1.1 	A bill for an act
1.2 	relating to state government; making changes to health and human services; 
1.3 	amending provisions related to continuing care, child care, Minnesota family 
1.4 	investment program, adult supports, program integrity, health care programs 
1.5 	including MinnesotaCare, medical assistance, and general assistance medical 
1.6 	care, state-operated services, the sex offender program, the Department of 
1.7 	Health, chemical and mental health, health-related fees; establishing licensing 
1.8 	for body art technicians and establishments; establishing and increasing fees; 
1.9 	requiring reports; appropriating money;amending Minnesota Statutes 2008, 
1.10 	sections 60A.092, subdivision 2; 62D.03, subdivision 4; 62D.05, subdivision 
1.11 	3; 62J.692, subdivision 7; 62Q.19, subdivision 1; 103I.208, subdivision 2; 
1.12 	119B.09, subdivision 7; 119B.13, subdivision 6; 125A.744, subdivision 3; 
1.13 	144.0724, subdivisions 2, 4, 8, by adding subdivisions; 144.121, subdivisions 
1.14 	1a, 1b; 144.122; 144.1222, subdivision 1a; 144.1501, subdivision 2; 144.226, 
1.15 	subdivision 4; 144.72, subdivisions 1, 3; 144.9501, subdivisions 22b, 26a, by 
1.16 	adding subdivisions; 144.9505, subdivisions 1g, 4; 144.9508, subdivisions 2, 3, 
1.17 	4; 144.97, subdivisions 2, 4, 6, by adding subdivisions; 144.98, subdivisions 
1.18 	1, 2, 3, by adding subdivisions; 144.99, subdivision 1; 144A.073, by adding 
1.19 	a subdivision; 144A.44, subdivision 2; 144A.46, subdivision 1; 144D.03, by 
1.20 	adding a subdivision; 148.108; 148.6445, by adding a subdivision; 148D.180, 
1.21 	subdivisions 1, 2, 3, 5; 148E.180, subdivisions 1, 2, 3, 5; 152.126, subdivisions 
1.22 	1, 2; 153A.17; 156.015; 157.15, by adding a subdivision; 157.16; 157.22; 
1.23 	176.011, subdivision 9; 198.003, by adding subdivisions; 245A.03, by adding a 
1.24 	subdivision; 245A.10, subdivision 3; 245A.11, by adding subdivisions; 245A.16, 
1.25 	subdivision 3; 245C.03, subdivision 2; 245C.04, subdivisions 1, 3; 245C.05, 
1.26 	subdivision 4; 245C.08, subdivision 2; 245C.10, subdivision 3, by adding a 
1.27 	subdivision; 245C.17, by adding a subdivision; 245C.20; 245C.21, subdivision 
1.28 	1a; 245C.23, subdivision 2; 246.50, subdivision 5, by adding subdivisions; 
1.29 	246.51, by adding subdivisions; 246.511; 246.52; 246.54, subdivision 2; 
1.30 	246B.01, by adding subdivisions; 252.025, subdivision 7; 252.46, by adding 
1.31 	a subdivision; 256.01, subdivision 2b, by adding subdivisions; 256.476, 
1.32 	subdivisions 5, 11; 256.9657, subdivision 1; 256.969, subdivisions 2b, 3a, by 
1.33 	adding subdivisions; 256.975, subdivision 7; 256.983, subdivision 1; 256B.04, 
1.34 	subdivision 16; 256B.055, subdivisions 7, 12; 256B.056, subdivisions 3, 3b, 3c, 
1.35 	3d; 256B.057, subdivision 9, by adding a subdivision; 256B.0575; 256B.0595, 
1.36 	subdivisions 1, 2; 256B.06, subdivisions 4, 5; 256B.0621, subdivision 2; 
1.37 	256B.0625, subdivisions 3, 6a, 7, 8, 8a, 11, 13, 13e, 13h, 17, 17a, 19a, 19c, 26, 
1.38 	47, by adding subdivisions; 256B.0651; 256B.0652; 256B.0653; 256B.0654; 
1.39 	256B.0655, subdivisions 1b, 4; 256B.0657, subdivisions 2, 6, 8; 256B.0751, 
2.1 	subdivision 7; 256B.08, by adding a subdivision; 256B.0911, subdivisions 1, 1a, 
2.2 	3, 3a, 3b, 3c, 4a, 5, 6, 7, by adding subdivisions; 256B.0913, subdivision 4; 
2.3 	256B.0915, subdivisions 3a, 3e, 3h, 5, by adding a subdivision; 256B.0917, 
2.4 	by adding a subdivision; 256B.092, subdivision 8a, by adding a subdivision; 
2.5 	256B.0943, subdivision 12; 256B.15, subdivisions 1, 1a, 1h, 2, by adding 
2.6 	subdivisions; 256B.199; 256B.37, subdivisions 1, 5; 256B.434, subdivision 
2.7 	4; 256B.437, subdivision 6; 256B.441, subdivisions 51a, 53, by adding 
2.8 	subdivisions; 256B.49, subdivisions 12, 13, 14, 17, by adding a subdivision; 
2.9 	256B.501, subdivision 4a; 256B.5011, subdivision 2; 256B.5012, by adding a 
2.10 	subdivision; 256B.69, subdivisions 5a, 5c, 5f, 6, 23, by adding a subdivision; 
2.11 	256B.76, subdivision 1; 256D.03, subdivision 4; 256G.02, subdivision 6; 
2.12 	256I.03, subdivision 7; 256I.05, subdivision 1a; 256J.24, subdivision 5; 256J.42, 
2.13 	by adding a subdivision; 256J.425, subdivisions 2, 3, 4, by adding a subdivision; 
2.14 	256J.45, subdivision 3; 256J.46, subdivision 1; 256J.49, subdivision 1; 256J.521, 
2.15 	subdivision 2; 256J.53, subdivision 1; 256J.545; 256J.561, subdivisions 2, 3; 
2.16 	256J.57, subdivision 1; 256J.575, subdivisions 3, 4, 6, 7; 256J.621; 256J.626, 
2.17 	subdivision 7; 256J.95, subdivisions 3, 11, 13; 256L.03, subdivision 1; 256L.04, 
2.18 	subdivisions 1, 7a, 10a, by adding a subdivision; 256L.05, subdivisions 3, 3a, 
2.19 	by adding a subdivision; 256L.07, subdivisions 1, 2, 3, by adding a subdivision; 
2.20 	256L.11, subdivision 1; 256L.12, subdivisions 7, 9; 256L.15, subdivisions 2, 3; 
2.21 	256L.17, subdivision 5; 327.14, by adding a subdivision; 327.15; 327.16; 327.20, 
2.22 	subdivision 1, by adding a subdivision; 501B.89, by adding a subdivision; 
2.23 	519.05; 604A.33, subdivision 1; 609.232, subdivision 11; 626.556, subdivision 
2.24 	3c; 626.5572, subdivisions 6, 13, 21; Laws 2003, First Special Session chapter 
2.25 	14, article 13C, section 2, subdivision 1, as amended; Laws 2008, chapter 
2.26 	358, article 3, section 8; proposing coding for new law in Minnesota Statutes, 
2.27 	chapters 144; 156; 246B; 256; 256B; proposing coding for new law as Minnesota 
2.28 	Statutes, chapter 146B; repealing Minnesota Statutes 2008, sections 62Q.80, 
2.29 	subdivision 1a; 103I.112; 144.9501, subdivision 17b; 148D.180, subdivision 
2.30 	8; 246.51, subdivision 1; 246.53, subdivision 3; 256.962, subdivision 7; 
2.31 	256B.037; 256B.0625, subdivision 9; 256B.0655, subdivisions 1, 1a, 1b, 1c, 
2.32 	1d, 1e, 1f, 1g, 1h, 1i, 2, 3, 5, 6, 7, 8, 9, 10, 11, 12, 13; 256B.071, subdivisions 
2.33 	1, 2, 3, 4; 256B.0951; 256B.19, subdivision 1d; 256B.431, subdivision 23; 
2.34 	256B.69, subdivision 6c; 256I.06, subdivision 9; 256L.17, subdivision 6; 327.14, 
2.35 	subdivisions 5, 6; Minnesota Rules, parts 4626.2015, subpart 9; 9100.0400, 
2.36 	subparts 1, 3; 9100.0500; 9100.0600.
2.37 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

2.38 	ARTICLE 1
2.39 	CONTINUING CARE

2.40 	Section 1. Minnesota Statutes 2008, section 144.0724, subdivision 2, is amended to 
2.41 	read:
2.42 		Subd. 2.Definitions. For purposes of this section, the following terms have the 
2.43 	meanings given.
2.44 	(a) "Assessment reference date" means the last day of the minimum data set 
2.45 	observation period. The date sets the designated endpoint of the common observation 
2.46 	period, and all minimum data set items refer back in time from that point.
2.47 	(b) "Case mix index" means the weighting factors assigned to the RUG-III 
2.48 	classifications.
3.1 	(c) "Index maximization" means classifying a resident who could be assigned to 
3.2 	more than one category, to the category with the highest case mix index.
3.3 	(d) "Minimum data set" means the assessment instrument specified by the Centers for 
3.4 	Medicare and Medicaid Services and designated by the Minnesota Department of Health.
3.5 	(e) "Representative" means a person who is the resident's guardian or conservator, 
3.6 	the person authorized to pay the nursing home expenses of the resident, a representative 
3.7 	of the nursing home ombudsman's office whose assistance has been requested, or any 
3.8 	other individual designated by the resident.
3.9 	(f) "Resource utilization groups" or "RUG" means the system for grouping a nursing 
3.10 	facility's residents according to their clinical and functional status identified in data 
3.11 	supplied by the facility's minimum data set.
3.12 	(g) "Activities of daily living" means grooming, dressing, bathing, transferring, 
3.13 	mobility, positioning, eating, and toileting.
3.14 	(h) "Nursing facility level of care determination" means the assessment process 
3.15 	that results in a determination of a resident's or prospective resident's need for nursing 
3.16 	facility level of care as established in subdivision 11 for purposes of medical assistance 
3.17 	payment of long-term care services for:
3.18 	(1) nursing facility services under section 256B.434 or 256B.441;
3.19 	(2) elderly waiver services under section 256B.0915;
3.20 	(3) CADI and TBI waiver services under section 256B.49; and
3.21 	(4) state payment of alternative care services under section 256B.0913.

3.22 	EFFECTIVE DATE. This section is effective January 1, 2011.

3.23 	Sec. 2. Minnesota Statutes 2008, section 144.0724, subdivision 4, is amended to read:
3.24 		Subd. 4.Resident assessment schedule. (a) A facility must conduct and 
3.25 	electronically submit to the commissioner of health case mix assessments that conform 
3.26 	with the assessment schedule defined by Code of Federal Regulations, title 42, section 
3.27 	483.20, and published by the United States Department of Health and Human Services, 
3.28 	Centers for Medicare and Medicaid Services, in the Long Term Care Assessment 
3.29 	Instrument User's Manual, version 2.0, October 1995, and subsequent clarifications made 
3.30 	in the Long-Term Care Assessment Instrument Questions and Answers, version 2.0, 
3.31 	August 1996. The commissioner of health may substitute successor manuals or question 
3.32 	and answer documents published by the United States Department of Health and Human 
3.33 	Services, Centers for Medicare and Medicaid Services, to replace or supplement the 
3.34 	current version of the manual or document.
4.1 	(b) The assessments used to determine a case mix classification for reimbursement 
4.2 	include the following:
4.3 	(1) a new admission assessment must be completed by day 14 following admission;
4.4 	(2) an annual assessment must be completed within 366 days of the last 
4.5 	comprehensive assessment;
4.6 	(3) a significant change assessment must be completed within 14 days of the 
4.7 	identification of a significant change; and
4.8 	(4) the second quarterly assessment following either a new admission assessment, 
4.9 	an annual assessment, or a significant change assessment, and all quarterly assessments 
4.10 	beginning October 1, 2006. Each quarterly assessment must be completed within 92 
4.11 	days of the previous assessment.
4.12 	(c) In addition to the assessments listed in paragraph (b), the assessments used to 
4.13 	determine nursing facility level of care include the following:
4.14 	(1) preadmission screening completed under section 256B.0911, subdivision 4a, 
4.15 	by a county, tribe, or managed care organization under contract with the Department 
4.16 	of Human Services; and
4.17 	(2) a face-to-face long-term care consultation assessment completed under section 
4.18 	256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or managed care organization 
4.19 	under contract with the Department of Human Services.

4.20 	EFFECTIVE DATE. This section is effective January 1, 2011.

4.21 	Sec. 3. Minnesota Statutes 2008, section 144.0724, subdivision 8, is amended to read:
4.22 		Subd. 8.Request for reconsideration of resident classifications. (a) The resident, 
4.23 	or resident's representative, or the nursing facility or boarding care home may request that 
4.24 	the commissioner of health reconsider the assigned reimbursement classification. The 
4.25 	request for reconsideration must be submitted in writing to the commissioner within 
4.26 	30 days of the day the resident or the resident's representative receives the resident 
4.27 	classification notice. The request for reconsideration must include the name of the 
4.28 	resident, the name and address of the facility in which the resident resides, the reasons for 
4.29 	the reconsideration, the requested classification changes, and documentation supporting 
4.30 	the requested classification. The documentation accompanying the reconsideration request 
4.31 	is limited to documentation which establishes that the needs of the resident at the time of 
4.32 	the assessment justify a classification which is different than the classification established 
4.33 	by the commissioner of health.
4.34 	(b) Upon request, the nursing facility must give the resident or the resident's 
4.35 	representative a copy of the assessment form and the other documentation that was given 
5.1 	to the commissioner of health to support the assessment findings. The nursing facility 
5.2 	shall also provide access to and a copy of other information from the resident's record that 
5.3 	has been requested by or on behalf of the resident to support a resident's reconsideration 
5.4 	request. A copy of any requested material must be provided within three working days of 
5.5 	receipt of a written request for the information. If a facility fails to provide the material 
5.6 	within this time, it is subject to the issuance of a correction order and penalty assessment 
5.7 	under sections 144.653 and 144A.10. Notwithstanding those sections, any correction order 
5.8 	issued under this subdivision must require that the nursing facility immediately comply 
5.9 	with the request for information and that as of the date of the issuance of the correction 
5.10 	order, the facility shall forfeit to the state a $100 fine for the first day of noncompliance, and 
5.11 	an increase in the $100 fine by $50 increments for each day the noncompliance continues. 
5.12 	(c) In addition to the information required under paragraphs (a) and (b), a 
5.13 	reconsideration request from a nursing facility must contain the following information: (i) 
5.14 	the date the reimbursement classification notices were received by the facility; (ii) the date 
5.15 	the classification notices were distributed to the resident or the resident's representative; 
5.16 	and (iii) a copy of a notice sent to the resident or to the resident's representative. This 
5.17 	notice must inform the resident or the resident's representative that a reconsideration of the 
5.18 	resident's classification is being requested, the reason for the request, that the resident's 
5.19 	rate will change if the request is approved by the commissioner, the extent of the change, 
5.20 	that copies of the facility's request and supporting documentation are available for review, 
5.21 	and that the resident also has the right to request a reconsideration. If the facility fails to 
5.22 	provide the required information with the reconsideration request, the request must be 
5.23 	denied, and the facility may not make further reconsideration requests on that specific 
5.24 	reimbursement classification.
5.25 	(d) Reconsideration by the commissioner must be made by individuals not involved 
5.26 	in reviewing the assessment, audit, or reconsideration that established the disputed 
5.27 	classification. The reconsideration must be based upon the initial assessment and upon the 
5.28 	information provided to the commissioner under paragraphs (a) and (b). If necessary for 
5.29 	evaluating the reconsideration request, the commissioner may conduct on-site reviews. 
5.30 	Within 15 working days of receiving the request for reconsideration, the commissioner 
5.31 	shall affirm or modify the original resident classification. The original classification 
5.32 	must be modified if the commissioner determines that the assessment resulting in the 
5.33 	classification did not accurately reflect the needs or assessment characteristics of the 
5.34 	resident at the time of the assessment. The resident and the nursing facility or boarding 
5.35 	care home shall be notified within five working days after the decision is made. A decision 
6.1 	by the commissioner under this subdivision is the final administrative decision of the 
6.2 	agency for the party requesting reconsideration.
6.3 	(e) The resident classification established by the commissioner shall be the 
6.4 	classification that applies to the resident while the request for reconsideration is pending.
6.5 	If a request for reconsideration applies to an assessment used to determine nursing facility 
6.6 	level of care under subdivision 4, paragraph (c), the resident shall continue to be eligible 
6.7 	for nursing facility level of care while the request for reconsideration is pending.
6.8 	(f) The commissioner may request additional documentation regarding a 
6.9 	reconsideration necessary to make an accurate reconsideration determination.

6.10 	EFFECTIVE DATE. This section is effective January 1, 2011.

6.11 	Sec. 4. Minnesota Statutes 2008, section 144.0724, is amended by adding a subdivision 
6.12 	to read:
6.13 		Subd. 11.Nursing facility level of care. (a) For purposes of medical assistance 
6.14 	payment of long-term care services, a recipient must be determined, using assessments 
6.15 	defined in subdivision 4, to meet one of the following nursing facility level of care criteria:
6.16 	(1) the person needs the assistance of another person or constant supervision to begin 
6.17 	and complete at least four of the following activities of daily living:
6.18 	(i) bathing;
6.19 	(ii) bed mobility;
6.20 	(iii) dressing;
6.21 	(iv) eating:
6.22 	(v) grooming:
6.23 	(vi) toileting;
6.24 	(vii) transferring; and 
6.25 	(viii) walking;
6.26 	(2) the person needs the assistance of another person or constant supervision to begin 
6.27 	and complete toileting, transferring, or positioning and the assistance cannot be scheduled;
6.28 	(3) the person has significant difficulty with memory, using information, daily 
6.29 	decision making, or behavioral needs that require intervention;
6.30 	(4) the person has had a qualifying nursing facility stay of at least 90 days; or
6.31 	(5) the person is determined to be at risk for nursing facility admission or 
6.32 	readmission through a face-to-face long-term care consultation assessment as specified 
6.33 	in section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or managed care 
6.34 	organization under contract with the Department of Human Services. The person is 
7.1 	considered at risk under this clause if the person currently lives alone or will live alone 
7.2 	upon discharge and also meets one of the following criteria:
7.3 	(i) the person has experienced a fall resulting in a fracture;
7.4 	(ii) the person has been determined to be at risk of maltreatment or neglect, 
7.5 	including self-neglect; or
7.6 	(iii) the person has a sensory impairment that substantially impacts functional ability 
7.7 	and maintenance of a community residence.
7.8 	(b) The assessment used to establish medical assistance payment for nursing facility 
7.9 	services must be the most recent assessment performed under subdivision 4, paragraph 
7.10 	(b), that occurred no more than 90 calendar days before the effective date of medical 
7.11 	assistance eligibility for payment of long-term care services. In no case shall medical 
7.12 	assistance payment for long-term care services occur prior to the date of the determination 
7.13 	of nursing facility level of care.
7.14 	(c) The assessment used to establish medical assistance payment for long-term care 
7.15 	services provided under sections 256B.0915 and 256B.49 and alternative care payment 
7.16 	for services provided under section 256B.0913 must be the most recent face-to-face 
7.17 	assessment performed under subdivision 4, paragraph (c), clause (2), that occurred no 
7.18 	more than 60 calendar days before the effective date of medical assistance eligibility 
7.19 	for payment of long-term care services.

7.20 	EFFECTIVE DATE. This section is effective January 1, 2011.

7.21 	Sec. 5. Minnesota Statutes 2008, section 144.0724, is amended by adding a subdivision 
7.22 	to read:
7.23 		Subd. 12.Appeal of nursing facility level of care determination. A resident or 
7.24 	prospective resident whose level of care determination results in a denial of long-term care 
7.25 	services can appeal the determination as outlined in section 256B.0911, subdivision 3a, 
7.26 	paragraph (h), clause (7).

7.27 	EFFECTIVE DATE. This section is effective January 1, 2011.

7.28 	Sec. 6. Minnesota Statutes 2008, section 144A.073, is amended by adding a 
7.29 	subdivision to read:
7.30 		Subd. 12.Extension of approval of moratorium exception projects.
 7.31 	Notwithstanding subdivision 3, the commissioner of health shall extend project approval 
7.32 	by an additional 18 months for an approved proposal for an exception to the nursing home 
8.1 	licensure and certification moratorium if the proposal was approved under this section 
8.2 	between July 1, 2007, and June 30, 2009.

8.3 	Sec. 7. Minnesota Statutes 2008, section 144A.44, subdivision 2, is amended to read:
8.4 		Subd. 2.Interpretation and enforcement of rights. These rights are established 
8.5 	for the benefit of persons who receive home care services. "Home care services" means 
8.6 	home care services as defined in section 144A.43, subdivision 3, and unlicensed personal 
8.7 	care assistance services, including services covered by medical assistance under section 
8.8 	256B.0625, subdivision 19a. A home care provider may not require a person to surrender 
8.9 	these rights as a condition of receiving services. A guardian or conservator or, when there 
8.10 	is no guardian or conservator, a designated person, may seek to enforce these rights. This 
8.11 	statement of rights does not replace or diminish other rights and liberties that may exist 
8.12 	relative to persons receiving home care services, persons providing home care services, or 
8.13 	providers licensed under Laws 1987, chapter 378. A copy of these rights must be provided 
8.14 	to an individual at the time home care services, including personal care assistance 
8.15 	services, are initiated. The copy shall also contain the address and phone number of the 
8.16 	Office of Health Facility Complaints and the Office of Ombudsman for Long-Term Care 
8.17 	and a brief statement describing how to file a complaint with these offices. Information 
8.18 	about how to contact the Office of Ombudsman for Long-Term Care shall be included in 
8.19 	notices of change in client fees and in notices where home care providers initiate transfer 
8.20 	or discontinuation of services. 

8.21 	Sec. 8. Minnesota Statutes 2008, section 144D.03, is amended by adding a subdivision 
8.22 	to read:
8.23 		Subd. 3.Certificate of transitional consultation. A housing with services 
8.24 	establishment shall not execute a contract or allow a prospective resident to move in until 
8.25 	the establishment has received certification from the Senior LinkAge Line that transition 
8.26 	to housing with services consultation under section 256B.0911, subdivision 3c, has been 
8.27 	completed. The housing with services establishment shall maintain copies of contracts 
8.28 	and certificates for audit for a period of three years.

8.29 	Sec. 9. Minnesota Statutes 2008, section 198.003, is amended by adding a subdivision 
8.30 	to read:
8.31 		Subd. 7.Medicare certification. (a) The commissioner shall apply to the federal 
8.32 	government under the following schedule for certification of the veterans homes for 
9.1 	participation as providers in the Medicare program under title XVIII of the Social Security 
9.2 	Act:
9.3 	(1) the veterans homes in Fergus Falls, Luverne, and Silver Bay by the end of fiscal 
9.4 	year 2010; and
9.5 	(2) the veterans home in Minneapolis by the end of fiscal year 2011.
9.6 	(b) Upon certification of a facility, the commissioner shall seek to maximize 
9.7 	Medicare reimbursements under Medicare part A and part B for services to eligible 
9.8 	residents.

9.9 	Sec. 10. Minnesota Statutes 2008, section 198.003, is amended by adding a subdivision 
9.10 	to read:
9.11 		Subd. 8.Use of Medicare Part D for pharmacy costs. (a) The commissioner 
9.12 	shall maximize the use of Medicare Part D to pay pharmacy costs for eligible veterans 
9.13 	residing at the veterans homes.
9.14 	(b) The commissioner shall encourage eligible veterans to participate in the 
9.15 	Medicare Part D program and assist veterans in obtaining Part D coverage.

9.16 	Sec. 11. Minnesota Statutes 2008, section 245A.03, is amended by adding a 
9.17 	subdivision to read:
9.18 		Subd. 7.Licensing moratorium. (a) The commissioner shall not issue an 
9.19 	initial license for child foster care licensed under Minnesota Rules, parts 2960.3000 to 
9.20 	2960.3340, or adult foster care licensed under Minnesota Rules, parts 9555.5105 to 
9.21 	9555.6265, under this chapter for a physical location that will not be the primary residence 
9.22 	of the license holder for the entire period of licensure. If a license is issued during this 
9.23 	moratorium, and the license holder changes the license holder's primary residence away 
9.24 	from the physical location of the foster care license, the commissioner shall revoke the 
9.25 	license according to section 245A.07. Exceptions to the moratorium include:
9.26 	(1) foster care settings that are required to be registered under chapter 144D;
9.27 	(2) foster care licenses replacing foster care licenses in existence on the effective 
9.28 	date of this section and determined to be needed by the commissioner under paragraph (b);
9.29 	(3) new foster care licenses determined to be needed by the commissioner under 
9.30 	paragraph (b) for the closure of a nursing facility, ICF/MR, or regional treatment center;
9.31 	(4) new foster care licenses determined to be needed by the commissioner under 
9.32 	paragraph (b) for persons requiring hospital level care; or
10.1 	(5) new foster care licenses determined to be needed by the commissioner for the 
10.2 	transition of people from personal care assistance to the home and community-based 
10.3 	services.
10.4 	(b) The commissioner shall determine the need for newly licensed foster care homes 
10.5 	as defined under this subdivision. As part of the determination, the commissioner shall 
10.6 	consider the availability of foster care capacity in the area which the licensee seeks to 
10.7 	operate, and the recommendation of the local county board. The determination by the 
10.8 	commissioner must be final. A determination of need is not required for a change in 
10.9 	ownership at the same address.
10.10 	(c) Residential settings that would otherwise be subject to the moratorium established 
10.11 	in paragraph (a), that are in the process of receiving an adult or child foster care license as 
10.12 	of July 1, 2009, shall be allowed to continue to complete the process of receiving an adult 
10.13 	or child foster care license. For this paragraph, all of the following conditions must be met 
10.14 	to be considered in process of receiving an adult or child foster care license:
10.15 	(1) participants have made decisions to move into the residential setting, including 
10.16 	documentation in each participant's care plan;
10.17 	(2) the provider has purchased housing or has made a financial investment in the 
10.18 	property;
10.19 	(3) the lead agency has approved the plans, including costs for the residential setting 
10.20 	for each individual;
10.21 	(4) the completion of the licensing process, including all necessary inspections, is 
10.22 	the only remaining component prior to being able to provide services; and
10.23 	(5) the needs of the individuals cannot be met within the existing capacity in that 
10.24 	county.
10.25 	To qualify for the process under this paragraph, the lead agency must submit 
10.26 	documentation to the commissioner by August 1, 2009, that all of the above criteria are 
10.27 	met.
10.28 	(d) The commissioner shall study the effects of the license moratorium under this 
10.29 	subdivision and shall report back to the legislature by January 15, 2011.

10.30 	EFFECTIVE DATE. This section is effective the day following final enactment.

10.31 	Sec. 12. Minnesota Statutes 2008, section 245A.11, is amended by adding a 
10.32 	subdivision to read:
10.33 		Subd. 8.Community residential setting license. (a) The commissioner shall 
10.34 	establish provider standards for residential support services that integrate service standards 
11.1 	and the residential setting under one license. The commissioner shall propose statutory 
11.2 	language and an implementation plan for licensing requirements for residential support 
11.3 	services to the legislature by January 15, 2011.
11.4 	(b) Providers licensed under chapter 245B, and providing, contracting, or arranging 
11.5 	for services in settings licensed as adult foster care under Minnesota Rules, parts 
11.6 	9555.5105 to 9555.6265, or child foster care under Minnesota Rules, parts 2960.3000 to 
11.7 	2960.3340; and meeting the provisions of section 256B.092, subdivision 11, paragraph 
11.8 	(b), must be required to obtain a community residential setting license.

11.9 	Sec. 13. Minnesota Statutes 2008, section 252.46, is amended by adding a subdivision 
11.10 	to read:
11.11 		Subd. 1a.Day training and habilitation rates. The commissioner shall establish 
11.12 	a statewide rate-setting methodology for all day training and habilitation services. The 
11.13 	rate-setting methodology must abide by the principles of transparency and equitability 
11.14 	across the state. The methodology must involve a uniform process of structuring rates for 
11.15 	each service and must promote quality and participant choice.

11.16 	Sec. 14. [256.0281] INTERAGENCY DATA EXCHANGE.
11.17 	The Department of Human Services, the Department of Health, and the Office of the 
11.18 	Ombudsman for Mental Health and Developmental Disabilities may establish interagency 
11.19 	agreements governing the electronic exchange of data on providers and individuals 
11.20 	collected, maintained, or used by each agency when such exchange is outlined by each 
11.21 	agency in an interagency agreement to accomplish the purposes in clauses (1) to (4):
11.22 	(1) to improve provider enrollment processes for home and community-based 
11.23 	services and state plan home care services;
11.24 	(2) to improve quality management of providers between state agencies;
11.25 	(3) to establish and maintain provider eligibility to participate as providers under 
11.26 	Minnesota health care programs; and
11.27 	(4) to meet the quality assurance reporting requirements under federal law under 
11.28 	section 1915(c) of the Social Security Act related to home and community-based waiver 
11.29 	programs.
11.30 	Each interagency agreement must include provisions to ensure anonymity of individuals, 
11.31 	including mandated reporters, and must outline the specific uses of and access to shared 
11.32 	data within each agency. Electronic interfaces between source data systems developed 
11.33 	under these interagency agreements must incorporate these provisions as well as other 
11.34 	HIPPA provisions related to individual data.

12.1 	Sec. 15. Minnesota Statutes 2008, section 256.476, subdivision 5, is amended to read:
12.2 		Subd. 5. Reimbursement, allocations, and reporting. (a) For the purpose of 
12.3 	transferring persons to the consumer support grant program from the family support 
12.4 	program and personal care assistant services, home health aide services, or private duty 
12.5 	nursing services, the amount of funds transferred by the commissioner between the 
12.6 	family support program account, the medical assistance account, or the consumer support 
12.7 	grant account shall be based on each county's participation in transferring persons to the 
12.8 	consumer support grant program from those programs and services. 
12.9 	(b) At the beginning of each fiscal year, county allocations for consumer support 
12.10 	grants shall be based on: 
12.11 	(1) the number of persons to whom the county board expects to provide consumer 
12.12 	supports grants; 
12.13 	(2) their eligibility for current program and services; 
12.14 	(3) the amount of nonfederal dollars monthly grant levels allowed under subdivision 
12.15 	11; and 
12.16 	(4) projected dates when persons will start receiving grants. County allocations shall 
12.17 	be adjusted periodically by the commissioner based on the actual transfer of persons or 
12.18 	service openings, and the nonfederal dollarsmonthly grant levels associated with those 
12.19 	persons or service openings, to the consumer support grant program. 
12.20 	(c) The amount of funds transferred by the commissioner from the medical 
12.21 	assistance account for an individual may be changed if it is determined by the county or its 
12.22 	agent that the individual's need for support has changed. 
12.23 	(d) The authority to utilize funds transferred to the consumer support grant account 
12.24 	for the purposes of implementing and administering the consumer support grant program 
12.25 	will not be limited or constrained by the spending authority provided to the program 
12.26 	of origination. 
12.27 	(e) The commissioner may use up to five percent of each county's allocation, as 
12.28 	adjusted, for payments for administrative expenses, to be paid as a proportionate addition 
12.29 	to reported direct service expenditures. 
12.30 	(f) The county allocation for each person or the person's legal representative or other 
12.31 	authorized representative cannot exceed the amount allowed under subdivision 11. 
12.32 	(g) The commissioner may recover, suspend, or withhold payments if the county 
12.33 	board, local agency, or grantee does not comply with the requirements of this section. 
12.34 	(h) Grant funds unexpended by consumers shall return to the state once a year. The 
12.35 	annual return of unexpended grant funds shall occur in the quarter following the end of 
12.36 	the state fiscal year. 

13.1 	Sec. 16. Minnesota Statutes 2008, section 256.476, subdivision 11, is amended to read:
13.2 		Subd. 11.Consumer support grant program after July 1, 2001. (a) Effective 
13.3 	July 1, 2001, the commissioner shall allocate consumer support grant resources to 
13.4 	serve additional individuals based on a review of Medicaid authorization and payment 
13.5 	information of persons eligible for a consumer support grant from the most recent fiscal 
13.6 	year. The commissioner shall use the following methodology to calculate maximum 
13.7 	allowable monthly consumer support grant levels:
13.8 	(1) For individuals whose program of origination is medical assistance home care 
13.9 	under sections 256B.0651 and 256B.0653 to 256B.0656, the maximum allowable monthly 
13.10 	grant levels are calculated by:
13.11 	(i) determining the nonfederal share 50 percent of the average service authorization 
13.12 	for each home care rating;
13.13 	(ii) calculating the overall ratio of actual payments to service authorizations by 
13.14 	program;
13.15 	(iii) applying the overall ratio to the average service authorization level of each 
13.16 	home care rating;
13.17 	(iv) adjusting the result for any authorized rate increases provided by the legislature; 
13.18 	and
13.19 	(v) adjusting the result for the average monthly utilization per recipient.
13.20 	(2) The commissioner may review and evaluate the methodology to reflect changes 
13.21 	in the home care program's overall ratio of actual payments to service authorizations.
13.22 	(b) Effective January 1, 2004, persons previously receiving exception grants will 
13.23 	have their grants calculated using the methodology in paragraph (a), clause (1). If a person 
13.24 	currently receiving an exception grant wishes to have their home care rating reevaluated, 
13.25 	they may request an assessment as defined in section 256B.0651, subdivision 1, paragraph 
13.26 	(b).

13.27 	Sec. 17. Minnesota Statutes 2008, section 256.9657, subdivision 1, is amended to read:
13.28 		Subdivision 1.Nursing home license surcharge. (a) Effective July 1, 1993, 
13.29 	each non-state-operated nursing home licensed under chapter 144A shall pay to the 
13.30 	commissioner an annual surcharge according to the schedule in subdivision 4. The 
13.31 	surcharge shall be calculated as $620 per licensed bed. If the number of licensed beds 
13.32 	is reduced, the surcharge shall be based on the number of remaining licensed beds the 
13.33 	second month following the receipt of timely notice by the commissioner of human 
13.34 	services that beds have been delicensed. The nursing home must notify the commissioner 
13.35 	of health in writing when beds are delicensed. The commissioner of health must notify 
14.1 	the commissioner of human services within ten working days after receiving written 
14.2 	notification. If the notification is received by the commissioner of human services by 
14.3 	the 15th of the month, the invoice for the second following month must be reduced 
14.4 	to recognize the delicensing of beds. Beds on layaway status continue to be subject to 
14.5 	the surcharge. The commissioner of human services must acknowledge a medical care 
14.6 	surcharge appeal within 30 days of receipt of the written appeal from the provider.
14.7 	(b) Effective July 1, 1994, the surcharge in paragraph (a) shall be increased to $625.
14.8 	(c) Effective August 15, 2002, the surcharge under paragraph (b) shall be increased 
14.9 	to $990.
14.10 	(d) Effective July 15, 2003, the surcharge under paragraph (c) shall be increased 
14.11 	to $2,815.
14.12 	(e) The commissioner may reduce, and may subsequently restore, the surcharge 
14.13 	under paragraph (d) based on the commissioner's determination of a permissible surcharge.
14.14 	(f) Between April 1, 2002, and August 15, 2004, a facility governed by this 
14.15 	subdivision may elect to assume full participation in the medical assistance program 
14.16 	by agreeing to comply with all of the requirements of the medical assistance program, 
14.17 	including the rate equalization law in section 256B.48, subdivision 1, paragraph (a), and 
14.18 	all other requirements established in law or rule, and to begin intake of new medical 
14.19 	assistance recipients. Rates will be determined under Minnesota Rules, parts 9549.0010 
14.20 	to 9549.0080. Notwithstanding section 256B.431, subdivision 27, paragraph (i), rate 
14.21 	calculations will be subject to limits as prescribed in rule and law. Other than the 
14.22 	adjustments in sections 256B.431, subdivisions 30 and 32; 256B.437, subdivision 3, 
14.23 	paragraph (b), Minnesota Rules, part 9549.0057, and any other applicable legislation 
14.24 	enacted prior to the finalization of rates, facilities assuming full participation in medical 
14.25 	assistance under this paragraph are not eligible for any rate adjustments until the July 1 
14.26 	following their settle-up period. 
14.27 	(g) Effective July 1, 2009, the surcharge in paragraph (d) shall be increased to $3,165.

14.28 	EFFECTIVE DATE. This section is effective the day following final enactment.

14.29 	Sec. 18. Minnesota Statutes 2008, section 256.975, subdivision 7, is amended to read:
14.30 		Subd. 7.Consumer information and assistance and long-term care options 
14.31 	counseling; senior linkage Senior LinkAge Line. (a) The Minnesota Board on Aging 
14.32 	shall operate a statewide information and assistance service to aid older Minnesotans and 
14.33 	their families in making informed choices about long-term care options and health care 
14.34 	benefits. Language services to persons with limited English language skills may be made 
15.1 	available. The service, known as Senior LinkAge Line, must be available during business 
15.2 	hours through a statewide toll-free number and must also be available through the Internet.
15.3 	(b) The service must assist provide long-term care options counseling by assisting
15.4 	older adults, caregivers, and providers in accessing information  and options counseling 
15.5 	about choices in long-term care services that are purchased through private providers or 
15.6 	available through public options. The service must:
15.7 	(1) develop a comprehensive database that includes detailed listings in both 
15.8 	consumer- and provider-oriented formats;
15.9 	(2) make the database accessible on the Internet and through other telecommunication 
15.10 	and media-related tools;
15.11 	(3) link callers to interactive long-term care screening tools and make these tools 
15.12 	available through the Internet by integrating the tools with the database;
15.13 	(4) develop community education materials with a focus on planning for long-term 
15.14 	care and evaluating independent living, housing, and service options;
15.15 	(5) conduct an outreach campaign to assist older adults and their caregivers in 
15.16 	finding information on the Internet and through other means of communication;
15.17 	(6) implement a messaging system for overflow callers and respond to these callers 
15.18 	by the next business day;
15.19 	(7) link callers with county human services and other providers to receive more 
15.20 	in-depth assistance and consultation related to long-term care options;
15.21 	(8) link callers with quality profiles for nursing facilities and other providers 
15.22 	developed by the commissioner of health; and
15.23 	(9) incorporate information about and availability of  housing  options, as well as 
15.24 	registered housing with services and consumer rights within the MinnesotaHelp.info 
15.25 	network long-term care database to facilitate consumer comparison of services and costs 
15.26 	among housing with services establishments and with other in-home services and to 
15.27 	support financial self-sufficiency as long as possible. Housing with services establishments 
15.28 	and their arranged home care providers shall provide information to the commissioner 
15.29 	of human services that is consistent with information required by the commissioner of 
15.30 	health under section 144G.06, the Uniform Consumer Information Guide price and 
15.31 	other information requested by the commissioner of human services regarding rents and 
15.32 	services. The commissioners of human services and health shall align the data elements 
15.33 	required by this section, and section 144G.06, the Uniform Consumer Information Guide, 
15.34 	to provide consumers standardized information and ease of comparison of long-term care 
15.35 	options. The commissioner of human services shall provide the data to the Minnesota 
15.36 	Board on Aging for inclusion in the MinnesotaHelp.info network long-term care database;
16.1 	(10) provide long-term care options counseling. Long-term care options counselors 
16.2 	shall:
16.3 	(i) for individuals not eligible for case management under a public program or public 
16.4 	funding source, provide interactive decision support under which consumers, family 
16.5 	members, or other helpers are supported in their deliberations to determine appropriate 
16.6 	long-term care choices in the context of the consumer's needs, preferences, values, and 
16.7 	individual circumstances, including implementing a community support plan;
16.8 	(ii) provide Web-based educational information and collateral written materials to 
16.9 	familiarize consumers, family members, or other helpers with the long-term care basics, 
16.10 	issues to be considered, and the range of options available in the community;
16.11 	(iii) provide long-term care futures planning, which means providing assistance to 
16.12 	individuals who anticipate having long-term care needs to develop a plan for the more 
16.13 	distant future; and
16.14 	(iv) provide expertise in benefits and financing options for long-term care, including 
16.15 	Medicare, long-term care insurance, tax or employer-based incentives, reverse mortgages, 
16.16 	private pay options, and ways to access low or no-cost services or benefits through 
16.17 	volunteer-based or charitable programs; and
16.18 	(11) using risk management and support planning protocols, provide long-term 
16.19 	care options counseling to prospective residents of housing with services establishments 
16.20 	registered under chapter 144D and current residents of nursing homes deemed appropriate 
16.21 	for discharge by the commissioner.
16.22 	In order to meet this requirement, the commissioner shall provide designated Senior 
16.23 	LinkAge Line contact centers with a list of nursing home residents appropriate for 
16.24 	discharge planning via a secure Web portal. Senior LinkAge Line shall provide these 
16.25 	residents, if they indicate a preference to receive long-term care options counseling, 
16.26 	with initial assessment, review of risk factors, independent living support consultation, 
16.27 	or referral to:
16.28 	(i) services under section 256B.0911, subdivision 3;
16.29 	(ii) designated care coordinators of contracted entities under section 256B.035 for 
16.30 	persons who are enrolled in a managed care plan; or
16.31 	(iii) the long-term care consultation team for those who are appropriate for relocation 
16.32 	service coordination due to high-risk factors or psychological or physical disability.
16.33 	(c) The Minnesota Board on Aging shall conduct an evaluation of the effectiveness 
16.34 	of the statewide information and assistance, and submit this evaluation to the legislature 
16.35 	by December 1, 2002. The evaluation must include an analysis of funding adequacy, gaps 
17.1 	in service delivery, continuity in information between the service and identified linkages, 
17.2 	and potential use of private funding to enhance the service.

17.3 	Sec. 19. Minnesota Statutes 2008, section 256B.0625, subdivision 6a, is amended to 
17.4 	read:
17.5 		Subd. 6a.Home health services. Home health services are those services specified 
17.6 	in Minnesota Rules, part 9505.0295 sections 256B.0651 and 256B.0653. Medical 
17.7 	assistance covers home health services at a recipient's home residence. Medical assistance 
17.8 	does not cover home health services for residents of a hospital, nursing facility, or 
17.9 	intermediate care facility, unless the commissioner of human services has prior authorized 
17.10 	skilled nurse visits for less than 90 days for a resident at an intermediate care facility for 
17.11 	persons with developmental disabilities, to prevent an admission to a hospital or nursing 
17.12 	facility or unless a resident who is otherwise eligible is on leave from the facility and the 
17.13 	facility either pays for the home health services or forgoes the facility per diem for the 
17.14 	leave days that home health services are used. Home health services must be provided by 
17.15 	a Medicare certified home health agency. All nursing and home health aide services must 
17.16 	be provided according to sections 256B.0651 to 256B.0656256B.0653.

17.17 	Sec. 20. Minnesota Statutes 2008, section 256B.0625, subdivision 7, is amended to 
17.18 	read:
17.19 		Subd. 7.Private duty nursing. Medical assistance covers private duty nursing 
17.20 	services in a recipient's home. Recipients who are authorized to receive private duty 
17.21 	nursing services in their home may use approved hours outside of the home during hours 
17.22 	when normal life activities take them outside of their home. To use private duty nursing 
17.23 	services at school, the recipient or responsible party must provide written authorization in 
17.24 	the care plan identifying the chosen provider and the daily amount of services to be used at 
17.25 	school. Medical assistance does not cover private duty nursing services for residents of a 
17.26 	hospital, nursing facility, intermediate care facility, or a health care facility licensed by the 
17.27 	commissioner of health, except as authorized in section 256B.64 for ventilator-dependent 
17.28 	recipients in hospitals or unless a resident who is otherwise eligible is on leave from the 
17.29 	facility and the facility either pays for the private duty nursing services or forgoes the 
17.30 	facility per diem for the leave days that private duty nursing services are used. Total hours 
17.31 	of service and payment allowed for services outside the home cannot exceed that which is 
17.32 	otherwise allowed in an in-home setting according to sections 256B.0651 and 256B.0653
17.33 	256B.0654 to 256B.0656. All private duty nursing services must be provided according to 
17.34 	the limits established under sections 256B.0651 and 256B.0653 to 256B.0656. Private 
18.1 	duty nursing services may not be reimbursed if the nurse is the  family foster care provider 
18.2 	of a recipient who is under age 18, unless allowed under section 256B.0654, subdivision 4.

18.3 	Sec. 21. Minnesota Statutes 2008, section 256B.0625, subdivision 8, is amended to 
18.4 	read:
18.5 		Subd. 8.Physical therapy. Medical assistance covers physical therapy, as 
18.6 	described in section 148.65, and related services, including specialized maintenance 
18.7 	therapy. Services provided by a physical therapy assistant shall be reimbursed at the 
18.8 	same rate as services performed by a physical therapist when the services of the physical 
18.9 	therapy assistant are provided under the direction of a physical therapist who is on the 
18.10 	premises. Services provided by a physical therapy assistant that are provided under the 
18.11 	direction of a physical therapist who is not on the premises shall be reimbursed at 65 
18.12 	percent of the physical therapist rate.

18.13 	Sec. 22. Minnesota Statutes 2008, section 256B.0625, subdivision 8a, is amended to 
18.14 	read:
18.15 		Subd. 8a.Occupational therapy. Medical assistance covers occupational therapy, 
18.16 	as described in section 148.6404, and related services, including specialized maintenance 
18.17 	therapy. Services provided by an occupational therapy assistant shall be reimbursed at 
18.18 	the same rate as services performed by an occupational therapist when the services of 
18.19 	the occupational therapy assistant are provided under the direction of the occupational 
18.20 	therapist who is on the premises. Services provided by an occupational therapy assistant 
18.21 	that are provided under the direction of an occupational therapist who is not on the 
18.22 	premises shall be reimbursed at 65 percent of the occupational therapist rate.

18.23 	Sec. 23. Minnesota Statutes 2008, section 256B.0625, subdivision 19a, is amended to 
18.24 	read:
18.25 		Subd. 19a.Personal care assistant assistance  services. Medical assistance covers 
18.26 	personal care assistant assistance  services in a recipient's home. To qualify for personal 
18.27 	care assistant assistance  services, a recipient must require assistance and be determined 
18.28 	dependent in one activity of daily living as defined in section 256B.0659, subdivision 1, 
18.29 	paragraph (b), or in a Level I behavior as defined in section 256B.0659, subdivision 1, 
18.30 	paragraph (c). Beginning July 1, 2011, to qualify for personal care assistance services, a 
18.31 	recipient must require assistance and be determined dependent in at least two activities 
18.32 	of daily living as defined in section 256B.0659. Recipients or responsible parties must 
18.33 	be able to identify the recipient's needs, direct and evaluate task accomplishment, and 
19.1 	provide for health and safety. Approved hours may be used outside the home when normal 
19.2 	life activities take them outside the home. To use personal care assistant assistance 
19.3 	 services at school, the recipient or responsible party must provide written authorization 
19.4 	in the care plan identifying the chosen provider and the daily amount of services to be 
19.5 	used at school. Total hours for services, whether actually performed inside or outside 
19.6 	the recipient's home, cannot exceed that which is otherwise allowed for personal care 
19.7 	assistant assistance  services in an in-home setting according to sections 256B.0651
19.8 	and 256B.0653 to 256B.0656. Medical assistance does not cover personal care assistant
19.9 	assistance  services for residents of a hospital, nursing facility, intermediate care facility, 
19.10 	health care facility licensed by the commissioner of health, or unless a resident who is 
19.11 	otherwise eligible is on leave from the facility and the facility either pays for the personal 
19.12 	care assistant assistance  services or forgoes the facility per diem for the leave days that 
19.13 	personal care assistant assistance  services are used. All personal care assistant assistance 
19.14 	 services must be provided according to sections 256B.0651and 256B.0653 to 256B.0656. 
19.15 	Personal care assistant assistance  services may not be reimbursed if the personal care 
19.16 	assistant is the spouse or legalpaid guardian of the recipient or the parent of a recipient 
19.17 	under age 18, or the responsible party or the family foster care provider of a recipient who 
19.18 	cannot direct the recipient's own care unless, in the case of a foster care provider, a county 
19.19 	or state case manager visits the recipient as needed, but not less than every six months, 
19.20 	to monitor the health and safety of the recipient and to ensure the goals of the care plan 
19.21 	are met. Parents of adult recipients, adult children of the recipient or adult siblings of 
19.22 	the recipient may be reimbursed for personal care assistant services, if they are granted 
19.23 	a waiver under sections 256B.0651 and 256B.0653 to 256B.0656. Notwithstanding the 
19.24 	provisions of section 256B.0655, subdivision 2, paragraph (b), clause (4) 256B.0659, the 
19.25 	noncorporate legal unpaid guardian or conservator of an adult, who is not the responsible 
19.26 	party and not the personal care provider organization, may be granted a hardship waiver 
19.27 	under sections 256B.0651 and 256B.0653 to 256B.0656, to be reimbursed to provide 
19.28 	personal care assistant assistance  services to the recipient if the guardian or conservator 
19.29 	meets all criteria for a personal care assistant according to section 256B.0659, and shall 
19.30 	not be considered to have a service provider interest for purposes of participation on the 
19.31 	screening team under section 256B.092, subdivision 7.

19.32 	Sec. 24. Minnesota Statutes 2008, section 256B.0625, subdivision 19c, is amended to 
19.33 	read:
19.34 		Subd. 19c.Personal care. Medical assistance covers personal care assistant
19.35 	assistance  services provided by an individual who is qualified to provide the services 
20.1 	according to subdivision 19a and sections 256B.0651and 256B.0653 to 256B.0656, 
20.2 	where the services have a statement of need by a physician, provided in accordance with 
20.3 	a plan, and are supervised by the recipient or a qualified professional. The physician's 
20.4 	statement of need for personal care assistant services shall be documented on a form 
20.5 	approved by the commissioner and include the diagnosis or condition of the person that 
20.6 	results in a need for personal care assistant services and be updated when the person's 
20.7 	medical condition requires a change, but at least annually if the need for personal care 
20.8 	assistant services is ongoing.
20.9 	"Qualified professional" means a mental health professional as defined in section 245.462, 
20.10 	subdivision 18, or 245.4871, subdivision 27; or a registered nurse as defined in sections 
20.11 	148.171 to 148.285, or a licensed social worker as defined in section 148B.21, or a 
20.12 	qualified developmental disabilities specialist under Code of Federal Regulations, title 42, 
20.13 	section 483.430. As part of the assessment, the county public health nurse will assist the 
20.14 	recipient or responsible party to identify the most appropriate person to provide supervision 
20.15 	of the personal care assistant. The qualified professional shall perform the duties described
20.16 	required in Minnesota Rules, part 9505.0335, subpart 4 section 256B.0659.

20.17 	Sec. 25. Minnesota Statutes 2008, section 256B.0651, is amended to read:
20.18 	256B.0651 HOME CARE SERVICES.
20.19 		Subdivision 1.Definitions. (a) "Activities of daily living" includes eating, toileting, 
20.20 	grooming, dressing, bathing, transferring, mobility, and positioning For the purposes of 
20.21 	sections 256B.0651 to 256B.0656 and 256B.0659, the terms in paragraphs (b) to (g) 
20.22 	have the meanings given.
20.23 	(b) "Activities of daily living" has the meaning given in section 256B.0659, 
20.24 	subdivision 1, paragraph (b).
20.25 	 (c) "Assessment" means a review and evaluation of a recipient's need for home care 
20.26 	services conducted in person. Assessments for home health agency services shall be 
20.27 	conducted by a home health agency nurse. Assessments for medical assistance home care 
20.28 	services for developmental disability and alternative care services for developmentally 
20.29 	disabled home and community-based waivered recipients may be conducted by the county 
20.30 	public health nurse to ensure coordination and avoid duplication. Assessments must be 
20.31 	completed on forms provided by the commissioner within 30 days of a request for home 
20.32 	care services by a recipient or responsible party.
20.33 	(c) (d) "Home care services" means a health service, determined by the commissioner 
20.34 	as medically necessary, that is ordered by a physician and documented in a service plan 
20.35 	that is reviewed by the physician at least once every 60 days for the provision of home 
21.1 	health services, or private duty nursing, or at least once every 365 days for personal care. 
21.2 	Home care services are provided to the recipient at the recipient's residence that is a 
21.3 	place other than a hospital or long-term care facility or as specified in section 256B.0625
21.4 	means medical assistance covered services that are home health agency services, including 
21.5 	skilled nurse visits; home health aide visits; physical therapy, occupational therapy, 
21.6 	respiratory therapy, and language-speech pathology therapy; private duty nursing; and 
21.7 	personal care assistance.
21.8 	(e) "Home residence" means a residence owned or rented by the recipient either 
21.9 	alone, with roommates of the recipient's choosing, or with an unpaid responsible party 
21.10 	or legal representative; or a family foster home where the license holder lives with the 
21.11 	recipient and is not paid to provide home care services for the recipient except as allowed 
21.12 	under sections 256B.0651, subdivision 9, and 256B.0654, subdivision 4.
21.13 	(d) (f) "Medically necessary" has the meaning given in Minnesota Rules, parts 
21.14 	9505.0170 to 9505.0475.
21.15 	(e) "Telehomecare" means the use of telecommunications technology by a home 
21.16 	health care professional to deliver home health care services, within the professional's 
21.17 	scope of practice, to a patient located at a site other than the site where the practitioner 
21.18 	is located.
21.19 	(g) "Ventilator-dependent" means an individual who receives mechanical ventilation 
21.20 	for life support at least six hours per day and is expected to be or has been dependent on a 
21.21 	ventilator for at least 30 consecutive days.
21.22 		Subd. 2.Services covered. Home care services covered under this section and 
21.23 	sections 256B.0653 256B.0652  to 256B.0656 and 256B.0659 include:
21.24 	(1) nursing services under section sections256B.0625, subdivision 6a, and 
21.25 	256B.0653;
21.26 	(2) private duty nursing services under section sections256B.0625, subdivision 
21.27 	7, and 256B.0654;
21.28 	(3) home health services under section sections256B.0625, subdivision 6a, and 
21.29 	256B.0653;
21.30 	(4) personal care assistant assistance  services under section sections256B.0625, 
21.31 	subdivision 19a, and 256B.0659;
21.32 	(5) supervision of personal care assistant assistance  services provided by a qualified 
21.33 	professional under section sections256B.0625, subdivision 19a, and 256B.0659;
21.34 	(6) qualified professional of personal care assistant services under the fiscal 
21.35 	intermediary option as specified in section 256B.0655, subdivision 7;
22.1 	(7) face-to-face assessments by county public health nurses for services under 
22.2 	section sections256B.0625, subdivision 19a, and 256B.0659; and
22.3 	(8) (7) service updates and review of temporary increases for personal care assistant
22.4 	assistance  services by the county public health nurse for services under section sections
22.5 	256B.0625, subdivision 19a, and 256B.0659.
22.6 		Subd. 3.Noncovered home care services. The following home care services are 
22.7 	not eligible for payment under medical assistance:
22.8 	(1) skilled nurse visits for the sole purpose of supervision of the home health aide;
22.9 	(2) a skilled nursing visit:
22.10 	(i) only for the purpose of monitoring medication compliance with an established 
22.11 	medication program for a recipient; or
22.12 	(ii) to administer or assist with medication administration, including injections, 
22.13 	prefilling syringes for injections, or oral medication set-up of an adult recipient, when as 
22.14 	determined and documented by the registered nurse, the need can be met by an available 
22.15 	pharmacy or the recipient is physically and mentally able to self-administer or prefill 
22.16 	a medication;
22.17 	(3) home care services to a recipient who is eligible for covered services under the 
22.18 	Medicare program or any other insurance held by the recipient;
22.19 	(4) services to other members of the recipient's household;
22.20 	(5) a visit made by a skilled nurse solely to train other home health agency workers;
22.21 	(6) any home care service included in the daily rate of the community-based 
22.22 	residential facility where the recipient is residing;
22.23 	(7) nursing and rehabilitation therapy services that are reasonably accessible to a 
22.24 	recipient outside the recipient's place of residence, excluding the assessment, counseling 
22.25 	and education, and personal assistant care;
22.26 	(8) any home health agency service, excluding personal care assistant services and 
22.27 	private duty nursing services, which are performed in a place other than the recipient's 
22.28 	residence; and
22.29 	(9) Medicare evaluation or administrative nursing visits on dual-eligible recipients 
22.30 	that do not qualify for Medicare visit billing.
22.31 	(1) services provided in a nursing facility, hospital, or intermediate care facility with 
22.32 	exceptions in section 256B.0653;
22.33 	(2) services for the sole purpose of monitoring medication compliance with an 
22.34 	established medication program for a recipient;
22.35 	(3) home care services for covered services under the Medicare program or any other 
22.36 	insurance held by the recipient;
23.1 	(4) services to other members of the recipient's household;
23.2 	(5) any home care service included in the daily rate of the community-based 
23.3 	residential facility where the recipient is residing;
23.4 	(6) nursing and rehabilitation therapy services that are reasonably accessible to a 
23.5 	recipient outside the recipient's place of residence, excluding the assessment, counseling 
23.6 	and education, and personal assistance care; or
23.7 	(7) Medicare evaluation or administrative nursing visits on dual-eligible recipients 
23.8 	that do not qualify for Medicare visit billing.
23.9 		Subd. 4.Prior Authorization; exceptions. All home care services above the limits 
23.10 	in subdivision 11 must receive the commissioner's prior authorization before services 
23.11 	begin, except when:
23.12 	(1) the home care services were required to treat an emergency medical condition 
23.13 	that if not immediately treated could cause a recipient serious physical or mental disability, 
23.14 	continuation of severe pain, or death. The provider must request retroactive authorization 
23.15 	no later than five working days after giving the initial service. The provider must be able 
23.16 	to substantiate the emergency by documentation such as reports, notes, and admission or 
23.17 	discharge histories;
23.18 	(2) the home care services were provided on or after the date on which the recipient's 
23.19 	eligibility began, but before the date on which the recipient was notified that the case was 
23.20 	opened. Authorization will be considered if the request is submitted by the provider 
23.21 	within 20 working days of the date the recipient was notified that the case was opened
23.22 	a recipient's eligibility lapse from medical assistance has been retroactively reinstated 
23.23 	and an authorization for home care services is completed based on the date of a current 
23.24 	assessment, eligibility, and request for authorization;
23.25 	(3) a third-party payor for home care services has denied or adjusted a payment. 
23.26 	Authorization requests must be submitted by the provider within 20 working days of the 
23.27 	notice of denial or adjustment. A copy of the notice must be included with the request;
23.28 	(4) the commissioner has determined that a county or state human services agency 
23.29 	has made an error; or
23.30 	(5) the professional nurse determines an immediate need for up to 40 skilled nursing 
23.31 	or home health aide visits per calendar year and submits a request for authorization within 
23.32 	20 working days of the initial service date, and medical assistance is determined to be 
23.33 	the appropriate payer if a recipient enrolled in managed care experiences a temporary 
23.34 	disenrollment from a health plan, the commissioner shall accept the current health plan 
23.35 	authorization for personal care assistance services for up to 60 days. The request must 
23.36 	be received within the first 30 days of the disenrollment. If the recipient's reenrollment 
24.1 	in managed care is after the 60 days and before 90 days, the provider shall request an 
24.2 	additional 30-day extension of the current health plan authorization, for a total limit of 
24.3 	90 days from the time of disenrollment.
24.4 		Subd. 5.Retroactive authorization. A request for retroactive authorization will be 
24.5 	evaluated according to the same criteria applied to prior authorization requests.
24.6 		Subd. 6.Prior Authorization. (a) The commissioner, or the commissioner's 
24.7 	designee, shall review the assessment, service update, request for temporary services, 
24.8 	request for flexible use option, service plan, and any additional information that is 
24.9 	submitted. The commissioner shall, within 30 days after receiving a complete request, 
24.10 	assessment, and service plan, authorize home care services as follows: provided in this 
24.11 	section.
24.12 	(a) Home health services.(b) All Home health services provided by a home health 
24.13 	aide including skilled nurse visits and home health aide visits must be prior authorized 
24.14 	by the commissioner or the commissioner's designee. Prior Authorization must be based 
24.15 	on medical necessity and cost-effectiveness when compared with other care options. 
24.16 	The commissioner must receive the request for authorization of skilled nurse visits and 
24.17 	home health aide visits within 20 working days of the start of service. When home health 
24.18 	services are used in combination with personal care and private duty nursing, the cost of 
24.19 	all home care services shall be considered for cost-effectiveness. The commissioner shall 
24.20 	limit home health aide visits to no more than one visit each per day. The commissioner, or 
24.21 	the commissioner's designee, may authorize up to two skilled nurse visits per day.
24.22 	(b) Ventilator-dependent recipients.(c) If the recipient is ventilator-dependent, the 
24.23 	monthly medical assistance authorization for home care services shall not exceed what the 
24.24 	commissioner would pay for care at the highest cost hospital designated as a long-term 
24.25 	hospital under the Medicare program. For purposes of this paragraph, home care services 
24.26 	means all direct care services provided in the home that would be included in the payment 
24.27 	for care at the long-term hospital. "Ventilator-dependent" means an individual who 
24.28 	receives mechanical ventilation for life support at least six hours per day and is expected 
24.29 	to be or has been dependent for at least 30 consecutive days. Recipients who meet the 
24.30 	definition of ventilator dependent and the EN home care rating and utilize a combination 
24.31 	of home care services are limited up to a total of 24 hours of home care services per day. 
24.32 	Additional hours may be authorized when a recipient's assessment indicates a need for two 
24.33 	staff to perform activities. Additional time is limited to four hours per day.
24.34 		Subd. 7.Prior Authorization; time limits. (a) The commissioner or the 
24.35 	commissioner's designee shall determine the time period for which a prior an authorization 
24.36 	shall be effective and, if flexible use has been requested, whether to allow the flexible use 
25.1 	option. If the recipient continues to require home care services beyond the duration of 
25.2 	the prior authorization, the home care provider must request a new prior authorization. 
25.3 	A personal care provider agency must request a new personal care assistant assistance 
25.4 	 services assessment, or service update if allowed, at least 60 days prior to the end of 
25.5 	the current prior authorization time period. The request for the assessment must be 
25.6 	made on a form approved by the commissioner. Under no circumstances, other than the 
25.7 	exceptions in subdivision 4, shall a prior An authorization must be valid prior to the date 
25.8 	the commissioner receives the request or for no more than 12 months.
25.9 	(b) The amount and type of personal care assistance services authorized based 
25.10 	upon the assessment and service plan must remain in effect for the recipient whether 
25.11 	the recipient chooses a different provider or enrolls or disenrolls from a managed care 
25.12 	plan under section 256B.0659, unless the service needs of the recipient change and new 
25.13 	assessment is warranted under section 256B.0655, subdivision 1b.
25.14 	(c) A recipient who appeals a reduction in previously authorized home care 
25.15 	services may continue previously authorized services, other than temporary services 
25.16 	under subdivision 8, pending an appeal under section 256.045. The commissioner must 
25.17 	provide ensure that the recipient has a copy of the most recent service plan that contains 
25.18 	 a detailed explanation of why the authorized serviceswhich areas of covered personal 
25.19 	care assistance tasks are reduced in amount from those requested by the home care 
25.20 	provider, and provide notice of the amount of time per day reduced, and the reasons for 
25.21 	the reduction in the recipient's notice of denial, termination, or reduction.
25.22 		Subd. 8.Prior Authorization requests; temporary services. The agency nurse, 
25.23 	the independently enrolled private duty nurse, or county public health nurse may request 
25.24 	a temporary authorization for home care services by telephone. The commissioner may 
25.25 	approve a temporary level of home care services based on the assessment, and service 
25.26 	or care plan information, and primary payer coverage determination information as 
25.27 	required. Authorization for a temporary level of home care services including nurse 
25.28 	supervision is limited to the time specified by the commissioner, but shall not exceed 
25.29 	45 days, unless extended because the county public health nurse has not completed the 
25.30 	required assessment and service plan, or the commissioner's determination has not been 
25.31 	made. The level of services authorized under this provision shall have no bearing on a 
25.32 	future prior authorization.
25.33 		Subd. 9.Prior Authorization for foster care setting. (a) Home care services 
25.34 	provided in an adult or child foster care setting must receive prior authorization by the 
25.35 	department commissioner according to the limits established in subdivision 11.
25.36 	(b) The commissioner may not authorize:
26.1 	(1) home care services that are the responsibility of the foster care provider under 
26.2 	the terms of the foster care placement agreement, difficulty of care rate,  and administrative 
26.3 	rules;
26.4 	(2) personal care assistant assistance  services when the foster care license holder is 
26.5 	also the personal care provider or personal care assistant unless the recipient can direct the 
26.6 	recipient's own care, or case management is provided as required in section 256B.0625, 
26.7 	subdivision 19a, unless the foster home is the licensed provider's primary residence; or
26.8 	(3) personal care assistant services when the responsible party is an employee of, or 
26.9 	under contract with, or has any direct or indirect financial relationship with the personal 
26.10 	care provider or personal care assistant, unless case management is provided as required 
26.11 	in section 256B.0625, subdivision 19a; or
26.12 	(4) (3) personal care assistant and private duty nursing services when the number
26.13 	of foster care residents licensed capacity is greater than four unless the county responsible 
26.14 	for the recipient's foster placement made the placement prior to April 1, 1992, requests 
26.15 	that personal care assistant and private duty nursing services be provided, and case 
26.16 	management is provided as required in section 256B.0625, subdivision 19a.
26.17 		Subd. 10.Limitation on payments. Medical assistance payments for home care 
26.18 	services shall be limited according to subdivisions 4 to 12 and sections 256B.0654, 
26.19 	subdivision 2, and 256B.0655, subdivisions 3 and 4.
26.20 		Subd. 11.Limits on services without prior authorization. A recipient may receive 
26.21 	the following home care services during a calendar year:
26.22 	(1) up to two face-to-face assessments to determine a recipient's need for personal 
26.23 	care assistant assistance  services;
26.24 	(2) one service update done to determine a recipient's need for personal care assistant
26.25 	assistance  services; and
26.26 	(3) up to nine face-to-face skilled nurse visits.
26.27 		Subd. 12.Approval of home care services. The commissioner or the 
26.28 	commissioner's designee shall determine the medical necessity of home care services, the 
26.29 	level of caregiver according to subdivision 2, and the institutional comparison according to 
26.30 	subdivisions 4 to 12 and sections 256B.0654, subdivision 2, and 256B.0655, subdivisions 
26.31 	3 and 4 256B.0659, the cost-effectiveness of services, and the amount, scope, and duration 
26.32 	of home care services reimbursable by medical assistance, based on the assessment, 
26.33 	primary payer coverage determination information as required, the service plan, the 
26.34 	recipient's age, the cost of services, the recipient's medical condition, and diagnosis or 
26.35 	disability. The commissioner may publish additional criteria for determining medical 
26.36 	necessity according to section 256B.04.
27.1 		Subd. 13.Recovery of excessive payments. The commissioner shall seek 
27.2 	monetary recovery from providers of payments made for services which exceed the limits 
27.3 	established in this section and sections 256B.0653 to 256B.0656. This subdivision does 
27.4 	not apply to services provided to a recipient at the previously authorized level pending an 
27.5 	appeal under section 256.045, subdivision 10.
27.6 		Subd. 14.Referrals to Medicare providers required. Home care providers that 
27.7 	do not participate in or accept Medicare assignment must refer and document the referral 
27.8 	of dual-eligible recipients to Medicare providers when Medicare is determined to be the 
27.9 	appropriate payer for services and supplies and equipment. Providers must be terminated 
27.10 	from participation in the medical assistance program for failure to make these referrals.
27.11 		Subd. 15.Quality assurance for program integrity. The commissioner shall 
27.12 	establish an ongoing quality assurance process for home care services to monitor program 
27.13 	integrity, including provider standards and training, consumer surveys, and random 
27.14 	reviews of documentation.
27.15 		Subd. 16.Oversight of enrolled providers. The commissioner has the authority to 
27.16 	request proof of documentation of meeting provider standards, quality standards of care, 
27.17 	correct billing practices, and other information. Failure to provide access and information 
27.18 	to demonstrate compliance with laws, rules, or policies must result in suspension, denial, 
27.19 	or termination of the provider agency's enrollment with the department.

27.20 	Sec. 26. Minnesota Statutes 2008, section 256B.0652, is amended to read:
27.21 	256B.0652 PRIOR AUTHORIZATION AND REVIEW OF HOME CARE 
27.22 	SERVICES.
27.23 		Subdivision 1.State coordination. The commissioner shall supervise the 
27.24 	coordination of the prior authorization and review of home care services that are 
27.25 	reimbursed by medical assistance.
27.26 		Subd. 2.Duties. (a) The commissioner may contract with or employ qualified 
27.27 	registered nurses and necessary support staff, or contract with qualified agencies, to 
27.28 	provide home care prior authorization and review services for medical assistance 
27.29 	recipients who are receiving home care services.
27.30 	(b) Reimbursement for the prior authorization function shall be made through the 
27.31 	medical assistance administrative authority. The state shall pay the nonfederal share 50 
27.32 	percent of the administrative functions. The functions will be to:
27.33 	(1) assess the recipient's individual need for services required to be cared for safely 
27.34 	in the community;
28.1 	(2) ensure that a service care plan that meets the recipient's needs is developed 
28.2 	by the appropriate agency or individual;
28.3 	(3) ensure cost-effectiveness and nonduplication of medical assistance home care 
28.4 	services;
28.5 	(4) recommend the approval or denial of the use of medical assistance funds to pay 
28.6 	for home care services;
28.7 	(5) reassess the recipient's need for and level of home care services at a frequency 
28.8 	determined by the commissioner; and
28.9 	(6) conduct on-site assessments when determined necessary by the commissioner 
28.10 	and recommend changes to care plans that will provide more efficient and appropriate 
28.11 	home care; and
28.12 	(7) on the department's Web site:
28.13 	(i) provide a link to MinnesotaHelp.info for a list of enrolled home care agencies 
28.14 	with the following information: main office address, contact information for the agency, 
28.15 	counties in which services are provided, type of home care services provided, whether 
28.16 	the personal care assistance choice option is offered, types of qualified professionals 
28.17 	employed, number of personal care assistants employed, and data on staff turnover; and
28.18 	(ii) post data on home care services including information from both fee-for-service 
28.19 	and managed care plans on recipients as available.
28.20 	(c) In addition, the commissioner or the commissioner's designee may:
28.21 	(1) review care plans, service plans,  and reimbursement data for utilization of 
28.22 	services that exceed community-based standards for home care, inappropriate home care 
28.23 	services, medical necessity, home care services that do not meet quality of care standards, 
28.24 	or unauthorized services and make appropriate referrals within the department or to other 
28.25 	appropriate entities based on the findings;
28.26 	(2) assist the recipient in obtaining services necessary to allow the recipient to 
28.27 	remain safely in or return to the community;
28.28 	(3) coordinate home care services with other medical assistance services under 
28.29 	section 256B.0625;
28.30 	(4) assist the recipient with problems related to the provision of home care services;
28.31 	(5) assure the quality of home care services; and
28.32 	(6) assure that all liable third-party payers including, but not limited to, Medicare 
28.33 	have been used prior to medical assistance for home care services, including but not 
28.34 	limited to, home health agency, elected hospice benefit, waivered services, alternative care 
28.35 	program services, and personal care services.
29.1 	(d) For the purposes of this section, "home care services" means medical assistance 
29.2 	services defined under section 256B.0625, subdivisions 6a, 7, and 19a.
29.3 		Subd. 3.Assessment and prior authorization process for persons receiving 
29.4 	personal care assistance and developmental disabilities services. Effective January 1, 
29.5 	1996, For purposes of providing informed choice, coordinating of local planning decisions, 
29.6 	and streamlining administrative requirements, the assessment and prior authorization 
29.7 	process for persons receiving both home care and home and community-based waivered 
29.8 	services for persons with developmental disabilities shall meet the requirements of 
29.9 	sections 256B.0651 and 256B.0653 to 256B.0656 with the following exceptions:
29.10 	(a) Upon request for home care services and subsequent assessment by the public 
29.11 	health nurse under sections 256B.0651 and 256B.0653 to 256B.0656, the public health 
29.12 	nurse shall participate in the screening process, as appropriate, and, if home care 
29.13 	services are determined to be necessary, participate in the development of a service plan 
29.14 	coordinating the need for home care and home and community-based waivered services 
29.15 	with the assigned county case manager, the recipient of services, and the recipient's legal 
29.16 	representative, if any.
29.17 	(b) The public health nurse shall give prior authorization for home care services 
29.18 	to the extent that home care services are:
29.19 	(1) medically necessary;
29.20 	(2) chosen by the recipient and their legal representative, if any, from the array of 
29.21 	home care and home and community-based waivered services available;
29.22 	(3) coordinated with other services to be received by the recipient as described 
29.23 	in the service plan; and
29.24 	(4) provided within the county's reimbursement limits for home care and home and 
29.25 	community-based waivered services for persons with developmental disabilities.
29.26 	(c) If the public health agency is or may be the provider of home care services to the 
29.27 	recipient, the public health agency shall provide the commissioner of human services with 
29.28 	a written plan that specifies how the assessment and prior authorization process will be 
29.29 	held separate and distinct from the provision of services.

29.30 	Sec. 27. Minnesota Statutes 2008, section 256B.0653, is amended to read:
29.31 	256B.0653 HOME HEALTH AGENCY COVERED SERVICES.
29.32 		Subdivision 1.Homecare; skilled nurse visits Scope.  "Skilled nurse visits" are 
29.33 	provided in a recipient's residence under a plan of care or service plan that specifies a level 
29.34 	of care which the nurse is qualified to provide. These services are:
30.1 	(1) nursing services according to the written plan of care or service plan and accepted 
30.2 	standards of medical and nursing practice in accordance with chapter 148;
30.3 	(2) services which due to the recipient's medical condition may only be safely and 
30.4 	effectively provided by a registered nurse or a licensed practical nurse;
30.5 	(3) assessments performed only by a registered nurse; and
30.6 	(4) teaching and training the recipient, the recipient's family, or other caregivers 
30.7 	requiring the skills of a registered nurse or licensed practical nurse. This section applies to 
30.8 	home health agency services including, home health aide, skilled nursing visits, physical 
30.9 	therapy, occupational therapy, respiratory therapy, and speech language pathology therapy.
30.10 		Subd. 2.Telehomecare; skilled nurse visits Definitions.  Medical assistance 
30.11 	covers skilled nurse visits according to section 256B.0625, subdivision 6a, provided via 
30.12 	telehomecare, for services which do not require hands-on care between the home care 
30.13 	nurse and recipient. The provision of telehomecare must be made via live, two-way 
30.14 	interactive audiovisual technology and may be augmented by utilizing store-and-forward 
30.15 	technologies. Store-and-forward technology includes telehomecare services that do not 
30.16 	occur in real time via synchronous transmissions, and that do not require a face-to-face 
30.17 	encounter with the recipient for all or any part of any such telehomecare visit. Individually 
30.18 	identifiable patient data obtained through real-time or store-and-forward technology must 
30.19 	be maintained as health records according to sections 144.291 to 144.298. If the video 
30.20 	is used for research, training, or other purposes unrelated to the care of the patient, the 
30.21 	identity of the patient must be concealed. A communication between the home care nurse 
30.22 	and recipient that consists solely of a telephone conversation, facsimile, electronic mail, or 
30.23 	a consultation between two health care practitioners, is not to be considered a telehomecare 
30.24 	visit. Multiple daily skilled nurse visits provided via telehomecare are allowed. Coverage 
30.25 	of telehomecare is limited to two visits per day. All skilled nurse visits provided via 
30.26 	telehomecare must be prior authorized by the commissioner or the commissioner's 
30.27 	designee and will be covered at the same allowable rate as skilled nurse visits provided 
30.28 	in-person. For the purposes of this section, the following terms have the meanings given.
30.29 	(a) "Assessment" means an evaluation of the recipient's medical need for home 
30.30 	health agency services by a registered nurse or appropriate therapist that is conducted 
30.31 	within 30 days of a request.
30.32 	(b) "Home care therapies" means occupational, physical, and respiratory therapy 
30.33 	and speech-language pathology services provided in the home by a Medicare certified 
30.34 	home health agency.
31.1 	(c) "Home health agency services" means services delivered in the recipient's home 
31.2 	residence, except as specified in section 256B.0625, by a home health agency to a recipient 
31.3 	with medical needs due to illness, disability, or physical conditions.
31.4 	(d) "Home health aide" means an employee of a home health agency who completes 
31.5 	medically oriented tasks written in the plan of care for a recipient.
31.6 	(e) "Home health agency" means a home care provider agency that is 
31.7 	Medicare-certified.
31.8 	(f) "Occupational therapy services" mean the services defined in section 148.6402.
31.9 	(g) "Physical therapy services" mean the services defined in section 148.65.
31.10 	(h) "Respiratory therapy services" mean the services defined in chapter 147C and 
31.11 	Minnesota Rules, part 4668.0003, subpart 37.
31.12 	(i) "Speech-language pathology services" mean the services defined in section 
31.13 	148.512.
31.14 	(j) "Skilled nurse visit" means a professional nursing visit to complete nursing tasks 
31.15 	required due to a recipient's medical condition that can only be safely provided by a 
31.16 	professional nurse to restore and maintain optimal health.
31.17 	(k) "Store-and-forward technology" means telehomecare services that do not occur 
31.18 	in real time via synchronous transmissions such as diabetic and vital sign monitoring.
31.19 	(l) "Telehomecare" means the use of telecommunications technology via 
31.20 	live, two-way interactive audiovisual technology which may be augmented by 
31.21 	store-and-forward technology.
31.22 	(m) "Telehomecare skilled nurse visit" means a visit by a professional nurse to 
31.23 	deliver a skilled nurse visit to a recipient located at a site other than the site where the 
31.24 	nurse is located and is used in combination with face-to-face skilled nurse visits to 
31.25 	adequately meet the recipient's needs.
31.26 		Subd. 3.Therapies through home health agencies Home health aide visits.
 31.27 	(a) Medical assistance covers physical therapy and related services, including specialized 
31.28 	maintenance therapy. Services provided by a physical therapy assistant shall be 
31.29 	reimbursed at the same rate as services performed by a physical therapist when the 
31.30 	services of the physical therapy assistant are provided under the direction of a physical 
31.31 	therapist who is on the premises. Services provided by a physical therapy assistant that are 
31.32 	provided under the direction of a physical therapist who is not on the premises shall be 
31.33 	reimbursed at 65 percent of the physical therapist rate. Direction of the physical therapy 
31.34 	assistant must be provided by the physical therapist as described in Minnesota Rules, part 
31.35 	9505.0390, subpart 1, item B. The physical therapist and physical therapist assistant may 
31.36 	not both bill for services provided to a recipient on the same day.
32.1 	(b) Medical assistance covers occupational therapy and related services, including 
32.2 	specialized maintenance therapy. Services provided by an occupational therapy assistant 
32.3 	shall be reimbursed at the same rate as services performed by an occupational therapist 
32.4 	when the services of the occupational therapy assistant are provided under the direction of 
32.5 	the occupational therapist who is on the premises. Services provided by an occupational 
32.6 	therapy assistant under the direction of an occupational therapist who is not on the 
32.7 	premises shall be reimbursed at 65 percent of the occupational therapist rate. Direction 
32.8 	of the occupational therapy assistant must be provided by the occupational therapist as 
32.9 	described in Minnesota Rules, part 9505.0390, subpart 1, item B. The occupational 
32.10 	therapist and occupational therapist assistant may not both bill for services provided 
32.11 	to a recipient on the same day.
32.12 	(a) Home health aide visits must be provided by a certified home health aide 
32.13 	using a written plan of care that is updated in compliance with Medicare regulations. 
32.14 	A home health aide shall provide hands-on personal care, perform simple procedures 
32.15 	as an extension of therapy or nursing services, and assist in instrumental activities of 
32.16 	daily living as defined in section 256B.0659. Home health aide visits must be provided 
32.17 	in the recipient's home.
32.18 	(b) All home health aide visits must have authorization under section 256B.0652. 
32.19 	The commissioner shall limit home health aide visits to no more than one visit per day 
32.20 	per recipient.
32.21 	(c) Home health aides must be supervised by a registered nurse or an appropriate 
32.22 	therapist when providing services that are an extension of therapy.
32.23 		Subd. 4.Skilled nurse visit services. (a) Skilled nurse visit services must be 
32.24 	provided by a registered nurse or a licensed practical nurse under the supervision of a 
32.25 	registered nurse, according to the written plan of care and accepted standards of medical 
32.26 	and nursing practice according to chapter 148. Skilled nurse visit services must be ordered 
32.27 	by a physician and documented in a plan of care that is reviewed and approved by the 
32.28 	ordering physician at least once every 60 days. All skilled nurse visits must be medically 
32.29 	necessary and provided in the recipient's home residence except as allowed under section 
32.30 	256B.0625, subdivision 6a.
32.31 	(b) Skilled nurse visits include face-to-face and telehomecare visits with a limit of 
32.32 	up to two visits per day per recipient. All visits must be based on assessed needs.
32.33 	(c) Telehomecare skilled nurse visits are allowed when the recipient's health status 
32.34 	can be accurately measured and assessed without a need for a face-to-face, hands-on 
32.35 	encounter. All telehomecare skilled nurse visits must have authorization and are paid at 
32.36 	the same allowable rates as face-to-face skilled nurse visits.
33.1 	(d) The provision of telehomecare must be made via live, two-way interactive 
33.2 	audiovisual technology and may be augmented by utilizing store-and-forward 
33.3 	technologies. Individually identifiable patient data obtained through real-time or 
33.4 	store-and-forward technology must be maintained as health records according to sections 
33.5 	144.291 to 144.298. If the video is used for research, training, or other purposes unrelated 
33.6 	to the care of the patient, the identity of the patient must be concealed.
33.7 	(e) Authorization for skilled nurse visits must be completed under section 
33.8 	256B.0652. A total of nine face-to-face skilled nurses visits per calendar year do not 
33.9 	require authorization. All telehomecare skilled nurse visits require authorization.
33.10 		Subd. 5.Home care therapies. (a) Home care therapies include the following: 
33.11 	physical therapy, occupational therapy, respiratory therapy, and speech and language 
33.12 	pathology therapy services.
33.13 	(b) Home care therapies must be:
33.14 	(1) provided in the recipient's residence after it has been determined the recipient is 
33.15 	unable to access outpatient therapy;
33.16 	(2) prescribed, ordered, or referred by a physician and documented in a plan of care 
33.17 	and reviewed, according to Minnesota Rules, part 9505.0390;
33.18 	(3) assessed by an appropriate therapist; and
33.19 	(4) provided by a Medicare-certified home health agency enrolled as a Medicaid 
33.20 	provider agency.
33.21 	(c) Restorative and specialized maintenance therapies must be provided according to 
33.22 	Minnesota Rules, part 9505.0390. Physical and occupational therapy assistants may be 
33.23 	used as allowed under Minnesota Rules, part 9505.0390, subpart 1, item B.
33.24 	(d) For both physical and occupational therapies, the therapist and the therapist's 
33.25 	assistant may not both bill for services provided to a recipient on the same day.
33.26 		Subd. 6.Noncovered home health agency services. The following are not eligible 
33.27 	for payment under medical assistance as a home health agency service:
33.28 	(1) telehomecare skilled nurses services that is communication between the home 
33.29 	care nurse and recipient that consists solely of a telephone conversation, facsimile, 
33.30 	electronic mail, or a consultation between two health care practitioners;
33.31 	(2) the following skilled nurse visits:
33.32 	(i) for the purpose of monitoring medication compliance with an established 
33.33 	medication program for a recipient;
33.34 	(ii) administering or assisting with medication administration, including injections, 
33.35 	prefilling syringes for injections, or oral medication setup of an adult recipient, when, 
33.36 	as determined and documented by the registered nurse, the need can be met by an 
34.1 	available pharmacy or the recipient or a family member is physically and mentally able 
34.2 	to self-administer or prefill a medication;
34.3 	(iii) services done for the sole purpose of supervision of the home health aide or 
34.4 	personal care assistant;
34.5 	(iv) services done for the sole purpose to train other home health agency workers;
34.6 	(v) services done for the sole purpose of blood samples or lab draw or Synagis 
34.7 	injections when the recipient is able to access these services outside the home; and
34.8 	(vi) Medicare evaluation or administrative nursing visits required by Medicare;
34.9 	(3) home health aide visits when the following activities are the sole purpose for the 
34.10 	visit: companionship, socialization, household tasks, transportation, and education; and
34.11 	(4) home care therapies provided in other settings such as a clinic, day program, or as 
34.12 	an inpatient or when the recipient can access therapy outside of the recipient's residence.

34.13 	Sec. 28. Minnesota Statutes 2008, section 256B.0654, is amended to read:
34.14 	256B.0654 PRIVATE DUTY NURSING.
34.15 		Subdivision 1.Definitions. (a) "Assessment" means a review and evaluation of a 
34.16 	recipient's need for home care services conducted in person. Assessments for private duty 
34.17 	nursing shall be conducted by a registered private duty nurse. Assessments for medical 
34.18 	assistance home care services for developmental disabilities and alternative care services 
34.19 	for developmentally disabled home and community-based waivered recipients may be 
34.20 	conducted by the county public health nurse to ensure coordination and avoid duplication.
34.21 	(b) (a) "Complex and regular private duty nursing care" means:
34.22 	(1) complex care is private duty nursing services provided to recipients who are 
34.23 	ventilator dependent or for whom a physician has certified that were it not for private duty 
34.24 	nursing the recipient would meet the criteria for inpatient hospital intensive care unit 
34.25 	(ICU) level of care; and
34.26 	(2) regular care is private duty nursing provided to all other recipients.
34.27 	(b) "Private duty nursing" means ongoing professional nursing services by a 
34.28 	registered or licensed practical nurse including assessment, professional nursing tasks, and 
34.29 	education, based on an assessment and physician orders to maintain or restore optimal 
34.30 	health of the recipient.
34.31 	(c) "Private duty nursing agency" means a medical assistance enrolled provider 
34.32 	licensed under chapter 144A to provide private duty nursing services.
34.33 	(d) "Regular private duty nursing" means nursing services provided to a recipient 
34.34 	who is considered stable and not at an inpatient hospital intensive care unit level of care, 
34.35 	but may have episodes of instability that are not life threatening.
35.1 	(e) "Shared private duty nursing" means the provision of nursing services by a 
35.2 	private duty nurse to two recipients at the same time and in the same setting.
35.3 		Subd. 2.Authorization; private duty nursing services. (a) All private duty 
35.4 	nursing services shall be prior authorized by the commissioner or the commissioner's 
35.5 	designee. Prior Authorization for private duty nursing services shall be based on 
35.6 	medical necessity and cost-effectiveness when compared with alternative care options. 
35.7 	The commissioner may authorize medically necessary private duty nursing services in 
35.8 	quarter-hour units when:
35.9 	(1) the recipient requires more individual and continuous care than can be provided 
35.10 	during a skilled nurse visit; or
35.11 	(2) the cares are outside of the scope of services that can be provided by a home 
35.12 	health aide or personal care assistant.
35.13 	(b) The commissioner may authorize:
35.14 	(1) up to two times the average amount of direct care hours provided in nursing 
35.15 	facilities statewide for case mix classification "K" as established by the annual cost report 
35.16 	submitted to the department by nursing facilities in May 1992;
35.17 	(2) private duty nursing in combination with other home care services up to the total 
35.18 	cost allowed under section 256B.0655, subdivision 4;
35.19 	(3) up to 16 hours per day if the recipient requires more nursing than the maximum 
35.20 	number of direct care hours as established in clause (1) and the recipient meets the hospital 
35.21 	admission criteria established under Minnesota Rules, parts 9505.0501 to 9505.0540.
35.22 	(c) The commissioner may authorize up to 16 hours per day of medically necessary 
35.23 	private duty nursing services or up to 24 hours per day of medically necessary private duty 
35.24 	nursing services until such time as the commissioner is able to make a determination of 
35.25 	eligibility for recipients who are cooperatively applying for home care services under 
35.26 	the community alternative care program developed under section 256B.49, or until it is 
35.27 	determined by the appropriate regulatory agency that a health benefit plan is or is not 
35.28 	required to pay for appropriate medically necessary health care services. Recipients 
35.29 	or their representatives must cooperatively assist the commissioner in obtaining this 
35.30 	determination. Recipients who are eligible for the community alternative care program 
35.31 	may not receive more hours of nursing under this section and sections 256B.0651, 
35.32 	256B.0653, 256B.0655, and256B.0656, and 256B.0659 than would otherwise be 
35.33 	authorized under section 256B.49.
35.34 		Subd. 2a.Private duty nursing services. (a) Private duty nursing services must 
35.35 	be used:
35.36 	(1) in the recipient's home or outside the home when normal life activities require;
36.1 	(2) when the recipient requires more individual and continuous care than can be 
36.2 	provided during a skilled nurse visit; and
36.3 	(3) when the care required is outside of the scope of services that can be provided by 
36.4 	a home health aide or personal care assistant.
36.5 	(b) Private duty nursing services must be:
36.6 	(1) assessed by a registered nurse on a form approved by the commissioner;
36.7 	(2) ordered by a physician and documented in a plan of care that is reviewed by the 
36.8 	physician at least once every 60 days; and
36.9 	(3) authorized by the commissioner under section 256B.0652.
36.10 		Subd. 2b.Noncovered private duty nursing services. Private duty nursing 
36.11 	services do not cover the following:
36.12 	(1) nursing services by a nurse who is the foster care provider of a person who has 
36.13 	not reached 18 years of age unless allowed under subdivision 4;
36.14 	(2) nursing services to more than two persons receiving shared private duty nursing 
36.15 	services from a private duty nurse in a single setting; and
36.16 	(3) nursing services provided by a registered nurse or licensed practical nurse who is 
36.17 	the recipient's legal guardian or related to the recipient as spouse, parent, or family foster 
36.18 	parent whether by blood, marriage, or adoption except as specified in section 256B.0652, 
36.19 	subdivision 4.
36.20 		Subd. 3.Shared private duty nursing care option. (a) Medical assistance 
36.21 	payments for shared private duty nursing services by a private duty nurse shall be limited 
36.22 	according to this subdivision. For the purposes of this section and sections 256B.0651, 
36.23 	256B.0653, 256B.0655, and 256B.0656, "private duty nursing agency" means an agency 
36.24 	licensed under chapter 144A to provide private duty nursing services. Unless otherwise 
36.25 	provided in this subdivision, all other statutory and regulatory provisions relating to 
36.26 	private duty nursing services apply to shared private duty nursing services. Nothing in 
36.27 	this subdivision shall be construed to reduce the total number of private duty nursing 
36.28 	hours authorized for an individual recipient.
36.29 	(b) Recipients of private duty nursing services may share nursing staff and the 
36.30 	commissioner shall provide a rate methodology for shared private duty nursing. For two 
36.31 	persons sharing nursing care, the rate paid to a provider shall not exceed 1.5 times the 
36.32 	regular private duty nursing rates paid for serving a single individual by a registered nurse 
36.33 	or licensed practical nurse. These rates apply only to situations in which both recipients 
36.34 	are present and receive shared private duty nursing care on the date for which the service 
36.35 	is billed. No more than two persons may receive shared private duty nursing services 
36.36 	from a private duty nurse in a single setting.
37.1 	(c) (b) Shared private duty nursing care is the provision of nursing services by a 
37.2 	private duty nurse to two medical assistance eligible recipients at the same time and in 
37.3 	the same setting. This subdivision does not apply when a private duty nurse is caring for 
37.4 	multiple recipients in more than one setting.
37.5 	(c) For the purposes of this subdivision, "setting" means:
37.6 	(1) the home residence or foster care home of one of the individual recipients as 
37.7 	defined in section 256B.0651; or
37.8 	(2) a child care program licensed under chapter 245A or operated by a local school 
37.9 	district or private school; or
37.10 	(3) an adult day care service licensed under chapter 245A; or
37.11 	(4) outside the home residence or foster care home of one of the recipients when 
37.12 	normal life activities take the recipients outside the home.
37.13 	This subdivision does not apply when a private duty nurse is caring for multiple 
37.14 	recipients in more than one setting.
37.15 	(d) The private duty nursing agency must offer the recipient the option of shared or 
37.16 	one-on-one private duty nursing services. The recipient may withdraw from participating 
37.17 	in a shared service arrangement at any time.
37.18 	(d) (e) The recipient or the recipient's legal representative, and the recipient's 
37.19 	physician, in conjunction with the home health care private duty nursing agency, shall 
37.20 	determine:
37.21 	(1) whether shared private duty nursing care is an appropriate option based on the 
37.22 	individual needs and preferences of the recipient; and
37.23 	(2) the amount of shared private duty nursing services authorized as part of the 
37.24 	overall authorization of nursing services.
37.25 	(e) (f) The recipient or the recipient's legal representative, in conjunction with the 
37.26 	private duty nursing agency, shall approve the setting, grouping, and arrangement of 
37.27 	shared private duty nursing care based on the individual needs and preferences of the 
37.28 	recipients. Decisions on the selection of recipients to share services must be based on the 
37.29 	ages of the recipients, compatibility, and coordination of their care needs.
37.30 	(f) (g) The following items must be considered by the recipient or the recipient's 
37.31 	legal representative and the private duty nursing agency, and documented in the recipient's 
37.32 	health service record:
37.33 	(1) the additional training needed by the private duty nurse to provide care to 
37.34 	two recipients in the same setting and to ensure that the needs of the recipients are met 
37.35 	appropriately and safely;
37.36 	(2) the setting in which the shared private duty nursing care will be provided;
38.1 	(3) the ongoing monitoring and evaluation of the effectiveness and appropriateness 
38.2 	of the service and process used to make changes in service or setting;
38.3 	(4) a contingency plan which accounts for absence of the recipient in a shared private 
38.4 	duty nursing setting due to illness or other circumstances;
38.5 	(5) staffing backup contingencies in the event of employee illness or absence; and
38.6 	(6) arrangements for additional assistance to respond to urgent or emergency care 
38.7 	needs of the recipients.
38.8 	(g) The provider must offer the recipient or responsible party the option of shared or 
38.9 	one-on-one private duty nursing services. The recipient or responsible party can withdraw 
38.10 	from participating in a shared service arrangement at any time.
38.11 	(h) The private duty nursing agency must document the following in the 
38.12 	health service record for each individual recipient sharing private duty nursing care
38.13 	The documentation for shared private duty nursing must be on a form approved by 
38.14 	the commissioner for each individual recipient sharing private duty nursing. The 
38.15 	documentation must be part of the recipient's health service record and include:
38.16 	(1) permission by the recipient or the recipient's legal representative for the 
38.17 	maximum number of shared nursing care hours per week chosen by the recipient and 
38.18 	permission for shared private duty nursing services provided in and outside the recipient's 
38.19 	home residence;
38.20 	(2) permission by the recipient or the recipient's legal representative for shared 
38.21 	private duty nursing services provided outside the recipient's residence;
38.22 	(3) permission by the recipient or the recipient's legal representative for others to 
38.23 	receive shared private duty nursing services in the recipient's residence;
38.24 	(4) revocation by the recipient or the recipient's legal representative of for the shared 
38.25 	private duty nursing care authorization, or the shared care to be provided to others in the 
38.26 	recipient's residence, or the shared private duty nursing services to be provided outside
38.27 	permission, or services provided to others in and outside the recipient's residence; and
38.28 	(5) (3) daily documentation of the shared private duty nursing services provided by 
38.29 	each identified private duty nurse, including:
38.30 	(i) the names of each recipient receiving shared private duty nursing services 
38.31 	together;
38.32 	(ii) the setting for the shared services, including the starting and ending times that 
38.33 	the recipient received shared private duty nursing care; and
38.34 	(iii) notes by the private duty nurse regarding changes in the recipient's condition, 
38.35 	problems that may arise from the sharing of private duty nursing services, and scheduling 
38.36 	and care issues.
39.1 	(i) Unless otherwise provided in this subdivision, all other statutory and regulatory 
39.2 	provisions relating to private duty nursing services apply to shared private duty nursing 
39.3 	services.
39.4 	Nothing in this subdivision shall be construed to reduce the total number of private 
39.5 	duty nursing hours authorized for an individual recipient under subdivision 2.
39.6 	(i) The commissioner shall provide a rate methodology for shared private duty 
39.7 	nursing. For two persons sharing nursing care, the rate paid to a provider must not exceed 
39.8 	1.5 times the regular private duty nursing rates paid for serving a single individual by a 
39.9 	registered nurse or licensed practical nurse. These rates apply only to situations in which 
39.10 	both recipients are present and receive shared private duty nursing care on the date for 
39.11 	which the service is billed.
39.12 		Subd. 4.Hardship criteria; private duty nursing. (a) Payment is allowed for 
39.13 	extraordinary services that require specialized nursing skills and are provided by parents 
39.14 	of minor children, spouses, and legal guardians who are providing private duty nursing 
39.15 	care under the following conditions:
39.16 	(1) the provision of these services is not legally required of the parents, spouses, 
39.17 	or legal guardians;
39.18 	(2) the services are necessary to prevent hospitalization of the recipient; and
39.19 	(3) the recipient is eligible for state plan home care or a home and community-based 
39.20 	waiver and one of the following hardship criteria are met:
39.21 	(i) the parent, spouse, or legal guardian resigns from a part-time or full-time job to 
39.22 	provide nursing care for the recipient; or
39.23 	(ii) the parent, spouse, or legal guardian goes from a full-time to a part-time job with 
39.24 	less compensation to provide nursing care for the recipient; or
39.25 	(iii) the parent, spouse, or legal guardian takes a leave of absence without pay to 
39.26 	provide nursing care for the recipient; or
39.27 	(iv) because of labor conditions, special language needs, or intermittent hours of 
39.28 	care needed, the parent, spouse, or legal guardian is needed in order to provide adequate 
39.29 	private duty nursing services to meet the medical needs of the recipient.
39.30 	(b) Private duty nursing may be provided by a parent, spouse, family foster parent, 
39.31 	or legal guardian who is a nurse licensed in Minnesota. Private duty nursing services 
39.32 	provided by a parent, spouse, family foster parent, or legal guardian cannot be used in 
39.33 	lieu of nursing services covered and available under liable third-party payors, including 
39.34 	Medicare. The private duty nursing provided by a parent, spouse, family foster parent, or 
39.35 	legal guardian must be included in the service plan agreement. Authorized skilled nursing 
39.36 	services for a single recipient or recipients with the same residence and provided by the 
40.1 	parent, spouse, family foster parent, or legal guardian may not exceed 50 percent of the 
40.2 	total approved nursing hours, or eight hours per day, whichever is less, up to a maximum 
40.3 	of 40 hours per week. A parent or parents, spouse, family foster parent, or legal guardian 
40.4 	shall not provide more than 40 hours of services in a seven-day period. For parents, family 
40.5 	foster parents, and legal guardians, 40 hours is the total amount allowed regardless of the 
40.6 	number of children or adults who receive services. Nothing in this subdivision precludes 
40.7 	the parent's, spouse's, or legal guardian's obligation of assuming the nonreimbursed family 
40.8 	responsibilities of emergency backup caregiver and primary caregiver.
40.9 	(c) A parent, family foster parent,  or a spouse may not be paid to provide private 
40.10 	duty nursing care if:
40.11 	(1) the parent or spouse fails to pass a criminal background check according to 
40.12 	chapter 245C, or if;
40.13 	(2) it has been determined by the home health private duty nursing agency, the 
40.14 	case manager, or the physician that the private duty nursing care provided by the parent, 
40.15 	family foster parent, spouse, or legal guardian is unsafe; or
40.16 	(3) the parent, family foster parent, spouse, or legal guardian do not follow physician 
40.17 	orders.
40.18 	(d) For purposes of this section, "assessment" means a review and evaluation of a 
40.19 	recipient's need for home care services conducted in person. Assessments for private duty 
40.20 	nursing must be conducted by a registered nurse.

40.21 	Sec. 29. Minnesota Statutes 2008, section 256B.0655, subdivision 1b, is amended to 
40.22 	read:
40.23 		Subd. 1b.Assessment. "Assessment" means a review and evaluation of a recipient's 
40.24 	need for home care services conducted in person. Assessments for personal care assistant 
40.25 	services shall be conducted by the county public health nurse or a certified public 
40.26 	health nurse under contract with the county. A face-to-face An in-person assessment 
40.27 	must include: documentation of health status, determination of need, evaluation of 
40.28 	service effectiveness, identification of appropriate services, service plan development 
40.29 	or modification, coordination of services, referrals and follow-up to appropriate payers 
40.30 	and community resources, completion of required reports, recommendation of service 
40.31 	authorization, and consumer education. Once the need for personal care assistant 
40.32 	services is determined under this section or sections 256B.0651, 256B.0653, 256B.0654, 
40.33 	and 256B.0656, the county public health nurse or certified public health nurse under 
40.34 	contract with the county is responsible for communicating this recommendation to the 
40.35 	commissioner and the recipient. A face-to-face assessment for personal care assistant 
41.1 	services is conducted on those recipients who have never had a county public health 
41.2 	nurse assessment. A face-to-face An in-person assessment must occur at least annually or 
41.3 	when there is a significant change in the recipient's condition or when there is a change 
41.4 	in the need for personal care assistant services. A service update may substitute for 
41.5 	the annual face-to-face assessment when there is not a significant change in recipient 
41.6 	condition or a change in the need for personal care assistant service. A service update 
41.7 	may be completed by telephone, used when there is no need for an increase in personal 
41.8 	care assistant services, and used for two consecutive assessments if followed by a 
41.9 	face-to-face assessment. A service update must be completed on a form approved by the 
41.10 	commissioner. A service update or review for temporary increase includes a review of 
41.11 	initial baseline data, evaluation of service effectiveness, redetermination of service need, 
41.12 	modification of service plan and appropriate referrals, update of initial forms, obtaining 
41.13 	service authorization, and on going consumer education. Assessments must be completed 
41.14 	on forms provided by the commissioner within 30 days of a request for home care services 
41.15 	by a recipient or responsible party or personal care provider agency.

