1.1CONFERENCE COMMITTEE REPORT ON H. F. No. 13621.2A bill for an act1.3relating to state government; establishing the health and human services budget; 1.4making changes to licensing; Minnesota family investment program, children, 1.5and adult supports; child support; the Department of Health; health care 1.6programs; making technical changes; chemical and mental health; continuing 1.7care programs; establishing the State-County Results, Accountability, and 1.8Service Delivery Redesign; public health; health-related fees; making forecast 1.9adjustments; creating work groups and pilot projects; requiring reports; 1.10decreasing provider reimbursements; increasing fees; appropriating money to 1.11various state agencies for health and human services provisions;amending 1.12Minnesota Statutes 2008, sections 62J.495; 62J.496; 62J.497, subdivisions 1.131, 2, by adding subdivisions; 62J.692, subdivision 7; 103I.208, subdivision 2; 1.14125A.744, subdivision 3; 144.0724, subdivisions 2, 4, 8, by adding subdivisions; 1.15144.121, subdivisions 1a, 1b; 144.122; 144.1222, subdivision 1a; 144.125, 1.16subdivision 1; 144.226, subdivision 4; 144.72, subdivisions 1, 3; 144.9501, 1.17subdivisions 22b, 26a, by adding subdivisions; 144.9505, subdivisions 1g, 4; 1.18144.9508, subdivisions 2, 3, 4; 144.9512, subdivision 2; 144.966, by adding 1.19a subdivision; 144.97, subdivisions 2, 4, 6, by adding subdivisions; 144.98, 1.20subdivisions 1, 2, 3, by adding subdivisions; 144.99, subdivision 1; 144A.073, by 1.21adding a subdivision; 144A.44, subdivision 2; 144A.46, subdivision 1; 148.108; 1.22148.6445, by adding a subdivision; 148D.180, subdivisions 1, 2, 3, 5; 148E.180, 1.23subdivisions 1, 2, 3, 5; 153A.17; 156.015; 157.15, by adding a subdivision; 1.24157.16; 157.22; 176.011, subdivision 9; 245.462, subdivision 18; 245.470, 1.25subdivision 1; 245.4871, subdivision 27; 245.488, subdivision 1; 245.4885, 1.26subdivision 1; 245A.03, by adding a subdivision; 245A.10, subdivisions 2, 3, 1.274, 5, by adding subdivisions; 245A.11, subdivision 2a, by adding a subdivision; 1.28245A.16, subdivisions 1, 3; 245C.03, subdivision 2; 245C.04, subdivisions 1, 1.293; 245C.05, subdivision 4; 245C.08, subdivision 2; 245C.10, subdivision 3, 1.30by adding subdivisions; 245C.17, by adding a subdivision; 245C.20; 245C.21, 1.31subdivision 1a; 245C.23, subdivision 2; 246.50, subdivision 5, by adding 1.32subdivisions; 246.51, by adding subdivisions; 246.511; 246.52; 246B.01, by 1.33adding subdivisions; 252.46, by adding a subdivision; 252.50, subdivision 1.341; 254A.02, by adding a subdivision; 254A.16, by adding a subdivision; 1.35254B.03, subdivisions 1, 3, by adding a subdivision; 254B.05, subdivision 1.361; 254B.09, subdivision 2; 256.01, subdivision 2b, by adding subdivisions; 1.37256.045, subdivision 3; 256.476, subdivisions 5, 11; 256.962, subdivisions 1.382, 6; 256.963, by adding a subdivision; 256.969, subdivision 3a; 256.975, 1.39subdivision 7; 256.983, subdivision 1; 256B.04, subdivision 16; 256B.055, 1.40subdivisions 7, 12; 256B.056, subdivisions 3, 3b, 3c, by adding a subdivision; 1.41256B.057, subdivisions 3, 9, by adding a subdivision; 256B.0575; 256B.0595, 1.42subdivisions 1, 2; 256B.06, subdivisions 4, 5; 256B.0621, subdivision 2; 2.1256B.0622, subdivision 2; 256B.0623, subdivision 5; 256B.0624, subdivisions 2.25, 8; 256B.0625, subdivisions 3c, 7, 8, 8a, 9, 13e, 17, 19a, 19c, 26, 41, 42, 47; 2.3256B.0631, subdivision 1; 256B.0641, subdivision 3; 256B.0651; 256B.0652; 2.4256B.0653; 256B.0654; 256B.0655, subdivisions 1b, 4; 256B.0657, subdivisions 2.52, 6, 8, by adding a subdivision; 256B.08, by adding a subdivision; 256B.0911, 2.6subdivisions 1, 1a, 3, 3a, 4a, 5, 6, 7, by adding subdivisions; 256B.0913, 2.7subdivision 4; 256B.0915, subdivisions 3e, 3h, 5, by adding a subdivision; 2.8256B.0916, subdivision 2; 256B.0917, by adding a subdivision; 256B.092, 2.9subdivision 8a, by adding subdivisions; 256B.0943, subdivision 1; 256B.0944, 2.10by adding a subdivision; 256B.0945, subdivision 4; 256B.0947, subdivision 2.111; 256B.15, subdivisions 1, 1a, 1h, 2, by adding subdivisions; 256B.37, 2.12subdivisions 1, 5; 256B.434, by adding a subdivision; 256B.437, subdivision 6; 2.13256B.441, subdivisions 48, 55, by adding subdivisions; 256B.49, subdivisions 2.1412, 13, 14, 17, by adding subdivisions; 256B.501, subdivision 4a; 256B.5011, 2.15subdivision 2; 256B.5012, by adding a subdivision; 256B.5013, subdivision 2.161; 256B.69, subdivisions 5a, 5c, 5f; 256B.76, subdivisions 1, 4, by adding 2.17a subdivision; 256B.761; 256D.024, by adding a subdivision; 256D.03, 2.18subdivision 4; 256D.051, subdivision 2a; 256D.0515; 256D.06, subdivision 2.192; 256D.09, subdivision 6; 256D.44, subdivision 5; 256D.49, subdivision 3; 2.20256G.02, subdivision 6; 256I.03, subdivision 7; 256I.05, subdivisions 1a, 7c; 2.21256J.08, subdivision 73a; 256J.20, subdivision 3; 256J.24, subdivisions 5a, 2.2210; 256J.26, by adding a subdivision; 256J.37, subdivision 3a, by adding a 2.23subdivision; 256J.38, subdivision 1; 256J.45, subdivision 3; 256J.49, subdivision 2.2413; 256J.575, subdivisions 3, 6, 7; 256J.621; 256J.626, subdivision 6; 256J.751, 2.25by adding a subdivision; 256J.95, subdivision 12; 256L.04, subdivision 10a, 2.26by adding a subdivision; 256L.05, subdivision 1, by adding subdivisions; 2.27256L.11, subdivisions 1, 7; 256L.12, subdivision 9; 256L.17, subdivision 3; 2.28259.67, by adding a subdivision; 270A.09, by adding a subdivision; 295.52, 2.29by adding a subdivision; 327.14, by adding a subdivision; 327.15; 327.16; 2.30327.20, subdivision 1, by adding a subdivision; 393.07, subdivision 10; 501B.89, 2.31by adding a subdivision; 518A.53, subdivisions 1, 4, 10; 519.05; 604A.33, 2.32subdivision 1; 609.232, subdivision 11; 626.556, subdivision 3c; 626.5572, 2.33subdivisions 6, 13, 21; Laws 2003, First Special Session chapter 14, article 2.3413C, section 2, subdivision 1, as amended; Laws 2007, chapter 147, article 2.3519, section 3, subdivision 4, as amended; proposing coding for new law in 2.36Minnesota Statutes, chapters 62A; 62Q; 156; 246B; 254B; 256; 256B; proposing 2.37coding for new law as Minnesota Statutes, chapter 402A; repealing Minnesota 2.38Statutes 2008, sections 62U.08; 103I.112; 144.9501, subdivision 17b; 148D.180, 2.39subdivision 8; 246.51, subdivision 1; 246.53, subdivision 3; 256.962, subdivision 2.407; 256B.0655, subdivisions 1, 1a, 1c, 1d, 1e, 1f, 1g, 1h, 1i, 2, 3, 5, 6, 7, 8, 9, 10, 2.4111, 12, 13; 256B.071, subdivisions 1, 2, 3, 4; 256B.092, subdivision 5a; 256B.19, 2.42subdivision 1d; 256B.431, subdivision 23; 256D.46; 256I.06, subdivision 9; 2.43256J.626, subdivision 7; 327.14, subdivisions 5, 6; Laws 1988, chapter 689, 2.44section 251; Minnesota Rules, parts 4626.2015, subpart 9; 9100.0400, subparts 2.451, 3; 9100.0500; 9100.0600; 9500.1243, subpart 3; 9500.1261, subparts 3, 4, 5, 2.466; 9555.6125, subpart 4, item B.2.47May 10, 20092.48The Honorable Margaret Anderson Kelliher2.49Speaker of the House of Representatives2.50The Honorable James P. Metzen2.51President of the Senate2.52We, the undersigned conferees for H. F. No. 1362 report that we have agreed upon 2.53the items in dispute and recommend as follows:3.1That the Senate recede from its amendment and that H. F. No. 1362 be further 3.2amended as follows:3.3Delete everything after the enacting clause and insert:3.4"ARTICLE 13.5LICENSING3.6    Section 1. Minnesota Statutes 2008, section 245A.10, subdivision 2, is amended to 3.7read:3.8    Subd. 2. County fees for background studies and licensing inspections. (a) For 3.9purposes of family and group family child care licensing under this chapter, a county 3.10agency may charge a fee to an applicant or license holder to recover the actual cost of 3.11background studies, but in any case not to exceed $100 annually. A county agency may 3.12also charge a license fee to an applicant or license holder not to exceed $50 for a one-year 3.13license or $100 for a two-year license.3.14    (b) A county agency may charge a fee to a legal nonlicensed child care provider or 3.15applicant for authorization to recover the actual cost of background studies completed 3.16under section 
         119B.125, but in any case not to exceed $100 annually. 3.17    (c) Counties may elect to reduce or waive the fees in paragraph (a) or (b):3.18    (1) in cases of financial hardship;3.19    (2)  if the county has a shortage of providers in the county's area;3.20    (3) for new providers; or3.21    (4) for providers who have attained at least 16 hours of training before seeking 3.22initial licensure.3.23    (d) Counties may allow providers to pay the applicant fees in paragraph (a) or (b) on 3.24an installment basis for up to one year. If the provider is receiving child care assistance 3.25payments from the state, the provider may have the fees under paragraph (a) or (b) 3.26deducted from the child care assistance payments for up to one year and the state shall 3.27reimburse the county for the county fees collected in this manner.3.28    (e) For purposes of adult foster care and child foster care licensing under this 3.29chapter, a county agency may charge a fee to a corporate applicant or corporate license 3.30holder to recover the actual cost of background studies. A county agency may also charge 3.31a fee to a corporate applicant or corporate license holder to recover the actual cost of 3.32licensing inspections, not to exceed $500 annually.3.33    (f) Counties may elect to reduce or waive the fees in paragraph (e) under the 3.34following circumstances: 3.35(1) in cases of financial hardship; 4.1(2) if the county has a shortage of providers in the county's area; or4.2(3) for new providers.4.3    Sec. 2. Minnesota Statutes 2008, section 245A.10, subdivision 3, is amended to read:4.4    Subd. 3. Application fee for initial license or certification. (a) For fees required 4.5under subdivision 1, an applicant for an initial license or certification issued by the 4.6commissioner shall submit a $500 application fee with each new application required 4.7under this subdivision. The application fee shall not be prorated, is nonrefundable, and 4.8is in lieu of the annual license or certification fee that expires on December 31. The 4.9commissioner shall not process an application until the application fee is paid.4.10(b) Except as provided in clauses (1) to (3), an applicant shall apply for a license 4.11to provide services at a specific location.4.12(1) For a license to provide waivered residential-based habilitation services to 4.13persons with developmental disabilities or related conditions under chapter 245B, an 4.14applicant shall submit an application for each county in which the waivered services will 4.15be provided. Upon licensure, the license holder may provide services to persons in that 4.16county plus no more than three persons at any one time in each of up to ten additional 4.17counties. A license holder in one county may not provide services under the home and 4.18community-based waiver for persons with developmental disabilities to more than three 4.19people in a second county without holding a separate license for that second county. 4.20Applicants or licensees providing services under this clause to not more than three persons 4.21remain subject to the inspection fees established in section 245A.10, subdivision 2, for 4.22each location. The license issued by the commissioner must state the name of each 4.23additional county where services are being provided to persons with developmental 4.24disabilities. A license holder must notify the commissioner before making any changes 4.25that would alter the license information listed under section 245A.04, subdivision 7, 4.26paragraph (a), including any additional counties where persons with developmental 4.27disabilities are being served.4.28(2) For a license to provide supported employment, crisis respite, or 4.29semi-independent living services to persons with developmental disabilities or related 4.30conditions under chapter 245B, an applicant shall submit a single application to provide 4.31services statewide.4.32(3) For a license to provide independent living assistance for youth under section 4.33245A.22
         , an applicant shall submit a single application to provide services statewide. 4.34    Sec. 3. Minnesota Statutes 2008, section 245A.11, subdivision 2a, is amended to read:5.1    Subd. 2a. Adult foster care license capacity.The commissioner shall issue adult 5.2foster care licenses with a maximum licensed capacity of four beds, including nonstaff 5.3roomers and boarders, except that the commissioner may issue a license with a capacity of 5.4five beds, including roomers and boarders, according to paragraphs (a) to (e).5.5(a) An adult foster care license holder may have a maximum license capacity of five 5.6if all persons in care are age 55 or over and do not have a serious and persistent mental 5.7illness or a developmental disability.5.8(b) The commissioner may grant variances to paragraph (a) to allow a foster care 5.9provider with a licensed capacity of five persons to admit an individual under the age of 55 5.10if the variance complies with section 
         245A.04, subdivision 9, and approval of the variance 5.11is recommended by the county in which the licensed foster care provider is located.  5.12(c) The commissioner may grant variances to paragraph (a) to allow the use of a fifth 5.13bed for emergency crisis services for a person with serious and persistent mental illness 5.14or a developmental disability, regardless of age, if the variance complies with section 5.15245A.04, subdivision 9
         , and approval of the variance is recommended by the county in 5.16which the licensed foster care provider is located.  5.17(d) Notwithstanding paragraph (a),If the 2009 legislature adopts a rate reduction 5.18that impacts providers of adult foster care services, the commissioner may issue an adult 5.19foster care license with a capacity of five adults if the fifth bed does not increase the 5.20overall statewide capacity of licensed adult foster care beds in homes that are not the 5.21primary residence of the license holder, over the licensed capacity in such homes on July 5.221, 2009, as identified in a plan submitted to the commissioner by the county, when the 5.23capacity is recommended by the county licensing agency of the county in which the 5.24facility is located and if the recommendation verifies that:5.25(1) the facility meets the physical environment requirements in the adult foster 5.26care licensing rule;5.27(2) the five-bed living arrangement is specified for each resident in the resident's:5.28(i) individualized plan of care;5.29(ii) individual service plan under section 
         256B.092, subdivision 1b, if required; or  5.30(iii) individual resident placement agreement under Minnesota Rules, part 5.319555.5105, subpart 19, if required;5.32(3) the license holder obtains written and signed informed consent from each 5.33resident or resident's legal representative documenting the resident's informed choice to 5.34living in the home and that the resident's refusal to consent would not have resulted in 5.35service termination; and5.36(4) the facility was licensed for adult foster care before March 1, 2003 2009.6.1(e) The commissioner shall not issue a new adult foster care license under paragraph 6.2(d) after June 30, 2005 2011. The commissioner shall allow a facility with an adult foster 6.3care license issued under paragraph (d) before June 30, 2005 2011, to continue with a 6.4capacity of five adults if the license holder continues to comply with the requirements in 6.5paragraph (d).6.6EFFECTIVE DATE.This section is effective July 1, 2009.6.7    Sec. 4. Minnesota Statutes 2008, section 245A.11, is amended by adding a subdivision 6.8to read:6.9    Subd. 7a.Alternate overnight supervision technology; adult foster care license.6.10    (a) The commissioner may grant an applicant or license holder an adult foster care license 6.11for a residence that does not have a caregiver in the residence during normal sleeping 6.12hours as required under Minnesota Rules, part 9555.5105, subpart 37, item B, but uses 6.13monitoring technology to alert the license holder when an incident occurs that may 6.14jeopardize the health, safety, or rights of a foster care recipient. The applicant or license 6.15holder must comply with all other requirements under Minnesota Rules, parts 9555.5105 6.16to 9555.6265, and the requirements under this subdivision. The license printed by the 6.17commissioner must state in bold and large font:6.18    (1) that the facility is under electronic monitoring; and6.19    (2) the telephone number of the county's common entry point for making reports of 6.20suspected maltreatment of vulnerable adults under section 626.557, subdivision 9.6.21(b) Applications for a license under this section must be submitted directly to 6.22the Department of Human Services licensing division. The licensing division must 6.23immediately notify the host county and lead county contract agency and the host county 6.24licensing agency. The licensing division must collaborate with the county licensing 6.25agency in the review of the application and the licensing of the program.6.26    (c) Before a license is issued by the commissioner, and for the duration of the 6.27license, the applicant or license holder must establish, maintain, and document the 6.28implementation of written policies and procedures addressing the requirements in 6.29paragraphs (d) through (f).6.30    (d) The applicant or license holder must have policies and procedures that:6.31    (1) establish characteristics of target populations that will be admitted into the home, 6.32and characteristics of populations that will not be accepted into the home;6.33    (2) explain the discharge process when a foster care recipient requires overnight 6.34supervision or other services that cannot be provided by the license holder due to the 6.35limited hours that the license holder is on-site;7.1    (3) describe the types of events to which the program will respond with a physical 7.2presence when those events occur in the home during time when staff are not on-site, and 7.3how the license holder's response plan meets the requirements in paragraph (e), clause 7.4(1) or (2);7.5    (4) establish a process for documenting a review of the implementation and 7.6effectiveness of the response protocol for the response required under paragraph (e), 7.7clause (1) or (2). The documentation must include:7.8    (i) a description of the triggering incident;7.9    (ii) the date and time of the triggering incident;7.10    (iii) the time of the response or responses under paragraph (e), clause (1) or (2);7.11    (iv) whether the response met the resident's needs;7.12    (v) whether the existing policies and response protocols were followed; and7.13    (vi) whether the existing policies and protocols are adequate or need modification.7.14    When no physical presence response is completed for a three-month period, the 7.15license holder's written policies and procedures must require a physical presence response 7.16drill be to conducted for which the effectiveness of the response protocol under paragraph 7.17(e), clause (1) or (2), will be reviewed and documented as required under this clause; and7.18    (5) establish that emergency and nonemergency phone numbers are posted in a 7.19prominent location in a common area of the home where they can be easily observed by a 7.20person responding to an incident who is not otherwise affiliated with the home.7.21    (e) The license holder must document and include in the license application which 7.22response alternative under clause (1) or (2) is in place for responding to situations that 7.23present a serious risk to the health, safety, or rights of people receiving foster care services 7.24in the home:7.25    (1) response alternative (1) requires only the technology to provide an electronic 7.26notification or alert to the license holder that an event is underway that requires a response. 7.27Under this alternative, no more than ten minutes will pass before the license holder will be 7.28physically present on-site to respond to the situation; or7.29    (2) response alternative (2) requires the electronic notification and alert system 7.30under alternative (1), but more than ten minutes may pass before the license holder is 7.31present on-site to respond to the situation. Under alternative (2), all of the following 7.32conditions are met:7.33    (i) the license holder has a written description of the interactive technological 7.34applications that will assist the licenser holder in communicating with and assessing the 7.35needs related to care, health, and safety of the foster care recipients. This interactive 7.36technology must permit the license holder to remotely assess the well being of the foster 8.1care recipient without requiring the initiation of the foster care recipient. Requiring the 8.2foster care recipient to initiate a telephone call does not meet this requirement;8.3(ii) the license holder documents how the remote license holder is qualified and 8.4capable of meeting the needs of the foster care recipients and assessing foster care 8.5recipients' needs under item (i) during the absence of the license holder on-site;8.6(iii) the license holder maintains written procedures to dispatch emergency response 8.7personnel to the site in the event of an identified emergency; and8.8    (iv) each foster care recipient's individualized plan of care, individual service plan 8.9under section 256B.092, subdivision 1b, if required, or individual resident placement 8.10agreement under Minnesota Rules, part 9555.5105, subpart 19, if required, identifies the 8.11maximum response time, which may be greater than ten minutes, for the license holder 8.12to be on-site for that foster care recipient.8.13    (f) All placement agreements, individual service agreements, and plans applicable 8.14to the foster care recipient must clearly state that the adult foster care license category is 8.15a program without the presence of a caregiver in the residence during normal sleeping 8.16hours; the protocols in place for responding to situations that present a serious risk to 8.17health, safety, or rights of foster care recipients under paragraph (e), clause (1) or (2); and a 8.18signed informed consent from each foster care recipient or the person's legal representative 8.19documenting the person's or legal representative's agreement with placement in the 8.20program. If electronic monitoring technology is used in the home, the informed consent 8.21form must also explain the following:8.22    (1) how any electronic monitoring is incorporated into the alternative supervision 8.23system;8.24    (2) the backup system for any electronic monitoring in times of electrical outages or 8.25other equipment malfunctions;8.26    (3) how the license holder is trained on the use of the technology;8.27    (4) the event types and license holder response times established under paragraph (e);8.28    (5) how the license holder protects the foster care recipient's privacy related to 8.29electronic monitoring and related to any electronically recorded data generated by the 8.30monitoring system. A foster care recipient may not be removed from a program under 8.31this subdivision for failure to consent to electronic monitoring. The consent form must 8.32explain where and how the electronically recorded data is stored, with whom it will be 8.33shared, and how long it is retained; and8.34    (6) the risks and benefits of the alternative overnight supervision system. 9.1    The written explanations under clauses (1) to (6) may be accomplished through 9.2cross-references to other policies and procedures as long as they are explained to the 9.3person giving consent, and the person giving consent is offered a copy.9.4(g) Nothing in this section requires the applicant or license holder to develop or 9.5maintain separate or duplicative polices, procedures, documentation, consent forms, or 9.6individual plans that may be required for other licensing standards, if the requirements of 9.7this section are incorporated into those documents.9.8(h) The commissioner may grant variances to the requirements of this section 9.9according to section 245A.04, subdivision 9.9.10(i) For the purposes of paragraphs (d) through (h), license holder has the meaning 9.11under section 245A.2, subdivision 9, and additionally includes all staff, volunteers, and 9.12contractors affiliated with the license holder.9.13(j) For the purposes of paragraph (e), the terms "assess" and "assessing" mean to 9.14remotely determine what action the license holder needs to take to protect the well-being 9.15of the foster care recipient.9.16    Sec. 5. Minnesota Statutes 2008, section 245A.11, is amended by adding a subdivision 9.17to read:9.18    Subd. 8b.Adult foster care data privacy and security.(a) An adult foster 9.19care license holder who creates, collects, records, maintains, stores, or discloses any 9.20individually identifiable recipient data, whether in an electronic or any other format, 9.21must comply with the privacy and security provisions of applicable privacy laws and 9.22regulations, including:9.23(1) the federal Health Insurance Portability and Accountability Act of 1996 9.24(HIPAA), Public Law 104-1; and the HIPAA Privacy Rule, Code of Federal Regulations, 9.25title 45, part 160, and subparts A and E of part 164; and9.26(2) the Minnesota Government Data Practices Act as codified in chapter 13.9.27(b) For purposes of licensure, the license holder shall be monitored for compliance 9.28with the following data privacy and security provisions:9.29(1) the license holder must control access to data on foster care recipients according 9.30to the definitions of public and private data on individuals under section 13.02; 9.31classification of the data on individuals as private under section 13.46, subdivision 2; 9.32and control over the collection, storage, use, access, protection, and contracting related 9.33to data according to section 13.05, in which the license holder is assigned the duties 9.34of a government entity;10.1(2) the license holder must provide each foster care recipient with a notice that 10.2meets the requirements under section 13.04, in which the license holder is assigned the 10.3duties of the government entity, and that meets the requirements of Code of Federal 10.4Regulations, title 45, part 164.52. The notice shall describe the purpose for collection of 10.5the data, and to whom and why it may be disclosed pursuant to law. The notice must 10.6inform the recipient that the license holder uses electronic monitoring and, if applicable, 10.7that recording technology is used;10.8(3) the license holder must not install monitoring cameras in bathrooms;10.9(4) electronic monitoring cameras must not be concealed from the foster care 10.10recipients; and10.11(5) electronic video and audio recordings of foster care recipients shall not be stored 10.12by the license holder for more than five days.10.13(c) The commissioner shall develop, and make available to license holders and 10.14county licensing workers, a checklist of the data privacy provisions to be monitored 10.15for purposes of licensure.10.16    Sec. 6. Minnesota Statutes 2008, section 245A.16, subdivision 1, is amended to read:10.17    Subdivision 1. Delegation of authority to agencies. (a) County agencies and 10.18private agencies that have been designated or licensed by the commissioner to perform 10.19licensing functions and activities under section 
         245A.04 and background studies for 10.20adult foster care, family adult day services, and family child care, under chapter 245C; to 10.21recommend denial of applicants under section 
         245A.05; to issue correction orders, to issue 10.22variances, and recommend a conditional license under section 
         245A.06, or to recommend 10.23suspending or revoking a license or issuing a fine under section 
         245A.07, shall comply 10.24with rules and directives of the commissioner governing those functions and with this 10.25section. The following variances are excluded from the delegation of variance authority 10.26and may be issued only by the commissioner:10.27    (1) dual licensure of family child care and child foster care, dual licensure of child 10.28and adult foster care, and adult foster care and family child care;10.29    (2) adult foster care maximum capacity;10.30    (3) adult foster care minimum age requirement;10.31    (4) child foster care maximum age requirement;10.32    (5) variances regarding disqualified individuals except that county agencies may 10.33issue variances under section 
         245C.30 regarding disqualified individuals when the county 10.34is responsible for conducting a consolidated reconsideration according to sections 
         245C.2511.1and 
         245C.27, subdivision 2, clauses (a) and (b), of a county maltreatment determination 11.2and a disqualification based on serious or recurring maltreatment; and11.3    (6) the required presence of a caregiver in the adult foster care residence during 11.4normal sleeping hours.11.5    (b) County agencies must report information about disqualification reconsiderations 11.6under sections 
         245C.25 and 
         245C.27, subdivision 2, paragraphs (a) and (b), and variances 11.7granted under paragraph (a), clause (5), to the commissioner at least monthly in a format 11.8prescribed by the commissioner.11.9    (c) For family day care programs, the commissioner may authorize licensing reviews 11.10every two years after a licensee has had at least one annual review.11.11    (d) For family adult day services programs, the commissioner may authorize 11.12licensing reviews every two years after a licensee has had at least one annual review.11.13    (e) A license issued under this section may be issued for up to two years.11.14    Sec. 7. Minnesota Statutes 2008, section 245A.16, subdivision 3, is amended to read:11.15    Subd. 3. Recommendations to commissioner. The county or private agency 11.16shall not make recommendations to the commissioner regarding licensure without first 11.17conducting an inspection, and for adult foster care, family adult day services, and family 11.18child care, a background study of the applicant under chapter 245C. The county or private 11.19agency must forward its recommendation to the commissioner regarding the appropriate 11.20licensing action within 20 working days of receipt of a completed application.11.21    Sec. 8. Minnesota Statutes 2008, section 245C.04, subdivision 1, is amended to read:11.22    Subdivision 1. Licensed programs. (a) The commissioner shall conduct a 11.23background study of an individual required to be studied under section 
         245C.03, 11.24subdivision 1
         , at least upon application for initial license for all license types. 11.25    (b) The commissioner shall conduct a background study of an individual required to 11.26be studied under section 
         245C.03, subdivision 1, at reapplication for a license for adult 11.27foster care, family adult day services, and family child care. 11.28    (c) The commissioner is not required to conduct a study of an individual at the time 11.29of reapplication for a license if the individual's background study was completed by the 11.30commissioner of human services for an adult foster care license holder that is also:11.31    (1) registered under chapter 144D; or11.32    (2) licensed to provide home and community-based services to people with 11.33disabilities at the foster care location and the license holder does not reside in the foster 11.34care residence; and12.1    (3) the following conditions are met:12.2    (i) a study of the individual was conducted either at the time of initial licensure or 12.3when the individual became affiliated with the license holder;12.4    (ii) the individual has been continuously affiliated with the license holder since 12.5the last study was conducted; and12.6    (iii) the last study of the individual was conducted on or after October 1, 1995.12.7    (d) From July 1, 2007, to June 30, 2009, the commissioner of human services shall 12.8conduct a study of an individual required to be studied under section 
         245C.03, at the 12.9time of reapplication for a child foster care license. The county or private agency shall 12.10collect and forward to the commissioner the information required under section 
         245C.05, 12.11subdivisions 1, paragraphs (a) and (b), and 5, paragraphs (a) and (b). The background 12.12study conducted by the commissioner of human services under this paragraph must 12.13include a review of the information required under section 
         245C.08, subdivisions 1, 12.14paragraph (a), clauses (1) to (5), 3, and 4.12.15    (e) The commissioner of human services shall conduct a background study of an 12.16individual specified under section 
         245C.03, subdivision 1, paragraph (a), clauses (2) 12.17to (6), who is newly affiliated with a child foster care license holder. The county or 12.18private agency shall collect and forward to the commissioner the information required 12.19under section 
         245C.05, subdivisions 1 and 5. The background study conducted by the 12.20commissioner of human services under this paragraph must include a review of the 12.21information required under section 
         245C.08, subdivisions 1, 3, and 4.12.22    (f) From January 1, 2010, to December 31, 2012, unless otherwise specified in 12.23paragraph (c), the commissioner shall conduct a study of an individual required to be 12.24studied under section 245C.03 at the time of reapplication for an adult foster care or family 12.25adult day services license: (1) the county shall collect and forward to the commissioner 12.26the information required under section 245C.05, subdivision 1, paragraphs (a) and (b), 12.27and subdivision 5, paragraphs (a) and (b), for background studies conducted by the 12.28commissioner for adult foster care and family adult day services when the license holder 12.29resides in the adult foster care or family adult day services residence; (2) the license 12.30holder shall collect and forward to the commissioner the information required under 12.31section 245C.05, subdivisions 1, paragraphs (a) and (b); and 5, paragraphs (a) and (b), 12.32for background studies conducted by the commissioner for adult foster care when the 12.33license holder does not reside in the adult foster care residence; and (3) the background 12.34study conducted by the commissioner under this paragraph must include a review of the 12.35information required under section 245C.08, subdivision 1, paragraph (a), clauses (1) 12.36to (5), and subdivisions 3 and 4.13.1(g) The commissioner shall conduct a background study of an individual specified 13.2under section 245C.03, subdivision 1, paragraph (a), clauses (2) to (6), who is newly 13.3affiliated with an adult foster care or family adult day services license holder: (1) the 13.4county shall collect and forward to the commissioner the information required under 13.5section 245C.05, subdivision 1, paragraphs (a) and (b), and subdivision 5, paragraphs (a) 13.6and (b), for background studies conducted by the commissioner for adult foster care 13.7and family adult day services when the license holder resides in the adult foster care or 13.8family adult day services residence; (2) the license holder shall collect and forward to the 13.9commissioner the information required under section 245C.05, subdivisions 1, paragraphs 13.10(a) and (b); and 5, paragraphs (a) and (b), for background studies conducted by the 13.11commissioner for adult foster care when the license holder does not reside in the adult 13.12foster care residence; and (3) the background study conducted by the commissioner under 13.13this paragraph must include a review of the information required under section 245C.08, 13.14subdivision 1, paragraph (a), and subdivisions 3 and 4.13.15 (h) Applicants for licensure, license holders, and other entities as provided in this 13.16chapter must submit completed background study forms to the commissioner before 13.17individuals specified in section 
         245C.03, subdivision 1, begin positions allowing direct 13.18contact in any licensed program. 13.19    (g) (i)  For purposes of this section, a physician licensed under chapter 147 is 13.20considered to be continuously affiliated upon the license holder's receipt from the 13.21commissioner of health or human services of the physician's background study results.13.22    Sec. 9. Minnesota Statutes 2008, section 245C.05, is amended by adding a subdivision 13.23to read:13.24    Subd. 2b.County agency to collect and forward information to the 13.25commissioner.For background studies related to adult foster care and family adult 13.26day services when the license holder resides in the adult foster care or family adult 13.27day services residence, the county agency must collect the information required under 13.28subdivision 1 and forward it to the commissioner.13.29    Sec. 10. Minnesota Statutes 2008, section 245C.05, subdivision 4, is amended to read:13.30    Subd. 4. Electronic transmission. For background studies conducted by the 13.31Department of Human Services, the commissioner shall implement a system for the 13.32electronic transmission of:13.33    (1) background study information to the commissioner; 13.34    (2) background study results to the license holder; and14.1    (3) background study results to county and private agencies for background studies 14.2conducted by the commissioner for child foster care; and14.3(4) background study results to county agencies for background studies conducted 14.4by the commissioner for adult foster care and family adult day services.14.5    Sec. 11. Minnesota Statutes 2008, section 245C.08, subdivision 2, is amended to read:14.6    Subd. 2. Background studies conducted by a county agency. (a) For a background 14.7study conducted by a county agency for adult foster care, family adult day services, and14.8family child care services, the commissioner shall review:14.9    (1) information from the county agency's record of substantiated maltreatment 14.10of adults and the maltreatment of minors;14.11    (2) information from juvenile courts as required in subdivision 4 for individuals 14.12listed in section 
         245C.03, subdivision 1, clauses (2), (5), and (6); and14.13    (3) information from the Bureau of Criminal Apprehension.14.14    (b) If the individual has resided in the county for less than five years, the study shall 14.15include the records specified under paragraph (a) for the previous county or counties of 14.16residence for the past five years.14.17    (c) Notwithstanding expungement by a court, the county agency may consider 14.18information obtained under paragraph (a), clause (3), unless the commissioner received 14.19notice of the petition for expungement and the court order for expungement is directed 14.20specifically to the commissioner.14.21    Sec. 12. Minnesota Statutes 2008, section 245C.10, is amended by adding a 14.22subdivision to read:14.23    Subd. 5.Adult foster care services.The commissioner shall recover the cost of 14.24background studies required under section 245C.03, subdivision 1, for the purposes of 14.25adult foster care and family adult day services licensing, through a fee of no more than 14.26$20 per study charged to the license holder. The fees collected under this subdivision are 14.27appropriated to the commissioner for the purpose of conducting background studies.14.28    Sec. 13. Minnesota Statutes 2008, section 245C.10, is amended by adding a 14.29subdivision to read:14.30    Subd. 8.Private agencies.The commissioner shall recover the cost of conducting 14.31background studies under section 245C.33 for studies initiated by private agencies for the 14.32purpose of adoption through a fee of no more than $70 per study charged to the private 15.1agency. The fees collected under this subdivision are appropriated to the commissioner for 15.2the purpose of conducting background studies.15.3    Sec. 14. Minnesota Statutes 2008, section 245C.17, is amended by adding a 15.4subdivision to read:15.5    Subd. 6.Notice to county agency.For studies on individuals related to a license 15.6to provide adult foster care and family adult day services, the commissioner shall also 15.7provide a notice of the background study results to the county agency that initiated the 15.8background study.15.9    Sec. 15. Minnesota Statutes 2008, section 245C.20, is amended to read:15.10245C.20 LICENSE HOLDER RECORD KEEPING.15.11A licensed program shall document the date the program initiates a background 15.12study under this chapter in the program's personnel files. When a background study is 15.13completed under this chapter, a licensed program shall maintain a notice that the study 15.14was undertaken and completed in the program's personnel files. Except when background 15.15studies are initiated through the commissioner's online system, if a licensed program 15.16has not received a response from the commissioner under section 
         245C.17 within 45 15.17days of initiation of the background study request, the licensed program must contact the 15.18commissioner human services licensing division to inquire about the status of the study.   If 15.19a license holder initiates a background study under the commissioner's online system, but 15.20the background study subject's name does not appear in the list of active or recent studies 15.21initiated by that license holder, the license holder must either contact the human services 15.22licensing division or resubmit the background study information online for that individual.15.23    Sec. 16. Minnesota Statutes 2008, section 245C.21, subdivision 1a, is amended to read:15.24    Subd. 1a. Submission of reconsideration request to county or private agency. (a) 15.25For disqualifications related to studies conducted by county agencies for family child care, 15.26and for disqualifications related to studies conducted by the commissioner for child foster 15.27care, adult foster care, and family adult day services, the individual shall submit the request 15.28for reconsideration to the county or private agency that initiated the background study.15.29    (b) For disqualifications related to studies conducted by the commissioner for child 15.30foster care, the individual shall submit the request for reconsideration to the private agency 15.31that initiated the background study.16.1(c) A reconsideration request shall be submitted within 30 days of the individual's 16.2receipt of the disqualification notice or the time frames specified in subdivision 2, 16.3whichever time frame is shorter.16.4    (c) (d)  The county or private agency shall forward the individual's request for 16.5reconsideration and provide the commissioner with a recommendation whether to set aside 16.6the individual's disqualification.16.7    Sec. 17. Minnesota Statutes 2008, section 245C.23, subdivision 2, is amended to read:16.8    Subd. 2. Commissioner's notice of disqualification that is not set aside. (a) The 16.9commissioner shall notify the license holder of the disqualification and order the license 16.10holder to immediately remove the individual from any position allowing direct contact 16.11with persons receiving services from the license holder if:16.12    (1) the individual studied does not submit a timely request for reconsideration 16.13under section 
         245C.21;16.14    (2) the individual submits a timely request for reconsideration, but the commissioner 16.15does not set aside the disqualification for that license holder under section 
         245C.22;16.16    (3) an individual who has a right to request a hearing under sections 
         245C.27 and 16.17256.045
         , or 
         245C.28 and chapter 14 for a disqualification that has not been set aside, does 16.18not request a hearing within the specified time; or16.19    (4) an individual submitted a timely request for a hearing under sections 
         245C.2716.20and 
         256.045, or 
         245C.28 and chapter 14, but the commissioner does not set aside the 16.21disqualification under section 
         245A.08, subdivision 5, or 
         256.045.16.22    (b) If the commissioner does not set aside the disqualification under section 
         245C.22, 16.23and the license holder was previously ordered under section 
         245C.17 to immediately 16.24remove the disqualified individual from direct contact with persons receiving services or 16.25to ensure that the individual is under continuous, direct supervision when providing direct 16.26contact services, the order remains in effect pending the outcome of a hearing under 16.27sections 
         245C.27 and 
         256.045, or 
         245C.28 and chapter 14.16.28    (c) For background studies related to child foster care, the commissioner shall 16.29also notify the county or private agency that initiated the study of the results of the 16.30reconsideration.16.31(d) For background studies related to adult foster care and family adult day services, 16.32the commissioner shall also notify the county that initiated the study of the results of 16.33the reconsideration.17.1    Sec. 18. Minnesota Statutes 2008, section 256B.092, is amended by adding a 17.2subdivision to read:17.3    Subd. 5b.Revised per diem based on legislated rate reduction.Notwithstanding 17.4section 252.28, subdivision 3, paragraph (d), if the 2009 legislature adopts a rate reduction 17.5that impacts payment to providers of adult foster care services, the commissioner may 17.6issue adult foster care licenses that permit a capacity of five adults. The application for a 17.7five-bed license must meet the requirements of section 245A.11, subdivision 2a. Prior to 17.8admission of the fifth recipient of adult foster care services, the county must negotiate a 17.9revised per diem rate for room and board and waiver services that reflects the legislated 17.10rate reduction and results in an overall average per diem reduction for all foster care 17.11recipients in that home. The revised per diem must allow the provider to maintain, as 17.12much as possible, the level of services or enhanced services provided in the residence, 17.13while mitigating the losses of the legislated rate reduction.17.14EFFECTIVE DATE.This section is effective July 1, 2009.17.15    Sec. 19. Minnesota Statutes 2008, section 256B.49, subdivision 17, is amended to read:17.16    Subd. 17. Cost of services and supports. (a) The commissioner shall ensure 17.17that the average per capita expenditures estimated in any fiscal year for home and 17.18community-based waiver recipients does not exceed the average per capita expenditures 17.19that would have been made to provide institutional services for recipients in the absence 17.20of the waiver.17.21(b) The commissioner shall implement on January 1, 2002, one or more aggregate, 17.22need-based methods for allocating to local agencies the home and community-based 17.23waivered service resources available to support recipients with disabilities in need of 17.24the level of care provided in a nursing facility or a hospital. The commissioner shall 17.25allocate resources to single counties and county partnerships in a manner that reflects 17.26consideration of:17.27(1) an incentive-based payment process for achieving outcomes;17.28(2) the need for a state-level risk pool;17.29(3) the need for retention of management responsibility at the state agency level; and17.30(4) a phase-in strategy as appropriate.17.31(c) Until the allocation methods described in paragraph (b) are implemented, the 17.32annual allowable reimbursement level of home and community-based waiver services 17.33shall be the greater of:18.1(1) the statewide average payment amount which the recipient is assigned under the 18.2waiver reimbursement system in place on June 30, 2001, modified by the percentage of 18.3any provider rate increase appropriated for home and community-based services; or18.4(2) an amount approved by the commissioner based on the recipient's extraordinary 18.5needs that cannot be met within the current allowable reimbursement level. The 18.6increased reimbursement level must be necessary to allow the recipient to be discharged 18.7from an institution or to prevent imminent placement in an institution. The additional 18.8reimbursement may be used to secure environmental modifications; assistive technology 18.9and equipment; and increased costs for supervision, training, and support services 18.10necessary to address the recipient's extraordinary needs. The commissioner may approve 18.11an increased reimbursement level for up to one year of the recipient's relocation from an 18.12institution or up to six months of a determination that a current waiver recipient is at 18.13imminent risk of being placed in an institution.18.14(d) Beginning July 1, 2001, medically necessary private duty nursing services will be 18.15authorized under this section as complex and regular care according to sections 
         256B.065118.16and 
         256B.0653 to 
         256B.0656. The rate established by the commissioner for registered 18.17nurse or licensed practical nurse services under any home and community-based waiver as 18.18of January 1, 2001, shall not be reduced.18.19(e) Notwithstanding section 252.28, subdivision 3, paragraph (d), if the 2009 18.20legislature adopts a rate reduction that impacts payment to providers of adult foster care 18.21services, the commissioner may issue adult foster care licenses that permit a capacity of 18.22five adults. The application for a five-bed license must meet the requirements of section 18.23245A.11, subdivision 2a. Prior to admission of the fifth recipient of adult foster care 18.24services, the county must negotiate a revised per diem rate for room and board and waiver 18.25services that reflects the legislated rate reduction and results in an overall average per 18.26diem reduction for all foster care recipients in that home. The revised per diem must allow 18.27the provider to maintain, as much as possible, the level of services or enhanced services 18.28provided in the residence, while mitigating the losses of the legislated rate reduction.18.29EFFECTIVE DATE.This section is effective July 1, 2009.18.30    Sec. 20. WAIVER.18.31By December 1, 2009, the commissioner shall request all federal approvals and 18.32waiver amendments to the disability home and community-based waivers to allow properly 18.33licensed adult foster care homes to provide residential services for up to five individuals.18.34EFFECTIVE DATE.This section is effective July 1, 2009.19.1    Sec. 21.  REPEALER.19.2(a) Minnesota Statutes 2008, section 245C.11, subdivisions 1 and 2, are repealed.19.3(b) Minnesota Statutes 2008, section 256B.092, subdivision 5a, is repealed effective 19.4July 1, 2009.19.5(c) Minnesota Rules, part 9555.6125, subpart 4, item B, is repealed.19.6ARTICLE 219.7MFIP/CHILD CARE/ADULT SUPPORTS/FRAUD PREVENTION19.8    Section 1. Minnesota Statutes 2008, section 119B.09, subdivision 7, is amended to read:19.9    Subd. 7. Date of eligibility for assistance. (a) The date of eligibility for child 19.10care assistance under this chapter is the later of the date the application was signed; the 19.11beginning date of employment, education, or training; the date the infant is born for 19.12applicants to the at-home infant care program; or the date a determination has been made 19.13that the applicant is a participant in employment and training services under Minnesota 19.14Rules, part 3400.0080, or chapter 256J.19.15    (b) Payment ceases for a family under the at-home infant child care program when a 19.16family has used a total of 12 months of assistance as specified under section 
         119B.035. 19.17Payment of child care assistance for employed persons on MFIP is effective the date of 19.18employment or the date of MFIP eligibility, whichever is later. Payment of child care 19.19assistance for MFIP or DWP participants in employment and training services is effective 19.20the date of commencement of the services or the date of MFIP or DWP eligibility, 19.21whichever is later. Payment of child care assistance for transition year child care must be 19.22made retroactive to the date of eligibility for transition year child care. 19.23(c) Notwithstanding paragraph (b), payment of child care assistance for participants 19.24eligible under section 119B.05 may only be made retroactive for a maximum of six 19.25months from the date of application for child care assistance.19.26EFFECTIVE DATE.This section is effective October 1, 2009.19.27    Sec. 2. Minnesota Statutes 2008, section 119B.13, subdivision 6, is amended to read:19.28    Subd. 6. Provider payments. (a) Counties or the state shall make vendor payments 19.29to the child care provider or pay the parent directly for eligible child care expenses.19.30(b) If payments for child care assistance are made to providers, the provider shall 19.31bill the county for services provided within ten days of the end of the service period. If 19.32bills are submitted within ten days of the end of the service period, a county or the state 19.33shall issue payment to the provider of child care under the child care fund within 30 days 20.1of receiving a bill from the provider. Counties or the state may establish policies that 20.2make payments on a more frequent basis.20.3(c) All billsIf a provider has received an authorization of care and been issued a 20.4billing form for an eligible family, the bill must be submitted within 60 days of the last 20.5date of service on the bill. A county may pay a bill submitted more than 60 days after 20.6the last date of service if the provider shows good cause why the bill was not submitted 20.7within 60 days. Good cause must be defined in the county's child care fund plan under 20.8section 
         119B.08, subdivision 3, and the definition of good cause must include county 20.9error. A county may not pay any bill submitted more than a year after the last date of 20.10service on the bill. 20.11(d) If a provider provided care for a time period without receiving an authorization 20.12of care and a billing form for an eligible family, payment of child care assistance may only 20.13be made retroactively for a maximum of six months from the date the provider is issued 20.14an authorization of care and billing form.20.15(e) A county may stop payment issued to a provider or may refuse to pay a bill 20.16submitted by a provider if:20.17(1) the provider admits to intentionally giving the county materially false information 20.18on the provider's billing forms; or20.19(2) a county finds by a preponderance of the evidence that the provider intentionally 20.20gave the county materially false information on the provider's billing forms.20.21(e)(f) A county's payment policies must be included in the county's child care plan 20.22under section 
         119B.08, subdivision 3. If payments are made by the state, in addition to 20.23being in compliance with this subdivision, the payments must be made in compliance 20.24with section 
         16A.124. 20.25EFFECTIVE DATE.This section is effective October 1, 2009.20.26    Sec. 3. Minnesota Statutes 2008, section 119B.21, subdivision 5, is amended to read:20.27    Subd. 5. Child care services grants. (a) A child care resource and referral program 20.28designated under section 
         119B.19, subdivision 1a, may award child care services grants 20.29for: 20.30    (1) creating new licensed child care facilities and expanding existing facilities, 20.31including, but not limited to, supplies, equipment, facility renovation, and remodeling;20.32    (2) improving licensed child care facility programs;20.33    (3) staff training and development services including, but not limited to, in-service 20.34training, curriculum development, accreditation, certification, consulting, resource 21.1centers, program and resource materials, supporting effective teacher-child interactions, 21.2child-focused teaching, and content-driven classroom instruction;21.3    (4) interim financing;21.4    (5) capacity building through the purchase of appropriate technology to create, 21.5enhance, and maintain business management systems;21.6    (6) emergency assistance for child care programs;21.7    (7) new programs or projects for the creation, expansion, or improvement of 21.8programs that serve ethnic immigrant and refugee communities; and21.9    (8) targeted recruitment initiatives to expand and build the capacity of the child 21.10care system and to improve the quality of care provided by legal nonlicensed child care 21.11providers.21.12    (b) A child care resource and referral program designated under section 
         119B.19, 21.13subdivision 1a
         , may award child care services grants to: 21.14    (1) licensed providers;21.15    (2) providers in the process of being licensed;21.16    (3) corporations or public agencies that develop or provide child care services;21.17    (4) school-age care programs;21.18    (5) legal nonlicensed or family, friend, and neighbor care providers; or21.19    (6) any combination of clauses (1) to (5).21.20    (c) A recipient of a child care services grant for facility improvements, interim 21.21financing, or staff training and development must provide a 25 percent local match.21.22(d) Beginning July 1, 2009, grants under this subdivision shall be increasingly 21.23awarded for activities that improve provider quality, including activities under paragraph 21.24(a), clauses (1) to (3) and (7).21.25    Sec. 4. Minnesota Statutes 2008, section 119B.21, subdivision 10, is amended to read:21.26    Subd. 10. Family child care technical assistance grants. (a) A child care resource 21.27and referral organization designated under section 
         119B.19, subdivision 1a, may award 21.28technical assistance grants of up to $1,000. These grants may be used for: 21.29    (1) facility improvements, including, but not limited to, improvements to meet 21.30licensing requirements;21.31    (2) improvements to expand a child care facility or program;21.32    (3) toys, materials, and equipment to improve the learning environment;21.33    (4) technology and software to create, enhance, and maintain business management 21.34systems;21.35    (5) start-up costs;22.1    (6) staff training and development; and22.2    (7) other uses approved by the commissioner.22.3    (b) A child care resource and referral program may award family child care technical 22.4assistance grants to:22.5    (1) licensed family child care providers; 22.6    (2) child care providers in the process of becoming licensed; or22.7    (3) legal nonlicensed or family, friend, and neighbor care providers.22.8    (c) A local match is not required for a family child care technical assistance grant.22.9(d) Beginning July 1, 2009, grants under this subdivision shall be increasingly 22.10awarded for activities that improve provider quality, including activities under paragraph 22.11(a), clauses (1), (3), and (6).22.12    Sec. 5. Minnesota Statutes 2008, section 119B.231, subdivision 2, is amended to read:22.13    Subd. 2. Provider eligibility. (a) To be considered for an SRSA, a provider shall 22.14apply to the commissioner or have been chosen as an SRSA provider prior to June 30, 22.152009, and have complied with all requirements of the SRSA agreement. Priority for funds 22.16is given to providers who had agreements prior to June 30, 2009. If sufficient funds are 22.17available, the commissioner shall make applications available to additional providers. To 22.18be eligible to apply for an SRSA, a provider shall:22.19    (1) be eligible for child care assistance payments under chapter 119B;22.20    (2) have at least 25 percent of the children enrolled with the provider subsidized 22.21through the child care assistance program;22.22    (3) provide full-time, full-year child care services; and22.23    (4) serve at least one child who is subsidized through the child care assistance 22.24program and who is expected to enter kindergarten within the following 30 months have 22.25obtained a level 3 or 4 star rating under the voluntary Parent Aware quality rating system.22.26    (b) The commissioner may waive the 25 percent requirement in paragraph (a), 22.27clause (2), if necessary to achieve geographic distribution of SRSA providers and diversity 22.28of types of care provided by SRSA providers.22.29    (c) An eligible provider who would like to enter into an SRSA with the commissioner 22.30shall submit an SRSA application. To determine whether to enter into an SRSA with a 22.31provider, the commissioner shall evaluate the following factors:22.32    (1) the qualifications of the provider and the provider's staff provider's Parent 22.33Aware rating score;22.34    (2) the provider's staff-child ratios;22.35    (3) the provider's curriculum;23.1    (4) the provider's current or planned parent education activities;23.2    (5)(2) the provider's current or planned social service and employment linkages;23.3    (6) the provider's child development assessment plan;23.4    (7)(3) the geographic distribution needed for SRSA providers;23.5    (8)(4) the inclusion of a variety of child care delivery models; and23.6    (9)(5) other related factors determined by the commissioner.23.7    Sec. 6. Minnesota Statutes 2008, section 119B.231, subdivision 3, is amended to read:23.8    Subd. 3. Family and child eligibility. (a) A family eligible to choose an SRSA 23.9provider for their children shall:23.10    (1) be eligible to receive child care assistance under any provision in chapter 119B 23.11except section 
         119B.035;23.12    (2) be in an authorized activity for an average of at least 35 hours per week when 23.13initial eligibility is determined; and23.14    (3) include a child who has not yet entered kindergarten.23.15    (b) A family who is determined to be eligible to choose an SRSA provider remains 23.16eligible to be paid at a higher rate through the SRSA provider when the following 23.17conditions exist:23.18    (1) the child attends child care with the SRSA provider a minimum of 25 hours per 23.19week, on average;23.20    (2) the family has a child who has not yet entered kindergarten; and23.21    (3) the family maintains eligibility under chapter 119B except section 
         119B.035.23.22    (c) For the 12 months After initial eligibility has been determined, a decrease in the 23.23family's authorized activities to an average of less than 35 hours per week does not result 23.24in ineligibility for the SRSA rate. A family must continue to maintain eligibility under this 23.25chapter and be in an authorized activity.23.26    (d) A family that moves between counties but continues to use the same SRSA 23.27provider shall continue to receive SRSA funding for the increased payments.23.28    Sec. 7. Minnesota Statutes 2008, section 119B.231, subdivision 4, is amended to read:23.29    Subd. 4. Requirements of providers. An SRSA must include assessment, 23.30evaluation, and reporting requirements that promote the goals of improved school 23.31readiness and movement toward appropriate child development milestones. A provider 23.32who enters into an SRSA shall comply with all SRSA requirements, including the 23.33assessment, evaluation, and reporting requirements in the SRSA. Providers who have been 23.34selected previously for SRSAs must begin the process to obtain a rating using Parent 24.1Aware according to timelines established by the commissioner. If the initial Parent Aware 24.2rating is less than three stars, the provider must submit a plan to improve the rating. If 24.3a 3 or 4 star rating is not obtained within established timelines, the commissioner may 24.4consider continuation of the agreement, depending upon the progress made and other 24.5factors. Providers who apply and are selected for a new SRSA agreement on or after July 24.61, 2009, must have a level 3 or 4 star rating under the voluntary Parent Aware quality 24.7rating system at the time the SRSA agreement is signed.24.8    Sec. 8. Minnesota Statutes 2008, section 145A.17, is amended by adding a subdivision 24.9to read:24.10    Subd. 4a.Home visitors as MFIP employment and training service providers.24.11The county social service agency and the local public health department may mutually 24.12agree to utilize home visitors under this section as MFIP employment and training service 24.13providers under section 256J.49, subdivision 4, for MFIP participants who are: (1) ill or 24.14incapacitated under section 256J.425, subdivision 2; or (2) minor caregivers under section 24.15256J.54. The county social service agency and the local public health department may 24.16also mutually agree to utilize home visitors to provide outreach to MFIP families who are 24.17being sanctioned or who have been terminated from MFIP due to the 60-month time limit.24.18    Sec. 9. Minnesota Statutes 2008, section 256.045, subdivision 3, is amended to read:24.19    Subd. 3. State agency hearings. (a) State agency hearings are available for the 24.20following: 24.21    (1) any person applying for, receiving or having received public assistance, medical 24.22care, or a program of social services granted by the state agency or a county agency or 24.23the federal Food Stamp Act whose application for assistance is denied, not acted upon 24.24with reasonable promptness, or whose assistance is suspended, reduced, terminated, or 24.25claimed to have been incorrectly paid;24.26    (2) any patient or relative aggrieved by an order of the commissioner under section 24.27252.27
         ; 24.28    (3) a party aggrieved by a ruling of a prepaid health plan;24.29    (4) except as provided under chapter 245C, any individual or facility determined by 24.30a lead agency to have maltreated a vulnerable adult under section 
         626.557 after they have 24.31exercised their right to administrative reconsideration under section 
         626.557;24.32    (5) any person whose claim for foster care payment according to a placement of the 24.33child resulting from a child protection assessment under section 
         626.556 is denied or not 24.34acted upon with reasonable promptness, regardless of funding source;25.1    (6) any person to whom a right of appeal according to this section is given by other 25.2provision of law;25.3    (7) an applicant aggrieved by an adverse decision to an application for a hardship 25.4waiver under section 
         256B.15;25.5    (8) an applicant aggrieved by an adverse decision to an application or redetermination 25.6for a Medicare Part D prescription drug subsidy under section 
         256B.04, subdivision 4a; 25.7    (9) except as provided under chapter 245A, an individual or facility determined 25.8to have maltreated a minor under section 
         626.556, after the individual or facility has 25.9exercised the right to administrative reconsideration under section 
         626.556; or25.10    (10) except as provided under chapter 245C, an individual disqualified under sections 25.11245C.14
          and 
         245C.15, on the basis of serious or recurring maltreatment; a preponderance 25.12of the evidence that the individual has committed an act or acts that meet the definition 25.13of any of the crimes listed in section 
         245C.15, subdivisions 1 to 4; or for failing to make 25.14reports required under section 
         626.556, subdivision 3, or 
         626.557, subdivision 3. Hearings 25.15regarding a maltreatment determination under clause (4) or (9) and a disqualification under 25.16this clause in which the basis for a disqualification is serious or recurring maltreatment, 25.17which has not been set aside under sections 
         245C.22 and 
         245C.23, shall be consolidated 25.18into a single fair hearing. In such cases, the scope of review by the human services referee 25.19shall include both the maltreatment determination and the disqualification. The failure to 25.20exercise the right to an administrative reconsideration shall not be a bar to a hearing under 25.21this section if federal law provides an individual the right to a hearing to dispute a finding 25.22of maltreatment. Individuals and organizations specified in this section may contest the 25.23specified action, decision, or final disposition before the state agency by submitting a 25.24written request for a hearing to the state agency within 30 days after receiving written 25.25notice of the action, decision, or final disposition, or within 90 days of such written notice 25.26if the applicant, recipient, patient, or relative shows good cause why the request was not 25.27submitted within the 30-day time limit.; or25.28    (11) any person with an outstanding debt resulting from receipt of public assistance, 25.29medical care, or the federal Food Stamp Act who is contesting a setoff claim by the 25.30Department of Human Services or a county agency. The scope of the appeal is the validity 25.31of the claimant agency's intention to request a setoff of a refund under chapter 270A 25.32against the debt.25.33    (b) The hearing for an individual or facility under paragraph (a), clause (4), (9), or 25.34(10), is the only administrative appeal to the final agency determination specifically, 25.35including a challenge to the accuracy and completeness of data under section 
         13.04. 25.36Hearings requested under paragraph (a), clause (4), apply only to incidents of maltreatment 26.1that occur on or after October 1, 1995. Hearings requested by nursing assistants in nursing 26.2homes alleged to have maltreated a resident prior to October 1, 1995, shall be held as a 26.3contested case proceeding under the provisions of chapter 14. Hearings requested under 26.4paragraph (a), clause (9), apply only to incidents of maltreatment that occur on or after 26.5July 1, 1997. A hearing for an individual or facility under paragraph (a), clause (9), is 26.6only available when there is no juvenile court or adult criminal action pending. If such 26.7action is filed in either court while an administrative review is pending, the administrative 26.8review must be suspended until the judicial actions are completed. If the juvenile court 26.9action or criminal charge is dismissed or the criminal action overturned, the matter may be 26.10considered in an administrative hearing.26.11    (c) For purposes of this section, bargaining unit grievance procedures are not an 26.12administrative appeal.26.13    (d) The scope of hearings involving claims to foster care payments under paragraph 26.14(a), clause (5), shall be limited to the issue of whether the county is legally responsible 26.15for a child's placement under court order or voluntary placement agreement and, if so, 26.16the correct amount of foster care payment to be made on the child's behalf and shall not 26.17include review of the propriety of the county's child protection determination or child 26.18placement decision.26.19    (e) A vendor of medical care as defined in section 
         256B.02, subdivision 7, or a 26.20vendor under contract with a county agency to provide social services is not a party and 26.21may not request a hearing under this section, except if assisting a recipient as provided in 26.22subdivision 4.26.23    (f) An applicant or recipient is not entitled to receive social services beyond the 26.24services prescribed under chapter 256M or other social services the person is eligible 26.25for under state law.26.26    (g) The commissioner may summarily affirm the county or state agency's proposed 26.27action without a hearing when the sole issue is an automatic change due to a change in 26.28state or federal law.26.29    Sec. 10. Minnesota Statutes 2008, section 256.983, subdivision 1, is amended to read:26.30    Subdivision 1. Programs established. Within the limits of available appropriations, 26.31the commissioner of human services shall require the maintenance of budget neutral 26.32fraud prevention investigation programs in the counties participating in the fraud 26.33prevention investigation project established under this section. If funds are sufficient, 26.34the commissioner may also extend fraud prevention investigation programs to other 26.35counties provided the expansion is budget neutral to the state. Under any expansion, the 27.1commissioner has the final authority in decisions regarding the creation and realignment 27.2of individual county or regional operations.27.3    Sec. 11. Minnesota Statutes 2008, section 256I.03, subdivision 7, is amended to read:27.4    Subd. 7. Countable income. "Countable income" means all income received by an 27.5applicant or recipient less any applicable exclusions or disregards. For a recipient of any 27.6cash benefit from the SSI program, countable income means the SSI benefit limit in effect 27.7at the time the person is in a GRH setting less $20, less the medical assistance personal 27.8needs allowance. If the SSI limit has been reduced for a person due to events occurring 27.9prior to the persons entering the GRH setting, countable income means actual income less 27.10any applicable exclusions and disregards.27.11EFFECTIVE DATE.This section is effective April 1, 2010.27.12    Sec. 12. Minnesota Statutes 2008, section 256I.05, subdivision 7c, is amended to read:27.13    Subd. 7c. Demonstration project. The commissioner is authorized to pursue the 27.14expansion of a demonstration project under federal food stamp regulation for the purpose 27.15of gaining additional federal reimbursement of food and nutritional costs currently paid by 27.16the state group residential housing program. The commissioner shall seek approval no 27.17later than January 1, 2004 October 1, 2009. Any reimbursement received is nondedicated 27.18revenue to the general fund.27.19    Sec. 13. Minnesota Statutes 2008, section 256J.24, subdivision 5, is amended to read:27.20    Subd. 5. MFIP transitional standard. The MFIP transitional standard is based 27.21on the number of persons in the assistance unit eligible for both food and cash assistance 27.22unless the restrictions in subdivision 6 on the birth of a child apply. The following table 27.23represents the transitional standards effective October 1, 2007 April 1, 2009.

27.24Number of Eligible PeopleTransitional StandardCash PortionFood Portion

27.251$391 $428:$250$141 $17827.262$698 $764:$437$261$32727.273$910$1,005:$532$378$47327.284$1,091 $1,217:$621$470 $59627.295$1,245 $1,393:$697$548 $69627.306$1,425$1,602:$773$652 $82928.17$1,553 $1,748:$850$703$89828.28$1,713 $1,934:$916$797$1,01828.39$1,871 $2,119:$980$891$1,13928.410$2,024 $2,298:$1,035$989 $1,26328.5over 10add $151 $178:$53$98 $12528.6per additional member.

28.7    The commissioner shall annually publish in the State Register the transitional 28.8standard for an assistance unit sizes 1 to 10 including a breakdown of the cash and food 28.9portions.28.10EFFECTIVE DATE.This section is effective retroactively from April 1, 2009.28.11    Sec. 14. Minnesota Statutes 2008, section 256J.425, subdivision 2, is amended to read:28.12    Subd. 2. Ill or incapacitated. (a) An assistance unit subject to the time limit in 28.13section 
         256J.42, subdivision 1, is eligible to receive months of assistance under a hardship 28.14extension if the participant who reached the time limit belongs to any of the following 28.15groups:28.16(1) participants who are suffering from an illness, injury, or incapacity which 28.17has been certified by a qualified professional when the illness, injury, or incapacity is 28.18expected to continue for more than 30 days and prevents the person from obtaining or 28.19retaining employment severely limits the person's ability to obtain or maintain suitable 28.20employment. These participants must follow the treatment recommendations of the 28.21qualified professional certifying the illness, injury, or incapacity;28.22(2) participants whose presence in the home is required as a caregiver because of 28.23the illness, injury, or incapacity of another member in the assistance unit, a relative in the 28.24household, or a foster child in the household when the illness or incapacity and the need 28.25for a person to provide assistance in the home has been certified by a qualified professional 28.26and is expected to continue for more than 30 days; or28.27(3) caregivers with a child or an adult in the household who meets the disability or 28.28medical criteria for home care services under section 
         256B.0651, subdivision 1, paragraph 28.29(c), or a home and community-based waiver services program under chapter 256B, or 28.30meets the criteria for severe emotional disturbance under section 
         245.4871, subdivision 28.316
         , or for serious and persistent mental illness under section 
         245.462, subdivision 20, 28.32paragraph (c). Caregivers in this category are presumed to be prevented from obtaining 28.33or retaining employment.29.1(b) An assistance unit receiving assistance under a hardship extension under this 29.2subdivision may continue to receive assistance as long as the participant meets the criteria 29.3in paragraph (a), clause (1), (2), or (3).29.4    Sec. 15. Minnesota Statutes 2008, section 256J.425, subdivision 3, is amended to read:29.5    Subd. 3. Hard-to-employ participants.(a) An assistance unit subject to the time 29.6limit in section 
         256J.42, subdivision 1, is eligible to receive months of assistance under 29.7a hardship extension if the participant who reached the time limit belongs to any of the 29.8following groups: 29.9(1) a person who is diagnosed by a licensed physician, psychological practitioner, 29.10or other qualified professional, as developmentally disabled or mentally ill, and that 29.11condition prevents the person from obtaining or retaining unsubsidized employment the 29.12condition severely limits the person's ability to obtain or maintain suitable employment;29.13(2) a person who:29.14(i) has been assessed by a vocational specialist or the county agency to be 29.15unemployable for purposes of this subdivision; or29.16(ii) has an IQ below 80 who has been assessed by a vocational specialist or a county 29.17agency to be employable, but not at a level that makes the participant eligible for an 29.18extension under subdivision 4 the condition severely limits the person's ability to obtain or 29.19maintain suitable employment. The determination of IQ level must be made by a qualified 29.20professional. In the case of a non-English-speaking person: (A) the determination must 29.21be made by a qualified professional with experience conducting culturally appropriate 29.22assessments, whenever possible; (B) the county may accept reports that identify an 29.23IQ range as opposed to a specific score; (C) these reports must include a statement of 29.24confidence in the results;29.25(3) a person who is determined by a qualified professional to be learning disabled, 29.26and the disability condition severely limits the person's ability to obtain, perform, or 29.27maintain suitable employment. For purposes of the initial approval of a learning disability 29.28extension, the determination must have been made or confirmed within the previous 12 29.29months. In the case of a non-English-speaking person: (i) the determination must be made 29.30by a qualified professional with experience conducting culturally appropriate assessments, 29.31whenever possible; and (ii) these reports must include a statement of confidence in the 29.32results. If a rehabilitation plan for a participant extended as learning disabled is developed 29.33or approved by the county agency, the plan must be incorporated into the employment 29.34plan. However, a rehabilitation plan does not replace the requirement to develop and 29.35comply with an employment plan under section 
         256J.521; or 30.1(4) a person who has been granted a family violence waiver, and who is complying 30.2with an employment plan under section 
         256J.521, subdivision 3. 30.3(b) For purposes of this section, "severely limits the person's ability to obtain or 30.4maintain suitable employment" means that a qualified professional has determined that the 30.5person's condition prevents the person from working 20 or more hours per week.30.6    Sec. 16. Minnesota Statutes 2008, section 256J.49, subdivision 1, is amended to read:30.7    Subdivision 1. Scope. The terms used in sections 
         256J.50 256J.425 to 
         256J.72 have 30.8the meanings given them in this section.  30.9    Sec. 17. Minnesota Statutes 2008, section 256J.49, subdivision 4, is amended to read:30.10    Subd. 4. Employment and training service provider. "Employment and training 30.11service provider" means:30.12(1) a public, private, or nonprofit agency with which a county has contracted to 30.13provide employment and training services and which is included in the county's service 30.14agreement submitted under section 
         256J.626, subdivision 4; or30.15(2) a county agency, if the county has opted to provide employment and training 30.16services and the county has indicated that fact in the service agreement submitted under 30.17section 
         256J.626, subdivision 4; or30.18(3) a local public health department under section 145A.17, subdivision 3a, that a 30.19county has designated to provide employment and training services and is included in the 30.20county's service agreement submitted under section 256J.626, subdivision 4.30.21Notwithstanding section 
         116L.871, an employment and training services provider 30.22meeting this definition may deliver employment and training services under this chapter.30.23    Sec. 18. Minnesota Statutes 2008, section 256J.521, subdivision 2, is amended to read:30.24    Subd. 2. Employment plan; contents. (a) Based on the assessment under 30.25subdivision 1, the job counselor and the participant must develop an employment plan 30.26that includes participation in activities and hours that meet the requirements of section 30.27256J.55, subdivision 1
         . The purpose of the employment plan is to identify for each 30.28participant the most direct path to unsubsidized employment and any subsequent steps that 30.29support long-term economic stability. The employment plan should be developed using 30.30the highest level of activity appropriate for the participant. Activities must be chosen from 30.31clauses (1) to (6), which are listed in order of preference. Notwithstanding this order of 30.32preference for activities, priority must be given for activities related to a family violence 30.33waiver when developing the employment plan. The employment plan must also list the 31.1specific steps the participant will take to obtain employment, including steps necessary 31.2for the participant to progress from one level of activity to another, and a timetable for 31.3completion of each step. Levels of activity include:31.4    (1) unsubsidized employment;31.5    (2) job search;31.6    (3) subsidized employment or unpaid work experience;31.7    (4) unsubsidized employment and job readiness education or job skills training;31.8    (5) unsubsidized employment or unpaid work experience and activities related to 31.9a family violence waiver or preemployment needs; and31.10    (6) activities related to a family violence waiver or preemployment needs.31.11    (b) Participants who are determined to possess sufficient skills such that the 31.12participant is likely to succeed in obtaining unsubsidized employment must job search at 31.13least 30 hours per week for up to six weeks and accept any offer of suitable employment. 31.14The remaining hours necessary to meet the requirements of section 
         256J.55, subdivision 31.151
         , may be met through participation in other work activities under section 
         256J.49, 31.16subdivision 13
         . The participant's employment plan must specify, at a minimum: (1) 31.17whether the job search is supervised or unsupervised; (2) support services that will 31.18be provided; and (3) how frequently the participant must report to the job counselor. 31.19Participants who are unable to find suitable employment after six weeks must meet 31.20with the job counselor to determine whether other activities in paragraph (a) should be 31.21incorporated into the employment plan. Job search activities which are continued after six 31.22weeks must be structured and supervised. 31.23    (c) Beginning July 1, 2004, activities and hourly requirements in the employment 31.24plan may be adjusted as necessary to accommodate the personal and family circumstances 31.25of participants identified under section 256J.561, subdivision 2, paragraph (d). Participants 31.26who no longer meet the provisions of section 256J.561, subdivision 2, paragraph (d), 31.27must meet with the job counselor within ten days of the determination to revise the 31.28employment plan. 31.29    (d) Participants who are determined to have barriers to obtaining or retaining 31.30employment that will not be overcome during six weeks of job search under paragraph (b) 31.31must work with the job counselor to develop an employment plan that addresses those 31.32barriers by incorporating appropriate activities from paragraph (a), clauses (1) to (6). 31.33The employment plan must include enough hours to meet the participation requirements 31.34in section 
         256J.55, subdivision 1, unless a compelling reason to require fewer hours 31.35is noted in the participant's file. 32.1    (e)(d) The job counselor and the participant must sign the employment plan to 32.2indicate agreement on the contents.32.3    (f)(e) Except as provided under paragraph (g) (f), failure to develop or comply with 32.4activities in the plan, or voluntarily quitting suitable employment without good cause, will 32.5result in the imposition of a sanction under section 
         256J.46. 32.6    (g)(f) When a participant fails to meet the agreed upon hours of participation in paid 32.7employment because the participant is not eligible for holiday pay and the participant's 32.8place of employment is closed for a holiday, the job counselor shall not impose a sanction 32.9or increase the hours of participation in any other activity, including paid employment, to 32.10offset the hours that were missed due to the holiday.32.11    (h)(g) Employment plans must be reviewed at least every three months to determine 32.12whether activities and hourly requirements should be revised. The job counselor is 32.13encouraged to allow participants who are participating in at least 20 hours of work 32.14activities to also participate in education and training activities in order to meet the federal 32.15hourly participation rates.32.16    Sec. 19. Minnesota Statutes 2008, section 256J.545, is amended to read:32.17256J.545 FAMILY VIOLENCE WAIVER CRITERIA.32.18    (a) In order to qualify for a family violence waiver, an individual must provide 32.19documentation of past or current family violence which may prevent the individual from 32.20participating in certain employment activities. 32.21    (b) The following items may be considered acceptable documentation or verification 32.22of family violence:32.23    (1) police, government agency, or court records;32.24    (2) a statement from a battered women's shelter staff with knowledge of the 32.25circumstances or credible evidence that supports the sworn statement;32.26    (3) a statement from a sexual assault or domestic violence advocate with knowledge 32.27of the circumstances or credible evidence that supports the sworn statement; or32.28    (4) a statement from professionals from whom the applicant or recipient has sought 32.29assistance for the abuse.32.30    (c) A claim of family violence may also be documented by a sworn statement from 32.31the applicant or participant and a sworn statement from any other person with knowledge 32.32of the circumstances or credible evidence that supports the client's statement.32.33    Sec. 20. Minnesota Statutes 2008, section 256J.561, subdivision 2, is amended to read:33.1    Subd. 2. Participation requirements. (a) All MFIP caregivers, except caregivers 33.2who meet the criteria in subdivision 3, must participate in employment services develop an 33.3individualized employment plan that identifies the activities the participant is required to 33.4participate in and the required hours of participation. Except as specified in paragraphs (b) 33.5to (d), the employment plan must meet the requirements of section 256J.521, subdivision 33.62, contain allowable work activities, as defined in section 256J.49, subdivision 13, and, 33.7include at a minimum, the number of participation hours required under section 256J.55, 33.8subdivision 1.33.9(b) Minor caregivers and caregivers who are less than age 20 who have not 33.10completed high school or obtained a GED are required to comply with section 256J.54.33.11(c) A participant who has a family violence waiver shall develop and comply with 33.12an employment plan under section 256J.521, subdivision 3.33.13(d) As specified in section 256J.521, subdivision 2, paragraph (c), a participant who 33.14meets any one of the following criteria may work with the job counselor to develop an 33.15employment plan that contains less than the number of participation hours under section 33.16256J.55, subdivision 1. Employment plans for participants covered under this paragraph 33.17must be tailored to recognize the special circumstances of caregivers and families 33.18including limitations due to illness or disability and caregiving needs:33.19(1) a participant who is age 60 or older;33.20(2) a participant who has been diagnosed by a qualified professional as suffering 33.21from an illness or incapacity that is expected to last for 30 days or more, including a 33.22pregnant participant who is determined to be unable to obtain or retain employment due 33.23to the pregnancy; or33.24(3) a participant who is determined by a qualified professional as being needed in 33.25the home to care for an ill or incapacitated family member, including caregivers with a 33.26child or an adult in the household who meets the disability or medical criteria for home 33.27care services under section 256B.0651, subdivision 1, paragraph (c), or a home and 33.28community-based waiver services program under chapter 256B, or meets the criteria for 33.29severe emotional disturbance under section 245.4871, subdivision 6, or for serious and 33.30persistent mental illness under section 245.462, subdivision 20, paragraph (c).33.31(e) For participants covered under paragraphs (c) and (d), the county shall review 33.32the participant's employment services status every three months to determine whether 33.33conditions have changed. When it is determined that the participant's status is no longer 33.34covered under paragraph (c) or (d), the county shall notify the participant that a new or 33.35revised employment plan is needed. The participant and job counselor shall meet within 33.36ten days of the determination to revise the employment plan.34.1(b) Participants who meet the eligibility requirements in section 256J.575, 34.2subdivision 3, must develop a family stabilization services plan that meets the 34.3requirements in section 256J.575, subdivision 5.34.4(c) Minor caregivers and caregivers who are less than age 20 who have not 34.5completed high school or obtained a GED must develop an education plan that meets the 34.6requirements in section 256J.54.34.7(d) Participants with a family violence waiver must develop an employment plan 34.8that meets the requirements in section 256J.521, which cover the provisions in section 34.9256J.575, subdivision 5.34.10(e) All other participants must develop an employment plan that meets the 34.11requirements of section 256J.521, subdivision 2, and contains allowable work activities, 34.12as defined in section 256J.49, subdivision 13. The employment plan must include, at a 34.13minimum, the number of participation hours required under section 256J.55, subdivision 1.34.14    Sec. 21. Minnesota Statutes 2008, section 256J.561, subdivision 3, is amended to read:34.15    Subd. 3. Child under 12 weeks months of age. (a) A participant who has a 34.16natural born child who is less than 12 weeks months of age who meets the criteria in this 34.17subdivision is not required to participate in employment services until the child reaches 34.1812 weeks months of age. To be eligible for this provision, the assistance unit must not 34.19have already used this provision or the previously allowed child under age one exemption. 34.20However, an assistance unit that has an approved child under age one exemption at the 34.21time this provision becomes effective may continue to use that exemption until the child 34.22reaches one year of age.34.23(b) The provision in paragraph (a) ends the first full month after the child reaches 34.2412 weeks months of age. This provision is available only once in a caregiver's lifetime. 34.25In a two-parent household, only one parent shall be allowed to use this provision. The 34.26participant and job counselor must meet within ten days after the child reaches 12 weeks34.27months of age to revise the participant's employment plan.34.28EFFECTIVE DATE.This section is effective March 1, 2010.34.29    Sec. 22. Minnesota Statutes 2008, section 256J.57, subdivision 1, is amended to read:34.30    Subdivision 1. Good cause for failure to comply. The county agency shall not 34.31impose the sanction under section 
         256J.46 if it determines that the participant has good 34.32cause for failing to comply with the requirements of sections 
         256J.515 to 
         256J.57. Good 34.33cause exists when: 34.34(1) appropriate child care is not available;35.1(2) the job does not meet the definition of suitable employment;35.2(3) the participant is ill or injured;35.3(4) a member of the assistance unit, a relative in the household, or a foster child in 35.4the household is ill and needs care by the participant that prevents the participant from 35.5complying with the employment plan;35.6(5) the participant is unable to secure necessary transportation;35.7(6) the participant is in an emergency situation that prevents compliance with the 35.8employment plan;35.9(7) the schedule of compliance with the employment plan conflicts with judicial 35.10proceedings;35.11(8) a mandatory MFIP meeting is scheduled during a time that conflicts with a 35.12judicial proceeding or a meeting related to a juvenile court matter, or a participant's work 35.13schedule;35.14(9) the participant is already participating in acceptable work activities;35.15(10) the employment plan requires an educational program for a caregiver under age 35.1620, but the educational program is not available;35.17(11) activities identified in the employment plan are not available;35.18(12) the participant is willing to accept suitable employment, but suitable 35.19employment is not available; or35.20(13) the participant documents other verifiable impediments to compliance with the 35.21employment plan beyond the participant's control; or35.22(14) the documentation needed to determine if a participant is eligible for family 35.23stabilization services is not available, but there is information that the participant may 35.24qualify and the participant is cooperating with the county or employment service provider's 35.25efforts to obtain the documentation necessary to determine eligibility.35.26The job counselor shall work with the participant to reschedule mandatory meetings 35.27for individuals who fall under clauses (1), (3), (4), (5), (6), (7), and (8).35.28    Sec. 23. Minnesota Statutes 2008, section 256J.575, subdivision 3, is amended to read:35.29    Subd. 3. Eligibility. (a) The following MFIP or diversionary work program (DWP)35.30participants are eligible for the services under this section:35.31    (1) a participant who meets the requirements for or has been granted a hardship 35.32extension under section 
         256J.425, subdivision 2 or 3, except that it is not necessary for 35.33the participant to have reached or be approaching 60 months of eligibility for this section 35.34to apply;36.1    (2) a participant who is applying for Supplemental Security Income or Social 36.2Security disability insurance; and36.3    (3) a participant who is a noncitizen who has been in the United States for 12 or 36.4fewer months; and36.5(4) a participant who is age 60 or older.36.6    (b) Families must meet all other eligibility requirements for MFIP established in 36.7this chapter. Families are eligible for financial assistance to the same extent as if they 36.8were participating in MFIP.36.9    (c) A participant under paragraph (a), clause (3), must be provided with English as a 36.10second language opportunities and skills training for up to 12 months. After 12 months, 36.11the case manager and participant must determine whether the participant should continue 36.12with English as a second language classes or skills training, or both, and continue to 36.13receive family stabilization services.36.14(d) If a county agency or employment services provider has information that 36.15an MFIP participant may meet the eligibility criteria set forth in this subdivision, the 36.16county agency or employment services provider must assist the participant in obtaining 36.17the documentation necessary to determine eligibility. Until necessary documentation is 36.18obtained, the participant must be treated as an eligible participant under subdivisions 5 to 7.36.19EFFECTIVE DATE.This section is effective July 1, 2009, except the amendment 36.20to paragraph (a) striking "or diversionary work program (DWP)" is effective March 1, 36.212010.36.22    Sec. 24. Minnesota Statutes 2008, section 256J.575, subdivision 4, is amended to read:36.23    Subd. 4. Universal participation. All caregivers must participate in family 36.24stabilization services as defined in subdivision 2, except for caregivers exempt under 36.25section 256J.561, subdivision 3.36.26EFFECTIVE DATE.This section is effective March 1, 2010.36.27    Sec. 25. Minnesota Statutes 2008, section 256J.575, subdivision 6, is amended to read:36.28    Subd. 6. Cooperation with services requirements. (a) To be eligible, A participant 36.29who is eligible for family stabilization services under this section shall comply with 36.30paragraphs (b) to (d).36.31    (b) Participants shall engage in family stabilization plan services for the appropriate 36.32number of hours per week that the activities are scheduled and available, unless good 36.33cause exists for not doing so, as defined in section 
         256J.57, subdivision 1. The appropriate 36.34number of hours must be based on the participant's plan.37.1    (c) The case manager shall review the participant's progress toward the goals in the 37.2family stabilization plan every six months to determine whether conditions have changed, 37.3including whether revisions to the plan are needed.37.4    (d) A participant's requirement to comply with any or all family stabilization plan 37.5requirements under this subdivision is excused when the case management services, 37.6training and educational services, or family support services identified in the participant's 37.7family stabilization plan are unavailable for reasons beyond the control of the participant, 37.8including when money appropriated is not sufficient to provide the services.37.9    Sec. 26. Minnesota Statutes 2008, section 256J.575, subdivision 7, is amended to read:37.10    Subd. 7. Sanctions. (a) The county agency or employment services provider must 37.11follow the requirements of this subdivision at the time the county agency or employment 37.12services provider has information that an MFIP recipient may meet the eligibility criteria 37.13in subdivision 3. 37.14(b) The financial assistance grant of a participating family is reduced according to 37.15section 
         256J.46, if a participating adult fails without good cause to comply or continue 37.16to comply with the family stabilization plan requirements in this subdivision, unless 37.17compliance has been excused under subdivision 6, paragraph (d).37.18    (b) (c) Given the purpose of the family stabilization services  in this section and the 37.19nature of the underlying family circumstances that act as barriers to both employment and 37.20full compliance with program requirements, there must be a review by the county agency 37.21prior to imposing a sanction to determine whether the plan was appropriated to the needs 37.22of the participant and family, and. There must be a current assessment by a behavioral 37.23health or medical professional confirming that the participant in all ways had the ability to 37.24comply with the plan, as confirmed by a behavioral health or medical professional.37.25    (c) (d) Prior to the imposition of a sanction, the county agency or employment 37.26services provider shall review the participant's case to determine if the family stabilization 37.27plan is still appropriate and meet with the participant face-to-face. The participant may 37.28bring an advocate The county agency or employment services provider must inform the 37.29participant of the right to bring an advocate to the face-to-face meeting. 37.30    During the face-to-face meeting, the county agency shall:37.31    (1) determine whether the continued noncompliance can be explained and mitigated 37.32by providing a needed family stabilization service, as defined in subdivision 2, paragraph 37.33(d);37.34    (2) determine whether the participant qualifies for a good cause exception under 37.35section 
         256J.57, or if the sanction is for noncooperation with child support requirements, 38.1determine if the participant qualifies for a good cause exemption under section 
         256.741, 38.2subdivision 10;38.3    (3) determine whether activities in the family stabilization plan are appropriate 38.4based on the family's circumstances;38.5    (4) explain the consequences of continuing noncompliance;38.6    (5) identify other resources that may be available to the participant to meet the 38.7needs of the family; and38.8    (6) inform the participant of the right to appeal under section 
         256J.40.38.9    If the lack of an identified activity or service can explain the noncompliance, the 38.10county shall work with the participant to provide the identified activity.38.11    (d) If the participant fails to come to the face-to-face meeting, the case manager or a 38.12designee shall attempt at least one home visit. If a face-to-face meeting is not conducted, 38.13the county agency shall send the participant a written notice that includes the information 38.14under paragraph (c).38.15    (e) After the requirements of paragraphs (c) and (d) are met and prior to imposition 38.16of a sanction, the county agency shall provide a notice of intent to sanction under section 38.17256J.57, subdivision 2
         , and, when applicable, a notice of adverse action under section 38.18256J.31
         .38.19    (f) Section 
         256J.57 applies to this section except to the extent that it is modified 38.20by this subdivision.38.21    Sec. 27. Minnesota Statutes 2008, section 256J.621, is amended to read:38.22256J.621 WORK PARTICIPATION CASH BENEFITS.38.23    (a) Effective October 1, 2009, upon exiting the diversionary work program (DWP) 38.24or upon terminating the Minnesota family investment program with earnings, a participant 38.25who is employed may be eligible for work participation cash benefits of $75 $50 per 38.26month to assist in meeting the family's basic needs as the participant continues to move 38.27toward self-sufficiency.38.28    (b) To be eligible for work participation cash benefits, the participant shall not 38.29receive MFIP or diversionary work program assistance during the month and the 38.30participant or participants must meet the following work requirements:38.31    (1) if the participant is a single caregiver and has a child under six years of age, the 38.32participant must be employed at least 87 hours per month;38.33    (2) if the participant is a single caregiver and does not have a child under six years of 38.34age, the participant must be employed at least 130 hours per month; or39.1    (3) if the household is a two-parent family, at least one of the parents must be 39.2employed an average of at least 130 hours per month.39.3    Whenever a participant exits the diversionary work program or is terminated from 39.4MFIP and meets the other criteria in this section, work participation cash benefits are 39.5available for up to 24 consecutive months.39.6    (c) Expenditures on the program are maintenance of effort state funds under 39.7a separate state program for participants under paragraph (b), clauses (1) and (2). 39.8Expenditures for participants under paragraph (b), clause (3), are nonmaintenance of effort 39.9funds. Months in which a participant receives work participation cash benefits under this 39.10section do not count toward the participant's MFIP 60-month time limit.39.11    Sec. 28. Minnesota Statutes 2008, section 256J.626, subdivision 7, is amended to read:39.12    Subd. 7. Performance base funds. (a) For the purpose of this section, the following 39.13terms have the meanings given.39.14(1) "Caseload Reduction Credit" (CRC) means the measure of how much Minnesota 39.15TANF and separate state program caseload has fallen relative to federal fiscal year 2005 39.16based on caseload data from October 1 to September 30.39.17(2) "TANF participation rate target" means a 50 percent participation rate reduced by 39.18the CRC for the previous year.39.19(b) For calendar year 2009 2010 and yearly thereafter, each county and tribe will be 39.20allocated 95 percent of their initial calendar year allocation. Counties and tribes will be 39.21allocated additional funds based on performance as follows:39.22    (1) a county or tribe that achieves a 50 percent the TANF participation rate target39.23or a five percentage point improvement over the previous year's TANF participation rate 39.24under section 
         256J.751, subdivision 2, clause (7), as averaged across 12 consecutive 39.25months for the most recent year for which the measurements are available, will receive an 39.26additional allocation equal to 2.5 percent of its initial allocation; and39.27    (2) a county or tribe that performs within or above its range of expected performance 39.28on the annualized three-year self-support index under section 
         256J.751, subdivision 2, 39.29clause (6), will receive an additional allocation equal to 2.5 percent of its initial allocation; 39.30and39.31    (3) a county or tribe that does not achieve a 50 percent the TANF participation rate39.32target or a five percentage point improvement over the previous year's TANF participation 39.33rate under section 
         256J.751, subdivision 2, clause (7), as averaged across 12 consecutive 39.34months for the most recent year for which the measurements are available, will not 40.1receive an additional 2.5 percent of its initial allocation until after negotiating a multiyear 40.2improvement plan with the commissioner; or 40.3    (4) a county or tribe that does not perform within or above its range of expected 40.4performance on the annualized three-year self-support index under section 
         256J.751, 40.5subdivision 2
         , clause (6), will not receive an additional allocation equal to 2.5 percent 40.6of its initial allocation until after negotiating a multiyear improvement plan with the 40.7commissioner.40.8    (b) (c) For calendar year 2009 and yearly thereafter, performance-based funds for 40.9a federally approved tribal TANF program in which the state and tribe have in place 40.10a contract under section 
         256.01, addressing consolidated funding, will be allocated as 40.11follows:40.12    (1) a tribe that achieves the participation rate approved in its federal TANF plan 40.13using the average of 12 consecutive months for the most recent year for which the 40.14measurements are available, will receive an additional allocation equal to 2.5 percent of 40.15its initial allocation; and40.16    (2) a tribe that performs within or above its range of expected performance on the 40.17annualized three-year self-support index under section 
         256J.751, subdivision 2, clause (6), 40.18will receive an additional allocation equal to 2.5 percent of its initial allocation; or 40.19    (3) a tribe that does not achieve the participation rate approved in its federal TANF 40.20plan using the average of 12 consecutive months for the most recent year for which the 40.21measurements are available, will not receive an additional allocation equal to 2.5 percent 40.22of its initial allocation until after negotiating a multiyear improvement plan with the 40.23commissioner; or40.24    (4) a tribe that does not perform within or above its range of expected performance 40.25on the annualized three-year self-support index under section 
         256J.751, subdivision 40.262
         , clause (6), will not receive an additional allocation equal to 2.5 percent until after 40.27negotiating a multiyear improvement plan with the commissioner.40.28    (c) (d) Funds remaining unallocated after the performance-based allocations 40.29in paragraph (a) (b) are available to the commissioner for innovation projects under 40.30subdivision 5.40.31    (d) (1) If available funds are insufficient to meet county and tribal allocations under 40.32paragraph (a) (b), the commissioner may make available for allocation funds that are 40.33unobligated and available from the innovation projects through the end of the current 40.34biennium.40.35    (2) If after the application of clause (1) funds remain insufficient to meet county 40.36and tribal allocations under paragraph (a) (b), the commissioner must proportionally 41.1reduce the allocation of each county and tribe with respect to their maximum allocation 41.2available under paragraph (a) (b).41.3    Sec. 29. Minnesota Statutes 2008, section 256J.95, subdivision 3, is amended to read:41.4    Subd. 3. Eligibility for diversionary work program. (a) Except for the categories 41.5of family units listed below, all family units who apply for cash benefits and who 41.6meet MFIP eligibility as required in sections 
         256J.11 to 
         256J.15 are eligible and must 41.7participate in the diversionary work program. Family units that are not eligible for the 41.8diversionary work program include:41.9    (1) child only cases;41.10    (2) a single-parent family unit that includes a child under 12 weeks months of age. 41.11A parent is eligible for this exception once in a parent's lifetime and is not eligible if 41.12the parent has already used the previously allowed child under age one exemption from 41.13MFIP employment services;41.14    (3) a minor parent without a high school diploma or its equivalent;41.15    (4) an 18- or 19-year-old caregiver without a high school diploma or its equivalent 41.16who chooses to have an employment plan with an education option;41.17    (5) a caregiver age 60 or over;41.18    (6) family units with a caregiver who received DWP benefits in the 12 months prior 41.19to the month the family applied for DWP, except as provided in paragraph (c);41.20    (7) family units with a caregiver who received MFIP within the 12 months prior to 41.21the month the family unit applied for DWP;41.22    (8) a family unit with a caregiver who received 60 or more months of TANF 41.23assistance; 41.24    (9) a family unit with a caregiver who is disqualified from DWP or MFIP due to 41.25fraud; and41.26    (10) refugees and asylees as defined in Code of Federal Regulations, title 45, part 41.27400, subpart d, section 
         400.43, who arrived in the United States in the 12 months prior to 41.28the date of application for family cash assistance.41.29    (b) A two-parent family must participate in DWP unless both caregivers meet the 41.30criteria for an exception under paragraph (a), clauses (1) through (5), or the family unit 41.31includes a parent who meets the criteria in paragraph (a), clause (6), (7), (8), (9), or (10).41.32    (c) Once DWP eligibility is determined, the four months run consecutively. If a 41.33participant leaves the program for any reason and reapplies during the four-month period, 41.34the county must redetermine eligibility for DWP.41.35EFFECTIVE DATE.This section is effective March 1, 2010.42.1    Sec. 30. Minnesota Statutes 2008, section 256J.95, subdivision 11, is amended to read:42.2    Subd. 11. Universal participation required. (a) All DWP caregivers, except 42.3caregivers who meet the criteria in paragraph (d), are required to participate in DWP 42.4employment services. Except as specified in paragraphs (b) and (c), employment plans 42.5under DWP must, at a minimum, meet the requirements in section 
         256J.55, subdivision 1.42.6(b) A caregiver who is a member of a two-parent family that is required to participate 42.7in DWP who would otherwise be ineligible for DWP under subdivision 3 may be allowed 42.8to develop an employment plan under section 
         256J.521, subdivision 2, paragraph (c), that 42.9may contain alternate activities and reduced hours.42.10(c) A participant who is a victim of family violence shall be allowed to develop an 42.11employment plan under section 
         256J.521, subdivision 3. A claim of family violence must 42.12be documented by the applicant or participant by providing a sworn statement which is 42.13supported by collateral documentation in section 
         256J.545, paragraph (b).42.14(d) One parent in a two-parent family unit that has a natural born child under 12 42.15weeks months of age is not required to have an employment plan until the child reaches 12 42.16weeks months of age unless the family unit has already used the exclusion under section 42.17256J.561, subdivision 3
         , or the previously allowed child under age one exemption under 42.18section 
         256J.56, paragraph (a), clause (5).42.19(e) The provision in paragraph (d) ends the first full month after the child reaches 12 42.20weeks months of age. This provision is allowable only once in a caregiver's lifetime. In a 42.21two-parent household, only one parent shall be allowed to use this category.42.22(f) The participant and job counselor must meet within ten working days after the 42.23child reaches 12 weeks months of age to revise the participant's employment plan. The 42.24employment plan for a family unit that has a child under 12 weeks months of age that has 42.25already used the exclusion in section 
         256J.561 or the previously allowed child under 42.26age one exemption under section 
         256J.56, paragraph (a), clause (5), must be tailored to 42.27recognize the caregiving needs of the parent.42.28EFFECTIVE DATE.This section is effective March 1, 2010.42.29    Sec. 31. Minnesota Statutes 2008, section 256J.95, subdivision 12, is amended to read:42.30    Subd. 12. Conversion or referral to MFIP. (a) If at any time during the DWP 42.31application process or during the four-month DWP eligibility period, it is determined that 42.32a participant is unlikely to benefit from the diversionary work program, the county shall 42.33convert or refer the participant to MFIP as specified in paragraph (d). Participants who are 42.34determined to be unlikely to benefit from the diversionary work program must develop 42.35and sign an employment plan. Participants who meet any one of the criteria in paragraph 43.1(b) shall be considered to be unlikely to benefit from DWP, provided the necessary 43.2documentation is available to support the determination.43.3(b) A participant who: meets the eligibility requirements under section 256J.575, 43.4subdivision 3, must be considered to be unlikely to benefit from DWP, provided the 43.5necessary documentation is available to support the determination.43.6(1) has been determined by a qualified professional as being unable to obtain or retain 43.7employment due to an illness, injury, or incapacity that is expected to last at least 60 days;43.8(2) is required in the home as a caregiver because of the illness, injury, or incapacity, 43.9of a family member, or a relative in the household, or a foster child, and the illness, injury, 43.10or incapacity and the need for a person to provide assistance in the home has been certified 43.11by a qualified professional and is expected to continue more than 60 days;43.12(3) is determined by a qualified professional as being needed in the home to care for 43.13a child or adult meeting the special medical criteria in section 256J.561, subdivision 2, 43.14paragraph (d), clause (3); 43.15(4) is pregnant and is determined by a qualified professional as being unable to 43.16obtain or retain employment due to the pregnancy; or43.17(5) has applied for SSI or SSDI.43.18(c) In a two-parent family unit, both parents must be if one parent is determined 43.19to be unlikely to benefit from the diversionary work program before, the family unit 43.20can must be converted or referred to MFIP.43.21(d) A participant who is determined to be unlikely to benefit from the diversionary 43.22work program shall be converted to MFIP and, if the determination was made within 30 43.23days of the initial application for benefits, no additional application form is required. 43.24A participant who is determined to be unlikely to benefit from the diversionary work 43.25program shall be referred to MFIP and, if the determination is made more than 30 43.26days after the initial application, the participant must submit a program change request 43.27form. The county agency shall process the program change request form by the first of 43.28the following month to ensure that no gap in benefits is due to delayed action by the 43.29county agency. In processing the program change request form, the county must follow 43.30section 
         256J.32, subdivision 1, except that the county agency shall not require additional 43.31verification of the information in the case file from the DWP application unless the 43.32information in the case file is inaccurate, questionable, or no longer current. 43.33(e) The county shall not request a combined application form for a participant who 43.34has exhausted the four months of the diversionary work program, has continued need for 43.35cash and food assistance, and has completed, signed, and submitted a program change 43.36request form within 30 days of the fourth month of the diversionary work program. The 44.1county must process the program change request according to section 
         256J.32, subdivision 44.21
         , except that the county agency shall not require additional verification of information 44.3in the case file unless the information is inaccurate, questionable, or no longer current. 44.4When a participant does not request MFIP within 30 days of the diversionary work 44.5program benefits being exhausted, a new combined application form must be completed 44.6for any subsequent request for MFIP. 44.7EFFECTIVE DATE.This section is effective March 1, 2010.44.8    Sec. 32. Minnesota Statutes 2008, section 256J.95, subdivision 13, is amended to read:44.9    Subd. 13. Immediate referral to employment services. Within one working day of 44.10determination that the applicant is eligible for the diversionary work program, but before 44.11benefits are issued to or on behalf of the family unit, the county shall refer all caregivers to 44.12employment services. The referral to the DWP employment services must be in writing 44.13and must contain the following information:44.14(1) notification that, as part of the application process, applicants are required to 44.15develop an employment plan or the DWP application will be denied;44.16(2) the employment services provider name and phone number;44.17(3) the date, time, and location of the scheduled employment services interview;44.18(4) the immediate availability of supportive services, including, but not limited to, 44.19child care, transportation, and other work-related aid; and44.20(5) (4) the rights, responsibilities, and obligations of participants in the program, 44.21including, but not limited to, the grounds for good cause, the consequences of refusing or 44.22failing to participate fully with program requirements, and the appeal process.44.23    Sec. 33. Minnesota Statutes 2008, section 259.67, is amended by adding a subdivision 44.24to read:44.25    Subd. 3b.Extension; adoption finalized after age 16.A child who has attained the 44.26age of 16 prior to finalization of their adoption is eligible for extension of the adoption 44.27assistance agreement to the date the child attains age 21 if the child is:44.28    (1) completing a secondary education program or a program leading to an equivalent 44.29credential;44.30    (2) enrolled in an institution which provides postsecondary or vocational education;44.31    (3) participating in a program or activity designed to promote or remove barriers to 44.32employment;44.33    (4) employed for at least 80 hours per month; or45.1    (5) incapable of doing any of the activities described in clauses (1) to (4) due to a 45.2medical condition which incapability is supported by regularly updated information in 45.3the case plan of the child.45.4EFFECTIVE DATE.This section is effective October 1, 2010.45.5    Sec. 34. Minnesota Statutes 2008, section 270A.09, is amended by adding a 45.6subdivision to read:45.7    Subd. 1b.Department of Human Services claims.Notwithstanding subdivision 1, 45.8any debtor contesting a setoff claim by the Department of Human Services or a county 45.9agency whose claim relates to a debt resulting from receipt of public assistance, medical 45.10care, or the federal Food Stamp Act shall have a hearing conducted in the same manner as 45.11an appeal under sections 256.045 and 256.0451.45.12    Sec. 35. AMERICAN INDIAN CHILD WELFARE PROJECTS.45.13Notwithstanding Minnesota Statutes, section 16A.28, the commissioner of human 45.14services shall extend payment of state fiscal year 2009 funds in state fiscal year 2010 45.15to tribes participating in the American Indian child welfare projects under Minnesota 45.16Statutes, section 256.01, subdivision 14b. Future extensions of payment for a tribe 45.17participating in the Indian child welfare projects under Minnesota Statutes, section 256.01, 45.18subdivision 14b, must be granted according to the commissioner's authority under 45.19Minnesota Statutes, section 16A.28.45.20    Sec. 36.  REPEALER.45.21Minnesota Statutes 2008, section 256I.06, subdivision 9, is repealed.45.22ARTICLE 345.23STATE-OPERATED SERVICES/MINNESOTA SEX OFFENDER PROGRAM45.24    Section 1. Minnesota Statutes 2008, section 246.50, subdivision 5, is amended to read:45.25    Subd. 5. Cost of care. "Cost of care" means the commissioner's charge for services 45.26provided to any person admitted to a state facility.45.27For purposes of this subdivision, "charge for services" means the cost of services, 45.28treatment, maintenance, bonds issued for capital improvements, depreciation of buildings 45.29and equipment, and indirect costs related to the operation of state facilities. The 45.30commissioner may determine the charge for services on an anticipated average per diem 45.31basis as an all inclusive charge per facility, per disability group, or per treatment program. 45.32The commissioner may determine a charge per service, using a method that includes direct 46.1and indirect costs usual and customary fee charged for services provided to clients. The 46.2usual and customary fee shall be established in a manner required to appropriately bill 46.3services to all payers and shall include the costs related to the operations of any program 46.4offered by the state.46.5    Sec. 2. Minnesota Statutes 2008, section 246.50, is amended by adding a subdivision 46.6to read:46.7    Subd. 10.State-operated community-based program. "State-operated 46.8community-based program" means any program operated in the community including 46.9community behavioral health hospitals, crisis centers, residential facilities, outpatient 46.10services, and other community-based services developed and operated by the state and 46.11under the commissioner's control.46.12    Sec. 3. Minnesota Statutes 2008, section 246.50, is amended by adding a subdivision 46.13to read:46.14    Subd. 11.Health plan company."Health plan company" has the meaning given it 46.15in section 62Q.01, subdivision 4, and also includes a demonstration provider as defined in 46.16section 256B.69, subdivision 2, paragraph (b), a county or group of counties participating 46.17in county-based purchasing according to section 256B.692, and a children's mental health 46.18collaborative under contract to provide medical assistance for individuals enrolled in 46.19the prepaid medical assistance and MinnesotaCare programs under sections 245.493 to 46.20245.495.46.21    Sec. 4. Minnesota Statutes 2008, section 246.51, is amended by adding a subdivision 46.22to read:46.23    Subd. 1a.Clients in state-operated community-based programs; determination.46.24The commissioner shall determine available health plan coverage from a health plan 46.25company for services provided to clients admitted to a state-operated community-based 46.26program. If the health plan coverage requires a co-pay or deductible, or if there is no 46.27available health plan coverage, the commissioner shall determine or redetermine, what 46.28part of the noncovered cost of care, if any, the client is able to pay. If the client is unable to 46.29pay the uncovered cost of care, the commissioner shall determine the client's relatives' 46.30ability to pay. The client and relatives shall provide to the commissioner documents and 46.31proof necessary to determine the client and relatives' ability to pay. Failure to provide the 46.32commissioner with sufficient information to determine ability to pay may make the client 46.33or relatives liable for the full cost of care until the time when sufficient information is 47.1provided. If it is determined that the responsible party does not have the ability to pay, 47.2the commissioner shall waive payment of the portion that exceeds ability to pay under 47.3the determination.47.4    Sec. 5. Minnesota Statutes 2008, section 246.51, is amended by adding a subdivision 47.5to read:47.6    Subd. 1b.Clients served by regional treatment centers or nursing homes; 47.7determination.The commissioner shall determine or redetermine, if necessary, what part 47.8of the cost of care, if any, a client served in regional treatment centers or nursing homes 47.9operated by state-operated services, is able to pay. If the client is unable to pay the full cost 47.10of care, the commissioner shall determine if the client's relatives have the ability to pay. 47.11The client and relatives shall provide to the commissioner documents and proof necessary 47.12to determine the client and relatives' ability to pay. Failure to provide the commissioner 47.13with sufficient information to determine ability to pay may make the client or relatives 47.14liable for the full cost of care until the time when sufficient information is provided. No 47.15parent shall be liable for the cost of care given a client at a regional treatment center after 47.16the client has reached the age of 18 years.47.17    Sec. 6. Minnesota Statutes 2008, section 246.511, is amended to read:47.18246.511 RELATIVE RESPONSIBILITY.47.19Except for chemical dependency services paid for with funds provided under chapter 47.20254B, a client's relatives shall not, pursuant to the commissioner's authority under section 47.21246.51
         , be ordered to pay more than ten percent of the cost ofthe following: (1) for 47.22services provided in a community-based service, the noncovered cost of care as determined 47.23under the ability to pay determination; and (2) for services provided at a regional treatment 47.24center operated by state-operated services, 20 percent of the cost of care, unless they 47.25reside outside the state. Parents of children in state facilities shall have their responsibility 47.26to pay determined according to section 
         252.27, subdivision 2, or in rules adopted under 47.27chapter 254B if the cost of care is paid under chapter 254B. The commissioner may 47.28accept voluntary payments in excess of ten 20 percent. The commissioner may require 47.29full payment of the full per capita cost of care in state facilities for clients whose parent, 47.30parents, spouse, guardian, or conservator do not reside in Minnesota.  47.31    Sec. 7. Minnesota Statutes 2008, section 246.52, is amended to read:47.32246.52 PAYMENT FOR CARE; ORDER; ACTION.48.1The commissioner shall issue an order to the client or the guardian of the estate, if 48.2there be one, and relatives determined able to pay requiring them to pay monthly to the 48.3state of Minnesota the amounts so determined the total of which shall not exceed the full 48.4cost of care. Such order shall specifically state the commissioner's determination and shall 48.5be conclusive unless appealed from as herein provided. When a client or relative fails to 48.6pay the amount due hereunder the attorney general, upon request of the commissioner, 48.7may institute, or direct the appropriate county attorney to institute, civil action to recover 48.8such amount.48.9    Sec. 8. Minnesota Statutes 2008, section 246.54, subdivision 2, is amended to read:48.10    Subd. 2. Exceptions. (a) Subdivision 1 does not apply to services provided at the 48.11Minnesota Security Hospital, the Minnesota sex offender program, or the Minnesota 48.12extended treatment options program. For services at these facilities, a county's payment 48.13shall be made from the county's own sources of revenue and payments shall be paid as 48.14follows: payments to the state from the county shall equal ten percent of the cost of care, 48.15as determined by the commissioner, for each day, or the portion thereof, that the client 48.16spends at the facility. If payments received by the state under sections 
         246.50 to 
         246.5348.17exceed 90 percent of the cost of care, the county shall be responsible for paying the state 48.18only the remaining amount. The county shall not be entitled to reimbursement from the 48.19client, the client's estate, or from the client's relatives, except as provided in section 
         246.53. 48.20    (b) Regardless of the facility to which the client is committed, subdivision 1 does 48.21not apply to the following individuals:48.22    (1) clients who are committed as mentally ill and dangerous under section 
         253B.02, 48.23subdivision 17;48.24    (2) clients who are committed as sexual psychopathic personalities under section 48.25253B.02, subdivision 18b
         ; and48.26    (3) clients who are committed as sexually dangerous persons under section 
         253B.02, 48.27subdivision 18c.48.28    For each of the individuals in clauses (1) to (3), the payment by the county to the state 48.29shall equal ten percent of the cost of care for each day as determined by the commissioner.48.30    Sec. 9. Minnesota Statutes 2008, section 246B.01, is amended by adding a subdivision 48.31to read:48.32    Subd. 1a.Client."Client" means a person who is admitted to the Minnesota sex 48.33offender program or subject to a court hold order under section 253B.185 for the purpose 49.1of assessment, diagnosis, care, treatment, supervision, or other services provided by the 49.2Minnesota sex offender program.49.3    Sec. 10. Minnesota Statutes 2008, section 246B.01, is amended by adding a 49.4subdivision to read:49.5    Subd. 1b.Client's county."Client's county" means the county of the client's 49.6legal settlement for poor relief purposes at the time of commitment. If the client has no 49.7legal settlement for poor relief in this state, it means the county of commitment, except 49.8that when a client with no legal settlement for poor relief is committed while serving a 49.9sentence at a penal institution, it means the county from which the client was sentenced.49.10    Sec. 11. Minnesota Statutes 2008, section 246B.01, is amended by adding a subdivision 49.11to read:49.12    Subd. 2a.Cost of care."Cost of care" means the commissioner's charge for housing 49.13and treatment services provided to any person admitted to the Minnesota sex offender 49.14program.49.15For purposes of this subdivision, "charge for housing and treatment services" means 49.16the cost of services, treatment, maintenance, bonds issued for capital improvements, 49.17depreciation of buildings and equipment, and indirect costs related to the operation of 49.18state facilities. The commissioner may determine the charge for services on an anticipated 49.19average per diem basis as an all-inclusive charge per facility.49.20    Sec. 12. Minnesota Statutes 2008, section 246B.01, is amended by adding a 49.21subdivision to read:49.22    Subd. 2b.Local social services agency."Local social services agency" means the 49.23local social services agency of the client's county as defined in subdivision 1b and of the 49.24county of commitment, and any other local social services agency possessing information 49.25regarding, or requested by the commissioner to investigate, the financial circumstances 49.26of a client.49.27    Sec. 13. [246B.07] PAYMENT FOR CARE AND TREATMENT: 49.28DETERMINATION.49.29    Subdivision 1.Procedures.The commissioner shall determine or redetermine, if 49.30necessary, what amount of the cost of care, if any, the client is able to pay. The client shall 49.31provide to the commissioner documents and proof necessary to determine the ability to 49.32pay. Failure to provide the commissioner with sufficient information to determine ability 50.1to pay may make the client liable for the full cost of care until the time when sufficient 50.2information is provided.50.3    Subd. 2.Rules.The commissioner shall use the standards in section 246.51, 50.4subdivision 2, to determine the client's liability for the care provided by the Minnesota sex 50.5offender program.50.6    Subd. 3.Applicability.The commissioner may recover, under sections 246B.07 to 50.7246B.10, the cost of any care provided by the Minnesota sex offender program.50.8    Sec. 14. [246B.08] PAYMENT FOR CARE; ORDER; ACTION.50.9The commissioner shall issue an order to the client or the guardian of the estate, if 50.10there is one, requiring the client or guardian to pay to the state the amounts determined, the 50.11total of which must not exceed the full cost of care. The order must specifically state the 50.12commissioner's determination and must be conclusive, unless appealed. If a client fails to 50.13pay the amount due, the attorney general, upon request of the commissioner, may institute, 50.14or direct the appropriate county attorney to institute a civil action to recover the amount.50.15    Sec. 15. [246B.09] CLAIM AGAINST ESTATE OF DECEASED CLIENT.50.16    Subdivision 1.Client's estate.Upon the death of a client, or a former client, the 50.17total cost of care provided to the client, less the amount actually paid toward the cost of 50.18care by the client, must be filed by the commissioner as a claim against the estate of the 50.19client with the court having jurisdiction to probate the estate, and all proceeds collected 50.20by the state in the case must be divided between the state and county in proportion to 50.21the cost of care each has borne.50.22    Subd. 2.Preferred status.An estate claim in subdivision 1 must be considered an 50.23expense of the last illness for purposes of section 524.3-805.50.24If the commissioner determines that the property or estate of a client is not more 50.25than needed to care for and maintain the spouse and minor or dependent children of a 50.26deceased client, the commissioner has the power to compromise the claim of the state in a 50.27manner deemed just and proper.50.28    Subd. 3.Exception from statute of limitations.Any statute of limitations that 50.29limits the commissioner in recovering the cost of care obligation incurred by a client or 50.30former client must not apply to any claim against an estate made under this section to 50.31recover cost of care.50.32    Sec. 16. [246B.10] LIABILITY OF COUNTY; REIMBURSEMENT.51.1The client's county shall pay to the state a portion of the cost of care provided in 51.2the Minnesota sex offender program to a client who has legally settled in that county. A 51.3county's payment must be made from the county's own sources of revenue and payments 51.4must equal ten percent of the cost of care, as determined by the commissioner, for each 51.5day or portion of a day, that the client spends at the facility. If payments received by the 51.6state under this chapter exceed 90 percent of the cost of care, the county is responsible 51.7for paying the state the remaining amount. The county is not entitled to reimbursement 51.8from the client, the client's estate, or from the client's relatives, except as provided in 51.9section 246B.07.51.10    Sec. 17. Minnesota Statutes 2008, section 252.025, subdivision 7, is amended to read:51.11    Subd. 7. Minnesota extended treatment options. The commissioner shall develop 51.12by July 1, 1997, the Minnesota extended treatment options to serve Minnesotans who have 51.13developmental disabilities and exhibit severe behaviors which present a risk to public 51.14safety. This program is statewide and must provide specialized residential services in 51.15Cambridge and an array of community support community-based services statewide with 51.16sufficient levels of care and a sufficient number of specialists to ensure that individuals 51.17referred to the program receive the appropriate care. The individuals working in the 51.18community-based services under this section are state employees supervised by the 51.19commissioner of human services. No layoffs shall occur as a result of restructuring 51.20under this section.51.21    Sec. 18. REQUIRING THE DEVELOPMENT OF COMMUNITY-BASED 51.22MENTAL HEALTH SERVICES FOR PATIENTS COMMITTED TO THE 51.23ANOKA-METRO REGIONAL TREATMENT CENTER.51.24In consultation with community partners, the commissioner of human services 51.25shall develop an array of community-based services to transform the current services 51.26now provided to patients at the Anoka-Metro Regional Treatment Center. The 51.27community-based services may be provided in facilities with 16 or fewer beds, and must 51.28provide the appropriate level of care for the patients being admitted to the facilities. The 51.29planning for this transition must be completed by October 1, 2009, with an initial report 51.30to the committee chairs of health and human services by November 30, 2009, and a 51.31semiannual report on progress until the transition is completed. The commissioner of 51.32human services shall solicit interest from stakeholders and potential community partners. 51.33The individuals working in the community-based services facilities under this section are 52.1state employees supervised by the commissioner of human services. No layoffs shall 52.2occur as a result of restructuring under this section.52.3    Sec. 19.  REPEALER.52.4Minnesota Statutes 2008, sections 246.51, subdivision 1; and 246.53, subdivision 52.53, are repealed.52.6ARTICLE 452.7DEPARTMENT OF HEALTH52.8    Section 1. Minnesota Statutes 2008, section 62J.495, is amended to read:52.962J.495 HEALTH INFORMATION TECHNOLOGY AND 52.10INFRASTRUCTURE.52.11    Subdivision 1. Implementation. By January 1, 2015, all hospitals and health care 52.12providers must have in place an interoperable electronic health records system within their 52.13hospital system or clinical practice setting. The commissioner of health, in consultation 52.14with the e-Health Information Technology and Infrastructure Advisory Committee, 52.15shall develop a statewide plan to meet this goal, including uniform standards to be used 52.16for the interoperable system for sharing and synchronizing patient data across systems. 52.17The standards must be compatible with federal efforts. The uniform standards must be 52.18developed by January 1, 2009, with a status report on the development of these standards 52.19submitted to the legislature by January 15, 2008 and updated on an ongoing basis. The 52.20commissioner shall include an update on standards development as part of an annual 52.21report to the legislature.52.22    Subd. 1a.Definitions.(a) "Certified electronic health record technology" means an 52.23electronic health record that is certified pursuant to section 3001(c)(5) of the HITECH 52.24Act to meet the standards and implementation specifications adopted under section 3004 52.25as applicable.52.26(b) "Commissioner" means the commissioner of health.52.27(c) "Pharmaceutical electronic data intermediary" means any entity that provides 52.28the infrastructure to connect computer systems or other electronic devices utilized 52.29by prescribing practitioners with those used by pharmacies, health plans, third party 52.30administrators, and pharmacy benefit manager in order to facilitate the secure transmission 52.31of electronic prescriptions, refill authorization requests, communications, and other 52.32prescription-related information between such entities.52.33(d) "HITECH Act" means the Health Information Technology for Economic and 52.34Clinical Health Act in division A, title XIII and division B, title IV of the American 53.1Recovery and Reinvestment Act of 2009, including federal regulations adopted under 53.2that act.53.3(e) "Interoperable electronic health record" means an electronic health record that 53.4securely exchanges health information with another electronic health record system that 53.5meets national requirements for certification under the HITECH Act.53.6(f) "Qualified electronic health record" means an electronic record of health-related 53.7information on an individual that includes patient demographic and clinical health 53.8information and has the capacity to:53.9(1) provide clinical decision support;53.10(2) support physician order entry;53.11(3) capture and query information relevant to health care quality; and53.12(4) exchange electronic health information with, and integrate such information 53.13from, other sources.53.14    Subd. 2. E-Health Information Technology and Infrastructure Advisory 53.15Committee. (a) The commissioner shall establish aan e-Health Information Technology 53.16and Infrastructure Advisory Committee governed by section 
         15.059 to advise the 53.17commissioner on the following matters:53.18    (1) assessment of the adoption and effective use of health information technology by 53.19the state, licensed health care providers and facilities, and local public health agencies;53.20    (2) recommendations for implementing a statewide interoperable health information 53.21infrastructure, to include estimates of necessary resources, and for determining standards 53.22for administrative clinical data exchange, clinical support programs, patient privacy 53.23requirements, and maintenance of the security and confidentiality of individual patient 53.24data; 53.25    (3) recommendations for encouraging use of innovative health care applications 53.26using information technology and systems to improve patient care and reduce the cost 53.27of care, including applications relating to disease management and personal health 53.28management that enable remote monitoring of patients' conditions, especially those with 53.29chronic conditions; and 53.30    (4) other related issues as requested by the commissioner.53.31    (b) The members of the e-Health Information Technology and Infrastructure53.32Advisory Committee shall include the commissioners, or commissioners' designees, of 53.33health, human services, administration, and commerce and additional members to be 53.34appointed by the commissioner to include persons representing Minnesota's local public 53.35health agencies, licensed hospitals and other licensed facilities and providers, private 53.36purchasers, the medical and nursing professions, health insurers and health plans, the 54.1state quality improvement organization, academic and research institutions, consumer 54.2advisory organizations with an interest and expertise in health information technology, and 54.3other stakeholders as identified by the Health Information Technology and Infrastructure 54.4Advisory Committee commissioner to fulfill the requirements of section 3013, paragraph 54.5(g) of the HITECH Act.54.6    (c) The commissioner shall prepare and issue an annual report not later than January 54.730 of each year outlining progress to date in implementing a statewide health information 54.8infrastructure and recommending future projects action on policy and necessary resources 54.9to continue the promotion of adoption and effective use of health information technology.54.10(d) Notwithstanding section 
         15.059, this subdivision expires June 30, 2015.54.11    Subd. 3. Interoperable electronic health record requirements.(a) To meet the 54.12requirements of subdivision 1, hospitals and health care providers must meet the following 54.13criteria when implementing an interoperable electronic health records system within their 54.14hospital system or clinical practice setting.54.15(a) The electronic health record must be a qualified electronic health record.54.16    (b) The electronic health record must be certified by the Certification Commission 54.17for Healthcare Information Technology, or its successor Office of the National Coordinator 54.18pursuant to the HITECH Act. This criterion only applies to hospitals and health care 54.19providers whose practice setting is a practice setting covered by the Certification 54.20Commission for Healthcare Information Technology certifications only if a certified 54.21electronic health record product for the provider's particular practice setting is available. 54.22This criterion shall be considered met if a hospital or health care provider is using an 54.23electronic health records system that has been certified within the last three years, even if a 54.24more current version of the system has been certified within the three-year period.54.25(c) The electronic health record must meet the standards established according to 54.26section 3004 of the HITECH Act as applicable.54.27(d) The electronic health record must have the ability to generate information on 54.28clinical quality measures and other measures reported under sections 4101, 4102, and 54.294201 of the HITECH Act.54.30    (c) (e) A health care provider who is a prescriber or dispenser of controlled 54.31substances legend drugs must have an electronic health record system that meets the 54.32requirements of section 
         62J.497.54.33    Subd. 4.Coordination with national HIT activities.(a) The commissioner, 54.34in consultation with the e-Health Advisory Committee, shall update the statewide 54.35implementation plan required under subdivision 2 and released June 2008, to be consistent 54.36with the updated Federal HIT Strategic Plan released by the Office of the National 55.1Coordinator in accordance with section 3001 of the HITECH Act.  The statewide plan 55.2shall meet the requirements for a plan required under section 3013 of the HITECH Act.55.3(b) The commissioner, in consultation with the e-Health Advisory Committee, shall 55.4work to ensure coordination between state, regional, and national efforts to support and 55.5accelerate efforts to effectively use health information technology to improve the quality 55.6and coordination of health care and continuity of patient care among health care providers, 55.7to reduce medical errors, to improve population health, to reduce health disparities, and 55.8to reduce chronic disease.  The commissioner's coordination efforts shall include but not 55.9be limited to:55.10(1) assisting in the development and support of health information technology 55.11regional extension centers established under section 3012(c) of the HITECH Act to 55.12provide technical assistance and disseminate best practices; and55.13(2) providing supplemental information to the best practices gathered by regional 55.14centers to ensure that the information is relayed in a meaningful way to the Minnesota 55.15health care community.55.16(c) The commissioner, in consultation with the e-Health Advisory Committee, shall 55.17monitor national activity related to health information technology and shall coordinate 55.18statewide input on policy development.  The commissioner shall coordinate statewide 55.19responses to proposed federal health information technology regulations in order to ensure 55.20that the needs of the Minnesota health care community are adequately and efficiently 55.21addressed in the proposed regulations. The commissioner's responses may include, but 55.22are not limited to:55.23(1) reviewing and evaluating any standard, implementation specification, or 55.24certification criteria proposed by the national HIT standards committee;55.25(2) reviewing and evaluating policy proposed by the national HIT policy 55.26committee relating to the implementation of a nationwide health information technology 55.27infrastructure;55.28(3) monitoring and responding to activity related to the development of quality 55.29measures and other measures as required by section 4101 of the HITECH Act. Any 55.30response related to quality measures shall consider and address the quality efforts required 55.31under chapter 62U; and55.32(4) monitoring and responding to national activity related to privacy, security, and 55.33data stewardship of electronic health information and individually identifiable health 55.34information.55.35(d) To the extent that the state is either required or allowed to apply, or designate an 55.36entity to apply for or carry out activities and programs under section 3013 of the HITECH 56.1Act, the commissioner of health, in consultation with the e-Health Advisory Committee 56.2and the commissioner of human services, shall be the lead applicant or sole designating 56.3authority. The commissioner shall make such designations consistent with the goals and 56.4objectives of sections 62J.495 to 62J.497, and sections 62J.50 to 62J.61.56.5(e) The commissioner of human services shall apply for funding necessary to 56.6administer the incentive payments to providers authorized under title IV of the American 56.7Recovery and Reinvestment Act.56.8(f) The commissioner shall include in the report to the legislature information on the 56.9activities of this subdivision and provide recommendations on any relevant policy changes 56.10that should be considered in Minnesota.56.11    Subd. 5.Collection of data for assessment and eligibility determination.(a) 56.12The commissioner of health, in consultation with the commissioner of human services, 56.13may require providers, dispensers, group purchasers, and pharmaceutical electronic data 56.14intermediaries to submit data in a form and manner specified by the commissioner to 56.15assess the status of adoption, effective use, and interoperability of electronic health 56.16records for the purpose of:56.17(1) demonstrating Minnesota's progress on goals established by the Office of the 56.18National Coordinator to accelerate the adoption and effective use of health information 56.19technology established under the HITECH Act;56.20(2) assisting the Center for Medicare and Medicaid Services and Department of 56.21Human Services in determining eligibility of health care professionals and hospitals 56.22to receive federal incentives for the adoption and effective use of health information 56.23technology under the HITECH Act or other federal incentive programs;56.24(3) assisting the Office of the National Coordinator in completing required 56.25assessments of the impact of the implementation and effective use of health information 56.26technology in achieving goals identified in the national strategic plan, and completing 56.27studies required by the HITECH Act;56.28(4) providing the data necessary to assist the Office of the National Coordinator in 56.29conducting evaluations of regional extension centers as required by the HITECH Act; and56.30(5) other purposes as necessary to support the implementation of the HITECH Act.56.31(b) The commissioner shall coordinate with the commissioner of human services 56.32and other state agencies in the collection of data required under this section to:56.33(1) avoid duplicative reporting requirements;56.34(2) maximize efficiencies in the development of reports on state activities as 56.35required by HITECH; and57.1(3) determine health professional and hospital eligibility for incentives available 57.2under the HITECH Act.57.3(c) The commissioner must not collect data or publish analyses that identify, or could 57.4potentially identify, individual patients. The commissioner must not collect individual 57.5data in identified or de-identified form.57.6    Sec. 2. Minnesota Statutes 2008, section 62J.496, is amended to read:57.762J.496 ELECTRONIC HEALTH RECORD SYSTEM REVOLVING 57.8ACCOUNT AND LOAN PROGRAM.57.9    Subdivision 1. Account establishment.(a) An account is established to:provide 57.10loans to eligible borrowers to assist in financing the installation or support of an 57.11interoperable health record system. The system must provide for the interoperable 57.12exchange of health care information between the applicant and, at a minimum, a hospital 57.13system, pharmacy, and a health care clinic or other physician group.57.14(1) finance the purchase of certified electronic health records or qualified electronic 57.15health records as defined in section 62J.495, subdivision 1a;57.16(2) enhance the utilization of electronic health record technology, which may include 57.17costs associated with upgrading the technology to meet the criteria necessary to be a 57.18certified electronic health record or a qualified electronic health record;57.19(3) train personnel in the use of electronic health record technology; and57.20(4) improve the secure electronic exchange of health information.57.21(b) Amounts deposited in the account, including any grant funds obtained through 57.22federal or other sources, loan repayments, and interest earned on the amounts shall be 57.23used only for awarding loans or loan guarantees, as a source of reserve and security for 57.24leveraged loans, or for the administration of the account.57.25(c) The commissioner may accept contributions to the account from private sector 57.26entities subject to the following provisions:57.27(1) the contributing entity may not specify the recipient or recipients of any loan 57.28issued under this subdivision;57.29(2) the commissioner shall make public the identity of any private contributor to the 57.30loan fund, as well as the amount of the contribution provided; and57.31(3) the commissioner may issue letters of commendation or make other awards that 57.32have no financial value to any such entity.57.33A contributing entity may not specify that the recipient or recipients of any loan use 57.34specific products or services, nor may the contributing entity imply that a contribution is 57.35an endorsement of any specific product or service.58.1(d) The commissioner may use the loan funds to reimburse private sector entities 58.2for any contribution made to the loan fund. Reimbursement to private entities may not 58.3exceed the principle amount contributed to the loan fund.58.4(e) The commissioner may use funds deposited in the account to guarantee, or 58.5purchase insurance for, a local obligation if the guarantee or purchase would improve 58.6credit market access or reduce the interest rate applicable to the obligation involved.58.7(f) The commissioner may use funds deposited in the account as a source of revenue 58.8or security for the payment of principal and interest on revenue or bonds issued by the 58.9state if the proceeds of the sale of the bonds will be deposited into the loan fund.58.10    Subd. 2. Eligibility. (a) "Eligible borrower" means one of the following:58.11(1) federally qualified health centers;58.12    (1) (2) community clinics, as defined under section 
         145.9268;58.13    (2) (3) nonprofit or local unit of government hospitals eligible for rural hospital 58.14capital improvement grants, as defined  in section 144.148 licensed under sections 144.50 58.15to 144.56;58.16    (3) physician clinics located in a community with a population of less than 50,000 58.17according to United States Census Bureau statistics and outside the seven-county 58.18metropolitan area;58.19(4) individual or small group physician practices that are focused primarily on 58.20primary care;58.21    (4) (5) nursing facilities licensed under sections 
         144A.01 to 
         144A.27; and58.22(6) local public health departments as defined in chapter 145A; and58.23    (5) (7) other providers of health or health care services approved by the 58.24commissioner for which interoperable electronic health record capability would improve 58.25quality of care, patient safety, or community health.58.26 (b) The commissioner shall administer the loan fund to prioritize support and 58.27assistance to:58.28(1) critical access hospitals;58.29(2) federally qualified health centers;58.30(3) entities that serve uninsured, underinsured, and medically underserved 58.31individuals, regardless of whether such area is urban or rural; and58.32(4) individual or small group practices that are primarily focused on primary care.58.33    (b) To be eligible for a loan under this section, the (c) An eligible applicant must 58.34submit a loan application to the commissioner of health on forms prescribed by the 58.35commissioner. The application must include, at a minimum:59.1    (1) the amount of the loan requested and a description of the purpose or project 59.2for which the loan proceeds will be used;59.3    (2) a quote from a vendor;59.4    (3) a description of the health care entities and other groups participating in the 59.5project;59.6    (4) evidence of financial stability and a demonstrated ability to repay the loan; and59.7    (5) a description of how the system to be financed interconnects interoperates or 59.8plans in the future to interconnect interoperate with other health care entities and provider 59.9groups located in the same geographical area;59.10(6) a plan on how the certified electronic health record technology will be maintained 59.11and supported over time; and59.12(7) any other requirements for applications included or developed pursuant to 59.13section 3014 of the HITECH Act.59.14    Subd. 3. Loans. (a) The commissioner of health may make a no interest loan or 59.15low interest loan to a provider or provider group who is eligible under subdivision 2 59.16on a first-come, first-served basis provided that the applicant is able to comply with this 59.17section consistent with the priorities established in subdivision 2. The total accumulative 59.18loan principal must not exceed $1,500,000 $3,000,000 per loan. The interest rate for each 59.19loan, if imposed, shall not exceed the current market interest rate. The commissioner of 59.20health has discretion over the size, interest rate, and number of loans made. Nothing in 59.21this section shall require the commissioner to make a loan to an eligible borrower under 59.22subdivision 2.59.23    (b) The commissioner of health may prescribe forms and establish an application 59.24process and, notwithstanding section 
         16A.1283, may impose a reasonable nonrefundable 59.25application fee to cover the cost of administering the loan program. Any application 59.26fees imposed and collected under the electronic health records system revolving account 59.27and loan program in this section are appropriated to the commissioner of health for the 59.28duration of the loan program. The commissioner may apply for and use all federal funds 59.29available through the HITECH Act to administer the loan program.59.30    (c) For loans approved prior to July 1, 2009, the borrower must begin repaying the 59.31principal no later than two years from the date of the loan. Loans must be amortized no 59.32later than six years from the date of the loan.59.33(d) For loans granted on January 1, 2010, or thereafter, the borrower must begin 59.34repaying the principle no later than one year from the date of the loan.  Loans must be 59.35amortized no later than six years after the date of the loan.60.1    (d) Repayments (e) All repayments and interest paid on each loan must be credited 60.2to the account.60.3(f) The loan agreement shall include the assurances that borrower meets requirements 60.4included or developed pursuant to section 3014 of the HITECH Act. The requirements 60.5shall include, but are not limited to:60.6(1) submitting reports on quality measures in compliance with regulations adopted 60.7by the federal government;60.8(2) demonstrating that any certified electronic health record technology purchased, 60.9improved, or otherwise financially supported by this loan program is used to exchange 60.10health information in a manner that, in accordance with law and standards applicable to 60.11the exchange of information, improves the quality of health care;60.12(3) including a plan on how the borrower intends to maintain and support the 60.13certified electronic health record technology over time and the resources expected to be 60.14used to maintain and support the technology purchased with the loan; and60.15(4) complying with other requirements the secretary may require to use loans funds 60.16under the HITECH Act.60.17    Subd. 4. Data classification. Data collected by the commissioner of health on the 60.18application to determine eligibility under subdivision 2 and to monitor borrowers' default 60.19risk or collect payments owed under subdivision 3 are (1) private data on individuals as 60.20defined in section 
         13.02, subdivision 12; and (2) nonpublic data as defined in section 60.2113.02, subdivision 9
         . The names of borrowers and the amounts of the loans granted 60.22are public data.60.23    Sec. 3. Minnesota Statutes 2008, section 62J.497, subdivision 1, is amended to read:60.24    Subdivision 1. Definitions. For the purposes of this section, the following terms 60.25have the meanings given.60.26(a) "Backward compatible" means that the newer version of a data transmission 60.27standard would retain, at a minimum, the full functionality of the versions previously 60.28adopted, and would permit the successful completion of the applicable transactions with 60.29entities that continue to use the older versions.60.30    (a) (b) "Dispense" or "dispensing" has the meaning given in section 
         151.01, 60.31subdivision 
         30. Dispensing does not include the direct administering of a controlled 60.32substance to a patient by a licensed health care professional.60.33    (b) (c) "Dispenser" means a person authorized by law to dispense a controlled 60.34substance, pursuant to a valid prescription.61.1    (c) (d) "Electronic media" has the meaning given under Code of Federal Regulations, 61.2title 45, part 
         160.103.61.3    (d) (e) "E-prescribing" means the transmission using electronic media of prescription 61.4or prescription-related information between a prescriber, dispenser, pharmacy benefit 61.5manager, or group purchaser, either directly or through an intermediary, including 61.6an e-prescribing network. E-prescribing includes, but is not limited to, two-way 61.7transmissions between the point of care and the dispenser and two-way transmissions 61.8related to eligibility, formulary, and medication history information.61.9    (e) (f) "Electronic prescription drug program" means a program that provides for 61.10e-prescribing.61.11    (f) (g) "Group purchaser" has the meaning given in section 
         62J.03, subdivision 6.61.12    (g) (h) "HL7 messages" means a standard approved by the standards development 61.13organization known as Health Level Seven.61.14    (h) (i) "National Provider Identifier" or "NPI" means the identifier described under 61.15Code of Federal Regulations, title 45, part 
         162.406.61.16    (i) (j) "NCPDP" means the National Council for Prescription Drug Programs, Inc.61.17    (j) (k) "NCPDP Formulary and Benefits Standard" means the National Council for 61.18Prescription Drug Programs Formulary and Benefits Standard, Implementation Guide, 61.19Version 1, Release 0, October 2005.61.20    (k) (l) "NCPDP SCRIPT Standard" means the National Council for Prescription 61.21Drug Programs Prescriber/Pharmacist Interface SCRIPT Standard, Implementation 61.22Guide Version 8, Release 1 (Version 8.1), October 2005, or the most recent standard 61.23adopted by the Centers for Medicare and Medicaid Services for e-prescribing under 61.24Medicare Part D as required by section 1860D-4(e)(4)(D) of the Social Security Act, and 61.25regulations adopted under it. The standards shall be implemented according to the Centers 61.26for Medicare and Medicaid Services schedule for compliance. Subsequently released 61.27versions of the NCPDP SCRIPT Standard may be used, provided that the new version 61.28of the standard is backward compatible to the current version adopted by the Centers for 61.29Medicare and Medicaid Services.61.30    (l) (m) "Pharmacy" has the meaning given in section 
         151.01, subdivision 2.61.31    (m) (n) "Prescriber" means a licensed health care professional who is authorized to 61.32prescribe a controlled substance under section 152.12, subdivision 1. practitioner, other 61.33than a veterinarian, as defined in section 151.01, subdivision 23.61.34    (n) (o) "Prescription-related information" means information regarding eligibility for 61.35drug benefits, medication history, or related health or drug information.62.1    (o) (p) "Provider" or "health care provider" has the meaning given in section 
         62J.03, 62.2subdivision 8.62.3    Sec. 4. Minnesota Statutes 2008, section 62J.497, subdivision 2, is amended to read:62.4    Subd. 2. Requirements for electronic prescribing. (a) Effective January 1, 2011, 62.5all providers, group purchasers, prescribers, and dispensers must establish and, maintain, 62.6and use an electronic prescription drug program that complies. This program must comply62.7with the applicable standards in this section for transmitting, directly or through an 62.8intermediary, prescriptions and prescription-related information using electronic media.62.9    (b) Nothing in this section requires providers, group purchasers, prescribers, or 62.10dispensers to conduct the transactions described in this section. If transactions described in 62.11this section are conducted, they must be done electronically using the standards described 62.12in this section. Nothing in this section requires providers, group purchasers, prescribers, 62.13or dispensers to electronically conduct transactions that are expressly prohibited by other 62.14sections or federal law.62.15    (c) Providers, group purchasers, prescribers, and dispensers must use either HL7 62.16messages or the NCPDP SCRIPT Standard to transmit prescriptions or prescription-related 62.17information internally when the sender and the recipient are part of the same legal entity. If 62.18an entity sends prescriptions outside the entity, it must use the NCPDP SCRIPT Standard 62.19or other applicable standards required by this section. Any pharmacy within an entity 62.20must be able to receive electronic prescription transmittals from outside the entity using 62.21the adopted NCPDP SCRIPT Standard. This exemption does not supersede any Health 62.22Insurance Portability and Accountability Act (HIPAA) requirement that may require the 62.23use of a HIPAA transaction standard within an organization.62.24    (d) Entities transmitting prescriptions or prescription-related information where the 62.25prescriber is required by law to issue a prescription for a patient to a nonprescribing 62.26provider that in turn forwards the prescription to a dispenser are exempt from the 62.27requirement to use the NCPDP SCRIPT Standard when transmitting prescriptions or 62.28prescription-related information.62.29    Sec. 5. Minnesota Statutes 2008, section 62J.497, is amended by adding a subdivision 62.30to read:62.31    Subd. 4.Development and use of uniform formulary exception form.(a) The 62.32commissioner of health, in consultation with the Minnesota Administrative Uniformity 62.33Committee, shall develop by July 1, 2009, or six weeks after enactment of this subdivision, 62.34whichever is later, a uniform formulary exception form that allows health care providers 63.1to request exceptions from group purchaser formularies using a uniform form. Upon 63.2development of the form, all health care providers must submit requests for formulary 63.3exceptions using the uniform form, and all group purchasers must accept this form from 63.4health care providers.63.5    (b) No later than January 1, 2011, the uniform formulary exception form must be 63.6accessible and submitted by health care providers, and accepted and processed by group 63.7purchasers, through secure electronic transmissions. Facsimile shall not be considered 63.8secure electronic transmissions.63.9    Sec. 6. Minnesota Statutes 2008, section 62J.497, is amended by adding a subdivision 63.10to read:63.11    Subd. 5.Electronic drug prior authorization standardization and transmission.63.12    (a) The commissioner of health, in consultation with the Minnesota e-Health Advisory 63.13Committee and the Minnesota Administrative Uniformity Committee, shall, by February 63.1415, 2010, identify an outline on how best to standardize drug prior authorization request 63.15transactions between providers and group purchasers with the goal of maximizing 63.16administrative simplification and efficiency in preparation for electronic transmissions.63.17    (b) No later than January 1, 2011, drug prior authorization requests must be 63.18accessible and submitted by health care providers, and accepted and processed by group 63.19purchasers, electronically through secure electronic transmissions. Facsimile shall not be 63.20considered electronic transmission.63.21    Sec. 7. [62Q.676] MEDICATION THERAPY MANAGEMENT.63.22    A pharmacy benefit manager that provides prescription drug services must make 63.23available medication therapy management services for enrollees taking four or more 63.24prescriptions to treat or prevent two or more chronic medical conditions. For purposes 63.25of this section, "medication therapy management" means the provision of the following 63.26pharmaceutical care services by, or under the supervision of, a licensed pharmacist to 63.27optimize the therapeutic outcomes of the patient's medications:63.28    (1) performing a comprehensive medication review to identify, resolve, and prevent 63.29medication-related problems, including adverse drug events;63.30    (2) communicating essential information to the patient's other primary care 63.31providers; and63.32    (3) providing verbal education and training designed to enhance patient 63.33understanding and appropriate use of the patient's medications.64.1    Nothing in this section shall be construed to expand or modify the scope of practice 64.2of the pharmacist as defined in section 151.01, subdivision 27.64.3    Sec. 8. Minnesota Statutes 2008, section 144.122, is amended to read:64.4144.122 LICENSE, PERMIT, AND SURVEY FEES.64.5    (a) The state commissioner of health, by rule, may prescribe procedures and fees 64.6for filing with the commissioner as prescribed by statute and for the issuance of original 64.7and renewal permits, licenses, registrations, and certifications issued under authority of 64.8the commissioner. The expiration dates of the various licenses, permits, registrations, 64.9and certifications as prescribed by the rules shall be plainly marked thereon. Fees may 64.10include application and examination fees and a penalty fee for renewal applications 64.11submitted after the expiration date of the previously issued permit, license, registration, 64.12and certification. The commissioner may also prescribe, by rule, reduced fees for permits, 64.13licenses, registrations, and certifications when the application therefor is submitted 64.14during the last three months of the permit, license, registration, or certification period. 64.15Fees proposed to be prescribed in the rules shall be first approved by the Department of 64.16Finance. All fees proposed to be prescribed in rules shall be reasonable. The fees shall be 64.17in an amount so that the total fees collected by the commissioner will, where practical, 64.18approximate the cost to the commissioner in administering the program. All fees collected 64.19shall be deposited in the state treasury and credited to the state government special revenue 64.20fund unless otherwise specifically appropriated by law for specific purposes.64.21    (b) The commissioner may charge a fee for voluntary certification of medical 64.22laboratories and environmental laboratories, and for environmental and medical laboratory 64.23services provided by the department, without complying with paragraph (a) or chapter 14. 64.24Fees charged for environment and medical laboratory services provided by the department 64.25must be approximately equal to the costs of providing the services.64.26    (c) The commissioner may develop a schedule of fees for diagnostic evaluations 64.27conducted at clinics held by the services for children with disabilities program. All 64.28receipts generated by the program are annually appropriated to the commissioner for use 64.29in the maternal and child health program.64.30    (d) The commissioner shall set license fees for hospitals and nursing homes that are 64.31not boarding care homes at the following levels:

