45.30  subdivision 3, is amended to read: 
 45.31     Subd. 3.  [ESTABLISHMENT FEES; DEFINITIONS.] (a) The 
 45.32  following fees are required for food and beverage service 
 45.33  establishments, hotels, motels, lodging establishments, and 
 45.34  resorts licensed under this chapter.  Food and beverage service 
 45.35  establishments must pay the highest applicable fee under 
 45.36  paragraph (e) (d), clause (1), (2), (3), or (4), and 
 46.1   establishments serving alcohol must pay the highest applicable 
 46.2   fee under paragraph (e) (d), clause (6) or (7).  The license fee 
 46.3   for new operators previously licensed under this chapter for the 
 46.4   same calendar year is one-half of the appropriate annual license 
 46.5   fee, plus any penalty that may be required.  The license fee for 
 46.6   operators opening on or after October 1 is one-half of the 
 46.7   appropriate annual license fee, plus any penalty that may be 
 46.8   required. 
 46.9      (b) All food and beverage service establishments, except 
 46.10  special event food stands, and all hotels, motels, lodging 
 46.11  establishments, and resorts shall pay an annual base fee of 
 46.12  $145 $150. 
 46.13     (c) A special event food stand shall pay a flat fee 
 46.14  of $35 $40 annually.  "Special event food stand" means a fee 
 46.15  category where food is prepared or served in conjunction with 
 46.16  celebrations, county fairs, or special events from a special 
 46.17  event food stand as defined in section 157.15. 
 46.18     (d) In addition to the base fee in paragraph (b), each food 
 46.19  and beverage service establishment, other than a special event 
 46.20  food stand, and each hotel, motel, lodging establishment, and 
 46.21  resort shall pay an additional annual fee for each fee category 
 46.22  as, additional food service, or required additional inspection 
 46.23  specified in this paragraph: 
 46.24     (1) Limited food menu selection, $40 $50.  "Limited food 
 46.25  menu selection" means a fee category that provides one or more 
 46.26  of the following: 
 46.27     (i) prepackaged food that receives heat treatment and is 
 46.28  served in the package; 
 46.29     (ii) frozen pizza that is heated and served; 
 46.30     (iii) a continental breakfast such as rolls, coffee, juice, 
 46.31  milk, and cold cereal; 
 46.32     (iv) soft drinks, coffee, or nonalcoholic beverages; or 
 46.33     (v) cleaning for eating, drinking, or cooking utensils, 
 46.34  when the only food served is prepared off site. 
 46.35     (2) Small establishment, including boarding establishments, 
 46.36  $75 $100.  "Small establishment" means a fee category that has 
 47.1   no salad bar and meets one or more of the following: 
 47.2      (i) possesses food service equipment that consists of no 
 47.3   more than a deep fat fryer, a grill, two hot holding containers, 
 47.4   and one or more microwave ovens; 
 47.5      (ii) serves dipped ice cream or soft serve frozen desserts; 
 47.6      (iii) serves breakfast in an owner-occupied bed and 
 47.7   breakfast establishment; 
 47.8      (iv) is a boarding establishment; or 
 47.9      (v) meets the equipment criteria in clause (3), item (i) or 
 47.10  (ii), and has a maximum patron seating capacity of not more than 
 47.11  50.  
 47.12     (3) Medium establishment, $210 $260.  "Medium establishment"
 47.13  means a fee category that meets one or more of the following: 
 47.14     (i) possesses food service equipment that includes a range, 
 47.15  oven, steam table, salad bar, or salad preparation area; 
 47.16     (ii) possesses food service equipment that includes more 
 47.17  than one deep fat fryer, one grill, or two hot holding 
 47.18  containers; or 
 47.19     (iii) is an establishment where food is prepared at one 
 47.20  location and served at one or more separate locations. 
 47.21     Establishments meeting criteria in clause (2), item (v), 
 47.22  are not included in this fee category.  
 47.23     (4) Large establishment, $350 $460.  "Large establishment" 
 47.24  means either: 
 47.25     (i) a fee category that (A) meets the criteria in clause 
 47.26  (3), items (i) or (ii), for a medium establishment, (B) seats 
 47.27  more than 175 people, and (C) offers the full menu selection an 
 47.28  average of five or more days a week during the weeks of 
 47.29  operation; or 
 47.30     (ii) a fee category that (A) meets the criteria in clause 
 47.31  (3), item (iii), for a medium establishment, and (B) prepares 
 47.32  and serves 500 or more meals per day. 
 47.33     (5) Other food and beverage service, including food carts, 
 47.34  mobile food units, seasonal temporary food stands, and seasonal 
 47.35  permanent food stands, $40 $50. 
 47.36     (6) Beer or wine table service, $40 $50.  "Beer or wine 
 48.1   table service" means a fee category where the only alcoholic 
 48.2   beverage service is beer or wine, served to customers seated at 
 48.3   tables. 
 48.4      (7) Alcoholic beverage service, other than beer or wine 
 48.5   table service, $105 $135. 
 48.6      "Alcohol beverage service, other than beer or wine table 
 48.7   service" means a fee category where alcoholic mixed drinks are 
 48.8   served or where beer or wine are served from a bar. 
 48.9      (8) Lodging per sleeping accommodation unit, $6 $8, 
 48.10  including hotels, motels, lodging establishments, and resorts, 
 48.11  up to a maximum of $600 $800.  "Lodging per sleeping 
 48.12  accommodation unit" means a fee category including the number of 
 48.13  guest rooms, cottages, or other rental units of a hotel, motel, 
 48.14  lodging establishment, or resort; or the number of beds in a 
 48.15  dormitory. 
 48.16     (9) First public swimming pool, $140 $180; each additional 
 48.17  public swimming pool, $80 $100.  "Public swimming pool" means a 
 48.18  fee category that has the meaning given in Minnesota Rules, part 
 48.19  4717.0250, subpart 8. 
 48.20     (10) First spa, $80 $110; each additional spa, $40 $50.  
 48.21  "Spa pool" means a fee category that has the meaning given in 
 48.22  Minnesota Rules, part 4717.0250, subpart 9. 
 48.23     (11) Private sewer or water, $40 $50.  "Individual private 
 48.24  water" means a fee category with a water supply other than a 
 48.25  community public water supply as defined in Minnesota Rules, 
 48.26  chapter 4720.  "Individual private sewer" means a fee category 
 48.27  with an individual sewage treatment system which uses subsurface 
 48.28  treatment and disposal. 
 48.29     (12) Additional food service, $130.  "Additional food 
 48.30  service" means a location at a food service establishment, other 
 48.31  than the primary food preparation and service area, used to 
 48.32  prepare or serve food to the public. 
 48.33     (13) Additional inspection fee, $300.  "Additional 
 48.34  inspection fee" means a fee to conduct the second inspection 
 48.35  each year for elementary and secondary education facility school 
 48.36  lunch programs when required by the Richard B. Russell National 
 49.1   School Lunch Act. 
 49.2      (e) A fee of $150 $350 for review of the construction plans 
 49.3   must accompany the initial license application for food and 
 49.4   beverage service establishments restaurants, hotels, motels, 
 49.5   lodging establishments, or resorts with five or more sleeping 
 49.6   units. 
 49.7      (f) When existing food and beverage service establishments, 
 49.8   hotels, motels, lodging establishments, or resorts are 
 49.9   extensively remodeled, a fee of $150 $250 must be submitted with 
 49.10  the remodeling plans.  A fee of $250 must be submitted for new 
 49.11  construction or remodeling for a restaurant with a limited food 
 49.12  menu selection, a seasonal permanent food stand, a mobile food 
 49.13  unit, or a food cart, or for a hotel, motel, resort, or lodging 
 49.14  establishment addition of less than five sleeping units. 
 49.15     (g) Seasonal temporary food stands and special event food 
 49.16  stands are not required to submit construction or remodeling 
 49.17  plans for review. 
 49.18     Sec. 38.  Minnesota Statutes 2004, section 157.16, is 
 49.19  amended by adding a subdivision to read: 
 49.20     Subd. 3a.  [STATEWIDE HOSPITALITY FEE.] Every person, firm, 
 49.21  or corporation that operates a licensed boarding establishment, 
 49.22  food and beverage service establishment, seasonal temporary or 
 49.23  permanent food stand, special event food stand, mobile food 
 49.24  unit, food cart, resort, hotel, motel, or lodging establishment 
 49.25  in Minnesota must submit to the commissioner a $35 annual 
 49.26  statewide hospitality fee for each licensed activity.  The fee 
 49.27  for establishments licensed by the Department of Health is 
 49.28  required at the same time the licensure fee is due.  For 
 49.29  establishments licensed by local governments, the fee is due by 
 49.30  July 1 of each year.  
 49.31     Sec. 39.  Minnesota Statutes 2004, section 157.20, 
 49.32  subdivision 2, is amended to read: 
 49.33     Subd. 2.  [INSPECTION FREQUENCY.] The frequency of 
 49.34  inspections of the establishments shall be based on the degree 
 49.35  of health risk. 
 49.36     (a) High-risk establishments must be inspected at least 
 50.1   once a year every 12 months. 
 50.2      (b) Medium-risk establishments must be inspected at least 
 50.3   once every 18 months. 
 50.4      (c) Low-risk establishments must be inspected at least once 
 50.5   every two years 24 months. 
 50.6      Sec. 40.  Minnesota Statutes 2004, section 157.20, 
 50.7   subdivision 2a, is amended to read: 
 50.8      Subd. 2a.  [RISK CATEGORIES.] (a)  [HIGH-RISK 
 50.9   ESTABLISHMENT.] "High-risk establishment" means any food and 
 50.10  beverage service establishment, hotel, motel, lodging 
 50.11  establishment, or resort that: 
 50.12     (1) serves potentially hazardous foods that require 
 50.13  extensive processing on the premises, including manual handling, 
 50.14  cooling, reheating, or holding for service; 
 50.15     (2) prepares foods several hours or days before service; 
 50.16     (3) serves menu items that epidemiologic experience has 
 50.17  demonstrated to be common vehicles of food-borne illness; 
 50.18     (4) has a public swimming pool; or 
 50.19     (5) draws its drinking water from a surface water supply. 
 50.20     (b)  [MEDIUM-RISK ESTABLISHMENT.] "Medium-risk 
 50.21  establishment" means a food and beverage service establishment, 
 50.22  hotel, motel, lodging establishment, or resort that: 
 50.23     (1) serves potentially hazardous foods but with minimal 
 50.24  holding between preparation and service; or 
 50.25     (2) serves foods, such as pizza, that require extensive 
 50.26  handling followed by heat treatment. 
 50.27     (c)  [LOW-RISK ESTABLISHMENT.] "Low-risk establishment" 
 50.28  means a food and beverage service establishment, hotel, motel, 
 50.29  lodging establishment, or resort that is not a high-risk or 
 50.30  medium-risk establishment. 
 50.31     (d)  [RISK EXCEPTIONS.] Mobile food units, seasonal 
 50.32  permanent and seasonal temporary food stands, food carts, and 
 50.33  special event food stands are not inspected on an established 
 50.34  schedule and therefore are not defined as high-risk, 
 50.35  medium-risk, or low-risk establishments. 
 50.36     (e)  [SCHOOL INSPECTION FREQUENCY.] Elementary and 
 51.1   secondary school food service establishments must be inspected 
 51.2   according to the assigned risk category or by the frequency 
 51.3   required in the Richard B. Russell National School Lunch Act, 
 51.4   whichever frequency is more restrictive. 
 51.5      Sec. 41.  Minnesota Statutes 2004, section 326.01, is 
 51.6   amended by adding a subdivision to read: 
 51.7      Subd. 9a.  [RESTRICTED PLUMBING CONTRACTOR.] A "restricted 
 51.8   plumbing contractor" is any person skilled in the planning, 
 51.9   superintending, and practical installation of plumbing who is 
 51.10  otherwise lawfully qualified to contract for plumbing and 
 51.11  installations and to conduct the business of plumbing, who is 
 51.12  familiar with the laws and rules governing the business of 
 51.13  plumbing, and who performs the plumbing trade in cities and 
 51.14  towns with a population of fewer than 5,000 according to federal 
 51.15  census.  
 51.16     Sec. 42.  Minnesota Statutes 2004, section 326.37, 
 51.17  subdivision 1, is amended to read: 
 51.18     Subdivision 1.  [RULES.] The state commissioner of 
 51.19  health may shall, by rule, prescribe minimum uniform standards 
 51.20  which shall be uniform, and which standards shall thereafter be 
 51.21  effective for all new plumbing installations, including 
 51.22  additions, extensions, alterations, and replacements connected 
 51.23  with any water or sewage disposal system owned or operated by or 
 51.24  for any municipality, institution, factory, office building, 
 51.25  hotel, apartment building, or any other place of business 
 51.26  regardless of location or the population of the city or town in 
 51.27  which located.  Notwithstanding the provisions of Minnesota 
 51.28  Rules, part 4715.3130, as they apply to review of plans and 
 51.29  specifications, the commissioner may allow plumbing 
 51.30  construction, alteration, or extension to proceed without 
 51.31  approval of the plans or specifications by the commissioner. 
 51.32     The commissioner shall administer the provisions of 
 51.33  sections 326.37 to 326.45 326.451 and for such purposes may 
 51.34  employ plumbing inspectors and other assistants. 
 51.35     Sec. 43.  Minnesota Statutes 2004, section 326.37, is 
 51.36  amended by adding a subdivision to read: 
 52.1      Subd. 1a.  [INSPECTION.] All new plumbing installations, 
 52.2   including additions, extensions, alterations, and replacements, 
 52.3   shall be inspected by the commissioner for compliance with 
 52.4   accepted standards of construction for health, safety to life 
 52.5   and property, and compliance with applicable codes.  The 
 52.6   Department of Health must have full implementation of its 
 52.7   inspections plan in place and operational July 1, 2007.  This 
 52.8   subdivision does not apply where a political subdivision 
 52.9   requires, by ordinance, plumbing inspections similar to the 
 52.10  requirements of this subdivision.  
 52.11     Sec. 44.  Minnesota Statutes 2004, section 326.38, is 
 52.12  amended to read: 
 52.13     326.38 [LOCAL REGULATIONS.] 
 52.14     Any city having a system of waterworks or sewerage, or any 
 52.15  town in which reside over 5,000 people exclusive of any 
 52.16  statutory cities located therein, or the metropolitan airports 
 52.17  commission, may, by ordinance, adopt local regulations providing 
 52.18  for plumbing permits, bonds, approval of plans, and inspections 
 52.19  of plumbing, which regulations are not in conflict with the 
 52.20  plumbing standards on the same subject prescribed by the state 
 52.21  commissioner of health.  No city or such town shall prohibit 
 52.22  plumbers licensed by the state commissioner of health from 
 52.23  engaging in or working at the business, except cities and 
 52.24  statutory cities which, prior to April 21, 1933, by ordinance 
 52.25  required the licensing of plumbers.  No city or such town may 
 52.26  require a license for persons performing building sewer or water 
 52.27  service installation who have completed pipe laying training as 
 52.28  prescribed by the commissioner of health.  Any city by ordinance 
 52.29  may prescribe regulations, reasonable standards, and inspections 
 52.30  and grant permits to any person, firm, or corporation engaged in 
 52.31  the business of installing water softeners, who is not licensed 
 52.32  as a master plumber or journeyman plumber by the state 
 52.33  commissioner of health, to connect water softening and water 
 52.34  filtering equipment to private residence water distribution 
 52.35  systems, where provision has been previously made therefor and 
 52.36  openings left for that purpose or by use of cold water 
 53.1   connections to a domestic water heater; where it is not 
 53.2   necessary to rearrange, make any extension or alteration of, or 
 53.3   addition to any pipe, fixture or plumbing connected with the 
 53.4   water system except to connect the water softener, and provided 
 53.5   the connections so made comply with minimum standards prescribed 
 53.6   by the state commissioner of health. 
 53.7      Sec. 45.  Minnesota Statutes 2004, section 326.40, 
 53.8   subdivision 1, is amended to read: 
 53.9      Subdivision 1.  [PLUMBERS MUST BE LICENSED IN CERTAIN 
 53.10  CITIES; MASTER AND JOURNEYMAN PLUMBERS MASTER, JOURNEYMAN, AND 
 53.11  RESTRICTED PLUMBING CONTRACTORS; PLUMBING ON ONE'S OWN PREMISES; 
 53.12  RULES FOR EXAMINATION.] In any city now or hereafter having 
 53.13  5,000 or more population, according to the last federal census, 
 53.14  and having a system of waterworks or sewerage, no person, firm, 
 53.15  or corporation shall engage in or work at the business of a 
 53.16  master plumber or journeyman plumber unless licensed to do so by 
 53.17  the state commissioner of health.  No person, firm, or 
 53.18  corporation may engage in or work at the business of a master 
 53.19  plumber, restricted plumbing contractor, or journeyman plumber 
 53.20  unless licensed to do so by the commissioner of health under 
 53.21  sections 326.37 to 326.451.  A license is not required for: 
 53.22     (1) persons performing building sewer or water service 
 53.23  installation who have completed pipe laying training as 
 53.24  prescribed by the commissioner of health; or 
 53.25     (2) persons selling an appliance plumbing installation 
 53.26  service at point of sale if the installation work is performed 
 53.27  by a plumber licensed under sections 326.37 to 326.451.  
 53.28     A master plumber may also work as a journeyman plumber.  
 53.29  Anyone not so licensed may do plumbing work which complies with 
 53.30  the provisions of the minimum standard prescribed by the state 
 53.31  commissioner of health on premises or that part of premises 
 53.32  owned and actually occupied by the worker as a residence, unless 
 53.33  otherwise forbidden to do so by a local ordinance. 
 53.34     In any such city No person, firm, or corporation shall 
 53.35  engage in the business of installing plumbing nor install 
 53.36  plumbing in connection with the dealing in and selling of 
 54.1   plumbing material and supplies unless at all times a licensed 
 54.2   master plumber or restricted plumbing contractor, who shall be 
 54.3   responsible for proper installation, is in charge of the 
 54.4   plumbing work of the person, firm, or corporation. 
 54.5      The Department of Health shall prescribe rules, not 
 54.6   inconsistent herewith, for the examination and licensing of 
 54.7   plumbers. 
 54.8      Sec. 46.  [326.402] [RESTRICTED PLUMBING CONTRACTOR 
 54.9   LICENSE.] 
 54.10     Subdivision 1.  [LICENSURE.] The commissioner shall grant a 
 54.11  restricted plumbing contractor license to any person who applies 
 54.12  to the commissioner and provides evidence of having at least two 
 54.13  years of practical plumbing experience in the plumbing trade 
 54.14  preceding application for licensure.  
 54.15     Subd. 2.  [USE OF LICENSE.] A restricted plumbing 
 54.16  contractor may engage in the plumbing trade only in cities and 
 54.17  towns with a population of fewer than 5,000 according to federal 
 54.18  census.  
 54.19     Subd. 3.  [APPLICATION PERIOD.] Applications for restricted 
 54.20  plumbing contractor licenses must be submitted to the 
 54.21  commissioner prior to January 1, 2006.  
 54.22     Subd. 4.  [USE PERIOD FOR RESTRICTED PLUMBING CONTRACTOR 
 54.23  LICENSE.] A restricted plumbing contractor license does not 
 54.24  expire and remains in effect for as long as that person engages 
 54.25  in the plumbing trade.  
 54.26     Subd. 5.  [PROHIBITION OF TRANSFERENCE.] A restricted 
 54.27  plumbing contractor license must not be transferred or sold to 
 54.28  any other person.  
 54.29     Subd. 6.  [RESTRICTED PLUMBING CONTRACTOR LICENSE RENEWAL.] 
 54.30  The commissioner shall adopt rules for renewal of the restricted 
 54.31  plumbing contractor license.  
 54.32     Sec. 47.  Minnesota Statutes 2004, section 326.42, 
 54.33  subdivision 2, is amended to read: 
 54.34     Subd. 2.  [FEES.] Plumbing system plans and specifications 
 54.35  that are submitted to the commissioner for review shall be 
 54.36  accompanied by the appropriate plan examination fees.  If the 
 55.1   commissioner determines, upon review of the plans, that 
 55.2   inadequate fees were paid, the necessary additional fees shall 
 55.3   be paid prior to plan approval.  The commissioner shall charge 
 55.4   the following fees for plan reviews and audits of plumbing 
 55.5   installations for public, commercial, and industrial buildings:  
 55.6      (1) systems with both water distribution and drain, waste, 
 55.7   and vent systems and having:  
 55.8      (i) 25 or fewer drainage fixture units, $150; 
 55.9      (ii) 26 to 50 drainage fixture units, $250; 
 55.10     (iii) 51 to 150 drainage fixture units, $350; 
 55.11     (iv) 151 to 249 drainage fixture units, $500; 
 55.12     (v) 250 or more drainage fixture units, $3 per drainage 
 55.13  fixture unit to a maximum of $4,000; and 
 55.14     (vi) interceptors, separators, or catch basins, $70 per 
 55.15  interceptor, separator, or catch basin design; 
 55.16     (2) building sewer service only, $150; 
 55.17     (3) building water service only, $150; 
 55.18     (4) building water distribution system only, no drainage 
 55.19  system, $5 per supply fixture unit or $150, whichever is 
 55.20  greater; 
 55.21     (5) storm drainage system, a minimum fee of $150 or: 
 55.22     (i) $50 per drain opening, up to a maximum of $500; and 
 55.23     (ii) $70 per interceptor, separator, or catch basin design; 
 55.24     (6) manufactured home park or campground, one to 25 sites, 
 55.25  $300; 
 55.26     (7) manufactured home park or campground, 26 to 50 sites, 
 55.27  $350; 
 55.28     (8) manufactured home park or campground, 51 to 125 sites, 
 55.29  $400; 
 55.30     (9) manufactured home park or campground, more than 125 
 55.31  sites, $500; 
 55.32     (10) accelerated review, double the regular fee, one-half 
 55.33  to be refunded if no response from the commissioner within 15 
 55.34  business days; and 
 55.35     (11) revision to previously reviewed or incomplete plans: 
 55.36     (i) review of plans for which commissioner has issued two 
 56.1   or more requests for additional information, per review, $100 or 
 56.2   ten percent of the original fee, whichever is greater; 
 56.3      (ii) proposer-requested revision with no increase in 
 56.4   project scope, $50 or ten percent of original fee, whichever is 
 56.5   greater; and 
 56.6      (iii) proposer-requested revision with an increase in 
 56.7   project scope, $50 plus the difference between the original 
 56.8   project fee and the revised project fee. 
 56.9      Sec. 48.  [326.451] [INSPECTORS.] 
 56.10     (a) The commissioner shall set all reasonable criteria and 
 56.11  procedures by rule for inspector certification, certification 
 56.12  period, examinations, examination fees, certification fees, and 
 56.13  renewal of certifications.  
 56.14     (b) The commissioner shall adopt reasonable rules 
 56.15  establishing criteria and procedures for refusal to grant or 
 56.16  renew inspector certifications, and for suspension and 
 56.17  revocation of inspector certifications.  
 56.18     (c) The commissioner shall refuse to renew or grant 
 56.19  inspector certifications, or suspend or revoke inspector 
 56.20  certifications, in accordance with the commissioner's criteria 
 56.21  and procedures as adopted by rule.  
 56.22     Sec. 49.  [CERVICAL CANCER ELIMINATION STUDY.] 
 56.23     (a) The commissioner of health shall develop a statewide 
 56.24  integrated and comprehensive cervical cancer prevention plan, 
 56.25  including strategies for promoting and implementing the plan.  
 56.26  The plan must include activities that identify and implement 
 56.27  methods to improve the cervical cancer screening rates in 
 56.28  Minnesota, including, but not limited to: 
 56.29     (1) identifying and disseminating appropriate 
 56.30  evidence-based cervical cancer screening guidelines to be used 
 56.31  in Minnesota; 
 56.32     (2) increasing the use of appropriate screening based on 
 56.33  these guidelines for patients seen by medical groups in 
 56.34  Minnesota and monitoring results of these medical groups; and 
 56.35     (3) reducing the number of women who should but have not 
 56.36  been screened.  
 57.1      (b) In developing the plan, the commissioner shall also 
 57.2   identify and examine limitations and barriers in providing 
 57.3   cervical cancer screening, diagnosis tools, and treatment, 
 57.4   including, but not limited to, medical care reimbursement, 
 57.5   treatment costs, and the availability of insurance coverage.  
 57.6      (c) The commissioner may work with a nonprofit quality 
 57.7   improvement organization in Minnesota to identify evidence-based 
 57.8   guidelines for cervical cancer screening and to identify methods 
 57.9   to improve the cervical cancer screening rates among medical 
 57.10  groups; and may work with a nonprofit health care result 
 57.11  reporting organization to monitor results by medical groups in 
 57.12  Minnesota.  
 57.13     (d) The commissioner may convene an advisory committee that 
 57.14  includes representatives of health care providers, the American 
 57.15  Cancer Society, health plan companies, the University of 
 57.16  Minnesota Academic Health Center, community health boards, and 
 57.17  the general public.  
 57.18     (e) The commissioner shall submit a report to the 
 57.19  legislature by January 15, 2006, on: 
 57.20     (1) the statewide cervical cancer prevention plan, 
 57.21  including a description of the plan activities and strategies 
 57.22  developed for promoting and implementing the plan; 
 57.23     (2) methods for monitoring the results by medical groups 
 57.24  and by the entire state of cervical cancer screening improvement 
 57.25  activities; and 
 57.26     (3) recommended changes to existing laws, programs, or 
 57.27  services in terms of reducing the occurrence of cervical cancer 
 57.28  by improving insurance coverage for the prevention, diagnosis, 
 57.29  and treatment for cervical cancer. 
 57.30     Sec. 50.  [CLINICAL TRIAL WORK GROUP; REPORT.] 
 57.31     The commissioners of health and commerce shall, in 
 57.32  consultation with the commissioner of employee relations, 
 57.33  convene a work group regarding health plan coverage of routine 
 57.34  care associated with clinical trials.  The work group must 
 57.35  explore what high-quality clinical trials beyond cancer-only 
 57.36  clinical trials should be covered by health plans.  All other 
 58.1   types of clinical trials, disease-based or technology-based such 
 58.2   as drug trials or device trials should be considered.  The work 
 58.3   group shall use the current, cancer-only model voluntary 
 58.4   agreement that includes definitions of high-quality clinical 
 58.5   trials, protocol induced costs, and routine care costs as a 
 58.6   starting point for discussions.  As determined appropriate, the 
 58.7   work group shall establish model voluntary agreement guidelines 
 58.8   for health plan coverage of routine patient care costs incurred 
 58.9   by patients participating in high quality clinical trials.  The 
 58.10  work group shall be made up of representatives of consumers, 
 58.11  patient advocates, health plan companies, fully insured and 
 58.12  self-insured purchasers, providers, and other health care 
 58.13  professionals involved in the care and treatment of patients.  
 58.14  The commissioners shall submit the findings and recommendations 
 58.15  of the work group to the chairs of the senate and house 
 58.16  committees having jurisdiction over health policy and finance by 
 58.17  January 15, 2006.  
 58.18     Sec. 51.  [PUBLIC HEALTH INFORMATION NETWORK.] 
 58.19     (a) The commissioner of health shall work with local public 
 58.20  health departments to develop a public health information 
 58.21  network.  The development of the network must be consistent with 
 58.22  the recommendations, goals, and strategies of the Minnesota 
 58.23  public health information network report to the 2005 legislature 
 58.24  and the e-health initiative.  
 58.25     (b) The commissioner of health shall work with the 
 58.26  commissioner of human services to determine how data from care 
 58.27  systems can be utilized to assist with population health needs 
 58.28  assessments and targeted prevention efforts.  The commissioner 
 58.29  of health shall incorporate these findings into the development 
 58.30  of a Minnesota public health information network and the 
 58.31  e-health initiative. 
 58.32     Sec. 52.  [REPORT TO LEGISLATURE ON SWING BED USAGE.] 
 58.33     The commissioner of health shall review swing bed and 
 58.34  related data reported under Minnesota Statutes, sections 
 58.35  144.562, subdivision 3, paragraph (f); 144.564; and 144.698.  
 58.36  The commissioner shall report and make any appropriate 
 59.1   recommendations to the legislature by January 31, 2007, on: 
 59.2      (1) the use of swing bed days by all hospitals and by 
 59.3   critical access hospitals; 
 59.4      (2) occupancy rates in skilled nursing facilities within 25 
 59.5   miles of hospitals with swing beds; and 
 59.6      (3) information provided by rural providers on the use of 
 59.7   swing beds and the adequacy of rural services across the 
 59.8   continuum of care.  
 59.9      Sec. 53.  [IMPLEMENTATION OF AN ELECTRONIC HEALTH RECORDS 
 59.10  SYSTEM.] 
 59.11     The commissioner of health, in consultation with the 
 59.12  electronic health record planning work group established in Laws 
 59.13  2004, chapter 288, article 7, section 7, shall develop a 
 59.14  statewide plan for all hospitals and physician group practices 
 59.15  to have in place an interoperable electronic health records 
 59.16  system by January 1, 2015.  In developing the plan, the 
 59.17  commissioner shall consider:  
 59.18     (1) creating financial assistance to hospitals and 
 59.19  providers for implementing or updating an electronic health 
 59.20  records system, including, but not limited to, the establishment 
 59.21  of grants, financial incentives, or low-interest loans; 
 59.22     (2) addressing specific needs and concerns of safety-net 
 59.23  hospitals, community health clinics, and other health care 
 59.24  providers who serve low-income patients in implementing an 
 59.25  electronic records system within the hospital or practice; and 
 59.26     (3) providing assistance in the development of possible 
 59.27  alliances or collaborations among providers.  
 59.28     The commissioner shall provide preliminary reports to the 
 59.29  chairs of the senate and house committees with jurisdiction over 
 59.30  health care policy and finance biennially beginning January 15, 
 59.31  2007, on the status of reaching the goal for all hospitals and 
 59.32  physician group practices to have an interoperable electronic 
 59.33  health records system in place by January 1, 2015.  The reports 
 59.34  shall include recommendations on statutory language necessary to 
 59.35  implement the plan, including possible financing options. 
 59.36     Sec. 54.  [RULE AMENDMENT.] 
 60.1      The commissioner of health shall amend Minnesota Rules, 
 60.2   part 4626.2015, subparts 3, item C; and 6, item B, to conform 
 60.3   with Minnesota Statutes, section 157.16, subdivision 2a.  The 
 60.4   commissioner may use the good cause exemption under Minnesota 
 60.5   Statutes, section 14.388, subdivision 1, clause (3).  Minnesota 
 60.6   Statutes, section 14.386, does not apply, except to the extent 
 60.7   provided under Minnesota Statutes, section 14.388. 
 60.8      Sec. 55.  [REVISOR'S INSTRUCTION.] 
 60.9      The revisor of statutes shall change all references to 
 60.10  Minnesota Statutes, section 326.45, to Minnesota Statutes, 
 60.11  section 326.451, in Minnesota Statutes, sections 144.99, 326.44, 
 60.12  326.61, and 326.65.  
 60.13     Sec. 56.  [REPEALER.] 
 60.14     Minnesota Statutes 2004, sections 144.1486; 157.215; and 
 60.15  326.45, are repealed. 
 60.16                             ARTICLE 2
 60.17             HEALTH CARE - DEPARTMENT OF HUMAN SERVICES
 60.18     Section 1.  Minnesota Statutes 2004, section 62D.12, 
 60.19  subdivision 19, is amended to read: 
 60.20     Subd. 19.  [COVERAGE OF SERVICE.] A health maintenance 
 60.21  organization may not deny or limit coverage of a service which 
 60.22  the enrollee has already received solely on the basis of lack of 
 60.23  prior authorization or second opinion, to the extent that the 
 60.24  service would otherwise have been covered under the member's 
 60.25  contract by the health maintenance organization had prior 
 60.26  authorization or second opinion been obtained.  This subdivision 
 60.27  does not apply to health maintenance organizations for services 
 60.28  provided in the prepaid health programs administered under 
 60.29  chapter 256B, 256D, or 256L.  
 60.30     Sec. 2.  Minnesota Statutes 2004, section 62M.06, 
 60.31  subdivision 2, is amended to read: 
 60.32     Subd. 2.  [EXPEDITED APPEAL.] (a) When an initial 
 60.33  determination not to certify a health care service is made prior 
 60.34  to or during an ongoing service requiring review and the 
 60.35  attending health care professional believes that the 
 60.36  determination warrants an expedited appeal, the utilization 
 61.1   review organization must ensure that the enrollee and the 
 61.2   attending health care professional have an opportunity to appeal 
 61.3   the determination over the telephone on an expedited basis.  In 
 61.4   such an appeal, the utilization review organization must ensure 
 61.5   reasonable access to its consulting physician or health care 
 61.6   provider.  For review of initial determinations not to certify a 
 61.7   service for prepaid health care programs under chapter 256B, 
 61.8   256D, or 256L, the health care provider conducting the review 
 61.9   must follow coverage policies adopted by the health plan company 
 61.10  that are based upon published evidence-based care guidelines as 
 61.11  established by a nonprofit Minnesota quality improvement 
 61.12  organization, a nationally recognized guideline development 
 61.13  organization, or by the professional association of the 
 61.14  specialty that typically provides the service.  
 61.15     (b) The utilization review organization shall notify the 
 61.16  enrollee and attending health care professional by telephone of 
 61.17  its determination on the expedited appeal as expeditiously as 
 61.18  the enrollee's medical condition requires, but no later than 72 
 61.19  hours after receiving the expedited appeal. 
 61.20     (c) If the determination not to certify is not reversed 
 61.21  through the expedited appeal, the utilization review 
 61.22  organization must include in its notification the right to 
 61.23  submit the appeal to the external appeal process described in 
 61.24  section 62Q.73 and the procedure for initiating the process.  
 61.25  This information must be provided in writing to the enrollee and 
 61.26  the attending health care professional as soon as practical. 
 61.27     Sec. 3.  Minnesota Statutes 2004, section 62M.06, 
 61.28  subdivision 3, is amended to read: 
 61.29     Subd. 3.  [STANDARD APPEAL.] The utilization review 
 61.30  organization must establish procedures for appeals to be made 
 61.31  either in writing or by telephone. 
 61.32     (a) A utilization review organization shall notify in 
 61.33  writing the enrollee, attending health care professional, and 
 61.34  claims administrator of its determination on the appeal within 
 61.35  30 days upon receipt of the notice of appeal.  If the 
 61.36  utilization review organization cannot make a determination 
 62.1   within 30 days due to circumstances outside the control of the 
 62.2   utilization review organization, the utilization review 
 62.3   organization may take up to 14 additional days to notify the 
 62.4   enrollee, attending health care professional, and claims 
 62.5   administrator of its determination.  If the utilization review 
 62.6   organization takes any additional days beyond the initial 30-day 
 62.7   period to make its determination, it must inform the enrollee, 
 62.8   attending health care professional, and claims administrator, in 
 62.9   advance, of the extension and the reasons for the extension. 
 62.10     (b) The documentation required by the utilization review 
 62.11  organization may include copies of part or all of the medical 
 62.12  record and a written statement from the attending health care 
 62.13  professional. 
 62.14     (c) Prior to upholding the initial determination not to 
 62.15  certify for clinical reasons, the utilization review 
 62.16  organization shall conduct a review of the documentation by a 
 62.17  physician who did not make the initial determination not to 
 62.18  certify.  For review of initial determinations not to certify a 
 62.19  service for prepaid health care programs under chapter 256B, 
 62.20  256D, or 256L, the physician conducting the review must follow 
 62.21  coverage policies adopted by the health plan company that are 
 62.22  based upon publicly available evidence-based care guidelines as 
 62.23  established by a nonprofit Minnesota quality improvement 
 62.24  organization, a nationally recognized guideline development 
 62.25  organization, or by the professional association of the 
 62.26  specialty that typically provides the service.  
 62.27     (d) The process established by a utilization review 
 62.28  organization may include defining a period within which an 
 62.29  appeal must be filed to be considered.  The time period must be 
 62.30  communicated to the enrollee and attending health care 
 62.31  professional when the initial determination is made. 
 62.32     (e) An attending health care professional or enrollee who 
 62.33  has been unsuccessful in an attempt to reverse a determination 
 62.34  not to certify shall, consistent with section 72A.285, be 
 62.35  provided the following: 
 62.36     (1) a complete summary of the review findings; 
 63.1      (2) qualifications of the reviewers, including any license, 
 63.2   certification, or specialty designation; and 
 63.3      (3) the relationship between the enrollee's diagnosis and 
 63.4   the review criteria used as the basis for the decision, 
 63.5   including the specific rationale for the reviewer's decision. 
 63.6      (f) In cases of appeal to reverse a determination not to 
 63.7   certify for clinical reasons, the utilization review 
 63.8   organization must ensure that a physician of the utilization 
 63.9   review organization's choice in the same or a similar specialty 
 63.10  as typically manages the medical condition, procedure, or 
 63.11  treatment under discussion is reasonably available to review the 
 63.12  case. 
 63.13     (g) If the initial determination is not reversed on appeal, 
 63.14  the utilization review organization must include in its 
 63.15  notification the right to submit the appeal to the external 
 63.16  review process described in section 62Q.73 and the procedure for 
 63.17  initiating the external process. 
 63.18     Sec. 4.  Minnesota Statutes 2004, section 256.045, 
 63.19  subdivision 3, is amended to read: 
 63.20     Subd. 3.  [STATE AGENCY HEARINGS.] (a) State agency 
 63.21  hearings are available for the following:  (1) any person 
 63.22  applying for, receiving or having received public assistance, 
 63.23  medical care, or a program of social services granted by the 
 63.24  state agency or a county agency or the federal Food Stamp Act 
 63.25  whose application for assistance is denied, not acted upon with 
 63.26  reasonable promptness, or whose assistance is suspended, 
 63.27  reduced, terminated, or claimed to have been incorrectly paid; 
 63.28  (2) any patient or relative aggrieved by an order of the 
 63.29  commissioner under section 252.27; (3) a party aggrieved by a 
 63.30  ruling of a prepaid health plan; (4) except as provided under 
 63.31  chapter 245C, any individual or facility determined by a lead 
 63.32  agency to have maltreated a vulnerable adult under section 
 63.33  626.557 after they have exercised their right to administrative 
 63.34  reconsideration under section 626.557; (5) any person whose 
 63.35  claim for foster care payment according to a placement of the 
 63.36  child resulting from a child protection assessment under section 
 64.1   626.556 is denied or not acted upon with reasonable promptness, 
 64.2   regardless of funding source; (6) any person to whom a right of 
 64.3   appeal according to this section is given by other provision of 
 64.4   law; (7) an applicant aggrieved by an adverse decision to an 
 64.5   application for a hardship waiver under section 256B.15; (8) an 
 64.6   applicant aggrieved by an adverse decision to an application or 
 64.7   redetermination for a Medicare Part D prescription drug subsidy 
 64.8   under section 256B.04, subdivision 4a; (9) except as provided 
 64.9   under chapter 245A, an individual or facility determined to have 
 64.10  maltreated a minor under section 626.556, after the individual 
 64.11  or facility has exercised the right to administrative 
 64.12  reconsideration under section 626.556; or (9) (10) except as 
 64.13  provided under chapter 245C, an individual disqualified under 
 64.14  sections 245C.14 and 245C.15, on the basis of serious or 
 64.15  recurring maltreatment; a preponderance of the evidence that the 
 64.16  individual has committed an act or acts that meet the definition 
 64.17  of any of the crimes listed in section 245C.15, subdivisions 1 
 64.18  to 4; or for failing to make reports required under section 
 64.19  626.556, subdivision 3, or 626.557, subdivision 3.  Hearings 
 64.20  regarding a maltreatment determination under clause (4) 
 64.21  or (8) (9) and a disqualification under this clause in which the 
 64.22  basis for a disqualification is serious or recurring 
 64.23  maltreatment, which has not been set aside under sections 
 64.24  245C.22 and 245C.23, shall be consolidated into a single fair 
 64.25  hearing.  In such cases, the scope of review by the human 
 64.26  services referee shall include both the maltreatment 
 64.27  determination and the disqualification.  The failure to exercise 
 64.28  the right to an administrative reconsideration shall not be a 
 64.29  bar to a hearing under this section if federal law provides an 
 64.30  individual the right to a hearing to dispute a finding of 
 64.31  maltreatment.  Individuals and organizations specified in this 
 64.32  section may contest the specified action, decision, or final 
 64.33  disposition before the state agency by submitting a written 
 64.34  request for a hearing to the state agency within 30 days after 
 64.35  receiving written notice of the action, decision, or final 
 64.36  disposition, or within 90 days of such written notice if the 
 65.1   applicant, recipient, patient, or relative shows good cause why 
 65.2   the request was not submitted within the 30-day time limit. 
 65.3      The hearing for an individual or facility under clause (4), 
 65.4   (8) (9), or (9) (10) is the only administrative appeal to the 
 65.5   final agency determination specifically, including a challenge 
 65.6   to the accuracy and completeness of data under section 13.04.  
 65.7   Hearings requested under clause (4) apply only to incidents of 
 65.8   maltreatment that occur on or after October 1, 1995.  Hearings 
 65.9   requested by nursing assistants in nursing homes alleged to have 
 65.10  maltreated a resident prior to October 1, 1995, shall be held as 
 65.11  a contested case proceeding under the provisions of chapter 14.  
 65.12  Hearings requested under clause (8) (9) apply only to incidents 
 65.13  of maltreatment that occur on or after July 1, 1997.  A hearing 
 65.14  for an individual or facility under clause (8) (9) is only 
 65.15  available when there is no juvenile court or adult criminal 
 65.16  action pending.  If such action is filed in either court while 
 65.17  an administrative review is pending, the administrative review 
 65.18  must be suspended until the judicial actions are completed.  If 
 65.19  the juvenile court action or criminal charge is dismissed or the 
 65.20  criminal action overturned, the matter may be considered in an 
 65.21  administrative hearing. 
 65.22     For purposes of this section, bargaining unit grievance 
 65.23  procedures are not an administrative appeal. 
 65.24     The scope of hearings involving claims to foster care 
 65.25  payments under clause (5) shall be limited to the issue of 
 65.26  whether the county is legally responsible for a child's 
 65.27  placement under court order or voluntary placement agreement 
 65.28  and, if so, the correct amount of foster care payment to be made 
 65.29  on the child's behalf and shall not include review of the 
 65.30  propriety of the county's child protection determination or 
 65.31  child placement decision. 
 65.32     (b) A vendor of medical care as defined in section 256B.02, 
 65.33  subdivision 7, or a vendor under contract with a county agency 
 65.34  to provide social services is not a party and may not request a 
 65.35  hearing under this section, except if assisting a recipient as 
 65.36  provided in subdivision 4. 
 66.1      (c) An applicant or recipient is not entitled to receive 
 66.2   social services beyond the services included in the amended 
 66.3   community social services plan. 
 66.4      (d) The commissioner may summarily affirm the county or 
 66.5   state agency's proposed action without a hearing when the sole 
 66.6   issue is an automatic change due to a change in state or federal 
 66.7   law. 
 66.8      Sec. 5.  Minnesota Statutes 2004, section 256.045, 
 66.9   subdivision 3a, is amended to read: 
 66.10     Subd. 3a.  [PREPAID HEALTH PLAN APPEALS.] (a) All prepaid 
 66.11  health plans under contract to the commissioner under chapter 
 66.12  256B or 256D must provide for a complaint system according to 
 66.13  section 62D.11.  When a prepaid health plan denies, reduces, or 
 66.14  terminates a health service or denies a request to authorize a 
 66.15  previously authorized health service, the prepaid health plan 
 66.16  must notify the recipient of the right to file a complaint or an 
 66.17  appeal.  The notice must include the name and telephone number 
 66.18  of the ombudsman and notice of the recipient's right to request 
 66.19  a hearing under paragraph (b).  When a complaint is filed, the 
 66.20  prepaid health plan must notify the ombudsman within three 
 66.21  working days.  Recipients may request the assistance of the 
 66.22  ombudsman in the complaint system process.  The prepaid health 
 66.23  plan must issue a written resolution of the complaint to the 
 66.24  recipient within 30 days after the complaint is filed with the 
 66.25  prepaid health plan.  A recipient is not required to exhaust the 
 66.26  complaint system procedures in order to request a hearing under 
 66.27  paragraph (b). 
 66.28     (b) Recipients enrolled in a prepaid health plan under 
 66.29  chapter 256B or 256D may contest a prepaid health plan's denial, 
 66.30  reduction, or termination of health services, a prepaid health 
 66.31  plan's denial of a request to authorize a previously authorized 
 66.32  health service, or the prepaid health plan's written resolution 
 66.33  of a complaint by submitting a written request for a hearing 
 66.34  according to subdivision 3.  A state human services referee 
 66.35  shall conduct a hearing on the matter and shall recommend an 
 66.36  order to the commissioner of human services.  The referee may 
 67.1   not overturn a decision by a prepaid health plan to deny or 
 67.2   limit coverage for services if the prepaid health plan has used 
 67.3   coverage policies adopted by the health plan company that are 
 67.4   based upon published evidence-based criteria or guidelines in 
 67.5   making the determination unless the recipient can show by clear 
 67.6   and convincing evidence that the determination should be 
 67.7   overturned.  The commissioner need not grant a hearing if the 
 67.8   sole issue raised by a recipient is the commissioner's authority 
 67.9   to require mandatory enrollment in a prepaid health plan in a 
 67.10  county where prepaid health plans are under contract with the 
 67.11  commissioner.  The state human services referee may order a 
 67.12  second medical opinion from the prepaid health plan or may order 
 67.13  a second medical opinion from a nonprepaid health plan provider 
 67.14  at the expense of the prepaid health plan.  Recipients may 
 67.15  request the assistance of the ombudsman in the appeal process. 
 67.16     (c) In the written request for a hearing to appeal from a 
 67.17  prepaid health plan's denial, reduction, or termination of a 
 67.18  health service, a prepaid health plan's denial of a request to 
 67.19  authorize a previously authorized service, or the prepaid health 
 67.20  plan's written resolution to a complaint, a recipient may 
 67.21  request an expedited hearing.  If an expedited appeal is 
 67.22  warranted, the state human services referee shall hear the 
 67.23  appeal and render a decision within a time commensurate with the 
 67.24  level of urgency involved, based on the individual circumstances 
 67.25  of the case. 
 67.26     Sec. 6.  Minnesota Statutes 2004, section 256.9365, is 
 67.27  amended to read: 
 67.28     256.9365 [PURCHASE OF CONTINUATION COVERAGE FOR AIDS 
 67.29  PATIENTS HIV HEALTH CARE ACCESS PROGRAMS.] 
 67.30     Subdivision 1.  [INSURANCE ASSISTANCE PROGRAM ESTABLISHED.] 
 67.31  The commissioner of human services shall establish a program to 
 67.32  pay private health plan premiums for persons who have contracted 
 67.33  human immunodeficiency virus (HIV) to enable them to continue 
 67.34  coverage under a group or individual health plan.  If a person 
 67.35  is determined to be eligible under subdivision 2, the 
 67.36  commissioner shall pay the portion of the group plan premium for 
 68.1   which the individual is responsible, if the individual is 
 68.2   responsible for at least 50 percent of the cost of the premium, 
 68.3   or pay the individual plan premium.  The commissioner shall not 
 68.4   pay for that portion of a premium that is attributable to other 
 68.5   family members or dependents health care access program for 
 68.6   low-income Minnesotans living with HIV that provides access to 
 68.7   HIV treatment consistent with the guidelines of the United 
 68.8   States Public Health Service.  The program shall provide 
 68.9   assistance with medical insurance premiums to secure or maintain 
 68.10  necessary health care insurance coverage.  
 68.11     Subd. 2.  [ELIGIBILITY REQUIREMENTS.] To be eligible for 
 68.12  the HIV health care access program, an applicant must satisfy 
 68.13  the following requirements: 
 68.14     (1) the applicant must provide a physician's statement 
 68.15  verifying that the applicant is infected with HIV and is, or 
 68.16  within three months is likely to become, too ill to work in the 
 68.17  applicant's current employment because of HIV-related disease; 
 68.18     (2) the applicant's have a monthly gross family income must 
 68.19  that does not exceed 300 percent of the federal poverty 
 68.20  guidelines, after deducting medical expenses and insurance 
 68.21  premiums; 
 68.22     (3) the applicant must not own assets with a combined value 
 68.23  of more than $25,000, excluding: 
 68.24     (i) all assets excluded under section 256B.056; 
 68.25     (ii) retirement accounts, Keogh plans, and pension plans; 
 68.26  and 
 68.27     (iii) medical expense accounts set up through the 
 68.28  individual's employer; and 
 68.29     (4) if applying for payment of group plan premiums, the 
 68.30  applicant must be covered by an employer's or former employer's 
 68.31  group insurance plan have no health insurance coverage; have no 
 68.32  health insurance coverage because of ineligibility due to a 
 68.33  preexisting condition; or face loss of health insurance coverage 
 68.34  due to a change in employment status; 
 68.35     (5) reside in Minnesota; 
 68.36     (6) have been determined ineligible for Medicare, Medicaid, 
 69.1   MinnesotaCare, and general assistance medical care; and 
 69.2      (7) meet monthly cost-sharing obligations as provided for 
 69.3   in subdivision 4. 
 69.4      Subd. 3.  [COST-EFFECTIVE COVERAGE BENEFITS.] (a) For 
 69.5   individuals who are uninsured or insured with 50 percent or less 
 69.6   of the premium by an employer, the commissioner shall pay that 
 69.7   portion of the group plan premium for which the individual is 
 69.8   responsible or shall pay the individual plan premium.  The 
 69.9   commissioner shall not pay for that portion of a premium that is 
 69.10  attributable to other family members or dependents.  
 69.11     (b) Requirements for the payment of individual plan 
 69.12  premiums under subdivision 2, clause (5), 1 must be designed to 
 69.13  ensure that the state cost of paying an individual plan premium 
 69.14  does not exceed the estimated state cost that would otherwise be 
 69.15  incurred in the medical assistance or general assistance medical 
 69.16  care program.  The commissioner shall purchase the most 
 69.17  cost-effective coverage available for eligible 
 69.18  individuals.  Efforts shall be made to obtain coverage that is 
 69.19  consistent with the guidelines of the United States Public 
 69.20  Health Service for HIV treatment, and to the extent possible, 
 69.21  provides comprehensive coverage that includes medical, mental 
 69.22  health, and substance abuse treatment.  
 69.23     Subd. 4.  [COST-SHARING RESPONSIBILITIES.] The commissioner 
 69.24  may establish cost-sharing responsibilities for individuals 
 69.25  determined to be eligible for the HIV health care access program 
 69.26  that are consistent with guidelines established in the federal 
 69.27  Ryan White Care Act.  These obligations, when appropriate for 
 69.28  efficient program administration, should be consistent with 
 69.29  cost-sharing requirements for other Minnesota health care 
 69.30  programs.  
 69.31     Subd. 5.  [FISCAL INTEGRITY.] (a) The commissioner shall 
 69.32  manage the HIV health care access program to assure that the 
 69.33  program spending does not exceed the resources made available by 
 69.34  the federal government and the legislature.  
 69.35     (b) The commissioner shall make necessary program changes 
 69.36  to assure the fiscal integrity of the program.  
 70.1      (c) Each year following the release of the November revenue 
 70.2   forecast, the commissioner shall report to the chairs of the 
 70.3   appropriate health and human services finance committees the 
 70.4   forecasted need for the HIV health care access programs included 
 70.5   in this section.  The report shall include information about the 
 70.6   anticipated enrollment, service utilization, service costs, 
 70.7   state, federal, and special revenue resources available to fund 
 70.8   the program needs, and any anticipated funding shortfall. 
 70.9      (d) When a shortfall of funding is projected, 
 70.10  recommendations should be included to assure that the program 
 70.11  expenditures are maintained within the anticipated available 
 70.12  funding. 
 70.13     Subd. 6.  [CONTINUATION OF CARE.] (a) The commissioner 
 70.14  shall establish policies and procedures to ensure that initial 
 70.15  and continued access to HIV treatment is provided to recipients 
 70.16  who meet the eligibility requirements in subdivision 2.  
 70.17     (b) The policies and procedures shall consider the impacts 
 70.18  of continued HIV treatment on: 
 70.19     (1) reducing the risk for HIV transmission; 
 70.20     (2) preventing program recipients from becoming drug 
 70.21  resistant; and 
 70.22     (3) the prevention of the development of drug-resistant 
 70.23  strains of HIV. 
 70.24     Subd. 7.  [COORDINATION WITH FEDERALLY FUNDED HIV HEALTH 
 70.25  CARE ACCESS PROGRAMS.] (a) The commissioner shall administer the 
 70.26  HIV health care access program in coordination with funding 
 70.27  received from the Ryan White Care Act.  
 70.28     (b) Within the limits of the federal funding available for 
 70.29  these purposes, the commissioner may provide access to drugs 
 70.30  that treat HIV and manage the side effects of HIV treatment to 
 70.31  persons who meet the eligibility requirements in subdivision 2. 
 70.32     (c) The commissioner may establish co-payment obligations 
 70.33  for drugs purchased under this section. 
 70.34     Subd. 8.  [COMMUNITY ADVISORY PROCESS.] The commissioner 
 70.35  shall establish a community advisory process for assessing the 
 70.36  effectiveness of the policies and procedures established for the 
 71.1   HIV health care access program.  As appropriate to minimize 
 71.2   duplicative efforts, the process shall include consultation 
 71.3   with, coordination with, and reporting to the Minnesota HIV 
 71.4   Services Planning Council.  Public notification shall be made of 
 71.5   the committee's members and meetings.  
 71.6      Sec. 7.  [256.9545] [PRESCRIPTION DRUG DISCOUNT PROGRAM.] 
 71.7      Subdivision 1.  [ESTABLISHMENT; ADMINISTRATION.] The 
 71.8   commissioner shall establish and administer the prescription 
 71.9   drug discount program.  
 71.10     Subd. 2.  [COMMISSIONER'S AUTHORITY.] The commissioner 
 71.11  shall administer a drug rebate program for drugs purchased 
 71.12  according to the prescription drug discount program.  The 
 71.13  commissioner shall execute a rebate agreement from all 
 71.14  manufacturers that choose to participate in the program for 
 71.15  those drugs covered under the medical assistance program.  For 
 71.16  each drug, the amount of the rebate shall be equal to the rebate 
 71.17  as defined for purposes of the federal rebate program in United 
 71.18  States Code, title 42, section 1396r-8.  The rebate program 
 71.19  shall utilize the terms and conditions used for the federal 
 71.20  rebate program established according to section 1927 of title 
 71.21  XIX of the federal Social Security Act.  
 71.22     Subd. 3.  [DEFINITIONS.] For the purpose of this section, 
 71.23  the following terms have the meanings given them.  
 71.24     (a) "Commissioner" means the commissioner of human services.
 71.25     (b) "Participating manufacturer" means a manufacturer as 
 71.26  defined in section 151.44, paragraph (c), that agrees to 
 71.27  participate in the prescription drug discount program.  
 71.28     (c) "Covered prescription drug" means a prescription drug 
 71.29  as defined in section 151.44, paragraph (d), that is covered 
 71.30  under medical assistance as described in section 256B.0625, 
 71.31  subdivision 13, and that is provided by a participating 
 71.32  manufacturer that has a fully executed rebate agreement with the 
 71.33  commissioner under this section and complies with that agreement.
 71.34     (d) "Health carrier" means an insurance company licensed 
 71.35  under chapter 60A to offer, sell, or issue an individual or 
 71.36  group policy of accident and sickness insurance as defined in 
 72.1   section 62A.01; a nonprofit health service plan corporation 
 72.2   operating under chapter 62C; a health maintenance organization 
 72.3   operating under chapter 62D; a joint self-insurance employee 
 72.4   health plan operating under chapter 62H; a community integrated 
 72.5   service network licensed under chapter 62N; a fraternal benefit 
 72.6   society operating under chapter 64B; a city, county, school 
 72.7   district, or other political subdivision providing self-insured 
 72.8   health coverage under section 471.617 or sections 471.98 to 
 72.9   471.982; and a self-funded health plan under the Employee 
 72.10  Retirement Income Security Act of 1974, as amended.  
 72.11     (e) "Participating pharmacy" means a pharmacy as defined in 
 72.12  section 151.01, subdivision 2, that agrees to participate in the 
 72.13  prescription drug discount program.  
 72.14     (f) "Enrolled individual" means a person who is eligible 
 72.15  for the program under subdivision 4 and has enrolled in the 
 72.16  program according to subdivision 5.  
 72.17     Subd. 4.  [ELIGIBILITY.] To be eligible for the program, an 
 72.18  applicant must: 
 72.19     (1) be a permanent resident of Minnesota as defined in 
 72.20  section 256L.09, subdivision 4; 
 72.21     (2) not be enrolled in Medicare, medical assistance, 
 72.22  general assistance medical care, or MinnesotaCare; 
 72.23     (3) not be enrolled in and have currently available 
 72.24  prescription drug coverage under a health plan offered by a 
 72.25  health carrier or employer or under a pharmacy benefit program 
 72.26  offered by a pharmaceutical manufacturer; and 
 72.27     (4) not be enrolled in and have currently available 
 72.28  prescription drug coverage under a Medicare supplement plan, as 
 72.29  defined in sections 62A.31 to 62A.44, or policies, contracts, or 
 72.30  certificates that supplement Medicare issued by health 
 72.31  maintenance organizations or those policies, contracts, or 
 72.32  certificates governed by section 1833 or 1876 of the federal 
 72.33  Social Security Act, United States Code, title 42, section 1395, 
 72.34  et seq., as amended. 
 72.35     Subd. 5.  [APPLICATION PROCEDURE.] (a) Applications and 
 72.36  information on the program must be made available at county 
 73.1   social services agencies, health care provider offices, and 
 73.2   agencies and organizations serving senior citizens.  Individuals 
 73.3   shall submit applications and any information specified by the 
 73.4   commissioner as being necessary to verify eligibility directly 
 73.5   to the commissioner.  The commissioner shall determine an 
 73.6   applicant's eligibility for the program within 30 days from the 
 73.7   date the application is received.  Upon notice of approval, the 
 73.8   applicant must submit to the commissioner the enrollment fee 
 73.9   specified in subdivision 10.  Eligibility begins the month after 
 73.10  the enrollment fee is received by the commissioner. 
 73.11     (b) An enrollee's eligibility must be renewed every 12 
 73.12  months with the 12-month period beginning in the month after the 
 73.13  application is approved.  
 73.14     (c) The commissioner shall develop an application form that 
 73.15  does not exceed one page in length and requires information 
 73.16  necessary to determine eligibility for the program. 
 73.17     Subd. 6.  [PARTICIPATING PHARMACY.] (a) Upon implementation 
 73.18  of the prescription drug discount program, until January 1, 
 73.19  2008, a participating pharmacy, in accordance with a valid 
 73.20  prescription, must sell a covered prescription drug to an 
 73.21  enrolled individual at the medical assistance rate.  
 73.22     (b) After January 1, 2008, a participating pharmacy, in 
 73.23  accordance with a valid prescription, must sell a covered 
 73.24  prescription drug to an enrolled individual at the medical 
 73.25  assistance rate, minus an amount that is equal to the rebate 
 73.26  amount described in subdivision 8, plus the amount of any switch 
 73.27  fee established by the commissioner under subdivision 10, 
 73.28  paragraph (b).  
 73.29     (c) Each participating pharmacy shall provide the 
 73.30  commissioner with all information necessary to administer the 
 73.31  program, including, but not limited to, information on 
 73.32  prescription drug sales to enrolled individuals and usual and 
 73.33  customary retail prices. 
 73.34     Subd. 7.  [NOTIFICATION OF REBATE AMOUNT.] The commissioner 
 73.35  shall notify each participating manufacturer, each calendar 
 73.36  quarter or according to a schedule to be established by the 
 74.1   commissioner, of the amount of the rebate owed on the 
 74.2   prescription drugs sold by participating pharmacies to enrolled 
 74.3   individuals.  
 74.4      Subd. 8.  [PROVISION OF REBATE.] To the extent that a 
 74.5   participating manufacturer's prescription drugs are prescribed 
 74.6   to a resident of this state, the manufacturer must provide a 
 74.7   rebate equal to the rebate provided under the medical assistance 
 74.8   program for any prescription drug distributed by the 
 74.9   manufacturer that is purchased by an enrolled individual at a 
 74.10  participating pharmacy.  The participating manufacturer must 
 74.11  provide full payment within 38 days of receipt of the state 
 74.12  invoice for the rebate, or according to a schedule to be 
 74.13  established by the commissioner.  The commissioner shall deposit 
 74.14  all rebates received into the Minnesota prescription drug 
 74.15  dedicated fund established under subdivision 11.  The 
 74.16  manufacturer must provide the commissioner with any information 
 74.17  necessary to verify the rebate determined per drug.  
 74.18     Subd. 9.  [PAYMENT TO PHARMACIES.] Beginning January 1, 
 74.19  2008, the commissioner shall distribute on a biweekly basis an 
 74.20  amount that is equal to an amount collected under subdivision 8 
 74.21  to each participating pharmacy based on the prescription drugs 
 74.22  sold by that pharmacy to enrolled individuals on or after 
 74.23  January 1, 2008. 
 74.24     Subd. 10.  [ENROLLMENT FEE; SWITCH FEE.] (a) The 
 74.25  commissioner shall establish an annual enrollment fee that 
 74.26  covers the commissioner's expenses for enrollment, processing 
 74.27  claims, and distributing rebates under this program.  
 74.28     (b) The commissioner shall establish a reasonable switch 
 74.29  fee that covers expenses incurred by participating pharmacies in 
 74.30  formatting for electronic submission claims for prescription 
 74.31  drugs sold to enrolled individuals. 