41.16 	Sec. 30. Minnesota Statutes 2008, section 256B.0655, subdivision 4, is amended to 
41.17 	read:
41.18 		Subd. 4.Prior Authorization; personal care assistance and qualified 
41.19 	professional. The commissioner, or the commissioner's designee, shall review the 
41.20 	assessment, service update, request for temporary services, request for flexible use option, 
41.21 	service plan, and any additional information that is submitted. The commissioner shall, 
41.22 	within 30 days after receiving a complete request, assessment, and service plan, authorize 
41.23 	home care services as follows:
41.24 	(1) (a) All personal care assistant assistance  services and, supervision by a 
41.25 	qualified professional, if requested by the recipient, and additional services beyond the 
41.26 	limits established in section 256B.0652, subdivision 11, must be prior authorized by 
41.27 	the commissioner or the commissioner's designee before services begin except for the 
41.28 	assessments established in section sections256B.0651, subdivision 11, and 256B.0911.
41.29 	The authorization for personal care assistance and qualified professional services under 
41.30 	section 256B.0659 must be completed within 30 days after receiving a complete request.
41.31 	(b) The amount of personal care assistant assistance  services authorized must be 
41.32 	based on the recipient's home care rating. The home care rating shall be determined by 
41.33 	the commissioner or the commissioner's designee based on information submitted to the 
41.34 	commissioner identifying the following:
42.1 	(1) total number of dependencies of activities of daily living as defined in section 
42.2 	256B.0659;
42.3 	(2) number of complex health-related functions as defined in section 256B.0659; and
42.4 	(3) number of behavior descriptions as defined in section 256B.0659.
42.5 	(c) The methodology to determine total time for personal care assistance services for 
42.6 	each home care rating is based on the median paid units per day for each home care rating 
42.7 	from fiscal year 2007 data for the personal care assistance program. Each home care rating 
42.8 	has a base level of hours assigned. Additional time is added through the assessment and 
42.9 	identification of the following:
42.10 	(1) 30 additional minutes per day for a dependency in each critical activity of daily 
42.11 	living as defined in section 256B.0659;
42.12 	(2) 30 additional minutes per day for each complex health-related function as 
42.13 	defined in section 256B.0659; and
42.14 	(3) 30 additional minutes per day for each behavior issue as defined in section 
42.15 	256B.0659.
42.16 	(d) A limit of 96 units of qualified professional supervision may be authorized for 
42.17 	each recipient receiving personal care assistance services. A request to the commissioner 
42.18 	to exceed this total in a calendar year must be requested by the personal care provider 
42.19 	agency on a form approved by the commissioner.
42.20 	A child may not be found to be dependent in an activity of daily living if because 
42.21 	of the child's age an adult would either perform the activity for the child or assist the 
42.22 	child with the activity and the amount of assistance needed is similar to the assistance 
42.23 	appropriate for a typical child of the same age. Based on medical necessity, the 
42.24 	commissioner may authorize:
42.25 	(A) up to two times the average number of direct care hours provided in nursing 
42.26 	facilities for the recipient's comparable case mix level; or
42.27 	(B) up to three times the average number of direct care hours provided in nursing 
42.28 	facilities for recipients who have complex medical needs or are dependent in at least seven 
42.29 	activities of daily living and need physical assistance with eating or have a neurological 
42.30 	diagnosis; or
42.31 	(C) up to 60 percent of the average reimbursement rate, as of July 1, 1991, for care 
42.32 	provided in a regional treatment center for recipients who have Level I behavior, plus any 
42.33 	inflation adjustment as provided by the legislature for personal care service; or
42.34 	(D) up to the amount the commissioner would pay, as of July 1, 1991, plus any 
42.35 	inflation adjustment provided for home care services, for care provided in a regional 
42.36 	treatment center for recipients referred to the commissioner by a regional treatment center 
43.1 	preadmission evaluation team. For purposes of this clause, home care services means 
43.2 	all services provided in the home or community that would be included in the payment 
43.3 	to a regional treatment center; or
43.4 	(E) up to the amount medical assistance would reimburse for facility care for 
43.5 	recipients referred to the commissioner by a preadmission screening team established 
43.6 	under section 256B.0911 or 256B.092; and
43.7 	(F) a reasonable amount of time for the provision of supervision by a qualified 
43.8 	professional of personal care assistant services, if a qualified professional is requested by 
43.9 	the recipient or responsible party.
43.10 	(2) The number of direct care hours shall be determined according to the annual cost 
43.11 	report submitted to the department by nursing facilities. The average number of direct care 
43.12 	hours, as established by May 1, 1992, shall be calculated and incorporated into the home 
43.13 	care limits on July 1, 1992. These limits shall be calculated to the nearest quarter hour.
43.14 	(3) The home care rating shall be determined by the commissioner or the 
43.15 	commissioner's designee based on information submitted to the commissioner by the 
43.16 	county public health nurse on forms specified by the commissioner. The home care rating 
43.17 	shall be a combination of current assessment tools developed under sections 256B.0911
43.18 	and 256B.501 with an addition for seizure activity that will assess the frequency and 
43.19 	severity of seizure activity and with adjustments, additions, and clarifications that are 
43.20 	necessary to reflect the needs and conditions of recipients who need home care including 
43.21 	children and adults under 65 years of age. The commissioner shall establish these forms 
43.22 	and protocols under this section and sections 256B.0651, 256B.0653, 256B.0654, and 
43.23 	256B.0656 and shall use an advisory group, including representatives of recipients, 
43.24 	providers, and counties, for consultation in establishing and revising the forms and 
43.25 	protocols.
43.26 	(4) A recipient shall qualify as having complex medical needs if the care required is 
43.27 	difficult to perform and because of recipient's medical condition requires more time than 
43.28 	community-based standards allow or requires more skill than would ordinarily be required 
43.29 	and the recipient needs or has one or more of the following:
43.30 	(A) daily tube feedings;
43.31 	(B) daily parenteral therapy;
43.32 	(C) wound or decubiti care;
43.33 	(D) postural drainage, percussion, nebulizer treatments, suctioning, tracheotomy 
43.34 	care, oxygen, mechanical ventilation;
43.35 	(E) catheterization;
43.36 	(F) ostomy care;
44.1 	(G) quadriplegia; or
44.2 	(H) other comparable medical conditions or treatments the commissioner determines 
44.3 	would otherwise require institutional care.
44.4 	(5) A recipient shall qualify as having Level I behavior if there is reasonable 
44.5 	supporting evidence that the recipient exhibits, or that without supervision, observation, or 
44.6 	redirection would exhibit, one or more of the following behaviors that cause, or have the 
44.7 	potential to cause:
44.8 	(A) injury to the recipient's own body;
44.9 	(B) physical injury to other people; or
44.10 	(C) destruction of property.
44.11 	(6) Time authorized for personal care relating to Level I behavior in paragraph 
44.12 	(5), clauses (A) to (C), shall be based on the predictability, frequency, and amount of 
44.13 	intervention required.
44.14 	(7) A recipient shall qualify as having Level II behavior if the recipient exhibits on a 
44.15 	daily basis one or more of the following behaviors that interfere with the completion of 
44.16 	personal care assistant services under subdivision 2, paragraph (a):
44.17 	(A) unusual or repetitive habits;
44.18 	(B) withdrawn behavior; or
44.19 	(C) offensive behavior.
44.20 	(8) A recipient with a home care rating of Level II behavior in paragraph (7), clauses 
44.21 	(A) to (C), shall be rated as comparable to a recipient with complex medical needs under 
44.22 	paragraph (4). If a recipient has both complex medical needs and Level II behavior, the 
44.23 	home care rating shall be the next complex category up to the maximum rating under 
44.24 	paragraph (1), clause (B).

44.25 	Sec. 31. [256B.0659] PERSONAL CARE ASSISTANCE PROGRAM.
44.26 		Subdivision 1.Definitions. (a) For the purposes of this section, the terms defined in 
44.27 	paragraphs (b) to (p) have the meanings given unless otherwise provided in text.
44.28 	(b) "Activities of daily living" means grooming, dressing, bathing, transferring, 
44.29 	mobility, positioning, eating, and toileting.
44.30 	(c) "Behavior" means a category to determine the home care rating and is based on 
44.31 	the criteria found in this section. "Level I behavior" means physical aggression towards 
44.32 	self, others, or property that requires the immediate response of another person.
44.33 	(d) "Complex health-related needs" means a category to determine the home care 
44.34 	rating and is based on the criteria found in this section.
45.1 	(e) "Critical activities of daily living" means transferring, mobility, eating, and 
45.2 	toileting.
45.3 	(f) "Dependency in activities of daily living" means a person requires assistance to 
45.4 	begin and complete one or more of the activities of daily living.
45.5 	(g) "Health-related procedures and tasks" means procedures and tasks that can 
45.6 	be delegated or assigned by a licensed health care professional under state law to be 
45.7 	performed by a personal care assistant.
45.8 	(h) "Instrumental activities of daily living" means activities to include meal planning 
45.9 	and preparation; basic assistance with paying bills; shopping for food, clothing, and 
45.10 	other essential items; performing household tasks integral to the personal care assistance 
45.11 	services; communication by telephone and other media; and traveling, including to 
45.12 	medical appointments and to participate in the community.
45.13 	(i) "Managing employee" has the same definition as Code of Federal Regulations, 
45.14 	title 42, section 455.
45.15 	(j) "Qualified professional" means a professional providing supervision of personal 
45.16 	care assistance services and staff as defined in section 256B.0625, subdivision 19c.
45.17 	(k) "Personal care assistance provider agency" means a medical assistance enrolled 
45.18 	provider that provides or assists with providing personal care assistance services and 
45.19 	includes personal care assistance provider organizations, personal care assistance choice 
45.20 	agency, class A licensed nursing agency, and Medicare-certified home health agency.
45.21 	(l) "Personal care assistant" or "PCA" means an individual employed by a personal 
45.22 	care assistance agency who provides personal care assistance services.
45.23 	(m) "Personal care assistance care plan" means a written description of personal 
45.24 	care assistance services developed by the personal care assistance provider according 
45.25 	to the service plan.
45.26 	(n) "Responsible party" means an individual who lives with and is capable of 
45.27 	providing the support necessary to assist the recipient to live in the community.
45.28 	(o) "Self-administered medication" means medication taken orally, by injection or 
45.29 	insertion, or applied topically without the need for assistance.
45.30 	(p) "Service plan" means a written summary of the assessment and description of the 
45.31 	services needed by the recipient.
45.32 		Subd. 2.Personal care assistance services; covered services. (a) The personal 
45.33 	care assistance services eligible for payment include services and supports furnished 
45.34 	to an individual, as needed, to assist in:
45.35 	(1) activities of daily living;
45.36 	(2) health-related procedures and tasks;
46.1 	(3) observation and redirection of behaviors; and
46.2 	(4) instrumental activities of daily living.
46.3 	(b) Activities of daily living include the following covered services:
46.4 	(1) dressing, including assistance with choosing, application, and changing of 
46.5 	clothing and application of special appliances, wraps, or clothing;
46.6 	(2) grooming, including assistance with basic hair care, oral care, shaving, applying 
46.7 	cosmetics and deodorant, and care of eyeglasses and hearing aids. Nail care is included, 
46.8 	except for recipients who are diabetic or have poor circulation;
46.9 	(3) bathing, including assistance with basic personal hygiene and skin care;
46.10 	(4) eating, including assistance with hand washing and application of orthotics 
46.11 	required for eating, transfers, and feeding;
46.12 	(5) transfers, including assistance with transferring the recipient from one seating or 
46.13 	reclining area to another;
46.14 	(6) mobility, including assistance with ambulation, including use of a wheelchair. 
46.15 	Mobility does not include providing transportation for a recipient;
46.16 	(7) positioning, including assistance with positioning or turning a recipient for 
46.17 	necessary care and comfort; and
46.18 	(8) toileting, including assistance with helping recipient with bowel or bladder 
46.19 	elimination and care including transfers, mobility, positioning, feminine hygiene, use of 
46.20 	toileting equipment or supplies, cleansing the perineal area, inspection of the skin, and 
46.21 	adjusting clothing.
46.22 	(c) Health-related procedures and tasks include the following covered services:
46.23 	(1) range of motion and passive exercise to maintain a recipient's strength and 
46.24 	muscle functioning;
46.25 	(2) assistance with self-administered medication as defined by this section, including 
46.26 	reminders to take medication, bringing medication to the recipient, and assistance with 
46.27 	opening medication under the direction of the recipient or responsible party;
46.28 	(3) interventions for seizure disorders, including monitoring and observation; and
46.29 	(4) other activities considered within the scope of the personal care service and 
46.30 	meeting the definition of health-related procedures and tasks under this section.
46.31 	(d) A personal care assistant may provide health-related procedures and tasks 
46.32 	associated with the complex health-related needs of a recipient if the procedures and 
46.33 	tasks meet the definition of health-related procedures and tasks under this section and the 
46.34 	personal care assistant is trained by a qualified professional and demonstrates competency 
46.35 	to safely complete the procedures and tasks. Delegation of health-related procedures and 
47.1 	tasks and all training must be documented in the personal care assistance care plan and the 
47.2 	recipient's and personal care assistant's files.
47.3 	(e) For a personal care assistant to provide the health-related procedures and tasks of 
47.4 	tracheostomy suctioning and services to recipients on ventilator support there must be:
47.5 	(1) delegation and training by a registered nurse, certified or licensed respiratory 
47.6 	therapist, or a physician;
47.7 	(2) utilization of clean rather than sterile procedure;
47.8 	(3) specialized training about the health-related procedures and tasks and equipment, 
47.9 	including ventilator operation and maintenance;
47.10 	(4) individualized training regarding the needs of the recipient; and
47.11 	(5) supervision by a qualified professional who is a registered nurse.
47.12 	(f) A personal care assistant may observe and redirect the recipient for episodes 
47.13 	where there is a need for redirection due to behaviors. Training of the personal care 
47.14 	assistant must occur based on the needs of the recipient, the personal care assistance care 
47.15 	plan, and any other support services provided.
47.16 	(g) Instrumental activities of daily living under subdivision 1, paragraph (h).
47.17 		Subd. 3.Noncovered personal care assistance services. (a) Personal care 
47.18 	assistance services are not eligible for medical assistance payment under this section 
47.19 	when provided:
47.20 	(1) by the recipient's spouse, parent of a recipient under the age of 18, paid legal 
47.21 	guardian, licensed foster provider, or responsible party;
47.22 	(2) in lieu of other staffing options in a residential or child care setting;
47.23 	(3) solely as a child care or babysitting service; or
47.24 	(4) without authorization by the commissioner or the commissioner's designee.
47.25 	(b) The following personal care services are not eligible for medical assistance 
47.26 	payment under this section when provided in residential settings:
47.27 	(1) when the provider of home care services who is not related by blood, marriage, 
47.28 	or adoption owns or otherwise controls the living arrangement, including licensed or 
47.29 	unlicensed services; or
47.30 	(2) when personal care assistance services are the responsibility of a residential or 
47.31 	program license holder under the terms of a service agreement and administrative rules.
47.32 	(c) Other specific tasks not covered under paragraph (a) or (b) that are not eligible 
47.33 	for medical assistance reimbursement for personal care assistance services under this 
47.34 	section include:
47.35 	(1) sterile procedures;
47.36 	(2) injections of fluids and medications into veins, muscles, or skin;
48.1 	(3) home maintenance or chore services;
48.2 	(4) homemaker services not an integral part of assessed personal care assistance 
48.3 	services needed by a recipient;
48.4 	(5) application of restraints or implementation of procedures under section 245.825;
48.5 	(6) instrumental activities of daily living for children under the age of 18; and
48.6 	(7) assessments for personal care assistance services by personal care assistance 
48.7 	provider agencies or by independently enrolled registered nurses.
48.8 		Subd. 4.Assessment for personal care assistance services. (a) An assessment 
48.9 	as defined in section 256B.0655, subdivision 1b, must be completed for personal care 
48.10 	assistance services.
48.11 	(b) The following limitations apply to the assessment:
48.12 	(1) a person must be assessed as dependent in an activity of daily living based 
48.13 	on the person's need, on a daily basis, for:
48.14 	(i) cueing and constant supervision to complete the task; or
48.15 	(ii) hands-on assistance to complete the task; and
48.16 	(2) a child may not be found to be dependent in an activity of daily living if because 
48.17 	of the child's age an adult would either perform the activity for the child or assist the child 
48.18 	with the activity. Assistance needed is the assistance appropriate for a typical child of 
48.19 	the same age.
48.20 	(c) Assessment for complex health-related needs must meet the criteria in this 
48.21 	paragraph. During the assessment process, a recipient qualifies as having complex 
48.22 	health-related needs if the recipient has one or more of the interventions that are ordered by 
48.23 	a physician, specified in a personal care assistance care plan, and found in the following:
48.24 	(1) tube feedings requiring:
48.25 	(i) a gastro/jejunostomy tube; or
48.26 	(ii) continuous tube feeding lasting longer than 12 hours per day;
48.27 	(2) wounds described as:
48.28 	(i) stage III or stage IV;
48.29 	(ii) multiple wounds;
48.30 	(iii) requiring sterile or clean dressing changes or a wound vac; or
48.31 	(iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require 
48.32 	specialized care;
48.33 	(3) parenteral therapy described as:
48.34 	(i) IV therapy more than two times per week lasting longer than four hours for 
48.35 	each treatment; or
48.36 	(ii) total parenteral nutrition (TPN) daily;
49.1 	(4) respiratory interventions including:
49.2 	(i) oxygen required more than eight hours per day;
49.3 	(ii) respiratory vest more than one time per day;
49.4 	(iii) bronchial drainage treatments more than two times per day;
49.5 	(iv) sterile or clean suctioning more than six times per day;
49.6 	(v) dependence on another to apply respiratory ventilation augmentation devises 
49.7 	such as BiPAP and CPAP; and
49.8 	(vi) ventilator dependence under section 256B.0652;
49.9 	(5) insertion and maintenance of catheter including:
49.10 	(i) sterile catheter changes more than one time per month;
49.11 	(ii) clean self-catheterization more than six times per day; or
49.12 	(iii) bladder irrigations;
49.13 	(6) bowel program more than two times per week requiring more than 30 minutes to 
49.14 	perform each time;
49.15 	(7) neurological intervention including:
49.16 	(i) seizures more than two times per week and requiring significant physical 
49.17 	assistance to maintain safety; or
49.18 	(ii) swallowing disorders diagnosed by a physician and requiring specialized 
49.19 	assistance from another on a daily basis; and
49.20 	(8) other congenital or acquired diseases creating a need for significantly increased 
49.21 	direct hands-on assistance and interventions in six to eight activities of daily living.
49.22 	(d) An assessment of behaviors must meet the criteria in this paragraph. A recipient 
49.23 	qualifies as having a need for assistance due to behaviors if the recipient's behavior requires 
49.24 	assistance at least four times per week and shows one or more of the following behaviors:
49.25 	(1) physical aggression towards self or others, or destruction of property that requires 
49.26 	the immediate response of another person;
49.27 	(2) increased vulnerability due to cognitive deficits or socially inappropriate 
49.28 	behavior; or
49.29 	(3) verbally aggressive and resistive to care.
49.30 		Subd. 5.Service, support planning, and referral. (a) The assessor, with the 
49.31 	recipient or responsible party, shall review the assessment information and determine 
49.32 	referrals for other payers, services, and community supports as appropriate.
49.33 	(b) The recipient must be referred for evaluation, services, or supports that are 
49.34 	appropriate to help meet the recipient's needs including, but not limited to, the following 
49.35 	circumstances:
50.1 	(1) when there is another payer who is responsible to provide the service to meet 
50.2 	the recipient's needs;
50.3 	(2) when the recipient qualifies for assistance due to mental illness or behaviors 
50.4 	under this section, a referral for a mental health diagnostic and functional assessment 
50.5 	must be completed, or referral must be made for other specific mental health services or 
50.6 	other community services;
50.7 	(3) when the recipient is eligible for medical assistance and meets medical assistance 
50.8 	eligibility for a home health aide or skilled nurse visit;
50.9 	(4) when the recipient would benefit from an evaluation for another service; and
50.10 	(5) when there is a more appropriate service to meet the assessed needs.
50.11 	(c) The reimbursement rates for public health nurse visits that relate to the provision 
50.12 	of personal care assistance services under this section and section 256B.0625, subdivision 
50.13 	19a, are:
50.14 	(1) $210.50 for a face-to-face assessment visit;
50.15 	(2) $105.25 for each service update; and
50.16 	(3) $105.25 for each request for a temporary service increase.
50.17 	(d) The rates specified in paragraph (c) must be adjusted to reflect provider rate 
50.18 	increases for personal care assistance services that are approved by the legislature for the 
50.19 	fiscal year ending June 30, 2000, and subsequent fiscal years. Any requirements applied 
50.20 	by the legislature to provider rate increases for personal care assistance services also 
50.21 	apply to adjustments under this paragraph.
50.22 	(e) Effective July 1, 2008, the payment rate for an assessment under this section and 
50.23 	section 256B.0651 shall be reduced by 25 percent when the assessment is not completed 
50.24 	on time and the service agreement documentation is not submitted in time to continue 
50.25 	services. The commissioner shall reduce the amount of the claim for those assessments 
50.26 	that are not submitted on time.
50.27 		Subd. 6.Service plan. The service plan must be completed by the assessor with the 
50.28 	recipient and responsible party on a form determined by the commissioner and include 
50.29 	a summary of the assessment with a description of the need, authorized amount, and 
50.30 	expected outcomes and goals of personal care assistance services. The recipient and 
50.31 	the provider chosen by the recipient or responsible party must be given a copy of the 
50.32 	completed service plan within ten working days of the assessment. The recipient or 
50.33 	responsible party must be given information by the assessor about the options in the 
50.34 	personal care assistance program to allow for review and decision making.
50.35 		Subd. 7.Personal care assistance care plan. (a) Each recipient must have a 
50.36 	current personal care assistance care plan based on the service plan in subdivision 6 that is 
51.1 	developed by the qualified professional with the recipient and responsible party. A copy of 
51.2 	the most current personal care assistance care plan is required to be in the recipient's home 
51.3 	and in the recipient's file at the provider agency.
51.4 	(b) The personal care assistance care plan must have the following components:
51.5 	(1) start and end date of the care plan;
51.6 	(2) recipient demographic information, including name and telephone number;
51.7 	(3) emergency numbers, procedures, and a description of measures to address 
51.8 	identified safety and vulnerability issues, including a backup staffing plan;
51.9 	(4) name of responsible party and instructions for contact;
51.10 	(5) description of the recipient's individualized needs for assistance with activities of 
51.11 	daily living, instrumental activities of daily living, health-related tasks, and behaviors; and
51.12 	(6) dated signatures of recipient or responsible party and qualified professional.
51.13 	(c) The personal care assistance care plan must have instructions and comments 
51.14 	about the recipient's needs for assistance and any special instructions or procedures 
51.15 	required. The month-to-month plan for the use of personal care assistance services is part 
51.16 	of the personal care assistance care plan. The personal care assistance care plan must 
51.17 	be completed within the first week after start of services with a personal care provider 
51.18 	agency and must be updated as needed when there is a change in need for personal care 
51.19 	assistance services. A new personal care assistance care plan is required annually at the 
51.20 	time of the reassessment.
51.21 		Subd. 8.Communication with recipient's physician. The personal care assistance 
51.22 	program requires communication with the recipient's physician about a recipient's assessed 
51.23 	needs for personal care assistance services. The commissioner shall work with the state 
51.24 	medical director to develop options for communication with the recipient's physician.
51.25 		Subd. 9.Responsible party; generally. (a) "Responsible party" means an 
51.26 	individual who lives with and is capable of providing the support necessary to assist the 
51.27 	recipient to live in the community.
51.28 	(b) A responsible party must be 18 years of age, actively participate in planning and 
51.29 	directing of personal care assistance services, and attend all assessments for the recipient.
51.30 	(c) A responsible party must not have a direct or indirect financial interest in care 
51.31 	provided to the recipient and must not be the:
51.32 	(1) personal care assistant;
51.33 	(2) home care provider agency owner or staff; or
51.34 	(3) county staff acting as part of employment.
52.1 	(d) A licensed family foster parent who lives with the recipient may be the 
52.2 	responsible party as long as the family foster parent meets the other responsible party 
52.3 	requirements.
52.4 	(e) A responsible party is required when:
52.5 	(1) the person is a minor according to section 524.5-102, subdivision 10;
52.6 	(2) the person is an incapacitated adult according to section 524.5-102, subdivision 
52.7 	6, resulting in a court-appointed guardian; or
52.8 	(3) the assessment according to section 256B.0655, subdivision 1b, determines that 
52.9 	the recipient is in need of a responsible party to direct the recipient's care.
52.10 	(f) There may be two persons designated as the responsible party for reasons such as 
52.11 	divided households and court-ordered custodies. Each person named as responsible party 
52.12 	must meet the program criteria and responsibilities including living with the recipient at 
52.13 	the time they are serving as the responsible party.
52.14 	(g) The recipient or the recipient's legal representative shall appoint a responsible 
52.15 	party if necessary to direct and supervise the care provided to the recipient. The 
52.16 	responsible party must be identified at the time of assessment and listed on the recipient's 
52.17 	service agreement and personal care assistance care plan.
52.18 		Subd. 10.Responsible party; duties; delegation. (a) A responsible party shall 
52.19 	enter into a written agreement with a personal care assistance provider agency, on a form 
52.20 	determined by the commissioner, to perform the following duties:
52.21 	(1) live with the individual who is receiving personal care assistance services;
52.22 	(2) be available while care is provided in a method agreed upon by the individual 
52.23 	or the individual's legal representative and documented in the recipient's personal care 
52.24 	assistance care plan;
52.25 	(3) monitor personal care assistance services to ensure the recipient's personal care 
52.26 	assistance care plan is being followed; and
52.27 	(4) review and sign personal care assistance time sheets after services are provided 
52.28 	to provide verification of the personal care assistance services.
52.29 	Failure to provide the support required by the recipient must result in a referral to the 
52.30 	county common entry point.
52.31 	(b) Responsible parties who are parents of minors or guardians of minors or 
52.32 	incapacitated persons may delegate the responsibility to another adult who is not the 
52.33 	personal care assistant during a temporary absence of at least 24 hours but not more 
52.34 	than six months. The person delegated as a responsible party must be able to meet the 
52.35 	definition of the responsible party, except that the delegated responsible party is required 
52.36 	to reside with the recipient only while serving as the responsible party. The responsible 
53.1 	party must ensure that the delegate performs the functions of the responsible party, is 
53.2 	identified at the time of the assessment, and is listed on the personal care assistance 
53.3 	care plan. The responsible party must communicate to the personal care assistance 
53.4 	provider agency about the need for a delegate responsible party, including the name of the 
53.5 	delegated responsible party, dates the delegated responsible party will be living with the 
53.6 	recipient, and contact numbers.
53.7 		Subd. 11.Personal care assistant; requirements. (a) A personal care assistant 
53.8 	must meet the following requirements:
53.9 	(1) be at least 18 years of age with the exception of persons who are 16 or 17 years 
53.10 	of age with these additional requirements:
53.11 	(i) supervision by a qualified professional every 60 days; and
53.12 	(ii) employment by only one personal care assistance provider agency responsible 
53.13 	for compliance with current labor laws;
53.14 	(2) be employed by a personal care assistance provider agency;
53.15 	(3) enroll with the department as a personal care assistant after clearing a background 
53.16 	study. Before a personal care assistant provides services, the personal care assistance 
53.17 	provider agency must initiate a background study on the personal care assistant under 
53.18 	chapter 245C, and the personal care assistance provider agency must have received a 
53.19 	notice from the commissioner that the personal care assistant is:
53.20 	(i) not disqualified under section 245C.14; or
53.21 	(ii) is disqualified, but the personal care assistant has received a set aside of the 
53.22 	disqualification under section 245C.22;
53.23 	(4) be able to effectively communicate with the recipient and personal care 
53.24 	assistance provider agency;
53.25 	(5) be able to provide covered personal care assistance services according to the 
53.26 	recipient's personal care assistance care plan, respond appropriately to recipient needs, 
53.27 	and report changes in the recipient's condition to the supervising qualified professional 
53.28 	or physician;
53.29 	(6) not be a consumer of personal care assistance services;
53.30 	(7) maintain daily written records including, but not limited to, time sheets under 
53.31 	subdivision 12;
53.32 	(8) complete standardized training as determined by the commissioner before 
53.33 	completing enrollment. Personal care assistant training must include successful completion 
53.34 	of the following training components: basic first aid, vulnerable adult, child maltreatment, 
53.35 	OSHA universal precautions, basic roles and responsibilities of personal care assistants 
53.36 	including information about assistance with lifting and transfers for recipients, emergency 
54.1 	preparedness, orientation to positive behavioral practices, fraud issues, and completion of 
54.2 	time sheets. Upon completion of the training components, the personal care assistant must 
54.3 	demonstrate the competency to provide assistance to recipients;
54.4 	(9) complete training and orientation on the needs of the recipient within the first 
54.5 	seven days after the services begin; and
54.6 	(10) be limited to providing and being paid for up to 310 hours per month of personal 
54.7 	care assistance services regardless of the number of recipients being served or the number 
54.8 	of personal care assistance provider agencies enrolled with.
54.9 	(b) A legal guardian may be a personal care assistant if the guardian is not being paid 
54.10 	for the guardian services and meets the criteria for personal care assistants in paragraph (a).
54.11 	(c) Persons who do not qualify as a personal care assistant include parents and 
54.12 	stepparents of minors, spouses, paid legal guardians, foster care providers, except as 
54.13 	otherwise allowed in section 256B.0625, subdivision 19a, or staff of a residential setting.
54.14 		Subd. 12.Documentation of personal care assistance services provided. (a) 
54.15 	Personal care assistance services for a recipient must be documented daily, on a time sheet 
54.16 	form approved by the commissioner by each personal care assistant. All documentation 
54.17 	may be Web-based or electronic or paper documents. The completed form must be 
54.18 	submitted on a monthly basis to the provider agency and kept in the recipient's health 
54.19 	record.
54.20 	(b) The activity documentation must correspond to the personal care assistance care 
54.21 	plan and be reviewed by the qualified professional.
54.22 	(c) The personal care assistant time sheet must be on a form approved by the 
54.23 	commissioner documenting time the personal care assistant provides services in the home. 
54.24 	The following criteria must be included in the time sheet:
54.25 	(1) full name of personal care assistant and individual provider number;
54.26 	(2) provider name and telephone numbers;
54.27 	(3) full name of recipient;
54.28 	(4) consecutive dates, including month, day, and year, and arrival and departure 
54.29 	time with a.m. or p.m. notations;
54.30 	(5) signatures of recipient or the responsible party;
54.31 	(6) personal signature of the personal care assistant;
54.32 	(7) any shared care provided, if applicable;
54.33 	(8) a statement that it is a federal crime to provide false information on personal 
54.34 	care service billings for medical assistance payments; and
54.35 	(9) dates and location of recipient stays in a hospital, care facility, or incarceration.
55.1 		Subd. 13.Qualified professional; qualifications. (a) The qualified professional 
55.2 	must be employed by a personal care assistance provider agency and meet the definition 
55.3 	under section 256B.0625, subdivision 19c. Before a qualified professional provides 
55.4 	services, the personal care assistance provider agency must initiate a background study on 
55.5 	the qualified professional under chapter 245C, and the personal care assistance provider 
55.6 	agency must have received a notice from the commissioner that the qualified professional:
55.7 	(1) is not disqualified under section 245C.14; or
55.8 	(2) is disqualified, but the qualified professional has received a set aside of the 
55.9 	disqualification under section 245C.22.
55.10 	(b) The qualified professional shall perform the duties of training, supervision, and 
55.11 	evaluation of the personal care assistance staff and evaluation of the effectiveness of 
55.12 	personal care assistance services. The qualified professional shall:
55.13 	(1) develop and monitor with the recipient a personal care assistance care plan based 
55.14 	on the service plan and individualized needs of the recipient;
55.15 	(2) develop and monitor with the recipient a monthly plan for the use of personal 
55.16 	care assistance services;
55.17 	(3) review documentation of personal care assistance services provided;
55.18 	(4) provide training and ensure competency for the personal care assistant in the 
55.19 	individual needs of the recipient; and
55.20 	(5) document all training, communication, evaluations, and needed actions to 
55.21 	improve performance of the personal care assistants.
55.22 	(c) The qualified professional shall complete the training approved by the 
55.23 	commissioner with basic information about the personal care assistance program within 
55.24 	six months of the date hired by a personal care assistance provider agency. Qualified 
55.25 	professionals who have completed the required trainings as an employee with a personal 
55.26 	care assistance provider agency do not need to repeat the required trainings if they are 
55.27 	hired by another agency, if they have completed the training within the last three years.
55.28 		Subd. 14.Qualified professional; duties. (a) All personal care assistants must 
55.29 	be supervised by a qualified professional.
55.30 	(b) Through direct training, observation, return demonstrations, and consultation 
55.31 	with the staff and the recipient, the qualified professional must ensure and document 
55.32 	that the personal care assistant is:
55.33 	(1) capable of providing the required personal care assistance services;
55.34 	(2) knowledgeable about the plan of personal care assistance services before services 
55.35 	are performed; and
56.1 	(3) able to identify conditions that should be immediately brought to the attention of 
56.2 	the qualified professional.
56.3 	(c) The qualified professional shall evaluate the personal care assistant within 
56.4 	the first 14 days of starting to provide services for a recipient except for the personal 
56.5 	care assistance choice option under subdivision 19. The qualified professional shall 
56.6 	evaluate the personal care assistance services for a recipient through direct observation of 
56.7 	a personal care assistant's work:
56.8 	(1) at least every 90 days thereafter for the first year of a recipient's services; and
56.9 	(2) every 120 days after the first year of a recipient's service or whenever needed for 
56.10 	response to a recipient's request for increased supervision of the personal care assistance 
56.11 	staff.
56.12 	(d) Communication with the recipient is a part of the evaluation process of the 
56.13 	personal care assistance staff.
56.14 	(e) At each supervisory visit, the qualified professional shall evaluate personal care 
56.15 	assistance services including the following information:
56.16 	(1) satisfaction level of the recipient with personal care assistance services;
56.17 	(2) review of the month-to-month plan for use of personal care assistance services;
56.18 	(3) review of documentation of personal care assistance services provided;
56.19 	(4) whether the personal care assistance services are meeting the goals of the service 
56.20 	as stated in the personal care assistance care plan and service plan;
56.21 	(5) a written record of the results of the evaluation and actions taken to correct any 
56.22 	deficiencies in the work of a personal care assistant; and
56.23 	(6) revision of the personal care assistance care plan as necessary in consultation 
56.24 	with the recipient or responsible party, to meet the needs of the recipient.
56.25 	(f) The qualified professional shall complete the required documentation in the 
56.26 	agency recipient and employee files and the recipient's home, including the following 
56.27 	documentation:
56.28 	(1) the personal care assistance care plan based on the service plan and individualized 
56.29 	needs of the recipient;
56.30 	(2) a month-to-month plan for use of personal care assistance services;
56.31 	(3) changes in need of the recipient requiring a change to the level of service and the 
56.32 	personal care assistance care plan;
56.33 	(4) evaluation results of supervision visits and identified issues with personal care 
56.34 	assistance staff with actions taken;
56.35 	(5) all communication with the recipient and personal care assistance staff; and
56.36 	(6) hands-on training or individualized training for the care of the recipient.
57.1 	(g) The documentation in paragraph (f) must be done on agency forms.
57.2 	(h) The services that are not eligible for payment as qualified professional services 
57.3 	include:
57.4 	(1) direct professional nursing tasks that could be assessed and authorized as skilled 
57.5 	nursing tasks;
57.6 	(2) supervision of personal care assistance completed by telephone;
57.7 	(3) agency administrative activities;
57.8 	(4) training other than the individualized training required to provide care for a 
57.9 	recipient; and
57.10 	(5) any other activity that is not described in this section.
57.11 		Subd. 15.Flexible use. (a) "Flexible use" means the scheduled use of authorized 
57.12 	hours of personal care assistance services, which vary within a service authorization 
57.13 	period covering no more than six months, in order to more effectively meet the needs and 
57.14 	schedule of the recipient. Each 12-month service agreement is divided into two six-month 
57.15 	authorization date spans. No more than 75 percent of the total authorized units for a 
57.16 	12-month service agreement may be used in a six-month date span.
57.17 	(b) Authorization of flexible use occurs during the authorization process under 
57.18 	section 256B.0652. The flexible use of authorized hours does not increase the total 
57.19 	amount of authorized hours available to a recipient. The commissioner shall not authorize 
57.20 	additional personal care assistance services to supplement a service authorization that 
57.21 	is exhausted before the end date under a flexible service use plan, unless the assessor 
57.22 	determines a change in condition and a need for increased services is established. 
57.23 	Authorized hours not used within the six-month period must not be carried over to another 
57.24 	time period.
57.25 	(c) A recipient who has terminated personal care assistance services before the end 
57.26 	of the 12-month authorization period must not receive additional hours upon reapplying 
57.27 	during the same 12-month authorization period, except if a change in condition is 
57.28 	documented. Services must be prorated for the remainder of the 12-month authorization 
57.29 	period based on the first six-month assessment.
57.30 	(d) The recipient, responsible party, and qualified professional must develop a 
57.31 	written month-to-month plan of the projected use of personal care assistance services that 
57.32 	is part of the personal care assistance care plan and ensures:
57.33 	(1) that the health and safety needs of the recipient are met throughout both date 
57.34 	spans of the authorization period; and
57.35 	(2) that the total authorized amount of personal care assistance services for each date 
57.36 	span must not be used before the end of each date span in the authorization period.
58.1 	(e) The personal care assistance provider agency shall monitor the use of personal 
58.2 	care assistance services to ensure health and safety needs of the recipient are met 
58.3 	throughout both date spans of the authorization period. The commissioner or the 
58.4 	commissioner's designee shall provide written notice to the provider and the recipient or 
58.5 	responsible party when a recipient is at risk of exceeding the personal care assistance 
58.6 	services prior to the end of the six-month period.
58.7 	(f) Misuse and abuse of the flexible use of personal care assistance services resulting 
58.8 	in the overuse of units in a manner where the recipient will not have enough units to meet 
58.9 	their needs for assistance and ensure health and safety for the entire six-month date span 
58.10 	may lead to an action by the commissioner. The commissioner may take action including, 
58.11 	but not limited to: (1) restricting recipients to service authorizations of no more than one 
58.12 	month in duration; (2) requiring the recipient to have a responsible party; and (3) requiring 
58.13 	a qualified professional to monitor and report services on a monthly basis.
58.14 		Subd. 16.Shared services. (a) Medical assistance payments for shared personal 
58.15 	care assistance services are limited according to this subdivision.
58.16 	(b) Shared service is the provision of personal care assistance services by a personal 
58.17 	care assistant to two or three recipients, eligible for medical assistance, who voluntarily 
58.18 	enter into an agreement to receive services at the same time and in the same setting.
58.19 	(c) For the purposes of this subdivision, "setting" means:
58.20 	(1) the home residence or family foster care home of one or more of the individual 
58.21 	recipients; or
58.22 	(2) a child care program licensed under chapter 245A or operated by a local school 
58.23 	district or private school.
58.24 	(d) Shared personal care assistance services follow the same criteria for covered 
58.25 	services as subdivision 2.
58.26 	(e) Noncovered shared personal care assistance services include the following:
58.27 	(1) services for more than three recipients by one personal care assistant at one time;
58.28 	(2) staff requirements for child care programs under chapter 245C;
58.29 	(3) caring for multiple recipients in more than one setting;
58.30 	(4) additional units of personal care assistance based on the selection of the option; 
58.31 	and
58.32 	(5) use of more than one personal care assistance provider agency for the shared 
58.33 	care services.
58.34 	(f) The option of shared personal care assistance is elected by the recipient or the 
58.35 	responsible party with the assistance of the assessor. The option must be determined 
58.36 	appropriate based on the ages of the recipients, compatibility, and coordination of their 
59.1 	assessed care needs. The recipient or the responsible party, in conjunction with the 
59.2 	qualified professional, shall arrange the setting and grouping of shared services based 
59.3 	on the individual needs and preferences of the recipients. The personal care assistance 
59.4 	provider agency shall offer the recipient or the responsible party the option of shared or 
59.5 	one-on-one personal care assistance services or a combination of both. The recipient or 
59.6 	the responsible party may withdraw from participating in a shared services arrangement at 
59.7 	any time.
59.8 	(g) Authorization for the shared service option must be determined by the 
59.9 	commissioner based on the criteria that the shared service is appropriate to meet all of the 
59.10 	recipients' needs and their health and safety is maintained. The authorization of shared 
59.11 	services is part of the overall authorization of personal care assistance services. Nothing 
59.12 	in this subdivision must be construed to reduce the total number of hours authorized for 
59.13 	an individual recipient.
59.14 	(h) A personal care assistant providing shared personal care assistance services must:
59.15 	(1) receive training specific for each recipient served; and
59.16 	(2) follow all required documentation requirements for time and services provided.
59.17 	(i) A qualified professional shall:
59.18 	(1) evaluate the ability of the personal care assistant to provide services for all of 
59.19 	the recipients in a shared setting;
59.20 	(2) visit the shared setting as services are being provided at least once every six 
59.21 	months or whenever needed for response to a recipient's request for increased supervision 
59.22 	of the personal care assistance staff;
59.23 	(3) provide ongoing monitoring and evaluation of the effectiveness and 
59.24 	appropriateness of the shared services;
59.25 	(4) develop a contingency plan with each of the recipients which accounts for 
59.26 	absence of the recipient in a share services setting due to illness or other circumstances;
59.27 	(5) obtain permission from each of the recipients who are sharing a personal care 
59.28 	assistant for number of shared hours for services provided inside and outside the home 
59.29 	residence; and
59.30 	(6) document the training completed by the personal care assistants specific to the 
59.31 	shared setting and recipients sharing services.
59.32 		Subd. 17.Shared services; rates. The commissioner shall provide a rate system for 
59.33 	shared personal care assistance services. For two persons sharing services, the rate paid 
59.34 	to a provider must not exceed one and one-half times the rate paid for serving a single 
59.35 	individual, and for three persons sharing services, the rate paid to a provider must not 
60.1 	exceed twice the rate paid for serving a single individual. These rates apply only when all 
60.2 	of the criteria for the shared care personal care assistance service have been met.
60.3 		Subd. 18.Personal care assistance choice option; generally. (a) The 
60.4 	commissioner may allow a recipient of personal care assistance services to use a fiscal 
60.5 	intermediary to assist the recipient in paying and accounting for medically necessary 
60.6 	covered personal care assistance services. Unless otherwise provided in this section, all 
60.7 	other statutory and regulatory provisions relating to personal care assistance services apply 
60.8 	to a recipient using the personal care assistance choice option.
60.9 	(b) Personal care assistance choice is an option of the personal care assistance 
60.10 	program that allows the recipient who receives personal care assistance services to be 
60.11 	responsible for the hiring, training, scheduling, and firing of personal care assistants. This 
60.12 	program offers greater control and choice for the recipient in who provides the personal 
60.13 	care assistance service and when the service is scheduled. The recipient or the recipient's 
60.14 	responsible party must choose a personal care assistance choice provider agency as 
60.15 	a fiscal intermediary. This personal care assistance choice provider agency manages 
60.16 	payroll, invoices the state, is responsible for all payroll related taxes and insurance, and is 
60.17 	responsible for providing the consumer training and support in managing the recipient's 
60.18 	personal care assistance services.
60.19 		Subd. 19.Personal care assistance choice option; qualifications; duties. (a) 
60.20 	Under personal care assistance choice, the recipient or responsible party shall:
60.21 	(1) recruit, hire, and terminate personal care assistants and a qualified professional;
60.22 	(2) develop a personal care assistance care plan based on the assessed needs 
60.23 	and addressing the health and safety of the recipient with the assistance of a qualified 
60.24 	professional as needed;
60.25 	(3) orient and train the personal care assistant with assistance as needed from the 
60.26 	qualified professional;
60.27 	(4) supervise and evaluate the personal care assistant with the qualified professional, 
60.28 	who is required to visit the recipient at least every 180 days;
60.29 	(5) monitor and verify in writing and report to the personal care assistance choice 
60.30 	agency the number of hours worked by the personal care assistant and the qualified 
60.31 	professional;
60.32 	(6) engage in an annual face-to-face reassessment to determine continuing eligibility 
60.33 	and service authorization; and
60.34 	(7) use the same personal care assistance choice provider agency if shared personal 
60.35 	assistance care is being used.
60.36 	(b) The personal care assistance choice provider agency shall:
61.1 	(1) meet all personal care assistance provider agency standards;
61.2 	(2) enter into a written agreement with the recipient, responsible party, and personal 
61.3 	care assistants;
61.4 	(3) not be related as a parent, child, sibling, or spouse to the recipient, qualified 
61.5 	professional, or the personal care assistant; and
61.6 	(4) ensure arm's-length transactions without undue influence or coercion with the 
61.7 	recipient and personal care assistant.
61.8 	(c) The duties of the personal care assistance choice provider agency are to:
61.9 	(1) be the employer of the personal care assistant and the qualified professional for 
61.10 	employment law and related regulations including, but not limited to, purchasing and 
61.11 	maintaining workers' compensation, unemployment insurance, surety and fidelity bonds, 
61.12 	and liability insurance, and submit any or all necessary documentation including, but not 
61.13 	limited to, workers' compensation and unemployment insurance;
61.14 	(2) bill the medical assistance program for personal care assistance services and 
61.15 	qualified professional services;
61.16 	(3) request and complete background studies that comply with the requirements for 
61.17 	personal care assistants and qualified professionals;
61.18 	(4) pay the personal care assistant and qualified professional based on actual hours 
61.19 	of services provided;
61.20 	(5) withhold and pay all applicable federal and state taxes;
61.21 	(6) verify and keep records of hours worked by the personal care assistant and 
61.22 	qualified professional;
61.23 	(7) make the arrangements and pay taxes and other benefits, if any; and comply with 
61.24 	any legal requirements for a Minnesota employer;
61.25 	(8) enroll in the medical assistance program as a personal care assistance choice 
61.26 	agency; and
61.27 	(9) enter into a written agreement as specified in subdivision 20 before services 
61.28 	are provided.
61.29 		Subd. 20.Personal care assistance choice option; administration. (a) Before 
61.30 	services commence under the personal care assistance choice option, and annually 
61.31 	thereafter, the personal care assistance choice provider agency, recipient, or responsible 
61.32 	party, each personal care assistant, and the qualified professional shall enter into a written 
61.33 	agreement. The agreement must include at a minimum:
61.34 	(1) duties of the recipient, qualified professional, personal care assistant, and 
61.35 	personal care assistance choice provider agency;
61.36 	(2) salary and benefits for the personal care assistant and the qualified professional;
62.1 	(3) administrative fee of the personal care assistance choice provider agency and 
62.2 	services paid for with that fee, including background study fees;
62.3 	(4) grievance procedures to respond to complaints;
62.4 	(5) procedures for hiring and terminating the personal care assistant; and
62.5 	(6) documentation requirements including, but not limited to, time sheets, activity 
62.6 	records, and the personal care assistance care plan.
62.7 	(b) Except for the administrative fee of the personal care assistance choice provider 
62.8 	agency as reported on the written agreement, the remainder of the rates paid to the personal 
62.9 	care assistance choice provider agency must be used to pay for the salary and benefits for 
62.10 	the personal care assistant or the qualified professional. The provider agency must use 
62.11 	a minimum of 70 percent of the revenue generated by the medical assistance rate for 
62.12 	personal care assistance services for employee personal care assistant wages and benefits.
62.13 	(c) The commissioner shall deny, revoke, or suspend the authorization to use the 
62.14 	personal care assistance choice option if:
62.15 	(1) it has been determined by the qualified professional or public health nurse that 
62.16 	the use of this option jeopardizes the recipient's health and safety;
62.17 	(2) the parties have failed to comply with the written agreement specified in this 
62.18 	subdivision;
62.19 	(3) the use of the option has led to abusive or fraudulent billing for personal care 
62.20 	assistance services; or
62.21 	(4) the department terminates the personal care assistance choice option.
62.22 	(d) The recipient or responsible party may appeal the commissioner's decision in 
62.23 	paragraph (c) according to section 256.045. The denial, revocation, or suspension to 
62.24 	use the personal care assistance choice option must not affect the recipient's authorized 
62.25 	level of personal care assistance services.
62.26 		Subd. 21.Requirements for initial enrollment of personal care assistance 
62.27 	provider agencies. (a) All personal care assistance provider agencies must provide, at the 
62.28 	time of enrollment as a personal care assistance provider agency in a format determined 
62.29 	by the commissioner, information and documentation that includes, but is not limited to, 
62.30 	the following:
62.31 	(1) the personal care assistance provider agency's current contact information 
62.32 	including address, telephone number, and e-mail address;
62.33 	(2) proof of surety bond coverage in the amount of $50,000 or ten percent of the 
62.34 	provider's payments from Medicaid in the previous year, whichever is less;
62.35 	(3) proof of fidelity bond coverage in the amount of $20,000;
62.36 	(4) proof of workers' compensation insurance coverage;
63.1 	(5) a description of the personal care assistance provider agency's organization 
63.2 	identifying the names of all owners, managing employees, staff, board of directors, and 
63.3 	the affiliations of the directors, owners, or staff to other service providers;
63.4 	(6) a copy of the personal care assistance provider agency's written policies and 
63.5 	procedures including: hiring of employees; training requirements; service delivery; 
63.6 	and employee and consumer safety including process for notification and resolution 
63.7 	of consumer grievances, identification and prevention of communicable diseases, and 
63.8 	employee misconduct;
63.9 	(7) copies of all other forms the personal care assistance provider agency uses in 
63.10 	the course of daily business including, but not limited to:
63.11 	(i) a copy of the personal care assistance provider agency's time sheet if the time 
63.12 	sheet varies from the standard time sheet for personal care assistance services approved 
63.13 	by the commissioner, and a letter requesting approval of the personal care assistance 
63.14 	provider agency's nonstandard time sheet;
63.15 	(ii) the personal care assistance provider agency's template for the personal care 
63.16 	assistance care plan; and
63.17 	(iii) the personal care assistance provider agency's template and the written 
63.18 	agreement in subdivision 20 for recipients using the personal care assistance choice 
63.19 	option, if applicable;
63.20 	(8) a list of all trainings and classes that the personal care assistance provider agency 
63.21 	requires of its staff providing personal care assistance services;
63.22 	(9) documentation that the personal care assistance provider agency and staff have 
63.23 	successfully completed all the training required by this section; 
63.24 	(10) documentation of the agency's marketing practices;
63.25 	(11) disclosure of ownership, leasing, or management of all residential properties 
63.26 	that is used or could be used for providing home care services; and 
63.27 	(12) documentation that the agency will use the following percentages of revenue 
63.28 	generated from the medical assistance rate paid for personal care assistance services 
63.29 	for employee personal care assistant wages and benefits: 70 percent of revenue in the 
63.30 	personal care assistance choice option and 65 percent of revenue from other personal 
63.31 	care assistance services.
63.32 	(b) Personal care assistance provider agencies shall provide the information specified 
63.33 	in paragraph (a) to the commissioner at the time the personal care assistance provider 
63.34 	agency enrolls as a vendor or upon request from the commissioner. The commissioner 
63.35 	shall collect the information specified in paragraph (a) from all personal care assistance 
63.36 	providers beginning upon enactment of this section.
64.1 	(c) All personal care assistance provider agencies shall complete mandatory training 
64.2 	as determined by the commissioner before enrollment as a provider. Personal care 
64.3 	assistance provider agencies are required to send all owners, qualified professionals 
64.4 	employed by the agency, and all other managing employees to the initial and subsequent 
64.5 	trainings. Personal care assistance provider agency billing staff shall complete training 
64.6 	about personal care assistance program financial management. This training is effective 
64.7 	upon enactment of this section. Any personal care assistance provider agency enrolled 
64.8 	before that date shall, if it has not already, complete the provider training within 18 months 
64.9 	of the effective date of this section. Any new owners, new qualified professionals, and new 
64.10 	managing employees are required to complete mandatory training as a requisite of hiring.
64.11 		Subd. 22.Annual review for personal care providers. (a) All personal care 
64.12 	assistance provider agencies shall resubmit, on an annual basis, the information specified 
64.13 	in subdivision 21, in a format determined by the commissioner, and provide a copy of the 
64.14 	personal care assistance provider agency's most current version of its grievance policies 
64.15 	and procedures along with a written record of grievances and resolutions of the grievances 
64.16 	that the personal care assistance provider agency has received in the previous year and any 
64.17 	other information requested by the commissioner.
64.18 	(b) The commissioner shall send annual review notification to personal care 
64.19 	assistance provider agencies 30 days prior to renewal. The notification must:
64.20 	(1) list the materials and information the personal care assistance provider agency is 
64.21 	required to submit;
64.22 	(2) provide instructions on submitting information to the commissioner; and
64.23 	(3) provide a due date by which the commissioner must receive the requested 
64.24 	information.
64.25 	Personal care assistance provider agencies shall submit required documentation for 
64.26 	annual review within 30 days of notification from the commissioner. If no documentation 
64.27 	is submitted, the personal care assistance provider agency enrollment number must be 
64.28 	terminated or suspended.
64.29 	(c) Personal care assistance provider agencies also currently licensed under 
64.30 	Minnesota Rules, part 4668.0012, as a class A provider or currently certified for 
64.31 	participation in Medicare as a home health agency are deemed in compliance with 
64.32 	the personal care assistance requirements for enrollment, annual review process, and 
64.33 	documentation.
64.34 		Subd. 23.Enrollment requirements following termination. (a) A terminated 
64.35 	personal care assistance provider agency, including all named individuals on the current 
64.36 	enrollment disclosure form and known or discovered affiliates of the personal care 
65.1 	assistance provider agency, is not eligible to enroll as a personal care assistance provider 
65.2 	agency for two years following the termination.
65.3 	(b) After the two-year period in paragraph (a), if the provider seeks to reenroll 
65.4 	as a personal care assistance provider agency, the personal care assistance provider 
65.5 	agency must be placed on a one-year probation period, beginning after completion of 
65.6 	the following:
65.7 	(1) the department's provider trainings under this section; and
65.8 	(2) initial enrollment requirements under subdivision 21.
65.9 	(c) During the probationary period the commissioner shall complete site visits and 
65.10 	request submission of documentation to review compliance with program policy.
65.11 		Subd. 24.Personal care assistance provider agency; general duties. A personal 
65.12 	care assistance provider agency shall:
65.13 	(1) enroll as a Medicaid provider meeting all provider standards, including 
65.14 	completion of the required provider training;
65.15 	(2) comply with general medical assistance coverage requirements;
65.16 	(3) demonstrate compliance with law and policies of the personal care assistance 
65.17 	program to be determined by the commissioner;
65.18 	(4) comply with background study requirements;
65.19 	(5) verify and keep records of hours worked by the personal care assistant and 
65.20 	qualified professional;
65.21 	(6) market agency services only through printed information in brochures and on 
65.22 	Web sites and not engage in any agency-initiated direct contact or marketing in person, by 
65.23 	phone, or other electronic means to potential recipients, guardians, or family members;
65.24 	(7) pay the personal care assistant and qualified professional based on actual hours 
65.25 	of services provided;
65.26 	(8) withhold and pay all applicable federal and state taxes;
65.27 	(9) document that the agency uses a minimum of 65 percent of the revenue generated 
65.28 	by the medical assistance rate for personal care assistance services for employee personal 
65.29 	care assistant wages and benefits;
65.30 	(10) make the arrangements and pay unemployment insurance, taxes, workers' 
65.31 	compensation, liability insurance, and other benefits, if any;
65.32 	(11) enter into a written agreement under subdivision 20 before services are provided;
65.33 	(12) report suspected neglect and abuse to the common entry point according to 
65.34 	section 256B.0651; and
65.35 	(13) provide the recipient with a copy of the home care bill of rights at start of 
65.36 	service.
66.1 		Subd. 25.Personal care assistance provider agency; background studies.
 66.2 	Personal care assistance provider agencies enrolled to provide personal care assistance 
66.3 	services under the medical assistance program shall comply with the following:
66.4 	(1) owners who have a five percent interest or more and all managerial officials are 
66.5 	subject to a background study as provided in chapter 245C. This applies to currently 
66.6 	enrolled personal care assistance provider agencies and those agencies seeking enrollment 
66.7 	as a personal care assistance provider agency. Managing employee has the same meaning 
66.8 	as Code of Federal Regulations, title 42, section 455. An organization is barred from 
66.9 	enrollment if:
66.10 	(i) the organization has not initiated background studies on owners and managing 
66.11 	employees; or
66.12 	(ii) the organization has initiated background studies on owners and managing 
66.13 	employees, but the commissioner has sent the organization a notice that an owner or 
66.14 	managing employee of the organization has been disqualified under section 245C.14, 
66.15 	and the owner or managing employee has not received a set aside of the disqualification 
66.16 	under section 245C.22;
66.17 	(2) a background study must be initiated and completed for all qualified 
66.18 	professionals; and
66.19 	(3) a background study must be initiated and completed for all personal care 
66.20 	assistants.
66.21 		Subd. 26.Personal care assistance provider agency; communicable disease 
66.22 	prevention. A personal care assistance provider agency shall establish and implement 
66.23 	policies and procedures for prevention, control, and investigation of infections and 
66.24 	communicable diseases according to current nationally recognized infection control 
66.25 	practices or guidelines established by the United States Centers for Disease Control and 
66.26 	Prevention, as well as applicable regulations of other federal or state agencies.
66.27 		Subd. 27.Personal care assistance provider agency; ventilator training. The 
66.28 	personal care assistance provider agency is required to provide training for the personal 
66.29 	care assistant responsible for working with a recipient who is ventilator dependent. All 
66.30 	training must be administered by a respiratory therapist, nurse, or physician. Qualified 
66.31 	professional supervision by a nurse must be completed and documented on file in the 
66.32 	personal care assistant's employment record and the recipient's health record. If offering 
66.33 	personal care services to a ventilator-dependent recipient, the personal care assistance 
66.34 	provider agency shall demonstrate the ability to:
66.35 	(1) train the personal care assistant;
66.36 	(2) supervise the personal care assistant in ventilator operation and maintenance; and
67.1 	(3) supervise the recipient and responsible party in ventilator operation and 
67.2 	maintenance.
67.3 		Subd. 28.Personal care assistance provider agency; required documentation.
 67.4 	Required documentation must be completed and kept in the personal care assistance 
67.5 	provider agency file or the recipient's home residence. The required documentation 
67.6 	consists of:
67.7 	(1) employee files, including:
67.8 	(i) applications for employment;
67.9 	(ii) background study requests and results;
67.10 	(iii) orientation records about the agency policies;
67.11 	(iv) trainings completed with demonstration of competence;
67.12 	(v) supervisory visits;
67.13 	(vi) evaluations of employment; and
67.14 	(vii) signature on fraud statement;
67.15 	(2) recipient files, including:
67.16 	(i) demographics;
67.17 	(ii) emergency contact information and emergency backup plan;
67.18 	(iii) medical assistance service plan;
67.19 	(iv) personal care assistance care plan;
67.20 	(v) month-to-month service use plan;
67.21 	(vi) all communication records;
67.22 	(vii) start of service information, including the written agreement with recipient; and
67.23 	(viii) date the home care bill of rights was given to the recipient;
67.24 	(3) agency policy manual, including:
67.25 	(i) policies for employment and termination;
67.26 	(ii) grievance policies with resolution of consumer grievances;
67.27 	(iii) staff and consumer safety;
67.28 	(iv) staff misconduct; and
67.29 	(v) staff hiring, service delivery, staff and consumer safety, staff misconduct, and 
67.30 	resolution of consumer grievances; 
67.31 	(4) time sheets for each personal care assistant along with completed activity sheets 
67.32 	for each recipient served; and
67.33 	(5) agency marketing and advertising materials and documentation of marketing 
67.34 	activities and costs.
67.35 		Subd. 29.Transitional assistance. The commissioner, counties, and personal care 
67.36 	assistance providers shall work together to provide transitional assistance for recipients 
68.1 	and families to come into compliance with the new live-in responsible party requirements 
68.2 	of this section and ensure the personal care assistance services are not provided by the 
68.3 	housing provider. The commissioner and counties shall provide this assistance until July 
68.4 	1, 2010.
68.5 		Subd. 30.Notice of service changes to recipients. All recipients who will be 
68.6 	affected by the changes in medical assistance home care services must be provided notice 
68.7 	of the changes at least 30 days before the effective date of the change. The notice shall 
68.8 	include how to get further information on the changes, how to get help to obtain other 
68.9 	services, if eligible, and appeal rights. 

68.10 	Sec. 32. Minnesota Statutes 2008, section 256B.0911, subdivision 1, is amended to 
68.11 	read:
68.12 		Subdivision 1.Purpose and goal. (a) The purpose of long-term care consultation 
68.13 	services is to assist persons with long-term or chronic care needs in making long-term 
68.14 	care decisions and selecting options that meet their needs and reflect their preferences. 
68.15 	The availability of, and access to, information and other types of assistance, including 
68.16 	assessment and support planning, is also intended to prevent or delay certified nursing 
68.17 	facility placements and to provide transition assistance after admission. Further, the goal 
68.18 	of these services is to contain costs associated with unnecessary certified nursing facility 
68.19 	admissions. Long-term consultation services must be available to any person regardless 
68.20 	of public program eligibility. The commissionerscommissioner of human services and 
68.21 	health shall seek to maximize use of available federal and state funds and establish the 
68.22 	broadest program possible within the funding available.
68.23 	(b) These services must be coordinated with serviceslong-term care options 
68.24 	counseling provided under section 256.975, subdivision 7, and with services provided by 
68.25 	other public and private agencies in the communitysection 256.01, subdivision 24, for 
68.26 	telephone assistance and follow up and to offer a variety of cost-effective alternatives 
68.27 	to persons with disabilities and elderly persons. The county or tribal agency providing 
68.28 	long-term care consultation services shall encourage the use of volunteers from families, 
68.29 	religious organizations, social clubs, and similar civic and service organizations to provide 
68.30 	community-based services.

68.31 	Sec. 33. Minnesota Statutes 2008, section 256B.0911, subdivision 1a, is amended to 
68.32 	read:
68.33 		Subd. 1a.Definitions. For purposes of this section, the following definitions apply:
68.34 	(a) "Long-term care consultation services" means:
69.1 	(1) providing information and education to the general public regarding availability 
69.2 	of the services authorized under this section;
69.3 	(2) an intake process that provides access to the services described in this section;
69.4 	(3) assessment of the health, psychological, and social needs of referred individuals;
69.5 	(4) assistance in identifying services needed to maintain an individual in the least 
69.6 	restrictivemost inclusive environment;
69.7 	(5)(2) providing recommendations on cost-effective community services that are 
69.8 	available to the individual;
69.9 	(6)(3) development of an individual's person-centered community support plan;
69.10 	(7)(4) providing information regarding eligibility for Minnesota health care 
69.11 	programs;
69.12 	(5) face-to-face long-term care consultation assessments, which may be completed 
69.13 	in a hospital, nursing facility, intermediate care facility for persons with developmental 
69.14 	disabilities (ICF/DDs), regional treatment centers, or the person's current or planned 
69.15 	residence;
69.16 	(8) preadmission(6) federally mandated screening to determine the need for 
69.17 	a nursing facilityinstitutional level of care under section 256B.0911, subdivision 4, 
69.18 	paragraph (a);
69.19 	(9) preliminary(7) determination of Minnesota health care programshome and 
69.20 	community-based waiver service eligibility including level of care determination for 
69.21 	individuals who need a nursing facilityan institutional level of care as defined under 
69.22 	section 144.0724, subdivision 11, or 256B.092, service eligibility including state plan 
69.23 	home care services identified in section 256B.0625, subdivisions 6, 7, and 19, paragraphs 
69.24 	(a) and (c), based on assessment and support plan development with appropriate referrals 
69.25 	for final determination;
69.26 	(10)(8) providing recommendations for nursing facility placement when there are 
69.27 	no cost-effective community services available; and
69.28 	(11)(9) assistance to transition people back to community settings after facility 
69.29 	admission.
69.30 	(b) "Long-term options counseling" means the services provided by the linkage 
69.31 	lines as mandated by sections 256.01 and 256.975, subdivision 7, and also includes 
69.32 	telephone assistance and follow up once a long-term care consultation assessment has 
69.33 	been completed. 
69.34 	(b) (c) "Minnesota health care programs" means the medical assistance program 
69.35 	under chapter 256B and the alternative care program under section 256B.0913.
70.1 	(d) "Lead agencies" means counties or a collaboration of counties, tribes, and health 
70.2 	plans administering long-term care consultation assessment and support planning services.

70.3 	EFFECTIVE DATE. This section is effective January 1, 2011.

70.4 	Sec. 34. Minnesota Statutes 2008, section 256B.0911, is amended by adding a 
70.5 	subdivision to read:
70.6 		Subd. 2b.Certified assessors. (a) Beginning January 1, 2011, each lead agency 
70.7 	shall use certified assessors who have completed training and certification process 
70.8 	determined by the commissioner in subdivision 2c. Certified assessors shall demonstrate 
70.9 	best practices in assessment and support planning including person-centered planning 
70.10 	principals and have a common set of skills that must ensure consistency and equitable 
70.11 	access to services statewide.
70.12 	(b) Certified assessors are persons with a minimum of a bachelor's degree in social 
70.13 	work, nursing with a public health nursing certificate, or other closely related field with at 
70.14 	least one year of home and community-based experience or a two-year registered nursing 
70.15 	degree with at least three years of home and community-based experience that have 
70.16 	received training and certification specific to assessment and consultation for long-term 
70.17 	care services in the state.

70.18 	Sec. 35. Minnesota Statutes 2008, section 256B.0911, is amended by adding a 
70.19 	subdivision to read:
70.20 		Subd. 2c.Assessor training and certification. The commissioner shall develop a 
70.21 	curriculum and an assessor certification process to begin no later than January 1, 2010. 
70.22 	All existing lead agency staff designated to provide the services defined in subdivision 
70.23 	1a must be certified by December 30, 2010. Each lead agency is required to ensure that 
70.24 	they have sufficient numbers of certified assessors to provide long-term consultation 
70.25 	assessment and support planning within the timelines and parameters of the service by 
70.26 	January 1, 2011. Certified assessors are required to be recertified every three years.

70.27 	Sec. 36. Minnesota Statutes 2008, section 256B.0911, subdivision 3, is amended to 
70.28 	read:
70.29 		Subd. 3.Long-term care consultation team. (a) Until January 1, 2011, a long-term 
70.30 	care consultation team shall be established by the county board of commissioners. Each 
70.31 	local consultation team shall consist of at least one social worker and at least one public 
70.32 	health nurse from their respective county agencies. The board may designate public 
70.33 	health or social services as the lead agency for long-term care consultation services. If a 
71.1 	county does not have a public health nurse available, it may request approval from the 
71.2 	commissioner to assign a county registered nurse with at least one year experience in 
71.3 	home care to participate on the team. Two or more counties may collaborate to establish 
71.4 	a joint local consultation team or teams.
71.5 	(b) The team is responsible for providing long-term care consultation services to 
71.6 	all persons located in the county who request the services, regardless of eligibility for 
71.7 	Minnesota health care programs.
71.8 	(c) The commissioner shall allow arrangements and make recommendations that 
71.9 	encourage counties to collaborate to establish joint local long-term care consultation teams 
71.10 	to ensure that long-term care consultations are done within the timelines and parameters 
71.11 	of the service. This includes integrated service models as required in subdivision 1, 
71.12 	paragraph (b).

71.13 	Sec. 37. Minnesota Statutes 2008, section 256B.0911, subdivision 3a, is amended to 
71.14 	read:
71.15 		Subd. 3a.Assessment and support planning. (a) Persons requesting assessment, 
71.16 	services planning, or other assistance intended to support community-based living, 
71.17 	including persons who need assessment in order to determine personal care assistance 
71.18 	services, private duty nursing services, home health agency services, waiver or alternative 
71.19 	care program eligibility, must be visited by a long-term care consultation team within 
71.20 	ten working15 calendar days after the date on which an assessment was requested or 
71.21 	recommended. Face-to-face assessments must be conducted according to paragraphs 
71.22 	(b) to (i).
71.23 	(b) The county may utilize a team of either the social worker or public health nurse, 
71.24 	or both,. After January 1, 2011, lead agencies shall use certified assessors  to conduct the 
71.25 	assessment in a face-to-face interview. The consultation team members must confer 
71.26 	regarding the most appropriate care for each individual screened or assessed.
71.27 	(c) The long-term care consultation team must assess the health and social needs of 
71.28 	the person assessment must be comprehensive and include a person-centered assessment 
71.29 	of the health, psychological, functional, environmental, and social needs of referred 
71.30 	individuals and provide information necessary to develop a support plan that meets the 
71.31 	consumers needs, using an assessment form provided by the commissioner.
71.32 	(d) The team must conduct the assessment must be conducted in a face-to-face 
71.33 	interview with the person being assessed and the person's legal representative, if applicable
71.34 	as required by legally executed documents, and other individuals as requested by the 
71.35 	person, who can provide information on the needs, strengths, and preferences of the 
72.1 	person necessary to develop a support plan that ensures the person's health and safety, but 
72.2 	who is not a provider of service or has any financial interest in the provision of services.
72.3 	(e) The team must provide the person, or the person's legal representative, must 
72.4 	be provided with written recommendations for facility- or community-based services. 
72.5 	The team must documentor institutional care that include documentation that the most 
72.6 	cost-effective alternatives available were offered to the individual. For purposes of 
72.7 	this requirement, "cost-effective alternatives" means community services and living 
72.8 	arrangements that cost the same as or less than nursing facility institutional care.
72.9 	(f) If the person chooses to use community-based services, the team must provide 
72.10 	the person or the person's legal representative must be provided with a written community 
72.11 	support plan, regardless of whether the individual is eligible for Minnesota health care 
72.12 	programs. TheA person may request assistance in developing a community support plan 
72.13 	 identifying community supports without participating in a complete assessment. Upon 
72.14 	a request for assistance identifying community support, the person must be transferred 
72.15 	or referred to the services available under sections 256.975, subdivision 7, and 256.01, 
72.16 	subdivision 24, for telephone assistance and follow up.
72.17 	(g) The person has the right to make the final decision between nursing 
72.18 	facility institutional placement and community placement after the screening team's 
72.19 	recommendation recommendations have been provided, except as provided in subdivision 
72.20 	4a, paragraph (c).
72.21 	(h) The team must give the person receiving assessment or support planning, or 
72.22 	the person's legal representative, materials, and forms supplied by the commissioner 
72.23 	containing the following information:
72.24 	(1) the need for and purpose of preadmission screening if the person selects nursing 
72.25 	facility placement;
72.26 	(2) the role of the long-term care consultation assessment and support planning in 
72.27 	waiver and alternative care program eligibility determination;
72.28 	(3) information about Minnesota health care programs;
72.29 	(4) the person's freedom to accept or reject the recommendations of the team;
72.30 	(5) the person's right to confidentiality under the Minnesota Government Data 
72.31 	Practices Act, chapter 13;
72.32 	(6) the long-term care consultant's decision regarding the person's need for nursing 
72.33 	facility institutional level of care as determined under criteria established in section 
72.34 	144.0724, subdivision 11, or 256B.092; and
73.1 	(7) the person's right to appeal the decision regarding the need for nursing facility 
73.2 	level of care or the county's final decisions regarding public programs eligibility according 
73.3 	to section 256.045, subdivision 3.
73.4 	(i) Face-to-face assessment completed as part of eligibility determination for 
73.5 	the alternative care, elderly waiver, community alternatives for disabled individuals, 
73.6 	community alternative care, and traumatic brain injury waiver programs under sections 
73.7 	256B.0915, 256B.0917, and 256B.49 is valid to establish service eligibility for no more 
73.8 	than 60 calendar days after the date of assessment. The effective eligibility start date 
73.9 	for these programs can never be prior to the date of assessment. If an assessment was 
73.10 	completed more than 60 days before the effective waiver or alternative care program 
73.11 	eligibility start date, assessment and support plan information must be updated in a 
73.12 	face-to-face visit and documented in the department's Medicaid Management Information 
73.13 	System (MMIS). The effective date of program eligibility in this case cannot be prior to 
73.14 	the date the updated assessment is completed.

73.15 	Sec. 38. Minnesota Statutes 2008, section 256B.0911, subdivision 3b, is amended to 
73.16 	read:
73.17 		Subd. 3b.Transition assistance. (a) A long-term care consultation team shall 
73.18 	provide assistance to persons residing in a nursing facility, hospital, regional treatment 
73.19 	center, or intermediate care facility for persons with developmental disabilities who 
73.20 	request or are referred for assistance. Transition assistance must include assessment, 
73.21 	community support plan development, referrals to long-term care options counseling 
73.22 	under section 256B.975, subdivision 10, for community support plan implementation and 
73.23 	to Minnesota health care programs, and referrals to programs that provide assistance 
73.24 	with housing. Transition assistance must also include information about the Centers for 
73.25 	Independent Living and the Senior LinkAge Line, and about other organizations that 
73.26 	can provide assistance with relocation efforts, and information about contacting these 
73.27 	organizations to obtain their assistance and support. 
73.28 	(b) The county shall develop transition processes with institutional social workers 
73.29 	and discharge planners to ensure that:
73.30 	(1) persons admitted to facilities receive information about transition assistance 
73.31 	that is available;
73.32 	(2) the assessment is completed for persons within ten working days of the date of 
73.33 	request or recommendation for assessment; and
73.34 	(3) there is a plan for transition and follow-up for the individual's return to the 
73.35 	community. The plan must require notification of other local agencies when a person 
74.1 	who may require assistance is screened by one county for admission to a facility located 
74.2 	in another county.
74.3 	(c) If a person who is eligible for a Minnesota health care program is admitted to a 
74.4 	nursing facility, the nursing facility must include a consultation team member or the case 
74.5 	manager in the discharge planning process.

74.6 	Sec. 39. Minnesota Statutes 2008, section 256B.0911, subdivision 3c, is amended to 
74.7 	read:
74.8 		Subd. 3c.Transition to housing with services. (a) Housing with services 
74.9 	establishments offering or providing assisted living under chapter 144G shall inform 
74.10 	all prospective residents of the availability of and contact information for transitional 
74.11 	consultation services under this subdivision prior to executing a lease or contract with the 
74.12 	prospective resident requirement to contact the Senior LinkAge Line for long-term care 
74.13 	options counseling and transitional consultation. The Senior LinkAge Line shall provide a 
74.14 	certificate to the prospective resident and also send a copy of the certificate to the housing 
74.15 	with services establishment, of the prospective resident's choice, that consultation has been 
74.16 	provided. The housing with services establishment shall not execute a contract or allow a 
74.17 	prospective resident to move in until the establishment has received certification from the 
74.18 	Senior LinkAge Line. The housing with services establishment shall maintain copies of 
74.19 	contracts and certificates for audit for a period of three years. The purpose of transitional 
74.20 	long-term care consultation is to support persons with current or anticipated long-term 
74.21 	care needs in making informed choices among options that include the most cost-effective 
74.22 	and least restrictive settings, and to delay spenddown to eligibility for publicly funded 
74.23 	programs by connecting people to alternative services in their homes before transition to 
74.24 	housing with services. Regardless of the consultation, prospective residents maintain the 
74.25 	right to choose housing with services or assisted living if that option is their preference.
74.26 	(b) Transitional consultation services are provided as determined by the 
74.27 	commissioner of human services in partnership with county long-term care consultation 
74.28 	units, and the Area Agencies on Aging under section 144D.03, subdivision 3, and 
74.29 	are a combination of telephone-based and in-person assistance provided under models 
74.30 	developed by the commissioner. The consultation shall be performed in a manner that 
74.31 	provides objective and complete information. Transitional consultation must be provided 
74.32 	within five working days of the request of the prospective resident as follows:
74.33 	(1) the consultation must be provided by a qualified professional as determined by 
74.34 	the commissioner;
75.1 	(2) the consultation must include a review of the prospective resident's reasons for 
75.2 	considering assisted living, the prospective resident's personal goals, a discussion of the 
75.3 	prospective resident's immediate and projected long-term care needs, and alternative 
75.4 	community services or assisted living settings that may meet the prospective resident's 
75.5 	needs; and
75.6 	(3) the prospective resident shall be informed of the availability of long-term care 
75.7 	consultation services described in subdivision 3a that are available at no charge to the 
75.8 	prospective resident to assist the prospective resident in assessment and planning to meet 
75.9 	the prospective resident's long-term care needs. The Senior LinkAge Line and long-term 
75.10 	care consultation team shall give the highest priority to referrals who are at highest risk of 
75.11 	nursing facility placement or as needed for determining eligibility; and
75.12 	(4) a prospective resident does not include:
75.13 	(i) a person moved from the community to housing with services during nonworking 
75.14 	hours when the move is based on a recent precipitating event that precludes the person 
75.15 	from living safely in the community, such as sustaining an injury or the caregiver's 
75.16 	inability to continue to provide needed care; and
75.17 	(ii) the Senior LinkAge Line is contacted on the first working day following the 
75.18 	nonworking day move to the registered housing with services.

75.19 	Sec. 40. Minnesota Statutes 2008, section 256B.0911, subdivision 4a, is amended to 
75.20 	read:
75.21 		Subd. 4a.Preadmission screening activities related to nursing facility 
75.22 	admissions. (a) All applicants to Medicaid certified nursing facilities, including certified 
75.23 	boarding care facilities, must be screened prior to admission regardless of income, assets, 
75.24 	or funding sources for nursing facility care, except as described in subdivision 4b. The 
75.25 	purpose of the screening is to determine the need for nursing facility level of care as 
75.26 	described in paragraph (d) and to complete activities required under federal law related to 
75.27 	mental illness and developmental disability as outlined in paragraph (b).
75.28 	(b) A person who has a diagnosis or possible diagnosis of mental illness or 
75.29 	developmental disability must receive a preadmission screening before admission 
75.30 	regardless of the exemptions outlined in subdivision 4b, paragraph (b), to identify the need 
75.31 	for further evaluation and specialized services, unless the admission prior to screening is 
75.32 	authorized by the local mental health authority or the local developmental disabilities case 
75.33 	manager, or unless authorized by the county agency according to Public Law 101-508.
75.34 	The following criteria apply to the preadmission screening:
76.1 	(1) the county must use forms and criteria developed by the commissioner to identify 
76.2 	persons who require referral for further evaluation and determination of the need for 
76.3 	specialized services; and
76.4 	(2) the evaluation and determination of the need for specialized services must be 
76.5 	done by:
76.6 	(i) a qualified independent mental health professional, for persons with a primary or 
76.7 	secondary diagnosis of a serious mental illness; or
76.8 	(ii) a qualified developmental disability professional, for persons with a primary or 
76.9 	secondary diagnosis of developmental disability. For purposes of this requirement, a 
76.10 	qualified developmental disability professional must meet the standards for a qualified 
76.11 	developmental disability professional under Code of Federal Regulations, title 42, section 
76.12 	483.430.
76.13 	(c) The local county mental health authority or the state developmental disability 
76.14 	authority under Public Law Numbers 100-203 and 101-508 may prohibit admission to a 
76.15 	nursing facility if the individual does not meet the nursing facility level of care criteria or 
76.16 	needs specialized services as defined in Public Law Numbers 100-203 and 101-508. For 
76.17 	purposes of this section, "specialized services" for a person with developmental disability 
76.18 	means active treatment as that term is defined under Code of Federal Regulations, title 
76.19 	42, section 483.440 (a)(1).
76.20 	(d) The determination of the need for nursing facility level of care must be made 
76.21 	according to criteria established in sections 144.0724, subdivision 11, and 256B.092, 
76.22 	using forms developed by the commissioner. In assessing a person's needs, consultation 
76.23 	team members shall have a physician available for consultation and shall consider the 
76.24 	assessment of the individual's attending physician, if any. The individual's physician must 
76.25 	be included if the physician chooses to participate. Other personnel may be included on 
76.26 	the team as deemed appropriate by the county.

76.27 	EFFECTIVE DATE. This section is effective January 1, 2011.

76.28 	Sec. 41. Minnesota Statutes 2008, section 256B.0911, subdivision 5, is amended to 
76.29 	read:
76.30 		Subd. 5.Administrative activity. The commissioner shall minimize the number 
76.31 	of forms required in the provision of long-term care consultation services and shall 
76.32 	limit the screening document to items necessary for community support plan approval, 
76.33 	reimbursement, program planning, evaluation, and policy development streamline the 
76.34 	processes required to provide the services in this section and shall implement integrated 
77.1 	solutions to automate the business processes to the extent necessary for community support 
77.2 	plan approval, reimbursement, program planning, evaluation, and policy development.

77.3 	EFFECTIVE DATE. This section is effective January 1, 2011.

77.4 	Sec. 42. Minnesota Statutes 2008, section 256B.0911, subdivision 6, is amended to 
77.5 	read:
77.6 		Subd. 6.Payment for long-term care consultation services. (a) The total payment 
77.7 	for each county must be paid monthly by certified nursing facilities in the county. The 
77.8 	monthly amount to be paid by each nursing facility for each fiscal year must be determined 
77.9 	by dividing the county's annual allocation for long-term care consultation services by 12 
77.10 	to determine the monthly payment and allocating the monthly payment to each nursing 
77.11 	facility based on the number of licensed beds in the nursing facility. Payments to counties 
77.12 	in which there is no certified nursing facility must be made by increasing the payment 
77.13 	rate of the two facilities located nearest to the county seat.
77.14 	(b) The commissioner shall include the total annual payment determined under 
77.15 	paragraph (a) for each nursing facility reimbursed under section 256B.431 or 256B.434
77.16 	according to section 256B.431, subdivision 2b, paragraph (g).
77.17 	(c) In the event of the layaway, delicensure and decertification, or removal from 
77.18 	layaway of 25 percent or more of the beds in a facility, the commissioner may adjust 
77.19 	the per diem payment amount in paragraph (b) and may adjust the monthly payment 
77.20 	amount in paragraph (a). The effective date of an adjustment made under this paragraph 
77.21 	shall be on or after the first day of the month following the effective date of the layaway, 
77.22 	delicensure and decertification, or removal from layaway.
77.23 	(d) Payments for long-term care consultation services are available to the county 
77.24 	or counties to cover staff salaries and expenses to provide the services described in 
77.25 	subdivision 1a. The county shall employ, or contract with other agencies to employ, within 
77.26 	the limits of available funding, sufficient personnel to provide long-term care consultation 
77.27 	services while meeting the state's long-term care outcomes and objectives as defined in 
77.28 	section 256B.0917, subdivision 1. The county shall be accountable for meeting local 
77.29 	objectives as approved by the commissioner in the biennial home and community-based 
77.30 	services quality assurance plan on a form provided by the commissioner.
77.31 	(e) Notwithstanding section 256B.0641, overpayments attributable to payment of the 
77.32 	screening costs under the medical assistance program may not be recovered from a facility.
77.33 	(f) The commissioner of human services shall amend the Minnesota medical 
77.34 	assistance plan to include reimbursement for the local consultation teams.
78.1 	(g) The county may bill, as case management services, assessments, support 
78.2 	planning, and follow-along provided to persons determined to be eligible for case 
78.3 	management under Minnesota health care programs. No individual or family member 
78.4 	shall be charged for an initial assessment or initial support plan development provided 
78.5 	under subdivision 3a or 3b.
78.6 	(h) The commissioner shall develop an alternative payment methodology for 
78.7 	long-term care consultation services that includes the funding available under this 
78.8 	subdivision, and sections 256B.092 and 256B.0659. In developing the new payment 
78.9 	methodology, the commissioner shall consider the maximization of federal funding for 
78.10 	this activity.

78.11 	Sec. 43. Minnesota Statutes 2008, section 256B.0911, subdivision 7, is amended to 
78.12 	read:
78.13 		Subd. 7.Reimbursement for certified nursing facilities. (a) Medical assistance 
78.14 	reimbursement for nursing facilities shall be authorized for a medical assistance recipient 
78.15 	only if a preadmission screening has been conducted prior to admission or the county has 
78.16 	authorized an exemption. Medical assistance reimbursement for nursing facilities shall 
78.17 	not be provided for any recipient who the local screener has determined does not meet the 
78.18 	level of care criteria for nursing facility placement in section 144.0724, subdivision 11, or, 
78.19 	if indicated, has not had a level II OBRA evaluation as required under the federal Omnibus 
78.20 	Budget Reconciliation Act of 1987 completed unless an admission for a recipient with 
78.21 	mental illness is approved by the local mental health authority or an admission for a 
78.22 	recipient with developmental disability is approved by the state developmental disability 
78.23 	authority.
78.24 	(b) The nursing facility must not bill a person who is not a medical assistance 
78.25 	recipient for resident days that preceded the date of completion of screening activities as 
78.26 	required under subdivisions 4a, 4b, and 4c. The nursing facility must include unreimbursed 
78.27 	resident days in the nursing facility resident day totals reported to the commissioner.

78.28 	EFFECTIVE DATE. This section is effective January 1, 2011.

78.29 	Sec. 44. Minnesota Statutes 2008, section 256B.0913, subdivision 4, is amended to 
78.30 	read:
78.31 		Subd. 4.Eligibility for funding for services for nonmedical assistance recipients.
 78.32 	(a) Funding for services under the alternative care program is available to persons who 
78.33 	meet the following criteria:
79.1 	(1) the person has been determined by a community assessment under section 
79.2 	256B.0911 to be a person who would require the level of care provided in a nursing 
79.3 	facility, but for the provision of services under the alternative care program. Effective 
79.4 	January 1, 2011, this determination must be made according to the criteria established in 
79.5 	section 144.0724, subdivision 11;
79.6 	(2) the person is age 65 or older;
79.7 	(3) the person would be eligible for medical assistance within 135 days of admission 
79.8 	to a nursing facility;
79.9 	(4) the person is not ineligible for the payment of long-term care services by the 
79.10 	medical assistance program due to an asset transfer penalty under section 256B.0595 or 
79.11 	equity interest in the home exceeding $500,000 as stated in section 256B.056;
79.12 	(5) the person needs long-term care services that are not funded through other state 
79.13 	or federal funding;
79.14 	(6) except for individuals described in clause (7), the monthly cost of the alternative 
79.15 	care services funded by the program for this person does not exceed 75 percent of the 
79.16 	monthly limit described under section 256B.0915, subdivision 3a. This monthly limit 
79.17 	does not prohibit the alternative care client from payment for additional services, but in no 
79.18 	case may the cost of additional services purchased under this section exceed the difference 
79.19 	between the client's monthly service limit defined under section 256B.0915, subdivision 
79.20 	3, and the alternative care program monthly service limit defined in this paragraph. If 
79.21 	care-related supplies and equipment or environmental modifications and adaptations are or 
79.22 	will be purchased for an alternative care services recipient, the costs may be prorated on a 
79.23 	monthly basis for up to 12 consecutive months beginning with the month of purchase. 
79.24 	If the monthly cost of a recipient's other alternative care services exceeds the monthly 
79.25 	limit established in this paragraph, the annual cost of the alternative care services shall be 
79.26 	determined. In this event, the annual cost of alternative care services shall not exceed 12 
79.27 	times the monthly limit described in this paragraph; and
79.28 	(7) for individuals assigned a case mix classification A as described under section 
79.29 	256B.0915, subdivision 3a, paragraph (a), with (i) no dependencies in activities of daily 
79.30 	living, (ii) only one dependency in bathing, dressing, grooming, or walking, or (iii) a 
79.31 	dependency score of less than three if eating is the only dependency as determined by an 
79.32 	assessment performed under section 256B.0911, the monthly cost of alternative care 
79.33 	services funded by the program cannot exceed $600 per month for all new participants 
79.34 	enrolled in the program on or after July 1, 2009. This monthly limit shall be applied to 
79.35 	all other participants who meet this criteria at reassessment. This monthly limit shall be 
79.36 	increased annually as described in section 256B.0915, subdivision 3a, paragraph (a). This 
80.1 	monthly limit does not prohibit the alternative care client from payment for additional 
80.2 	services, but in no case may the cost of additional services purchased exceed the difference 
80.3 	between the client's monthly service limit defined in this clause and the limit described in 
80.4 	clause (6) for case mix classification A; and
80.5 	(8) the person is making timely payments of the assessed monthly fee.
80.6 	A person is ineligible if payment of the fee is over 60 days past due, unless the person 
80.7 	agrees to:
80.8 	(i) the appointment of a representative payee;
80.9 	(ii) automatic payment from a financial account;
80.10 	(iii) the establishment of greater family involvement in the financial management of 
80.11 	payments; or
80.12 	(iv) another method acceptable to the lead agency to ensure prompt fee payments.
80.13 	The lead agency may extend the client's eligibility as necessary while making 
80.14 	arrangements to facilitate payment of past-due amounts and future premium payments. 
80.15 	Following disenrollment due to nonpayment of a monthly fee, eligibility shall not be 
80.16 	reinstated for a period of 30 days.
80.17 	(b) Alternative care funding under this subdivision is not available for a person 
80.18 	who is a medical assistance recipient or who would be eligible for medical assistance 
80.19 	without a spenddown or waiver obligation. A person whose initial application for medical 
80.20 	assistance and the elderly waiver program is being processed may be served under the 
80.21 	alternative care program for a period up to 60 days. If the individual is found to be eligible 
80.22 	for medical assistance, medical assistance must be billed for services payable under the 
80.23 	federally approved elderly waiver plan and delivered from the date the individual was 
80.24 	found eligible for the federally approved elderly waiver plan. Notwithstanding this 
80.25 	provision, alternative care funds may not be used to pay for any service the cost of which: 
80.26 	(i) is payable by medical assistance; (ii) is used by a recipient to meet a waiver obligation; 
80.27 	or (iii) is used to pay a medical assistance income spenddown for a person who is eligible 
80.28 	to participate in the federally approved elderly waiver program under the special income 
80.29 	standard provision.
80.30 	(c) Alternative care funding is not available for a person who resides in a licensed 
80.31 	nursing home, certified boarding care home, hospital, or intermediate care facility, except 
80.32 	for case management services which are provided in support of the discharge planning 
80.33 	process for a nursing home resident or certified boarding care home resident to assist with 
80.34 	a relocation process to a community-based setting.
80.35 	(d) Alternative care funding is not available for a person whose income is greater 
80.36 	than the maintenance needs allowance under section 256B.0915, subdivision 1d, but equal 
81.1 	to or less than 120 percent of the federal poverty guideline effective July 1 in the fiscal 
81.2 	year for which alternative care eligibility is determined, who would be eligible for the 
81.3 	elderly waiver with a waiver obligation.

81.4 	Sec. 45. Minnesota Statutes 2008, section 256B.0915, subdivision 3a, is amended to 
81.5 	read:
81.6 		Subd. 3a. Elderly waiver cost limits. (a) The monthly limit for the cost of 
81.7 	waivered services to an individual elderly waiver client except for individuals described 
81.8 	in paragraph (b) shall be the weighted average monthly nursing facility rate of the case 
81.9 	mix resident class to which the elderly waiver client would be assigned under Minnesota 
81.10 	Rules, parts 9549.0050 to 9549.0059, less the recipient's maintenance needs allowance 
81.11 	as described in subdivision 1d, paragraph (a), until the first day of the state fiscal year in 
81.12 	which the resident assessment system as described in section 256B.438 for nursing home 
81.13 	rate determination is implemented. Effective on the first day of the state fiscal year in 
81.14 	which the resident assessment system as described in section 256B.438 for nursing home 
81.15 	rate determination is implemented and the first day of each subsequent state fiscal year, the 
81.16 	monthly limit for the cost of waivered services to an individual elderly waiver client shall 
81.17 	be the rate of the case mix resident class to which the waiver client would be assigned 
81.18 	under Minnesota Rules, parts 9549.0050 to 9549.0059, in effect on the last day of the 
81.19 	previous state fiscal year, adjusted by the greater of any legislatively adopted home and 
81.20 	community-based services percentage rate increase or the average statewide percentage 
81.21 	increase in nursing facility payment rates. 
81.22 	(b) The monthly limit for the cost of waivered services to an individual elderly 
81.23 	waiver client assigned to a case mix classification A under paragraph (a) with (i) no 
81.24 	dependencies in activities of daily living, (ii) only one dependency in bathing, dressing, 
81.25 	grooming, or walking, or (iii) a dependency score of less than three if eating is the only 
81.26 	dependency, shall be the lower of the case mix classification amount for case mix A as 
81.27 	determined under paragraph (a) or the case mix classification amount for case mix A 
81.28 	effective on October 1, 2008, per month for all new participants enrolled in the program 
81.29 	on or after July 1, 2009. This monthly limit shall be applied to all other participants 
81.30 	who meet this criteria at reassessment. This monthly limit shall be increased annually as 
81.31 	described in paragraph (a).
81.32 	(c)  If extended medical supplies and equipment or environmental modifications are 
81.33 	or will be purchased for an elderly waiver client, the costs may be prorated for up to 
81.34 	12 consecutive months beginning with the month of purchase. If the monthly cost of a 
81.35 	recipient's waivered services exceeds the monthly limit established in paragraph (a) or (b), 
82.1 	the annual cost of all waivered services shall be determined. In this event, the annual cost 
82.2 	of all waivered services shall not exceed 12 times the monthly limit of waivered services 
82.3 	as described in paragraph (a) or (b). 

82.4 	Sec. 46. Minnesota Statutes 2008, section 256B.0915, subdivision 3e, is amended to 
82.5 	read:
82.6 		Subd. 3e.Customized living service rate. (a) Payment for customized living 
82.7 	services shall be a monthly rate negotiated and authorized by the lead agency within the 
82.8 	parameters established by the commissioner. The payment agreement must delineate the 
82.9 	services that have been customized for each recipient and specify the amount of each 
82.10 	component service included in the recipient's customized living service to be provided
82.11 	plan. The lead agency shall ensure that there is a documented need for allwithin the 
82.12 	parameters established by the commissioner for all component customized living services 
82.13 	authorized. Customized living services must not include rent or raw food costs.
82.14 	(b) The negotiated payment rate must be based on the amount of component services 
82.15 	to be provided utilizing component rates established by the commissioner. Counties and 
82.16 	tribes shall use tools issued by the commissioner to develop and document customized 
82.17 	living service plans and rates.
82.18 	Negotiated (c) Component service rates must not exceed payment rates for 
82.19 	comparable elderly waiver or medical assistance services and must reflect economies of 
82.20 	scale. Customized living services must not include rent or raw food costs.
82.21 	(b)(d) The individualized monthly negotiated authorized payment for the 
82.22 	customized living services service plan shall not exceed the nonfederal share, in effect 
82.23 	on July 1 of the state fiscal year for which the rate limit is being calculated, 50 percent
82.24 	of the greater of either the statewide or any of the geographic groups' weighted average 
82.25 	monthly nursing facility rate of the case mix resident class to which the elderly waiver 
82.26 	eligible client would be assigned under Minnesota Rules, parts 9549.0050 to 9549.0059, 
82.27 	less the maintenance needs allowance as described in subdivision 1d, paragraph (a), until 
82.28 	the July 1 of the state fiscal year in which the resident assessment system as described 
82.29 	in section 256B.438 for nursing home rate determination is implemented. Effective on 
82.30 	July 1 of the state fiscal year in which the resident assessment system as described in 
82.31 	section 256B.438 for nursing home rate determination is implemented and July 1 of each 
82.32 	subsequent state fiscal year, the individualized monthly negotiated authorized payment 
82.33 	for the services described in this clause shall not exceed the limit described in this clause
82.34 	which was in effect on June 30 of the previous state fiscal year and which has been 
82.35 	adjusted by the greater of any legislatively adopted home and community-based services 
83.1 	cost-of-living percentage increase or any legislatively adopted statewide percent rate 
83.2 	increase for nursing facilities updated annually based on legislatively adopted changes to 
83.3 	all service rate maximums for home and community-based service providers.
83.4 	(c)(e) Customized living services are delivered by a provider licensed by the 
83.5 	Department of Health as a class A or class F home care provider and provided in a 
83.6 	building that is registered as a housing with services establishment under chapter 144D.

83.7 	Sec. 47. Minnesota Statutes 2008, section 256B.0915, subdivision 3h, is amended to 
83.8 	read:
83.9 		Subd. 3h.Service rate limits; 24-hour customized living services. (a) The 
83.10 	payment rates rate  for 24-hour customized living services is a monthly rate negotiated 
83.11 	and authorized by the lead agency within the parameters established by the commissioner 
83.12 	of human services. The payment agreement must delineate the services that have been 
83.13 	customized for each recipient and specify the amount of each component service included 
83.14 	in each recipient's customized living service to be provided plan. The lead agency 
83.15 	shall ensure that there is a documented need within the parameters established by the 
83.16 	commissioner for all component customized living services authorized. The lead agency 
83.17 	shall not authorize 24-hour customized living services unless there is a documented need 
83.18 	for 24-hour supervision.
83.19 	(b) For purposes of this section, "24-hour supervision" means that the recipient 
83.20 	requires assistance due to needs related to one or more of the following:
83.21 	(1) intermittent assistance with toileting, positioning,  or transferring;
83.22 	(2) cognitive or behavioral issues;
83.23 	(3) a medical condition that requires clinical monitoring; or
83.24 	(4) other conditions or needs as defined by the commissioner of human services for 
83.25 	all new participants enrolled in the program on or after January 1, 2011, and all other 
83.26 	participants at their first reassessment after January 1, 2011, dependency in at least two 
83.27 	of the following activities of daily living as determined by assessment under section 
83.28 	256B.0911: bathing; dressing; grooming; walking; or eating; and  needs medication 
83.29 	management and at least 50 hours of service per month. The lead agency shall ensure that 
83.30 	the frequency and mode of supervision of the recipient and the qualifications of staff 
83.31 	providing supervision are described and meet the needs of the recipient. Customized 
83.32 	living services must not include rent or raw food costs.
83.33 	(c) The negotiated payment rate for 24-hour customized living services must be 
83.34 	based on the amount of component services to be provided utilizing component rates 
84.1 	established by the commissioner. Counties and tribes will use tools issued by the 
84.2 	commissioner to develop and document customized living plans and authorize rates.
84.3 	Negotiated (d) Component service rates must not exceed payment rates for 
84.4 	comparable elderly waiver or medical assistance services and must reflect economies 
84.5 	of scale.
84.6 	(e) The individually negotiated authorized 24-hour customized living payments, 
84.7 	in combination with the payment for other elderly waiver services, including case 
84.8 	management, must not exceed the recipient's community budget cap specified in 
84.9 	subdivision 3a. Customized living services must not include rent or raw food costs.
84.10 	(f) The individually authorized 24-hour customized living payment rates shall not 
84.11 	exceed the 95 percentile of statewide monthly authorizations for 24-hour customized 
84.12 	living services in effect and in the Medicaid management information systems on March 
84.13 	31, 2009, for each case mix resident class under Minnesota Rules, parts 9549.0050 
84.14 	to 9549.0059, to which elderly waiver service clients are assigned. When there are 
84.15 	fewer than 50 authorizations in effect in the case mix resident class, the commissioner 
84.16 	shall multiply the calculated service payment rate maximum for the A classification by 
84.17 	the standard weight for that classification under Minnesota Rules, parts 9549.0050 to 
84.18 	9549.0059, to determine the applicable payment rate maximum. Service payment rate 
84.19 	maximums shall be updated annually based on legislatively adopted changes to all service 
84.20 	rates for home and community-based service providers.
84.21 	(g) Notwithstanding the requirements of paragraphs (d) and (f), the commissioner 
84.22 	may establish an alternative payment rate system for 24-hour customized living services 
84.23 	by approving a single hourly rate for direct services provided in establishments, which 
84.24 	meet the following criteria:
84.25 	(1) are registered as housing with services establishments with a capacity of 12 or 
84.26 	fewer residents; and
84.27 	(2) are licensed as adult foster care or as a board and lodge establishment.

84.28 	Sec. 48. Minnesota Statutes 2008, section 256B.0915, subdivision 5, is amended to 
84.29 	read:
84.30 		Subd. 5.Assessments and reassessments for waiver clients. (a) Each client shall 
84.31 	receive an initial assessment of strengths, informal supports, and need for services in 
84.32 	accordance with section 256B.0911, subdivisions 3, 3a, and 3b. A reassessment of a client 
84.33 	served under the elderly waiver must be conducted at least every 12 months and at other 
84.34 	times when the case manager determines that there has been significant change in the 
84.35 	client's functioning. This may include instances where the client is discharged from the 
85.1 	hospital. There must be a determination that the client requires a nursing facility level of 
85.2 	care as defined in section 144.0724, subdivision 11, at initial and subsequent assessments 
85.3 	to initiate and maintain participation in the waiver program.
85.4 	(b) Regardless of other assessments identified in section 144.0724, subdivision 
85.5 	4, as appropriate to determine nursing facility level of care for purposes of medical 
85.6 	assistance payment for nursing facility services, only face-to-face assessments conducted 
85.7 	according to section 256B.0911, subdivisions 3a and 3b, that result in a nursing facility 
85.8 	level of care determination will be accepted for purposes of initial and ongoing access to 
85.9 	waiver service payment.

85.10 	EFFECTIVE DATE. This section is effective January 1, 2011.

85.11 	Sec. 49. Minnesota Statutes 2008, section 256B.0915, is amended by adding a 
85.12 	subdivision to read:
85.13 		Subd. 10.Waiver payment rates; managed care organizations. The 
85.14 	commissioner shall adjust the elderly waiver capitation payment rates for managed care 
85.15 	organizations paid under section 256B.69, subdivisions 6a and 23, to reflect the maximum 
85.16 	service rate limits for customized living services and 24-hour customized living services 
85.17 	under subdivisions 3e and 3h for the contract period beginning October 1, 2009. Medical 
85.18 	assistance rates paid to customized living providers by managed care organizations 
85.19 	under this section shall not exceed the maximum service rate limits determined by the 
85.20 	commissioner under subdivisions 3e and 3h.

85.21 	Sec. 50. Minnesota Statutes 2008, section 256B.0917, is amended by adding a 
85.22 	subdivision to read:
85.23 		Subd. 14.Essential community supports grants. (a) The purpose of the essential 
85.24 	community supports grant program is to provide targeted services to persons 65 years and 
85.25 	older who need essential community support, but whose needs do not meet the level of 
85.26 	care required for nursing facility placement under section 144.0724, subdivision 11.
85.27 	(b) Within the limits of the appropriation and not to exceed $400 per person per 
85.28 	month, funding must be available to a person who:
85.29 	(1) is age 65 or older;
85.30 	(2) is not eligible for medical assistance;
85.31 	(3) would otherwise be financially eligible for the alternative care program under 
85.32 	section 256B.0913, subdivision 4;
85.33 	(4) has received a community assessment under section 256B.0911, subdivision 3a 
85.34 	or 3b, and does not require the level of care provided in a nursing facility;
86.1 	(5) has a community support plan; and
86.2 	(6) has been determined by a community assessment under section 256B.0911, 
86.3 	subdivision 3a or 3b, to be a person who would require provision of at least one of the 
86.4 	following services, as defined in the approved elderly waiver plan, in order to maintain 
86.5 	their community residence:
86.6 	(i) caregiver support;
86.7 	(ii) homemaker;
86.8 	(iii) chore; or
86.9 	(iv) a personal emergency response device or system.
86.10 	(c) The person receiving any of the essential community supports in this subdivision 
86.11 	must also receive service coordination as part of their community support plan.
86.12 	(d) A person who has been determined to be eligible for an essential community 
86.13 	support grant must be reassessed at least annually and continue to meet the criteria in 
86.14 	paragraph (b) to remain eligible for an essential community support grant.
86.15 	(e) The commissioner shall allocate grants to counties and tribes under contract with 
86.16 	the department based upon the historic use of the medical assistance elderly waiver and 
86.17 	alternative care grant programs and other criteria as determined by the commissioner.

86.18 	EFFECTIVE DATE. This section is effective January 1, 2011.

86.19 	Sec. 51. Minnesota Statutes 2008, section 256B.092, subdivision 8a, is amended to 
86.20 	read:
86.21 		Subd. 8a.County concurrence. (a) If the county of financial responsibility wishes 
86.22 	to place a person in another county for services, the county of financial responsibility shall 
86.23 	seek concurrence from the proposed county of service and the placement shall be made 
86.24 	cooperatively between the two counties. Arrangements shall be made between the two 
86.25 	counties for ongoing social service, including annual reviews of the person's individual 
86.26 	service plan. The county where services are provided may not make changes in the 
86.27 	person's service plan without approval by the county of financial responsibility.
86.28 	(b) When a person has been screened and authorized for services in an intermediate 
86.29 	care facility for persons with developmental disabilities or for home and community-based 
86.30 	services for persons with developmental disabilities, the case manager shall assist that 
86.31 	person in identifying a service provider who is able to meet the needs of the person 
86.32 	according to the person's individual service plan. If the identified service is to be provided 
86.33 	in a county other than the county of financial responsibility, the county of financial 
86.34 	responsibility shall request concurrence of the county where the person is requesting to 
86.35 	receive the identified services. The county of service may refuse to concur if:
87.1 	(1) it can demonstrate that the provider is unable to provide the services identified in 
87.2 	the person's individual service plan as services that are needed and are to be provided; or
87.3 	(2) in the case of an intermediate care facility for persons with developmental 
87.4 	disabilities, there has been no authorization for admission by the admission review team 
87.5 	as required in section 256B.0926; or
87.6 	(3) in the case of home and community-based services for persons with 
87.7 	developmental disabilities, the county of service can demonstrate that the prospective 
87.8 	provider has failed to substantially comply with the terms of a past contract or has had a 
87.9 	prior contract terminated within the last 12 months for failure to provide adequate services, 
87.10 	or has received a notice of intent to terminate the contract.
87.11 	(c) The county of service shall notify the county of financial responsibility of 
87.12 	concurrence or refusal to concur no later than 20 working days following receipt of the 
87.13 	written request. Unless other mutually acceptable arrangements are made by the involved 
87.14 	county agencies, the county of financial responsibility is responsible for costs of social 
87.15 	services and the costs associated with the development and maintenance of the placement. 
87.16 	The county of service may request that the county of financial responsibility purchase 
87.17 	case management services from the county of service or from a contracted provider 
87.18 	of case management when the county of financial responsibility is not providing case 
87.19 	management as defined in this section and rules adopted under this section, unless other 
87.20 	mutually acceptable arrangements are made by the involved county agencies. Standards 
87.21 	for payment limits under this section may be established by the commissioner. Financial 
87.22 	disputes between counties shall be resolved as provided in section 256G.09.