65.165.265.365.4Joint Commission on Accreditation of 
                  		Healthcare Organizations (JCAHO) and 
                  		American Osteopathic Association (AOA) 
                  		hospitals$7,555$7,655 plus $13$16 per bed65.5Non-JCAHO and non-AOA hospitals$5,180$5,280 plus $247$250 per bed65.6Nursing home$183 plus $91 per bed

65.7    The commissioner shall set license fees for outpatient surgical centers, boarding care 65.8homes, and supervised living facilities at the following levels:

65.9Outpatient surgical centers$3,349$3,71265.10Boarding care homes$183 plus $91 per bed65.11Supervised living facilities$183 plus $91 per bed.

65.12    (e) Unless prohibited by federal law, the commissioner of health shall charge 65.13applicants the following fees to cover the cost of any initial certification surveys required 65.14to determine a provider's eligibility to participate in the Medicare or Medicaid program:

65.15Prospective payment surveys for hospitals$90065.16Swing bed surveys for nursing homes$1,20065.17Psychiatric hospitals$1,40065.18Rural health facilities$1,10065.19Portable x-ray providers$50065.20Home health agencies$1,80065.21Outpatient therapy agencies$80065.22End stage renal dialysis providers$2,10065.23Independent therapists$80065.24Comprehensive rehabilitation outpatient facilities$1,20065.25Hospice providers$1,70065.26Ambulatory surgical providers$1,80065.27Hospitals$4,20065.2865.2965.30Other provider categories or additional
                  		resurveys required to complete initial
                  		certificationActual surveyor costs: average 
                  		surveyor cost x number of hours 
                  		for the survey process.