 74.32     Subd. 11.  [DEDICATED FUND; CREATION; USE OF FUND.] (a) The 
 74.33  Minnesota prescription drug dedicated fund is established as an 
 74.34  account in the state treasury.  The commissioner of finance 
 74.35  shall credit to the dedicated fund all rebates paid under 
 74.36  subdivision 8, any federal funds received for the program, all 
 75.1   enrollment fees paid by the enrollees, and any appropriations or 
 75.2   allocations designated for the fund.  The commissioner of 
 75.3   finance shall ensure that fund money is invested under section 
 75.4   11A.25.  All money earned by the fund must be credited to the 
 75.5   fund.  The fund shall earn a proportionate share of the total 
 75.6   state annual investment income. 
 75.7      (b) Money in the fund is appropriated to the commissioner 
 75.8   to reimburse participating pharmacies for prescription drugs the 
 75.9   rebate discount provided to enrolled individuals under 
 75.10  subdivision 6, paragraph (b); to reimburse the commissioner for 
 75.11  costs related to enrollment, processing claims, and distributing 
 75.12  rebates and for other reasonable administrative costs related to 
 75.13  administration of the prescription drug discount program; and to 
 75.14  repay the appropriation provided for this section.  The 
 75.15  commissioner must administer the program so that the costs total 
 75.16  no more than funds appropriated plus the drug rebate proceeds. 
 75.17     <b>[EFFECTIVE DATE.]</b> This section is effective August 1, 2006, 
 75.18  or upon HealthMatch implementation, whichever is later.  
 75.19     Sec. 8.  Minnesota Statutes 2004, section 256.969, is 
 75.20  amended by adding a subdivision to read: 
 75.21     Subd. 27.  [ANNUAL NONMEDICAL ASSISTANCE PAYMENT.] (a) In 
 75.22  addition to any other payment under this section, the 
 75.23  commissioner shall make the following payments: 
 75.24     (1) for a hospital located in Minnesota and not eligible 
 75.25  for payments under subdivision 20, with a medical assistance 
 75.26  inpatient utilization rate greater than 19 percent of total 
 75.27  patient days during the base year, a payment equal to 13 percent 
 75.28  of the total of the operating and payment rates; 
 75.29     (2) for a hospital located in Minnesota in a specified 
 75.30  urban area outside of the seven-county metropolitan area and not 
 75.31  eligible for payments under subdivision 20, with a medical 
 75.32  assistance inpatient utilization rate less than or equal to 19 
 75.33  percent of total patient days during the base year, a payment 
 75.34  equal to ten percent of the total of the operating and property 
 75.35  payment rates.  For purposes of this clause, the following 
 75.36  cities are specified urban areas:  Detroit Lakes, Rochester, 
 76.1   Willmar, Hutchinson, Alexandria, Austin, Cambridge, Brainerd, 
 76.2   Hibbing, Mankato, Duluth, St. Cloud, Grand Rapids, Wyoming, 
 76.3   Fergus Falls, Albert Lea, Winona, Virginia, Thief River Falls, 
 76.4   and Wadena; and 
 76.5      (3) for a hospital located in Minnesota but not located in 
 76.6   a specified urban area under clause (2) and not eligible for 
 76.7   payments under subdivision 20, with a medical assistance 
 76.8   inpatient utilization rate less than or equal to 19 percent of 
 76.9   total patient days during the base year, a payment equal to five 
 76.10  percent of the total of the operating and property payment rates.
 76.11     (b) The payments under paragraph (a) shall be 100 percent 
 76.12  state dollars derived from federal reimbursements to the 
 76.13  commissioner to reimburse nonstate expenditures reported under 
 76.14  section 256B.199. 
 76.15     (c) The payments under paragraph (a) shall be paid annually 
 76.16  on July 1, beginning July 1, 2005, or upon the receipt of 
 76.17  federal reimbursements under section 256B.199, whichever occurs 
 76.18  last, for services to be rendered in the fiscal year beginning 
 76.19  on July 1, based on services rendered in the previous calendar 
 76.20  year.  
 76.21     (d) The commissioner shall not adjust rates paid to a 
 76.22  prepaid health plan under contract with the commissioner to 
 76.23  reflect payments provided in paragraph (a). 
 76.24     (e) If federal reimbursements are not available under 
 76.25  section 256B.199 for all payments under paragraph (a), the 
 76.26  commissioner shall reduce payments under paragraph (a) on a pro 
 76.27  rata basis so that payments under paragraph (a) do not exceed 
 76.28  the federal reimbursements. 
 76.29     (f) For purposes of this subdivision, medical assistance 
 76.30  does not include general assistance medical care.  
 76.31     (g) The commissioner may ratably reduce or increase the 
 76.32  payments under this subdivision in order to ensure that these 
 76.33  total payments equal the amount of reimbursement received by the 
 76.34  commissioner under section 256B.199. 
 76.35     (h) The commissioner may, in consultation with the nonstate 
 76.36  entities identified in section 256B.199, adjust the amounts 
 77.1   reported by nonstate entities under section 256B.199 when 
 77.2   application for reimbursement is made to the federal government, 
 77.3   and otherwise adjust the provisions of this subdivision in order 
 77.4   to maximize payments to qualifying hospitals. 
 77.5      <b>[EFFECTIVE DATE.]</b> This section is effective the day 
 77.6   following final enactment.  The commissioner of human services 
 77.7   shall submit necessary medical assistance plan amendments to 
 77.8   implement this section within 30 days of enactment.  
 77.9      Sec. 9.  Minnesota Statutes 2004, section 256B.02, 
 77.10  subdivision 12, is amended to read: 
 77.11     Subd. 12.  [THIRD-PARTY PAYER.] "Third-party payer" means a 
 77.12  person, entity, or agency or government program that has a 
 77.13  probable obligation to pay all or part of the costs of a medical 
 77.14  assistance recipient's health services.  Third-party payer 
 77.15  includes an entity under contract with the recipient to cover 
 77.16  all or part of the recipient's medical costs. 
 77.17     Sec. 10.  Minnesota Statutes 2004, section 256B.04, is 
 77.18  amended by adding a subdivision to read: 
 77.19     Subd. 4a.  [MEDICARE PRESCRIPTION DRUG SUBSIDY.] The 
 77.20  commissioner shall perform all duties necessary to administer 
 77.21  eligibility determinations for the Medicare Part D prescription 
 77.22  drug subsidy and facilitate the enrollment of eligible medical 
 77.23  assistance recipients into Medicare prescription drug plans as 
 77.24  required by the Medicare Prescription Drug, Improvement, and 
 77.25  Modernization Act of 2003 (MMA), Public Law 108-173, and Code of 
 77.26  Federal Regulations, title 42, sections 423.30 to 423.56 and 
 77.27  423.771 to 423.800. 
 77.28     Sec. 11.  Minnesota Statutes 2004, section 256B.055, is 
 77.29  amended by adding a subdivision to read: 
 77.30     Subd. 14.  [PERSONS DETAINED BY LAW.] (a) An inmate of a 
 77.31  correctional facility who is conditionally released as 
 77.32  authorized under section 241.26, 244.065, or 631.425 may be 
 77.33  eligible for medical assistance if the individual does not 
 77.34  require the security of a public detention facility and is 
 77.35  housed in a halfway house or community correction center, or 
 77.36  under house arrest and monitored by electronic surveillance in a 
 78.1   residence approved by the commissioner of corrections.  
 78.2      (b) An individual, regardless of age, who is considered an 
 78.3   inmate of a public institution as defined in Code of Federal 
 78.4   Regulations, title 42, section 435.1009, is not eligible for 
 78.5   medical assistance. 
 78.6      Sec. 12.  Minnesota Statutes 2004, section 256B.056, is 
 78.7   amended by adding a subdivision to read: 
 78.8      Subd. 3d.  [REDUCTION OF EXCESS ASSETS.] Assets in excess 
 78.9   of the limits in subdivisions 3 to 3c may be reduced to 
 78.10  allowable limits as follows: 
 78.11     (a) Assets may be reduced in any of the three calendar 
 78.12  months before the month of application in which the applicant 
 78.13  seeks coverage by: 
 78.14     (1) designating burial funds up to $1,500 for each 
 78.15  applicant, spouse, and MA-eligible dependent child; and 
 78.16     (2) paying health service bills incurred in the retroactive 
 78.17  period for which the applicant seeks eligibility, starting with 
 78.18  the oldest bill.  After assets are reduced to allowable limits, 
 78.19  eligibility begins with the next dollar of MA-covered health 
 78.20  services incurred in the retroactive period.  Applicants 
 78.21  reducing assets under this subdivision who also have excess 
 78.22  income shall first spend excess assets to pay health service 
 78.23  bills and may meet the income spenddown on remaining bills. 
 78.24     (b) Assets may be reduced beginning the month of 
 78.25  application by: 
 78.26     (1) paying bills for health services that would otherwise 
 78.27  be paid by medical assistance; and 
 78.28     (2) using any means other than a transfer of assets for 
 78.29  less than fair market value as defined in section 256B.0595, 
 78.30  subdivision 1, paragraph (b). 
 78.31     Sec. 13.  Minnesota Statutes 2004, section 256B.056, 
 78.32  subdivision 5, is amended to read: 
 78.33     Subd. 5.  [EXCESS INCOME.] A person who has excess income 
 78.34  is eligible for medical assistance if the person has expenses 
 78.35  for medical care that are more than the amount of the person's 
 78.36  excess income, computed by deducting incurred medical expenses 
 79.1   from the excess income to reduce the excess to the income 
 79.2   standard specified in subdivision 5c.  The person shall elect to 
 79.3   have the medical expenses deducted at the beginning of a 
 79.4   one-month budget period or at the beginning of a six-month 
 79.5   budget period.  The commissioner shall allow persons eligible 
 79.6   for assistance on a one-month spenddown basis under this 
 79.7   subdivision to elect to pay the monthly spenddown amount in 
 79.8   advance of the month of eligibility to the state agency in order 
 79.9   to maintain eligibility on a continuous basis.  If the recipient 
 79.10  does not pay the spenddown amount on or before the 20th last 
 79.11  business day of the month, the recipient is ineligible for this 
 79.12  option for the following month.  The local agency shall code the 
 79.13  Medicaid Management Information System (MMIS) to indicate that 
 79.14  the recipient has elected this option.  The state agency shall 
 79.15  convey recipient eligibility information relative to the 
 79.16  collection of the spenddown to providers through the Electronic 
 79.17  Verification System (EVS).  A recipient electing advance payment 
 79.18  must pay the state agency the monthly spenddown amount on or 
 79.19  before noon on the 20th last business day of the month in order 
 79.20  to be eligible for this option in the following month.  
 79.21     <b>[EFFECTIVE DATE.]</b> This section is effective August 1, 2006, 
 79.22  or upon HealthMatch implementation, whichever is later. 
 79.23     Sec. 14.  Minnesota Statutes 2004, section 256B.056, 
 79.24  subdivision 5a, is amended to read: 
 79.25     Subd. 5a.  [INDIVIDUALS ON FIXED OR EXCLUDED INCOME.] 
 79.26  Recipients of medical assistance who receive only fixed unearned 
 79.27  or excluded income, when that income is excluded from 
 79.28  consideration as income or unvarying in amount and timing of 
 79.29  receipt throughout the year, shall report and verify their 
 79.30  income annually every 12 months.  The 12-month period begins 
 79.31  with the month of application. 
 79.32     <b>[EFFECTIVE DATE.]</b> This section is effective August 1, 2006, 
 79.33  or upon HealthMatch implementation, whichever is later. 
 79.34     Sec. 15.  Minnesota Statutes 2004, section 256B.056, 
 79.35  subdivision 5b, is amended to read: 
 79.36     Subd. 5b.  [INDIVIDUALS WITH LOW INCOME.] Recipients of 
 80.1   medical assistance not residing in a long-term care facility who 
 80.2   have slightly fluctuating income which is below the medical 
 80.3   assistance income limit shall report and verify their income on 
 80.4   a semiannual basis every six months.  The six-month period 
 80.5   begins the month of application. 
 80.6      <b>[EFFECTIVE DATE.]</b> This section is effective August 1, 2006, 
 80.7   or upon HealthMatch implementation, whichever is later. 
 80.8      Sec. 16.  Minnesota Statutes 2004, section 256B.056, 
 80.9   subdivision 7, is amended to read: 
 80.10     Subd. 7.  [PERIOD OF ELIGIBILITY.] Eligibility is available 
 80.11  for the month of application and for three months prior to 
 80.12  application if the person was eligible in those prior 
 80.13  months.  Eligibility for months prior to application is 
 80.14  determined independently from eligibility for the month of 
 80.15  application and future months.  A redetermination of eligibility 
 80.16  must occur every 12 months.  The 12-month period begins with the 
 80.17  month of application. 
 80.18     <b>[EFFECTIVE DATE.]</b> This section is effective August 1, 2006, 
 80.19  or upon HealthMatch implementation, whichever is later. 
 80.20     Sec. 17.  Minnesota Statutes 2004, section 256B.056, is 
 80.21  amended by adding a subdivision to read: 
 80.22     Subd. 9.  [NOTICE.] The state agency must be given notice 
 80.23  of monetary claims against a person, entity, or corporation that 
 80.24  may be liable to pay all or part of the cost of medical care 
 80.25  when the state agency has paid or becomes liable for the cost of 
 80.26  that care.  Notice must be given according to paragraphs (a) to 
 80.27  (d). 
 80.28     (a) An applicant for medical assistance shall notify the 
 80.29  state or local agency of any possible claims when the applicant 
 80.30  submits the application.  A recipient of medical assistance 
 80.31  shall notify the state or local agency of any possible claims 
 80.32  when those claims arise. 
 80.33     (b) A person providing medical care services to a recipient 
 80.34  of medical assistance shall notify the state agency when the 
 80.35  person has reason to believe that a third party may be liable 
 80.36  for payment of the cost of medical care. 
 81.1      (c) A party to a claim that may be assigned to the state 
 81.2   agency under this section shall notify the state agency of its 
 81.3   potential assignment claim in writing at each of the following 
 81.4   stages of a claim: 
 81.5      (1) when a claim is filed; 
 81.6      (2) when an action is commenced; and 
 81.7      (3) when a claim is concluded by payment, award, judgment, 
 81.8   settlement, or otherwise.  
 81.9      (d) Every party involved in any stage of a claim under this 
 81.10  subdivision is required to provide notice to the state agency at 
 81.11  that stage of the claim.  However, when one of the parties to 
 81.12  the claim provides notice at that stage, every other party to 
 81.13  the claim is deemed to have provided the required notice for 
 81.14  that stage of the claim.  If the required notice under this 
 81.15  paragraph is not provided to the state agency, all parties to 
 81.16  the claim are deemed to have failed to provide the required 
 81.17  notice.  A party to the claim includes the injured person or the 
 81.18  person's legal representative, the plaintiff, the defendants, or 
 81.19  persons alleged to be responsible for compensating the injured 
 81.20  person or plaintiff, and any other party to the cause of action 
 81.21  or claim, regardless of whether the party knows the state agency 
 81.22  has a potential or actual assignment claim. 
 81.23     Sec. 18.  Minnesota Statutes 2004, section 256B.057, 
 81.24  subdivision 1, is amended to read: 
 81.25     Subdivision 1.  [INFANTS AND PREGNANT WOMEN.] (a)(1) An 
 81.26  infant less than one year of age is eligible for medical 
 81.27  assistance if countable family income is equal to or less than 
 81.28  275 percent of the federal poverty guideline for the same family 
 81.29  size.  A pregnant woman who has written verification of a 
 81.30  positive pregnancy test from a physician or licensed registered 
 81.31  nurse is eligible for medical assistance if countable family 
 81.32  income is equal to or less than 200 275 percent of the federal 
 81.33  poverty guideline for the same family size.  For purposes of 
 81.34  this subdivision, "countable family income" means the amount of 
 81.35  income considered available using the methodology of the AFDC 
 81.36  program under the state's AFDC plan as of July 16, 1996, as 
 82.1   required by the Personal Responsibility and Work Opportunity 
 82.2   Reconciliation Act of 1996 (PRWORA), Public Law 104-193, except 
 82.3   for the earned income disregard and employment deductions. 
 82.4      (2) For applications processed within one calendar month 
 82.5   prior to the effective date, eligibility shall be determined by 
 82.6   applying the income standards and methodologies in effect prior 
 82.7   to the effective date for any months in the six-month budget 
 82.8   period before that date and the income standards and 
 82.9   methodologies in effect on the effective date for any months in 
 82.10  the six-month budget period on or after that date.  The income 
 82.11  standards for each month shall be added together and compared to 
 82.12  the applicant's total countable income for the six-month budget 
 82.13  period to determine eligibility. 
 82.14     (b)(1)  (Expired, 1Sp2003 c 14 art 12 s 19) 
 82.15     (2) For applications processed within one calendar month 
 82.16  prior to July 1, 2003, eligibility shall be determined by 
 82.17  applying the income standards and methodologies in effect prior 
 82.18  to July 1, 2003, for any months in the six-month budget period 
 82.19  before July 1, 2003, and the income standards and methodologies 
 82.20  in effect on the expiration date for any months in the six-month 
 82.21  budget period on or after July 1, 2003.  The income standards 
 82.22  for each month shall be added together and compared to the 
 82.23  applicant's total countable income for the six-month budget 
 82.24  period to determine eligibility. 
 82.25     (c) Dependent care and child support paid under court order 
 82.26  shall be deducted from the countable income of pregnant 
 82.27  women.  An amount equal to the amount of earned income exceeding 
 82.28  275 percent of the federal poverty guideline plus the earned 
 82.29  income disregards and deductions of the AFDC program under the 
 82.30  state's AFDC plan as of July 16, 1996, as required by the 
 82.31  Personal Responsibility and Work Opportunity Reconciliation Act 
 82.32  of 1996 (PRWORA), Public Law 104-193, that exceeds 275 percent 
 82.33  of the federal poverty guideline will be deducted for pregnant 
 82.34  women and infants less than one year of age. 
 82.35     (d) An infant born on or after January 1, 1991, to a woman 
 82.36  who was eligible for and receiving medical assistance on the 
 83.1   date of the child's birth shall continue to be eligible for 
 83.2   medical assistance without redetermination until the child's 
 83.3   first birthday, as long as the child remains in the woman's 
 83.4   household. 
 83.5      <b>[EFFECTIVE DATE.]</b> The amendments to paragraphs (a) and (b) 
 83.6   are effective retroactively from July 1, 2004, and the amendment 
 83.7   to paragraph (c) is effective retroactively from October 1, 2003.
 83.8      Sec. 19.  Minnesota Statutes 2004, section 256B.0625, 
 83.9   subdivision 9, is amended to read: 
 83.10     Subd. 9.  [DENTAL SERVICES.] (a) Medical assistance covers 
 83.11  dental services.  Dental services include, with prior 
 83.12  authorization, fixed bridges that are cost-effective for persons 
 83.13  who cannot use removable dentures because of their medical 
 83.14  condition.  
 83.15     (b) Coverage of dental services for adults age 21 and over 
 83.16  who are not pregnant is subject to a $500 annual benefit limit 
 83.17  and covered services are limited to:  
 83.18     (1) diagnostic and preventative services; 
 83.19     (2) restorative services; and 
 83.20     (3) emergency services. 
 83.21     Emergency services, dentures, and extractions related to 
 83.22  dentures are not included in the $500 annual benefit limit. 
 83.23     Sec. 20.  Minnesota Statutes 2004, section 256B.0625, 
 83.24  subdivision 13e, as amended by 2005 S.F. No. 1879, article 13, 
 83.25  section 7, subdivision 13e, if enacted, is amended to read: 
 83.26     Subd. 13e.  [PAYMENT RATES.] (a) The basis for determining 
 83.27  the amount of payment shall be the lower of the actual 
 83.28  acquisition costs of the drugs plus a fixed dispensing fee; the 
 83.29  maximum allowable cost set by the federal government or by the 
 83.30  commissioner plus the fixed dispensing fee; or the usual and 
 83.31  customary price charged to the public.  The amount of payment 
 83.32  basis must be reduced to reflect all discount amounts applied to 
 83.33  the charge by any provider/insurer agreement or contract for 
 83.34  submitted charges to medical assistance programs.  The net 
 83.35  submitted charge may not be greater than the patient liability 
 83.36  for the service.  The pharmacy dispensing fee shall be $3.65, 
 84.1   except that the dispensing fee for intravenous solutions which 
 84.2   must be compounded by the pharmacist shall be $8 per bag, $14 
 84.3   per bag for cancer chemotherapy products, and $30 per bag for 
 84.4   total parenteral nutritional products dispensed in one liter 
 84.5   quantities, or $44 per bag for total parenteral nutritional 
 84.6   products dispensed in quantities greater than one liter.  Actual 
 84.7   acquisition cost includes quantity and other special discounts 
 84.8   except time and cash discounts.  The actual acquisition cost of 
 84.9   a drug shall be estimated by the commissioner, at average 
 84.10  wholesale price minus 11.5 percent, except that where a drug has 
 84.11  had its wholesale price reduced as a result of the actions of 
 84.12  the National Association of Medicaid Fraud Control Units, the 
 84.13  estimated actual acquisition cost shall be the reduced average 
 84.14  wholesale price, without the 11.5 percent deduction.  The actual 
 84.15  acquisition cost of antihemophilic factor drugs shall be 
 84.16  estimated at the average wholesale price minus 30 percent.  The 
 84.17  maximum allowable cost of a multisource drug may be set by the 
 84.18  commissioner and it shall be comparable to, but no higher than, 
 84.19  the maximum amount paid by other third-party payors in this 
 84.20  state who have maximum allowable cost programs.  Establishment 
 84.21  of the amount of payment for drugs shall not be subject to the 
 84.22  requirements of the Administrative Procedure Act.  
 84.23     (b) An additional dispensing fee of $.30 may be added to 
 84.24  the dispensing fee paid to pharmacists for legend drug 
 84.25  prescriptions dispensed to residents of long-term care 
 84.26  facilities when a unit dose blister card system, approved by the 
 84.27  department, is used.  Under this type of dispensing system, the 
 84.28  pharmacist must dispense a 30-day supply of drug.  The National 
 84.29  Drug Code (NDC) from the drug container used to fill the blister 
 84.30  card must be identified on the claim to the department.  The 
 84.31  unit dose blister card containing the drug must meet the 
 84.32  packaging standards set forth in Minnesota Rules, part 
 84.33  6800.2700, that govern the return of unused drugs to the 
 84.34  pharmacy for reuse.  The pharmacy provider will be required to 
 84.35  credit the department for the actual acquisition cost of all 
 84.36  unused drugs that are eligible for reuse.  Over-the-counter 
 85.1   medications must be dispensed in the manufacturer's unopened 
 85.2   package.  The commissioner may permit the drug clozapine to be 
 85.3   dispensed in a quantity that is less than a 30-day supply.  
 85.4      (c) Whenever a generically equivalent product is available, 
 85.5   payment shall be on the basis of the actual acquisition cost of 
 85.6   the generic drug, or on the maximum allowable cost established 
 85.7   by the commissioner. 
 85.8      (d) The basis for determining the amount of payment for 
 85.9   drugs administered in an outpatient setting shall be the lower 
 85.10  of the usual and customary cost submitted by the provider or the 
 85.11  amount established for Medicare by the United States Department 
 85.12  of Health and Human Services pursuant to title XVIII, section 
 85.13  1847a of the federal Social Security Act. 
 85.14     (e) The commissioner may negotiate lower reimbursement 
 85.15  rates for specialty pharmacy products than the rates specified 
 85.16  in paragraph (a).  The commissioner may require individuals 
 85.17  enrolled in the health care programs administered by the 
 85.18  department to obtain specialty pharmacy products from providers 
 85.19  with whom the commissioner has negotiated lower reimbursement 
 85.20  rates.  Specialty pharmacy products are defined as those used by 
 85.21  a small number of recipients or recipients with complex and 
 85.22  chronic diseases that require expensive and challenging drug 
 85.23  regimens.  Examples of these conditions include, but are not 
 85.24  limited to:  multiple sclerosis, HIV/AIDS, transplantation, 
 85.25  hepatitis C, growth hormone deficiency, Crohn's Disease, 
 85.26  rheumatoid arthritis, and certain forms of cancer.  Specialty 
 85.27  pharmaceutical products include injectable and infusion 
 85.28  therapies, biotechnology drugs, high-cost therapies, and 
 85.29  therapies that require complex care.  The commissioner shall 
 85.30  consult with the formulary committee to develop a list of 
 85.31  specialty pharmacy products subject to this paragraph.  In 
 85.32  consulting with the formulary committee in developing this list, 
 85.33  the commissioner shall take into consideration the population 
 85.34  served by special pharmacy products, the current delivery system 
 85.35  and standard of care in the state, and any access to care issues 
 85.36  that lower reimbursement rates may create.  The commissioner 
 86.1   shall have the discretion to adjust the reimbursement rate to 
 86.2   prevent access to care issues. 
 86.3      Sec. 21.  Minnesota Statutes 2004, section 256B.0625, 
 86.4   subdivision 13f, is amended to read: 
 86.5      Subd. 13f.  [PRIOR AUTHORIZATION.] (a) The Formulary 
 86.6   Committee shall review and recommend drugs which require prior 
 86.7   authorization.  The Formulary Committee shall establish general 
 86.8   criteria to be used for the prior authorization of brand-name 
 86.9   drugs for which generically equivalent drugs are available, but 
 86.10  the committee is not required to review each brand-name drug for 
 86.11  which a generically equivalent drug is available.  
 86.12     (b) Prior authorization may be required by the commissioner 
 86.13  before certain formulary drugs are eligible for payment.  The 
 86.14  Formulary Committee may recommend drugs for prior authorization 
 86.15  directly to the commissioner.  The commissioner may also request 
 86.16  that the Formulary Committee review a drug for prior 
 86.17  authorization.  Before the commissioner may require prior 
 86.18  authorization for a drug: 
 86.19     (1) the commissioner must provide information to the 
 86.20  Formulary Committee on the impact that placing the drug on prior 
 86.21  authorization may have on the quality of patient care and on 
 86.22  program costs, information regarding whether the drug is subject 
 86.23  to clinical abuse or misuse, and relevant data from the state 
 86.24  Medicaid program if such data is available; 
 86.25     (2) the Formulary Committee must review the drug, taking 
 86.26  into account medical and clinical data and the information 
 86.27  provided by the commissioner; and 
 86.28     (3) the Formulary Committee must hold a public forum and 
 86.29  receive public comment for an additional 15 days. 
 86.30  The commissioner must provide a 15-day notice period before 
 86.31  implementing the prior authorization.  
 86.32     (c) Prior authorization shall not be required or utilized 
 86.33  for any atypical antipsychotic drug prescribed for the treatment 
 86.34  of mental illness if: 
 86.35     (1) there is no generically equivalent drug available; and 
 86.36     (2) the drug was initially prescribed for the recipient 
 87.1   prior to July 1, 2003; or 
 87.2      (3) the drug is part of the recipient's current course of 
 87.3   treatment. 
 87.4   This paragraph applies to any multistate preferred drug list or 
 87.5   supplemental drug rebate program established or administered by 
 87.6   the commissioner. 
 87.7      (d) Prior authorization shall not be required or utilized 
 87.8   for any antihemophilic factor drug prescribed for the treatment 
 87.9   of hemophilia and blood disorders where there is no generically 
 87.10  equivalent drug available if the prior authorization is used in 
 87.11  conjunction with any supplemental drug rebate program or 
 87.12  multistate preferred drug list established or administered by 
 87.13  the commissioner.  This paragraph expires July 1, 2005. 
 87.14     (e) The commissioner may require prior authorization for 
 87.15  brand name drugs whenever a generically equivalent product is 
 87.16  available, even if the prescriber specifically indicates 
 87.17  "dispense as written-brand necessary" on the prescription as 
 87.18  required by section 151.21, subdivision 2. 
 87.19     <b>[EFFECTIVE DATE.]</b> This section is effective June 30, 2005. 
 87.20     Sec. 22.  Minnesota Statutes 2004, section 256B.0625, is 
 87.21  amended by adding a subdivision to read: 
 87.22     Subd. 13h.  [MEDICATION THERAPY MANAGEMENT CARE.] (a) 
 87.23  Medical assistance covers medication therapy management services 
 87.24  for a recipient taking four or more prescriptions to treat or 
 87.25  prevent two or more chronic medical conditions, or a recipient 
 87.26  with a drug therapy problem that is identified or prior 
 87.27  authorized by the commissioner that has resulted or is likely to 
 87.28  result in significant nondrug program costs.  For purposes of 
 87.29  this subdivision, "medication therapy management" means the 
 87.30  provision of the following pharmaceutical care services by a 
 87.31  licensed pharmacist to optimize the therapeutic outcomes of the 
 87.32  patient's medications:  
 87.33     (1) performing or obtaining necessary assessments of the 
 87.34  patient's health status; 
 87.35     (2) formulating a medication treatment plan; 
 87.36     (3) monitoring and evaluating the patient's response to 
 88.1   therapy, including safety and effectiveness; 
 88.2      (4) performing a comprehensive medication review to 
 88.3   identify, resolve, and prevent medication-related problems, 
 88.4   including adverse drug events; 
 88.5      (5) documenting the care delivered and communicating 
 88.6   essential information to the patient's other primary care 
 88.7   providers; 
 88.8      (6) providing verbal education and training designed to 
 88.9   enhance patient understanding and appropriate use of the 
 88.10  patient's medications; 
 88.11     (7) providing information, support services, and resources 
 88.12  designed to enhance patient adherence with the patient's 
 88.13  therapeutic regimens; and 
 88.14     (8) coordinating and integrating medication therapy 
 88.15  management services within the broader health care management 
 88.16  services being provided to the patient.  
 88.17  Nothing in this subdivision shall be construed to expand or 
 88.18  modify the scope of practice of the pharmacist as defined in 
 88.19  section 151.01, subdivision 27. 
 88.20     (b) To be eligible for reimbursement for services under 
 88.21  this subdivision, a pharmacist must meet the following 
 88.22  requirements:  
 88.23     (1) have a valid license issued under chapter 151; 
 88.24     (2) have graduated from an accredited college of pharmacy 
 88.25  on or after May 1996 or completed a structured and comprehensive 
 88.26  education program approved by the Board of Pharmacy and the 
 88.27  American Council of Pharmaceutical Education for the provision 
 88.28  and documentation of pharmaceutical care management services 
 88.29  that has both clinical and didactic elements; 
 88.30     (3) be practicing in an ambulatory care setting as part of 
 88.31  a multidisciplinary team or have developed a structured patient 
 88.32  care process that is offered in a private or semiprivate patient 
 88.33  care area that is separate from the commercial business that 
 88.34  also occurs in the setting; and 
 88.35     (4) make use of an electronic patient record system that 
 88.36  meets state standards.  
 89.1      (c) For the purposes of reimbursement for medication 
 89.2   therapy management services, the commissioner may enroll 
 89.3   individual pharmacists as medical assistance providers.  The 
 89.4   commissioner may also establish contact requirements between the 
 89.5   pharmacist and recipient, including limiting the number of 
 89.6   reimbursable consultations per recipient. 
 89.7      (d) The commissioner, after receiving recommendations from 
 89.8   professional medical associations, professional pharmacy 
 89.9   associations, and consumer groups shall convene an 11-member 
 89.10  Medication Therapy Management Advisory Committee, to advise the 
 89.11  commissioner on the implementation and administration of 
 89.12  medication therapy management services.  The committee shall be 
 89.13  comprised of two licensed physicians; two licensed pharmacists; 
 89.14  two consumer representatives; two health plan representatives; 
 89.15  and three members with expertise in the area of medication 
 89.16  therapy management, who may be licensed physicians or licensed 
 89.17  pharmacists.  The committee is governed by section 15.059, 
 89.18  except that committee members do not receive compensation or 
 89.19  reimbursement for expenses.  The advisory committee shall expire 
 89.20  on June 30, 2007. 
 89.21     (e) The commissioner shall evaluate the effect of 
 89.22  medication therapy management on quality of care, patient 
 89.23  outcomes, and program costs, and shall include a description of 
 89.24  any savings generated in the medical assistance program that can 
 89.25  be attributable to this coverage.  The evaluation shall be 
 89.26  submitted to the legislature by December 15, 2007.  The 
 89.27  commissioner may contract with a vendor or an academic 
 89.28  institution that has expertise in evaluating health care 
 89.29  outcomes for the purpose of completing the evaluation. 
 89.30     Sec. 23.  [256B.072] [PERFORMANCE REPORTING AND QUALITY 
 89.31  IMPROVEMENT PAYMENT SYSTEM.] 
 89.32     (a) The commissioner of human services shall establish a 
 89.33  performance reporting and propose a payment system for health 
 89.34  care providers who provide health care services to public 
 89.35  program recipients covered under chapters 256B, 256D, and 256L, 
 89.36  reporting separately for managed care and fee-for-service 
 90.1   recipients.  
 90.2      (b) The measures used for the performance reporting and 
 90.3   payment system for medical groups shall include, but are not 
 90.4   limited to, measures of care for asthma, diabetes, hypertension, 
 90.5   and coronary artery disease and measures of preventive care 
 90.6   services.  The measures used for the performance reporting and 
 90.7   payment system for inpatient hospitals shall include, but are 
 90.8   not limited to, measures of care for acute myocardial 
 90.9   infarction, heart failure, and pneumonia, and measures of care 
 90.10  and prevention of surgical infections.  In the case of a medical 
 90.11  group, the measures used shall be consistent with measures 
 90.12  published by nonprofit Minnesota or national organizations that 
 90.13  produce and disseminate health care quality measures or 
 90.14  evidence-based health care guidelines.  In the case of inpatient 
 90.15  hospital measures, the commissioner shall appoint the Minnesota 
 90.16  Hospital Association and Stratis Health to advise on the 
 90.17  development of the performance measures to be used for hospital 
 90.18  reporting.  To enable a consistent measurement process across 
 90.19  the community, the commissioner may use measures of care 
 90.20  provided for patients in addition to those identified in 
 90.21  paragraph (a).  The commissioner shall ensure collaboration with 
 90.22  other health care reporting organizations so that the measures 
 90.23  described in this section are consistent with those reported by 
 90.24  those organizations and used by other purchasers in Minnesota.  
 90.25     (c) For recipients seen on or after January 1, 2007, the 
 90.26  commissioner shall propose a performance bonus payment to 
 90.27  providers who have achieved certain levels of performance 
 90.28  established by the commissioner with respect to the measures or 
 90.29  who have achieved certain rates of improvement established by 
 90.30  the commissioner with respect to the measures or whose rates of 
 90.31  achievement have increased over a previous period, as 
 90.32  established by the commissioner.  The performance bonus payment 
 90.33  may be a fixed dollar amount per patient, paid quarterly or 
 90.34  annually, or alternatively payment may be made as a percentage 
 90.35  increase over payments allowed elsewhere in statute for the 
 90.36  recipients identified in paragraph (a).  In order for providers 
 91.1   to be eligible for a performance bonus payment under this 
 91.2   section, the commissioner may require the providers to submit 
 91.3   information in a required format to a health care reporting 
 91.4   organization or to cooperate with the information collection 
 91.5   procedures of that organization.  The commissioner may contract 
 91.6   with a reporting organization to assist with the collection of 
 91.7   reporting information and to prevent duplication of reporting.  
 91.8   The commissioner may limit application of the performance bonus 
 91.9   payment system to providers that provide a sufficiently large 
 91.10  volume of care to permit adequate statistical precision in the 
 91.11  measurement of that care, as established by the commissioner, 
 91.12  after consulting with other health care quality reporting 
 91.13  organizations.  
 91.14     (d) The commissioner shall publish a description of the 
 91.15  proposed performance reporting and proposed payment system for 
 91.16  the calendar year beginning January 1, 2007, and each subsequent 
 91.17  calendar year, at least three months prior to the beginning of 
 91.18  that calendar year. 
 91.19     (e) By October 1, 2007, and annually thereafter, the 
 91.20  commissioner shall report through a public Web site the results 
 91.21  by medical group and hospitals where possible of the measures 
 91.22  and when feasible the performance payments under this section, 
 91.23  and shall compare the results by medical group and hospital for 
 91.24  patients enrolled in public programs to patients enrolled in 
 91.25  private health plans.  To achieve this reporting, the 
 91.26  commissioner may contract with a health care reporting 
 91.27  organization that operates a Web site suitable for this purpose. 
 91.28     Sec. 24.  Minnesota Statutes 2004, section 256B.0916, is 
 91.29  amended by adding a subdivision to read: 
 91.30     Subd. 10.  [TRANSITIONAL SUPPORTS ALLOWANCE.] A 
 91.31  transitional supports allowance shall be available to all 
 91.32  persons under a home and community-based waiver who are moving 
 91.33  from a licensed setting to a community setting.  "Transitional 
 91.34  supports allowance" means a onetime payment of up to $3,000, to 
 91.35  cover the costs, not covered by other sources, associated with 
 91.36  moving from a licensed setting to a community setting.  Covered 
 92.1   costs include: 
 92.2      (1) lease or rent deposits; 
 92.3      (2) security deposits; 
 92.4      (3) utilities set-up costs, including telephone; 
 92.5      (4) essential furnishings and supplies; and 
 92.6      (5) personal supports and transports needed to locate and 
 92.7   transition to community settings. 
 92.8      <b>[EFFECTIVE DATE.]</b> This section is effective upon federal 
 92.9   approval and to the extent approved as a federal waiver 
 92.10  amendment. 
 92.11     Sec. 25.  [256B.0918] [EMPLOYEE SCHOLARSHIP COSTS AND 
 92.12  TRAINING IN ENGLISH AS A SECOND LANGUAGE.] 
 92.13     (a) For the fiscal year beginning July 1, 2005, the 
 92.14  commissioner shall provide to each provider listed in paragraph 
 92.15  (c) a scholarship reimbursement increase of two-tenths percent 
 92.16  of the reimbursement rate for that provider to be used: 
 92.17     (1) for employee scholarships that satisfy the following 
 92.18  requirements: 
 92.19     (i) scholarships are available to all employees who work an 
 92.20  average of at least 20 hours per week for the provider, except 
 92.21  administrators, department supervisors, and registered nurses; 
 92.22  and 
 92.23     (ii) the course of study is expected to lead to career 
 92.24  advancement with the provider or in long-term care, including 
 92.25  home care or care of persons with disabilities, including 
 92.26  medical care interpreter services and social work; and 
 92.27     (2) to provide job-related training in English as a second 
 92.28  language. 
 92.29     (b) A provider receiving a rate adjustment under this 
 92.30  subdivision with an annualized value of at least $1,000 shall 
 92.31  maintain documentation to be submitted to the commissioner on a 
 92.32  schedule determined by the commissioner and on a form supplied 
 92.33  by the commissioner of the scholarship rate increase received, 
 92.34  including:  
 92.35     (1) the amount received from this reimbursement increase; 
 92.36     (2) the amount used for training in English as a second 
 93.1   language; 
 93.2      (3) the number of persons receiving the training; 
 93.3      (4) the name of the person or entity providing the 
 93.4   training; and 
 93.5      (5) for each scholarship recipient, the name of the 
 93.6   recipient, the amount awarded, the educational institution 
 93.7   attended, the nature of the educational program, the program 
 93.8   completion date, and a determination of the amount spent as a 
 93.9   percentage of the provider's reimbursement.  
 93.10  The commissioner shall report to the legislature annually, 
 93.11  beginning January 15, 2006, with information on the use of these 
 93.12  funds. 
 93.13     (c) The rate increases described in this section shall be 
 93.14  provided to home and community-based waivered services for 
 93.15  persons with mental retardation or related conditions under 
 93.16  section 256B.501; home and community-based waivered services for 
 93.17  the elderly under section 256B.0915; waivered services under 
 93.18  community alternatives for disabled individuals under section 
 93.19  256B.49; community alternative care waivered services under 
 93.20  section 256B.49; traumatic brain injury waivered services under 
 93.21  section 256B.49; nursing services and home health services under 
 93.22  section 256B.0625, subdivision 6a; personal care services and 
 93.23  nursing supervision of personal care services under section 
 93.24  256B.0625, subdivision 19a; private duty nursing services under 
 93.25  section 256B.0625, subdivision 7; day training and habilitation 
 93.26  services for adults with mental retardation or related 
 93.27  conditions under sections 252.40 to 252.46; alternative care 
 93.28  services under section 256B.0913; adult residential program 
 93.29  grants under Minnesota Rules, parts 9535.2000 to 9535.3000; 
 93.30  semi-independent living services (SILS) under section 252.275, 
 93.31  including SILS funding under county social services grants 
 93.32  formerly funded under chapter 256I; community support services 
 93.33  for deaf and hard-of-hearing adults with mental illness who use 
 93.34  or wish to use sign language as their primary means of 
 93.35  communication; the group residential housing supplementary 
 93.36  service rate under section 256I.05, subdivision 1a; chemical 
 94.1   dependency residential and nonresidential service providers 
 94.2   under section 254B.03; and intermediate care facilities for 
 94.3   persons with mental retardation under section 256B.5012. 
 94.4      (d) These increases shall be included in the provider's 
 94.5   reimbursement rate for the purpose of determining future rates 
 94.6   for the provider. 
 94.7      Sec. 26.  [256B.199] [PAYMENTS REPORTED BY GOVERNMENTAL 
 94.8   ENTITIES.] 
 94.9      (a) Hennepin County, Hennepin County Medical Center, Ramsey 
 94.10  County, Regions Hospital, the University of Minnesota, and 
 94.11  Fairview-University Medical Center shall annually report to the 
 94.12  commissioner by June 1, beginning June 1, 2005, payments made 
 94.13  during the previous calendar year that may qualify for 
 94.14  reimbursement under federal law.  Subject to the reports due 
 94.15  June 1, 2005, the amounts for calendar year 2004 are expected to 
 94.16  be as follows: 
 94.17     (1) Hennepin County and Hennepin County Medical Center, 
 94.18  $31,980,000; 
 94.19     (2) Ramsey County and Regions Hospital, $20,980,000; and 
 94.20     (3) University of Minnesota and Fairview-University Medical 
 94.21  Center, $11,050,000. 
 94.22     (b) Based on these reports, the commissioner shall apply 
 94.23  for federal matching funds.  These funds are appropriated to the 
 94.24  commissioner for the annual payments under section 256.969, 
 94.25  subdivision 27. 
 94.26     <b>[EFFECTIVE DATE.]</b> This section is effective the day 
 94.27  following final enactment.  The commissioner of human services 
 94.28  shall submit necessary medical assistance plan amendments to 
 94.29  implement this section within 30 days of enactment.  
 94.30     Sec. 27.  Minnesota Statutes 2004, section 256B.69, 
 94.31  subdivision 4, is amended to read: 
 94.32     Subd. 4.  [LIMITATION OF CHOICE.] (a) The commissioner 
 94.33  shall develop criteria to determine when limitation of choice 
 94.34  may be implemented in the experimental counties.  The criteria 
 94.35  shall ensure that all eligible individuals in the county have 
 94.36  continuing access to the full range of medical assistance 
 95.1   services as specified in subdivision 6.  
 95.2      (b) The commissioner shall exempt the following persons 
 95.3   from participation in the project, in addition to those who do 
 95.4   not meet the criteria for limitation of choice:  
 95.5      (1) persons eligible for medical assistance according to 
 95.6   section 256B.055, subdivision 1; 
 95.7      (2) persons eligible for medical assistance due to 
 95.8   blindness or disability as determined by the Social Security 
 95.9   Administration or the state medical review team, unless:  
 95.10     (i) they are 65 years of age or older; or 
 95.11     (ii) they reside in Itasca County or they reside in a 
 95.12  county in which the commissioner conducts a pilot project under 
 95.13  a waiver granted pursuant to section 1115 of the Social Security 
 95.14  Act; 
 95.15     (3) recipients who currently have private coverage through 
 95.16  a health maintenance organization; 
 95.17     (4) recipients who are eligible for medical assistance by 
 95.18  spending down excess income for medical expenses other than the 
 95.19  nursing facility per diem expense; 
 95.20     (5) recipients who receive benefits under the Refugee 
 95.21  Assistance Program, established under United States Code, title 
 95.22  8, section 1522(e); 
 95.23     (6) children who are both determined to be severely 
 95.24  emotionally disturbed and receiving case management services 
 95.25  according to section 256B.0625, subdivision 20; 
 95.26     (7) adults who are both determined to be seriously and 
 95.27  persistently mentally ill and received case management services 
 95.28  according to section 256B.0625, subdivision 20; 
 95.29     (8) persons eligible for medical assistance according to 
 95.30  section 256B.057, subdivision 10; and 
 95.31     (9) persons with access to cost-effective 
 95.32  employer-sponsored private health insurance or persons enrolled 
 95.33  in an non-Medicare individual health plan determined to be 
 95.34  cost-effective according to section 256B.0625, subdivision 15.  
 95.35  Children under age 21 who are in foster placement may enroll in 
 95.36  the project on an elective basis.  Individuals excluded under 
 96.1   clauses (1), (6), and (7) may choose to enroll on an elective 
 96.2   basis.  The commissioner may enroll recipients in the prepaid 
 96.3   medical assistance program for seniors who are (1) age 65 and 
 96.4   over, and (2) eligible for medical assistance by spending down 
 96.5   excess income. 
 96.6      (c) The commissioner may allow persons with a one-month 
 96.7   spenddown who are otherwise eligible to enroll to voluntarily 
 96.8   enroll or remain enrolled, if they elect to prepay their monthly 
 96.9   spenddown to the state.  
 96.10     (d) The commissioner may require those individuals to 
 96.11  enroll in the prepaid medical assistance program who otherwise 
 96.12  would have been excluded under paragraph (b), clauses (1), (3), 
 96.13  and (8), and under Minnesota Rules, part 9500.1452, subpart 2, 
 96.14  items H, K, and L.  
 96.15     (e) Before limitation of choice is implemented, eligible 
 96.16  individuals shall be notified and after notification, shall be 
 96.17  allowed to choose only among demonstration providers.  The 
 96.18  commissioner may assign an individual with private coverage 
 96.19  through a health maintenance organization, to the same health 
 96.20  maintenance organization for medical assistance coverage, if the 
 96.21  health maintenance organization is under contract for medical 
 96.22  assistance in the individual's county of residence.  After 
 96.23  initially choosing a provider, the recipient is allowed to 
 96.24  change that choice only at specified times as allowed by the 
 96.25  commissioner.  If a demonstration provider ends participation in 
 96.26  the project for any reason, a recipient enrolled with that 
 96.27  provider must select a new provider but may change providers 
 96.28  without cause once more within the first 60 days after 
 96.29  enrollment with the second provider. 
 96.30     (f) An infant born to a woman who is eligible for and 
 96.31  receiving medical assistance and who is enrolled in the prepaid 
 96.32  medical assistance program shall be retroactively enrolled to 
 96.33  the month of birth in the same managed care plan as the mother 
 96.34  once the child is enrolled in medical assistance unless the 
 96.35  child is determined to be excluded from enrollment in a prepaid 
 96.36  plan under this section. 
 97.1      Sec. 28.  Minnesota Statutes 2004, section 256D.03, 
 97.2   subdivision 4, is amended to read: 
 97.3      Subd. 4.  [GENERAL ASSISTANCE MEDICAL CARE; SERVICES.] 
 97.4   (a)(i) For a person who is eligible under subdivision 3, 
 97.5   paragraph (a), clause (2), item (i), general assistance medical 
 97.6   care covers, except as provided in paragraph (c): 
 97.7      (1) inpatient hospital services; 
 97.8      (2) outpatient hospital services; 
 97.9      (3) services provided by Medicare certified rehabilitation 
 97.10  agencies; 
 97.11     (4) prescription drugs and other products recommended 
 97.12  through the process established in section 256B.0625, 
 97.13  subdivision 13; 
 97.14     (5) equipment necessary to administer insulin and 
 97.15  diagnostic supplies and equipment for diabetics to monitor blood 
 97.16  sugar level; 
 97.17     (6) eyeglasses and eye examinations provided by a physician 
 97.18  or optometrist; 
 97.19     (7) hearing aids; 
 97.20     (8) prosthetic devices; 
 97.21     (9) laboratory and X-ray services; 
 97.22     (10) physician's services; 
 97.23     (11) medical transportation except special transportation; 
 97.24     (12) chiropractic services as covered under the medical 
 97.25  assistance program; 
 97.26     (13) podiatric services; 
 97.27     (14) dental services and dentures, subject to the 
 97.28  limitations specified in section 256B.0625, subdivision 9 as 
 97.29  covered under the medical assistance program; 
 97.30     (15) outpatient services provided by a mental health center 
 97.31  or clinic that is under contract with the county board and is 
 97.32  established under section 245.62; 
 97.33     (16) day treatment services for mental illness provided 
 97.34  under contract with the county board; 
 97.35     (17) prescribed medications for persons who have been 
 97.36  diagnosed as mentally ill as necessary to prevent more 
 98.1   restrictive institutionalization; 
 98.2      (18) psychological services, medical supplies and 
 98.3   equipment, and Medicare premiums, coinsurance and deductible 
 98.4   payments; 
 98.5      (19) medical equipment not specifically listed in this 
 98.6   paragraph when the use of the equipment will prevent the need 
 98.7   for costlier services that are reimbursable under this 
 98.8   subdivision; 
 98.9      (20) services performed by a certified pediatric nurse 
 98.10  practitioner, a certified family nurse practitioner, a certified 
 98.11  adult nurse practitioner, a certified obstetric/gynecological 
 98.12  nurse practitioner, a certified neonatal nurse practitioner, or 
 98.13  a certified geriatric nurse practitioner in independent 
 98.14  practice, if (1) the service is otherwise covered under this 
 98.15  chapter as a physician service, (2) the service provided on an 
 98.16  inpatient basis is not included as part of the cost for 
 98.17  inpatient services included in the operating payment rate, and 
 98.18  (3) the service is within the scope of practice of the nurse 
 98.19  practitioner's license as a registered nurse, as defined in 
 98.20  section 148.171; 
 98.21     (21) services of a certified public health nurse or a 
 98.22  registered nurse practicing in a public health nursing clinic 
 98.23  that is a department of, or that operates under the direct 
 98.24  authority of, a unit of government, if the service is within the 
 98.25  scope of practice of the public health nurse's license as a 
 98.26  registered nurse, as defined in section 148.171; and 
 98.27     (22) telemedicine consultations, to the extent they are 
 98.28  covered under section 256B.0625, subdivision 3b.  
 98.29     (ii) Effective October 1, 2003, for a person who is 
 98.30  eligible under subdivision 3, paragraph (a), clause (2), item 
 98.31  (ii), general assistance medical care coverage is limited to 
 98.32  inpatient hospital services, including physician services 
 98.33  provided during the inpatient hospital stay.  A $1,000 
 98.34  deductible is required for each inpatient hospitalization.  
 98.35     (b) Gender reassignment surgery and related services are 
 98.36  not covered services under this subdivision unless the 
 99.1   individual began receiving gender reassignment services prior to 
 99.2   July 1, 1995.  
 99.3      (c) In order to contain costs, the commissioner of human 
 99.4   services shall select vendors of medical care who can provide 
 99.5   the most economical care consistent with high medical standards 
 99.6   and shall where possible contract with organizations on a 
 99.7   prepaid capitation basis to provide these services.  The 
 99.8   commissioner shall consider proposals by counties and vendors 
 99.9   for prepaid health plans, competitive bidding programs, block 
 99.10  grants, or other vendor payment mechanisms designed to provide 
 99.11  services in an economical manner or to control utilization, with 
 99.12  safeguards to ensure that necessary services are provided.  
 99.13  Before implementing prepaid programs in counties with a county 
 99.14  operated or affiliated public teaching hospital or a hospital or 
 99.15  clinic operated by the University of Minnesota, the commissioner 
 99.16  shall consider the risks the prepaid program creates for the 
 99.17  hospital and allow the county or hospital the opportunity to 
 99.18  participate in the program in a manner that reflects the risk of 
 99.19  adverse selection and the nature of the patients served by the 
 99.20  hospital, provided the terms of participation in the program are 
 99.21  competitive with the terms of other participants considering the 
 99.22  nature of the population served.  Payment for services provided 
 99.23  pursuant to this subdivision shall be as provided to medical 
 99.24  assistance vendors of these services under sections 256B.02, 
 99.25  subdivision 8, and 256B.0625.  For payments made during fiscal 
 99.26  year 1990 and later years, the commissioner shall consult with 
 99.27  an independent actuary in establishing prepayment rates, but 
 99.28  shall retain final control over the rate methodology.  
 99.29     (d) Recipients eligible under subdivision 3, paragraph (a), 
 99.30  clause (2), item (i), shall pay the following co-payments for 
 99.31  services provided on or after October 1, 2003: 
 99.32     (1) $3 per nonpreventive visit.  For purposes of this 
 99.33  subdivision, a visit means an episode of service which is 
 99.34  required because of a recipient's symptoms, diagnosis, or 
 99.35  established illness, and which is delivered in an ambulatory 
 99.36  setting by a physician or physician ancillary, chiropractor, 
100.1   podiatrist, nurse midwife, advanced practice nurse, audiologist, 
100.2   optician, or optometrist; 
100.3      (2) $25 for eyeglasses; 
100.4      (3) $25 for nonemergency visits to a hospital-based 
100.5   emergency room; 
100.6      (4) $3 per brand-name drug prescription and $1 per generic 
100.7   drug prescription, subject to a $20 per month maximum for 
100.8   prescription drug co-payments.  No co-payments shall apply to 
100.9   antipsychotic drugs when used for the treatment of mental 
100.10  illness; and 
100.11     (5) 50 percent coinsurance on restorative dental services.  
100.12     (e) Co-payments shall be limited to one per day per 
100.13  provider for nonpreventive visits, eyeglasses, and nonemergency 
100.14  visits to a hospital-based emergency room.  Recipients of 
100.15  general assistance medical care are responsible for all 
100.16  co-payments in this subdivision.  The general assistance medical 
100.17  care reimbursement to the provider shall be reduced by the 
100.18  amount of the co-payment, except that reimbursement for 
100.19  prescription drugs shall not be reduced once a recipient has 
100.20  reached the $20 per month maximum for prescription drug 
100.21  co-payments.  The provider collects the co-payment from the 
100.22  recipient.  Providers may not deny services to recipients who 
100.23  are unable to pay the co-payment, except as provided in 
100.24  paragraph (f). 
100.25     (f) If it is the routine business practice of a provider to 
100.26  refuse service to an individual with uncollected debt, the 
100.27  provider may include uncollected co-payments under this 
100.28  section.  A provider must give advance notice to a recipient 
100.29  with uncollected debt before services can be denied. 
100.30     (g) (d) Any county may, from its own resources, provide 
100.31  medical payments for which state payments are not made. 
100.32     (h) (e) Chemical dependency services that are reimbursed 
100.33  under chapter 254B must not be reimbursed under general 
100.34  assistance medical care. 
100.35     (i) (f) The maximum payment for new vendors enrolled in the 
100.36  general assistance medical care program after the base year 
101.1   shall be determined from the average usual and customary charge 
101.2   of the same vendor type enrolled in the base year. 
101.3      (j) (g) The conditions of payment for services under this 
101.4   subdivision are the same as the conditions specified in rules 
101.5   adopted under chapter 256B governing the medical assistance 
101.6   program, unless otherwise provided by statute or rule. 
101.7      (k) (h) Inpatient and outpatient payments shall be reduced 
101.8   by five percent, effective July 1, 2003.  This reduction is in 
101.9   addition to the five percent reduction effective July 1, 2003, 
101.10  and incorporated by reference in paragraph (i) (f).  
101.11     (l) (i) Payments for all other health services except 
101.12  inpatient, outpatient, and pharmacy services shall be reduced by 
101.13  five percent, effective July 1, 2003.  
101.14     (m) (j) Payments to managed care plans shall be reduced by 
101.15  five percent for services provided on or after October 1, 2003. 
101.16     (n) (k) A hospital receiving a reduced payment as a result 
101.17  of this section may apply the unpaid balance toward satisfaction 
101.18  of the hospital's bad debts. 
101.19     <b>[EFFECTIVE DATE.]</b> This section is effective January 1, 2006.
101.20     Sec. 29.  Minnesota Statutes 2004, section 256D.045, is 
101.21  amended to read: 
101.22     256D.045 [SOCIAL SECURITY NUMBER REQUIRED.] 
101.23     To be eligible for general assistance under sections 
101.24  256D.01 to 256D.21, an individual must provide the individual's 
101.25  Social Security number to the county agency or submit proof that 
101.26  an application has been made.  An individual who refuses to 
101.27  provide a Social Security number because of a well-established 
101.28  religious objection as described in Code of Federal Regulations, 
101.29  title 42, section 435.910, may be eligible for general 
101.30  assistance medical care under section 256D.03.  The provisions 
101.31  of this section do not apply to the determination of eligibility 
101.32  for emergency general assistance under section 256D.06, 
101.33  subdivision 2.  This provision applies to eligible children 
101.34  under the age of 18 effective July 1, 1997.  
101.35     <b>[EFFECTIVE DATE.]</b> This section is effective August 1, 2006, 
101.36  or upon HealthMatch implementation, whichever is later. 
102.1      Sec. 30.  Minnesota Statutes 2004, section 256L.01, 
102.2   subdivision 4, is amended to read: 
102.3      Subd. 4.  [GROSS INDIVIDUAL OR GROSS FAMILY INCOME.] (a) 
102.4   "Gross individual or gross family income" for nonfarm 
102.5   self-employed means income calculated for the six-month period 
102.6   of eligibility using as the baseline the adjusted gross income 
102.7   reported on the applicant's federal income tax form for the 
102.8   previous year and adding back in reported depreciation, 
102.9   carryover loss, and net operating loss amounts that apply to the 
102.10  business in which the family is currently engaged.  
102.11     (b) "Gross individual or gross family income" for farm 
102.12  self-employed means income calculated for the six-month period 
102.13  of eligibility using as the baseline the adjusted gross income 
102.14  reported on the applicant's federal income tax form for the 
102.15  previous year and adding back in reported depreciation amounts 
102.16  that apply to the business in which the family is currently 
102.17  engaged.  
102.18     (c) Applicants shall report the most recent financial 
102.19  situation of the family if it has changed from the period of 
102.20  time covered by the federal income tax form.  The report may be 
102.21  in the form of percentage increase or decrease "Gross individual 
102.22  or gross family income" means the total income for all family 
102.23  members, calculated for the six-month period of eligibility. 
102.24     <b>[EFFECTIVE DATE.]</b> This section is effective August 1, 2006, 
102.25  or upon HealthMatch implementation, whichever is later. 
102.26     Sec. 31.  Minnesota Statutes 2004, section 256L.01, 
102.27  subdivision 5, is amended to read: 
102.28     Subd. 5.  [INCOME.] (a) "Income" has the meaning given for 
102.29  earned and unearned income for families and children in the 
102.30  medical assistance program, according to the state's aid to 
102.31  families with dependent children plan in effect as of July 16, 
102.32  1996.  The definition does not include medical assistance income 
102.33  methodologies and deeming requirements.  The earned income of 
102.34  full-time and part-time students under age 19 is not counted as 
102.35  income.  Public assistance payments and supplemental security 
102.36  income are not excluded income. 
103.1      (b) For purposes of this subdivision, and unless otherwise 
103.2   specified in this section, the commissioner shall use reasonable 
103.3   methods to calculate gross earned and unearned income including, 
103.4   but not limited to, projecting income based on income received 
103.5   within the past 30 days, the last 90 days, or the last 12 months.
103.6      <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2005. 
103.7      Sec. 32.  Minnesota Statutes 2004, section 256L.03, 
103.8   subdivision 1, is amended to read: 
103.9      Subdivision 1.  [COVERED HEALTH SERVICES.] For individuals 
103.10  under section 256L.04, subdivision 7, with income no greater 
103.11  than 75 percent of the federal poverty guidelines or for 
103.12  families with children under section 256L.04, subdivision 1, all 
103.13  subdivisions of this section apply.  "Covered health services" 
103.14  means the health services reimbursed under chapter 256B, with 
103.15  the exception of inpatient hospital services, special education 
103.16  services, private duty nursing services, adult dental care 
103.17  services other than services covered under section 256B.0625, 
103.18  subdivision 9, paragraph (b), orthodontic services, nonemergency 
103.19  medical transportation services, personal care assistant and 
103.20  case management services, nursing home or intermediate care 
103.21  facilities services, inpatient mental health services, and 
103.22  chemical dependency services.  Outpatient mental health services 
103.23  covered under the MinnesotaCare program are limited to 
103.24  diagnostic assessments, psychological testing, explanation of 
103.25  findings, medication management by a physician, day treatment, 
103.26  partial hospitalization, and individual, family, and group 
103.27  psychotherapy. 
103.28     No public funds shall be used for coverage of abortion 
103.29  under MinnesotaCare except where the life of the female would be 
103.30  endangered or substantial and irreversible impairment of a major 
103.31  bodily function would result if the fetus were carried to term; 
103.32  or where the pregnancy is the result of rape or incest. 
103.33     Covered health services shall be expanded as provided in 
103.34  this section. 
103.35     <b>[EFFECTIVE DATE.]</b> Notwithstanding section 256B.69, 
103.36  subdivision 5a, paragraph (b), this section is effective July 1, 
104.1   2005.  
104.2      Sec. 33.  Minnesota Statutes 2004, section 256L.03, 
104.3   subdivision 1b, is amended to read: 
104.4      Subd. 1b.  [PREGNANT WOMEN; ELIGIBILITY FOR FULL MEDICAL 
104.5   ASSISTANCE SERVICES.] Beginning January 1, 1999, A pregnant 
104.6   woman who is enrolled in MinnesotaCare when her pregnancy is 
104.7   diagnosed is eligible for coverage of all services provided 
104.8   under the medical assistance program according to chapter 256B 
104.9   retroactive to the date the pregnancy is medically diagnosed of 
104.10  conception.  Co-payments totaling $30 or more, paid after the 
104.11  date the pregnancy is diagnosed of conception, shall be refunded.