87.23 	Sec. 52. Minnesota Statutes 2008, section 256B.092, is amended by adding a 
87.24 	subdivision to read:
87.25 		Subd. 11.Residential support services. (a) Upon federal approval, there is 
87.26 	established a new service called residential support that is available on the CAC, CADI, 
87.27 	DD, and TBI waivers. Existing waiver service descriptions must be modified to the extent 
87.28 	necessary to ensure there is no duplication between other services. Residential support 
87.29 	services must be provided by vendors licensed as a community residential setting as 
87.30 	defined in section 245A.11, subdivision 8.
87.31 	(b) Residential support services must meet the following criteria:
87.32 	(1) providers of residential support services must own or control the residential site;
87.33 	(2) the residential site must not be the primary residence of the license holder;
87.34 	(3) the residential site must have a designated program supervisor responsible for 
87.35 	program oversight, development, and implementation of policies and procedures;
88.1 	(4) the provider of residential support services must provide supervision, training, 
88.2 	and assistance as described in the person's community support plan; and
88.3 	(5) the provider of residential support services must meet the requirements of 
88.4 	licensure and additional requirements of the person's community support plan.
88.5 	(c) Providers of residential support services that meet the definition in paragraph (a) 
88.6 	must be registered using a process determined by the commissioner beginning July 1, 2009.

88.7 	Sec. 53. [256B.0948] FOSTER CARE RATE LIMITS.
88.8 	The commissioner shall decrease by five percent rates for adult foster care and 
88.9 	supportive living services that are reimbursed under section 256B.092 or 256B.49, and 
88.10 	are above 95 percent of the statewide rate for the service. The reduction in rates shall 
88.11 	take into account acuity of individuals served based on the methodology used to allocate 
88.12 	dollars to local lead agency budgets. Lead agency contracts for services specified in 
88.13 	this section shall be amended to implement these rate changes for services rendered on 
88.14 	or after July 1, 2009. The commissioner shall make corresponding reductions to waiver 
88.15 	allocations and capitated rates.

88.16 	Sec. 54. Minnesota Statutes 2008, section 256B.37, subdivision 1, is amended to read:
88.17 		Subdivision 1.Subrogation. Upon furnishing medical assistance  services under this 
88.18 	chapter or alternative care services under section 256B.0913 to any person who has private 
88.19 	accident or health care coverage, or receives or has a right to receive health or medical care 
88.20 	from any type of organization or entity, or has a cause of action arising out of an occurrence 
88.21 	that necessitated the payment of medical assistance, the state agency or the state agency's 
88.22 	agent shall be subrogated, to the extent of the cost of medical care furnished, to any rights 
88.23 	the person may have under the terms of the coverage, or against the organization or entity 
88.24 	providing or liable to provide health or medical care, or under the cause of action.
88.25 	The right of subrogation created in this section includes all portions of the cause 
88.26 	of action, notwithstanding any settlement allocation or apportionment that purports to 
88.27 	dispose of portions of the cause of action not subject to subrogation.

88.28 	EFFECTIVE DATE. This section is effective January 1, 2011.

88.29 	Sec. 55. Minnesota Statutes 2008, section 256B.37, subdivision 5, is amended to read:
88.30 		Subd. 5.Private benefits to be used first. Private accident and health care coverage 
88.31 	including Medicare for medical services is primary coverage and must be exhausted before 
88.32 	medical assistance is or alternative care services are  paid for medical services including 
88.33 	home health care, personal care assistant services, hospice, supplies and equipment, or 
89.1 	services covered under a Centers for Medicare and Medicaid Services waiver. When a 
89.2 	person who is otherwise eligible for medical assistance has private accident or health care 
89.3 	coverage, including Medicare or a prepaid health plan, the private health care benefits 
89.4 	available to the person must be used first and to the fullest extent.

89.5 	EFFECTIVE DATE. This section is effective January 1, 2011.

89.6 	Sec. 56. Minnesota Statutes 2008, section 256B.434, subdivision 4, is amended to read:
89.7 		Subd. 4.Alternate rates for nursing facilities. (a) For nursing facilities which 
89.8 	have their payment rates determined under this section rather than section 256B.431, the 
89.9 	commissioner shall establish a rate under this subdivision. The nursing facility must enter 
89.10 	into a written contract with the commissioner.
89.11 	(b) A nursing facility's case mix payment rate for the first rate year of a facility's 
89.12 	contract under this section is the payment rate the facility would have received under 
89.13 	section 256B.431.
89.14 	(c) A nursing facility's case mix payment rates for the second and subsequent years 
89.15 	of a facility's contract under this section are the previous rate year's contract payment 
89.16 	rates plus an inflation adjustment and, for facilities reimbursed under this section or 
89.17 	section 256B.431, an adjustment to include the cost of any increase in Health Department 
89.18 	licensing fees for the facility taking effect on or after July 1, 2001. The index for the 
89.19 	inflation adjustment must be based on the change in the Consumer Price Index-All Items 
89.20 	(United States City average) (CPI-U) forecasted by the commissioner of finance's national 
89.21 	economic consultant, as forecasted in the fourth quarter of the calendar year preceding 
89.22 	the rate year. The inflation adjustment must be based on the 12-month period from the 
89.23 	midpoint of the previous rate year to the midpoint of the rate year for which the rate is 
89.24 	being determined. For the rate years beginning on July 1, 1999, July 1, 2000, July 1, 
89.25 	2001, July 1, 2002, July 1, 2003, July 1, 2004, July 1, 2005, July 1, 2006, July 1, 2007, 
89.26 	July 1, 2008, October 1, 2009, and October 1, 2010, October 1, 2011, October 1, 2012, 
89.27 	and October 1, 2013, this paragraph shall apply only to the property-related payment 
89.28 	rate, except that adjustments to include the cost of any increase in Health Department 
89.29 	licensing fees taking effect on or after July 1, 2001, shall be provided. Beginning in 2005, 
89.30 	adjustment to the property payment rate under this section and section 256B.431 shall be 
89.31 	effective on October 1. In determining the amount of the property-related payment rate 
89.32 	adjustment under this paragraph, the commissioner shall determine the proportion of the 
89.33 	facility's rates that are property-related based on the facility's most recent cost report. 
89.34 	(d) The commissioner shall develop additional incentive-based payments of up to 
89.35 	five percent above a facility's operating payment rate for achieving outcomes specified 
90.1 	in a contract. The commissioner may solicit contract amendments and implement those 
90.2 	which, on a competitive basis, best meet the state's policy objectives. The commissioner 
90.3 	shall limit the amount of any incentive payment and the number of contract amendments 
90.4 	under this paragraph to operate the incentive payments within funds appropriated for this 
90.5 	purpose. The contract amendments may specify various levels of payment for various 
90.6 	levels of performance. Incentive payments to facilities under this paragraph may be in the 
90.7 	form of time-limited rate adjustments or onetime supplemental payments. In establishing 
90.8 	the specified outcomes and related criteria, the commissioner shall consider the following 
90.9 	state policy objectives:
90.10 	(1) successful diversion or discharge of residents to the residents' prior home or other 
90.11 	community-based alternatives;
90.12 	(2) adoption of new technology to improve quality or efficiency; 
90.13 	(3) improved quality as measured in the Nursing Home Report Card; 
90.14 	(4) reduced acute care costs; and
90.15 	(5) any additional outcomes proposed by a nursing facility that the commissioner 
90.16 	finds desirable.
90.17 	(e) Notwithstanding the threshold in section 256B.431, subdivision 16, facilities that 
90.18 	take action to come into compliance with existing or pending requirements of the life 
90.19 	safety code provisions or federal regulations governing sprinkler systems must receive 
90.20 	reimbursement for the costs associated with compliance if all of the following conditions 
90.21 	are met:
90.22 	(1) the expenses associated with compliance occurred on or after January 1, 2005, 
90.23 	and before December 31, 2008;
90.24 	(2) the costs were not otherwise reimbursed under subdivision 4f or section 
90.25 	144A.071 or 144A.073; and
90.26 	(3) the total allowable costs reported under this paragraph are  less than the minimum 
90.27 	threshold established under section 256B.431, subdivision 15, paragraph (e), and 
90.28 	subdivision 16.
90.29 	The commissioner shall use money appropriated for this purpose to provide to qualifying 
90.30 	nursing facilities a rate adjustment beginning October 1, 2007, and ending September 30, 
90.31 	2008. Nursing facilities that have spent money or anticipate the need to spend money 
90.32 	to satisfy the most recent life safety code requirements by (1) installing a sprinkler 
90.33 	system or (2) replacing all or portions of an existing sprinkler system may submit to the 
90.34 	commissioner by June 30, 2007, on a form provided by the commissioner the actual 
90.35 	costs of a completed project or the estimated costs, based on a project bid, of a planned 
90.36 	project. The commissioner shall calculate a rate adjustment equal to the allowable 
91.1 	costs of the project divided by the resident days reported for the report year ending 
91.2 	September 30, 2006. If the costs from all projects exceed the appropriation for this 
91.3 	purpose, the commissioner shall allocate the money appropriated on a pro rata basis 
91.4 	to the qualifying facilities by reducing the rate adjustment determined for each facility 
91.5 	by an equal percentage. Facilities that used estimated costs when requesting the rate 
91.6 	adjustment shall report to the commissioner by January 31, 2009, on the use of this 
91.7 	money on a form provided by the commissioner. If the nursing facility fails to provide 
91.8 	the report, the commissioner shall recoup the money paid to the facility for this purpose. 
91.9 	If the facility reports expenditures allowable under this subdivision that are less than 
91.10 	the amount received in the facility's annualized rate adjustment, the commissioner shall 
91.11 	recoup the difference.

91.12 	Sec. 57. Minnesota Statutes 2008, section 256B.437, subdivision 6, is amended to read:
91.13 		Subd. 6.Planned closure rate adjustment. (a) The commissioner of human 
91.14 	services shall calculate the amount of the planned closure rate adjustment available under 
91.15 	subdivision 3, paragraph (b), for up to 5,140 beds according to clauses (1) to (4):
91.16 	(1) the amount available is the net reduction of nursing facility beds multiplied 
91.17 	by $2,080;
91.18 	(2) the total number of beds in the nursing facility or facilities receiving the planned 
91.19 	closure rate adjustment must be identified;
91.20 	(3) capacity days are determined by multiplying the number determined under 
91.21 	clause (2) by 365; and
91.22 	(4) the planned closure rate adjustment is the amount available in clause (1), divided 
91.23 	by capacity days determined under clause (3).
91.24 	(b) A planned closure rate adjustment under this section is effective on the first day 
91.25 	of the month following completion of closure of the facility designated for closure in the 
91.26 	application and becomes part of the nursing facility's total operating payment rate.
91.27 	(c) Applicants may use the planned closure rate adjustment to allow for a property 
91.28 	payment for a new nursing facility or an addition to an existing nursing facility or as an 
91.29 	operating payment rate adjustment. Applications approved under this subdivision are 
91.30 	exempt from other requirements for moratorium exceptions under section 144A.073, 
91.31 	subdivisions 2 and 3.
91.32 	(d) Upon the request of a closing facility, the commissioner must allow the facility a 
91.33 	closure rate adjustment as provided under section 144A.161, subdivision 10.
92.1 	(e) A facility that has received a planned closure rate adjustment may reassign it 
92.2 	to another facility that is under the same ownership at any time within three years of its 
92.3 	effective date. The amount of the adjustment shall be computed according to paragraph (a).
92.4 	(f) If the per bed dollar amount specified in paragraph (a), clause (1), is increased, 
92.5 	the commissioner shall recalculate planned closure rate adjustments for facilities that 
92.6 	delicense beds under this section on or after July 1, 2001, to reflect the increase in the per 
92.7 	bed dollar amount. The recalculated planned closure rate adjustment shall be effective 
92.8 	from the date the per bed dollar amount is increased.
92.9 	(g) For planned closures approved after June 30, 2009, the commissioner of human 
92.10 	services shall calculate the amount of the planned closure rate adjustment available under 
92.11 	subdivision 3, paragraph (b), according to paragraph (a), clauses (1) to (4).

92.12 	Sec. 58. Minnesota Statutes 2008, section 256B.441, subdivision 51a, is amended to 
92.13 	read:
92.14 		Subd. 51a.Exception allowing contracting for specialized care. (a) For rate years 
92.15 	beginning on or after October 1, 2009, and prior to October 1, 2016, the commissioner 
92.16 	may negotiate rate adjustments for nursing facilities that provide specialized care and that 
92.17 	receive rate adjustments under subdivision 61. These rate adjustments may restore to 
92.18 	these facilities a portion of the amount of the rate reduction resulting from subdivision 
92.19 	59. The commissioner shall publish a request for proposals and may negotiate these rate 
92.20 	adjustments in accordance with paragraph (c), at a cost to the general fund not to exceed 
92.21 	$150,000 per year.
92.22 	(b) For rate years beginning on or after October 1, 2016, the commissioner may 
92.23 	negotiate increases to the care-related limit for nursing facilities that provide specialized 
92.24 	care, at a cost to the general fund not to exceed $600,000 per year. The commissioner 
92.25 	shall publish a request for proposals annually, and may negotiate increases to the limits 
92.26 	that shall apply for either one or two years before the increase shall be subject to a new 
92.27 	proposal and negotiation. The care-related limit may be increased by up to 50 percent.
92.28 	(b) (c)  In selecting facilities with which to negotiate, the commissioner shall 
92.29 	consider:
92.30 	(1) the diagnoses or other circumstances of residents in the specialized program that 
92.31 	require care that costs substantially more than the RUG's rates associated with those 
92.32 	residents;
92.33 	(2) the nature of the specialized program or programs offered to meet the needs 
92.34 	of these individuals; and 
92.35 	(3) outcomes achieved by the specialized program.

93.1 	Sec. 59. Minnesota Statutes 2008, section 256B.441, subdivision 53, is amended to 
93.2 	read:
93.3 		Subd. 53.Calculation of payment rate for external fixed costs. The commissioner 
93.4 	shall calculate a payment rate for external fixed costs.
93.5 	(a) For a facility licensed as a nursing home, the portion related to section 
93.6 	256.9657shall be equal to $8.86. For a facility licensed as both a nursing home and a 
93.7 	boarding care home, the portion related to section 256.9657 shall be equal to $8.86 
93.8 	multiplied by the result of its number of nursing home beds divided by its total number of 
93.9 	licensed beds. Effective June 1, 2009, for a facility licensed as a nursing home, the portion 
93.10 	related to section 256.9657 shall be equal to $10.06. Effective June 1, 2009, for a facility 
93.11 	licensed as both a nursing home and a boarding care home, the portion related to section 
93.12 	256.9657 shall be equal to $10.06 multiplied by the result of its number of nursing home 
93.13 	beds divided by its total number of licensed beds.
93.14 	(b) The portion related to the licensure fee under section 144.122, paragraph (d), 
93.15 	shall be the amount of the fee divided by actual resident days.
93.16 	(c) The portion related to scholarships shall be determined under section 256B.431, 
93.17 	subdivision 36.
93.18 	(d) The portion related to long-term care consultation shall be determined according 
93.19 	to section 256B.0911, subdivision 6.
93.20 	(e) The portion related to development and education of resident and family advisory 
93.21 	councils under section 144A.33 shall be $5 divided by 365.
93.22 	(f) The portion related to planned closure rate adjustments shall be as determined 
93.23 	under sections 256B.436 and 256B.437, subdivision 6. Planned closure rate adjustments 
93.24 	that take effect before October 1, 2014, shall no longer be included in the payment rate 
93.25 	for external fixed costs beginning October 1, 2016. Planned closure rate adjustments that 
93.26 	take effect on or after October 1, 2014, shall no longer be included in the payment rate 
93.27 	for external fixed costs beginning on October 1 of the first year not less than two years 
93.28 	after their effective date.
93.29 	(g) The portions related to property insurance, real estate taxes, special assessments, 
93.30 	and payments made in lieu of real estate taxes directly identified or allocated to the nursing 
93.31 	facility shall be the actual amounts divided by actual resident days.
93.32 	(h) The portion related to the Public Employees Retirement Association shall be 
93.33 	actual costs divided by resident days.
93.34 	(i) The single bed room incentives shall be as determined under section 256B.431, 
93.35 	subdivision 42. Single bed room incentives that take effect before October 1, 2014, shall 
93.36 	no longer be included in the payment rate for external fixed costs beginning October 1, 
94.1 	2016. Single bed room incentives that take effect on or after October 1, 2014, shall no 
94.2 	longer be included in the payment rate for external fixed costs beginning on October 1 of 
94.3 	the first year not less than two years after their effective date.
94.4 	(j) The payment rate for external fixed costs shall be the sum of the amounts in 
94.5 	paragraphs (a) to (i).

94.6 	EFFECTIVE DATE. This section is effective the day following final enactment.

94.7 	Sec. 60. Minnesota Statutes 2008, section 256B.441, is amended by adding a 
94.8 	subdivision to read:
94.9 		Subd. 59.Single-bed payments for medical assistance recipients. Effective 
94.10 	October 1, 2009, a single-room payment rate of 111.5 percent of the established total 
94.11 	payment rate for a resident must be allowed if the resident is a medical assistance recipient 
94.12 	and the single room is considered as a medical necessity for the resident or others who 
94.13 	are affected by the resident's condition. Conditions requiring a single room must be 
94.14 	determined by the resident's attending physician and submitted to the commissioner for 
94.15 	approval or denial on the basis of medical necessity.

94.16 	Sec. 61. Minnesota Statutes 2008, section 256B.441, is amended by adding a 
94.17 	subdivision to read:
94.18 		Subd. 60.Rebasing not to be implemented. Notwithstanding subdivision 55, 
94.19 	for rate years beginning on October 1, 2009, and after, no rate adjustments shall be 
94.20 	implemented under this section. For rate years beginning October 1, 2009, and after, 
94.21 	nursing facility rates shall be determined under section 256B.434.

94.22 	Sec. 62. Minnesota Statutes 2008, section 256B.441, is amended by adding a 
94.23 	subdivision to read:
94.24 		Subd. 61.Rate adjustments effective October 1, 2009. (a) For the rate year 
94.25 	beginning October 1, 2009, nursing facility operating payment rates shall be reduced for 
94.26 	facilities that have the highest operating payment rates within their peer group and facility 
94.27 	type. These rate reductions shall not apply to facilities that are licensed under Minnesota 
94.28 	Rules, parts 9570.2000 to 9570.3400. These rate reductions shall be determined after 
94.29 	application of the phase-in provided in subdivision 55 and the hold harmless provided 
94.30 	in subdivision 56. The commissioner shall calculate the rate reductions in accordance 
94.31 	with paragraphs (b) to (d).
94.32 	(b) Within each peer group and facility type determine the operating payment rate at 
94.33 	the 64th percentile at a resource utilization group (RUGs) weight of 1.00.
95.1 	(c) Each nursing facility with an operating payment rate greater than the 64th 
95.2 	percentile at a RUGs weight of 1.00 shall have the difference between its rates at a RUGS 
95.3 	weight of 1.00 and the 64th percentile amount determined in paragraph (b) reduced by 
95.4 	an amount equal to the sum of:
95.5 	(1) 25 percent of the first $5 of the difference;
95.6 	(2) 35 percent of the amount of the difference that exceeds $5 but is less than $10;
95.7 	(3) 45 percent of the amount of the difference that exceeds $10 but is less than $15;
95.8 	(4) 55 percent of the amount of the difference that exceeds $15 but is less than 
95.9 	$20; and
95.10 	(5) 65 percent of the amount of the difference that exceeds $20.
95.11 	(d) The reductions computed in paragraph (c), clauses (1) to (5), shall be apportioned 
95.12 	to the direct care per diem, the other care-related per diem, the other operating per diem, 
95.13 	and the efficiency incentive in accordance with clauses (1) to (3):
95.14 	(1) the commissioner shall determine the percentage of the operating payment rate 
95.15 	determined in subdivisions 55 and 56, at a RUGs weight of 1.00 for October 1, 2009, that 
95.16 	is for the direct care per diem, the other care-related per diem, the other operating per 
95.17 	diem, and the efficiency incentive;
95.18 	(2) the percentages determined in clause (1) shall be multiplied by the operating 
95.19 	payment rate reduction determined in paragraph (c); and
95.20 	(3) for each RUGs level, the operating payment rate shall be reduced by the sum 
95.21 	of items (i) and (ii): 
95.22 	(i) the direct care rate reduction determined for a RUGs weight of 1.00 determined 
95.23 	in clause (2) multiplied by the corresponding weight in subdivision 14; and
95.24 	(ii) the other care-related per diem, the other operating per diem, and the efficiency 
95.25 	incentive rate reductions determined for a RUGs weight of 1.00 determined in clause (2).
95.26 	(e) Notwithstanding the provisions of section 256B.48, subdivision 1, paragraph 
95.27 	(a), a nursing facility that receives a rate reduction under this subdivision may continue to 
95.28 	charge private paying residents the rate in effect on September 30, 2009. This paragraph 
95.29 	expires on the effective date of any nursing facility rate adjustment that increases the 
95.30 	medical assistance rate to a level greater than the rate in effect on September 30, 2009.

95.31 	Sec. 63. Minnesota Statutes 2008, section 256B.49, subdivision 12, is amended to read:
95.32 		Subd. 12.Informed choice. Persons who are determined likely to require the level 
95.33 	of care provided in a nursing facility as determined under sections 144.0724, subdivision 
95.34 	11, and 256B.0911, or hospital shall be informed of the home and community-based 
95.35 	support alternatives to the provision of inpatient hospital services or nursing facility 
96.1 	services. Each person must be given the choice of either institutional or home and 
96.2 	community-based services using the provisions described in section 256B.77, subdivision 
96.3 	2, paragraph (p).

96.4 	EFFECTIVE DATE. This section is effective January 1, 2011.

96.5 	Sec. 64. Minnesota Statutes 2008, section 256B.49, subdivision 13, is amended to read:
96.6 		Subd. 13.Case management. (a) Each recipient of a home and community-based 
96.7 	waiver shall be provided case management services by qualified vendors as described 
96.8 	in the federally approved waiver application. The case management service activities 
96.9 	provided will include:
96.10 	(1) assessing the needs of the individual within 20 working days of a recipient's 
96.11 	request;
96.12 	(2) developing the written individual service plan within ten working days after the 
96.13 	assessment is completed;
96.14 	(3) informing the recipient or the recipient's legal guardian or conservator of service 
96.15 	options;
96.16 	(4) assisting the recipient in the identification of potential service providers;
96.17 	(5) assisting the recipient to access services;
96.18 	(6) coordinating, evaluating, and monitoring of the services identified in the service 
96.19 	plan;
96.20 	(7) completing the annual reviews of the service plan; and
96.21 	(8) informing the recipient or legal representative of the right to have assessments 
96.22 	completed and service plans developed within specified time periods, and to appeal county 
96.23 	action or inaction under section 256.045, subdivision 3, including the determination of 
96.24 	nursing facility level of care.
96.25 	(b) The case manager may delegate certain aspects of the case management service 
96.26 	activities to another individual provided there is oversight by the case manager. The case 
96.27 	manager may not delegate those aspects which require professional judgment including 
96.28 	assessments, reassessments, and care plan development.

96.29 	EFFECTIVE DATE. This section is effective January 1, 2011.

96.30 	Sec. 65. Minnesota Statutes 2008, section 256B.49, subdivision 14, is amended to read:
96.31 		Subd. 14.Assessment and reassessment. (a) Assessments of each recipient's 
96.32 	strengths, informal support systems, and need for services shall be completed within 
96.33 	20 working days of the recipient's request. Reassessment of each recipient's strengths, 
97.1 	support systems, and need for services shall be conducted at least every 12 months and at 
97.2 	other times when there has been a significant change in the recipient's functioning.
97.3 	(b) There must be a determination that the client requires a hospital level of care or a 
97.4 	nursing facility level of care as defined in section 144.0724, subdivision 11, at initial and 
97.5 	subsequent assessments to initiate and maintain participation in the waiver program.
97.6 	(c) Regardless of other assessments identified in section 144.0724, subdivision 4, as 
97.7 	appropriate to determine nursing facility level of care for purposes of medical assistance 
97.8 	payment for nursing facility services, only face-to-face assessments conducted according 
97.9 	to section 256B.0911, subdivisions 3a, 3b, and 4d, that result in a hospital level of care 
97.10 	determination or a nursing facility level of care determination must be accepted for 
97.11 	purposes of initial and ongoing access to waiver services payment.
97.12 	(d) Persons with developmental disabilities who apply for services under the nursing 
97.13 	facility level waiver programs shall be screened for the appropriate level of care according 
97.14 	to section 256B.092.
97.15 	(c)(e) Recipients who are found eligible for home and community-based services 
97.16 	under this section before their 65th birthday may remain eligible for these services after 
97.17 	their 65th birthday if they continue to meet all other eligibility factors.

97.18 	EFFECTIVE DATE. This section is effective January 1, 2011.

97.19 	Sec. 66. Minnesota Statutes 2008, section 256B.49, is amended by adding a 
97.20 	subdivision to read:
97.21 		Subd. 22.Residential support services. For the purposes of this section, the 
97.22 	provisions of section 256B.092, subdivision 11, are controlling.

97.23 	Sec. 67. [256B.4912] HOME AND COMMUNITY-BASED WAIVERS; 
97.24 	PROVIDERS AND PAYMENT.
97.25 		Subdivision 1.Provider qualifications. For the home and community-based 
97.26 	waivers providing services to seniors and individuals with disabilities, the commissioner 
97.27 	shall establish:
97.28 	(1) agreements with enrolled waiver service providers to ensure providers meet 
97.29 	qualifications defined in the waiver plans;
97.30 	(2) regular reviews of provider qualifications; and
97.31 	(3) processes to gather the necessary information to determine provider 
97.32 	qualifications.
98.1 	By July 1, 2010, staff that provide direct contact, as defined in section 245C.02, subdivision 
98.2 	11, that are employees of waiver service providers must meet the requirements of chapter 
98.3 	245C prior to providing waiver services and as part of ongoing enrollment. Upon federal 
98.4 	approval, this requirement must also apply to consumer-directed community supports.
98.5 		Subd. 2.Rate-setting methodologies. The commissioner shall establish 
98.6 	statewide rate-setting methodologies that meet federal waiver requirements for home 
98.7 	and community-based waiver services for individuals with disabilities. The rate-setting 
98.8 	methodologies must abide by the principles of transparency and equitability across the 
98.9 	state. The methodologies must involve a uniform process of structuring rates for each 
98.10 	service and must promote quality and participant choice.

98.11 	Sec. 68. Minnesota Statutes 2008, section 256B.5012, is amended by adding a 
98.12 	subdivision to read:
98.13 		Subd. 8.ICF/MR rate decreases effective July 1, 2009. Effective July 1, 2009, 
98.14 	the commissioner shall decrease each facility reimbursed under this section operating 
98.15 	payment adjustments equal to 3.0 percent of the operating payment rates in effect on June 
98.16 	30, 2009. For each facility, the commissioner shall implement the rate reduction, based on 
98.17 	occupied beds, using the percentage specified in this subdivision multiplied by the total 
98.18 	payment rate, including the variable rate but excluding the property-related payment rate, 
98.19 	in effect on the preceding date. The total rate reduction shall include the adjustment 
98.20 	provided in section 256B.502, subdivision 7.

98.21 	Sec. 69. Minnesota Statutes 2008, section 256B.69, subdivision 5a, is amended to read:
98.22 		Subd. 5a.Managed care contracts. (a) Managed care contracts under this section 
98.23 	and sections 256L.12 and 256D.03, shall be entered into or renewed on a calendar year 
98.24 	basis beginning January 1, 1996. Managed care contracts which were in effect on June 
98.25 	30, 1995, and set to renew on July 1, 1995, shall be renewed for the period July 1, 1995 
98.26 	through December 31, 1995 at the same terms that were in effect on June 30, 1995. The 
98.27 	commissioner may issue separate contracts with requirements specific to services to 
98.28 	medical assistance recipients age 65 and older.
98.29 	(b) A prepaid health plan providing covered health services for eligible persons 
98.30 	pursuant to chapters 256B, 256D, and 256L, is responsible for complying with the terms 
98.31 	of its contract with the commissioner. Requirements applicable to managed care programs 
98.32 	under chapters 256B, 256D, and 256L, established after the effective date of a contract 
98.33 	with the commissioner take effect when the contract is next issued or renewed.
99.1 	(c) Effective for services rendered on or after January 1, 2003, the commissioner 
99.2 	shall withhold five percent of managed care plan payments under this section for the 
99.3 	prepaid medical assistance and general assistance medical care programs pending 
99.4 	completion of performance targets. Each performance target must be quantifiable, 
99.5 	objective, measurable, and reasonably attainable, except in the case of a performance 
99.6 	target based on a federal or state law or rule. Criteria for assessment of each performance 
99.7 	target must be outlined in writing prior to the contract effective date. The managed 
99.8 	care plan must demonstrate, to the commissioner's satisfaction, that the data submitted 
99.9 	regarding attainment of the performance target is accurate. The commissioner shall 
99.10 	periodically change the administrative measures used as performance targets in order 
99.11 	to improve plan performance across a broader range of administrative services. The 
99.12 	performance targets must include measurement of plan efforts to contain spending 
99.13 	on health care services and administrative activities. The commissioner may adopt 
99.14 	plan-specific performance targets that take into account factors affecting only one plan, 
99.15 	including characteristics of the plan's enrollee population. The withheld funds must be 
99.16 	returned no sooner than July of the following year if performance targets in the contract 
99.17 	are achieved. The commissioner may exclude special demonstration projects under 
99.18 	subdivision 23. A managed care plan or a county-based purchasing plan under section 
99.19 	256B.692 may include as admitted assets under section 62D.044 any amount withheld 
99.20 	under this paragraph that is reasonably expected to be returned.
99.21 	(d)(1) Effective for services rendered on or after January 1, 2009, the commissioner 
99.22 	shall withhold three percent of managed care plan payments under this section for the 
99.23 	prepaid medical assistance and general assistance medical care programs. The withheld 
99.24 	funds must be returned no sooner than July 1 and no later than July 31 of the following 
99.25 	year. The commissioner may exclude special demonstration projects under subdivision 23.
99.26 	(2) A managed care plan or a county-based purchasing plan under section 256B.692 
99.27 	may include as admitted assets under section 62D.044 any amount withheld under 
99.28 	this paragraph. The return of the withhold under this paragraph is not subject to the 
99.29 	requirements of paragraph (c).
99.30 	(e) Effective for services provided on or after January 1, 2010, the commissioner 
99.31 	shall require that managed care plans use the fee-for-service medical assistance assessment 
99.32 	and authorization processes, forms, timelines, standards, documentation, and data 
99.33 	reporting requirements, protocols, billing processes, and policies for all personal care 
99.34 	assistance services under section 256B.0659.

99.35 	Sec. 70. Minnesota Statutes 2008, section 626.556, subdivision 3c, is amended to read:
100.1 		Subd. 3c.Local welfare agency, Department of Human Services or Department 
100.2 	of Health responsible for assessing or investigating reports of maltreatment. (a) 
100.3 	The county local welfare agency is the agency responsible for assessing or investigating 
100.4 	allegations of maltreatment in child foster care, family child care, and legally unlicensed 
100.5 	child care and in, juvenile correctional facilities licensed under section 241.021 located 
100.6 	in the local welfare agency's county, and unlicensed personal care assistance provider 
100.7 	organizations providing services and receiving reimbursements under chapter 256B. 
100.8 	(b) The Department of Human Services is the agency responsible for assessing or 
100.9 	investigating allegations of maltreatment in facilities licensed under chapters 245A and 
100.10 	245B, except for child foster care and family child care.
100.11 	(c) The Department of Health is the agency responsible for assessing or investigating 
100.12 	allegations of child maltreatment in facilities licensed under sections  144.50 to  144.58, 
100.13 	and in unlicensed home health care  and 144A.46. 
100.14 	(d) The commissioners of human services, public safety, and education must 
100.15 	jointly submit a written report by January 15, 2007, to the education policy and finance 
100.16 	committees of the legislature recommending the most efficient and effective allocation 
100.17 	of agency responsibility for assessing or investigating reports of maltreatment and must 
100.18 	specifically address allegations of maltreatment that currently are not the responsibility 
100.19 	of a designated agency. 

100.20 	Sec. 71. Minnesota Statutes 2008, section 626.5572, subdivision 13, is amended to 
100.21 	read:
100.22 		Subd. 13.Lead agency. "Lead agency" is the primary administrative agency 
100.23 	responsible for investigating reports made under section 626.557.  
100.24 	(a) The Department of Health is the lead agency for the facilities which are licensed 
100.25 	or are required to be licensed as hospitals, home care providers, nursing homes, residential 
100.26 	care homes, or boarding care homes.
100.27 	(b) The Department of Human Services is the lead agency for the programs licensed 
100.28 	or required to be licensed as adult day care, adult foster care, programs for people with 
100.29 	developmental disabilities, mental health programs, or chemical health programs, or 
100.30 	personal care provider organizations.
100.31 	(c) The county social service agency or its designee is the lead agency for all other 
100.32 	reports, including personal care provider organizations under section 256B.0659.

100.33 	Sec. 72. COLA COMPENSATION REQUIREMENTS.
 101.1 	Effective July 1, 2009, providers who received rate increases under Laws 2007, 
101.2 	chapter 147, article 7, section 71, as amended by Laws 2008, chapter 363, article 15, 
101.3 	section 17, and Minnesota Statutes, section 256B.5012, subdivision 7, for state fiscal years 
101.4 	2008 and 2009 are no longer required to continue or retain employee compensation or 
101.5 	wage-related increases required by those sections. This paragraph shall not apply to 
101.6 	employees covered by a collective bargaining agreement.

101.7 	Sec. 73. PROVIDER RATE AND GRANT REDUCTIONS.
 101.8 	(a) The commissioner of human services shall decrease grants, allocations, 
101.9 	reimbursement rates, or rate limits, as applicable, by 3.0 percent effective July 1, 2009, for 
101.10 	services rendered on or after that date. County or tribal contracts for services specified 
101.11 	in this section must be amended to pass through these rate reductions within 60 days of 
101.12 	the effective date of the decrease and must be retroactive from the effective date of the 
101.13 	rate decrease.
101.14 	(b) The annual rate decreases described in this section must be provided to:
101.15 	(1) home and community-based waivered services for persons with developmental 
101.16 	disabilities or related conditions, including consumer-directed community supports, under 
101.17 	Minnesota Statutes, section 256B.501;
101.18 	(2) home and community-based waivered services for the elderly, including 
101.19 	consumer-directed community supports, under Minnesota Statutes, section 256B.0915;
101.20 	(3) waivered services under community alternatives for disabled individuals, 
101.21 	including consumer-directed community supports, under Minnesota Statutes, section 
101.22 	256B.49;
101.23 	(4) community alternative care waivered services, including consumer-directed 
101.24 	community supports, under Minnesota Statutes, section 256B.49;
101.25 	(5) traumatic brain injury waivered services, including consumer-directed 
101.26 	community supports, under Minnesota Statutes, section 256B.49;
101.27 	(6) nursing services and home health services under Minnesota Statutes, section 
101.28 	256B.0625, subdivision 6a;
101.29 	(7) personal care services and qualified professional supervision of personal care 
101.30 	services under Minnesota Statutes, section 256B.0625, subdivisions 6a and 19a;
101.31 	(8) private duty nursing services under Minnesota Statutes, section 256B.0625, 
101.32 	subdivision 7;
101.33 	(9) day training and habilitation services for adults with developmental disabilities 
101.34 	or related conditions under Minnesota Statutes, sections 252.40 to 252.46, including the 
102.1 	additional cost of rate adjustments on day training and habilitation services, provided as a 
102.2 	social service under Minnesota Statutes, section 256M.60;
102.3 	(10) alternative care services under Minnesota Statutes, section 256B.0913;
102.4 	(11) the group residential housing supplementary service rate under Minnesota 
102.5 	Statutes, section 256I.05, subdivision 1a;
102.6 	(12) semi-independent living services (SILS) under Minnesota Statutes, section 
102.7 	252.275, including SILS funding under county social services grants formerly funded 
102.8 	under Minnesota Statutes, chapter 256I;
102.9 	(13) community support services for deaf and hard-of-hearing adults with mental 
102.10 	illness who use or wish to use sign language as their primary means of communication 
102.11 	under Minnesota Statutes, section 256.01, subdivision 2; and deaf and hard-of-hearing 
102.12 	grants under Minnesota Statutes, sections 256C.233 and 256C.25; Laws 1985, chapter 9; 
102.13 	and Laws 1997, First Special Session chapter 5, section 20;
102.14 	(14) physical therapy services under Minnesota Statutes, sections 256B.0625, 
102.15 	subdivision 8, and 256D.03, subdivision 4;
102.16 	(15) occupational therapy services under Minnesota Statutes, sections 256B.0625, 
102.17 	subdivision 8a, and 256D.03, subdivision 4;
102.18 	(16) speech-language therapy services under Minnesota Statutes, section 256D.03, 
102.19 	subdivision 4, and Minnesota Rules, part 9505.0390;
102.20 	(17) respiratory therapy services under Minnesota Statutes, section 256D.03, 
102.21 	subdivision 4, and Minnesota Rules, part 9505.0295;
102.22 	(18) consumer support grants under Minnesota Statutes, section 256.476;
102.23 	(19) family support grants under Minnesota Statutes, section 252.32;
102.24 	(20) aging grants under Minnesota Statutes, sections 256.975 to 256.977, 256B.0917, 
102.25 	and 256B.0928;
102.26 	(21) disability linkage line grants under Minnesota Statutes, section 256.01, 
102.27 	subdivision 24; and
102.28 	(22) housing access grants under Minnesota Statutes, section 256B.0658.
102.29 	(c) A managed care plan receiving state payments for the services in this section 
102.30 	must include these decreases in their payments to providers effective on October 1 
102.31 	following the effective date of the rate decrease.

102.32 	Sec. 74. RESULTS OF CHANGES TO THE PERSONAL CARE ASSISTANCE 
102.33 	PROGRAM.
 102.34 	The commissioner of human services must provide data to the legislative committees 
102.35 	with jurisdiction over health and human services policy and finance by January 15, 2010, 
103.1 	on the training developed and delivered for all types of participants in the personal 
103.2 	care assistance program, audit and financial integrity measures and results, information 
103.3 	developed for consumers and responsible parties, and quality assurance measures and 
103.4 	results.

103.5 	Sec. 75. DEVELOPMENT OF ALTERNATIVE SERVICES.
 103.6 	The commissioner of human services, in consultation with advocates, consumers, 
103.7 	and legislators, shall develop alternative services to personal care assistance services for 
103.8 	persons with mental health and other behavioral challenges who can benefit from other 
103.9 	services that more appropriately meet their needs and assist them in living independently 
103.10 	in the community. In the development of these services, the commissioner shall:
103.11 	(1) take into consideration ways in which these alternative services will qualify for 
103.12 	federal financial participation; and 
103.13 	(2) analyze a variety of alternatives, including but not limited to a 1915(i) state 
103.14 	plan option.
103.15 	The commissioner shall report to the legislature by January 15, 2011, with plans for 
103.16 	implementation of these services by July 1, 2011.

103.17 	Sec. 76. 30-DAY NOTICE REQUIRED.
 103.18 	Notwithstanding any contrary provision in law, persons impacted by amendments 
103.19 	in this article to Minnesota Statutes, sections 256B.0625, subdivision 19c; 256B.0655, 
103.20 	subdivision 4; 256B.0659; and 256B.0911, subdivision 1, must be given a 30-day notice 
103.21 	of action by the commissioner. This section expires July 1, 2011.

103.22 	Sec. 77. REVISOR'S INSTRUCTION.
 103.23 		Subdivision 1.Renumbering of Minnesota Statutes, section 256B.0652, 
103.24 	authorization and review of home care services. (a) The revisor of statutes shall 
103.25 	renumber each section of Minnesota Statutes listed in column A with the number in 
103.26 	column B.

103.27	Column A
	Column B
	
103.28	256B.0652, subdivision 3
	256B.0652, subdivision 14
	
103.29	256B.0651, subdivision 6, paragraph (a)
	256B.0652, subdivision 3
	
103.30	256B.0651, subdivision 6, paragraph (b)
	256B.0652, subdivision 4
	
103.31	256B.0651, subdivision 6, paragraph (c)
	256B.0652, subdivision 7
	
103.32	256B.0651, subdivision 7, paragraph (a)
	256B.0652, subdivision 8
	
103.33	256B.0651, subdivision 7, paragraph (b)
	256B.0652, subdivision 14
	
103.34	256B.0651, subdivision 8
	256B.0652, subdivision 9
	
104.1	256B.0651, subdivision 9
	256B.0652, subdivision 10
	
104.2	256B.0651, subdivision 11
	256B.0652, subdivision 11
	
104.3	256B.0654, subdivision 2
	256B.0652, subdivision 5
	
104.4	256B.0655, subdivision 4
	256B.0652, subdivision 6
	
104.5 	(b) The revisor of statutes shall make necessary cross-reference changes in statutes 
104.6 	and rules consistent with the renumbering in paragraph (a). The Department of Human 
104.7 	Services shall assist the revisor with any cross-reference changes. The revisor may make 
104.8 	changes necessary to correct the punctuation, grammar, or structure of the remaining text 
104.9 	to conform with the intent of the renumbering in paragraph (a).
104.10 		Subd. 2.Renumbering personal care assistance services. The revisor of statutes 
104.11 	shall replace any reference to Minnesota Statutes, section 256B.0655 with section 
104.12 	256B.0659, wherever it appears in statutes or rules. The revisor shall correct any cross 
104.13 	reference changes that are necessary as a result of this section. The Department of Human 
104.14 	Services shall assist the revisor in making these changes, and if necessary, shall draft a 
104.15 	corrections bill with changes for introduction in the 2010 legislative session. The revisor 
104.16 	may make changes to punctuation, grammar, or sentence structure to preserve the integrity 
104.17 	of statutes and effectuate the intention of this section.

104.18 	Sec. 78.  REPEALER.
 104.19 	(a) Minnesota Statutes 2008, sections 256B.19, subdivision 1d; and 256B.431, 
104.20 	subdivision 23, are repealed effective May 1, 2009.
104.21 	(b) Minnesota Statutes 2008, section 256B.0951, is repealed effective July 1, 2009.
104.22 	(c) Minnesota Statutes 2008, sections 256B.0655, subdivisions 1, 1a, 1b, 1c, 1d, 1e, 
104.23 	1f, 1g, 1h, 1i, 2, 3, 5, 6, 7, 8, 9, 10, 11, 12, and 13; and 256B.071, subdivisions 1, 2, 3, 
104.24 	and 4, are repealed.

104.25 	ARTICLE 2
104.26 	MFIP/CHILD CARE/ADULT SUPPORTS/FRAUD PREVENTION

104.27 	Section 1. Minnesota Statutes 2008, section 119B.09, subdivision 7, is amended to read:
104.28 		Subd. 7.Date of eligibility for assistance. (a) The date of eligibility for child 
104.29 	care assistance under this chapter is the later of the date the application was signed; the 
104.30 	beginning date of employment, education, or training; the date the infant is born for 
104.31 	applicants to the at-home infant care program; or the date a determination has been made 
104.32 	that the applicant is a participant in employment and training services under Minnesota 
104.33 	Rules, part 3400.0080, or chapter 256J.
105.1 	(b) Payment ceases for a family under the at-home infant child care program when a 
105.2 	family has used a total of 12 months of assistance as specified under section 119B.035. 
105.3 	Payment of child care assistance for employed persons on MFIP is effective the date of 
105.4 	employment or the date of MFIP eligibility, whichever is later. Payment of child care 
105.5 	assistance for MFIP or DWP participants in employment and training services is effective 
105.6 	the date of commencement of the services or the date of MFIP or DWP eligibility, 
105.7 	whichever is later. Payment of child care assistance for transition year child care must be 
105.8 	made retroactive to the date of eligibility for transition year child care. 
105.9 	(c) Notwithstanding paragraph (b), payment of child care assistance for participants 
105.10 	eligible under section 119B.05 may only be made retroactive for a maximum of six 
105.11 	months from the date of application for child care assistance.

105.12 	EFFECTIVE DATE. This section is effective October 1, 2009.

105.13 	Sec. 2. Minnesota Statutes 2008, section 119B.13, subdivision 6, is amended to read:
105.14 		Subd. 6.Provider payments. (a) Counties or the state shall make vendor payments 
105.15 	to the child care provider or pay the parent directly for eligible child care expenses.
105.16 	(b) If payments for child care assistance are made to providers, the provider shall 
105.17 	bill the county for services provided within ten days of the end of the service period. If 
105.18 	bills are submitted within ten days of the end of the service period, a county or the state 
105.19 	shall issue payment to the provider of child care under the child care fund within 30 days 
105.20 	of receiving a bill from the provider. Counties or the state may establish policies that 
105.21 	make payments on a more frequent basis.
105.22 	(c) All billsIf a provider has received an authorization of care and been issued a 
105.23 	billing form for an eligible family, the bill must be submitted within 60 days of the last 
105.24 	date of service on the bill. A county may pay a bill submitted more than 60 days after 
105.25 	the last date of service if the provider shows good cause why the bill was not submitted 
105.26 	within 60 days. Good cause must be defined in the county's child care fund plan under 
105.27 	section 119B.08, subdivision 3, and the definition of good cause must include county 
105.28 	error. A county may not pay any bill submitted more than a year after the last date of 
105.29 	service on the bill. 
105.30 	(d) If a provider provided care for a time period without receiving an authorization 
105.31 	of care and a billing form for an eligible family, payment of child care assistance may only 
105.32 	be made retroactively for a maximum of six months from the date the provider is issued 
105.33 	an authorization of care and billing form.
105.34 	(e) A county may stop payment issued to a provider or may refuse to pay a bill 
105.35 	submitted by a provider if:
106.1 	(1) the provider admits to intentionally giving the county materially false information 
106.2 	on the provider's billing forms; or
106.3 	(2) a county finds by a preponderance of the evidence that the provider intentionally 
106.4 	gave the county materially false information on the provider's billing forms.
106.5 	(e)(f) A county's payment policies must be included in the county's child care plan 
106.6 	under section 119B.08, subdivision 3. If payments are made by the state, in addition to 
106.7 	being in compliance with this subdivision, the payments must be made in compliance 
106.8 	with section 16A.124. 

106.9 	EFFECTIVE DATE. This section is effective October 1, 2009.

106.10 	Sec. 3. Minnesota Statutes 2008, section 256.983, subdivision 1, is amended to read:
106.11 		Subdivision 1.Programs established. Within the limits of available appropriations, 
106.12 	the commissioner of human services shall require the maintenance of budget neutral 
106.13 	fraud prevention investigation programs in the counties participating in the fraud 
106.14 	prevention investigation project established under this section. If funds are sufficient, 
106.15 	the commissioner may also extend fraud prevention investigation programs to other 
106.16 	counties provided the expansion is budget neutral to the state. Under any expansion, the 
106.17 	commissioner has the final authority in decisions regarding the creation and realignment 
106.18 	of individual county or regional operations.

106.19 	Sec. 4. Minnesota Statutes 2008, section 256I.03, subdivision 7, is amended to read:
106.20 		Subd. 7.Countable income. "Countable income" means all income received by an 
106.21 	applicant or recipient less any applicable exclusions or disregards. For a recipient of any 
106.22 	cash benefit from the SSI program, countable income means the SSI benefit limit in effect 
106.23 	at the time the person is in a GRH setting less $20, less the medical assistance personal 
106.24 	needs allowance. If the SSI limit has been reduced for a person due to events occurring 
106.25 	prior to the persons entering the GRH setting, countable income means actual income less 
106.26 	any applicable exclusions and disregards.

106.27 	Sec. 5. Minnesota Statutes 2008, section 256J.24, subdivision 5, is amended to read:
106.28 		Subd. 5.MFIP transitional standard. The MFIP transitional standard is based 
106.29 	on the number of persons in the assistance unit eligible for both food and cash assistance 
106.30 	unless the restrictions in subdivision 6 on the birth of a child apply. The following table 
106.31 	represents the transitional standards effective October 1, 2007 April 1, 2009.

106.32	Number of Eligible People
	Transitional Standard
	Cash Portion
	Food Portion

107.1	1
	$391 $428:
	$250
	$141 $178
		
107.2	2
	$698 $764:
	$437
	$261$327
		
107.3	3
	$910$1,005:
	$532
	$378$473
		
107.4	4
	$1,091 $1,217:
	$621
	$470 $596
		
107.5	5
	$1,245 $1,393:
	$697
	$548 $696
		
107.6	6
	$1,425$1,602:
	$773
	$652 $829
		
107.7	7
	$1,553 $1,748:
	$850
	$703$898
		
107.8	8
	$1,713 $1,934:
	$916
	$797$1,018
		
107.9	9
	$1,871 $2,119:
	$980
	$891$1,139
		
107.10	10
	$2,024 $2,298:
	$1,035
	$989 $1,263
		
107.11	over 10
	add $151 $178:
	$53
	$98 $125
		
107.12	per additional member.
				
107.13 	The commissioner shall annually publish in the State Register the transitional 
107.14 	standard for an assistance unit sizes 1 to 10 including a breakdown of the cash and food 
107.15 	portions.

107.16 	EFFECTIVE DATE. This section is effective retroactively from April 1, 2009.

107.17 	Sec. 6. Minnesota Statutes 2008, section 256J.42, is amended by adding a subdivision 
107.18 	to read:
107.19 		Subd. 1a.Temporary suspension of time limit. (a) The months of MFIP cash 
107.20 	assistance received from July 1, 2009, through June 30, 2011, do not count toward the 
107.21 	60-month time limit in subdivision 1.
107.22 	(b) The months of assistance received under this subdivision are state funded.

107.23 	Sec. 7. Minnesota Statutes 2008, section 256J.425, subdivision 2, is amended to read:
107.24 		Subd. 2.Ill or incapacitated. (a) An assistance unit subject to the time limit in 
107.25 	section 256J.42, subdivision 1, is eligible to receive months of assistance under a hardship 
107.26 	extension if the participant who reached the time limit belongs to any of the following 
107.27 	groups:
107.28 	(1) participants who are suffering from an illness, injury, or incapacity which 
107.29 	has been certified by a qualified professional when the illness, injury, or incapacity is 
107.30 	expected to continue for more than 30 days and prevents the person from obtaining or 
107.31 	retaining employment severely limits the person's ability to obtain or maintain suitable 
107.32 	employment. These participants must follow the treatment recommendations of the 
107.33 	qualified professional certifying the illness, injury, or incapacity;
107.34 	(2) participants whose presence in the home is required as a caregiver because of 
107.35 	the illness, injury, or incapacity of another member in the assistance unit, a relative in the 
108.1 	household, or a foster child in the household when the illness or incapacity and the need 
108.2 	for a person to provide assistance in the home has been certified by a qualified professional 
108.3 	and is expected to continue for more than 30 days; or
108.4 	(3) caregivers with a child or an adult in the household who meets the disability or 
108.5 	medical criteria for home care services under section 256B.0651, subdivision 1, paragraph 
108.6 	(c), or a home and community-based waiver services program under chapter 256B, or 
108.7 	meets the criteria for severe emotional disturbance under section 245.4871, subdivision 
108.8 	6, or for serious and persistent mental illness under section 245.462, subdivision 20, 
108.9 	paragraph (c). Caregivers in this category are presumed to be prevented from obtaining 
108.10 	or retaining employment.
108.11 	(b) An assistance unit receiving assistance under a hardship extension under this 
108.12 	subdivision may continue to receive assistance as long as the participant meets the criteria 
108.13 	in paragraph (a), clause (1), (2), or (3).

108.14 	Sec. 8. Minnesota Statutes 2008, section 256J.425, subdivision 3, is amended to read:
108.15 		Subd. 3.Hard-to-employ participants. (a) An assistance unit subject to the time 
108.16 	limit in section 256J.42, subdivision 1, is eligible to receive months of assistance under 
108.17 	a hardship extension if the participant who reached the time limit belongs to any of the 
108.18 	following groups: 
108.19 	(1) a person who is diagnosed by a licensed physician, psychological practitioner, 
108.20 	or other qualified professional, as developmentally disabled or mentally ill, and that 
108.21 	condition prevents the person from obtaining or retaining unsubsidized employment the 
108.22 	condition severely limits the person's ability to obtain or maintain suitable employment;
108.23 	(2) a person who:
108.24 	(i) has been assessed by a vocational specialist or the county agency to be 
108.25 	unemployable for purposes of this subdivision; or
108.26 	(ii) has an IQ below 80 who has been assessed by a vocational specialist or a county 
108.27 	agency to be employable, but not at a level that makes the participant eligible for an 
108.28 	extension under subdivision 4 the condition severely limits the person's ability to obtain or 
108.29 	maintain suitable employment. The determination of IQ level must be made by a qualified 
108.30 	professional. In the case of a non-English-speaking person: (A) the determination must 
108.31 	be made by a qualified professional with experience conducting culturally appropriate 
108.32 	assessments, whenever possible; (B) the county may accept reports that identify an 
108.33 	IQ range as opposed to a specific score; (C) these reports must include a statement of 
108.34 	confidence in the results;
109.1 	(3) a person who is determined by a qualified professional to be learning disabled, 
109.2 	and the disability condition severely limits the person's ability to obtain, perform, or 
109.3 	maintain suitable employment. For purposes of the initial approval of a learning disability 
109.4 	extension, the determination must have been made or confirmed within the previous 12 
109.5 	months. In the case of a non-English-speaking person: (i) the determination must be made 
109.6 	by a qualified professional with experience conducting culturally appropriate assessments, 
109.7 	whenever possible; and (ii) these reports must include a statement of confidence in the 
109.8 	results. If a rehabilitation plan for a participant extended as learning disabled is developed 
109.9 	or approved by the county agency, the plan must be incorporated into the employment 
109.10 	plan. However, a rehabilitation plan does not replace the requirement to develop and 
109.11 	comply with an employment plan under section 256J.521; or 
109.12 	(4) a person who has been granted a family violence waiver, and who is complying 
109.13 	with an employment plan under section 256J.521, subdivision 3. 
109.14 	(b) For purposes of this section, "severely limits the person's ability to obtain or 
109.15 	maintain suitable employment" means that a qualified professional has determined that the 
109.16 	person's condition prevents the person from working 20 or more hours per week.

109.17 	Sec. 9. Minnesota Statutes 2008, section 256J.425, is amended by adding a subdivision 
109.18 	to read:
109.19 		Subd. 3a.Temporary hardship. A participant who has reached the 60-month time 
109.20 	limit under section 256J.42, and does not qualify for an extension under subdivision 2, 3, 
109.21 	4, or 5, may receive MFIP assistance under a temporary hardship extension between July 
109.22 	1, 2009, and June 30, 2011. To receive a temporary hardship extension, the participant 
109.23 	must meet the MFIP eligibility criteria in chapter 256J, except that the requirement that 
109.24 	the participant be in compliance in the 60th month does not apply. Sanction provisions in 
109.25 	subdivisions 6 and 7 apply to participants extended under this subdivision.

109.26 	Sec. 10. Minnesota Statutes 2008, section 256J.425, subdivision 4, is amended to read:
109.27 		Subd. 4.Employed participants. (a) An assistance unit subject to the time limit 
109.28 	under section 256J.42, subdivision 1, is eligible to receive assistance under a hardship 
109.29 	extension if the participant who reached the time limit belongs to: 
109.30 	(1) a one-parent assistance unit in which the participant is participating in work 
109.31 	activities for at least 30 hours per week, of which an average of at least 25 hours per week 
109.32 	every month are spent participating in employment;
110.1 	(2) a two-parent assistance unit in which the participants are participating in work 
110.2 	activities for at least 55 hours per week, of which an average of at least 45 hours per week 
110.3 	every month are spent participating in employment; or
110.4 	(3) an assistance unit in which a participant is participating in employment for fewer 
110.5 	hours than those specified in clause (1), and the participant submits verification from a 
110.6 	qualified professional, in a form acceptable to the commissioner, stating that the number 
110.7 	of hours the participant may work is limited due to illness or disability, as long as the 
110.8 	participant is participating in employment for at least the number of hours specified by the 
110.9 	qualified professional. The participant must be following the treatment recommendations 
110.10 	of the qualified professional providing the verification. The commissioner shall develop a 
110.11 	form to be completed and signed by the qualified professional, documenting the diagnosis 
110.12 	and any additional information necessary to document the functional limitations of the 
110.13 	participant that limit work hours. If the participant is part of a two-parent assistance unit, 
110.14 	the other parent must be treated as a one-parent assistance unit for purposes of meeting the 
110.15 	work requirements under this subdivision.
110.16 	(b) For purposes of this section, employment means:
110.17 	(1) unsubsidized employment under section 256J.49, subdivision 13, clause (1); 
110.18 	(2) subsidized employment under section 256J.49, subdivision 13, clause (2); 
110.19 	(3) on-the-job training under section 256J.49, subdivision 13, clause (2); 
110.20 	(4) an apprenticeship under section 256J.49, subdivision 13, clause (1); 
110.21 	(5) supported work under section 256J.49, subdivision 13, clause (2); 
110.22 	(6) a combination of clauses (1) to (5); or
110.23 	(7) child care under section 256J.49, subdivision 13, clause (7), if it is in combination 
110.24 	with paid employment; or
110.25 	(8) unpaid work under section 256J.49, subdivision 13, clause (3), if it is combined 
110.26 	with job search for up to 12 months in duration. 
110.27 	(c) If a participant is complying with a child protection plan under chapter 260C, 
110.28 	the number of hours required under the child protection plan count toward the number 
110.29 	of hours required under this subdivision.
110.30 	(d) The county shall provide the opportunity for subsidized employment to 
110.31 	participants needing that type of employment within available appropriations.
110.32 	(e) To be eligible for a hardship extension for employed participants under this 
110.33 	subdivision, a participant must be in compliance for at least ten out of the 12 months 
110.34 	the participant received MFIP immediately preceding the participant's 61st month on 
110.35 	assistance. If ten or fewer months of eligibility for TANF assistance remain at the time the 
111.1 	participant from another state applies for assistance, the participant must be in compliance 
111.2 	every month.
111.3 	(f) The employment plan developed under section 256J.521, subdivision 2, for 
111.4 	participants under this subdivision must contain at least the minimum number of hours 
111.5 	specified in paragraph (a) for the purpose of meeting the requirements for an extension 
111.6 	under this subdivision. The job counselor and the participant must sign the employment 
111.7 	plan to indicate agreement between the job counselor and the participant on the contents 
111.8 	of the plan. 
111.9 	(g) Participants who fail to meet the requirements in paragraph (a), without good 
111.10 	cause under section 256J.57, shall be sanctioned or permanently disqualified under 
111.11 	subdivision 6. Good cause may only be granted for that portion of the month for which 
111.12 	the good cause reason applies. Participants must meet all remaining requirements in the 
111.13 	approved employment plan or be subject to sanction or permanent disqualification. 
111.14 	(h) If the noncompliance with an employment plan is due to the involuntary loss of 
111.15 	employment, the participant is exempt from the hourly employment requirement under 
111.16 	this subdivision for one month. Participants must meet all remaining requirements in the 
111.17 	approved employment plan or be subject to sanction or permanent disqualification. This 
111.18 	exemption is available to each participant two times in a 12-month period.

111.19 	Sec. 11. Minnesota Statutes 2008, section 256J.46, subdivision 1, is amended to read:
111.20 		Subdivision 1. Participants not complying with program requirements. (a) 
111.21 	A participant who fails without good cause under section 256J.57 to comply with the 
111.22 	requirements of this chapter, and who is not subject to a sanction under subdivision 2, 
111.23 	shall be subject to a sanction as provided in this subdivision. Prior to the imposition of 
111.24 	a sanction, a county agency shall provide a notice of intent to sanction under section 
111.25 	256J.57, subdivision 2, and, when applicable, a notice of adverse action as provided 
111.26 	in section 256J.31. 
111.27 	(b) A sanction under this subdivision becomes effective the month following the 
111.28 	month in which a required notice is given. A sanction must not be imposed when a 
111.29 	participant comes into compliance with the requirements for orientation under section 
111.30 	256J.45 prior to the effective date of the sanction. A sanction must not be imposed 
111.31 	when a participant comes into compliance with the requirements for employment and 
111.32 	training services under sections 256J.515 to 256J.57 ten days prior to the effective date 
111.33 	of the sanction. For purposes of this subdivision, each month that a participant fails to 
111.34 	comply with a requirement of this chapter shall be considered a separate occurrence of 
112.1 	noncompliance. If both participants in a two-parent assistance unit are out of compliance 
112.2 	at the same time, it is considered one occurrence of noncompliance. 
112.3 	(c) Sanctions for noncompliance shall be imposed as follows: 
112.4 	(1) For the first occurrence of noncompliance by a participant in an assistance unit, 
112.5 	the assistance unit's grant shall be reduced by ten percent of the MFIP standard of need 
112.6 	for an assistance unit of the same size with the residual grant paid to the participant. The 
112.7 	reduction in the grant amount must be in effect for a minimum of one month and shall be 
112.8 	removed in the month following the month that the participant returns to compliance. 
112.9 	(2) For a second, third, fourth, fifth, or sixth occurrence of noncompliance by a 
112.10 	participant in an assistance unit, the assistance unit's shelter costs shall be vendor paid 
112.11 	up to the amount of the cash portion of the MFIP grant for which the assistance unit is 
112.12 	eligible. At county option, the assistance unit's utilities may also be vendor paid up to 
112.13 	the amount of the cash portion of the MFIP grant remaining after vendor payment of the 
112.14 	assistance unit's shelter costs. The residual amount of the grant after vendor payment, if 
112.15 	any, must be reduced by an amount equal to 30 percent of the MFIP standard of need for an 
112.16 	assistance unit of the same size before the residual grant is paid to the assistance unit. The 
112.17 	reduction in the grant amount must be in effect for a minimum of one month and shall be 
112.18 	removed in the month following the month that the participant in a one-parent assistance 
112.19 	unit returns to compliance. In a two-parent assistance unit, the grant reduction must 
112.20 	be in effect for a minimum of one month and shall be removed in the month following 
112.21 	the month both participants return to compliance. The vendor payment of shelter costs 
112.22 	and, if applicable, utilities shall be removed six months after the month in which the 
112.23 	participant or participants return to compliance. If an assistance unit is sanctioned under 
112.24 	this clause, the participant's case file must be reviewed to determine if the employment 
112.25 	plan is still appropriate. 
112.26 	(d) For a seventh occurrence of noncompliance by a participant in an assistance unit, 
112.27 	or when the participants in a two-parent assistance unit have a total of seven occurrences 
112.28 	of noncompliance, the county agency shall close the MFIP assistance unit's financial 
112.29 	assistance case, both the cash and food portions, and redetermine the family's continued 
112.30 	eligibility for food support payments. The MFIP case must remain closed for a minimum 
112.31 	of one full month. Before the case is closed, the county agency or employment services 
112.32 	provider must assess the participant and determine if information is available that the 
112.33 	participant may be eligible for family stabilization services based on the criteria in 
112.34 	section 256J.575, subdivision 3. The county agency must  also review the participant's 
112.35 	case to determine if the employment plan is still appropriate and attempt to meet with 
112.36 	the participant face-to-face. The participant may bring an advocate to the face-to-face 
113.1 	meeting. If a face-to-face meeting is not conducted, the county agency must send the 
113.2 	participant a written notice that includes the information required under clause (1). 
113.3 	(1) During the face-to-face meeting, the county agency must: 
113.4 	(i) determine whether the continued noncompliance can be explained and mitigated 
113.5 	by providing a needed preemployment activity, as defined in section 256J.49, subdivision 
113.6 	13, clause (9); 
113.7 	(ii) determine whether the participant qualifies for a good cause exception under 
113.8 	section 256J.57, or if the sanction is for noncooperation with child support requirements, 
113.9 	determine if the participant qualifies for a good cause exemption under section 256.741, 
113.10 	subdivision 10; 
113.11 	(iii) determine whether the work activities in the employment plan are appropriate 
113.12 	based on the criteria in section 256J.521, subdivision 2 or 3; 
113.13 	(iv) determine whether the participant qualifies for the family violence waiver; 
113.14 	(v) inform the participant of the participant's sanction status and explain the 
113.15 	consequences of continuing noncompliance; 
113.16 	(vi) identify other resources that may be available to the participant to meet the 
113.17 	needs of the family; and 
113.18 	(vii) inform the participant of the right to appeal under section 256J.40. 
113.19 	(2) If the lack of an identified activity or service can explain the noncompliance, the 
113.20 	county must work with the participant to provide the identified activity. 
113.21 	(3) The grant must be restored to the full amount for which the assistance unit is 
113.22 	eligible retroactively to the first day of the month in which the participant was found to lack 
113.23 	preemployment activities or to qualify for a family violence waiver, family stabilization 
113.24 	services,  or for a good cause exemption under section 256.741, subdivision 10, or 256J.57. 
113.25 	(e) For the purpose of applying sanctions under this section, only occurrences of 
113.26 	noncompliance that occur after July 1, 2003, shall be considered. If the participant is in 
113.27 	30 percent sanction in the month this section takes effect, that month counts as the first 
113.28 	occurrence for purposes of applying the sanctions under this section, but the sanction 
113.29 	shall remain at 30 percent for that month. 
113.30 	(f) An assistance unit whose case is closed under paragraph (d) or (g), may 
113.31 	reapply for MFIP and shall be eligible if the participant complies with MFIP program 
113.32 	requirements and demonstrates compliance for up to one month. No assistance shall be 
113.33 	paid during this period. 
113.34 	(g) An assistance unit whose case has been closed for noncompliance, that reapplies 
113.35 	under paragraph (f), is subject to sanction under paragraph (c), clause (2), for a first 
114.1 	occurrence of noncompliance. Any subsequent occurrence of noncompliance shall result 
114.2 	in case closure under paragraph (d). 

114.3 	Sec. 12. Minnesota Statutes 2008, section 256J.49, subdivision 1, is amended to read:
114.4 		Subdivision 1.Scope. The terms used in sections 256J.50 256J.425 to 256J.72 have 
114.5 	the meanings given them in this section.  

114.6 	Sec. 13. Minnesota Statutes 2008, section 256J.521, subdivision 2, is amended to read:
114.7 		Subd. 2.Employment plan; contents. (a) Based on the assessment under 
114.8 	subdivision 1, the job counselor and the participant must develop an employment plan 
114.9 	that includes participation in activities and hours that meet the requirements of section 
114.10 	256J.55, subdivision 1. The purpose of the employment plan is to identify for each 
114.11 	participant the most direct path to unsubsidized employment and any subsequent steps that 
114.12 	support long-term economic stability. The employment plan should be developed using 
114.13 	the highest level of activity appropriate for the participant. Activities must be chosen from 
114.14 	clauses (1) to (6), which are listed in order of preference. Notwithstanding this order of 
114.15 	preference for activities, priority must be given for activities related to a family violence 
114.16 	waiver when developing the employment plan. The employment plan must also list the 
114.17 	specific steps the participant will take to obtain employment, including steps necessary 
114.18 	for the participant to progress from one level of activity to another, and a timetable for 
114.19 	completion of each step. Levels of activity include:
114.20 	(1) unsubsidized employment;
114.21 	(2) job search;
114.22 	(3) subsidized employment or unpaid work experience;
114.23 	(4) unsubsidized employment and job readiness education or job skills training;
114.24 	(5) unsubsidized employment or unpaid work experience and activities related to 
114.25 	a family violence waiver or preemployment needs; and
114.26 	(6) activities related to a family violence waiver or preemployment needs.
114.27 	(b) Participants who are determined to possess sufficient skills such that the 
114.28 	participant is likely to succeed in obtaining unsubsidized employment must job search at 
114.29 	least 30 hours per week for up to six weeks and accept any offer of suitable employment. 
114.30 	The remaining hours necessary to meet the requirements of section 256J.55, subdivision 
114.31 	1, may be met through participation in other work activities under section 256J.49, 
114.32 	subdivision 13. The participant's employment plan must specify, at a minimum: (1) 
114.33 	whether the job search is supervised or unsupervised; (2) support services that will 
114.34 	be provided; and (3) how frequently the participant must report to the job counselor. 
115.1 	Participants who are unable to find suitable employment after six weeks must meet 
115.2 	with the job counselor to determine whether other activities in paragraph (a) should be 
115.3 	incorporated into the employment plan. Job search activities which are continued after six 
115.4 	weeks must be structured and supervised. 
115.5 	(c) Beginning July 1, 2004, activities and hourly requirements in the employment 
115.6 	plan may be adjusted as necessary to accommodate the personal and family circumstances 
115.7 	of participants identified under section 256J.561, subdivision 2, paragraph (d). Participants 
115.8 	who no longer meet the provisions of section 256J.561, subdivision 2, paragraph (d), 
115.9 	must meet with the job counselor within ten days of the determination to revise the 
115.10 	employment plan. 
115.11 	(d) Participants who are determined to have barriers to obtaining or retaining 
115.12 	employment that will not be overcome during six weeks of job search under paragraph (b) 
115.13 	must work with the job counselor to develop an employment plan that addresses those 
115.14 	barriers by incorporating appropriate activities from paragraph (a), clauses (1) to (6). 
115.15 	The employment plan must include enough hours to meet the participation requirements 
115.16 	in section 256J.55, subdivision 1, unless a compelling reason to require fewer hours 
115.17 	is noted in the participant's file. 
115.18 	(e)(d) The job counselor and the participant must sign the employment plan to 
115.19 	indicate agreement on the contents.
115.20 	(f)(e) Except as provided under paragraph (g) (f), failure to develop or comply with 
115.21 	activities in the plan, or voluntarily quitting suitable employment without good cause, will 
115.22 	result in the imposition of a sanction under section 256J.46. 
115.23 	(g)(f) When a participant fails to meet the agreed upon hours of participation in paid 
115.24 	employment because the participant is not eligible for holiday pay and the participant's 
115.25 	place of employment is closed for a holiday, the job counselor shall not impose a sanction 
115.26 	or increase the hours of participation in any other activity, including paid employment, to 
115.27 	offset the hours that were missed due to the holiday.
115.28 	(h)(g) Employment plans must be reviewed at least every three months to determine 
115.29 	whether activities and hourly requirements should be revised. The job counselor is 
115.30 	encouraged to allow participants who are participating in at least 20 hours of work 
115.31 	activities to also participate in education and training activities in order to meet the federal 
115.32 	hourly participation rates.

115.33 	Sec. 14. Minnesota Statutes 2008, section 256J.53, subdivision 1, is amended to read:
115.34 		Subdivision 1.Length of program. In order for A postsecondary education or 
115.35 	training program to be an approved as a work activity as defined in section 256J.49, 
116.1 	subdivision 13, clause (6), it must be a program lasting 24 months or less may include 
116.2 	associate and baccalaureate programs, and the participant must meet the requirements of 
116.3 	subdivisions 2, 3, and 5. 

116.4 	Sec. 15. Minnesota Statutes 2008, section 256J.545, is amended to read:
116.5 	256J.545 FAMILY VIOLENCE WAIVER CRITERIA.
116.6 	(a) In order to qualify for a family violence waiver, an individual must provide 
116.7 	documentation of past or current family violence which may prevent the individual from 
116.8 	participating in certain employment activities. 
116.9 	(b) The following items may be considered acceptable documentation or verification 
116.10 	of family violence:
116.11 	(1) police, government agency, or court records;
116.12 	(2) a statement from a battered women's shelter staff with knowledge of the 
116.13 	circumstances or credible evidence that supports the sworn statement;
116.14 	(3) a statement from a sexual assault or domestic violence advocate with knowledge 
116.15 	of the circumstances or credible evidence that supports the sworn statement; or
116.16 	(4) a statement from professionals from whom the applicant or recipient has sought 
116.17 	assistance for the abuse.
116.18 	(c) A claim of family violence may also be documented by a sworn statement from 
116.19 	the applicant or participant and a sworn statement from any other person with knowledge 
116.20 	of the circumstances or credible evidence that supports the client's statement.

116.21 	Sec. 16. Minnesota Statutes 2008, section 256J.561, subdivision 2, is amended to read:
116.22 		Subd. 2.Participation requirements. (a) All MFIP caregivers, except caregivers 
116.23 	who meet the criteria in subdivision 3, must participate in employment services develop an 
116.24 	individualized employment plan that identifies the activities the participant is required to 
116.25 	participate in and the required hours of participation. Except as specified in paragraphs (b) 
116.26 	to (d), the employment plan must meet the requirements of section 256J.521, subdivision 
116.27 	2, contain allowable work activities, as defined in section 256J.49, subdivision 13, and, 
116.28 	include at a minimum, the number of participation hours required under section 256J.55, 
116.29 	subdivision 1.
116.30 	(b) Minor caregivers and caregivers who are less than age 20 who have not 
116.31 	completed high school or obtained a GED are required to comply with section 256J.54.
116.32 	(c) A participant who has a family violence waiver shall develop and comply with 
116.33 	an employment plan under section 256J.521, subdivision 3.
117.1 	(d) As specified in section 256J.521, subdivision 2, paragraph (c), a participant who 
117.2 	meets any one of the following criteria may work with the job counselor to develop an 
117.3 	employment plan that contains less than the number of participation hours under section 
117.4 	256J.55, subdivision 1. Employment plans for participants covered under this paragraph 
117.5 	must be tailored to recognize the special circumstances of caregivers and families 
117.6 	including limitations due to illness or disability and caregiving needs:
117.7 	(1) a participant who is age 60 or older;
117.8 	(2) a participant who has been diagnosed by a qualified professional as suffering 
117.9 	from an illness or incapacity that is expected to last for 30 days or more, including a 
117.10 	pregnant participant who is determined to be unable to obtain or retain employment due 
117.11 	to the pregnancy; or
117.12 	(3) a participant who is determined by a qualified professional as being needed in 
117.13 	the home to care for an ill or incapacitated family member, including caregivers with a 
117.14 	child or an adult in the household who meets the disability or medical criteria for home 
117.15 	care services under section 256B.0651, subdivision 1, paragraph (c), or a home and 
117.16 	community-based waiver services program under chapter 256B, or meets the criteria for 
117.17 	severe emotional disturbance under section 245.4871, subdivision 6, or for serious and 
117.18 	persistent mental illness under section 245.462, subdivision 20, paragraph (c).
117.19 	(e) For participants covered under paragraphs (c) and (d), the county shall review 
117.20 	the participant's employment services status every three months to determine whether 
117.21 	conditions have changed. When it is determined that the participant's status is no longer 
117.22 	covered under paragraph (c) or (d), the county shall notify the participant that a new or 
117.23 	revised employment plan is needed. The participant and job counselor shall meet within 
117.24 	ten days of the determination to revise the employment plan.
117.25 	(b) Participants who meet the eligibility requirements in section 256J.575, 
117.26 	subdivision 3, must develop a family stabilization services plan that meets the 
117.27 	requirements in section 256J.575, subdivision 5.
117.28 	(c) Minor caregivers and caregivers who are less than age 20 who have not 
117.29 	completed high school or obtained a GED must develop an education plan that meets the 
117.30 	requirements in section 256J.54.
117.31 	(d) Participants with a family violence waiver must develop an employment plan 
117.32 	that meets the requirements in section 256J.521, which cover the provisions in section 
117.33 	256J.575, subdivision 5.
117.34 	(e) All other participants must develop an employment plan that meets the 
117.35 	requirements of section 256J.521, subdivision 2, and contains allowable work activities, 
118.1 	as defined in section 256J.49, subdivision 13. The employment plan must include, at a 
118.2 	minimum, the number of participation hours required under section 256J.55, subdivision 1.

118.3 	Sec. 17. Minnesota Statutes 2008, section 256J.561, subdivision 3, is amended to read:
118.4 		Subd. 3.Child under 12 weeks months of age. (a) A participant who has a 
118.5 	natural born child who is less than 12 weeks months of age who meets the criteria in this 
118.6 	subdivision is not required to participate in employment services until the child reaches 
118.7 	12 weeks months of age. To be eligible for this provision, the assistance unit must not 
118.8 	have already used this provision or the previously allowed child under age one exemption. 
118.9 	However, an assistance unit that has an approved child under age one exemption at the 
118.10 	time this provision becomes effective may continue to use that exemption until the child 
118.11 	reaches one year of age.
118.12 	(b) The provision in paragraph (a) ends the first full month after the child reaches 
118.13 	12 weeks months of age. This provision is available only once in a caregiver's lifetime. 
118.14 	In a two-parent household, only one parent shall be allowed to use this provision. The 
118.15 	participant and job counselor must meet within ten days after the child reaches 12 weeks
118.16 	months of age to revise the participant's employment plan.

118.17 	Sec. 18. Minnesota Statutes 2008, section 256J.57, subdivision 1, is amended to read:
118.18 		Subdivision 1.Good cause for failure to comply. The county agency shall not 
118.19 	impose the sanction under section 256J.46 if it determines that the participant has good 
118.20 	cause for failing to comply with the requirements of sections 256J.515 to 256J.57. Good 
118.21 	cause exists when: 
118.22 	(1) appropriate child care is not available;
118.23 	(2) the job does not meet the definition of suitable employment;
118.24 	(3) the participant is ill or injured;
118.25 	(4) a member of the assistance unit, a relative in the household, or a foster child in 
118.26 	the household is ill and needs care by the participant that prevents the participant from 
118.27 	complying with the employment plan;
118.28 	(5) the participant is unable to secure necessary transportation;
118.29 	(6) the participant is in an emergency situation that prevents compliance with the 
118.30 	employment plan;
118.31 	(7) the schedule of compliance with the employment plan conflicts with judicial 
118.32 	proceedings;
119.1 	(8) a mandatory MFIP meeting is scheduled during a time that conflicts with a 
119.2 	judicial proceeding or a meeting related to a juvenile court matter, or a participant's work 
119.3 	schedule;
119.4 	(9) the participant is already participating in acceptable work activities;
119.5 	(10) the employment plan requires an educational program for a caregiver under age 
119.6 	20, but the educational program is not available;
119.7 	(11) activities identified in the employment plan are not available;
119.8 	(12) the participant is willing to accept suitable employment, but suitable 
119.9 	employment is not available; or
119.10 	(13) the participant documents other verifiable impediments to compliance with the 
119.11 	employment plan beyond the participant's control; or
119.12 	(14) the documentation needed to determine if a participant is eligible for family 
119.13 	stabilization services is not available, but there is information that the participant may 
119.14 	qualify and the participant is cooperating with the county or employment service provider's 
119.15 	efforts to obtain the documentation necessary to determine eligibility.
119.16 	The job counselor shall work with the participant to reschedule mandatory meetings 
119.17 	for individuals who fall under clauses (1), (3), (4), (5), (6), (7), and (8).

119.18 	Sec. 19. Minnesota Statutes 2008, section 256J.575, subdivision 3, is amended to read:
119.19 		Subd. 3.Eligibility. (a) The following MFIP or diversionary work program (DWP) 
119.20 	participants are eligible for the services under this section:
119.21 	(1) a participant who meets the requirements for or has been granted a hardship 
119.22 	extension under section 256J.425, subdivision 2 or 3, except that it is not necessary for 
119.23 	the participant to have reached or be approaching 60 months of eligibility for this section 
119.24 	to apply;
119.25 	(2) a participant who is applying for Supplemental Security Income or Social 
119.26 	Security disability insurance; and
119.27 	(3) a participant who is a noncitizen who has been in the United States for 12 or 
119.28 	fewer months; and
119.29 	(4) a participant who is age 60 or older.
119.30 	(b) Families must meet all other eligibility requirements for MFIP established in 
119.31 	this chapter. Families are eligible for financial assistance to the same extent as if they 
119.32 	were participating in MFIP.
119.33 	(c) A participant under paragraph (a), clause (3), must be provided with English as a 
119.34 	second language opportunities and skills training for up to 12 months. After 12 months, 
119.35 	the case manager and participant must determine whether the participant should continue 
120.1 	with English as a second language classes or skills training, or both, and continue to 
120.2 	receive family stabilization services.
120.3 	(d) If a county agency or employment services provider has information that 
120.4 	an MFIP participant may meet the eligibility criteria set forth in this subdivision, the 
120.5 	county agency or employment services provider must assist the participant in obtaining 
120.6 	the documentation necessary to determine eligibility. Until necessary documentation is 
120.7 	obtained, the participant must be treated as an eligible participant under subdivisions 5 to 7.

120.8 	Sec. 20. Minnesota Statutes 2008, section 256J.575, subdivision 4, is amended to read:
120.9 		Subd. 4.Universal participation. All caregivers must participate in family 
120.10 	stabilization services as defined in subdivision 2, except for caregivers exempt under 
120.11 	section 256J.561, subdivision 3.

120.12 	Sec. 21. Minnesota Statutes 2008, section 256J.575, subdivision 6, is amended to read:
120.13 		Subd. 6.Cooperation with services requirements. (a) To be eligible, A participant 
120.14 	who is eligible for family stabilization services under this section shall comply with 
120.15 	paragraphs (b) to (d).
120.16 	(b) Participants shall engage in family stabilization plan services for the appropriate 
120.17 	number of hours per week that the activities are scheduled and available, unless good 
120.18 	cause exists for not doing so, as defined in section 256J.57, subdivision 1. The appropriate 
120.19 	number of hours must be based on the participant's plan.
120.20 	(c) The case manager shall review the participant's progress toward the goals in the 
120.21 	family stabilization plan every six months to determine whether conditions have changed, 
120.22 	including whether revisions to the plan are needed.
120.23 	(d) A participant's requirement to comply with any or all family stabilization plan 
120.24 	requirements under this subdivision is excused when the case management services, 
120.25 	training and educational services, or family support services identified in the participant's 
120.26 	family stabilization plan are unavailable for reasons beyond the control of the participant, 
120.27 	including when money appropriated is not sufficient to provide the services.

120.28 	Sec. 22. Minnesota Statutes 2008, section 256J.575, subdivision 7, is amended to read:
120.29 		Subd. 7.Sanctions. (a) The county agency or employment services provider must 
120.30 	follow the requirements of this subdivision at the time the county agency or employment 
120.31 	services provider has information that an MFIP recipient may meet the eligibility criteria 
120.32 	in subdivision 3. 
121.1 	(b) The financial assistance grant of a participating family is reduced according to 
121.2 	section 256J.46, if a participating adult fails without good cause to comply or continue 
121.3 	to comply with the family stabilization plan requirements in this subdivision, unless 
121.4 	compliance has been excused under subdivision 6, paragraph (d).
121.5 	(b) (c) Given the purpose of the family stabilization services  in this section and the 
121.6 	nature of the underlying family circumstances that act as barriers to both employment and 
121.7 	full compliance with program requirements, there must be a review by the county agency 
121.8 	prior to imposing a sanction to determine whether the plan was appropriated to the needs 
121.9 	of the participant and family, and. There must be a current assessment by a behavioral 
121.10 	health or medical professional confirming that the participant in all ways had the ability to 
121.11 	comply with the plan, as confirmed by a behavioral health or medical professional.
121.12 	(c) (d) Prior to the imposition of a sanction, the county agency or employment 
121.13 	services provider shall review the participant's case to determine if the family stabilization 
121.14 	plan is still appropriate and meet with the participant face-to-face. The participant may 
121.15 	bring an advocate The county agency or employment services provider must inform the 
121.16 	participant of the right to bring an advocate to the face-to-face meeting. 
121.17 	During the face-to-face meeting, the county agency shall:
121.18 	(1) determine whether the continued noncompliance can be explained and mitigated 
121.19 	by providing a needed family stabilization service, as defined in subdivision 2, paragraph 
121.20 	(d);
121.21 	(2) determine whether the participant qualifies for a good cause exception under 
121.22 	section 256J.57, or if the sanction is for noncooperation with child support requirements, 
121.23 	determine if the participant qualifies for a good cause exemption under section 256.741, 
121.24 	subdivision 10;
121.25 	(3) determine whether activities in the family stabilization plan are appropriate 
121.26 	based on the family's circumstances;
121.27 	(4) explain the consequences of continuing noncompliance;
121.28 	(5) identify other resources that may be available to the participant to meet the 
121.29 	needs of the family; and
121.30 	(6) inform the participant of the right to appeal under section 256J.40.
121.31 	If the lack of an identified activity or service can explain the noncompliance, the 
121.32 	county shall work with the participant to provide the identified activity.
121.33 	(d) If the participant fails to come to the face-to-face meeting, the case manager or a 
121.34 	designee shall attempt at least one home visit. If a face-to-face meeting is not conducted, 
121.35 	the county agency shall send the participant a written notice that includes the information 
121.36 	under paragraph (c).
122.1 	(e) After the requirements of paragraphs (c) and (d) are met and prior to imposition 
122.2 	of a sanction, the county agency shall provide a notice of intent to sanction under section 
122.3 	256J.57, subdivision 2, and, when applicable, a notice of adverse action under section 
122.4 	256J.31.
122.5 	(f) Section 256J.57 applies to this section except to the extent that it is modified 
122.6 	by this subdivision.

122.7 	Sec. 23. Minnesota Statutes 2008, section 256J.621, is amended to read:
122.8 	256J.621 WORK PARTICIPATION CASH BENEFITS.
122.9 	(a) Effective October 1, 2009, upon exiting the diversionary work program (DWP) 
122.10 	or upon terminating the Minnesota family investment program with earnings, a participant 
122.11 	who is employed may be eligible for work participation cash benefits of $75 $50 per 
122.12 	month to assist in meeting the family's basic needs as the participant continues to move 
122.13 	toward self-sufficiency.
122.14 	(b) To be eligible for work participation cash benefits, the participant shall not 
122.15 	receive MFIP or diversionary work program assistance during the month and the 
122.16 	participant or participants must meet the following work requirements:
122.17 	(1) if the participant is a single caregiver and has a child under six years of age, the 
122.18 	participant must be employed at least 87 hours per month;
122.19 	(2) if the participant is a single caregiver and does not have a child under six years of 
122.20 	age, the participant must be employed at least 130 hours per month; or
122.21 	(3) if the household is a two-parent family, at least one of the parents must be 
122.22 	employed an average of at least 130 hours per month.
122.23 	Whenever a participant exits the diversionary work program or is terminated from 
122.24 	MFIP and meets the other criteria in this section, work participation cash benefits are 
122.25 	available for up to 24 consecutive months.
122.26 	(c) Expenditures on the program are maintenance of effort state funds under 
122.27 	a separate state program for participants under paragraph (b), clauses (1) and (2). 
122.28 	Expenditures for participants under paragraph (b), clause (3), are nonmaintenance of effort 
122.29 	funds. Months in which a participant receives work participation cash benefits under this 
122.30 	section do not count toward the participant's MFIP 60-month time limit.

122.31 	Sec. 24. Minnesota Statutes 2008, section 256J.626, subdivision 7, is amended to read:
122.32 		Subd. 7.Performance base funds. (a) For the purpose of this section, the following 
122.33 	terms have the meanings given.
123.1 	(1) "Caseload Reduction Credit" (CRC) means the measure of how much Minnesota 
123.2 	TANF and separate state program caseload has fallen relative to federal fiscal year 2005 
123.3 	based on caseload data from October 1 to September 30.
123.4 	(2) "TANF participation rate target" means a 50 percent participation rate reduced by 
123.5 	the CRC for the previous year.
123.6 	(b) For calendar year 2009 2010 and yearly thereafter, each county and tribe will be 
123.7 	allocated 95 percent of their initial calendar year allocation. Counties and tribes will be 
123.8 	allocated additional funds based on performance as follows:
123.9 	(1) a county or tribe that achieves a 50 percent the TANF participation rate target
123.10 	or a five percentage point improvement over the previous year's TANF participation rate 
123.11 	under section 256J.751, subdivision 2, clause (7), as averaged across 12 consecutive 
123.12 	months for the most recent year for which the measurements are available, will receive an 
123.13 	additional allocation equal to 2.5 percent of its initial allocation; and
123.14 	(2) a county or tribe that performs within or above its range of expected performance 
123.15 	on the annualized three-year self-support index under section 256J.751, subdivision 2, 
123.16 	clause (6), will receive an additional allocation equal to 2.5 percent of its initial allocation; 
123.17 	and
123.18 	(3) a county or tribe that does not achieve a 50 percent the TANF participation rate
123.19 	target or a five percentage point improvement over the previous year's TANF participation 
123.20 	rate under section 256J.751, subdivision 2, clause (7), as averaged across 12 consecutive 
123.21 	months for the most recent year for which the measurements are available, will not 
123.22 	receive an additional 2.5 percent of its initial allocation until after negotiating a multiyear 
123.23 	improvement plan with the commissioner; or 
123.24 	(4) a county or tribe that does not perform within or above its range of expected 
123.25 	performance on the annualized three-year self-support index under section 256J.751, 
123.26 	subdivision 2, clause (6), will not receive an additional allocation equal to 2.5 percent 
123.27 	of its initial allocation until after negotiating a multiyear improvement plan with the 
123.28 	commissioner.
123.29 	(b) (c) For calendar year 2009 and yearly thereafter, performance-based funds for 
123.30 	a federally approved tribal TANF program in which the state and tribe have in place 
123.31 	a contract under section 256.01, addressing consolidated funding, will be allocated as 
123.32 	follows:
123.33 	(1) a tribe that achieves the participation rate approved in its federal TANF plan 
123.34 	using the average of 12 consecutive months for the most recent year for which the 
123.35 	measurements are available, will receive an additional allocation equal to 2.5 percent of 
123.36 	its initial allocation; and
124.1 	(2) a tribe that performs within or above its range of expected performance on the 
124.2 	annualized three-year self-support index under section 256J.751, subdivision 2, clause (6), 
124.3 	will receive an additional allocation equal to 2.5 percent of its initial allocation; or 
124.4 	(3) a tribe that does not achieve the participation rate approved in its federal TANF 
124.5 	plan using the average of 12 consecutive months for the most recent year for which the 
124.6 	measurements are available, will not receive an additional allocation equal to 2.5 percent 
124.7 	of its initial allocation until after negotiating a multiyear improvement plan with the 
124.8 	commissioner; or
124.9 	(4) a tribe that does not perform within or above its range of expected performance 
124.10 	on the annualized three-year self-support index under section 256J.751, subdivision 
124.11 	2, clause (6), will not receive an additional allocation equal to 2.5 percent until after 
124.12 	negotiating a multiyear improvement plan with the commissioner.
124.13 	(c) (d) Funds remaining unallocated after the performance-based allocations 
124.14 	in paragraph (a) (b) are available to the commissioner for innovation projects under 
124.15 	subdivision 5.
124.16 	(d) (1) If available funds are insufficient to meet county and tribal allocations under 
124.17 	paragraph (a) (b), the commissioner may make available for allocation funds that are 
124.18 	unobligated and available from the innovation projects through the end of the current 
124.19 	biennium.
124.20 	(2) If after the application of clause (1) funds remain insufficient to meet county 
124.21 	and tribal allocations under paragraph (a) (b), the commissioner must proportionally 
124.22 	reduce the allocation of each county and tribe with respect to their maximum allocation 
124.23 	available under paragraph (a) (b).

124.24 	Sec. 25. Minnesota Statutes 2008, section 256J.95, subdivision 3, is amended to read:
124.25 		Subd. 3.Eligibility for diversionary work program. (a) Except for the categories 
124.26 	of family units listed below, all family units who apply for cash benefits and who 
124.27 	meet MFIP eligibility as required in sections 256J.11 to 256J.15 are eligible and must 
124.28 	participate in the diversionary work program. Family units that are not eligible for the 
124.29 	diversionary work program include:
124.30 	(1) child only cases;
124.31 	(2) a single-parent family unit that includes a child under 12 weeks months of age. 
124.32 	A parent is eligible for this exception once in a parent's lifetime and is not eligible if 
124.33 	the parent has already used the previously allowed child under age one exemption from 
124.34 	MFIP employment services;
124.35 	(3) a minor parent without a high school diploma or its equivalent;
125.1 	(4) an 18- or 19-year-old caregiver without a high school diploma or its equivalent 
125.2 	who chooses to have an employment plan with an education option;
125.3 	(5) a caregiver age 60 or over;
125.4 	(6) family units with a caregiver who received DWP benefits in the 12 months prior 
125.5 	to the month the family applied for DWP, except as provided in paragraph (c);
125.6 	(7) family units with a caregiver who received MFIP within the 12 months prior to 
125.7 	the month the family unit applied for DWP;
125.8 	(8) a family unit with a caregiver who received 60 or more months of TANF 
125.9 	assistance; 
125.10 	(9) a family unit with a caregiver who is disqualified from DWP or MFIP due to 
125.11 	fraud; and
125.12 	(10) refugees and asylees as defined in Code of Federal Regulations, title 45, part 
125.13 	400, subpart d, section 400.43, who arrived in the United States in the 12 months prior to 
125.14 	the date of application for family cash assistance.
125.15 	(b) A two-parent family must participate in DWP unless both caregivers meet the 
125.16 	criteria for an exception under paragraph (a), clauses (1) through (5), or the family unit 
125.17 	includes a parent who meets the criteria in paragraph (a), clause (6), (7), (8), (9), or (10).
125.18 	(c) Once DWP eligibility is determined, the four months run consecutively. If a 
125.19 	participant leaves the program for any reason and reapplies during the four-month period, 
125.20 	the county must redetermine eligibility for DWP.

125.21 	Sec. 26. Minnesota Statutes 2008, section 256J.95, subdivision 11, is amended to read:
125.22 		Subd. 11.Universal participation required. (a) All DWP caregivers, except 
125.23 	caregivers who meet the criteria in paragraph (d), are required to participate in DWP 
125.24 	employment services. Except as specified in paragraphs (b) and (c), employment plans 
125.25 	under DWP must, at a minimum, meet the requirements in section 256J.55, subdivision 1.
125.26 	(b) A caregiver who is a member of a two-parent family that is required to participate 
125.27 	in DWP who would otherwise be ineligible for DWP under subdivision 3 may be allowed 
125.28 	to develop an employment plan under section 256J.521, subdivision 2, paragraph (c), that 
125.29 	may contain alternate activities and reduced hours.
125.30 	(c) A participant who is a victim of family violence shall be allowed to develop an 
125.31 	employment plan under section 256J.521, subdivision 3. A claim of family violence must 
125.32 	be documented by the applicant or participant by providing a sworn statement which is 
125.33 	supported by collateral documentation in section 256J.545, paragraph (b).
125.34 	(d) One parent in a two-parent family unit that has a natural born child under 12 
125.35 	weeks months of age is not required to have an employment plan until the child reaches 12 
126.1 	weeks months of age unless the family unit has already used the exclusion under section 
126.2 	256J.561, subdivision 3, or the previously allowed child under age one exemption under 
126.3 	section 256J.56, paragraph (a), clause (5).
126.4 	(e) The provision in paragraph (d) ends the first full month after the child reaches 12 
126.5 	weeks months of age. This provision is allowable only once in a caregiver's lifetime. In a 
126.6 	two-parent household, only one parent shall be allowed to use this category.
126.7 	(f) The participant and job counselor must meet within ten working days after the 
126.8 	child reaches 12 weeks months of age to revise the participant's employment plan. The 
126.9 	employment plan for a family unit that has a child under 12 weeks months of age that has 
126.10 	already used the exclusion in section 256J.561 or the previously allowed child under 
126.11 	age one exemption under section 256J.56, paragraph (a), clause (5), must be tailored to 
126.12 	recognize the caregiving needs of the parent.

126.13 	Sec. 27. Minnesota Statutes 2008, section 256J.95, subdivision 13, is amended to read:
126.14 		Subd. 13.Immediate referral to employment services. Within one working day of 
126.15 	determination that the applicant is eligible for the diversionary work program, but before 
126.16 	benefits are issued to or on behalf of the family unit, the county shall refer all caregivers to 
126.17 	employment services. The referral to the DWP employment services must be in writing 
126.18 	and must contain the following information:
126.19 	(1) notification that, as part of the application process, applicants are required to 
126.20 	develop an employment plan or the DWP application will be denied;
126.21 	(2) the employment services provider name and phone number;
126.22 	(3) the date, time, and location of the scheduled employment services interview;
126.23 	(4) the immediate availability of supportive services, including, but not limited to, 
126.24 	child care, transportation, and other work-related aid; and
126.25 	(5) (4) the rights, responsibilities, and obligations of participants in the program, 
126.26 	including, but not limited to, the grounds for good cause, the consequences of refusing or 
126.27 	failing to participate fully with program requirements, and the appeal process.

126.28 	Sec. 28.  REPEALER.
 126.29 	Minnesota Statutes 2008, section 256I.06, subdivision 9, is repealed.

126.30 	ARTICLE 3
126.31 	SERVICES FOR PERSONS WITH DISABILITIES

126.32 	Section 1. Minnesota Statutes 2008, section 245A.10, subdivision 3, is amended to 
126.33 	read:
127.1 		Subd. 3.Application fee for initial license or certification. (a) For fees required 
127.2 	under subdivision 1, an applicant for an initial license or certification issued by the 
127.3 	commissioner shall submit a $500 application fee with each new application required 
127.4 	under this subdivision. The application fee shall not be prorated, is nonrefundable, and 
127.5 	is in lieu of the annual license or certification fee that expires on December 31. The 
127.6 	commissioner shall not process an application until the application fee is paid.
127.7 	(b) Except as provided in clauses (1) to (3), an applicant shall apply for a license 
127.8 	to provide services at a specific location.
127.9 	(1) For a license to provide waivered services to persons with developmental 
127.10 	disabilities or related conditions, an applicant shall submit an application for each county 
127.11 	in which the waivered services will be provided. Upon licensure, the license holder may 
127.12 	provide services to persons in that county plus no more than three persons at any one time 
127.13 	in each of up to ten additional counties. A license holder in one county may not provide 
127.14 	services under the home and community-based waiver for persons with developmental 
127.15 	disabilities to more than three people in a second county without holding a separate license 
127.16 	for that second county. Applicants or licensees providing services under this clause to 
127.17 	not more than three persons, remain subject to the inspection fees established in section 
127.18 	245A.10, subdivision 2, for each location.
127.19 	(2) For a license to provide semi-independent living services to persons with 
127.20 	developmental disabilities or related conditions, an applicant shall submit a single 
127.21 	application to provide services statewide.
127.22 	(3) For a license to provide independent living assistance for youth under section 
127.23 	245A.22, an applicant shall submit a single application to provide services statewide. 

127.24 	Sec. 2. Minnesota Statutes 2008, section 245A.11, is amended by adding a subdivision 
127.25 	to read:
127.26 		Subd. 7a.Alternate overnight supervision technology; adult foster care license.
 127.27 	(a) The commissioner may grant an applicant or license holder an adult foster care license 
127.28 	for a residence that does not have a caregiver in the residence during normal sleeping 
127.29 	hours as required under Minnesota Rules, part 9555.5105, subpart 37, item B, but uses 
127.30 	monitoring technology to alert the license holder when an incident occurs that may 
127.31 	jeopardize the health, safety, or rights of a foster care recipient. The applicant or license 
127.32 	holder must comply with all other requirements under Minnesota Rules, parts 9555.5105 
127.33 	to 9555.6265, and the requirements under this subdivision. The license printed by the 
127.34 	commissioner must state in bold and large font:
127.35 	(1) that staff are not present on-site overnight; and
128.1 	(2) the telephone number of the county's common entry point for making reports of 
128.2 	suspected maltreatment of vulnerable adults under section 626.557, subdivision 9.
128.3 	(b) Applications for a license under this section must be submitted directly to 
128.4 	the Department of Human Services licensing division. The licensing division must 
128.5 	immediately notify the host county and lead county contract agency and the host county 
128.6 	licensing agency. The licensing division must collaborate with the county licensing 
128.7 	agency in the review of the application and the licensing of the program.
128.8 	(c) Before a license is issued by the commissioner, and for the duration of the 
128.9 	license, the applicant or license holder must establish, maintain, and document the 
128.10 	implementation of written policies and procedures addressing the requirements in 
128.11 	paragraphs (d) through (f).
128.12 	(d) The applicant or license holder must have policies and procedures that:
128.13 	(1) establish characteristics of target populations that will be admitted into the home, 
128.14 	and characteristics of populations that will not be accepted into the home;
128.15 	(2) explain the discharge process when a foster care recipient requires overnight 
128.16 	supervision or other services that cannot be provided by the license holder due to the 
128.17 	limited hours that the license holder is on-site;
128.18 	(3) describe the types of events to which the program will respond with a physical 
128.19 	presence when those events occur in the home during time when staff are not on-site, and 
128.20 	how the license holder's response plan meets the requirements in paragraph (e), clause 
128.21 	(1) or (2);
128.22 	(4) establish a process for documenting a review of the implementation and 
128.23 	effectiveness of the response protocol for the response required under paragraph (e), 
128.24 	clause (1) or (2). The documentation must include:
128.25 	(i) a description of the triggering incident;
128.26 	(ii) the date and time of the triggering incident;
128.27 	(iii) the time of the response or responses under paragraph (e), clause (1) or (2);
128.28 	(iv) whether the response met the resident's needs;
128.29 	(v) whether the existing policies and response protocols were followed; and
128.30 	(vi) whether the existing policies and protocols are adequate or need modification.
128.31 	When no physical presence response is completed for a three-month period, the 
128.32 	license holder's written policies and procedures must require a physical presence response 
128.33 	drill be to conducted for which the effectiveness of the response protocol under paragraph 
128.34 	(e), clause (1) or (2), will be reviewed and documented as required under this clause; and
129.1 	(5) establish that emergency and nonemergency phone numbers are posted in a 
129.2 	prominent location in a common area of the home where they can be easily observed by a 
129.3 	person responding to an incident who is not otherwise affiliated with the home.
129.4 	(e) The license holder must document and include in the license application which 
129.5 	response alternative under clause (1) or (2) is in place for responding to situations that 
129.6 	present a serious risk to the health, safety, or rights of people receiving foster care services 
129.7 	in the home:
129.8 	(1) response alternative (1) requires only the technology to provide an electronic 
129.9 	notification or alert to the license holder that an event is underway that requires a response. 
129.10 	Under this alternative, no more than ten minutes will pass before the license holder will be 
129.11 	physically present on-site to respond to the situation; or
129.12 	(2) response alternative (2) requires the electronic notification and alert system 
129.13 	under alternative (1), but more than ten minutes may pass before the license holder is 
129.14 	present on-site to respond to the situation. Under alternative (2), all of the following 
129.15 	conditions are met:
129.16 	(i) the license holder has a written description of the interactive technological 
129.17 	applications that will assist the licenser holder in communicating with and assessing the 
129.18 	needs related to care, health, and safety of the foster care recipients. This interactive 
129.19 	technology must permit the license holder to remotely assess the well being of the foster 
129.20 	care recipient without requiring the initiation or participation by the foster care recipient. 
129.21 	Requiring the foster care recipient to initiate a telephone call or answer a telephone call 
129.22 	does not meet this requirement;
129.23 	(ii) the license holder documents how the remote license holder is qualified and 
129.24 	capable of meeting the needs of the foster care recipients and assessing foster care 
129.25 	recipients' needs under item (i) during the absence of the license holder on-site;
129.26 	(iii) the license holder maintains written procedures to dispatch emergency response 
129.27 	personnel to the site in the event of an identified emergency; and
129.28 	(iv) each foster care recipient's individualized plan of care, individual service plan 
129.29 	under section 256B.092, subdivision 1b, if required, or individual resident placement 
129.30 	agreement under Minnesota Rules, part 9555.5105, subpart 19, if required, identifies the 
129.31 	maximum response time, which may be greater than ten minutes, for the license holder 
129.32 	to be on-site for that foster care recipient.
129.33 	(f) All placement agreements, individual service agreements, and plans applicable 
129.34 	to the foster care recipient must clearly state that the adult foster care license category is 
129.35 	a program without the presence of a caregiver in the residence during normal sleeping 
129.36 	hours; the protocols in place for responding to situations that present a serious risk to 
130.1 	health, safety, or rights of foster care recipients under paragraph (e), clause (1) or (2); and a 
130.2 	signed informed consent from each foster care recipient or the person's legal representative 
130.3 	documenting the person's or legal representative's agreement with placement in the 
130.4 	program. If electronic monitoring technology is used in the home, the informed consent 
130.5 	form must also explain the following:
130.6 	(1) how any electronic monitoring is incorporated into the alternative supervision 
130.7 	system;
130.8 	(2) the backup system for any electronic monitoring in times of electrical outages or 
130.9 	other equipment malfunctions;
130.10 	(3) how the license holder is trained on the use of the technology;
130.11 	(4) the event types and license holder response times established under paragraph (e);
130.12 	(5) how the license holder protects the foster care recipient's privacy related to 
130.13 	electronic monitoring and related to any electronically recorded data generated by the 
130.14 	monitoring system. The consent form must explain where and how the electronically 
130.15 	recorded data is stored, with whom it will be shared, and how long it is retained; and
130.16 	(6) the risks and benefits of the alternative overnight supervision system. 
130.17 	The written explanations under clauses (1) to (6) may be accomplished through 
130.18 	cross-references to other policies and procedures as long as they are explained to the 
130.19 	person giving consent, and the person giving consent is offered a copy.
130.20 	(g) Nothing in this section requires the applicant or license holder to develop or 
130.21 	maintain separate or duplicative polices, procedures, documentation, consent forms, or 
130.22 	individual plans that may be required for other licensing standards, if the requirements of 
130.23 	this section are incorporated into those documents.
130.24 	(h) The commissioner may grant variances to the requirements of this section 
130.25 	according to section 245A.04, subdivision 9.
130.26 	(i) For the purposes of paragraphs (d) through (h), license holder has the meaning 
130.27 	under section 245A.2, subdivision 9, and additionally includes all staff, volunteers, and 
130.28 	contractors affiliated with the license holder.

