1.1 	A bill for an act
1.2 	relating to human services; modifying programs and
1.3 	services for persons with disabilities; amending
1.4 	Minnesota Statutes 2004, sections 256B.04, by adding a
1.5 	subdivision; 256B.056, subdivisions 3, 5c; 256B.057,
1.6 	subdivision 9; 256B.0575; 256B.0621, subdivisions 2,
1.7 	3, 4, 5, 6, 7, by adding a subdivision; 256B.0622,
1.8 	subdivision 2; 256B.0625, subdivision 9; 256B.0916, by
1.9 	adding a subdivision; 256B.092, subdivision 4b;
1.10 	256B.35, subdivision 1; 256B.49, subdivisions 13, 14,
1.11 	16; 256B.5012, by adding a subdivision; 256B.69,
1.12 	subdivision 23; 256B.765; 256D.03, subdivision 4;
1.13 	256L.03, subdivisions 1, 5.
1.14 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.15 	Section 1. Minnesota Statutes 2004, section 256B.04, is
1.16 	amended by adding a subdivision to read:
1.17 		Subd. 20.Incentive for wellness visits. The
1.18 	commissioner of human services shall consult with private sector
1.19 	health plan companies and shall develop an incentive program to
1.20 	encourage medical assistance enrollees with disabilities to have
1.21 	regular wellness exams conducted by a primary care physician.
1.22 	The commissioner shall implement the incentive program beginning
1.23 	January 1, 2006.

1.24 	Sec. 2. Minnesota Statutes 2004, section 256B.056,
1.25 	subdivision 3, is amended to read:
1.26 		Subd. 3.Asset limitations for individuals and
1.27 	families the aged, blind, or disabled.  To be eligible for
1.28 	medical assistance, a person whose eligibility category is based
1.29 	on blindness, disability, or age of 65 or more years must not
2.1 	individually own more than $3,000 $10,000 in assets, or if a
2.2 	member of a household with two family members, husband and wife,
2.3 	or parent and child or more persons, the household must not own
2.4 	more than $6,000 $18,000 in assets, plus $200 for each
2.5 	additional legal dependent.  In addition to these maximum
2.6 	amounts, an eligible individual or family may accrue interest on
2.7 	these amounts, but they must be reduced to the maximum at the
2.8 	time of an eligibility redetermination.  The accumulation of the
2.9 	clothing and personal needs allowance according to section
2.10 	256B.35 must also be reduced to the maximum at the time of the
2.11 	eligibility redetermination.  The value of assets that are not
2.12 	considered in determining eligibility for medical assistance is
2.13 	the value of those assets excluded under the supplemental
2.14 	security income program for aged, blind, and disabled persons,
2.15 	with the following exceptions:
2.16 	(a) Household goods and personal effects are not considered.
2.17 	(b) Capital and operating assets of a trade or business
2.18 	that the local agency determines are necessary to the person's
2.19 	ability to earn an income are not considered.
2.20 	(c) Motor vehicles are excluded to the same extent excluded
2.21 	by the supplemental security income program.
2.22 	(d) Assets designated as burial expenses are excluded to
2.23 	the same extent excluded by the supplemental security income
2.24 	program.  Burial expenses funded by annuity contracts or life
2.25 	insurance policies must irrevocably designate the individual's
2.26 	estate as contingent beneficiary to the extent proceeds are not
2.27 	used for payment of selected burial expenses.
2.28 	(e) Effective upon federal approval, for a person who no
2.29 	longer qualifies as an employed person with a disability due to
2.30 	loss of earnings, assets allowed while eligible for medical
2.31 	assistance under section 256B.057, subdivision 9, are not
2.32 	considered for 12 months, beginning with the first month of
2.33 	ineligibility as an employed person with a disability, to the
2.34 	extent that the person's total assets remain within the allowed
2.35 	limits of section 256B.057, subdivision 9, paragraph (b).
2.36 	(f) Assets owned by children are not considered.

3.1 	Sec. 3. Minnesota Statutes 2004, section 256B.056,
3.2 	subdivision 5c, is amended to read:
3.3 		Subd. 5c.Excess income standard.  (a) The excess income
3.4 	standard for families with children is the standard specified in
3.5 	subdivision 4.
3.6 	(b) The excess income standard for a person whose
3.7 	eligibility is based on blindness, disability, or age of 65 or
3.8 	more years is 70 100 percent of the federal poverty guidelines
3.9 	for the family size. Effective July 1, 2002, the excess income
3.10 	standard for this paragraph shall equal 75 percent of the
3.11 	federal poverty guidelines.

3.12 	Sec. 4. Minnesota Statutes 2004, section 256B.057,
3.13 	subdivision 9, is amended to read:
3.14 		Subd. 9.Employed persons with disabilities.  (a) Medical
3.15 	assistance may be paid for a person who is employed and who:
3.16 	(1) meets the definition of disabled under the supplemental
3.17 	security income program;
3.18 	(2) is at least 16 but less than 65 years of age;
3.19 	(3) meets the asset limits in paragraph (b); and
3.20 	(4) effective November 1, 2003, pays a premium and other
3.21 	obligations under paragraph (d).
3.22 	Any spousal income or assets shall be disregarded for purposes
3.23 	of eligibility and premium determinations.
3.24 	After the month of enrollment, a person enrolled in medical
3.25 	assistance under this subdivision who:
3.26 	(1) is temporarily unable to work and without receipt of
3.27 	earned income due to a medical condition, as verified by a
3.28 	physician, may retain eligibility for up to four calendar
3.29 	months; or
3.30 	(2) effective January 1, 2004, loses employment for reasons
3.31 	not attributable to the enrollee, may retain eligibility for up
3.32 	to four consecutive months after the month of job loss.  To
3.33 	receive a four-month extension, enrollees must verify the
3.34 	medical condition or provide notification of job loss.  All
3.35 	other eligibility requirements must be met and the enrollee must
3.36 	pay all calculated premium costs for continued eligibility.
4.1 	(b) For purposes of determining eligibility under this
4.2 	subdivision, a person's assets must not exceed $20,000,
4.3 	excluding:
4.4 	(1) all assets excluded under section 256B.056;
4.5 	(2) retirement accounts, including individual accounts,
4.6 	401(k) plans, 403(b) plans, Keogh plans, and pension plans; and
4.7 	(3) medical expense accounts set up through the person's
4.8 	employer.
4.9 	(c)(1) Effective January 1, 2004, for purposes of
4.10 	eligibility, there will be a $65 earned income disregard.  To be
4.11 	eligible, a person applying for medical assistance under this
4.12 	subdivision must have earned income above the disregard level.
4.13 	(2) Effective January 1, 2004, to be considered earned
4.14 	income, Medicare, Social Security, and applicable state and
4.15 	federal income taxes must be withheld.  To be eligible, a person
4.16 	must document earned income tax withholding.
4.17 	(d)(1) A person whose earned and unearned income is equal
4.18 	to or greater than 100 percent of federal poverty guidelines for
4.19 	the applicable family size must pay a premium to be eligible for
4.20 	medical assistance under this subdivision.  The premium shall be
4.21 	based on the person's gross earned and unearned income and the
4.22 	applicable family size using a sliding fee scale established by
4.23 	the commissioner, which begins at one percent of income at 100
4.24 	percent of the federal poverty guidelines and increases to 7.5
4.25 	percent of income for those with incomes at or above 300 percent
4.26 	of the federal poverty guidelines.  Annual adjustments in the
4.27 	premium schedule based upon changes in the federal poverty
4.28 	guidelines shall be effective for premiums due in July of each
4.29 	year.
4.30 	(2) Effective January 1, 2004, all enrollees must pay a
4.31 	premium to be eligible for medical assistance under this
4.32 	subdivision.  An enrollee shall pay the greater of a $35 premium
4.33 	or the premium calculated in clause (1).
4.34 	(3) Effective November 1, 2003, all enrollees who receive
4.35 	unearned income must pay one-half of one percent of unearned
4.36 	income in addition to the premium amount.
5.1 	(4) Effective November 1, 2003 July 1, 2005, for
5.2 	enrollees whose income does not exceed 200 percent of the
5.3 	federal poverty guidelines and who are also enrolled in
5.4 	Medicare, the commissioner must reimburse the enrollee for
5.5 	Medicare Part B premiums under section 256B.0625, subdivision
5.6 	15, paragraph (a).
5.7 	(5) Increases in benefits under title II of the Social
5.8 	Security Act shall not be counted as income for purposes of this
5.9 	subdivision until July 1 of each year.
5.10 	(e) A person's eligibility and premium shall be determined
5.11 	by the local county agency.  Premiums must be paid to the
5.12 	commissioner.  All premiums are dedicated to the commissioner.
5.13 	(f) Any required premium shall be determined at application
5.14 	and redetermined at the enrollee's six-month income review or
5.15 	when a change in income or household size is reported.
5.16 	Enrollees must report any change in income or household size
5.17 	within ten days of when the change occurs.  A decreased premium
5.18 	resulting from a reported change in income or household size
5.19 	shall be effective the first day of the next available billing
5.20 	month after the change is reported.  Except for changes
5.21 	occurring from annual cost-of-living increases, a change
5.22 	resulting in an increased premium shall not affect the premium
5.23 	amount until the next six-month review.
5.24 	(g) Premium payment is due upon notification from the
5.25 	commissioner of the premium amount required.  Premiums may be
5.26 	paid in installments at the discretion of the commissioner.
5.27 	(h) Nonpayment of the premium shall result in denial or
5.28 	termination of medical assistance unless the person demonstrates
5.29 	good cause for nonpayment.  Good cause exists if the
5.30 	requirements specified in Minnesota Rules, part 9506.0040,
5.31 	subpart 7, items B to D, are met.  Except when an installment
5.32 	agreement is accepted by the commissioner, all persons
5.33 	disenrolled for nonpayment of a premium must pay any past due
5.34 	premiums as well as current premiums due prior to being
5.35 	reenrolled.  Nonpayment shall include payment with a returned,
5.36 	refused, or dishonored instrument.  The commissioner may require
6.1 	a guaranteed form of payment as the only means to replace a
6.2 	returned, refused, or dishonored instrument.