104.12     Sec. 34.  Minnesota Statutes 2004, section 256L.03, 
104.13  subdivision 5, is amended to read: 
104.14     Subd. 5.  [CO-PAYMENTS AND COINSURANCE.] (a) Except as 
104.15  provided in paragraphs (b) and (c), the MinnesotaCare benefit 
104.16  plan shall include the following co-payments and coinsurance 
104.17  requirements for all enrollees:  
104.18     (1) ten percent of the paid charges for inpatient hospital 
104.19  services for adult enrollees, subject to an annual inpatient 
104.20  out-of-pocket maximum of $1,000 per individual and $3,000 per 
104.21  family; 
104.22     (2) $3 per prescription for adult enrollees; 
104.23     (3) $25 for eyeglasses for adult enrollees; and 
104.24     (4) 50 percent of the fee-for-service rate for adult dental 
104.25  care services other than preventive care services for persons 
104.26  eligible under section 256L.04, subdivisions 1 to 7, with income 
104.27  equal to or less greater than 175 190 percent of the federal 
104.28  poverty guidelines. 
104.29     (b) Paragraph (a), clause (1), does not apply to parents 
104.30  and relative caretakers of children under the age of 21 in 
104.31  households with family income equal to or less than 175 percent 
104.32  of the federal poverty guidelines.  Paragraph (a), clause (1), 
104.33  does not apply to parents and relative caretakers of children 
104.34  under the age of 21 in households with family income greater 
104.35  than 175 percent of the federal poverty guidelines for inpatient 
104.36  hospital admissions occurring on or after January 1, 2001.  
105.1      (c) Paragraph (a), clauses (1) to (4), do not apply to 
105.2   pregnant women and children under the age of 21.  
105.3      (d) Adult enrollees with family gross income that exceeds 
105.4   175 percent of the federal poverty guidelines and who are not 
105.5   pregnant shall be financially responsible for the coinsurance 
105.6   amount, if applicable, and amounts which exceed the $10,000 
105.7   inpatient hospital benefit limit. 
105.8      (e) When a MinnesotaCare enrollee becomes a member of a 
105.9   prepaid health plan, or changes from one prepaid health plan to 
105.10  another during a calendar year, any charges submitted towards 
105.11  the $10,000 annual inpatient benefit limit, and any 
105.12  out-of-pocket expenses incurred by the enrollee for inpatient 
105.13  services, that were submitted or incurred prior to enrollment, 
105.14  or prior to the change in health plans, shall be disregarded. 
105.15     <b>[EFFECTIVE DATE.]</b> This section is effective August 1, 2006, 
105.16  or upon HealthMatch implementation, whichever is later.  
105.17     Sec. 35.  Minnesota Statutes 2004, section 256L.04, is 
105.18  amended by adding a subdivision to read: 
105.19     Subd. 1a.  [SOCIAL SECURITY NUMBER REQUIRED.] (a) 
105.20  Individuals and families applying for MinnesotaCare coverage 
105.21  must provide a Social Security number. 
105.22     (b) The commissioner shall not deny eligibility to an 
105.23  otherwise eligible applicant who has applied for a Social 
105.24  Security number and is awaiting issuance of that Social Security 
105.25  number. 
105.26     (c) Newborns enrolled under section 256L.05, subdivision 3, 
105.27  are exempt from the requirements of this subdivision. 
105.28     (d) Individuals who refuse to provide a Social Security 
105.29  number because of well-established religious objections are 
105.30  exempt from the requirements of this subdivision.  The term 
105.31  "well-established religious objections" has the meaning given in 
105.32  Code of Federal Regulations, title 42, section 435.910. 
105.33     <b>[EFFECTIVE DATE.]</b> This section is effective August 1, 2006, 
105.34  or upon HealthMatch implementation, whichever is later. 
105.35     Sec. 36.  Minnesota Statutes 2004, section 256L.04, 
105.36  subdivision 2, is amended to read: 
106.1      Subd. 2.  [COOPERATION IN ESTABLISHING THIRD-PARTY 
106.2   LIABILITY, PATERNITY, AND OTHER MEDICAL SUPPORT.] (a) To be 
106.3   eligible for MinnesotaCare, individuals and families must 
106.4   cooperate with the state agency to identify potentially liable 
106.5   third-party payers and assist the state in obtaining third-party 
106.6   payments.  "Cooperation" includes, but is not limited 
106.7   to, complying with the notice requirements in section 256B.056, 
106.8   subdivision 9, identifying any third party who may be liable for 
106.9   care and services provided under MinnesotaCare to the enrollee, 
106.10  providing relevant information to assist the state in pursuing a 
106.11  potentially liable third party, and completing forms necessary 
106.12  to recover third-party payments. 
106.13     (b) A parent, guardian, relative caretaker, or child 
106.14  enrolled in the MinnesotaCare program must cooperate with the 
106.15  Department of Human Services and the local agency in 
106.16  establishing the paternity of an enrolled child and in obtaining 
106.17  medical care support and payments for the child and any other 
106.18  person for whom the person can legally assign rights, in 
106.19  accordance with applicable laws and rules governing the medical 
106.20  assistance program.  A child shall not be ineligible for or 
106.21  disenrolled from the MinnesotaCare program solely because the 
106.22  child's parent, relative caretaker, or guardian fails to 
106.23  cooperate in establishing paternity or obtaining medical support.
106.24     Sec. 37.  Minnesota Statutes 2004, section 256L.04, is 
106.25  amended by adding a subdivision to read: 
106.26     Subd. 2a.  [APPLICATIONS FOR OTHER BENEFITS.] To be 
106.27  eligible for MinnesotaCare, individuals and families must take 
106.28  all necessary steps to obtain other benefits as described in 
106.29  Code of Federal Regulations, title 42, section 435.608.  
106.30  Applicants and enrollees must apply for other benefits within 30 
106.31  days. 
106.32     <b>[EFFECTIVE DATE.]</b> This section is effective August 1, 2006, 
106.33  or upon HealthMatch implementation, whichever is later. 
106.34     Sec. 38.  Minnesota Statutes 2004, section 256L.04, 
106.35  subdivision 7, is amended to read: 
106.36     Subd. 7.  [SINGLE ADULTS AND HOUSEHOLDS WITH NO CHILDREN.] 
107.1   The definition of eligible persons includes all individuals and 
107.2   households with no children who have gross family incomes that 
107.3   are equal to or less than 175 190 percent of the federal poverty 
107.4   guidelines. 
107.5      <b>[EFFECTIVE DATE.]</b> This section is effective August 1, 2006, 
107.6   or upon HealthMatch implementation, whichever is later.  
107.7      Sec. 39.  Minnesota Statutes 2004, section 256L.05, 
107.8   subdivision 3, is amended to read: 
107.9      Subd. 3.  [EFFECTIVE DATE OF COVERAGE.] (a) The effective 
107.10  date of coverage is the first day of the month following the 
107.11  month in which eligibility is approved and the first premium 
107.12  payment has been received.  As provided in section 256B.057, 
107.13  coverage for newborns is automatic from the date of birth and 
107.14  must be coordinated with other health coverage.  The effective 
107.15  date of coverage for eligible newly adoptive children added to a 
107.16  family receiving covered health services is the date of entry 
107.17  into the family month of placement.  The effective date of 
107.18  coverage for other new recipients members added to the family 
107.19  receiving covered health services is the first day of the month 
107.20  following the month in which eligibility is approved or at 
107.21  renewal, whichever the family receiving covered health services 
107.22  prefers the change is reported.  All eligibility criteria must 
107.23  be met by the family at the time the new family member is 
107.24  added.  The income of the new family member is included with the 
107.25  family's gross income and the adjusted premium begins in the 
107.26  month the new family member is added.  
107.27     (b) The initial premium must be received by the last 
107.28  working day of the month for coverage to begin the first day of 
107.29  the following month.  
107.30     (c) Benefits are not available until the day following 
107.31  discharge if an enrollee is hospitalized on the first day of 
107.32  coverage.  
107.33     (d) Notwithstanding any other law to the contrary, benefits 
107.34  under sections 256L.01 to 256L.18 are secondary to a plan of 
107.35  insurance or benefit program under which an eligible person may 
107.36  have coverage and the commissioner shall use cost avoidance 
108.1   techniques to ensure coordination of any other health coverage 
108.2   for eligible persons.  The commissioner shall identify eligible 
108.3   persons who may have coverage or benefits under other plans of 
108.4   insurance or who become eligible for medical assistance. 
108.5      <b>[EFFECTIVE DATE.]</b> This section is effective August 1, 2006, 
108.6   or upon HealthMatch implementation, whichever is later. 
108.7      Sec. 40.  Minnesota Statutes 2004, section 256L.05, 
108.8   subdivision 3a, is amended to read: 
108.9      Subd. 3a.  [RENEWAL OF ELIGIBILITY.] (a) Beginning January 
108.10  1, 1999, an enrollee's eligibility must be renewed every 12 
108.11  months.  The 12-month period begins in the month after the month 
108.12  the application is approved.  
108.13     (b) Beginning October 1, 2004, an enrollee's eligibility 
108.14  must be renewed every six months.  The first six-month period of 
108.15  eligibility begins in the month after the month the application 
108.16  is approved received by the commissioner.  The effective date of 
108.17  coverage within the first six-month period of eligibility is as 
108.18  provided in subdivision 3.  Each new period of eligibility must 
108.19  take into account any changes in circumstances that impact 
108.20  eligibility and premium amount.  An enrollee must provide all 
108.21  the information needed to redetermine eligibility by the first 
108.22  day of the month that ends the eligibility period.  The premium 
108.23  for the new period of eligibility must be received as provided 
108.24  in section 256L.06 in order for eligibility to continue. 
108.25     <b>[EFFECTIVE DATE.]</b> This section is effective August 1, 2006, 
108.26  or upon HealthMatch implementation, whichever is later. 
108.27     Sec. 41.  Minnesota Statutes 2004, section 256L.07, 
108.28  subdivision 1, is amended to read: 
108.29     Subdivision 1.  [GENERAL REQUIREMENTS.] (a) Children 
108.30  enrolled in the original children's health plan as of September 
108.31  30, 1992, children who enrolled in the MinnesotaCare program 
108.32  after September 30, 1992, pursuant to Laws 1992, chapter 549, 
108.33  article 4, section 17, and children who have family gross 
108.34  incomes that are equal to or less than 150 percent of the 
108.35  federal poverty guidelines are eligible without meeting the 
108.36  requirements of subdivision 2 and the four-month requirement in 
109.1   subdivision 3, as long as they maintain continuous coverage in 
109.2   the MinnesotaCare program or medical assistance.  Children who 
109.3   apply for MinnesotaCare on or after the implementation date of 
109.4   the employer-subsidized health coverage program as described in 
109.5   Laws 1998, chapter 407, article 5, section 45, who have family 
109.6   gross incomes that are equal to or less than 150 percent of the 
109.7   federal poverty guidelines, must meet the requirements of 
109.8   subdivision 2 to be eligible for MinnesotaCare. 
109.9      (b) Families enrolled in MinnesotaCare under section 
109.10  256L.04, subdivision 1, whose income increases above 275 percent 
109.11  of the federal poverty guidelines, are no longer eligible for 
109.12  the program and shall be disenrolled by the commissioner.  
109.13  Individuals enrolled in MinnesotaCare under section 256L.04, 
109.14  subdivision 7, whose income increases above 175 percent of the 
109.15  federal poverty guidelines are no longer eligible for the 
109.16  program and shall be disenrolled by the commissioner.  For 
109.17  persons disenrolled under this subdivision, MinnesotaCare 
109.18  coverage terminates the last day of the calendar month following 
109.19  the month in which the commissioner determines that the income 
109.20  of a family or individual exceeds program income limits.  
109.21     (c)(1) Notwithstanding paragraph (b), families enrolled in 
109.22  MinnesotaCare under section 256L.04, subdivision 1, may remain 
109.23  enrolled in MinnesotaCare if ten percent of their annual income 
109.24  is less than the annual premium for a policy with a $500 
109.25  deductible available through the Minnesota Comprehensive Health 
109.26  Association.  Families who are no longer eligible for 
109.27  MinnesotaCare under this subdivision shall be given an 18-month 
109.28  notice period from the date that ineligibility is determined 
109.29  before disenrollment.  This clause expires February 1, 2004. 
109.30     (2) Effective February 1, 2004, notwithstanding paragraph 
109.31  (b), children may remain enrolled in MinnesotaCare if ten 
109.32  percent of their annual gross individual or gross family income 
109.33  as defined in section 256L.01, subdivision 4, is less than the 
109.34  annual premium for a six-month policy with a $500 deductible 
109.35  available through the Minnesota Comprehensive Health 
109.36  Association.  Children who are no longer eligible for 
110.1   MinnesotaCare under this clause shall be given a 12-month notice 
110.2   period from the date that ineligibility is determined before 
110.3   disenrollment.  The premium for children remaining eligible 
110.4   under this clause shall be the maximum premium determined under 
110.5   section 256L.15, subdivision 2, paragraph (b). 
110.6      (d) Effective July 1, 2003, notwithstanding paragraphs (b) 
110.7   and (c), parents are no longer eligible for MinnesotaCare if 
110.8   gross household income exceeds $50,000 $25,000 for the six-month 
110.9   period of eligibility. 
110.10     <b>[EFFECTIVE DATE.]</b> This section is effective August 1, 2006, 
110.11  or upon HealthMatch implementation, whichever is later. 
110.12     Sec. 42.  Minnesota Statutes 2004, section 256L.07, 
110.13  subdivision 3, is amended to read: 
110.14     Subd. 3.  [OTHER HEALTH COVERAGE.] (a) Families and 
110.15  individuals enrolled in the MinnesotaCare program must have no 
110.16  health coverage while enrolled or for at least four months prior 
110.17  to application and renewal.  Children enrolled in the original 
110.18  children's health plan and children in families with income 
110.19  equal to or less than 150 percent of the federal poverty 
110.20  guidelines, who have other health insurance, are eligible if the 
110.21  coverage: 
110.22     (1) lacks two or more of the following: 
110.23     (i) basic hospital insurance; 
110.24     (ii) medical-surgical insurance; 
110.25     (iii) prescription drug coverage; 
110.26     (iv) dental coverage; or 
110.27     (v) vision coverage; 
110.28     (2) requires a deductible of $100 or more per person per 
110.29  year; or 
110.30     (3) lacks coverage because the child has exceeded the 
110.31  maximum coverage for a particular diagnosis or the policy 
110.32  excludes a particular diagnosis. 
110.33     The commissioner may change this eligibility criterion for 
110.34  sliding scale premiums in order to remain within the limits of 
110.35  available appropriations.  The requirement of no health coverage 
110.36  does not apply to newborns.  
111.1      (b) Medical assistance, general assistance medical care, 
111.2   and the Civilian Health and Medical Program of the Uniformed 
111.3   Service, CHAMPUS, or other coverage provided under United States 
111.4   Code, title 10, subtitle A, part II, chapter 55, are not 
111.5   considered insurance or health coverage for purposes of the 
111.6   four-month requirement described in this subdivision. 
111.7      (c) For purposes of this subdivision, an applicant or 
111.8   enrollee who is entitled to Medicare Part A or enrolled in 
111.9   Medicare Part B coverage under title XVIII of the Social 
111.10  Security Act, United States Code, title 42, sections 1395c 
111.11  to 1395w-4 1395w-152, is considered to have health coverage.  An 
111.12  applicant or enrollee who is entitled to premium-free Medicare 
111.13  Part A may not refuse to apply for or enroll in Medicare 
111.14  coverage to establish eligibility for MinnesotaCare. 
111.15     (d) Applicants who were recipients of medical assistance or 
111.16  general assistance medical care within one month of application 
111.17  must meet the provisions of this subdivision and subdivision 2. 
111.18     (e) Effective October 1, 2003, applicants who were 
111.19  recipients of medical assistance and had Cost-effective health 
111.20  insurance which that was paid for by medical assistance are 
111.21  exempt from is not considered health coverage for purposes of 
111.22  the four-month requirement under this section, except if the 
111.23  insurance continued after medical assistance no longer 
111.24  considered it cost-effective or after medical assistance closed. 
111.25     Sec. 43.  Minnesota Statutes 2004, section 256L.07, is 
111.26  amended by adding a subdivision to read: 
111.27     Subd. 5.  [VOLUNTARY DISENROLLMENT FOR MEMBERS OF 
111.28  MILITARY.] Notwithstanding section 256L.05, subdivision 3b, 
111.29  MinnesotaCare enrollees who are members of the military and 
111.30  their families, who choose to voluntarily disenroll from the 
111.31  program when one or more family members are called to active 
111.32  duty, may reenroll during or following that member's tour of 
111.33  active duty.  Those individuals and families shall be considered 
111.34  to have good cause for voluntary termination under section 
111.35  256L.06, subdivision 3, paragraph (d).  Income and asset 
111.36  increases reported at the time of reenrollment shall be 
112.1   disregarded.  All provisions of sections 256L.01 to 256L.18, 
112.2   shall apply to individuals and families enrolled under this 
112.3   subdivision upon six-month renewal. 
112.4      Sec. 44.  Minnesota Statutes 2004, section 256L.12, 
112.5   subdivision 6, is amended to read: 
112.6      Subd. 6.  [CO-PAYMENTS AND BENEFIT LIMITS.] Enrollees are 
112.7   responsible for all co-payments in sections section 256L.03, 
112.8   subdivision 5, and 256L.035, and shall pay co-payments to the 
112.9   managed care plan or to its participating providers.  The 
112.10  enrollee is also responsible for payment of inpatient hospital 
112.11  charges which exceed the MinnesotaCare benefit limit. 
112.12     Sec. 45.  Minnesota Statutes 2004, section 256L.15, 
112.13  subdivision 2, is amended to read: 
112.14     Subd. 2.  [SLIDING FEE SCALE TO DETERMINE PERCENTAGE OF 
112.15  MONTHLY GROSS INDIVIDUAL OR FAMILY INCOME.] (a) The commissioner 
112.16  shall establish a sliding fee scale to determine the percentage 
112.17  of monthly gross individual or family income that households at 
112.18  different income levels must pay to obtain coverage through the 
112.19  MinnesotaCare program.  The sliding fee scale must be based on 
112.20  the enrollee's monthly gross individual or family income.  The 
112.21  sliding fee scale must contain separate tables based on 
112.22  enrollment of one, two, or three or more persons.  The sliding 
112.23  fee scale begins with a premium of 1.5 percent of monthly gross 
112.24  individual or family income for individuals or families with 
112.25  incomes below the limits for the medical assistance program for 
112.26  families and children in effect on January 1, 1999, and proceeds 
112.27  through the following evenly spaced steps:  1.8, 2.3, 3.1, 3.8, 
112.28  4.8, 5.9, 7.4, and 8.8 percent.  These percentages are matched 
112.29  to evenly spaced income steps ranging from the medical 
112.30  assistance income limit for families and children in effect on 
112.31  January 1, 1999, to 275 percent of the federal poverty 
112.32  guidelines for the applicable family size, up to a family size 
112.33  of five.  The sliding fee scale for a family of five must be 
112.34  used for families of more than five.  Effective October 1, 2003, 
112.35  the commissioner shall increase each percentage by 0.5 
112.36  percentage points for enrollees with income greater than 100 
113.1   percent but not exceeding 200 percent of the federal poverty 
113.2   guidelines and shall increase each percentage by 1.0 percentage 
113.3   points for families and children with incomes greater than 200 
113.4   percent of the federal poverty guidelines.  The sliding fee 
113.5   scale and percentages are not subject to the provisions of 
113.6   chapter 14.  If a family or individual reports increased income 
113.7   after enrollment, premiums shall not be adjusted until 
113.8   eligibility renewal. 
113.9      (b)(1) Enrolled families whose gross annual income 
113.10  increases above 275 percent of the federal poverty guideline 
113.11  shall pay the maximum premium.  This clause expires effective 
113.12  February 1, 2004.  
113.13     (2) Effective February 1, 2004, children in families whose 
113.14  gross income is above 275 percent of the federal poverty 
113.15  guidelines shall pay the maximum premium.  
113.16     (3) The maximum premium is defined as a base charge for 
113.17  one, two, or three or more enrollees so that if all 
113.18  MinnesotaCare cases paid the maximum premium, the total revenue 
113.19  would equal the total cost of MinnesotaCare medical coverage and 
113.20  administration.  In this calculation, administrative costs shall 
113.21  be assumed to equal ten percent of the total.  The costs of 
113.22  medical coverage for pregnant women and children under age two 
113.23  and the enrollees in these groups shall be excluded from the 
113.24  total.  The maximum premium for two enrollees shall be twice the 
113.25  maximum premium for one, and the maximum premium for three or 
113.26  more enrollees shall be three times the maximum premium for one. 
113.27     <b>[EFFECTIVE DATE.]</b> This section is effective August 1, 2006, 
113.28  or upon HealthMatch implementation, whichever is later. 
113.29     Sec. 46.  Minnesota Statutes 2004, section 256L.15, 
113.30  subdivision 3, is amended to read: 
113.31     Subd. 3.  [EXCEPTIONS TO SLIDING SCALE.] An annual premium 
113.32  of $48 is required for all Children in families with income at 
113.33  or less than below 150 percent of the federal poverty guidelines 
113.34  pay a monthly premium of $4. 
113.35     <b>[EFFECTIVE DATE.]</b> This section is effective August 1, 2006, 
113.36  or upon HealthMatch implementation, whichever is later. 
114.1      Sec. 47.  [256L.20] [MINNESOTACARE OPTION FOR SMALL 
114.2   EMPLOYERS.] 
114.3      Subdivision 1.  [DEFINITIONS.] (a) For the purpose of this 
114.4   section, the terms used have the meanings given them.  
114.5      (b) "Dependent" means an unmarried child under 21 years of 
114.6   age.  
114.7      (c) "Eligible employer" means a business that employs at 
114.8   least two, but not more than 50, eligible employees, the 
114.9   majority of whom are employed in the state, and includes a 
114.10  municipality that has 50 or fewer employees.  
114.11     (d) "Eligible employee" means an employee who works at 
114.12  least 20 hours per week for an eligible employer.  Eligible 
114.13  employee does not include an employee who works on a temporary 
114.14  or substitute basis or who does not work more than 26 weeks 
114.15  annually.  
114.16     (e) "Maximum premium" has the meaning given under section 
114.17  256L.15, subdivision 2, paragraph (b), clause (3). 
114.18     (f) "Participating employer" means an eligible employer who 
114.19  meets the requirements in subdivision 3 and applies to the 
114.20  commissioner to enroll its eligible employees and their 
114.21  dependents in the MinnesotaCare program.  
114.22     (g) "Program" means the MinnesotaCare program.  
114.23     Subd. 2.  [OPTION.] Eligible employees and their dependents 
114.24  may enroll in MinnesotaCare if the eligible employer meets the 
114.25  requirements of subdivision 3.  The effective date of coverage 
114.26  is according to section 256L.05, subdivision 3. 
114.27     Subd. 3.  [EMPLOYER REQUIREMENTS.] The commissioner shall 
114.28  establish procedures for an eligible employer to apply for 
114.29  coverage through the program.  In order to participate, an 
114.30  eligible employer must meet the following requirements:  
114.31     (1) agrees to contribute toward the cost of the premium for 
114.32  the employee and the employee's dependents according to 
114.33  subdivision 4; 
114.34     (2) certifies that at least 75 percent of its eligible 
114.35  employees who do not have other creditable health coverage are 
114.36  enrolled in the program; 
115.1      (3) offers coverage to all eligible employees and the 
115.2   dependents of eligible employees; and 
115.3      (4) has not provided employer-subsidized health coverage as 
115.4   an employee benefit during the previous 12 months, as defined in 
115.5   section 256L.07, subdivision 2, paragraph (c).  
115.6      Subd. 4.  [PREMIUMS.] (a) The premium for MinnesotaCare 
115.7   coverage provided under this section is equal to the maximum 
115.8   premium regardless of the income of the eligible employee.  
115.9      (b) For eligible employees without dependents with income 
115.10  equal to or less than 175 percent of the federal poverty 
115.11  guidelines and for eligible employees with dependents with 
115.12  income equal to or less than 275 percent of the federal poverty 
115.13  guidelines, the participating employer shall pay 50 percent of 
115.14  the maximum premium for the eligible employee and any 
115.15  dependents, if applicable.  
115.16     (c) For eligible employees without dependents with income 
115.17  over 175 percent of the federal poverty guidelines and for 
115.18  eligible employees with dependents with income over 275 percent 
115.19  of the federal poverty guidelines, the participating employer 
115.20  shall pay the full cost of the maximum premium for the eligible 
115.21  employee and any dependents, if applicable.  The participating 
115.22  employer may require the employee to pay a portion of the cost 
115.23  of the premium so long as the employer pays 50 percent of the 
115.24  cost.  If the employer requires the employee to pay a portion of 
115.25  the premium, the employee shall pay the portion of the cost to 
115.26  the employer.  
115.27     (d) The commissioner shall collect premium payments from 
115.28  participating employers for eligible employees and their 
115.29  dependents who are covered by the program as provided under this 
115.30  section.  All premiums collected shall be deposited in the 
115.31  health care access fund.  
115.32     Subd. 5.  [COVERAGE.] The coverage offered to those 
115.33  enrolled in the program under this section must include all 
115.34  health services described under section 256L.03 and all 
115.35  co-payments and coinsurance requirements under section 256L.03, 
115.36  subdivision 5, apply.  
116.1      Subd. 6.  [ENROLLMENT.] Upon payment of the premium, in 
116.2   accordance with this section and section 256L.06, eligible 
116.3   employees and their dependents shall be enrolled in 
116.4   MinnesotaCare.  For purposes of enrollment under this section, 
116.5   income eligibility limits established under sections 256L.04 and 
116.6   256L.07, subdivision 1, and asset limits established under 
116.7   section 256L.17 do not apply.  The barriers established under 
116.8   section 256L.07, subdivision 2 or 3, do not apply to enrollees 
116.9   eligible under this section.  The commissioner may require 
116.10  eligible employees to provide income verification to determine 
116.11  premiums. 
116.12     <b>[EFFECTIVE DATE.]</b> This section is effective August 1, 2006, 
116.13  or upon HealthMatch implementation, whichever is later.  
116.14     Sec. 48.  Minnesota Statutes 2004, section 549.02, is 
116.15  amended by adding a subdivision to read: 
116.16     Subd. 3.  [LIMITATION.] Notwithstanding subdivisions 1 and 
116.17  2, where the state agency is named or intervenes as a party to 
116.18  enforce the agency's rights under section 256B.056, the agency 
116.19  shall not be liable for costs to any prevailing defendant. 
116.20     Sec. 49.  Minnesota Statutes 2004, section 549.04, is 
116.21  amended to read: 
116.22     549.04 [DISBURSEMENTS; TAXATION AND ALLOWANCE.] 
116.23     Subdivision 1.  [GENERALLY.] In every action in a district 
116.24  court, the prevailing party, including any public employee who 
116.25  prevails in an action for wrongfully denied or withheld 
116.26  employment benefits or rights, shall be allowed reasonable 
116.27  disbursements paid or incurred, including fees and mileage paid 
116.28  for service of process by the sheriff or by a private person.  
116.29     Subd. 2.  [LIMITATION.] Notwithstanding subdivision 1, 
116.30  where the state agency is named or intervenes as a party to 
116.31  enforce the agency's rights under section 256B.056, the agency 
116.32  shall not be liable for disbursements to any prevailing 
116.33  defendant. 
116.34     Sec. 50.  [EMPLOYER DISCLOSURE FOR MINNESOTA HEALTH CARE 
116.35  PROGRAM.] 
116.36     Subdivision 1.  [DEFINITIONS.] (a) For purposes of this 
117.1   section, the following definitions apply.  
117.2      (b) "Commissioner" means the commissioner of human services.
117.3      (c) "Minnesota health care program" means the prescription 
117.4   drug program under section 256.955, medical assistance under 
117.5   chapter 256B, general assistance medical care under section 
117.6   256D.03, subdivision 3, and MinnesotaCare under chapter 256L.  
117.7      Subd. 2.  [REPORT.] (a) By January 15, 2007, for the 
117.8   previous fiscal year, the commissioner shall submit to the 
117.9   legislature a report identifying all employers that employ 50 or 
117.10  more employees who are Minnesota health care program 
117.11  recipients.  In determining whether the 50-employee threshold is 
117.12  met, the commissioner shall include all employees employed by an 
117.13  employer and its subsidiaries at all locations within the 
117.14  state.  The report shall include the following information:  
117.15     (1) the name of the employer and, as appropriate, the names 
117.16  of its subsidiaries that employ Minnesota health care program 
117.17  recipients; 
117.18     (2) the number of Minnesota health care program recipients 
117.19  who are employees of the employer; 
117.20     (3) the number of Minnesota health care program recipients 
117.21  who are spouses or dependents of employees of the employer; and 
117.22     (4) the cost to the state of providing health care benefits 
117.23  for these employers' employees and enrolled dependents.  
117.24     (b) In preparing and publishing the report, the 
117.25  commissioner shall take reasonable precautions to protect the 
117.26  identity of Minnesota health care program recipients:  
117.27     (1) the report shall include only nonindividually 
117.28  identifiable summary data as defined in section 13.02, 
117.29  subdivision 19; 
117.30     (2) the commissioner shall employ generally accepted 
117.31  statistical and scientific principles and methods for rendering 
117.32  information as not individually identifiable.  The commissioner 
117.33  must determine that there is an insignificant risk that 
117.34  information in the report could be used, alone or in combination 
117.35  with other reasonably available information, to identify any 
117.36  Minnesota health care program recipient; and 
118.1      (3) the commissioner shall comply with all other applicable 
118.2   privacy and security provisions of the Health Insurance 
118.3   Portability and Accountability Act of 1996, Public Law 104-191, 
118.4   and its corresponding regulations, Code of Federal Regulations, 
118.5   title 45, sections 160, 162, and 164; Minnesota Statutes, 
118.6   chapter 13; section 144.335; and any other applicable state and 
118.7   federal law.  
118.8      (c) The commissioner shall make the report available to the 
118.9   public on the Department of Human Services' Web site, and shall 
118.10  provide a copy of the report to any member of the public upon 
118.11  request. 
118.12     Sec. 51.  [LIMITING COVERAGE OF HEALTH CARE SERVICES FOR 
118.13  MEDICAL ASSISTANCE, GENERAL ASSISTANCE MEDICAL CARE, AND 
118.14  MINNESOTACARE PROGRAMS.] 
118.15     Subdivision 1.  [PRIOR AUTHORIZATION OF SERVICES.] (a) 
118.16  Effective July 1, 2005, prior authorization is required for the 
118.17  services described in subdivision 2 for reimbursement under 
118.18  chapters 256B, 256D, and 256L.  
118.19     (b) Prior authorization shall be conducted under the 
118.20  direction of the medical director of the Department of Human 
118.21  Services in conjunction with a medical policy advisory council.  
118.22  To the extent available, the medical director shall use publicly 
118.23  available evidence-based guidelines developed by an independent, 
118.24  nonprofit organization or by the professional association of the 
118.25  specialty that typically provides the service or by a multistate 
118.26  Medicaid evidence-based practice center.  If the commissioner 
118.27  does not have a medical director and medical policy director in 
118.28  place, the commissioner shall contract prior authorization to a 
118.29  Minnesota-licensed utilization review organization or to another 
118.30  entity such as a peer review organization eligible to operate in 
118.31  Minnesota. 
118.32     (c) A prepaid health plan shall use prior authorization for 
118.33  the services described in subdivision 2 unless the prepaid 
118.34  health plan is otherwise using evidence-based practices to 
118.35  address these services.  
118.36     (d) This section expires July 1, 2007, or upon the 
119.1   completion of the prior authorization system required under 
119.2   subdivision 1, paragraph (b), whichever is earlier. 
119.3      Subd. 2.  [SERVICES REQUIRING PRIOR AUTHORIZATION.] The 
119.4   following services require prior authorization:  
119.5      (1) elective outpatient high-technology imaging to include 
119.6   positive emission tomography (PET) scans, magnetic resonance 
119.7   imaging (MRI), computed tomography (CT), and nuclear cardiology; 
119.8      (2) spinal fusion, unless in an emergency situation related 
119.9   to trauma; 
119.10     (3) bariatric surgery; 
119.11     (4) chiropractic visits beyond ten visits; 
119.12     (5) circumcision; and 
119.13     (6) orthodontia. 
119.14     Subd. 3.  [RATE REDUCTION.] (a) Effective for the services 
119.15  identified in subdivision 2, rendered on or after July 1, 2005, 
119.16  the payment rate shall be reduced by ten percent from the rate 
119.17  in effect on June 30, 2005. 
119.18     (b) This subdivision shall expire on June 30, 2006, or upon 
119.19  the completion of the prior authorization system required under 
119.20  subdivision 1, paragraph (b), whichever is earlier. 
119.21     Sec. 52.  [ORAL HEALTH CARE PILOT PROJECT.] 
119.22     The commissioner shall implement a two-year pilot project 
119.23  to provide services for state program recipients through a new 
119.24  oral health care delivery system.  The commissioner shall 
119.25  contract with a qualified entity or entities to administer the 
119.26  pilot project. 
119.27     Sec. 53.  [PLANNING PROCESS FOR MANAGED CARE.] 
119.28     The commissioner of human services shall develop a planning 
119.29  process for the purposes of implementing at least one additional 
119.30  managed care arrangement to provide medical assistance services, 
119.31  excluding continuing care services, to recipients enrolled in 
119.32  the medical assistance fee-for-service program, effective 
119.33  January 1, 2007.  This planning process shall include an 
119.34  advisory committee composed of current fee-for-service 
119.35  consumers, consumer advocates, and providers, as well as 
119.36  representatives of health plans and other provider organizations 
120.1   qualified to provide basic health care services to persons with 
120.2   disabilities.  The commissioner shall seek any additional 
120.3   federal authority necessary to provide basic health care 
120.4   services through contracted managed care arrangements. 
120.5      Sec. 54.  [REPEALER.] 
120.6      (a) Notwithstanding Minnesota Statutes, section 256B.69, 
120.7   subdivision 5a, paragraph (b), Minnesota Statutes 2004, section 
120.8   256L.035, is repealed effective July 1, 2005. 
120.9      (b) Minnesota Statutes 2004, section 256B.0631, is repealed 
120.10  effective January 1, 2006. 
120.11                             ARTICLE 3 
120.12                    HEALTH CARE COST CONTAINMENT 
120.13     Section 1.  Minnesota Statutes 2004, section 62A.65, 
120.14  subdivision 3, is amended to read: 
120.15     Subd. 3.  [PREMIUM RATE RESTRICTIONS.] No individual health 
120.16  plan may be offered, sold, issued, or renewed to a Minnesota 
120.17  resident unless the premium rate charged is determined in 
120.18  accordance with the following requirements:  
120.19     (a) Premium rates must be no more than 25 percent above and 
120.20  no more than 25 percent below the index rate charged to 
120.21  individuals for the same or similar coverage, adjusted pro rata 
120.22  for rating periods of less than one year.  The premium 
120.23  variations permitted by this paragraph must be based only upon 
120.24  health status, claims experience, and occupation.  For purposes 
120.25  of this paragraph, health status includes refraining from 
120.26  tobacco use or other actuarially valid lifestyle factors 
120.27  associated with good health, provided that the lifestyle factor 
120.28  and its effect upon premium rates have been determined by the 
120.29  commissioner to be actuarially valid and have been approved by 
120.30  the commissioner.  Variations permitted under this paragraph 
120.31  must not be based upon age or applied differently at different 
120.32  ages.  This paragraph does not prohibit use of a constant 
120.33  percentage adjustment for factors permitted to be used under 
120.34  this paragraph. 
120.35     (b) Premium rates may vary based upon the ages of covered 
120.36  persons only as provided in this paragraph.  In addition to the 
121.1   variation permitted under paragraph (a), each health carrier may 
121.2   use an additional premium variation based upon age of up to plus 
121.3   or minus 50 percent of the index rate. 
121.4      (c) A health carrier may request approval by the 
121.5   commissioner to establish no more than three geographic regions 
121.6   and to establish separate index rates for each region, provided 
121.7   that the index rates do not vary between any two regions by more 
121.8   than 20 percent.  Health carriers that do not do business in the 
121.9   Minneapolis/St. Paul metropolitan area may request approval for 
121.10  no more than two geographic regions, and clauses (2) and (3) do 
121.11  not apply to approval of requests made by those health 
121.12  carriers.  The commissioner may grant approval if the following 
121.13  conditions are met: 
121.14     (1) the geographic regions must be applied uniformly by the 
121.15  health carrier; 
121.16     (2) one geographic region must be based on the 
121.17  Minneapolis/St. Paul metropolitan area; 
121.18     (3) for each geographic region that is rural, the index 
121.19  rate for that region must not exceed the index rate for the 
121.20  Minneapolis/St. Paul metropolitan area; and 
121.21     (4) the health carrier provides actuarial justification 
121.22  acceptable to the commissioner for the proposed geographic 
121.23  variations in index rates, establishing that the variations are 
121.24  based upon differences in the cost to the health carrier of 
121.25  providing coverage. 
121.26     (d) Health carriers may use rate cells and must file with 
121.27  the commissioner the rate cells they use.  Rate cells must be 
121.28  based upon the number of adults or children covered under the 
121.29  policy and may reflect the availability of Medicare coverage.  
121.30  The rates for different rate cells must not in any way reflect 
121.31  generalized differences in expected costs between principal 
121.32  insureds and their spouses. 
121.33     (e) In developing its index rates and premiums for a health 
121.34  plan, a health carrier shall take into account only the 
121.35  following factors: 
121.36     (1) actuarially valid differences in rating factors 
122.1   permitted under paragraphs (a) and (b); and 
122.2      (2) actuarially valid geographic variations if approved by 
122.3   the commissioner as provided in paragraph (c). 
122.4      (f) All premium variations must be justified in initial 
122.5   rate filings and upon request of the commissioner in rate 
122.6   revision filings.  All rate variations are subject to approval 
122.7   by the commissioner. 
122.8      (g) The loss ratio must comply with the section 62A.021 
122.9   requirements for individual health plans. 
122.10     (h) Notwithstanding paragraphs (a) to (g), the rates must 
122.11  not be approved, unless the commissioner has determined that the 
122.12  rates are reasonable.  In determining reasonableness, the 
122.13  commissioner shall consider the growth rates applied under 
122.14  section 62J.04, subdivision 1, paragraph (b) apply the premium 
122.15  growth limits established under section 62J.04, subdivision 1b, 
122.16  to the calendar year or years that the proposed premium rate 
122.17  would be in effect, and shall consider actuarially valid changes 
122.18  in risks associated with the enrollee populations, and 
122.19  actuarially valid changes as a result of statutory changes in 
122.20  Laws 1992, chapter 549. 
122.21     Sec. 2.  Minnesota Statutes 2004, section 62J.04, is 
122.22  amended by adding a subdivision to read: 
122.23     Subd. 1b.  [PREMIUM GROWTH LIMITS.] (a) For calendar year 
122.24  2005 and each year thereafter, the commissioner shall set annual 
122.25  premium growth limits for health plan companies.  The premium 
122.26  limits set by the commissioner for calendar years 2005 to 2010 
122.27  shall not exceed the regional Consumer Price Index for urban 
122.28  consumers for the preceding calendar year plus two percentage 
122.29  points and an additional one percentage point to be used to 
122.30  finance the implementation of the electronic medical record 
122.31  system.  The commissioner shall ensure that the additional 
122.32  percentage point is being used to provide financial assistance 
122.33  to health care providers to implement electronic medical record 
122.34  systems either directly or through an increase in reimbursement. 
122.35     (b) For the calendar years beyond 2010, the rate of premium 
122.36  growth shall be limited to the change in the Consumer Price 
123.1   Index for urban consumers for the previous calendar year plus 
123.2   two percentage points.  The commissioners of health and commerce 
123.3   shall make a recommendation to the legislature by January 15, 
123.4   2009, regarding the continuation of the additional percentage 
123.5   point to the growth limit described in paragraph (a).  The 
123.6   recommendation shall be based on the progress made by health 
123.7   care providers in instituting an electronic medical record 
123.8   system and in creating a statewide interactive electronic health 
123.9   record system.  
123.10     (c) The commissioner may add additional percentage points 
123.11  as needed to the premium limit for a calendar year if a major 
123.12  disaster, bioterrorism, or a public health emergency occurs that 
123.13  results in higher health care costs.  Any additional percentage 
123.14  points must reflect the additional cost to the health care 
123.15  system directly attributed to the disaster or emergency.  
123.16     (d) The commissioner shall publish the annual premium 
123.17  growth limits in the State Register by January 31 of the year 
123.18  that the limits are to be in effect.  
123.19     (e) For the purpose of this subdivision, premium growth is 
123.20  measured as the percentage change in per member, per month 
123.21  premium revenue from the current year to the previous year.  
123.22  Premium growth rates shall be calculated for the following lines 
123.23  of business:  individual, small group, and large group.  Data 
123.24  used for premium growth rate calculations shall be submitted as 
123.25  part of the cost containment filing under section 62J.38.  
123.26     (f) For purposes of this subdivision, "health plan company" 
123.27  has the meaning given in section 62J.041.  
123.28     (g) A health plan company may reduce reimbursement to 
123.29  providers in order to meet the premium growth limitations 
123.30  required by this section. 
123.31     Sec. 3.  Minnesota Statutes 2004, section 62J.04, 
123.32  subdivision 3, is amended to read: 
123.33     Subd. 3.  [COST CONTAINMENT DUTIES.] The commissioner shall:
123.34     (1) establish statewide and regional cost containment goals 
123.35  for total health care spending under this section and collect 
123.36  data as described in sections 62J.38 to 62J.41 to monitor 
124.1   statewide achievement of the cost containment goals and premium 
124.2   growth limits; 
124.3      (2) divide the state into no fewer than four regions, with 
124.4   one of those regions being the Minneapolis/St. Paul metropolitan 
124.5   statistical area but excluding Chisago, Isanti, Wright, and 
124.6   Sherburne Counties, for purposes of fostering the development of 
124.7   regional health planning and coordination of health care 
124.8   delivery among regional health care systems and working to 
124.9   achieve the cost containment goals; 
124.10     (3) monitor the quality of health care throughout the state 
124.11  and take action as necessary to ensure an appropriate level of 
124.12  quality; 
124.13     (4) issue recommendations regarding uniform billing forms, 
124.14  uniform electronic billing procedures and data interchanges, 
124.15  patient identification cards, and other uniform claims and 
124.16  administrative procedures for health care providers and private 
124.17  and public sector payers.  In developing the recommendations, 
124.18  the commissioner shall review the work of the work group on 
124.19  electronic data interchange (WEDI) and the American National 
124.20  Standards Institute (ANSI) at the national level, and the work 
124.21  being done at the state and local level.  The commissioner may 
124.22  adopt rules requiring the use of the Uniform Bill 82/92 form, 
124.23  the National Council of Prescription Drug Providers (NCPDP) 3.2 
124.24  electronic version, the Centers for Medicare and Medicaid 
124.25  Services 1500 form, or other standardized forms or procedures; 
124.26     (5) undertake health planning responsibilities; 
124.27     (6) authorize, fund, or promote research and 
124.28  experimentation on new technologies and health care procedures; 
124.29     (7) within the limits of appropriations for these purposes, 
124.30  administer or contract for statewide consumer education and 
124.31  wellness programs that will improve the health of Minnesotans 
124.32  and increase individual responsibility relating to personal 
124.33  health and the delivery of health care services, undertake 
124.34  prevention programs including initiatives to improve birth 
124.35  outcomes, expand childhood immunization efforts, and provide 
124.36  start-up grants for worksite wellness programs; 
125.1      (8) undertake other activities to monitor and oversee the 
125.2   delivery of health care services in Minnesota with the goal of 
125.3   improving affordability, quality, and accessibility of health 
125.4   care for all Minnesotans; and 
125.5      (9) make the cost containment goal and premium growth limit 
125.6   data available to the public in a consumer-oriented manner. 
125.7      Sec. 4.  Minnesota Statutes 2004, section 62J.041, is 
125.8   amended to read: 
125.9      62J.041 [INTERIM HEALTH PLAN COMPANY COST CONTAINMENT GOALS 
125.10  HEALTH CARE EXPENDITURE LIMITS.] 
125.11     Subdivision 1.  [DEFINITIONS.] (a) For purposes of this 
125.12  section, the following definitions apply. 
125.13     (b) "Health plan company" has the definition provided in 
125.14  section 62Q.01.  This definition does not include the state 
125.15  employee health plan offered under chapter 43A.  
125.16     (c) "Total Health care expenditures" means incurred claims 
125.17  or expenditures on health care services, administrative 
125.18  expenses, charitable contributions, and all other payments made 
125.19  by health plan companies out of premium revenues. 
125.20     (d) "Net expenditures" means total expenditures minus 
125.21  exempted taxes and assessments and payments or allocations made 
125.22  to establish or maintain reserves.  
125.23     (e) "Exempted taxes and assessments" means direct payments 
125.24  for taxes to government agencies, contributions to the Minnesota 
125.25  Comprehensive Health Association, the medical assistance 
125.26  provider's surcharge under section 256.9657, the MinnesotaCare 
125.27  provider tax under section 295.52, assessments by the Health 
125.28  Coverage Reinsurance Association, assessments by the Minnesota 
125.29  Life and Health Insurance Guaranty Association, assessments by 
125.30  the Minnesota Risk Adjustment Association, and any new 
125.31  assessments imposed by federal or state law. 
125.32     (f) "Consumer cost-sharing or subscriber liability" means 
125.33  enrollee coinsurance, co-payment, deductible payments, and 
125.34  amounts in excess of benefit plan maximums. 
125.35     Subd. 2.  [ESTABLISHMENT.] The commissioner of health shall 
125.36  establish cost containment goals health care expenditure limits 
126.1   for the increase in net calendar year 2006, and each year 
126.2   thereafter, for health care expenditures by each health plan 
126.3   company for calendar years 1994, 1995, 1996, and 1997.  The cost 
126.4   containment goals must be the same as the annual cost 
126.5   containment goals for health care spending established under 
126.6   section 62J.04, subdivision 1, paragraph (b).  Health plan 
126.7   companies that are affiliates may elect to meet one 
126.8   combined cost containment goal health care expenditure limit.  
126.9   The limits set by the commissioner shall not exceed the premium 
126.10  limits established in section 62J.04, subdivision 1b. 
126.11     Subd. 3.  [DETERMINATION OF EXPENDITURES.] Health plan 
126.12  companies shall submit to the commissioner of health, by April 
126.13  1, 1994, for calendar year 1993; April 1, 1995, for calendar 
126.14  year 1994; April 1, 1996, for calendar year 1995; April 1, 1997, 
126.15  for calendar year 1996; and April 1, 1998, for calendar year 
126.16  1997 of each year beginning 2006, all information the 
126.17  commissioner determines to be necessary to implement this 
126.18  section.  The information must be submitted in the form 
126.19  specified by the commissioner.  The information must include, 
126.20  but is not limited to, health care expenditures per member per 
126.21  month or cost per employee per month, and detailed information 
126.22  on revenues and reserves.  The commissioner, to the extent 
126.23  possible, shall coordinate the submittal of the information 
126.24  required under this section with the submittal of the financial 
126.25  data required under chapter 62J, to minimize the administrative 
126.26  burden on health plan companies.  The commissioner may adjust 
126.27  final expenditure figures for demographic changes, risk 
126.28  selection, changes in basic benefits, and legislative 
126.29  initiatives that materially change health care costs, as long as 
126.30  these adjustments are consistent with the methodology submitted 
126.31  by the health plan company to the commissioner, and approved by 
126.32  the commissioner as actuarially justified.  The methodology to 
126.33  be used for adjustments and the election to meet one cost 
126.34  containment goal for affiliated health plan companies must be 
126.35  submitted to the commissioner by September 1, 1994.  Community 
126.36  integrated service networks may submit the information with 
127.1   their application for licensure.  The commissioner shall also 
127.2   accept changes to methodologies already submitted.  The 
127.3   adjustment methodology submitted and approved by the 
127.4   commissioner must apply to the data submitted for calendar years 
127.5   1994 and 1995.  The commissioner may allow changes to accepted 
127.6   adjustment methodologies for data submitted for calendar years 
127.7   1996 and 1997.  Changes to the adjustment methodology must be 
127.8   received by September 1, 1996, and must be approved by the 
127.9   commissioner. 
127.10     Subd. 4.  [MONITORING OF RESERVES.] (a) The commissioners 
127.11  of health and commerce shall monitor health plan company 
127.12  reserves and net worth as established under chapters 60A, 62C, 
127.13  62D, 62H, and 64B, with respect to the health plan companies 
127.14  that each commissioner respectively regulates to assess the 
127.15  degree to which savings resulting from the establishment of cost 
127.16  containment goals are passed on to consumers in the form of 
127.17  lower premium rates.  
127.18     (b) Health plan companies shall fully reflect in the 
127.19  premium rates the savings generated by the cost containment 
127.20  goals.  No premium rate, currently reviewed by the Department of 
127.21  Health or Commerce, may be approved for those health plan 
127.22  companies unless the health plan company establishes to the 
127.23  satisfaction of the commissioner of commerce or the commissioner 
127.24  of health, as appropriate, that the proposed new rate would 
127.25  comply with this paragraph. 
127.26     (c) Health plan companies, except those licensed under 
127.27  chapter 60A to sell accident and sickness insurance under 
127.28  chapter 62A, shall annually before the end of the fourth fiscal 
127.29  quarter provide to the commissioner of health or commerce, as 
127.30  applicable, a projection of the level of reserves the company 
127.31  expects to attain during each quarter of the following fiscal 
127.32  year.  These health plan companies shall submit with required 
127.33  quarterly financial statements a calculation of the actual 
127.34  reserve level attained by the company at the end of each quarter 
127.35  including identification of the sources of any significant 
127.36  changes in the reserve level and an updated projection of the 
128.1   level of reserves the health plan company expects to attain by 
128.2   the end of the fiscal year.  In cases where the health plan 
128.3   company has been given a certificate to operate a new health 
128.4   maintenance organization under chapter 62D, or been licensed as 
128.5   a community integrated service network under chapter 62N, or 
128.6   formed an affiliation with one of these organizations, the 
128.7   health plan company shall also submit with its quarterly 
128.8   financial statement, total enrollment at the beginning and end 
128.9   of the quarter and enrollment changes within each service area 
128.10  of the new organization.  The reserve calculations shall be 
128.11  maintained by the commissioners as trade secret information, 
128.12  except to the extent that such information is also required to 
128.13  be filed by another provision of state law and is not treated as 
128.14  trade secret information under such other provisions. 
128.15     (d) Health plan companies in paragraph (c) whose reserves 
128.16  are less than the required minimum or more than the required 
128.17  maximum at the end of the fiscal year shall submit a plan of 
128.18  corrective action to the commissioner of health or commerce 
128.19  under subdivision 7. 
128.20     (e) The commissioner of commerce, in consultation with the 
128.21  commissioner of health, shall report to the legislature no later 
128.22  than January 15, 1995, as to whether the concept of a reserve 
128.23  corridor or other mechanism for purposes of monitoring reserves 
128.24  is adaptable for use with indemnity health insurers that do 
128.25  business in multiple states and that must comply with their 
128.26  domiciliary state's reserves requirements. 
128.27     Subd. 5.  [NOTICE.] The commissioner of health shall 
128.28  publish in the State Register and make available to the public 
128.29  by July 1, 1995 2007, and each year thereafter, a list of all 
128.30  health plan companies that exceeded their cost containment goal 
128.31  health care expenditure limit for the 1994 previous calendar 
128.32  year.  The commissioner shall publish in the State Register and 
128.33  make available to the public by July 1, 1996, a list of all 
128.34  health plan companies that exceeded their combined cost 
128.35  containment goal for calendar years 1994 and 1995.  The 
128.36  commissioner shall notify each health plan company that the 
129.1   commissioner has determined that the health plan company 
129.2   exceeded its cost containment goal, health care expenditure 
129.3   limit at least 30 days before publishing the list, and shall 
129.4   provide each health plan company with ten days to provide an 
129.5   explanation for exceeding the cost containment goal health care 
129.6   expenditure limit.  The commissioner shall review the 
129.7   explanation and may change a determination if the commissioner 
129.8   determines the explanation to be valid. 
129.9      Subd. 6.  [ASSISTANCE BY THE COMMISSIONER OF COMMERCE.] The 
129.10  commissioner of commerce shall provide assistance to the 
129.11  commissioner of health in monitoring health plan companies 
129.12  regulated by the commissioner of commerce. 
129.13     Sec. 5.  [62J.255] [HEALTH RISK INFORMATION SHEET.] 
129.14     (a) A health plan company shall provide to each enrollee on 
129.15  an annual basis information on the increased personal health 
129.16  risks and the additional costs to the health care system due to 
129.17  obesity and to the use of tobacco.  
129.18     (b) The commissioner, in consultation with the Minnesota 
129.19  Medical Association, shall develop an information sheet on the 
129.20  personal health risks of obesity and smoking and on the 
129.21  additional costs to the health care system due to obesity and 
129.22  due to smoking.  The information sheet shall be posted on the 
129.23  Minnesota Department of Health's Web site.  
129.24     (c) When providing the information required in paragraph 
129.25  (a), the health plan company must also provide each enrollee 
129.26  with information on the best practices care guidelines and 
129.27  quality of care measurement criteria identified in section 
129.28  62J.43 as well as the availability of this information on the 
129.29  department's Web site. 
129.30     (d) This section does not apply to health plan companies 
129.31  offering only limited dental or vision plans. 
129.32     Sec. 6.  Minnesota Statutes 2004, section 62J.301, 
129.33  subdivision 3, is amended to read: 
129.34     Subd. 3.  [GENERAL DUTIES.] The commissioner shall: 
129.35     (1) collect and maintain data which enable population-based 
129.36  monitoring and trending of the access, utilization, quality, and 
130.1   cost of health care services within Minnesota; 
130.2      (2) collect and maintain data for the purpose of estimating 
130.3   total Minnesota health care expenditures and trends; 
130.4      (3) collect and maintain data for the purposes of setting 
130.5   cost containment goals and premium growth limits under section 
130.6   62J.04, and measuring cost containment goal and premium growth 
130.7   limit compliance; 
130.8      (4) conduct applied research using existing and new data 
130.9   and promote applications based on existing research; 
130.10     (5) develop and implement data collection procedures to 
130.11  ensure a high level of cooperation from health care providers 
130.12  and health plan companies, as defined in section 62Q.01, 
130.13  subdivision 4; 
130.14     (6) work closely with health plan companies and health care 
130.15  providers to promote improvements in health care efficiency and 
130.16  effectiveness; and 
130.17     (7) participate as a partner or sponsor of private sector 
130.18  initiatives that promote publicly disseminated applied research 
130.19  on health care delivery, outcomes, costs, quality, and 
130.20  management. 
130.21     Sec. 7.  Minnesota Statutes 2004, section 62J.38, is 
130.22  amended to read: 
130.23     62J.38 [COST CONTAINMENT DATA FROM GROUP PURCHASERS.] 
130.24     (a) The commissioner shall require group purchasers to 
130.25  submit detailed data on total health care spending for each 
130.26  calendar year.  Group purchasers shall submit data for the 1993 
130.27  calendar year by April 1, 1994, and each April 1 thereafter 
130.28  shall submit data for the preceding calendar year. 
130.29     (b) The commissioner shall require each group purchaser to 
130.30  submit data on revenue, expenses, and member months, as 
130.31  applicable.  Revenue data must distinguish between premium 
130.32  revenue and revenue from other sources and must also include 
130.33  information on the amount of revenue in reserves and changes in 
130.34  reserves.  Premium revenue data, information on aggregate 
130.35  enrollment, and data on member months must be broken down to 
130.36  distinguish between individual market, small group market, and 
131.1   large group market.  Filings under this section for calendar 
131.2   year 2005 must also include information broken down by 
131.3   individual market, small group market, and large group market 
131.4   for calendar year 2004.  Expenditure data must distinguish 
131.5   between costs incurred for patient care and administrative 
131.6   costs.  Patient care and administrative costs must include only 
131.7   expenses incurred on behalf of health plan members and must not 
131.8   include the cost of providing health care services for 
131.9   nonmembers at facilities owned by the group purchaser or 
131.10  affiliate.  Expenditure data must be provided separately for the 
131.11  following categories and for other categories required by the 
131.12  commissioner:  physician services, dental services, other 
131.13  professional services, inpatient hospital services, outpatient 
131.14  hospital services, emergency, pharmacy services and other 
131.15  nondurable medical goods, mental health, and chemical dependency 
131.16  services, other expenditures, subscriber liability, and 
131.17  administrative costs.  Administrative costs must include costs 
131.18  for marketing; advertising; overhead; salaries and benefits of 
131.19  central office staff who do not provide direct patient care; 
131.20  underwriting; lobbying; claims processing; provider contracting 
131.21  and credentialing; detection and prevention of payment for 
131.22  fraudulent or unjustified requests for reimbursement or 
131.23  services; clinical quality assurance and other types of medical 
131.24  care quality improvement efforts; concurrent or prospective 
131.25  utilization review as defined in section 62M.02; costs incurred 
131.26  to acquire a hospital, clinic, or health care facility, or the 
131.27  assets thereof; capital costs incurred on behalf of a hospital 
131.28  or clinic; lease payments; or any other costs incurred pursuant 
131.29  to a partnership, joint venture, integration, or affiliation 
131.30  agreement with a hospital, clinic, or other health care 
131.31  provider.  Capital costs and costs incurred must be recorded 
131.32  according to standard accounting principles.  The reports of 
131.33  this data must also separately identify expenses for local, 
131.34  state, and federal taxes, fees, and assessments.  The 
131.35  commissioner may require each group purchaser to submit any 
131.36  other data, including data in unaggregated form, for the 
132.1   purposes of developing spending estimates, setting spending 
132.2   limits, and monitoring actual spending and costs.  In addition 
132.3   to reporting administrative costs incurred to acquire a 
132.4   hospital, clinic, or health care facility, or the assets 
132.5   thereof; or any other costs incurred pursuant to a partnership, 
132.6   joint venture, integration, or affiliation agreement with a 
132.7   hospital, clinic, or other health care provider; reports 
132.8   submitted under this section also must include the payments made 
132.9   during the calendar year for these purposes.  The commissioner 
132.10  shall make public, by group purchaser data collected under this 
132.11  paragraph in accordance with section 62J.321, subdivision 5.  
132.12  Workers' compensation insurance plans and automobile insurance 
132.13  plans are exempt from complying with this paragraph as it 
132.14  relates to the submission of administrative costs. 
132.15     (c) The commissioner may collect information on: 
132.16     (1) premiums, benefit levels, managed care procedures, and 
132.17  other features of health plan companies; 
132.18     (2) prices, provider experience, and other information for 
132.19  services less commonly covered by insurance or for which 
132.20  patients commonly face significant out-of-pocket expenses; and 
132.21     (3) information on health care services not provided 
132.22  through health plan companies, including information on prices, 
132.23  costs, expenditures, and utilization. 
132.24     (d) All group purchasers shall provide the required data 
132.25  using a uniform format and uniform definitions, as prescribed by 
132.26  the commissioner. 
132.27     Sec. 8.  [62J.82] [CHARGES TO UNINSURED; PROVIDER 
132.28  RECOURSE.] 
132.29     Subdivision 1.  [DEFINITIONS.] (a) For purposes of this 
132.30  section, the terms defined in this subdivision have the meanings 
132.31  given them. 
132.32     (b) "Covered individual" means an individual who has health 
132.33  plan company or public health care program coverage for health 
132.34  care services. 
132.35     (c) "CPT code" means a code contained in the most current 
132.36  edition of the Physician's Current Procedural Terminology (CPT) 
133.1   manual published by the American Medical Association. 
133.2      (d) "Dependent" has the meaning given under section 62L.02, 
133.3   subdivision 11. 
133.4      (e) "Health care service" has the meaning given under 
133.5   section 62J.17, subdivision 2. 
133.6      (f) "Health plan company" has the meaning given under 
133.7   section 62Q.01, subdivision 4. 
133.8      (g) "Person" means an individual, corporation, firm, 
133.9   partnership, incorporated or unincorporated association, or any 
133.10  other legal or commercial entity. 
133.11     (h) "Provider" means a hospital or outpatient surgical 
133.12  center licensed under chapter 144. 
133.13     (i) "Third-party payer" means a health plan company or a 
133.14  public health care plan or program. 
133.15     (j) "Uninsured individual" means a person or dependent who 
133.16  does not have health plan company coverage or who is not 
133.17  otherwise covered by a third-party payer. 
133.18     Subd. 2.  [NOTICE TO UNINSURED.] (a) A provider may attempt 
133.19  to obtain from a person or the person's representative 
133.20  information about whether any third-party payer may fully or 
133.21  partially cover the charges for health care services rendered by 
133.22  the provider to the person. 
133.23     (b) A provider shall inform each person, both orally and in 
133.24  writing, immediately upon first meeting with that person, or as 
133.25  soon as practicable thereafter, that uninsured individuals will 
133.26  be charged or billed for health care services in amounts that do 
133.27  not exceed the amounts described in subdivision 3. 
133.28     (c) If, at the time health care services are provided, a 
133.29  person has not provided proof of coverage by a third-party payer 
133.30  or a provider otherwise determines that the person is an 
133.31  uninsured individual, the provider, as part of any billing to 
133.32  the person, shall provide the person with a clear and 
133.33  conspicuous notice that includes: 
133.34     (1) a statement of charges for health care services 
133.35  rendered by the provider; and 
133.36     (2) a statement that uninsured individuals will be charged 
134.1   or billed for health care services in amounts that do not exceed 
134.2   the amounts described in subdivision 3. 