130.29 	Sec. 3. Minnesota Statutes 2008, section 245A.16, subdivision 3, is amended to read:
130.30 		Subd. 3.Recommendations to commissioner. The county or private agency 
130.31 	shall not make recommendations to the commissioner regarding licensure without first 
130.32 	conducting an inspection, and for adult foster care, family adult day services, and family 
130.33 	child care, a background study of the applicant under chapter 245C. The county or private 
130.34 	agency must forward its recommendation to the commissioner regarding the appropriate 
130.35 	licensing action within 20 working days of receipt of a completed application.

131.1 	Sec. 4. Minnesota Statutes 2008, section 245C.04, subdivision 1, is amended to read:
131.2 		Subdivision 1.Licensed programs. (a) The commissioner shall conduct a 
131.3 	background study of an individual required to be studied under section 245C.03, 
131.4 	subdivision 1, at least upon application for initial license for all license types. 
131.5 	(b) The commissioner shall conduct a background study of an individual required to 
131.6 	be studied under section 245C.03, subdivision 1, at reapplication for a license for adult 
131.7 	foster care, family adult day services, and family child care. 
131.8 	(c) The commissioner is not required to conduct a study of an individual at the time 
131.9 	of reapplication for a license if the individual's background study was completed by the 
131.10 	commissioner of human services for an adult foster care license holder that is also:
131.11 	(1) registered under chapter 144D; or
131.12 	(2) licensed to provide home and community-based services to people with 
131.13 	disabilities at the foster care location and the license holder does not reside in the foster 
131.14 	care residence; and
131.15 	(3) the following conditions are met:
131.16 	(i) a study of the individual was conducted either at the time of initial licensure or 
131.17 	when the individual became affiliated with the license holder;
131.18 	(ii) the individual has been continuously affiliated with the license holder since 
131.19 	the last study was conducted; and
131.20 	(iii) the last study of the individual was conducted on or after October 1, 1995.
131.21 	(d) From July 1, 2007, to June 30, 2009, the commissioner of human services shall 
131.22 	conduct a study of an individual required to be studied under section 245C.03, at the 
131.23 	time of reapplication for a child foster care license. The county or private agency shall 
131.24 	collect and forward to the commissioner the information required under section 245C.05, 
131.25 	subdivisions 1, paragraphs (a) and (b), and 5, paragraphs (a) and (b). The background 
131.26 	study conducted by the commissioner of human services under this paragraph must 
131.27 	include a review of the information required under section 245C.08, subdivisions 1, 
131.28 	paragraph (a), clauses (1) to (5), 3, and 4.
131.29 	(e) The commissioner of human services shall conduct a background study of an 
131.30 	individual specified under section 245C.03, subdivision 1, paragraph (a), clauses (2) 
131.31 	to (6), who is newly affiliated with a child foster care license holder. The county or 
131.32 	private agency shall collect and forward to the commissioner the information required 
131.33 	under section 245C.05, subdivisions 1 and 5. The background study conducted by the 
131.34 	commissioner of human services under this paragraph must include a review of the 
131.35 	information required under section 245C.08, subdivisions 1, 3, and 4.
132.1 	(f) From January 1, 2010, to December 31, 2012, unless otherwise specified in 
132.2 	paragraph (c), the commissioner shall conduct a study of an individual required to be 
132.3 	studied under section 245C.03, at the time of reapplication for an adult foster care license. 
132.4 	The county shall collect and forward to the commissioner the information required under 
132.5 	section 245C.05, subdivision 1, paragraphs (a) and (b), and subdivision 5, paragraphs (a) 
132.6 	and (b). The background study conducted by the commissioner under this paragraph 
132.7 	must include a review of the information required under section 245C.08, subdivision 1, 
132.8 	paragraph (a), clauses (1) to (5), and subdivisions 3 and 4.
132.9 	(g) The commissioner shall conduct a background study of an individual specified 
132.10 	under section 245C.03, subdivision 1, paragraph (a), clauses (2) to (6), who is newly 
132.11 	affiliated with an adult foster care license holder. The county shall collect and forward 
132.12 	to the commissioner the information required under section 245C.05, subdivision 1, 
132.13 	paragraphs (a) and (b), and subdivision 5, paragraphs (a) and (b). The background 
132.14 	study conducted by the commissioner under this paragraph must include a review of 
132.15 	the information required under section 245C.08, subdivision 1, paragraph (a), and 
132.16 	subdivisions 3 and 4.
132.17 	 (h) Applicants for licensure, license holders, and other entities as provided in this 
132.18 	chapter must submit completed background study forms to the commissioner before 
132.19 	individuals specified in section 245C.03, subdivision 1, begin positions allowing direct 
132.20 	contact in any licensed program. 
132.21 	(g) (i)  For purposes of this section, a physician licensed under chapter 147 is 
132.22 	considered to be continuously affiliated upon the license holder's receipt from the 
132.23 	commissioner of health or human services of the physician's background study results.

132.24 	Sec. 5. Minnesota Statutes 2008, section 245C.05, subdivision 4, is amended to read:
132.25 		Subd. 4.Electronic transmission. For background studies conducted by the 
132.26 	Department of Human Services, the commissioner shall implement a system for the 
132.27 	electronic transmission of:
132.28 	(1) background study information to the commissioner; 
132.29 	(2) background study results to the license holder; and
132.30 	(3) background study results to county and private agencies for background studies 
132.31 	conducted by the commissioner for child foster care; and
132.32 	(4) background study results to county agencies for background studies conducted 
132.33 	by the commissioner for adult foster care.

132.34 	Sec. 6. Minnesota Statutes 2008, section 245C.08, subdivision 2, is amended to read:
133.1 		Subd. 2.Background studies conducted by a county agency. (a) For a background 
133.2 	study conducted by a county agency for adult foster care, family adult day services, and 
133.3 	family child care services, the commissioner shall review:
133.4 	(1) information from the county agency's record of substantiated maltreatment 
133.5 	of adults and the maltreatment of minors;
133.6 	(2) information from juvenile courts as required in subdivision 4 for individuals 
133.7 	listed in section 245C.03, subdivision 1, clauses (2), (5), and (6); and
133.8 	(3) information from the Bureau of Criminal Apprehension.
133.9 	(b) If the individual has resided in the county for less than five years, the study shall 
133.10 	include the records specified under paragraph (a) for the previous county or counties of 
133.11 	residence for the past five years.
133.12 	(c) Notwithstanding expungement by a court, the county agency may consider 
133.13 	information obtained under paragraph (a), clause (3), unless the commissioner received 
133.14 	notice of the petition for expungement and the court order for expungement is directed 
133.15 	specifically to the commissioner.

133.16 	Sec. 7. Minnesota Statutes 2008, section 245C.10, is amended by adding a subdivision 
133.17 	to read:
133.18 		Subd. 5.Adult foster care services. The commissioner shall recover the cost 
133.19 	of background studies required under section 245C.03, subdivision 1, for the purposes 
133.20 	of adult foster care licensing, through a fee of no more than $20 per study charged to 
133.21 	the license holder. The fees collected under this subdivision are appropriated to the 
133.22 	commissioner for the purpose of conducting background studies.

133.23 	Sec. 8. Minnesota Statutes 2008, section 245C.17, is amended by adding a subdivision 
133.24 	to read:
133.25 		Subd. 6.Notice to county agency. For studies on individuals related to a license to 
133.26 	provide adult foster care, the commissioner shall also provide a notice of the background 
133.27 	study results to the county agency that initiated the background study.

133.28 	Sec. 9. Minnesota Statutes 2008, section 245C.20, is amended to read:
133.29 	245C.20 LICENSE HOLDER RECORD KEEPING.
133.30 	A licensed program shall document the date the program initiates a background 
133.31 	study under this chapter in the program's personnel files. When a background study is 
133.32 	completed under this chapter, a licensed program shall maintain a notice that the study 
133.33 	was undertaken and completed in the program's personnel files. Except when background 
134.1 	studies are initiated through the commissioner's online system, if a licensed program 
134.2 	has not received a response from the commissioner under section 245C.17 within 45 
134.3 	days of initiation of the background study request, the licensed program must contact the 
134.4 	commissioner human services licensing division  to inquire about the status of the study.   If 
134.5 	a license holder initiates a background study under the commissioner's online system, but 
134.6 	the background study subject's name does not appear in the list of active or recent studies 
134.7 	initiated by that license holder, the license holder must either contact the human services 
134.8 	licensing division or resubmit the background study information online for that individual.

134.9 	Sec. 10. Minnesota Statutes 2008, section 245C.21, subdivision 1a, is amended to read:
134.10 		Subd. 1a.Submission of reconsideration request to county or private agency.
 134.11 	(a) For disqualifications related to studies conducted by county agencies for family child 
134.12 	care and family adult day services, and for disqualifications related to studies conducted 
134.13 	by the commissioner for child foster care and adult foster care, the individual shall 
134.14 	submit the request for reconsideration to the county or private agency that initiated the 
134.15 	background study.
134.16 	(b) For disqualifications related to studies conducted by the commissioner for child 
134.17 	foster care, the individual shall submit the request for reconsideration to the private agency 
134.18 	that initiated the background study.
134.19 	(c) A reconsideration request shall be submitted within 30 days of the individual's 
134.20 	receipt of the disqualification notice or the time frames specified in subdivision 2, 
134.21 	whichever time frame is shorter.
134.22 	(c) (d)  The county or private agency shall forward the individual's request for 
134.23 	reconsideration and provide the commissioner with a recommendation whether to set aside 
134.24 	the individual's disqualification.

134.25 	Sec. 11. Minnesota Statutes 2008, section 245C.23, subdivision 2, is amended to read:
134.26 		Subd. 2.Commissioner's notice of disqualification that is not set aside. (a) The 
134.27 	commissioner shall notify the license holder of the disqualification and order the license 
134.28 	holder to immediately remove the individual from any position allowing direct contact 
134.29 	with persons receiving services from the license holder if:
134.30 	(1) the individual studied does not submit a timely request for reconsideration 
134.31 	under section 245C.21;
134.32 	(2) the individual submits a timely request for reconsideration, but the commissioner 
134.33 	does not set aside the disqualification for that license holder under section 245C.22;
135.1 	(3) an individual who has a right to request a hearing under sections 245C.27 and 
135.2 	256.045, or 245C.28 and chapter 14 for a disqualification that has not been set aside, does 
135.3 	not request a hearing within the specified time; or
135.4 	(4) an individual submitted a timely request for a hearing under sections 245C.27
135.5 	and 256.045, or 245C.28 and chapter 14, but the commissioner does not set aside the 
135.6 	disqualification under section 245A.08, subdivision 5, or 256.045.
135.7 	(b) If the commissioner does not set aside the disqualification under section 245C.22, 
135.8 	and the license holder was previously ordered under section 245C.17 to immediately 
135.9 	remove the disqualified individual from direct contact with persons receiving services or 
135.10 	to ensure that the individual is under continuous, direct supervision when providing direct 
135.11 	contact services, the order remains in effect pending the outcome of a hearing under 
135.12 	sections 245C.27 and 256.045, or 245C.28 and chapter 14.
135.13 	(c) For background studies related to child foster care, the commissioner shall 
135.14 	also notify the county or private agency that initiated the study of the results of the 
135.15 	reconsideration.
135.16 	(d) For background studies related to adult foster care, the commissioner shall also 
135.17 	notify the county that initiated the study of the results of the reconsideration.

135.18 	Sec. 12. Minnesota Statutes 2008, section 256B.5011, subdivision 2, is amended to 
135.19 	read:
135.20 		Subd. 2.Contract provisions. (a) The service contract with each intermediate 
135.21 	care facility must include provisions for:
135.22 	(1) modifying payments when significant changes occur in the needs of the 
135.23 	consumers;
135.24 	(2) the establishment and use of a quality improvement plan. Using criteria and 
135.25 	options for performance measures developed by the commissioner, each intermediate care 
135.26 	facility must identify a minimum of one performance measure on which to focus its efforts 
135.27 	for quality improvement during the contract period;
135.28 	(3) appropriate and necessary statistical information required by the commissioner;
135.29 	(4) (3) annual aggregate facility financial information; and
135.30 	(5) (4) additional requirements for intermediate care facilities not meeting the 
135.31 	standards set forth in the service contract.
135.32 	(b) The commissioner of human services and the commissioner of health, in 
135.33 	consultation with representatives from counties, advocacy organizations, and the provider 
135.34 	community, shall review the consolidated standards under chapter 245B and the supervised 
135.35 	living facility rule under Minnesota Rules, chapter 4665, to determine what provisions 
136.1 	in Minnesota Rules, chapter 4665, may be waived by the commissioner of health for 
136.2 	intermediate care facilities in order to enable facilities to implement the performance 
136.3 	measures in their contract and provide quality services to residents without a duplication 
136.4 	of or increase in regulatory requirements.

136.5 	Sec. 13. COMMON SERVICE MENU FOR HOME AND COMMUNITY-BASED 
136.6 	WAIVER PROGRAMS.
 136.7 	The commissioner of human services shall confer with representatives of recipients, 
136.8 	advocacy groups, counties, providers, and health plans to develop and update a common 
136.9 	service menu for home and community-based waiver programs. The commissioner may 
136.10 	consult with existing stakeholder groups convened under the commissioner's authority to 
136.11 	meet all or part of the requirements of this section.

136.12 	Sec. 14. INTERMEDIATE CARE FACILITIES FOR PERSONS WITH 
136.13 	DEVELOPMENTAL DISABILITIES REPORT.
 136.14 	The commissioner of human services shall also consult with intermediate care 
136.15 	facilities for persons with developmental disabilities providers and advocates to 
136.16 	monitor progress made in response to the commissioner's December 15, 2008, report 
136.17 	to the legislature regarding intermediate care facilities for persons with developmental 
136.18 	disabilities.

136.19 	ARTICLE 4
136.20 	STATE-OPERATED SERVICES/MINNESOTA SEX OFFENDER PROGRAM

136.21 	Section 1. Minnesota Statutes 2008, section 246.50, subdivision 5, is amended to read:
136.22 		Subd. 5.Cost of care. "Cost of care" means the commissioner's charge for services 
136.23 	provided to any person admitted to a state facility.
136.24 	For purposes of this subdivision, "charge for services" means the cost of services, 
136.25 	treatment, maintenance, bonds issued for capital improvements, depreciation of buildings 
136.26 	and equipment, and indirect costs related to the operation of state facilities. The 
136.27 	commissioner may determine the charge for services on an anticipated average per diem 
136.28 	basis as an all inclusive charge per facility, per disability group, or per treatment program. 
136.29 	The commissioner may determine a charge per service, using a method that includes direct 
136.30 	and indirect costs usual and customary fee charged for services provided to clients. The 
136.31 	usual and customary fee shall be established in a manner required to appropriately bill 
136.32 	services to all payers and shall include the costs related to the operations of any program 
136.33 	offered by the state.

137.1 	Sec. 2. Minnesota Statutes 2008, section 246.50, is amended by adding a subdivision 
137.2 	to read:
137.3 		Subd. 10.State-operated community-based program.  "State-operated 
137.4 	community-based program" means any program operated in the community including 
137.5 	community behavioral health hospitals, crisis centers, residential facilities, outpatient 
137.6 	services, and other community-based services developed and operated by the state and 
137.7 	under the commissioner's control.

137.8 	Sec. 3. Minnesota Statutes 2008, section 246.50, is amended by adding a subdivision 
137.9 	to read:
137.10 		Subd. 11.Health plan company. "Health plan company" has the meaning given it 
137.11 	in section 62Q.01, subdivision 4, and also includes a demonstration provider as defined in 
137.12 	section 256B.69, subdivision 2, paragraph (b), a county or group of counties participating 
137.13 	in county-based purchasing according to section 256B.692, and a children's mental health 
137.14 	collaborative under contract to provide medical assistance for individuals enrolled in 
137.15 	the prepaid medical assistance and MinnesotaCare programs under sections 245.493 to 
137.16 	245.495.

137.17 	Sec. 4. Minnesota Statutes 2008, section 246.51, is amended by adding a subdivision 
137.18 	to read:
137.19 		Subd. 1a.Clients in state-operated community-based programs; determination.
 137.20 	The commissioner shall determine available health plan coverage from a health plan 
137.21 	company for services provided to clients admitted to a state-operated community-based 
137.22 	program. If the health plan coverage requires a co-pay or deductible, or if there is no 
137.23 	available health plan coverage, the commissioner shall determine or redetermine, what 
137.24 	part of the noncovered cost of care, if any, the client is able to pay. If the client is unable to 
137.25 	pay the uncovered cost of care, the commissioner shall determine the client's relatives' 
137.26 	ability to pay. The client and relatives shall provide to the commissioner documents and 
137.27 	proof necessary to determine the client and relatives' ability to pay. Failure to provide the 
137.28 	commissioner with sufficient information to determine ability to pay may make the client 
137.29 	or relatives liable for the full cost of care until the time when sufficient information is 
137.30 	provided. If it is determined that the responsible party does not have the ability to pay, 
137.31 	the commissioner shall waive payment of the portion that exceeds ability to pay under 
137.32 	the determination.

138.1 	Sec. 5. Minnesota Statutes 2008, section 246.51, is amended by adding a subdivision 
138.2 	to read:
138.3 		Subd. 1b.Clients served by regional treatment centers or nursing homes; 
138.4 	determination. The commissioner shall determine or redetermine, if necessary, what part 
138.5 	of the cost of care, if any, a client served in regional treatment centers or nursing homes 
138.6 	operated by state-operated services, is able to pay. If the client is unable to pay the full cost 
138.7 	of care, the commissioner shall determine if the client's relatives have the ability to pay. 
138.8 	The client and relatives shall provide to the commissioner documents and proof necessary 
138.9 	to determine the client and relatives' ability to pay. Failure to provide the commissioner 
138.10 	with sufficient information to determine ability to pay may make the client or relatives 
138.11 	liable for the full cost of care until the time when sufficient information is provided. No 
138.12 	parent shall be liable for the cost of care given a client at a regional treatment center after 
138.13 	the client has reached the age of 18 years.

138.14 	Sec. 6. Minnesota Statutes 2008, section 246.511, is amended to read:
138.15 	246.511 RELATIVE RESPONSIBILITY.
138.16 	Except for chemical dependency services paid for with funds provided under chapter 
138.17 	254B, a client's relatives shall not, pursuant to the commissioner's authority under section 
138.18 	246.51, be ordered to pay more than ten percent of the cost ofthe following: (1) for 
138.19 	services provided in a community-based service, the noncovered cost of care as determined 
138.20 	under the ability to pay determination; and (2) for services provided at a regional treatment 
138.21 	center operated by state-operated services, 20 percent of the cost of care, unless they 
138.22 	reside outside the state. Parents of children in state facilities shall have their responsibility 
138.23 	to pay determined according to section 252.27, subdivision 2, or in rules adopted under 
138.24 	chapter 254B if the cost of care is paid under chapter 254B. The commissioner may 
138.25 	accept voluntary payments in excess of ten 20 percent. The commissioner may require 
138.26 	full payment of the full per capita cost of care in state facilities for clients whose parent, 
138.27 	parents, spouse, guardian, or conservator do not reside in Minnesota.  

138.28 	Sec. 7. Minnesota Statutes 2008, section 246.52, is amended to read:
138.29 	246.52 PAYMENT FOR CARE; ORDER; ACTION.
138.30 	The commissioner shall issue an order to the client or the guardian of the estate, if 
138.31 	there be one, and relatives determined able to pay requiring them to pay monthly to the 
138.32 	state of Minnesota the amounts so determined the total of which shall not exceed the full 
138.33 	cost of care. Such order shall specifically state the commissioner's determination and shall 
138.34 	be conclusive unless appealed from as herein provided. When a client or relative fails to 
139.1 	pay the amount due hereunder the attorney general, upon request of the commissioner, 
139.2 	may institute, or direct the appropriate county attorney to institute, civil action to recover 
139.3 	such amount.

139.4 	Sec. 8. Minnesota Statutes 2008, section 246.54, subdivision 2, is amended to read:
139.5 		Subd. 2.Exceptions. (a) Subdivision 1 does not apply to services provided at the 
139.6 	Minnesota Security Hospital, the Minnesota sex offender program, or the Minnesota 
139.7 	extended treatment options program. For services at thesethe Minnesota security hospital 
139.8 	and the Minnesota sex offender facilities, a county's payment shall be made from the 
139.9 	county's own sources of revenue and payments shall be paid as follows: payments to the 
139.10 	state from the county shall equal ten percent of the cost of care, as determined by the 
139.11 	commissioner, for each day, or the portion thereof, that the client spends at the facility. 
139.12 	If payments received by the state under sections 246.50 to 246.53 exceed 90 percent of 
139.13 	the cost of care, the county shall be responsible for paying the state only the remaining 
139.14 	amount. The county shall not be entitled to reimbursement from the client, the client's 
139.15 	estate, or from the client's relatives, except as provided in section 246.53.
139.16 	(b) For services at the Minnesota extended treatment options program, a county's 
139.17 	payment shall be made from the county's own sources of revenue and payments shall equal 
139.18 	a percentage of the cost of care, as determined by the commissioner, for each day, or the 
139.19 	portion thereof, that the client spends at the program according to the following schedule:
139.20 	(1) ten percent for the first 90 days;
139.21 	(2) 20 percent for days 91 to 270; and
139.22 	(3) 50 percent for any days over 271.
139.23 	If payments received by the state under sections 246.50 to 246.53 exceed 90 percent of the 
139.24 	cost of care for days zero to 90, 80 percent for days 91 to 270, or 50 percent for any days 
139.25 	over 271, the county shall be responsible for paying the state only the remaining amount. 
139.26 	The county shall not be entitled to reimbursement from the client, the client's estate, or 
139.27 	from the client's relatives, except as provided in section 246.53.
139.28 	(c) Regardless of the facility to which the client is committed, subdivision 1 does not 
139.29 	apply to the following individuals:
139.30 	(1) clients who are committed as mentally ill and dangerous under section 253B.02, 
139.31 	subdivision 17;
139.32 	(2) clients who are committed as sexual psychopathic personalities under section 
139.33 	253B.02, subdivision 18b; and
139.34 	(3) clients who are committed as sexually dangerous persons under section 253B.02, 
139.35 	subdivision 18c.
140.1 	For each of the individuals in clauses (1) to (3), the payment by the county to the state 
140.2 	shall equal ten percent of the cost of care for each day as determined by the commissioner.

140.3 	EFFECTIVE DATE. This section is effective January 1, 2010.

140.4 	Sec. 9. Minnesota Statutes 2008, section 246B.01, is amended by adding a subdivision 
140.5 	to read:
140.6 		Subd. 1a. Client. "Client" means a person who is admitted to the Minnesota sex 
140.7 	offender program or subject to a court hold order under section 253B.185 for the purpose 
140.8 	of assessment, diagnosis, care, treatment, supervision, or other services provided by the 
140.9 	Minnesota sex offender program.

140.10 	Sec. 10. Minnesota Statutes 2008, section 246B.01, is amended by adding a 
140.11 	subdivision to read:
140.12 		Subd. 1b.Client's county. "Client's county" means the county of the client's 
140.13 	legal settlement for poor relief purposes at the time of commitment. If the client has no 
140.14 	legal settlement for poor relief in this state, it means the county of commitment, except 
140.15 	that when a client with no legal settlement for poor relief is committed while serving a 
140.16 	sentence at a penal institution, it means the county from which the client was sentenced.

140.17 	Sec. 11. Minnesota Statutes 2008, section 246B.01, is amended by adding a subdivision 
140.18 	to read:
140.19 		Subd. 2a.Cost of care. "Cost of care" means the commissioner's charge for housing 
140.20 	and treatment services provided to any person admitted to the Minnesota sex offender 
140.21 	program.
140.22 	For purposes of this subdivision, "charge for housing and treatment services" means 
140.23 	the cost of services, treatment, maintenance, bonds issued for capital improvements, 
140.24 	depreciation of buildings and equipment, and indirect costs related to the operation of 
140.25 	state facilities. The commissioner may determine the charge for services on an anticipated 
140.26 	average per diem basis as an all-inclusive charge per facility.

140.27 	Sec. 12. Minnesota Statutes 2008, section 246B.01, is amended by adding a 
140.28 	subdivision to read:
140.29 		Subd. 2b.Local social services agency. "Local social services agency" means the 
140.30 	local social services agency of the client's county as defined in subdivision 1b and of the 
140.31 	county of commitment, and any other local social services agency possessing information 
141.1 	regarding, or requested by the commissioner to investigate, the financial circumstances 
141.2 	of a client.

141.3 	Sec. 13. [246B.07] PAYMENT FOR CARE AND TREATMENT: 
141.4 	DETERMINATION.
141.5 		Subdivision 1.Procedures. The commissioner shall determine or redetermine, if 
141.6 	necessary, what amount of the cost of care, if any, the client is able to pay. The client shall 
141.7 	provide to the commissioner documents and proof necessary to determine the ability to 
141.8 	pay. Failure to provide the commissioner with sufficient information to determine ability 
141.9 	to pay may make the client liable for the full cost of care until the time when sufficient 
141.10 	information is provided.
141.11 		Subd. 2.Rules. The commissioner shall use the standards in section 246.51, 
141.12 	subdivision 2, to determine the client's liability for the care provided by the Minnesota sex 
141.13 	offender program.
141.14 		Subd. 3.Applicability. The commissioner may recover, under sections 246B.07 to 
141.15 	246B.10, the cost of any care provided by the Minnesota sex offender program.

141.16 	Sec. 14. [246B.08] PAYMENT FOR CARE; ORDER; ACTION.
141.17 	The commissioner shall issue an order to the client or the guardian of the estate, if 
141.18 	there is one, requiring the client or guardian to pay to the state the amounts determined, the 
141.19 	total of which must not exceed the full cost of care. The order must specifically state the 
141.20 	commissioner's determination and must be conclusive, unless appealed. If a client fails to 
141.21 	pay the amount due, the attorney general, upon request of the commissioner, may institute, 
141.22 	or direct the appropriate county attorney to institute a civil action to recover the amount.

141.23 	Sec. 15. [246B.09] CLAIM AGAINST ESTATE OF DECEASED CLIENT.
141.24 		Subdivision 1.Client's estate. Upon the death of a client, or a former client, the 
141.25 	total cost of care provided to the client, less the amount actually paid toward the cost of 
141.26 	care by the client, must be filed by the commissioner as a claim against the estate of the 
141.27 	client with the court having jurisdiction to probate the estate, and all proceeds collected 
141.28 	by the state in the case must be divided between the state and county in proportion to 
141.29 	the cost of care each has borne.
141.30 		Subd. 2.Preferred status. An estate claim in subdivision 1 must be considered an 
141.31 	expense of the last illness for purposes of section 524.3-805.
141.32 	If the commissioner determines that the property or estate of a client is not more 
141.33 	than needed to care for and maintain the spouse and minor or dependent children of a 
142.1 	deceased client, the commissioner has the power to compromise the claim of the state in a 
142.2 	manner deemed just and proper.
142.3 		Subd. 3.Exception from statute of limitations. Any statute of limitations that 
142.4 	limits the commissioner in recovering the cost of care obligation incurred by a client or 
142.5 	former client must not apply to any claim against an estate made under this section to 
142.6 	recover cost of care.

142.7 	Sec. 16. [246B.10] LIABILITY OF COUNTY; REIMBURSEMENT.
142.8 	The client's county shall pay to the state a portion of the cost of care provided in 
142.9 	the Minnesota sex offender program to a client who has legally settled in that county. A 
142.10 	county's payment must be made from the county's own sources of revenue and payments 
142.11 	must equal ten percent of the cost of care, as determined by the commissioner, for each 
142.12 	day or portion of a day, that the client spends at the facility. If payments received by the 
142.13 	state under this chapter exceed 90 percent of the cost of care, the county is responsible 
142.14 	for paying the state the remaining amount. The county is not entitled to reimbursement 
142.15 	from the client, the client's estate, or from the client's relatives, except as provided in 
142.16 	section 246B.07.

142.17 	Sec. 17. Minnesota Statutes 2008, section 252.025, subdivision 7, is amended to read:
142.18 		Subd. 7.Minnesota extended treatment options. The commissioner shall develop 
142.19 	by July 1, 1997, the Minnesota extended treatment options to serve Minnesotans who have 
142.20 	developmental disabilities and exhibit severe behaviors which present a risk to public 
142.21 	safety. This program is statewide and must provide specialized residential services in 
142.22 	Cambridge and an array of community support community-based services statewide with 
142.23 	sufficient levels of care and a sufficient number of specialists to ensure that individuals 
142.24 	referred to the program receive the appropriate care.

142.25 	Sec. 18. REQUIRING THE DEVELOPMENT OF COMMUNITY-BASED 
142.26 	MENTAL HEALTH SERVICES FOR PATIENTS COMMITTED TO THE 
142.27 	ANOKA-METRO REGIONAL TREATMENT CENTER.
 142.28 	In consultation with community partners, the commissioner of human services 
142.29 	shall develop an array of community-based services to transform the current services 
142.30 	now provided to patients at the Anoka-Metro Regional Treatment Center. The 
142.31 	community-based services may be provided in facilities with 16 or fewer beds, and must 
142.32 	provide the appropriate level of care for the patients being admitted to the facilities. The 
142.33 	planning for this transition must be completed by October 1, 2009, with an initial report 
143.1 	to the committee chairs of health and human services by November 30, 2009, and a 
143.2 	semiannual report on progress until the transition is completed. The commissioner of 
143.3 	human services shall solicit interest from stakeholders and potential community partners. 
143.4 	The individuals working in the community-based services facilities under this section are 
143.5 	state employees supervised by the commissioner of human services.

143.6 	Sec. 19.  REPEALER.
 143.7 	Minnesota Statutes 2008, sections 246.51, subdivision 1; and 246.53, subdivision 
143.8 	3, are repealed.

143.9 	ARTICLE 5
143.10 	DEPARTMENT OF HEALTH

143.11 	Section 1. Minnesota Statutes 2008, section 62Q.19, subdivision 1, is amended to read:
143.12 		Subdivision 1.Designation. (a) The commissioner shall designate essential 
143.13 	community providers. The criteria for essential community provider designation shall be 
143.14 	the following:
143.15 	(1) a demonstrated ability to integrate applicable supportive and stabilizing services 
143.16 	with medical care for uninsured persons and high-risk and special needs populations, 
143.17 	underserved, and other special needs populations; and
143.18 	(2) a commitment to serve low-income and underserved populations by meeting the 
143.19 	following requirements:
143.20 	(i) has nonprofit status in accordance with chapter 317A;
143.21 	(ii) has tax exempt status in accordance with the Internal Revenue Service Code, 
143.22 	section 501(c)(3);
143.23 	(iii) charges for services on a sliding fee schedule based on current poverty income 
143.24 	guidelines; and
143.25 	(iv) does not restrict access or services because of a client's financial limitation;
143.26 	(3) status as a local government unit as defined in section 62D.02, subdivision 11, a 
143.27 	hospital district created or reorganized under sections 447.31 to 447.37, an Indian tribal 
143.28 	government, an Indian health service unit, or a community health board as defined in 
143.29 	chapter 145A;  
143.30 	(4) a former state hospital that specializes in the treatment of cerebral palsy, spina 
143.31 	bifida, epilepsy, closed head injuries, specialized orthopedic problems, and other disabling 
143.32 	conditions; or
143.33 	(5) a sole community hospital. For these rural hospitals, the essential community 
143.34 	provider designation applies to all health services provided, including both inpatient and 
144.1 	outpatient services. For purposes of this section, "sole community hospital" means a 
144.2 	rural hospital that:
144.3 	(i) is eligible to be classified as a sole community hospital according to Code 
144.4 	of Federal Regulations, title 42, section 412.92, or is located in a community with a 
144.5 	population of less than 5,000 and located more than 25 miles from a like hospital currently 
144.6 	providing acute short-term services;  
144.7 	(ii) has experienced net operating income losses in two of the previous three 
144.8 	most recent consecutive hospital fiscal years for which audited financial information is 
144.9 	available; and
144.10 	(iii) consists of 40 or fewer licensed beds; or
144.11 	(6) a birthing center licensed under section 144.566.
144.12 	(b) Prior to designation, the commissioner shall publish the names of all applicants 
144.13 	in the State Register. The public shall have 30 days from the date of publication to submit 
144.14 	written comments to the commissioner on the application. No designation shall be made 
144.15 	by the commissioner until the 30-day period has expired.
144.16 	(c) The commissioner may designate an eligible provider as an essential community 
144.17 	provider for all the services offered by that provider or for specific services designated by 
144.18 	the commissioner.
144.19 	(d) For the purpose of this subdivision, supportive and stabilizing services include at 
144.20 	a minimum, transportation, child care, cultural, and linguistic services where appropriate.

144.21 	Sec. 2. Minnesota Statutes 2008, section 103I.208, subdivision 2, is amended to read:
144.22 		Subd. 2.Permit fee. The permit fee to be paid by a property owner is:
144.23 	(1) for a water supply well that is not in use under a maintenance permit, $175 
144.24 	annually;
144.25 	(2) for construction of a monitoring well, $215, which includes the state core 
144.26 	function fee;
144.27 	(3) for a monitoring well that is unsealed under a maintenance permit, $175 annually;
144.28 	(4) for a monitoring well owned by a federal agency, state agency, or local unit of 
144.29 	government that is unsealed under a maintenance permit, $50 annually. "Local unit of 
144.30 	government" means a statutory or home rule charter city, town, county, or soil and water 
144.31 	conservation district, watershed district, and organization formed for the joint exercise 
144.32 	of powers under section 471.59, a board of health or community health board, or other 
144.33 	special purpose district or authority with local jurisdiction in water and related land 
144.34 	resources management;
145.1 	(5) for monitoring wells used as a leak detection device at a single motor fuel retail 
145.2 	outlet, a single petroleum bulk storage site excluding tank farms, or a single agricultural 
145.3 	chemical facility site, the construction permit fee is $215, which includes the state core 
145.4 	function fee, per site regardless of the number of wells constructed on the site, and 
145.5 	the annual fee for a maintenance permit for unsealed monitoring wells is $175 per site 
145.6 	regardless of the number of monitoring wells located on site;
145.7 	(5) (6) for a groundwater thermal exchange device, in addition to the notification fee 
145.8 	for water supply wells, $215, which includes the state core function fee;
145.9 	(6) (7) for a vertical heat exchanger with less than ten tons of heating/cooling 
145.10 	capacity, $215;
145.11 	(8) for a vertical heat exchanger with ten to 50 tons of heating/cooling capacity, $425;
145.12 	(9) for a vertical heat exchanger with greater than 50 tons of heating/cooling 
145.13 	capacity, $650;
145.14 	(7) (10) for a dewatering well that is unsealed under a maintenance permit, $175 
145.15 	annually for each dewatering well, except a dewatering project comprising more than five 
145.16 	dewatering wells shall be issued a single permit for $875 annually for dewatering wells 
145.17 	recorded on the permit; and
145.18 	(8) (11) for an elevator boring, $215 for each boring.

145.19 	Sec. 3. Minnesota Statutes 2008, section 144.121, subdivision 1a, is amended to read:
145.20 		Subd. 1a.Fees for ionizing radiation-producing equipment. (a) A facility with 
145.21 	ionizing radiation-producing equipment must pay an annual initial or annual renewal 
145.22 	registration fee consisting of a base facility fee of $66 $100 and an additional fee for 
145.23 	each radiation source, as follows:

145.24	(1)
	medical or veterinary equipment
		$
	53100
	
145.25	(2)
	dental x-ray equipment
		$
	3340
	
145.26	(3)
	accelerator
		$
	66
	
145.27	(4)
	radiation therapy equipment
		$
	66
	
145.28
145.29	(5)(3)
	x-ray equipment not used on 
humans or animals
		$
	53100
	
145.30
145.31
145.32	(6)(4)
	devices with sources of ionizing 
radiation not used on humans or 
animals
		$
	53100
	
145.33 	(b) A facility with radiation therapy and accelerator equipment must pay an annual 
145.34 	registration fee of $500. A facility with an industrial accelerator must pay an annual 
145.35 	registration fee of $150.
145.36 	(c) Electron microscopy equipment is exempt from the registration fee requirements 
145.37 	of this section.

146.1 	Sec. 4. Minnesota Statutes 2008, section 144.121, subdivision 1b, is amended to read:
146.2 		Subd. 1b.Penalty fee for late registration. Applications for initial or renewal 
146.3 	registrations submitted to the commissioner after the time specified by the commissioner 
146.4 	shall be accompanied by a penalty fee of $20 an amount equal to 25 percent of the fee 
146.5 	due in addition to the fees prescribed in subdivision 1a.

146.6 	Sec. 5. Minnesota Statutes 2008, section 144.122, is amended to read:
146.7 	144.122 LICENSE, PERMIT, AND SURVEY FEES.
146.8 	(a) The state commissioner of health, by rule, may prescribe procedures and fees 
146.9 	for filing with the commissioner as prescribed by statute and for the issuance of original 
146.10 	and renewal permits, licenses, registrations, and certifications issued under authority of 
146.11 	the commissioner. The expiration dates of the various licenses, permits, registrations, 
146.12 	and certifications as prescribed by the rules shall be plainly marked thereon. Fees may 
146.13 	include application and examination fees and a penalty fee for renewal applications 
146.14 	submitted after the expiration date of the previously issued permit, license, registration, 
146.15 	and certification. The commissioner may also prescribe, by rule, reduced fees for permits, 
146.16 	licenses, registrations, and certifications when the application therefor is submitted 
146.17 	during the last three months of the permit, license, registration, or certification period. 
146.18 	Fees proposed to be prescribed in the rules shall be first approved by the Department of 
146.19 	Finance. All fees proposed to be prescribed in rules shall be reasonable. The fees shall be 
146.20 	in an amount so that the total fees collected by the commissioner will, where practical, 
146.21 	approximate the cost to the commissioner in administering the program. All fees collected 
146.22 	shall be deposited in the state treasury and credited to the state government special revenue 
146.23 	fund unless otherwise specifically appropriated by law for specific purposes.
146.24 	(b) The commissioner may charge a fee for voluntary certification of medical 
146.25 	laboratories and environmental laboratories, and for environmental and medical laboratory 
146.26 	services provided by the department, without complying with paragraph (a) or chapter 14. 
146.27 	Fees charged for environment and medical laboratory services provided by the department 
146.28 	must be approximately equal to the costs of providing the services.
146.29 	(c) The commissioner may develop a schedule of fees for diagnostic evaluations 
146.30 	conducted at clinics held by the services for children with disabilities program. All 
146.31 	receipts generated by the program are annually appropriated to the commissioner for use 
146.32 	in the maternal and child health program.
146.33 	(d) The commissioner shall set license fees for hospitals and nursing homes that are 
146.34 	not boarding care homes at the following levels:

147.1
147.2
147.3
147.4	Joint Commission on Accreditation of 
Healthcare Organizations (JCAHO) and 
American Osteopathic Association (AOA) 
hospitals
	$7,555$7,655 plus $13$16 per bed
	
147.5	Non-JCAHO and non-AOA hospitals
	$5,180$5,280 plus $247$250 per bed
	
147.6	Nursing home
	$183 plus $91 per bed
	
147.7 	The commissioner shall set license fees for outpatient surgical centers, boarding care 
147.8 	homes, and supervised living facilities at the following levels:

147.9	Outpatient surgical centers
	$3,349$3,712
	
147.10	Boarding care homes
	$183 plus $91 per bed
	
147.11	Supervised living facilities
	$183 plus $91 per bed.
	
147.12 	(e) Unless prohibited by federal law, the commissioner of health shall charge 
147.13 	applicants the following fees to cover the cost of any initial certification surveys required 
147.14 	to determine a provider's eligibility to participate in the Medicare or Medicaid program:

147.15	Prospective payment surveys for hospitals
	$
	900
	
147.16	Swing bed surveys for nursing homes
	$
	1,200
	
147.17	Psychiatric hospitals
	$
	1,400
	
147.18	Rural health facilities
	$
	1,100
	
147.19	Portable x-ray providers
	$
	500
	
147.20	Home health agencies
	$
	1,800
	
147.21	Outpatient therapy agencies
	$
	800
	
147.22	End stage renal dialysis providers
	$
	2,100
	
147.23	Independent therapists
	$
	800
	
147.24	Comprehensive rehabilitation outpatient facilities
	$
	1,200
	
147.25	Hospice providers
	$
	1,700
	
147.26	Ambulatory surgical providers
	$
	1,800
	
147.27	Hospitals
	$
	4,200
	
147.28
147.29
147.30	Other provider categories or additional
resurveys required to complete initial
certification
	Actual surveyor costs: average 
surveyor cost x number of hours 
for the survey process.
	
147.31 	These fees shall be submitted at the time of the application for federal certification 
147.32 	and shall not be refunded. All fees collected after the date that the imposition of fees is not 
147.33 	prohibited by federal law shall be deposited in the state treasury and credited to the state 
147.34 	government special revenue fund.

147.35 	Sec. 6. Minnesota Statutes 2008, section 144.1222, subdivision 1a, is amended to read:
147.36 		Subd. 1a. Fees. All plans and specifications for public pool and spa construction, 
147.37 	installation, or alteration or requests for a variance that are submitted to the commissioner 
147.38 	according to Minnesota Rules, part 4717.3975, shall be accompanied by the appropriate 
147.39 	fees. All public pool construction plans submitted for review after January 1, 2009, 
148.1 	must be certified by a professional engineer registered in the state of Minnesota. If the 
148.2 	commissioner determines, upon review of the plans, that inadequate fees were paid, the 
148.3 	necessary additional fees shall be paid before plan approval. For purposes of determining 
148.4 	fees, a project is defined as a proposal to construct or install a public pool, spa, special 
148.5 	purpose pool, or wading pool and all associated water treatment equipment and drains, 
148.6 	gutters, decks, water recreation features, spray pads, and those design and safety features 
148.7 	that are within five feet of any pool or spa. The commissioner shall charge the following 
148.8 	fees for plan review and inspection of public pools and spas and for requests for variance 
148.9 	from the public pool and spa rules: 
148.10 	(1) each pool, $800 $1,500; 
148.11 	(2) each spa pool, $500 $800; 
148.12 	(3) each slide, $400 $600; 
148.13 	(4) projects valued at $250,000 or more, the greater of the sum of the fees in clauses 
148.14 	(1), (2), and (3) or 0.5 percent of the documented estimated project cost to a maximum 
148.15 	fee of $10,000 $15,000; 
148.16 	(5) alterations to an existing pool without changing the size or configuration of 
148.17 	the pool, $400 $600; 
148.18 	(6) removal or replacement of pool disinfection equipment only, $75 $100; and 
148.19 	(7) request for variance from the public pool and spa rules, $500. 

148.20 	Sec. 7. Minnesota Statutes 2008, section 144.1501, subdivision 2, is amended to read:
148.21 		Subd. 2. Creation of account. (a) A health professional education loan forgiveness 
148.22 	program account is established. The commissioner of health shall use money from the 
148.23 	account to establish a loan forgiveness program: 
148.24 	(1) for medical residents agreeing to practice in designated rural areas or underserved 
148.25 	urban communities or specializing in the area of pediatric psychiatry; 
148.26 	(2) for midlevel practitioners agreeing to practice in designated rural areas or to 
148.27 	teach at least 12 credit hours, or 720 hours  per year  in the nursing field in a postsecondary 
148.28 	program at the undergraduate level or the equivalent at the graduate level; 
148.29 	(3) for nurses who agreeagreeing to practice in a Minnesota nursing home or, an
148.30 	intermediate care facility for persons with developmental disability, or in a hospital 
148.31 	pediatric psychiatric unit or to teach at least 12 credit hours, or 720 hours per year in the 
148.32 	nursing field in a postsecondary program at the undergraduate level or the equivalent at 
148.33 	the graduate level; 
148.34 	(4) for other health care technicians agreeing to teach at least 12 credit hours, or 720 
148.35 	hours  per year  in their designated field in a postsecondary program at the undergraduate 
149.1 	level or the equivalent at the graduate level. The commissioner, in consultation with 
149.2 	the Healthcare Education-Industry Partnership, shall determine the health care fields 
149.3 	where the need is the greatest, including, but not limited to, respiratory therapy, clinical 
149.4 	laboratory technology, radiologic technology, and surgical technology; 
149.5 	(5) for pharmacists who agree to practice in designated rural areas; and 
149.6 	(6) for dentists agreeing to deliver at least 25 percent of the dentist's yearly patient 
149.7 	encounters to state public program enrollees or patients receiving sliding fee schedule 
149.8 	discounts through a formal sliding fee schedule meeting the standards established by 
149.9 	the United States Department of Health and Human Services under Code of Federal 
149.10 	Regulations, title 42, section 51, chapter 303. 
149.11 	(b) Appropriations made to the account do not cancel and are available until 
149.12 	expended, except that at the end of each biennium, any remaining balance in the account 
149.13 	that is not committed by contract and not needed to fulfill existing commitments shall 
149.14 	cancel to the fund.

149.15 	Sec. 8. Minnesota Statutes 2008, section 144.226, subdivision 4, is amended to read:
149.16 		Subd. 4.Vital records surcharge. (a) In addition to any fee prescribed under 
149.17 	subdivision 1, there is a nonrefundable surcharge of $2 for each certified and noncertified 
149.18 	birth, stillbirth, or death record, and for a certification that the record cannot be found. 
149.19 	The local or state registrar shall forward this amount to the commissioner of finance to 
149.20 	be deposited into the state government special revenue fund. This surcharge shall not be 
149.21 	charged under those circumstances in which no fee for a birth, stillbirth, or death record is 
149.22 	permitted under subdivision 1, paragraph (a).
149.23 	(b) Effective August 1, 2005, to June 30, 2009, the surcharge in paragraph (a) shall 
149.24 	be is $4.

149.25 	Sec. 9. [144.566] BIRTHING CENTERS.
149.26 		Subdivision 1.Definitions. (a) For purposes of this section, the following definitions 
149.27 	have the meanings given to them.
149.28 	(b) "Birthing center" means a health care facility licensed for the primary purpose 
149.29 	of performing low-risk deliveries that is not a hospital or in a hospital and where 
149.30 	births are planned to occur away from the mother's usual residence following a normal 
149.31 	uncomplicated pregnancy.
149.32 	(c) "Licensed traditional midwife" means a midwife who is licensed under chapter 
149.33 	147D.
150.1 	(d) "Low-risk pregnancy" means a normal, uncomplicated prenatal course as 
150.2 	determined by documentation of adequate prenatal care and the anticipation of a normal 
150.3 	uncomplicated labor and birth, as defined by reasonable and generally accepted criteria 
150.4 	adopted by professional groups for maternal, fetal, and neonatal health care, and 
150.5 	generally accepted by the health care providers to whom they apply and approved by 
150.6 	the commissioner as reasonable.
150.7 		Subd. 2.License required. (a) Effective January 1, 2011, no birthing center shall 
150.8 	be established, operated, or maintained in the state without first obtaining a license from 
150.9 	the commissioner of health according to this section. The license is effective for one year 
150.10 	following the date of issuance.
150.11 	(b) A license issued under this section is not transferable or assignable and is subject 
150.12 	to suspension or revocation at any time for failure to comply with this section.
150.13 	(c) A birthing center licensed under this section shall not assert, represent, offer, 
150.14 	provide, or imply that the center is or may render care or services other than the services it 
150.15 	is permitted to render within the scope of the license issued.
150.16 	(d) The license must be conspicuously posted in an area where patients are admitted.
150.17 		Subd. 3.Application. An application for a license to operate a birthing center and 
150.18 	the applicable fee under subdivision 7 must be submitted to the commissioner on a form 
150.19 	provided by the commissioner and must contain:
150.20 	(1) the name of the applicant;
150.21 	(2) the location of the birthing center;
150.22 	(3) the name of the person in charge of the center;
150.23 	(4) documentation that the standards described under subdivision 5 have been 
150.24 	met; and
150.25 	(5) any other information the commissioner deems necessary.
150.26 		Subd. 4.Suspension, revocation, and refusal to renew. The commissioner may 
150.27 	refuse to grant or renew, or may suspend or revoke, a license on any of the grounds 
150.28 	described under section 144.55, subdivision 6, and the applicant or licensee is entitled to 
150.29 	notice and a hearing as described under section 144.55, subdivision 7.
150.30 		Subd. 5.Standards for licensure. (a) To be eligible for licensure under this section, 
150.31 	a birthing center must meet the following requirements:
150.32 	(1) a governing body or person must be clearly identified as being legally responsible 
150.33 	for setting policies and procedures and ensuring that they are implemented; 
150.34 	(2) care must be provided by a physician, advanced practice registered nurse, or 
150.35 	licensed traditional midwife during labor, birth, and puerperium;
151.1 	(3) an obstetrician and pediatrician must be on call and available to provide medical 
151.2 	guidance at all times;
151.3 	(4) procedures must be in place to transfer a patient within 30 minutes from the time 
151.4 	of diagnosis of an emergency to an acute care hospital capable of providing obstetrical and 
151.5 	neonatal services;
151.6 	(5) the birthing center must be equipped to initiate emergency procedures 
151.7 	in life-threatening events to the mother and baby including, but not limited to, 
151.8 	cardiopulmonary resuscitation (CPR) equipment, oxygen, positive pressure mask, 
151.9 	suction, intravenous medications, and equipment for maintaining infant temperature and 
151.10 	ventilation; and
151.11 	(6) the birthing center must maintain a quality assurance program.
151.12 	(b) The center must have procedures in place specifying criteria by which risk status 
151.13 	will be established and applied to each woman at admission and during labor. Before 
151.14 	admitting a patient, the birthing center must fully inform each woman seeking care on 
151.15 	the benefits and risks of the services available at the center and each woman must sign a 
151.16 	written informed consent indicating that she has received this information.
151.17 		Subd. 6.Limitations of services. The following limitations apply to the services 
151.18 	performed at a birthing center:
151.19 	(1) surgical procedures must be limited to those normally accomplished during an 
151.20 	uncomplicated birth, including episiotomy and repair;
151.21 	(2) no abortions may be performed; and
151.22 	(3) no general or conduction anesthesia may be performed.
151.23 		Subd. 7.Fees. The annual license fee for a birthing center is $3,900, and shall be 
151.24 	collected and deposited according to section 144.122.
151.25 		Subd. 8.Inspections. The commissioner shall annually conduct an inspection of 
151.26 	each licensed birthing center for the purpose of determining compliance with this section 
151.27 	and any rules promulgated under subdivision 9.
151.28 		Subd. 9.Rules. The commissioner may promulgate rules necessary to implement 
151.29 	this section.

151.30 	Sec. 10. Minnesota Statutes 2008, section 144.72, subdivision 1, is amended to read:
151.31 		Subdivision 1.Permits License required. The state commissioner of health is 
151.32 	authorized to issue permits for the operation of youth camps which are required to obtain 
151.33 	the permits a license according to chapter 157.

151.34 	Sec. 11. Minnesota Statutes 2008, section 144.72, subdivision 3, is amended to read:
152.1 		Subd. 3.Issuance of permits license. If the commissioner should determine from 
152.2 	the application that the health and safety of the persons using the camp will be properly 
152.3 	safeguarded, the commissioner may, prior to actual inspection of the camp, issue the 
152.4 	permit license in writing. No fee shall be charged for the permit. The permit license shall 
152.5 	be posted in a conspicuous place on the premises occupied by the camp.

152.6 	Sec. 12. Minnesota Statutes 2008, section 144.9501, is amended by adding a 
152.7 	subdivision to read:
152.8 		Subd. 8a.Disclosure pamphlet. "Disclosure pamphlet" means the EPA pamphlet 
152.9 	titled "Renovate Right: Important Lead Hazard Information for Families, Child Care 
152.10 	Providers and Schools" developed under section 406(a) of the Toxic Substance Control 
152.11 	Act.

152.12 	Sec. 13. Minnesota Statutes 2008, section 144.9501, subdivision 22b, is amended to 
152.13 	read:
152.14 		Subd. 22b.Lead sampling technician. "Lead sampling technician" means an 
152.15 	individual who performs clearance inspections for nonabatement or nonorder lead hazard 
152.16 	reduction renovation sites, and lead dust sampling in other settings, or visual assessment 
152.17 	for deteriorated paint for nonabatement sites, and who is registered with the commissioner 
152.18 	under section 144.9505. 

152.19 	Sec. 14. Minnesota Statutes 2008, section 144.9501, subdivision 26a, is amended to 
152.20 	read:
152.21 		Subd. 26a.Regulated lead work. (a) "Regulated lead work" means:
152.22 	(1) abatement;
152.23 	(2) interim controls;
152.24 	(3) a clearance inspection;
152.25 	(4) a lead hazard screen;
152.26 	(5) a lead inspection;
152.27 	(6) a lead risk assessment;
152.28 	(7) lead project designer services;
152.29 	(8) lead sampling technician services; or
152.30 	(9) swab team services;
152.31 	(10) renovation activities; or
152.32 	(11) activities performed to comply with lead orders issued by a board of health.
153.1 	(b) Regulated lead work does not include abatement, interim controls, swab team 
153.2 	services, or renovation activities that disturb painted surfaces that total no more than:
153.3 	(1) activities such as remodeling, renovation, installation, rehabilitation, or 
153.4 	landscaping activities, the primary intent of which is to remodel, repair, or restore a 
153.5 	structure or dwelling, rather than to permanently eliminate lead hazards, even though these 
153.6 	activities may incidentally result in a reduction in lead hazards; or
153.7 	(2) interim control activities that are not performed as a result of a lead order and 
153.8 	that do not disturb painted surfaces that total more than:
153.9 	(i) 20 square feet (two square meters) on exterior surfaces; or
153.10 	(ii) (2)two six square feet (0.2 0.6 square meters) in an interior room; or
153.11 	(iii) ten percent of the total surface area on an interior or exterior type of component 
153.12 	with a small surface area.

153.13 	Sec. 15. Minnesota Statutes 2008, section 144.9501, is amended by adding a 
153.14 	subdivision to read:
153.15 		Subd. 26b.Renovation. "Renovation" means the modification of any affected 
153.16 	property that results in the disturbance of painted surfaces, unless that activity is performed 
153.17 	as an abatement. A renovation performed for the purpose of converting a building or part 
153.18 	of a building into an affected property is a renovation under this subdivision.

153.19 	Sec. 16. Minnesota Statutes 2008, section 144.9505, subdivision 1g, is amended to 
153.20 	read:
153.21 		Subd. 1g.Certified lead firm. A person within the state intending to directly 
153.22 	perform or cause to be performed through subcontracting or similar delegation any 
153.23 	regulated lead work shall first obtain certification from the commissioner A person who 
153.24 	employs individuals to perform regulated lead work outside of the person's property must 
153.25 	obtain certification as a lead firm. The certificate must be in writing, contain an expiration 
153.26 	date, be signed by the commissioner, and give the name and address of the person to 
153.27 	whom it is issued. The certification fee is $100, is nonrefundable, and must be submitted 
153.28 	with each application. The certificate or a copy of the certificate must be readily available 
153.29 	at the worksite for review by the contracting entity, the commissioner, and other public 
153.30 	health officials charged with the health, safety, and welfare of the state's citizens.

153.31 	Sec. 17. Minnesota Statutes 2008, section 144.9505, subdivision 4, is amended to read:
154.1 		Subd. 4.Notice of regulated lead work. (a) At least five working days before 
154.2 	starting work at each regulated lead worksite, the person performing the regulated lead 
154.3 	work shall give written notice to the commissioner and the appropriate board of health.
154.4 	(b) This provision does not apply to lead hazard screen, lead inspection, lead risk 
154.5 	assessment, lead sampling technician, renovation, or lead project design activities.

154.6 	Sec. 18. Minnesota Statutes 2008, section 144.9508, subdivision 2, is amended to read:
154.7 		Subd. 2.Regulated lead work standards and methods. (a) The commissioner 
154.8 	shall adopt rules establishing regulated lead work standards and methods in accordance 
154.9 	with the provisions of this section, for lead in paint, dust, drinking water, and soil in 
154.10 	a manner that protects public health and the environment for all residences, including 
154.11 	residences also used for a commercial purpose, child care facilities, playgrounds, and 
154.12 	schools.
154.13 	(b) In the rules required by this section, the commissioner shall require lead hazard 
154.14 	reduction of intact paint only if the commissioner finds that the intact paint is on a 
154.15 	chewable or lead-dust producing surface that is a known source of actual lead exposure to 
154.16 	a specific individual. The commissioner shall prohibit methods that disperse lead dust into 
154.17 	the air that could accumulate to a level that would exceed the lead dust standard specified 
154.18 	under this section. The commissioner shall work cooperatively with the commissioner 
154.19 	of administration to determine which lead hazard reduction methods adopted under this 
154.20 	section may be used for lead-safe practices including prohibited practices, preparation, 
154.21 	disposal, and cleanup. The commissioner shall work cooperatively with the commissioner 
154.22 	of the Pollution Control Agency to develop disposal procedures. In adopting rules under 
154.23 	this section, the commissioner shall require the best available technology for regulated 
154.24 	lead work methods, paint stabilization, and repainting.
154.25 	(c) The commissioner of health shall adopt regulated lead work standards and 
154.26 	methods for lead in bare soil in a manner to protect public health and the environment. 
154.27 	The commissioner shall adopt a maximum standard of 100 parts of lead per million in 
154.28 	bare soil. The commissioner shall set a soil replacement standard not to exceed 25 parts 
154.29 	of lead per million. Soil lead hazard reduction methods shall focus on erosion control 
154.30 	and covering of bare soil.
154.31 	(d) The commissioner shall adopt regulated lead work standards and methods for 
154.32 	lead in dust in a manner to protect the public health and environment. Dust standards 
154.33 	shall use a weight of lead per area measure and include dust on the floor, on the window 
154.34 	sills, and on window wells. Lead hazard reduction methods for dust shall focus on dust 
155.1 	removal and other practices which minimize the formation of lead dust from paint, soil, or 
155.2 	other sources.
155.3 	(e) The commissioner shall adopt lead hazard reduction standards and methods for 
155.4 	lead in drinking water both at the tap and public water supply system or private well 
155.5 	in a manner to protect the public health and the environment. The commissioner may 
155.6 	adopt the rules for controlling lead in drinking water as contained in Code of Federal 
155.7 	Regulations, title 40, part 141. Drinking water lead hazard reduction methods may include 
155.8 	an educational approach of minimizing lead exposure from lead in drinking water.
155.9 	(f) The commissioner of the Pollution Control Agency shall adopt rules to ensure that 
155.10 	removal of exterior lead-based coatings from residences and steel structures by abrasive 
155.11 	blasting methods is conducted in a manner that protects health and the environment.
155.12 	(g) All regulated lead work standards shall provide reasonable margins of safety that 
155.13 	are consistent with more than a summary review of scientific evidence and an emphasis on 
155.14 	overprotection rather than underprotection when the scientific evidence is ambiguous.
155.15 	(h) No unit of local government shall have an ordinance or regulation governing 
155.16 	regulated lead work standards or methods for lead in paint, dust, drinking water, or soil 
155.17 	that require a different regulated lead work standard or method than the standards or 
155.18 	methods established under this section.
155.19 	(i) Notwithstanding paragraph (h), the commissioner may approve the use by a unit 
155.20 	of local government of an innovative lead hazard reduction method which is consistent 
155.21 	in approach with methods established under this section.
155.22 	(j) The commissioner shall adopt rules for issuing lead orders required under section 
155.23 	144.9504, rules for notification of abatement or interim control activities requirements, 
155.24 	and other rules necessary to implement sections 144.9501 to 144.9512. 
155.25 	(k) The commissioners shall adopt rules consistent with section 402(c)(3) of the 
155.26 	Toxic Substances Control Act to ensure that renovation is a pre-1978 affected property 
155.27 	where a child or pregnant female resides is conducted in a manner that protects health 
155.28 	and the environment.
155.29 	(l) The commissioner shall adopt rules consistent with sections 406(a) and 406(b) of 
155.30 	the Toxic Substances Control Act.

155.31 	Sec. 19. Minnesota Statutes 2008, section 144.9508, subdivision 3, is amended to read:
155.32 		Subd. 3.Licensure and certification. The commissioner shall adopt rules to 
155.33 	license lead supervisors, lead workers, lead project designers, lead inspectors, and lead 
155.34 	risk assessors, and lead sampling technicians. The commissioner shall also adopt rules 
155.35 	requiring certification of firms that perform regulated lead work and rules requiring 
156.1 	registration of lead sampling technicians. The commissioner shall require periodic renewal 
156.2 	of licenses, and certificates, and registrations and shall establish the renewal periods.

156.3 	Sec. 20. Minnesota Statutes 2008, section 144.9508, subdivision 4, is amended to read:
156.4 		Subd. 4.Lead training course. The commissioner shall establish by rule 
156.5 	requirements for training course providers and the renewal period for each lead-related 
156.6 	training course required for certification or licensure. The commissioner shall establish 
156.7 	criteria in rules for the content and presentation of training courses intended to qualify 
156.8 	trainees for licensure under subdivision 3. The commissioner shall establish criteria 
156.9 	in rules for the content and presentation of training courses for lead interim control 
156.10 	workers renovation and lead sampling technicians. Training course permit fees shall be 
156.11 	nonrefundable and must be submitted with each application in the amount of $500 for an 
156.12 	initial training course, $250 for renewal of a permit for an initial training course, $250 for 
156.13 	a refresher training course, and $125 for renewal of a permit of a refresher training course.

156.14 	Sec. 21. Minnesota Statutes 2008, section 144.97, subdivision 2, is amended to read:
156.15 		Subd. 2.Certification Accreditation. "Certification" means written 
156.16 	acknowledgment of a laboratory's demonstrated capability to perform tests for a specific 
156.17 	purpose "Accreditation" means written acknowledgment that a laboratory has the 
156.18 	policies, procedures, equipment, and practices to produce reliable data in the analysis of 
156.19 	environmental samples.

156.20 	Sec. 22. Minnesota Statutes 2008, section 144.97, subdivision 4, is amended to read:
156.21 		Subd. 4.ContractCommercial laboratory. "Contract Commercial laboratory" 
156.22 	means a laboratory that performs tests on samples on a contract or fee-for-service basis.

156.23 	Sec. 23. Minnesota Statutes 2008, section 144.97, is amended by adding a subdivision 
156.24 	to read:
156.25 		Subd. 5a.Field of testing. "Field of testing" means the combination of analyte, 
156.26 	method, matrix, and test category for which a laboratory may hold accreditation.

156.27 	Sec. 24. Minnesota Statutes 2008, section 144.97, subdivision 6, is amended to read:
156.28 		Subd. 6.Laboratory. "Laboratory" means the state, a person, corporation, or other 
156.29 	entity, including governmental, that examines, analyzes, or tests samples in a specified 
156.30 	physical location.

157.1 	Sec. 25. Minnesota Statutes 2008, section 144.97, is amended by adding a subdivision 
157.2 	to read:
157.3 		Subd. 8.Test category. "Test category" means the combination of program and 
157.4 	category as provided by section 144.98, subdivisions 3, paragraph (b), clauses (1) to (10), 
157.5 	and 3a, paragraph (a), clauses (1) to (5).

157.6 	Sec. 26. Minnesota Statutes 2008, section 144.98, subdivision 1, is amended to read:
157.7 		Subdivision 1.Authorization. The commissioner of health may certify shall 
157.8 	accredit environmental laboratories that test environmental samples according to national 
157.9 	standards developed using a consensus process as established by Circular A-119, 
157.10 	published by the United States Office of Management and Budget.

157.11 	Sec. 27. Minnesota Statutes 2008, section 144.98, subdivision 2, is amended to read:
157.12 		Subd. 2.Rules and standards. The commissioner may adopt rules to implement 
157.13 	this section, including: carry out the commissioner's responsibilities under the national 
157.14 	standards specified in subdivisions 1 and 2a.
157.15 	(1) procedures, requirements, and fee adjustments for laboratory certification, 
157.16 	including provisional status and recertification;
157.17 	(2) standards and fees for certificate approval, suspension, and revocation;
157.18 	(3) standards for environmental samples;
157.19 	(4) analysis methods that assure reliable test results;
157.20 	(5) laboratory quality assurance, including internal quality control, proficiency 
157.21 	testing, and personnel training; and
157.22 	(6) criteria for recognition of certification programs of other states and the federal 
157.23 	government.

157.24 	Sec. 28. Minnesota Statutes 2008, section 144.98, is amended by adding a subdivision 
157.25 	to read:
157.26 		Subd. 2a.Standards. The commissioner shall accredit laboratories according to 
157.27 	the most current environmental laboratory accreditation standards under subdivision 1 
157.28 	and as accepted by the accreditation bodies recognized by the National Environmental 
157.29 	Laboratory Accreditation Program, NELAP, of the NELAC Institute.

157.30 	Sec. 29. Minnesota Statutes 2008, section 144.98, subdivision 3, is amended to read:
158.1 		Subd. 3.Annual fees. (a) An application for certification accreditation under 
158.2 	subdivision 1 6 must be accompanied by the biennial fee annual fees specified in this 
158.3 	subdivision. The fees are for annual fees include:
158.4 	(1) base certification accreditation fee, $1,600 $1,500;
158.5 	(2) sample preparation techniques fees fee, $100 $200 per technique; and
158.6 	(3) an administrative fee for laboratories located outside this state, $3,750; and
158.7 	(4) test category certification fees:.

158.8
158.9	Test Category
	Certification 
Fee
	
158.10	Clean water program bacteriology
	$800
	
158.11	Safe drinking water program bacteriology
	$800
	
158.12	Clean water program inorganic chemistry
	$800
	
158.13	Safe drinking water program inorganic chemistry
	$800
	
158.14	Clean water program chemistry metals
	$1,200
	
158.15	Safe drinking water program chemistry metals
	$1,200
	
158.16	Resource conservation and recovery program chemistry metals
	$1,200
	
158.17	Clean water program volatile organic compounds
	$1,500
	
158.18	Safe drinking water program volatile organic compounds
	$1,500
	
158.19	Resource conservation and recovery program volatile organic compounds
	$1,500
	
158.20	Underground storage tank program volatile organic compounds
	$1,500
	
158.21	Clean water program other organic compounds
	$1,500
	
158.22	Safe drinking water program other organic compounds
	$1,500
	
158.23	Resource conservation and recovery program other organic compounds
	$1,500
	
158.24	Clean water program radiochemistry
	$2,500
	
158.25	Safe drinking water program radiochemistry
	$2,500
	
158.26	Resource conservation and recovery program agricultural contaminants
	$2,500
	
158.27	Resource conservation and recovery program emerging contaminants
	$2,500
	
158.28 	(b) Laboratories located outside of this state that require an on-site inspection shall be 
158.29 	assessed an additional $3,750 fee. For the programs in subdivision 3a, the commissioner 
158.30 	may accredit laboratories for fields of testing under the categories listed in clauses (1) to 
158.31 	(10) upon completion of the application requirements provided by subdivision 6 and 
158.32 	receipt of the fees for each category under each program that accreditation is requested. 
158.33 	The categories offered and related fees include:
158.34 	(1) microbiology, $450;
158.35 	(2) inorganics, $450;
158.36 	(3) metals, $1,000;
158.37 	(4) volatile organics, $1,300;
158.38 	(5) other organics, $1,300;
158.39 	(6) radiochemistry, $1,500;
159.1 	(7) emerging contaminants, $1,500;
159.2 	(8) agricultural contaminants, $1,250;
159.3 	(9) toxicity (bioassay), $1,000; and
159.4 	(10) physical characterization, $250.
159.5 	(c) The total biennial certification annual fee includes the base fee, the sample 
159.6 	preparation techniques fees, the test category fees per program, and, when applicable, the 
159.7 	on-site inspection fee an administrative fee for out-of-state laboratories.
159.8 	(d) Fees must be set so that the total fees support the laboratory certification program. 
159.9 	Direct costs of the certification service include program administration, inspections, the 
159.10 	agency's general support costs, and attorney general costs attributable to the fee function.
159.11 	(e) A change fee shall be assessed if a laboratory requests additional analytes 
159.12 	or methods at any time other than when applying for or renewing its certification. The 
159.13 	change fee is equal to the test category certification fee for the analyte.
159.14 	(f) A variance fee shall be assessed if a laboratory requests and is granted a variance 
159.15 	from a rule adopted under this section. The variance fee is $500 per variance.
159.16 	(g) Refunds or credits shall not be made for analytes or methods requested but 
159.17 	not approved.
159.18 	(h) Certification of a laboratory shall not be awarded until all fees are paid.

159.19 	Sec. 30. Minnesota Statutes 2008, section 144.98, is amended by adding a subdivision 
159.20 	to read:
159.21 		Subd. 3a.Available programs, categories, and analytes. (a) The commissioner 
159.22 	shall accredit laboratories that test samples under the following programs:
159.23 	(1) the clean water program, such as compliance monitoring under the federal Clean 
159.24 	Water Act, and ambient monitoring of surface and ground water, or analysis of biological 
159.25 	tissue;
159.26 	(2) the safe drinking water program, including compliance monitoring under the 
159.27 	federal Safe Drinking Water Act, and the state requirements for monitoring private wells;
159.28 	(3) the resource conservation and recovery program, including federal and state 
159.29 	requirements for monitoring solid and hazardous wastes, biological tissue, leachates, and 
159.30 	ground water monitoring wells not intended as drinking water sources;
159.31 	(4) the underground storage tank program; and
159.32 	(5) the clean air program, including air and emissions testing under the federal Clean 
159.33 	Air Act, and state and federal requirements for vapor intrusion monitoring.
159.34 	(b) The commissioner shall maintain and publish a list of analytes available for 
159.35 	accreditation. The list must be reviewed at least once every six months and the changes 
160.1 	published in the State Register and posted on the program's Web site. The commissioner 
160.2 	shall publish the notification of changes and review comments on the changes no less than 
160.3 	30 days from the date the list is published.

160.4 	Sec. 31. Minnesota Statutes 2008, section 144.98, is amended by adding a subdivision 
160.5 	to read:
160.6 		Subd. 3b.Additional fees. (a) Laboratories located outside of this state that require 
160.7 	an on-site assessment more frequent than once every two years must pay an additional 
160.8 	assessed fee of $3,000 per assessment for each additional on-site assessment conducted. 
160.9 	The laboratory must pay the fee within 15 business days of receiving the commissioner's 
160.10 	notification that an on-site assessment is required. The commissioner may conduct 
160.11 	additional on-site assessments to determine a laboratory's continued compliance with 
160.12 	the standards provided in subdivision 2a.
160.13 	(b) A late fee of $200 shall be added to the annual fee for accredited laboratories 
160.14 	submitting renewal applications to the commissioner after November 1.
160.15 	(c) A change fee shall be assessed if a laboratory requests additional fields of testing 
160.16 	at any time other than when initially applying for or renewing its accreditation. A change 
160.17 	fee does not apply for applications to add fields of testing for new analytes in response 
160.18 	to the published notice under subdivision 3a, paragraph (b), if the laboratory holds valid 
160.19 	accreditation for the changed test category and applies for additional analytes within the 
160.20 	same test category. The change fee is equal to the applicable test category fee for the 
160.21 	field of testing requested.  An application that requests accreditation of multiple fields of 
160.22 	testing within a test category requires a single payment of the applicable test category fee 
160.23 	per application submitted.
160.24 	(d) A variance fee shall be assessed if a laboratory requests a variance from a 
160.25 	standard provided in subdivision 2a. The variance fee is $500 per variance.
160.26 	(e) The commissioner shall assess a fee for changes to laboratory information 
160.27 	regarding ownership, name, address, or personnel. Laboratories must submit changes 
160.28 	through the application process under subdivision 6. The information update fee is $250 
160.29 	per application.
160.30 	(f) Fees must be set so that the total fees support the laboratory accreditation 
160.31 	program.  Direct costs of the accreditation service include program administration, 
160.32 	assessments, the agency's general support costs, and attorney general costs attributable 
160.33 	to the fee function.

161.1 	Sec. 32. Minnesota Statutes 2008, section 144.98, is amended by adding a subdivision 
161.2 	to read:
161.3 		Subd. 3c.Refunds and nonpayment. Refunds or credits shall not be made for 
161.4 	applications received but not approved. Accreditation of a laboratory shall not be awarded 
161.5 	until all fees are paid.

161.6 	Sec. 33. Minnesota Statutes 2008, section 144.98, is amended by adding a subdivision 
161.7 	to read:
161.8 		Subd. 6.Application. (a) Laboratories seeking accreditation must apply on a form 
161.9 	provided by the commissioner, include the laboratory's procedures and quality manual, 
161.10 	and pay the applicable fees.
161.11 	(b) Laboratories may be fixed-base or mobile. The commissioner shall accredit 
161.12 	mobile laboratories individually and require a vehicle identification number, license 
161.13 	plate number, or other uniquely identifying information in addition to the application 
161.14 	requirements of paragraph (a).
161.15 	(c) Laboratories maintained on separate properties, even though operated under the 
161.16 	same management or ownership, must apply separately. Laboratories with more than one 
161.17 	building on the same or adjoining properties do not need to submit a separate application.
161.18 	(d) The commissioner may accredit laboratories located out-of-state. Accreditation 
161.19 	for out-of-state laboratories may be obtained directly from the commissioner following 
161.20 	the requirements in paragraph (a), or out-of-state laboratories may be accredited through 
161.21 	a reciprocal agreement if the laboratory:
161.22 	(1) is accredited by a NELAP-recognized accreditation body for those fields of 
161.23 	testing in which the laboratory requests accreditation from the commissioner;
161.24 	(2) submits an application and documentation according to this subdivision; and
161.25 	(3) submits a current copy of the laboratory's unexpired accreditation from a 
161.26 	NELAP-recognized accreditation body showing the fields of accreditation for which the 
161.27 	laboratory is currently accredited.
161.28 	(e) Under the conflict of interest determinations provided in section 43A.38, 
161.29 	subdivision 6, clause (a), the commissioner shall not accredit governmental laboratories 
161.30 	operated by agencies of the executive branch of the state. If accreditation is required, 
161.31 	laboratories operated by agencies of the executive branch of the state must apply for 
161.32 	accreditation through any other NELAP-recognized accreditation body.

161.33 	Sec. 34. Minnesota Statutes 2008, section 144.98, is amended by adding a subdivision 
161.34 	to read:
162.1 		Subd. 6a.Implementation and effective date. All laboratories must comply with 
162.2 	standards under this section by July 1, 2009. Fees under subdivisions 3 and 3b apply to 
162.3 	applications received and accreditations issued after June 30, 2009. Accreditations issued 
162.4 	on or after June 30, 2009, shall expire upon their current expiration date.

162.5 	Sec. 35. Minnesota Statutes 2008, section 144.98, is amended by adding a subdivision 
162.6 	to read:
162.7 		Subd. 7.Initial accreditation and annual accreditation renewal. (a) The 
162.8 	commissioner shall issue or renew accreditation after receipt of the completed application 
162.9 	and documentation required in this section, provided the laboratory maintains compliance 
162.10 	with the standards specified in subdivision 2a, and attests to the compliance on the 
162.11 	application form.
162.12 	(b) The commissioner shall prorate the fees in subdivision 3 for laboratories 
162.13 	applying for accreditation after December 31. The fees are prorated on a quarterly basis 
162.14 	beginning with the quarter in which the commissioner receives the completed application 
162.15 	from the laboratory.
162.16 	(c) Applications for renewal of accreditation must be received by November 1 and 
162.17 	no earlier than October 1 of each year. The commissioner shall send annual renewal 
162.18 	notices to laboratories 90 days before expiration. Failure to receive a renewal notice does 
162.19 	not exempt laboratories from meeting the annual November 1 renewal date.
162.20 	(d) The commissioner shall issue all accreditations for the calendar year for which 
162.21 	the application is made, and the accreditation shall expire on December 31 of that year.
162.22 	(e) The accreditation of any laboratory that fails to submit a renewal application 
162.23 	and fees to the commissioner expires automatically on December 31 without notice or 
162.24 	further proceeding. Any person who operates a laboratory as accredited after expiration of 
162.25 	accreditation or without having submitted an application and paid the fees is in violation 
162.26 	of the provisions of this section and is subject to enforcement action under sections 
162.27 	144.989 to 144.993, the Health Enforcement Consolidation Act. A laboratory with expired 
162.28 	accreditation may reapply under subdivision 6.

162.29 	Sec. 36. Minnesota Statutes 2008, section 144.99, subdivision 1, is amended to read:
162.30 		Subdivision 1.Remedies available. The provisions of chapters 103I and 157 and 
162.31 	sections 115.71 to 115.77; 144.12, subdivision 1, paragraphs (1), (2), (5), (6), (10), (12), 
162.32 	(13), (14), and (15); 144.1201 to 144.1204; 144.121; 144.1222; 144.35; 144.381 to 
162.33 	144.385; 144.411 to 144.417; 144.495; 144.71 to 144.74; 144.9501 to 144.9512; 144.992; 
162.34 	144.97 to 144.98; 326.70 to 326.785; 327.10 to 327.131; and 327.14 to 327.28 and all 
163.1 	rules, orders, stipulation agreements, settlements, compliance agreements, licenses, 
163.2 	registrations, certificates, and permits adopted or issued by the department or under any 
163.3 	other law now in force or later enacted for the preservation of public health may, in 
163.4 	addition to provisions in other statutes, be enforced under this section. 

163.5 	Sec. 37. Minnesota Statutes 2008, section 148.6445, is amended by adding a 
163.6 	subdivision to read:
163.7 		Subd. 2a.Duplicate license fee. The fee for a duplicate license is $25.

163.8 	Sec. 38. Minnesota Statutes 2008, section 153A.17, is amended to read:
163.9 	153A.17 EXPENSES; FEES.
163.10 	The expenses for administering the certification requirements including the 
163.11 	complaint handling system for hearing aid dispensers in sections 153A.14 and 153A.15
163.12 	and the Consumer Information Center under section 153A.18 must be paid from initial 
163.13 	application and examination fees, renewal fees, penalties, and fines. All fees are 
163.14 	nonrefundable. The initial and annual renewal certificate application fee is $350 $700, 
163.15 	the examination fee is $250 $500 for the written portion and $250 $500 for the practical 
163.16 	portion each time one or the other is taken, and. For persons meeting the requirements of 
163.17 	section 148.515, subdivision 2, the fee for the practical portion of the hearing instrument 
163.18 	dispensing examination is $250 each time it is taken. The trainee application fee is 
163.19 	$200. Effective July 1, 2009, a surcharge of $550 shall be paid at the time of certification 
163.20 	application or renewal until June 30, 2011, to recover the commissioner's accumulated 
163.21 	direct expenditures for administering the requirements of this chapter. The penalty fee for 
163.22 	late submission of a renewal application is $200. The fee for verification of certification 
163.23 	to other jurisdictions or entities is $25. All fees, penalties, and fines received must be 
163.24 	deposited in the state government special revenue fund. The commissioner may prorate 
163.25 	the certification fee for new applicants based on the number of quarters remaining in 
163.26 	the annual certification period.  

163.27 	Sec. 39. Minnesota Statutes 2008, section 157.15, is amended by adding a subdivision 
163.28 	to read:
163.29 		Subd. 20.Youth camp. "Youth camp" has the meaning given in section 144.71, 
163.30 	subdivision 2.

163.31 	Sec. 40. Minnesota Statutes 2008, section 157.16, is amended to read:
163.32 	157.16 LICENSES REQUIRED; FEES. 
164.1 		Subdivision 1. License required annually. A license is required annually for every 
164.2 	person, firm, or corporation engaged in the business of conducting a food and beverage 
164.3 	service establishment, youth camp, hotel, motel, lodging establishment, public pool, or 
164.4 	resort. Any person wishing to operate a place of business licensed in this section shall 
164.5 	first make application, pay the required fee specified in this section, and receive approval 
164.6 	for operation, including plan review approval. Seasonal and temporary food stands and
164.7 	Special event food stands are not required to submit plans. Nonprofit organizations 
164.8 	operating a special event food stand with multiple locations at an annual one-day event 
164.9 	shall be issued only one license. Application shall be made on forms provided by the 
164.10 	commissioner and shall require the applicant to state the full name and address of the 
164.11 	owner of the building, structure, or enclosure, the lessee and manager of the food and 
164.12 	beverage service establishment, hotel, motel, lodging establishment, public pool, or resort; 
164.13 	the name under which the business is to be conducted; and any other information as may 
164.14 	be required by the commissioner to complete the application for license. 
164.15 		Subd. 2. License renewal. Initial and renewal licenses for all food and beverage 
164.16 	service establishments, youth camps, hotels, motels, lodging establishments, public pools, 
164.17 	and resorts shall be issued for the calendar year for which application is made and shall 
164.18 	expire on December 31 of such year on an annual basis. Any person who operates a place 
164.19 	of business after the expiration date of a license or without having submitted an application 
164.20 	and paid the fee shall be deemed to have violated the provisions of this chapter and shall 
164.21 	be subject to enforcement action, as provided in the Health Enforcement Consolidation 
164.22 	Act, sections 144.989 to 144.993. In addition, a penalty of $50 $60 shall be added to the 
164.23 	total of the license fee for any food and beverage service establishment operating without 
164.24 	a license as a mobile food unit, a seasonal temporary or seasonal permanent food stand, or 
164.25 	a special event food stand, and a penalty of $100 $120 shall be added to the total of the 
164.26 	license fee for all restaurants, food carts, hotels, motels, lodging establishments, youth 
164.27 	camps, public pools, and resorts operating without a license for a period of up to 30 days. 
164.28 	A late fee of $300 $360 shall be added to the license fee for establishments operating more 
164.29 	than 30 days without a license. 
164.30 		Subd. 2a. Food manager certification. An applicant for certification or certification 
164.31 	renewal as a food manager must submit to the commissioner a $28 $35 nonrefundable 
164.32 	certification fee payable to the Department of Health. The commissioner shall issue a 
164.33 	duplicate certificate to replace a lost, destroyed, or mutilated certificate if the applicant 
164.34 	submits a completed application on a form provided by the commissioner for a duplicate 
164.35 	certificate and pays $20 to the department for the cost of duplication.
165.1 		Subd. 3. Establishment fees; definitions. (a) The following fees are required 
165.2 	for food and beverage service establishments, youth camps, hotels, motels, lodging 
165.3 	establishments, public pools, and resorts licensed under this chapter. Food and beverage 
165.4 	service establishments must pay the highest applicable fee under paragraph (d), clause 
165.5 	(1), (2), (3), or (4), and establishments serving alcohol must pay the highest applicable 
165.6 	fee under paragraph (d), clause (6) or (7). The license fee for new operators previously 
165.7 	licensed under this chapter for the same calendar year is one-half of the appropriate annual 
165.8 	license fee, plus any penalty that may be required. The license fee for operators opening 
165.9 	on or after October 1 is one-half of the appropriate annual license fee, plus any penalty 
165.10 	that may be required. 
165.11 	(b) All food and beverage service establishments, except special event food stands, 
165.12 	and all hotels, motels, lodging establishments, public pools, and resorts shall pay an 
165.13 	annual base fee of $150. 
165.14 	(c) A special event food stand shall pay a flat fee of $40 $50 annually. "Special event 
165.15 	food stand" means a fee category where food is prepared or served in conjunction with 
165.16 	celebrations, county fairs, or special events from a special event food stand as defined 
165.17 	in section 157.15. 
165.18 	(d) In addition to the base fee in paragraph (b), each food and beverage service 
165.19 	establishment, other than a special event food stand, and each hotel, motel, lodging 
165.20 	establishment, public pool, and resort shall pay an additional annual fee for each fee 
165.21 	category, additional food service, or required additional inspection specified in this 
165.22 	paragraph: 
165.23 	(1) Limited food menu selection, $50 $60. "Limited food menu selection" means a 
165.24 	fee category that provides one or more of the following: 
165.25 	(i) prepackaged food that receives heat treatment and is served in the package; 
165.26 	(ii) frozen pizza that is heated and served; 
165.27 	(iii) a continental breakfast such as rolls, coffee, juice, milk, and cold cereal; 
165.28 	(iv) soft drinks, coffee, or nonalcoholic beverages; or 
165.29 	(v) cleaning for eating, drinking, or cooking utensils, when the only food served 
165.30 	is prepared off site. 
165.31 	(2) Small establishment, including boarding establishments, $100 $120. "Small 
165.32 	establishment" means a fee category that has no salad bar and meets one or more of 
165.33 	the following: 
165.34 	(i) possesses food service equipment that consists of no more than a deep fat fryer, a 
165.35 	grill, two hot holding containers, and one or more microwave ovens; 
165.36 	(ii) serves dipped ice cream or soft serve frozen desserts; 
166.1 	(iii) serves breakfast in an owner-occupied bed and breakfast establishment; 
166.2 	(iv) is a boarding establishment; or 
166.3 	(v) meets the equipment criteria in clause (3), item (i) or (ii), and has a maximum 
166.4 	patron seating capacity of not more than 50. 
166.5 	(3) Medium establishment, $260 $310. "Medium establishment" means a fee 
166.6 	category that meets one or more of the following: 
166.7 	(i) possesses food service equipment that includes a range, oven, steam table, salad 
166.8 	bar, or salad preparation area; 
166.9 	(ii) possesses food service equipment that includes more than one deep fat fryer, 
166.10 	one grill, or two hot holding containers; or 
166.11 	(iii) is an establishment where food is prepared at one location and served at one or 
166.12 	more separate locations. 
166.13 	Establishments meeting criteria in clause (2), item (v), are not included in this fee 
166.14 	category. 
166.15 	(4) Large establishment, $460 $540. "Large establishment" means either: 
166.16 	(i) a fee category that (A) meets the criteria in clause (3), items (i) or (ii), for a 
166.17 	medium establishment, (B) seats more than 175 people, and (C) offers the full menu 
166.18 	selection an average of five or more days a week during the weeks of operation; or 
166.19 	(ii) a fee category that (A) meets the criteria in clause (3), item (iii), for a medium 
166.20 	establishment, and (B) prepares and serves 500 or more meals per day. 
166.21 	(5) Other food and beverage service, including food carts, mobile food units, 
166.22 	seasonal temporary food stands, and seasonal permanent food stands, $50 $60. 
166.23 	(6) Beer or wine table service, $50 $60. "Beer or wine table service" means a fee 
166.24 	category where the only alcoholic beverage service is beer or wine, served to customers 
166.25 	seated at tables. 
166.26 	(7) Alcoholic beverage service, other than beer or wine table service, $135 $165. 
166.27 	"Alcohol beverage service, other than beer or wine table service" means a fee 
166.28 	category where alcoholic mixed drinks are served or where beer or wine are served from 
166.29 	a bar. 
166.30 	(8) Lodging per sleeping accommodation unit, $8 $10, including hotels, motels, 
166.31 	lodging establishments, and resorts, up to a maximum of $800 $1,000. "Lodging per 
166.32 	sleeping accommodation unit" means a fee category including the number of guest rooms, 
166.33 	cottages, or other rental units of a hotel, motel, lodging establishment, or resort; or the 
166.34 	number of beds in a dormitory. 
166.35 	(9) First public pool, $180 $325; each additional public pool, $100 $175. "Public 
166.36 	pool" means a fee category that has the meaning given in section 144.1222, subdivision 4. 
167.1 	(10) First spa, $110 $175; each additional spa, $50 $100. "Spa pool" means a fee 
167.2 	category that has the meaning given in Minnesota Rules, part 4717.0250, subpart 9. 
167.3 	(11) Private sewer or water, $50 $60. "Individual private water" means a fee 
167.4 	category with a water supply other than a community public water supply as defined in 
167.5 	Minnesota Rules, chapter 4720. "Individual private sewer" means a fee category with an 
167.6 	individual sewage treatment system which uses subsurface treatment and disposal. 
167.7 	(12) Additional food service, $130 $150. "Additional food service" means a location 
167.8 	at a food service establishment, other than the primary food preparation and service area, 
167.9 	used to prepare or serve food to the public. 
167.10 	(13) Additional inspection fee, $300 $360. "Additional inspection fee" means a 
167.11 	fee to conduct the second inspection each year for elementary and secondary education 
167.12 	facility school lunch programs when required by the Richard B. Russell National School 
167.13 	Lunch Act. 
167.14 	(e) A fee of $350 for review of the construction plans must accompany the initial 
167.15 	license application for restaurants, hotels, motels, lodging establishments, or resorts with 
167.16 	five or more sleeping units., seasonal food stands, and mobile food units. The fee for 
167.17 	this construction plan review is as follows:

167.18	Service Area
	Type
	Fee
	
167.19	Food
	limited food menu
	$275
	
167.20		small establishment
	$400
	
167.21		medium establishment
	$450
	
167.22		large food establishment
	$500
	
167.23		additional food service
	$150
	
167.24	Transient food service
	food cart
	$250
	
167.25		seasonal permanent food stand
	$250
	
167.26		seasonal temporary food stand
	$250
	
167.27		mobile food unit
	$350
	
167.28	Alcohol
	beer or wine table service
	$150
	
167.29		alcohol service from bar
	$250
	
167.30	Lodging
	< 25 rooms
	$375
	
167.31		≥ 25 to < 100 rooms
	$400
	
167.32		≥ 100 rooms
	$500

167.33		< five cabins
	$350
	
167.34		≥ five to < ten cabins
	$400
	
167.35		≥ ten cabins
	$450
	
167.36 	(f) When existing food and beverage service establishments, hotels, motels, lodging 
167.37 	establishments, or resorts, seasonal food stands, and mobile food units are extensively 
167.38 	remodeled, a fee of $250 must be submitted with the remodeling plans. A fee of $250 
168.1 	must be submitted for new construction or remodeling for a restaurant with a limited food 
168.2 	menu selection, a seasonal permanent food stand, a mobile food unit, or a food cart, or for 
168.3 	a hotel, motel, resort, or lodging establishment addition of less than five sleeping units.
168.4 	The fee for this construction plan review is as follows:

168.5	Service Area
	Type
	Fee
	
168.6	Food
	limited food menu
	$250
	
168.7		small establishment
	$300
	
168.8		medium establishment
	$350
	
168.9		large food establishment
	$400
	
168.10		additional food service
	$150
	
168.11	Transient food service
	food cart
	$250
	
168.12		seasonal permanent food stand
	$250
	
168.13		seasonal temporary food stand
	$250
	
168.14		mobile food unit
	$250
	
168.15	Alcohol
	beer or wine table service
	$150
	
168.16		alcohol service from bar
	$250
	
168.17	Lodging
	< 25 rooms
	$250
	
168.18		≥ 25 to < 100 rooms
	$300
	
168.19		≥ 100 rooms
	$450

168.20		< five cabins
	$250
	
168.21		≥ five to < ten cabins
	$350
	
168.22		≥ ten cabins
	$400
	
168.23 	(g) Seasonal temporary food stands and Special event food stands are not required to 
168.24 	submit construction or remodeling plans for review. 
168.25 	(h) Youth camp fee, $500.
168.26 		Subd. 3a. Statewide hospitality fee. Every person, firm, or corporation that 
168.27 	operates a licensed boarding establishment, food and beverage service establishment, 
168.28 	seasonal temporary or permanent food stand, special event food stand, mobile food unit, 
168.29 	food cart, resort, hotel, motel, or lodging establishment in Minnesota must submit to the 
168.30 	commissioner a $35 annual statewide hospitality fee for each licensed activity. The fee 
168.31 	for establishments licensed by the Department of Health is required at the same time the 
168.32 	licensure fee is due. For establishments licensed by local governments, the fee is due by 
168.33 	July 1 of each year. 
168.34 		Subd. 4. Posting requirements. Every food and beverage service establishment,
168.35 	youth camp, hotel, motel, lodging establishment, public pool, or resort must have the 
168.36 	license posted in a conspicuous place at the establishment. Mobile food units, food carts, 
168.37 	and seasonal temporary food stands shall be issued decals with the initial license and each 
169.1 	calendar year with license renewals. The current license year decal must be placed on the 
169.2 	unit or stand in a location determined by the commissioner. Decals are not transferable.

169.3 	Sec. 41. Minnesota Statutes 2008, section 157.22, is amended to read:
169.4 	157.22 EXEMPTIONS.
169.5 	This chapter shall not be construed to does not apply to:
169.6 	(1) interstate carriers under the supervision of the United States Department of 
169.7 	Health and Human Services;
169.8 	(2) any building constructed and primarily used for religious worship;
169.9 	(3) any building owned, operated, and used by a college or university in accordance 
169.10 	with health regulations promulgated by the college or university under chapter 14;
169.11 	(4) any person, firm, or corporation whose principal mode of business is licensed 
169.12 	under sections 28A.04 and 28A.05, is exempt at that premises from licensure as a food 
169.13 	or beverage establishment; provided that the holding of any license pursuant to sections 
169.14 	28A.04 and 28A.05 shall not exempt any person, firm, or corporation from the applicable 
169.15 	provisions of this chapter or the rules of the state commissioner of health relating to 
169.16 	food and beverage service establishments;  
169.17 	(5) family day care homes and group family day care homes governed by sections 
169.18 	245A.01 to 245A.16;  
169.19 	(6) nonprofit senior citizen centers for the sale of home-baked goods;
169.20 	(7) fraternal or patriotic organizations that are tax exempt under section 501(c)(3), 
169.21 	501(c)(4), 501(c)(6), 501(c)(7), 501(c)(10), or 501(c)(19) of the Internal Revenue Code of 
169.22 	1986, or organizations related to or affiliated with such fraternal or patriotic organizations. 
169.23 	Such organizations may organize events at which home-prepared food is donated by 
169.24 	organization members for sale at the events, provided:
169.25 	(i) the event is not a circus, carnival, or fair;
169.26 	(ii) the organization controls the admission of persons to the event, the event agenda, 
169.27 	or both; and
169.28 	(iii) the organization's licensed kitchen is not used in any manner for the event;
169.29 	(8) food not prepared at an establishment and brought in by individuals attending a 
169.30 	potluck event for consumption at the potluck event. An organization sponsoring a potluck 
169.31 	event under this clause may advertise the potluck event to the public through any means. 
169.32 	Individuals who are not members of an organization sponsoring a potluck event under this 
169.33 	clause may attend the potluck event and consume the food at the event. Licensed food 
169.34 	establishments other than schools cannot be sponsors of potluck events. A school may 
169.35 	sponsor and hold potluck events in areas of the school other than the school's kitchen, 
170.1 	provided that the school's kitchen is not used in any manner for the potluck event. For 
170.2 	purposes of this clause, "school" means a public school as defined in section 120A.05, 
170.3 	subdivisions 9, 11, 13, and 17, or a nonpublic school, church, or religious organization 
170.4 	at which a child is provided with instruction in compliance with sections 120A.22 and 
170.5 	120A.24. Potluck event food shall not be brought into a licensed food establishment 
170.6 	kitchen; and
170.7 	(9) a home school in which a child is provided instruction at home; and
170.8 	(10) concession stands operated in conjunction with school-sponsored events on 
170.9 	school property are exempt from the 21-day restriction.

170.10 	Sec. 42. Minnesota Statutes 2008, section 327.14, is amended by adding a subdivision 
170.11 	to read:
170.12 		Subd. 9.Special event recreational camping area. "Special event recreational 
170.13 	camping area" means a recreational camping area which operates no more than two times 
170.14 	annually and for no more than 14 consecutive days.

170.15 	Sec. 43. Minnesota Statutes 2008, section 327.15, is amended to read:
170.16 	327.15 LICENSE REQUIRED; RENEWAL; PLANS FOR EXPANSIONFEES.
170.17 		Subdivision 1.License required; plan review.  No person, firm or corporation shall 
170.18 	establish, maintain, conduct or operate a manufactured home park or recreational camping 
170.19 	area within this state without first obtaining a an annual license therefor from the state 
170.20 	Department of Health. Any person wishing to obtain a license shall first make application, 
170.21 	pay the required fee specified in this section, and receive approval for operation, including 
170.22 	plan review approval. Application shall be made on forms provided by the commissioner 
170.23 	and shall require the applicant to state the full name and address of the owner of the 
170.24 	manufactured home park or recreational camping area, the name under which the business 
170.25 	is to be conducted, and any other information as may be required by the commissioner 
170.26 	to complete the application for license. Any person, firm, or corporation desiring to 
170.27 	operate either a manufactured home park or a recreational camping area on the same site 
170.28 	in connection with the other, need only obtain one license. A license shall expire and be 
170.29 	renewed as prescribed by the commissioner pursuant to section 144.122. The license shall 
170.30 	state the number of manufactured home sites and recreational camping sites allowed 
170.31 	according to state commissioner of health approval. No renewal license shall be issued if 
170.32 	the number of sites specified in the application exceeds those of the original application
170.33 	The number of licensed sites shall not be increased unless the plans for expansion or 
170.34 	the construction for expansion are submitted and the expansion first approved by the 
171.1 	Department of Health. Any manufactured home park or recreational camping area located 
171.2 	in more than one municipality shall be dealt with as two separate manufactured home 
171.3 	parks or camping areas. The license shall be conspicuously displayed in the office of the 
171.4 	manufactured home park or camping area. The license is not transferable as to person 
171.5 	or place. 
171.6 		Subd. 2.License renewal. Initial and renewal licenses for all manufactured home 
171.7 	parks and recreational camping areas shall be issued annually and shall have an expiration 
171.8 	date included on the license. Any person who operates a manufactured home park or 
171.9 	recreational camping area after the expiration date of a license or without having submitted 
171.10 	an application and paid the fee shall be deemed to have violated the provisions of this 
171.11 	chapter and shall be subject to enforcement action, as provided in the Health Enforcement 
171.12 	Consolidation Act, sections 144.989 to 144.993. In addition, a penalty of $120 shall 
171.13 	be added to the total of the license fee for any manufactured home park or recreational 
171.14 	camping area operating without a license for a period of up to 30 days. A late fee of $360 
171.15 	shall be added to the license fee for any manufactured home park or recreational camping 
171.16 	area operating more than 30 days without a license.
171.17 		Subd. 3.Fees, manufactured home parks and recreational camping areas. (a) 
171.18 	The following fees are required for manufactured home parks and recreational camping 
171.19 	areas licensed under this chapter. Recreational camping areas and manufactured home 
171.20 	parks must pay the highest applicable fee under paragraph (c). The license fee for new 
171.21 	operators of a manufactured home park or recreational camping area previously licensed 
171.22 	under this chapter for the same calendar year is one-half of the appropriate annual license 
171.23 	fee, plus any penalty that may be required. The license fee for operators opening on 
171.24 	or after October 1 is one-half of the appropriate annual license fee, plus any penalty 
171.25 	that may be required.
171.26 	(b) All manufactured home parks and recreational camping areas, except special 
171.27 	event recreational camping areas, shall pay an annual base fee of $150 plus $4 for each 
171.28 	licensed site, except that any operator of a manufactured home park or recreational 
171.29 	camping area who is licensed under section 157.16 for the same location shall not be 
171.30 	required to pay the base fee.
171.31 	(c) In addition to the fee in paragraph (b), each manufactured home park or 
171.32 	recreational camping area shall pay an additional annual fee for each fee category 
171.33 	specified in this paragraph:
171.34 	(1) Manufactured home parks and recreational camping areas with public swimming 
171.35 	pools and spas shall pay the appropriate fees specified in section 157.16.
172.1 	(2) Individual private sewer or water, $60. "Individual private water" means a fee 
172.2 	category with a water supply other than a community public water supply as defined in 
172.3 	Minnesota Rules, chapter 4720. "Individual private sewer" means a fee category with an 
172.4 	individual sewage treatment system which uses subsurface treatment and disposal.
172.5 	(d) The following fees must accompany a plan review application for initial 
172.6 	construction of a manufactured home park or recreational camping area:
172.7 	(1) for initial construction of less than 25 sites, $375;
172.8 	(2) for initial construction of 25 to less than 100 sites, $400; and
172.9 	(3) for initial construction of 100 or more sites, $500.
172.10 	(e) The following fees must accompany a plan review application when an existing 
172.11 	manufactured home park or recreational camping area is expanded:
172.12 	(1) for expansion of less than 25 sites, $250;
172.13 	(2) for expansion of 25 and less than 100 sites, $300; and
172.14 	(3) for expansion of 100 or more sites, $450.
172.15 		Subd. 4.Fees, special event recreational camping areas. (a) The following fees 
172.16 	are required for special event recreational camping areas licensed under this chapter.
172.17 	(b) All special event recreational camping areas shall pay an annual fee of $150 plus 
172.18 	$1 for each licensed site.
172.19 	(c) A special event recreational camping area shall pay a late fee of $360 for failing 
172.20 	to obtain a license prior to operating.
172.21 	(d) The following fees must accompany a plan review application for initial 
172.22 	construction of a special event recreational camping area:
172.23 	(1) for initial construction of less than 25 special event recreational camping sites, 
172.24 	$375;
172.25 	(2) for initial construction of 25 to less than 100 sites, $400; and
172.26 	(3) for initial construction of 100 or more sites, $500.
172.27 	(e) The following fees must accompany a plan review application for expansion of a 
172.28 	special event recreational camping area:
172.29 	(1) for expansion of less than 25 sites, $250;
172.30 	(2) for expansion of 25 and less than 100 sites, $300; and
172.31 	(3) for expansion of 100 or more sites, $450.