66.1    These fees shall be submitted at the time of the application for federal certification 66.2and shall not be refunded. All fees collected after the date that the imposition of fees is not 66.3prohibited by federal law shall be deposited in the state treasury and credited to the state 66.4government special revenue fund.66.5    Sec. 9. Minnesota Statutes 2008, section 144.226, subdivision 4, is amended to read:66.6    Subd. 4. Vital records surcharge. (a) In addition to any fee prescribed under 66.7subdivision 1, there is a nonrefundable surcharge of $2 for each certified and noncertified 66.8birth, stillbirth, or death record, and for a certification that the record cannot be found. 66.9The local or state registrar shall forward this amount to the commissioner of finance to 66.10be deposited into the state government special revenue fund. This surcharge shall not be 66.11charged under those circumstances in which no fee for a birth, stillbirth, or death record is 66.12permitted under subdivision 1, paragraph (a).66.13(b) Effective August 1, 2005, to June 30, 2009, the surcharge in paragraph (a) shall 66.14be is $4.66.15    Sec. 10. Minnesota Statutes 2008, section 148.6445, is amended by adding a 66.16subdivision to read:66.17    Subd. 2a.Duplicate license fee.The fee for a duplicate license is $25.66.18ARTICLE 566.19HEALTH CARE66.20    Section 1. Minnesota Statutes 2008, section 60A.092, subdivision 2, is amended to 66.21read:66.22    Subd. 2. Licensed assuming insurer. Reinsurance is ceded to an assuming insurer 66.23if the assuming insurer is licensed to transact insurance or reinsurance in this state. For 66.24purposes of reinsuring any health risk, an insurer is defined under section 62A.63.66.25    Sec. 2. Minnesota Statutes 2008, section 62D.03, subdivision 4, is amended to read:66.26    Subd. 4. Application requirements. Each application for a certificate of authority 66.27shall be verified by an officer or authorized representative of the applicant, and shall be 66.28in a form prescribed by the commissioner of health. Each application shall include the 66.29following:66.30(a) a copy of the basic organizational document, if any, of the applicant and of 66.31each major participating entity; such as the articles of incorporation, or other applicable 66.32documents, and all amendments thereto;67.1(b) a copy of the bylaws, rules and regulations, or similar document, if any, and all 67.2amendments thereto which regulate the conduct of the affairs of the applicant and of 67.3each major participating entity;67.4(c) a list of the names, addresses, and official positions of the following:67.5(1) all members of the board of directors, or governing body of the local government 67.6unit, and the principal officers and shareholders of the applicant organization; and67.7(2) all members of the board of directors, or governing body of the local government 67.8unit, and the principal officers of the major participating entity and each shareholder 67.9beneficially owning more than ten percent of any voting stock of the major participating 67.10entity;67.11The commissioner may by rule identify persons included in the term "principal 67.12officers";67.13(d) a full disclosure of the extent and nature of any contract or financial arrangements 67.14between the following:67.15(1) the health maintenance organization and the persons listed in clause (c)(1);67.16(2) the health maintenance organization and the persons listed in clause (c)(2);67.17(3) each major participating entity and the persons listed in clause (c)(1) concerning 67.18any financial relationship with the health maintenance organization; and67.19(4) each major participating entity and the persons listed in clause (c)(2) concerning 67.20any financial relationship with the health maintenance organization;67.21(e) the name and address of each participating entity and the agreed upon duration of 67.22each contract or agreement;67.23(f) a copy of the form of each contract binding the participating entities and the 67.24health maintenance organization. Contractual provisions shall be consistent with the 67.25purposes of sections 
         62D.01 to 
         62D.30, in regard to the services to be performed under the 67.26contract, the manner in which payment for services is determined, the nature and extent 67.27of responsibilities to be retained by the health maintenance organization, the nature and 67.28extent of risk sharing permissible, and contractual termination provisions; 67.29(g) a copy of each contract binding major participating entities and the health 67.30maintenance organization. Contract information filed with the commissioner shall be 67.31confidential and subject to the provisions of section 
         13.37, subdivision 1, clause (b), upon 67.32the request of the health maintenance organization. 67.33Upon initial filing of each contract, the health maintenance organization shall file 67.34a separate document detailing the projected annual expenses to the major participating 67.35entity in performing the contract and the projected annual revenues received by the entity 67.36from the health maintenance organization for such performance. The commissioner 68.1shall disapprove any contract with a major participating entity if the contract will result 68.2in an unreasonable expense under section 
         62D.19. The commissioner shall approve or 68.3disapprove a contract within 30 days of filing. 68.4Within 120 days of the anniversary of the implementation of each contract, the 68.5health maintenance organization shall file a document detailing the actual expenses 68.6incurred and reported by the major participating entity in performing the contract in the 68.7preceding year and the actual revenues received from the health maintenance organization 68.8by the entity in payment for the performance;68.9(h) a statement generally describing the health maintenance organization, its health 68.10maintenance contracts and separate health service contracts, facilities, and personnel, 68.11including a statement describing the manner in which the applicant proposes to provide 68.12enrollees with comprehensive health maintenance services and separate health services;68.13(i) a copy of the form of each evidence of coverage to be issued to the enrollees;68.14(j) a copy of the form of each individual or group health maintenance contract 68.15and each separate health service contract which is to be issued to enrollees or their 68.16representatives;68.17(k) financial statements showing the applicant's assets, liabilities, and sources of 68.18financial support. If the applicant's financial affairs are audited by independent certified 68.19public accountants, a copy of the applicant's most recent certified financial statement 68.20may be deemed to satisfy this requirement;68.21(l) a description of the proposed method of marketing the plan, a schedule of 68.22proposed charges, and a financial plan which includes a three-year projection of the 68.23expenses and income and other sources of future capital;68.24(m) a statement reasonably describing the geographic area or areas to be served and 68.25the type or types of enrollees to be served;68.26(n) a description of the complaint procedures to be utilized as required under section 68.2762D.11
         ; 68.28(o) a description of the procedures and programs to be implemented to meet the 68.29requirements of section 
         62D.04, subdivision 1, clauses (b) and (c) and to monitor the 68.30quality of health care provided to enrollees; 68.31(p) a description of the mechanism by which enrollees will be afforded an 68.32opportunity to participate in matters of policy and operation under section 
         62D.06; 68.33(q) a copy of any agreement between the health maintenance organization and 68.34an insurer or, including any  nonprofit health service corporation or another health 68.35maintenance organization, regarding reinsurance, stop-loss coverage, insolvency 69.1coverage, or any other type of coverage for potential costs of health services, as authorized 69.2in sections 
         62D.04, subdivision 1, clause (f), 
         62D.05, subdivision 3, and 
         62D.13; 69.3(r) a copy of the conflict of interest policy which applies to all members of the board 69.4of directors and the principal officers of the health maintenance organization, as described 69.5in section 
         62D.04, subdivision 1, paragraph (g). All currently licensed health maintenance 69.6organizations shall also file a conflict of interest policy with the commissioner within 60 69.7days after August 1, 1990, or at a later date if approved by the commissioner; 69.8(s) a copy of the statement that describes the health maintenance organization's prior 69.9authorization administrative procedures; and69.10(t) other information as the commissioner of health may reasonably require to be 69.11provided.69.12    Sec. 3. Minnesota Statutes 2008, section 62D.05, subdivision 3, is amended to read:69.13    Subd. 3. Contracts; health services. A health maintenance organization may 69.14contract with providers of health care services to render the services the health maintenance 69.15organization has promised to provide under the terms of its health maintenance contracts, 69.16may, subject to section 
         62D.12, subdivision 11, enter into separate prepaid dental contracts, 69.17or other separate health service contracts, may, subject to the limitations of section 69.1862D.04, subdivision 1
         , clause (f), contract with insurance companies and, including 69.19 nonprofit health service plan corporations or other health maintenance organizations, 69.20for insurance, indemnity or reimbursement of its cost of providing health care services 69.21for enrollees or against the risks incurred by the health maintenance organization, may 69.22contract with insurance companies and nonprofit health service plan corporations for 69.23insolvency insurance coverage, and may contract with insurance companies and nonprofit 69.24health service plan corporations to insure or cover the enrollees' costs and expenses in the 69.25health maintenance organization, including the customary prepayment amount and any 69.26co-payment obligations, and may contract to provide reinsurance or insolvency insurance 69.27coverage to health insurers or nonprofit health service plan corporations.  69.28    Sec. 4. Minnesota Statutes 2008, section 62J.692, subdivision 7, is amended to read:69.29    Subd. 7. Transfers from the commissioner of human services.(a) The amount 69.30transferred according to section 256B.69, subdivision 5c, paragraph (a), clause (1), shall 69.31be distributed by the commissioner annually to clinical medical education programs that 69.32meet the qualifications of subdivision 3 based on the formula in subdivision 4, paragraph 69.33(a) Of the amount transferred according to section 256B.69, subdivision 5c, paragraph (a), 69.34clauses (1) to (4), $21,714,000 shall be distributed as follows:70.1(1) $2,157,000 shall be distributed by the commissioner to the University of 70.2Minnesota Board of Regents for the purposes described in sections 137.38 to 137.40;70.3(2) $1,035,360 shall be distributed by the commissioner to the Hennepin County 70.4Medical Center for clinical medical education;70.5(3) $17,400,000 shall be distributed by the commissioner to the University of 70.6Minnesota Board of Regents for purposes of medial education;70.7(4) $1,121,640 shall be distributed by the commissioner to clinical medical education 70.8dental innovation grants in accordance with subdivision 7a; and70.9(5) the remainder of the amount transferred according to section 256B.69, 70.10subdivision 5c, clauses (1) to (4), shall be distributed by the commissioner annually to 70.11clinical medical education programs that meet the qualifications of subdivision 3 based on 70.12the formula in subdivision 4, paragraph (a).70.13(b) Fifty percent of the amount transferred according to section 256B.69, subdivision 70.145c, paragraph (a), clause (2), shall be distributed by the commissioner to the University of 70.15Minnesota Board of Regents for the purposes described in sections 137.38 to 137.40. Of 70.16the remaining amount transferred according to section 256B.69, subdivision 5c, paragraph 70.17(a), clause (2), 24 percent of the amount shall be distributed by the commissioner to 70.18the Hennepin County Medical Center for clinical medical education. The remaining 26 70.19percent of the amount transferred shall be distributed by the commissioner in accordance 70.20with subdivision 7a. If the federal approval is not obtained for the matching funds under 70.21section 256B.69, subdivision 5c, paragraph (a), clause (2), 100 percent of the amount 70.22transferred under this paragraph shall be distributed by the commissioner to the University 70.23of Minnesota Board of Regents for the purposes described in sections 137.38 to 137.40.70.24(c) The amount transferred according to section 256B.69, subdivision 5c, paragraph 70.25(a), clauses (3) and (4), shall be distributed by the commissioner upon receipt to the 70.26University of Minnesota Board of Regents for the purposes of clinical graduate medical 70.27education.70.28    Sec. 5. Minnesota Statutes 2008, section 256.01, subdivision 2b, is amended to read:70.29    Subd. 2b.  Performance payments.(a) The commissioner shall develop and 70.30implement a pay-for-performance system to provide performance payments to eligible 70.31medical groups and clinics that demonstrate optimum care in serving individuals 70.32with chronic diseases who are enrolled in health care programs administered by the 70.33commissioner under chapters 256B, 256D, and 256L. The commissioner may receive any 70.34federal matching money that is made available through the medical assistance program 70.35for managed care oversight contracted through vendors, including consumer surveys, 71.1studies, and external quality reviews as required by the federal Balanced Budget Act of 71.21997, Code of Federal Regulations, title 42, part 438-managed care, subpart E-external 71.3quality review. Any federal money received for managed care oversight is appropriated 71.4to the commissioner for this purpose. The commissioner may expend the federal money 71.5received in either year of the biennium. 71.6    (b) Effective July 1, 2008, or upon federal approval, whichever is later, the 71.7commissioner shall develop and implement a patient incentive health program to provide 71.8incentives and rewards to patients who are enrolled in health care programs administered 71.9by the commissioner under chapters 256B, 256D, and 256L, and who have agreed to and 71.10have met personal health goals established with the patients' primary care providers to 71.11manage a chronic disease or condition, including but not limited to diabetes, high blood 71.12pressure, and coronary artery disease. 71.13    Sec. 6. Minnesota Statutes 2008, section 256.01, is amended by adding a subdivision 71.14to read:71.15    Subd. 18a.Public Assistance Reporting Information System.(a) Effective 71.16October 1, 2009, the commissioner shall comply with the federal requirements in Public 71.17Law 110-379 in implementing the Public Assistance Reporting Information System 71.18(PARIS) to determine eligibility for all individuals applying for:71.19(1) health care benefits under chapters 256B, 256D, and 256L; and71.20(2) public benefits under chapters 119B, 256D, 256I, and the supplemental nutrition 71.21assistance program.71.22(b) The commissioner shall determine eligibility under paragraph (a) by performing 71.23data matches, including matching with medical assistance, cash, child care, and 71.24supplemental assistance programs operated by other states.71.25EFFECTIVE DATE.This section is effective October 1, 2009.71.26    Sec. 7. Minnesota Statutes 2008, section 256.01, is amended by adding a subdivision 71.27to read:71.28    Subd. 18b.Protections for American Indians.Effective February 18, 2009, the 71.29commissioner shall comply with the federal requirements in the American Recovery and 71.30Reinvestment Act of 2009, Public Law 111-5, section 5006, regarding American Indians.71.31    Sec. 8. Minnesota Statutes 2008, section 256.962, subdivision 2, is amended to read:72.1    Subd. 2. Outreach grants. (a) The commissioner shall award grants to public and 72.2private organizations, regional collaboratives, and regional health care outreach centers 72.3for outreach activities, including, but not limited to: 72.4    (1) providing information, applications, and assistance in obtaining coverage 72.5through Minnesota public health care programs;72.6    (2) collaborating with public and private entities such as hospitals, providers, health 72.7plans, legal aid offices, pharmacies, insurance agencies, and faith-based organizations to 72.8develop outreach activities and partnerships to ensure the distribution of information 72.9and applications and provide assistance in obtaining coverage through Minnesota health 72.10care programs; and72.11    (3) providing or collaborating with public and private entities to provide multilingual 72.12and culturally specific information and assistance to applicants in areas of high 72.13uninsurance in the state or populations with high rates of uninsurance; and72.14(4) targeting geographic areas with high rates of (i) eligible but unenrolled children, 72.15including children who reside in rural areas, or (ii) racial and ethnic minorities and health 72.16disparity populations.72.17    (b) The commissioner shall ensure that all outreach materials are available in 72.18languages other than English.72.19    (c) The commissioner shall establish an outreach trainer program to provide 72.20training to designated individuals from the community and public and private entities on 72.21application assistance in order for these individuals to provide training to others in the 72.22community on an as-needed basis.72.23    Sec. 9. Minnesota Statutes 2008, section 256.962, subdivision 6, is amended to read:72.24    Subd. 6. School districts and charter schools. (a) At the beginning of each school 72.25year, a school district  or charter school shall provide information to each student on the 72.26availability of health care coverage through the Minnesota health care programs and how 72.27to obtain an application for the Minnesota health care programs.72.28    (b) For each child who is determined to be eligible for the free and reduced-price 72.29school lunch program, the district shall provide the child's family with information on how 72.30to obtain an application for the Minnesota health care programs and application assistance.72.31    (c) A school district or charter school shall also ensure that applications and 72.32information on application assistance are available at early childhood education sites and 72.33public schools located within the district's jurisdiction.72.34    (d) (c) Each district shall designate an enrollment specialist to provide application 72.35assistance and follow-up services with families who have indicated an interest in receiving 73.1information or an application for the Minnesota health care program. A district is eligible 73.2for the application assistance bonus described in subdivision 5.73.3    (e) Each (d) If a school district or charter school maintains a district Web site, the73.4school district or charter school shall provide on their its Web site a link to information on 73.5how to obtain an application and application assistance.73.6    Sec. 10. [256.964] DENTAL CARE PILOT PROJECTS.73.7The commissioner shall authorize pilot projects to reduce the total cost to the state 73.8for dental services provided to enrollees of the state public health care programs by 73.9reducing hospital emergency room costs for preventable or nonemergency dental services. 73.10As part of the project, a community dental clinic or dental provider, in collaboration with a 73.11hospital emergency room, shall provide urgent care dental services as an alternative to the 73.12hospital emergency room for nonemergency dental care. The project participants shall 73.13establish a process to divert a patient presenting at the emergency room for nonemergency 73.14dental care to the dental community clinic or to an appropriate dental provider. The 73.15commissioner may establish special payment rates for urgent care services provided and 73.16may change or waive existing payment policies in order to adequately reimburse providers 73.17for providing cost-effective alternative services in an outpatient or urgent care setting. 73.18The commissioner may establish a project in conjunction with the initiative authorized 73.19under section 256.963.73.20    Sec. 11. Minnesota Statutes 2008, section 256.969, subdivision 2b, is amended to read:73.21    Subd. 2b. Operating payment rates. In determining operating payment rates for 73.22admissions occurring on or after the rate year beginning January 1, 1991, and every two 73.23years after, or more frequently as determined by the commissioner, the commissioner 73.24shall obtain operating data from an updated base year and establish operating payment 73.25rates per admission for each hospital based on the cost-finding methods and allowable 73.26costs of the Medicare program in effect during the base year. Rates under the general 73.27assistance medical care, medical assistance, and MinnesotaCare programs shall not be 73.28rebased to more current data on January 1, 1997, January 1, 2005, and for the first 24 73.29months of the rebased period beginning January 1, 2009, and for the first three months of 73.30the rebased period beginning January 1, 2011. From April 1, 2011, to March 31, 2012, 73.31rates shall be rebased at 39.2 percent of the full value of the rebasing percentage change. 73.32Effective April 1, 2012, rates shall be rebased at full value. The base year operating 73.33payment rate per admission is standardized by the case mix index and adjusted by the 73.34hospital cost index, relative values, and disproportionate population adjustment. The 74.1cost and charge data used to establish operating rates shall only reflect inpatient services 74.2covered by medical assistance and shall not include property cost information and costs 74.3recognized in outlier payments.74.4    Sec. 12. Minnesota Statutes 2008, section 256.969, subdivision 3a, is amended to read:74.5    Subd. 3a. Payments. (a) Acute care hospital billings under the medical 74.6assistance program must not be submitted until the recipient is discharged. However, 74.7the commissioner shall establish monthly interim payments for inpatient hospitals that 74.8have individual patient lengths of stay over 30 days regardless of diagnostic category. 74.9Except as provided in section 
         256.9693, medical assistance reimbursement for treatment 74.10of mental illness shall be reimbursed based on diagnostic classifications. Individual 74.11hospital payments established under this section and sections 
         256.9685, 
         256.9686, and 74.12256.9695
         , in addition to third party and recipient liability, for discharges occurring during 74.13the rate year shall not exceed, in aggregate, the charges for the medical assistance covered 74.14inpatient services paid for the same period of time to the hospital. This payment limitation 74.15shall be calculated separately for medical assistance and general assistance medical 74.16care services. The limitation on general assistance medical care shall be effective for 74.17admissions occurring on or after July 1, 1991. Services that have rates established under 74.18subdivision 11 or 12, must be limited separately from other services. After consulting with 74.19the affected hospitals, the commissioner may consider related hospitals one entity and 74.20may merge the payment rates while maintaining separate provider numbers. The operating 74.21and property base rates per admission or per day shall be derived from the best Medicare 74.22and claims data available when rates are established. The commissioner shall determine 74.23the best Medicare and claims data, taking into consideration variables of recency of the 74.24data, audit disposition, settlement status, and the ability to set rates in a timely manner. 74.25The commissioner shall notify hospitals of payment rates by December 1 of the year 74.26preceding the rate year. The rate setting data must reflect the admissions data used to 74.27establish relative values. Base year changes from 1981 to the base year established for the 74.28rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited 74.29to the limits ending June 30, 1987, on the maximum rate of increase under subdivision 74.301. The commissioner may adjust base year cost, relative value, and case mix index data 74.31to exclude the costs of services that have been discontinued by the October 1 of the year 74.32preceding the rate year or that are paid separately from inpatient services. Inpatient stays 74.33that encompass portions of two or more rate years shall have payments established based 74.34on payment rates in effect at the time of admission unless the date of admission preceded 74.35the rate year in effect by six months or more. In this case, operating payment rates for 75.1services rendered during the rate year in effect and established based on the date of 75.2admission shall be adjusted to the rate year in effect by the hospital cost index.75.3    (b) For fee-for-service admissions occurring on or after July 1, 2002, the total 75.4payment, before third-party liability and spenddown, made to hospitals for inpatient 75.5services is reduced by .5 percent from the current statutory rates.75.6    (c) In addition to the reduction in paragraph (b), the total payment for fee-for-service 75.7admissions occurring on or after July 1, 2003, made to hospitals for inpatient services 75.8before third-party liability and spenddown, is reduced five percent from the current 75.9statutory rates. Mental health services within diagnosis related groups 424 to 432, and 75.10facilities defined under subdivision 16 are excluded from this paragraph.75.11    (d) In addition to the reduction in paragraphs (b) and (c), the total payment for 75.12fee-for-service admissions occurring on or after July 1, 2005, made to hospitals for 75.13inpatient services before third-party liability and spenddown, is reduced 6.0 percent 75.14from the current statutory rates. Mental health services within diagnosis related groups 75.15424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph. 75.16Notwithstanding section 
         256.9686, subdivision 7, for purposes of this paragraph, medical 75.17assistance does not include general assistance medical care. Payments made to managed 75.18care plans shall be reduced for services provided on or after January 1, 2006, to reflect 75.19this reduction.75.20    (e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for 75.21fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made 75.22to hospitals for inpatient services before third-party liability and spenddown, is reduced 75.233.46 percent from the current statutory rates. Mental health services with diagnosis related 75.24groups 424 to 432 and facilities defined under subdivision 16 are excluded from this 75.25paragraph. Payments made to managed care plans shall be reduced for services provided 75.26on or after January 1, 2009, through June 30, 2009, to reflect this reduction.75.27    (f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for 75.28fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2010, made 75.29to hospitals for inpatient services before third-party liability and spenddown, is reduced 75.301.9 percent from the current statutory rates. Mental health services with diagnosis related 75.31groups 424 to 432 and facilities defined under subdivision 16 are excluded from this 75.32paragraph. Payments made to managed care plans shall be reduced for services provided 75.33on or after July 1, 2009, through June 30, 2010, to reflect this reduction.75.34    (g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment 75.35for fee-for-service admissions occurring on or after July 1, 2010, made to hospitals for 75.36inpatient services before third-party liability and spenddown, is reduced 1.79 percent 76.1from the current statutory rates. Mental health services with diagnosis related groups 76.2424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph. 76.3Payments made to managed care plans shall be reduced for services provided on or after 76.4July 1, 2010, to reflect this reduction.76.5(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total 76.6payment for fee-for-service admissions occurring on or after July 1, 2009, made to 76.7hospitals for inpatient services before third-party liability and spenddown, is reduced 76.8one percent from the current statutory rates. Facilities defined under subdivision 16 are 76.9excluded from this paragraph. Payments made to managed care plans shall be reduced for 76.10services provided on or after October 1, 2009, to reflect this reduction.76.11    Sec. 13. Minnesota Statutes 2008, section 256.969, is amended by adding a subdivision 76.12to read:76.13    Subd. 3b.Nonpayment for hospital-acquired conditions and for certain 76.14treatments.(a) The commissioner must not make medical assistance payments to a 76.15hospital for any costs of care that result from a condition listed in paragraph (c), if the 76.16condition was hospital acquired. 76.17    (b) For purposes of this subdivision, a condition is hospital acquired if it is not 76.18identified by the hospital as present on admission. For purposes of this subdivision, 76.19medical assistance includes general assistance medical care and MinnesotaCare.76.20(c) The prohibition in paragraph (a) applies to payment for each hospital-acquired 76.21condition listed in this paragraph that is represented by an ICD-9-CM diagnosis code and 76.22is designated as a complicating condition or a major complicating condition:76.23(1) foreign object retained after surgery (ICD-9-CM codes 998.4 or 998.7);76.24(2) air embolism (ICD-9-CM code 999.1);76.25(3) blood incompatibility (ICD-9-CM code 999.6);76.26(4) pressure ulcers stage III or IV (ICD-9-CM codes 707.23 or 707.24);76.27(5) falls and trauma, including fracture, dislocation, intracranial injury, crushing 76.28injury, burn, and electric shock (ICD-9-CM codes with these ranges on the complicating 76.29condition and major complicating condition list: 800-829; 830-839; 850-854; 925-929; 76.30940-949; and 991-994);76.31(6) catheter-associated urinary tract infection (ICD-9-CM code 996.64);76.32(7) vascular catheter-associated infection (ICD-9-CM code 999.31);76.33(8) manifestations of poor glycemic control (ICD-9-CM codes 249.10; 249.11; 76.34249.20; 249.21; 250.10; 250.11; 250.12; 250.13; 250.20; 250.21; 250.22; 250.23; and 76.35251.0);77.1(9) surgical site infection (ICD-9-CM codes 996.67 or 998.59) following certain 77.2orthopedic procedures (procedure codes 81.01; 81.02; 81.03; 81.04; 81.05; 81.06; 81.07; 77.381.08; 81.23; 81.24; 81.31; 81.32; 81.33; 81.34; 81.35; 81.36; 81.37; 81.38; 81.83; and 77.481.85);77.5(10) surgical site infection (ICD-9-CM code 998.59) following bariatric surgery 77.6(procedure codes 44.38; 44.39; or 44.95) for a principal diagnosis of morbid obesity 77.7(ICD-9-CM code 278.01);77.8(11) surgical site infection, mediastinitis (ICD-9-CM code 519.2) following coronary 77.9artery bypass graft (procedure codes 36.10 to 36.19); and77.10(12) deep vein thrombosis (ICD-9-CM codes 453.40 to 453.42) or pulmonary 77.11embolism (ICD-9-CM codes 415.11 or 415.91) following total knee replacement 77.12(procedure code 81.54) or hip replacement (procedure codes 00.85 to 00.87 or 81.51 77.13to 81.52).77.14(d) The prohibition in paragraph (a) applies to any additional payments that result 77.15from a hospital-acquired condition listed in paragraph (c), including, but not limited to, 77.16additional treatment or procedures, readmission to the facility after discharge, increased 77.17length of stay, change to a higher diagnostic category, or transfer to another hospital. In 77.18the event of a transfer to another hospital, the hospital where the condition listed under 77.19paragraph (c) was acquired is responsible for any costs incurred at the hospital to which 77.20the patient is transferred.77.21(e) A hospital shall not bill a recipient of services for any payment disallowed under 77.22this subdivision.77.23    Sec. 14. Minnesota Statutes 2008, section 256.969, is amended by adding a subdivision 77.24to read:77.25    Subd. 28.Temporary rate increase for qualifying hospitals.For the period 77.26from April 1, 2009, to September 30, 2010, for each hospital with a medical assistance 77.27utilization rate equal to or greater than 25 percent during the base year, the commissioner 77.28shall provide an equal percentage rate increase for each medical assistance admission. The 77.29commissioner shall estimate the percentage rate increase using as the state share of the 77.30increase the amount available under section 256B.199, paragraph (d). The commissioner 77.31shall settle up payments to qualifying hospitals based on actual payments under that 77.32section and actual hospital admissions.77.33EFFECTIVE DATE.This section is effective the day following final enactment.78.1    Sec. 15. Minnesota Statutes 2008, section 256.969, is amended by adding a subdivision 78.2to read:78.3    Subd. 29.Reimbursement for the fee increase for the early hearing detection 78.4and intervention program.For services provided on or after July 1, 2010, in addition to 78.5any other payment under this section, the commissioner shall reimburse hospitals for the 78.6increase in the fee for the early hearing detection and intervention program described in 78.7section 144.125, subdivision 1, paid by the hospital for public program recipients.78.8    Sec. 16. [256B.032] ELIGIBLE VENDORS OF MEDICAL CARE.78.9(a) Effective January 1, 2011, the commissioner shall establish performance 78.10thresholds for health care providers included in the provider peer grouping system 78.11developed by the commissioner of health under section 62U.04. The thresholds shall be 78.12set at the 10th percentile of the combined cost and quality measure used for provider peer 78.13grouping, and separate thresholds shall be set for hospital and physician services.78.14(b) Beginning January 1, 2012, any health care provider with a combined cost and 78.15quality score below the threshold set in paragraph (a) shall be prohibited from enrolling 78.16as a vendor of medical care in the medical assistance, general assistance medical care, 78.17or MinnesotaCare programs, and shall not be eligible for direct payments under those 78.18programs or for payments made by managed care plans under their contracts with the 78.19commissioner under section 256B.69 or 256L.12. A health care provider that is prohibited 78.20from enrolling as a vendor or receiving payments under this paragraph may reenroll 78.21effective January 1 of any subsequent year if the provider's most recent combined cost and 78.22quality score exceeds the threshold established in paragraph (a).78.23(c) Notwithstanding paragraph (b), a provider may continue to participate as a vendor 78.24or as part of a managed care plan provider network if the commissioner determines that a 78.25contract with the provider is necessary to ensure adequate access to health care services.78.26(d) By January 15, 2013, the commissioner shall report to the legislature on the 78.27impact of this section. The commissioner's report shall include information on:78.28(1) the providers falling below the thresholds as of January 1, 2012;78.29(2) the volume of services and cost of care provided to enrollees in the medical 78.30assistance, general assistance medical care, or MinnesotaCare programs in the 12 months 78.31prior to January 1, 2012, by providers falling below the thresholds;78.32(3) providers who fell below the thresholds but continued to be eligible vendors 78.33under paragraph (c);78.34(4) the estimated cost savings achieved by not contracting with providers who do 78.35not meet the performance thresholds; and79.1(5) recommendations for increasing the threshold levels of performance over time.79.2    Sec. 17. Minnesota Statutes 2008, section 256B.056, subdivision 3c, is amended to 79.3read:79.4    Subd. 3c. Asset limitations for families and children. A household of two or more 79.5persons must not own more than $20,000 in total net assets, and a household of one 79.6person must not own more than $10,000 in total net assets. In addition to these maximum 79.7amounts, an eligible individual or family may accrue interest on these amounts, but they 79.8must be reduced to the maximum at the time of an eligibility redetermination. The value of 79.9assets that are not considered in determining eligibility for medical assistance for families 79.10and children is the value of those assets excluded under the AFDC state plan as of July 16, 79.111996, as required by the Personal Responsibility and Work Opportunity Reconciliation 79.12Act of 1996 (PRWORA), Public Law 104-193, with the following exceptions:79.13(1) household goods and personal effects are not considered;79.14(2) capital and operating assets of a trade or business up to $200,000 are not 79.15considered, except that a bank account that contains personal income or assets, or is used to 79.16pay personal expenses, is not considered a capital or operating asset of a trade or business;79.17(3) one motor vehicle is excluded for each person of legal driving age who is 79.18employed or seeking employment;79.19(4) one burial plot and all other burial expenses equal to the supplemental security 79.20income program asset limit are not considered for each individual;79.21(5) court-ordered settlements up to $10,000 are not considered;79.22(6) individual retirement accounts and funds are not considered; and79.23(7) assets owned by children are not considered.79.24The assets specified in clause (2) must be disclosed to the local agency at the time of 79.25application and at the time of an eligibility redetermination, and must be verified upon 79.26request of the local agency.79.27EFFECTIVE DATE.This section is effective January 1, 2011, or upon federal 79.28approval, whichever is later.79.29    Sec. 18. Minnesota Statutes 2008, section 256B.056, subdivision 3d, is amended to 79.30read:79.31    Subd. 3d. Reduction of excess assets. Assets in excess of the limits in subdivisions 79.323 to 3c may be reduced to allowable limits as follows:79.33(a) Assets may be reduced in any of the three calendar months before the month 79.34of application in which the applicant seeks coverage by:80.1(1) designating burial funds up to $1,500 for each applicant, spouse, and MA-eligible 80.2dependent child; and80.3(2) paying health service bills for health services that are incurred in the retroactive 80.4period for which the applicant seeks eligibility, starting with the oldest bill. After assets 80.5are reduced to allowable limits, eligibility begins with the next dollar of MA-covered 80.6health services incurred in the retroactive period. Applicants reducing assets under this 80.7subdivision who also have excess income shall first spend excess assets to pay health 80.8service bills and may meet the income spenddown on remaining bills.80.9(b) Assets may be reduced beginning the month of application by:80.10(1) paying bills for health services that are incurred during the period specified in 80.11Minnesota Rules, part 9505.0090, subpart 2, that would otherwise be paid by medical 80.12assistance; and. After assets are reduced to allowable limits, eligibility begins with the 80.13next dollar of medical assistance covered health services incurred in the period. Applicants 80.14reducing assets under this subdivision who also have excess income shall first spend excess 80.15assets to pay health service bills and may meet the income spenddown on remaining bills.80.16(2) using any means other than a transfer of assets for less than fair market value as 80.17defined in section 256B.0595, subdivision 1, paragraph (b).80.18EFFECTIVE DATE.This section is effective January 1, 2011.80.19    Sec. 19. Minnesota Statutes 2008, section 256B.057, is amended by adding a 80.20subdivision to read:80.21    Subd. 11.Treatment for colorectal cancer.(a) Medical assistance shall be paid for 80.22an individual who:80.23(1) has been screened for colorectal cancer by the colorectal cancer prevention 80.24demonstration project;80.25(2) according to the individual's treating health professional, needs treatment for 80.26colorectal cancer;80.27(3) meets income eligibility guidelines for the colorectal cancer prevention 80.28demonstration project;80.29(4) is under the age of 65; and80.30(5) is not otherwise eligible for medical assistance or covered under creditable 80.31coverage as defined under United States Code, title 42, section 300gg(a).80.32(b) Medical assistance provided under this subdivision shall be limited to services 80.33provided during the period that the individual receives treatment for colorectal cancer.81.1(c) An individual meeting the criteria in paragraph (a) is eligible for medical 81.2assistance without meeting the eligibility criteria relating to income and assets in section 81.3256B.056, subdivisions 1a to 5b.81.4(d) This subdivision expires December 31, 2010.81.5    Sec. 20. Minnesota Statutes 2008, section 256B.0575, is amended to read:81.6256B.0575 AVAILABILITY OF INCOME FOR INSTITUTIONALIZED 81.7PERSONS.81.8    Subdivision 1.Income deductions. When an institutionalized person is determined 81.9eligible for medical assistance, the income that exceeds the deductions in paragraphs (a) 81.10and (b) must be applied to the cost of institutional care.81.11(a) The following amounts must be deducted from the institutionalized person's 81.12income in the following order:81.13(1) the personal needs allowance under section 
         256B.35 or, for a veteran who 81.14does not have a spouse or child, or a surviving spouse of a veteran having no child, the 81.15amount of an improved pension received from the veteran's administration not exceeding 81.16$90 per month;81.17(2) the personal allowance for disabled individuals under section 
         256B.36;81.18(3) if the institutionalized person has a legally appointed guardian or conservator, 81.19five percent of the recipient's gross monthly income up to $100 as reimbursement for 81.20guardianship or conservatorship services;81.21(4) a monthly income allowance determined under section 
         256B.058, subdivision 81.222
         , but only to the extent income of the institutionalized spouse is made available to the 81.23community spouse;81.24(5) a monthly allowance for children under age 18 which, together with the net 81.25income of the children, would provide income equal to the medical assistance standard 81.26for families and children according to section 
         256B.056, subdivision 4, for a family size 81.27that includes only the minor children. This deduction applies only if the children do not 81.28live with the community spouse and only to the extent that the deduction is not included 81.29in the personal needs allowance under section 
         256B.35, subdivision 1, as child support 81.30garnished under a court order;81.31(6) a monthly family allowance for other family members, equal to one-third of the 81.32difference between 122 percent of the federal poverty guidelines and the monthly income 81.33for that family member;82.1(7) reparations payments made by the Federal Republic of Germany and reparations 82.2payments made by the Netherlands for victims of Nazi persecution between 1940 and 82.31945;82.4(8) all other exclusions from income for institutionalized persons as mandated by 82.5federal law; and82.6(9) amounts for reasonable expenses, as specified in subdivision 2, incurred for 82.7necessary medical or remedial care for the institutionalized person that are recognized 82.8under state law, not medical assistance covered expenses, and that are not subject to 82.9payment by a third party.82.10Reasonable expenses are limited to expenses that have not been previously used as a 82.11deduction from income and are incurred during the enrollee's current period of eligibility, 82.12including retroactive months associated with the current period of eligibility, for medical 82.13assistance payment of long-term care services.82.14For purposes of clause (6), "other family member" means a person who resides 82.15with the community spouse and who is a minor or dependent child, dependent parent, or 82.16dependent sibling of either spouse. "Dependent" means a person who could be claimed as 82.17a dependent for federal income tax purposes under the Internal Revenue Code.82.18(b) Income shall be allocated to an institutionalized person for a period of up to three 82.19calendar months, in an amount equal to the medical assistance standard for a family 82.20size of one if:82.21(1) a physician certifies that the person is expected to reside in the long-term care 82.22facility for three calendar months or less;82.23(2) if the person has expenses of maintaining a residence in the community; and82.24(3) if one of the following circumstances apply:82.25(i) the person was not living together with a spouse or a family member as defined in 82.26paragraph (a) when the person entered a long-term care facility; or82.27(ii) the person and the person's spouse become institutionalized on the same date, in 82.28which case the allocation shall be applied to the income of one of the spouses.82.29For purposes of this paragraph, a person is determined to be residing in a licensed nursing 82.30home, regional treatment center, or medical institution if the person is expected to remain 82.31for a period of one full calendar month or more.82.32    Subd. 2.Reasonable expenses.For the purposes of subdivision 1, paragraph (a), 82.33clause (9), reasonable expenses are limited to expenses that have not been previously used 82.34as a deduction from income and were not:82.35    (1) for long-term care expenses incurred during a period of ineligibility as defined in 82.36section 256B.0595, subdivision 2;83.1    (2) incurred more than three months before the month of application associated with 83.2the current period of eligibility;83.3    (3) for expenses incurred by a recipient that are duplicative of services that are 83.4covered under chapter 256B; or83.5    (4) nursing facility expenses incurred without a timely assessment as required under 83.6section 256B.0911.83.7    Sec. 21. Minnesota Statutes 2008, section 256B.0595, subdivision 1, is amended to 83.8read:83.9    Subdivision 1.  Prohibited transfers. (a) For transfers of assets made on or before 83.10August 10, 1993, if an institutionalized person or the institutionalized person's spouse has 83.11given away, sold, or disposed of, for less than fair market value, any asset or interest 83.12therein, except assets other than the homestead that are excluded under the supplemental 83.13security program, within 30 months before or any time after the date of institutionalization 83.14if the person has been determined eligible for medical assistance, or within 30 months 83.15before or any time after the date of the first approved application for medical assistance 83.16if the person has not yet been determined eligible for medical assistance, the person is 83.17ineligible for long-term care services for the period of time determined under subdivision 83.182. 83.19    (b) Effective for transfers made after August 10, 1993, an institutionalized person, an 83.20institutionalized person's spouse, or any person, court, or administrative body with legal 83.21authority to act in place of, on behalf of, at the direction of, or upon the request of the 83.22institutionalized person or institutionalized person's spouse, may not give away, sell, or 83.23dispose of, for less than fair market value, any asset or interest therein, except assets other 83.24than the homestead that are excluded under the Supplemental Security Income program, 83.25for the purpose of establishing or maintaining medical assistance eligibility. This applies 83.26to all transfers, including those made by a community spouse after the month in which 83.27the institutionalized spouse is determined eligible for medical assistance. For purposes of 83.28determining eligibility for long-term care services, any transfer of such assets within 36 83.29months before or any time after an institutionalized person requests medical assistance 83.30payment of long-term care services, or 36 months before or any time after a medical 83.31assistance recipient becomes an institutionalized person, for less than fair market value 83.32may be considered. Any such transfer is presumed to have been made for the purpose 83.33of establishing or maintaining medical assistance eligibility and the institutionalized 83.34person is ineligible for long-term care services for the period of time determined under 83.35subdivision 2, unless the institutionalized person furnishes convincing evidence to 84.1establish that the transaction was exclusively for another purpose, or unless the transfer is 84.2permitted under subdivision 3 or 4.  In the case of payments from a trust or portions of a 84.3trust that are considered transfers of assets under federal law, or in the case of any other 84.4disposal of assets made on or after February 8, 2006, any transfers made within 60 months 84.5before or any time after an institutionalized person requests medical assistance payment of 84.6long-term care services and within 60 months before or any time after a medical assistance 84.7recipient becomes an institutionalized person, may be considered. 84.8    (c) This section applies to transfers, for less than fair market value, of income 84.9or assets, including assets that are considered income in the month received, such as 84.10inheritances, court settlements, and retroactive benefit payments or income to which the 84.11institutionalized person or the institutionalized person's spouse is entitled but does not 84.12receive due to action by the institutionalized person, the institutionalized person's spouse, 84.13or any person, court, or administrative body with legal authority to act in place of, on 84.14behalf of, at the direction of, or upon the request of the institutionalized person or the 84.15institutionalized person's spouse. 84.16    (d) This section applies to payments for care or personal services provided by a 84.17relative, unless the compensation was stipulated in a notarized, written agreement which 84.18was in existence when the service was performed, the care or services directly benefited 84.19the person, and the payments made represented reasonable compensation for the care 84.20or services provided. A notarized written agreement is not required if payment for the 84.21services was made within 60 days after the service was provided. 84.22    (e) This section applies to the portion of any asset or interest that an institutionalized 84.23person, an institutionalized person's spouse, or any person, court, or administrative body 84.24with legal authority to act in place of, on behalf of, at the direction of, or upon the request 84.25of the institutionalized person or the institutionalized person's spouse, transfers to any 84.26annuity that exceeds the value of the benefit likely to be returned to the institutionalized 84.27person or institutionalized person's spouse while alive, based on estimated life expectancy 84.28as determined according to the current actuarial tables published by the Office of the 84.29Chief Actuary of the Social Security Administration. The commissioner may adopt rules 84.30reducing life expectancies based on the need for long-term care. This section applies to an 84.31annuity purchased on or after March 1, 2002, that: 84.32    (1) is not purchased from an insurance company or financial institution that is 84.33subject to licensing or regulation by the Minnesota Department of Commerce or a similar 84.34regulatory agency of another state; 84.35    (2) does not pay out principal and interest in equal monthly installments; or 84.36    (3) does not begin payment at the earliest possible date after annuitization. 85.1    (f) Effective for transactions, including the purchase of an annuity, occurring on or 85.2after February 8, 2006, by or on behalf of an institutionalized person who has applied for 85.3or is receiving long-term care services or the institutionalized person's spouse shall be 85.4treated as the disposal of an asset for less than fair market value unless the department is 85.5named a preferred remainder beneficiary  as described in section 
         256B.056, subdivision 85.611
         . Any subsequent change to the designation of the department as a preferred remainder 85.7beneficiary shall result in the annuity being treated as a disposal of assets for less than 85.8fair market value. The amount of such transfer shall be the maximum amount the 85.9institutionalized person or the institutionalized person's spouse could receive from the 85.10annuity or similar financial instrument. Any change in the amount of the income or 85.11principal being withdrawn from the annuity or other similar financial instrument at the 85.12time of the most recent disclosure shall be deemed to be a transfer of assets for less than 85.13fair market value unless the institutionalized person or the institutionalized person's spouse 85.14demonstrates that the transaction was for fair market value. In the event a distribution 85.15of income or principal has been improperly distributed or disbursed from an annuity or 85.16other retirement planning instrument of an institutionalized person or the institutionalized 85.17person's spouse, a cause of action exists against the individual receiving the improper 85.18distribution for the cost of medical assistance services provided or the amount of the 85.19improper distribution, whichever is less. 85.20    (g) Effective for transactions, including the purchase of an annuity, occurring on 85.21or after February 8, 2006, by or on behalf of an institutionalized person applying for or 85.22receiving long-term care services shall be treated as a disposal of assets for less than fair 85.23market value unless it is: 85.24    (i) an annuity described in subsection (b) or (q) of section 408 of the Internal 85.25Revenue Code of 1986; or 85.26    (ii) purchased with proceeds from: 85.27    (A) an account or trust described in subsection (a), (c), or (p) of section 408 of the 85.28Internal Revenue Code; 85.29    (B) a simplified employee pension within the meaning of section 408(k) of the 85.30Internal Revenue Code; or 85.31    (C) a Roth IRA described in section 408A of the Internal Revenue Code; or 85.32    (iii) an annuity that is irrevocable and nonassignable; is actuarially sound as 85.33determined in accordance with actuarial publications of the Office of the Chief Actuary of 85.34the Social Security Administration; and provides for payments in equal amounts during 85.35the term of the annuity, with no deferral and no balloon payments made.86.1     (h) For purposes of this section, long-term care services include services in a nursing 86.2facility, services that are eligible for payment according to section 
         256B.0625, subdivision 86.32
         , because they are provided in a swing bed, intermediate care facility for persons with 86.4developmental disabilities, and home and community-based services provided pursuant 86.5to sections 
         256B.0915, 
         256B.092, and 
         256B.49. For purposes of this subdivision and 86.6subdivisions 2, 3, and 4, "institutionalized person" includes a person who is an inpatient 86.7in a nursing facility or in a swing bed, or intermediate care facility for persons with 86.8developmental disabilities or who is receiving home and community-based services under 86.9sections 
         256B.0915, 
         256B.092, and 
         256B.49. 86.10    (i) This section applies to funds used to purchase a promissory note, loan, or 86.11mortgage unless the note, loan, or mortgage: 86.12    (1) has a repayment term that is actuarially sound; 86.13    (2) provides for payments to be made in equal amounts during the term of the loan, 86.14with no deferral and no balloon payments made; and 86.15    (3) prohibits the cancellation of the balance upon the death of the lender. 86.16    In the case of a promissory note, loan, or mortgage that does not meet an exception 86.17in clauses (1) to (3), the value of such note, loan, or mortgage shall be the outstanding 86.18balance due as of the date of the institutionalized person's request for medical assistance 86.19payment of long-term care services. 86.20    (j) This section applies to the purchase of a life estate interest in another person's 86.21home unless the purchaser resides in the home for a period of at least one year after the 86.22date of purchase. 86.23(k) This section applies to transfers into a pooled trust that qualifies under United 86.24States Code, title 42, section 1396p(d)(4)(C), by:86.25(1) a person age 65 or older or the person's spouse; or86.26(2) any person, court, or administrative body with legal authority to act in place 86.27of, on behalf of, at the direction of, or upon the request of a person age 65 or older or 86.28the person's spouse.86.29    Sec. 22. Minnesota Statutes 2008, section 256B.0595, subdivision 2, is amended to 86.30read:86.31    Subd. 2.  Period of ineligibility for long-term care services. (a) For any 86.32uncompensated transfer occurring on or before August 10, 1993, the number of months 86.33of ineligibility for long-term care services shall be the lesser of 30 months, or the 86.34uncompensated transfer amount divided by the average medical assistance rate for nursing 86.35facility services in the state in effect on the date of application. The amount used to 87.1calculate the average medical assistance payment rate shall be adjusted each July 1 to 87.2reflect payment rates for the previous calendar year. The period of ineligibility begins 87.3with the month in which the assets were transferred. If the transfer was not reported to 87.4the local agency at the time of application, and the applicant received long-term care 87.5services during what would have been the period of ineligibility if the transfer had been 87.6reported, a cause of action exists against the transferee for the cost of long-term care 87.7services provided during the period of ineligibility, or for the uncompensated amount of 87.8the transfer, whichever is less. The uncompensated transfer amount is the fair market 87.9value of the asset at the time it was given away, sold, or disposed of, less the amount of 87.10compensation received. 87.11    (b) For uncompensated transfers made after August 10, 1993, the number of months 87.12of ineligibility for long-term care services shall be the total uncompensated value of the 87.13resources transferred divided by the average medical assistance rate for nursing facility 87.14services in the state in effect on the date of application. The amount used to calculate 87.15the average medical assistance payment rate shall be adjusted each July 1 to reflect 87.16payment rates for the previous calendar year. The period of ineligibility begins with the 87.17first day of the month after the month in which the assets were transferred except that 87.18if one or more uncompensated transfers are made during a period of ineligibility, the 87.19total assets transferred during the ineligibility period shall be combined and a penalty 87.20period calculated to begin on the first day of the month after the month in which the first 87.21uncompensated transfer was made. If the transfer was reported to the local agency after 87.22the date that advance notice of a period of ineligibility that affects the next month could 87.23be provided to the recipient and the recipient received medical assistance services or the 87.24transfer was not reported to the local agency, and the applicant or recipient received 87.25medical assistance services during what would have been the period of ineligibility if 87.26the transfer had been reported, a cause of action exists against the transferee for that 87.27portion of long-term care services provided during the period of ineligibility, or for the 87.28uncompensated amount of the transfer, whichever is less. The uncompensated transfer 87.29amount is the fair market value of the asset at the time it was given away, sold, or disposed 87.30of, less the amount of compensation received. Effective for transfers made on or after 87.31March 1, 1996, involving persons who apply for medical assistance on or after April 13, 87.321996, no cause of action exists for a transfer unless: 87.33    (1) the transferee knew or should have known that the transfer was being made by a 87.34person who was a resident of a long-term care facility or was receiving that level of care in 87.35the community at the time of the transfer; 88.1    (2) the transferee knew or should have known that the transfer was being made to 88.2assist the person to qualify for or retain medical assistance eligibility; or 88.3    (3) the transferee actively solicited the transfer with intent to assist the person to 88.4qualify for or retain eligibility for medical assistance. 88.5    (c) For uncompensated transfers made on or after February 8, 2006, the period 88.6of ineligibility: 88.7    (1) for uncompensated transfers by or on behalf of individuals receiving medical 88.8assistance payment of long-term care services, begins the first day of the month following 88.9advance notice of the penalty period of ineligibility, but no later than the first day of the 88.10month that follows three full calendar months from the date of the report or discovery 88.11of the transfer; or 88.12    (2) for uncompensated transfers by individuals requesting medical assistance 88.13payment of long-term care services, begins the date on which the individual is eligible 88.14for medical assistance under the Medicaid state plan and would otherwise be receiving 88.15long-term care services based on an approved application for such care but for the88.16application of the penalty period of ineligibility resulting from the uncompensated 88.17transfer; and 88.18    (3) cannot begin during any other period of ineligibility. 88.19    (d) If a calculation of a penalty period of ineligibility results in a partial month, 88.20payments for long-term care services shall be reduced in an amount equal to the fraction. 88.21    (e) In the case of multiple fractional transfers of assets in more than one month for 88.22less than fair market value on or after February 8, 2006, the period of ineligibility is 88.23calculated by treating the total, cumulative, uncompensated value of all assets transferred 88.24during all months on or after February 8, 2006, as one transfer. 88.25    (f) A period of ineligibility established under paragraph (c) may be eliminated if 88.26all of the assets transferred for less than fair market value used to calculate the period of 88.27ineligibility, or cash equal to the value of the assets at the time of the transfer, are returned 88.28within 12 months after the date the period of ineligibility began. A period of ineligibility 88.29must not be adjusted if less than the full amount of the transferred assets or the full cash 88.30value of the transferred assets are returned.88.31EFFECTIVE DATE.This section is effective for periods of ineligibility established 88.32on or after January 1, 2011.88.33    Sec. 23. Minnesota Statutes 2008, section 256B.06, subdivision 4, is amended to read:88.34    Subd. 4.  Citizenship requirements. (a) Eligibility for medical assistance is limited 88.35to citizens of the United States, qualified noncitizens as defined in this subdivision, and 89.1other persons residing lawfully in the United States. Citizens or nationals of the United 89.2States must cooperate in obtaining satisfactory documentary evidence of citizenship or 89.3nationality according to the requirements of the federal Deficit Reduction Act of 2005, 89.4Public Law 109-171. 89.5(b) "Qualified noncitizen" means a person who meets one of the following 89.6immigration criteria: 89.7(1) admitted for lawful permanent residence according to United States Code, title 8; 89.8(2) admitted to the United States as a refugee according to United States Code, 89.9title 8, section 1157; 89.10(3) granted asylum according to United States Code, title 8, section 1158; 89.11(4) granted withholding of deportation according to United States Code, title 8, 89.12section 1253(h); 89.13(5) paroled for a period of at least one year according to United States Code, title 8, 89.14section 1182(d)(5); 89.15(6) granted conditional entrant status according to United States Code, title 8, 89.16section 1153(a)(7); 89.17(7) determined to be a battered noncitizen by the United States Attorney General 89.18according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, 89.19title V of the Omnibus Consolidated Appropriations Bill, Public Law 104-200; 89.20(8) is a child of a noncitizen determined to be a battered noncitizen by the United 89.21States Attorney General according to the Illegal Immigration Reform and Immigrant 89.22Responsibility Act of 1996, title V, of the Omnibus Consolidated Appropriations Bill, 89.23Public Law 104-200; or 89.24(9) determined to be a Cuban or Haitian entrant as defined in section 501(e) of Public 89.25Law 96-422, the Refugee Education Assistance Act of 1980. 89.26(c) All qualified noncitizens who were residing in the United States before August 89.2722, 1996, who otherwise meet the eligibility requirements of this chapter, are eligible for 89.28medical assistance with federal financial participation. 89.29(d) All qualified noncitizens who entered the United States on or after August 22, 89.301996, and who otherwise meet the eligibility requirements of this chapter, are eligible for 89.31medical assistance with federal financial participation through November 30, 1996. 89.32Beginning December 1, 1996, qualified noncitizens who entered the United States 89.33on or after August 22, 1996, and who otherwise meet the eligibility requirements of this 89.34chapter are eligible for medical assistance with federal participation for five years if they 89.35meet one of the following criteria: 90.1(i) refugees admitted to the United States according to United States Code, title 8, 90.2section 1157; 90.3(ii) persons granted asylum according to United States Code, title 8, section 1158; 90.4(iii) persons granted withholding of deportation according to United States Code, 90.5title 8, section 1253(h); 90.6(iv) veterans of the United States armed forces with an honorable discharge for 90.7a reason other than noncitizen status, their spouses and unmarried minor dependent 90.8children; or 90.9(v) persons on active duty in the United States armed forces, other than for training, 90.10their spouses and unmarried minor dependent children. 90.11Beginning December 1, 1996, qualified noncitizens who do not meet one of the 90.12criteria in items (i) to (v) are eligible for medical assistance without federal financial 90.13participation as described in paragraph (j). 90.14Notwithstanding paragraph (j), beginning July 1, 2010, children and pregnant 90.15women who are qualified noncitizens, as described in paragraph (b), are eligible for 90.16medical assistance with federal financial participation as provided by the federal Children's 90.17Health Insurance Program Reauthorization Act of 2009, Public Law 111-3.90.18(e) Noncitizens who are not qualified noncitizens as defined in paragraph (b), who 90.19are lawfully present in the United States, as defined in Code of Federal Regulations, title 90.208, section 
         103.12, and who otherwise meet the eligibility requirements of this chapter, are 90.21eligible for medical assistance under clauses (1) to (3). These individuals must cooperate 90.22with the United States Citizenship and Immigration Services to pursue any applicable 90.23immigration status, including citizenship, that would qualify them for medical assistance 90.24with federal financial participation. 90.25(1) Persons who were medical assistance recipients on August 22, 1996, are eligible 90.26for medical assistance with federal financial participation through December 31, 1996. 90.27(2) Beginning January 1, 1997, persons described in clause (1) are eligible for 90.28medical assistance without federal financial participation as described in paragraph (j). 90.29(3) Beginning December 1, 1996, persons residing in the United States prior to 90.30August 22, 1996, who were not receiving medical assistance and persons who arrived on 90.31or after August 22, 1996, are eligible for medical assistance without federal financial 90.32participation as described in paragraph (j). 90.33(f) Nonimmigrants who otherwise meet the eligibility requirements of this chapter 90.34are eligible for the benefits as provided in paragraphs (g) to (i). For purposes of this 90.35subdivision, a "nonimmigrant" is a person in one of the classes listed in United States 90.36Code, title 8, section 1101(a)(15). 91.1(g) Payment shall also be made for care and services that are furnished to noncitizens, 91.2regardless of immigration status, who otherwise meet the eligibility requirements of 91.3this chapter, if such care and services are necessary for the treatment of an emergency 91.4medical condition, except for organ transplants and related care and services and routine 91.5prenatal care. 91.6(h) For purposes of this subdivision, the term "emergency medical condition" means 91.7a medical condition that meets the requirements of United States Code, title 42, section 91.81396b(v). 91.9(i) Beginning July 1, 2009, pregnant noncitizens who are undocumented, 91.10nonimmigrants, or eligible for medical assistance as described in paragraph (j),lawfully 91.11present as designated in paragraph (e) and who are not covered by a group health plan 91.12or health insurance coverage according to Code of Federal Regulations, title 42, section 91.13457.310, and who otherwise meet the eligibility requirements of this chapter, are eligible 91.14for medical assistance through the period of pregnancy, including labor and delivery,91.15and 60 days postpartum, to the extent federal funds are available under title XXI of the 91.16Social Security Act, and the state children's health insurance program, followed by 60 91.17days postpartum without federal financial participation. 91.18(j) Qualified noncitizens as described in paragraph (d), and all other noncitizens 91.19lawfully residing in the United States as described in paragraph (e), who are ineligible 91.20for medical assistance with federal financial participation and who otherwise meet the 91.21eligibility requirements of chapter 256B and of this paragraph, are eligible for medical 91.22assistance without federal financial participation. Qualified noncitizens as described 91.23in paragraph (d) are only eligible for medical assistance without federal financial 91.24participation for five years from their date of entry into the United States. 91.25(k) Beginning October 1, 2003, persons who are receiving care and rehabilitation 91.26services from a nonprofit center established to serve victims of torture and are otherwise 91.27ineligible for medical assistance under this chapter are eligible for medical assistance 91.28without federal financial participation. These individuals are eligible only for the period 91.29during which they are receiving services from the center. Individuals eligible under this 91.30paragraph shall not be required to participate in prepaid medical assistance. 91.31EFFECTIVE DATE.This section is effective July 1, 2009.91.32    Sec. 24. Minnesota Statutes 2008, section 256B.06, subdivision 5, is amended to read:91.33    Subd. 5. Deeming of sponsor income and resources. When determining eligibility 91.34for any federal or state funded medical assistance under this section, the income 91.35and resources of all noncitizens shall be deemed to include their sponsors' income 92.1and resources as required under the Personal Responsibility and Work Opportunity 92.2Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and 92.3subsequently set out in federal rules. This section is effective May 1, 1997. Beginning 92.4July 1, 2010, sponsor deeming does not apply to pregnant women and children who are 92.5qualified noncitizens, as described in section 256B.06, subdivision 4, paragraph (b).92.6EFFECTIVE DATE.This section is effective July 1, 2010.92.7    Sec. 25. Minnesota Statutes 2008, section 256B.0625, subdivision 3, is amended to 92.8read:92.9    Subd. 3. Physicians' services.(a) Medical assistance covers physicians' services.92.10(b)  Rates paid for anesthesiology services provided by physicians shall be according 92.11to the formula utilized in the Medicare program and shall use a conversion factor "at 92.12percentile of calendar year set by legislature.," except that rates paid to physicians for the 92.13medical direction of a certified registered nurse anesthetist shall be the same as the rate 92.14paid to the certified registered nurse anesthetist under medical direction.92.15    Sec. 26. Minnesota Statutes 2008, section 256B.0625, subdivision 3c, is amended to 92.16read:92.17    Subd. 3c.  Health Services Policy Committee.(a) The commissioner, after 92.18receiving recommendations from professional physician associations, professional 92.19associations representing licensed nonphysician health care professionals, and consumer 92.20groups, shall establish a 13-member Health Services Policy Committee, which consists of 92.2112 voting members and one nonvoting member. The Health Services Policy Committee 92.22shall advise the commissioner regarding health services pertaining to the administration 92.23of health care benefits covered under the medical assistance, general assistance medical 92.24care, and MinnesotaCare programs. The Health Services Policy Committee shall meet at 92.25least quarterly. The Health Services Policy Committee shall annually elect a physician 92.26chair from among its members, who shall work directly with the commissioner's medical 92.27director, to establish the agenda for each meeting. The Health Services Policy Committee 92.28shall also recommend criteria for verifying centers of excellence for specific aspects of 92.29medical care where a specific set of combined services, a volume of patients necessary to 92.30maintain a high level of competency, or a specific level of technical capacity is associated 92.31with improved health outcomes. 92.32(b) The commissioner shall establish a dental subcommittee to operate under the 92.33Health Services Policy Committee. The dental subcommittee consists of general dentists, 92.34dental specialists, safety net providers, dental hygienists, health plan company and 93.1county and public health representatives, health researchers, consumers, and a designee 93.2of the commissioner of health. The dental subcommittee shall advise the commissioner 93.3regarding:93.4(1) the critical access dental program under section 256B.76, subdivision 4, including 93.5but not limited to criteria for designating and terminating critical access dental providers;93.6(2) any changes to the critical access dental provider program necessary to comply 93.7with program expenditure limits;93.8(3) dental coverage policy based on evidence, quality, continuity of care, and best 93.9practices;93.10(4) the development of dental delivery models; and93.11(5) dental services to be added or eliminated from subdivision 9, paragraph (b).93.12(c) The Health Services Policy Committee shall study approaches to making 93.13provider reimbursement under the medical assistance, MinnesotaCare, and general 93.14assistance medical care programs contingent on patient participation in a patient-centered 93.15decision-making process, and shall evaluate the impact of these approaches on health 93.16care quality, patient satisfaction, and health care costs. The committee shall present 93.17findings and recommendations to the commissioner and the legislative committees with 93.18jurisdiction over health care by January 15, 2010.93.19(d) The Health Services Policy Committee shall monitor and track the practice 93.20patterns of physicians providing services to medical assistance, MinnesotaCare, and 93.21general assistance medical care enrollees under fee-for-service, managed care, and 93.22county-based purchasing. The committee shall focus on services or specialties for which 93.23there is a high variation in utilization across physicians, or which are associated with 93.24high medical costs. The commissioner, based upon the findings of the committee, shall 93.25regularly notify physicians whose practice patterns indicate higher than average utilization 93.26or costs. Managed care and county-based purchasing plans shall provide the committee 93.27with utilization and cost data necessary to implement this paragraph.93.28    (e) The Health Services Policy Committee shall review caesarean section rates 93.29for the fee-for-service medical assistance population. The committee may develop best 93.30practices policies related to the minimization of caesarean sections, including but not 93.31limited to standards and guidelines for health care providers and health care facilities.93.32    Sec. 27. Minnesota Statutes 2008, section 256B.0625, subdivision 9, is amended to 93.33read:94.1    Subd. 9. Dental services.(a) Medical assistance covers dental services. Dental 94.2services include, with prior authorization, fixed bridges that are cost-effective for persons 94.3who cannot use removable dentures because of their medical condition.94.4(b) Medical assistance dental coverage for nonpregnant adults is limited to the 94.5following services:94.6(1) comprehensive exams, limited to once every five years;94.7(2) periodic exams, limited to one per year;94.8(3) limited exams;94.9(4) bitewing x-rays, limited to one per year;94.10(5) periapical x-rays;94.11(6) panoramic x-rays, limited to one every five years, and only if provided in 94.12conjunction with a posterior extraction or scheduled outpatient facility procedure, or as 94.13medically necessary for the diagnosis and follow-up of oral and maxillofacial pathology 94.14and trauma. Panoramic x-rays may be taken once every two years for patients who cannot 94.15cooperate for intraoral film due to a developmental disability or medical condition that 94.16does not allow for intraoral film placement;94.17(7) prophylaxis, limited to one per year;94.18(8) application of fluoride varnish, limited to one per year;94.19(9) posterior fillings, all at the amalgam rate;94.20(10) anterior fillings;94.21(11) endodontics, limited to root canals on the anterior and premolars only;94.22(12) removable prostheses, each dental arch limited to one every six years;94.23(13) oral surgery, limited to extractions, biopsies, and incision and drainage of 94.24abscesses;94.25(14) palliative treatment and sedative fillings for relief of pain; and94.26(15) full-mouth debridement, limited to one every five years.94.27(c) In addition to the services specified in paragraph (b), medical assistance 94.28covers the following services for adults, if provided in an outpatient hospital setting or 94.29freestanding ambulatory surgical center as part of outpatient dental surgery:94.30(1) periodontics, limited to periodontal scaling and root planing once every two 94.31years;94.32(2) general anesthesia; and94.33(3) full-mouth survey once every five years.94.34(d) Medical assistance covers dental services for children that are medically 94.35necessary. The following guidelines apply:94.36(1) posterior fillings are paid at the amalgam rate;95.1(2) application of sealants once every five years per permanent molar; and95.2(3) application of fluoride varnish once every six months.95.3EFFECTIVE DATE.This section is effective January 1, 2010.95.4    Sec. 28. Minnesota Statutes 2008, section 256B.0625, subdivision 11, is amended to 95.5read:95.6    Subd. 11. Nurse anesthetist services. Medical assistance covers nurse anesthetist 95.7services. Rates paid for anesthesiology services provided by a certified registered nurse 95.8anesthetistsanesthetist under the direction of a physician shall be according to the formula 95.9utilized in the Medicare program and shall use the conversion factor that is used by 95.10the Medicare program. Rates paid for anesthesiology services provided by a certified 95.11registered nurse anesthetist who is not directed by a physician shall be the same rate as 95.12paid under subdivision 3, paragraph (b).95.13    Sec. 29. Minnesota Statutes 2008, section 256B.0625, subdivision 13, is amended to 95.14read:95.15    Subd. 13. Drugs. (a) Medical assistance covers drugs, except for fertility drugs 95.16when specifically used to enhance fertility, if prescribed by a licensed practitioner and 95.17dispensed by a licensed pharmacist, by a physician enrolled in the medical assistance 95.18program as a dispensing physician, or by a physician, physician assistant,  or a nurse 95.19practitioner employed by or under contract with a community health board as defined in 95.20section 
         145A.02, subdivision 5, for the purposes of communicable disease control.95.21(b) The dispensed quantity of a prescription drug must not exceed a 34-day supply, 95.22unless authorized by the commissioner.95.23(c) Medical assistance covers the following over-the-counter drugs when prescribed 95.24by a licensed practitioner or by a licensed pharmacist who meets standards established by 95.25the commissioner, in consultation with the board of pharmacy: antacids, acetaminophen, 95.26family planning products, aspirin, insulin, products for the treatment of lice, vitamins for 95.27adults with documented vitamin deficiencies, vitamins for children under the age of seven 95.28and pregnant or nursing women, and any other over-the-counter drug identified by the 95.29commissioner, in consultation with the formulary committee, as necessary, appropriate, 95.30and cost-effective for the treatment of certain specified chronic diseases, conditions, 95.31or disorders, and this determination shall not be subject to the requirements of chapter 95.3214. A pharmacist may prescribe over-the-counter medications as provided under this 95.33paragraph for purposes of receiving reimbursement under Medicaid. When prescribing 95.34over-the-counter drugs under this paragraph, licensed pharmacists must consult with the 96.1recipient to determine necessity, provide drug counseling, review drug therapy for potential 96.2adverse interactions, and make referrals as needed to other health care professionals.96.3(d) Effective January 1, 2006, medical assistance shall not cover drugs that 96.4are coverable under Medicare Part D as defined in the Medicare Prescription Drug, 96.5Improvement, and Modernization Act of 2003, Public Law 108-173, section 1860D-2(e), 96.6for individuals eligible for drug coverage as defined in the Medicare Prescription 96.7Drug, Improvement, and Modernization Act of 2003, Public Law 108-173, section 96.81860D-1(a)(3)(A). For these individuals, medical assistance may cover drugs from the 96.9drug classes listed in United States Code, title 42, section 1396r-8(d)(2), subject to this 96.10subdivision and subdivisions 13a to 13g, except that drugs listed in United States Code, 96.11title 42, section 1396r-8(d)(2)(E), shall not be covered.96.12    Sec. 30. Minnesota Statutes 2008, section 256B.0625, subdivision 13e, is amended to 96.13read:96.14    Subd. 13e. Payment rates. (a) The basis for determining the amount of payment 96.15shall be the lower of the actual acquisition costs of the drugs plus a fixed dispensing fee; 96.16the maximum allowable cost set by the federal government or by the commissioner plus 96.17the fixed dispensing fee; or the usual and customary price charged to the public. The 96.18amount of payment basis must be reduced to reflect all discount amounts applied to the 96.19charge by any provider/insurer agreement or contract for submitted charges to medical 96.20assistance programs. The net submitted charge may not be greater than the patient liability 96.21for the service. The pharmacy dispensing fee shall be $3.65, except that the dispensing fee 96.22for intravenous solutions which must be compounded by the pharmacist shall be $8 per 96.23bag, $14 per bag for cancer chemotherapy products, and $30 per bag for total parenteral 96.24nutritional products dispensed in one liter quantities, or $44 per bag for total parenteral 96.25nutritional products dispensed in quantities greater than one liter. Actual acquisition 96.26cost includes quantity and other special discounts except time and cash discounts. 96.27Effective July 1, 2008 2009, the actual acquisition cost of a drug shall be estimated by the 96.28commissioner, at average wholesale price minus 1415 percent. The actual acquisition 96.29cost of antihemophilic factor drugs shall be estimated at the average wholesale price 96.30minus 30 percent. The maximum allowable cost of a multisource drug may be set by the 96.31commissioner and it shall be comparable to, but no higher than, the maximum amount 96.32paid by other third-party payors in this state who have maximum allowable cost programs. 96.33Establishment of the amount of payment for drugs shall not be subject to the requirements 96.34of the Administrative Procedure Act.97.1    (b) An additional dispensing fee of $.30 may be added to the dispensing fee paid 97.2to pharmacists for legend drug prescriptions dispensed to residents of long-term care 97.3facilities when a unit dose blister card system, approved by the department, is used. Under 97.4this type of dispensing system, the pharmacist must dispense a 30-day supply of drug. 97.5The National Drug Code (NDC) from the drug container used to fill the blister card must 97.6be identified on the claim to the department. The unit dose blister card containing the 97.7drug must meet the packaging standards set forth in Minnesota Rules, part 6800.2700, 97.8that govern the return of unused drugs to the pharmacy for reuse. The pharmacy provider 97.9will be required to credit the department for the actual acquisition cost of all unused 97.10drugs that are eligible for reuse. Over-the-counter medications must be dispensed in the 97.11manufacturer's unopened package. The commissioner may permit the drug clozapine to be 97.12dispensed in a quantity that is less than a 30-day supply.97.13    (c) Whenever a generically equivalent product is available, payment shall be on the 97.14basis of the actual acquisition cost of the generic drug, or on the maximum allowable cost 97.15established by the commissioner.97.16    (d) The basis for determining the amount of payment for drugs administered in an 97.17outpatient setting shall be the lower of the usual and customary cost submitted by the 97.18provider or the amount established for Medicare by the United States Department of 97.19Health and Human Services pursuant to title XVIII, section 1847a of the federal Social 97.20Security Act.97.21    (e) The commissioner may negotiate lower reimbursement rates for specialty 97.22pharmacy products than the rates specified in paragraph (a). The commissioner may 97.23require individuals enrolled in the health care programs administered by the department 97.24to obtain specialty pharmacy products from providers with whom the commissioner has 97.25negotiated lower reimbursement rates. Specialty pharmacy products are defined as those 97.26used by a small number of recipients or recipients with complex and chronic diseases 97.27that require expensive and challenging drug regimens. Examples of these conditions 97.28include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis 97.29C, growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms 97.30of cancer. Specialty pharmaceutical products include injectable and infusion therapies, 97.31biotechnology drugs, high-cost therapies, and therapies that require complex care. The 97.32commissioner shall consult with the formulary committee to develop a list of specialty 97.33pharmacy products subject to this paragraph. In consulting with the formulary committee 97.34in developing this list, the commissioner shall take into consideration the population 97.35served by specialty pharmacy products, the current delivery system and standard of care in 98.1the state, and access to care issues. The commissioner shall have the discretion to adjust 98.2the reimbursement rate to prevent access to care issues.98.3    Sec. 31. Minnesota Statutes 2008, section 256B.0625, subdivision 13h, is amended to 98.4read:98.5    Subd. 13h.  Medication therapy management services. (a) Medical assistance 98.6and general assistance medical care cover medication therapy management services for 98.7a recipient taking four or more prescriptions to treat or prevent two or more chronic 98.8medical conditions, or a recipient with a drug therapy problem that is identified or prior 98.9authorized by the commissioner that has resulted or is likely to result in significant 98.10nondrug program costs. The commissioner may cover medical therapy management 98.11services under MinnesotaCare if the commissioner determines this is cost-effective. For 98.12purposes of this subdivision, "medication therapy management" means the provision 98.13of the following pharmaceutical care services by a licensed pharmacist to optimize the 98.14therapeutic outcomes of the patient's medications: 98.15    (1) performing or obtaining necessary assessments of the patient's health status; 98.16    (2) formulating a medication treatment plan; 98.17    (3) monitoring and evaluating the patient's response to therapy, including safety 98.18and effectiveness; 98.19    (4) performing a comprehensive medication review to identify, resolve, and prevent 98.20medication-related problems, including adverse drug events; 98.21    (5) documenting the care delivered and communicating essential information to 98.22the patient's other primary care providers; 98.23    (6) providing verbal education and training designed to enhance patient 98.24understanding and appropriate use of the patient's medications; 98.25    (7) providing information, support services, and resources designed to enhance 98.26patient adherence with the patient's therapeutic regimens; and 98.27    (8) coordinating and integrating medication therapy management services within the 98.28broader health care management services being provided to the patient. 98.29Nothing in this subdivision shall be construed to expand or modify the scope of practice of 98.30the pharmacist as defined in section 
         151.01, subdivision 27. 98.31    (b) To be eligible for reimbursement for services under this subdivision, a pharmacist 98.32must meet the following requirements: 98.33    (1) have a valid license issued under chapter 151; 98.34    (2) have graduated from an accredited college of pharmacy on or after May 1996, or 98.35completed a structured and comprehensive education program approved by the Board of 99.1Pharmacy and the American Council of Pharmaceutical Education for the provision and 99.2documentation of pharmaceutical care management services that has both clinical and 99.3didactic elements; 99.4    (3) be practicing in an ambulatory care setting as part of a multidisciplinary team or 99.5have developed a structured patient care process that is offered in a private or semiprivate 99.6patient care area that is separate from the commercial business that also occurs in the 99.7setting, or in home settings, excluding long-term care and group homes, if the service is 99.8ordered by the provider-directed care coordination team; and 99.9    (4) make use of an electronic patient record system that meets state standards. 99.10    (c) For purposes of reimbursement for medication therapy management services, 99.11the commissioner may enroll individual pharmacists as medical assistance and general 99.12assistance medical care providers. The commissioner may also establish contact 99.13requirements between the pharmacist and recipient, including limiting the number of 99.14reimbursable consultations per recipient. 99.15    (d) The commissioner, after receiving recommendations from professional medical 99.16associations, professional pharmacy associations, and consumer groups, shall convene 99.17an 11-member Medication Therapy Management Advisory Committee to advise 99.18the commissioner on the implementation and administration of medication therapy 99.19management services. The committee shall be comprised of: two licensed physicians; 99.20two licensed pharmacists; two consumer representatives; two health plan company 99.21representatives; and three members with expertise in the area of medication therapy 99.22management, who may be licensed physicians or licensed pharmacists. The committee is 99.23governed by section 15.059, except that committee members do not receive compensation 99.24or reimbursement for expenses. The advisory committee expires on June 30, 2007. 99.25    (e) The commissioner shall evaluate the effect of medication therapy management 99.26on quality of care, patient outcomes, and program costs, and shall include a description 99.27of any savings generated in the medical assistance and general assistance medical care 99.28programs that can be attributable to this coverage. The evaluation shall be submitted to 99.29the legislature by December 15, 2007. The commissioner may contract with a vendor 99.30or an academic institution that has expertise in evaluating health care outcomes for the 99.31purpose of completing the evaluation. 99.32(d) The commissioner shall establish a pilot project for an intensive medication 99.33therapy management program for patients identified by the commissioner with multiple 99.34chronic conditions and a high number of medications who are at high risk of preventable 99.35hospitalizations, emergency room use, medication complications, and suboptimal 99.36treatment outcomes due to medication-related problems. For purposes of the pilot 100.1project, medication therapy management services may be provided in a patient's home 100.2or community setting, in addition to other authorized settings. The commissioner may 100.3waive existing payment policies and establish special payment rates for the pilot project. 100.4The pilot project must be designed to produce a net savings to the state compared to the 100.5estimated costs that would otherwise be incurred for similar patients without the program.100.6    Sec. 32. Minnesota Statutes 2008, section 256B.0625, subdivision 17, is amended to 100.7read:100.8    Subd. 17. Transportation costs. (a) Medical assistance covers medical 100.9transportation costs incurred solely for obtaining emergency medical care or transportation 100.10costs incurred by eligible persons in obtaining emergency or nonemergency medical 100.11care when paid directly to an ambulance company, common carrier, or other recognized 100.12providers of transportation services. Medical transportation must be provided by:100.13(1) an ambulance, as defined in section 144E.001, subdivision 2;100.14(2) special transportation; or100.15(3) common carrier including, but not limited to, bus, taxicab, other commercial 100.16carrier, or private automobile.100.17(b) Medical assistance covers special transportation, as defined in Minnesota Rules, 100.18part 9505.0315, subpart 1, item F, if the recipient has a physical or mental impairment that 100.19would prohibit the recipient from safely accessing and using a bus, taxi, other commercial 100.20transportation, or private automobile.100.21The commissioner may use an order by the recipient's attending physician to certify that 100.22the recipient requires special transportation services. Special transportation includes100.23providers shall perform driver-assisted service to services for eligible individuals. 100.24Driver-assisted service includes passenger pickup at and return to the individual's 100.25residence or place of business, assistance with admittance of the individual to the medical 100.26facility, and assistance in passenger securement or in securing of wheelchairs or stretchers 100.27in the vehicle. Special transportation providers must obtain written documentation 100.28from the health care service provider who is serving the recipient being transported, 100.29identifying the time that the recipient arrived. Special transportation providers may not 100.30bill for separate base rates for the continuation of a trip beyond the original destination. 100.31Special transportation providers must take recipients to the nearest appropriate health 100.32care provider, using the most direct route available. The maximum minimum medical 100.33assistance reimbursement rates for special transportation services are:100.34(1) (i) $17 for the base rate and $1.35 per mile for special transportation services to 100.35eligible persons who need a wheelchair-accessible van;101.1(2) (ii)  $11.50 for the base rate and $1.30 per mile for special transportation services 101.2to eligible persons who do not need a wheelchair-accessible van; and101.3(3) (iii)  $60 for the base rate and $2.40 per mile, and an attendant rate of $9 per trip, 101.4for special transportation services to eligible persons who need a stretcher-accessible 101.5vehicle;101.6(2) the base rates for special transportation services in areas defined under RUCA 101.7to be super rural shall be equal to the reimbursement rate established in clause (1) plus 101.811.3 percent; and101.9(3) for special transportation services in areas defined under RUCA to be rural 101.10or super rural areas:101.11(i) for a trip equal to 17 miles or less, mileage reimbursement shall be equal to 125 101.12percent of the respective mileage rate in clause (1); and101.13(ii) for a trip between 18 and 50 miles, mileage reimbursement shall be equal to 101.14112.5 percent of the respective mileage rate in clause (1).101.15(c) For purposes of reimbursement rates for special transportation services under 101.16paragraph (b), the zip code of the recipient's place of residence shall determine whether 101.17the urban, rural, or super rural reimbursement rate applies.101.18(d) For purposes of this subdivision, "rural urban commuting area" or "RUCA" 101.19means a census-tract based classification system under which a geographical area is 101.20determined to be urban, rural, or super rural.101.21    Sec. 33. Minnesota Statutes 2008, section 256B.0625, subdivision 17a, is amended to 101.22read:101.23    Subd. 17a. Payment for ambulance services.Medical assistance covers 101.24ambulance services. Providers shall bill ambulance services according to Medicare 101.25criteria. Nonemergency ambulance services shall not be paid as emergencies. Effective 101.26for services rendered on or after July 1, 2001, medical assistance payments for ambulance 101.27services shall be paid at the Medicare reimbursement rate or at the medical assistance 101.28payment rate in effect on July 1, 2000, whichever is greater.101.29    Sec. 34. Minnesota Statutes 2008, section 256B.0625, is amended by adding a 101.30subdivision to read:101.31    Subd. 18b.Broker dispatching prohibition.The commissioner shall not use a 101.32broker or coordinator for any purpose related to transportation services under subdivision 101.3318.102.1    Sec. 35. Minnesota Statutes 2008, section 256B.0625, is amended by adding a 102.2subdivision to read:102.3    Subd. 25a.Prior authorization of diagnostic imaging services.(a) Effective 102.4January 1, 2010, the commissioner shall require prior authorization or decision support 102.5for the ordering providers at the time the service is ordered for the following outpatient 102.6diagnostic imaging services: computerized tomography (CT), magnetic resonance 102.7imaging (MRI), magnetic resonance angiography (MRA), positive emission tomography 102.8(PET), cardiac imaging and ultrasound diagnostic imaging.102.9(b) Prior authorization under this subdivision is not required for diagnostic imaging 102.10services performed as part of a hospital emergency room visit, inpatient hospitalization, or 102.11if concurrent with or on the same day as an urgent care facility visit.102.12(c) This subdivision does not apply to services provided to recipients who are 102.13enrolled in Medicare, the prepaid medical assistance program, the prepaid general 102.14assistance medical care program, or the MinnesotaCare program.102.15(d) The commissioner may contract with a private entity to provide the prior 102.16authorization or decision support required under this subdivision. The contracting entity 102.17must incorporate clinical guidelines that are based on evidence-based medical literature, if 102.18available. By January 1, 2012, the contracting entity shall report to the commissioner the 102.19results of prior authorization or decision support.102.20    Sec. 36. Minnesota Statutes 2008, section 256B.0625, subdivision 26, is amended to 102.21read:102.22    Subd. 26. Special education services. (a) Medical assistance covers medical 102.23services identified in a recipient's individualized education plan and covered under the 102.24medical assistance state plan. Covered services include occupational therapy, physical 102.25therapy, speech-language therapy, clinical psychological services, nursing services, 102.26school psychological services, school social work services, personal care assistants 102.27serving as management aides, assistive technology devices, transportation services, 102.28health assessments, and other services covered under the medical assistance state plan. 102.29Mental health services eligible for medical assistance reimbursement must be provided or 102.30coordinated through a children's mental health collaborative where a collaborative exists if 102.31the child is included in the collaborative operational target population. The provision or 102.32coordination of services does not require that the individual education plan be developed 102.33by the collaborative.102.34The services may be provided by a Minnesota school district that is enrolled as a 102.35medical assistance provider or its subcontractor, and only if the services meet all the 103.1requirements otherwise applicable if the service had been provided by a provider other 103.2than a school district, in the following areas: medical necessity, physician's orders, 103.3documentation, personnel qualifications, and prior authorization requirements. The 103.4nonfederal share of costs for services provided under this subdivision is the responsibility 103.5of the local school district as provided in section 
         125A.74. Services listed in a child's 103.6individual education plan are eligible for medical assistance reimbursement only if those 103.7services meet criteria for federal financial participation under the Medicaid program. 103.8(b) Approval of health-related services for inclusion in the individual education plan 103.9does not require prior authorization for purposes of reimbursement under this chapter. 103.10The commissioner may require physician review and approval of the plan not more than 103.11once annually or upon any modification of the individual education plan that reflects a 103.12change in health-related services.103.13(c) Services of a speech-language pathologist provided under this section are covered 103.14notwithstanding Minnesota Rules, part 9505.0390, subpart 1, item L, if the person:103.15(1) holds a masters degree in speech-language pathology;103.16(2) is licensed by the Minnesota Board of Teaching as an educational 103.17speech-language pathologist; and103.18(3) either has a certificate of clinical competence from the American Speech and 103.19Hearing Association, has completed the equivalent educational requirements and work 103.20experience necessary for the certificate or has completed the academic program and is 103.21acquiring supervised work experience to qualify for the certificate.103.22(d) Medical assistance coverage for medically necessary services provided under 103.23other subdivisions in this section may not be denied solely on the basis that the same or 103.24similar services are covered under this subdivision.103.25(e) The commissioner shall develop and implement package rates, bundled rates, or 103.26per diem rates for special education services under which separately covered services are 103.27grouped together and billed as a unit in order to reduce administrative complexity.103.28(f) The commissioner shall develop a cost-based payment structure for payment 103.29of these services. The commissioner shall reimburse claims submitted based on an 103.30interim rate, and shall settle at a final rate once the department has determined it. The 103.31commissioner shall notify the school district of the final rate. The school district has 60 103.32days to appeal the final rate. To appeal the final rate, the school district shall file a written 103.33appeal request to the commissioner within 60 days of the date the final rate determination 103.34was mailed. The appeal request shall specify (1) the disputed items and (2) the name and 103.35address of the person to contact regarding the appeal.104.1(g) Effective July 1, 2000, medical assistance services provided under an individual 104.2education plan or an individual family service plan by local school districts shall not count 104.3against medical assistance authorization thresholds for that child.104.4(h) Nursing services as defined in section 
         148.171, subdivision 15, and provided 104.5as an individual education plan health-related service, are eligible for medical assistance 104.6payment if they are otherwise a covered service under the medical assistance program. 104.7Medical assistance covers the administration of prescription medications by a licensed 104.8nurse who is employed by or under contract with a school district when the administration 104.9of medications is identified in the child's individualized education plan. The simple 104.10administration of medications alone is not covered under medical assistance when 104.11administered by a provider other than a school district or when it is not identified in the 104.12child's individualized education plan. 104.13    Sec. 37. Minnesota Statutes 2008, section 256B.08, is amended by adding a 104.14subdivision to read:104.15    Subd. 4.Data from Social Security.The commissioner shall accept data from the 104.16Social Security Administration in accordance with United States Code, title 42, section 104.171396U-5(a).104.18EFFECTIVE DATE.This section is effective January 1, 2010.104.19    Sec. 38. Minnesota Statutes 2008, section 256B.15, subdivision 1, is amended to read:104.20    Subdivision 1. Policy and applicability. (a) It is the policy of this state that 104.21individuals or couples, either or both of whom participate in the medical assistance 104.22program, use their own assets to pay their share of the total cost of their care during or 104.23after their enrollment in the program according to applicable federal law and the laws of 104.24this state. The following provisions apply:104.25    (1) subdivisions 1c to 1k shall not apply to claims arising under this section which 104.26are presented under section 
         525.313;104.27    (2) the provisions of subdivisions 1c to 1k expanding the interests included in an 104.28estate for purposes of recovery under this section give effect to the provisions of United 104.29States Code, title 42, section 1396p, governing recoveries, but do not give rise to any 104.30express or implied liens in favor of any other parties not named in these provisions;104.31    (3) the continuation of a recipient's life estate or joint tenancy interest in real 104.32property after the recipient's death for the purpose of recovering medical assistance under 104.33this section modifies common law principles holding that these interests terminate on 104.34the death of the holder;105.1    (4) all laws, rules, and regulations governing or involved with a recovery of medical 105.2assistance shall be liberally construed to accomplish their intended purposes;105.3    (5) a deceased recipient's life estate and joint tenancy interests continued under this 105.4section shall be owned by the remaindermen or surviving joint tenants as their interests 105.5may appear on the date of the recipient's death. They shall not be merged into the 105.6remainder interest or the interests of the surviving joint tenants by reason of ownership. 105.7They shall be subject to the provisions of this section. Any conveyance, transfer, sale, 105.8assignment, or encumbrance by a remainderman, a surviving joint tenant, or their heirs, 105.9successors, and assigns shall be deemed to include all of their interest in the deceased 105.10recipient's life estate or joint tenancy interest continued under this section; and105.11    (6) the provisions of subdivisions 1c to 1k continuing a recipient's joint tenancy 105.12interests in real property after the recipient's death do not apply to a homestead owned 105.13of record, on the date the recipient dies, by the recipient and the recipient's spouse as 105.14joint tenants with a right of survivorship. Homestead means the real property occupied 105.15by the surviving joint tenant spouse as their sole residence on the date the recipient dies 105.16and classified and taxed to the recipient and surviving joint tenant spouse as homestead 105.17property for property tax purposes in the calendar year in which the recipient dies. For 105.18purposes of this exemption, real property the recipient and their surviving joint tenant 105.19spouse purchase solely with the proceeds from the sale of their prior homestead, own 105.20of record as joint tenants, and qualify as homestead property under section 
         273.124 in 105.21the calendar year in which the recipient dies and prior to the recipient's death shall be 105.22deemed to be real property classified and taxed to the recipient and their surviving joint 105.23tenant spouse as homestead property in the calendar year in which the recipient dies. 105.24The surviving spouse, or any person with personal knowledge of the facts, may provide 105.25an affidavit describing the homestead property affected by this clause and stating facts 105.26showing compliance with this clause. The affidavit shall be prima facie evidence of the 105.27facts it states.105.28    (b) For purposes of this section, "medical assistance" includes the medical assistance 105.29program under this chapter and the general assistance medical care program under chapter 105.30256D and alternative care for nonmedical assistance recipients under section 
         256B.0913.105.31    (c) For purposes of this section, beginning January 1, 2010, "medical assistance" 105.32does not include Medicare cost-sharing benefits in accordance with United States Code, 105.33title 42, section 1396p.105.34    (d) All provisions in this subdivision, and subdivisions 1d, 1f, 1g, 1h, 1i, and 1j, 105.35related to the continuation of a recipient's life estate or joint tenancy interests in real 105.36property after the recipient's death for the purpose of recovering medical assistance, are 106.1effective only for life estates and joint tenancy interests established on or after August 1, 106.22003. For purposes of this paragraph, medical assistance does not include alternative care.106.3    Sec. 39. Minnesota Statutes 2008, section 256B.15, subdivision 1a, is amended to read:106.4    Subd. 1a. Estates subject to claims.(a) If a person receives any medical assistance 106.5hereunder, on the person's death, if single, or on the death of the survivor of a married 106.6couple, either or both of whom received medical assistance, or as otherwise provided 106.7for in this section, the total amount paid for medical assistance rendered for the person 106.8and spouse shall be filed as a claim against the estate of the person or the estate of the 106.9surviving spouse in the court having jurisdiction to probate the estate or to issue a decree 106.10of descent according to sections 
         525.31 to 
         525.313. 106.11(b) For the purposes of this section, the person's estate must consist of:106.12(1) the person's probate estate;106.13(2) all of the person's interests or proceeds of those interests in real property the 106.14person owned as a life tenant or as a joint tenant with a right of survivorship at the time of 106.15the person's death;106.16(3) all of the person's interests or proceeds of those interests in securities the person 106.17owned in beneficiary form as provided under sections 524.6-301 to 524.6-311 at the time 106.18of the person's death, to the extent the interests or proceeds of those interests become part 106.19of the probate estate under section 524.6-307;106.20(4) all of the person's interests in joint accounts, multiple-party accounts, and 106.21pay-on-death accounts, brokerage accounts, investment accounts, or the proceeds of 106.22those accounts, as provided under sections 524.6-201 to 524.6-214 at the time of the 106.23person's death to the extent the interests become part of the probate estate under section 106.24524.6-207; and106.25(5) assets conveyed to a survivor, heir, or assign of the person through survivorship, 106.26living trust, or other arrangements.106.27(c) For the purpose of this section and recovery in a surviving spouse's estate for 106.28medical assistance paid for a predeceased spouse, the estate must consist of all of the legal 106.29title and interests the deceased individual's predeceased spouse had in jointly owned or 106.30marital property at the time of the spouse's death, as defined in subdivision 2b, and the 106.31proceeds of those interests, that passed to the deceased individual or another individual, a 106.32survivor, an heir, or an assign of the predeceased spouse through a joint tenancy, tenancy 106.33in common, survivorship, life estate, living trust, or other arrangement. A deceased 106.34recipient who, at death, owned the property jointly with the surviving spouse shall have 106.35an interest in the entire property.107.1(d) For the purpose of recovery in a single person's estate or the estate of a survivor 107.2of a married couple, "other arrangement" includes any other means by which title to all or 107.3any part of the jointly owned or marital property or interest passed from the predeceased 107.4spouse to another including, but not limited to, transfers between spouses which are 107.5permitted, prohibited, or penalized for purposes of medical assistance.107.6(e) A claim shall be filed if medical assistance was rendered for either or both 107.7persons under one of the following circumstances:107.8(a) (1) the person was over 55 years of age, and received services under this chapter;107.9(b) (2) the person resided in a medical institution for six months or longer, received 107.10services under this chapter, and, at the time of institutionalization or application for 107.11medical assistance, whichever is later, the person could not have reasonably been expected 107.12to be discharged and returned home, as certified in writing by the person's treating 107.13physician. For purposes of this section only, a "medical institution" means a skilled 107.14nursing facility, intermediate care facility, intermediate care facility for persons with 107.15developmental disabilities, nursing facility, or inpatient hospital; or107.16(c) (3) the person received general assistance medical care services under chapter 107.17256D.107.18(f) The claim shall be considered an expense of the last illness of the decedent for the 107.19purpose of section 
         524.3-805. Notwithstanding any law or rule to the contrary, a state or 107.20county agency with a claim under this section must be a creditor under section 524.6-307.107.21Any statute of limitations that purports to limit any county agency or the state agency, 107.22or both, to recover for medical assistance granted hereunder shall not apply to any claim 107.23made hereunder for reimbursement for any medical assistance granted hereunder. Notice 107.24of the claim shall be given to all heirs and devisees of the decedent whose identity can be 107.25ascertained with reasonable diligence. The notice must include procedures and instructions 107.26for making an application for a hardship waiver under subdivision 5; time frames for 107.27submitting an application and determination; and information regarding appeal rights and 107.28procedures. Counties are entitled to one-half of the nonfederal share of medical assistance 107.29collections from estates that are directly attributable to county effort. Counties are entitled 107.30to ten percent of the collections for alternative care directly attributable to county effort. 107.31    Sec. 40. Minnesota Statutes 2008, section 256B.15, subdivision 1h, is amended to read:107.32    Subd. 1h.  Estates of specific persons receiving medical assistance. (a) For 107.33purposes of this section, paragraphs (b) to (k) (j) apply if a person received medical 107.34assistance for which a claim may be filed under this section and died single, or the 108.1surviving spouse of the couple and was not survived by any of the persons described 108.2in subdivisions 3 and 4. 108.3    (b) For purposes of this section, the person's estate consists of: (1) the person's 108.4probate estate; (2) all of the person's interests or proceeds of those interests in real property 108.5the person owned as a life tenant or as a joint tenant with a right of survivorship at the 108.6time of the person's death; (3) all of the person's interests or proceeds of those interests in 108.7securities the person owned in beneficiary form as provided under sections 524.6-301 to 108.8524.6-311 at the time of the person's death, to the extent they become part of the probate 108.9estate under section 524.6-307; (4) all of the person's interests in joint accounts, multiple 108.10party accounts, and pay on death accounts, or the proceeds of those accounts, as provided 108.11under sections 524.6-201 to 524.6-214 at the time of the person's death to the extent 108.12they become part of the probate estate under section 524.6-207; and (5) the person's 108.13legal title or interest at the time of the person's death in real property transferred under 108.14a transfer on death deed under section 507.071, or in the proceeds from the subsequent 108.15sale of the person's interest in the real property. Notwithstanding any law or rule to the 108.16contrary, a state or county agency with a claim under this section shall be a creditor under 108.17section 524.6-307. 108.18    (c) (b) Notwithstanding any law or rule to the contrary, the person's life estate or joint 108.19tenancy interest in real property not subject to a medical assistance lien under sections 108.20514.980
          to 
         514.985 on the date of the person's death shall not end upon the person's death 108.21and shall continue as provided in this subdivision. The life estate in the person's estate 108.22shall be that portion of the interest in the real property subject to the life estate that is equal 108.23to the life estate percentage factor for the life estate as listed in the Life Estate Mortality 108.24Table of the health care program's manual for a person who was the age of the medical 108.25assistance recipient on the date of the person's death. The joint tenancy interest in real 108.26property in the estate shall be equal to the fractional interest the person would have owned 108.27in the jointly held interest in the property had they and the other owners held title to the 108.28property as tenants in common on the date the person died. 108.29    (d) (c) The court upon its own motion, or upon motion by the personal representative 108.30or any interested party, may enter an order directing the remaindermen or surviving joint 108.31tenants and their spouses, if any, to sign all documents, take all actions, and otherwise 108.32fully cooperate with the personal representative and the court to liquidate the decedent's 108.33life estate or joint tenancy interests in the estate and deliver the cash or the proceeds of 108.34those interests to the personal representative and provide for any legal and equitable 108.35sanctions as the court deems appropriate to enforce and carry out the order, including an 108.36award of reasonable attorney fees. 109.1    (e) (d) The personal representative may make, execute, and deliver any conveyances 109.2or other documents necessary to convey the decedent's life estate or joint tenancy interest 109.3in the estate that are necessary to liquidate and reduce to cash the decedent's interest or 109.4for any other purposes. 109.5    (f) (e) Subject to administration, all costs, including reasonable attorney fees, 109.6directly and immediately related to liquidating the decedent's life estate or joint tenancy 109.7interest in the decedent's estate, shall be paid from the gross proceeds of the liquidation 109.8allocable to the decedent's interest and the net proceeds shall be turned over to the personal 109.9representative and applied to payment of the claim presented under this section. 109.10    (g) (f) The personal representative shall bring a motion in the district court in which 109.11the estate is being probated to compel the remaindermen or surviving joint tenants to 109.12account for and deliver to the personal representative all or any part of the proceeds of any 109.13sale, mortgage, transfer, conveyance, or any disposition of real property allocable to the 109.14decedent's life estate or joint tenancy interest in the decedent's estate, and do everything 109.15necessary to liquidate and reduce to cash the decedent's interest and turn the proceeds of 109.16the sale or other disposition over to the personal representative. The court may grant any 109.17legal or equitable relief including, but not limited to, ordering a partition of real estate 109.18under chapter 558 necessary to make the value of the decedent's life estate or joint tenancy 109.19interest available to the estate for payment of a claim under this section. 109.20    (h) (g) Subject to administration, the personal representative shall use all of the cash 109.21or proceeds of interests to pay an allowable claim under this section. The remaindermen 109.22or surviving joint tenants and their spouses, if any, may enter into a written agreement 109.23with the personal representative or the claimant to settle and satisfy obligations imposed at 109.24any time before or after a claim is filed. 109.25    (i) (h) The personal representative may, at their discretion, provide any or all of the 109.26other owners, remaindermen, or surviving joint tenants with an affidavit terminating the 109.27decedent's estate's interest in real property the decedent owned as a life tenant or as a joint 109.28tenant with others, if the personal representative determines in good faith that neither the 109.29decedent nor any of the decedent's predeceased spouses received any medical assistance 109.30for which a claim could be filed under this section, or if the personal representative has 109.31filed an affidavit with the court that the estate has other assets sufficient to pay a claim, as 109.32presented, or if there is a written agreement under paragraph (h) (g), or if the claim, as 109.33allowed, has been paid in full or to the full extent of the assets the estate has available 109.34to pay it. The affidavit may be recorded in the office of the county recorder or filed in 109.35the Office of the Registrar of Titles for the county in which the real property is located. 109.36Except as provided in section 
         514.981, subdivision 6, when recorded or filed, the affidavit 110.1shall terminate the decedent's interest in real estate the decedent owned as a life tenant or a 110.2joint tenant with others. The affidavit shall:110.3(1) be signed by the personal representative;110.4(2) identify the decedent and the interest being terminated;110.5(3) give recording information sufficient to identify the instrument that created the 110.6interest in real property being terminated;110.7(4) legally describe the affected real property;110.8(5) state that the personal representative has determined that neither the decedent 110.9nor any of the decedent's predeceased spouses received any medical assistance for which 110.10a claim could be filed under this section;110.11(6) state that the decedent's estate has other assets sufficient to pay the claim, as 110.12presented, or that there is a written agreement between the personal representative and 110.13the claimant and the other owners or remaindermen or other joint tenants to satisfy the 110.14obligations imposed under this subdivision; and110.15(7) state that the affidavit is being given to terminate the estate's interest under this 110.16subdivision, and any other contents as may be appropriate.110.17The recorder or registrar of titles shall accept the affidavit for recording or filing. The 110.18affidavit shall be effective as provided in this section and shall constitute notice even if it 110.19does not include recording information sufficient to identify the instrument creating the 110.20interest it terminates. The affidavit shall be conclusive evidence of the stated facts. 110.21    (j) (i) The holder of a lien arising under subdivision 1c shall release the lien at 110.22the holder's expense against an interest terminated under paragraph (h) (g) to the extent 110.23of the termination. 110.24    (k) (j) If a lien arising under subdivision 1c is not released under paragraph (j) (i), 110.25prior to closing the estate, the personal representative shall deed the interest subject to the 110.26lien to the remaindermen or surviving joint tenants as their interests may appear. Upon 110.27recording or filing, the deed shall work a merger of the recipient's life estate or joint 110.28tenancy interest, subject to the lien, into the remainder interest or interest the decedent and 110.29others owned jointly. The lien shall attach to and run with the property to the extent of 110.30the decedent's interest at the time of the decedent's death. 110.31    Sec. 41. Minnesota Statutes 2008, section 256B.15, subdivision 2, is amended to read:110.32    Subd. 2. Limitations on claims. The claim shall include only the total amount 110.33of medical assistance rendered after age 55 or during a period of institutionalization 110.34described in subdivision 1a, clause (b) paragraph (e), and the total amount of general 110.35assistance medical care rendered, and shall not include interest. Claims that have been 111.1allowed but not paid shall bear interest according to section 
         524.3-806, paragraph (d). A 111.2claim against the estate of a surviving spouse who did not receive medical assistance, for 111.3medical assistance rendered for the predeceased spouse, shall be payable from the full 111.4value of all of the predeceased spouse's assets and interests which are part of the surviving 111.5spouse's estate under subdivisions 1a and 2b. Recovery of medical assistance expenses in 111.6the nonrecipient surviving spouse's estate is limited to the value of the assets of the estate 111.7that were marital property or jointly owned property at any time during the marriage. The 111.8claim is not payable from the value of assets or proceeds of assets in the estate attributable 111.9to a predeceased spouse whom the individual married after the death of the predeceased 111.10recipient spouse for whom the claim is filed or from assets and the proceeds of assets in the 111.11estate which the nonrecipient decedent spouse acquired with assets which were not marital 111.12property or jointly owned property after the death of the predeceased recipient spouse.111.13Claims for alternative care shall be net of all premiums paid under section 
         256B.0913, 111.14subdivision 12
         , on or after July 1, 2003, and shall be limited to services provided on or 111.15after July 1, 2003. Claims against marital property shall be limited to claims against 111.16recipients who died on or after July 1, 2009.111.17    Sec. 42. Minnesota Statutes 2008, section 256B.15, is amended by adding a 111.18subdivision to read:111.19    Subd. 2b.Controlling provisions.(a) For purposes of this subdivision and 111.20subdivisions 1a and 2, paragraphs (b) to (d) apply.111.21(b) At the time of death of a recipient spouse and solely for purpose of recovery of 111.22medical assistance benefits received, a predeceased recipient spouse shall have a legal 111.23title or interest in the undivided whole of all of the property which the recipient and the 111.24recipient's surviving spouse owned jointly or which was marital property at any time 111.25during their marriage regardless of the form of ownership and regardless of whether 111.26it was owned or titled in the names of one or both the recipient and the recipient's 111.27spouse. Title and interest in the property of a predeceased recipient spouse shall not end 111.28or extinguish upon the person's death and shall continue for the purpose of allowing 111.29recovery of medical assistance in the estate of the surviving spouse. Upon the death of 111.30the predeceased recipient spouse, title and interest in the predeceased spouse's property 111.31shall vest in the surviving spouse by operation of law and without the necessity for any 111.32probate or decree of descent proceedings and shall continue to exist after the death of the 111.33predeceased spouse and the surviving spouse to permit recovery of medical assistance. 111.34The recipient spouse and the surviving spouse of a deceased recipient spouse shall not 112.1encumber, disclaim, transfer, alienate, hypothecate, or otherwise divest themselves of 112.2these interests before or upon death.112.3(c) For purposes of this section, "marital property" includes any and all real or 112.4personal property of any kind or interests in such property the predeceased recipient 112.5spouse and their spouse, or either of them, owned at the time of their marriage to each 112.6other or acquired during their marriage regardless of whether it was owned or titled in 112.7the names of one or both of them. If either or both spouses of a married couple received 112.8medical assistance, all property owned during the marriage or which either or both spouses 112.9acquired during their marriage shall be presumed to be marital property for purposes of 112.10recovering medical assistance unless there is clear and convincing evidence to the contrary.112.11(d) The agency responsible for the claim for medical assistance for a recipient spouse 112.12may, at its discretion, release specific real and personal property from the provisions of 112.13this section. The release shall extinguish the interest created under paragraph (b) in the 112.14land it describes upon filing or recording. The release need not be attested, certified, or 112.15acknowledged as a condition of filing or recording and shall be filed or recorded in the 112.16office of the county recorder or registrar of titles, as appropriate, in the county where the 112.17real property is located. The party to whom the release is given shall be responsible for 112.18paying all fees and costs necessary to record and file the release. If the property described 112.19in the release is registered property, the registrar of titles shall accept it for recording and 112.20shall record it on the certificate of title for each parcel of property described in the release. 112.21If the property described in the release is abstract property, the recorder shall accept it 112.22for filing and file it in the county's grantor-grantee indexes and any tract index the county 112.23maintains for each parcel of property described in the release.112.24    Sec. 43. Minnesota Statutes 2008, section 256B.15, is amended by adding a 112.25subdivision to read:112.26    Subd. 9.Commissioner's intervention.The commissioner shall be permitted to 112.27intervene as a party in any proceeding involving recovery of medical assistance upon 112.28filing a notice of intervention and serving such notice on the other parties.112.29    Sec. 44. [256B.196] INTERGOVERNMENTAL TRANSFERS; HOSPITAL 112.30PAYMENTS.112.31    Subdivision 1.Federal approval required.This section is contingent on federal 112.32approval of the intergovernmental transfers and payments authorized under this section. 112.33This section is also contingent on current payment by the government entities of the 112.34intergovernmental transfers under this section.113.1    Subd. 2.Commissioner's duties.(a) For the purposes of this subdivision and 113.2subdivision 3, the commissioner shall determine the fee-for-service outpatient hospital 113.3services upper payment limit for nonstate government hospitals. The commissioner shall 113.4then determine the amount of a supplemental payment to Hennepin County Medical 113.5Center and Regions Hospital for these services that would increase medical assistance 113.6spending in this category to the aggregate upper payment limit for all nonstate government 113.7hospitals in Minnesota. In making this determination, the commissioner shall allot the 113.8available increases between Hennepin County Medical Center and Regions Hospital 113.9based on the ratio of medical assistance fee-for-service outpatient hospital payments to 113.10the two facilities. The commissioner shall adjust this allotment as necessary based on 113.11federal approvals, the amount of intergovernmental transfers received from Hennepin and 113.12Ramsey Counties, and other factors, in order to maximize the additional total payments. 113.13The commissioner shall inform Hennepin County and Ramsey County of the periodic 113.14intergovernmental transfers necessary to match federal Medicaid payments available 113.15under this subdivision in order to make supplementary medical assistance payments to 113.16Hennepin County Medical Center and Regions Hospital equal to an amount that when 113.17combined with existing medical assistance payments to nonstate governmental hospitals 113.18would increase total payments to hospitals in this category for outpatient services to 113.19the aggregate upper payment limit for all hospitals in this category in Minnesota. Upon 113.20receipt of these periodic transfers, the commissioner shall make supplementary payments 113.21to Hennepin County Medical Center and Regions Hospital.113.22(b) For the purposes of this subdivision and subdivision 3, the commissioner shall 113.23determine an upper payment limit for physicians affiliated with Hennepin County Medical 113.24Center and with Regions Hospital. The upper payment limit shall be based on the average 113.25commercial rate or be determined using another method acceptable to the Centers for 113.26Medicare and Medicaid Services. The commissioner shall inform Hennepin County and 113.27Ramsey County of the periodic intergovernmental transfers necessary to match the federal 113.28Medicaid payments available under this subdivision in order to make supplementary 113.29payments to physicians affiliated with Hennepin County Medical Center and Regions 113.30Hospital equal to the difference between the established medical assistance payment for 113.31physician services and the upper payment limit. Upon receipt of these periodic transfers, 113.32the commissioner shall make supplementary payments to physicians of Hennepin Faculty 113.33Associates and HealthPartners.113.34(c) Beginning January 1, 2010, Hennepin County and Ramsey County shall make 113.35monthly intergovernmental transfers to the commissioner in the following amounts: 113.36$133,333 by Hennepin County and $100,000 by Ramsey County. The commissioner shall 114.1increase the medical assistance capitation payments to Metropolitan Health Plan and 114.2HealthPartners by an amount equal to the annual value of the monthly transfers plus 114.3federal financial participation.114.4(d) The commissioner shall inform Hennepin County and Ramsey County on an 114.5ongoing basis of the need for any changes needed in the intergovernmental transfers 114.6in order to continue the payments under paragraphs (a) to (c), at their maximum level, 114.7including increases in upper payment limits, changes in the federal Medicaid match, and 114.8other factors.114.9(e) The payments in paragraphs (a) to (c) shall be implemented independently of 114.10each other, subject to federal approval and to the receipt of transfers under subdivision 3.114.11    Subd. 3.Intergovernmental transfers.Based on the determination by the 114.12commissioner under subdivision 2, Hennepin County and Ramsey County shall make 114.13periodic intergovernmental transfers to the commissioner for the purposes of subdivision 114.142, paragraphs (a) to (c). All of the intergovernmental transfers made by Hennepin County 114.15shall be used to match federal payments to Hennepin County Medical Center under 114.16subdivision 2, paragraph (a); to physicians affiliated with Hennepin Faculty Associates 114.17under subdivision 2, paragraph (b); and to Metropolitan Health Plan under subdivision 114.182, paragraph (c). All of the intergovernmental transfers made by Ramsey County shall 114.19be used to match federal payments to Regions Hospital under subdivision 2, paragraph 114.20(a); to physicians affiliated with HealthPartners under subdivision 2, paragraph (b); and to 114.21HealthPartners under subdivision 2, paragraph (c).114.22    Subd. 4.Adjustments permitted.(a) The commissioner may adjust the 114.23intergovernmental transfers under subdivision 3 and the payments under subdivision 114.242, based on the commissioner's determination of Medicare upper payment limits, 114.25hospital-specific charge limits, hospital-specific limitations on disproportionate share 114.26payments, medical inflation, actuarial certification, and cost-effectiveness for purposes 114.27of federal waivers. Any adjustments must be made on a proportional basis. The 114.28commissioner may make adjustments under this subdivision only after consultation 114.29with the affected counties and hospitals. All payments under subdivision 2 and all 114.30intergovernmental transfers under subdivision 3 are limited to amounts available after all 114.31other base rates, adjustments, and supplemental payments in chapter 256B are calculated.114.32(b) The ratio of medical assistance payments specified in subdivision 2 to the 114.33voluntary intergovernmental transfers specified in subdivision 3 shall not be reduced 114.34except as provided under paragraph (a).115.1    Subd. 5.Recession period.Each type of intergovernmental transfer in subdivision 115.22, paragraphs (a) to (d), for payment periods from October 1, 2008, through December 115.331, 2010, is voluntary on the part of Hennepin and Ramsey Counties, meaning that the 115.4transfer must be agreed to, in writing, by the counties prior to any payments being issued. 115.5One agreement on each type of transfer shall cover the entire recession period.115.6    Sec. 45. Minnesota Statutes 2008, section 256B.199, is amended to read:115.7256B.199 PAYMENTS REPORTED BY GOVERNMENTAL ENTITIES.115.8    (a) Effective July 1, 2007, the commissioner shall apply for federal matching funds 115.9for the expenditures in paragraphs (b) and (c).115.10    (b) The commissioner shall apply for federal matching funds for certified public 115.11expenditures as follows:115.12    (1) Hennepin County, Hennepin County Medical Center, Ramsey County, Regions 115.13Hospital, the University of Minnesota, and Fairview-University Medical Center shall 115.14report quarterly to the commissioner beginning June 1, 2007, payments made during the 115.15second previous quarter that may qualify for reimbursement under federal law;115.16     (2) based on these reports, the commissioner shall apply for federal matching 115.17funds. These funds are appropriated to the commissioner for the payments under section 115.18256.969, subdivision 27
         ; and115.19     (3) by May 1 of each year, beginning May 1, 2007, the commissioner shall inform 115.20the nonstate entities listed in paragraph (a) of the amount of federal disproportionate share 115.21hospital payment money expected to be available in the current federal fiscal year.115.22    (c) The commissioner shall apply for federal matching funds for general assistance 115.23medical care expenditures as follows:115.24    (1) for hospital services occurring on or after July 1, 2007, general assistance medical 115.25care expenditures for fee-for-service inpatient and outpatient hospital payments made by 115.26the department shall be used to apply for federal matching funds, except as limited below:115.27    (i) only those general assistance medical care expenditures made to an individual 115.28hospital that would not cause the hospital to exceed its individual hospital limits under 115.29section 1923 of the Social Security Act may be considered; and115.30    (ii) general assistance medical care expenditures may be considered only to the extent 115.31of Minnesota's aggregate allotment under section 1923 of the Social Security Act; and115.32    (2) all hospitals must provide any necessary expenditure, cost, and revenue 115.33information required by the commissioner as necessary for purposes of obtaining federal 115.34Medicaid matching funds for general assistance medical care expenditures.116.1(d) For the period from April 1, 2009, to September 30, 2010, the commissioner shall 116.2apply for additional federal matching funds available as disproportionate share hospital 116.3payments under the American Recovery and Reinvestment Act of 2009. These funds shall 116.4be made available as the state share of payments under section 256.969, subdivision 28. 116.5The entities required to report certified public expenditures under paragraph (b), clause 116.6(1), shall report additional certified public expenditures as necessary under this paragraph.116.7EFFECTIVE DATE.This section is effective the day following final enactment.116.8    Sec. 46. Minnesota Statutes 2008, section 256B.69, subdivision 5a, is amended to read:116.9    Subd. 5a. Managed care contracts. (a) Managed care contracts under this section 116.10and sections 
         256L.12 and 
         256D.03, shall be entered into or renewed on a calendar year 116.11basis beginning January 1, 1996. Managed care contracts which were in effect on June 116.1230, 1995, and set to renew on July 1, 1995, shall be renewed for the period July 1, 1995 116.13through December 31, 1995 at the same terms that were in effect on June 30, 1995. The 116.14commissioner may issue separate contracts with requirements specific to services to 116.15medical assistance recipients age 65 and older.116.16    (b) A prepaid health plan providing covered health services for eligible persons 116.17pursuant to chapters 256B, 256D, and 256L, is responsible for complying with the terms 116.18of its contract with the commissioner. Requirements applicable to managed care programs 116.19under chapters 256B, 256D, and 256L, established after the effective date of a contract 116.20with the commissioner take effect when the contract is next issued or renewed.116.21    (c) Effective for services rendered on or after January 1, 2003, the commissioner shall 116.22withhold five percent of managed care plan payments under this section and county-based 116.23purchasing plan's payment rate under section 256B.692 for the prepaid medical assistance 116.24and general assistance medical care programs pending completion of performance targets. 116.25Each performance target must be quantifiable, objective, measurable, and reasonably 116.26attainable, except in the case of a performance target based on a federal or state law or rule. 116.27Criteria for assessment of each performance target must be outlined in writing prior to the 116.28contract effective date. The managed care plan must demonstrate, to the commissioner's 116.29satisfaction, that the data submitted regarding attainment of the performance target is 116.30accurate. The commissioner shall periodically change the administrative measures used 116.31as performance targets in order to improve plan performance across a broader range of 116.32administrative services. The performance targets must include measurement of plan 116.33efforts to contain spending on health care services and administrative activities. The 116.34commissioner may adopt plan-specific performance targets that take into account factors 116.35affecting only one plan, including characteristics of the plan's enrollee population. The 117.1withheld funds must be returned no sooner than July of the following year if performance 117.2targets in the contract are achieved. The commissioner may exclude special demonstration 117.3projects under subdivision 23. A managed care plan or a county-based purchasing plan 117.4under section 256B.692 may include as admitted assets under section 62D.044 any amount 117.5withheld under this paragraph that is reasonably expected to be returned.117.6    (d)(1) Effective for services rendered on or after January 1, 2009, through December 117.731, 2009, the commissioner shall withhold three percent of managed care plan payments 117.8under this section and county-based purchasing plan payments under section 256B.692 for 117.9the prepaid medical assistance and general assistance medical care programs. The withheld 117.10funds must be returned no sooner than July 1 and no later than July 31 of the following 117.11year. The commissioner may exclude special demonstration projects under subdivision 23.117.12    (2) A managed care plan or a county-based purchasing plan under section 256B.692 117.13may include as admitted assets under section 62D.044 any amount withheld under 117.14this paragraph. The return of the withhold under this paragraph is not subject to the 117.15requirements of paragraph (c).117.16(e) Effective for services rendered on or after January 1, 2010, through December 117.1731, 2010, the commissioner shall withhold 3.5 percent of managed care plan payments 117.18under this section and county-based purchasing plan payments under section 256B.692 117.19for the prepaid medical assistance program. The withheld funds must be returned no 117.20sooner than July 1 and no later than July 31 of the following year. The commissioner may 117.21exclude special demonstration projects under subdivision 23. 117.22(f) Effective for services rendered on or after January 1, 2011, through December 31, 117.232011, the commissioner shall withhold four percent of managed care plan payments under 117.24this section and county-based purchasing plan payments under section 256B.692 for the 117.25prepaid medical assistance program. The withheld funds must be returned no sooner than 117.26July 1 and no later than July 31 of the following year. The commissioner may exclude 117.27special demonstration projects under subdivision 23. 117.28(g) Effective for services rendered on or after January 1, 2012, through December 117.2931, 2012, the commissioner shall withhold 4.5 percent of managed care plan payments 117.30under this section and county-based purchasing plan payments under section 256B.692 117.31for the prepaid medical assistance program. The withheld funds must be returned no 117.32sooner than July 1 and no later than July 31 of the following year. The commissioner may 117.33exclude special demonstration projects under subdivision 23.117.34(h) Effective for services rendered on or after January 1, 2013, through December 117.3531, 2013, the commissioner shall withhold 4.5 percent of managed care plan payments 117.36under this section and county-based purchasing plan payments under section 256B.692 118.1for the prepaid medical assistance program. The withheld funds must be returned no 118.2sooner than July 1 and no later than July 31 of the following year. The commissioner may 118.3exclude special demonstration projects under subdivision 23.118.4(i) Effective for services rendered on or after January 1, 2014, the commissioner 118.5shall withhold three percent of managed care plan payments under this section and 118.6county-based purchasing plan payments under section 256B.692 for the prepaid medical 118.7assistance and prepaid general assistance medical care programs. The withheld funds must 118.8be returned no sooner than July 1 and no later than July 31 of the following year. The 118.9commissioner may exclude special demonstration projects under subdivision 23.118.10(j) A managed care plan or a county-based purchasing plan under section 256B.692 118.11may include as admitted assets under section 62D.044 any amount withheld under this 118.12section that is reasonably expected to be returned.118.13    Sec. 47. Minnesota Statutes 2008, section 256B.69, subdivision 5c, is amended to read:118.14    Subd. 5c. Medical education and research fund. (a) Except as provided in 118.15paragraph (c), the commissioner of human services shall transfer each year to the medical 118.16education and research fund established under section 
         62J.692, the following: 118.17(1) an amount equal to the reduction in the prepaid medical assistance and prepaid 118.18general assistance medical care payments as specified in this clause. Until January 1, 118.192002, the county medical assistance and general assistance medical care capitation base 118.20rate prior to plan specific adjustments and after the regional rate adjustments under section 118.21256B.69, subdivision 5b
         , is reduced 6.3 percent for Hennepin County, two percent for 118.22the remaining metropolitan counties, and no reduction for nonmetropolitan Minnesota 118.23counties; and after January 1, 2002, the county medical assistance and general assistance 118.24medical care capitation base rate prior to plan specific adjustments is reduced 6.3 percent 118.25for Hennepin County, two percent for the remaining metropolitan counties, and 1.6 percent 118.26for nonmetropolitan Minnesota counties. Nursing facility and elderly waiver payments 118.27and demonstration project payments operating under subdivision 23 are excluded from 118.28this reduction. The amount calculated under this clause shall not be adjusted for periods 118.29already paid due to subsequent changes to the capitation payments; 118.30(2) beginning July 1, 2003, $2,157,000$4,314,000 from the capitation rates paid 118.31under this section plus any federal matching funds on this amount;118.32(3) beginning July 1, 2002, an additional $12,700,000 from the capitation rates 118.33paid under this section; and118.34(4) beginning July 1, 2003, an additional $4,700,000 from the capitation rates paid 118.35under this section.119.1(b) This subdivision shall be effective upon approval of a federal waiver which 119.2allows federal financial participation in the medical education and research fund. Effective 119.3July 1, 2009, and thereafter, the transfers required by paragraph (a), clauses (1) to (4), 119.4shall not exceed the total amount transferred for fiscal year 2009. Any excess shall first 119.5reduce the amounts otherwise required to be transferred under paragraph (a), clauses 119.6(2) to (4). Any excess following this reduction shall proportionally reduce the transfers 119.7under paragraph (a), clause (1).119.8(c) Effective July 1, 2003, the amount reduced from the prepaid general assistance 119.9medical care payments under paragraph (a), clause (1), shall be transferred to the general 119.10fund.119.11(d) Beginning July 1, 2009, of the amounts in paragraph (a), the commissioner shall 119.12transfer $21,714,000 each fiscal year to the medical education and research fund. The 119.13balance of the transfers under paragraph (a) shall be transferred to the medical education 119.14and research fund no earlier than July 1 of the following fiscal year.119.15    Sec. 48. Minnesota Statutes 2008, section 256B.69, subdivision 5f, is amended to read:119.16    Subd. 5f. Capitation rates.(a) Beginning July 1, 2002, the capitation rates paid 119.17under this section are increased by $12,700,000 per year. Beginning July 1, 2003, the 119.18capitation rates paid under this section are increased by $4,700,000 per year.119.19(b) Beginning July 1, 2009, the capitation rates paid under this section are increased 119.20each year by the lesser of $21,714,000 or an amount equal to the difference between the 119.21estimated value of the reductions described in subdivision 5c, paragraph (a), clause (1), 119.22and the amount of the limit described in subdivision 5c, paragraph (b).119.23    Sec. 49. Minnesota Statutes 2008, section 256B.69, subdivision 23, is amended to read:119.24    Subd. 23. Alternative services; elderly and disabled persons. (a) The 119.25commissioner may implement demonstration projects to create alternative integrated 119.26delivery systems for acute and long-term care services to elderly persons and persons 119.27with disabilities as defined in section 
         256B.77, subdivision 7a, that provide increased 119.28coordination, improve access to quality services, and mitigate future cost increases. 119.29The commissioner may seek federal authority to combine Medicare and Medicaid 119.30capitation payments for the purpose of such demonstrations and may contract with 119.31Medicare-approved special needs plans to provide Medicaid services. Medicare funds and 119.32services shall be administered according to the terms and conditions of the federal contract 119.33and demonstration provisions. For the purpose of administering medical assistance funds, 119.34demonstrations under this subdivision are subject to subdivisions 1 to 22. The provisions 120.1of Minnesota Rules, parts 
         9500.1450 to 
         9500.1464, apply to these demonstrations, 120.2with the exceptions of parts 
         9500.1452, subpart 2, item B; and 
         9500.1457, subpart 1, 120.3items B and C, which do not apply to persons enrolling in demonstrations under this 120.4section. An initial open enrollment period may be provided. Persons who disenroll from 120.5demonstrations under this subdivision remain subject to Minnesota Rules, parts 9500.1450 120.6to 9500.1464. When a person is enrolled in a health plan under these demonstrations and 120.7the health plan's participation is subsequently terminated for any reason, the person shall 120.8be provided an opportunity to select a new health plan and shall have the right to change 120.9health plans within the first 60 days of enrollment in the second health plan. Persons 120.10required to participate in health plans under this section who fail to make a choice of 120.11health plan shall not be randomly assigned to health plans under these demonstrations. 120.12Notwithstanding section 
         256L.12, subdivision 5, and Minnesota Rules, part 
         9505.5220, 120.13subpart 1, item A, if adopted, for the purpose of demonstrations under this subdivision, 120.14the commissioner may contract with managed care organizations, including counties, to 120.15serve only elderly persons eligible for medical assistance, elderly and disabled persons, or 120.16disabled persons only. For persons with a primary diagnosis of developmental disability, 120.17serious and persistent mental illness, or serious emotional disturbance, the commissioner 120.18must ensure that the county authority has approved the demonstration and contracting 120.19design. Enrollment in these projects for persons with disabilities shall be voluntary. The 120.20commissioner shall not implement any demonstration project under this subdivision for 120.21persons with a primary diagnosis of developmental disabilities, serious and persistent 120.22mental illness, or serious emotional disturbance, without approval of the county board of 120.23the county in which the demonstration is being implemented.120.24    (b) Notwithstanding chapter 245B, sections 
         252.40 to 
         252.46, 
         256B.092, 
         256B.501120.25to 
         256B.5015, and Minnesota Rules, parts 9525.0004 to 9525.0036, 9525.1200 to 120.269525.1330, 9525.1580, and 9525.1800 to 9525.1930, the commissioner may implement 120.27under this section projects for persons with developmental disabilities. The commissioner 120.28may capitate payments for ICF/MR services, waivered services for developmental 120.29disabilities, including case management services, day training and habilitation and 120.30alternative active treatment services, and other services as approved by the state and by the 120.31federal government. Case management and active treatment must be individualized and 120.32developed in accordance with a person-centered plan. Costs under these projects may not 120.33exceed costs that would have been incurred under fee-for-service. Beginning July 1, 2003, 120.34and until four years after the pilot project implementation date, subcontractor participation 120.35in the long-term care developmental disability pilot is limited to a nonprofit long-term 120.36care system providing ICF/MR services, home and community-based waiver services, 121.1and in-home services to no more than 120 consumers with developmental disabilities in 121.2Carver, Hennepin, and Scott Counties. The commissioner shall report to the legislature 121.3prior to expansion of the developmental disability pilot project. This paragraph expires 121.4four years after the implementation date of the pilot project.121.5    (c) Before implementation of a demonstration project for disabled persons, the 121.6commissioner must provide information to appropriate committees of the house of 121.7representatives and senate and must involve representatives of affected disability groups 121.8in the design of the demonstration projects.121.9    (d) A nursing facility reimbursed under the alternative reimbursement methodology 121.10in section 
         256B.434 may, in collaboration with a hospital, clinic, or other health care entity 121.11provide services under paragraph (a). The commissioner shall amend the state plan and 121.12seek any federal waivers necessary to implement this paragraph.121.13    (e) The commissioner, in consultation with the commissioners of commerce and 121.14health, may approve and implement programs for all-inclusive care for the elderly (PACE) 121.15according to federal laws and regulations governing that program and state laws or rules 121.16applicable to participating providers. The process for approval of these programs shall 121.17begin only after the commissioner receives grant money in an amount sufficient to cover 121.18the state share of the administrative and actuarial costs to implement the programs during 121.19state fiscal years 2006 and 2007. Grant amounts for this purpose shall be deposited in an 121.20account in the special revenue fund and are appropriated to the commissioner to be used 121.21solely for the purpose of PACE administrative and actuarial costs. A PACE provider is 121.22not required to be licensed or certified as a health plan company as defined in section 121.2362Q.01, subdivision 4
         . Persons age 55 and older who have been screened by the county 121.24and found to be eligible for services under the elderly waiver or community alternatives 121.25for disabled individuals or who are already eligible for Medicaid but meet level of 121.26care criteria for receipt of waiver services may choose to enroll in the PACE program. 121.27Medicare and Medicaid services will be provided according to this subdivision and 121.28federal Medicare and Medicaid requirements governing PACE providers and programs. 121.29PACE enrollees will receive Medicaid home and community-based services through the 121.30PACE provider as an alternative to services for which they would otherwise be eligible 121.31through home and community-based waiver programs and Medicaid State Plan Services. 121.32The commissioner shall establish Medicaid rates for PACE providers that do not exceed 121.33costs that would have been incurred under fee-for-service or other relevant managed care 121.34programs operated by the state.121.35    (f) The commissioner shall seek federal approval to expand the Minnesota disability 121.36health options (MnDHO) program established under this subdivision in stages, first to 122.1regional population centers outside the seven-county metro area and then to all areas of 122.2the state. Until July 1, 2009, expansion for MnDHO projects that include home and 122.3community-based services is limited to the two projects and service areas in effect on 122.4March 1, 2006.  Enrollment in integrated MnDHO programs that include home and 122.5community-based services shall remain voluntary. Costs for home and community-based 122.6services included under MnDHO must not exceed costs that would have been incurred 122.7under the fee-for-service program. Notwithstanding whether expansion occurs under 122.8this paragraph, in determining MnDHO payment rates and risk adjustment methods for 122.9contract years starting in 2012, the commissioner must consider the methods used to 122.10determine county allocations for home and community-based program participants. If 122.11necessary to reduce MnDHO rates to comply with the provision regarding MnDHO costs 122.12for home and community-based services, the commissioner shall achieve the reduction by 122.13maintaining the base rate for contract years 2010 and 2011 for services provided under the 122.14community alternatives for disabled individuals waiver at the same level as for contract 122.15year 2009. The commissioner may apply other reductions to MnDHO rates to implement 122.16decreases in provider payment rates required by state law. In developing program 122.17specifications for expansion of integrated programs, the commissioner shall involve and 122.18consult the state-level stakeholder group established in subdivision 28, paragraph (d), 122.19including consultation on whether and how to include home and community-based waiver 122.20programs. Plans for further expansion of MnDHO projects shall be presented to the chairs 122.21of the house of representatives and senate committees with jurisdiction over health and 122.22human services policy and finance by February 1, 2007.122.23    (g) Notwithstanding section 
         256B.0261, health plans providing services under this 122.24section are responsible for home care targeted case management and relocation targeted 122.25case management. Services must be provided according to the terms of the waivers and 122.26contracts approved by the federal government.122.27    Sec. 50. [256B.756] REIMBURSEMENT RATES FOR BIRTHS.122.28    Subdivision 1.Facility rate.(a) Notwithstanding section 256.969, effective for 122.29services provided on or after October 1, 2009, the facility payment rate for the following 122.30diagnosis-related groups, as they fall within the diagnostic categories: (1) 371 cesarean 122.31section without complicating diagnosis; (2) 372 vaginal delivery with complicating 122.32diagnosis; and (3) 373 vaginal delivery without complicating diagnosis, shall be calculated 122.33as provided in paragraph (b).122.34(b) The commissioner shall calculate a single rate for all of the diagnostic related 122.35groups specified in paragraph (a) consistent with an increase in the proportion of births 123.1by vaginal delivery and a reduction in the percentage of births by cesarean section. The 123.2calculated single rate must be based on an expected increase in the number of vaginal 123.3births and expected reduction in the number of cesarean section such that the reduction 123.4in cesarean sections is less than or equal to one standard deviation below the average in 123.5the frequency of cesarean births for Minnesota health care program clients at hospitals 123.6performing greater than 50 deliveries per year.123.7(c) The rates described in this subdivision do not include newborn care.123.8    Subd. 2.Provider rate.Notwithstanding section 256B.76, effective for services 123.9provided on or after October 1, 2009, the payment rate for professional services related 123.10to labor, delivery, and antepartum and postpartum care when provided for any of the 123.11diagnostic categories identified in subdivision 1, paragraph (a), shall be calculated using 123.12the methodology specified in subdivision 1, paragraph (b).123.13    Subd. 3.Health plans.Payments to managed care and county-based purchasing 123.14plans under sections 256B.69, 256B.692, or 256L.12 shall be reduced for services 123.15provided on or after October 1, 2009, to reflect the adjustments in subdivisions 1 and 2.123.16    Subd. 4.Prior authorization.Prior authorization shall not be required before 123.17reimbursement is paid for a cesarean section delivery.123.18    Sec. 51. Minnesota Statutes 2008, section 256B.76, subdivision 1, is amended to read:123.19    Subdivision 1. Physician reimbursement.  (a) Effective for services rendered on 123.20or after October 1, 1992, the commissioner shall make payments for physician services 123.21as follows:123.22    (1) payment for level one Centers for Medicare and Medicaid Services' common 123.23procedural coding system codes titled "office and other outpatient services," "preventive 123.24medicine new and established patient," "delivery, antepartum, and postpartum care," 123.25"critical care," cesarean delivery and pharmacologic management provided to psychiatric 123.26patients, and level three codes for enhanced services for prenatal high risk, shall be paid 123.27at the lower of (i) submitted charges, or (ii) 25 percent above the rate in effect on June 123.2830, 1992. If the rate on any procedure code within these categories is different than the 123.29rate that would have been paid under the methodology in section 
         256B.74, subdivision 2, 123.30then the larger rate shall be paid; 123.31    (2) payments for all other services shall be paid at the lower of (i) submitted charges, 123.32or (ii) 15.4 percent above the rate in effect on June 30, 1992; and123.33    (3) all physician rates shall be converted from the 50th percentile of 1982 to the 50th 123.34percentile of 1989, less the percent in aggregate necessary to equal the above increases 124.1except that payment rates for home health agency services shall be the rates in effect 124.2on September 30, 1992.124.3    (b) Effective for services rendered on or after January 1, 2000, payment rates for 124.4physician and professional services shall be increased by three percent over the rates 124.5in effect on December 31, 1999, except for home health agency and family planning 124.6agency services. The increases in this paragraph shall be implemented January 1, 2000, 124.7for managed care.124.8(c) Effective for services rendered on or after July 1, 2009, payment rates for 124.9physician and professional services shall be reduced by five percent over the rates in effect 124.10on June 30, 2009. This reduction does not apply to office or other outpatient services 124.11(procedure codes 99201 to 99215), preventive medicine services (procedure codes 99381 124.12to 99412) and family planning services billed by the following primary care specialties: 124.13general practice, internal medicine, pediatrics, geriatrics, family practice, or by an 124.14advanced practice registered nurse or physician assistant practicing in pediatrics, geriatrics, 124.15or family practice. This reduction does not apply to federally qualified health centers, 124.16rural health centers, and Indian health services. Effective October 1, 2009, payments 124.17made to managed care plans and county-based purchasing plans under sections 256B.69, 124.18256B.692, and 256L.12 shall reflect the payment reduction described in this paragraph.124.19    Sec. 52. [256B.766] REIMBURSEMENT FOR BASIC CARE SERVICES.124.20(a) Effective for services provided on or after July 1, 2009, total payments for basic 124.21care services, shall be reduced by three percent, prior to third-party liability and spenddown 124.22calculation. Payments made to managed care plans and county-based purchasing plans 124.23shall be reduced for services provided on or after October 1, 2009, to reflect this reduction.124.24(b) This section does not apply to physician and professional services, inpatient 124.25hospital services, family planning services, mental health services, dental services, 124.26prescription drugs, and medical transportation.124.27    Sec. 53. Minnesota Statutes 2008, section 256D.03, subdivision 4, is amended to read:124.28    Subd. 4. General assistance medical care; services. (a)(i) For a person who is 124.29eligible under subdivision 3, paragraph (a), clause (2), item (i), general assistance medical 124.30care covers, except as provided in paragraph (c):124.31    (1) inpatient hospital services;124.32    (2) outpatient hospital services;124.33    (3) services provided by Medicare certified rehabilitation agencies;125.1    (4) prescription drugs and other products recommended through the process 125.2established in section 
         256B.0625, subdivision 13;125.3    (5) equipment necessary to administer insulin and diagnostic supplies and equipment 125.4for diabetics to monitor blood sugar level;125.5    (6) eyeglasses and eye examinations provided by a physician or optometrist;125.6    (7) hearing aids;125.7    (8) prosthetic devices;125.8    (9) laboratory and X-ray services;125.9    (10) physician's services;125.10    (11) medical transportation except special transportation;125.11    (12) chiropractic services as covered under the medical assistance program;125.12    (13) podiatric services;125.13    (14) dental services as covered under the medical assistance program;125.14    (15) mental health services covered under chapter 256B;125.15    (16) prescribed medications for persons who have been diagnosed as mentally ill as 125.16necessary to prevent more restrictive institutionalization;125.17    (17) medical supplies and equipment, and Medicare premiums, coinsurance and 125.18deductible payments;125.19    (18) medical equipment not specifically listed in this paragraph when the use of 125.20the equipment will prevent the need for costlier services that are reimbursable under 125.21this subdivision;125.22    (19) services performed by a certified pediatric nurse practitioner, a certified family 125.23nurse practitioner, a certified adult nurse practitioner, a certified obstetric/gynecological 125.24nurse practitioner, a certified neonatal nurse practitioner, or a certified geriatric nurse 125.25practitioner in independent practice, if (1) the service is otherwise covered under this 125.26chapter as a physician service, (2) the service provided on an inpatient basis is not included 125.27as part of the cost for inpatient services included in the operating payment rate, and (3) the 125.28service is within the scope of practice of the nurse practitioner's license as a registered 125.29nurse, as defined in section 
         148.171;125.30    (20) services of a certified public health nurse or a registered nurse practicing in 125.31a public health nursing clinic that is a department of, or that operates under the direct 125.32authority of, a unit of government, if the service is within the scope of practice of the 125.33public health nurse's license as a registered nurse, as defined in section 
         148.171;125.34    (21) telemedicine consultations, to the extent they are covered under section 125.35256B.0625, subdivision 3b
         ; 126.1    (22) care coordination and patient education services provided by a community 126.2health worker according to section 
         256B.0625, subdivision 49; and126.3    (23) regardless of the number of employees that an enrolled health care provider 126.4may have, sign language interpreter services when provided by an enrolled health care 126.5provider during the course of providing a direct, person-to-person covered health care 126.6service to an enrolled recipient who has a hearing loss and uses interpreting services.126.7    (ii) Effective October 1, 2003, for a person who is eligible under subdivision 3, 126.8paragraph (a), clause (2), item (ii), general assistance medical care coverage is limited 126.9to inpatient hospital services, including physician services provided during the inpatient 126.10hospital stay. A $1,000 deductible is required for each inpatient hospitalization.126.11    (b) Effective August 1, 2005, sex reassignment surgery is not covered under this 126.12subdivision.126.13    (c) In order to contain costs, the commissioner of human services shall select 126.14vendors of medical care who can provide the most economical care consistent with high 126.15medical standards and shall where possible contract with organizations on a prepaid 126.16capitation basis to provide these services. The commissioner shall consider proposals by 126.17counties and vendors for prepaid health plans, competitive bidding programs, block grants, 126.18or other vendor payment mechanisms designed to provide services in an economical 126.19manner or to control utilization, with safeguards to ensure that necessary services are 126.20provided. Before implementing prepaid programs in counties with a county operated or 126.21affiliated public teaching hospital or a hospital or clinic operated by the University of 126.22Minnesota, the commissioner shall consider the risks the prepaid program creates for the 126.23hospital and allow the county or hospital the opportunity to participate in the program in a 126.24manner that reflects the risk of adverse selection and the nature of the patients served by 126.25the hospital, provided the terms of participation in the program are competitive with the 126.26terms of other participants considering the nature of the population served. Payment for 126.27services provided pursuant to this subdivision shall be as provided to medical assistance 126.28vendors of these services under sections 
         256B.02, subdivision 8, and 
         256B.0625. For 126.29payments made during fiscal year 1990 and later years, the commissioner shall consult 126.30with an independent actuary in establishing prepayment rates, but shall retain final control 126.31over the rate methodology.126.32    (d) Effective January 1, 2008, drug coverage under general assistance medical 126.33care is limited to prescription drugs that:126.34    (i) are covered under the medical assistance program as described in section 126.35256B.0625, subdivisions 13
          and 13d; and127.1    (ii) are provided by manufacturers that have fully executed general assistance 127.2medical care rebate agreements with the commissioner and comply with the agreements. 127.3Prescription drug coverage under general assistance medical care must conform to 127.4coverage under the medical assistance program according to section 
         256B.0625, 127.5subdivisions 13 to 13g.127.6     (e) Recipients eligible under subdivision 3, paragraph (a), shall pay the following 127.7co-payments for services provided on or after October 1, 2003, and before January 1, 2009:127.8    (1) $25 for eyeglasses;127.9    (2) $25 for nonemergency visits to a hospital-based emergency room;127.10    (3) $3 per brand-name drug prescription and $1 per generic drug prescription, 127.11subject to a $12 per month maximum for prescription drug co-payments. No co-payments 127.12shall apply to antipsychotic drugs when used for the treatment of mental illness; and127.13    (4) 50 percent coinsurance on restorative dental services.127.14    (f) Recipients eligible under subdivision 3, paragraph (a), shall include the following 127.15co-payments for services provided on or after January 1, 2009: 127.16    (1) $25 for nonemergency visits to a hospital-based emergency room; and127.17    (2) $3 per brand-name drug prescription and $1 per generic drug prescription, 127.18subject to a $7 per month maximum for prescription drug co-payments. No co-payments 127.19shall apply to antipsychotic drugs when used for the treatment of mental illness.127.20    (g) MS 2007 Supp [Expired]127.21    (h) Effective January 1, 2009, co-payments shall be limited to one per day per 127.22provider for nonemergency visits to a hospital-based emergency room. Recipients of 127.23general assistance medical care are responsible for all co-payments in this subdivision. 127.24The general assistance medical care reimbursement to the provider shall be reduced by the 127.25amount of the co-payment, except that reimbursement for prescription drugs shall not be 127.26reduced once a recipient has reached the $7 per month maximum for prescription drug 127.27co-payments. The provider collects the co-payment from the recipient. Providers may not 127.28deny services to recipients who are unable to pay the co-payment.127.29    (i) General assistance medical care reimbursement to fee-for-service providers 127.30and payments to managed care plans shall not be increased as a result of the removal of 127.31the co-payments effective January 1, 2009.127.32    (j) Any county may, from its own resources, provide medical payments for which 127.33state payments are not made.127.34    (k) Chemical dependency services that are reimbursed under chapter 254B must not 127.35be reimbursed under general assistance medical care.128.1    (l) The maximum payment for new vendors enrolled in the general assistance 128.2medical care program after the base year shall be determined from the average usual and 128.3customary charge of the same vendor type enrolled in the base year.128.4    (m) The conditions of payment for services under this subdivision are the same 128.5as the conditions specified in rules adopted under chapter 256B governing the medical 128.6assistance program, unless otherwise provided by statute or rule.128.7     (n) Inpatient and outpatient payments shall be reduced by five percent, effective July 128.81, 2003. This reduction is in addition to the five percent reduction effective July 1, 2003, 128.9and incorporated by reference in paragraph (l).128.10    (o) Payments for all other health services except inpatient, outpatient, and pharmacy 128.11services shall be reduced by five percent, effective July 1, 2003.128.12    (p) Payments to managed care plans shall be reduced by five percent for services 128.13provided on or after October 1, 2003.128.14    (q) A hospital receiving a reduced payment as a result of this section may apply the 128.15unpaid balance toward satisfaction of the hospital's bad debts.128.16    (r) Fee-for-service payments for nonpreventive visits shall be reduced by $3 for 128.17services provided on or after January 1, 2006. For purposes of this subdivision, a visit 128.18means an episode of service which is required because of a recipient's symptoms, 128.19diagnosis, or established illness, and which is delivered in an ambulatory setting by 128.20a physician or physician ancillary, chiropractor, podiatrist, advance practice nurse, 128.21audiologist, optician, or optometrist.128.22    (s) Payments to managed care plans shall not be increased as a result of the removal 128.23of the $3 nonpreventive visit co-payment effective January 1, 2006.128.24    (t) Payments for mental health services added as covered benefits after December 128.2531, 2007, are not subject to the reductions in paragraphs (l), (n), (o), and (p).128.26(u) Effective for services provided on or after July 1, 2009, total payment rates for 128.27basic care services shall be reduced by three percent, in accordance with section 256B.766. 128.28Payments made to managed care plans shall be reduced for services provided on or after 128.29October 1, 2009, to reflect this reduction.128.30(v) Effective for services provided on or after July 1, 2009, payment rates for 128.31physician and professional services shall be reduced as described under section 256B.76, 128.32subdivision 1, paragraph (c). Payments made to managed care plans shall be reduced for 128.33services provided on or after October 1, 2009, to reflect this reduction.128.34    Sec. 54. Minnesota Statutes 2008, section 256L.03, is amended by adding a subdivision 128.35to read:129.1    Subd. 3b.Chiropractic services.MinnesotaCare covers the following chiropractic 129.2services: medically necessary exams, manual manipulation of the spine, and x-rays.129.3EFFECTIVE DATE.This section is effective January 1, 2010.129.4    Sec. 55. Minnesota Statutes 2008, section 256L.04, subdivision 1, is amended to read:129.5    Subdivision 1. Families with children. (a) Families with children with family 129.6income equal to or less than 275 percent of the federal poverty guidelines for the 129.7applicable family size shall be eligible for MinnesotaCare according to this section. All 129.8other provisions of sections 
         256L.01 to 
         256L.18, including the insurance-related barriers 129.9to enrollment under section 
         256L.07, shall apply unless otherwise specified. 129.10    (b) Parents who enroll in the MinnesotaCare program must also enroll their children, 129.11if the children are eligible. Children may be enrolled separately without enrollment by 129.12parents. However, if one parent in the household enrolls, both parents must enroll, unless 129.13other insurance is available. If one child from a family is enrolled, all children must 129.14be enrolled, unless other insurance is available. If one spouse in a household enrolls, 129.15the other spouse in the household must also enroll, unless other insurance is available. 129.16Families cannot choose to enroll only certain uninsured members.129.17    (c) Beginning October 1, 2003, the dependent sibling definition no longer applies 129.18to the MinnesotaCare program. These persons are no longer counted in the parental 129.19household and may apply as a separate household.129.20    (d) Beginning July 1, 2003, or upon federal approval, whichever is later, parents are 129.21not eligible for MinnesotaCare if their gross income exceeds $57,500.129.22    (e) Children formerly enrolled in medical assistance and automatically deemed 129.23eligible for MinnesotaCare according to section 
         256B.057, subdivision 2c, are exempt 129.24from the requirements of this section until renewal.129.25(f) Children deemed eligible for MinnesotaCare under section 256L.07, subdivision 129.268, are exempt from the eligibility requirements of this subdivision.129.27    Sec. 56. Minnesota Statutes 2008, section 256L.04, is amended by adding a subdivision 129.28to read:129.29    Subd. 1b.Children with family income greater than 275 percent of federal 129.30poverty guidelines.Children with family income greater than 275 percent of federal 129.31poverty guidelines for the applicable family size shall be eligible for MinnesotaCare. All 129.32other provisions of sections 256L.01 to 256L.18, including the insurance-related barriers 129.33to enrollment under section 256L.07, shall apply unless otherwise specified.130.1EFFECTIVE DATE.This section is effective July 1, 2009, or upon federal 130.2approval, whichever is later.130.3    Sec. 57. Minnesota Statutes 2008, section 256L.04, subdivision 7a, is amended to read:130.4    Subd. 7a. Ineligibility.ApplicantsAdults whose income is greater than the limits 130.5established under this section may not enroll in the MinnesotaCare program.130.6EFFECTIVE DATE.This section is effective July 1, 2009, or upon federal 130.7approval, whichever is later.130.8    Sec. 58. Minnesota Statutes 2008, section 256L.04, subdivision 10a, is amended to 130.9read:130.10    Subd. 10a. Sponsor's income and resources deemed available; documentation.130.11When determining eligibility for any federal or state benefits under sections 
         256L.01 to 130.12256L.18
         , the income and resources of all noncitizens whose sponsor signed an affidavit of 130.13support as defined under United States Code, title 8, section 1183a, shall be deemed to 130.14include their sponsors' income and resources as defined in the Personal Responsibility 130.15and Work Opportunity Reconciliation Act of 1996, title IV, Public Law 104-193, sections 130.16421 and 422, and subsequently set out in federal rules. To be eligible for the program, 130.17noncitizens must provide documentation of their immigration status. Beginning July 130.181, 2010, or upon federal approval, whichever is later, sponsor deeming does not apply 130.19to pregnant women and children who are qualified noncitizens, as described in section 130.20256B.06, subdivision 4, paragraph (b).130.21EFFECTIVE DATE.This section is effective July 1, 2010, or upon federal 130.22approval, whichever is later. The commissioner shall notify the revisor of statutes when 130.23federal approval has been obtained.130.24    Sec. 59. Minnesota Statutes 2008, section 256L.05, subdivision 1, is amended to read:130.25    Subdivision 1. Application assistance and information availability.(a) 130.26Applications and application assistance must be made available at provider offices, local 130.27human services agencies, school districts, public and private elementary schools in which 130.2825 percent or more of the students receive free or reduced price lunches, community health 130.29offices, Women, Infants and Children (WIC) program sites, Head Start program sites, 130.30public housing councils, crisis nurseries, child care centers, early childhood education 130.31and preschool program sites, legal aid offices, and libraries. These sites may accept 130.32applications and forward the forms to the commissioner or local county human services 131.1agencies that choose to participate as an enrollment site. Otherwise, applicants may apply 131.2directly to the commissioner or to participating local county human services agencies. 131.3(b) Application assistance must be available for applicants choosing to file an 131.4online application.131.5    Sec. 60. Minnesota Statutes 2008, section 256L.05, is amended by adding a subdivision 131.6to read:131.7    Subd. 1c.Open enrollment and streamlined application and enrollment 131.8process.(a) The commissioner and local agencies working in partnership must develop a 131.9streamlined and efficient application and enrollment process for medical assistance and 131.10MinnesotaCare enrollees that meets the criteria specified in this subdivision.131.11(b) The commissioners of human services and education shall provide 131.12recommendations to the legislature by January 15, 2010, on the creation of an open 131.13enrollment process for medical assistance and MinnesotaCare that is coordinated with 131.14the public education system. The recommendations must:131.15(1) be developed in consultation with medical assistance and MinnesotaCare 131.16enrollees and representatives from organizations that advocate on behalf of children and 131.17families, low-income persons and minority populations, counties, school administrators 131.18and nurses, health plans, and health care providers;131.19 (2) be based on enrollment and renewal procedures best practices, including express 131.20lane eligibility as required under subdivision 1d;131.21(3) simplify the enrollment and renewal processes wherever possible; and131.22(4) establish a process:131.23(i) to disseminate information on medical assistance and MinnesotaCare to all 131.24children in the public education system, including prekindergarten programs; and131.25(ii) for the commissioner of human services to enroll children and other household 131.26members who are eligible.131.27The commissioner of human services in coordination with the commissioner of 131.28education shall implement an open enrollment process by August 1, 2010, to be effective 131.29beginning with the 2010-2011 school year.131.30(c) The commissioner and local agencies shall develop an online application process 131.31for medical assistance and MinnesotaCare.131.32(d) The commissioner shall develop an application that is easily understandable 131.33and does not exceed four pages in length.132.1(e) The commissioner of human services shall present to the legislature, by January 132.215, 2010, an implementation plan for the open enrollment period and online application 132.3process.132.4EFFECTIVE DATE.This section is effective July 1, 2010, or upon federal 132.5approval, which must be requested by the commissioner, whichever is later.132.6    Sec. 61. Minnesota Statutes 2008, section 256L.05, subdivision 3, is amended to read:132.7    Subd. 3. Effective date of coverage. (a) The effective date of coverage is the 132.8first day of the month following the month in which eligibility is approved and the first 132.9premium payment has been received. As provided in section 
         256B.057, coverage for 132.10newborns is automatic from the date of birth and must be coordinated with other health 132.11coverage. The effective date of coverage for eligible newly adoptive children added to a 132.12family receiving covered health services is the month of placement. The effective date 132.13of coverage for other new members added to the family is the first day of the month 132.14following the month in which the change is reported. All eligibility criteria must be met 132.15by the family at the time the new family member is added. The income of the new family 132.16member is included with the family's gross income and the adjusted premium begins in 132.17the month the new family member is added.132.18(b) The initial premium must be received by the last working day of the month for 132.19coverage to begin the first day of the following month.132.20(c) Benefits are not available until the day following discharge if an enrollee is 132.21hospitalized on the first day of coverage.132.22(d) Notwithstanding any other law to the contrary, benefits under sections 
         256L.01 to 132.23256L.18
          are secondary to a plan of insurance or benefit program under which an eligible 132.24person may have coverage and the commissioner shall use cost avoidance techniques to 132.25ensure coordination of any other health coverage for eligible persons. The commissioner 132.26shall identify eligible persons who may have coverage or benefits under other plans of 132.27insurance or who become eligible for medical assistance.132.28(e) The effective date of coverage for single adults and households with no children 132.29formerly enrolled in general assistance medical care and enrolled in MinnesotaCare 132.30according to section 
         256D.03, subdivision 3, is the first day of the month following the 132.31last day of general assistance medical care coverage.132.32(f) The effective date of coverage for children eligible under section 256L.07, 132.33subdivision 8, is the first day of the month following the date of termination from foster 132.34care or release from a juvenile residential correctional facility.133.1EFFECTIVE DATE.This section is effective July 1, 2009, or upon federal 133.2approval, whichever is later.133.3    Sec. 62. Minnesota Statutes 2008, section 256L.05, subdivision 3a, is amended to read:133.4    Subd. 3a. Renewal of eligibility. (a) Beginning July 1, 2007, an enrollee's eligibility 133.5must be renewed every 12 months. The 12-month period begins in the month after the 133.6month the application is approved.133.7    (b) Each new period of eligibility must take into account any changes in 133.8circumstances that impact eligibility and premium amount. An enrollee must provide all 133.9the information needed to redetermine eligibility by the first day of the month that ends 133.10the eligibility period. If there is no change in circumstances, the enrollee may renew 133.11eligibility at designated locations that include community clinics and health care providers' 133.12offices. The designated sites shall forward the renewal forms to the commissioner. The 133.13commissioner may establish criteria and timelines for sites to forward applications to the 133.14commissioner or county agencies. The premium for the new period of eligibility must be 133.15received as provided in section 
         256L.06 in order for eligibility to continue.133.16    (c) For single adults and households with no children formerly enrolled in general 133.17assistance medical care and enrolled in MinnesotaCare according to section 
         256D.03, 133.18subdivision 3
         , the first period of eligibility begins the month the enrollee submitted the 133.19application or renewal for general assistance medical care.133.20    (d) An enrolleeNotwithstanding paragraph (e), an enrollee who fails to submit 133.21renewal forms and related documentation necessary for verification of continued eligibility 133.22in a timely manner shall remain eligible for one additional month beyond the end of the 133.23current eligibility period before being disenrolled. The enrollee remains responsible for 133.24MinnesotaCare premiums for the additional month.133.25(e) Children in families with family income equal to or below 275 percent of federal 133.26poverty guidelines who fail to submit renewal forms and related documentation necessary 133.27for verification of continued eligibility in a timely manner shall remain eligible for the 133.28program. The commissioner shall use the means described in subdivision 2 or any other 133.29means available to verify family income. If the commissioner determines that there has 133.30been a change in income in which premium payment is required to remain enrolled, the 133.31commissioner shall notify the family of the premium payment, and that the children 133.32will be disenrolled if the premium payment is not received effective the first day of the 133.33calendar month following the calendar month for which the premium is due.133.34(f) For children enrolled in MinnesotaCare under section 256L.07, subdivision 8, the 133.35first period of renewal begins the month the enrollee turns 21 years of age.134.1EFFECTIVE DATE.This section is effective July 1, 2009, or upon federal 134.2approval, whichever is later.134.3    Sec. 63. Minnesota Statutes 2008, section 256L.07, subdivision 1, is amended to read:134.4    Subdivision 1. General requirements. (a) Children enrolled in the original 134.5children's health plan as of September 30, 1992, children who enrolled in the 134.6MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549, 134.7article 4, section 17, and children who have family gross incomes that are equal to or 134.8less than 150200 percent of the federal poverty guidelines are eligible without meeting 134.9the requirements of subdivision 2 and the four-month requirement in subdivision 3, as 134.10long as they maintain continuous coverage in the MinnesotaCare program or medical 134.11assistance. Children who apply for MinnesotaCare on or after the implementation date 134.12of the employer-subsidized health coverage program as described in Laws 1998, chapter 134.13407, article 5, section 45, who have family gross incomes that are equal to or less than 150 134.14percent of the federal poverty guidelines, must meet the requirements of subdivision 2 to 134.15be eligible for MinnesotaCare.134.16    FamiliesParents enrolled in MinnesotaCare under section 
         256L.04, subdivision 1, 134.17whose income increases above 275 percent of the federal poverty guidelines, are no longer 134.18eligible for the program and shall be disenrolled by the commissioner. Beginning January 134.191, 2008, individuals enrolled in MinnesotaCare under section 
         256L.04, subdivision 134.207
         , whose income increases above 200 percent of the federal poverty guidelines or 250 134.21percent of the federal poverty guidelines on or after July 1, 2009, are no longer eligible for 134.22the program and shall be disenrolled by the commissioner. For persons disenrolled under 134.23this subdivision, MinnesotaCare coverage terminates the last day of the calendar month 134.24following the month in which the commissioner determines that the income of a family or 134.25individual exceeds program income limits.134.26    (b) Notwithstanding paragraph (a), Children may remain enrolled in MinnesotaCare 134.27if ten percent of their gross individual or gross family income as defined in section 134.28256L.01, subdivision 4
         , is less than the annual premium for a policy with a $500 134.29deductible available through the Minnesota Comprehensive Health Association. Children 134.30who are no longer eligible for MinnesotaCare under this clause shall be given a 12-month 134.31notice period from the date that ineligibility is determined before disenrollment greater 134.32than 275 percent of federal poverty guidelines. The premium for children remaining 134.33eligible under this clauseparagraph shall be the maximum premium determined under 134.34section 
         256L.15, subdivision 2, paragraph (b).135.1    (c) Notwithstanding paragraphsparagraph (a) and (b), parents are not eligible for 135.2MinnesotaCare if gross household income exceeds $57,500 for the 12-month period 135.3of eligibility.135.4EFFECTIVE DATE.This section is effective July 1, 2009, or upon federal 135.5approval, whichever is later.135.6    Sec. 64. Minnesota Statutes 2008, section 256L.07, subdivision 2, is amended to read:135.7    Subd. 2. Must not have access to employer-subsidized coverage. (a) To be 135.8eligible, a family or individual must not have access to subsidized health coverage through 135.9an employer and must not have had access to employer-subsidized coverage through 135.10a current employer for 18 months prior to application or reapplication. A family or 135.11individual whose employer-subsidized coverage is lost due to an employer terminating 135.12health care coverage as an employee benefit during the previous 18 months is not eligible.135.13(b) This subdivision does not apply to a family or individual who was enrolled 135.14in MinnesotaCare within six months or less of reapplication and who no longer has 135.15employer-subsidized coverage due to the employer terminating health care coverage as an 135.16employee benefit. This subdivision does not apply to children with family gross incomes 135.17that are equal to or less than 200 percent of federal poverty guidelines.135.18(c) For purposes of this requirement, subsidized health coverage means health 135.19coverage for which the employer pays at least 50 percent of the cost of coverage for 135.20the employee or dependent, or a higher percentage as specified by the commissioner. 135.21Children are eligible for employer-subsidized coverage through either parent, including 135.22the noncustodial parent. The commissioner must treat employer contributions to Internal 135.23Revenue Code Section 125 plans and any other employer benefits intended to pay 135.24health care costs as qualified employer subsidies toward the cost of health coverage for 135.25employees for purposes of this subdivision.135.26EFFECTIVE DATE.This section is effective July 1, 2009, or upon federal 135.27approval, whichever is later.135.28    Sec. 65. Minnesota Statutes 2008, section 256L.07, subdivision 3, is amended to read:135.29    Subd. 3. Other health coverage. (a) Families and individuals enrolled in the 135.30MinnesotaCare program must have no health coverage while enrolled or for at least four 135.31months prior to application and renewal. Children with family gross incomes equal to or 135.32greater than 200 percent of federal poverty guidelines, and adults, must have had no health 135.33coverage for at least four months prior to application and renewal. Children enrolled in the 135.34original children's health plan and children in families with income equal to or less than 136.1150200 percent of the federal poverty guidelines, who have other health insurance, are 136.2eligible if the coverage:136.3(1) lacks two or more of the following:136.4(i) basic hospital insurance;136.5(ii) medical-surgical insurance;136.6(iii) prescription drug coverage;136.7(iv) dental coverage; or136.8(v) vision coverage;136.9(2) requires a deductible of $100 or more per person per year; or136.10(3) lacks coverage because the child has exceeded the maximum coverage for a 136.11particular diagnosis or the policy excludes a particular diagnosis.136.12The commissioner may change this eligibility criterion for sliding scale premiums 136.13in order to remain within the limits of available appropriations. The requirement of no 136.14health coverage does not apply to newborns.136.15(b) Medical assistance, general assistance medical care, and the Civilian Health and 136.16Medical Program of the Uniformed Service, CHAMPUS, or other coverage provided under 136.17United States Code, title 10, subtitle A, part II, chapter 55, are not considered insurance or 136.18health coverage for purposes of the four-month requirement described in this subdivision.136.19(c) For purposes of this subdivision, an applicant or enrollee who is entitled to 136.20Medicare Part A or enrolled in Medicare Part B coverage under title XVIII of the Social 136.21Security Act, United States Code, title 42, sections 1395c to 1395w-152, is considered to 136.22have health coverage. An applicant or enrollee who is entitled to premium-free Medicare 136.23Part A may not refuse to apply for or enroll in Medicare coverage to establish eligibility 136.24for MinnesotaCare.136.25(d) Applicants who were recipients of medical assistance or general assistance 136.26medical care within one month of application must meet the provisions of this subdivision 136.27and subdivision 2.136.28(e) Cost-effective health insurance that was paid for by medical assistance is not 136.29considered health coverage for purposes of the four-month requirement under this 136.30section, except if the insurance continued after medical assistance no longer considered it 136.31cost-effective or after medical assistance closed.136.32EFFECTIVE DATE.This section is effective July 1, 2009, or upon federal 136.33approval, whichever is later.136.34    Sec. 66. Minnesota Statutes 2008, section 256L.07, is amended by adding a subdivision 136.35to read:137.1    Subd. 8.Automatic eligibility for certain children.Any child who was residing 137.2in foster care or a juvenile residential correctional facility on the child's 18th birthday is 137.3automatically deemed eligible for MinnesotaCare upon termination or release until the 137.4child reaches the age of 21, and is exempt from the requirements of this section and 137.5section 256L.15. To be enrolled under this section, a child must complete an initial 137.6application for MinnesotaCare. The commissioner shall contact individuals enrolled 137.7under this section annually to ensure the individual continues to reside in the state and is 137.8interested in continuing MinnesotaCare coverage.137.9EFFECTIVE DATE.This section is effective July 1, 2009, or upon federal 137.10approval, whichever is later.137.11    Sec. 67. Minnesota Statutes 2008, section 256L.11, subdivision 1, is amended to read:137.12    Subdivision 1. Medical assistance rate to be used.(a) Payment to providers under 137.13sections 
         256L.01 to 
         256L.11 shall be at the same rates and conditions established for 137.14medical assistance, except as provided in subdivisions 2 to 6. 137.15(b) Effective for services provided on or after July 1, 2009, total payments for basic 137.16care services shall be reduced by three percent, in accordance with section 256B.766. 137.17Payments made to managed care plans shall be reduced for services provided on or after 137.18October 1, 2009, to reflect this reduction.137.19    Sec. 68. Minnesota Statutes 2008, section 256L.15, subdivision 2, is amended to read:137.20    Subd. 2. Sliding fee scale; monthly gross individual or family income. (a) The 137.21commissioner shall establish a sliding fee scale to determine the percentage of monthly 137.22gross individual or family income that households at different income levels must pay to 137.23obtain coverage through the MinnesotaCare program. The sliding fee scale must be based 137.24on the enrollee's monthly gross individual or family income. The sliding fee scale must 137.25contain separate tables based on enrollment of one, two, or three or more persons. Until 137.26June 30, 2009, the sliding fee scale begins with a premium of 1.5 percent of monthly gross 137.27individual or family income for individuals or families with incomes below the limits for 137.28the medical assistance program for families and children in effect on January 1, 1999, and 137.29proceeds through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8, 4.8, 5.9, 7.4, and 137.308.8 percent. These percentages are matched to evenly spaced income steps ranging from 137.31the medical assistance income limit for families and children in effect on January 1, 1999, 137.32to 275 percent of the federal poverty guidelines for the applicable family size, up to a 137.33family size of five. The sliding fee scale for a family of five must be used for families of 137.34more than five. The sliding fee scale and percentages are not subject to the provisions of 138.1chapter 14. If a family or individual reports increased income after enrollment, premiums 138.2shall be adjusted at the time the change in income is reported.138.3    (b) Children in families whose gross income is above 275 percent of the federal 138.4poverty guidelines shall pay the maximum premium. The maximum premium is defined 138.5as a base charge for one, two, or three or more enrollees so that if all MinnesotaCare 138.6cases paid the maximum premium, the total revenue would equal the total cost of 138.7MinnesotaCare medical coverage and administration. In this calculation, administrative 138.8costs shall be assumed to equal ten percent of the total. The costs of medical coverage 138.9for pregnant women and children under age two and the enrollees in these groups shall 138.10be excluded from the total. The maximum premium for two enrollees shall be twice the 138.11maximum premium for one, and the maximum premium for three or more enrollees shall 138.12be three times the maximum premium for one.138.13    (c) Beginning July 1, 2009, MinnesotaCare enrollees shall pay premiums according 138.14to the premium scale specified in paragraph (d) with the exception that children in families 138.15with income at or below 150200 percent of the federal poverty guidelines shall pay 138.16a monthly premium of $4 no premiums. For purposes of paragraph (d), "minimum" 138.17means a monthly premium of $4.138.18    (d) The following premium scale is established for individuals and families with 138.19gross family incomes of 300 percent of the federal poverty guidelines or less:

138.20138.21Federal Poverty Guideline RangePercent of Average Gross Monthly Income138.220-45%minimum138.2346-54%1.1%138.2455-81%1.6%138.2582-109%2.2%138.26110-136%2.9%138.27137-164%3.6%138.28165-191%4.6%138.29192-219%5.6%138.30220-248%6.5%138.31249-274%7.2%138.32275-300%8.0%

139.1EFFECTIVE DATE.This section is effective July 1, 2009, or upon federal 139.2approval, whichever is later.139.3    Sec. 69. Minnesota Statutes 2008, section 256L.15, subdivision 3, is amended to read:139.4    Subd. 3. Exceptions to sliding scale. Children in families with income at or below 139.5150200 percent of the federal poverty guidelines shall pay ano monthly premium of 139.6$4 premiums.139.7EFFECTIVE DATE.This section is effective July 1, 2009, or upon federal 139.8approval, whichever is later.139.9    Sec. 70. Minnesota Statutes 2008, section 256L.17, subdivision 3, is amended to read:139.10    Subd. 3. Documentation. (a) The commissioner of human services shall require 139.11individuals and families, at the time of application or renewal, to indicate on a checkoff139.12form developed by the commissioner whether they satisfy the MinnesotaCare asset 139.13requirement. 139.14    (b) The commissioner may require individuals and families to provide any 139.15information the commissioner determines necessary to verify compliance with the asset 139.16requirement, if the commissioner determines that there is reason to believe that an 139.17individual or family has assets that exceed the program limit.139.18    Sec. 71. Minnesota Statutes 2008, section 256L.17, subdivision 5, is amended to read:139.19    Subd. 5. Exemption. This section does not apply to pregnant women or children. 139.20For purposes of this subdivision, a woman is considered pregnant for 60 days postpartum.139.21    Sec. 72. Minnesota Statutes 2008, section 501B.89, is amended by adding a 139.22subdivision to read:139.23    Subd. 4.Annual filing requirement for supplemental needs trusts.(a) A trustee 139.24of a trust under subdivision 3 and United States Code, title 42, section 1396p(d)(4)(A) or 139.25(C), shall submit to the commissioner of human services, at the time of a beneficiary's 139.26request for medical assistance, the following information about the trust:139.27(1) a copy of the trust instrument; and139.28(2) an inventory of the beneficiary's trust account assets and the value of those assets.139.29(b) A trustee of a trust under subdivision 3 and United States Code, title 42, section 139.301396p(d)(4)(A) or (C), shall submit an accounting of the beneficiary's trust account to the 139.31commissioner of human services at least annually until the trust, or the beneficiary's 139.32interest in the trust, terminates. Accountings are due on the anniversary of the execution 140.1date of the trust unless another annual date is established by the terms of the trust. The 140.2accounting must include the following information for the accounting period:140.3(1) an inventory of trust assets and the value of those assets at the beginning of the 140.4accounting period;140.5(2) additions to the trust during the accounting period and the source of those 140.6additions;140.7(3) itemized distributions from the trust during the accounting period, including the 140.8purpose of the distributions and to whom the distributions were made;140.9(4) an inventory of trust assets and the value of those assets at the end of the 140.10accounting period; and140.11(5) changes to the trust instrument during the accounting period.140.12(c) For the purpose of paragraph (b), an accounting period is 12 months unless an 140.13accounting period of a different length is permitted by the commissioner.140.14EFFECTIVE DATE.This section is effective for applications for medical 140.15assistance and renewals of medical assistance submitted on or after July 1, 2009.140.16    Sec. 73. Minnesota Statutes 2008, section 519.05, is amended to read:140.17519.05 LIABILITY OF HUSBAND AND WIFE.140.18(a) A spouse is not liable to a creditor for any debts of the other spouse. Where 140.19husband and wife are living together, they shall be jointly and severally liable for 140.20necessary medical services that have been furnished to either spouse, including any claims 140.21arising under section 246.53, 256B.15, 256D.16, or 261.04, and necessary household 140.22articles and supplies furnished to and used by the family. Notwithstanding this paragraph, 140.23in a proceeding under chapter 518 the court may apportion such debt between the spouses.140.24(b) Either spouse may close a credit card account or other unsecured consumer line 140.25of credit on which both spouses are contractually liable, by giving written notice to the 140.26creditor.140.27    Sec. 74. Laws 2003, First Special Session chapter 14, article 13C, section 2, subdivision 140.281, as amended by Laws 2004, chapter 272, article 2, section 2, is amended to read:

140.29Subdivision 1.Total Appropriation$3,848,049,000$4,135,780,000

140.30Summary by Fund140.31General3,301,811,0003,561,055,000141.1141.2State Government 
                  		Special Revenue534,000534,000141.3Health Care Access273,723,000302,272,000141.4Federal TANF270,425,000270,363,000141.5Lottery Cash Flow1,556,0001,556,000

