1.1 	A bill for an act
1.2 	relating to human services; changing provisions for long-term care, adverse 
1.3 	health care events, suicide prevention, doula services, developmental disabilities, 
1.4 	mental health commitment, alternative care services, self-directed options, 
1.5 	nursing facilities, ICF/MR facilities, and data management; requiring a safe 
1.6 	patient handling plan; establishing a health department work group and an 
1.7 	Alzheimer's disease work group;amending Minnesota Statutes 2008, sections 
1.8 	43A.318, subdivision 2; 62Q.525, subdivision 2; 144.7065, subdivisions 8, 10; 
1.9 	145.56, subdivisions 1, 2; 148.995, subdivisions 2, 4; 182.6551; 182.6552, 
1.10 	by adding a subdivision; 252.27, subdivision 1a; 252.282, subdivisions 3, 5; 
1.11 	253B.095, subdivision 1; 256B.0657, subdivision 5; 256B.0913, subdivisions 
1.12 	4, 5a, 12; 256B.0915, subdivision 2; 256B.431, subdivision 10; 256B.433, 
1.13 	subdivision 1; 256B.441, subdivisions 5, 11; 256B.5011, subdivision 2; 
1.14 	256B.5012, subdivisions 6, 7; 256B.5013, subdivisions 1, 6; 256B.69, 
1.15 	subdivision 9b; 403.03; 626.557, subdivision 12b; proposing coding for new law 
1.16 	in Minnesota Statutes, chapter 182; repealing Minnesota Statutes 2008, section 
1.17 	256B.5013, subdivisions 2, 3, 5.
1.18 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.19 	Section 1. Minnesota Statutes 2008, section 43A.318, subdivision 2, is amended to 
1.20 	read:
1.21 		Subd. 2.Program creation; general provisions. (a) The commissioner may 
1.22 	administer a program to make long-term care coverage available to eligible persons. The 
1.23 	commissioner may determine the program's funding arrangements, request bids from 
1.24 	qualified vendors, and negotiate and enter into contracts with qualified vendors. Contracts 
1.25 	are not subject to the requirements of section 16C.16 or 16C.19. Contracts must be for a 
1.26 	uniform term of at least one year, but may be made automatically renewable from term 
1.27 	to term in the absence of notice of termination by either party. The program may not be 
1.28 	self-insured until the commissioner has completed an actuarial study of the program and 
2.1 	reported the results of the study to the legislature and self-insurance has been specifically 
2.2 	authorized by law. 
2.3 	(b) The program may provide coverage for home, community, and institutional 
2.4 	long-term care and any other benefits as determined by the commissioner. Coverage is 
2.5 	optional. The enrolled eligible person must pay the full cost of the coverage.
2.6 	(c) The commissioner shall promote activities that attempt to raise awareness of 
2.7 	the need for long-term care insurance among residents of the state and encourage the 
2.8 	increased prevalence of long-term care coverage. These activities must include the sharing 
2.9 	of knowledge gained in the development of the program.
2.10 	(d) The commissioner may employ and contract with persons and other entities to 
2.11 	perform the duties under this section and may determine their duties and compensation 
2.12 	consistent with this chapter.
2.13 	(e) The benefits provided under this section are not terms and conditions of 
2.14 	employment as defined under section 179A.03, subdivision 19, and are not subject to 
2.15 	collective bargaining. 
2.16 	(f) The commissioner shall establish underwriting criteria for entry of all eligible 
2.17 	persons into the program. Eligible persons who would be immediately eligible for benefits 
2.18 	may not enroll.
2.19 	(g) Eligible persons who meet underwriting criteria may enroll in the program upon 
2.20 	hiring and at other times established by the commissioner.
2.21 	(h) An eligible person enrolled in the program may continue to participate in the 
2.22 	program even if an event, such as termination of employment, changes the person's 
2.23 	employment status.
2.24 	(i) Participating public employee pension plans and public employers may provide 
2.25 	automatic pension or payroll deduction for payment of long-term care insurance premiums 
2.26 	to qualified vendors contracted with under this section.
2.27 	(j) The premium charged to program enrollees must include an administrative fee to 
2.28 	cover all program expenses incurred in addition to the cost of coverage. All fees collected 
2.29 	are appropriated to the commissioner for the purpose of administrating the program.
2.30 	(k) Public employees of local units of government including but not limited to 
2.31 	townships, municipalities, cities, and counties may buy into the long-term care insurance 
2.32 	under this section.

2.33 	Sec. 2. Minnesota Statutes 2008, section 62Q.525, subdivision 2, is amended to read:
2.34 		Subd. 2.Definitions. (a) For purposes of this section, the terms defined in this 
2.35 	subdivision have the meanings given them.
3.1 	(b) "Medical literature" means articles from major peer reviewed medical journals 
3.2 	that have recognized the drug or combination of drugs' safety and effectiveness for 
3.3 	treatment of the indication for which it has been prescribed. Each article shall meet the 
3.4 	uniform requirements for manuscripts submitted to biomedical journals established by 
3.5 	the International Committee of Medical Journal Editors or be published in a journal 
3.6 	specified by the United States Secretary of Health and Human Services pursuant to United 
3.7 	States Code, title 42, section 1395x, paragraph (t), clause (2), item (B), as amended, as 
3.8 	acceptable peer review medical literature. Each article must use generally acceptable 
3.9 	scientific standards and must not use case reports to satisfy this criterion.
3.10 	(c) "Off-label use of drugs" means when drugs are prescribed for treatments other 
3.11 	than those stated in the labeling approved by the federal Food and Drug Administration.
3.12 	(d) "Standard reference compendia" means any of the following:
3.13 	(1) the United States Pharmacopeia Drug Information; or
3.14 	(2) (1) the American Hospital Formulary Service Drug Information.;
3.15 	(2) the National Comprehensive Cancer Network's Drugs and Biologics 
3.16 	Compendium;
3.17 	(3) Thomson Micromedex's DrugDex;
3.18 	(4) Elsevier Gold Standard's Clinical Pharmacology; or
3.19 	(5) other authoritative compendia as identified from time to time by the United 
3.20 	States Department of Health and Human Services.

3.21 	Sec. 3. Minnesota Statutes 2008, section 144.7065, subdivision 8, is amended to read:
3.22 		Subd. 8.Root cause analysis; corrective action plan. Following the occurrence of 
3.23 	an adverse health care event, the facility must conduct a root cause analysis of the event. 
3.24 	 In conducting the root cause analysis, if evidence determines staffing is a factor, then the 
3.25 	facility will review the impact of staffing levels on the event. Following the analysis, the 
3.26 	facility must: (1) implement a corrective action plan to implement the findings of the 
3.27 	analysis or (2) report to the commissioner any reasons for not taking corrective action. If 
3.28 	the root cause analysis and the implementation of a corrective action plan are complete at 
3.29 	the time an event must be reported, the findings of the analysis and the corrective action 
3.30 	plan must be included in the report of the event. The findings of the root cause analysis 
3.31 	and a copy of the corrective action plan must otherwise be filed with the commissioner 
3.32 	within 60 days of the event.

3.33 	Sec. 4. Minnesota Statutes 2008, section 144.7065, subdivision 10, is amended to read:
4.1 		Subd. 10.Relation to other law; data classification. (a) Adverse health events 
4.2 	described in subdivisions 2 to 6 do not constitute "maltreatment," "neglect," or "a physical 
4.3 	injury that is not reasonably explained" under section 626.556 or 626.557 and are excluded 
4.4 	from the reporting requirements of sections 626.556 and 626.557, provided the facility 
4.5 	makes a determination within 24 hours of the discovery of the event that this section is 
4.6 	applicable and the facility files the reports required under this section in a timely fashion.  
4.7 	(b) A facility that has determined that an event described in subdivisions 2 to 6 
4.8 	has occurred must inform persons who are mandated reporters under section 626.556, 
4.9 	subdivision 3, or 626.5572, subdivision 16, of that determination. A mandated reporter 
4.10 	otherwise required to report under section 626.556, subdivision 3, or 626.557, subdivision 
4.11 	3, paragraph (e), is relieved of the duty to report an event that the facility determines under 
4.12 	paragraph (a) to be reportable under subdivisions 2 to 6.  
4.13 	(c) The protections and immunities applicable to voluntary reports under sections 
4.14 	626.556 and 626.557 are not affected by this section.  
4.15 	(d) Notwithstanding section 626.556, 626.557, or any other provision of Minnesota 
4.16 	statute or rule to the contrary, neither a lead agency under section 626.556, subdivision 3c, 
4.17 	or 626.5572, subdivision 13, the commissioner of health, nor the director of the Office of 
4.18 	Health Facility Complaints is required to conduct an investigation of or obtain or create 
4.19 	investigative data or reports regarding an event described in subdivisions 2 to 6. If the 
4.20 	facility satisfies the requirements described in paragraph (a), the review or investigation 
4.21 	shall be conducted and data or reports shall be obtained or created only under sections 
4.22 	144.706 to 144.7069, except as permitted or required under sections 144.50 to 144.564, 
4.23 	or as necessary to carry out the state's certification responsibility under the provisions of 
4.24 	sections 1864 and 1867 of the Social Security Act.   If a licensed health care provider 
4.25 	reports an event to the facility required to be reported under subdivisions 2 to 6, in a 
4.26 	timely manner, the provider's licensing board is not required to conduct an investigation of 
4.27 	or obtain or create investigative data or reports regarding the individual reporting of the 
4.28 	events described in subdivisions 2 to 6.
4.29 	(e) Data contained in the following records are nonpublic and, to the extent they 
4.30 	contain data on individuals, confidential data on individuals, as defined in section 13.02:  
4.31 	(1) reports provided to the commissioner under sections 147.155, 147A.155, 
4.32 	148.267, 151.301, and 153.255;  
4.33 	(2) event reports, findings of root cause analyses, and corrective action plans filed by 
4.34 	a facility under this section; and
4.35 	(3) records created or obtained by the commissioner in reviewing or investigating 
4.36 	the reports, findings, and plans described in clause (2).
5.1 	For purposes of the nonpublic data classification contained in this paragraph, the 
5.2 	reporting facility shall be deemed the subject of the data.