172.32 	Sec. 44. Minnesota Statutes 2008, section 327.16, is amended to read:
172.33 	327.16 LICENSE PLAN REVIEW APPLICATION.
172.34 		Subdivision 1.Made to state Department of Health. The plan review application 
172.35 	for license to operate and maintain a manufactured home park or recreational camping 
173.1 	area shall be made to the state Department of Health, at such office and in such manner 
173.2 	as may be prescribed by that department.
173.3 		Subd. 2.Contents. The applicant for a primary license or annual license shall make 
173.4 	application in writing plan review application shall be made upon a form provided by the 
173.5 	state Department of Health setting forth:
173.6 	(1) The full name and address of the applicant or applicants, or names and addresses 
173.7 	of the partners if the applicant is a partnership, or the names and addresses of the officers 
173.8 	if the applicant is a corporation.
173.9 	(2) A legal description of the site, lot, field, or tract of land upon which the applicant 
173.10 	proposes to operate and maintain a manufactured home park or recreational camping area.
173.11 	(3) The proposed and existing facilities on and about the site, lot, field, or tract of 
173.12 	land for the proposed construction or alteration and maintaining of a sanitary community 
173.13 	building for toilets, urinals, sinks, wash basins, slop-sinks, showers, drains, laundry 
173.14 	facilities, source of water supply, sewage, garbage and waste disposal; except that no 
173.15 	toilet facilities shall be required in any manufactured home park which permits only 
173.16 	manufactured homes equipped with toilet facilities discharging to water carried sewage 
173.17 	disposal systems; and method of fire and storm protection.
173.18 	(4) The proposed method of lighting the structures and site, lot, field, or tract of land 
173.19 	upon which the manufactured home park or recreational camping area is to be located.
173.20 	(5) The calendar months of the year which the applicant will operate the 
173.21 	manufactured home park or recreational camping area.
173.22 	(6) Plans and drawings for new construction or alteration, including buildings, wells, 
173.23 	plumbing and sewage disposal systems.
173.24 		Subd. 3.Fees; Approval. The application for the primary license plan review shall 
173.25 	be submitted with all plans and specifications enumerated in subdivision 2, and payment 
173.26 	of a fee in an amount prescribed by the state commissioner of health pursuant to section 
173.27 	144.122 and shall be accompanied by an approved zoning permit from the municipality or 
173.28 	county wherein the park is to be located, or a statement from the municipality or county 
173.29 	that it does not require an approved zoning permit. The fee for the annual license shall be 
173.30 	in an amount prescribed by the state commissioner of health pursuant to section 144.122. 
173.31 	All license fees paid to the commissioner of health shall be turned over to the state 
173.32 	treasury. The fee submitted for the primary license plan review shall be retained by the 
173.33 	state even though the proposed project is not approved and a license is denied. 
173.34 	When construction has been completed in accordance with approved plans and 
173.35 	specifications the state commissioner of health shall promptly cause the manufactured 
173.36 	home park or recreational camping area and appurtenances thereto to be inspected. When 
174.1 	the inspection and report has been made and the state commissioner of health finds that 
174.2 	all requirements of sections 327.10, 327.11, 327.14 to 327.28, and such conditions of 
174.3 	health and safety as the state commissioner of health may require, have been met by 
174.4 	the applicant, the state commissioner of health shall forthwith issue the primary license 
174.5 	in the name of the state. 
174.6 		Subd. 4.Sanitary facilities Compliance with current state law. During the 
174.7 	pendency of the application for such primary license any change in the sanitary or safety 
174.8 	facilities of the intended manufactured home park or recreational camping area shall be 
174.9 	immediately reported in writing to the state Department of Health through the office 
174.10 	through which the application was made. If no objection is made by the state Department 
174.11 	of Health to such change in such sanitary or safety facilities within 60 days of the date 
174.12 	such change is reported, it shall be deemed to have the approval of the state Department of 
174.13 	Health. Any manufactured home park or recreational camping area must be constructed 
174.14 	and operated according to all applicable state electrical, fire, plumbing, and building codes.
174.15 		Subd. 5.Permit. When the plans and specifications have been approved, the state 
174.16 	Department of Health shall issue an approval report permitting the applicant to construct 
174.17 	or make alterations upon a manufactured home park or recreational camping area and the 
174.18 	appurtenances thereto according to the plans and specifications presented.
174.19 	Such approval does not relieve the applicant from securing building permits in 
174.20 	municipalities that require permits or from complying with any other municipal ordinance 
174.21 	or ordinances, applicable thereto, not in conflict with this statute.
174.22 		Subd. 6.Denial of construction. If the application to construct or make alterations 
174.23 	upon a manufactured home park or recreational camping area and the appurtenances 
174.24 	thereto or a primary license to operate and maintain the same is denied by the state 
174.25 	commissioner of health, the commissioner shall so state in writing giving the reason 
174.26 	or reasons for denying the application. If the objections can be corrected the applicant 
174.27 	may amend the application and resubmit it for approval, and if denied the applicant may 
174.28 	appeal from the decision of the state commissioner of health as provided in section 
174.29 	144.99, subdivision 10. 

174.30 	Sec. 45. Minnesota Statutes 2008, section 327.20, subdivision 1, is amended to read:
174.31 		Subdivision 1.Rules. No domestic animals or house pets of occupants of 
174.32 	manufactured home parks or recreational camping areas shall be allowed to run at large, 
174.33 	or commit any nuisances within the limits of a manufactured home park or recreational 
174.34 	camping area. Each manufactured home park or recreational camping area licensed under 
175.1 	the provisions of sections 327.10, 327.11, and327.14 to 327.28 shall, among other things, 
175.2 	provide for the following, in the manner hereinafter specified: 
175.3 	(1) A responsible attendant or caretaker shall be in charge of every manufactured 
175.4 	home park or recreational camping area at all times, who shall maintain the park or 
175.5 	area, and its facilities and equipment in a clean, orderly and sanitary condition. In any 
175.6 	manufactured home park containing more than 50 lots, the attendant, caretaker, or other 
175.7 	responsible park employee, shall be readily available at all times in case of emergency.
175.8 	(2) All manufactured home parks shall be well drained and be located so that the 
175.9 	drainage of the park area will not endanger any water supply. No wastewater from 
175.10 	manufactured homes or recreational camping vehicles shall be deposited on the surface of 
175.11 	the ground. All sewage and other water carried wastes shall be discharged into a municipal 
175.12 	sewage system whenever available. When a municipal sewage system is not available, a 
175.13 	sewage disposal system acceptable to the state commissioner of health shall be provided.
175.14 	(3) No manufactured home shall be located closer than three feet to the side lot lines 
175.15 	of a manufactured home park, if the abutting property is improved property, or closer than 
175.16 	ten feet to a public street or alley. Each individual site shall abut or face on a driveway 
175.17 	or clear unoccupied space of not less than 16 feet in width, which space shall have 
175.18 	unobstructed access to a public highway or alley. There shall be an open space of at least 
175.19 	ten feet between the sides of adjacent manufactured homes including their attachments 
175.20 	and at least three feet between manufactured homes when parked end to end. The space 
175.21 	between manufactured homes may be used for the parking of motor vehicles and other 
175.22 	property, if the vehicle or other property is parked at least ten feet from the nearest 
175.23 	adjacent manufactured home position. The requirements of this paragraph shall not apply 
175.24 	to recreational camping areas and variances may be granted by the state commissioner 
175.25 	of health in manufactured home parks when the variance is applied for in writing and in 
175.26 	the opinion of the commissioner the variance will not endanger the health, safety, and 
175.27 	welfare of manufactured home park occupants.
175.28 	(4) An adequate supply of water of safe, sanitary quality shall be furnished at each 
175.29 	manufactured home park or recreational camping area. The source of the water supply 
175.30 	shall first be approved by the state Department of Health.
175.31 	(5) All plumbing shall be installed in accordance with the rules of the state 
175.32 	commissioner of labor and industry and the provisions of the Minnesota Plumbing Code.
175.33 	(6) In the case of a manufactured home park with less than ten manufactured homes, 
175.34 	a plan for the sheltering or the safe evacuation to a safe place of shelter of the residents of 
175.35 	the park in times of severe weather conditions, such as tornadoes, high winds, and floods. 
175.36 	The shelter or evacuation plan shall be developed with the assistance and approval of 
176.1 	the municipality where the park is located and shall be posted at conspicuous locations 
176.2 	throughout the park. The park owner shall provide each resident with a copy of the 
176.3 	approved shelter or evacuation plan, as provided by section 327C.01, subdivision 1c. 
176.4 	Nothing in this paragraph requires the Department of Health to review or approve any 
176.5 	shelter or evacuation plan developed by a park. Failure of a municipality to approve a plan 
176.6 	submitted by a park shall not be grounds for action against the park by the Department of 
176.7 	Health if the park has made a good faith effort to develop the plan and obtain municipal 
176.8 	approval. 
176.9 	(7) A manufactured home park with ten or more manufactured homes, licensed prior 
176.10 	to March 1, 1988, shall provide a safe place of shelter for park residents or a plan for the 
176.11 	evacuation of park residents to a safe place of shelter within a reasonable distance of the 
176.12 	park for use by park residents in times of severe weather, including tornadoes and high 
176.13 	winds. The shelter or evacuation plan must be approved by the municipality by March 1, 
176.14 	1989. The municipality may require the park owner to construct a shelter if it determines 
176.15 	that a safe place of shelter is not available within a reasonable distance from the park. A 
176.16 	copy of the municipal approval and the plan shall be submitted by the park owner to the 
176.17 	Department of Health. The park owner shall provide each resident with a copy of the 
176.18 	approved shelter or evacuation plan, as provided by section 327C.01, subdivision 1c. 
176.19 	(8) A manufactured home park with ten or more manufactured homes, receiving 
176.20 	a primary an initial license after March 1, 1988, must provide the type of shelter required 
176.21 	by section 327.205, except that for manufactured home parks established as temporary, 
176.22 	emergency housing in a disaster area declared by the President of the United States or 
176.23 	the governor, an approved evacuation plan may be provided in lieu of a shelter for a 
176.24 	period not exceeding 18 months. 
176.25 	(9) For the purposes of this subdivision, "park owner" and "resident" have the 
176.26 	meaning meanings given them in section 327C.01. 

176.27 	Sec. 46. Minnesota Statutes 2008, section 327.20, is amended by adding a subdivision 
176.28 	to read:
176.29 		Subd. 4.Special event recreational camping areas. Each special event camping 
176.30 	area licensed under sections 327.10, 327.11, and 327.14 to 327.28 is subject to this section.
176.31 	(1) Recreational camping vehicles and tents, including attachments, must be 
176.32 	separated from each other and other structures by at least seven feet.
176.33 	(2) A minimum area of 300 square feet per site must be provided and the total 
176.34 	number of sites must not exceed one site for every 300 square feet of usable land area.
177.1 	(3) Each site must abut or face a driveway or clear unoccupied space of at least 16 
177.2 	feet in width, which space must have unobstructed access to a public roadway.
177.3 	(4) If no approved on-site water supply system is available, hauled water may be 
177.4 	used, provided that persons using hauled water comply with Minnesota Rules, parts 
177.5 	4720.4000 to 4720.4600.
177.6 	(5) Nonburied sewer lines may be permitted provided they are of approved materials, 
177.7 	watertight, and properly maintained.
177.8 	(6) If a sanitary dumping station is not provided on-site, arrangements must be 
177.9 	made with a licensed sewage pumper to service recreational camping vehicle holding 
177.10 	tanks as needed.
177.11 	(7) Toilet facilities must be provided consisting of toilets connected to an approved 
177.12 	sewage disposal system, portable toilets, or approved, properly constructed privies.
177.13 	(8) Toilets must be provided in the ratio of one toilet for each sex for each 150 sites.
177.14 	(9) Toilets must be not more than 400 feet from any site.
177.15 	(10) If a central building or buildings are provided with running water, then toilets 
177.16 	and hand-washing lavatories must be provided in the building or buildings that meet the 
177.17 	requirements of this subdivision.
177.18 	(11) Showers, if provided, must be provided in the ratio of one shower for each sex 
177.19 	for each 250 sites. Showerheads must be provided, where running water is available, for 
177.20 	each camping event exceeding two nights.
177.21 	(12) Central toilet and shower buildings, if provided, must be constructed with 
177.22 	adequate heating, ventilation, and lighting, and floors of impervious material sloped 
177.23 	to drain. Walls must be of a washable material. Permanent facilities must meet the 
177.24 	requirements of the Americans with Disabilities Act.
177.25 	(13) An adequate number of durable, covered, watertight containers must be 
177.26 	provided for all garbage and refuse. Garbage and refuse must be collected as often as 
177.27 	necessary to prevent nuisance conditions.
177.28 	(14) Campgrounds must be located in areas free of poison ivy or other noxious 
177.29 	weeds considered detrimental to health. Sites must not be located in areas of tall grass or 
177.30 	weeds and sites must be adequately drained.
177.31 	(15) Campsites for recreational vehicles may not be located on inclines of greater 
177.32 	than eight percent grade or one inch drop per lineal foot.
177.33 	(16) A responsible attendant or caretaker must be available on-site at all times during 
177.34 	the operation of any special event recreational camping area that has 50 or more sites.

178.1 	Sec. 47. MINNESOTA COLORECTAL CANCER PREVENTION 
178.2 	DEMONSTRATION PROJECT.
 178.3 		Subdivision 1.Establishment. The commissioner of health shall award grants 
178.4 	to Hennepin County Medical Center and MeritCare Bemidji for a colorectal screening 
178.5 	demonstration project to provide screening to uninsured and underinsured women and 
178.6 	men. The project shall expire December 31, 2010.
178.7 		Subd. 2.Eligibility. To be eligible for colorectal screening under this demonstration 
178.8 	project, an applicant must:
178.9 	(1) be at least 50 years of age, or under the age of 50 and at high risk for colon cancer;
178.10 	(2) be uninsured, or if insured, have coverage that does not cover the full cost of 
178.11 	colorectal cancer screenings;
178.12 	(3) not be eligible for medical assistance, general assistance medical care, or 
178.13 	MinnesotaCare programs; and
178.14 	(4) have a gross family income at or below 250 percent of the federal poverty level.
178.15 		Subd. 3.Services. Services provided under this project shall include:
178.16 	(1) colorectal cancer screening, according to standard practices of medicine, or 
178.17 	guidelines provided by the Institute for Clinical Systems Improvement or the American 
178.18 	Cancer Society;
178.19 	(2) follow-up services for abnormal tests; and
178.20 	(3) diagnostic services to determine the extent and proper course of treatment.
178.21 		Subd. 4.Project evaluation. The commissioner of health shall evaluate the 
178.22 	demonstration project and make recommendations for increasing the number of persons in 
178.23 	Minnesota who receive recommended colon cancer screening. The commissioner of health 
178.24 	shall submit the evaluation and recommendations to the legislature by January 15, 2011.

178.25 	Sec. 48.  REPEALER.
 178.26 	(a) Minnesota Statutes 2008, sections 103I.112; 144.9501, subdivision 17b; and 
178.27 	327.14, subdivisions 5 and 6, are repealed.
178.28 	(b) Minnesota Rules, part 4626.2015, subpart 9, is repealed.

178.29 	ARTICLE 6
178.30 	TECHNICAL

178.31 	Section 1. Minnesota Statutes 2008, section 125A.744, subdivision 3, is amended to 
178.32 	read:
178.33 		Subd. 3.Implementation. Consistent with section 256B.0625, subdivision 26, 
178.34 	school districts may enroll as medical assistance providers or subcontractors and bill 
179.1 	the Department of Human Services under the medical assistance fee for service claims 
179.2 	processing system for special education services which are covered services under chapter 
179.3 	256B, which are provided in the school setting for a medical assistance recipient, and for 
179.4 	whom the district has secured informed consent consistent with section 13.05, subdivision 
179.5 	4, paragraph (d), and section 256B.77, subdivision 2, paragraph (p), to bill for each type 
179.6 	of covered service. School districts shall be reimbursed by the commissioner of human 
179.7 	services for the federal share of individual education plan health-related services that 
179.8 	qualify for reimbursement by medical assistance, minus up to five percent retained by the 
179.9 	commissioner of human services for administrative costs, not to exceed $350,000 per 
179.10 	fiscal year. The commissioner may withhold up to five percent of each payment to a 
179.11 	school district. Following the end of each fiscal year, the commissioner shall settle up with 
179.12 	each school district in order to ensure that collections from each district for departmental 
179.13 	administrative costs are made on a pro rata basis according to federal earnings for these 
179.14 	services in each district. A school district is not eligible to enroll as a home care provider 
179.15 	or a personal care provider organization for purposes of billing home care services under 
179.16 	sections 256B.0651and 256B.0653 to 256B.0656and 256B.0659 until the commissioner 
179.17 	of human services issues a bulletin instructing county public health nurses on how to 
179.18 	assess for the needs of eligible recipients during school hours. To use private duty nursing 
179.19 	services or personal care services at school, the recipient or responsible party must provide 
179.20 	written authorization in the care plan identifying the chosen provider and the daily amount 
179.21 	of services to be used at school.

179.22 	Sec. 2. Minnesota Statutes 2008, section 144A.46, subdivision 1, is amended to read:
179.23 		Subdivision 1. License required. (a) A home care provider may not operate in the 
179.24 	state without a current license issued by the commissioner of health. A home care provider 
179.25 	may hold a separate license for each class of home care licensure. 
179.26 	(b) Within ten days after receiving an application for a license, the commissioner 
179.27 	shall acknowledge receipt of the application in writing. The acknowledgment must 
179.28 	indicate whether the application appears to be complete or whether additional information 
179.29 	is required before the application will be considered complete. Within 90 days after 
179.30 	receiving a complete application, the commissioner shall either grant or deny the license. 
179.31 	If an applicant is not granted or denied a license within 90 days after submitting a 
179.32 	complete application, the license must be deemed granted. An applicant whose license has 
179.33 	been deemed granted must provide written notice to the commissioner before providing a 
179.34 	home care service. 
180.1 	(c) Each application for a home care provider license, or for a renewal of a license, 
180.2 	shall be accompanied by a fee to be set by the commissioner under section 144.122. 
180.3 	(d) The commissioner of health, in consultation with the commissioner of human 
180.4 	services, shall provide recommendations to the legislature by February 15, 2009, for 
180.5 	provider standards for personal care assistant services as described in section 256B.0655
180.6 	256B.0659. 

180.7 	Sec. 3. Minnesota Statutes 2008, section 176.011, subdivision 9, is amended to read:
180.8 		Subd. 9. Employee. "Employee" means any person who performs services for 
180.9 	another for hire including the following: 
180.10 	(1) an alien; 
180.11 	(2) a minor; 
180.12 	(3) a sheriff, deputy sheriff, police officer, firefighter, county highway engineer, and 
180.13 	peace officer while engaged in the enforcement of peace or in the pursuit or capture of a 
180.14 	person charged with or suspected of crime; 
180.15 	(4) a person requested or commanded to aid an officer in arresting or retaking a 
180.16 	person who has escaped from lawful custody, or in executing legal process, in which 
180.17 	cases, for purposes of calculating compensation under this chapter, the daily wage of the 
180.18 	person shall be the prevailing wage for similar services performed by paid employees; 
180.19 	(5) a county assessor; 
180.20 	(6) an elected or appointed official of the state, or of a county, city, town, school 
180.21 	district, or governmental subdivision in the state. An officer of a political subdivision 
180.22 	elected or appointed for a regular term of office, or to complete the unexpired portion of a 
180.23 	regular term, shall be included only after the governing body of the political subdivision 
180.24 	has adopted an ordinance or resolution to that effect; 
180.25 	(7) an executive officer of a corporation, except those executive officers excluded 
180.26 	by section 176.041; 
180.27 	(8) a voluntary uncompensated worker, other than an inmate, rendering services in 
180.28 	state institutions under the commissioners of human services and corrections similar to 
180.29 	those of officers and employees of the institutions, and whose services have been accepted 
180.30 	or contracted for by the commissioner of human services or corrections as authorized by 
180.31 	law. In the event of injury or death of the worker, the daily wage of the worker, for the 
180.32 	purpose of calculating compensation under this chapter, shall be the usual wage paid at 
180.33 	the time of the injury or death for similar services in institutions where the services are 
180.34 	performed by paid employees; 
181.1 	(9) a voluntary uncompensated worker engaged in emergency management as 
181.2 	defined in section 12.03, subdivision 4, who is: 
181.3 	(i) registered with the state or any political subdivision of it, according to the 
181.4 	procedures set forth in the state or political subdivision emergency operations plan; and 
181.5 	(ii) acting under the direction and control of, and within the scope of duties approved 
181.6 	by, the state or political subdivision. 
181.7 	The daily wage of the worker, for the purpose of calculating compensation under this 
181.8 	chapter, shall be the usual wage paid at the time of the injury or death for similar services 
181.9 	performed by paid employees; 
181.10 	(10) a voluntary uncompensated worker participating in a program established by a 
181.11 	local social services agency. For purposes of this clause, "local social services agency" 
181.12 	means any agency established under section 393.01. In the event of injury or death of the 
181.13 	worker, the wage of the worker, for the purpose of calculating compensation under this 
181.14 	chapter, shall be the usual wage paid in the county at the time of the injury or death for 
181.15 	similar services performed by paid employees working a normal day and week; 
181.16 	(11) a voluntary uncompensated worker accepted by the commissioner of natural 
181.17 	resources who is rendering services as a volunteer pursuant to section 84.089. The daily 
181.18 	wage of the worker for the purpose of calculating compensation under this chapter, shall 
181.19 	be the usual wage paid at the time of injury or death for similar services performed by 
181.20 	paid employees; 
181.21 	(12) a voluntary uncompensated worker in the building and construction industry 
181.22 	who renders services for joint labor-management nonprofit community service projects. 
181.23 	The daily wage of the worker for the purpose of calculating compensation under this 
181.24 	chapter shall be the usual wage paid at the time of injury or death for similar services 
181.25 	performed by paid employees; 
181.26 	(13) a member of the military forces, as defined in section 190.05, while in state 
181.27 	active service, as defined in section 190.05, subdivision 5a. The daily wage of the member 
181.28 	for the purpose of calculating compensation under this chapter shall be based on the 
181.29 	member's usual earnings in civil life. If there is no evidence of previous occupation or 
181.30 	earning, the trier of fact shall consider the member's earnings as a member of the military 
181.31 	forces; 
181.32 	(14) a voluntary uncompensated worker, accepted by the director of the Minnesota 
181.33 	Historical Society, rendering services as a volunteer, pursuant to chapter 138. The daily 
181.34 	wage of the worker, for the purposes of calculating compensation under this chapter, 
181.35 	shall be the usual wage paid at the time of injury or death for similar services performed 
181.36 	by paid employees; 
182.1 	(15) a voluntary uncompensated worker, other than a student, who renders services 
182.2 	at the Minnesota State Academy for the Deaf or the Minnesota State Academy for the 
182.3 	Blind, and whose services have been accepted or contracted for by the commissioner of 
182.4 	education, as authorized by law. In the event of injury or death of the worker, the daily 
182.5 	wage of the worker, for the purpose of calculating compensation under this chapter, shall 
182.6 	be the usual wage paid at the time of the injury or death for similar services performed in 
182.7 	institutions by paid employees; 
182.8 	(16) a voluntary uncompensated worker, other than a resident of the veterans home, 
182.9 	who renders services at a Minnesota veterans home, and whose services have been 
182.10 	accepted or contracted for by the commissioner of veterans affairs, as authorized by law. 
182.11 	In the event of injury or death of the worker, the daily wage of the worker, for the purpose 
182.12 	of calculating compensation under this chapter, shall be the usual wage paid at the time of 
182.13 	the injury or death for similar services performed in institutions by paid employees; 
182.14 	(17) a worker performing services under section 256B.0655256B.0659 for a 
182.15 	recipient in the home of the recipient or in the community under section 256B.0625, 
182.16 	subdivision 19a, who is paid from government funds through a fiscal intermediary under 
182.17 	section 256B.0655, subdivision 7 256B.0659, subdivision 33. For purposes of maintaining 
182.18 	workers' compensation insurance, the employer of the worker is as designated in law 
182.19 	by the commissioner of the Department of Human Services, notwithstanding any other 
182.20 	law to the contrary;
182.21 	(18) students enrolled in and regularly attending the Medical School of the 
182.22 	University of Minnesota in the graduate school program or the postgraduate program. The 
182.23 	students shall not be considered employees for any other purpose. In the event of the 
182.24 	student's injury or death, the weekly wage of the student for the purpose of calculating 
182.25 	compensation under this chapter, shall be the annualized educational stipend awarded to 
182.26 	the student, divided by 52 weeks. The institution in which the student is enrolled shall 
182.27 	be considered the "employer" for the limited purpose of determining responsibility for 
182.28 	paying benefits under this chapter; 
182.29 	(19) a faculty member of the University of Minnesota employed for an academic 
182.30 	year is also an employee for the period between that academic year and the succeeding 
182.31 	academic year if: 
182.32 	(a) the member has a contract or reasonable assurance of a contract from the 
182.33 	University of Minnesota for the succeeding academic year; and 
182.34 	(b) the personal injury for which compensation is sought arises out of and in the 
182.35 	course of activities related to the faculty member's employment by the University of 
182.36 	Minnesota; 
183.1 	(20) a worker who performs volunteer ambulance driver or attendant services is an 
183.2 	employee of the political subdivision, nonprofit hospital, nonprofit corporation, or other 
183.3 	entity for which the worker performs the services. The daily wage of the worker for the 
183.4 	purpose of calculating compensation under this chapter shall be the usual wage paid at the 
183.5 	time of injury or death for similar services performed by paid employees; 
183.6 	(21) a voluntary uncompensated worker, accepted by the commissioner of 
183.7 	administration, rendering services as a volunteer at the Department of Administration. In 
183.8 	the event of injury or death of the worker, the daily wage of the worker, for the purpose of 
183.9 	calculating compensation under this chapter, shall be the usual wage paid at the time of the 
183.10 	injury or death for similar services performed in institutions by paid employees; 
183.11 	(22) a voluntary uncompensated worker rendering service directly to the Pollution 
183.12 	Control Agency. The daily wage of the worker for the purpose of calculating compensation 
183.13 	payable under this chapter is the usual going wage paid at the time of injury or death for 
183.14 	similar services if the services are performed by paid employees; 
183.15 	(23) a voluntary uncompensated worker while volunteering services as a first 
183.16 	responder or as a member of a law enforcement assistance organization while acting 
183.17 	under the supervision and authority of a political subdivision. The daily wage of the 
183.18 	worker for the purpose of calculating compensation payable under this chapter is the 
183.19 	usual going wage paid at the time of injury or death for similar services if the services 
183.20 	are performed by paid employees; 
183.21 	(24) a voluntary uncompensated member of the civil air patrol rendering service on 
183.22 	the request and under the authority of the state or any of its political subdivisions. The 
183.23 	daily wage of the member for the purposes of calculating compensation payable under this 
183.24 	chapter is the usual going wage paid at the time of injury or death for similar services if 
183.25 	the services are performed by paid employees; and 
183.26 	(25) a Minnesota Responds Medical Reserve Corps volunteer, as provided in 
183.27 	sections 145A.04 and 145A.06, responding at the request of or engaged in training 
183.28 	conducted by the commissioner of health. The daily wage of the volunteer for the purposes 
183.29 	of calculating compensation payable under this chapter is established in section 145A.06. 
183.30 	A person who qualifies under this clause and who may also qualify under another clause 
183.31 	of this subdivision shall receive benefits in accordance with this clause. 
183.32 	If it is difficult to determine the daily wage as provided in this subdivision, the trier 
183.33 	of fact may determine the wage upon which the compensation is payable. 

183.34 	Sec. 4. Minnesota Statutes 2008, section 245C.03, subdivision 2, is amended to read:
184.1 		Subd. 2.Personal care provider organizations. The commissioner shall conduct 
184.2 	background studies on any individual required under sections 256B.0651and 256B.0653
184.3 	to 256B.0656and 256B.0659 to have a background study completed under this chapter.

184.4 	Sec. 5. Minnesota Statutes 2008, section 245C.04, subdivision 3, is amended to read:
184.5 		Subd. 3.Personal care provider organizations. (a) The commissioner shall 
184.6 	conduct a background study of an individual required to be studied under section 245C.03, 
184.7 	subdivision 2, at least upon application for initial enrollment under sections 256B.0651
184.8 	and 256B.0653 to 256B.0656 and 256B.0659.
184.9 	(b) Organizations required to initiate background studies under sections 256B.0651
184.10 	and 256B.0653 to 256B.0656and 256B.0659 for individuals described in section 245C.03, 
184.11 	subdivision 2, must submit a completed background study form to the commissioner 
184.12 	before those individuals begin a position allowing direct contact with persons served 
184.13 	by the organization.

184.14 	Sec. 6. Minnesota Statutes 2008, section 245C.10, subdivision 3, is amended to read:
184.15 		Subd. 3.Personal care provider organizations. The commissioner shall recover 
184.16 	the cost of background studies initiated by a personal care provider organization under 
184.17 	sections 256B.0651and 256B.0653 to 256B.0656and 256B.0659 through a fee of no 
184.18 	more than $20 per study charged to the organization responsible for submitting the 
184.19 	background study form. The fees collected under this subdivision are appropriated to the 
184.20 	commissioner for the purpose of conducting background studies.

184.21 	Sec. 7. Minnesota Statutes 2008, section 256B.04, subdivision 16, is amended to read:
184.22 		Subd. 16. Personal care services. (a) Notwithstanding any contrary language in 
184.23 	this paragraph, the commissioner of human services and the commissioner of health shall 
184.24 	jointly promulgate rules to be applied to the licensure of personal care services provided 
184.25 	under the medical assistance program. The rules shall consider standards for personal care 
184.26 	services that are based on the World Institute on Disability's recommendations regarding 
184.27 	personal care services. These rules shall at a minimum consider the standards and 
184.28 	requirements adopted by the commissioner of health under section 144A.45, which the 
184.29 	commissioner of human services determines are applicable to the provision of personal 
184.30 	care services, in addition to other standards or modifications which the commissioner of 
184.31 	human services determines are appropriate. 
184.32 	The commissioner of human services shall establish an advisory group including 
184.33 	personal care consumers and providers to provide advice regarding which standards or 
185.1 	modifications should be adopted. The advisory group membership must include not less 
185.2 	than 15 members, of which at least 60 percent must be consumers of personal care services 
185.3 	and representatives of recipients with various disabilities and diagnoses and ages. At least 
185.4 	51 percent of the members of the advisory group must be recipients of personal care. 
185.5 	The commissioner of human services may contract with the commissioner of health 
185.6 	to enforce the jointly promulgated licensure rules for personal care service providers. 
185.7 	Prior to final promulgation of the joint rule the commissioner of human services 
185.8 	shall report preliminary findings along with any comments of the advisory group and a 
185.9 	plan for monitoring and enforcement by the Department of Health to the legislature by 
185.10 	February 15, 1992. 
185.11 	Limits on the extent of personal care services that may be provided to an individual 
185.12 	must be based on the cost-effectiveness of the services in relation to the costs of inpatient 
185.13 	hospital care, nursing home care, and other available types of care. The rules must 
185.14 	provide, at a minimum: 
185.15 	(1) that agencies be selected to contract with or employ and train staff to provide and 
185.16 	supervise the provision of personal care services; 
185.17 	(2) that agencies employ or contract with a qualified applicant that a qualified 
185.18 	recipient proposes to the agency as the recipient's choice of assistant; 
185.19 	(3) that agencies bill the medical assistance program for a personal care service 
185.20 	by a personal care assistant and supervision by a qualified professional supervising the 
185.21 	personal care assistant unless the recipient selects the fiscal agent option under section 
185.22 	256B.0655, subdivision 7 256B.0659, subdivision 33; 
185.23 	(4) that agencies establish a grievance mechanism; and 
185.24 	(5) that agencies have a quality assurance program. 
185.25 	(b) The commissioner may waive the requirement for the provision of personal care 
185.26 	services through an agency in a particular county, when there are less than two agencies 
185.27 	providing services in that county and shall waive the requirement for personal care 
185.28 	assistants required to join an agency for the first time during 1993 when personal care 
185.29 	services are provided under a relative hardship waiver under Minnesota Statutes 1992, 
185.30 	section 256B.0627, subdivision 4, paragraph (b), clause (7), and at least two agencies 
185.31 	providing personal care services have refused to employ or contract with the independent 
185.32 	personal care assistant. 

185.33 	Sec. 8. Minnesota Statutes 2008, section 256B.055, subdivision 12, is amended to read:
185.34 		Subd. 12. Disabled children. (a) A person is eligible for medical assistance if the 
185.35 	person is under age 19 and qualifies as a disabled individual under United States Code, 
186.1 	title 42, section 1382c(a), and would be eligible for medical assistance under the state 
186.2 	plan if residing in a medical institution, and the child requires a level of care provided in 
186.3 	a hospital, nursing facility, or intermediate care facility for persons with developmental 
186.4 	disabilities, for whom home care is appropriate, provided that the cost to medical 
186.5 	assistance under this section is not more than the amount that medical assistance would pay 
186.6 	for if the child resides in an institution. After the child is determined to be eligible under 
186.7 	this section, the commissioner shall review the child's disability under United States Code, 
186.8 	title 42, section 1382c(a) and level of care defined under this section no more often than 
186.9 	annually and may elect, based on the recommendation of health care professionals under 
186.10 	contract with the state medical review team, to extend the review of disability and level of 
186.11 	care up to a maximum of four years. The commissioner's decision on the frequency of 
186.12 	continuing review of disability and level of care is not subject to administrative appeal 
186.13 	under section 256.045. The county agency shall send a notice of disability review to the 
186.14 	enrollee six months prior to the date the recertification of disability is due. Nothing in this 
186.15 	subdivision shall be construed as affecting other redeterminations of medical assistance 
186.16 	eligibility under this chapter and annual cost-effective reviews under this section. 
186.17 	(b) For purposes of this subdivision, "hospital" means an institution as defined 
186.18 	in section 144.696, subdivision 3, 144.55, subdivision 3, or Minnesota Rules, part 
186.19 	4640.3600, and licensed pursuant to sections 144.50 to 144.58. For purposes of this 
186.20 	subdivision, a child requires a level of care provided in a hospital if the child is determined 
186.21 	by the commissioner to need an extensive array of health services, including mental health 
186.22 	services, for an undetermined period of time, whose health condition requires frequent 
186.23 	monitoring and treatment by a health care professional or by a person supervised by a 
186.24 	health care professional, who would reside in a hospital or require frequent hospitalization 
186.25 	if these services were not provided, and the daily care needs are more complex than 
186.26 	a nursing facility level of care. 
186.27 	A child with serious emotional disturbance requires a level of care provided in a 
186.28 	hospital if the commissioner determines that the individual requires 24-hour supervision 
186.29 	because the person exhibits recurrent or frequent suicidal or homicidal ideation or 
186.30 	behavior, recurrent or frequent psychosomatic disorders or somatopsychic disorders that 
186.31 	may become life threatening, recurrent or frequent severe socially unacceptable behavior 
186.32 	associated with psychiatric disorder, ongoing and chronic psychosis or severe, ongoing 
186.33 	and chronic developmental problems requiring continuous skilled observation, or severe 
186.34 	disabling symptoms for which office-centered outpatient treatment is not adequate, and 
186.35 	which overall severely impact the individual's ability to function. 
187.1 	(c) For purposes of this subdivision, "nursing facility" means a facility which 
187.2 	provides nursing care as defined in section 144A.01, subdivision 5, licensed pursuant to 
187.3 	sections 144A.02 to 144A.10, which is appropriate if a person is in active restorative 
187.4 	treatment; is in need of special treatments provided or supervised by a licensed nurse; or 
187.5 	has unpredictable episodes of active disease processes requiring immediate judgment 
187.6 	by a licensed nurse. For purposes of this subdivision, a child requires the level of care 
187.7 	provided in a nursing facility if the child is determined by the commissioner to meet 
187.8 	the requirements of the preadmission screening assessment document under section 
187.9 	256B.0911 and the home care independent rating document under section 256B.0655, 
187.10 	subdivision 4, clause (3) 256B.0659, adjusted to address age-appropriate standards for 
187.11 	children age 18 and under, pursuant to section 256B.0655, subdivision 3 256B.0659. 
187.12 	(d) For purposes of this subdivision, "intermediate care facility for persons with 
187.13 	developmental disabilities" or "ICF/MR" means a program licensed to provide services to 
187.14 	persons with developmental disabilities under section 252.28, and chapter 245A, and a 
187.15 	physical plant licensed as a supervised living facility under chapter 144, which together 
187.16 	are certified by the Minnesota Department of Health as meeting the standards in Code of 
187.17 	Federal Regulations, title 42, part 483, for an intermediate care facility which provides 
187.18 	services for persons with developmental disabilities who require 24-hour supervision 
187.19 	and active treatment for medical, behavioral, or habilitation needs. For purposes of this 
187.20 	subdivision, a child requires a level of care provided in an ICF/MR if the commissioner 
187.21 	finds that the child has a developmental disability in accordance with section 256B.092, 
187.22 	is in need of a 24-hour plan of care and active treatment similar to persons with 
187.23 	developmental disabilities, and there is a reasonable indication that the child will need 
187.24 	ICF/MR services. 
187.25 	(e) For purposes of this subdivision, a person requires the level of care provided 
187.26 	in a nursing facility if the person requires 24-hour monitoring or supervision and a plan 
187.27 	of mental health treatment because of specific symptoms or functional impairments 
187.28 	associated with a serious mental illness or disorder diagnosis, which meet severity criteria 
187.29 	for mental health established by the commissioner and published in March 1997 as 
187.30 	the Minnesota Mental Health Level of Care for Children and Adolescents with Severe 
187.31 	Emotional Disorders. 
187.32 	(f) The determination of the level of care needed by the child shall be made by 
187.33 	the commissioner based on information supplied to the commissioner by the parent or 
187.34 	guardian, the child's physician or physicians, and other professionals as requested by the 
187.35 	commissioner. The commissioner shall establish a screening team to conduct the level of 
187.36 	care determinations according to this subdivision. 
188.1 	(g) If a child meets the conditions in paragraph (b), (c), (d), or (e), the commissioner 
188.2 	must assess the case to determine whether: 
188.3 	(1) the child qualifies as a disabled individual under United States Code, title 42, 
188.4 	section 1382c(a), and would be eligible for medical assistance if residing in a medical 
188.5 	institution; and 
188.6 	(2) the cost of medical assistance services for the child, if eligible under this 
188.7 	subdivision, would not be more than the cost to medical assistance if the child resides in a 
188.8 	medical institution to be determined as follows: 
188.9 	(i) for a child who requires a level of care provided in an ICF/MR, the cost of 
188.10 	care for the child in an institution shall be determined using the average payment rate 
188.11 	established for the regional treatment centers that are certified as ICF's/MR; 
188.12 	(ii) for a child who requires a level of care provided in an inpatient hospital setting 
188.13 	according to paragraph (b), cost-effectiveness shall be determined according to Minnesota 
188.14 	Rules, part 9505.3520, items F and G; and 
188.15 	(iii) for a child who requires a level of care provided in a nursing facility according 
188.16 	to paragraph (c) or (e), cost-effectiveness shall be determined according to Minnesota 
188.17 	Rules, part 9505.3040, except that the nursing facility average rate shall be adjusted to 
188.18 	reflect rates which would be paid for children under age 16. The commissioner may 
188.19 	authorize an amount up to the amount medical assistance would pay for a child referred to 
188.20 	the commissioner by the preadmission screening team under section 256B.0911. 
188.21 	(h) Children eligible for medical assistance services under section 256B.055, 
188.22 	subdivision 12, as of June 30, 1995, must be screened according to the criteria in this 
188.23 	subdivision prior to January 1, 1996. Children found to be ineligible may not be removed 
188.24 	from the program until January 1, 1996. 

188.25 	Sec. 9. Minnesota Statutes 2008, section 256B.0621, subdivision 2, is amended to read:
188.26 		Subd. 2.Targeted case management; definitions. For purposes of subdivisions 3 
188.27 	to 10, the following terms have the meanings given them:
188.28 	(1) "home care service recipients" means those individuals receiving the following 
188.29 	services under sections 256B.0651 to 256B.0656 and 256B.0659: skilled nursing visits, 
188.30 	home health aide visits, private duty nursing, personal care assistants, or therapies 
188.31 	provided through a home health agency;
188.32 	(2) "home care targeted case management" means the provision of targeted case 
188.33 	management services for the purpose of assisting home care service recipients to gain 
188.34 	access to needed services and supports so that they may remain in the community;
189.1 	(3) "institutions" means hospitals, consistent with Code of Federal Regulations, title 
189.2 	42, section 440.10; regional treatment center inpatient services, consistent with section 
189.3 	245.474; nursing facilities; and intermediate care facilities for persons with developmental 
189.4 	disabilities;
189.5 	(4) "relocation targeted case management" includes the provision of both county 
189.6 	targeted case management and public or private vendor service coordination services 
189.7 	for the purpose of assisting recipients to gain access to needed services and supports if 
189.8 	they choose to move from an institution to the community. Relocation targeted case 
189.9 	management may be provided during the lesser of:
189.10 	(i) the last 180 consecutive days of an eligible recipient's institutional stay; or
189.11 	(ii) the limits and conditions which apply to federal Medicaid funding for this 
189.12 	service; and
189.13 	(5) "targeted case management" means case management services provided to help 
189.14 	recipients gain access to needed medical, social, educational, and other services and 
189.15 	supports.

189.16 	Sec. 10. Minnesota Statutes 2008, section 256B.0625, subdivision 19a, is amended to 
189.17 	read:
189.18 		Subd. 19a.Personal care assistant services. Medical assistance covers personal 
189.19 	care assistant services in a recipient's home. To qualify for personal care assistant services, 
189.20 	recipients or responsible parties must be able to identify the recipient's needs, direct and 
189.21 	evaluate task accomplishment, and provide for health and safety. Approved hours may be 
189.22 	used outside the home when normal life activities take them outside the home. To use 
189.23 	personal care assistant services at school, the recipient or responsible party must provide 
189.24 	written authorization in the care plan identifying the chosen provider and the daily amount 
189.25 	of services to be used at school. Total hours for services, whether actually performed 
189.26 	inside or outside the recipient's home, cannot exceed that which is otherwise allowed for 
189.27 	personal care assistant services in an in-home setting according to sections 256B.0651and 
189.28 	256B.0653 to 256B.0656 and 256B.0659. Medical assistance does not cover personal care 
189.29 	assistant services for residents of a hospital, nursing facility, intermediate care facility, 
189.30 	health care facility licensed by the commissioner of health, or unless a resident who is 
189.31 	otherwise eligible is on leave from the facility and the facility either pays for the personal 
189.32 	care assistant services or forgoes the facility per diem for the leave days that personal care 
189.33 	assistant services are used. All personal care assistant services must be provided according 
189.34 	to sections 256B.0651and 256B.0653 to 256B.0656 and 256B.0659. Personal care 
189.35 	assistant services may not be reimbursed if the personal care assistant is the spouse or legal 
190.1 	guardian of the recipient or the parent of a recipient under age 18, or the responsible party 
190.2 	or the foster care provider of a recipient who cannot direct the recipient's own care unless, 
190.3 	in the case of a foster care provider, a county or state case manager visits the recipient as 
190.4 	needed, but not less than every six months, to monitor the health and safety of the recipient 
190.5 	and to ensure the goals of the care plan are met. Parents of adult recipients, adult children 
190.6 	of the recipient or adult siblings of the recipient may be reimbursed for personal care 
190.7 	assistant services, if they are granted a waiver under sections 256B.0651and 256B.0653
190.8 	to 256B.0656 and 256B.0659. Notwithstanding the provisions of section 256B.0655, 
190.9 	subdivision 2, paragraph (b), clause (4) 256B.0659, the noncorporate legal guardian or 
190.10 	conservator of an adult, who is not the responsible party and not the personal care provider 
190.11 	organization, may be granted a hardship waiver under sections 256B.0651and 256B.0653
190.12 	to 256B.0656 and 256B.0659, to be reimbursed to provide personal care assistant services 
190.13 	to the recipient, and shall not be considered to have a service provider interest for purposes 
190.14 	of participation on the screening team under section 256B.092, subdivision 7.

190.15 	Sec. 11. Minnesota Statutes 2008, section 256B.0651, subdivision 13, is amended to 
190.16 	read:
190.17 		Subd. 13.Recovery of excessive payments. The commissioner shall seek 
190.18 	monetary recovery from providers of payments made for services which exceed the 
190.19 	limits established in this section and sections 256B.0653256B.0652 to 256B.0656 and 
190.20 	256B.0659. This subdivision does not apply to services provided to a recipient at the 
190.21 	previously authorized level pending an appeal under section 256.045, subdivision 10.

190.22 	Sec. 12. Minnesota Statutes 2008, section 256B.0652, subdivision 3, is amended to 
190.23 	read:
190.24 		Subd. 3.Assessment and prior authorization process. Effective January 1, 1996, 
190.25 	for purposes of providing informed choice, coordinating of local planning decisions, and 
190.26 	streamlining administrative requirements, the assessment and prior authorization process 
190.27 	for persons receiving both home care and home and community-based waivered services 
190.28 	for persons with developmental disabilities shall meet the requirements of sections 
190.29 	256B.0651and 256B.0653 to 256B.0656and 256B.0659 with the following exceptions:
190.30 	(a) Upon request for home care services and subsequent assessment by the public 
190.31 	health nurse under sections 256B.0651and 256B.0653 to 256B.0656 and 256B.0659, 
190.32 	the public health nurse shall participate in the screening process, as appropriate, and, 
190.33 	if home care services are determined to be necessary, participate in the development 
190.34 	of a service plan coordinating the need for home care and home and community-based 
191.1 	waivered services with the assigned county case manager, the recipient of services, and 
191.2 	the recipient's legal representative, if any.
191.3 	(b) The public health nurse shall give prior authorization for home care services 
191.4 	to the extent that home care services are:
191.5 	(1) medically necessary;
191.6 	(2) chosen by the recipient and their legal representative, if any, from the array of 
191.7 	home care and home and community-based waivered services available;
191.8 	(3) coordinated with other services to be received by the recipient as described 
191.9 	in the service plan; and
191.10 	(4) provided within the county's reimbursement limits for home care and home and 
191.11 	community-based waivered services for persons with developmental disabilities.
191.12 	(c) If the public health agency is or may be the provider of home care services to the 
191.13 	recipient, the public health agency shall provide the commissioner of human services with 
191.14 	a written plan that specifies how the assessment and prior authorization process will be 
191.15 	held separate and distinct from the provision of services.

191.16 	Sec. 13. Minnesota Statutes 2008, section 256B.0657, subdivision 2, is amended to 
191.17 	read:
191.18 		Subd. 2.Eligibility. (a) The self-directed supports option is available to a person 
191.19 	who:
191.20 	(1) is a recipient of medical assistance as determined under sections 256B.055, 
191.21 	256B.056, and 256B.057, subdivision 9;
191.22 	(2) is eligible for personal care assistant services under section 256B.0655
191.23 	256B.0659;
191.24 	(3) lives in the person's own apartment or home, which is not owned, operated, or 
191.25 	controlled by a provider of services not related by blood or marriage;
191.26 	(4) has the ability to hire, fire, supervise, establish staff compensation for, and 
191.27 	manage the individuals providing services, and to choose and obtain items, related 
191.28 	services, and supports as described in the participant's plan. If the recipient is not able to 
191.29 	carry out these functions but has a legal guardian or parent to carry them out, the guardian 
191.30 	or parent may fulfill these functions on behalf of the recipient; and
191.31 	(5) has not been excluded or disenrolled by the commissioner.
191.32 	(b) The commissioner may disenroll or exclude recipients, including guardians and 
191.33 	parents, under the following circumstances:
191.34 	(1) recipients who have been restricted by the Primary Care Utilization Review 
191.35 	Committee may be excluded for a specified time period; 
192.1 	(2) recipients who exit the self-directed supports option during the recipient's 
192.2 	service plan year shall not access the self-directed supports option for the remainder of 
192.3 	that service plan year; and
192.4 	(3) when the department determines that the recipient cannot manage recipient 
192.5 	responsibilities under the program.

192.6 	Sec. 14. Minnesota Statutes 2008, section 256B.0657, subdivision 6, is amended to 
192.7 	read:
192.8 		Subd. 6.Services covered. (a) Services covered under the self-directed supports 
192.9 	option include:
192.10 	(1) personal care assistant services under section 256B.0655 256B.0659; and 
192.11 	(2) items, related services, and supports, including assistive technology, that increase 
192.12 	independence or substitute for human assistance to the extent expenditures would 
192.13 	otherwise be used for human assistance.
192.14 	(b) Items, supports, and related services purchased under this option shall not be 
192.15 	considered home care services for the purposes of section 144A.43.

192.16 	Sec. 15. Minnesota Statutes 2008, section 256B.0657, subdivision 8, is amended to 
192.17 	read:
192.18 		Subd. 8.Self-directed budget requirements. The budget for the provision of the 
192.19 	self-directed service option shall be equal to the greater of either:
192.20 	(1) the annual amount of personal care assistant services under section 256B.0655
192.21 	256B.0659 that the recipient has used in the most recent 12-month period; or 
192.22 	(2) the amount determined using the consumer support grant methodology under 
192.23 	section 256.476, subdivision 11, except that the budget amount shall include the federal 
192.24 	and nonfederal share of the average service costs.

192.25 	Sec. 16. Minnesota Statutes 2008, section 256B.49, subdivision 17, is amended to read:
192.26 		Subd. 17.Cost of services and supports. (a) The commissioner shall ensure 
192.27 	that the average per capita expenditures estimated in any fiscal year for home and 
192.28 	community-based waiver recipients does not exceed the average per capita expenditures 
192.29 	that would have been made to provide institutional services for recipients in the absence 
192.30 	of the waiver.
192.31 	(b) The commissioner shall implement on January 1, 2002, one or more aggregate, 
192.32 	need-based methods for allocating to local agencies the home and community-based 
192.33 	waivered service resources available to support recipients with disabilities in need of 
193.1 	the level of care provided in a nursing facility or a hospital. The commissioner shall 
193.2 	allocate resources to single counties and county partnerships in a manner that reflects 
193.3 	consideration of:
193.4 	(1) an incentive-based payment process for achieving outcomes;
193.5 	(2) the need for a state-level risk pool;
193.6 	(3) the need for retention of management responsibility at the state agency level; and
193.7 	(4) a phase-in strategy as appropriate.
193.8 	(c) Until the allocation methods described in paragraph (b) are implemented, the 
193.9 	annual allowable reimbursement level of home and community-based waiver services 
193.10 	shall be the greater of:
193.11 	(1) the statewide average payment amount which the recipient is assigned under the 
193.12 	waiver reimbursement system in place on June 30, 2001, modified by the percentage of 
193.13 	any provider rate increase appropriated for home and community-based services; or
193.14 	(2) an amount approved by the commissioner based on the recipient's extraordinary 
193.15 	needs that cannot be met within the current allowable reimbursement level. The 
193.16 	increased reimbursement level must be necessary to allow the recipient to be discharged 
193.17 	from an institution or to prevent imminent placement in an institution. The additional 
193.18 	reimbursement may be used to secure environmental modifications; assistive technology 
193.19 	and equipment; and increased costs for supervision, training, and support services 
193.20 	necessary to address the recipient's extraordinary needs. The commissioner may approve 
193.21 	an increased reimbursement level for up to one year of the recipient's relocation from an 
193.22 	institution or up to six months of a determination that a current waiver recipient is at 
193.23 	imminent risk of being placed in an institution.
193.24 	(d) Beginning July 1, 2001, medically necessary private duty nursing services 
193.25 	will be authorized under this section as complex and regular care according to sections 
193.26 	256B.0651and 256B.0653 to 256B.0656 and 256B.0659. The rate established by the 
193.27 	commissioner for registered nurse or licensed practical nurse services under any home and 
193.28 	community-based waiver as of January 1, 2001, shall not be reduced.

193.29 	Sec. 17. Minnesota Statutes 2008, section 256B.501, subdivision 4a, is amended to 
193.30 	read:
193.31 		Subd. 4a.Inclusion of home care costs in waiver rates. The commissioner 
193.32 	shall adjust the limits of the established average daily reimbursement rates for waivered 
193.33 	services to include the cost of home care services that may be provided to waivered 
193.34 	services recipients. This adjustment must be used to maintain or increase services and 
193.35 	shall not be used by county agencies for inflation increases for waivered services vendors. 
194.1 	Home care services referenced in this section are those listed in section 256B.0651, 
194.2 	subdivision 2. The average daily reimbursement rates established in accordance with 
194.3 	the provisions of this subdivision apply only to the combined average, daily costs of 
194.4 	waivered and home care services and do not change home care limitations under sections 
194.5 	256B.0651and 256B.0653 to 256B.0656 and 256B.0659. Waivered services recipients 
194.6 	receiving home care as of June 30, 1992, shall not have the amount of their services 
194.7 	reduced as a result of this section.

194.8 	Sec. 18. Minnesota Statutes 2008, section 256G.02, subdivision 6, is amended to read:
194.9 		Subd. 6.Excluded time. "Excluded time" means:
194.10 	(a) any period an applicant spends in a hospital, sanitarium, nursing home, shelter 
194.11 	other than an emergency shelter, halfway house, foster home, semi-independent living 
194.12 	domicile or services program, residential facility offering care, board and lodging facility 
194.13 	or other institution for the hospitalization or care of human beings, as defined in section 
194.14 	144.50, 144A.01, or 245A.02, subdivision 14; maternity home, battered women's shelter, 
194.15 	or correctional facility; or any facility based on an emergency hold under sections 
194.16 	253B.05, subdivisions 1 and 2, and 253B.07, subdivision 6;
194.17 	(b) any period an applicant spends on a placement basis in a training and habilitation 
194.18 	program, including a rehabilitation facility or work or employment program as defined 
194.19 	in section 268A.01; or receiving personal care assistant services pursuant to section 
194.20 	256B.0655, subdivision 2 256B.0659; semi-independent living services provided under 
194.21 	section 252.275, and Minnesota Rules, parts 9525.0500 to 9525.0660; day training and 
194.22 	habilitation programs and assisted living services; and
194.23 	(c) any placement for a person with an indeterminate commitment, including 
194.24 	independent living.

194.25 	Sec. 19. Minnesota Statutes 2008, section 256I.05, subdivision 1a, is amended to read:
194.26 		Subd. 1a.Supplementary service rates. (a) Subject to the provisions of section 
194.27 	256I.04, subdivision 3, the county agency may negotiate a payment not to exceed $426.37 
194.28 	for other services necessary to provide room and board provided by the group residence 
194.29 	if the residence is licensed by or registered by the Department of Health, or licensed by 
194.30 	the Department of Human Services to provide services in addition to room and board, 
194.31 	and if the provider of services is not also concurrently receiving funding for services for 
194.32 	a recipient under a home and community-based waiver under title XIX of the Social 
194.33 	Security Act; or funding from the medical assistance program under section 256B.0655, 
194.34 	subdivision 2 256B.0659, for personal care services for residents in the setting; or residing 
195.1 	in a setting which receives funding under Minnesota Rules, parts 9535.2000 to 9535.3000. 
195.2 	If funding is available for other necessary services through a home and community-based 
195.3 	waiver, or personal care services under section 256B.0655, subdivision 2 256B.0659, 
195.4 	then the GRH rate is limited to the rate set in subdivision 1. Unless otherwise provided 
195.5 	in law, in no case may the supplementary service rate exceed $426.37. The registration 
195.6 	and licensure requirement does not apply to establishments which are exempt from state 
195.7 	licensure because they are located on Indian reservations and for which the tribe has 
195.8 	prescribed health and safety requirements. Service payments under this section may be 
195.9 	prohibited under rules to prevent the supplanting of federal funds with state funds. The 
195.10 	commissioner shall pursue the feasibility of obtaining the approval of the Secretary of 
195.11 	Health and Human Services to provide home and community-based waiver services under 
195.12 	title XIX of the Social Security Act for residents who are not eligible for an existing home 
195.13 	and community-based waiver due to a primary diagnosis of mental illness or chemical 
195.14 	dependency and shall apply for a waiver if it is determined to be cost-effective.
195.15 	(b) The commissioner is authorized to make cost-neutral transfers from the GRH 
195.16 	fund for beds under this section to other funding programs administered by the department 
195.17 	after consultation with the county or counties in which the affected beds are located. 
195.18 	The commissioner may also make cost-neutral transfers from the GRH fund to county 
195.19 	human service agencies for beds permanently removed from the GRH census under a plan 
195.20 	submitted by the county agency and approved by the commissioner. The commissioner 
195.21 	shall report the amount of any transfers under this provision annually to the legislature.
195.22 	(c) The provisions of paragraph (b) do not apply to a facility that has its 
195.23 	reimbursement rate established under section 256B.431, subdivision 4, paragraph (c).

195.24 	Sec. 20. Minnesota Statutes 2008, section 256J.45, subdivision 3, is amended to read:
195.25 		Subd. 3.Good cause exemptions for not attending orientation. (a) The county 
195.26 	agency shall not impose the sanction under section 256J.46 if it determines that the 
195.27 	participant has good cause for failing to attend orientation. Good cause exists when:
195.28 	(1) appropriate child care is not available;
195.29 	(2) the participant is ill or injured;
195.30 	(3) a family member is ill and needs care by the participant that prevents the 
195.31 	participant from attending orientation. For a caregiver with a child or adult in the 
195.32 	household who meets the disability or medical criteria for home care services under 
195.33 	section 256B.0655, subdivision 1c 256B.0659, or a home and community-based waiver 
195.34 	services program under chapter 256B, or meets the criteria for severe emotional 
195.35 	disturbance under section 245.4871, subdivision 6, or for serious and persistent mental 
196.1 	illness under section 245.462, subdivision 20, paragraph (c), good cause also exists when 
196.2 	an interruption in the provision of those services occurs which prevents the participant 
196.3 	from attending orientation;
196.4 	(4) the caregiver is unable to secure necessary transportation;
196.5 	(5) the caregiver is in an emergency situation that prevents orientation attendance;
196.6 	(6) the orientation conflicts with the caregiver's work, training, or school schedule; or
196.7 	(7) the caregiver documents other verifiable impediments to orientation attendance 
196.8 	beyond the caregiver's control.
196.9 	(b) Counties must work with clients to provide child care and transportation 
196.10 	necessary to ensure a caregiver has every opportunity to attend orientation.

196.11 	Sec. 21. Minnesota Statutes 2008, section 604A.33, subdivision 1, is amended to read:
196.12 		Subdivision 1.Application. This section applies to residential treatment programs 
196.13 	for children or group homes for children licensed under chapter 245A, residential 
196.14 	services and programs for juveniles licensed under section 241.021, providers licensed 
196.15 	pursuant to sections 144A.01 to 144A.33 or sections 144A.43 to  144A.47, personal care 
196.16 	provider organizations under section 256B.0655, subdivision 1g 256B.0659, providers 
196.17 	of day training and habilitation services under sections 252.40 to 252.46, board and 
196.18 	lodging facilities licensed under chapter 157, intermediate care facilities for persons with 
196.19 	developmental disabilities, and other facilities licensed to provide residential services to 
196.20 	persons with developmental disabilities.

196.21 	Sec. 22. Minnesota Statutes 2008, section 609.232, subdivision 11, is amended to read:
196.22 		Subd. 11.Vulnerable adult. "Vulnerable adult" means any person 18 years of 
196.23 	age or older who:
196.24 	(1) is a resident inpatient of a facility;
196.25 	(2) receives services at or from a facility required to be licensed to serve adults 
196.26 	under sections 245A.01 to 245A.15, except that a person receiving outpatient services for 
196.27 	treatment of chemical dependency or mental illness, or one who is committed as a sexual 
196.28 	psychopathic personality or as a sexually dangerous person under chapter 253B, is not 
196.29 	considered a vulnerable adult unless the person meets the requirements of clause (4);
196.30 	(3) receives services from a home care provider required to be licensed under section 
196.31 	144A.46; or from a person or organization that exclusively offers, provides, or arranges 
196.32 	for personal care assistant services under the medical assistance program as authorized 
196.33 	under sections 256B.04, subdivision 16, 256B.0625, subdivision 19a, 256B.0651, and 
196.34 	256B.0653 to 256B.0656 and 256B.0659; or
197.1 	(4) regardless of residence or whether any type of service is received, possesses a 
197.2 	physical or mental infirmity or other physical, mental, or emotional dysfunction:
197.3 	(i) that impairs the individual's ability to provide adequately for the individual's 
197.4 	own care without assistance, including the provision of food, shelter, clothing, health 
197.5 	care, or supervision; and
197.6 	(ii) because of the dysfunction or infirmity and the need for assistance, the individual 
197.7 	has an impaired ability to protect the individual from maltreatment.

197.8 	Sec. 23. Minnesota Statutes 2008, section 626.5572, subdivision 6, is amended to read:
197.9 		Subd. 6.Facility. (a) "Facility" means a hospital or other entity required to be 
197.10 	licensed under sections 144.50 to 144.58; a nursing home required to be licensed to 
197.11 	serve adults under section 144A.02; a residential or nonresidential facility required to 
197.12 	be licensed to serve adults under sections 245A.01 to 245A.16; a home care provider 
197.13 	licensed or required to be licensed under section 144A.46; a hospice provider licensed 
197.14 	under sections 144A.75 to 144A.755; or a person or organization that exclusively offers, 
197.15 	provides, or arranges for personal care assistant services under the medical assistance 
197.16 	program as authorized under sections 256B.04, subdivision 16, 256B.0625, subdivision 
197.17 	19a, 256B.0651, and 256B.0653 to 256B.0656, and 256B.0659.
197.18 	(b) For home care providers and personal care attendants, the term "facility" refers 
197.19 	to the provider or person or organization that exclusively offers, provides, or arranges for 
197.20 	personal care services, and does not refer to the client's home or other location at which 
197.21 	services are rendered.

197.22 	Sec. 24. Minnesota Statutes 2008, section 626.5572, subdivision 21, is amended to 
197.23 	read:
197.24 		Subd. 21. Vulnerable adult. "Vulnerable adult" means any person 18 years of 
197.25 	age or older who: 
197.26 	(1) is a resident or inpatient of a facility; 
197.27 	(2) receives services at or from a facility required to be licensed to serve adults 
197.28 	under sections 245A.01 to 245A.15, except that a person receiving outpatient services for 
197.29 	treatment of chemical dependency or mental illness, or one who is served in the Minnesota 
197.30 	sex offender program on a court-hold order for commitment, or is committed as a sexual 
197.31 	psychopathic personality or as a sexually dangerous person under chapter 253B, is not 
197.32 	considered a vulnerable adult unless the person meets the requirements of clause (4); 
197.33 	(3) receives services from a home care provider required to be licensed under section 
197.34 	144A.46; or from a person or organization that exclusively offers, provides, or arranges 
198.1 	for personal care assistant services under the medical assistance program as authorized 
198.2 	under sections 256B.04, subdivision 16, 256B.0625, subdivision 19a, 256B.0651, and
198.3 	256B.0653 to 256B.0656, and 256B.0659; or 
198.4 	(4) regardless of residence or whether any type of service is received, possesses a 
198.5 	physical or mental infirmity or other physical, mental, or emotional dysfunction: 
198.6 	(i) that impairs the individual's ability to provide adequately for the individual's 
198.7 	own care without assistance, including the provision of food, shelter, clothing, health 
198.8 	care, or supervision; and 
198.9 	(ii) because of the dysfunction or infirmity and the need for assistance, the individual 
198.10 	has an impaired ability to protect the individual from maltreatment. 

198.11 	ARTICLE 7
198.12 	MENTAL HEALTH

198.13 	Section 1. Minnesota Statutes 2008, section 256B.0625, subdivision 47, is amended to 
198.14 	read:
198.15 		Subd. 47.Treatment foster care services. Effective July 1, 2007 2011, and subject 
198.16 	to federal approval, medical assistance covers treatment foster care services according to 
198.17 	section 256B.0946.

198.18 	Sec. 2. Minnesota Statutes 2008, section 256B.0943, subdivision 12, is amended to 
198.19 	read:
198.20 		Subd. 12.Excluded services. The following services are not eligible for medical 
198.21 	assistance payment as children's therapeutic services and supports:
198.22 	(1) service components of children's therapeutic services and supports 
198.23 	simultaneously provided by more than one provider entity unless prior authorization is 
198.24 	obtained;
198.25 	(2) treatment by multiple providers within the same agency at the same clock time;
198.26 	(3) children's therapeutic services and supports provided in violation of medical 
198.27 	assistance policy in Minnesota Rules, part 9505.0220;
198.28 	(3) (4) mental health behavioral aide services provided by a personal care assistant 
198.29 	who is not qualified as a mental health behavioral aide and employed by a certified 
198.30 	children's therapeutic services and supports provider entity;
198.31 	(4)(5) service components of CTSS that are the responsibility of a residential or 
198.32 	program license holder, including foster care providers under the terms of a service 
198.33 	agreement or administrative rules governing licensure; 
199.1 	(5)(6) adjunctive activities that may be offered by a provider entity but are not 
199.2 	otherwise covered by medical assistance, including:
199.3 	(i) a service that is primarily recreation oriented or that is provided in a setting that 
199.4 	is not medically supervised. This includes sports activities, exercise groups, activities 
199.5 	such as craft hours, leisure time, social hours, meal or snack time, trips to community 
199.6 	activities, and tours;
199.7 	(ii) a social or educational service that does not have or cannot reasonably be 
199.8 	expected to have a therapeutic outcome related to the client's emotional disturbance;
199.9 	(iii) consultation with other providers or service agency staff about the care or 
199.10 	progress of a client;
199.11 	(iv) prevention or education programs provided to the community; and
199.12 	(v) treatment for clients with primary diagnoses of alcohol or other drug abuse; and
199.13 	(6)(7) activities that are not direct service time.

199.14 	Sec. 3. STATE-COUNTY CHEMICAL HEALTH CARE HOME PILOT 
199.15 	PROJECT.
 199.16 		Subdivision 1.Establishment; purpose. There is established a state-county 
199.17 	chemical health care home pilot project. The purpose of the pilot project is for the 
199.18 	Department of Human Services and counties to authentically and creatively work in 
199.19 	partnership to redesign the current chemical health service delivery system in a way 
199.20 	that promotes greater accountability, productivity, and results in the delivery of state 
199.21 	chemical dependency services. The pilot project or projects must look to provide 
199.22 	appropriate flexibility in a way that ensures timely access to needed services as well 
199.23 	as better aligning systems and services to offer the most appropriate level of chemical 
199.24 	health care services to the client. This may include, but is not limited to, looking into new 
199.25 	governance agreements, performance agreements, or service level agreements. Pilot 
199.26 	projects must maintain eligibility requirements for the consolidated chemical dependency 
199.27 	treatment fund, continue to meet the requirements of Minnesota Rules, parts 9530.6600 to 
199.28 	9530.6655 (also known as Rule 25) and Minnesota Rules, parts 9530.6405 to 9530.6505 
199.29 	(also known as Rule 31), and must not put at risk current and future federal funding toward 
199.30 	chemical health-related services in the state of Minnesota. 
199.31 		Subd. 2.Workgroup; report. A workgroup must be convened on or before July 
199.32 	15, 2009, consisting of representatives from the Department of Human Services and 
199.33 	potential participating counties to develop draft proposals for pilot projects meeting the 
199.34 	requirements of this section. The workgroup shall report back to the legislative committees 
200.1 	with jurisdiction over chemical health by January 15, 2010, for potential approval of one 
200.2 	metro and one nonmetro county pilot project to be implemented beginning July 10, 2010.
200.3 		Subd. 3.Report. The Department of Human Services shall evaluate the efficacy and 
200.4 	feasibility of the pilot projects and report the results of that evaluation to the legislative 
200.5 	committees having jurisdiction over chemical health by June 30, 2011. Expansion of pilot 
200.6 	projects may occur only if the department's report finds the pilot projects effective.
200.7 		Subd. 4.Expiration. This section expires June 30, 2012.

200.8 	EFFECTIVE DATE. This section is effective the day following final enactment.

200.9 	ARTICLE 8
200.10 	HEALTH-RELATED FEES

200.11 	Section 1. Minnesota Statutes 2008, section 148.108, is amended to read:
200.12 	148.108 FEES.
200.13 		Subdivision 1.Fees. In addition to the fees established in Minnesota Rules, chapter 
200.14 	2500, and according to sections 148.05, 148.06, 148.07, and 148.10, subdivisions 2 and 3, 
200.15 	the board is authorized to charge the fees in this section.
200.16 		Subd. 2.Annual renewal of inactive acupuncture registration License and 
200.17 	registration fees. The annual renewal of an inactive acupuncture registration fee is $25.
200.18 	License and registration fees are as follows:
200.19 	(1) for a license application fee, $300;
200.20 	(2) for a license active renewal fee, $220;
200.21 	(3) for a license inactive renewal fee, $165;
200.22 	(4) for an acupuncture initial registration fee, $125;
200.23 	(5) for an acupuncture active registration renewal fee, $75;
200.24 	(6) for an acupuncture registration reinstatement fee, $50;
200.25 	(7) for an acupuncture inactive registration renewal fee, $25;
200.26 	(8) for an animal chiropractic registration fee, $125;
200.27 	(9) for an animal chiropractic active registration renewal fee, $75; and
200.28 	(10) for an animal chiropractic inactive registration renewal fee, $25.
200.29 		Subd. 3.Acupuncture reinstatement. The acupuncture reinstatement fee is $50.

200.30 	Sec. 2. Minnesota Statutes 2008, section 148D.180, subdivision 1, is amended to read:
200.31 		Subdivision 1.Application fees. Application fees for licensure are as follows:
200.32 	(1) for a licensed social worker, $45;
200.33 	(2) for a licensed graduate social worker, $45;
201.1 	(3) for a licensed independent social worker, $90 $45;
201.2 	(4) for a licensed independent clinical social worker, $90 $45;
201.3 	(5) for a temporary license, $50; and
201.4 	(6) for a licensure by endorsement, $150 $85.
201.5 	The fee for criminal background checks is the fee charged by the Bureau of Criminal 
201.6 	Apprehension. The criminal background check fee must be included with the application 
201.7 	fee as required pursuant to section 148D.055.

201.8 	Sec. 3. Minnesota Statutes 2008, section 148D.180, subdivision 2, is amended to read:
201.9 		Subd. 2.License fees. License fees are as follows:
201.10 	(1) for a licensed social worker, $115.20 $81;
201.11 	(2) for a licensed graduate social worker, $201.60 $144;
201.12 	(3) for a licensed independent social worker, $302.40 $216;
201.13 	(4) for a licensed independent clinical social worker, $331.20 $238.50;
201.14 	(5) for an emeritus license, $43.20; and
201.15 	(6) for a temporary leave fee, the same as the renewal fee specified in subdivision 3.
201.16 	If the licensee's initial license term is less or more than 24 months, the required 
201.17 	license fees must be prorated proportionately.

201.18 	Sec. 4. Minnesota Statutes 2008, section 148D.180, subdivision 3, is amended to read:
201.19 		Subd. 3.Renewal fees. Renewal fees for licensure are as follows:
201.20 	(1) for a licensed social worker, $115.20 $81;
201.21 	(2) for a licensed graduate social worker, $201.60 $144;
201.22 	(3) for a licensed independent social worker, $302.40 $216; and
201.23 	(4) for a licensed independent clinical social worker, $331.20 $238.50.

201.24 	Sec. 5. Minnesota Statutes 2008, section 148D.180, subdivision 5, is amended to read:
201.25 		Subd. 5.Late fees. Late fees are as follows:
201.26 	(1) renewal late fee, one-half one-fourth of the renewal fee specified in subdivision 
201.27 	3; and
201.28 	(2) supervision plan late fee, $40.

201.29 	Sec. 6. Minnesota Statutes 2008, section 148E.180, subdivision 1, is amended to read:
201.30 		Subdivision 1.Application fees. Application fees for licensure are as follows:
201.31 	(1) for a licensed social worker, $45;
201.32 	(2) for a licensed graduate social worker, $45;
202.1 	(3) for a licensed independent social worker, $90 $45;
202.2 	(4) for a licensed independent clinical social worker, $90 $45;
202.3 	(5) for a temporary license, $50; and
202.4 	(6) for a licensure by endorsement, $150 $85.
202.5 	The fee for criminal background checks is the fee charged by the Bureau of Criminal 
202.6 	Apprehension. The criminal background check fee must be included with the application 
202.7 	fee as required according to section 148E.055.

202.8 	Sec. 7. Minnesota Statutes 2008, section 148E.180, subdivision 2, is amended to read:
202.9 		Subd. 2.License fees. License fees are as follows:
202.10 	(1) for a licensed social worker, $115.20 $81;
202.11 	(2) for a licensed graduate social worker, $201.60 $144;
202.12 	(3) for a licensed independent social worker, $302.40 $216;
202.13 	(4) for a licensed independent clinical social worker, $331.20 $238.50;
202.14 	(5) for an emeritus license, $43.20; and
202.15 	(6) for a temporary leave fee, the same as the renewal fee specified in subdivision 3.
202.16 	If the licensee's initial license term is less or more than 24 months, the required 
202.17 	license fees must be prorated proportionately.

202.18 	Sec. 8. Minnesota Statutes 2008, section 148E.180, subdivision 3, is amended to read:
202.19 		Subd. 3.Renewal fees. Renewal fees for licensure are as follows:
202.20 	(1) for a licensed social worker, $115.20 $81;
202.21 	(2) for a licensed graduate social worker, $201.60 $144;
202.22 	(3) for a licensed independent social worker, $302.40 $216; and
202.23 	(4) for a licensed independent clinical social worker, $331.20 $238.50.

202.24 	Sec. 9. Minnesota Statutes 2008, section 148E.180, subdivision 5, is amended to read:
202.25 		Subd. 5.Late fees. Late fees are as follows:
202.26 	(1) renewal late fee, one-half one-fourth of the renewal fee specified in subdivision 
202.27 	3; and
202.28 	(2) supervision plan late fee, $40.

202.29 	Sec. 10. Minnesota Statutes 2008, section 152.126, subdivision 1, is amended to read:
202.30 		Subdivision 1.Definitions. For purposes of this section, the terms defined in this 
202.31 	subdivision have the meanings given.
203.1 	(a) "Board" means the Minnesota State Board of Pharmacy established under 
203.2 	chapter 151.
203.3 	(b) "Controlled substances" means those substances listed in section 152.02, 
203.4 	subdivisions 3 and 4 to 5, and those substances defined by the board pursuant to section 
203.5 	152.02, subdivisions 7, 8, and 12.
203.6 	(c) "Dispense" or "dispensing" has the meaning given in section 151.01, subdivision 
203.7 	30. Dispensing does not include the direct administering of a controlled substance to a 
203.8 	patient by a licensed health care professional.
203.9 	(d) "Dispenser" means a person authorized by law to dispense a controlled substance, 
203.10 	pursuant to a valid prescription. For the purposes of this section, a dispenser does not 
203.11 	include a licensed hospital pharmacy that distributes controlled substances for inpatient 
203.12 	hospital care or a veterinarian who is dispensing prescriptions under section 156.18.
203.13 	(e) "Prescriber" means a licensed health care professional who is authorized to 
203.14 	prescribe a controlled substance under section 152.12, subdivision 1.
203.15 	(f) "Prescription" has the meaning given in section 151.01, subdivision 16.

203.16 	Sec. 11. Minnesota Statutes 2008, section 152.126, subdivision 2, is amended to read:
203.17 		Subd. 2.Prescription electronic reporting system. (a) The board shall establish 
203.18 	by January 1, 2010, an electronic system for reporting the information required under 
203.19 	subdivision 4 for all controlled substances dispensed within the state. 
203.20 	(b) The board may contract with a vendor for the purpose of obtaining technical 
203.21 	assistance in the design, implementation, operation, and maintenance of the electronic 
203.22 	reporting system. The vendor's role shall be limited to providing technical support to the 
203.23 	board concerning the software, databases, and computer systems required to interface with 
203.24 	the existing systems currently used by pharmacies to dispense prescriptions and transmit 
203.25 	prescription data to other third parties.

203.26 	Sec. 12. [156.011] LICENSE, APPLICATION, AND EXAMINATION FEES.
203.27 		Subdivision 1.Application fee. A person applying for a license to practice 
203.28 	veterinary medicine in Minnesota or applying for a permit to take the national veterinary 
203.29 	medical examination must pay a $60 nonrefundable application fee to the board. Persons 
203.30 	submitting concurrent applications for licensure and a national examination permit shall 
203.31 	pay only one application fee.
203.32 		Subd. 2.Examination fees. (a) An applicant for veterinary licensure in Minnesota 
203.33 	must successfully pass the Minnesota Veterinary Jurisprudence Examination. The fee for 
203.34 	this examination is $60, payable to the board.
204.1 	(b) An applicant participating in the national veterinary licensing examination must 
204.2 	complete a separate application for the national examination and submit the application 
204.3 	to the board for approval. Payment for the national examination must be made by the 
204.4 	applicant to the national board examination committee.

204.5 	Sec. 13. [156.012] INITIAL AND RENEWAL FEE.
204.6 		Subdivision 1.Required for licensure. A person now licensed to practice 
204.7 	veterinary medicine in this state, or who becomes licensed by the Board of Veterinary 
204.8 	Medicine to engage in the practice, shall pay an initial fee or a biennial license renewal 
204.9 	fee if the person wishes to practice veterinary medicine in the coming two-year period 
204.10 	or remain licensed as a veterinarian. A licensure period begins on March 1 and expires 
204.11 	the last day of February two years later. A licensee with an even-numbered license shall 
204.12 	renew by March 1 of even-numbered years and a licensee with an odd-numbered license 
204.13 	shall renew by March 1 of odd-numbered years.
204.14 		Subd. 2.Amount. The initial licensure fee and the biennial renewal fee is $280 
204.15 	and must be paid to the executive director of the board. By January 1 of the first year 
204.16 	for which the biennial renewal fee is due, the board shall issue a renewal application to 
204.17 	a current licensee to the last address maintained in the board file. Failure to receive this 
204.18 	notice does not relieve the licensee of the obligation to pay renewal fees so that they are 
204.19 	received by the board on or before the renewal date of March 1.
204.20 	Initial licenses issued after the start of the licensure renewal period are valid only 
204.21 	until the end of the period.
204.22 		Subd. 3.Date due. A licensee must apply for a renewal license on or before March 
204.23 	1 of the first year of the biennial license renewal period. A renewal license is valid 
204.24 	from March 1 through the last day of February of the last year of the two-year license 
204.25 	renewal period. An application postmarked no later than the last day of February must be 
204.26 	considered to have been received on March 1.
204.27 		Subd. 4.Late renewal penalty. An applicant for renewal must pay a late renewal 
204.28 	penalty of $140 in addition to the renewal fee if the application for renewal is received 
204.29 	after March 1 of the licensure renewal period. A renewed license issued after March 1 of 
204.30 	the licensure renewal period is valid only to the end of the period regardless of when the 
204.31 	renewal fee is received.
204.32 		Subd. 5.Reinstatement fee. An applicant for license renewal whose license 
204.33 	has previously been suspended by official board action for nonrenewal must pay a 
204.34 	reinstatement fee of $60 in addition to the $280 renewal fee and the $140 late renewal 
204.35 	penalty.
205.1 		Subd. 6.Penalty for failure to pay. Within 30 days after the renewal date, a 
205.2 	licensee who has not renewed the license must be notified by letter sent to the last known 
205.3 	address of the licensee in the file of the board that the renewal is overdue and that failure 
205.4 	to pay the current fee and current late fee within 60 days after the renewal date will result 
205.5 	in suspension of the license. A second notice must be sent by registered or certified mail at 
205.6 	least seven days before a board meeting occurring 60 days or more after the renewal date 
205.7 	to a licensee who has not paid the renewal fee and late fee.
205.8 		Subd. 7.Suspension. The board, by means of a roll call vote, shall suspend the 
205.9 	license of a licensee whose license renewal is at least 60 days overdue and to whom 
205.10 	notification has been sent as provided in subpart 5. Failure of a licensee to receive 
205.11 	notification is not grounds for later challenge by the licensee of the suspension. The 
205.12 	former licensee must be notified by registered or certified letter within seven days of the 
205.13 	board action. The suspended status placed on a license may be removed only on payment 
205.14 	of renewal fees and late penalty fees for each licensure period or part of a period that the 
205.15 	license was not renewed. A licensee who fails to renew a license for five years or more 
205.16 	must meet the criteria of section 156.071, for relicensure.
205.17 		Subd. 8.Inactive license. (a) A person holding a current active license to practice 
205.18 	veterinary medicine in Minnesota may, at the time of the person's next biennial license 
205.19 	renewal date, renew the license as an inactive license at one-half the renewal fee of an 
205.20 	active license. The license may be continued in an inactive status by renewal on a biennial 
205.21 	basis at one-half the regular license fee.
205.22 	(b) A person holding an inactive license is not permitted to practice veterinary 
205.23 	medicine in Minnesota and remains under the disciplinary authority of the board.
205.24 	(c) A person may convert a current inactive license to an active license upon 
205.25 	application to and approval by the board. The application must include:
205.26 	(1) documentation of licensure in good standing and of having met continuing 
205.27 	education requirements of current state of practice, or documentation of having met 
205.28 	Minnesota continuing education requirements retroactive to the date of licensure 
205.29 	inactivation;
205.30 	(2) certification by the applicant that the applicant is not currently under disciplinary 
205.31 	orders or investigation for acts that could result in disciplinary action in any other 
205.32 	jurisdiction; and
205.33 	(3) payment of a fee equal to the full difference between an inactive and active 
205.34 	license if converting during the first year of the biennial license cycle or payment of a fee 
205.35 	equal to one-half the difference between an inactive and an active license if converting 
205.36 	during the second year of the license cycle.
206.1 	(d) Deadline for renewal of an inactive license is March 1 of the first year of the 
206.2 	biennial license renewal period. A late renewal penalty of one-half the inactive renewal 
206.3 	fee must be paid if renewal is received after March 1.

206.4 	Sec. 14. Minnesota Statutes 2008, section 156.015, is amended to read:
206.5 	156.015 MISCELLANEOUS FEES.
206.6 		Subdivision 1.Verification of licensure. The board may charge a fee of $25 per 
206.7 	license verification to a licensee for verification of licensure status provided to other 
206.8 	veterinary licensing boards.
206.9 		Subd. 2.Continuing education review. The board may charge a fee of $50 per 
206.10 	submission to a sponsor for review and approval of individual continuing education 
206.11 	seminars, courses, wet labs, and lectures. This fee does not apply to continuing education 
206.12 	sponsors that already meet the criteria for preapproval under Minnesota Rules, part 
206.13 	9100.1000, subpart 3, item A.
206.14 		Subd. 3.Temporary license fee. A person meeting the requirements for issuance 
206.15 	of a temporary permit to practice veterinary medicine under section 156.073, pending 
206.16 	examination, who desires a temporary permit shall pay a fee of $60 to the board.
206.17 		Subd. 4.Duplicate license. A person requesting issuance of a duplicate or 
206.18 	replacement license shall pay a fee of $15 to the board.
206.19 		Subd. 5.Mailing examination and reference materials. An applicant who resides 
206.20 	outside the Twin Cities metropolitan area may request to take the Minnesota Veterinary 
206.21 	Jurisprudence Examination by mail. The fee for mailing the examination and reference 
206.22 	materials is $15.

206.23 	Sec. 15.  REPEALER.
 206.24 	(a) Minnesota Rules, parts 9100.0400, subparts 1 and 3; 9100.0500; and 9100.0600,
206.25 	are repealed.
206.26 	(b) Minnesota Statutes 2008, section 148D.180, subdivision 8, is repealed.

206.27 	ARTICLE 9
206.28 	BODY ART TECHNICIANS AND ESTABLISHMENTS

206.29 	Section 1. [146B.01] DEFINITIONS.
206.30 		Subdivision 1.Scope. The terms defined in this section apply to this chapter.
206.31 		Subd. 2.Aftercare. "Aftercare" means written instructions given to a client, 
206.32 	specific to the procedure rendered, on caring for the body art and surrounding area. These 
206.33 	instructions must include information on when to seek medical treatment.
207.1 		Subd. 3.Antiseptic. "Antiseptic" means an agent that destroys disease-causing 
207.2 	microorganisms on human skin or mucosa.
207.3 		Subd. 4.Apprentice. "Apprentice" means an individual working under the direct 
207.4 	supervision of a licensed technician in a licensed body art establishment according to 
207.5 	the requirements under section 146B.04.
207.6 		Subd. 5.Body art. "Body art" means physical body adornment using, but not 
207.7 	limited to, the following techniques: body piercing, tattooing, micropigmentation, and 
207.8 	cosmetic tattooing. This definition of body art does not include piercing of the outer 
207.9 	perimeter or lobe of the ear using a presterilized single-use stud-and-clasp ear piercing 
207.10 	system. This definition of body art does not include practices that are part of a medical 
207.11 	procedure performed by board-certified medical or dental personnel including, but not 
207.12 	limited to, implants under the skin.
207.13 		Subd. 6.Body art establishment. "Body art establishment" means any place or 
207.14 	premise, whether public or private, temporary or permanent in nature or location, where 
207.15 	the practice of body art, whether or not for profit, is performed.
207.16 		Subd. 7.Body piercing. "Body piercing" means the penetration or puncturing of 
207.17 	human skin by any method for the purpose of inserting jewelry or other objects in or 
207.18 	through the human body. This definition does not include any procedure performed by 
207.19 	a licensed or registered health professional if the procedure is within the professional's 
207.20 	scope of practice.
207.21 		Subd. 8.Commissioner. "Commissioner" means the commissioner of health.
207.22 		Subd. 9.Contaminated waste. "Contaminated waste" means: any liquid or 
207.23 	semiliquid blood or other potentially infectious materials; contaminated items that would 
207.24 	release blood or other potentially infectious materials in a liquid or semiliquid state 
207.25 	if compressed; items that are caked with dried blood or other potentially infectious 
207.26 	materials and are capable of releasing these materials during handling; and sharps and any 
207.27 	wastes containing blood and other potentially infectious materials, as defined in Code of 
207.28 	Federal Regulations, title 29, section 1910.1030, known as "Occupational Exposure to 
207.29 	Bloodborne Pathogens."
207.30 		Subd. 10.Department. "Department" means the Department of Health.
207.31 		Subd. 11.Disinfection. "Disinfection" means the destruction of disease-causing 
207.32 	microorganisms on inanimate objects or surfaces, rendering the objects safe for use or 
207.33 	handling.
207.34 		Subd. 12.Equipment. "Equipment" means all machinery, including fixtures, 
207.35 	containers, vessels, tools, devices, implements, furniture, display and storage areas, sinks, 
207.36 	and all other apparatus and appurtenances used in the operation of a body art establishment. 
208.1 		Subd. 13.Establishment plan. "Establishment plan" means a scale drawing of the 
208.2 	establishment's layout illustrating how the establishment complies with the requirements 
208.3 	of this chapter.
208.4 		Subd. 14.Guest artist. "Guest artist" means an individual who performs body art 
208.5 	procedures according to the requirements under section 146B.04.
208.6 		Subd. 15.Hand sink. "Hand sink" means a room equipped with hot and cold water 
208.7 	held under pressure, used solely for washing hands, wrists, arms, or other portions of 
208.8 	the body.
208.9 		Subd. 16.Hot water. "Hot water" means water at a temperature of at least 110 
208.10 	degrees Fahrenheit.
208.11 		Subd. 17.Jewelry. "Jewelry" means any personal ornament inserted into a newly 
208.12 	pierced area.
208.13 		Subd. 18.Liquid chemical germicide. "Liquid chemical germicide" means a 
208.14 	tuberculocidal disinfectant or sanitizer registered with the Environmental Protection 
208.15 	Agency.
208.16 		Subd. 19.Operator. "Operator" means any individual who controls, operates, 
208.17 	or manages body art activities at a body art establishment and who is responsible for 
208.18 	compliance with these regulations, whether actually performing body art activities or not.
208.19 		Subd. 20.Procedure area. "Procedure area" means the physical space or room used 
208.20 	solely for conducting body art procedures.
208.21 		Subd. 21.Procedure surface. "Procedure surface" means the surface area of 
208.22 	furniture or accessories that may come into contact with the client's clothed or unclothed 
208.23 	body during a body art procedure and the area of the client's skin where the body art 
208.24 	procedure is to be performed and the surrounding area, or any other associated work 
208.25 	area requiring sanitizing.
208.26 		Subd. 22.Sanitization. "Sanitization" means a process of reducing the numbers of 
208.27 	microorganisms on clean surfaces and equipment to a safe level.
208.28 		Subd. 23.Safe level. "Safe level" means not more than 50 colonies of 
208.29 	microorganisms per four square inches of equipment or procedure surface.
208.30 		Subd. 24.Sharps. "Sharps" means any object, sterile or contaminated, that may 
208.31 	purposefully or accidentally cut or penetrate the skin or mucosa including, but not limited 
208.32 	to, presterilized singe-use needles, scalpel blades, and razor blades.
208.33 		Subd. 25.Sharps container. "Sharps container" means a closed, puncture-resistant, 
208.34 	leak-proof container, labeled with the international biohazard symbol, that is used for 
208.35 	handling, storage, transportation, and disposal.
209.1 		Subd. 26.Single use. "Single use" means products or items intended for onetime 
209.2 	use which are disposed of after use on a client. This definition includes, but is not limited 
209.3 	to, cotton swabs or balls, tissues or paper products, paper or plastic cups, gauze and 
209.4 	sanitary coverings, razors, piercing needles, tattoo needles, scalpel blades, stencils, ink 
209.5 	cups, and protective gloves.
209.6 		Subd. 27.Standard precautions or universal precautions. "Standard precautions 
209.7 	or universal precautions" means the guidelines and controls published by the Centers for 
209.8 	Disease Control and Prevention (CDC) as "guidelines for prevention of transmission 
209.9 	of human immunodeficiency virus and hepatitis B virus to health care and public 
209.10 	safety workers" in Morbidity and Mortality Weekly Report (MMWR), June 23, 1989, 
209.11 	Vol. 38, No. S-6, and as "recommendation for preventing transmission of human 
209.12 	immunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive 
209.13 	procedures," in MMWR, July 12, 1991, Vol. 40, No. RR-Subd. T. 
209.14 		Subd. 28.Sterilization. "Sterilization" means a process resulting in the destruction 
209.15 	of all forms of microbial life, including highly resistant bacterial spores.
209.16 		Subd. 29.Tattooing. "Tattooing" means any method of placing ink or other 
209.17 	pigments into or under the skin or mucosa with needles or any other instruments used to 
209.18 	puncture the skin, resulting in permanent coloration of the skin or mucosa. This definition 
209.19 	includes cosmetic tattooing and micropigmentation.
209.20 		Subd. 30.Technician. "Technician" means any individual who conducts or 
209.21 	practices body art procedures at a body art establishment.
209.22 		Subd. 31.Temporary body art establishment. "Temporary body art establishment" 
209.23 	means any place or premise operating at a fixed location where an operator performs body 
209.24 	art procedures for no more than 21 days in conjunction with a single event or celebration.

209.25 	Sec. 2. [146B.02] ESTABLISHMENT LICENSE PROCEDURES.
209.26 		Subdivision 1.General. Beginning January 1, 2010, no person acting generally 
209.27 	or jointly with any other person may maintain, own, or operate a body art establishment 
209.28 	in the state without an establishment license issued by the commissioner in accordance 
209.29 	with this chapter.
209.30 		Subd. 2.Requirements. (a) Each application for an establishment license must be 
209.31 	submitted to the commissioner on a form provided by the commissioner accompanied 
209.32 	with the applicable fee required under section 146B.10. The application must contain:
209.33 	(1) the name of the owner and operator of the establishment;
209.34 	(2) certificates of compliance with all applicable local and state codes;
209.35 	(3) a description of the general nature of the business;
210.1 	(4) a copy of a to-scale drawing of the establishment's layout that provides sufficient 
210.2 	detail to ensure compliance with the requirements of this chapter; and
210.3 	(5) any other relevant information deemed necessary by the commissioner.
210.4 	(b) Upon approval, the commissioner shall issue an establishment license. The 
210.5 	license is valid commencing on the date of issuance for three years after which time the 
210.6 	license may be renewed upon approval by the commissioner. 
210.7 		Subd. 3.Inspection. (a) Before issuing an initial license or renewing a license, the 
210.8 	commissioner shall conduct an inspection of the body art establishment and a review of 
210.9 	any records necessary to ensure that the standards required under this chapter are met.
210.10 	(b) If the establishment seeking licensure is new construction or if a licensed 
210.11 	establishment is remodeling, the commissioner shall inspect the establishment at least 
210.12 	once during the construction or remodeling process to ensure that construction is in 
210.13 	conformance with this chapter.
210.14 	(c) The commissioner shall have the authority to enter the premises to make the 
210.15 	inspection. Refusal to permit an inspection constitutes valid grounds for licensure denial 
210.16 	or revocation.
210.17 		Subd. 4.Location restricted. No person may perform body art procedures at 
210.18 	any location other than a body art establishment licensed under this chapter except as 
210.19 	permitted under subdivisions 6 and 8.
210.20 		Subd. 5.Transfer and display of license. A body art establishment license must 
210.21 	be issued to a specific person and location and is not transferable. A valid license must 
210.22 	be prominently displayed onsite.
210.23 		Subd. 6.Temporary events permit. (a) An owner or operator of a temporary 
210.24 	body establishment shall submit an application for a temporary events permit to the 
210.25 	commissioner at least 14 days before the start of the event. The application must include 
210.26 	the specific days and hours of operation. The owner or operator shall comply with the 
210.27 	requirements of this chapter.
210.28 	(b) The temporary events permit must be prominently displayed at the location.
210.29 	(c) The temporary events permit, if approved, must be valid for the specified dates 
210.30 	and hours listed on the application. No temporary events permit may be issued for longer 
210.31 	than a 21-day period.
210.32 		Subd. 7.Establishment information. The following information must be kept on 
210.33 	file for two years on the premises of the establishment and must be made available for 
210.34 	inspection upon request by the commissioner:
210.35 	(1) a description of all body art procedures performed by the establishment; 
211.1 	(2) an inventory of instruments, body jewelry, sharps, inks, or pigments used for all 
211.2 	procedures, including the names of manufacturers and serial and lot numbers, if available;
211.3 	(3) copies of the spore tests conducted in the sterilizer; and
211.4 	(4) the following information for each technician, apprentice, or guest artist 
211.5 	employed or performing body art procedures in the establishment:
211.6 	(i) name;
211.7 	(ii) home address;
211.8 	(iii) home telephone number;
211.9 	(iv) date of birth;
211.10 	(v) copy of an identification photo;
211.11 	(vi) duties performed; and
211.12 	(vii) license number or apprenticeship or guest artist registration number.
211.13 		Subd. 8.Exception. (a) Any body art establishment located within a county or 
211.14 	municipal jurisdiction that has enacted an ordinance that establishes licensure for body art 
211.15 	establishments operating within the jurisdiction shall be exempt from this chapter if the 
211.16 	provisions of the ordinance meet or exceed the provisions of this chapter.
211.17 	(b) Any technician, apprentice, or guest artist employed by or performing body art 
211.18 	procedures in the establishment must be licensed or registered as required under this 
211.19 	chapter.

211.20 	Sec. 3. [146B.03] LICENSURE FOR BODY ART TECHNICIANS.
211.21 		Subdivision 1.Licensure required. Effective January 1, 2010, no individual may 
211.22 	perform body art procedures unless the individual holds a valid technician license issued 
211.23 	by the commissioner under this chapter, except as provided in subdivision 3.
211.24 		Subd. 2.Designation. No individual may use the title of "tattooist," "tattoo artist," 
211.25 	"body piercer," "body piercing artist," or other letters or titles in connection with that 
211.26 	individual's name which in any way represents that the individual is engaged in the 
211.27 	practice of tattooing or body piercing, or authorized to do so, unless the individual is 
211.28 	licensed and authorized to perform body art procedures under this chapter.
211.29 		Subd. 3.Exceptions. (a) The following individuals may perform body art 
211.30 	procedures within the scope of their practice without a technician's license:
211.31 	(1) a physician licensed under chapter 147; 
211.32 	(2) a nurse licensed under sections 148.171 to 148.285; 
211.33 	(3) a chiropractor licensed under chapter 148; 
211.34 	(4) an acupuncturist licensed under chapter 147B; 
211.35 	(5) a physician assistant licensed under chapter 147A; or 
212.1 	(6) a dental professional licensed or registered under chapter 150A.
212.2 	(b) An individual registered as an apprentice or guest artist under section 146B.04 
212.3 	may perform body art procedures in accordance with the requirements of section 146B.04 
212.4 	without a technician's license.
212.5 		Subd. 4.Licensure requirements. (a) An applicant for licensure under this section 
212.6 	shall submit to the commissioner on a form provided by the commissioner:
212.7 	(1) proof that the applicant is over the age of 18; 
212.8 	(2) all fees required under section 146B.10; 
212.9 	(3) proof of completing a minimum of 200 hours of supervised training as an 
212.10 	apprentice under section 146B.04;
212.11 	(4) proof of having satisfactorily completed a course approved by the commissioner 
212.12 	on bloodborne pathogens, the prevention of disease transmission, infection control, and 
212.13 	aseptic technique. Courses to be considered for approval by the commissioner may 
212.14 	include those administered by one of the following:
212.15 	(i) the American Red Cross;
212.16 	(ii) United States Occupational Safety and Health Administration (OSHA); or 
212.17 	(iii) the Alliance of Professional Tattooists; and 
212.18 	(5) any other relevant information requested by the commissioner.
212.19 	(b) Until January 1, 2011, the supervised training requirement under paragraph (a), 
212.20 	clause (3), shall be waived by the commissioner if the applicant submits evidence to 
212.21 	the commissioner that the applicant has, at a minimum, 200 hours of performing body 
212.22 	art procedures within the last five years.
212.23 		Subd. 5.Action on licensure applications. The commissioner shall notify the 
212.24 	applicant in writing of the action taken on the application. If licensure is denied, the 
212.25 	applicant must be notified of the determination and the grounds for it, and the applicant 
212.26 	may request a hearing on the determination by filing a written statement with the 
212.27 	commissioner within 20 days after receipt of the notice of denial. After the hearing, the 
212.28 	commissioner shall notify the applicant in writing of the decision.
212.29 		Subd. 6.License by reciprocity. The commissioner shall issue a technician's 
212.30 	license to a person who holds a current license, certification, or registration from another 
212.31 	state if the commissioner determines that the standards for licensure, certification, or 
212.32 	registration in the other jurisdiction meets or exceeds the requirements for licensure stated 
212.33 	in this chapter and a letter is received from that jurisdiction stating that the applicant 
212.34 	is in good standing.
213.1 		Subd. 7.Licensure term; renewal. A technician's license is valid for one year from 
213.2 	the date of issuance and may be renewed upon payment of the renewal fee established 
213.3 	under section 146B.10.
213.4 		Subd. 8.Transfer and display of license. A license issued under this section is 
213.5 	not transferable to another individual. A valid license must be located at the site and 
213.6 	available to the public upon request.

213.7 	Sec. 4. [146B.04] APPRENTICESHIP AND GUEST ARTISTS.
213.8 		Subdivision 1.General. Before an individual may begin an apprenticeship or work 
213.9 	as a guest artist, a licensed technician shall register the apprentice or guest artist with the 
213.10 	commissioner by submitting the name of the apprentice or guest artist to the commissioner 
213.11 	on a form provided by the commissioner. The form must include:
213.12 	(1) the name of the apprentice or guest artist;
213.13 	(2) the name of the licensed technician supervising the apprenticeship or sponsoring 
213.14 	the guest artist; 
213.15 	(3) proof of having satisfactorily completed a course approved by the commissioner 
213.16 	on bloodborne pathogens, the prevention of disease transmission, infection control, and 
213.17 	aseptic technique; and
213.18 	(4) the starting and anticipated completion dates of the apprenticeship or the dates 
213.19 	the guest artist will be working.
213.20 		Subd. 2.Supervision. An apprentice shall complete a minimum of 200 hours of 
213.21 	training under the direct supervision of a licensed technician. For purposes of this chapter, 
213.22 	"direct supervision" means that a licensed technician is present when the apprentice is 
213.23 	performing body art procedures.
213.24 		Subd. 3.Guest artists. A guest artist may not conduct body art procedures for more 
213.25 	than 30 days per calendar year per licensed establishment. If the guest artist exceeds this 
213.26 	time period, the guest artist shall apply for a technician's license.

213.27 	Sec. 5. [146B.05] GROUNDS FOR EMERGENCY CLOSURE.
213.28 		Subdivision 1.General. If any of the following conditions exist, the owner or 
213.29 	operator of a licensed establishment may be ordered by the commissioner to discontinue 
213.30 	all operations of a licensed body art establishment:
213.31 	(1) evidence of a sewage backup in an area of the body art establishment where 
213.32 	body art activities are conducted;
213.33 	(2) lack of potable, plumbed, or hot or cold water to the extent that handwashing or 
213.34 	toilet facilities are not operational;
214.1 	(3) lack of electricity or gas service to the extent that handwashing, lighting, or 
214.2 	toilet facilities are not operational;
214.3 	(4) significant damage to the body art establishment due to tornado, fire, flood, 
214.4 	or another disaster;
214.5 	(5) evidence of an infestation of rodents or other vermin;
214.6 	(6) evidence of contamination, filthy conditions, untrained staff, or poor personal 
214.7 	hygiene;
214.8 	(7) evidence of existence of a public health nuisance;
214.9 	(8) use of instruments or jewelry that are not sterile;
214.10 	(9) failure to maintain required records;
214.11 	(10) failure to use gloves as required;
214.12 	(11) failure to properly dispose of sharps, blood or body fluids, or items contaminated 
214.13 	by blood or body fluids;
214.14 	(12) failure to properly report complaints of potential bloodborne pathogen 
214.15 	transmission to the commissioner; or
214.16 	(13) evidence of a positive spore test on the sterilizer.
214.17 		Subd. 2.Reopening requirements. Prior to reopening, the establishment shall 
214.18 	submit to the commissioner satisfactory proof that the problem condition causing the 
214.19 	need for the emergency closure has been corrected or removed by the operator of the 
214.20 	establishment. A body art establishment may not reopen without the written approval of 
214.21 	the commissioner.