134.3      (d) For purposes of the notice required under paragraph 
134.4   (c), a provider may incorporate the items into the provider's 
134.5   existing billing statements and is not required to develop a 
134.6   separate notice.  All communications to a person required by 
134.7   this subdivision must be language appropriate. 
134.8      Subd. 3.  [PROVIDER CHARGES TO UNINSURED.] In billing or 
134.9   charging an uninsured individual or the individual's 
134.10  representative for medically necessary health care services, a 
134.11  provider must bill by CPT code, or other billing identifier as 
134.12  may be routinely used for billing that health care service.  A 
134.13  provider shall not bill or charge an uninsured individual or the 
134.14  individual's representative more than the amount the provider is 
134.15  paid for that service by the nongovernmental third-party payer 
134.16  that provided the most revenue to the provider during the 
134.17  previous calendar year, plus any applicable cost sharing 
134.18  payments payable by an individual covered by that provider's 
134.19  highest volume plan.  After a bill or charge is issued under 
134.20  this subdivision, a provider may not increase the bill or charge.
134.21     Subd. 4.  [LIMITATIONS.] Notwithstanding any other 
134.22  provision of law, the amounts paid by uninsured individuals for 
134.23  health care services according to subdivision 3 does not 
134.24  constitute a provider's uniform, published, prevailing, or 
134.25  customary charges, or its usual fees to the general public, for 
134.26  purposes of any payment limit under the Medicare or medical 
134.27  assistance programs or any other federal or state financed 
134.28  health care program. 
134.29     Subd. 5.  [RECOURSE LIMITED.] (a) Providers under agreement 
134.30  with a health plan company or public health care plan or program 
134.31  to provide health care services shall not have recourse against 
134.32  covered individuals, or persons acting on their behalf, for 
134.33  amounts above those specified in the evidence of coverage or 
134.34  other plan or program document as co-payments or coinsurance for 
134.35  health care services.  This subdivision applies only to health 
134.36  plans that provide coverage equivalent to or greater than a 
135.1   number two qualified plan described under section 62E.08, and is 
135.2   not limited to the following events: 
135.3      (1) nonpayment by the health plan company; 
135.4      (2) insolvency of the health plan company; and 
135.5      (3) breach of the agreement between the health plan company 
135.6   and the provider. 
135.7      (b) This subdivision does not limit a provider's ability to 
135.8   seek payment from any person other than the covered individual, 
135.9   the covered individual's guardian or conservator, the covered 
135.10  individual's immediate family members, or the covered 
135.11  individual's legal representative in the event of nonpayment by 
135.12  a health plan company. 
135.13     Subd. 6.  [REMEDIES.] A person may file an action in 
135.14  district court seeking injunctive relief and damages for 
135.15  violations of this section.  In any such action, a person may 
135.16  also recover costs and disbursements and reasonable attorney 
135.17  fees. 
135.18     Subd. 7.  [GROUNDS FOR DISCIPLINARY ACTION.] Violations of 
135.19  this section may be grounds for disciplinary or regulatory 
135.20  action against a provider by the appropriate licensing board or 
135.21  agency. 
135.22     Subd. 8.  [AUTHORITY OF ATTORNEY GENERAL.] The attorney 
135.23  general may investigate violations of this section under section 
135.24  8.31.  The attorney general may file an action for violations of 
135.25  this section according to section 8.31 or may pursue other 
135.26  remedies available to the attorney general. 
135.27     Subd. 9.  [INCOME AND ASSET LIMITATIONS.] The provisions of 
135.28  this section shall not apply to uninsured individuals with an 
135.29  annual family income above $125,000. 
135.30     Sec. 9.  [62J.83] [PROVIDER COST DISCLOSURE.] 
135.31     Subdivision 1.  [REPORT; AVAILABILITY.] (a) Each health 
135.32  care provider, as defined by section 62J.03, subdivision 8, 
135.33  shall report annually to the commissioner of health, in a form 
135.34  and manner specified by the commissioner, the following:  
135.35     (1) the average and median allowable charge from private 
135.36  third-party payers for the 20 services or procedures most 
136.1   commonly performed; 
136.2      (2) the average and median payment rates for those services 
136.3   and procedures for medical assistance; and 
136.4      (3) the average and median payment rates for private pay 
136.5   individuals. 
136.6      (b) This information shall be available to the public:  
136.7      (1) through the health care provider; and 
136.8      (2) through the commissioner on agency Web sites, including 
136.9   minnesotahealthinfo.com.  
136.10     Subd. 2.  [COMPARABILITY.] The commissioner may contract 
136.11  with one or more private, nonprofit organizations to make this 
136.12  information available in an easily understood format that 
136.13  promotes comparisons by integrated health care systems, 
136.14  individual practice groups, single-provider practices, specialty 
136.15  groups, and hospitals.  
136.16     Subd. 3.  [DETERMINATION OF MOST COMMON PROCEDURES.] The 
136.17  commissioner may specify the 20 most common procedures by 
136.18  specialty, provider type, or other suitable categories. 
136.19     Sec. 10.  Minnesota Statutes 2004, section 62L.08, 
136.20  subdivision 8, is amended to read: 
136.21     Subd. 8.  [FILING REQUIREMENT.] (a) No later than July 1, 
136.22  1993, and each year thereafter, a health carrier that offers, 
136.23  sells, issues, or renews a health benefit plan for small 
136.24  employers shall file with the commissioner the index rates and 
136.25  must demonstrate that all rates shall be within the rating 
136.26  restrictions defined in this chapter.  Such demonstration must 
136.27  include the allowable range of rates from the index rates and a 
136.28  description of how the health carrier intends to use demographic 
136.29  factors including case characteristics in calculating the 
136.30  premium rates.  
136.31     (b) Notwithstanding paragraph (a), the rates shall not be 
136.32  approved, unless the commissioner has determined that the rates 
136.33  are reasonable.  In determining reasonableness, the commissioner 
136.34  shall consider the growth rates applied under section 62J.04, 
136.35  subdivision 1, paragraph (b) apply the premium growth limits 
136.36  established under section 62J.04, subdivision 1b, to the 
137.1   calendar year or years that the proposed premium rate would be 
137.2   in effect, and shall consider actuarially valid changes in risk 
137.3   associated with the enrollee population, and actuarially valid 
137.4   changes as a result of statutory changes in Laws 1992, chapter 
137.5   549.  For premium rates proposed to go into effect between July 
137.6   1, 1993 and December 31, 1993, the pertinent growth rate is the 
137.7   growth rate applied under section 62J.04, subdivision 1, 
137.8   paragraph (b), to calendar year 1994. 
137.9      Sec. 11.  Minnesota Statutes 2004, section 62Q.37, 
137.10  subdivision 7, is amended to read: 
137.11     Subd. 7.  [HUMAN SERVICES.] (a) The commissioner of human 
137.12  services shall implement this section in a manner that is 
137.13  consistent with applicable federal laws and regulations and that 
137.14  avoids the duplication of review activities performed by a 
137.15  nationally recognized independent organization. 
137.16     (b) By December 31 of each year, the commissioner shall 
137.17  submit to the legislature a written report identifying the 
137.18  number of audits performed by a nationally recognized 
137.19  independent organization that were accepted, partially accepted, 
137.20  or rejected by the commissioner under this section.  The 
137.21  commissioner shall provide the rationale for partial acceptance 
137.22  or rejection.  If the rationale for the partial acceptance or 
137.23  rejection was based on the commissioner's determination that the 
137.24  standards used in the audit were not equivalent to state law, 
137.25  regulation, or contract requirement, the report must document 
137.26  the variances between the audit standards and the applicable 
137.27  state requirements.  
137.28                             ARTICLE 4
137.29                 LONG-TERM CARE AND CONTINUING CARE 
137.30     Section 1.  Minnesota Statutes 2004, section 144A.073, is 
137.31  amended by adding a subdivision to read: 
137.32     Subd. 3d.  [PROJECT AMENDMENT AUTHORIZED.] Notwithstanding 
137.33  the provisions of subdivision 3b: 
137.34     (1) a nursing facility located in the city of Duluth with 
137.35  42 licensed beds as of January 1, 2005, that received approval 
137.36  under this section in 2002 for a moratorium exception project 
138.1   may reduce the number of resident rooms in the new addition from 
138.2   13 to nine and may reduce the common space by more than five 
138.3   percent; and 
138.4      (2) a nursing facility located in the city of Duluth with 
138.5   127 licensed beds as of January 1, 2005, that received approval 
138.6   under this section in 2002 for a moratorium exception project 
138.7   may reduce the number of single rooms from 46 to 42 and may 
138.8   reduce the common space by more than five percent. 
138.9      Sec. 2.  Minnesota Statutes 2004, section 144A.073, 
138.10  subdivision 10, is amended to read: 
138.11     Subd. 10.  [EXTENSION OF APPROVAL OF MORATORIUM EXCEPTION.] 
138.12  Notwithstanding subdivision 3, the commissioner of health shall 
138.13  extend project approval for an additional 18 36 months for any 
138.14  proposed exception to the nursing home licensure and 
138.15  certification moratorium if the proposal was approved under this 
138.16  section between July 1, 2001, and June 30, 2003. 
138.17     Sec. 3.  Minnesota Statutes 2004, section 252.291, is 
138.18  amended by adding a subdivision to read: 
138.19     Subd. 2b.  [EXCEPTION FOR BROWN COUNTY FACILITY.] (a) The 
138.20  commissioner shall authorize and grant a new license under 
138.21  chapter 245A to a new intermediate care facility for persons 
138.22  with mental retardation under the following circumstances: 
138.23     (1) the new facility replaces an existing six-bed 
138.24  intermediate care facility for the mentally retarded located in 
138.25  Brown County that has been operating since June 1982; 
138.26     (2) the new facility is located on an already purchased 
138.27  parcel of land; and 
138.28     (3) the new facility is handicapped accessible. 
138.29     (b) The medical assistance payment rate for the new 
138.30  facility shall be the higher of the rate specified in paragraph 
138.31  (c) or as otherwise provided by law. 
138.32     (c) The new facility shall be considered a newly 
138.33  established facility for rate-setting purposes and shall be 
138.34  eligible for the investment per bed limit specified in section 
138.35  256B.501, subdivision 11, paragraph (c), and the interest 
138.36  expense limitation specified in section 256B.501, subdivision 
139.1   11, paragraph (d).  Notwithstanding section 256B.5011, the newly 
139.2   established facility's initial payment rate shall be set 
139.3   according to Minnesota Rules, part 9553.0075, and shall not be 
139.4   subject to the provisions of section 256B.501, subdivision 5b. 
139.5      (d) During the construction of the new facility, Brown 
139.6   County shall work with residents, families, and service 
139.7   providers to explore all service options open to current 
139.8   residents of the facility. 
139.9      Sec. 4.  Minnesota Statutes 2004, section 256B.0621, 
139.10  subdivision 2, is amended to read: 
139.11     Subd. 2.  [TARGETED CASE MANAGEMENT; DEFINITIONS.] For 
139.12  purposes of subdivisions 3 to 10, the following terms have the 
139.13  meanings given them: 
139.14     (1) "home care service recipients" means those individuals 
139.15  receiving the following services under section 256B.0627:  
139.16  skilled nursing visits, home health aide visits, private duty 
139.17  nursing, personal care assistants, or therapies provided through 
139.18  a home health agency; 
139.19     (2) "home care targeted case management" means the 
139.20  provision of targeted case management services for the purpose 
139.21  of assisting home care service recipients to gain access to 
139.22  needed services and supports so that they may remain in the 
139.23  community; 
139.24     (3) "institutions" means hospitals, consistent with Code of 
139.25  Federal Regulations, title 42, section 440.10; regional 
139.26  treatment center inpatient services, consistent with section 
139.27  245.474; nursing facilities; and intermediate care facilities 
139.28  for persons with mental retardation; 
139.29     (4) "relocation targeted case management" means includes 
139.30  the provision of both county targeted case management and public 
139.31  or private vendor service coordination services for the purpose 
139.32  of assisting recipients to gain access to needed services and 
139.33  supports if they choose to move from an institution to the 
139.34  community.  Relocation targeted case management may be provided 
139.35  during the last 180 consecutive days of an eligible recipient's 
139.36  institutional stay; and 
140.1      (5) "targeted case management" means case management 
140.2   services provided to help recipients gain access to needed 
140.3   medical, social, educational, and other services and supports. 
140.4      Sec. 5.  Minnesota Statutes 2004, section 256B.0621, 
140.5   subdivision 3, is amended to read: 
140.6      Subd. 3.  [ELIGIBILITY.] The following persons are eligible 
140.7   for relocation targeted case management or home care-targeted 
140.8   care targeted case management: 
140.9      (1) medical assistance eligible persons residing in 
140.10  institutions who choose to move into the community are eligible 
140.11  for relocation targeted case management services; and 
140.12     (2) medical assistance eligible persons receiving home care 
140.13  services, who are not eligible for any other medical assistance 
140.14  reimbursable case management service, are eligible for home 
140.15  care-targeted care targeted case management services beginning 
140.16  January 1, 2003 July 1, 2005. 
140.17     Sec. 6.  Minnesota Statutes 2004, section 256B.0621, 
140.18  subdivision 4, is amended to read: 
140.19     Subd. 4.  [RELOCATION TARGETED COUNTY CASE MANAGEMENT 
140.20  PROVIDER QUALIFICATIONS.] (a) A relocation targeted county case 
140.21  management provider is an enrolled medical assistance provider 
140.22  who is determined by the commissioner to have all of the 
140.23  following characteristics: 
140.24     (1) the legal authority to provide public welfare under 
140.25  sections 393.01, subdivision 7; and 393.07; or a federally 
140.26  recognized Indian tribe; 
140.27     (2) the demonstrated capacity and experience to provide the 
140.28  components of case management to coordinate and link community 
140.29  resources needed by the eligible population; 
140.30     (3) the administrative capacity and experience to serve the 
140.31  target population for whom it will provide services and ensure 
140.32  quality of services under state and federal requirements; 
140.33     (4) the legal authority to provide complete investigative 
140.34  and protective services under section 626.556, subdivision 10; 
140.35  and child welfare and foster care services under section 393.07, 
140.36  subdivisions 1 and 2; or a federally recognized Indian tribe; 
141.1      (5) a financial management system that provides accurate 
141.2   documentation of services and costs under state and federal 
141.3   requirements; and 
141.4      (6) the capacity to document and maintain individual case 
141.5   records under state and federal requirements. 
141.6      (b) A provider of targeted case management under section 
141.7   256B.0625, subdivision 20, may be deemed a certified provider of 
141.8   relocation targeted case management. 
141.9      (c) A relocation targeted county case management provider 
141.10  may subcontract with another provider to deliver relocation 
141.11  targeted case management services.  Subcontracted providers must 
141.12  demonstrate the ability to provide the services outlined in 
141.13  subdivision 6, and have a procedure in place that notifies the 
141.14  recipient and the recipient's legal representative of any 
141.15  conflict of interest if the contracted targeted case management 
141.16  provider also provides, or will provide, the recipient's 
141.17  services and supports.  Counties must require that contracted 
141.18  providers must provide information on all conflicts of interest 
141.19  and obtain the recipient's informed consent or provide the 
141.20  recipient with alternatives.  
141.21     Sec. 7.  Minnesota Statutes 2004, section 256B.0621, 
141.22  subdivision 5, is amended to read: 
141.23     Subd. 5.  [HOME CARE TARGETED CASE MANAGEMENT AND 
141.24  RELOCATION SERVICE COORDINATION PROVIDER QUALIFICATIONS.] The 
141.25  following qualifications and certification standards must be met 
141.26  by Providers of home care targeted case management and 
141.27  relocation service coordination must meet the qualifications 
141.28  under subdivision 4 for county vendors or the following 
141.29  qualifications and certification standards for private vendors. 
141.30     (a) The commissioner must certify each provider of home 
141.31  care targeted case management and relocation service 
141.32  coordination before enrollment.  The certification process shall 
141.33  examine the provider's ability to meet the requirements in this 
141.34  subdivision and other state and federal requirements of this 
141.35  service. 
141.36     (b) A Both home care targeted case management provider is 
142.1   an providers and relocation service coordination providers are 
142.2   enrolled medical assistance provider providers who has have a 
142.3   minimum of a bachelor's degree or a license in a health or human 
142.4   services field, or comparable training and two years of 
142.5   experience in human services, and is have been determined by the 
142.6   commissioner to have all of the following characteristics: 
142.7      (1) the demonstrated capacity and experience to provide the 
142.8   components of case management to coordinate and link community 
142.9   resources needed by the eligible population; 
142.10     (2) the administrative capacity and experience to serve the 
142.11  target population for whom it will provide services and ensure 
142.12  quality of services under state and federal requirements; 
142.13     (3) a financial management system that provides accurate 
142.14  documentation of services and costs under state and federal 
142.15  requirements; 
142.16     (4) the capacity to document and maintain individual case 
142.17  records under state and federal requirements; and 
142.18     (5) the capacity to coordinate with county administrative 
142.19  functions; 
142.20     (6) have no financial interest in the provision of 
142.21  out-of-home residential services to persons for whom targeted 
142.22  case management or relocation service coordination is provided; 
142.23  and 
142.24     (7) if a provider has a financial interest in services 
142.25  other than out-of-home residential services provided to persons 
142.26  for whom targeted case management or relocation service 
142.27  coordination is also provided, the county must determine each 
142.28  year that: 
142.29     (i) any possible conflict of interest is explained annually 
142.30  at a face-to-face meeting and in writing and the person provides 
142.31  written informed consent consistent with section 256B.77, 
142.32  subdivision 2, paragraph (p); and 
142.33     (ii) information on a range of other feasible service 
142.34  provider options has been provided. 
142.35     (c) The State of Minnesota, a county board, or agency 
142.36  acting on behalf of a county board shall not be liable for 
143.1   damages, injuries, or liabilities sustained because of services 
143.2   provided to a client by a private service coordination vendor. 
143.3      Sec. 8.  Minnesota Statutes 2004, section 256B.0621, 
143.4   subdivision 6, is amended to read: 
143.5      Subd. 6.  [ELIGIBLE SERVICES.] (a) Services eligible for 
143.6   medical assistance reimbursement as targeted case management 
143.7   include: 
143.8      (1) assessment of the recipient's need for targeted case 
143.9   management services and for persons choosing to relocate, the 
143.10  county must provide service coordination provider options at the 
143.11  first contact and upon request; 
143.12     (2) development, completion, and regular review of a 
143.13  written individual service plan, which is based upon the 
143.14  assessment of the recipient's needs and choices, and which will 
143.15  ensure access to medical, social, educational, and other related 
143.16  services and supports; 
143.17     (3) routine contact or communication with the recipient, 
143.18  recipient's family, primary caregiver, legal representative, 
143.19  substitute care provider, service providers, or other relevant 
143.20  persons identified as necessary to the development or 
143.21  implementation of the goals of the individual service plan; 
143.22     (4) coordinating referrals for, and the provision of, case 
143.23  management services for the recipient with appropriate service 
143.24  providers, consistent with section 1902(a)(23) of the Social 
143.25  Security Act; 
143.26     (5) coordinating and monitoring the overall service 
143.27  delivery and engaging in advocacy as needed to ensure quality of 
143.28  services, appropriateness, and continued need; 
143.29     (6) completing and maintaining necessary documentation that 
143.30  supports and verifies the activities in this subdivision; 
143.31     (7) traveling assisting individuals in order to access 
143.32  needed services, including travel to conduct a visit with the 
143.33  recipient or other relevant person necessary to develop or 
143.34  implement the goals of the individual service plan; and 
143.35     (8) coordinating with the institution discharge planner in 
143.36  the 180-day period before the recipient's discharge. 
144.1      (b) Relocation targeted county case management includes 
144.2   services under paragraph (a), clauses (1), (2), and (4).  
144.3   Relocation service coordination includes services under 
144.4   paragraph (a), clauses (3) and (5) to (8).  Home care targeted 
144.5   case management includes services under paragraph (a), clauses 
144.6   (1) to (8). 
144.7      Sec. 9.  Minnesota Statutes 2004, section 256B.0621, 
144.8   subdivision 7, is amended to read: 
144.9      Subd. 7.  [TIME LINES.] The following time lines must be 
144.10  met for assigning a case manager: 
144.11     (a) For relocation targeted case management, an eligible 
144.12  recipient must be assigned a county case manager who visits the 
144.13  person within 20 working days of requesting a case manager from 
144.14  their county of financial responsibility as determined under 
144.15  chapter 256G.  
144.16     (1) If a county agency, its contractor, or federally 
144.17  recognized tribe does not provide case management services as 
144.18  required, the recipient may obtain targeted relocation case 
144.19  management services relocation service coordination from an 
144.20  alternative a provider of targeted case management services 
144.21  enrolled by the commissioner qualified under subdivision 5. 
144.22     (2) The commissioner may waive the provider requirements in 
144.23  subdivision 4, paragraph (a), clauses (1) and (4), to ensure 
144.24  recipient access to the assistance necessary to move from an 
144.25  institution to the community.  The recipient or the recipient's 
144.26  legal guardian shall provide written notice to the county or 
144.27  tribe of the decision to obtain services from an alternative 
144.28  provider. 
144.29     (3) Providers of relocation targeted case management 
144.30  enrolled under this subdivision shall: 
144.31     (i) meet the provider requirements under subdivision 4 that 
144.32  are not waived by the commissioner; 
144.33     (ii) be qualified to provide the services specified in 
144.34  subdivision 6; 
144.35     (iii) coordinate efforts with local social service agencies 
144.36  and tribes; and 
145.1      (iv) comply with the conflict of interest provisions 
145.2   established under subdivision 4, paragraph (c). 
145.3      (4) Local social service agencies and federally recognized 
145.4   tribes shall cooperate with providers certified by the 
145.5   commissioner under this subdivision to facilitate the 
145.6   recipient's successful relocation from an institution to the 
145.7   community. 
145.8      (b) For home care targeted case management, an eligible 
145.9   recipient must be assigned a case manager within 20 working days 
145.10  of requesting a case manager from a home care targeted case 
145.11  management provider, as defined in subdivision 5. 
145.12     Sec. 10.  Minnesota Statutes 2004, section 256B.0625, 
145.13  subdivision 2, is amended to read: 
145.14     Subd. 2.  [SKILLED AND INTERMEDIATE NURSING CARE.] Medical 
145.15  assistance covers skilled nursing home services and services of 
145.16  intermediate care facilities, including training and 
145.17  habilitation services, as defined in section 252.41, subdivision 
145.18  3, for persons with mental retardation or related conditions who 
145.19  are residing in intermediate care facilities for persons with 
145.20  mental retardation or related conditions.  Medical assistance 
145.21  must not be used to pay the costs of nursing care provided to a 
145.22  patient in a swing bed as defined in section 144.562, unless (a) 
145.23  the facility in which the swing bed is located is eligible as a 
145.24  sole community provider, as defined in Code of Federal 
145.25  Regulations, title 42, section 412.92, or the facility is a 
145.26  public hospital owned by a governmental entity with 15 or fewer 
145.27  licensed acute care beds; (b) the Centers for Medicare and 
145.28  Medicaid Services approves the necessary state plan amendments; 
145.29  (c) the patient was screened as provided by law; (d) the patient 
145.30  no longer requires acute care services; and (e) no nursing home 
145.31  beds are available within 25 miles of the facility.  The 
145.32  commissioner shall exempt a facility from compliance with the 
145.33  sole community provider requirement in clause (a) if, as of 
145.34  January 1, 2004, the facility had an agreement with the 
145.35  commissioner to provide medical assistance swing bed services.  
145.36  Medical assistance also covers up to ten days of nursing care 
146.1   provided to a patient in a swing bed if:  (1) the patient's 
146.2   physician certifies that the patient has a terminal illness or 
146.3   condition that is likely to result in death within 30 days and 
146.4   that moving the patient would not be in the best interests of 
146.5   the patient and patient's family; (2) no open nursing home beds 
146.6   are available within 25 miles of the facility; and (3) no open 
146.7   beds are available in any Medicare hospice program within 50 
146.8   miles of the facility.  The daily medical assistance payment for 
146.9   nursing care for the patient in the swing bed is the statewide 
146.10  average medical assistance skilled nursing care per diem as 
146.11  computed annually by the commissioner on July 1 of each year. 
146.12     <b>[EFFECTIVE DATE.]</b> This section is effective the day 
146.13  following final enactment and applies to medical assistance 
146.14  payments for swing bed services provided on or after March 5, 
146.15  2005. 
146.16     Sec. 11.  Minnesota Statutes 2004, section 256B.0625, 
146.17  subdivision 19c, is amended to read: 
146.18     Subd. 19c.  [PERSONAL CARE.] Medical assistance covers 
146.19  personal care assistant services provided by an individual who 
146.20  is qualified to provide the services according to subdivision 
146.21  19a and section 256B.0627, where the services are prescribed 
146.22  determined to be medically necessary by a physician, provided in 
146.23  accordance with a service plan of treatment, and are supervised 
146.24  by the recipient or a qualified professional.  The physician's 
146.25  determination of medical necessity for personal care assistant 
146.26  services shall be documented on a form approved by the 
146.27  commissioner and include the diagnosis or condition of the 
146.28  person that results in a need for personal care assistant 
146.29  services and be updated either when the person's medical 
146.30  condition requires a change or at least annually if the medical 
146.31  need for personal care services is ongoing. 
146.32  "Qualified professional" means a mental health professional as 
146.33  defined in section 245.462, subdivision 18, or 245.4871, 
146.34  subdivision 27; or a registered nurse as defined in sections 
146.35  148.171 to 148.285, or a licensed social worker as defined in 
146.36  section 148B.21.  As part of the assessment, the county public 
147.1   health nurse will assist the recipient or responsible party to 
147.2   identify the most appropriate person to provide supervision of 
147.3   the personal care assistant.  The qualified professional shall 
147.4   perform the duties described in Minnesota Rules, part 9505.0335, 
147.5   subpart 4.  
147.6      Sec. 12.  Minnesota Statutes 2004, section 256B.0627, 
147.7   subdivision 1, is amended to read: 
147.8      Subdivision 1.  [DEFINITION.] (a) "Activities of daily 
147.9   living" includes eating, toileting, grooming, dressing, bathing, 
147.10  transferring, mobility, and positioning.  
147.11     (b) "Assessment" means a review and evaluation of a 
147.12  recipient's need for home care services conducted in person.  
147.13  Assessments for private duty nursing shall be conducted by a 
147.14  registered private duty nurse.  Assessments for home health 
147.15  agency services shall be conducted by a home health agency 
147.16  nurse.  Assessments for personal care assistant services shall 
147.17  be conducted by the county public health nurse or a certified 
147.18  public health nurse under contract with the county.  A 
147.19  face-to-face assessment must include:  documentation of health 
147.20  status, determination of need, evaluation of service 
147.21  effectiveness, identification of appropriate services, service 
147.22  plan development or modification, coordination of services, 
147.23  referrals and follow-up to appropriate payers and community 
147.24  resources, completion of required reports, recommendation of 
147.25  service authorization, and consumer education.  Once the need 
147.26  for personal care assistant services is determined under this 
147.27  section, the county public health nurse or certified public 
147.28  health nurse under contract with the county is responsible for 
147.29  communicating this recommendation to the commissioner and the 
147.30  recipient.  A face-to-face assessment for personal care 
147.31  assistant services is conducted on those recipients who have 
147.32  never had a county public health nurse assessment.  A 
147.33  face-to-face assessment must occur at least annually or when 
147.34  there is a significant change in the recipient's condition or 
147.35  when there is a change in the need for personal care assistant 
147.36  services.  A service update may substitute for the annual 
148.1   face-to-face assessment when there is not a significant change 
148.2   in recipient condition or a change in the need for personal care 
148.3   assistant service.  A service update or review for temporary 
148.4   increase includes a review of initial baseline data, evaluation 
148.5   of service effectiveness, redetermination of service need, 
148.6   modification of service plan and appropriate referrals, update 
148.7   of initial forms, obtaining service authorization, and on going 
148.8   consumer education.  Assessments for medical assistance home 
148.9   care services for mental retardation or related conditions and 
148.10  alternative care services for developmentally disabled home and 
148.11  community-based waivered recipients may be conducted by the 
148.12  county public health nurse to ensure coordination and avoid 
148.13  duplication.  Assessments must be completed on forms provided by 
148.14  the commissioner within 30 days of a request for home care 
148.15  services by a recipient or responsible party.  
148.16     (c) "Care plan" means a written description of personal 
148.17  care assistant services developed by the qualified professional 
148.18  or the recipient's physician with the recipient or responsible 
148.19  party to be used by the personal care assistant with a copy 
148.20  provided to the recipient or responsible party. 
148.21     (d) "Complex and regular private duty nursing care" means: 
148.22     (1) complex care is private duty nursing provided to 
148.23  recipients who are ventilator dependent or for whom a physician 
148.24  has certified that were it not for private duty nursing the 
148.25  recipient would meet the criteria for inpatient hospital 
148.26  intensive care unit (ICU) level of care; and 
148.27     (2) regular care is private duty nursing provided to all 
148.28  other recipients. 
148.29     (e) "Health-related functions" means functions that can be 
148.30  delegated or assigned by a licensed health care professional 
148.31  under state law to be performed by a personal care attendant. 
148.32     (f) "Home care services" means a health service, determined 
148.33  by the commissioner as medically necessary, that is ordered by a 
148.34  physician and documented in a service plan that is reviewed by 
148.35  the physician at least once every 60 days for the provision of 
148.36  home health services, or private duty nursing, or at least once 
149.1   every 365 days for personal care.  Home care services are 
149.2   provided to the recipient at the recipient's residence that is a 
149.3   place other than a hospital or long-term care facility or as 
149.4   specified in section 256B.0625.  
149.5      (g) "Instrumental activities of daily living" includes meal 
149.6   planning and preparation, managing finances, shopping for food, 
149.7   clothing, and other essential items, performing essential 
149.8   household chores, communication by telephone and other media, 
149.9   and getting around and participating in the community. 
149.10     (h) "Medically necessary" has the meaning given in 
149.11  Minnesota Rules, parts 9505.0170 to 9505.0475.  
149.12     (i) "Personal care assistant" means a person who:  
149.13     (1) is at least 18 years old, except for persons 16 to 18 
149.14  years of age who participated in a related school-based job 
149.15  training program or have completed a certified home health aide 
149.16  competency evaluation; 
149.17     (2) is able to effectively communicate with the recipient 
149.18  and personal care provider organization; 
149.19     (3) effective July 1, 1996, has completed one of the 
149.20  training requirements as specified in Minnesota Rules, part 
149.21  9505.0335, subpart 3, items A to D; 
149.22     (4) has the ability to, and provides covered personal care 
149.23  assistant services according to the recipient's care plan, 
149.24  responds appropriately to recipient needs, and reports changes 
149.25  in the recipient's condition to the supervising qualified 
149.26  professional or physician; 
149.27     (5) is not a consumer of personal care assistant services; 
149.28  and 
149.29     (6) maintains daily written records detailing: 
149.30     (i) the actual services provided to the recipient; and 
149.31     (ii) the amount of time spent providing the services; and 
149.32     (7) is subject to criminal background checks and procedures 
149.33  specified in chapter 245C.  
149.34     (j) "Personal care provider organization" means an 
149.35  organization enrolled to provide personal care assistant 
149.36  services under the medical assistance program that complies with 
150.1   the following:  
150.2      (1) owners who have a five percent interest or more, and 
150.3   managerial officials are subject to a background study as 
150.4   provided in chapter 245C.  This applies to currently enrolled 
150.5   personal care provider organizations and those agencies seeking 
150.6   enrollment as a personal care provider organization.  An 
150.7   organization will be barred from enrollment if an owner or 
150.8   managerial official of the organization has been convicted of a 
150.9   crime specified in chapter 245C, or a comparable crime in 
150.10  another jurisdiction, unless the owner or managerial official 
150.11  meets the reconsideration criteria specified in chapter 245C; 
150.12     (2) the organization must maintain a surety bond and 
150.13  liability insurance throughout the duration of enrollment and 
150.14  provides proof thereof.  The insurer must notify the Department 
150.15  of Human Services of the cancellation or lapse of policy; and 
150.16  (3) the organization must maintain documentation of services as 
150.17  specified in Minnesota Rules, part 9505.2175, subpart 7, as well 
150.18  as evidence of compliance with personal care assistant training 
150.19  requirements; 
150.20     (3) the organization must maintain documentation and a 
150.21  recipient file and satisfy communication requirements in 
150.22  subdivision 4, paragraph (f); and 
150.23     (4) the organization must comply with all laws and rules 
150.24  governing the provision of personal care services. 
150.25     (k) "Responsible party" means an individual who is capable 
150.26  of providing the support necessary to assist the recipient to 
150.27  live in the community, is at least 18 years old, actively 
150.28  participates in planning and directing of personal care 
150.29  assistant services, and is not the personal care assistant.  The 
150.30  responsible party must be accessible to the recipient and the 
150.31  personal care assistant when personal care services are being 
150.32  provided and monitor the services at least weekly according to 
150.33  the plan of care.  The responsible party must be identified at 
150.34  the time of assessment and listed on the recipient's service 
150.35  agreement and care plan.  Responsible parties who are parents of 
150.36  minors or guardians of minors or incapacitated persons may 
151.1   delegate the responsibility to another adult who is not the 
151.2   personal care assistant during a temporary absence of at least 
151.3   24 hours but not more than six months.  The person delegated as 
151.4   a responsible party must be able to meet the definition of 
151.5   responsible party, except that the delegated responsible party 
151.6   is required to reside with the recipient only while serving as 
151.7   the responsible party.  The delegated responsible party is not 
151.8   required to reside with the recipient while serving as the 
151.9   responsible party if adequate supervision and monitoring are 
151.10  provided for as part of the person's individual service plan 
151.11  under a home and community-based waiver program or in 
151.12  conjunction with a home care targeted case management service 
151.13  provider or other case manager.  The responsible party must 
151.14  assure that the delegate performs the functions of the 
151.15  responsible party, is identified at the time of the assessment, 
151.16  and is listed on the service agreement and the care plan.  
151.17  Foster care license holders may be designated the responsible 
151.18  party for residents of the foster care home if case management 
151.19  is provided as required in section 256B.0625, subdivision 19a.  
151.20  For persons who, as of April 1, 1992, are sharing personal care 
151.21  assistant services in order to obtain the availability of 
151.22  24-hour coverage, an employee of the personal care provider 
151.23  organization may be designated as the responsible party if case 
151.24  management is provided as required in section 256B.0625, 
151.25  subdivision 19a. 
151.26     (l) "Service plan" means a written description of the 
151.27  services needed based on the assessment developed by the nurse 
151.28  who conducts the assessment together with the recipient or 
151.29  responsible party.  The service plan shall include a description 
151.30  of the covered home care services, frequency and duration of 
151.31  services, and expected outcomes and goals.  The recipient and 
151.32  the provider chosen by the recipient or responsible party must 
151.33  be given a copy of the completed service plan within 30 calendar 
151.34  days of the request for home care services by the recipient or 
151.35  responsible party. 
151.36     (m) "Skilled nurse visits" are provided in a recipient's 
152.1   residence under a plan of care or service plan that specifies a 
152.2   level of care which the nurse is qualified to provide.  These 
152.3   services are: 
152.4      (1) nursing services according to the written plan of care 
152.5   or service plan and accepted standards of medical and nursing 
152.6   practice in accordance with chapter 148; 
152.7      (2) services which due to the recipient's medical condition 
152.8   may only be safely and effectively provided by a registered 
152.9   nurse or a licensed practical nurse; 
152.10     (3) assessments performed only by a registered nurse; and 
152.11     (4) teaching and training the recipient, the recipient's 
152.12  family, or other caregivers requiring the skills of a registered 
152.13  nurse or licensed practical nurse. 
152.14     (n) "Telehomecare" means the use of telecommunications 
152.15  technology by a home health care professional to deliver home 
152.16  health care services, within the professional's scope of 
152.17  practice, to a patient located at a site other than the site 
152.18  where the practitioner is located. 
152.19     Sec. 13.  Minnesota Statutes 2004, section 256B.0627, 
152.20  subdivision 4, is amended to read: 
152.21     Subd. 4.  [PERSONAL CARE ASSISTANT SERVICES.] (a) The 
152.22  personal care assistant services that are eligible for payment 
152.23  are services and supports furnished to an individual, as needed, 
152.24  to assist in accomplishing activities of daily living; 
152.25  instrumental activities of daily living; health-related 
152.26  functions through hands-on assistance, supervision, and cuing; 
152.27  and redirection and intervention for behavior including 
152.28  observation and monitoring.  
152.29     (b) Payment for services will be made within the limits 
152.30  approved using the prior authorized process established in 
152.31  subdivision 5. 
152.32     (c) The amount and type of services authorized shall be 
152.33  based on an assessment of the recipient's needs in these areas: 
152.34     (1) bowel and bladder care; 
152.35     (2) skin care to maintain the health of the skin; 
152.36     (3) repetitive maintenance range of motion, muscle 
153.1   strengthening exercises, and other tasks specific to maintaining 
153.2   a recipient's optimal level of function; 
153.3      (4) respiratory assistance; 
153.4      (5) transfers and ambulation; 
153.5      (6) bathing, grooming, and hairwashing necessary for 
153.6   personal hygiene; 
153.7      (7) turning and positioning; 
153.8      (8) assistance with furnishing medication that is 
153.9   self-administered; 
153.10     (9) application and maintenance of prosthetics and 
153.11  orthotics; 
153.12     (10) cleaning medical equipment; 
153.13     (11) dressing or undressing; 
153.14     (12) assistance with eating and meal preparation and 
153.15  necessary grocery shopping; 
153.16     (13) accompanying a recipient to obtain medical diagnosis 
153.17  or treatment; 
153.18     (14) assisting, monitoring, or prompting the recipient to 
153.19  complete the services in clauses (1) to (13); 
153.20     (15) redirection, monitoring, and observation that are 
153.21  medically necessary and an integral part of completing the 
153.22  personal care assistant services described in clauses (1) to 
153.23  (14); 
153.24     (16) redirection and intervention for behavior, including 
153.25  observation and monitoring; 
153.26     (17) interventions for seizure disorders, including 
153.27  monitoring and observation if the recipient has had a seizure 
153.28  that requires intervention within the past three months; 
153.29     (18) tracheostomy suctioning using a clean procedure if the 
153.30  procedure is properly delegated by a registered nurse.  Before 
153.31  this procedure can be delegated to a personal care assistant, a 
153.32  registered nurse must determine that the tracheostomy suctioning 
153.33  can be accomplished utilizing a clean rather than a sterile 
153.34  procedure and must ensure that the personal care assistant has 
153.35  been taught the proper procedure; and 
153.36     (19) incidental household services that are an integral 
154.1   part of a personal care service described in clauses (1) to (18).
154.2   For purposes of this subdivision, monitoring and observation 
154.3   means watching for outward visible signs that are likely to 
154.4   occur and for which there is a covered personal care service or 
154.5   an appropriate personal care intervention.  For purposes of this 
154.6   subdivision, a clean procedure refers to a procedure that 
154.7   reduces the numbers of microorganisms or prevents or reduces the 
154.8   transmission of microorganisms from one person or place to 
154.9   another.  A clean procedure may be used beginning 14 days after 
154.10  insertion. 
154.11     (d) The personal care assistant services that are not 
154.12  eligible for payment are the following:  
154.13     (1) services not ordered by the physician provided without 
154.14  a physician's determination of medical necessity as required by 
154.15  section 256B.0625, subdivision 19c.  The determination must be 
154.16  in the recipient's file at the time claims are submitted for 
154.17  payment; 
154.18     (2) assessments by personal care assistant provider 
154.19  organizations or by independently enrolled registered nurses; 
154.20     (3) services that are not in the service plan; 
154.21     (4) services provided by the recipient's spouse, legal 
154.22  guardian for an adult or child recipient, or parent of a 
154.23  recipient under age 18; 
154.24     (5) services provided by a foster care provider of a 
154.25  recipient who cannot direct the recipient's own care, unless 
154.26  monitored by a county or state case manager under section 
154.27  256B.0625, subdivision 19a; 
154.28     (6) services provided by the residential or program license 
154.29  holder in a residence for more than four persons; 
154.30     (7) services that are the responsibility of a residential 
154.31  or program license holder under the terms of a service agreement 
154.32  and administrative rules; 
154.33     (8) sterile procedures; 
154.34     (9) injections of fluids into veins, muscles, or skin; 
154.35     (10) homemaker services that are not an integral part of a 
154.36  personal care assistant services; 
155.1      (11) home maintenance or chore services; 
155.2      (12) services not specified under paragraph (a); and 
155.3      (13) services not authorized by the commissioner or the 
155.4   commissioner's designee. 
155.5      (e) The recipient or responsible party may choose to 
155.6   supervise the personal care assistant or to have a qualified 
155.7   professional, as defined in section 256B.0625, subdivision 19c, 
155.8   provide the supervision.  As required under section 256B.0625, 
155.9   subdivision 19c, the county public health nurse, as a part of 
155.10  the assessment, will assist the recipient or responsible party 
155.11  to identify the most appropriate person to provide supervision 
155.12  of the personal care assistant.  Health-related delegated tasks 
155.13  performed by the personal care assistant will be under the 
155.14  supervision of a qualified professional or the direction of the 
155.15  recipient's physician.  If the recipient has a qualified 
155.16  professional, Minnesota Rules, part 9505.0335, subpart 4, 
155.17  applies. 
155.18     (f) In order to be paid for personal care services, 
155.19  personal care provider organizations, and personal care choice 
155.20  providers are required: 
155.21     (1) to maintain a recipient file for each recipient for 
155.22  whom services are being billed that contains: 
155.23     (i) the current physician's determination of medical 
155.24  necessity as required by section 256B.0625, subdivision 19c; 
155.25     (ii) the service plan, including the monthly authorized 
155.26  hours, or flexible use plan; 
155.27     (iii) the care plan, signed by the recipient and the 
155.28  qualified professional, if required or designated, detailing the 
155.29  personal care services to be provided; 
155.30     (iv) documentation, on a form approved by the commissioner 
155.31  and signed by the personal care assistant, specifying the day, 
155.32  month, year, arrival, and departure times, with AM and PM 
155.33  notation, for all services provided to the recipient.  The form 
155.34  must include a notice that it is a federal crime to provide 
155.35  false information on personal care service billings for medical 
155.36  assistance payment; and 
156.1      (v) all notices to the recipient regarding personal care 
156.2   service use exceeding authorized hours; and 
156.3      (2) to communicate, by telephone if available, and in 
156.4   writing, with the recipient or the responsible party about the 
156.5   schedule for use of authorized hours and to notify the recipient 
156.6   and the county public health nurse in advance and as soon as 
156.7   possible, on a form approved by the commissioner, if the monthly 
156.8   number of hours authorized is likely to be exceeded for the 
156.9   month. 
156.10     (g) The commissioner shall establish an ongoing audit 
156.11  process for potential fraud and abuse for personal care 
156.12  assistant services.  The audit process must include, at a 
156.13  minimum, a requirement that the documentation of hours of care 
156.14  provided be on a form approved by the commissioner and include 
156.15  the personal care assistant's signature attesting that the hours 
156.16  shown on each bill were provided by the personal care assistant 
156.17  on the dates and the times specified.  
156.18     Sec. 14.  Minnesota Statutes 2004, section 256B.0627, 
156.19  subdivision 5, is amended to read: 
156.20     Subd. 5.  [LIMITATION ON PAYMENTS.] Medical assistance 
156.21  payments for home care services shall be limited according to 
156.22  this subdivision.  
156.23     (a)  [LIMITS ON SERVICES WITHOUT PRIOR AUTHORIZATION.] A 
156.24  recipient may receive the following home care services during a 
156.25  calendar year: 
156.26     (1) up to two face-to-face assessments to determine a 
156.27  recipient's need for personal care assistant services; 
156.28     (2) one service update done to determine a recipient's need 
156.29  for personal care assistant services; and 
156.30     (3) up to nine skilled nurse visits.  
156.31     (b)  [PRIOR AUTHORIZATION; EXCEPTIONS.] All home care 
156.32  services above the limits in paragraph (a) must receive the 
156.33  commissioner's prior authorization, except when: 
156.34     (1) the home care services were required to treat an 
156.35  emergency medical condition that if not immediately treated 
156.36  could cause a recipient serious physical or mental disability, 
157.1   continuation of severe pain, or death.  The provider must 
157.2   request retroactive authorization no later than five working 
157.3   days after giving the initial service.  The provider must be 
157.4   able to substantiate the emergency by documentation such as 
157.5   reports, notes, and admission or discharge histories; 
157.6      (2) the home care services were provided on or after the 
157.7   date on which the recipient's eligibility began, but before the 
157.8   date on which the recipient was notified that the case was 
157.9   opened.  Authorization will be considered if the request is 
157.10  submitted by the provider within 20 working days of the date the 
157.11  recipient was notified that the case was opened; 
157.12     (3) a third-party payor for home care services has denied 
157.13  or adjusted a payment.  Authorization requests must be submitted 
157.14  by the provider within 20 working days of the notice of denial 
157.15  or adjustment.  A copy of the notice must be included with the 
157.16  request; 
157.17     (4) the commissioner has determined that a county or state 
157.18  human services agency has made an error; or 
157.19     (5) the professional nurse determines an immediate need for 
157.20  up to 40 skilled nursing or home health aide visits per calendar 
157.21  year and submits a request for authorization within 20 working 
157.22  days of the initial service date, and medical assistance is 
157.23  determined to be the appropriate payer. 
157.24     (c)  [RETROACTIVE AUTHORIZATION.] A request for retroactive 
157.25  authorization will be evaluated according to the same criteria 
157.26  applied to prior authorization requests.  
157.27     (d)  [ASSESSMENT AND SERVICE PLAN.] Assessments under 
157.28  section 256B.0627, subdivision 1, paragraph (a), shall be 
157.29  conducted initially, and at least annually thereafter, in person 
157.30  with the recipient and result in a completed service plan using 
157.31  forms specified by the commissioner.  Within 30 days of 
157.32  recipient or responsible party request for home care services, 
157.33  the assessment, the service plan, and other information 
157.34  necessary to determine medical necessity such as diagnostic or 
157.35  testing information, social or medical histories, and hospital 
157.36  or facility discharge summaries shall be submitted to the 
158.1   commissioner.  Notwithstanding the provisions of section 
158.2   256B.0627, subdivision 12, the commissioner shall maximize 
158.3   federal financial participation to pay for public health nurse 
158.4   assessments for personal care services.  For personal care 
158.5   assistant services: 
158.6      (1) The amount and type of service authorized based upon 
158.7   the assessment and service plan will follow the recipient if the 
158.8   recipient chooses to change providers.  
158.9      (2) If the recipient's medical need changes, the 
158.10  recipient's provider may assess the need for a change in service 
158.11  authorization and request the change from the county public 
158.12  health nurse.  Within 30 days of the request, the public health 
158.13  nurse will determine whether to request the change in services 
158.14  based upon the provider assessment, or conduct a home visit to 
158.15  assess the need and determine whether the change is 
158.16  appropriate.  If the change in service need is due to a change 
158.17  in medical condition, a new physician's determination of medical 
158.18  necessity, required by section 256B.0625, subdivision 19c, must 
158.19  be obtained. 
158.20     (3) To continue to receive personal care assistant services 
158.21  after the first year, the recipient or the responsible party, in 
158.22  conjunction with the public health nurse, may complete a service 
158.23  update on forms developed by the commissioner according to 
158.24  criteria and procedures in subdivision 1.  
158.25     (e)  [PRIOR AUTHORIZATION.] The commissioner, or the 
158.26  commissioner's designee, shall review the assessment, service 
158.27  update, request for temporary services, request for flexible use 
158.28  option, service plan, and any additional information that is 
158.29  submitted.  The commissioner shall, within 30 days after 
158.30  receiving a complete request, assessment, and service plan, 
158.31  authorize home care services as follows:  
158.32     (1)  [HOME HEALTH SERVICES.] All home health services 
158.33  provided by a home health aide must be prior authorized by the 
158.34  commissioner or the commissioner's designee.  Prior 
158.35  authorization must be based on medical necessity and 
158.36  cost-effectiveness when compared with other care options.  When 
159.1   home health services are used in combination with personal care 
159.2   and private duty nursing, the cost of all home care services 
159.3   shall be considered for cost-effectiveness.  The commissioner 
159.4   shall limit home health aide visits to no more than one visit 
159.5   each per day.  The commissioner, or the commissioner's designee, 
159.6   may authorize up to two skilled nurse visits per day. 
159.7      (2)  [PERSONAL CARE ASSISTANT SERVICES.] (i) All personal 
159.8   care assistant services and supervision by a qualified 
159.9   professional, if requested by the recipient, must be prior 
159.10  authorized by the commissioner or the commissioner's designee 
159.11  except for the assessments established in paragraph (a).  The 
159.12  amount of personal care assistant services authorized must be 
159.13  based on the recipient's home care rating.  A child may not be 
159.14  found to be dependent in an activity of daily living if because 
159.15  of the child's age an adult would either perform the activity 
159.16  for the child or assist the child with the activity and the 
159.17  amount of assistance needed is similar to the assistance 
159.18  appropriate for a typical child of the same age.  Based on 
159.19  medical necessity, the commissioner may authorize: 
159.20     (A) up to two times the average number of direct care hours 
159.21  provided in nursing facilities for the recipient's comparable 
159.22  case mix level; or 
159.23     (B) up to three times the average number of direct care 
159.24  hours provided in nursing facilities for recipients who have 
159.25  complex medical needs or are dependent in at least seven 
159.26  activities of daily living and need physical assistance with 
159.27  eating or have a neurological diagnosis; or 
159.28     (C) up to 60 percent of the average reimbursement rate, as 
159.29  of July 1, 1991, for care provided in a regional treatment 
159.30  center for recipients who have Level I behavior, plus any 
159.31  inflation adjustment as provided by the legislature for personal 
159.32  care service; or 
159.33     (D) up to the amount the commissioner would pay, as of July 
159.34  1, 1991, plus any inflation adjustment provided for home care 
159.35  services, for care provided in a regional treatment center for 
159.36  recipients referred to the commissioner by a regional treatment 
160.1   center preadmission evaluation team.  For purposes of this 
160.2   clause, home care services means all services provided in the 
160.3   home or community that would be included in the payment to a 
160.4   regional treatment center; or 
160.5      (E) up to the amount medical assistance would reimburse for 
160.6   facility care for recipients referred to the commissioner by a 
160.7   preadmission screening team established under section 256B.0911 
160.8   or 256B.092; and 
160.9      (F) a reasonable amount of time for the provision of 
160.10  supervision by a qualified professional of personal care 
160.11  assistant services, if a qualified professional is requested by 
160.12  the recipient or responsible party.  
160.13     (ii) The number of direct care hours shall be determined 
160.14  according to the annual cost report submitted to the department 
160.15  by nursing facilities.  The average number of direct care hours, 
160.16  as established by May 1, 1992, shall be calculated and 
160.17  incorporated into the home care limits on July 1, 1992.  These 
160.18  limits shall be calculated to the nearest quarter hour. 
160.19     (iii) The home care rating shall be determined by the 
160.20  commissioner or the commissioner's designee based on information 
160.21  submitted to the commissioner by the county public health nurse 
160.22  on forms specified by the commissioner.  The home care rating 
160.23  shall be a combination of current assessment tools developed 
160.24  under sections 256B.0911 and 256B.501 with an addition for 
160.25  seizure activity that will assess the frequency and severity of 
160.26  seizure activity and with adjustments, additions, and 
160.27  clarifications that are necessary to reflect the needs and 
160.28  conditions of recipients who need home care including children 
160.29  and adults under 65 years of age.  The commissioner shall 
160.30  establish these forms and protocols under this section and shall 
160.31  use an advisory group, including representatives of recipients, 
160.32  providers, and counties, for consultation in establishing and 
160.33  revising the forms and protocols. 
160.34     (iv) A recipient shall qualify as having complex medical 
160.35  needs if the care required is difficult to perform and because 
160.36  of recipient's medical condition requires more time than 
161.1   community-based standards allow or requires more skill than 
161.2   would ordinarily be required and the recipient needs or has one 
161.3   or more of the following: 
161.4      (A) daily tube feedings; 
161.5      (B) daily parenteral therapy; 
161.6      (C) wound or decubiti care; 
161.7      (D) postural drainage, percussion, nebulizer treatments, 
161.8   suctioning, tracheotomy care, oxygen, mechanical ventilation; 
161.9      (E) catheterization; 
161.10     (F) ostomy care; 
161.11     (G) quadriplegia; or 
161.12     (H) other comparable medical conditions or treatments the 
161.13  commissioner determines would otherwise require institutional 
161.14  care.  
161.15     (v) A recipient shall qualify as having Level I behavior if 
161.16  there is reasonable supporting evidence that the recipient 
161.17  exhibits, or that without supervision, observation, or 
161.18  redirection would exhibit, one or more of the following 
161.19  behaviors that cause, or have the potential to cause: 
161.20     (A) injury to the recipient's own body; 
161.21     (B) physical injury to other people; or 
161.22     (C) destruction of property. 
161.23     (vi) Time authorized for personal care relating to Level I 
161.24  behavior in subclause (v), items (A) to (C), shall be based on 
161.25  the predictability, frequency, and amount of intervention 
161.26  required. 
161.27     (vii) A recipient shall qualify as having Level II behavior 
161.28  if the recipient exhibits on a daily basis one or more of the 
161.29  following behaviors that interfere with the completion of 
161.30  personal care assistant services under subdivision 4, paragraph 
161.31  (a): 
161.32     (A) unusual or repetitive habits; 
161.33     (B) withdrawn behavior; or 
161.34     (C) offensive behavior. 
161.35     (viii) A recipient with a home care rating of Level II 
161.36  behavior in subclause (vii), items (A) to (C), shall be rated as 
162.1   comparable to a recipient with complex medical needs under 
162.2   subclause (iv).  If a recipient has both complex medical needs 
162.3   and Level II behavior, the home care rating shall be the next 
162.4   complex category up to the maximum rating under subclause (i), 
162.5   item (B). 
162.6      (3)  [PRIVATE DUTY NURSING SERVICES.] All private duty 
162.7   nursing services shall be prior authorized by the commissioner 
162.8   or the commissioner's designee.  Prior authorization for private 
162.9   duty nursing services shall be based on medical necessity and 
162.10  cost-effectiveness when compared with alternative care options.  
162.11  The commissioner may authorize medically necessary private duty 
162.12  nursing services in quarter-hour units when: 
162.13     (i) the recipient requires more individual and continuous 
162.14  care than can be provided during a nurse visit; or 
162.15     (ii) the cares are outside of the scope of services that 
162.16  can be provided by a home health aide or personal care assistant.
162.17     The commissioner may authorize: 
162.18     (A) up to two times the average amount of direct care hours 
162.19  provided in nursing facilities statewide for case mix 
162.20  classification "K" as established by the annual cost report 
162.21  submitted to the department by nursing facilities in May 1992; 
162.22     (B) private duty nursing in combination with other home 
162.23  care services up to the total cost allowed under clause (2); 
162.24     (C) up to 16 hours per day if the recipient requires more 
162.25  nursing than the maximum number of direct care hours as 
162.26  established in item (A) and the recipient meets the hospital 
162.27  admission criteria established under Minnesota Rules, parts 
162.28  9505.0501 to 9505.0540.  
162.29     The commissioner may authorize up to 16 hours per day of 
162.30  medically necessary private duty nursing services or up to 24 
162.31  hours per day of medically necessary private duty nursing 
162.32  services until such time as the commissioner is able to make a 
162.33  determination of eligibility for recipients who are 
162.34  cooperatively applying for home care services under the 
162.35  community alternative care program developed under section 
162.36  256B.49, or until it is determined by the appropriate regulatory 
163.1   agency that a health benefit plan is or is not required to pay 
163.2   for appropriate medically necessary health care services.  
163.3   Recipients or their representatives must cooperatively assist 
163.4   the commissioner in obtaining this determination.  Recipients 
163.5   who are eligible for the community alternative care program may 
163.6   not receive more hours of nursing under this section than would 
163.7   otherwise be authorized under section 256B.49.  
163.8      (4)  [VENTILATOR-DEPENDENT RECIPIENTS.] If the recipient is 
163.9   ventilator-dependent, the monthly medical assistance 
163.10  authorization for home care services shall not exceed what the 
163.11  commissioner would pay for care at the highest cost hospital 
163.12  designated as a long-term hospital under the Medicare program.  
163.13  For purposes of this clause, home care services means all 
163.14  services provided in the home that would be included in the 
163.15  payment for care at the long-term hospital.  
163.16  "Ventilator-dependent" means an individual who receives 
163.17  mechanical ventilation for life support at least six hours per 
163.18  day and is expected to be or has been dependent for at least 30 
163.19  consecutive days.  
163.20     (f)  [PRIOR AUTHORIZATION; TIME LIMITS.] The commissioner 
163.21  or the commissioner's designee shall determine the time period 
163.22  for which a prior authorization shall be effective and, if 
163.23  flexible use has been requested, whether to allow the flexible 
163.24  use option.  If the recipient continues to require home care 
163.25  services beyond the duration of the prior authorization, the 
163.26  home care provider must request a new prior authorization.  
163.27  Under no circumstances, other than the exceptions in paragraph 
163.28  (b), shall a prior authorization be valid prior to the date the 
163.29  commissioner receives the request or for more than 12 months.  A 
163.30  recipient who appeals a reduction in previously authorized home 
163.31  care services may continue previously authorized services, other 
163.32  than temporary services under paragraph (h), pending an appeal 
163.33  under section 256.045.  The commissioner must provide a detailed 
163.34  explanation of why the authorized services are reduced in amount 
163.35  from those requested by the home care provider.  
163.36     (g)  [APPROVAL OF HOME CARE SERVICES.] The commissioner or 
164.1   the commissioner's designee shall determine the medical 
164.2   necessity of home care services, the level of caregiver 
164.3   according to subdivision 2, and the institutional comparison 
164.4   according to this subdivision, the cost-effectiveness of 
164.5   services, and the amount, scope, and duration of home care 
164.6   services reimbursable by medical assistance, based on the 
164.7   assessment, primary payer coverage determination information as 
164.8   required, the service plan, the recipient's age, the cost of 
164.9   services, the recipient's medical condition, and diagnosis or 
164.10  disability.  The commissioner may publish additional criteria 
164.11  for determining medical necessity according to section 256B.04. 
164.12     (h)  [PRIOR AUTHORIZATION REQUESTS; TEMPORARY SERVICES.] 
164.13  The agency nurse, the independently enrolled private duty nurse, 
164.14  or county public health nurse may request a temporary 
164.15  authorization for home care services by telephone.  The 
164.16  commissioner may approve a temporary level of home care services 
164.17  based on the assessment, and service or care plan information, 
164.18  and primary payer coverage determination information as required.
164.19  Authorization for a temporary level of home care services 
164.20  including nurse supervision is limited to the time specified by 
164.21  the commissioner, but shall not exceed 45 days, unless extended 
164.22  because the county public health nurse has not completed the 
164.23  required assessment and service plan, or the commissioner's 
164.24  determination has not been made.  The level of services 
164.25  authorized under this provision shall have no bearing on a 
164.26  future prior authorization. 
164.27     (i)  [PRIOR AUTHORIZATION REQUIRED IN FOSTER CARE SETTING.] 
164.28  Home care services provided in an adult or child foster care 
164.29  setting must receive prior authorization by the department 
164.30  according to the limits established in paragraph (a). 
164.31     The commissioner may not authorize: 
164.32     (1) home care services that are the responsibility of the 
164.33  foster care provider under the terms of the foster care 
164.34  placement agreement and administrative rules; 
164.35     (2) personal care assistant services when the foster care 
164.36  license holder is also the personal care provider or personal 
165.1   care assistant unless the recipient can direct the recipient's 
165.2   own care, or case management is provided as required in section 
165.3   256B.0625, subdivision 19a; 
165.4      (3) personal care assistant services when the responsible 
165.5   party is an employee of, or under contract with, or has any 
165.6   direct or indirect financial relationship with the personal care 
165.7   provider or personal care assistant, unless case management is 
165.8   provided as required in section 256B.0625, subdivision 19a; or 
165.9      (4) personal care assistant and private duty nursing 
165.10  services when the number of foster care residents is greater 
165.11  than four unless the county responsible for the recipient's 
165.12  foster placement made the placement prior to April 1, 1992, 
165.13  requests that personal care assistant and private duty nursing 
165.14  services be provided, and case management is provided as 
165.15  required in section 256B.0625, subdivision 19a. 
165.16     Sec. 15.  Minnesota Statutes 2004, section 256B.0627, 
165.17  subdivision 9, is amended to read: 
165.18     Subd. 9.  [OPTION FOR FLEXIBLE USE OF PERSONAL CARE 
165.19  ASSISTANT HOURS.] (a) "Flexible use option" means the scheduled 
165.20  use of authorized hours of personal care assistant services, 
165.21  which vary within the length of the a service authorization 
165.22  period covering no more than six months, in order to more 
165.23  effectively meet the needs and schedule of the 
165.24  recipient.  Authorized hours not used within the six-month 
165.25  period may not be carried over to another time period.  The 
165.26  flexible use of personal care assistant hours for a six-month 
165.27  period must be prior authorized by the commissioner, based on a 
165.28  request submitted on a form approved by the commissioner.  The 
165.29  request must include the assessment and the annual service plan 
165.30  prepared by the county public health nurse.  
165.31     (b) The recipient or responsible party, together with the 
165.32  case manager, if the recipient has case management services, and 
165.33  the county public health nurse, shall determine whether flexible 
165.34  use is an appropriate option based on the needs, abilities, 
165.35  preferences, and history of service use of the recipient or 
165.36  responsible party, and if appropriate, must ensure that the 
166.1   allocation of hours covers the ongoing needs of the recipient 
166.2   over an entire year divided into two six-month periods of 
166.3   flexible use. 