5.3 	Sec. 5. Minnesota Statutes 2008, section 145.56, subdivision 1, is amended to read:
5.4 		Subdivision 1.Suicide prevention plan. The commissioner of health shall refine, 
5.5 	coordinate, and implement the state's suicide prevention plan using an evidence-based, 
5.6 	public health approach for a life span plan focused on awareness and prevention, in 
5.7 	collaboration with the commissioner of human services; the commissioner of public 
5.8 	safety; the commissioner of education; the chancellor of Minnesota State Colleges and 
5.9 	Universities; the president of the University of Minnesota; and appropriate agencies, 
5.10 	organizations, and institutions in the community.

5.11 	Sec. 6. Minnesota Statutes 2008, section 145.56, subdivision 2, is amended to read:
5.12 		Subd. 2.Community-based programs. To the extent funds are appropriated for the 
5.13 	purposes of this subdivision, the commissioner shall establish a grant program to fund:
5.14 	(1) community-based programs to provide education, outreach, and advocacy 
5.15 	services to populations who may be at risk for suicide;
5.16 	(2) community-based programs that educate community helpers and gatekeepers, 
5.17 	such as family members, spiritual leaders, coaches, and business owners, employers, and 
5.18 	coworkers on how to prevent suicide by encouraging help-seeking behaviors;
5.19 	(3) community-based programs that educate populations at risk for suicide and 
5.20 	community helpers and gatekeepers that must include information on the symptoms 
5.21 	of depression and other psychiatric illnesses, the warning signs of suicide, skills for 
5.22 	preventing suicides, and making or seeking effective referrals to intervention and 
5.23 	community resources; and
5.24 	(4) community-based programs to provide evidence-based suicide prevention and 
5.25 	intervention education to school staff, parents, and students in grades kindergarten through 
5.26 	12, and for students attending Minnesota colleges and universities.

5.27 	Sec. 7. Minnesota Statutes 2008, section 148.995, subdivision 2, is amended to read:
5.28 		Subd. 2.Certified doula. "Certified doula" means an individual who has received 
5.29 	a certification to perform doula services from the International Childbirth Education 
5.30 	Association, the Doulas of North America (DONA), the Association of Labor Assistants 
5.31 	and Childbirth Educators (ALACE), Birthworks, Childbirth and Postpartum Professional 
5.32 	Association (CAPPA), or Childbirth International, or International Center for Traditional 
5.33 	Childbearing.

6.1 	Sec. 8. Minnesota Statutes 2008, section 148.995, subdivision 4, is amended to read:
6.2 		Subd. 4.Doula services. "Doula services" means continuous emotional and 
6.3 	physical support during pregnancy, labor, birth, and postpartum throughout labor and 
6.4 	birth, and intermittently during the prenatal and postpartum periods.

6.5 	Sec. 9. Minnesota Statutes 2008, section 182.6551, is amended to read:
6.6 	182.6551 CITATION; SAFE PATIENT HANDLING ACT.
6.7 	Sections 182.6551 to 182.6553 182.6554 may be cited as the "Safe Patient Handling 
6.8 	Act."

6.9 	Sec. 10. Minnesota Statutes 2008, section 182.6552, is amended by adding a 
6.10 	subdivision to read:
6.11 		Subd. 5.Clinical settings that move patients. "Clinical settings that move 
6.12 	patients" means physician, dental, and other outpatient care facilities, except for outpatient 
6.13 	surgical settings, where service requires movement of patients from point to point as part 
6.14 	of the scope of service.

6.15 	Sec. 11. [182.6554] SAFE PATIENT HANDLING IN CLINICAL SETTINGS.
6.16 		Subdivision 1.Safe patient handling plan required. (a) By July 1, 2010, every 
6.17 	clinical setting that moves patients in the state shall develop a written safe patient handling 
6.18 	plan to achieve by January 1, 2012, the goal of ensuring the safe handling of patients by 
6.19 	minimizing manual lifting of patients by direct patient care workers and by utilizing 
6.20 	safe patient handling equipment.
6.21 	(b) The plan shall address:
6.22 	(1) assessment of risks with regard to patient handling that considers the patient 
6.23 	population and environment of care;
6.24 	(2) the acquisition of an adequate supply of appropriate safe patient handling 
6.25 	equipment;
6.26 	(3) initial and ongoing training of direct patient care workers on the use of this 
6.27 	equipment;
6.28 	(4) procedures to ensure that physical plant modifications and major construction 
6.29 	projects are consistent with plan goals; and
6.30 	(5) periodic evaluations of the safe patient handling plan. A health care organization 
6.31 	with more than one covered clinical setting that moves patients may establish a plan at 
6.32 	each clinical setting or establish one plan to serve this function for all the clinical settings.
7.1 		Subd. 2.Facilities with existing programs. A clinical setting that moves patients 
7.2 	that has already adopted a safe patient handling plan that satisfies the requirements of 
7.3 	subdivision 1, or a clinical setting that moves patients that is covered by a safe patient 
7.4 	handling plan that is covered under and consistent with section 182.6553, is considered 
7.5 	to be in compliance with the requirements of this section. 
7.6 		Subd. 3.Training materials. The commissioner shall make training materials on 
7.7 	implementation of this section available at no cost to all clinical settings that move patients 
7.8 	as part of the training and education duties of the commissioner under section 182.673.
7.9 		Subd. 4.Enforcement. This section shall be enforced by the commissioner under 
7.10 	section 182.661. An initial violation of this section shall not be assessed a penalty. A 
7.11 	subsequent violation of this section is subject to the penalties provided under section 
7.12 	182.666.
7.13 		Subd. 5.Restriction; civil liability. The safe patient handling plan required under 
7.14 	this section is not a standard of care for purposes of civil liability. A court may not 
7.15 	consider a breach of the safe patient handling plan as a breach of duty, a breach of the 
7.16 	standard of care, or as negligence in a civil action.

7.17 	Sec. 12. Minnesota Statutes 2008, section 252.27, subdivision 1a, is amended to read:
7.18 		Subd. 1a.Definitions. A "related condition" is a condition (1) that is found to be 
7.19 	closely related to developmental disability, including, but not limited to, cerebral palsy, 
7.20 	epilepsy, autism, fetal alcohol spectrum disorder, and Prader-Willi syndrome, and (2) that 
7.21 	meets all of the following criteria:
7.22 	(1) (i) is severe and chronic;
7.23 	(2) (ii) results in impairment of general intellectual functioning or adaptive behavior 
7.24 	similar to that of persons with developmental disabilities;
7.25 	(3) (iii) requires treatment or services similar to those required for persons with 
7.26 	developmental disabilities;
7.27 	(4) (iv) is manifested before the person reaches 22 years of age;
7.28 	(5) (v) is likely to continue indefinitely;
7.29 	(6) (vi) results in substantial functional limitations in three or more of the following 
7.30 	areas of major life activity: (i) (A) self-care, (ii) (B) understanding and use of language, 
7.31 	(iii) (C) learning, (iv) (D) mobility, (v) (E) self-direction, (vi) (F) capacity for independent 
7.32 	living; and
7.33 	(7) (vii) is not attributable to mental illness as defined in section 245.462, subdivision 
7.34 	20, or an emotional disturbance as defined in section 245.4871, subdivision 15. 
8.1 	For purposes of clause (7) item (vii), notwithstanding section 245.462, subdivision 20, 
8.2 	or 245.4871, subdivision 15, "mental illness" does not include autism or other pervasive 
8.3 	developmental disorders.

