1.1A bill for an act1.2relating to human services; licensing; state health care programs; continuing 1.3care; children and family services; health reform; public health; assessing 1.4administrative penalties; requiring reports; making supplemental appropriations 1.5and reductions; amending Minnesota Statutes 2008, sections 3.971, subdivision 1.62; 3.98, by adding a subdivision; 62D.08, by adding a subdivision; 62J.07, 1.7subdivision 2, by adding a subdivision; 62J.38; 62Q.19, subdivision 1; 1.862Q.76, subdivision 1; 62U.05; 144.226, subdivision 3; 144.291, subdivision 1.92; 144.651, subdivision 2; 144.9504, by adding a subdivision; 144A.51, 1.10subdivision 5; 144E.37; 245C.27, subdivision 2; 245C.28, subdivision 3; 1.11254B.01, subdivision 2; 254B.02, subdivisions 1, 5; 254B.03, subdivision 4, 1.12by adding a subdivision; 254B.05, subdivision 4; 254B.06, subdivision 2; 1.13254B.09, subdivision 8; 256.01, by adding a subdivision; 256.9657, subdivision 1.143; 256B.04, subdivision 14; 256B.055, by adding a subdivision; 256B.056, 1.15subdivision 4; 256B.057, subdivision 9; 256B.0625, subdivisions 8, 8a, 8b, 1.1618a, 31, by adding subdivisions; 256B.0631, subdivisions 1, 3; 256B.0644, as 1.17amended; 256B.0754, by adding a subdivision; 256B.0915, subdivision 3b; 1.18256B.19, subdivision 1c; 256B.69, subdivisions 20, as amended, 27, by adding 1.19subdivisions; 256B.692, subdivision 1; 256B.75; 256B.76, subdivisions 2, 4, by 1.20adding a subdivision; 256D.0515; 256J.20, subdivision 3; 256J.24, subdivision 1.2110; 256J.37, subdivision 3a; 256L.02, subdivision 3; 256L.03, subdivision 1.223, by adding a subdivision; 256L.05, by adding a subdivision; 256L.07, by 1.23adding a subdivision; 256L.12, subdivisions 5, 6, 9; 626.556, subdivision 1.2410i; 626.557, subdivision 9d; Minnesota Statutes 2009 Supplement, sections 1.2562J.495, subdivisions 1a, 3, by adding a subdivision; 245C.27, subdivision 1; 1.26252.025, subdivision 7; 252.27, subdivision 2a; 256.045, subdivision 3; 256.969, 1.27subdivision 3a; 256B.0625, subdivisions 9, 13e; 256B.0653, subdivision 5; 1.28256B.0915, subdivision 3a; 256B.69, subdivision 23; 256B.76, subdivision 1.291; 256B.766; 256D.03, subdivision 3, as amended; 256J.425, subdivision 3; 1.30256L.03, subdivision 5; 256L.11, subdivision 1; Laws 2009, chapter 79, article 3, 1.31section 18; article 5, section 78, subdivision 5; article 13, section 3, subdivisions 1.321, as amended, 3, as amended, 4, as amended, 8, as amended; Laws 2010, chapter 1.33200, article 1, sections 12, subdivisions 6, 7, 8; 16; 21; article 2, section 2, 1.34subdivisions 1, 8; proposing coding for new law in Minnesota Statutes, chapters 1.3562A; 62D; 62E; 62J; 62Q; 144; 245; 254B; 256; 256B; repealing Minnesota 1.36Statutes 2008, sections 254B.02, subdivisions 2, 3, 4; 254B.09, subdivisions 4, 5, 1.377; 256D.03, subdivisions 3a, 3b, 5, 6, 7, 8; Minnesota Statutes 2009 Supplement, 1.38section 256D.03, subdivision 3; Laws 2009, chapter 79, article 7, section 26, 2.1subdivision 3; Laws 2010, chapter 200, article 1, sections 12, subdivisions 1, 2.22, 3, 4, 5, 6, 7, 8, 9; 18; 19.2.3BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:2.4ARTICLE 12.5DHS LICENSING2.6    Section 1. Minnesota Statutes 2009 Supplement, section 245C.27, subdivision 1, is 2.7amended to read:2.8    Subdivision 1. Fair hearing when disqualification is not set aside rescinded. (a) 2.9If the commissioner does not set aside rescind a disqualification of an individual under 2.10section 
         245C.22 who is disqualified on the basis of a preponderance of evidence that the 2.11individual committed an act or acts that meet the definition of any of the crimes listed in 2.12section 
         245C.15; for a determination under section 
         626.556 or 
         626.557 of substantiated 2.13maltreatment that was serious or recurring under section 
         245C.15; or for failure to make 2.14required reports under section 
         626.556, subdivision 3; or 
         626.557, subdivision 3, pursuant 2.15to section 
         245C.15, subdivision 4, paragraph (b), clause (1), the individual may request 2.16a fair hearing under section 
         256.045, unless the disqualification is deemed conclusive 2.17under section 
         245C.29.2.18    (b) The fair hearing is the only administrative appeal of the final agency 2.19determination for purposes of appeal by the disqualified individual. The disqualified 2.20individual does not have the right to challenge the accuracy and completeness of data 2.21under section 
         13.04.2.22    (c) Except as provided under paragraph (e), if the individual was disqualified based 2.23on a conviction of, admission to, or Alford Plea to any crimes listed in section 
         245C.15, 2.24subdivisions 1 to 4
         , or for a disqualification under section 
         256.98, subdivision 8, the 2.25reconsideration decision under section 
         245C.22 is the final agency determination for 2.26purposes of appeal by the disqualified individual and is not subject to a hearing under 2.27section 
         256.045. If the individual was disqualified based on a judicial determination, that 2.28determination is treated the same as a conviction for purposes of appeal.2.29    (d) This subdivision does not apply to a public employee's appeal of a disqualification 2.30under section 
         245C.28, subdivision 3.2.31    (e) Notwithstanding paragraph (c), if the commissioner does not set aside a 2.32disqualification of an individual who was disqualified based on both a preponderance 2.33of evidence and a conviction or admission, the individual may request a fair hearing 2.34under section 
         256.045, unless the disqualifications are deemed conclusive under section 2.35245C.29
         . The scope of the hearing conducted under section 
         256.045 with regard to the 3.1disqualification based on a conviction or admission shall be limited solely to whether the 3.2individual poses a risk of harm, according to section 
         256.045, subdivision 3b. In this case, 3.3the reconsideration decision under section 
         245C.22 is not the final agency decision for 3.4purposes of appeal by the disqualified individual.3.5    Sec. 2. Minnesota Statutes 2008, section 245C.27, subdivision 2, is amended to read:3.6    Subd. 2. Consolidated fair hearing. (a) If an individual who is disqualified on the 3.7bases of serious or recurring maltreatment requests a fair hearing on the maltreatment 3.8determination under section 
         626.556, subdivision 10i, or 
         626.557, subdivision 9d, and 3.9requests a fair hearing under this section on the disqualification, which has not been 3.10set aside rescinded, the scope of the fair hearing under section 
         256.045 shall include the 3.11maltreatment determination and the disqualification. 3.12(b) A fair hearing is the only administrative appeal of the final agency determination. 3.13The disqualified individual does not have the right to challenge the accuracy and 3.14completeness of data under section 
         13.04. 3.15(c) This subdivision does not apply to a public employee's appeal of a disqualification 3.16under section 
         245C.28, subdivision 3. 3.17    Sec. 3. Minnesota Statutes 2008, section 245C.28, subdivision 3, is amended to read:3.18    Subd. 3. Employees of public employer. (a) If the commissioner does not set 3.19aside rescind the disqualification of an individual who is an employee of an employer, as 3.20defined in section 
         179A.03, subdivision 15, the individual may request a contested case 3.21hearing under chapter 14, unless the disqualification is deemed conclusive under section 3.22245C.29. The request for a contested case hearing must be made in writing and must be 3.23postmarked and sent within 30 calendar days after the employee receives notice that the 3.24disqualification has not been set aside rescinded. If the individual was disqualified based 3.25on a conviction or admission to any crimes listed in section 
         245C.15, the scope of the 3.26contested case hearing shall be limited solely to whether the individual poses a risk of 3.27harm pursuant to section 
         245C.22.3.28(b) If the commissioner does not set aside rescind a disqualification that is based on 3.29a maltreatment determination, the scope of the contested case hearing must include the 3.30maltreatment determination and the disqualification. In such cases, a fair hearing must 3.31not be conducted under section 
         256.045.3.32(c) If the commissioner does not rescind a disqualification that is based on a 3.33preponderance of evidence that the individual committed an act or acts that meet the 3.34definition of any of the crimes listed in section 245C.15, the scope of the contested case 4.1hearing must include the disqualification decision. In such cases, a fair hearing must 4.2not be conducted under section 256.045.4.3(c) (d) Rules adopted under this chapter may not preclude an employee in a contested 4.4case hearing for a disqualification from submitting evidence concerning information 4.5gathered under this chapter.4.6(d) (e) When an individual has been disqualified from multiple licensed programs 4.7and the disqualifications have not been set aside rescinded under section 
         245C.22, if at 4.8least one of the disqualifications entitles the person to a contested case hearing under this 4.9subdivision, the scope of the contested case hearing shall include all disqualifications from 4.10licensed programs which were not set aside rescinded.4.11(e) (f) In determining whether the disqualification should be set aside, the 4.12administrative law judge shall consider all of the characteristics that cause the individual 4.13to be disqualified in order to determine whether the individual poses a risk of harm. The 4.14administrative law judge's recommendation and the commissioner's order to set aside 4.15a disqualification that is the subject of the hearing constitutes a determination that the 4.16individual does not pose a risk of harm and that the individual may provide direct contact 4.17services in the individual program specified in the set aside.4.18    Sec. 4. Minnesota Statutes 2009 Supplement, section 256.045, subdivision 3, is 4.19amended to read:4.20    Subd. 3. State agency hearings. (a) State agency hearings are available for the 4.21following:4.22    (1) any person applying for, receiving or having received public assistance, medical 4.23care, or a program of social services granted by the state agency or a county agency or 4.24the federal Food Stamp Act whose application for assistance is denied, not acted upon 4.25with reasonable promptness, or whose assistance is suspended, reduced, terminated, or 4.26claimed to have been incorrectly paid;4.27    (2) any patient or relative aggrieved by an order of the commissioner under section 4.28252.27
         ;4.29    (3) a party aggrieved by a ruling of a prepaid health plan;4.30    (4) except as provided under chapter 245C, any individual or facility determined by 4.31a lead agency to have maltreated a vulnerable adult under section 
         626.557 after they have 4.32exercised their right to administrative reconsideration under section 
         626.557;4.33    (5) any person whose claim for foster care payment according to a placement of the 4.34child resulting from a child protection assessment under section 
         626.556 is denied or not 4.35acted upon with reasonable promptness, regardless of funding source;5.1    (6) any person to whom a right of appeal according to this section is given by other 5.2provision of law;5.3    (7) an applicant aggrieved by an adverse decision to an application for a hardship 5.4waiver under section 
         256B.15;5.5    (8) an applicant aggrieved by an adverse decision to an application or redetermination 5.6for a Medicare Part D prescription drug subsidy under section 
         256B.04, subdivision 4a;5.7    (9) except as provided under chapter 245A, an individual or facility determined 5.8to have maltreated a minor under section 
         626.556, after the individual or facility has 5.9exercised the right to administrative reconsideration under section 
         626.556;5.10    (10) except as provided under chapter 245C, an individual disqualified under 5.11sections 
         245C.14 and 
         245C.15, which has not been set aside rescinded under sections 5.12245C.22
          and 
         245C.23, on the basis of serious or recurring maltreatment; a preponderance 5.13of the evidence that the individual has committed an act or acts that meet the definition 5.14of any of the crimes listed in section 
         245C.15, subdivisions 1 to 4; or for failing to make 5.15reports required under section 
         626.556, subdivision 3, or 
         626.557, subdivision 3. Hearings 5.16regarding a maltreatment determination under clause (4) or (9) and a disqualification under 5.17this clause in which the basis for a disqualification is serious or recurring maltreatment, 5.18which has not been set aside rescinded under sections 
         245C.22 and 
         245C.23, shall be 5.19consolidated into a single fair hearing. In such cases, the scope of review by the human 5.20services referee shall include both the maltreatment determination and the disqualification. 5.21The failure to exercise the right to an administrative reconsideration shall not be a bar to a 5.22hearing under this section if federal law provides an individual the right to a hearing to 5.23dispute a finding of maltreatment. Individuals and organizations specified in this section 5.24may contest the specified action, decision, or final disposition before the state agency by 5.25submitting a written request for a hearing to the state agency within 30 days after receiving 5.26written notice of the action, decision, or final disposition, or within 90 days of such written 5.27notice if the applicant, recipient, patient, or relative shows good cause why the request 5.28was not submitted within the 30-day time limit; or5.29    (11) any person with an outstanding debt resulting from receipt of public assistance, 5.30medical care, or the federal Food Stamp Act who is contesting a setoff claim by the 5.31Department of Human Services or a county agency. The scope of the appeal is the validity 5.32of the claimant agency's intention to request a setoff of a refund under chapter 270A 5.33against the debt.5.34    (b) The hearing for an individual or facility under paragraph (a), clause (4), (9), or 5.35(10), is the only administrative appeal to the final agency determination specifically, 5.36including a challenge to the accuracy and completeness of data under section 
         13.04. 6.1Hearings requested under paragraph (a), clause (4), apply only to incidents of maltreatment 6.2that occur on or after October 1, 1995. Hearings requested by nursing assistants in nursing 6.3homes alleged to have maltreated a resident prior to October 1, 1995, shall be held as a 6.4contested case proceeding under the provisions of chapter 14. Hearings requested under 6.5paragraph (a), clause (9), apply only to incidents of maltreatment that occur on or after 6.6July 1, 1997. A hearing for an individual or facility under paragraph (a), clause (9), is 6.7only available when there is no juvenile court or adult criminal action pending. If such 6.8action is filed in either court while an administrative review is pending, the administrative 6.9review must be suspended until the judicial actions are completed. If the juvenile court 6.10action or criminal charge is dismissed or the criminal action overturned, the matter may be 6.11considered in an administrative hearing.6.12    (c) For purposes of this section, bargaining unit grievance procedures are not an 6.13administrative appeal.6.14    (d) The scope of hearings involving claims to foster care payments under paragraph 6.15(a), clause (5), shall be limited to the issue of whether the county is legally responsible 6.16for a child's placement under court order or voluntary placement agreement and, if so, 6.17the correct amount of foster care payment to be made on the child's behalf and shall not 6.18include review of the propriety of the county's child protection determination or child 6.19placement decision.6.20    (e) A vendor of medical care as defined in section 
         256B.02, subdivision 7, or a 6.21vendor under contract with a county agency to provide social services is not a party and 6.22may not request a hearing under this section, except if assisting a recipient as provided in 6.23subdivision 4.6.24    (f) An applicant or recipient is not entitled to receive social services beyond the 6.25services prescribed under chapter 256M or other social services the person is eligible 6.26for under state law.6.27    (g) The commissioner may summarily affirm the county or state agency's proposed 6.28action without a hearing when the sole issue is an automatic change due to a change in 6.29state or federal law.6.30    Sec. 5. Minnesota Statutes 2008, section 626.556, subdivision 10i, is amended to read:6.31    Subd. 10i. Administrative reconsideration; review panel. (a) Administrative 6.32reconsideration is not applicable in family assessments since no determination concerning 6.33maltreatment is made. For investigations, except as provided under paragraph (e), an 6.34individual or facility that the commissioner of human services, a local social service 6.35agency, or the commissioner of education determines has maltreated a child, an interested 7.1person acting on behalf of the child, regardless of the determination, who contests 7.2the investigating agency's final determination regarding maltreatment, may request the 7.3investigating agency to reconsider its final determination regarding maltreatment. The 7.4request for reconsideration must be submitted in writing to the investigating agency within 7.515 calendar days after receipt of notice of the final determination regarding maltreatment 7.6or, if the request is made by an interested person who is not entitled to notice, within 7.715 days after receipt of the notice by the parent or guardian of the child. If mailed, the 7.8request for reconsideration must be postmarked and sent to the investigating agency 7.9within 15 calendar days of the individual's or facility's receipt of the final determination. If 7.10the request for reconsideration is made by personal service, it must be received by the 7.11investigating agency within 15 calendar days after the individual's or facility's receipt of the 7.12final determination. Effective January 1, 2002, an individual who was determined to have 7.13maltreated a child under this section and who was disqualified on the basis of serious or 7.14recurring maltreatment under sections 
         245C.14 and 
         245C.15, may request reconsideration 7.15of the maltreatment determination and the disqualification. The request for reconsideration 7.16of the maltreatment determination and the disqualification must be submitted within 30 7.17calendar days of the individual's receipt of the notice of disqualification under sections 7.18245C.16
          and 
         245C.17. If mailed, the request for reconsideration of the maltreatment 7.19determination and the disqualification must be postmarked and sent to the investigating 7.20agency within 30 calendar days of the individual's receipt of the maltreatment 7.21determination and notice of disqualification. If the request for reconsideration is made by 7.22personal service, it must be received by the investigating agency within 30 calendar days 7.23after the individual's receipt of the notice of disqualification.7.24    (b) Except as provided under paragraphs (e) and (f), if the investigating agency 7.25denies the request or fails to act upon the request within 15 working days after receiving 7.26the request for reconsideration, the person or facility entitled to a fair hearing under section 7.27256.045
          may submit to the commissioner of human services or the commissioner of 7.28education a written request for a hearing under that section. Section 
         256.045 also governs 7.29hearings requested to contest a final determination of the commissioner of education. For 7.30reports involving maltreatment of a child in a facility, an interested person acting on behalf 7.31of the child may request a review by the Child Maltreatment Review Panel under section 7.32256.022
          if the investigating agency denies the request or fails to act upon the request or 7.33if the interested person contests a reconsidered determination. The investigating agency 7.34shall notify persons who request reconsideration of their rights under this paragraph. 7.35The request must be submitted in writing to the review panel and a copy sent to the 7.36investigating agency within 30 calendar days of receipt of notice of a denial of a request 8.1for reconsideration or of a reconsidered determination. The request must specifically 8.2identify the aspects of the agency determination with which the person is dissatisfied.8.3    (c) If, as a result of a reconsideration or review, the investigating agency changes 8.4the final determination of maltreatment, that agency shall notify the parties specified in 8.5subdivisions 10b, 10d, and 10f.8.6    (d) Except as provided under paragraph (f), if an individual or facility contests the 8.7investigating agency's final determination regarding maltreatment by requesting a fair 8.8hearing under section 
         256.045, the commissioner of human services shall assure that the 8.9hearing is conducted and a decision is reached within 90 days of receipt of the request for 8.10a hearing. The time for action on the decision may be extended for as many days as the 8.11hearing is postponed or the record is held open for the benefit of either party.8.12    (e) Effective January 1, 2002, If an individual was disqualified under sections 8.13245C.14
          and 
         245C.15, on the basis of a determination of maltreatment, which was 8.14serious or recurring, and the individual has requested reconsideration of the maltreatment 8.15determination under paragraph (a) and requested reconsideration of the disqualification 8.16under sections 
         245C.21 to 
         245C.27, reconsideration of the maltreatment determination and 8.17reconsideration of the disqualification shall be consolidated into a single reconsideration. 8.18If reconsideration of the maltreatment determination is denied or the disqualification is not 8.19set aside rescinded under sections 
         245C.21 to 
         245C.27, the individual may request a fair 8.20hearing under section 
         256.045. If an individual requests a fair hearing on the maltreatment 8.21determination and the disqualification, the scope of the fair hearing shall include both the 8.22maltreatment determination and the disqualification.8.23    (f) Effective January 1, 2002, If a maltreatment determination or a disqualification 8.24based on serious or recurring maltreatment is the basis for a denial of a license under 8.25section 
         245A.05 or a licensing sanction under section 
         245A.07, the license holder has the 8.26right to a contested case hearing under chapter 14 and Minnesota Rules, parts 1400.8505 8.27to 1400.8612. As provided for under section 
         245A.08, subdivision 2a, the scope of the 8.28contested case hearing shall include the maltreatment determination, disqualification, 8.29and licensing sanction or denial of a license. In such cases, a fair hearing regarding 8.30the maltreatment determination and disqualification shall not be conducted under 8.31section 
         256.045. Except for family child care and child foster care, reconsideration of a 8.32maltreatment determination as provided under this subdivision, and reconsideration of a 8.33disqualification as provided under section 
         245C.22, shall also not be conducted when:8.34    (1) a denial of a license under section 
         245A.05 or a licensing sanction under section 8.35245A.07
         , is based on a determination that the license holder is responsible for maltreatment 8.36or the disqualification of a license holder based on serious or recurring maltreatment;9.1    (2) the denial of a license or licensing sanction is issued at the same time as the 9.2maltreatment determination or disqualification; and9.3    (3) the license holder appeals the maltreatment determination or disqualification, and 9.4denial of a license or licensing sanction. 9.5    Notwithstanding clauses (1) to (3), if the license holder appeals the maltreatment 9.6determination or disqualification, but does not appeal the denial of a license or a licensing 9.7sanction, reconsideration of the maltreatment determination shall be conducted under 9.8sections 
         626.556, subdivision 10i, and 
         626.557, subdivision 9d, and reconsideration of the 9.9disqualification shall be conducted under section 
         245C.22. In such cases, a fair hearing 9.10shall also be conducted as provided under sections 
         245C.27, 
         626.556, subdivision 10i, and 9.11626.557, subdivision 9d
         .9.12    If the disqualified subject is an individual other than the license holder and upon 9.13whom a background study must be conducted under chapter 245C, the hearings of all 9.14parties may be consolidated into a single contested case hearing upon consent of all parties 9.15and the administrative law judge.9.16    (g) For purposes of this subdivision, "interested person acting on behalf of the 9.17child" means a parent or legal guardian; stepparent; grandparent; guardian ad litem; adult 9.18stepbrother, stepsister, or sibling; or adult aunt or uncle; unless the person has been 9.19determined to be the perpetrator of the maltreatment.9.20    Sec. 6. Minnesota Statutes 2008, section 626.557, subdivision 9d, is amended to read:9.21    Subd. 9d. Administrative reconsideration; review panel. (a) Except as provided 9.22under paragraph (e), any individual or facility which a lead agency determines has 9.23maltreated a vulnerable adult, or the vulnerable adult or an interested person acting on 9.24behalf of the vulnerable adult, regardless of the lead agency's determination, who contests 9.25the lead agency's final disposition of an allegation of maltreatment, may request the 9.26lead agency to reconsider its final disposition. The request for reconsideration must be 9.27submitted in writing to the lead agency within 15 calendar days after receipt of notice of 9.28final disposition or, if the request is made by an interested person who is not entitled to 9.29notice, within 15 days after receipt of the notice by the vulnerable adult or the vulnerable 9.30adult's legal guardian. If mailed, the request for reconsideration must be postmarked and 9.31sent to the lead agency within 15 calendar days of the individual's or facility's receipt of 9.32the final disposition. If the request for reconsideration is made by personal service, it must 9.33be received by the lead agency within 15 calendar days of the individual's or facility's 9.34receipt of the final disposition. An individual who was determined to have maltreated a 9.35vulnerable adult under this section and who was disqualified on the basis of serious or 10.1recurring maltreatment under sections 
         245C.14 and 
         245C.15, may request reconsideration 10.2of the maltreatment determination and the disqualification. The request for reconsideration 10.3of the maltreatment determination and the disqualification must be submitted in writing 10.4within 30 calendar days of the individual's receipt of the notice of disqualification 10.5under sections 
         245C.16 and 
         245C.17. If mailed, the request for reconsideration of 10.6the maltreatment determination and the disqualification must be postmarked and sent 10.7to the lead agency within 30 calendar days of the individual's receipt of the notice of 10.8disqualification. If the request for reconsideration is made by personal service, it must be 10.9received by the lead agency within 30 calendar days after the individual's receipt of the 10.10notice of disqualification.10.11    (b) Except as provided under paragraphs (e) and (f), if the lead agency denies the 10.12request or fails to act upon the request within 15 working days after receiving the request 10.13for reconsideration, the person or facility entitled to a fair hearing under section 
         256.045, 10.14may submit to the commissioner of human services a written request for a hearing 10.15under that statute. The vulnerable adult, or an interested person acting on behalf of the 10.16vulnerable adult, may request a review by the Vulnerable Adult Maltreatment Review 10.17Panel under section 
         256.021 if the lead agency denies the request or fails to act upon the 10.18request, or if the vulnerable adult or interested person contests a reconsidered disposition. 10.19The lead agency shall notify persons who request reconsideration of their rights under this 10.20paragraph. The request must be submitted in writing to the review panel and a copy sent 10.21to the lead agency within 30 calendar days of receipt of notice of a denial of a request for 10.22reconsideration or of a reconsidered disposition. The request must specifically identify the 10.23aspects of the agency determination with which the person is dissatisfied.10.24    (c) If, as a result of a reconsideration or review, the lead agency changes the final 10.25disposition, it shall notify the parties specified in subdivision 9c, paragraph (d).10.26    (d) For purposes of this subdivision, "interested person acting on behalf of the 10.27vulnerable adult" means a person designated in writing by the vulnerable adult to act 10.28on behalf of the vulnerable adult, or a legal guardian or conservator or other legal 10.29representative, a proxy or health care agent appointed under chapter 145B or 145C, 10.30or an individual who is related to the vulnerable adult, as defined in section 
         245A.02, 10.31subdivision 13
         .10.32    (e) If an individual was disqualified under sections 
         245C.14 and 
         245C.15, on 10.33the basis of a determination of maltreatment, which was serious or recurring, and 10.34the individual has requested reconsideration of the maltreatment determination under 10.35paragraph (a) and reconsideration of the disqualification under sections 
         245C.21 to 10.36245C.27
         , reconsideration of the maltreatment determination and requested reconsideration 11.1of the disqualification shall be consolidated into a single reconsideration. If reconsideration 11.2of the maltreatment determination is denied or if the disqualification is not set aside11.3rescinded under sections 
         245C.21 to 
         245C.27, the individual may request a fair hearing 11.4under section 
         256.045. If an individual requests a fair hearing on the maltreatment 11.5determination and the disqualification, the scope of the fair hearing shall include both the 11.6maltreatment determination and the disqualification.11.7    (f) If a maltreatment determination or a disqualification based on serious or recurring 11.8maltreatment is the basis for a denial of a license under section 
         245A.05 or a licensing 11.9sanction under section 
         245A.07, the license holder has the right to a contested case hearing 11.10under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. As provided 11.11for under section 
         245A.08, the scope of the contested case hearing must include the 11.12maltreatment determination, disqualification, and licensing sanction or denial of a license. 11.13In such cases, a fair hearing must not be conducted under section 
         256.045. Except for 11.14family child care and child foster care, reconsideration of a maltreatment determination 11.15under this subdivision, and reconsideration of a disqualification under section 
         245C.22, 11.16must not be conducted when:11.17    (1) a denial of a license under section 
         245A.05, or a licensing sanction under section 11.18245A.07
         , is based on a determination that the license holder is responsible for maltreatment 11.19or the disqualification of a license holder based on serious or recurring maltreatment;11.20    (2) the denial of a license or licensing sanction is issued at the same time as the 11.21maltreatment determination or disqualification; and11.22    (3) the license holder appeals the maltreatment determination or disqualification, and 11.23denial of a license or licensing sanction.11.24    Notwithstanding clauses (1) to (3), if the license holder appeals the maltreatment 11.25determination or disqualification, but does not appeal the denial of a license or a licensing 11.26sanction, reconsideration of the maltreatment determination shall be conducted under 11.27sections 
         626.556, subdivision 10i, and 
         626.557, subdivision 9d, and reconsideration of the 11.28disqualification shall be conducted under section 
         245C.22. In such cases, a fair hearing 11.29shall also be conducted as provided under sections 
         245C.27, 
         626.556, subdivision 10i, and 11.30626.557, subdivision 9d
         .11.31    If the disqualified subject is an individual other than the license holder and upon 11.32whom a background study must be conducted under chapter 245C, the hearings of all 11.33parties may be consolidated into a single contested case hearing upon consent of all parties 11.34and the administrative law judge.11.35    (g) Until August 1, 2002, an individual or facility that was determined by the 11.36commissioner of human services or the commissioner of health to be responsible for 12.1neglect under section 
         626.5572, subdivision 17, after October 1, 1995, and before August 12.21, 2001, that believes that the finding of neglect does not meet an amended definition of 12.3neglect may request a reconsideration of the determination of neglect. The commissioner 12.4of human services or the commissioner of health shall mail a notice to the last known 12.5address of individuals who are eligible to seek this reconsideration. The request for 12.6reconsideration must state how the established findings no longer meet the elements of 12.7the definition of neglect. The commissioner shall review the request for reconsideration 12.8and make a determination within 15 calendar days. The commissioner's decision on this 12.9reconsideration is the final agency action.12.10    (1) For purposes of compliance with the data destruction schedule under subdivision 12.1112b, paragraph (d), when a finding of substantiated maltreatment has been changed as 12.12a result of a reconsideration under this paragraph, the date of the original finding of a 12.13substantiated maltreatment must be used to calculate the destruction date.12.14    (2) For purposes of any background studies under chapter 245C, when a 12.15determination of substantiated maltreatment has been changed as a result of a 12.16reconsideration under this paragraph, any prior disqualification of the individual under 12.17chapter 245C that was based on this determination of maltreatment shall be rescinded, 12.18and for future background studies under chapter 245C the commissioner must not use the 12.19previous determination of substantiated maltreatment as a basis for disqualification or as a 12.20basis for referring the individual's maltreatment history to a health-related licensing board 12.21under section 
         245C.31.12.22ARTICLE 212.23HEALTH CARE12.24    Section 1. Minnesota Statutes 2008, section 144.291, subdivision 2, is amended to read:12.25    Subd. 2. Definitions. For the purposes of sections 
         144.291 to 
         144.298, the following 12.26terms have the meanings given.12.27    (a) "Group purchaser" has the meaning given in section 
         62J.03, subdivision 6.12.28    (b) "Health information exchange" means a legal arrangement between health care 12.29providers and group purchasers to enable and oversee the business and legal issues 12.30involved in the electronic exchange of health records between the entities for the delivery 12.31of patient care.12.32    (c) "Health record" means any information, whether oral or recorded in any form or 12.33medium, that relates to the past, present, or future physical or mental health or condition of 12.34a patient; the provision of health care to a patient; or the past, present, or future payment 12.35for the provision of health care to a patient.13.1    (d) "Identifying information" means the patient's name, address, date of birth, 13.2gender, parent's or guardian's name regardless of the age of the patient, and other 13.3nonclinical data which can be used to uniquely identify a patient.13.4    (e) "Individually identifiable form" means a form in which the patient is or can be 13.5identified as the subject of the health records.13.6    (f) "Medical emergency" means medically necessary care which is immediately 13.7needed to preserve life, prevent serious impairment to bodily functions, organs, or parts, 13.8or prevent placing the physical or mental health of the patient in serious jeopardy.13.9    (g) "Patient" means a natural person who has received health care services from a 13.10provider for treatment or examination of a medical, psychiatric, or mental condition, the 13.11surviving spouse and parents of a deceased patient, or a person the patient appoints in 13.12writing as a representative, including a health care agent acting according to chapter 145C, 13.13unless the authority of the agent has been limited by the principal in the principal's health 13.14care directive. Except for minors who have received health care services under sections 13.15144.341
          to 
         144.347, in the case of a minor, patient includes a parent or guardian, or a 13.16person acting as a parent or guardian in the absence of a parent or guardian.13.17    (h) "Provider" means: 13.18    (1) any person who furnishes health care services and is regulated to furnish the 13.19services under chapter 147, 147A, 147B, 147C, 147D, 148, 148B, 148C, 148D, 150A, 13.20151, 153, or 153A; 13.21    (2) a home care provider licensed under section 
         144A.46; 13.22    (3) a health care facility licensed under this chapter or chapter 144A; 13.23    (4) a physician assistant registered under chapter 147A; and 13.24    (5) an unlicensed mental health practitioner regulated under sections 
         148B.60 to 13.25148B.71
         .13.26    (i) "Record locator service" means an electronic index of patient identifying 13.27information that directs providers in a health information exchange to the location of 13.28patient health records held by providers and group purchasers.13.29    (j) "Related health care entity" means an affiliate, as defined in section 
         144.6521, 13.30subdivision 3
         , paragraph (b), of the provider releasing the health records, including, but 13.31not limited to, affiliates of providers participating in a coordinated care delivery system 13.32established under section 256D.031, subdivision 6.13.33    Sec. 2. Minnesota Statutes 2008, section 256.01, is amended by adding a subdivision 13.34to read:14.1    Subd. 30.Review and evaluation of studies.The commissioner shall review 14.2all published studies, reports, and program evaluations completed by the Department 14.3of Human Services, and those requested by the legislature but not completed, for state 14.4fiscal years 2000 through 2010. For each item, the commissioner shall report the 14.5legislature's original appropriation for that work, if any, and the actual reported cost of the 14.6completed work by the Department of Human Services. The commissioner shall make 14.7recommendations to the legislature about which studies, reports, and program evaluations 14.8required by law are duplicative, unnecessary, or obsolete. The commissioner shall repeat 14.9this review every five fiscal years.14.10    Sec. 3. Minnesota Statutes 2008, section 256.9657, subdivision 3, is amended to read:14.11    Subd. 3. Surcharge on HMOs and community integrated service networks. (a) 14.12Effective October 1, 1992, each health maintenance organization with a certificate of 14.13authority issued by the commissioner of health under chapter 62D and each community 14.14integrated service network licensed by the commissioner under chapter 62N shall pay to 14.15the commissioner of human services a surcharge equal to six-tenths of one percent of the 14.16total premium revenues of the health maintenance organization or community integrated 14.17service network as reported to the commissioner of health according to the schedule in 14.18subdivision 4.14.19(b) Effective June 1, 2010: (1) the surcharge under paragraph (a) is increased to 3.0 14.20percent; and (2) each county-based purchasing plan authorized under section 256B.692 14.21shall pay to the commissioner a surcharge equal to 3.0 percent of the total premium 14.22revenues of the plan, as reported to the commissioner of health, according to the payment 14.23schedule in subdivision 4.14.24(c) For purposes of this subdivision, total premium revenue means:14.25(1) premium revenue recognized on a prepaid basis from individuals and groups 14.26for provision of a specified range of health services over a defined period of time which 14.27is normally one month, excluding premiums paid to a health maintenance organization 14.28or community integrated service network from the Federal Employees Health Benefit 14.29Program;14.30(2) premiums from Medicare wrap-around subscribers for health benefits which 14.31supplement Medicare coverage;14.32(3) Medicare revenue, as a result of an arrangement between a health maintenance 14.33organization or a community integrated service network and the Centers for Medicare 14.34and Medicaid Services of the federal Department of Health and Human Services, for 14.35services to a Medicare beneficiary, excluding Medicare revenue that states are prohibited 15.1from taxing under sections 1854, 1860D-12, and 1876 of title XVIII of the federal Social 15.2Security Act, codified as United States Code, title 42, sections 1395mm, 1395w-112, and 15.31395w-24, respectively, as they may be amended from time to time; and15.4(4) medical assistance revenue, as a result of an arrangement between a health 15.5maintenance organization or community integrated service network and a Medicaid state 15.6agency, for services to a medical assistance beneficiary.15.7If advance payments are made under clause (1) or (2) to the health maintenance 15.8organization or community integrated service network for more than one reporting period, 15.9the portion of the payment that has not yet been earned must be treated as a liability.15.10(c) (d) When a health maintenance organization or community integrated service 15.11network merges or consolidates with or is acquired by another health maintenance 15.12organization or community integrated service network, the surviving corporation or the 15.13new corporation shall be responsible for the annual surcharge originally imposed on 15.14each of the entities or corporations subject to the merger, consolidation, or acquisition, 15.15regardless of whether one of the entities or corporations does not retain a certificate of 15.16authority under chapter 62D or a license under chapter 62N.15.17(d) (e) Effective July 1 of each year, the surviving corporation's or the new 15.18corporation's surcharge shall be based on the revenues earned in the second previous 15.19calendar year by all of the entities or corporations subject to the merger, consolidation, 15.20or acquisition regardless of whether one of the entities or corporations does not retain a 15.21certificate of authority under chapter 62D or a license under chapter 62N until the total 15.22premium revenues of the surviving corporation include the total premium revenues of all 15.23the merged entities as reported to the commissioner of health.15.24(e) (f) When a health maintenance organization or community integrated service 15.25network, which is subject to liability for the surcharge under this chapter, transfers, 15.26assigns, sells, leases, or disposes of all or substantially all of its property or assets, liability 15.27for the surcharge imposed by this chapter is imposed on the transferee, assignee, or buyer 15.28of the health maintenance organization or community integrated service network.15.29(f) (g) In the event a health maintenance organization or community integrated 15.30service network converts its licensure to a different type of entity subject to liability 15.31for the surcharge under this chapter, but survives in the same or substantially similar 15.32form, the surviving entity remains liable for the surcharge regardless of whether one of 15.33the entities or corporations does not retain a certificate of authority under chapter 62D 15.34or a license under chapter 62N.16.1(g) (h) The surcharge assessed to a health maintenance organization or community 16.2integrated service network ends when the entity ceases providing services for premiums 16.3and the cessation is not connected with a merger, consolidation, acquisition, or conversion.16.4EFFECTIVE DATE.This section is effective June 1, 2010.16.5    Sec. 4. Minnesota Statutes 2009 Supplement, section 256.969, subdivision 3a, is 16.6amended to read:16.7    Subd. 3a. Payments. (a) Acute care hospital billings under the medical 16.8assistance program must not be submitted until the recipient is discharged. However, 16.9the commissioner shall establish monthly interim payments for inpatient hospitals that 16.10have individual patient lengths of stay over 30 days regardless of diagnostic category. 16.11Except as provided in section 
         256.9693, medical assistance reimbursement for treatment 16.12of mental illness shall be reimbursed based on diagnostic classifications. Individual 16.13hospital payments established under this section and sections 
         256.9685, 
         256.9686, and 16.14256.9695
         , in addition to third party and recipient liability, for discharges occurring during 16.15the rate year shall not exceed, in aggregate, the charges for the medical assistance covered 16.16inpatient services paid for the same period of time to the hospital. This payment limitation 16.17shall be calculated separately for medical assistance and general assistance medical 16.18care services. The limitation on general assistance medical care shall be effective for 16.19admissions occurring on or after July 1, 1991. Services that have rates established under 16.20subdivision 11 or 12, must be limited separately from other services. After consulting with 16.21the affected hospitals, the commissioner may consider related hospitals one entity and 16.22may merge the payment rates while maintaining separate provider numbers. The operating 16.23and property base rates per admission or per day shall be derived from the best Medicare 16.24and claims data available when rates are established. The commissioner shall determine 16.25the best Medicare and claims data, taking into consideration variables of recency of the 16.26data, audit disposition, settlement status, and the ability to set rates in a timely manner. 16.27The commissioner shall notify hospitals of payment rates by December 1 of the year 16.28preceding the rate year. The rate setting data must reflect the admissions data used to 16.29establish relative values. Base year changes from 1981 to the base year established for the 16.30rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited 16.31to the limits ending June 30, 1987, on the maximum rate of increase under subdivision 16.321. The commissioner may adjust base year cost, relative value, and case mix index data 16.33to exclude the costs of services that have been discontinued by the October 1 of the year 16.34preceding the rate year or that are paid separately from inpatient services. Inpatient stays 16.35that encompass portions of two or more rate years shall have payments established based 17.1on payment rates in effect at the time of admission unless the date of admission preceded 17.2the rate year in effect by six months or more. In this case, operating payment rates for 17.3services rendered during the rate year in effect and established based on the date of 17.4admission shall be adjusted to the rate year in effect by the hospital cost index.17.5    (b) For fee-for-service admissions occurring on or after July 1, 2002, the total 17.6payment, before third-party liability and spenddown, made to hospitals for inpatient 17.7services is reduced by .5 percent from the current statutory rates.17.8    (c) In addition to the reduction in paragraph (b), the total payment for fee-for-service 17.9admissions occurring on or after July 1, 2003, made to hospitals for inpatient services 17.10before third-party liability and spenddown, is reduced five percent from the current 17.11statutory rates. Mental health services within diagnosis related groups 424 to 432, and 17.12facilities defined under subdivision 16 are excluded from this paragraph.17.13    (d) In addition to the reduction in paragraphs (b) and (c), the total payment for 17.14fee-for-service admissions occurring on or after August 1, 2005, made to hospitals for 17.15inpatient services before third-party liability and spenddown, is reduced 6.0 percent 17.16from the current statutory rates. Mental health services within diagnosis related groups 17.17424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph. 17.18Notwithstanding section 
