1.1 	A bill for an act
1.2 	relating to human services; making technical changes; amending children's 
1.3 	mental health, health care, and miscellaneous provisions;amending Minnesota 
1.4 	Statutes 2006, sections 254A.035, subdivision 2; 254A.04; 256.046; 256B.093, 
1.5 	subdivision 1; 256B.0943, subdivisions 1, 2, 7; 256L.07, subdivision 5; 
1.6 	Minnesota Statutes 2007 Supplement, sections 256.01, subdivision 2b; 256.476, 
1.7 	subdivisions 4, 5; 256B.057, subdivision 2c; 256B.06, subdivision 4; 256B.0655, 
1.8 	subdivision 12; 256B.0943, subdivisions 6, 9, 12; 256D.03, subdivision 3; 
1.9 	256L.15, subdivision 2; repealing Minnesota Statutes 2006, section 256B.039.
1.10 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.11 	ARTICLE 1
1.12 	CHILDREN'S MENTAL HEALTH

1.13 	Section 1. Minnesota Statutes 2006, section 256B.0943, subdivision 1, is amended to 
1.14 	read:
1.15 		Subdivision 1.Definitions. For purposes of this section, the following terms have 
1.16 	the meanings given them.
1.17 	(a) "Children's therapeutic services and supports" means the flexible package of 
1.18 	mental health services for children who require varying therapeutic and rehabilitative 
1.19 	levels of intervention. The services are time-limited interventions that are delivered using 
1.20 	various treatment modalities and combinations of services designed to reach treatment 
1.21 	outcomes identified in the individual treatment plan.
1.22 	(b) "Clinical supervision" means the overall responsibility of the mental health 
1.23 	professional for the control and direction of individualized treatment planning, service 
1.24 	delivery, and treatment review for each client. A mental health professional who is an 
1.25 	enrolled Minnesota health care program provider accepts full professional responsibility 
2.1 	for a supervisee's actions and decisions, instructs the supervisee in the supervisee's work, 
2.2 	and oversees or directs the supervisee's work.
2.3 	(c) "County board" means the county board of commissioners or board established 
2.4 	under sections 402.01 to 402.10 or 471.59. 
2.5 	(d) "Crisis assistance" has the meaning given in section 245.4871, subdivision 9a. 
2.6 	(e) "Culturally competent provider" means a provider who understands and can 
2.7 	utilize to a client's benefit the client's culture when providing services to the client. A 
2.8 	provider may be culturally competent because the provider is of the same cultural or 
2.9 	ethnic group as the client or the provider has developed the knowledge and skills through 
2.10 	training and experience to provide services to culturally diverse clients.
2.11 	(f) "Day treatment program" for children means a site-based structured program 
2.12 	consisting of group psychotherapy for more than three individuals and other intensive 
2.13 	therapeutic services provided by a multidisciplinary team, under the clinical supervision 
2.14 	of a mental health professional.
2.15 	(g) "Diagnostic assessment" has the meaning given in section 245.4871, subdivision 
2.16 	11. 
2.17 	(h) "Direct service time" means the time that a mental health professional, mental 
2.18 	health practitioner, or mental health behavioral aide spends face-to-face with a client 
2.19 	and the client's family. Direct service time includes time in which the provider obtains 
2.20 	a client's history or provides service components of children's therapeutic services and 
2.21 	supports. Notwithstanding Minnesota Rules, part 9505.0323, subpart 1, item M, direct 
2.22 	service time does not include time doing work before and after providing direct services, 
2.23 	including scheduling, maintaining clinical records, consulting with others about the client's 
2.24 	mental health status, preparing reports, receiving clinical supervision directly related to 
2.25 	the client's psychotherapy session, and revising the client's individual treatment plan.
2.26 	(i) "Direction of mental health behavioral aide" means the activities of a mental 
2.27 	health professional or mental health practitioner in guiding the mental health behavioral 
2.28 	aide in providing services to a client. The direction of a mental health behavioral aide 
2.29 	must be based on the client's individualized treatment plan and meet the requirements in 
2.30 	subdivision 6, paragraph (b), clause (5).
2.31 	(j) "Emotional disturbance" has the meaning given in section 245.4871, subdivision 
2.32 	15. For persons at least age 18 but under age 21, mental illness has the meaning given in 
2.33 	section 245.462, subdivision 20, paragraph (a). 
2.34 	(k) "Individual behavioral plan" means a plan of intervention, treatment, and 
2.35 	services for a child written by a mental health professional or mental health practitioner, 
3.1 	under the clinical supervision of a mental health professional, to guide the work of the 
3.2 	mental health behavioral aide.
3.3 	(l) "Individual treatment plan" has the meaning given in section 245.4871, 
3.4 	subdivision 21. 
3.5 	(m) "Mental health professional" means an individual as defined in section 
3.6 	245.4871, subdivision 27, clauses (1) to (5), or tribal vendor as defined in section 256B.02, 
3.7 	subdivision 7, paragraph (b). 
3.8 	(n) "Preschool program" means a day program licensed under Minnesota Rules, 
3.9 	parts 9503.0005 to 9503.0175, and enrolled as a children's therapeutic services and 
3.10 	supports provider to provide a structured treatment program to a child who is at least 33 
3.11 	months old but who has not yet attended the first day of kindergarten.
3.12 	(o) "Skills training" means individual, family, or group training designed to improve 
3.13 	the basic functioning of the child with emotional disturbance and the child's family in the 
3.14 	activities of daily living and community living, and to improve the social functioning of the 
3.15 	child and the child's family in areas important to the child's maintaining or reestablishing 
3.16 	residency in the community. Individual, family, and group skills training must:
3.17 	(1) consist of activities designed to promote skill development of the child and the 
3.18 	child's family in the use of age-appropriate daily living skills, interpersonal and family 
3.19 	relationships, and leisure and recreational services;
3.20 	(2) consist of activities that will assist the family's understanding of normal child 
3.21 	development and to use parenting skills that will help the child with emotional disturbance 
3.22 	achieve the goals outlined in the child's individual treatment plan; and
3.23 	(3) promote family preservation and unification, promote the family's integration 
3.24 	with the community, and reduce the use of unnecessary out-of-home placement or 
3.25 	institutionalization of children with emotional disturbance. provide rehabilitation of 
3.26 	specific skills deficits or maladaptive skills acquired over the course of a psychiatric 
3.27 	illness. Skills training is subject to the following requirements:
3.28 	(1) a mental health professional or a mental health practitioner shall provide skills 
3.29 	training;
3.30 	(2) the child shall always be present during skills training; however, a brief absence 
3.31 	of the child for no more than ten percent of the session unit may be allowed to redirect or 
3.32 	instruct family members;
3.33 	(3) skills training delivered to children or their families shall be targeted to the 
3.34 	specific deficits or maladaptations of the child's mental health disorder and shall be 
3.35 	prescribed in the child's individual treatment plan; and
4.1 	(4) group skills training may be provided to multiple recipients who, because of the 
4.2 	nature of their emotional, behavioral, or social dysfunction, can derive mutual benefit from 
4.3 	interaction in a group setting, which shall be staffed as follows:
4.4 	(i) one mental health professional or one mental health practitioner under supervision 
4.5 	of a licensed mental health professional shall work with a group of four to eight clients; or
4.6 	(ii) two mental health professionals or two mental health practitioners under 
4.7 	supervision of a licensed mental health professional, or one professional plus one 
4.8 	practitioner shall work with a group of nine to 12 clients.

4.9 	Sec. 2. Minnesota Statutes 2006, section 256B.0943, subdivision 2, is amended to read:
4.10 		Subd. 2.Covered service components of children's therapeutic services and 
4.11 	supports. (a) Subject to federal approval, medical assistance covers medically necessary 
4.12 	children's therapeutic services and supports as defined in this section that an eligible 
4.13 	provider entity certified under subdivisionssubdivision 4 and 5 provides to a client 
4.14 	eligible under subdivision 3.
4.15 	(b) The service components of children's therapeutic services and supports are:
4.16 	(1) individual, family, and group psychotherapy;
4.17 	(2) individual, family, or group skills training provided by a mental health 
4.18 	professional or mental health practitioner;
4.19 	(3) crisis assistance;
4.20 	(4) mental health behavioral aide services; and
4.21 	(5) direction of a mental health behavioral aide.
4.22 	(c) Service components in paragraph (b) may be combined to constitute therapeutic 
4.23 	programs, including day treatment programs and therapeutic preschool programs. 
4.24 	Although day treatment and preschool programs have specific client and provider 
4.25 	eligibility requirements, medical assistance only pays for the service components listed in 
4.26 	paragraph (b).