8.4 	Sec. 13. Minnesota Statutes 2008, section 252.282, subdivision 3, is amended to read:
8.5 		Subd. 3.Recommendations. (a) Upon completion of the local system needs 
8.6 	planning assessment, the host county shall make recommendations by May 15, 2000, and 
8.7 	by July 1 every two years thereafter beginning in 2001. If no change is recommended, a 
8.8 	copy of the assessment along with corresponding documentation shall be provided to the 
8.9 	commissioner by July 1 prior to the contract year.
8.10 	(b) Except as provided in section 252.292, subdivision 4, recommendations 
8.11 	regarding closures, relocations, or downsizings that include a rate increase shall be 
8.12 	submitted to the statewide advisory committee for review, along with the assessment, plan, 
8.13 	and corresponding documentation that supports the payment rate adjustment request.  
8.14 	(c) (b) Recommendations for closures, relocations, and downsizings that do not 
8.15 	include a rate increase and for modification of existing services for which a change in the 
8.16 	framework of service delivery is necessary shall be provided to the commissioner by July 
8.17 	1 prior to the contract year or at least 90 days prior to the anticipated change, along with 
8.18 	the assessment and corresponding documentation.

8.19 	Sec. 14. Minnesota Statutes 2008, section 252.282, subdivision 5, is amended to read:
8.20 		Subd. 5.Responsibilities of commissioner. (a) In collaboration with counties and 
8.21 	providers, the commissioner shall ensure that services recognize the preferences and needs 
8.22 	of persons with developmental disabilities and related conditions through a recurring 
8.23 	systemic review and assessment of ICF/MR facilities within the state.
8.24 	(b) The commissioner shall publish a notice in the State Register no less than 
8.25 	biannually to announce the opportunity for counties or providers to submit requests for 
8.26 	payment rate adjustments associated with plans for downsizing, relocation, and closure of 
8.27 	ICF/MR facilities.
8.28 	(c) The commissioner shall designate funding parameters to counties and to the 
8.29 	statewide advisory committee for the overall implementation of system needs within the 
8.30 	fiscal resources allocated by the legislature.
8.31 	(d) (b) The commissioner shall contract with ICF/MR providers. Contracts shall 
8.32 	be for two-year periods.

8.33 	Sec. 15. Minnesota Statutes 2008, section 253B.095, subdivision 1, is amended to read:
9.1 		Subdivision 1.Court release. (a) After the hearing and before a commitment order 
9.2 	has been issued, the court may release a proposed patient to the custody of an individual or 
9.3 	agency upon conditions that guarantee the care and treatment of the patient.
9.4 	(b) A person against whom a criminal proceeding is pending may not be released.
9.5 	(c) A continuance for dismissal, with or without findings, may be granted for up to 
9.6 	90 days.
9.7 	(d) When the court stays an order for commitment for more than 14 days beyond the 
9.8 	date of the initially scheduled hearing, the court shall issue an order that must include:
9.9 	(1) a written plan for services to which the proposed patient has agreed;
9.10 	(2) a finding that the proposed treatment is available and accessible to the patient 
9.11 	and that public or private financial resources are available to pay for the proposed 
9.12 	treatment; and
9.13 	(3) conditions the patient must meet to avoid revocation of the stayed commitment 
9.14 	order and imposition of the commitment order; and
9.15 	(4) a condition that the patient is prohibited from giving consent to participate in a 
9.16 	psychiatric clinical drug trial while the court order is in effect.
9.17 	(e) If a stay of commitment is continued as provided in subdivision 3, the court may 
9.18 	allow the patient to give consent to participate in a specific psychiatric clinical drug trial if 
9.19 	the treating psychiatrist submits an affidavit that the patient may benefit from participating 
9.20 	in the trial because treatment options offered have been ineffective. The treating 
9.21 	psychiatrist must not be the psychiatrist conducting the psychiatric clinical drug trial.
9.22 	(e) (f) A person receiving treatment under this section has all rights under this 
9.23 	chapter.

9.24 	Sec. 16. Minnesota Statutes 2008, section 256B.0657, subdivision 5, is amended to 
9.25 	read:
9.26 		Subd. 5.Self-directed supports option plan requirements. (a) The plan for the 
9.27 	self-directed supports option must meet the following requirements:
9.28 	(1) the plan must be completed using a person-centered process that:
9.29 	(i) builds upon the recipient's capacity to engage in activities that promote 
9.30 	community life;
9.31 	(ii) respects the recipient's preferences, choices, and abilities;
9.32 	(iii) involves families, friends, and professionals in the planning or delivery of 
9.33 	services or supports as desired or required by the recipient; and 
9.34 	(iv) addresses the need for personal care assistant services identified in the recipient's 
9.35 	self-directed supports option assessment;
10.1 	(2) the plan shall be developed by the recipient or by the guardian of an adult 
10.2 	recipient or by a parent or guardian of a minor child, with the assistance of an enrolled 
10.3 	medical assistance home care targeted case manager and may be assisted by a provider 
10.4 	who meets the requirements established for using a person-centered planning process and 
10.5 	shall be reviewed at least annually upon reassessment or when there is a significant change 
10.6 	in the recipient's condition; and 
10.7 	(3) the plan must include the total budget amount available divided into monthly 
10.8 	amounts that cover the number of months of personal care assistant services authorization 
10.9 	included in the budget. The amount used each month may vary, but additional funds shall 
10.10 	not be provided above the annual personal care assistant services authorized amount 
10.11 	unless a change in condition is documented.
10.12 	(b) The commissioner shall:
10.13 	(1) establish the format and criteria for the plan as well as the requirements for 
10.14 	providers who assist with plan development;
10.15 	(2) review the assessment and plan and, within 30 days after receiving the 
10.16 	assessment and plan, make a decision on approval of the plan;
10.17 	(3) notify the recipient, parent, or guardian of approval or denial of the plan and 
10.18 	provide notice of the right to appeal under section 256.045; and 
10.19 	(4) provide a copy of the plan to the fiscal support entity selected by the recipient.

10.20 	Sec. 17. Minnesota Statutes 2008, section 256B.0913, subdivision 4, is amended to 
10.21 	read:
10.22 		Subd. 4.Eligibility for funding for services for nonmedical assistance recipients.
 10.23 	(a) Funding for services under the alternative care program is available to persons who 
10.24 	meet the following criteria:
10.25 	(1) the person has been determined by a community assessment under section 
10.26 	256B.0911 to be a person who would require the level of care provided in a nursing 
10.27 	facility, but for the provision of services under the alternative care program;
10.28 	(2) the person is age 65 or older;
10.29 	(3) the person would be eligible for medical assistance within 135 days of admission 
10.30 	to a nursing facility;
10.31 	(4) the person is not ineligible for the payment of long-term care services by the 
10.32 	medical assistance program due to an asset transfer penalty under section 256B.0595 or 
10.33 	equity interest in the home exceeding $500,000 as stated in section 256B.056;
11.1 	(5) the person needs long-term care services that are not funded through other 
11.2 	state or federal funding, or other health insurance or other third-party insurance such as 
11.3 	long-term care insurance;
11.4 	(6) the monthly cost of the alternative care services funded by the program for 
11.5 	this person does not exceed 75 percent of the monthly limit described under section 
11.6 	256B.0915, subdivision 3a. This monthly limit does not prohibit the alternative care 
11.7 	client from payment for additional services, but in no case may the cost of additional 
11.8 	services purchased under this section exceed the difference between the client's monthly 
11.9 	service limit defined under section 256B.0915, subdivision 3, and the alternative care 
11.10 	program monthly service limit defined in this paragraph. If care-related supplies and 
11.11 	equipment or environmental modifications and adaptations are or will be purchased for 
11.12 	an alternative care services recipient, the costs may be prorated on a monthly basis for 
11.13 	up to 12 consecutive months beginning with the month of purchase. If the monthly cost 
11.14 	of a recipient's other alternative care services exceeds the monthly limit established in 
11.15 	this paragraph, the annual cost of the alternative care services shall be determined. In this 
11.16 	event, the annual cost of alternative care services shall not exceed 12 times the monthly 
11.17 	limit described in this paragraph; and
11.18 	(7) the person is making timely payments of the assessed monthly fee.
11.19 	A person is ineligible if payment of the fee is over 60 days past due, unless the person 
11.20 	agrees to:
11.21 	(i) the appointment of a representative payee;
11.22 	(ii) automatic payment from a financial account;
11.23 	(iii) the establishment of greater family involvement in the financial management of 
11.24 	payments; or
11.25 	(iv) another method acceptable to the lead agency to ensure prompt fee payments.
11.26 	The lead agency may extend the client's eligibility as necessary while making 
11.27 	arrangements to facilitate payment of past-due amounts and future premium payments. 
11.28 	Following disenrollment due to nonpayment of a monthly fee, eligibility shall not be 
11.29 	reinstated for a period of 30 days.
11.30 	(b) Alternative care funding under this subdivision is not available for a person 
11.31 	who is a medical assistance recipient or who would be eligible for medical assistance 
11.32 	without a spenddown or waiver obligation. A person whose initial application for medical 
11.33 	assistance and the elderly waiver program is being processed may be served under the 
11.34 	alternative care program for a period up to 60 days. If the individual is found to be eligible 
11.35 	for medical assistance, medical assistance must be billed for services payable under the 
11.36 	federally approved elderly waiver plan and delivered from the date the individual was 
12.1 	found eligible for the federally approved elderly waiver plan. Notwithstanding this 
12.2 	provision, alternative care funds may not be used to pay for any service the cost of which: 
12.3 	(i) is payable by medical assistance; (ii) is used by a recipient to meet a waiver obligation; 
12.4 	or (iii) is used to pay a medical assistance income spenddown for a person who is eligible 
12.5 	to participate in the federally approved elderly waiver program under the special income 
12.6 	standard provision.
12.7 	(c) Alternative care funding is not available for a person who resides in a licensed 
12.8 	nursing home, certified boarding care home, hospital, or intermediate care facility, except 
12.9 	for case management services which are provided in support of the discharge planning 
12.10 	process for a nursing home resident or certified boarding care home resident to assist with 
12.11 	a relocation process to a community-based setting.
12.12 	(d) Alternative care funding is not available for a person whose income is greater 
12.13 	than the maintenance needs allowance under section 256B.0915, subdivision 1d, but equal 
12.14 	to or less than 120 percent of the federal poverty guideline effective July 1 in the fiscal 
12.15 	year for which alternative care eligibility is determined, who would be eligible for the 
12.16 	elderly waiver with a waiver obligation.