6.3 	Sec. 5. Minnesota Statutes 2004, section 256B.0575, is
6.4 	amended to read:
6.5 	256B.0575 AVAILABILITY OF INCOME FOR INSTITUTIONALIZED
6.6 	PERSONS.
6.7 	When an institutionalized person is determined eligible for
6.8 	medical assistance, the income that exceeds the deductions in
6.9 	paragraphs (a) and (b) must be applied to the cost of
6.10 	institutional care.
6.11 	(a) The following amounts must be deducted from the
6.12 	institutionalized person's income in the following order:
6.13 	(1) the personal needs allowance under section 256B.35 or,
6.14 	for a veteran who does not have a spouse or child, or a
6.15 	surviving spouse of a veteran having no child, the amount of an
6.16 	improved pension received from the veteran's administration not
6.17 	exceeding $90 per month;
6.18 	(2) the personal allowance for disabled individuals under
6.19 	section 256B.36;
6.20 	(3) if the institutionalized person has a legally appointed
6.21 	guardian or conservator, five percent of the recipient's gross
6.22 	monthly income up to $100 as reimbursement for guardianship or
6.23 	conservatorship services;
6.24 	(4) a monthly income allowance determined under section
6.25 	256B.058, subdivision 2, but only to the extent income of the
6.26 	institutionalized spouse is made available to the community
6.27 	spouse;
6.28 	(5) a monthly allowance for children under age 18 which,
6.29 	together with the net income of the children, would provide
6.30 	income equal to the medical assistance standard for families and
6.31 	children according to section 256B.056, subdivision 4, for a
6.32 	family size that includes only the minor children.  This
6.33 	deduction applies only if the children do not live with the
6.34 	community spouse and only to the extent that the deduction is
6.35 	not included in the personal needs allowance under section
6.36 	256B.35, subdivision 1, as child support garnished under a court
7.1 	order;
7.2 	(6) a monthly family allowance for other family members,
7.3 	equal to one-third of the difference between 122 percent of the
7.4 	federal poverty guidelines and the monthly income for that
7.5 	family member;
7.6 	(7) reparations payments made by the Federal Republic of
7.7 	Germany and reparations payments made by the Netherlands for
7.8 	victims of Nazi persecution between 1940 and 1945;
7.9 	(8) all other exclusions from income for institutionalized
7.10 	persons as mandated by federal law; and
7.11 	(9) amounts for reasonable expenses incurred for necessary
7.12 	medical or remedial care for the institutionalized person that
7.13 	are not medical assistance covered expenses and that are not
7.14 	subject to payment by a third party.
7.15 	For purposes of clause (6), "other family member" means a
7.16 	person who resides with the community spouse and who is a minor
7.17 	or dependent child, dependent parent, or dependent sibling of
7.18 	either spouse.  "Dependent" means a person who could be claimed
7.19 	as a dependent for federal income tax purposes under the
7.20 	Internal Revenue Code.
7.21 	(b) Income shall be allocated to an institutionalized
7.22 	person for a period of up to three six calendar months, in an
7.23 	amount equal to 100 percent of the medical assistance standard 
7.24 	federal poverty guidelines for a family size of one if:
7.25 	(1) a physician certifies that the person is expected to
7.26 	reside in the long-term care facility for three six calendar
7.27 	months or less;
7.28 	(2) if the person has expenses of maintaining a residence
7.29 	in the community; and
7.30 	(3) if one of the following circumstances apply:
7.31 	(i) the person was not living together with a spouse or a
7.32 	family member as defined in paragraph (a) when the person
7.33 	entered a long-term care facility; or
7.34 	(ii) the person and the person's spouse become
7.35 	institutionalized on the same date, in which case the allocation
7.36 	shall be applied to the income of one of the spouses.
8.1 	For purposes of this paragraph, a person is determined to be
8.2 	residing in a licensed nursing home, regional treatment center,
8.3 	or medical institution if the person is expected to remain for a
8.4 	period of one full calendar month or more.

8.5 	Sec. 6. Minnesota Statutes 2004, section 256B.0621,
8.6 	subdivision 2, is amended to read:
8.7 		Subd. 2.Targeted case management; definitions.  For
8.8 	purposes of subdivisions 3 to 10, the following terms have the
8.9 	meanings given them:
8.10 	(1) "home care service recipients" means those individuals
8.11 	receiving the following services under section 256B.0627:
8.12 	skilled nursing visits, home health aide visits, private duty
8.13 	nursing, personal care assistants, or therapies provided through
8.14 	a home health agency;
8.15 	(2) "home care targeted case management" means the
8.16 	provision of targeted case management services for the purpose
8.17 	of assisting home care service recipients to gain access to
8.18 	needed services and supports so that they may remain in the
8.19 	community;
8.20 	(3) "institutions" means hospitals, consistent with Code of
8.21 	Federal Regulations, title 42, section 440.10; regional
8.22 	treatment center inpatient services, consistent with section
8.23 	245.474; nursing facilities; and intermediate care facilities
8.24 	for persons with mental retardation;
8.25 	(4) "relocation targeted case management" means includes 
8.26 	the provision of both county targeted case management and
8.27 	service coordination services for the purpose of assisting
8.28 	recipients to gain access to needed services and supports if
8.29 	they choose to move from an institution to the community.
8.30 	Relocation targeted case management may be provided during the
8.31 	last 180 consecutive days of an eligible recipient's
8.32 	institutional stay; and
8.33 	(5) "targeted case management" means case management
8.34 	services provided to help recipients gain access to needed
8.35 	medical, social, educational, and other services and supports.

8.36 	Sec. 7. Minnesota Statutes 2004, section 256B.0621,
9.1 	subdivision 3, is amended to read:
9.2 		Subd. 3.Eligibility.  The following persons are eligible
9.3 	for relocation targeted case management or home care-targeted 
9.4 	care targeted case management:
9.5 	(1) medical assistance eligible persons residing in
9.6 	institutions who choose to move into the community are eligible
9.7 	for relocation targeted case management services; and
9.8 	(2) medical assistance eligible persons receiving home care
9.9 	services, who are not eligible for any other medical assistance
9.10 	reimbursable case management service, are eligible for home
9.11 	care-targeted care targeted case management services beginning
9.12 	January 1, 2003 July 1, 2005.