166.4      (c) If prior authorized, recipients may use their approved 
166.5   hours flexibly within the service authorization period for 
166.6   medically necessary covered services specified in the assessment 
166.7   required in subdivision 1.  The flexible use of authorized hours 
166.8   does not increase the total amount of authorized hours available 
166.9   to a recipient as determined under subdivision 5.  The 
166.10  commissioner shall not authorize additional personal care 
166.11  assistant services to supplement a service authorization that is 
166.12  exhausted before the end date under a flexible service use plan, 
166.13  unless the county public health nurse determines a change in 
166.14  condition and a need for increased services is established. 
166.15     (b) (d) The personal care provider organization and the 
166.16  recipient or responsible party, together with the provider, must 
166.17  work to monitor and document the use of authorized hours and 
166.18  ensure that a recipient is able to manage services effectively 
166.19  throughout the authorized period.  Upon request of the recipient 
166.20  or responsible party, the provider must furnish regular updates 
166.21  to the recipient or responsible party on the amount of personal 
166.22  care assistant services used develop a written month-to-month 
166.23  plan of the projected use of personal care assistant services 
166.24  that is part of the care plan and ensures: 
166.25     (1) that the health and safety needs of the recipient will 
166.26  be met; 
166.27     (2) that the total annual authorization will not be used 
166.28  before the end of the authorization period; and 
166.29     (3) monthly monitoring will be conducted of hours used as a 
166.30  percentage of the authorized amount. 
166.31     (e) The provider shall notify the recipient, the case 
166.32  manager, if the recipient has case management services, and the 
166.33  county public health nurse in advance and as soon as possible, 
166.34  on a form approved by the commissioner, if the monthly amount of 
166.35  hours authorized is likely to be exceeded for the month. 
166.36     (f) The commissioner shall provide written notice to the 
167.1   provider, the recipient or responsible party, the county case 
167.2   manager, if the recipient has case management services, and the 
167.3   county public health nurse, when a flexible use recipient 
167.4   exceeds the personal care service authorization for the month by 
167.5   an amount determined by the commissioner.  If the use of hours 
167.6   exceeds the monthly service authorization by the amount 
167.7   determined by the commissioner for two months during any 
167.8   three-month period, the commissioner shall notify the recipient 
167.9   and the county public health nurse that the flexible use 
167.10  authorization will be revoked beginning the following month.  
167.11  The revocation will not become effective if, within ten working 
167.12  days of the commissioner's notice of flexible use revocation, 
167.13  the county public health nurse requests prior authorization for 
167.14  an increase in the service authorization and continuation of the 
167.15  flexible use option, or the recipient appeals and assistance 
167.16  pending appeal is ordered.  The commissioner shall determine 
167.17  whether to approve the increase and continued flexible use. 
167.18     (g) The recipient or responsible party may stop the 
167.19  flexible use of hours by notifying the provider and county 
167.20  public health nurse in writing.  
167.21     (h)  The recipient or responsible party may appeal the 
167.22  commissioner's action according to section 256.045.  The denial 
167.23  or revocation of the flexible use option shall not affect the 
167.24  recipient's authorized level of personal care assistant services 
167.25  as determined under subdivision 5. 
167.26     Sec. 16.  Minnesota Statutes 2004, section 256B.0627, is 
167.27  amended by adding a subdivision to read: 
167.28     Subd. 18.  [OVERSIGHT OF ENROLLED PERSONAL CARE ASSISTANT 
167.29  SERVICES PROVIDERS.] The commissioner may request from providers 
167.30  documentation of compliance with laws, rules, and policies 
167.31  governing the provision of personal care assistant services.  A 
167.32  personal care assistant service provider must provide the 
167.33  requested documentation to the commissioner within ten business 
167.34  days of the request.  Failure to provide information to 
167.35  demonstrate substantial compliance with laws, rules, or policies 
167.36  may result in suspension, denial, or termination of the provider 
168.1   agreement. 
168.2      Sec. 17.  Minnesota Statutes 2004, section 256B.15, 
168.3   subdivision 1, is amended to read: 
168.4      Subdivision 1.  [POLICY, APPLICABILITY, PURPOSE, AND 
168.5   CONSTRUCTION; DEFINITION.] (a) It is the policy of this state 
168.6   that individuals or couples, either or both of whom participate 
168.7   in the medical assistance program, use their own assets to pay 
168.8   their share of the total cost of their care during or after 
168.9   their enrollment in the program according to applicable federal 
168.10  law and the laws of this state.  The following provisions apply: 
168.11     (1) subdivisions 1c to 1k shall not apply to claims arising 
168.12  under this section which are presented under section 525.313; 
168.13     (2) the provisions of subdivisions 1c to 1k expanding the 
168.14  interests included in an estate for purposes of recovery under 
168.15  this section give effect to the provisions of United States 
168.16  Code, title 42, section 1396p, governing recoveries, but do not 
168.17  give rise to any express or implied liens in favor of any other 
168.18  parties not named in these provisions; 
168.19     (3) the continuation of a recipient's life estate or joint 
168.20  tenancy interest in real property after the recipient's death 
168.21  for the purpose of recovering medical assistance under this 
168.22  section modifies common law principles holding that these 
168.23  interests terminate on the death of the holder; 
168.24     (4) all laws, rules, and regulations governing or involved 
168.25  with a recovery of medical assistance shall be liberally 
168.26  construed to accomplish their intended purposes; 
168.27     (5) a deceased recipient's life estate and joint tenancy 
168.28  interests continued under this section shall be owned by the 
168.29  remaindermen or surviving joint tenants as their interests may 
168.30  appear on the date of the recipient's death.  They shall not be 
168.31  merged into the remainder interest or the interests of the 
168.32  surviving joint tenants by reason of ownership.  They shall be 
168.33  subject to the provisions of this section.  Any conveyance, 
168.34  transfer, sale, assignment, or encumbrance by a remainderman, a 
168.35  surviving joint tenant, or their heirs, successors, and assigns 
168.36  shall be deemed to include all of their interest in the deceased 
169.1   recipient's life estate or joint tenancy interest continued 
169.2   under this section; and 
169.3      (6) the provisions of subdivisions 1c to 1k continuing a 
169.4   recipient's joint tenancy interests in real property after the 
169.5   recipient's death do not apply to a homestead owned of record, 
169.6   on the date the recipient dies, by the recipient and the 
169.7   recipient's spouse as joint tenants with a right of 
169.8   survivorship.  Homestead means the real property occupied by the 
169.9   surviving joint tenant spouse as their sole residence on the 
169.10  date the recipient dies and classified and taxed to the 
169.11  recipient and surviving joint tenant spouse as homestead 
169.12  property for property tax purposes in the calendar year in which 
169.13  the recipient dies.  For purposes of this exemption, real 
169.14  property the recipient and their surviving joint tenant spouse 
169.15  purchase solely with the proceeds from the sale of their prior 
169.16  homestead, own of record as joint tenants, and qualify as 
169.17  homestead property under section 273.124 in the calendar year in 
169.18  which the recipient dies and prior to the recipient's death 
169.19  shall be deemed to be real property classified and taxed to the 
169.20  recipient and their surviving joint tenant spouse as homestead 
169.21  property in the calendar year in which the recipient dies.  The 
169.22  surviving spouse, or any person with personal knowledge of the 
169.23  facts, may provide an affidavit describing the homestead 
169.24  property affected by this clause and stating facts showing 
169.25  compliance with this clause.  The affidavit shall be prima facie 
169.26  evidence of the facts it states. 
169.27     (b) The commissioner shall release liens arising under 
169.28  notices of potential claims under this section and medical 
169.29  assistance liens under sections 514.980 to 514.985, against a 
169.30  deceased recipient's life estates and jointly owned interests in 
169.31  farm and income producing real property they own of record on 
169.32  the date they die if their interest in the property ends at 
169.33  their death, the surviving remainderman or surviving joint 
169.34  tenant owns their interest in the property of record on that 
169.35  date, and all of the following conditions apply with respect to 
169.36  the surviving remainderman or the surviving joint tenant and 
170.1   their interest in the property: 
170.2      (1) the farm property is real property for which all of the 
170.3   following apply continuously for a period beginning at least 
170.4   three years before the calendar year in which the recipient 
170.5   first received long-term care medical assistance through the 
170.6   date of the recipient's death: 
170.7      (i) the remainderman or surviving joint tenant is a farmer, 
170.8   as defined in section 500.24, subdivision 2, paragraph (n), and 
170.9   is engaged in farming, as defined in section 500.24, subdivision 
170.10  2, paragraph (a); 
170.11     (ii) all of the land is a family farm as defined in section 
170.12  500.24, subdivision 2, paragraph (b); and 
170.13     (iii) all of the land is classified and taxed as class 2a 
170.14  agricultural land under section 273.13, subdivision 23, 
170.15  paragraph (a), for property tax purposes; and 
170.16     (2) the income-producing property is real property for 
170.17  which all of the following apply continuously for a period 
170.18  beginning at least three years before the calendar year in which 
170.19  the recipient first received long-term care medical assistance 
170.20  through the date of the recipient's death:  
170.21     (i) no part of the property is classified or taxed as 
170.22  homestead property for property tax purposes, provided that if 
170.23  the property is classified and taxed as both homestead and 
170.24  nonhomestead property, the portion of the property classified 
170.25  and taxed as nonhomestead property shall be considered to 
170.26  satisfy this requirement; 
170.27     (ii) all of the property is classified and taxed as class 
170.28  1c property under section 273.13, subdivision 22, paragraph (c), 
170.29  except that part of the class 1c property that is a dwelling 
170.30  occupied as a homestead; class 3a or 3b commercial or industrial 
170.31  property under section 273.13, subdivision 24; or as class 4a or 
170.32  4c property classified under section 273.13, subdivision 25, 
170.33  paragraphs (a) and (d), for property tax purposes; and 
170.34     (iii) the business, profession, or occupation in which the 
170.35  real property is used is the primary business, profession, or 
170.36  occupation of the remainderman or surviving joint tenant and the 
171.1   real property is used solely for that business, profession, or 
171.2   occupation.  A primary business, profession, or occupation is 
171.3   one the ongoing operation of which provides at least 65 percent 
171.4   of a person's gross income for federal income tax purposes for 
171.5   the calendar year. 
171.6      (c) For purposes of this section, "medical assistance" 
171.7   includes the medical assistance program under this chapter and 
171.8   the general assistance medical care program under chapter 256D 
171.9   and but does not include the alternative care program for 
171.10  nonmedical assistance recipients under section 256B.0913. 
171.11     <b>[EFFECTIVE DATE.]</b> The amendments in this section are 
171.12  effective July 1, 2005, and apply to the estates of decedents 
171.13  who die on or after that date. 
171.14     Sec. 18.  Minnesota Statutes 2004, section 256B.15, 
171.15  subdivision 1a, is amended to read: 
171.16     Subd. 1a.  [ESTATES SUBJECT TO CLAIMS.] If a person 
171.17  receives any medical assistance hereunder, on the person's 
171.18  death, if single, or on the death of the survivor of a married 
171.19  couple, either or both of whom received medical assistance, or 
171.20  as otherwise provided for in this section, the total amount paid 
171.21  for medical assistance rendered for the person and spouse shall 
171.22  be filed as a claim against the estate of the person or the 
171.23  estate of the surviving spouse in the court having jurisdiction 
171.24  to probate the estate or to issue a decree of descent according 
171.25  to sections 525.31 to 525.313.  
171.26     A claim shall be filed if medical assistance was rendered 
171.27  for either or both persons under one of the following 
171.28  circumstances: 
171.29     (a) the person was over 55 years of age, and received 
171.30  services under this chapter, excluding alternative care; 
171.31     (b) the person resided in a medical institution for six 
171.32  months or longer, received services under this chapter, 
171.33  excluding alternative care, and, at the time of 
171.34  institutionalization or application for medical assistance, 
171.35  whichever is later, the person could not have reasonably been 
171.36  expected to be discharged and returned home, as certified in 
172.1   writing by the person's treating physician.  For purposes of 
172.2   this section only, a "medical institution" means a skilled 
172.3   nursing facility, intermediate care facility, intermediate care 
172.4   facility for persons with mental retardation, nursing facility, 
172.5   or inpatient hospital; or 
172.6      (c) the person received general assistance medical care 
172.7   services under chapter 256D.  
172.8      The claim shall be considered an expense of the last 
172.9   illness of the decedent for the purpose of section 524.3-805.  
172.10  Any statute of limitations that purports to limit any county 
172.11  agency or the state agency, or both, to recover for medical 
172.12  assistance granted hereunder shall not apply to any claim made 
172.13  hereunder for reimbursement for any medical assistance granted 
172.14  hereunder.  Notice of the claim shall be given to all heirs and 
172.15  devisees of the decedent whose identity can be ascertained with 
172.16  reasonable diligence.  The notice must include procedures and 
172.17  instructions for making an application for a hardship waiver 
172.18  under subdivision 5; time frames for submitting an application 
172.19  and determination; and information regarding appeal rights and 
172.20  procedures.  Counties are entitled to one-half of the nonfederal 
172.21  share of medical assistance collections from estates that are 
172.22  directly attributable to county effort.  Counties are entitled 
172.23  to ten percent of the collections for alternative care directly 
172.24  attributable to county effort. 
172.25     <b>[EFFECTIVE DATE.]</b> The amendments in this section are 
172.26  effective July 1, 2005, and apply to the estates of decedents 
172.27  who die on or after that date.  
172.28     Sec. 19.  Minnesota Statutes 2004, section 256B.15, 
172.29  subdivision 2, is amended to read: 
172.30     Subd. 2.  [LIMITATIONS ON CLAIMS.] The claim shall include 
172.31  only the total amount of medical assistance rendered after age 
172.32  55 or during a period of institutionalization described in 
172.33  subdivision 1a, clause (b), and the total amount of general 
172.34  assistance medical care rendered, and shall not include 
172.35  interest.  Claims that have been allowed but not paid shall bear 
172.36  interest according to section 524.3-806, paragraph (d).  A claim 
173.1   against the estate of a surviving spouse who did not receive 
173.2   medical assistance, for medical assistance rendered for the 
173.3   predeceased spouse, is limited to the value of the assets of the 
173.4   estate that were marital property or jointly owned property at 
173.5   any time during the marriage.  Claims for alternative care shall 
173.6   be net of all premiums paid under section 256B.0913, subdivision 
173.7   12, on or after July 1, 2003, and shall be limited to services 
173.8   provided on or after July 1, 2003. 
173.9      <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2005, 
173.10  for decedents dying on or after that date. 
173.11     Sec. 20.  Minnesota Statutes 2004, section 256B.431, is 
173.12  amended by adding a subdivision to read: 
173.13     Subd. 41.  [NURSING FACILITY RATE INCREASES FOR OCTOBER 1, 
173.14  2005, AND JULY 1, 2006.] (a) For the rate period beginning 
173.15  October 1, 2005, and the rate year beginning July 1, 2006, the 
173.16  commissioner shall make available to each nursing facility 
173.17  reimbursed under this section or section 256B.434 an adjustment 
173.18  equal to two percent of the total operating payment rate.  
173.19     (b) Money resulting from the rate adjustment under 
173.20  paragraph (a) must be used to increase wages and benefits and 
173.21  pay associated costs for employees, except management fees, the 
173.22  administrator, and central office staff.  Except as provided in 
173.23  paragraph (c), money received by a facility as a result of the 
173.24  rate adjustment provided in paragraph (a) must be used only for 
173.25  wage, benefit, and staff increases implemented on or after the 
173.26  effective date of the rate increase each year, and must not be 
173.27  used for increases implemented prior to that date. 
173.28     (c) With respect only to the October 1, 2005, rate 
173.29  increase, a hospital-attached nursing facility that incurred 
173.30  costs for salary and employee benefit increases first provided 
173.31  after July 1, 2003, may count those costs towards the amount 
173.32  required to be spent on salaries and benefits under paragraph 
173.33  (b).  These costs must be reported to the commissioner in the 
173.34  form and manner specified by the commissioner. 
173.35     (d) Nursing facilities may apply for the rate adjustment 
173.36  under paragraph (a).  The application must be made to the 
174.1   commissioner and contain a plan by which the nursing facility 
174.2   will distribute the funds according to paragraph (b).  For 
174.3   nursing facilities in which the employees are represented by an 
174.4   exclusive bargaining representative, an agreement negotiated and 
174.5   agreed to by the employer and the exclusive bargaining 
174.6   representative constitutes the plan.  A negotiated agreement may 
174.7   constitute the plan only if the agreement is finalized after the 
174.8   date of enactment of all increases for the rate year and signed 
174.9   by both parties prior to submission to the commissioner.  The 
174.10  commissioner shall review the plan to ensure that the rate 
174.11  adjustments are used as provided in paragraph (b).  To be 
174.12  eligible, a facility must submit its distribution plan by March 
174.13  31, 2006, and December 31, 2006, respectively.  If a facility's 
174.14  distribution plan is effective after the first day of the 
174.15  applicable rate period that the funds are available, the rate 
174.16  adjustments are effective the same date as the facility's plan. 
174.17     (e) A copy of the approved distribution plan must be made 
174.18  available to all employees by giving each employee a copy or by 
174.19  posting a copy in an area of the nursing facility to which all 
174.20  employees have access.  If an employee does not receive the wage 
174.21  and benefit adjustment described in the facility's approved plan 
174.22  and is unable to resolve the problem with the facility's 
174.23  management or through the employee's union representative, the 
174.24  employee may contact the commissioner at an address or telephone 
174.25  number provided by the commissioner and included in the approved 
174.26  plan. 
174.27     Sec. 21.  Minnesota Statutes 2004, section 256B.431, is 
174.28  amended by adding a subdivision to read: 
174.29     Subd. 42.  [SINGLE-BED ROOM PAYMENT RATE.] (a) Beginning 
174.30  July 1, 2005, the operating payment rate for nursing facilities 
174.31  reimbursed under this section or section 256B.434 shall be 
174.32  increased by five percent multiplied by the ratio of the number 
174.33  of new single-bed rooms created divided by the number of active 
174.34  beds on July 1, 2005, for each bed closure that results in the 
174.35  creation of a single-bed room after July 1, 2005. 
174.36     (b) A nursing facility is prohibited from discharging 
175.1   residents for purposes of establishing single-bed rooms.  A 
175.2   nursing facility must retain a statement from any resident 
175.3   discharged to another nursing facility between July 1, 2005, and 
175.4   December 31, 2007, signed by the resident or the resident's 
175.5   designated responsible party, certifying the resident requests 
175.6   to move and is under no coercion to be discharged.  This signed 
175.7   statement must be witnessed and signed by the local ombudsman.  
175.8   The commissioner shall assess a monetary penalty of $5,000 per 
175.9   occurrence against any nursing facility determined to have 
175.10  discharged a resident for purposes of establishing single-bed 
175.11  rooms. 
175.12     (c) If after the date of enactment of this section and 
175.13  before December 31, 2007, more than 4,000 nursing home beds are 
175.14  removed from service, a portion of the appropriation for nursing 
175.15  homes shall be transferred to the alternative care program.  The 
175.16  amount of this transfer shall equal the number of beds removed 
175.17  from service less 4,000, multiplied by the average monthly 
175.18  per-person cost for alternative care, multiplied by 12, and 
175.19  further multiplied by 0.3. 
175.20     (d) Savings that result from bed closures on or after July 
175.21  1, 2005, that do not result in the establishment of single-bed 
175.22  rooms and exceed the number of closures included in the February 
175.23  2005 forecast shall not cancel to the general fund but are 
175.24  appropriated to the commissioner for the medical assistance 
175.25  costs of nursing home moratorium exceptions approved by the 
175.26  commissioner of health under section 144A.073.  The commissioner 
175.27  of health, in consultation with the commissioner of human 
175.28  services, shall publish a request for proposals under section 
175.29  144A.073, subdivision 2, when, in the determination of the 
175.30  commissioner of health, sufficient funds are available under 
175.31  this paragraph.  Money appropriated to the commissioner of human 
175.32  services under this paragraph shall not cancel and shall be 
175.33  available until expended. 
175.34     (e) For the rate year beginning July 1, 2005, the amount 
175.35  nursing facilities receive for medically necessary single-bed 
175.36  rooms under Minnesota Rules, part 9549.0070, subpart 3, shall be 
176.1   up to 114.365 percent of the established total payment rate for 
176.2   the resident.  For the rate year beginning July 1, 2006, the 
176.3   amount nursing facilities receive for medically necessary 
176.4   single-bed rooms under Minnesota Rules, part 9549.0070, subpart 
176.5   3, shall be up to 114.75 percent of the established total 
176.6   payment rate for the resident.  For the rate years beginning on 
176.7   or after July 1, 2007, the single-bed payment rate shall be up 
176.8   to 115 percent of the established total payment rate for the 
176.9   resident. 
176.10     Sec. 22.  Minnesota Statutes 2004, section 256B.434, 
176.11  subdivision 4, is amended to read: 
176.12     Subd. 4.  [ALTERNATE RATES FOR NURSING FACILITIES.] (a) For 
176.13  nursing facilities which have their payment rates determined 
176.14  under this section rather than section 256B.431, the 
176.15  commissioner shall establish a rate under this subdivision.  The 
176.16  nursing facility must enter into a written contract with the 
176.17  commissioner. 
176.18     (b) A nursing facility's case mix payment rate for the 
176.19  first rate year of a facility's contract under this section is 
176.20  the payment rate the facility would have received under section 
176.21  256B.431. 
176.22     (c) A nursing facility's case mix payment rates for the 
176.23  second and subsequent years of a facility's contract under this 
176.24  section are the previous rate year's contract payment rates plus 
176.25  an inflation adjustment and, for facilities reimbursed under 
176.26  this section or section 256B.431, an adjustment to include the 
176.27  cost of any increase in Health Department licensing fees for the 
176.28  facility taking effect on or after July 1, 2001.  The index for 
176.29  the inflation adjustment must be based on the change in the 
176.30  Consumer Price Index-All Items (United States City average) 
176.31  (CPI-U) forecasted by the commissioner of finance's national 
176.32  economic consultant, as forecasted in the fourth quarter of the 
176.33  calendar year preceding the rate year.  The inflation adjustment 
176.34  must be based on the 12-month period from the midpoint of the 
176.35  previous rate year to the midpoint of the rate year for which 
176.36  the rate is being determined.  For the rate years beginning on 
177.1   July 1, 1999, July 1, 2000, July 1, 2001, July 1, 2002, July 1, 
177.2   2003, and July 1, 2004, July 1, 2005, and July 1, 2006, this 
177.3   paragraph shall apply only to the property-related payment rate, 
177.4   except that adjustments to include the cost of any increase in 
177.5   Health Department licensing fees taking effect on or after July 
177.6   1, 2001, shall be provided.  In determining the amount of the 
177.7   property-related payment rate adjustment under this paragraph, 
177.8   the commissioner shall determine the proportion of the 
177.9   facility's rates that are property-related based on the 
177.10  facility's most recent cost report. 
177.11     (d) The commissioner shall develop additional 
177.12  incentive-based payments of up to five percent above the 
177.13  standard contract rate for achieving outcomes specified in each 
177.14  contract.  The specified facility-specific outcomes must be 
177.15  measurable and approved by the commissioner.  The commissioner 
177.16  may establish, for each contract, various levels of achievement 
177.17  within an outcome.  After the outcomes have been specified the 
177.18  commissioner shall assign various levels of payment associated 
177.19  with achieving the outcome.  Any incentive-based payment cancels 
177.20  if there is a termination of the contract.  In establishing the 
177.21  specified outcomes and related criteria the commissioner shall 
177.22  consider the following state policy objectives: 
177.23     (1) improved cost effectiveness and quality of life as 
177.24  measured by improved clinical outcomes; 
177.25     (2) successful diversion or discharge to community 
177.26  alternatives; 
177.27     (3) decreased acute care costs; 
177.28     (4) improved consumer satisfaction; 
177.29     (5) the achievement of quality; or 
177.30     (6) any additional outcomes proposed by a nursing facility 
177.31  that the commissioner finds desirable. 
177.32     Sec. 23.  Minnesota Statutes 2004, section 256B.434, is 
177.33  amended by adding a subdivision to read: 
177.34     Subd. 4f.  [RATE INCREASE EFFECTIVE JULY 1, 2005.] For the 
177.35  rate year beginning July 1, 2005, a facility in Ramsey County 
177.36  licensed for 180 beds shall have its operating payment rate as 
178.1   determined under this section and in effect on June 30, 2005, 
178.2   increased by $2.49.  The increase under this subdivision shall 
178.3   be included in the facility's total payment rates for the 
178.4   purposes of determining future rates under this section or any 
178.5   other section. 
178.6      Sec. 24.  Minnesota Statutes 2004, section 256B.440, is 
178.7   amended by adding a subdivision to read: 
178.8      Subd. 4.  [CONTINUED SYSTEM DEVELOPMENT.] (a) The 
178.9   commissioner shall continue developmental work on a new nursing 
178.10  home reimbursement system and present recommendations for a new 
178.11  system to the legislature by January 15, 2006.  The new system 
178.12  shall comply with subdivisions 1 and 2. 
178.13     (b) Nursing facilities shall continue to file, and the 
178.14  commissioner shall continue to collect and audit, annual cost 
178.15  reports under the conditions specified in subdivision 3. 
178.16     (c) Notwithstanding any contrary provisions of chapter 16C, 
178.17  the commissioner may, within the limits of appropriations 
178.18  specifically available for this purpose, extend contracts 
178.19  previously negotiated for consulting work on development of the 
178.20  new reimbursement system. 
178.21     Sec. 25.  Minnesota Statutes 2004, section 256B.5012, is 
178.22  amended by adding a subdivision to read: 
178.23     Subd. 6.  [ICF/MR RATE INCREASES BEGINNING OCTOBER 1, 2005, 
178.24  AND JULY 1, 2006.] (a) For the rate periods beginning October 1, 
178.25  2005, and July 1, 2006, the commissioner shall make available to 
178.26  each facility reimbursed under this section an adjustment to the 
178.27  total operating payment rate of two percent. 
178.28     (b) Money resulting from the rate adjustment under 
178.29  paragraph (a) must be used to increase wages and benefits and 
178.30  pay associated costs for employees, except for administrative 
178.31  and central office employees.  Money received by a facility as a 
178.32  result of the rate adjustment provided in paragraph (a) must be 
178.33  used only for wage, benefit, and staff increases implemented on 
178.34  or after the effective date of the rate increase each year, and 
178.35  must not be used for increases implemented prior to that date. 
178.36     (c) For each facility, the commissioner shall make 
179.1   available an adjustment using the percentage specified in 
179.2   paragraph (a) multiplied by the total payment rate, excluding 
179.3   the property-related payment rate, in effect on the preceding 
179.4   day.  The total payment rate shall include the adjustment 
179.5   provided in section 256B.501, subdivision 12. 
179.6      (d) A facility whose payment rates are governed by closure 
179.7   agreements, receivership agreements, or Minnesota Rules, part 
179.8   9553.0075, is not eligible for an adjustment otherwise granted 
179.9   under this subdivision.  
179.10     (e) A facility may apply for the payment rate adjustment 
179.11  provided under paragraph (a).  The application must be made to 
179.12  the commissioner and contain a plan by which the facility will 
179.13  distribute the funds according to paragraph (b).  For facilities 
179.14  in which the employees are represented by an exclusive 
179.15  bargaining representative, an agreement negotiated and agreed to 
179.16  by the employer and the exclusive bargaining representative 
179.17  constitutes the plan.  A negotiated agreement may constitute the 
179.18  plan only if the agreement is finalized after the date of 
179.19  enactment of all rate increases for the rate year.  The 
179.20  commissioner shall review the plan to ensure that the payment 
179.21  rate adjustment per diem is used as provided in this 
179.22  subdivision.  To be eligible, a facility must submit its plan by 
179.23  March 31, 2006, and December 31, 2006, respectively.  If a 
179.24  facility's plan is effective for its employees after the first 
179.25  day of the applicable rate period that the funds are available, 
179.26  the payment rate adjustment per diem is effective the same date 
179.27  as its plan. 
179.28     (f) A copy of the approved distribution plan must be made 
179.29  available to all employees by giving each employee a copy or by 
179.30  posting it in an area of the facility to which all employees 
179.31  have access.  If an employee does not receive the wage and 
179.32  benefit adjustment described in the facility's approved plan and 
179.33  is unable to resolve the problem with the facility's management 
179.34  or through the employee's union representative, the employee may 
179.35  contact the commissioner at an address or telephone number 
179.36  provided by the commissioner and included in the approved plan. 
180.1      Sec. 26.  Minnesota Statutes 2004, section 256B.69, 
180.2   subdivision 23, is amended to read: 
180.3      Subd. 23.  [ALTERNATIVE INTEGRATED LONG-TERM CARE SERVICES; 
180.4   ELDERLY AND DISABLED PERSONS.] (a) The commissioner may 
180.5   implement demonstration projects to create alternative 
180.6   integrated delivery systems for acute and long-term care 
180.7   services to elderly persons and persons with disabilities as 
180.8   defined in section 256B.77, subdivision 7a, that provide 
180.9   increased coordination, improve access to quality services, and 
180.10  mitigate future cost increases.  The commissioner may seek 
180.11  federal authority to combine Medicare and Medicaid capitation 
180.12  payments for the purpose of such demonstrations.  Medicare funds 
180.13  and services shall be administered according to the terms and 
180.14  conditions of the federal waiver and demonstration provisions.  
180.15  For the purpose of administering medical assistance funds, 
180.16  demonstrations under this subdivision are subject to 
180.17  subdivisions 1 to 22.  The provisions of Minnesota Rules, parts 
180.18  9500.1450 to 9500.1464, apply to these demonstrations, with the 
180.19  exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457, 
180.20  subpart 1, items B and C, which do not apply to persons 
180.21  enrolling in demonstrations under this section.  An initial open 
180.22  enrollment period may be provided.  Persons who disenroll from 
180.23  demonstrations under this subdivision remain subject to 
180.24  Minnesota Rules, parts 9500.1450 to 9500.1464.  When a person is 
180.25  enrolled in a health plan under these demonstrations and the 
180.26  health plan's participation is subsequently terminated for any 
180.27  reason, the person shall be provided an opportunity to select a 
180.28  new health plan and shall have the right to change health plans 
180.29  within the first 60 days of enrollment in the second health 
180.30  plan.  Persons required to participate in health plans under 
180.31  this section who fail to make a choice of health plan shall not 
180.32  be randomly assigned to health plans under these demonstrations. 
180.33  Notwithstanding section 256L.12, subdivision 5, and Minnesota 
180.34  Rules, part 9505.5220, subpart 1, item A, if adopted, for the 
180.35  purpose of demonstrations under this subdivision, the 
180.36  commissioner may contract with managed care organizations, 
181.1   including counties, to serve only elderly persons eligible for 
181.2   medical assistance, elderly and disabled persons, or disabled 
181.3   persons only.  For persons with primary diagnoses of mental 
181.4   retardation or a related condition, serious and persistent 
181.5   mental illness, or serious emotional disturbance, the 
181.6   commissioner must ensure that the county authority has approved 
181.7   the demonstration and contracting design.  Enrollment in these 
181.8   projects for persons with disabilities shall be voluntary.  The 
181.9   commissioner shall not implement any demonstration project under 
181.10  this subdivision for persons with primary diagnoses of mental 
181.11  retardation or a related condition, serious and persistent 
181.12  mental illness, or serious emotional disturbance, without 
181.13  approval of the county board of the county in which the 
181.14  demonstration is being implemented.  
181.15     (b) Notwithstanding chapter 245B, sections 252.40 to 
181.16  252.46, 256B.092, 256B.501 to 256B.5015, and Minnesota Rules, 
181.17  parts 9525.0004 to 9525.0036, 9525.1200 to 9525.1330, 9525.1580, 
181.18  and 9525.1800 to 9525.1930, the commissioner may implement under 
181.19  this section projects for persons with developmental 
181.20  disabilities.  The commissioner may capitate payments for ICF/MR 
181.21  services, waivered services for mental retardation or related 
181.22  conditions, including case management services, day training and 
181.23  habilitation and alternative active treatment services, and 
181.24  other services as approved by the state and by the federal 
181.25  government.  Case management and active treatment must be 
181.26  individualized and developed in accordance with a 
181.27  person-centered plan.  Costs under these projects may not exceed 
181.28  costs that would have been incurred under fee-for-service. 
181.29  Beginning July 1, 2003, and until two years after the pilot 
181.30  project implementation date, subcontractor participation in the 
181.31  long-term care developmental disability pilot is limited to a 
181.32  nonprofit long-term care system providing ICF/MR services, home 
181.33  and community-based waiver services, and in-home services to no 
181.34  more than 120 consumers with developmental disabilities in 
181.35  Carver, Hennepin, and Scott Counties.  The commissioner shall 
181.36  report to the legislature prior to expansion of the 
182.1   developmental disability pilot project.  This paragraph expires 
182.2   two years after the implementation date of the pilot project.  
182.3      (c) Before implementation of a demonstration project for 
182.4   disabled persons, the commissioner must provide information to 
182.5   appropriate committees of the house of representatives and 
182.6   senate and must involve representatives of affected disability 
182.7   groups in the design of the demonstration projects. 
182.8      (d) A nursing facility reimbursed under the alternative 
182.9   reimbursement methodology in section 256B.434 may, in 
182.10  collaboration with a hospital, clinic, or other health care 
182.11  entity provide services under paragraph (a).  The commissioner 
182.12  shall amend the state plan and seek any federal waivers 
182.13  necessary to implement this paragraph. 
182.14     (e) Notwithstanding section 256B.0621, health plans 
182.15  providing services under this section are responsible for home 
182.16  care targeted case management and relocation targeted case 
182.17  management.  Services must be provided according to the terms of 
182.18  the waivers and contracts approved by the federal government. 
182.19     Sec. 27.  [501B.895] [PUBLIC HEALTH CARE PROGRAMS AND 
182.20  CERTAIN TRUSTS.] 
182.21     (a) It is the public policy of this state that individuals 
182.22  use all available resources to pay for the cost of long-term 
182.23  care services, as defined in section 256B.0595, before turning 
182.24  to Minnesota health care program funds, and that trust 
182.25  instruments should not be permitted to shield available 
182.26  resources of an individual or an individual's spouse from such 
182.27  use.  Any irrevocable inter vivos trust or any legal instrument, 
182.28  device, or arrangement similar to an irrevocable inter vivos 
182.29  trust created on or after July 1, 2005, containing assets or 
182.30  income of an individual or an individual's spouse, including 
182.31  those created by a person, court, or administrative body with 
182.32  legal authority to act in place of, at the direction of, upon 
182.33  the request of, or on behalf of the individual or individual's 
182.34  spouse, becomes revocable by operation of law for the sole 
182.35  purpose of a state or local human services agency determination 
182.36  on an application by the individual or the individual's spouse 
183.1   for payment of long-term care services through a Minnesota 
183.2   public health care program under chapter 256.  For purposes of 
183.3   this section, any inter vivos trust and any legal instrument, 
183.4   device, or arrangement similar to an inter vivos trust: 
183.5      (1) shall be deemed to be located in and subject to the 
183.6   laws of this state; and 
183.7      (2) is created as of the date it is fully executed by or on 
183.8   behalf of all of the settlors or others.  
183.9      (b) For purposes of this section, a legal instrument, 
183.10  device, or arrangement similar to an irrevocable inter vivos 
183.11  trust means any instrument, device, or arrangement which 
183.12  involves a grantor who transfers or whose property is 
183.13  transferred by another including, but not limited to, any court, 
183.14  administrative body, or anyone else with authority to act on 
183.15  their behalf or at their direction, to an individual or entity 
183.16  with fiduciary, contractual, or legal obligations to the grantor 
183.17  or others to be held, managed, or administered by the individual 
183.18  or entity for the benefit of the grantor or others.  These legal 
183.19  instruments, devices, or other arrangements are irrevocable 
183.20  inter vivos trusts for purposes of this section. 
183.21     (c) In the event of a conflict between this section and the 
183.22  provisions of an irrevocable trust created on or after July 1, 
183.23  2005, this section shall control. 
183.24     (d) This section does not apply to trusts that qualify as 
183.25  supplemental needs trusts under section 501B.89 or to trusts 
183.26  meeting the criteria of United States Code, title 42, section 
183.27  1396p (d)(4)(a) and (c) for purposes of eligibility for medical 
183.28  assistance. 
183.29     (e) This section applies to all trusts first created on or 
183.30  after July 1, 2005, and to all interests in real or personal 
183.31  property regardless of the date on which the interest was 
183.32  created, reserved, or acquired.  
183.33     Sec. 28.  Minnesota Statutes 2004, section 514.981, 
183.34  subdivision 6, is amended to read: 
183.35     Subd. 6.  [TIME LIMITS; CLAIM LIMITS; LIENS ON LIFE ESTATES 
183.36  AND JOINT TENANCIES.] (a) A medical assistance lien is a lien on 
184.1   the real property it describes for a period of ten years from 
184.2   the date it attaches according to section 514.981, subdivision 
184.3   2, paragraph (a), except as otherwise provided for in sections 
184.4   514.980 to 514.985.  The agency may renew a medical assistance 
184.5   lien for an additional ten years from the date it would 
184.6   otherwise expire by recording or filing a certificate of renewal 
184.7   before the lien expires.  The certificate shall be recorded or 
184.8   filed in the office of the county recorder or registrar of 
184.9   titles for the county in which the lien is recorded or filed.  
184.10  The certificate must refer to the recording or filing data for 
184.11  the medical assistance lien it renews.  The certificate need not 
184.12  be attested, certified, or acknowledged as a condition for 
184.13  recording or filing.  The registrar of titles or the recorder 
184.14  shall file, record, index, and return the certificate of renewal 
184.15  in the same manner as provided for medical assistance liens in 
184.16  section 514.982, subdivision 2. 
184.17     (b) A medical assistance lien is not enforceable against 
184.18  the real property of an estate to the extent there is a 
184.19  determination by a court of competent jurisdiction, or by an 
184.20  officer of the court designated for that purpose, that there are 
184.21  insufficient assets in the estate to satisfy the agency's 
184.22  medical assistance lien in whole or in part because of the 
184.23  homestead exemption under section 256B.15, subdivision 4, the 
184.24  rights of the surviving spouse or minor children under section 
184.25  524.2-403, paragraphs (a) and (b), or claims with a priority 
184.26  under section 524.3-805, paragraph (a), clauses (1) to (4).  For 
184.27  purposes of this section, the rights of the decedent's adult 
184.28  children to exempt property under section 524.2-403, paragraph 
184.29  (b), shall not be considered costs of administration under 
184.30  section 524.3-805, paragraph (a), clause (1). 
184.31     (c) Notwithstanding any law or rule to the contrary, the 
184.32  provisions in clauses (1) to (7) apply if a life estate subject 
184.33  to a medical assistance lien ends according to its terms, or if 
184.34  a medical assistance recipient who owns a life estate or any 
184.35  interest in real property as a joint tenant that is subject to a 
184.36  medical assistance lien dies. 
185.1      (1) The medical assistance recipient's life estate or joint 
185.2   tenancy interest in the real property shall not end upon the 
185.3   recipient's death but shall merge into the remainder interest or 
185.4   other interest in real property the medical assistance recipient 
185.5   owned in joint tenancy with others.  The medical assistance lien 
185.6   shall attach to and run with the remainder or other interest in 
185.7   the real property to the extent of the medical assistance 
185.8   recipient's interest in the property at the time of the 
185.9   recipient's death as determined under this section. 
185.10     (2) If the medical assistance recipient's interest was a 
185.11  life estate in real property, the lien shall be a lien against 
185.12  the portion of the remainder equal to the percentage factor for 
185.13  the life estate of a person the medical assistance recipient's 
185.14  age on the date the life estate ended according to its terms or 
185.15  the date of the medical assistance recipient's death as listed 
185.16  in the Life Estate Mortality Table in the health care program's 
185.17  manual. 
185.18     (3) If the medical assistance recipient owned the interest 
185.19  in real property in joint tenancy with others, the lien shall be 
185.20  a lien against the portion of that interest equal to the 
185.21  fractional interest the medical assistance recipient would have 
185.22  owned in the jointly owned interest had the medical assistance 
185.23  recipient and the other owners held title to that interest as 
185.24  tenants in common on the date the medical assistance recipient 
185.25  died. 
185.26     (4) The medical assistance lien shall remain a lien against 
185.27  the remainder or other jointly owned interest for the length of 
185.28  time and be renewable as provided in paragraph (a). 
185.29     (5) Subdivision 5, paragraph (a), clause (4), paragraph 
185.30  (b), clauses (1) and (2); and subdivision 6, paragraph (b), do 
185.31  not apply to medical assistance liens which attach to interests 
185.32  in real property as provided under this subdivision. 
185.33     (6) The continuation of a medical assistance recipient's 
185.34  life estate or joint tenancy interest in real property after the 
185.35  medical assistance recipient's death for the purpose of 
185.36  recovering medical assistance provided for in sections 514.980 
186.1   to 514.985 modifies common law principles holding that these 
186.2   interests terminate on the death of the holder. 
186.3      (7) Notwithstanding any law or rule to the contrary, no 
186.4   release, satisfaction, discharge, or affidavit under section 
186.5   256B.15 shall extinguish or terminate the life estate or joint 
186.6   tenancy interest of a medical assistance recipient subject to a 
186.7   lien under sections 514.980 to 514.985 on the date the recipient 
186.8   dies. 
186.9      (8) The provisions of clauses (1) to (7) do not apply to a 
186.10  homestead owned of record, on the date the recipient dies, by 
186.11  the recipient and the recipient's spouse as joint tenants with a 
186.12  right of survivorship.  Homestead means the real property 
186.13  occupied by the surviving joint tenant spouse as their sole 
186.14  residence on the date the recipient dies and classified and 
186.15  taxed to the recipient and surviving joint tenant spouse as 
186.16  homestead property for property tax purposes in the calendar 
186.17  year in which the recipient dies.  For purposes of this 
186.18  exemption, real property the recipient and their surviving joint 
186.19  tenant spouse purchase solely with the proceeds from the sale of 
186.20  their prior homestead, own of record as joint tenants, and 
186.21  qualify as homestead property under section 273.124 in the 
186.22  calendar year in which the recipient dies and prior to the 
186.23  recipient's death shall be deemed to be real property classified 
186.24  and taxed to the recipient and their surviving joint tenant 
186.25  spouse as homestead property in the calendar year in which the 
186.26  recipient dies.  The surviving spouse, or any person with 
186.27  personal knowledge of the facts, may provide an affidavit 
186.28  describing the homestead property affected by this clause and 
186.29  stating facts showing compliance with this clause.  The 
186.30  affidavit shall be prima facie evidence of the facts it states.  
186.31     (d) The commissioner shall release liens arising under 
186.32  notices of potential claims under section 256B.15 and medical 
186.33  assistance liens under sections 514.980 to 514.985, against a 
186.34  deceased recipient's life estates and jointly owned interests in 
186.35  farm and income producing real property they own of record on 
186.36  the date they die if their interest in the property ends at 
187.1   their death, the surviving remainderman or surviving joint 
187.2   tenant owns their interest in the property of record on that 
187.3   date, and all of the following conditions apply with respect to 
187.4   the surviving remainderman or surviving joint tenant and their 
187.5   interest in the property: 
187.6      (1) the farm property is real property for which all of the 
187.7   following apply continuously for a period beginning at least 
187.8   three years before the calendar year in which the recipient 
187.9   first received long-term care medical assistance through the 
187.10  date of the recipient's death: 
187.11     (i) the remainderman or surviving joint tenant is a farmer, 
187.12  as defined in section 500.24, subdivision 2, paragraph (n), and 
187.13  is engaged in farming, as defined in section 500.24, subdivision 
187.14  2, paragraph (a); 
187.15     (ii) all of the land is a family farm as defined in section 
187.16  500.24, subdivision 2, paragraph (b); and 
187.17     (iii) all of the land is classified and taxed as class 2a 
187.18  agricultural land under section 273.13, subdivision 23, 
187.19  paragraph (a), for property tax purposes; and 
187.20     (2) the income-producing property is real property for 
187.21  which all of the following apply continuously for a period 
187.22  beginning at least three years before the calendar year in which 
187.23  the recipient first received long-term care medical assistance 
187.24  through the date of the recipient's death:  
187.25     (i) no part of the property is classified or taxed as 
187.26  homestead property for property tax purposes, provided that if 
187.27  the property is classified and taxed as both homestead and 
187.28  nonhomestead property, the portion of the property classified 
187.29  and taxed as nonhomestead property shall be considered to 
187.30  satisfy this requirement; 
187.31     (ii) all of the property is classified and taxed as class 
187.32  1c property under section 273.13, subdivision 22, paragraph (c), 
187.33  except that part of the class 1c property that is a dwelling 
187.34  occupied as a homestead; class 3a or 3b commercial or industrial 
187.35  property under section 273.13, subdivision 24; or as class 4a or 
187.36  4c property classified under section 273.13, subdivision 25, 
188.1   paragraphs (a) and (d), for property tax purposes; and 
188.2      (iii) the business, profession, or occupation in which the 
188.3   real property is used is the primary business, profession, or 
188.4   occupation of the remainderman or surviving joint tenant and the 
188.5   real property is used solely for that business, profession, or 
188.6   occupation.  A primary business, profession, or occupation is 
188.7   one the ongoing operation of which provides at least 65 percent 
188.8   of a person's gross income for federal income tax purposes for 
188.9   the calendar year. 
188.10     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2005, 
188.11  and applies to the estates of decedents who die on or after that 
188.12  date. 
188.13     Sec. 29.  Minnesota Statutes 2004, section 524.3-805, is 
188.14  amended to read: 
188.15     524.3-805 [CLASSIFICATION OF CLAIMS.] 
188.16     (a) If the applicable assets of the estate are insufficient 
188.17  to pay all claims in full, the personal representative shall 
188.18  make payment in the following order: 
188.19     (1) costs and expenses of administration; 
188.20     (2) reasonable funeral expenses; 
188.21     (3) debts and taxes with preference under federal law; 
188.22     (4) reasonable and necessary medical, hospital, or nursing 
188.23  home expenses of the last illness of the decedent, including 
188.24  compensation of persons attending the decedent, a claim filed 
188.25  under section 256B.15 for recovery of expenditures for 
188.26  alternative care for nonmedical assistance recipients under 
188.27  section 256B.0913, and including a claim filed pursuant to 
188.28  section 256B.15; 
188.29     (5) reasonable and necessary medical, hospital, and nursing 
188.30  home expenses for the care of the decedent during the year 
188.31  immediately preceding death; 
188.32     (6) debts with preference under other laws of this state, 
188.33  and state taxes; 
188.34     (7) all other claims. 
188.35     (b) No preference shall be given in the payment of any 
188.36  claim over any other claim of the same class, and a claim due 
189.1   and payable shall not be entitled to a preference over claims 
189.2   not due, except that if claims for expenses of the last illness 
189.3   involve only claims filed under section 256B.15 for recovery of 
189.4   expenditures for alternative care for nonmedical assistance 
189.5   recipients under section 256B.0913, section 246.53 for costs of 
189.6   state hospital care and claims filed under section 256B.15, 
189.7   claims filed to recover expenditures for alternative care for 
189.8   nonmedical assistance recipients under section 256B.0913 shall 
189.9   have preference over claims filed under both sections 246.53 and 
189.10  other claims filed under section 256B.15, and.  Claims filed 
189.11  under section 246.53 have preference over claims filed under 
189.12  section 256B.15 for recovery of amounts other than those for 
189.13  expenditures for alternative care for nonmedical assistance 
189.14  recipients under section 256B.0913. 
189.15     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2005, 
189.16  for decedents dying on or after that date. 
189.17     Sec. 30.  [COMMUNITY SERVICES PROVIDER RATE INCREASES.] 
189.18     (a) The commissioner of human services shall increase 
189.19  reimbursement rates by two percent for the rate period beginning 
189.20  October 1, 2005, and the rate year beginning July 1, 2006, 
189.21  effective for services rendered on or after those dates. 
189.22     (b) The two percent annual rate increase described in this 
189.23  section must be provided to: 
189.24     (1) home and community-based waivered services for persons 
189.25  with mental retardation or related conditions under Minnesota 
189.26  Statutes, section 256B.501; 
189.27     (2) home and community-based waivered services for the 
189.28  elderly under Minnesota Statutes, section 256B.0915; 
189.29     (3) waivered services under community alternatives for 
189.30  disabled individuals under Minnesota Statutes, section 256B.49; 
189.31     (4) community alternative care waivered services under 
189.32  Minnesota Statutes, section 256B.49; 
189.33     (5) traumatic brain injury waivered services under 
189.34  Minnesota Statutes, section 256B.49; 
189.35     (6) nursing services and home health services under 
189.36  Minnesota Statutes, section 256B.0625, subdivision 6a; 
190.1      (7) personal care services and nursing supervision of 
190.2   personal care services under Minnesota Statutes, section 
190.3   256B.0625, subdivision 19a; 
190.4      (8) private duty nursing services under Minnesota Statutes, 
190.5   section 256B.0625, subdivision 7; 
190.6      (9) day training and habilitation services for adults with 
190.7   mental retardation or related conditions under Minnesota 
190.8   Statutes, sections 252.40 to 252.46; 
190.9      (10) alternative care services under Minnesota Statutes, 
190.10  section 256B.0913; 
190.11     (11) adult residential program grants under Minnesota 
190.12  Rules, parts 9535.2000 to 9535.3000; 
190.13     (12) adult and family community support grants under 
190.14  Minnesota Rules, parts 9535.1700 to 9535.1760; 
190.15     (13) the group residential housing supplementary service 
190.16  rate under Minnesota Statutes, section 256I.05, subdivision 1a; 
190.17     (14) adult mental health integrated fund grants under 
190.18  Minnesota Statutes, section 245.4661; 
190.19     (15) semi-independent living services under Minnesota 
190.20  Statutes, section 252.275, including SILS funding under county 
190.21  social services grants formerly funded under Minnesota Statutes, 
190.22  chapter 256I; 
190.23     (16) community support services for deaf and 
190.24  hard-of-hearing adults with mental illness who use or wish to 
190.25  use sign language as their primary means of communication; and 
190.26     (17) living skills training programs for persons with 
190.27  intractable epilepsy who need assistance in the transition to 
190.28  independent living. 
190.29     (c) Providers that receive a rate increase under this 
190.30  section shall use the additional revenue to increase wages and 
190.31  benefits and pay associated costs for employees, except for 
190.32  management fees, the administrator, and central office staffs. 
190.33     (d) For public employees, the increase for wages and 
190.34  benefits for certain staff is available and pay rates shall be 
190.35  increased only to the extent that they comply with laws 
190.36  governing public employees collective bargaining.  Money 
191.1   received by a provider for pay increases under this section may 
191.2   be used only for increases implemented on or after the first day 
191.3   of the rate period in which the increase is available and must 
191.4   not be used for increases implemented prior to that date. 
191.5      (e) A copy of the provider's plan for complying with 
191.6   paragraph (c) must be made available to all employees by giving 
191.7   each employee a copy or by posting a copy in an area of the 
191.8   provider's operation to which all employees have access.  If an 
191.9   employee does not receive the adjustment, if any, described in 
191.10  the plan and is unable to resolve the problem with the provider, 
191.11  the employee may contact the employee's union representative.  
191.12  If the employee is not covered by a collective bargaining 
191.13  agreement, the employee may contact the commissioner at a 
191.14  telephone number provided by the commissioner and included in 
191.15  the provider's plan. 
191.16     Sec. 31.  [CONSUMER-DIRECTED COMMUNITY SUPPORTS 
191.17  METHODOLOGY.] 
191.18     For persons using the home and community-based waiver for 
191.19  persons with developmental disabilities whose Consumer-Directed 
191.20  Community Supports budgets were reduced by the October 2004, 
191.21  state-set budget methodology, the commissioner of human services 
191.22  must allow exceptions to exceed the state-set budget formula up 
191.23  to the daily average cost during calendar year 2004 or for 
191.24  persons who graduated from school during 2004, the average daily 
191.25  cost during July through December 2004, less one-half of case 
191.26  management and home modifications over $5,000 when the 
191.27  individual's county of financial responsibility determines that: 
191.28     (1) necessary alternative services will cost the same or 
191.29  more than the person's current budget; and 
191.30     (2) administrative expenses or provider rates will result 
191.31  in fewer hours of needed staffing for the person than under the 
191.32  Consumer-Directed Community Supports option.  Any exceptions the 
191.33  county grants must be within the county's allowable aggregate 
191.34  amount for the home and community-based waiver for persons with 
191.35  developmental disabilities. 
191.36     <b>[EFFECTIVE DATE.]</b> This section is effective upon federal 
192.1   approval of the waiver amendment in section 33. 
192.2      Sec. 32.  [COSTS ASSOCIATED WITH PHYSICAL ACTIVITIES.] 
192.3      The expenses allowed for adults under the Consumer-Directed 
192.4   Community Supports option shall include costs at the lowest rate 
192.5   available, considering daily, monthly, semiannual, annual, or 
192.6   membership rates, including transportation, associated with 
192.7   physical exercise or other physical activities to maintain or 
192.8   improve the person's health and functioning. 
192.9      <b>[EFFECTIVE DATE.]</b> This section is effective upon federal 
192.10  approval of the waiver amendment in section 33. 
192.11     Sec. 33.  [WAIVER AMENDMENT.] 
192.12     The commissioner of human services shall submit an 
192.13  amendment to the Centers for Medicare and Medicaid Services 
192.14  consistent with sections 31 and 32 by August 1, 2005. 
192.15     Sec. 34.  [INDEPENDENT EVALUATION AND REVIEW OF UNALLOWABLE 
192.16  ITEMS.] 
192.17     The commissioner of human services shall include in the 
192.18  independent evaluation of the Consumer-Directed Community 
192.19  Supports option provided through the home and community-based 
192.20  services waivers for persons with disabilities under 65 years of 
192.21  age: 
192.22     (1) provision for ongoing, regular participation by 
192.23  stakeholder representatives through June 30, 2007; 
192.24     (2) recommendations on whether changes to the unallowable 
192.25  items should be made to meet the health, safety, or welfare 
192.26  needs of participants in the Consumer-Directed Community 
192.27  Supports option within the allowed budget amounts.  The 
192.28  recommendations on allowable items shall be provided to the 
192.29  senate and house of representatives committees with jurisdiction 
192.30  over human services policy and finance issues by January 15, 
192.31  2006; and 
192.32     (3) a review of the statewide caseload changes for the 
192.33  disability waiver programs for persons under 65 years of age 
192.34  that occurred since the state-set budget methodology 
192.35  implementation on October 1, 2004, and recommendations on the 
192.36  fiscal impact of the budget methodology on use of the 
193.1   Consumer-Directed Community Supports option. 
193.2      <b>[EFFECTIVE DATE.]</b> This section is effective the day 
193.3   following final enactment. 
193.4      Sec. 35.  [IMMUNITY; REFUNDS BARRED.] 
193.5      (a) The commissioner of human services, county agencies, 
193.6   and elected officials and their employees are immune from all 
193.7   liability for any action taken implementing those portions of 
193.8   Laws 2003, First Special Session chapter 14, that extend medical 
193.9   assistance lien and estate claims recovery policies to include 
193.10  the alternative care program, as those laws existed at the time 
193.11  the action was taken. 
193.12     (b) The legislature expressly intends that none of the 
193.13  recoveries of alternative care payments the state or a local 
193.14  agency made under Minnesota Statutes, sections 256B.15 and 
193.15  514.991 to 514.995, as they existed prior to the effective date 
193.16  of this amendment, shall be refunded or repaid. 
193.17     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2005. 
193.18     Sec. 36.  [SKILLED NURSING FACILITIES IN FARIBAULT COUNTY.] 
193.19     All skilled nursing facilities in Faribault County shall 
193.20  have the inspection required under Minnesota Statutes, section 
193.21  144A.10, conducted by the Department of Health's Mankato survey 
193.22  team. 
193.23     Sec. 37.  [EXPIRATION DATE.] 
193.24     Section 31 shall expire on the date the commissioner of 
193.25  human services implements a new consumer-directed community 
193.26  supports budget methodology that is based on reliable and 
193.27  accurate information about the services and supports intensity 
193.28  needs of persons using the option and that adequately accounts 
193.29  for the increased costs of adults who graduate from school and 
193.30  need services funded by the waiver during the day. 
193.31     Sec. 38.  [REPEALER.] 
193.32     Minnesota Statutes 2004, sections 514.991; 514.992; 
193.33  514.993; 514.994; and 514.995, are repealed effective July 1, 
193.34  2005.  On and after the repeal date all alternative care liens 
193.35  of record shall be of no force and effect, shall not be liens on 
193.36  real property, and examiners of title shall disregard these 
194.1   liens and shall not carry them forward to subsequent 
194.2   certificates of title. 
194.3                              ARTICLE 5 
194.4                      MENTAL AND CHEMICAL HEALTH 
194.5      Section 1.  Minnesota Statutes 2004, section 62J.692, 
194.6   subdivision 3, is amended to read: 
194.7      Subd. 3.  [APPLICATION PROCESS.] (a) A clinical medical 
194.8   education program conducted in Minnesota by a teaching 
194.9   institution to train physicians, doctor of pharmacy 
194.10  practitioners, dentists, chiropractors, or physician assistants 
194.11  is eligible for funds under subdivision 4 if the program: 
194.12     (1) is funded, in part, by patient care revenues; 
194.13     (2) occurs in patient care settings that face increased 
194.14  financial pressure as a result of competition with nonteaching 
194.15  patient care entities; and 
194.16     (3) emphasizes primary care or specialties that are in 
194.17  undersupply in Minnesota. 
194.18     A clinical medical education program that trains 
194.19  pediatricians is requested to include in its program curriculum 
194.20  training in case management and medication management for 
194.21  children suffering from mental illness to be eligible for funds 
194.22  under subdivision 4. 
194.23     (b) A clinical medical education program for advanced 
194.24  practice nursing is eligible for funds under subdivision 4 if 
194.25  the program meets the eligibility requirements in paragraph (a), 
194.26  clauses (1) to (3), and is sponsored by the University of 
194.27  Minnesota Academic Health Center, the Mayo Foundation, or 
194.28  institutions that are part of the Minnesota State Colleges and 
194.29  Universities system or members of the Minnesota Private College 
194.30  Council.  
194.31     (c) Applications must be submitted to the commissioner by a 
194.32  sponsoring institution on behalf of an eligible clinical medical 
194.33  education program and must be received by October 31 of each 
194.34  year for distribution in the following year.  An application for 
194.35  funds must contain the following information: 
194.36     (1) the official name and address of the sponsoring 
195.1   institution and the official name and site address of the 
195.2   clinical medical education programs on whose behalf the 
195.3   sponsoring institution is applying; 
195.4      (2) the name, title, and business address of those persons 
195.5   responsible for administering the funds; 
195.6      (3) for each clinical medical education program for which 
195.7   funds are being sought; the type and specialty orientation of 
195.8   trainees in the program; the name, site address, and medical 
195.9   assistance provider number of each training site used in the 
195.10  program; the total number of trainees at each training site; and 
195.11  the total number of eligible trainee FTEs at each site.  Only 
195.12  those training sites that host 0.5 FTE or more eligible trainees 
195.13  for a program may be included in the program's application; and 
195.14     (4) other supporting information the commissioner deems 
195.15  necessary to determine program eligibility based on the criteria 
195.16  in paragraphs (a) and (b) and to ensure the equitable 
195.17  distribution of funds.  
195.18     (d) An application must include the information specified 
195.19  in clauses (1) to (3) for each clinical medical education 
195.20  program on an annual basis for three consecutive years.  After 
195.21  that time, an application must include the information specified 
195.22  in clauses (1) to (3) in the first year of each biennium:  
195.23     (1) audited clinical training costs per trainee for each 
195.24  clinical medical education program when available or estimates 
195.25  of clinical training costs based on audited financial data; 
195.26     (2) a description of current sources of funding for 
195.27  clinical medical education costs, including a description and 
195.28  dollar amount of all state and federal financial support, 
195.29  including Medicare direct and indirect payments; and 
195.30     (3) other revenue received for the purposes of clinical 
195.31  training.  
195.32     (e) An applicant that does not provide information 
195.33  requested by the commissioner shall not be eligible for funds 
195.34  for the current funding cycle. 
195.35     Sec. 2.  Minnesota Statutes 2004, section 244.054, is 
195.36  amended to read: 
196.1      244.054 [DISCHARGE PLANS; OFFENDERS WITH SERIOUS AND 
196.2   PERSISTENT MENTAL ILLNESS.] 
196.3      Subdivision 1.  [OFFER TO DEVELOP PLAN.] The commissioner 
196.4   of human services, in collaboration with the commissioner of 
196.5   corrections, shall offer to develop a discharge plan for 
196.6   community-based services for every offender with serious and 
196.7   persistent mental illness, as defined in section 245.462, 
196.8   subdivision 20, paragraph (c), and every offender who has had a 
196.9   diagnosis of mental illness and would otherwise be eligible for 
196.10  case management services under section 245.462, subdivision 20, 
196.11  paragraph (c), but for the requirement that the offender be 
196.12  hospitalized or in residential treatment, who is being released 
196.13  from a correctional facility.  If an offender is being released 
196.14  pursuant to section 244.05, the offender may choose to have the 
196.15  discharge plan made one of the conditions of the offender's 
196.16  supervised release and shall follow the conditions to the extent 
196.17  that services are available and offered to the offender. 