214.22 	Sec. 6. [146B.06] STANDARDS FOR HEALTH AND SAFETY.
214.23 		Subdivision 1.Establishment standards. (a) Except as permitted under subdivision 
214.24 	2, the body art establishment must meet the health and safety standards in this subdivision 
214.25 	before a licensed technician may conduct body art procedures at the establishment.
214.26 	(b) There must be no less than 45 square feet of floor space for each procedure 
214.27 	area in the body art establishment.
214.28 	(c) The procedure area must be separated from the bathroom, retail sales area, hair 
214.29 	salon area, or any other area that may cause potential contamination of work surfaces.
214.30 	(d) For clients requesting privacy, at a minimum, a divider, curtain, or partition must 
214.31 	be provided to separate multiple procedure areas.
214.32 	(e) All procedure surfaces must be smooth, nonabsorbent, and easily cleanable.
214.33 	(f) The establishment must have a readily accessible hand sink that is not in a 
214.34 	restroom, does not require access through a door, and is equipped with:
214.35 	(1) potable hot and cold running water under pressure;
215.1 	(2) liquid hand soap;
215.2 	(3) single-use paper towels; and
215.3 	(4) a garbage can with a foot-operated lid or with no lid.
215.4 	(g) The establishment must have at least one available bathroom equipped with a 
215.5 	toilet and a hand sink, which must be supplied with:
215.6 	(1) potable hot and cold running water under pressure;
215.7 	(2) liquid hand soap;
215.8 	(3) single-use paper towels or a mechanical hand drier or blower;
215.9 	(4) a garbage can with a foot-operated lid or with no lid;
215.10 	(5) a self-closing door; and
215.11 	(6) adequate ventilation.
215.12 	(h) An artificial light source equivalent to 20-foot candles at three feet above the 
215.13 	floor.
215.14 	(i) At least 100-foot candles of light must be provided at the level where body 
215.15 	art procedures are performed, where sterilization takes place, and where instruments 
215.16 	and sharps are assembled.
215.17 	(j) All ceilings in the body art establishment must be in good condition.
215.18 	(k) All walls and floors must be free of open holes or cracks and be washable.
215.19 	(l) All facilities within the establishment must be maintained in a clean and sanitary 
215.20 	condition and in good working order.
215.21 	(m) No animals shall be allowed in the procedure area, unless the animal is a 
215.22 	service animal.
215.23 		Subd. 2.Establishment exception. (a) Any establishment that is operating as a 
215.24 	body art establishment on August 1, 2009, is exempt from any health and safety standard 
215.25 	required under subdivision 1 that would require remodeling in order to comply including, 
215.26 	but not limited to, adding a new procedure area, plumbing changes, or expanding existing 
215.27 	space. If the establishment proceeds with any remodeling plans after August 1, 2009, the 
215.28 	remodeling must meet all health and safety standards required under subdivision 1.
215.29 	(b) An exemption from any of the standards in subdivision 1 must be approved by 
215.30 	the commissioner.
215.31 		Subd. 3.Standards for equipment, instruments, and supplies. (a) Equipment, 
215.32 	instruments, and supplies must comply with the health and safety standards in this 
215.33 	subdivision before a licensed technician may conduct body art procedures.
215.34 	(b) Jewelry used as part of a body piercing procedure must be made of surgical 
215.35 	implant-grade stainless steel, solid 14-karat or 18-karat white or yellow gold, niobium, 
215.36 	titanium, or platinum, or a dense low-porosity plastic.
216.1 	(c) Jewelry used as part of a body piercing procedure must be free of nicks, 
216.2 	scratches, or irregular surfaces and must be properly sterilized before use.
216.3 	(d) Reusable instruments must be thoroughly washed to remove all organic matter, 
216.4 	rinsed, and sterilized before and after use.
216.5 	(e) Needles must be single-use needles and sterilized before use.
216.6 	(f) Sterilization must be conducted using steam heat or chemical vapor.
216.7 	(g) Steam heat sterilization units must be operated according to the manufacturer's 
216.8 	specifications.
216.9 	(h) At least once a month, but not to exceed 30 days between tests, a spore test must 
216.10 	be conducted on the sterilizer to ensure that it is working properly. If a positive spore test 
216.11 	result is received, the sterilizer may not be used until a negative result is obtained.
216.12 	(i) All inks and other pigments used in a body art procedure must be specifically 
216.13 	manufactured for tattoo procedures. Approved inks and pigments may be diluted with 
216.14 	distilled water or alcohol.
216.15 	(j) Immediately before applying a tattoo, the quantity of the ink needed must be 
216.16 	transferred from the ink bottle and placed into single-use paper or plastic cups immediately 
216.17 	before applying the tattoo. Upon completion of the tattoo, the single-use cups and their 
216.18 	contents must be discarded.
216.19 	(k) All tables, chairs, furniture, or other procedure surfaces that may be exposed to 
216.20 	blood or body fluids during the tattooing or body piercing procedure must be cleanable 
216.21 	and must be sanitized after each client with a liquid chemical germicide.
216.22 	(l) Single-use towels or wipes must be provided to the client. These towels must be 
216.23 	dispensed in a manner that precludes contamination and disposed of in a washable garbage 
216.24 	container with a foot-operated lid or with no lid and a liner.
216.25 	(m) All bandages and surgical dressings used must be sterile or bulk-packaged 
216.26 	clean and stored in a clean, closed container.
216.27 	(n) All equipment and instruments must be maintained in good working order and in 
216.28 	a clean and sanitary condition.
216.29 	(o) All instruments and supplies must be stored clean and dry in covered containers.
216.30 	(p) Single-use disposable barriers must be provided on all equipment that cannot be 
216.31 	sterilized as part of the procedure as required under this section including, but not limited 
216.32 	to, spray bottles, procedure light fixture handles, and tattoo machines.
216.33 		Subd. 4.Standards for body art procedures. (a) Body art procedures must comply 
216.34 	with the health and safety standards in this subdivision.
217.1 	(b) The skin area subject to a body art procedure must be thoroughly cleaned 
217.2 	with soap and water, rinsed thoroughly, and swabbed with an antiseptic solution. Only 
217.3 	single-use towels or wipes may be used to clean the skin.
217.4 	(c) Whenever it is necessary to shave the skin, a new disposable razor must be 
217.5 	used for each client.
217.6 	(d) No body art procedure may be performed on any area of the skin where there is 
217.7 	an evident infection, irritation, or open wound.
217.8 	(e) Single-use gloves of adequate size and quality to preserve dexterity must be 
217.9 	used for touching clients, for handling sterile instruments, or for handling blood or body 
217.10 	fluids. Nonlatex gloves must be provided for use with clients or employees who request 
217.11 	them. Gloves must be changed if a glove becomes damaged or comes in contact with 
217.12 	any nonclean surface or objects or with a third person. At a minimum, gloves must be 
217.13 	discarded after the completion of a procedure on a client. Hands and wrists must be 
217.14 	washed before putting on a clean pair of gloves and after removing a pair of gloves. 
217.15 	Gloves may not be reused.
217.16 		Subd. 5.Standards for technicians. (a) Technicians must comply with the health 
217.17 	and safety standards in this subdivision.
217.18 	(b) Technicians must scrub their hands and wrists thoroughly for 20 seconds before 
217.19 	and after performing a body art procedure. Technicians must also wash hands after contact 
217.20 	with the client receiving the procedure or after contact with potentially contaminated 
217.21 	materials.
217.22 	(c) Technicians must wear clean clothing and use a disposable barrier, such as an 
217.23 	apron, when performing body art procedures.
217.24 	(d) A technician may not smoke, eat, or drink while performing body art procedures.
217.25 		Subd. 6.Contamination standards. (a) Infectious waste and sharps must be 
217.26 	managed according to sections 116.76 to 116.83 and must be disposed of by an approved 
217.27 	infectious waste hauler at a site permitted to accept the waste, according to Minnesota 
217.28 	Rules, parts 7035.9100 to 7035.9150. Sharps ready for disposal must be disposed of 
217.29 	in an approved sharps container.
217.30 	(b) Contaminated waste that may release liquid blood or body fluids when 
217.31 	compressed or that may release dried blood or body fluids when handled must be placed in 
217.32 	an approved red bag that is marked with the international biohazard symbol.
217.33 	(c) Contaminated waste that does not release liquid blood or body fluids when 
217.34 	compressed or handled may be placed in a covered receptacle and disposed of through 
217.35 	normal approved disposal methods.
218.1 	(d) Storage of contaminated waste onsite must not exceed the period specified by 
218.2 	Code of Federal Regulations, title 29, section 1910.1030.

218.3 	Sec. 7. [146B.07] PROFESSIONAL STANDARDS.
218.4 		Subdivision 1.Standard practice. (a) A technician shall require proof of age 
218.5 	before performing any body art procedure on a client. Proof of age must be established 
218.6 	by one of the following methods:
218.7 	(1) a valid driver's license or identification card issued by the state of Minnesota or 
218.8 	another state that includes a photograph and date of birth of the individual; 
218.9 	(2) a valid military identification card issued by the United States Department of 
218.10 	Defense; 
218.11 	(3) a valid passport;
218.12 	(4) a resident alien card; or
218.13 	(5) a tribal identification card.
218.14 	(b) No technician shall tattoo or pierce any individual under the age of 18 years 
218.15 	unless the individual provides a notarized parental consent or the individual's parent or 
218.16 	legal guardian is present. The consent must include both the custodial and noncustodial 
218.17 	parents, where applicable. Nipple and genital piercing or tattooing is prohibited on an 
218.18 	individual under the age of 18 years regardless of parental consent. 
218.19 	(c) Before performing any body art procedure, the technician must provide the client 
218.20 	with a disclosure and authorization form that indicates whether the client has:
218.21 	(1) diabetes; 
218.22 	(2) a history of hemophilia; 
218.23 	(3) a history of skin diseases, skin lesions, or skin sensitivities to soap or 
218.24 	disinfectants; 
218.25 	(4) a history of epilepsy, seizures, fainting, or narcolepsy;
218.26 	(5) any condition that requires the client to take medications such as anticoagulants 
218.27 	that thin the blood or interfere with blood clotting; or 
218.28 	(6) any other information that would aid the technician in the body art procedure 
218.29 	process evaluation.
218.30 	The technician shall ask the client to sign and date the disclosure and authorization form 
218.31 	confirming that the information listed on the form was provided.
218.32 	(d) No technician shall perform body art procedures on any individual who appears 
218.33 	to be under the influence of alcohol, controlled substances as defined in section 152.01, 
218.34 	subdivision 4, or hazardous substances as defined in rules adopted under chapter 182.
219.1 	(e) No technician shall perform body art procedures while under the influence of 
219.2 	alcohol, controlled substances as defined under section 152.01, subdivision 4, or hazardous 
219.3 	substances as defined in the rules adopted under chapter 182.
219.4 	(f) No technician shall administer anesthetic injections or other medications. 
219.5 		Subd. 2.Informed consent. Before performing a body art procedure, the technician 
219.6 	shall obtain from the client a signed and dated informed consent form. The consent form 
219.7 	must disclose:
219.8 	(1) that a tattoo is considered permanent and may only be removed with a surgical 
219.9 	procedure and that any effective removal may leave scarring; and
219.10 	(2) that a piercing may leave scarring.
219.11 		Subd. 3.Client record maintenance. For each client, the body art establishment 
219.12 	operator shall maintain proper records of each procedure. The records of the procedure 
219.13 	must be kept for two years and must be available for inspection by the commissioner upon 
219.14 	request. The record must include the following:
219.15 	(1) the date of the procedure;
219.16 	(2) the information on the required picture identification showing the name, age, 
219.17 	and current address of the client; 
219.18 	(3) a copy of the release form signed and dated by the client required under 
219.19 	subdivision 1, paragraph (c);
219.20 	(4) a description of the body art procedure performed;
219.21 	(5) the name and license number of the technician performing the procedure; 
219.22 	(6) a copy of the consent form required under subdivision 2; and 
219.23 	(7) if the client is under the age of 18 years, a copy of the consent form signed by the 
219.24 	parents as required under subdivision 1.
219.25 		Subd. 4.Aftercare. A technician shall provide each client with verbal and 
219.26 	written instructions for the care of the tattooed or pierced site upon the completion of 
219.27 	the procedure. The written instructions must advise the client to consult a health care 
219.28 	professional at the first sign of infection. 
219.29 		Subd. 5.State, county, and municipal public health regulations. An operator 
219.30 	and technician shall comply with all applicable state, county, and municipal requirements 
219.31 	regarding public health.
219.32 		Subd. 6.Notification. The operator of the body art establishment shall immediately 
219.33 	notify the commissioner or local health authority of any reports they receive of a potential 
219.34 	bloodborne pathogen transmission.

220.1 	Sec. 8. [146B.08] INVESTIGATION PROCESS AND GROUNDS FOR 
220.2 	DISCIPLINARY ACTION.
220.3 		Subdivision 1.Investigations of complaints. The commissioner may initiate an 
220.4 	investigation upon receiving a signed complaint or other signed written communication 
220.5 	that alleges or implies that an individual or establishment has violated this chapter or the 
220.6 	rules adopted according to this chapter. According to section 214.13, subdivision 6, in 
220.7 	the receipt, investigation, and hearing of a complaint that alleges or implies an individual 
220.8 	or establishment has violated this chapter, the commissioner shall follow the procedures 
220.9 	in section 214.10.
220.10 		Subd. 2.Rights of applicants and licensees. The rights of an applicant denied 
220.11 	licensure are stated in section 146B.03, subdivision 5. A licensee may not be subjected to 
220.12 	disciplinary action under this section without first having an opportunity for a contested 
220.13 	case hearing under chapter 14.
220.14 		Subd. 3.Grounds for disciplinary action by commissioner. The commissioner 
220.15 	may take any of the disciplinary actions listed in subdivision 4 on proof that a technician 
220.16 	or an operator of an establishment has:
220.17 	(1) intentionally submitted false or misleading information to the commissioner;
220.18 	(2) failed, within 30 days, to provide information in response to a written request, 
220.19 	via certified mail, by the commissioner;
220.20 	(3) violated any provision of this chapter;
220.21 	(4) failed to perform services with reasonable judgment, skill, or safety due to the 
220.22 	use of alcohol or drugs, or other physical or mental impairment;
220.23 	(5) aided or abetted another person in violating any provision of this chapter;
220.24 	(6) been or is being disciplined by another jurisdiction, if any of the grounds for the 
220.25 	discipline are the same or substantially equivalent to those under this chapter; 
220.26 	(7) not cooperated with the commissioner in an investigation conducted according to 
220.27 	subdivision 1;
220.28 	(8) advertised in a manner that is false or misleading;
220.29 	(9) engaged in conduct likely to deceive, defraud, or harm the public; 
220.30 	(10) demonstrated a willful or careless disregard for the health, welfare, or safety 
220.31 	of a client;
220.32 	(11) obtained money, property, or services from a client through harassment, duress, 
220.33 	deception, or fraud; or 
220.34 	(12) failed to refer a client for medical evaluation or to other health care professionals 
220.35 	when appropriate or when a client indicated symptoms associated with diseases that 
220.36 	could be medically or surgically treated. 
221.1 		Subd. 4.Disciplinary actions. If the commissioner finds that a technician or 
221.2 	an operator of an establishment should be disciplined according to subdivision 3, the 
221.3 	commissioner may take any one or more of the following actions:
221.4 	(1) refuse to grant or renew licensure;
221.5 	(2) suspend licensure for a period not exceeding one year;
221.6 	(3) revoke licensure;
221.7 	(4) take any reasonable lesser action against an individual upon proof that the 
221.8 	individual has violated this chapter; or
221.9 	(5) impose, for each violation, a civil penalty not exceeding $10,000 that deprives 
221.10 	the licensee of any economic advantage gained by the violation and that reimburses the 
221.11 	department for costs of the investigation and proceedings resulting in disciplinary action, 
221.12 	including the amount paid for services of the Office of Administrative Hearings, the 
221.13 	amount paid for services of the Office of the Attorney General, attorney fees, court 
221.14 	reporters, witnesses, reproduction of records, department staff time, and expenses incurred 
221.15 	by department staff.
221.16 		Subd. 5.Consequences of disciplinary actions. Upon the suspension or revocation 
221.17 	of licensure, the technician or establishment shall cease to:
221.18 	(1) perform body art procedures;
221.19 	(2) use titles protected under this chapter; and
221.20 	(3) represent to the public that the technician or establishment is licensed by the 
221.21 	commissioner.
221.22 		Subd. 6.Reinstatement requirements after disciplinary action. A technician 
221.23 	who has had licensure suspended may petition on forms provided by the commissioner 
221.24 	for reinstatement following the period of suspension specified by the commissioner. The 
221.25 	requirements of section 146B.03 for renewing licensure must be met before licensure 
221.26 	may be reinstated. 

221.27 	Sec. 9. [146B.09] COUNTY OR MUNICIPAL REGULATION.
221.28 	Nothing in this chapter preempts or supersedes any county or municipal ordinances 
221.29 	relating to land use, building and construction requirements, nuisance control, or the 
221.30 	licensing of commercial enterprises in general. 

221.31 	Sec. 10. [146B.10] FEES.
221.32 		Subdivision 1.Annual licensing fees. (a) The fee for the initial technician licensure 
221.33 	and annual licensure renewal is $100.
221.34 	(b) The fee for the establishment licensure is $1,000.
222.1 	(c) The fee for a temporary body art establishment permit renewal is $75.
222.2 		Subd. 2.Penalty for late renewals. The penalty fee for late submission for renewal 
222.3 	applications is $75.
222.4 		Subd. 3.Deposit. Fees collected by the commissioner under this section must be 
222.5 	deposited in the state government special revenue fund.

222.6 	ARTICLE 10
222.7 	HEALTH CARE

222.8 	Section 1. Minnesota Statutes 2008, section 60A.092, subdivision 2, is amended to 
222.9 	read:
222.10 		Subd. 2.Licensed assuming insurer. Reinsurance is ceded to an assuming insurer 
222.11 	if the assuming insurer is licensed to transact insurance or reinsurance in this state. For 
222.12 	purposes of reinsuring any health risk, an insurer is defined under section 62A.63.

222.13 	Sec. 2. Minnesota Statutes 2008, section 62D.03, subdivision 4, is amended to read:
222.14 		Subd. 4.Application requirements. Each application for a certificate of authority 
222.15 	shall be verified by an officer or authorized representative of the applicant, and shall be 
222.16 	in a form prescribed by the commissioner of health. Each application shall include the 
222.17 	following:
222.18 	(a) a copy of the basic organizational document, if any, of the applicant and of 
222.19 	each major participating entity; such as the articles of incorporation, or other applicable 
222.20 	documents, and all amendments thereto;
222.21 	(b) a copy of the bylaws, rules and regulations, or similar document, if any, and all 
222.22 	amendments thereto which regulate the conduct of the affairs of the applicant and of 
222.23 	each major participating entity;
222.24 	(c) a list of the names, addresses, and official positions of the following:
222.25 	(1) all members of the board of directors, or governing body of the local government 
222.26 	unit, and the principal officers and shareholders of the applicant organization; and
222.27 	(2) all members of the board of directors, or governing body of the local government 
222.28 	unit, and the principal officers of the major participating entity and each shareholder 
222.29 	beneficially owning more than ten percent of any voting stock of the major participating 
222.30 	entity;
222.31 	The commissioner may by rule identify persons included in the term "principal 
222.32 	officers";
222.33 	(d) a full disclosure of the extent and nature of any contract or financial arrangements 
222.34 	between the following:
223.1 	(1) the health maintenance organization and the persons listed in clause (c)(1);
223.2 	(2) the health maintenance organization and the persons listed in clause (c)(2);
223.3 	(3) each major participating entity and the persons listed in clause (c)(1) concerning 
223.4 	any financial relationship with the health maintenance organization; and
223.5 	(4) each major participating entity and the persons listed in clause (c)(2) concerning 
223.6 	any financial relationship with the health maintenance organization;
223.7 	(e) the name and address of each participating entity and the agreed upon duration of 
223.8 	each contract or agreement;
223.9 	(f) a copy of the form of each contract binding the participating entities and the 
223.10 	health maintenance organization. Contractual provisions shall be consistent with the 
223.11 	purposes of sections 62D.01 to 62D.30, in regard to the services to be performed under the 
223.12 	contract, the manner in which payment for services is determined, the nature and extent 
223.13 	of responsibilities to be retained by the health maintenance organization, the nature and 
223.14 	extent of risk sharing permissible, and contractual termination provisions; 
223.15 	(g) a copy of each contract binding major participating entities and the health 
223.16 	maintenance organization. Contract information filed with the commissioner shall be 
223.17 	confidential and subject to the provisions of section 13.37, subdivision 1, clause (b), upon 
223.18 	the request of the health maintenance organization. 
223.19 	Upon initial filing of each contract, the health maintenance organization shall file 
223.20 	a separate document detailing the projected annual expenses to the major participating 
223.21 	entity in performing the contract and the projected annual revenues received by the entity 
223.22 	from the health maintenance organization for such performance. The commissioner 
223.23 	shall disapprove any contract with a major participating entity if the contract will result 
223.24 	in an unreasonable expense under section 62D.19. The commissioner shall approve or 
223.25 	disapprove a contract within 30 days of filing. 
223.26 	Within 120 days of the anniversary of the implementation of each contract, the 
223.27 	health maintenance organization shall file a document detailing the actual expenses 
223.28 	incurred and reported by the major participating entity in performing the contract in the 
223.29 	preceding year and the actual revenues received from the health maintenance organization 
223.30 	by the entity in payment for the performance;
223.31 	(h) a statement generally describing the health maintenance organization, its health 
223.32 	maintenance contracts and separate health service contracts, facilities, and personnel, 
223.33 	including a statement describing the manner in which the applicant proposes to provide 
223.34 	enrollees with comprehensive health maintenance services and separate health services;
223.35 	(i) a copy of the form of each evidence of coverage to be issued to the enrollees;
224.1 	(j) a copy of the form of each individual or group health maintenance contract 
224.2 	and each separate health service contract which is to be issued to enrollees or their 
224.3 	representatives;
224.4 	(k) financial statements showing the applicant's assets, liabilities, and sources of 
224.5 	financial support. If the applicant's financial affairs are audited by independent certified 
224.6 	public accountants, a copy of the applicant's most recent certified financial statement 
224.7 	may be deemed to satisfy this requirement;
224.8 	(l) a description of the proposed method of marketing the plan, a schedule of 
224.9 	proposed charges, and a financial plan which includes a three-year projection of the 
224.10 	expenses and income and other sources of future capital;
224.11 	(m) a statement reasonably describing the geographic area or areas to be served and 
224.12 	the type or types of enrollees to be served;
224.13 	(n) a description of the complaint procedures to be utilized as required under section 
224.14 	62D.11; 
224.15 	(o) a description of the procedures and programs to be implemented to meet the 
224.16 	requirements of section 62D.04, subdivision 1, clauses (b) and (c) and to monitor the 
224.17 	quality of health care provided to enrollees; 
224.18 	(p) a description of the mechanism by which enrollees will be afforded an 
224.19 	opportunity to participate in matters of policy and operation under section 62D.06; 
224.20 	(q) a copy of any agreement between the health maintenance organization and 
224.21 	an insurer or, including any  nonprofit health service corporation or another health 
224.22 	maintenance organization, regarding reinsurance, stop-loss coverage, insolvency 
224.23 	coverage, or any other type of coverage for potential costs of health services, as authorized 
224.24 	in sections 62D.04, subdivision 1, clause (f), 62D.05, subdivision 3, and 62D.13; 
224.25 	(r) a copy of the conflict of interest policy which applies to all members of the board 
224.26 	of directors and the principal officers of the health maintenance organization, as described 
224.27 	in section 62D.04, subdivision 1, paragraph (g). All currently licensed health maintenance 
224.28 	organizations shall also file a conflict of interest policy with the commissioner within 60 
224.29 	days after August 1, 1990, or at a later date if approved by the commissioner; 
224.30 	(s) a copy of the statement that describes the health maintenance organization's prior 
224.31 	authorization administrative procedures; and
224.32 	(t) other information as the commissioner of health may reasonably require to be 
224.33 	provided.

224.34 	Sec. 3. Minnesota Statutes 2008, section 62D.05, subdivision 3, is amended to read:
225.1 		Subd. 3.Contracts; health services. A health maintenance organization may 
225.2 	contract with providers of health care services to render the services the health maintenance 
225.3 	organization has promised to provide under the terms of its health maintenance contracts, 
225.4 	may, subject to section 62D.12, subdivision 11, enter into separate prepaid dental contracts, 
225.5 	or other separate health service contracts, may, subject to the limitations of section 
225.6 	62D.04, subdivision 1, clause (f), contract with insurance companies and, including 
225.7 	 nonprofit health service plan corporations or other health maintenance organizations, 
225.8 	for insurance, indemnity or reimbursement of its cost of providing health care services 
225.9 	for enrollees or against the risks incurred by the health maintenance organization, may 
225.10 	contract with insurance companies and nonprofit health service plan corporations for 
225.11 	insolvency insurance coverage, and may contract with insurance companies and nonprofit 
225.12 	health service plan corporations to insure or cover the enrollees' costs and expenses in the 
225.13 	health maintenance organization, including the customary prepayment amount and any 
225.14 	co-payment obligations, and may contract to provide reinsurance or insolvency insurance 
225.15 	coverage to health insurers or nonprofit health service plan corporations.  

225.16 	Sec. 4. Minnesota Statutes 2008, section 62J.692, subdivision 7, is amended to read:
225.17 		Subd. 7.Transfers from the commissioner of human services. (a) The amount 
225.18 	transferred according to section 256B.69, subdivision 5c, paragraph (a), clause (1), shall 
225.19 	be distributed by the commissioner annually to clinical medical education programs that 
225.20 	meet the qualifications of subdivision 3 based on the formula in subdivision 4, paragraph 
225.21 	(a) Of the amount transferred according to section 256B.69, subdivision 5c, paragraph (a), 
225.22 	clauses (1) to (4), $21,714,000 shall be distributed as follows:
225.23 	(1) $2,157,000 shall be distributed by the commissioner to the University of 
225.24 	Minnesota Board of Regents for the purposes described in sections 137.38 to 137.40;
225.25 	(2) $1,035,360 shall be distributed by the commissioner to the Hennepin County 
225.26 	Medical Center for clinical medical education;
225.27 	(3) $17,400,000 shall be distributed by the commissioner to the University of 
225.28 	Minnesota Board of Regents for purposes of medial education;
225.29 	(4) $1,121,640 shall be distributed by the commissioner to clinical medical education 
225.30 	dental innovation grants in accordance with subdivision 7a; and
225.31 	(5) the remainder of the amount transferred according to section 256B.69, 
225.32 	subdivision 5c, clauses (1) to (4), shall be distributed by the commissioner annually to 
225.33 	clinical medical education programs that meet the qualifications of subdivision 3 based on 
225.34 	the formula in subdivision 4, paragraph (a).
226.1 	(b) Fifty percent of the amount transferred according to section 256B.69, subdivision 
226.2 	5c, paragraph (a), clause (2), shall be distributed by the commissioner to the University of 
226.3 	Minnesota Board of Regents for the purposes described in sections 137.38 to 137.40. Of 
226.4 	the remaining amount transferred according to section 256B.69, subdivision 5c, paragraph 
226.5 	(a), clause (2), 24 percent of the amount shall be distributed by the commissioner to 
226.6 	the Hennepin County Medical Center for clinical medical education. The remaining 26 
226.7 	percent of the amount transferred shall be distributed by the commissioner in accordance 
226.8 	with subdivision 7a. If the federal approval is not obtained for the matching funds under 
226.9 	section 256B.69, subdivision 5c, paragraph (a), clause (2), 100 percent of the amount 
226.10 	transferred under this paragraph shall be distributed by the commissioner to the University 
226.11 	of Minnesota Board of Regents for the purposes described in sections 137.38 to 137.40.
226.12 	(c) The amount transferred according to section 256B.69, subdivision 5c, paragraph 
226.13 	(a), clauses (3) and (4), shall be distributed by the commissioner upon receipt to the 
226.14 	University of Minnesota Board of Regents for the purposes of clinical graduate medical 
226.15 	education.

226.16 	Sec. 5. Minnesota Statutes 2008, section 125A.744, subdivision 3, is amended to read:
226.17 		Subd. 3.Implementation. Consistent with section 256B.0625, subdivision 26, 
226.18 	school districts may enroll as medical assistance providers or subcontractors and bill 
226.19 	the Department of Human Services under the medical assistance fee for service claims 
226.20 	processing system for special education services which are covered services under chapter 
226.21 	256B, which are provided in the school setting for a medical assistance recipient, and for 
226.22 	whom the district has secured informed consent consistent with section 13.05, subdivision 
226.23 	4, paragraph (d), and section 256B.77, subdivision 2, paragraph (p), to bill for each type 
226.24 	of covered service. School districts shall be reimbursed by the commissioner of human 
226.25 	services for the federal share of individual education plan health-related services that 
226.26 	qualify for reimbursement by medical assistance, minus up to five percent retained by the 
226.27 	commissioner of human services for administrative costs, not to exceed $350,000 per 
226.28 	fiscal year. The commissioner may withhold up to five percent of each payment to a 
226.29 	school district. Following the end of each fiscal year, the commissioner shall settle up with 
226.30 	each school district in order to ensure that collections from each district for departmental 
226.31 	administrative costs are made on a pro rata basis according to federal earnings for these 
226.32 	services in each district. A school district is not eligible to enroll as a home care provider 
226.33 	or a personal care provider organization for purposes of billing home care services under 
226.34 	sections 256B.0651 and 256B.0653 to 256B.0656 until the commissioner of human 
226.35 	services issues a bulletin instructing county public health nurses on how to assess for the 
227.1 	needs of eligible recipients during school hours. To use private duty nursing services or 
227.2 	personal care services at school, the recipient or responsible party must provide written 
227.3 	authorization in the care plan identifying the chosen provider and the daily amount 
227.4 	of services to be used at school.

227.5 	Sec. 6. Minnesota Statutes 2008, section 256.01, subdivision 2b, is amended to read:
227.6 		Subd. 2b. Performance payments. (a) The commissioner shall develop and 
227.7 	implement a pay-for-performance system to provide performance payments to eligible 
227.8 	medical groups and clinics that demonstrate optimum care in serving individuals 
227.9 	with chronic diseases who are enrolled in health care programs administered by the 
227.10 	commissioner under chapters 256B, 256D, and 256L. The commissioner may receive any 
227.11 	federal matching money that is made available through the medical assistance program 
227.12 	for managed care oversight contracted through vendors, including consumer surveys, 
227.13 	studies, and external quality reviews as required by the federal Balanced Budget Act of 
227.14 	1997, Code of Federal Regulations, title 42, part 438-managed care, subpart E-external 
227.15 	quality review. Any federal money received for managed care oversight is appropriated 
227.16 	to the commissioner for this purpose. The commissioner may expend the federal money 
227.17 	received in either year of the biennium. 
227.18 	(b) Effective July 1, 2008, or upon federal approval, whichever is later, the 
227.19 	commissioner shall develop and implement a patient incentive health program to provide 
227.20 	incentives and rewards to patients who are enrolled in health care programs administered 
227.21 	by the commissioner under chapters 256B, 256D, and 256L, and who have agreed to and 
227.22 	have met personal health goals established with the patients' primary care providers to 
227.23 	manage a chronic disease or condition, including but not limited to diabetes, high blood 
227.24 	pressure, and coronary artery disease. 

227.25 	Sec. 7. Minnesota Statutes 2008, section 256.01, is amended by adding a subdivision 
227.26 	to read:
227.27 		Subd. 18a.Public Assistance Reporting Information System. (a) Effective 
227.28 	October 1, 2009, the commissioner shall comply with the federal requirements in Public 
227.29 	Law 110-379 in implementing the Public Assistance Reporting Information System 
227.30 	(PARIS) to determine eligibility for all individuals applying for:
227.31 	(1) health care benefits under chapters 256B, 256D, and 256L; and
227.32 	(2) public benefits under chapters 119B, 256D, 256I, and the supplemental nutrition 
227.33 	assistance program.
228.1 	(b) The commissioner shall determine eligibility under paragraph (a) by performing 
228.2 	data matches, including matching with medical assistance, cash, child care, and 
228.3 	supplemental assistance programs operated by other states.

228.4 	Sec. 8. Minnesota Statutes 2008, section 256.01, is amended by adding a subdivision 
228.5 	to read:
228.6 		Subd. 18b.Protections for American Indians. Effective February 18, 2009, the 
228.7 	commissioner shall comply with the federal requirements in the American Recovery and 
228.8 	Reinvestment Act of 2009, Public Law 111-5, section 5006, regarding American Indians.

228.9 	Sec. 9. Minnesota Statutes 2008, section 256.01, is amended by adding a subdivision 
228.10 	to read:
228.11 		Subd. 29.State medical review team. (a) To ensure the timely processing of 
228.12 	determinations of disability by the commissioner's state medical review team under 
228.13 	section 256B.055, subdivision 7, paragraph (b), and section 256B.057, subdivision 9, 
228.14 	paragraph (j), the commissioner shall review all medical evidence submitted by counties 
228.15 	with a referral and seek additional information from providers, applicants, or enrollees to 
228.16 	support the determination of disability where necessary.
228.17 	(b) Prior to a denial or withdrawal of a requested determination of disability due 
228.18 	to insufficient evidence, the commissioner shall (1) ensure that the missing evidence is 
228.19 	necessary and appropriate to a determination of disability and (2) assist applicants and 
228.20 	enrollees to obtain the evidence, including, but not limited to, medical examinations 
228.21 	and electronic medical records.
228.22 	(c) The commissioner shall provide the chairs of the legislative committees with 
228.23 	jurisdiction over health and human services finance and budget the following information 
228.24 	on the activities of the state medical review team by February 1, 2010, and annually 
228.25 	thereafter:
228.26 	(1) the number of applications to the state medical review team that were denied, 
228.27 	approved, or withdrawn;
228.28 	(2) the average length of time from receipt of the application to a decision;
228.29 	(3) the number of appeals and appeal results;
228.30 	(4) for applicants, their age, health coverage at the time of application, hospitalization 
228.31 	history within three months of application, and whether an application for Social Security 
228.32 	or Supplemental Security Income benefits is pending; and 
229.1 	(5) specific information on the medical certification, licensure, or other credentials 
229.2 	of the person or persons performing the medical review determinations and length of 
229.3 	time in that position.

229.4 	Sec. 10. [256.964] DENTAL CARE PILOT PROJECTS.
229.5 		Subdivision 1.Urgent dental care services. The commissioner shall authorize a 
229.6 	pilot project to reduce the total cost to the state for dental services provided to enrollees 
229.7 	of the state public health care programs by reducing hospital emergency room costs 
229.8 	for preventable or nonemergency dental services. As part of the project, a community 
229.9 	dental clinic or dental provider, in collaboration with a hospital emergency room, shall 
229.10 	provide urgent care dental services as an alternative to the hospital emergency room for 
229.11 	nonemergency dental care. The project participants shall establish a process to divert a 
229.12 	patient presenting at the emergency room for nonemergency dental care to the dental 
229.13 	community clinic or to an appropriate dental provider. The commissioner may establish 
229.14 	special payment rates for urgent care services provided and may change or waive existing 
229.15 	payment policies in order to adequately reimburse providers for providing cost-effective 
229.16 	alternative services in an outpatient or urgent care setting. The commissioner may 
229.17 	establish a project in conjunction with the initiative authorized under section 256.963.
229.18 		Subd. 2.Dental care in nursing facilities. (a) The commissioner shall establish 
229.19 	a pilot project to improve access to on-site dental services for residents of nursing 
229.20 	facilities. The pilot project must demonstrate methods of reducing total costs to the state 
229.21 	by providing more cost-effective delivery of dental services, including new workforce 
229.22 	roles, enhanced caregiver assistance with daily oral care, periodic assessment and triage of 
229.23 	dental problems, care coordination and provision of comprehensive year round on-site 
229.24 	dental services. As part of the pilot project, the commissioner may:
229.25 	(1) establish a special pilot project funding model for dental services provided that 
229.26 	waives existing reimbursement policies; and
229.27 	(2) contract with a single on-site dental provider to provide services to residents 
229.28 	of pilot project nursing facilities.
229.29 	(b) The commissioner shall evaluate the effectiveness of the pilot project on 
229.30 	cost-savings and health outcomes.
229.31 		Subd. 3.Dental health care homes. The commissioner shall establish a pilot 
229.32 	project under which dental providers shall be paid a care coordination fee to coordinate 
229.33 	dental care for patients with existing dental disease and for whom the total cost of dental 
229.34 	care for the patients can be reduced through better prevention, coordination of services, use 
230.1 	of cost-effective treatments and settings, and reducing utilization of hospital emergency 
230.2 	rooms and reductions in hospitalizations for medical problems linked with oral infections.

230.3 	Sec. 11. [256.9652] E-PRESCRIBING INITIATIVE.
230.4 	(a) The commissioner shall implement a demonstration project that incorporates 
230.5 	e-prescribing applications with a clinical information database in order to increase 
230.6 	patient safety and efficiencies and reduce medication errors, duplication of therapies, 
230.7 	and eliminate waste.
230.8 	(b) The commissioner shall identify providers who are currently using e-prescribing 
230.9 	and ensure that each provider has the ability through e-prescribing software to receive 
230.10 	the following:
230.11 	(1) a patient's specific medication history for the last 100 days;
230.12 	(2) the preferred drug list and formulary verification;
230.13 	(3) prescription details; and
230.14 	(4) drug interaction alerts.
230.15 	(c) Beginning January 1, 2010, each provider identified by the commissioner shall 
230.16 	use the e-prescribing applications for each prescription.
230.17 	(d) Beginning January 1, 2011, the commissioner shall ensure that any provider 
230.18 	using e-prescribing has access to the applications identified in paragraph (b).

230.19 	Sec. 12. Minnesota Statutes 2008, section 256.969, subdivision 2b, is amended to read:
230.20 		Subd. 2b.Operating payment rates. In determining operating payment rates for 
230.21 	admissions occurring on or after the rate year beginning January 1, 1991, and every two 
230.22 	years after, or more frequently as determined by the commissioner, the commissioner shall 
230.23 	obtain operating data from an updated base year and establish operating payment rates 
230.24 	per admission for each hospital based on the cost-finding methods and allowable costs of 
230.25 	the Medicare program in effect during the base year. Rates under the general assistance 
230.26 	medical care, medical assistance, and MinnesotaCare programs shall not be rebased to 
230.27 	more current data on January 1, 1997, January 1, 2005, and for the first 24 months of the 
230.28 	rebased period beginning January 1, 2009, and for the first three months of the rebased 
230.29 	period beginning January 1, 2011. From April 1, 2011, to March 31, 2012, rates shall be 
230.30 	rebased at 72.5 percent of full value. Effective April 1, 2012, rates shall be rebased at full 
230.31 	value. The base year operating payment rate per admission is standardized by the case 
230.32 	mix index and adjusted by the hospital cost index, relative values, and disproportionate 
230.33 	population adjustment. The cost and charge data used to establish operating rates shall 
231.1 	only reflect inpatient services covered by medical assistance and shall not include property 
231.2 	cost information and costs recognized in outlier payments.

231.3 	Sec. 13. Minnesota Statutes 2008, section 256.969, subdivision 3a, is amended to read:
231.4 		Subd. 3a.Payments. (a) Acute care hospital billings under the medical 
231.5 	assistance program must not be submitted until the recipient is discharged. However, 
231.6 	the commissioner shall establish monthly interim payments for inpatient hospitals that 
231.7 	have individual patient lengths of stay over 30 days regardless of diagnostic category. 
231.8 	Except as provided in section 256.9693, medical assistance reimbursement for treatment 
231.9 	of mental illness shall be reimbursed based on diagnostic classifications. Individual 
231.10 	hospital payments established under this section and sections 256.9685, 256.9686, and 
231.11 	256.9695, in addition to third party and recipient liability, for discharges occurring during 
231.12 	the rate year shall not exceed, in aggregate, the charges for the medical assistance covered 
231.13 	inpatient services paid for the same period of time to the hospital. This payment limitation 
231.14 	shall be calculated separately for medical assistance and general assistance medical 
231.15 	care services. The limitation on general assistance medical care shall be effective for 
231.16 	admissions occurring on or after July 1, 1991. Services that have rates established under 
231.17 	subdivision 11 or 12, must be limited separately from other services. After consulting with 
231.18 	the affected hospitals, the commissioner may consider related hospitals one entity and 
231.19 	may merge the payment rates while maintaining separate provider numbers. The operating 
231.20 	and property base rates per admission or per day shall be derived from the best Medicare 
231.21 	and claims data available when rates are established. The commissioner shall determine 
231.22 	the best Medicare and claims data, taking into consideration variables of recency of the 
231.23 	data, audit disposition, settlement status, and the ability to set rates in a timely manner. 
231.24 	The commissioner shall notify hospitals of payment rates by December 1 of the year 
231.25 	preceding the rate year. The rate setting data must reflect the admissions data used to 
231.26 	establish relative values. Base year changes from 1981 to the base year established for the 
231.27 	rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited 
231.28 	to the limits ending June 30, 1987, on the maximum rate of increase under subdivision 
231.29 	1. The commissioner may adjust base year cost, relative value, and case mix index data 
231.30 	to exclude the costs of services that have been discontinued by the October 1 of the year 
231.31 	preceding the rate year or that are paid separately from inpatient services. Inpatient stays 
231.32 	that encompass portions of two or more rate years shall have payments established based 
231.33 	on payment rates in effect at the time of admission unless the date of admission preceded 
231.34 	the rate year in effect by six months or more. In this case, operating payment rates for 
232.1 	services rendered during the rate year in effect and established based on the date of 
232.2 	admission shall be adjusted to the rate year in effect by the hospital cost index.
232.3 	(b) For fee-for-service admissions occurring on or after July 1, 2002, the total 
232.4 	payment, before third-party liability and spenddown, made to hospitals for inpatient 
232.5 	services is reduced by .5 percent from the current statutory rates.
232.6 	(c) In addition to the reduction in paragraph (b), the total payment for fee-for-service 
232.7 	admissions occurring on or after July 1, 2003, made to hospitals for inpatient services 
232.8 	before third-party liability and spenddown, is reduced five percent from the current 
232.9 	statutory rates. Mental health services within diagnosis related groups 424 to 432, and 
232.10 	facilities defined under subdivision 16 are excluded from this paragraph.
232.11 	(d) In addition to the reduction in paragraphs (b) and (c), the total payment for 
232.12 	fee-for-service admissions occurring on or after July 1, 2005, made to hospitals for 
232.13 	inpatient services before third-party liability and spenddown, is reduced 6.0 percent 
232.14 	from the current statutory rates. Mental health services within diagnosis related groups 
232.15 	424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph. 
232.16 	Notwithstanding section 256.9686, subdivision 7, for purposes of this paragraph, medical 
232.17 	assistance does not include general assistance medical care. Payments made to managed 
232.18 	care plans shall be reduced for services provided on or after January 1, 2006, to reflect 
232.19 	this reduction.
232.20 	(e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for 
232.21 	fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made 
232.22 	to hospitals for inpatient services before third-party liability and spenddown, is reduced 
232.23 	3.46 percent from the current statutory rates. Mental health services with diagnosis related 
232.24 	groups 424 to 432 and facilities defined under subdivision 16 are excluded from this 
232.25 	paragraph. Payments made to managed care plans shall be reduced for services provided 
232.26 	on or after January 1, 2009, through June 30, 2009, to reflect this reduction.
232.27 	(f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for 
232.28 	fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2010, made 
232.29 	to hospitals for inpatient services before third-party liability and spenddown, is reduced 
232.30 	1.9 percent from the current statutory rates. Mental health services with diagnosis related 
232.31 	groups 424 to 432 and facilities defined under subdivision 16 are excluded from this 
232.32 	paragraph. Payments made to managed care plans shall be reduced for services provided 
232.33 	on or after July 1, 2009, through June 30, 2010, to reflect this reduction.
232.34 	(g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment 
232.35 	for fee-for-service admissions occurring on or after July 1, 2010, made to hospitals for 
232.36 	inpatient services before third-party liability and spenddown, is reduced 1.79 percent 
233.1 	from the current statutory rates. Mental health services with diagnosis related groups 
233.2 	424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph. 
233.3 	Payments made to managed care plans shall be reduced for services provided on or after 
233.4 	July 1, 2010, to reflect this reduction.
233.5 	(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total 
233.6 	payment for fee-for-service admissions occurring on or after July 1, 2009, made to 
233.7 	hospitals for inpatient services before third-party liability and spenddown, is reduced 
233.8 	one percent from the current statutory rates. Facilities defined under subdivision 16 are 
233.9 	excluded from this paragraph. Payments made to managed care plans shall be reduced for 
233.10 	services provided on or after October 1, 2009, to reflect this reduction.

233.11 	Sec. 14. Minnesota Statutes 2008, section 256.969, is amended by adding a subdivision 
233.12 	to read:
233.13 		Subd. 3b.Nonpayment for hospital-acquired conditions and for certain 
233.14 	treatments. (a) The commissioner must not make medical assistance payments to a 
233.15 	hospital for any costs of care that result from a condition listed in paragraph (c), if the 
233.16 	condition was hospital acquired. 
233.17 	(b) For purposes of this subdivision, a condition is hospital acquired if it is not 
233.18 	identified by the hospital as present on admission. For purposes of this subdivision, 
233.19 	medical assistance includes general assistance medical care and MinnesotaCare.
233.20 	(c) The prohibition in paragraph (a) applies to payment for each hospital-acquired 
233.21 	condition listed in this paragraph that is represented by an ICD-9-CM diagnosis code and 
233.22 	is designated as a complicating condition or a major complicating condition:
233.23 	(1) foreign object retained after surgery (ICD-9-CM codes 998.4 or 998.7);
233.24 	(2) air embolism (ICD-9-CM code 999.1);
233.25 	(3) blood incompatibility (ICD-9-CM code 999.6);
233.26 	(4) pressure ulcers stage III or IV (ICD-9-CM codes 707.23 or 707.24);
233.27 	(5) falls and trauma, including fracture, dislocation, intracranial injury, crushing 
233.28 	injury, burn, and electric shock (ICD-9-CM codes with these ranges on the complicating 
233.29 	condition and major complicating condition list: 800-829; 830-839; 850-854; 925-929; 
233.30 	940-949; and 991-994);
233.31 	(6) catheter-associated urinary tract infection (ICD-9-CM code 996.64);
233.32 	(7) vascular catheter-associated infection (ICD-9-CM code 999.31);
233.33 	(8) manifestations of poor glycemic control (ICD-9-CM codes 249.10; 249.11; 
233.34 	249.20; 249.21; 250.10; 250.11; 250.12; 250.13; 250.20; 250.21; 250.22; 250.23; and 
233.35 	251.0);
234.1 	(9) surgical site infection (ICD-9-CM codes 996.67 or 998.59) following certain 
234.2 	orthopedic procedures (procedure codes 81.01; 81.02; 81.03; 81.04; 81.05; 81.06; 81.07; 
234.3 	81.08; 81.23; 81.24; 81.31; 81.32; 81.33; 81.34; 81.35; 81.36; 81.37; 81.38; 81.83; and 
234.4 	81.85);
234.5 	(10) surgical site infection (ICD-9-CM code 998.59) following bariatric surgery 
234.6 	(procedure codes 44.38; 44.39; or 44.95) for a principal diagnosis of morbid obesity 
234.7 	(ICD-9-CM code 278.01);
234.8 	(11) surgical site infection, mediastinitis (ICD-9-CM code 519.2) following coronary 
234.9 	artery bypass graft (procedure codes 36.10 to 36.19); and
234.10 	(12) deep vein thrombosis (ICD-9-CM codes 453.40 to 453.42) or pulmonary 
234.11 	embolism (ICD-9-CM codes 415.11 or 415.91) following total knee replacement 
234.12 	(procedure code 81.54) or hip replacement (procedure codes 00.85 to 00.87 or 81.51 
234.13 	to 81.52).
234.14 	(d) The prohibition in paragraph (a) applies to any additional payments that result 
234.15 	from a hospital-acquired condition listed in paragraph (c), including, but not limited to, 
234.16 	additional treatment or procedures, readmission to the facility after discharge, increased 
234.17 	length of stay, change to a higher diagnostic category, or transfer to another hospital. In 
234.18 	the event of a transfer to another hospital, the hospital where the condition listed under 
234.19 	paragraph (c) was acquired is responsible for any costs incurred at the hospital to which 
234.20 	the patient is transferred.
234.21 	(e) A hospital shall not bill a recipient of services for any payment disallowed under 
234.22 	this subdivision.

234.23 	Sec. 15. Minnesota Statutes 2008, section 256.969, is amended by adding a subdivision 
234.24 	to read:
234.25 		Subd. 28.Temporary rate increase for qualifying hospitals. For the period 
234.26 	from April 1, 2009, to September 30, 2010, for each hospital with a medical assistance 
234.27 	utilization rate equal to or greater than 25 percent during the base year, the commissioner 
234.28 	shall provide an equal percentage rate increase for each medical assistance admission. The 
234.29 	commissioner shall estimate the percentage rate increase using as the state share of the 
234.30 	increase the amount available under section 256B.199, paragraph (d). The commissioner 
234.31 	shall settle up payments to qualifying hospitals based on actual payments under that 
234.32 	section and actual hospital admissions.

234.33 	EFFECTIVE DATE. This section is effective the day following final enactment.

234.34 	Sec. 16. [256B.032] ELIGIBLE VENDORS OF MEDICAL CARE.
235.1 	(a) Effective January 1, 2011, the commissioner shall establish performance 
235.2 	thresholds for health care providers included in the provider peer grouping system 
235.3 	developed by the commissioner of health under section 62U.04. The thresholds shall be 
235.4 	set at the 10th percentile of the combined cost and quality measure used for provider peer 
235.5 	grouping, and separate thresholds shall be set for hospital and physician services.
235.6 	(b) Beginning January 1, 2012, any health care provider with a combined cost and 
235.7 	quality score below the threshold set in paragraph (a) shall be prohibited from enrolling 
235.8 	as a vendor of medical care in the medical assistance, general assistance medical care, 
235.9 	or MinnesotaCare programs, and shall not be eligible for direct payments under those 
235.10 	programs or for payments made by managed care plans under their contracts with the 
235.11 	commissioner under section 256B.69 or 256L.12. A health care provider that is prohibited 
235.12 	from enrolling as a vendor or receiving payments under this paragraph may reenroll 
235.13 	effective January 1 of any subsequent year if the provider's most recent combined cost and 
235.14 	quality score exceeds the threshold established in paragraph (a).
235.15 	(c) Notwithstanding paragraph (b), a provider may continue to participate as a vendor 
235.16 	or as part of a managed care plan provider network if the commissioner determines that a 
235.17 	contract with the provider is necessary to ensure adequate access to health care services.
235.18 	(d) By January 15, 2013, the commissioner shall report to the legislature on the 
235.19 	impact of this section. The commissioner's report shall include information on:
235.20 	(1) the providers falling below the thresholds as of January 1, 2012;
235.21 	(2) the volume of services and cost of care provided to enrollees in the medical 
235.22 	assistance, general assistance medical care, or MinnesotaCare programs in the 12 months 
235.23 	prior to January 1, 2012, by providers falling below the thresholds;
235.24 	(3) providers who fell below the thresholds but continued to be eligible vendors 
235.25 	under paragraph (c);
235.26 	(4) the estimated cost savings achieved by not contracting with providers who do 
235.27 	not meet the performance thresholds; and
235.28 	(5) recommendations for increasing the threshold levels of performance over time.

235.29 	Sec. 17. Minnesota Statutes 2008, section 256B.055, subdivision 7, is amended to read:
235.30 		Subd. 7.Aged, blind, or disabled persons. (a) Medical assistance may be paid for 
235.31 	a person who meets the categorical eligibility requirements of the supplemental security 
235.32 	income program or, who would meet those requirements except for excess income or 
235.33 	assets, and who meets the other eligibility requirements of this section.
235.34 	(b) Following a determination that the applicant is not aged or blind and does not 
235.35 	meet any other category of eligibility for medical assistance and has not been determined 
236.1 	disabled by the Social Security Administration, applicants under this subdivision shall be 
236.2 	referred to the commissioner's state medical review team for a determination of disability. 
236.3 	Disability shall be determined according to the rules of title XVI and title XIX of the 
236.4 	Social Security Act and pertinent rules and policies of the Social Security Administration.

236.5 	Sec. 18. Minnesota Statutes 2008, section 256B.056, subdivision 3, is amended to read:
236.6 		Subd. 3.Asset limitations for individuals and families. To be eligible for medical 
236.7 	assistance, a person must not individually own more than $3,000 in assets, or if a member 
236.8 	of a household with two family members, husband and wife, or parent and child, the 
236.9 	household must not own more than $6,000 in assets, plus $200 for each additional legal 
236.10 	dependent. In addition to these maximum amounts, an eligible individual or family may 
236.11 	accrue interest on these amounts, but they must be reduced to the maximum at the time 
236.12 	of an eligibility redetermination. The accumulation of the clothing and personal needs 
236.13 	allowance according to section 256B.35 must also be reduced to the maximum at the 
236.14 	time of the eligibility redetermination. The value of assets that are not considered in 
236.15 	determining eligibility for medical assistance is the value of those assets excluded under 
236.16 	the supplemental security income program for aged, blind, and disabled persons, with 
236.17 	the following exceptions: 
236.18 	(1) household goods and personal effects are not considered;
236.19 	(2) capital and operating assets of a trade or business that the local agency 
236.20 	determines are necessary to the person's ability to earn an income are not considered. A 
236.21 	bank account that contains income or assets, or is used to pay personal expenses is not 
236.22 	considered a capital or operating asset of a trade or business;
236.23 	(3) motor vehicles are excluded to the same extent excluded by the supplemental 
236.24 	security income program;
236.25 	(4) assets designated as burial expenses are excluded to the same extent excluded by 
236.26 	the supplemental security income program. Burial expenses funded by annuity contracts 
236.27 	or life insurance policies must irrevocably designate the individual's estate as contingent 
236.28 	beneficiary to the extent proceeds are not used for payment of selected burial expenses; and
236.29 	(5) effective upon federal approval, for a person who no longer qualifies as an 
236.30 	employed person with a disability due to loss of earnings, assets allowed while eligible 
236.31 	for medical assistance under section 256B.057, subdivision 9, are not considered for 12 
236.32 	months, beginning with the first month of ineligibility as an employed person with a 
236.33 	disability, to the extent that the person's total assets remain within the allowed limits of 
236.34 	section 256B.057, subdivision 9, paragraph (c).
237.1 	The assets specified in clauses (1) to (4) must be disclosed to the local agency at the 
237.2 	time of application and at the time of an eligibility redetermination, and must be verified 
237.3 	upon request of the local agency.

237.4 	EFFECTIVE DATE. This section is effective January 1, 2011.

237.5 	Sec. 19. Minnesota Statutes 2008, section 256B.056, subdivision 3b, is amended to 
237.6 	read:
237.7 		Subd. 3b.Treatment of trusts. (a) A "medical assistance qualifying trust" is a 
237.8 	revocable or irrevocable trust, or similar legal device, established on or before August 
237.9 	10, 1993, by a person or the person's spouse under the terms of which the person 
237.10 	receives or could receive payments from the trust principal or income and the trustee 
237.11 	has discretion in making payments to the person from the trust principal or income. 
237.12 	Notwithstanding that definition, a medical assistance qualifying trust does not include: 
237.13 	(1) a trust set up by will; (2) a trust set up before April 7, 1986, solely to benefit a person 
237.14 	with a developmental disability living in an intermediate care facility for persons with 
237.15 	developmental disabilities; or (3) a trust set up by a person with payments made by the 
237.16 	Social Security Administration pursuant to the United States Supreme Court decision in 
237.17 	Sullivan v. Zebley, 110 S. Ct. 885 (1990). The maximum amount of payments that a 
237.18 	trustee of a medical assistance qualifying trust may make to a person under the terms of 
237.19 	the trust is considered to be available assets to the person, without regard to whether the 
237.20 	trustee actually makes the maximum payments to the person and without regard to the 
237.21 	purpose for which the medical assistance qualifying trust was established.
237.22 	(b) Except as provided in paragraphs (c) and (d), trusts established after August 10, 
237.23 	1993, are treated according to section 13611(b) of the Omnibus Budget Reconciliation 
237.24 	Act of 1993 (OBRA), Public Law 103-66.
237.25 	(c) For purposes of paragraph (d), a pooled trust means a trust established under 
237.26 	United States Code, title 42, section 1396p(d)(4)(C).
237.27 	(d) A beneficiary's interest in a pooled trust is considered an available asset unless 
237.28 	the trust provides that upon the death of the beneficiary or termination of the trust during 
237.29 	the beneficiary's lifetime, whichever is sooner, the department receives any amount up 
237.30 	to the amount of medical assistance benefits paid on behalf of the beneficiary remaining 
237.31 	in the beneficiary's trust account after a deduction for reasonable administrative fees 
237.32 	and expenses and an additional remainder amount. The retained remainder amount 
237.33 	of the subaccount must not exceed ten percent of the account value at the time of the 
237.34 	beneficiary's death or termination of the trust and must only be used for the benefit of 
237.35 	disabled individuals who have a beneficiary interest in the pooled trust.

238.1 	EFFECTIVE DATE. This section is effective for pooled trust accounts established 
238.2 	on or after January 1, 2011.

238.3 	Sec. 20. Minnesota Statutes 2008, section 256B.056, subdivision 3c, is amended to 
238.4 	read:
238.5 		Subd. 3c.Asset limitations for families and children. A household of two or more 
238.6 	persons must not own more than $20,000 in total net assets, and a household of one 
238.7 	person must not own more than $10,000 in total net assets. In addition to these maximum 
238.8 	amounts, an eligible individual or family may accrue interest on these amounts, but they 
238.9 	must be reduced to the maximum at the time of an eligibility redetermination. The value of 
238.10 	assets that are not considered in determining eligibility for medical assistance for families 
238.11 	and children is the value of those assets excluded under the AFDC state plan as of July 16, 
238.12 	1996, as required by the Personal Responsibility and Work Opportunity Reconciliation 
238.13 	Act of 1996 (PRWORA), Public Law 104-193, with the following exceptions:
238.14 	(1) household goods and personal effects are not considered;
238.15 	(2) capital and operating assets of a trade or business up to $200,000 are not 
238.16 	considered, except that a bank account that contains personal income or assets, or is used to 
238.17 	pay personal expenses, is not considered a capital or operating asset of a trade or business;
238.18 	(3) one motor vehicle is excluded for each person of legal driving age who is 
238.19 	employed or seeking employment;
238.20 	(4) one burial plot and all other burial expenses equal to the supplemental security 
238.21 	income program asset limit are not considered for each individual;
238.22 	(5) court-ordered settlements up to $10,000 are not considered;
238.23 	(6) individual retirement accounts and funds are not considered; and
238.24 	(7) assets owned by children are not considered.
238.25 	The assets specified in clauses (1) to (7) must be disclosed to the local agency at the 
238.26 	time of application and at the time of an eligibility redetermination, and must be verified 
238.27 	upon request of the local agency.

238.28 	EFFECTIVE DATE. This section is effective January 1, 2011.

238.29 	Sec. 21. Minnesota Statutes 2008, section 256B.056, subdivision 3d, is amended to 
238.30 	read:
238.31 		Subd. 3d.Reduction of excess assets. Assets in excess of the limits in subdivisions 
238.32 	3 to 3c may be reduced to allowable limits as follows:
239.1 	(a) Assets may be reduced in any of the three calendar months before the month 
239.2 	of application in which the applicant seeks coverage by:
239.3 	(1) designating burial funds up to $1,500 for each applicant, spouse, and MA-eligible 
239.4 	dependent child; and
239.5 	(2) paying health service bills for health services that are incurred in the retroactive 
239.6 	period for which the applicant seeks eligibility, starting with the oldest bill. After assets 
239.7 	are reduced to allowable limits, eligibility begins with the next dollar of MA-covered 
239.8 	health services incurred in the retroactive period. Applicants reducing assets under this 
239.9 	subdivision who also have excess income shall first spend excess assets to pay health 
239.10 	service bills and may meet the income spenddown on remaining bills.
239.11 	(b) Assets may be reduced beginning the month of application by:
239.12 	(1) paying bills for health services that are incurred during the period specified in 
239.13 	Minnesota Rules, part 9505.0090, subpart 2, that would otherwise be paid by medical 
239.14 	assistance; and. After assets are reduced to allowable limits, eligibility begins with the 
239.15 	next dollar of medical assistance covered health services incurred in the period. Applicants 
239.16 	reducing assets under this subdivision who also have excess income shall first spend excess 
239.17 	assets to pay health service bills and may meet the income spenddown on remaining bills.
239.18 	(2) using any means other than a transfer of assets for less than fair market value as 
239.19 	defined in section 256B.0595, subdivision 1, paragraph (b).

239.20 	EFFECTIVE DATE. This section is effective January 1, 2011.

239.21 	Sec. 22. Minnesota Statutes 2008, section 256B.057, subdivision 9, is amended to read:
239.22 		Subd. 9.Employed persons with disabilities. (a) Medical assistance may be paid 
239.23 	for a person who is employed and who:
239.24 	(1) meets the definition of disabled under the supplemental security income program;
239.25 	(2) is at least 16 but less than 65 years of age;
239.26 	(3) meets the asset limits in paragraph (c); and
239.27 	(4) effective November 1, 2003, pays a premium and other obligations under 
239.28 	paragraph (e).
239.29 	Any spousal income or assets shall be disregarded for purposes of eligibility and premium 
239.30 	determinations.
239.31 	(b) After the month of enrollment, a person enrolled in medical assistance under 
239.32 	this subdivision who:
240.1 	(1) is temporarily unable to work and without receipt of earned income due to a 
240.2 	medical condition, as verified by a physician, may retain eligibility for up to four calendar 
240.3 	months; or
240.4 	(2) effective January 1, 2004, loses employment for reasons not attributable to the 
240.5 	enrollee, may retain eligibility for up to four consecutive months after the month of job 
240.6 	loss. To receive a four-month extension, enrollees must verify the medical condition or 
240.7 	provide notification of job loss. All other eligibility requirements must be met and the 
240.8 	enrollee must pay all calculated premium costs for continued eligibility.
240.9 	(c) For purposes of determining eligibility under this subdivision, a person's assets 
240.10 	must not exceed $20,000, excluding:
240.11 	(1) all assets excluded under section 256B.056;
240.12 	(2) retirement accounts, including individual accounts, 401(k) plans, 403(b) plans, 
240.13 	Keogh plans, and pension plans; and
240.14 	(3) medical expense accounts set up through the person's employer.
240.15 	(d)(1) Effective January 1, 2004, for purposes of eligibility, there will be a $65 
240.16 	earned income disregard. To be eligible, a person applying for medical assistance under 
240.17 	this subdivision must have earned income above the disregard level.
240.18 	(2) Effective January 1, 2004, to be considered earned income, Medicare, Social 
240.19 	Security, and applicable state and federal income taxes must be withheld. To be eligible, 
240.20 	a person must document earned income tax withholding.
240.21 	(e)(1) A person whose earned and unearned income is equal to or greater than 100 
240.22 	percent of federal poverty guidelines for the applicable family size must pay a premium 
240.23 	to be eligible for medical assistance under this subdivision. The premium shall be based 
240.24 	on the person's gross earned and unearned income and the applicable family size using a 
240.25 	sliding fee scale established by the commissioner, which begins at one percent of income 
240.26 	at 100 percent of the federal poverty guidelines and increases to 7.5 percent of income 
240.27 	for those with incomes at or above 300 percent of the federal poverty guidelines. Annual 
240.28 	adjustments in the premium schedule based upon changes in the federal poverty guidelines 
240.29 	shall be effective for premiums due in July of each year.
240.30 	(2) Effective January 1, 2004, all enrollees must pay a premium to be eligible for 
240.31 	medical assistance under this subdivision. An enrollee shall pay the greater of a $35 
240.32 	premium or the premium calculated in clause (1).
240.33 	(3) Effective November 1, 2003, all enrollees who receive unearned income must 
240.34 	pay one-half of one percent of unearned income in addition to the premium amount.
240.35 	(4) Effective November 1, 2003, for enrollees whose income does not exceed 200 
240.36 	percent of the federal poverty guidelines and who are also enrolled in Medicare, the 
241.1 	commissioner must reimburse the enrollee for Medicare Part B premiums under section 
241.2 	256B.0625, subdivision 15, paragraph (a).
241.3 	(5) Increases in benefits under title II of the Social Security Act shall not be counted 
241.4 	as income for purposes of this subdivision until July 1 of each year.
241.5 	(f) A person's eligibility and premium shall be determined by the local county 
241.6 	agency. Premiums must be paid to the commissioner. All premiums are dedicated to 
241.7 	the commissioner.
241.8 	(g) Any required premium shall be determined at application and redetermined at 
241.9 	the enrollee's six-month income review or when a change in income or household size is 
241.10 	reported. Enrollees must report any change in income or household size within ten days 
241.11 	of when the change occurs. A decreased premium resulting from a reported change in 
241.12 	income or household size shall be effective the first day of the next available billing month 
241.13 	after the change is reported. Except for changes occurring from annual cost-of-living 
241.14 	increases, a change resulting in an increased premium shall not affect the premium amount 
241.15 	until the next six-month review.
241.16 	(h) Premium payment is due upon notification from the commissioner of the 
241.17 	premium amount required. Premiums may be paid in installments at the discretion of 
241.18 	the commissioner.
241.19 	(i) Nonpayment of the premium shall result in denial or termination of medical 
241.20 	assistance unless the person demonstrates good cause for nonpayment. Good cause exists 
241.21 	if the requirements specified in Minnesota Rules, part 9506.0040, subpart 7, items B to 
241.22 	D, are met. Except when an installment agreement is accepted by the commissioner, 
241.23 	all persons disenrolled for nonpayment of a premium must pay any past due premiums 
241.24 	as well as current premiums due prior to being reenrolled. Nonpayment shall include 
241.25 	payment with a returned, refused, or dishonored instrument. The commissioner may 
241.26 	require a guaranteed form of payment as the only means to replace a returned, refused, 
241.27 	or dishonored instrument.
241.28 	(j) Following a determination that the applicant is not aged or blind and does not 
241.29 	meet any other category of eligibility for medical assistance and has not been determined 
241.30 	disabled by the Social Security Administration, applicants under this subdivision shall be 
241.31 	referred to the commissioner's state medical review team for a determination of disability. 
241.32 	Disability shall be determined according to the rules of title XVI and title XIX of the 
241.33 	Social Security Act and pertinent rules and policies of the Social Security Administration.

241.34 	Sec. 23. Minnesota Statutes 2008, section 256B.057, is amended by adding a 
241.35 	subdivision to read:
242.1 		Subd. 11.Treatment for colorectal cancer. (a) Medical assistance shall be paid for 
242.2 	an individual who:
242.3 	(1) has been screened for colorectal cancer by the colorectal cancer prevention 
242.4 	demonstration project;
242.5 	(2) according to the individual's treating health professional, needs treatment for 
242.6 	colorectal cancer;
242.7 	(3) meets income eligibility guidelines for the colorectal cancer prevention 
242.8 	demonstration project;
242.9 	(4) is under the age of 65; and
242.10 	(5) is not otherwise eligible for medical assistance or other creditable coverage as 
242.11 	defined under United States Code, title 42, section 1396a(aa).
242.12 	(b) Medical assistance provided under this subdivision shall be limited to services 
242.13 	provided during the period that the individual receives treatment for colorectal cancer.
242.14 	(c) An individual meeting the criteria in paragraph (a) is eligible for medical 
242.15 	assistance without meeting the eligibility criteria relating to income and assets in section 
242.16 	256B.056, subdivisions 1a to 5b.
242.17 	(d) This subdivision expires December 31, 2010.

242.18 	Sec. 24. Minnesota Statutes 2008, section 256B.0575, is amended to read:
242.19 	256B.0575 AVAILABILITY OF INCOME FOR INSTITUTIONALIZED 
242.20 	PERSONS.
242.21 		Subdivision 1.Income deductions. When an institutionalized person is determined 
242.22 	eligible for medical assistance, the income that exceeds the deductions in paragraphs (a) 
242.23 	and (b) must be applied to the cost of institutional care.
242.24 	(a) The following amounts must be deducted from the institutionalized person's 
242.25 	income in the following order:
242.26 	(1) the personal needs allowance under section 256B.35 or, for a veteran who 
242.27 	does not have a spouse or child, or a surviving spouse of a veteran having no child, the 
242.28 	amount of an improved pension received from the veteran's administration not exceeding 
242.29 	$90 per month;
242.30 	(2) the personal allowance for disabled individuals under section 256B.36;
242.31 	(3) if the institutionalized person has a legally appointed guardian or conservator, 
242.32 	five percent of the recipient's gross monthly income up to $100 as reimbursement for 
242.33 	guardianship or conservatorship services;
243.1 	(4) a monthly income allowance determined under section 256B.058, subdivision 
243.2 	2, but only to the extent income of the institutionalized spouse is made available to the 
243.3 	community spouse;
243.4 	(5) a monthly allowance for children under age 18 which, together with the net 
243.5 	income of the children, would provide income equal to the medical assistance standard 
243.6 	for families and children according to section 256B.056, subdivision 4, for a family size 
243.7 	that includes only the minor children. This deduction applies only if the children do not 
243.8 	live with the community spouse and only to the extent that the deduction is not included 
243.9 	in the personal needs allowance under section 256B.35, subdivision 1, as child support 
243.10 	garnished under a court order;
243.11 	(6) a monthly family allowance for other family members, equal to one-third of the 
243.12 	difference between 122 percent of the federal poverty guidelines and the monthly income 
243.13 	for that family member;
243.14 	(7) reparations payments made by the Federal Republic of Germany and reparations 
243.15 	payments made by the Netherlands for victims of Nazi persecution between 1940 and 
243.16 	1945;
243.17 	(8) all other exclusions from income for institutionalized persons as mandated by 
243.18 	federal law; and
243.19 	(9) amounts for reasonable expenses as specified in subdivision 2, incurred for 
243.20 	necessary medical or remedial care for the institutionalized person that are recognized 
243.21 	under state law, not medical assistance covered expenses, and that are not subject to 
243.22 	payment by a third party.
243.23 	Reasonable expenses are limited to expenses that have not been previously used as a 
243.24 	deduction from income and are incurred during the enrollee's current period of eligibility, 
243.25 	including retroactive months associated with the current period of eligibility, for medical 
243.26 	assistance payment of long-term care services.
243.27 	For purposes of clause (6), "other family member" means a person who resides 
243.28 	with the community spouse and who is a minor or dependent child, dependent parent, or 
243.29 	dependent sibling of either spouse. "Dependent" means a person who could be claimed as 
243.30 	a dependent for federal income tax purposes under the Internal Revenue Code.
243.31 	(b) Income shall be allocated to an institutionalized person for a period of up to three 
243.32 	calendar months, in an amount equal to the medical assistance standard for a family 
243.33 	size of one if:
243.34 	(1) a physician certifies that the person is expected to reside in the long-term care 
243.35 	facility for three calendar months or less;
243.36 	(2) if the person has expenses of maintaining a residence in the community; and
244.1 	(3) if one of the following circumstances apply:
244.2 	(i) the person was not living together with a spouse or a family member as defined in 
244.3 	paragraph (a) when the person entered a long-term care facility; or
244.4 	(ii) the person and the person's spouse become institutionalized on the same date, in 
244.5 	which case the allocation shall be applied to the income of one of the spouses.
244.6 	For purposes of this paragraph, a person is determined to be residing in a licensed nursing 
244.7 	home, regional treatment center, or medical institution if the person is expected to remain 
244.8 	for a period of one full calendar month or more.
244.9 		Subd. 2.Reasonable expenses. For the purposes of subdivision 1, paragraph (a), 
244.10 	clause (9), reasonable expenses are limited to expenses that have not been previously used 
244.11 	as a deduction from income and were not:
244.12 	(1) for long-term care expenses incurred during a period of ineligibility as defined in 
244.13 	section 256B.0595, subdivision 2;
244.14 	(2) incurred more than three months before the month of application associated with 
244.15 	the current period of eligibility;
244.16 	(3) for expenses incurred by a recipient that are duplicative of services that are 
244.17 	covered under chapter 256B; or
244.18 	(4) nursing facility expenses incurred without a timely assessment as required under 
244.19 	section 256B.0911.

244.20 	Sec. 25. Minnesota Statutes 2008, section 256B.0595, subdivision 1, is amended to 
244.21 	read:
244.22 		Subdivision 1. Prohibited transfers. (a) For transfers of assets made on or before 
244.23 	August 10, 1993, if an institutionalized person or the institutionalized person's spouse has 
244.24 	given away, sold, or disposed of, for less than fair market value, any asset or interest 
244.25 	therein, except assets other than the homestead that are excluded under the supplemental 
244.26 	security program, within 30 months before or any time after the date of institutionalization 
244.27 	if the person has been determined eligible for medical assistance, or within 30 months 
244.28 	before or any time after the date of the first approved application for medical assistance 
244.29 	if the person has not yet been determined eligible for medical assistance, the person is 
244.30 	ineligible for long-term care services for the period of time determined under subdivision 
244.31 	2. 
244.32 	(b) Effective for transfers made after August 10, 1993, an institutionalized person, an 
244.33 	institutionalized person's spouse, or any person, court, or administrative body with legal 
244.34 	authority to act in place of, on behalf of, at the direction of, or upon the request of the 
244.35 	institutionalized person or institutionalized person's spouse, may not give away, sell, or 
245.1 	dispose of, for less than fair market value, any asset or interest therein, except assets other 
245.2 	than the homestead that are excluded under the Supplemental Security Income program, 
245.3 	for the purpose of establishing or maintaining medical assistance eligibility. This applies 
245.4 	to all transfers, including those made by a community spouse after the month in which 
245.5 	the institutionalized spouse is determined eligible for medical assistance. For purposes of 
245.6 	determining eligibility for long-term care services, any transfer of such assets within 36 
245.7 	months before or any time after an institutionalized person requests medical assistance 
245.8 	payment of long-term care services, or 36 months before or any time after a medical 
245.9 	assistance recipient becomes an institutionalized person, for less than fair market value 
245.10 	may be considered. Any such transfer is presumed to have been made for the purpose 
245.11 	of establishing or maintaining medical assistance eligibility and the institutionalized 
245.12 	person is ineligible for long-term care services for the period of time determined under 
245.13 	subdivision 2, unless the institutionalized person furnishes convincing evidence to 
245.14 	establish that the transaction was exclusively for another purpose, or unless the transfer is 
245.15 	permitted under subdivision 3 or 4.  In the case of payments from a trust or portions of a 
245.16 	trust that are considered transfers of assets under federal law, or in the case of any other 
245.17 	disposal of assets made on or after February 8, 2006, any transfers made within 60 months 
245.18 	before or any time after an institutionalized person requests medical assistance payment of 
245.19 	long-term care services and within 60 months before or any time after a medical assistance 
245.20 	recipient becomes an institutionalized person, may be considered. 
245.21 	(c) This section applies to transfers, for less than fair market value, of income 
245.22 	or assets, including assets that are considered income in the month received, such as 
245.23 	inheritances, court settlements, and retroactive benefit payments or income to which the 
245.24 	institutionalized person or the institutionalized person's spouse is entitled but does not 
245.25 	receive due to action by the institutionalized person, the institutionalized person's spouse, 
245.26 	or any person, court, or administrative body with legal authority to act in place of, on 
245.27 	behalf of, at the direction of, or upon the request of the institutionalized person or the 
245.28 	institutionalized person's spouse. 
245.29 	(d) This section applies to payments for care or personal services provided by a 
245.30 	relative, unless the compensation was stipulated in a notarized, written agreement which 
245.31 	was in existence when the service was performed, the care or services directly benefited 
245.32 	the person, and the payments made represented reasonable compensation for the care 
245.33 	or services provided. A notarized written agreement is not required if payment for the 
245.34 	services was made within 60 days after the service was provided. 
245.35 	(e) This section applies to the portion of any asset or interest that an institutionalized 
245.36 	person, an institutionalized person's spouse, or any person, court, or administrative body 
246.1 	with legal authority to act in place of, on behalf of, at the direction of, or upon the request 
246.2 	of the institutionalized person or the institutionalized person's spouse, transfers to any 
246.3 	annuity that exceeds the value of the benefit likely to be returned to the institutionalized 
246.4 	person or institutionalized person's spouse while alive, based on estimated life expectancy 
246.5 	as determined according to the current actuarial tables published by the Office of the 
246.6 	Chief Actuary of the Social Security Administration. The commissioner may adopt rules 
246.7 	reducing life expectancies based on the need for long-term care. This section applies to an 
246.8 	annuity purchased on or after March 1, 2002, that: 
246.9 	(1) is not purchased from an insurance company or financial institution that is 
246.10 	subject to licensing or regulation by the Minnesota Department of Commerce or a similar 
246.11 	regulatory agency of another state; 
246.12 	(2) does not pay out principal and interest in equal monthly installments; or 
246.13 	(3) does not begin payment at the earliest possible date after annuitization. 
246.14 	(f) Effective for transactions, including the purchase of an annuity, occurring on or 
246.15 	after February 8, 2006, by or on behalf of an institutionalized person who has applied for 
246.16 	or is receiving long-term care services or the institutionalized person's spouse shall be 
246.17 	treated as the disposal of an asset for less than fair market value unless the department is 
246.18 	named a preferred remainder beneficiary  as described in section 256B.056, subdivision 
246.19 	11. Any subsequent change to the designation of the department as a preferred remainder 
246.20 	beneficiary shall result in the annuity being treated as a disposal of assets for less than 
246.21 	fair market value. The amount of such transfer shall be the maximum amount the 
246.22 	institutionalized person or the institutionalized person's spouse could receive from the 
246.23 	annuity or similar financial instrument. Any change in the amount of the income or 
246.24 	principal being withdrawn from the annuity or other similar financial instrument at the 
246.25 	time of the most recent disclosure shall be deemed to be a transfer of assets for less than 
246.26 	fair market value unless the institutionalized person or the institutionalized person's spouse 
246.27 	demonstrates that the transaction was for fair market value. In the event a distribution 
246.28 	of income or principal has been improperly distributed or disbursed from an annuity or 
246.29 	other retirement planning instrument of an institutionalized person or the institutionalized 
246.30 	person's spouse, a cause of action exists against the individual receiving the improper 
246.31 	distribution for the cost of medical assistance services provided or the amount of the 
246.32 	improper distribution, whichever is less. 
246.33 	(g) Effective for transactions, including the purchase of an annuity, occurring on 
246.34 	or after February 8, 2006, by or on behalf of an institutionalized person applying for or 
246.35 	receiving long-term care services shall be treated as a disposal of assets for less than fair 
246.36 	market value unless it is: 
247.1 	(i) an annuity described in subsection (b) or (q) of section 408 of the Internal 
247.2 	Revenue Code of 1986; or 
247.3 	(ii) purchased with proceeds from: 
247.4 	(A) an account or trust described in subsection (a), (c), or (p) of section 408 of the 
247.5 	Internal Revenue Code; 
247.6 	(B) a simplified employee pension within the meaning of section 408(k) of the 
247.7 	Internal Revenue Code; or 
247.8 	(C) a Roth IRA described in section 408A of the Internal Revenue Code; or 
247.9 	(iii) an annuity that is irrevocable and nonassignable; is actuarially sound as 
247.10 	determined in accordance with actuarial publications of the Office of the Chief Actuary of 
247.11 	the Social Security Administration; and provides for payments in equal amounts during 
247.12 	the term of the annuity, with no deferral and no balloon payments made.
247.13 	 (h) For purposes of this section, long-term care services include services in a nursing 
247.14 	facility, services that are eligible for payment according to section 256B.0625, subdivision 
247.15 	2, because they are provided in a swing bed, intermediate care facility for persons with 
247.16 	developmental disabilities, and home and community-based services provided pursuant 
247.17 	to sections 256B.0915, 256B.092, and 256B.49. For purposes of this subdivision and 
247.18 	subdivisions 2, 3, and 4, "institutionalized person" includes a person who is an inpatient 
247.19 	in a nursing facility or in a swing bed, or intermediate care facility for persons with 
247.20 	developmental disabilities or who is receiving home and community-based services under 
247.21 	sections 256B.0915, 256B.092, and 256B.49. 
247.22 	(i) This section applies to funds used to purchase a promissory note, loan, or 
247.23 	mortgage unless the note, loan, or mortgage: 
247.24 	(1) has a repayment term that is actuarially sound; 
247.25 	(2) provides for payments to be made in equal amounts during the term of the loan, 
247.26 	with no deferral and no balloon payments made; and 
247.27 	(3) prohibits the cancellation of the balance upon the death of the lender. 
247.28 	In the case of a promissory note, loan, or mortgage that does not meet an exception 
247.29 	in clauses (1) to (3), the value of such note, loan, or mortgage shall be the outstanding 
247.30 	balance due as of the date of the institutionalized person's request for medical assistance 
247.31 	payment of long-term care services. 
247.32 	(j) This section applies to the purchase of a life estate interest in another person's 
247.33 	home unless the purchaser resides in the home for a period of at least one year after the 
247.34 	date of purchase. 
247.35 	(k) This section applies to transfers into a pooled trust that qualifies under United 
247.36 	States Code, title 42, section 1396p(d)(4)(C), by:
248.1 	(1) a person age 65 or older or the person's spouse; or
248.2 	(2) any person, court, or administrative body with legal authority to act in place 
248.3 	of, on behalf of, at the direction of, or upon the request of a person age 65 or older or 
248.4 	the person's spouse.

248.5 	EFFECTIVE DATE. This section is effective January 1, 2011.

248.6 	Sec. 26. Minnesota Statutes 2008, section 256B.0595, subdivision 2, is amended to 
248.7 	read:
248.8 		Subd. 2. Period of ineligibility for long-term care services. (a) For any 
248.9 	uncompensated transfer occurring on or before August 10, 1993, the number of months 
248.10 	of ineligibility for long-term care services shall be the lesser of 30 months, or the 
248.11 	uncompensated transfer amount divided by the average medical assistance rate for nursing 
248.12 	facility services in the state in effect on the date of application. The amount used to 
248.13 	calculate the average medical assistance payment rate shall be adjusted each July 1 to 
248.14 	reflect payment rates for the previous calendar year. The period of ineligibility begins 
248.15 	with the month in which the assets were transferred. If the transfer was not reported to 
248.16 	the local agency at the time of application, and the applicant received long-term care 
248.17 	services during what would have been the period of ineligibility if the transfer had been 
248.18 	reported, a cause of action exists against the transferee for the cost of long-term care 
248.19 	services provided during the period of ineligibility, or for the uncompensated amount of 
248.20 	the transfer, whichever is less. The uncompensated transfer amount is the fair market 
248.21 	value of the asset at the time it was given away, sold, or disposed of, less the amount of 
248.22 	compensation received. 
248.23 	(b) For uncompensated transfers made after August 10, 1993, the number of months 
248.24 	of ineligibility for long-term care services shall be the total uncompensated value of the 
248.25 	resources transferred divided by the average medical assistance rate for nursing facility 
248.26 	services in the state in effect on the date of application. The amount used to calculate 
248.27 	the average medical assistance payment rate shall be adjusted each July 1 to reflect 
248.28 	payment rates for the previous calendar year. The period of ineligibility begins with the 
248.29 	first day of the month after the month in which the assets were transferred except that 
248.30 	if one or more uncompensated transfers are made during a period of ineligibility, the 
248.31 	total assets transferred during the ineligibility period shall be combined and a penalty 
248.32 	period calculated to begin on the first day of the month after the month in which the first 
248.33 	uncompensated transfer was made. If the transfer was reported to the local agency after 
248.34 	the date that advance notice of a period of ineligibility that affects the next month could 
248.35 	be provided to the recipient and the recipient received medical assistance services or the 
249.1 	transfer was not reported to the local agency, and the applicant or recipient received 
249.2 	medical assistance services during what would have been the period of ineligibility if 
249.3 	the transfer had been reported, a cause of action exists against the transferee for that 
249.4 	portion of long-term care services provided during the period of ineligibility, or for the 
249.5 	uncompensated amount of the transfer, whichever is less. The uncompensated transfer 
249.6 	amount is the fair market value of the asset at the time it was given away, sold, or disposed 
249.7 	of, less the amount of compensation received. Effective for transfers made on or after 
249.8 	March 1, 1996, involving persons who apply for medical assistance on or after April 13, 
249.9 	1996, no cause of action exists for a transfer unless: 
249.10 	(1) the transferee knew or should have known that the transfer was being made by a 
249.11 	person who was a resident of a long-term care facility or was receiving that level of care in 
249.12 	the community at the time of the transfer; 
249.13 	(2) the transferee knew or should have known that the transfer was being made to 
249.14 	assist the person to qualify for or retain medical assistance eligibility; or 
249.15 	(3) the transferee actively solicited the transfer with intent to assist the person to 
249.16 	qualify for or retain eligibility for medical assistance. 
249.17 	(c) For uncompensated transfers made on or after February 8, 2006, the period 
249.18 	of ineligibility: 
249.19 	(1) for uncompensated transfers by or on behalf of individuals receiving medical 
249.20 	assistance payment of long-term care services, begins the first day of the month following 
249.21 	advance notice of the penalty period of ineligibility, but no later than the first day of the 
249.22 	month that follows three full calendar months from the date of the report or discovery 
249.23 	of the transfer; or 
249.24 	(2) for uncompensated transfers by individuals requesting medical assistance 
249.25 	payment of long-term care services, begins the date on which the individual is eligible 
249.26 	for medical assistance under the Medicaid state plan and would otherwise be receiving 
249.27 	long-term care services based on an approved application for such care but for the 
249.28 	application of the penalty period of ineligibility resulting from the uncompensated 
249.29 	transfer; and 
249.30 	(3) cannot begin during any other period of ineligibility. 
249.31 	(d) If a calculation of a penalty period of ineligibility results in a partial month, 
249.32 	payments for long-term care services shall be reduced in an amount equal to the fraction. 
249.33 	(e) In the case of multiple fractional transfers of assets in more than one month for 
249.34 	less than fair market value on or after February 8, 2006, the period of ineligibility is 
249.35 	calculated by treating the total, cumulative, uncompensated value of all assets transferred 
249.36 	during all months on or after February 8, 2006, as one transfer. 
250.1 	(f) A period of ineligibility established under paragraph (c) may be eliminated if 
250.2 	all of the assets transferred for less than fair market value used to calculate the period of 
250.3 	ineligibility, or cash equal to the value of the assets at the time of the transfer, are returned 
250.4 	within 12 months after the date the period of ineligibility begins. A period of ineligibility 
250.5 	must not be adjusted if less than the full amounts of the transferred assets or the full cash 
250.6 	values of the transferred assets are returned.

250.7 	EFFECTIVE DATE. This section is effective for periods of ineligibility established 
250.8 	on or after January 1, 2011.

250.9 	Sec. 27. Minnesota Statutes 2008, section 256B.06, subdivision 4, is amended to read:
250.10 		Subd. 4. Citizenship requirements. (a) Eligibility for medical assistance is limited 
250.11 	to citizens of the United States, qualified noncitizens as defined in this subdivision, and 
250.12 	other persons residing lawfully in the United States. Citizens or nationals of the United 
250.13 	States must cooperate in obtaining satisfactory documentary evidence of citizenship or 
250.14 	nationality according to the requirements of the federal Deficit Reduction Act of 2005, 
250.15 	Public Law 109-171. 
250.16 	(b) "Qualified noncitizen" means a person who meets one of the following 
250.17 	immigration criteria: 
250.18 	(1) admitted for lawful permanent residence according to United States Code, title 8; 
250.19 	(2) admitted to the United States as a refugee according to United States Code, 
250.20 	title 8, section 1157; 
250.21 	(3) granted asylum according to United States Code, title 8, section 1158; 
250.22 	(4) granted withholding of deportation according to United States Code, title 8, 
250.23 	section 1253(h); 
250.24 	(5) paroled for a period of at least one year according to United States Code, title 8, 
250.25 	section 1182(d)(5); 
250.26 	(6) granted conditional entrant status according to United States Code, title 8, 
250.27 	section 1153(a)(7); 
250.28 	(7) determined to be a battered noncitizen by the United States Attorney General 
250.29 	according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, 
250.30 	title V of the Omnibus Consolidated Appropriations Bill, Public Law 104-200; 
250.31 	(8) is a child of a noncitizen determined to be a battered noncitizen by the United 
250.32 	States Attorney General according to the Illegal Immigration Reform and Immigrant 
250.33 	Responsibility Act of 1996, title V, of the Omnibus Consolidated Appropriations Bill, 
250.34 	Public Law 104-200; or 
251.1 	(9) determined to be a Cuban or Haitian entrant as defined in section 501(e) of Public 
251.2 	Law 96-422, the Refugee Education Assistance Act of 1980. 
251.3 	(c) All qualified noncitizens who were residing in the United States before August 
251.4 	22, 1996, who otherwise meet the eligibility requirements of this chapter, are eligible for 
251.5 	medical assistance with federal financial participation. 
251.6 	(d) All qualified noncitizens who entered the United States on or after August 22, 
251.7 	1996, and who otherwise meet the eligibility requirements of this chapter, are eligible for 
251.8 	medical assistance with federal financial participation through November 30, 1996. 
251.9 	Beginning December 1, 1996, qualified noncitizens who entered the United States 
251.10 	on or after August 22, 1996, and who otherwise meet the eligibility requirements of this 
251.11 	chapter are eligible for medical assistance with federal participation for five years if they 
251.12 	meet one of the following criteria: 
251.13 	(i) refugees admitted to the United States according to United States Code, title 8, 
251.14 	section 1157; 
251.15 	(ii) persons granted asylum according to United States Code, title 8, section 1158; 
251.16 	(iii) persons granted withholding of deportation according to United States Code, 
251.17 	title 8, section 1253(h); 
251.18 	(iv) veterans of the United States armed forces with an honorable discharge for 
251.19 	a reason other than noncitizen status, their spouses and unmarried minor dependent 
251.20 	children; or 
251.21 	(v) persons on active duty in the United States armed forces, other than for training, 
251.22 	their spouses and unmarried minor dependent children. 
251.23 	Beginning December 1, 1996, qualified noncitizens who do not meet one of the 
251.24 	criteria in items (i) to (v) are eligible for medical assistance without federal financial 
251.25 	participation as described in paragraph (j). Notwithstanding paragraph (j), beginning 
251.26 	July 1, 2010, children and pregnant women who are qualified noncitizens, as described 
251.27 	in paragraph (b), are eligible for medical assistance with federal financial participation 
251.28 	as provided by the federal Children's Health Insurance Program Reauthorization Act of 
251.29 	2009, Public Law 111-3.
251.30 	(e) Noncitizens who are not qualified noncitizens as defined in paragraph (b), who 
251.31 	are lawfully present in the United States, as defined in Code of Federal Regulations, title 
251.32 	8, section 103.12, and who otherwise meet the eligibility requirements of this chapter, are 
251.33 	eligible for medical assistance under clauses (1) to (3). These individuals must cooperate 
251.34 	with the United States Citizenship and Immigration Services to pursue any applicable 
251.35 	immigration status, including citizenship, that would qualify them for medical assistance 
251.36 	with federal financial participation. 
252.1 	(1) Persons who were medical assistance recipients on August 22, 1996, are eligible 
252.2 	for medical assistance with federal financial participation through December 31, 1996. 
252.3 	(2) Beginning January 1, 1997, persons described in clause (1) are eligible for 
252.4 	medical assistance without federal financial participation as described in paragraph (j). 
252.5 	(3) Beginning December 1, 1996, persons residing in the United States prior to 
252.6 	August 22, 1996, who were not receiving medical assistance and persons who arrived on 
252.7 	or after August 22, 1996, are eligible for medical assistance without federal financial 
252.8 	participation as described in paragraph (j). 
252.9 	(f) Nonimmigrants who otherwise meet the eligibility requirements of this chapter 
252.10 	are eligible for the benefits as provided in paragraphs (g) to (i). For purposes of this 
252.11 	subdivision, a "nonimmigrant" is a person in one of the classes listed in United States 
252.12 	Code, title 8, section 1101(a)(15). 
252.13 	(g) Payment shall also be made for care and services that are furnished to noncitizens, 
252.14 	regardless of immigration status, who otherwise meet the eligibility requirements of 
252.15 	this chapter, if such care and services are necessary for the treatment of an emergency 
252.16 	medical condition, except for organ transplants and related care and services and routine 
252.17 	prenatal care. 
252.18 	(h) For purposes of this subdivision, the term "emergency medical condition" means 
252.19 	a medical condition that meets the requirements of United States Code, title 42, section 
252.20 	1396b(v). 
252.21 	(i) Beginning July 1, 2009, pregnant noncitizens who are undocumented, 
252.22 	nonimmigrants, or eligible for medical assistance as described in paragraph (j), and who 
252.23 	are not covered by a group health plan or health insurance coverage according to Code of 
252.24 	Federal Regulations, title 42, section 457.310,lawfully present as designated in paragraph 
252.25 	(e), and who otherwise meet the eligibility requirements of this chapter, are eligible for 
252.26 	medical assistance through the period of pregnancy, including labor and delivery, and 60 
252.27 	days postpartum, to the extent federal funds are available under title XXI of the Social 
252.28 	Security Act, and the state children's health insurance program, followed by 60 days 
252.29 	postpartum without federal financial participation. 
252.30 	(j) Qualified noncitizens as described in paragraph (d), and all other noncitizens 
252.31 	lawfully residing in the United States as described in paragraph (e), who are ineligible 
252.32 	for medical assistance with federal financial participation and who otherwise meet the 
252.33 	eligibility requirements of chapter 256B and of this paragraph, are eligible for medical 
252.34 	assistance without federal financial participation. Qualified noncitizens as described 
252.35 	in paragraph (d) are only eligible for medical assistance without federal financial 
252.36 	participation for five years from their date of entry into the United States. 
253.1 	(k) Beginning October 1, 2003, persons who are receiving care and rehabilitation 
253.2 	services from a nonprofit center established to serve victims of torture and are otherwise 
253.3 	ineligible for medical assistance under this chapter are eligible for medical assistance 
253.4 	without federal financial participation. These individuals are eligible only for the period 
253.5 	during which they are receiving services from the center. Individuals eligible under this 
253.6 	paragraph shall not be required to participate in prepaid medical assistance. 

253.7 	EFFECTIVE DATE. This section is effective July 1, 2009.

253.8 	Sec. 28. Minnesota Statutes 2008, section 256B.06, subdivision 5, is amended to read:
253.9 		Subd. 5.Deeming of sponsor income and resources. When determining eligibility 
253.10 	for any federal or state funded medical assistance under this section, the income 
253.11 	and resources of all noncitizens shall be deemed to include their sponsors' income 
253.12 	and resources as required under the Personal Responsibility and Work Opportunity 
253.13 	Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and 
253.14 	subsequently set out in federal rules. This section is effective May 1, 1997. Beginning 
253.15 	July 1, 2010, sponsor deeming does not apply to pregnant women and children who are 
253.16 	qualified noncitizens, as described in section 256B.06, subdivision 4, paragraph (b).

253.17 	EFFECTIVE DATE. This section is effective July 1, 2010.

253.18 	Sec. 29. Minnesota Statutes 2008, section 256B.0625, subdivision 3, is amended to 
253.19 	read:
253.20 		Subd. 3.Physicians' services. (a) Medical assistance covers physicians' services.
253.21 	(b)  Rates paid for anesthesiology services provided by physicians shall only be paid 
253.22 	if the physician directly performs the services. Rates for anesthesiology services that 
253.23 	are directly provided by the physician shall be paid according to the formula utilized in 
253.24 	the Medicare program and shall use a conversion factor "at percentile of calendar year 
253.25 	set by legislature."
253.26 	(c) Medical assistance does not cover physicians' services related to the provision of 
253.27 	care related to a treatment reportable under section 144.7065, subdivision 2, clauses (1), 
253.28 	(2), (3), and (5), and subdivision 7, clause (1). 
253.29 	(d) Medical assistance does not cover physicians' services related to the provision of 
253.30 	care (1) for which hospital reimbursement is prohibited under section 256.969, subdivision 
253.31 	3b, paragraph (c), or (2) reportable under section 144.7065, subdivisions 2 to 7, if the 
253.32 	physicians' services are billed by a physician who delivered care that contributed to or 
253.33 	caused the adverse health care event or hospital-acquired condition.
254.1 	(e) The payment limitations in this subdivision shall also apply to MinnesotaCare 
254.2 	and general assistance medical care.
254.3 	(f) A physician shall not bill a recipient of services for any payment disallowed 
254.4 	under this subdivision.

254.5 	Sec. 30. Minnesota Statutes 2008, section 256B.0625, is amended by adding a 
254.6 	subdivision to read:
254.7 		Subd. 9a.Dental services for children. (a) Medical assistance covers dental 
254.8 	services for children with the following limits:
254.9 	(1) the application of sealants are limited to permanent teeth and to once every 
254.10 	five years;
254.11 	(2) the application of fluoride varnish is limited to once every six months; and
254.12 	(3) posterior and anterior restorations shall be reimbursed at the amalgam rate 
254.13 	regardless of the materials used.
254.14 	(b) Dental services provided under this subdivision shall be reimbursed on a 
254.15 	fee-for-service basis in accordance with section 256B.76.

254.16 	Sec. 31. Minnesota Statutes 2008, section 256B.0625, is amended by adding a 
254.17 	subdivision to read:
254.18 		Subd. 9b.Dental services for adult recipients. (a) Medical assistance covers 
254.19 	the following dental services for adults:
254.20 	(1) diagnostic services limited to:
254.21 	(i) a comprehensive examination, once every five years;
254.22 	(ii) a periodic examination, once per year;
254.23 	(iii) a limited examination, once every two years;
254.24 	(iv) bitewing x-rays, once every two years;
254.25 	(v) periapical x-rays; and
254.26 	(vi) panoramic x-rays, once every five years; or in conjunction with a posterior 
254.27 	extraction, a scheduled outpatient facility procedure, or as medically necessary for 
254.28 	diagnosis and follow up of oral and maxillofacial pathology and trauma. Panoramic x-rays 
254.29 	may be taken once every two years for patients who cannot cooperate for intraoral film 
254.30 	due to a developmental disability or medical condition that does not allow for intraoral 
254.31 	film placement;
254.32 	(2) preventive services limited to:
254.33 	(i) prophylaxis, once per year;
254.34 	(ii) the application of fluoride varnish, once per year;
255.1 	(3) posterior and anterior restorations, reimbursed at the amalgam rate regardless of 
255.2 	the material used;
255.3 	(4) endodontic services limited to root canals on the anterior and premolars only;
255.4 	(5) periodontic services limited to full-mouth debridement, once every five years;
255.5 	(6) prosthodontics: dentures or partials are limited to one set every six years;
255.6 	(7) oral surgery is limited to biopsies, extractions, incisions, and the drainage of 
255.7 	abscesses; and
255.8 	(8) palliative treatment and sedative fillings for relief of pain.
255.9 	(b) In addition to the services specified in paragraph (a), medical assistance covers 
255.10 	the following services if provided in an outpatient hospital setting or free-standing 
255.11 	ambulatory surgical center as part of outpatient dental surgery:
255.12 	(1) diagnostic services limited to full-mouth survey, once every five years;
255.13 	(2) periodontics services limited to periodental scaling and root planing, once every 
255.14 	two years; and
255.15 	(3) general anesthesia.
255.16 	(c) Dental services provided under this subdivision shall be reimbursed on a 
255.17 	fee-for-service basis in accordance with section 256B.76.

255.18 	Sec. 32. Minnesota Statutes 2008, section 256B.0625, subdivision 11, is amended to 
255.19 	read:
255.20 		Subd. 11.Nurse anesthetist services. Medical assistance covers nurse anesthetist 
255.21 	services. Rates paid for anesthesiology services provided by a certified registered nurse 
255.22 	anesthetistsanesthetist under the direction of a physician shall be according to the formula 
255.23 	utilized in the Medicare program and shall use the conversion factor that is used by the 
255.24 	Medicare program. Rates paid for anesthesiology services provided by a nondirected 
255.25 	certified registered nurse anesthetist who is not directed by an anesthesiologist shall be 
255.26 	the same rate as paid under subdivision 3, paragraph (b).

255.27 	Sec. 33. Minnesota Statutes 2008, section 256B.0625, subdivision 13, is amended to 
255.28 	read:
255.29 		Subd. 13.Drugs. (a) Medical assistance covers drugs, except for fertility drugs 
255.30 	when specifically used to enhance fertility, if prescribed by a licensed practitioner and 
255.31 	dispensed by a licensed pharmacist, by a physician enrolled in the medical assistance 
255.32 	program as a dispensing physician, or by a physician, physician assistant,  or a nurse 
255.33 	practitioner employed by or under contract with a community health board as defined in 
255.34 	section 145A.02, subdivision 5, for the purposes of communicable disease control.
256.1 	(b) The dispensed quantity of a prescription drug must not exceed a 34-day supply, 
256.2 	unless authorized by the commissioner.
256.3 	(c) Medical assistance covers the following over-the-counter drugs when prescribed 
256.4 	by a licensed practitioner or by a licensed pharmacist who meets standards established by 
256.5 	the commissioner, in consultation with the board of pharmacy: antacids, acetaminophen, 
256.6 	family planning products, aspirin, insulin, products for the treatment of lice, vitamins for 
256.7 	adults with documented vitamin deficiencies, vitamins for children under the age of seven 
256.8 	and pregnant or nursing women, and any other over-the-counter drug identified by the 
256.9 	commissioner, in consultation with the formulary committee, as necessary, appropriate, 
256.10 	and cost-effective for the treatment of certain specified chronic diseases, conditions, 
256.11 	or disorders, and this determination shall not be subject to the requirements of chapter 
256.12 	14. A pharmacist may prescribe over-the-counter medications as provided under this 
256.13 	paragraph for purposes of receiving reimbursement under Medicaid. When prescribing 
256.14 	over-the-counter drugs under this paragraph, licensed pharmacists must consult with the 
256.15 	recipient to determine necessity, provide drug counseling, review drug therapy for potential 
256.16 	adverse interactions, and make referrals as needed to other health care professionals.
256.17 	(d) Effective January 1, 2006, medical assistance shall not cover drugs that 
256.18 	are coverable under Medicare Part D as defined in the Medicare Prescription Drug, 
256.19 	Improvement, and Modernization Act of 2003, Public Law 108-173, section 1860D-2(e), 
256.20 	for individuals eligible for drug coverage as defined in the Medicare Prescription 
256.21 	Drug, Improvement, and Modernization Act of 2003, Public Law 108-173, section 
256.22 	1860D-1(a)(3)(A). For these individuals, medical assistance may cover drugs from the 
256.23 	drug classes listed in United States Code, title 42, section 1396r-8(d)(2), subject to this 
256.24 	subdivision and subdivisions 13a to 13g, except that drugs listed in United States Code, 
256.25 	title 42, section 1396r-8(d)(2)(E), shall not be covered.

256.26 	Sec. 34. Minnesota Statutes 2008, section 256B.0625, subdivision 13e, is amended to 
256.27 	read:
256.28 		Subd. 13e.Payment rates. (a) The basis for determining the amount of payment 
256.29 	shall be the lower of the actual acquisition costs of the drugs plus a fixed dispensing fee; 
256.30 	the maximum allowable cost set by the federal government or by the commissioner plus 
256.31 	the fixed dispensing fee; or the usual and customary price charged to the public. The 
256.32 	amount of payment basis must be reduced to reflect all discount amounts applied to the 
256.33 	charge by any provider/insurer agreement or contract for submitted charges to medical 
256.34 	assistance programs. The net submitted charge may not be greater than the patient liability 
256.35 	for the service. The pharmacy dispensing fee shall be $3.65, except that the dispensing fee 
257.1 	for intravenous solutions which must be compounded by the pharmacist shall be $8 per 
257.2 	bag, $14 per bag for cancer chemotherapy products, and $30 per bag for total parenteral 
257.3 	nutritional products dispensed in one liter quantities, or $44 per bag for total parenteral 
257.4 	nutritional products dispensed in quantities greater than one liter. Actual acquisition 
257.5 	cost includes quantity and other special discounts except time and cash discounts. 
257.6 	Effective July 1, 2008 2009, the actual acquisition cost of a drug shall be estimated by the 
257.7 	commissioner, at average wholesale price minus 1415 percent. The actual acquisition 
257.8 	cost of antihemophilic factor drugs shall be estimated at the average wholesale price 
257.9 	minus 30 percent. The maximum allowable cost of a multisource drug may be set by the 
257.10 	commissioner and it shall be comparable to, but no higher than, the maximum amount 
257.11 	paid by other third-party payors in this state who have maximum allowable cost programs. 
257.12 	Establishment of the amount of payment for drugs shall not be subject to the requirements 
257.13 	of the Administrative Procedure Act.
257.14 	(b) An additional dispensing fee of $.30 may be added to the dispensing fee paid 
257.15 	to pharmacists for legend drug prescriptions dispensed to residents of long-term care 
257.16 	facilities when a unit dose blister card system, approved by the department, is used. Under 
257.17 	this type of dispensing system, the pharmacist must dispense a 30-day supply of drug. 
257.18 	The National Drug Code (NDC) from the drug container used to fill the blister card must 
257.19 	be identified on the claim to the department. The unit dose blister card containing the 
257.20 	drug must meet the packaging standards set forth in Minnesota Rules, part 6800.2700, 
257.21 	that govern the return of unused drugs to the pharmacy for reuse. The pharmacy provider 
257.22 	will be required to credit the department for the actual acquisition cost of all unused 
257.23 	drugs that are eligible for reuse. Over-the-counter medications must be dispensed in the 
257.24 	manufacturer's unopened package. The commissioner may permit the drug clozapine to be 
257.25 	dispensed in a quantity that is less than a 30-day supply.
257.26 	(c) Whenever a generically equivalent product is available, payment shall be on the 
257.27 	basis of the actual acquisition cost of the generic drug, or on the maximum allowable cost 
257.28 	established by the commissioner.
257.29 	(d) The basis for determining the amount of payment for drugs administered in an 
257.30 	outpatient setting shall be the lower of the usual and customary cost submitted by the 
257.31 	provider or the amount established for Medicare by the United States Department of 
257.32 	Health and Human Services pursuant to title XVIII, section 1847a of the federal Social 
257.33 	Security Act.
257.34 	(e) The commissioner may negotiate lower reimbursement rates for specialty 
257.35 	pharmacy products than the rates specified in paragraph (a). The commissioner may 
257.36 	require individuals enrolled in the health care programs administered by the department 
258.1 	to obtain specialty pharmacy products from providers with whom the commissioner has 
258.2 	negotiated lower reimbursement rates. Specialty pharmacy products are defined as those 
258.3 	used by a small number of recipients or recipients with complex and chronic diseases 
258.4 	that require expensive and challenging drug regimens. Examples of these conditions 
258.5 	include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis 
258.6 	C, growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms 
258.7 	of cancer. Specialty pharmaceutical products include injectable and infusion therapies, 
258.8 	biotechnology drugs, high-cost therapies, and therapies that require complex care. The 
258.9 	commissioner shall consult with the formulary committee to develop a list of specialty 
258.10 	pharmacy products subject to this paragraph. In consulting with the formulary committee 
258.11 	in developing this list, the commissioner shall take into consideration the population 
258.12 	served by specialty pharmacy products, the current delivery system and standard of care in 
258.13 	the state, and access to care issues. The commissioner shall have the discretion to adjust 
258.14 	the reimbursement rate to prevent access to care issues.