9.13 	Sec. 8. Minnesota Statutes 2004, section 256B.0621,
9.14 	subdivision 4, is amended to read:
9.15 		Subd. 4.Relocation targeted county case management
9.16 	provider qualifications.  (a) A relocation targeted county case
9.17 	management provider is an enrolled medical assistance provider
9.18 	who is determined by the commissioner to have all of the
9.19 	following characteristics:
9.20 	(1) the legal authority to provide public welfare under
9.21 	sections 393.01, subdivision 7; and 393.07; or a federally
9.22 	recognized Indian tribe;
9.23 	(2) the demonstrated capacity and experience to provide the
9.24 	components of case management to coordinate and link community
9.25 	resources needed by the eligible population;
9.26 	(3) the administrative capacity and experience to serve the
9.27 	target population for whom it will provide services and ensure
9.28 	quality of services under state and federal requirements;
9.29 	(4) the legal authority to provide complete investigative
9.30 	and protective services under section 626.556, subdivision 10;
9.31 	and child welfare and foster care services under section 393.07,
9.32 	subdivisions 1 and 2; or a federally recognized Indian tribe;
9.33 	(5) a financial management system that provides accurate
9.34 	documentation of services and costs under state and federal
9.35 	requirements; and
9.36 	(6) the capacity to document and maintain individual case
10.1 	records under state and federal requirements.
10.2 	(b) A provider of targeted case management under section
10.3 	256B.0625, subdivision 20, may be deemed a certified provider of
10.4 	relocation targeted case management.
10.5 	(c) A relocation targeted county case management provider
10.6 	may subcontract with another provider to deliver relocation
10.7 	targeted case management services.  Subcontracted providers must
10.8 	demonstrate the ability to provide the services outlined in
10.9 	subdivision 6, and have a procedure in place that notifies the
10.10 	recipient and the recipient's legal representative of any
10.11 	conflict of interest if the contracted targeted case management
10.12 	provider also provides, or will provide, the recipient's
10.13 	services and supports. Counties must require that contracted
10.14 	providers must provide information on all conflicts of interest
10.15 	and obtain the recipient's informed consent or provide the
10.16 	recipient with alternatives.

10.17 	Sec. 9. Minnesota Statutes 2004, section 256B.0621,
10.18 	subdivision 5, is amended to read:
10.19 		Subd. 5.Home care targeted case management and
10.20 	relocation service coordination provider qualifications. The
10.21 	following qualifications and certification standards must be met
10.22 	by Providers of home care targeted case management and
10.23 	relocation service coordination must meet the qualifications
10.24 	under subdivision 4 or the following qualifications and
10.25 	certification standards.
10.26 	(a) The commissioner must certify each provider of home
10.27 	care targeted case management and relocation service
10.28 	coordination before enrollment.  The certification process shall
10.29 	examine the provider's ability to meet the requirements in this
10.30 	subdivision and other state and federal requirements of this
10.31 	service.
10.32 	(b) A Both home care targeted case management provider is
10.33 	an providers and relocation service coordination providers are 
10.34 	enrolled medical assistance provider providers who has have a
10.35 	minimum of a bachelor's degree or a license in a health or human
10.36 	services field, or comparable training and two years of
11.1 	experience in human services, and is have been determined by the
11.2 	commissioner to have all of the following characteristics:
11.3 	(1) the demonstrated capacity and experience to provide the
11.4 	components of case management to coordinate and link community
11.5 	resources needed by the eligible population;
11.6 	(2) the administrative capacity and experience to serve the
11.7 	target population for whom it will provide services and ensure
11.8 	quality of services under state and federal requirements;
11.9 	(3) a financial management system that provides accurate
11.10 	documentation of services and costs under state and federal
11.11 	requirements;
11.12 	(4) the capacity to document and maintain individual case
11.13 	records under state and federal requirements; and 
11.14 	(5) the capacity to coordinate with county administrative
11.15 	functions;
11.16 	(6) have no financial interest in the provision of
11.17 	out-of-home residential services to persons for whom targeted
11.18 	case management or relocation service coordination is provided;
11.19 	and 
11.20 	(7) if a provider has a financial interest in services
11.21 	other than out-of-home residential services provided to persons
11.22 	for whom targeted case management or relocation service
11.23 	coordination is also provided, the county must determine each
11.24 	year that:
11.25 	(i) any possible conflict of interest is explained annually
11.26 	at a face-to-face meeting and in writing and the person provides
11.27 	written informed consent consistent with section 256B.77,
11.28 	subdivision 2, paragraph (p); and 
11.29 	(ii) information on a range of other feasible service
11.30 	provider options has been provided.

11.31 	Sec. 10. Minnesota Statutes 2004, section 256B.0621,
11.32 	subdivision 6, is amended to read:
11.33 		Subd. 6.Eligible services. (a) Services eligible for
11.34 	medical assistance reimbursement as targeted case management
11.35 	include:
11.36 	(1) assessment of the recipient's need for targeted case
12.1 	management services;
12.2 	(2) development, completion, and regular review of a
12.3 	written individual service plan, which is based upon the
12.4 	assessment of the recipient's needs and choices, and which will
12.5 	ensure access to medical, social, educational, and other related
12.6 	services and supports;
12.7 	(3) routine contact or communication with the recipient,
12.8 	recipient's family, primary caregiver, legal representative,
12.9 	substitute care provider, service providers, or other relevant
12.10 	persons identified as necessary to the development or
12.11 	implementation of the goals of the individual service plan;
12.12 	(4) coordinating referrals for, and the provision of, case
12.13 	management services for the recipient with appropriate service
12.14 	providers, consistent with section 1902(a)(23) of the Social
12.15 	Security Act;
12.16 	(5) coordinating and monitoring the overall service
12.17 	delivery and engaging in advocacy as needed to ensure quality of
12.18 	services, appropriateness, and continued need;
12.19 	(6) completing and maintaining necessary documentation that
12.20 	supports and verifies the activities in this subdivision;
12.21 	(7) traveling assisting individuals in order to access
12.22 	needed services, including travel to conduct a visit with the
12.23 	recipient or other relevant person necessary to develop or
12.24 	implement the goals of the individual service plan; and
12.25 	(8) coordinating with the institution discharge planner in
12.26 	the 180-day period before the recipient's discharge.
12.27 	(b) Relocation targeted county case management includes
12.28 	services under paragraph (a), clauses (2) and (4).  Relocation
12.29 	service coordination includes services under paragraph (a),
12.30 	clauses (1), (3), and (5) to (8).  Home care targeted case
12.31 	management includes services under paragraph (a), clauses (1) to
12.32 	(8).

12.33 	Sec. 11. Minnesota Statutes 2004, section 256B.0621,
12.34 	subdivision 7, is amended to read:
12.35 		Subd. 7.Time lines.  The following time lines must be
12.36 	met for assigning a case manager:
13.1 	(a) For relocation targeted case management, an eligible
13.2 	recipient must be assigned a county case manager who visits the
13.3 	person within 20 working days of requesting a case manager from
13.4 	their county of financial responsibility as determined under
13.5 	chapter 256G.
13.6 	(1) If a county agency, its contractor, or federally
13.7 	recognized tribe does not provide case management services as
13.8 	required, the recipient may obtain targeted relocation case
13.9 	management services relocation service coordination from an
13.10 	alternative a provider of targeted case management services
13.11 	enrolled by the commissioner qualified under subdivision 5.
13.12 	(2) The commissioner may waive the provider requirements in
13.13 	subdivision 4, paragraph (a), clauses (1) and (4), to ensure
13.14 	recipient access to the assistance necessary to move from an
13.15 	institution to the community.  The recipient or the recipient's
13.16 	legal guardian shall provide written notice to the county or
13.17 	tribe of the decision to obtain services from an alternative
13.18 	provider.
13.19 	(3) Providers of relocation targeted case management
13.20 	enrolled under this subdivision shall:
13.21 	(i) meet the provider requirements under subdivision 4 that
13.22 	are not waived by the commissioner;
13.23 	(ii) be qualified to provide the services specified in
13.24 	subdivision 6;
13.25 	(iii) coordinate efforts with local social service agencies
13.26 	and tribes; and
13.27 	(iv) comply with the conflict of interest provisions
13.28 	established under subdivision 4, paragraph (c).
13.29 	(4) Local social service agencies and federally recognized
13.30 	tribes shall cooperate with providers certified by the
13.31 	commissioner under this subdivision to facilitate the
13.32 	recipient's successful relocation from an institution to the
13.33 	community.
13.34 	(b) For home care targeted case management, an eligible
13.35 	recipient must be assigned a case manager within 20 working days
13.36 	of requesting a case manager from a home care targeted case
14.1 	management provider, as defined in subdivision 5.