         256.9686, subdivision 7, for purposes of this paragraph, medical 17.19assistance does not include general assistance medical care. Payments made to managed 17.20care plans shall be reduced for services provided on or after January 1, 2006, to reflect 17.21this reduction.17.22    (e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for 17.23fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made 17.24to hospitals for inpatient services before third-party liability and spenddown, is reduced 17.253.46 percent from the current statutory rates. Mental health services with diagnosis related 17.26groups 424 to 432 and facilities defined under subdivision 16 are excluded from this 17.27paragraph. Payments made to managed care plans shall be reduced for services provided 17.28on or after January 1, 2009, through June 30, 2009, to reflect this reduction.17.29    (f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for 17.30fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2010, made 17.31to hospitals for inpatient services before third-party liability and spenddown, is reduced 17.321.9 percent from the current statutory rates. Mental health services with diagnosis related 17.33groups 424 to 432 and facilities defined under subdivision 16 are excluded from this 17.34paragraph. Payments made to managed care plans shall be reduced for services provided 17.35on or after July 1, 2009, through June 30, 2010, to reflect this reduction.18.1    (g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment 18.2for fee-for-service admissions occurring on or after July 1, 2010, made to hospitals for 18.3inpatient services before third-party liability and spenddown, is reduced 1.79 percent 18.4from the current statutory rates. Mental health services with diagnosis related groups 18.5424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph. 18.6Payments made to managed care plans shall be reduced for services provided on or after 18.7July 1, 2010, to reflect this reduction.18.8(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total 18.9payment for fee-for-service admissions occurring on or after July 1, 2009, made to 18.10hospitals for inpatient services before third-party liability and spenddown, is reduced 18.11one percent from the current statutory rates. Facilities defined under subdivision 16 are 18.12excluded from this paragraph. Payments made to managed care plans shall be reduced for 18.13services provided on or after October 1, 2009, to reflect this reduction.18.14(i) In addition to the reductions in paragraphs (b), (c), (d), (g), and (h), the total 18.15payment for fee-for-service admissions occurring on or after July 1, 2011, made to 18.16hospitals for inpatient services before third-party liability and spenddown, is reduced 18.17seven percent from the current statutory rates. Facilities defined under subdivision 16 are 18.18excluded from this paragraph. Payments made to managed care plans shall be reduced 18.19for services provided on or after January 1, 2012, to reflect this reduction. Hospitals that, 18.20prior to December 31, 2007, received payment to support the training of residents from an 18.21approved graduate medical residency training program pursuant to United States Code, 18.22title 42, section 256e, are not subject to the provisions of this paragraph.18.23    Sec. 5. Minnesota Statutes 2008, section 256B.04, subdivision 14, is amended to read:18.24    Subd. 14. Competitive bidding. (a) When determined to be effective, economical, 18.25and feasible, the commissioner may utilize volume purchase through competitive bidding 18.26and negotiation under the provisions of chapter 16C, to provide items under the medical 18.27assistance program including but not limited to the following:18.28    (1) eyeglasses;18.29    (2) oxygen. The commissioner shall provide for oxygen needed in an emergency 18.30situation on a short-term basis, until the vendor can obtain the necessary supply from 18.31the contract dealer;18.32    (3) hearing aids and supplies; and18.33    (4) durable medical equipment, including but not limited to:18.34    (i) hospital beds;18.35    (ii) commodes;19.1    (iii) glide-about chairs;19.2    (iv) patient lift apparatus;19.3    (v) wheelchairs and accessories;19.4    (vi) oxygen administration equipment;19.5    (vii) respiratory therapy equipment;19.6    (viii) electronic diagnostic, therapeutic and life-support systems;19.7    (5) nonemergency medical transportation level of need determinations, disbursement 19.8of public transportation passes and tokens, and volunteer and recipient mileage and 19.9parking reimbursements; and19.10    (6) drugs; and19.11(7) medical supplies.19.12    (b) Rate changes under this chapter and chapters 256D and 256L do not affect 19.13contract payments under this subdivision unless specifically identified.19.14    (c) The commissioner may not utilize volume purchase through competitive bidding 19.15and negotiation for special transportation services under the provisions of chapter 16C.19.16    Sec. 6. Minnesota Statutes 2008, section 256B.055, is amended by adding a 19.17subdivision to read:19.18    Subd. 15.Adults without children.Medical assistance may be paid for a person 19.19who is over age 21 and under age 65, who is not pregnant, and who is not described in 19.20subdivision 4, 7, or another subdivision of this section.19.21EFFECTIVE DATE.This section is effective upon federal approval and is 19.22retroactive from April 1, 2010.19.23    Sec. 7. Minnesota Statutes 2008, section 256B.056, subdivision 4, is amended to read:19.24    Subd. 4. Income. (a) To be eligible for medical assistance, a person eligible under 19.25section 
         256B.055, subdivisions 7, 7a, and 12, may have income up to 100 percent of 19.26the federal poverty guidelines. Effective January 1, 2000, and each successive January, 19.27recipients of supplemental security income may have an income up to the supplemental 19.28security income standard in effect on that date. 19.29(b) To be eligible for medical assistance, families and children may have an income 19.30up to 133-1/3 percent of the AFDC income standard in effect under the July 16, 1996, 19.31AFDC state plan. Effective July 1, 2000, the base AFDC standard in effect on July 16, 19.321996, shall be increased by three percent.19.33(c) Effective July 1, 2002, to be eligible for medical assistance, families and children 19.34may have an income up to 100 percent of the federal poverty guidelines for the family size.20.1(d) In computing income to determine eligibility of persons under paragraphs (a) 20.2to (c) and (e) who are not residents of long-term care facilities, the commissioner shall 20.3disregard increases in income as required by Public Law Numbers 94-566, section 503; 20.499-272; and 99-509. Veterans aid and attendance benefits and Veterans Administration 20.5unusual medical expense payments are considered income to the recipient.20.6(e) To be eligible for medical assistance, a person eligible under section 256B.055, 20.7subdivision 15, may have income up to 75 percent of the federal poverty guidelines for 20.8family size.20.9EFFECTIVE DATE.This section is effective upon federal approval and is 20.10retroactive from April 1, 2010.20.11    Sec. 8. Minnesota Statutes 2008, section 256B.0625, subdivision 8, is amended to read:20.12    Subd. 8. Physical therapy. Medical assistance covers physical therapy and related 20.13services, including specialized maintenance therapy. Authorization by the commissioner 20.14is required to provide services to a recipient beyond any of the following onetime service 20.15thresholds: (1) 80 units of any approved CPT code other than modalities; (2) 20 modality 20.16sessions; and (3) three evaluations or reevaluations. Services provided by a physical 20.17therapy assistant shall be reimbursed at the same rate as services performed by a physical 20.18therapist when the services of the physical therapy assistant are provided under the 20.19direction of a physical therapist who is on the premises. Services provided by a physical 20.20therapy assistant that are provided under the direction of a physical therapist who is not on 20.21the premises shall be reimbursed at 65 percent of the physical therapist rate.20.22    Sec. 9. Minnesota Statutes 2008, section 256B.0625, subdivision 8a, is amended to 20.23read:20.24    Subd. 8a. Occupational therapy. Medical assistance covers occupational therapy 20.25and related services, including specialized maintenance therapy. Authorization by the 20.26commissioner is required to provide services to a recipient beyond any of the following 20.27onetime service thresholds: (1) 120 units of any combination of approved CPT codes; 20.28and (2) two evaluations or reevaluations. Services provided by an occupational therapy 20.29assistant shall be reimbursed at the same rate as services performed by an occupational 20.30therapist when the services of the occupational therapy assistant are provided under the 20.31direction of the occupational therapist who is on the premises. Services provided by an 20.32occupational therapy assistant that are provided under the direction of an occupational 20.33therapist who is not on the premises shall be reimbursed at 65 percent of the occupational 20.34therapist rate.21.1    Sec. 10. Minnesota Statutes 2008, section 256B.0625, subdivision 8b, is amended to 21.2read:21.3    Subd. 8b. Speech language pathology and audiology services. Medical assistance 21.4covers speech language pathology and related services, including specialized maintenance 21.5therapy. Authorization by the commissioner is required to provide services to a recipient 21.6beyond any of the following onetime service thresholds: (1) 50 treatment sessions with 21.7any combination of approved CPT codes; and (2) one evaluation. Medical assistance 21.8covers audiology services and related services. Services provided by a person who has 21.9been issued a temporary registration under section 
         148.5161 shall be reimbursed at the 21.10same rate as services performed by a speech language pathologist or audiologist as long as 21.11the requirements of section 
         148.5161, subdivision 3, are met. 21.12    Sec. 11. Minnesota Statutes 2008, section 256B.0625, is amended by adding a 21.13subdivision to read:21.14    Subd. 8d.Chiropractic services.Payment for chiropractic services is limited to 21.15one annual evaluation and 12 visits per year unless prior authorization of a greater number 21.16of visits is obtained.21.17    Sec. 12. Minnesota Statutes 2009 Supplement, section 256B.0625, subdivision 9, 21.18is amended to read:21.19    Subd. 9. Dental services. (a) Medical assistance covers dental services.21.20(b) Medical assistance dental coverage for nonpregnant adults is limited to the 21.21following services:21.22(1) comprehensive exams, limited to once every five years;21.23(2) periodic exams, limited to one per year;21.24(3) limited exams;21.25(4) bitewing x-rays, limited to one set per year;21.26(5) periapical x-rays;21.27(6) panoramic x-rays or full-mouth radiographs, limited to one every five years, 21.28and only if provided in conjunction with a posterior extraction or scheduled outpatient 21.29facility procedure, or as medically necessary for the diagnosis and follow-up of oral and 21.30maxillofacial pathology and trauma. Panoramic x-rays may be taken once every two years 21.31for patients who cannot cooperate for intraoral film due to a developmental disability or 21.32medical condition that does not allow for intraoral film placement;21.33(7) prophylaxis, limited to one per year;21.34(8) application of fluoride varnish, limited to one per year;22.1(9) posterior fillings, all at the amalgam rate;22.2(10) anterior fillings;22.3(11) endodontics, limited to root canals on the anterior and premolars only, and 22.4molar root canal therapy as deemed medically necessary for patients that are at high risk 22.5of osteonecrosis from molar extractions;22.6(12) removable prostheses, each dental arch limited to one every six years; including:22.7(i) relines of full dentures once every six years per dental arch;22.8(ii) repair of acrylic bases of full dentures and acrylic partial dentures, limited to one 22.9per year; and22.10(iii) adding a maximum of two denture teeth and two wrought wire clasps per year to 22.11partial dentures per dental arch;22.12(13) oral surgery, limited to extractions, biopsies, and incision and drainage of 22.13abscesses;22.14(14) palliative treatment and sedative fillings for relief of pain; and22.15(15) full-mouth debridement periodontal scaling and root planing, limited to one 22.16every five years; and22.17(16) moderate sedation, deep sedation, and general anesthesia, limited to when 22.18provided by an oral maxillofacial surgeon who is board-certified, or actively participating 22.19in the American Board of Oral and Maxillofacial Surgery certification process, when 22.20medically necessary to allow the surgical management of acute oral and maxillofacial 22.21pathology which cannot be accomplished safely with local anesthesia alone and would 22.22otherwise require operating room services.22.23(c) In addition to the services specified in paragraph (b), medical assistance 22.24covers the following services for adults, if provided in an outpatient hospital setting or 22.25freestanding ambulatory surgical center as part of outpatient dental surgery:22.26(1) periodontics, limited to periodontal scaling and root planing once every two 22.27years;22.28(2) general anesthesia; and22.29(3) full-mouth survey once every five two years.22.30(d) Medical assistance covers dental services for children that are medically 22.31necessary. The following guidelines apply:22.32(1) posterior fillings are paid at the amalgam rate;22.33(2) application of sealants once every five years per permanent molar; and22.34(3) application of fluoride varnish once every six months.23.1    Sec. 13. Minnesota Statutes 2009 Supplement, section 256B.0625, subdivision 13e, 23.2is amended to read:23.3    Subd. 13e. Payment rates. (a) The basis for determining the amount of payment 23.4shall be the lower of the actual acquisition costs of the drugs plus a fixed dispensing fee; 23.5the maximum allowable cost set by the federal government or by the commissioner plus 23.6the fixed dispensing fee; or the usual and customary price charged to the public. The 23.7amount of payment basis must be reduced to reflect all discount amounts applied to the 23.8charge by any provider/insurer agreement or contract for submitted charges to medical 23.9assistance programs. The net submitted charge may not be greater than the patient liability 23.10for the service. The pharmacy dispensing fee shall be $3.65, except that the dispensing fee 23.11for intravenous solutions which must be compounded by the pharmacist shall be $8 per 23.12bag, $14 per bag for cancer chemotherapy products, and $30 per bag for total parenteral 23.13nutritional products dispensed in one liter quantities, or $44 per bag for total parenteral 23.14nutritional products dispensed in quantities greater than one liter. Actual acquisition cost 23.15includes quantity and other special discounts except time and cash discounts. Effective 23.16July 1, 2009 July 1, 2010, the actual acquisition cost of a drug shall be estimated by the 23.17commissioner, at average wholesale price minus 15 12.5 percent or wholesale acquisition 23.18cost plus 5.0 percent, whichever is lower. The actual acquisition cost of antihemophilic 23.19factor drugs shall be estimated at the average wholesale price minus 30 28.12 percent or 23.20wholesale acquisition cost minus 13.76 percent, whichever is lower. Average wholesale 23.21price is defined as the price for a drug product listed as the average wholesale price in the 23.22commissioner's primary reference source. Wholesale acquisition cost is defined as the 23.23manufacturer's list price for a drug or biological to wholesalers or direct purchasers in the 23.24United States, not including prompt pay or other discounts, rebates, or reductions in price, 23.25for the most recent month for which information is available, as reported in wholesale price 23.26guides or other publications of drug or biological pricing data. The maximum allowable 23.27cost of a multisource drug may be set by the commissioner and it shall be comparable to, 23.28but no higher than, the maximum amount paid by other third-party payors in this state who 23.29have maximum allowable cost programs. Establishment of the amount of payment for 23.30drugs shall not be subject to the requirements of the Administrative Procedure Act.23.31    (b) An additional dispensing fee of $.30 may be added to the dispensing fee paid 23.32to pharmacists for legend drug prescriptions dispensed to residents of long-term care 23.33facilities when a unit dose blister card system, approved by the department, is used. Under 23.34this type of dispensing system, the pharmacist must dispense a 30-day supply of drug. 23.35The National Drug Code (NDC) from the drug container used to fill the blister card must 23.36be identified on the claim to the department. The unit dose blister card containing the 24.1drug must meet the packaging standards set forth in Minnesota Rules, part 6800.2700, 24.2that govern the return of unused drugs to the pharmacy for reuse. The pharmacy provider 24.3will be required to credit the department for the actual acquisition cost of all unused 24.4drugs that are eligible for reuse. Over-the-counter medications must be dispensed in the 24.5manufacturer's unopened package. The commissioner may permit the drug clozapine to be 24.6dispensed in a quantity that is less than a 30-day supply.24.7    (c) Whenever a generically equivalent product is available, payment shall be on the 24.8basis of the actual acquisition cost of the generic drug, or on the maximum allowable cost 24.9established by the commissioner.24.10    (d) The basis for determining the amount of payment for drugs administered in an 24.11outpatient setting shall be the lower of the usual and customary cost submitted by the 24.12provider or the amount established for Medicare by the United States Department of 24.13Health and Human Services pursuant to title XVIII, section 1847a of the federal Social 24.14Security Act.24.15    (e) The commissioner may negotiate lower reimbursement rates for specialty 24.16pharmacy products than the rates specified in paragraph (a). The commissioner may 24.17require individuals enrolled in the health care programs administered by the department 24.18to obtain specialty pharmacy products from providers with whom the commissioner has 24.19negotiated lower reimbursement rates. Specialty pharmacy products are defined as those 24.20used by a small number of recipients or recipients with complex and chronic diseases 24.21that require expensive and challenging drug regimens. Examples of these conditions 24.22include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis 24.23C, growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms 24.24of cancer. Specialty pharmaceutical products include injectable and infusion therapies, 24.25biotechnology drugs, high-cost therapies, and therapies that require complex care. The 24.26commissioner shall consult with the formulary committee to develop a list of specialty 24.27pharmacy products subject to this paragraph. In consulting with the formulary committee 24.28in developing this list, the commissioner shall take into consideration the population 24.29served by specialty pharmacy products, the current delivery system and standard of care in 24.30the state, and access to care issues. The commissioner shall have the discretion to adjust 24.31the reimbursement rate to prevent access to care issues.24.32EFFECTIVE DATE.This section is effective July 1, 2010, or upon federal 24.33approval, whichever is later.24.34    Sec. 14. Minnesota Statutes 2008, section 256B.0625, subdivision 18a, is amended to 24.35read:25.1    Subd. 18a. Access to medical services. (a) Medical assistance reimbursement for 25.2meals for persons traveling to receive medical care may not exceed $5.50 for breakfast, 25.3$6.50 for lunch, or $8 for dinner.25.4    (b) Medical assistance reimbursement for lodging for persons traveling to receive 25.5medical care may not exceed $50 per day unless prior authorized by the local agency.25.6    (c) Medical assistance direct mileage reimbursement to the eligible person or the 25.7eligible person's driver may not exceed 20 cents per mile.25.8    (d) Regardless of the number of employees that an enrolled health care provider 25.9may have, medical assistance covers sign and oral language interpreter services when 25.10provided by an enrolled health care provider during the course of providing a direct, 25.11person-to-person covered health care service to an enrolled recipient with limited English 25.12proficiency or who has a hearing loss and uses interpreting services. Coverage for oral 25.13language interpreter services shall be provided only if the oral language interpreter used 25.14by the enrolled health care provider is listed in the registry or roster established under 25.15section 144.058.25.16EFFECTIVE DATE.This section is effective July 1, 2010.25.17    Sec. 15. Minnesota Statutes 2008, section 256B.0625, subdivision 31, is amended to 25.18read:25.19    Subd. 31. Medical supplies and equipment. Medical assistance covers medical 25.20supplies and equipment. Separate payment outside of the facility's payment rate shall 25.21be made for wheelchairs and wheelchair accessories for recipients who are residents 25.22of intermediate care facilities for the developmentally disabled. Reimbursement for 25.23wheelchairs and wheelchair accessories for ICF/MR recipients shall be subject to the same 25.24conditions and limitations as coverage for recipients who do not reside in institutions. A 25.25wheelchair purchased outside of the facility's payment rate is the property of the recipient.25.26The commissioner may set reimbursement rates for specified categories of medical 25.27supplies at levels below the Medicare payment rate.25.28    Sec. 16. Minnesota Statutes 2008, section 256B.0625, is amended by adding a 25.29subdivision to read:25.30    Subd. 54.Services provided in birth centers.(a) Medical assistance covers 25.31services provided in a birth center licensed under section 144.615 by a licensed health 25.32professional if the service would otherwise be covered if provided in a hospital.25.33(b) Facility services provided by a birth center shall be paid at the lower of billed 25.34charges or 70 percent of the statewide average for a facility payment rate made to a 26.1hospital for an uncomplicated vaginal birth as determined using the most recent calendar 26.2year for which complete claims data is available. If a recipient is transported from a birth 26.3center to a hospital prior to the delivery, the payment for facility services to the birth center 26.4shall be the lower of billed charges or 15 percent of the average facility payment made to a 26.5hospital for the services provided for an uncomplicated vaginal delivery as determined 26.6using the most recent calendar year for which complete claims data is available.26.7(c) Professional services provided by traditional midwives licensed under chapter 26.8147D shall be paid at the lower of billed charges or 100 percent of the rate paid to a 26.9physician performing the same services. If a recipient is transported from a birth center to 26.10a hospital prior to the delivery, a licensed traditional midwife who does not perform the 26.11delivery may not bill for any delivery services. Services are not covered if provided by an 26.12unlicensed traditional midwife.26.13(d) The commissioner shall apply for any necessary waivers from the Centers for 26.14Medicare and Medicaid Services to allow birth centers and birth center providers to be 26.15reimbursed.26.16EFFECTIVE DATE.This section is effective January 1, 2011, or upon federal 26.17approval, whichever is later.26.18    Sec. 17. Minnesota Statutes 2008, section 256B.0631, subdivision 1, is amended to 26.19read:26.20    Subdivision 1. Co-payments. (a) Except as provided in subdivision 2, the medical 26.21assistance benefit plan shall include the following co-payments for all recipients, effective 26.22for services provided on or after October 1, 2003, and before January 1, 2009:26.23    (1) $3 per nonpreventive visit. For purposes of this subdivision, a visit means an 26.24episode of service which is required because of a recipient's symptoms, diagnosis, or 26.25established illness, and which is delivered in an ambulatory setting by a physician or 26.26physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse, 26.27audiologist, optician, or optometrist;26.28    (2) $3 for eyeglasses;26.29    (3) $6 for nonemergency visits to a hospital-based emergency room; and26.30    (4) $3 per brand-name drug prescription and $1 per generic drug prescription, 26.31subject to a $12 per month maximum for prescription drug co-payments. No co-payments 26.32shall apply to antipsychotic drugs when used for the treatment of mental illness.26.33    (b) Except as provided in subdivision 2, the medical assistance benefit plan shall 26.34include the following co-payments for all recipients, effective for services provided on 26.35or after January 1, 2009:27.1    (1) $6 $3.50 for nonemergency visits to a hospital-based emergency room; 27.2    (2) $3 per brand-name drug prescription and $1 per generic drug prescription, subject 27.3to a $7 $12 per month maximum for prescription drug co-payments. No co-payments shall 27.4apply to antipsychotic drugs when used for the treatment of mental illness; and27.5    (3) for individuals identified by the commissioner with income at or below 100 27.6percent of the federal poverty guidelines, total monthly co-payments must not exceed five 27.7percent of family income. For purposes of this paragraph, family income is the total 27.8earned and unearned income of the individual and the individual's spouse, if the spouse is 27.9enrolled in medical assistance and also subject to the five percent limit on co-payments.27.10    (c) Recipients of medical assistance are responsible for all co-payments in this 27.11subdivision.27.12EFFECTIVE DATE.The amendment to paragraph (b), clause (1), related to the 27.13co-payment for nonemergency visits is effective January 1, 2011, and the amendment 27.14to paragraph (b), clause (2), related to the per month maximum for prescription drug 27.15co-payments is effective July 1, 2010.27.16    Sec. 18. Minnesota Statutes 2008, section 256B.0631, subdivision 3, is amended to 27.17read:27.18    Subd. 3. Collection. (a) The medical assistance reimbursement to the provider 27.19shall be reduced by the amount of the co-payment, except that reimbursements shall 27.20not be reduced:27.21    (1) once a recipient has reached the $12 per month maximum or the $7 per month 27.22maximum effective January 1, 2009, for prescription drug co-payments; or27.23    (2) for a recipient identified by the commissioner under 100 percent of the federal 27.24poverty guidelines who has met their monthly five percent co-payment limit.27.25    (b) The provider collects the co-payment from the recipient. Providers may not deny 27.26services to recipients who are unable to pay the co-payment.27.27    (c) Medical assistance reimbursement to fee-for-service providers and payments to 27.28managed care plans shall not be increased as a result of the removal of the co-payments 27.29effective on or after January 1, 2009.27.30    Sec. 19. Minnesota Statutes 2008, section 256B.0644, as amended by Laws 2010, 27.31chapter 200, article 1, section 6, is amended to read:27.32256B.0644 REIMBURSEMENT UNDER OTHER STATE HEALTH CARE 27.33PROGRAMS.28.1    (a) A vendor of medical care, as defined in section 
         256B.02, subdivision 7, and a 28.2health maintenance organization, as defined in chapter 62D, must participate as a provider 28.3or contractor in the medical assistance program, general assistance medical care program, 28.4and MinnesotaCare as a condition of participating as a provider in health insurance plans 28.5and programs or contractor for state employees established under section 
         43A.18, the 28.6public employees insurance program under section 
         43A.316, for health insurance plans 28.7offered to local statutory or home rule charter city, county, and school district employees, 28.8the workers' compensation system under section 
         176.135, and insurance plans provided 28.9through the Minnesota Comprehensive Health Association under sections 
         62E.01 to 28.1062E.19
         . The limitations on insurance plans offered to local government employees shall 28.11not be applicable in geographic areas where provider participation is limited by managed 28.12care contracts with the Department of Human Services.28.13    (b) For providers other than health maintenance organizations, participation in the 28.14medical assistance program means that:28.15     (1) the provider accepts new medical assistance, general assistance medical care, 28.16and MinnesotaCare patients;28.17    (2) for providers other than dental service providers, at least 20 percent of the 28.18provider's patients are covered by medical assistance, general assistance medical care, 28.19and MinnesotaCare as their primary source of coverage; or28.20    (3) for dental service providers, at least ten percent of the provider's patients are 28.21covered by medical assistance, general assistance medical care, and MinnesotaCare as 28.22their primary source of coverage, or the provider accepts new medical assistance and 28.23MinnesotaCare patients who are children with special health care needs. For purposes 28.24of this section, "children with special health care needs" means children up to age 18 28.25who: (i) require health and related services beyond that required by children generally; 28.26and (ii) have or are at risk for a chronic physical, developmental, behavioral, or emotional 28.27condition, including: bleeding and coagulation disorders; immunodeficiency disorders; 28.28cancer; endocrinopathy; developmental disabilities; epilepsy, cerebral palsy, and other 28.29neurological diseases; visual impairment or deafness; Down syndrome and other genetic 28.30disorders; autism; fetal alcohol syndrome; and other conditions designated by the 28.31commissioner after consultation with representatives of pediatric dental providers and 28.32consumers.28.33    (c) Patients seen on a volunteer basis by the provider at a location other than 28.34the provider's usual place of practice may be considered in meeting the participation 28.35requirement in this section. The commissioner shall establish participation requirements 28.36for health maintenance organizations. The commissioner shall provide lists of participating 29.1medical assistance providers on a quarterly basis to the commissioner of management and 29.2budget, the commissioner of labor and industry, and the commissioner of commerce. Each 29.3of the commissioners shall develop and implement procedures to exclude as participating 29.4providers in the program or programs under their jurisdiction those providers who do 29.5not participate in the medical assistance program. The commissioner of management 29.6and budget shall implement this section through contracts with participating health and 29.7dental carriers.29.8    (d) Any hospital or other provider that is participating in a coordinated care 29.9delivery system under section 256D.031, subdivision 6, or receives payments from the 29.10uncompensated care pool under section 256D.031, subdivision 8, shall not refuse to 29.11provide services to any patient enrolled in general assistance medical care regardless of 29.12the availability or the amount of payment.29.13    (e) (d) For purposes of paragraphs (a) and (b), participation in the general assistance 29.14medical care program applies only to pharmacy providers dispensing prescription drugs 29.15according to section 256D.03, subdivision 3.29.16EFFECTIVE DATE.The amendment striking the existing paragraph (d) is effective 29.1730 days after federal approval of the amendments in this article to Minnesota Statutes, 29.18sections 256B.055, subdivision 15, and 256B.056, subdivision 4, or January 1, 2011, 29.19whichever is later. The amendment to the new paragraph (d) is effective June 1, 2010.29.20    Sec. 20. Minnesota Statutes 2009 Supplement, section 256B.0653, subdivision 5, 29.21is amended to read:29.22    Subd. 5. Home care therapies. (a) Home care therapies include the following: 29.23physical therapy, occupational therapy, respiratory therapy, and speech and language 29.24pathology therapy services.29.25(b) Home care therapies must be:29.26(1) provided in the recipient's residence after it has been determined the recipient is 29.27unable to access outpatient therapy;29.28(2) prescribed, ordered, or referred by a physician and documented in a plan of care 29.29and reviewed, according to Minnesota Rules, part 9505.0390;29.30(3) assessed by an appropriate therapist; and29.31(4) provided by a Medicare-certified home health agency enrolled as a Medicaid 29.32provider agency.29.33(c) Restorative and specialized maintenance therapies must be provided according to 29.34Minnesota Rules, part 9505.0390. Physical and occupational therapy assistants may be 29.35used as allowed under Minnesota Rules, part 9505.0390, subpart 1, item B.30.1(d) For both physical and occupational therapies, the therapist and the therapist's 30.2assistant may not both bill for services provided to a recipient on the same day.30.3    Sec. 21. [256B.0755] PAYMENT REFORM DEMONSTRATION PROJECT FOR 30.4SPECIAL PATIENT POPULATIONS.30.5    Subdivision 1.Demonstration project.(a) The commissioner of human services, 30.6in consultation with the commissioner of health, shall establish a payment reform 30.7demonstration project implementing an alternative payment system for health care 30.8providers serving an identified group of patients who are enrolled in a state health 30.9care program, and are either high utilizers of high-cost health care services or have 30.10characteristics that put them at high risk of becoming high utilizers.  The purpose of the 30.11demonstration project is to implement and evaluate methods of reducing hospitalizations, 30.12emergency room use, high-cost medications and specialty services, admissions to nursing 30.13facilities, or use of long-term home and community-based services, in order to reduce the 30.14total cost of care and services for the patients.   30.15(b) The commissioner shall give the highest priority to projects that will serve 30.16patients who have chronic medical conditions or complex medical needs that are 30.17complicated by a physical disability, serious mental illness, or serious socioeconomic 30.18factors such as poverty, homelessness, or language or cultural barriers.  The commissioner 30.19shall also give the highest priority to providers or groups of providers who have the 30.20highest concentrations of patients with these characteristics. 30.21(c) The commissioner must implement this payment reform demonstration project 30.22in a manner consistent with the payment reform initiative provided in sections 62U.02 30.23to 62U.04.30.24(d) For purposes of this section, "state health care program" means the medical 30.25assistance, MinnesotaCare, and general assistance medical care programs.30.26    Subd. 2.Participation.(a) The commissioner shall request eligible providers or 30.27groups of providers to submit a proposal to participate in the demonstration project by 30.28September 1, 2010. The providers who are interested in participating shall negotiate with 30.29the commissioner to determine: 30.30(1) the identified group of patients who are to be enrolled in the program;30.31(2) the services that are to be included in the total cost of care calculation;30.32(3) the methodology for calculating the total cost of care, which may take into 30.33consideration the impact on costs to other state or local government programs including, 30.34but not limited to, social services and income maintenance programs;30.35(4) the time period to be covered under the bid;31.1(5) the implementation of a risk adjustment mechanism to adjust for factors that are 31.2beyond the control of the provider including nonclinical factors that will affect the cost 31.3or outcomes of treatment;31.4(6) the payment reforms and payment methods to be used under the project, which 31.5may include but are not limited to adjustments in fee-for-service payments, payment of 31.6care coordination fees, payments for start-up and implementation costs to be recovered or 31.7repaid later in the project, payments adjusted based on a provider's proportion of patients 31.8who are enrolled in state health care programs; payments adjusted for the clinical or 31.9socioeconomic complexity of the patients served, payment incentives tied to use of 31.10inpatient and emergency room services, and periodic settle-up adjustments;31.11(7) methods of sharing financial risk and benefit between the commissioner and 31.12the provider or groups of providers, which may include but are not limited to stop-loss 31.13arrangements to cover high-cost outlier cases or costs that are beyond the control of the 31.14provider, and risk-sharing and benefit-sharing corridors; and31.15(8) performance and outcome benchmarks to be used to measure performance, 31.16achievement of cost-savings targets, and quality of care provided.31.17(b) A provider or group of providers may submit a proposal for a demonstration 31.18project in partnership with a health maintenance organization or county-based purchasing 31.19plan for the purposes of sharing risk, claims processing, or administration of the project, 31.20or to extend participation in the project to persons who are enrolled in prepaid health 31.21care programs.31.22    Subd. 3.Total cost of care agreement.Based on negotiations, the commissioner 31.23must enter into an agreement with interested and eligible providers or groups of providers 31.24to implement projects that are designed to reduce the total cost of care for the identified 31.25patients. To the extent possible, the projects shall begin implementation on January 1, 31.262011, or upon federal approval, whichever is later.31.27    Subd. 4.Eligibility.To be eligible to participate, providers or groups of providers 31.28must meet certification standards for health care homes established by the Department of 31.29Health and the Department of Human Services under section 256B.0751.31.30    Subd. 5.Alternative payments.The commissioner shall seek all federal waivers 31.31and approvals necessary to implement this section and to obtain federal matching funds. To 31.32the extent authorized by federal law, the commissioner may waive existing fee-for-service 31.33payment rates, provider contract or performance requirements, consumer incentive 31.34policies, or other requirements in statute or rule in order to allow the providers or groups 31.35of providers to utilize alternative payment and financing methods that will appropriately 31.36fund necessary and cost-effective primary care and care coordination services; establish 32.1appropriate incentives for prevention, health promotion, and care coordination; and 32.2mitigate financial harm to participating providers caused by the successful reduction in 32.3preventable hospitalization, emergency room use, and other costly services.32.4    Subd. 6.Cost neutrality.The total cost, including administrative costs, of this 32.5demonstration project must not exceed the costs that would otherwise be incurred by 32.6the state had services to the state health care program enrollees participating in the 32.7demonstration project been provided, as applicable for the enrollee, under fee-for-service 32.8or through managed care or county-based purchasing plans.32.9    Sec. 22. [256B.0757] INTENSIVE CARE MANAGEMENT PROGRAM.32.10    Subdivision 1.Report.The commissioner shall review medical assistance 32.11enrollment and by July 1, 2011, present a report to the legislature that describes the 32.12common characteristics and costs of those enrollees age 18 and over whose annual medical 32.13costs are greater than 95 percent of all other enrollees, using deidentified data.32.14    Subd. 2.Intensive care management system established.The commissioner shall 32.15implement, by January 1, 2012, or upon federal approval, whichever is later, a program 32.16to provide intensive care management to medical assistance enrollees age 18 and over 32.17currently served under fee-for-service, managed care, or county-based purchasing, whose 32.18annual medical care costs are in the top five percent of all medical assistance enrollees. 32.19The intensive care management program must reduce these enrollees' medical assistance 32.20costs by at least 20 percent on average, improve quality of care through care coordination, 32.21and provide financial incentives for providers to deliver care efficiently. The commissioner 32.22may require medical assistance enrollees meeting the criteria specified in this subdivision 32.23to participate in the intensive care management program, and may reassign enrollees 32.24from existing managed care and county-based purchasing plans to those plans that are 32.25participating in the demonstration program. The commissioner shall seek all federal 32.26approvals and waivers necessary to implement the intensive care management program.32.27    Subd. 3.Request for proposals.The commissioner of human services shall 32.28request proposals by September 1, 2011, or upon federal approval, whichever is later, 32.29from health care providers, managed care plans, and county-based purchasing plans to 32.30provide  intensive care management services under the requirements of subdivision 1. 32.31Proposals submitted must:32.32(1) designate the medical assistance population and geographic area of the state 32.33to be served;32.34(2) describe in detail the proposed intensive care management program;33.1(3) provide estimates of cost savings to the state and the evidence supporting these 33.2estimates;33.3(4) describe the extent to which the intensive care management program is consistent 33.4with and builds upon current state health care home, care coordination, and payment 33.5reform initiatives; and33.6(5) meet quality assurance, data reporting, and other criteria specified by the 33.7commissioner in the request for proposals.33.8EFFECTIVE DATE.This section is effective the day following final enactment.33.9    Sec. 23. Minnesota Statutes 2008, section 256B.19, subdivision 1c, is amended to read:33.10    Subd. 1c. Additional portion of nonfederal share. (a) Hennepin County shall 33.11be responsible for a monthly transfer payment of $1,500,000, due before noon on the 33.1215th of each month and the University of Minnesota shall be responsible for a monthly 33.13transfer payment of $500,000 due before noon on the 15th of each month, beginning July 33.1415, 1995. These sums shall be part of the designated governmental unit's portion of the 33.15nonfederal share of medical assistance costs.33.16(b) Beginning July 1, 2001, Hennepin County's payment under paragraph (a) shall 33.17be $2,066,000 each month.33.18(c) Beginning July 1, 2001, the commissioner shall increase annual capitation 33.19payments to the metropolitan health plan under section 
         256B.69 for the prepaid medical 33.20assistance program by approximately $3,400,000, plus any available federal matching 33.21funds, $6,800,000 to recognize higher than average medical education costs.33.22(d) Effective August 1, 2005, Hennepin County's payment under paragraphs (a) 33.23and (b) shall be reduced to $566,000, and the University of Minnesota's payment under 33.24paragraph (a) shall be reduced to zero. Effective October 1, 2008, to December 30, 2010, 33.25Hennepin County's payment under paragraphs (a) and (b) shall be $434,688.  Effective 33.26January 1, 2011, Hennepin County's payment under paragraphs (a) and (b) shall be 33.27$566,000.33.28(e) Notwithstanding paragraph (d), upon federal enactment of an extension to June 33.2930, 2011, of the enhanced federal medical assistance percentage (FMAP) originally 33.30provided under Public Law 111-5, for the six-month period from January 1, 2011, to June 33.3130, 2011, Hennepin County's payment under paragraphs (a) and (b) shall be $434,688.33.32    Sec. 24. Minnesota Statutes 2008, section 256B.69, is amended by adding a 33.33subdivision to read:34.1    Subd. 5k.Payment rate modification.For services rendered on or after August 34.21, 2010, the total payment made to managed care and county-based purchasing plans 34.3under the medical assistance program and under MinnesotaCare for families with children 34.4shall be increased by 1.4 percent.34.5EFFECTIVE DATE.This section is effective August 1, 2010.34.6    Sec. 25. Minnesota Statutes 2008, section 256B.69, is amended by adding a 34.7subdivision to read:34.8    Subd. 5l.Payment reduction.For services rendered on or after January 1, 2011, 34.9the total payment made to managed care plans for providing covered services under 34.10the medical assistance, general assistance medical care, and MinnesotaCare programs 34.11is reduced by one percent from their current statutory rates. This provision excludes 34.12payments for nursing home services, home and community-based waivers, home care 34.13services covered under section 256B.0651, subdivision 2, payments to demonstration 34.14projects for persons with disabilities, and mental health services added as covered benefits 34.15after December 31, 2007.34.16    Sec. 26. Minnesota Statutes 2008, section 256B.69, subdivision 20, as amended by 34.17Laws 2010, chapter 200, article 1, section 10, is amended to read:34.18    Subd. 20. Ombudsperson.(a) The commissioner shall designate an ombudsperson 34.19to advocate for persons required to enroll in prepaid health plans under this section. The 34.20ombudsperson shall advocate for recipients enrolled in prepaid health plans through 34.21complaint and appeal procedures and ensure that necessary medical services are provided 34.22either by the prepaid health plan directly or by referral to appropriate social services. At 34.23the time of enrollment in a prepaid health plan, the local agency shall inform recipients 34.24about the ombudsperson program and their right to a resolution of a complaint by the 34.25prepaid health plan if they experience a problem with the plan or its providers.34.26    (b) The commissioner shall designate an ombudsperson to advocate for persons 34.27enrolled in a care coordination delivery system under section 256D.031. The 34.28ombudsperson shall advocate for recipients enrolled in a care coordination delivery 34.29system through the state appeal process and assist enrollees in accessing necessary 34.30medical services through the care coordination delivery systems directly or by referral to 34.31appropriate services. At the time of enrollment in a care coordination delivery system, the 34.32local agency shall inform recipients about the ombudsperson program.35.1EFFECTIVE DATE.This section is effective 30 days after federal approval of the 35.2amendments in this article to Minnesota Statutes, sections 256B.055, subdivision 15, and 35.3256B.056, subdivision 4, or January 1, 2011, whichever is later.35.4    Sec. 27. Minnesota Statutes 2008, section 256B.69, subdivision 27, is amended to read:35.5    Subd. 27.  Information for persons with limited English-language proficiency.35.6    Managed care contracts entered into under this section and sections 256D.03, subdivision 35.74, paragraph (c), andsection 256L.12 must require demonstration providers to provide 35.8language assistance to enrollees that ensures meaningful access to its programs and 35.9services according to Title VI of the Civil Rights Act and federal regulations adopted 35.10under that law or any guidance from the United States Department of Health and Human 35.11Services. 35.12EFFECTIVE DATE.This section is effective retroactively from April 1, 2010.35.13    Sec. 28. Minnesota Statutes 2008, section 256B.692, subdivision 1, is amended to read:35.14    Subdivision 1. In general. County boards or groups of county boards may elect 35.15to purchase or provide health care services on behalf of persons eligible for medical 35.16assistance and general assistance medical care who would otherwise be required to or may 35.17elect to participate in the prepaid medical assistance or prepaid general assistance medical 35.18care programs according to sectionssection 256B.69and 256D.03. Counties that elect to 35.19purchase or provide health care under this section must provide all services included in 35.20prepaid managed care programs according to sectionssection 256B.69, subdivisions 1 35.21to 22
         , and 256D.03. County-based purchasing under this section is governed by section 35.22256B.69
         , unless otherwise provided for under this section.  35.23EFFECTIVE DATE.This section is effective retroactively from April 1, 2010.35.24    Sec. 29. Minnesota Statutes 2008, section 256B.75, is amended to read:35.25256B.75 HOSPITAL OUTPATIENT REIMBURSEMENT.35.26    (a) For outpatient hospital facility fee payments for services rendered on or after 35.27October 1, 1992, the commissioner of human services shall pay the lower of (1) submitted 35.28charge, or (2) 32 percent above the rate in effect on June 30, 1992, except for those 35.29services for which there is a federal maximum allowable payment. Effective for services 35.30rendered on or after January 1, 2000, payment rates for nonsurgical outpatient hospital 35.31facility fees and emergency room facility fees shall be increased by eight percent over the 35.32rates in effect on December 31, 1999, except for those services for which there is a federal 36.1maximum allowable payment. Services for which there is a federal maximum allowable 36.2payment shall be paid at the lower of (1) submitted charge, or (2) the federal maximum 36.3allowable payment. Total aggregate payment for outpatient hospital facility fee services 36.4shall not exceed the Medicare upper limit. If it is determined that a provision of this 36.5section conflicts with existing or future requirements of the United States government with 36.6respect to federal financial participation in medical assistance, the federal requirements 36.7prevail. The commissioner may, in the aggregate, prospectively reduce payment rates to 36.8avoid reduced federal financial participation resulting from rates that are in excess of 36.9the Medicare upper limitations.36.10    (b) Notwithstanding paragraph (a), payment for outpatient, emergency, and 36.11ambulatory surgery hospital facility fee services for critical access hospitals designated 36.12under section 
         144.1483, clause (10), shall be paid on a cost-based payment system that is 36.13based on the cost-finding methods and allowable costs of the Medicare program.36.14    (c) Effective for services provided on or after July 1, 2003, rates that are based 36.15on the Medicare outpatient prospective payment system shall be replaced by a budget 36.16neutral prospective payment system that is derived using medical assistance data. The 36.17commissioner shall provide a proposal to the 2003 legislature to define and implement 36.18this provision.36.19    (d) For fee-for-service services provided on or after July 1, 2002, the total payment, 36.20before third-party liability and spenddown, made to hospitals for outpatient hospital 36.21facility services is reduced by .5 percent from the current statutory rate.36.22    (e) In addition to the reduction in paragraph (d), the total payment for fee-for-service 36.23services provided on or after July 1, 2003, made to hospitals for outpatient hospital 36.24facility services before third-party liability and spenddown, is reduced five percent from 36.25the current statutory rates. Facilities defined under section 
         256.969, subdivision 16, are 36.26excluded from this paragraph.36.27    (f) In addition to the reductions in paragraphs (d) and (e), the total payment for 36.28fee-for-service services provided on or after July 1, 2008, made to hospitals for outpatient 36.29hospital facility services before third-party liability and spenddown, is reduced three 36.30percent from the current statutory rates. Mental health services and facilities defined under 36.31section 
         256.969, subdivision 16, are excluded from this paragraph.36.32    (g) Notwithstanding any contrary provision in this section, payment for all outpatient 36.33and emergency services provided by any hospital that, prior to December 31, 2007, has 36.34received payment to support the training of residents from an approved graduate medical 36.35residency training program under United States Code, title 42, section 256e, must be paid 37.1for fiscal years 2012 and 2013 an additional $7,000,000. Payment rates for subsequent 37.2fiscal years are as follows:37.3    (1) 2014: 50 percent of costs;37.4    (2) 2015: 60 percent of costs;37.5    (3) 2016: 70 percent of costs;37.6    (4) 2017: 80 percent of costs;37.7    (5) 2018: 90 percent of costs; and37.8    (6) 2019 and thereafter: 100 percent of costs.37.9    Sec. 30. Minnesota Statutes 2009 Supplement, section 256B.76, subdivision 1, is 37.10amended to read:37.11    Subdivision 1. Physician reimbursement.  (a) Effective for services rendered on 37.12or after October 1, 1992, the commissioner shall make payments for physician services 37.13as follows:37.14    (1) payment for level one Centers for Medicare and Medicaid Services' common 37.15procedural coding system codes titled "office and other outpatient services," "preventive 37.16medicine new and established patient," "delivery, antepartum, and postpartum care," 37.17"critical care," cesarean delivery and pharmacologic management provided to psychiatric 37.18patients, and level three codes for enhanced services for prenatal high risk, shall be paid 37.19at the lower of (i) submitted charges, or (ii) 25 percent above the rate in effect on June 37.2030, 1992. If the rate on any procedure code within these categories is different than the 37.21rate that would have been paid under the methodology in section 