4.27 	Sec. 3. Minnesota Statutes 2007 Supplement, section 256B.0943, subdivision 6, 
4.28 	is amended to read:
4.29 		Subd. 6.Provider entity clinical infrastructure requirements. (a) To be 
4.30 	an eligible provider entity under this section, a provider entity must have a clinical 
4.31 	infrastructure that utilizes diagnostic assessment, an individualized treatment plan plans, 
4.32 	service delivery, and individual treatment plan review that are culturally competent, 
4.33 	child-centered, and family-driven to achieve maximum benefit for the client. The provider 
4.34 	entity must review and update the clinical policies and procedures every three years and 
5.1 	must distribute the policies and procedures to staff initially and upon each subsequent 
5.2 	update.
5.3 	(b) The clinical infrastructure written policies and procedures must include policies 
5.4 	and procedures for:
5.5 	(1) providing or obtaining a client's diagnostic assessment that identifies acute and 
5.6 	chronic clinical disorders, co-occurring medical conditions, sources of psychological and 
5.7 	environmental problems, and a functional assessment. The functional assessment must 
5.8 	clearly summarize the client's individual strengths and needs;
5.9 	(2) developing an individual treatment plan that is:
5.10 	(i) is based on the information in the client's diagnostic assessment;
5.11 	(ii) identifies goals and objectives of treatment, treatment strategy, a schedule 
5.12 	for accomplishing treatment goals and objectives, and the individuals responsible for 
5.13 	providing treatment services and supports;
5.14 	(ii)(iii) is developed no later than the end of the first psychotherapy session after
5.15 	within 30 days of the completion of the client's diagnostic assessment by thea mental 
5.16 	health professional who provides the client's psychotherapy and before the provision of 
5.17 	children's therapeutic services and supports;
5.18 	(iii)(iv) is developed through a child-centered, family-driven, culturally appropriate
5.19 	planning process that identifies service needs and individualized, planned, and culturally 
5.20 	appropriate interventions that contain specific treatment goals and objectives for the client 
5.21 	and the client's family or foster family;
5.22 	(iv)(v) is reviewed at least once every 90 days and revised, if necessary; and
5.23 	(v)(vi) is signed by the clinical supervisor and by the client or, if appropriate, by the
5.24 	client's parent or other person authorized by statute to consent to mental health services 
5.25 	for the client;
5.26 	(3) developing an individual behavior plan that documents servicestreatment 
5.27 	strategies to be provided by the mental health behavioral aide. The individual behavior 
5.28 	plan must include:
5.29 	(i) detailed instructions on the servicetreatment strategies to be provided;
5.30 	(ii) time allocated to each service treatment strategy;
5.31 	(iii) methods of documenting the child's behavior;
5.32 	(iv) methods of monitoring the child's progress in reaching objectives; and
5.33 	(v) goals to increase or decrease targeted behavior as identified in the individual 
5.34 	treatment plan;
5.35 	(4) providing clinical supervision of the mental health practitioner and mental health 
5.36 	behavioral aide. A mental health professional must document the clinical supervision 
6.1 	the professional provides by cosigning individual treatment plans and making entries in 
6.2 	the client's record on supervisory activities. Clinical supervision does not include the 
6.3 	authority to make or terminate court-ordered placements of the child. A clinical supervisor 
6.4 	must be available for urgent consultation as required by the individual client's needs or 
6.5 	the situation. Clinical supervision may occur individually or in a small group to discuss 
6.6 	treatment and review progress toward goals. The focus of clinical supervision must be the 
6.7 	client's treatment needs and progress and the mental health practitioner's or behavioral 
6.8 	aide's ability to provide services;
6.9 	(4a) CTSS certified provider entities providingmeeting day treatment and 
6.10 	therapeutic preschool programs must meet the conditions in items (i) to (iii):
6.11 	(i) the supervisor must be present and available on the premises more than 50 
6.12 	percent of the time in a five-working-day period during which the supervisee is providing 
6.13 	a mental health service;
6.14 	(ii) the diagnosis and the client's individual treatment plan or a change in the 
6.15 	diagnosis or individual treatment plan must be made by or reviewed, approved, and signed 
6.16 	by the supervisor; and
6.17 	(iii) every 30 days, the supervisor must review and sign the record of the client's care 
6.18 	for all activities in the preceding 30-day period;
6.19 	(4b) meeting the clinical supervision standards in items (i) to (iii) for all other 
6.20 	services provided under CTSS, clinical supervision standards provided in items (i) to 
6.21 	(iii) must be used:
6.22 	(i) medical assistance shall reimburse a mental health practitioner and a mental 
6.23 	health behavioral aide who maintains a consulting relationship with a mental health 
6.24 	professional who accepts full professional responsibility and is present on site for at 
6.25 	least one clock hour for observation during the first 12 hours in which the mental health 
6.26 	practitioner or mental health behavioral aide provides the individual, family, or group 
6.27 	skills training to the child or the child's family children's therapeutic services and supports;
6.28 	(ii) thereafter, the mental health professional is required to be present on site for 
6.29 	observation as clinically appropriate when the mental health practitioner or mental health 
6.30 	behavioral aide is providing individual, family, or group skills training to the child or the 
6.31 	child's family CTSS services; and
6.32 	(iii) the observation must be a minimum of one clinical unit. The on-site presence of 
6.33 	the mental health professional must be documented in the child's record and signed by the 
6.34 	mental health professional who accepts full professional responsibility;
6.35 	(5) providing direction to a mental health behavioral aide. For entities that employ 
6.36 	mental health behavioral aides, the clinical supervisor must be employed by the provider 
7.1 	entity or other certified children's therapeutic supports and services provider entity to 
7.2 	ensure necessary and appropriate oversight for the client's treatment and continuity 
7.3 	of care. The mental health professional or mental health practitioner giving direction 
7.4 	must begin with the goals on the individualized treatment plan, and instruct the mental 
7.5 	health behavioral aide on how to construct therapeutic activities and interventions that 
7.6 	will lead to goal attainment. The professional or practitioner giving direction must also 
7.7 	instruct the mental health behavioral aide about the client's diagnosis, functional status, 
7.8 	and other characteristics that are likely to affect service delivery. Direction must also 
7.9 	include determining that the mental health behavioral aide has the skills to interact with 
7.10 	the client and the client's family in ways that convey personal and cultural respect and 
7.11 	that the aide actively solicits information relevant to treatment from the family. The aide 
7.12 	must be able to clearly explain the activities the aide is doing with the client and the 
7.13 	activities' relationship to treatment goals. Direction is more didactic than is supervision 
7.14 	and requires the professional or practitioner providing it to continuously evaluate the 
7.15 	mental health behavioral aide's ability to carry out the activities of the individualized 
7.16 	treatment plan and the individualized behavior plan. When providing direction, the 
7.17 	professional or practitioner must:
7.18 	(i) review progress notes prepared by the mental health behavioral aide for accuracy 
7.19 	and consistency with diagnostic assessment, treatment plan, and behavior goals and the 
7.20 	professional or practitioner must approve and sign the progress notes;
7.21 	(ii) identify changes in treatment strategies, revise the individual behavior plan, 
7.22 	and communicate treatment instructions and methodologies as appropriate to ensure 
7.23 	that treatment is implemented correctly;
7.24 	(iii) demonstrate family-friendly behaviors that support healthy collaboration among 
7.25 	the child, the child's family, and providers as treatment is planned and implemented;
7.26 	(iv) ensure that the mental health behavioral aide is able to effectively communicate 
7.27 	with the child, the child's family, and the provider; and
7.28 	(v) record the results of any evaluation and corrective actions taken to modify the 
7.29 	work of the mental health behavioral aide;
7.30 	(6) providing service delivery that implements the individual treatment plan and 
7.31 	meets the requirements under subdivision 9; and
7.32 	(7) individual treatment plan review. The review must determine the extent to which 
7.33 	the services have met the goals and objectives in the previous treatment plan. The review 
7.34 	must assess the client's progress and ensure that services and treatment goals continue to 
7.35 	be necessary and appropriate to the client and the client's family or foster family. Revision 
7.36 	of the individual treatment plan does not require a new diagnostic assessment unless the 
8.1 	client's mental health status has changed markedly. The updated treatment plan must be 
8.2 	signed by the clinical supervisor and by the client, if appropriate, and by the client's 
8.3 	parent or other person authorized by statute to give consent to the mental health services 
8.4 	for the child.