141.6Federal Contingency Appropriation. (a) 141.7Federal Medicaid funds made available 141.8under title IV of the federal Jobs and Growth 141.9Tax Relief Reconciliation Act of 2003 141.10are appropriated to the commissioner of 141.11human services for use in the state's medical 141.12assistance and MinnesotaCare programs. 141.13The commissioners of human services and 141.14finance shall report to the legislative advisory 141.15committee on the additional federal Medicaid 141.16matching funds that will be available to the 141.17state.141.18(b) Because of the availability of these funds, 141.19the following policies shall become effective:141.20(1) medical assistance and MinnesotaCare 141.21eligibility and local financial participation 141.22changes provided for in this act may be 141.23implemented prior to September 2, 2003, or 141.24may be delayed as necessary to maximize 141.25the use of federal funds received under 141.26title IV of the Jobs and Growth Tax Relief 141.27Reconciliation Act of 2003;141.28(2) the aggregate cap on the services 141.29identified in Minnesota Statutes, section 141.30256L.035
         , paragraph (a), clause (3), shall 141.31be increased from $2,000 to $5,000. This 141.32increase shall expire at the end of fiscal year 141.332007. Funds may be transferred from the 142.1general fund to the health care access fund as 142.2necessary to implement this provision; and142.3(3) the following payment shifts shall not be 142.4implemented:142.5(i) MFIP payment shift found in subdivision 142.611;142.7(ii) the county payment shift found in 142.8subdivision 1; and142.9(iii) the delay in medical assistance 142.10and general assistance medical care 142.11fee-for-service payments found in 142.12subdivision 6.142.13(c) Notwithstanding section 14, paragraphs 142.14(a) and (b) shall expire June 30, 2007.142.15Receipts for Systems Projects.142.16Appropriations and federal receipts for 142.17information system projects for MAXIS, 142.18PRISM, MMIS, and SSIS must be deposited 142.19in the state system account authorized in 142.20Minnesota Statutes, section 
         256.014. Money 142.21appropriated for computer projects approved 142.22by the Minnesota office of technology, 142.23funded by the legislature, and approved 142.24by the commissioner of finance may be 142.25transferred from one project to another 142.26and from development to operations as the 142.27commissioner of human services considers 142.28necessary. Any unexpended balance in 142.29the appropriation for these projects does 142.30not cancel but is available for ongoing 142.31development and operations.142.32Gifts. Notwithstanding Minnesota Statutes, 142.33chapter 7, the commissioner may accept 142.34on behalf of the state additional funding 143.1from sources other than state funds for the 143.2purpose of financing the cost of assistance 143.3program grants or nongrant administration. 143.4All additional funding is appropriated to the 143.5commissioner for use as designated by the 143.6grantor of funding.143.7Systems Continuity. In the event of 143.8disruption of technical systems or computer 143.9operations, the commissioner may use 143.10available grant appropriations to ensure 143.11continuity of payments for maintaining the 143.12health, safety, and well-being of clients 143.13served by programs administered by the 143.14department of human services. Grant funds 143.15must be used in a manner consistent with the 143.16original intent of the appropriation.143.17Nonfederal Share Transfers. The 143.18nonfederal share of activities for which 143.19federal administrative reimbursement is 143.20appropriated to the commissioner may be 143.21transferred to the special revenue fund.143.22TANF Funds Appropriated to Other 143.23Entities. Any expenditures from the TANF 143.24block grant shall be expended in accordance 143.25with the requirements and limitations of part 143.26A of title IV of the Social Security Act, as 143.27amended, and any other applicable federal 143.28requirement or limitation. Prior to any 143.29expenditure of these funds, the commissioner 143.30shall assure that funds are expended in 143.31compliance with the requirements and 143.32limitations of federal law and that any 143.33reporting requirements of federal law are 143.34met. It shall be the responsibility of any entity 143.35to which these funds are appropriated to 144.1implement a memorandum of understanding 144.2with the commissioner that provides the 144.3necessary assurance of compliance prior to 144.4any expenditure of funds. The commissioner 144.5shall receipt TANF funds appropriated 144.6to other state agencies and coordinate all 144.7related interagency accounting transactions 144.8necessary to implement these appropriations. 144.9Unexpended TANF funds appropriated to 144.10any state, local, or nonprofit entity cancel 144.11at the end of the state fiscal year unless 144.12appropriating language permits otherwise.144.13TANF Funds Transferred to Other Federal 144.14Grants. The commissioner must authorize 144.15transfers from TANF to other federal block 144.16grants so that funds are available to meet the 144.17annual expenditure needs as appropriated. 144.18Transfers may be authorized prior to the 144.19expenditure year with the agreement of the 144.20receiving entity. Transferred funds must be 144.21expended in the year for which the funds 144.22were appropriated unless appropriation 144.23language permits otherwise. In accelerating 144.24transfer authorizations, the commissioner 144.25must aim to preserve the future potential 144.26transfer capacity from TANF to other block 144.27grants.144.28TANF Maintenance of Effort. (a) In 144.29order to meet the basic maintenance of 144.30effort (MOE) requirements of the TANF 144.31block grant specified under Code of Federal 144.32Regulations, title 45, section 
         263.1, the 144.33commissioner may only report nonfederal 144.34money expended for allowable activities 144.35listed in the following clauses as TANF/MOE 144.36expenditures:145.1(1) MFIP cash, diversionary work program, 145.2and food assistance benefits under Minnesota 145.3Statutes, chapter 256J;145.4(2) the child care assistance programs 145.5under Minnesota Statutes, sections 
         119B.03145.6and 
         119B.05, and county child care 145.7administrative costs under Minnesota 145.8Statutes, section 
         119B.15;145.9(3) state and county MFIP administrative 145.10costs under Minnesota Statutes, chapters 145.11256J and 256K;145.12(4) state, county, and tribal MFIP 145.13employment services under Minnesota 145.14Statutes, chapters 256J and 256K;145.15(5) expenditures made on behalf of 145.16noncitizen MFIP recipients who qualify 145.17for the medical assistance without federal 145.18financial participation program under 145.19Minnesota Statutes, section 
         256B.06, 145.20subdivision 4
         , paragraphs (d), (e), and (j); 145.21and145.22(6) qualifying working family credit 145.23expenditures under Minnesota Statutes, 145.24section 
         290.0671.145.25(b) The commissioner shall ensure that 145.26sufficient qualified nonfederal expenditures 145.27are made each year to meet the state's 145.28TANF/MOE requirements. For the activities 145.29listed in paragraph (a), clauses (2) to 145.30(6), the commissioner may only report 145.31expenditures that are excluded from the 145.32definition of assistance under Code of 145.33Federal Regulations, title 45, section 
         260.31.146.1(c) By August 31 of each year, the 146.2commissioner shall make a preliminary 146.3calculation to determine the likelihood 146.4that the state will meet its annual federal 146.5work participation requirement under Code 146.6of Federal Regulations, title 45, sections 146.7261.21
          and 
         261.23, after adjustment for any 146.8caseload reduction credit under Code of 146.9Federal Regulations, title 45, section 
         261.41. 146.10If the commissioner determines that the 146.11state will meet its federal work participation 146.12rate for the federal fiscal year ending that 146.13September, the commissioner may reduce the 146.14expenditure under paragraph (a), clause (1), 146.15to the extent allowed under Code of Federal 146.16Regulations, title 45, section 263.1(a)(2).146.17(d) For fiscal years beginning with state 146.18fiscal year 2003, the commissioner shall 146.19assure that the maintenance of effort used 146.20by the commissioner of finance for the 146.21February and November forecasts required 146.22under Minnesota Statutes, section 
         16A.103, 146.23contains expenditures under paragraph (a), 146.24clause (1), equal to at least 25 percent of 146.25the total required under Code of Federal 146.26Regulations, title 45, section 
         263.1.146.27(e) If nonfederal expenditures for the 146.28programs and purposes listed in paragraph 146.29(a) are insufficient to meet the state's 146.30TANF/MOE requirements, the commissioner 146.31shall recommend additional allowable 146.32sources of nonfederal expenditures to the 146.33legislature, if the legislature is or will be in 146.34session to take action to specify additional 146.35sources of nonfederal expenditures for 146.36TANF/MOE before a federal penalty is 147.1imposed. The commissioner shall otherwise 147.2provide notice to the legislative commission 147.3on planning and fiscal policy under paragraph 147.4(g).147.5(f) If the commissioner uses authority 147.6granted under section 11, or similar authority 147.7granted by a subsequent legislature, to 147.8meet the state's TANF/MOE requirement 147.9in a reporting period, the commissioner 147.10shall inform the chairs of the appropriate 147.11legislative committees about all transfers 147.12made under that authority for this purpose.147.13(g) If the commissioner determines that 147.14nonfederal expenditures under paragraph 147.15(a) are insufficient to meet TANF/MOE 147.16expenditure requirements, and if the 147.17legislature is not or will not be in 147.18session to take timely action to avoid a 147.19federal penalty, the commissioner may 147.20report nonfederal expenditures from 147.21other allowable sources as TANF/MOE 147.22expenditures after the requirements of this 147.23paragraph are met. The commissioner 147.24may report nonfederal expenditures 147.25in addition to those specified under 147.26paragraph (a) as nonfederal TANF/MOE 147.27expenditures, but only ten days after the 147.28commissioner of finance has first submitted 147.29the commissioner's recommendations for 147.30additional allowable sources of nonfederal 147.31TANF/MOE expenditures to the members of 147.32the legislative commission on planning and 147.33fiscal policy for their review.147.34(h) The commissioner of finance shall not 147.35incorporate any changes in federal TANF 148.1expenditures or nonfederal expenditures for 148.2TANF/MOE that may result from reporting 148.3additional allowable sources of nonfederal 148.4TANF/MOE expenditures under the interim 148.5procedures in paragraph (g) into the February 148.6or November forecasts required under 148.7Minnesota Statutes, section 
         16A.103, unless 148.8the commissioner of finance has approved 148.9the additional sources of expenditures under 148.10paragraph (g).148.11(i) Minnesota Statutes, section 
         256.011, 148.12subdivision 3
         , which requires that federal 148.13grants or aids secured or obtained under that 148.14subdivision be used to reduce any direct 148.15appropriations provided by law, do not apply 148.16if the grants or aids are federal TANF funds.148.17(j) Notwithstanding section 14, paragraph 148.18(a), clauses (1) to (6), and paragraphs (b) to 148.19(j) expire June 30, 2007.148.20Working Family Credit Expenditures as 148.21TANF MOE. The commissioner may claim 148.22as TANF maintenance of effort up to the 148.23following amounts of working family credit 148.24expenditures for the following fiscal years:148.25(1) fiscal year 2004, $7,013,000;148.26(2) fiscal year 2005, $25,133,000;148.27(3) fiscal year 2006, $6,942,000; and148.28(4) fiscal year 2007, $6,707,000.148.29Fiscal Year 2003 Appropriations 148.30Carryforward. Effective the day following 148.31final enactment, notwithstanding Minnesota 148.32Statutes, section 
         16A.28, or any other law to 148.33the contrary, state agencies and constitutional 148.34offices may carry forward unexpended 149.1and unencumbered nongrant operating 149.2balances from fiscal year 2003 general fund 149.3appropriations into fiscal year 2004 to offset 149.4general budget reductions.149.5Transfer of Grant Balances. Effective 149.6the day following final enactment, the 149.7commissioner of human services, with 149.8the approval of the commissioner of 149.9finance and after notification of the chair 149.10of the senate health, human services and 149.11corrections budget division and the chair 149.12of the house of representatives health 149.13and human services finance committee, 149.14may transfer unencumbered appropriation 149.15balances for the biennium ending June 30, 149.162003, in fiscal year 2003 among the MFIP, 149.17MFIP child care assistance under Minnesota 149.18Statutes, section 
         119B.05, general assistance, 149.19general assistance medical care, medical 149.20assistance, Minnesota supplemental aid, 149.21and group residential housing programs, 149.22and the entitlement portion of the chemical 149.23dependency consolidated treatment fund, and 149.24between fiscal years of the biennium.149.25TANF Appropriation Cancellation.149.26Notwithstanding the provisions of Laws 149.272000, chapter 488, article 1, section 16, 149.28any prior appropriations of TANF funds 149.29to the department of trade and economic 149.30development or to the job skills partnership 149.31board or any transfers of TANF funds from 149.32another agency to the department of trade 149.33and economic development or to the job 149.34skills partnership board are not available 149.35until expended, and if unobligated as of June 150.130, 2003, these appropriations or transfers 150.2shall cancel to the TANF fund.150.3Shift County Payment. The commissioner 150.4shall make up to 100 percent of the 150.5calendar year 2005 payments to counties for 150.6developmental disabilities semi-independent 150.7living services grants, developmental 150.8disabilities family support grants, and 150.9adult mental health grants from fiscal year 150.102006 appropriations. This is a onetime 150.11payment shift. Calendar year 2006 and future 150.12payments for these grants are not affected by 150.13this shift. This provision expires June 30, 150.142006.150.15Capitation Rate Increase. Of the health care 150.16access fund appropriations to the University 150.17of Minnesota in the higher education 150.18omnibus appropriation bill, $2,157,000 in 150.19fiscal year 2004 and $2,157,000 in fiscal year 150.202005 are to be used to increase the capitation 150.21payments underfor fiscal years beginning 150.22July 1, 2003, and thereafter, $2,157,000 each 150.23year shall be transferred to the commissioner 150.24for purposes of Minnesota Statutes, section 150.25256B.69
         . Notwithstanding the provisions of 150.26section 14, this provision shall not expire.150.27    Sec. 75. ASTHMA COVERAGE DEMONSTRATION PROJECT.150.28    Subdivision 1.Medical assistance coverage.The commissioner of human services 150.29shall establish a demonstration project to provide additional medical assistance coverage 150.30for a maximum of 200 American Indian children in Minneapolis, St. Paul, and Duluth 150.31who are burdened by health disparities associated with the cumulative health impact of 150.32toxic environmental exposures. Under this demonstration project, the additional medical 150.33assistance coverage for this population must include, but is not limited to, the following 150.34durable medical equipment: high efficiency particulate air (HEPA) cleaners, HEPA 150.35vacuum cleaners, allergy bed and pillow encasements, high filtration filters for forced air 151.1gas furnaces, and dehumidifiers with medical tubing to connect the appliance to a floor 151.2drain, if the listed item is medically necessary to reduce asthma symptoms. Provision 151.3of these items must be preceded by a home environmental assessment for triggers of 151.4asthma and in-home asthma education on the proper medical management of asthma by a 151.5Certified Asthma Educator or public health nurse with asthma management training.151.6    Subd. 2.Report.(a) Two years following implementation of the medical assistance 151.7coverage demonstration project established under this section, the commissioner of health, 151.8in collaboration with the Department of Human Services, must report to the legislature 151.9on the number of asthma-related hospital admittances that occurred in the population of 151.10children described in subdivision 1, before and after implementation of the demonstration 151.11project, and whether the demonstration project had an impact on asthma-related school 151.12absenteeism for this population of children.151.13(b) The commissioner of health must seek nonstate funding to conduct this report. 151.14The reporting requirement is contingent upon the availability of nonstate funds.151.15    Sec. 76. CLAIMS AND UTILIZATION DATA.151.16The commissioner of human services, in consultation with the Health Services 151.17Policy Committee, shall develop and provide to the legislature by December 15, 2009, a 151.18methodology and any draft legislation necessary to allow for the release, upon request, of 151.19summary data as defined in Minnesota Statutes, section 13.02, subdivision 19, on claims 151.20and utilization for medical assistance, general assistance medical care, and MinnesotaCare 151.21enrollees at no charge to the University of Minnesota Medical School, the Mayo Medical 151.22School, Northwestern Health Sciences University, the Institute for Clinical Systems 151.23Improvement, and other research institutions, to conduct analyses of health care outcomes 151.24and treatment effectiveness, provided the research institutions do not release private or 151.25nonpublic data, or data for which dissemination is prohibited by law.151.26    Sec. 77. ADMINISTRATION OF PUBLICLY FUNDED HEALTH CARE 151.27PROGRAMS.151.28(a) The commissioner of human services, in cooperation with the representatives 151.29of county human services agencies and with input from organizations that advocate on 151.30behalf of families and children, shall develop a plan that, to the extent feasible, seeks to 151.31align standards, income and asset methodologies, and procedures for families and children 151.32under medical assistance and MinnesotaCare. The commissioner shall evaluate the impact 151.33of different approaches toward alignment on the number of potential medical assistance 151.34and MinnesotaCare enrollees who are families and children, and on administrative, health 152.1care, and other costs to the state. The commissioner shall present recommendations to the 152.2legislative committees with jurisdiction over health care by September 15, 2010.152.3(b) The commissioner shall report in detail to the chair of the Health Care and 152.4Human Services Finance Committee of the house of representatives and to the chair of 152.5the Health and Human Services Division of the Finance Committee of the senate, prior 152.6to entering into any contracts involving counties for streamlined electronic enrollment 152.7and eligibility determinations for publicly funded health care programs, if such contracts 152.8would require payment from either the general fund, or the health care access fund, as 152.9described in Minnesota Statutes, sections 295.58 and 297I.05.152.10    Sec. 78. COBRA PREMIUM STATE SUBSIDY.152.11    Subdivision 1.Eligibility.(a) An individual and the individual's qualified 152.12beneficiaries shall be eligible for a state premium subsidy equal to 35 percent of the 152.13premiums the individual is required to pay for the continuation of health care coverage 152.14under COBRA, if the individual and the individual's qualified beneficiaries:152.15(1) are eligible for the 65 percent COBRA continuation premium subsidy for health 152.16care coverage under the American Recovery and Reinvestment Act of 2009;152.17(2) elect COBRA continuation health care coverage; and152.18(3) are eligible for medical assistance under Minnesota Statutes, chapter 256B; 152.19general assistance medical care under Minnesota Statutes, section 256D.03; or 152.20MinnesotaCare under Minnesota Statutes, chapter 256L, except for the four-month barrier 152.21requirement under Minnesota Statutes, section 256L.07, subdivision 3.152.22(b) Eligibility for the state subsidy shall continue for as long as the individual 152.23remains eligible for the COBRA premium subsidies provided under the American 152.24Recovery and Reinvestment Act of 2009.152.25    Subd. 2.Subsidy.(a) The commissioner of human services shall pay 35 percent of 152.26the COBRA premiums that the individual must pay for continuation health care coverage 152.27for the individual and the individual's qualified beneficiaries, if the individual and the 152.28individual's qualified beneficiaries meet the requirements in subdivision 1.152.29(b) The state subsidy payment required under this section shall be made directly to 152.30the entity to which the individual is required to make COBRA premium payments.152.31(c) If any eligible individual has paid either the full amount of the COBRA premiums 152.32or 35 percent of the COBRA premiums before the date of enactment of this section, the 152.33individual is not entitled to a reimbursement of any premium paid.152.34    Subd. 3.Notification.(a) All employers and plan administrators who are required to 152.35provide notice to all qualified individuals under the American Recovery and Reinvestment 153.1Act of 2009 must include information to qualified individuals residing in Minnesota of 153.2the availability of the state subsidy available under this section. The notice shall include 153.3the eligibility requirements for the state subsidy and that the individual must apply to the 153.4commissioner of human services to receive the state subsidy.153.5(b) The commissioner of employment and economic development must inform an 153.6applicant for unemployment benefits of the availability of a state subsidy if the applicant 153.7elects COBRA continuation coverage and the applicant meets the eligibility requirements 153.8of this section.153.9    Subd. 4.Exemption.Any individual who receives a state subsidy under this 153.10section is exempt from the four-month requirement under Minnesota Statutes, section 153.11256L.07, subdivision 3, if the individual or the individual's qualified beneficiaries apply 153.12for MinnesotaCare after the individual no longer receives COBRA continuation coverage.153.13    Subd. 5.Expiration.This section expires December 31, 2010.153.14    Sec. 79. FEDERAL APPROVAL.153.15The commissioner of human services shall resubmit for federal approval the 153.16elimination of depreciation for self-employed farmers in determining income eligibility 153.17for MinnesotaCare passed in Laws 2007, chapter 147, article 5, section 19.153.18    Sec. 80. REPEALER.153.19Minnesota Statutes 2008, sections 256.962, subdivision 7; and 256L.17, subdivision 153.206, are repealed.153.21ARTICLE 6153.22TECHNICAL153.23    Section 1. Minnesota Statutes 2008, section 144A.46, subdivision 1, is amended to 153.24read:153.25    Subdivision 1.  License required. (a) A home care provider may not operate in the 153.26state without a current license issued by the commissioner of health. A home care provider 153.27may hold a separate license for each class of home care licensure. 153.28    (b) Within ten days after receiving an application for a license, the commissioner 153.29shall acknowledge receipt of the application in writing. The acknowledgment must 153.30indicate whether the application appears to be complete or whether additional information 153.31is required before the application will be considered complete. Within 90 days after 153.32receiving a complete application, the commissioner shall either grant or deny the license. 153.33If an applicant is not granted or denied a license within 90 days after submitting a 154.1complete application, the license must be deemed granted. An applicant whose license has 154.2been deemed granted must provide written notice to the commissioner before providing a 154.3home care service. 154.4    (c) Each application for a home care provider license, or for a renewal of a license, 154.5shall be accompanied by a fee to be set by the commissioner under section 
         144.122. 154.6    (d) The commissioner of health, in consultation with the commissioner of human 154.7services, shall provide recommendations to the legislature by February 15, 2009, for 154.8provider standards for personal care assistant services as described in section 
         256B.0655154.9256B.0659. 154.10    Sec. 2. Minnesota Statutes 2008, section 176.011, subdivision 9, is amended to read:154.11    Subd. 9.  Employee. "Employee" means any person who performs services for 154.12another for hire including the following: 154.13(1) an alien; 154.14(2) a minor; 154.15(3) a sheriff, deputy sheriff, police officer, firefighter, county highway engineer, and 154.16peace officer while engaged in the enforcement of peace or in the pursuit or capture of a 154.17person charged with or suspected of crime; 154.18(4) a person requested or commanded to aid an officer in arresting or retaking a 154.19person who has escaped from lawful custody, or in executing legal process, in which 154.20cases, for purposes of calculating compensation under this chapter, the daily wage of the 154.21person shall be the prevailing wage for similar services performed by paid employees; 154.22(5) a county assessor; 154.23(6) an elected or appointed official of the state, or of a county, city, town, school 154.24district, or governmental subdivision in the state. An officer of a political subdivision 154.25elected or appointed for a regular term of office, or to complete the unexpired portion of a 154.26regular term, shall be included only after the governing body of the political subdivision 154.27has adopted an ordinance or resolution to that effect; 154.28(7) an executive officer of a corporation, except those executive officers excluded 154.29by section 
         176.041; 154.30(8) a voluntary uncompensated worker, other than an inmate, rendering services in 154.31state institutions under the commissioners of human services and corrections similar to 154.32those of officers and employees of the institutions, and whose services have been accepted 154.33or contracted for by the commissioner of human services or corrections as authorized by 154.34law. In the event of injury or death of the worker, the daily wage of the worker, for the 154.35purpose of calculating compensation under this chapter, shall be the usual wage paid at 155.1the time of the injury or death for similar services in institutions where the services are 155.2performed by paid employees; 155.3(9) a voluntary uncompensated worker engaged in emergency management as 155.4defined in section 
         12.03, subdivision 4, who is: 155.5(i) registered with the state or any political subdivision of it, according to the 155.6procedures set forth in the state or political subdivision emergency operations plan; and 155.7(ii) acting under the direction and control of, and within the scope of duties approved 155.8by, the state or political subdivision. 155.9The daily wage of the worker, for the purpose of calculating compensation under this 155.10chapter, shall be the usual wage paid at the time of the injury or death for similar services 155.11performed by paid employees; 155.12(10) a voluntary uncompensated worker participating in a program established by a 155.13local social services agency. For purposes of this clause, "local social services agency" 155.14means any agency established under section 
         393.01. In the event of injury or death of the 155.15worker, the wage of the worker, for the purpose of calculating compensation under this 155.16chapter, shall be the usual wage paid in the county at the time of the injury or death for 155.17similar services performed by paid employees working a normal day and week; 155.18(11) a voluntary uncompensated worker accepted by the commissioner of natural 155.19resources who is rendering services as a volunteer pursuant to section 
         84.089. The daily 155.20wage of the worker for the purpose of calculating compensation under this chapter, shall 155.21be the usual wage paid at the time of injury or death for similar services performed by 155.22paid employees; 155.23(12) a voluntary uncompensated worker in the building and construction industry 155.24who renders services for joint labor-management nonprofit community service projects. 155.25The daily wage of the worker for the purpose of calculating compensation under this 155.26chapter shall be the usual wage paid at the time of injury or death for similar services 155.27performed by paid employees; 155.28(13) a member of the military forces, as defined in section 
         190.05, while in state 155.29active service, as defined in section 
         190.05, subdivision 5a. The daily wage of the member 155.30for the purpose of calculating compensation under this chapter shall be based on the 155.31member's usual earnings in civil life. If there is no evidence of previous occupation or 155.32earning, the trier of fact shall consider the member's earnings as a member of the military 155.33forces; 155.34(14) a voluntary uncompensated worker, accepted by the director of the Minnesota 155.35Historical Society, rendering services as a volunteer, pursuant to chapter 138. The daily 155.36wage of the worker, for the purposes of calculating compensation under this chapter, 156.1shall be the usual wage paid at the time of injury or death for similar services performed 156.2by paid employees; 156.3(15) a voluntary uncompensated worker, other than a student, who renders services 156.4at the Minnesota State Academy for the Deaf or the Minnesota State Academy for the 156.5Blind, and whose services have been accepted or contracted for by the commissioner of 156.6education, as authorized by law. In the event of injury or death of the worker, the daily 156.7wage of the worker, for the purpose of calculating compensation under this chapter, shall 156.8be the usual wage paid at the time of the injury or death for similar services performed in 156.9institutions by paid employees; 156.10(16) a voluntary uncompensated worker, other than a resident of the veterans home, 156.11who renders services at a Minnesota veterans home, and whose services have been 156.12accepted or contracted for by the commissioner of veterans affairs, as authorized by law. 156.13In the event of injury or death of the worker, the daily wage of the worker, for the purpose 156.14of calculating compensation under this chapter, shall be the usual wage paid at the time of 156.15the injury or death for similar services performed in institutions by paid employees; 156.16(17) a worker performing services under section 
         256B.0655256B.0659 for a 156.17recipient in the home of the recipient or in the community under section 
         256B.0625, 156.18subdivision 19a
         , who is paid from government funds through a fiscal intermediary under 156.19section 
         256B.0655, subdivision 7 256B.0659, subdivision 33. For purposes of maintaining 156.20workers' compensation insurance, the employer of the worker is as designated in law 156.21by the commissioner of the Department of Human Services, notwithstanding any other 156.22law to the contrary;156.23(18) students enrolled in and regularly attending the Medical School of the 156.24University of Minnesota in the graduate school program or the postgraduate program. The 156.25students shall not be considered employees for any other purpose. In the event of the 156.26student's injury or death, the weekly wage of the student for the purpose of calculating 156.27compensation under this chapter, shall be the annualized educational stipend awarded to 156.28the student, divided by 52 weeks. The institution in which the student is enrolled shall 156.29be considered the "employer" for the limited purpose of determining responsibility for 156.30paying benefits under this chapter; 156.31(19) a faculty member of the University of Minnesota employed for an academic 156.32year is also an employee for the period between that academic year and the succeeding 156.33academic year if: 156.34(a) the member has a contract or reasonable assurance of a contract from the 156.35University of Minnesota for the succeeding academic year; and 157.1(b) the personal injury for which compensation is sought arises out of and in the 157.2course of activities related to the faculty member's employment by the University of 157.3Minnesota; 157.4(20) a worker who performs volunteer ambulance driver or attendant services is an 157.5employee of the political subdivision, nonprofit hospital, nonprofit corporation, or other 157.6entity for which the worker performs the services. The daily wage of the worker for the 157.7purpose of calculating compensation under this chapter shall be the usual wage paid at the 157.8time of injury or death for similar services performed by paid employees; 157.9(21) a voluntary uncompensated worker, accepted by the commissioner of 157.10administration, rendering services as a volunteer at the Department of Administration. In 157.11the event of injury or death of the worker, the daily wage of the worker, for the purpose of 157.12calculating compensation under this chapter, shall be the usual wage paid at the time of the 157.13injury or death for similar services performed in institutions by paid employees; 157.14(22) a voluntary uncompensated worker rendering service directly to the Pollution 157.15Control Agency. The daily wage of the worker for the purpose of calculating compensation 157.16payable under this chapter is the usual going wage paid at the time of injury or death for 157.17similar services if the services are performed by paid employees; 157.18(23) a voluntary uncompensated worker while volunteering services as a first 157.19responder or as a member of a law enforcement assistance organization while acting 157.20under the supervision and authority of a political subdivision. The daily wage of the 157.21worker for the purpose of calculating compensation payable under this chapter is the 157.22usual going wage paid at the time of injury or death for similar services if the services 157.23are performed by paid employees; 157.24(24) a voluntary uncompensated member of the civil air patrol rendering service on 157.25the request and under the authority of the state or any of its political subdivisions. The 157.26daily wage of the member for the purposes of calculating compensation payable under this 157.27chapter is the usual going wage paid at the time of injury or death for similar services if 157.28the services are performed by paid employees; and 157.29(25) a Minnesota Responds Medical Reserve Corps volunteer, as provided in 157.30sections 
         145A.04 and 
         145A.06, responding at the request of or engaged in training 157.31conducted by the commissioner of health. The daily wage of the volunteer for the purposes 157.32of calculating compensation payable under this chapter is established in section 
         145A.06. 157.33A person who qualifies under this clause and who may also qualify under another clause 157.34of this subdivision shall receive benefits in accordance with this clause. 157.35If it is difficult to determine the daily wage as provided in this subdivision, the trier 157.36of fact may determine the wage upon which the compensation is payable. 158.1    Sec. 3. Minnesota Statutes 2008, section 245C.03, subdivision 2, is amended to read:158.2    Subd. 2. Personal care provider organizations. The commissioner shall conduct 158.3background studies on any individual required under sections 
         256B.0651and 256B.0653158.4to 
         256B.0656and 256B.0659 to have a background study completed under this chapter.158.5    Sec. 4. Minnesota Statutes 2008, section 245C.04, subdivision 3, is amended to read:158.6    Subd. 3. Personal care provider organizations. (a) The commissioner shall 158.7conduct a background study of an individual required to be studied under section 
         245C.03, 158.8subdivision 2
         , at least upon application for initial enrollment under sections 
         256B.0651158.9and 256B.0653 to 
         256B.0656 and 256B.0659.158.10(b) Organizations required to initiate background studies under sections 
         256B.0651158.11and 256B.0653 to 
         256B.0656and 256B.0659 for individuals described in section 
         245C.03, 158.12subdivision 2
         , must submit a completed background study form to the commissioner 158.13before those individuals begin a position allowing direct contact with persons served 158.14by the organization.158.15    Sec. 5. Minnesota Statutes 2008, section 245C.10, subdivision 3, is amended to read:158.16    Subd. 3. Personal care provider organizations. The commissioner shall recover 158.17the cost of background studies initiated by a personal care provider organization under 158.18sections 
         256B.0651and 256B.0653 to 
         256B.0656and 256B.0659 through a fee of no 158.19more than $20 per study charged to the organization responsible for submitting the 158.20background study form. The fees collected under this subdivision are appropriated to the 158.21commissioner for the purpose of conducting background studies.158.22    Sec. 6. Minnesota Statutes 2008, section 256B.04, subdivision 16, is amended to read:158.23    Subd. 16.  Personal care services. (a) Notwithstanding any contrary language in 158.24this paragraph, the commissioner of human services and the commissioner of health shall 158.25jointly promulgate rules to be applied to the licensure of personal care services provided 158.26under the medical assistance program. The rules shall consider standards for personal care 158.27services that are based on the World Institute on Disability's recommendations regarding 158.28personal care services. These rules shall at a minimum consider the standards and 158.29requirements adopted by the commissioner of health under section 
         144A.45, which the 158.30commissioner of human services determines are applicable to the provision of personal 158.31care services, in addition to other standards or modifications which the commissioner of 158.32human services determines are appropriate. 159.1The commissioner of human services shall establish an advisory group including 159.2personal care consumers and providers to provide advice regarding which standards or 159.3modifications should be adopted. The advisory group membership must include not less 159.4than 15 members, of which at least 60 percent must be consumers of personal care services 159.5and representatives of recipients with various disabilities and diagnoses and ages. At least 159.651 percent of the members of the advisory group must be recipients of personal care. 159.7The commissioner of human services may contract with the commissioner of health 159.8to enforce the jointly promulgated licensure rules for personal care service providers. 159.9Prior to final promulgation of the joint rule the commissioner of human services 159.10shall report preliminary findings along with any comments of the advisory group and a 159.11plan for monitoring and enforcement by the Department of Health to the legislature by 159.12February 15, 1992. 159.13Limits on the extent of personal care services that may be provided to an individual 159.14must be based on the cost-effectiveness of the services in relation to the costs of inpatient 159.15hospital care, nursing home care, and other available types of care. The rules must 159.16provide, at a minimum: 159.17(1) that agencies be selected to contract with or employ and train staff to provide and 159.18supervise the provision of personal care services; 159.19(2) that agencies employ or contract with a qualified applicant that a qualified 159.20recipient proposes to the agency as the recipient's choice of assistant; 159.21(3) that agencies bill the medical assistance program for a personal care service 159.22by a personal care assistant and supervision by a qualified professional supervising the 159.23personal care assistant unless the recipient selects the fiscal agent option under section 159.24256B.0655, subdivision 7 256B.0659, subdivision 33; 159.25(4) that agencies establish a grievance mechanism; and 159.26(5) that agencies have a quality assurance program. 159.27(b) The commissioner may waive the requirement for the provision of personal care 159.28services through an agency in a particular county, when there are less than two agencies 159.29providing services in that county and shall waive the requirement for personal care 159.30assistants required to join an agency for the first time during 1993 when personal care 159.31services are provided under a relative hardship waiver under Minnesota Statutes 1992, 159.32section 
         256B.0627, subdivision 4, paragraph (b), clause (7), and at least two agencies 159.33providing personal care services have refused to employ or contract with the independent 159.34personal care assistant. 159.35    Sec. 7. Minnesota Statutes 2008, section 256B.055, subdivision 12, is amended to read:160.1    Subd. 12.  Disabled children. (a) A person is eligible for medical assistance if the 160.2person is under age 19 and qualifies as a disabled individual under United States Code, 160.3title 42, section 1382c(a), and would be eligible for medical assistance under the state 160.4plan if residing in a medical institution, and the child requires a level of care provided in 160.5a hospital, nursing facility, or intermediate care facility for persons with developmental 160.6disabilities, for whom home care is appropriate, provided that the cost to medical 160.7assistance under this section is not more than the amount that medical assistance would pay 160.8for if the child resides in an institution. After the child is determined to be eligible under 160.9this section, the commissioner shall review the child's disability under United States Code, 160.10title 42, section 1382c(a) and level of care defined under this section no more often than 160.11annually and may elect, based on the recommendation of health care professionals under 160.12contract with the state medical review team, to extend the review of disability and level of 160.13care up to a maximum of four years. The commissioner's decision on the frequency of 160.14continuing review of disability and level of care is not subject to administrative appeal 160.15under section 
         256.045. The county agency shall send a notice of disability review to the 160.16enrollee six months prior to the date the recertification of disability is due. Nothing in this 160.17subdivision shall be construed as affecting other redeterminations of medical assistance 160.18eligibility under this chapter and annual cost-effective reviews under this section. 160.19    (b) For purposes of this subdivision, "hospital" means an institution as defined 160.20in section 
         144.696, subdivision 3, 
         144.55, subdivision 3, or Minnesota Rules, part 160.214640.3600, and licensed pursuant to sections 
         144.50 to 
         144.58. For purposes of this 160.22subdivision, a child requires a level of care provided in a hospital if the child is determined 160.23by the commissioner to need an extensive array of health services, including mental health 160.24services, for an undetermined period of time, whose health condition requires frequent 160.25monitoring and treatment by a health care professional or by a person supervised by a 160.26health care professional, who would reside in a hospital or require frequent hospitalization 160.27if these services were not provided, and the daily care needs are more complex than 160.28a nursing facility level of care. 160.29    A child with serious emotional disturbance requires a level of care provided in a 160.30hospital if the commissioner determines that the individual requires 24-hour supervision 160.31because the person exhibits recurrent or frequent suicidal or homicidal ideation or 160.32behavior, recurrent or frequent psychosomatic disorders or somatopsychic disorders that 160.33may become life threatening, recurrent or frequent severe socially unacceptable behavior 160.34associated with psychiatric disorder, ongoing and chronic psychosis or severe, ongoing 160.35and chronic developmental problems requiring continuous skilled observation, or severe 161.1disabling symptoms for which office-centered outpatient treatment is not adequate, and 161.2which overall severely impact the individual's ability to function. 161.3    (c) For purposes of this subdivision, "nursing facility" means a facility which 161.4provides nursing care as defined in section 
         144A.01, subdivision 5, licensed pursuant to 161.5sections 
         144A.02 to 
         144A.10, which is appropriate if a person is in active restorative 161.6treatment; is in need of special treatments provided or supervised by a licensed nurse; or 161.7has unpredictable episodes of active disease processes requiring immediate judgment 161.8by a licensed nurse. For purposes of this subdivision, a child requires the level of care 161.9provided in a nursing facility if the child is determined by the commissioner to meet 161.10the requirements of the preadmission screening assessment document under section 161.11256B.0911
         and the home care independent rating document under section 256B.0655, 161.12subdivision 4, clause (3), adjusted to address age-appropriate standards for children age 18 161.13and under, pursuant to section256B.0655, subdivision 3. 161.14    (d) For purposes of this subdivision, "intermediate care facility for persons with 161.15developmental disabilities" or "ICF/MR" means a program licensed to provide services to 161.16persons with developmental disabilities under section 
         252.28, and chapter 245A, and a 161.17physical plant licensed as a supervised living facility under chapter 144, which together 161.18are certified by the Minnesota Department of Health as meeting the standards in Code of 161.19Federal Regulations, title 42, part 483, for an intermediate care facility which provides 161.20services for persons with developmental disabilities who require 24-hour supervision 161.21and active treatment for medical, behavioral, or habilitation needs. For purposes of this 161.22subdivision, a child requires a level of care provided in an ICF/MR if the commissioner 161.23finds that the child has a developmental disability in accordance with section 
         256B.092, 161.24is in need of a 24-hour plan of care and active treatment similar to persons with 161.25developmental disabilities, and there is a reasonable indication that the child will need 161.26ICF/MR services. 161.27    (e) For purposes of this subdivision, a person requires the level of care provided 161.28in a nursing facility if the person requires 24-hour monitoring or supervision and a plan 161.29of mental health treatment because of specific symptoms or functional impairments 161.30associated with a serious mental illness or disorder diagnosis, which meet severity criteria 161.31for mental health established by the commissioner and published in March 1997 as 161.32the Minnesota Mental Health Level of Care for Children and Adolescents with Severe 161.33Emotional Disorders. 161.34    (f) The determination of the level of care needed by the child shall be made by 161.35the commissioner based on information supplied to the commissioner by the parent or 161.36guardian, the child's physician or physicians, and other professionals as requested by the 162.1commissioner. The commissioner shall establish a screening team to conduct the level of 162.2care determinations according to this subdivision. 162.3    (g) If a child meets the conditions in paragraph (b), (c), (d), or (e), the commissioner 162.4must assess the case to determine whether: 162.5    (1) the child qualifies as a disabled individual under United States Code, title 42, 162.6section 1382c(a), and would be eligible for medical assistance if residing in a medical 162.7institution; and 162.8    (2) the cost of medical assistance services for the child, if eligible under this 162.9subdivision, would not be more than the cost to medical assistance if the child resides in a 162.10medical institution to be determined as follows: 162.11    (i) for a child who requires a level of care provided in an ICF/MR, the cost of 162.12care for the child in an institution shall be determined using the average payment rate 162.13established for the regional treatment centers that are certified as ICF's/MR; 162.14    (ii) for a child who requires a level of care provided in an inpatient hospital setting 162.15according to paragraph (b), cost-effectiveness shall be determined according to Minnesota 162.16Rules, part 9505.3520, items F and G; and 162.17    (iii) for a child who requires a level of care provided in a nursing facility according 162.18to paragraph (c) or (e), cost-effectiveness shall be determined according to Minnesota 162.19Rules, part 9505.3040, except that the nursing facility average rate shall be adjusted to 162.20reflect rates which would be paid for children under age 16. The commissioner may 162.21authorize an amount up to the amount medical assistance would pay for a child referred to 162.22the commissioner by the preadmission screening team under section 
         256B.0911. 162.23    (h) Children eligible for medical assistance services under section 
         256B.055, 162.24subdivision 12
         , as of June 30, 1995, must be screened according to the criteria in this 162.25subdivision prior to January 1, 1996. Children found to be ineligible may not be removed 162.26from the program until January 1, 1996. 162.27    Sec. 8. Minnesota Statutes 2008, section 256B.0621, subdivision 2, is amended to read:162.28    Subd. 2. Targeted case management; definitions. For purposes of subdivisions 3 162.29to 10, the following terms have the meanings given them:162.30    (1) "home care service recipients" means those individuals receiving the following 162.31services under sections 
         256B.0651 to 
         256B.0656 and 256B.0659: skilled nursing visits, 162.32home health aide visits, private duty nursing, personal care assistants, or therapies 162.33provided through a home health agency;163.1    (2) "home care targeted case management" means the provision of targeted case 163.2management services for the purpose of assisting home care service recipients to gain 163.3access to needed services and supports so that they may remain in the community;163.4    (3) "institutions" means hospitals, consistent with Code of Federal Regulations, title 163.542, section 
         440.10; regional treatment center inpatient services, consistent with section 163.6245.474
         ; nursing facilities; and intermediate care facilities for persons with developmental 163.7disabilities;163.8    (4) "relocation targeted case management" includes the provision of both county 163.9targeted case management and public or private vendor service coordination services 163.10for the purpose of assisting recipients to gain access to needed services and supports if 163.11they choose to move from an institution to the community. Relocation targeted case 163.12management may be provided during the lesser of:163.13    (i) the last 180 consecutive days of an eligible recipient's institutional stay; or163.14    (ii) the limits and conditions which apply to federal Medicaid funding for this 163.15service; and163.16    (5) "targeted case management" means case management services provided to help 163.17recipients gain access to needed medical, social, educational, and other services and 163.18supports.163.19    Sec. 9. Minnesota Statutes 2008, section 256B.0652, subdivision 3, is amended to read:163.20    Subd. 3. Assessment and prior authorization process. Effective January 1, 1996, 163.21for purposes of providing informed choice, coordinating of local planning decisions, and 163.22streamlining administrative requirements, the assessment and prior authorization process 163.23for persons receiving both home care and home and community-based waivered services 163.24for persons with developmental disabilities shall meet the requirements of sections 163.25256B.0651
         and 256B.0653 to 
         256B.0656and 256B.0659 with the following exceptions:163.26(a) Upon request for home care services and subsequent assessment by the public 163.27health nurse under sections 
         256B.0651and 256B.0653 to 
         256B.0656 and 256B.0659, 163.28the public health nurse shall participate in the screening process, as appropriate, and, 163.29if home care services are determined to be necessary, participate in the development 163.30of a service plan coordinating the need for home care and home and community-based 163.31waivered services with the assigned county case manager, the recipient of services, and 163.32the recipient's legal representative, if any.163.33(b) The public health nurse shall give prior authorization for home care services 163.34to the extent that home care services are:163.35(1) medically necessary;164.1(2) chosen by the recipient and their legal representative, if any, from the array of 164.2home care and home and community-based waivered services available;164.3(3) coordinated with other services to be received by the recipient as described 164.4in the service plan; and164.5(4) provided within the county's reimbursement limits for home care and home and 164.6community-based waivered services for persons with developmental disabilities.164.7(c) If the public health agency is or may be the provider of home care services to the 164.8recipient, the public health agency shall provide the commissioner of human services with 164.9a written plan that specifies how the assessment and prior authorization process will be 164.10held separate and distinct from the provision of services.164.11    Sec. 10. Minnesota Statutes 2008, section 256B.0657, subdivision 2, is amended to 164.12read:164.13    Subd. 2. Eligibility. (a) The self-directed supports option is available to a person 164.14who:164.15    (1) is a recipient of medical assistance as determined under sections 
         256B.055, 164.16256B.056
         , and 
         256B.057, subdivision 9;164.17    (2) is eligible for personal care assistant services under section 
         256B.0655164.18256B.0659;164.19    (3) lives in the person's own apartment or home, which is not owned, operated, or 164.20controlled by a provider of services not related by blood or marriage;164.21    (4) has the ability to hire, fire, supervise, establish staff compensation for, and 164.22manage the individuals providing services, and to choose and obtain items, related 164.23services, and supports as described in the participant's plan. If the recipient is not able to 164.24carry out these functions but has a legal guardian or parent to carry them out, the guardian 164.25or parent may fulfill these functions on behalf of the recipient; and164.26    (5) has not been excluded or disenrolled by the commissioner.164.27    (b) The commissioner may disenroll or exclude recipients, including guardians and 164.28parents, under the following circumstances:164.29    (1) recipients who have been restricted by the Primary Care Utilization Review 164.30Committee may be excluded for a specified time period; 164.31    (2) recipients who exit the self-directed supports option during the recipient's 164.32service plan year shall not access the self-directed supports option for the remainder of 164.33that service plan year; and164.34    (3) when the department determines that the recipient cannot manage recipient 164.35responsibilities under the program.165.1    Sec. 11. Minnesota Statutes 2008, section 256B.0657, subdivision 6, is amended to 165.2read:165.3    Subd. 6. Services covered. (a) Services covered under the self-directed supports 165.4option include:165.5    (1) personal care assistant services under section 
         256B.0655 256B.0659; and 165.6    (2) items, related services, and supports, including assistive technology, that increase 165.7independence or substitute for human assistance to the extent expenditures would 165.8otherwise be used for human assistance.165.9    (b) Items, supports, and related services purchased under this option shall not be 165.10considered home care services for the purposes of section 
         144A.43.165.11    Sec. 12. Minnesota Statutes 2008, section 256B.0657, subdivision 8, is amended to 165.12read:165.13    Subd. 8. Self-directed budget requirements. The budget for the provision of the 165.14self-directed service option shall be equal to the greater of either:165.15    (1) the annual amount of personal care assistant services under section 
         256B.0655165.16256B.0659 that the recipient has used in the most recent 12-month period; or 165.17    (2) the amount determined using the consumer support grant methodology under 165.18section 
         256.476, subdivision 11, except that the budget amount shall include the federal 165.19and nonfederal share of the average service costs.165.20    Sec. 13. Minnesota Statutes 2008, section 256B.49, subdivision 17, is amended to read:165.21    Subd. 17. Cost of services and supports. (a) The commissioner shall ensure 165.22that the average per capita expenditures estimated in any fiscal year for home and 165.23community-based waiver recipients does not exceed the average per capita expenditures 165.24that would have been made to provide institutional services for recipients in the absence 165.25of the waiver.165.26(b) The commissioner shall implement on January 1, 2002, one or more aggregate, 165.27need-based methods for allocating to local agencies the home and community-based 165.28waivered service resources available to support recipients with disabilities in need of 165.29the level of care provided in a nursing facility or a hospital. The commissioner shall 165.30allocate resources to single counties and county partnerships in a manner that reflects 165.31consideration of:165.32(1) an incentive-based payment process for achieving outcomes;165.33(2) the need for a state-level risk pool;165.34(3) the need for retention of management responsibility at the state agency level; and166.1(4) a phase-in strategy as appropriate.166.2(c) Until the allocation methods described in paragraph (b) are implemented, the 166.3annual allowable reimbursement level of home and community-based waiver services 166.4shall be the greater of:166.5(1) the statewide average payment amount which the recipient is assigned under the 166.6waiver reimbursement system in place on June 30, 2001, modified by the percentage of 166.7any provider rate increase appropriated for home and community-based services; or166.8(2) an amount approved by the commissioner based on the recipient's extraordinary 166.9needs that cannot be met within the current allowable reimbursement level. The 166.10increased reimbursement level must be necessary to allow the recipient to be discharged 166.11from an institution or to prevent imminent placement in an institution. The additional 166.12reimbursement may be used to secure environmental modifications; assistive technology 166.13and equipment; and increased costs for supervision, training, and support services 166.14necessary to address the recipient's extraordinary needs. The commissioner may approve 166.15an increased reimbursement level for up to one year of the recipient's relocation from an 166.16institution or up to six months of a determination that a current waiver recipient is at 166.17imminent risk of being placed in an institution.166.18(d) Beginning July 1, 2001, medically necessary private duty nursing services 166.19will be authorized under this section as complex and regular care according to sections 166.20256B.0651
         and 256B.0653 to 
         256B.0656 and 256B.0659. The rate established by the 166.21commissioner for registered nurse or licensed practical nurse services under any home and 166.22community-based waiver as of January 1, 2001, shall not be reduced.166.23    Sec. 14. Minnesota Statutes 2008, section 256B.501, subdivision 4a, is amended to 166.24read:166.25    Subd. 4a. Inclusion of home care costs in waiver rates. The commissioner 166.26shall adjust the limits of the established average daily reimbursement rates for waivered 166.27services to include the cost of home care services that may be provided to waivered 166.28services recipients. This adjustment must be used to maintain or increase services and 166.29shall not be used by county agencies for inflation increases for waivered services vendors. 166.30Home care services referenced in this section are those listed in section 
         256B.0651, 166.31subdivision 2
         . The average daily reimbursement rates established in accordance with 166.32the provisions of this subdivision apply only to the combined average, daily costs of 166.33waivered and home care services and do not change home care limitations under sections 166.34256B.0651
         and 256B.0653 to 
         256B.0656 and 256B.0659. Waivered services recipients 167.1receiving home care as of June 30, 1992, shall not have the amount of their services 167.2reduced as a result of this section.167.3    Sec. 15. Minnesota Statutes 2008, section 256G.02, subdivision 6, is amended to read:167.4    Subd. 6. Excluded time. "Excluded time" means:167.5(a) any period an applicant spends in a hospital, sanitarium, nursing home, shelter 167.6other than an emergency shelter, halfway house, foster home, semi-independent living 167.7domicile or services program, residential facility offering care, board and lodging facility 167.8or other institution for the hospitalization or care of human beings, as defined in section 167.9144.50
         , 
         144A.01, or 
         245A.02, subdivision 14; maternity home, battered women's shelter, 167.10or correctional facility; or any facility based on an emergency hold under sections 167.11253B.05, subdivisions 1 and 2
         , and 
         253B.07, subdivision 6;167.12(b) any period an applicant spends on a placement basis in a training and habilitation 167.13program, including a rehabilitation facility or work or employment program as defined 167.14in section 
         268A.01; or receiving personal care assistant services pursuant to section 167.15256B.0655, subdivision 2 256B.0659; semi-independent living services provided under 167.16section 
         252.275, and Minnesota Rules, parts 9525.0500 to 9525.0660; day training and 167.17habilitation programs and assisted living services; and167.18(c) any placement for a person with an indeterminate commitment, including 167.19independent living.167.20    Sec. 16. Minnesota Statutes 2008, section 256I.05, subdivision 1a, is amended to read:167.21    Subd. 1a. Supplementary service rates. (a) Subject to the provisions of section 167.22256I.04, subdivision 3
         , the county agency may negotiate a payment not to exceed $426.37 167.23for other services necessary to provide room and board provided by the group residence 167.24if the residence is licensed by or registered by the Department of Health, or licensed by 167.25the Department of Human Services to provide services in addition to room and board, 167.26and if the provider of services is not also concurrently receiving funding for services for 167.27a recipient under a home and community-based waiver under title XIX of the Social 167.28Security Act; or funding from the medical assistance program under section 
         256B.0655, 167.29subdivision 2 256B.0659, for personal care services for residents in the setting; or residing 167.30in a setting which receives funding under Minnesota Rules, parts 9535.2000 to 9535.3000. 167.31If funding is available for other necessary services through a home and community-based 167.32waiver, or personal care services under section 
         256B.0655, subdivision 2 256B.0659, 167.33then the GRH rate is limited to the rate set in subdivision 1. Unless otherwise provided 167.34in law, in no case may the supplementary service rate exceed $426.37. The registration 168.1and licensure requirement does not apply to establishments which are exempt from state 168.2licensure because they are located on Indian reservations and for which the tribe has 168.3prescribed health and safety requirements. Service payments under this section may be 168.4prohibited under rules to prevent the supplanting of federal funds with state funds. The 168.5commissioner shall pursue the feasibility of obtaining the approval of the Secretary of 168.6Health and Human Services to provide home and community-based waiver services under 168.7title XIX of the Social Security Act for residents who are not eligible for an existing home 168.8and community-based waiver due to a primary diagnosis of mental illness or chemical 168.9dependency and shall apply for a waiver if it is determined to be cost-effective.168.10(b) The commissioner is authorized to make cost-neutral transfers from the GRH 168.11fund for beds under this section to other funding programs administered by the department 168.12after consultation with the county or counties in which the affected beds are located. 168.13The commissioner may also make cost-neutral transfers from the GRH fund to county 168.14human service agencies for beds permanently removed from the GRH census under a plan 168.15submitted by the county agency and approved by the commissioner. The commissioner 168.16shall report the amount of any transfers under this provision annually to the legislature.168.17(c) The provisions of paragraph (b) do not apply to a facility that has its 168.18reimbursement rate established under section 
         256B.431, subdivision 4, paragraph (c).168.19    Sec. 17. Minnesota Statutes 2008, section 256J.45, subdivision 3, is amended to read:168.20    Subd. 3. Good cause exemptions for not attending orientation. (a) The county 168.21agency shall not impose the sanction under section 
         256J.46 if it determines that the 168.22participant has good cause for failing to attend orientation. Good cause exists when:168.23(1) appropriate child care is not available;168.24(2) the participant is ill or injured;168.25(3) a family member is ill and needs care by the participant that prevents the 168.26participant from attending orientation. For a caregiver with a child or adult in the 168.27household who meets the disability or medical criteria for home care services under 168.28section 
         256B.0655, subdivision 1c 256B.0659, or a home and community-based waiver 168.29services program under chapter 256B, or meets the criteria for severe emotional 168.30disturbance under section 
         245.4871, subdivision 6, or for serious and persistent mental 168.31illness under section 
         245.462, subdivision 20, paragraph (c), good cause also exists when 168.32an interruption in the provision of those services occurs which prevents the participant 168.33from attending orientation;168.34(4) the caregiver is unable to secure necessary transportation;168.35(5) the caregiver is in an emergency situation that prevents orientation attendance;169.1(6) the orientation conflicts with the caregiver's work, training, or school schedule; or169.2(7) the caregiver documents other verifiable impediments to orientation attendance 169.3beyond the caregiver's control.169.4(b) Counties must work with clients to provide child care and transportation 169.5necessary to ensure a caregiver has every opportunity to attend orientation.169.6    Sec. 18. Minnesota Statutes 2008, section 604A.33, subdivision 1, is amended to read:169.7    Subdivision 1. Application. This section applies to residential treatment programs 169.8for children or group homes for children licensed under chapter 245A, residential 169.9services and programs for juveniles licensed under section 
         241.021, providers licensed 169.10pursuant to sections 
         144A.01 to 
         144A.33 or sections 
         144A.43 to 
          144A.47, personal care 169.11provider organizations under section 
         256B.0655, subdivision 1g 256B.0659, providers 169.12of day training and habilitation services under sections 
         252.40 to 
         252.46, board and 169.13lodging facilities licensed under chapter 157, intermediate care facilities for persons with 169.14developmental disabilities, and other facilities licensed to provide residential services to 169.15persons with developmental disabilities.169.16    Sec. 19. Minnesota Statutes 2008, section 609.232, subdivision 11, is amended to read:169.17    Subd. 11. Vulnerable adult. "Vulnerable adult" means any person 18 years of 169.18age or older who:169.19(1) is a resident inpatient of a facility;169.20(2) receives services at or from a facility required to be licensed to serve adults 169.21under sections 
         245A.01 to 
         245A.15, except that a person receiving outpatient services for 169.22treatment of chemical dependency or mental illness, or one who is committed as a sexual 169.23psychopathic personality or as a sexually dangerous person under chapter 253B, is not 169.24considered a vulnerable adult unless the person meets the requirements of clause (4);169.25(3) receives services from a home care provider required to be licensed under section 169.26144A.46
         ; or from a person or organization that exclusively offers, provides, or arranges 169.27for personal care assistant services under the medical assistance program as authorized 169.28under sections 
         256B.04, subdivision 16, 
         256B.0625, subdivision 19a, 
         256B.0651, and 169.29256B.0653 to 
         256B.0656 and 256B.0659; or169.30(4) regardless of residence or whether any type of service is received, possesses a 169.31physical or mental infirmity or other physical, mental, or emotional dysfunction:169.32(i) that impairs the individual's ability to provide adequately for the individual's 169.33own care without assistance, including the provision of food, shelter, clothing, health 169.34care, or supervision; and170.1(ii) because of the dysfunction or infirmity and the need for assistance, the individual 170.2has an impaired ability to protect the individual from maltreatment.170.3    Sec. 20. Minnesota Statutes 2008, section 626.5572, subdivision 6, is amended to read:170.4    Subd. 6. Facility. (a) "Facility" means a hospital or other entity required to be 170.5licensed under sections 
         144.50 to 
         144.58; a nursing home required to be licensed to 170.6serve adults under section 
         144A.02; a residential or nonresidential facility required to 170.7be licensed to serve adults under sections 
         245A.01 to 
         245A.16; a home care provider 170.8licensed or required to be licensed under section 
         144A.46; a hospice provider licensed 170.9under sections 
         144A.75 to 
         144A.755; or a person or organization that exclusively offers, 170.10provides, or arranges for personal care assistant services under the medical assistance 170.11program as authorized under sections 
         256B.04, subdivision 16, 
         256B.0625, subdivision 170.1219a
         , 
         256B.0651, and 256B.0653 to 
         256B.0656, and 256B.0659.170.13(b) For home care providers and personal care attendants, the term "facility" refers 170.14to the provider or person or organization that exclusively offers, provides, or arranges for 170.15personal care services, and does not refer to the client's home or other location at which 170.16services are rendered.170.17    Sec. 21. Minnesota Statutes 2008, section 626.5572, subdivision 21, is amended to 170.18read:170.19    Subd. 21.  Vulnerable adult. "Vulnerable adult" means any person 18 years of 170.20age or older who: 170.21    (1) is a resident or inpatient of a facility; 170.22    (2) receives services at or from a facility required to be licensed to serve adults 170.23under sections 
         245A.01 to 
         245A.15, except that a person receiving outpatient services for 170.24treatment of chemical dependency or mental illness, or one who is served in the Minnesota 170.25sex offender program on a court-hold order for commitment, or is committed as a sexual 170.26psychopathic personality or as a sexually dangerous person under chapter 253B, is not 170.27considered a vulnerable adult unless the person meets the requirements of clause (4); 170.28    (3) receives services from a home care provider required to be licensed under section 170.29144A.46
         ; or from a person or organization that exclusively offers, provides, or arranges 170.30for personal care assistant services under the medical assistance program as authorized 170.31under sections 
         256B.04, subdivision 16, 
         256B.0625, subdivision 19a, 
         256B.0651, and170.32256B.0653
          to 
         256B.0656, and 256B.0659; or 170.33    (4) regardless of residence or whether any type of service is received, possesses a 170.34physical or mental infirmity or other physical, mental, or emotional dysfunction: 171.1    (i) that impairs the individual's ability to provide adequately for the individual's 171.2own care without assistance, including the provision of food, shelter, clothing, health 171.3care, or supervision; and 171.4    (ii) because of the dysfunction or infirmity and the need for assistance, the individual 171.5has an impaired ability to protect the individual from maltreatment. 171.6ARTICLE 7171.7CHEMICAL AND MENTAL HEALTH171.8    Section 1. Minnesota Statutes 2008, section 245.462, subdivision 18, is amended to 171.9read:171.10    Subd. 18. Mental health professional. "Mental health professional" means a 171.11person providing clinical services in the treatment of mental illness who is qualified in at 171.12least one of the following ways:171.13    (1) in psychiatric nursing: a registered nurse who is licensed under sections 
         148.171171.14to 
         148.285; and:171.15    (i) who is certified as a clinical specialist or as a nurse practitioner in adult or family 171.16psychiatric and mental health nursing by a national nurse certification organization; or171.17    (ii) who has a master's degree in nursing or one of the behavioral sciences or related 171.18fields from an accredited college or university or its equivalent, with at least 4,000 hours 171.19of post-master's supervised experience in the delivery of clinical services in the treatment 171.20of mental illness;171.21    (2) in clinical social work: a person licensed as an independent clinical social worker 171.22under chapter 148D, or a person with a master's degree in social work from an accredited 171.23college or university, with at least 4,000 hours of post-master's supervised experience in 171.24the delivery of clinical services in the treatment of mental illness;171.25    (3) in psychology: an individual licensed by the Board of Psychology under sections 171.26148.88
          to 
         148.98 who has stated to the Board of Psychology competencies in the diagnosis 171.27and treatment of mental illness;171.28    (4) in psychiatry: a physician licensed under chapter 147 and certified by the 171.29American Board of Psychiatry and Neurology or eligible for board certification in 171.30psychiatry;171.31    (5) in marriage and family therapy: the mental health professional must be a 171.32marriage and family therapist licensed under sections 
         148B.29 to 
         148B.39 with at least 171.33two years of post-master's supervised experience in the delivery of clinical services in 171.34the treatment of mental illness; or172.1    (6) in licensed professional clinical counseling, the mental health professional 172.2shall be a licensed professional clinical counselor under section 148B.5301 with at least 172.34,000 hours of postmaster's supervised experience in the delivery of clinical services in 172.4the treatment of mental illness; or172.5    (7) in allied fields: a person with a master's degree from an accredited college or 172.6university in one of the behavioral sciences or related fields, with at least 4,000 hours of 172.7post-master's supervised experience in the delivery of clinical services in the treatment of 172.8mental illness.172.9    Sec. 2. Minnesota Statutes 2008, section 245.470, subdivision 1, is amended to read:172.10    Subdivision 1. Availability of outpatient services. (a) County boards must provide 172.11or contract for enough outpatient services within the county to meet the needs of adults 172.12with mental illness residing in the county. Services may be provided directly by the 172.13county through county-operated mental health centers or mental health clinics approved 172.14by the commissioner under section 
         245.69, subdivision 2; by contract with privately 172.15operated mental health centers or mental health clinics approved by the commissioner 172.16under section 
         245.69, subdivision 2; by contract with hospital mental health outpatient 172.17programs certified by the Joint Commission on Accreditation of Hospital Organizations; 172.18or by contract with a licensed mental health professional as defined in section 
         245.462, 172.19subdivision 18
         , clauses (1) to (4) (6). Clients may be required to pay a fee according to 172.20section 
         245.481. Outpatient services include:  172.21    (1) conducting diagnostic assessments;172.22    (2) conducting psychological testing;172.23    (3) developing or modifying individual treatment plans;172.24    (4) making referrals and recommending placements as appropriate;172.25    (5) treating an adult's mental health needs through therapy;172.26    (6) prescribing and managing medication and evaluating the effectiveness of 172.27prescribed medication; and172.28    (7) preventing placement in settings that are more intensive, costly, or restrictive 172.29than necessary and appropriate to meet client needs.172.30    (b) County boards may request a waiver allowing outpatient services to be provided 172.31in a nearby trade area if it is determined that the client can best be served outside the 172.32county.172.33    Sec. 3. Minnesota Statutes 2008, section 245.4871, subdivision 27, is amended to read:173.1    Subd. 27. Mental health professional. "Mental health professional" means a 173.2person providing clinical services in the diagnosis and treatment of children's emotional 173.3disorders. A mental health professional must have training and experience in working with 173.4children consistent with the age group to which the mental health professional is assigned. 173.5A mental health professional must be qualified in at least one of the following ways:173.6    (1) in psychiatric nursing, the mental health professional must be a registered nurse 173.7who is licensed under sections 
         148.171 to 
         148.285 and who is certified as a clinical 173.8specialist in child and adolescent psychiatric or mental health nursing by a national nurse 173.9certification organization or who has a master's degree in nursing or one of the behavioral 173.10sciences or related fields from an accredited college or university or its equivalent, with 173.11at least 4,000 hours of post-master's supervised experience in the delivery of clinical 173.12services in the treatment of mental illness;173.13    (2) in clinical social work, the mental health professional must be a person licensed 173.14as an independent clinical social worker under chapter 148D, or a person with a master's 173.15degree in social work from an accredited college or university, with at least 4,000 hours of 173.16post-master's supervised experience in the delivery of clinical services in the treatment 173.17of mental disorders;173.18    (3) in psychology, the mental health professional must be an individual licensed by 173.19the board of psychology under sections 
         148.88 to 
         148.98 who has stated to the board of 173.20psychology competencies in the diagnosis and treatment of mental disorders;173.21    (4) in psychiatry, the mental health professional must be a physician licensed under 173.22chapter 147 and certified by the American board of psychiatry and neurology or eligible 173.23for board certification in psychiatry;173.24    (5) in marriage and family therapy, the mental health professional must be a 173.25marriage and family therapist licensed under sections 
         148B.29 to 
         148B.39 with at least 173.26two years of post-master's supervised experience in the delivery of clinical services in the 173.27treatment of mental disorders or emotional disturbances; or173.28    (6) in licensed professional clinical counseling, the mental health professional shall 173.29be a licensed professional clinical counselor under section 148B.5301 with at least 4,000 173.30hours of postmaster's supervised experience in the delivery of clinical services in the 173.31treatment of mental disorders or emotional disturbances; or173.32    (7) in allied fields, the mental health professional must be a person with a master's 173.33degree from an accredited college or university in one of the behavioral sciences or related 173.34fields, with at least 4,000 hours of post-master's supervised experience in the delivery of 173.35clinical services in the treatment of emotional disturbances.174.1    Sec. 4. Minnesota Statutes 2008, section 245.488, subdivision 1, is amended to read:174.2    Subdivision 1. Availability of outpatient services. (a) County boards must provide 174.3or contract for enough outpatient services within the county to meet the needs of each 174.4child with emotional disturbance residing in the county and the child's family. Services 174.5may be provided directly by the county through county-operated mental health centers or 174.6mental health clinics approved by the commissioner under section 
         245.69, subdivision 2; 174.7by contract with privately operated mental health centers or mental health clinics approved 174.8by the commissioner under section 
         245.69, subdivision 2; by contract with hospital 174.9mental health outpatient programs certified by the Joint Commission on Accreditation 174.10of Hospital Organizations; or by contract with a licensed mental health professional as 174.11defined in section 
         245.4871, subdivision 27, clauses (1) to (4) (6). A child or a child's 174.12parent may be required to pay a fee based in accordance with section 
         245.481. Outpatient 174.13services include:  174.14    (1) conducting diagnostic assessments;174.15    (2) conducting psychological testing;174.16    (3) developing or modifying individual treatment plans;174.17    (4) making referrals and recommending placements as appropriate;174.18    (5) treating the child's mental health needs through therapy; and174.19    (6) prescribing and managing medication and evaluating the effectiveness of 174.20prescribed medication.174.21    (b) County boards may request a waiver allowing outpatient services to be provided 174.22in a nearby trade area if it is determined that the child requires necessary and appropriate 174.23services that are only available outside the county.174.24    (c) Outpatient services offered by the county board to prevent placement must be at 174.25the level of treatment appropriate to the child's diagnostic assessment.174.26    Sec. 5. Minnesota Statutes 2008, section 254A.02, is amended by adding a subdivision 174.27to read:174.28    Subd. 8a.Placing authority."Placing authority" means a county, prepaid health 174.29plan, or tribal governing board governed by Minnesota Rules, parts 9530.6600 to 174.309530.6655.174.31    Sec. 6. Minnesota Statutes 2008, section 254A.16, is amended by adding a subdivision 174.32to read:174.33    Subd. 6.Monitoring.The commissioner shall gather and placing authorities shall 174.34provide information to measure compliance with Minnesota Rules, parts 9530.6600 to 175.19530.6655. The commissioner shall specify the format for data collection to facilitate 175.2tracking, aggregating, and using the information.175.3    Sec. 7. Minnesota Statutes 2008, section 254B.03, subdivision 1, is amended to read:175.4    Subdivision 1. Local agency duties. (a) Every local agency shall provide chemical 175.5dependency services to persons residing within its jurisdiction who meet criteria 175.6established by the commissioner for placement in a chemical dependency residential or 175.7nonresidential treatment service. Chemical dependency money must be administered 175.8by the local agencies according to law and rules adopted by the commissioner under 175.9sections 
         14.001 to 
         14.69. 175.10    (b) In order to contain costs, the county board shall, with the approval of the 175.11commissioner of human services,shall select eligible vendors of chemical dependency 175.12services who can provide economical and appropriate treatment. Unless the local agency 175.13is a social services department directly administered by a county or human services board, 175.14the local agency shall not be an eligible vendor under section 
         254B.05. The commissioner 175.15may approve proposals from county boards to provide services in an economical manner 175.16or to control utilization, with safeguards to ensure that necessary services are provided. 175.17If a county implements a demonstration or experimental medical services funding plan, 175.18the commissioner shall transfer the money as appropriate. If a county selects a vendor 175.19located in another state, the county shall ensure that the vendor is in compliance with the 175.20rules governing licensure of programs located in the state.175.21    (c) A culturally specific vendor that provides assessments under a variance under 175.22Minnesota Rules, part 9530.6610, shall be allowed to provide assessment services to 175.23persons not covered by the variance.175.24EFFECTIVE DATE.This section is effective July 1, 2011.175.25    Sec. 8. Minnesota Statutes 2008, section 254B.03, subdivision 3, is amended to read:175.26    Subd. 3. Local agencies to pay state for county share.  Local agencies shall pay 175.27the state for the county share of the services authorized by the local agency, except when 175.28the payment is made according to section 254B.09, subdivision 8.175.29    Sec. 9. Minnesota Statutes 2008, section 254B.03, is amended by adding a subdivision 175.30to read:175.31    Subd. 9.Commissioner to select vendors and set rates.(a) Effective July 1, 2011, 175.32the commissioner shall:175.33(1) enter into agreements with eligible vendors that:176.1(i) meet the standards in section 254B.05, subdivision 1;176.2(ii) have good standing in all applicable licensure; and176.3(iii) have a current approved provider agreement as a Minnesota health care program 176.4provider; and176.5(2) set rates for services reimbursed under this chapter.176.6(b) When setting rates, the commissioner shall consider the complexity and the 176.7acuity of the problems presented by the client.176.8(c) When rates set under this section and rates set under section 254B.09, subdivision 176.98, apply to the same treatment placement, section 254B.09, subdivision 8, supersedes.176.10    Sec. 10. Minnesota Statutes 2008, section 254B.05, subdivision 1, is amended to read:176.11    Subdivision 1. Licensure required. Programs licensed by the commissioner are 176.12eligible vendors. Hospitals may apply for and receive licenses to be eligible vendors, 176.13notwithstanding the provisions of section 
         245A.03. American Indian programs located on 176.14federally recognized tribal lands that provide chemical dependency primary treatment, 176.15extended care, transitional residence, or outpatient treatment services, and are licensed by 176.16tribal government are eligible vendors. Detoxification programs are not eligible vendors. 176.17Programs that are not licensed as a chemical dependency residential or nonresidential 176.18treatment program by the commissioner or by tribal government are not eligible vendors. 176.19To be eligible for payment under the Consolidated Chemical Dependency Treatment Fund, 176.20a vendor of a chemical dependency service must participate in the Drug and Alcohol 176.21Abuse Normative Evaluation System and the treatment accountability plan.  176.22Effective January 1, 2000, vendors of room and board are eligible for chemical 176.23dependency fund payment if the vendor:176.24(1) is certified by the county or tribal governing body as havinghas rules prohibiting 176.25residents bringing chemicals into the facility or using chemicals while residing in the 176.26facility and provide consequences for infractions of those rules;176.27(2) has a current contract with a county or tribal governing body;176.28(3) is determined to meet applicable health and safety requirements;176.29(4) is not a jail or prison; and176.30(5) is not concurrently receiving funds under chapter 256I for the recipient.176.31EFFECTIVE DATE.This section is effective July 1, 2011.176.32    Sec. 11. Minnesota Statutes 2008, section 254B.09, subdivision 2, is amended to read:176.33    Subd. 2. American Indian agreements. The commissioner may enter into 176.34agreements with federally recognized tribal units to pay for chemical dependency 177.1treatment services provided under Laws 1986, chapter 394, sections 8 to 20. The 177.2agreements must clarify how the governing body of the tribal unit fulfills local agency 177.3responsibilities regarding:177.4(1) selection of eligible vendors under section 254B.03, subdivision 1;  177.5(2) negotiation of agreements that establish vendor services and rates for programs 177.6located on the tribal governing body's reservation;177.7(3)(1) the form and manner of invoicing; and177.8(4)(2) provide that only invoices for eligible vendors according to section 
         254B.05177.9will be included in invoices sent to the commissioner for payment, to the extent that 177.10money allocated under subdivisions 4 and 5 is used.  177.11EFFECTIVE DATE.This section is effective July 1, 2011.177.12    Sec. 12. [254B.11] MAXIMUM RATES.177.13The commissioner shall publish maximum rates for vendors of the consolidated 177.14chemical dependency treatment fund by July 1 of each year for implementation the 177.15following January 1. Rates for calendar year 2010 must not exceed 185 percent of the 177.16average rate on January 1, 2009, for each group of vendors with similar attributes. Unless 177.17a new rate methodology is developed under section 254B.12, rates for services provided on 177.18and after July 1, 2011, must not exceed 160 percent of the average rate on January 1, 2009, 177.19for each group of vendors with similar attributes. Payment for services provided by Indian 177.20Health Services or by agencies operated by Indian tribes for medical assistance-eligible 177.21individuals must be governed by the applicable federal rate methodology.177.22    Sec. 13. [254B.12] RATE METHODOLOGY.177.23The commissioner shall, with broad-based stakeholder input, develop a 177.24recommendation and present a report to the 2011 legislature, including proposed 177.25legislation for a new rate methodology for the consolidated chemical dependency 177.26treatment fund. The new methodology must replace county-negotiated rates with a 177.27uniform statewide methodology that must include a graduated reimbursement scale based 177.28on the patients' level of acuity and complexity.177.29    Sec. 14. Minnesota Statutes 2008, section 256B.0622, subdivision 2, is amended to 177.30read:177.31    Subd. 2. Definitions. For purposes of this section, the following terms have the 177.32meanings given them.178.1    (a) "Intensive nonresidential rehabilitative mental health services" means adult 178.2rehabilitative mental health services as defined in section 
         256B.0623, subdivision 2, 178.3paragraph (a), except that these services are provided by a multidisciplinary staff using 178.4a total team approach consistent with assertive community treatment, the Fairweather 178.5Lodge treatment model, as defined by the standards established by the National Coalition 178.6for Community Living, and other evidence-based practices, and directed to recipients with 178.7a serious mental illness who require intensive services.178.8    (b) "Intensive residential rehabilitative mental health services" means short-term, 178.9time-limited services provided in a residential setting to recipients who are in need of 178.10more restrictive settings and are at risk of significant functional deterioration if they do 178.11not receive these services. Services are designed to develop and enhance psychiatric 178.12stability, personal and emotional adjustment, self-sufficiency, and skills to live in a more 178.13independent setting. Services must be directed toward a targeted discharge date with 178.14specified client outcomes and must be consistent with the Fairweather Lodge treatment 178.15model as defined in paragraph (a), and other evidence-based practices.178.16    (c) "Evidence-based practices" are nationally recognized mental health services that 178.17are proven by substantial research to be effective in helping individuals with serious 178.18mental illness obtain specific treatment goals.178.19    (d) "Overnight staff" means a member of the intensive residential rehabilitative 178.20mental health treatment team who is responsible during hours when recipients are 178.21typically asleep.178.22    (e) "Treatment team" means all staff who provide services under this section to 178.23recipients. At a minimum, this includes the clinical supervisor, mental health professionals 178.24as defined in section 
         245.462, subdivision 18, clauses (1) to (5) (6); mental health 178.25practitioners as defined in section 
         245.462, subdivision 17; mental health rehabilitation 178.26workers under section 
         256B.0623, subdivision 5, clause (3); and certified peer specialists 178.27under section 
         256B.0615.178.28    Sec. 15. Minnesota Statutes 2008, section 256B.0623, subdivision 5, is amended to 178.29read:178.30    Subd. 5. Qualifications of provider staff. Adult rehabilitative mental health 178.31services must be provided by qualified individual provider staff of a certified provider 178.32entity. Individual provider staff must be qualified under one of the following criteria:178.33    (1) a mental health professional as defined in section 
         245.462, subdivision 18, 178.34clauses (1) to (5) (6). If the recipient has a current diagnostic assessment by a licensed 178.35mental health professional as defined in section 
         245.462, subdivision 18, clauses (1) to (5)179.1(6), recommending receipt of adult mental health rehabilitative services, the definition of 179.2mental health professional for purposes of this section includes a person who is qualified 179.3under section 
         245.462, subdivision 18, clause (6) (7), and who holds a current and valid 179.4national certification as a certified rehabilitation counselor or certified psychosocial 179.5rehabilitation practitioner; 179.6    (2) a mental health practitioner as defined in section 
         245.462, subdivision 17. The 179.7mental health practitioner must work under the clinical supervision of a mental health 179.8professional; 179.9    (3) a certified peer specialist under section 
         256B.0615. The certified peer specialist 179.10must work under the clinical supervision of a mental health professional; or179.11    (4) a mental health rehabilitation worker. A mental health rehabilitation worker 179.12means a staff person working under the direction of a mental health practitioner or mental 179.13health professional and under the clinical supervision of a mental health professional in 179.14the implementation of rehabilitative mental health services as identified in the recipient's 179.15individual treatment plan who:179.16    (i) is at least 21 years of age;179.17    (ii) has a high school diploma or equivalent;179.18    (iii) has successfully completed 30 hours of training during the past two years in all 179.19of the following areas: recipient rights, recipient-centered individual treatment planning, 179.20behavioral terminology, mental illness, co-occurring mental illness and substance abuse, 179.21psychotropic medications and side effects, functional assessment, local community 179.22resources, adult vulnerability, recipient confidentiality; and179.23    (iv) meets the qualifications in subitem (A) or (B):179.24    (A) has an associate of arts degree in one of the behavioral sciences or human 179.25services, or is a registered nurse without a bachelor's degree, or who within the previous 179.26ten years has:179.27    (1) three years of personal life experience with serious and persistent mental illness;179.28    (2) three years of life experience as a primary caregiver to an adult with a serious 179.29mental illness or traumatic brain injury; or179.30    (3) 4,000 hours of supervised paid work experience in the delivery of mental health 179.31services to adults with a serious mental illness or traumatic brain injury; or179.32    (B)(1) is fluent in the non-English language or competent in the culture of the 179.33ethnic group to which at least 20 percent of the mental health rehabilitation worker's 179.34clients belong;179.35    (2) receives during the first 2,000 hours of work, monthly documented individual 179.36clinical supervision by a mental health professional;180.1    (3) has 18 hours of documented field supervision by a mental health professional 180.2or practitioner during the first 160 hours of contact work with recipients, and at least six 180.3hours of field supervision quarterly during the following year;180.4    (4) has review and cosignature of charting of recipient contacts during field 180.5supervision by a mental health professional or practitioner; and180.6    (5) has 40 hours of additional continuing education on mental health topics during 180.7the first year of employment.180.8    Sec. 16. Minnesota Statutes 2008, section 256B.0624, subdivision 5, is amended to 180.9read:180.10    Subd. 5. Mobile crisis intervention staff qualifications. For provision of adult 180.11mental health mobile crisis intervention services, a mobile crisis intervention team is 180.12comprised of at least two mental health professionals as defined in section 
         245.462, 180.13subdivision 18
         , clauses (1) to (5) (6), or a combination of at least one mental health 180.14professional and one mental health practitioner as defined in section 
         245.462, subdivision 180.1517
         , with the required mental health crisis training and under the clinical supervision of 180.16a mental health professional on the team. The team must have at least two people with 180.17at least one member providing on-site crisis intervention services when needed. Team 180.18members must be experienced in mental health assessment, crisis intervention techniques, 180.19and clinical decision-making under emergency conditions and have knowledge of local 180.20services and resources. The team must recommend and coordinate the team's services 180.21with appropriate local resources such as the county social services agency, mental health 180.22services, and local law enforcement when necessary. 180.23    Sec. 17. Minnesota Statutes 2008, section 256B.0624, subdivision 8, is amended to 180.24read:180.25    Subd. 8. Adult crisis stabilization staff qualifications. (a) Adult mental health 180.26crisis stabilization services must be provided by qualified individual staff of a qualified 180.27provider entity. Individual provider staff must have the following qualifications:180.28    (1) be a mental health professional as defined in section 
         245.462, subdivision 18, 180.29clauses (1) to (5) (6); 180.30    (2) be a mental health practitioner as defined in section 
         245.462, subdivision 17. 180.31The mental health practitioner must work under the clinical supervision of a mental health 180.32professional; or 180.33    (3) be a mental health rehabilitation worker who meets the criteria in section 180.34256B.0623, subdivision 5
         , clause (3); works under the direction of a mental health 181.1practitioner as defined in section 
         245.462, subdivision 17, or under direction of a 181.2mental health professional; and works under the clinical supervision of a mental health 181.3professional. 181.4    (b) Mental health practitioners and mental health rehabilitation workers must have 181.5completed at least 30 hours of training in crisis intervention and stabilization during 181.6the past two years.181.7    Sec. 18. Minnesota Statutes 2008, section 256B.0625, subdivision 42, is amended to 181.8read:181.9    Subd. 42. Mental health professional. Notwithstanding Minnesota Rules, part 181.109505.0175, subpart 28, the definition of a mental health professional shall include a person 181.11who is qualified as specified in section 
         245.462, subdivision 18, clause clauses  (5) and (6); 181.12or 
         245.4871, subdivision 27, clause clauses  (5) and (6), for the purpose of this section and 181.13Minnesota Rules, parts 9505.0170 to 9505.0475. 181.14    Sec. 19. Minnesota Statutes 2008, section 256B.0943, subdivision 1, is amended to 181.15read:181.16    Subdivision 1. Definitions. For purposes of this section, the following terms have 181.17the meanings given them.181.18    (a) "Children's therapeutic services and supports" means the flexible package of 181.19mental health services for children who require varying therapeutic and rehabilitative 181.20levels of intervention. The services are time-limited interventions that are delivered using 181.21various treatment modalities and combinations of services designed to reach treatment 181.22outcomes identified in the individual treatment plan.181.23    (b) "Clinical supervision" means the overall responsibility of the mental health 181.24professional for the control and direction of individualized treatment planning, service 181.25delivery, and treatment review for each client. A mental health professional who is an 181.26enrolled Minnesota health care program provider accepts full professional responsibility 181.27for a supervisee's actions and decisions, instructs the supervisee in the supervisee's work, 181.28and oversees or directs the supervisee's work.181.29    (c) "County board" means the county board of commissioners or board established 181.30under sections 
         402.01 to 
         402.10 or 
         471.59.  181.31    (d) "Crisis assistance" has the meaning given in section 
         245.4871, subdivision 9a.  181.32    (e) "Culturally competent provider" means a provider who understands and can 181.33utilize to a client's benefit the client's culture when providing services to the client. A 181.34provider may be culturally competent because the provider is of the same cultural or 182.1ethnic group as the client or the provider has developed the knowledge and skills through 182.2training and experience to provide services to culturally diverse clients.182.3    (f) "Day treatment program" for children means a site-based structured program 182.4consisting of group psychotherapy for more than three individuals and other intensive 182.5therapeutic services provided by a multidisciplinary team, under the clinical supervision 182.6of a mental health professional.182.7    (g) "Diagnostic assessment" has the meaning given in section 
         245.4871, subdivision 182.811
         .  182.9    (h) "Direct service time" means the time that a mental health professional, mental 182.10health practitioner, or mental health behavioral aide spends face-to-face with a client 182.11and the client's family. Direct service time includes time in which the provider obtains 182.12a client's history or provides service components of children's therapeutic services and 182.13supports. Direct service time does not include time doing work before and after providing 182.14direct services, including scheduling, maintaining clinical records, consulting with others 182.15about the client's mental health status, preparing reports, receiving clinical supervision 182.16directly related to the client's psychotherapy session, and revising the client's individual 182.17treatment plan.182.18    (i) "Direction of mental health behavioral aide" means the activities of a mental 182.19health professional or mental health practitioner in guiding the mental health behavioral 182.20aide in providing services to a client. The direction of a mental health behavioral aide 182.21must be based on the client's individualized treatment plan and meet the requirements in 182.22subdivision 6, paragraph (b), clause (5).182.23    (j) "Emotional disturbance" has the meaning given in section 
         245.4871, subdivision 182.2415
         . For persons at least age 18 but under age 21, mental illness has the meaning given in 182.25section 
         245.462, subdivision 20, paragraph (a).  182.26    (k) "Individual behavioral plan" means a plan of intervention, treatment, and 182.27services for a child written by a mental health professional or mental health practitioner, 182.28under the clinical supervision of a mental health professional, to guide the work of the 182.29mental health behavioral aide.182.30    (l) "Individual treatment plan" has the meaning given in section 
         245.4871, 182.31subdivision 21
         .  182.32    (m) "Mental health professional" means an individual as defined in section 
         245.4871, 182.33subdivision 27
         , clauses (1) to (5) (6), or tribal vendor as defined in section 
         256B.02, 182.34subdivision 7
         , paragraph (b).  182.35    (n) "Preschool program" means a day program licensed under Minnesota Rules, 182.36parts 9503.0005 to 9503.0175, and enrolled as a children's therapeutic services and 183.1supports provider to provide a structured treatment program to a child who is at least 33 183.2months old but who has not yet attended the first day of kindergarten.183.3    (o) "Skills training" means individual, family, or group training designed to improve 183.4the basic functioning of the child with emotional disturbance and the child's family in the 183.5activities of daily living and community living, and to improve the social functioning of the 183.6child and the child's family in areas important to the child's maintaining or reestablishing 183.7residency in the community. Individual, family, and group skills training must:183.8    (1) consist of activities designed to promote skill development of the child and the 183.9child's family in the use of age-appropriate daily living skills, interpersonal and family 183.10relationships, and leisure and recreational services;183.11    (2) consist of activities that will assist the family's understanding of normal child 183.12development and to use parenting skills that will help the child with emotional disturbance 183.13achieve the goals outlined in the child's individual treatment plan; and183.14    (3) promote family preservation and unification, promote the family's integration 183.15with the community, and reduce the use of unnecessary out-of-home placement or 183.16institutionalization of children with emotional disturbance.183.17    Sec. 20. Minnesota Statutes 2008, section 256B.0625, subdivision 47, is amended to 183.18read:183.19    Subd. 47. Treatment foster care services. Effective July 1, 2007 2011, and subject 183.20to federal approval, medical assistance covers treatment foster care services according to 183.21section 
         256B.0946.183.22    Sec. 21. Minnesota Statutes 2008, section 256B.0943, subdivision 12, is amended to 183.23read:183.24    Subd. 12. Excluded services. The following services are not eligible for medical 183.25assistance payment as children's therapeutic services and supports:183.26    (1) service components of children's therapeutic services and supports 183.27simultaneously provided by more than one provider entity unless prior authorization is 183.28obtained;183.29    (2) treatment by multiple providers within the same agency at the same clock time;183.30(3) children's therapeutic services and supports provided in violation of medical 183.31assistance policy in Minnesota Rules, part 9505.0220;183.32    (3) (4) mental health behavioral aide services provided by a personal care assistant 183.33who is not qualified as a mental health behavioral aide and employed by a certified 183.34children's therapeutic services and supports provider entity;184.1    (4)(5) service components of CTSS that are the responsibility of a residential or 184.2program license holder, including foster care providers under the terms of a service 184.3agreement or administrative rules governing licensure; 184.4    (5)(6) adjunctive activities that may be offered by a provider entity but are not 184.5otherwise covered by medical assistance, including:184.6    (i) a service that is primarily recreation oriented or that is provided in a setting that 184.7is not medically supervised. This includes sports activities, exercise groups, activities 184.8such as craft hours, leisure time, social hours, meal or snack time, trips to community 184.9activities, and tours;184.10    (ii) a social or educational service that does not have or cannot reasonably be 184.11expected to have a therapeutic outcome related to the client's emotional disturbance;184.12    (iii) consultation with other providers or service agency staff about the care or 184.13progress of a client;184.14    (iv) prevention or education programs provided to the community; and184.15    (v) treatment for clients with primary diagnoses of alcohol or other drug abuse; and184.16    (6)(7) activities that are not direct service time.184.17    Sec. 22. Minnesota Statutes 2008, section 256B.0944, is amended by adding a 184.18subdivision to read:184.19    Subd. 4a.Alternative provider standards.If a provider entity demonstrates that, 184.20due to geographic or other barriers, it is not feasible to provide mobile crisis intervention 184.21services 24 hours a day, seven days a week, according to the standards in subdivision 4, 184.22paragraph (b), clause (1), the commissioner may approve a crisis response provider based 184.23on an alternative plan proposed by a provider entity. The alternative plan must:184.24(1) result in increased access and a reduction in disparities in the availability of 184.25crisis services; and184.26(2) provide mobile services outside of the usual nine-to-five office hours and on 184.27weekends and holidays.184.28    Sec. 23. Minnesota Statutes 2008, section 256B.0947, subdivision 1, is amended to 184.29read:184.30    Subdivision 1. Scope.Subject to federal approval Effective November 1, 2010, and 184.31subject to federal approval, medical assistance covers medically necessary, intensive 184.32nonresidential rehabilitative mental health services as defined in subdivision 2, for 184.33recipients as defined in subdivision 3, when the services are provided by an entity meeting 184.34the standards in this section.185.1    Sec. 24. Minnesota Statutes 2008, section 256J.08, subdivision 73a, is amended to read:185.2    Subd. 73a. Qualified professional. (a) For physical illness, injury, or incapacity, 185.3a "qualified professional" means a licensed physician, a physician's assistant, a nurse 185.4practitioner, or a licensed chiropractor.185.5    (b) For developmental disability and intelligence testing, a "qualified professional" 185.6means an individual qualified by training and experience to administer the tests necessary 185.7to make determinations, such as tests of intellectual functioning, assessments of adaptive 185.8behavior, adaptive skills, and developmental functioning. These professionals include 185.9licensed psychologists, certified school psychologists, or certified psychometrists working 185.10under the supervision of a licensed psychologist.185.11    (c) For learning disabilities, a "qualified professional" means a licensed psychologist 185.12or school psychologist with experience determining learning disabilities.185.13    (d) For mental health, a "qualified professional" means a licensed physician or a 185.14qualified mental health professional. A "qualified mental health professional" means:185.15    (1) for children, in psychiatric nursing, a registered nurse who is licensed under 185.16sections 
         148.171 to 
         148.285, and who is certified as a clinical specialist in child 185.17and adolescent psychiatric or mental health nursing by a national nurse certification 185.18organization or who has a master's degree in nursing or one of the behavioral sciences 185.19or related fields from an accredited college or university or its equivalent, with at least 185.204,000 hours of post-master's supervised experience in the delivery of clinical services in 185.21the treatment of mental illness;185.22    (2) for adults, in psychiatric nursing, a registered nurse who is licensed under 185.23sections 
         148.171 to 
         148.285, and who is certified as a clinical specialist in adult psychiatric 185.24and mental health nursing by a national nurse certification organization or who has a 185.25master's degree in nursing or one of the behavioral sciences or related fields from an 185.26accredited college or university or its equivalent, with at least 4,000 hours of post-master's 185.27supervised experience in the delivery of clinical services in the treatment of mental illness;185.28    (3) in clinical social work, a person licensed as an independent clinical social worker 185.29under chapter 148D, or a person with a master's degree in social work from an accredited 185.30college or university, with at least 4,000 hours of post-master's supervised experience in 185.31the delivery of clinical services in the treatment of mental illness;185.32    (4) in psychology, an individual licensed by the Board of Psychology under sections 185.33148.88
          to 
         148.98, who has stated to the Board of Psychology competencies in the 185.34diagnosis and treatment of mental illness;186.1    (5) in psychiatry, a physician licensed under chapter 147 and certified by the 186.2American Board of Psychiatry and Neurology or eligible for board certification in 186.3psychiatry; and186.4    (6) in marriage and family therapy, the mental health professional must be a 186.5marriage and family therapist licensed under sections 
         148B.29 to 
         148B.39, with at least 186.6two years of post-master's supervised experience in the delivery of clinical services in the 186.7treatment of mental illness; and186.8    (7) in licensed professional clinical counseling, the mental health professional 186.9shall be a licensed professional clinical counselor under section 148B.5301 with at least 186.104,000 hours of postmaster's supervised experience in the delivery of clinical services in 186.11the treatment of mental illness.186.12    Sec. 25. AUTISM SPECTRUM DISORDER TASK FORCE.186.13(a) The Autism Spectrum Disorder Task Force is composed of 15 members, 186.14appointed as follows:186.15(1) two members of the senate appointed by the Subcommittee on Committees of the 186.16Committee on Rules and Administration, one of whom must be a member of the minority;186.17(2) two members of the house of representatives, one from the majority party, 186.18appointed by the speaker of the house, and one from the minority party, appointed by 186.19the minority leader;186.20    (3) two members appointed by the legislature, with regard to geographic diversity in 186.21the state, who are parents of children with autism spectrum disorder (ASD); one member 186.22shall be appointed by the senate Subcommittee on Committees of the Committee on 186.23Rules and Administration making appointments for the senate; and one member shall be 186.24appointed by the speaker of the house making the appointments for the house;186.25(4) one member appointed by the Minnesota chapter of the American Academy of 186.26Pediatrics who is a general primary care pediatrician; 186.27(5) one member appointed by the Minnesota Academy of Family Physicians who is 186.28a family practice physician;186.29(6) one member appointed by the Minnesota Psychological Association who is a 186.30neuropsychologist;186.31(7) one member appointed by the directors of public school student support services;186.32(8) one member appointed by the Somali American Autism Foundation;186.33(9) one member appointed by the ARC of Minnesota;186.34(10) one member appointed by the Autism Society of Minnesota;187.1(11) one member appointed by the Parent Advocacy Coalition for Educational 187.2Rights; and187.3(12) one member appointed by the Minnesota Council of Health Plans.187.4Appointments must be made by September 1, 2009. The Legislative Coordinating 187.5Commission shall provide meeting space for the task force. The senate member appointed 187.6by the minority leader of the senate shall convene the first meeting of the task force no 187.7later than October 1, 2009. The task force shall elect a chair at the first meeting.187.8(b) If federal or state funding is available, the commissioners of education, 187.9employment and economic development, health, and human services shall provide 187.10assistance to the task force.187.11(c) The task force shall develop recommendations and report on the following topics:187.12(1) ways to improve services provided by all state and political subdivisions;187.13(2) sources of public and private funding available for treatment and ways to 187.14improve efficiency in the use of these funds;187.15(3) methods to improve coordination in the delivery of service between public 187.16and private agencies, health providers, and schools, and to address any geographic 187.17discrepancies in the delivery of services;187.18(4) increasing the availability of and the training for medical providers and educators 187.19who identify and provide services to individuals with ASD; and187.20(5) treatment options supported by peer-reviewed, established scientific research 187.21for individuals with ASD.187.22(d) The task force shall coordinate with existing efforts at the Departments of 187.23Education, Health, Human Services, and Employment and Economic Development 187.24related to ASD.187.25(e) By January 15 of each year, the task force shall provide a report regarding its 187.26findings and consideration of the topics listed under paragraph (c), and the action taken 187.27under paragraph (d), including draft legislation if necessary, to the chairs and ranking 187.28minority members of the legislative committees with jurisdiction over health and human 187.29services.187.30(f) This section expires June 30, 2011.187.31    Sec. 26. STATE-COUNTY CHEMICAL HEALTH CARE HOME PILOT 187.32PROJECT.187.33    Subdivision 1.Establishment; purpose.There is established a state-county 187.34chemical health care home pilot project. The purpose of the pilot project is for the 187.35Department of Human Services and counties to authentically and creatively work in 188.1partnership to redesign the current chemical health service delivery system in a way 188.2that promotes greater accountability, productivity, and results in the delivery of state 188.3chemical dependency services. The pilot project or projects must look to provide 188.4appropriate flexibility in a way that ensures timely access to needed services as well 188.5as better aligning systems and services to offer the most appropriate level of chemical 188.6health care services to the client. This may include, but is not limited to, looking into new 188.7governance agreements, performance agreements, or service level agreements. Pilot 188.8projects must maintain eligibility requirements for the consolidated chemical dependency 188.9treatment fund, continue to meet the requirements of Minnesota Rules, parts 9530.6600 to 188.109530.6655 (also known as Rule 25) and Minnesota Rules, parts 9530.6405 to 9530.6505 188.11(also known as Rule 31), and must not put at risk current and future federal funding toward 188.12chemical health-related services in the state of Minnesota. 188.13    Subd. 2.Workgroup; report.A workgroup must be convened on or before July 188.1415, 2009, consisting of representatives from the Department of Human Services and 188.15potential participating counties to develop draft proposals for pilot projects meeting the 188.16requirements of this section. The workgroup shall report back to the legislative committees 188.17with jurisdiction over chemical health by January 15, 2010, for potential approval of one 188.18metro and one nonmetro county pilot project to be implemented beginning July 10, 2010.188.19    Subd. 3.Report.The Department of Human Services shall evaluate the efficacy and 188.20feasibility of the pilot projects and report the results of that evaluation to the legislative 188.21committees having jurisdiction over chemical health by June 30, 2011. Expansion of pilot 188.22projects may occur only if the department's report finds the pilot projects effective.188.23    Subd. 4.Expiration.This section expires June 30, 2012.188.24EFFECTIVE DATE.This section is effective the day following final enactment.188.25ARTICLE 8188.26CONTINUING CARE188.27    Section 1. Minnesota Statutes 2008, section 144.0724, subdivision 2, is amended to 188.28read:188.29    Subd. 2. Definitions. For purposes of this section, the following terms have the 188.30meanings given.188.31(a) "Assessment reference date" means the last day of the minimum data set 188.32observation period. The date sets the designated endpoint of the common observation 188.33period, and all minimum data set items refer back in time from that point.189.1(b) "Case mix index" means the weighting factors assigned to the RUG-III 189.2classifications.189.3(c) "Index maximization" means classifying a resident who could be assigned to 189.4more than one category, to the category with the highest case mix index.189.5(d) "Minimum data set" means the assessment instrument specified by the Centers for 189.6Medicare and Medicaid Services and designated by the Minnesota Department of Health.189.7(e) "Representative" means a person who is the resident's guardian or conservator, 189.8the person authorized to pay the nursing home expenses of the resident, a representative 189.9of the nursing home ombudsman's office whose assistance has been requested, or any 189.10other individual designated by the resident.189.11(f) "Resource utilization groups" or "RUG" means the system for grouping a nursing 189.12facility's residents according to their clinical and functional status identified in data 189.13supplied by the facility's minimum data set.189.14(g) "Activities of daily living" means grooming, dressing, bathing, transferring, 189.15mobility, positioning, eating, and toileting.189.16(h) "Nursing facility level of care determination" means the assessment process 189.17that results in a determination of a resident's or prospective resident's need for nursing 189.18facility level of care as established in subdivision 11 for purposes of medical assistance 189.19payment of long-term care services for:189.20(1) nursing facility services under section 256B.434 or 256B.441;189.21(2) elderly waiver services under section 256B.0915;189.22(3) CADI and TBI waiver services under section 256B.49; and189.23(4) state payment of alternative care services under section 256B.0913.189.24EFFECTIVE DATE.The section is effective January 1, 2011.189.25    Sec. 2. Minnesota Statutes 2008, section 144.0724, subdivision 4, is amended to read:189.26    Subd. 4. Resident assessment schedule. (a) A facility must conduct and 189.27electronically submit to the commissioner of health case mix assessments that conform 189.28with the assessment schedule defined by Code of Federal Regulations, title 42, section 189.29483.20
         , and published by the United States Department of Health and Human Services, 189.30Centers for Medicare and Medicaid Services, in the Long Term Care Assessment 189.31Instrument User's Manual, version 2.0, October 1995, and subsequent clarifications made 189.32in the Long-Term Care Assessment Instrument Questions and Answers, version 2.0, 189.33August 1996. The commissioner of health may substitute successor manuals or question 189.34and answer documents published by the United States Department of Health and Human 190.1Services, Centers for Medicare and Medicaid Services, to replace or supplement the 190.2current version of the manual or document.190.3(b) The assessments used to determine a case mix classification for reimbursement 190.4include the following:190.5(1) a new admission assessment must be completed by day 14 following admission;190.6(2) an annual assessment must be completed within 366 days of the last 190.7comprehensive assessment;190.8(3) a significant change assessment must be completed within 14 days of the 190.9identification of a significant change; and190.10(4) the second quarterly assessment following either a new admission assessment, 190.11an annual assessment, or a significant change assessment, and all quarterly assessments 190.12beginning October 1, 2006. Each quarterly assessment must be completed within 92 190.13days of the previous assessment.190.14(c) In addition to the assessments listed in paragraph (b), the assessments used to 190.15determine nursing facility level of care include the following:190.16(1) preadmission screening completed under section 256B.0911, subdivision 4a, 190.17by a county, tribe, or managed care organization under contract with the Department 190.18of Human Services; and190.19(2) a face-to-face long-term care consultation assessment completed under section 190.20256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or managed care organization 190.21under contract with the Department of Human Services.190.22EFFECTIVE DATE.The section is effective January 1, 2011.190.23    Sec. 3. Minnesota Statutes 2008, section 144.0724, subdivision 8, is amended to read:190.24    Subd. 8. Request for reconsideration of resident classifications. (a) The resident, 190.25or resident's representative, or the nursing facility or boarding care home may request that 190.26the commissioner of health reconsider the assigned reimbursement classification. The 190.27request for reconsideration must be submitted in writing to the commissioner within 190.2830 days of the day the resident or the resident's representative receives the resident 190.29classification notice. The request for reconsideration must include the name of the 190.30resident, the name and address of the facility in which the resident resides, the reasons for 190.31the reconsideration, the requested classification changes, and documentation supporting 190.32the requested classification. The documentation accompanying the reconsideration request 190.33is limited to documentation which establishes that the needs of the resident at the time of 190.34the assessment justify a classification which is different than the classification established 190.35by the commissioner of health.191.1(b) Upon request, the nursing facility must give the resident or the resident's 191.2representative a copy of the assessment form and the other documentation that was given 191.3to the commissioner of health to support the assessment findings. The nursing facility 191.4shall also provide access to and a copy of other information from the resident's record that 191.5has been requested by or on behalf of the resident to support a resident's reconsideration 191.6request. A copy of any requested material must be provided within three working days of 191.7receipt of a written request for the information. If a facility fails to provide the material 191.8within this time, it is subject to the issuance of a correction order and penalty assessment 191.9under sections 
         144.653 and 
         144A.10. Notwithstanding those sections, any correction order 191.10issued under this subdivision must require that the nursing facility immediately comply 191.11with the request for information and that as of the date of the issuance of the correction 191.12order, the facility shall forfeit to the state a $100 fine for the first day of noncompliance, and 191.13an increase in the $100 fine by $50 increments for each day the noncompliance continues. 191.14(c) In addition to the information required under paragraphs (a) and (b), a 191.15reconsideration request from a nursing facility must contain the following information: (i) 191.16the date the reimbursement classification notices were received by the facility; (ii) the date 191.17the classification notices were distributed to the resident or the resident's representative; 191.18and (iii) a copy of a notice sent to the resident or to the resident's representative. This 191.19notice must inform the resident or the resident's representative that a reconsideration of the 191.20resident's classification is being requested, the reason for the request, that the resident's 191.21rate will change if the request is approved by the commissioner, the extent of the change, 191.22that copies of the facility's request and supporting documentation are available for review, 191.23and that the resident also has the right to request a reconsideration. If the facility fails to 191.24provide the required information with the reconsideration request, the request must be 191.25denied, and the facility may not make further reconsideration requests on that specific 191.26reimbursement classification.191.27(d) Reconsideration by the commissioner must be made by individuals not involved 191.28in reviewing the assessment, audit, or reconsideration that established the disputed 191.29classification. The reconsideration must be based upon the initial assessment and upon the 191.30information provided to the commissioner under paragraphs (a) and (b). If necessary for 191.31evaluating the reconsideration request, the commissioner may conduct on-site reviews. 191.32Within 15 working days of receiving the request for reconsideration, the commissioner 191.33shall affirm or modify the original resident classification. The original classification 191.34must be modified if the commissioner determines that the assessment resulting in the 191.35classification did not accurately reflect the needs or assessment characteristics of the 191.36resident at the time of the assessment. The resident and the nursing facility or boarding 192.1care home shall be notified within five working days after the decision is made. A decision 192.2by the commissioner under this subdivision is the final administrative decision of the 192.3agency for the party requesting reconsideration.192.4(e) The resident classification established by the commissioner shall be the 192.5classification that applies to the resident while the request for reconsideration is pending.192.6If a request for reconsideration applies to an assessment used to determine nursing facility 192.7level of care under subdivision 4, paragraph (c), the resident shall continue to be eligible 192.8for nursing facility level of care while the request for reconsideration is pending.192.9(f) The commissioner may request additional documentation regarding a 192.10reconsideration necessary to make an accurate reconsideration determination.192.11EFFECTIVE DATE.The section is effective January 1, 2011.192.12    Sec. 4. Minnesota Statutes 2008, section 144.0724, is amended by adding a subdivision 192.13to read:192.14    Subd. 11.Nursing facility level of care.(a) For purposes of medical assistance 192.15payment of long-term care services, a recipient must be determined, using assessments 192.16defined in subdivision 4, to meet one of the following nursing facility level of care criteria:192.17(1) the person needs the assistance of another person or constant supervision to begin 192.18and complete at least four of the following activities of living: bathing, bed mobility, 192.19dressing, eating, grooming, toileting, transferring, and walking; 192.20(2) the person needs the assistance of another person or constant supervision to begin 192.21and complete toileting, transferring, or positioning and the assistance cannot be scheduled;192.22(3) the person has significant difficulty with memory, using information, daily 192.23decision making, or behavioral needs that require intervention;192.24(4) the person has had a qualifying nursing facility stay of at least 90 days; or192.25(5) the person is determined to be at risk for nursing facility admission or 192.26readmission through a face-to-face long-term care consultation assessment as specified 192.27in section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or managed care 192.28organization under contract with the Department of Human Services. The person is 192.29considered at risk under this clause if the person currently lives alone or will live alone 192.30upon discharge and also meets one of the following criteria:192.31(i) the person has experienced a fall resulting in a fracture;192.32(ii) the person has been determined to be at risk of maltreatment or neglect, 192.33including self-neglect; or192.34(iii) the person has a sensory impairment that substantially impacts functional ability 192.35and maintenance of a community residence.193.1(b) The assessment used to establish medical assistance payment for nursing facility 193.2services must be the most recent assessment performed under subdivision 4, paragraph 193.3(b), that occurred no more than 90 calendar days before the effective date of medical 193.4assistance eligibility for payment of long-term care services. In no case shall medical 193.5assistance payment for long-term care services occur prior to the date of the determination 193.6of nursing facility level of care.193.7(c) The assessment used to establish medical assistance payment for long-term care 193.8services provided under sections 256B.0915 and 256B.49 and alternative care payment 193.9for services provided under section 256B.0913 must be the most recent face-to-face 193.10assessment performed under section 256B.0911, subdivision 3a, that occurred no more 193.11than 60 calendar days before the effective date of medical assistance eligibility for 193.12payment of long-term care services.193.13EFFECTIVE DATE.The section is effective January 1, 2011.193.14    Sec. 5. Minnesota Statutes 2008, section 144.0724, is amended by adding a subdivision 193.15to read:193.16    Subd. 12.Appeal of nursing facility level of care determination.A resident or 193.17prospective resident whose level of care determination results in a denial of long-term care 193.18services can appeal the determination as outlined in section 256B.0911, subdivision 3a, 193.19paragraph (h), clause (7).193.20EFFECTIVE DATE.The section is effective January 1, 2011.193.21    Sec. 6. Minnesota Statutes 2008, section 144A.073, is amended by adding a 193.22subdivision to read:193.23    Subd. 12.Extension of approval of moratorium exception projects.193.24Notwithstanding subdivision 3, the commissioner of health shall extend project approval 193.25by an additional 18 months for an approved proposal for an exception to the nursing home 193.26licensure and certification moratorium if the proposal was approved under this section 193.27between July 1, 2007, and June 30, 2009.193.28    Sec. 7. Minnesota Statutes 2008, section 144A.44, subdivision 2, is amended to read:193.29    Subd. 2. Interpretation and enforcement of rights. These rights are established 193.30for the benefit of persons who receive home care services. "Home care services" means 193.31home care services as defined in section 
         144A.43, subdivision 3, and unlicensed personal 193.32care assistance services, including services covered by medical assistance under section 193.33256B.0625, subdivision 19a. A home care provider may not require a person to surrender 194.1these rights as a condition of receiving services. A guardian or conservator or, when there 194.2is no guardian or conservator, a designated person, may seek to enforce these rights. This 194.3statement of rights does not replace or diminish other rights and liberties that may exist 194.4relative to persons receiving home care services, persons providing home care services, or 194.5providers licensed under Laws 1987, chapter 378. A copy of these rights must be provided 194.6to an individual at the time home care services, including personal care assistance 194.7services, are initiated. The copy shall also contain the address and phone number of the 194.8Office of Health Facility Complaints and the Office of Ombudsman for Long-Term Care 194.9and a brief statement describing how to file a complaint with these offices. Information 194.10about how to contact the Office of Ombudsman for Long-Term Care shall be included in 194.11notices of change in client fees and in notices where home care providers initiate transfer 194.12or discontinuation of services. 194.13    Sec. 8. Minnesota Statutes 2008, section 245A.03, is amended by adding a subdivision 194.14to read:194.15    Subd. 7.Licensing moratorium.(a) The commissioner shall not issue an 194.16initial license for child foster care licensed under Minnesota Rules, parts 2960.3000 to 194.172960.3340, or adult foster care licensed under Minnesota Rules, parts 9555.5105 to 194.189555.6265, under this chapter for a physical location that will not be the primary residence 194.19of the license holder for the entire period of licensure. If a license is issued during this 194.20moratorium, and the license holder changes the license holder's primary residence away 194.21from the physical location of the foster care license, the commissioner shall revoke the 194.22license according to section 245A.07. Exceptions to the moratorium include:194.23(1) foster care settings that are required to be registered under chapter 144D;194.24(2) foster care licenses replacing foster care licenses in existence on the effective 194.25date of this section and determined to be needed by the commissioner under paragraph (b);194.26(3) new foster care licenses determined to be needed by the commissioner under 194.27paragraph (b) for the closure of a nursing facility, ICF/MR, or regional treatment center;194.28(4) new foster care licenses determined to be needed by the commissioner under 194.29paragraph (b) for persons requiring hospital level care; or194.30(5) new foster care licenses determined to be needed by the commissioner for the 194.31transition of people from personal care assistance to the home and community-based 194.32services.194.33(b) The commissioner shall determine the need for newly licensed foster care homes 194.34as defined under this subdivision. As part of the determination, the commissioner shall 194.35consider the availability of foster care capacity in the area which the licensee seeks to 195.1operate, and the recommendation of the local county board. The determination by the 195.2commissioner must be final. A determination of need is not required for a change in 195.3ownership at the same address.195.4    (c) Residential settings that would otherwise be subject to the moratorium established 195.5in paragraph (a), that are in the process of receiving an adult or child foster care license as 195.6of July 1, 2009, shall be allowed to continue to complete the process of receiving an adult 195.7or child foster care license. For this paragraph, all of the following conditions must be met 195.8to be considered in process of receiving an adult or child foster care license:195.9    (1) participants have made decisions to move into the residential setting, including 195.10documentation in each participant's care plan;195.11    (2) the provider has purchased housing or has made a financial investment in the 195.12property;195.13    (3) the lead agency has approved the plans, including costs for the residential setting 195.14for each individual;195.15    (4) the completion of the licensing process, including all necessary inspections, is 195.16the only remaining component prior to being able to provide services; and195.17    (5) the needs of the individuals cannot be met within the existing capacity in that 195.18county.195.19To qualify for the process under this paragraph, the lead agency must submit 195.20documentation to the commissioner by August 1, 2009, that all of the above criteria are 195.21met.195.22(d) The commissioner shall study the effects of the license moratorium under this 195.23subdivision and shall report back to the legislature by January 15, 2011.195.24EFFECTIVE DATE.This section is effective the day following final enactment.195.25    Sec. 9. Minnesota Statutes 2008, section 245A.11, is amended by adding a subdivision 195.26to read:195.27    Subd. 8.Community residential setting license.(a) The commissioner shall 195.28establish provider standards for residential support services that integrate service standards 195.29and the residential setting under one license. The commissioner shall propose statutory 195.30language and an implementation plan for licensing requirements for residential support 195.31services to the legislature by January 15, 2011.195.32(b) Providers licensed under chapter 245B, and providing, contracting, or arranging 195.33for services in settings licensed as adult foster care under Minnesota Rules, parts 195.349555.5105 to 9555.6265, or child foster care under Minnesota Rules, parts 2960.3000 to 196.12960.3340; and meeting the provisions of section 256B.092, subdivision 11, paragraph 196.2(b), must be required to obtain a community residential setting license.196.3    Sec. 10. Minnesota Statutes 2008, section 252.46, is amended by adding a subdivision 196.4to read:196.5    Subd. 1a.Day training and habilitation rates.The commissioner shall establish 196.6a statewide rate-setting methodology for all day training and habilitation services. The 196.7rate-setting methodology must abide by the principles of transparency and equitability 196.8across the state. The methodology must involve a uniform process of structuring rates for 196.9each service and must promote quality and participant choice.196.10    Sec. 11. Minnesota Statutes 2008, section 252.50, subdivision 1, is amended to read:196.11    Subdivision 1.  Community-based programs established. The commissioner 196.12shall establish a system of state-operated, community-based programs for persons with 196.13developmental disabilities. For purposes of this section, "state-operated, community-based 196.14program" means a program administered by the state to provide treatment and habilitation 196.15in noninstitutional community settings to persons with developmental disabilities. 196.16Employees of the programs, except clients who work within and benefit from these 196.17treatment and habilitation programs, must be state employees under chapters 43A and 196.18179A. Although any clients who work within and benefit from these treatment and 196.19habilitation programs are not employees under chapters 43A and 179A, the Department 196.20of Human Services may consider clients who work within and benefit from these 196.21programs employees for federal tax purposes. The establishment of state-operated, 196.22community-based programs must be within the context of a comprehensive definition of 196.23the role of state-operated services in the state. The role of state-operated services must 196.24be defined within the context of a comprehensive system of services for persons with 196.25developmental disabilities. State-operated, community-based programs may include, but 196.26are not limited to, community group homes, foster care, supportive living services, day 196.27training and habilitation programs, and respite care arrangements. The commissioner 196.28may operate the pilot projects established under Laws 1985, First Special Session 196.29chapter 9, article 1, section 2, subdivision 6, and shall, within the limits of available 196.30appropriations, establish additional state-operated, community-based programs for 196.31persons with developmental disabilities. State-operated, community-based programs may 196.32accept admissions from regional treatment centers, from the person's own home, or from 196.33community programs. State-operated, community-based programs offering day program 196.34services may be provided for persons with developmental disabilities who are living in 197.1state-operated, community-based residential programs until July 1, 2000. No later than 197.21994, the commissioner, together with family members, counties, advocates, employee 197.3representatives, and other interested parties, shall begin planning so that by July 1, 2000, 197.4state-operated, community-based residential facilities will be in compliance with section 197.5252.41, subdivision 9
         . 197.6    Sec. 12. Minnesota Statutes 2008, section 256.01, is amended by adding a subdivision 197.7to read:197.8    Subd. 29.State medical review team.(a) To ensure the timely processing of 197.9determinations of disability by the commissioner's state medical review team under 197.10sections 256B.055, subdivision 7, paragraph (b), 256B.057, subdivision 9, paragraph 197.11(j), and 256B.055, subdivision 12, the commissioner shall review all medical evidence 197.12submitted by county agencies with a referral and seek additional information from 197.13providers, applicants, and enrollees to support the determination of disability where 197.14necessary. Disability shall be determined according to the rules of title XVI and title 197.15XIX of the Social Security Act and pertinent rules and policies of the Social Security 197.16Administration.197.17    (b) Prior to a denial or withdrawal of a requested determination of disability due 197.18to insufficient evidence, the commissioner shall (1) ensure that the missing evidence is 197.19necessary and appropriate to a determination of disability, and (2) assist applicants and 197.20enrollees to obtain the evidence, including, but not limited to, medical examinations 197.21and electronic medical records.197.22(c) The commissioner shall provide the chairs of the legislative committees with 197.23jurisdiction over health and human services finance and budget the following information 197.24on the activities of the state medical review team by February 1, 2010, and annually 197.25thereafter:197.26(1) the number of applications to the state medical review team that were denied, 197.27approved, or withdrawn;197.28(2) the average length of time from receipt of the application to a decision;197.29(3) the number of appeals and appeal results;197.30(4) for applicants, their age, health coverage at the time of application, hospitalization 197.31history within three months of application, and whether an application for Social Security 197.32or Supplemental Security Income benefits is pending; and 197.33(5) specific information on the medical certification, licensure, or other credentials 197.34of the person or persons performing the medical review determinations and length of 197.35time in that position.198.1    Sec. 13. [256.0281] INTERAGENCY DATA EXCHANGE.198.2The Department of Human Services, the Department of Health, and the Office of the 198.3Ombudsman for Mental Health and Developmental Disabilities may establish interagency 198.4agreements governing the electronic exchange of data on providers and individuals 198.5collected, maintained, or used by each agency when such exchange is outlined by each 198.6agency in an interagency agreement to accomplish the purposes in clauses (1) to (4):198.7(1) to improve provider enrollment processes for home and community-based 198.8services and state plan home care services;198.9(2) to improve quality management of providers between state agencies;198.10(3) to establish and maintain provider eligibility to participate as providers under 198.11Minnesota health care programs; or198.12(4) to meet the quality assurance reporting requirements under federal law under 198.13section 1915(c) of the Social Security Act related to home and community-based waiver 198.14programs.198.15Each interagency agreement must include provisions to ensure anonymity of individuals, 198.16including mandated reporters, and must outline the specific uses of and access to shared 198.17data within each agency. Electronic interfaces between source data systems developed 198.18under these interagency agreements must incorporate these provisions as well as other 198.19HIPPA provisions related to individual data.198.20    Sec. 14. Minnesota Statutes 2008, section 256.476, subdivision 5, is amended to read:198.21    Subd. 5.  Reimbursement, allocations, and reporting. (a) For the purpose of 198.22transferring persons to the consumer support grant program from the family support 198.23program and personal care assistant services, home health aide services, or private duty 198.24nursing services, the amount of funds transferred by the commissioner between the 198.25family support program account, the medical assistance account, or the consumer support 198.26grant account shall be based on each county's participation in transferring persons to the 198.27consumer support grant program from those programs and services. 198.28    (b) At the beginning of each fiscal year, county allocations for consumer support 198.29grants shall be based on: 198.30    (1) the number of persons to whom the county board expects to provide consumer 198.31supports grants; 198.32    (2) their eligibility for current program and services; 198.33    (3) the amount of nonfederal dollars monthly grant levels allowed under subdivision 198.3411; and 199.1    (4) projected dates when persons will start receiving grants. County allocations shall 199.2be adjusted periodically by the commissioner based on the actual transfer of persons or 199.3service openings, and the nonfederal dollars monthly grant levels associated with those 199.4persons or service openings, to the consumer support grant program. 199.5    (c) The amount of funds transferred by the commissioner from the medical 199.6assistance account for an individual may be changed if it is determined by the county or its 199.7agent that the individual's need for support has changed. 199.8    (d) The authority to utilize funds transferred to the consumer support grant account 199.9for the purposes of implementing and administering the consumer support grant program 199.10will not be limited or constrained by the spending authority provided to the program 199.11of origination. 199.12    (e) The commissioner may use up to five percent of each county's allocation, as 199.13adjusted, for payments for administrative expenses, to be paid as a proportionate addition 199.14to reported direct service expenditures. 199.15    (f) The county allocation for each person or the person's legal representative or other 199.16authorized representative cannot exceed the amount allowed under subdivision 11. 199.17    (g) The commissioner may recover, suspend, or withhold payments if the county 199.18board, local agency, or grantee does not comply with the requirements of this section. 199.19    (h) Grant funds unexpended by consumers shall return to the state once a year. The 199.20annual return of unexpended grant funds shall occur in the quarter following the end of 199.21the state fiscal year. 199.22    Sec. 15. Minnesota Statutes 2008, section 256.476, subdivision 11, is amended to read:199.23    Subd. 11. Consumer support grant program after July 1, 2001.(a) Effective 199.24July 1, 2001, the commissioner shall allocate consumer support grant resources to 199.25serve additional individuals based on a review of Medicaid authorization and payment 199.26information of persons eligible for a consumer support grant from the most recent fiscal 199.27year. The commissioner shall use the following methodology to calculate maximum 199.28allowable monthly consumer support grant levels:199.29    (1) For individuals whose program of origination is medical assistance home care 199.30under sections 
         256B.0651 and 
         256B.0653 to 
         256B.0656, the maximum allowable monthly 199.31grant levels are calculated by:199.32    (i) determining the nonfederal share 50 percent of the average service authorization 199.33for each home care rating;199.34    (ii) calculating the overall ratio of actual payments to service authorizations by 199.35program;200.1    (iii) applying the overall ratio to the average service authorization level of each 200.2home care rating;200.3    (iv) adjusting the result for any authorized rate increases provided by the legislature; 200.4and200.5    (v) adjusting the result for the average monthly utilization per recipient.200.6    (2) The commissioner may review and evaluate the methodology to reflect changes 200.7in the home care program's overall ratio of actual payments to service authorizations200.8programs.200.9    (b) Effective January 1, 2004, persons previously receiving exception grants will 200.10have their grants calculated using the methodology in paragraph (a), clause (1). If a person 200.11currently receiving an exception grant wishes to have their home care rating reevaluated, 200.12they may request an assessment as defined in section 256B.0651, subdivision 1, paragraph 200.13(b).200.14    Sec. 16. Minnesota Statutes 2008, section 256.975, subdivision 7, is amended to read:200.15    Subd. 7. Consumer information and assistance and long-term care options 200.16counseling; senior linkage Senior LinkAge Line. (a) The Minnesota Board on Aging 200.17shall operate a statewide information and assistance service to aid older Minnesotans and 200.18their families in making informed choices about long-term care options and health care 200.19benefits. Language services to persons with limited English language skills may be made 200.20available. The service, known as Senior LinkAge Line, must be available during business 200.21hours through a statewide toll-free number and must also be available through the Internet.200.22    (b) The service must assist provide long-term care options counseling by assisting200.23older adults, caregivers, and providers in accessing information  and options counseling 200.24about choices in long-term care services that are purchased through private providers or 200.25available through public options. The service must:200.26    (1) develop a comprehensive database that includes detailed listings in both 200.27consumer- and provider-oriented formats;200.28    (2) make the database accessible on the Internet and through other telecommunication 200.29and media-related tools;200.30    (3) link callers to interactive long-term care screening tools and make these tools 200.31available through the Internet by integrating the tools with the database;200.32    (4) develop community education materials with a focus on planning for long-term 200.33care and evaluating independent living, housing, and service options;200.34    (5) conduct an outreach campaign to assist older adults and their caregivers in 200.35finding information on the Internet and through other means of communication;201.1    (6) implement a messaging system for overflow callers and respond to these callers 201.2by the next business day;201.3    (7) link callers with county human services and other providers to receive more 201.4in-depth assistance and consultation related to long-term care options;201.5    (8) link callers with quality profiles for nursing facilities and other providers 201.6developed by the commissioner of health; and201.7    (9) incorporate information about housing with services and consumer rights 201.8within the MinnesotaHelp.info network long-term care database to facilitate consumer 201.9comparison of services and costs among housing with services establishments and with 201.10other in-home services and to support financial self-sufficiency as long as possible. 201.11Housing with services establishments and their arranged home care providers shall provide 201.12information to the commissioner of human services that is consistent with information 201.13required by the commissioner of health under section 
         144G.06, the Uniform Consumer 201.14Information Guide. The commissioner of human services shall provide the data to the 201.15Minnesota Board on Aging for inclusion in the MinnesotaHelp.info network long-term 201.16care database.;201.17(10) provide long-term care options counseling. Long-term care options counselors 201.18shall:201.19(i) for individuals not eligible for case management under a public program or public 201.20funding source, provide interactive decision support under which consumers, family 201.21members, or other helpers are supported in their deliberations to determine appropriate 201.22long-term care choices in the context of the consumer's needs, preferences, values, and 201.23individual circumstances, including implementing a community support plan;201.24(ii) provide Web-based educational information and collateral written materials to 201.25familiarize consumers, family members, or other helpers with the long-term care basics, 201.26issues to be considered, and the range of options available in the community;201.27(iii) provide long-term care futures planning, which means providing assistance to 201.28individuals who anticipate having long-term care needs to develop a plan for the more 201.29distant future; and201.30(iv) provide expertise in benefits and financing options for long-term care, including 201.31Medicare, long-term care insurance, tax or employer-based incentives, reverse mortgages, 201.32private pay options, and ways to access low or no-cost services or benefits through 201.33volunteer-based or charitable programs; and201.34(11) using risk management and support planning protocols, provide long-term care 201.35options counseling to current residents of nursing homes deemed appropriate for discharge 201.36by the commissioner. In order to meet this requirement, the commissioner shall provide 202.1designated Senior LinkAge Line contact centers with a list of nursing home residents 202.2appropriate for discharge planning via a secure Web portal. Senior LinkAge Line shall 202.3provide these residents, if they indicate a preference to receive long-term care options 202.4counseling, with initial assessment, review of risk factors, independent living support 202.5consultation, or referral to:202.6(i) services under section 256B.0911, subdivision 3;202.7(ii) designated care coordinators of contracted entities under section 256B.035 for 202.8persons who are enrolled in a managed care plan; or202.9(iii) the long-term care consultation team for those who are appropriate for relocation 202.10service coordination due to high-risk factors or psychological or physical disability.202.11    (c) The Minnesota Board on Aging shall conduct an evaluation of the effectiveness 202.12of the statewide information and assistance, and submit this evaluation to the legislature 202.13by December 1, 2002. The evaluation must include an analysis of funding adequacy, gaps 202.14in service delivery, continuity in information between the service and identified linkages, 202.15and potential use of private funding to enhance the service.202.16    Sec. 17. Minnesota Statutes 2008, section 256B.055, subdivision 7, is amended to read:202.17    Subd. 7. Aged, blind, or disabled persons.(a) Medical assistance may be paid for 202.18a person who meets the categorical eligibility requirements of the supplemental security 202.19income program or, who would meet those requirements except for excess income or 202.20assets, and who meets the other eligibility requirements of this section.202.21(b) Following a determination that the applicant is not aged or blind and does not 202.22meet any other category of eligibility for medical assistance and has not been determined 202.23disabled by the Social Security Administration, applicants under this subdivision shall be 202.24referred to the commissioner's state medical review team for a determination of disability. 202.25    Sec. 18. Minnesota Statutes 2008, section 256B.0625, subdivision 6a, is amended to 202.26read:202.27    Subd. 6a. Home health services. Home health services are those services specified 202.28in Minnesota Rules, part 9505.0295 and sections 256B.0651 and 256B.0653. Medical 202.29assistance covers home health services at a recipient's home residence. Medical assistance 202.30does not cover home health services for residents of a hospital, nursing facility, or 202.31intermediate care facility, unless the commissioner of human services has prior authorized 202.32skilled nurse visits for less than 90 days for a resident at an intermediate care facility for 202.33persons with developmental disabilities, to prevent an admission to a hospital or nursing 202.34facility or unless a resident who is otherwise eligible is on leave from the facility and the 203.1facility either pays for the home health services or forgoes the facility per diem for the 203.2leave days that home health services are used. Home health services must be provided by 203.3a Medicare certified home health agency. All nursing and home health aide services must 203.4be provided according to sections 
         256B.0651 to 
         256B.0656256B.0653.203.5    Sec. 19. Minnesota Statutes 2008, section 256B.0625, subdivision 7, is amended to 203.6read:203.7    Subd. 7. Private duty nursing. Medical assistance covers private duty nursing 203.8services in a recipient's home. Recipients who are authorized to receive private duty 203.9nursing services in their home may use approved hours outside of the home during hours 203.10when normal life activities take them outside of their home. To use private duty nursing 203.11services at school, the recipient or responsible party must provide written authorization in 203.12the care plan identifying the chosen provider and the daily amount of services to be used at 203.13school. Medical assistance does not cover private duty nursing services for residents of a 203.14hospital, nursing facility, intermediate care facility, or a health care facility licensed by the 203.15commissioner of health, except as authorized in section 
         256B.64 for ventilator-dependent 203.16recipients in hospitals or unless a resident who is otherwise eligible is on leave from the 203.17facility and the facility either pays for the private duty nursing services or forgoes the 203.18facility per diem for the leave days that private duty nursing services are used. Total hours 203.19of service and payment allowed for services outside the home cannot exceed that which is 203.20otherwise allowed in an in-home setting according to sections 
         256B.0651 and 
         256B.0653203.21256B.0654 to 
         256B.0656. All private duty nursing services must be provided according to 203.22the limits established under sections 
         256B.0651 and 
         256B.0653 to 
         256B.0656. Private 203.23duty nursing services may not be reimbursed if the nurse is the  family foster care provider 203.24of a recipient who is under age 18, unless allowed under section 256B.0654, subdivision 4.203.25    Sec. 20. Minnesota Statutes 2008, section 256B.0625, subdivision 19a, is amended to 203.26read:203.27    Subd. 19a. Personal care assistant assistance  services. Medical assistance covers 203.28personal care assistant assistance  services in a recipient's home. Effective January 1, 203.292010, to qualify for personal care assistant assistance  services, a recipient must require 203.30assistance and be determined dependent in one activity of daily living as defined in section 203.31256B.0659, subdivision 1, paragraph (b), or in a Level I behavior as defined in section 203.32256B.0659, subdivision 1, paragraph (c). Beginning July 1, 2011, to qualify for personal 203.33care assistance services, a recipient must require assistance and be determined dependent 203.34in at least two activities of daily living as defined in section 256B.0659. Recipients or 204.1responsible parties must be able to identify the recipient's needs, direct and evaluate task 204.2accomplishment, and provide for health and safety. Approved hours may be used outside 204.3the home when normal life activities take them outside the home. To use personal care 204.4assistant assistance  services at school, the recipient or responsible party must provide 204.5written authorization in the care plan identifying the chosen provider and the daily amount 204.6of services to be used at school. Total hours for services, whether actually performed 204.7inside or outside the recipient's home, cannot exceed that which is otherwise allowed for 204.8personal care assistant assistance  services in an in-home setting according to sections 204.9256B.0651
         and 256B.0653 to 
         256B.0656. Medical assistance does not cover personal care 204.10assistant assistance  services for residents of a hospital, nursing facility, intermediate care 204.11facility, health care facility licensed by the commissioner of health, or unless a resident 204.12who is otherwise eligible is on leave from the facility and the facility either pays for the 204.13personal care assistant assistance  services or forgoes the facility per diem for the leave 204.14days that personal care assistant assistance  services are used. All personal care assistant204.15assistance  services must be provided according to sections 
         256B.0651and 256B.0653204.16to 
         256B.0656. Personal care assistant assistance  services may not be reimbursed if the 204.17personal care assistant is the spouse or legalpaid guardian of the recipient or the parent of 204.18a recipient under age 18, or the responsible party or the family foster care provider of a 204.19recipient who cannot direct the recipient's own care unless, in the case of a foster care 204.20provider, a county or state case manager visits the recipient as needed, but not less than 204.21every six months, to monitor the health and safety of the recipient and to ensure the goals 204.22of the care plan are met. Parents of adult recipients, adult children of the recipient or 204.23adult siblings of the recipient may be reimbursed for personal care assistant services, 204.24if they are granted a waiver under sections 256B.0651 and 256B.0653 to 256B.0656. 204.25Notwithstanding the provisions of section 
         256B.0655, subdivision 2, paragraph (b), clause 204.26(4) 256B.0659, the noncorporate legal unpaid guardian or conservator of an adult, who is 204.27not the responsible party and not the personal care provider organization, may be granted a 204.28hardship waiver under sections 256B.0651 and 256B.0653 to 256B.0656, to be reimbursed 204.29to provide personal care assistant assistance  services to the recipient if the guardian or 204.30conservator meets all criteria for a personal care assistant according to section 256B.0659, 204.31and shall not be considered to have a service provider interest for purposes of participation 204.32on the screening team under section 
         256B.092, subdivision 7.204.33    Sec. 21. Minnesota Statutes 2008, section 256B.0625, subdivision 19c, is amended to 204.34read:205.1    Subd. 19c. Personal care. Medical assistance covers personal care assistant205.2assistance  services provided by an individual who is qualified to provide the services 205.3according to subdivision 19a and sections 
         256B.0651and 256B.0653 to 
         256B.0656, 205.4where the services have a statement of need by a physician, provided in accordance with 205.5a plan, and are supervised by the recipient or a qualified professional. The physician's 205.6statement of need for personal care assistant services shall be documented on a form 205.7approved by the commissioner and include the diagnosis or condition of the person that 205.8results in a need for personal care assistant services and be updated when the person's 205.9medical condition requires a change, but at least annually if the need for personal care 205.10assistant services is ongoing.205.11"Qualified professional" means a mental health professional as defined in section 
         245.462, 205.12subdivision 18
         , or 
         245.4871, subdivision 27; or a registered nurse as defined in sections 205.13148.171
          to 
         148.285, or a licensed social worker as defined in section 
         148B.21, or a 205.14qualified developmental disabilities specialist undersection 245B.07, subdivision 4. 205.15As part of the assessment, the county public health nurse will assist the recipient or 205.16responsible party to identify the most appropriate person to provide supervision of the 205.17personal care assistant. The qualified professional shall perform the duties described205.18required in Minnesota Rules, part 9505.0335, subpart 4 section 256B.0659.205.19    Sec. 22. Minnesota Statutes 2008, section 256B.0641, subdivision 3, is amended to 205.20read:205.21    Subd. 3. Facility in receivership. Subdivision 2 does not apply to the change of 205.22ownership of a facility to a nonrelated organization while the facility to be sold, transferred 205.23or reorganized is in receivership under section 144A.14, 144A.15, 245A.12, or 
         245A.13, 205.24and the commissioner during the receivership has not determined the need to place 205.25residents of the facility into a newly constructed or newly established facility. Nothing 205.26in this subdivision limits the liability of a former owner.205.27    Sec. 23. Minnesota Statutes 2008, section 256B.0651, is amended to read:205.28256B.0651 HOME CARE SERVICES.205.29    Subdivision 1. Definitions. (a) "Activities of daily living" includes eating, toileting, 205.30grooming, dressing, bathing, transferring, mobility, and positioning For the purposes of 205.31sections 256B.0651 to 256B.0656 and 256B.0659, the terms in paragraphs (b) to (g) 205.32have the meanings given.205.33(b) "Activities of daily living" has the meaning given in section 256B.0659, 205.34subdivision 1, paragraph (b).206.1(c) "Assessment" means a review and evaluation of a recipient's need for home care 206.2services conducted in person. Assessments for home health agency services shall be 206.3conducted by a home health agency nurse. Assessments for medical assistance home care 206.4services for developmental disability and alternative care services for developmentally 206.5disabled home and community-based waivered recipients may be conducted by the county 206.6public health nurse to ensure coordination and avoid duplication. Assessments must be 206.7completed on forms provided by the commissioner within 30 days of a request for home 206.8care services by a recipient or responsible party.206.9(c) (d) "Home care services" means a health service, determined by the commissioner 206.10as medically necessary, that is ordered by a physician and documented in a service plan 206.11that is reviewed by the physician at least once every 60 days for the provision of home 206.12health services, or private duty nursing, or at least once every 365 days for personal care. 206.13Home care services are provided to the recipient at the recipient's residence that is a 206.14place other than a hospital or long-term care facility or as specified in section 256B.0625206.15means medical assistance covered services that are home health agency services, including 206.16skilled nurse visits; home health aide visits; physical therapy, occupational therapy, 206.17respiratory therapy, and language-speech pathology therapy; private duty nursing; and 206.18personal care assistance.206.19(e) "Home residence," effective January 1, 2010, means a residence owned or rented 206.20by the recipient either alone, with roommates of the recipient's choosing, or with an unpaid 206.21responsible party or legal representative; or a family foster home where the license holder 206.22lives with the recipient and is not paid to provide home care services for the recipient 206.23except as allowed under sections 256B.0651, subdivision 9, and 256B.0654, subdivision 4.206.24(d) (f) "Medically necessary" has the meaning given in Minnesota Rules, parts 206.259505.0170 to 9505.0475.206.26(e) "Telehomecare" means the use of telecommunications technology by a home 206.27health care professional to deliver home health care services, within the professional's 206.28scope of practice, to a patient located at a site other than the site where the practitioner 206.29is located.206.30(g) "Ventilator-dependent" means an individual who receives mechanical ventilation 206.31for life support at least six hours per day and is expected to be or has been dependent on a 206.32ventilator for at least 30 consecutive days.206.33    Subd. 2. Services covered. Home care services covered under this section and 206.34sections 
         256B.0653 256B.0652  to 
         256B.0656 and 256B.0659 include:206.35(1) nursing services under section sections256B.0625, subdivision 6a, and 206.36256B.0653;207.1(2) private duty nursing services under section sections256B.0625, subdivision 207.27
         , and 256B.0654;207.3(3) home health services under section sections256B.0625, subdivision 6a, and 207.4256B.0653;207.5(4) personal care assistant assistance  services under section sections256B.0625, 207.6subdivision 19a
         , and 256B.0659;207.7(5) supervision of personal care assistant assistance  services provided by a qualified 207.8professional under section sections256B.0625, subdivision 19a, and 256B.0659;207.9(6) qualified professional of personal care assistant services under the fiscal 207.10intermediary option as specified in section 256B.0655, subdivision 7;207.11(7) face-to-face assessments by county public health nurses for services under 207.12section sections256B.0625, subdivision 19a, 256B.0655, and 256B.0659; and207.13(8) (7) service updates and review of temporary increases for personal care assistant207.14assistance  services by the county public health nurse for services under section sections207.15256B.0625, subdivision 19a
         , and 256B.0659.207.16    Subd. 3. Noncovered home care services. The following home care services are 207.17not eligible for payment under medical assistance:207.18(1) skilled nurse visits for the sole purpose of supervision of the home health aide;207.19(2) a skilled nursing visit:207.20(i) only for the purpose of monitoring medication compliance with an established 207.21medication program for a recipient; or207.22(ii) to administer or assist with medication administration, including injections, 207.23prefilling syringes for injections, or oral medication set-up of an adult recipient, when as 207.24determined and documented by the registered nurse, the need can be met by an available 207.25pharmacy or the recipient is physically and mentally able to self-administer or prefill 207.26a medication;207.27(3) home care services to a recipient who is eligible for covered services under the 207.28Medicare program or any other insurance held by the recipient;207.29(4) services to other members of the recipient's household;207.30(5) a visit made by a skilled nurse solely to train other home health agency workers;207.31(6) any home care service included in the daily rate of the community-based 207.32residential facility where the recipient is residing;207.33(7) nursing and rehabilitation therapy services that are reasonably accessible to a 207.34recipient outside the recipient's place of residence, excluding the assessment, counseling 207.35and education, and personal assistant care;208.1(8) any home health agency service, excluding personal care assistant services and 208.2private duty nursing services, which are performed in a place other than the recipient's 208.3residence; and208.4(9) Medicare evaluation or administrative nursing visits on dual-eligible recipients 208.5that do not qualify for Medicare visit billing.208.6(1) services provided in a nursing facility, hospital, or intermediate care facility with 208.7exceptions in section 256B.0653;208.8(2) services for the sole purpose of monitoring medication compliance with an 208.9established medication program for a recipient;208.10(3) home care services for covered services under the Medicare program or any other 208.11insurance held by the recipient;208.12(4) services to other members of the recipient's household;208.13(5) any home care service included in the daily rate of the community-based 208.14residential facility where the recipient is residing;208.15(6) nursing and rehabilitation therapy services that are reasonably accessible to a 208.16recipient outside the recipient's place of residence, excluding the assessment, counseling 208.17and education, and personal assistance care; or208.18(7) Medicare evaluation or administrative nursing visits on dual-eligible recipients 208.19that do not qualify for Medicare visit billing.208.20    Subd. 4. Prior Authorization; exceptions. All home care services above the limits 208.21in subdivision 11 must receive the commissioner's prior authorization before services 208.22begin, except when:208.23(1) the home care services were required to treat an emergency medical condition 208.24that if not immediately treated could cause a recipient serious physical or mental disability, 208.25continuation of severe pain, or death. The provider must request retroactive authorization 208.26no later than five working days after giving the initial service. The provider must be able 208.27to substantiate the emergency by documentation such as reports, notes, and admission or 208.28discharge histories;208.29(2) the home care services were provided on or after the date on which the recipient's 208.30eligibility began, but before the date on which the recipient was notified that the case was 208.31opened. Authorization will be considered if the request is submitted by the provider 208.32within 20 working days of the date the recipient was notified that the case was opened;208.33a recipient's medical assistance eligibility has lapsed, is then retroactively reinstated, 208.34and an authorization for home care services is completed based on the date of a current 208.35assessment, eligibility, and request for authorization;209.1(3) a third-party payor for home care services has denied or adjusted a payment. 209.2Authorization requests must be submitted by the provider within 20 working days of the 209.3notice of denial or adjustment. A copy of the notice must be included with the request;209.4(4) the commissioner has determined that a county or state human services agency 209.5has made an error; or209.6(5) the professional nurse determines an immediate need for up to 40 skilled nursing 209.7or home health aide visits per calendar year and submits a request for authorization within 209.820 working days of the initial service date, and medical assistance is determined to be 209.9the appropriate payer. if a recipient enrolled in managed care experiences a temporary 209.10disenrollment from a health plan, the commissioner shall accept the current health plan 209.11authorization for personal care assistance services for up to 60 days. The request must 209.12be received within the first 30 days of the disenrollment. If the recipient's reenrollment 209.13in managed care is after the 60 days and before 90 days, the provider shall request an 209.14additional 30-day extension of the current health plan authorization, for a total limit of 209.1590 days from the time of disenrollment.209.16    Subd. 5.Retroactive authorization.A request for retroactive authorization will be 209.17evaluated according to the same criteria applied to prior authorization requests.209.18    Subd. 6. Prior Authorization.(a) The commissioner, or the commissioner's 209.19designee, shall review the assessment, service update, request for temporary services, 209.20request for flexible use option, service plan, and any additional information that is 209.21submitted. The commissioner shall, within 30 days after receiving a complete request, 209.22assessment, and service plan, authorize home care services as follows: provided in this 209.23section.209.24(a) Home health services.(b) All Home health services provided by a home health 209.25aide including skilled nurse visits and home health aide visits must be prior authorized 209.26by the commissioner or the commissioner's designee. Prior Authorization must be based 209.27on medical necessity and cost-effectiveness when compared with other care options. 209.28The commissioner must receive the request for authorization of skilled nurse visits and 209.29home health aide visits within 20 working days of the start of service. When home health 209.30services are used in combination with personal care and private duty nursing, the cost of 209.31all home care services shall be considered for cost-effectiveness. The commissioner shall 209.32limit home health aide visits to no more than one visit each per day. The commissioner, or 209.33the commissioner's designee, may authorize up to two skilled nurse visits per day.209.34(b) Ventilator-dependent recipients.(c) If the recipient is ventilator-dependent, the 209.35monthly medical assistance authorization for home care services shall not exceed what the 209.36commissioner would pay for care at the highest cost hospital designated as a long-term 210.1hospital under the Medicare program. For purposes of this paragraph, home care services 210.2means all direct care services provided in the home that would be included in the payment 210.3for care at the long-term hospital. "Ventilator-dependent" means an individual who 210.4receives mechanical ventilation for life support at least six hours per day and is expected 210.5to be or has been dependent for at least 30 consecutive days. Recipients who meet the 210.6definition of ventilator dependent and the EN home care rating and utilize a combination 210.7of home care services are limited up to a total of 24 hours of home care services per day. 210.8Additional hours may be authorized when a recipient's assessment indicates a need for two 210.9staff to perform activities. Additional time is limited to four hours per day.210.10    Subd. 7. Prior Authorization; time limits.(a) The commissioner or the 210.11commissioner's designee shall determine the time period for which a prior an authorization 210.12shall be effective and, if flexible use has been requested, whether to allow the flexible use 210.13option. If the recipient continues to require home care services beyond the duration of 210.14the prior authorization, the home care provider must request a new prior authorization. 210.15A personal care provider agency must request a new personal care assistant assistance 210.16 services assessment, or service update if allowed, at least 60 days prior to the end of 210.17the current prior authorization time period. The request for the assessment must be 210.18made on a form approved by the commissioner. Under no circumstances, other than the 210.19exceptions in subdivision 4, shall a prior An authorization must be valid prior to the date 210.20the commissioner receives the request or for no more than 12 months.210.21(b) The amount and type of personal care assistance services authorized based 210.22upon the assessment and service plan must remain in effect for the recipient whether 210.23the recipient chooses a different provider or enrolls or disenrolls from a managed care 210.24plan under section 256B.0659, unless the service needs of the recipient change and new 210.25assessment is warranted under section 256B.0655, subdivision 1b.210.26(c) A recipient who appeals a reduction in previously authorized home care 210.27services may continue previously authorized services, other than temporary services 210.28under subdivision 8, pending an appeal under section 
         256.045. The commissioner must 210.29provide ensure that the recipient has a copy of the most recent service plan that contains 210.30 a detailed explanation of why the authorized serviceswhich areas of covered personal 210.31care assistance tasks are reduced in amount from those requested by the home care 210.32provider, and provide notice of the amount of time per day reduced, and the reasons for 210.33the reduction in the recipient's notice of denial, termination, or reduction.210.34    Subd. 8. Prior Authorization requests; temporary services. The agency nurse, 210.35the independently enrolled private duty nurse, or county public health nurse may request 210.36a temporary authorization for home care services by telephone. The commissioner may 211.1approve a temporary level of home care services based on the assessment, and service 211.2or care plan information, and primary payer coverage determination information as 211.3required. Authorization for a temporary level of home care services including nurse 211.4supervision is limited to the time specified by the commissioner, but shall not exceed 211.545 days, unless extended because the county public health nurse has not completed the 211.6required assessment and service plan, or the commissioner's determination has not been 211.7made. The level of services authorized under this provision shall have no bearing on a 211.8future prior authorization.211.9    Subd. 9. Prior Authorization for foster care setting.(a) Home care services 211.10provided in an adult or child foster care setting must receive prior authorization by the 211.11department commissioner according to the limits established in subdivision 11.211.12(b) The commissioner may not authorize:211.13(1) home care services that are the responsibility of the foster care provider under 211.14the terms of the foster care placement agreement, difficulty of care rate as of January 1, 211.152010, and administrative rules;211.16(2) personal care assistant assistance  services when the foster care license holder is 211.17also the personal care provider or personal care assistant unless the recipient can direct the 211.18recipient's own care, or case management is provided as required in section 256B.0625, 211.19subdivision 19a, unless the foster home is the licensed provider's primary residence as 211.20defined in section 256B.0625, subdivision 19a; or211.21(3) personal care assistant services when the responsible party is an employee of, or 211.22under contract with, or has any direct or indirect financial relationship with the personal 211.23care provider or personal care assistant, unless case management is provided as required 211.24in section 256B.0625, subdivision 19a; or211.25(4) (3) personal care assistant and private duty nursing services when the number211.26of foster care residents licensed capacity is greater than four unless the county responsible 211.27for the recipient's foster placement made the placement prior to April 1, 1992, requests 211.28that personal care assistant and private duty nursing services be provided, and case 211.29management is provided as required in section 256B.0625, subdivision 19a.211.30    Subd. 10.Limitation on payments.Medical assistance payments for home care 211.31services shall be limited according to subdivisions 4 to 12 and sections 256B.0654, 211.32subdivision 2, and 256B.0655, subdivisions 3 and 4.211.33    Subd. 11. Limits on services without prior authorization. A recipient may receive 211.34the following home care services during a calendar year:212.1(1) up to two face-to-face assessments to determine a recipient's need for personal 212.2care assistant assistance  services;212.3(2) one service update done to determine a recipient's need for personal care assistant212.4assistance  services; and212.5(3) up to nine face-to-face skilled nurse visits.212.6    Subd. 12. Approval of home care services. The commissioner or the 212.7commissioner's designee shall determine the medical necessity of home care services, 212.8the level of caregiver according to subdivision 2, and the institutional comparison 212.9according to subdivisions 4 to 12 and sections 
         256B.0654, subdivision 2, and256B.0655, 212.10subdivisions 3 and 4
         , and 256B.0659, the cost-effectiveness of services, and the amount, 212.11scope, and duration of home care services reimbursable by medical assistance, based 212.12on the assessment, primary payer coverage determination information as required, the 212.13service plan, the recipient's age, the cost of services, the recipient's medical condition, and 212.14diagnosis or disability. The commissioner may publish additional criteria for determining 212.15medical necessity according to section 
         256B.04.212.16    Subd. 13. Recovery of excessive payments. The commissioner shall seek 212.17monetary recovery from providers of payments made for services which exceed the limits 212.18established in this section and sections 
         256B.0653 to 
         256B.0656, and 256B.0659. This 212.19subdivision does not apply to services provided to a recipient at the previously authorized 212.20level pending an appeal under section 
         256.045, subdivision 10.212.21    Subd. 14.Referrals to Medicare providers required.Home care providers that 212.22do not participate in or accept Medicare assignment must refer and document the referral 212.23of dual-eligible recipients to Medicare providers when Medicare is determined to be the 212.24appropriate payer for services and supplies and equipment. Providers must be terminated 212.25from participation in the medical assistance program for failure to make these referrals.212.26    Subd. 15.Quality assurance for program integrity.The commissioner shall 212.27establish an ongoing quality assurance process for home care services to monitor program 212.28integrity, including provider standards and training, consumer surveys, and random 212.29reviews of documentation.212.30    Subd. 16.Oversight of enrolled providers.The commissioner has the authority to 212.31request proof of documentation of meeting provider standards, quality standards of care, 212.32correct billing practices, and other information. Failure to comply with or to provide access 212.33and information to demonstrate compliance with laws, rules, or policies may result in 212.34suspension, denial, or termination of the provider agency's enrollment with the department.213.1    Sec. 24. Minnesota Statutes 2008, section 256B.0652, is amended to read:213.2256B.0652 PRIOR AUTHORIZATION AND REVIEW OF HOME CARE 213.3SERVICES.213.4    Subdivision 1. State coordination. The commissioner shall supervise the 213.5coordination of the prior authorization and review of home care services that are 213.6reimbursed by medical assistance.213.7    Subd. 2. Duties. (a) The commissioner may contract with or employ qualified 213.8registered nurses and necessary support staff, or contract with qualified agencies, to 213.9provide home care prior authorization and review services for medical assistance 213.10recipients who are receiving home care services.213.11(b) Reimbursement for the prior authorization function shall be made through the 213.12medical assistance administrative authority. The state shall pay the nonfederal share. 213.13The functions will be to:213.14(1) assess the recipient's individual need for services required to be cared for safely 213.15in the community;213.16(2) ensure that a service care plan that meets the recipient's needs is developed 213.17by the appropriate agency or individual;213.18(3) ensure cost-effectiveness and nonduplication of medical assistance home care 213.19services;213.20(4) recommend the approval or denial of the use of medical assistance funds to pay 213.21for home care services;213.22(5) reassess the recipient's need for and level of home care services at a frequency 213.23determined by the commissioner; and213.24(6) conduct on-site assessments when determined necessary by the commissioner 213.25and recommend changes to care plans that will provide more efficient and appropriate 213.26home care; and213.27(7) on the department's Web site:213.28(i) provide a link to MinnesotaHelp.info for a list of enrolled home care agencies 213.29with the following information: main office address, contact information for the agency, 213.30counties in which services are provided, type of home care services provided, whether 213.31the personal care assistance choice option is offered, types of qualified professionals 213.32employed, number of personal care assistants employed, and data on staff turnover; and213.33(ii) post data on home care services including information from both fee-for-service 213.34and managed care plans on recipients as available.213.35(c) In addition, the commissioner or the commissioner's designee may:214.1(1) review care plans, service plans,  and reimbursement data for utilization of 214.2services that exceed community-based standards for home care, inappropriate home care 214.3services, medical necessity, home care services that do not meet quality of care standards, 214.4or unauthorized services and make appropriate referrals within the department or to other 214.5appropriate entities based on the findings;214.6(2) assist the recipient in obtaining services necessary to allow the recipient to 214.7remain safely in or return to the community;214.8(3) coordinate home care services with other medical assistance services under 214.9section 
         256B.0625;214.10(4) assist the recipient with problems related to the provision of home care services;214.11(5) assure the quality of home care services; and214.12(6) assure that all liable third-party payers including, but not limited to, Medicare 214.13have been used prior to medical assistance for home care services, including but not 214.14limited to, home health agency, elected hospice benefit, waivered services, alternative care 214.15program services, and personal care services.214.16(d) For the purposes of this section, "home care services" means medical assistance 214.17services defined under section 
         256B.0625, subdivisions 6a, 7, and 19a.214.18    Subd. 3. Assessment and prior authorization process for persons receiving 214.19personal care assistance and developmental disabilities services.Effective January 1, 214.201996, For purposes of providing informed choice, coordinating of local planning decisions, 214.21and streamlining administrative requirements, the assessment and prior authorization 214.22process for persons receiving both home care and home and community-based waivered 214.23services for persons with developmental disabilities shall meet the requirements of 214.24sections 
         256B.0651 and 
         256B.0653 to 
         256B.0656 with the following exceptions:214.25(a) Upon request for home care services and subsequent assessment by the public 214.26health nurse under sections 
         256B.0651 and 
         256B.0653 to 
         256B.0656, the public health 214.27nurse shall participate in the screening process, as appropriate, and, if home care 214.28services are determined to be necessary, participate in the development of a service plan 214.29coordinating the need for home care and home and community-based waivered services 214.30with the assigned county case manager, the recipient of services, and the recipient's legal 214.31representative, if any.214.32(b) The public health nurse shall give prior authorization for home care services 214.33to the extent that home care services are:214.34(1) medically necessary;214.35(2) chosen by the recipient and their legal representative, if any, from the array of 214.36home care and home and community-based waivered services available;215.1(3) coordinated with other services to be received by the recipient as described 215.2in the service plan; and215.3(4) provided within the county's reimbursement limits for home care and home and 215.4community-based waivered services for persons with developmental disabilities.215.5(c) If the public health agency is or may be the provider of home care services to the 215.6recipient, the public health agency shall provide the commissioner of human services with 215.7a written plan that specifies how the assessment and prior authorization process will be 215.8held separate and distinct from the provision of services.215.9    Sec. 25. Minnesota Statutes 2008, section 256B.0653, is amended to read:215.10256B.0653 HOME HEALTH AGENCY COVERED SERVICES.215.11    Subdivision 1. Homecare; skilled nurse visits Scope. "Skilled nurse visits" are 215.12provided in a recipient's residence under a plan of care or service plan that specifies a level 215.13of care which the nurse is qualified to provide. These services are:215.14(1) nursing services according to the written plan of care or service plan and accepted 215.15standards of medical and nursing practice in accordance with chapter 148;215.16(2) services which due to the recipient's medical condition may only be safely and 215.17effectively provided by a registered nurse or a licensed practical nurse;215.18(3) assessments performed only by a registered nurse; and215.19(4) teaching and training the recipient, the recipient's family, or other caregivers 215.20requiring the skills of a registered nurse or licensed practical nurse. This section applies to 215.21home health agency services including, home health aide, skilled nursing visits, physical 215.22therapy, occupational therapy, respiratory therapy, and speech language pathology therapy.215.23    Subd. 2. Telehomecare; skilled nurse visits Definitions. Medical assistance 215.24covers skilled nurse visits according to section 256B.0625, subdivision 6a, provided via 215.25telehomecare, for services which do not require hands-on care between the home care 215.26nurse and recipient. The provision of telehomecare must be made via live, two-way 215.27interactive audiovisual technology and may be augmented by utilizing store-and-forward 215.28technologies. Store-and-forward technology includes telehomecare services that do not 215.29occur in real time via synchronous transmissions, and that do not require a face-to-face 215.30encounter with the recipient for all or any part of any such telehomecare visit. Individually 215.31identifiable patient data obtained through real-time or store-and-forward technology must 215.32be maintained as health records according to sections 144.291 to 144.298. If the video 215.33is used for research, training, or other purposes unrelated to the care of the patient, the 215.34identity of the patient must be concealed. A communication between the home care nurse 215.35and recipient that consists solely of a telephone conversation, facsimile, electronic mail, or 216.1a consultation between two health care practitioners, is not to be considered a telehomecare 216.2visit. Multiple daily skilled nurse visits provided via telehomecare are allowed. Coverage 216.3of telehomecare is limited to two visits per day. All skilled nurse visits provided via 216.4telehomecare must be prior authorized by the commissioner or the commissioner's 216.5designee and will be covered at the same allowable rate as skilled nurse visits provided 216.6in-person. For the purposes of this section, the following terms have the meanings given.216.7(a) "Assessment" means an evaluation of the recipient's medical need for home 216.8health agency services by a registered nurse or appropriate therapist that is conducted 216.9within 30 days of a request.216.10(b) "Home care therapies" means occupational, physical, and respiratory therapy 216.11and speech-language pathology services provided in the home by a Medicare certified 216.12home health agency.216.13(c) "Home health agency services" means services delivered in the recipient's home 216.14residence, except as specified in section 256B.0625, by a home health agency to a recipient 216.15with medical needs due to illness, disability, or physical conditions.216.16(d) "Home health aide" means an employee of a home health agency who completes 216.17medically oriented tasks written in the plan of care for a recipient.216.18(e) "Home health agency" means a home care provider agency that is 216.19Medicare-certified.216.20(f) "Occupational therapy services" mean the services defined in Minnesota Rules, 216.21part 9505.0390.216.22(g) "Physical therapy services" mean the services defined in Minnesota Rules, part 216.239505.0390.216.24(h) "Respiratory therapy services" mean the services defined in chapter 147C and 216.25Minnesota Rules, part 4668.0003, subpart 37.216.26(i) "Speech-language pathology services" mean the services defined in Minnesota 216.27Rules, part 9505.0390.216.28(j) "Skilled nurse visit" means a professional nursing visit to complete nursing tasks 216.29required due to a recipient's medical condition that can only be safely provided by a 216.30professional nurse to restore and maintain optimal health.216.31(k) "Store-and-forward technology" means telehomecare services that do not occur 216.32in real time via synchronous transmissions such as diabetic and vital sign monitoring.216.33(l) "Telehomecare" means the use of telecommunications technology via 216.34live, two-way interactive audiovisual technology which may be augmented by 216.35store-and-forward technology.217.1(m) "Telehomecare skilled nurse visit" means a visit by a professional nurse to 217.2deliver a skilled nurse visit to a recipient located at a site other than the site where the 217.3nurse is located and is used in combination with face-to-face skilled nurse visits to 217.4adequately meet the recipient's needs.217.5    Subd. 3. Therapies through home health agencies Home health aide visits.217.6(a) Medical assistance covers physical therapy and related services, including specialized 217.7maintenance therapy. Services provided by a physical therapy assistant shall be 217.8reimbursed at the same rate as services performed by a physical therapist when the 217.9services of the physical therapy assistant are provided under the direction of a physical 217.10therapist who is on the premises. Services provided by a physical therapy assistant that are 217.11provided under the direction of a physical therapist who is not on the premises shall be 217.12reimbursed at 65 percent of the physical therapist rate. Direction of the physical therapy 217.13assistant must be provided by the physical therapist as described in Minnesota Rules, part 217.149505.0390, subpart 1, item B. The physical therapist and physical therapist assistant may 217.15not both bill for services provided to a recipient on the same day.217.16(b) Medical assistance covers occupational therapy and related services, including 217.17specialized maintenance therapy. Services provided by an occupational therapy assistant 217.18shall be reimbursed at the same rate as services performed by an occupational therapist 217.19when the services of the occupational therapy assistant are provided under the direction of 217.20the occupational therapist who is on the premises. Services provided by an occupational 217.21therapy assistant under the direction of an occupational therapist who is not on the 217.22premises shall be reimbursed at 65 percent of the occupational therapist rate. Direction 217.23of the occupational therapy assistant must be provided by the occupational therapist as 217.24described in Minnesota Rules, part 9505.0390, subpart 1, item B. The occupational 217.25therapist and occupational therapist assistant may not both bill for services provided 217.26to a recipient on the same day.217.27(a) Home health aide visits must be provided by a certified home health aide 217.28using a written plan of care that is updated in compliance with Medicare regulations. 217.29A home health aide shall provide hands-on personal care, perform simple procedures 217.30as an extension of therapy or nursing services, and assist in instrumental activities of 217.31daily living as defined in section 256B.0659. Home health aide visits must be provided 217.32in the recipient's home.217.33(b) All home health aide visits must have authorization under section 256B.0652. 217.34The commissioner shall limit home health aide visits to no more than one visit per day 217.35per recipient.218.1(c) Home health aides must be supervised by a registered nurse or an appropriate 218.2therapist when providing services that are an extension of therapy.218.3    Subd. 4.Skilled nurse visit services.(a) Skilled nurse visit services must be 218.4provided by a registered nurse or a licensed practical nurse under the supervision of a 218.5registered nurse, according to the written plan of care and accepted standards of medical 218.6and nursing practice according to chapter 148. Skilled nurse visit services must be ordered 218.7by a physician and documented in a plan of care that is reviewed and approved by the 218.8ordering physician at least once every 60 days. All skilled nurse visits must be medically 218.9necessary and provided in the recipient's home residence except as allowed under section 218.10256B.0625, subdivision 6a.218.11(b) Skilled nurse visits include face-to-face and telehomecare visits with a limit of 218.12up to two visits per day per recipient. All visits must be based on assessed needs.218.13(c) Telehomecare skilled nurse visits are allowed when the recipient's health status 218.14can be accurately measured and assessed without a need for a face-to-face, hands-on 218.15encounter. All telehomecare skilled nurse visits must have authorization and are paid at 218.16the same allowable rates as face-to-face skilled nurse visits.218.17(d) The provision of telehomecare must be made via live, two-way interactive 218.18audiovisual technology and may be augmented by utilizing store-and-forward 218.19technologies. Individually identifiable patient data obtained through real-time or 218.20store-and-forward technology must be maintained as health records according to sections 218.21144.291 to 144.298. If the video is used for research, training, or other purposes unrelated 218.22to the care of the patient, the identity of the patient must be concealed.218.23(e) Authorization for skilled nurse visits must be completed under section 218.24256B.0652. A total of nine face-to-face skilled nurses visits per calendar year do not 218.25require authorization. All telehomecare skilled nurse visits require authorization.218.26    Subd. 5.Home care therapies.(a) Home care therapies include the following: 218.27physical therapy, occupational therapy, respiratory therapy, and speech and language 218.28pathology therapy services.218.29(b) Home care therapies must be:218.30(1) provided in the recipient's residence after it has been determined the recipient is 218.31unable to access outpatient therapy;218.32(2) prescribed, ordered, or referred by a physician and documented in a plan of care 218.33and reviewed, according to Minnesota Rules, part 9505.0390;218.34(3) assessed by an appropriate therapist; and218.35(4) provided by a Medicare-certified home health agency enrolled as a Medicaid 218.36provider agency.219.1(c) Restorative and specialized maintenance therapies must be provided according to 219.2Minnesota Rules, part 9505.0390. Physical and occupational therapy assistants may be 219.3used as allowed under Minnesota Rules, part 9505.0390, subpart 1, item B.219.4(d) For both physical and occupational therapies, the therapist and the therapist's 219.5assistant may not both bill for services provided to a recipient on the same day.219.6    Subd. 6.Noncovered home health agency services.The following are not eligible 219.7for payment under medical assistance as a home health agency service:219.8(1) telehomecare skilled nurses services that is communication between the home 219.9care nurse and recipient that consists solely of a telephone conversation, facsimile, 219.10electronic mail, or a consultation between two health care practitioners;219.11(2) the following skilled nurse visits:219.12(i) for the purpose of monitoring medication compliance with an established 219.13medication program for a recipient;219.14(ii) administering or assisting with medication administration, including injections, 219.15prefilling syringes for injections, or oral medication setup of an adult recipient, when, 219.16as determined and documented by the registered nurse, the need can be met by an 219.17available pharmacy or the recipient or a family member is physically and mentally able 219.18to self-administer or prefill a medication;219.19(iii) services done for the sole purpose of supervision of the home health aide or 219.20personal care assistant;219.21(iv) services done for the sole purpose to train other home health agency workers;219.22(v) services done for the sole purpose of blood samples or lab draw when the 219.23recipient is able to access these services outside the home; and219.24(vi) Medicare evaluation or administrative nursing visits required by Medicare;219.25(3) home health aide visits when the following activities are the sole purpose for the 219.26visit: companionship, socialization, household tasks, transportation, and education; and219.27(4) home care therapies provided in other settings such as a clinic, day program, or as 219.28an inpatient or when the recipient can access therapy outside of the recipient's residence.219.29    Sec. 26. Minnesota Statutes 2008, section 256B.0654, is amended to read:219.30256B.0654 PRIVATE DUTY NURSING.219.31    Subdivision 1. Definitions.(a) "Assessment" means a review and evaluation of a 219.32recipient's need for home care services conducted in person. Assessments for private duty 219.33nursing shall be conducted by a registered private duty nurse. Assessments for medical 219.34assistance home care services for developmental disabilities and alternative care services 220.1for developmentally disabled home and community-based waivered recipients may be 220.2conducted by the county public health nurse to ensure coordination and avoid duplication.220.3(b) (a) "Complex and regular private duty nursing care" means:220.4(1) complex care is private duty nursing services provided to recipients who are 220.5ventilator dependent or for whom a physician has certified that were it not for private duty 220.6nursing the recipient would meet the criteria for inpatient hospital intensive care unit 220.7(ICU) level of care; and220.8(2) regular care is private duty nursing provided to all other recipients.220.9(b) "Private duty nursing" means ongoing professional nursing services by a 220.10registered or licensed practical nurse including assessment, professional nursing tasks, and 220.11education, based on an assessment and physician orders to maintain or restore optimal 220.12health of the recipient.220.13(c) "Private duty nursing agency" means a medical assistance enrolled provider 220.14licensed under chapter 144A to provide private duty nursing services.220.15(d) "Regular private duty nursing" means nursing services provided to a recipient 220.16who is considered stable and not at an inpatient hospital intensive care unit level of care, 220.17but may have episodes of instability that are not life threatening.220.18(e) "Shared private duty nursing" means the provision of nursing services by a 220.19private duty nurse to two recipients at the same time and in the same setting.220.20    Subd. 2. Authorization; private duty nursing services. (a) All private duty 220.21nursing services shall be prior authorized by the commissioner or the commissioner's 220.22designee. Prior Authorization for private duty nursing services shall be based on 220.23medical necessity and cost-effectiveness when compared with alternative care options. 220.24The commissioner may authorize medically necessary private duty nursing services in 220.25quarter-hour units when:220.26(1) the recipient requires more individual and continuous care than can be provided 220.27during a skilled nurse visit; or220.28(2) the cares are outside of the scope of services that can be provided by a home 220.29health aide or personal care assistant.220.30(b) The commissioner may authorize:220.31(1) up to two times the average amount of direct care hours provided in nursing 220.32facilities statewide for case mix classification "K" as established by the annual cost report 220.33submitted to the department by nursing facilities in May 1992;220.34(2) private duty nursing in combination with other home care services up to the total 220.35cost allowed under section 