         256B.74, subdivision 2, 37.22then the larger rate shall be paid;37.23    (2) payments for all other services shall be paid at the lower of (i) submitted charges, 37.24or (ii) 15.4 percent above the rate in effect on June 30, 1992; and37.25    (3) all physician rates shall be converted from the 50th percentile of 1982 to the 50th 37.26percentile of 1989, less the percent in aggregate necessary to equal the above increases 37.27except that payment rates for home health agency services shall be the rates in effect 37.28on September 30, 1992.37.29    (b) Effective for services rendered on or after January 1, 2000, payment rates for 37.30physician and professional services shall be increased by three percent over the rates 37.31in effect on December 31, 1999, except for home health agency and family planning 37.32agency services. The increases in this paragraph shall be implemented January 1, 2000, 37.33for managed care.37.34(c) Effective for services rendered on or after July 1, 2009, payment rates for 37.35physician and professional services shall be reduced by five percent over the rates in 38.1effect on June 30, 2009. This reduction does not apply to office or other outpatient visits, 38.2preventive medicine visits and family planning visits billed by physicians, advanced 38.3practice nurses, or physician assistants in a family planning agency or in one of the 38.4following primary care practices: general practice, general internal medicine, general 38.5pediatrics, general geriatrics, and family medicine. This reduction does not apply to 38.6federally qualified health centers, rural health centers, and Indian health services. This 38.7reduction does not apply to physical therapy services, occupational therapy services, 38.8and speech pathology and related services provided on or after July 1, 2010. Effective 38.9October 1, 2009, payments made to managed care plans and county-based purchasing 38.10plans under sections 
         256B.69, 
         256B.692, and 
         256L.12 shall reflect the payment reduction 38.11described in this paragraph.38.12(d) Effective for services rendered on or after July 1, 2010, payment rates for 38.13physician and professional services shall be reduced by three percent over the rates in 38.14effect on June 30, 2010. This reduction does not apply to those providers and entities 38.15exempt from the reduction in paragraph (c). Effective October 1, 2010, payments made 38.16to managed care plans and county-based purchasing plans under sections 256B.69, 38.17256B.692, and 256L.12 shall reflect the payment reductions in this paragraph.38.18(e) Effective for services rendered on or after June 1, 2010, payment rates for 38.19physician and professional services billed by physicians employed by and clinics that are 38.20owned by a nonprofit health maintenance organization shall be increased by 15 percent. 38.21Effective October 1, 2010, payments to managed care and county-based purchasing 38.22plans under sections 256B.69, 256B.692, and 256L.12 shall reflect the payment increase 38.23described in this paragraph.38.24    Sec. 31. Minnesota Statutes 2008, section 256B.76, subdivision 2, is amended to read:38.25    Subd. 2. Dental reimbursement.  (a) Effective for services rendered on or after 38.26October 1, 1992, the commissioner shall make payments for dental services as follows:38.27    (1) dental services shall be paid at the lower of (i) submitted charges, or (ii) 25 38.28percent above the rate in effect on June 30, 1992; and38.29    (2) dental rates shall be converted from the 50th percentile of 1982 to the 50th 38.30percentile of 1989, less the percent in aggregate necessary to equal the above increases.38.31    (b) Beginning October 1, 1999, the payment for tooth sealants and fluoride treatments 38.32shall be the lower of (1) submitted charge, or (2) 80 percent of median 1997 charges.38.33    (c) Effective for services rendered on or after January 1, 2000, payment rates for 38.34dental services shall be increased by three percent over the rates in effect on December 38.3531, 1999.39.1    (d) Effective for services provided on or after January 1, 2002, payment for 39.2diagnostic examinations and dental x-rays provided to children under age 21 shall be the 39.3lower of (1) the submitted charge, or (2) 85 percent of median 1999 charges.39.4    (e) The increases listed in paragraphs (b) and (c) shall be implemented January 1, 39.52000, for managed care.39.6(f) Effective for dental services rendered on or after October 1, 2010, by a 39.7state-operated dental clinic, payment shall be paid on a cost-based payment system that 39.8is based on the cost-finding methods and allowable costs of the Medicare program. For 39.9services performed by a state-operated dental clinic pursuant to a contract between the 39.10clinic and a managed care plan or a county-based purchasing plan, a supplemental payment 39.11shall be made to the clinic by the commissioner that is equal to the amount by which the 39.12amount determined under this paragraph exceeds the amount of the payments provided 39.13under the contract. Managed care plans and county-based purchasing plans participating 39.14in medical assistance must provide to the commissioner any expenditure, cost, and 39.15revenue information deemed necessary by the commissioner for purposes of obtaining 39.16federal Medicaid matching funds for cost-based reimbursement for state-operated dental 39.17clinics. Cost-based reimbursement shall be implemented in managed care contracts 39.18beginning January 1, 2011.39.19(g) Beginning in fiscal year 2011, if the payments to state-operated dental clinics 39.20in paragraph (f), including state and federal shares, are less than $1,850,000 per fiscal 39.21year, a supplemental state payment equal to the difference between the total payments 39.22in paragraph (f) and $1,850,000 shall be paid from the general fund to state-operated 39.23services for the operation of the dental clinics.39.24    Sec. 32. Minnesota Statutes 2008, section 256B.76, subdivision 4, is amended to read:39.25    Subd. 4. Critical access dental providers.   Effective for dental services rendered 39.26on or after January 1, 2002, the commissioner shall increase reimbursements to dentists 39.27and dental clinics deemed by the commissioner to be critical access dental providers. 39.28For dental services rendered on or after July 1, 2007, the commissioner shall increase 39.29reimbursement by 30 percent above the reimbursement rate that would otherwise be paid to 39.30the critical access dental provider. The commissioner shall pay the health plan companies 39.31in amounts sufficient to reflect increased reimbursements to critical access dental providers 39.32as approved by the commissioner. In determining which dentists and dental clinics shall 39.33be deemed critical access dental providers, the commissioner shall review:40.1    (1) the utilization rate in the service area in which the dentist or dental clinic operates 40.2for dental services to patients covered by medical assistance, general assistance medical 40.3care, or MinnesotaCare as their primary source of coverage;40.4    (2) the level of services provided by the dentist or dental clinic to patients covered 40.5by medical assistance, general assistance medical care, or MinnesotaCare as their primary 40.6source of coverage; and. The commissioner shall pay critical access dental provider 40.7payments to a dentist or dental clinic that meets any one of the following criteria:40.8    (i) at least 40 percent of patient encounters are with patients who are uninsured or 40.9covered by medical assistance, general assistance medical care, or MinnesotaCare;40.10    (ii) the dental clinic or dental group is owned and operated by a nonprofit operation 40.11under chapter 317A with more than 10,000 patient encounters per year with patients 40.12who are uninsured or covered by medical assistance, general assistance medical care, 40.13or MinnesotaCare; 40.14    (iii) the dental clinic is associated with an oral health or dental education program 40.15operated by the University of Minnesota or an institution within the Minnesota State 40.16Colleges and Universities system; or40.17(iv) the dental clinic is a state-operated dental clinic;40.18    (3) whether the level of services provided by the dentist or dental clinic is critical to 40.19maintaining adequate levels of patient access within the a geographic service area, and 40.20to ensure that the maximum travel distance or travel time is the lesser of 60 miles or 60 40.21minutes;40.22    (4) whether the provider has completed the application for critical access dental 40.23provider designation by the due date, and has provided correct information;40.24    (5) whether the dentist or dental clinic meets the quality and continuity of care 40.25criteria recommended by the dental services advisory committee and adopted by the 40.26department; and40.27(6) whether the dentist or dental clinic serves people in all Minnesota health care 40.28programs. 40.29In the absence of a critical access dental provider in a service area, the commissioner may 40.30designate a dentist or dental clinic as a critical access dental provider if the dentist or 40.31dental clinic is willing to provide care to patients covered by medical assistance, general 40.32assistance medical care, or MinnesotaCare at a level which significantly increases access 40.33to dental care in the service area.40.34EFFECTIVE DATE.This section is effective January 1, 2011.41.1    Sec. 33. Minnesota Statutes 2008, section 256B.76, is amended by adding a 41.2subdivision to read:41.3    Subd. 4a.Designation and termination of critical access dental providers.(a) 41.4Notwithstanding the provisions in subdivision 4, the commissioner may review and not 41.5designate an individual dentist or dental clinic as a critical access dental provider under 41.6subdivision 4 or section 256L.11, subdivision 7, when the dentist or clinic:41.7(1) has been subject to a corrective or disciplinary action by the Board of Dentistry 41.8related to fraud or direct patient care. Designation shall not be made until the provider is no 41.9longer subject to a corrective or disciplinary action related to fraud or direct patient care; or41.10(2) has been subject, within the past three years, to a postinvestigation action by the 41.11commissioner of human services or issuance of a warning as specified in Minnesota Rules, 41.12parts 9505.2160 to 9505.2245. The provider shall not be considered for critical access 41.13dental designation until the January following the year in which the action has ended.41.14(b) The commissioner may terminate a critical access designation of an individual 41.15dentist or clinic if the dentist or clinic:41.16(1) becomes subject to a disciplinary or corrective action by the Board of Dentistry 41.17related to fraud or direct patient care. The provider shall not be considered for critical 41.18access designation until the January following the year in which the action has ended;41.19(2) becomes subject to a postinvestigation action by the commissioner of human 41.20services or issuance of a warning as specified in Minnesota Rules, parts 9505.2160 41.21to 9505.2245;41.22(3) does not meet the quality and continuity of care criteria that have been 41.23recommended by the Dental Services Advisory Committee and adopted by the department; 41.24or41.25(4) does not serve people in all Minnesota public health care programs.41.26(c) Any termination is effective on the date of notification of the:41.27(1) postinvestigative action;41.28(2) disciplinary or corrective action by the Minnesota Board of Dentistry; or41.29(3) determination of not meeting quality and continuity of care criteria.41.30The commissioner may review postinvestigative actions taken by a health plan 41.31under contract to provide dental services to Minnesota health care program enrollees. 41.32After an investigation conducted by the Department of Human Services surveillance unit, 41.33the findings of the health plan may be incorporated to determine if a provider will be 41.34designated or terminated from the program.41.35(d) A provider who has been terminated or not designated under this section may 41.36appeal only through the contested hearing process as defined in section 14.02, subdivision 42.13, by filing with the commissioner a written request of appeal. The appeal request must 42.2be received by the commissioner no later than 30 days after notification of termination 42.3or nondesignation.42.4(e) The commissioner may make an exception to paragraphs (a) and (b) if an action 42.5taken by the Board of Dentistry or the commissioner is the result of events not directly 42.6related to patient care or that will not affect direct patient care to Minnesota health care 42.7program enrollees.42.8EFFECTIVE DATE.This section is effective the day following final enactment.42.9    Sec. 34. Minnesota Statutes 2009 Supplement, section 256B.766, is amended to read: 42.10256B.766 REIMBURSEMENT FOR BASIC CARE SERVICES.42.11(a) Effective for services provided on or after July 1, 2009, total payments for 42.12basic care services, shall be reduced by three percent, prior to third-party liability and 42.13spenddown calculation. This reduction applies to physical therapy services, occupational 42.14therapy services, and speech language pathology and related services provided on or after 42.15July 1, 2010. Effective July 1, 2010, the commissioner shall classify physical therapy 42.16services, occupational therapy services, and speech language pathology and related 42.17services as basic care services. Payments made to managed care plans and county-based 42.18purchasing plans shall be reduced for services provided on or after October 1, 2009, 42.19to reflect this reduction.42.20(b) This section does not apply to physician and professional services, inpatient 42.21hospital services, family planning services, mental health services, dental services, 42.22prescription drugs, medical transportation, federally qualified health centers, rural health 42.23centers, Indian health services, and Medicare cost-sharing.42.24    Sec. 35. [256B.767] MEDICARE PAYMENT LIMIT.42.25Effective for services rendered on or after July 1, 2010, fee-for-service payment 42.26rates for physician and professional services under section 256B.76, subdivision 1, and 42.27basic care services subject to the rate reduction specified in section 256B.766, shall not 42.28exceed the Medicare payment rate for the applicable service.42.29    Sec. 36. [256B.768] FEE-FOR-SERVICE PAYMENT INCREASE.42.30Effective for services rendered on or after January 1, 2011, the commissioner shall 42.31increase fee-for-service payment rates by seven percent for physician and professional 43.1services under section 256B.76, subdivision 1, and basic care services subject to the rate 43.2reduction specified in section 256B.766.43.3    Sec. 37. Minnesota Statutes 2009 Supplement, section 256D.03, subdivision 3, as 43.4amended by Laws 2010, chapter 200, article 1, section 11, is amended to read:43.5    Subd. 3. General assistance medical care; eligibility. (a) Beginning April 1, 2010, 43.6the general assistance medical care program shall be administered according to section 43.7256D.031
         , unless otherwise stated, except for outpatient prescription drug coverage, 43.8which shall continue to be administered under this section and funded under section 43.9256D.031, subdivision 9
         , beginning June 1, 2010.43.10(b) Outpatient prescription drug coverage under general assistance medical care is 43.11limited to prescription drugs that:43.12(1) are covered under the medical assistance program as described in section 43.13256B.0625, subdivisions 13
          and 13d; and43.14(2) are provided by manufacturers that have fully executed general assistance 43.15medical care rebate agreements with the commissioner and comply with the agreements. 43.16Outpatient prescription drug coverage under general assistance medical care must conform 43.17to coverage under the medical assistance program according to section 
         256B.0625, 43.18subdivisions 13
          to 13g 13h.43.19    (c) Outpatient prescription drug coverage does not include drugs administered in a 43.20clinic or other outpatient setting.43.21(d) For the period beginning April 1, 2010, to May 31, 2010, general assistance 43.22medical care covers the services listed in subdivision 4.43.23EFFECTIVE DATE.This section is effective retroactively from April 1, 2010.43.24    Sec. 38. Minnesota Statutes 2008, section 256L.02, subdivision 3, is amended to read:43.25    Subd. 3. Financial management. (a) The commissioner shall manage spending for 43.26the MinnesotaCare program in a manner that maintains a minimum reserve. As part of 43.27each state revenue and expenditure forecast, the commissioner must make an assessment 43.28of the expected expenditures for the covered services for the remainder of the current 43.29biennium and for the following biennium. The estimated expenditure, including the 43.30reserve, shall be compared to an estimate of the revenues that will be available in the health 43.31care access fund. Based on this comparison, and after consulting with the chairs of the 43.32house of representatives Ways and Means Committee and the senate Finance Committee, 43.33and the Legislative Commission on Health Care Access, the commissioner shall, as 43.34necessary, make the adjustments specified in paragraph (b) to ensure that expenditures 44.1remain within the limits of available revenues for the remainder of the current biennium 44.2and for the following biennium. The commissioner shall not hire additional staff using 44.3appropriations from the health care access fund until the commissioner of management 44.4and budget makes a determination that the adjustments implemented under paragraph (b) 44.5are sufficient to allow MinnesotaCare expenditures to remain within the limits of available 44.6revenues for the remainder of the current biennium and for the following biennium.44.7(b) The adjustments the commissioner shall use must be implemented in this order, 44.8but shall not be implemented before July 1, 2014: first, stop enrollment of single adults 44.9and households without children; and second, upon 45 days' notice, stop coverage of 44.10single adults and households without children already enrolled in the MinnesotaCare 44.11program; third, upon 90 days' notice, decrease the premium subsidy amounts by ten 44.12percent for families with gross annual income above 200 percent of the federal poverty 44.13guidelines; fourth, upon 90 days' notice, decrease the premium subsidy amounts by ten 44.14percent for families with gross annual income at or below 200 percent; and fifth, require 44.15applicants to be uninsured for at least six months prior to eligibility in the MinnesotaCare 44.16program. If these measures are insufficient to limit the expenditures to the estimated 44.17amount of revenue, the commissioner shall further limit enrollment or decrease premium 44.18subsidies notify the chairs of the house of representatives Ways and Means Committee and 44.19the senate Finance Committee, and the Legislative Commission on Health Care Access, 44.20and present recommendations to the chairs and commission for limiting expenditures to 44.21the estimated amount of revenue.44.22EFFECTIVE DATE.This section is effective upon federal approval of the 44.23amendments in this article to Minnesota Statutes, sections 256B.055, subdivision 15, and 44.24256B.056, subdivision 4.44.25    Sec. 39. Minnesota Statutes 2008, section 256L.03, subdivision 3, is amended to read:44.26    Subd. 3. Inpatient hospital services. (a) Covered health services shall include 44.27inpatient hospital services, including inpatient hospital mental health services and inpatient 44.28hospital and residential chemical dependency treatment, subject to those limitations 44.29necessary to coordinate the provision of these services with eligibility under the medical 44.30assistance spenddown. The inpatient hospital benefit for adult enrollees who qualify under 44.31section 
         256L.04, subdivision 7, or who qualify under section 
         256L.04, subdivisions 1 and 44.322
         , with family gross income that exceeds 200 percent of the federal poverty guidelines or 44.33215 percent of the federal poverty guidelines on or after July 1, 2009, and who are not 44.34pregnant, is subject to an annual limit of $10,000, unless supplemental hospital coverage 44.35has been purchased under subdivision 3c. 45.1    (b) Admissions for inpatient hospital services paid for under section 
         256L.11, 45.2subdivision 3
         , must be certified as medically necessary in accordance with Minnesota 45.3Rules, parts 9505.0500 to 9505.0540, except as provided in clauses (1) and (2): 45.4    (1) all admissions must be certified, except those authorized under rules established 45.5under section 
         254A.03, subdivision 3, or approved under Medicare; and 45.6    (2) payment under section 
         256L.11, subdivision 3, shall be reduced by five percent 45.7for admissions for which certification is requested more than 30 days after the day of 45.8admission. The hospital may not seek payment from the enrollee for the amount of the 45.9payment reduction under this clause. 45.10EFFECTIVE DATE.This section is effective January 1, 2011, or upon federal 45.11approval, whichever is later.45.12    Sec. 40. Minnesota Statutes 2008, section 256L.03, is amended by adding a subdivision 45.13to read:45.14    Subd. 3c.Supplemental hospital coverage.(a) Effective January 1, 2011, or upon 45.15federal approval, whichever is later, the commissioner shall offer all MinnesotaCare 45.16applicants, and all enrollees during the open enrollment periods specified in paragraph 45.17(b), the opportunity to purchase at full cost, supplemental hospital coverage to cover 45.18inpatient hospital expenses in excess of the inpatient hospital annual limit established 45.19under subdivision 3. Premiums for this coverage may vary only for age and shall be 45.20collected by the commissioner using the procedures established for the sliding scale 45.21premium determined under section 256L.15.45.22(b) The commissioner shall notify all persons submitting applications of the option to 45.23purchase this coverage at the time of application. The commissioner shall provide persons 45.24enrolled in MinnesotaCare on the effective date of this subdivision with the opportunity to 45.25purchase this supplemental coverage during an initial open enrollment period. Following 45.26this initial open enrollment period, the commissioner shall provide all enrollees with the 45.27opportunity to purchase this supplemental coverage during an annual open enrollment 45.28period during the month of November with coverage to take effect the following January 1.45.29    Sec. 41. Minnesota Statutes 2009 Supplement, section 256L.03, subdivision 5, is 45.30amended to read:45.31    Subd. 5. Co-payments and coinsurance. (a) Except as provided in paragraphs (b) 45.32and (c), the MinnesotaCare benefit plan shall include the following co-payments and 45.33coinsurance requirements for all enrollees:46.1    (1) ten percent of the paid charges for inpatient hospital services for adult enrollees, 46.2subject to an annual inpatient out-of-pocket maximum of $1,000 per individual;46.3    (2) $3 per prescription for adult enrollees;46.4    (3) $25 for eyeglasses for adult enrollees;46.5    (4) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an 46.6episode of service which is required because of a recipient's symptoms, diagnosis, or 46.7established illness, and which is delivered in an ambulatory setting by a physician or 46.8physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse, 46.9audiologist, optician, or optometrist; and46.10    (5) $6 for nonemergency visits to a hospital-based emergency room for services 46.11provided through December 31, 2010, and $3.50 effective January 1, 2011.46.12    (b) Paragraph (a), clause (1), does not apply to parents and relative caretakers of 46.13children under the age of 21.46.14    (c) Paragraph (a) does not apply to pregnant women and children under the age of 21.46.15    (d) Paragraph (a), clause (4), does not apply to mental health services.46.16    (e) Adult enrollees with family gross income that exceeds 200 percent of the federal 46.17poverty guidelines or 215 percent of the federal poverty guidelines on or after July 1, 2009, 46.18and who are not pregnant shall be financially responsible for the coinsurance amount, if 46.19applicable, and if supplemental coverage has not been purchased under subdivision 3c,46.20amounts which exceed the $10,000 inpatient hospital benefit limit.46.21    (f) When a MinnesotaCare enrollee becomes a member of a prepaid health plan, 46.22or changes from one prepaid health plan to another during a calendar year, any charges 46.23submitted towards the $10,000 annual inpatient benefit limit, and any out-of-pocket 46.24expenses incurred by the enrollee for inpatient services, that were submitted or incurred 46.25prior to enrollment, or prior to the change in health plans, shall be disregarded.46.26(g) MinnesotaCare reimbursement to fee-for-service providers and payments to 46.27managed care plans shall not be increased as a result of the reduction of the co-payments 46.28in paragraph (a), clause (5), effective January 1, 2011.46.29EFFECTIVE DATE.The amendment to paragraph (e) is effective January 1, 2011, 46.30or upon federal approval, whichever is later.46.31    Sec. 42. Minnesota Statutes 2008, section 256L.05, is amended by adding a subdivision 46.32to read:46.33    Subd. 6.Disclosure statement for inpatient hospital limit.The commissioner 46.34shall develop, and include with MinnesotaCare application and renewal materials, a 46.35disclosure statement that contains the following or similar language: "For adults without 47.1children, and for parents and relative caretakers with family gross income that exceeds 47.2215 percent of the federal poverty guidelines, who are not pregnant, coverage of inpatient 47.3hospital services under MinnesotaCare is subject to an annual limit of $10,000. Enrollees 47.4subject to the limit may be responsible for inpatient hospital costs that exceed the $10,000 47.5annual limit."47.6    Sec. 43. Minnesota Statutes 2008, section 256L.07, is amended by adding a subdivision 47.7to read:47.8    Subd. 9.Firefighters; volunteer ambulance attendants.(a) For purposes of this 47.9subdivision, "qualified individual" means:47.10(1) a volunteer firefighter with a department as defined in section 299N.01, 47.11subdivision 2, who has passed the probationary period; and47.12(2) a volunteer ambulance attendant as defined in section 144E.001, subdivision 15.47.13(b) A qualified individual who documents to the satisfaction of the commissioner 47.14status as a qualified individual by completing and submitting a one-page form developed 47.15by the commissioner is eligible for MinnesotaCare without meeting other eligibility 47.16requirements of this chapter, but must pay premiums equal to the average expected 47.17capitation rate for adults with no children paid under section 256L.12. Individuals eligible 47.18under this subdivision shall receive coverage for the benefit set provided to adults with no 47.19children.47.20    Sec. 44. Minnesota Statutes 2009 Supplement, section 256L.11, subdivision 1, is 47.21amended to read:47.22    Subdivision 1. Medical assistance rate to be used. (a) Payment to providers under 47.23sections 
         256L.01 to 
         256L.11 shall be at the same rates and conditions established for 47.24medical assistance, except as provided in subdivisions 2 to 6.47.25(b) Effective for services provided on or after July 1, 2009, total payments for basic 47.26care services shall be reduced by three percent, in accordance with section 
         256B.766. 47.27Payments made to managed care and county-based purchasing plans shall be reduced for 47.28services provided on or after October 1, 2009, to reflect this reduction.47.29(c) Effective for services provided on or after July 1, 2009, payment rates for 47.30physician and professional services shall be reduced as described under section 
         256B.76, 47.31subdivision 1, paragraph (c). Payments made to managed care and county-based 47.32purchasing plans shall be reduced for services provided on or after October 1, 2009, 47.33to reflect this reduction.48.1(d) Effective for services provided on or after July 1, 2010, payment rates for 48.2physician and professional services shall be reduced as described under section 256B.76, 48.3subdivision 1, paragraph (d). Payments made to managed care plans and county-based 48.4purchasing plans shall be reduced for services provided on or after October 1, 2010, 48.5to reflect this reduction.48.6    Sec. 45. Minnesota Statutes 2008, section 256L.12, subdivision 5, is amended to read:48.7    Subd. 5. Eligibility for other state programs. MinnesotaCare enrollees who 48.8become eligible for medical assistance or general assistance medical care will remain in 48.9the same managed care plan if the managed care plan has a contract for that population. 48.10Effective January 1, 1998, MinnesotaCare enrollees who were formerly eligible for 48.11general assistance medical care pursuant to section 
         256D.03, subdivision 3, within six 48.12months of MinnesotaCare enrollment and were enrolled in a prepaid health plan pursuant 48.13to section 
         256D.03, subdivision 4, paragraph (c), must remain in the same managed care 48.14plan if the managed care plan has a contract for that population. Managed care plans must 48.15participate in the MinnesotaCare and general assistance medical care programsprogram 48.16under a contract with the Department of Human Services in service areas where they 48.17participate in the medical assistance program.  48.18EFFECTIVE DATE.This section is effective retroactively from April 1, 2010.48.19    Sec. 46. Minnesota Statutes 2008, section 256L.12, subdivision 6, is amended to read:48.20    Subd. 6. Co-payments and benefit limits. Enrollees are responsible for all 48.21co-payments in sections 
         256L.03, subdivision 5, and 
         256L.035, and shall pay co-payments 48.22to the managed care plan or to its participating providers. The enrollee is also responsible 48.23for payment of inpatient hospital charges which exceed the MinnesotaCare benefit limit, 48.24unless supplemental hospital coverage has been purchased under subdivision 3c.  48.25EFFECTIVE DATE.This section is effective January 1, 2011, or upon federal 48.26approval, whichever is later.48.27    Sec. 47. Minnesota Statutes 2008, section 256L.12, subdivision 9, is amended to read:48.28    Subd. 9. Rate setting; performance withholds. (a) Rates will be prospective, 48.29per capita, where possible. The commissioner may allow health plans to arrange for 48.30inpatient hospital services on a risk or nonrisk basis. The commissioner shall consult with 48.31an independent actuary to determine appropriate rates.49.1    (b) For services rendered on or after January 1, 2003, to December 31, 2003, the 49.2commissioner shall withhold .5 percent of managed care plan payments under this section 49.3pending completion of performance targets. The withheld funds must be returned no 49.4sooner than July 1 and no later than July 31 of the following year if performance targets 49.5in the contract are achieved. A managed care plan may include as admitted assets under 49.6section 
         62D.044 any amount withheld under this paragraph that is reasonably expected 49.7to be returned. 49.8    (c) For services rendered on or after January 1, 2004, the commissioner shall 49.9withhold five percent of managed care plan payments under this section pending 49.10completion of performance targets. Each performance target must be quantifiable, 49.11objective, measurable, and reasonably attainable, except in the case of a performance target 49.12based on a federal or state law or rule. Criteria for assessment of each performance target 49.13must be outlined in writing prior to the contract effective date. The managed care plan 49.14must demonstrate, to the commissioner's satisfaction, that the data submitted regarding 49.15attainment of the performance target is accurate. The commissioner shall periodically 49.16change the administrative measures used as performance targets in order to improve plan 49.17performance across a broader range of administrative services. The performance targets 49.18must include measurement of plan efforts to contain spending on health care services and 49.19administrative activities. The commissioner may adopt plan-specific performance targets 49.20that take into account factors affecting only one plan, such as characteristics of the plan's 49.21enrollee population. The withheld funds must be returned no sooner than July 1 and no 49.22later than July 31 of the following calendar year if performance targets in the contract are 49.23achieved. A managed care plan or a county-based purchasing plan under section 256B.692 49.24may include as admitted assets under section 62D.044 any amount withheld under this 49.25paragraph that is reasonably expected to be returned.49.26(d) For services rendered on or after January 1, 2011, the commissioner shall 49.27withhold an additional three percent of managed care plan payments under this section. 49.28The withheld funds must be returned no sooner than July 1, and no later than July 31 of 49.29the following calendar year. The return of the withhold under this paragraph is not subject 49.30to the requirements of paragraph (b) or (c).49.31(e) A managed care plan or a county-based purchasing plan under section 256B.692 49.32may include as admitted assets under section 62D.044 any amount withheld under this 49.33section.49.34    Sec. 48. Laws 2009, chapter 79, article 5, section 78, subdivision 5, is amended to read:50.1    Subd. 5. Expiration. This section, with the exception of subdivision 4, expires 50.2December 31, 2010 June 30, 2011. Subdivision 4 expires December 31, 2011.50.3    Sec. 49. Laws 2010, chapter 200, article 1, section 12, subdivision 6, is amended to 50.4read:50.5    Subd. 6. Coordinated care delivery systems. (a) Effective June 1, 2010, the 50.6commissioner shall contract with hospitals or groups of hospitals that qualify under 50.7paragraph (b) and agree to deliver services according to this subdivision. Contracting 50.8hospitals shall develop and implement a coordinated care delivery system to provide health 50.9care services to individuals who are eligible for general assistance medical care under this 50.10section and who either choose to receive services through the coordinated care delivery 50.11system or who are enrolled by the commissioner under paragraph (c). A contracting 50.12hospital may negotiate a limit to the number of general assistance medical care enrollees it 50.13serves, but must comply with the emergency care requirements of United States Code, title 50.1442, 1395dd (EMTALA). The health care services provided by the system must include: 50.15(1) the services described in subdivision 4 with the exception of outpatient prescription 50.16drug coverage but shall include drugs administered in a clinic or other outpatient setting; 50.17or (2) a set of comprehensive and medically necessary health services that the recipients 50.18might reasonably require to be maintained in good health and that has been approved by 50.19the commissioner, including at a minimum, but not limited to, emergency care, medical 50.20transportation services, inpatient hospital and physician care, outpatient health services, 50.21preventive health services, mental health services, and prescription drugs administered 50.22in a clinic or other outpatient setting. Outpatient prescription drug coverage is covered 50.23on a fee-for-service basis in accordance with section 
         256D.03, subdivision 3, and funded 50.24under subdivision 9. A hospital establishing a coordinated care delivery system under this 50.25subdivision must ensure that the requirements of this subdivision are met.50.26(b) A hospital or group of hospitals may contract with the commissioner to develop 50.27and implement a coordinated care delivery system as follows:50.28(1) effective June 1, 2010, a hospital qualifies under this subdivision if: (i) during 50.29calendar year 2008, it received fee-for-service payments for services to general assistance 50.30medical care recipients (A) equal to or greater than $1,500,000, or (B) equal to or greater 50.31than 1.3 percent of net patient revenue; or (ii) a contract with the hospital is necessary to 50.32provide geographic access or to ensure that at least 80 percent of enrollees have access to 50.33a coordinated care delivery system; and51.1(2) effective December 1, 2010, a Minnesota hospital not qualified under clause 51.2(1) may contract with the commissioner under this subdivision if it agrees to satisfy the 51.3requirements of this subdivision.51.4Participation by hospitals shall become effective quarterly on June 1, September 1, 51.5December 1, or March 1. Hospital participation is effective for a period of 12 months and 51.6may be renewed for successive 12-month periods.51.7Coordinated care delivery system contracts are in effect from June 1, 2010, to 51.8December 31, 2010, or upon the effective date of the expansion of medical assistance 51.9coverage to include adults without children, whichever is later.51.10(c) Applicants and recipients may enroll in any available coordinated care delivery 51.11system statewide. If more than one coordinated care delivery system is available, the 51.12applicant or recipient shall be allowed to choose among the systems that provide services 51.13within 25 miles of the individual's community of residence. The commissioner may assign 51.14an applicant or recipient to a coordinated care delivery system that provides services 51.15within 25 miles of the individual's community of residence, if no choice is made by the 51.16applicant or recipient. The commissioner shall consider a recipient's zip code, city of 51.17residence, county of residence, or distance from a participating coordinated care delivery 51.18system when determining default assignment. An applicant or recipient may decline 51.19enrollment in a coordinated care delivery system. Upon enrollment into a coordinated care 51.20delivery system, the recipient must agree to receive all nonemergency services through the 51.21coordinated care delivery system. Enrollment in a coordinated care delivery system is 51.22for six months and may be renewed for additional six-month periods, except that initial 51.23enrollment is for six months or until the end of a recipient's period of general assistance 51.24medical care eligibility, whichever occurs first. A recipient who continues to meet the 51.25eligibility requirements of this section is not eligible to enroll in MinnesotaCare during 51.26a period of enrollment in a coordinated care delivery system. From June 1, 2010, to 51.27November 30, 2010, applicants and recipients not enrolled in a coordinated care delivery 51.28system may seek services from a hospital eligible for reimbursement under the temporary 51.29uncompensated care pool established under subdivision 8. After November 30, 2010, 51.30services are available only through a coordinated care delivery system.51.31(d) A hospital must provide access to cost-effective outpatient services available 51.32in its service area. The hospital may contract and coordinate with providers and clinics 51.33for the delivery of services and shall contract with federally qualified health centers and51.34essential community providers as defined under section 
         62Q.19, subdivision 1, paragraph 51.35(a), clauses (1) and (2), to the extent practicable. If a provider or clinic contracts with a 51.36hospital to provide services through the coordinated care delivery system, the provider 52.1may not refuse to provide services to any recipient enrolled in the system, and payment for 52.2services shall be negotiated with the hospital and paid by the hospital from the system's 52.3allocation under subdivision 7.52.4(e) A coordinated care delivery system must:52.5(1) provide the covered services required under paragraph (a) to recipients enrolled 52.6in the coordinated care delivery system, and comply with the requirements of subdivision 52.74, paragraphs (b) to (g);52.8(2) establish a process to monitor enrollment and ensure the quality of care provided; 52.9and52.10(3) in cooperation with counties, coordinate the delivery of health care services with 52.11existing homeless prevention, supportive housing, and rent subsidy programs and funding 52.12administered by the Minnesota Housing Finance Agency under chapter 462A; and52.13(4) adopt innovative and cost-effective methods of care delivery and coordination, 52.14which may include the use of allied health professionals, telemedicine, patient educators, 52.15care coordinators, and community health workers.52.16(f) The hospital may require a recipient to designate a primary care provider or 52.17a primary care clinic. The hospital may limit the delivery of services to a network of 52.18providers who have contracted with the hospital to deliver services in accordance with 52.19this subdivision, and require a recipient to seek services only within this network. The 52.20hospital may also require a referral to a provider before the service is eligible for payment. 52.21A coordinated care delivery system is not required to provide payment to a provider who 52.22is not employed by or under contract with the system for services provided to a recipient 52.23enrolled in the system, except in cases of an emergency. For purposes of this section, 52.24emergency services are defined in accordance with Code of Federal Regulations, title 52.2542, section 
         438.114 (a).52.26(g) A recipient enrolled in a coordinated care delivery system has the right to appeal 52.27to the commissioner according to section 
         256.045.52.28(h) The state shall not be liable for the payment of any cost or obligation incurred 52.29by the coordinated care delivery system.52.30(i) The hospital must provide the commissioner with data necessary for assessing 52.31enrollment, quality of care, cost, and utilization of services. Each hospital must provide, 52.32on a quarterly basis on a form prescribed by the commissioner for each recipient served by 52.33the coordinated care delivery system, the services provided, the cost of services provided, 52.34and the actual payment amount for the services provided and any other information the 52.35commissioner deems necessary to claim federal Medicaid match. The commissioner must 52.36provide this data to the legislature on a quarterly basis.53.1(j) Effective June 1, 2010, the provisions of section 
         256.9695, subdivision 2, 53.2paragraph (b), do not apply to general assistance medical care provided under this section.53.3(k) If a recipient is transferred from a hospital that is not participating in a 53.4coordinated care delivery system to a hospital participating in a coordinated care delivery 53.5system, in order to receive a higher level of care, the transferring hospital remains eligible 53.6to receive any available funding through the temporary uncompensated care pool for the 53.7care initially provided at that hospital. The hospital participating in the coordinated care 53.8delivery system shall be responsible only for care provided at that hospital, and is not 53.9financially liable for the initial care provided by the transferring hospital.53.10    Sec. 50. Laws 2010, chapter 200, article 1, section 12, subdivision 7, is amended to 53.11read:53.12    Subd. 7. Payments; rate setting for the hospital coordinated care delivery 53.13system. (a) Effective for general assistance medical care services, with the exception 53.14of outpatient prescription drug coverage, provided on or after June 1, 2010, through a 53.15coordinated care delivery system, the commissioner shall allocate the annual appropriation 53.16for the coordinated care delivery system to hospitals participating under subdivision 53.176 in quarterly payments, beginning on the first scheduled warrant on or after June 1, 53.182010. The payment shall be allocated among all hospitals qualified to participate on the 53.19allocation date. Each hospital or group of hospitals shall receive a pro rata share of the 53.20allocation based on the hospital's or group of hospitals' calendar year 2008 payments for 53.21general assistance medical care services, adjusted for any limits on the number of general 53.22assistance medical care enrollees accepted by a hospital, provided that, for the purposes of 53.23this allocation, payments to Hennepin County Medical Center, Regions Hospital, Saint 53.24Mary's Medical Center, and University of Minnesota Medical Center, Fairview, shall be 53.25weighted at 110 percent of the actual amount. The commissioner may prospectively 53.26reallocate payments to participating hospitals on a biannual basis to ensure that final 53.27allocations reflect actual coordinated care delivery system enrollment. The 2008 base year 53.28shall be updated by one calendar year each June 1, beginning June 1, 2011.53.29(b) Beginning June 1, 2010, and every quarter beginning in June thereafter, the 53.30commissioner shall make one-third of the quarterly payment in June and the remaining 53.31two-thirds of the quarterly payment in July to each participating hospital or group of 53.32hospitals.53.33(b) (c) In order to be reimbursed under this section, nonhospital providers of health 53.34care services shall contract with one or more hospitals described in paragraph (a) to 53.35provide services to general assistance medical care recipients through the coordinated care 54.1delivery system established by the hospital. The hospital shall reimburse bills submitted 54.2by nonhospital providers participating under this paragraph at a rate negotiated between 54.3the hospital and the nonhospital provider.54.4(c) (d) The commissioner shall apply for federal matching funds under section 54.5256B.199
         , paragraphs (a) to (d), for expenditures under this subdivision.54.6(d) (e) Outpatient prescription drug coverage is provided in accordance with section 54.7256D.03, subdivision 3
         , and paid on a fee-for-service basis under subdivision 9.54.8    Sec. 51. Laws 2010, chapter 200, article 1, section 12, subdivision 8, is amended to 54.9read:54.10    Subd. 8. Temporary uncompensated care pool. (a) The commissioner shall 54.11establish a temporary uncompensated care pool, effective June 1, 2010. Payments from 54.12the pool must be distributed, within the limits of the available appropriation, to hospitals 54.13that are not part of a coordinated care delivery system established under subdivision 54.146. Payments from the pool must also be distributed, within the limits of the available 54.15appropriation, to ambulance services licensed under chapter 144E that respond to a request 54.16for an emergency ambulance call or interfacility transfer for a general assistance medical 54.17care enrollee, if the call or transfer originates from a location more than 25 miles from the 54.18health care facility that receives the enrollee.54.19(b) Hospitals seeking reimbursement from this pool must submit an invoice to 54.20the commissioner in a form prescribed by the commissioner for payment for services 54.21provided to an applicant or recipient not enrolled in a coordinated care delivery system. A 54.22payment amount, as calculated under current law, must be determined, but not paid, for 54.23each admission of or service provided to a general assistance medical care recipient on 54.24or after June 1, 2010, to November 30 December 31, 2010, or until medical assistance 54.25coverage is expanded to include adults without children, whichever is later.54.26(c) The aggregated payment amounts for each hospital must be calculated as a 54.27percentage of the total calculated amount for all hospitals.54.28(d) Distributions from the uncompensated care pool for each hospital must be 54.29determined by multiplying the factor in paragraph (c) by the amount of money in the 54.30uncompensated care pool that is available for the six-month period.54.31(e) The commissioner shall apply for federal matching funds under section 54.32256B.199
         , paragraphs (a) to (d), for expenditures under this subdivision.54.33(f) Outpatient prescription drugs are not eligible for payment under this subdivision.55.1    Sec. 52. Laws 2010, chapter 200, article 1, section 12, the effective date, is amended to 55.2read:55.3EFFECTIVE DATE.This section is effective for services rendered on or after 55.4April 1, 2010, except that subdivision 4 is effective June 1, 2010.55.5EFFECTIVE DATE.This section is effective retroactively from April 1, 2010.55.6    Sec. 53. Laws 2010, chapter 200, article 1, section 16, is amended to read:55.7    Sec. 16. Minnesota Statutes 2008, section 256L.05, subdivision 3c, is amended to 55.8read:55.9    Subd. 3c. Retroactive coverage. Notwithstanding subdivision 3, the effective 55.10date of coverage shall be the first day of the month following termination from medical 55.11assistance for families and individuals who are eligible for MinnesotaCare and who 55.12submitted a written request for retroactive MinnesotaCare coverage with a completed 55.13application within 30 days of the mailing of notification of termination from medical 55.14assistance. The applicant must provide all required verifications within 30 days of the 55.15written request for verification. For retroactive coverage, premiums must be paid in full 55.16for any retroactive month, current month, and next month within 30 days of the premium 55.17billing. General assistance medical care recipients may qualify for retroactive coverage 55.18under this subdivision at six-month renewal.55.19EFFECTIVE DATE.This section is effective June 1, 2010.55.20    Sec. 54. Laws 2010, chapter 200, article 1, section 21, is amended to read:55.21    Sec. 21. REPEALER.55.22(a) Minnesota Statutes 2008, sections 256.742; 256.979, subdivision 8; and 256D.03, 55.23subdivision 9, are repealed effective April 1, 2010.55.24(b) Minnesota Statutes 2009 Supplement, section 256D.03, subdivision 4, is repealed 55.25effective AprilJune 1, 2010.55.26(c) Minnesota Statutes 2008, section 256B.195, subdivisions 4 and 5, are repealed 55.27effective for federal fiscal year 2010.55.28(d) Minnesota Statutes 2009 Supplement, section 256B.195, subdivisions 1, 2, and 55.293, are repealed effective for federal fiscal year 2010.55.30(e) Minnesota Statutes 2008, sections 256L.07, subdivision 6; 256L.15, subdivision 55.314; and 256L.17, subdivision 7, are repealed January 1, 2011.55.32EFFECTIVE DATE.This section is effective retroactively from April 1, 2010.56.1    Sec. 55. Laws 2010, chapter 200, article 2, section 2, subdivision 1, is amended to read:

56.2Subdivision 1.Total Appropriation$(7,985,000)$(93,128,000)

56.3Appropriations by Fund56.42010201156.5General34,807,000118,493,00056.6Health Care Access(42,792,000)(211,621,000)

56.7The amounts that may be spent for each 56.8purpose are specified in the following 56.9subdivisions.56.10Special Revenue Fund Transfers.56.11(1) The commissioner shall transfer the 56.12following amounts from special revenue 56.13fund balances to the general fund by June 56.1430 of each respective fiscal year: $410,000 56.15for fiscal year 2010, and $412,000 for fiscal 56.16year 2011.56.17(2) Actual transfers made under clause (1) 56.18must be separately identified and reported as 56.19part of the quarterly reporting of transfers 56.20to the chairs of the relevant senate budget 56.21division and house of representatives finance 56.22division.56.23EFFECTIVE DATE.This section is effective the day following final enactment.56.24    Sec. 56. Laws 2010, chapter 200, article 2, section 2, subdivision 8, is amended to read:

56.25Subd. 8.Transfers

56.26The commissioner must transfer $29,538,000 56.27in fiscal year 2010 and $18,462,000 in fiscal 56.28year 2011 from the health care access fund to 56.29the general fund. This is a onetime transfer.56.30The commissioner must transfer $4,800,000 56.31from the consolidated chemical dependency 56.32treatment fund to the general fund by June 56.3330, 2010.57.1Compulsive Gambling Special Revenue57.2Administration.The lottery prize fund 57.3appropriation for compulsive gambling 57.4administration is reduced by $6,000 for fiscal 57.5year 2010 and $4,000 for fiscal year 201157.6must be transferred from the lottery prize 57.7fund appropriation for compulsive gambling 57.8administration to the general fund by June 57.930 of each respective fiscal year. These are 57.10onetime reductions.57.11EFFECTIVE DATE.This section is effective the day following final enactment.57.12    Sec. 57. EARLY EXPANSION.57.13All costs related to implementation of Minnesota Statutes, sections 256B.055, 57.14subdivision 15, and 256B.056, subdivision 4, paragraph (e), shall be paid from the health 57.15care access fund.57.16EFFECTIVE DATE.This section is effective upon federal approval and is 57.17retroactive to April 1, 2010.57.18    Sec. 58. FISCAL AND ACTUARIAL ANALYSIS.57.19The commissioner of human services shall offer a request for proposal and accept 57.20bids for the completion of a complete fiscal and actuarial analysis of 2010 House File 135 57.21and 2010 Senate File 118. The commissioner shall report this analysis to the chairs of the 57.22health and human services finance and policy divisions in the house of representatives and 57.23senate no later than December 15, 2010.57.24    Sec. 59.  REPEALER; TRANSFER.57.25(a) Laws 2010, chapter 200, article 1, section 12, subdivisions 1, 2, 3, 4, 5, 6, 7, 8, 57.26and 9, are repealed.57.27(b) Laws 2010, chapter 200, article 1, sections 18; and 19, are repealed.57.28(c) Minnesota Statutes 2008, section 256D.03, subdivisions 3a, 3b, 5, 6, 7, and 8,57.29and Minnesota Statutes 2009 Supplement, section 256D.03, subdivision 3, are repealed.57.30EFFECTIVE DATE.Paragraphs (a) and (b) are effective 30 days after federal 57.31approval of the amendments in this article to Minnesota Statutes, sections 256B.055, 57.32subdivision 15, and 256B.056, subdivision 4, or January 1, 2011, whichever is later, 58.1and all remaining unspent appropriations for the program established by Laws 2010, 58.2chapter 200, are transferred to the health care access fund. Paragraph (c) is effective 58.330 days after federal approval of the amendments in this article to Minnesota Statutes, 58.4sections 256B.055, subdivision 15, and 256B.056, subdivision 4, or January 1, 2011, 58.5whichever is later.58.6ARTICLE 358.7CONTINUING CARE58.8    Section 1. Minnesota Statutes 2009 Supplement, section 252.27, subdivision 2a, 58.9is amended to read:58.10    Subd. 2a. Contribution amount. (a) The natural or adoptive parents of a minor 58.11child, including a child determined eligible for medical assistance without consideration of 58.12parental income, must contribute to the cost of services used by making monthly payments 58.13on a sliding scale based on income, unless the child is married or has been married, 58.14parental rights have been terminated, or the child's adoption is subsidized according to 58.15section 
         259.67 or through title IV-E of the Social Security Act. The parental contribution 58.16is a partial or full payment for medical services provided for diagnostic, therapeutic, 58.17curing, treating, mitigating, rehabilitation, maintenance, and personal care services as 58.18defined in United States Code, title 26, section 213, needed by the child with a chronic 58.19illness or disability.58.20    (b) For households with adjusted gross income equal to or greater than 100 percent 58.21of federal poverty guidelines, the parental contribution shall be computed by applying the 58.22following schedule of rates to the adjusted gross income of the natural or adoptive parents:58.23    (1) if the adjusted gross income is equal to or greater than 100 percent of federal 58.24poverty guidelines and less than 175 percent of federal poverty guidelines, the parental 58.25contribution is $4 per month;58.26    (2) if the adjusted gross income is equal to or greater than 175 percent of federal 58.27poverty guidelines and less than or equal to 545 percent of federal poverty guidelines, 58.28the parental contribution shall be determined using a sliding fee scale established by the 58.29commissioner of human services which begins at one percent of adjusted gross income 58.30at 175 percent of federal poverty guidelines and increases to 7.5 percent of adjusted 58.31gross income for those with adjusted gross income up to 545 percent of federal poverty 58.32guidelines; and58.33    (3) if the adjusted gross income is greater than 545 percent of federal poverty 58.34guidelines and less than 675 percent of federal poverty guidelines, the parental 58.35contribution shall be 7.512.5 percent of adjusted gross income;.59.1    (4) if the adjusted gross income is equal to or greater than 675 percent of federal 59.2poverty guidelines and less than 975 percent of federal poverty guidelines, the parental 59.3contribution shall be determined using a sliding fee scale established by the commissioner 59.4of human services which begins at 7.5 percent of adjusted gross income at 675 percent of 59.5federal poverty guidelines and increases to ten percent of adjusted gross income for those 59.6with adjusted gross income up to 975 percent of federal poverty guidelines; and59.7    (5) if the adjusted gross income is equal to or greater than 975 percent of federal 59.8poverty guidelines, the parental contribution shall be 12.5 percent of adjusted gross 59.9income.59.10    If the child lives with the parent, the annual adjusted gross income is reduced by 59.11$2,400 prior to calculating the parental contribution. If the child resides in an institution 59.12specified in section 
         256B.35, the parent is responsible for the personal needs allowance 59.13specified under that section in addition to the parental contribution determined under this 59.14section. The parental contribution is reduced by any amount required to be paid directly to 59.15the child pursuant to a court order, but only if actually paid.59.16    (c) The household size to be used in determining the amount of contribution under 59.17paragraph (b) includes natural and adoptive parents and their dependents, including the 59.18child receiving services. Adjustments in the contribution amount due to annual changes 59.19in the federal poverty guidelines shall be implemented on the first day of July following 59.20publication of the changes.59.21    (d) For purposes of paragraph (b), "income" means the adjusted gross income of the 59.22natural or adoptive parents determined according to the previous year's federal tax form, 59.23except, effective retroactive to July 1, 2003, taxable capital gains to the extent the funds 59.24have been used to purchase a home shall not be counted as income.59.25    (e) The contribution shall be explained in writing to the parents at the time eligibility 59.26for services is being determined. The contribution shall be made on a monthly basis 59.27effective with the first month in which the child receives services. Annually upon 59.28redetermination or at termination of eligibility, if the contribution exceeded the cost of 59.29services provided, the local agency or the state shall reimburse that excess amount to 59.30the parents, either by direct reimbursement if the parent is no longer required to pay a 59.31contribution, or by a reduction in or waiver of parental fees until the excess amount is 59.32exhausted. All reimbursements must include a notice that the amount reimbursed may be 59.33taxable income if the parent paid for the parent's fees through an employer's health care 59.34flexible spending account under the Internal Revenue Code, section 125, and that the 59.35parent is responsible for paying the taxes owed on the amount reimbursed.60.1    (f) The monthly contribution amount must be reviewed at least every 12 months; 60.2when there is a change in household size; and when there is a loss of or gain in income 60.3from one month to another in excess of ten percent. The local agency shall mail a written 60.4notice 30 days in advance of the effective date of a change in the contribution amount. 60.5A decrease in the contribution amount is effective in the month that the parent verifies a 60.6reduction in income or change in household size.60.7    (g) Parents of a minor child who do not live with each other shall each pay the 60.8contribution required under paragraph (a). An amount equal to the annual court-ordered 60.9child support payment actually paid on behalf of the child receiving services shall be 60.10deducted from the adjusted gross income of the parent making the payment prior to 60.11calculating the parental contribution under paragraph (b).60.12    (h) The contribution under paragraph (b) shall be increased by an additional five 60.13percent if the local agency determines that insurance coverage is available but not 60.14obtained for the child. For purposes of this section, "available" means the insurance is a 60.15benefit of employment for a family member at an annual cost of no more than five percent 60.16of the family's annual income. For purposes of this section, "insurance" means health 60.17and accident insurance coverage, enrollment in a nonprofit health service plan, health 60.18maintenance organization, self-insured plan, or preferred provider organization.60.19    Parents who have more than one child receiving services shall not be required 60.20to pay more than the amount for the child with the highest expenditures. There shall 60.21be no resource contribution from the parents. The parent shall not be required to pay 60.22a contribution in excess of the cost of the services provided to the child, not counting 60.23payments made to school districts for education-related services. Notice of an increase in 60.24fee payment must be given at least 30 days before the increased fee is due.60.25    (i) The contribution under paragraph (b) shall be reduced by $300 per fiscal year if, 60.26in the 12 months prior to July 1:60.27    (1) the parent applied for insurance for the child;60.28    (2) the insurer denied insurance;60.29    (3) the parents submitted a complaint or appeal, in writing to the insurer, submitted 60.30a complaint or appeal, in writing, to the commissioner of health or the commissioner of 60.31commerce, or litigated the complaint or appeal; and60.32    (4) as a result of the dispute, the insurer reversed its decision and granted insurance.60.33    For purposes of this section, "insurance" has the meaning given in paragraph (h).60.34    A parent who has requested a reduction in the contribution amount under this 60.35paragraph shall submit proof in the form and manner prescribed by the commissioner or 60.36county agency, including, but not limited to, the insurer's denial of insurance, the written 61.1letter or complaint of the parents, court documents, and the written response of the insurer 61.2approving insurance. The determinations of the commissioner or county agency under this 61.3paragraph are not rules subject to chapter 14.61.4    Sec. 2. Minnesota Statutes 2008, section 256B.057, subdivision 9, is amended to read:61.5    Subd. 9. Employed persons with disabilities. (a) Medical assistance may be paid 61.6for a person who is employed and who:61.7(1) but for excess earnings or assets, meets the definition of disabled under the 61.8supplemental security income program;61.9(2) is at least 16 but less than 65 years of age;61.10(3) meets the asset limits in paragraph (c); and61.11(4) effective November 1, 2003, pays a premium and other obligations under 61.12paragraph (e).61.13Any spousal income or assets shall be disregarded for purposes of eligibility and premium 61.14determinations.61.15(b) After the month of enrollment, a person enrolled in medical assistance under 61.16this subdivision who:61.17(1) is temporarily unable to work and without receipt of earned income due to a 61.18medical condition, as verified by a physician, may retain eligibility for up to four calendar 61.19months; or61.20(2) effective January 1, 2004, loses employment for reasons not attributable to the 61.21enrollee, may retain eligibility for up to four consecutive months after the month of job 61.22loss. To receive a four-month extension, enrollees must verify the medical condition or 61.23provide notification of job loss. All other eligibility requirements must be met and the 61.24enrollee must pay all calculated premium costs for continued eligibility.61.25(c) For purposes of determining eligibility under this subdivision, a person's assets 61.26must not exceed $20,000, excluding:61.27(1) all assets excluded under section 
         256B.056;61.28(2) retirement accounts, including individual accounts, 401(k) plans, 403(b) plans, 61.29Keogh plans, and pension plans; and61.30(3) medical expense accounts set up through the person's employer.61.31(d)(1) Effective January 1, 2004, for purposes of eligibility, there will be a $65 61.32earned income disregard. To be eligible, a person applying for medical assistance under 61.33this subdivision must have earned income above the disregard level.62.1(2) Effective January 1, 2004, to be considered earned income, Medicare, Social 62.2Security, and applicable state and federal income taxes must be withheld. To be eligible, 62.3a person must document earned income tax withholding.62.4(e)(1) A person whose earned and unearned income is equal to or greater than 100 62.5percent of federal poverty guidelines for the applicable family size must pay a premium 62.6to be eligible for medical assistance under this subdivision. The premium shall be based 62.7on the person's gross earned and unearned income and the applicable family size using a 62.8sliding fee scale established by the commissioner, which begins at one percent of income 62.9at 100 percent of the federal poverty guidelines and increases to 7.5 percent of income 62.10for those with incomes at or above 300 percent of the federal poverty guidelines. Annual 62.11adjustments in the premium schedule based upon changes in the federal poverty guidelines 62.12shall be effective for premiums due in July of each year.62.13(2) Effective January 1, 2004, all enrollees must pay a premium to be eligible for 62.14medical assistance under this subdivision. An enrollee shall pay the greater of a $35 $5062.15premium or the premium calculated in clause (1).62.16(3) Effective November 1, 2003, all enrollees who receive unearned income must 62.17pay one-half of one 2.5 percent of unearned income in addition to the premium amount.62.18(4) Effective November 1, 2003, for enrollees whose income does not exceed 200 62.19percent of the federal poverty guidelines and who are also enrolled in Medicare, the 62.20commissioner must reimburse the enrollee for Medicare Part B premiums under section 62.21256B.0625, subdivision 15
         , paragraph (a).62.22(5) Increases in benefits under title II of the Social Security Act shall not be counted 62.23as income for purposes of this subdivision until July 1 of each year.62.24(f) A person's eligibility and premium shall be determined by the local county 62.25agency. Premiums must be paid to the commissioner. All premiums are dedicated to 62.26the commissioner.62.27(g) Any required premium shall be determined at application and redetermined at 62.28the enrollee's six-month income review or when a change in income or household size is 62.29reported. Enrollees must report any change in income or household size within ten days 62.30of when the change occurs. A decreased premium resulting from a reported change in 62.31income or household size shall be effective the first day of the next available billing month 62.32after the change is reported. Except for changes occurring from annual cost-of-living 62.33increases, a change resulting in an increased premium shall not affect the premium amount 62.34until the next six-month review.63.1(h) Premium payment is due upon notification from the commissioner of the 63.2premium amount required. Premiums may be paid in installments at the discretion of 63.3the commissioner.63.4(i) Nonpayment of the premium shall result in denial or termination of medical 63.5assistance unless the person demonstrates good cause for nonpayment. Good cause exists 63.6if the requirements specified in Minnesota Rules, part 9506.0040, subpart 7, items B to 63.7D, are met. Except when an installment agreement is accepted by the commissioner, 63.8all persons disenrolled for nonpayment of a premium must pay any past due premiums 63.9as well as current premiums due prior to being reenrolled. Nonpayment shall include 63.10payment with a returned, refused, or dishonored instrument. The commissioner may 63.11require a guaranteed form of payment as the only means to replace a returned, refused, 63.12or dishonored instrument.63.13(j) The commissioner shall notify enrollees annually beginning at least 24 months 63.14before the person's 65th birthday of the medical assistance eligibility rules affecting 63.15income, assets, and treatment of a spouse's income and assets that will be applied upon 63.16reaching age 65.63.17EFFECTIVE DATE.This section is effective January 1, 2011.63.18    Sec. 3. Minnesota Statutes 2009 Supplement, section 256B.0915, subdivision 3a, 63.19is amended to read:63.20    Subd. 3a. Elderly waiver cost limits. (a) The monthly limit for the cost of 63.21waivered services to an individual elderly waiver client except for individuals described 63.22in paragraph (b) shall be the weighted average monthly nursing facility rate of the case 63.23mix resident class to which the elderly waiver client would be assigned under Minnesota 63.24Rules, parts 9549.0050 to 9549.0059, less the recipient's maintenance needs allowance 63.25as described in subdivision 1d, paragraph (a), until the first day of the state fiscal year in 63.26which the resident assessment system as described in section 
         256B.438 for nursing home 63.27rate determination is implemented. Effective on the first day of the state fiscal year in 63.28which the resident assessment system as described in section 
         256B.438 for nursing home 63.29rate determination is implemented and the first day of each subsequent state fiscal year, the 63.30monthly limit for the cost of waivered services to an individual elderly waiver client shall 63.31be the rate of the case mix resident class to which the waiver client would be assigned 63.32under Minnesota Rules, parts 9549.0050 to 9549.0059, in effect on the last day of the 63.33previous state fiscal year, adjusted by the greater of any legislatively adopted home and 63.34community-based services percentage rate increase or the average statewide percentage 63.35increase in nursing facility payment rates adjustment.64.1    (b) The monthly limit for the cost of waivered services to an individual elderly 64.2waiver client assigned to a case mix classification A under paragraph (a) with (1) no 64.3dependencies in activities of daily living, (2) only one dependency in bathing, dressing, 64.4grooming, or walking, or (3) a dependency score of less than three if eating is the only 64.5dependency, shall be the lower of the case mix classification amount for case mix A as 64.6determined under paragraph (a) or the case mix classification amount for case mix A 64.7effective on October 1, 2008, per month for all new participants enrolled in the program 64.8on or after July 1, 2009. This monthly limit shall be applied to all other participants who 64.9meet this criteria at reassessment.64.10(c) If extended medical supplies and equipment or environmental modifications are 64.11or will be purchased for an elderly waiver client, the costs may be prorated for up to 64.1212 consecutive months beginning with the month of purchase. If the monthly cost of a 64.13recipient's waivered services exceeds the monthly limit established in paragraph (a) or 64.14(b), the annual cost of all waivered services shall be determined. In this event, the annual 64.15cost of all waivered services shall not exceed 12 times the monthly limit of waivered 64.16services as described in paragraph (a) or (b).64.17    Sec. 4. Minnesota Statutes 2008, section 256B.0915, subdivision 3b, is amended to 64.18read:64.19    Subd. 3b. Cost limits for elderly waiver applicants who reside in a nursing 64.20facility. (a) For a person who is a nursing facility resident at the time of requesting a 64.21determination of eligibility for elderly waivered services, a monthly conversion limit for 64.22the cost of elderly waivered services may be requested. The monthly conversion limit for 64.23the cost of elderly waiver services shall be the resident class assigned under Minnesota 64.24Rules, parts 9549.0050 to 9549.0059, for that resident in the nursing facility where 64.25the resident currently resides until July 1 of the state fiscal year in which the resident 64.26assessment system as described in section 
         256B.438 for nursing home rate determination 64.27is implemented. Effective on July 1 of the state fiscal year in which the resident 64.28assessment system as described in section 
         256B.438 for nursing home rate determination 64.29is implemented, the monthly conversion limit for the cost of elderly waiver services shall 64.30be the per diem nursing facility rate as determined by the resident assessment system as 64.31described in section 
         256B.438 for that residentresidents in the nursing facility where the 64.32resident currently resides, but in effect on June 30, 2010, and adjusted annually by any 64.33legislatively adopted percentage change in the elderly waiver services rates. That per 64.34diem shall be multiplied by 365 and, divided by 12, lessand reduced by the recipient's 64.35maintenance needs allowance as described in subdivision 1d. The initially approved 65.1conversion rate maymust be adjusted by the greater of any subsequent legislatively 65.2adopted home and community-based services percentage rate increase or the average 65.3statewide percentage increase in nursing facility payment rates adjustment. The limit 65.4under this subdivision only applies to persons discharged from a nursing facility after a 65.5minimum 30-day stay and found eligible for waivered services on or after July 1, 1997. 65.6For conversions from the nursing home to the elderly waiver with consumer directed 65.7community support services, the conversion rate limit is equal to the nursing facility rate 65.8reduced by a percentage equal to the percentage difference between the consumer directed 65.9services budget limit that would be assigned according to the federally approved waiver 65.10plan and the corresponding community case mix cap, but not to exceed 50 percent.65.11    (b) The following costs must be included in determining the total monthly costs 65.12for the waiver client:65.13    (1) cost of all waivered services, including extended medicalspecialized supplies 65.14and equipment and environmental modifications andaccessibility adaptations; and65.15    (2) cost of skilled nursing, home health aide, and personal care services reimbursable 65.16by medical assistance.65.17    Sec. 5. Minnesota Statutes 2009 Supplement, section 256B.69, subdivision 23, is 65.18amended to read:65.19    Subd. 23. Alternative services; elderly and disabled persons. (a) The 65.20commissioner may implement demonstration projects to create alternative integrated 65.21delivery systems for acute and long-term care services to elderly persons and persons 65.22with disabilities as defined in section 
         256B.77, subdivision 7a, that provide increased 65.23coordination, improve access to quality services, and mitigate future cost increases. 65.24The commissioner may seek federal authority to combine Medicare and Medicaid 65.25capitation payments for the purpose of such demonstrations and may contract with 65.26Medicare-approved special needs plans to provide Medicaid services. Medicare funds and 65.27services shall be administered according to the terms and conditions of the federal contract 65.28and demonstration provisions. For the purpose of administering medical assistance funds, 65.29demonstrations under this subdivision are subject to subdivisions 1 to 22. The provisions 65.30of Minnesota Rules, parts 
         9500.1450 to 
         9500.1464, apply to these demonstrations, 65.31with the exceptions of parts 
         9500.1452, subpart 2, item B; and 
         9500.1457, subpart 1, 65.32items B and C, which do not apply to persons enrolling in demonstrations under this 65.33section. An initial open enrollment period may be provided. Persons who disenroll from 65.34demonstrations under this subdivision remain subject to Minnesota Rules, parts 9500.1450 65.35to 9500.1464. When a person is enrolled in a health plan under these demonstrations and 66.1the health plan's participation is subsequently terminated for any reason, the person shall 66.2be provided an opportunity to select a new health plan and shall have the right to change 66.3health plans within the first 60 days of enrollment in the second health plan. Persons 66.4required to participate in health plans under this section who fail to make a choice of 66.5health plan shall not be randomly assigned to health plans under these demonstrations. 66.6Notwithstanding section 
         256L.12, subdivision 5, and Minnesota Rules, part 
         9505.5220, 66.7subpart 1, item A, if adopted, for the purpose of demonstrations under this subdivision, 66.8the commissioner may contract with managed care organizations, including counties, to 66.9serve only elderly persons eligible for medical assistance, elderly and disabled persons, or 66.10disabled persons only. For persons with a primary diagnosis of developmental disability, 66.11serious and persistent mental illness, or serious emotional disturbance, the commissioner 66.12must ensure that the county authority has approved the demonstration and contracting 66.13design. Enrollment in these projects for persons with disabilities shall be voluntary. The 66.14commissioner shall not implement any demonstration project under this subdivision for 66.15persons with a primary diagnosis of developmental disabilities, serious and persistent 66.16mental illness, or serious emotional disturbance, without approval of the county board of 66.17the county in which the demonstration is being implemented.66.18    (b) Notwithstanding chapter 245B, sections 
         252.40 to 
         252.46, 
         256B.092, 
         256B.501 66.19to 
         256B.5015, and Minnesota Rules, parts 9525.0004 to 9525.0036, 9525.1200 to 66.209525.1330, 9525.1580, and 9525.1800 to 9525.1930, the commissioner may implement 66.21under this section projects for persons with developmental disabilities. The commissioner 66.22may capitate payments for ICF/MR services, waivered services for developmental 66.23disabilities, including case management services, day training and habilitation and 66.24alternative active treatment services, and other services as approved by the state and by the 66.25federal government. Case management and active treatment must be individualized and 66.26developed in accordance with a person-centered plan. Costs under these projects may not 66.27exceed costs that would have been incurred under fee-for-service. Beginning July 1, 2003, 66.28and until four years after the pilot project implementation date, subcontractor participation 66.29in the long-term care developmental disability pilot is limited to a nonprofit long-term 66.30care system providing ICF/MR services, home and community-based waiver services, 66.31and in-home services to no more than 120 consumers with developmental disabilities in 66.32Carver, Hennepin, and Scott Counties. The commissioner shall report to the legislature 66.33prior to expansion of the developmental disability pilot project. This paragraph expires 66.34four years after the implementation date of the pilot project.66.35    (c) Before implementation of a demonstration project for disabled persons, the 66.36commissioner must provide information to appropriate committees of the house of 67.1representatives and senate and must involve representatives of affected disability groups 67.2in the design of the demonstration projects.67.3    (d) A nursing facility reimbursed under the alternative reimbursement methodology 67.4in section 
         256B.434 may, in collaboration with a hospital, clinic, or other health care entity 67.5provide services under paragraph (a). The commissioner shall amend the state plan and 67.6seek any federal waivers necessary to implement this paragraph.67.7    (e) The commissioner, in consultation with the commissioners of commerce and 67.8health, may approve and implement programs for all-inclusive care for the elderly (PACE) 67.9according to federal laws and regulations governing that program and state laws or rules 67.10applicable to participating providers. The process for approval of these programs shall 67.11begin only after the commissioner receives grant money in an amount sufficient to cover 67.12the state share of the administrative and actuarial costs to implement the programs during 67.13state fiscal years 2006 and 2007. Grant amounts for this purpose shall be deposited in an 67.14account in the special revenue fund and are appropriated to the commissioner to be used 67.15solely for the purpose of PACE administrative and actuarial costs. A PACE provider is 67.16not required to be licensed or certified as a health plan company as defined in section 67.1762Q.01, subdivision 4
         . Persons age 55 and older who have been screened by the county 67.18and found to be eligible for services under the elderly waiver or community alternatives 67.19for disabled individuals or who are already eligible for Medicaid but meet level of 67.20care criteria for receipt of waiver services may choose to enroll in the PACE program. 67.21Medicare and Medicaid services will be provided according to this subdivision and 67.22federal Medicare and Medicaid requirements governing PACE providers and programs. 67.23PACE enrollees will receive Medicaid home and community-based services through the 67.24PACE provider as an alternative to services for which they would otherwise be eligible 67.25through home and community-based waiver programs and Medicaid State Plan Services. 67.26The commissioner shall establish Medicaid rates for PACE providers that do not exceed 67.27costs that would have been incurred under fee-for-service or other relevant managed care 67.28programs operated by the state.67.29    (f) The commissioner shall seek federal approval to expand the Minnesota disability 67.30health options (MnDHO) program established under this subdivision in stages, first to 67.31regional population centers outside the seven-county metro area and then to all areas of 67.32the state. Until July 1, 2009, expansion for MnDHO projects that include home and 67.33community-based services is limited to the two projects and service areas in effect on 67.34March 1, 2006. Enrollment in integrated MnDHO programs that include home and 67.35community-based services shall remain voluntary. Costs for home and community-based 67.36services included under MnDHO must not exceed costs that would have been incurred 68.1under the fee-for-service program. Notwithstanding whether expansion occurs under 68.2this paragraph, in determining MnDHO payment rates and risk adjustment methods for 68.3contract years starting in 2012, the commissioner must consider the methods used to 68.4determine county allocations for home and community-based program participants. If 68.5necessary to reduce MnDHO rates to comply with the provision regarding MnDHO costs 68.6for home and community-based services, the commissioner shall achieve the reduction by 68.7maintaining the base rate for contract years 2010 and 2011 for services provided under the 68.8community alternatives for disabled individuals waiver at the same level as for contract 68.9year 2009. The commissioner may apply other reductions to MnDHO rates to implement 68.10decreases in provider payment rates required by state law. In developing program 68.11specifications for expansion of integrated programs, the commissioner shall involve and 68.12consult the state-level stakeholder group established in subdivision 28, paragraph (d), 68.13including consultation on whether and how to include home and community-based waiver 68.14programs. Plans for further expansion of MnDHO projects shall be presented to the chairs 68.15of the house of representatives and senate committees with jurisdiction over health and 68.16human services policy and finance by February 1, 2007.68.17    (g) Notwithstanding section 
         256B.0261, health plans providing services under this 68.18section are responsible for home care targeted case management and relocation targeted 68.19case management. Services must be provided according to the terms of the waivers and 68.20contracts approved by the federal government.68.21    Sec. 6. CASE MANAGEMENT REFORM.68.22(a) By February 1, 2011, the commissioner of human services shall provide specific 68.23recommendations and language for proposed legislation to:68.24(1) define the administrative and the service functions of case management and make 68.25changes to improve the funding for administrative functions;68.26(2) standardize and simplify processes, standards, and timelines for administrative 68.27functions of case management within the Department of Human Services, Disability 68.28Services Division, including eligibility determinations, resource allocation, management 68.29of dollars, provision for assignment of one case manager at a time per person, waiting lists, 68.30quality assurance, host county concurrence requirements, county of financial responsibility 68.31provisions, and waiver compliance; and68.32(3) increase opportunities for consumer choice of case management functions 68.33involving service coordination.68.34(b) In developing these recommendations, the commissioner shall consider the 68.35recommendations of the 2007 Redesigning Case Management Services for Persons 69.1with Disabilities report and consult with existing stakeholder groups, which include 69.2representatives of counties, disability and senior advocacy groups, service providers, and 69.3representatives of agencies which provide contracted case management.69.4EFFECTIVE DATE.This section is effective the day following final enactment.69.5    Sec. 7. [256.4825] REPORT REGARDING PROGRAMS AND SERVICES FOR 69.6PEOPLE WITH DISABILITIES.69.7The Minnesota State Council on Disability, the Minnesota Consortium for Citizens 69.8with Disabilities, and the Arc of Minnesota may submit an annual report by January 15 of 69.9each year, beginning in 2012, to the chairs and ranking minority members of the legislative 69.10committees with jurisdiction over programs serving people with disabilities as provided in 69.11this section. The report must describe the existing state policies and goals for programs 69.12serving people with disabilities including, but not limited to, programs for employment, 69.13transportation, housing, education, quality assurance, consumer direction, physical and 69.14programmatic access, and health. The report must provide data and measurements to 69.15assess the extent to which the policies and goals are being met. The commissioner of 69.16human services and the commissioners of other state agencies administering programs for 69.17people with disabilities shall cooperate with the Minnesota State Council on Disability, 69.18the Minnesota Consortium for Citizens with Disabilities, and the Arc of Minnesota and 69.19provide those organizations with existing published information and reports that will assist 69.20in the preparation of the report.69.21    Sec. 8. COMMISSIONER TO SEEK FEDERAL MATCH.69.22(a) The commissioner of human services shall seek federal financial participation 69.23for eligible activity related to fiscal years 2010 and 2011 grants to Advocating Change 69.24Together to establish a statewide self-advocacy network for persons with developmental 69.25disabilities and for eligible activities under any future grants to the organization.69.26(b) The commissioner shall report to the chairs of the senate Health and Human 69.27Services Budget Division and the house of representatives Health Care and Human 69.28Services Finance Division by December 15, 2010, with the results of the application for 69.29federal matching funds.70.1ARTICLE 470.2CHILDREN AND FAMILY SERVICES70.3    Section 1. Minnesota Statutes 2008, section 256D.0515, is amended to read:70.4256D.0515 ASSET LIMITATIONS FOR FOOD STAMP HOUSEHOLDS.70.5All food stamp households must be determined eligible for the benefit discussed 70.6under section 
         256.029. Food stamp households must demonstrate that:70.7(1) their gross income meets the federal Food Stamp requirements under United70.8States Code, title 7, section 2014(c); andis equal to or less than 165 percent of the federal 70.9poverty guidelines for the same family size.70.10(2) they have financial resources, excluding vehicles, of less than $7,000.70.11    Sec. 2. Minnesota Statutes 2008, section 256J.20, subdivision 3, is amended to read:70.12    Subd. 3. Other property limitations. To be eligible for MFIP, the equity value of 70.13all nonexcluded real and personal property of the assistance unit must not exceed $2,000 70.14for applicants and $5,000 for ongoing participants. The value of assets in clauses (1) to 70.15(19) must be excluded when determining the equity value of real and personal property:70.16    (1) a licensed vehicle up to a loan value of less than or equal to $15,000 $7,500. If the 70.17assistance unit owns more than one licensed vehicle, the county agency shall determine the 70.18loan value of all additional vehicles and exclude the combined loan value of less than or 70.19equal to $7,500. The county agency shall apply any excess loan value as if it were equity 70.20value to the asset limit described in this section,. If the assistance unit owns more than 70.21one licensed vehicle, the county agency shall determine the vehicle with the highest loan 70.22value and count only the loan value over $7,500, excluding: (i) the value of one vehicle 70.23per physically disabled person when the vehicle is needed to transport the disabled unit 70.24member; this exclusion does not apply to mentally disabled people; (ii) the value of special 70.25equipment for a disabled member of the assistance unit; and (iii) any vehicle used for 70.26long-distance travel, other than daily commuting, for the employment of a unit member.70.27    The county agency shall count the loan value of all other vehicles and apply this 70.28amount as if it were equity value to the asset limit described in this section. To establish the 70.29loan value of vehicles, a county agency must use the N.A.D.A. Official Used Car Guide, 70.30Midwest Edition, for newer model cars. When a vehicle is not listed in the guidebook, 70.31or when the applicant or participant disputes the loan value listed in the guidebook as 70.32unreasonable given the condition of the particular vehicle, the county agency may require 70.33the applicant or participant document the loan value by securing a written statement from 70.34a motor vehicle dealer licensed under section 
         168.27, stating the amount that the dealer 71.1would pay to purchase the vehicle. The county agency shall reimburse the applicant or 71.2participant for the cost of a written statement that documents a lower loan value; 71.3    (2) the value of life insurance policies for members of the assistance unit;71.4    (3) one burial plot per member of an assistance unit;71.5    (4) the value of personal property needed to produce earned income, including 71.6tools, implements, farm animals, inventory, business loans, business checking and 71.7savings accounts used at least annually and used exclusively for the operation of a 71.8self-employment business, and any motor vehicles if at least 50 percent of the vehicle's use 71.9is to produce income and if the vehicles are essential for the self-employment business;71.10    (5) the value of personal property not otherwise specified which is commonly 71.11used by household members in day-to-day living such as clothing, necessary household 71.12furniture, equipment, and other basic maintenance items essential for daily living;71.13    (6) the value of real and personal property owned by a recipient of Supplemental 71.14Security Income or Minnesota supplemental aid;71.15    (7) the value of corrective payments, but only for the month in which the payment 71.16is received and for the following month;71.17    (8) a mobile home or other vehicle used by an applicant or participant as the 71.18applicant's or participant's home;71.19    (9) money in a separate escrow account that is needed to pay real estate taxes or 71.20insurance and that is used for this purpose;71.21    (10) money held in escrow to cover employee FICA, employee tax withholding, 71.22sales tax withholding, employee worker compensation, business insurance, property rental, 71.23property taxes, and other costs that are paid at least annually, but less often than monthly;71.24    (11) monthly assistance payments for the current month's or short-term emergency 71.25needs under section 
         256J.626, subdivision 2; 71.26    (12) the value of school loans, grants, or scholarships for the period they are 71.27intended to cover;71.28    (13) payments listed in section 
         256J.21, subdivision 2, clause (9), which are held 71.29in escrow for a period not to exceed three months to replace or repair personal or real 71.30property; 71.31    (14) income received in a budget month through the end of the payment month;71.32    (15) savings from earned income of a minor child or a minor parent that are set aside 71.33in a separate account designated specifically for future education or employment costs;71.34    (16) the federal earned income credit, Minnesota working family credit, state and 71.35federal income tax refunds, state homeowners and renters credits under chapter 290A, 72.1property tax rebates and other federal or state tax rebates in the month received and the 72.2following month;72.3    (17) payments excluded under federal law as long as those payments are held in a 72.4separate account from any nonexcluded funds;72.5    (18) the assets of children ineligible to receive MFIP benefits because foster care or 72.6adoption assistance payments are made on their behalf; and72.7    (19) the assets of persons whose income is excluded under section 
         256J.21, 72.8subdivision 2
         , clause (43). 72.9EFFECTIVE DATE.This section is effective October 1, 2010.72.10    Sec. 3. Minnesota Statutes 2008, section 256J.24, subdivision 10, is amended to read:72.11    Subd. 10. MFIP exit level. The commissioner shall adjust the MFIP earned income 72.12disregard to ensure that most participants do not lose eligibility for MFIP until their 72.13income reaches at least 115 110 percent of the federal poverty guidelines in effect in 72.14October of each fiscal year at the time of the adjustment. The adjustment to the disregard 72.15shall be based on a household size of three, and the resulting earned income disregard 72.16percentage must be applied to all household sizes. The adjustment under this subdivision 72.17must be implemented at the same time as the October food stamp or whenever there is a72.18food support cost-of-living adjustment is reflected in the food portion of MFIP transitional 72.19standard as required under subdivision 5a.72.20EFFECTIVE DATE.This section is effective October 1, 2010.72.21    Sec. 4. Minnesota Statutes 2008, section 256J.37, subdivision 3a, is amended to read:72.22    Subd. 3a. Rental subsidies; unearned income. (a) Effective July 1, 2003, The 72.23county agency shall count $50$100 of the value of public and assisted rental subsidies 72.24provided through the Department of Housing and Urban Development (HUD) as unearned 72.25income to the cash portion of the MFIP grant. The full amount of the subsidy must be 72.26counted as unearned income when the subsidy is less than $50 $100. The income from 72.27this subsidy shall be budgeted according to section 
         256J.34. 72.28(b) The provisions of this subdivision shall not apply to an MFIP assistance unit 72.29which includes a participant who is:72.30(1) age 60 or older;72.31(2) a caregiver who is suffering from an illness, injury, or incapacity that has been 72.32certified by a qualified professional when the illness, injury, or incapacity is expected 73.1to continue for more than 30 days and prevents the person from obtaining or retaining 73.2employment; or73.3(3) a caregiver whose presence in the home is required due to the illness or 73.4incapacity of another member in the assistance unit, a relative in the household, or a foster 73.5child in the household when the illness or incapacity and the need for the participant's 73.6presence in the home has been certified by a qualified professional and is expected to 73.7continue for more than 30 days.73.8(c) The provisions of this subdivision shall not apply to an MFIP assistance unit 73.9where the parental caregiver is an SSI recipient.73.10(d) Prior to implementing this provision, the commissioner must identify the MFIP 73.11participants subject to this provision and provide written notice to these participants at 73.12least 30 days before the first grant reduction. The notice must inform the participant of the 73.13basis for the potential grant reduction, the exceptions to the provision, if any, and inform 73.14the participant of the steps necessary to claim an exception. A person who is found not to 73.15meet one of the exceptions to the provision must be notified and informed of the right to a 73.16fair hearing under section 
         256J.40. The notice must also inform the participant that the 73.17participant may be eligible for a rent reduction resulting from a reduction in the MFIP 73.18grant and encourage the participant to contact the local housing authority. 73.19EFFECTIVE DATE.This section is effective October 1, 2010.73.20    Sec. 5. Minnesota Statutes 2009 Supplement, section 256J.425, subdivision 3, is 73.21amended to read:73.22    Subd. 3. Hard-to-employ participants. (a) An assistance unit subject to the time 73.23limit in section 
         256J.42, subdivision 1, is eligible to receive months of assistance under 73.24a hardship extension if the participant who reached the time limit belongs to any of the 73.25following groups: 73.26    (1) a person who is diagnosed by a licensed physician, psychological practitioner, or 73.27other qualified professional, as developmentally disabled or mentally ill, and the condition 73.28severely limits the person's ability to obtain or maintain suitable employment;73.29    (2) a person who:73.30    (i) has been assessed by a vocational specialist or the county agency to be 73.31unemployable for purposes of this subdivision; or73.32    (ii) has an IQ below 80 who has been assessed by a vocational specialist or a county 73.33agency to be employable, but the condition severely limits the person's ability to obtain or 73.34maintain suitable employment. The determination of IQ level must be made by a qualified 73.35professional. In the case of a non-English-speaking person: (A) the determination must 74.1be made by a qualified professional with experience conducting culturally appropriate 74.2assessments, whenever possible; (B) the county may accept reports that identify an 74.3IQ range as opposed to a specific score; (C) these reports must include a statement of 74.4confidence in the results;74.5    (3) a person who is determined by a qualified professional to be learning disabled, 74.6and the condition severely limits the person's ability to obtain or maintain suitable 74.7employment. For purposes of the initial approval of a learning disability extension, the 74.8determination must have been made or confirmed within the previous 12 months. In the 74.9case of a non-English-speaking person: (i) the determination must be made by a qualified 74.10professional with experience conducting culturally appropriate assessments, whenever 74.11possible; and (ii) these reports must include a statement of confidence in the results. If a 74.12rehabilitation plan for a participant extended as learning disabled is developed or approved 74.13by the county agency, the plan must be incorporated into the employment plan. However, 74.14a rehabilitation plan does not replace the requirement to develop and comply with an 74.15employment plan under section 
         256J.521; or 74.16    (4) a person who has been granted a family violence waiver, and who is complying 74.17with an employment plan under section 
         256J.521, subdivision 3. 74.18    (b) For purposes of this section chapter, "severely limits the person's ability to obtain 74.19or maintain suitable employment" means: 74.20    (1) that a qualified professional has determined that the person's condition prevents 74.21the person from working 20 or more hours per week; or 74.22    (2) for a person who meets the requirements of paragraph (a), clause (2), item (ii), or 74.23clause (3), a qualified professional has determined the person's condition:74.24    (i) significantly restricts the range of employment that the person is able to perform; 74.25or 74.26    (ii) significantly interferes with the person's ability to obtain or maintain suitable 74.27employment for 20 or more hours per week.74.28ARTICLE 574.29MISCELLANEOUS74.30    Section 1. Minnesota Statutes 2008, section 3.971, subdivision 2, is amended to read:74.31    Subd. 2.  Staff; compensation. The legislative auditor shall establish a Financial 74.32Audits Division and a Program Evaluation Division to fulfill the duties prescribed in 74.33this section. The legislative auditor shall establish a Legislative Budget Office Division 74.34to fulfill the duties in section 3.98, subdivision 5. Each division may be supervised by a 74.35deputy auditor, appointed by the legislative auditor, with the approval of the commission, 75.1for a term coterminous with the legislative auditor's term. The deputy auditors may be 75.2removed before the expiration of their terms only for cause. The legislative auditor 75.3and deputy auditors may each appoint a confidential secretary to serve at pleasure. 75.4The salaries and benefits of the legislative auditor, deputy auditors and confidential 75.5secretaries shall be determined by the compensation plan approved by the Legislative 75.6Coordinating Commission. The deputy auditors may perform and exercise the powers, 75.7duties and responsibilities imposed by law on the legislative auditor when authorized by 75.8the legislative auditor. The deputy auditors and the confidential secretaries serve in the 75.9unclassified civil service, but all other employees of the legislative auditor are in the 75.10classified civil service. Compensation for employees of the legislative auditor in the 75.11classified service shall be governed by a plan prepared by the legislative auditor and 75.12approved by the Legislative Coordinating Commission and the legislature under section 75.133.855, subdivision 3
         . While in office, a person appointed deputy for the Financial Audit 75.14Division must hold an active license as a certified public accountant. 75.15EFFECTIVE DATE.This section is effective July 1, 2011.75.16    Sec. 2. Minnesota Statutes 2008, section 3.98, is amended by adding a subdivision to 75.17read:75.18    Subd. 5.Fiscal notes; Department of Human Services.(a) The responsibilities of 75.19the Department of Human Services for the preparation of fiscal notes under this chapter 75.20are transferred to the Legislative Budget Office Division under section 3.971.75.21(b) The Legislative Budget Office Division shall prepare a fiscal note for any bill that 75.22increases or decreases expenditures at the Department of Human Services at the request of 75.23the chair of the budget or finance division to which a bill relating to the department has 75.24been referred, or at the request of either the chair of the house of representatives Ways and 75.25Means Committee, or the chair of the senate Finance Committee. At the request of the 75.26commissioner of human services, the Legislative Budget Office Division shall include a 75.27statement from the commissioner:75.28(1) concurring with the information provided;75.29(2) suggesting alternative dollar amounts for a specific program or function; or75.30(3) indicating any other information which the commissioner deems relevant.75.31    Sec. 3. [62A.3075] CANCER CHEMOTHERAPY TREATMENT COVERAGE.75.32(a) A health plan company that provides coverage under a health plan for cancer 75.33chemotherapy treatment shall not require a higher co-payment, deductible, or coinsurance 75.34amount for a prescribed, orally administered anticancer medication that is used to kill or 76.1slow the growth of cancerous cells than what the health plan requires for an intravenously 76.2administered or injected cancer medication that is provided, regardless of formulation or 76.3benefit category determination by the health plan company.76.4(b) A health plan company must not achieve compliance with this section 76.5by imposing an increase in co-payment, deductible, or coinsurance amount for an 76.6intravenously administered or injected cancer chemotherapy agent covered under the 76.7health plan.76.8(c) Nothing in this section shall be interpreted to prohibit a health plan company 76.9from requiring prior authorization or imposing other appropriate utilization controls in 76.10approving coverage for any chemotherapy.76.11(d) A plan offered by the commissioner of management and budget under section 76.1243A.23 is deemed to be at parity and in compliance with this section.76.13EFFECTIVE DATE.Paragraphs (a) and (c) are effective August 1, 2010, and apply 76.14to health plans providing coverage to a Minnesota resident offered, issued, sold, renewed, 76.15or continued as defined in Minnesota Statutes, section 60A.02, subdivision 2a, on or after 76.16that date. Paragraph (b) is effective the day following final enactment.76.17    Sec. 4. [62A.3094] COVERAGE FOR AUTISM SPECTRUM DISORDERS.76.18    Subdivision 1.Definitions.(a) For purposes of this section, the terms defined in 76.19paragraphs (b) to (e) have the meanings given.76.20(b) "Autism spectrum disorder" means the following conditions as determined by 76.21criteria set forth in the most recent edition of the Diagnostic and Statistical Manual of 76.22Mental Disorders of the American Psychiatric Association:76.23(1) autism or autistic disorder;76.24(2) Asperger's syndrome; or76.25(3) pervasive developmental disorder - not otherwise specified.76.26(c) "Board-certified behavior analyst" means an individual certified by the Behavior 76.27Analyst Certification Board as a board-certified behavior analyst.76.28(d) "Evidence-based," for purposes of this section only, is as described in subdivision 76.292, paragraph (c), clause (2).76.30(e) "Health plan" has the meaning given in section 62Q.01, subdivision 3.76.31(f) "Manualized approach" means a self-contained volume, text, or set of 76.32instructional media, which may include videos or compact discs, that codifies in 76.33reasonable detail the procedures for implementing treatment.76.34(g) "Medical necessity" or "medically necessary care" has the meaning given in 76.35section 62Q.53, subdivision 2.77.1(h) "Mental health professional" has the meaning given in section 245.4871, 77.2subdivision 27, clauses (1) to (6).77.3(i) "Qualified mental health behavioral aide" means a mental health behavioral aide 77.4as defined in section 256B.0943, subdivision 7.77.5(j) "Qualified mental health practitioner" means a mental health practitioner as 77.6defined in section 245.4871, subdivision 26.77.7(k) "Statistically superior outcomes" means a research study in which the probability 77.8that the results would be obtained under the null hypothesis is less than five percent.77.9    Subd. 2.Coverage required.(a) For coverage requirements to apply, an individual 77.10must have a diagnosis of autism spectrum disorder made through an evaluation of the 77.11patient, completed within the six months prior to the start of treatment, which includes 77.12all of the following:77.13(1) a complete medical and psychological evaluation performed by a licensed 77.14physician and psychologist using empirically validated tools or tests that incorporate 77.15measures for intellectual functioning, language development, adaptive skills, and 77.16behavioral problems, which must include:77.17(i) a developmental history of the child, focusing on developmental milestones 77.18and delays;77.19(ii) a family history, including whether there are other family members with an 77.20autism spectrum disorder, developmental disability, fragile X syndrome, or tuberous 77.21sclerosis;77.22(iii) a medical history, including signs of deterioration, seizure activity, brain injury, 77.23and head circumference;77.24(iv) a physical examination completed within the past 12 months;77.25(v) an evaluation for intellectual functioning;77.26(vi) a lead screening for those children with a developmental disability; and77.27(vii) other evaluations and testing as indicated by the medical evaluation, which 77.28may include neuropsychological testing, occupational therapy, physical therapy, family 77.29functioning, genetic testing, imaging laboratory tests, and electrophysiological testing;77.30(2) a communication assessment conducted by a speech pathologist; and77.31(3) a comprehensive hearing test conducted by an audiologist with experience in 77.32testing very young children.77.33(b) A health plan must provide coverage for the diagnosis, evaluation, assessment, 77.34and medically necessary care of autism spectrum disorders that is evidence-based, 77.35including but not limited to:78.1(1) neurodevelopmental and behavioral health treatments, instruction, and 78.2management;78.3(2) applied behavior analysis and intensive early intervention services, including 78.4service package models such as intensive early intervention behavior therapy services 78.5and Lovaas therapy;78.6(3) speech therapy;78.7(4) occupational therapy;78.8(5) physical therapy; and78.9(6) prescription medications.78.10(c) Coverage required under this section shall include treatment that is in accordance 78.11with:78.12(1) an individualized treatment plan prescribed by the insured's treating physician or 78.13mental health professional as defined in this section; and78.14(2) medically and scientifically accepted evidence that meets the criteria of a 78.15peer-reviewed, published study that is one of the following:78.16(i) a randomized study with adequate statistical power, including a sample size of 78.1730 or more for each group, that shows statistically superior outcomes to a pill placebo 78.18group, psychological placebo group, another treatment group, or a wait list control group, 78.19or that is equivalent to another evidence-based treatment that meets the above standard 78.20for the specified problem area; or78.21(ii) a series of at least three single-case design experiments with clear specification 78.22of the subjects and with clear specification of the treatment approach that:78.23(A) use robust experimental designs;78.24(B) show statistically superior outcomes to pill placebo, psychological placebo, 78.25or another treatment group; and 78.26(C) either use a manualized approach or are conducted by at least two independent 78.27investigators or teams; or78.28(3) where evidence meeting the standards of this subdivision does not exist for 78.29the treatment of a diagnosed condition or for an individual matching the demographic 78.30characteristics for which the evidence is valid, practice guidelines based on consensus 78.31of Minnesota health care professionals knowledgeable in the treatment of individuals 78.32with autism spectrum disorders. 78.33(d) Early intensive behavior therapies that meet the criteria set forth in paragraphs 78.34(b) and (c) must also meet the following best practices standards:78.35(1) the services must be prescribed by a mental health professional as an appropriate 78.36treatment option for the individual child;79.1(2) regular reporting of services provided and the child's progress must be submitted 79.2to the prescribing mental health professional;79.3(3) care must include appropriate parent or legal guardian education and 79.4involvement;79.5(4) the medically prescribed treatment and frequency of services should be 79.6coordinated between the school and provider for all children up to age 21; and79.7(5) services must be provided by a mental health professional or, as appropriate, a 79.8board-certified behavior analyst, a qualified mental health practitioner, or a qualified 79.9mental health behavioral aide.79.10(e) Providers under this section must work with the commissioner in implementing 79.11evidence-based practices and, specifically for children under age 21, the Minnesota 79.12Evidence-Based Practice Database of research-informed practice elements and specific 79.13constituent practices.79.14(f) A health plan company may not refuse to renew or reissue, or otherwise terminate 79.15or restrict coverage of an individual solely because the individual is diagnosed with an 79.16autism spectrum disorder.79.17(g) A health plan company may request an updated treatment plan only once every 79.18six months, unless the health plan company and the treating physician or mental health 79.19professional agree that a more frequent review is necessary due to emerging circumstances.79.20    Subd. 3.Supervision, delegation of duties, and observation of qualified mental 79.21health practitioner, board-certified behavior analyst, or mental health behavioral 79.22aide. A mental health professional who uses the services of a qualified mental health 79.23practitioner, board-certified behavior analyst, or qualified mental health behavioral aide for 79.24the purpose of assisting in the provision of services to patients who have autism spectrum 79.25disorder is responsible for functions performed by these service providers. The qualified 79.26mental health professional must maintain clinical supervision of services they provide 79.27and accept full responsibility for their actions. The services provided must be medically 79.28necessary and identified in the child's individual treatment plan. Service providers must 79.29document their activities in written progress notes that reflect implementation of the 79.30individual treatment plan.79.31    Subd. 4.State health care programs.This section does not affect benefits 79.32available under the medical assistance, MinnesotaCare, and general assistance medical 79.33care programs, and the state employee group insurance plan offered under sections 79.3443A.22 to 43A.30. These programs and the state employee group insurance plan must 79.35maintain current levels of coverage, and section 256B.0644 shall continue to apply. 79.36The commissioner shall monitor these services and report to the chairs of the house 80.1of representatives and senate standing committees that have jurisdiction over health 80.2and human services by February 1, 2011, whether there are gaps in the level of service 80.3provided by these programs and the state employee group insurance plan, and the level of 80.4service provided by private health plans following enactment of this section.80.5    Subd. 5.No effect on other law.Nothing in this section limits in any way the 80.6coverage required under sections 62Q.47 and 62Q.53.80.7EFFECTIVE DATE.This section is effective August 1, 2010, and applies to 80.8coverage offered, issued, sold, renewed, or continued as defined in Minnesota Statutes, 80.9section 60A.02, subdivision 2a, on or after that date.80.10    Sec. 5. Minnesota Statutes 2008, section 62J.38, is amended to read:80.1162J.38 COST CONTAINMENT DATA FROM GROUP PURCHASERS.80.12(a) The commissioner shall require group purchasers to submit detailed data on total 80.13health care spending for each calendar year. Group purchasers shall submit data for the 80.141993 calendar year by April 1, 1994, and each April 1 thereafter shall submit data for the 80.15preceding calendar year.80.16(b) The commissioner shall require each group purchaser to submit data on revenue, 80.17expenses, and member months, as applicable. Revenue data must distinguish between 80.18premium revenue and revenue from other sources and must also include information 80.19on the amount of revenue in reserves and changes in reserves. Expenditure data must 80.20distinguish between costs incurred for patient care and administrative costs, including 80.21amounts paid to contractors, subcontractors, and other entities for the purpose of managing 80.22provider utilization or distributing provider payments. Patient care and administrative 80.23costs must include only expenses incurred on behalf of health plan members and must 80.24not include the cost of providing health care services for nonmembers at facilities owned 80.25by the group purchaser or affiliate. Expenditure data must be provided separately 80.26for the following categories and for other categories required by the commissioner: 80.27physician services, dental services, other professional services, inpatient hospital services, 80.28outpatient hospital services, emergency, pharmacy services and other nondurable medical 80.29goods, mental health, and chemical dependency services, other expenditures, subscriber 80.30liability, and administrative costs. Administrative costs must include costs for marketing; 80.31advertising; overhead; salaries and benefits of central office staff who do not provide 80.32direct patient care; underwriting; lobbying; claims processing; provider contracting and 80.33credentialing; detection and prevention of payment for fraudulent or unjustified requests 80.34for reimbursement or services; clinical quality assurance and other types of medical care 81.1quality improvement efforts; concurrent or prospective utilization review as defined in 81.2section 