8.5 	Sec. 4. Minnesota Statutes 2006, section 256B.0943, subdivision 7, is amended to read:
8.6 		Subd. 7.Qualifications of individual and team providers. (a) An individual 
8.7 	or team provider working within the scope of the provider's practice or qualifications 
8.8 	may provide service components of children's therapeutic services and supports that are 
8.9 	identified as medically necessary in a client's individual treatment plan.
8.10 	(b) An individual provider must be qualified as:
8.11 	(1) a mental health professional as defined in subdivision 1, paragraph (m); or
8.12 	(2) a mental health practitioner as defined in section 245.4871, subdivision 26. The 
8.13 	mental health practitioner must work under the clinical supervision of a mental health 
8.14 	professional; or 
8.15 	(3) a mental health behavioral aide working under the directionclinical supervision 
8.16 	of a mental health professional to implement the rehabilitative mental health services 
8.17 	identified in the client's individual treatment plan and individual behavior plan.
8.18 	(A) A level I mental health behavioral aide must:
8.19 	(i) be at least 18 years old;
8.20 	(ii) have a high school diploma or general equivalency diploma (GED) or two years 
8.21 	of experience as a primary caregiver to a child with severe emotional disturbance within 
8.22 	the previous ten years; and
8.23 	(iii) meet preservice and continuing education requirements under subdivision 8.
8.24 	(B) A level II mental health behavioral aide must:
8.25 	(i) be at least 18 years old;
8.26 	(ii) have an associate or bachelor's degree or 4,000 hours of experience in delivering 
8.27 	clinical services in the treatment of mental illness concerning children or adolescents; and
8.28 	(iii) meet preservice and continuing education requirements in subdivision 8.
8.29 	(c) A preschool program multidisciplinary team must include at least one mental 
8.30 	health professional and one or more of the following individuals under the clinical 
8.31 	supervision of a mental health professional:
8.32 	(i) a mental health practitioner; or
8.33 	(ii) a program person, including a teacher, assistant teacher, or aide, who meets the 
8.34 	qualifications and training standards of a level I mental health behavioral aide.
9.1 	(d) A day treatment multidisciplinary team must include at least one mental health 
9.2 	professional and one mental health practitioner.

9.3 	Sec. 5. Minnesota Statutes 2007 Supplement, section 256B.0943, subdivision 9, 
9.4 	is amended to read:
9.5 		Subd. 9.Service delivery criteria. (a) In delivering services under this section, a 
9.6 	certified provider entity must ensure that:
9.7 	(1) each individual provider's caseload size permits the provider to deliver services 
9.8 	to both clients with severe, complex needs and clients with less intensive needs. The 
9.9 	provider's caseload size should reasonably enable the provider to play an active role in 
9.10 	service planning, monitoring, and delivering services to meet the client's and client's 
9.11 	family's needs, as specified in each client's individual treatment plan;
9.12 	(2) site-based programs, including day treatment and preschool programs, provide 
9.13 	staffing and facilities to ensure the client's health, safety, and protection of rights, and that 
9.14 	the programs are able to implement each client's individual treatment plan;
9.15 	(3) a day treatment program is provided to a group of clients by a multidisciplinary 
9.16 	team under the clinical supervision of a mental health professional. The day treatment 
9.17 	program must be provided in and by: (i) an outpatient hospital accredited by the Joint 
9.18 	Commission on Accreditation of Health Organizations and licensed under sections 144.50
9.19 	to 144.55; (ii) a community mental health center under section 245.62; andor (iii) an 
9.20 	entity that is under contract with the county board to operate a program that meets the 
9.21 	requirements of sections 245.4712, subdivision 2, and or245.4884, subdivision 2, and 
9.22 	Minnesota Rules, parts 9505.0170 to 9505.0475. The day treatment program must 
9.23 	stabilize the client's mental health status while developing and improving the client's 
9.24 	independent living and socialization skills. The goal of the day treatment program must be 
9.25 	to reduce or relieve the effects of mental illness and provide training to enable the client 
9.26 	to live in the community. The program must be available at least one day a week for a 
9.27 	three-hour time block three hours per day, five days per week, and 12 months of each 
9.28 	calendar year. The three-hour daily time block must include at least one hour, but no more 
9.29 	than two hours, of individual or group psychotherapy. The remainder of the three-hour 
9.30 	time block may include recreation therapy, socialization therapy, or independent living 
9.31 	skills therapy,individual or group skills training but only if the therapies are included in 
9.32 	the client's individual treatment plan. Day treatment programs are not part of inpatient 
9.33 	or residential treatment services. A day treatment program may provide fewer than the 
9.34 	minimally required hours for a particular child during the billing period in which the child 
9.35 	is transitioning into, or out of, the program; and 
10.1 	(4) a therapeutic preschool program is a structured treatment program offered 
10.2 	to a child who is at least 33 months old, but who has not yet reached the first day of 
10.3 	kindergarten, by a preschool multidisciplinary team in a day program licensed under 
10.4 	Minnesota Rules, parts 9503.0005 to 9503.0175. The program must be available at least 
10.5 	one day a week for a minimum two-hour time block. The structured treatment program 
10.6 	may include individual or group psychotherapy and recreation therapy, socialization 
10.7 	therapy, or independent living skills therapy, if included in the client's individual treatment 
10.8 	plan. A therapeutic preschool program may provide fewer than the minimally required 
10.9 	hours for a particular child during the billing period in which the child is transitioning 
10.10 	into, or out of, the program.
10.11 	(b) A provider entity must deliver the service components of children's therapeutic 
10.12 	services and supports in compliance with the following requirements:
10.13 	(1) individual, family, and group psychotherapy must be delivered as specified in 
10.14 	Minnesota Rules, part 9505.0323;
10.15 	(2) individual, family, or group skills training must be provided by a mental health 
10.16 	professional or a mental health practitioner who has a consulting relationship with a 
10.17 	mental health professional who accepts full professional responsibility for the training;
10.18 	(3) crisis assistance must be time-limited and designed to resolve or stabilize crisis 
10.19 	through arrangements for direct intervention and support services to the child and the 
10.20 	child's family. Crisis assistance must utilize resources designed to address abrupt or 
10.21 	substantial changes in the functioning of the child or the child's family as evidenced by 
10.22 	a sudden change in behavior with negative consequences for well being, a loss of usual 
10.23 	coping mechanisms, or the presentation of danger to self or others;
10.24 	(4) mental health behavioral aide services must be medically necessary services 
10.25 	that are provided by a mental health behavioral aideand must be designed to improve 
10.26 	the functioning of the child and support the family in activities of daily and community 
10.27 	living. A mental health behavioral aide must document the delivery of services in written 
10.28 	progress notes. The mental health behavioral aide must implement goals in the treatment 
10.29 	plan for the child's emotional disturbance that allow the child to acquire developmentally 
10.30 	and therapeutically appropriate daily living skills, social skills, and leisure and recreational
10.31 	skills through targeted activities. These activities may include:
10.32 	(i) assisting a child as needed with skills development in dressing, eating, and 
10.33 	toileting;
10.34 	(ii) assisting, monitoring, and guiding the child to complete tasks, including 
10.35 	facilitating the child's participation in medical appointments;
11.1 	(iii) observing the child and(i) intervening to redirect the child's inappropriate 
11.2 	behavior;
11.3 	(iv)(ii) assisting the child in usingto progressively use age-appropriate 
11.4 	self-management skills as related toaffected by the child's emotional disorder or mental 
11.5 	illness, including problem solving, decision making, communication, conflict resolution, 
11.6 	anger management, social skills, and recreational skills as identified in the child's 
11.7 	individual treatment plan and individual behavioral plan; or
11.8 	(v)(iii) implementing deescalation de-escalation techniques as recommended by the 
11.9 	mental health professional; and
11.10 	(vi) implementing any other mental health service that the mental health professional 
11.11 	has approved as being within the scope of the behavioral aide's duties; or
11.12 	(vii) assisting the parents to develop and use parenting skills that help the child 
11.13 	achieve the goals outlined in the child's individual treatment plan or individual behavioral 
11.14 	plan. Parenting skills must be directed exclusively to the child's treatment; and
11.15 	(5) direction of a mental health behavioral aide must include the following:
11.16 	(i) a total of one hour of on-site observation by a mental health professional during 
11.17 	the first 12 hours of service provided to a child;
11.18 	(ii) ongoing on-site observation by a mental health professional or mental health 
11.19 	practitioner for at least a total of one hour during every 40 hours of service provided 
11.20 	to a child; and
11.21 	(iii) immediate accessibility of the mental health professional or mental health 
11.22 	practitioner to the mental health behavioral aide during service provision.