         256B.0655, subdivision 4;221.1(3) up to 16 hours per day if the recipient requires more nursing than the maximum 221.2number of direct care hours as established in clause (1) and the recipient meets the hospital 221.3admission criteria established under Minnesota Rules, parts 9505.0501 to 9505.0540.221.4(c) The commissioner may authorize up to 16 hours per day of medically necessary 221.5private duty nursing services or up to 24 hours per day of medically necessary private duty 221.6nursing services until such time as the commissioner is able to make a determination of 221.7eligibility for recipients who are cooperatively applying for home care services under 221.8the community alternative care program developed under section 
         256B.49, or until it is 221.9determined by the appropriate regulatory agency that a health benefit plan is or is not 221.10required to pay for appropriate medically necessary health care services. Recipients 221.11or their representatives must cooperatively assist the commissioner in obtaining this 221.12determination. Recipients who are eligible for the community alternative care program 221.13may not receive more hours of nursing under this section and sections 
         256B.0651, 221.14256B.0653
         , 
         256B.0655, and256B.0656, and 256B.0659 than would otherwise be 221.15authorized under section 
         256B.49.221.16    Subd. 2a.Private duty nursing services.(a) Private duty nursing services must 221.17be used:221.18(1) in the recipient's home or outside the home when normal life activities require;221.19(2) when the recipient requires more individual and continuous care than can be 221.20provided during a skilled nurse visit; and221.21(3) when the care required is outside of the scope of services that can be provided by 221.22a home health aide or personal care assistant.221.23(b) Private duty nursing services must be:221.24(1) assessed by a registered nurse on a form approved by the commissioner;221.25(2) ordered by a physician and documented in a plan of care that is reviewed by the 221.26physician at least once every 60 days; and221.27(3) authorized by the commissioner under section 256B.0652.221.28    Subd. 2b.Noncovered private duty nursing services.Private duty nursing 221.29services do not cover the following:221.30(1) nursing services by a nurse who is the family foster care provider of a person 221.31who has not reached 18 years of age unless allowed under subdivision 4;221.32(2) nursing services to more than two persons receiving shared private duty nursing 221.33services from a private duty nurse in a single setting; and221.34(3) nursing services provided by a registered nurse or licensed practical nurse who is 221.35the recipient's legal guardian or related to the recipient as spouse, parent, or family foster 222.1parent whether by blood, marriage, or adoption except as specified in section 256B.0652, 222.2subdivision 4.222.3    Subd. 3. Shared private duty nursing care option. (a) Medical assistance 222.4payments for shared private duty nursing services by a private duty nurse shall be limited 222.5according to this subdivision. For the purposes of this section and sections 256B.0651, 222.6256B.0653, 256B.0655, and 256B.0656, "private duty nursing agency" means an agency 222.7licensed under chapter 144A to provide private duty nursing services. Unless otherwise 222.8provided in this subdivision, all other statutory and regulatory provisions relating to 222.9private duty nursing services apply to shared private duty nursing services. Nothing in 222.10this subdivision shall be construed to reduce the total number of private duty nursing 222.11hours authorized for an individual recipient.222.12(b) Recipients of private duty nursing services may share nursing staff and the 222.13commissioner shall provide a rate methodology for shared private duty nursing. For two 222.14persons sharing nursing care, the rate paid to a provider shall not exceed 1.5 times the 222.15regular private duty nursing rates paid for serving a single individual by a registered nurse 222.16or licensed practical nurse. These rates apply only to situations in which both recipients 222.17are present and receive shared private duty nursing care on the date for which the service 222.18is billed. No more than two persons may receive shared private duty nursing services 222.19from a private duty nurse in a single setting.222.20(c) (b) Shared private duty nursing care is the provision of nursing services by a 222.21private duty nurse to two medical assistance eligible recipients at the same time and in 222.22the same setting. This subdivision does not apply when a private duty nurse is caring for 222.23multiple recipients in more than one setting.222.24(c) For the purposes of this subdivision, "setting" means:222.25(1) the home residence or foster care home of one of the individual recipients as 222.26defined in section 256B.0651; or222.27(2) a child care program licensed under chapter 245A or operated by a local school 222.28district or private school; or222.29(3) an adult day care service licensed under chapter 245A; or222.30(4) outside the home residence or foster care home of one of the recipients when 222.31normal life activities take the recipients outside the home.222.32This subdivision does not apply when a private duty nurse is caring for multiple 222.33recipients in more than one setting.222.34(d) The private duty nursing agency must offer the recipient the option of shared or 222.35one-on-one private duty nursing services. The recipient may withdraw from participating 222.36in a shared service arrangement at any time.223.1(d) (e) The recipient or the recipient's legal representative, and the recipient's 223.2physician, in conjunction with the home health care private duty nursing agency, shall 223.3determine:223.4(1) whether shared private duty nursing care is an appropriate option based on the 223.5individual needs and preferences of the recipient; and223.6(2) the amount of shared private duty nursing services authorized as part of the 223.7overall authorization of nursing services.223.8(e) (f) The recipient or the recipient's legal representative, in conjunction with the 223.9private duty nursing agency, shall approve the setting, grouping, and arrangement of 223.10shared private duty nursing care based on the individual needs and preferences of the 223.11recipients. Decisions on the selection of recipients to share services must be based on the 223.12ages of the recipients, compatibility, and coordination of their care needs.223.13(f) (g) The following items must be considered by the recipient or the recipient's 223.14legal representative and the private duty nursing agency, and documented in the recipient's 223.15health service record:223.16(1) the additional training needed by the private duty nurse to provide care to 223.17two recipients in the same setting and to ensure that the needs of the recipients are met 223.18appropriately and safely;223.19(2) the setting in which the shared private duty nursing care will be provided;223.20(3) the ongoing monitoring and evaluation of the effectiveness and appropriateness 223.21of the service and process used to make changes in service or setting;223.22(4) a contingency plan which accounts for absence of the recipient in a shared private 223.23duty nursing setting due to illness or other circumstances;223.24(5) staffing backup contingencies in the event of employee illness or absence; and223.25(6) arrangements for additional assistance to respond to urgent or emergency care 223.26needs of the recipients.223.27(g) The provider must offer the recipient or responsible party the option of shared or 223.28one-on-one private duty nursing services. The recipient or responsible party can withdraw 223.29from participating in a shared service arrangement at any time.223.30(h) The private duty nursing agency must document the following in the 223.31health service record for each individual recipient sharing private duty nursing care223.32The documentation for shared private duty nursing must be on a form approved by 223.33the commissioner for each individual recipient sharing private duty nursing. The 223.34documentation must be part of the recipient's health service record and include:223.35(1) permission by the recipient or the recipient's legal representative for the 223.36maximum number of shared nursing care hours per week chosen by the recipient and 224.1permission for shared private duty nursing services provided in and outside the recipient's 224.2home residence;224.3(2) permission by the recipient or the recipient's legal representative for shared 224.4private duty nursing services provided outside the recipient's residence;224.5(3) permission by the recipient or the recipient's legal representative for others to 224.6receive shared private duty nursing services in the recipient's residence;224.7(4) revocation by the recipient or the recipient's legal representative of for the shared 224.8private duty nursing care authorization, or the shared care to be provided to others in the 224.9recipient's residence, or the shared private duty nursing services to be provided outside224.10permission, or services provided to others in and outside the recipient's residence; and224.11(5) (3) daily documentation of the shared private duty nursing services provided by 224.12each identified private duty nurse, including:224.13(i) the names of each recipient receiving shared private duty nursing services 224.14together;224.15(ii) the setting for the shared services, including the starting and ending times that 224.16the recipient received shared private duty nursing care; and224.17(iii) notes by the private duty nurse regarding changes in the recipient's condition, 224.18problems that may arise from the sharing of private duty nursing services, and scheduling 224.19and care issues.224.20(i) Unless otherwise provided in this subdivision, all other statutory and regulatory 224.21provisions relating to private duty nursing services apply to shared private duty nursing 224.22services.224.23Nothing in this subdivision shall be construed to reduce the total number of private 224.24duty nursing hours authorized for an individual recipient under subdivision 2.224.25(i) The commissioner shall provide a rate methodology for shared private duty 224.26nursing. For two persons sharing nursing care, the rate paid to a provider must not exceed 224.271.5 times the regular private duty nursing rates paid for serving a single individual by a 224.28registered nurse or licensed practical nurse. These rates apply only to situations in which 224.29both recipients are present and receive shared private duty nursing care on the date for 224.30which the service is billed.224.31    Subd. 4. Hardship criteria; private duty nursing. (a) Payment is allowed for 224.32extraordinary services that require specialized nursing skills and are provided by parents 224.33of minor children, family foster parents, spouses, and legal guardians who are providing 224.34private duty nursing care under the following conditions:224.35(1) the provision of these services is not legally required of the parents, spouses, 224.36or legal guardians;225.1(2) the services are necessary to prevent hospitalization of the recipient; and225.2(3) the recipient is eligible for state plan home care or a home and community-based 225.3waiver and one of the following hardship criteria are met:225.4(i) the parent, spouse, or legal guardian resigns from a part-time or full-time job to 225.5provide nursing care for the recipient; or225.6(ii) the parent, spouse, or legal guardian goes from a full-time to a part-time job with 225.7less compensation to provide nursing care for the recipient; or225.8(iii) the parent, spouse, or legal guardian takes a leave of absence without pay to 225.9provide nursing care for the recipient; or225.10(iv) because of labor conditions, special language needs, or intermittent hours of 225.11care needed, the parent, spouse, or legal guardian is needed in order to provide adequate 225.12private duty nursing services to meet the medical needs of the recipient.225.13(b) Private duty nursing may be provided by a parent, spouse, family foster parent, 225.14or legal guardian who is a nurse licensed in Minnesota. Private duty nursing services 225.15provided by a parent, spouse, family foster parent, or legal guardian cannot be used in 225.16lieu of nursing services covered and available under liable third-party payors, including 225.17Medicare. The private duty nursing provided by a parent, spouse, family foster parent, or 225.18legal guardian must be included in the service plan agreement. Authorized skilled nursing 225.19services for a single recipient or recipients with the same residence and provided by the 225.20parent, spouse, family foster parent, or legal guardian may not exceed 50 percent of the 225.21total approved nursing hours, or eight hours per day, whichever is less, up to a maximum 225.22of 40 hours per week. A parent or parents, spouse, family foster parent, or legal guardian 225.23shall not provide more than 40 hours of services in a seven-day period. For parents, family 225.24foster parents, and legal guardians, 40 hours is the total amount allowed regardless of the 225.25number of children or adults who receive services. Nothing in this subdivision precludes 225.26the parent's, spouse's, or legal guardian's obligation of assuming the nonreimbursed family 225.27responsibilities of emergency backup caregiver and primary caregiver.225.28(c) A parent, family foster parent,  or a spouse may not be paid to provide private 225.29duty nursing care if:225.30(1) the parent or spouse fails to pass a criminal background check according to 225.31chapter 245C, or if;225.32(2) it has been determined by the home health private duty nursing agency, the 225.33case manager, or the physician that the private duty nursing care provided by the parent, 225.34family foster parent, spouse, or legal guardian is unsafe; or225.35(3) the parent, family foster parent, spouse, or legal guardian do not follow physician 225.36orders.226.1(d) For purposes of this section, "assessment" means a review and evaluation of a 226.2recipient's need for home care services conducted in person. Assessments for private duty 226.3nursing must be conducted by a registered nurse.226.4    Sec. 27. Minnesota Statutes 2008, section 256B.0655, subdivision 1b, is amended to 226.5read:226.6    Subd. 1b. Assessment. "Assessment" means a review and evaluation of a recipient's 226.7need for home care services conducted in person. Assessments for personal care assistant 226.8services shall be conducted by the county public health nurse or a certified public 226.9health nurse under contract with the county. A face-to-face An in-person assessment 226.10must include: documentation of health status, determination of need, evaluation of 226.11service effectiveness, identification of appropriate services, service plan development 226.12or modification, coordination of services, referrals and follow-up to appropriate payers 226.13and community resources, completion of required reports, recommendation of service 226.14authorization, and consumer education. Once the need for personal care assistant 226.15services is determined under this section or sections 
         256B.0651, 
         256B.0653, 
         256B.0654, 226.16and 
         256B.0656, the county public health nurse or certified public health nurse under 226.17contract with the county is responsible for communicating this recommendation to the 226.18commissioner and the recipient. A face-to-face assessment for personal care assistant 226.19services is conducted on those recipients who have never had a county public health 226.20nurse assessment. A face-to-face An in-person assessment must occur at least annually or 226.21when there is a significant change in the recipient's condition or when there is a change 226.22in the need for personal care assistant services. A service update may substitute for 226.23the annual face-to-face assessment when there is not a significant change in recipient 226.24condition or a change in the need for personal care assistant service. A service update 226.25may be completed by telephone, used when there is no need for an increase in personal 226.26care assistant services, and used for two consecutive assessments if followed by a 226.27face-to-face assessment. A service update must be completed on a form approved by the 226.28commissioner. A service update or review for temporary increase includes a review of 226.29initial baseline data, evaluation of service effectiveness, redetermination of service need, 226.30modification of service plan and appropriate referrals, update of initial forms, obtaining 226.31service authorization, and on going consumer education. Assessments must be completed 226.32on forms provided by the commissioner within 30 days of a request for home care services 226.33by a recipient or responsible party or personal care provider agency.227.1    Sec. 28. Minnesota Statutes 2008, section 256B.0655, subdivision 4, is amended to 227.2read:227.3    Subd. 4. Prior Authorization; personal care assistance and qualified 227.4professional.The commissioner, or the commissioner's designee, shall review the 227.5assessment, service update, request for temporary services, request for flexible use option, 227.6service plan, and any additional information that is submitted. The commissioner shall, 227.7within 30 days after receiving a complete request, assessment, and service plan, authorize 227.8home care services as follows:227.9(1) (a) All personal care assistant assistance  services and, supervision by a 227.10qualified professional, if requested by the recipient, and additional services beyond the 227.11limits established in section 256B.0651, subdivision 11, must be prior authorized by 227.12the commissioner or the commissioner's designee before services begin except for the 227.13assessments established in section sections256B.0651, subdivision 11, and 256B.0911.227.14The authorization for personal care assistance and qualified professional services under 227.15section 256B.0659 must be completed within 30 days after receiving a complete request.227.16(b) The amount of personal care assistant assistance  services authorized must be 227.17based on the recipient's home care rating. The home care rating shall be determined by 227.18the commissioner or the commissioner's designee based on information submitted to the 227.19commissioner identifying the following:227.20(1) total number of dependencies of activities of daily living as defined in section 227.21256B.0659;227.22(2) number of complex health-related functions as defined in section 256B.0659; and227.23(3) number of behavior descriptions as defined in section 256B.0659.227.24(c) The methodology to determine total time for personal care assistance services for 227.25each home care rating is based on the median paid units per day for each home care rating 227.26from fiscal year 2007 data for the personal care assistance program. Each home care rating 227.27has a base level of hours assigned. Additional time is added through the assessment and 227.28identification of the following:227.29(1) 30 additional minutes per day for a dependency in each critical activity of daily 227.30living as defined in section 256B.0659;227.31(2) 30 additional minutes per day for each complex health-related function as 227.32defined in section 256B.0659; and227.33(3) 30 additional minutes per day for each behavior issue as defined in section 227.34256B.0659.227.35(d) A limit of 96 units of qualified professional supervision may be authorized for 227.36each recipient receiving personal care assistance services. A request to the commissioner 228.1to exceed this total in a calendar year must be requested by the personal care provider 228.2agency on a form approved by the commissioner.228.3A child may not be found to be dependent in an activity of daily living if because 228.4of the child's age an adult would either perform the activity for the child or assist the 228.5child with the activity and the amount of assistance needed is similar to the assistance 228.6appropriate for a typical child of the same age. Based on medical necessity, the 228.7commissioner may authorize:228.8(A) up to two times the average number of direct care hours provided in nursing 228.9facilities for the recipient's comparable case mix level; or228.10(B) up to three times the average number of direct care hours provided in nursing 228.11facilities for recipients who have complex medical needs or are dependent in at least seven 228.12activities of daily living and need physical assistance with eating or have a neurological 228.13diagnosis; or228.14(C) up to 60 percent of the average reimbursement rate, as of July 1, 1991, for care 228.15provided in a regional treatment center for recipients who have Level I behavior, plus any 228.16inflation adjustment as provided by the legislature for personal care service; or228.17(D) up to the amount the commissioner would pay, as of July 1, 1991, plus any 228.18inflation adjustment provided for home care services, for care provided in a regional 228.19treatment center for recipients referred to the commissioner by a regional treatment center 228.20preadmission evaluation team. For purposes of this clause, home care services means 228.21all services provided in the home or community that would be included in the payment 228.22to a regional treatment center; or228.23(E) up to the amount medical assistance would reimburse for facility care for 228.24recipients referred to the commissioner by a preadmission screening team established 228.25under section 256B.0911 or 256B.092; and228.26(F) a reasonable amount of time for the provision of supervision by a qualified 228.27professional of personal care assistant services, if a qualified professional is requested by 228.28the recipient or responsible party.228.29(2) The number of direct care hours shall be determined according to the annual cost 228.30report submitted to the department by nursing facilities. The average number of direct care 228.31hours, as established by May 1, 1992, shall be calculated and incorporated into the home 228.32care limits on July 1, 1992. These limits shall be calculated to the nearest quarter hour.228.33(3) The home care rating shall be determined by the commissioner or the 228.34commissioner's designee based on information submitted to the commissioner by the 228.35county public health nurse on forms specified by the commissioner. The home care rating 228.36shall be a combination of current assessment tools developed under sections 256B.0911229.1and 256B.501 with an addition for seizure activity that will assess the frequency and 229.2severity of seizure activity and with adjustments, additions, and clarifications that are 229.3necessary to reflect the needs and conditions of recipients who need home care including 229.4children and adults under 65 years of age. The commissioner shall establish these forms 229.5and protocols under this section and sections 256B.0651, 256B.0653, 256B.0654, and 229.6256B.0656 and shall use an advisory group, including representatives of recipients, 229.7providers, and counties, for consultation in establishing and revising the forms and 229.8protocols.229.9(4) A recipient shall qualify as having complex medical needs if the care required is 229.10difficult to perform and because of recipient's medical condition requires more time than 229.11community-based standards allow or requires more skill than would ordinarily be required 229.12and the recipient needs or has one or more of the following:229.13(A) daily tube feedings;229.14(B) daily parenteral therapy;229.15(C) wound or decubiti care;229.16(D) postural drainage, percussion, nebulizer treatments, suctioning, tracheotomy 229.17care, oxygen, mechanical ventilation;229.18(E) catheterization;229.19(F) ostomy care;229.20(G) quadriplegia; or229.21(H) other comparable medical conditions or treatments the commissioner determines 229.22would otherwise require institutional care.229.23(5) A recipient shall qualify as having Level I behavior if there is reasonable 229.24supporting evidence that the recipient exhibits, or that without supervision, observation, or 229.25redirection would exhibit, one or more of the following behaviors that cause, or have the 229.26potential to cause:229.27(A) injury to the recipient's own body;229.28(B) physical injury to other people; or229.29(C) destruction of property.229.30(6) Time authorized for personal care relating to Level I behavior in paragraph 229.31(5), clauses (A) to (C), shall be based on the predictability, frequency, and amount of 229.32intervention required.229.33(7) A recipient shall qualify as having Level II behavior if the recipient exhibits on a 229.34daily basis one or more of the following behaviors that interfere with the completion of 229.35personal care assistant services under subdivision 2, paragraph (a):229.36(A) unusual or repetitive habits;230.1(B) withdrawn behavior; or230.2(C) offensive behavior.230.3(8) A recipient with a home care rating of Level II behavior in paragraph (7), clauses 230.4(A) to (C), shall be rated as comparable to a recipient with complex medical needs under 230.5paragraph (4). If a recipient has both complex medical needs and Level II behavior, the 230.6home care rating shall be the next complex category up to the maximum rating under 230.7paragraph (1), clause (B).230.8EFFECTIVE DATE.The amendments to paragraphs (a) and (b) are effective 230.9January 1, 2010.230.10    Sec. 29. Minnesota Statutes 2008, section 256B.0657, subdivision 8, is amended to 230.11read:230.12    Subd. 8. Self-directed budget requirements. The budget for the provision of the 230.13self-directed service option shall be equal to the greater of either established based on:230.14    (1) the annual amount of personal care assistant services under section 256B.0655230.15that the recipient has used in the most recent 12-month period assessed personal care 230.16assistance units, not to exceed the maximum number of personal care assistance units 230.17available, as determined by section 256B.0655; or and230.18    (2) the amount determined using the consumer support grant methodology under 230.19section 256.476, subdivision 11, except that the budget amount shall include the federal 230.20and nonfederal share of the average service costs. the personal care assistance unit rate:230.21    (i) with a reduction to the unit rate to pay for a program administrator as defined in 230.22subdivision 10; and230.23    (ii) an additional adjustment to the unit rate as needed to ensure cost neutrality for 230.24the state.230.25    Sec. 30. Minnesota Statutes 2008, section 256B.0657, is amended by adding a 230.26subdivision to read:230.27    Subd. 12.Enrollment and evaluation.Enrollment in the self-directed supports 230.28option is available to current personal care assistance recipients upon annual personal care 230.29assistance reassessment, with a maximum enrollment of 1,000 people in the first fiscal 230.30year of implementation and an additional 1,000 people in the second fiscal year.  The 230.31commissioner shall evaluate the self-directed supports option during the first two years of 230.32implementation and make any necessary changes prior to the option becoming available 230.33statewide.231.1    Sec. 31. [256B.0659] PERSONAL CARE ASSISTANCE PROGRAM.231.2    Subdivision 1.Definitions.(a) For the purposes of this section, the terms defined in 231.3paragraphs (b) to (p) have the meanings given unless otherwise provided in text.231.4(b) "Activities of daily living" means grooming, dressing, bathing, transferring, 231.5mobility, positioning, eating, and toileting.231.6(c) "Behavior," effective January 1, 2010, means a category to determine the home 231.7care rating and is based on the criteria found in this section. "Level I behavior" means 231.8physical aggression towards self, others, or destruction of property that requires the 231.9immediate response of another person.231.10(d) "Complex health-related needs," effective January 1, 2010, means a category to 231.11determine the home care rating and is based on the criteria found in this section.231.12(e) "Critical activities of daily living," effective January 1, 2010, means transferring, 231.13mobility, eating, and toileting.231.14(f) "Dependency in activities of daily living" means a person requires assistance to 231.15begin and complete one or more of the activities of daily living.231.16(g) "Health-related procedures and tasks" means procedures and tasks that can 231.17be delegated or assigned by a licensed health care professional under state law to be 231.18performed by a personal care assistant.231.19(h) "Instrumental activities of daily living" means activities to include meal planning 231.20and preparation; basic assistance with paying bills; shopping for food, clothing, and 231.21other essential items; performing household tasks integral to the personal care assistance 231.22services; communication by telephone and other media; and traveling, including to 231.23medical appointments and to participate in the community.231.24(i) "Managing employee" has the same definition as Code of Federal Regulations, 231.25title 42, section 455.231.26(j) "Qualified professional" means a professional providing supervision of personal 231.27care assistance services and staff as defined in section 256B.0625, subdivision 19c.231.28(k) "Personal care assistance provider agency" means a medical assistance enrolled 231.29provider that provides or assists with providing personal care assistance services and 231.30includes personal care assistance provider organizations, personal care assistance choice 231.31agency, class A licensed nursing agency, and Medicare-certified home health agency.231.32(l) "Personal care assistant" or "PCA" means an individual employed by a personal 231.33care assistance agency who provides personal care assistance services.231.34(m) "Personal care assistance care plan" means a written description of personal 231.35care assistance services developed by the personal care assistance provider according 231.36to the service plan.232.1(n) "Responsible party" means an individual who is capable of providing the support 232.2necessary to assist the recipient to live in the community.232.3(o) "Self-administered medication" means medication taken orally, by injection or 232.4insertion, or applied topically without the need for assistance.232.5(p) "Service plan" means a written summary of the assessment and description of the 232.6services needed by the recipient.232.7    Subd. 2.Personal care assistance services; covered services.(a) The personal 232.8care assistance services eligible for payment include services and supports furnished 232.9to an individual, as needed, to assist in:232.10(1) activities of daily living;232.11(2) health-related procedures and tasks;232.12(3) observation and redirection of behaviors; and232.13(4) instrumental activities of daily living.232.14(b) Activities of daily living include the following covered services:232.15(1) dressing, including assistance with choosing, application, and changing of 232.16clothing and application of special appliances, wraps, or clothing;232.17(2) grooming, including assistance with basic hair care, oral care, shaving, applying 232.18cosmetics and deodorant, and care of eyeglasses and hearing aids. Nail care is included, 232.19except for recipients who are diabetic or have poor circulation;232.20(3) bathing, including assistance with basic personal hygiene and skin care;232.21(4) eating, including assistance with hand washing and application of orthotics 232.22required for eating, transfers, and feeding;232.23(5) transfers, including assistance with transferring the recipient from one seating or 232.24reclining area to another;232.25(6) mobility, including assistance with ambulation, including use of a wheelchair. 232.26Mobility does not include providing transportation for a recipient;232.27(7) positioning, including assistance with positioning or turning a recipient for 232.28necessary care and comfort; and232.29(8) toileting, including assistance with helping recipient with bowel or bladder 232.30elimination and care including transfers, mobility, positioning, feminine hygiene, use of 232.31toileting equipment or supplies, cleansing the perineal area, inspection of the skin, and 232.32adjusting clothing.232.33(c) Health-related procedures and tasks include the following covered services:232.34(1) range of motion and passive exercise to maintain a recipient's strength and 232.35muscle functioning;233.1(2) assistance with self-administered medication as defined by this section, including 233.2reminders to take medication, bringing medication to the recipient, and assistance with 233.3opening medication under the direction of the recipient or responsible party;233.4(3) interventions for seizure disorders, including monitoring and observation; and233.5(4) other activities considered within the scope of the personal care service and 233.6meeting the definition of health-related procedures and tasks under this section.233.7(d) A personal care assistant may provide health-related procedures and tasks 233.8associated with the complex health-related needs of a recipient if the procedures and 233.9tasks meet the definition of health-related procedures and tasks under this section and the 233.10personal care assistant is trained by a qualified professional and demonstrates competency 233.11to safely complete the procedures and tasks. Delegation of health-related procedures and 233.12tasks and all training must be documented in the personal care assistance care plan and the 233.13recipient's and personal care assistant's files.233.14(e) Effective January 1, 2010, for a personal care assistant to provide the 233.15health-related procedures and tasks of tracheostomy suctioning and services to recipients 233.16on ventilator support there must be:233.17(1) delegation and training by a registered nurse, certified or licensed respiratory 233.18therapist, or a physician;233.19(2) utilization of clean rather than sterile procedure;233.20(3) specialized training about the health-related procedures and tasks and equipment, 233.21including ventilator operation and maintenance;233.22(4) individualized training regarding the needs of the recipient; and233.23(5) supervision by a qualified professional who is a registered nurse.233.24(f) Effective January 1, 2010, a personal care assistant may observe and redirect the 233.25recipient for episodes where there is a need for redirection due to behaviors. Training of 233.26the personal care assistant must occur based on the needs of the recipient, the personal 233.27care assistance care plan, and any other support services provided.233.28(g) Instrumental activities of daily living under subdivision 1, paragraph (h).233.29    Subd. 3.Noncovered personal care assistance services.(a) Personal care 233.30assistance services are not eligible for medical assistance payment under this section 233.31when provided:233.32(1) by the recipient's spouse, parent of a recipient under the age of 18, paid legal 233.33guardian, licensed foster provider, except as allowed under section 256B.0651, subdivision 233.349a, or responsible party;233.35(2) in lieu of other staffing options in a residential or child care setting;233.36(3) solely as a child care or babysitting service; or234.1(4) without authorization by the commissioner or the commissioner's designee.234.2(b) The following personal care services are not eligible for medical assistance 234.3payment under this section when provided in residential settings:234.4(1) effective January 1, 2010, when the provider of home care services who is not 234.5related by blood, marriage, or adoption owns or otherwise controls the living arrangement, 234.6including licensed or unlicensed services; or234.7(2) when personal care assistance services are the responsibility of a residential or 234.8program license holder under the terms of a service agreement and administrative rules.234.9(c) Other specific tasks not covered under paragraph (a) or (b) that are not eligible 234.10for medical assistance reimbursement for personal care assistance services under this 234.11section include:234.12(1) sterile procedures;234.13(2) injections of fluids and medications into veins, muscles, or skin;234.14(3) home maintenance or chore services;234.15(4) homemaker services not an integral part of assessed personal care assistance 234.16services needed by a recipient;234.17(5) application of restraints or implementation of procedures under section 245.825;234.18(6) instrumental activities of daily living for children under the age of 18; and234.19(7) assessments for personal care assistance services by personal care assistance 234.20provider agencies or by independently enrolled registered nurses.234.21    Subd. 4.Assessment for personal care assistance services.(a) An assessment 234.22as defined in section 256B.0655, subdivision 1b, must be completed for personal care 234.23assistance services.234.24(b) The following limitations apply to the assessment:234.25(1) a person must be assessed as dependent in an activity of daily living based 234.26on the person's need, on a daily basis, for:234.27(i) cueing and constant supervision to complete the task; or234.28(ii) hands-on assistance to complete the task; and234.29(2) a child may not be found to be dependent in an activity of daily living if because 234.30of the child's age an adult would either perform the activity for the child or assist the child 234.31with the activity. Assistance needed is the assistance appropriate for a typical child of 234.32the same age.234.33(c) Assessment for complex health-related needs must meet the criteria in this 234.34paragraph. During the assessment process, a recipient qualifies as having complex 234.35health-related needs if the recipient has one or more of the interventions that are ordered by 234.36a physician, specified in a personal care assistance care plan, and found in the following:235.1(1) tube feedings requiring:235.2(i) a gastro/jejunostomy tube; or235.3(ii) continuous tube feeding lasting longer than 12 hours per day;235.4(2) wounds described as:235.5    (i) stage III or stage IV;235.6    (ii) multiple wounds;235.7    (iii) requiring sterile or clean dressing changes or a wound vac; or235.8    (iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require 235.9specialized care;235.10    (3) parenteral therapy described as:235.11    (i) IV therapy more than two times per week lasting longer than four hours for 235.12each treatment; or235.13    (ii) total parenteral nutrition (TPN) daily;235.14    (4) respiratory interventions including:235.15    (i) oxygen required more than eight hours per day;235.16    (ii) respiratory vest more than one time per day;235.17    (iii) bronchial drainage treatments more than two times per day;235.18    (iv) sterile or clean suctioning more than six times per day;235.19    (v) dependence on another to apply respiratory ventilation augmentation devises 235.20such as BiPAP and CPAP; and235.21    (vi) ventilator dependence under section 256B.0652;235.22    (5) insertion and maintenance of catheter including:235.23(i) sterile catheter changes more than one time per month;235.24(ii) clean self-catheterization more than six times per day; or235.25(iii) bladder irrigations;235.26(6) bowel program more than two times per week requiring more than 30 minutes to 235.27perform each time;235.28(7) neurological intervention including:235.29(i) seizures more than two times per week and requiring significant physical 235.30assistance to maintain safety; or235.31(ii) swallowing disorders diagnosed by a physician and requiring specialized 235.32assistance from another on a daily basis; and235.33(8) other congenital or acquired diseases creating a need for significantly increased 235.34direct hands-on assistance and interventions in six to eight activities of daily living.236.1(d) An assessment of behaviors must meet the criteria in this paragraph. A recipient 236.2qualifies as having a need for assistance due to behaviors if the recipient's behavior requires 236.3assistance at least four times per week and shows one or more of the following behaviors:236.4(1) physical aggression towards self or others, or destruction of property that requires 236.5the immediate response of another person;236.6(2) increased vulnerability due to cognitive deficits or socially inappropriate 236.7behavior; or236.8(3) verbally aggressive and resistive to care.236.9    Subd. 5.Service, support planning, and referral.(a) The assessor, with the 236.10recipient or responsible party, shall review the assessment information and determine 236.11referrals for other payers, services, and community supports as appropriate.236.12(b) The recipient must be referred for evaluation, services, or supports that are 236.13appropriate to help meet the recipient's needs including, but not limited to, the following 236.14circumstances:236.15(1) when there is another payer who is responsible to provide the service to meet 236.16the recipient's needs;236.17(2) when the recipient qualifies for assistance due to mental illness or behaviors 236.18under this section, a referral for a mental health diagnostic and functional assessment 236.19must be completed, or referral must be made for other specific mental health services or 236.20other community services;236.21(3) when the recipient is eligible for medical assistance and meets medical assistance 236.22eligibility for a home health aide or skilled nurse visit;236.23(4) when the recipient would benefit from an evaluation for another service; and236.24(5) when there is a more appropriate service to meet the assessed needs.236.25    (c) The reimbursement rates for public health nurse visits that relate to the provision 236.26of personal care assistance services under this section and section 256B.0625, subdivision 236.2719a, are:236.28    (1) $210.50 for a face-to-face assessment visit;236.29    (2) $105.25 for each service update; and236.30    (3) $105.25 for each request for a temporary service increase.236.31    (d) The rates specified in paragraph (c) must be adjusted to reflect provider rate 236.32increases for personal care assistance services that are approved by the legislature for the 236.33fiscal year ending June 30, 2000, and subsequent fiscal years. Any requirements applied 236.34by the legislature to provider rate increases for personal care assistance services also 236.35apply to adjustments under this paragraph.237.1    (e) Effective July 1, 2008, the payment rate for an assessment under this section and 237.2section 256B.0651 shall be reduced by 25 percent when the assessment is not completed 237.3on time and the service agreement documentation is not submitted in time to continue 237.4services. The commissioner shall reduce the amount of the claim for those assessments 237.5that are not submitted on time.237.6    Subd. 6.Service plan.The service plan must be completed by the assessor with the 237.7recipient and responsible party on a form determined by the commissioner and include 237.8a summary of the assessment with a description of the need, authorized amount, and 237.9expected outcomes and goals of personal care assistance services. The recipient and 237.10the provider chosen by the recipient or responsible party must be given a copy of the 237.11completed service plan within ten working days of the assessment. The recipient or 237.12responsible party must be given information by the assessor about the options in the 237.13personal care assistance program to allow for review and decision making.237.14    Subd. 7.Personal care assistance care plan.(a) Each recipient must have a 237.15current personal care assistance care plan based on the service plan in subdivision 6 that is 237.16developed by the qualified professional with the recipient and responsible party. A copy of 237.17the most current personal care assistance care plan is required to be in the recipient's home 237.18and in the recipient's file at the provider agency.237.19(b) The personal care assistance care plan must have the following components:237.20(1) start and end date of the care plan;237.21(2) recipient demographic information, including name and telephone number;237.22(3) emergency numbers, procedures, and a description of measures to address 237.23identified safety and vulnerability issues, including a backup staffing plan;237.24(4) name of responsible party and instructions for contact;237.25(5) description of the recipient's individualized needs for assistance with activities of 237.26daily living, instrumental activities of daily living, health-related tasks, and behaviors; and237.27(6) dated signatures of recipient or responsible party and qualified professional.237.28(c) The personal care assistance care plan must have instructions and comments 237.29about the recipient's needs for assistance and any special instructions or procedures 237.30required. The month-to-month plan for the use of personal care assistance services is part 237.31of the personal care assistance care plan. The personal care assistance care plan must 237.32be completed within the first week after start of services with a personal care provider 237.33agency and must be updated as needed when there is a change in need for personal care 237.34assistance services. A new personal care assistance care plan is required annually at the 237.35time of the reassessment.238.1    Subd. 8.Communication with recipient's physician.The personal care assistance 238.2program requires communication with the recipient's physician about a recipient's assessed 238.3needs for personal care assistance services. The commissioner shall work with the state 238.4medical director to develop options for communication with the recipient's physician.238.5    Subd. 9.Responsible party; generally.(a) "Responsible party," effective January 238.61, 2010, means an individual who is capable of providing the support necessary to assist 238.7the recipient to live in the community.238.8(b) A responsible party must be 18 years of age, actively participate in planning and 238.9directing of personal care assistance services, and attend all assessments for the recipient.238.10(c) A responsible party must not be the:238.11(1) personal care assistant;238.12(2) home care provider agency owner or staff; or238.13(3) county staff acting as part of employment.238.14(d) A licensed family foster parent who lives with the recipient may be the 238.15responsible party as long as the family foster parent meets the other responsible party 238.16requirements.238.17(e) A responsible party is required when:238.18(1) the person is a minor according to section 524.5-102, subdivision 10;238.19(2) the person is an incapacitated adult according to section 524.5-102, subdivision 238.206, resulting in a court-appointed guardian; or238.21(3) the assessment according to section 256B.0655, subdivision 1b, determines that 238.22the recipient is in need of a responsible party to direct the recipient's care.238.23(f) There may be two persons designated as the responsible party for reasons such 238.24as divided households and court-ordered custodies. Each person named as responsible 238.25party must meet the program criteria and responsibilities.238.26(g) The recipient or the recipient's legal representative shall appoint a responsible 238.27party if necessary to direct and supervise the care provided to the recipient. The 238.28responsible party must be identified at the time of assessment and listed on the recipient's 238.29service agreement and personal care assistance care plan.238.30    Subd. 10.Responsible party; duties; delegation.(a) A responsible party shall 238.31enter into a written agreement with a personal care assistance provider agency, on a form 238.32determined by the commissioner, to perform the following duties:238.33(1) be available while care is provided in a method agreed upon by the individual 238.34or the individual's legal representative and documented in the recipient's personal care 238.35assistance care plan;239.1(2) monitor personal care assistance services to ensure the recipient's personal care 239.2assistance care plan is being followed; and239.3(3) review and sign personal care assistance time sheets after services are provided 239.4to provide verification of the personal care assistance services.239.5Failure to provide the support required by the recipient must result in a referral to the 239.6county common entry point.239.7(b) Responsible parties who are parents of minors or guardians of minors or 239.8incapacitated persons may delegate the responsibility to another adult who is not the 239.9personal care assistant during a temporary absence of at least 24 hours but not more 239.10than six months. The person delegated as a responsible party must be able to meet the 239.11definition of the responsible party, except that the delegated responsible party is required 239.12to reside with the recipient only while serving as the responsible party. The responsible 239.13party must ensure that the delegate performs the functions of the responsible party, is 239.14identified at the time of the assessment, and is listed on the personal care assistance 239.15care plan. The responsible party must communicate to the personal care assistance 239.16provider agency about the need for a delegate responsible party, including the name of the 239.17delegated responsible party, dates the delegated responsible party will be living with the 239.18recipient, and contact numbers.239.19    Subd. 11.Personal care assistant; requirements.(a) A personal care assistant 239.20must meet the following requirements:239.21(1) be at least 18 years of age with the exception of persons who are 16 or 17 years 239.22of age with these additional requirements:239.23(i) supervision by a qualified professional every 60 days; and239.24(ii) employment by only one personal care assistance provider agency responsible 239.25for compliance with current labor laws;239.26(2) be employed by a personal care assistance provider agency;239.27(3) enroll with the department as a personal care assistant after clearing a background 239.28study. Before a personal care assistant provides services, the personal care assistance 239.29provider agency must initiate a background study on the personal care assistant under 239.30chapter 245C, and the personal care assistance provider agency must have received a 239.31notice from the commissioner that the personal care assistant is:239.32(i) not disqualified under section 245C.14; or239.33(ii) is disqualified, but the personal care assistant has received a set aside of the 239.34disqualification under section 245C.22;239.35(4) be able to effectively communicate with the recipient and personal care 239.36assistance provider agency;240.1(5) be able to provide covered personal care assistance services according to the 240.2recipient's personal care assistance care plan, respond appropriately to recipient needs, 240.3and report changes in the recipient's condition to the supervising qualified professional 240.4or physician;240.5(6) not be a consumer of personal care assistance services;240.6(7) maintain daily written records including, but not limited to, time sheets under 240.7subdivision 12;240.8(8) effective January 1, 2010, complete standardized training as determined by the 240.9commissioner before completing enrollment. Personal care assistant training must include 240.10successful completion of the following training components: basic first aid, vulnerable 240.11adult, child maltreatment, OSHA universal precautions, basic roles and responsibilities of 240.12personal care assistants including information about assistance with lifting and transfers 240.13for recipients, emergency preparedness, orientation to positive behavioral practices, fraud 240.14issues, and completion of time sheets. Upon completion of the training components, 240.15the personal care assistant must demonstrate the competency to provide assistance to 240.16recipients;240.17(9) complete training and orientation on the needs of the recipient within the first 240.18seven days after the services begin; and240.19(10) be limited to providing and being paid for up to 310 hours per month of personal 240.20care assistance services regardless of the number of recipients being served or the number 240.21of personal care assistance provider agencies enrolled with.240.22(b) A legal guardian may be a personal care assistant if the guardian is not being paid 240.23for the guardian services and meets the criteria for personal care assistants in paragraph (a).240.24(c) Effective January 1, 2010, persons who do not qualify as a personal care assistant 240.25include parents and stepparents of minors, spouses, paid legal guardians, family foster 240.26care providers, except as otherwise allowed in section 256B.0625, subdivision 19a, or 240.27staff of a residential setting.240.28    Subd. 12.Documentation of personal care assistance services provided.(a) 240.29Personal care assistance services for a recipient must be documented daily by each personal 240.30care assistant, on a time sheet form approved by the commissioner. All documentation 240.31may be Web-based, electronic, or paper documentation. The completed form must be 240.32submitted on a monthly basis to the provider and kept in the recipient's health record.240.33(b) The activity documentation must correspond to the personal care assistance care 240.34plan and be reviewed by the qualified professional.241.1(c) The personal care assistant time sheet must be on a form approved by the 241.2commissioner documenting time the personal care assistant provides services in the home. 241.3The following criteria must be included in the time sheet:241.4(1) full name of personal care assistant and individual provider number;241.5(2) provider name and telephone numbers;241.6(3) full name of recipient;241.7(4) consecutive dates, including month, day, and year, and arrival and departure 241.8time with a.m. or p.m. notations;241.9(5) signatures of recipient or the responsible party;241.10(6) personal signature of the personal care assistant;241.11(7) any shared care provided, if applicable;241.12(8) a statement that it is a federal crime to provide false information on personal 241.13care service billings for medical assistance payments; and241.14(9) dates and location of recipient stays in a hospital, care facility, or incarceration.241.15    Subd. 13.Qualified professional; qualifications.(a) The qualified professional 241.16must be employed by a personal care assistance provider agency and meet the definition 241.17under section 256B.0625, subdivision 19c. Before a qualified professional provides 241.18services, the personal care assistance provider agency must initiate a background study on 241.19the qualified professional under chapter 245C, and the personal care assistance provider 241.20agency must have received a notice from the commissioner that the qualified professional:241.21(1) is not disqualified under section 245C.14; or241.22(2) is disqualified, but the qualified professional has received a set aside of the 241.23disqualification under section 245C.22.241.24(b) The qualified professional shall perform the duties of training, supervision, and 241.25evaluation of the personal care assistance staff and evaluation of the effectiveness of 241.26personal care assistance services. The qualified professional shall:241.27(1) develop and monitor with the recipient a personal care assistance care plan based 241.28on the service plan and individualized needs of the recipient;241.29(2) develop and monitor with the recipient a monthly plan for the use of personal 241.30care assistance services;241.31(3) review documentation of personal care assistance services provided;241.32(4) provide training and ensure competency for the personal care assistant in the 241.33individual needs of the recipient; and241.34(5) document all training, communication, evaluations, and needed actions to 241.35improve performance of the personal care assistants.242.1(c) The qualified professional shall complete the provider training with basic 242.2information about the personal care assistance program approved by the commissioner 242.3within six months of the date hired by a personal care assistance provider agency. 242.4Qualified professionals who have completed the required trainings as an employee with a 242.5personal care assistance provider agency do not need to repeat the required trainings if they 242.6are hired by another agency, if they have completed the training within the last three years.242.7    Subd. 14.Qualified professional; duties.(a) Effective January 1, 2010, all personal 242.8care assistants must be supervised by a qualified professional.242.9(b) Through direct training, observation, return demonstrations, and consultation 242.10with the staff and the recipient, the qualified professional must ensure and document 242.11that the personal care assistant is:242.12(1) capable of providing the required personal care assistance services;242.13(2) knowledgeable about the plan of personal care assistance services before services 242.14are performed; and242.15(3) able to identify conditions that should be immediately brought to the attention of 242.16the qualified professional.242.17(c) The qualified professional shall evaluate the personal care assistant within the 242.18first 14 days of starting to provide services for a recipient except for the personal care 242.19assistance choice option under subdivision 19, paragraph (a), clause (4). The qualified 242.20professional shall evaluate the personal care assistance services for a recipient through 242.21direct observation of a personal care assistant's work:242.22(1) at least every 90 days thereafter for the first year of a recipient's services; and242.23(2) every 120 days after the first year of a recipient's service or whenever needed for 242.24response to a recipient's request for increased supervision of the personal care assistance 242.25staff.242.26(d) Communication with the recipient is a part of the evaluation process of the 242.27personal care assistance staff.242.28(e) At each supervisory visit, the qualified professional shall evaluate personal care 242.29assistance services including the following information:242.30(1) satisfaction level of the recipient with personal care assistance services;242.31(2) review of the month-to-month plan for use of personal care assistance services;242.32(3) review of documentation of personal care assistance services provided;242.33(4) whether the personal care assistance services are meeting the goals of the service 242.34as stated in the personal care assistance care plan and service plan;242.35(5) a written record of the results of the evaluation and actions taken to correct any 242.36deficiencies in the work of a personal care assistant; and243.1(6) revision of the personal care assistance care plan as necessary in consultation 243.2with the recipient or responsible party, to meet the needs of the recipient.243.3(f) The qualified professional shall complete the required documentation in the 243.4agency recipient and employee files and the recipient's home, including the following 243.5documentation:243.6(1) the personal care assistance care plan based on the service plan and individualized 243.7needs of the recipient;243.8(2) a month-to-month plan for use of personal care assistance services;243.9(3) changes in need of the recipient requiring a change to the level of service and the 243.10personal care assistance care plan;243.11(4) evaluation results of supervision visits and identified issues with personal care 243.12assistance staff with actions taken;243.13(5) all communication with the recipient and personal care assistance staff; and243.14(6) hands-on training or individualized training for the care of the recipient.243.15(g) The documentation in paragraph (f) must be done on agency forms.243.16(h) The services that are not eligible for payment as qualified professional services 243.17include:243.18(1) direct professional nursing tasks that could be assessed and authorized as skilled 243.19nursing tasks;243.20(2) supervision of personal care assistance completed by telephone;243.21(3) agency administrative activities;243.22(4) training other than the individualized training required to provide care for a 243.23recipient; and243.24(5) any other activity that is not described in this section.243.25    Subd. 15.Flexible use.(a) "Flexible use" means the scheduled use of authorized 243.26hours of personal care assistance services, which vary within a service authorization 243.27period covering no more than six months, in order to more effectively meet the needs and 243.28schedule of the recipient. Each 12-month service agreement is divided into two six-month 243.29authorization date spans. No more than 75 percent of the total authorized units for a 243.3012-month service agreement may be used in a six-month date span.243.31(b) Authorization of flexible use occurs during the authorization process under 243.32section 256B.0652. The flexible use of authorized hours does not increase the total 243.33amount of authorized hours available to a recipient. The commissioner shall not authorize 243.34additional personal care assistance services to supplement a service authorization that 243.35is exhausted before the end date under a flexible service use plan, unless the assessor 243.36determines a change in condition and a need for increased services is established. 244.1Authorized hours not used within the six-month period must not be carried over to another 244.2time period.244.3(c) A recipient who has terminated personal care assistance services before the end 244.4of the 12-month authorization period must not receive additional hours upon reapplying 244.5during the same 12-month authorization period, except if a change in condition is 244.6documented. Services must be prorated for the remainder of the 12-month authorization 244.7period based on the first six-month assessment.244.8(d) The recipient, responsible party, and qualified professional must develop a 244.9written month-to-month plan of the projected use of personal care assistance services that 244.10is part of the personal care assistance care plan and ensures:244.11(1) that the health and safety needs of the recipient are met throughout both date 244.12spans of the authorization period; and244.13(2) that the total authorized amount of personal care assistance services for each date 244.14span must not be used before the end of each date span in the authorization period.244.15(e) The personal care assistance provider agency shall monitor the use of personal 244.16care assistance services to ensure health and safety needs of the recipient are met 244.17throughout both date spans of the authorization period. The commissioner or the 244.18commissioner's designee shall provide written notice to the provider and the recipient or 244.19responsible party when a recipient is at risk of exceeding the personal care assistance 244.20services prior to the end of the six-month period.244.21(f) Misuse and abuse of the flexible use of personal care assistance services resulting 244.22in the overuse of units in a manner where the recipient will not have enough units to meet 244.23their needs for assistance and ensure health and safety for the entire six-month date span 244.24may lead to an action by the commissioner. The commissioner may take action including, 244.25but not limited to: (1) restricting recipients to service authorizations of no more than one 244.26month in duration; (2) requiring the recipient to have a responsible party; and (3) requiring 244.27a qualified professional to monitor and report services on a monthly basis.244.28    Subd. 16.Shared services.(a) Medical assistance payments for shared personal 244.29care assistance services are limited according to this subdivision.244.30(b) Shared service is the provision of personal care assistance services by a personal 244.31care assistant to two or three recipients, eligible for medical assistance, who voluntarily 244.32enter into an agreement to receive services at the same time and in the same setting.244.33(c) For the purposes of this subdivision, "setting" means:244.34(1) the home residence or family foster care home of one or more of the individual 244.35recipients; or245.1(2) a child care program licensed under chapter 245A or operated by a local school 245.2district or private school.245.3(d) Shared personal care assistance services follow the same criteria for covered 245.4services as subdivision 2.245.5(e) Noncovered shared personal care assistance services include the following:245.6(1) services for more than three recipients by one personal care assistant at one time;245.7(2) staff requirements for child care programs under chapter 245C;245.8(3) caring for multiple recipients in more than one setting;245.9(4) additional units of personal care assistance based on the selection of the option; 245.10and245.11(5) use of more than one personal care assistance provider agency for the shared 245.12care services.245.13(f) The option of shared personal care assistance is elected by the recipient or the 245.14responsible party with the assistance of the assessor. The option must be determined 245.15appropriate based on the ages of the recipients, compatibility, and coordination of their 245.16assessed care needs. The recipient or the responsible party, in conjunction with the 245.17qualified professional, shall arrange the setting and grouping of shared services based 245.18on the individual needs and preferences of the recipients. The personal care assistance 245.19provider agency shall offer the recipient or the responsible party the option of shared or 245.20one-on-one personal care assistance services or a combination of both. The recipient or 245.21the responsible party may withdraw from participating in a shared services arrangement at 245.22any time.245.23(g) Authorization for the shared service option must be determined by the 245.24commissioner based on the criteria that the shared service is appropriate to meet all of the 245.25recipients' needs and their health and safety is maintained. The authorization of shared 245.26services is part of the overall authorization of personal care assistance services. Nothing 245.27in this subdivision must be construed to reduce the total number of hours authorized for 245.28an individual recipient.245.29(h) A personal care assistant providing shared personal care assistance services must:245.30(1) receive training specific for each recipient served; and245.31(2) follow all required documentation requirements for time and services provided.245.32(i) A qualified professional shall:245.33(1) evaluate the ability of the personal care assistant to provide services for all of 245.34the recipients in a shared setting;246.1(2) visit the shared setting as services are being provided at least once every six 246.2months or whenever needed for response to a recipient's request for increased supervision 246.3of the personal care assistance staff;246.4(3) provide ongoing monitoring and evaluation of the effectiveness and 246.5appropriateness of the shared services;246.6(4) develop a contingency plan with each of the recipients which accounts for 246.7absence of the recipient in a share services setting due to illness or other circumstances;246.8(5) obtain permission from each of the recipients who are sharing a personal care 246.9assistant for number of shared hours for services provided inside and outside the home 246.10residence; and246.11(6) document the training completed by the personal care assistants specific to the 246.12shared setting and recipients sharing services.246.13    Subd. 17.Shared services; rates.The commissioner shall provide a rate system for 246.14shared personal care assistance services. For two persons sharing services, the rate paid 246.15to a provider must not exceed one and one-half times the rate paid for serving a single 246.16individual, and for three persons sharing services, the rate paid to a provider must not 246.17exceed twice the rate paid for serving a single individual. These rates apply only when all 246.18of the criteria for the shared care personal care assistance service have been met.246.19    Subd. 18.Personal care assistance choice option; generally.(a) The 246.20commissioner may allow a recipient of personal care assistance services to use a fiscal 246.21intermediary to assist the recipient in paying and accounting for medically necessary 246.22covered personal care assistance services. Unless otherwise provided in this section, all 246.23other statutory and regulatory provisions relating to personal care assistance services apply 246.24to a recipient using the personal care assistance choice option.246.25(b) Personal care assistance choice is an option of the personal care assistance 246.26program that allows the recipient who receives personal care assistance services to be 246.27responsible for the hiring, training, scheduling, and firing of personal care assistants. This 246.28program offers greater control and choice for the recipient in who provides the personal 246.29care assistance service and when the service is scheduled. The recipient or the recipient's 246.30responsible party must choose a personal care assistance choice provider agency as 246.31a fiscal intermediary. This personal care assistance choice provider agency manages 246.32payroll, invoices the state, is responsible for all payroll related taxes and insurance, and is 246.33responsible for providing the consumer training and support in managing the recipient's 246.34personal care assistance services.247.1    Subd. 19.Personal care assistance choice option; qualifications; duties.(a) 247.2Under personal care assistance choice, the recipient or responsible party shall:247.3(1) recruit, hire, schedule, and terminate personal care assistants and a qualified 247.4professional;247.5(2) develop a personal care assistance care plan based on the assessed needs 247.6and addressing the health and safety of the recipient with the assistance of a qualified 247.7professional as needed;247.8(3) orient and train the personal care assistant with assistance as needed from the 247.9qualified professional;247.10(4) effective January 1, 2010, supervise and evaluate the personal care assistant with 247.11the qualified professional, who is required to visit the recipient at least every 180 days;247.12(5) monitor and verify in writing and report to the personal care assistance choice 247.13agency the number of hours worked by the personal care assistant and the qualified 247.14professional;247.15(6) engage in an annual face-to-face reassessment to determine continuing eligibility 247.16and service authorization; and247.17(7) use the same personal care assistance choice provider agency if shared personal 247.18assistance care is being used.247.19(b) The personal care assistance choice provider agency shall:247.20(1) meet all personal care assistance provider agency standards;247.21(2) enter into a written agreement with the recipient, responsible party, and personal 247.22care assistants;247.23(3) not be related as a parent, child, sibling, or spouse to the recipient, qualified 247.24professional, or the personal care assistant; and247.25(4) ensure arm's-length transactions without undue influence or coercion with the 247.26recipient and personal care assistant.247.27(c) The duties of the personal care assistance choice provider agency are to:247.28(1) be the employer of the personal care assistant and the qualified professional for 247.29employment law and related regulations including, but not limited to, purchasing and 247.30maintaining workers' compensation, unemployment insurance, surety and fidelity bonds, 247.31and liability insurance, and submit any or all necessary documentation including, but not 247.32limited to, workers' compensation and unemployment insurance;247.33(2) bill the medical assistance program for personal care assistance services and 247.34qualified professional services;247.35(3) request and complete background studies that comply with the requirements for 247.36personal care assistants and qualified professionals;248.1(4) pay the personal care assistant and qualified professional based on actual hours 248.2of services provided;248.3(5) withhold and pay all applicable federal and state taxes;248.4(6) verify and keep records of hours worked by the personal care assistant and 248.5qualified professional;248.6(7) make the arrangements and pay taxes and other benefits, if any; and comply with 248.7any legal requirements for a Minnesota employer;248.8(8) enroll in the medical assistance program as a personal care assistance choice 248.9agency; and248.10(9) enter into a written agreement as specified in subdivision 20 before services 248.11are provided.248.12    Subd. 20.Personal care assistance choice option; administration.(a) Before 248.13services commence under the personal care assistance choice option, and annually 248.14thereafter, the personal care assistance choice provider agency, recipient, or responsible 248.15party, each personal care assistant, and the qualified professional shall enter into a written 248.16agreement. The agreement must include at a minimum:248.17(1) duties of the recipient, qualified professional, personal care assistant, and 248.18personal care assistance choice provider agency;248.19(2) salary and benefits for the personal care assistant and the qualified professional;248.20(3) administrative fee of the personal care assistance choice provider agency and 248.21services paid for with that fee, including background study fees;248.22(4) grievance procedures to respond to complaints;248.23(5) procedures for hiring and terminating the personal care assistant; and248.24(6) documentation requirements including, but not limited to, time sheets, activity 248.25records, and the personal care assistance care plan.248.26(b) Effective January 1, 2010, except for the administrative fee of the personal care 248.27assistance choice provider agency as reported on the written agreement, the remainder 248.28of the rates paid to the personal care assistance choice provider agency must be used to 248.29pay for the salary and benefits for the personal care assistant or the qualified professional. 248.30The provider agency must use a minimum of 72.5 percent of the revenue generated by 248.31the medical assistance rate for personal care assistance services for employee personal 248.32care assistant wages and benefits.248.33(c) The commissioner shall deny, revoke, or suspend the authorization to use the 248.34personal care assistance choice option if:248.35(1) it has been determined by the qualified professional or public health nurse that 248.36the use of this option jeopardizes the recipient's health and safety;249.1(2) the parties have failed to comply with the written agreement specified in this 249.2subdivision;249.3(3) the use of the option has led to abusive or fraudulent billing for personal care 249.4assistance services; or249.5(4) the department terminates the personal care assistance choice option.249.6(d) The recipient or responsible party may appeal the commissioner's decision in 249.7paragraph (c) according to section 256.045. The denial, revocation, or suspension to 249.8use the personal care assistance choice option must not affect the recipient's authorized 249.9level of personal care assistance services.249.10    Subd. 21.Requirements for initial enrollment of personal care assistance 249.11provider agencies.(a) All personal care assistance provider agencies must provide, at the 249.12time of enrollment as a personal care assistance provider agency in a format determined 249.13by the commissioner, information and documentation that includes, but is not limited to, 249.14the following:249.15(1) the personal care assistance provider agency's current contact information 249.16including address, telephone number, and e-mail address;249.17(2) proof of surety bond coverage in the amount of $50,000 or ten percent of the 249.18provider's payments from Medicaid in the previous year, whichever is less;249.19(3) proof of fidelity bond coverage in the amount of $20,000;249.20(4) proof of workers' compensation insurance coverage;249.21(5) a description of the personal care assistance provider agency's organization 249.22identifying the names of all owners, managing employees, staff, board of directors, and 249.23the affiliations of the directors, owners, or staff to other service providers;249.24(6) a copy of the personal care assistance provider agency's written policies and 249.25procedures including: hiring of employees; training requirements; service delivery; 249.26and employee and consumer safety including process for notification and resolution 249.27of consumer grievances, identification and prevention of communicable diseases, and 249.28employee misconduct;249.29(7) copies of all other forms the personal care assistance provider agency uses in 249.30the course of daily business including, but not limited to:249.31(i) a copy of the personal care assistance provider agency's time sheet if the time 249.32sheet varies from the standard time sheet for personal care assistance services approved 249.33by the commissioner, and a letter requesting approval of the personal care assistance 249.34provider agency's nonstandard time sheet;249.35(ii) the personal care assistance provider agency's template for the personal care 249.36assistance care plan; and250.1(iii) the personal care assistance provider agency's template and the written 250.2agreement in subdivision 20 for recipients using the personal care assistance choice 250.3option, if applicable;250.4(8) a list of all trainings and classes that the personal care assistance provider agency 250.5requires of its staff providing personal care assistance services;250.6(9) documentation that the personal care assistance provider agency and staff have 250.7successfully completed all the training required by this section; 250.8(10) documentation of the agency's marketing practices;250.9(11) disclosure of ownership, leasing, or management of all residential properties 250.10that is used or could be used for providing home care services; and 250.11(12) documentation that the agency will use the following percentages of revenue 250.12generated from the medical assistance rate paid for personal care assistance services 250.13for employee personal care assistant wages and benefits: 72.5 percent of revenue in the 250.14personal care assistance choice option and 72.5 percent of revenue from other personal 250.15care assistance providers.250.16(b) Personal care assistance provider agencies shall provide the information specified 250.17in paragraph (a) to the commissioner at the time the personal care assistance provider 250.18agency enrolls as a vendor or upon request from the commissioner. The commissioner 250.19shall collect the information specified in paragraph (a) from all personal care assistance 250.20providers beginning upon enactment of this section.250.21(c) All personal care assistance provider agencies shall complete mandatory training 250.22as determined by the commissioner before enrollment as a provider. Personal care 250.23assistance provider agencies are required to send all owners, qualified professionals 250.24employed by the agency, and all other managing employees to the initial and subsequent 250.25trainings. Personal care assistance provider agency billing staff shall complete training 250.26about personal care assistance program financial management. This training is effective 250.27upon enactment of this section. Any personal care assistance provider agency enrolled 250.28before that date shall, if it has not already, complete the provider training within 18 months 250.29of the effective date of this section. Any new owners, new qualified professionals, and new 250.30managing employees are required to complete mandatory training as a requisite of hiring.250.31    Subd. 22.Annual review for personal care providers.(a) All personal care 250.32assistance provider agencies shall resubmit, on an annual basis, the information specified 250.33in subdivision 21, in a format determined by the commissioner, and provide a copy of the 250.34personal care assistance provider agency's most current version of its grievance policies 250.35and procedures along with a written record of grievances and resolutions of the grievances 251.1that the personal care assistance provider agency has received in the previous year and any 251.2other information requested by the commissioner.251.3(b) The commissioner shall send annual review notification to personal care 251.4assistance provider agencies 30 days prior to renewal. The notification must:251.5(1) list the materials and information the personal care assistance provider agency is 251.6required to submit;251.7(2) provide instructions on submitting information to the commissioner; and251.8(3) provide a due date by which the commissioner must receive the requested 251.9information.251.10Personal care assistance provider agencies shall submit required documentation for 251.11annual review within 30 days of notification from the commissioner. If no documentation 251.12is submitted, the personal care assistance provider agency enrollment number must be 251.13terminated or suspended.251.14(c) Personal care assistance provider agencies also currently licensed under 251.15Minnesota Rules, part 4668.0012, as a class A provider or currently certified for 251.16participation in Medicare as a home health agency are deemed in compliance with 251.17the personal care assistance requirements for enrollment, annual review process, and 251.18documentation.251.19    Subd. 23.Enrollment requirements following termination.(a) A terminated 251.20personal care assistance provider agency, including all named individuals on the current 251.21enrollment disclosure form and known or discovered affiliates of the personal care 251.22assistance provider agency, is not eligible to enroll as a personal care assistance provider 251.23agency for two years following the termination.251.24(b) After the two-year period in paragraph (a), if the provider seeks to reenroll 251.25as a personal care assistance provider agency, the personal care assistance provider 251.26agency must be placed on a one-year probation period, beginning after completion of 251.27the following:251.28(1) the department's provider trainings under this section; and251.29(2) initial enrollment requirements under subdivision 21.251.30(c) During the probationary period the commissioner shall complete site visits and 251.31request submission of documentation to review compliance with program policy.251.32    Subd. 24.Personal care assistance provider agency; general duties.A personal 251.33care assistance provider agency shall:251.34(1) enroll as a Medicaid provider meeting all provider standards, including 251.35completion of the required provider training;251.36(2) comply with general medical assistance coverage requirements;252.1(3) demonstrate compliance with law and policies of the personal care assistance 252.2program to be determined by the commissioner;252.3(4) comply with background study requirements;252.4(5) verify and keep records of hours worked by the personal care assistant and 252.5qualified professional;252.6(6) market agency services only through printed information in brochures and on 252.7Web sites and not engage in any agency-initiated direct contact or marketing in person, by 252.8phone, or other electronic means to potential recipients, guardians, or family members;252.9(7) pay the personal care assistant and qualified professional based on actual hours 252.10of services provided;252.11(8) withhold and pay all applicable federal and state taxes;252.12(9) effective January 1, 2010, document that the agency uses a minimum of 72.5 252.13percent of the revenue generated by the medical assistance rate for personal care assistance 252.14services for employee personal care assistant wages and benefits;252.15(10) make the arrangements and pay unemployment insurance, taxes, workers' 252.16compensation, liability insurance, and other benefits, if any;252.17(11) enter into a written agreement under subdivision 20 before services are provided;252.18(12) report suspected neglect and abuse to the common entry point according to 252.19section 256B.0651; 252.20(13) provide the recipient with a copy of the home care bill of rights at start of 252.21service; and252.22    (14) request reassessments at least 60 days prior to the end of the current 252.23authorization for personal care assistance services, on forms provided by the commissioner.252.24    Subd. 25.Personal care assistance provider agency; background studies.252.25Personal care assistance provider agencies enrolled to provide personal care assistance 252.26services under the medical assistance program shall comply with the following:252.27(1) owners who have a five percent interest or more and all managing employees 252.28are subject to a background study as provided in chapter 245C. This applies to currently 252.29enrolled personal care assistance provider agencies and those agencies seeking enrollment 252.30as a personal care assistance provider agency. Managing employee has the same meaning 252.31as Code of Federal Regulations, title 42, section 455. An organization is barred from 252.32enrollment if:252.33(i) the organization has not initiated background studies on owners and managing 252.34employees; or252.35(ii) the organization has initiated background studies on owners and managing 252.36employees, but the commissioner has sent the organization a notice that an owner or 253.1managing employee of the organization has been disqualified under section 245C.14, 253.2and the owner or managing employee has not received a set aside of the disqualification 253.3under section 245C.22;253.4(2) a background study must be initiated and completed for all qualified 253.5professionals; and253.6(3) a background study must be initiated and completed for all personal care 253.7assistants.253.8    Subd. 26.Personal care assistance provider agency; communicable disease 253.9prevention.A personal care assistance provider agency shall establish and implement 253.10policies and procedures for prevention, control, and investigation of infections and 253.11communicable diseases according to current nationally recognized infection control 253.12practices or guidelines established by the United States Centers for Disease Control and 253.13Prevention, as well as applicable regulations of other federal or state agencies.253.14    Subd. 27.Personal care assistance provider agency; ventilator training.The 253.15personal care assistance provider agency is required to provide training for the personal 253.16care assistant responsible for working with a recipient who is ventilator dependent. All 253.17training must be administered by a respiratory therapist, nurse, or physician. Qualified 253.18professional supervision by a nurse must be completed and documented on file in the 253.19personal care assistant's employment record and the recipient's health record. If offering 253.20personal care services to a ventilator-dependent recipient, the personal care assistance 253.21provider agency shall demonstrate the ability to:253.22(1) train the personal care assistant;253.23(2) supervise the personal care assistant in ventilator operation and maintenance; and253.24(3) supervise the recipient and responsible party in ventilator operation and 253.25maintenance.253.26    Subd. 28.Personal care assistance provider agency; required documentation.253.27Required documentation must be completed and kept in the personal care assistance 253.28provider agency file or the recipient's home residence. The required documentation 253.29consists of:253.30(1) employee files, including:253.31(i) applications for employment;253.32(ii) background study requests and results;253.33(iii) orientation records about the agency policies;253.34(iv) trainings completed with demonstration of competence;253.35(v) supervisory visits;254.1(vi) evaluations of employment; and254.2(vii) signature on fraud statement;254.3(2) recipient files, including:254.4(i) demographics;254.5(ii) emergency contact information and emergency backup plan;254.6(iii) personal care assistance service plan;254.7(iv) personal care assistance care plan;254.8(v) month-to-month service use plan;254.9(vi) all communication records;254.10(vii) start of service information, including the written agreement with recipient; and254.11(viii) date the home care bill of rights was given to the recipient;254.12(3) agency policy manual, including:254.13(i) policies for employment and termination;254.14(ii) grievance policies with resolution of consumer grievances;254.15(iii) staff and consumer safety;254.16(iv) staff misconduct; and254.17(v) staff hiring, service delivery, staff and consumer safety, staff misconduct, and 254.18resolution of consumer grievances; 254.19(4) time sheets for each personal care assistant along with completed activity sheets 254.20for each recipient served; and254.21(5) agency marketing and advertising materials and documentation of marketing 254.22activities and costs.254.23    Subd. 29.Transitional assistance.The commissioner, counties, health plans, 254.24tribes, and personal care assistance providers shall work together to provide transitional 254.25assistance for recipients and families to come into compliance with the new requirements 254.26of this section and ensure the personal care assistance services are not provided by the 254.27housing provider.254.28    Subd. 30.Notice of service changes to recipients.The commissioner must provide:254.29(1) by October 31, 2009, information to recipients likely to be affected that (i) 254.30describes the changes to the personal care assistance program that may result in the 254.31loss of access to personal care assistance services, and (ii) includes resources to obtain 254.32further information; and254.33(2) notice of changes in medical assistance home care services to each affected 254.34recipient at least 30 days before the effective date of the change.254.35The notice shall include how to get further information on the changes, how to get help to 254.36obtain other services, a list of community resources, and appeal rights. Notwithstanding 255.1section 256.045, a recipient may request continued services pending appeal within the 255.2time period allowed to request an appeal.255.3EFFECTIVE DATE.Subdivisions 4, 22, and 27 are effective January 1, 2010.255.4    Sec. 32. Minnesota Statutes 2008, section 256B.0911, subdivision 1, is amended to 255.5read:255.6    Subdivision 1. Purpose and goal. (a) The purpose of long-term care consultation 255.7services is to assist persons with long-term or chronic care needs in making long-term 255.8care decisions and selecting options that meet their needs and reflect their preferences. 255.9The availability of, and access to, information and other types of assistance, including 255.10assessment and support planning, is also intended to prevent or delay certified nursing 255.11facility placements and to provide transition assistance after admission. Further, the goal 255.12of these services is to contain costs associated with unnecessary certified nursing facility 255.13admissions. Long-term consultation services must be available to any person regardless 255.14of public program eligibility. The commissionerscommissioner of human services and 255.15health shall seek to maximize use of available federal and state funds and establish the 255.16broadest program possible within the funding available.255.17(b) These services must be coordinated with serviceslong-term care options 255.18counseling provided under section 
         256.975, subdivision 7, and with services provided by 255.19other public and private agencies in the communitysection 256.01, subdivision 24, for 255.20telephone assistance and follow up and to offer a variety of cost-effective alternatives to 255.21persons with disabilities and elderly persons. The county or tribal agency or managed 255.22care plan providing long-term care consultation services shall encourage the use of 255.23volunteers from families, religious organizations, social clubs, and similar civic and 255.24service organizations to provide community-based services.255.25    Sec. 33. Minnesota Statutes 2008, section 256B.0911, subdivision 1a, is amended to 255.26read:255.27    Subd. 1a. Definitions. For purposes of this section, the following definitions apply:255.28(a) "Long-term care consultation services" means:255.29(1) providing information and education to the general public regarding availability 255.30of the services authorized under this section;255.31(2) an intake process that provides access to the services described in this section;255.32(3) assessment of the health, psychological, and social needs of referred individuals;255.33(4) assistance in identifying services needed to maintain an individual in the least 255.34restrictivemost inclusive environment;256.1(5)(2) providing recommendations on cost-effective community services that are 256.2available to the individual;256.3(6)(3) development of an individual's person-centered community support plan;256.4(7)(4) providing information regarding eligibility for Minnesota health care 256.5programs;256.6(5) face-to-face long-term care consultation assessments, which may be completed 256.7in a hospital, nursing facility, intermediate care facility for persons with developmental 256.8disabilities (ICF/DDs), regional treatment centers, or the person's current or planned 256.9residence;256.10(8) preadmission(6) federally mandated screening to determine the need for 256.11a nursing facilityinstitutional level of care under section 256B.0911, subdivision 4, 256.12paragraph (a);256.13(9) preliminary(7) determination of Minnesota health care programshome and 256.14community-based waiver service eligibility including level of care determination for 256.15individuals who need a nursing facilityan institutional level of care as defined under 256.16section 144.0724, subdivision 11, or 256B.092, service eligibility including state plan 256.17home care services identified in section 256B.0625, subdivisions 6, 7, and 19, paragraphs 256.18(a) and (c), based on assessment and support plan development with appropriate referrals 256.19for final determination;256.20(10)(8) providing recommendations for nursing facility placement when there are 256.21no cost-effective community services available; and256.22(11)(9) assistance to transition people back to community settings after facility 256.23admission.256.24(b) "Long-term options counseling" means the services provided by the linkage 256.25lines as mandated by sections 256.01 and 256.975, subdivision 7, and also includes 256.26telephone assistance and follow up once a long-term care consultation assessment has 256.27been completed. 256.28(b) (c) "Minnesota health care programs" means the medical assistance program 256.29under chapter 256B and the alternative care program under section 
         256B.0913.256.30(d) "Lead agencies" means counties or a collaboration of counties, tribes, and health 256.31plans administering long-term care consultation assessment and support planning services.256.32EFFECTIVE DATE.This section is effective January 1, 2011.256.33    Sec. 34. Minnesota Statutes 2008, section 256B.0911, is amended by adding a 256.34subdivision to read:257.1    Subd. 2b.Certified assessors.(a) Beginning January 1, 2011, each lead agency 257.2shall use certified assessors who have completed training and certification process 257.3determined by the commissioner in subdivision 2c. Certified assessors shall demonstrate 257.4best practices in assessment and support planning including person-centered planning 257.5principals and have a common set of skills that must ensure consistency and equitable 257.6access to services statewide. Assessors must be part of a multidisciplinary team of 257.7professionals that includes public health nurses, social workers, and other professionals 257.8as defined in paragraph (b). For persons with complex health care needs, a public health 257.9nurse or registered nurse from a multidisciplinary team must be consulted.257.10(b) Certified assessors are persons with a minimum of a bachelor's degree in social 257.11work, nursing with a public health nursing certificate, or other closely related field with at 257.12least one year of home and community-based experience or a two-year registered nursing 257.13degree with at least three years of home and community-based experience that have 257.14received training and certification specific to assessment and consultation for long-term 257.15care services in the state.257.16    Sec. 35. Minnesota Statutes 2008, section 256B.0911, is amended by adding a 257.17subdivision to read:257.18    Subd. 2c.Assessor training and certification.The commissioner shall develop a 257.19curriculum and an assessor certification process to begin no later than January 1, 2010. 257.20All existing lead agency staff designated to provide the services defined in subdivision 257.211a must be certified by December 30, 2010. Each lead agency is required to ensure that 257.22they have sufficient numbers of certified assessors to provide long-term consultation 257.23assessment and support planning within the timelines and parameters of the service by 257.24January 1, 2011. Certified assessors are required to be recertified every three years.257.25    Sec. 36. Minnesota Statutes 2008, section 256B.0911, subdivision 3, is amended to 257.26read:257.27    Subd. 3. Long-term care consultation team. (a) Until January 1, 2011, a long-term 257.28care consultation team shall be established by the county board of commissioners. Each 257.29local consultation team shall consist of at least one social worker and at least one public 257.30health nurse from their respective county agencies. The board may designate public 257.31health or social services as the lead agency for long-term care consultation services. If a 257.32county does not have a public health nurse available, it may request approval from the 257.33commissioner to assign a county registered nurse with at least one year experience in 258.1home care to participate on the team. Two or more counties may collaborate to establish 258.2a joint local consultation team or teams.258.3(b) The team is responsible for providing long-term care consultation services to 258.4all persons located in the county who request the services, regardless of eligibility for 258.5Minnesota health care programs.258.6(c) The commissioner shall allow arrangements and make recommendations that 258.7encourage counties to collaborate to establish joint local long-term care consultation teams 258.8to ensure that long-term care consultations are done within the timelines and parameters 258.9of the service. This includes integrated service models as required in subdivision 1, 258.10paragraph (b).258.11    Sec. 37. Minnesota Statutes 2008, section 256B.0911, subdivision 3a, is amended to 258.12read:258.13    Subd. 3a. Assessment and support planning. (a) Persons requesting assessment, 258.14services planning, or other assistance intended to support community-based living, 258.15including persons who need assessment in order to determine waiver or alternative 258.16care program eligibility, must be visited by a long-term care consultation team within 258.17ten working15 calendar days after the date on which an assessment was requested or 258.18recommended. After January 1, 2011, these requirements also apply to personal care 258.19assistance services, private duty nursing, and home health agency services, on timelines 258.20established in subdivision 5. Face-to-face  assessments must be conducted according 258.21to paragraphs (b) to (i).258.22    (b) The county may utilize a team of either the social worker or public health nurse, 258.23or both,. After January 1, 2011, lead agencies shall use certified assessors  to conduct the 258.24assessment in a face-to-face interview. The consultation team members must confer 258.25regarding the most appropriate care for each individual screened or assessed.258.26    (c) The long-term care consultation team must assess the health and social needs of 258.27the person assessment must be comprehensive and include a person-centered assessment 258.28of the health, psychological, functional, environmental, and social needs of referred 258.29individuals and provide information necessary to develop a support plan that meets the 258.30consumers needs, using an assessment form provided by the commissioner.258.31    (d) The team must conduct the assessment must be conducted in a face-to-face 258.32interview with the person being assessed and the person's legal representative, if applicable258.33as required by legally executed documents, and other individuals as requested by the 258.34person, who can provide information on the needs, strengths, and preferences of the 259.1person necessary to develop a support plan that ensures the person's health and safety, but 259.2who is not a provider of service or has any financial interest in the provision of services.259.3    (e) The team must provide the person, or the person's legal representative, must 259.4be provided with written recommendations for facility- or community-based services. 259.5The team must documentor institutional care that include documentation that the most 259.6cost-effective alternatives available were offered to the individual. For purposes of 259.7this requirement, "cost-effective alternatives" means community services and living 259.8arrangements that cost the same as or less than nursing facility institutional care.259.9    (f) If the person chooses to use community-based services, the team must provide 259.10the person or the person's legal representative must be provided with a written community 259.11support plan, regardless of whether the individual is eligible for Minnesota health care 259.12programs. TheA person may request assistance in developing a community support plan 259.13 identifying community supports without participating in a complete assessment. Upon 259.14a request for assistance identifying community support, the person must be transferred 259.15or referred to the services available under sections 256.975, subdivision 7, and 256.01, 259.16subdivision 24, for telephone assistance and follow up.259.17    (g) The person has the right to make the final decision between nursing 259.18facility institutional placement and community placement after the screening team's 259.19recommendation recommendations have been provided, except as provided in subdivision 259.204a, paragraph (c).259.21    (h) The team must give the person receiving assessment or support planning, or 259.22the person's legal representative, materials, and forms supplied by the commissioner 259.23containing the following information:259.24    (1) the need for and purpose of preadmission screening if the person selects nursing 259.25facility placement;259.26    (2) the role of the long-term care consultation assessment and support planning in 259.27waiver and alternative care program eligibility determination;259.28    (3) information about Minnesota health care programs;259.29    (4) the person's freedom to accept or reject the recommendations of the team;259.30    (5) the person's right to confidentiality under the Minnesota Government Data 259.31Practices Act, chapter 13;259.32    (6) the long-term care consultant's decision regarding the person's need for nursing 259.33facility institutional level of care as determined under criteria established in section 259.34144.0724, subdivision 11, or 256B.092; and260.1    (7) the person's right to appeal the decision regarding the need for nursing facility 260.2level of care or the county's final decisions regarding public programs eligibility according 260.3to section 
         256.045, subdivision 3.260.4    (i) Face-to-face assessment completed as part of eligibility determination for 260.5the alternative care, elderly waiver, community alternatives for disabled individuals, 260.6community alternative care, and traumatic brain injury waiver programs under sections 260.7256B.0915
         , 
         256B.0917, and 
         256B.49 is valid to establish service eligibility for no more 260.8than 60 calendar days after the date of assessment. The effective eligibility start date 260.9for these programs can never be prior to the date of assessment. If an assessment was 260.10completed more than 60 days before the effective waiver or alternative care program 260.11eligibility start date, assessment and support plan information must be updated in a 260.12face-to-face visit and documented in the department's Medicaid Management Information 260.13System (MMIS). The effective date of program eligibility in this case cannot be prior to 260.14the date the updated assessment is completed.260.15    Sec. 38. Minnesota Statutes 2008, section 256B.0911, subdivision 3b, is amended to 260.16read:260.17    Subd. 3b. Transition assistance. (a) A long-term care consultation team shall 260.18provide assistance to persons residing in a nursing facility, hospital, regional treatment 260.19center, or intermediate care facility for persons with developmental disabilities who 260.20request or are referred for assistance. Transition assistance must include assessment, 260.21community support plan development, referrals to long-term care options counseling 260.22under section 256B.975, subdivision 10, for community support plan implementation and 260.23to Minnesota health care programs, and referrals to programs that provide assistance 260.24with housing. Transition assistance must also include information about the Centers for 260.25Independent Living and the Senior LinkAge Line, and about other organizations that 260.26can provide assistance with relocation efforts, and information about contacting these 260.27organizations to obtain their assistance and support. 260.28    (b) The county shall develop transition processes with institutional social workers 260.29and discharge planners to ensure that:260.30    (1) persons admitted to facilities receive information about transition assistance 260.31that is available;260.32    (2) the assessment is completed for persons within ten working days of the date of 260.33request or recommendation for assessment; and260.34    (3) there is a plan for transition and follow-up for the individual's return to the 260.35community. The plan must require notification of other local agencies when a person 261.1who may require assistance is screened by one county for admission to a facility located 261.2in another county.261.3    (c) If a person who is eligible for a Minnesota health care program is admitted to a 261.4nursing facility, the nursing facility must include a consultation team member or the case 261.5manager in the discharge planning process.261.6    Sec. 39. Minnesota Statutes 2008, section 256B.0911, subdivision 3c, is amended to 261.7read:261.8    Subd. 3c. Transition to housing with services. (a) Housing with services 261.9establishments offering or providing assisted living under chapter 144G shall inform 261.10all prospective residents of the availability of and contact information for transitional 261.11consultation services under this subdivision prior to executing a lease or contract with the 261.12prospective resident. The purpose of transitional long-term care consultation is to support 261.13persons with current or anticipated long-term care needs in making informed choices 261.14among options that include the most cost-effective and least restrictive settings, and to 261.15delay spenddown to eligibility for publicly funded programs by connecting people to 261.16alternative services in their homes before transition to housing with services. Regardless 261.17of the consultation, prospective residents maintain the right to choose housing with 261.18services or assisted living if that option is their preference.261.19    (b) Transitional consultation services are provided as determined by the 261.20commissioner of human services in partnership with county long-term care consultation 261.21units, and the Area Agencies on Aging, and are a combination of telephone-based 261.22and in-person assistance provided under models developed by the commissioner. The 261.23consultation shall be performed in a manner that provides objective and complete 261.24information. Transitional consultation must be provided within five working days of the 261.25request of the prospective resident as follows:261.26    (1) the consultation must be provided by a qualified professional as determined by 261.27the commissioner;261.28    (2) the consultation must include a review of the prospective resident's reasons for 261.29considering assisted living, the prospective resident's personal goals, a discussion of the 261.30prospective resident's immediate and projected long-term care needs, and alternative 261.31community services or assisted living settings that may meet the prospective resident's 261.32needs; and261.33    (3) the prospective resident shall be informed of the availability of long-term care 261.34consultation services described in subdivision 3a that are available at no charge to the 261.35prospective resident to assist the prospective resident in assessment and planning to meet 262.1the prospective resident's long-term care needs. The Senior LinkAge Line and long-term 262.2care consultation team shall give the highest priority to referrals who are at highest risk of 262.3nursing facility placement or as needed for determining eligibility.262.4    Sec. 40. Minnesota Statutes 2008, section 256B.0911, subdivision 4a, is amended to 262.5read:262.6    Subd. 4a. Preadmission screening activities related to nursing facility 262.7admissions. (a) All applicants to Medicaid certified nursing facilities, including certified 262.8boarding care facilities, must be screened prior to admission regardless of income, assets, 262.9or funding sources for nursing facility care, except as described in subdivision 4b. The 262.10purpose of the screening is to determine the need for nursing facility level of care as 262.11described in paragraph (d) and to complete activities required under federal law related to 262.12mental illness and developmental disability as outlined in paragraph (b).262.13(b) A person who has a diagnosis or possible diagnosis of mental illness or 262.14developmental disability must receive a preadmission screening before admission 262.15regardless of the exemptions outlined in subdivision 4b, paragraph (b), to identify the need 262.16for further evaluation and specialized services, unless the admission prior to screening is 262.17authorized by the local mental health authority or the local developmental disabilities case 262.18manager, or unless authorized by the county agency according to Public Law 101-508.262.19The following criteria apply to the preadmission screening:262.20(1) the county must use forms and criteria developed by the commissioner to identify 262.21persons who require referral for further evaluation and determination of the need for 262.22specialized services; and262.23(2) the evaluation and determination of the need for specialized services must be 262.24done by:262.25(i) a qualified independent mental health professional, for persons with a primary or 262.26secondary diagnosis of a serious mental illness; or262.27(ii) a qualified developmental disability professional, for persons with a primary or 262.28secondary diagnosis of developmental disability. For purposes of this requirement, a 262.29qualified developmental disability professional must meet the standards for a qualified 262.30developmental disability professional under Code of Federal Regulations, title 42, section 262.31483.430
         .262.32(c) The local county mental health authority or the state developmental disability 262.33authority under Public Law Numbers 100-203 and 101-508 may prohibit admission to a 262.34nursing facility if the individual does not meet the nursing facility level of care criteria or 262.35needs specialized services as defined in Public Law Numbers 100-203 and 101-508. For 263.1purposes of this section, "specialized services" for a person with developmental disability 263.2means active treatment as that term is defined under Code of Federal Regulations, title 263.342, section 
         483.440 (a)(1).263.4(d) The determination of the need for nursing facility level of care must be made 263.5according to criteria established in section 144.0724, subdivision 11, and 256B.092, 263.6using forms developed by the commissioner. In assessing a person's needs, consultation 263.7team members shall have a physician available for consultation and shall consider the 263.8assessment of the individual's attending physician, if any. The individual's physician must 263.9be included if the physician chooses to participate. Other personnel may be included on 263.10the team as deemed appropriate by the county.263.11EFFECTIVE DATE.The section is effective January 1, 2011.263.12    Sec. 41. Minnesota Statutes 2008, section 256B.0911, subdivision 5, is amended to 263.13read:263.14    Subd. 5. Administrative activity. The commissioner shall minimize the number 263.15of forms required in the provision of long-term care consultation services and shall 263.16limit the screening document to items necessary for community support plan approval, 263.17reimbursement, program planning, evaluation, and policy development streamline the 263.18processes, including timelines for when assessments need to be completed, required to 263.19provide the services in this section and shall implement integrated solutions to automate 263.20the business processes to the extent necessary for community support plan approval, 263.21reimbursement, program planning, evaluation, and policy development.263.22    Sec. 42. Minnesota Statutes 2008, section 256B.0911, subdivision 6, is amended to 263.23read:263.24    Subd. 6. Payment for long-term care consultation services. (a) The total payment 263.25for each county must be paid monthly by certified nursing facilities in the county. The 263.26monthly amount to be paid by each nursing facility for each fiscal year must be determined 263.27by dividing the county's annual allocation for long-term care consultation services by 12 263.28to determine the monthly payment and allocating the monthly payment to each nursing 263.29facility based on the number of licensed beds in the nursing facility. Payments to counties 263.30in which there is no certified nursing facility must be made by increasing the payment 263.31rate of the two facilities located nearest to the county seat.263.32    (b) The commissioner shall include the total annual payment determined under 263.33paragraph (a) for each nursing facility reimbursed under section 
         256B.431 or 
         256B.434263.34according to section 
         256B.431, subdivision 2b, paragraph (g).264.1    (c) In the event of the layaway, delicensure and decertification, or removal from 264.2layaway of 25 percent or more of the beds in a facility, the commissioner may adjust 264.3the per diem payment amount in paragraph (b) and may adjust the monthly payment 264.4amount in paragraph (a). The effective date of an adjustment made under this paragraph 264.5shall be on or after the first day of the month following the effective date of the layaway, 264.6delicensure and decertification, or removal from layaway.264.7    (d) Payments for long-term care consultation services are available to the county 264.8or counties to cover staff salaries and expenses to provide the services described in 264.9subdivision 1a. The county shall employ, or contract with other agencies to employ, within 264.10the limits of available funding, sufficient personnel to provide long-term care consultation 264.11services while meeting the state's long-term care outcomes and objectives as defined in 264.12section 
         256B.0917, subdivision 1. The county shall be accountable for meeting local 264.13objectives as approved by the commissioner in the biennial home and community-based 264.14services quality assurance plan on a form provided by the commissioner.264.15    (e) Notwithstanding section 
         256B.0641, overpayments attributable to payment of the 264.16screening costs under the medical assistance program may not be recovered from a facility.264.17    (f) The commissioner of human services shall amend the Minnesota medical 264.18assistance plan to include reimbursement for the local consultation teams.264.19    (g) The county may bill, as case management services, assessments, support 264.20planning, and follow-along provided to persons determined to be eligible for case 264.21management under Minnesota health care programs. No individual or family member 264.22shall be charged for an initial assessment or initial support plan development provided 264.23under subdivision 3a or 3b.264.24(h) The commissioner shall develop an alternative payment methodology for 264.25long-term care consultation services that includes the funding available under this 264.26subdivision, and sections 256B.092 and 256B.0659. In developing the new payment 264.27methodology, the commissioner shall consider the maximization of federal funding for 264.28this activity.264.29    Sec. 43. Minnesota Statutes 2008, section 256B.0911, subdivision 7, is amended to 264.30read:264.31    Subd. 7. Reimbursement for certified nursing facilities. (a) Medical assistance 264.32reimbursement for nursing facilities shall be authorized for a medical assistance recipient 264.33only if a preadmission screening has been conducted prior to admission or the county has 264.34authorized an exemption. Medical assistance reimbursement for nursing facilities shall 264.35not be provided for any recipient who the local screener has determined does not meet the 265.1level of care criteria for nursing facility placement in section 144.0724, subdivision 11, or, 265.2if indicated, has not had a level II OBRA evaluation as required under the federal Omnibus 265.3Budget Reconciliation Act of 1987 completed unless an admission for a recipient with 265.4mental illness is approved by the local mental health authority or an admission for a 265.5recipient with developmental disability is approved by the state developmental disability 265.6authority.265.7    (b) The nursing facility must not bill a person who is not a medical assistance 265.8recipient for resident days that preceded the date of completion of screening activities as 265.9required under subdivisions 4a, 4b, and 4c. The nursing facility must include unreimbursed 265.10resident days in the nursing facility resident day totals reported to the commissioner.265.11EFFECTIVE DATE.The section is effective January 1, 2011.265.12    Sec. 44. Minnesota Statutes 2008, section 256B.0913, subdivision 4, is amended to 265.13read:265.14    Subd. 4. Eligibility for funding for services for nonmedical assistance recipients.265.15    (a) Funding for services under the alternative care program is available to persons who 265.16meet the following criteria:265.17    (1) the person has been determined by a community assessment under section 265.18256B.0911
          to be a person who would require the level of care provided in a nursing 265.19facility, but for the provision of services under the alternative care program. Effective 265.20January 1, 2011, this determination must be made according to the criteria established in 265.21section 144.0724, subdivision 11;265.22    (2) the person is age 65 or older;265.23    (3) the person would be eligible for medical assistance within 135 days of admission 265.24to a nursing facility;265.25    (4) the person is not ineligible for the payment of long-term care services by the 265.26medical assistance program due to an asset transfer penalty under section 
         256B.0595 or 265.27equity interest in the home exceeding $500,000 as stated in section 
         256B.056;265.28    (5) the person needs long-term care services that are not funded through other state 265.29or federal funding;265.30    (6) except for individuals described in clause (7), the monthly cost of the alternative 265.31care services funded by the program for this person does not exceed 75 percent of the 265.32monthly limit described under section 
         256B.0915, subdivision 3a. This monthly limit 265.33does not prohibit the alternative care client from payment for additional services, but in no 265.34case may the cost of additional services purchased under this section exceed the difference 265.35between the client's monthly service limit defined under section 
         256B.0915, subdivision 266.13
         , and the alternative care program monthly service limit defined in this paragraph. If 266.2care-related supplies and equipment or environmental modifications and adaptations are or 266.3will be purchased for an alternative care services recipient, the costs may be prorated on a 266.4monthly basis for up to 12 consecutive months beginning with the month of purchase. 266.5If the monthly cost of a recipient's other alternative care services exceeds the monthly 266.6limit established in this paragraph, the annual cost of the alternative care services shall be 266.7determined. In this event, the annual cost of alternative care services shall not exceed 12 266.8times the monthly limit described in this paragraph; and266.9    (7) for individuals assigned a case mix classification A as described under section 266.10256B.0915, subdivision 3a, paragraph (a), with (i) no dependencies in activities of daily 266.11living, (ii) only one dependency in bathing, dressing, grooming, or walking, or (iii) a 266.12dependency score of less than three if eating is the only dependency as determined by an 266.13assessment performed under section 256B.0911, the monthly cost of alternative care 266.14services funded by the program cannot exceed $600 per month for all new participants 266.15enrolled in the program on or after July 1, 2009. This monthly limit shall be applied to 266.16all other participants who meet this criteria at reassessment. This monthly limit shall be 266.17increased annually as described in section 256B.0915, subdivision 3a, paragraph (a). This 266.18monthly limit does not prohibit the alternative care client from payment for additional 266.19services, but in no case may the cost of additional services purchased exceed the difference 266.20between the client's monthly service limit defined in this clause and the limit described in 266.21clause (6) for case mix classification A; and266.22(8) the person is making timely payments of the assessed monthly fee.266.23A person is ineligible if payment of the fee is over 60 days past due, unless the person 266.24agrees to:266.25    (i) the appointment of a representative payee;266.26    (ii) automatic payment from a financial account;266.27    (iii) the establishment of greater family involvement in the financial management of 266.28payments; or266.29    (iv) another method acceptable to the lead agency to ensure prompt fee payments.266.30    The lead agency may extend the client's eligibility as necessary while making 266.31arrangements to facilitate payment of past-due amounts and future premium payments. 266.32Following disenrollment due to nonpayment of a monthly fee, eligibility shall not be 266.33reinstated for a period of 30 days.266.34    (b) Alternative care funding under this subdivision is not available for a person 266.35who is a medical assistance recipient or who would be eligible for medical assistance 266.36without a spenddown or waiver obligation. A person whose initial application for medical 267.1assistance and the elderly waiver program is being processed may be served under the 267.2alternative care program for a period up to 60 days. If the individual is found to be eligible 267.3for medical assistance, medical assistance must be billed for services payable under the 267.4federally approved elderly waiver plan and delivered from the date the individual was 267.5found eligible for the federally approved elderly waiver plan. Notwithstanding this 267.6provision, alternative care funds may not be used to pay for any service the cost of which: 267.7(i) is payable by medical assistance; (ii) is used by a recipient to meet a waiver obligation; 267.8or (iii) is used to pay a medical assistance income spenddown for a person who is eligible 267.9to participate in the federally approved elderly waiver program under the special income 267.10standard provision.267.11    (c) Alternative care funding is not available for a person who resides in a licensed 267.12nursing home, certified boarding care home, hospital, or intermediate care facility, except 267.13for case management services which are provided in support of the discharge planning 267.14process for a nursing home resident or certified boarding care home resident to assist with 267.15a relocation process to a community-based setting.267.16    (d) Alternative care funding is not available for a person whose income is greater 267.17than the maintenance needs allowance under section 
         256B.0915, subdivision 1d, but equal 267.18to or less than 120 percent of the federal poverty guideline effective July 1 in the fiscal 267.19year for which alternative care eligibility is determined, who would be eligible for the 267.20elderly waiver with a waiver obligation.267.21    Sec. 45. Minnesota Statutes 2008, section 256B.0915, subdivision 3a, is amended to 267.22read:267.23    Subd. 3a.  Elderly waiver cost limits. (a) The monthly limit for the cost of 267.24waivered services to an individual elderly waiver client except for individuals described 267.25in paragraph (b) shall be the weighted average monthly nursing facility rate of the case 267.26mix resident class to which the elderly waiver client would be assigned under Minnesota 267.27Rules, parts 9549.0050 to 9549.0059, less the recipient's maintenance needs allowance 267.28as described in subdivision 1d, paragraph (a), until the first day of the state fiscal year in 267.29which the resident assessment system as described in section 
         256B.438 for nursing home 267.30rate determination is implemented. Effective on the first day of the state fiscal year in 267.31which the resident assessment system as described in section 
         256B.438 for nursing home 267.32rate determination is implemented and the first day of each subsequent state fiscal year, the 267.33monthly limit for the cost of waivered services to an individual elderly waiver client shall 267.34be the rate of the case mix resident class to which the waiver client would be assigned 267.35under Minnesota Rules, parts 9549.0050 to 9549.0059, in effect on the last day of the 268.1previous state fiscal year, adjusted by the greater of any legislatively adopted home and 268.2community-based services percentage rate increase or the average statewide percentage 268.3increase in nursing facility payment rates. 268.4    (b) The monthly limit for the cost of waivered services to an individual elderly 268.5waiver client assigned to a case mix classification A under paragraph (a) with (1) no 268.6dependencies in activities of daily living, (2) only one dependency in bathing, dressing, 268.7grooming, or walking, or (3) a dependency score of less than three if eating is the only 268.8dependency, shall be the lower of the case mix classification amount for case mix A as 268.9determined under paragraph (a) or the case mix classification amount for case mix A 268.10effective on October 1, 2008, per month for all new participants enrolled in the program 268.11on or after July 1, 2009. This monthly limit shall be applied to all other participants who 268.12meet this criteria at reassessment.268.13(c)  If extended medical supplies and equipment or environmental modifications are 268.14or will be purchased for an elderly waiver client, the costs may be prorated for up to 268.1512 consecutive months beginning with the month of purchase. If the monthly cost of a 268.16recipient's waivered services exceeds the monthly limit established in paragraph (a) or (b), 268.17the annual cost of all waivered services shall be determined. In this event, the annual cost 268.18of all waivered services shall not exceed 12 times the monthly limit of waivered services 268.19as described in paragraph (a) or (b). 268.20    Sec. 46. Minnesota Statutes 2008, section 256B.0915, subdivision 3e, is amended to 268.21read:268.22    Subd. 3e. Customized living service rate. (a) Payment for customized living 268.23services shall be a monthly rate negotiated and authorized by the lead agency within the 268.24parameters established by the commissioner. The payment agreement must delineate the 268.25services that have been customized for each recipient and specify the amount of each 268.26component service included in the recipient's customized living service to be provided268.27plan. The lead agency shall ensure that there is a documented need for allwithin the 268.28parameters established by the commissioner for all component customized living services 268.29authorized. Customized living services must not include rent or raw food costs.268.30(b) The negotiated payment rate must be based on the amount of component services 268.31to be provided utilizing component rates established by the commissioner. Counties and 268.32tribes shall use tools issued by the commissioner to develop and document customized 268.33living service plans and rates.269.1Negotiated (c) Component service rates must not exceed payment rates for 269.2comparable elderly waiver or medical assistance services and must reflect economies of 269.3scale. Customized living services must not include rent or raw food costs.269.4    (b)(d) The individualized monthly negotiated authorized payment for the 269.5customized living services service plan shall not exceed the nonfederal share, in effect 269.6on July 1 of the state fiscal year for which the rate limit is being calculated, 50 percent269.7of the greater of either the statewide or any of the geographic groups' weighted average 269.8monthly nursing facility rate of the case mix resident class to which the elderly waiver 269.9eligible client would be assigned under Minnesota Rules, parts 9549.0050 to 9549.0059, 269.10less the maintenance needs allowance as described in subdivision 1d, paragraph (a), until 269.11the July 1 of the state fiscal year in which the resident assessment system as described 269.12in section 
         256B.438 for nursing home rate determination is implemented. Effective on 269.13July 1 of the state fiscal year in which the resident assessment system as described in 269.14section 
         256B.438 for nursing home rate determination is implemented and July 1 of each 269.15subsequent state fiscal year, the individualized monthly negotiated authorized payment 269.16for the services described in this clause shall not exceed the limit described in this clause269.17which was in effect on June 30 of the previous state fiscal year and which has been 269.18adjusted by the greater of any legislatively adopted home and community-based services 269.19cost-of-living percentage increase or any legislatively adopted statewide percent rate 269.20increase for nursing facilities updated annually based on legislatively adopted changes to 269.21all service rate maximums for home and community-based service providers.269.22    (c)(e) Customized living services are delivered by a provider licensed by the 269.23Department of Health as a class A or class F home care provider and provided in a 269.24building that is registered as a housing with services establishment under chapter 144D.269.25    Sec. 47. Minnesota Statutes 2008, section 256B.0915, subdivision 3h, is amended to 269.26read:269.27    Subd. 3h. Service rate limits; 24-hour customized living services.(a) The 269.28payment rates rate  for 24-hour customized living services is a monthly rate negotiated 269.29and authorized by the lead agency within the parameters established by the commissioner 269.30of human services. The payment agreement must delineate the services that have been 269.31customized for each recipient and specify the amount of each component service included 269.32in each recipient's customized living service to be provided plan. The lead agency 269.33shall ensure that there is a documented need within the parameters established by the 269.34commissioner for all component customized living services authorized. The lead agency 270.1shall not authorize 24-hour customized living services unless there is a documented need 270.2for 24-hour supervision.270.3(b) For purposes of this section, "24-hour supervision" means that the recipient 270.4requires assistance due to needs related to one or more of the following:270.5    (1) intermittent assistance with toileting, positioning,  or transferring;270.6    (2) cognitive or behavioral issues;270.7    (3) a medical condition that requires clinical monitoring; or270.8    (4) other conditions or needs as defined by the commissioner of human services for 270.9all new participants enrolled in the program on or after January 1, 2011, and all other 270.10participants at their first reassessment after January 1, 2011, dependency in at least two 270.11of the following activities of daily living as determined by assessment under section 270.12256B.0911: bathing; dressing; grooming; walking; or eating; and  needs medication 270.13management and at least 50 hours of service per month. The lead agency shall ensure that 270.14the frequency and mode of supervision of the recipient and the qualifications of staff 270.15providing supervision are described and meet the needs of the recipient. Customized 270.16living services must not include rent or raw food costs.270.17(c) The negotiated payment rate for 24-hour customized living services must be 270.18based on the amount of component services to be provided utilizing component rates 270.19established by the commissioner. Counties and tribes will use tools issued by the 270.20commissioner to develop and document customized living plans and authorize rates.270.21Negotiated (d) Component service rates must not exceed payment rates for 270.22comparable elderly waiver or medical assistance services and must reflect economies 270.23of scale.270.24(e) The individually negotiated authorized 24-hour customized living payments, 270.25in combination with the payment for other elderly waiver services, including case 270.26management, must not exceed the recipient's community budget cap specified in 270.27subdivision 3a. Customized living services must not include rent or raw food costs.270.28(f) The individually authorized 24-hour customized living payment rates shall not 270.29exceed the 95 percentile of statewide monthly authorizations for 24-hour customized 270.30living services in effect and in the Medicaid management information systems on March 270.3131, 2009, for each case mix resident class under Minnesota Rules, parts 9549.0050 270.32to 9549.0059, to which elderly waiver service clients are assigned. When there are 270.33fewer than 50 authorizations in effect in the case mix resident class, the commissioner 270.34shall multiply the calculated service payment rate maximum for the A classification by 270.35the standard weight for that classification under Minnesota Rules, parts 9549.0050 to 270.369549.0059, to determine the applicable payment rate maximum. Service payment rate 271.1maximums shall be updated annually based on legislatively adopted changes to all service 271.2rates for home and community-based service providers.271.3    (g) Notwithstanding the requirements of paragraphs (d) and (f), the commissioner 271.4may establish alternative payment rate systems for 24-hour customized living services in 271.5housing with services establishments which are freestanding buildings with a capacity of 271.616 or fewer, by applying a single hourly rate for covered component services provided 271.7in either:271.8    (1) licensed corporate adult foster homes; or271.9    (2) specialized dementia care units which meet the requirements of section 144D.065 271.10and in which:271.11    (i) each resident is offered the option of having their own apartment; or271.12    (ii) the units are licensed as board and lodge establishments with maximum capacity 271.13of eight residents, and which meet the requirements of Minnesota Rules, part 9555.6205, 271.14subparts 1, 2, 3, and 4, item A.271.15    Sec. 48. Minnesota Statutes 2008, section 256B.0915, subdivision 5, is amended to 271.16read:271.17    Subd. 5. Assessments and reassessments for waiver clients.(a) Each client 271.18shall receive an initial assessment of strengths, informal supports, and need for services 271.19in accordance with section 
         256B.0911, subdivisions 3, 3a, and 3b. A reassessment of a 271.20client served under the elderly waiver must be conducted at least every 12 months and at 271.21other times when the case manager determines that there has been significant change in 271.22the client's functioning. This may include instances where the client is discharged from 271.23the hospital. There must be a determination that the client requires nursing facility level of 271.24care as defined in section 144.0724, subdivision 11, at initial and subsequent assessments 271.25to initiate and maintain participation in the waiver program.271.26(b) Regardless of other assessments identified in section 144.0724, subdivision 271.274, as appropriate to determine nursing facility level of care for purposes of medical 271.28assistance payment for nursing facility services, only face-to-face assessments conducted 271.29according to section 256B.0911, subdivisions 3a and 3b, that result in a nursing facility 271.30level of care determination will be accepted for purposes of initial and ongoing access to 271.31waiver service payment.271.32EFFECTIVE DATE.This section is effective January 1, 2011.271.33    Sec. 49. Minnesota Statutes 2008, section 256B.0915, is amended by adding a 271.34subdivision to read:272.1    Subd. 10.Waiver payment rates; managed care organizations.The 272.2commissioner shall adjust the elderly waiver capitation payment rates for managed care 272.3organizations paid under section 256B.69, subdivisions 6a and 23, to reflect the maximum 272.4service rate limits for customized living services and 24-hour customized living services 272.5under subdivisions 3e and 3h for the contract period beginning October 1, 2009. Medical 272.6assistance rates paid to customized living providers by managed care organizations 272.7under this section shall not exceed the maximum service rate limits determined by the 272.8commissioner under subdivisions 3e and 3h.272.9    Sec. 50. Minnesota Statutes 2008, section 256B.0916, subdivision 2, is amended to 272.10read:272.11    Subd. 2. Distribution of funds; partnerships. (a) Beginning with fiscal year 2000, 272.12the commissioner shall distribute all funding available for home and community-based 272.13waiver services for persons with developmental disabilities to individual counties or to 272.14groups of counties that form partnerships to jointly plan, administer, and authorize funding 272.15for eligible individuals. The commissioner shall encourage counties to form partnerships 272.16that have a sufficient number of recipients and funding to adequately manage the risk 272.17and maximize use of available resources.272.18    (b) Counties must submit a request for funds and a plan for administering the 272.19program as required by the commissioner. The plan must identify the number of clients to 272.20be served, their ages, and their priority listing based on:272.21    (1) requirements in Minnesota Rules, part 9525.1880; and272.22    (2) unstable living situations due to the age or incapacity of the primary caregiver;272.23statewide priorities identified in section 256B.092, subdivision 12.272.24    (3) the need for services to avoid out-of-home placement of children;272.25    (4) the need to serve persons affected by private sector ICF/MR closures; and272.26    (5) the need to serve persons whose consumer support grant exception amount 272.27was eliminated in 2004.272.28The plan must also identify changes made to improve services to eligible persons and to 272.29improve program management.272.30    (c) In allocating resources to counties, priority must be given to groups of counties 272.31that form partnerships to jointly plan, administer, and authorize funding for eligible 272.32individuals and to counties determined by the commissioner to have sufficient waiver 272.33capacity to maximize resource use.273.1    (d) Within 30 days after receiving the county request for funds and plans, the 273.2commissioner shall provide a written response to the plan that includes the level of 273.3resources available to serve additional persons.273.4    (e) Counties are eligible to receive medical assistance administrative reimbursement 273.5for administrative costs under criteria established by the commissioner.273.6    Sec. 51. Minnesota Statutes 2008, section 256B.0917, is amended by adding a 273.7subdivision to read:273.8    Subd. 14.Essential community supports grants.(a) The purpose of the essential 273.9community supports grant program is to provide targeted services to persons 65 years and 273.10older who need essential community support, but whose needs do not meet the level of 273.11care required for nursing facility placement under section 144.0724, subdivision 11.273.12(b) Within the limits of the appropriation and not to exceed $400 per person per 273.13month, funding must be available to a person who:273.14(1) is age 65 or older;273.15(2) is not eligible for medical assistance;273.16(3) would otherwise be financially eligible for the alternative care program under 273.17section 256B.0913, subdivision 4;273.18(4) has received a community assessment under section 256B.0911, subdivision 3a 273.19or 3b, and does not require the level of care provided in a nursing facility;273.20(5) has a community support plan; and273.21(6) has been determined by a community assessment under section 256B.0911, 273.22subdivision 3a or 3b, to be a person who would require provision of at least one of the 273.23following services, as defined in the approved elderly waiver plan, in order to maintain 273.24their community residence:273.25(i) caregiver support;273.26(ii) homemaker;273.27(iii) chore; or273.28(iv) a personal emergency response device or system.273.29(c) The person receiving any of the essential community supports in this subdivision 273.30must also receive service coordination as part of their community support plan.273.31(d) A person who has been determined to be eligible for an essential community 273.32support grant must be reassessed at least annually and continue to meet the criteria in 273.33paragraph (b) to remain eligible for an essential community support grant.274.1(e) The commissioner shall allocate grants to counties and tribes under contract with 274.2the department based upon the historic use of the medical assistance elderly waiver and 274.3alternative care grant programs and other criteria as determined by the commissioner.274.4EFFECTIVE DATE.This section is effective January 1, 2011.274.5    Sec. 52. Minnesota Statutes 2008, section 256B.092, subdivision 8a, is amended to 274.6read:274.7    Subd. 8a. County concurrence. (a) If the county of financial responsibility wishes 274.8to place a person in another county for services, the county of financial responsibility shall 274.9seek concurrence from the proposed county of service and the placement shall be made 274.10cooperatively between the two counties. Arrangements shall be made between the two 274.11counties for ongoing social service, including annual reviews of the person's individual 274.12service plan. The county where services are provided may not make changes in the 274.13person's service plan without approval by the county of financial responsibility.274.14(b) When a person has been screened and authorized for services in an intermediate 274.15care facility for persons with developmental disabilities or for home and community-based 274.16services for persons with developmental disabilities, the case manager shall assist that 274.17person in identifying a service provider who is able to meet the needs of the person 274.18according to the person's individual service plan. If the identified service is to be provided 274.19in a county other than the county of financial responsibility, the county of financial 274.20responsibility shall request concurrence of the county where the person is requesting to 274.21receive the identified services. The county of service may refuse to concur if:274.22(1) it can demonstrate that the provider is unable to provide the services identified in 274.23the person's individual service plan as services that are needed and are to be provided; or274.24(2) in the case of an intermediate care facility for persons with developmental 274.25disabilities, there has been no authorization for admission by the admission review team 274.26as required in section 
         256B.0926; or.274.27(3) in the case of home and community-based services for persons with 274.28developmental disabilities, the county of service can demonstrate that the prospective 274.29provider has failed to substantially comply with the terms of a past contract or has had a 274.30prior contract terminated within the last 12 months for failure to provide adequate services, 274.31or has received a notice of intent to terminate the contract.274.32(c) The county of service shall notify the county of financial responsibility of 274.33concurrence or refusal to concur no later than 20 working days following receipt of the 274.34written request. Unless other mutually acceptable arrangements are made by the involved 274.35county agencies, the county of financial responsibility is responsible for costs of social 275.1services and the costs associated with the development and maintenance of the placement. 275.2The county of service may request that the county of financial responsibility purchase 275.3case management services from the county of service or from a contracted provider 275.4of case management when the county of financial responsibility is not providing case 275.5management as defined in this section and rules adopted under this section, unless other 275.6mutually acceptable arrangements are made by the involved county agencies. Standards 275.7for payment limits under this section may be established by the commissioner. Financial 275.8disputes between counties shall be resolved as provided in section 
         256G.09.275.9    Sec. 53. Minnesota Statutes 2008, section 256B.092, is amended by adding a 275.10subdivision to read:275.11    Subd. 11.Residential support services.(a) Upon federal approval, there is 275.12established a new service called residential support that is available on the CAC, CADI, 275.13DD, and TBI waivers. Existing waiver service descriptions must be modified to the extent 275.14necessary to ensure there is no duplication between other services. Residential support 275.15services must be provided by vendors licensed as a community residential setting as 275.16defined in section 245A.11, subdivision 8.275.17(b) Residential support services must meet the following criteria:275.18(1) providers of residential support services must own or control the residential site;275.19(2) the residential site must not be the primary residence of the license holder;275.20(3) the residential site must have a designated program supervisor responsible for 275.21program oversight, development, and implementation of policies and procedures;275.22(4) the provider of residential support services must provide supervision, training, 275.23and assistance as described in the person's community support plan; and275.24(5) the provider of residential support services must meet the requirements of 275.25licensure and additional requirements of the person's community support plan.275.26(c) Providers of residential support services that meet the definition in paragraph (a) 275.27must be registered using a process determined by the commissioner beginning July 1, 2009.275.28    Sec. 54. Minnesota Statutes 2008, section 256B.092, is amended by adding a 275.29subdivision to read:275.30    Subd. 12.Waivered services statewide priorities.(a) The commissioner shall 275.31establish statewide priorities for individuals on the waiting list for developmental 275.32disabilities (DD) waiver services, as of January 1, 2010. The statewide priorities must 275.33include, but are not limited to, individuals who continue to have a need for waiver services 275.34after they have maximized the use of state plan services and other funding resources, 276.1including natural supports, prior to accessing waiver services, and who meet at least one 276.2of the following criteria:276.3(1) have unstable living situations due to the age, incapacity, or sudden loss of 276.4the primary caregivers;276.5(2) are moving from an institution due to bed closures;276.6(3) experience a sudden closure of their current living arrangement;276.7(4) require protection from confirmed abuse, neglect, or exploitation;276.8(5) experience a sudden change in need that can  no longer be met through state plan 276.9services or other funding resources alone; or276.10(6) meet other priorities established by the department.276.11(b) When allocating resources to lead agencies, the commissioner must take into 276.12consideration the number of individuals waiting who meet statewide priorities and the 276.13lead agencies' current use of waiver funds and existing service options.276.14(c) The commissioner shall evaluate the impact of the use of statewide priorities and 276.15provide recommendations to the legislature on whether to continue the use of statewide 276.16priorities in the November 1, 2011, annual report required by the commissioner in sections 276.17256B.0916, subdivision 7, and 256B.49, subdivision 21.276.18    Sec. 55. [256B.0948] FOSTER CARE RATE LIMITS.276.19The commissioner shall decrease by five percent rates for adult foster care and 276.20supportive living services that are reimbursed under section 256B.092 or 256B.49, and 276.21are above the 95th percentile of the statewide rates for the service. The reduction in rates 276.22shall take into account the acuity of individuals served based on the methodology used to 276.23allocate dollars to local lead agency budgets, and assure that affected service rates are not 276.24reduced below the rate level represented by the above percentile due to this rate change. 276.25Lead agency contracts for services specified in this section shall be amended to implement 276.26these rate changes for services rendered on or after July 1, 2009. The commissioner shall 276.27make corresponding reductions to waiver allocations and capitated rates.276.28    Sec. 56. Minnesota Statutes 2008, section 256B.37, subdivision 1, is amended to read:276.29    Subdivision 1. Subrogation. Upon furnishing medical assistance or alternative 276.30care services under section 256B.0913 to any person who has private accident or health 276.31care coverage, or receives or has a right to receive health or medical care from any 276.32type of organization or entity, or has a cause of action arising out of an occurrence that 276.33necessitated the payment of medical assistance, the state agency or the state agency's agent 276.34shall be subrogated, to the extent of the cost of medical care furnished, to any rights the 277.1person may have under the terms of the coverage, or against the organization or entity 277.2providing or liable to provide health or medical care, or under the cause of action.277.3    The right of subrogation created in this section includes all portions of the cause 277.4of action, notwithstanding any settlement allocation or apportionment that purports to 277.5dispose of portions of the cause of action not subject to subrogation.277.6    Sec. 57. Minnesota Statutes 2008, section 256B.37, subdivision 5, is amended to read:277.7    Subd. 5. Private benefits to be used first. Private accident and health care coverage 277.8including Medicare for medical services is primary coverage and must be exhausted before 277.9medical assistance is or alternative care services are paid for medical services including 277.10home health care, personal care assistant services, hospice, supplies and equipment, or 277.11services covered under a Centers for Medicare and Medicaid Services waiver. When a 277.12person who is otherwise eligible for medical assistance has private accident or health care 277.13coverage, including Medicare or a prepaid health plan, the private health care benefits 277.14available to the person must be used first and to the fullest extent.277.15    Sec. 58. Minnesota Statutes 2008, section 256B.434, subdivision 4, is amended to read:277.16    Subd. 4. Alternate rates for nursing facilities. (a) For nursing facilities which 277.17have their payment rates determined under this section rather than section 
         256B.431, the 277.18commissioner shall establish a rate under this subdivision. The nursing facility must enter 277.19into a written contract with the commissioner.277.20    (b) A nursing facility's case mix payment rate for the first rate year of a facility's 277.21contract under this section is the payment rate the facility would have received under 277.22section 
         256B.431.277.23    (c) A nursing facility's case mix payment rates for the second and subsequent years 277.24of a facility's contract under this section are the previous rate year's contract payment 277.25rates plus an inflation adjustment and, for facilities reimbursed under this section or 277.26section 
         256B.431, an adjustment to include the cost of any increase in Health Department 277.27licensing fees for the facility taking effect on or after July 1, 2001. The index for the 277.28inflation adjustment must be based on the change in the Consumer Price Index-All Items 277.29(United States City average) (CPI-U) forecasted by the commissioner of finance's national 277.30economic consultant, as forecasted in the fourth quarter of the calendar year preceding 277.31the rate year. The inflation adjustment must be based on the 12-month period from the 277.32midpoint of the previous rate year to the midpoint of the rate year for which the rate is 277.33being determined. For the rate years beginning on July 1, 1999, July 1, 2000, July 1, 2001, 277.34July 1, 2002, July 1, 2003, July 1, 2004, July 1, 2005, July 1, 2006, July 1, 2007, July 1, 278.12008, October 1, 2009, and October 1, 2010, October 1, 2011, and October 1, 2012. This 278.2paragraph shall apply only to the property-related payment rate, except that adjustments 278.3to include the cost of any increase in Health Department licensing fees taking effect on 278.4or after July 1, 2001, shall be provided. Beginning in 2005, adjustment to the property 278.5payment rate under this section and section 
         256B.431 shall be effective on October 1. 278.6In determining the amount of the property-related payment rate adjustment under this 278.7paragraph, the commissioner shall determine the proportion of the facility's rates that are 278.8property-related based on the facility's most recent cost report. 278.9    (d) The commissioner shall develop additional incentive-based payments of up to 278.10five percent above a facility's operating payment rate for achieving outcomes specified 278.11in a contract. The commissioner may solicit contract amendments and implement those 278.12which, on a competitive basis, best meet the state's policy objectives. The commissioner 278.13shall limit the amount of any incentive payment and the number of contract amendments 278.14under this paragraph to operate the incentive payments within funds appropriated for this 278.15purpose. The contract amendments may specify various levels of payment for various 278.16levels of performance. Incentive payments to facilities under this paragraph may be in the 278.17form of time-limited rate adjustments or onetime supplemental payments. In establishing 278.18the specified outcomes and related criteria, the commissioner shall consider the following 278.19state policy objectives:278.20    (1) successful diversion or discharge of residents to the residents' prior home or other 278.21community-based alternatives;278.22    (2) adoption of new technology to improve quality or efficiency; 278.23    (3) improved quality as measured in the Nursing Home Report Card; 278.24    (4) reduced acute care costs; and278.25    (5) any additional outcomes proposed by a nursing facility that the commissioner 278.26finds desirable.278.27    (e) Notwithstanding the threshold in section 
         256B.431, subdivision 16, facilities that 278.28take action to come into compliance with existing or pending requirements of the life 278.29safety code provisions or federal regulations governing sprinkler systems must receive 278.30reimbursement for the costs associated with compliance if all of the following conditions 278.31are met:278.32    (1) the expenses associated with compliance occurred on or after January 1, 2005, 278.33and before December 31, 2008;278.34    (2) the costs were not otherwise reimbursed under subdivision 4f or section 278.35144A.071
          or 
         144A.073; and279.1    (3) the total allowable costs reported under this paragraph are  less than the minimum 279.2threshold established under section 
         256B.431, subdivision 15, paragraph (e), and 279.3subdivision 16.279.4The commissioner shall use money appropriated for this purpose to provide to qualifying 279.5nursing facilities a rate adjustment beginning October 1, 2007, and ending September 30, 279.62008. Nursing facilities that have spent money or anticipate the need to spend money 279.7to satisfy the most recent life safety code requirements by (1) installing a sprinkler 279.8system or (2) replacing all or portions of an existing sprinkler system may submit to the 279.9commissioner by June 30, 2007, on a form provided by the commissioner the actual 279.10costs of a completed project or the estimated costs, based on a project bid, of a planned 279.11project. The commissioner shall calculate a rate adjustment equal to the allowable 279.12costs of the project divided by the resident days reported for the report year ending 279.13September 30, 2006. If the costs from all projects exceed the appropriation for this 279.14purpose, the commissioner shall allocate the money appropriated on a pro rata basis 279.15to the qualifying facilities by reducing the rate adjustment determined for each facility 279.16by an equal percentage. Facilities that used estimated costs when requesting the rate 279.17adjustment shall report to the commissioner by January 31, 2009, on the use of this 279.18money on a form provided by the commissioner. If the nursing facility fails to provide 279.19the report, the commissioner shall recoup the money paid to the facility for this purpose. 279.20If the facility reports expenditures allowable under this subdivision that are less than 279.21the amount received in the facility's annualized rate adjustment, the commissioner shall 279.22recoup the difference.279.23    Sec. 59. Minnesota Statutes 2008, section 256B.434, is amended by adding a 279.24subdivision to read:279.25    Subd. 21.Payment of post-PERA pension benefit costs.Nursing facilities that 279.26convert or converted after September 30, 2006, from public to private ownership shall 279.27have a portion of their post-PERA pension costs treated as a component of the historic 279.28operating rate. Effective for the rate years beginning on or after October 1, 2009, and prior 279.29to October 1, 2016, the commissioner shall determine the pension costs to be included 279.30in the facility's base for determining rates under this section by using the following 279.31formula: post-privatization pension benefit costs as a percent of salary shall be determined 279.32from either the cost report for the first full reporting year after privatization or the most 279.33recent report year available, whichever is later. This percentage shall be applied to the 279.34salary costs of the alternative payment system base rate year to determine the allowable 279.35amount of pension costs. The adjustments provided for in sections 256B.431, 256B.434, 280.1256B.441, and any other law enacted after the base rate year and prior to the year for 280.2which rates are being determined shall be applied to the allowable amount. The adjusted 280.3allowable amount shall be added to the operating rate effective the first rate year PERA 280.4ceases to remain as a pass-through component of the rate.280.5    Sec. 60. Minnesota Statutes 2008, section 256B.437, subdivision 6, is amended to read:280.6    Subd. 6. Planned closure rate adjustment. (a) The commissioner of human 280.7services shall calculate the amount of the planned closure rate adjustment available under 280.8subdivision 3, paragraph (b), for up to 5,140 beds according to clauses (1) to (4):280.9(1) the amount available is the net reduction of nursing facility beds multiplied 280.10by $2,080;280.11(2) the total number of beds in the nursing facility or facilities receiving the planned 280.12closure rate adjustment must be identified;280.13(3) capacity days are determined by multiplying the number determined under 280.14clause (2) by 365; and280.15(4) the planned closure rate adjustment is the amount available in clause (1), divided 280.16by capacity days determined under clause (3).280.17(b) A planned closure rate adjustment under this section is effective on the first day 280.18of the month following completion of closure of the facility designated for closure in the 280.19application and becomes part of the nursing facility's total operating payment rate.280.20(c) Applicants may use the planned closure rate adjustment to allow for a property 280.21payment for a new nursing facility or an addition to an existing nursing facility or as an 280.22operating payment rate adjustment. Applications approved under this subdivision are 280.23exempt from other requirements for moratorium exceptions under section 
         144A.073, 280.24subdivisions 2 and 3
         .280.25(d) Upon the request of a closing facility, the commissioner must allow the facility a 280.26closure rate adjustment as provided under section 
         144A.161, subdivision 10.280.27(e) A facility that has received a planned closure rate adjustment may reassign it 280.28to another facility that is under the same ownership at any time within three years of its 280.29effective date. The amount of the adjustment shall be computed according to paragraph (a).280.30(f) If the per bed dollar amount specified in paragraph (a), clause (1), is increased, 280.31the commissioner shall recalculate planned closure rate adjustments for facilities that 280.32delicense beds under this section on or after July 1, 2001, to reflect the increase in the per 280.33bed dollar amount. The recalculated planned closure rate adjustment shall be effective 280.34from the date the per bed dollar amount is increased.281.1(g) For planned closures approved after June 30, 2009, the commissioner of human 281.2services shall calculate the amount of the planned closure rate adjustment available under 281.3subdivision 3, paragraph (b), according to paragraph (a), clauses (1) to (4).281.4    Sec. 61. Minnesota Statutes 2008, section 256B.441, subdivision 55, is amended to 281.5read:281.6    Subd. 55. Phase-in of rebased operating payment rates.  (a) For the rate years 281.7beginning October 1, 2008, to October 1, 2015, the operating payment rate calculated 281.8under this section shall be phased in by blending the operating rate with the operating 281.9payment rate determined under section 
         256B.434. For purposes of this subdivision, the 281.10rate to be used that is determined under section 
         256B.434 shall not include the portion of 281.11the operating payment rate related to performance-based incentive payments under section 281.12256B.434, subdivision 4
         , paragraph (d). For the rate year beginning October 1, 2008, the 281.13operating payment rate for each facility shall be 13 percent of the operating payment rate 281.14from this section, and 87 percent of the operating payment rate from section 
         256B.434. 281.15For the rate year period beginning October 1, 2009, through September 30, 2013, the 281.16operating payment rate for each facility shall be 14 percent of the operating payment rate 281.17from this section, and 86 percent of the operating payment rate from section 
         256B.434. 281.18For the rate year beginning October 1, 2010, the operating payment rate for each facility 281.19shall be 14 percent of the operating payment rate from this section, and 86 percent of the 281.20operating payment rate from section 256B.434. For the rate year beginning October 1, 281.212011, the operating payment rate for each facility shall be 31 percent of the operating 281.22payment rate from this section, and 69 percent of the operating payment rate from section 281.23256B.434. For the rate year beginning October 1, 2012, the operating payment rate for 281.24each facility shall be 48 percent of the operating payment rate from this section, and 52 281.25percent of the operating payment rate from section 256B.434. For the rate year beginning 281.26October 1, 2013, the operating payment rate for each facility shall be 65 percent of the 281.27operating payment rate from this section, and 35 percent of the operating payment rate 281.28from section 
         256B.434. For the rate year beginning October 1, 2014, the operating 281.29payment rate for each facility shall be 82 percent of the operating payment rate from this 281.30section, and 18 percent of the operating payment rate from section 
         256B.434. For the rate 281.31year beginning October 1, 2015, the operating payment rate for each facility shall be the 281.32operating payment rate determined under this section. The blending of operating payment 281.33rates under this section shall be performed separately for each RUG's class.282.1    (b) For the rate year beginning October 1, 2008, the commissioner shall apply limits 282.2to the operating payment rate increases under paragraph (a) by creating a minimum 282.3percentage increase and a maximum percentage increase.282.4    (1) Each nursing facility that receives a blended October 1, 2008, operating payment 282.5rate increase under paragraph (a) of less than one percent, when compared to its operating 282.6payment rate on September 30, 2008, computed using rates with RUG's weight of 
         1.00, 282.7shall receive a rate adjustment of one percent.282.8    (2) The commissioner shall determine a maximum percentage increase that will 282.9result in savings equal to the cost of allowing the minimum increase in clause (1). Nursing 282.10facilities with a blended October 1, 2008, operating payment rate increase under paragraph 282.11(a) greater than the maximum percentage increase determined by the commissioner, when 282.12compared to its operating payment rate on September 30, 2008, computed using rates with 282.13a RUG's weight of 
         1.00, shall receive the maximum percentage increase.282.14    (3) Nursing facilities with a blended October 1, 2008, operating payment rate 282.15increase under paragraph (a) greater than one percent and less than the maximum 282.16percentage increase determined by the commissioner, when compared to its operating 282.17payment rate on September 30, 2008, computed using rates with a RUG's weight of 
         1.00, 282.18shall receive the blended October 1, 2008, operating payment rate increase determined 282.19under paragraph (a).282.20    (4) The October 1, 2009, through October 1, 2015, operating payment rate for 282.21facilities receiving the maximum percentage increase determined in clause (2) shall be 282.22the amount determined under paragraph (a) less the difference between the amount 282.23determined under paragraph (a) for October 1, 2008, and the amount allowed under clause 282.24(2). This rate restriction does not apply to rate increases provided in any other section.282.25    (c) A portion of the funds received under this subdivision that are in excess of 282.26operating payment rates that a facility would have received under section 
         256B.434, as 282.27determined in accordance with clauses (1) to (3), shall be subject to the requirements in 282.28section 
         256B.434, subdivision 19, paragraphs (b) to (h).282.29    (1) Determine the amount of additional funding available to a facility, which shall be 282.30equal to total medical assistance resident days from the most recent reporting year times 282.31the difference between the blended rate determined in paragraph (a) for the rate year being 282.32computed and the blended rate for the prior year.282.33    (2) Determine the portion of all operating costs, for the most recent reporting year, 282.34that are compensation related. If this value exceeds 75 percent, use 75 percent.282.35    (3) Subtract the amount determined in clause (2) from 75 percent.283.1    (4) The portion of the fund received under this subdivision that shall be subject to 283.2the requirements in section 
         256B.434, subdivision 19, paragraphs (b) to (h), shall equal 283.3the amount determined in clause (1) times the amount determined in clause (3).283.4    Sec. 62. Minnesota Statutes 2008, section 256B.441, subdivision 58, is amended to 283.5read:283.6    Subd. 58. Implementation delay. Within six months prior to the effective date of 283.7(1) rebasing of property payment rates under subdivision 1; (2) quality-based rate limits 283.8under subdivision 50; and (3) the removal of planned closure rate adjustments and single 283.9bed room incentives from external fixed costs under subdivision 53, the commissioner 283.10shall compare the average operating cost for all facilities combined from the most recent 283.11cost reports to the average medical assistance operating payment rates for all facilities 283.12combined from the same time period. Each provision shall not go into effect until the 283.13average medical assistance operating payment rate is at least 92 percent of the average 283.14operating cost. The rebasing of property payment rates under subdivision 1, and the 283.15removal of planned closure rate adjustments and single-bed room incentives from external 283.16fixed costs under subdivision 53 shall not go into effect until 82 percent of the operating 283.17payment rate from this section is phased in as described in subdivision 55.283.18    Sec. 63. Minnesota Statutes 2008, section 256B.441, is amended by adding a 283.19subdivision to read:283.20    Subd. 59.Single-bed payments for medical assistance recipients.Effective 283.21October 1, 2009, the amount paid for a private room under Minnesota Rules, part 283.229549.0070, subpart 3, is reduced from 115 percent to 111.5 percent.283.23    Sec. 64. Minnesota Statutes 2008, section 256B.49, is amended by adding a 283.24subdivision to read:283.25    Subd. 11a.Waivered services waiting list.(a) The commissioner shall establish 283.26statewide priorities for individuals on the waiting list for CAC, CADI, and TBI waiver 283.27services, as of January 1, 2010. The statewide priorities must include, but are not limited 283.28to, individuals who continue to have a need for waiver services after they have maximized 283.29the use of state plan services and other funding resources, including natural supports, prior 283.30to accessing waiver services, and who meet at least one of the following criteria:283.31(1) have unstable living situations due to the age, incapacity, or sudden loss of 283.32the primary caregivers;283.33(2) are moving from an institution due to bed closures;284.1(3) experience a sudden closure of their current living arrangement;284.2(4) require protection from confirmed abuse, neglect, or exploitation;284.3(5) experience a sudden change in need that can  no longer be met through state plan 284.4services or other funding resources alone; or284.5(6) meet other priorities established by the department.284.6(b) When allocating resources to lead agencies, the commissioner must take into 284.7consideration the number of individuals waiting who meet statewide priorities and the 284.8lead agencies' current use of waiver funds and existing service options.284.9(c) The commissioner shall evaluate the impact of the use of statewide priorities and 284.10provide recommendations to the legislature on whether to continue the use of statewide 284.11priorities in the November 1, 2011, annual report required by the commissioner in sections 284.12256B.0916, subdivision 7, and 256B.49, subdivision 21.284.13    Sec. 65. Minnesota Statutes 2008, section 256B.49, subdivision 12, is amended to read:284.14    Subd. 12. Informed choice. Persons who are determined likely to require the level 284.15of care provided in a nursing facility as determined under sections 144.0724, subdivision 284.1611, and 256B.0911, or hospital shall be informed of the home and community-based 284.17support alternatives to the provision of inpatient hospital services or nursing facility 284.18services. Each person must be given the choice of either institutional or home and 284.19community-based services using the provisions described in section 
         256B.77, subdivision 284.202
         , paragraph (p).284.21EFFECTIVE DATE.This section is effective January 1, 2011.284.22    Sec. 66. Minnesota Statutes 2008, section 256B.49, subdivision 13, is amended to read:284.23    Subd. 13. Case management. (a) Each recipient of a home and community-based 284.24waiver shall be provided case management services by qualified vendors as described 284.25in the federally approved waiver application. The case management service activities 284.26provided will include:284.27    (1) assessing the needs of the individual within 20 working days of a recipient's 284.28request;284.29    (2) developing the written individual service plan within ten working days after the 284.30assessment is completed;284.31    (3) informing the recipient or the recipient's legal guardian or conservator of service 284.32options;284.33    (4) assisting the recipient in the identification of potential service providers;284.34    (5) assisting the recipient to access services;285.1    (6) coordinating, evaluating, and monitoring of the services identified in the service 285.2plan;285.3    (7) completing the annual reviews of the service plan; and285.4    (8) informing the recipient or legal representative of the right to have assessments 285.5completed and service plans developed within specified time periods, and to appeal county 285.6action or inaction under section 
         256.045, subdivision 3, including the determination of 285.7nursing facility level of care. 285.8    (b) The case manager may delegate certain aspects of the case management service 285.9activities to another individual provided there is oversight by the case manager. The case 285.10manager may not delegate those aspects which require professional judgment including 285.11assessments, reassessments, and care plan development.285.12EFFECTIVE DATE.This section is effective January 1, 2011.285.13    Sec. 67. Minnesota Statutes 2008, section 256B.49, subdivision 14, is amended to read:285.14    Subd. 14. Assessment and reassessment. (a) Assessments of each recipient's 285.15strengths, informal support systems, and need for services shall be completed within 285.1620 working days of the recipient's request. Reassessment of each recipient's strengths, 285.17support systems, and need for services shall be conducted at least every 12 months and at 285.18other times when there has been a significant change in the recipient's functioning.285.19(b) There must be a determination that the client requires a hospital level of care or a 285.20nursing facility level of care as defined in section 144.0724, subdivision 11, at initial and 285.21subsequent assessments to initiate and maintain participation in the waiver program.285.22(c) Regardless of other assessments identified in section 144.0724, subdivision 4, as 285.23appropriate to determine nursing facility level of care for purposes of medical assistance 285.24payment for nursing facility services, only face-to-face assessments conducted according 285.25to section 256B.0911, subdivisions 3a, 3b, and 4d, that result in a hospital level of care 285.26determination or a nursing facility level of care determination must be accepted for 285.27purposes of initial and ongoing access to waiver services payment.285.28(d) Persons with developmental disabilities who apply for services under the nursing 285.29facility level waiver programs shall be screened for the appropriate level of care according 285.30to section 
         256B.092.285.31(c)(e) Recipients who are found eligible for home and community-based services 285.32under this section before their 65th birthday may remain eligible for these services after 285.33their 65th birthday if they continue to meet all other eligibility factors.285.34EFFECTIVE DATE.The section is effective January 1, 2011.286.1    Sec. 68. Minnesota Statutes 2008, section 256B.49, is amended by adding a 286.2subdivision to read:286.3    Subd. 22.Residential support services.For the purposes of this section, the 286.4provisions of section 256B.092, subdivision 11, are controlling.286.5    Sec. 69. [256B.4912] HOME AND COMMUNITY-BASED WAIVERS; 286.6PROVIDERS AND PAYMENT.286.7    Subdivision 1.Provider qualifications.For the home and community-based 286.8waivers providing services to seniors and individuals with disabilities, the commissioner 286.9shall establish:286.10(1) agreements with enrolled waiver service providers to ensure providers meet 286.11qualifications defined in the waiver plans;286.12(2) regular reviews of provider qualifications; and286.13(3) processes to gather the necessary information to determine provider 286.14qualifications.286.15By July 2010, staff that provide direct contact, as defined in section 245C.02, subdivision 286.1611, that are employees of waiver service providers must meet the requirements of chapter 286.17245C prior to providing waiver services and as part of ongoing enrollment. Upon federal 286.18approval, this requirement must also apply to consumer-directed community supports.286.19    Subd. 2.Rate-setting methodologies.The commissioner shall establish 286.20statewide rate-setting methodologies that meet federal waiver requirements for home 286.21and community-based waiver services for individuals with disabilities. The rate-setting 286.22methodologies must abide by the principles of transparency and equitability across the 286.23state. The methodologies must involve a uniform process of structuring rates for each 286.24service and must promote quality and participant choice.286.25    Sec. 70. Minnesota Statutes 2008, section 256B.5011, subdivision 2, is amended to 286.26read:286.27    Subd. 2. Contract provisions. (a) The service contract with each intermediate 286.28care facility must include provisions for:286.29(1) modifying payments when significant changes occur in the needs of the 286.30consumers;286.31(2) the establishment and use of a quality improvement plan. Using criteria and 286.32options for performance measures developed by the commissioner, each intermediate care 286.33facility must identify a minimum of one performance measure on which to focus its efforts 286.34for quality improvement during the contract period;287.1(3) appropriate and necessary statistical information required by the commissioner;287.2(4) (3) annual aggregate facility financial information; and287.3(5) (4) additional requirements for intermediate care facilities not meeting the 287.4standards set forth in the service contract.287.5(b) The commissioner of human services and the commissioner of health, in 287.6consultation with representatives from counties, advocacy organizations, and the provider 287.7community, shall review the consolidated standards under chapter 245B and the supervised 287.8living facility rule under Minnesota Rules, chapter 4665, to determine what provisions 287.9in Minnesota Rules, chapter 4665, may be waived by the commissioner of health for 287.10intermediate care facilities in order to enable facilities to implement the performance 287.11measures in their contract and provide quality services to residents without a duplication 287.12of or increase in regulatory requirements.287.13    Sec. 71. Minnesota Statutes 2008, section 256B.5012, is amended by adding a 287.14subdivision to read:287.15    Subd. 8.ICF/MR rate decreases effective July 1, 2009.Effective July 1, 2009, 287.16the commissioner shall decrease each facility reimbursed under this section operating 287.17payment adjustments equal to 2.58 percent of the operating payment rates in effect on 287.18June 30, 2009. For each facility, the commissioner shall implement the rate reduction, 287.19based on occupied beds, using the percentage specified in this subdivision multiplied by 287.20the total payment rate, including the variable rate but excluding the property-related 287.21payment rate, in effect on the preceding date. The total rate reduction shall include the 287.22adjustment provided in section 256B.502, subdivision 7.287.23    Sec. 72. Minnesota Statutes 2008, section 256B.69, subdivision 5a, is amended to read:287.24    Subd. 5a. Managed care contracts. (a) Managed care contracts under this section 287.25and sections 
         256L.12 and 
         256D.03, shall be entered into or renewed on a calendar year 287.26basis beginning January 1, 1996. Managed care contracts which were in effect on June 287.2730, 1995, and set to renew on July 1, 1995, shall be renewed for the period July 1, 1995 287.28through December 31, 1995 at the same terms that were in effect on June 30, 1995. The 287.29commissioner may issue separate contracts with requirements specific to services to 287.30medical assistance recipients age 65 and older.287.31    (b) A prepaid health plan providing covered health services for eligible persons 287.32pursuant to chapters 256B, 256D, and 256L, is responsible for complying with the terms 287.33of its contract with the commissioner. Requirements applicable to managed care programs 288.1under chapters 256B, 256D, and 256L, established after the effective date of a contract 288.2with the commissioner take effect when the contract is next issued or renewed.288.3    (c) Effective for services rendered on or after January 1, 2003, the commissioner 288.4shall withhold five percent of managed care plan payments under this section for the 288.5prepaid medical assistance and general assistance medical care programs pending 288.6completion of performance targets. Each performance target must be quantifiable, 288.7objective, measurable, and reasonably attainable, except in the case of a performance 288.8target based on a federal or state law or rule. Criteria for assessment of each performance 288.9target must be outlined in writing prior to the contract effective date. The managed 288.10care plan must demonstrate, to the commissioner's satisfaction, that the data submitted 288.11regarding attainment of the performance target is accurate. The commissioner shall 288.12periodically change the administrative measures used as performance targets in order 288.13to improve plan performance across a broader range of administrative services. The 288.14performance targets must include measurement of plan efforts to contain spending 288.15on health care services and administrative activities. The commissioner may adopt 288.16plan-specific performance targets that take into account factors affecting only one plan, 288.17including characteristics of the plan's enrollee population. The withheld funds must be 288.18returned no sooner than July of the following year if performance targets in the contract 288.19are achieved. The commissioner may exclude special demonstration projects under 288.20subdivision 23. A managed care plan or a county-based purchasing plan under section 288.21256B.692
          may include as admitted assets under section 
         62D.044 any amount withheld 288.22under this paragraph that is reasonably expected to be returned.288.23    (d)(1) Effective for services rendered on or after January 1, 2009, the commissioner 288.24shall withhold three percent of managed care plan payments under this section for the 288.25prepaid medical assistance and general assistance medical care programs. The withheld 288.26funds must be returned no sooner than July 1 and no later than July 31 of the following 288.27year. The commissioner may exclude special demonstration projects under subdivision 23.288.28    (2) A managed care plan or a county-based purchasing plan under section 
         256B.692 288.29may include as admitted assets under section 
         62D.044 any amount withheld under 288.30this paragraph. The return of the withhold under this paragraph is not subject to the 288.31requirements of paragraph (c).288.32(e) Effective for services provided on or after January 1, 2010, the commissioner 288.33shall require that managed care plans use the assessment and authorization processes, 288.34forms, timelines, standards, documentation, and data reporting requirements, protocols, 288.35billing processes, and policies consistent with medical assistance fee-for-service or the 288.36Department of Human Services contract requirements consistent with medical assistance 289.1fee-for-service or the Department of Human Services contract requirements for all 289.2personal care assistance services under section 256B.0659.289.3    Sec. 73. Minnesota Statutes 2008, section 256D.44, subdivision 5, is amended to read:289.4    Subd. 5. Special needs. In addition to the state standards of assistance established in 289.5subdivisions 1 to 4, payments are allowed for the following special needs of recipients of 289.6Minnesota supplemental aid who are not residents of a nursing home, a regional treatment 289.7center, or a group residential housing facility.289.8    (a) The county agency shall pay a monthly allowance for medically prescribed 289.9diets if the cost of those additional dietary needs cannot be met through some other 289.10maintenance benefit. The need for special diets or dietary items must be prescribed by 289.11a licensed physician. Costs for special diets shall be determined as percentages of the 289.12allotment for a one-person household under the thrifty food plan as defined by the United 289.13States Department of Agriculture. The types of diets and the percentages of the thrifty 289.14food plan that are covered are as follows:289.15    (1) high protein diet, at least 80 grams daily, 25 percent of thrifty food plan;289.16    (2) controlled protein diet, 40 to 60 grams and requires special products, 100 percent 289.17of thrifty food plan;289.18    (3) controlled protein diet, less than 40 grams and requires special products, 125 289.19percent of thrifty food plan;289.20    (4) low cholesterol diet, 25 percent of thrifty food plan;289.21    (5) high residue diet, 20 percent of thrifty food plan;289.22    (6) pregnancy and lactation diet, 35 percent of thrifty food plan;289.23    (7) gluten-free diet, 25 percent of thrifty food plan;289.24    (8) lactose-free diet, 25 percent of thrifty food plan;289.25    (9) antidumping diet, 15 percent of thrifty food plan;289.26    (10) hypoglycemic diet, 15 percent of thrifty food plan; or289.27    (11) ketogenic diet, 25 percent of thrifty food plan.289.28    (b) Payment for nonrecurring special needs must be allowed for necessary home 289.29repairs or necessary repairs or replacement of household furniture and appliances using 289.30the payment standard of the AFDC program in effect on July 16, 1996, for these expenses, 289.31as long as other funding sources are not available.289.32    (c) A fee for guardian or conservator service is allowed at a reasonable rate 289.33negotiated by the county or approved by the court. This rate shall not exceed five percent 289.34of the assistance unit's gross monthly income up to a maximum of $100 per month. If the 289.35guardian or conservator is a member of the county agency staff, no fee is allowed.290.1    (d) The county agency shall continue to pay a monthly allowance of $68 for 290.2restaurant meals for a person who was receiving a restaurant meal allowance on June 1, 290.31990, and who eats two or more meals in a restaurant daily. The allowance must continue 290.4until the person has not received Minnesota supplemental aid for one full calendar month 290.5or until the person's living arrangement changes and the person no longer meets the criteria 290.6for the restaurant meal allowance, whichever occurs first.290.7    (e) A fee of ten percent of the recipient's gross income or $25, whichever is less, 290.8is allowed for representative payee services provided by an agency that meets the 290.9requirements under SSI regulations to charge a fee for representative payee services. This 290.10special need is available to all recipients of Minnesota supplemental aid regardless of 290.11their living arrangement.290.12    (f)(1) Notwithstanding the language in this subdivision, an amount equal to the 290.13maximum allotment authorized by the federal Food Stamp Program for a single individual 290.14which is in effect on the first day of July of each year will be added to the standards of 290.15assistance established in subdivisions 1 to 4 for adults under the age of 65 who qualify 290.16as shelter needy and are: (i) relocating from an institution, or an adult mental health 290.17residential treatment program under section 
         256B.0622; (ii) eligible for the self-directed 290.18supports option as defined under section 
         256B.0657, subdivision 2; or (iii) home and 290.19community-based waiver recipients living in their own home or rented or leased apartment 290.20which is not owned, operated, or controlled by a provider of service not related by blood 290.21or marriage.290.22    (2) Notwithstanding subdivision 3, paragraph (c), an individual eligible for the 290.23shelter needy benefit under this paragraph is considered a household of one. An eligible 290.24individual who receives this benefit prior to age 65 may continue to receive the benefit 290.25after the age of 65.290.26    (3) "Shelter needy" means that the assistance unit incurs monthly shelter costs that 290.27exceed 40 percent of the assistance unit's gross income before the application of this 290.28special needs standard. "Gross income" for the purposes of this section is the applicant's or 290.29recipient's income as defined in section 
         256D.35, subdivision 10, or the standard specified 290.30in subdivision 3, paragraph (a) or (b), whichever is greater. A recipient of a federal or 290.31state housing subsidy, that limits shelter costs to a percentage of gross income, shall not be 290.32considered shelter needy for purposes of this paragraph.290.33(g) Notwithstanding this subdivision, recipients of home and community-based 290.34services may relocate to services without 24-hour supervision and receive the equivalent 290.35of the recipient's group residential housing allocation in Minnesota supplemental 290.36assistance shelter needy funding if the cost of the services and housing is equal to or less 291.1than provided to the recipient in home and community-based services and the relocation is 291.2the recipient's choice and is approved by the recipient or guardian.291.3(h) To access housing and services as provided in paragraph (g), the recipient may 291.4choose housing that may or may not be owned, operated, or controlled by the recipient's 291.5service provider.291.6(i) The provisions in paragraphs (g) and (h) are effective to June 30, 2011. The 291.7commissioner shall assess the development of publicly owned housing, other housing 291.8alternatives, and whether a public equity housing fund may be established that would 291.9maintain the state's interest, to the extent paid from group residential housing and 291.10Minnesota supplemental aid shelter needy funds in provider-owned housing so that when 291.11sold, the state would recover its share for a public equity fund to be used for future public 291.12needs under this chapter. The commissioner shall report findings and recommendations to 291.13the legislative committees and budget divisions with jurisdiction over health and human 291.14services policy and financing by January 15, 2012. 291.15(j) In selecting prospective services needed by recipients for whom home and 291.16community-based services have been authorized, the recipient and the recipient's guardian 291.17shall first consider alternatives to home and community-based services. Minnesota 291.18supplemental aid shelter needy funding for recipients who utilize Minnesota supplemental 291.19aid shelter needy funding as provided in this section shall remain permanent unless the 291.20recipient with the recipient's guardian later chooses to access home and community-based 291.21services.291.22    Sec. 74. Minnesota Statutes 2008, section 626.556, subdivision 3c, is amended to read:291.23    Subd. 3c. Local welfare agency, Department of Human Services or Department 291.24of Health responsible for assessing or investigating reports of maltreatment. (a) 291.25The county local welfare agency is the agency responsible for assessing or investigating 291.26allegations of maltreatment in child foster care, family child care, and legally unlicensed 291.27child care and in, juvenile correctional facilities licensed under section 241.021 located 291.28in the local welfare agency's county, and unlicensed personal care assistance provider 291.29organizations providing services and receiving reimbursements under chapter 256B. 291.30(b) The Department of Human Services is the agency responsible for assessing or 291.31investigating allegations of maltreatment in facilities licensed under chapters 245A and 291.32245B, except for child foster care and family child care.291.33(c) The Department of Health is the agency responsible for assessing or investigating 291.34allegations of child maltreatment in facilities licensed under sections  144.50 to  144.58, 291.35and in unlicensed home health care  and 144A.46. 292.1(d) The commissioners of human services, public safety, and education must 292.2jointly submit a written report by January 15, 2007, to the education policy and finance 292.3committees of the legislature recommending the most efficient and effective allocation 292.4of agency responsibility for assessing or investigating reports of maltreatment and must 292.5specifically address allegations of maltreatment that currently are not the responsibility 292.6of a designated agency. 292.7    Sec. 75. Minnesota Statutes 2008, section 626.5572, subdivision 13, is amended to 292.8read:292.9    Subd. 13. Lead agency. "Lead agency" is the primary administrative agency 292.10responsible for investigating reports made under section 
         626.557.  292.11(a) The Department of Health is the lead agency for the facilities which are licensed 292.12or are required to be licensed as hospitals, home care providers, nursing homes, residential 292.13care homes, or boarding care homes.292.14(b) The Department of Human Services is the lead agency for the programs licensed 292.15or required to be licensed as adult day care, adult foster care, programs for people with 292.16developmental disabilities, mental health programs, or chemical health programs, or 292.17personal care provider organizations.292.18(c) The county social service agency or its designee is the lead agency for all 292.19other reports, including reports involving vulnerable adults receiving services from an 292.20unlicensed personal care provider organization under section 256B.0659.292.21    Sec. 76. DEVELOPMENT OF ALTERNATIVE SERVICES.292.22The commissioner of human services, in consultation with advocates, consumers, 292.23and legislators, shall develop alternative services to personal care assistance services for 292.24persons with mental health and other behavioral challenges who can benefit from other 292.25services that more appropriately meet their needs and assist them in living independently 292.26in the community. In the development of these services, the commissioner shall:292.27(1) take into consideration ways in which these alternative services will qualify for 292.28federal financial participation; and 292.29(2) analyze a variety of alternatives, including but not limited to a 1915(i) state 292.30plan option.292.31The commissioner shall report to the legislature by January 15, 2011, with plans for 292.32implementation of these services by July 1, 2011.292.33    Sec. 77. 30-DAY NOTICE REQUIRED.293.1Notwithstanding any contrary provision in law, persons impacted by amendments 293.2in this article to Minnesota Statutes, sections 256B.0625, subdivision 19c; 256B.0655, 293.3subdivision 4; 256B.0659; and 256B.0911, subdivision 1, must be given a 30-day notice 293.4of action by the commissioner. This section expires July 1, 2011.293.5    Sec. 78. COLA COMPENSATION REQUIREMENTS.293.6Effective July 1, 2009, providers who received rate increases under Laws 2007, 293.7chapter 147, article 7, section 71, as amended by Laws 2008, chapter 363, article 15, 293.8section 17, and Minnesota Statutes, section 256B.5012, subdivision 7, for state fiscal years 293.92008 and 2009 are no longer required to continue or retain employee compensation or 293.10wage-related increases required by those sections. This paragraph shall not apply to 293.11employees covered by a collective bargaining agreement.293.12    Sec. 79. PROVIDER RATE AND GRANT REDUCTIONS.293.13(a) The commissioner of human services shall decrease grants, allocations, 293.14reimbursement rates, or rate limits, as applicable, by 2.58 percent effective July 1, 2009, 293.15for services rendered on or after that date. County or tribal contracts for services specified 293.16in this section must be amended to pass through these rate reductions within 60 days of 293.17the effective date of the decrease and must be retroactive from the effective date of the 293.18rate decrease.293.19(b) The annual rate decreases described in this section must be provided to:293.20(1) home and community-based waivered services for persons with developmental 293.21disabilities or related conditions, including consumer-directed community supports, under 293.22Minnesota Statutes, section 256B.501;293.23(2) home and community-based waivered services for the elderly, including 293.24consumer-directed community supports, under Minnesota Statutes, section 256B.0915;293.25(3) waivered services under community alternatives for disabled individuals, 293.26including consumer-directed community supports, under Minnesota Statutes, section 293.27256B.49;293.28(4) community alternative care waivered services, including consumer-directed 293.29community supports, under Minnesota Statutes, section 256B.49;293.30(5) traumatic brain injury waivered services, including consumer-directed 293.31community supports, under Minnesota Statutes, section 256B.49;293.32(6) nursing services and home health services under Minnesota Statutes, section 293.33256B.0625, subdivision 6a;293.34(7) personal care services and qualified professional supervision of personal care 293.35services under Minnesota Statutes, section 256B.0625, subdivisions 6a and 19a;294.1(8) private duty nursing services under Minnesota Statutes, section 256B.0625, 294.2subdivision 7;294.3(9) day training and habilitation services for adults with developmental disabilities 294.4or related conditions under Minnesota Statutes, sections 252.40 to 252.46, including the 294.5additional cost of rate adjustments on day training and habilitation services, provided as a 294.6social service under Minnesota Statutes, section 256M.60;294.7(10) alternative care services under Minnesota Statutes, section 256B.0913;294.8(11) the group residential housing supplementary service rate under Minnesota 294.9Statutes, section 256I.05, subdivision 1a;294.10(12) semi-independent living services (SILS) under Minnesota Statutes, section 294.11252.275, including SILS funding under county social services grants formerly funded 294.12under Minnesota Statutes, chapter 256I;294.13(13) community support services for deaf and hard-of-hearing adults with mental 294.14illness who use or wish to use sign language as their primary means of communication 294.15under Minnesota Statutes, section 256.01, subdivision 2; and deaf and hard-of-hearing 294.16grants under Minnesota Statutes, sections 256C.233 and 256C.25; Laws 1985, chapter 9; 294.17and Laws 1997, First Special Session chapter 5, section 20;294.18(14) physical therapy services under Minnesota Statutes, sections 256B.0625, 294.19subdivision 8, and 256D.03, subdivision 4;294.20(15) occupational therapy services under Minnesota Statutes, sections 256B.0625, 294.21subdivision 8a, and 256D.03, subdivision 4;294.22(16) speech-language therapy services under Minnesota Statutes, section 256D.03, 294.23subdivision 4, and Minnesota Rules, part 9505.0390;294.24(17) respiratory therapy services under Minnesota Statutes, section 256D.03, 294.25subdivision 4, and Minnesota Rules, part 9505.0295;294.26(18) consumer support grants under Minnesota Statutes, section 256.476;294.27(19) family support grants under Minnesota Statutes, section 252.32;294.28(20) aging grants under Minnesota Statutes, sections 256.975 to 256.977, 256B.0917, 294.29and 256B.0928;294.30(21) disability linkage line grants under Minnesota Statutes, section 256.01, 294.31subdivision 24; and294.32(22) housing access grants under Minnesota Statutes, section 256B.0658.294.33(c) A managed care plan receiving state payments for the services in this section 294.34must include these decreases in their payments to providers effective on October 1 294.35following the effective date of the rate decrease.295.1    Sec. 80. RECOMMENDATIONS FOR PERSONAL CARE ASSISTANCE 295.2SERVICES CHANGES, CONSULTATION WITH STAKEHOLDERS, AND DATA 295.3REPORTING.295.4The commissioner shall:295.5(1) consult with existing stakeholder groups convened under the commissioner's 295.6authority, including the home and community-based expert services panel beginning in 295.7August 2009 on implementation of the changes in the personal care assistance program, 295.8assistance for recipients whose services and housing must change, alternative services 295.9for those whose personal care assistance services are terminated or reduced, costs for 295.10those whose services will change, data on the effects of the changes in the personal care 295.11assistance program for recipients, and ongoing data on personal care assistance services 295.12for public reporting; and295.13(2) report data on the training developed and delivered for all types of participants in 295.14the personal care assistance program, audit and financial integrity measures and results, 295.15information developed for consumers and responsible parties, available demographic, 295.16health care service use, and housing information about individuals who no longer qualify 295.17for personal care assistance, and quality assurance measures and results to the legislative 295.18committees with jurisdiction over health and human services policy and finance by 295.19January 15, 2010, and January 15, 2011.295.20    Sec. 81. ESTABLISHING A SINGLE SET OF STANDARDS.295.21(a) The commissioner of human services shall consult with disability service 295.22providers, advocates, counties, and consumer families to develop a single set of standards 295.23governing services for people with disabilities receiving services under the home and 295.24community-based waiver services program to replace all or portions of existing laws and 295.25rules including, but not limited to, data practices, licensure of facilities and providers, 295.26background studies, reporting of maltreatment of minors, reporting of maltreatment of 295.27vulnerable adults, and the psychotropic medication checklist. The standards must:295.28(1) enable optimum consumer choice;295.29(2) be consumer driven;295.30(3) link services to individual needs and life goals;295.31(4) be based on quality assurance and individual outcomes; 295.32(5) utilize the people closest to the recipient, who may include family, friends, and 295.33health and service providers, in conjunction with the recipient's risk management plan to 295.34assist the recipient or the recipient's guardian in making decisions that meet the recipient's 295.35needs in a cost-effective manner and assure the recipient's health and safety;296.1(6) utilize person-centered planning; and296.2(7) maximize federal financial participation.296.3(b) The commissioner may consult with existing stakeholder groups convened under 296.4the commissioner's authority, including the home and community-based expert services 296.5panel established by the commissioner in 2008, to meet all or some of the requirements 296.6of this section.296.7(c) The commissioner shall provide the reports and plans required by this section to 296.8the legislative committees and budget divisions with jurisdiction over health and human 296.9services policy and finance by January 15, 2012.296.10    Sec. 82. COMMON SERVICE MENU FOR HOME AND COMMUNITY-BASED 296.11WAIVER PROGRAMS.296.12The commissioner of human services shall confer with representatives of recipients, 296.13advocacy groups, counties, providers, and health plans to develop and update a common 296.14service menu for home and community-based waiver programs. The commissioner may 296.15consult with existing stakeholder groups convened under the commissioner's authority to 296.16meet all or some of the requirements of this section.296.17    Sec. 83. INTERMEDIATE CARE FACILITIES FOR PERSONS WITH 296.18DEVELOPMENTAL DISABILITIES REPORT.296.19The commissioner of human services shall consult with providers and advocates of 296.20intermediate care facilities for persons with developmental disabilities to monitor progress 296.21made in response to the commissioner's December 15, 2008, report to the legislature 296.22regarding intermediate care facilities for persons with developmental disabilities.296.23    Sec. 84. HOUSING OPTIONS.296.24The commissioner of human services, in consultation with the commissioner of 296.25administration and the Minnesota Housing Finance Agency, and representatives of 296.26counties, residents' advocacy groups, consumers of housing services, and provider 296.27agencies shall explore ways to maximize the availability and affordability of housing 296.28choices available to persons with disabilities or who need care assistance due to other 296.29health challenges. A goal shall also be to minimize state physical plant costs in order to 296.30serve more persons with appropriate program and care support. Consideration shall be 296.31given to:296.32(1) improved access to rent subsidies;296.33(2) use of cooperatives, land trusts, and other limited equity ownership models;297.1(3) whether a public equity housing fund should be established that would maintain 297.2the state's interest, to the extent paid from state funds, including group residential housing 297.3and Minnesota supplemental aid shelter-needy funds in provider-owned housing, so that 297.4when sold, the state would recover its share for a public equity fund to be used for future 297.5public needs under this chapter;297.6(4) the desirability of the state acquiring an ownership interest or promoting the 297.7use of publicly owned housing;297.8(5) promoting more choices in the market for accessible housing that meets the 297.9needs of persons with physical challenges; and297.10(6) what consumer ownership models, if any, are appropriate.297.11The commissioner shall provide a written report on the findings of the evaluation of 297.12housing options to the chairs and ranking minority members of the house of representatives 297.13and senate standing committees with jurisdiction over health and human services policy 297.14and funding by December 15, 2010. This report shall replace the November 1, 2010, 297.15annual report by the commissioner required in Minnesota Statutes, sections 256B.0916, 297.16subdivision 7, and 256B.49, subdivision 21.297.17    Sec. 85. REVISOR'S INSTRUCTION.297.18    Subdivision 1.Renumbering of Minnesota Statutes, section 256B.0652, 297.19authorization and review of home care services.(a) The revisor of statutes shall 297.20renumber each section of Minnesota Statutes listed in column A with the number in 297.21column B.