12.17 	Sec. 18. Minnesota Statutes 2008, section 256B.0913, subdivision 5a, is amended to 
12.18 	read:
12.19 		Subd. 5a.Services; service definitions; service standards. (a) Unless specified in 
12.20 	statute, the services, service definitions, and standards for alternative care services shall 
12.21 	be the same as the services, service definitions, and standards specified in the federally 
12.22 	approved elderly waiver plan, except alternative care does not cover transitional support 
12.23 	services, assisted living services, adult foster care services, and residential care and 
12.24 	benefits defined under section 256B.0625 that meet primary and acute health care needs.
12.25 	(b) The lead agency must ensure that the funds are not used to supplant or 
12.26 	supplement services available through other public assistance or services programs, 
12.27 	including supplementation of client co-pays, deductibles, premiums, or other cost-sharing 
12.28 	arrangements for health-related benefits and services or entitlement programs and 
12.29 	services that are available to the person, but in which they have elected not to enroll. 
12.30 	The lead agency must ensure that the benefit department recovery system in the Medicaid 
12.31 	Management Information System (MMIS) has the necessary information on any other 
12.32 	health insurance or third-party insurance policy to which the client may have access. For a 
12.33 	provider of supplies and equipment when the monthly cost of the supplies and equipment 
12.34 	is less than $250, persons or agencies must be employed by or under a contract with the 
12.35 	lead agency or the public health nursing agency of the local board of health in order to 
13.1 	receive funding under the alternative care program. Supplies and equipment may be 
13.2 	purchased from a vendor not certified to participate in the Medicaid program if the cost for 
13.3 	the item is less than that of a Medicaid vendor.
13.4 	(c) Personal care services must meet the service standards defined in the federally 
13.5 	approved elderly waiver plan, except that a lead agency may contract with a client's 
13.6 	relative who meets the relative hardship waiver requirements or a relative who meets the 
13.7 	criteria and is also the responsible party under an individual service plan that ensures the 
13.8 	client's health and safety and supervision of the personal care services by a qualified 
13.9 	professional as defined in section 256B.0625, subdivision 19c. Relative hardship is 
13.10 	established by the lead agency when the client's care causes a relative caregiver to do any 
13.11 	of the following: resign from a paying job, reduce work hours resulting in lost wages, 
13.12 	obtain a leave of absence resulting in lost wages, incur substantial client-related expenses, 
13.13 	provide services to address authorized, unstaffed direct care time, or meet special needs of 
13.14 	the client unmet in the formal service plan.

13.15 	Sec. 19. Minnesota Statutes 2008, section 256B.0913, subdivision 12, is amended to 
13.16 	read:
13.17 		Subd. 12.Client fees. (a) A fee is required for all alternative care eligible clients 
13.18 	to help pay for the cost of participating in the program. The amount of the fee for the 
13.19 	alternative care client shall be determined as follows:
13.20 	(1) when the alternative care client's income less recurring and predictable medical 
13.21 	expenses is less than 100 percent of the federal poverty guideline effective on July 1 of 
13.22 	the state fiscal year in which the fee is being computed, and total assets are less than 
13.23 	$10,000, the fee is zero;
13.24 	(2) when the alternative care client's income less recurring and predictable medical 
13.25 	expenses is equal to or greater than 100 percent but less than 150 percent of the federal 
13.26 	poverty guideline effective on July 1 of the state fiscal year in which the fee is being 
13.27 	computed, and total assets are less than $10,000, the fee is five percent of the cost of 
13.28 	alternative care services;
13.29 	(3) when the alternative care client's income less recurring and predictable medical 
13.30 	expenses is equal to or greater than 150 percent but less than 200 percent of the federal 
13.31 	poverty guidelines effective on July 1 of the state fiscal year in which the fee is being 
13.32 	computed and assets are less than $10,000, the fee is 15 percent of the cost of alternative 
13.33 	care services;
13.34 	(4) when the alternative care client's income less recurring and predictable medical 
13.35 	expenses is equal to or greater than 200 percent of the federal poverty guidelines effective 
14.1 	on July 1 of the state fiscal year in which the fee is being computed and assets are less than 
14.2 	$10,000, the fee is 30 percent of the cost of alternative care services; and
14.3 	(5) when the alternative care client's assets are equal to or greater than $10,000, the 
14.4 	fee is 30 percent of the cost of alternative care services.
14.5 	For married persons, total assets are defined as the total marital assets less the 
14.6 	estimated community spouse asset allowance, under section 256B.059, if applicable. For 
14.7 	married persons, total income is defined as the client's income less the monthly spousal 
14.8 	allotment, under section 256B.058. 
14.9 	All alternative care services shall be included in the estimated costs for the purpose 
14.10 	of determining the fee.
14.11 	Fees are due and payable each month alternative care services are received unless the 
14.12 	actual cost of the services is less than the fee, in which case the fee is the lesser amount.
14.13 	(b) The fee shall be waived by the commissioner when:
14.14 	(1) a person is residing in a nursing facility;
14.15 	(2) a married couple is requesting an asset assessment under the spousal 
14.16 	impoverishment provisions;
14.17 	(3) a person is found eligible for alternative care, but is not yet receiving alternative 
14.18 	care services including case management services; or
14.19 	(4) a person has chosen to participate in a consumer-directed service plan for which 
14.20 	the cost is no greater than the total cost of the person's alternative care service plan less 
14.21 	the monthly fee amount that would otherwise be assessed.
14.22 	(c) The commissioner will bill and collect the fee from the client. Money collected 
14.23 	must be deposited in the general fund and is appropriated to the commissioner for the 
14.24 	alternative care program. The client must supply the lead agency with the client's Social 
14.25 	Security number at the time of application. The lead agency shall supply the commissioner 
14.26 	with the client's Social Security number and other information the commissioner requires 
14.27 	to collect the fee from the client. The commissioner shall collect unpaid fees using the 
14.28 	Revenue Recapture Act in chapter 270A and other methods available to the commissioner. 
14.29 	The commissioner may require lead agencies to inform clients of the collection procedures 
14.30 	that may be used by the state if a fee is not paid. This paragraph does not apply to 
14.31 	alternative care pilot projects authorized in Laws 1993, First Special Session chapter 1, 
14.32 	article 5, section 133, if a county operating under the pilot project reports the following 
14.33 	dollar amounts to the commissioner quarterly:
14.34 	(1) total fees billed to clients;
14.35 	(2) total collections of fees billed; and
14.36 	(3) balance of fees owed by clients.
15.1 	If a lead agency does not adhere to these reporting requirements, the commissioner may 
15.2 	terminate the billing, collecting, and remitting portions of the pilot project and require the 
15.3 	lead agency involved to operate under the procedures set forth in this paragraph.

15.4 	Sec. 20. Minnesota Statutes 2008, section 256B.0915, subdivision 2, is amended to 
15.5 	read:
15.6 		Subd. 2.Spousal impoverishment policies. The commissioner shall apply:
15.7 	(1) the spousal impoverishment criteria as authorized under United States Code, title 
15.8 	42, section 1396r-5, and as implemented in sections 256B.0575, 256B.058, and 256B.059;, 
15.9 	except that individuals with income at or below the special income standard according 
15.10 	to Code of Federal Regulations, title 42, section 435.236, receive the maintenance needs 
15.11 	amount in subdivision 1d.
15.12 	(2) the personal needs allowance permitted in section 256B.0575; and
15.13 	(3) an amount equivalent to the group residential housing rate as set by section 
15.14 	256I.03, subdivision 5, and according to the approved federal waiver and medical 
15.15 	assistance state plan. 