11.23 	Sec. 6. Minnesota Statutes 2007 Supplement, section 256B.0943, subdivision 12, 
11.24 	is amended to read:
11.25 		Subd. 12.Excluded services. The following services are not eligible for medical 
11.26 	assistance payment as children's therapeutic services and supports:
11.27 	(1) service components of children's therapeutic services and supports 
11.28 	simultaneously provided by more than one provider entity unless prior authorization is 
11.29 	obtained;
11.30 	(2) treatment by multiple providers within the same agency at the same clock time;
11.31 	(2)(3) children's therapeutic services and supports provided in violation of medical 
11.32 	assistance policy in Minnesota Rules, part 9505.0220;
11.33 	(3)(4) mental health behavioral aide services provided by a personal care assistant 
11.34 	who is not qualified as a mental health behavioral aide and employed by a certified 
11.35 	children's therapeutic services and supports provider entity as provided in this section;
12.1 	(4)(5) service components of CTSS that are the responsibility of a residential or 
12.2 	program license holder, including foster care providers under the terms of a service 
12.3 	agreement or administrative rules governing licensure; 
12.4 	(5)(6) adjunctive activities that may be offered by a provider entity but are not 
12.5 	otherwise covered by medical assistance, including:
12.6 	(i) a service that is primarily recreation oriented or that is provided in a setting that 
12.7 	is not medically supervised. This includes sports activities, exercise groups, activities 
12.8 	such as craft hours, leisure time, social hours, meal or snack time, trips to community 
12.9 	activities, and tours;
12.10 	(ii) a social or educational service that does not have or cannot reasonably be 
12.11 	expected to have a therapeutic outcome related to the client's emotional disturbance;
12.12 	(iii) consultation with other providers or service agency staff about the care or 
12.13 	progress of a client;
12.14 	(iv) prevention or education programs provided to the community; and
12.15 	(v) treatment for clients with primary diagnoses of alcohol or other drug abuse; and
12.16 	(6) (7) activities that are not direct service time.

12.17 	ARTICLE 2
12.18 	HEALTH CARE AND CONTINUING CARE

12.19 	Section 1. Minnesota Statutes 2007 Supplement, section 256.01, subdivision 2b, 
12.20 	is amended to read:
12.21 		Subd. 2b.Performance payments. (a) The commissioner shall develop and 
12.22 	implement a pay-for-performance system to provide performance payments to eligible 
12.23 	medical groups and clinics that demonstrate optimum care in serving individuals 
12.24 	with chronic diseases who are enrolled in health care programs administered by the 
12.25 	commissioner under chapters 256B, 256D, and 256L. The commissioner may receive any 
12.26 	federal matching money that is made available through the medical assistance program 
12.27 	for managed care oversight contracted through vendors, including consumer surveys, 
12.28 	studies, and external quality reviews as required by the federal Balanced Budget Act of 
12.29 	1997, Code of Federal Regulations, title 42, part 438-managed care, subpart E-external 
12.30 	quality review. Any federal money received for managed care oversight is appropriated 
12.31 	to the commissioner for this purpose. The commissioner may expend the federal money 
12.32 	received in either year of the biennium.
12.33 	(b) Effective July 1, 2009 2008, or upon federal approval, whichever is later, the 
12.34 	commissioner shall develop and implement a patient incentive health program to provide 
12.35 	incentives and rewards to patients who are enrolled in health care programs administered 
13.1 	by the commissioner under chapters 256B, 256D, and 256L, and who have agreed to and 
13.2 	have met personal health goals established with the patients' primary care providers to 
13.3 	manage a chronic disease or condition, including but not limited to diabetes, high blood 
13.4 	pressure, and coronary artery disease.

13.5 	Sec. 2. Minnesota Statutes 2006, section 256.046, is amended to read:
13.6 	256.046 ADMINISTRATIVE FRAUD DISQUALIFICATION HEARINGS.
13.7 		Subdivision 1.Hearing authority. A local agency must initiate an administrative 
13.8 	fraud disqualification hearing for individuals, including child care providers caring for 
13.9 	children receiving child care assistance, accused of wrongfully obtaining assistance or 
13.10 	intentional program violations, in lieu of a criminal action when it has not been pursued, in 
13.11 	the aid to families with dependent children program formerly codified in sections 256.72
13.12 	to 256.87, MFIP, the diversionary work program, child care assistance programs, general 
13.13 	assistance, family general assistance program formerly codified in section 256D.05, 
13.14 	subdivision 1, clause (15), Minnesota supplemental aid, food stamp programs, general 
13.15 	assistance medical care, MinnesotaCare for adults without children, and upon federal 
13.16 	approval, all categories of medical assistance and remaining categories of MinnesotaCare 
13.17 	except for children through age 18. The Department of Human Services, in lieu of a local 
13.18 	agency, may initiate an administrative fraud disqualification hearing when the state agency 
13.19 	is directly responsible for administration or investigation of the health care program for 
13.20 	which benefits were wrongfully obtained. The hearing is subject to the requirements of 
13.21 	section 256.045 and the requirements in Code of Federal Regulations, title 7, section 
13.22 	273.16, for the food stamp program and title 45, section 235.112, as of September 30, 1995, 
13.23 	for the cash grant, medical care programs, and child care assistance under chapter 119B.
13.24 		Subd. 2.Combined hearing. The referee may combine a fair hearing and 
13.25 	administrative fraud disqualification hearing into a single hearing if the factual issues 
13.26 	arise out of the same, or related, circumstances and the individual receives prior notice 
13.27 	that the hearings will be combined. If the administrative fraud disqualification hearing 
13.28 	and fair hearing are combined, the time frames for administrative fraud disqualification 
13.29 	hearings specified in Code of Federal Regulations, title 7, section 273.16, and title 45, 
13.30 	section 235.112, as of September 30, 1995, apply. If the individual accused of wrongfully 
13.31 	obtaining assistance is charged under section 256.98 for the same act or acts which are 
13.32 	the subject of the hearing, the individual may request that the hearing be delayed until 
13.33 	the criminal charge is decided by the court or withdrawn. 