         62M.02; costs incurred to acquire a hospital, clinic, or health care facility, or the 81.3assets thereof; capital costs incurred on behalf of a hospital or clinic; lease payments; or 81.4any other costs incurred pursuant to a partnership, joint venture, integration, or affiliation 81.5agreement with a hospital, clinic, or other health care provider. Capital costs and costs 81.6incurred must be recorded according to standard accounting principles. The reports of 81.7this data must also separately identify expenses for local, state, and federal taxes, fees, 81.8and assessments. The commissioner may require each group purchaser to submit any 81.9other data, including data in unaggregated form, for the purposes of developing spending 81.10estimates, setting spending limits, and monitoring actual spending and costs. In addition to 81.11reporting administrative costs incurred to acquire a hospital, clinic, or health care facility, 81.12or the assets thereof; or any other costs incurred pursuant to a partnership, joint venture, 81.13integration, or affiliation agreement with a hospital, clinic, or other health care provider; 81.14reports submitted under this section also must include the payments made during the 81.15calendar year for these purposes. The commissioner shall make public, by group purchaser 81.16data collected under this paragraph in accordance with section 
         62J.321, subdivision 5. 81.17Workers' compensation insurance plans and automobile insurance plans are exempt from 81.18complying with this paragraph as it relates to the submission of administrative costs.  81.19(c) The commissioner may collect information on:81.20(1) premiums, benefit levels, managed care procedures, and other features of health 81.21plan companies;81.22(2) prices, provider experience, and other information for services less commonly 81.23covered by insurance or for which patients commonly face significant out-of-pocket 81.24expenses; and81.25(3) information on health care services not provided through health plan companies, 81.26including information on prices, costs, expenditures, and utilization.81.27(d) All group purchasers shall provide the required data using a uniform format and 81.28uniform definitions, as prescribed by the commissioner.81.29    Sec. 6. [62Q.545] COVERAGE OF PRIVATE DUTY NURSING SERVICES.81.30(a) A health plan must cover private duty nursing services as provided under section 81.31256B.0625, subdivision 7, for persons who are covered under the health plan and require 81.32private duty nursing services.81.33(b) For purposes of this section, a period of private duty nursing services may 81.34be subject to the co-payment, coinsurance, deductible, or other enrollee cost-sharing 81.35requirements that apply under the health plan. Cost-sharing requirements for private duty 82.1nursing services must not place a greater financial burden on the insured or enrollee than 82.2those requirements applied by the health plan to other similar services or benefits.82.3EFFECTIVE DATE.This section is effective July 1, 2010, and applies to health 82.4plans offered, sold, issued, or renewed on or after that date.82.5    Sec. 7. Minnesota Statutes 2008, section 62Q.76, subdivision 1, is amended to read:82.6    Subdivision 1. Applicability. For purposes of sections 
         62Q.76 to 
         62Q.79 62Q.791, 82.7the terms defined in this section contract, health care provider, dental plan, dental 82.8organization, dentist, and enrollee have the meanings given them in sections 62Q.733 82.9and 62Q.76.  82.10    Sec. 8. [62Q.791] CONTRACTS WITH DENTAL CARE PROVIDERS.82.11    (a) Notwithstanding any other provision of law, no contract of any dental 82.12organization licensed under chapter 62C for provision of dental care services may:82.13    (1) require, directly or indirectly, that a dentist or health care provider provide dental 82.14care services to its enrollees at a fee set by the dental organization, unless the services 82.15provided are covered dental care services for enrollees under the dental plan or contract; or82.16    (2) prohibit, directly or indirectly, the dentist or health care provider from offering or 82.17providing dental care services that are not covered dental care services under the dental 82.18plan or contract, on terms and conditions acceptable to the enrollee and the dentist or 82.19health care provider. For purposes of this section, "covered dental care services" means 82.20dental care services that are expressly covered under the dental plan or contract, including 82.21dental care services that are subject to contractual limitations such as deductibles, 82.22co-payments, annual maximums, and waiting periods.82.23    (b) When making payment or otherwise adjudicating any claim for dental care 82.24services provided to an enrollee, a dental organization or dental plan must clearly identify 82.25on an explanation of benefits form or other form of claim resolution the amount, if any, 82.26that is the enrollee's responsibility to pay to the enrollee's dentist or health care provider.82.27    (c) This section does not apply to any contract for the provision of dental care 82.28services under any public program sponsored or funded by the state or federal government.82.29EFFECTIVE DATE.This section is effective August 1, 2010.82.30    Sec. 9. [245.6971] ADVISORY GROUP ON STATE-OPERATED SERVICES 82.31REDESIGN.83.1    Subdivision 1.Establishment.The Advisory Group on State-Operated Services 83.2Redesign is established to make recommendations to the commissioner of human services 83.3and the legislature on the continuum of services needed to provide individuals with 83.4complex conditions including mental illness and developmental disabilities access to 83.5quality care and the appropriate level of care across the state to promote wellness, reduce 83.6cost, and improve efficiency.83.7    Subd. 2.Duties.The Advisory Group on State-Operated Services Redesign shall 83.8make recommendations to the commissioner and the legislature no later than December 83.915, 2010, on the following:83.10(1) transformation needed to improve service delivery and provide a continuum of 83.11care, such as transition of current facilities, closure of current facilities, or the development 83.12of new models of care;83.13(2) gaps and barriers to accessing quality care, system inefficiencies, and cost 83.14pressures;83.15(3) services that are best provided by the state and those that are best provided 83.16in the community;83.17(4) an implementation plan to achieve integrated service delivery across the public, 83.18private, and nonprofit sectors;83.19(5) an implementation plan to ensure that individuals with complex chemical and 83.20mental health needs receive the appropriate level of care to achieve recovery and wellness; 83.21and83.22(6) financing mechanisms that include all possible revenue sources to maximize 83.23federal funding and promote cost efficiencies and sustainability.83.24    Subd. 3.Membership.The advisory group shall be composed of the following, 83.25who will serve at the pleasure of their appointing authority:83.26(1) the commissioner of human services or the commissioner's designee, and two 83.27additional representatives from the department;83.28(2) two legislators appointed by the speaker of the house, one from the minority 83.29and one from the majority;83.30(3) two legislators appointed by the senate rules committee, one from the minority 83.31and one from the majority;83.32(4) one representative appointed by AFSCME Council 5;83.33(5) one representative appointed by the ombudsman for mental health and 83.34developmental disabilities;83.35(6) one representative appointed by the Minnesota Association of Professional 83.36Employees;84.1(7) one representative appointed by the Minnesota Hospital Association;84.2(8) one representative appointed by the Minnesota Nurses Association;84.3(9) one representative appointed by NAMI-MN;84.4(10) one representative appointed by the Mental Health Association of Minnesota;84.5(11) one representative appointed by the Minnesota Association Of Community 84.6Mental Health Programs;84.7(12) one representative appointed by the Minnesota Dental Association;84.8(13) three clients or client family members representing different populations 84.9receiving services from state-operated services, who are appointed by the commissioner;84.10(14) one representative appointed by the chair of the state-operated services 84.11governing board; and84.12(15) one representative appointed by the Minnesota Disability Law Center.84.13    Subd. 4.Administration.The commissioner shall convene the first meeting of the 84.14advisory group and shall provide administrative support and staff.84.15    Subd. 5.Recommendations.The advisory group must report its recommendations 84.16to the commissioner and to the legislature no later than December 15, 2010.84.17    Subd. 6.Expiration.This section expires January 31, 2011.84.18    Sec. 10. [245.6972] LEGISLATIVE APPROVAL REQUIRED.84.19The commissioner of human services shall not redesign or move state-operated 84.20services programs without specific legislative approval. The commissioner may proceed 84.21with redesign at the Mankato Crisis Center and the closure of the Community Behavioral 84.22Health Hospital in Cold Spring.84.23    Sec. 11. Minnesota Statutes 2009 Supplement, section 252.025, subdivision 7, is 84.24amended to read:84.25    Subd. 7. Minnesota extended treatment options. The commissioner shall develop 84.26by July 1, 1997, the Minnesota extended treatment options to serve Minnesotans who have 84.27developmental disabilities and exhibit severe behaviors which present a risk to public 84.28safety. This program is statewide and must provide specialized residential services in 84.29Cambridge and an array of community-based services with sufficient levels of care and a 84.30sufficient number of specialists to ensure that individuals referred to the program receive 84.31the appropriate care. The number of beds at the Cambridge facility may be reorganized 84.32into two 16-bed facilities, one for individuals with developmental disabilities and one 84.33for individuals with developmental disabilities and a co-occurring mental illness, with 84.34the remaining beds converted into transitional intensive treatment foster homes.The 85.1individuals working in the community-based services under this section are state 85.2employees supervised by the commissioner of human services. No layoffs shall occur as a 85.3result of restructuring under this section.85.4EFFECTIVE DATE.This section is effective the day following final enactment.85.5    Sec. 12. Minnesota Statutes 2008, section 254B.01, subdivision 2, is amended to read:85.6    Subd. 2. American Indian. For purposes of services provided under section 85.7254B.09, subdivision 7 254B.09, subdivision 8, "American Indian" means a person who is 85.8a member of an Indian tribe, and the commissioner shall use the definitions of "Indian" 85.9and "Indian tribe" and "Indian organization" provided in Public Law 93-638. For purposes 85.10of services provided under section 
         254B.09, subdivision 4 254B.09, subdivision 6, 85.11"American Indian" means a resident of federally recognized tribal lands who is recognized 85.12as an Indian person by the federally recognized tribal governing body.  85.13    Sec. 13. Minnesota Statutes 2008, section 254B.02, subdivision 1, is amended to read:85.14    Subdivision 1. Chemical dependency treatment allocation. The chemical 85.15dependency funds appropriated for allocation treatment appropriation shall be placed in 85.16a special revenue account. The commissioner shall annually transfer funds from the 85.17chemical dependency fund to pay for operation of the drug and alcohol abuse normative 85.18evaluation system and to pay for all costs incurred by adding two positions for licensing 85.19of chemical dependency treatment and rehabilitation programs located in hospitals for 85.20which funds are not otherwise appropriated. Six percent of the remaining money must 85.21be reserved for tribal allocation under section 254B.09, subdivisions 4 and 5. The 85.22commissioner shall annually divide the money available in the chemical dependency 85.23fund that is not held in reserve by counties from a previous allocation, or allocated to 85.24the American Indian chemical dependency tribal account. Six percent of the remaining 85.25money must be reserved for the nonreservation American Indian chemical dependency 85.26allocation for treatment of American Indians by eligible vendors under section 254B.05, 85.27subdivision 1. The remainder of the money must be allocated among the counties 85.28according to the following formula, using state demographer data and other data sources 85.29determined by the commissioner: in the special revenue account must be used according 85.30to the requirements in this chapter.85.31    (a) For purposes of this formula, American Indians and children under age 14 are 85.32subtracted from the population of each county to determine the restricted population.85.33    (b) The amount of chemical dependency fund expenditures for entitled persons for 85.34services not covered by prepaid plans governed by section 256B.69 in the previous year is 86.1divided by the amount of chemical dependency fund expenditures for entitled persons for 86.2all services to determine the proportion of exempt service expenditures for each county. 86.3    (c) The prepaid plan months of eligibility is multiplied by the proportion of exempt 86.4service expenditures to determine the adjusted prepaid plan months of eligibility for 86.5each county.86.6    (d) The adjusted prepaid plan months of eligibility is added to the number of 86.7restricted population fee for service months of eligibility for the Minnesota family 86.8investment program, general assistance, and medical assistance and divided by the county 86.9restricted population to determine county per capita months of covered service eligibility.86.10    (e) The number of adjusted prepaid plan months of eligibility for the state is added 86.11to the number of fee for service months of eligibility for the Minnesota family investment 86.12program, general assistance, and medical assistance for the state restricted population and 86.13divided by the state restricted population to determine state per capita months of covered 86.14service eligibility.86.15    (f) The county per capita months of covered service eligibility is divided by the 86.16state per capita months of covered service eligibility to determine the county welfare 86.17caseload factor.86.18    (g) The median married couple income for the most recent three-year period 86.19available for the state is divided by the median married couple income for the same period 86.20for each county to determine the income factor for each county.86.21    (h) The county restricted population is multiplied by the sum of the county welfare 86.22caseload factor and the county income factor to determine the adjusted population.86.23    (i) $15,000 shall be allocated to each county.86.24    (j) The remaining funds shall be allocated proportional to the county adjusted 86.25population.86.26    Sec. 14. Minnesota Statutes 2008, section 254B.02, subdivision 5, is amended to read:86.27    Subd. 5. Administrative adjustment. The commissioner may make payments to 86.28local agencies from money allocated under this section to support administrative activities 86.29under sections 
         254B.03 and 
         254B.04. The administrative payment must not exceed 86.30the lesser of (1) five percent of the first $50,000, four percent of the next $50,000, and 86.31three percent of the remaining payments for services from the allocation special revenue 86.32account according to subdivision 1; or (2) the local agency administrative payment for 86.33the fiscal year ending June 30, 2009, adjusted in proportion to the statewide change in 86.34the appropriation for this chapter. 87.1    Sec. 15. Minnesota Statutes 2008, section 254B.03, subdivision 4, is amended to read:87.2    Subd. 4. Division of costs. Except for services provided by a county under 87.3section 
         254B.09, subdivision 1, or services provided under section 
         256B.69 or 
         256D.03, 87.4subdivision 4
         , paragraph (b), the county shall, out of local money, pay the state for 87.515 16.14 percent of the cost of chemical dependency services, including those services 87.6provided to persons eligible for medical assistance under chapter 256B and general 87.7assistance medical care under chapter 256D. Counties may use the indigent hospitalization 87.8levy for treatment and hospital payments made under this section. Fifteen 16.14 percent 87.9of any state collections from private or third-party pay, less 15 percent of for the cost 87.10of payment and collections, must be distributed to the county that paid for a portion of 87.11the treatment under this section. If all funds allocated according to section 254B.02 are 87.12exhausted by a county and the county has met or exceeded the base level of expenditures 87.13under section 254B.02, subdivision 3, the county shall pay the state for 15 percent of the 87.14costs paid by the state under this section. The commissioner may refuse to pay state funds 87.15for services to persons not eligible under section 254B.04, subdivision 1, if the county 87.16financially responsible for the persons has exhausted its allocation. 87.17    Sec. 16. Minnesota Statutes 2008, section 254B.03, is amended by adding a 87.18subdivision to read:87.19    Subd. 4a.Division of costs for medical assistance services.Notwithstanding 87.20subdivision 4, for chemical dependency services provided on or after October 1, 2008, and 87.21reimbursed by medical assistance, the county share is 30 percent of the nonfederal share.87.22    Sec. 17. Minnesota Statutes 2008, section 254B.05, subdivision 4, is amended to read:87.23    Subd. 4. Regional treatment centers. Regional treatment center chemical 87.24dependency treatment units are eligible vendors. The commissioner may expand the 87.25capacity of chemical dependency treatment units beyond the capacity funded by direct 87.26legislative appropriation to serve individuals who are referred for treatment by counties 87.27and whose treatment will be paid for with a county's allocation under section 254B.02 by 87.28funding under this chapter or other funding sources. Notwithstanding the provisions of 87.29sections 
         254B.03 to 
         254B.041, payment for any person committed at county request to 87.30a regional treatment center under chapter 253B for chemical dependency treatment and 87.31determined to be ineligible under the chemical dependency consolidated treatment fund, 87.32shall become the responsibility of the county.  87.33    Sec. 18. Minnesota Statutes 2008, section 254B.06, subdivision 2, is amended to read:88.1    Subd. 2. Allocation of collections. The commissioner shall allocate all federal 88.2financial participation collections to the reserve fund under section 254B.02, subdivision 388.3a special revenue account. The commissioner shall retain 85 allocate 83.86 percent of 88.4patient payments and third-party payments to the special revenue account and allocate 88.5the collections to the treatment allocation for the county that is financially responsible 88.6for the person. Fifteen 16.14 percent of patient and third-party payments must be paid88.7to the county financially responsible for the patient. Collections for patient payment and 88.8third-party payment for services provided under section 254B.09 shall be allocated to the 88.9allocation of the tribal unit which placed the person. Collections of federal financial 88.10participation for services provided under section 254B.09 shall be allocated to the tribal 88.11reserve account under section 254B.09, subdivision 5.88.12    Sec. 19. Minnesota Statutes 2008, section 254B.09, subdivision 8, is amended to read:88.13    Subd. 8. Payments to improve services to American Indians. The commissioner 88.14may set rates for chemical dependency services to American Indians according to the 88.15American Indian Health Improvement Act, Public Law 94-437, for eligible vendors. 88.16These rates shall supersede rates set in county purchase of service agreements when 88.17payments are made on behalf of clients eligible according to Public Law 94-437.88.18    Sec. 20. [254B.13] PILOT PROJECTS; CHEMICAL HEALTH CARE.88.19    Subdivision 1.Authorization for pilot projects.The commissioner of human 88.20services may approve and implement pilot projects developed under the planning process 88.21required under Laws 2009, chapter 79, article 7, section 26, to provide alternatives to and 88.22enhance coordination of the delivery of chemical health services required under section 88.23254B.03.88.24    Subd. 2.Program design and implementation.(a) The commissioner of 88.25human services and counties participating in the pilot projects shall continue to work in 88.26partnership to refine and implement the pilot projects initiated under Laws 2009, chapter 88.2779, article 7, section 26.88.28    (b) The commissioner and counties participating in the pilot projects shall 88.29complete the planning phase by June 30, 2010, and, if approved by the commissioner for 88.30implementation, enter into agreements governing the operation of the pilot projects with 88.31implementation scheduled no earlier than July 1, 2010.88.32    Subd. 3.Program evaluation. The commissioner of human services shall evaluate 88.33pilot projects under this section and report the results of the evaluation to the legislative 88.34committees with jurisdiction over chemical health by June 30, 2013. Evaluation of the 89.1pilot projects must be based on outcome evaluation criteria negotiated with the projects 89.2prior to implementation.89.3    Subd. 4.Notice of project discontinuation.Each county's participation in the 89.4pilot project may be discontinued for any reason by the county or the commissioner of 89.5human services after 30 days' written notice to the other party. Any unspent funds held 89.6for the exiting county's pro rata share in the special revenue fund under the authority 89.7in subdivision 5, paragraph (c), shall be transferred to the general fund following 89.8discontinuation of the pilot project.89.9    Subd. 5.Duties of commissioner.(a) Notwithstanding any other provisions in 89.10this chapter, the commissioner may authorize pilot projects to use chemical dependency 89.11treatment funds to pay for services:89.12    (1) in addition to those authorized under section 254B.03, subdivision 2, paragraph 89.13(a); and89.14    (2) by vendors in addition to those authorized under section 254B.05 when not 89.15providing chemical dependency treatment services.89.16    (b) State expenditures for chemical dependency services and any other services 89.17provided by or through the pilot projects must not be greater than chemical dependency 89.18treatment fund expenditures expected in the absence of the pilot projects. The 89.19commissioner may restructure the schedule of payments between the state and participating 89.20counties under the local agency share and division of cost provisions under section 89.21254B.03, subdivisions 3 and 4, as necessary to facilitate the operation of the pilot projects.89.22    (c) To the extent that state fiscal year expenditures within a pilot project region are 89.23less than expected in the absence of the pilot projects, the commissioner may deposit 89.24these unexpended funds in the special revenue fund and make these funds available for 89.25expenditure by the pilot counties the following year. To the extent that treatment and pilot 89.26project ancillary services expenditures within the pilot project exceed the amount expected 89.27in the absence of the pilot projects, the pilot counties are responsible for the portion of 89.28nontreatment expenditures in excess of otherwise expected expenditures.89.29    (d) The commissioner may waive administrative rule requirements which are 89.30incompatible with the implementation of the pilot project.89.31    (e) The commissioner shall not approve or enter into any agreement related to pilot 89.32projects authorized under this section which puts current or future federal funding at risk.89.33    Subd. 6.Duties of county board.The county board, or other county entity that is 89.34approved to administer a pilot project, shall:89.35    (1) administer the pilot project in a manner consistent with the objectives described 89.36in subdivision 2 and the planning process in subdivision 5;90.1    (2) ensure that no one is denied chemical dependency treatment services for which 90.2they would otherwise be eligible under section 254A.03, subdivision 3; and90.3    (3) provide the commissioner of human services with timely and pertinent 90.4information as negotiated in agreements governing operation of the pilot projects.90.5    Sec. 21. Minnesota Statutes 2008, section 256.01, is amended by adding a subdivision 90.6to read:90.7    Subd. 30.Office of Health Care Inspector General.(a) The commissioner shall 90.8create within the Department of Human Services an Office of Health Care Inspector 90.9General to enhance antifraud activities and to protect the integrity of the state health care 90.10programs, as well as the health and welfare of the beneficiaries of those programs. The 90.11Office of Health Care Inspector General must periodically report to the commissioner and 90.12to the legislature program and management problems and recommendations to correct 90.13them.90.14(b) The duties of the Office of Health Care Inspector General include, but are not 90.15limited to:90.16(1) promoting economy, efficiency, and effectiveness through the elimination of 90.17waste, fraud, and abuse;90.18(2) conducting and supervising audits, investigations, inspections, and evaluations 90.19relating to the state health care programs under chapters 256B, 256D, and 256L;90.20(3) identifying weaknesses giving rise to opportunities for fraud and abuse in the 90.21state health care programs and operations and making recommendations to prevent their 90.22recurrence;90.23(4) leading and coordinating activities to prevent and detect fraud and abuse in the 90.24state health care programs and operations;90.25(5) detecting wrongdoers and abusers of the state health care programs and 90.26beneficiaries so appropriate remedies may be brought;90.27(6) keeping the commissioner and the legislature fully and currently informed about 90.28problems and deficiencies in the administration of the state health care programs and 90.29operations and about the need for and progress of corrective action;90.30(7) operating a toll-free hotline to permit individuals to call in suspected fraud, 90.31waste, or abuse, referring the calls for appropriate action by the agency, and analyzing the 90.32calls to identify trends and patterns of fraud and abuse needing attention;90.33(8) developing and reviewing legislative, regulatory, and program proposals to 90.34reduce vulnerabilities to fraud, waste, and mismanagement; and91.1(9) recommending changes in program policies, regulations, and laws to improve 91.2efficiency and effectiveness, and to prevent fraud, waste, abuse, and mismanagement.91.3(c) Beginning July 1, 2011, the commissioner, in consultation with the Office of 91.4Health Care Inspector General, shall annually report to the legislature and the governor 91.5new results from the two ongoing federal Medicaid audits. The commissioner shall report 91.6(1) the most recent Medicaid Integrity Program (MIP) audit results, with any corrective 91.7actions needed, and (2) certify the rate of errors determined for the state health care 91.8programs under chapters 256B, 256D, and 256L, as determined from the most recent 91.9Payment Error Rate Measurement (PERM) audit results for Minnesota. When the PERM 91.10audit rate for Minnesota is greater than the national rate for the year or the MIP audit 91.11determines the need for corrective action, the commissioner shall present a plan to the 91.12legislature and the governor for the corrective actions and reduction of the error rate 91.13in the next calendar year.91.14    Sec. 22. Laws 2009, chapter 79, article 3, section 18, is amended to read:91.15    Sec. 18. REQUIRING THE DEVELOPMENT OF COMMUNITY-BASED 91.16MENTAL HEALTH SERVICES FOR PATIENTS COMMITTED TO THE 91.17ANOKA-METRO REGIONAL TREATMENT CENTER.91.18In consultation with community partners, the commissioner of human services The 91.19Advisory Group on State-Operated Services Redesign shall develop recommend an array 91.20of community-based services to transform the current services now provided to patients 91.21at the Anoka-Metro Regional Treatment Center. The community-based services may 91.22be provided in facilities with 16 or fewer beds, and must provide the appropriate level 91.23of care for the patients being admitted to the facilities. The planning for this transition 91.24must be completed by October 1, 2009 2010, with an initial report to the committee chairs 91.25of health and human services by November 30, 2009 2010, and a semiannual report on 91.26progress until the transition is completed. The commissioner of human services shall 91.27solicit interest from stakeholders and potential community partners. The individuals 91.28working in the community-based services facilities under this section are state employees 91.29supervised by the commissioner of human services. No layoffs shall occur as a result of 91.30restructuring under this section.91.31EFFECTIVE DATE.This section is effective the day following final enactment.91.32    Sec. 23. NONSUBMISSION OF HEALTH CARE CLAIM BY 91.33CLEARINGHOUSE; SIGNIFICANT DISRUPTION.92.1(a) A situation shall be considered a significant disruption to normal operations that 92.2materially affects the provider's or facility's ability to conduct business in a normal manner 92.3and to submit claims on a timely basis under Minnesota Statutes, section 62Q.75, if: 92.4(1) a clearinghouse loses, or otherwise does not submit, a health care claim as 92.5required by Minnesota Statutes, section 62J.536; and92.6(2) the provider or facility can substantiate that it submitted a complete claim to the 92.7clearinghouse within provisions stated in contract or six months of the date of service, 92.8whichever is less.92.9(b) This section expires January 1, 2012.92.10    Sec. 24.  REPEALER.92.11Minnesota Statutes 2008, sections 254B.02, subdivisions 2, 3, and 4; and 254B.09, 92.12subdivisions 4, 5, and 7, and Laws 2009, chapter 79, article 7, section 26, subdivision 92.133,  are repealed.92.14    Sec. 25. EFFECTIVE DATE.92.15Sections 12 to 17 and 24 are effective for claims paid on or after July 1, 2010.92.16ARTICLE 692.17DEPARTMENT OF HEALTH92.18    Section 1. Minnesota Statutes 2008, section 62D.08, is amended by adding a 92.19subdivision to read:92.20    Subd. 7.Consistent administrative expenses and investment income reporting.92.21(a) Every health maintenance organization must directly allocate administrative expenses 92.22to specific lines of business or products when such information is available. Remaining 92.23expenses that cannot be directly allocated must be allocated based on other methods, as 92.24recommended by the Advisory Group on Administrative Expenses. Health maintenance 92.25organizations must submit this information, including administrative expenses for dental 92.26services, using the reporting template provided by the commissioner of health.92.27(b) Every health maintenance organization must allocate investment income based 92.28on cumulative net income over time by business line or product and must submit this 92.29information, including investment income for dental services, using the reporting template 92.30provided by the commissioner of health.92.31EFFECTIVE DATE.This section is effective January 1, 2012.93.1    Sec. 2. [62D.31] ADVISORY GROUP ON ADMINISTRATIVE EXPENSES.93.2    Subdivision 1.Establishment.The Advisory Group on Administrative Expenses 93.3is established to make recommendations on the development of consistent guidelines 93.4and reporting requirements, including development of a reporting template, for health 93.5maintenance organizations and county-based purchasers that participate in publicly 93.6funded programs. 93.7    Subd. 2.Membership.The membership of the advisory group shall be comprised 93.8of the following, who serve at the pleasure of their appointing authority:93.9(1) the commissioner of health or the commissioner's designee;93.10(2) the commissioner of human services or the commissioner's designee;93.11(3) the commissioner of commerce or the commissioner's designee; and93.12(4) representatives of health maintenance organizations and county-based purchasers 93.13appointed by the commissioner of health.93.14    Subd. 3.Administration.The commissioner of health shall convene the first 93.15meeting of the advisory group by September 1, 2010, and shall provide administrative 93.16support and staff. The commissioner of health may contract with a consultant to provide 93.17professional assistance and expertise to the advisory group.93.18    Subd. 4.Recommendations.The Advisory Group on Administrative Expenses 93.19must report its recommendations, including any proposed legislation necessary to 93.20implement the recommendations, to the commissioner of health and to the chairs and 93.21ranking minority members of the legislative committees and divisions with jurisdiction 93.22over health policy and finance by July 1, 2011.93.23    Subd. 5.Expiration.This section expires after submission of the report required 93.24under subdivision 4 or June 30, 2012, whichever is sooner.93.25    Sec. 3. Minnesota Statutes 2009 Supplement, section 62J.495, subdivision 1a, is 93.26amended to read:93.27    Subd. 1a. Definitions. (a) "Certified electronic health record technology" means an 93.28electronic health record that is certified pursuant to section 3001(c)(5) of the HITECH 93.29Act to meet the standards and implementation specifications adopted under section 3004 93.30as applicable.93.31(b) "Commissioner" means the commissioner of health.93.32(c) "Pharmaceutical electronic data intermediary" means any entity that provides 93.33the infrastructure to connect computer systems or other electronic devices utilized 93.34by prescribing practitioners with those used by pharmacies, health plans, third-party 93.35administrators, and pharmacy benefit managers in order to facilitate the secure 94.1transmission of electronic prescriptions, refill authorization requests, communications, 94.2and other prescription-related information between such entities.94.3(d) "HITECH Act" means the Health Information Technology for Economic and 94.4Clinical Health Act in division A, title XIII and division B, title IV of the American 94.5Recovery and Reinvestment Act of 2009, including federal regulations adopted under 94.6that act.94.7(e) "Interoperable electronic health record" means an electronic health record that 94.8securely exchanges health information with another electronic health record system that 94.9meets requirements specified in subdivision 3, and national requirements for certification 94.10under the HITECH Act.94.11(f) "Qualified electronic health record" means an electronic record of health-related 94.12information on an individual that includes patient demographic and clinical health 94.13information and has the capacity to:94.14(1) provide clinical decision support;94.15(2) support physician order entry;94.16(3) capture and query information relevant to health care quality; and94.17(4) exchange electronic health information with, and integrate such information 94.18from, other sources.94.19    Sec. 4. Minnesota Statutes 2009 Supplement, section 62J.495, subdivision 3, is 94.20amended to read:94.21    Subd. 3. Interoperable electronic health record requirements.  To meet the 94.22requirements of subdivision 1, hospitals and health care providers must meet the following 94.23criteria when implementing an interoperable electronic health records system within their 94.24hospital system or clinical practice setting.94.25(a) The electronic health record must be a qualified electronic health record.94.26    (b) The electronic health record must be certified by the Office of the National 94.27Coordinator pursuant to the HITECH Act. This criterion only applies to hospitals and 94.28health care providers only if a certified electronic health record product for the provider's 94.29particular practice setting is available. This criterion shall be considered met if a hospital 94.30or health care provider is using an electronic health records system that has been certified 94.31within the last three years, even if a more current version of the system has been certified 94.32within the three-year period.94.33(c) The electronic health record must meet the standards established according to 94.34section 3004 of the HITECH Act as applicable.95.1(d) The electronic health record must have the ability to generate information on 95.2clinical quality measures and other measures reported under sections 4101, 4102, and 95.34201 of the HITECH Act.95.4(e) The electronic health record system must be connected to a state-certified 95.5health information organization either directly or through a connection facilitated by a 95.6state-certified health data intermediary as defined in section 62J.498.95.7    (e) (f) A health care provider who is a prescriber or dispenser of legend drugs must 95.8have an electronic health record system that meets the requirements of section 
         62J.497.95.9    Sec. 5. Minnesota Statutes 2009 Supplement, section 62J.495, is amended by adding a 95.10subdivision to read:95.11    Subd. 6.State agency information system.Development of a state agency 95.12information system necessary to implement this section is subject to the authority of the 95.13Office of Enterprise Technology in chapter 16E, including, but not limited to:95.14(1) evaluation and approval of the system as specified in section 16E.03, subdivisions 95.153 and 4;95.16(2) review of the system to ensure compliance with security policies, guidelines, and 95.17standards as specified in section 16E.03, subdivision 7; and95.18(3) assurance that the system complies with accessibility standards developed under 95.19section 16E.03, subdivision 9.95.20    Sec. 6. [62J.498] HEALTH INFORMATION EXCHANGE.95.21    Subdivision 1. Definitions. The following definitions apply to sections 62J.498 to 95.2262J.4982:95.23(a) "Clinical transaction" means any meaningful use transaction that is not covered 95.24by section 62J.536.95.25(b) "Commissioner" means the commissioner of health.95.26(c) "Direct health information exchange" means the electronic transmission of 95.27health-related information through a direct connection between the electronic health 95.28record systems of health care providers without the use of a health data intermediary.95.29(d) "Health care provider" or "provider" means a health care provider or provider as 95.30defined in section 62J.03, subdivision 8.95.31(e) "Health data intermediary" means an entity that provides the infrastructure to 95.32connect computer systems or other electronic devices used by health care providers, 95.33laboratories, pharmacies, health plans, third-party administrators, or pharmacy benefit 95.34managers to facilitate the secure transmission of health information, including 96.1pharmaceutical electronic data intermediaries as defined in section 62J.495.  This does not 96.2include health care providers engaged in a direct health information exchange.96.3(f) "Health information exchange" means the electronic transmission of 96.4health-related information between organizations according to nationally recognized 96.5standards.96.6(g) "Health information exchange service provider" means a health data intermediary 96.7or health information organization that has been issued a certificate of authority by the 96.8commissioner under section 62J.4981.96.9(h) "Health information organization" means an organization that oversees, governs, 96.10and facilitates the exchange of health-related information among organizations according 96.11to nationally recognized standards.96.12(i) "HITECH Act" means the Health Information Technology for Economic and 96.13Clinical Health Act as defined in section 62J.495.96.14(j) "Major participating entity" means:96.15(1) a participating entity that receives compensation for services that is greater 96.16than 30 percent of the health information organization's gross annual revenues from the 96.17health information exchange service provider;96.18(2) a participating entity providing administrative, financial, or management services 96.19to the health information organization, if the total payment for all services provided by the 96.20participating entity exceeds three percent of the gross revenue of the health information 96.21organization; and96.22(3) a participating entity that nominates or appoints 30 percent or more of the board 96.23of directors of the health information organization.96.24(k) "Meaningful use" means use of certified electronic health record technology that 96.25includes e-prescribing, and is connected in a manner that provides for the electronic 96.26exchange of health information and used for the submission of clinical quality measures 96.27as established by the Center for Medicare and Medicaid Services and the Minnesota 96.28Department of Human Services pursuant to sections 4101, 4102, and 4201 of the HITECH 96.29Act.96.30(l) "Meaningful use transaction" means an electronic transaction that a health care 96.31provider must exchange to receive Medicare or Medicaid incentives or avoid Medicare 96.32penalties pursuant to sections 4101, 4102, and 4201 of the HITECH Act.96.33(m) "Participating entity" means any of the following persons, health care providers, 96.34companies, or other organizations with which a health information organization or health 96.35data intermediary has contracts or other agreements for the provision of health information 96.36exchange service providers: 97.1(1) a health care facility licensed under sections 144.50 to 144.56, a nursing home 97.2licensed under sections 144A.02 to 144A.10, and any other health care facility otherwise 97.3licensed under the laws of this state or registered with the commissioner;97.4(2) a health care provider, and any other health care professional otherwise licensed 97.5under the laws of this state or registered with the commissioner;97.6(3) a group, professional corporation, or other organization that provides the 97.7services of individuals or entities identified in clause (2), including but not limited to a 97.8medical clinic, a medical group, a home health care agency, an urgent care center, and 97.9an emergent care center;97.10(4) a health plan as defined in section 62A.011, subdivision 3; and97.11(5) a state agency as defined in section 13.02, subdivision 17.97.12(n) "Reciprocal agreement" means an arrangement in which two or more health 97.13information exchange service providers agree to share in-kind services and resources to 97.14allow for the pass-through of meaningful use transactions.97.15(o) "State-certified health data intermediary" means a health data intermediary that:97.16(1) provides a subset of the meaningful use transaction capabilities necessary for 97.17hospitals and providers to achieve meaningful use of electronic health records;97.18(2) is not exclusively engaged in the exchange of meaningful use transactions 97.19covered by section 62J.536; and97.20(3) has been issued a certificate of authority to operate in Minnesota.97.21(p) "State-certified health information organization" means a nonprofit health 97.22information organization that provides transaction capabilities necessary to fully support 97.23clinical transactions required for meaningful use of electronic health records that has been 97.24issued a certificate of authority to operate in Minnesota.97.25    Subd. 2. Health information exchange oversight. (a) The commissioner shall 97.26protect the public interest on matters pertaining to health information exchange. The 97.27commissioner shall:97.28(1) review and act on applications from health data intermediaries and health 97.29information organizations for certificates of authority to operate in Minnesota;97.30(2) provide ongoing monitoring to ensure compliance with criteria established under 97.31sections 62J.498 to 62J.4982;97.32(3) respond to public complaints related to health information exchange services;97.33(4) take enforcement actions as necessary, including the imposition of fines, 97.34suspension, or revocation of certificates of authority as outlined in section 62J.4982;97.35(5) provide a biannual report on the status of health information exchange services 97.36that includes but is not limited to:98.1(i) recommendations on actions necessary to ensure that health information exchange 98.2services are adequate to meet the needs of Minnesota citizens and providers statewide;98.3(ii) recommendations on enforcement actions to ensure that health information 98.4exchange service providers act in the public interest without causing disruption in health 98.5information exchange services;98.6(iii) recommendations on updates to criteria for obtaining certificates of authority 98.7under this section; and98.8(iv) recommendations on standard operating procedures for health information 98.9exchange, including but not limited to the management of consumer preferences; and98.10(6) other duties necessary to protect the public interest.98.11(b) As part of the application review process for certification under paragraph (a), 98.12prior to issuing a certificate of authority, the commissioner shall:98.13(1) hold public hearings that provide an adequate opportunity for participating 98.14entities and consumers to provide feedback and recommendations on the application under 98.15consideration. The commissioner shall make all portions of the application classified 98.16as public data available to the public at least ten days in advance of the hearing. The 98.17applicant shall participate in the hearing by presenting an application overview and 98.18responding to questions from interested parties;98.19(2) make available all feedback and recommendations from the hearing available to 98.20the public prior to issuing a certificate of authority; and98.21(3) consult with hospitals, physicians, and other professionals eligible to receive 98.22meaningful use incentive payments or are subject to penalties as established in the 98.23HITECH Act, and their respective statewide associations, prior to issuing a certificate of 98.24authority.98.25(c)(1) When the commissioner is actively considering a suspension or revocation of 98.26a certificate of authority as described in section 62J.4982, subdivision 3, all investigatory 98.27data that are collected, created, or maintained related to the suspension or revocation 98.28are classified as confidential data on individuals and as protected nonpublic data in the 98.29case of data not on individuals.98.30(2) The commissioner may disclose data classified as protected nonpublic or 98.31confidential under this paragraph if disclosing the data will protect the health or safety of 98.32patients.98.33(d) After the commissioner makes a final determination regarding a suspension or 98.34revocation of a certificate of authority, all minutes, orders for hearing, findings of fact, 98.35conclusions of law, and the specification of the final disciplinary action, are classified 98.36as public data.99.1    Sec. 7. [62J.4981] CERTIFICATE OF AUTHORITY TO PROVIDE HEALTH 99.2INFORMATION EXCHANGE SERVICES.99.3    Subdivision 1. Authority to require organizations to apply. The commissioner 99.4shall require an entity providing health information exchange services to apply for a 99.5certificate of authority under this section. An applicant may continue to operate until 99.6the commissioner acts on the application. If the application is denied, the applicant is 99.7considered a health information organization whose certificate of authority has been 99.8revoked under section 62J.4982, subdivision 2, paragraph (d).99.9    Subd. 2. Certificate of authority for health data intermediaries. (a) A health 99.10data intermediary that provides health information exchange services for the transmission 99.11of one or more clinical transactions necessary for hospitals, providers, or eligible 99.12professionals to achieve meaningful use must be registered with the state and comply with 99.13requirements established in this section.99.14(b) Notwithstanding any law to the contrary, any corporation organized to do so 99.15may apply to the commissioner for a certificate of authority to establish and operate as 99.16a health data intermediary in compliance with this section. No person shall establish or 99.17operate a health data intermediary in this state, nor sell or offer to sell, or solicit offers 99.18to purchase or receive advance or periodic consideration in conjunction with a health 99.19data intermediary contract unless the organization has a certificate of authority or has an 99.20application under active consideration under  this section.99.21(c) In issuing the certificate of authority, the commissioner shall determine whether 99.22the applicant for the certificate of authority has demonstrated that the applicant meets 99.23the following minimum criteria:99.24(1) can interoperate with at least one state-certified health information organization;99.25(2) can provide an option for Minnesota entities to connect to their services through 99.26at least one state-certified health information organization;99.27(3) has a record locator service as defined in section 144.291, subdivision 2, 99.28paragraph (i), that is compliant with the requirements of section 144.293, subdivision 8, 99.29when conducting meaningful use transactions; and99.30(4) holds reciprocal agreements with at least one state-certified health information 99.31organization to enable access to record locator services to find patient data, and for the 99.32transmission and receipt of meaningful use transactions consistent with the format and 99.33content required by national standards established by Centers for Medicare and Medicaid 99.34Services. Reciprocal agreements must meet the requirements established in subdivision 5.99.35    Subd. 3. Certificate of authority for health information organizations.99.36(a) A health information organization that provides all electronic capabilities for the 100.1transmission of clinical transactions necessary for meaningful use of electronic health 100.2records must obtain a certificate of authority from the commissioner and demonstrate 100.3compliance with the criteria in paragraph (c).100.4(b) Notwithstanding any law to the contrary, a nonprofit corporation organized to do 100.5so may apply for a certificate of authority to establish and operate a health information 100.6organization under this section. No person shall establish or operate a health information 100.7organization in this state, or sell or offer to sell, or solicit offers to purchase or receive 100.8advance or periodic consideration in conjunction with a health information organization 100.9or health information contract unless the organization has a certificate of authority under 100.10this section.100.11(c) In issuing the certificate of authority, the commissioner shall determine whether 100.12the applicant for the certificate of authority has demonstrated that the applicant meets 100.13the following minimum criteria:100.14(1) the entity is a legally established, nonprofit organization;100.15(2) has appropriate insurance, including liability insurance, for the operation of the 100.16health information organization is in place and sufficient to protect the interest of the 100.17public and participating entities;100.18(3) has strategic and operational plans that clearly address how the organization will 100.19expand technical capacity of the health information organization to support providers in 100.20achieving meaningful use of electronic health records over time;100.21(4) the entity addresses the parameters to be used with participating entities and 100.22other health information organizations for meaningful use transactions, compliance with 100.23Minnesota law, and interstate health information exchange in trust agreements;100.24(5) the entity's board of directors is comprised of members that broadly represent the 100.25health information organization's participating entities and consumers;100.26(6) the entity maintains a professional staff responsible to the board of directors with 100.27the capacity to ensure accountability to the organization's mission;100.28(7) the entity is compliant with criteria established under the Health Information 100.29Exchange Accreditation Program of the Electronic Healthcare Network Accreditation 100.30Commission (EHNAC) or equivalent criteria established by the commissioner;100.31(8) the entity maintains a record locator service as defined in section 144.291, 100.32subdivision 2, paragraph (i), that is compliant with the requirements of section 144.293, 100.33subdivision 8, when conducting meaningful use transactions;100.34(9) the organization demonstrates interoperability with all other state-certified health 100.35information organizations using nationally recognized standards;101.1(10) the organization demonstrates compliance with all privacy and security 101.2requirements required by state and federal law; and101.3(11) the organization uses financial policies and procedures consistent with generally 101.4accepted accounting principles and has an independent audit of the organization's 101.5financials on an annual basis.101.6(d) Health information organizations that have obtained a certificate of authority 101.7must:101.8(1) meet the requirements established for connecting to the Nationwide Health 101.9Information Network (NHIN) within the federally mandated timeline or within a time 101.10frame established by the commissioner and published in the State Register. If the state 101.11timeline for implementation varies from the federal timeline, the State Register notice 101.12shall include an explanation for the variation;101.13(2) annually submit strategic and operational plans for review by the commissioner 101.14that address:101.15(i) increasing adoption rates to include a sufficient number of participating entities to 101.16achieve financial sustainability; and101.17(ii) progress in achieving objectives included in previously submitted strategic 101.18and operational plans across the following domains:  business and technical operations, 101.19technical infrastructure, legal and policy issues, finance, and organizational governance;101.20(3) develop and maintain a business plan that addresses:101.21(i) plans for ensuring the necessary capacity to support meaningful use transactions;101.22(ii) approach for attaining financial sustainability, including public and private 101.23financing strategies, and rate structures;101.24(iii) rates of adoption, utilization, and transaction volume, and mechanisms to 101.25support health information exchange; and101.26(iv) an explanation of methods employed to address the needs of community clinics, 101.27critical access hospitals, and free clinics in accessing health information exchange services;101.28(4) annually submit a rate plan outlining fee structures for health information 101.29exchange services for approval by the commissioner. The commissioner shall approve the 101.30rate plan if it:101.31(i) distributes costs equitably among users of health information services;101.32(ii) provides predictable costs for participating entities;101.33(iii) covers all costs associated with conducting the full range of meaningful use 101.34clinical transactions, including access to health information retrieved through other 101.35state-certified health information exchange service providers; and102.1(iv) provides for a predictable revenue stream for the health information organization 102.2and generates sufficient resources to maintain operating costs and develop technical 102.3infrastructure necessary to serve the public interest;102.4(5) enter into reciprocal agreements with all other state-certified health information 102.5organizations to enable access to record locator services to find patient data, and 102.6transmission and receipt of meaningful use transactions consistent with the format and 102.7content required by national standards established by Centers for Medicare and Medicaid 102.8Services. Reciprocal agreements must meet the requirements in subdivision 5; and102.9(6) comply with additional requirements for the certification or recertification of 102.10health information organizations that may be established by the commissioner.102.11    Subd. 4. Application for certificate of authority for health information exchange 102.12service providers.