14.2 	Sec. 12. Minnesota Statutes 2004, section 256B.0621, is
14.3 	amended by adding a subdivision to read:
14.4 		Subd. 11.Data use agreement and notice of relocation
14.5 	targeted case management availability. (a) The commissioner
14.6 	shall execute a data use agreement with the Center for Medicare
14.7 	and Medicaid Services to obtain the long-term care minimum data
14.8 	set data to assist residents of nursing facilities who have
14.9 	indicated a desire to live in the community.  The commissioner
14.10 	shall in turn enter into agreements with the Centers for
14.11 	Independent Living and other disability advocacy organizations
14.12 	to assist persons who want help to move to the community.
14.13 	(b) Upon admission and annually thereafter, the
14.14 	commissioner shall provide notification to medical assistance
14.15 	eligible persons who are residing in institutions of the
14.16 	availability of relocation targeted case management services,
14.17 	including contact information for the responsible county and
14.18 	senior and disability organizations that provide assistance to
14.19 	persons with disabilities.

14.20 	Sec. 13. Minnesota Statutes 2004, section 256B.0622,
14.21 	subdivision 2, is amended to read:
14.22 		Subd. 2.Definitions.  For purposes of this section, the
14.23 	following terms have the meanings given them.
14.24 	(a) "Intensive nonresidential rehabilitative mental health
14.25 	services" means adult rehabilitative mental health services as
14.26 	defined in section 256B.0623, subdivision 2, paragraph (a),
14.27 	except that these services are provided by a multidisciplinary
14.28 	staff using a total team approach consistent with assertive
14.29 	community treatment, the Fairweather Lodge treatment model, as
14.30 	defined by the standards established by the National Coalition
14.31 	for Community Living,and other evidence-based practices, and
14.32 	directed to recipients with a serious mental illness who require
14.33 	intensive services.
14.34 	(b) "Intensive residential rehabilitative mental health
14.35 	services" means short-term, time-limited services provided in a
14.36 	residential setting to recipients who are in need of more
15.1 	restrictive settings and are at risk of significant functional
15.2 	deterioration if they do not receive these services.  Services
15.3 	are designed to develop and enhance psychiatric stability,
15.4 	personal and emotional adjustment, self-sufficiency, and skills
15.5 	to live in a more independent setting.  Services must be
15.6 	directed toward a targeted discharge date with specified client
15.7 	outcomes and must be consistent with the Fairweather Lodge
15.8 	treatment model as defined in paragraph (a), and other 
15.9 	evidence-based practices.
15.10 	(c) "Evidence-based practices" are nationally recognized
15.11 	mental health services that are proven by substantial research
15.12 	to be effective in helping individuals with serious mental
15.13 	illness obtain specific treatment goals.
15.14 	(d) "Overnight staff" means a member of the intensive
15.15 	residential rehabilitative mental health treatment team who is
15.16 	responsible during hours when recipients are typically asleep.
15.17 	(e) "Treatment team" means all staff who provide services
15.18 	under this section to recipients.  At a minimum, this includes
15.19 	the clinical supervisor, mental health professionals, mental
15.20 	health practitioners, and mental health rehabilitation workers.

15.21 	Sec. 14. Minnesota Statutes 2004, section 256B.0625,
15.22 	subdivision 9, is amended to read:
15.23 		Subd. 9.Dental services. (a) Medical assistance covers
15.24 	dental services.  Dental services include, with prior
15.25 	authorization, fixed bridges that are cost-effective for persons
15.26 	who cannot use removable dentures because of their medical
15.27 	condition.
15.28 	(b) Coverage of dental services for adults age 21 and over
15.29 	who are not pregnant is subject to a $500 annual benefit limit
15.30 	and covered services are limited to:
15.31 	(1) diagnostic and preventative services;
15.32 	(2) restorative services; and 
15.33 	(3) emergency services.
15.34 	Emergency services, dentures, and extractions related to
15.35 	dentures are not included in the $500 annual benefit limit.

15.36 	Sec. 15. Minnesota Statutes 2004, section 256B.0916, is
16.1 	amended by adding a subdivision to read:
16.2 		Subd. 10.Transitional supports allowance. A
16.3 	transitional supports allowance shall be available to all
16.4 	persons under a home and community-based waiver who are moving
16.5 	from a licensed setting to a community setting.  "Transitional
16.6 	supports allowance" means a onetime payment of up to $3,000, to
16.7 	cover the costs, not covered by other sources, associated with
16.8 	moving from a licensed setting to a community setting.  Covered
16.9 	costs include:
16.10 	(1) lease or rent deposits;
16.11 	(2) security deposits;
16.12 	(3) utilities set-up costs, including telephone;
16.13 	(4) essential furnishings and supplies; and 
16.14 	(5) personal supports and transports needed to locate and
16.15 	transition to community settings.
16.16 	
EFFECTIVE DATE. This section is effective upon federal
16.17 	approval and to the extent approved as a federal waiver
16.18 	amendment.

16.19 	Sec. 16. Minnesota Statutes 2004, section 256B.092,
16.20 	subdivision 4b, is amended to read:
16.21 		Subd. 4b.county case management and service coordination 
16.22 	for persons receiving home and community-based services. (a) 
16.23 	Persons authorized for and receiving home and community-based
16.24 	services may select from public vendors of county case
16.25 	management which have provider agreements with the state to
16.26 	provide home and community-based case management service
16.27 	activities. This subdivision becomes effective July 1, 1992,
16.28 	only if the state agency is unable to secure federal approval
16.29 	for limiting choice of case management vendors to the county of
16.30 	financial responsibility.
16.31 	(b) The commissioner shall ensure that each eligible person
16.32 	is given a choice between county and private agency service
16.33 	coordination vendors consistent with the provisions of section
16.34 	256B.49, subdivision 13.
16.35 	
EFFECTIVE DATE. This section is effective July 1, 2005,
16.36 	or, if a federal waiver is required, on the date the federal
17.1 	waiver is granted.

17.2 	Sec. 17. Minnesota Statutes 2004, section 256B.35,
17.3 	subdivision 1, is amended to read:
17.4 		Subdivision 1.Personal needs allowance.  (a)
17.5 	Notwithstanding any law to the contrary, welfare allowances for
17.6 	clothing and personal needs for individuals receiving medical
17.7 	assistance while residing in any skilled nursing home,
17.8 	intermediate care facility, or medical institution including
17.9 	recipients of supplemental security income, in this state shall
17.10 	not be less than $45 $150 per month from all sources.  When
17.11 	benefit amounts for Social Security or supplemental security
17.12 	income recipients are increased pursuant to United States Code,
17.13 	title 42, sections 415(i) and 1382f, the commissioner shall,
17.14 	effective in the month in which the increase takes effect,
17.15 	increase by the same percentage to the nearest whole dollar the
17.16 	clothing and personal needs allowance for individuals receiving
17.17 	medical assistance while residing in any skilled nursing home,
17.18 	medical institution, or intermediate care facility.  The
17.19 	commissioner shall provide timely notice to local agencies,
17.20 	providers, and recipients of increases under this provision.
17.21 	(b) The personal needs allowance may be paid as part of the
17.22 	Minnesota supplemental aid program, notwithstanding the
17.23 	provisions of section 256D.37, subdivision 2, and payments to
17.24 	recipients of Minnesota supplemental aid may be made once each
17.25 	three months covering liabilities that accrued during the
17.26 	preceding three months.
17.27 	(c) The personal needs allowance shall be increased to
17.28 	include income garnished for child support under a court order,
17.29 	up to a maximum of $250 per month but only to the extent that
17.30 	the amount garnished is not deducted as a monthly allowance for
17.31 	children under section 256B.0575, paragraph (a), clause (5).