258.15 	Sec. 35. Minnesota Statutes 2008, section 256B.0625, subdivision 13h, is amended to 
258.16 	read:
258.17 		Subd. 13h. Medication therapy management services. (a) Medical assistance 
258.18 	and general assistance medical care cover medication therapy management services for 
258.19 	a recipient taking four or more prescriptions to treat or prevent two or more chronic 
258.20 	medical conditions, or a recipient with a drug therapy problem that is identified or prior 
258.21 	authorized by the commissioner that has resulted or is likely to result in significant 
258.22 	nondrug program costs. The commissioner may cover medical therapy management 
258.23 	services under MinnesotaCare if the commissioner determines this is cost-effective. For 
258.24 	purposes of this subdivision, "medication therapy management" means the provision 
258.25 	of the following pharmaceutical care services by a licensed pharmacist to optimize the 
258.26 	therapeutic outcomes of the patient's medications: 
258.27 	(1) performing or obtaining necessary assessments of the patient's health status; 
258.28 	(2) formulating a medication treatment plan; 
258.29 	(3) monitoring and evaluating the patient's response to therapy, including safety 
258.30 	and effectiveness; 
258.31 	(4) performing a comprehensive medication review to identify, resolve, and prevent 
258.32 	medication-related problems, including adverse drug events; 
258.33 	(5) documenting the care delivered and communicating essential information to 
258.34 	the patient's other primary care providers; 
259.1 	(6) providing verbal education and training designed to enhance patient 
259.2 	understanding and appropriate use of the patient's medications; 
259.3 	(7) providing information, support services, and resources designed to enhance 
259.4 	patient adherence with the patient's therapeutic regimens; and 
259.5 	(8) coordinating and integrating medication therapy management services within the 
259.6 	broader health care management services being provided to the patient. 
259.7 	Nothing in this subdivision shall be construed to expand or modify the scope of practice of 
259.8 	the pharmacist as defined in section 151.01, subdivision 27. 
259.9 	(b) To be eligible for reimbursement for services under this subdivision, a pharmacist 
259.10 	must meet the following requirements: 
259.11 	(1) have a valid license issued under chapter 151; 
259.12 	(2) have graduated from an accredited college of pharmacy on or after May 1996, or 
259.13 	completed a structured and comprehensive education program approved by the Board of 
259.14 	Pharmacy and the American Council of Pharmaceutical Education for the provision and 
259.15 	documentation of pharmaceutical care management services that has both clinical and 
259.16 	didactic elements; 
259.17 	(3) be practicing in an ambulatory care setting as part of a multidisciplinary team or 
259.18 	have developed a structured patient care process that is offered in a private or semiprivate 
259.19 	patient care area that is separate from the commercial business that also occurs in the 
259.20 	setting, or in home settings, excluding long-term care and group homes, if the service is 
259.21 	ordered by the provider-directed care coordination team; and 
259.22 	(4) make use of an electronic patient record system that meets state standards. 
259.23 	(c) For purposes of reimbursement for medication therapy management services, 
259.24 	the commissioner may enroll individual pharmacists as medical assistance and general 
259.25 	assistance medical care providers. The commissioner may also establish contact 
259.26 	requirements between the pharmacist and recipient, including limiting the number of 
259.27 	reimbursable consultations per recipient. 
259.28 	(d) The commissioner, after receiving recommendations from professional medical 
259.29 	associations, professional pharmacy associations, and consumer groups, shall convene 
259.30 	an 11-member Medication Therapy Management Advisory Committee to advise 
259.31 	the commissioner on the implementation and administration of medication therapy 
259.32 	management services. The committee shall be comprised of: two licensed physicians; 
259.33 	two licensed pharmacists; two consumer representatives; two health plan company 
259.34 	representatives; and three members with expertise in the area of medication therapy 
259.35 	management, who may be licensed physicians or licensed pharmacists. The committee is 
260.1 	governed by section 15.059, except that committee members do not receive compensation 
260.2 	or reimbursement for expenses. The advisory committee expires on June 30, 2007. 
260.3 	(e) The commissioner shall evaluate the effect of medication therapy management 
260.4 	on quality of care, patient outcomes, and program costs, and shall include a description 
260.5 	of any savings generated in the medical assistance and general assistance medical care 
260.6 	programs that can be attributable to this coverage. The evaluation shall be submitted to 
260.7 	the legislature by December 15, 2007. The commissioner may contract with a vendor 
260.8 	or an academic institution that has expertise in evaluating health care outcomes for the 
260.9 	purpose of completing the evaluation. 
260.10 	(d) The commissioner shall establish a pilot project for an intensive medication 
260.11 	therapy management program for patients identified by the commissioner with multiple 
260.12 	chronic conditions and a high number of medications who are at high risk of preventable 
260.13 	hospitalizations, emergency room use, medication complications, and suboptimal 
260.14 	treatment outcomes due to medication-related problems. For purposes of the pilot 
260.15 	project, medication therapy management services may be provided in a patient's home 
260.16 	or community setting, in addition to other authorized settings. The commissioner may 
260.17 	waive existing payment policies and establish special payment rates for the pilot project. 
260.18 	The pilot project must be designed to produce a net savings to the state compared to the 
260.19 	estimated costs that would otherwise be incurred for similar patients without the program.

260.20 	Sec. 36. Minnesota Statutes 2008, section 256B.0625, is amended by adding a 
260.21 	subdivision to read:
260.22 		Subd. 13i.Collaborative psychiatric consultation. (a) Within the available 
260.23 	appropriations, the commissioner shall establish a collaborative psychiatric consultation 
260.24 	service to be available via telephone, interactive video, e-mail, facsimile, or other means 
260.25 	of communication to primary care practitioners, including pediatricians. The service shall 
260.26 	include child and adolescent psychiatrists was well as adult psychiatrists. The first priority 
260.27 	for this service shall be to provide the consultations required under paragraph (b).
260.28 	(b) The commissioner shall require prior authorization and a collaborative 
260.29 	psychiatric consultation for attention deficit/hyperactivity disorder (ADHD) and attention 
260.30 	deficit disorder (ADD) medication and psychotropic medication prescribed to children 
260.31 	under the following circumstances:
260.32 	(1) prior authorization and a collaborative consultation from a 
260.33 	commissioner-approved provider shall be required when ADD or ADHD medication is 
260.34 	prescribed to children under five years of age;
261.1 	(2) a collaborative consultation from a commissioner-approved provider shall be 
261.2 	required when ADD or ADHD medication is prescribed for children five years of age 
261.3 	and under 18 years of age for ADHD medications if the prescribed amount exceeds the 
261.4 	following dosages:
261.5 	(i) methylphenidates 120 mg/day;
261.6 	(ii) dexmethylphenidates 60 mg/day;
261.7 	(iii) amphetamines 60 mg/day; and
261.8 	(iv) Strattera 120 mg/day.
261.9 	The commissioner shall periodically review the list of medications included in this 
261.10 	paragraph and update the medications and dosages listed as needed, in accordance with 
261.11 	the requirements in subdivision 13f, paragraph (b);
261.12 	(3) prior authorization and a collaborative consultation from a 
261.13 	commissioner-approved provider shall be required when more than one type of medication 
261.14 	identified in clause (2) is prescribed at one time to a child under the age of 18; and
261.15 	(4) a collaborative consultation from a commissioner-approved provider shall be 
261.16 	required if any of the following conditions apply:
261.17 	(i) the absence of a DSM-IV diagnosis in the child's claim record;
261.18 	(ii) five or more psychotropic medications prescribed concomitantly after 60 days;
261.19 	(iii) two or more concomitant antipsychotic medications after 60 days;
261.20 	(iv) three or more concomitant mood stabilizer medications for a mental health 
261.21 	diagnosis after 60 days;
261.22 	(v) the prescribed psychotropic medication is not consistent with appropriate care 
261.23 	for the child's diagnosed mental disorder or with documented target symptoms associated 
261.24 	with a therapeutic response to the medication prescribed; and
261.25 	(vi) psychotropic medications prescribed for children under five years of age.
261.26 	The commissioner may establish threshold amounts for identified psychotropic 
261.27 	medications that, if exceeded, may require a collaborative consultation from a 
261.28 	commissioner-approved provider.

261.29 	Sec. 37. Minnesota Statutes 2008, section 256B.0625, subdivision 17, is amended to 
261.30 	read:
261.31 		Subd. 17.Transportation costs. (a) Medical assistance covers medical 
261.32 	transportation costs incurred solely for obtaining emergency medical care or transportation 
261.33 	costs incurred by eligible persons in obtaining emergency or nonemergency medical 
261.34 	care when paid directly to an ambulance company, common carrier, or other recognized 
261.35 	providers of transportation services. Medical transportation must be provided by:
262.1 	(1) an ambulance, as defined in section 144E.001, subdivision 2;
262.2 	(2) special transportation; or
262.3 	(3) common carrier including, but not limited to, bus, taxicab, other commercial 
262.4 	carrier, or private automobile.
262.5 	(b) Medical assistance covers special transportation, as defined in Minnesota Rules, 
262.6 	part 9505.0315, subpart 1, item F, if the recipient has a physical or mental impairment that 
262.7 	would prohibit the recipient from safely accessing and using a bus, taxi, other commercial 
262.8 	transportation, or private automobile.
262.9 	The commissioner may use an order by the recipient's attending physician to certify that 
262.10 	the recipient requires special transportation services. Special transportation includes
262.11 	providers shall perform driver-assisted service to services for eligible individuals. 
262.12 	Driver-assisted service includes passenger pickup at and return to the individual's 
262.13 	residence or place of business, assistance with admittance of the individual to the medical 
262.14 	facility, and assistance in passenger securement or in securing of wheelchairs or stretchers 
262.15 	in the vehicle. Special transportation providers must obtain written documentation 
262.16 	from the health care service provider who is serving the recipient being transported, 
262.17 	identifying the time that the recipient arrived. Special transportation providers may not 
262.18 	bill for separate base rates for the continuation of a trip beyond the original destination. 
262.19 	Special transportation providers must take recipients to the nearest appropriate health 
262.20 	care provider, using the most direct route available. The maximum minimum medical 
262.21 	assistance reimbursement rates for special transportation services are:
262.22 	(1) (i) $17 for the base rate and $1.35 per mile for special transportation services to 
262.23 	eligible persons who need a wheelchair-accessible van;
262.24 	(2) (ii)  $11.50 for the base rate and $1.30 per mile for special transportation services 
262.25 	to eligible persons who do not need a wheelchair-accessible van; and
262.26 	(3) (iii)  $60 for the base rate and $2.40 per mile, and an attendant rate of $9 per trip, 
262.27 	for special transportation services to eligible persons who need a stretcher-accessible 
262.28 	vehicle;
262.29 	(2) the base rates for special transportation services in areas defined under RUCA 
262.30 	to be super rural shall be equal to the reimbursement rate established in clause (1) plus 
262.31 	11.3 percent; and
262.32 	(3) for special transportation services in areas defined under RUCA to be rural 
262.33 	or super rural areas:
262.34 	(i) for a trip equal to 17 miles or less, mileage reimbursement shall be equal to 125 
262.35 	percent of the respective mileage rate in clause (1); and
263.1 	(ii) for a trip between 18 and 50 miles, mileage reimbursement shall be equal to 
263.2 	112.5 percent of the respective mileage rate in clause (1).
263.3 	(c) For purposes of reimbursement rates for special transportation services under 
263.4 	paragraph (b), the zip code of the recipient's place of residence shall determine whether 
263.5 	the urban, rural, or super rural reimbursement rate applies.
263.6 	(d) For purposes of this subdivision, "rural urban commuting area" or "RUCA" 
263.7 	means a census-tract based classification system under which a geographical area is 
263.8 	determined to be urban, rural, or super rural.

263.9 	Sec. 38. Minnesota Statutes 2008, section 256B.0625, subdivision 17a, is amended to 
263.10 	read:
263.11 		Subd. 17a.Payment for ambulance services. Medical assistance covers 
263.12 	ambulance services. Providers shall bill ambulance services according to Medicare 
263.13 	criteria. Nonemergency ambulance services shall not be paid as emergencies. Effective 
263.14 	for services rendered on or after July 1, 2001, medical assistance payments for ambulance 
263.15 	services shall be paid at the Medicare reimbursement rate or at the medical assistance 
263.16 	payment rate in effect on July 1, 2000, whichever is greater.

263.17 	Sec. 39. Minnesota Statutes 2008, section 256B.0625, is amended by adding a 
263.18 	subdivision to read:
263.19 		Subd. 18b.Broker dispatching prohibition. The commissioner shall not use a 
263.20 	broker or coordinator for any purpose related to transportation services under subdivision 
263.21 	18.

263.22 	Sec. 40. Minnesota Statutes 2008, section 256B.0625, is amended by adding a 
263.23 	subdivision to read:
263.24 		Subd. 25a.Prior authorization of diagnostic imaging services. (a) Effective 
263.25 	January 1, 2010, the commissioner shall require prior authorization or decision support 
263.26 	for the ordering providers at the time the service is ordered for the following outpatient 
263.27 	diagnostic imaging services: computerized tomography (CT), magnetic resonance 
263.28 	imaging (MRI), magnetic resonance angiography (MRA), positive emission tomography 
263.29 	(PET), cardiac imaging and ultrasound diagnostic imaging.
263.30 	(b) Prior authorization under this subdivision is not required for diagnostic imaging 
263.31 	services performed as part of a hospital emergency room visit, inpatient hospitalization, or 
263.32 	if concurrent with or on the same day as an urgent care facility visit.
264.1 	(c) This subdivision does not apply to services provided to recipients who are 
264.2 	enrolled in Medicare, the prepaid medical assistance program, the prepaid general 
264.3 	assistance medical care program, or the MinnesotaCare program.
264.4 	(d) The commissioner may contract with a private entity to provide the prior 
264.5 	authorization or decision support required under this subdivision. The contracting entity 
264.6 	must incorporate clinical guidelines that are based on evidence-based medical literature, if 
264.7 	available. By January 1, 2012, the contracting entity shall report to the commissioner the 
264.8 	results of prior authorization or decision support.

264.9 	Sec. 41. Minnesota Statutes 2008, section 256B.0625, subdivision 26, is amended to 
264.10 	read:
264.11 		Subd. 26.Special education services. (a) Medical assistance covers medical 
264.12 	services identified in a recipient's individualized education plan and covered under the 
264.13 	medical assistance state plan. Covered services include occupational therapy, physical 
264.14 	therapy, speech-language therapy, clinical psychological services, nursing services, 
264.15 	school psychological services, school social work services, personal care assistants 
264.16 	serving as management aides, assistive technology devices, transportation services, 
264.17 	health assessments, and other services covered under the medical assistance state plan. 
264.18 	Mental health services eligible for medical assistance reimbursement must be provided or 
264.19 	coordinated through a children's mental health collaborative where a collaborative exists if 
264.20 	the child is included in the collaborative operational target population. The provision or 
264.21 	coordination of services does not require that the individual education plan be developed 
264.22 	by the collaborative.
264.23 	The services may be provided by a Minnesota school district that is enrolled as a 
264.24 	medical assistance provider or its subcontractor, and only if the services meet all the 
264.25 	requirements otherwise applicable if the service had been provided by a provider other 
264.26 	than a school district, in the following areas: medical necessity, physician's orders, 
264.27 	documentation, personnel qualifications, and prior authorization requirements. The 
264.28 	nonfederal share of costs for services provided under this subdivision is the responsibility 
264.29 	of the local school district as provided in section 125A.74. Services listed in a child's 
264.30 	individual education plan are eligible for medical assistance reimbursement only if those 
264.31 	services meet criteria for federal financial participation under the Medicaid program. 
264.32 	(b) Approval of health-related services for inclusion in the individual education plan 
264.33 	does not require prior authorization for purposes of reimbursement under this chapter. 
264.34 	The commissioner may require physician review and approval of the plan not more than 
265.1 	once annually or upon any modification of the individual education plan that reflects a 
265.2 	change in health-related services.
265.3 	(c) Services of a speech-language pathologist provided under this section are covered 
265.4 	notwithstanding Minnesota Rules, part 9505.0390, subpart 1, item L, if the person:
265.5 	(1) holds a masters degree in speech-language pathology;
265.6 	(2) is licensed by the Minnesota Board of Teaching as an educational 
265.7 	speech-language pathologist; and
265.8 	(3) either has a certificate of clinical competence from the American Speech and 
265.9 	Hearing Association, has completed the equivalent educational requirements and work 
265.10 	experience necessary for the certificate or has completed the academic program and is 
265.11 	acquiring supervised work experience to qualify for the certificate.
265.12 	(d) Medical assistance coverage for medically necessary services provided under 
265.13 	other subdivisions in this section may not be denied solely on the basis that the same or 
265.14 	similar services are covered under this subdivision.
265.15 	(e) The commissioner shall develop and implement package rates, bundled rates, or 
265.16 	per diem rates for special education services under which separately covered services are 
265.17 	grouped together and billed as a unit in order to reduce administrative complexity.
265.18 	(f) The commissioner shall develop a cost-based payment structure for payment 
265.19 	of these services. The commissioner shall reimburse claims submitted based on an 
265.20 	interim rate, and shall settle at a final rate once the department has determined it. The 
265.21 	commissioner shall notify the school district of the final rate. The school district has 60 
265.22 	days to appeal the final rate. To appeal the final rate, the school district shall file a written 
265.23 	appeal request to the commissioner within 60 days of the date the final rate determination 
265.24 	was mailed. The appeal request shall specify (1) the disputed items and (2) the name and 
265.25 	address of the person to contact regarding the appeal.
265.26 	(g) Effective July 1, 2000, medical assistance services provided under an individual 
265.27 	education plan or an individual family service plan by local school districts shall not count 
265.28 	against medical assistance authorization thresholds for that child.
265.29 	(h) Nursing services as defined in section 148.171, subdivision 15, and provided 
265.30 	as an individual education plan health-related service, are eligible for medical assistance 
265.31 	payment if they are otherwise a covered service under the medical assistance program. 
265.32 	Medical assistance covers the administration of prescription medications by a licensed 
265.33 	nurse who is employed by or under contract with a school district when the administration 
265.34 	of medications is identified in the child's individualized education plan. The simple 
265.35 	administration of medications alone is not covered under medical assistance when 
266.1 	administered by a provider other than a school district or when it is not identified in the 
266.2 	child's individualized education plan. 

266.3 	Sec. 42. Minnesota Statutes 2008, section 256B.0751, subdivision 7, is amended to 
266.4 	read:
266.5 		Subd. 7.Outreach. Beginning July 1, 2009, the commissioner shall encourage
266.6 	require state health care program enrollees who have a complex or chronic condition to 
266.7 	select a primary care clinic with clinicians who have been certified as health care homes, 
266.8 	if there are two or more primary care clinics with clinicians who have been certified as 
266.9 	health care homes available to the enrollee.

266.10 	Sec. 43. [256B.0756] PODIATRY-DIRECTED WOUND CARE FOR 
266.11 	DIABETICS.
266.12 	(a) The commissioner shall implement a demonstration project for enrollees in 
266.13 	medical assistance or general assistance medical care who have or are at risk of developing 
266.14 	diabetes. The project shall be designed as a podiatry-directed wound care program that 
266.15 	focuses on the prevention and care of diabetic-related wounds in order to reduce wound 
266.16 	treatment costs and prevent amputations.
266.17 	(b) The commissioner, in consultation with the Minnesota Podiatric Medical 
266.18 	Association, shall develop the request for proposals to be submitted by providers or 
266.19 	groups of providers by November 1, 2009, for implementation by January 1, 2010. The 
266.20 	proposals must incorporate:
266.21 	(1) health care provider education and training;
266.22 	(2) patient education and training;
266.23 	(3) patient evaluation and assessments;
266.24 	(4) new wound diagnostic, treatment, and prevention technologies using best 
266.25 	practices in wound treatment;
266.26 	(5) an electronic reporting system for patient measurement, monitoring, and 
266.27 	reporting; and
266.28 	(6) a process for documenting patient compliance and satisfaction.
266.29 	(c) The commissioner may establish minimum standards for quality care that must 
266.30 	be met by participating providers and must establish quality measurements for the project.
266.31 	(d) The project shall provide podiatric wound care to at least 1,000 enrollees for 
266.32 	a two-year period. To the extent possible, the commissioner shall include enrollees 
266.33 	throughout the state.
267.1 	(e) The commissioner shall report to the legislature by January 15, 2013, the status 
267.2 	of the demonstration project, including the number of patients, patient compliance, 
267.3 	patient satisfaction, amputation data, and cost-savings data related to drug utilization and 
267.4 	treatment-related costs.
267.5 	(f) The commissioner shall seek any federal waivers necessary to obtain federal 
267.6 	matching funds.

267.7 	Sec. 44. Minnesota Statutes 2008, section 256B.08, is amended by adding a 
267.8 	subdivision to read:
267.9 		Subd. 4.Social Security data. The commissioner shall accept data received from 
267.10 	the Social Security Administration as an application for medical assistance in accordance 
267.11 	with United States Code, title 42, section 1396u-5(a).

267.12 	EFFECTIVE DATE. This section is effective January 1, 2010.

267.13 	Sec. 45. Minnesota Statutes 2008, section 256B.15, subdivision 1, is amended to read:
267.14 		Subdivision 1.Policy and applicability. (a) It is the policy of this state that 
267.15 	individuals or couples, either or both of whom participate in the medical assistance 
267.16 	program, use their own assets to pay their share of the total cost of their care during or 
267.17 	after their enrollment in the program according to applicable federal law and the laws of 
267.18 	this state. The following provisions apply:
267.19 	(1) subdivisions 1c to 1k shall not apply to claims arising under this section which 
267.20 	are presented under section 525.313;
267.21 	(2) the provisions of subdivisions 1c to 1k expanding the interests included in an 
267.22 	estate for purposes of recovery under this section give effect to the provisions of United 
267.23 	States Code, title 42, section 1396p, governing recoveries, but do not give rise to any 
267.24 	express or implied liens in favor of any other parties not named in these provisions;
267.25 	(3) the continuation of a recipient's life estate or joint tenancy interest in real 
267.26 	property after the recipient's death for the purpose of recovering medical assistance under 
267.27 	this section modifies common law principles holding that these interests terminate on 
267.28 	the death of the holder;
267.29 	(4) all laws, rules, and regulations governing or involved with a recovery of medical 
267.30 	assistance shall be liberally construed to accomplish their intended purposes;
267.31 	(5) a deceased recipient's life estate and joint tenancy interests continued under this 
267.32 	section shall be owned by the remaindermen or surviving joint tenants as their interests 
267.33 	may appear on the date of the recipient's death. They shall not be merged into the 
267.34 	remainder interest or the interests of the surviving joint tenants by reason of ownership. 
268.1 	They shall be subject to the provisions of this section. Any conveyance, transfer, sale, 
268.2 	assignment, or encumbrance by a remainderman, a surviving joint tenant, or their heirs, 
268.3 	successors, and assigns shall be deemed to include all of their interest in the deceased 
268.4 	recipient's life estate or joint tenancy interest continued under this section; and
268.5 	(6) the provisions of subdivisions 1c to 1k continuing a recipient's joint tenancy 
268.6 	interests in real property after the recipient's death do not apply to a homestead owned 
268.7 	of record, on the date the recipient dies, by the recipient and the recipient's spouse as 
268.8 	joint tenants with a right of survivorship. Homestead means the real property occupied 
268.9 	by the surviving joint tenant spouse as their sole residence on the date the recipient dies 
268.10 	and classified and taxed to the recipient and surviving joint tenant spouse as homestead 
268.11 	property for property tax purposes in the calendar year in which the recipient dies. For 
268.12 	purposes of this exemption, real property the recipient and their surviving joint tenant 
268.13 	spouse purchase solely with the proceeds from the sale of their prior homestead, own 
268.14 	of record as joint tenants, and qualify as homestead property under section 273.124 in 
268.15 	the calendar year in which the recipient dies and prior to the recipient's death shall be 
268.16 	deemed to be real property classified and taxed to the recipient and their surviving joint 
268.17 	tenant spouse as homestead property in the calendar year in which the recipient dies. 
268.18 	The surviving spouse, or any person with personal knowledge of the facts, may provide 
268.19 	an affidavit describing the homestead property affected by this clause and stating facts 
268.20 	showing compliance with this clause. The affidavit shall be prima facie evidence of the 
268.21 	facts it states.
268.22 	(b) For purposes of this section, "medical assistance" includes the medical assistance 
268.23 	program under this chapter and the general assistance medical care program under chapter 
268.24 	256D and alternative care for nonmedical assistance recipients under section 256B.0913.
268.25 	(c) For purposes of this section, beginning January 1, 2010, "medical assistance" 
268.26 	does not include Medicare cost-sharing benefits in accordance with United States Code, 
268.27 	title 42, section 1396p.
268.28 	(d) All provisions in this subdivision, and subdivisions 1d, 1f, 1g, 1h, 1i, and 1j, 
268.29 	related to the continuation of a recipient's life estate or joint tenancy interests in real 
268.30 	property after the recipient's death for the purpose of recovering medical assistance, are 
268.31 	effective only for life estates and joint tenancy interests established on or after August 1, 
268.32 	2003. For purposes of this paragraph, medical assistance does not include alternative care.

268.33 	Sec. 46. Minnesota Statutes 2008, section 256B.15, subdivision 1a, is amended to read:
268.34 		Subd. 1a.Estates subject to claims. (a) If a person receives any medical assistance 
268.35 	hereunder, on the person's death, if single, or on the death of the survivor of a married 
269.1 	couple, either or both of whom received medical assistance, or as otherwise provided 
269.2 	for in this section, the total amount paid for medical assistance rendered for the person 
269.3 	and spouse shall be filed as a claim against the estate of the person or the estate of the 
269.4 	surviving spouse in the court having jurisdiction to probate the estate or to issue a decree 
269.5 	of descent according to sections 525.31 to 525.313. 
269.6 	(b) For the purposes of this section, the person's estate must consist of:
269.7 	(1) the person's probate estate;
269.8 	(2) all of the person's interests or proceeds of those interests in real property the 
269.9 	person owned as a life tenant or as a joint tenant with a right of survivorship at the time of 
269.10 	the person's death;
269.11 	(3) all of the person's interests or proceeds of those interests in securities the person 
269.12 	owned in beneficiary form as provided under sections 524.6-301 to 524.6-311 at the time 
269.13 	of the person's death, to the extent the interests or proceeds of those interests become part 
269.14 	of the probate estate under section 524.6-307;
269.15 	(4) all of the person's interests in joint accounts, multiple-party accounts, and 
269.16 	pay-on-death accounts, brokerage accounts, investment accounts, or the proceeds of 
269.17 	those accounts, as provided under sections 524.6-201 to 524.6-214 at the time of the 
269.18 	person's death to the extent the interests become part of the probate estate under section 
269.19 	524.6-207; and
269.20 	(5) assets conveyed to a survivor, heir, or assign of the person through survivorship, 
269.21 	living trust, or other arrangements.
269.22 	(c) For the purpose of this section and recovery in a surviving spouse's estate for 
269.23 	medical assistance paid for a predeceased spouse, the estate must consist of all of the legal 
269.24 	title and interests the deceased individual's predeceased spouse had in jointly owned or 
269.25 	marital property at the time of the spouse's death, as defined in subdivision 2b, and the 
269.26 	proceeds of those interests, that passed to the deceased individual or another individual, a 
269.27 	survivor, an heir, or an assign of the predeceased spouse through a joint tenancy, tenancy 
269.28 	in common, survivorship, life estate, living trust, or other arrangement. A deceased 
269.29 	recipient who, at death, owned the property jointly with the surviving spouse shall have 
269.30 	an interest in the entire property.
269.31 	(d) For the purpose of recovery in a single person's estate or the estate of a survivor 
269.32 	of a married couple, "other arrangement" includes any other means by which title to 
269.33 	all or any part of the jointly owned or marital property or interest passed from the 
269.34 	predeceased spouse to another including, but not limited to, transfers between spouses that 
269.35 	are permitted, prohibited, or penalized for purposes of medical assistance.
270.1 	(e) A claim shall be filed if medical assistance was rendered for either or both 
270.2 	persons under one of the following circumstances:
270.3 	(a) (1) the person was over 55 years of age, and received services under this chapter;
270.4 	(b) (2) the person resided in a medical institution for six months or longer, received 
270.5 	services under this chapter, and, at the time of institutionalization or application for 
270.6 	medical assistance, whichever is later, the person could not have reasonably been expected 
270.7 	to be discharged and returned home, as certified in writing by the person's treating 
270.8 	physician. For purposes of this section only, a "medical institution" means a skilled 
270.9 	nursing facility, intermediate care facility, intermediate care facility for persons with 
270.10 	developmental disabilities, nursing facility, or inpatient hospital; or
270.11 	(c) (3) the person received general assistance medical care services under chapter 
270.12 	256D.
270.13 	(f) The claim shall be considered an expense of the last illness of the decedent for the 
270.14 	purpose of section 524.3-805. Notwithstanding any law or rule to the contrary, a state or 
270.15 	county agency with a claim under this section must be a creditor under section 524.6-307.
270.16 	Any statute of limitations that purports to limit any county agency or the state agency, 
270.17 	or both, to recover for medical assistance granted hereunder shall not apply to any claim 
270.18 	made hereunder for reimbursement for any medical assistance granted hereunder. Notice 
270.19 	of the claim shall be given to all heirs and devisees of the decedent whose identity can be 
270.20 	ascertained with reasonable diligence. The notice must include procedures and instructions 
270.21 	for making an application for a hardship waiver under subdivision 5; time frames for 
270.22 	submitting an application and determination; and information regarding appeal rights and 
270.23 	procedures. Counties are entitled to one-half of the nonfederal share of medical assistance 
270.24 	collections from estates that are directly attributable to county effort. Counties are entitled 
270.25 	to ten percent of the collections for alternative care directly attributable to county effort. 

270.26 	Sec. 47. Minnesota Statutes 2008, section 256B.15, subdivision 1h, is amended to read:
270.27 		Subd. 1h. Estates of specific persons receiving medical assistance. (a) For 
270.28 	purposes of this section, paragraphs (b) to (k) (j) apply if a person received medical 
270.29 	assistance for which a claim may be filed under this section and died single, or the 
270.30 	surviving spouse of the couple and was not survived by any of the persons described 
270.31 	in subdivisions 3 and 4. 
270.32 	(b) For purposes of this section, the person's estate consists of: (1) the person's 
270.33 	probate estate; (2) all of the person's interests or proceeds of those interests in real property 
270.34 	the person owned as a life tenant or as a joint tenant with a right of survivorship at the 
270.35 	time of the person's death; (3) all of the person's interests or proceeds of those interests in 
271.1 	securities the person owned in beneficiary form as provided under sections 524.6-301 to 
271.2 	524.6-311 at the time of the person's death, to the extent they become part of the probate 
271.3 	estate under section 524.6-307; (4) all of the person's interests in joint accounts, multiple 
271.4 	party accounts, and pay on death accounts, or the proceeds of those accounts, as provided 
271.5 	under sections 524.6-201 to 524.6-214 at the time of the person's death to the extent 
271.6 	they become part of the probate estate under section 524.6-207; and (5) the person's 
271.7 	legal title or interest at the time of the person's death in real property transferred under 
271.8 	a transfer on death deed under section 507.071, or in the proceeds from the subsequent 
271.9 	sale of the person's interest in the real property. Notwithstanding any law or rule to the 
271.10 	contrary, a state or county agency with a claim under this section shall be a creditor under 
271.11 	section 524.6-307. 
271.12 	(c) Notwithstanding any law or rule to the contrary, the person's life estate or joint 
271.13 	tenancy interest in real property not subject to a medical assistance lien under sections 
271.14 	514.980 to 514.985 on the date of the person's death shall not end upon the person's death 
271.15 	and shall continue as provided in this subdivision. The life estate in the person's estate 
271.16 	shall be that portion of the interest in the real property subject to the life estate that is equal 
271.17 	to the life estate percentage factor for the life estate as listed in the Life Estate Mortality 
271.18 	Table of the health care program's manual for a person who was the age of the medical 
271.19 	assistance recipient on the date of the person's death. The joint tenancy interest in real 
271.20 	property in the estate shall be equal to the fractional interest the person would have owned 
271.21 	in the jointly held interest in the property had they and the other owners held title to the 
271.22 	property as tenants in common on the date the person died. 
271.23 	(d) (c) The court upon its own motion, or upon motion by the personal representative 
271.24 	or any interested party, may enter an order directing the remaindermen or surviving joint 
271.25 	tenants and their spouses, if any, to sign all documents, take all actions, and otherwise 
271.26 	fully cooperate with the personal representative and the court to liquidate the decedent's 
271.27 	life estate or joint tenancy interests in the estate and deliver the cash or the proceeds of 
271.28 	those interests to the personal representative and provide for any legal and equitable 
271.29 	sanctions as the court deems appropriate to enforce and carry out the order, including an 
271.30 	award of reasonable attorney fees. 
271.31 	(e) (d) The personal representative may make, execute, and deliver any conveyances 
271.32 	or other documents necessary to convey the decedent's life estate or joint tenancy interest 
271.33 	in the estate that are necessary to liquidate and reduce to cash the decedent's interest or 
271.34 	for any other purposes. 
271.35 	(f) (e) Subject to administration, all costs, including reasonable attorney fees, 
271.36 	directly and immediately related to liquidating the decedent's life estate or joint tenancy 
272.1 	interest in the decedent's estate, shall be paid from the gross proceeds of the liquidation 
272.2 	allocable to the decedent's interest and the net proceeds shall be turned over to the personal 
272.3 	representative and applied to payment of the claim presented under this section. 
272.4 	(g) (f) The personal representative shall bring a motion in the district court in which 
272.5 	the estate is being probated to compel the remaindermen or surviving joint tenants to 
272.6 	account for and deliver to the personal representative all or any part of the proceeds of any 
272.7 	sale, mortgage, transfer, conveyance, or any disposition of real property allocable to the 
272.8 	decedent's life estate or joint tenancy interest in the decedent's estate, and do everything 
272.9 	necessary to liquidate and reduce to cash the decedent's interest and turn the proceeds of 
272.10 	the sale or other disposition over to the personal representative. The court may grant any 
272.11 	legal or equitable relief including, but not limited to, ordering a partition of real estate 
272.12 	under chapter 558 necessary to make the value of the decedent's life estate or joint tenancy 
272.13 	interest available to the estate for payment of a claim under this section. 
272.14 	(h) (g) Subject to administration, the personal representative shall use all of the cash 
272.15 	or proceeds of interests to pay an allowable claim under this section. The remaindermen 
272.16 	or surviving joint tenants and their spouses, if any, may enter into a written agreement 
272.17 	with the personal representative or the claimant to settle and satisfy obligations imposed at 
272.18 	any time before or after a claim is filed. 
272.19 	(i) (h) The personal representative may, at their discretion, provide any or all of the 
272.20 	other owners, remaindermen, or surviving joint tenants with an affidavit terminating the 
272.21 	decedent's estate's interest in real property the decedent owned as a life tenant or as a joint 
272.22 	tenant with others, if the personal representative determines in good faith that neither the 
272.23 	decedent nor any of the decedent's predeceased spouses received any medical assistance 
272.24 	for which a claim could be filed under this section, or if the personal representative has 
272.25 	filed an affidavit with the court that the estate has other assets sufficient to pay a claim, as 
272.26 	presented, or if there is a written agreement under paragraph (h) (g), or if the claim, as 
272.27 	allowed, has been paid in full or to the full extent of the assets the estate has available 
272.28 	to pay it. The affidavit may be recorded in the office of the county recorder or filed in 
272.29 	the Office of the Registrar of Titles for the county in which the real property is located. 
272.30 	Except as provided in section 514.981, subdivision 6, when recorded or filed, the affidavit 
272.31 	shall terminate the decedent's interest in real estate the decedent owned as a life tenant or a 
272.32 	joint tenant with others. The affidavit shall:
272.33 	(1) be signed by the personal representative;
272.34 	(2) identify the decedent and the interest being terminated;
272.35 	(3) give recording information sufficient to identify the instrument that created the 
272.36 	interest in real property being terminated;
273.1 	(4) legally describe the affected real property;
273.2 	(5) state that the personal representative has determined that neither the decedent 
273.3 	nor any of the decedent's predeceased spouses received any medical assistance for which 
273.4 	a claim could be filed under this section;
273.5 	(6) state that the decedent's estate has other assets sufficient to pay the claim, as 
273.6 	presented, or that there is a written agreement between the personal representative and 
273.7 	the claimant and the other owners or remaindermen or other joint tenants to satisfy the 
273.8 	obligations imposed under this subdivision; and
273.9 	(7) state that the affidavit is being given to terminate the estate's interest under this 
273.10 	subdivision, and any other contents as may be appropriate.
273.11 	The recorder or registrar of titles shall accept the affidavit for recording or filing. The 
273.12 	affidavit shall be effective as provided in this section and shall constitute notice even if it 
273.13 	does not include recording information sufficient to identify the instrument creating the 
273.14 	interest it terminates. The affidavit shall be conclusive evidence of the stated facts. 
273.15 	(j) (i) The holder of a lien arising under subdivision 1c shall release the lien at 
273.16 	the holder's expense against an interest terminated under paragraph (h) (g) to the extent 
273.17 	of the termination. 
273.18 	(k) (j) If a lien arising under subdivision 1c is not released under paragraph (j) (i), 
273.19 	prior to closing the estate, the personal representative shall deed the interest subject to the 
273.20 	lien to the remaindermen or surviving joint tenants as their interests may appear. Upon 
273.21 	recording or filing, the deed shall work a merger of the recipient's life estate or joint 
273.22 	tenancy interest, subject to the lien, into the remainder interest or interest the decedent and 
273.23 	others owned jointly. The lien shall attach to and run with the property to the extent of 
273.24 	the decedent's interest at the time of the decedent's death. 

273.25 	Sec. 48. Minnesota Statutes 2008, section 256B.15, subdivision 2, is amended to read:
273.26 		Subd. 2.Limitations on claims. The claim shall include only the total amount 
273.27 	of medical assistance rendered after age 55 or during a period of institutionalization 
273.28 	described in subdivision 1a, clause (b) paragraph (e), and the total amount of general 
273.29 	assistance medical care rendered, and shall not include interest. Claims that have been 
273.30 	allowed but not paid shall bear interest according to section 524.3-806, paragraph (d). A 
273.31 	claim against the estate of a surviving spouse who did not receive medical assistance, for 
273.32 	medical assistance rendered for the predeceased spouse, shall be payable from the full 
273.33 	value of all of the predeceased spouse's assets and interests that are part of the surviving 
273.34 	spouse's estate under subdivisions 1a and 2b. Recovery of medical assistance expenses in 
273.35 	the nonrecipient surviving spouse's estate is limited to the value of the assets of the estate 
274.1 	that were marital property or jointly owned property at any time during the marriage. The 
274.2 	claim is not payable from the value of assets or proceeds of assets in the estate attributable 
274.3 	to a predeceased spouse whom the individual married after the death of the predeceased 
274.4 	recipient spouse for whom the claim is filed or from assets and the proceeds of assets in the 
274.5 	estate which the nonrecipient decedent spouse acquired with assets which were not marital 
274.6 	property or jointly owned property after the death of the predeceased recipient spouse.
274.7 	Claims for alternative care shall be net of all premiums paid under section 256B.0913, 
274.8 	subdivision 12, on or after July 1, 2003, and shall be limited to services provided on or 
274.9 	after July 1, 2003. Claims against marital property shall be limited to claims against 
274.10 	recipients who died on or after July 1, 2009.

274.11 	Sec. 49. Minnesota Statutes 2008, section 256B.15, is amended by adding a 
274.12 	subdivision to read:
274.13 		Subd. 2b.Controlling provisions. (a) For purposes of this subdivision and 
274.14 	subdivisions 1a and 2, paragraphs (b) to (d) apply.
274.15 	(b) At the time of death of a recipient spouse and solely for purpose of recovery of 
274.16 	medical assistance benefits received, a predeceased recipient spouse shall have a legal 
274.17 	title or interest in the undivided whole of all of the property which the recipient and the 
274.18 	recipient's surviving spouse owned jointly or which was marital property at any time 
274.19 	during their marriage regardless of the form of ownership and regardless of whether 
274.20 	it was owned or titled in the names of one or both the recipient and the recipient's 
274.21 	spouse. Title and interest in the property of a predeceased recipient spouse shall not end 
274.22 	or extinguish upon the person's death and shall continue for the purpose of allowing 
274.23 	recovery of medical assistance in the estate of the surviving spouse. Upon the death of 
274.24 	the predeceased recipient spouse, title and interest in the predeceased spouse's property 
274.25 	shall vest in the surviving spouse by operation of law and without the necessity for any 
274.26 	probate or decree of descent proceedings and shall continue to exist after the death of the 
274.27 	predeceased spouse and the surviving spouse to permit recovery of medical assistance. 
274.28 	The recipient spouse and the surviving spouse of a deceased recipient spouse shall not 
274.29 	encumber, disclaim, transfer, alienate, hypothecate, or otherwise divest themselves of 
274.30 	these interests before or upon death.
274.31 	(c) For purposes of this section, "marital property" includes any and all real or 
274.32 	personal property of any kind or interests in such property the predeceased recipient 
274.33 	spouse and their spouse, or either of them, owned at the time of their marriage to each 
274.34 	other or acquired during their marriage regardless of whether it was owned or titled in 
274.35 	the names of one or both of them. If either or both spouses of a married couple received 
275.1 	medical assistance, all property owned during the marriage or which either or both spouses 
275.2 	acquired during their marriage shall be presumed to be marital property for purposes of 
275.3 	recovering medical assistance unless there is clear and convincing evidence to the contrary.
275.4 	(d) The agency responsible for the claim for medical assistance for a recipient spouse 
275.5 	may, at its discretion, release specific real and personal property from the provisions of 
275.6 	this section. The release shall extinguish the interest created under paragraph (b) in the 
275.7 	land it describes upon filing or recording. The release need not be attested, certified, or 
275.8 	acknowledged as a condition of filing or recording and shall be filed or recorded in the 
275.9 	office of the county recorder or registrar of titles, as appropriate, in the county where the 
275.10 	real property is located. The party to whom the release is given shall be responsible for 
275.11 	paying all fees and costs necessary to record and file the release. If the property described 
275.12 	in the release is registered property, the registrar of titles shall accept it for recording and 
275.13 	shall record it on the certificate of title for each parcel of property described in the release. 
275.14 	If the property described in the release is abstract property, the recorder shall accept it 
275.15 	for filing and file it in the county's grantor-grantee indexes and any tract index the county 
275.16 	maintains for each parcel of property described in the release.

275.17 	Sec. 50. Minnesota Statutes 2008, section 256B.15, is amended by adding a 
275.18 	subdivision to read:
275.19 		Subd. 9.Commissioner's intervention. The commissioner shall be permitted to 
275.20 	intervene as a party in any proceeding involving recovery of medical assistance upon 
275.21 	filing a notice of intervention and serving such notice on the other parties.

275.22 	Sec. 51. [256B.196] INTERGOVERNMENTAL TRANSFERS; HOSPITAL 
275.23 	PAYMENTS.
275.24 		Subdivision 1.Federal approval required. This section is contingent on federal 
275.25 	approval of the intergovernmental transfers and payments authorized under this section. 
275.26 	This section is also contingent on current payment by the government entities of the 
275.27 	intergovernmental transfers under this section.
275.28 		Subd. 2.Commissioner's duties. (a) For the purposes of this subdivision and 
275.29 	subdivision 3, the commissioner shall determine the fee-for-service outpatient hospital 
275.30 	services upper payment limit for nonstate government hospitals. The commissioner shall 
275.31 	then determine the amount of a supplemental payment to Hennepin County Medical 
275.32 	Center and Regions Hospital for these services that would increase medical assistance 
275.33 	spending in this category to the aggregate upper payment limit for all nonstate government 
275.34 	hospitals in Minnesota. In making this determination, the commissioner shall allot the 
276.1 	available increases between Hennepin County Medical Center and Regions Hospital 
276.2 	based on the ratio of medical assistance fee-for-service outpatient hospital payments to 
276.3 	the two facilities. The commissioner shall adjust this allotment as necessary based on 
276.4 	federal approvals, the amount of intergovernmental transfers received from Hennepin and 
276.5 	Ramsey Counties, and other factors, in order to maximize the additional total payments. 
276.6 	The commissioner shall inform Hennepin County and Ramsey County of the periodic 
276.7 	intergovernmental transfers necessary to match federal Medicaid payments available 
276.8 	under this subdivision in order to make supplementary medical assistance payments to 
276.9 	Hennepin County Medical Center and Regions Hospital equal to an amount that when 
276.10 	combined with existing medical assistance payments to nonstate governmental hospitals 
276.11 	would increase total payments to hospitals in this category for outpatient services to 
276.12 	the aggregate upper payment limit for all hospitals in this category in Minnesota. Upon 
276.13 	receipt of these periodic transfers, the commissioner shall make supplementary payments 
276.14 	to Hennepin County Medical Center and Regions Hospital.
276.15 	(b) For the purposes of this subdivision and subdivision 3, the commissioner shall 
276.16 	determine an upper payment limit for physicians affiliated with Hennepin County Medical 
276.17 	Center and with Regions Hospital. The upper payment limit shall be based on the average 
276.18 	commercial rate or be determined using another method acceptable to the Centers for 
276.19 	Medicare and Medicaid Services. The commissioner shall inform Hennepin County and 
276.20 	Ramsey County of the periodic intergovernmental transfers necessary to match the federal 
276.21 	Medicaid payments available under this subdivision in order to make supplementary 
276.22 	payments to physicians affiliated with Hennepin County Medical Center and Regions 
276.23 	Hospital equal to the difference between the established medical assistance payment for 
276.24 	physician services and the upper payment limit. Upon receipt of these periodic transfers, 
276.25 	the commissioner shall make supplementary payments to physicians of Hennepin Faculty 
276.26 	Associates and HealthPartners.
276.27 	(c) Beginning January 1, 2010, Hennepin County and Ramsey County shall each 
276.28 	make monthly intergovernmental transfers to the commissioner in an amount determined 
276.29 	by each county. The commissioner shall increase the medical assistance capitation 
276.30 	payments to Metropolitan Health Plan and HealthPartners by an amount equal to the 
276.31 	annual value of the monthly transfers plus federal financial participation.
276.32 	(d) The commissioner shall inform Hennepin County and Ramsey County on an 
276.33 	ongoing basis of the need for any changes needed in the intergovernmental transfers 
276.34 	in order to continue the payments under paragraphs (a) to (c), at their maximum level, 
276.35 	including increases in upper payment limits, changes in the federal Medicaid match, and 
276.36 	other factors.
277.1 	(e) The payments in paragraphs (a) to (c) shall be implemented independently of 
277.2 	each other, subject to federal approval and to the receipt of transfers under subdivision 3.
277.3 		Subd. 3.Intergovernmental transfers. Based on the determination by the 
277.4 	commissioner under subdivision 2, Hennepin County and Ramsey County shall make 
277.5 	periodic intergovernmental transfers to the commissioner for the purposes of subdivision 
277.6 	2, paragraphs (a) to (c). All of the intergovernmental transfers made by Hennepin County 
277.7 	shall be used to match federal payments to Hennepin County Medical Center under 
277.8 	subdivision 2, paragraph (a); to physicians affiliated with Hennepin Faculty Associates 
277.9 	under subdivision 2, paragraph (b); and to Metropolitan Health Plan under subdivision 
277.10 	2, paragraph (c). All of the intergovernmental transfers made by Ramsey County shall 
277.11 	be used to match federal payments to Regions Hospital under subdivision 2, paragraph 
277.12 	(a); to physicians affiliated with HealthPartners under subdivision 2, paragraph (b); and to 
277.13 	HealthPartners under subdivision 2, paragraph (c).
277.14 		Subd. 4.Adjustments permitted. (a) The commissioner may adjust the 
277.15 	intergovernmental transfers under subdivision 3 and the payments under subdivision 
277.16 	2, based on the commissioner's determination of Medicare upper payment limits, 
277.17 	hospital-specific charge limits, hospital-specific limitations on disproportionate share 
277.18 	payments, medical inflation, actuarial certification, and cost-effectiveness for purposes 
277.19 	of federal waivers. Any adjustments must be made on a proportional basis. The 
277.20 	commissioner may make adjustments under this subdivision only after consultation 
277.21 	with the affected counties and hospitals. All payments under subdivision 2 and all 
277.22 	intergovernmental transfers under subdivision 3 are limited to amounts available after all 
277.23 	other base rates, adjustments, and supplemental payments in chapter 256B are calculated.
277.24 	(b) The ratio of medical assistance payments specified in subdivision 2 to the 
277.25 	voluntary intergovernmental transfers specified in subdivision 3 shall not be reduced 
277.26 	except as provided under paragraph (a).
277.27 		Subd. 5.Recession period. Each type of intergovernmental transfer in subdivision 
277.28 	2, paragraphs (a) to (d), for payment periods from October 1, 2008, through December 
277.29 	31, 2010, is voluntary on the part of Hennepin and Ramsey Counties, meaning that the 
277.30 	transfer must be agreed to, in writing, by the counties prior to any payments being issued. 
277.31 	One agreement on each type of transfer shall cover the entire recession period.

277.32 	Sec. 52. Minnesota Statutes 2008, section 256B.199, is amended to read:
277.33 	256B.199 PAYMENTS REPORTED BY GOVERNMENTAL ENTITIES.
277.34 	(a) Effective July 1, 2007, the commissioner shall apply for federal matching funds 
277.35 	for the expenditures in paragraphs (b) and (c).
278.1 	(b) The commissioner shall apply for federal matching funds for certified public 
278.2 	expenditures as follows:
278.3 	(1) Hennepin County, Hennepin County Medical Center, Ramsey County, Regions 
278.4 	Hospital, the University of Minnesota, and Fairview-University Medical Center shall 
278.5 	report quarterly to the commissioner beginning June 1, 2007, payments made during the 
278.6 	second previous quarter that may qualify for reimbursement under federal law;
278.7 	 (2) based on these reports, the commissioner shall apply for federal matching 
278.8 	funds. These funds are appropriated to the commissioner for the payments under section 
278.9 	256.969, subdivision 27; and
278.10 	 (3) by May 1 of each year, beginning May 1, 2007, the commissioner shall inform 
278.11 	the nonstate entities listed in paragraph (a) of the amount of federal disproportionate share 
278.12 	hospital payment money expected to be available in the current federal fiscal year.
278.13 	(c) The commissioner shall apply for federal matching funds for general assistance 
278.14 	medical care expenditures as follows:
278.15 	(1) for hospital services occurring on or after July 1, 2007, general assistance medical 
278.16 	care expenditures for fee-for-service inpatient and outpatient hospital payments made by 
278.17 	the department shall be used to apply for federal matching funds, except as limited below:
278.18 	(i) only those general assistance medical care expenditures made to an individual 
278.19 	hospital that would not cause the hospital to exceed its individual hospital limits under 
278.20 	section 1923 of the Social Security Act may be considered; and
278.21 	(ii) general assistance medical care expenditures may be considered only to the extent 
278.22 	of Minnesota's aggregate allotment under section 1923 of the Social Security Act; and
278.23 	(2) all hospitals must provide any necessary expenditure, cost, and revenue 
278.24 	information required by the commissioner as necessary for purposes of obtaining federal 
278.25 	Medicaid matching funds for general assistance medical care expenditures.
278.26 	(d) For the period from April 1, 2009, to September 30, 2010, the commissioner shall 
278.27 	apply for additional federal matching funds available as disproportionate share hospital 
278.28 	payments under the American Recovery and Reinvestment Act of 2009. These funds shall 
278.29 	be made available as the state share of payments under section 256.969, subdivision 28. 
278.30 	The entities required to report certified public expenditures under paragraph (b), clause 
278.31 	(1), shall report additional certified public expenditures as necessary under this paragraph.

278.32 	EFFECTIVE DATE. This section is effective the day following final enactment.

278.33 	Sec. 53. Minnesota Statutes 2008, section 256B.69, subdivision 5a, is amended to read:
278.34 		Subd. 5a.Managed care contracts. (a) Managed care contracts under this section 
278.35 	and sections 256L.12 and 256D.03, shall be entered into or renewed on a calendar year 
279.1 	basis beginning January 1, 1996. Managed care contracts which were in effect on June 
279.2 	30, 1995, and set to renew on July 1, 1995, shall be renewed for the period July 1, 1995 
279.3 	through December 31, 1995 at the same terms that were in effect on June 30, 1995. The 
279.4 	commissioner may issue separate contracts with requirements specific to services to 
279.5 	medical assistance recipients age 65 and older.
279.6 	(b) A prepaid health plan providing covered health services for eligible persons 
279.7 	pursuant to chapters 256B, 256D, and 256L, is responsible for complying with the terms 
279.8 	of its contract with the commissioner. Requirements applicable to managed care programs 
279.9 	under chapters 256B, 256D, and 256L, established after the effective date of a contract 
279.10 	with the commissioner take effect when the contract is next issued or renewed.
279.11 	(c) Effective for services rendered on or after January 1, 2003, the commissioner shall 
279.12 	withhold five percent of managed care plan payments under this section and county-based 
279.13 	purchasing plan's payment rate under section 256B.692 for the prepaid medical assistance 
279.14 	and general assistance medical care programs pending completion of performance targets. 
279.15 	Each performance target must be quantifiable, objective, measurable, and reasonably 
279.16 	attainable, except in the case of a performance target based on a federal or state law or rule. 
279.17 	Criteria for assessment of each performance target must be outlined in writing prior to the 
279.18 	contract effective date. The managed care plan must demonstrate, to the commissioner's 
279.19 	satisfaction, that the data submitted regarding attainment of the performance target is 
279.20 	accurate. The commissioner shall periodically change the administrative measures used 
279.21 	as performance targets in order to improve plan performance across a broader range of 
279.22 	administrative services. The performance targets must include measurement of plan 
279.23 	efforts to contain spending on health care services and administrative activities. The 
279.24 	commissioner may adopt plan-specific performance targets that take into account factors 
279.25 	affecting only one plan, including characteristics of the plan's enrollee population. The 
279.26 	withheld funds must be returned no sooner than July of the following year if performance 
279.27 	targets in the contract are achieved. The commissioner may exclude special demonstration 
279.28 	projects under subdivision 23. A managed care plan or a county-based purchasing plan 
279.29 	under section 256B.692 may include as admitted assets under section 62D.044 any amount 
279.30 	withheld under this paragraph that is reasonably expected to be returned.
279.31 	(d)(1) Effective for services rendered on or after January 1, 2009, the commissioner 
279.32 	shall withhold three percent of managed care plan payments under this section and 
279.33 	county-based purchasing plan payments under section 256B.692 for the prepaid medical 
279.34 	assistance and general assistance medical care programs. The withheld funds must be 
279.35 	returned no sooner than July 1 and no later than July 31 of the following year. The 
279.36 	commissioner may exclude special demonstration projects under subdivision 23.
280.1 	(2) A managed care plan or a county-based purchasing plan under section 256B.692 
280.2 	may include as admitted assets under section 62D.044 any amount withheld under 
280.3 	this paragraph. The return of the withhold under this paragraph is not subject to the 
280.4 	requirements of paragraph (c).
280.5 	(e) Effective for services rendered on or after January 1, 2010, the commissioner 
280.6 	shall include as part of the performance targets described in paragraph (c) a reduction in 
280.7 	the health plan's emergency room utilization rate for state health care program enrollees 
280.8 	by a measurable rate of five percent from the plan's utilization rate for state health care 
280.9 	program enrollees for the previous calendar year.
280.10 	The withheld funds must be returned no sooner than July 1 and no later than July 
280.11 	31 of the following calendar year if the managed care plan or county-based purchasing 
280.12 	plan demonstrates to the satisfaction of the commissioner that a reduction in the utilization 
280.13 	rate was achieved.
280.14 	The withhold described in this paragraph shall continue for each consecutive contract 
280.15 	period until the managed care plan's emergency room utilization rate for state health care 
280.16 	program enrollees is reduced by 25 percent of the managed care plan's emergency room 
280.17 	utilization rate for state health care program enrollees for calendar year 2008.
280.18 	(f) A managed care plan or a county-based purchasing plan under section 256B.692 
280.19 	may include as admitted assets under section 62D.044 any amount withheld under this 
280.20 	subdivision that is reasonably expected to be returned.

280.21 	Sec. 54. Minnesota Statutes 2008, section 256B.69, subdivision 5c, is amended to read:
280.22 		Subd. 5c.Medical education and research fund. (a) Except as provided in 
280.23 	paragraph (c), the commissioner of human services shall transfer each year to the medical 
280.24 	education and research fund established under section 62J.692, the following: 
280.25 	(1) an amount equal to the reduction in the prepaid medical assistance and prepaid 
280.26 	general assistance medical care payments as specified in this clause. Until January 1, 
280.27 	2002, the county medical assistance and general assistance medical care capitation base 
280.28 	rate prior to plan specific adjustments and after the regional rate adjustments under section 
280.29 	256B.69, subdivision 5b, is reduced 6.3 percent for Hennepin County, two percent for 
280.30 	the remaining metropolitan counties, and no reduction for nonmetropolitan Minnesota 
280.31 	counties; and after January 1, 2002, the county medical assistance and general assistance 
280.32 	medical care capitation base rate prior to plan specific adjustments is reduced 6.3 percent 
280.33 	for Hennepin County, two percent for the remaining metropolitan counties, and 1.6 percent 
280.34 	for nonmetropolitan Minnesota counties. Nursing facility and elderly waiver payments 
280.35 	and demonstration project payments operating under subdivision 23 are excluded from 
281.1 	this reduction. The amount calculated under this clause shall not be adjusted for periods 
281.2 	already paid due to subsequent changes to the capitation payments; 
281.3 	(2) beginning July 1, 2003, $2,157,000$4,314,000 from the capitation rates paid 
281.4 	under this section plus any federal matching funds on this amount;
281.5 	(3) beginning July 1, 2002, an additional $12,700,000 from the capitation rates 
281.6 	paid under this section; and
281.7 	(4) beginning July 1, 2003, an additional $4,700,000 from the capitation rates paid 
281.8 	under this section.
281.9 	(b) This subdivision shall be effective upon approval of a federal waiver which 
281.10 	allows federal financial participation in the medical education and research fund. Effective 
281.11 	July 1, 2009, and thereafter, the transfers required by paragraph (a), clauses (1) to (4), 
281.12 	shall not exceed the total amount transferred for fiscal year 2009. Any excess shall first 
281.13 	reduce the amounts otherwise required to be transferred under paragraph (a), clauses 
281.14 	(2) to (4). Any excess following this reduction shall proportionally reduce the transfers 
281.15 	under paragraph (a), clause (1).
281.16 	(c) Effective July 1, 2003, the amount reduced from the prepaid general assistance 
281.17 	medical care payments under paragraph (a), clause (1), shall be transferred to the general 
281.18 	fund.
281.19 	(d) Beginning July 1, 2009, of the amounts in paragraph (a), the commissioner shall 
281.20 	transfer $21,714,000 each fiscal year to the medical education and research fund. The 
281.21 	balance of the transfers under paragraph (a) shall be transferred to the medical education 
281.22 	and research fund no earlier than July 1 of the following fiscal year.

281.23 	Sec. 55. Minnesota Statutes 2008, section 256B.69, subdivision 5f, is amended to read:
281.24 		Subd. 5f.Capitation rates. (a) Beginning July 1, 2002, the capitation rates paid 
281.25 	under this section are increased by $12,700,000 per year. Beginning July 1, 2003, the 
281.26 	capitation rates paid under this section are increased by $4,700,000 per year.
281.27 	(b) Beginning July 1, 2009, the capitation rates paid under this section are increased 
281.28 	each year by the lesser of $21,714,000 or an amount equal to the difference between the 
281.29 	estimated value of the reductions described in subdivision 5c, paragraph (a), clause (1), 
281.30 	and the amount of the limit described in subdivision 5c, paragraph (b).

281.31 	Sec. 56. Minnesota Statutes 2008, section 256B.69, subdivision 6, is amended to read:
281.32 		Subd. 6.Service delivery. (a) Except as provided in paragraph (c), each 
281.33 	demonstration provider shall be responsible for the health care coordination for eligible 
281.34 	individuals. Demonstration providers:
282.1 	(1) shall authorize and arrange for the provision of all needed health services 
282.2 	including but not limited to the full range of services listed in sections 256B.02, 
282.3 	subdivision 8, and 256B.0625 in order to ensure appropriate health care is delivered to 
282.4 	enrollees. Notwithstanding section 256B.0621, demonstration providers that provide 
282.5 	nursing home and community-based services under this section shall provide relocation 
282.6 	service coordination to enrolled persons age 65 and over; 
282.7 	(2) shall accept the prospective, per capita payment from the commissioner in return 
282.8 	for the provision of comprehensive and coordinated health care services for eligible 
282.9 	individuals enrolled in the program;
282.10 	(3) may contract with other health care and social service practitioners to provide 
282.11 	services to enrollees; and
282.12 	(4) shall institute recipient grievance procedures according to the method established 
282.13 	by the project, utilizing applicable requirements of chapter 62D. Disputes not resolved 
282.14 	through this process shall be appealable to the commissioner as provided in subdivision 11.
282.15 	(b) Demonstration providers must comply with the standards for claims settlement 
282.16 	under section 72A.201, subdivisions 4, 5, 7, and 8, when contracting with other health 
282.17 	care and social service practitioners to provide services to enrollees. A demonstration 
282.18 	provider must pay a clean claim, as defined in Code of Federal Regulations, title 42, 
282.19 	section 447.45(b), within 30 business days of the date of acceptance of the claim. 
282.20 	(c) A demonstration provider shall not authorize, arrange, or provide dental services 
282.21 	listed under section 256B.0625; 256D.03, subdivision 4; or 256L.03, as part of the 
282.22 	comprehensive health care services that are required to be provided by the demonstration 
282.23 	provider under this section. Dental services shall be reimbursed on a fee-for-service basis.

282.24 	Sec. 57. Minnesota Statutes 2008, section 256B.69, subdivision 23, is amended to read:
282.25 		Subd. 23.Alternative services; elderly and disabled persons. (a) The 
282.26 	commissioner may implement demonstration projects to create alternative integrated 
282.27 	delivery systems for acute and long-term care services to elderly persons and persons 
282.28 	with disabilities as defined in section 256B.77, subdivision 7a, that provide increased 
282.29 	coordination, improve access to quality services, and mitigate future cost increases. 
282.30 	The commissioner may seek federal authority to combine Medicare and Medicaid 
282.31 	capitation payments for the purpose of such demonstrations and may contract with 
282.32 	Medicare-approved special needs plans to provide Medicaid services. Medicare funds and 
282.33 	services shall be administered according to the terms and conditions of the federal contract 
282.34 	and demonstration provisions. For the purpose of administering medical assistance funds, 
282.35 	demonstrations under this subdivision are subject to subdivisions 1 to 22. The provisions 
283.1 	of Minnesota Rules, parts 9500.1450 to 9500.1464, apply to these demonstrations, 
283.2 	with the exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457, subpart 1, 
283.3 	items B and C, which do not apply to persons enrolling in demonstrations under this 
283.4 	section. An initial open enrollment period may be provided. Persons who disenroll from 
283.5 	demonstrations under this subdivision remain subject to Minnesota Rules, parts 9500.1450 
283.6 	to 9500.1464. When a person is enrolled in a health plan under these demonstrations and 
283.7 	the health plan's participation is subsequently terminated for any reason, the person shall 
283.8 	be provided an opportunity to select a new health plan and shall have the right to change 
283.9 	health plans within the first 60 days of enrollment in the second health plan. Persons 
283.10 	required to participate in health plans under this section who fail to make a choice of 
283.11 	health plan shall not be randomly assigned to health plans under these demonstrations. 
283.12 	Notwithstanding section 256L.12, subdivision 5, and Minnesota Rules, part 9505.5220, 
283.13 	subpart 1, item A, if adopted, for the purpose of demonstrations under this subdivision, 
283.14 	the commissioner may contract with managed care organizations, including counties, to 
283.15 	serve only elderly persons eligible for medical assistance, elderly and disabled persons, or 
283.16 	disabled persons only. For persons with a primary diagnosis of developmental disability, 
283.17 	serious and persistent mental illness, or serious emotional disturbance, the commissioner 
283.18 	must ensure that the county authority has approved the demonstration and contracting 
283.19 	design. Enrollment in these projects for persons with disabilities shall be voluntary. The 
283.20 	commissioner shall not implement any demonstration project under this subdivision for 
283.21 	persons with a primary diagnosis of developmental disabilities, serious and persistent 
283.22 	mental illness, or serious emotional disturbance, without approval of the county board of 
283.23 	the county in which the demonstration is being implemented.
283.24 	(b) Notwithstanding chapter 245B, sections 252.40 to 252.46, 256B.092, 256B.501
283.25 	to 256B.5015, and Minnesota Rules, parts 9525.0004 to 9525.0036, 9525.1200 to 
283.26 	9525.1330, 9525.1580, and 9525.1800 to 9525.1930, the commissioner may implement 
283.27 	under this section projects for persons with developmental disabilities. The commissioner 
283.28 	may capitate payments for ICF/MR services, waivered services for developmental 
283.29 	disabilities, including case management services, day training and habilitation and 
283.30 	alternative active treatment services, and other services as approved by the state and by the 
283.31 	federal government. Case management and active treatment must be individualized and 
283.32 	developed in accordance with a person-centered plan. Costs under these projects may not 
283.33 	exceed costs that would have been incurred under fee-for-service. Beginning July 1, 2003, 
283.34 	and until four years after the pilot project implementation date, subcontractor participation 
283.35 	in the long-term care developmental disability pilot is limited to a nonprofit long-term 
283.36 	care system providing ICF/MR services, home and community-based waiver services, 
284.1 	and in-home services to no more than 120 consumers with developmental disabilities in 
284.2 	Carver, Hennepin, and Scott Counties. The commissioner shall report to the legislature 
284.3 	prior to expansion of the developmental disability pilot project. This paragraph expires 
284.4 	four years after the implementation date of the pilot project.
284.5 	(c) Before implementation of a demonstration project for disabled persons, the 
284.6 	commissioner must provide information to appropriate committees of the house of 
284.7 	representatives and senate and must involve representatives of affected disability groups 
284.8 	in the design of the demonstration projects.
284.9 	(d) A nursing facility reimbursed under the alternative reimbursement methodology 
284.10 	in section 256B.434 may, in collaboration with a hospital, clinic, or other health care entity 
284.11 	provide services under paragraph (a). The commissioner shall amend the state plan and 
284.12 	seek any federal waivers necessary to implement this paragraph.
284.13 	(e) The commissioner, in consultation with the commissioners of commerce and 
284.14 	health, may approve and implement programs for all-inclusive care for the elderly (PACE) 
284.15 	according to federal laws and regulations governing that program and state laws or rules 
284.16 	applicable to participating providers. The process for approval of these programs shall 
284.17 	begin only after the commissioner receives grant money in an amount sufficient to cover 
284.18 	the state share of the administrative and actuarial costs to implement the programs during 
284.19 	state fiscal years 2006 and 2007. Grant amounts for this purpose shall be deposited in an 
284.20 	account in the special revenue fund and are appropriated to the commissioner to be used 
284.21 	solely for the purpose of PACE administrative and actuarial costs. A PACE provider is 
284.22 	not required to be licensed or certified as a health plan company as defined in section 
284.23 	62Q.01, subdivision 4. Persons age 55 and older who have been screened by the county 
284.24 	and found to be eligible for services under the elderly waiver or community alternatives 
284.25 	for disabled individuals or who are already eligible for Medicaid but meet level of 
284.26 	care criteria for receipt of waiver services may choose to enroll in the PACE program. 
284.27 	Medicare and Medicaid services will be provided according to this subdivision and 
284.28 	federal Medicare and Medicaid requirements governing PACE providers and programs. 
284.29 	PACE enrollees will receive Medicaid home and community-based services through the 
284.30 	PACE provider as an alternative to services for which they would otherwise be eligible 
284.31 	through home and community-based waiver programs and Medicaid State Plan Services. 
284.32 	The commissioner shall establish Medicaid rates for PACE providers that do not exceed 
284.33 	costs that would have been incurred under fee-for-service or other relevant managed care 
284.34 	programs operated by the state.
284.35 	(f) The commissioner shall seek federal approval to expand the Minnesota disability 
284.36 	health options (MnDHO) program established under this subdivision in stages, first to 
285.1 	regional population centers outside the seven-county metro area and then to all areas of 
285.2 	the state. Until July 1, 2009, expansion for MnDHO projects that include home and 
285.3 	community-based services is limited to the two projects and service areas in effect on 
285.4 	March 1, 2006.  Enrollment in integrated MnDHO programs that include home and 
285.5 	community-based services shall remain voluntary. Costs for home and community-based 
285.6 	services included under MnDHO must not exceed costs that would have been incurred 
285.7 	under the fee-for-service program. In determining MnDHO payment rates and risk 
285.8 	adjustment methods, the commissioner must consider the methods used to determine 
285.9 	county allocations for home and community-based program participants. If necessary to 
285.10 	reduce MnDHO rates to comply with this provision, the commissioner must implement 
285.11 	successive overall rate-to-rate reductions not including any other reductions provided by 
285.12 	law. The rate reductions must not exceed ten percent in any calendar year. In developing 
285.13 	program specifications for expansion of integrated programs, the commissioner shall 
285.14 	involve and consult the state-level stakeholder group established in subdivision 28, 
285.15 	paragraph (d), including consultation on whether and how to include home and 
285.16 	community-based waiver programs. Plans for further expansion of MnDHO projects shall 
285.17 	be presented to the chairs of the house of representatives and senate committees with 
285.18 	jurisdiction over health and human services policy and finance by February 1, 2007.
285.19 	(g) Notwithstanding section 256B.0261, health plans providing services under this 
285.20 	section are responsible for home care targeted case management and relocation targeted 
285.21 	case management. Services must be provided according to the terms of the waivers and 
285.22 	contracts approved by the federal government.

285.23 	Sec. 58. Minnesota Statutes 2008, section 256B.69, is amended by adding a 
285.24 	subdivision to read:
285.25 		Subd. 29.Birthing centers. As a condition of participating in the prepaid 
285.26 	medical assistance program, prepaid general assistance medical care program, or the 
285.27 	MinnesotaCare program under section 256B.69, 256B.692, 256D.03, or 256L.12, a 
285.28 	managed care plan or county-based purchasing plan must either contract with or establish 
285.29 	a birthing center for the provision of obstetric services that are covered under section 
285.30 	256B.0625 and are provided by a birthing center. The birthing center must be licensed 
285.31 	under section 144.566.

285.32 	Sec. 59. [256B.756] REIMBURSEMENT RATES FOR BIRTHS.
285.33 		Subdivision 1.Facility rate. (a) Notwithstanding section 256.969, effective for 
285.34 	services provided on or after October 1, 2009, the facility payment rate shall be:
286.1 	(1) no greater than $4,187 for the following diagnosis-related groups, as they fall 
286.2 	within the diagnostic categories:
286.3 	(i) 371 cesarean section without complicating diagnosis; and
286.4 	(ii) 372 vaginal delivery with complicating diagnosis; and
286.5 	(2) no greater than $1,650 for the following diagnosis group as it falls within the 
286.6 	following diagnostic category: 373 vaginal delivery without complicating diagnosis. This 
286.7 	rate applies only if the woman's enrollment date in medical assistance, general assistance 
286.8 	medical care, or the MinnesotaCare program was at least 45 days before the date the 
286.9 	service was provided. If the enrollment date is within 45 days of the service, then the 
286.10 	payment rate shall be the rate identified in clause (1).
286.11 	(b) The rates described in this subdivision do not include newborn care.
286.12 		Subd. 2.Provider rate. Notwithstanding section 256B.76, effective for services 
286.13 	provided on or after October 1, 2009, the payment rate for professional services related to 
286.14 	labor, delivery, antepartum, and postpartum care when provided for any of the diagnostic 
286.15 	categories identified in subdivision 1, paragraph (a), clause (1), shall be no greater than 
286.16 	$982 per birth.
286.17 		Subd. 3.Application. Payments made to managed care plans and county-based 
286.18 	purchasing plans under section 256B.69, 256B.692, or 256L.12 shall be reduced 
286.19 	for services provided on or after October 1, 2009, to reflect the rates established in 
286.20 	subdivisions 1 and 2.
286.21 		Subd. 4.Prior authorization. Prior authorization shall not be required before 
286.22 	reimbursement is paid for a cesarean section delivery.

286.23 	Sec. 60. Minnesota Statutes 2008, section 256B.76, subdivision 1, is amended to read:
286.24 		Subdivision 1.Physician reimbursement.  (a) Effective for services rendered on 
286.25 	or after October 1, 1992, the commissioner shall make payments for physician services 
286.26 	as follows:
286.27 	(1) payment for level one Centers for Medicare and Medicaid Services' common 
286.28 	procedural coding system codes titled "office and other outpatient services," "preventive 
286.29 	medicine new and established patient," "delivery, antepartum, and postpartum care," 
286.30 	"critical care," cesarean delivery and pharmacologic management provided to psychiatric 
286.31 	patients, and level three codes for enhanced services for prenatal high risk, shall be paid 
286.32 	at the lower of (i) submitted charges, or (ii) 25 percent above the rate in effect on June 
286.33 	30, 1992. If the rate on any procedure code within these categories is different than the 
286.34 	rate that would have been paid under the methodology in section 256B.74, subdivision 2, 
286.35 	then the larger rate shall be paid; 
287.1 	(2) payments for all other services shall be paid at the lower of (i) submitted charges, 
287.2 	or (ii) 15.4 percent above the rate in effect on June 30, 1992; and
287.3 	(3) all physician rates shall be converted from the 50th percentile of 1982 to the 50th 
287.4 	percentile of 1989, less the percent in aggregate necessary to equal the above increases 
287.5 	except that payment rates for home health agency services shall be the rates in effect 
287.6 	on September 30, 1992.
287.7 	(b) Effective for services rendered on or after January 1, 2000, payment rates for 
287.8 	physician and professional services shall be increased by three percent over the rates 
287.9 	in effect on December 31, 1999, except for home health agency and family planning 
287.10 	agency services. The increases in this paragraph shall be implemented January 1, 2000, 
287.11 	for managed care.
287.12 	(c) Effective for services rendered on or after July 1, 2009, payment rates for 
287.13 	physician and professional services shall be reduced by five percent over the rates in 
287.14 	effect on June 30, 2009. This reduction does not apply to office or other outpatient 
287.15 	services (procedure codes 99201 to 99215), preventive medicine services (procedure 
287.16 	codes 99381 to 99412) and family planning services billed by the following primary care 
287.17 	specialties:  general practice, internal medicine, pediatrics, geriatrics, family practice, or 
287.18 	by an advanced practice registered nurse or physician assistant practicing in pediatrics, 
287.19 	geriatrics, or family practice.  Effective October 1, 2009, payments made to managed care 
287.20 	plans and county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 
287.21 	shall reflect the payment reduction described in this paragraph.

287.22 	Sec. 61. [256B.766] REIMBURSEMENT FOR BASIC CARE SERVICES.
287.23 	(a) Effective for services provided on or after July 1, 2009, total payments for basic 
287.24 	care services, shall be reduced by three percent, prior to third-party liability and spenddown 
287.25 	calculation. Payments made to managed care plans and county-based purchasing plans 
287.26 	shall be reduced for services provided on or after October 1, 2009, to reflect this reduction.
287.27 	(b) This section does not apply to physician and professional services, inpatient 
287.28 	hospital services, family planning services, mental health services, dental services, 
287.29 	prescription drugs, and medical transportation.

287.30 	Sec. 62. [256B.767] PATIENT-CENTERED DECISION MAKING.
287.31 	(a) Effective January 1, 2010, the commissioner of human services shall require 
287.32 	active participation in a patient-centered decision-making process before authorization is 
287.33 	approved or payment reimbursement is provided for any of the following:
288.1 	(1) a surgical procedure for the following conditions: abnormal uterine bleeding; 
288.2 	benign prostate enlargement; chronic back pain; early stage of breast and prostate cancers; 
288.3 	gastroesophageal reflux disease; hemorrhoids; spinal stenosis; temporomandibular joint 
288.4 	dysfunction; ulcerative colitis; urinary incontinence; uterine fibroids; or varicose veins; and
288.5 	(2) bypass surgery for coronary disease; angioplasty for stable coronary artery 
288.6 	disease; or total hip replacement. 
288.7 	(b) A list of these procedures shall be published in the State Register by October 1, 
288.8 	2009. The list shall be reviewed no less than every two years by the commissioner, in 
288.9 	consultation with the commissioner of health. The commissioner shall hold a public forum 
288.10 	and receive public comment prior to any changes to the list provided in paragraph (a). 
288.11 	Any changes made shall be published in the State Register.
288.12 	(c) Prior to receiving authorization or reimbursement for the procedures identified 
288.13 	under this section, a health care provider must certify that the patient has participated in a 
288.14 	patient-centered decision-making process. The format for this certification and the process 
288.15 	for coordination between providers shall be developed by the Health Services Policy 
288.16 	Committee under section 256B.0625, subdivision 3c.
288.17 	(d) For purposes of this section, "patient-centered decision-making process" means a 
288.18 	process that involves directed interaction with the patient to assist the patient in arriving at 
288.19 	an informed objective health care decision regarding the surgical procedure that is both 
288.20 	informed and consistent with the patient's preference and values. The interaction may be 
288.21 	conducted by a health care provider or through the electronic use of decision aids. If 
288.22 	decision aids are used in the process, the aids must meet the criteria established by the 
288.23 	International Patients Decision Aids Standards Collaboration or the Cochrane Decision 
288.24 	Aid Registry.
288.25 	(e) This section does not apply if any of the procedures identified in this section are 
288.26 	performed under an emergency situation.

288.27 	Sec. 63. Minnesota Statutes 2008, section 256D.03, subdivision 4, is amended to read:
288.28 		Subd. 4.General assistance medical care; services. (a)(i) For a person who is 
288.29 	eligible under subdivision 3, paragraph (a), clause (2), item (i), general assistance medical 
288.30 	care covers, except as provided in paragraph (c):
288.31 	(1) inpatient hospital services;
288.32 	(2) outpatient hospital services;
288.33 	(3) services provided by Medicare certified rehabilitation agencies;
288.34 	(4) prescription drugs and other products recommended through the process 
288.35 	established in section 256B.0625, subdivision 13;
289.1 	(5) equipment necessary to administer insulin and diagnostic supplies and equipment 
289.2 	for diabetics to monitor blood sugar level;
289.3 	(6) eyeglasses and eye examinations provided by a physician or optometrist;
289.4 	(7) hearing aids;
289.5 	(8) prosthetic devices;
289.6 	(9) laboratory and X-ray services;
289.7 	(10) physician's services;
289.8 	(11) medical transportation except special transportation;
289.9 	(12) chiropractic services as covered under the medical assistance program;
289.10 	(13) podiatric services;
289.11 	(14) dental services as covered under the medical assistance program;
289.12 	(15) mental health services covered under chapter 256B;
289.13 	(16) prescribed medications for persons who have been diagnosed as mentally ill as 
289.14 	necessary to prevent more restrictive institutionalization;
289.15 	(17) medical supplies and equipment, and Medicare premiums, coinsurance and 
289.16 	deductible payments;
289.17 	(18) medical equipment not specifically listed in this paragraph when the use of 
289.18 	the equipment will prevent the need for costlier services that are reimbursable under 
289.19 	this subdivision;
289.20 	(19) services performed by a certified pediatric nurse practitioner, a certified family 
289.21 	nurse practitioner, a certified adult nurse practitioner, a certified obstetric/gynecological 
289.22 	nurse practitioner, a certified neonatal nurse practitioner, or a certified geriatric nurse 
289.23 	practitioner in independent practice, if (1) the service is otherwise covered under this 
289.24 	chapter as a physician service, (2) the service provided on an inpatient basis is not included 
289.25 	as part of the cost for inpatient services included in the operating payment rate, and (3) the 
289.26 	service is within the scope of practice of the nurse practitioner's license as a registered 
289.27 	nurse, as defined in section 148.171;
289.28 	(20) services of a certified public health nurse or a registered nurse practicing in 
289.29 	a public health nursing clinic that is a department of, or that operates under the direct 
289.30 	authority of, a unit of government, if the service is within the scope of practice of the 
289.31 	public health nurse's license as a registered nurse, as defined in section 148.171;
289.32 	(21) telemedicine consultations, to the extent they are covered under section 
289.33 	256B.0625, subdivision 3b; 
289.34 	(22) care coordination and patient education services provided by a community 
289.35 	health worker according to section 256B.0625, subdivision 49; and
290.1 	(23) regardless of the number of employees that an enrolled health care provider 
290.2 	may have, sign language interpreter services when provided by an enrolled health care 
290.3 	provider during the course of providing a direct, person-to-person covered health care 
290.4 	service to an enrolled recipient who has a hearing loss and uses interpreting services.
290.5 	(ii) Effective October 1, 2003, for a person who is eligible under subdivision 3, 
290.6 	paragraph (a), clause (2), item (ii), general assistance medical care coverage is limited 
290.7 	to inpatient hospital services, including physician services provided during the inpatient 
290.8 	hospital stay. A $1,000 deductible is required for each inpatient hospitalization.
290.9 	(b) Effective August 1, 2005, sex reassignment surgery is not covered under this 
290.10 	subdivision.
290.11 	(c) In order to contain costs, the commissioner of human services shall select 
290.12 	vendors of medical care who can provide the most economical care consistent with high 
290.13 	medical standards and shall where possible contract with organizations on a prepaid 
290.14 	capitation basis to provide these services. The commissioner shall consider proposals by 
290.15 	counties and vendors for prepaid health plans, competitive bidding programs, block grants, 
290.16 	or other vendor payment mechanisms designed to provide services in an economical 
290.17 	manner or to control utilization, with safeguards to ensure that necessary services are 
290.18 	provided. Before implementing prepaid programs in counties with a county operated or 
290.19 	affiliated public teaching hospital or a hospital or clinic operated by the University of 
290.20 	Minnesota, the commissioner shall consider the risks the prepaid program creates for the 
290.21 	hospital and allow the county or hospital the opportunity to participate in the program in a 
290.22 	manner that reflects the risk of adverse selection and the nature of the patients served by 
290.23 	the hospital, provided the terms of participation in the program are competitive with the 
290.24 	terms of other participants considering the nature of the population served. Payment for 
290.25 	services provided pursuant to this subdivision shall be as provided to medical assistance 
290.26 	vendors of these services under sections 256B.02, subdivision 8, and 256B.0625. For 
290.27 	payments made during fiscal year 1990 and later years, the commissioner shall consult 
290.28 	with an independent actuary in establishing prepayment rates, but shall retain final control 
290.29 	over the rate methodology.
290.30 	(d) Effective January 1, 2008, drug coverage under general assistance medical 
290.31 	care is limited to prescription drugs that:
290.32 	(i) are covered under the medical assistance program as described in section 
290.33 	256B.0625, subdivisions 13 and 13d; and
290.34 	(ii) are provided by manufacturers that have fully executed general assistance 
290.35 	medical care rebate agreements with the commissioner and comply with the agreements. 
290.36 	Prescription drug coverage under general assistance medical care must conform to 
291.1 	coverage under the medical assistance program according to section 256B.0625, 
291.2 	subdivisions 13 to 13g.
291.3 	 (e) Recipients eligible under subdivision 3, paragraph (a), shall pay the following 
291.4 	co-payments for services provided on or after October 1, 2003, and before January 1, 2009:
291.5 	(1) $25 for eyeglasses;
291.6 	(2) $25 for nonemergency visits to a hospital-based emergency room;
291.7 	(3) $3 per brand-name drug prescription and $1 per generic drug prescription, 
291.8 	subject to a $12 per month maximum for prescription drug co-payments. No co-payments 
291.9 	shall apply to antipsychotic drugs when used for the treatment of mental illness; and
291.10 	(4) 50 percent coinsurance on restorative dental services.
291.11 	(f) Recipients eligible under subdivision 3, paragraph (a), shall include the following 
291.12 	co-payments for services provided on or after January 1, 2009: 
291.13 	(1) $25 for nonemergency visits to a hospital-based emergency room; and
291.14 	(2) $3 per brand-name drug prescription and $1 per generic drug prescription, 
291.15 	subject to a $7 per month maximum for prescription drug co-payments. No co-payments 
291.16 	shall apply to antipsychotic drugs when used for the treatment of mental illness.
291.17 	(g) MS 2007 Supp [Expired]
291.18 	(h) Effective January 1, 2009, co-payments shall be limited to one per day per 
291.19 	provider for nonemergency visits to a hospital-based emergency room. Recipients of 
291.20 	general assistance medical care are responsible for all co-payments in this subdivision. 
291.21 	The general assistance medical care reimbursement to the provider shall be reduced by the 
291.22 	amount of the co-payment, except that reimbursement for prescription drugs shall not be 
291.23 	reduced once a recipient has reached the $7 per month maximum for prescription drug 
291.24 	co-payments. The provider collects the co-payment from the recipient. Providers may not 
291.25 	deny services to recipients who are unable to pay the co-payment.
291.26 	(i) General assistance medical care reimbursement to fee-for-service providers 
291.27 	and payments to managed care plans shall not be increased as a result of the removal of 
291.28 	the co-payments effective January 1, 2009.
291.29 	(j) Any county may, from its own resources, provide medical payments for which 
291.30 	state payments are not made.
291.31 	(k) Chemical dependency services that are reimbursed under chapter 254B must not 
291.32 	be reimbursed under general assistance medical care.
291.33 	(l) The maximum payment for new vendors enrolled in the general assistance 
291.34 	medical care program after the base year shall be determined from the average usual and 
291.35 	customary charge of the same vendor type enrolled in the base year.
292.1 	(m) The conditions of payment for services under this subdivision are the same 
292.2 	as the conditions specified in rules adopted under chapter 256B governing the medical 
292.3 	assistance program, unless otherwise provided by statute or rule.
292.4 	 (n) Inpatient and outpatient payments shall be reduced by five percent, effective July 
292.5 	1, 2003. This reduction is in addition to the five percent reduction effective July 1, 2003, 
292.6 	and incorporated by reference in paragraph (l).
292.7 	(o) Payments for all other health services except inpatient, outpatient, and pharmacy 
292.8 	services shall be reduced by five percent, effective July 1, 2003.
292.9 	(p) Payments to managed care plans shall be reduced by five percent for services 
292.10 	provided on or after October 1, 2003.
292.11 	(q) A hospital receiving a reduced payment as a result of this section may apply the 
292.12 	unpaid balance toward satisfaction of the hospital's bad debts.
292.13 	(r) Fee-for-service payments for nonpreventive visits shall be reduced by $3 for 
292.14 	services provided on or after January 1, 2006. For purposes of this subdivision, a visit 
292.15 	means an episode of service which is required because of a recipient's symptoms, 
292.16 	diagnosis, or established illness, and which is delivered in an ambulatory setting by 
292.17 	a physician or physician ancillary, chiropractor, podiatrist, advance practice nurse, 
292.18 	audiologist, optician, or optometrist.
292.19 	(s) Payments to managed care plans shall not be increased as a result of the removal 
292.20 	of the $3 nonpreventive visit co-payment effective January 1, 2006.
292.21 	(t) Payments for mental health services added as covered benefits after December 
292.22 	31, 2007, are not subject to the reductions in paragraphs (l), (n), (o), and (p).
292.23 	(u) Effective for services provided on or after July 1, 2009, total payment rates for 
292.24 	basic care services shall be reduced by three percent, in accordance with section 256B.766. 
292.25 	Payments made to managed care plans shall be reduced for services provided on or after 
292.26 	October 1, 2009, to reflect this reduction.
292.27 	(v) Effective for services provided on or after July 1, 2009, payment rates for 
292.28 	physician and professional services shall be reduced as described under section 256B.76, 
292.29 	subdivision 1, paragraph (c). Payments made to managed care plans shall be reduced for 
292.30 	services provided on or after October 1, 2009, to reflect this reduction.

292.31 	Sec. 64. Minnesota Statutes 2008, section 256L.03, subdivision 1, is amended to read:
292.32 		Subdivision 1.Covered health services.  "Covered health services" means 
292.33 	the health services reimbursed under chapter 256B, with the exception of inpatient 
292.34 	hospital services, special education services, private duty nursing services, adult dental 
292.35 	care services other than services covered under section 256B.0625, subdivision 9 9b, 
293.1 	orthodontic services, nonemergency medical transportation services, personal care 
293.2 	assistant and case management services, nursing home or intermediate care facilities 
293.3 	services, inpatient mental health services, and chemical dependency services.
293.4 	No public funds shall be used for coverage of abortion under MinnesotaCare 
293.5 	except where the life of the female would be endangered or substantial and irreversible 
293.6 	impairment of a major bodily function would result if the fetus were carried to term; or 
293.7 	where the pregnancy is the result of rape or incest.
293.8 	Covered health services shall be expanded as provided in this section.

293.9 	Sec. 65. Minnesota Statutes 2008, section 256L.04, subdivision 1, is amended to read:
293.10 		Subdivision 1.Families with children. (a) Families with children with family 
293.11 	income equal to or less than 275 percent of the federal poverty guidelines for the 
293.12 	applicable family size shall be eligible for MinnesotaCare according to this section. All 
293.13 	other provisions of sections 256L.01 to 256L.18, including the insurance-related barriers 
293.14 	to enrollment under section 256L.07, shall apply unless otherwise specified. 
293.15 	(b) Parents who enroll in the MinnesotaCare program must also enroll their children, 
293.16 	if the children are eligible. Children may be enrolled separately without enrollment by 
293.17 	parents. However, if one parent in the household enrolls, both parents must enroll, unless 
293.18 	other insurance is available. If one child from a family is enrolled, all children must 
293.19 	be enrolled, unless other insurance is available. If one spouse in a household enrolls, 
293.20 	the other spouse in the household must also enroll, unless other insurance is available. 
293.21 	Families cannot choose to enroll only certain uninsured members.
293.22 	(c) Beginning October 1, 2003, the dependent sibling definition no longer applies 
293.23 	to the MinnesotaCare program. These persons are no longer counted in the parental 
293.24 	household and may apply as a separate household.
293.25 	(d) Beginning July 1, 2003, or upon federal approval, whichever is later, parents are 
293.26 	not eligible for MinnesotaCare if their gross income exceeds $57,500.
293.27 	(e) Children formerly enrolled in medical assistance and automatically deemed 
293.28 	eligible for MinnesotaCare according to section 256B.057, subdivision 2c, are exempt 
293.29 	from the requirements of this section until renewal.
293.30 	(f) Children deemed eligible for MinnesotaCare under section 256L.07, subdivision 
293.31 	8, are exempt from the eligibility requirements of this subdivision.

293.32 	Sec. 66. Minnesota Statutes 2008, section 256L.04, is amended by adding a subdivision 
293.33 	to read:
294.1 		Subd. 1b.Children with family income greater than 275 percent of federal 
294.2 	poverty guidelines. Children with family income greater than 275 percent of federal 
294.3 	poverty guidelines for the applicable family size shall be eligible for MinnesotaCare. All 
294.4 	other provisions of sections 256L.01 to 256L.18, including the insurance-related barriers 
294.5 	to enrollment under section 256L.07, shall apply unless otherwise specified.

294.6 	Sec. 67. Minnesota Statutes 2008, section 256L.04, subdivision 7a, is amended to read:
294.7 		Subd. 7a.Ineligibility. ApplicantsAdults whose income is greater than the limits 
294.8 	established under this section may not enroll in the MinnesotaCare program.

294.9 	Sec. 68. Minnesota Statutes 2008, section 256L.04, subdivision 10a, is amended to 
294.10 	read:
294.11 		Subd. 10a.Sponsor's income and resources deemed available; documentation.
 294.12 	When determining eligibility for any federal or state benefits under sections 256L.01 to 
294.13 	256L.18, the income and resources of all noncitizens whose sponsor signed an affidavit of 
294.14 	support as defined under United States Code, title 8, section 1183a, shall be deemed to 
294.15 	include their sponsors' income and resources as defined in the Personal Responsibility 
294.16 	and Work Opportunity Reconciliation Act of 1996, title IV, Public Law 104-193, sections 
294.17 	421 and 422, and subsequently set out in federal rules. To be eligible for the program, 
294.18 	noncitizens must provide documentation of their immigration status. Beginning July 
294.19 	1, 2010, or upon federal approval, whichever is later, sponsor deeming does not apply 
294.20 	to pregnant women and children who are qualified noncitizens, as described in section 
294.21 	256B.06, subdivision 4, paragraph (b).

294.22 	EFFECTIVE DATE. This section is effective July 1, 2010, or upon federal 
294.23 	approval, whichever is later. The commissioner shall notify the revisor of statutes when 
294.24 	federal approval is obtained.

294.25 	Sec. 69. Minnesota Statutes 2008, section 256L.05, subdivision 3, is amended to read:
294.26 		Subd. 3.Effective date of coverage. (a) The effective date of coverage is the 
294.27 	first day of the month following the month in which eligibility is approved and the first 
294.28 	premium payment has been received. As provided in section 256B.057, coverage for 
294.29 	newborns is automatic from the date of birth and must be coordinated with other health 
294.30 	coverage. The effective date of coverage for eligible newly adoptive children added to a 
294.31 	family receiving covered health services is the month of placement. The effective date 
294.32 	of coverage for other new members added to the family is the first day of the month 
294.33 	following the month in which the change is reported. All eligibility criteria must be met 
295.1 	by the family at the time the new family member is added. The income of the new family 
295.2 	member is included with the family's gross income and the adjusted premium begins in 
295.3 	the month the new family member is added.
295.4 	(b) The initial premium must be received by the last working day of the month for 
295.5 	coverage to begin the first day of the following month.
295.6 	(c) Benefits are not available until the day following discharge if an enrollee is 
295.7 	hospitalized on the first day of coverage.
295.8 	(d) Notwithstanding any other law to the contrary, benefits under sections 256L.01 to 
295.9 	256L.18 are secondary to a plan of insurance or benefit program under which an eligible 
295.10 	person may have coverage and the commissioner shall use cost avoidance techniques to 
295.11 	ensure coordination of any other health coverage for eligible persons. The commissioner 
295.12 	shall identify eligible persons who may have coverage or benefits under other plans of 
295.13 	insurance or who become eligible for medical assistance.
295.14 	(e) The effective date of coverage for single adults and households with no children 
295.15 	formerly enrolled in general assistance medical care and enrolled in MinnesotaCare 
295.16 	according to section 256D.03, subdivision 3, is the first day of the month following the 
295.17 	last day of general assistance medical care coverage.
295.18 	(f) The effective date of coverage for children eligible under section 256L.07, 
295.19 	subdivision 8, is the first day of the month following the date of termination from foster 
295.20 	care or release from a juvenile residential correctional facility.

295.21 	Sec. 70. Minnesota Statutes 2008, section 256L.05, subdivision 3a, is amended to read:
295.22 		Subd. 3a.Renewal of eligibility. (a) Beginning July 1, 2007, an enrollee's eligibility 
295.23 	must be renewed every 12 months. The 12-month period begins in the month after the 
295.24 	month the application is approved.
295.25 	(b) Each new period of eligibility must take into account any changes in 
295.26 	circumstances that impact eligibility and premium amount. An enrollee must provide all 
295.27 	the information needed to redetermine eligibility by the first day of the month that ends 
295.28 	the eligibility period. If there is no change in circumstances, the enrollee may renew 
295.29 	eligibility at designated locations that include community clinics and health care providers' 
295.30 	offices. The designated sites shall forward the renewal forms to the commissioner. The 
295.31 	commissioner may establish criteria and timelines for sites to forward applications to the 
295.32 	commissioner or county agencies. The premium for the new period of eligibility must be 
295.33 	received as provided in section 256L.06 in order for eligibility to continue.
295.34 	(c) For single adults and households with no children formerly enrolled in general 
295.35 	assistance medical care and enrolled in MinnesotaCare according to section 256D.03, 
296.1 	subdivision 3, the first period of eligibility begins the month the enrollee submitted the 
296.2 	application or renewal for general assistance medical care.
296.3 	(d) An enrolleeNotwithstanding paragraph (e), an enrollee who fails to submit 
296.4 	renewal forms and related documentation necessary for verification of continued eligibility 
296.5 	in a timely manner shall remain eligible for one additional month beyond the end of the 
296.6 	current eligibility period before being disenrolled. The enrollee remains responsible for 
296.7 	MinnesotaCare premiums for the additional month.
296.8 	(e) Children in families with family income equal to or below 275 percent of federal 
296.9 	poverty guidelines who fail to submit renewal forms and related documentation necessary 
296.10 	for verification of continued eligibility in a timely manner shall remain eligible for the 
296.11 	program. The commissioner shall use the means described in subdivision 2 or any other 
296.12 	means available to verify family income. If the commissioner determines that there has 
296.13 	been a change in income in which premium payment is required to remain enrolled, the 
296.14 	commissioner shall notify the family of the premium payment, and that the children 
296.15 	will be disenrolled if the premium payment is not received effective the first day of the 
296.16 	calendar month following the calendar month for which the premium is due.
296.17 	(f) For children enrolled in MinnesotaCare under section 256L.07, subdivision 8, the 
296.18 	first period of renewal begins the month the enrollee turns 21 years of age.

296.19 	Sec. 71. Minnesota Statutes 2008, section 256L.05, is amended by adding a subdivision 
296.20 	to read:
296.21 		Subd. 6.Delayed verification. On the basis of information provided on the 
296.22 	application, a child whose family gross income is less than 90 percent of the applicable 
296.23 	income standard shall be determined eligible beginning in the month of application. The 
296.24 	child must provide all required verifications within 60 days' notice of the eligibility 
296.25 	determination or eligibility shall be terminated. Applicants who are terminated for failure 
296.26 	to provide all required verifications are not eligible to apply for coverage using the delayed 
296.27 	verification procedures specified in this subdivision for 12 months.

296.28 	EFFECTIVE DATE. This section is effective January 1, 2010, or upon federal 
296.29 	approval, whichever is later.

296.30 	Sec. 72. Minnesota Statutes 2008, section 256L.07, subdivision 1, is amended to read:
296.31 		Subdivision 1.General requirements. (a) Children enrolled in the original 
296.32 	children's health plan as of September 30, 1992, children who enrolled in the 
296.33 	MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549, 
296.34 	article 4, section 17, and children who have family gross incomes that are equal to or 
297.1 	less than 150200 percent of the federal poverty guidelines are eligible without meeting 
297.2 	the requirements of subdivision 2 and the four-month requirement in subdivision 3, as 
297.3 	long as they maintain continuous coverage in the MinnesotaCare program or medical 
297.4 	assistance. Children who apply for MinnesotaCare on or after the implementation date 
297.5 	of the employer-subsidized health coverage program as described in Laws 1998, chapter 
297.6 	407, article 5, section 45, who have family gross incomes that are equal to or less than 150 
297.7 	percent of the federal poverty guidelines, must meet the requirements of subdivision 2 to 
297.8 	be eligible for MinnesotaCare.
297.9 	FamiliesParents enrolled in MinnesotaCare under section 256L.04, subdivision 1, 
297.10 	whose income increases above 275 percent of the federal poverty guidelines, are no longer 
297.11 	eligible for the program and shall be disenrolled by the commissioner. Beginning January 
297.12 	1, 2008, individuals enrolled in MinnesotaCare under section 256L.04, subdivision 
297.13 	7, whose income increases above 200 percent of the federal poverty guidelines or 250 
297.14 	percent of the federal poverty guidelines on or after July 1, 2009, are no longer eligible for 
297.15 	the program and shall be disenrolled by the commissioner. For persons disenrolled under 
297.16 	this subdivision, MinnesotaCare coverage terminates the last day of the calendar month 
297.17 	following the month in which the commissioner determines that the income of a family or 
297.18 	individual exceeds program income limits.
297.19 	(b) Notwithstanding paragraph (a), Children may remain enrolled in MinnesotaCare 
297.20 	if ten percent of their gross individual or gross family income as defined in section 
297.21 	256L.01, subdivision 4, is less than the annual premium for a policy with a $500 
297.22 	deductible available through the Minnesota Comprehensive Health Association. Children 
297.23 	who are no longer eligible for MinnesotaCare under this clause shall be given a 12-month 
297.24 	notice period from the date that ineligibility is determined before disenrollment greater 
297.25 	than 275 percent of federal poverty guidelines. The premium for children remaining 
297.26 	eligible under this clauseparagraph shall be the maximum premium determined under 
297.27 	section 256L.15, subdivision 2, paragraph (b).
297.28 	(c) Notwithstanding paragraphsparagraph (a) and (b), parents are not eligible for 
297.29 	MinnesotaCare if gross household income exceeds $57,500 for the 12-month period 
297.30 	of eligibility.

297.31 	Sec. 73. Minnesota Statutes 2008, section 256L.07, subdivision 2, is amended to read:
297.32 		Subd. 2.Must not have access to employer-subsidized coverage. (a) To be 
297.33 	eligible, a family or individual must not have access to subsidized health coverage through 
297.34 	an employer and must not have had access to employer-subsidized coverage through 
297.35 	a current employer for 18 months prior to application or reapplication. A family or 
298.1 	individual whose employer-subsidized coverage is lost due to an employer terminating 
298.2 	health care coverage as an employee benefit during the previous 18 months is not eligible.
298.3 	(b) This subdivision does not apply to a family or individual who was enrolled 
298.4 	in MinnesotaCare within six months or less of reapplication and who no longer has 
298.5 	employer-subsidized coverage due to the employer terminating health care coverage as an 
298.6 	employee benefit. This subdivision does not apply to children with family gross incomes 
298.7 	that are equal to or less than 200 percent of federal poverty guidelines.
298.8 	(c) For purposes of this requirement, subsidized health coverage means health 
298.9 	coverage for which the employer pays at least 50 percent of the cost of coverage for 
298.10 	the employee or dependent, or a higher percentage as specified by the commissioner. 
298.11 	Children are eligible for employer-subsidized coverage through either parent, including 
298.12 	the noncustodial parent. The commissioner must treat employer contributions to Internal 
298.13 	Revenue Code Section 125 plans and any other employer benefits intended to pay 
298.14 	health care costs as qualified employer subsidies toward the cost of health coverage for 
298.15 	employees for purposes of this subdivision.

298.16 	Sec. 74. Minnesota Statutes 2008, section 256L.07, subdivision 3, is amended to read:
298.17 		Subd. 3.Other health coverage. (a) Families and individuals enrolled in the 
298.18 	MinnesotaCare program must have no health coverage while enrolled or for at least four 
298.19 	months prior to application and renewal. Children with family gross incomes equal to or 
298.20 	greater than 200 percent of federal poverty guidelines, and adults, must have had no health 
298.21 	coverage for at least four months prior to application and renewal. Children enrolled in the 
298.22 	original children's health plan and children in families with income equal to or less than 
298.23 	150200 percent of the federal poverty guidelines, who have other health insurance, are 
298.24 	eligible if the coverage:
298.25 	(1) lacks two or more of the following:
298.26 	(i) basic hospital insurance;
298.27 	(ii) medical-surgical insurance;
298.28 	(iii) prescription drug coverage;
298.29 	(iv) dental coverage; or
298.30 	(v) vision coverage;
298.31 	(2) requires a deductible of $100 or more per person per year; or
298.32 	(3) lacks coverage because the child has exceeded the maximum coverage for a 
298.33 	particular diagnosis or the policy excludes a particular diagnosis.
299.1 	The commissioner may change this eligibility criterion for sliding scale premiums 
299.2 	in order to remain within the limits of available appropriations. The requirement of no 
299.3 	health coverage does not apply to newborns.
299.4 	(b) Medical assistance, general assistance medical care, and the Civilian Health and 
299.5 	Medical Program of the Uniformed Service, CHAMPUS, or other coverage provided under 
299.6 	United States Code, title 10, subtitle A, part II, chapter 55, are not considered insurance or 
299.7 	health coverage for purposes of the four-month requirement described in this subdivision.
299.8 	(c) For purposes of this subdivision, an applicant or enrollee who is entitled to 
299.9 	Medicare Part A or enrolled in Medicare Part B coverage under title XVIII of the Social 
299.10 	Security Act, United States Code, title 42, sections 1395c to 1395w-152, is considered to 
299.11 	have health coverage. An applicant or enrollee who is entitled to premium-free Medicare 
299.12 	Part A may not refuse to apply for or enroll in Medicare coverage to establish eligibility 
299.13 	for MinnesotaCare.
299.14 	(d) Applicants who were recipients of medical assistance or general assistance 
299.15 	medical care within one month of application must meet the provisions of this subdivision 
299.16 	and subdivision 2.
299.17 	(e) Cost-effective health insurance that was paid for by medical assistance is not 
299.18 	considered health coverage for purposes of the four-month requirement under this 
299.19 	section, except if the insurance continued after medical assistance no longer considered it 
299.20 	cost-effective or after medical assistance closed.