297.22Column AColumn B297.23256B.0652, subdivision 3256B.0652, subdivision 14297.24256B.0651, subdivision 6, paragraph (a)256B.0652, subdivision 3297.25256B.0651, subdivision 6, paragraph (b)256B.0652, subdivision 4297.26256B.0651, subdivision 6, paragraph (c)256B.0652, subdivision 7297.27256B.0651, subdivision 7, paragraph (a)256B.0652, subdivision 8297.28256B.0651, subdivision 7, paragraph (b)256B.0652, subdivision 14297.29256B.0651, subdivision 8256B.0652, subdivision 9297.30256B.0651, subdivision 9256B.0652, subdivision 10297.31256B.0651, subdivision 11256B.0652, subdivision 11298.1256B.0654, subdivision 2256B.0652, subdivision 5298.2256B.0655, subdivision 4256B.0652, subdivision 6

298.3(b) The revisor of statutes shall make necessary cross-reference changes in statutes 298.4and rules consistent with the renumbering in paragraph (a). The Department of Human 298.5Services shall assist the revisor with any cross-reference changes. The revisor may make 298.6changes necessary to correct the punctuation, grammar, or structure of the remaining text 298.7to conform with the intent of the renumbering in paragraph (a).298.8    Subd. 2.Renumbering personal care assistance services.The revisor of statutes 298.9shall replace any reference to Minnesota Statutes, section 256B.0655 with section 298.10256B.0659, wherever it appears in statutes or rules. The revisor shall correct any cross 298.11reference changes that are necessary as a result of this section. The Department of Human 298.12Services shall assist the revisor in making these changes, and if necessary, shall draft a 298.13corrections bill with changes for introduction in the 2010 legislative session. The revisor 298.14may make changes to punctuation, grammar, or sentence structure to preserve the integrity 298.15of statutes and effectuate the intention of this section.298.16    Sec. 86.  REPEALER.298.17(a) Minnesota Statutes 2008, sections 256B.0655, subdivisions 1, 1a, 1c, 1d, 1e, 298.181h, 1i, 3, 5, 6, 7, 8, 9, 10, 11, 12, and 13; and 256B.071, subdivisions 1, 2, 3, and 4, are 298.19repealed.298.20(b) Minnesota Statutes 2008, sections 256B.19, subdivision 1d; and 256B.431, 298.21subdivision 23, are repealed effective May 1, 2009.298.22(c) Minnesota Statutes 2008, section 256B.0655, subdivisions 1f, 1g, and 2, are 298.23repealed effective January 1, 2010.298.24ARTICLE 9298.25STATE-COUNTY RESULTS, ACCOUNTABILITY, AND SERVICE 298.26DELIVERY REFORM ACT298.27    Section 1. [402A.01] CITATION.298.28Sections 402A.01 to 402A.50 may be cited as the "State-County Results, 298.29Accountability, and Service Delivery Reform Act."298.30    Sec. 2. [402A.10] DEFINITIONS.298.31    Subdivision 1.Terms defined.For the purposes of this chapter, the terms defined 298.32in this section have the meanings given.299.1    Subd. 2.Commissioner."Commissioner" means the commissioner of human 299.2services.299.3    Subd. 3.Council."Council" means the State-County Results, Accountability, and 299.4Service Delivery Redesign Council established in section 402A.20.299.5    Subd. 4.Essential human services or essential services."Essential human 299.6services" or "essential services" means assistance and services to recipients or potential 299.7recipients of public welfare and other services delivered by counties that are mandated in 299.8federal and state law that are to be available in all counties of the state.299.9    Subd. 5.Service delivery authority."Service delivery authority" means a single 299.10county, or group of counties operating by execution of a joint powers agreement under 299.11section 471.59 or other contractual agreement, that has voluntarily chosen by resolution of 299.12the county board of commissioners to participate in the redesign under this chapter.299.13    Subd. 6.Steering committee."Steering committee" means the Steering Committee 299.14on Performance and Outcome Reforms.299.15EFFECTIVE DATE.This section is effective the day following final enactment.299.16    Sec. 3. [402A.15] STEERING COMMITTEE ON PERFORMANCE AND 299.17OUTCOME REFORMS.299.18    Subdivision 1.Duties.(a) The Steering Committee on Performance and Outcome 299.19Reforms shall develop a uniform process to establish and review performance and 299.20outcome standards for all essential human services based on the current level of resources 299.21available, and to develop appropriate reporting measures and a uniform accountability 299.22process for responding to a county's or human service authority's failure to make adequate 299.23progress on achieving performance measures. The accountability process shall focus on 299.24the performance measures rather than inflexible implementation requirements.299.25(b) The steering committee shall:299.26(1) by November 1, 2009, establish an agreed upon list of essential services;299.27(2) by February 15, 2010, develop and recommend to the legislature a uniform, 299.28graduated process, in addition to the remedies identified in section 402A.18, for responding 299.29to a county's failure to make adequate progress on achieving performance measures; and299.30(3) by December 15, 2012, for each essential service make recommendations to the 299.31legislature regarding (1) performance measures and goals based on those measures for 299.32each essential service, (2) a system for reporting on the performance measures and goals, 299.33and (3) appropriate resources, including funding, needed to achieve those performance 299.34measures and goals. The resource recommendations shall take into consideration program 300.1demand and the unique differences of local areas in geography and the populations 300.2served. Priority shall be given to services with the greatest variation in availability and 300.3greatest administrative demands. By January 15 of each year starting January 15, 2011, 300.4the steering committee shall report its recommendations to the governor and legislative 300.5committees with jurisdiction over health and human services. As part of its report, the 300.6steering committee shall, as appropriate, recommend statutory provisions, rules and 300.7requirements, and reports that should be repealed or eliminated.300.8(c) As far as possible, the performance measures, reporting system, and funding 300.9shall be consistent across program areas. The development of performance measures shall 300.10consider the manner in which data will be collected and performance will be reported. 300.11The steering committee shall consider state and local administrative costs related to 300.12collecting data and reporting outcomes when developing performance measures. The 300.13steering committee shall correlate the performance measures and goals to available 300.14levels of resources, including state and local funding. The steering committee shall 300.15take into consideration that the goal of implementing changes to program monitoring 300.16and reporting the progress toward achieving outcomes is to significantly minimize the 300.17cost of administrative requirements and to allow funds freed by reduced administrative 300.18expenditures to be used to provide additional services, allow flexibility in service design 300.19and management, and focus energies on achieving program and client outcomes.300.20(d) In making its recommendations, the steering committee shall consider input from 300.21the council established in section 402A.20. The steering committee shall review the 300.22measurable goals established in a memorandum of understanding entered into under 300.23section 402A.30, subdivision 2, paragraph (b), and consider whether they may be applied 300.24as statewide performance outcomes.300.25(e) The steering committee shall form work groups that include persons who provide 300.26or receive essential services and representatives of organizations who advocate on behalf 300.27of those persons.300.28(f) By December 15, 2009, the steering committee shall establish a three-year 300.29schedule for completion of its work. The schedule shall be published on the Department of 300.30Human Services Web site and reported to the legislative committees with jurisdiction over 300.31health and human services. In addition, the commissioner shall post quarterly updates on 300.32the progress of the steering committee on the Department of Human Services Web site.300.33    Subd. 2.Composition.(a) The steering committee shall include:300.34(1) the commissioner of human services, or designee, and two additional 300.35representatives of the department;301.1(2) two county commissioners, representative of rural and urban counties, selected 301.2by the Association of Minnesota Counties;301.3(3) two county directors of human services, representative of rural and urban 301.4counties, selected by the Minnesota Association of County Social Service Administrators; 301.5and301.6(4) three clients or client advocates representing different populations receiving 301.7services from the Department of Human Services, who are appointed by the commissioner.301.8(b) The commissioner, or designee, and a county commissioner shall serve as 301.9cochairs of the committee. The committee shall be convened within 60 days of final 301.10enactment of this legislation.301.11(c) State agency staff shall serve as informational resources and staff to the steering 301.12committee. Statewide county associations may assemble county program data as required.301.13(d) To promote information sharing and coordination between the steering committee 301.14and council, one of the county representatives from paragraph (a), clause (2), and one of the 301.15county representatives from paragraph (a), clause (3), must also serve as a representative 301.16on the council under section 402A.20, subdivision 1, paragraph (b), clause (5) or (6).301.17EFFECTIVE DATE.This section is effective the day following final enactment.301.18    Sec. 4. [402A.18] COMMISSIONER POWER TO REMEDY FAILURE TO 301.19MEET PERFORMANCE OUTCOMES.301.20    Subdivision 1.Underperforming county; specific service.If the commissioner 301.21determines that a county or service delivery authority is deficient in achieving minimum 301.22performance outcomes for a specific essential service, the commissioner may impose 301.23the following remedies:301.24(1) voluntary incorporation of the administration and operation of the specific 301.25essential service with an existing service delivery authority or another county. A 301.26service delivery authority or county incorporating an underperforming county shall 301.27not be financially liable for the costs associated with remedying performance outcome 301.28deficiencies;301.29(2) mandatory incorporation of the administration and operation of the specific 301.30essential service with an existing service delivery authority or another county. A 301.31service delivery authority or county incorporating an underperforming county shall 301.32not be financially liable for the costs associated with remedying performance outcome 301.33deficiencies; or 301.34(3) transfer of authority for program administration and operation of the specific 301.35essential service to the commissioner.302.1    Subd. 2.Underperforming county; more than one-half of service.If the 302.2commissioner determines that a county or service delivery authority is deficient in 302.3achieving minimum performance outcomes for more than one-half of the defined essential 302.4service, the commissioner may impose the following remedies:302.5(1) voluntary incorporation of the administration and operation of the specific 302.6essential service with an existing service delivery authority or another county. A 302.7service delivery authority or county incorporating an underperforming county shall 302.8not be financially liable for the costs associated with remedying performance outcome 302.9deficiencies;302.10(2) mandatory incorporation of the administration and operation of the specific 302.11essential service with an existing service delivery authority or another county. A 302.12service delivery authority or county incorporating an underperforming county shall 302.13not be financially liable for the costs associated with remedying performance outcome 302.14deficiencies; or 302.15(3) transfer of authority for program administration and operation of the specific 302.16essential service to the commissioner.302.17    Subd. 3.Conditions prior to imposing remedies.Before the commissioner may 302.18impose the remedies authorized under this section, the following conditions must be met:302.19(1) the county or service delivery authority determined by the commissioner 302.20to be deficient in achieving minimum performance outcomes has the opportunity, in 302.21coordination with the council, to develop a program outcome improvement plan. The 302.22program outcome improvement plan must be developed no later than six months from the 302.23date of the deficiency determination; and302.24(2) the council has conducted an assessment of the program outcome improvement 302.25plan to determine if the county or service delivery authority has made satisfactory progress 302.26toward performance outcomes and has made a recommendation about remedies to the 302.27commissioner. The review and recommendation must be made to the commissioner within 302.2812 months from the date of the deficiency determination.302.29    Sec. 5. [402A.20] COUNCIL.302.30    Subdivision 1.Council.(a) The State-County Results, Accountability, and Service 302.31Delivery Redesign Council is established. Appointed council members must be appointed 302.32by their respective agencies, associations, or governmental units by November 1, 2009. 302.33The council shall be cochaired by the commissioner of human services, or designee, and a 302.34county representative from paragraph (b), clause (4) or (5), appointed by the Association 302.35of Minnesota Counties. Recommendations of the council must be approved by a majority 303.1of the council members. The provisions of section 15.059 do not apply to this council, 303.2and this council does not expire.303.3(b) The council must consist of the following members:303.4(1) two legislators appointed by the speaker of the house, one from the minority 303.5and one from the majority;303.6(2) two legislators appointed by the Senate Rules Committee, one from the majority 303.7and one from the minority;303.8(3) the commissioner of human services, or designee, and three employees from 303.9the department;303.10(4) two county commissioners appointed by the Association of Minnesota Counties;303.11(5) two county representatives appointed by the Minnesota Association of County 303.12Social Service Administrators; 303.13(6) one representative appointed by AFSCME as a nonvoting member; and303.14(7) one representative appointed by the Teamsters as a nonvoting member.303.15(c) Administrative support to the council may be provided by the Association of 303.16Minnesota Counties and affiliates.303.17(d) Member agencies and associations are responsible for initial and subsequent 303.18appointments to the council.303.19    Subd. 2.Council duties.The council shall:303.20(1) provide review of the redesign process;303.21(2) certify, in accordance with section 402A.30, subdivision 4, the formation of 303.22a service delivery authority, including the memorandum of understanding in section 303.23402A.30, subdivision 2, paragraph (b);303.24(3) ensure the consistency of the memoranda of understanding entered into 303.25under section 402A.30, subdivision 2, paragraph (b), with the performance standards 303.26recommended by the steering committee and enacted by the legislature;303.27(4) ensure the consistency of the memoranda of understanding, to the extent 303.28appropriate, or other memoranda of understanding entered into by other service delivery 303.29authorities; 303.30(5) establish a process to take public input on the service delivery framework 303.31specified in the memorandum of understanding in section 402A.30, subdivision 2, 303.32paragraph (b);303.33(6) form work groups as necessary to carry out the duties of the council under the 303.34redesign;304.1(7) serve as a forum for resolving conflicts among participating counties or between 304.2participating counties and the commissioner of human services, provided nothing in this 304.3section is intended to create a formal binding legal process;304.4(8) engage in the program improvement process established in section 402A.18, 304.5subdivision 3; and304.6(9) identify and recommend incentives for counties to participate in human services 304.7authorities.304.8EFFECTIVE DATE.This section is effective the day following final enactment.304.9    Sec. 6. [402A.30] DESIGNATION OF SERVICE DELIVERY AUTHORITY.304.10    Subdivision 1.Establishment.After certification by the council and approval by 304.11the commissioner, in accordance with subdivision 4, a county or consortium of counties 304.12may establish a service delivery authority to redesign the delivery of some or all essential 304.13services. Once a county or consortium of counties establishes a service delivery authority, 304.14no county that is a participant in the service delivery authority may participate in or be 304.15a member of any other service delivery authority. The service delivery authority may 304.16allow an additional county or counties to join the service delivery authority subject to the 304.17approval of the council and the commissioner.304.18    Subd. 2.New state-county governance framework.(a) To establish a service 304.19delivery authority, each participating county and the state must enter into a binding 304.20memorandum of understanding to establish a joint state-county service delivery 304.21framework:304.22(b) The memorandum of understanding must:304.23(1) comply with current state and federal law except where waivers are approved 304.24under clause (7);304.25(2) define the scope of essential services over which the service delivery authority 304.26has jurisdiction;304.27(3) designate a single administrative structure to oversee the delivery of services over 304.28which the service delivery authority has jurisdiction and identify a single administrative 304.29agent for purposes of contact and communication with the department;304.30(4) define measurable performance and outcome goals in key operational areas 304.31that the service delivery authority is expected to achieve, provided that the performance 304.32goals must, at a minimum, satisfy performance outcomes recommended by the steering 304.33committee and enacted into law;305.1(5) identify the state and local resources, including funding and administrative and 305.2information technology support, and other requirements necessary for the service delivery 305.3authority to achieve the performance and outcome goals;305.4(6) state the relief available to the service delivery authority if the resource 305.5commitments identified in clause (5) are not met;305.6(7) identify in the agreement the waivers from statutory requirements that are needed 305.7to ensure greater local control and flexibility to determine the most cost-effective means 305.8of achieving specified measurable goals and the date by which the commissioner shall 305.9grant the identified waivers;305.10(8) set forth a graduated accountability process and penalties for responding to a 305.11county's failure to make adequate progress on achieving performance and outcome goals;305.12(9) set forth a reasonable level of targeted reductions in overhead and administrative 305.13costs for each county participating in the service delivery authority; and305.14(10) set forth the terms under which a county may withdraw from participation.305.15The memorandum of understanding may be later amended to add additional services over 305.16which the service delivery authority has jurisdiction.305.17(c) Nothing in this chapter precludes local governments from utilizing sections 305.18465.81 and 465.82 to establish procedures for local governments to merge, with the 305.19consent of the voters. Any agreement under paragraph (b) must be governed by this 305.20chapter. Nothing in this chapter limits the authority of a county board to enter into 305.21contractual agreements for services not covered by the provisions of a memorandum of 305.22understanding establishing a service delivery authority with other agencies or with other 305.23units of government.305.24    Subd. 3.Duties.The service delivery authority shall:305.25(1) within the scope of essential services set forth in the memorandum of 305.26understanding establishing the authority, carry out the responsibilities required of local 305.27agencies under chapter 393 and human services boards under chapter 402;305.28(2) manage the public resources devoted to human services and other public services 305.29delivered or purchased by the counties that are subsidized or regulated by the Department 305.30of Human Services under chapters 245 and 267;305.31(3) employ staff to assist in carrying out its duties;305.32(4) develop and maintain a continuity of operations plan to ensure the continued 305.33operation or resumption of essential human services functions in the event of any business 305.34interruption according to local, state, and federal emergency planning requirements;305.35(5) receive and expend funds received for the redesign process under the 305.36memorandum of understanding;306.1(6) plan and deliver services directly or through contract with other governmental 306.2or nongovernmental providers;306.3(7) rent, purchase, sell, and otherwise dispose of real and personal property as 306.4necessary to carry out the redesign; and306.5(8) carry out any other service designated as a responsibility of a county.306.6    Subd. 4.Process for establishing a service delivery authority.(a) The county or 306.7consortium of counties proposing to form a service delivery authority shall, in conjunction 306.8with the commissioner, prevent a proposed memorandum of understanding to the council 306.9accompanied by a resolution from the board of commissioners of each participating 306.10county stating the county's intent to participate in a service delivery authority.306.11(b) The council shall certify a county or consortium of counties as a service delivery 306.12authority if:306.13(1) the conditions in subdivision 2, paragraphs (a) and (b), are met; and306.14(2) the county or consortium of counties are:306.15(i) a single county with a population of 55,000 or more;306.16(ii) a consortium of counties with a total combined population of 55,000 or more and 306.17the counties comprising the consortium are in reasonable geographic proximity; or306.18(iii) four or more counties in reasonable geographic proximity without regard 306.19to population.306.20The council may recommend that the commissioner of human services exempt a 306.21single county or multicounty service delivery authority from the minimum population 306.22standard if that service delivery authority can demonstrate that it can otherwise meet 306.23the requirements of this chapter.306.24(c) After the council has certified a county or consortium of counties as a service 306.25delivery authority, the commissioner may enter into the memoranda of understanding with 306.26the participating counties to form the service delivery authority.306.27    Subd. 5.Single county service delivery authority.For counties with populations 306.28over 55,000, the board of county commissioners may be the service delivery authority and 306.29retain existing authority under law.306.30    Sec. 7. [402A.45] ESSENTIAL SERVICES OUTSIDE THE JURISDICTION OF 306.31A SERVICE DELIVERY AUTHORITY.306.32(a) With the approval of the council, a county that is a participant in a service 306.33delivery authority may enter into cooperative arrangements with other service delivery 306.34authorities or other counties to provide essential services that are not within the jurisdiction 306.35and duties of the service delivery authority.307.1(b) With the approval of the council, a service delivery authority may enter into a 307.2cooperative arrangement with a nonparticipating county to provide an essential service 307.3within the jurisdiction and duties of the service delivery authority.307.4    Sec. 8. [402A.50] PRIVATE SECTOR FUNDING.307.5The council may support stakeholder agencies, if not otherwise prohibited by law, to 307.6separately or jointly seek and receive funds to provide expert technical assistance to the 307.7council, the council's work group, and any subwork groups for executing the provisions 307.8of the redesign. 307.9    Sec. 9. APPROPRIATION.307.10$350,000 is appropriated for the biennium beginning July 1, 2009, from the general 307.11fund to the State-County Results, Accountability, and Service Delivery Redesign Council, 307.12for the purposes of the State-County Results, Accountability, and Service Delivery Reform 307.13Act under Minnesota Statutes, sections 402A.01 to 402A.50. The council shall establish a 307.14methodology for distributing funds to certified service delivery authorities for the purposes 307.15of carrying out the requirements of the redesign.307.16ARTICLE 10307.17PUBLIC HEALTH307.18    Section 1. Minnesota Statutes 2008, section 103I.208, subdivision 2, is amended to 307.19read:307.20    Subd. 2. Permit fee. The permit fee to be paid by a property owner is:307.21    (1) for a water supply well that is not in use under a maintenance permit, $175 307.22annually;307.23    (2) for construction of a monitoring well, $215, which includes the state core 307.24function fee;307.25    (3) for a monitoring well that is unsealed under a maintenance permit, $175 annually;307.26    (4) for a monitoring well owned by a federal agency, state agency, or local unit of 307.27government that is unsealed under a maintenance permit, $50 annually. "Local unit of 307.28government" means a statutory or home rule charter city, town, county, or soil and water 307.29conservation district, watershed district, an organization formed for the joint exercise of 307.30powers under section 471.59, a board of health or community health board, or other 307.31special purpose district or authority with local jurisdiction in water and related land 307.32resources management;307.33(5) for monitoring wells used as a leak detection device at a single motor fuel retail 307.34outlet, a single petroleum bulk storage site excluding tank farms, or a single agricultural 308.1chemical facility site, the construction permit fee is $215, which includes the state core 308.2function fee, per site regardless of the number of wells constructed on the site, and 308.3the annual fee for a maintenance permit for unsealed monitoring wells is $175 per site 308.4regardless of the number of monitoring wells located on site;308.5    (5) (6) for a groundwater thermal exchange device, in addition to the notification fee 308.6for water supply wells, $215, which includes the state core function fee;308.7    (6) (7) for a vertical heat exchanger with less than ten tons of heating/cooling 308.8capacity, $215;308.9(8) for a vertical heat exchanger with ten to 50 tons of heating/cooling capacity, $425;308.10(9) for a vertical heat exchanger with greater than 50 tons of heating/cooling 308.11capacity, $650;308.12    (7) (10) for a dewatering well that is unsealed under a maintenance permit, $175 308.13annually for each dewatering well, except a dewatering project comprising more than five 308.14dewatering wells shall be issued a single permit for $875 annually for dewatering wells 308.15recorded on the permit; and308.16    (8) (11) for an elevator boring, $215 for each boring.308.17    Sec. 2. Minnesota Statutes 2008, section 144.121, subdivision 1a, is amended to read:308.18    Subd. 1a. Fees for ionizing radiation-producing equipment.(a) A facility with 308.19ionizing radiation-producing equipment must pay an annual initial or annual renewal 308.20registration fee consisting of a base facility fee of $66 $100 and an additional fee for 308.21each radiation source, as follows:

308.22(1)medical or veterinary equipment$53100308.23(2)dental x-ray equipment$3340308.24(3)accelerator$66308.25(4)radiation therapy equipment$66308.26308.27(5)(3)x-ray equipment not used on 
                  		humans or animals$53100308.28308.29308.30(6)(4)devices with sources of ionizing 
                  		radiation not used on humans or 
                  		animals$53100

308.31(b) A facility with radiation therapy and accelerator equipment must pay an annual 308.32registration fee of $500. A facility with an industrial accelerator must pay an annual 308.33registration fee of $150.309.1(c) Electron microscopy equipment is exempt from the registration fee requirements 309.2of this section.309.3    Sec. 3. Minnesota Statutes 2008, section 144.121, subdivision 1b, is amended to read:309.4    Subd. 1b. Penalty fee for late registration. Applications for initial or renewal 309.5registrations submitted to the commissioner after the time specified by the commissioner 309.6shall be accompanied by a penalty fee of $20 an amount equal to 25 percent of the fee 309.7due in addition to the fees prescribed in subdivision 1a.309.8    Sec. 4. Minnesota Statutes 2008, section 144.1222, subdivision 1a, is amended to read:309.9    Subd. 1a.  Fees. All plans and specifications for public pool and spa construction, 309.10installation, or alteration or requests for a variance that are submitted to the commissioner 309.11according to Minnesota Rules, part 4717.3975, shall be accompanied by the appropriate 309.12fees. All public pool construction plans submitted for review after January 1, 2009, 309.13must be certified by a professional engineer registered in the state of Minnesota. If the 309.14commissioner determines, upon review of the plans, that inadequate fees were paid, the 309.15necessary additional fees shall be paid before plan approval. For purposes of determining 309.16fees, a project is defined as a proposal to construct or install a public pool, spa, special 309.17purpose pool, or wading pool and all associated water treatment equipment and drains, 309.18gutters, decks, water recreation features, spray pads, and those design and safety features 309.19that are within five feet of any pool or spa. The commissioner shall charge the following 309.20fees for plan review and inspection of public pools and spas and for requests for variance 309.21from the public pool and spa rules: 309.22    (1) each pool, $800 $1,500; 309.23    (2) each spa pool, $500 $800; 309.24    (3) each slide, $400 $600; 309.25    (4) projects valued at $250,000 or more, the greater of the sum of the fees in clauses 309.26(1), (2), and (3) or 0.5 percent of the documented estimated project cost to a maximum 309.27fee of $10,000 $15,000; 309.28    (5) alterations to an existing pool without changing the size or configuration of 309.29the pool, $400 $600; 309.30    (6) removal or replacement of pool disinfection equipment only, $75 $100; and 309.31    (7) request for variance from the public pool and spa rules, $500. 309.32    Sec. 5. Minnesota Statutes 2008, section 144.125, subdivision 1, is amended to read:310.1    Subdivision 1. Duty to perform testing. It is the duty of (1) the administrative 310.2officer or other person in charge of each institution caring for infants 28 days or less 310.3of age, (2) the person required in pursuance of the provisions of section 
         144.215, to 310.4register the birth of a child, or (3) the nurse midwife or midwife in attendance at the 310.5birth, to arrange to have administered to every infant or child in its care tests for heritable 310.6and congenital disorders according to subdivision 2 and rules prescribed by the state 310.7commissioner of health. Testing and the recording and reporting of test results shall be 310.8performed at the times and in the manner prescribed by the commissioner of health. The 310.9commissioner shall charge a fee so that the total of fees collected will approximate the 310.10costs of conducting the tests and implementing and maintaining a system to follow-up 310.11infants with heritable or congenital disorders, including hearing loss detected through the 310.12early hearing detection and intervention program under section 
         144.966. The fee is $101 310.13per specimen. Effective July 1, 2010, the fee shall be increased to $106 per specimen. The 310.14increased fee amount shall be deposited in the general fund. Costs associated with capital 310.15expenditures and the development of new procedures may be prorated over a three-year 310.16period when calculating the amount of the fees. 310.17EFFECTIVE DATE.This section is effective July 1, 2010.310.18    Sec. 6. Minnesota Statutes 2008, section 144.72, subdivision 1, is amended to read:310.19    Subdivision 1. Permits License required. The state commissioner of health is 310.20authorized to issue permits for the operation of youth camps which are required to obtain 310.21the permits a license according to chapter 157.310.22    Sec. 7. Minnesota Statutes 2008, section 144.72, subdivision 3, is amended to read:310.23    Subd. 3. Issuance of permits license. If the commissioner should determine from 310.24the application that the health and safety of the persons using the camp will be properly 310.25safeguarded, the commissioner may, prior to actual inspection of the camp, issue the 310.26permit license in writing. No fee shall be charged for the permit. The permit license shall 310.27be posted in a conspicuous place on the premises occupied by the camp.310.28    Sec. 8. Minnesota Statutes 2008, section 144.9501, is amended by adding a subdivision 310.29to read:310.30    Subd. 8a.Disclosure pamphlet."Disclosure pamphlet" means the EPA pamphlet 310.31titled "Renovate Right: Important Lead Hazard Information for Families, Child Care 310.32Providers and Schools" developed under section 406(a) of the Toxic Substance Control 310.33Act.311.1    Sec. 9. Minnesota Statutes 2008, section 144.9501, subdivision 22b, is amended to 311.2read:311.3    Subd. 22b. Lead sampling technician. "Lead sampling technician" means an 311.4individual who performs clearance inspections for nonabatement or nonorder lead hazard 311.5reduction renovation sites, and lead dust sampling in other settings, or visual assessment 311.6for deteriorated paint for nonabatement sites, and who is registered with the commissioner 311.7under section 
         144.9505. 311.8    Sec. 10. Minnesota Statutes 2008, section 144.9501, subdivision 26a, is amended to 311.9read:311.10    Subd. 26a. Regulated lead work. (a) "Regulated lead work" means:311.11(1) abatement;311.12(2) interim controls;311.13(3) a clearance inspection;311.14(4) a lead hazard screen;311.15(5) a lead inspection;311.16(6) a lead risk assessment;311.17(7) lead project designer services;311.18(8) lead sampling technician services; or311.19(9) swab team services.;311.20(10) renovation activities; or311.21(11) activities performed to comply with lead orders issued by a board of health.311.22(b) Regulated lead work does not include abatement, interim controls, swab team 311.23services, or renovation activities that disturb painted surfaces that total no more than:311.24(1) activities such as remodeling, renovation, installation, rehabilitation, or 311.25landscaping activities, the primary intent of which is to remodel, repair, or restore a 311.26structure or dwelling, rather than to permanently eliminate lead hazards, even though these 311.27activities may incidentally result in a reduction in lead hazards; or311.28(2) interim control activities that are not performed as a result of a lead order and 311.29that do not disturb painted surfaces that total more than:311.30(i) (1) 20 square feet (two square meters) on exterior surfaces; or311.31(ii) two (2) six square feet (0.2 0.6 square meters) in an interior room; or.311.32(iii) ten percent of the total surface area on an interior or exterior type of component 311.33with a small surface area.312.1    Sec. 11. Minnesota Statutes 2008, section 144.9501, is amended by adding a 312.2subdivision to read:312.3    Subd. 26b.Renovation."Renovation" means the modification of any affected 312.4property that results in the disturbance of painted surfaces, unless that activity is performed 312.5as an abatement. A renovation performed for the purpose of converting a building or part 312.6of a building into an affected property is a renovation under this subdivision.312.7    Sec. 12. Minnesota Statutes 2008, section 144.9505, subdivision 1g, is amended to 312.8read:312.9    Subd. 1g. Certified lead firm.A person within the state intending to directly 312.10perform or cause to be performed through subcontracting or similar delegation any 312.11regulated lead work shall first obtain certification from the commissioner A person who 312.12employs individuals to perform regulated lead work outside of the person's property must 312.13obtain certification as a lead firm. The certificate must be in writing, contain an expiration 312.14date, be signed by the commissioner, and give the name and address of the person to 312.15whom it is issued. The certification fee is $100, is nonrefundable, and must be submitted 312.16with each application. The certificate or a copy of the certificate must be readily available 312.17at the worksite for review by the contracting entity, the commissioner, and other public 312.18health officials charged with the health, safety, and welfare of the state's citizens.312.19    Sec. 13. Minnesota Statutes 2008, section 144.9505, subdivision 4, is amended to read:312.20    Subd. 4. Notice of regulated lead work. (a) At least five working days before 312.21starting work at each regulated lead worksite, the person performing the regulated lead 312.22work shall give written notice to the commissioner and the appropriate board of health.312.23(b) This provision does not apply to lead hazard screen, lead inspection, lead risk 312.24assessment, lead sampling technician, renovation, or lead project design activities.312.25    Sec. 14. Minnesota Statutes 2008, section 144.9508, subdivision 2, is amended to read:312.26    Subd. 2. Regulated lead work standards and methods. (a) The commissioner 312.27shall adopt rules establishing regulated lead work standards and methods in accordance 312.28with the provisions of this section, for lead in paint, dust, drinking water, and soil in 312.29a manner that protects public health and the environment for all residences, including 312.30residences also used for a commercial purpose, child care facilities, playgrounds, and 312.31schools.312.32(b) In the rules required by this section, the commissioner shall require lead hazard 312.33reduction of intact paint only if the commissioner finds that the intact paint is on a 313.1chewable or lead-dust producing surface that is a known source of actual lead exposure to 313.2a specific individual. The commissioner shall prohibit methods that disperse lead dust into 313.3the air that could accumulate to a level that would exceed the lead dust standard specified 313.4under this section. The commissioner shall work cooperatively with the commissioner 313.5of administration to determine which lead hazard reduction methods adopted under this 313.6section may be used for lead-safe practices including prohibited practices, preparation, 313.7disposal, and cleanup. The commissioner shall work cooperatively with the commissioner 313.8of the Pollution Control Agency to develop disposal procedures. In adopting rules under 313.9this section, the commissioner shall require the best available technology for regulated 313.10lead work methods, paint stabilization, and repainting.313.11(c) The commissioner of health shall adopt regulated lead work standards and 313.12methods for lead in bare soil in a manner to protect public health and the environment. 313.13The commissioner shall adopt a maximum standard of 100 parts of lead per million in 313.14bare soil. The commissioner shall set a soil replacement standard not to exceed 25 parts 313.15of lead per million. Soil lead hazard reduction methods shall focus on erosion control 313.16and covering of bare soil.313.17(d) The commissioner shall adopt regulated lead work standards and methods for 313.18lead in dust in a manner to protect the public health and environment. Dust standards 313.19shall use a weight of lead per area measure and include dust on the floor, on the window 313.20sills, and on window wells. Lead hazard reduction methods for dust shall focus on dust 313.21removal and other practices which minimize the formation of lead dust from paint, soil, or 313.22other sources.313.23(e) The commissioner shall adopt lead hazard reduction standards and methods for 313.24lead in drinking water both at the tap and public water supply system or private well 313.25in a manner to protect the public health and the environment. The commissioner may 313.26adopt the rules for controlling lead in drinking water as contained in Code of Federal 313.27Regulations, title 40, part 141. Drinking water lead hazard reduction methods may include 313.28an educational approach of minimizing lead exposure from lead in drinking water.313.29(f) The commissioner of the Pollution Control Agency shall adopt rules to ensure that 313.30removal of exterior lead-based coatings from residences and steel structures by abrasive 313.31blasting methods is conducted in a manner that protects health and the environment.313.32(g) All regulated lead work standards shall provide reasonable margins of safety that 313.33are consistent with more than a summary review of scientific evidence and an emphasis on 313.34overprotection rather than underprotection when the scientific evidence is ambiguous.313.35(h) No unit of local government shall have an ordinance or regulation governing 313.36regulated lead work standards or methods for lead in paint, dust, drinking water, or soil 314.1that require a different regulated lead work standard or method than the standards or 314.2methods established under this section.314.3(i) Notwithstanding paragraph (h), the commissioner may approve the use by a unit 314.4of local government of an innovative lead hazard reduction method which is consistent 314.5in approach with methods established under this section.314.6(j) The commissioner shall adopt rules for issuing lead orders required under section 314.7144.9504
         , rules for notification of abatement or interim control activities requirements, 314.8and other rules necessary to implement sections 
         144.9501 to 
         144.9512. 314.9(k) The commissioner shall adopt rules consistent with section 402(c)(3) of the 314.10Toxic Substances Control Act to ensure that renovation in a pre-1978 affected property 314.11where a child or pregnant female resides is conducted in a manner that protects health 314.12and the environment.314.13(l) The commissioner shall adopt rules consistent with sections 406(a) and 406(b) of 314.14the Toxic Substances Control Act.314.15    Sec. 15. Minnesota Statutes 2008, section 144.9508, subdivision 3, is amended to read:314.16    Subd. 3. Licensure and certification. The commissioner shall adopt rules to 314.17license lead supervisors, lead workers, lead project designers, lead inspectors, and lead 314.18risk assessors, and lead sampling technicians. The commissioner shall also adopt rules 314.19requiring certification of firms that perform regulated lead work and rules requiring 314.20registration of lead sampling technicians. The commissioner shall require periodic renewal 314.21of licenses, and certificates, and registrations and shall establish the renewal periods.314.22    Sec. 16. Minnesota Statutes 2008, section 144.9508, subdivision 4, is amended to read:314.23    Subd. 4. Lead training course. The commissioner shall establish by rule 314.24requirements for training course providers and the renewal period for each lead-related 314.25training course required for certification or licensure. The commissioner shall establish 314.26criteria in rules for the content and presentation of training courses intended to qualify 314.27trainees for licensure under subdivision 3. The commissioner shall establish criteria 314.28in rules for the content and presentation of training courses for lead interim control 314.29workers renovation and lead sampling technicians. Training course permit fees shall be 314.30nonrefundable and must be submitted with each application in the amount of $500 for an 314.31initial training course, $250 for renewal of a permit for an initial training course, $250 for 314.32a refresher training course, and $125 for renewal of a permit of a refresher training course.314.33    Sec. 17. Minnesota Statutes 2008, section 144.9512, subdivision 2, is amended to read:315.1    Subd. 2. Grants; administration. Within the limits of the available appropriation, 315.2the commissioner shall make grants to a nonprofit organization currently operating the 315.3CLEARCorps lead hazard reduction project organizations to train workers to provide lead 315.4screening, education, outreach, and swab team services for residential property. Projects 315.5that provide Americorps funding or positions, or leverage matching funds, as part of the 315.6delivery of the services must be given priority for the grant funds.315.7    Sec. 18. Minnesota Statutes 2008, section 144.966, is amended by adding a subdivision 315.8to read:315.9    Subd. 3a.Support services to families.The commissioner shall contract with 315.10a nonprofit organization to provide support and assistance to families with children 315.11who are deaf or have a hearing loss. The family support provided must include direct 315.12parent-to-parent assistance and information on communication, educational, and medical 315.13options. The commissioner shall give preference to a nonprofit organization that has the 315.14ability to provide these services throughout the state.315.15    Sec. 19. Minnesota Statutes 2008, section 144.97, subdivision 2, is amended to read:315.16    Subd. 2. Certification Accreditation."Certification" means written 315.17acknowledgment of a laboratory's demonstrated capability to perform tests for a specific 315.18purpose "Accreditation" means written acknowledgment that a laboratory has the 315.19policies, procedures, equipment, and practices to produce reliable data in the analysis of 315.20environmental samples.315.21EFFECTIVE DATE.This section is effective July 1, 2009.315.22    Sec. 20. Minnesota Statutes 2008, section 144.97, subdivision 4, is amended to read:315.23    Subd. 4. ContractCommercial laboratory. "Contract Commercial laboratory" 315.24means a laboratory that performs tests on samples on a contract or fee-for-service basis.315.25EFFECTIVE DATE.This section is effective July 1, 2009.315.26    Sec. 21. Minnesota Statutes 2008, section 144.97, is amended by adding a subdivision 315.27to read:315.28    Subd. 5a.Field of testing."Field of testing" means the combination of analyte, 315.29method, matrix, and test category for which a laboratory may hold accreditation.315.30EFFECTIVE DATE.This section is effective July 1, 2009.316.1    Sec. 22. Minnesota Statutes 2008, section 144.97, subdivision 6, is amended to read:316.2    Subd. 6. Laboratory. "Laboratory" means the state, a person, corporation, or other 316.3entity, including governmental, that examines, analyzes, or tests samples in a specified 316.4physical location.316.5EFFECTIVE DATE.This section is effective July 1, 2009.316.6    Sec. 23. Minnesota Statutes 2008, section 144.97, is amended by adding a subdivision 316.7to read:316.8    Subd. 8.Test category."Test category" means the combination of program and 316.9category as provided by section 144.98, subdivisions 3, paragraph (b), clauses (1) to (10), 316.10and 3a, paragraph (a), clauses (1) to (5).316.11EFFECTIVE DATE.This section is effective July 1, 2009.316.12    Sec. 24. Minnesota Statutes 2008, section 144.98, subdivision 1, is amended to read:316.13    Subdivision 1. Authorization. The commissioner of health may certify shall 316.14accredit environmental laboratories that test environmental samples according to national 316.15standards developed using a consensus process as established by Circular A-119, 316.16published by the United States Office of Management and Budget.316.17EFFECTIVE DATE.This section is effective July 1, 2009.316.18    Sec. 25. Minnesota Statutes 2008, section 144.98, subdivision 2, is amended to read:316.19    Subd. 2. Rules and standards. The commissioner may adopt rules to implement 316.20this section, including: carry out the commissioner's responsibilities under the national 316.21standards specified in subdivisions 1 and 2a.316.22(1) procedures, requirements, and fee adjustments for laboratory certification, 316.23including provisional status and recertification;316.24(2) standards and fees for certificate approval, suspension, and revocation;316.25(3) standards for environmental samples;316.26(4) analysis methods that assure reliable test results;316.27(5) laboratory quality assurance, including internal quality control, proficiency 316.28testing, and personnel training; and316.29(6) criteria for recognition of certification programs of other states and the federal 316.30government.316.31EFFECTIVE DATE.This section is effective July 1, 2009.317.1    Sec. 26. Minnesota Statutes 2008, section 144.98, is amended by adding a subdivision 317.2to read:317.3    Subd. 2a.Standards.The commissioner shall accredit laboratories according to 317.4the most current environmental laboratory accreditation standards under subdivision 1 317.5and as accepted by the accreditation bodies recognized by the National Environmental 317.6Laboratory Accreditation Program (NELAP) of the NELAC Institute.317.7EFFECTIVE DATE.This section is effective July 1, 2009.317.8    Sec. 27. Minnesota Statutes 2008, section 144.98, subdivision 3, is amended to read:317.9    Subd. 3. Annual fees. (a) An application for certification accreditation under 317.10subdivision 1 6 must be accompanied by the biennial fee annual fees specified in this 317.11subdivision. The fees are for annual fees include:317.12(1) base certification accreditation fee, $1,600 $1,500;317.13(2) sample preparation techniques fees fee, $100 $200 per technique; and317.14(3) an administrative fee for laboratories located outside this state, $3,750; and317.15(4) test category certification fees:.

317.16Test CategoryCertification Fee317.17Clean water program bacteriology$800317.18Safe drinking water program bacteriology$800317.19Clean water program inorganic chemistry$800317.20Safe drinking water program inorganic chemistry$800317.21Clean water program chemistry metals$1,200317.22Safe drinking water program chemistry metals$1,200317.23Resource conservation and recovery program chemistry metals$1,200317.24Clean water program volatile organic compounds$1,500317.25Safe drinking water program volatile organic compounds$1,500317.26317.27Resource conservation and recovery program volatile organic compounds$1,500317.28Underground storage tank program volatile organic compounds$1,500317.29Clean water program other organic compounds$1,500317.30Safe drinking water program other organic compounds$1,500317.31Resource conservation and recovery program other organic compounds$1,500318.1Clean water program radiochemistry$2,500318.2Safe drinking water program radiochemistry$2,500318.3Resource conservation and recovery program agricultural contaminants$2,500318.4Resource conservation and recovery program emerging contaminants$2,500

318.5(b) Laboratories located outside of this state that require an on-site inspection shall be 318.6assessed an additional $3,750 fee. For the programs in subdivision 3a, the commissioner 318.7may accredit laboratories for fields of testing under the categories listed in clauses (1) to 318.8(10) upon completion of the application requirements provided by subdivision 6 and 318.9receipt of the fees for each category under each program that accreditation is requested. 318.10The categories offered and related fees include:318.11(1) microbiology, $450;318.12(2) inorganics, $450;318.13(3) metals, $1,000;318.14(4) volatile organics, $1,300;318.15(5) other organics, $1,300;318.16(6) radiochemistry, $1,500;318.17(7) emerging contaminants, $1,500;318.18(8) agricultural contaminants, $1,250;318.19(9) toxicity (bioassay), $1,000; and318.20(10) physical characterization, $250.318.21(c) The total biennial certification annual fee includes the base fee, the sample 318.22preparation techniques fees, the test category fees per program, and, when applicable, the 318.23on-site inspection fee an administrative fee for out-of-state laboratories.318.24(d) Fees must be set so that the total fees support the laboratory certification program. 318.25Direct costs of the certification service include program administration, inspections, the 318.26agency's general support costs, and attorney general costs attributable to the fee function.318.27(e) A change fee shall be assessed if a laboratory requests additional analytes 318.28or methods at any time other than when applying for or renewing its certification. The 318.29change fee is equal to the test category certification fee for the analyte.318.30(f) A variance fee shall be assessed if a laboratory requests and is granted a variance 318.31from a rule adopted under this section. The variance fee is $500 per variance.318.32(g) Refunds or credits shall not be made for analytes or methods requested but 318.33not approved.318.34(h) Certification of a laboratory shall not be awarded until all fees are paid.319.1    Sec. 28. Minnesota Statutes 2008, section 144.98, is amended by adding a subdivision 319.2to read:319.3    Subd. 3a.Available programs, categories, and analytes.(a) The commissioner 319.4shall accredit laboratories that test samples under the following programs:319.5(1) the clean water program, such as compliance monitoring under the federal Clean 319.6Water Act, and ambient monitoring of surface and groundwater, or analysis of biological 319.7tissue;319.8(2) the safe drinking water program, including compliance monitoring under the 319.9federal Safe Drinking Water Act, and the state requirements for monitoring private wells;319.10(3) the resource conservation and recovery program, including federal and state 319.11requirements for monitoring solid and hazardous wastes, biological tissue, leachates, and 319.12groundwater monitoring wells not intended as drinking water sources;319.13(4) the underground storage tank program; and319.14(5) the clean air program, including air and emissions testing under the federal Clean 319.15Air Act, and state and federal requirements for vapor intrusion monitoring.319.16(b) The commissioner shall maintain and publish a list of analytes available for 319.17accreditation. The list must be reviewed at least once every six months and the changes 319.18published in the State Register and posted on the program's Web site. The commissioner 319.19shall publish the notification of changes and review comments on the changes no less than 319.2030 days from the date the list is published.319.21    Sec. 29. Minnesota Statutes 2008, section 144.98, is amended by adding a subdivision 319.22to read:319.23    Subd. 3b.Additional fees.(a) Laboratories located outside of this state that require 319.24an on-site assessment more frequent than once every two years must pay an additional 319.25assessed fee of $3,000 per assessment for each additional on-site assessment conducted. 319.26The laboratory must pay the fee within 15 business days of receiving the commissioner's 319.27notification that an on-site assessment is required. The commissioner may conduct 319.28additional on-site assessments to determine a laboratory's continued compliance with 319.29the standards provided in subdivision 2a.319.30(b) A late fee of $200 shall be added to the annual fee for accredited laboratories 319.31submitting renewal applications to the commissioner after November 1.319.32(c) A change fee shall be assessed if a laboratory requests additional fields of testing 319.33at any time other than when initially applying for or renewing its accreditation. A change 319.34fee does not apply for applications to add fields of testing for new analytes in response 319.35to the published notice under subdivision 3a, paragraph (b), if the laboratory holds valid 320.1accreditation for the changed test category and applies for additional analytes within the 320.2same test category. The change fee is equal to the applicable test category fee for the 320.3field of testing requested. An application that requests accreditation of multiple fields of 320.4testing within a test category requires a single payment of the applicable test category fee 320.5per application submitted.320.6(d) A variance fee shall be assessed if a laboratory requests a variance from a 320.7standard provided in subdivision 2a. The variance fee is $500 per variance.320.8(e) The commissioner shall assess a fee for changes to laboratory information 320.9regarding ownership, name, address, or personnel. Laboratories must submit changes 320.10through the application process under subdivision 6. The information update fee is $250 320.11per application.320.12(f) Fees must be set so that the total fees support the laboratory accreditation 320.13program. Direct costs of the accreditation service include program administration, 320.14assessments, the agency's general support costs, and attorney general costs attributable 320.15to the fee function.320.16    Sec. 30. Minnesota Statutes 2008, section 144.98, is amended by adding a subdivision 320.17to read:320.18    Subd. 3c.Refunds and nonpayment.Refunds or credits shall not be made for 320.19applications received but not approved. Accreditation of a laboratory shall not be awarded 320.20until all fees are paid.320.21    Sec. 31. Minnesota Statutes 2008, section 144.98, is amended by adding a subdivision 320.22to read:320.23    Subd. 6.Application.(a) Laboratories seeking accreditation must apply on a form 320.24provided by the commissioner, include the laboratory's procedures and quality manual, 320.25and pay the applicable fees.320.26(b) Laboratories may be fixed-base or mobile. The commissioner shall accredit 320.27mobile laboratories individually and require a vehicle identification number, license 320.28plate number, or other uniquely identifying information in addition to the application 320.29requirements of paragraph (a).320.30(c) Laboratories maintained on separate properties, even though operated under the 320.31same management or ownership, must apply separately. Laboratories with more than one 320.32building on the same or adjoining properties do not need to submit a separate application.320.33(d) The commissioner may accredit laboratories located out-of-state. Accreditation 320.34for out-of-state laboratories may be obtained directly from the commissioner following 321.1the requirements in paragraph (a), or out-of-state laboratories may be accredited through 321.2a reciprocal agreement if the laboratory:321.3(1) is accredited by a NELAP-recognized accreditation body for those fields of 321.4testing in which the laboratory requests accreditation from the commissioner;321.5(2) submits an application and documentation according to this subdivision; and321.6(3) submits a current copy of the laboratory's unexpired accreditation from a 321.7NELAP-recognized accreditation body showing the fields of accreditation for which the 321.8laboratory is currently accredited.321.9(e) Under the conflict of interest determinations provided in section 43A.38, 321.10subdivision 6, clause (a), the commissioner shall not accredit governmental laboratories 321.11operated by agencies of the executive branch of the state. If accreditation is required, 321.12laboratories operated by agencies of the executive branch of the state must apply for 321.13accreditation through any other NELAP-recognized accreditation body.321.14EFFECTIVE DATE.This section is effective July 1, 2009.321.15    Sec. 32. Minnesota Statutes 2008, section 144.98, is amended by adding a subdivision 321.16to read:321.17    Subd. 6a.Implementation and effective date.All laboratories must comply with 321.18standards under this section by July 1, 2009. Fees under subdivisions 3 and 3b apply to 321.19applications received and accreditations issued after June 30, 2009. Accreditations issued 321.20on or before June 30, 2009, shall expire upon their current expiration date.321.21    Sec. 33. Minnesota Statutes 2008, section 144.98, is amended by adding a subdivision 321.22to read:321.23    Subd. 7.Initial accreditation and annual accreditation renewal.(a) The 321.24commissioner shall issue or renew accreditation after receipt of the completed application 321.25and documentation required in this section, provided the laboratory maintains compliance 321.26with the standards specified in subdivision 2a, and attests to the compliance on the 321.27application form.321.28(b) The commissioner shall prorate the fees in subdivision 3 for laboratories 321.29applying for accreditation after December 31. The fees are prorated on a quarterly basis 321.30beginning with the quarter in which the commissioner receives the completed application 321.31from the laboratory.321.32(c) Applications for renewal of accreditation must be received by November 1 and 321.33no earlier than October 1 of each year. The commissioner shall send annual renewal 322.1notices to laboratories 90 days before expiration. Failure to receive a renewal notice does 322.2not exempt laboratories from meeting the annual November 1 renewal date.322.3(d) The commissioner shall issue all accreditations for the calendar year for which 322.4the application is made, and the accreditation shall expire on December 31 of that year.322.5(e) The accreditation of any laboratory that fails to submit a renewal application 322.6and fees to the commissioner expires automatically on December 31 without notice or 322.7further proceeding. Any person who operates a laboratory as accredited after expiration of 322.8accreditation or without having submitted an application and paid the fees is in violation 322.9of the provisions of this section and is subject to enforcement action under sections 322.10144.989 to 144.993, the Health Enforcement Consolidation Act. A laboratory with expired 322.11accreditation may reapply under subdivision 6.322.12EFFECTIVE DATE.This section is effective July 1, 2009.322.13    Sec. 34. Minnesota Statutes 2008, section 144.99, subdivision 1, is amended to read:322.14    Subdivision 1. Remedies available. The provisions of chapters 103I and 157 and 322.15sections 
         115.71 to 
         115.77; 
         144.12, subdivision 1, paragraphs (1), (2), (5), (6), (10), (12), 322.16(13), (14), and (15)
         ; 
         144.1201 to 
         144.1204; 
         144.121; 
         144.1222; 
         144.35; 
         144.381 to 322.17144.385
         ; 
         144.411 to 
         144.417; 
         144.495; 
         144.71 to 
         144.74; 
         144.9501 to 
         144.9512; 144.97 322.18to 144.98;144.992; 
         326.70 to 
         326.785; 
         327.10 to 
         327.131; and 
         327.14 to 
         327.28 and 322.19all rules, orders, stipulation agreements, settlements, compliance agreements, licenses, 322.20registrations, certificates, and permits adopted or issued by the department or under any 322.21other law now in force or later enacted for the preservation of public health may, in 322.22addition to provisions in other statutes, be enforced under this section. 322.23EFFECTIVE DATE.This section is effective July 1, 2009.322.24    Sec. 35. Minnesota Statutes 2008, section 153A.17, is amended to read:322.25153A.17 EXPENSES; FEES.322.26The expenses for administering the certification requirements including the 322.27complaint handling system for hearing aid dispensers in sections 153A.14 and 153A.15322.28and the Consumer Information Center under section 153A.18 must be paid from 322.29initial application and examination fees, renewal fees, penalties, and fines. All fees 322.30are nonrefundable. The certificate application fee is $350, the examination fee is $250 322.31for the written portion and $250 for the practical portion each time one or the other is 322.32taken, and the trainee application fee is $200. The penalty fee for late submission of a 322.33renewal application is $200. The fee for verification of certification to other jurisdictions 322.34or entities is $25. All fees, penalties, and fines received must be deposited in the state 323.1government special revenue fund. The commissioner may prorate the certification fee for 323.2new applicants based on the number of quarters remaining in the annual certification 323.3period.(a) The expenses for administering the certification requirements, including the 323.4complaint handling system for hearing aid dispensers in sections 153A.14 and 153A.15, 323.5and the Consumer Information Center under section 153A.18, must be paid from initial 323.6application and examination fees, renewal fees, penalties, and fines. 323.7 (b) The fees are as follows:323.8(1) the initial and annual renewal certification application fee is $600;323.9(2) the initial examination fee for the written portion is $500, and for each time it 323.10is taken, thereafter;323.11(3) the initial examination fee for the practical portion is $1,200, and $600 for each 323.12time it is taken, thereafter; for individuals meeting the requirements of section 148.515, 323.13subdivision 2, the fee for the practical portion of the hearing instrument dispensing 323.14examination is $250 each time it is taken;323.15(4) the trainee application fee is $200;323.16(5) the penalty fee for late submission of a renewal application is $200; and 323.17(6) the fee for verification of certification to other jurisdictions or entities is $25.323.18(c) The commissioner may prorate the certification fee for new applicants based on 323.19the number of quarters remaining in the annual certification period.323.20(d) All fees are nonrefundable. All fees, penalties, and fines received must be 323.21deposited in the state government special revenue fund.323.22(e) Beginning July 1, 2009, until June 30, 2016, a surcharge of $100 shall be paid 323.23at the time of initial certification application or renewal to recover the commissioner's 323.24accumulated direct expenditures for administering the requirements of this chapter.323.25    Sec. 36. Minnesota Statutes 2008, section 157.15, is amended by adding a subdivision 323.26to read:323.27    Subd. 20.Youth camp."Youth camp" has the meaning given in section 144.71, 323.28subdivision 2.323.29    Sec. 37. Minnesota Statutes 2008, section 157.16, is amended to read:323.30157.16 LICENSES REQUIRED; FEES. 323.31    Subdivision 1.  License required annually. A license is required annually for every 323.32person, firm, or corporation engaged in the business of conducting a food and beverage 323.33service establishment, youth camp, hotel, motel, lodging establishment, public pool, or 323.34resort. Any person wishing to operate a place of business licensed in this section shall 324.1first make application, pay the required fee specified in this section, and receive approval 324.2for operation, including plan review approval. Seasonal and temporary food stands and324.3Special event food stands are not required to submit plans. Nonprofit organizations 324.4operating a special event food stand with multiple locations at an annual one-day event 324.5shall be issued only one license. Application shall be made on forms provided by the 324.6commissioner and shall require the applicant to state the full name and address of the 324.7owner of the building, structure, or enclosure, the lessee and manager of the food and 324.8beverage service establishment, hotel, motel, lodging establishment, public pool, or resort; 324.9the name under which the business is to be conducted; and any other information as may 324.10be required by the commissioner to complete the application for license. 324.11    Subd. 2.  License renewal. Initial and renewal licenses for all food and beverage 324.12service establishments, youth camps, hotels, motels, lodging establishments, public pools, 324.13and resorts shall be issued for the calendar year for which application is made and shall 324.14expire on December 31 of such year on an annual basis. Any person who operates a place 324.15of business after the expiration date of a license or without having submitted an application 324.16and paid the fee shall be deemed to have violated the provisions of this chapter and shall 324.17be subject to enforcement action, as provided in the Health Enforcement Consolidation 324.18Act, sections 
         144.989 to 
         144.993. In addition, a penalty of $50 $60 shall be added to the 324.19total of the license fee for any food and beverage service establishment operating without 324.20a license as a mobile food unit, a seasonal temporary or seasonal permanent food stand, or 324.21a special event food stand, and a penalty of $100 $120 shall be added to the total of the 324.22license fee for all restaurants, food carts, hotels, motels, lodging establishments, youth 324.23camps, public pools, and resorts operating without a license for a period of up to 30 days. 324.24A late fee of $300 $360 shall be added to the license fee for establishments operating more 324.25than 30 days without a license. 324.26    Subd. 2a.  Food manager certification. An applicant for certification or certification 324.27renewal as a food manager must submit to the commissioner a $28 $35 nonrefundable 324.28certification fee payable to the Department of Health. The commissioner shall issue a 324.29duplicate certificate to replace a lost, destroyed, or mutilated certificate if the applicant 324.30submits a completed application on a form provided by the commissioner for a duplicate 324.31certificate and pays $20 to the department for the cost of duplication.324.32    Subd. 3.  Establishment fees; definitions. (a) The following fees are required 324.33for food and beverage service establishments, youth camps, hotels, motels, lodging 324.34establishments, public pools, and resorts licensed under this chapter. Food and beverage 324.35service establishments must pay the highest applicable fee under paragraph (d), clause 325.1(1), (2), (3), or (4), and establishments serving alcohol must pay the highest applicable 325.2fee under paragraph (d), clause (6) or (7). The license fee for new operators previously 325.3licensed under this chapter for the same calendar year is one-half of the appropriate annual 325.4license fee, plus any penalty that may be required. The license fee for operators opening 325.5on or after October 1 is one-half of the appropriate annual license fee, plus any penalty 325.6that may be required. 325.7    (b) All food and beverage service establishments, except special event food stands, 325.8and all hotels, motels, lodging establishments, public pools, and resorts shall pay an 325.9annual base fee of $150. 325.10    (c) A special event food stand shall pay a flat fee of $40 $50 annually. "Special event 325.11food stand" means a fee category where food is prepared or served in conjunction with 325.12celebrations, county fairs, or special events from a special event food stand as defined 325.13in section 
         157.15. 325.14    (d) In addition to the base fee in paragraph (b), each food and beverage service 325.15establishment, other than a special event food stand, and each hotel, motel, lodging 325.16establishment, public pool, and resort shall pay an additional annual fee for each fee 325.17category, additional food service, or required additional inspection specified in this 325.18paragraph: 325.19    (1) Limited food menu selection, $50 $60. "Limited food menu selection" means a 325.20fee category that provides one or more of the following: 325.21    (i) prepackaged food that receives heat treatment and is served in the package; 325.22    (ii) frozen pizza that is heated and served; 325.23    (iii) a continental breakfast such as rolls, coffee, juice, milk, and cold cereal; 325.24    (iv) soft drinks, coffee, or nonalcoholic beverages; or 325.25    (v) cleaning for eating, drinking, or cooking utensils, when the only food served 325.26is prepared off site. 325.27    (2) Small establishment, including boarding establishments, $100 $120. "Small 325.28establishment" means a fee category that has no salad bar and meets one or more of 325.29the following: 325.30    (i) possesses food service equipment that consists of no more than a deep fat fryer, a 325.31grill, two hot holding containers, and one or more microwave ovens; 325.32    (ii) serves dipped ice cream or soft serve frozen desserts; 325.33    (iii) serves breakfast in an owner-occupied bed and breakfast establishment; 325.34    (iv) is a boarding establishment; or 325.35    (v) meets the equipment criteria in clause (3), item (i) or (ii), and has a maximum 325.36patron seating capacity of not more than 50. 326.1    (3) Medium establishment, $260 $310. "Medium establishment" means a fee 326.2category that meets one or more of the following: 326.3    (i) possesses food service equipment that includes a range, oven, steam table, salad 326.4bar, or salad preparation area; 326.5    (ii) possesses food service equipment that includes more than one deep fat fryer, 326.6one grill, or two hot holding containers; or 326.7    (iii) is an establishment where food is prepared at one location and served at one or 326.8more separate locations. 326.9    Establishments meeting criteria in clause (2), item (v), are not included in this fee 326.10category. 326.11    (4) Large establishment, $460 $540. "Large establishment" means either: 326.12    (i) a fee category that (A) meets the criteria in clause (3), items (i) or (ii), for a 326.13medium establishment, (B) seats more than 175 people, and (C) offers the full menu 326.14selection an average of five or more days a week during the weeks of operation; or 326.15    (ii) a fee category that (A) meets the criteria in clause (3), item (iii), for a medium 326.16establishment, and (B) prepares and serves 500 or more meals per day. 326.17    (5) Other food and beverage service, including food carts, mobile food units, 326.18seasonal temporary food stands, and seasonal permanent food stands, $50 $60. 326.19    (6) Beer or wine table service, $50 $60. "Beer or wine table service" means a fee 326.20category where the only alcoholic beverage service is beer or wine, served to customers 326.21seated at tables. 326.22    (7) Alcoholic beverage service, other than beer or wine table service, $135 $165. 326.23    "Alcohol beverage service, other than beer or wine table service" means a fee 326.24category where alcoholic mixed drinks are served or where beer or wine are served from 326.25a bar. 326.26    (8) Lodging per sleeping accommodation unit, $8 $10, including hotels, motels, 326.27lodging establishments, and resorts, up to a maximum of $800 $1,000. "Lodging per 326.28sleeping accommodation unit" means a fee category including the number of guest rooms, 326.29cottages, or other rental units of a hotel, motel, lodging establishment, or resort; or the 326.30number of beds in a dormitory. 326.31    (9) First public pool, $180 $325; each additional public pool, $100 $175. "Public 326.32pool" means a fee category that has the meaning given in section 
         144.1222, subdivision 4. 326.33    (10) First spa, $110 $175; each additional spa, $50 $100. "Spa pool" means a fee 326.34category that has the meaning given in Minnesota Rules, part 4717.0250, subpart 9. 326.35    (11) Private sewer or water, $50 $60. "Individual private water" means a fee 326.36category with a water supply other than a community public water supply as defined in 327.1Minnesota Rules, chapter 4720. "Individual private sewer" means a fee category with an 327.2individual sewage treatment system which uses subsurface treatment and disposal. 327.3    (12) Additional food service, $130 $150. "Additional food service" means a location 327.4at a food service establishment, other than the primary food preparation and service area, 327.5used to prepare or serve food to the public. 327.6    (13) Additional inspection fee, $300 $360. "Additional inspection fee" means a 327.7fee to conduct the second inspection each year for elementary and secondary education 327.8facility school lunch programs when required by the Richard B. Russell National School 327.9Lunch Act. 327.10    (e) A fee of $350 for review of the construction plans must accompany the initial 327.11license application for restaurants, hotels, motels, lodging establishments, or resorts with 327.12five or more sleeping units., seasonal food stands, and mobile food units. The fee for 327.13this construction plan review is as follows:

327.14Service AreaTypeFee327.15Foodlimited food menu$275327.16small establishment$400327.17medium establishment$450327.18large food establishment$500327.19additional food service$150327.20Transient food servicefood cart$250327.21seasonal permanent food stand$250327.22seasonal temporary food stand$250327.23mobile food unit$350327.24Alcoholbeer or wine table service$150327.25alcohol service from bar$250327.26Lodgingless than 25 rooms$375327.2725 to less than 100 rooms$400327.28100 rooms or more$500327.29less than five cabins$350327.30five to less than ten cabins$400327.31ten cabins or more$450

328.1    (f) When existing food and beverage service establishments, hotels, motels, lodging 328.2establishments, or resorts, seasonal food stands, and mobile food units are extensively 328.3remodeled, a fee of $250 must be submitted with the remodeling plans. A fee of $250 328.4must be submitted for new construction or remodeling for a restaurant with a limited food 328.5menu selection, a seasonal permanent food stand, a mobile food unit, or a food cart, or for 328.6a hotel, motel, resort, or lodging establishment addition of less than five sleeping units.328.7The fee for this construction plan review is as follows:

328.8Service AreaTypeFee328.9Foodlimited food menu$250328.10small establishment$300328.11medium establishment$350328.12large food establishment$400328.13additional food service$150328.14Transient food servicefood cart$250328.15seasonal permanent food stand$250328.16seasonal temporary food stand$250328.17mobile food unit$250328.18Alcoholbeer or wine table service$150328.19alcohol service from bar$250328.20Lodgingless than 25 rooms$250328.2125 to less than 100 rooms$300328.22100 rooms or more$450328.23less than five cabins$250328.24five to less than ten cabins$350328.25ten cabins or more$400

328.26    (g) Seasonal temporary food stands and Special event food stands are not required to 328.27submit construction or remodeling plans for review. 328.28(h) Youth camps shall pay an annual single fee for food and lodging as follows:328.29(1) camps with up to 99 campers, $325;328.30(2) camps with 100 to 199 campers, $550; and328.31(3) camps with 200 or more campers; $750.329.1    Subd. 3a.  Statewide hospitality fee. Every person, firm, or corporation that 329.2operates a licensed boarding establishment, food and beverage service establishment, 329.3seasonal temporary or permanent food stand, special event food stand, mobile food unit, 329.4food cart, resort, hotel, motel, or lodging establishment in Minnesota must submit to the 329.5commissioner a $35 annual statewide hospitality fee for each licensed activity. The fee 329.6for establishments licensed by the Department of Health is required at the same time the 329.7licensure fee is due. For establishments licensed by local governments, the fee is due by 329.8July 1 of each year. 329.9    Subd. 4.  Posting requirements. Every food and beverage service establishment,329.10for-profit youth camp, hotel, motel, lodging establishment, public pool, or resort must have 329.11the license posted in a conspicuous place at the establishment. Mobile food units, food 329.12carts, and seasonal temporary food stands shall be issued decals with the initial license and 329.13each calendar year with license renewals. The current license year decal must be placed on 329.14the unit or stand in a location determined by the commissioner. Decals are not transferable.329.15    Sec. 38. Minnesota Statutes 2008, section 157.22, is amended to read:329.16157.22 EXEMPTIONS.329.17This chapter shall not be construed to does not apply to:329.18(1) interstate carriers under the supervision of the United States Department of 329.19Health and Human Services;329.20(2) any building constructed and primarily used for religious worship;329.21(3) any building owned, operated, and used by a college or university in accordance 329.22with health regulations promulgated by the college or university under chapter 14;329.23(4) any person, firm, or corporation whose principal mode of business is licensed 329.24under sections 
         28A.04 and 
         28A.05, is exempt at that premises from licensure as a food 329.25or beverage establishment; provided that the holding of any license pursuant to sections 329.2628A.04
          and 
         28A.05 shall not exempt any person, firm, or corporation from the applicable 329.27provisions of this chapter or the rules of the state commissioner of health relating to 329.28food and beverage service establishments;329.29(5) family day care homes and group family day care homes governed by sections 329.30245A.01
          to 
         245A.16;329.31(6) nonprofit senior citizen centers for the sale of home-baked goods;329.32(7) fraternal or patriotic organizations that are tax exempt under section 501(c)(3), 329.33501(c)(4), 501(c)(6), 501(c)(7), 501(c)(10), or 501(c)(19) of the Internal Revenue Code of 329.341986, or organizations related to or affiliated with such fraternal or patriotic organizations. 330.1Such organizations may organize events at which home-prepared food is donated by 330.2organization members for sale at the events, provided:330.3(i) the event is not a circus, carnival, or fair;330.4(ii) the organization controls the admission of persons to the event, the event agenda, 330.5or both; and330.6(iii) the organization's licensed kitchen is not used in any manner for the event;330.7(8) food not prepared at an establishment and brought in by individuals attending a 330.8potluck event for consumption at the potluck event. An organization sponsoring a potluck 330.9event under this clause may advertise the potluck event to the public through any means. 330.10Individuals who are not members of an organization sponsoring a potluck event under this 330.11clause may attend the potluck event and consume the food at the event. Licensed food 330.12establishments other than schools cannot be sponsors of potluck events. A school may 330.13sponsor and hold potluck events in areas of the school other than the school's kitchen, 330.14provided that the school's kitchen is not used in any manner for the potluck event. For 330.15purposes of this clause, "school" means a public school as defined in section 
         120A.05, 330.16subdivisions 9, 11, 13, and 17
         , or a nonpublic school, church, or religious organization 330.17at which a child is provided with instruction in compliance with sections 
         120A.22 and 330.18120A.24
         . Potluck event food shall not be brought into a licensed food establishment 330.19kitchen; and330.20(9) a home school in which a child is provided instruction at home; and330.21(10) concession stands operated in conjunction with school-sponsored events on 330.22school property are exempt from the 21-day restriction.330.23    Sec. 39. Minnesota Statutes 2008, section 327.14, is amended by adding a subdivision 330.24to read:330.25    Subd. 9.Special event recreational camping area."Special event recreational 330.26camping area" means a recreational camping area which operates no more than two times 330.27annually and for no more than 14 consecutive days.330.28    Sec. 40. Minnesota Statutes 2008, section 327.15, is amended to read:330.29327.15 LICENSE REQUIRED; RENEWAL; PLANS FOR EXPANSION FEES.330.30    Subdivision 1.License required; plan review.  No person, firm or corporation shall 330.31establish, maintain, conduct or operate a manufactured home park or recreational camping 330.32area within this state without first obtaining a an annual license therefor from the state 330.33Department of Health. Any person wishing to obtain a license shall submit an application, 330.34pay the required fee specified in this section, and receive approval for operation, including 331.1plan review approval. Application shall be made on forms provided by the commissioner 331.2and shall require the applicant to state the full name and address of the owner of the 331.3manufactured home park or recreational camping area, the name under which the business 331.4is to be conducted, and any other information as may be required by the commissioner 331.5to complete the application for license. Any person, firm, or corporation desiring to 331.6operate either a manufactured home park or a recreational camping area on the same site 331.7in connection with the other, need only obtain one license. A license shall expire and be 331.8renewed as prescribed by the commissioner pursuant to section 144.122. The license shall 331.9state the number of manufactured home sites and recreational camping sites allowed 331.10according to state commissioner of health approval. No renewal license shall be issued if 331.11the number of sites specified in the application exceeds those of the original application331.12The number of licensed sites shall not be increased unless the plans for expansion or 331.13the construction for expansion are first submitted and the expansion is approved by 331.14the Department of Health. Any manufactured home park or recreational camping area 331.15located in more than one municipality shall be dealt with as two separate manufactured 331.16home parks or camping areas. The license shall be conspicuously displayed in the office 331.17of the manufactured home park or camping area. The license is not transferable as toto 331.18another person or  place. 331.19    Subd. 2.License renewal.Initial and renewal licenses for all manufactured home 331.20parks and recreational camping areas shall be issued annually and shall have an expiration 331.21date included on the license. Any person who operates a manufactured home park or 331.22recreational camping area after the expiration date of a license or without having submitted 331.23an application and paid the fee shall be deemed to have violated the provisions of this 331.24chapter and shall be subject to enforcement action, as provided in the Health Enforcement 331.25Consolidation Act, sections 144.989 to 144.993. In addition, a penalty of $120 shall 331.26be added to the total of the license fee for any manufactured home park or recreational 331.27camping area operating without a license for a period of up to 30 days. A late fee of $360 331.28shall be added to the license fee for any manufactured home park or recreational camping 331.29area operating more than 30 days without a license.331.30    Subd. 3.Fees, manufactured home parks and recreational camping areas.(a) 331.31The following fees are required for manufactured home parks and recreational camping 331.32areas licensed under this chapter. Recreational camping areas and manufactured home 331.33parks shall pay the highest applicable fee under paragraph (c). The license fee for new 331.34operators of a manufactured home park or recreational camping area previously licensed 331.35under this chapter for the same calendar year is one-half of the appropriate annual license 331.36fee, plus any penalty that may be required. The license fee for operators opening on 332.1or after October 1 is one-half of the appropriate annual license fee, plus any penalty 332.2that may be required.332.3(b) All manufactured home parks and recreational camping areas shall pay the 332.4following annual base fee:332.5(1) a manufactured home park, $150; and332.6(2) a recreational camping area with:332.7(i) 24 or less sites, $50;332.8(ii) 25-99 sites, $212; and332.9(iii) 100 or more sites, $300.332.10In addition to the base fee, manufactured home parks and recreational camping areas shall 332.11pay $4 for each licensed site. This paragraph does not apply to special event recreational 332.12camping areas or to operators of a manufactured home park or a recreational camping area 332.13licensed under section 157.16 for the same location.332.14(c) In addition to the fee in paragraph (b), each manufactured home park or 332.15recreational camping area shall pay an additional annual fee for each fee category 332.16specified in this paragraph:332.17(1) Manufactured home parks and recreational camping areas with public swimming 332.18pools and spas shall pay the appropriate fees specified in section 157.16.332.19(2) Individual private sewer or water, $60. "Individual private water" means a fee 332.20category with a water supply other than a community public water supply as defined in 332.21Minnesota Rules, chapter 4720. "Individual private sewer" means a fee category with an 332.22individual sewage treatment system which uses subsurface treatment and disposal.332.23(d) The following fees must accompany a plan review application for initial 332.24construction of a manufactured home park or recreational camping area:332.25(1) for initial construction of less than 25 sites, $375;332.26(2) for initial construction of 25 to less than 100 sites, $400; and332.27(3) for initial construction of 100 or more sites, $500.332.28(e) The following fees must accompany a plan review application when an existing 332.29manufactured home park or recreational camping area is expanded:332.30(1) for expansion of less than 25 sites, $250;332.31(2) for expansion of 25 and less than 100 sites, $300; and332.32(3) for expansion of 100 or more sites, $450.332.33    Subd. 4.Fees, special event recreational camping areas.(a) The following fees 332.34are required for special event recreational camping areas licensed under this chapter.332.35(b) All special event recreational camping areas shall pay an annual fee of $150 plus 332.36$1 for each licensed site.333.1(c) A special event recreational camping area shall pay a late fee of $360 for failing 333.2to obtain a license prior to operating.333.3(d) The following fees must accompany a plan review application for initial 333.4construction of a special event recreational camping area:333.5(1) for initial construction of less than 25 special event recreational camping sites, 333.6$375;333.7(2) for initial construction of 25 to less than 100 sites, $400; and333.8(3) for initial construction of 100 or more sites, $500.333.9(e) The following fees must accompany a plan review application for expansion of a 333.10special event recreational camping area:333.11(1) for expansion of less than 25 sites, $250;333.12(2) for expansion of 25 and less than 100 sites, $300; and333.13(3) for expansion of 100 or more sites, $450.333.14    Sec. 41. Minnesota Statutes 2008, section 327.16, is amended to read:333.15327.16 LICENSE PLAN REVIEW APPLICATION.333.16    Subdivision 1. Made to state Department of Health. The plan review application 333.17for license to operate and maintain a manufactured home park or recreational camping 333.18area shall be made to the state Department of Health, at such office and in such manner 333.19as may be prescribed by that department.333.20    Subd. 2. Contents. The applicant for a primary license or annual license shall make 333.21application in writing plan review application shall be made upon a form provided by the 333.22state Department of Health setting forth:333.23(1) The full name and address of the applicant or applicants, or names and addresses 333.24of the partners if the applicant is a partnership, or the names and addresses of the officers 333.25if the applicant is a corporation.333.26(2) A legal description of the site, lot, field, or tract of land upon which the applicant 333.27proposes to operate and maintain a manufactured home park or recreational camping area.333.28(3) The proposed and existing facilities on and about the site, lot, field, or tract of 333.29land for the proposed construction or alteration and maintaining of a sanitary community 333.30building for toilets, urinals, sinks, wash basins, slop-sinks, showers, drains, laundry 333.31facilities, source of water supply, sewage, garbage and waste disposal; except that no 333.32toilet facilities shall be required in any manufactured home park which permits only 333.33manufactured homes equipped with toilet facilities discharging to water carried sewage 333.34disposal systems; and method of fire and storm protection.334.1(4) The proposed method of lighting the structures and site, lot, field, or tract of land 334.2upon which the manufactured home park or recreational camping area is to be located.334.3(5) The calendar months of the year which the applicant will operate the 334.4manufactured home park or recreational camping area.334.5(6) Plans and drawings for new construction or alteration, including buildings, wells, 334.6plumbing and sewage disposal systems.334.7    Subd. 3. Fees; Approval. The application for the primary license plan review shall 334.8be submitted with all plans and specifications enumerated in subdivision 2, and payment 334.9of a fee in an amount prescribed by the state commissioner of health pursuant to section 334.10144.122 and shall be accompanied by an approved zoning permit from the municipality or 334.11county wherein the park is to be located, or a statement from the municipality or county 334.12that it does not require an approved zoning permit. The fee for the annual license shall be 334.13in an amount prescribed by the state commissioner of health pursuant to section 144.122. 334.14All license fees paid to the commissioner of health shall be turned over to the state 334.15treasury. The fee submitted for the primary license plan review shall be retained by the 334.16state even though the proposed project is not approved and a license is denied. 334.17When construction has been completed in accordance with approved plans and 334.18specifications the state commissioner of health shall promptly cause the manufactured 334.19home park or recreational camping area and appurtenances thereto to be inspected. When 334.20the inspection and report has been made and the state commissioner of health finds that 334.21all requirements of sections 
         327.10, 
         327.11, 
         327.14 to 
         327.28, and such conditions of 334.22health and safety as the state commissioner of health may require, have been met by 334.23the applicant, the state commissioner of health shall forthwith issue the primary license 334.24in the name of the state. 334.25    Subd. 4. Sanitary facilities Compliance with current state law.During the 334.26pendency of the application for such primary license any change in the sanitary or safety 334.27facilities of the intended manufactured home park or recreational camping area shall be 334.28immediately reported in writing to the state Department of Health through the office 334.29through which the application was made. If no objection is made by the state Department 334.30of Health to such change in such sanitary or safety facilities within 60 days of the date 334.31such change is reported, it shall be deemed to have the approval of the state Department of 334.32Health. Any manufactured home park or recreational camping area must be constructed 334.33and operated according to all applicable state electrical, fire, plumbing, and building codes.334.34    Subd. 5. Permit. When the plans and specifications have been approved, the state 334.35Department of Health shall issue an approval report permitting the applicant to construct 335.1or make alterations upon a manufactured home park or recreational camping area and the 335.2appurtenances thereto according to the plans and specifications presented.335.3Such approval does not relieve the applicant from securing building permits in 335.4municipalities that require permits or from complying with any other municipal ordinance 335.5or ordinances, applicable thereto, not in conflict with this statute.335.6    Subd. 6. Denial of construction. If the application to construct or make alterations 335.7upon a manufactured home park or recreational camping area and the appurtenances 335.8thereto or a primary license to operate and maintain the same is denied by the state 335.9commissioner of health, the commissioner shall so state in writing giving the reason 335.10or reasons for denying the application. If the objections can be corrected the applicant 335.11may amend the application and resubmit it for approval, and if denied the applicant may 335.12appeal from the decision of the state commissioner of health as provided in section 335.13144.99, subdivision 10
         . 335.14    Sec. 42. Minnesota Statutes 2008, section 327.20, subdivision 1, is amended to read:335.15    Subdivision 1. Rules. No domestic animals or house pets of occupants of 335.16manufactured home parks or recreational camping areas shall be allowed to run at large, 335.17or commit any nuisances within the limits of a manufactured home park or recreational 335.18camping area. Each manufactured home park or recreational camping area licensed under 335.19the provisions of sections 
         327.10, 
         327.11, and327.14 to 
         327.28 shall, among other things, 335.20provide for the following, in the manner hereinafter specified: 335.21    (1) A responsible attendant or caretaker shall be in charge of every manufactured 335.22home park or recreational camping area at all times, who shall maintain the park or 335.23area, and its facilities and equipment in a clean, orderly and sanitary condition. In any 335.24manufactured home park containing more than 50 lots, the attendant, caretaker, or other 335.25responsible park employee, shall be readily available at all times in case of emergency.335.26    (2) All manufactured home parks shall be well drained and be located so that the 335.27drainage of the park area will not endanger any water supply. No wastewater from 335.28manufactured homes or recreational camping vehicles shall be deposited on the surface of 335.29the ground. All sewage and other water carried wastes shall be discharged into a municipal 335.30sewage system whenever available. When a municipal sewage system is not available, a 335.31sewage disposal system acceptable to the state commissioner of health shall be provided.335.32    (3) No manufactured home shall be located closer than three feet to the side lot lines 335.33of a manufactured home park, if the abutting property is improved property, or closer than 335.34ten feet to a public street or alley. Each individual site shall abut or face on a driveway 335.35or clear unoccupied space of not less than 16 feet in width, which space shall have 336.1unobstructed access to a public highway or alley. There shall be an open space of at least 336.2ten feet between the sides of adjacent manufactured homes including their attachments 336.3and at least three feet between manufactured homes when parked end to end. The space 336.4between manufactured homes may be used for the parking of motor vehicles and other 336.5property, if the vehicle or other property is parked at least ten feet from the nearest 336.6adjacent manufactured home position. The requirements of this paragraph shall not apply 336.7to recreational camping areas and variances may be granted by the state commissioner 336.8of health in manufactured home parks when the variance is applied for in writing and in 336.9the opinion of the commissioner the variance will not endanger the health, safety, and 336.10welfare of manufactured home park occupants.336.11    (4) An adequate supply of water of safe, sanitary quality shall be furnished at each 336.12manufactured home park or recreational camping area. The source of the water supply 336.13shall first be approved by the state Department of Health.336.14    (5) All plumbing shall be installed in accordance with the rules of the state 336.15commissioner of labor and industry and the provisions of the Minnesota Plumbing Code.336.16    (6) In the case of a manufactured home park with less than ten manufactured homes, 336.17a plan for the sheltering or the safe evacuation to a safe place of shelter of the residents of 336.18the park in times of severe weather conditions, such as tornadoes, high winds, and floods. 336.19The shelter or evacuation plan shall be developed with the assistance and approval of 336.20the municipality where the park is located and shall be posted at conspicuous locations 336.21throughout the park. The park owner shall provide each resident with a copy of the 336.22approved shelter or evacuation plan, as provided by section 
         327C.01, subdivision 1c. 336.23Nothing in this paragraph requires the Department of Health to review or approve any 336.24shelter or evacuation plan developed by a park. Failure of a municipality to approve a plan 336.25submitted by a park shall not be grounds for action against the park by the Department of 336.26Health if the park has made a good faith effort to develop the plan and obtain municipal 336.27approval. 336.28    (7) A manufactured home park with ten or more manufactured homes, licensed prior 336.29to March 1, 1988, shall provide a safe place of shelter for park residents or a plan for the 336.30evacuation of park residents to a safe place of shelter within a reasonable distance of the 336.31park for use by park residents in times of severe weather, including tornadoes and high 336.32winds. The shelter or evacuation plan must be approved by the municipality by March 1, 336.331989. The municipality may require the park owner to construct a shelter if it determines 336.34that a safe place of shelter is not available within a reasonable distance from the park. A 336.35copy of the municipal approval and the plan shall be submitted by the park owner to the 337.1Department of Health. The park owner shall provide each resident with a copy of the 337.2approved shelter or evacuation plan, as provided by section 
         327C.01, subdivision 1c. 337.3    (8) A manufactured home park with ten or more manufactured homes, receiving 337.4a primary an initial license after March 1, 1988, must provide the type of shelter required 337.5by section 
         327.205, except that for manufactured home parks established as temporary, 337.6emergency housing in a disaster area declared by the President of the United States or 337.7the governor, an approved evacuation plan may be provided in lieu of a shelter for a 337.8period not exceeding 18 months. 337.9    (9) For the purposes of this subdivision, "park owner" and "resident" have the 337.10meaning meanings given them in section 
         327C.01. 337.11    Sec. 43. Minnesota Statutes 2008, section 327.20, is amended by adding a subdivision 337.12to read:337.13    Subd. 4.Special event recreational camping areas.Each special event camping 337.14area licensed under sections 327.10, 327.11, and 327.14 to 327.28 is subject to this section.337.15(1) Recreational camping vehicles and tents, including attachments, must be 337.16separated from each other and other structures by at least seven feet.337.17(2) A minimum area of 300 square feet per site must be provided and the total 337.18number of sites must not exceed one site for every 300 square feet of usable land area.337.19(3) Each site must abut or face a driveway or clear unoccupied space of at least 16 337.20feet in width, which space must have unobstructed access to a public roadway.337.21(4) If no approved on-site water supply system is available, hauled water may be 337.22used, provided that persons using hauled water comply with Minnesota Rules, parts 337.234720.4000 to 4720.4600.337.24(5) Nonburied sewer lines may be permitted provided they are of approved materials, 337.25watertight, and properly maintained.337.26(6) If a sanitary dumping station is not provided on-site, arrangements must be 337.27made with a licensed sewage pumper to service recreational camping vehicle holding 337.28tanks as needed.337.29(7) Toilet facilities must be provided consisting of toilets connected to an approved 337.30sewage disposal system, portable toilets, or approved, properly constructed privies.337.31(8) Toilets must be provided in the ratio of one toilet for each sex for each 150 sites.337.32(9) Toilets must be not more than 400 feet from any site.337.33(10) If a central building or buildings are provided with running water, then toilets 337.34and handwashing lavatories must be provided in the building or buildings that meet the 337.35requirements of this subdivision.338.1(11) Showers, if provided, must be provided in the ratio of one shower for each sex 338.2for each 250 sites. Showerheads must be provided, where running water is available, for 338.3each camping event exceeding two nights.338.4(12) Central toilet and shower buildings, if provided, must be constructed with 338.5adequate heating, ventilation, and lighting, and floors of impervious material sloped 338.6to drain. Walls must be of a washable material. Permanent facilities must meet the 338.7requirements of the Americans with Disabilities Act.338.8(13) An adequate number of durable, covered, watertight containers must be 338.9provided for all garbage and refuse. Garbage and refuse must be collected as often as 338.10necessary to prevent nuisance conditions.338.11(14) Campgrounds must be located in areas free of poison ivy or other noxious 338.12weeds considered detrimental to health. Sites must not be located in areas of tall grass or 338.13weeds and sites must be adequately drained.338.14(15) Campsites for recreational vehicles may not be located on inclines of greater 338.15than eight percent grade or one inch drop per lineal foot.338.16(16) A responsible attendant or caretaker must be available on-site at all times during 338.17the operation of any special event recreational camping area that has 50 or more sites.338.18    Sec. 44. MINNESOTA COLORECTAL CANCER PREVENTION 338.19DEMONSTRATION PROJECT.338.20    Subdivision 1.Establishment.The commissioner of health shall award grants 338.21to Hennepin County Medical Center and MeritCare Bemidji for a colorectal screening 338.22demonstration project to provide screening to uninsured and underinsured women and 338.23men. The project shall expire December 31, 2010.338.24    Subd. 2.Eligibility.To be eligible for colorectal screening under this demonstration 338.25project, an applicant must:338.26(1) be at least 50 years of age, or under the age of 50 and at high risk for colon cancer;338.27(2) be uninsured, or if insured, have coverage that does not cover the full cost of 338.28colorectal cancer screenings;338.29(3) not be eligible for medical assistance, general assistance medical care, or 338.30MinnesotaCare programs; and338.31(4) have a gross family income at or below 250 percent of the federal poverty level.338.32    Subd. 3.Services.Services provided under this project shall include:338.33(1) colorectal cancer screening, according to standard practices of medicine, or 338.34guidelines provided by the Institute for Clinical Systems Improvement or the American 338.35Cancer Society;339.1(2) follow-up services for abnormal tests; and339.2(3) diagnostic services to determine the extent and proper course of treatment.339.3    Subd. 4.Project evaluation.The commissioner of health shall evaluate the 339.4demonstration project and make recommendations for increasing the number of persons in 339.5Minnesota who receive recommended colon cancer screening. The commissioner of health 339.6shall submit the evaluation and recommendations to the legislature by January 15, 2011.339.7    Sec. 45. RESEARCH OF EXPOSURE PATHWAYS FOR 339.8PERFLUOROCHEMICALS.339.9The commissioner of health shall study and report to the legislature by January 339.1015, 2011, on the exposure pathways for perfluorochemicals, focusing on food sources 339.11that might be affected by contact with contaminated water or air. This research will be 339.12performed to the extent that nonstate funds and environmental health tracking funds are 339.13available and include garden vegetables produced or consumed by a representative sample 339.14of the population from the east metropolitan area including indigenous people and people 339.15of color. In developing and performing the research, the commissioner must convene and 339.16consult with a citizen advisory group consisting of residents from the east metropolitan 339.17area, including indigenous people and people of color.339.18    Sec. 46. FEASIBILITY PILOT PROJECT FOR CANCER SURVEILLANCE.339.19The commissioner of health must provide a grant to the Hennepin County Medical 339.20Center for a one-year feasibility pilot project to collect occupational, residential, and 339.21military service history data from newly diagnosed cancer patients at the Hennepin 339.22County Medical Center's Cancer Center. Funding for this grant shall come from the 339.23Department of Health's current resources for the Chronic Disease and Environmental 339.24Epidemiology Section.339.25Under this pilot project, Hennepin County Medical Center will design an expansion 339.26of its existing cancer registry to include the collection of additional data, including the 339.27cancer patient's occupational, residential, and military service history. Patient consent is 339.28required for collection of these additional data. The consent must be in writing and must 339.29contain notice informing the patient about private and confidential data concerning the 339.30patient pursuant to Minnesota Statutes, section 13.04, subdivision 2. The patient is entitled 339.31to opt out of the project at any time. The data collection expansion may also include the 339.32cancer patient's possible toxic environmental exposure history, if known. The purpose of 339.33this pilot project is to determine the following:339.34(1) the feasibility of collecting these data on a statewide scale; 340.1(2) the potential design of a self-administered patient questionnaire template; and 340.2(3) necessary qualifications for staff who will collect these data. 340.3Hennepin County Medical Center must report the results of this pilot project to the 340.4legislature by October 1, 2010.340.5    Sec. 47. SMOKING CESSATION.340.6The commissioner of health must prioritize smoking prevention and smoking 340.7cessation activities in low-income, indigenous, and minority communities in their 340.8collaborations with the organization specifically described in Minnesota Statutes, section 340.9144.396, subdivision 8.340.10    Sec. 48. MEDICAL RESPONSE UNIT REIMBURSEMENT PILOT PROGRAM.340.11(a) The Department of Public Safety or its contract designee shall collaborate 340.12with the Minnesota Ambulance Association to create the parameters of the medical 340.13response unit reimbursement pilot program, including determining criteria for baseline 340.14data reporting.340.15(b) In conducting the pilot program, the Department of Public Safety must consult 340.16with the Minnesota Ambulance Association, Minnesota Fire Chiefs Association, 340.17Emergency Services Regulatory Board, and the Minnesota Council of Health Plans to:340.18(1) identify no more than five medical response units registered as medical response 340.19units with the Minnesota Emergency Medical Services Regulatory Board according to 340.20Minnesota Statutes, chapter 144E, to participate in the program;340.21(2) outline and develop criteria for reimbursement;340.22(3) determine the amount of reimbursement for each unit response; and340.23(4) collect program data to be analyzed for a final report.340.24(c) Further criteria for the medical response unit reimbursement pilot program 340.25shall include:340.26(1) the pilot program will expire on December 31, 2010, or when the appropriation 340.27is extended, whichever occurs first;340.28(2) a report shall be made to the legislature by March 1, 2011, by the Department 340.29of Public Safety or its contractor as to the effectiveness and value of this reimbursement 340.30pilot program to the emergency medical services delivery system, any actual or potential 340.31savings to the health care system, and impact on patient outcomes;340.32(3) participating medical response units must adhere to the requirements of this 340.33pilot program outlined in an agreement between the Department of Public Safety and 340.34the medical response unit, including but not limited to, requirements relating to data 340.35collection, response criteria, and patient outcomes and disposition;341.1(4) individual entities licensed to provide ambulance care under Minnesota Statutes, 341.2chapter 144E, are not eligible for participation in this pilot program;341.3(5) if a participating medical response unit withdraws from the pilot program, the 341.4Department of Public Safety in consultation with the Minnesota Ambulance Association 341.5may choose another pilot site if funding is available;341.6(6) medical response units must coordinate their operations under this pilot project 341.7with the ambulance service or services licensed to provide care in their first response 341.8geographic areas;341.9(7) licensed ambulance services that participate with the medical response unit in 341.10the pilot program assume no financial or legal liability for the actions of the participating 341.11medical response unit; and341.12(8) the Department of Public Safety and its pilot program partners have no ongoing 341.13responsibility to reimburse medical response units beyond the parameters of the pilot 341.14program.341.15    Sec. 49. REVIEW OF PROPOSED REGULATIONS FOR BODY ART 341.16TECHNICIANS AND BODY ART ESTABLISHMENTS.341.17The commissioner of health shall review proposed regulatory legislation for 341.18body art technicians and body art establishments and develop recommendations on the 341.19proper level of regulation needed for body art technicians and establishments in order 341.20to protect public health. The recommendations must include a review of how other 341.21states comply with the American Association of Blood Banks standards, how regulatory 341.22requirements affect currently operating body art establishments, and the appropriate level 341.23of coordination between the state and local jurisdictions that currently regulate body art 341.24establishments. The commissioner shall submit the results of the review and possible 341.25regulatory recommendations for body art technicians and establishments to the chairs and 341.26ranking minority members of the legislative committees with jurisdiction over health 341.27care by January 15, 2010.341.28    Sec. 50. HEARING AIDS; ENFORCEMENT.341.29Costs incurred by the Minnesota Department of Health for conducting investigations 341.30of unlicensed hearing aid dispensers shall be apportioned between all licensed or 341.31credentialed professions that dispense hearing aids.341.32EFFECTIVE DATE.This section is effect July 1, 2011.341.33    Sec. 51. REPEALER.342.1(a) Minnesota Statutes 2008, sections 103I.112; 144.9501, subdivision 17b; and 342.2327.14, subdivisions 5 and 6, are repealed.342.3(b) Minnesota Rules, part 4626.2015, subpart 9, is repealed.342.4ARTICLE 11342.5HEALTH-RELATED FEES342.6    Section 1. Minnesota Statutes 2008, section 148D.180, subdivision 1, is amended to 342.7read:342.8    Subdivision 1. Application fees. Application fees for licensure are as follows:342.9(1) for a licensed social worker, $45;342.10(2) for a licensed graduate social worker, $45;342.11(3) for a licensed independent social worker, $90 $45;342.12(4) for a licensed independent clinical social worker, $90 $45;342.13(5) for a temporary license, $50; and342.14(6) for a licensure by endorsement, $150 $85.342.15The fee for criminal background checks is the fee charged by the Bureau of Criminal 342.16Apprehension. The criminal background check fee must be included with the application 342.17fee as required pursuant to section 
         148D.055.342.18    Sec. 2. Minnesota Statutes 2008, section 148D.180, subdivision 2, is amended to read:342.19    Subd. 2. License fees. License fees are as follows:342.20(1) for a licensed social worker, $115.20 $81;342.21(2) for a licensed graduate social worker, $201.60 $144;342.22(3) for a licensed independent social worker, $302.40 $216;342.23(4) for a licensed independent clinical social worker, $331.20 $238.50;342.24(5) for an emeritus license, $43.20; and342.25(6) for a temporary leave fee, the same as the renewal fee specified in subdivision 3.342.26If the licensee's initial license term is less or more than 24 months, the required 342.27license fees must be prorated proportionately.342.28    Sec. 3. Minnesota Statutes 2008, section 148D.180, subdivision 3, is amended to read:342.29    Subd. 3. Renewal fees. Renewal fees for licensure are as follows:342.30(1) for a licensed social worker, $115.20 $81;342.31(2) for a licensed graduate social worker, $201.60 $144;342.32(3) for a licensed independent social worker, $302.40 $216; and342.33(4) for a licensed independent clinical social worker, $331.20 $238.50.343.1    Sec. 4. Minnesota Statutes 2008, section 148D.180, subdivision 5, is amended to read:343.2    Subd. 5. Late fees. Late fees are as follows:343.3(1) renewal late fee, one-half one-fourth of the renewal fee specified in subdivision 343.43; and343.5(2) supervision plan late fee, $40.343.6    Sec. 5. Minnesota Statutes 2008, section 148E.180, subdivision 1, is amended to read:343.7    Subdivision 1. Application fees. Application fees for licensure are as follows:343.8    (1) for a licensed social worker, $45;343.9    (2) for a licensed graduate social worker, $45;343.10    (3) for a licensed independent social worker, $90 $45;343.11    (4) for a licensed independent clinical social worker, $90 $45;343.12    (5) for a temporary license, $50; and343.13    (6) for a licensure by endorsement, $150 $85.343.14    The fee for criminal background checks is the fee charged by the Bureau of Criminal 343.15Apprehension. The criminal background check fee must be included with the application 343.16fee as required according to section 
         148E.055.343.17    Sec. 6. Minnesota Statutes 2008, section 148E.180, subdivision 2, is amended to read:343.18    Subd. 2. License fees. License fees are as follows:343.19    (1) for a licensed social worker, $115.20 $81;343.20    (2) for a licensed graduate social worker, $201.60 $144;343.21    (3) for a licensed independent social worker, $302.40 $216;343.22    (4) for a licensed independent clinical social worker, $331.20 $238.50;343.23    (5) for an emeritus license, $43.20; and343.24    (6) for a temporary leave fee, the same as the renewal fee specified in subdivision 3.343.25    If the licensee's initial license term is less or more than 24 months, the required 343.26license fees must be prorated proportionately.343.27    Sec. 7. Minnesota Statutes 2008, section 148E.180, subdivision 3, is amended to read:343.28    Subd. 3. Renewal fees. Renewal fees for licensure are as follows:343.29    (1) for a licensed social worker, $115.20 $81;343.30    (2) for a licensed graduate social worker, $201.60 $144;343.31    (3) for a licensed independent social worker, $302.40 $216; and343.32    (4) for a licensed independent clinical social worker, $331.20 $238.50.344.1    Sec. 8. Minnesota Statutes 2008, section 148E.180, subdivision 5, is amended to read:344.2    Subd. 5. Late fees. Late fees are as follows:344.3    (1) renewal late fee, one-half one-fourth of the renewal fee specified in subdivision 344.43; and344.5    (2) supervision plan late fee, $40.344.6    Sec. 9. Minnesota Statutes 2008, section 152.126, subdivision 1, is amended to read:344.7    Subdivision 1. Definitions. For purposes of this section, the terms defined in this 344.8subdivision have the meanings given.344.9    (a) "Board" means the Minnesota State Board of Pharmacy established under 344.10chapter 151.344.11    (b) "Controlled substances" means those substances listed in section 
         152.02, 344.12subdivisions 3 and 4 to 5, and those substances defined by the board pursuant to section 344.13152.02, subdivisions 7
         , 8, and 12.344.14    (c) "Dispense" or "dispensing" has the meaning given in section 
         151.01, subdivision 344.1530. Dispensing does not include the direct administering of a controlled substance to a 344.16patient by a licensed health care professional.344.17    (d) "Dispenser" means a person authorized by law to dispense a controlled substance, 344.18pursuant to a valid prescription. For the purposes of this section, a dispenser does not 344.19include a licensed hospital pharmacy that distributes controlled substances for inpatient 344.20hospital care or a veterinarian who is dispensing prescriptions under section 
         156.18.344.21    (e) "Prescriber" means a licensed health care professional who is authorized to 344.22prescribe a controlled substance under section 
         152.12, subdivision 1.344.23    (f) "Prescription" has the meaning given in section 
         151.01, subdivision 16.344.24    Sec. 10. Minnesota Statutes 2008, section 152.126, subdivision 2, is amended to read:344.25    Subd. 2. Prescription electronic reporting system. (a) The board shall establish 344.26by January 1, 2010, an electronic system for reporting the information required under 344.27subdivision 4 for all controlled substances dispensed within the state. 344.28    (b) The board may contract with a vendor for the purpose of obtaining technical 344.29assistance in the design, implementation, operation, and maintenance of the electronic 344.30reporting system. The vendor's role shall be limited to providing technical support to the 344.31board concerning the software, databases, and computer systems required to interface with 344.32the existing systems currently used by pharmacies to dispense prescriptions and transmit 344.33prescription data to other third parties.345.1    Sec. 11. Minnesota Statutes 2008, section 152.126, subdivision 6, is amended to read:345.2    Subd. 6. Access to reporting system data. (a) Except as indicated in this 345.3subdivision, the data submitted to the board under subdivision 4 is private data on 345.4individuals as defined in section 
         13.02, subdivision 12, and not subject to public disclosure.345.5    (b) Except as specified in subdivision 5, the following persons shall be considered 345.6permissible users and may access the data submitted under subdivision 4 in the same or 345.7similar manner, and for the same or similar purposes, as those persons who are authorized 345.8to access similar private data on individuals under federal and state law:345.9    (1) a prescriber, to the extent the information relates specifically to a current patient, 345.10to whom the prescriber is prescribing or considering prescribing any controlled substance;345.11    (2) a dispenser, to the extent the information relates specifically to a current patient 345.12to whom that dispenser is dispensing or considering dispensing any controlled substance;345.13    (3) an individual who is the recipient of a controlled substance prescription for 345.14which data was submitted under subdivision 4, or a guardian of the individual, parent or 345.15guardian of a minor, or health care agent of the individual acting under a health care 345.16directive under chapter 145C;345.17    (4) personnel of the board specifically assigned to conduct a bona fide investigation 345.18of a specific licensee;345.19    (5) personnel of the board engaged in the collection of controlled substance 345.20prescription information as part of the assigned duties and responsibilities under this 345.21section;345.22    (6) authorized personnel of a vendor under contract with the board who are engaged 345.23in the design, implementation, operation, and maintenance of the electronic reporting 345.24system as part of the assigned duties and responsibilities of their employment, provided 345.25that access to data is limited to the minimum amount necessary to test and maintain the 345.26system databases carry out such duties and responsibilities;345.27    (7) federal, state, and local law enforcement authorities acting pursuant to a valid 345.28search warrant; and345.29    (8) personnel of the medical assistance program assigned to use the data collected 345.30under this section to identify recipients whose usage of controlled substances may warrant 345.31restriction to a single primary care physician, a single outpatient pharmacy, or a single 345.32hospital.345.33    For purposes of clause (3), access by an individual includes persons in the definition 345.34of an individual under section 
         13.02.345.35    (c) Any permissible user identified in paragraph (b), who directly accesses 345.36the data electronically, shall implement and maintain a comprehensive information 346.1security program that contains administrative, technical, and physical safeguards that 346.2are appropriate to the user's size and complexity, and the sensitivity of the personal 346.3information obtained. The permissible user shall identify reasonably foreseeable internal 346.4and external risks to the security, confidentiality, and integrity of personal information 346.5that could result in the unauthorized disclosure, misuse, or other compromise of the 346.6information and assess the sufficiency of any safeguards in place to control the risks.346.7    (d) The board shall not release data submitted under this section unless it is provided 346.8with evidence, satisfactory to the board, that the person requesting the information is 346.9entitled to receive the data.346.10    (e) The board shall not release the name of a prescriber without the written consent 346.11of the prescriber or a valid search warrant or court order. The board shall provide a 346.12mechanism for a prescriber to submit to the board a signed consent authorizing the release 346.13of the prescriber's name when data containing the prescriber's name is requested.346.14    (f) The board shall maintain a log of all persons who access the data and shall ensure 346.15that any permissible user complies with paragraph (c) prior to attaining direct access to 346.16the data.346.17(g) Section 13.05, subdivision 6, shall apply to any contract the board enters into 346.18pursuant to subdivision 2. A vendor shall not use data collected under this section for 346.19any purpose not specified in this section.346.20    Sec. 12.  REPEALER.346.21Minnesota Statutes 2008, section 148D.180, subdivision 8, is repealed.346.22ARTICLE 12346.23HUMAN SERVICES FORECAST ADJUSTMENTS

346.24346.25Section 1. SUMMARY OF APPROPRIATIONS; DEPARTMENT OF HUMAN SERVICES FORECAST ADJUSTMENT.