(a)  Each application for a certificate of authority shall be in a form 102.13prescribed by the commissioner and verified by an officer or authorized representative of 102.14the applicant. Each application shall include the following:102.15(1) a copy of the basic organizational document, if any, of the applicant and of 102.16each major participating entity, such as the articles of incorporation, or other applicable 102.17documents, and all amendments to it;102.18(2) a list of the names, addresses, and official positions of the following:102.19(i) all members of the board of directors and the principal officers and, if applicable, 102.20shareholders of the applicant organization; and102.21(ii) all members of the board of directors and the principal officers of each major 102.22participating entity and, if applicable, each shareholder beneficially owning more than ten 102.23percent of any voting stock of the major participating entity;102.24(3) the name and address of each participating entity and the agreed-upon duration 102.25of each contract or agreement if applicable;102.26(4) a copy of each standard agreement or contract intended to bind the participating 102.27entities and the health information organization. Contractual provisions shall be consistent 102.28with the purposes of this section in regard to the services to be performed under the 102.29standard agreement or contract, the manner in which payment for services is determined, 102.30the nature and extent of responsibilities to be retained by the health information 102.31organization, and contractual termination provisions;102.32(5) a copy of each contract intended to bind major participating entities and the 102.33health information organization. Contract information filed with the commissioner under 102.34this section shall be nonpublic as defined in section 13.02, subdivision 9;102.35(6) a statement generally describing the health information organization, its health 102.36information exchange contracts, facilities, and personnel, including a statement describing 103.1the manner in which the applicant proposes to provide participants with comprehensive 103.2health information exchange services;103.3(7) financial statements showing the applicant's assets, liabilities, and sources 103.4of financial support, including a copy of the applicant's most recent certified financial 103.5statement;103.6(8) strategic and operational plans that specifically address how the organization 103.7will expand technical capacity of the health information organization to support providers 103.8in achieving meaningful use of electronic health records over time, a description of 103.9the proposed method of marketing the services, a schedule of proposed charges, and a 103.10financial plan that includes a three-year projection of the expenses and income and other 103.11sources of future capital;103.12(9) a statement reasonably describing the geographic area or areas to be served and 103.13the type or types of participants to be served;103.14(10) a description of the complaint procedures to be used as required under this 103.15section;103.16(11) a description of the mechanism by which participating entities will have an 103.17opportunity to participate in matters of policy and operation;103.18(12) a copy of any pertinent agreements between the health information organization 103.19and insurers, including liability insurers, demonstrating coverage is in place;103.20(13) a copy of the conflict of interest policy that applies to all members of the board 103.21of directors and the principal officers of the health information organization; and103.22(14) other information as the commissioner may reasonably require to be provided.103.23(b) Thirty days after the receipt of the application for a certificate of authority, 103.24the commissioner shall determine whether or not the application submitted meets the 103.25requirements for completion in paragraph (a), and notify the applicant of any further 103.26information required for the application to be processed.103.27(c) Ninety days after the receipt of a complete application for a certificate of 103.28authority, the commissioner shall issue a certificate of authority to the applicant if the 103.29commissioner determines that the applicant meets the minimum criteria requirements 103.30of subdivision 2 for health data intermediaries or subdivision 3 for health information 103.31organizations. If the commissioner determines that the applicant is not qualified, the 103.32commissioner shall notify the applicant and specify the reasons for disqualification.103.33(d) Upon being granted a certificate of authority to operate as a health information 103.34organization, the organization must operate in compliance with the provisions of this 103.35section. Noncompliance may result in the imposition of a fine or the suspension or 103.36revocation of the certificate of authority according to section 62J.4982.104.1    Subd. 5. Reciprocal agreements between health information exchange entities.104.2(a) Reciprocal agreements between two health information organizations or between a 104.3health information organization and a health data intermediary must include a fair and 104.4equitable model for charges between the entities that:104.5(1) does not impede the secure transmission of transactions necessary to achieve 104.6meaningful use;104.7(2) does not charge a fee for the exchange of meaningful use transactions transmitted 104.8according to nationally recognized standards where no additional value-added service 104.9is rendered to the sending or receiving health information organization or health data 104.10intermediary either directly or on behalf of the client;104.11(3) is consistent with fair market value and proportionately reflects the value-added 104.12services accessed as a result of the agreement; and104.13(4) prevents health care stakeholders from being charged multiple times for the 104.14same service.104.15(b) Reciprocal agreements must include comparable quality of service standards that 104.16ensure equitable levels of services.104.17(c) Reciprocal agreements are subject to review and approval by the commissioner.104.18(d) Nothing in this section precludes a state-certified health information organization 104.19or state-certified health data intermediary from entering into contractual agreements for 104.20the provision of value-added services beyond meaningful use. 104.21(e) The commissioner of human services or health, when providing access to data or 104.22services through a certified health information organization, must offer the same data or 104.23services directly through any certified health information organization at the same pricing, 104.24if the health information organization pays for all connection costs to the state data or 104.25service. For all external connectivity to the respective agencies through existing or future 104.26information exchange implementations, the respective agency shall establish the required 104.27connectivity methods as well as protocol standards to be utilized.104.28    Subd. 6.State participation in health information exchange.A state agency 104.29that connects to a health information exchange service provider for the purpose of 104.30exchanging meaningful use transactions must ensure that the contracted health information 104.31exchange service provider has reciprocal agreements in place as required by this section. 104.32The reciprocal agreements must provide equal access to information supplied by the 104.33agency and necessary for meaningful use by the participating entities of the other health 104.34information service providers.104.35    Sec. 8. [62J.4982] ENFORCEMENT AUTHORITY; COMPLIANCE.105.1    Subdivision 1. Penalties and enforcement. (a) The commissioner may, for any 105.2violation of statute or rule applicable to a health information exchange service provider, 105.3levy an administrative penalty in an amount up to $25,000 for each violation. In 105.4determining the level of an administrative penalty, the commissioner shall consider the 105.5following factors:105.6(1) the number of participating entities affected by the violation;105.7(2) the effect of the violation on participating entities' access to health information 105.8exchange services;105.9(3) if only one participating entity is affected, the effect of the violation on the 105.10patients of that entity;105.11(4) whether the violation is an isolated incident or part of a pattern of violations;105.12(5) the economic benefits derived by the health information organization or a health 105.13data intermediary by virtue of the violation;105.14(6) whether the violation hindered or facilitated an individual's ability to obtain 105.15health care;105.16(7) whether the violation was intentional;105.17(8) whether the violation was beyond the direct control of the health information 105.18exchange service provider;105.19(9) any history of prior compliance with the provisions of this section, including 105.20violations;105.21(10) whether and to what extent the health information exchange service provider 105.22attempted to correct previous violations;105.23(11) how the health information exchange service provider responded to technical 105.24assistance from the commissioner provided in the context of a compliance effort; and105.25(12) the financial condition of the health information exchange service provider 105.26including, but not limited to, whether the health information exchange service provider 105.27had financial difficulties that affected its ability to comply or whether the imposition of an 105.28administrative monetary penalty would jeopardize the ability of the health information 105.29exchange service provider to continue to deliver health information exchange services.105.30Reasonable notice in writing shall be given to the health information exchange 105.31service provider of the intent to levy the penalty and the reasons for them. A health 105.32information exchange service provider may have 15 days within which to contest whether 105.33the finding of facts constitute a violation of this section and section 62J.4981, according to 105.34the contested case and judicial review provisions of sections 14.57 to 14.69.105.35(b) If the commissioner has reason to believe that a violation of this section or 105.36section 62J.4981 has occurred or is likely, the commissioner may confer with the persons 106.1involved before commencing action under subdivision 2. The commissioner may notify 106.2the health information exchange service provider and the representatives, or other persons 106.3who appear to be involved in the suspected violation, to arrange a voluntary conference 106.4with the alleged violators or their authorized representatives. The purpose of the 106.5conference is to attempt to learn the facts about the suspected violation and if it appears 106.6that a violation has occurred or is threatened, to find a way to correct or prevent it. The 106.7conference is not governed by any formal procedural requirements and may be conducted 106.8as the commissioner considers appropriate.106.9(c) The commissioner may issue an order directing a health information exchange 106.10service provider or a representative of a health information exchange service provider to 106.11cease and desist from engaging in any act or practice in violation of this section and 106.12section 62J.4981.106.13(d) Within 20 days after service of the order to cease and desist, a health information 106.14exchange service provider may contest whether the finding of facts constitutes a violation 106.15of this section and section 62J.4981 according to the contested case and judicial review 106.16provisions of sections 14.57 to 14.69.106.17(e) In the event of noncompliance with a cease and desist order issued under this 106.18subdivision, the commissioner may institute a proceeding to obtain injunctive relief or 106.19other appropriate relief in Ramsey County District Court.106.20    Subd. 2. Suspension or revocation of certificates of authority.(a) The 106.21commissioner may suspend or revoke a certificate of authority issued to a health 106.22data intermediary or health information organization under section 62J.4981 if the 106.23commissioner finds that:106.24(1) the health information exchange service provider is operating significantly 106.25in contravention of its basic organizational document, or in a manner contrary to that 106.26described in and reasonably inferred from any other information submitted under section 106.2762J.4981, unless amendments to the submissions have been filed with and approved by 106.28the commissioner;106.29(2) the health information exchange service provider is unable to fulfill its 106.30obligations to furnish comprehensive health information exchange services as required 106.31under its health information exchange contract;106.32(3) the health information exchange service provider is no longer financially solvent 106.33or may not reasonably be expected to meet its obligations to participating entities;106.34(4) the health information exchange service provider has failed to implement the 106.35complaint system in a manner designed to reasonably resolve valid complaints;107.1(5) the health information exchange service provider, or any person acting with its 107.2sanction, has advertised or merchandised its services in an untrue, misleading, deceptive, 107.3or unfair manner;107.4(6) the continued operation of the health information exchange service provider 107.5would be hazardous to its participating entities or the patients served by the participating 107.6entities; or107.7(7) the health information exchange service provider has otherwise failed to 107.8substantially comply with section 62J.4981 or with any other statute or administrative 107.9rule applicable to health information exchange service providers, or has submitted false 107.10information in any report required under sections 62J.498 to 62J.4982.107.11(b) A certificate of authority shall be suspended or revoked only after meeting the 107.12requirements of subdivision 3.107.13(c) If the certificate of authority of a health information exchange service provider is 107.14suspended, the health information exchange service provider shall not, during the period 107.15of suspension, enroll any additional participating entities, and shall not engage in any 107.16advertising or solicitation.107.17(d) If the certificate of authority of a health information exchange service provider is 107.18revoked, the organization shall proceed, immediately following the effective date of the 107.19order of revocation, to wind up its affairs and shall conduct no further business except as 107.20necessary to the orderly conclusion of the affairs of the organization. The organization 107.21shall engage in no further advertising or solicitation. The commissioner may, by written 107.22order, permit further operation of the organization as the commissioner finds to be in the 107.23best interest of participating entities, to the end that participating entities will be given the 107.24greatest practical opportunity to access continuing health information exchange services.107.25    Subd. 3. Denial, suspension, and revocation; administrative procedures. (a) 107.26When the commissioner has cause to believe that grounds for the denial, suspension, 107.27or revocation of a certificate of authority exists, the commissioner shall notify the 107.28health information exchange service provider in writing stating the grounds for denial, 107.29suspension, or revocation and setting a time within 20 days for a hearing on the matter.107.30(b) After a hearing before the commissioner at which the health information 107.31exchange service provider may respond to the grounds for denial, suspension, or 107.32revocation, or upon the failure of the health information exchange service provider to 107.33appear at the hearing, the commissioner shall take action as deemed necessary and shall 107.34issue written findings that shall be mailed to the health information exchange service 107.35provider.108.1(c) If suspension, revocation, or an administrative penalty is proposed according 108.2to this section, the commissioner must deliver, or send by certified mail with return 108.3receipt requested, to the health information exchange service provider written notice of 108.4the commissioner's intent to impose a penalty. This notice of proposed determination 108.5must include:108.6(1) a reference to the statutory basis for the penalty;108.7(2) a description of the findings of fact regarding the violations with respect to 108.8which the penalty is proposed;108.9(3) the nature and amount of the proposed penalty;108.10(4) any circumstances described in subdivision 1, paragraph (a), that were considered 108.11in determining the amount of the proposed penalty;108.12(5) instructions for responding to the notice, including a statement of the health 108.13information exchange service provider's right to a contested case proceeding and a 108.14statement that failure to request a contested case proceeding within 30 calendar days 108.15permits the imposition of the proposed penalty; and108.16(6) the address to which the contested case proceeding request must be sent.108.17    Subd. 4. Coordination.(a) To the extent possible when implementing sections 108.1862J.498 to 62J.4982, the commissioner shall seek the advice of the Minnesota e-Health 108.19Advisory Committee, in the review and update of criteria for the certification and 108.20recertification of health information exchange service providers.108.21(b) By January 1, 2011, the commissioner shall report to the governor and the 108.22chairs of the senate and house of representatives committees having jurisdiction over 108.23health information policy issues on the status of the health information exchange in 108.24Minnesota and provide recommendations on further action necessary to facilitate the 108.25secure electronic movement of health information among health providers that will enable 108.26Minnesota providers and hospitals to meet meaningful use exchange requirements.108.27    Subd. 5. Fees and monetary penalties. (a) Every health information exchange 108.28service provider subject to this section and section 62J.4981 shall be assessed fees as 108.29follows:108.30(1) filing an application for certificate of authority to operate as a health information 108.31organization, $10,500;108.32(2) filing an application for certificate of authority to operate as a health data 108.33intermediary, $7,000;108.34(3) annual health information organization certificate fee, $14,000;108.35(4) annual health data intermediary certificate fee, $7,000; and108.36(5) fees for other filings, as specified by rule.109.1(b) Administrative monetary penalties imposed under this subdivision shall be 109.2deposited into a revolving fund and are appropriated to the commissioner for the purposes 109.3of sections 62J.498 to 62J.4982.109.4    Sec. 9. Minnesota Statutes 2008, section 62Q.19, subdivision 1, is amended to read:109.5    Subdivision 1. Designation. (a) The commissioner shall designate essential 109.6community providers. The criteria for essential community provider designation shall be 109.7the following:109.8(1) a demonstrated ability to integrate applicable supportive and stabilizing services 109.9with medical care for uninsured persons and high-risk and special needs populations, 109.10underserved, and other special needs populations; and109.11(2) a commitment to serve low-income and underserved populations by meeting the 109.12following requirements:109.13(i) has nonprofit status in accordance with chapter 317A;109.14(ii) has tax exempt status in accordance with the Internal Revenue Service Code, 109.15section 501(c)(3);109.16(iii) charges for services on a sliding fee schedule based on current poverty income 109.17guidelines; and109.18(iv) does not restrict access or services because of a client's financial limitation;109.19(3) status as a local government unit as defined in section 
         62D.02, subdivision 11, a 109.20hospital district created or reorganized under sections 
         447.31 to 
         447.37, an Indian tribal 109.21government, an Indian health service unit, or a community health board as defined in 109.22chapter 145A;  109.23(4) a former state hospital that specializes in the treatment of cerebral palsy, spina 109.24bifida, epilepsy, closed head injuries, specialized orthopedic problems, and other disabling 109.25conditions; or109.26(5) a sole community hospital. For these rural hospitals, the essential community 109.27provider designation applies to all health services provided, including both inpatient and 109.28outpatient services. For purposes of this section, "sole community hospital" means a 109.29rural hospital that:109.30(i) is eligible to be classified as a sole community hospital according to Code 109.31of Federal Regulations, title 42, section 
         412.92, or is located in a community with a 109.32population of less than 5,000 and located more than 25 miles from a like hospital currently 109.33providing acute short-term services;  110.1(ii) has experienced net operating income losses in two of the previous three 110.2most recent consecutive hospital fiscal years for which audited financial information is 110.3available; and110.4(iii) consists of 40 or fewer licensed beds; or110.5(6) a birth center licensed under section 144.615.110.6(b) Prior to designation, the commissioner shall publish the names of all applicants 110.7in the State Register. The public shall have 30 days from the date of publication to submit 110.8written comments to the commissioner on the application. No designation shall be made 110.9by the commissioner until the 30-day period has expired.110.10(c) The commissioner may designate an eligible provider as an essential community 110.11provider for all the services offered by that provider or for specific services designated by 110.12the commissioner.110.13(d) For the purpose of this subdivision, supportive and stabilizing services include at 110.14a minimum, transportation, child care, cultural, and linguistic services where appropriate.110.15    Sec. 10. Minnesota Statutes 2008, section 144.226, subdivision 3, is amended to read:110.16    Subd. 3. Birth record surcharge.(a) In addition to any fee prescribed under 110.17subdivision 1, there shall be a nonrefundable surcharge of $3 for each certified birth or 110.18stillbirth record and for a certification that the vital record cannot be found. The local or 110.19state registrar shall forward this amount to the commissioner of management and budget 110.20for deposit into the account for the children's trust fund for the prevention of child abuse 110.21established under section 
         256E.22. This surcharge shall not be charged under those 110.22circumstances in which no fee for a certified birth or stillbirth record is permitted under 110.23subdivision 1, paragraph (a). Upon certification by the commissioner of management and 110.24budget that the assets in that fund exceed $20,000,000, this surcharge shall be discontinued.110.25(b) In addition to any fee prescribed under subdivision 1, there shall be a 110.26nonrefundable surcharge of $10 for each certified birth record. The local or state registrar 110.27shall forward this amount to the commissioner of finance for deposit in the general fund 110.28for the Minnesota Birth Defects Information System established under section 144.2215. 110.29This surcharge shall not be charged under those circumstances in which no fee for a 110.30certified birth record is permitted under subdivision 1, paragraph (a).110.31EFFECTIVE DATE.This section is effective July 1, 2010.110.32    Sec. 11. [144.615] BIRTH CENTERS.110.33    Subdivision 1.Definitions.(a) For purposes of this section, the following definitions 110.34have the meanings given them.111.1(b) "Birth center" means a facility licensed for the primary purpose of performing 111.2low-risk deliveries that is not a hospital or licensed as part of a hospital and where births are 111.3planned to occur away from the mother's usual residence following a low-risk pregnancy.111.4(c) "CABC" means the Commission for the Accreditation of Birth Centers.111.5(d) "Low-risk pregnancy" means a normal, uncomplicated prenatal course as 111.6determined by documentation of adequate prenatal care and the anticipation of a normal 111.7uncomplicated labor and birth, as defined by reasonable and generally accepted criteria 111.8adopted by professional groups for maternal, fetal, and neonatal health care.111.9    Subd. 2.License required.(a) Beginning January 1, 2011, no birth center shall be 111.10established, operated, or maintained in the state without first obtaining a license from the 111.11commissioner of health according to this section.111.12(b) A license issued under this section is not transferable or assignable and is subject 111.13to suspension or revocation at any time for failure to comply with this section.111.14(c) A birth center licensed under this section shall not assert, represent, offer, 111.15provide, or imply that the center is or may render care or services other than the services it 111.16is permitted to render within the scope of the license or the accreditation issued.111.17(d) The license must be conspicuously posted in an area where patients are admitted.111.18    Subd. 3.Temporary license.For new birth centers planning to begin operations 111.19after January 1, 2011, the commissioner may issue a temporary license to the birth center 111.20that is valid for a period of six months from the date of issuance. The birth center must 111.21submit to the commissioner an application and applicable fee for licensure as required 111.22under subdivision 4. The application must include the information required in subdivision 111.234, clauses (1) to (3) and (5) to (7), and documentation that the birth center has submitted 111.24an application for accreditation to the CABC. Upon receipt of accreditation from the 111.25CABC, the birth center must submit to the commissioner the information required in 111.26subdivision 4, clause (4), and the applicable fee under subdivision 8. The commissioner 111.27shall issue a new license.111.28    Subd. 4.Application.An application for a license to operate a birth center and the 111.29applicable fee under subdivision 8 must be submitted to the commissioner on a form 111.30provided by the commissioner and must contain:111.31(1) the name of the applicant;111.32(2) the site location of the birth center;111.33(3) the name of the person in charge of the center;111.34(4) documentation that the accreditation described under subdivision 6 has been 111.35issued, including the effective date and the expiration date of the accreditation, and the 111.36date of the last site visit by the CABC;112.1(5) the number of patients the birth center is capable of serving at a given time;112.2(6) the names and license numbers, if applicable, of the health care professionals 112.3on staff at the birth center; and112.4(7) any other information the commissioner deems necessary.112.5    Subd. 5.Suspension, revocation, and refusal to renew.The commissioner may 112.6refuse to grant or renew, or may suspend or revoke, a license on any of the grounds 112.7described under section 144.55, subdivision 6, paragraph (a), clause (2), (3), or (4), or 112.8upon the loss of accreditation by the CABC. The applicant or licensee is entitled to notice 112.9and a hearing as described under section 144.55, subdivision 7, and a new license may be 112.10issued after proper inspection of the birth center has been conducted.112.11    Subd. 6.Standards for licensure.(a) To be eligible for licensure under this 112.12section, a birth center must be accredited by the CABC or must obtain accreditation 112.13within six months of the date of the application for licensure. If the birth center loses its 112.14accreditation, the birth center must immediately notify the commissioner.112.15(b) The center must have procedures in place specifying criteria by which risk status 112.16will be established and applied to each woman at admission and during labor.112.17(c) Upon request, the birth center shall provide the commissioner of health with any 112.18material submitted by the birth center to the CABC as part of the accreditation process, 112.19including the accreditation application, the self-evaluation report, the accreditation 112.20decision letter from the CABC, and any reports from the CABC following a site visit.112.21    Subd. 7.Limitations of services.(a) The following limitations apply to the services 112.22performed at a birth center:112.23(1) surgical procedures must be limited to those normally accomplished during an 112.24uncomplicated birth, including episiotomy and repair;112.25(2) no abortions may be administered; and112.26(3) no general or regional anesthesia may be administered.112.27(b) Notwithstanding paragraph (a), local anesthesia may be administered at a birth 112.28center if the administration of the anesthetic is performed within the scope of practice of a 112.29health care professional.112.30    Subd. 8.Fees.(a) The biennial license fee for a birth center is $365.112.31(b) The temporary license fee is $365.112.32(c) Fees shall be collected and deposited according to section 144.122.112.33    Subd. 9.Renewal.(a) Except as provided in paragraph (b), a license issued under 112.34this section expires two years from the date of issue.112.35(b) A temporary license issued under subdivision 3 expires six months from the date 112.36of issue, and may be renewed for one additional six-month period.113.1(c) An application for renewal shall be submitted at least 60 days prior to expiration 113.2of the license on forms prescribed by the commissioner of health.113.3    Subd. 10.Records.All health records maintained on each client by a birth center 113.4are subject to sections 144.292 to 144.298.113.5    Subd. 11.Report.(a) The commissioner of health, in consultation with the 113.6commissioner of human services and representatives of the licensed birth centers, 113.7the American College of Obstetricians and Gynecologists, the American Academy 113.8of Pediatrics, the Minnesota Hospital Association, and the Minnesota Ambulance 113.9Association, shall evaluate the quality of care and outcomes for services provided in 113.10licensed birth centers, including, but not limited to, the utilization of services provided at a 113.11birth center, the outcomes of care provided to both mothers and newborns, and the numbers 113.12of transfers to other health care facilities that are required and the reasons for the transfers. 113.13The commissioner shall work with the birth centers to establish a process to gather and 113.14analyze the data within protocols that protect the confidentiality of patient identification.113.15(b) The commissioner of health shall report the findings of the evaluation to the 113.16legislature by January 15, 2014.113.17    Sec. 12. Minnesota Statutes 2008, section 144.651, subdivision 2, is amended to read:113.18    Subd. 2. Definitions. For the purposes of this section, "patient" means a person 113.19who is admitted to an acute care inpatient facility for a continuous period longer than 113.2024 hours, for the purpose of diagnosis or treatment bearing on the physical or mental 113.21health of that person. For purposes of subdivisions 4 to 9, 12, 13, 15, 16, and 18 to 20, 113.22"patient" also means a person who receives health care services at an outpatient surgical 113.23center or at a birth center licensed under section 144.615. "Patient" also means a minor 113.24who is admitted to a residential program as defined in section 
         253C.01. For purposes of 113.25subdivisions 1, 3 to 16, 18, 20 and 30, "patient" also means any person who is receiving 113.26mental health treatment on an outpatient basis or in a community support program or other 113.27community-based program. "Resident" means a person who is admitted to a nonacute care 113.28facility including extended care facilities, nursing homes, and boarding care homes for 113.29care required because of prolonged mental or physical illness or disability, recovery from 113.30injury or disease, or advancing age. For purposes of all subdivisions except subdivisions 113.3128 and 29, "resident" also means a person who is admitted to a facility licensed as a board 113.32and lodging facility under Minnesota Rules, parts 4625.0100 to 4625.2355, or a supervised 113.33living facility under Minnesota Rules, parts 4665.0100 to 4665.9900, and which operates 113.34a rehabilitation program licensed under Minnesota Rules, parts 9530.4100 to 9530.4450. 114.1    Sec. 13. Minnesota Statutes 2008, section 144.9504, is amended by adding a 114.2subdivision to read:114.3    Subd. 12.Blood lead level guidelines.(a) By January 1, 2011, the commissioner 114.4must revise clinical and case management guidelines to include recommendations 114.5for protective health actions and follow-up services when a child's blood lead level 114.6exceeds five micrograms of lead per deciliter of blood. The revised guidelines must be 114.7implemented to the extent possible using available resources.114.8(b) In revising the clinical and case management guidelines for blood lead levels 114.9greater than five micrograms of lead per deciliter of blood under this subdivision, 114.10the commissioner of health must consult with a statewide organization representing 114.11physicians, the public health department of Minneapolis and other public health 114.12departments, and a nonprofit organization with expertise in lead abatement.114.13    Sec. 14. Minnesota Statutes 2008, section 144A.51, subdivision 5, is amended to read:114.14    Subd. 5. Health facility. "Health facility" means a facility or that part of a facility 114.15which is required to be licensed pursuant to sections 
         144.50 to 
         144.58, 144.615, and a 114.16facility or that part of a facility which is required to be licensed under any law of this state 114.17which provides for the licensure of nursing homes. 114.18    Sec. 15. Minnesota Statutes 2008, section 144E.37, is amended to read:114.19144E.37 COMPREHENSIVE ADVANCED LIFE SUPPORT.114.20The board commissioner of health shall establish a comprehensive advanced 114.21life-support educational program to train rural medical personnel, including physicians, 114.22physician assistants, nurses, and allied health care providers, in a team approach to 114.23anticipate, recognize, and treat life-threatening emergencies before serious injury or 114.24cardiac arrest occurs.114.25EFFECTIVE DATE.This section is effective July 1, 2010.114.26    Sec. 16. HEALTH PLAN AND COUNTY ADMINISTRATIVE COST 114.27REDUCTION; REPORTING REQUIREMENTS.114.28(a) Minnesota health plans and county-based purchasing plans may complete an 114.29inventory of existing data collection and reporting requirements for health plans and 114.30county-based purchasing plans and submit to the commissioners of health and human 114.31services a list of data, documentation, and reports that:115.1(1) are collected from the same health plan or county-based purchasing plan more 115.2than once;115.3(2) are collected directly from the health plan or county-based purchasing plan but 115.4are available to the state agencies from other sources;115.5(3) are not currently being used by state agencies; or115.6(4) collect similar information more than once in different formats, at different 115.7times, or by more than one state agency.115.8(b) The report to the commissioners may also identify the percentage of health 115.9plan and county-based purchasing plan administrative time and expense attributed to 115.10fulfilling reporting requirements and include recommendations regarding ways to reduce 115.11duplicative reporting requirements.115.12(c) Upon receipt, the commissioners shall submit the inventory and recommendations 115.13to the chairs of the appropriate legislative committees, along with their comments 115.14and recommendations as to whether any action should be taken by the legislature to 115.15establish a consolidated and streamlined reporting system under which data, reports, and 115.16documentation are collected only once and only when needed for the state agencies to 115.17fulfill their duties under law and applicable regulations.115.18    Sec. 17. APPLICATION PROCESS FOR HEALTH INFORMATION 115.19EXCHANGE.115.20To the extent that the commissioner of health applies for additional federal funding 115.21to support the commissioner's responsibilities of developing and maintaining state level 115.22health information exchange under section 3013 of the HITECH Act, the commissioner of 115.23health shall ensure that applications are made through an open process that provides health 115.24information exchange service providers equal opportunity to receive funding.115.25    Sec. 18. TRANSFER.115.26The powers and duties of the Emergency Medical Services Regulatory Board with 115.27respect to the comprehensive advanced life-support educational program under Minnesota 115.28Statutes, section 144E.37, are transferred to the commissioner of health under Minnesota 115.29Statutes, section 15.039.115.30EFFECTIVE DATE.This section is effective July 1, 2010.115.31    Sec. 19. REVISOR'S INSTRUCTION.116.1The revisor of statutes shall renumber Minnesota Statutes, section 144E.37, as 116.2Minnesota Statutes, section 144.6062, and make all necessary changes in statutory 116.3cross-references in Minnesota Statutes and Minnesota Rules.116.4EFFECTIVE DATE.This section is effective July 1, 2010.116.5ARTICLE 7116.6HEALTH CARE REFORM116.7    Section 1. [62E.20] RELATIONSHIP TO TEMPORARY FEDERAL HIGH-RISK 116.8POOL.116.9    Subdivision 1.Definitions.(a) For purposes of this section, the terms defined in 116.10this subdivision have the meanings given.116.11(b) "Association" means the Minnesota Comprehensive Health Association.116.12(c) "Federal law" means Title I, subtitle B, section 1101, of the federal Patient 116.13Protection and Affordable Care Act, Public Law 111-148, including any federal 116.14regulations adopted under it.116.15(d) "Federal qualified high-risk pool" means an arrangement established by the 116.16federal secretary of health and human services that meets the requirements of the federal 116.17law.116.18    Subd. 2.Timing of this section.This section applies beginning as of the date the 116.19temporary federal qualified high risk health pool created under the federal law begins 116.20to provide coverage in this state.116.21    Subd. 3.Maintenance of effort.The assessments made by the comprehensive 116.22health association on its member insurers must comply with the maintenance of effort 116.23requirement contained in paragraph (b), clause (3), of the federal law, to the extent that 116.24requirement applies to assessments made by the association.116.25    Subd. 4.Coordination with federal law.Upon the date a federal qualified high-risk 116.26pool begins to provide coverage in this state, the comprehensive health association must 116.27not enroll new enrollees, notwithstanding section 62E.14 or other law to the contrary. If 116.28the lack of new enrollees would otherwise lead to noncompliance with subdivision 3, the 116.29association shall reduce the premiums to levels below those otherwise required under 116.30section 62E.08, to the extent necessary to comply with subdivision 3.116.31    Subd. 5.Coordination with state health care programs.The commissioner of 116.32human services, in consultation with the commissioner of commerce and the Minnesota 116.33Comprehensive Health Association, shall coordinate enrollment between medical 117.1assistance, MinnesotaCare, the federal qualified high-risk pool, and the Minnesota 117.2Comprehensive Health Association, to ensure that:117.3(1) applicants for coverage through the federal qualified high-risk pool, or through 117.4the Minnesota Comprehensive Health Association to the extent the association is enrolling 117.5new members, are referred to the medical assistance or MinnesotaCare programs if they 117.6are determined to be potentially eligible for coverage through those programs; and117.7(2) applicants for coverage under medical assistance or MinnesotaCare who are 117.8determined not to be eligible for those programs are provided information about coverage 117.9through the federal qualified high-risk pool and the Minnesota Comprehensive Health 117.10Association.117.11    Sec. 2. Minnesota Statutes 2008, section 62J.07, subdivision 2, is amended to read:117.12    Subd. 2. Membership. The Legislative Commission on Health Care Access 117.13consists of five seven members of the senate appointed under the rules of the senate and 117.14five seven members of the house of representatives appointed under the rules of the house 117.15of representatives. The Legislative Commission on Health Care Access must include three117.16five members of the majority party and two members of the minority party in each house.117.17    Sec. 3. Minnesota Statutes 2008, section 62J.07, is amended by adding a subdivision to 117.18read:117.19    Subd. 5.Federal health care reform.(a) The Legislative Commission on 117.20Health Care Access shall analyze  options  and make recommendations regarding the 117.21implementation of provisions of the Patient Protection and Affordable Health Care Act, 117.22Public Law 111-148, and the health care reform provisions in the Health Care and 117.23Education Reconciliation Act of 2010, Public Law 111-152, including:117.24(1) development of accountable care organizations;117.25(2) health insurance reform, including options related to coverage, purchasing, 117.26exchange development, and coverage for high-risk individuals; and117.27(3) other provisions that will require changes in state law.117.28(b) Before finalizing and submitting federal applications for pilot projects authorized 117.29under federal health care reform, the governor and state agencies shall seek review and 117.30advice from the commission.117.31(c) The commission may create and make appointments to work groups to assist the 117.32commission in its work. Work group members may include legislators, representatives 117.33of businesses and nonprofit agencies impacted by federal health care reform, academic 117.34experts, and consumer representatives.118.1    Sec. 4. Minnesota Statutes 2008, section 62U.05, is amended to read:118.262U.05 PROVIDER PRICING FOR BASKETS OF CARE; ACCOUNTABLE 118.3CARE ORGANIZATIONS.118.4    Subdivision 1. Establishment of definitions. (a) By July 1, 2009, the commissioner 118.5of health shall establish uniform definitions for baskets of care beginning with a minimum 118.6of seven baskets of care. In selecting health conditions for which baskets of care should 118.7be defined, the commissioner shall consider coronary artery and heart disease, diabetes, 118.8asthma, and depression. In selecting health conditions, the commissioner shall also 118.9consider the prevalence of the health conditions, the cost of treating the health conditions, 118.10and the potential for innovations to reduce cost and improve quality.118.11    (b) The commissioner shall convene one or more work groups to assist in 118.12establishing these definitions. Each work group shall include members appointed by 118.13statewide associations representing relevant health care providers and health plan 118.14companies, and organizations that work to improve health care quality in Minnesota.118.15    (c) To the extent possible, the baskets of care must incorporate a patient-directed, 118.16decision-making support model.118.17(d) By January 1, 2012, the commissioner shall establish uniform definitions for the 118.18total cost of providing all necessary services to a patient through an accountable care 118.19organization meeting the standards specified in section 3022 of the Patient Protection 118.20and Affordable Care Act, Public Law 111-148, and shall develop a standard method 118.21and format for accountable care organizations to use for submitting package prices for 118.22the total cost of care. This method must be published in the State Register and must be 118.23made available to all providers.118.24    Subd. 2. Package prices. (a) Beginning January 1, 2010, health care providers may 118.25establish package prices for the baskets of care defined under subdivision 1. Beginning 118.26July 1, 2012, accountable care organizations may establish package prices for the total 118.27cost of care defined under subdivision 1.118.28    (b) Beginning January 1, 2010, no health care provider or group of providers that 118.29has established a package price for a basket of care under this section, and beginning 118.30July 1, 2012, no accountable care organization that has established a package price for 118.31the total cost of care under this section, shall vary the payment amount that the provider 118.32or organization accepts as full payment for a health care service based upon the identity of 118.33the payer, upon a contractual relationship with a payer, upon the identity of the patient, 118.34or upon whether the patient has coverage through a group purchaser. This paragraph 118.35applies only to health care services provided to Minnesota residents or to non-Minnesota 118.36residents who obtain health insurance through a Minnesota employer. This paragraph does 119.1not apply to services paid for by Medicare, state public health care programs through 119.2fee-for-service or prepaid arrangements, workers' compensation, or no-fault automobile 119.3insurance. This paragraph does not affect the right of a provider to provide charity care 119.4or care for a reduced price due to financial hardship of the patient or due to the patient 119.5being a relative or friend of the provider. 119.6    Subd. 3. Quality measurements for baskets of care. (a) The commissioner shall 119.7establish quality measurements for the defined baskets of care by December 31, 2009.119.8The commissioner shall establish quality measures for the total cost of care for services 119.9delivered through an accountable care organization by June 30, 2012. The commissioner 119.10may contract with an organization that works to improve health care quality to make 119.11recommendations about the use of existing measures or establishing new measures where 119.12no measures currently exist.119.13    (b) Beginning July 1, 2010, the commissioner or the commissioner's designee shall 119.14publish comparative price and quality information on the baskets of care in a manner 119.15that is easily accessible and understandable to the public, as this information becomes 119.16available. Beginning January 1, 2013, the commissioner or the commissioner's designee 119.17shall publish comparative price and quality information on the total cost of care for 119.18services delivered through an accountable care organization in a manner that is easily 119.19accessible and understandable to the public, as this information becomes available.119.20    Sec. 5. Minnesota Statutes 2008, section 256B.0754, is amended by adding a 119.21subdivision to read:119.22    Subd. 3.Accountable care organizations.By July 1, 2012, the commissioner of 119.23human services shall deliver services to enrollees in state health care programs through 119.24accountable care organizations, and shall provide incentive payments to accountable care 119.25organizations that meet or exceed annual quality and performance targets. Accountable 119.26care organizations and incentive payments must meet the standards specified in the Patient 119.27Protection and Affordable Care Act, Public Law 111-148.119.28    Sec. 6. [256B.0756] COORDINATED CARE THROUGH A HEALTH HOME.119.29    Subdivision 1.Provision of coverage.(a) The commissioner shall provide 119.30medical assistance coverage of health home services for eligible individuals with chronic 119.31conditions who select a designated provider, a team of health care professionals, or a 119.32health team as the individual's health home.119.33(b) The commissioner shall implement this section in compliance with the 119.34requirements of the state option to provide health homes for enrollees with chronic 120.1conditions, as provided under the Patient Protection and Affordable Care Act, Public 120.2Law 111-148, sections 2703 and 3502. Terms used in this section have the meaning 120.3provided in that act.120.4    Subd. 2.Eligible individual.An individual is eligible for health home services 120.5under this section if the individual is eligible for medical assistance under this chapter 120.6and has at least:120.7(1) two chronic conditions;120.8(2) one chronic condition and is at risk of having a second chronic condition; or120.9(3) one serious and persistent mental health condition.120.10    Subd. 3.Health home services.(a) Health home services means comprehensive and 120.11timely high-quality services that are provided by a health home. These services include:120.12(1) comprehensive care management;120.13(2) care coordination and health promotion;120.14(3) comprehensive transitional care, including appropriate follow-up, from inpatient 120.15to other settings;120.16(4) patient and family support, including authorized representatives;120.17(5) referral to community and social support services, if relevant; and120.18(6) use of health information technology to link services, as feasible and appropriate.120.19(b) The commissioner shall maximize the number and type of services 120.20included in this subdivision to the extent permissible under federal law, including 120.21physician, outpatient, mental health treatment, and rehabilitation services necessary for 120.22comprehensive transitional care following hospitalization.120.23    Subd. 4.Health teams.The commissioner shall establish health teams to support 120.24the patient-centered health home and provide the services described in subdivision 3 to 120.25individuals eligible under subdivision 2. The commissioner shall apply for grants or 120.26contracts as provided under section 3502 of the Patient Protection and Affordable Care 120.27Act to establish health teams and provide capitated payments to primary care providers. 120.28For purposes of this section, "health teams" means community-based, interdisciplinary, 120.29inter-professional teams of health care providers that support primary care practices. 120.30These providers may include medical specialists, nurses, advanced practice registered 120.31nurses, pharmacists, nutritionists, social workers, behavioral and mental health providers, 120.32doctors of chiropractic, licensed complementary and alternative medicine practitioners, 120.33and physician's assistants.120.34    Subd. 5.Payments.The commissioner shall make payments to each health home 120.35and each health team for the provision of health home services to each eligible individual 120.36with chronic conditions that selects the health home as a provider.121.1    Subd. 6.Coordination.The commissioner, to the extent feasible, shall ensure that 121.2the requirements and payment methods for health homes and health teams developed 121.3under this section are consistent with the requirements and payment methods for health 121.4care homes established under sections 256B.0751 and 256B.0753. The commissioner may 121.5modify requirements and payment methods under sections 256B.0751 and 256B.0753 in 121.6order to be consistent with federal health home requirements and payment methods.121.7    Subd. 7.State plan amendment.The commissioner shall submit a state plan 121.8amendment to implement this section to the federal Centers for Medicare and Medicaid 121.9Services by January 1, 2011.121.10EFFECTIVE DATE.This section is effective January 1, 2011, or upon federal 121.11approval, whichever is later.121.12    Sec. 7. FEDERAL HEALTH CARE REFORM DEMONSTRATION PROJECTS 121.13AND GRANTS.121.14(a) The commissioner of human services shall seek to participate in the following 121.15demonstration projects, or apply for the following grants, as described in the federal 121.16Patient Protection and Affordable Care Act, Public Law 111-148:121.17(1) the demonstration project to evaluate integrated care around a hospitalization, 121.18Public Law 111-148, section 2704;121.19(2) the Medicaid global payment system demonstration project, Public Law 111-148, 121.20section 2705;121.21(3) the pediatric accountable care organization demonstration project, Public Law 121.22111-148, section 2706;121.23(4) the Medicaid emergency psychiatric demonstration project, Public Law 111-148, 121.24section 2707; and121.25(5) grants to provide incentives for prevention of chronic diseases in Medicaid, 121.26Public Law 111-148, section 4108.121.27(b) The commissioner of human services shall report to the chairs and ranking 121.28minority members of the house of representatives and senate committees or divisions with 121.29jurisdiction over health care policy and finance on the status of the demonstration project 121.30and grant applications. If the state is accepted as a demonstration project participant, or is 121.31awarded a grant, the commissioner shall notify the chairs and ranking minority members 121.32of those committees or divisions of any legislative changes necessary to implement the 121.33demonstration projects or grants.121.34    Sec. 8. HEALTH CARE REFORM TASK FORCE.122.1    Subdivision 1.Task force.(a) The governor shall convene a Health Care 122.2Reform Task Force to advise and assist the governor and the legislature regarding state 122.3implementation of federal health care reform legislation. For purposes of this section, 122.4"federal health care reform legislation" means the Patient Protection and Affordable Care 122.5Act, Public Law 111-148, and the health care reform provisions in the Health Care and 122.6Education Reconciliation Act of 2010, Public Law 111-152. The task force shall consist of:122.7(1) two legislators from the house of representatives appointed by the speaker and 122.8two legislators from the senate appointed by the Subcommittee on Committees of the 122.9Committee on Rules and Administration;122.10    (2) two representatives appointed by the governor to represent the governor and 122.11state agencies;122.12    (3) three persons appointed by the governor who have demonstrated leadership in 122.13health care organizations, health plan companies, or health care trade or professional 122.14associations;122.15    (4) three persons appointed by the governor who have demonstrated leadership in 122.16employer and group purchaser activities related to health system improvement of whom at 122.17least two must be from a labor organization; and122.18    (5) five persons appointed by the governor who have demonstrated expertise in the 122.19areas of health care financing, access, and quality.122.20    The governor is exempt from the requirements of the open appointments process 122.21for purposes of appointing task force members. Members shall be appointed for one-year 122.22terms and may be reappointed.122.23    (b) The Department of Health, Department of Human Services, and Department of 122.24Commerce shall provide staff support to the task force. The task force may accept outside 122.25resources to help support its efforts.122.26    (c) Task force members must be appointed by July 1, 2010.  The task force must hold 122.27its first meeting by July 15, 2010.122.28    Subd. 2.Duties.(a) By December 15, 2010, the task force shall develop and 122.29present to the legislature and the governor a preliminary report and recommendations on 122.30state implementation of federal health care reform legislation. The report must include 122.31recommendations for state law and program changes necessary to comply with the federal 122.32health care reform legislation, and also recommendations for implementing provisions of 122.33the federal legislation that are optional for states. In developing recommendations, the task 122.34force shall consider the extent to which an approach maximizes federal funding to the state.123.1(b) The task force, in consultation with the governor and the legislature, shall also 123.2establish timelines and criteria for future reports on state implementation of the federal 123.3health care reform legislation.123.4    Sec. 9. AMERICAN HEALTH BENEFIT EXCHANGE; PLANNING 123.5PROVISIONS.123.6    Subdivision 1.Federal planning grants.The commissioners of commerce, health, 123.7and human services shall jointly or separately apply to the federal secretary of health and 123.8human services for one or more planning and establishment grants, including renewal 123.9grants, authorized under section 1311 of the Patient Protection and Affordable Care Act, 123.10Public Law 111-148, including any future amendments of that provision, relating to state 123.11creation of American Health Benefit Exchanges.123.12    Subd. 2.Consideration of early creation and operation of exchange.(a) The 123.13commissioners referenced in subdivision 1 shall analyze the advantages and disadvantages 123.14to the state of planning to have a state health insurance exchange, similar to an American 123.15Health Benefit Exchange referenced in subdivision 1, begin prior to the federal deadline 123.16of January 1, 2014.123.17(b) The commissioners shall provide a written report to the legislature on the results 123.18of the analysis required under paragraph (a) no later than December 15, 2010. The written 123.19report must comply with Minnesota Statutes, sections 3.195 and 3.197.123.20ARTICLE 8123.21HUMAN SERVICES FORECAST ADJUSTMENTS