299.21 	Sec. 75. Minnesota Statutes 2008, section 256L.07, is amended by adding a subdivision 
299.22 	to read:
299.23 		Subd. 8.Automatic eligibility for certain children. Any child who was residing 
299.24 	in foster care or a juvenile residential correctional facility on the child's 18th birthday is 
299.25 	automatically deemed eligible for MinnesotaCare upon termination or release until the 
299.26 	child reaches the age of 21, and is exempt from the requirements of this section and 
299.27 	section 256L.15. Any child eligible under this subdivision must fill out an application and 
299.28 	must submit a renewal every 12 months.

299.29 	Sec. 76. Minnesota Statutes 2008, section 256L.11, subdivision 1, is amended to read:
299.30 		Subdivision 1.Medical assistance rate to be used. (a) Payment to providers under 
299.31 	sections 256L.01 to 256L.11 shall be at the same rates and conditions established for 
299.32 	medical assistance, except as provided in subdivisions 2 to 6. 
299.33 	(b) Effective for services provided on or after July 1, 2009, total payments for basic 
299.34 	care services shall be reduced by three percent, in accordance with section 256B.766. 
300.1 	Payments made to managed care plans shall be reduced for services provided on or after 
300.2 	October 1, 2009, to reflect this reduction.

300.3 	Sec. 77. Minnesota Statutes 2008, section 256L.12, subdivision 7, is amended to read:
300.4 		Subd. 7.Managed care plan vendor requirements. The following requirements 
300.5 	apply to all counties or vendors who contract with the Department of Human Services to 
300.6 	serve MinnesotaCare recipients. Managed care plan contractors:
300.7 	(1) shall authorize and arrange for the provision of the full range of services listed in 
300.8 	section 256L.03 in order to ensure appropriate health care is delivered to enrollees with 
300.9 	the exception of dental services, which shall be provided on a fee-for-service basis;  
300.10 	(2) shall accept the prospective, per capita payment or other contractually defined 
300.11 	payment from the commissioner in return for the provision and coordination of covered 
300.12 	health care services for eligible individuals enrolled in the program;
300.13 	(3) may contract with other health care and social service practitioners to provide 
300.14 	services to enrollees;
300.15 	(4) shall provide for an enrollee grievance process as required by the commissioner 
300.16 	and set forth in the contract with the department;
300.17 	(5) shall retain all revenue from enrollee co-payments;
300.18 	(6) shall accept all eligible MinnesotaCare enrollees, without regard to health status 
300.19 	or previous utilization of health services;
300.20 	(7) shall demonstrate capacity to accept financial risk according to requirements 
300.21 	specified in the contract with the department. A health maintenance organization licensed 
300.22 	under chapter 62D, or a nonprofit health plan licensed under chapter 62C, is not required 
300.23 	to demonstrate financial risk capacity, beyond that which is required to comply with 
300.24 	chapters 62C and 62D; and
300.25 	(8) shall submit information as required by the commissioner, including data 
300.26 	required for assessing enrollee satisfaction, quality of care, cost, and utilization of services.

300.27 	Sec. 78. Minnesota Statutes 2008, section 256L.12, subdivision 9, is amended to read:
300.28 		Subd. 9.Rate setting; performance withholds. (a) Rates will be prospective, 
300.29 	per capita, where possible. The commissioner may allow health plans to arrange for 
300.30 	inpatient hospital services on a risk or nonrisk basis. The commissioner shall consult with 
300.31 	an independent actuary to determine appropriate rates.
300.32 	(b) For services rendered on or after January 1, 2003, to December 31, 2003, the 
300.33 	commissioner shall withhold .5 percent of managed care plan payments under this section 
300.34 	pending completion of performance targets. The withheld funds must be returned no 
301.1 	sooner than July 1 and no later than July 31 of the following year if performance targets 
301.2 	in the contract are achieved. A managed care plan may include as admitted assets under 
301.3 	section 62D.044 any amount withheld under this paragraph that is reasonably expected 
301.4 	to be returned. 
301.5 	(c) For services rendered on or after January 1, 2004, the commissioner shall 
301.6 	withhold five percent of managed care plan payments and county-based purchasing 
301.7 	plan payments under this section pending completion of performance targets. Each 
301.8 	performance target must be quantifiable, objective, measurable, and reasonably attainable, 
301.9 	except in the case of a performance target based on a federal or state law or rule. Criteria 
301.10 	for assessment of each performance target must be outlined in writing prior to the 
301.11 	contract effective date. The managed care plan must demonstrate, to the commissioner's 
301.12 	satisfaction, that the data submitted regarding attainment of the performance target is 
301.13 	accurate. The commissioner shall periodically change the administrative measures used 
301.14 	as performance targets in order to improve plan performance across a broader range of 
301.15 	administrative services. The performance targets must include measurement of plan 
301.16 	efforts to contain spending on health care services and administrative activities. The 
301.17 	commissioner may adopt plan-specific performance targets that take into account factors 
301.18 	affecting only one plan, such as characteristics of the plan's enrollee population. The 
301.19 	withheld funds must be returned no sooner than July 1 and no later than July 31 of the 
301.20 	following calendar year if performance targets in the contract are achieved. A managed 
301.21 	care plan or a county-based purchasing plan under section 256B.692 may include as 
301.22 	admitted assets under section 62D.044 any amount withheld under this paragraph that is 
301.23 	reasonably expected to be returned.
301.24 	(c) For services rendered on or after January 1, 2010, the commissioner shall 
301.25 	withhold an additional three percent of managed care plan payments under this section. 
301.26 	The withheld funds must be returned no sooner than July 1 and no later than July 31 of the 
301.27 	following calendar year. The return of the withhold under this paragraph is not subject to 
301.28 	the requirements of paragraph (b).
301.29 	(d) Effective for services rendered on or after January 1, 2010, the commissioner 
301.30 	shall include as part of the performance targets described in paragraph (b) a reduction in 
301.31 	the plan's emergency room utilization rate for state health care program enrollees by a 
301.32 	measurable rate of five percent from the plan's utilization rate for the previous calendar 
301.33 	year.
301.34 	The withheld funds must be returned no sooner than July 1 and no later than July 
301.35 	31 of the following calendar year if the managed care plan or county-based purchasing 
302.1 	plan demonstrates to the satisfaction of the commissioner that a reduction in the utilization 
302.2 	rate was achieved.
302.3 	The withhold described in this paragraph shall continue for each consecutive contract 
302.4 	period until the managed care plan's emergency room utilization rate for state health care 
302.5 	program enrollees is reduced by 25 percent of the managed care plan's emergency room 
302.6 	utilization rate for state health care program enrollees for calendar year 2008.
302.7 	(e) A managed care plan or a county-based purchasing plan under section 256B.692 
302.8 	may include as admitted assets under section 62D.044 any amount withheld under this 
302.9 	section that is reasonably expected to be returned.

302.10 	Sec. 79. Minnesota Statutes 2008, section 256L.15, subdivision 2, is amended to read:
302.11 		Subd. 2.Sliding fee scale; monthly gross individual or family income. (a) The 
302.12 	commissioner shall establish a sliding fee scale to determine the percentage of monthly 
302.13 	gross individual or family income that households at different income levels must pay to 
302.14 	obtain coverage through the MinnesotaCare program. The sliding fee scale must be based 
302.15 	on the enrollee's monthly gross individual or family income. The sliding fee scale must 
302.16 	contain separate tables based on enrollment of one, two, or three or more persons. Until 
302.17 	June 30, 2009, the sliding fee scale begins with a premium of 1.5 percent of monthly gross 
302.18 	individual or family income for individuals or families with incomes below the limits for 
302.19 	the medical assistance program for families and children in effect on January 1, 1999, and 
302.20 	proceeds through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8, 4.8, 5.9, 7.4, and 
302.21 	8.8 percent. These percentages are matched to evenly spaced income steps ranging from 
302.22 	the medical assistance income limit for families and children in effect on January 1, 1999, 
302.23 	to 275 percent of the federal poverty guidelines for the applicable family size, up to a 
302.24 	family size of five. The sliding fee scale for a family of five must be used for families of 
302.25 	more than five. The sliding fee scale and percentages are not subject to the provisions of 
302.26 	chapter 14. If a family or individual reports increased income after enrollment, premiums 
302.27 	shall be adjusted at the time the change in income is reported.
302.28 	(b) Children in families whose gross income is above 275 percent of the federal 
302.29 	poverty guidelines shall pay the maximum premium. The maximum premium is defined 
302.30 	as a base charge for one, two, or three or more enrollees so that if all MinnesotaCare 
302.31 	cases paid the maximum premium, the total revenue would equal the total cost of 
302.32 	MinnesotaCare medical coverage and administration. In this calculation, administrative 
302.33 	costs shall be assumed to equal ten percent of the total. The costs of medical coverage 
302.34 	for pregnant women and children under age two and the enrollees in these groups shall 
302.35 	be excluded from the total. The maximum premium for two enrollees shall be twice the 
303.1 	maximum premium for one, and the maximum premium for three or more enrollees shall 
303.2 	be three times the maximum premium for one.
303.3 	(c) Beginning July 1, 2009, MinnesotaCare enrollees shall pay premiums according 
303.4 	to the premium scale specified in paragraph (d) with the exception that children in families 
303.5 	with income at or below 150200 percent of the federal poverty guidelines shall pay 
303.6 	a monthly premium of $4 no premiums. For purposes of paragraph (d), "minimum" 
303.7 	means a monthly premium of $4.
303.8 	(d) The following premium scale is established for individuals and families with 
303.9 	gross family incomes of 300 percent of the federal poverty guidelines or less:

303.10
303.11	Federal Poverty Guideline Range
	Percent of Average Gross Monthly 
Income
	
303.12	0-45%
	minimum
	
303.13	46-54%
	1.1%
	
303.14	55-81%
	1.6%
	
303.15	82-109%
	2.2%
	
303.16	110-136%
	2.9%
	
303.17	137-164%
	3.6%
	
303.18	165-191%
	4.6%
	
303.19	192-219%
	5.6%
	
303.20	220-248%
	6.5%
	
303.21	249-274%
	7.2%
	
303.22	275-300%
	8.0%

303.23 	Sec. 80. Minnesota Statutes 2008, section 256L.15, subdivision 3, is amended to read:
303.24 		Subd. 3.Exceptions to sliding scale. Children in families with income at or below 
303.25 	150200 percent of the federal poverty guidelines shall pay ano monthly premium of 
303.26 	$4 premiums.

303.27 	Sec. 81. Minnesota Statutes 2008, section 256L.17, subdivision 5, is amended to read:
303.28 		Subd. 5.Exemption. This section does not apply to pregnant women or children. 
303.29 	For purposes of this subdivision, a woman is considered pregnant for 60 days postpartum.

303.30 	Sec. 82. Minnesota Statutes 2008, section 501B.89, is amended by adding a 
303.31 	subdivision to read:
303.32 		Subd. 4.Annual filing requirement for supplemental needs trusts. (a) A trustee 
303.33 	of a trust under subdivision 3 and United States Code, title 42, section 1396p(d)(4)(A) or 
303.34 	(C), shall submit to the commissioner of human services, at the time of a beneficiary's 
303.35 	request for medical assistance, the following information about the trust:
304.1 	(1) a copy of the trust instrument; and
304.2 	(2) an inventory of the beneficiary's trust account assets and the value of those assets.
304.3 	(b) A trustee of a trust under subdivision 3 and United States Code, title 42, section 
304.4 	1396p(d)(4)(A) or (C), shall submit an accounting of the beneficiary's trust account to the 
304.5 	commissioner of human services at least annually until the trust, or the beneficiary's 
304.6 	interest in the trust, terminates. Accountings are due on the anniversary of the execution 
304.7 	date of the trust unless another annual date is established by the terms of the trust. The 
304.8 	accounting must include the following information for the accounting period:
304.9 	(1) an inventory of trust assets and the value of those assets at the beginning of the 
304.10 	accounting period;
304.11 	(2) additions to the trust during the accounting period and the source of those 
304.12 	additions;
304.13 	(3) itemized distributions from the trust during the accounting period, including the 
304.14 	purpose of the distributions and to whom the distributions were made;
304.15 	(4) an inventory of trust assets and the value of those assets at the end of the 
304.16 	accounting period; and
304.17 	(5) changes to the trust instrument during the accounting period.
304.18 	(c) For the purpose of paragraph (b), an accounting period is 12 months unless an 
304.19 	accounting period of a different length is permitted by the commissioner.

304.20 	EFFECTIVE DATE. This section is effective for applications for medical 
304.21 	assistance and renewals of medical assistance submitted on or after July 1, 2009.

304.22 	Sec. 83. Minnesota Statutes 2008, section 519.05, is amended to read:
304.23 	519.05 LIABILITY OF HUSBAND AND WIFE.
304.24 	(a) A spouse is not liable to a creditor for any debts of the other spouse. Where 
304.25 	husband and wife are living together, they shall be jointly and severally liable for 
304.26 	necessary medical services that have been furnished to either spouse, including any claims 
304.27 	arising under section 246.53, 256B.15, 256D.16, or 261.04, and necessary household 
304.28 	articles and supplies furnished to and used by the family. Notwithstanding this paragraph, 
304.29 	in a proceeding under chapter 518 the court may apportion such debt between the spouses.
304.30 	(b) Either spouse may close a credit card account or other unsecured consumer line 
304.31 	of credit on which both spouses are contractually liable, by giving written notice to the 
304.32 	creditor.

305.1 	Sec. 84. Laws 2003, First Special Session chapter 14, article 13C, section 2, subdivision 
305.2 	1, as amended by Laws 2004, chapter 272, article 2, section 2, is amended to read:

						

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

305.4	Summary by Fund
	
305.5	General
	3,301,811,000
	3,561,055,000
	
305.6
305.7	State Government 
Special Revenue
	534,000
	534,000
	
305.8	Health Care Access
	273,723,000
	302,272,000
	
305.9	Federal TANF
	270,425,000
	270,363,000
	
305.10	Lottery Cash Flow
	1,556,000
	1,556,000
	
305.11 	[FEDERAL CONTINGENCY 
305.12 	APPROPRIATION.] (a) Federal Medicaid 
305.13 	funds made available under title IV of 
305.14 	the federal Jobs and Growth Tax Relief 
305.15 	Reconciliation Act of 2003 are appropriated 
305.16 	to the commissioner of human services 
305.17 	for use in the state's medical assistance 
305.18 	and MinnesotaCare programs. The 
305.19 	commissioners of human services and 
305.20 	finance shall report to the legislative advisory 
305.21 	committee on the additional federal Medicaid 
305.22 	matching funds that will be available to the 
305.23 	state.
305.24 	(b) Because of the availability of these funds, 
305.25 	the following policies shall become effective:
305.26 	(1) medical assistance and MinnesotaCare 
305.27 	eligibility and local financial participation 
305.28 	changes provided for in this act may be 
305.29 	implemented prior to September 2, 2003, or 
305.30 	may be delayed as necessary to maximize 
305.31 	the use of federal funds received under 
305.32 	title IV of the Jobs and Growth Tax Relief 
305.33 	Reconciliation Act of 2003;
305.34 	(2) the aggregate cap on the services 
305.35 	identified in Minnesota Statutes, section 
306.1 	256L.035, paragraph (a), clause (3), shall 
306.2 	be increased from $2,000 to $5,000. This 
306.3 	increase shall expire at the end of fiscal year 
306.4 	2007. Funds may be transferred from the 
306.5 	general fund to the health care access fund as 
306.6 	necessary to implement this provision; and
306.7 	(3) the following payment shifts shall not be 
306.8 	implemented:
306.9 	(i) MFIP payment shift found in subdivision 
306.10 	11;
306.11 	(ii) the county payment shift found in 
306.12 	subdivision 1; and
306.13 	(iii) the delay in medical assistance 
306.14 	and general assistance medical care 
306.15 	fee-for-service payments found in 
306.16 	subdivision 6.
306.17 	(c) Notwithstanding section 14, paragraphs 
306.18 	(a) and (b) shall expire June 30, 2007.
306.19 	[RECEIPTS FOR SYSTEMS PROJECTS.] 
306.20 	Appropriations and federal receipts for 
306.21 	information system projects for MAXIS, 
306.22 	PRISM, MMIS, and SSIS must be deposited 
306.23 	in the state system account authorized in 
306.24 	Minnesota Statutes, section 256.014. Money 
306.25 	appropriated for computer projects approved 
306.26 	by the Minnesota office of technology, 
306.27 	funded by the legislature, and approved 
306.28 	by the commissioner of finance may be 
306.29 	transferred from one project to another 
306.30 	and from development to operations as the 
306.31 	commissioner of human services considers 
306.32 	necessary. Any unexpended balance in 
306.33 	the appropriation for these projects does 
306.34 	not cancel but is available for ongoing 
306.35 	development and operations.
307.1 	[GIFTS.] Notwithstanding Minnesota 
307.2 	Statutes, chapter 7, the commissioner may 
307.3 	accept on behalf of the state additional 
307.4 	funding from sources other than state funds 
307.5 	for the purpose of financing the cost of 
307.6 	assistance program grants or nongrant 
307.7 	administration. All additional funding is 
307.8 	appropriated to the commissioner for use as 
307.9 	designated by the grantor of funding.
307.10 	[SYSTEMS CONTINUITY.] In the event of 
307.11 	disruption of technical systems or computer 
307.12 	operations, the commissioner may use 
307.13 	available grant appropriations to ensure 
307.14 	continuity of payments for maintaining the 
307.15 	health, safety, and well-being of clients 
307.16 	served by programs administered by the 
307.17 	department of human services. Grant funds 
307.18 	must be used in a manner consistent with the 
307.19 	original intent of the appropriation.
307.20 	[NONFEDERAL SHARE TRANSFERS.] 
307.21 	The nonfederal share of activities for which 
307.22 	federal administrative reimbursement is 
307.23 	appropriated to the commissioner may be 
307.24 	transferred to the special revenue fund.
307.25 	[TANF FUNDS APPROPRIATED TO 
307.26 	OTHER ENTITIES.] Any expenditures from 
307.27 	the TANF block grant shall be expended 
307.28 	in accordance with the requirements and 
307.29 	limitations of part A of title IV of the 
307.30 	Social Security Act, as amended, and any 
307.31 	other applicable federal requirement or 
307.32 	limitation. Prior to any expenditure of these 
307.33 	funds, the commissioner shall assure that 
307.34 	funds are expended in compliance with the 
307.35 	requirements and limitations of federal law 
308.1 	and that any reporting requirements of federal 
308.2 	law are met. It shall be the responsibility 
308.3 	of any entity to which these funds are 
308.4 	appropriated to implement a memorandum 
308.5 	of understanding with the commissioner 
308.6 	that provides the necessary assurance of 
308.7 	compliance prior to any expenditure of funds. 
308.8 	The commissioner shall receipt TANF funds 
308.9 	appropriated to other state agencies and 
308.10 	coordinate all related interagency accounting 
308.11 	transactions necessary to implement these 
308.12 	appropriations. Unexpended TANF funds 
308.13 	appropriated to any state, local, or nonprofit 
308.14 	entity cancel at the end of the state fiscal 
308.15 	year unless appropriating language permits 
308.16 	otherwise.
308.17 	[TANF FUNDS TRANSFERRED TO 
308.18 	OTHER FEDERAL GRANTS.] The 
308.19 	commissioner must authorize transfers 
308.20 	from TANF to other federal block grants so 
308.21 	that funds are available to meet the annual 
308.22 	expenditure needs as appropriated. Transfers 
308.23 	may be authorized prior to the expenditure 
308.24 	year with the agreement of the receiving 
308.25 	entity. Transferred funds must be expended 
308.26 	in the year for which the funds were 
308.27 	appropriated unless appropriation language 
308.28 	permits otherwise. In accelerating transfer 
308.29 	authorizations, the commissioner must aim to 
308.30 	preserve the future potential transfer capacity 
308.31 	from TANF to other block grants.
308.32 	[TANF MAINTENANCE OF EFFORT.] 
308.33 	(a) In order to meet the basic maintenance 
308.34 	of effort (MOE) requirements of the TANF 
308.35 	block grant specified under Code of Federal 
308.36 	Regulations, title 45, section 263.1, the 
309.1 	commissioner may only report nonfederal 
309.2 	money expended for allowable activities 
309.3 	listed in the following clauses as TANF/MOE 
309.4 	expenditures:
309.5 	(1) MFIP cash, diversionary work program, 
309.6 	and food assistance benefits under Minnesota 
309.7 	Statutes, chapter 256J;
309.8 	(2) the child care assistance programs 
309.9 	under Minnesota Statutes, sections 119B.03
309.10 	and 119B.05, and county child care 
309.11 	administrative costs under Minnesota 
309.12 	Statutes, section 119B.15;
309.13 	(3) state and county MFIP administrative 
309.14 	costs under Minnesota Statutes, chapters 
309.15 	256J and 256K;
309.16 	(4) state, county, and tribal MFIP 
309.17 	employment services under Minnesota 
309.18 	Statutes, chapters 256J and 256K;
309.19 	(5) expenditures made on behalf of 
309.20 	noncitizen MFIP recipients who qualify 
309.21 	for the medical assistance without federal 
309.22 	financial participation program under 
309.23 	Minnesota Statutes, section 256B.06, 
309.24 	subdivision 4, paragraphs (d), (e), and (j); 
309.25 	and
309.26 	(6) qualifying working family credit 
309.27 	expenditures under Minnesota Statutes, 
309.28 	section 290.0671.
309.29 	(b) The commissioner shall ensure that 
309.30 	sufficient qualified nonfederal expenditures 
309.31 	are made each year to meet the state's 
309.32 	TANF/MOE requirements. For the activities 
309.33 	listed in paragraph (a), clauses (2) to 
309.34 	(6), the commissioner may only report 
310.1 	expenditures that are excluded from the 
310.2 	definition of assistance under Code of 
310.3 	Federal Regulations, title 45, section 260.31.
310.4 	(c) By August 31 of each year, the 
310.5 	commissioner shall make a preliminary 
310.6 	calculation to determine the likelihood 
310.7 	that the state will meet its annual federal 
310.8 	work participation requirement under Code 
310.9 	of Federal Regulations, title 45, sections 
310.10 	261.21 and 261.23, after adjustment for any 
310.11 	caseload reduction credit under Code of 
310.12 	Federal Regulations, title 45, section 261.41. 
310.13 	If the commissioner determines that the 
310.14 	state will meet its federal work participation 
310.15 	rate for the federal fiscal year ending that 
310.16 	September, the commissioner may reduce the 
310.17 	expenditure under paragraph (a), clause (1), 
310.18 	to the extent allowed under Code of Federal 
310.19 	Regulations, title 45, section 263.1(a)(2).
310.20 	(d) For fiscal years beginning with state 
310.21 	fiscal year 2003, the commissioner shall 
310.22 	assure that the maintenance of effort used 
310.23 	by the commissioner of finance for the 
310.24 	February and November forecasts required 
310.25 	under Minnesota Statutes, section 16A.103, 
310.26 	contains expenditures under paragraph (a), 
310.27 	clause (1), equal to at least 25 percent of 
310.28 	the total required under Code of Federal 
310.29 	Regulations, title 45, section 263.1.
310.30 	(e) If nonfederal expenditures for the 
310.31 	programs and purposes listed in paragraph 
310.32 	(a) are insufficient to meet the state's 
310.33 	TANF/MOE requirements, the commissioner 
310.34 	shall recommend additional allowable 
310.35 	sources of nonfederal expenditures to the 
311.1 	legislature, if the legislature is or will be in 
311.2 	session to take action to specify additional 
311.3 	sources of nonfederal expenditures for 
311.4 	TANF/MOE before a federal penalty is 
311.5 	imposed. The commissioner shall otherwise 
311.6 	provide notice to the legislative commission 
311.7 	on planning and fiscal policy under paragraph 
311.8 	(g).
311.9 	(f) If the commissioner uses authority 
311.10 	granted under section 11, or similar authority 
311.11 	granted by a subsequent legislature, to 
311.12 	meet the state's TANF/MOE requirement 
311.13 	in a reporting period, the commissioner 
311.14 	shall inform the chairs of the appropriate 
311.15 	legislative committees about all transfers 
311.16 	made under that authority for this purpose.
311.17 	(g) If the commissioner determines that 
311.18 	nonfederal expenditures under paragraph 
311.19 	(a) are insufficient to meet TANF/MOE 
311.20 	expenditure requirements, and if the 
311.21 	legislature is not or will not be in 
311.22 	session to take timely action to avoid a 
311.23 	federal penalty, the commissioner may 
311.24 	report nonfederal expenditures from 
311.25 	other allowable sources as TANF/MOE 
311.26 	expenditures after the requirements of this 
311.27 	paragraph are met. The commissioner 
311.28 	may report nonfederal expenditures 
311.29 	in addition to those specified under 
311.30 	paragraph (a) as nonfederal TANF/MOE 
311.31 	expenditures, but only ten days after the 
311.32 	commissioner of finance has first submitted 
311.33 	the commissioner's recommendations for 
311.34 	additional allowable sources of nonfederal 
311.35 	TANF/MOE expenditures to the members of 
312.1 	the legislative commission on planning and 
312.2 	fiscal policy for their review.
312.3 	(h) The commissioner of finance shall not 
312.4 	incorporate any changes in federal TANF 
312.5 	expenditures or nonfederal expenditures for 
312.6 	TANF/MOE that may result from reporting 
312.7 	additional allowable sources of nonfederal 
312.8 	TANF/MOE expenditures under the interim 
312.9 	procedures in paragraph (g) into the February 
312.10 	or November forecasts required under 
312.11 	Minnesota Statutes, section 16A.103, unless 
312.12 	the commissioner of finance has approved 
312.13 	the additional sources of expenditures under 
312.14 	paragraph (g).
312.15 	(i) Minnesota Statutes, section 256.011, 
312.16 	subdivision 3, which requires that federal 
312.17 	grants or aids secured or obtained under that 
312.18 	subdivision be used to reduce any direct 
312.19 	appropriations provided by law, do not apply 
312.20 	if the grants or aids are federal TANF funds.
312.21 	(j) Notwithstanding section 14, paragraph 
312.22 	(a), clauses (1) to (6), and paragraphs (b) to 
312.23 	(j) expire June 30, 2007.
312.24 	[WORKING FAMILY CREDIT 
312.25 	EXPENDITURES AS TANF MOE.] 
312.26 	The commissioner may claim as TANF 
312.27 	maintenance of effort up to the following 
312.28 	amounts of working family credit 
312.29 	expenditures for the following fiscal years:
312.30 	(1) fiscal year 2004, $7,013,000;
312.31 	(2) fiscal year 2005, $25,133,000;
312.32 	(3) fiscal year 2006, $6,942,000; and
312.33 	(4) fiscal year 2007, $6,707,000.
313.1 	[FISCAL YEAR 2003 APPROPRIATIONS 
313.2 	CARRYFORWARD.] Effective the day 
313.3 	following final enactment, notwithstanding 
313.4 	Minnesota Statutes, section 16A.28, or any 
313.5 	other law to the contrary, state agencies and 
313.6 	constitutional offices may carry forward 
313.7 	unexpended and unencumbered nongrant 
313.8 	operating balances from fiscal year 2003 
313.9 	general fund appropriations into fiscal year 
313.10 	2004 to offset general budget reductions.
313.11 	[TRANSFER OF GRANT BALANCES.] 
313.12 	Effective the day following final enactment, 
313.13 	the commissioner of human services, 
313.14 	with the approval of the commissioner of 
313.15 	finance and after notification of the chair 
313.16 	of the senate health, human services and 
313.17 	corrections budget division and the chair 
313.18 	of the house of representatives health 
313.19 	and human services finance committee, 
313.20 	may transfer unencumbered appropriation 
313.21 	balances for the biennium ending June 30, 
313.22 	2003, in fiscal year 2003 among the MFIP, 
313.23 	MFIP child care assistance under Minnesota 
313.24 	Statutes, section 119B.05, general assistance, 
313.25 	general assistance medical care, medical 
313.26 	assistance, Minnesota supplemental aid, 
313.27 	and group residential housing programs, 
313.28 	and the entitlement portion of the chemical 
313.29 	dependency consolidated treatment fund, and 
313.30 	between fiscal years of the biennium.
313.31 	[TANF APPROPRIATION 
313.32 	CANCELLATION.] Notwithstanding 
313.33 	the provisions of Laws 2000, chapter 488, 
313.34 	article 1, section 16, any prior appropriations 
313.35 	of TANF funds to the department of trade and 
313.36 	economic development or to the job skills 
314.1 	partnership board or any transfers of TANF 
314.2 	funds from another agency to the department 
314.3 	of trade and economic development or to the 
314.4 	job skills partnership board are not available 
314.5 	until expended, and if unobligated as of June 
314.6 	30, 2003, these appropriations or transfers 
314.7 	shall cancel to the TANF fund.
314.8 	[SHIFT COUNTY PAYMENT.] The 
314.9 	commissioner shall make up to 100 percent 
314.10 	of the calendar year 2005 payments to 
314.11 	counties for developmental disabilities 
314.12 	semi-independent living services grants, 
314.13 	developmental disabilities family support 
314.14 	grants, and adult mental health grants from 
314.15 	fiscal year 2006 appropriations. This is a 
314.16 	onetime payment shift. Calendar year 2006 
314.17 	and future payments for these grants are not 
314.18 	affected by this shift. This provision expires 
314.19 	June 30, 2006.
314.20 	[CAPITATION RATE INCREASE.] Of 
314.21 	the health care access fund appropriations 
314.22 	to the University of Minnesota in the 
314.23 	higher education omnibus appropriation 
314.24 	bill, $2,157,000 in fiscal year 2004 and 
314.25 	$2,157,000 in fiscal year 2005 are to be used 
314.26 	to increase the capitation payments under
314.27 	for fiscal years beginning July 1, 2003, and 
314.28 	thereafter, $2,157,000 each year shall be 
314.29 	transferred to the commissioner for purposes 
314.30 	of Minnesota Statutes, section 256B.69. 
314.31 	Notwithstanding the provisions of section 
314.32 	14, this provision shall not expire.

314.33 	Sec. 85. Laws 2008, chapter 358, article 3, section 8, the effective date, is amended to 
314.34 	read:

315.1 	EFFECTIVE DATE. This section is effective January 1, 2009, or upon federal 
315.2 	approval, whichever is later. The commissioner of human services shall notify the revisor 
315.3 	of statutes when federal approval is obtained.

315.4 	Sec. 86. EXCESS SURPLUS.
 315.5 	(a) The commissioner of human services, in consultation with the commissioner of 
315.6 	health, shall determine the amount of excess surplus each health maintenance organization 
315.7 	and county-based purchasing plan had as of December 31, 2008. A health maintenance 
315.8 	organization and a county-based purchasing plan shall be determined to have excess 
315.9 	surplus if, as of December 31, 2008, its total adjusted capital met both of the following 
315.10 	conditions:
315.11 	(1) total adjusted capital was greater than the product of 5.5 and the authorized 
315.12 	control level risk-based capital; and
315.13 	(2) total adjusted capital was greater than the sum of the action level risk-based 
315.14 	capital and $100,000,000.
315.15 	(b) Effective for payments made between January 1, 2012, and June 30, 2013, 
315.16 	the commissioner of human services shall reduce the general assistance medical care 
315.17 	capitation rate paid to each health maintenance organization under Minnesota Statutes, 
315.18 	section 256B.69, and to each county-based purchasing plan under Minnesota Statutes, 
315.19 	section 256B.692, by an amount that equals 33 percent of the excess surplus determined in 
315.20 	paragraph (a).

315.21 	Sec. 87. AUTISM SPECTRUM DISORDER TASK FORCE.
 315.22 	(a) The Autism Spectrum Disorder Task Force is composed of 15 members, 
315.23 	appointed as follows:
315.24 	(1) two members of the senate appointed by the Subcommittee on Committees of the 
315.25 	Committee on Rules and Administration, one of whom must be a member of the minority;
315.26 	(2) two members of the house of representatives, one from the majority party, 
315.27 	appointed by the speaker of the house, and one from the minority party, appointed by 
315.28 	the minority leader;
315.29 	(3) two members appointed by the legislature, with regard to geographic diversity in 
315.30 	the state, who are parents of children with autism spectrum disorder (ASD); one member 
315.31 	shall be appointed by the senate Subcommittee on Committees of the Committee on 
315.32 	Rules and Administration making appointments for the senate; and one member shall be 
315.33 	appointed by the speaker of the house making the appointments for the house;
316.1 	(4) one member appointed by the Minnesota chapter of the American Academy of 
316.2 	Pediatrics who is a general primary care pediatrician; 
316.3 	(5) one member appointed by the Minnesota Academy of Family Medicine who is a 
316.4 	family practice physician;
316.5 	(6) one member appointed by the Minnesota Psychological Association who is a 
316.6 	neuropsychologist;
316.7 	(7) one member appointed by the directors of public school student support services;
316.8 	(8) one member appointed by the Somali American Autism Foundation;
316.9 	(9) one member appointed by the ARC of Minnesota;
316.10 	(10) one member appointed by the Autism Society of Minnesota;
316.11 	(11) one member appointed by the Parent Advocacy Coalition for Educational 
316.12 	Rights; and
316.13 	(12) one member appointed by the Minnesota Council of Health Plans.
316.14 	Appointments must be made by September 1, 2009. The Legislative Coordinating 
316.15 	Commission shall provide meeting space for the task force. The senate member appointed 
316.16 	by the minority leader of the senate shall convene the first meeting of the task force no 
316.17 	later than October 1, 2009. The task force shall elect a chair at the first meeting.
316.18 	(b) If federal or state funding is available, the commissioners of education, 
316.19 	employment and economic development, health, and human services shall provide 
316.20 	assistance to the task force.
316.21 	(c) The task force shall develop recommendations and report on the following topics:
316.22 	(1) ways to improve services provided by all state and political subdivisions;
316.23 	(2) sources of public and private funding available for treatment and ways to 
316.24 	improve efficiency in the use of these funds;
316.25 	(3) methods to improve coordination in the delivery of service between public 
316.26 	and private agencies, health providers, and schools, and to address any geographic 
316.27 	discrepancies in the delivery of services;
316.28 	(4) increasing the availability of and the training for medical providers and educators 
316.29 	who identify and provide services to individuals with ASD; and
316.30 	(5) treatment options supported by peer-reviewed, established scientific research 
316.31 	for individuals with ASD.
316.32 	(d) The task force shall coordinate with existing efforts at the Departments of 
316.33 	Education, Health, Human Services, and Employment and Economic Development 
316.34 	related to ASD.
316.35 	(e) By January 15 of each year, the task force shall provide a report regarding its 
316.36 	findings and consideration of the topics listed under paragraph (c), and the action taken 
317.1 	under paragraph (d), including draft legislation if necessary, to the chairs and ranking 
317.2 	minority members of the legislative committees with jurisdiction over health and human 
317.3 	services.
317.4 	(f) This section expires June 30, 2011.

317.5 	Sec. 88. FEDERAL APPROVAL.
 317.6 	(a) The commissioner of human services shall seek federal approval, if necessary, to 
317.7 	implement Minnesota Statutes, section 256B.0751, subdivision 7.
317.8 	(b) The commissioner of human services shall resubmit for federal approval the 
317.9 	elimination of depreciation for self-employed farmers in determining income eligibility 
317.10 	for MinnesotaCare passed in Laws 2007, chapter 147, article 5, section 19.

317.11 	Sec. 89.  REPEALER.
 317.12 	Minnesota Statutes 2008, sections 62Q.80, subdivision 1a; 256.962, subdivision 7; 
317.13 	256B.037; 256B.0625, subdivision 9; 256B.69, subdivision 6c; and 256L.17, subdivision 
317.14 	6, are repealed.

317.15 	ARTICLE 11
317.16 	FORECAST ADJUSTMENTS

317.17
317.18	Section 1. SUMMARY OF APPROPRIATIONS; DEPARTMENT OF HUMAN 
SERVICES FORECAST ADJUSTMENT.
 	
317.19 	The dollar amounts shown are added to or, if shown in parentheses, are subtracted 
317.20 	from the appropriations in Laws 2008, chapter 363, from the general fund, or any other 
317.21 	fund named, to the Department of Human Services for the purposes specified in this 
317.22 	article, to be available for the fiscal year indicated for each purpose. The figure "2009" 
317.23 	used in this article means that the appropriation or appropriations listed are available 
317.24 	for the fiscal year ending June 30, 2009.

317.25							2009
	
317.26	General 
					$
	(445,130,000)
	
317.27	Health Care Access
					$
	(19,460,000)
	
317.28	TANF
					$
	(14,404,000)
	
317.29	Total
					$
	(478,994,000)

317.30
317.31	Sec. 2. COMMISSIONER OF HUMAN 
SERVICES

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

318.1	Appropriations by Fund
	
318.2			2009
	
318.3	General
		(445,130,000)
	
318.4	Health Care Access
		(19,460,000)
	
318.5	TANF
		(14,404,000)

318.6	Subd. 2.Revenue and Pass Through

318.7	Appropriations by Fund
	
318.8	TANF
		1,107,000

318.9318.10
	Subd. 3.Children and Economic Assistance 
Grants

318.11	Appropriations by Fund
	
318.12	General
		27,002,000
	
318.13	TANF
		(16,211,000)
	
318.14 	The amounts that may be spent from this 
318.15 	appropriation for each purpose are as follows:

318.16	(a) MFIP/DWP Grants

318.17	Appropriations by Fund
	
318.18	General
		17,530,000
	
318.19	TANF
		(16,211,000)

318.20	(b) MFIP Child Care Assistance Grants
				4,933,000

318.21	(c) General Assistance Grants
				1,458,000

318.22	(d) Minnesota Supplemental Aid Grants
				513,000

318.23	(e) Group Residential Housing Grants
				2,568,000

318.24	Subd. 4.Basic Health Care Grants

318.25	Appropriations by Fund
	
318.26	General 
		(224,341,000)
	
318.27	Health Care Access
		(19,460,000)
	
318.28 	The amounts that may be spent from the 
318.29 	appropriation for each purpose are as follows:

318.30	(a) MinnesotaCare Health Care Access
				(19,460,000)

318.31
318.32	(b) Medical Assistance Basic Health Care; 
Families and Children
				(100,055,000)

318.33
318.34	(c) Medical Assistance Basic Health Care; 
Elderly and Disabled
				(136,795,000)

319.1	(d) General Assistance Medical Care
				12,539,000

319.2	Subd. 5.Continuing Care Grants
 				(247,791,000)
	
319.3 	The amounts that may be spent from this 
319.4 	appropriation for each purpose are as follows:

319.5
319.6	(a) Medical Assistance Long-Term Care 
Facilities 
				(59,204,000)

319.7
319.8	(b) Medical Assistance Long-Term Care 
Waivers
				(168,927,000)

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

319.10 	Sec. 3. EFFECTIVE DATE.
 319.11 	Sections 1 and 2 are effective the day following final enactment.

319.12 	ARTICLE 12
319.13 	HEALTH AND HUMAN SERVICES APPROPRIATIONS

319.14	Section 1.  SUMMARY OF APPROPRIATIONS.
 	
319.15 	The amounts shown in this section summarize direct appropriations by fund made 
319.16 	in this article.

319.17			2010
		2011
		Total
	
319.18	General
	$
	4,487,921,000
	$
	5,278,322,000
	$
	9,766,243,000
	
319.19
319.20	State Government Special 
Revenue
		67,075,000
		61,675,000
		128,750,000
	
319.21	Health Care Access
		474,579,000
		554,192,000
		1,028,771,000
	
319.22	Federal TANF
		295,652,000
		285,641,000
		581,293,000
	
319.23	Lottery Prize
		1,665,000
		1,655,000
		3,330,000
	
319.24	Total
	$
	5,326,892,000
	$
	6,181,495,000
	$
	11,508,387,000

319.25	Sec. 2. HEALTH AND HUMAN SERVICES APPROPRIATION.
 	
319.26 	The sums shown in the columns marked "Appropriations" are appropriated to the 
319.27 	agencies and for the purposes specified in this article. The appropriations are from the 
319.28 	general fund, or another named fund, and are available for the fiscal years indicated 
319.29 	for each purpose. The figures "2010" and "2011" used in this article mean that the 
319.30 	appropriations listed under them are available for the fiscal year ending June 30, 2010, or 
319.31 	June 30, 2011, respectively. "The first year" is fiscal year 2010. "The second year" is fiscal 
319.32 	year 2011. "The biennium" is fiscal years 2010 and 2011. Appropriations for the fiscal 
319.33 	year ending June 30, 2009, are effective the day following final enactment.

320.1				APPROPRIATIONS
	
320.2				Available for the Year
	
320.3				Ending June 30
	
320.4					2010
		2011

320.5	Sec. 3. HUMAN SERVICES

320.6	Subdivision 1.Total Appropriation
 	$
	5,073,896,000
	$
	5,929,006,000

320.7	Appropriations by Fund
	
320.8		2010
	2011
	
320.9	General
	4,345,752,000
	5,139,485,000
	
320.10
320.11	State Government 
Special Revenue
	5,809,000
	565,000
	
320.12	Health Care Access
	436,751,000
	513,383,000
	
320.13	Federal TANF
	283,919,000
	273,908,000
	
320.14	Lottery Prize
	1,665,000
	1,665,000
	
320.15 	Receipts for Systems Projects.
320.16 	Appropriations and federal receipts for 
320.17 	information systems projects for MAXIS, 
320.18 	PRISM, MMIS, and SSIS must be deposited 
320.19 	in the state system account authorized in 
320.20 	Minnesota Statutes, section 256.014. Money 
320.21 	appropriated for computer projects approved 
320.22 	by the Minnesota Office of Enterprise 
320.23 	Technology, funded by the legislature, and 
320.24 	approved by the commissioner of finance, 
320.25 	may be transferred from one project to 
320.26 	another and from development to operations 
320.27 	as the commissioner of human services 
320.28 	considers necessary, except that any transfers 
320.29 	to one project that exceed $1,000,000 or 
320.30 	multiple transfers to one project that exceed 
320.31 	$1,000,000 in total require the express 
320.32 	approval of the legislature. Any unexpended 
320.33 	balance in the appropriation for these 
320.34 	projects does not cancel but is available for 
320.35 	ongoing development and operations. Any 
320.36 	computer project with a total cost exceeding 
320.37 	$1,000,000, including, but not limited to, a 
321.1 	replacement for the proposed HealthMatch 
321.2 	system, shall not be commenced without the 
321.3 	express approval of the legislature.
321.4 	HealthMatch Systems Account. In fiscal 
321.5 	year 2010, $3,053,000 shall be transferred 
321.6 	from the HealthMatch systems account in the 
321.7 	special revenue fund to the general fund.
321.8 	Minnesota Joint Underwriting 
321.9 	Association. By June 30, 2010, the 
321.10 	commissioner of finance shall transfer 
321.11 	$6,404,000 in assets of the Minnesota Joint 
321.12 	Underwriting Association under chapter 62I 
321.13 	to the general fund.
321.14 	Nonfederal Share Transfers. The 
321.15 	nonfederal share of activities for which 
321.16 	federal administrative reimbursement is 
321.17 	appropriated to the commissioner may be 
321.18 	transferred to the special revenue fund.
321.19 	Local Share Payment Modification 
321.20 	Required for ARRA Compliance.
321.21 	Effective from July 1, 2009, to December 
321.22 	31, 2010, Hennepin County's monthly 
321.23 	contribution to the nonfederal share of 
321.24 	medical assistance costs must be reduced 
321.25 	to the percentage required on September 
321.26 	1, 2008, to meet federal requirements for 
321.27 	enhanced federal match under the American 
321.28 	Reinvestment and Recovery Act (ARRA) 
321.29 	of 2009. Notwithstanding  the requirements 
321.30 	of Minnesota Statutes, section 256B.19, 
321.31 	subdivision 1c, paragraph (d), for the period 
321.32 	beginning July 1, 2009, to December 31, 
321.33 	2010, Hennepin County's monthly payment 
321.34 	under that provision is reduced to $434,688.
321.35 	TANF Maintenance of Effort.
322.1 	(a) In order to meet the basic maintenance 
322.2 	of effort (MOE) requirements of the TANF 
322.3 	block grant specified under Code of Federal 
322.4 	Regulations, title 45, section 263.1, the 
322.5 	commissioner may only report nonfederal 
322.6 	money expended for allowable activities 
322.7 	listed in the following clauses as TANF/MOE 
322.8 	expenditures:
322.9 	(1) MFIP cash, diversionary work program, 
322.10 	and food assistance benefits under Minnesota 
322.11 	Statutes, chapter 256J;
322.12 	(2) the child care assistance programs 
322.13 	under Minnesota Statutes, sections 119B.03 
322.14 	and 119B.05, and county child care 
322.15 	administrative costs under Minnesota 
322.16 	Statutes, section 119B.15;
322.17 	(3) state and county MFIP administrative 
322.18 	costs under Minnesota Statutes, chapters 
322.19 	256J and 256K;
322.20 	(4) state, county, and tribal MFIP 
322.21 	employment services under Minnesota 
322.22 	Statutes, chapters 256J and 256K;
322.23 	(5) expenditures made on behalf of 
322.24 	noncitizen MFIP recipients who qualify 
322.25 	for the medical assistance without federal 
322.26 	financial participation program under 
322.27 	Minnesota Statutes, section 256B.06, 
322.28 	subdivision 4, paragraphs (d), (e), and (j); 
322.29 	and
322.30 	(6) qualifying working family credit 
322.31 	expenditures under Minnesota Statutes, 
322.32 	section 290.0671.
322.33 	(b) The commissioner shall ensure that 
322.34 	sufficient qualified nonfederal expenditures 
323.1 	are made each year to meet the state's 
323.2 	TANF/MOE requirements. For the activities 
323.3 	listed in paragraph (a), clauses (2) to 
323.4 	(6), the commissioner may only report 
323.5 	expenditures that are excluded from the 
323.6 	definition of assistance under Code of 
323.7 	Federal Regulations, title 45, section 260.31.
323.8 	(c) For fiscal years beginning with state 
323.9 	fiscal year 2003, the commissioner shall 
323.10 	ensure that the maintenance of effort used 
323.11 	by the commissioner of finance for the 
323.12 	February and November forecasts required 
323.13 	under Minnesota Statutes, section 16A.103, 
323.14 	contains expenditures under paragraph (a), 
323.15 	clause (1), equal to at least 16 percent of 
323.16 	the total required under Code of Federal 
323.17 	Regulations, title 45, section 263.1.
323.18 	(d) For federal fiscal years beginning on or 
323.19 	after October 1, 2007, the commissioner 
323.20 	may not claim an amount of TANF/MOE in 
323.21 	excess of the 75 percent standard in Code 
323.22 	of Federal Regulations, title 45, section 
323.23 	263.1(a)(2), except:
323.24 	(1) to the extent necessary to meet the 80 
323.25 	percent standard under Code of Federal 
323.26 	Regulations, title 45, section 263.1(a)(1), 
323.27 	if it is determined by the commissioner 
323.28 	that the state will not meet the TANF work 
323.29 	participation target rate for the current year;
323.30 	(2) to provide any additional amounts 
323.31 	under Code of Federal Regulations, title 45, 
323.32 	section 264.5, that relate to replacement of 
323.33 	TANF funds due to the operation of TANF 
323.34 	penalties; and
324.1 	(3) to provide any additional amounts that 
324.2 	may contribute to avoiding or reducing 
324.3 	TANF work participation penalties through 
324.4 	the operation of the excess MOE provisions 
324.5 	of Code of Federal Regulations, title 45, 
324.6 	section 261.43(a)(2).
324.7 	For the purposes of clauses (1) to (3), 
324.8 	the commissioner may supplement the 
324.9 	MOE claim with working family credit 
324.10 	expenditures to the extent such expenditures 
324.11 	or other qualified expenditures are otherwise 
324.12 	available after considering the expenditures 
324.13 	allowed in this section.
324.14 	(e) Minnesota Statutes, section 256.011, 
324.15 	subdivision 3, which requires that federal 
324.16 	grants or aids secured or obtained under that 
324.17 	subdivision be used to reduce any direct 
324.18 	appropriations provided by law, do not apply 
324.19 	if the grants or aids are federal TANF funds.
324.20 	(f) Notwithstanding any contrary provision 
324.21 	in this article, this provision expires June 30, 
324.22 	2013.
324.23 	Working Family Credit Expenditures as 
324.24 	TANF/MOE. The commissioner may claim 
324.25 	as TANF/MOE up to $6,707,000 per year of 
324.26 	working family credit expenditures for fiscal 
324.27 	year 2010 through fiscal year 2011.
324.28 	Working Family Credit Expenditures 
324.29 	to be Claimed for TANF/MOE. The 
324.30 	commissioner may count the following 
324.31 	amounts of working family credit expenditure 
324.32 	as TANF/MOE:
324.33 	(1) fiscal year 2010, $49,792,000;
324.34 	(2) fiscal year 2011, $66,531,000;
325.1 	(3) fiscal year 2012, $15,825,000; and
325.2 	(4) fiscal year 2013, $16,150,000.
325.3 	Notwithstanding any contrary provision in 
325.4 	this article, this rider expires June 30, 2013.
325.5 	TANF Transfer to Federal Child Care 
325.6 	and Development Fund. The following 
325.7 	TANF fund amounts are appropriated to the 
325.8 	commissioner for the purposes of MFIP and 
325.9 	transition year child care under Minnesota 
325.10 	Statutes, section 119B.05:
325.11 	(1) fiscal year 2010, $6,313,000;
325.12 	(2) fiscal year 2011, $23,321,000;
325.13 	(3) fiscal year 2012, $2,475,000; and
325.14 	(4) fiscal year 2013, $2,180,000.
325.15 	The commissioner shall authorize the 
325.16 	transfer of sufficient TANF funds to the 
325.17 	federal child care and development fund to 
325.18 	meet this appropriation and shall ensure that 
325.19 	all transferred funds are expended according 
325.20 	to federal child care and development fund 
325.21 	regulations.
325.22 	Food Stamps Employment and Training.
325.23 	(a) The commissioner shall apply for and 
325.24 	claim the maximum allowable federal 
325.25 	matching funds under United States Code, 
325.26 	title 7, section 2025, paragraph (h), for 
325.27 	state expenditures made on behalf of family 
325.28 	stabilization services participants voluntarily 
325.29 	engaged in food stamp employment and 
325.30 	training activities, where appropriate.
325.31 	(b) Notwithstanding Minnesota Statutes, 
325.32 	sections 256D.051, subdivisions 1a, 6b, 
325.33 	and 6c, and 256J.626, federal food stamps 
325.34 	employment and training funds received 
326.1 	as reimbursement of MFIP consolidated 
326.2 	fund grant expenditures for diversionary 
326.3 	work program participants and child 
326.4 	care assistance program expenditures for 
326.5 	two-parent families must be deposited in the 
326.6 	general fund. The amount of funds must be 
326.7 	limited to $4,340,000 in fiscal year 2010 
326.8 	and $4,340,000 in fiscal years 2011 through 
326.9 	2013, contingent on approval by the federal 
326.10 	Food and Nutrition Service. 
326.11 	(c) Consistent with the receipt of these federal 
326.12 	funds, the commissioner may adjust the 
326.13 	level of working family credit expenditures 
326.14 	claimed as TANF maintenance of effort. 
326.15 	Notwithstanding any contrary provision in 
326.16 	this article, this rider expires June 30, 2013.
326.17 	ARRA Food Support Administration.
326.18 	The funds available for food support 
326.19 	administration under the American Recovery 
326.20 	and Reinvestment Act (ARRA) of 2009 
326.21 	must be appropriated to the commissioner 
326.22 	for implementing the food support 
326.23 	benefit increases, increased eligibility 
326.24 	determinations, and outreach. Of these 
326.25 	funds, 20 percent shall be allocated to 
326.26 	the commissioner and 80 percent must be 
326.27 	allocated to counties. The commissioner 
326.28 	shall reimburse counties proportionate to 
326.29 	their food support caseload based on data 
326.30 	for the most recent quarter available. Tribal 
326.31 	reimbursement must be made from  the state 
326.32 	portion based on a caseload factor equivalent 
326.33 	to that of a county.
326.34 	Emergency Fund for the TANF Program.
326.35 	TANF Emergency Contingency funds 
327.1 	available under the American Recovery 
327.2 	and Reinvestment Act of 2009 (Public Law 
327.3 	111-5) are appropriated to the commissioner. 
327.4 	The commissioner must request TANF 
327.5 	Emergency Contingency funds from the 
327.6 	Secretary of the Department of Health 
327.7 	and Human Services to the extent the 
327.8 	commissioner meets or expects to meet 
327.9 	the requirements of section 403(c) of the 
327.10 	Social Security Act. The commissioner must 
327.11 	seek to maximize such grants. The funds 
327.12 	received must  be used as appropriated. Each 
327.13 	county must maintain the county's current 
327.14 	level of emergency assistance funding under 
327.15 	the children and community services fund 
327.16 	and use the funds under this paragraph to 
327.17 	supplement existing emergency assistance 
327.18 	funding levels.

327.19	Subd. 2.Agency Management
 					
327.20 	The amounts that may be spent from the 
327.21 	appropriation for each purpose are as follows:

327.22	(a) Financial Operations

327.23	Appropriations by Fund
	
327.24	General
	3,380,000
	3,908,000
	
327.25	Health Care Access
	1,241,000
	1,016,000
	
327.26	Federal TANF
	122,000
	122,000

327.27	(b) Legal and Regulatory Operations

327.28	Appropriations by Fund
	
327.29	General
	13,555,000
	13,355,000
	
327.30
327.31	State Government 
Special Revenue
	440,000
	440,000
	
327.32	Health Care Access
	943,000
	943,000
	
327.33	Federal TANF
	100,000
	100,000

327.34	(c) Management Operations

328.1	Appropriations by Fund
	
328.2	General
	4,334,000
	4,562,000
	
328.3	Health Care Access
	242,000
	242,000
	
328.4 	Lease Cost Reduction. Base level funding 
328.5 	to the commissioner shall be reduced by 
328.6 	$381,000 in fiscal year 2010, and $153,000 
328.7 	in fiscal year 2011, to reflect a reduction in 
328.8 	lease costs related to the Minnehaha Avenue 
328.9 	building.
328.10 	Base Adjustment. The general fund base is 
328.11 	increased $153,000 in fiscal year 2012 and 
328.12 	$153,000 in fiscal year 2013.

328.13	(d) Information Technology Operations

328.14	Appropriations by Fund
	
328.15	General
	28,077,000
	28,077,000
	
328.16	Health Care Access
	4,856,000
	4,868,000

328.17
328.18	Subd. 3.Revenue and Pass-Through Revenue 
Expenditures
 		77,303,000
		89,773,000
	
328.19 	This appropriation is from the federal TANF 
328.20 	fund.

328.21
328.22	Subd. 4.Children and Economic Assistance 
Grants
 					
328.23 	The amounts that may be spent from this 
328.24 	appropriation for each purpose are as follows:

328.25	(a) MFIP/DWP Grants

328.26	Appropriations by Fund
	
328.27	General
	74,126,000
	117,550,000
	
328.28	Federal TANF
	95,841,000
	69,050,000

328.29	(b) Support Services Grants

328.30	Appropriations by Fund
	
328.31	General
	8,715,000
	12,498,000
	
328.32	Federal TANF
	 114,961,000
	113,511,000
	
328.33 	Supported Work. Of the TANF 
328.34 	appropriation, $6,400,000 in fiscal year 
329.1 	2011 is to the commissioner for supported 
329.2 	work for MFIP recipients and is available 
329.3 	until expended. Supported work includes 
329.4 	paid transitional work experience and 
329.5 	a continuum of employment assistance, 
329.6 	including outreach and recruitment, 
329.7 	program orientation and intake, testing and 
329.8 	assessment, job development and marketing, 
329.9 	preworksite training, supported worksite 
329.10 	experience, job coaching, and postplacement 
329.11 	follow-up, in addition to extensive case 
329.12 	management and referral services.
329.13 	TANF Emergency Fund; Nonrecurrent 
329.14 	Short-Term Benefits. TANF Emergency 
329.15 	Contingency fund grants received due to 
329.16 	increases in expenditures for nonrecurrent 
329.17 	short-term benefits must be used to offset the 
329.18 	increase in these expenditures for counties 
329.19 	under the MFIP consolidated fund under 
329.20 	Minnesota Statutes, section 256J.626, 
329.21 	and the diversionary work program. The 
329.22 	commissioner shall develop procedures 
329.23 	to maximize reimbursement of these 
329.24 	expenditures over the TANF emergency fund 
329.25 	base year quarters.
329.26 	Base Adjustment. The general fund base is 
329.27 	decreased $3,783,000 in fiscal year 2012 and 
329.28 	$3,783,000 in fiscal year 2013. The federal 
329.29 	TANF fund base in increased $1,450,000 in 
329.30 	both fiscal year 2012 and fiscal year 2013.

329.31	(c) MFIP Child Care Assistance Grants

329.32	Appropriations by Fund
	
329.33	General
	51,690,000
	42,505,000
	
329.34	Federal TANF
	-0-
	616,000
	
330.1 	ARRA Child Care Development Block 
330.2 	Grant Funds. The funds available from the 
330.3 	child care development block grant under 
330.4 	ARRA must be used for MFIP child care to 
330.5 	the extent that those funds are not earmarked 
330.6 	for quality expansion or to improve the 
330.7 	quality of infant and toddler care.

330.8
330.9	(d) Basic Sliding Fee Child Care Assistance 
Grants
		 39,843,000
		 44,835,000
	
330.10 	Child Care Development Fund 
330.11 	Unexpended Balance. In addition to 
330.12 	the amount provided in this section, the 
330.13 	commissioner shall expend $5,244,000 in 
330.14 	fiscal year 2010 from the federal child care 
330.15 	development fund unexpended balance 
330.16 	for basic sliding fee child care under 
330.17 	Minnesota Statutes, section 119B.03. The 
330.18 	commissioner shall ensure that all child 
330.19 	care and development funds are expended 
330.20 	according to the federal child care and 
330.21 	development fund regulations.

330.22	(e) Child Care Development Grants
		1,487,000
		1,487,000
	
330.23 	Family, Friend, and Neighbor Grants. 
330.24 	 $375,000 in fiscal year 2010 and $375,000 
330.25 	in fiscal year 2011 are appropriated from 
330.26 	the federal child care development fund 
330.27 	required quality set-aside from the American 
330.28 	Recovery and Reinvestment Act of 2009, 
330.29 	Public Law 111-5, funds to the commissioner 
330.30 	consistent with federal regulations for the 
330.31 	purpose of the family, friend, and neighbor 
330.32 	grant program under Minnesota Statutes, 
330.33 	section 119B.232. 
330.34 	Quality Rating System.  (a) $633,000 in 
330.35 	fiscal year 2010 and $633,000 in fiscal year 
331.1 	2011 are appropriated from the federal child 
331.2 	care development fund required quality 
331.3 	set-aside from the American Recovery and 
331.4 	Reinvestment Act of 2009, Public Law 
331.5 	111-5, funds to the commissioner consistent 
331.6 	with federal regulations for the purpose 
331.7 	of providing grants to provide statewide 
331.8 	provider training to prepare for the Parent 
331.9 	Aware quality star rating system.
331.10 	(b) For the biennium beginning July 1, 
331.11 	2009, $1,384,000 is appropriated from the 
331.12 	federal child care development fund required 
331.13 	quality set-aside from American Recovery 
331.14 	and Reinvestment Act of 2009, Public Law 
331.15 	111-5, funds to the commissioner of human 
331.16 	services consistent with federal regulations 
331.17 	for the purpose of implementing the Parent 
331.18 	Aware quality star rating system pilot in 
331.19 	coordination with the Minnesota Early 
331.20 	Learning Foundation. These funds must be 
331.21 	spent on ratings and evaluations of the Parent 
331.22 	Aware quality star rating system. These 
331.23 	funds must be spent on implementation of 
331.24 	the Parent Aware quality ratings and may not 
331.25 	be used for scholarships or administrative 
331.26 	operations of that organization.

331.27	(f) Child Support Enforcement Grants
		3,705,000
		3,705,000

331.28	(g) Children's Services Grants

331.29	Appropriations by Fund
	
331.30	General
	 47,533,000
	50,498,000
	
331.31	Federal TANF
	340,000
	240,000
	
331.32 	Base Adjustment. The general fund base is 
331.33 	decreased by $5,371,000 in fiscal year 2012 
331.34 	and increased $8,737,000 in fiscal year 2013.
332.1 	Privatized Adoption Grants. Federal 
332.2 	reimbursement for privatized adoption grant 
332.3 	and foster care recruitment grant expenditures 
332.4 	is appropriated to the commissioner for 
332.5 	adoption grants and foster care and adoption 
332.6 	administrative purposes.
332.7 	Adoption Assistance Incentive Grants.
332.8 	Federal funds available during fiscal year 
332.9 	2010 and fiscal year 2011 for the adoption 
332.10 	incentive grants are appropriated to the 
332.11 	commissioner for these purposes.
332.12 	Adoption Assistance and Relative Custody 
332.13 	Assistance. The commissioner may transfer 
332.14 	unencumbered appropriation balances for 
332.15 	adoption assistance and relative custody 
332.16 	assistance between fiscal years and between 
332.17 	programs.

332.18	(h) Children and Community Services Grants
		67,604,000
		67,463,000
	
332.19 	Targeted Case Management Temporary 
332.20 	Funding Adjustment. The commissioner 
332.21 	shall recover from each county and tribe 
332.22 	receiving a targeted case management 
332.23 	temporary funding payment in fiscal year 
332.24 	2008 an amount equal to that payment. The 
332.25 	commissioner shall recover one-half of the 
332.26 	funds by February 1, 2010, and the remainder 
332.27 	by February 1, 2011. At the commissioner's 
332.28 	discretion and at the request of a county 
332.29 	or tribe, the commissioner may revise 
332.30 	the payment schedule, but full payment 
332.31 	must not be delayed beyond May 1, 2011. 
332.32 	The commissioner may use the recovery 
332.33 	procedure under Minnesota Statutes, section 
332.34 	256.017, to recover the funds. Recovered 
333.1 	funds must be deposited into the general 
333.2 	fund.

333.3	(i) General Assistance Grants
		48,215,000
		48,608,000
	
333.4 	General Assistance Standard. The 
333.5 	commissioner shall set the monthly standard 
333.6 	of assistance for general assistance units 
333.7 	consisting of an adult recipient who is 
333.8 	childless and unmarried or living apart 
333.9 	from parents or a legal guardian at $203. 
333.10 	The commissioner may reduce this amount 
333.11 	according to Laws 1997, chapter 85, article 
333.12 	3, section 54.
333.13 	Emergency General Assistance. The 
333.14 	amount appropriated for emergency general 
333.15 	assistance funds is limited to no more 
333.16 	than $7,889,812 in fiscal year 2010 and 
333.17 	$7,889,812 in fiscal year 2011. Funds 
333.18 	to counties must be allocated by the 
333.19 	commissioner using the allocation method 
333.20 	specified in Minnesota Statutes, section 
333.21 	256D.06.

333.22	(j) Minnesota Supplemental Aid Grants
		 33,930,000
		35,191,000
	
333.23 	Emergency Minnesota Supplemental 
333.24 	Aid Funds. The amount appropriated for 
333.25 	emergency Minnesota supplemental aid 
333.26 	funds is limited to no more than $1,100,000 
333.27 	in fiscal year 2010 and $1,100,000 in fiscal 
333.28 	year 2011. Funds to counties must be 
333.29 	allocated by the commissioner using the 
333.30 	allocation method specified in Minnesota 
333.31 	Statutes, section 256D.46.

333.32	(k) Group Residential Housing Grants
		 111,689,000
		113,937,000

333.33	(l) Children's Mental Health Grants
		16,885,000
		16,882,000
	
334.1 	Funding Usage. Up to 75 percent of a fiscal 
334.2 	year's appropriation for children's mental 
334.3 	health grants may be used to fund allocations 
334.4 	in that portion of the fiscal year ending 
334.5 	December 31.

334.6
334.7	(m) Other Children and Economic Assistance 
Grants
		 16,029,000
		 13,859,000
	
334.8 	Base Adjustment. The general fund base is 
334.9 	increased by $2,324,000 in fiscal year 2012 
334.10 	and $2,324,000 in fiscal year 2013.
334.11 	Temporary Community Action Grants 
334.12 	Reduction. The community action grants 
334.13 	appropriation is reduced by $1,964,000 in 
334.14 	fiscal year 2011. This is a onetime reduction.
334.15 	ARRA Homeless Youth Funds. To the 
334.16 	extent permitted under federal law, the 
334.17 	commissioner shall delegate $2,500,000 
334.18 	of the Homeless Prevention and Rapid 
334.19 	Re-Housing Program funds provided under 
334.20 	the American Recovery and Reinvestment 
334.21 	Act of 2009, Public Law 111-5, for agencies 
334.22 	providing homelessness prevention and rapid 
334.23 	rehousing services to youth.
334.24 	Senior Nutrition Program Funding. For 
334.25 	state fiscal year 2010, the commissioner 
334.26 	shall expend economic stimulus funding and 
334.27 	federal funding for senior nutrition programs 
334.28 	before expending state funds.
334.29 	Long-Term Homeless Supportive 
334.30 	Service Fund Appropriation. To the 
334.31 	extent permitted under federal law, the 
334.32 	commissioner shall designate $3,000,000 
334.33 	of the Homelessness Prevention and Rapid 
334.34 	Re-Housing Program funds provided under 
334.35 	the American Recovery and Reinvestment 
335.1 	Act of 2009, Public Law, 111-5, to the 
335.2 	long-term homeless service fund under 
335.3 	Minnesota Statutes, section 256K.26. This 
335.4 	appropriation shall become available by July 
335.5 	1, 2009. This paragraph is effective the day 
335.6 	following final enactment.

335.7
335.8	Subd. 5.Children and Economic Assistance 
Management
 					
335.9 	The amounts that may be spent from the 
335.10 	appropriation for each purpose are as follows:

335.11
335.12	(a) Children and Economic Assistance 
Administration

335.13	Appropriations by Fund
	
335.14	General
	10,318,000
	10,308,000
	
335.15	Federal TANF
	496,000
	496,000
	
335.16 	Base Adjustment. The federal TANF base 
335.17 	is increased by $700,000 in fiscal year 2012 
335.18 	and in fiscal year 2013.

335.19
335.20	(b) Children and Economic Assistance 
Operations

335.21	Appropriations by Fund
	
335.22	General
	 648,000
	33,423,000
	
335.23	Health Care Access
	361,000
	361,000
	
335.24 	Financial Institution Data Match and 
335.25 	Payment of Fees. The commissioner is 
335.26 	authorized to allocate up to $310,000 each 
335.27 	year in fiscal years 2010 and 2011 from the 
335.28 	PRISM special revenue account to make 
335.29 	payments to financial institutions in exchange 
335.30 	for performing data matches between account 
335.31 	information held by financial institutions 
335.32 	and the public authority's database of child 
335.33 	support obligors as authorized by Minnesota 
335.34 	Statutes, section 13B.06, subdivision 7.
336.1 	Use of Federal Stabilization Funds. Of 
336.2 	this appropriation, $33,000,000 in fiscal year 
336.3 	2010 is from the fiscal stabilization account 
336.4 	in the federal fund to the commissioner. 
336.5 	This appropriation must not be used for 
336.6 	any activity or service for which federal 
336.7 	reimbursement is claimed. This is a onetime 
336.8 	appropriation.

336.9	Subd. 6.Basic Health Care Grants
 					
336.10 	The amounts that may be spent from this 
336.11 	appropriation for each purpose are as follows:

336.12	(a) MinnesotaCare Grants
		 401,842,000
		 478,494,000
	
336.13 	This appropriation is from the health care 
336.14 	access fund.

336.15
336.16	(b) Medical Assistance Basic Health Care 
Grants - Families and Children
		 752,266,000 
		 956,938,000
	
336.17 	Capitation Payments. Effective from 
336.18 	July 1, 2009, to December 31, 2010, 
336.19 	notwithstanding the provisions of Minnesota 
336.20 	Statutes 2008, section 256B.19, subdivision 
336.21 	1c, paragraph (c), the commissioner shall 
336.22 	increase capitation payments made to the 
336.23 	Metropolitan Health Plan under Minnesota 
336.24 	Statutes 2008, section 256B.69, by 
336.25 	$6,800,000 to recognize higher than average 
336.26 	medical education costs. The increased 
336.27 	amount includes federal matching funds.
336.28 	Use of Savings. Any savings derived 
336.29 	from implementation of the prohibition in 
336.30 	Minnesota Statutes, section 256B.032, on the 
336.31 	enrollment of low-quality, high-cost health 
336.32 	care providers as vendors of state health care 
336.33 	program services shall be used to offset on a 
336.34 	pro rata basis the reimbursement reductions 
337.1 	for basic care services in Minnesota Statutes, 
337.2 	section 256B.766.

337.3
337.4	(c) Medical Assistance Basic Health Care 
Grants - Elderly and Disabled
		 970,156,000 
		 1,134,407,000
	
337.5 	Minnesota Disability Health Options. 
337.6 	Notwithstanding Minnesota Statutes, section 
337.7 	256B.69, subdivision 5a, paragraph (b), for 
337.8 	the period beginning July 1, 2009, to June 
337.9 	30, 2011, the monthly enrollment of persons 
337.10 	receiving home and community-based 
337.11 	waivered services under Minnesota 
337.12 	Disability Health Options shall not exceed 
337.13 	1,000. If the budget neutrality provision 
337.14 	in Minnesota Statutes, section 256B.69, 
337.15 	subdivision 23, paragraph (f), is reached 
337.16 	prior to June 30, 2011, the commissioner may 
337.17 	waive this monthly enrollment requirement.
337.18 	Hospital Fee-for-Service Payment Delay.
337.19 	Payments from the Medicaid Management 
337.20 	Information System that would otherwise 
337.21 	have been made for inpatient hospital 
337.22 	services for Minnesota health care program 
337.23 	enrollees must be delayed as follows: for 
337.24 	fiscal year 2011, the payments in the month 
337.25 	of June must be included in the first payment 
337.26 	of fiscal year 2012, and for fiscal year 2013, 
337.27 	the payments in the month of June must 
337.28 	be included in the first payment of fiscal 
337.29 	year 2013. The provisions of Minnesota 
337.30 	Statutes, section 16A.124, do not apply to 
337.31 	these delayed payments. Notwithstanding 
337.32 	any contrary provision in this article, this 
337.33 	paragraph expires December 31, 2013.
337.34 	Nonhospital Fee-for-Service Payment 
337.35 	Delay. Payments from the Medicaid 
337.36 	Management Information System that would 
338.1 	otherwise have been made for nonhospital 
338.2 	acute care services for Minnesota health 
338.3 	care program enrollees must be delayed as 
338.4 	follows: the last payment for fiscal year 2011 
338.5 	must be included in the first payment for 
338.6 	fiscal year 2012, and the last payment for 
338.7 	fiscal year 2013 must be included in the first 
338.8 	payment for fiscal year 2014. This payment 
338.9 	delay must not include nursing facilities, 
338.10 	intermediate care facilities for persons 
338.11 	with developmental disabilities, home and 
338.12 	community-based services, prepaid health 
338.13 	plans, personal care provider organizations, 
338.14 	and home health agencies. The provisions 
338.15 	of Minnesota Statutes, section 16A.124, 
338.16 	do not apply to these delayed payments. 
338.17 	Notwithstanding any contrary provision in 
338.18 	this article, this paragraph expires December 
338.19 	31, 2013.

338.20	(d) General Assistance Medical Care Grants
		 344,430,000
		372,982,000

338.21	(e) Other Health Care Grants

338.22	Appropriations by Fund
	
338.23	General
	295,000
	295,000
	
338.24	Health Care Access
	940,000
	940,000
	
338.25 	Community-Based Health Care 
338.26 	Demonstration Project. Notwithstanding 
338.27 	the provisions of Laws 2007, chapter 147, 
338.28 	article 19, section 3, subdivision 6, paragraph 
338.29 	(e), base level funding to be transferred to the 
338.30 	commissioner of health for the demonstration 
338.31 	project grant described in Minnesota Statutes, 
338.32 	section 62Q.80, subdivision 1a, shall be zero 
338.33 	for fiscal years 2010, 2011, and 2012.

338.34	Subd. 7.Health Care Management
 					
339.1 	The amounts that may be spent from the 
339.2 	appropriation for each purpose are as follows:

339.3	(a) Health Care Administration

339.4	Appropriations by Fund
	
339.5	General
	 8,571,000
	8,567,000
	
339.6	Health Care Access
	 1,089,000
	906,000
	
339.7 	Medical Education Research Costs. In 
339.8 	fiscal year 2010, $38,000,000 is appropriated 
339.9 	from the general fund to the commissioner 
339.10 	to restore the fiscal year 2009 unallotment 
339.11 	of the transfers under Minnesota Statutes, 
339.12 	section 256B.69, subdivision 5c, paragraph 
339.13 	(a), for the July 1, 2008, through June 30, 
339.14 	2009, period. The commissioner shall 
339.15 	transfer $38,000,000 in fiscal year 2010 to 
339.16 	the medical education research fund.
339.17 	Base Adjustment. The general fund base is 
339.18 	increased by $40,000 in fiscal year 2012 and 
339.19 	$65,000 in fiscal year 2013. 

339.20	(b) Health Care Operations

339.21	Appropriations by Fund
	
339.22	General
	 9,971,000
	 8,942,000
	
339.23	Health Care Access
	 24,487,000
	25,613,000
	
339.24 	Base Adjustment. The health care access 
339.25 	fund base is increased by $1,434,000 in 
339.26 	fiscal year 2012 and $2,153,000 in fiscal year 
339.27 	2013. The general fund base is decreased by 
339.28 	$237,000 in fiscal year 2012 and $237,000 in 
339.29 	fiscal year 2013.

339.30	Subd. 8.Continuing Care Grants
 					
339.31 	The amounts that may be spent from the 
339.32 	appropriation for each purpose are as follows:

339.33	(a) Aging and Adult Services Grants
		 13,975,000
		15,290,000
	
340.1 	Base Adjustment. The general fund base is 
340.2 	increased by $6,748,000 in fiscal year 2012 
340.3 	and $6,702,000 in fiscal year 2013.
340.4 	Information and Assistance 
340.5 	Reimbursement. Federal administrative 
340.6 	reimbursement obtained from information 
340.7 	and assistance services provided by the 
340.8 	Senior LinkAge or Disability Linkage lines 
340.9 	to people who are identified as eligible for 
340.10 	medical assistance shall be appropriated to 
340.11 	the commissioner for this activity.
340.12 	Community Service Development Grant 
340.13 	Reduction. Funding for community service 
340.14 	development grants must be reduced by 
340.15 	$240,000 per year for fiscal years 2010 and 
340.16 	2011. This reduction shall not adjust the base 
340.17 	appropriation.

340.18	(b) Alternative Care Grants
		 50,100,000 
		48,394,000
	
340.19 	Base Adjustment. The general fund base is 
340.20 	decreased by $3,619,000 in fiscal year 2012 
340.21 	and $3,503,000 in fiscal year 2013.
340.22 	Alternative Care Transfer. Any money 
340.23 	allocated to the alternative care program that 
340.24 	is not spent for the purposes indicated does 
340.25 	not cancel but must be transferred to the 
340.26 	medical assistance account.

340.27
340.28	(c) Medical Assistance Grants; Long-Term 
Care Facilities.
		 364,352,000
		 416,483,000

340.29
340.30	(d) Medical Assistance Long-Term Care 
Waivers and Home Care Grants
		 848,065,000
		 1,025,510,000
	
340.31 	Manage Growth in TBI and CADI 
340.32 	Waivers. During the fiscal years beginning 
340.33 	on July 1, 2009, and July 1, 2010, the 
340.34 	commissioner shall allocate money for home 
340.35 	and community-based waiver programs 
341.1 	under Minnesota Statutes, section 256B.49, 
341.2 	to ensure a reduction in state spending that is 
341.3 	equivalent to limiting the caseload growth of 
341.4 	the TBI waiver to 12.5 allocations per month 
341.5 	each year of the biennium and the CADI 
341.6 	waiver to 95 allocations per month each year 
341.7 	of the biennium. Limits do not apply: (1) 
341.8 	when there is an approved plan for nursing 
341.9 	facility bed closures for individuals under 
341.10 	age 65 who require relocation due to the 
341.11 	bed closure; (2) to fiscal year 2009 waiver 
341.12 	allocations delayed due to unallotment; or (3) 
341.13 	to transfers authorized by the commissioner 
341.14 	from the personal care assistance program 
341.15 	of individuals having a home care rating 
341.16 	of "CS," "MT," or "HL." Priorities for the 
341.17 	allocation of funds must be for individuals 
341.18 	anticipated to be discharged from institutional 
341.19 	settings or who are at imminent risk of a 
341.20 	placement in an institutional setting.
341.21 	Manage Growth in DD Waiver. The 
341.22 	commissioner shall manage the growth in 
341.23 	the DD waiver by limiting the allocations 
341.24 	included in the February 2009 forecast to 15 
341.25 	additional diversion allocations each month 
341.26 	for the calendar years that begin on January 
341.27 	1, 2010, and January 1, 2011. Additional 
341.28 	allocations must be made available for 
341.29 	transfers authorized by the commissioner 
341.30 	from the personal care program of individuals 
341.31 	having a home care rating of "CS," "MT," 
341.32 	or "HL."
341.33 	Adjustment to Lead Agency Waiver 
341.34 	allocations. Prior to the availability of the 
341.35 	alternative license defined in Minnesota 
341.36 	Statutes, section 245A.11, subdivision 8, 
342.1 	the commissioner shall reduce lead agency 
342.2 	waiver allocations for the purposes of 
342.3 	implementing a moratorium on corporate 
342.4 	foster care.
342.5 	Alternatives to Personal Care Assistance 
342.6 	Services. In fiscal year 2012, base level 
342.7 	funding shall be $8,093,000 to implement 
342.8 	alternative services to personal care 
342.9 	assistance services for persons with mental 
342.10 	health and other behavioral challenges 
342.11 	who can benefit from other services that 
342.12 	more appropriately meet their needs and 
342.13 	assist them in living independently in the 
342.14 	community. These services may include, but 
342.15 	not be limited to, a 1915(i) state plan option.

342.16	(e) Mental Health Grants

342.17	Appropriations by Fund
	
342.18	General
	 77,739,000
	 77,739,000
	
342.19	Health Care Access
	750,000
	750,000
	
342.20	Lottery Prize
	1,508,000
	1,508,000
	
342.21 	Funding Usage. Up to 75 percent of a fiscal 
342.22 	year's appropriation for adult mental health 
342.23 	grants may be used to fund allocations in that 
342.24 	portion of the fiscal year ending December 
342.25 	31.

342.26	(f) Deaf and Hard-of-Hearing Grants
		1,924,000
		1,909,000

342.27	(g) Chemical Dependency Entitlement Grants
		 110,415,000
		 121,997,000
	
342.28 	Chemical Dependency Maximum Rates.
342.29 	Chemical dependency rates for providers 
342.30 	under Minnesota Statutes, chapter 254B, 
342.31 	effective from January 1, 2010, to June 30, 
342.32 	2013, must not exceed 185 percent of the 
342.33 	average rate on January 1, 2009, for each 
342.34 	group of vendors with similar attributes. 
342.35 	Payment for services provided by Indian 
343.1 	Health Services or by agencies operated by 
343.2 	Indian tribes for medical assistance-eligible 
343.3 	individuals must be governed by the 
343.4 	applicable federal rate methodology.
343.5 	Chemical Dependency Special Revenue 
343.6 	Account. For fiscal year 2010, $750,000 
343.7 	must be transferred from the consolidated 
343.8 	chemical dependency treatment fund 
343.9 	administrative account and deposited into the 
343.10 	general fund.

343.11
343.12	(h) Chemical Dependency Nonentitlement 
Grants
		1,729,000
		1,729,000
	
343.13 	Base Adjustment. The general fund base is 
343.14 	decreased $3,000 in fiscal year 2012 and in 
343.15 	fiscal year 2013.

343.16	(i) Other Continuing Care Grants
		19,095,000
		17,388,000
	
343.17 	Base Adjustment. The general fund base is 
343.18 	increased $7,487,000 in fiscal year 2012 and 
343.19 	decreased $1,019,000 in fiscal year 2013.
343.20 	Technology Grants. $650,000 in fiscal 
343.21 	year 2010 and $1,000,000 in fiscal year 
343.22 	2011 are for technology grants, case 
343.23 	consultation, evaluation, and consumer 
343.24 	information grants related to developing and 
343.25 	supporting alternatives to shift-staff foster 
343.26 	care residential service models.
343.27 	Other Continuing Care Grants; HIV 
343.28 	Grants. Money appropriated for the HIV 
343.29 	drug and insurance grant program in fiscal 
343.30 	year 2010 may be used in either year of the 
343.31 	biennium.

343.32	Subd. 9.Continuing Care Management

343.33	Appropriations by Fund
	
343.34	General
	24,640,000
	25,285,000
	
344.1
344.2	State Government 
Special Revenue
	125,000
	125,000
	
344.3	Lottery Prize
	157,000
	157,000
	
344.4 	Base Adjustment.  The general fund base is 
344.5 	decreased $2,632,000 in fiscal year 2012 and 
344.6 	$2,654,000 in fiscal year 2013.

344.7	Subd. 10.State-Operated Services
 					
344.8 	The amounts that may be spent from the 
344.9 	appropriation for each purpose are as follows:
344.10 	Transfer Authority Related to 
344.11 	State-Operated Services. Money 
344.12 	appropriated to finance state-operated 
344.13 	services may be transferred between the 
344.14 	fiscal years of the biennium with the approval 
344.15 	of the commissioner of finance.
344.16 	County Past Due Receivables. The 
344.17 	commissioner is authorized to withhold 
344.18 	county federal administrative reimbursement 
344.19 	when the county of financial responsibility 
344.20 	for cost-of-care payments due the state 
344.21 	under Minnesota Statutes, section 246.54 
344.22 	or 253B.045, is 90 days past due. The 
344.23 	commissioner shall deposit the withheld 
344.24 	federal administrative earnings for the county 
344.25 	into the general fund to settle the claims with 
344.26 	the county of financial responsibility. The 
344.27 	process for withholding funds is governed by 
344.28 	Minnesota Statutes, section 256.017.
344.29 	Forecast and Census Data. The 
344.30 	commissioner shall include forecast and 
344.31 	census data for state-operated services and 
344.32 	Minnesota sex offender services with the 
344.33 	November and February budget forecasts. 
344.34 	Notwithstanding any contrary provision in 
344.35 	this article, this paragraph shall not expire.

345.1	(a) Adult Mental Health Services
		 100,508,000
		99,808,000
	
345.2 	Appropriation Limitation. No part of 
345.3 	the appropriation in this article to the 
345.4 	commissioner for mental health treatment 
345.5 	services provided by state-operated services 
345.6 	shall be used for the Minnesota sex offender 
345.7 	program.
345.8 	Community Behavioral Health Hospitals.
345.9 	Under Minnesota Statutes, section 246.51, 
345.10 	subdivision 1, a determination order for the 
345.11 	clients served in a community behavioral 
345.12 	health hospital operated by the commissioner 
345.13 	of human services is only required when 
345.14 	a client's third-party coverage has been 
345.15 	exhausted.
345.16 	Base Adjustment. The general fund base is 
345.17 	decreased by $500,000 for fiscal year 2012 
345.18 	and by $500,000 for fiscal year 2013.

345.19
345.20	(b) Minnesota Security Hospital and Minnesota 
Extended Treatment Option Services
		19,750,000
		83,735,000
	
345.21 	Minnesota Security Hospital.  For the 
345.22 	purposes of enhancing the safety of 
345.23 	the public, improving supervision, and 
345.24 	enhancing community-based mental health 
345.25 	treatment, state-operated services may 
345.26 	establish additional community capacity 
345.27 	for providing treatment and supervision 
345.28 	of clients who have been ordered into a 
345.29 	less restrictive alternative of care from the 
345.30 	state-operated services transitional services 
345.31 	program consistent with Minnesota Statutes, 
345.32 	section 246.014.
345.33 	Use of Federal Stabilization Funds. Of 
345.34 	this appropriation, $63,985,000 in fiscal year 
345.35 	2010 is from the fiscal stabilization account 
346.1 	in the federal fund to the commissioner. 
346.2 	This appropriation must not be used for 
346.3 	any activity or service for which federal 
346.4 	reimbursement is claimed. This is a onetime 
346.5 	appropriation.

346.6	(c) Minnesota Sex Offender Services
		46,008,000
		59,436,000
	
346.7 	Base Adjustment. The general fund base is 
346.8 	decreased by $5,525,000 for fiscal year 2012 
346.9 	and by $7,232,000 for fiscal year 2013.
346.10 	Incarcerated Offenders. Base level 
346.11 	funding for Minnesota sex offender services 
346.12 	is reduced by $836,500 each year of the 
346.13 	biennium for the 50-bed sex offender 
346.14 	treatment program within the Moose Lake 
346.15 	correctional facility in which Department of 
346.16 	Human Services staff from Minnesota sex 
346.17 	offender services provide clinical treatment 
346.18 	to incarcerated offenders. The commissioner 
346.19 	of corrections shall transfer $836,500 per 
346.20 	year of the biennium to the commissioner of 
346.21 	human services for the program under this 
346.22 	paragraph.
346.23 	Use of Federal Stabilization Funds. Of 
346.24 	this appropriation, $16,000,000 in fiscal year 
346.25 	2010 is from the fiscal stabilization account 
346.26 	in the federal fund to the commissioner. 
346.27 	This appropriation must not be used for 
346.28 	any activity or service for which federal 
346.29 	reimbursement is claimed. This is a onetime 
346.30 	appropriation.

346.31	Sec. 4. COMMISSIONER OF HEALTH

346.32	Subdivision 1.Total Appropriation
 	$
	163,397,000
	$
	160,917,000

346.33	Appropriations by Fund
	
346.34		2010
	2011
	
347.1	General
	68,291,000
	62,800,000
	
347.2
347.3	State Government 
Special Revenue
	45,545,000
	45,575,000
	
347.4	Health Care Access
	37,828,000
	40,809,000
	
347.5	Federal TANF
	11,733,000
	11,733,000

347.6	Subd. 2.Community and Family Health

347.7	Appropriations by Fund
	
347.8	General
	44,714,000
	39,387,000
	
347.9347.10
	State Government 
Special Revenue
	1,033,000
	1,033,000
	
347.11	Health Care Access
	21,642,000
	28,719,000
	
347.12	Federal TANF
	11,733,000
	11,733,000
	
347.13 	Funding Usage. Up to 75 percent of the 
347.14 	fiscal year 2012 appropriation for local public 
347.15 	health grants may be used to fund calendar 
347.16 	year 2011 allocations for this program. The 
347.17 	general fund reduction of $5,193,000 in 
347.18 	fiscal year 2011 for local public health grants 
347.19 	is onetime and the base funding for local 
347.20 	public health grants for fiscal year 2012 is 
347.21 	increased by $5,193,000.
347.22 	TANF Appropriations. (1) $1,156,000 of 
347.23 	the TANF funds are appropriated each year to 
347.24 	the commissioner for family planning grants 
347.25 	under Minnesota Statutes, section 145.925.
347.26 	(2) $3,579,000 of the TANF funds are 
347.27 	appropriated each year to the commissioner 
347.28 	for home visiting and nutritional services 
347.29 	listed under Minnesota Statutes, section 
347.30 	145.882, subdivision 7, clauses (6) and (7). 
347.31 	Funds must be distributed to community 
347.32 	health boards according to Minnesota 
347.33 	Statutes, section 145A.131, subdivision 1.
347.34 	(3) $2,000,000 of the TANF funds are 
347.35 	appropriated each year to the commissioner 
347.36 	for decreasing racial and ethnic disparities 
348.1 	in infant mortality rates under Minnesota 
348.2 	Statutes, section 145.928, subdivision 7.
348.3 	(4) $4,998,000 of the TANF funds are 
348.4 	appropriated each year to the commissioner 
348.5 	for the family home visiting grant program 
348.6 	according to Minnesota Statutes, section 
348.7 	145A.17. $4,000,000 of the funding must 
348.8 	be distributed to community health boards 
348.9 	according to Minnesota Statutes, section 
348.10 	145A.131, subdivision 1. $998,000 of 
348.11 	the funding must be distributed to tribal 
348.12 	governments based on Minnesota Statutes, 
348.13 	section 145A.14, subdivision 2a. The 
348.14 	commissioner may use five percent of 
348.15 	the funds appropriated each fiscal year to 
348.16 	conduct the ongoing evaluations required 
348.17 	under Minnesota Statutes, section 145A.17, 
348.18 	subdivision 7, and may use ten percent of 
348.19 	the funds appropriated each fiscal year to 
348.20 	provide training and technical assistance as 
348.21 	required under Minnesota Statutes, section 
348.22 	145A.17, subdivisions 4 and 5.
348.23 	Base Adjustment. The general fund base 
348.24 	is increased by $10,286,000 for fiscal year 
348.25 	2012 and increased by $5,093,000 for fiscal 
348.26 	year 2013.
348.27 	TANF Carryforward. Any unexpended 
348.28 	balance of the TANF appropriation in the 
348.29 	first year of the biennium does not cancel but 
348.30 	is available for the second year.

348.31	Subd. 3.Policy Quality and Compliance

348.32	Appropriations by Fund
	
348.33	General
	6,857,000
	6,693,000
	
348.34
348.35	State Government 
Special Revenue
	14,173,000
	14,214,000
	
348.36	Health Care Access
	16,186,000
	12,090,000
	
349.1 	Medical Education and Research Cost 
349.2 	Federal Compliance. Notwithstanding 
349.3 	Laws 2008, chapter 363, article 18, section 
349.4 	4, subdivision 3, the base level funding 
349.5 	for the commissioner to distribute to the 
349.6 	Mayo Clinic for transitional funding while 
349.7 	federal compliance changes are made to the 
349.8 	medical education and research cost funding 
349.9 	distribution formula shall be $0 for fiscal 
349.10 	years 2010 and 2011.
349.11 	Autism Clinical Research. The 
349.12 	commissioner, in partnership with a 
349.13 	Minnesota research institution, shall apply 
349.14 	for funds available for research grants under 
349.15 	the American Recovery and Reinvestment 
349.16 	Act (ARRA) of 2009 in order to expand 
349.17 	research and treatment of autism spectrum 
349.18 	disorders.
349.19 	State Loan Repayment Program. In 
349.20 	appropriating the federal stimulus funds, 
349.21 	the commissioner shall give priority in the 
349.22 	distribution of these funds, to the extent 
349.23 	possible under federal requirements to 
349.24 	midlevel mental health practitioners who 
349.25 	practice in the areas of pediatric psychiatry 
349.26 	or mental health.
349.27 	Birthing Centers. (a) Of the general fund 
349.28 	appropriation, $164,000 in fiscal year 2010 is 
349.29 	to the commissioner for rulemaking activities 
349.30 	for birthing centers. This is a onetime 
349.31 	appropriation.
349.32 	(b) Of the state government special revenue 
349.33 	fund appropriation, $41,000 in fiscal year 
349.34 	2011 is to the commissioner for the birthing 
349.35 	center licensure regulatory requirement 
350.1 	under Minnesota Statutes, section 144.566. 
350.2 	Base level funding for this activity shall be 
350.3 	$131,000 in fiscal year 2012 and $58,000 
350.4 	beginning in fiscal year 2013.
350.5 	Health Information Technology. Of the 
350.6 	health care access fund appropriation for 
350.7 	fiscal year 2010, $2,800,000 is to fund the 
350.8 	revolving loan account under Minnesota 
350.9 	Statutes, section 62J.496.  This appropriation 
350.10 	must not be expended prior to the expenditure 
350.11 	of $1,200,000 of existing resources in the 
350.12 	revolving account and unless it is matched 
350.13 	with federal funding under the federal Health 
350.14 	Information Technology for Economic and 
350.15 	Clinical Health (HITECH) Act. This is a 
350.16 	onetime appropriation.
350.17 	Base Adjustment. The general fund base is 
350.18 	increased $1,000,000 for each of fiscal years 
350.19 	2012 and 2013. The health care access fund 
350.20 	base is decreased $1,140,000 in fiscal year 
350.21 	2012 and $5,274,000 in fiscal year 2013.

350.22	Subd. 4.Health Protection

350.23	Appropriations by Fund
	
350.24	General
	9,730,000
	9,730,000
	
350.25
350.26	State Government 
Special Revenue
	30,339,000
	30,328,000

350.27	Subd. 5.Administrative Support Services
 		6,990,000
		6,990,000

350.28	Sec. 5. VETERANS AFFAIRS

350.29	Subdivision 1.Total Appropriation
 	$
	68,425,000
	$
	70,584,000

350.30	Subd. 2.Veterans Homes
 		68,425,000
		70,584,000
	
350.31 	Veterans Homes Special Revenue Account.
350.32 	The general fund appropriations made to 
350.33 	the department may be transferred to a 
350.34 	veterans homes special revenue account in 
351.1 	the special revenue fund in the same manner 
351.2 	as other receipts are deposited according 
351.3 	to Minnesota Statutes, section 198.34, and 
351.4 	are appropriated to the department for the 
351.5 	operation of veterans homes facilities and 
351.6 	programs.
351.7 	Base Reduction. Base level funding for each 
351.8 	year of the biennium is reduced by $200,000 
351.9 	to reflect a reduction in the excessive use of 
351.10 	overtime pay for veterans homes employees.
351.11 	Medicare Certification. Of this 
351.12 	appropriation, the following amounts are 
351.13 	to the commissioner in fiscal year 2011 for 
351.14 	the purposes of Medicare certification of 
351.15 	veterans nursing homes under Minnesota 
351.16 	Statutes, section 198.003, subdivision 7:
351.17 	(1) $259,000 to employ one central 
351.18 	reimbursement billing specialist and 3.5 
351.19 	full-time equivalent senior occupational 
351.20 	therapists. This appropriation shall become 
351.21 	part of base level funding; and 
351.22 	(2) $300,000 for billing system software and 
351.23 	systems costs and for training, education, 
351.24 	and implementation costs. This is a onetime 
351.25 	appropriation.
351.26 	Base Adjustment. The general fund base is 
351.27 	decreased by $300,000 for fiscal years 2012 
351.28 	and 2013.

351.29	Sec. 6. HEALTH-RELATED BOARDS

351.30	Subdivision 1.Total Appropriation 
 	$
	15,017,000
	$
	14,831,000
	
351.31 	This appropriation is from the state 
351.32 	government special revenue fund.
352.1 	The amounts that may be spent for each 
352.2 	purpose are specified in the following 
352.3 	subdivisions.
352.4 	Transfer. In fiscal year 2010, $3,000,000 
352.5 	shall be transferred from the state government 
352.6 	special revenue fund to the general fund.

352.7	Subd. 2.Board of Chiropractic Examiners
 		447,000
		447,000

352.8	Subd. 3.Board of Dentistry
 		1,009,000
		1,009,000

352.9352.10
	Subd. 4.Board of Dietetic and Nutrition 
Practice
 		105,000
		105,000

352.11
352.12	Subd. 5.Board of Marriage and Family 
Therapy
 		137,000
		137,000

352.13	Subd. 6.Board of Medical Practice
 		3,674,000
		3,674,000

352.14	Subd. 7.Board of Nursing
 		4,217,000
		4,219,000

352.15
352.16	Subd. 8.Board of Nursing Home 
Administrators
 		1,146,000
		958,000
	
352.17 	Administrative Services Unit - Operating 
352.18 	Costs. Of this appropriation, $524,000 
352.19 	in fiscal year 2010 and $526,000 in 
352.20 	fiscal year 2011 are for operating costs 
352.21 	of the administrative services unit. The 
352.22 	administrative services unit may receive 
352.23 	and expend reimbursements for services 
352.24 	performed by other agencies.
352.25 	Administrative Services Unit - Retirement 
352.26 	Costs. Of this appropriation in fiscal year 
352.27 	2010, $201,000 is for onetime retirement 
352.28 	costs in the health-related boards. This 
352.29 	funding may be transferred to the health 
352.30 	boards incurring those costs for their 
352.31 	payment. These funds are available either 
352.32 	year of the biennium.
352.33 	Administrative Services Unit - Volunteer 
352.34 	Health Care Provider Program. Of this 
353.1 	appropriation, $79,000 in fiscal year 2010 
353.2 	and $89,000 in fiscal year 2011 are to pay 
353.3 	for medical professional liability coverage 
353.4 	required under Minnesota Statutes, section 
353.5 	214.40.
353.6 	Administrative Services Unit - Contested 
353.7 	Cases and Other Legal Proceedings. Of 
353.8 	this appropriation, $200,000 in fiscal year 
353.9 	2010 and $200,000 in fiscal year 2011 
353.10 	are for costs of contested case hearings 
353.11 	and other unanticipated costs of legal 
353.12 	proceedings involving health-related 
353.13 	boards funded under this section. Upon 
353.14 	certification of a health-related board to the 
353.15 	administrative services unit that the costs 
353.16 	will be incurred and that there is insufficient 
353.17 	money available to pay for the costs out of 
353.18 	money currently available to that board, the 
353.19 	administrative services unit is authorized 
353.20 	to transfer money from this appropriation 
353.21 	to the board for payment of those costs 
353.22 	with the approval of the commissioner of 
353.23 	finance. This appropriation does not cancel. 
353.24 	Any unencumbered and unspent balances 
353.25 	remain available for these expenditures in 
353.26 	subsequent fiscal years.

353.27	Subd. 9.Board of Optometry
 		101,000
		101,000

353.28	Subd. 10.Board of Pharmacy
 		1,413,000
		1,413,000

353.29	Subd. 11.Board of Physical Therapy
 		295,000
		295,000

353.30	Subd. 12.Board of Podiatry
 		56,000
		56,000

353.31	Subd. 13.Board of Psychology
 		806,000
		806,000

353.32	Subd. 14.Board of Social Work
 		1,022,000
		1,022,000

353.33	Subd. 15.Board of Veterinary Medicine
 		195,000
		195,000

354.1
354.2	Subd. 16.Board of Behavioral Health and 
Therapy
 		394,000
		394,000

354.3
354.4	Sec. 7. EMERGENCY MEDICAL SERVICES 
REGULATORY BOARD
 	$
	3,828,000
	$
	3,828,000

354.5	Appropriations by Fund
	
354.6		2010
	2011
	
354.7	General
	3,124,000
	3,124,000
	
354.8
354.9	State Government 
Special Revenue
	704,000
	704,000
	
354.10 	Longevity Award and Incentive Program.
354.11 	(a) Of the general fund appropriation, 
354.12 	$700,000 in fiscal year 2010 and $700,000 
354.13 	in fiscal year 2011 are to the board for the 
354.14 	ambulance service personnel longevity award 
354.15 	and incentive program, under Minnesota 
354.16 	Statutes, section 144E.40.
354.17 	(b) In fiscal year 2010, $11,839,000 shall 
354.18 	be transferred from the ambulance service 
354.19 	personnel longevity award and incentive 
354.20 	trust to the general fund.
354.21 	Health Professional Services Program.
354.22 	$704,000 in fiscal year 2010 and $704,000 in 
354.23 	fiscal year 2011 from the state government 
354.24 	special revenue fund are for the health 
354.25 	professional services program.

354.26	Sec. 8. COUNCIL ON DISABILITY
 	$
	498,000
	$
	498,000

354.27
354.28
354.29	Sec. 9. OMBUDSMAN FOR MENTAL 
HEALTH AND DEVELOPMENTAL 
DISABILITIES
 	$
	1,580,000
	$
	1,580,000

354.30	Sec. 10. OMBUDSPERSON FOR FAMILIES
 	$
	251,000
	$
	251,000

354.31 	Sec. 11. TRANSFERS.
 354.32 		Subdivision 1.Grants. The commissioner of human services, with the approval 
354.33 	of the commissioner of finance, and after notification of the chairs of the relevant senate 
355.1 	budget division and house of representatives finance division committee, may transfer 
355.2 	unencumbered appropriation balances for the biennium ending June 30, 2011, within 
355.3 	fiscal years among the MFIP, general assistance, general assistance medical care, medical 
355.4 	assistance, MinnesotaCare, MFIP child care assistance under Minnesota Statutes, section 
355.5 	119B.05, Minnesota supplemental aid, and group residential housing programs, and the 
355.6 	entitlement portion of the chemical dependency consolidated treatment fund, and between 
355.7 	fiscal years of the biennium.
355.8 		Subd. 2.Administration. Positions, salary money, and nonsalary administrative 
355.9 	money may be transferred within the Departments of Human Services and Health as the 
355.10 	commissioners consider necessary, with the advance approval of the commissioner of 
355.11 	finance. The commissioner shall inform the chairs of the relevant house and senate health 
355.12 	committees quarterly about transfers made under this provision.

355.13 	Sec. 12. 2007 AND 2008 APPROPRIATION AMENDMENTS.
 355.14 	(a) Notwithstanding Laws 2007, chapter 147, article 19, section 3, subdivision 4, 
355.15 	paragraph (g), as amended by Laws 2008, chapter 363, article 18, section 7, the TANF 
355.16 	fund base for the Children's Mental Health Pilots is $0 in fiscal year 2011. This paragraph 
355.17 	is effective retroactively from July 1, 2008.
355.18 	(b) The appropriation for patient incentive programs under Laws 2007, chapter 147, 
355.19 	article 19, section 3, subdivision 6, paragraph (e), is canceled. This paragraph is effective 
355.20 	retroactively from July 1, 2007.
355.21 	(c) The onetime general fund base reduction for Child Care Development Grants 
355.22 	under Laws 2008, chapter 363, article 18, section 3, subdivision 4, paragraph (d), is 
355.23 	increased by $4,000. This paragraph is effective retroactively from July 1, 2008.
355.24 	(d) The base for Children Services Grants under Laws 2008, chapter 363, article 18, 
355.25 	section 3, subdivision 4, paragraph (e), is decreased $1,000 in each year of the fiscal year 
355.26 	2010 and 2011 biennium. This paragraph is effective retroactively from July 1, 2008.
355.27 	(e) Notwithstanding Laws 2008, chapter 363, article 18, section 3, subdivision 4, the 
355.28 	general fund base adjustment for Children and Community Services Grants under Laws 
355.29 	2008, chapter 363, article 18, section 3, subdivision 4, paragraph (f), is increased by 
355.30 	$98,000 each year of fiscal years 2010 and 2011. This paragraph is effective retroactively 
355.31 	from July 1, 2008.
355.32 	(f) The base for Other Continuing Care Grants under Laws 2008, chapter 363, article 
355.33 	18, section 3, subdivision 6, paragraph (h), is decreased by $10,000 in fiscal year 2010. 
355.34 	This paragraph is effective retroactively from July 1, 2008.
356.1 	(g) The appropriation for the Community-Based Health Care Demonstration Project 
356.2 	under Minnesota Statutes, section 62Q.80, subdivision 1a, authorized under Laws 2007, 
356.3 	chapter 147, article 19, section 3, subdivision 6, paragraph (e), is canceled. This paragraph 
356.4 	is effective retroactively from July 1, 2007.
356.5 	(h) The appropriation for Section 125 Employer Incentives in Laws 2008, chapter 
356.6 	358, article 5, section 4, subdivision 3, is reduced by $800,000. This paragraph is effective 
356.7 	retroactively from July 1, 2008.

356.8 	Sec. 13. INDIRECT COSTS NOT TO FUND PROGRAMS.
 356.9 	The commissioners of health and human services shall not use indirect cost 
356.10 	allocations to pay for the operational costs of any program for which they are responsible.

356.11 	Sec. 14. EXPIRATION OF UNCODIFIED LANGUAGE.
 356.12 	All uncodified language contained in this article expires on June 30, 2011, unless a 
356.13 	different expiration date is explicit.

356.14 	Sec. 15. EFFECTIVE DATE.
 356.15 	The provisions in this article are effective July 1, 2009, unless a different effective 
356.16 	date is specified.