14.1 	Sec. 3. Minnesota Statutes 2007 Supplement, section 256.476, subdivision 4, is 
14.2 	amended to read:
14.3 		Subd. 4.Support grants; criteria and limitations. (a) A county board may 
14.4 	choose to participate in the consumer support grant program. If a county has not chosen 
14.5 	to participate by July 1, 2002, the commissioner shall contract with another county or 
14.6 	other entity to provide access to residents of the nonparticipating county who choose 
14.7 	the consumer support grant option. The commissioner shall notify the county board 
14.8 	in a county that has declined to participate of the commissioner's intent to enter into 
14.9 	a contract with another county or other entity at least 30 days in advance of entering 
14.10 	into the contract. The local agency shall establish written procedures and criteria to 
14.11 	determine the amount and use of support grants. These procedures must include, at least, 
14.12 	the availability of respite care, assistance with daily living, and adaptive aids. The local 
14.13 	agency may establish monthly or annual maximum amounts for grants and procedures 
14.14 	where exceptional resources may be required to meet the health and safety needs of the 
14.15 	person on a time-limited basis, however, the total amount awarded to each individual may 
14.16 	not exceed the limits established in subdivision 11.
14.17 	(b) Support grants to a person, a person's legal representative, or other authorized 
14.18 	representative will be provided through a monthly subsidy payment and be in the form 
14.19 	of cash, voucher, or direct county payment to vendor. Support grant amounts must be 
14.20 	determined by the local agency. Each service and item purchased with a support grant 
14.21 	must meet all of the following criteria:
14.22 	(1) it must be over and above the normal cost of caring for the person if the person 
14.23 	did not have functional limitations;
14.24 	(2) it must be directly attributable to the person's functional limitations;
14.25 	(3) it must enable the person, a person's legal representative, or other authorized 
14.26 	representative to delay or prevent out-of-home placement of the person; and
14.27 	(4) it must be consistent with the needs identified in the service agreement, when 
14.28 	applicable.
14.29 	(c) Items and services purchased with support grants must be those for which there 
14.30 	are no other public or private funds available to the person, a person's legal representative, 
14.31 	or other authorized representative. Fees assessed to the person or the person's family for 
14.32 	health and human services are not reimbursable through the grant.
14.33 	(d) In approving or denying applications, the local agency shall consider the 
14.34 	following factors:
14.35 	(1) the extent and areas of the person's functional limitations;
14.36 	(2) the degree of need in the home environment for additional support; and
15.1 	(3) the potential effectiveness of the grant to maintain and support the person in the 
15.2 	family environment or the person's own home.
15.3 	(e) At the time of application to the program or screening for other services, the 
15.4 	person, a person's legal representative, or other authorized representative shall be provided 
15.5 	sufficient information to ensure an informed choice of alternatives by the person, the 
15.6 	person's legal representative, or other authorized representative, if any. The application 
15.7 	shall be made to the local agency and shall specify the needs of the person and family or 
15.8 	the person's legal representative or other authorized representative, the form and amount 
15.9 	of grant requested, the items and services to be reimbursed, and evidence of eligibility for 
15.10 	medical assistance.
15.11 	(f) Upon approval of an application by the local agency and agreement on a 
15.12 	support plan for the person or the person's family legal representative or other authorized 
15.13 	representative, the local agency shall make grants to the person or the person's family legal 
15.14 	representative or other authorized representative. The grant shall be in an amount for the 
15.15 	direct costs of the services or supports outlined in the service agreement.
15.16 	(g) Reimbursable costs shall not include costs for resources already available, 
15.17 	such as special education classes, day training and habilitation, case management, other 
15.18 	services to which the person is entitled, medical costs covered by insurance or other health 
15.19 	programs, or other resources usually available at no cost to the person or the person's 
15.20 	family legal representative or other authorized representative.
15.21 	(h) The state of Minnesota, the county boards participating in the consumer 
15.22 	support grant program, or the agencies acting on behalf of the county boards in the 
15.23 	implementation and administration of the consumer support grant program shall not be 
15.24 	liable for damages, injuries, or liabilities sustained through the purchase of support by 
15.25 	the individual, the individual's family, or the authorized representative under this section 
15.26 	with funds received through the consumer support grant program. Liabilities include but 
15.27 	are not limited to: workers' compensation liability, the Federal Insurance Contributions 
15.28 	Act (FICA), or the Federal Unemployment Tax Act (FUTA). For purposes of this section, 
15.29 	participating county boards and agencies acting on behalf of county boards are exempt 
15.30 	from the provisions of section 268.04.

15.31 	Sec. 4. Minnesota Statutes 2007 Supplement, section 256.476, subdivision 5, is 
15.32 	amended to read:
15.33 		Subd. 5.Reimbursement, allocations, and reporting. (a) For the purpose of 
15.34 	transferring persons to the consumer support grant program from the family support 
15.35 	program and personal care assistant services, home health aide services, or private duty 
16.1 	nursing services, the amount of funds transferred by the commissioner between the 
16.2 	family support program account, the medical assistance account, or the consumer support 
16.3 	grant account shall be based on each county's participation in transferring persons to the 
16.4 	consumer support grant program from those programs and services.
16.5 	(b) At the beginning of each fiscal year, county allocations for consumer support 
16.6 	grants shall be based on:
16.7 	(1) the number of persons to whom the county board expects to provide consumer 
16.8 	supports grants;
16.9 	(2) their eligibility for current program and services;
16.10 	(3) the amount of nonfederal dollars allowed under subdivision 11; and
16.11 	(4) projected dates when persons will start receiving grants. County allocations shall 
16.12 	be adjusted periodically by the commissioner based on the actual transfer of persons or 
16.13 	service openings, and the nonfederal dollars associated with those persons or service 
16.14 	openings, to the consumer support grant program.
16.15 	(c) The amount of funds transferred by the commissioner from the medical 
16.16 	assistance account for an individual may be changed if it is determined by the county or its 
16.17 	agent that the individual's need for support has changed.
16.18 	(d) The authority to utilize funds transferred to the consumer support grant account 
16.19 	for the purposes of implementing and administering the consumer support grant program 
16.20 	will not be limited or constrained by the spending authority provided to the program 
16.21 	of origination.
16.22 	(e) The commissioner may use up to five percent of each county's allocation, as 
16.23 	adjusted, for payments for administrative expenses, to be paid as a proportionate addition 
16.24 	to reported direct service expenditures.
16.25 	(f) The county allocation for each individual person or individual's family the 
16.26 	person's legal representative or other authorized representative cannot exceed the amount 
16.27 	allowed under subdivision 11.
16.28 	(g) The commissioner may recover, suspend, or withhold payments if the county 
16.29 	board, local agency, or grantee does not comply with the requirements of this section.
16.30 	(h) Grant funds unexpended by consumers shall return to the state once a year. The 
16.31 	annual return of unexpended grant funds shall occur in the quarter following the end of 
16.32 	the state fiscal year.

16.33 	Sec. 5. Minnesota Statutes 2007 Supplement, section 256B.057, subdivision 2c, 
16.34 	is amended to read:
17.1 		Subd. 2c.Extended coverage for children. A child receiving medical assistance 
17.2 	under subdivision 2, who becomes ineligible due to excess income, is eligible for two 
17.3 	additional months of medical assistance. Eligibility under this section is effective 
17.4 	following any coverage available under section 256B.0625 256B.0635.
17.5 	A child eligible for extended coverage under this section is deemed automatically 
17.6 	eligible for MinnesotaCare until renewal. MinnesotaCare coverage begins in accordance 
17.7 	with section 256L.05, subdivision 3.