15.16 	Sec. 21. Minnesota Statutes 2008, section 256B.431, subdivision 10, is amended to 
15.17 	read:
15.18 		Subd. 10.Property rate adjustments and construction projects. A nursing 
15.19 	facility's facility completing a construction project that is eligible for a rate adjustment 
15.20 	under section 256B.434, subdivision 4f, and that was not approved through the moratorium 
15.21 	exception process in section 144A.073 must request for from the commissioner a 
15.22 	property-related payment rate adjustment and the related supporting documentation of 
15.23 	project construction cost information must be submitted to the commissioner. If the 
15.24 	request is made within 60 days after the construction project's completion date to be 
15.25 	considered eligible for a property-related payment rate adjustment the effective date of 
15.26 	the rate adjustment is the first of the month following the completion date. If the request 
15.27 	is made more than 60 days after the completion date, the rate adjustment is effective on 
15.28 	the first of the month following the request. The commissioner shall provide a rate notice 
15.29 	reflecting the allowable costs within 60 days after receiving all the necessary information 
15.30 	to compute the rate adjustment. No sooner than the effective date of the rate adjustment 
15.31 	for the building construction project, a nursing facility may adjust its rates by the amount 
15.32 	anticipated to be allowed. Any amounts collected from private pay residents in excess of 
15.33 	the allowable rate must be repaid to private pay residents with interest at the rate used by 
15.34 	the commissioner of revenue for the late payment of taxes and in effect on the date the 
16.1 	rate increase is effective. Construction projects with completion dates within one year 
16.2 	of the completion date associated with the property rate adjustment request and phased 
16.3 	projects with project completion dates within three years of the last phase of the phased 
16.4 	project must be aggregated for purposes of the minimum thresholds in subdivisions 16 
16.5 	and 17, and the maximum threshold in section 144A.071, subdivision 2. "Construction 
16.6 	project" and "project construction costs" have the meanings given them in Minnesota 
16.7 	Statutes, section 144A.071, subdivision 1a. 

16.8 	Sec. 22. Minnesota Statutes 2008, section 256B.433, subdivision 1, is amended to read:
16.9 		Subdivision 1.Setting payment; monitoring use of therapy services. The 
16.10 	commissioner shall promulgate adopt rules pursuant to under the Administrative 
16.11 	Procedure Act to set the amount and method of payment for ancillary materials and 
16.12 	services provided to recipients residing in nursing facilities. Payment for materials and 
16.13 	services may be made to either the nursing facility in the operating cost per diem, to the 
16.14 	vendor of ancillary services pursuant to Minnesota Rules, parts 9505.0170 to 9505.0475,
16.15 	or to a nursing facility pursuant to Minnesota Rules, parts 9505.0170 to 9505.0475. 
16.16 	Payment for the same or similar service to a recipient shall not be made to both the nursing 
16.17 	facility and the vendor. The commissioner shall ensure the avoidance of double payments 
16.18 	through audits and adjustments to the nursing facility's annual cost report as required by 
16.19 	section 256B.47, and that charges and arrangements for ancillary materials and services 
16.20 	are cost-effective and as would be incurred by a prudent and cost-conscious buyer. 
16.21 	Therapy services provided to a recipient must be medically necessary and appropriate 
16.22 	to the medical condition of the recipient. If the vendor, nursing facility, or ordering 
16.23 	physician cannot provide adequate medical necessity justification, as determined by the 
16.24 	commissioner, the commissioner may recover or disallow the payment for the services 
16.25 	and may require prior authorization for therapy services as a condition of payment or 
16.26 	may impose administrative sanctions to limit the vendor, nursing facility, or ordering 
16.27 	physician's participation in the medical assistance program. If the provider number of a 
16.28 	nursing facility is used to bill services provided by a vendor of therapy services that is 
16.29 	not related to the nursing facility by ownership, control, affiliation, or employment status, 
16.30 	no withholding of payment shall be imposed against the nursing facility for services not 
16.31 	medically necessary except for funds due the unrelated vendor of therapy services as 
16.32 	provided in subdivision 3, paragraph (c). For the purpose of this subdivision, no monetary 
16.33 	recovery may be imposed against the nursing facility for funds paid to the unrelated 
16.34 	vendor of therapy services as provided in subdivision 3, paragraph (c), for services not 
16.35 	medically necessary. For purposes of this section and section 256B.47, therapy includes 
17.1 	physical therapy, occupational therapy, speech therapy, audiology, and mental health 
17.2 	services that are covered services according to Minnesota Rules, parts 9505.0170 to 
17.3 	9505.0475, and that could be reimbursed separately from the nursing facility per diem. 
17.4 	For purposes of this subdivision, "ancillary services" include transportation defined as 
17.5 	a covered service in section 256B.0625, subdivision 17.

17.6 	Sec. 23. Minnesota Statutes 2008, section 256B.441, subdivision 5, is amended to read:
17.7 		Subd. 5.Administrative costs. "Administrative costs" means the direct costs for 
17.8 	administering the overall activities of the nursing home. These costs include salaries and 
17.9 	wages of the administrator, assistant administrator, business office employees, security 
17.10 	guards, and associated fringe benefits and payroll taxes, fees, contracts, or purchases 
17.11 	related to business office functions, licenses, and permits except as provided in the external 
17.12 	fixed costs category, employee recognition, travel including meals and lodging, all training
17.13 	except as specified in subdivision 11, voice and data communication or transmission, 
17.14 	office supplies, liability insurance and other forms of insurance not designated to other 
17.15 	areas, personnel recruitment, legal services, accounting services, management or business 
17.16 	consultants, data processing, information technology, Web site, central or home office 
17.17 	costs, business meetings and seminars, postage, fees for professional organizations, 
17.18 	subscriptions, security services, advertising, board of director's fees, working capital 
17.19 	interest expense, and bad debts and bad debt collection fees.

17.20 	Sec. 24. Minnesota Statutes 2008, section 256B.441, subdivision 11, is amended to 
17.21 	read:
17.22 		Subd. 11.Direct care costs. "Direct care costs" means costs for the wages of 
17.23 	nursing administration, staff education, direct care registered nurses, licensed practical 
17.24 	nurses, certified nursing assistants, trained medication aides, employees conducting 
17.25 	training in resident care topics and associated fringe benefits and payroll taxes; services 
17.26 	from a supplemental nursing services agency; supplies that are stocked at nursing stations 
17.27 	or on the floor and distributed or used individually, including, but not limited to: alcohol, 
17.28 	applicators, cotton balls, incontinence pads, disposable ice bags, dressings, bandages, 
17.29 	water pitchers, tongue depressors, disposable gloves, enemas, enema equipment, soap, 
17.30 	medication cups, diapers, plastic waste bags, sanitary products, thermometers, hypodermic 
17.31 	needles and syringes, clinical reagents or similar diagnostic agents, drugs that are not paid 
17.32 	on a separate fee schedule by the medical assistance program or any other payer, and 
17.33 	technology related to the provision of nursing care to residents, such as electronic charting 
18.1 	systems; costs of materials used for resident care training, and training courses outside of 
18.2 	the facility attended by direct care staff on resident care topics.

18.3 	Sec. 25. Minnesota Statutes 2008, section 256B.5011, subdivision 2, is amended to 
18.4 	read:
18.5 		Subd. 2.Contract provisions. (a) The service contract with each intermediate 
18.6 	care facility must include provisions for:
18.7 	(1) modifying payments when significant changes occur in the needs of the 
18.8 	consumers;
18.9 	(2) the establishment and use of a quality improvement plan. Using criteria and 
18.10 	options for performance measures developed by the commissioner, each intermediate care 
18.11 	facility must identify a minimum of one performance measure on which to focus its efforts 
18.12 	for quality improvement during the contract period;
18.13 	(3) (2) appropriate and necessary statistical information required by the 
18.14 	commissioner;
18.15 	(4) (3) annual aggregate facility financial information; and
18.16 	(5) (4) additional requirements for intermediate care facilities not meeting the 
18.17 	standards set forth in the service contract.
18.18 	(b) The commissioner of human services and the commissioner of health, in 
18.19 	consultation with representatives from counties, advocacy organizations, and the provider 
18.20 	community, shall review the consolidated standards under chapter 245B and the supervised 
18.21 	living facility rule under Minnesota Rules, chapter 4665, to determine what provisions 
18.22 	in Minnesota Rules, chapter 4665, may be waived by the commissioner of health for 
18.23 	intermediate care facilities in order to enable facilities to implement the performance 
18.24 	measures in their contract and provide quality services to residents without a duplication 
18.25 	of or increase in regulatory requirements.