123.22123.23Section 1. SUMMARY OF APPROPRIATIONS; DEPARTMENT OF HUMAN SERVICES FORECAST ADJUSTMENT.

123.24The dollar amounts shown are added to or if shown in parentheses, are subtracted 123.25from the appropriations in Laws 2009, chapter 79, article 13, as amended by Laws 2009, 123.26chapter 173, article 2, from the general fund or any fund named to the Department of 123.27Human Services for the purposes specified in this article, to be available for the fiscal 123.28year indicated for each purpose. The figure "2010" used in this article means that the 123.29appropriation or appropriations listed are available for the fiscal year ending June 30, 123.302010. The figure "2011" used in this article means that the appropriation or appropriations 123.31listed are available for the fiscal year ending June 30, 2011.

123.3220102011123.33General$(109,876,000)$(28,344,000)123.34Health Care Access99,654,000276,500,000124.1Federal TANF (9,830,000)15,133,000124.2Total$(20,052,000)$263,289,000

124.3124.4Sec. 2. COMMISSIONER OF HUMAN SERVICES

124.5Subdivision 1.Total Appropriation$(20,052,000)$263,289,000

124.6Appropriations by Fund124.720102011124.8General(109,876,000)(28,344,000)124.9Health Care Access99,654,000276,500,000124.10Federal TANF (9,830,000)15,133,000

124.11Subd. 2. Revenue and Pass-Through

124.12Federal TANF390,000(251,000)

124.13124.14Subd. 3.Children and Economic Assistance Grants

124.15General Fund4,489,000(4,140,000)124.16Federal TANF(10,220,000)15,384,000

124.17The amounts that may be spent from this 124.18appropriation are as follows:

124.19(a) MFIP Grants

124.20General Fund7,916,000(14,481,000)124.21TANF Fund(10,220,000)15,384,000

124.22(b) MFIP Child Care Assistance Grants(7,832,000)2,579,000

124.23(c) General Assistance Grants875,0001,339,000

124.24(d) Minnesota Supplemental Aid Grants2,454,0003,843,000

124.25(e) Group Residential Housing Grants1,076,0002,580,000

124.26Subd. 4.Basic Health Care Grants

124.27General Fund(62,770,000)29,192,000124.28TANF Fund99,654,000276,500,000

124.29The amounts that may be spent from this 124.30appropriation are as follows:

124.31(a) MinnesotaCare Grants

125.1125.2Health Care Access Fund99,654,000276,500,000

125.3125.4(b) Medical Assistance Basic Health Care – Families and Children1,165,00024,146,000

125.5125.6(c) Medical Assistance Basic Health Care – Elderly and Disabled(63,935,000)5,046,000

125.7Subd. 5.Continuing Care Grants(51,595,000)(53,396,000)

125.8The amounts that may be spent from this 125.9appropriation are as follows:

125.10125.11(a) Medical Assistance Long-Term Care Facilities(3,774,000)(8,275,000)

125.12125.13(b) Medical Assistance Long-Term Care Waivers(27,710,000)(22,452,000)

125.14(c) Chemical Dependency Entitlement Grants(20,111,000)(22,669,000)

125.15    Sec. 3. EFFECTIVE DATE.125.16Sections 1 and 2 are effective the date following final enactment.125.17ARTICLE 9125.18HEALTH AND HUMAN SERVICES APPROPRIATIONS

125.19Section 1.  SUMMARY OF APPROPRIATIONS.

125.20The amounts shown in this section summarize direct appropriations, by fund, made 125.21in this article.

125.2220102011Total125.23General$(10,162,000)$(99,234,000)$(109,396,000)125.24125.25State Government Special Revenue(608,000)(275,000)(883,000)125.26Health Care Access(1,094,000)72,459,00071,365,000125.27Federal TANF-0-27,918,00027,918,000125.28Total$(11,864,000)$(867,000)$(10,997,000)

125.29Sec. 2. HEALTH AND HUMAN SERVICES APPROPRIATIONS.

125.30The sums shown in the columns marked "Appropriations" are added to or, if shown 125.31in parentheses, subtracted from the appropriations in Laws 2009, chapter 79, article 13, 125.32as amended by Laws 2009, chapter 173, article 2, to the agencies and for the purposes 125.33specified in this article. The appropriations are from the general fund and are available 126.1for the fiscal years indicated for each purpose. The figures "2010" and "2011" used in 126.2this article mean that the addition to or subtraction from the appropriation listed under 126.3them is available for the fiscal year ending June 30, 2010, or June 30, 2011, respectively. 126.4Supplemental appropriations and reductions to appropriations for the fiscal year ending 126.5June 30, 2010, are effective the day following final enactment unless a different effective 126.6date is explicit.

126.7APPROPRIATIONS126.8Available for the Year126.9Ending June 30126.1020102011

126.11126.12Sec. 3. COMMISSIONER OF HUMAN SERVICES

126.13Subdivision 1.Total Appropriation$(9,467,000)$(5,084,000)

126.14Appropriations by Fund126.1520102011126.16General(8,365,000)(105,244,000)126.17126.18State Government Special Revenue(8,000)(16,000)126.19Health Care Access(1,094,000)72,259,000126.20Federal TANF-0-27,918,000

126.21Working Family Credit Expenditures to 126.22be Claimed for TANF/MOE. For fiscal year 126.232011, the commissioner may count $38,000 126.24of working family credit expenditures as 126.25TANF/MOE. Notwithstanding any provision 126.26to the contrary, this rider expires June 30, 126.272013.126.28TANF Financing and Maintenance of 126.29Effort. The commissioner of human 126.30services, with the approval of the 126.31commissioner of management and budget, 126.32and after notification of the chairs of the 126.33relevant senate budget division and house of 126.34representatives finance division, may adjust 126.35the amount of TANF transfers between the 126.36MFIP transition year child care assistance 126.37program and MFIP grant programs within the 127.1fiscal year, and within the current biennium 127.2and the biennium ending June 30, 2013, 127.3to ensure that state and federal match and 127.4maintenance of effort requirements are 127.5met. These transfers and amounts must be 127.6reported to the chairs of the senate and house 127.7of representatives Finance Committees, the 127.8senate Health and Human Services Budget 127.9Division, the house of representatives Health 127.10Care and Human Services Finance Division, 127.11and Early Childhood Finance and Policy 127.12Division by December 1 of each fiscal 127.13year. Notwithstanding any provision to the 127.14contrary, this rider expires June 30, 2013.127.15The appropriation reductions for each 127.16purpose are shown in the following 127.17subdivisions.

127.18127.19Subd. 2.Agency Management; Financial Operations(8,000)(16,000)

127.20This appropriation reduction is from the state 127.21government special revenue fund.

127.22127.23Subd. 3.Revenue and Pass-Through Revenue Expenditures-0-28,000,000

127.24TANF Funding for the Working Family 127.25Tax Credit. In addition to the amounts 127.26specified in Minnesota Statutes, section 127.27290.0671, subdivision 6, $18,722,000 127.28of TANF funds in fiscal year 2010 and 127.29$18,689,000 of TANF funds in fiscal year 127.302011 are appropriated to the commissioner 127.31of human services to reimburse the cost of 127.32the working family tax credit for eligible 127.33families. Beginning January 1, 2011, the 127.34commissioner shall reimburse the general 127.35fund on a monthly basis according to a 127.36schedule based on the pattern of working 128.1family credit expenditures through June 20, 128.22011. This rider is effective upon enactment.

128.3128.4Subd. 4.Children and Economic Assistance Grants

128.5128.6(a) MFIP and Diversionary Work Program Grants-0-(2,033,000)

128.7This appropriation reduces the general 128.8fund appropriation by $5,691,000 and 128.9increases the federal TANF appropriation by 128.10$3,658,000.

128.11(b) Support Services Grants-0-(7,646,000)

128.12Supported Work. The fiscal year 2011 128.13TANF appropriation to the commissioner of 128.14human services for supported work for MFIP 128.15recipients is reduced by $4,000,000. This 128.16reduction is onetime.128.17Base Adjustment. The general fund base 128.18shall be increased by $2,642,000 for fiscal 128.19years 2012 and 2013.

128.20(c) MFIP Child Care Assistance Grants-0-(38,000)

128.21This appropriation reduces the general 128.22fund appropriation by $4,000,000 and 128.23increases the federal TANF appropriation by 128.24$3,962,000.

128.25(d) Children and Community Services Grants-0-(9,900,000)

128.26Children and Community Services Grant 128.27Reduction. The fiscal year 2011 general 128.28fund appropriation to the commissioner 128.29of human services for the children and 128.30community services grants under Minnesota 128.31Statutes, section 256M.40, is reduced by 128.32$9,900,000. This reduction is ongoing and is 128.33subtracted from the base.

128.34(e) Children's Mental Health Grants-0-(8,028,000)

129.1(1) The general fund appropriation for 129.2respite care services for children with 129.3severe emotional disturbance who are at 129.4risk of out-of-home placement is reduced 129.5by $1,024,000 for fiscal year 2011. This 129.6reduction is onetime.129.7(2) The general fund appropriation for 129.8children's early intervention services is 129.9reduced by $1,024,000 for fiscal year 2011. 129.10This reduction is onetime.129.11(3) The general fund appropriation for 129.12children's capacity school-based services is 129.13reduced by $4,777,000 for fiscal year 2011.129.14(4) The general fund appropriation for 129.15children's mental health targeted case 129.16management grants is reduced by $1,210,000 129.17for fiscal year 2011.

129.18129.19Subd. 5.Children and Economic Assistance Management

129.20129.21(a) Children and Economic Assistance Administration-0--0-

129.22The general fund appropriation is reduced by 129.23$172,000 in fiscal year 2010 and by $176,000 129.24in fiscal year 2011.129.25The federal TANF appropriation is increased 129.26by $172,000 in fiscal year 2010 and by 129.27$176,000 in fiscal year 2011. The TANF 129.28fund base shall be reduced by $700,000 in 129.29fiscal years 2012 and 2013.

129.30129.31(b) Children and Economic Assistance Operations(1,580,000)(1,692,000)

129.32The general fund appropriation is reduced 129.33by $1,408,000 in fiscal year 2010 and by 129.34$1,534,000 in fiscal year 2011. The general 130.1fund base is reduced by $26,000 in each of 130.2fiscal years 2012 and 2013.130.3$74,000 in fiscal year 2011 is appropriated 130.4from the health care access fund. This 130.5appropriation is onetime.130.6The federal TANF appropriation is reduced 130.7by $172,000 in fiscal year 2010 and by 130.8$232,000 in fiscal year 2011.

130.9Subd. 6.Basic Health Care Grants

130.10(a) MinnesotaCare Grants-0-(67,549,000)

130.11This appropriation reduction is from the 130.12health care access fund.

130.13130.14(b) Medical Assistance Basic Health Care Grants - Families and Children-0-(1,108,000)

130.15130.16(c) Medical Assistance Basic Health Care Grants - Elderly and Disabled-0-(2,817,000)

130.17(d) General Assistance Medical Care Grants-0-(52,614,000)

130.18Funding Reduction; Coordinated Care 130.19Delivery Systems. The appropriation for 130.20payments to coordinated care delivery 130.21systems in Laws 2010, chapter 200, article 130.222, section 2, subdivision 4, paragraph (d), is 130.23reduced by $20,000,000 in fiscal year 2011.

130.24130.25(e) Medical Assistance; Adults Without Children-0-144,114,000

130.26Of this appropriation, $142,768,000 is from 130.27the health care access fund.

130.28(f) Other Health Care Grants-0-(1,831,000)

130.29Of this appropriation, the general fund is 130.30increased by $19,000 and the health care 130.31access fund appropriation is reduced by 130.32$1,850,000. This appropriation is onetime.131.1COBRA Carryforward. Unexpended 131.2funds appropriated in fiscal year 2010 for 131.3COBRA grants under Laws 2009, chapter 131.479, article 5, section 78, do not cancel and 131.5are available to the commissioner of human 131.6services for fiscal year 2011 COBRA grant 131.7expenditures. Up to $110,000 of the fiscal 131.8year 2011 appropriation for COBRA grants 131.9provided in Laws 2009, chapter 79, article 131.1013, section 3, subdivision 6, may be used 131.11by the commissioner of human services for 131.12costs related to administration of the COBRA 131.13grants.131.14Transfer. The commissioner shall transfer 131.15$19,000 to the commissioner of commerce 131.16for regulation of Minnesota Statutes, section 131.1762A.3075.

131.18Subd. 7.Health Care Management

131.19(a) Health Care Administration(2,853,000)(4,783,000)

131.20For fiscal year 2011 the health care access 131.21fund appropriation is increased by $250,000 131.22and the general fund appropriation is reduced 131.23by $4,633,000.131.24Reduction in Appropriation. The base 131.25funding under the current law forecast used 131.26to calculate the state appropriation for the 131.27medical assistance program is reduced by 131.28one percent for the 2012-2013 biennium. 131.29This reduction is subject to federal approval 131.30of the intensive care management program 131.31authorized under Minnesota Statutes, section 131.32256B.0755, and is ongoing and shall apply 131.33to future bienniums, or for as long as the 131.34intensive care management program is 132.1determined to be cost-effective by the 132.2commissioner of human services.132.3PACE Implementation Funding. For fiscal 132.4year 2011, $145,000 is appropriated from 132.5the general fund to the commissioner of 132.6human services to complete the actuarial and 132.7administrative work necessary to begin the 132.8operation of PACE under Minnesota Statutes, 132.9section 256B.69, subdivision 23, paragraph 132.10(e). Base level funding for this activity shall 132.11be $130,000 in fiscal year 2012 and $0 in 132.12fiscal year 2013.132.13Minnesota Senior Health Options 132.14Reimbursement. Effective July 1, 2011, 132.15federal administrative reimbursement 132.16resulting from the Minnesota senior 132.17health options project is appropriated 132.18to the commissioner for this activity. 132.19Notwithstanding any contrary provision, this 132.20provision expires June 30, 2013.132.21Health Care Inspector General. $120,000 132.22from the general fund in fiscal year 2011 132.23is for the Office of Health Care Inspector 132.24General, established under Minnesota 132.25Statutes, section 256.01, subdivision 30.132.26Fiscal and Actuarial Analysis. $250,000 132.27from the general fund is for the fiscal and 132.28actuarial analysis of 2010 House File No. 132.29135 and 2010 Senate File No. 118. This 132.30appropriation is onetime.132.31Utilization Review. Effective July 1, 132.322011, federal administrative reimbursement 132.33resulting from prior authorization and 132.34inpatient admission certification by a 132.35professional review organization shall be 133.1dedicated to, and is appropriated to, the 133.2commissioner for these activities. A portion 133.3of these funds must be used for activities to 133.4decrease unnecessary pharmaceutical costs 133.5in medical assistance. Notwithstanding any 133.6contrary provision, this provision expires 133.7June 30, 2013.133.8Base Adjustment. The health care access 133.9fund base is reduced by $50,000 in each of 133.10fiscal years 2012 and 2013.133.11The general fund base is reduced by $416,000 133.12in each of fiscal years 2012 and 2013.

133.13(b) Health Care Operations

133.14Appropriations by Fund133.15General-0-64,000133.16Health Care Access(1,094,000)(1,234,000)

133.17Base Adjustment. The health care access 133.18fund base for health care operations is 133.19reduced by $1,272,000 in fiscal year 2012 133.20and $1,337,000 in fiscal year 2013. The 133.21general fund appropriation is onetime.

133.22Subd. 8.Continuing Care Grants

133.23(a) Aging and Adult Services Grants(154,000)(139,000)

133.24This reduction is onetime and must not be 133.25applied to the base.133.26Community Service Development 133.27Reduction. The appropriation in Laws 133.282009, chapter 79, article 13, section 3, 133.29subdivision 8, paragraph (a), for community 133.30service development grants, as amended by 133.31Laws 2009, chapter 173, article 2, section 133.321, subdivision 8, paragraph (a), is reduced 133.33by $154,000 in fiscal year 2011. The 133.34appropriation base is reduced by $139,000 134.1for fiscal year 2012 and $0 for fiscal year 134.22013. Notwithstanding any law or rule to 134.3the contrary, this provision expires June 30, 134.42012.

134.5134.6(b) Medical Assistance Long-Term Care Facilities Grants-0-551,000

134.7134.8(c) Medical Assistance Long-Term Care Waivers and Home Care Grants-0-(2,747,000)

134.9Manage Growth in Traumatic Brain 134.10Injury and Community Alternatives for 134.11Disabled Individuals' Waivers. During 134.12the fiscal year beginning July 1, 2010, the 134.13commissioner shall allocate money for home 134.14and community-based waiver programs 134.15under Minnesota Statutes, section 256B.49, 134.16to ensure a reduction in state spending that is 134.17equivalent to limiting the caseload growth 134.18of the traumatic brain injury waiver to six 134.19allocations per month and the community 134.20alternatives for disabled individuals waiver 134.21to 60 allocations per month. The limits do not 134.22apply: (1) when there is an approved plan for 134.23nursing facility bed closures for individuals 134.24under age 65 who require relocation due to 134.25the bed closure; (2) to fiscal year 2009 waiver 134.26allocations delayed due to unallotment; or (3) 134.27to transfers authorized by the commissioner 134.28from the personal care assistance program 134.29of individuals having a home care rating of 134.30CS, MT, or HL. Priorities for the allocation 134.31of funds must be for individuals anticipated 134.32to be discharged from institutional settings or 134.33who are at imminent risk of a placement in 134.34an institutional setting.134.35Manage Growth in the Developmental 134.36Disability (DD) Waiver. The commissioner 135.1shall manage the growth in the developmental 135.2disability waiver by limiting the allocations 135.3included in the November 2010 forecast to 135.4six additional diversion allocations each 135.5month for the calendar year that begins on 135.6January 1, 2011. Additional allocations must 135.7be made available for transfers authorized 135.8by the commissioner from the personal care 135.9assistance program of individuals having a 135.10home care rating of CS, MT, or HL. This 135.11provision is effective through December 31, 135.122011.

135.13(d) Adult Mental Health Grants(3,500,000)(9,903,000)

135.14Compulsive Gambling Special Revenue 135.15Account. $149,000 for fiscal year 2010 135.16and $27,000 for fiscal year 2011 from 135.17the compulsive gambling special revenue 135.18account established under Minnesota 135.19Statutes, section 245.982, must be transferred 135.20and deposited into the general fund by June 135.2130 of each respective fiscal year.135.22Compulsive Gambling Lottery Prize Fund 135.23Appropriation. The lottery prize fund 135.24appropriation for compulsive gambling, is 135.25reduced by $80,000 in fiscal year 2010 and 135.26$79,000 in fiscal year 2011. This is a onetime 135.27reduction.135.28Adult Mental Health. (1) The general 135.29fund appropriation for adult mental health 135.30evidence-based practices, including but not 135.31limited to, assertive community treatment 135.32and integrated dual diagnosis treatment 135.33services, is reduced by $750,000 for fiscal 135.34year 2011. This reduction is onetime.136.1(2) The general fund appropriation for 136.2mental health grants to increase availability 136.3of culturally specific adult mental health 136.4services is reduced by $300,000 for fiscal 136.5year 2011. This reduction is onetime.136.6(3) The general fund appropriation for 136.7grants to community hospitals to provide 136.8alternatives to residential treatment center 136.9mental health programs is reduced by 136.10$2,653,000 for fiscal year 2011. This 136.11reduction is onetime.136.12(4) The general fund appropriation for grants 136.13to counties for adult mental health services is 136.14reduced by $6,200,000 for fiscal year 2011, 136.15and $6,000,000 in each of fiscal years 2012 136.16and 2013.136.17(5) Of the fiscal year 2010 general fund 136.18appropriation for grants to counties for 136.19housing with support services for adults 136.20with serious and persistent mental illness, 136.21$3,300,000 is canceled and returned to the 136.22general fund.136.23(6) Of the fiscal year 2010 general 136.24fund appropriation for additional crisis 136.25intervention team training for law 136.26enforcement, $200,000 is canceled and 136.27returned to the general fund.

136.28(e) Chemical Dependency Entitlement Grants-0-(3,986,000)

136.29136.30(f) Chemical Dependency Nonentitlement Grants(389,000)-0-

136.31Chemical Health. Of the fiscal year 2010 136.32general fund appropriation to Mother's First 136.33and the Native American Program, $389,000 136.34is canceled and returned to the general fund.

137.1(g) Other Continuing Care Grants-0-100,000

137.2Intermediate Care Facilities for the 137.3Developmentally Disabled Payment Rates.137.4$36,000 is appropriated from the general 137.5fund in fiscal year 2011 and $4,000 in fiscal 137.6year 2012 to increase payment rates for an 137.7ICF/MR licensed for six beds and located in 137.8Kandiyohi County to serve persons with high 137.9behavioral needs. The payment rate increase 137.10shall be effective for services provided from 137.11July 1, 2010, through June 30, 2011. These 137.12appropriations are onetime.137.13Region 10 Quality Assurance Commission.137.14$100,000 is appropriated from the general 137.15fund in fiscal year 2011 to the commissioner 137.16of human services for the purposes 137.17of the Region 10 Quality Assurance 137.18Commission under Minnesota Statutes, 137.19section 256B.0951. This appropriation is 137.20onetime.

137.21Subd. 9.Continuing Care Management111,000101,000

137.22PACE Implementation Funding. For fiscal 137.23year 2011, $111,000 is appropriated from 137.24the general fund to the commissioner of 137.25human services to complete the actuarial 137.26and administrative work necessary to begin 137.27the operation of PACE under Minnesota 137.28Statutes, section 256B.69, subdivision 23, 137.29paragraph (e). Base level funding for this 137.30activity shall be $101,000 in fiscal year 2012 137.31and $0 in fiscal year 2013. For fiscal year 137.322013 and beyond, the commissioner must 137.33work with stakeholders to develop financing 137.34mechanisms to complete the actuarial 137.35and administrative costs of PACE. The 138.1commissioner shall inform the chairs and 138.2ranking minority members of the legislative 138.3committee with jurisdiction over health care 138.4funding by January 15, 2011, on progress to 138.5develop financing mechanisms.

138.6Subd. 10.State-Operated Services

138.7Obsolete Laundry Depreciation Account.138.8$669,000, or the balance, whichever is 138.9greater, must be transferred from the 138.10state-operated services laundry depreciation 138.11account in the special revenue fund and 138.12deposited into the general fund by June 30, 138.132010.138.14State-operated Services Programs. Of 138.15the fiscal year 2011 appropriation for 138.16the Minnesota sex offender program, 138.17$12,600,000 is transferred to state-operated 138.18services to maintain the METO program and 138.19other residential adult mental health services.

138.20Subd. 11.Adult Mental Health Services-0-12,600,000

138.21Subd. 12.Minnesota Sex Offender Services-0-(12,600,000)

138.22138.23Subd. 13.Contingent Appropriations Reductions

138.24Upon enactment of the extension of 138.25the enhanced federal medical assistance 138.26percentage (FMAP) under Public Law 111-5 138.27to June 30, 2011, that is contained in the 138.28president's budget for federal fiscal year 2011 138.29or contained in House Resolution 2847, the 138.30federal "Jobs for Main Street Act of 2010," or 138.31subsequent federal legislation, the reductions 138.32identified in each clause shall be made to 138.33the specified general fund appropriations 138.34for fiscal year 2011. These contingent 138.35reductions, if implemented, are in addition 139.1to the reductions specified in subdivision 6, 139.2paragraphs (a), (b), and (c), and subdivision 139.38, paragraphs (c) and (d), respectively.

139.4(1) MinnesotaCare Grants-0-(9,200,000)

139.5139.6(2) Medical Assistance Basic Health Care Grants - Families and Children-0-(109,662,500)

139.7139.8(3) Medical Assistance Basic Health Care Grants - Elderly and Disabled-0-(110,437,500)

139.9139.10(4) Medical Assistance Long-Term Care Facilities Grants-0-(51,925,000)

139.11139.12(5) Medical Assistance Long-Term Care Waivers and Home Care Grants-0-(115,475,000)

139.13Sec. 4. COMMISSIONER OF HEALTH

139.14APPROPRIATIONS139.15Available for the Year139.16Ending June 30139.1720102011

139.18Subdivision 1.Total Appropriation$(2,397,000)$5,751,000

139.19Appropriations by Fund139.2020102011139.21General(1,797,000)5,810,000139.22139.23State Government Special Revenue(600,000)(259,000)139.24139.25Health Care Access Fund-0-200,000

139.26Subd. 2.Community and Family Health-0-100,000

139.27Grant for Memory Care Clinic. $100,000 139.28from the general fund in fiscal year 2011 139.29is for a grant to a nonprofit, multispecialty 139.30clinic located in the city of St. Cloud that 139.31provides early identification, diagnosis, and 139.32treatment of memory loss, and information 139.33and support for family members who care for 139.34persons with memory impairment. In order 139.35to receive the grant, the clinic must certify to 139.36the commissioner that it has a commitment 140.1from a private foundation to provide a 50 140.2percent match of the grant amount. This 140.3appropriation is onetime.140.4Statewide Health Improvement Program.140.5$8,500,000 from the health care access 140.6fund in fiscal year 2012 and $8,500,000 in 140.7fiscal year 2013 is for the statewide health 140.8improvement program under Minnesota 140.9Statutes, section 145.986. These additions 140.10are onetime.