196.18     Subd. 2.  [CONTENT OF PLAN.] If an offender chooses to have 
196.19  a discharge plan developed, the commissioner of human services 
196.20  shall develop and implement a discharge plan, which must include 
196.21  at least the following: 
196.22     (1) at least 90 days before the offender is due to be 
196.23  discharged, the commissioner of human services shall designate 
196.24  an agent of the Department of Human Services a discharge planner 
196.25  with mental health training to serve as the primary person 
196.26  responsible for carrying out discharge planning activities; 
196.27     (2) at least 75 days before the offender is due to be 
196.28  discharged, the offender's designated agent discharge planner 
196.29  shall: 
196.30     (i) obtain informed consent and releases of information 
196.31  from the offender that are needed for transition services, and 
196.32  forward them to the appropriate local entity; 
196.33     (ii) contact the county human services department in the 
196.34  community where the offender expects to reside following 
196.35  discharge, and inform the department of the offender's impending 
196.36  discharge and the planned date of the offender's return to the 
197.1   community; determine whether the county or a designated 
197.2   contracted provider will provide case management services to the 
197.3   offender; refer the offender to the case management services 
197.4   provider; and confirm that the case management services provider 
197.5   will have opened the offender's case prior to the offender's 
197.6   discharge; and 
197.7      (iii) refer the offender to appropriate staff in the county 
197.8   human services department in the community where the offender 
197.9   expects to reside following discharge, for enrollment of the 
197.10  offender if eligible in medical assistance or general assistance 
197.11  medical care, using special procedures established by process 
197.12  and Department of Human Services bulletin assist the offender in 
197.13  filling out an application for medical assistance, general 
197.14  assistance medical care, or MinnesotaCare and submit the 
197.15  application for eligibility determination to the commissioner.  
197.16  The commissioner shall determine an offender's eligibility no 
197.17  more than 45 days, or no more than 60 days if the offender's 
197.18  disability status must be determined, from the date that the 
197.19  application is received by the department.  The effective date 
197.20  of eligibility for the health care program shall be no earlier 
197.21  than the date of the offender's release.  If eligibility is 
197.22  approved, the commissioner shall mail a Minnesota health care 
197.23  program membership card to the facility in which the offender 
197.24  resides and transfer the offender's case to MinnesotaCare 
197.25  operations within the department or the appropriate county human 
197.26  services agency in the county where the offender expects to 
197.27  reside following release for ongoing case management; 
197.28     (3) at least 2-1/2 months before discharge, the offender's 
197.29  designated agent discharge planner shall secure timely 
197.30  appointments for the offender with a psychiatrist no later than 
197.31  30 days following discharge, and with other program staff at a 
197.32  community mental health provider that is able to serve former 
197.33  offenders with serious and persistent mental illness; 
197.34     (4) at least 30 days before discharge, the offender's 
197.35  designated agent discharge planner shall convene a predischarge 
197.36  assessment and planning meeting of key staff from the programs 
198.1   in which the offender has participated while in the correctional 
198.2   facility, the offender, the supervising agent, and the mental 
198.3   health case management services provider assigned to the 
198.4   offender.  At the meeting, attendees shall provide background 
198.5   information and continuing care recommendations for the 
198.6   offender, including information on the offender's risk for 
198.7   relapse; current medications, including dosage and frequency; 
198.8   therapy and behavioral goals; diagnostic and assessment 
198.9   information, including results of a chemical dependency 
198.10  evaluation; confirmation of appointments with a psychiatrist and 
198.11  other program staff in the community; a relapse prevention plan; 
198.12  continuing care needs; needs for housing, employment, and 
198.13  finance support and assistance; and recommendations for 
198.14  successful community integration, including chemical dependency 
198.15  treatment or support if chemical dependency is a risk factor.  
198.16  Immediately following this meeting, the offender's designated 
198.17  agent discharge planner shall summarize this background 
198.18  information and continuing care recommendations in a written 
198.19  report; 
198.20     (5) immediately following the predischarge assessment and 
198.21  planning meeting, the provider of mental health case management 
198.22  services who will serve the offender following discharge shall 
198.23  offer to make arrangements and referrals for housing, financial 
198.24  support, benefits assistance, employment counseling, and other 
198.25  services required in sections 245.461 to 245.486; 
198.26     (6) at least ten days before the offender's first scheduled 
198.27  postdischarge appointment with a mental health provider, the 
198.28  offender's designated agent discharge planner shall transfer the 
198.29  following records to the offender's case management services 
198.30  provider and psychiatrist:  the predischarge assessment and 
198.31  planning report, medical records, and pharmacy records.  These 
198.32  records may be transferred only if the offender provides 
198.33  informed consent for their release; 
198.34     (7) upon discharge, the offender's designated agent 
198.35  discharge planner shall ensure that the offender leaves the 
198.36  correctional facility with at least a ten-day supply of all 
199.1   necessary medications; and 
199.2      (8) upon discharge, the prescribing authority at the 
199.3   offender's correctional facility shall telephone in 
199.4   prescriptions for all necessary medications to a pharmacy in the 
199.5   community where the offender plans to reside.  The prescriptions 
199.6   must provide at least a 30-day 60-day supply of all necessary 
199.7   medications, and must be able to be refilled once for one 
199.8   additional 30-day supply. 
199.9      <b>[EFFECTIVE DATE.]</b> Subdivision 2, clause (2), item (iii), is 
199.10  effective August 1, 2006, or upon HealthMatch implementation, 
199.11  whichever is later. 
199.12     Sec. 3.  Minnesota Statutes 2004, section 245.4661, is 
199.13  amended by adding a subdivision to read: 
199.14     Subd. 8.  [SUPPORTIVE HOUSING AND OTHER COMMUNITY SERVICES 
199.15  FOR INDIVIDUALS TRANSITIONING FROM ANOKA-METRO REGIONAL 
199.16  TREATMENT CENTER.] The commissioner, through agreements with 
199.17  counties and in consultation with providers of supportive 
199.18  housing with services and others, shall transition individuals 
199.19  who are currently at Anoka-Metro Regional Treatment Center into 
199.20  the community, who are ready to be discharged or who are at 
199.21  imminent risk of admission.  The commissioner shall expand the 
199.22  adult mental health initiative pilot projects under section 
199.23  245.4661 to provide appropriate, thorough, flexible, and 
199.24  sufficient services that may include supportive housing with 
199.25  services, assertive community treatment, case management, and 
199.26  other community supports for individuals with a mental illness 
199.27  who: 
199.28     (1) are at imminent risk of being admitted to, or are ready 
199.29  to be discharged or have recently been discharged from, a 
199.30  regional treatment center, community hospital, or residential 
199.31  treatment program; and 
199.32     (2) have no appropriate housing available or lack the 
199.33  resources necessary to access permanent housing. 
199.34     Sec. 4.  Minnesota Statutes 2004, section 245.4661, is 
199.35  amended by adding a subdivision to read: 
199.36     Subd. 9.  [BED CLOSING.] The commissioner shall close 25 
200.1   beds at the Anoka-Metro Regional Treatment Center by July 1, 
200.2   2007, and an additional 25 beds by July 1, 2008, or after 
200.3   sufficient alternative services have been developed.  The 
200.4   commissioner shall transfer state savings resulting from these 
200.5   bed closures into appropriate accounts according to subdivision 
200.6   10 to pay for the ongoing provision of the alternative services 
200.7   in subdivision 8 and for expansion of contract beds under 
200.8   section 256.9693.  No individual will be involuntarily 
200.9   discharged under this subdivision if appropriate community 
200.10  services are not available to support the individual. 
200.11     Sec. 5.  Minnesota Statutes 2004, section 245.4661, is 
200.12  amended by adding a subdivision to read: 
200.13     Subd. 10.  [BUDGET FLEXIBILITY.] The commissioner may make 
200.14  budget transfers that do not increase the state share of costs 
200.15  to effectively implement the restructuring of adult mental 
200.16  health services. 
200.17     Sec. 6.  Minnesota Statutes 2004, section 245.4661, is 
200.18  amended by adding a subdivision to read: 
200.19     Subd. 11.  [COUNTY ELIGIBILITY.] The commissioner may 
200.20  approve funding for services under subdivision 8 according to 
200.21  subdivisions 9 and 10 for a county or group of counties that: 
200.22     (1) agrees to outcome-based performance criteria that 
200.23  includes a reduction in utilization of regional treatment center 
200.24  inpatient services through provision of quality services that 
200.25  meet individual needs; 
200.26     (2) agrees to the collection and submission of data 
200.27  necessary to measure progress towards the criteria in clause (1) 
200.28  and measurement of any resulting state or county savings; 
200.29     (3) agrees to reinvest in the services defined in 
200.30  subdivision 8 an amount equal to the ten percent county share of 
200.31  regional treatment center services for the fiscal year ending 
200.32  June 30, 2004, applied against the bed utilization reduction in 
200.33  clause (1); and 
200.34     (4) agrees to develop a supportive housing program that 
200.35  insures the delivery of employment services, supportive 
200.36  services, housing and health care for eligible individuals, or 
201.1   agrees to contract with an existing integrated program. 
201.2      Sec. 7.  Minnesota Statutes 2004, section 245.4874, is 
201.3   amended to read: 
201.4      245.4874 [DUTIES OF COUNTY BOARD.] 
201.5      (a) The county board in each county shall use its share of 
201.6   mental health and Community Social Services Act funds allocated 
201.7   by the commissioner according to a biennial children's mental 
201.8   health component of the community social services plan that is 
201.9   approved by the commissioner.  The county board must: 
201.10     (1) develop a system of affordable and locally available 
201.11  children's mental health services according to sections 245.487 
201.12  to 245.4887; 
201.13     (2) establish a mechanism providing for interagency 
201.14  coordination as specified in section 245.4875, subdivision 6; 
201.15     (3) develop a biennial children's mental health component 
201.16  of the community social services plan which considers the 
201.17  assessment of unmet needs in the county as reported by the local 
201.18  children's mental health advisory council under section 
201.19  245.4875, subdivision 5, paragraph (b), clause (3).  The county 
201.20  shall provide, upon request of the local children's mental 
201.21  health advisory council, readily available data to assist in the 
201.22  determination of unmet needs; 
201.23     (4) assure that parents and providers in the county receive 
201.24  information about how to gain access to services provided 
201.25  according to sections 245.487 to 245.4887; 
201.26     (5) coordinate the delivery of children's mental health 
201.27  services with services provided by social services, education, 
201.28  corrections, health, and vocational agencies to improve the 
201.29  availability of mental health services to children and the 
201.30  cost-effectiveness of their delivery; 
201.31     (6) assure that mental health services delivered according 
201.32  to sections 245.487 to 245.4887 are delivered expeditiously and 
201.33  are appropriate to the child's diagnostic assessment and 
201.34  individual treatment plan; 
201.35     (7) provide the community with information about predictors 
201.36  and symptoms of emotional disturbances and how to access 
202.1   children's mental health services according to sections 245.4877 
202.2   and 245.4878; 
202.3      (8) provide for case management services to each child with 
202.4   severe emotional disturbance according to sections 245.486; 
202.5   245.4871, subdivisions 3 and 4; and 245.4881, subdivisions 1, 3, 
202.6   and 5; 
202.7      (9) provide for screening of each child under section 
202.8   245.4885 upon admission to a residential treatment facility, 
202.9   acute care hospital inpatient treatment, or informal admission 
202.10  to a regional treatment center; 
202.11     (10) prudently administer grants and purchase-of-service 
202.12  contracts that the county board determines are necessary to 
202.13  fulfill its responsibilities under sections 245.487 to 245.4887; 
202.14     (11) assure that mental health professionals, mental health 
202.15  practitioners, and case managers employed by or under contract 
202.16  to the county to provide mental health services are qualified 
202.17  under section 245.4871; 
202.18     (12) assure that children's mental health services are 
202.19  coordinated with adult mental health services specified in 
202.20  sections 245.461 to 245.486 so that a continuum of mental health 
202.21  services is available to serve persons with mental illness, 
202.22  regardless of the person's age; 
202.23     (13) assure that culturally informed mental health 
202.24  consultants are used as necessary to assist the county board in 
202.25  assessing and providing appropriate treatment for children of 
202.26  cultural or racial minority heritage; and 
202.27     (14) consistent with section 245.486, arrange for or 
202.28  provide a children's mental health screening to a child 
202.29  receiving child protective services or a child in out-of-home 
202.30  placement, a child for whom parental rights have been 
202.31  terminated, a child found to be delinquent, and a child found to 
202.32  have committed a juvenile petty offense for the third or 
202.33  subsequent time, unless a screening has been performed within 
202.34  the previous 180 days, or the child is currently under the care 
202.35  of a mental health professional.  The court or county agency 
202.36  must notify a parent or guardian whose parental rights have not 
203.1   been terminated of the potential mental health screening and the 
203.2   option to prevent the screening by notifying the court or county 
203.3   agency in writing.  The screening shall be conducted with a 
203.4   screening instrument approved by the commissioner of human 
203.5   services according to criteria that are updated and issued 
203.6   annually to ensure that approved screening instruments are valid 
203.7   and useful for child welfare and juvenile justice populations, 
203.8   and shall be conducted by a mental health practitioner as 
203.9   defined in section 245.4871, subdivision 26, or a probation 
203.10  officer or local social services agency staff person who is 
203.11  trained in the use of the screening instrument.  Training in the 
203.12  use of the instrument shall include training in the 
203.13  administration of the instrument, the interpretation of its 
203.14  validity given the child's current circumstances, the state and 
203.15  federal data practices laws and confidentiality standards, the 
203.16  parental consent requirement, and providing respect for families 
203.17  and cultural values.  If the screen indicates a need for 
203.18  assessment, the child's family, or if the family lacks mental 
203.19  health insurance, the local social services agency, in 
203.20  consultation with the child's family, shall have conducted a 
203.21  diagnostic assessment, including a functional assessment, as 
203.22  defined in section 245.4871.  The administration of the 
203.23  screening shall safeguard the privacy of children receiving the 
203.24  screening and their families and shall comply with the Minnesota 
203.25  Government Data Practices Act, chapter 13, and the federal 
203.26  Health Insurance Portability and Accountability Act of 1996, 
203.27  Public Law 104-191.  Screening results shall be considered 
203.28  private data and the commissioner shall not collect individual 
203.29  screening results. 
203.30     (b) When the county board refers clients to providers of 
203.31  children's therapeutic services and supports under section 
203.32  256B.0943, the county board must clearly identify the 
203.33  nonchildren's therapeutic services and supports covered services 
203.34  components and identify the reimbursement source for those 
203.35  requested services, the method of payment, and the payment rate 
203.36  to the provider. 
204.1      Sec. 8.  Minnesota Statutes 2004, section 245.4885, 
204.2   subdivision 1, is amended to read: 
204.3      Subdivision 1.  [SCREENING REQUIRED ADMISSION CRITERIA.] 
204.4   The county board shall, prior to admission, except in the case 
204.5   of emergency admission, screen determine the needed level of 
204.6   care for all children referred for treatment of severe emotional 
204.7   disturbance to in a treatment foster care setting, residential 
204.8   treatment facility, or informally admitted to a regional 
204.9   treatment center if public funds are used to pay for the 
204.10  services.  The county board shall also screen determine the 
204.11  needed level of care for all children admitted to an acute care 
204.12  hospital for treatment of severe emotional disturbance if public 
204.13  funds other than reimbursement under chapters 256B and 256D are 
204.14  used to pay for the services.  If a child is admitted to a 
204.15  residential treatment facility or acute care hospital for 
204.16  emergency treatment or held for emergency care by a regional 
204.17  treatment center under section 253B.05, subdivision 1, screening 
204.18  must occur within three working days of admission.  
204.19  Screening The level of care determination shall determine 
204.20  whether the proposed treatment:  
204.21     (1) is necessary; 
204.22     (2) is appropriate to the child's individual treatment 
204.23  needs; 
204.24     (3) cannot be effectively provided in the child's home; and 
204.25     (4) provides a length of stay as short as possible 
204.26  consistent with the individual child's need. 
204.27     When a screening level of care determination is conducted, 
204.28  the county board may not determine that referral or admission to 
204.29  a treatment foster care setting, residential treatment facility, 
204.30  or acute care hospital is not appropriate solely because 
204.31  services were not first provided to the child in a less 
204.32  restrictive setting and the child failed to make progress toward 
204.33  or meet treatment goals in the less restrictive 
204.34  setting.  Screening shall include both The level of care 
204.35  determination must be based on a diagnostic assessment and that 
204.36  includes a functional assessment which evaluates family, school, 
205.1   and community living situations; and an assessment of the 
205.2   child's need for care out of the home using a validated tool 
205.3   which assesses a child's functional status and assigns an 
205.4   appropriate level of care.  The validated tool must be approved 
205.5   by the commissioner of human services.  If a diagnostic 
205.6   assessment or including a functional assessment has been 
205.7   completed by a mental health professional within the past 180 
205.8   days, a new diagnostic or functional assessment need not be 
205.9   completed unless in the opinion of the current treating mental 
205.10  health professional the child's mental health status has changed 
205.11  markedly since the assessment was completed.  The child's parent 
205.12  shall be notified if an assessment will not be completed and of 
205.13  the reasons.  A copy of the notice shall be placed in the 
205.14  child's file.  Recommendations developed as part of 
205.15  the screening level of care determination process shall include 
205.16  specific community services needed by the child and, if 
205.17  appropriate, the child's family, and shall indicate whether or 
205.18  not these services are available and accessible to the child and 
205.19  family.  
205.20     During the screening level of care determination process, 
205.21  the child, child's family, or child's legal representative, as 
205.22  appropriate, must be informed of the child's eligibility for 
205.23  case management services and family community support services 
205.24  and that an individual family community support plan is being 
205.25  developed by the case manager, if assigned.  
205.26     Screening The level of care determination shall be in 
205.27  compliance comply with section 260C.212.  Wherever possible, the 
205.28  parent shall be consulted in the screening process, unless 
205.29  clinically inappropriate.  
205.30     The screening process level of care determination, and 
205.31  placement decision, and recommendations for mental health 
205.32  services must be documented in the child's record.  
205.33     An alternate review process may be approved by the 
205.34  commissioner if the county board demonstrates that an alternate 
205.35  review process has been established by the county board and the 
205.36  times of review, persons responsible for the review, and review 
206.1   criteria are comparable to the standards in clauses (1) to (4). 
206.2      <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2006. 
206.3      Sec. 9.  Minnesota Statutes 2004, section 245.4885, is 
206.4   amended by adding a subdivision to read: 
206.5      Subd. 1a.  [EMERGENCY ADMISSION.] Effective July 1, 2006, 
206.6   if a child is admitted to a treatment foster care setting, 
206.7   residential treatment facility, or acute care hospital for 
206.8   emergency treatment or held for emergency care by a regional 
206.9   treatment center under section 253B.05, subdivision 1, the level 
206.10  of care determination must occur within three working days of 
206.11  admission. 
206.12     Sec. 10.  Minnesota Statutes 2004, section 245.4885, 
206.13  subdivision 2, is amended to read: 
206.14     Subd. 2.  [QUALIFICATIONS.] No later than July 1, 1991, 
206.15  Screening Level of care determination of children for treatment 
206.16  foster care, residential, and inpatient services must be 
206.17  conducted by a mental health professional.  Where appropriate 
206.18  and available, culturally informed mental health consultants 
206.19  must participate in the screening level of care determination.  
206.20  Mental health professionals providing screening level of care 
206.21  determination for treatment foster care, inpatient, and 
206.22  residential services must not be financially affiliated with any 
206.23  acute care inpatient hospital, residential treatment facility, 
206.24  or regional treatment center nongovernment entity which may be 
206.25  providing those services.  The commissioner may waive this 
206.26  requirement for mental health professional participation after 
206.27  July 1, 1991, if the county documents that: 
206.28     (1) mental health professionals or mental health 
206.29  practitioners are unavailable to provide this service; and 
206.30     (2) services are provided by a designated person with 
206.31  training in human services who receives clinical supervision 
206.32  from a mental health professional. 
206.33     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2006. 
206.34     Sec. 11.  Minnesota Statutes 2004, section 254B.03, 
206.35  subdivision 4, is amended to read: 
206.36     Subd. 4.  [DIVISION OF COSTS.] Except for services provided 
207.1   by a county under section 254B.09, subdivision 1, or services 
207.2   provided under section 256B.69 or 256D.03, subdivision 4, 
207.3   paragraph (b), or when the primary drug problem is amphetamine 
207.4   or methamphetamine abuse or dependence, the county shall, out of 
207.5   local money, pay the state for 15 percent of the cost of 
207.6   chemical dependency services, including those services provided 
207.7   to persons eligible for medical assistance under chapter 256B 
207.8   and general assistance medical care under chapter 256D.  
207.9   Counties may use the indigent hospitalization levy for treatment 
207.10  and hospital payments made under this section.  Fifteen percent 
207.11  of any state collections from private or third-party pay, less 
207.12  15 percent of the cost of payment and collections, must be 
207.13  distributed to the county that paid for a portion of the 
207.14  treatment under this section.  If all funds allocated according 
207.15  to section 254B.02 are exhausted by a county and, except for 
207.16  treatment provided for amphetamine or methamphetamine abuse or 
207.17  dependence, the county has met or exceeded the base level of 
207.18  expenditures under section 254B.02, subdivision 3, the county 
207.19  shall pay the state for 15 percent of the costs paid by the 
207.20  state under this section, unless the payment is for treatment of 
207.21  amphetamine or methamphetamine abuse of dependence.  The 
207.22  commissioner may refuse to pay state funds for services to 
207.23  persons not eligible under section 254B.04, subdivision 1, if 
207.24  the county financially responsible for the persons has exhausted 
207.25  its allocation. 
207.26     <b>[EFFECTIVE DATE.]</b> This section is effective January 1, 2006.
207.27     Sec. 12.  Minnesota Statutes 2004, section 256B.0622, 
207.28  subdivision 2, is amended to read: 
207.29     Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
207.30  following terms have the meanings given them.  
207.31     (a) "Intensive nonresidential rehabilitative mental health 
207.32  services" means adult rehabilitative mental health services as 
207.33  defined in section 256B.0623, subdivision 2, paragraph (a), 
207.34  except that these services are provided by a multidisciplinary 
207.35  staff using a total team approach consistent with assertive 
207.36  community treatment, the Fairweather Lodge treatment model, as 
208.1   defined by the standards established by the National Coalition 
208.2   for Community Living, and other evidence-based practices, and 
208.3   directed to recipients with a serious mental illness who require 
208.4   intensive services. 
208.5      (b) "Intensive residential rehabilitative mental health 
208.6   services" means short-term, time-limited services provided in a 
208.7   residential setting to recipients who are in need of more 
208.8   restrictive settings and are at risk of significant functional 
208.9   deterioration if they do not receive these services.  Services 
208.10  are designed to develop and enhance psychiatric stability, 
208.11  personal and emotional adjustment, self-sufficiency, and skills 
208.12  to live in a more independent setting.  Services must be 
208.13  directed toward a targeted discharge date with specified client 
208.14  outcomes and must be consistent with the Fairweather Lodge 
208.15  treatment model as defined in paragraph (a), and other 
208.16  evidence-based practices. 
208.17     (c) "Evidence-based practices" are nationally recognized 
208.18  mental health services that are proven by substantial research 
208.19  to be effective in helping individuals with serious mental 
208.20  illness obtain specific treatment goals. 
208.21     (d) "Overnight staff" means a member of the intensive 
208.22  residential rehabilitative mental health treatment team who is 
208.23  responsible during hours when recipients are typically asleep. 
208.24     (e) "Treatment team" means all staff who provide services 
208.25  under this section to recipients.  At a minimum, this includes 
208.26  the clinical supervisor, mental health professionals, mental 
208.27  health practitioners, and mental health rehabilitation workers. 
208.28     Sec. 13.  Minnesota Statutes 2004, section 256B.0625, is 
208.29  amended by adding a subdivision to read: 
208.30     Subd. 46.  [MENTAL HEALTH TELEMEDICINE.] Effective January 
208.31  1, 2006, and subject to federal approval, mental health services 
208.32  that are otherwise covered by medical assistance as direct 
208.33  face-to-face services may be provided via two-way interactive 
208.34  video.  Use of two-way interactive video must be medically 
208.35  appropriate to the condition and needs of the person being 
208.36  served.  Reimbursement is at the same rates and under the same 
209.1   conditions that would otherwise apply to the service.  The 
209.2   interactive video equipment and connection must comply with 
209.3   Medicare standards in effect at the time the service is provided.
209.4      Sec. 14.  Minnesota Statutes 2004, section 256B.0625, is 
209.5   amended by adding a subdivision to read: 
209.6      Subd. 47.  [TREATMENT FOSTER CARE SERVICES.] Effective July 
209.7   1, 2006, and subject to federal approval, medical assistance 
209.8   covers treatment foster care services according to section 
209.9   256B.0946. 
209.10     Sec. 15.  Minnesota Statutes 2004, section 256B.0625, is 
209.11  amended by adding a subdivision to read: 
209.12     Subd. 48.  [PSYCHIATRIC CONSULTATION TO PRIMARY CARE 
209.13  PRACTITIONERS.] Effective January 1, 2006, medical assistance 
209.14  covers consultation provided by a psychiatrist via telephone, 
209.15  e-mail, facsimile, or other means of communication to primary 
209.16  care practitioners, including pediatricians.  The need for 
209.17  consultation and the receipt of the consultation must be 
209.18  documented in the patient record maintained by the primary care 
209.19  practitioner.  If the patient consents, and subject to federal 
209.20  limitations and data privacy provisions, the consultation may be 
209.21  provided without the patient present. 
209.22     Sec. 16.  [256B.0946] [TREATMENT FOSTER CARE.] 
209.23     Subdivision 1.  [COVERED SERVICE.] (a) Effective July 1, 
209.24  2006, and subject to federal approval, medical assistance covers 
209.25  medically necessary services described under paragraph (b) that 
209.26  are provided by a provider entity eligible under subdivision 3 
209.27  to a client eligible under subdivision 2 who is placed in a 
209.28  treatment foster home licensed under Minnesota Rules, parts 
209.29  2960.3000 to 2960.3340. 
209.30     (b) Services to children with severe emotional disturbance 
209.31  residing in treatment foster care settings must meet the 
209.32  relevant standards for mental health services under sections 
209.33  245.487 to 245.4887.  In addition, specific service components 
209.34  reimbursed by medical assistance must meet the following 
209.35  standards: 
209.36     (1) case management service component must meet the 
210.1   standards in Minnesota Rules, parts 9520.0900 to 9520.0926 and 
210.2   9505.0322, excluding subparts 6 and 10; 
210.3      (2) psychotherapy and skills training components must meet 
210.4   the standards for children's therapeutic services and supports 
210.5   in section 256B.0943; and 
210.6      (3) family psychoeducation services under supervision of a 
210.7   mental health professional. 
210.8      Subd. 2.  [DETERMINATION OF CLIENT ELIGIBILITY.] A client's 
210.9   eligibility to receive treatment foster care under this section 
210.10  shall be determined by a diagnostic assessment, an evaluation of 
210.11  level of care needed, and development of an individual treatment 
210.12  plan, as defined in paragraphs (a) to (c). 
210.13     (a) The diagnostic assessment must: 
210.14     (1) be conducted by a psychiatrist, licensed psychologist, 
210.15  or licensed independent clinical social worker that is performed 
210.16  within 180 days prior to the start of service; 
210.17     (2) include current diagnoses on all five axes of the 
210.18  client's current mental health status; 
210.19     (3) determine whether or not a child meets the criteria for 
210.20  severe emotional disturbance in section 245.4871, subdivision 6, 
210.21  or for serious and persistent mental illness in section 245.462, 
210.22  subdivision 20; and 
210.23     (4) be completed annually until age 18.  For individuals 
210.24  between age 18 and 21, unless a client's mental health condition 
210.25  has changed markedly since the client's most recent diagnostic 
210.26  assessment, annual updating is necessary.  For the purpose of 
210.27  this section, "updating" means a written summary, including 
210.28  current diagnoses on all five axes, by a mental health 
210.29  professional of the client's current mental status and service 
210.30  needs. 
210.31     (b) The evaluation of level of care must be conducted by 
210.32  the placing county with an instrument approved by the 
210.33  commissioner of human services.  The commissioner shall update 
210.34  the list of approved level of care instruments annually. 
210.35     (c) The individual treatment plan must be: 
210.36     (1) based on the information in the client's diagnostic 
211.1   assessment; 
211.2      (2) developed through a child-centered, family driven 
211.3   planning process that identifies service needs and 
211.4   individualized, planned, and culturally appropriate 
211.5   interventions that contain specific measurable treatment goals 
211.6   and objectives for the client and treatment strategies for the 
211.7   client's family and foster family; 
211.8      (3) reviewed at least once every 90 days and revised; and 
211.9      (4) signed by the client or, if appropriate, by the 
211.10  client's parent or other person authorized by statute to consent 
211.11  to mental health services for the client. 
211.12     Subd. 3.  [ELIGIBLE PROVIDERS.] For purposes of this 
211.13  section, a provider agency must have an individual placement 
211.14  agreement for each recipient and must be a licensed child 
211.15  placing agency, under Minnesota Rules, parts 9543.0010 to 
211.16  9543.0150, and either: 
211.17     (1) a county; 
211.18     (2) an Indian Health Services facility operated by a tribe 
211.19  or tribal organization under funding authorized by United States 
211.20  Code, title 25, sections 450f to 450n, or title 3 of the Indian 
211.21  Self-Determination Act, Public Law 93-638, section 638 
211.22  (facilities or providers); or 
211.23     (3) a noncounty entity under contract with a county board. 
211.24     Subd. 4.  [ELIGIBLE PROVIDER RESPONSIBILITIES.] (a) To be 
211.25  an eligible provider under this section, a provider must develop 
211.26  written policies and procedures for treatment foster care 
211.27  services consistent with subdivision 1, paragraph (b), clauses 
211.28  (1), (2), and (3). 
211.29     (b) In delivering services under this section, a treatment 
211.30  foster care provider must ensure that staff caseload size 
211.31  reasonably enables the provider to play an active role in 
211.32  service planning, monitoring, delivering, and reviewing for 
211.33  discharge planning to meet the needs of the client, the client's 
211.34  foster family, and the birth family, as specified in each 
211.35  client's individual treatment plan. 
211.36     Subd. 5.  [SERVICE AUTHORIZATION.] The commissioner will 
212.1   administer authorizations for services under this section in 
212.2   compliance with section 256B.0625, subdivision 25. 
212.3      Subd. 6.  [EXCLUDED SERVICES.] (a) Services in clauses (1) 
212.4   to (4) are not eligible as components of treatment foster care 
212.5   services: 
212.6      (1) treatment foster care services provided in violation of 
212.7   medical assistance policy in Minnesota Rules, part 9505.0220; 
212.8      (2) service components of children's therapeutic services 
212.9   and supports simultaneously provided by more than one treatment 
212.10  foster care provider; 
212.11     (3) home and community-based waiver services; and 
212.12     (4) treatment foster care services provided to a child 
212.13  without a level of care determination according to section 
212.14  245.4885, subdivision 1. 
212.15     (b) Children receiving treatment foster care services are 
212.16  not eligible for medical assistance reimbursement for the 
212.17  following services while receiving treatment foster care: 
212.18     (1) mental health case management services under section 
212.19  256B.0625, subdivision 20; and 
212.20     (2) psychotherapy and skill training components of 
212.21  children's therapeutic services and supports under section 
212.22  256B.0625, subdivision 35b. 
212.23     Sec. 17.  [256B.0947] [TRANSITIONAL YOUTH INTENSIVE 
212.24  REHABILITATIVE MENTAL HEALTH SERVICES.] 
212.25     Subdivision 1.  [SCOPE.] Subject to federal approval, 
212.26  medical assistance covers medically necessary, intensive 
212.27  nonresidential rehabilitative mental health services as defined 
212.28  in subdivision 2, for recipients as defined in subdivision 3, 
212.29  when the services are provided by an entity meeting the 
212.30  standards in this section. 
212.31     Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
212.32  following terms have the meanings given them. 
212.33     (a) "Intensive nonresidential rehabilitative mental health 
212.34  services" means child rehabilitative mental health services as 
212.35  defined in section 256B.0943, except that these services are 
212.36  provided by a multidisciplinary staff using a total team 
213.1   approach consistent with assertive community treatment, or other 
213.2   evidence-based practices, and directed to recipients with a 
213.3   serious mental illness who require intensive services. 
213.4      (b) "Evidence-based practices" are nationally recognized 
213.5   mental health services that are proven by substantial research 
213.6   to be effective in helping individuals with serious mental 
213.7   illness obtain specific treatment goals. 
213.8      (c) "Treatment team" means all staff who provide services 
213.9   to recipients under this section.  At a minimum, this includes 
213.10  the clinical supervisor, mental health professionals, mental 
213.11  health practitioners, mental health behavioral aides, and a 
213.12  school representative familiar with the recipient's individual 
213.13  education plan (IEP) if applicable. 
213.14     Subd. 3.  [ELIGIBILITY FOR TRANSITIONAL YOUTH.] An eligible 
213.15  recipient under the age of 18 is an individual who: 
213.16     (1) is age 16 or 17; 
213.17     (2) is diagnosed with a medical condition, such as an 
213.18  emotional disturbance or traumatic brain injury, for which 
213.19  intensive nonresidential rehabilitative mental health services 
213.20  are needed; 
213.21     (3) has substantial disability and functional impairment in 
213.22  three or more of the areas listed in section 245.462, 
213.23  subdivision 11a, so that self-sufficiency upon adulthood or 
213.24  emancipation is unlikely; and 
213.25     (4) has had a recent diagnostic assessment by a qualified 
213.26  professional that documents that intensive nonresidential 
213.27  rehabilitative mental health services are medically necessary to 
213.28  address identified disability and functional impairments and 
213.29  individual recipient goals. 
213.30     Subd. 4.  [PROVIDER CERTIFICATION AND CONTRACT 
213.31  REQUIREMENTS.] (a) The intensive nonresidential rehabilitative 
213.32  mental health services provider must: 
213.33     (1) have a contract with the host county to provide 
213.34  intensive transition youth rehabilitative mental health 
213.35  services; and 
213.36     (2) be certified by the commissioner as being in compliance 
214.1   with this section and section 256B.0943. 
214.2      (b) The commissioner shall develop procedures for counties 
214.3   and providers to submit contracts and other documentation as 
214.4   needed to allow the commissioner to determine whether the 
214.5   standards in this section are met. 
214.6      Subd. 5.  [STANDARDS APPLICABLE TO NONRESIDENTIAL 
214.7   PROVIDERS.] (a) Services must be provided by a certified 
214.8   provider entity as defined in section 256B.0943, subdivision 4 
214.9   that meets the requirements in section 245B.0943, subdivisions 5 
214.10  and 6. 
214.11     (b) The clinical supervisor must be an active member of the 
214.12  treatment team.  The treatment team must meet with the clinical 
214.13  supervisor at least weekly to discuss recipients' progress and 
214.14  make rapid adjustments to meet recipients' needs.  The team 
214.15  meeting shall include recipient-specific case reviews and 
214.16  general treatment discussions among team members.  
214.17  Recipient-specific case reviews and planning must be documented 
214.18  in the individual recipient's treatment record. 
214.19     (c) Treatment staff must have prompt access in person or by 
214.20  telephone to a mental health practitioner or mental health 
214.21  professional.  The provider must have the capacity to promptly 
214.22  and appropriately respond to emergent needs and make any 
214.23  necessary staffing adjustments to assure the health and safety 
214.24  of recipients. 
214.25     (d) The initial functional assessment must be completed 
214.26  within ten days of intake and updated at least every three 
214.27  months or prior to discharge from the service, whichever comes 
214.28  first. 
214.29     (e) The initial individual treatment plan must be completed 
214.30  within ten days of intake and reviewed and updated at least 
214.31  monthly with the recipient. 
214.32     Subd. 6.  [ADDITIONAL STANDARDS FOR NONRESIDENTIAL 
214.33  SERVICES.] The standards in this subdivision apply to intensive 
214.34  nonresidential rehabilitative mental health services. 
214.35     (1) The treatment team must use team treatment, not an 
214.36  individual treatment model. 
215.1      (2) The clinical supervisor must function as a practicing 
215.2   clinician at least on a part-time basis. 
215.3      (3) The staffing ratio must not exceed ten recipients to 
215.4   one full-time equivalent treatment team position. 
215.5      (4) Services must be available at times that meet client 
215.6   needs. 
215.7      (5) The treatment team must actively and assertively engage 
215.8   and reach out to the recipient's family members and significant 
215.9   others, after obtaining the recipient's permission. 
215.10     (6) The treatment team must establish ongoing communication 
215.11  and collaboration between the team, family, and significant 
215.12  others and educate the family and significant others about 
215.13  mental illness, symptom management, and the family's role in 
215.14  treatment. 
215.15     (7) The treatment team must provide interventions to 
215.16  promote positive interpersonal relationships. 
215.17     Subd. 7.  [MEDICAL ASSISTANCE PAYMENT FOR INTENSIVE 
215.18  REHABILITATIVE MENTAL HEALTH SERVICES.] (a) Payment for 
215.19  nonresidential services in this section shall be based on one 
215.20  daily rate per provider inclusive of the following services 
215.21  received by an eligible recipient in a given calendar day: all 
215.22  rehabilitative services under this section, staff travel time to 
215.23  provide rehabilitative services under this section, and 
215.24  nonresidential crisis stabilization services under section 
215.25  256B.0944. 
215.26     (b) Except as indicated in paragraph (c), payment will not 
215.27  be made to more than one entity for each recipient for services 
215.28  provided under this section on a given day.  If services under 
215.29  this section are provided by a team that includes staff from 
215.30  more than one entity, the team must determine how to distribute 
215.31  the payment among the members. 
215.32     (c) The host county shall recommend to the commissioner one 
215.33  rate for each entity that will bill medical assistance for 
215.34  nonresidential intensive rehabilitative mental health services.  
215.35  In developing these rates, the host county shall consider and 
215.36  document: 
216.1      (1) the cost for similar services in the local trade area; 
216.2      (2) actual costs incurred by entities providing the 
216.3   services; 
216.4      (3) the intensity and frequency of services to be provided 
216.5   to each recipient; 
216.6      (4) the degree to which recipients will receive services 
216.7   other than services under this section; and 
216.8      (5) the costs of other services that will be separately 
216.9   reimbursed. 
216.10     (d) The rate for intensive rehabilitative mental health 
216.11  services must exclude medical assistance room and board rate, as 
216.12  defined in section 256I.03, subdivision 6, and services not 
216.13  covered under this section, such as partial hospitalization and 
216.14  inpatient services.  Physician services are not a component of 
216.15  the treatment team and may be billed separately.  The county's 
216.16  recommendation shall specify the period for which the rate will 
216.17  be applicable, not to exceed two years. 
216.18     (e) When services under this section are provided by an 
216.19  assertive community team, case management functions must be an 
216.20  integral part of the team. 
216.21     (f) The rate for a provider must not exceed the rate 
216.22  charged by that provider for the same service to other payors. 
216.23     (g) The commissioner shall approve or reject the county's 
216.24  rate recommendation, based on the commissioner's own analysis of 
216.25  the criteria in paragraph (c). 
216.26     Subd. 9.  [PROVIDER ENROLLMENT; RATE SETTING FOR 
216.27  COUNTY-OPERATED ENTITIES.] Counties that employ their own staff 
216.28  to provide services under this section shall apply directly to 
216.29  the commissioner for enrollment and rate setting.  In this case, 
216.30  a county contract is not required and the commissioner shall 
216.31  perform the program review and rate setting duties which would 
216.32  otherwise be required of counties under this section. 
216.33     <b>[EFFECTIVE DATE.]</b> This section is effective July 1, 2006. 
216.34     Sec. 18.  Minnesota Statutes 2004, section 256B.19, 
216.35  subdivision 1, is amended to read: 
216.36     Subdivision 1.  [DIVISION OF COST.] The state and county 
217.1   share of medical assistance costs not paid by federal funds 
217.2   shall be as follows:  
217.3      (1) beginning January 1, 1992, 50 percent state funds and 
217.4   50 percent county funds for the cost of placement of severely 
217.5   emotionally disturbed children in regional treatment centers; 
217.6      (2) beginning January 1, 2003, 80 percent state funds and 
217.7   20 percent county funds for the costs of nursing facility 
217.8   placements of persons with disabilities under the age of 65 that 
217.9   have exceeded 90 days.  This clause shall be subject to chapter 
217.10  256G and shall not apply to placements in facilities not 
217.11  certified to participate in medical assistance; 
217.12     (3) beginning July 1, 2004, 80 percent state funds and 20 
217.13  percent county funds for the costs of placements that have 
217.14  exceeded 90 days in intermediate care facilities for persons 
217.15  with mental retardation or a related condition that have seven 
217.16  or more beds.  This provision includes pass-through payments 
217.17  made under section 256B.5015; and 
217.18     (4) beginning July 1, 2004, when state funds are used to 
217.19  pay for a nursing facility placement due to the facility's 
217.20  status as an institution for mental diseases (IMD), the county 
217.21  shall pay 20 percent of the nonfederal share of costs that have 
217.22  exceeded 90 days.  This clause is subject to chapter 256G; and 
217.23     (5) beginning July 1, 2006, 50 percent state funds and 50 
217.24  percent county funds for the cost of treatment foster care 
217.25  services under section 256B.0946. 
217.26     For counties that participate in a Medicaid demonstration 
217.27  project under sections 256B.69 and 256B.71, the division of the 
217.28  nonfederal share of medical assistance expenses for payments 
217.29  made to prepaid health plans or for payments made to health 
217.30  maintenance organizations in the form of prepaid capitation 
217.31  payments, this division of medical assistance expenses shall be 
217.32  95 percent by the state and five percent by the county of 
217.33  financial responsibility.  
217.34     In counties where prepaid health plans are under contract 
217.35  to the commissioner to provide services to medical assistance 
217.36  recipients, the cost of court ordered treatment ordered without 
218.1   consulting the prepaid health plan that does not include 
218.2   diagnostic evaluation, recommendation, and referral for 
218.3   treatment by the prepaid health plan is the responsibility of 
218.4   the county of financial responsibility. 
218.5      Sec. 19.  Minnesota Statutes 2004, section 256D.03, 
218.6   subdivision 4, is amended to read: 
218.7      Subd. 4.  [GENERAL ASSISTANCE MEDICAL CARE; SERVICES.] 
218.8   (a)(i) For a person who is eligible under subdivision 3, 
218.9   paragraph (a), clause (2), item (i), general assistance medical 
218.10  care covers, except as provided in paragraph (c): 
218.11     (1) inpatient hospital services; 
218.12     (2) outpatient hospital services; 
218.13     (3) services provided by Medicare certified rehabilitation 
218.14  agencies; 
218.15     (4) prescription drugs and other products recommended 
218.16  through the process established in section 256B.0625, 
218.17  subdivision 13; 
218.18     (5) equipment necessary to administer insulin and 
218.19  diagnostic supplies and equipment for diabetics to monitor blood 
218.20  sugar level; 
218.21     (6) eyeglasses and eye examinations provided by a physician 
218.22  or optometrist; 
218.23     (7) hearing aids; 
218.24     (8) prosthetic devices; 
218.25     (9) laboratory and X-ray services; 
218.26     (10) physician's services; 
218.27     (11) medical transportation except special transportation; 
218.28     (12) chiropractic services as covered under the medical 
218.29  assistance program; 
218.30     (13) podiatric services; 
218.31     (14) dental services and dentures, subject to the 
218.32  limitations specified in section 256B.0625, subdivision 9; 
218.33     (15) outpatient services provided by a mental health center 
218.34  or clinic that is under contract with the county board and is 
218.35  established under section 245.62; 
218.36     (16) day treatment services for mental illness provided 
219.1   under contract with the county board; 
219.2      (17) prescribed medications for persons who have been 
219.3   diagnosed as mentally ill as necessary to prevent more 
219.4   restrictive institutionalization; 
219.5      (18) psychological services, medical supplies and 
219.6   equipment, and Medicare premiums, coinsurance and deductible 
219.7   payments; 
219.8      (19) medical equipment not specifically listed in this 
219.9   paragraph when the use of the equipment will prevent the need 
219.10  for costlier services that are reimbursable under this 
219.11  subdivision; 
219.12     (20) services performed by a certified pediatric nurse 
219.13  practitioner, a certified family nurse practitioner, a certified 
219.14  adult nurse practitioner, a certified obstetric/gynecological 
219.15  nurse practitioner, a certified neonatal nurse practitioner, or 
219.16  a certified geriatric nurse practitioner in independent 
219.17  practice, if (1) the service is otherwise covered under this 
219.18  chapter as a physician service, (2) the service provided on an 
219.19  inpatient basis is not included as part of the cost for 
219.20  inpatient services included in the operating payment rate, and 
219.21  (3) the service is within the scope of practice of the nurse 
219.22  practitioner's license as a registered nurse, as defined in 
219.23  section 148.171; 
219.24     (21) services of a certified public health nurse or a 
219.25  registered nurse practicing in a public health nursing clinic 
219.26  that is a department of, or that operates under the direct 
219.27  authority of, a unit of government, if the service is within the 
219.28  scope of practice of the public health nurse's license as a 
219.29  registered nurse, as defined in section 148.171; and 
219.30     (22) telemedicine consultations, to the extent they are 
219.31  covered under section 256B.0625, subdivision 3b; and 
219.32     (23) mental health telemedicine and psychiatric 
219.33  consultation as covered under section 256B.0625, subdivisions 46 
219.34  and 48. 
219.35     (ii) Effective October 1, 2003, for a person who is 
219.36  eligible under subdivision 3, paragraph (a), clause (2), item 
220.1   (ii), general assistance medical care coverage is limited to 
220.2   inpatient hospital services, including physician services 
220.3   provided during the inpatient hospital stay.  A $1,000 
220.4   deductible is required for each inpatient hospitalization.  
220.5      (b) Gender reassignment surgery and related services are 
220.6   not covered services under this subdivision unless the 
220.7   individual began receiving gender reassignment services prior to 
220.8   July 1, 1995.  
220.9      (c) In order to contain costs, the commissioner of human 
220.10  services shall select vendors of medical care who can provide 
220.11  the most economical care consistent with high medical standards 
220.12  and shall where possible contract with organizations on a 
220.13  prepaid capitation basis to provide these services.  The 
220.14  commissioner shall consider proposals by counties and vendors 
220.15  for prepaid health plans, competitive bidding programs, block 
220.16  grants, or other vendor payment mechanisms designed to provide 
220.17  services in an economical manner or to control utilization, with 
220.18  safeguards to ensure that necessary services are provided.  
220.19  Before implementing prepaid programs in counties with a county 
220.20  operated or affiliated public teaching hospital or a hospital or 
220.21  clinic operated by the University of Minnesota, the commissioner 
220.22  shall consider the risks the prepaid program creates for the 
220.23  hospital and allow the county or hospital the opportunity to 
220.24  participate in the program in a manner that reflects the risk of 
220.25  adverse selection and the nature of the patients served by the 
220.26  hospital, provided the terms of participation in the program are 
220.27  competitive with the terms of other participants considering the 
220.28  nature of the population served.  Payment for services provided 
220.29  pursuant to this subdivision shall be as provided to medical 
220.30  assistance vendors of these services under sections 256B.02, 
220.31  subdivision 8, and 256B.0625.  For payments made during fiscal 
220.32  year 1990 and later years, the commissioner shall consult with 
220.33  an independent actuary in establishing prepayment rates, but 
220.34  shall retain final control over the rate methodology.  
220.35     (d) Recipients eligible under subdivision 3, paragraph (a), 
220.36  clause (2), item (i), shall pay the following co-payments for 
221.1   services provided on or after October 1, 2003: 
221.2      (1) $3 per nonpreventive visit.  For purposes of this 
221.3   subdivision, a visit means an episode of service which is 
221.4   required because of a recipient's symptoms, diagnosis, or 
221.5   established illness, and which is delivered in an ambulatory 
221.6   setting by a physician or physician ancillary, chiropractor, 
221.7   podiatrist, nurse midwife, advanced practice nurse, audiologist, 
221.8   optician, or optometrist; 
221.9      (2) $25 for eyeglasses; 
221.10     (3) $25 for nonemergency visits to a hospital-based 
221.11  emergency room; 
221.12     (4) $3 per brand-name drug prescription and $1 per generic 
221.13  drug prescription, subject to a $20 per month maximum for 
221.14  prescription drug co-payments.  No co-payments shall apply to 
221.15  antipsychotic drugs when used for the treatment of mental 
221.16  illness; and 
221.17     (5) 50 percent coinsurance on restorative dental services.  
221.18     (e) Co-payments shall be limited to one per day per 
221.19  provider for nonpreventive visits, eyeglasses, and nonemergency 
221.20  visits to a hospital-based emergency room.  Recipients of 
221.21  general assistance medical care are responsible for all 
221.22  co-payments in this subdivision.  The general assistance medical 
221.23  care reimbursement to the provider shall be reduced by the 
221.24  amount of the co-payment, except that reimbursement for 
221.25  prescription drugs shall not be reduced once a recipient has 
221.26  reached the $20 per month maximum for prescription drug 
221.27  co-payments.  The provider collects the co-payment from the 
221.28  recipient.  Providers may not deny services to recipients who 
221.29  are unable to pay the co-payment, except as provided in 
221.30  paragraph (f). 
221.31     (f) If it is the routine business practice of a provider to 
221.32  refuse service to an individual with uncollected debt, the 
221.33  provider may include uncollected co-payments under this 
221.34  section.  A provider must give advance notice to a recipient 
221.35  with uncollected debt before services can be denied. 
221.36     (g) Any county may, from its own resources, provide medical 
222.1   payments for which state payments are not made. 
222.2      (h) Chemical dependency services that are reimbursed under 
222.3   chapter 254B must not be reimbursed under general assistance 
222.4   medical care. 
222.5      (i) The maximum payment for new vendors enrolled in the 
222.6   general assistance medical care program after the base year 
222.7   shall be determined from the average usual and customary charge 
222.8   of the same vendor type enrolled in the base year. 
222.9      (j) The conditions of payment for services under this 
222.10  subdivision are the same as the conditions specified in rules 
222.11  adopted under chapter 256B governing the medical assistance 
222.12  program, unless otherwise provided by statute or rule. 
222.13     (k) Inpatient and outpatient payments shall be reduced by 
222.14  five percent, effective July 1, 2003.  This reduction is in 
222.15  addition to the five percent reduction effective July 1, 2003, 
222.16  and incorporated by reference in paragraph (i).  
222.17     (l) Payments for all other health services except 
222.18  inpatient, outpatient, and pharmacy services shall be reduced by 
222.19  five percent, effective July 1, 2003.  
222.20     (m) Payments to managed care plans shall be reduced by five 
222.21  percent for services provided on or after October 1, 2003. 
222.22     (n) A hospital receiving a reduced payment as a result of 
222.23  this section may apply the unpaid balance toward satisfaction of 
222.24  the hospital's bad debts. 
222.25     <b>[EFFECTIVE DATE.]</b> This section is effective January 1, 2006.
222.26     Sec. 20.  Minnesota Statutes 2004, section 256D.44, 
222.27  subdivision 5, is amended to read: 
222.28     Subd. 5.  [SPECIAL NEEDS.] In addition to the state 
222.29  standards of assistance established in subdivisions 1 to 4, 
222.30  payments are allowed for the following special needs of 
222.31  recipients of Minnesota supplemental aid who are not residents 
222.32  of a nursing home, a regional treatment center, or a group 
222.33  residential housing facility. 
222.34     (a) The county agency shall pay a monthly allowance for 
222.35  medically prescribed diets if the cost of those additional 
222.36  dietary needs cannot be met through some other maintenance 
223.1   benefit.  The need for special diets or dietary items must be 
223.2   prescribed by a licensed physician.  Costs for special diets 
223.3   shall be determined as percentages of the allotment for a 
223.4   one-person household under the thrifty food plan as defined by 
223.5   the United States Department of Agriculture.  The types of diets 
223.6   and the percentages of the thrifty food plan that are covered 
223.7   are as follows: 
223.8      (1) high protein diet, at least 80 grams daily, 25 percent 
223.9   of thrifty food plan; 
223.10     (2) controlled protein diet, 40 to 60 grams and requires 
223.11  special products, 100 percent of thrifty food plan; 
223.12     (3) controlled protein diet, less than 40 grams and 
223.13  requires special products, 125 percent of thrifty food plan; 
223.14     (4) low cholesterol diet, 25 percent of thrifty food plan; 
223.15     (5) high residue diet, 20 percent of thrifty food plan; 
223.16     (6) pregnancy and lactation diet, 35 percent of thrifty 
223.17  food plan; 
223.18     (7) gluten-free diet, 25 percent of thrifty food plan; 
223.19     (8) lactose-free diet, 25 percent of thrifty food plan; 
223.20     (9) antidumping diet, 15 percent of thrifty food plan; 
223.21     (10) hypoglycemic diet, 15 percent of thrifty food plan; or 
223.22     (11) ketogenic diet, 25 percent of thrifty food plan. 
223.23     (b) Payment for nonrecurring special needs must be allowed 
223.24  for necessary home repairs or necessary repairs or replacement 
223.25  of household furniture and appliances using the payment standard 
223.26  of the AFDC program in effect on July 16, 1996, for these 
223.27  expenses, as long as other funding sources are not available.  
223.28     (c) A fee for guardian or conservator service is allowed at 
223.29  a reasonable rate negotiated by the county or approved by the 
223.30  court.  This rate shall not exceed five percent of the 
223.31  assistance unit's gross monthly income up to a maximum of $100 
223.32  per month.  If the guardian or conservator is a member of the 
223.33  county agency staff, no fee is allowed. 
223.34     (d) The county agency shall continue to pay a monthly 
223.35  allowance of $68 for restaurant meals for a person who was 
223.36  receiving a restaurant meal allowance on June 1, 1990, and who 
224.1   eats two or more meals in a restaurant daily.  The allowance 
224.2   must continue until the person has not received Minnesota 
224.3   supplemental aid for one full calendar month or until the 
224.4   person's living arrangement changes and the person no longer 
224.5   meets the criteria for the restaurant meal allowance, whichever 
224.6   occurs first. 
224.7      (e) A fee of ten percent of the recipient's gross income or 
224.8   $25, whichever is less, is allowed for representative payee 
224.9   services provided by an agency that meets the requirements under 
224.10  SSI regulations to charge a fee for representative payee 
224.11  services.  This special need is available to all recipients of 
224.12  Minnesota supplemental aid regardless of their living 
224.13  arrangement.  
224.14     (f) Notwithstanding the language in this subdivision, an 
224.15  amount equal to the maximum allotment authorized by the federal 
224.16  Food Stamp Program for a single individual which is in effect on 
224.17  the first day of January of the previous year will be added to 
224.18  the standards of assistance established in subdivisions 1 to 4 
224.19  for individuals under the age of 65 who are relocating from an 
224.20  institution, or an adult mental health residential treatment 
224.21  program under section 256B.0622, and who are shelter needy.  An 
224.22  eligible individual who receives this benefit prior to age 65 
224.23  may continue to receive the benefit after the age of 65. 
224.24     "Shelter needy" means that the assistance unit incurs 
224.25  monthly shelter costs that exceed 40 percent of the assistance 
224.26  unit's gross income before the application of this special needs 
224.27  standard.  "Gross income" for the purposes of this section is 
224.28  the applicant's or recipient's income as defined in section 
224.29  256D.35, subdivision 10, or the standard specified in 
224.30  subdivision 3, whichever is greater.  A recipient of a federal 
224.31  or state housing subsidy, that limits shelter costs to a 
224.32  percentage of gross income, shall not be considered shelter 
224.33  needy for purposes of this paragraph. 
224.34     Sec. 21.  Minnesota Statutes 2004, section 256L.03, 
224.35  subdivision 1, is amended to read: 
224.36     Subdivision 1.  [COVERED HEALTH SERVICES.] For individuals 
225.1   under section 256L.04, subdivision 7, with income no greater 
225.2   than 75 percent of the federal poverty guidelines or for 
225.3   families with children under section 256L.04, subdivision 1, all 
225.4   subdivisions of this section apply.  "Covered health services" 
225.5   means the health services reimbursed under chapter 256B, with 
225.6   the exception of inpatient hospital services, special education 
225.7   services, private duty nursing services, adult dental care 
225.8   services other than services covered under section 256B.0625, 
225.9   subdivision 9, paragraph (b), orthodontic services, nonemergency 
225.10  medical transportation services, personal care assistant and 
225.11  case management services, nursing home or intermediate care 
225.12  facilities services, inpatient mental health services, and 
225.13  chemical dependency services.  Outpatient mental health services 
225.14  covered under the MinnesotaCare program are limited to 
225.15  diagnostic assessments, psychological testing, explanation of 
225.16  findings, mental health telemedicine, psychiatric consultation, 
225.17  medication management by a physician, day treatment, partial 
225.18  hospitalization, and individual, family, and group psychotherapy.
225.19     No public funds shall be used for coverage of abortion 
225.20  under MinnesotaCare except where the life of the female would be 
225.21  endangered or substantial and irreversible impairment of a major 
225.22  bodily function would result if the fetus were carried to term; 
225.23  or where the pregnancy is the result of rape or incest. 
225.24     Covered health services shall be expanded as provided in 
225.25  this section. 
225.26     <b>[EFFECTIVE DATE.]</b> This section is effective January 1, 2006.
225.27     Sec. 22.  [641.155] [DISCHARGE PLANS; OFFENDERS WITH 
225.28  SERIOUS AND PERSISTENT MENTAL ILLNESS.] 
225.29     The commissioner of corrections shall develop a model 
225.30  discharge planning process for every offender with a serious and 
225.31  persistent mental illness, as defined in section 245.462, 
225.32  subdivision 20, paragraph (c), who has been convicted and 
225.33  sentenced to serve three or more months and is being released 
225.34  from a county jail or county regional jail. 
225.35     An offender with a serious and persistent mental illness, 
225.36  as defined in section 245.462, subdivision 20, paragraph (c), 
226.1   who has been convicted and sentenced to serve three or more 
226.2   months and is being released from a county jail or county 
226.3   regional jail shall be referred to the appropriate staff in the 
226.4   county human services department at least 60 days before being 
226.5   released.  The county human services department may carry out 
226.6   provisions of the model discharge planning process such as: 
226.7      (1) providing assistance in filling out an application for 
226.8   medical assistance, general assistance medical care, or 
226.9   MinnesotaCare; 
226.10     (2) making a referral for case management as outlined under 
226.11  section 245.467, subdivision 4; 
226.12     (3) providing assistance in obtaining a state photo 
226.13  identification; 
226.14     (4) securing a timely appointment with a psychiatrist or 
226.15  other appropriate community mental health providers; and 
226.16     (5) providing prescriptions for a 30-day supply of all 
226.17  necessary medications. 
226.18     Sec. 23.  [PRIORITY IN JANITORIAL CONTRACTS.] 
226.19     When awarding contracts to provide the janitorial services 
226.20  for the new Department of Human Services and Department of 
226.21  Health buildings, the commissioner of administration shall give 
226.22  priority to supported work vendors. 
226.23                             ARTICLE 6
226.24                           FAMILY SUPPORT
226.25     Section 1.  Minnesota Statutes 2004, section 119B.011, is 
226.26  amended by adding a subdivision to read: 
226.27     Subd. 23.  [WORK PARTICIPATION RATE ENHANCEMENT 
226.28  PROGRAM.] "Work participation rate enhancement program" means 
226.29  the program established under section 256J.575. 
226.30     Sec. 2.  Minnesota Statutes 2004, section 119B.05, 
226.31  subdivision 1, is amended to read: 
226.32     Subdivision 1.  [ELIGIBLE PARTICIPANTS.] Families eligible 
226.33  for child care assistance under the MFIP child care program are: 
226.34     (1) MFIP participants who are employed or in job search and 
226.35  meet the requirements of section 119B.10; 
226.36     (2) persons who are members of transition year families 
227.1   under section 119B.011, subdivision 20, and meet the 
227.2   requirements of section 119B.10; 
227.3      (3) families who are participating in employment 
227.4   orientation or job search, or other employment or training 
227.5   activities that are included in an approved employability 
227.6   development plan under section 256J.95; 
227.7      (4) MFIP families who are participating in work job search, 
227.8   job support, employment, or training activities as required in 
227.9   their employment plan, or in appeals, hearings, assessments, or 
227.10  orientations according to chapter 256J; 
227.11     (5) MFIP families who are participating in social services 
227.12  activities under chapter 256J as required in their employment 
227.13  plan approved according to chapter 256J; 
227.14     (6) families who are participating in services or 
227.15  activities that are included in an approved family stabilization 
227.16  plan under section 256J.575; 
227.17     (7) families who are participating in programs as required 
227.18  in tribal contracts under section 119B.02, subdivision 2, or 
227.19  256.01, subdivision 2; and 
227.20     (7) (8) families who are participating in the transition 
227.21  year extension under section 119B.011, subdivision 20a. 