18.26 	Sec. 26. Minnesota Statutes 2008, section 256B.5012, subdivision 6, is amended to 
18.27 	read:
18.28 		Subd. 6.ICF/MR rate increases October 1, 2005, and October 1, 2006. (a) For 
18.29 	the rate periods beginning October 1, 2005, and October 1, 2006, the commissioner shall 
18.30 	make available to each facility reimbursed under this section an adjustment to the total 
18.31 	operating payment rate of 2.2553 percent.
18.32 	(b) 75 percent of the money resulting from the rate adjustment under paragraph (a) 
18.33 	must be used to increase wages and benefits and pay associated costs for  employees, 
18.34 	except for administrative and central office employees. 75 percent of the money received 
19.1 	by a facility as a result of the rate adjustment provided in paragraph (a) must be used only 
19.2 	for wage, benefit, and staff increases implemented on or after the effective date of the rate 
19.3 	increase each year, and must not be used for increases implemented prior to that date. The 
19.4 	wage adjustment eligible employees may receive may vary based on merit, seniority, or 
19.5 	other factors determined by the provider.
19.6 	(c) For each facility, the commissioner shall make available an adjustment, based 
19.7 	on occupied beds,  using the percentage specified in paragraph (a) multiplied by the total 
19.8 	payment rate, including variable rate but excluding the property-related payment rate, in 
19.9 	effect on the preceding day. The total payment rate shall include the adjustment provided 
19.10 	in section 256B.501, subdivision 12.
19.11 	(d) A facility whose payment rates are governed by closure agreements,or 
19.12 	receivership agreements, or Minnesota Rules, part 9553.0075, is not eligible for an 
19.13 	adjustment otherwise granted under this subdivision.
19.14 	(e) A facility may apply for the portion of the payment rate adjustment provided 
19.15 	under paragraph (a) for employee wages and benefits and associated costs. The application 
19.16 	must be made to the commissioner and contain a plan by which the facility will distribute 
19.17 	the funds according to paragraph (b). For facilities in which the employees are represented 
19.18 	by an exclusive bargaining representative, an agreement negotiated and agreed to by the 
19.19 	employer and the exclusive bargaining representative constitutes the plan. A negotiated 
19.20 	agreement may constitute the plan only if the agreement is finalized after the date of 
19.21 	enactment of all rate increases for the rate year. The commissioner shall review the plan to 
19.22 	ensure that the payment rate adjustment per diem is used as provided in this subdivision. 
19.23 	To be eligible, a facility must submit its plan by March 31, 2006, and December 31, 
19.24 	2006, respectively. If a facility's plan is effective for its employees after the first day of 
19.25 	the applicable rate period that the funds are available, the payment rate adjustment per 
19.26 	diem is effective the same date as its plan.
19.27 	(f) A copy of the approved distribution plan must be made available to all employees 
19.28 	by giving each employee a copy or by posting it in an area of the facility to which all 
19.29 	employees have access. If an employee does not receive the wage and benefit adjustment 
19.30 	described in the facility's approved plan and is unable to resolve the problem with the 
19.31 	facility's management or through the employee's union representative, the employee 
19.32 	may contact the commissioner at an address or telephone number provided by the 
19.33 	commissioner and included in the approved plan.

19.34 	Sec. 27. Minnesota Statutes 2008, section 256B.5012, subdivision 7, is amended to 
19.35 	read:
20.1 		Subd. 7.ICF/MR rate increases effective October 1, 2007, and October 1, 2008.
 20.2 	(a) For the rate year beginning October 1, 2007, the commissioner shall make available to 
20.3 	each facility reimbursed under this section operating payment rate adjustments equal to 
20.4 	2.0 percent of the operating payment rates in effect on September 30, 2007. For the rate 
20.5 	year beginning October 1, 2008, the commissioner shall make available to each facility 
20.6 	reimbursed under this section operating payment rate adjustments equal to 2.0 percent 
20.7 	of the operating payment rates in effect on September 30, 2008. For each facility, the 
20.8 	commissioner shall make available an adjustment, based on occupied beds, using the 
20.9 	percentage specified in this paragraph multiplied by the total payment rate, including the 
20.10 	variable rate but excluding the property-related payment rate, in effect on the preceding 
20.11 	day. The total payment rate shall include the adjustment provided in section 256B.501, 
20.12 	subdivision 12. A facility whose payment rates are governed by closure agreements,
20.13 	or receivership agreements, or Minnesota Rules, part 9553.0075, is not eligible for an 
20.14 	adjustment otherwise granted under this subdivision.
20.15 	(b) Seventy-five percent of the money resulting from the rate adjustments under 
20.16 	paragraph (a) must be used for increases in compensation-related costs for employees 
20.17 	directly employed by the facility on or after the effective date of the rate adjustments, 
20.18 	except:
20.19 	(1) the administrator;
20.20 	(2) persons employed in the central office of a corporation that has an ownership 
20.21 	interest in the facility or exercises control over the facility; and 
20.22 	(3) persons paid by the facility under a management contract.
20.23 	(c) Two-thirds of the money available under paragraph (b) must be used for wage 
20.24 	increases for all employees directly employed by the facility on or after the effective 
20.25 	date of the rate adjustments, except those listed in paragraph (b), clauses (1) to (3). The 
20.26 	wage adjustment that employees receive under this paragraph must be paid as an equal 
20.27 	hourly percentage wage increase for all eligible employees. All wage increases under this 
20.28 	paragraph must be effective on the same date. Only costs associated with the portion of 
20.29 	the equal hourly percentage wage increase that goes to all employees shall qualify under 
20.30 	this paragraph. Costs associated with wage increases in excess of the amount of the equal 
20.31 	hourly percentage wage increase provided to all employees shall be allowed only for 
20.32 	meeting the requirements in paragraph (b). This paragraph shall not apply to employees 
20.33 	covered by a collective bargaining agreement.
20.34 	(d) The commissioner shall allow as compensation-related costs all costs for:
20.35 	(1) wages and salaries;
21.1 	(2) FICA taxes, Medicare taxes, state and federal unemployment taxes, and workers' 
21.2 	compensation;
21.3 	(3) the employer's share of health and dental insurance, life insurance, disability 
21.4 	insurance, long-term care insurance, uniform allowance, and pensions; and
21.5 	(4) other benefits provided, subject to the approval of the commissioner.
21.6 	(e) The portion of the rate adjustments under paragraph (a) that is not subject to the 
21.7 	requirements in paragraphs (b) and (c) shall be provided to facilities effective October 
21.8 	1 of each year.
21.9 	(f) Facilities may apply for the portion of the rate adjustments under paragraph 
21.10 	(a) that is subject to the requirements in paragraphs (b) and (c). The application 
21.11 	must be submitted to the commissioner within six months of the effective date of the 
21.12 	rate adjustments, and the facility must provide additional information required by 
21.13 	the commissioner within nine months of the effective date of the rate adjustments. 
21.14 	The commissioner must respond to all applications within three weeks of receipt. 
21.15 	The commissioner may waive the deadlines in this paragraph under extraordinary 
21.16 	circumstances, to be determined at the sole discretion of the commissioner. The 
21.17 	application must contain:
21.18 	(1) an estimate of the amounts of money that must be used as specified in paragraphs 
21.19 	(b) and (c);
21.20 	(2) a detailed distribution plan specifying the allowable compensation-related and 
21.21 	wage increases the facility will implement to use the funds available in clause (1);
21.22 	(3) a description of how the facility will notify eligible employees of the contents of 
21.23 	the approved application, which must provide for giving each eligible employee a copy of 
21.24 	the approved application, excluding the information required in clause (1), or posting a 
21.25 	copy of the approved application, excluding the information required in clause (1), for 
21.26 	a period of at least six weeks in an area of the facility to which all eligible employees 
21.27 	have access; and
21.28 	(4) instructions for employees who believe they have not received the 
21.29 	compensation-related or wage increases specified in clause (2), as approved by the 
21.30 	commissioner, and which must include a mailing address, e-mail address, and the 
21.31 	telephone number that may be used by the employee to contact the commissioner or the 
21.32 	commissioner's representative.
21.33 	(g) The commissioner shall ensure that cost increases in distribution plans under 
21.34 	paragraph (f), clause (2), that may be included in approved applications, comply with 
21.35 	requirements in clauses (1) to (4):
22.1 	(1) costs to be incurred during the applicable rate year resulting from wage and 
22.2 	salary increases effective after October 1, 2006, and prior to the first day of the facility's 
22.3 	payroll period that includes October 1 of each year shall be allowed if they were not used 
22.4 	in the prior year's application and they meet the requirements of paragraphs (b) and (c);
22.5 	(2) a portion of the costs resulting from tenure-related wage or salary increases 
22.6 	may be considered to be allowable wage increases, according to formulas that the 
22.7 	commissioner shall provide, where employee retention is above the average statewide 
22.8 	rate of retention of direct care employees;
22.9 	(3) the annualized amount of increases in costs for the employer's share of health 
22.10 	and dental insurance, life insurance, disability insurance, and workers' compensation shall 
22.11 	be allowable compensation-related increases if they are effective on or after April 1 of 
22.12 	the year in which the rate adjustments are effective and prior to April 1 of the following 
22.13 	year; and 
22.14 	(4) for facilities in which employees are represented by an exclusive bargaining 
22.15 	representative, the commissioner shall approve the application only upon receipt of a letter 
22.16 	of acceptance of the distribution plan, as regards members of the bargaining unit, signed 
22.17 	by the exclusive bargaining agent and dated after May 25, 2007. Upon receipt of the letter 
22.18 	of acceptance, the commissioner shall deem all requirements of this section as having 
22.19 	been met in regard to the members of the bargaining unit.
22.20 	(h) The commissioner shall review applications received under paragraph (f) and 
22.21 	shall provide the portion of the rate adjustments under paragraphs (b) and (c) if the 
22.22 	requirements of this subdivision have been met. The rate adjustments shall be effective 
22.23 	October 1 of each year. Notwithstanding paragraph (a), if the approved application 
22.24 	distributes less money than is available, the amount of the rate adjustment shall be reduced 
22.25 	so that the amount of money made available is equal to the amount to be distributed.