346.26    The dollar amounts shown are added to or, if shown in parentheses, are subtracted 346.27from the appropriations in Laws 2008, chapter 363, from the general fund, or any other 346.28fund named, to the Department of Human Services for the purposes specified in this 346.29article, to be available for the fiscal year indicated for each purpose. The figure "2009" 346.30used in this article means that the appropriation or appropriations listed are available 346.31for the fiscal year ending June 30, 2009.

346.32346.33Sec. 2. COMMISSIONER OF HUMAN SERVICES

347.1Subdivision 1.Total Appropriation$(478,994,000)

347.2Appropriations by Fund347.32009347.4General(445,130,000)347.5Health Care Access(19,460,000)347.6Federal TANF(14,404,000)

347.7Subd. 2.Revenue and Pass-Through

347.8Federal TANF1,107,000

347.9347.10Subd. 3.Children and Economic Assistance Grants

347.11General27,002,000347.12Federal TANF(16,211,000)

347.13The amounts that may be spent from this 347.14appropriation for each purpose are as follows:

347.15(a) MFIP/DWP Grants

347.16General17,530,000347.17Federal TANF(16,211,000)

347.18(b) MFIP Child Care Assistance Grants4,933,000

347.19(c) General Assistance Grants1,458,000

347.20(d) Minnesota Supplemental Aid Grants513,000

347.21(e) Group Residential Housing Grants2,568,000

347.22Subd. 4.Basic Health Care Grants

347.23General(224,341,000)347.24Health Care Access(19,460,000)

348.1The amounts that may be spent from this 348.2appropriation for each purpose are as follows:

348.3(a) MinnesotaCare

348.4 Health Care Access(19,460,000)

348.5348.6(b) MA Basic Health Care - Families and Children(100,055,000)

348.7348.8(c) MA Basic Health Care - Elderly and Disabled(136,795,000)

348.9(d) General Assistance Medical Care12,539,000

348.10Subd. 5.Continuing Care Grants(247,791,000)

348.11The amounts that may be spent from this 348.12appropriation for each purpose are as follows:

348.13(a) MA Long-Term Care Facilities(59,204,000)

348.14(b) MA Long-Term Care Waivers(168,927,000)

348.15(c) Chemical Dependency Entitlement Grants(19,660,000)

348.16    Sec. 3. EFFECTIVE DATE.348.17Sections 1 and 2 are effective the day following final enactment.348.18ARTICLE 13348.19APPROPRIATIONS

348.20Section 1. SUMMARY OF APPROPRIATIONS.

348.21    The amounts shown in this section summarize direct appropriations by fund made 348.22in this article.

348.2320102011Total348.24General$4,452,323,000$5,280,470,000$9,732,793,000348.25348.26State Government Special Revenue62,451,00061,515,000123,966,000349.1Health Care Access489,995,000568,298,0001,058,293,000349.2Federal TANF301,220,000268,711,000569,931,000349.3Lottery Prize1,665,0001,665,0003,330,000349.4Federal Fund110,000,0000110,000,000349.5Total$5,417,704,000$6,180,659,000$11,598,363,000

349.6Sec. 2. HEALTH AND HUMAN SERVICES APPROPRIATION.

349.7    The sums shown in the columns marked "Appropriations" are appropriated to the 349.8agencies and for the purposes specified in this article. The appropriations are from the 349.9general fund, or another named fund, and are available for the fiscal years indicated 349.10for each purpose. The figures "2010" and "2011" used in this article mean that the 349.11appropriations listed under them are available for the fiscal year ending June 30, 2010, or 349.12June 30, 2011, respectively. "The first year" is fiscal year 2010. "The second year" is fiscal 349.13year 2011. "The biennium" is fiscal years 2010 and 2011. Appropriations for the fiscal 349.14year ending June 30, 2009, are effective the day following final enactment.

349.15APPROPRIATIONS349.16Available for the Year349.17Ending June 30349.1820102011

349.19Sec. 3. HUMAN SERVICES

349.20Subdivision 1.Total Appropriation$5,230,100,000$5,997,715,000

349.21Appropriations by Fund349.2220102011349.23General4,376,839,0005,211,018,000349.24349.25State Government Special Revenue1,315,000565,000349.26Health Care Access450,792,000527,489,000349.27Federal TANF289,487,000256,978,000349.28Lottery Prize1,665,0001,665,000349.29Federal Fund110,000,0000

350.1Receipts for Systems Projects.350.2Appropriations and federal receipts for 350.3information systems projects for MAXIS, 350.4PRISM, MMIS, and SSIS must be deposited 350.5in the state system account authorized in 350.6Minnesota Statutes, section 256.014. Money 350.7appropriated for computer projects approved 350.8by the Minnesota Office of Enterprise 350.9Technology, funded by the legislature, and 350.10approved by the commissioner of finance, 350.11may be transferred from one project to 350.12another and from development to operations 350.13as the commissioner of human services 350.14considers necessary, except that any transfers 350.15to one project that exceed $1,000,000 or 350.16multiple transfers to one project that exceed 350.17$1,000,000 in total require the express 350.18approval of the legislature. The preceding 350.19requirement for legislative approval does not 350.20apply to transfers made to establish a project's 350.21initial operating budget each year; instead, 350.22the requirements of section 11, subdivision 2, 350.23of this article apply to those transfers. Any 350.24unexpended balance in the appropriation 350.25for these projects does not cancel but is 350.26available for ongoing development and 350.27operations. Any computer project with a 350.28total cost exceeding $1,000,000, including, 350.29but not limited to, a replacement for the 350.30proposed HealthMatch system, shall not be 350.31commenced without the express approval of 350.32the legislature.350.33HealthMatch Systems Project. In fiscal 350.34year 2010, $3,054,000 shall be transferred 350.35from the HealthMatch account in the state 351.1systems account in the special revenue fund 351.2to the general fund.351.3Nonfederal Share Transfers. The 351.4nonfederal share of activities for which 351.5federal administrative reimbursement is 351.6appropriated to the commissioner may be 351.7transferred to the special revenue fund.351.8TANF Maintenance of Effort.351.9(a) In order to meet the basic maintenance 351.10of effort (MOE) requirements of the TANF 351.11block grant specified under Code of Federal 351.12Regulations, title 45, section 263.1, the 351.13commissioner may only report nonfederal 351.14money expended for allowable activities 351.15listed in the following clauses as TANF/MOE 351.16expenditures:351.17(1) MFIP cash, diversionary work program, 351.18and food assistance benefits under Minnesota 351.19Statutes, chapter 256J;351.20(2) the child care assistance programs 351.21under Minnesota Statutes, sections 119B.03 351.22and 119B.05, and county child care 351.23administrative costs under Minnesota 351.24Statutes, section 119B.15;351.25(3) state and county MFIP administrative 351.26costs under Minnesota Statutes, chapters 351.27256J and 256K;351.28(4) state, county, and tribal MFIP 351.29employment services under Minnesota 351.30Statutes, chapters 256J and 256K;351.31(5) expenditures made on behalf of 351.32noncitizen MFIP recipients who qualify 351.33for the medical assistance without federal 351.34financial participation program under 352.1Minnesota Statutes, section 256B.06, 352.2subdivision 4, paragraphs (d), (e), and (j); 352.3and352.4(6) qualifying working family credit 352.5expenditures under Minnesota Statutes, 352.6section 290.0671.352.7(b) The commissioner shall ensure that 352.8sufficient qualified nonfederal expenditures 352.9are made each year to meet the state's 352.10TANF/MOE requirements. For the activities 352.11listed in paragraph (a), clauses (2) to 352.12(6), the commissioner may only report 352.13expenditures that are excluded from the 352.14definition of assistance under Code of 352.15Federal Regulations, title 45, section 260.31.352.16(c) For fiscal years beginning with state 352.17fiscal year 2003, the commissioner shall 352.18ensure that the maintenance of effort used 352.19by the commissioner of finance for the 352.20February and November forecasts required 352.21under Minnesota Statutes, section 16A.103, 352.22contains expenditures under paragraph (a), 352.23clause (1), equal to at least 16 percent of 352.24the total required under Code of Federal 352.25Regulations, title 45, section 263.1.352.26(d) For the federal fiscal years beginning on 352.27or after October 1, 2007, the commissioner 352.28may not claim an amount of TANF/MOE in 352.29excess of the 75 percent standard in Code 352.30of Federal Regulations, title 45, section 352.31263.1(a)(2), except:352.32(1) to the extent necessary to meet the 80 352.33percent standard under Code of Federal 352.34Regulations, title 45, section 263.1(a)(1), 352.35if it is determined by the commissioner 353.1that the state will not meet the TANF work 353.2participation target rate for the current year;353.3(2) to provide any additional amounts 353.4under Code of Federal Regulations, title 45, 353.5section 264.5, that relate to replacement of 353.6TANF funds due to the operation of TANF 353.7penalties; and353.8(3) to provide any additional amounts that 353.9may contribute to avoiding or reducing 353.10TANF work participation penalties through 353.11the operation of the excess MOE provisions 353.12of Code of Federal Regulations, title 45, 353.13section 261.43(a)(2).353.14For the purposes of clauses (1) to (3), 353.15the commissioner may supplement the 353.16MOE claim with working family credit 353.17expenditures to the extent such expenditures 353.18or other qualified expenditures are otherwise 353.19available after considering the expenditures 353.20allowed in this section.353.21(e) Minnesota Statutes, section 256.011, 353.22subdivision 3, which requires that federal 353.23grants or aids secured or obtained under that 353.24subdivision be used to reduce any direct 353.25appropriations provided by law, do not apply 353.26if the grants or aids are federal TANF funds.353.27(f) Notwithstanding any contrary provision 353.28in this article, this provision expires June 30, 353.292013.353.30Working Family Credit Expenditures as 353.31TANF/MOE. The commissioner may claim 353.32as TANF/MOE up to $6,707,000 per year of 353.33working family credit expenditures for fiscal 353.34year 2010 through fiscal year 2011.354.1Working Family Credit Expenditures 354.2to be Claimed for TANF/MOE. The 354.3commissioner may count the following 354.4amounts of working family credit expenditure 354.5as TANF/MOE:354.6(1) fiscal year 2010, $30,217,000;354.7(2) fiscal year 2011, $55,596,000;354.8(3) fiscal year 2012, $28,519,000; and354.9(4) fiscal year 2013, $22,138,000.354.10Notwithstanding any contrary provision in 354.11this article, this rider expires June 30, 2013.354.12TANF Transfer to Federal Child Care 354.13and Development Fund. The following 354.14TANF fund amounts are appropriated to the 354.15commissioner for the purposes of MFIP and 354.16transition year child care under Minnesota 354.17Statutes, section 119B.05:354.18(1) fiscal year 2010, $5,909,000;354.19(2) fiscal year 2011, $9,808,000;354.20(3) fiscal year 2012, $10,826,000; and354.21(4) fiscal year 2013, $4,026,000.354.22The commissioner shall authorize the 354.23transfer of sufficient TANF funds to the 354.24federal child care and development fund to 354.25meet this appropriation and shall ensure that 354.26all transferred funds are expended according 354.27to federal child care and development fund 354.28regulations.354.29Food Stamps Employment and Training.354.30(a) The commissioner shall apply for and 354.31claim the maximum allowable federal 354.32matching funds under United States Code, 355.1title 7, section 2025, paragraph (h), for 355.2state expenditures made on behalf of family 355.3stabilization services participants voluntarily 355.4engaged in food stamp employment and 355.5training activities, where appropriate.355.6(b) Notwithstanding Minnesota Statutes, 355.7sections 256D.051, subdivisions 1a, 6b, 355.8and 6c, and 256J.626, federal food stamps 355.9employment and training funds received 355.10as reimbursement of MFIP consolidated 355.11fund grant expenditures for diversionary 355.12work program participants and child 355.13care assistance program expenditures for 355.14two-parent families must be deposited in the 355.15general fund. The amount of funds must be 355.16limited to $3,350,000 in fiscal year 2010 355.17and $4,440,000 in fiscal years 2011 through 355.182013, contingent on approval by the federal 355.19Food and Nutrition Service. 355.20(c) Consistent with the receipt of these federal 355.21funds, the commissioner may adjust the 355.22level of working family credit expenditures 355.23claimed as TANF maintenance of effort. 355.24Notwithstanding any contrary provision in 355.25this article, this rider expires June 30, 2013.355.26ARRA Food Support Administration.355.27The funds available for food support 355.28administration under the American Recovery 355.29and Reinvestment Act (ARRA) of 2009 355.30are appropriated to the commissioner 355.31to pay actual costs of implementing the 355.32food support benefit increases, increased 355.33eligibility determinations, and outreach. Of 355.34these funds, 20 percent shall be allocated 355.35to the commissioner and 80 percent shall 356.1be allocated to counties. The commissioner 356.2shall allocate the county portion based on 356.3caseload. Reimbursement shall be based on 356.4actual costs reported by counties through 356.5existing processes. Tribal reimbursement 356.6must be made from the state portion based 356.7on a caseload factor equivalent to that of a 356.8county.356.9ARRA Food Support Benefit Increases.356.10The funds provided for food support benefit 356.11increases under the Supplemental Nutrition 356.12Assistance Program provisions of the 356.13American Recovery and Reinvestment Act 356.14(ARRA) of 2009 must be used for benefit 356.15increases beginning July 1, 2009.356.16Emergency Fund for the TANF Program.356.17TANF Emergency Contingency funds 356.18available under the American Recovery 356.19and Reinvestment Act of 2009 (Public Law 356.20111-5) are appropriated to the commissioner. 356.21The commissioner must request TANF 356.22Emergency Contingency funds from the 356.23Secretary of the Department of Health 356.24and Human Services to the extent the 356.25commissioner meets or expects to meet the 356.26requirements of section 403(c) of the Social 356.27Security Act. The commissioner must seek 356.28to maximize such grants. The funds received 356.29must  be used as appropriated. Each county 356.30must maintain the county's current level of 356.31emergency assistance funding under the 356.32MFIP consolidated fund and use the funds 356.33under this paragraph to supplement existing 356.34emergency assistance funding levels.

356.35Subd. 2.Agency Management

357.1The amounts that may be spent from the 357.2appropriation for each purpose are as follows:

357.3(a) Financial Operations

357.4Appropriations by Fund357.5General3,380,0003,908,000357.6Health Care Access1,281,0001,016,000357.7Federal TANF122,000122,000

357.8(b) Legal and Regulatory Operations

357.9Appropriations by Fund357.10General13,749,00013,534,000357.11357.12State Government Special Revenue440,000440,000357.13Health Care Access943,000943,000357.14Federal TANF100,000100,000

357.15(c) Management Operations

357.16Appropriations by Fund357.17General4,334,0004,562,000357.18Health Care Access242,000242,000

357.19Lease Cost Reduction. Base level funding 357.20to the commissioner shall be reduced by 357.21$381,000 in fiscal year 2010, and $153,000 357.22in fiscal year 2011, to reflect a reduction in 357.23lease costs related to the Minnehaha Avenue 357.24building.357.25Base Adjustment. The general fund base is 357.26increased by $153,000 in each of fiscal years 357.272012 and 2013.

357.28(d) Information Technology Operations

358.1Appropriations by Fund358.2General28,077,00028,077,000358.3Health Care Access4,856,0004,868,000

358.4358.5Subd. 3.Revenue and Pass-Through Revenue Expenditures65,746,00067,068,000

358.6This appropriation is from the federal TANF 358.7fund.

358.8358.9Subd. 4.Children and Economic Assistance Grants

358.10The amounts that may be spent from this 358.11appropriation for each purpose are as follows:

358.12(a) MFIP/DWP Grants

358.13Appropriations by Fund358.14General63,205,00089,033,000358.15Federal TANF100,404,00085,789,000

358.16(b) Support Services Grants

358.17Appropriations by Fund358.18General8,715,00012,498,000358.19Federal TANF121,257,000102,757,000

358.20MFIP Consolidated Fund. The MFIP 358.21consolidated fund TANF appropriation is 358.22reduced by $1,854,000 in fiscal year 2011 358.23and fiscal year 2012.358.24Notwithstanding Minnesota Statutes, section 358.25256J.626, subdivision 8, paragraph (b), the 358.26commissioner shall reduce proportionately 358.27the reimbursement to counties for 358.28administrative expenses.359.1Subsidized Employment Funding Through 359.2ARRA. The commissioner is authorized to 359.3apply for TANF emergency fund grants for 359.4subsidized employment activities. Growth 359.5in expenditures for subsidized employment 359.6within the supported work program and the 359.7MFIP consolidated fund over the amount 359.8expended in the calendar quarters in the 359.9TANF emergency fund base year shall be 359.10used to leverage the TANF emergency fund 359.11grants for subsidized employment and to 359.12fund supported work. The commissioner 359.13shall develop procedures to maximize 359.14reimbursement of these expenditures over the 359.15TANF emergency fund base year quarters, 359.16and may contract directly with employers 359.17and providers to maximize these TANF 359.18emergency fund grants.359.19Supported Work. Of the TANF 359.20appropriation, $6,400,000 in fiscal year 359.212011 is to the commissioner for supported 359.22work for MFIP recipients and is available 359.23until expended. Supported work includes 359.24paid transitional work experience and 359.25a continuum of employment assistance, 359.26including outreach and recruitment, 359.27program orientation and intake, testing and 359.28assessment, job development and marketing, 359.29preworksite training, supported worksite 359.30experience, job coaching, and postplacement 359.31follow-up, in addition to extensive case 359.32management and referral services.359.33Base Adjustment. The general fund base 359.34is reduced by $3,783,000 in each of fiscal 359.35years 2012 and 2013. The TANF fund base 360.1is increased by $9,704,000 in each of fiscal 360.2years 2012 and 2013.360.3Integrated Services Program Funding.360.4The TANF appropriation for integrated 360.5services program funding is $1,250,000 in 360.6fiscal year 2010 and $2,500,000 in fiscal year 360.72011.360.8TANF Emergency Fund; Nonrecurrent 360.9Short-Term Benefits. TANF emergency 360.10contingency fund grants received due to 360.11increases in expenditures for nonrecurrent 360.12short-term benefits must be used to offset the 360.13increase in these expenditures for counties 360.14under the MFIP consolidated fund, under 360.15Minnesota Statutes, section 256J.626, 360.16and the diversionary work program. The 360.17commissioner shall develop procedures 360.18to maximize reimbursement of these 360.19expenditures over the TANF emergency fund 360.20base year quarters. Growth in expenditures 360.21for the diversionary work program over the 360.22amount expended in the calendar quarters in 360.23the TANF emergency fund base year shall be 360.24used to leverage these funds.

360.25(c) MFIP Child Care Assistance Grants

360.26Appropriations by Fund360.27General61,171,00065,214,000360.28Federal TANF1,022,000406,000

360.29ARRA Child Care Development Block 360.30Grant Funds. The funds available from the 360.31child care development block grant under 360.32ARRA must be used for MFIP child care to 360.33the extent that those funds are not earmarked 361.1for quality expansion or to improve the 361.2quality of infant and toddler care.361.3Acceleration of ARRA Child Care and 361.4Development Fund Expenditure. The 361.5commissioner must liquidate all child care 361.6and development money available under 361.7the American Recovery and Reinvestment 361.8Act (ARRA) of 2009, Public Law 111-5, 361.9by September 30, 2010. In order to expend 361.10those funds by September 30, 2010, the 361.11commissioner may redesignate and expend 361.12the ARRA child care and development funds 361.13appropriated in fiscal year 2011 for purposes 361.14under this section for related purposes that 361.15will allow liquidation by September 30, 361.162010. Child care and development funds 361.17otherwise available to the commissioner 361.18for those related purposes shall be used to 361.19fund the purposes from which the ARRA 361.20child care and development funds had been 361.21redesignated.

361.22361.23(d) Basic Sliding Fee Child Care Assistance Grants40,104,00045,096,000

361.24Base Adjustment. The general fund base is 361.25decreased by $260,000 in each of fiscal years 361.262012 and 2013.361.27School Readiness Service Agreements.361.28$261,000 in fiscal year 2010 and $261,000 361.29in fiscal year 2011 are from the federal 361.30child care development funds received from 361.31the American Recovery and Reinvestment 361.32Act of 2009, Public Law 111-5, to the 361.33commissioner of human services consistent 361.34with federal regulations for the purpose of 362.1school readiness service agreements under 362.2Minnesota Statutes, section 119B.231. This 362.3is a onetime appropriation. Any unexpended 362.4balance the first year is available in the 362.5second year.362.6Child Care Development Fund 362.7Unexpended Balance. In addition to 362.8the amount provided in this section, the 362.9commissioner shall expend $5,244,000 in 362.10fiscal year 2010 from the federal child care 362.11development fund unexpended balance 362.12for basic sliding fee child care under 362.13Minnesota Statutes, section 119B.03. The 362.14commissioner shall ensure that all child 362.15care and development funds are expended 362.16according to the federal child care and 362.17development fund regulations.362.18Basic Sliding Fee. $7,045,000 in fiscal year 362.192010 and $6,974,000 in fiscal year 2011 are 362.20from the federal child care development 362.21funds received from the American Recovery 362.22and Reinvestment Act of 2009, Public 362.23Law 111-5, to the commissioner of human 362.24services consistent with federal regulations 362.25for the purpose of basic sliding fee child care 362.26assistance under Minnesota Statutes, section 362.27119B.03. This is a onetime appropriation. 362.28Any unexpended balance the first year is 362.29available in the second year.362.30Basic Sliding Fee Allocation for Calendar 362.31Year 2010. Notwithstanding Minnesota 362.32Statutes, section 119B.03, subdivision 6, 362.33in calendar year 2010, basic sliding fee 362.34funds shall be distributed according to 362.35this provision. Funds shall be allocated 363.1first in amounts equal to each county's 363.2guaranteed floor, according to Minnesota 363.3Statutes, section 119B.03, subdivision 8, 363.4with any remaining available funds allocated 363.5according to the following formula:363.6(a) Up to one-fourth of the funds shall be 363.7allocated in proportion to the number of 363.8families participating in the transition year 363.9child care program as reported during and 363.10averaged over the most recent six months 363.11completed at the time of the notice of 363.12allocation. Funds in excess of the amount 363.13necessary to serve all families in this category 363.14shall be allocated according to paragraph (d).363.15(b) Up to three-fourths of the funds shall 363.16be allocated in proportion to the average 363.17of each county's most recent six months of 363.18reported waiting list as defined in Minnesota 363.19Statutes, section 119B.03, subdivision 2, and 363.20the reinstatement list of those families whose 363.21assistance was terminated with the approval 363.22of the commissioner under Minnesota Rules, 363.23part 3400.0183, subpart 1. Funds in excess 363.24of the amount necessary to serve all families 363.25in this category shall be allocated according 363.26to paragraph (d).363.27(c) The amount necessary to serve all families 363.28in paragraphs (a) and (b) shall be calculated 363.29based on the basic sliding fee average cost of 363.30care per family in the county with the highest 363.31cost in the most recently completed calendar 363.32year.363.33(d) Funds in excess of the amount necessary 363.34to serve all families in paragraphs (a) and 363.35(b) shall be allocated in proportion to each 364.1county's total expenditures for the basic 364.2sliding fee child care program reported 364.3during the most recent fiscal year completed 364.4at the time of the notice of allocation. To 364.5the extent that funds are available, and 364.6notwithstanding Minnesota Statutes, section 364.7119B.03, subdivision 8, for the period 364.8January 1, 2011, to December 31, 2011, each 364.9county's guaranteed floor must be equal to its 364.10original calendar year 2010 allocation.

364.11(e) Child Care Development Grants1,487,0001,487,000

364.12Family, friends, and neighbor grants.364.13$375,000 in fiscal year 2010 and $375,000 364.14in fiscal year 2011 are from the child 364.15care development fund required targeted 364.16quality funds for quality expansion and 364.17infant/toddler from the American Recovery 364.18and Reinvestment Act of 2009, Public 364.19Law 111-5, to the commissioner of human 364.20services for family, friends, and neighbor 364.21grants under Minnesota Statutes, section 364.22119B.232. This appropriation may be used 364.23on programs receiving family, friends, and 364.24neighbor grant funds as of June 30, 2009, 364.25or on new programs or projects. This is a 364.26onetime appropriation. Any unexpended 364.27balance the first year is available in the 364.28second year.364.29Voluntary quality rating system training, 364.30coaching, consultation, and supports.364.31$633,000 in fiscal year 2010 and $633,000 364.32in fiscal year 2011 are from the federal child 364.33care development fund required targeted 364.34quality funds for quality expansion and 364.35infant/toddler from the American Recovery 365.1and Reinvestment Act of 2009, Public 365.2Law 111-5, to the commissioner of human 365.3services consistent with federal regulations 365.4for the purpose of providing grants to provide 365.5statewide child-care provider training, 365.6coaching, consultation, and supports to 365.7prepare for the voluntary Minnesota quality 365.8rating system rating tool. This is a onetime 365.9appropriation. Any unexpended balance the 365.10first year is available in the second year.365.11Voluntary quality rating system. $184,000 365.12in fiscal year 2010 and $1,200,000 in fiscal 365.13year 2011 are from the federal child care 365.14development fund required targeted funds for 365.15quality expansion and infant/toddler from the 365.16American Recovery and Reinvestment Act of 365.172009, Public Law 111-5, to the commissioner 365.18of human services consistent with federal 365.19regulations for the purpose of implementing 365.20the voluntary Parent Aware quality star 365.21rating system pilot in coordination with the 365.22Minnesota Early Learning Foundation. The 365.23appropriation for the first year is to complete 365.24and promote the voluntary Parent Aware 365.25quality rating system pilot program through 365.26June 30, 2010, and the appropriation for the 365.27second year is to continue the voluntary 365.28Minnesota quality rating system pilot 365.29through June 30, 2011. This is a onetime 365.30appropriation. Any unexpended balance the 365.31first year is available in the second year.

365.32(f) Child Support Enforcement Grants3,705,0003,705,000

365.33(g) Children's Services Grants

366.1Appropriations by Fund366.2General 48,333,00050,498,000366.3Federal TANF340,000240,000

366.4Base Adjustment. The general fund base is 366.5decreased by $5,371,000 in fiscal year 2012 366.6and increased $8,737,000 in fiscal year 2013.366.7Privatized Adoption Grants. Federal 366.8reimbursement for privatized adoption grant 366.9and foster care recruitment grant expenditures 366.10is appropriated to the commissioner for 366.11adoption grants and foster care and adoption 366.12administrative purposes.366.13Adoption Assistance Incentive Grants.366.14Federal funds available during fiscal year 366.152010 and fiscal year 2011 for the adoption 366.16incentive grants are appropriated to the 366.17commissioner for these purposes.366.18Adoption Assistance and Relative Custody 366.19Assistance. The commissioner may transfer 366.20unencumbered appropriation balances for 366.21adoption assistance and relative custody 366.22assistance between fiscal years and between 366.23programs.

366.24(h) Children and Community Services Grants67,663,00067,542,000

366.25Targeted Case Management Temporary 366.26Funding Adjustment. The commissioner 366.27shall recover from each county and tribe 366.28receiving a targeted case management 366.29temporary funding payment in fiscal year 366.302008 an amount equal to that payment. The 366.31commissioner shall recover one-half of the 366.32funds by February 1, 2010, and the remainder 366.33by February 1, 2011. At the commissioner's 367.1discretion and at the request of a county 367.2or tribe, the commissioner may revise 367.3the payment schedule, but full payment 367.4must not be delayed beyond May 1, 2011. 367.5The commissioner may use the recovery 367.6procedure under Minnesota Statutes, section 367.7256.017, to recover the funds. Recovered 367.8funds must be deposited into the general 367.9fund.

367.10(i) General Assistance Grants48,215,00048,608,000

367.11General Assistance Standard. The 367.12commissioner shall set the monthly standard 367.13of assistance for general assistance units 367.14consisting of an adult recipient who is 367.15childless and unmarried or living apart 367.16from parents or a legal guardian at $203. 367.17The commissioner may reduce this amount 367.18according to Laws 1997, chapter 85, article 367.193, section 54.367.20Emergency General Assistance. The 367.21amount appropriated for emergency general 367.22assistance funds is limited to no more 367.23than $7,889,812 in fiscal year 2010 and 367.24$7,889,812 in fiscal year 2011. Funds 367.25to counties must be allocated by the 367.26commissioner using the allocation method 367.27specified in Minnesota Statutes, section 367.28256D.06.

367.29(j) Minnesota Supplemental Aid Grants33,930,00035,191,000

367.30Emergency Minnesota Supplemental 367.31Aid Funds. The amount appropriated for 367.32emergency Minnesota supplemental aid 367.33funds is limited to no more than $1,100,000 367.34in fiscal year 2010 and $1,100,000 in fiscal 368.1year 2011. Funds to counties must be 368.2allocated by the commissioner using the 368.3allocation method specified in Minnesota 368.4Statutes, section 256D.46.

368.5(k) Group Residential Housing Grants111,778,000114,034,000

368.6Group Residential Housing Costs 368.7Refinanced. (a) Effective July 1, 2011, the 368.8commissioner shall increase the home and 368.9community-based service rates and county 368.10allocations provided to programs for persons 368.11with disabilities established under section 368.121915(c) of the Social Security Act to the 368.13extent that these programs will be paying 368.14for the costs above the rate established 368.15in Minnesota Statutes, section 256I.05, 368.16subdivision 1.368.17(b) For persons receiving services under 368.18Minnesota Statutes, section 245A.02, who 368.19reside in licensed adult foster care beds 368.20for which a difficulty of care payment 368.21was being made under Minnesota Statutes, 368.22section 256I.05, subdivision 1c, paragraph 368.23(b), counties may request an exception to 368.24the individual's service authorization not to 368.25exceed the difference between the client's 368.26monthly service expenditures plus the 368.27amount of the difficulty of care payment.

368.28(l) Children's Mental Health Grants16,885,00016,882,000

368.29Funding Usage. Up to 75 percent of a fiscal 368.30year's appropriation for children's mental 368.31health grants may be used to fund allocations 368.32in that portion of the fiscal year ending 368.33December 31.

369.1369.2(m) Other Children and Economic Assistance Grants16,047,00015,339,000

369.3Fraud Prevention Grants. Of this 369.4appropriation, $379,000 in fiscal year 2010 369.5and $379,000 in fiscal year 2011 is to the 369.6commissioner for fraud prevention grants to 369.7counties.369.8Homeless and Runaway Youth. $218,000 369.9in fiscal year 2010 is for the Runaway 369.10and Homeless Youth Act under Minnesota 369.11Statutes, section 256K.45. Funds shall be 369.12spent in each area of the continuum of care 369.13to ensure that programs are meeting the 369.14greatest need. Any unexpended balance in 369.15the first year is available in the second year. 369.16Beginning July 1, 2011, the base is increased 369.17by $119,000 each year.369.18ARRA Homeless Youth Funds. To the 369.19extent permitted under federal law, the 369.20commissioner shall designate $2,500,000 369.21of the Homeless Prevention and Rapid 369.22Re-Housing Program funds provided under 369.23the American Recovery and Reinvestment 369.24Act of 2009, Public Law 111-5, for agencies 369.25providing homelessness prevention and rapid 369.26rehousing services to youth.369.27Supportive Housing Services. $1,500,000 369.28each year is for supportive services under 369.29Minnesota Statutes, section 256K.26. This is 369.30a onetime appropriation. Beginning in fiscal 369.31year 2012, the base is increased by $68,000 369.32per year.369.33Community Action Grants. Community 369.34action grants are reduced one time by 370.1$1,764,000 each year. This reduction is due 370.2to the availability of federal funds under the 370.3American Recovery and Reinvestment Act.370.4Base Adjustment. The general fund base 370.5is increased by $773,000 in fiscal year 2012 370.6and $773,000 in fiscal year 2013.370.7Federal ARRA Funds for Existing 370.8Programs. (a) Federal funds received by the 370.9commissioner for the emergency food and 370.10shelter program from the American Recovery 370.11and Reinvestment Act of 2009, Public 370.12Law 111-5, but not previously approved 370.13by the legislature are appropriated to the 370.14commissioner for the purposes of the grant 370.15program.370.16(b) Federal funds received by the 370.17commissioner for the emergency shelter 370.18grant program including the Homelessness 370.19Prevention and Rapid Re-Housing 370.20Program from the American Recovery and 370.21Reinvestment Act of 2009, Public Law 370.22111-5, are appropriated to the commissioner 370.23for the purposes of the grant programs.370.24(c) Federal funds received by the 370.25commissioner for the emergency food 370.26assistance program from the American 370.27Recovery and Reinvestment Act of 2009, 370.28Public Law 111-5, are appropriated to the 370.29commissioner for the purposes of the grant 370.30program.370.31(d) Federal funds received by the 370.32commissioner for senior congregate meals 370.33and senior home-delivered meals from the 370.34American Recovery and Reinvestment Act 370.35of 2009, Public Law 111-5, are appropriated 371.1to the commissioner for the Minnesota Board 371.2on Aging, for purposes of the grant programs.371.3(e) Federal funds received by the 371.4commissioner for the community services 371.5block grant program from the American 371.6Recovery and Reinvestment Act of 2009, 371.7Public Law 111-5, are appropriated to the 371.8commissioner for the purposes of the grant 371.9program.371.10Long-Term Homeless Supportive 371.11Service Fund Appropriation. To the 371.12extent permitted under federal law, the 371.13commissioner shall designate $3,000,000 371.14of the Homelessness Prevention and Rapid 371.15Re-Housing Program funds provided under 371.16the American Recovery and Reinvestment 371.17Act of 2009, Public Law, 111-5, to the 371.18long-term homeless service fund under 371.19Minnesota Statutes, section 256K.26. This 371.20appropriation shall become available by July 371.211, 2009. This paragraph is effective the day 371.22following final enactment.

371.23371.24Subd. 5.Children and Economic Assistance Management

371.25The amounts that may be spent from the 371.26appropriation for each purpose are as follows:

371.27371.28(a) Children and Economic Assistance Administration

371.29Appropriations by Fund371.30General10,318,00010,308,000371.31Federal TANF496,000496,000

372.1Base Adjustment. The federal TANF base 372.2is increased by $700,000 in each of fiscal 372.3years 2012 and 2013.372.4School Readiness Service Agreements.372.5$406,000 in fiscal year 2010 and $406,000 372.6in fiscal year 2011 are from the federal 372.7child care development funds received from 372.8the American Recovery and Reinvestment 372.9Act of 2009, Public Law 111-5, to the 372.10commissioner of human services consistent 372.11with federal regulations for the purpose of 372.12school readiness service agreements under 372.13Minnesota Statutes, section 119B.231. This 372.14is a onetime appropriation. Any unexpended 372.15balance the first year is available in the 372.16second year.

372.17372.18(b) Children and Economic Assistance Operations

372.19Appropriations by Fund372.20General33,590,00033,423,000372.21Health Care Access361,000361,000

372.22Financial Institution Data Match and 372.23Payment of Fees. The commissioner is 372.24authorized to allocate up to $310,000 each 372.25year in fiscal years 2010 and 2011 from the 372.26PRISM special revenue account to make 372.27payments to financial institutions in exchange 372.28for performing data matches between account 372.29information held by financial institutions 372.30and the public authority's database of child 372.31support obligors as authorized by Minnesota 372.32Statutes, section 13B.06, subdivision 7.373.1School Readiness Service Agreements.373.2$106,000 in fiscal year 2010 and $241,000 373.3in fiscal year 2011 are from the federal 373.4child care development funds received from 373.5the American Recovery and Reinvestment 373.6Act of 2009, Public Law 111-5, to the 373.7commissioner of human services consistent 373.8with federal regulations for the purpose of 373.9school readiness service agreements under 373.10Minnesota Statutes, section 119B.231. This 373.11is a onetime appropriation.373.12Use of Federal Stabilization Funds.373.13$33,000,000 in fiscal year 2010 is 373.14appropriated from the fiscal stabilization 373.15account in the federal fund to the 373.16commissioner. This appropriation must not 373.17be used for any activity or service for which 373.18federal reimbursement is claimed. This is a 373.19onetime appropriation.

373.20Subd. 6.Basic Health Care Grants

373.21The amounts that may be spent from this 373.22appropriation for each purpose are as follows:

373.23(a) MinnesotaCare Grants391,915,000485,448,000

373.24This appropriation is from the health care 373.25access fund.

373.26373.27(b) MA Basic Health Care Grants - Families and Children751,988,000973,088,000

373.28Medical Education Research Costs 373.29(MERC). Of these funds, the commissioner 373.30of human services shall transfer $38,000,000 373.31in fiscal year 2010 to the medical education 373.32research fund. These funds must restore the 373.33fiscal year 2009 unallotment of the transfers 374.1under Minnesota Statutes, section 256B.69, 374.2subdivision 5c, paragraph (a), for the July 1, 374.32008, through June 30, 2009, period.374.4Newborn Screening Fee. Of the general 374.5fund appropriation, $34,000 in fiscal 374.6year 2011 is to the commissioner for the 374.7hospital reimbursement increase described 374.8under Minnesota Statutes, section 256.969, 374.9subdivision 28.374.10Local Share Payment Modification 374.11Required for ARRA Compliance.374.12Effective from July 1, 2009, to December 374.1331, 2010, Hennepin County's monthly 374.14contribution to the nonfederal share of 374.15medical assistance costs must be reduced 374.16to the percentage required on September 374.171, 2008, to meet federal requirements for 374.18enhanced federal match under the American 374.19Reinvestment and Recovery Act (ARRA) 374.20of 2009. Notwithstanding  the requirements 374.21of Minnesota Statutes, section 256B.19, 374.22subdivision 1c, paragraph (d), for the period 374.23beginning July 1, 2009, to December 31, 374.242010, Hennepin County's monthly payment 374.25under that provision is reduced to $434,688.374.26Capitation Payments. Effective from 374.27July 1, 2009, to December 31, 2010, 374.28notwithstanding the provisions of Minnesota 374.29Statutes 2008, section 256B.19, subdivision 374.301c, paragraph (c), the commissioner shall 374.31increase capitation payments made to the 374.32Metropolitan Health Plan under Minnesota 374.33Statutes 2008, section 256B.69, by 374.34$6,800,000 to recognize higher than average 375.1medical education costs. The increased 375.2amount includes federal matching funds.375.3Use of Savings. Any savings derived 375.4from implementation of the prohibition in 375.5Minnesota Statutes, section 256B.032, on the 375.6enrollment of low-quality, high-cost health 375.7care providers as vendors of state health care 375.8program services shall be used to offset on a 375.9pro rata basis the reimbursement reductions 375.10for basic care services in Minnesota Statutes, 375.11section 256B.766.

375.12375.13(c) MA Basic Health Care Grants - Elderly and Disabled970,183,0001,142,310,000

375.14Minnesota Disability Health Options. 375.15Notwithstanding Minnesota Statutes, section 375.16256B.69, subdivision 5a, paragraph (b), for 375.17the period beginning July 1, 2009, to June 375.1830, 2011, the monthly enrollment of persons 375.19receiving home and community-based 375.20waivered services under Minnesota 375.21Disability Health Options shall not exceed 375.221,000. If the budget neutrality provision 375.23in Minnesota Statutes, section 256B.69, 375.24subdivision 23, paragraph (f), is reached 375.25prior to June 30, 2013, the commissioner may 375.26waive this monthly enrollment requirement.375.27Hospital Fee-for-Service Payment Delay.375.28Payments from the Medicaid Management 375.29Information System that would otherwise 375.30have been made for inpatient hospital 375.31services for Minnesota health care program 375.32enrollees must be delayed as follows: for 375.33fiscal year 2011, payments in the month of 375.34June equal to $15,937,000 must be included 376.1in the first payment of fiscal year 2012 and 376.2for fiscal year 2013, payments in the month 376.3of June equal to $6,666,000 must be included 376.4in the first payment of fiscal year 2014. The 376.5provisions of Minnesota Statutes, section 376.616A.124, do not apply to these delayed 376.7payments. Notwithstanding any contrary 376.8provision in this article, this paragraph 376.9expires December 31, 2014.376.10Nonhospital Fee-for-Service Payment 376.11Delay. Payments from the Medicaid 376.12Management Information System that would 376.13otherwise have been made for nonhospital 376.14acute care services for Minnesota health 376.15care program enrollees must be delayed as 376.16follows: payments in the month of June equal 376.17to $23,438,000 for fiscal year 2011 must be 376.18included in the first payment for fiscal year 376.192012, and payments in the month of June 376.20equal to $27,156,000 for fiscal year 2013 376.21must be included in the first payment for 376.22fiscal year 2014. This payment delay must 376.23not include nursing facilities, intermediate 376.24care facilities for persons with developmental 376.25disabilities, home and community-based 376.26services, prepaid health plans, personal care 376.27provider organizations, and home health 376.28agencies. The provisions of Minnesota 376.29Statutes, section 16A.124, do not apply to 376.30these delayed payments. Notwithstanding 376.31any contrary provision in this article, this 376.32paragraph expires December 31, 2014.

376.33(d) General Assistance Medical Care Grants345,223,000381,081,000

376.34(e) Other Health Care Grants

377.1Appropriations by Fund377.2General295,000295,000377.3Health Care Access23,533,0007,080,000

377.4Base Adjustment. The health care access 377.5fund base is reduced to $190,000 in each of 377.6fiscal years 2012 and 2013.

377.7Subd. 7.Health Care Management

377.8The amounts that may be spent from the 377.9appropriation for each purpose are as follows:

377.10(a) Health Care Administration

377.11Appropriations by Fund377.12General7,831,0007,742,000377.13Health Care Access1,812,000906,000

377.14(b) Health Care Operations

377.15Appropriations by Fund377.16General19,914,00018,949,000377.17Health Care Access25,099,00025,875,000

377.18Base Adjustment. The health care access 377.19fund base is increased by $1,006,000 in 377.20fiscal year 2012 and $1,781,000 in fiscal year 377.212013. The general fund base is decreased by 377.22$237,000 in fiscal year 2012 and $237,000 in 377.23fiscal year 2013.

377.24Subd. 8.Continuing Care Grants

377.25The amounts that may be spent from the 377.26appropriation for each purpose are as follows:

377.27(a) Aging and Adult Services Grants

378.1Appropriations by Fund378.2General13,488,00015,779,000378.3Federal500,0000

378.4Base Adjustment. The general fund base is 378.5increased by $5,751,000 in fiscal year 2012 378.6and $6,705,000 in fiscal year 2013.378.7Information and Assistance 378.8Reimbursement. Federal administrative 378.9reimbursement obtained from information 378.10and assistance services provided by the 378.11Senior LinkAge or Disability Linkage lines 378.12to people who are identified as eligible for 378.13medical assistance shall be appropriated to 378.14the commissioner for this activity.378.15Community Service Development Grant 378.16Reduction. Funding for community service 378.17development grants must be reduced by 378.18$251,000 for fiscal year 2010; $266,000 in 378.19fiscal year 2011; $25,000 in fiscal year 2012; 378.20and $25,000 in fiscal year 2013. Base level 378.21funding shall be restored in fiscal year 2014.378.22Senior Nutrition Use of Federal Funds.378.23For fiscal year 2010, general fund grants 378.24for home-delivered meals and congregate 378.25dining shall be reduced by $500,000. The 378.26commissioner must replace these general 378.27fund reductions with equal amounts from 378.28federal funding for senior nutrition from the 378.29American Recovery and Reinvestment Act 378.30of 2009.

378.31(b) Alternative Care Grants50,234,00048,576,000

379.1Base Adjustment. The general fund base is 379.2decreased by $3,598,000 in fiscal year 2012 379.3and $3,470,000 in fiscal year 2013.379.4Alternative Care Transfer. Any money 379.5allocated to the alternative care program that 379.6is not spent for the purposes indicated does 379.7not cancel but must be transferred to the 379.8medical assistance account.

379.9379.10(c) Medical Assistance Grants; Long-Term Care Facilities.367,444,000419,749,000

379.11379.12(d) Medical Assistance Long-Term Care Waivers and Home Care Grants854,373,0001,043,411,000

379.13Manage Growth in TBI and CADI 379.14Waivers. During the fiscal years beginning 379.15on July 1, 2009, and July 1, 2010, the 379.16commissioner shall allocate money for home 379.17and community-based waiver programs 379.18under Minnesota Statutes, section 256B.49, 379.19to ensure a reduction in state spending that is 379.20equivalent to limiting the caseload growth of 379.21the TBI waiver to 12.5 allocations per month 379.22each year of the biennium and the CADI 379.23waiver to 95 allocations per month each year 379.24of the biennium. Limits do not apply: (1) 379.25when there is an approved plan for nursing 379.26facility bed closures for individuals under 379.27age 65 who require relocation due to the 379.28bed closure; (2) to fiscal year 2009 waiver 379.29allocations delayed due to unallotment; or (3) 379.30to transfers authorized by the commissioner 379.31from the personal care assistance program 379.32of individuals having a home care rating 379.33of "CS," "MT," or "HL." Priorities for the 379.34allocation of funds must be for individuals 380.1anticipated to be discharged from institutional 380.2settings or who are at imminent risk of a 380.3placement in an institutional setting.380.4Manage Growth in DD Waiver. The 380.5commissioner shall manage the growth in 380.6the DD waiver by limiting the allocations 380.7included in the February 2009 forecast to 15 380.8additional diversion allocations each month 380.9for the calendar years that begin on January 380.101, 2010, and January 1, 2011. Additional 380.11allocations must be made available for 380.12transfers authorized by the commissioner 380.13from the personal care program of individuals 380.14having a home care rating of "CS," "MT," 380.15or "HL."380.16Adjustment to Lead Agency Waiver 380.17Allocations. Prior to the availability of the 380.18alternative license defined in Minnesota 380.19Statutes, section 245A.11, subdivision 8, 380.20the commissioner shall reduce lead agency 380.21waiver allocations for the purposes of 380.22implementing a moratorium on corporate 380.23foster care.380.24Alternatives to Personal Care Assistance 380.25Services. Base level funding of $3,237,000 380.26in fiscal year 2012 and $4,856,000 in 380.27fiscal year 2013 is to implement alternative 380.28services to personal care assistance services 380.29for persons with mental health and other 380.30behavioral challenges who can benefit 380.31from other services that more appropriately 380.32meet their needs and assist them in living 380.33independently in the community. These 380.34services may include, but not be limited to, a 380.351915(i) state plan option.

381.1(e) Mental Health Grants

381.2Appropriations by Fund381.3General77,739,00077,739,000381.4Health Care Access750,000750,000381.5Lottery Prize1,508,0001,508,000

381.6Funding Usage. Up to 75 percent of a fiscal 381.7year's appropriation for adult mental health 381.8grants may be used to fund allocations in that 381.9portion of the fiscal year ending December 381.1031.

381.11(f) Deaf and Hard-of-Hearing Grants1,930,0001,917,000

381.12(g) Chemical Dependency Entitlement Grants111,303,000122,822,000

381.13Payments for Substance Abuse Treatment.381.14For services provided during fiscal years 381.152010 and 2011, county-negotiated rates and 381.16provider claims to the consolidated chemical 381.17dependency fund must not exceed rates 381.18charged for these services on January 1, 2009. 381.19For services provided in fiscal years 2012 381.20and 2013, statewide average rates under the 381.21new rate methodology to be developed under 381.22Minnesota Statutes, section 254B.12, must 381.23not exceed the average rates charged for these 381.24services on January 1, 2009, plus $3,787,000 381.25for fiscal year 2012 and $5,023,000 for fiscal 381.26year 2013. Notwithstanding any provision 381.27to the contrary in this article, this provision 381.28expires on June 30, 2013.381.29Chemical Dependency Special Revenue 381.30Account. For fiscal year 2010, $750,000 381.31must be transferred from the consolidated 382.1chemical dependency treatment fund 382.2administrative account and deposited into the 382.3general fund.382.4County CD Share of MA Costs for 382.5ARRA Compliance. Notwithstanding the 382.6provisions of Minnesota Statutes, chapter 382.7254B, for chemical dependency services 382.8provided during the period July 1, 2009, 382.9to December 31, 2010, and reimbursed by 382.10medical assistance at the enhanced federal 382.11matching rate provided under the American 382.12Recovery and Reinvestment Act of 2009, the 382.13county share is 30 percent of the nonfederal 382.14share.

382.15382.16(h) Chemical Dependency Nonentitlement Grants1,729,0001,729,000

382.17Base Adjustment. The general fund base is 382.18decreased by $3,000 in each of fiscal years 382.192012 and 2013.

382.20(i) Other Continuing Care Grants18,272,00013,139,000

382.21Base Adjustment. The general fund base is 382.22increased by $7,028,000 in fiscal year 2012 382.23and increased by $8,243,000 in fiscal year 382.242013.382.25Technology Grants. $650,000 in fiscal 382.26year 2010 and $1,000,000 in fiscal year 382.272011 are for technology grants, case 382.28consultation, evaluation, and consumer 382.29information grants related to developing and 382.30supporting alternatives to shift-staff foster 382.31care residential service models.382.32Other Continuing Care Grants; HIV 382.33Grants. Money appropriated for the HIV 383.1drug and insurance grant program in fiscal 383.2year 2010 may be used in either year of the 383.3biennium.

383.4Subd. 9.Continuing Care Management

383.5Appropriations by Fund383.6General24,927,00025,314,000383.7383.8State Government Special Revenue875,000125,000383.9Lottery Prize157,000157,000

383.10Quality Assurance Commission. Effective 383.11July 1, 2009, state funding for the quality 383.12assurance commission under Minnesota 383.13Statutes, section 256B.0951, is canceled.383.14County Maintenance of Effort. $350,000 in 383.15fiscal year 2010 is from the general fund for 383.16the State-County Results Accountability and 383.17Service Delivery Reform under Minnesota 383.18Statutes, chapter 402A.383.19Base Adjustment.  The general fund base is 383.20decreased $2,697,000 in fiscal year 2012 and 383.21$2,791,000 in fiscal year 2013.

383.22Subd. 10.State-Operated Services258,794,000266,191,000

383.23The amounts that may be spent from the 383.24appropriation for each purpose are as follows:383.25Transfer Authority Related to 383.26State-Operated Services. Money 383.27appropriated to finance state-operated 383.28services may be transferred between the 383.29fiscal years of the biennium with the approval 383.30of the commissioner of finance.383.31County Past Due Receivables. The 383.32commissioner is authorized to withhold 384.1county federal administrative reimbursement 384.2when the county of financial responsibility 384.3for cost-of-care payments due the state 384.4under Minnesota Statutes, section 246.54 384.5or 253B.045, is 90 days past due. The 384.6commissioner shall deposit the withheld 384.7federal administrative earnings for the county 384.8into the general fund to settle the claims with 384.9the county of financial responsibility. The 384.10process for withholding funds is governed by 384.11Minnesota Statutes, section 256.017.384.12Forecast and Census Data. The 384.13commissioner shall include census data and 384.14fiscal projections for state-operated services 384.15and Minnesota sex offender services with the 384.16November and February budget forecasts. 384.17Notwithstanding any contrary provision in 384.18this article, this paragraph shall not expire.

384.19(a) Adult Mental Health Services107,702,000107,201,000

384.20Appropriation Limitation. No part of 384.21the appropriation in this article to the 384.22commissioner for mental health treatment 384.23services provided by state-operated services 384.24shall be used for the Minnesota sex offender 384.25program.384.26Community Behavioral Health Hospitals.384.27Under Minnesota Statutes, section 246.51, 384.28subdivision 1, a determination order for the 384.29clients served in a community behavioral 384.30health hospital operated by the commissioner 384.31of human services is only required when 384.32a client's third-party coverage has been 384.33exhausted.385.1Base Adjustment. The general fund base is 385.2decreased by $500,000 for fiscal year 2012 385.3and by $500,000 for fiscal year 2013.

385.4(b) Minnesota Sex Offender Services

385.5Appropriations by Fund385.6General 38,348,00067,503,000385.7Federal Fund26,495,0000

385.8Use of Federal Stabilization Funds. Of 385.9this appropriation, $26,495,000 in fiscal year 385.102010 is from the fiscal stabilization account 385.11in the federal fund to the commissioner. 385.12This appropriation must not be used for 385.13any activity or service for which federal 385.14reimbursement is claimed. This is a onetime 385.15appropriation.

385.16385.17(c) Minnesota Security Hospital and METO Services

385.18Appropriations by Fund385.19General 230,000,00083,735,000385.20Federal Fund83,504,0000

385.21Minnesota Security Hospital.  For the 385.22purposes of enhancing the safety of 385.23the public, improving supervision, and 385.24enhancing community-based mental health 385.25treatment, state-operated services may 385.26establish additional community capacity 385.27for providing treatment and supervision 385.28of clients who have been ordered into a 385.29less restrictive alternative of care from the 385.30state-operated services transitional services 386.1program consistent with Minnesota Statutes, 386.2section 246.014.386.3Use of Federal Stabilization Funds.386.4$83,505,000 in fiscal year 2010 is 386.5appropriated from the fiscal stabilization 386.6account in the federal fund to the 386.7commissioner. This appropriation must not 386.8be used for any activity or service for which 386.9federal reimbursement is claimed. This is a 386.10onetime appropriation.

386.11Sec. 4. COMMISSIONER OF HEALTH

386.12Subdivision 1.Total Appropriation$165,717,000$161,841,000

386.13Appropriations by Fund386.1420102011386.15General69,366,00063,884,000386.16386.17State Government Special Revenue45,415,00045,415,000386.18Health Care Access39,203,00040,809,000386.19Federal TANF11,733,00011,733,000

386.20386.21Subd. 2.Community and Family Health Promotion

386.22Appropriations by Fund386.23General44,814,00039,671,000386.24386.25State Government Special Revenue1,033,000 1,304,000386.26Federal TANF11,733,00011,733,000386.27Health Care Access21,642,00028,719,000

386.28Newborn Screening Fee. Of the general 386.29fund appropriation, $300,000 in fiscal year 386.302011 is to the commissioner for the purpose 387.1of providing support services to families as 387.2required under Minnesota Statutes, section 387.3144.966, subdivision 3a. $74,000 of this 387.4appropriation in fiscal year 2011 and $51,000 387.5of this appropriation in subsequent fiscal 387.6years may be used by the commissioner 387.7for administrative costs associated with 387.8increasing the fee, contract administration, 387.9program oversight, and provide follow-up to 387.10families who need assistance beyond those 387.11available through the contractor.387.12Support Services for Families With 387.13Children Who are Deaf or Have Hearing 387.14Loss. Of the general fund amount, $16,000 387.15in fiscal year 2010 and $284,000 in fiscal 387.16year 2011 is for support services to families 387.17with children who are deaf or have hearing 387.18loss. Of this amount, in fiscal year 2011, 387.19$223,000 is for grants and the balance is for 387.20administrative costs. Base funding in fiscal 387.21years 2012 and 2013 is $300,000 each year. 387.22Of this amount, $241,000 each year is for 387.23grants and the balance is for administrative 387.24costs.387.25Funding Usage. Up to 75 percent of the 387.26fiscal year 2012 appropriation for local public 387.27health grants may be used to fund calendar 387.28year 2011 allocations for this program. The 387.29general fund reduction of $5,193,000 in 387.30fiscal year 2011 for local public health grants 387.31is onetime and the base funding for local 387.32public health grants for fiscal year 2012 is 387.33increased by $5,193,000.387.34Colorectal Screening. $88,000 in fiscal year 387.352010 and $62,000 in fiscal year 2011 are 388.1for grants to the Hennepin County Medical 388.2Center and MeritCare Bemidji for colorectal 388.3screening demonstration projects.388.4Feasibility Pilot Project for Cancer 388.5Surveillance. Of the general fund 388.6appropriation for fiscal year 2010, $100,000 388.7is to the commissioner to provide grant 388.8funding to cover the cost of one full-time 388.9equivalent position at the Hennepin County 388.10Medical Center to carry out the feasibility 388.11pilot project.388.12American Recovery and Reinvestment 388.13Act Funds. Federal funds received by the 388.14commissioner for WIC program management 388.15information systems from the American 388.16Recovery and Reinvestment Act of 2009, 388.17Public Law 111-5, are appropriated to the 388.18commissioner for the purpose of the grant.388.19TANF Appropriations. (1) $1,156,000 of 388.20the TANF funds are appropriated each year to 388.21the commissioner for family planning grants 388.22under Minnesota Statutes, section 145.925.388.23(2) $3,579,000 of the TANF funds are 388.24appropriated each year to the commissioner 388.25for home visiting and nutritional services 388.26listed under Minnesota Statutes, section 388.27145.882, subdivision 7, clauses (6) and (7). 388.28Funds must be distributed to community 388.29health boards according to Minnesota 388.30Statutes, section 145A.131, subdivision 1.388.31(3) $2,000,000 of the TANF funds are 388.32appropriated each year to the commissioner 388.33for decreasing racial and ethnic disparities 388.34in infant mortality rates under Minnesota 388.35Statutes, section 145.928, subdivision 7.389.1(4) $4,998,000 of the TANF funds are 389.2appropriated each year to the commissioner 389.3for the family home visiting grant program 389.4according to Minnesota Statutes, section 389.5145A.17. $4,000,000 of the funding must 389.6be distributed to community health boards 389.7according to Minnesota Statutes, section 389.8145A.131, subdivision 1. $998,000 of 389.9the funding must be distributed to tribal 389.10governments based on Minnesota Statutes, 389.11section 145A.14, subdivision 2a. The 389.12commissioner may use five percent of 389.13the funds appropriated each fiscal year to 389.14conduct the ongoing evaluations required 389.15under Minnesota Statutes, section 145A.17, 389.16subdivision 7, and may use ten percent of 389.17the funds appropriated each fiscal year to 389.18provide training and technical assistance as 389.19required under Minnesota Statutes, section 389.20145A.17, subdivisions 4 and 5.389.21Base Adjustment. The general fund base 389.22is increased by $10,302,000 for fiscal year 389.232012 and increased by $5,109,000 for fiscal 389.24year 2013. The health care access fund base 389.25is reduced to $1,719,000 for both fiscal years 389.262012 and 2013.389.27TANF Carryforward. Any unexpended 389.28balance of the TANF appropriation in the 389.29first year of the biennium does not cancel but 389.30is available for the second year.

389.31Subd. 3.Policy Quality and Compliance

389.32Appropriations by Fund389.33General7,491,0007,242,000390.1390.2State Government Special Revenue14,173,00014,173,000390.3Health Care Access17,561,00012,090,000

390.4Community-Based Health Care 390.5Demonstration Project. Notwithstanding 390.6the provisions of Laws 2007, chapter 147, 390.7article 19, section 3, subdivision 6, paragraph 390.8(e), base level funding to the commissioner 390.9for the demonstration project grant described 390.10in Minnesota Statutes, section 62Q.80, 390.11subdivision 1a, shall be zero for fiscal years 390.122011 and 2012.390.13Medical Education and Research Cost 390.14Federal Compliance. Notwithstanding 390.15Laws 2008, chapter 363, article 18, section 390.164, subdivision 3, the base level funding 390.17for the commissioner to distribute to the 390.18Mayo Clinic for transitional funding while 390.19federal compliance changes are made to the 390.20medical education and research cost funding 390.21distribution formula shall be $0 for fiscal 390.22years 2010 and 2011.390.23Autism Clinical Research. The 390.24commissioner, in partnership with a 390.25Minnesota research institution, shall apply 390.26for funds available for research grants under 390.27the American Recovery and Reinvestment 390.28Act (ARRA) of 2009 in order to expand 390.29research and treatment of autism spectrum 390.30disorders.390.31Health Information Technology. (a) Of 390.32the health care access fund appropriation, 390.33$4,000,000 is to fund the revolving loan 390.34account under Minnesota Statutes, section 391.162J.496. This appropriation must not be 391.2expended unless it is matched with federal 391.3funding under the federal Health Information 391.4Technology for Economic and Clinical 391.5Health (HITECH) Act. This appropriation 391.6must not be included in the agency's base 391.7budget for the fiscal year beginning July 1, 391.82012.391.9(b) On or before June 30, 2013, $1,200,000 391.10shall be transferred from the revolving loan 391.11account under Minnesota Statutes, section 391.1262J.496, to the health care access fund. 391.13This is a onetime transfer and must not be 391.14included in the agency's base budget for the 391.15fiscal year beginning July 1, 2014.391.16Base Adjustment. The general fund 391.17base is $8,243,000 in fiscal year 2012 and 391.18$8,243,000 in fiscal year 2013. The health 391.19care access fund base is $10,950,000 in fiscal 391.20year 2012 and $6,816,000 in fiscal year 2013.

391.21Subd. 4.Health Protection

391.22Appropriations by Fund391.23General9,871,0009,780,000391.24391.25State Government Special Revenue30,209,00030,209,000

391.26Base Adjustment. The general fund base is 391.27reduced by $50,000 in each of fiscal years 391.282012 and 2013.391.29Health Protection Appropriations. (a) 391.30$163,000 each year is for the lead abatement 391.31grant program. 391.32(b) $100,000 each year is for emergency 391.33preparedness and response activities. 392.1(c) $50,000 each year is for tuberculosis 392.2prevention and control. This is a onetime 392.3appropriation.392.4American Recovery and Reinvestment 392.5Act Funds. Federal funds received 392.6by the commissioner for immunization 392.7operations from the American Recovery 392.8and Reinvestment Act of 2009, Public Law 392.9111-5, are appropriated to the commissioner 392.10for the purposes of the grant.

392.11Subd. 5.Administrative Support Services7,190,0007,190,000

392.12Sec. 5. HEALTH-RELATED BOARDS

392.13Subdivision 1.Total Appropriation $15,017,000$14,831,000

392.14This appropriation is from the state 392.15government special revenue fund.392.16Transfer. In fiscal year 2010, $6,000,000 392.17shall be transferred from the state government 392.18special revenue fund to the general fund. 392.19The amounts that may be spent for each 392.20purpose are specified in the following 392.21subdivisions.

392.22Subd. 2.Board of Chiropractic Examiners447,000447,000

392.23Subd. 3.Board of Dentistry1,009,0001,009,000

392.24392.25Subd. 4.Board of Dietetic and Nutrition Practice105,000105,000

392.26392.27Subd. 5.Board of Marriage and Family Therapy137,000137,000

392.28Subd. 6.Board of Medical Practice3,674,0003,674,000

392.29Subd. 7.Board of Nursing4,217,0004,219,000

393.1393.2Subd. 8.Board of Nursing Home Administrators1,146,000958,000

393.3Administrative Services Unit - Operating 393.4Costs. Of this appropriation, $524,000 393.5in fiscal year 2010 and $526,000 in 393.6fiscal year 2011 are for operating costs 393.7of the administrative services unit. The 393.8administrative services unit may receive 393.9and expend reimbursements for services 393.10performed by other agencies.393.11Administrative Services Unit - Retirement 393.12Costs. Of this appropriation in fiscal year 393.132010, $201,000 is for onetime retirement 393.14costs in the health-related boards. This 393.15funding may be transferred to the health 393.16boards incurring those costs for their 393.17payment. These funds are available either 393.18year of the biennium.393.19Administrative Services Unit - Volunteer 393.20Health Care Provider Program. Of this 393.21appropriation, $79,000 in fiscal year 2010 393.22and $89,000 in fiscal year 2011 are to pay 393.23for medical professional liability coverage 393.24required under Minnesota Statutes, section 393.25214.40.393.26Administrative Services Unit - Contested 393.27Cases and Other Legal Proceedings. Of 393.28this appropriation, $200,000 in fiscal year 393.292010 and $200,000 in fiscal year 2011 393.30are for costs of contested case hearings 393.31and other unanticipated costs of legal 393.32proceedings involving health-related 393.33boards funded under this section. Upon 393.34certification of a health-related board to the 394.1administrative services unit that the costs 394.2will be incurred and that there is insufficient 394.3money available to pay for the costs out of 394.4money currently available to that board, the 394.5administrative services unit is authorized 394.6to transfer money from this appropriation 394.7to the board for payment of those costs 394.8with the approval of the commissioner of 394.9finance. This appropriation does not cancel. 394.10Any unencumbered and unspent balances 394.11remain available for these expenditures in 394.12subsequent fiscal years.

394.13Subd. 9.Board of Optometry101,000101,000

394.14Subd. 10.Board of Pharmacy1,413,0001,413,000

394.15Subd. 11.Board of Physical Therapy295,000295,000

394.16Subd. 12.Board of Podiatry56,00056,000

394.17Subd. 13.Board of Psychology806,000806,000

394.18Subd. 14.Board of Social Work1,022,0001,022,000

394.19Subd. 15.Board of Veterinary Medicine195,000195,000

394.20394.21Subd. 16.Board of Behavioral Health and Therapy394,000394,000

394.22394.23Sec. 6. EMERGENCY MEDICAL SERVICES BOARD$ 4,378,000$3,828,000

394.24Appropriations by Fund394.2520102011394.26General 3,674,0003,124,000394.27394.28State Government Special Revenue704,000704 ,000

394.29Longevity Award and Incentive Program.394.30Of the general fund appropriation, $700,000 395.1in fiscal year 2010 and $700,000 in fiscal year 395.22011 are to the board for the Cooper/Sams 395.3volunteer ambulance program, under 395.4Minnesota Statutes, section 144E.40.395.5Transfer. In fiscal year 2010, $6,182,000 395.6is transferred from the Cooper/Sams 395.7volunteer ambulance trust, established under 395.8Minnesota Statutes, section 144E.42, to the 395.9general fund.395.10Health Professional Services Program.395.11$704,000 in fiscal year 2010 and $704,000 in 395.12fiscal year 2011 from the state government 395.13special revenue fund are for the health 395.14professional services program.395.15Comprehensive Advanced Life-Support 395.16Educational (CALS) Program.$100,000 in 395.17the first year from the Cooper/Sams volunteer 395.18ambulance trust is for the comprehensive 395.19advanced life-support educational (CALS) 395.20program established under Minnesota 395.21Statutes, section 144E.37. This appropriation 395.22is to extend availability and affordability 395.23of the CALS program for rural emergency 395.24medical personnel and to assist hospital staff 395.25in attaining the credentialing levels necessary 395.26for implementation of the statewide trauma 395.27system.

395.28395.29Sec. 7. DEPARTMENT OF VETERANS AFFAIRS$200,000$0

395.30Veterans Paramedic Apprenticeship 395.31Program. Of this appropriation, $200,000 395.32in the first year is from the Cooper/Sams 395.33volunteer ambulance trust for transfer 395.34to the commissioner of veterans affairs 396.1for a grant to the Minnesota Ambulance 396.2Association to implement a veterans 396.3paramedic apprenticeship program to 396.4reintegrate returning military medics into 396.5Minnesota's workforce in the field of 396.6paramedic and emergency services, thereby 396.7guaranteeing returning military medics 396.8gainful employment with livable wages and 396.9benefits. This appropriation is available until 396.10expended.

396.11Sec. 8. DEPARTMENT OF PUBLIC SAFETY$250,000$0

396.12Medical Response Unit Reimbursement 396.13Pilot Program. (a) $250,000 in the first 396.14year is from the Cooper/Sams volunteer 396.15ambulance trust for a transfer to the 396.16Department of Public Safety for a medical 396.17response unit reimbursement pilot program. 396.18Of this appropriation, $75,000 is for 396.19administrative costs to the Department of 396.20Public Safety, including providing contract 396.21staff support and technical assistance to the 396.22pilot program partners if necessary.396.23(b) Of the amount in paragraph (a), $175,000 396.24is to be used to provide a predetermined 396.25reimbursement amount to the participating 396.26medical response units. The Department 396.27of Public Safety or its contract designee 396.28will develop an agreement with the medical 396.29response units outlining reimbursement and 396.30program requirements to include HIPAA 396.31compliance while participating in the pilot 396.32program.

396.33Sec. 9. COUNCIL ON DISABILITY$524,000$524,000

397.1397.2397.3Sec. 10. OMBUDSMAN FOR MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES$1,655,000$1,655,000

397.4Sec. 11. OMBUDSPERSON FOR FAMILIES$265,000$265,000

397.5    Sec. 12. Laws 2007, chapter 147, article 19, section 3, subdivision 4, as amended 397.6by Laws 2008, chapter 277, article 5, section 1; and Laws 2008, chapter 363, article 397.718, section 7, is amended to read:

397.8397.9Subd. 4. Children and Economic Assistance Grants

397.10The amounts that may be spent from this 397.11appropriation for each purpose are as follows: 

397.12(a) MFIP/DWP Grants 

397.13Appropriations by Fund 397.14General 62,069,000 62,405,000 397.15Federal TANF 75,904,000 80,841,000 

397.16(b) Support Services Grants 

397.17Appropriations by Fund 397.18General 8,715,000 8,715,000 397.19Federal TANF 113,429,000 115,902,000 

397.20TANF Prior Appropriation Cancellation.397.21Notwithstanding Laws 2001, First Special 397.22Session chapter 9, article 17, section 397.232, subdivision 11, paragraph (b), any 397.24unexpended TANF funds appropriated to the 397.25commissioner to contract with the Board of 397.26Trustees of Minnesota State Colleges and 397.27Universities, to provide tuition waivers to 397.28employees of health care and human service 398.1providers that are members of qualifying 398.2consortia operating under Minnesota 398.3Statutes, sections 
         116L.10 to 
         116L.15, must 398.4cancel at the end of fiscal year 2007. 398.5MFIP Pilot Program. Of the TANF 398.6appropriation, $100,000 in fiscal year 2008 398.7and $750,000 in fiscal year 2009 are for a 398.8grant to the Stearns-Benton Employment and 398.9Training Council for the Workforce U pilot 398.10program. Base level funding for this program 398.11shall be $750,000 in 2010 and $0 in 2011. 398.12Supported Work. (1) Of the TANF 398.13appropriation, $5,468,000 in fiscal year 2008 398.14is for supported work for MFIP participants, 398.15to be allocated to counties and tribes based 398.16on the criteria under clauses (2) and (3), and 398.17is available until expended. Paid transitional 398.18work experience and other supported 398.19employment under this rider provides 398.20a continuum of employment assistance, 398.21including outreach and recruitment, 398.22program orientation and intake, testing and 398.23assessment, job development and marketing, 398.24preworksite training, supported worksite 398.25experience, job coaching, and postplacement 398.26follow-up, in addition to extensive case 398.27management and referral services. * (The 398.28preceding text "and $7,291,000 in fiscal 398.29year 2009" was indicated as vetoed by the 398.30governor.) 398.31(2) A county or tribe is eligible to receive an 398.32allocation under this rider if: 398.33(i) the county or tribe is not meeting the 398.34federal work participation rate; 399.1(ii) the county or tribe has participants who 399.2are required to perform work activities under 399.3Minnesota Statutes, chapter 256J, but are not 399.4meeting hourly work requirements; and 399.5(iii) the county or tribe has assessed 399.6participants who have completed six weeks 399.7of job search or are required to perform 399.8work activities and are not meeting the 399.9hourly requirements, and the county or tribe 399.10has determined that the participant would 399.11benefit from working in a supported work 399.12environment. 399.13(3) A county or tribe may also be eligible for 399.14funds in order to contract for supplemental 399.15hours of paid work at the participant's child's 399.16place of education, child care location, or the 399.17child's physical or mental health treatment 399.18facility or office. This grant to counties and 399.19tribes is specifically for MFIP participants 399.20who need to work up to five hours more 399.21per week in order to meet the hourly work 399.22requirement, and the participant's employer 399.23cannot or will not offer more hours to the 399.24participant. 399.25Work Study. Of the TANF appropriation, 399.26$750,000 each year are to the commissioner 399.27to contract with the Minnesota Office of 399.28Higher Education for the biennium beginning 399.29July 1, 2007, for work study grants under 399.30Minnesota Statutes, section 
         136A.233, 399.31specifically for low-income individuals who 399.32receive assistance under Minnesota Statutes, 399.33chapter 256J, and for grants to opportunities 399.34industrialization centers. * (The preceding 399.35text beginning "Work Study. Of the TANF 400.1appropriation," was indicated as vetoed 400.2by the governor.) 400.3Integrated Service Projects. $2,500,000 400.4in fiscal year 2008 and $2,500,000 in fiscal 400.5year 2009 are appropriated from the TANF 400.6fund to the commissioner to continue to 400.7fund the existing integrated services projects 400.8for MFIP families, and if funding allows, 400.9additional similar projects. 400.10Base Adjustment. The TANF base for fiscal 400.11year 2010 is $115,902,000 and for fiscal year 400.122011 is $115,152,000. 

400.13(c) MFIP Child Care Assistance Grants 

400.14General 74,654,000 71,951,000 

400.15400.16(d) Basic Sliding Fee Child Care Assistance Grants 

400.17General 42,995,000 45,008,000 

400.18Base Adjustment. The general fund base 400.19is $44,881,000 for fiscal year 2010 and 400.20$44,852,000 for fiscal year 2011. 400.21At-Home Infant Care Program. No 400.22funding shall be allocated to or spent on 400.23the at-home infant care program under 400.24Minnesota Statutes, section 
         119B.035. 

400.25(e) Child Care Development Grants 

400.26General 4,390,000 6,390,000 

400.27Prekindergarten Exploratory Projects. Of 400.28the general fund appropriation, $2,000,000 400.29the first year and $4,000,000 the second 401.1year are for grants to the city of St. Paul, 401.2Hennepin County, and Blue Earth County to 401.3establish scholarship demonstration projects 401.4to be conducted in partnership with the 401.5Minnesota Early Learning Foundation to 401.6promote children's school readiness. This 401.7appropriation is available until June 30, 2009. 401.8Child Care Services Grants. Of this 401.9appropriation, $250,000 each year are for 401.10the purpose of providing child care services 401.11grants under Minnesota Statutes, section 401.12119B.21, subdivision 5
         . This appropriation 401.13is for the 2008-2009 biennium only, and does 401.14not increase the base funding. 401.15Early Childhood Professional 401.16Development System. Of this appropriation, 401.17$250,000 each year are for purposes of the 401.18early childhood professional development 401.19system, which increases the quality and 401.20continuum of professional development 401.21opportunities for child care practitioners. 401.22This appropriation is for the 2008-2009 401.23biennium only, and does not increase the 401.24base funding. 401.25Base Adjustment. The general fund base 401.26is $1,515,000 for each of fiscal years 2010 401.27and 2011. 

401.28(f) Child Support Enforcement Grants 

401.29General 11,038,000 3,705,000 

401.30Child Support Enforcement. $7,333,000 401.31for fiscal year 2008 is to make grants to 401.32counties for child support enforcement 401.33programs to make up for the loss under the 402.12005 federal Deficit Reduction Act of federal 402.2matching funds for federal incentive funds 402.3passed on to the counties by the state. 402.4This appropriation is available until June 30, 402.52009. 

402.6(g) Children's Services Grants 

402.7Appropriations by Fund 402.8General 63,647,000 71,147,000 402.9Health Care Access 250,000 -0- 402.10TANF 240,000 340,000 

402.11Grants for Programs Serving Young 402.12Parents. Of the TANF fund appropriation, 402.13$140,000 each year is for a grant to a program 402.14or programs that provide comprehensive 402.15services through a private, nonprofit agency 402.16to young parents in Hennepin County who 402.17have dropped out of school and are receiving 402.18public assistance. The program administrator 402.19shall report annually to the commissioner on 402.20skills development, education, job training, 402.21and job placement outcomes for program 402.22participants. 402.23County Allocations for Rate Increases.402.24County Children and Community Services 402.25Act allocations shall be increased by 402.26$197,000 effective October 1, 2007, and 402.27$696,000 effective October 1, 2008, to help 402.28counties pay for the rate adjustments to 402.29day training and habilitation providers for 402.30participants paid by county social service 402.31funds. Notwithstanding the provisions of 402.32Minnesota Statutes, section 
         256M.40, the 402.33allocation to a county shall be based on 403.1the county's proportion of social services 403.2spending for day training and habilitation 403.3services as determined in the most recent 403.4social services expenditure and grant 403.5reconciliation report. 403.6Privatized Adoption Grants. Federal 403.7reimbursement for privatized adoption grant 403.8and foster care recruitment grant expenditures 403.9is appropriated to the commissioner for 403.10adoption grants and foster care and adoption 403.11administrative purposes. 403.12Adoption Assistance Incentive Grants.403.13Federal funds available during fiscal year 403.142008 and fiscal year 2009 for the adoption 403.15incentive grants are appropriated to the 403.16commissioner for these purposes. 403.17Adoption Assistance and Relative Custody 403.18Assistance. The commissioner may transfer 403.19unencumbered appropriation balances for 403.20adoption assistance and relative custody 403.21assistance between fiscal years and between 403.22programs. 403.23Children's Mental Health Grants. Of the 403.24general fund appropriation, $5,913,000 in 403.25fiscal year 2008 and $6,825,000 in fiscal year 403.262009 are for children's mental health grants. 403.27The purpose of these grants is to increase and 403.28maintain the state's children's mental health 403.29service capacity, especially for school-based 403.30mental health services. The commissioner 403.31shall require grantees to utilize all available 403.32third party reimbursement sources as a 403.33condition of using state grant funds. At 403.34least 15 percent of these funds shall be 403.35used to encourage efficiencies through early 404.1intervention services. At least another 15 404.2percent shall be used to provide respite care 404.3services for children with severe emotional 404.4disturbance at risk of out-of-home placement. 404.5Mental Health Crisis Services. Of the 404.6general fund appropriation, $2,528,000 in 404.7fiscal year 2008 and $2,850,000 in fiscal year 404.82009 are for statewide funding of children's 404.9mental health crisis services. Providers must 404.10utilize all available funding streams. 404.11Children's Mental Health Evidence-Based 404.12and Best Practices. Of the general fund 404.13appropriation, $375,000 in fiscal year 2008 404.14and $750,000 in fiscal year 2009 are for 404.15children's mental health evidence-based and 404.16best practices including, but not limited 404.17to: Adolescent Integrated Dual Diagnosis 404.18Treatment services; school-based mental 404.19health services; co-location of mental 404.20health and physical health care, and; the 404.21use of technological resources to better 404.22inform diagnosis and development of 404.23treatment plan development by mental 404.24health professionals. The commissioner 404.25shall require grantees to utilize all available 404.26third-party reimbursement sources as a 404.27condition of using state grant funds. 404.28Culturally Specific Mental Health 404.29Treatment Grants. Of the general fund 404.30appropriation, $75,000 in fiscal year 2008 404.31and $300,000 in fiscal year 2009 are for 404.32children's mental health grants to support 404.33increased availability of mental health 404.34services for persons from cultural and 404.35ethnic minorities within the state. The 405.1commissioner shall use at least 20 percent 405.2of these funds to help members of cultural 405.3and ethnic minority communities to become 405.4qualified mental health professionals and 405.5practitioners. The commissioner shall assist 405.6grantees to meet third-party credentialing 405.7requirements and require them to utilize all 405.8available third-party reimbursement sources 405.9as a condition of using state grant funds. 405.10Mental Health Services for Children with 405.11Special Treatment Needs. Of the general 405.12fund appropriation, $50,000 in fiscal year 405.132008 and $200,000 in fiscal year 2009 are 405.14for children's mental health grants to support 405.15increased availability of mental health 405.16services for children with special treatment 405.17needs. These shall include, but not be limited 405.18to: victims of trauma, including children 405.19subjected to abuse or neglect, veterans and 405.20their families, and refugee populations; 405.21persons with complex treatment needs, such 405.22as eating disorders; and those with low 405.23incidence disorders. 405.24MFIP and Children's Mental Health 405.25Pilot Project. Of the TANF appropriation, 405.26$100,000 in fiscal year 2008 and $200,000 405.27in fiscal year 2009 are to fund the MFIP 405.28and children's mental health pilot project. 405.29Of these amounts, up to $100,000 may be 405.30expended on evaluation of this pilot. 405.31Prenatal Alcohol or Drug Use. Of the 405.32general fund appropriation, $75,000 each 405.33year is to award grants beginning July 1, 405.342007, to programs that provide services 405.35under Minnesota Statutes, section 254A.171, 406.1in Pine, Kanabec, and Carlton Counties.406.2the second year is for a grant to A Circle 406.3of Women for program services. This 406.4appropriation shall become part of the base 406.5appropriation.406.6Base Adjustment. The general fund base 406.7is $62,572,000 in fiscal year 2010 and 406.8$62,575,000 in fiscal year 2011.

406.9(h) Children and Community Services Grants

406.10General101,369,000 69,208,000 

406.11Base Adjustment. The general fund base 406.12is $69,274,000 in each of fiscal years 2010 406.13and 2011.406.14Targeted Case Management Temporary 406.15Funding. (a) Of the general fund 406.16appropriation, $32,667,000 in fiscal year 406.172008 is transferred to the targeted case 406.18management contingency reserve account in 406.19the general fund to be allocated to counties 406.20and tribes affected by reductions in targeted 406.21case management federal Medicaid revenue 406.22as a result of the provisions in the federal 406.23Deficit Reduction Act of 2005, Public Law 406.24109-171. 406.25(b) Contingent upon (1) publication by the 406.26federal Centers for Medicare and Medicaid 406.27Services of final regulations implementing 406.28the targeted case management provisions 406.29of the federal Deficit Reduction Act of 406.302005, Public Law 109-171, or (2) the 406.31issuance of a finding by the Centers for 406.32Medicare and Medicaid Services of federal 406.33Medicaid overpayments for targeted case 407.1management expenditures, up to $32,667,000 407.2is appropriated to the commissioner of human 407.3services. Prior to distribution of funds, the 407.4commissioner shall estimate and certify the 407.5amount by which the federal regulations or 407.6federal disallowance will reduce targeted 407.7case management Medicaid revenue over the 407.82008-2009 biennium. 407.9(c) Within 60 days of a contingency described 407.10in paragraph (b), the commissioner shall 407.11distribute the grants proportionate to each 407.12affected county or tribe's targeted case 407.13management federal earnings for calendar 407.14year 2005, not to exceed the lower of (1) the 407.15amount of the estimated reduction in federal 407.16revenue or (2) $32,667,000. 407.17(d) These funds are available in either year of 407.18the biennium. Counties and tribes shall use 407.19these funds to pay for social service-related 407.20costs, but the funds are not subject to 407.21provisions of the Children and Community 407.22Services Act grant under Minnesota Statutes, 407.23chapter 256M. 407.24(e) This appropriation shall be available to 407.25pay counties and tribes for expenses incurred 407.26on or after July 1, 2007. The appropriation 407.27shall be available until expended. 

407.28(i) General Assistance Grants 

407.29General 37,876,000 38,253,000 

407.30General Assistance Standard. The 407.31commissioner shall set the monthly standard 407.32of assistance for general assistance units 407.33consisting of an adult recipient who is 408.1childless and unmarried or living apart 408.2from parents or a legal guardian at $203. 408.3The commissioner may reduce this amount 408.4according to Laws 1997, chapter 85, article 408.53, section 54. 408.6Emergency General Assistance. The 408.7amount appropriated for emergency general 408.8assistance funds is limited to no more 408.9than $7,889,812 in fiscal year 2008 and 408.10$7,889,812 in fiscal year 2009. Funds 408.11to counties must be allocated by the 408.12commissioner using the allocation method 408.13specified in Minnesota Statutes, section 408.14256D.06
         . 

408.15(j) Minnesota Supplemental Aid Grants 

408.16General 30,505,000 30,812,000 

408.17Emergency Minnesota Supplemental 408.18Aid Funds. The amount appropriated for 408.19emergency Minnesota supplemental aid 408.20funds is limited to no more than $1,100,000 408.21in fiscal year 2008 and $1,100,000 in fiscal 408.22year 2009. Funds to counties must be 408.23allocated by the commissioner using the 408.24allocation method specified in Minnesota 408.25Statutes, section 
         256D.46. 

408.26(k) Group Residential Housing Grants 

408.27General 91,069,000 98,671,000 

408.28People Incorporated. Of the general fund 408.29appropriation, $460,000 each year is to 408.30augment community support and mental 408.31health services provided to individuals 409.1residing in facilities under Minnesota 409.2Statutes, section 
         256I.05, subdivision 1m. 

409.3409.4(l) Other Children and Economic Assistance Grants 

409.5General 20,183,000 16,333,000 409.6Federal TANF 1,500,000 1,500,000 

409.7Base Adjustment. The general fund base 409.8shall be $16,033,000 in fiscal year 2010 and 409.9$15,533,000 in fiscal year 2011. The TANF 409.10base shall be $1,500,000 in fiscal year 2010 409.11and $1,181,000 in fiscal year 2011. 409.12Homeless and Runaway Youth. Of the 409.13general fund appropriation, $500,000 each 409.14year are for the Runaway and Homeless 409.15Youth Act under Minnesota Statutes, section 409.16256K.45
         . Funds shall be spent in each area 409.17of the continuum of care to ensure that 409.18programs are meeting the greatest need. This 409.19is a onetime appropriation. 409.20Long-Term Homelessness. Of the general 409.21fund appropriation, $2,000,000 in fiscal year 409.222008 is for implementation of programs 409.23to address long-term homelessness and is 409.24available in either year of the biennium. This 409.25is a onetime appropriation. 409.26Minnesota Community Action Grants. (a) 409.27Of the general fund appropriation, $250,000 409.28each year is for the purposes of Minnesota 409.29community action grants under Minnesota 409.30Statutes, sections 
         256E.30 to 
         256E.32. This 409.31is a onetime appropriation. 409.32(b) Of the TANF appropriation, $1,500,000 409.33each year is for community action agencies 410.1for auto repairs, auto loans, and auto 410.2purchase grants to individuals who are 410.3eligible to receive benefits under Minnesota 410.4Statutes, chapter 256J, or who have lost 410.5eligibility for benefits under Minnesota 410.6Statutes, chapter 256J, due to earnings in the 410.7prior 12 months. Base level funding for this 410.8activity shall be $1,500,000 in fiscal year 410.92010 and $1,181,000 in fiscal year 2011. * 410.10(The preceding text beginning "(b) Of the 410.11TANF appropriation," was indicated as 410.12vetoed by the governor.) 410.13(c) Money appropriated under paragraphs (a) 410.14and (b) that is not spent in the first year does 410.15not cancel but is available for the second 410.16year.410.17EFFECTIVE DATE.This section is effective the day following final enactment.410.18    Sec. 13. EMERGENCY SERVICES SHELTER GRANTS FROM AMERICAN 410.19RECOVERY AND REINVESTMENT ACT.410.20    (a) To the extent permitted under federal law, the commissioner of human services, 410.21when determining the uses of the emergency services shelter grants provided under the 410.22American Recovery and Reinvestment Act, shall give priority to programs that serve 410.23the following:410.24    (1) homeless youth;410.25    (2) American Indian women who are victims of trafficking; 410.26    (3) high-risk adult males considered to be very likely to enter or reenter state or 410.27county correctional programs, or chemical and mental health programs;410.28    (4) battered women; and410.29    (5) families affected by foreclosure.410.30(b) Paragraph (a) does not supersede use of ARRA funds as otherwise provided 410.31in this act.410.32    Sec. 14. TRANSFERS.410.33    Subdivision 1.Grants.The commissioner of human services, with the approval 410.34of the commissioner of finance, and after notification of the chairs of the relevant senate 411.1budget division and house of representatives finance division committee, may transfer 411.2unencumbered appropriation balances for the biennium ending June 30, 2011, within 411.3fiscal years among the MFIP, general assistance, general assistance medical care, medical 411.4assistance, MinnesotaCare, MFIP child care assistance under Minnesota Statutes, section 411.5119B.05, Minnesota supplemental aid, and group residential housing programs, and the 411.6entitlement portion of the chemical dependency consolidated treatment fund, and between 411.7fiscal years of the biennium.411.8    Subd. 2.Administration.Positions, salary money, and nonsalary administrative 411.9money may be transferred within the Departments of Human Services and Health as the 411.10commissioners consider necessary, with the advance approval of the commissioner of 411.11finance. The commissioner shall inform the chairs of the relevant house and senate health 411.12committees quarterly about transfers made under this provision.411.13    Sec. 15. 2007 AND 2008 APPROPRIATION AMENDMENTS.411.14(a) Notwithstanding Laws 2007, chapter 147, article 19, section 3, subdivision 4, 411.15paragraph (g), as amended by Laws 2008, chapter 363, article 18, section 7, the TANF 411.16fund base for the Children's Mental Health Pilots is $0 in fiscal year 2011. This paragraph 411.17is effective retroactively from July 1, 2008.411.18(b) The appropriation for patient incentive programs under Laws 2007, chapter 147, 411.19article 19, section 3, subdivision 6, paragraph (e), is canceled. This paragraph is effective 411.20retroactively from July 1, 2007.411.21(c) The onetime general fund base reduction for Child Care Development Grants 411.22under Laws 2008, chapter 363, article 18, section 3, subdivision 4, paragraph (d), is 411.23increased by $4,000. This paragraph is effective retroactively from July 1, 2008.411.24(d) The base for Children Services Grants under Laws 2008, chapter 363, article 18, 411.25section 3, subdivision 4, paragraph (e), is decreased $1,000 in each year of the fiscal year 411.262010 and 2011 biennium. This paragraph is effective retroactively from July 1, 2008.411.27(e) Notwithstanding Laws 2008, chapter 363, article 18, section 3, subdivision 4, the 411.28general fund base adjustment for Children and Community Services Grants under Laws 411.292008, chapter 363, article 18, section 3, subdivision 4, paragraph (f), is increased by 411.30$98,000 each year of fiscal years 2010 and 2011. This paragraph is effective retroactively 411.31from July 1, 2008.411.32(f) The base for Other Continuing Care Grants under Laws 2008, chapter 363, article 411.3318, section 3, subdivision 6, paragraph (h), is decreased by $10,000 in fiscal year 2010. 411.34This paragraph is effective retroactively from July 1, 2008.412.1    Sec. 16. INDIRECT COSTS NOT TO FUND PROGRAMS.412.2The commissioners of health and human services shall not use indirect cost 412.3allocations to pay for the operational costs of any program for which they are responsible.412.4    Sec. 17. EXPIRATION OF UNCODIFIED LANGUAGE.412.5    All uncodified language contained in this article expires on June 30, 2011, unless a 412.6different expiration date is explicit.412.7    Sec. 18. EFFECTIVE DATE.412.8    The provisions in this article are effective July 1, 2009, unless a different effective 412.9date is specified."412.10Delete the title and insert:412.11"A bill for an act412.12relating to state government; making changes to health and human services; 412.13amending provisions related to licensing, the Minnesota family investment 412.14program, child care, adult supports; fraud prevention, state-operated services, 412.15the Minnesota sex offender program, the Department of Health, health care 412.16programs, chemical and mental health; continuing care programs, and public 412.17health; establishing the State-County Results, Accountability, and Service 412.18Delivery Redesign; making technical changes; making forecast adjustments; 412.19requiring reports; establishing and increasing fees; appropriating money;412.20amending Minnesota Statutes 2008, sections 60A.092, subdivision 2; 62D.03, 412.21subdivision 4; 62D.05, subdivision 3; 62J.495; 62J.496; 62J.497, subdivisions 412.221, 2, by adding subdivisions; 62J.692, subdivision 7; 103I.208, subdivision 412.232; 119B.09, subdivision 7; 119B.13, subdivision 6; 119B.21, subdivisions 5, 412.2410; 119B.231, subdivisions 2, 3, 4; 144.0724, subdivisions 2, 4, 8, by adding 412.25subdivisions; 144.121, subdivisions 1a, 1b; 144.122; 144.1222, subdivision 412.261a; 144.125, subdivision 1; 144.226, subdivision 4; 144.72, subdivisions 1, 3; 412.27144.9501, subdivisions 22b, 26a, by adding subdivisions; 144.9505, subdivisions 412.281g, 4; 144.9508, subdivisions 2, 3, 4; 144.9512, subdivision 2; 144.966, by 412.29adding a subdivision; 144.97, subdivisions 2, 4, 6, by adding subdivisions; 412.30144.98, subdivisions 1, 2, 3, by adding subdivisions; 144.99, subdivision 412.311; 144A.073, by adding a subdivision; 144A.44, subdivision 2; 144A.46, 412.32subdivision 1; 145A.17, by adding a subdivision; 148.6445, by adding a 412.33subdivision; 148D.180, subdivisions 1, 2, 3, 5; 148E.180, subdivisions 1, 2, 3, 5; 412.34152.126, subdivisions 1, 2, 6; 153A.17; 157.15, by adding a subdivision; 157.16; 412.35157.22; 176.011, subdivision 9; 245.462, subdivision 18; 245.470, subdivision 412.361; 245.4871, subdivision 27; 245.488, subdivision 1; 245A.03, by adding a 412.37subdivision; 245A.10, subdivisions 2, 3; 245A.11, subdivision 2a, by adding 412.38subdivisions; 245A.16, subdivisions 1, 3; 245C.03, subdivision 2; 245C.04, 412.39subdivisions 1, 3; 245C.05, subdivision 4, by adding a subdivision; 245C.08, 412.40subdivision 2; 245C.10, subdivision 3, by adding subdivisions; 245C.17, by 412.41adding a subdivision; 245C.20; 245C.21, subdivision 1a; 245C.23, subdivision 2; 412.42246.50, subdivision 5, by adding subdivisions; 246.51, by adding subdivisions; 412.43246.511; 246.52; 246.54, subdivision 2; 246B.01, by adding subdivisions; 412.44252.025, subdivision 7; 252.46, by adding a subdivision; 252.50, subdivision 1; 412.45254A.02, by adding a subdivision; 254A.16, by adding a subdivision; 254B.03, 412.46subdivisions 1, 3, by adding a subdivision; 254B.05, subdivision 1; 254B.09, 412.47subdivision 2; 256.01, subdivision 2b, by adding subdivisions; 256.045, 412.48subdivision 3; 256.476, subdivisions 5, 11; 256.962, subdivisions 2, 6; 256.969, 412.49subdivisions 2b, 3a, by adding subdivisions; 256.975, subdivision 7; 256.983, 413.1subdivision 1; 256B.04, subdivision 16; 256B.055, subdivisions 7, 12; 256B.056, 413.2subdivisions 3c, 3d; 256B.057, by adding a subdivision; 256B.0575; 256B.0595, 413.3subdivisions 1, 2; 256B.06, subdivisions 4, 5; 256B.0621, subdivision 2; 413.4256B.0622, subdivision 2; 256B.0623, subdivision 5; 256B.0624, subdivisions 413.55, 8; 256B.0625, subdivisions 3, 3c, 6a, 7, 9, 11, 13, 13e, 13h, 17, 17a, 19a, 413.619c, 26, 42, 47, by adding subdivisions; 256B.0641, subdivision 3; 256B.0651; 413.7256B.0652; 256B.0653; 256B.0654; 256B.0655, subdivisions 1b, 4; 256B.0657, 413.8subdivisions 2, 6, 8, by adding a subdivision; 256B.08, by adding a subdivision; 413.9256B.0911, subdivisions 1, 1a, 3, 3a, 3b, 3c, 4a, 5, 6, 7, by adding subdivisions; 413.10256B.0913, subdivision 4; 256B.0915, subdivisions 3a, 3e, 3h, 5, by adding a 413.11subdivision; 256B.0916, subdivision 2; 256B.0917, by adding a subdivision; 413.12256B.092, subdivision 8a, by adding subdivisions; 256B.0943, subdivisions 1, 413.1312; 256B.0944, by adding a subdivision; 256B.0947, subdivision 1; 256B.15, 413.14subdivisions 1, 1a, 1h, 2, by adding subdivisions; 256B.199; 256B.37, 413.15subdivisions 1, 5; 256B.434, subdivision 4, by adding a subdivision; 256B.437, 413.16subdivision 6; 256B.441, subdivisions 55, 58, by adding a subdivision; 256B.49, 413.17subdivisions 12, 13, 14, 17, by adding subdivisions; 256B.501, subdivision 413.184a; 256B.5011, subdivision 2; 256B.5012, by adding a subdivision; 256B.69, 413.19subdivisions 5a, 5c, 5f, 23; 256B.76, subdivision 1; 256D.03, subdivision 4; 413.20256D.44, subdivision 5; 256G.02, subdivision 6; 256I.03, subdivision 7; 256I.05, 413.21subdivisions 1a, 7c; 256J.08, subdivision 73a; 256J.24, subdivision 5; 256J.425, 413.22subdivisions 2, 3; 256J.45, subdivision 3; 256J.49, subdivisions 1, 4; 256J.521, 413.23subdivision 2; 256J.545; 256J.561, subdivisions 2, 3; 256J.57, subdivision 413.241; 256J.575, subdivisions 3, 4, 6, 7; 256J.621; 256J.626, subdivision 7; 413.25256J.95, subdivisions 3, 11, 12, 13; 256L.03, by adding a subdivision; 256L.04, 413.26subdivisions 1, 7a, 10a, by adding a subdivision; 256L.05, subdivisions 1, 3, 3a, 413.27by adding a subdivision; 256L.07, subdivisions 1, 2, 3, by adding a subdivision; 413.28256L.11, subdivision 1; 256L.15, subdivisions 2, 3; 256L.17, subdivisions 3, 5; 413.29259.67, by adding a subdivision; 270A.09, by adding a subdivision; 327.14, 413.30by adding a subdivision; 327.15; 327.16; 327.20, subdivision 1, by adding a 413.31subdivision; 501B.89, by adding a subdivision; 519.05; 604A.33, subdivision 413.321; 609.232, subdivision 11; 626.556, subdivision 3c; 626.5572, subdivisions 413.336, 13, 21; Laws 2003, First Special Session chapter 14, article 13C, section 413.342, subdivision 1, as amended; Laws 2007, chapter 147, article 19, section 3, 413.35subdivision 4, as amended; proposing coding for new law in Minnesota Statutes, 413.36chapters 62Q; 246B; 254B; 256; 256B; proposing coding for new law as 413.37Minnesota Statutes, chapter 402A; repealing Minnesota Statutes 2008, sections 413.38103I.112; 144.9501, subdivision 17b; 148D.180, subdivision 8; 245C.11, 413.39subdivisions 1, 2; 246.51, subdivision 1; 246.53, subdivision 3; 256.962, 413.40subdivision 7; 256B.0655, subdivisions 1, 1a, 1c, 1d, 1e, 1f, 1g, 1h, 1i, 2, 3, 5, 6, 413.417, 8, 9, 10, 11, 12, 13; 256B.071, subdivisions 1, 2, 3, 4; 256B.092, subdivision 413.425a; 256B.19, subdivision 1d; 256B.431, subdivision 23; 256I.06, subdivision 413.439; 256L.17, subdivision 6; 327.14, subdivisions 5, 6; Minnesota Rules, parts 413.444626.2015, subpart 9; 9555.6125, subpart 4, item B."
         		We request the adoption of this report and repassage of the bill.House Conferees: (Signed) Thomas Huntley, Paul Thissen, Larry Hosch, Karen Clark, Jim AbelerSenate Conferees: (Signed) Linda Berglin, Tony Lourey, Kathy Sheran, Julie Rosen, Yvonne Prettner Solon

414.1We request the adoption of this report and repassage of the bill.414.2House Conferees:(Signed)414.3
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                     						414.4Thomas HuntleyPaul Thissen414.5
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                     						414.6Larry HoschKaren Clark414.7
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                     						414.8Jim Abeler414.9Senate Conferees:(Signed)414.10
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                     						414.11Linda BerglinTony Lourey414.12
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                     						414.13Kathy SheranJulie Rosen414.14
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                     						414.15Yvonne Prettner Solon