17.32 	Sec. 18. Minnesota Statutes 2004, section 256B.49,
17.33 	subdivision 13, is amended to read:
17.34 		Subd. 13.county case management and service coordination
17.35 	services.  (a) Each recipient of a home and community-based
17.36 	waiver shall be provided county case management and service
18.1 	coordination services by qualified vendors as described in the
18.2 	federally approved waiver application and offered a choice
18.3 	between county and private vendors for service coordination
18.4 	services.  The county case management service
18.5 	activities services to be provided will include:
18.6 	(1) assessing the needs of the individual within 20 working
18.7 	days of a recipient's request;
18.8 	(2) developing the written individual service plan within
18.9 	ten working days after the assessment is completed, including a
18.10 	determination of resources needed to meet assessed needs;
18.11 	(3) informing the recipient or the recipient's legal
18.12 	guardian or conservator of service options; and 
18.13 	(4) monitoring and evaluating the overall service plan
18.14 	implementation to assure the recipient's health, safety,
18.15 	welfare, and service outcomes.
18.16 	(b) Each recipient shall be offered a choice of a service
18.17 	coordination vendor among qualified public and private vendors
18.18 	as described in the federally approved waiver application.  The
18.19 	service coordination activities include:
18.20 	(1) assisting the recipient to provide medical and other
18.21 	information to determine services needs;
18.22 	(2) assisting the recipient in the identification of
18.23 	potential service providers;
18.24 	(5) (3) assisting the recipient to access services;
18.25 	(6) (4) coordinating, evaluating, and monitoring of the
18.26 	recipient and the services identified in the service plan to
18.27 	assure that the ongoing needs of the recipient are met or
18.28 	changes are made, if needed;
18.29 	(7) (5) assisting the recipient to obtain all information
18.30 	for completing the annual or other reviews described in
18.31 	subdivision 14 of the service plan with the case manager; and 
18.32 	(6) participating in meetings and consultations and
18.33 	advocating for the recipient with recipient's service providers,
18.34 	medical providers, and county staff as needed;
18.35 	(7) having no financial interest in out-of-home residential
18.36 	services for persons for whom service coordination is provided;
19.1 	and 
19.2 	(8) informing the recipient or legal representative of the
19.3 	right to have assessments completed and service plans developed
19.4 	within specified time periods, and to appeal county action or
19.5 	inaction under section 256.045, subdivision 3if a provider has
19.6 	a financial interest in services other than out-of-home
19.7 	residential services provided to persons for whom targeted case
19.8 	management or relocation service coordination is also provided,
19.9 	the county must determine each year that:
19.10 	(i) any possible conflict of interest is explained annually
19.11 	at a face-to-face meeting and in writing and the person provides
19.12 	written informed consent consistent with section 256B.77,
19.13 	subdivision 2, paragraph (p); and 
19.14 	(ii) information on a range of other feasible service
19.15 	provider options has been provided.
19.16 	(b) (c) The case manager county may delegate certain
19.17 	aspects of the county case management or service coordination 
19.18 	activities to another individual provided there is oversight by
19.19 	the case manager.  The case manager may not delegate those
19.20 	aspects which require professional judgment including
19.21 	assessments, reassessments, and care plan development.
19.22 	
EFFECTIVE DATE. This section is effective July 1, 2005,
19.23 	or, if a federal waiver is required, on the date the federal
19.24 	waiver is granted.

19.25 	Sec. 19. Minnesota Statutes 2004, section 256B.49,
19.26 	subdivision 14, is amended to read:
19.27 		Subd. 14.Assessment and reassessment.  (a) Assessments
19.28 	of each recipient's strengths, informal support systems, and
19.29 	need for services shall be completed by the county case manager 
19.30 	within 20 working days of the recipient's request.  Reassessment
19.31 	of each recipient's strengths, support systems, and need for
19.32 	services shall be conducted by the county case manager at least
19.33 	every 12 months and at other times when there has been a
19.34 	significant change in the recipient's functioning.
19.35 	(b) Persons with mental retardation or a related condition
19.36 	who apply for services under the nursing facility level waiver
20.1 	programs shall be screened for the appropriate level of care
20.2 	according to section 256B.092.
20.3 	(c) Recipients who are found eligible for home and
20.4 	community-based services under this section before their 65th
20.5 	birthday may remain eligible for these services after their 65th
20.6 	birthday if they continue to meet all other eligibility factors.

20.7 	Sec. 20. Minnesota Statutes 2004, section 256B.49,
20.8 	subdivision 16, is amended to read:
20.9 		Subd. 16.Services and supports.  (a) Services and
20.10 	supports included in the home and community-based waivers for
20.11 	persons with disabilities shall meet the requirements set out in
20.12 	United States Code, title 42, section 1396n.  The services and
20.13 	supports, which are offered as alternatives to institutional
20.14 	care, shall promote consumer choice, community inclusion,
20.15 	self-sufficiency, and self-determination.
20.16 	(b) Beginning January 1, 2003, the commissioner shall
20.17 	simplify and improve access to home and community-based waivered
20.18 	services, to the extent possible, through the establishment of a
20.19 	common service menu that is available to eligible recipients
20.20 	regardless of age, disability type, or waiver program.
20.21 	(c) Consumer directed community support services shall be
20.22 	offered as an option to all persons eligible for services under
20.23 	subdivision 11, by January 1, 2002.
20.24 	(d) Services and supports shall be arranged and provided
20.25 	consistent with individualized written plans of care for
20.26 	eligible waiver recipients.
20.27 	(e) A transitional supports allowance shall be available to
20.28 	all persons under a home and community-based waiver who are
20.29 	moving from a licensed setting to a community setting.
20.30 	"Transitional supports allowance" means a onetime payment of up
20.31 	to $3,000, to cover the costs, not covered by other sources,
20.32 	associated with moving from a licensed setting to a community
20.33 	setting.  Covered costs include:
20.34 	(1) lease or rent deposits;
20.35 	(2) security deposits;
20.36 	(3) utilities set-up costs, including telephone;
21.1 	(4) essential furnishings and supplies; and 
21.2 	(5) personal supports and transports needed to locate and
21.3 	transition to community settings.
21.4 	(f) The state of Minnesota and county agencies that
21.5 	administer home and community-based waivered services for
21.6 	persons with disabilities, shall not be liable for damages,
21.7 	injuries, or liabilities sustained through the purchase of
21.8 	supports by the individual, the individual's family, legal
21.9 	representative, or the authorized representative with funds
21.10 	received through the consumer-directed community support service
21.11 	under this section.  Liabilities include but are not limited
21.12 	to:  workers' compensation liability, the Federal Insurance
21.13 	Contributions Act (FICA), or the Federal Unemployment Tax Act
21.14 	(FUTA).
21.15 	
EFFECTIVE DATE. This section is effective upon federal
21.16 	approval and to the extent approved as a federal waiver
21.17 	amendment.

21.18 	Sec. 21. Minnesota Statutes 2004, section 256B.5012, is
21.19 	amended by adding a subdivision to read:
21.20 		Subd. 6.Icf/mr rate increases beginning january 1, 2006,
21.21 	and january 1, 2007. For the rate years beginning January 1,
21.22 	2006, and January 1, 2007, the commissioner shall provide
21.23 	facilities reimbursed under this section an adjustment to the
21.24 	total operating payment rate of ..... percent.  At least
21.25 	two-thirds of each year's adjustment must be used for increased
21.26 	costs of employee salaries and benefits and associated costs for
21.27 	FICA, the Medicare tax, workers' compensation premiums, and
21.28 	federal and state unemployment insurance.  Each facility
21.29 	receiving an adjustment shall report to the commissioner, in the
21.30 	form and manner specified by the commissioner, on how the
21.31 	additional funding was used.