17.8 	Sec. 6. Minnesota Statutes 2007 Supplement, section 256B.06, subdivision 4, is 
17.9 	amended to read:
17.10 		Subd. 4.Citizenship requirements. (a) Eligibility for medical assistance is limited 
17.11 	to citizens of the United States, qualified noncitizens as defined in this subdivision, and 
17.12 	other persons residing lawfully in the United States. Citizens or nationals of the United 
17.13 	States must cooperate in obtaining satisfactory documentary evidence of citizenship or 
17.14 	nationality according to the requirements of the federal Deficit Reduction Act of 2005, 
17.15 	Public Law 109-171.
17.16 	(b) "Qualified noncitizen" means a person who meets one of the following 
17.17 	immigration criteria:
17.18 	(1) admitted for lawful permanent residence according to United States Code, title 8;
17.19 	(2) admitted to the United States as a refugee according to United States Code, 
17.20 	title 8, section 1157;
17.21 	(3) granted asylum according to United States Code, title 8, section 1158;
17.22 	(4) granted withholding of deportation according to United States Code, title 8, 
17.23 	section 1253(h);
17.24 	(5) paroled for a period of at least one year according to United States Code, title 8, 
17.25 	section 1182(d)(5);
17.26 	(6) granted conditional entrant status according to United States Code, title 8, 
17.27 	section 1153(a)(7);
17.28 	(7) determined to be a battered noncitizen by the United States Attorney General 
17.29 	according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, 
17.30 	title V of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;
17.31 	(8) is a child of a noncitizen determined to be a battered noncitizen by the United 
17.32 	States Attorney General according to the Illegal Immigration Reform and Immigrant 
17.33 	Responsibility Act of 1996, title V, of the Omnibus Consolidated Appropriations Bill, 
17.34 	Public Law 104-200; or
18.1 	(9) determined to be a Cuban or Haitian entrant as defined in section 501(e) of Public 
18.2 	Law 96-422, the Refugee Education Assistance Act of 1980.
18.3 	(c) All qualified noncitizens who were residing in the United States before August 
18.4 	22, 1996, who otherwise meet the eligibility requirements of this chapter, are eligible for 
18.5 	medical assistance with federal financial participation.
18.6 	(d) All qualified noncitizens who entered the United States on or after August 22, 
18.7 	1996, and who otherwise meet the eligibility requirements of this chapter, are eligible for 
18.8 	medical assistance with federal financial participation through November 30, 1996.
18.9 	Beginning December 1, 1996, qualified noncitizens who entered the United States 
18.10 	on or after August 22, 1996, and who otherwise meet the eligibility requirements of this 
18.11 	chapter are eligible for medical assistance with federal participation for five years if they 
18.12 	meet one of the following criteria:
18.13 	(i) refugees admitted to the United States according to United States Code, title 8, 
18.14 	section 1157;
18.15 	(ii) persons granted asylum according to United States Code, title 8, section 1158;
18.16 	(iii) persons granted withholding of deportation according to United States Code, 
18.17 	title 8, section 1253(h);
18.18 	(iv) veterans of the United States armed forces with an honorable discharge for 
18.19 	a reason other than noncitizen status, their spouses and unmarried minor dependent 
18.20 	children; or
18.21 	(v) persons on active duty in the United States armed forces, other than for training, 
18.22 	their spouses and unmarried minor dependent children.
18.23 	Beginning December 1, 1996, qualified noncitizens who do not meet one of the 
18.24 	criteria in items (i) to (v) are eligible for medical assistance without federal financial 
18.25 	participation as described in paragraph (j).
18.26 	(e) Noncitizens who are not qualified noncitizens as defined in paragraph (b), 
18.27 	who are lawfully residing present in the United States, as defined in Code of Federal 
18.28 	Regulations, title 8, section 103.12, and who otherwise meet the eligibility requirements of 
18.29 	this chapter, are eligible for medical assistance under clauses (1) to (3). These individuals 
18.30 	must cooperate with the United States Citizenship and Immigration Services to pursue any 
18.31 	applicable immigration status, including citizenship, that would qualify them for medical 
18.32 	assistance with federal financial participation.
18.33 	(1) Persons who were medical assistance recipients on August 22, 1996, are eligible 
18.34 	for medical assistance with federal financial participation through December 31, 1996.
18.35 	(2) Beginning January 1, 1997, persons described in clause (1) are eligible for 
18.36 	medical assistance without federal financial participation as described in paragraph (j).
19.1 	(3) Beginning December 1, 1996, persons residing in the United States prior to 
19.2 	August 22, 1996, who were not receiving medical assistance and persons who arrived on 
19.3 	or after August 22, 1996, are eligible for medical assistance without federal financial 
19.4 	participation as described in paragraph (j).
19.5 	(f) Nonimmigrants who otherwise meet the eligibility requirements of this chapter 
19.6 	are eligible for the benefits as provided in paragraphs (g) to (i). For purposes of this 
19.7 	subdivision, a "nonimmigrant" is a person in one of the classes listed in United States 
19.8 	Code, title 8, section 1101(a)(15).
19.9 	(g) Payment shall also be made for care and services that are furnished to noncitizens, 
19.10 	regardless of immigration status, who otherwise meet the eligibility requirements of 
19.11 	this chapter, if such care and services are necessary for the treatment of an emergency 
19.12 	medical condition, except for organ transplants and related care and services and routine 
19.13 	prenatal care.
19.14 	(h) For purposes of this subdivision, the term "emergency medical condition" means 
19.15 	a medical condition that meets the requirements of United States Code, title 42, section 
19.16 	1396b(v).
19.17 	(i) Pregnant noncitizens who are undocumented, nonimmigrants, or eligible for 
19.18 	medical assistance as described in paragraph (j), and who are not covered by a group 
19.19 	health plan or health insurance coverage according to Code of Federal Regulations, title 
19.20 	42, section 457.310, and who otherwise meet the eligibility requirements of this chapter, 
19.21 	are eligible for medical assistance through the period of pregnancy, including labor and 
19.22 	delivery, to the extent federal funds are available under title XXI of the Social Security 
19.23 	Act, and the state children's health insurance program, followed by 60 days postpartum 
19.24 	without federal financial participation.
19.25 	(j) Qualified noncitizens as described in paragraph (d), and all other noncitizens 
19.26 	lawfully residing in the United States as described in paragraph (e), who are ineligible 
19.27 	for medical assistance with federal financial participation and who otherwise meet the 
19.28 	eligibility requirements of chapter 256B and of this paragraph, are eligible for medical 
19.29 	assistance without federal financial participation. Qualified noncitizens as described 
19.30 	in paragraph (d) are only eligible for medical assistance without federal financial 
19.31 	participation for five years from their date of entry into the United States.
19.32 	(k) Beginning October 1, 2003, persons who are receiving care and rehabilitation 
19.33 	services from a nonprofit center established to serve victims of torture and are otherwise 
19.34 	ineligible for medical assistance under this chapter are eligible for medical assistance 
19.35 	without federal financial participation. These individuals are eligible only for the period 
20.1 	during which they are receiving services from the center. Individuals eligible under this 
20.2 	paragraph shall not be required to participate in prepaid medical assistance.

20.3 	Sec. 7. Minnesota Statutes 2007 Supplement, section 256B.0655, subdivision 12, 
20.4 	is amended to read:
20.5 		Subd. 12.Personal care provider; employment prohibition. A personal care 
20.6 	provider shall not employ a person to provide personal care service for a qualified 
20.7 	recipient if the person:
20.8 	(1) refuses to provide full disclosure of criminal history records as specified in 
20.9 	subdivision 1g, clause (1) Minnesota Rules, part 9505.0335, subpart 12;
20.10 	(2) has been convicted of a crime that directly relates to the occupation of providing 
20.11 	personal care services to a qualified recipient;
20.12 	(3) has jeopardized the health or welfare of a vulnerable adult through physical 
20.13 	abuse, sexual abuse, or neglect as defined in section 626.557; or
20.14 	(4) is misusing or is dependent on mood-altering chemicals, including alcohol, to 
20.15 	the extent that the personal care provider knows or has reason to believe that the use of 
20.16 	chemicals has a negative effect on the person's ability to provide personal care services 
20.17 	or the use of chemicals is apparent during the hours the person is providing personal 
20.18 	care services.

20.19 	Sec. 8. Minnesota Statutes 2006, section 256B.093, subdivision 1, is amended to read:
20.20 		Subdivision 1.State traumatic brain injury program. The commissioner of 
20.21 	human services shall:
20.22 	(1) maintain a statewide traumatic brain injury program;
20.23 	(2) supervise and coordinate services and policies for persons with traumatic brain 
20.24 	injuries;
20.25 	(3) contract with qualified agencies or employ staff to provide statewide 
20.26 	administrative case management and consultation;
20.27 	(4) maintain an advisory committee to provide recommendations in reports to the 
20.28 	commissioner regarding program and service needs of persons with traumatic brain 
20.29 	injuries;
20.30 	(5) investigate the need for the development of rules or statutes for the traumatic 
20.31 	brain injury home and community-based services waiver;
20.32 	(6) investigate present and potential models of service coordination which can be 
20.33 	delivered at the local level; and
21.1 	(7) the advisory committee required by clause (4) must consist of no fewer than ten 
21.2 	members and no more than 30 members. The commissioner shall appoint all advisory 
21.3 	committee members to one- or two-year terms and appoint one member as chair. 
21.4 	Notwithstanding section 15.059, subdivision 5, the advisory committee does not terminate 
21.5 	until June 30, 2008 2012.