140.11Subd. 3.Policy, Quality, and Compliance

140.12Appropriations by Fund140.1320102011140.14General(1,797,000)5,210,000140.15140.16State Government Special Revenue(600,000)(268,000)140.17140.18Health Care Access Fund-0-200,000

140.19Of this appropriation, $74,000 in fiscal 140.20year 2011 is to restore unallotments for the 140.21Office of Unlicensed Complementary and 140.22Alternative Health Care Practice.140.23Health Care Reform. Funds appropriated 140.24in Laws 2008, chapter 358, article 5, section 140.254, subdivision 3, for health reform activities 140.26to implement Laws 2008, chapter 358, 140.27article 4, are available until expended. 140.28Notwithstanding any contrary provision in 140.29this article, this provision shall not expire.140.30Health Care Reform Task Force. $200,000 140.31from the general fund is for expenses related 140.32to the Health Care Reform Task Force 140.33established under article 7, section 8.140.34Autism Coverage Study. $50,000 in 140.35fiscal year 2011 is appropriated to the 140.36commissioner of health to monitor the gaps 141.1in the level of service provided by state 141.2health programs, the state employee group 141.3insurance plan, and private health plans for 141.4autism spectrum disorder. This appropriation 141.5is onetime.141.6Rural Hospital Capital Improvement 141.7Grants. Of the general fund reductions in 141.8fiscal year 2010, $1,755,000 is for the rural 141.9hospital capital improvement grant program.141.10Health Information Exchange Oversight.141.11Of the state government special revenue fund 141.12appropriations, $104,000 in fiscal year 2011 141.13is for the duties required under Minnesota 141.14Statutes, sections 62J.498 to 62J.4982.141.15Birth Centers. Of the state government 141.16special revenue fund appropriations, $9,000 141.17is for licensing birth centers under Minnesota 141.18Statutes, section 144.651. Base funding shall 141.19be $7,000 in fiscal year 2012 and $7,000 in 141.20fiscal year 2013.141.21Advisory Group on Administrative 141.22Expenses. Of the general fund appropriation, 141.23$40,000 in fiscal year 2011 is for the advisory 141.24group established under Minnesota Statutes, 141.25section 62D.31.141.26Community Clinic Grants. Of this 141.27appropriation, $2,500,000 in fiscal 141.28year 2011 is for the commissioner to 141.29provide community clinic grants under 141.30Minnesota Statutes, section 145.9268. This 141.31appropriation is onetime. In awarding grants 141.32using this funding, the commissioner shall 141.33give priority to proposals that seek to serve 141.34medically underserved areas of the state that 141.35are not served by a coordinated care delivery 142.1system established under Minnesota Statutes, 142.2section 256D.031, subdivision 6.142.3Federally Qualified Health Center 142.4Subsidies. Of this appropriation, $2,500,000 142.5in fiscal year 2011 is for the commissioner to 142.6increase subsidies to federally qualified health 142.7centers provided under Minnesota Statutes, 142.8section 145.9269. This appropriation is 142.9onetime. In awarding subsidies using this 142.10funding, the commissioner shall give priority 142.11to federally qualified health centers that serve 142.12medically underserved areas of the state that 142.13are not served by a coordinated care delivery 142.14system established under Minnesota Statutes, 142.15section 256D.031, subdivision 6.142.16Base Level Adjustment. The general fund 142.17base is increased by $76,000 in each of fiscal 142.18years 2012 and 2013. The state government 142.19special revenue fund base is increased by 142.20$97,000 in each of fiscal years 2012 and 142.212013.

142.22Subd. 4.Health Protection-0-500,000

142.23Birth Defects Information System. Of 142.24the general fund appropriation, $500,000 in 142.25fiscal year 2011 is for the Minnesota Birth 142.26Defects Information System established 142.27under Minnesota Statutes, section 144.2215.

142.28Sec. 5. Office of the Legislative Auditor$-0-$200,000

142.29$200,000 or an amount equal to 90 percent 142.30of the nonfederal administrative staff funds 142.31expended by the commissioner of human 142.32services related to the preparation and 142.33drafting of fiscal notes during fiscal year 142.342009, is transferred from the Department 143.1of Human Services to the Office of the 143.2Legislative Auditor, and appropriated for 143.3the fiscal year beginning July 1, 2011, 143.4for completion of the duties described in 143.5Minnesota Statutes, section 3.98.143.6    Sec. 6. Laws 2009, chapter 79, article 13, section 3, subdivision 1, as amended by 143.7Laws 2009, chapter 173, article 2, section 1, subdivision 1, is amended to read:

143.8Subdivision 1.Total Appropriation$5,225,451,000$6,002,864,000

143.9Appropriations by Fund143.1020102011143.11General4,375,689,0005,209,765,000143.12143.13State Government 
                  		Special Revenue565,000565,000143.14Health Care Access450,662,000527,411,000143.15Federal TANF286,770,000263,458,000143.16Lottery Prize1,665,0001,665,000143.17Federal Fund110,000,0000

143.18Receipts for Systems Projects.143.19Appropriations and federal receipts for 143.20information systems projects for MAXIS, 143.21PRISM, MMIS, and SSIS must be deposited 143.22in the state system account authorized in 143.23Minnesota Statutes, section 
         256.014. Money 143.24appropriated for computer projects approved 143.25by the Minnesota Office of Enterprise 143.26Technology, funded by the legislature, and 143.27approved by the commissioner of finance, 143.28may be transferred from one project to 143.29another and from development to operations 143.30as the commissioner of human services 143.31considers necessary, except that any transfers 143.32to one project that exceed $1,000,000 or 143.33multiple transfers to one project that exceed 143.34$1,000,000 in total require the express 143.35approval of the legislature. The preceding 143.36requirement for legislative approval does not 144.1apply to transfers made to establish a project's 144.2initial operating budget each year; instead, 144.3the requirements of section 11, subdivision 144.42, of this article apply to those transfers. Any 144.5unexpended balance in the appropriation 144.6for these projects does not cancel but is 144.7available for ongoing development and 144.8operations. Any computer project with a 144.9total cost exceeding $1,000,000, including, 144.10but not limited to, a replacement for the 144.11proposed HealthMatch system, shall not be 144.12commenced without the express approval of 144.13the legislature.144.14HealthMatch Systems Project. In fiscal 144.15year 2010, $3,054,000 shall be transferred 144.16from the HealthMatch account in the state 144.17systems account in the special revenue fund 144.18to the general fund.144.19Nonfederal Share Transfers. The 144.20nonfederal share of activities for which 144.21federal administrative reimbursement is 144.22appropriated to the commissioner may be 144.23transferred to the special revenue fund.144.24TANF Maintenance of Effort.144.25(a) In order to meet the basic maintenance 144.26of effort (MOE) requirements of the TANF 144.27block grant specified under Code of Federal 144.28Regulations, title 45, section 263.1, the 144.29commissioner may only report nonfederal 144.30money expended for allowable activities 144.31listed in the following clauses as TANF/MOE 144.32expenditures:144.33(1) MFIP cash, diversionary work program, 144.34and food assistance benefits under Minnesota 144.35Statutes, chapter 256J;145.1(2) the child care assistance programs 145.2under Minnesota Statutes, sections 
         119B.03145.3and 
         119B.05, and county child care 145.4administrative costs under Minnesota 145.5Statutes, section 
         119B.15;145.6(3) state and county MFIP administrative 145.7costs under Minnesota Statutes, chapters 145.8256J and 256K;145.9(4) state, county, and tribal MFIP 145.10employment services under Minnesota 145.11Statutes, chapters 256J and 256K;145.12(5) expenditures made on behalf of 145.13noncitizen MFIP recipients who qualify 145.14for the medical assistance without federal 145.15financial participation program under 145.16Minnesota Statutes, section 
         256B.06, 145.17subdivision 4
         , paragraphs (d), (e), and (j); 145.18and145.19(6) qualifying working family credit 145.20expenditures under Minnesota Statutes, 145.21section 
         290.0671.; and145.22(7) qualifying Minnesota education credit 145.23expenditures under Minnesota Statutes, 145.24section 290.0674.145.25(b) The commissioner shall ensure that 145.26sufficient qualified nonfederal expenditures 145.27are made each year to meet the state's 145.28TANF/MOE requirements. For the activities 145.29listed in paragraph (a), clauses (2) to 145.30(6), the commissioner may only report 145.31expenditures that are excluded from the 145.32definition of assistance under Code of 145.33Federal Regulations, title 45, section 
         260.31.146.1(c) For fiscal years beginning with state 146.2fiscal year 2003, the commissioner shall 146.3ensure that the maintenance of effort used 146.4by the commissioner of finance for the 146.5February and November forecasts required 146.6under Minnesota Statutes, section 
         16A.103, 146.7contains expenditures under paragraph (a), 146.8clause (1), equal to at least 16 percent of 146.9the total required under Code of Federal 146.10Regulations, title 45, section 263.1.146.11(d) For the federal fiscal years beginning on 146.12or after October 1, 2007, the commissioner 146.13may not claim an amount of TANF/MOE in 146.14excess of the 75 percent standard in Code 146.15of Federal Regulations, title 45, section 146.16263.1(a)(2), except:146.17(1) to the extent necessary to meet the 80 146.18percent standard under Code of Federal 146.19Regulations, title 45, section 263.1(a)(1), 146.20if it is determined by the commissioner 146.21that the state will not meet the TANF work 146.22participation target rate for the current year;146.23(2) to provide any additional amounts 146.24under Code of Federal Regulations, title 45, 146.25section 264.5, that relate to replacement of 146.26TANF funds due to the operation of TANF 146.27penalties; and146.28(3) to provide any additional amounts that 146.29may contribute to avoiding or reducing 146.30TANF work participation penalties through 146.31the operation of the excess MOE provisions 146.32of Code of Federal Regulations, title 45, 146.33section 
         261.43 (a)(2).146.34For the purposes of clauses (1) to (3), 146.35the commissioner may supplement the 147.1MOE claim with working family credit 147.2expenditures to the extent such expenditures 147.3or other qualified expenditures are otherwise 147.4available after considering the expenditures 147.5allowed in this section.147.6(e) Minnesota Statutes, section 
         256.011, 147.7subdivision 3
         , which requires that federal 147.8grants or aids secured or obtained under that 147.9subdivision be used to reduce any direct 147.10appropriations provided by law, do not apply 147.11if the grants or aids are federal TANF funds.147.12(f) Notwithstanding any contrary provision 147.13in this article, this provision expires June 30, 147.142013.147.15Working Family Credit Expenditures as 147.16TANF/MOE. The commissioner may claim 147.17as TANF/MOE up to $6,707,000 per year of 147.18working family credit expenditures for fiscal 147.19year 2010 through fiscal year 2011.147.20Working Family Credit Expenditures 147.21to be Claimed for TANF/MOE. The 147.22commissioner may count the following 147.23amounts of working family credit expenditure 147.24as TANF/MOE:147.25(1) fiscal year 2010, $50,973,000147.26$50,897,000;147.27(2) fiscal year 2011, $53,793,000147.28$54,243,000;147.29(3) fiscal year 2012, $23,516,000147.30$23,345,000; and147.31(4) fiscal year 2013, $16,808,000147.32$16,585,000.147.33Notwithstanding any contrary provision in 147.34this article, this rider expires June 30, 2013.148.1Food Stamps Employment and Training.148.2(a) The commissioner shall apply for and 148.3claim the maximum allowable federal 148.4matching funds under United States Code, 148.5title 7, section 2025, paragraph (h), for 148.6state expenditures made on behalf of family 148.7stabilization services participants voluntarily 148.8engaged in food stamp employment and 148.9training activities, where appropriate.148.10(b) Notwithstanding Minnesota Statutes, 148.11sections 
         256D.051, subdivisions 1a, 6b, 148.12and 6c, and 
         256J.626, federal food stamps 148.13employment and training funds received 148.14as reimbursement of MFIP consolidated 148.15fund grant expenditures for diversionary 148.16work program participants and child 148.17care assistance program expenditures for 148.18two-parent families must be deposited in the 148.19general fund. The amount of funds must be 148.20limited to $3,350,000 in fiscal year 2010 148.21and $4,440,000 in fiscal years 2011 through 148.222013, contingent on approval by the federal 148.23Food and Nutrition Service. 148.24(c) Consistent with the receipt of these federal 148.25funds, the commissioner may adjust the 148.26level of working family credit expenditures 148.27claimed as TANF maintenance of effort. 148.28Notwithstanding any contrary provision in 148.29this article, this rider expires June 30, 2013.148.30ARRA Food Support Administration.148.31The funds available for food support 148.32administration under the American Recovery 148.33and Reinvestment Act (ARRA) of 2009 148.34are appropriated to the commissioner 148.35to pay actual costs of implementing the 149.1food support benefit increases, increased 149.2eligibility determinations, and outreach. Of 149.3these funds, 20 percent shall be allocated 149.4to the commissioner and 80 percent shall 149.5be allocated to counties. The commissioner 149.6shall allocate the county portion based on 149.7caseload. Reimbursement shall be based on 149.8actual costs reported by counties through 149.9existing processes. Tribal reimbursement 149.10must be made from the state portion based 149.11on a caseload factor equivalent to that of a 149.12county.149.13ARRA Food Support Benefit Increases.149.14The funds provided for food support benefit 149.15increases under the Supplemental Nutrition 149.16Assistance Program provisions of the 149.17American Recovery and Reinvestment Act 149.18(ARRA) of 2009 must be used for benefit 149.19increases beginning July 1, 2009.149.20Emergency Fund for the TANF Program.149.21TANF Emergency Contingency funds 149.22available under the American Recovery 149.23and Reinvestment Act of 2009 (Public Law 149.24111-5) are appropriated to the commissioner. 149.25The commissioner must request TANF 149.26Emergency Contingency funds from the 149.27Secretary of the Department of Health 149.28and Human Services to the extent the 149.29commissioner meets or expects to meet the 149.30requirements of section 403(c) of the Social 149.31Security Act. The commissioner must seek 149.32to maximize such grants. The funds received 149.33must be used as appropriated. Each county 149.34must maintain the county's current level of 149.35emergency assistance funding under the 149.36MFIP consolidated fund and use the funds 150.1under this paragraph to supplement existing 150.2emergency assistance funding levels.150.3    Sec. 7. Laws 2009, chapter 79, article 13, section 3, subdivision 3, as amended by 150.4Laws 2009, chapter 173, article 2, section 1, subdivision 3, is amended to read:

150.5150.6Subd. 3.Revenue and Pass-Through Revenue Expenditures68,337,00070,505,000

150.7This appropriation is from the federal TANF 150.8fund.150.9TANF Transfer to Federal Child Care 150.10and Development Fund. The following 150.11TANF fund amounts are appropriated to the 150.12commissioner for the purposes of MFIP and 150.13transition year child care under Minnesota 150.14Statutes, section 
         119B.05: 150.15(1) fiscal year 2010, $6,531,000 $862,000;150.16(2) fiscal year 2011, $10,241,000 $978,000;150.17(3) fiscal year 2012, $10,826,000 $0; and150.18(4) fiscal year 2013, $4,046,000 $0.150.19The commissioner shall authorize the 150.20transfer of sufficient TANF funds to the 150.21federal child care and development fund to 150.22meet this appropriation and shall ensure that 150.23all transferred funds are expended according 150.24to federal child care and development fund 150.25regulations.150.26    Sec. 8. Laws 2009, chapter 79, article 13, section 3, subdivision 4, as amended by 150.27Laws 2009, chapter 173, article 2, section 1, subdivision 4, is amended to read:

150.28150.29Subd. 4.Children and Economic Assistance Grants

150.30The amounts that may be spent from this 150.31appropriation for each purpose are as follows:

150.32(a) MFIP/DWP Grants

151.1Appropriations by Fund151.2General63,205,00089,033,000151.3Federal TANF100,818,00084,538,000

151.4(b) Support Services Grants

151.5Appropriations by Fund151.6General8,715,00012,498,000151.7Federal TANF116,557,000107,457,000

151.8MFIP Consolidated Fund. The MFIP 151.9consolidated fund TANF appropriation is 151.10reduced by $1,854,000 in fiscal year 2010 151.11and fiscal year 2011.151.12Notwithstanding Minnesota Statutes, section 151.13256J.626, subdivision 8
         , paragraph (b), the 151.14commissioner shall reduce proportionately 151.15the reimbursement to counties for 151.16administrative expenses.151.17Subsidized Employment Funding Through 151.18ARRA. The commissioner is authorized to 151.19apply for TANF emergency fund grants for 151.20subsidized employment activities. Growth 151.21in expenditures for subsidized employment 151.22within the supported work program and the 151.23MFIP consolidated fund over the amount 151.24expended in the calendar quarters in the 151.25TANF emergency fund base year shall be 151.26used to leverage the TANF emergency fund 151.27grants for subsidized employment and to 151.28fund supported work. The commissioner 151.29shall develop procedures to maximize 151.30reimbursement of these expenditures over the 151.31TANF emergency fund base year quarters, 151.32and may contract directly with employers 151.33and providers to maximize these TANF 151.34emergency fund grants.152.1Supported Work. Of the TANF 152.2appropriation, $4,700,000 in fiscal year 2010 152.3and $4,700,000 in fiscal year 2011 are to the 152.4commissioner for supported work for MFIP 152.5recipients and is available until expended. 152.6Supported work includes paid transitional 152.7work experience and a continuum of 152.8employment assistance, including outreach 152.9and recruitment, program orientation 152.10and intake, testing and assessment, job 152.11development and marketing, preworksite 152.12training, supported worksite experience, 152.13job coaching, and postplacement follow-up, 152.14in addition to extensive case management 152.15and referral services. This is a onetime 152.16appropriation.152.17Base Adjustment. The general fund base 152.18is reduced by $3,783,000 in each of fiscal 152.19years 2012 and 2013. The TANF fund base 152.20is increased by $5,004,000 in each of fiscal 152.21years 2012 and 2013.152.22Integrated Services Program Funding.152.23The TANF appropriation for integrated 152.24services program funding is $1,250,000 in 152.25fiscal year 2010 and $0 in fiscal year 2011 152.26and the base for fiscal years 2012 and 2013 152.27is $0.152.28TANF Emergency Fund; Nonrecurrent 152.29Short-Term Benefits.(1) TANF emergency 152.30contingency fund grants received due to 152.31increases in expenditures for nonrecurrent 152.32short-term benefits must be used to offset the 152.33increase in these expenditures for counties 152.34under the MFIP consolidated fund, under 152.35Minnesota Statutes, section 
         256J.626, 153.1and the diversionary work program. The 153.2commissioner shall develop procedures 153.3to maximize reimbursement of these 153.4expenditures over the TANF emergency fund 153.5base year quarters. Growth in expenditures 153.6for the diversionary work program over the 153.7amount expended in the calendar quarters in 153.8the TANF emergency fund base year shall be 153.9used to leverage these funds.153.10(2) To the extent that the commissioner 153.11can claim eligible tax credit growth as 153.12nonrecurrent short-term benefits, the 153.13commissioner shall use those funds to 153.14leverage the increased expenditures in clause 153.15(1).153.16(3) TANF emergency funds for nonrecurrent 153.17short-term benefits received in excess of the 153.18amounts necessary for clauses (1) and (2) 153.19shall be used to reimburse the general fund 153.20for the costs of eligible tax credits in fiscal 153.21year 2011. The amount of such funds shall 153.22not exceed $28,000,000.

153.23(c) MFIP Child Care Assistance Grants61,171,00065,214,000

153.24Acceleration of ARRA Child Care and 153.25Development Fund Expenditure. The 153.26commissioner must liquidate all child care 153.27and development money available under 153.28the American Recovery and Reinvestment 153.29Act (ARRA) of 2009, Public Law 111-5, 153.30by September 30, 2010. In order to expend 153.31those funds by September 30, 2010, the 153.32commissioner may redesignate and expend 153.33the ARRA child care and development funds 153.34appropriated in fiscal year 2011 for purposes 153.35under this section for related purposes that 154.1will allow liquidation by September 30, 154.22010. Child care and development funds 154.3otherwise available to the commissioner 154.4for those related purposes shall be used to 154.5fund the purposes from which the ARRA 154.6child care and development funds had been 154.7redesignated.154.8School Readiness Service Agreements.154.9$400,000 in fiscal year 2010 and $400,000 154.10in fiscal year 2011 are from the federal 154.11TANF fund to the commissioner of human 154.12services consistent with federal regulations 154.13for the purpose of school readiness service 154.14agreements under Minnesota Statutes, 154.15section 
         119B.231. This is a onetime 154.16appropriation. Any unexpended balance the 154.17first year is available in the second year.

154.18154.19(d) Basic Sliding Fee Child Care Assistance Grants40,100,00045,092,000

154.20School Readiness Service Agreements.154.21$257,000 in fiscal year 2010 and $257,000 154.22in fiscal year 2011 are from the general 154.23fund for the purpose of school readiness 154.24service agreements under Minnesota 154.25Statutes, section 
         119B.231. This is a onetime 154.26appropriation. Any unexpended balance the 154.27first year is available in the second year.154.28Child Care Development Fund 154.29Unexpended Balance. In addition to 154.30the amount provided in this section, the 154.31commissioner shall expend $5,244,000 in 154.32fiscal year 2010 from the federal child care 154.33development fund unexpended balance 154.34for basic sliding fee child care under 154.35Minnesota Statutes, section 
         119B.03. The 154.36commissioner shall ensure that all child 155.1care and development funds are expended 155.2according to the federal child care and 155.3development fund regulations.155.4Basic Sliding Fee. $4,000,000 in fiscal year 155.52010 and $4,000,000 in fiscal year 2011 are 155.6from the federal child care development 155.7funds received from the American Recovery 155.8and Reinvestment Act of 2009, Public 155.9Law 111-5, to the commissioner of human 155.10services consistent with federal regulations 155.11for the purpose of basic sliding fee child care 155.12assistance under Minnesota Statutes, section 155.13119B.03
         . This is a onetime appropriation. 155.14Any unexpended balance the first year is 155.15available in the second year.155.16Basic Sliding Fee Allocation for Calendar 155.17Year 2010. Notwithstanding Minnesota 155.18Statutes, section 
         119B.03, subdivision 6, 155.19in calendar year 2010, basic sliding fee 155.20funds shall be distributed according to 155.21this provision. Funds shall be allocated 155.22first in amounts equal to each county's 155.23guaranteed floor, according to Minnesota 155.24Statutes, section 
         119B.03, subdivision 8, 155.25with any remaining available funds allocated 155.26according to the following formula:155.27(a) Up to one-fourth of the funds shall be 155.28allocated in proportion to the number of 155.29families participating in the transition year 155.30child care program as reported during and 155.31averaged over the most recent six months 155.32completed at the time of the notice of 155.33allocation. Funds in excess of the amount 155.34necessary to serve all families in this category 155.35shall be allocated according to paragraph (d).156.1(b) Up to three-fourths of the funds shall 156.2be allocated in proportion to the average 156.3of each county's most recent six months of 156.4reported waiting list as defined in Minnesota 156.5Statutes, section 
         119B.03, subdivision 2, and 156.6the reinstatement list of those families whose 156.7assistance was terminated with the approval 156.8of the commissioner under Minnesota Rules, 156.9part 3400.0183, subpart 1. Funds in excess 156.10of the amount necessary to serve all families 156.11in this category shall be allocated according 156.12to paragraph (d).156.13(c) The amount necessary to serve all families 156.14in paragraphs (a) and (b) shall be calculated 156.15based on the basic sliding fee average cost of 156.16care per family in the county with the highest 156.17cost in the most recently completed calendar 156.18year.156.19(d) Funds in excess of the amount necessary 156.20to serve all families in paragraphs (a) and 156.21(b) shall be allocated in proportion to each 156.22county's total expenditures for the basic 156.23sliding fee child care program reported 156.24during the most recent fiscal year completed 156.25at the time of the notice of allocation. To 156.26the extent that funds are available, and 156.27notwithstanding Minnesota Statutes, section 156.28119B.03, subdivision 8
         , for the period 156.29January 1, 2011, to December 31, 2011, each 156.30county's guaranteed floor must be equal to its 156.31original calendar year 2010 allocation.156.32Base Adjustment. The general fund base is 156.33decreased by $257,000 in each of fiscal years 156.342012 and 2013.

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

157.1Family, friends, and neighbor grants.157.2$375,000 in fiscal year 2010 and $375,000 157.3in fiscal year 2011 are from the child 157.4care development fund required targeted 157.5quality funds for quality expansion and 157.6infant/toddler from the American Recovery 157.7and Reinvestment Act of 2009, Public 157.8Law 111-5, to the commissioner of human 157.9services for family, friends, and neighbor 157.10grants under Minnesota Statutes, section 157.11119B.232
         . This appropriation may be used 157.12on programs receiving family, friends, and 157.13neighbor grant funds as of June 30, 2009, 157.14or on new programs or projects. This is a 157.15onetime appropriation. Any unexpended 157.16balance the first year is available in the 157.17second year.157.18Voluntary quality rating system training, 157.19coaching, consultation, and supports.157.20$633,000 in fiscal year 2010 and $633,000 157.21in fiscal year 2011 are from the federal child 157.22care development fund required targeted 157.23quality funds for quality expansion and 157.24infant/toddler from the American Recovery 157.25and Reinvestment Act of 2009, Public 157.26Law 111-5, to the commissioner of human 157.27services consistent with federal regulations 157.28for the purpose of providing grants to provide 157.29statewide child-care provider training, 157.30coaching, consultation, and supports to 157.31prepare for the voluntary Minnesota quality 157.32rating system rating tool. This is a onetime 157.33appropriation. Any unexpended balance the 157.34first year is available in the second year.157.35Voluntary quality rating system. $184,000 157.36in fiscal year 2010 and $1,200,000 in fiscal 158.1year 2011 are from the federal child care 158.2development fund required targeted funds for 158.3quality expansion and infant/toddler from the 158.4American Recovery and Reinvestment Act of 158.52009, Public Law 111-5, to the commissioner 158.6of human services consistent with federal 158.7regulations for the purpose of implementing 158.8the voluntary Parent Aware quality star 158.9rating system pilot in coordination with the 158.10Minnesota Early Learning Foundation. The 158.11appropriation for the first year is to complete 158.12and promote the voluntary Parent Aware 158.13quality rating system pilot program through 158.14June 30, 2010, and the appropriation for 158.15the second year is to continue the voluntary 158.16Minnesota quality rating system pilot 158.17through June 30, 2011. This is a onetime 158.18appropriation. Any unexpended balance the 158.19first year is available in the second year.

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

158.21(g) Children's Services Grants

158.22Appropriations by Fund158.23General48,333,00050,498,000158.24Federal TANF340,000240,000

158.25Base Adjustment. The general fund base is 158.26decreased by $5,371,000 in fiscal year 2012 158.27and decreased $5,371,000 in fiscal year 2013.158.28Privatized Adoption Grants. Federal 158.29reimbursement for privatized adoption grant 158.30and foster care recruitment grant expenditures 158.31is appropriated to the commissioner for 158.32adoption grants and foster care and adoption 158.33administrative purposes.158.34Adoption Assistance Incentive Grants.158.35Federal funds available during fiscal year 159.12010 and fiscal year 2011 for the adoption 159.2incentive grants are appropriated to the 159.3commissioner for postadoption services 159.4including parent support groups.159.5Adoption Assistance and Relative Custody 159.6Assistance. The commissioner may transfer 159.7unencumbered appropriation balances for 159.8adoption assistance and relative custody 159.9assistance between fiscal years and between 159.10programs.

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

159.12Targeted Case Management Temporary 159.13Funding Adjustment. The commissioner 159.14shall recover from each county and tribe 159.15receiving a targeted case management 159.16temporary funding payment in fiscal year 159.172008 an amount equal to that payment. The 159.18commissioner shall recover one-half of the 159.19funds by February 1, 2010, and the remainder 159.20by February 1, 2011. At the commissioner's 159.21discretion and at the request of a county 159.22or tribe, the commissioner may revise 159.23the payment schedule, but full payment 159.24must not be delayed beyond May 1, 2011. 159.25The commissioner may use the recovery 159.26procedure under Minnesota Statutes, section 159.27256.017
         , to recover the funds. Recovered 159.28funds must be deposited into the general 159.29fund.

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

159.31General Assistance Standard. The 159.32commissioner shall set the monthly standard 159.33of assistance for general assistance units 159.34consisting of an adult recipient who is 159.35childless and unmarried or living apart 160.1from parents or a legal guardian at $203. 160.2The commissioner may reduce this amount 160.3according to Laws 1997, chapter 85, article 160.43, section 54.160.5Emergency General Assistance. The 160.6amount appropriated for emergency general 160.7assistance funds is limited to no more 160.8than $7,889,812 in fiscal year 2010 and 160.9$7,889,812 in fiscal year 2011. Funds 160.10to counties must be allocated by the 160.11commissioner using the allocation method 160.12specified in Minnesota Statutes, section 160.13256D.06
         .

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

160.15Emergency Minnesota Supplemental 160.16Aid Funds. The amount appropriated for 160.17emergency Minnesota supplemental aid 160.18funds is limited to no more than $1,100,000 160.19in fiscal year 2010 and $1,100,000 in fiscal 160.20year 2011. Funds to counties must be 160.21allocated by the commissioner using the 160.22allocation method specified in Minnesota 160.23Statutes, section 
         256D.46.

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

160.25Group Residential Housing Costs 160.26Refinanced. (a) Effective July 1, 2011, the 160.27commissioner shall increase the home and 160.28community-based service rates and county 160.29allocations provided to programs for persons 160.30with disabilities established under section 160.311915(c) of the Social Security Act to the 160.32extent that these programs will be paying 160.33for the costs above the rate established 160.34in Minnesota Statutes, section 
         256I.05, 160.35subdivision 1
         .161.1(b) For persons receiving services under 161.2Minnesota Statutes, section 
         245A.02, who 161.3reside in licensed adult foster care beds 161.4for which a difficulty of care payment 161.5was being made under Minnesota Statutes, 161.6section 
         256I.05, subdivision 1c, paragraph 161.7(b), counties may request an exception to 161.8the individual's service authorization not to 161.9exceed the difference between the client's 161.10monthly service expenditures plus the 161.11amount of the difficulty of care payment.

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

161.13Funding Usage. Up to 75 percent of a fiscal 161.14year's appropriation for children's mental 161.15health grants may be used to fund allocations 161.16in that portion of the fiscal year ending 161.17December 31.

161.18161.19(m) Other Children and Economic Assistance Grants16,047,00015,339,000

161.20Fraud Prevention Grants. Of this 161.21appropriation, $228,000 in fiscal year 2010 161.22and $228,000 in fiscal year 2011 is to the 161.23commissioner for fraud prevention grants to 161.24counties.161.25Homeless and Runaway Youth. $218,000 161.26in fiscal year 2010 is for the Runaway 161.27and Homeless Youth Act under Minnesota 161.28Statutes, section 
         256K.45. Funds shall be 161.29spent in each area of the continuum of care 161.30to ensure that programs are meeting the 161.31greatest need. Any unexpended balance in 161.32the first year is available in the second year. 161.33Beginning July 1, 2011, the base is increased 161.34by $119,000 each year.162.1ARRA Homeless Youth Funds. To the 162.2extent permitted under federal law, the 162.3commissioner shall designate $2,500,000 162.4of the Homeless Prevention and Rapid 162.5Re-Housing Program funds provided under 162.6the American Recovery and Reinvestment 162.7Act of 2009, Public Law 111-5, for agencies 162.8providing homelessness prevention and rapid 162.9rehousing services to youth.162.10Supportive Housing Services. $1,500,000 162.11each year is for supportive services under 162.12Minnesota Statutes, section 
         256K.26. This is 162.13a onetime appropriation. 162.14Community Action Grants. Community 162.15action grants are reduced one time by 162.16$1,794,000 each year. This reduction is due 162.17to the availability of federal funds under the 162.18American Recovery and Reinvestment Act.162.19Base Adjustment. The general fund base 162.20is increased by $773,000 in fiscal year 2012 162.21and $773,000 in fiscal year 2013.162.22Federal ARRA Funds for Existing 162.23Programs.(a) (1) Federal funds received by 162.24the commissioner for the emergency food 162.25and shelter program from the American 162.26Recovery and Reinvestment Act of 2009, 162.27Public Law 111-5, but not previously 162.28approved by the legislature are appropriated 162.29to the commissioner for the purposes of the 162.30grant program.162.31(b) (2) Federal funds received by the 162.32commissioner for the emergency shelter 162.33grant program including the Homelessness 162.34Prevention and Rapid Re-Housing 162.35Program from the American Recovery and 163.1Reinvestment Act of 2009, Public Law 163.2111-5, are appropriated to the commissioner 163.3for the purposes of the grant programs.163.4(c) (3) Federal funds received by the 163.5commissioner for the emergency food 163.6assistance program from the American 163.7Recovery and Reinvestment Act of 2009, 163.8Public Law 111-5, are appropriated to the 163.9commissioner for the purposes of the grant 163.10program.163.11(d) (4) Federal funds received by the 163.12commissioner for senior congregate meals 163.13and senior home-delivered meals from the 163.14American Recovery and Reinvestment Act 163.15of 2009, Public Law 111-5, are appropriated 163.16to the commissioner for the Minnesota Board 163.17on Aging, for purposes of the grant programs.163.18(e) (5) Federal funds received by the 163.19commissioner for the community services 163.20block grant program from the American 163.21Recovery and Reinvestment Act of 2009, 163.22Public Law 111-5, are appropriated to the 163.23commissioner for the purposes of the grant 163.24program.163.25Long-Term Homeless Supportive 163.26Service Fund Appropriation. To the 163.27extent permitted under federal law, the 163.28commissioner shall designate $3,000,000 163.29of the Homelessness Prevention and Rapid 163.30Re-Housing Program funds provided under 163.31the American Recovery and Reinvestment 163.32Act of 2009, Public Law, 111-5, to the 163.33long-term homeless service fund under 163.34Minnesota Statutes, section 
         256K.26. This 163.35appropriation shall become available by July 164.11, 2009. This paragraph is effective the day 164.2following final enactment.164.3    Sec. 9. Laws 2009, chapter 79, article 13, section 3, subdivision 8, as amended by 164.4Laws 2009, chapter 173, article 2, section 1, subdivision 8, is amended to read:

164.5Subd. 8.Continuing Care Grants

164.6The amounts that may be spent from the 164.7appropriation for each purpose are as follows:

164.8(a) Aging and Adult Services Grants13,499,00015,805,000

164.9Base Adjustment. The general fund base is 164.10increased by $5,751,000 in fiscal year 2012 164.11and $6,705,000 in fiscal year 2013.164.12Information and Assistance 164.13Reimbursement. Federal administrative 164.14reimbursement obtained from information 164.15and assistance services provided by the 164.16Senior LinkAge or Disability Linkage lines 164.17to people who are identified as eligible for 164.18medical assistance shall be appropriated to 164.19the commissioner for this activity.164.20Community Service Development Grant 164.21Reduction. Funding for community service 164.22development grants must be reduced by 164.23$260,000 for fiscal year 2010; $284,000 in 164.24fiscal year 2011; $43,000 in fiscal year 2012; 164.25and $43,000 in fiscal year 2013. Base level 164.26funding shall be restored in fiscal year 2014.164.27Community Service Development Grant 164.28Community Initiative. Funding for 164.29community service development grants shall 164.30be used to offset the cost of aging support 164.31grants. Base level funding shall be restored 164.32in fiscal year 2014.165.1Senior Nutrition Use of Federal Funds.165.2For fiscal year 2010, general fund grants 165.3for home-delivered meals and congregate 165.4dining shall be reduced by $500,000. The 165.5commissioner must replace these general 165.6fund reductions with equal amounts from 165.7federal funding for senior nutrition from the 165.8American Recovery and Reinvestment Act 165.9of 2009.

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

165.11Base Adjustment. The general fund base is 165.12decreased by $3,598,000 in fiscal year 2012 165.13and $3,470,000 in fiscal year 2013.165.14Alternative Care Transfer. Any money 165.15allocated to the alternative care program that 165.16is not spent for the purposes indicated does 165.17not cancel but must be transferred to the 165.18medical assistance account.

165.19165.20(c) Medical Assistance Grants; Long-Term Care Facilities.367,444,000419,749,000

165.21165.22(d) Medical Assistance Long-Term Care Waivers and Home Care Grants853,567,0001,039,517,000

165.23Manage Growth in TBI and CADI 165.24Waivers. During the fiscal years beginning 165.25on July 1, 2009, and July 1, 2010, the 165.26commissioner shall allocate money for home 165.27and community-based waiver programs 165.28under Minnesota Statutes, section 
         256B.49, 165.29to ensure a reduction in state spending that is 165.30equivalent to limiting the caseload growth of 165.31the TBI waiver to 12.5 allocations per month 165.32each year of the biennium and the CADI 165.33waiver to 95 allocations per month each year 165.34of the biennium. Limits do not apply: (1) 165.35when there is an approved plan for nursing 166.1facility bed closures for individuals under 166.2age 65 who require relocation due to the 166.3bed closure; (2) to fiscal year 2009 waiver 166.4allocations delayed due to unallotment; or (3) 166.5to transfers authorized by the commissioner 166.6from the personal care assistance program 166.7of individuals having a home care rating 166.8of "CS," "MT," or "HL." Priorities for the 166.9allocation of funds must be for individuals 166.10anticipated to be discharged from institutional 166.11settings or who are at imminent risk of a 166.12placement in an institutional setting.166.13Manage Growth in DD Developmental 166.14Disability Waiver. The commissioner 166.15shall manage the growth in the DD waiver 166.16by limiting the allocations included in the 166.17February 2009 forecast to 15 additional 166.18diversion allocations each month for the 166.19calendar years that begin on January 1, 2010, 166.20and January 1, 2011. Additional allocations 166.21must be made available for transfers 166.22authorized by the commissioner from the 166.23personal care program of individuals having 166.24a home care rating of "CS," "MT," or "HL."166.25Adjustment to Lead Agency Waiver 166.26Allocations. Prior to the availability of the 166.27alternative license defined in Minnesota 166.28Statutes, section 
         245A.11, subdivision 8, 166.29the commissioner shall reduce lead agency 166.30waiver allocations for the purposes of 166.31implementing a moratorium on corporate 166.32foster care.166.33Alternatives to Personal Care Assistance 166.34Services. Base level funding of $3,237,000 166.35in fiscal year 2012 and $4,856,000 in 167.1fiscal year 2013 is to implement alternative 167.2services to personal care assistance services 167.3for persons with mental health and other 167.4behavioral challenges who can benefit 167.5from other services that more appropriately 167.6meet their needs and assist them in living 167.7independently in the community. These 167.8services may include, but not be limited to, a 167.91915(i) state plan option.

167.10(e) Mental Health Grants

167.11Appropriations by Fund167.12General77,739,00077,739,000167.13Health Care Access750,000750,000167.14Lottery Prize1,508,0001,508,000

167.15Funding Usage. Up to 75 percent of a fiscal 167.16year's appropriation for adult mental health 167.17grants may be used to fund allocations in that 167.18portion of the fiscal year ending December 167.1931.

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

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

167.22Payments for Substance Abuse Treatment.167.23For services provided during fiscal years 167.242010 and 2011, county-negotiated rates 167.25and provider claims to the consolidated 167.26chemical dependency fund must not exceed167.27the lesser of: (1) rates charged for these 167.28services on January 1, 2009; or (2) 160 167.29percent of the average rate on January 1, 167.302009, for each group of vendors with similar 167.31attributes. For services provided in fiscal 167.32years 2012 and 2013, the statewide average 167.33rates aggregate payment under the new 167.34rate methodology to be developed under 167.35Minnesota Statutes, section 
         254B.12, must 168.1not exceed the average rates charged for 168.2these services on January 1, 2009, plus a 168.3state share increase of $3,787,000 for fiscal 168.4year 2012 and $5,023,000 for fiscal year 168.52013 projected aggregate payment under 168.6the rates in effect for fiscal year 2010 minus 168.71.25 percent. Notwithstanding any provision 168.8to the contrary in this article, this provision 168.9expires on June 30, 2013.168.10Chemical Dependency Special Revenue 168.11Account. For fiscal year 2010, $750,000 168.12must be transferred from the consolidated 168.13chemical dependency treatment fund 168.14administrative account and deposited into the 168.15general fund.168.16County CD Share of MA Costs for 168.17ARRA Compliance. Notwithstanding the 168.18provisions of Minnesota Statutes, chapter 168.19254B, for chemical dependency services 168.20provided during the period October 1, 2008, 168.21to December 31, 2010, and reimbursed by 168.22medical assistance at the enhanced federal 168.23matching rate provided under the American 168.24Recovery and Reinvestment Act of 2009, the 168.25county share is 30 percent of the nonfederal 168.26share. This provision is effective the day 168.27following final enactment.

168.28168.29(h) Chemical Dependency Nonentitlement Grants1,729,0001,729,000

168.30(i) Other Continuing Care Grants19,201,00017,528,000

168.31Base Adjustment. The general fund base is 168.32increased by $2,639,000 in fiscal year 2012 168.33and increased by $3,854,000 in fiscal year 168.342013.169.1Technology Grants. $650,000 in fiscal 169.2year 2010 and $1,000,000 in fiscal year 169.32011 are for technology grants, case 169.4consultation, evaluation, and consumer 169.5information grants related to developing and 169.6supporting alternatives to shift-staff foster 169.7care residential service models.169.8Other Continuing Care Grants; HIV 169.9Grants. Money appropriated for the HIV 169.10drug and insurance grant program in fiscal 169.11year 2010 may be used in either year of the 169.12biennium.169.13Quality Assurance Commission. Effective 169.14July 1, 2009, state funding for the quality 169.15assurance commission under Minnesota 169.16Statutes, section 
         256B.0951, is canceled.169.17    Sec. 10. CANCELLATIONS.169.18The remaining balance from Laws 2008, chapter 358, article 5, section 4, subdivision 169.193, appropriation for Section 125 employer incentives, is canceled.169.20    Sec. 11. TRANSFERS.169.21The commissioner of management and budget shall transfer from the general fund to 169.22the health care access fund $38,475,000 in fiscal year 2011, $14,758,000 in fiscal year 169.232012, and $35,058,000 in fiscal year 2013.169.24EFFECTIVE DATE.This section is effective upon federal approval of the 169.25amendments to Minnesota Statutes, sections 256B.055, subdivision 15, and 256B.056, 169.26subdivision 4.169.27    Sec. 12. EXPIRATION OF UNCODIFIED LANGUAGE.169.28All uncodified language contained in this article expires on June 30, 2011, unless a 169.29different expiration date is explicit.169.30    Sec. 13. EFFECTIVE DATE.170.1The provisions in this article are effective July 1, 2010, unless a different effective 170.2date is explicit.