22.26 	Sec. 28. Minnesota Statutes 2008, section 256B.5013, subdivision 1, is amended to 
22.27 	read:
22.28 		Subdivision 1.Variable rate adjustments. (a) For rate years beginning on or after 
22.29 	October 1, 2000, when there is a documented increase in the needs of a current ICF/MR 
22.30 	recipient, the county of financial responsibility may recommend a variable rate to enable 
22.31 	the facility to meet the individual's increased needs. Variable rate adjustments made under 
22.32 	this subdivision replace payments for persons with special needs under section 256B.501, 
22.33 	subdivision 8, and payments for persons with special needs for crisis intervention services 
22.34 	under section 256B.501, subdivision 8a. Effective July 1, 2003, facilities with a base rate 
22.35 	above the 50th percentile of the statewide average reimbursement rate for a Class A 
23.1 	facility or Class B facility, whichever matches the facility licensure, are not eligible for a 
23.2 	variable rate adjustment. Variable rate adjustments may not exceed a 12-month period, 
23.3 	except when approved for purposes established in paragraph (b), clause (1). Variable rate 
23.4 	adjustments approved solely on the basis of changes on a developmental disabilities 
23.5 	screening document will end June 30, 2002. 
23.6 	(b) A variable rate may be recommended by the county of financial responsibility 
23.7 	for increased needs in the following situations:
23.8 	(1) a need for resources due to an individual's full or partial retirement from 
23.9 	participation in a day training and habilitation service when the individual: (i) has reached 
23.10 	the age of 65 or has a change in health condition that makes it difficult for the person 
23.11 	to participate in day training and habilitation services over an extended period of time 
23.12 	because it is medically contraindicated; and (ii) has expressed a desire for change through 
23.13 	the developmental disability screening process under section 256B.092; 
23.14 	(2) a need for additional resources for intensive short-term programming which is 
23.15 	necessary prior to an individual's discharge to a less restrictive, more integrated setting;
23.16 	(3) a demonstrated medical need that significantly impacts the type or amount of 
23.17 	services needed by the individual; or
23.18 	(4) a demonstrated behavioral need that significantly impacts the type or amount of 
23.19 	services needed by the individual.
23.20 	(c) The county of financial responsibility must justify the purpose, the projected 
23.21 	length of time, and the additional funding needed for the facility to meet the needs of 
23.22 	the individual.
23.23 	(d) The facility shall provide a quarterly an annual report to the county case manager 
23.24 	on the use of the variable rate funds and the status of the individual on whose behalf the 
23.25 	funds were approved. The county case manager will forward the facility's report with a 
23.26 	recommendation to the commissioner to approve or disapprove a continuation of the 
23.27 	variable rate.
23.28 	(e) Funds made available through the variable rate process that are not used by 
23.29 	the facility to meet the needs of the individual for whom they were approved shall be 
23.30 	returned to the state.

23.31 	Sec. 29. Minnesota Statutes 2008, section 256B.5013, subdivision 6, is amended to 
23.32 	read:
23.33 		Subd. 6.Commissioner's responsibilities. The commissioner shall:
23.34 	(1) make a determination to approve, deny, or modify a request for a variable rate 
23.35 	adjustment within 30 days of the receipt of the completed application;
24.1 	(2) notify the ICF/MR facility and county case manager of the duration and 
24.2 	conditions of variable rate adjustment approvals; and
24.3 	(3) modify MMIS II service agreements to reimburse ICF/MR facilities for approved 
24.4 	variable rates;.
24.5 	(4) provide notification of legislatively appropriated funding for facility closures, 
24.6 	downsizings, and relocations;
24.7 	(5) assess the fiscal impacts of the proposals for closures, downsizings, and 
24.8 	relocations forwarded for consideration through the state advisory committee; and
24.9 	(6) review the payment rate process on a biannual basis and make recommendations 
24.10 	to the legislature for necessary adjustments to the review and approval process.

24.11 	Sec. 30. Minnesota Statutes 2008, section 256B.69, subdivision 9b, is amended to read:
24.12 		Subd. 9b.Reporting provider payment rates. (a) According to guidelines 
24.13 	developed by the commissioner, in consultation with health care providers, managed care 
24.14 	plans, and county-based purchasing plans, each managed care plan and county-based 
24.15 	purchasing plan must annually provide to the commissioner, at the commissioner's request, 
24.16 	detailed or aggregate information on reimbursement rates paid by the managed care plan 
24.17 	under this section or the county-based purchasing plan under section 256B.692 to provider 
24.18 	types and vendors for administrative services under contract with the plan.
24.19 	(b) Each managed care plan and county-based purchasing plan must annually 
24.20 	provide to the commissioner, in the form and manner specified by the commissioner:
24.21 	(1) aggregate provider payment data, categorized by subspecialty and primary care; 
24.22 	(2) evidence that increases in payments made to the plan under this section are 
24.23 	passed through to health care providers, including information on the proportion of the 
24.24 	increases paid to providers, categorized by subspecialty and primary care; and
24.25 	(3) specific information on the methodology used to establish provider 
24.26 	reimbursement rates paid by the managed health care plan and county-based purchasing 
24.27 	plan.
24.28 	Data provided to the commissioner under this subdivision must allow the 
24.29 	commissioner to conduct the analyses required under paragraph (d).
24.30 	(b) Data provided to the commissioner under this subdivision are nonpublic data as 
24.31 	defined in section 13.02.
24.32 	(c) The commissioner shall analyze data provided under this subdivision by 
24.33 	procedure code, provider type, provider size, and geographic location of the provider. The 
24.34 	commissioner shall also array aggregate provider reimbursement rates across all plans by 
24.35 	subspecialty and primary care category. The commissioner shall report this information to 
25.1 	the legislature annually, beginning December 15, 2010, and each December 15 thereafter. 
25.2 	The commissioner shall also make this information available on the agency's Web site to 
25.3 	managed care and county-based purchasing plans, health care providers, and the public.

25.4 	Sec. 31. Minnesota Statutes 2008, section 403.03, is amended to read:
25.5 	403.03 911 SERVICES TO BE PROVIDED.
25.6 	Services available through a 911 system shall must include police, firefighting, 
25.7 	and emergency medical and ambulance services. Other emergency and civil defense 
25.8 	services may be incorporated into the 911 system at the discretion of the public agency 
25.9 	operating the public safety answering point. The 911 system may include a referral to 
25.10 	mental health crisis teams, where available.