227.22     Sec. 3.  Minnesota Statutes 2004, section 252.27, 
227.23  subdivision 2a, is amended to read: 
227.24     Subd. 2a.  [CONTRIBUTION AMOUNT.] (a) The natural or 
227.25  adoptive parents of a minor child, including a child determined 
227.26  eligible for medical assistance without consideration of 
227.27  parental income, must contribute to the cost of services used by 
227.28  making monthly payments on a sliding scale based on income, 
227.29  unless the child is married or has been married, parental rights 
227.30  have been terminated, or the child's adoption is subsidized 
227.31  according to section 259.67 or through title IV-E of the Social 
227.32  Security Act. 
227.33     (b) For households with adjusted gross income equal to or 
227.34  greater than 100 percent of federal poverty guidelines, the 
227.35  parental contribution shall be computed by applying the 
227.36  following schedule of rates to the adjusted gross income of the 
228.1   natural or adoptive parents: 
228.2      (1) if the adjusted gross income is equal to or greater 
228.3   than 100 percent of federal poverty guidelines and less than 175 
228.4   percent of federal poverty guidelines, the parental contribution 
228.5   is $4 per month; 
228.6      (2) if the adjusted gross income is equal to or greater 
228.7   than 175 percent of the federal poverty guidelines and less than 
228.8   or equal to 200 percent of the federal poverty guidelines, the 
228.9   parental contribution shall be one percent of the adjusted gross 
228.10  income; 
228.11     (3) if the adjusted gross income is equal to or greater 
228.12  than 175 200 percent of federal poverty guidelines and less than 
228.13  or equal to 375 420 percent of federal poverty guidelines, the 
228.14  parental contribution shall be determined using a sliding fee 
228.15  scale established by the commissioner of human services which 
228.16  begins at one percent of adjusted gross income at 175 200 
228.17  percent of federal poverty guidelines and increases to 7.5 
228.18  percent of adjusted gross income for those with adjusted gross 
228.19  income up to 375 420 percent of federal poverty guidelines; 
228.20     (3) (4) if the adjusted gross income is greater than 375 
228.21  420 percent of federal poverty guidelines and less than 675 
228.22  percent of federal poverty guidelines, the parental contribution 
228.23  shall be 7.5 percent of adjusted gross income; 
228.24     (4) (5) if the adjusted gross income is equal to or greater 
228.25  than 675 percent of federal poverty guidelines and less than 975 
228.26  percent of federal poverty guidelines, the parental contribution 
228.27  shall be ten percent of adjusted gross income; and 
228.28     (5) (6) if the adjusted gross income is equal to or greater 
228.29  than 975 percent of federal poverty guidelines, the parental 
228.30  contribution shall be 12.5 percent of adjusted gross income. 
228.31     If the child lives with the parent, the annual adjusted 
228.32  gross income is reduced by $2,400 prior to calculating the 
228.33  parental contribution.  If the child resides in an institution 
228.34  specified in section 256B.35, the parent is responsible for the 
228.35  personal needs allowance specified under that section in 
228.36  addition to the parental contribution determined under this 
229.1   section.  The parental contribution is reduced by any amount 
229.2   required to be paid directly to the child pursuant to a court 
229.3   order, but only if actually paid. 
229.4      (c) The household size to be used in determining the amount 
229.5   of contribution under paragraph (b) includes natural and 
229.6   adoptive parents and their dependents, including the child 
229.7   receiving services.  Adjustments in the contribution amount due 
229.8   to annual changes in the federal poverty guidelines shall be 
229.9   implemented on the first day of July following publication of 
229.10  the changes. 
229.11     (d) For purposes of paragraph (b), "income" means the 
229.12  adjusted gross income of the natural or adoptive parents 
229.13  determined according to the previous year's federal tax form, 
229.14  except, effective retroactive to July 1, 2003, taxable capital 
229.15  gains to the extent the funds have been used to purchase a 
229.16  home and funds from early withdrawn qualified retirement 
229.17  accounts under the Internal Revenue Code shall not be counted as 
229.18  income. 
229.19     (e) The contribution shall be explained in writing to the 
229.20  parents at the time eligibility for services is being 
229.21  determined.  The contribution shall be made on a monthly basis 
229.22  effective with the first month in which the child receives 
229.23  services.  Annually upon redetermination or at termination of 
229.24  eligibility, if the contribution exceeded the cost of services 
229.25  provided, the local agency or the state shall reimburse that 
229.26  excess amount to the parents, either by direct reimbursement if 
229.27  the parent is no longer required to pay a contribution, or by a 
229.28  reduction in or waiver of parental fees until the excess amount 
229.29  is exhausted. 
229.30     (f) The monthly contribution amount must be reviewed at 
229.31  least every 12 months; when there is a change in household size; 
229.32  and when there is a loss of or gain in income from one month to 
229.33  another in excess of ten percent.  The local agency shall mail a 
229.34  written notice 30 days in advance of the effective date of a 
229.35  change in the contribution amount.  A decrease in the 
229.36  contribution amount is effective in the month that the parent 
230.1   verifies a reduction in income or change in household size. 
230.2      (g) Parents of a minor child who do not live with each 
230.3   other shall each pay the contribution required under paragraph 
230.4   (a).  An amount equal to the annual, except that a court-ordered 
230.5   child support payment actually paid on behalf of the child 
230.6   receiving services shall be deducted from the adjusted gross 
230.7   income contribution of the parent making the payment prior to 
230.8   calculating the parental contribution under paragraph (b). 
230.9      (h) The contribution under paragraph (b) shall be increased 
230.10  by an additional five percent if the local agency determines 
230.11  that insurance coverage is available but not obtained for the 
230.12  child.  For purposes of this section, "available" means the 
230.13  insurance is a benefit of employment for a family member at an 
230.14  annual cost of no more than five percent of the family's annual 
230.15  income.  For purposes of this section, "insurance" means health 
230.16  and accident insurance coverage, enrollment in a nonprofit 
230.17  health service plan, health maintenance organization, 
230.18  self-insured plan, or preferred provider organization. 
230.19     Parents who have more than one child receiving services 
230.20  shall not be required to pay more than the amount for the child 
230.21  with the highest expenditures.  There shall be no resource 
230.22  contribution from the parents.  The parent shall not be required 
230.23  to pay a contribution in excess of the cost of the services 
230.24  provided to the child, not counting payments made to school 
230.25  districts for education-related services.  Notice of an increase 
230.26  in fee payment must be given at least 30 days before the 
230.27  increased fee is due.  
230.28     (i) The contribution under paragraph (b) shall be reduced 
230.29  by $300 per fiscal year if, in the 12 months prior to July 1: 
230.30     (1) the parent applied for insurance for the child; 
230.31     (2) the insurer denied insurance; 
230.32     (3) the parents submitted a complaint or appeal, in writing 
230.33  to the insurer, submitted a complaint or appeal, in writing, to 
230.34  the commissioner of health or the commissioner of commerce, or 
230.35  litigated the complaint or appeal; and 
230.36     (4) as a result of the dispute, the insurer reversed its 
231.1   decision and granted insurance. 
231.2      For purposes of this section, "insurance" has the meaning 
231.3   given in paragraph (h). 
231.4      A parent who has requested a reduction in the contribution 
231.5   amount under this paragraph shall submit proof in the form and 
231.6   manner prescribed by the commissioner or county agency, 
231.7   including, but not limited to, the insurer's denial of 
231.8   insurance, the written letter or complaint of the parents, court 
231.9   documents, and the written response of the insurer approving 
231.10  insurance.  The determinations of the commissioner or county 
231.11  agency under this paragraph are not rules subject to chapter 14. 
231.12     Sec. 4.  Minnesota Statutes 2004, section 256.01, is 
231.13  amended by adding a subdivision to read: 
231.14     Subd. 14b.  [AMERICAN INDIAN CHILD WELFARE PROJECTS.] (a) 
231.15  The commissioner of human services may authorize projects to 
231.16  test tribal delivery of child welfare services to American 
231.17  Indian children and their parents and custodians living on the 
231.18  reservation.  The commissioner has authority to solicit and 
231.19  determine which tribes may participate in a project.  Grants may 
231.20  be issued to Minnesota Indian tribes to support the projects.  
231.21  The commissioner may waive existing state rules as needed to 
231.22  accomplish the projects.  Notwithstanding section 626.556, the 
231.23  commissioner may authorize projects to use alternative methods 
231.24  of investigating and assessing reports of child maltreatment, 
231.25  provided that the projects comply with the provisions of section 
231.26  626.556 dealing with the rights of individuals who are subjects 
231.27  of reports or investigations, including notice and appeal rights 
231.28  and data practices requirements.  The commissioner may seek any 
231.29  federal approvals necessary to carry out the projects as well as 
231.30  seek and use any funds available to the commissioner, including 
231.31  use of federal funds, foundation funds, existing grant funds, 
231.32  and other funds.  The commissioner is authorized to advance 
231.33  state funds as necessary to operate the projects.  Federal 
231.34  reimbursement applicable to the projects is appropriated to the 
231.35  commissioner for the purposes of the projects.  The projects 
231.36  must be required to address responsibility for safety, 
232.1   permanency, and well-being of children. 
232.2      (b) For the purposes of this section, "American Indian 
232.3   child" means a person from birth to 18 years of age who is a 
232.4   tribal member or eligible for membership in one of the tribes 
232.5   chosen for the project under this subdivision and who is 
232.6   residing on the reservation of that tribe. 
232.7      (c) In order to qualify for an American Indian child 
232.8   welfare project, a tribe must: 
232.9      (1) be one of the existing tribes with reservation land in 
232.10  Minnesota; 
232.11     (2) have a tribal court with jurisdiction over child 
232.12  custody proceedings; 
232.13     (3) have a substantial number of children for whom 
232.14  determinations of maltreatment have occurred; 
232.15     (4) have capacity to respond to reports of abuse and 
232.16  neglect under section 626.556; 
232.17     (5) provide a wide range of services to families in need of 
232.18  child welfare services; and 
232.19     (6) have a tribal-state title IV-E agreement in effect. 
232.20     (d) Grants awarded under this section may be used for the 
232.21  nonfederal costs of providing child welfare services to American 
232.22  Indian children on the tribe's reservation, including costs 
232.23  associated with: 
232.24     (1) assessment and prevention of child abuse and neglect; 
232.25     (2) family preservation; 
232.26     (3) facilitative, supportive, and reunification services; 
232.27     (4) out-of-home placement for children removed from the 
232.28  home for child protective purposes; and 
232.29     (5) other activities and services approved by the 
232.30  commissioner that further the goals of providing safety, 
232.31  permanency, and well-being of American Indian children. 
232.32     (e) When a tribe has initiated a project and has been 
232.33  approved by the commissioner to assume child welfare 
232.34  responsibilities for American Indian children of that tribe 
232.35  under this section, the affected county social service agency is 
232.36  relieved of responsibility for responding to reports of abuse 
233.1   and neglect under section 626.556 for those children during the 
233.2   time the tribal project is in effect and receiving funding for 
233.3   the project.  The commissioner shall work with tribes and 
233.4   affected counties to develop procedures for data collection, 
233.5   evaluation, and clarification of the ongoing role and financial 
233.6   responsibilities of the county and tribe for child welfare 
233.7   services prior to initiation of the project.  Children who have 
233.8   not been identified by the tribe as participating in the project 
233.9   shall remain the responsibility of the county.  Nothing in this 
233.10  section changes the responsibilities of the county law 
233.11  enforcement agency or court services. 
233.12     (f) The commissioner shall collect information on outcomes 
233.13  relating to child safety, permanency, and well-being of American 
233.14  Indian children who are served in the projects.  Participating 
233.15  tribes must provide information to the state in a format deemed 
233.16  acceptable by the state to meet state and federal reporting 
233.17  requirements. 
233.18     (g) For counties with tribes participating in the American 
233.19  Indian Child Welfare Project, five percent of the total cost of 
233.20  the nonfederal share is to be paid by the county. 
233.21     Sec. 5.  Minnesota Statutes 2004, section 256J.021, is 
233.22  amended to read: 
233.23     256J.021 [SEPARATE STATE PROGRAM PROGRAMS FOR USE OF STATE 
233.24  MONEY.] 
233.25     (a) Beginning October 1, 2001, and each year thereafter, 
233.26  the commissioner of human services must treat MFIP expenditures 
233.27  made to or on behalf of any minor child under section 256J.02, 
233.28  subdivision 2, clause (1), who is a resident of this state under 
233.29  section 256J.12, and who is part of a two-parent eligible 
233.30  household as expenditures under a separately funded state 
233.31  program and report those expenditures to the federal Department 
233.32  of Health and Human Services as separate state program 
233.33  expenditures under Code of Federal Regulations, title 45, 
233.34  section 263.5. 
233.35     (b) Beginning October 1, 2005, and each year thereafter, 
233.36  the commissioner of human services must treat MFIP expenditures 
234.1   made to or on behalf of any minor child under section 256J.02, 
234.2   subdivision 2, clause (1), who is a resident of this state under 
234.3   section 256J.12, and who is part of a household participating in 
234.4   the work participation rate enhancement program under section 
234.5   256J.575 as expenditures under a separately funded state program 
234.6   and report those expenditures to the federal Department of 
234.7   Health and Human Services as separate state program expenditures 
234.8   under Code of Federal Regulations, title 45, section 263.5. 
234.9      Sec. 6.  Minnesota Statutes 2004, section 256J.08, 
234.10  subdivision 65, is amended to read: 
234.11     Subd. 65.  [PARTICIPANT.] "Participant" means a person who 
234.12  is currently receiving cash assistance or the food portion 
234.13  available through MFIP.  A person who fails to withdraw or 
234.14  access electronically any portion of the person's cash and food 
234.15  assistance payment by the end of the payment month, who makes a 
234.16  written request for closure before the first of a payment month 
234.17  and repays cash and food assistance electronically issued for 
234.18  that payment month within that payment month, or who returns any 
234.19  uncashed assistance check and food coupons and withdraws from 
234.20  the program is not a participant.  A person who withdraws a cash 
234.21  or food assistance payment by electronic transfer or receives 
234.22  and cashes an MFIP assistance check or food coupons and is 
234.23  subsequently determined to be ineligible for assistance for that 
234.24  period of time is a participant, regardless whether that 
234.25  assistance is repaid.  The term "participant" includes the 
234.26  caregiver relative and the minor child whose needs are included 
234.27  in the assistance payment.  A person in an assistance unit who 
234.28  does not receive a cash and food assistance payment because the 
234.29  case has been suspended from MFIP is a participant.  A person 
234.30  who receives cash payments under the diversionary work program 
234.31  under section 256J.95 is a participant.  A person who receives 
234.32  cash payments under the work participation rate enhancement 
234.33  program under section 256J.575 is a participant. 
234.34     Sec. 7.  Minnesota Statutes 2004, section 256J.21, 
234.35  subdivision 2, is amended to read: 
234.36     Subd. 2.  [INCOME EXCLUSIONS.] The following must be 
235.1   excluded in determining a family's available income: 
235.2      (1) payments for basic care, difficulty of care, and 
235.3   clothing allowances received for providing family foster care to 
235.4   children or adults under Minnesota Rules, parts 9545.0010 to 
235.5   9545.0260 and 9555.5050 to 9555.6265, and payments received and 
235.6   used for care and maintenance of a third-party beneficiary who 
235.7   is not a household member; 
235.8      (2) reimbursements for employment training received through 
235.9   the Workforce Investment Act of 1998, United States Code, title 
235.10  20, chapter 73, section 9201; 
235.11     (3) reimbursement for out-of-pocket expenses incurred while 
235.12  performing volunteer services, jury duty, employment, or 
235.13  informal carpooling arrangements directly related to employment; 
235.14     (4) all educational assistance, except the county agency 
235.15  must count graduate student teaching assistantships, 
235.16  fellowships, and other similar paid work as earned income and, 
235.17  after allowing deductions for any unmet and necessary 
235.18  educational expenses, shall count scholarships or grants awarded 
235.19  to graduate students that do not require teaching or research as 
235.20  unearned income; 
235.21     (5) loans, regardless of purpose, from public or private 
235.22  lending institutions, governmental lending institutions, or 
235.23  governmental agencies; 
235.24     (6) loans from private individuals, regardless of purpose, 
235.25  provided an applicant or participant documents that the lender 
235.26  expects repayment; 
235.27     (7)(i) state income tax refunds; and 
235.28     (ii) federal income tax refunds; 
235.29     (8)(i) federal earned income credits; 
235.30     (ii) Minnesota working family credits; 
235.31     (iii) state homeowners and renters credits under chapter 
235.32  290A; and 
235.33     (iv) federal or state tax rebates; 
235.34     (9) funds received for reimbursement, replacement, or 
235.35  rebate of personal or real property when these payments are made 
235.36  by public agencies, awarded by a court, solicited through public 
236.1   appeal, or made as a grant by a federal agency, state or local 
236.2   government, or disaster assistance organizations, subsequent to 
236.3   a presidential declaration of disaster; 
236.4      (10) the portion of an insurance settlement that is used to 
236.5   pay medical, funeral, and burial expenses, or to repair or 
236.6   replace insured property; 
236.7      (11) reimbursements for medical expenses that cannot be 
236.8   paid by medical assistance; 
236.9      (12) payments by a vocational rehabilitation program 
236.10  administered by the state under chapter 268A, except those 
236.11  payments that are for current living expenses; 
236.12     (13) in-kind income, including any payments directly made 
236.13  by a third party to a provider of goods and services; 
236.14     (14) assistance payments to correct underpayments, but only 
236.15  for the month in which the payment is received; 
236.16     (15) payments for short-term emergency needs under section 
236.17  256J.626, subdivision 2; 
236.18     (16) funeral and cemetery payments as provided by section 
236.19  256.935; 
236.20     (17) nonrecurring cash gifts of $30 or less, not exceeding 
236.21  $30 per participant in a calendar month; 
236.22     (18) any form of energy assistance payment made through 
236.23  Public Law 97-35, Low-Income Home Energy Assistance Act of 1981, 
236.24  payments made directly to energy providers by other public and 
236.25  private agencies, and any form of credit or rebate payment 
236.26  issued by energy providers; 
236.27     (19) Supplemental Security Income (SSI), including 
236.28  retroactive SSI payments and other income of an SSI recipient, 
236.29  except as described in section 256J.37, subdivision 3b; 
236.30     (20) Minnesota supplemental aid, including retroactive 
236.31  payments; 
236.32     (21) proceeds from the sale of real or personal property; 
236.33     (22) state adoption assistance payments under section 
236.34  259.67, and up to an equal amount of county adoption assistance 
236.35  payments; 
236.36     (23) state-funded family subsidy program payments made 
237.1   under section 252.32 to help families care for children with 
237.2   mental retardation or related conditions, consumer support grant 
237.3   funds under section 256.476, and resources and services for a 
237.4   disabled household member under one of the home and 
237.5   community-based waiver services programs under chapter 256B; 
237.6      (24) interest payments and dividends from property that is 
237.7   not excluded from and that does not exceed the asset limit; 
237.8      (25) rent rebates; 
237.9      (26) income earned by a minor caregiver, minor child 
237.10  through age 6, or a minor child who is at least a half-time 
237.11  student in an approved elementary or secondary education 
237.12  program; 
237.13     (27) income earned by a caregiver under age 20 who is at 
237.14  least a half-time student in an approved elementary or secondary 
237.15  education program; 
237.16     (28) MFIP child care payments under section 119B.05; 
237.17     (29) all other payments made through MFIP to support a 
237.18  caregiver's pursuit of greater economic stability; 
237.19     (30) income a participant receives related to shared living 
237.20  expenses; 
237.21     (31) reverse mortgages; 
237.22     (32) benefits provided by the Child Nutrition Act of 1966, 
237.23  United States Code, title 42, chapter 13A, sections 1771 to 
237.24  1790; 
237.25     (33) benefits provided by the women, infants, and children 
237.26  (WIC) nutrition program, United States Code, title 42, chapter 
237.27  13A, section 1786; 
237.28     (34) benefits from the National School Lunch Act, United 
237.29  States Code, title 42, chapter 13, sections 1751 to 1769e; 
237.30     (35) relocation assistance for displaced persons under the 
237.31  Uniform Relocation Assistance and Real Property Acquisition 
237.32  Policies Act of 1970, United States Code, title 42, chapter 61, 
237.33  subchapter II, section 4636, or the National Housing Act, United 
237.34  States Code, title 12, chapter 13, sections 1701 to 1750jj; 
237.35     (36) benefits from the Trade Act of 1974, United States 
237.36  Code, title 19, chapter 12, part 2, sections 2271 to 2322; 
238.1      (37) war reparations payments to Japanese Americans and 
238.2   Aleuts under United States Code, title 50, sections 1989 to 
238.3   1989d; 
238.4      (38) payments to veterans or their dependents as a result 
238.5   of legal settlements regarding Agent Orange or other chemical 
238.6   exposure under Public Law 101-239, section 10405, paragraph 
238.7   (a)(2)(E); 
238.8      (39) income that is otherwise specifically excluded from 
238.9   MFIP consideration in federal law, state law, or federal 
238.10  regulation; 
238.11     (40) security and utility deposit refunds; 
238.12     (41) American Indian tribal land settlements excluded under 
238.13  Public Laws 98-123, 98-124, and 99-377 to the Mississippi Band 
238.14  Chippewa Indians of White Earth, Leech Lake, and Mille Lacs 
238.15  reservations and payments to members of the White Earth Band, 
238.16  under United States Code, title 25, chapter 9, section 331, and 
238.17  chapter 16, section 1407; 
238.18     (42) all income of the minor parent's parents and 
238.19  stepparents when determining the grant for the minor parent in 
238.20  households that include a minor parent living with parents or 
238.21  stepparents on MFIP with other children; 
238.22     (43) income of the minor parent's parents and stepparents 
238.23  equal to 200 percent of the federal poverty guideline for a 
238.24  family size not including the minor parent and the minor 
238.25  parent's child in households that include a minor parent living 
238.26  with parents or stepparents not on MFIP when determining the 
238.27  grant for the minor parent.  The remainder of income is deemed 
238.28  as specified in section 256J.37, subdivision 1b; 
238.29     (44) payments made to children eligible for relative 
238.30  custody assistance under section 257.85; 
238.31     (45) vendor payments for goods and services made on behalf 
238.32  of a client unless the client has the option of receiving the 
238.33  payment in cash; and 
238.34     (46) the principal portion of a contract for deed payment. 
238.35     Sec. 8.  Minnesota Statutes 2004, section 256J.521, 
238.36  subdivision 1, is amended to read: 
239.1      Subdivision 1.  [ASSESSMENTS.] (a) For purposes of MFIP 
239.2   employment services, assessment is a continuing process of 
239.3   gathering information related to employability for the purpose 
239.4   of identifying both participant's strengths and strategies for 
239.5   coping with issues that interfere with employment.  The job 
239.6   counselor must use information from the assessment process to 
239.7   develop and update the employment plan under subdivision 2 or 3, 
239.8   as appropriate, and to determine whether the participant 
239.9   qualifies for a family violence waiver including an employment 
239.10  plan under subdivision 3, and to determine whether the 
239.11  participant should be referred to the work participation rate 
239.12  enhancement program under section 256J.575. 
239.13     (b) The scope of assessment must cover at least the 
239.14  following areas: 
239.15     (1) basic information about the participant's ability to 
239.16  obtain and retain employment, including:  a review of the 
239.17  participant's education level; interests, skills, and abilities; 
239.18  prior employment or work experience; transferable work skills; 
239.19  child care and transportation needs; 
239.20     (2) identification of personal and family circumstances 
239.21  that impact the participant's ability to obtain and retain 
239.22  employment, including:  any special needs of the children, the 
239.23  level of English proficiency, family violence issues, and any 
239.24  involvement with social services or the legal system; 
239.25     (3) the results of a mental and chemical health screening 
239.26  tool designed by the commissioner and results of the brief 
239.27  screening tool for special learning needs.  Screening tools for 
239.28  mental and chemical health and special learning needs must be 
239.29  approved by the commissioner and may only be administered by job 
239.30  counselors or county staff trained in using such screening 
239.31  tools.  The commissioner shall work with county agencies to 
239.32  develop protocols for referrals and follow-up actions after 
239.33  screens are administered to participants, including guidance on 
239.34  how employment plans may be modified based upon outcomes of 
239.35  certain screens.  Participants must be told of the purpose of 
239.36  the screens and how the information will be used to assist the 
240.1   participant in identifying and overcoming barriers to 
240.2   employment.  Screening for mental and chemical health and 
240.3   special learning needs must be completed by participants who are 
240.4   unable to find suitable employment after six weeks of job search 
240.5   under subdivision 2, paragraph (b), and participants who are 
240.6   determined to have barriers to employment under subdivision 2, 
240.7   paragraph (d).  Failure to complete the screens will result in 
240.8   sanction under section 256J.46; and 
240.9      (4) a comprehensive review of participation and progress 
240.10  for participants who have received MFIP assistance and have not 
240.11  worked in unsubsidized employment during the past 12 months.  
240.12  The purpose of the review is to determine the need for 
240.13  additional services and supports, including placement in 
240.14  subsidized employment or unpaid work experience under section 
240.15  256J.49, subdivision 13, or referral to the work participation 
240.16  rate enhancement program under section 256J.575. 
240.17     (c) Information gathered during a caregiver's participation 
240.18  in the diversionary work program under section 256J.95 must be 
240.19  incorporated into the assessment process. 
240.20     (d) The job counselor may require the participant to 
240.21  complete a professional chemical use assessment to be performed 
240.22  according to the rules adopted under section 254A.03, 
240.23  subdivision 3, including provisions in the administrative rules 
240.24  which recognize the cultural background of the participant, or a 
240.25  professional psychological assessment as a component of the 
240.26  assessment process, when the job counselor has a reasonable 
240.27  belief, based on objective evidence, that a participant's 
240.28  ability to obtain and retain suitable employment is impaired by 
240.29  a medical condition.  The job counselor may assist the 
240.30  participant with arranging services, including child care 
240.31  assistance and transportation, necessary to meet needs 
240.32  identified by the assessment.  Data gathered as part of a 
240.33  professional assessment must be classified and disclosed 
240.34  according to the provisions in section 13.46. 
240.35     Sec. 9.  Minnesota Statutes 2004, section 256J.53, 
240.36  subdivision 2, is amended to read: 
241.1      Subd. 2.  [APPROVAL OF POSTSECONDARY EDUCATION OR 
241.2   TRAINING.] (a) In order for a postsecondary education or 
241.3   training program to be an approved activity in an employment 
241.4   plan, the participant must be working in unsubsidized employment 
241.5   at least 20 ten hours per week. 
241.6      (b) Participants seeking approval of a postsecondary 
241.7   education or training plan must provide documentation that: 
241.8      (1) the employment goal can only be met with the additional 
241.9   education or training; 
241.10     (2) there are suitable employment opportunities that 
241.11  require the specific education or training in the area in which 
241.12  the participant resides or is willing to reside; 
241.13     (3) the education or training will result in significantly 
241.14  higher wages for the participant than the participant could earn 
241.15  without the education or training; 
241.16     (4) the participant can meet the requirements for admission 
241.17  into the program; and 
241.18     (5) there is a reasonable expectation that the participant 
241.19  will complete the training program based on such factors as the 
241.20  participant's MFIP assessment, previous education, training, and 
241.21  work history; current motivation; and changes in previous 
241.22  circumstances. 
241.23     (c) The hourly unsubsidized employment requirement does not 
241.24  apply for intensive education or training programs lasting 12 
241.25  weeks or less when full-time attendance is required. 
241.26     (d) Participants with an approved employment plan in place 
241.27  on July 1, 2003, which includes more than 12 months of 
241.28  postsecondary education or training shall be allowed to complete 
241.29  that plan provided that hourly requirements in section 256J.55, 
241.30  subdivision 1, and conditions specified in paragraph (b), and 
241.31  subdivisions 3 and 5 are met.  A participant whose case is 
241.32  subsequently closed for three months or less for reasons other 
241.33  than noncompliance with program requirements and who returns to 
241.34  MFIP shall be allowed to complete that plan provided that hourly 
241.35  requirements in section 256J.55, subdivision 1, and conditions 
241.36  specified in paragraph (b) and subdivisions 3 and 5 are met. 
242.1      Sec. 10.  [256J.575] [WORK PARTICIPATION RATE ENHANCEMENT 
242.2   PROGRAM.] 
242.3      Subdivision 1.  [PURPOSE.] (a) The work participation rate 
242.4   enhancement program (WORK PREP) is Minnesota's TANF program to 
242.5   serve families who are not making significant progress within 
242.6   MFIP due to a variety of barriers to employment. 
242.7      (b) The goal of this program is to stabilize and improve 
242.8   the lives of families at risk of long-term welfare dependency or 
242.9   family instability due to employment barriers such as physical 
242.10  disability, mental disability, age, and caring for a disabled 
242.11  household member.  WORK PREP provides services to promote and 
242.12  support families to achieve the greatest possible degree of 
242.13  self-sufficiency.  Counties may provide supportive and other 
242.14  allowable services funded by the MFIP consolidated fund under 
242.15  section 256J.626 to eligible participants. 
242.16     Subd. 2.  [DEFINITIONS.] The terms used in this section 
242.17  have the meanings given them in paragraphs (a) to (d). 
242.18     (a) The "work participation rate enhancement program" means 
242.19  the program established under this section. 
242.20     (b) "Case management" means the services provided by or 
242.21  through the county agency to participating families, including 
242.22  assessment, information, referrals, and assistance in the 
242.23  preparation and implementation of a family stabilization plan 
242.24  under subdivision 5. 
242.25     (c) "Family stabilization plan" means a plan developed by a 
242.26  case manager and the participant, which identifies the 
242.27  participant's most appropriate path to unsubsidized employment, 
242.28  family stability, and barrier reduction, taking into account the 
242.29  family's circumstances. 
242.30     (d) "Family stabilization services" means programs, 
242.31  activities, and services in this section that provide 
242.32  participants and their family members with assistance regarding, 
242.33  but not limited to: 
242.34     (1) obtaining and retaining unsubsidized employment; 
242.35     (2) family stability; 
242.36     (3) economic stability; and 
243.1      (4) barrier reduction.  
243.2      The goal of the program is to achieve the greatest degree 
243.3   of economic self-sufficiency and family well-being possible for 
243.4   the family under the circumstances. 
243.5      Subd. 3.  [ELIGIBILITY.] (a) The following MFIP or DWP 
243.6   participants are eligible for the program under this section: 
243.7      (1) a participant identified under section 256J.561, 
243.8   subdivision 2, paragraph (d), who has or is eligible for an 
243.9   employment plan developed under section 256J.521, subdivision 2, 
243.10  paragraph (c); 
243.11     (2) a participant identified under section 256J.95, 
243.12  subdivision 12, paragraph (b), as unlikely to benefit from the 
243.13  diversionary work program; 
243.14     (3) a participant who meets the requirements for or has 
243.15  been granted a hardship extension under section 256J.425, 
243.16  subdivision 2 or 3; and 
243.17     (4) a participant who is applying for supplemental security 
243.18  income or Social Security disability insurance. 
243.19     (b) Families must meet all other eligibility requirements 
243.20  for MFIP established in this chapter.  Families are eligible for 
243.21  financial assistance to the same extent as if they were 
243.22  participating in MFIP. 
243.23     Subd. 4.  [UNIVERSAL PARTICIPATION.] All caregivers must 
243.24  participate in family stabilization services as defined in 
243.25  subdivision 2. 
243.26     Subd. 5.  [CASE MANAGEMENT; FAMILY STABILIZATION PLANS; 
243.27  COORDINATED SERVICES.] (a) The county agency shall provide 
243.28  family stabilization services to families through a case 
243.29  management model.  A case manager shall be assigned to each 
243.30  participating family within 30 days after the family begins to 
243.31  receive financial assistance as a participant of the work 
243.32  participation rate enhancement program.  The case manager, with 
243.33  the full involvement of the family, shall recommend, and the 
243.34  county agency shall establish and modify as necessary, a family 
243.35  stabilization plan for each participating family. 
243.36     (b) The family stabilization plan shall include: 
244.1      (1) each participant's plan for long-term self-sufficiency, 
244.2   including an employment goal where applicable; 
244.3      (2) an assessment of each participant's strengths and 
244.4   barriers, and any special circumstances of the participant's 
244.5   family that impact, or are likely to impact, the participant's 
244.6   progress towards the goals in the plan; and 
244.7      (3) an identification of the services, supports, education, 
244.8   training, and accommodations needed to overcome any barriers to 
244.9   enable the family to achieve self-sufficiency and to fulfill 
244.10  each caregiver's personal and family responsibilities. 
244.11     (c) The case manager and the participant must meet within 
244.12  30 days of the family's referral to the case manager.  The 
244.13  initial family stabilization plan shall be completed within 30 
244.14  days of the first meeting with the case manager.  The case 
244.15  manager shall establish a schedule for periodic review of the 
244.16  family stabilization plan that includes personal contact with 
244.17  the participant at least once per month.  In addition, the case 
244.18  manager shall review and modify if necessary the plan under the 
244.19  following circumstances: 
244.20     (1) there is a lack of satisfactory progress in achieving 
244.21  the goals of the plan; 
244.22     (2) the participant has lost unsubsidized or subsidized 
244.23  employment; 
244.24     (3) a family member has failed to comply with a family 
244.25  stabilization plan requirement; 
244.26     (4) services required by the plan are unavailable; or 
244.27     (5) changes to the plan are needed to promote the 
244.28  well-being of the children. 
244.29     (d) Family stabilization plans under this section shall be 
244.30  written for a period of time not to exceed six months. 
244.31     Subd. 6.  [COOPERATION WITH PROGRAM REQUIREMENTS.] (a) To 
244.32  be eligible, a participant must comply with paragraphs (b) to 
244.33  (f). 
244.34     (b) Participants shall engage in family stabilization plan 
244.35  activities listed in clause (1) or (2) for the number of hours 
244.36  per week that the activities are scheduled and available, unless 
245.1   good cause exists for not doing so, as defined in section 
245.2   256J.57, subdivision 1: 
245.3      (1) in single-parent families with no children under six 
245.4   years of age, the case manager and the participant must develop 
245.5   a family stabilization plan that includes 30 to 35 hours per 
245.6   week of activities; and 
245.7      (2) in single-parent families with a child under six years 
245.8   of age, the case manager and the participant must develop a 
245.9   family stabilization plan that includes 20 to 35 hours per week 
245.10  of activities. 
245.11     (c) The case manager shall review the participant's 
245.12  progress toward the goals in the family stabilization plan every 
245.13  six months to determine whether conditions have changed, 
245.14  including whether revisions to the plan are needed. 
245.15     (d) When the participant has increased participation in 
245.16  work-related activities sufficient to meet the federal 
245.17  participation requirements of TANF, the county agency shall 
245.18  refer the participant to the MFIP program and assign the 
245.19  participant to a job counselor.  The participant and the job 
245.20  counselor must meet within 15 days of referral to MFIP to 
245.21  develop an employment plan under section 256J.521.  No 
245.22  reapplication is necessary and financial assistance shall 
245.23  continue without interruption. 
245.24     (e) Participants who have not increased their participation 
245.25  in work activities sufficient to meet the federal participation 
245.26  requirements of TANF may request a referral to the MFIP program 
245.27  and assignment to a job counselor after 12 months in the program.
245.28     (f) A participant's requirement to comply with any or all 
245.29  family stabilization plan requirements under this subdivision 
245.30  shall be excused when the case management services, training and 
245.31  educational services, and family support services identified in 
245.32  the participant's family stabilization plan are unavailable for 
245.33  reasons beyond the control of the participant, including when 
245.34  money appropriated is not sufficient to provide the services. 
245.35     Subd. 7.  [SANCTIONS.] (a) The financial assistance grant 
245.36  of a participating family shall be reduced, according to section 
246.1   256J.46, if a participating adult fails without good cause to 
246.2   comply or continue to comply with the family stabilization plan 
246.3   requirements in this subdivision, unless compliance has been 
246.4   excused under subdivision 6, paragraph (f). 
246.5      (b) Given the purpose of the work participation rate 
246.6   enhancement program in this section and the nature of the 
246.7   underlying family circumstances that act as barriers to both 
246.8   employment and full compliance with program requirements, 
246.9   sanctions are appropriate only when it is clear that there is 
246.10  both ability to comply and willful noncompliance on the part of 
246.11  the participant.  
246.12     (c) Prior to the imposition of a sanction, the county 
246.13  agency must review the participant's case to determine if the 
246.14  family stabilization plan is still appropriate and meet with the 
246.15  participants face-to-face.  The participant may bring an 
246.16  advocate to the face-to-face meeting.  If a face-to-face meeting 
246.17  is not conducted, the county agency must send the participant a 
246.18  written notice that includes the information required under 
246.19  clause (1): 
246.20     (1) during the face-to-face meeting, the county agency must:
246.21     (i) determine whether the continued noncompliance can be 
246.22  explained and mitigated by providing a needed family 
246.23  stabilization service, as defined in subdivision 2, paragraph 
246.24  (d); 
246.25     (ii) determine whether the participant qualifies for a good 
246.26  cause exception under section 256J.57, or if the sanction is for 
246.27  noncooperation with child support requirements, determine if the 
246.28  participant qualifies for a good cause exemption under section 
246.29  256.741, subdivision 10; 
246.30     (iii) determine whether activities in the family 
246.31  stabilization plan are appropriate based on the family's 
246.32  circumstances; 
246.33     (iv) explain the consequences of continuing noncompliance; 
246.34     (v) identify other resources that may be available to the 
246.35  participant to meet the needs of the family; and 
246.36     (vi) inform the participant of the right to appeal under 
247.1   section 256J.40; and 
247.2      (2) if the lack of an identified activity or service can 
247.3   explain the noncompliance, the county must work with the 
247.4   participant to provide the identified activity. 
247.5      (d) After the requirements of paragraph (c) are met and 
247.6   prior to imposition of a sanction, the county agency shall 
247.7   provide a notice of intent to sanction under section 256J.57, 
247.8   subdivision 2, and, when applicable, a notice of adverse action 
247.9   as provided in section 256J.31. 
247.10     (e) Section 256J.57 applies to this section except to the 
247.11  extent that it is modified by this subdivision. 
247.12     Sec. 11.  [256J.621] [WORK PARTICIPATION BONUS.] 
247.13     Upon exiting the diversionary work program (DWP) or upon 
247.14  terminating MFIP cash assistance with earnings, a participant 
247.15  who is employed and working 24 hours a week may be eligible for 
247.16  transitional assistance of $50 per month to assist in meeting 
247.17  the family's basic needs as the participant continues to move 
247.18  toward self-sufficiency. 
247.19     To be eligible for a transitional assistance payment, the 
247.20  participant must not receive MFIP cash assistance or 
247.21  diversionary work program assistance during the month and must 
247.22  be employed an average of at least 24 hours a week.  
247.23  Transitional assistance shall be available for a maximum of 12 
247.24  months from the date the participant exited the diversionary 
247.25  work program or terminated MFIP cash assistance. 
247.26     The commissioner shall establish policies and develop forms 
247.27  to verify eligibility for transitional assistance.  The forms 
247.28  must contain all data elements required to meet federal TANF 
247.29  reporting requirements. 
247.30     Expenditures on the transitional assistance program shall 
247.31  be state-funded and treated as segregated funds under the 
247.32  state's TANF maintenance of effort requirement.  Months in which 
247.33  a participant receives transitional assistance under this 
247.34  section shall not count toward the participant's MFIP 60-month 
247.35  time limit. 
247.36     This section shall take effect if federal law changes the 
248.1   TANF work participation rates that states must meet and the 
248.2   commissioner determines that implementation of this program will 
248.3   enhance Minnesota's TANF work participation rates. 
248.4      Sec. 12.  Minnesota Statutes 2004, section 256J.626, 
248.5   subdivision 1, is amended to read: 
248.6      Subdivision 1.  [CONSOLIDATED FUND.] The consolidated fund 
248.7   is established to support counties and tribes in meeting their 
248.8   duties under this chapter.  Counties and tribes must use funds 
248.9   from the consolidated fund to develop programs and services that 
248.10  are designed to improve participant outcomes as measured in 
248.11  section 256J.751, subdivision 2, and to provide case management 
248.12  services to participants of the work participation rate 
248.13  enhancement program.  Counties may use the funds for any 
248.14  allowable expenditures under subdivision 2.  Tribes may use the 
248.15  funds for any allowable expenditures under subdivision 2, except 
248.16  those in clauses (1) and (6). 
248.17     Sec. 13.  Minnesota Statutes 2004, section 256J.626, 
248.18  subdivision 2, is amended to read: 
248.19     Subd. 2.  [ALLOWABLE EXPENDITURES.] (a) The commissioner 
248.20  must restrict expenditures under the consolidated fund to 
248.21  benefits and services allowed under title IV-A of the federal 
248.22  Social Security Act.  Allowable expenditures under the 
248.23  consolidated fund may include, but are not limited to: 
248.24     (1) short-term, nonrecurring shelter and utility needs that 
248.25  are excluded from the definition of assistance under Code of 
248.26  Federal Regulations, title 45, section 260.31, for families who 
248.27  meet the residency requirement in section 256J.12, subdivisions 
248.28  1 and 1a.  Payments under this subdivision are not considered 
248.29  TANF cash assistance and are not counted towards the 60-month 
248.30  time limit; 
248.31     (2) transportation needed to obtain or retain employment or 
248.32  to participate in other approved work activities or activities 
248.33  under a family stabilization plan; 
248.34     (3) direct and administrative costs of staff to deliver 
248.35  employment services for MFIP or, the diversionary work 
248.36  program, or the work participation rate enhancement program; to 
249.1   administer financial assistance,; and to provide specialized 
249.2   services intended to assist hard-to-employ participants to 
249.3   transition to work or transition from the work participation 
249.4   rate enhancement program to MFIP; 
249.5      (4) costs of education and training including functional 
249.6   work literacy and English as a second language; 
249.7      (5) cost of work supports including tools, clothing, boots, 
249.8   and other work-related expenses; 
249.9      (6) county administrative expenses as defined in Code of 
249.10  Federal Regulations, title 45, section 260(b); 
249.11     (7) services to parenting and pregnant teens; 
249.12     (8) supported work; 
249.13     (9) wage subsidies; 
249.14     (10) child care needed for MFIP or, the diversionary work 
249.15  program, or the work participation rate enhancement program 
249.16  participants to participate in social services; 
249.17     (11) child care to ensure that families leaving MFIP or 
249.18  diversionary work program will continue to receive child care 
249.19  assistance from the time the family no longer qualifies for 
249.20  transition year child care until an opening occurs under the 
249.21  basic sliding fee child care program; and 
249.22     (12) services to help noncustodial parents who live in 
249.23  Minnesota and have minor children receiving MFIP or DWP 
249.24  assistance, but do not live in the same household as the child, 
249.25  obtain or retain employment; and 
249.26     (13) services to help families participating in the work 
249.27  participation rate enhancement program achieve the greatest 
249.28  possible degree of self-sufficiency. 
249.29     (b) Administrative costs that are not matched with county 
249.30  funds as provided in subdivision 8 may not exceed 7.5 percent of 
249.31  a county's or 15 percent of a tribe's allocation under this 
249.32  section.  The commissioner shall define administrative costs for 
249.33  purposes of this subdivision. 
249.34     Sec. 14.  Minnesota Statutes 2004, section 256J.626, 
249.35  subdivision 3, is amended to read: 
249.36     Subd. 3.  [ELIGIBILITY FOR SERVICES.] Families with a minor 
250.1   child, a pregnant woman, or a noncustodial parent of a minor 
250.2   child receiving assistance, with incomes below 200 percent of 
250.3   the federal poverty guideline for a family of the applicable 
250.4   size, are eligible for services funded under the consolidated 
250.5   fund.  Counties and tribes must give priority to families 
250.6   currently receiving MFIP or, the diversionary work program, or 
250.7   the work participation rate enhancement program, and families at 
250.8   risk of receiving MFIP or diversionary work program. 
250.9      Sec. 15.  Minnesota Statutes 2004, section 256J.626, 
250.10  subdivision 4, is amended to read: 
250.11     Subd. 4.  [COUNTY AND TRIBAL BIENNIAL SERVICE AGREEMENTS.] 
250.12  (a) Effective January 1, 2004, and each two-year period 
250.13  thereafter, each county and tribe must have in place an approved 
250.14  biennial service agreement related to the services and programs 
250.15  in this chapter.  In counties with a city of the first class 
250.16  with a population over 300,000, the county must consider a 
250.17  service agreement that includes a jointly developed plan for the 
250.18  delivery of employment services with the city.  Counties may 
250.19  collaborate to develop multicounty, multitribal, or regional 
250.20  service agreements. 
250.21     (b) The service agreements will be completed in a form 
250.22  prescribed by the commissioner.  The agreement must include: 
250.23     (1) a statement of the needs of the service population and 
250.24  strengths and resources in the community; 
250.25     (2) numerical goals for participant outcomes measures to be 
250.26  accomplished during the biennial period.  The commissioner may 
250.27  identify outcomes from section 256J.751, subdivision 2, as core 
250.28  outcomes for all counties and tribes; 
250.29     (3) strategies the county or tribe will pursue to achieve 
250.30  the outcome targets.  Strategies must include specification of 
250.31  how funds under this section will be used and may include 
250.32  community partnerships that will be established or strengthened; 
250.33  and 
250.34     (4) strategies the county or tribe will pursue under the 
250.35  work participation rate enhancement program; and 
250.36     (5) other items prescribed by the commissioner in 
251.1   consultation with counties and tribes. 
251.2      (c) The commissioner shall provide each county and tribe 
251.3   with information needed to complete an agreement, including:  
251.4   (1) information on MFIP cases in the county or tribe; (2) 
251.5   comparisons with the rest of the state; (3) baseline performance 
251.6   on outcome measures; and (4) promising program practices. 
251.7      (d) The service agreement must be submitted to the 
251.8   commissioner by October 15, 2003, and October 15 of each second 
251.9   year thereafter.  The county or tribe must allow a period of not 
251.10  less than 30 days prior to the submission of the agreement to 
251.11  solicit comments from the public on the contents of the 
251.12  agreement. 
251.13     (e) The commissioner must, within 60 days of receiving each 
251.14  county or tribal service agreement, inform the county or tribe 
251.15  if the service agreement is approved.  If the service agreement 
251.16  is not approved, the commissioner must inform the county or 
251.17  tribe of any revisions needed prior to approval. 
251.18     (f) The service agreement in this subdivision supersedes 
251.19  the plan requirements of section 116L.88. 
251.20     Sec. 16.  Minnesota Statutes 2004, section 256J.626, 
251.21  subdivision 7, is amended to read: 
251.22     Subd. 7.  [PERFORMANCE BASE FUNDS.] (a) Beginning calendar 
251.23  year 2005, each county and tribe will be allocated 95 100 
251.24  percent of their initial calendar year allocation.  Counties and 
251.25  tribes will be allocated additional funds from federal TANF 
251.26  bonus funds the state receives based on performance as follows: 
251.27     (1) for calendar year 2005, a county or tribe that achieves 
251.28  a 30 percent rate or higher on the MFIP participation rate under 
251.29  section 256J.751, subdivision 2, clause (8), as averaged across 
251.30  the four quarterly measurements for the most recent year for 
251.31  which the measurements are available, will receive an additional 
251.32  allocation equal to 2.5 percent of its initial allocation to be 
251.33  determined by the commissioner based upon available funds; and 
251.34     (2) for calendar year 2006, a county or tribe that achieves 
251.35  a 40 percent rate or a five percentage point improvement over 
251.36  the previous year's MFIP participation rate under section 
252.1   256J.751, subdivision 2, clause (8), as averaged across the four 
252.2   quarterly measurements for the most recent year for which the 
252.3   measurements are available, will receive an additional 
252.4   allocation equal to 2.5 percent of its initial allocation to be 
252.5   determined by the commissioner based upon available funds; and 
252.6      (3) for calendar year 2007, a county or tribe that achieves 
252.7   a 50 percent rate or a five percentage point improvement over 
252.8   the previous year's MFIP participation rate under section 
252.9   256J.751, subdivision 2, clause (8), as averaged across the four 
252.10  quarterly measurements for the most recent year for which the 
252.11  measurements are available, will receive an additional 
252.12  allocation equal to 2.5 percent of its initial allocation to be 
252.13  determined by the commissioner based upon available funds; and 
252.14     (4) for calendar year 2008 and yearly thereafter, a county 
252.15  or tribe that achieves a 50 percent MFIP participation rate 
252.16  under section 256J.751, subdivision 2, clause (8), as averaged 
252.17  across the four quarterly measurements for the most recent year 
252.18  for which the measurements are available, will receive an 
252.19  additional allocation equal to 2.5 percent of its initial 
252.20  allocation to be determined by the commissioner based upon 
252.21  available funds; and 
252.22     (5) for calendar years 2005 and thereafter, a county or 
252.23  tribe that performs above the top of its range of expected 
252.24  performance on the three-year self-support index under section 
252.25  256J.751, subdivision 2, clause (7), in both measurements in the 
252.26  preceding year will receive an additional allocation equal to 
252.27  five percent of its initial allocation to be determined by the 
252.28  commissioner based upon available funds; or 
252.29     (6) for calendar years 2005 and thereafter, a county or 
252.30  tribe that performs within its range of expected performance on 
252.31  the three-year self-support index under section 256J.751, 
252.32  subdivision 2, clause (7), in both measurements in the preceding 
252.33  year, or above the top of its range of expected performance in 
252.34  one measurement and within its expected range of performance in 
252.35  the other measurement, will receive an additional allocation 
252.36  equal to 2.5 percent of its initial allocation to be determined 
253.1   by the commissioner based upon available funds. 
253.2      (b) Funds remaining unallocated after the performance-based 
253.3   allocations in paragraph (a) are available to the commissioner 
253.4   for innovation projects under subdivision 5. 
253.5      (c)(1) If available funds are insufficient to meet county 
253.6   and tribal allocations under paragraph (a), the commissioner may 
253.7   make available for allocation funds that are unobligated and 
253.8   available from the innovation projects through the end of the 
253.9   current biennium. 
253.10     (2) If after the application of clause (1) funds remain 
253.11  insufficient to meet county and tribal allocations under 
253.12  paragraph (a), the commissioner must proportionally reduce the 
253.13  allocation of each county and tribe with respect to their 
253.14  maximum allocation available under paragraph (a). 
253.15     Sec. 17.  Minnesota Statutes 2004, section 256J.95, 
253.16  subdivision 3, is amended to read: 
253.17     Subd. 3.  [ELIGIBILITY FOR DIVERSIONARY WORK PROGRAM.] (a) 
253.18  Except for the categories of family units listed below, all 
253.19  family units who apply for cash benefits and who meet MFIP 
253.20  eligibility as required in sections 256J.11 to 256J.15 are 
253.21  eligible and must participate in the diversionary work program.  
253.22  Family units that are not eligible for the diversionary work 
253.23  program include: 
253.24     (1) child only cases; 
253.25     (2) a single-parent family unit that includes a child under 
253.26  12 weeks of age.  A parent is eligible for this exception once 
253.27  in a parent's lifetime and is not eligible if the parent has 
253.28  already used the previously allowed child under age one 
253.29  exemption from MFIP employment services; 
253.30     (3) a minor parent without a high school diploma or its 
253.31  equivalent; 
253.32     (4) an 18- or 19-year-old caregiver without a high school 
253.33  diploma or its equivalent who chooses to have an employment plan 
253.34  with an education option; 
253.35     (5) a caregiver age 60 or over; 
253.36     (6) family units with a caregiver who received DWP benefits 
254.1   in the 12 months prior to the month the family applied for DWP, 
254.2   except as provided in paragraph (c); 
254.3      (7) family units with a caregiver who received MFIP within 
254.4   the 12 months prior to the month the family unit applied for 
254.5   DWP; 
254.6      (8) a family unit with a caregiver who received 60 or more 
254.7   months of TANF assistance; and 
254.8      (9) a family unit with a caregiver who is disqualified from 
254.9   DWP or MFIP due to fraud. 
254.10     (b) A two-parent family must participate in DWP unless both 
254.11  caregivers meet the criteria for an exception under paragraph 
254.12  (a), clauses (1) through (5), or the family unit includes a 
254.13  parent who meets the criteria in paragraph (a), clause (6), (7), 
254.14  (8), or (9). 
254.15     (c) Once DWP eligibility is determined, the four months run 
254.16  consecutively.  If a participant leaves the program for any 
254.17  reason and reapplies during the four-month period, the county 
254.18  must redetermine eligibility for DWP. 
254.19     (d) Newly arrived refugees and asylees as defined in Code 
254.20  of Federal Regulations, title 45, chapter IV, section 400.2, who 
254.21  have arrived in the United States within the last two months 
254.22  shall be exempt from mandatory participation in the diversionary 
254.23  work program and may enroll directly into the MFIP program. 
254.24     <b>[EFFECTIVE DATE.]</b> This section is effective the day 
254.25  following final enactment. 
254.26     Sec. 18.  Minnesota Statutes 2004, section 256J.95, 
254.27  subdivision 9, is amended to read: 
254.28     Subd. 9.  [PROPERTY AND INCOME LIMITATIONS.] The asset 
254.29  limits and exclusions in section 256J.20 apply to applicants and 
254.30  recipients of DWP.  All payments, unless excluded in section 
254.31  256J.21, must be counted as income to determine eligibility for 
254.32  the diversionary work program.  The county shall treat income as 
254.33  outlined in section 256J.37, except for subdivision 3a.  The 
254.34  initial income test and the disregards in section 256J.21, 
254.35  subdivision 3, shall be followed for determining eligibility for 
254.36  the diversionary work program. 
255.1      Sec. 19.  [REPEALER.] 
255.2      Minnesota Statutes 2004, section 256J.37, subdivisions 3a 
255.3   and 3b, are repealed effective the first day of the second month 
255.4   after the date of approval by the United States Department of 
255.5   Agriculture. 
255.6                              ARTICLE 7
255.7                            MISCELLANEOUS
255.8      Section 1.  [151.52] [MANUFACTURER PRICE REPORT.] 
255.9      Subdivision 1.  [REPORT.] All drug manufacturers registered 
255.10  or licensed to do business in this state shall, on a quarterly 
255.11  basis, report by National Drug Code the following pharmaceutical 
255.12  pricing criteria to the commissioner of human services for each 
255.13  of their drugs:  average wholesale price, wholesale acquisition 
255.14  cost, average manufacturer price as defined in United States 
255.15  Code, title 42, chapter 7, subchapter XIX, section 1396r-8(k), 
255.16  and best price as defined in United States Code, title 42, 
255.17  chapter 7, subchapter XIX, section 1396r-8(c)(1)(C).  The 
255.18  calculation of average wholesale price and wholesale acquisition 
255.19  cost shall be the net of all volume discounts, prompt payment 
255.20  discounts, chargebacks, short-dated product discounts, cash 
255.21  discounts, free goods, rebates, and all other price concessions 
255.22  or incentives provided to a purchaser that result in a reduction 
255.23  in the ultimate cost to the purchaser.  When reporting average 
255.24  wholesale price, wholesale acquisition cost, average 
255.25  manufacturer price, and best price, manufacturers shall also 
255.26  include a detailed description of the methodology by which the 
255.27  prices were calculated.  When a manufacturer reports average 
255.28  wholesale price, wholesale acquisition cost, average 
255.29  manufacturer price, or best price, the president or chief 
255.30  executive officer of the manufacturer shall certify on a form 
255.31  provided by the commissioner of human services, that the 
255.32  reported prices are accurate.  Any information reported under 
255.33  this section shall be classified as nonpublic data under section 
255.34  13.02, subdivision 9.  Notwithstanding the classification of 
255.35  data in this section and subdivision 2, the Minnesota Attorney 
255.36  General's Office, the federal Centers for Medicare and Medicaid 
256.1   Services or another law enforcement agency may access and obtain 
256.2   copies of the data required under this section and use that data 
256.3   for law enforcement purposes. 
256.4      Subd. 2.  [PENALTIES AND REMEDIES.] The attorney general 
256.5   may pursue the penalties and remedies available to the attorney 
256.6   general under section 8.31 against any manufacturer who violates 
256.7   this section.  
256.8      Sec. 2.  [151.55] [CANCER DRUG REPOSITORY PROGRAM.] 
256.9      Subdivision 1.  [DEFINITIONS.] (a) For the purposes of this 
256.10  section, the terms defined in this subdivision have the meanings 
256.11  given. 
256.12     (b) "Board" means the Board of Pharmacy.  
256.13     (c) "Cancer drug" means a prescription drug that is used to 
256.14  treat:  
256.15     (1) cancer or the side effects of cancer; or 
256.16     (2) the side effects of any prescription drug that is used 
256.17  to treat cancer or the side effects of cancer.  
256.18     (d) "Cancer drug repository" means a medical facility or 
256.19  pharmacy that has notified the board of its election to 
256.20  participate in the cancer drug repository program.  
256.21     (e) "Cancer supply" or "supplies" means prescription and 
256.22  nonprescription cancer supplies needed to administer a cancer 
256.23  drug.  
256.24     (f) "Dispense" has the meaning given in section 151.01, 
256.25  subdivision 30.  
256.26     (g) "Distribute" means to deliver, other than by 
256.27  administering or dispensing.  
256.28     (h) "Medical facility" means an institution defined in 
256.29  section 144.50, subdivision 2.  
256.30     (i) "Medical supplies" means any prescription and 
256.31  nonprescription medical supply needed to administer a cancer 
256.32  drug.  
256.33     (j) "Pharmacist" has the meaning given in section 151.01, 
256.34  subdivision 3.  
256.35     (k) "Pharmacy" means any pharmacy registered with the Board 
256.36  of Pharmacy according to section 151.19, subdivision 1.  
257.1      (l) "Practitioner" has the meaning given in section 151.01, 
257.2   subdivision 23.  
257.3      (m) "Prescription drug" means a legend drug as defined in 
257.4   section 151.01, subdivision 17.  
257.5      (n) "Side effects of cancer" means symptoms of cancer.  
257.6      (o) "Single-unit-dose packaging" means a single-unit 
257.7   container for articles intended for administration as a single 
257.8   dose, direct from the container. 
257.9      (p) "Tamper-evident unit dose packaging" means a container 
257.10  within which a drug is sealed so that the contents cannot be 
257.11  opened without obvious destruction of the seal.  
257.12     Subd. 2.  [ESTABLISHMENT.] The Board of Pharmacy shall 
257.13  establish and maintain a cancer drug repository program, under 
257.14  which any person may donate a cancer drug or supply for use by 
257.15  an individual who meets the eligibility criteria specified under 
257.16  subdivision 4.  Under the program, donations may be made on the 
257.17  premises of a medical facility or pharmacy that elects to 
257.18  participate in the program and meets the requirements specified 
257.19  under subdivision 3.  
257.20     Subd. 3.  [REQUIREMENTS FOR PARTICIPATION BY PHARMACIES AND 
257.21  MEDICAL FACILITIES.] (a) To be eligible for participation in the 
257.22  cancer drug repository program, a pharmacy or medical facility 
257.23  must be licensed and in compliance with all applicable federal 
257.24  and state laws and administrative rules.  
257.25     (b) Participation in the cancer drug repository program is 
257.26  voluntary.  A pharmacy or medical facility may elect to 
257.27  participate in the cancer drug repository program by submitting 
257.28  the following information to the board, in a form provided by 
257.29  the board:  
257.30     (1) the name, street address, and telephone number of the 
257.31  pharmacy or medical facility; 
257.32     (2) the name and telephone number of a pharmacist who is 
257.33  employed by or under contract with the pharmacy or medical 
257.34  facility, or other contact person who is familiar with the 
257.35  pharmacy's or medical facility's participation in the cancer 
257.36  drug repository program; and 
258.1      (3) a statement indicating that the pharmacy or medical 
258.2   facility meets the eligibility requirements under paragraph (a) 
258.3   and the chosen level of participation under paragraph (c). 
258.4      (c) A pharmacy or medical facility may fully participate in 
258.5   the cancer drug repository program by accepting, storing, and 
258.6   dispensing or administering donated drugs and supplies, or may 
258.7   limit its participation to only accepting and storing donated 
258.8   drugs and supplies.  If a pharmacy or facility chooses to limit 
258.9   its participation, the pharmacy or facility shall distribute any 
258.10  donated drugs to a fully participating cancer drug repository 
258.11  according to subdivision 8.  
258.12     (d) A pharmacy or medical facility may withdraw from 
258.13  participation in the cancer drug repository program at any time 
258.14  upon notification to the board.  A notice to withdraw from 
258.15  participation may be given by telephone or regular mail.  
258.16     Subd. 4.  [INDIVIDUAL ELIGIBILITY REQUIREMENTS.] Any 
258.17  Minnesota resident who is diagnosed with cancer is eligible to 
258.18  receive drugs or supplies under the cancer drug repository 
258.19  program.  Drugs and supplies shall be dispensed or administered 
258.20  according to the priority given under subdivision 6, paragraph 
258.21  (d).  
258.22     Subd. 5.  [DONATIONS OF CANCER DRUGS AND SUPPLIES.] (a) Any 
258.23  one of the following persons may donate legally obtained cancer 
258.24  drugs or supplies to a cancer drug repository, if the drugs or 
258.25  supplies meet the requirements under paragraph (b) or (c) as 
258.26  determined by a pharmacist who is employed by or under contract 
258.27  with a cancer drug repository:  
258.28     (1) an individual who is 18 years old or older; or 
258.29     (2) a pharmacy, medical facility, drug manufacturer, or 
258.30  wholesale drug distributor, if the donated drugs have not been 
258.31  previously dispensed.  
258.32     (b) A cancer drug is eligible for donation under the cancer 
258.33  drug repository program only if the following requirements are 
258.34  met:  
258.35     (1) the donation is accompanied by a cancer drug repository 
258.36  donor form described under paragraph (d) that is signed by the 
259.1   person making the donation or that person's authorized 
259.2   representative; 
259.3      (2) the drug's expiration date is at least six months later 
259.4   than the date that the drug was donated; 
259.5      (3) the drug is in its original, unopened, tamper-evident 
259.6   unit dose packaging that includes the drug's lot number and 
259.7   expiration date.  Single-unit dose drugs may be accepted if the 
259.8   single-unit-dose packaging is unopened; and 
259.9      (4) the drug is not adulterated or misbranded.  
259.10     (c) Cancer supplies are eligible for donation under the 
259.11  cancer drug repository program only if the following 
259.12  requirements are met:  
259.13     (1) the supplies are not adulterated or misbranded; 
259.14     (2) the supplies are in their original, unopened, sealed 
259.15  packaging; and 
259.16     (3) the donation is accompanied by a cancer drug repository 
259.17  donor form described under paragraph (d) that is signed by the 
259.18  person making the donation or that person's authorized 
259.19  representative.  
259.20     (d) The cancer drug repository donor form must be provided 
259.21  by the board and shall state that to the best of the donor's 
259.22  knowledge the donated drug or supply has been properly stored 
259.23  and that the drug or supply has never been opened, used, 
259.24  tampered with, adulterated, or misbranded.  The board shall make 
259.25  the cancer drug repository donor form available on the 
259.26  Department of Health's Web site.  
259.27     (e) Controlled substances and drugs and supplies that do 
259.28  not meet the criteria under this subdivision are not eligible 
259.29  for donation or acceptance under the cancer drug repository 
259.30  program. 
