<a id="pl.1.3"></a><var>1.3</var>modifying provisions for alternative care services for elderly and disabled <br/>
<a id="pl.1.4"></a><var>1.4</var>persons; appropriating money;amending Minnesota Statutes 2008, section <br/>
<a id="pl.1.5"></a><var>1.5</var>256B.431, subdivision 35; Minnesota Statutes 2009 Supplement, section <br/>
<a id="pl.1.6"></a><var>1.6</var>256B.69, subdivision 23.<br/>
<a id="pl.1.7"></a><var>1.7</var>BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:<br/>
<br/>
<a id="bill.0.1.0"></a><a id="pl.1.8"></a><var>1.8</var>    Section 1. Minnesota Statutes 2008, section 256B.431, subdivision 35, is amended to <br/>
<a id="pl.1.9"></a><var>1.9</var>read:<br/>
<a id="pl.1.10"></a><var>1.10</var>    Subd. 35. <b>Exclusion of raw food cost adjustment.</b> For rate years beginning on <br/>
<a id="pl.1.11"></a><var>1.11</var>or after July 1, 2001, in calculating a nursing facility's operating cost per diem for the <br/>
<a id="pl.1.12"></a><var>1.12</var>purposes of constructing comparing to an array, determining a median, or otherwise <br/>
<a id="pl.1.13"></a><var>1.13</var>performing a other statistical measure of nursing facility payment rates to be used to <br/>
<a id="pl.1.14"></a><var>1.14</var>determine future rate increases adjustments under this section, section 
         <statute_ref>256B.434</statute_ref>, or any <br/>
<a id="pl.1.15"></a><var>1.15</var>other section, the commissioner shall exclude adjustments for raw food costs under <br/>
<a id="pl.1.16"></a><var>1.16</var>subdivision 2b, paragraph (h), that are related to providing special diets based on religious <br/>
<a id="pl.1.17"></a><var>1.17</var>beliefs. <br/>
<br/>
<a id="bill.0.2.0"></a><a id="pl.1.18"></a><var>1.18</var>    Sec. 2. Minnesota Statutes 2009 Supplement, section 256B.69, subdivision 23, is <br/>
<a id="pl.1.19"></a><var>1.19</var>amended to read:<br/>
<a id="pl.1.20"></a><var>1.20</var>    Subd. 23. <b>Alternative services; elderly and disabled persons.</b> (a) The <br/>
<a id="pl.1.21"></a><var>1.21</var>commissioner may implement demonstration projects to create alternative integrated <br/>
<a id="pl.1.22"></a><var>1.22</var>delivery systems for acute and long-term care services to elderly persons and persons <br/>
<a id="pl.1.23"></a><var>1.23</var>with disabilities as defined in section 
         <statute_ref>256B.77, subdivision 7a</statute_ref>, that provide increased <br/>
<a id="pl.1.24"></a><var>1.24</var>coordination, improve access to quality services, and mitigate future cost increases. <br/>
<a id="pl.2.1"></a><var>2.1</var>The commissioner may seek federal authority to combine Medicare and Medicaid <br/>
<a id="pl.2.2"></a><var>2.2</var>capitation payments for the purpose of such demonstrations and may contract with <br/>
<a id="pl.2.3"></a><var>2.3</var>Medicare-approved special needs plans to provide Medicaid services. Medicare funds and <br/>
<a id="pl.2.4"></a><var>2.4</var>services shall be administered according to the terms and conditions of the federal contract <br/>
<a id="pl.2.5"></a><var>2.5</var>and demonstration provisions. For the purpose of administering medical assistance funds, <br/>
<a id="pl.2.6"></a><var>2.6</var>demonstrations under this subdivision are subject to subdivisions 1 to 22. The provisions <br/>
<a id="pl.2.7"></a><var>2.7</var>of Minnesota Rules, parts 
         <statute_ref>9500.1450</statute_ref> to 
         <statute_ref>9500.1464</statute_ref>, apply to these demonstrations, <br/>
<a id="pl.2.8"></a><var>2.8</var>with the exceptions of parts 
         <statute_ref>9500.1452</statute_ref>, subpart 2, item B; and 
         <statute_ref>9500.1457</statute_ref>, subpart 1, <br/>
<a id="pl.2.9"></a><var>2.9</var>items B and C, which do not apply to persons enrolling in demonstrations under this <br/>