21.32 	Sec. 22. Minnesota Statutes 2004, section 256B.69,
21.33 	subdivision 23, is amended to read:
21.34 		Subd. 23.Alternative integrated long-term care services;
21.35 	elderly and disabled persons.  (a) The commissioner may
21.36 	implement demonstration projects to create alternative
22.1 	integrated delivery systems for acute and long-term care
22.2 	services to elderly persons and persons with disabilities as
22.3 	defined in section 256B.77, subdivision 7a, that provide
22.4 	increased coordination, improve access to quality services, and
22.5 	mitigate future cost increases.  The commissioner may seek
22.6 	federal authority to combine Medicare and Medicaid capitation
22.7 	payments for the purpose of such demonstrations.  Medicare funds
22.8 	and services shall be administered according to the terms and
22.9 	conditions of the federal waiver and demonstration provisions.
22.10 	For the purpose of administering medical assistance funds,
22.11 	demonstrations under this subdivision are subject to
22.12 	subdivisions 1 to 22.  The provisions of Minnesota Rules, parts
22.13 	9500.1450 to 9500.1464, apply to these demonstrations, with the
22.14 	exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457,
22.15 	subpart 1, items B and C, which do not apply to persons
22.16 	enrolling in demonstrations under this section.  An initial open
22.17 	enrollment period may be provided.  Persons who disenroll from
22.18 	demonstrations under this subdivision remain subject to
22.19 	Minnesota Rules, parts 9500.1450 to 9500.1464.  When a person is
22.20 	enrolled in a health plan under these demonstrations and the
22.21 	health plan's participation is subsequently terminated for any
22.22 	reason, the person shall be provided an opportunity to select a
22.23 	new health plan and shall have the right to change health plans
22.24 	within the first 60 days of enrollment in the second health
22.25 	plan.  Persons required to participate in health plans under
22.26 	this section who fail to make a choice of health plan shall not
22.27 	be randomly assigned to health plans under these demonstrations.
22.28 	Notwithstanding section 256L.12, subdivision 5, and Minnesota
22.29 	Rules, part 9505.5220, subpart 1, item A, if adopted, for the
22.30 	purpose of demonstrations under this subdivision, the
22.31 	commissioner may contract with managed care organizations,
22.32 	including counties, to serve only elderly persons eligible for
22.33 	medical assistance, elderly and disabled persons, or disabled
22.34 	persons only.  For persons with primary diagnoses of mental
22.35 	retardation or a related condition, serious and persistent
22.36 	mental illness, or serious emotional disturbance, the
23.1 	commissioner must ensure that the county authority has approved
23.2 	the demonstration and contracting design.  Enrollment in these
23.3 	projects for persons with disabilities shall be voluntary.  The
23.4 	commissioner shall not implement any demonstration project under
23.5 	this subdivision for persons with primary diagnoses of mental
23.6 	retardation or a related condition, serious and persistent
23.7 	mental illness, or serious emotional disturbance, without
23.8 	approval of the county board of the county in which the
23.9 	demonstration is being implemented.
23.10 	(b) Notwithstanding chapter 245B, sections 252.40 to
23.11 	252.46, 256B.092, 256B.501 to 256B.5015, and Minnesota Rules,
23.12 	parts 9525.0004 to 9525.0036, 9525.1200 to 9525.1330, 9525.1580,
23.13 	and 9525.1800 to 9525.1930, the commissioner may implement under
23.14 	this section projects for persons with developmental
23.15 	disabilities.  The commissioner may capitate payments for ICF/MR
23.16 	services, waivered services for mental retardation or related
23.17 	conditions, including case management services, day training and
23.18 	habilitation and alternative active treatment services, and
23.19 	other services as approved by the state and by the federal
23.20 	government.  Case management and active treatment must be
23.21 	individualized and developed in accordance with a
23.22 	person-centered plan.  Costs under these projects may not exceed
23.23 	costs that would have been incurred under fee-for-service.
23.24 	Beginning July 1, 2003, and until two years after the pilot
23.25 	project implementation date, subcontractor participation in the
23.26 	long-term care developmental disability pilot is limited to a
23.27 	nonprofit long-term care system providing ICF/MR services, home
23.28 	and community-based waiver services, and in-home services to no
23.29 	more than 120 consumers with developmental disabilities in
23.30 	Carver, Hennepin, and Scott Counties.  The commissioner shall
23.31 	report to the legislature prior to expansion of the
23.32 	developmental disability pilot project.  This paragraph expires
23.33 	two years after the implementation date of the pilot project.
23.34 	(c) Before implementation of a demonstration project for
23.35 	disabled persons, the commissioner must provide information to
23.36 	appropriate committees of the house of representatives and
24.1 	senate and must involve representatives of affected disability
24.2 	groups in the design of the demonstration projects.
24.3 	(d) A nursing facility reimbursed under the alternative
24.4 	reimbursement methodology in section 256B.434 may, in
24.5 	collaboration with a hospital, clinic, or other health care
24.6 	entity provide services under paragraph (a).  The commissioner
24.7 	shall amend the state plan and seek any federal waivers
24.8 	necessary to implement this paragraph.
24.9 	(e) The commissioner shall seek federal approval to expand
24.10 	the Minnesota disability health options (MnDHO) program
24.11 	established under this subdivision in stages, first to regional
24.12 	population centers outside the seven-county metro area and then
24.13 	to all areas of the state.

24.14 	Sec. 23. Minnesota Statutes 2004, section 256B.765, is
24.15 	amended to read:
24.16 	256B.765 PROVIDER RATE INCREASES.
24.17 		Subdivision 1.Annual inflation adjustments. (a)
24.18 	Effective July 1, 2001, within the limits of appropriations
24.19 	specifically for this purpose, the commissioner shall provide an
24.20 	annual inflation adjustment for the providers listed
24.21 	in paragraph (c) subdivision 2.  The index for the inflation
24.22 	adjustment must be based on the change in the Employment Cost
24.23 	Index for Private Industry Workers - Total Compensation
24.24 	forecasted by Data Resources, Inc., as forecasted in the fourth
24.25 	quarter of the calendar year preceding the fiscal year.  The
24.26 	commissioner shall increase reimbursement or allocation rates by
24.27 	the percentage of this adjustment, and county boards shall
24.28 	adjust provider contracts as needed.
24.29 	(b) The commissioner of finance shall include an annual
24.30 	inflationary adjustment in reimbursement rates for the providers
24.31 	listed in paragraph (c) subdivision 2 using the inflation factor
24.32 	specified in paragraph (a) as a budget change request in each
24.33 	biennial detailed expenditure budget submitted to the
24.34 	legislature under section 16A.11.
24.35 	(c) Subd. 2.[ELIGIBLE PROVIDERS.] The annual adjustment
24.36 	under subdivision 1,paragraph (a),shall be provided for home
25.1 	and community-based waiver services for persons with mental
25.2 	retardation or related conditions under section 256B.501; home
25.3 	and community-based waiver services for the elderly under
25.4 	section 256B.0915; waivered services under community
25.5 	alternatives for disabled individuals under section 256B.49;
25.6 	community alternative care waivered services under section
25.7 	256B.49; traumatic brain injury waivered services under section
25.8 	256B.49; nursing services and home health services under section
25.9 	256B.0625, subdivision 6a; personal care services and nursing
25.10 	supervision of personal care services under section 256B.0625,
25.11 	subdivision 19a; private duty nursing services under section
25.12 	256B.0625, subdivision 7; day training and habilitation services
25.13 	for adults with mental retardation or related conditions under
25.14 	sections 252.40 to 252.46; physical therapy services under
25.15 	sections 256B.0625, subdivision 8, and 256D.03, subdivision 4;
25.16 	occupational therapy services under sections 256B.0625,
25.17 	subdivision 8a, and 256D.03, subdivision 4; speech-language
25.18 	therapy services under section 256D.03, subdivision 4, and
25.19 	Minnesota Rules, part 9505.0390; respiratory therapy services
25.20 	under section 256D.03, subdivision 4, and Minnesota Rules, part
25.21 	9505.0295; alternative care services under section 256B.0913;
25.22 	adult residential program grants under Minnesota Rules, parts
25.23 	9535.2000 to 9535.3000; adult and family community support
25.24 	grants under Minnesota Rules, parts 9535.1700 to 9535.1760;
25.25 	semi-independent living services under section 252.275 including
25.26 	SILS funding under county social services grants formerly funded
25.27 	under chapter 256I; and community support services for deaf and
25.28 	hard-of-hearing adults with mental illness who use or wish to
25.29 	use sign language as their primary means of communication.
25.30 		Subd. 3.Rate increase for biennium beginning july 1,
25.31 	2005. For the fiscal years beginning July 1, 2005, and July 1,
25.32 	2006, the commissioner shall increase reimbursement rates for
25.33 	the providers listed in subdivision 2 by ..... percent.  At
25.34 	least two-thirds of each year's adjustment must be used for
25.35 	increased costs of employee salaries and benefits and associated
25.36 	costs for FICA, the Medicare tax, workers' compensation
26.1 	premiums, and federal and state unemployment insurance.  Each
26.2 	provider receiving an adjustment shall report to the
26.3 	commissioner, in the form and manner specified by the
26.4 	commissioner, on how the additional funding was used.