259.31     (f) Drugs and supplies may be donated on the premises of a 
259.32  cancer drug repository to a pharmacist designated by the 
259.33  repository.  A drop box may not be used to deliver or accept 
259.34  donations.  
259.35     (g) Cancer drugs and supplies donated under the cancer drug 
259.36  repository program must be stored in a secure storage area under 
260.1   environmental conditions appropriate for the drugs or supplies 
260.2   being stored.  Donated drugs and supplies may not be stored with 
260.3   nondonated inventory.  
260.4      Subd. 6.  [DISPENSING REQUIREMENTS.] (a) Drugs and supplies 
260.5   must be dispensed by a licensed pharmacist pursuant to a 
260.6   prescription by a practitioner or may be dispensed or 
260.7   administered by a practitioner according to the requirements of 
260.8   chapter 151 and within the practitioner's scope of practice. 
260.9      (b) Cancer drugs and supplies shall be visually inspected 
260.10  by the pharmacist or practitioner before being dispensed or 
260.11  administered for adulteration, misbranding, and date of 
260.12  expiration.  Drugs or supplies that have expired or appear upon 
260.13  visual inspection to be adulterated, misbranded, or tampered 
260.14  with in any way may not be dispensed or administered.  
260.15     (c) Before a cancer drug or supply may be dispensed or 
260.16  administered to an individual, the individual must sign a cancer 
260.17  drug repository recipient form provided by the board 
260.18  acknowledging that the individual understands the information 
260.19  stated on the form.  The form shall include the following 
260.20  information:  
260.21     (1) that the drug or supply being dispensed or administered 
260.22  has been donated and may have been previously dispensed; 
260.23     (2) that a visual inspection has been conducted by the 
260.24  pharmacist or practitioner to ensure that the drug has not 
260.25  expired, has not been adulterated or misbranded, and is in its 
260.26  original, unopened packaging; and 
260.27     (3) that the dispensing pharmacist, the dispensing or 
260.28  administering practitioner, the cancer drug repository, the 
260.29  state Department of Health, and any other participant of the 
260.30  cancer drug repository program cannot guarantee the safety of 
260.31  the drug or supply being dispensed or administered and that the 
260.32  pharmacist or practitioner has determined that the drug or 
260.33  supply is safe to dispense or administer based on the accuracy 
260.34  of the donor's form submitted with the donated drug or supply 
260.35  and the visual inspection required to be performed by the 
260.36  pharmacist or practitioner before dispensing or administering.  
261.1   The board shall make the cancer drug repository form available 
261.2   on the Department of Health's Web site.  
261.3      (d) Drugs and supplies shall only be dispensed or 
261.4   administered to individuals who meet the eligibility 
261.5   requirements in subdivision 4 and in the following order of 
261.6   priority:  
261.7      (1) individuals who are uninsured; 
261.8      (2) individuals who are enrolled in medical assistance, 
261.9   general assistance medical care, MinnesotaCare, Medicare, or 
261.10  other public assistance health care; and 
261.11     (3) all other individuals who are otherwise eligible under 
261.12  subdivision 4 to receive drugs or supplies from a cancer drug 
261.13  repository.  
261.14     Subd. 7.  [HANDLING FEES.] A cancer drug repository may 
261.15  charge the individual receiving a drug or supply a handling fee 
261.16  of no more than 250 percent of the medical assistance program 
261.17  dispensing fee for each cancer drug or supply dispensed or 
261.18  administered.  
261.19     Subd. 8.  [DISTRIBUTION OF DONATED CANCER DRUGS AND 
261.20  SUPPLIES.] (a) Cancer drug repositories may distribute drugs and 
261.21  supplies donated under the cancer drug repository program to 
261.22  other repositories if requested by a participating repository.  
261.23     (b) A cancer drug repository that has elected not to 
261.24  dispense donated drugs or supplies shall distribute any donated 
261.25  drugs and supplies to a participating repository upon request of 
261.26  the repository.  
261.27     (c) If a cancer drug repository distributes drugs or 
261.28  supplies under paragraph (a) or (b), the repository shall 
261.29  complete a cancer drug repository donor form provided by the 
261.30  board.  The completed form and a copy of the donor form that was 
261.31  completed by the original donor under subdivision 5 shall be 
261.32  provided to the fully participating cancer drug repository at 
261.33  the time of distribution. 
261.34     Subd. 9.  [RESALE OF DONATED DRUGS OR SUPPLIES.] Donated 
261.35  drugs and supplies may not be resold.  
261.36     Subd. 10.  [RECORD-KEEPING REQUIREMENTS.] (a) Cancer drug 
262.1   repository donor and recipient forms shall be maintained for at 
262.2   least five years.  
262.3      (b) A record of destruction of donated drugs and supplies 
262.4   that are not dispensed under subdivision 6 shall be maintained 
262.5   by the dispensing repository for at least five years.  For each 
262.6   drug or supply destroyed, the record shall include the following 
262.7   information:  
262.8      (1) the date of destruction; 
262.9      (2) the name, strength, and quantity of the cancer drug 
262.10  destroyed; 
262.11     (3) the name of the person or firm that destroyed the drug; 
262.12  and 
262.13     (4) the source of the drugs or supplies destroyed.  
262.14     Subd. 11.  [LIABILITY.] A medical facility or pharmacy 
262.15  participating in the program, a pharmacist dispensing a drug or 
262.16  supply pursuant to the program, a practitioner dispensing or 
262.17  administering a drug or supply pursuant to the program, or the 
262.18  donor of a cancer drug or supply is immune from civil liability 
262.19  for an act or omission relating to the quality of a cancer drug 
262.20  or supply that causes injury to or the death of an individual to 
262.21  whom the cancer drug or supply is dispensed or administered and 
262.22  no disciplinary action shall be taken against a pharmacist or 
262.23  practitioner so long as the drug or supply is donated, accepted, 
262.24  distributed, and dispensed or administered according to the 
262.25  requirements of this section.  This immunity does not apply if 
262.26  the act or omission involves reckless, wanton, or intentional 
262.27  misconduct or malpractice unrelated to the quality of the 
262.28  donated cancer drug or supply. 
262.29     Sec. 3.  Minnesota Statutes 2004, section 241.01, is 
262.30  amended by adding a subdivision to read: 
262.31     Subd. 10.  [PURCHASING FOR PRESCRIPTION DRUGS.] In 
262.32  accordance with section 241.021, subdivision 4, the commissioner 
262.33  may contract with a separate entity to purchase prescription 
262.34  drugs for persons confined in institutions under the control of 
262.35  the commissioner.  Local governments may participate in this 
262.36  purchasing pool in order to purchase prescription drugs for 
263.1   those persons confined in local correctional facilities in which 
263.2   the local government has responsibility for providing health 
263.3   care.  If any county participates, the commissioner shall 
263.4   appoint a county representative to any committee convened by the 
263.5   commissioner for the purpose of establishing a drug formulary to 
263.6   be used for state and local correctional facilities. 
263.7      Sec. 4.  Minnesota Statutes 2004, section 256.741, 
263.8   subdivision 4, is amended to read: 
263.9      Subd. 4.  [EFFECT OF ASSIGNMENT.] Assignments in this 
263.10  section take effect upon a determination that the applicant is 
263.11  eligible for public assistance.  The amount of support assigned 
263.12  under this subdivision may not exceed the total amount of public 
263.13  assistance issued or the total support obligation, whichever is 
263.14  less.  Child care support collections made according to an 
263.15  assignment under subdivision 2, paragraph (c), must be 
263.16  deposited, subject to any limitations of federal law, by the 
263.17  commissioner of human services in the child support collection 
263.18  account in the special revenue fund and appropriated to the 
263.19  commissioner of education for child care assistance under 
263.20  section 119B.03.  These collections are in addition to state and 
263.21  federal funds appropriated to the child care in the general fund.
263.22     Sec. 5.  [256.957] [HEALTH CARE QUALITY IMPROVEMENT 
263.23  ACCOUNT.] 
263.24     A health care quality improvement account is established in 
263.25  the general fund. 
263.26     Sec. 6.  Minnesota Statutes 2004, section 256B.0625, 
263.27  subdivision 13e, is amended to read: 
263.28     Subd. 13e.  [PAYMENT RATES.] (a) The basis for determining 
263.29  the amount of payment shall be the lower of the actual 
263.30  acquisition costs of the drugs plus a fixed dispensing fee; the 
263.31  maximum allowable cost set by the federal government or by the 
263.32  commissioner plus the fixed dispensing fee; or the usual and 
263.33  customary price charged to the public.  The amount of payment 
263.34  basis must be reduced to reflect all discount amounts applied to 
263.35  the charge by any provider/insurer agreement or contract for 
263.36  submitted charges to medical assistance programs.  The net 
264.1   submitted charge may not be greater than the patient liability 
264.2   for the service.  The pharmacy dispensing fee shall be $3.65, 
264.3   except that the dispensing fee for intravenous solutions which 
264.4   must be compounded by the pharmacist shall be $8 per bag, $14 
264.5   per bag for cancer chemotherapy products, and $30 per bag for 
264.6   total parenteral nutritional products dispensed in one liter 
264.7   quantities, or $44 per bag for total parenteral nutritional 
264.8   products dispensed in quantities greater than one liter.  Actual 
264.9   acquisition cost includes quantity and other special discounts 
264.10  except time and cash discounts.  The actual acquisition cost of 
264.11  a drug shall be estimated by the commissioner, at average 
264.12  wholesale price minus 11.5 percent, except that where a drug has 
264.13  had its wholesale price reduced as a result of the actions of 
264.14  the National Association of Medicaid Fraud Control Units, the 
264.15  estimated actual acquisition cost shall be the reduced average 
264.16  wholesale price, without the 11.5 percent deduction.  The 
264.17  maximum allowable cost of a multisource drug may be set by the 
264.18  commissioner and it shall be comparable to, but no higher than, 
264.19  the maximum amount paid by other third-party payors in this 
264.20  state who have maximum allowable cost programs.  Establishment 
264.21  of the amount of payment for drugs shall not be subject to the 
264.22  requirements of the Administrative Procedure Act.  
264.23     (b) An additional dispensing fee of $.30 may be added to 
264.24  the dispensing fee paid to pharmacists for legend drug 
264.25  prescriptions dispensed to residents of long-term care 
264.26  facilities when a unit dose blister card system, approved by the 
264.27  department, is used.  Under this type of dispensing system, the 
264.28  pharmacist must dispense a 30-day supply of drug.  The National 
264.29  Drug Code (NDC) from the drug container used to fill the blister 
264.30  card must be identified on the claim to the department.  The 
264.31  unit dose blister card containing the drug must meet the 
264.32  packaging standards set forth in Minnesota Rules, part 
264.33  6800.2700, that govern the return of unused drugs to the 
264.34  pharmacy for reuse.  The pharmacy provider will be required to 
264.35  credit the department for the actual acquisition cost of all 
264.36  unused drugs that are eligible for reuse.  Over-the-counter 
265.1   medications must be dispensed in the manufacturer's unopened 
265.2   package.  The commissioner may permit the drug clozapine to be 
265.3   dispensed in a quantity that is less than a 30-day supply.  
265.4      (c) Whenever a generically equivalent product is available, 
265.5   payment shall be on the basis of the actual acquisition cost of 
265.6   the generic drug, or on the maximum allowable cost established 
265.7   by the commissioner. 
265.8      (d) The basis for determining the amount of payment for 
265.9   drugs administered in an outpatient setting shall be the lower 
265.10  of the usual and customary cost submitted by the provider, the 
265.11  average wholesale price minus five percent, or the maximum 
265.12  allowable cost set by the federal government under United States 
265.13  Code, title 42, chapter 7, section 1396r-8(e), and Code of 
265.14  Federal Regulations, title 42, section 447.332, or by the 
265.15  commissioner under paragraphs (a) to (c). 
265.16     (e) The commissioner may consider the prices reported under 
265.17  section 151.52, when determining reimbursement payments under 
265.18  this subdivision.  
265.19     Sec. 7.  Minnesota Statutes 2004, section 295.582, is 
265.20  amended to read: 
265.21     295.582 [AUTHORITY.] 
265.22     Subdivision 1.  [WHOLESALE DRUG DISTRIBUTOR TAX.] (a) A 
265.23  hospital, surgical center, or health care provider that is 
265.24  subject to a tax under section 295.52, or a pharmacy that has 
265.25  paid additional expense transferred under this section by a 
265.26  wholesale drug distributor, may transfer additional expense 
265.27  generated by section 295.52 obligations on to all third-party 
265.28  contracts for the purchase of health care services on behalf of 
265.29  a patient or consumer.  Nothing shall prohibit a pharmacy from 
265.30  transferring the additional expense generated under section 
265.31  295.52 to a pharmacy benefits manager.  The additional expense 
265.32  transferred to the third-party purchaser or a pharmacy benefits 
265.33  manager must not exceed the tax percentage specified in section 
265.34  295.52 multiplied against the gross revenues received under the 
265.35  third-party contract, and the tax percentage specified in 
265.36  section 295.52 multiplied against co-payments and deductibles 
266.1   paid by the individual patient or consumer.  The expense must 
266.2   not be generated on revenues derived from payments that are 
266.3   excluded from the tax under section 295.53.  All third-party 
266.4   purchasers of health care services including, but not limited 
266.5   to, third-party purchasers regulated under chapter 60A, 62A, 
266.6   62C, 62D, 62H, 62N, 64B, 65A, 65B, 79, or 79A, or under section 
266.7   471.61 or 471.617, and pharmacy benefits managers must pay the 
266.8   transferred expense in addition to any payments due under 
266.9   existing contracts with the hospital, surgical center, pharmacy, 
266.10  or health care provider, to the extent allowed under federal 
266.11  law.  A third-party purchaser of health care services includes, 
266.12  but is not limited to, a health carrier or community integrated 
266.13  service network that pays for health care services on behalf of 
266.14  patients or that reimburses, indemnifies, compensates, or 
266.15  otherwise insures patients for health care services.  For 
266.16  purposes of this section, a pharmacy benefits manager means an 
266.17  entity that performs pharmacy benefits management.  A 
266.18  third-party purchaser or pharmacy benefits manager shall comply 
266.19  with this section regardless of whether the third-party 
266.20  purchaser or pharmacy benefits manager is a for-profit, 
266.21  not-for-profit, or nonprofit entity.  A wholesale drug 
266.22  distributor may transfer additional expense generated by section 
266.23  295.52 obligations to entities that purchase from the 
266.24  wholesaler, and the entities must pay the additional expense.  
266.25  Nothing in this section limits the ability of a hospital, 
266.26  surgical center, pharmacy, wholesale drug distributor, or health 
266.27  care provider to recover all or part of the section 295.52 
266.28  obligation by other methods, including increasing fees or 
266.29  charges.  
266.30     (b) Each third-party purchaser regulated under any chapter 
266.31  cited in paragraph (a) shall include with its annual renewal for 
266.32  certification of authority or licensure documentation indicating 
266.33  compliance with paragraph (a).  
266.34     (c) Any hospital, surgical center, or health care provider 
266.35  subject to a tax under section 295.52 or a pharmacy that has 
266.36  paid additional expense transferred under this section by a 
267.1   wholesale drug distributor may file a complaint with the 
267.2   commissioner responsible for regulating the third-party 
267.3   purchaser if at any time the third-party purchaser fails to 
267.4   comply with paragraph (a).  
267.5      (d) If the commissioner responsible for regulating the 
267.6   third-party purchaser finds at any time that the third-party 
267.7   purchaser has not complied with paragraph (a), the commissioner 
267.8   may take enforcement action against a third-party purchaser 
267.9   which is subject to the commissioner's regulatory jurisdiction 
267.10  and which does not allow a hospital, surgical center, pharmacy, 
267.11  or provider to pass-through the tax.  The commissioner may by 
267.12  order fine or censure the third-party purchaser or revoke or 
267.13  suspend the certificate of authority or license of the 
267.14  third-party purchaser to do business in this state if the 
267.15  commissioner finds that the third-party purchaser has not 
267.16  complied with this section.  The third-party purchaser may 
267.17  appeal the commissioner's order through a contested case hearing 
267.18  in accordance with chapter 14. 
267.19     Subd. 2.  [AGREEMENT.] A contracting agreement between a 
267.20  third-party purchaser or a pharmacy benefits manager and a 
267.21  resident or nonresident pharmacy registered under chapter 151, 
267.22  may not prohibit: 
267.23     (1) a pharmacy that has paid additional expense transferred 
267.24  under this section by a wholesale drug distributor from 
267.25  exercising its option under this section to transfer such 
267.26  additional expenses generated by the section 295.52 obligations 
267.27  on to the third-party purchaser or pharmacy benefits manager; or 
267.28     (2) a pharmacy that is subject to tax under section 295.52, 
267.29  subdivision 4, from exercising its option under this section to 
267.30  recover all or part of the section 295.52 obligations from the 
267.31  third-party purchaser or a pharmacy benefits manager. 
267.32     Sec. 8.  Minnesota Statutes 2004, section 641.15, 
267.33  subdivision 2, is amended to read: 
267.34     Subd. 2.  [MEDICAL AID.] Except as provided in section 
267.35  466.101, the county board shall pay the costs of medical 
267.36  services provided to prisoners.  The amount paid by the Anoka 
268.1   county board and Dakota County boards for a medical service 
268.2   shall not exceed the maximum allowed medical assistance payment 
268.3   rate for the service, as determined by the commissioner of human 
268.4   services.  The county is entitled to reimbursement from the 
268.5   prisoner for payment of medical bills to the extent that the 
268.6   prisoner to whom the medical aid was provided has the ability to 
268.7   pay the bills.  The prisoner shall, at a minimum, incur 
268.8   co-payment obligations for health care services provided by a 
268.9   county correctional facility.  The county board shall determine 
268.10  the co-payment amount.  Notwithstanding any law to the contrary, 
268.11  the co-payment shall be deducted from any of the prisoner's 
268.12  funds held by the county, to the extent possible.  If there is a 
268.13  disagreement between the county and a prisoner concerning the 
268.14  prisoner's ability to pay, the court with jurisdiction over the 
268.15  defendant shall determine the extent, if any, of the prisoner's 
268.16  ability to pay for the medical services.  If a prisoner is 
268.17  covered by health or medical insurance or other health plan when 
268.18  medical services are provided, the county providing the medical 
268.19  services has a right of subrogation to be reimbursed by the 
268.20  insurance carrier for all sums spent by it for medical services 
268.21  to the prisoner that are covered by the policy of insurance or 
268.22  health plan, in accordance with the benefits, limitations, 
268.23  exclusions, provider restrictions, and other provisions of the 
268.24  policy or health plan.  The county may maintain an action to 
268.25  enforce this subrogation right.  The county does not have a 
268.26  right of subrogation against the medical assistance program or 
268.27  the general assistance medical care program. 
268.28     Sec. 9.  Laws 2003, First Special Session chapter 14, 
268.29  article 13C, section 2, subdivision 6, is amended to read: 
268.30  Sec. 2.  COMMISSIONER OF
268.31  HUMAN SERVICES
268.32  Subd. 6.  Basic Health Care Grants 
268.33                Summary by Fund
268.34  General           1,499,941,000 1,533,016,000
268.35  Health Care Access  268,151,000   282,605,000
268.36  [UPDATING FEDERAL POVERTY GUIDELINES.] 
268.37  Annual updates to the federal poverty 
269.1   guidelines are effective each July 1, 
269.2   following publication by the United 
269.3   States Department of Health and Human 
269.4   Services for health care programs under 
269.5   Minnesota Statutes, chapters 256, 256B, 
269.6   256D, and 256L. 
269.7   The amounts that may be spent from this 
269.8   appropriation for each purpose are as 
269.9   follows: 
269.10  (a) MinnesotaCare Grants 
269.11  Health Care Access 267,401,000   281,855,000
269.12  [MINNESOTACARE FEDERAL RECEIPTS.] 
269.13  Receipts received as a result of 
269.14  federal participation pertaining to 
269.15  administrative costs of the Minnesota 
269.16  health care reform waiver shall be 
269.17  deposited as nondedicated revenue in 
269.18  the health care access fund.  Receipts 
269.19  received as a result of federal 
269.20  participation pertaining to grants 
269.21  shall be deposited in the federal fund 
269.22  and shall offset health care access 
269.23  funds for payments to providers. 
269.24  [MINNESOTACARE FUNDING.] The 
269.25  commissioner may expend money 
269.26  appropriated from the health care 
269.27  access fund for MinnesotaCare in either 
269.28  fiscal year of the biennium. 
269.29  (b) MA Basic Health Care Grants - 
269.30  Families and Children 
269.31  General             568,254,000   582,161,000
269.32  [SERVICES TO PREGNANT WOMEN.] The 
269.33  commissioner shall use available 
269.34  federal money for the State-Children's 
269.35  Health Insurance Program for medical 
269.36  assistance services provided to 
269.37  pregnant women who are not otherwise 
269.38  eligible for federal financial 
269.39  participation beginning in fiscal year 
269.40  2003.  This federal money shall be 
269.41  deposited in the federal fund and shall 
269.42  offset general funds for payments to 
269.43  providers.  Notwithstanding section 14, 
269.44  this paragraph shall not expire. 
269.45  [MANAGED CARE RATE INCREASE.] (a) 
269.46  Effective January 1, 2004, the 
269.47  commissioner of human services shall 
269.48  increase the total payments to managed 
269.49  care plans under Minnesota Statutes, 
269.50  section 256B.69, by an amount equal to 
269.51  the cost increases to the managed care 
269.52  plans from by the elimination of: (1) 
269.53  the exemption from the taxes imposed 
269.54  under Minnesota Statutes, section 
269.55  297I.05, subdivision 5, for premiums 
269.56  paid by the state for medical 
269.57  assistance, general assistance medical 
269.58  care, and the MinnesotaCare program; 
269.59  and (2) the exemption of gross revenues 
269.60  subject to the taxes imposed under 
269.61  Minnesota Statutes, sections 295.50 to 
269.62  295.57, for payments paid by the state 
270.1   for services provided under medical 
270.2   assistance, general assistance medical 
270.3   care, and the MinnesotaCare program.  
270.4   Any increase based on clause (2) must 
270.5   be reflected in provider rates paid by 
270.6   the managed care plan unless the 
270.7   managed care plan is a staff model 
270.8   health plan company. 
270.9   (b) The commissioner of human services 
270.10  shall increase by two percent the 
270.11  applicable tax rate in effect under 
270.12  Minnesota Statutes, section 295.52, the 
270.13  fee-for-service payments under medical 
270.14  assistance, general assistance medical 
270.15  care, and the MinnesotaCare program for 
270.16  services subject to the hospital, 
270.17  surgical center, or health care 
270.18  provider taxes under Minnesota 
270.19  Statutes, sections 295.50 to 295.57, 
270.20  effective for services rendered on or 
270.21  after January 1, 2004.  
270.22  (c) The commissioner of finance shall 
270.23  transfer from the health care access 
270.24  fund to the general fund the following 
270.25  amounts in the fiscal years indicated:  
270.26  2004, $16,587,000; 2005, $46,322,000; 
270.27  2006, $49,413,000; and 2007, 
270.28  $52,659,000. 
270.29  (d) For fiscal years after 2007, the 
270.30  commissioner of finance shall transfer 
270.31  from the health care access fund to the 
270.32  general fund an amount equal to the 
270.33  revenue collected by the commissioner 
270.34  of revenue on the following:  
270.35  (1) gross revenues received by 
270.36  hospitals, surgical centers, and health 
270.37  care providers as payments for services 
270.38  provided under medical assistance, 
270.39  general assistance medical care, and 
270.40  the MinnesotaCare program, including 
270.41  payments received directly from the 
270.42  state or from a prepaid plan, under 
270.43  Minnesota Statutes, sections 295.50 to 
270.44  295.57; and 
270.45  (2) premiums paid by the state under 
270.46  medical assistance, general assistance 
270.47  medical care, and the MinnesotaCare 
270.48  program under Minnesota Statutes, 
270.49  section 297I.05, subdivision 5.  
270.50  The commissioner of finance shall 
270.51  monitor and adjust if necessary the 
270.52  amount transferred each fiscal year 
270.53  from the health care access fund to the 
270.54  general fund to ensure that the amount 
270.55  transferred equals the tax revenue 
270.56  collected for the items described in 
270.57  clauses (1) and (2) for that fiscal 
270.58  year. 
270.59  (e) Notwithstanding section 14, these 
270.60  provisions shall not expire. 
270.61  (c) MA Basic Health Care Grants - Elderly 
270.62  and Disabled 
271.1   General             695,421,000   741,605,000
271.2   [DELAY MEDICAL ASSISTANCE 
271.3   FEE-FOR-SERVICE - ACUTE CARE.] The 
271.4   following payments in fiscal year 2005 
271.5   from the Medicaid Management 
271.6   Information System that would otherwise 
271.7   have been made to providers for medical 
271.8   assistance and general assistance 
271.9   medical care services shall be delayed 
271.10  and included in the first payment in 
271.11  fiscal year 2006: 
271.12  (1) for hospitals, the last two 
271.13  payments; and 
271.14  (2) for nonhospital providers, the last 
271.15  payment. 
271.16  This payment delay shall not include 
271.17  payments to skilled nursing facilities, 
271.18  intermediate care facilities for mental 
271.19  retardation, prepaid health plans, home 
271.20  health agencies, personal care nursing 
271.21  providers, and providers of only waiver 
271.22  services.  The provisions of Minnesota 
271.23  Statutes, section 16A.124, shall not 
271.24  apply to these delayed payments.  
271.25  Notwithstanding section 14, this 
271.26  provision shall not expire. 
271.27  [DEAF AND HARD-OF-HEARING SERVICES.] 
271.28  If, after making reasonable efforts, 
271.29  the service provider for mental health 
271.30  services to persons who are deaf or 
271.31  hearing impaired is not able to earn 
271.32  $227,000 through participation in 
271.33  medical assistance intensive 
271.34  rehabilitation services in fiscal year 
271.35  2005, the commissioner shall transfer 
271.36  $227,000 minus medical assistance 
271.37  earnings achieved by the grantee to 
271.38  deaf and hard-of-hearing grants to 
271.39  enable the provider to continue 
271.40  providing services to eligible persons. 
271.41  (d) General Assistance Medical Care 
271.42  Grants 
271.43  General             223,960,000   196,617,000
271.44  (e) Health Care Grants - Other 
271.45  Assistance 
271.46  General               3,067,000     3,407,000
271.47  Health Care Access      750,000       750,000
271.48  [MINNESOTA PRESCRIPTION DRUG DEDICATED 
271.49  FUND.] Of the general fund 
271.50  appropriation, $284,000 in fiscal year 
271.51  2005 is appropriated to the 
271.52  commissioner for the prescription drug 
271.53  dedicated fund established under the 
271.54  prescription drug discount program. 
271.55  [DENTAL ACCESS GRANTS CARRYOVER 
271.56  AUTHORITY.] Any unspent portion of the 
271.57  appropriation from the health care 
271.58  access fund in fiscal years 2002 and 
271.59  2003 for dental access grants under 
272.1   Minnesota Statutes, section 256B.53, 
272.2   shall not cancel but shall be allowed 
272.3   to carry forward to be spent in the 
272.4   biennium beginning July 1, 2003, for 
272.5   these purposes. 
272.6   [STOP-LOSS FUND ACCOUNT.] The 
272.7   appropriation to the purchasing 
272.8   alliance stop-loss fund account 
272.9   established under Minnesota Statutes, 
272.10  section 256.956, subdivision 2, for 
272.11  fiscal years 2004 and 2005 shall only 
272.12  be available for claim reimbursements 
272.13  for qualifying enrollees who are 
272.14  members of purchasing alliances that 
272.15  meet the requirements described under 
272.16  Minnesota Statutes, section 256.956, 
272.17  subdivision 1, paragraph (f), clauses 
272.18  (1), (2), and (3). 
272.19  (f) Prescription Drug Program 
272.20  General               9,239,000     9,226,000
272.21  [PRESCRIPTION DRUG ASSISTANCE PROGRAM.] 
272.22  Of the general fund appropriation, 
272.23  $702,000 in fiscal year 2004 and 
272.24  $887,000 in fiscal year 2005 are for 
272.25  the commissioner to establish and 
272.26  administer the prescription drug 
272.27  assistance program through the 
272.28  Minnesota board on aging. 
272.29  [REBATE REVENUE RECAPTURE.] Any funds 
272.30  received by the state from a drug 
272.31  manufacturer due to errors in the 
272.32  pharmaceutical pricing used by the 
272.33  manufacturer in determining the 
272.34  prescription drug rebate are 
272.35  appropriated to the commissioner to 
272.36  augment funding of the prescription 
272.37  drug program established in Minnesota 
272.38  Statutes, section 256.955. 
272.39     Sec. 10.  [LANGUAGE INTERPRETER SERVICES STUDY.] 
272.40     The commissioner of commerce, in consultation with the 
272.41  commissioners of health, human services, and employee relations, 
272.42  and representatives of health plan companies, health care 
272.43  providers, and limited-English-speaking communities, and 
272.44  communities that communicate through sign language shall study 
272.45  and make recommendations on providing language interpreter 
272.46  services to limited-English-speaking patients and patients who 
272.47  communicate through sign language in order to facilitate the 
272.48  provision of health care services by health care providers and 
272.49  health care facilities.  The recommendations shall include: 
272.50     (1) ways to address the needed availability of professional 
272.51  interpreter services; 
272.52     (2) an accreditation system for language interpreters, 
273.1   including appropriate standards for education, training, and 
273.2   credentialing; and 
273.3      (3) criteria for determining financial responsibility for 
273.4   providing interpreter services to patients, including the 
273.5   responsible parties for arranging interpreter services and for 
273.6   reimbursement for these services. 
273.7      The commissioner of commerce shall submit these 
273.8   recommendations to the legislature by January 15, 2006.  
273.9      Sec. 11.  [REBATE REVENUE RECAPTURE.] 
273.10     Any money received by the state from a drug manufacturer 
273.11  due to errors in the pharmaceutical pricing used by the 
273.12  manufacturer in determining the prescription drug rebate shall 
273.13  be deposited in the health care quality improvement account 
273.14  established in Minnesota Statutes, section 256.957. 
273.15     Sec. 12.  [REPEALER.] 
273.16     Minnesota Statutes 2004, section 119B.074, is repealed. 
273.17                             ARTICLE 8 
273.18                           APPROPRIATIONS
273.19  Section 1.  [HEALTH AND HUMAN SERVICES APPROPRIATIONS.] 
273.20     The sums in the columns marked "APPROPRIATIONS" are added 
273.21  to, or, if shown in parentheses, are subtracted from the 
273.22  appropriations to the specified agencies in 2005 S.F. No. 1879, 
273.23  article 11, if enacted.  The appropriations are from the general 
273.24  fund, unless another fund is named, and are available for the 
273.25  fiscal year indicated for each purpose.  The figures "2006" and 
273.26  "2007," where used in this article, mean that the additions to 
273.27  or subtractions from the appropriations listed under them are 
273.28  for the fiscal year ending June 30, 2006, or June 30, 2007, 
273.29  respectively.  The "first year" is fiscal year 2006.  The 
273.30  "second year" is fiscal year 2007.  The "biennium" is fiscal 
273.31  years 2006 and 2007. 
273.32                          SUMMARY BY FUND
273.33                                                       BIENNIAL
273.34                             2006          2007           TOTAL
273.35  General            $   37,776,000 $   64,173,000 $  101,949,000
273.36  State Government
273.37  Special Revenue         7,151,000     12,625,000     19,776,000
274.1   Health Care 
274.2   Access                 42,451,000     65,060,000    107,511,000
274.3   Federal TANF           (3,665,000)    11,064,000      7,399,000
274.4   Lottery Prize 
274.5   Fund                      400,000        400,000        800,000
274.6   TOTAL              $   84,113,000 $  153,322,000 $  237,435,000
274.7                                              APPROPRIATIONS 
274.8                                          Available for the Year 
274.9                                              Ending June 30 
274.10                                            2006         2007 
274.11  Sec. 2.  COMMISSIONER OF
274.12  HUMAN SERVICES
274.13  Subdivision 1.  Total
274.14  Appropriation                     $   75,525,000 $  138,198,000
274.15                Summary by Fund
274.16  General              36,409,000    61,744,000
274.17  Health Care
274.18  Access               42,381,000    64,990,000
274.19  Federal TANF         (3,665,000)   11,064,000
274.20  Lottery Cash
274.21  Flow                    400,000       400,000
274.22  Subd. 2.  Agency Management        
274.23                Summary by Fund
274.24  General                (165,000)     (231,000)
274.25  Health Care Access    1,623,000     1,701,000
274.26  The amounts that may be spent from the 
274.27  appropriation for each purpose are as 
274.28  follows: 
274.29  (a) Financial Operations 
274.30  General                 424,000       424,000
274.31  Health Care Access      152,000       183,000
274.32  [ADMINISTRATIVE REDUCTION.] The general 
274.33  fund appropriation in this section 
274.34  includes a department-wide 
274.35  administrative reduction of $6,885,000 
274.36  the first year and $7,201,000 the 
274.37  second year.  The commissioner shall 
274.38  ensure that any staff reductions made 
274.39  under this paragraph comply with 
274.40  Minnesota Statutes, section 43A.046. 
274.41  (b) Legal and
274.42  Regulation Operations 
274.43  General              (5,208,000)   (5,482,000)
274.44  Health Care Access       75,000        75,000
274.45  (c) Information Technology
274.46  Operations 
275.1   General               4,619,000     4,827,000
275.2   Health Care Access    1,396,000     1,443,000
275.3   Subd. 3.  Revenue and Pass-Through 
275.4   Federal TANF        (16,956,000)   (5,221,000)
275.5   [REDUCED TANF TRANSFER.] 
275.6   Notwithstanding Laws 2000, chapter 488, 
275.7   article 8, section 2, subdivision 6, 
275.8   with respect to TANF funds used as 
275.9   refinancing for the state share of the 
275.10  child support pass-through under 
275.11  Minnesota Statutes, section 256.741, 
275.12  subdivision 15, and notwithstanding 
275.13  Minnesota Statutes, section 290.0671, 
275.14  subdivision 6a, with respect to the 
275.15  TANF-funded expansion of the Minnesota 
275.16  working family credit, the commissioner 
275.17  shall reduce the combined amount of the 
275.18  TANF funds transferred to the 
275.19  commissioner of revenue for deposit in 
275.20  the general fund by $11,020,000 in 
275.21  fiscal year 2006, by $6,860,000 in 
275.22  fiscal year 2007, and by $7,000,000 in 
275.23  fiscal year 2008 and subsequent years.  
275.24  Notwithstanding section 7, this 
275.25  paragraph shall not expire. 
275.26  [TANF TRANSFER TO FEDERAL CHILD CARE 
275.27  AND DEVELOPMENT FUND.] The following 
275.28  amounts are appropriated to the 
275.29  commissioner for the purposes of MFIP 
275.30  transition year child care under 
275.31  Minnesota Statutes, section 119B.05; 
275.32  $756,000 in fiscal year 2006; 
275.33  $4,831,000 in fiscal year 2007; 
275.34  $5,183,000 in fiscal year 2008; and 
275.35  $1,127,000 in fiscal year 2009.  The 
275.36  commissioner shall authorize the 
275.37  transfer of sufficient TANF funds to 
275.38  the federal child care and development 
275.39  fund to meet this appropriation and 
275.40  shall ensure that all transferred funds 
275.41  are expended according to the federal 
275.42  child care and development fund 
275.43  regulations.  Notwithstanding section 
275.44  7, this paragraph expires June 30, 2009.
275.45  Subd. 4.  Economic Support Grants 
275.46                Summary by Fund
275.47  General               1,722,000     7,109,000
275.48  Federal TANF         13,291,000    16,285,000
275.49  The amounts that may be spent from this 
275.50  appropriation for each purpose are as 
275.51  follows: 
275.52  (a) Minnesota Family Investment Program 
275.53  General                 -0-         3,740,000
275.54  Federal TANF         13,151,000    16,145,000
275.55  (b) MFIP Child Care Assistance Grants 
276.1          -0-         (3,740,000)
276.2   (c) Children Services Grants 
276.3        1,119,000      6,074,000
276.4   (d) Children and Community Services 
276.5   Grants 
276.6   General Fund             3,000        11,000
276.7   Federal TANF           140,000       140,000
276.8   [NEW CHANCE PROGRAM.] Of the TANF 
276.9   appropriation, $140,000 each year is to 
276.10  the commissioner for a grant to the new 
276.11  chance program.  The new chance program 
276.12  shall provide comprehensive services 
276.13  through a private, nonprofit agency to 
276.14  young parents in Hennepin County who 
276.15  have dropped out of school and are 
276.16  receiving public assistance.  The 
276.17  program administrator shall report 
276.18  annually to the commissioner on skills 
276.19  development, education, job training, 
276.20  and job placement outcomes for program 
276.21  participants. 
276.22  (e) Minnesota Supplemental Aid Grants 
276.23         118,000        363,000 
276.24  (f) Group Residential Housing Grants 
276.25         122,000        301,000
276.26  (g) Other Children's and Economic 
276.27  Assistance Grants 
276.28         360,000        360,000 
276.29  [TRANSITIONAL HOUSING.] This 
276.30  appropriation is to the commissioner 
276.31  for the transitional housing program 
276.32  established in the 2005 Environment, 
276.33  Agriculture, and Economic Development 
276.34  omnibus appropriations bill. 
276.35  Subd. 5.  Children and Economic
276.36  Assistance Management
276.37         272,000        261,000
276.38  Subd. 6.  Basic Health Care Grants 
276.39                Summary by Fund
276.40  General                  14,000     6,844,000
276.41  Health Care Access   30,843,000    51,903,000
276.42  The amounts that may be spent from this 
276.43  appropriation for each purpose are as 
276.44  follows: 
276.45  (a) MinnesotaCare Grants 
276.46  Health Care Access  30,843,000    51,903,000
276.47  [HEALTHMATCH DELAY.] Of this 
276.48  appropriation, $3,112,000 the first 
277.1   year and $7,541,000 the second year is 
277.2   for the MinnesotaCare program costs 
277.3   related to a one-month delay in 
277.4   implementation of the HealthMatch 
277.5   program. 
277.6   (b) MA Basic Health Care Grants - 
277.7   Families and Children 
277.8          339,000      3,746,000
277.9   [GREATER MINNESOTA HOSPITAL PAYMENT 
277.10  ADJUSTMENT.] Of the general fund 
277.11  appropriation for medical assistance 
277.12  basic health care grants - families and 
277.13  children, medical assistance basic 
277.14  health care grants - elderly and 
277.15  disabled, and general assistance 
277.16  medical care, $400,000 each year is for 
277.17  greater Minnesota payment adjustments 
277.18  under Minnesota Statutes, section 
277.19  256.969, subdivision 26, for admissions 
277.20  occurring on or after July 1, 2005. 
277.21  [PROVIDER RATES NOT TO INCREASE.] 
277.22  Provider rates under medical assistance 
277.23  and general assistance medical care, 
277.24  except for rates paid for dental 
277.25  services and pharmacy services, in 
277.26  effect on June 30, 2005, shall not be 
277.27  increased as a result of the repeal of 
277.28  recipient co-payments effective July 1, 
277.29  2005. 
277.30  (c) MA Basic Health Care Grants - Elderly 
277.31  and Disabled 
277.32      (1,146,000)      (727,000)
277.33  (d) General Assistance Medical Care 
277.34  Grants 
277.35       1,029,000      4,349,000
277.36  (e) Health Care Grants - Other 
277.37  Assistance 
277.38      (2,500,000)     (1,978,000)
277.39  [PRESCRIPTION DRUG DISCOUNT PROGRAM.] 
277.40  Of the general fund appropriation for 
277.41  the second year, $1,022,000 is to be 
277.42  transferred to the Minnesota 
277.43  prescription drug dedicated fund 
277.44  established in Minnesota Statutes, 
277.45  section 156.9545, subdivision 11.  This 
277.46  is a onetime appropriation and shall 
277.47  not become part of base level funding 
277.48  for the biennium beginning July 1, 2007.
277.49  Subd. 7.  Health Care Management 
277.50                Summary by Fund
277.51  General               4,670,000     4,411,000
277.52  Health Care Access    9,915,000    11,386,000
277.53  The amounts that may be spent from this 
277.54  appropriation for each purpose are as 
277.55  follows: 
278.1   (a) Health Care Administration 
278.2   General               4,206,000     4,157,000
278.3   Health Care Access    7,465,000    10,693,000
278.4   (b) Health Care Operations 
278.5   General                 464,000       254,000
278.6   Health Care Access    2,450,000       693,000
278.7   Subd. 8.  Continuing Care Grants 
278.8                 Summary by Fund
278.9   General               6,616,000    36,090,000
278.10  Lottery Prize Fund      400,000       400,000
278.11  The amounts that may be spent from this 
278.12  appropriation for each purpose are as 
278.13  follows: 
278.14  (a) Aging and Adult Service Grant 
278.15           3,000         10,000
278.16  (b) Alternative Care Grants 
278.17      10,468,000     19,442,000
278.18  (c) Medical Assistance Long-Term 
278.19  Care Facilities Grants 
278.20      (2,799,000)   (12,569,000)
278.21  [RATE ADJUSTMENTS UNDER NEW NURSING 
278.22  FACILITY REIMBURSEMENT SYSTEM.] Of this 
278.23  appropriation, $12,992,000 the second 
278.24  year is to adjust nursing facility 
278.25  rates in order to facilitate the 
278.26  transition from the current ratesetting 
278.27  system to the system developed under 
278.28  Minnesota Statutes, section 256B.440. 
278.29  [NURSING HOME MORATORIUM EXCEPTIONS.] 
278.30  During the first year, the commissioner 
278.31  of health may approve moratorium 
278.32  exception projects under Minnesota 
278.33  Statutes, section 144A.073, for which 
278.34  the full annualized state share of 
278.35  medical assistance costs does not 
278.36  exceed $3,000,000. 
278.37  [ICF/MR DOWNSIZING.] Of this 
278.38  appropriation, $300,000 each year is 
278.39  for rate adjustments for intermediate 
278.40  care facilities for persons with mental 
278.41  retardation that are downsizing. 
278.42  (d) Medical Assistance Long-Term 
278.43  Care Waivers and Home Care Grants 
278.44      (4,354,000)    (3,279,000)
278.45  [LIMITING WAIVER GROWTH.] For each year 
278.46  of the biennium ending June 30, 2007, 
278.47  the commissioner of human services 
278.48  shall make available additional 
278.49  allocations for community alternatives 
279.1   for disabled individuals waivered 
279.2   services covered under Minnesota 
279.3   Statutes, section 256B.49, at a rate of 
279.4   105 per month or 1,260 per year, plus 
279.5   any additional legislatively authorized 
279.6   growth.  Priorities for the allocation 
279.7   of funds shall be for individuals 
279.8   anticipated to be discharged from 
279.9   institutional settings or who are at 
279.10  imminent risk of a placement in an 
279.11  institutional setting. 
279.12  For each year of the biennium ending 
279.13  June 30, 2007, the commissioner shall 
279.14  make available additional allocations 
279.15  for traumatic brain injury waivered 
279.16  services covered under Minnesota 
279.17  Statutes, section 256B.49, at a rate of 
279.18  165 per year.  Priorities for the 
279.19  allocation of funds shall be for 
279.20  individuals anticipated to be 
279.21  discharged from institutional settings 
279.22  or who are at imminent risk of a 
279.23  placement in an institutional setting. 
279.24  Notwithstanding 2005 S.F. No. 1879, 
279.25  article 11, section 2, subdivision 8, 
279.26  paragraph (d), if enacted, for each 
279.27  year of the biennium ending June 30, 
279.28  2007, the commissioner shall limit the 
279.29  new diversion caseload growth in the 
279.30  mental retardation and related 
279.31  conditions waiver to 75 additional 
279.32  allocations.  Notwithstanding Minnesota 
279.33  Statutes, section 256B.0916, 
279.34  subdivision 5, paragraph (b), the 
279.35  available diversion allocations shall 
279.36  be awarded to support individuals whose 
279.37  health and safety needs result in an 
279.38  imminent risk of an institutional 
279.39  placement at any time during the fiscal 
279.40  year. 
279.41  (e) Mental Health Grants 
279.42  General                 950,000     1,888,000
279.43  Lottery Prize Fund      400,000       400,000
279.44  [ALTERNATIVES TO ANOKA-METRO REGIONAL 
279.45  TREATMENT CENTER.] Of this 
279.46  appropriation, $350,000 the first year 
279.47  and $145,000 the second year is to the 
279.48  commissioner to develop community 
279.49  alternatives to Anoka-Metro Regional 
279.50  Treatment Center under Minnesota 
279.51  Statutes, section 245.4661, 
279.52  subdivisions 8 to 11.  Any amount of 
279.53  this appropriation that is unspent 
279.54  shall not cancel but shall be available 
279.55  until expended.  Notwithstanding 
279.56  section 7, this paragraph shall not 
279.57  expire. 
279.58  (f) Deaf and Hard-of-Hearing 
279.59  Service Grants 
279.60           9,000         33,000
279.61  (g) Chemical Dependency
279.62  Entitlement Grants
280.1        2,144,000      4,762,000
280.2   (h) Other Continuing Care 
280.3          195,000        665,000
280.4   Subd. 9.  Continuing Care Management 
280.5          599,000        465,000
280.6   [TASK FORCE ON COLLABORATIVE SERVICES.] 
280.7   The commissioner, in collaboration with 
280.8   the commissioner of education, shall 
280.9   create a task force to discuss 
280.10  collaboration between schools and 
280.11  mental health providers to:  promote 
280.12  colocation and integrated services; 
280.13  identify barriers to collaboration; 
280.14  develop a model contract; and identify 
280.15  examples of successful collaboration.  
280.16  The task force shall also develop 
280.17  recommendations on how to pay for 
280.18  children's mental health screenings.  
280.19  The task force shall include 
280.20  representatives of school boards; 
280.21  administrative personnel; special 
280.22  education directors; counties; parent 
280.23  advocacy organizations; school social 
280.24  workers, counselors, nurses, and 
280.25  psychologists; community mental health 
280.26  professionals; health plans; and other 
280.27  interested parties.  The task force 
280.28  shall present a report to the chairs of 
280.29  the education and health policy 
280.30  committees by February 1, 2006. 
280.31  Of the general fund appropriation, 
280.32  $5,000 the first year is to the 
280.33  commissioner to contract with a 
280.34  nonprofit organization that is 
280.35  knowledgeable about children's mental 
280.36  health issues to provide the research 
280.37  necessary for the task force to make 
280.38  recommendations and complete the report.
280.39  Subd. 10.  State-Operated Services 
280.40      22,682,000      6,796,000
280.41  [EVIDENCE-BASED PRACTICE FOR 
280.42  METHAMPHETAMINE TREATMENT.] Of the 
280.43  general fund appropriation, $300,000 
280.44  each year is to support development of 
280.45  evidence-based practices for the 
280.46  treatment of methamphetamine abuse at 
280.47  the state-operated services chemical 
280.48  dependency program in Willmar.  These 
280.49  funds shall be used to support research 
280.50  on evidence-based practices for the 
280.51  treatment of methamphetamine abuse, 
280.52  dissemination of the results of the 
280.53  evidence-based practice research 
280.54  statewide, and creation of training for 
280.55  addiction counselors specializing in 
280.56  the treatment of methamphetamine abuse. 
280.57  Sec. 3.  COMMISSIONER OF HEALTH
280.58  Subdivision 1.  Total
280.59  Appropriation                          6,271,000     13,118,000
281.1                 Summary by Fund
281.2   General               1,367,000     2,429,000
281.3   State Government
281.4   Special Revenue       4,834,000    10,619,000
281.5   Health Care Access       70,000        70,000
281.6   [RENTAL COSTS, ADMINISTRATIVE 
281.7   REDUCTIONS, FEE INCREASES, AND REVENUE 
281.8   TRANSFER.] (a) Of this appropriation, 
281.9   $722,000 the first year and $2,583,000 
281.10  the second year is for rental costs in 
281.11  the new public health laboratory 
281.12  building. 
281.13  (b) The general fund appropriation in 
281.14  this section includes a department-wide 
281.15  administrative reduction of $242,000 
281.16  the first year and $1,007,000 the 
281.17  second year.  The commissioner shall 
281.18  ensure that any staff reductions made 
281.19  under this paragraph comply with 
281.20  Minnesota Statutes, section 43A.046. 
281.21  (c) The commissioner shall increase all 
281.22  fees levied by the commissioner a pro 
281.23  rata amount in order to generate 
281.24  revenue of $731,000 the first year and 
281.25  $1,823,000 the second year.  These 
281.26  amounts shall be deposited in the 
281.27  general fund.  This paragraph shall not 
281.28  apply to fees paid by occupational 
281.29  therapists. 
281.30  (d) $254,000 each year shall be 
281.31  transferred from the state government 
281.32  special revenue fund to the general 
281.33  fund. 
281.34  Subd. 2.  Community and Family 
281.35  Health Improvement
281.36                Summary by Fund
281.37  General                 159,000      (640,000)
281.38  State Government
281.39  Special Revenue         335,000       335,000
281.40  Health Care Access       70,000        70,000
281.41  [TANF CARRYFORWARD.] Any unexpended 
281.42  balance of the TANF appropriation in 
281.43  the first year of the biennium in this 
281.44  section and 2005 S.F. No. 1879, article 
281.45  11, section 3, if enacted, does not 
281.46  cancel but is available for the second 
281.47  year. 
281.48  [WORK GROUP ON CHILDHOOD OBESITY.] (a) 
281.49  Of the general fund appropriation, 
281.50  $5,000 the first year and $1,000 the 
281.51  second year is to the commissioner to 
281.52  convene an interagency work group with 
281.53  the commissioners of human services and 
281.54  education to study and make 
281.55  recommendations on reducing the rate of 
281.56  obesity among the children in Minnesota.
282.1   (b) The work group shall determine the 
282.2   number of children who are currently 
282.3   obese and set a goal, including 
282.4   measurable outcomes for the state in 
282.5   terms of reducing the rate of childhood 
282.6   obesity.  The work group shall make 
282.7   recommendations on how to achieve this 
282.8   goal, including, but not limited to, 
282.9   increasing physical activities; 
282.10  exploring opportunities to promote 
282.11  physical education and healthy eating 
282.12  programs; improving the nutritional 
282.13  offerings through breakfast and lunch 
282.14  menus; and evaluating the availability 
282.15  and choice of nutritional products 
282.16  offered in public schools.  
282.17  (c) The work group may include 
282.18  representatives of the Minnesota 
282.19  Medical Association; the Minnesota 
282.20  Nurses Association; the Local Public 
282.21  Health Association of Minnesota; the 
282.22  Minnesota Dietetic Association; the 
282.23  Minnesota School Food Service 
282.24  Association; the Minnesota Association 
282.25  of Health, Physical Education, 
282.26  Recreation, and Dance; the Minnesota 
282.27  School Boards Association; the 
282.28  Minnesota School Administrators 
282.29  Association; the Minnesota Secondary 
282.30  Principals Association; the vending 
282.31  industry; and consumers.  
282.32  (d) The commissioner must submit the 
282.33  recommendations of the work group to 
282.34  the legislature by January 15, 2007. 
282.35  Subd. 3.  Policy Quality and 
282.36  Compliance 
282.37                Summary by Fund
282.38  State Government
282.39  Special Revenue         770,000       770,000
282.40  [STATEWIDE TRAUMA SYSTEM.] (a) Of the 
282.41  general fund appropriation, $382,000 
282.42  the first year and $352,000 the second 
282.43  year is for development of a statewide 
282.44  trauma system. 
282.45  (b) The commissioner shall increase 
282.46  hospital licensing fees a pro rata 
282.47  amount to increase fee revenue by 
282.48  $382,000 the first year and $352,000 
282.49  the second year.  This revenue shall be 
282.50  deposited in the general fund. 
282.51  [AIDS PREVENTION FOR AFRICAN-BORN 
282.52  RESIDENTS.] For fiscal year 2006 only, 
282.53  the commissioner shall reallocate 
282.54  $300,000 from the grant program under 
282.55  Minnesota Statutes, section 145.928, 
282.56  for grants in accordance with Minnesota 
282.57  Statutes, section 145.924, paragraph 
282.58  (b), for a public education and 
282.59  awareness campaign targeting 
282.60  communities of African-born Minnesota 
282.61  residents.  The grants shall be 
282.62  designed to: 
283.1   (1) promote knowledge and understanding 
283.2   about HIV and to increase knowledge in 
283.3   order to eliminate and reduce the risk 
283.4   for HIV infection; 
283.5   (2) encourage screening and testing for 
283.6   HIV; and 
283.7   (3) connect individuals to public 
283.8   health and health care resources.  The 
283.9   grants must be awarded to collaborative 
283.10  efforts that bring together nonprofit 
283.11  community-based groups with 
283.12  demonstrated experience in addressing 
283.13  the public health, health care, and 
283.14  social service needs of African-born 
283.15  communities. 
283.16  [FAMILY PLANNING GRANTS.] Of the 
283.17  general fund appropriation, $500,000 
283.18  each year is to the commissioner for 
283.19  grants under Minnesota Statutes, 
283.20  section 145.925, to family planning 
283.21  clinics serving outstate Minnesota that 
283.22  demonstrate financial need. 
283.23  Subd. 4.  Health Protection 
283.24                Summary by Fund
283.25  State Government
283.26  Special Revenue       3,729,000     9,514,000
283.27  Subd. 5.  Administrative Support 
283.28  Services 
283.29       1,208,000      3,069,000
283.30  Sec. 4.  VETERANS NURSING HOMES BOARD
283.31  [VETERANS HOMES SPECIAL REVENUE 
283.32  ACCOUNT.] The general fund 
283.33  appropriations made to the board in 
283.34  2005 S.F. No. 1879, if enacted, may be 
283.35  transferred to a veterans homes special 
283.36  revenue account in the special revenue 
283.37  fund in the same manner as other 
283.38  receipts are deposited according to 
283.39  Minnesota Statutes, section 198.34, and 
283.40  are appropriated to the board for the 
283.41  operation of board facilities and 
283.42  programs. 
283.43  Sec. 5.  HEALTH-RELATED BOARDS 
283.44  Subdivision 1.  Total
283.45  Appropriation                          2,317,000      2,006,000
283.46                Summary by Fund
283.47  State Government            
283.48  Special Revenue       2,317,000     2,006,000
283.49  [STATE GOVERNMENT SPECIAL REVENUE 
283.50  FUND.] The appropriations in this 
283.51  section are from the state government 
283.52  special revenue fund, except where 
283.53  noted. 
283.54  [NO SPENDING IN EXCESS OF REVENUES.] 
283.55  The commissioner of finance shall not 
284.1   permit the allotment, encumbrance, or 
284.2   expenditure of money appropriated in 
284.3   this section in excess of the 
284.4   anticipated biennial revenues or 
284.5   accumulated surplus revenues from fees 
284.6   collected by the boards.  Neither this 
284.7   provision nor Minnesota Statutes, 
284.8   section 214.06, applies to transfers 
284.9   from the general contingent account. 
284.10  Subd. 2.  Board of Dentistry                                    
284.11                Summary by Fund
284.12  State Government
284.13  Special Revenue         150,000       -0-    
284.14  [ORAL HEALTH PILOT PROJECT.] Of this 
284.15  appropriation, $150,000 the first year 
284.16  is to be transferred to the 
284.17  commissioner of human services for an 
284.18  oral health care system pilot project. 
284.19  Subd. 3.  Board of Nursing     
284.20       1,563,000      1,407,000
284.21  [MINNESOTA CENTER OF NURSING.] (a) Of 
284.22  this appropriation, $500,000 in fiscal 
284.23  year 2006 is to be used as start-up 
284.24  funding to establish a Minnesota Center 
284.25  of Nursing.  The goals of the center 
284.26  shall be to: 
284.27  (1) maintain information on the current 
284.28  and projected supply and demand of 
284.29  nurses through the collection and 
284.30  analysis of data on the nursing 
284.31  workforce; 
284.32  (2) develop a strategic statewide plan 
284.33  for the nursing workforce; 
284.34  (3) convene work groups of stakeholders 
284.35  to examine issues and make 
284.36  recommendations regarding factors 
284.37  affecting nursing education, 
284.38  recruitment, and retention; 
284.39  (4) promote recognition, reward, and 
284.40  renewal activities for nurses in 
284.41  Minnesota; and 
284.42  (5) provide consultation, technical 
284.43  assistance, and data on the nursing 
284.44  workforce to the legislature. 
284.45  (b) The board shall report to the 
284.46  legislature by January 15, 2007, on the 
284.47  Center of Nursing's progress, the 
284.48  center's collaboration efforts with 
284.49  other organizations and governmental 
284.50  entities, and the activities conducted 
284.51  by the center in achieving the goals 
284.52  outlined. 
284.53  [TRANSFERS FROM SPECIAL REVENUE FUND.] 
284.54  Of this appropriation, the following 
284.55  transfers shall be made as directed 
284.56  from the state government special 
284.57  revenue fund: 
285.1   (a) $938,000 the first year and 
285.2   $1,207,000 the second year shall be 
285.3   transferred to the commissioner of 
285.4   human services for the long-term care 
285.5   and home and community-based care 
285.6   employee scholarship program.  This 
285.7   appropriation shall not become part of 
285.8   base level funding for the biennium 
285.9   beginning July 1, 2007. 
285.10  (b) $125,000 the first year and 
285.11  $200,000 the second year shall be 
285.12  transferred to the health professional 
285.13  education loan forgiveness program 
285.14  account for loan forgiveness for nurses 
285.15  under Minnesota Statutes, section 
285.16  144.1501.  This appropriation shall 
285.17  become part of base level funding for 
285.18  the commissioner for the biennium 
285.19  beginning July 1, 2007, but shall not 
285.20  be part of base level funding for the 
285.21  biennium beginning July 1, 2009.  
285.22  Notwithstanding section 7, this 
285.23  paragraph expires on June 30, 2009.  
285.24  Subd. 4.  Board of Pharmacy 
285.25         499,000        499,000
285.26  [RURAL PHARMACY PROGRAM.] Of this 
285.27  appropriation, $200,000 each year shall 
285.28  be transferred to the commissioner of 
285.29  health for the rural pharmacy planning 
285.30  and transition grant program under 
285.31  Minnesota Statutes, section 144.1476.  
285.32  Of this transferred amount, $20,000 
285.33  each year may be retained by the 
285.34  commissioner for related administrative 
285.35  costs.  This appropriation shall become 
285.36  part of base level funding for the 
285.37  commissioner for the biennium beginning 
285.38  July 1, 2007.  Notwithstanding section 
285.39  7, this paragraph expires on June 30, 
285.40  2009.  
285.41  [PHARMACIST LOAN FORGIVENESS.] $200,000 
285.42  each year shall be transferred to the 
285.43  health professional education loan 
285.44  forgiveness program account for loan 
285.45  forgiveness for pharmacists under 
285.46  Minnesota Statutes, section 144.501.  
285.47  This appropriation shall become part of 
285.48  base level funding for the commissioner 
285.49  for the biennium beginning July 1, 
285.50  2007.  Notwithstanding section 7, this 
285.51  paragraph expires on June 30, 2009. 
285.52  [DRUG MANUFACTURER PRICING DISCLOSURE.] 
285.53  (a) The board shall increase the 
285.54  licensing or registration fee for 
285.55  wholesale drug distributors and drug 
285.56  manufacturers required under Minnesota 
285.57  Statutes, chapter 151, by $65 per year 
285.58  beginning July 1, 2005. 
285.59  (b) Of the appropriation in this 
285.60  subdivision, $74,000 each year is to be 
285.61  transferred to the commissioner of 
285.62  human services for the data received 
285.63  under Minnesota Statutes, section 
285.64  151.52. 
286.1   [CANCER DRUG REPOSITORY PROGRAM.] Of 
286.2   this appropriation, $25,000 each year 
286.3   is for the cancer drug repository 
286.4   program under Minnesota Statutes, 
286.5   section 151.55.  This appropriation 
286.6   shall become part of base level funding 
286.7   for the board for the biennium 
286.8   beginning July 1, 2007, but shall not 
286.9   be part of the base for the biennium 
286.10  beginning July 1, 2009.  
286.11  Notwithstanding section 7, this 
286.12  paragraph expires June 30, 2009. 
286.13  Subd. 5.  Board of Social 
286.14  Work               
286.15         105,000        100,000
286.16  [ADMINISTRATIVE MANAGEMENT.] This 
286.17  appropriation is to provide 
286.18  administrative management under 
286.19  Minnesota Statutes, section 148B.61, 
286.20  subdivision 4.  The following boards 
286.21  shall be assessed a prorated amount 
286.22  depending on the number of licensees 
286.23  under the board's regulatory authority 
286.24  providing mental health services within 
286.25  their scope of practice:  Board of 
286.26  Medical Practice, the Board of Nursing, 
286.27  the Board of Psychology, the Board of 
286.28  Social Work, the Board of Marriage and 
286.29  Family Therapy, and the Board of 
286.30  Behavioral Health and Therapy. 
286.31     Sec. 6.  [BASE LEVEL FUNDING ADJUSTMENTS.] 
286.32     Base level funding for the biennium beginning July 1, 2007, 
286.33  for nonentitlement grants and administration appropriations in 
286.34  this article shall be shown in legislative tracking documents.  
286.35  Notwithstanding section 7, this section shall expire on June 30, 
286.36  2009. 
286.37     Sec. 7.  [SUNSET OF UNCODIFIED LANGUAGE.] 
286.38     All uncodified language in this article expires on June 30, 
286.39  2007, unless a different expiration date is explicit.