21.6 	Sec. 9. Minnesota Statutes 2007 Supplement, section 256D.03, subdivision 3, is 
21.7 	amended to read:
21.8 		Subd. 3.General assistance medical care; eligibility. (a) General assistance 
21.9 	medical care may be paid for any person who is not eligible for medical assistance under 
21.10 	chapter 256B, including eligibility for medical assistance based on a spenddown of excess 
21.11 	income according to section 256B.056, subdivision 5, or MinnesotaCare as defined in 
21.12 	paragraph (b), except as provided in paragraph (c), and:
21.13 	(1) who is receiving assistance under section 256D.05, except for families with 
21.14 	children who are eligible under Minnesota family investment program (MFIP), or who is 
21.15 	having a payment made on the person's behalf under sections 256I.01 to 256I.06; or
21.16 	(2) who is a resident of Minnesota; and
21.17 	(i) who has gross countable income not in excess of 75 percent of the federal poverty 
21.18 	guidelines for the family size, using a six-month budget period and whose equity in assets 
21.19 	is not in excess of $1,000 per assistance unit. General assistance medical care is not 
21.20 	available for applicants or enrollees who are otherwise eligible for medical assistance but 
21.21 	fail to verify their assets. Enrollees who become eligible for medical assistance shall be 
21.22 	terminated and transferred to medical assistance. Exempt assets, the reduction of excess 
21.23 	assets, and the waiver of excess assets must conform to the medical assistance program in 
21.24 	section 256B.056, subdivision subdivisions 3 and 3d, with the following exception: the 
21.25 	maximum amount of undistributed funds in a trust that could be distributed to or on behalf 
21.26 	of the beneficiary by the trustee, assuming the full exercise of the trustee's discretion under 
21.27 	the terms of the trust, must be applied toward the asset maximum;
21.28 	(ii) who has gross countable income above 75 percent of the federal poverty 
21.29 	guidelines but not in excess of 175 percent of the federal poverty guidelines for the 
21.30 	family size, using a six-month budget period, whose equity in assets is not in excess 
21.31 	of the limits in section 256B.056, subdivision 3c, and who applies during an inpatient 
21.32 	hospitalization; or
21.33 	(iii) the commissioner shall adjust the income standards under this section each July 
21.34 	1 by the annual update of the federal poverty guidelines following publication by the 
21.35 	United States Department of Health and Human Services.
22.1 	(b) Effective for applications and renewals processed on or after September 1, 2006, 
22.2 	general assistance medical care may not be paid for applicants or recipients who are adults 
22.3 	with dependent children under 21 whose gross family income is equal to or less than 275 
22.4 	percent of the federal poverty guidelines who are not described in paragraph (e).
22.5 	(c) Effective for applications and renewals processed on or after September 1, 2006, 
22.6 	general assistance medical care may be paid for applicants and recipients who meet all 
22.7 	eligibility requirements of paragraph (a), clause (2), item (i), for a temporary period 
22.8 	beginning the date of application. Immediately following approval of general assistance 
22.9 	medical care, enrollees shall be enrolled in MinnesotaCare under section 256L.04, 
22.10 	subdivision 7, with covered services as provided in section 256L.03 for the rest of the 
22.11 	six-month general assistance medical care eligibility period, until their six-month renewal. 
22.12 	(d) To be eligible for general assistance medical care following enrollment in 
22.13 	MinnesotaCare as required by paragraph (c), an individual must complete a new 
22.14 	application.
22.15 	(e) Applicants and recipients eligible under paragraph (a), clause (1); who have 
22.16 	applied for and are awaiting a determination of blindness or disability by the state medical 
22.17 	review team or a determination of eligibility for Supplemental Security Income or Social 
22.18 	Security Disability Insurance by the Social Security Administration; who fail to meet the 
22.19 	requirements of section 256L.09, subdivision 2; who are homeless as defined by United 
22.20 	States Code, title 42, section 11301, et seq.;  who are classified as end-stage renal disease 
22.21 	beneficiaries in the Medicare program; who are enrolled in private health care coverage as 
22.22 	defined in section 256B.02, subdivision 9; who are eligible under paragraph (j); or who 
22.23 	receive treatment funded pursuant to section 254B.02 are exempt from the MinnesotaCare 
22.24 	enrollment requirements of this subdivision.
22.25 	(f) For applications received on or after October 1, 2003, eligibility may begin no 
22.26 	earlier than the date of application. For individuals eligible under paragraph (a), clause 
22.27 	(2), item (i), a redetermination of eligibility must occur every 12 months. Individuals are 
22.28 	eligible under paragraph (a), clause (2), item (ii), only during inpatient hospitalization but 
22.29 	may reapply if there is a subsequent period of inpatient hospitalization.
22.30 	(g) Beginning September 1, 2006, Minnesota health care program applications and 
22.31 	renewals completed by recipients and applicants who are persons described in paragraph 
22.32 	(c) and submitted to the county agency shall be determined for MinnesotaCare eligibility 
22.33 	by the county agency. If all other eligibility requirements of this subdivision are met, 
22.34 	eligibility for general assistance medical care shall be available in any month during which 
22.35 	MinnesotaCare enrollment is pending. Upon notification of eligibility for MinnesotaCare, 
22.36 	notice of termination for eligibility for general assistance medical care shall be sent to 
23.1 	an applicant or recipient. If all other eligibility requirements of this subdivision are 
23.2 	met, eligibility for general assistance medical care shall be available until enrollment in 
23.3 	MinnesotaCare subject to the provisions of paragraphs (c), (e), and (f).
23.4 	(h) The date of an initial Minnesota health care program application necessary to 
23.5 	begin a determination of eligibility shall be the date the applicant has provided a name, 
23.6 	address, and Social Security number, signed and dated, to the county agency or the 
23.7 	Department of Human Services. If the applicant is unable to provide a name, address, 
23.8 	Social Security number, and signature when health care is delivered due to a medical 
23.9 	condition or disability, a health care provider may act on an applicant's behalf to establish 
23.10 	the date of an initial Minnesota health care program application by providing the county 
23.11 	agency or Department of Human Services with provider identification and a temporary 
23.12 	unique identifier for the applicant. The applicant must complete the remainder of the 
23.13 	application and provide necessary verification before eligibility can be determined. The 
23.14 	county agency must assist the applicant in obtaining verification if necessary.
23.15 	(i) County agencies are authorized to use all automated databases containing 
23.16 	information regarding recipients' or applicants' income in order to determine eligibility for 
23.17 	general assistance medical care or MinnesotaCare. Such use shall be considered sufficient 
23.18 	in order to determine eligibility and premium payments by the county agency.
23.19 	(j) General assistance medical care is not available for a person in a correctional 
23.20 	facility unless the person is detained by law for less than one year in a county correctional 
23.21 	or detention facility as a person accused or convicted of a crime, or admitted as an 
23.22 	inpatient to a hospital on a criminal hold order, and the person is a recipient of general 
23.23 	assistance medical care at the time the person is detained by law or admitted on a criminal 
23.24 	hold order and as long as the person continues to meet other eligibility requirements 
23.25 	of this subdivision.
23.26 	(k) General assistance medical care is not available for applicants or recipients who 
23.27 	do not cooperate with the county agency to meet the requirements of medical assistance.
23.28 	(l) In determining the amount of assets of an individual eligible under paragraph 
23.29 	(a), clause (2), item (i), there shall be included any asset or interest in an asset, including 
23.30 	an asset excluded under paragraph (a), that was given away, sold, or disposed of for 
23.31 	less than fair market value within the 60 months preceding application for general 
23.32 	assistance medical care or during the period of eligibility. Any transfer described in this 
23.33 	paragraph shall be presumed to have been for the purpose of establishing eligibility for 
23.34 	general assistance medical care, unless the individual furnishes convincing evidence to 
23.35 	establish that the transaction was exclusively for another purpose. For purposes of this 
23.36 	paragraph, the value of the asset or interest shall be the fair market value at the time it 
24.1 	was given away, sold, or disposed of, less the amount of compensation received. For any 
24.2 	uncompensated transfer, the number of months of ineligibility, including partial months, 
24.3 	shall be calculated by dividing the uncompensated transfer amount by the average monthly 
24.4 	per person payment made by the medical assistance program to skilled nursing facilities 
24.5 	for the previous calendar year. The individual shall remain ineligible until this fixed period 
24.6 	has expired. The period of ineligibility may exceed 30 months, and a reapplication for 
24.7 	benefits after 30 months from the date of the transfer shall not result in eligibility unless 
24.8 	and until the period of ineligibility has expired. The period of ineligibility begins in the 
24.9 	month the transfer was reported to the county agency, or if the transfer was not reported, 
24.10 	the month in which the county agency discovered the transfer, whichever comes first. For 
24.11 	applicants, the period of ineligibility begins on the date of the first approved application.
24.12 	(m) When determining eligibility for any state benefits under this subdivision, 
24.13 	the income and resources of all noncitizens shall be deemed to include their sponsor's 
24.14 	income and resources as defined in the Personal Responsibility and Work Opportunity 
24.15 	Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and 
24.16 	subsequently set out in federal rules.
24.17 	(n) Undocumented noncitizens and nonimmigrants are ineligible for general 
24.18 	assistance medical care. For purposes of this subdivision, a nonimmigrant is an individual 
24.19 	in one or more of the classes listed in United States Code, title 8, section 1101(a)(15), and 
24.20 	an undocumented noncitizen is an individual who resides in the United States without the 
24.21 	approval or acquiescence of the United States Citizenship and Immigration Services.
24.22 	(o) Notwithstanding any other provision of law, a noncitizen who is ineligible for 
24.23 	medical assistance due to the deeming of a sponsor's income and resources, is ineligible 
24.24 	for general assistance medical care.
24.25 	(p) Effective July 1, 2003, general assistance medical care emergency services end.