25.11 	Sec. 32. Minnesota Statutes 2008, section 626.557, subdivision 12b, is amended to 
25.12 	read:
25.13 		Subd. 12b.Data management. (a) In performing any of the duties of this section as 
25.14 	a lead agency, the county social service agency shall maintain appropriate records. Data 
25.15 	collected by the county social service agency under this section are welfare data under 
25.16 	section 13.46. Notwithstanding section 13.46, subdivision 1, paragraph (a), data under this 
25.17 	paragraph that are inactive investigative data on an individual who is a vendor of services 
25.18 	are private data on individuals, as defined in section 13.02. The identity of the reporter 
25.19 	may only be disclosed as provided in paragraph (c).
25.20 	Data maintained by the common entry point are confidential data on individuals or 
25.21 	protected nonpublic data as defined in section 13.02. Notwithstanding section 138.163, 
25.22 	the common entry point shall destroy data maintain data for  three calendar years after date 
25.23 	of receipt and then destroy the data unless otherwise directed by federal requirements.
25.24 	(b) The commissioners of health and human services shall prepare an investigation 
25.25 	memorandum for each report alleging maltreatment investigated under this section. 
25.26 	County social service agencies must maintain private data on individuals but are not 
25.27 	required to prepare an investigation memorandum. During an investigation by the 
25.28 	commissioner of health or the commissioner of human services, data collected under this 
25.29 	section are confidential data on individuals or protected nonpublic data as defined in 
25.30 	section 13.02. Upon completion of the investigation, the data are classified as provided in 
25.31 	clauses (1) to (3) and paragraph (c).
25.32 	(1) The investigation memorandum must contain the following data, which are 
25.33 	public:
25.34 	(i) the name of the facility investigated;
26.1 	(ii) a statement of the nature of the alleged maltreatment;
26.2 	(iii) pertinent information obtained from medical or other records reviewed;
26.3 	(iv) the identity of the investigator;
26.4 	(v) a summary of the investigation's findings;
26.5 	(vi) statement of whether the report was found to be substantiated, inconclusive, 
26.6 	false, or that no determination will be made;
26.7 	(vii) a statement of any action taken by the facility;
26.8 	(viii) a statement of any action taken by the lead agency; and
26.9 	(ix) when a lead agency's determination has substantiated maltreatment, a statement 
26.10 	of whether an individual, individuals, or a facility were responsible for the substantiated 
26.11 	maltreatment, if known.
26.12 	The investigation memorandum must be written in a manner which protects the 
26.13 	identity of the reporter and of the vulnerable adult and may not contain the names or, to 
26.14 	the extent possible, data on individuals or private data listed in clause (2).
26.15 	(2) Data on individuals collected and maintained in the investigation memorandum 
26.16 	are private data, including:
26.17 	(i) the name of the vulnerable adult;
26.18 	(ii) the identity of the individual alleged to be the perpetrator;
26.19 	(iii) the identity of the individual substantiated as the perpetrator; and
26.20 	(iv) the identity of all individuals interviewed as part of the investigation.
26.21 	(3) Other data on individuals maintained as part of an investigation under this section 
26.22 	are private data on individuals upon completion of the investigation.
26.23 	(c) The subject of the report may compel disclosure of the name of the reporter only 
26.24 	with the consent of the reporter or upon a written finding by a court that the report was 
26.25 	false and there is evidence that the report was made in bad faith. This subdivision does 
26.26 	not alter disclosure responsibilities or obligations under the Rules of Criminal Procedure, 
26.27 	except that where the identity of the reporter is relevant to a criminal prosecution, the 
26.28 	district court shall do an in-camera review prior to determining whether to order disclosure 
26.29 	of the identity of the reporter.
26.30 	(d) Notwithstanding section 138.163, data maintained under this section by the 
26.31 	commissioners of health and human services must be destroyed maintained under the 
26.32 	following schedule and then destroyed unless otherwise directed by federal requirements:
26.33 	(1) data from reports determined to be false, two maintained for three years after the 
26.34 	finding was made;
26.35 	(2) data from reports determined to be inconclusive, maintained for four years after 
26.36 	the finding was made;
27.1 	(3) data from reports determined to be substantiated, maintained for seven years 
27.2 	after the finding was made; and
27.3 	(4) data from reports which were not investigated by a lead agency and for which 
27.4 	there is no final disposition, two maintained for three years from the date of the report.
27.5 	(e) The commissioners of health and human services shall each annually report to 
27.6 	the legislature and the governor on the number and type of reports of alleged maltreatment 
27.7 	involving licensed facilities reported under this section, the number of those requiring 
27.8 	investigation under this section, and the resolution of those investigations. The report 
27.9 	shall identify:
27.10 	(1) whether and where backlogs of cases result in a failure to conform with statutory 
27.11 	time frames;
27.12 	(2) where adequate coverage requires additional appropriations and staffing; and
27.13 	(3) any other trends that affect the safety of vulnerable adults.
27.14 	(f) Each lead agency must have a record retention policy.
27.15 	(g) Lead agencies, prosecuting authorities, and law enforcement agencies may 
27.16 	exchange not public data, as defined in section 13.02, if the agency or authority requesting 
27.17 	the data determines that the data are pertinent and necessary to the requesting agency in 
27.18 	initiating, furthering, or completing an investigation under this section. Data collected 
27.19 	under this section must be made available to prosecuting authorities and law enforcement 
27.20 	officials, local county agencies, and licensing agencies investigating the alleged 
27.21 	maltreatment under this section. The lead agency shall exchange not public data with the 
27.22 	vulnerable adult maltreatment review panel established in section 256.021 if the data are 
27.23 	pertinent and necessary for a review requested under that section. Upon completion of the 
27.24 	review, not public data received by the review panel must be returned to the lead agency.
27.25 	(h) Each lead agency shall keep records of the length of time it takes to complete its 
27.26 	investigations.
27.27 	(i) A lead agency may notify other affected parties and their authorized representative 
27.28 	if the agency has reason to believe maltreatment has occurred and determines the 
27.29 	information will safeguard the well-being of the affected parties or dispel widespread 
27.30 	rumor or unrest in the affected facility.
27.31 	(j) Under any notification provision of this section, where federal law specifically 
27.32 	prohibits the disclosure of patient identifying information, a lead agency may not provide 
27.33 	any notice unless the vulnerable adult has consented to disclosure in a manner which 
27.34 	conforms to federal requirements.

28.1 	Sec. 33. HEALTH DEPARTMENT WORKGROUP; HOSPITAL ASSOCIATION 
28.2 	COMMITTEES.
 28.3 	(a) The commissioner of health shall consult with representatives from the 
28.4 	Minnesota Nurses Association, Minnesota Hospital Association, and other shareholders 
28.5 	to further define staffing levels for purposes of Minnesota Statutes, section 144.7065, 
28.6 	subdivision 8, and to develop questions related to staffing for inclusion in the root cause 
28.7 	analysis tool required under that subdivision.
28.8 	(b) The Minnesota Nurses Association and the Minnesota Hospital Association shall 
28.9 	develop a memorandum of understanding that outlines ways to include representatives 
28.10 	from the Minnesota Nurses Association and the Minnesota Hospital Association work 
28.11 	groups and committees dealing with adverse health care events and corrective action plans 
28.12 	under Minnesota Statutes, section 144.7065.

28.13 	Sec. 34. ALZHEIMER'S DISEASE WORKING GROUP.
 28.14 		Subdivision 1.Establishment; members. The commissioner of health, in 
28.15 	collaboration with the Minnesota Board on Aging, must convene an Alzheimer's disease 
28.16 	working group that consists of no more than 15 members including, but not limited to:
28.17 	(a) at least one caregiver of a person who has been diagnosed with Alzheimer's 
28.18 	disease;
28.19 	(b) at least one person who has been diagnosed with Alzheimer's disease;
28.20 	(c) a representative of the nursing facility industry;
28.21 	(d) a representative of the assisted living industry;
28.22 	(e) a representative of the adult day services industry;
28.23 	(f) a representative of the medical care provider community;
28.24 	(g) an Alzheimer's researcher;
28.25 	(h) a representative of the Alzheimer's Association;
28.26 	(i) the commissioner of human services or a designee;
28.27 	(j) the commissioner of health or a designee;
28.28 	(k) the ombudsman for long-term care or a designee;
28.29 	(l) the commissioner of public safety or a designee; and
28.30 	(m) at least two members named by the governor.
28.31 		Subd. 2.Duties; recommendations. The Alzheimer's disease working group must 
28.32 	examine the array of needs of individuals diagnosed with Alzheimer's disease, services 
28.33 	available to meet these needs, and the capacity of the state and current providers to meet 
28.34 	these and future needs. The working group shall consider and make recommendations 
28.35 	on the following issues:
29.1 	(a) trends in the state's Alzheimer's population and service needs including, but 
29.2 	not limited to:
29.3 	(1) the state's role in long-term care, family caregiver support, and assistance to 
29.4 	persons with early-stage and early-onset of Alzheimer's disease;
29.5 	(2) state policy regarding persons with Alzheimer's disease and dementia; and
29.6 	(3) establishment of a surveillance system for the purpose of having proper estimates 
29.7 	of the number of persons in the state with Alzheimer's disease, and the changing 
29.8 	population with dementia;
29.9 	(b) existing resources, services, and capacity including, but not limited to:
29.10 	(1) type, cost, and availability of dementia services;
29.11 	(2) dementia-specific training requirements for long-term care staff;
29.12 	(3) quality care measures for residential care facilities;
29.13 	(4) capacity of public safety and law enforcement officers to respond to persons with 
29.14 	Alzheimer's disease or dementia;
29.15 	(5) availability of home and community-based resources for persons with 
29.16 	Alzheimer's disease, including respite care;
29.17 	(6) number and availability of long-term care dementia units;
29.18 	(7) adequacy and appropriateness of geriatric psychiatric units for persons with 
29.19 	behavior disorders associated with Alzheimer's and related dementia;
29.20 	(8) assisted living residential options for persons with dementia; and
29.21 	(9) state support of Alzheimer's research through Minnesota universities and other 
29.22 	resources;
29.23 	(c) needed policies or responses including, but not limited to, the provision of 
29.24 	coordinated services and supports to persons and families living with Alzheimer's and 
29.25 	related disorders, the capacity to meet these needs, and strategies to address identified 
29.26 	gaps in services.
29.27 		Subd. 3.Meetings. At least four working group meetings must be public meetings, 
29.28 	and to the extent practicable, technological means, such as Web casts, should be used to 
29.29 	reach the greatest number of people throughout the state.
29.30 		Subd. 4.Report. The commissioner of health must submit a report and 
29.31 	recommendations to the governor and chairs and ranking minority members of the 
29.32 	legislative committees with jurisdiction over health care no later than January 15, 2011.
29.33 		Subd. 5.Private funding. To the extent available, the commissioner of health may 
29.34 	utilize funding provided by private foundations and other private funding sources to 
29.35 	complete the duties of the Alzheimer's disease working group.
30.1 		Subd. 6.Sunset. The Alzheimer's disease working group sunsets upon delivery of 
30.2 	the required report to the governor and legislative committees.

30.3 	Sec. 35.  REPEALER.
 30.4 	Minnesota Statutes 2008, section 256B.5013, subdivisions 2, 3, and 5, are repealed.