26.5 	Sec. 24. Minnesota Statutes 2004, section 256D.03,
26.6 	subdivision 4, is amended to read:
26.7 		Subd. 4.General assistance medical care; services.
 26.8 	(a)(i) For a person who is eligible under subdivision 3,
26.9 	paragraph (a), clause (2), item (i), general assistance medical
26.10 	care covers, except as provided in paragraph (c):
26.11 	(1) inpatient hospital services;
26.12 	(2) outpatient hospital services;
26.13 	(3) services provided by Medicare certified rehabilitation
26.14 	agencies;
26.15 	(4) prescription drugs and other products recommended
26.16 	through the process established in section 256B.0625,
26.17 	subdivision 13;
26.18 	(5) equipment necessary to administer insulin and
26.19 	diagnostic supplies and equipment for diabetics to monitor blood
26.20 	sugar level;
26.21 	(6) eyeglasses and eye examinations provided by a physician
26.22 	or optometrist;
26.23 	(7) hearing aids;
26.24 	(8) prosthetic devices;
26.25 	(9) laboratory and X-ray services;
26.26 	(10) physician's services;
26.27 	(11) medical transportation except special transportation;
26.28 	(12) chiropractic services as covered under the medical
26.29 	assistance program;
26.30 	(13) podiatric services;
26.31 	(14) dental services and dentures, subject to the
26.32 	limitations specified in section 256B.0625, subdivision 9as
26.33 	covered under the medical assistance program;
26.34 	(15) outpatient services provided by a mental health center
26.35 	or clinic that is under contract with the county board and is
26.36 	established under section 245.62;
27.1 	(16) day treatment services for mental illness provided
27.2 	under contract with the county board;
27.3 	(17) prescribed medications for persons who have been
27.4 	diagnosed as mentally ill as necessary to prevent more
27.5 	restrictive institutionalization;
27.6 	(18) psychological services, medical supplies and
27.7 	equipment, and Medicare premiums, coinsurance and deductible
27.8 	payments;
27.9 	(19) medical equipment not specifically listed in this
27.10 	paragraph when the use of the equipment will prevent the need
27.11 	for costlier services that are reimbursable under this
27.12 	subdivision;
27.13 	(20) services performed by a certified pediatric nurse
27.14 	practitioner, a certified family nurse practitioner, a certified
27.15 	adult nurse practitioner, a certified obstetric/gynecological
27.16 	nurse practitioner, a certified neonatal nurse practitioner, or
27.17 	a certified geriatric nurse practitioner in independent
27.18 	practice, if (1) the service is otherwise covered under this
27.19 	chapter as a physician service, (2) the service provided on an
27.20 	inpatient basis is not included as part of the cost for
27.21 	inpatient services included in the operating payment rate, and
27.22 	(3) the service is within the scope of practice of the nurse
27.23 	practitioner's license as a registered nurse, as defined in
27.24 	section 148.171;
27.25 	(21) services of a certified public health nurse or a
27.26 	registered nurse practicing in a public health nursing clinic
27.27 	that is a department of, or that operates under the direct
27.28 	authority of, a unit of government, if the service is within the
27.29 	scope of practice of the public health nurse's license as a
27.30 	registered nurse, as defined in section 148.171; and
27.31 	(22) telemedicine consultations, to the extent they are
27.32 	covered under section 256B.0625, subdivision 3b.
27.33 	(ii) Effective October 1, 2003, for a person who is
27.34 	eligible under subdivision 3, paragraph (a), clause (2), item
27.35 	(ii), general assistance medical care coverage is limited to
27.36 	inpatient hospital services, including physician services
28.1 	provided during the inpatient hospital stay.  A $1,000
28.2 	deductible is required for each inpatient hospitalization.
28.3 	(b) Gender reassignment surgery and related services are
28.4 	not covered services under this subdivision unless the
28.5 	individual began receiving gender reassignment services prior to
28.6 	July 1, 1995.
28.7 	(c) In order to contain costs, the commissioner of human
28.8 	services shall select vendors of medical care who can provide
28.9 	the most economical care consistent with high medical standards
28.10 	and shall where possible contract with organizations on a
28.11 	prepaid capitation basis to provide these services.  The
28.12 	commissioner shall consider proposals by counties and vendors
28.13 	for prepaid health plans, competitive bidding programs, block
28.14 	grants, or other vendor payment mechanisms designed to provide
28.15 	services in an economical manner or to control utilization, with
28.16 	safeguards to ensure that necessary services are provided.
28.17 	Before implementing prepaid programs in counties with a county
28.18 	operated or affiliated public teaching hospital or a hospital or
28.19 	clinic operated by the University of Minnesota, the commissioner
28.20 	shall consider the risks the prepaid program creates for the
28.21 	hospital and allow the county or hospital the opportunity to
28.22 	participate in the program in a manner that reflects the risk of
28.23 	adverse selection and the nature of the patients served by the
28.24 	hospital, provided the terms of participation in the program are
28.25 	competitive with the terms of other participants considering the
28.26 	nature of the population served.  Payment for services provided
28.27 	pursuant to this subdivision shall be as provided to medical
28.28 	assistance vendors of these services under sections 256B.02,
28.29 	subdivision 8, and 256B.0625.  For payments made during fiscal
28.30 	year 1990 and later years, the commissioner shall consult with
28.31 	an independent actuary in establishing prepayment rates, but
28.32 	shall retain final control over the rate methodology.
28.33 	(d) Recipients eligible under subdivision 3, paragraph (a),
28.34 	clause (2), item (i), shall pay the following co-payments for
28.35 	services provided on or after October 1, 2003:
28.36 	(1) $3 per nonpreventive visit.  For purposes of this
29.1 	subdivision, a visit means an episode of service which is
29.2 	required because of a recipient's symptoms, diagnosis, or
29.3 	established illness, and which is delivered in an ambulatory
29.4 	setting by a physician or physician ancillary, chiropractor,
29.5 	podiatrist, nurse midwife, advanced practice nurse, audiologist,
29.6 	optician, or optometrist;
29.7 	(2) $25 for eyeglasses;
29.8 	(3) $25 for nonemergency visits to a hospital-based
29.9 	emergency room; and 
29.10 	(4) $3 per brand-name drug prescription and $1 per generic
29.11 	drug prescription, subject to a $20 per month maximum for
29.12 	prescription drug co-payments.  No co-payments shall apply to
29.13 	antipsychotic drugs when used for the treatment of mental
29.14 	illness; and 
29.15 	(5) 50 percent coinsurance on restorative dental services.
29.16 	(e) Co-payments shall be limited to one per day per
29.17 	provider for nonpreventive visits, eyeglasses, and nonemergency
29.18 	visits to a hospital-based emergency room.  Recipients of
29.19 	general assistance medical care are responsible for all
29.20 	co-payments in this subdivision.  The general assistance medical
29.21 	care reimbursement to the provider shall be reduced by the
29.22 	amount of the co-payment, except that reimbursement for
29.23 	prescription drugs shall not be reduced once a recipient has
29.24 	reached the $20 per month maximum for prescription drug
29.25 	co-payments.  The provider collects the co-payment from the
29.26 	recipient.  Providers may not deny services to recipients who
29.27 	are unable to pay the co-payment, except as provided in
29.28 	paragraph (f).
29.29 	(f) If it is the routine business practice of a provider to
29.30 	refuse service to an individual with uncollected debt, the
29.31 	provider may include uncollected co-payments under this
29.32 	section.  A provider must give advance notice to a recipient
29.33 	with uncollected debt before services can be denied.
29.34 	(g) Any county may, from its own resources, provide medical
29.35 	payments for which state payments are not made.
29.36 	(h) Chemical dependency services that are reimbursed under
30.1 	chapter 254B must not be reimbursed under general assistance
30.2 	medical care.
30.3 	(i) The maximum payment for new vendors enrolled in the
30.4 	general assistance medical care program after the base year
30.5 	shall be determined from the average usual and customary charge
30.6 	of the same vendor type enrolled in the base year.
30.7 	(j) The conditions of payment for services under this
30.8 	subdivision are the same as the conditions specified in rules
30.9 	adopted under chapter 256B governing the medical assistance
30.10 	program, unless otherwise provided by statute or rule.
30.11 	(k) Inpatient and outpatient payments shall be reduced by
30.12 	five percent, effective July 1, 2003.  This reduction is in
30.13 	addition to the five percent reduction effective July 1, 2003,
30.14 	and incorporated by reference in paragraph (i).
30.15 	(l) Payments for all other health services except
30.16 	inpatient, outpatient, and pharmacy services shall be reduced by
30.17 	five percent, effective July 1, 2003.
30.18 	(m) Payments to managed care plans shall be reduced by five
30.19 	percent for services provided on or after October 1, 2003.
30.20 	(n) A hospital receiving a reduced payment as a result of
30.21 	this section may apply the unpaid balance toward satisfaction of
30.22 	the hospital's bad debts.