24.26 	Sec. 10. Minnesota Statutes 2006, section 256L.07, subdivision 5, is amended to read:
24.27 		Subd. 5.Voluntary disenrollment for members of military. Notwithstanding 
24.28 	section 256L.05, subdivision 3b, MinnesotaCare enrollees who are members of the 
24.29 	military and their families, who choose to voluntarily disenroll from the program when 
24.30 	one or more family members are called to active duty, may reenroll during or following 
24.31 	that member's tour of active duty. Those individuals and families shall be considered 
24.32 	to have good cause for voluntary termination under section 256L.06, subdivision 3, 
24.33 	paragraph (d). Income and asset increases reported at the time of reenrollment shall be 
24.34 	disregarded. All provisions of sections 256L.01 to 256L.18 shall apply to individuals and 
24.35 	families enrolled under this subdivision upon six-month12-month renewal.

25.1 	Sec. 11. Minnesota Statutes 2007 Supplement, section 256L.15, subdivision 2, is 
25.2 	amended to read:
25.3 		Subd. 2.Sliding fee scale; monthly gross individual or family income. (a) The 
25.4 	commissioner shall establish a sliding fee scale to determine the percentage of monthly 
25.5 	gross individual or family income that households at different income levels must pay 
25.6 	to obtain coverage through the MinnesotaCare program. The sliding fee scale must be 
25.7 	based on the enrollee's monthly gross individual or family income. The sliding fee scale 
25.8 	must contain separate tables based on enrollment of one, two, or three or more persons. 
25.9 	The sliding fee scale begins with a premium of 1.5 percent of monthly gross individual or 
25.10 	family income for individuals or families with incomes below the limits for the medical 
25.11 	assistance program for families and children in effect on January 1, 1999, and proceeds 
25.12 	through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8, 4.8, 5.9, 7.4, and 8.8 percent. 
25.13 	These percentages are matched to evenly spaced income steps ranging from the medical 
25.14 	assistance income limit for families and children in effect on January 1, 1999, to 275 
25.15 	percent of the federal poverty guidelines for the applicable family size, up to a family size 
25.16 	of five. The sliding fee scale for a family of five must be used for families of more than 
25.17 	five. The sliding fee scale and percentages are not subject to the provisions of chapter 
25.18 	14. If a family or individual reports increased income after enrollment, premiums shall 
25.19 	be adjusted at the time the change in income is reported.
25.20 	(b) FamiliesChildren whose gross income is above 275 percent of the federal 
25.21 	poverty guidelines shall pay the maximum premium. The maximum premium is defined 
25.22 	as a base charge for one, two, or three or more enrollees so that if all MinnesotaCare 
25.23 	cases paid the maximum premium, the total revenue would equal the total cost of 
25.24 	MinnesotaCare medical coverage and administration. In this calculation, administrative 
25.25 	costs shall be assumed to equal ten percent of the total. The costs of medical coverage 
25.26 	for pregnant women and children under age two and the enrollees in these groups shall 
25.27 	be excluded from the total. The maximum premium for two enrollees shall be twice the 
25.28 	maximum premium for one, and the maximum premium for three or more enrollees shall 
25.29 	be three times the maximum premium for one.

25.30 	ARTICLE 3
25.31 	MISCELLANEOUS

25.32 	Section 1. Minnesota Statutes 2006, section 254A.035, subdivision 2, is amended to 
25.33 	read:
25.34 		Subd. 2.Membership terms, compensation, removal and expiration. The 
25.35 	membership of this council shall be composed of 17 persons who are American Indians 
26.1 	and who are appointed by the commissioner. The commissioner shall appoint one 
26.2 	representative from each of the following groups: Red Lake Band of Chippewa Indians; 
26.3 	Fond du Lac Band, Minnesota Chippewa Tribe; Grand Portage Band, Minnesota 
26.4 	Chippewa Tribe; Leech Lake Band, Minnesota Chippewa Tribe; Mille Lacs Band, 
26.5 	Minnesota Chippewa Tribe; Bois Forte Band, Minnesota Chippewa Tribe; White Earth 
26.6 	Band, Minnesota Chippewa Tribe; Lower Sioux Indian Reservation; Prairie Island Sioux 
26.7 	Indian Reservation; Shakopee Mdewakanton Sioux Indian Reservation; Upper Sioux 
26.8 	Indian Reservation; International Falls Northern Range; Duluth Urban Indian Community; 
26.9 	and two representatives from the Minneapolis Urban Indian Community and two from the 
26.10 	St. Paul Urban Indian Community. The terms, compensation, and removal of American 
26.11 	Indian Advisory Council members shall be as provided in section 15.059. The council 
26.12 	expires June 30, 2008 2012.

26.13 	Sec. 2. Minnesota Statutes 2006, section 254A.04, is amended to read:
26.14 	254A.04 CITIZENS ADVISORY COUNCIL.
26.15 	There is hereby created an Alcohol and Other Drug Abuse Advisory Council to 
26.16 	advise the Department of Human Services concerning the problems of alcohol and 
26.17 	other drug dependency and abuse, composed of ten members. Five members shall be 
26.18 	individuals whose interests or training are in the field of alcohol dependency and abuse; 
26.19 	and five members whose interests or training are in the field of dependency and abuse of 
26.20 	drugs other than alcohol. The terms, compensation and removal of members shall be as 
26.21 	provided in section 15.059. The council expires June 30, 2008 2012. The commissioner 
26.22 	of human services shall appoint members whose terms end in even-numbered years. The 
26.23 	commissioner of health shall appoint members whose terms end in odd-numbered years.

26.24 	Sec. 3. REPEALER.
 26.25 	Minnesota Statutes 2006, section 256B.039, is repealed.