30.23 	Sec. 25. Minnesota Statutes 2004, section 256L.03,
30.24 	subdivision 1, is amended to read:
30.25 		Subdivision 1.Covered health services.  For individuals
30.26 	under section 256L.04, subdivision 7, with income no greater
30.27 	than 75 percent of the federal poverty guidelines or for
30.28 	families with children under section 256L.04, subdivision 1, all
30.29 	subdivisions of this section apply.  "Covered health services"
30.30 	means the health services reimbursed under chapter 256B, with
30.31 	the exception of inpatient hospital services, special education
30.32 	services, private duty nursing services, adult dental care
30.33 	services other than services except as covered under section
30.34 	256B.0625, subdivision 9, paragraph (b), orthodontic services,
30.35 	nonemergency medical transportation services, personal care
30.36 	assistant and case management services, nursing home or
31.1 	intermediate care facilities services, inpatient mental health
31.2 	services, and chemical dependency services.  Outpatient mental
31.3 	health services covered under the MinnesotaCare program are
31.4 	limited to diagnostic assessments, psychological testing,
31.5 	explanation of findings, medication management by a physician,
31.6 	day treatment, partial hospitalization, and individual, family,
31.7 	and group psychotherapy.
31.8 	No public funds shall be used for coverage of abortion
31.9 	under MinnesotaCare except where the life of the female would be
31.10 	endangered or substantial and irreversible impairment of a major
31.11 	bodily function would result if the fetus were carried to term;
31.12 	or where the pregnancy is the result of rape or incest.
31.13 	Covered health services shall be expanded as provided in
31.14 	this section.

31.15 	Sec. 26. Minnesota Statutes 2004, section 256L.03,
31.16 	subdivision 5, is amended to read:
31.17 		Subd. 5.Co-payments and coinsurance.  (a) Except as
31.18 	provided in paragraphs (b) and (c), the MinnesotaCare benefit
31.19 	plan shall include the following co-payments and coinsurance
31.20 	requirements for all enrollees:
31.21 	(1) ten percent of the paid charges for inpatient hospital
31.22 	services for adult enrollees, subject to an annual inpatient
31.23 	out-of-pocket maximum of $1,000 per individual and $3,000 per
31.24 	family;
31.25 	(2) $3 per prescription for adult enrollees; and 
31.26 	(3) $25 for eyeglasses for adult enrollees; and 
31.27 	(4) 50 percent of the fee-for-service rate for adult dental
31.28 	care services other than preventive care services for persons
31.29 	eligible under section 256L.04, subdivisions 1 to 7, with income
31.30 	equal to or less than 175 percent of the federal poverty
31.31 	guidelines.
31.32 	(b) Paragraph (a), clause (1), does not apply to parents
31.33 	and relative caretakers of children under the age of 21 in
31.34 	households with family income equal to or less than 175 percent
31.35 	of the federal poverty guidelines.  Paragraph (a), clause (1),
31.36 	does not apply to parents and relative caretakers of children
32.1 	under the age of 21 in households with family income greater
32.2 	than 175 percent of the federal poverty guidelines for inpatient
32.3 	hospital admissions occurring on or after January 1, 2001.
32.4 	(c) Paragraph (a), clauses (1) to (4), do not apply to
32.5 	pregnant women and children under the age of 21.
32.6 	(d) Adult enrollees with family gross income that exceeds
32.7 	175 percent of the federal poverty guidelines and who are not
32.8 	pregnant shall be financially responsible for the coinsurance
32.9 	amount, if applicable, and amounts which exceed the $10,000
32.10 	inpatient hospital benefit limit.
32.11 	(e) When a MinnesotaCare enrollee becomes a member of a
32.12 	prepaid health plan, or changes from one prepaid health plan to
32.13 	another during a calendar year, any charges submitted towards
32.14 	the $10,000 annual inpatient benefit limit, and any
32.15 	out-of-pocket expenses incurred by the enrollee for inpatient
32.16 	services, that were submitted or incurred prior to enrollment,
32.17 	or prior to the change in health plans, shall be disregarded.

32.18 	Sec. 27. FEDERAL APPROVAL.
 32.19 	By August 1, 2005, the commissioner of human services shall
32.20 	request any federal approval and plan amendments necessary to
32.21 	implement (1) the transitional supports allowance under
32.22 	Minnesota Statutes, sections 256B.0916, subdivision 10; and
32.23 	256B.49, subdivision 16; and (2) the choice of case management
32.24 	service coordination provisions under Minnesota Statutes,
32.25 	sections 256B.0621, subdivision 4; 256B.092, subdivisions 2a and
32.26 	4b; and 256B.49, subdivision 13.

32.27 	Sec. 28. DENTAL ACCESS FOR PERSONS WITH DISABILITIES.
 32.28 	The commissioner of human services shall study access to
32.29 	dental services for persons with disabilities, and shall present
32.30 	recommendations for improving access to dental services to the
32.31 	legislature by January 15, 2006.  The study must examine
32.32 	physical and geographic access, the willingness of dentists to
32.33 	serve persons with disabilities enrolled in state health care
32.34 	programs, reimbursement rates for dental service providers, and
32.35 	other factors identified by the commissioner as potential
32.36 	barriers to accessing dental services.

33.1 	Sec. 29. DISABILITY SERVICES INTERAGENCY WORK GROUP.
 33.2 		Subdivision 1.Establishment. The commissioners of human
33.3 	services and housing finance and the Minnesota State Council on
33.4 	Disability shall convene an interagency work group of interested
33.5 	stakeholders, including other state agencies, counties, public
33.6 	housing authorities, the Metropolitan Council, disability
33.7 	service providers, and representatives from disability advocacy
33.8 	organizations to identify barriers, strengthen coordination,
33.9 	recommend policy and funding changes, and pursue federal
33.10 	financing that will assist Minnesotans with disabilities who are
33.11 	attempting to relocate from or avoid placement in institutional
33.12 	settings.
33.13 		Subd. 2.Work group activities. The work group shall
33.14 	make recommendations to the state agencies and the legislature
33.15 	related to:
33.16 	(1) coordinating the availability of housing,
33.17 	transportation, and support services needed to discharge persons
33.18 	with disabilities from institutions;
33.19 	(2) improving information and assistance needed to make an
33.20 	informed choice about relocating from an institutional placement
33.21 	to community-based services;
33.22 	(3) identifying gaps in human services, transportation, and
33.23 	housing access that are barriers to moving to community
33.24 	services;
33.25 	(4) identifying strategies that would result in earlier
33.26 	identification of persons most at risk of institutional
33.27 	placement in order to promote diversion to community services or
33.28 	reduce lengths of stay in an institutional facility;
33.29 	(5) identifying funding mechanisms and financial strategies
33.30 	to assure a financially sustainable community support system
33.31 	that diverts and relocates individuals from institutional
33.32 	placement; and 
33.33 	(6) identifying state actions needed to address any federal
33.34 	changes affecting policies, benefits, or funding used to support
33.35 	persons with disabilities in avoiding institutional placement.
33.36 		Subd. 3.Recommendations. Recommendations of the work
34.1 	group must be submitted to each state agency and to the chairs
34.2 	of the health and human services policy and finance committees
34.3 	of the senate and house of representatives by October 15, 2006.