<a id="pl.2.10"></a><var>2.10</var>section. An initial open enrollment period may be provided. Persons who disenroll from <br/>
<a id="pl.2.11"></a><var>2.11</var>demonstrations under this subdivision remain subject to Minnesota Rules, parts 9500.1450 <br/>
<a id="pl.2.12"></a><var>2.12</var>to 9500.1464. When a person is enrolled in a health plan under these demonstrations and <br/>
<a id="pl.2.13"></a><var>2.13</var>the health plan's participation is subsequently terminated for any reason, the person shall <br/>
<a id="pl.2.14"></a><var>2.14</var>be provided an opportunity to select a new health plan and shall have the right to change <br/>
<a id="pl.2.15"></a><var>2.15</var>health plans within the first 60 days of enrollment in the second health plan. Persons <br/>
<a id="pl.2.16"></a><var>2.16</var>required to participate in health plans under this section who fail to make a choice of <br/>
<a id="pl.2.17"></a><var>2.17</var>health plan shall not be randomly assigned to health plans under these demonstrations. <br/>
<a id="pl.2.18"></a><var>2.18</var>Notwithstanding section 
         <statute_ref>256L.12, subdivision 5</statute_ref>, and Minnesota Rules, part 
         <statute_ref>9505.5220</statute_ref>, <br/>
<a id="pl.2.19"></a><var>2.19</var>subpart 1, item A, if adopted, for the purpose of demonstrations under this subdivision, <br/>
<a id="pl.2.20"></a><var>2.20</var>the commissioner may contract with managed care organizations, including counties, to <br/>
<a id="pl.2.21"></a><var>2.21</var>serve only elderly persons eligible for medical assistance, elderly and disabled persons, or <br/>
<a id="pl.2.22"></a><var>2.22</var>disabled persons only. For persons with a primary diagnosis of developmental disability, <br/>
<a id="pl.2.23"></a><var>2.23</var>serious and persistent mental illness, or serious emotional disturbance, the commissioner <br/>
<a id="pl.2.24"></a><var>2.24</var>must ensure that the county authority has approved the demonstration and contracting <br/>
<a id="pl.2.25"></a><var>2.25</var>design. Enrollment in these projects for persons with disabilities shall be voluntary. The <br/>
<a id="pl.2.26"></a><var>2.26</var>commissioner shall not implement any demonstration project under this subdivision for <br/>
<a id="pl.2.27"></a><var>2.27</var>persons with a primary diagnosis of developmental disabilities, serious and persistent <br/>
<a id="pl.2.28"></a><var>2.28</var>mental illness, or serious emotional disturbance, without approval of the county board of <br/>
<a id="pl.2.29"></a><var>2.29</var>the county in which the demonstration is being implemented.<br/>
<a id="pl.2.30"></a><var>2.30</var>    (b) Notwithstanding chapter 245B, sections 
         <statute_ref>252.40</statute_ref> to 
         <statute_ref>252.46</statute_ref>, 
         <statute_ref>256B.092</statute_ref>, 
         <statute_ref>256B.501 <br/>
</statute_ref><a id="pl.2.31"></a><var>2.31</var>to 
         <statute_ref>256B.5015</statute_ref>, and Minnesota Rules, parts 9525.0004 to 9525.0036, 9525.1200 to <br/>
<a id="pl.2.32"></a><var>2.32</var>9525.1330, 9525.1580, and 9525.1800 to 9525.1930, the commissioner may implement <br/>
<a id="pl.2.33"></a><var>2.33</var>under this section projects for persons with developmental disabilities. The commissioner <br/>
<a id="pl.2.34"></a><var>2.34</var>may capitate payments for ICF/MR services, waivered services for developmental <br/>
<a id="pl.2.35"></a><var>2.35</var>disabilities, including case management services, day training and habilitation and <br/>
<a id="pl.2.36"></a><var>2.36</var>alternative active treatment services, and other services as approved by the state and by the <br/>
<a id="pl.3.1"></a><var>3.1</var>federal government. Case management and active treatment must be individualized and <br/>
<a id="pl.3.2"></a><var>3.2</var>developed in accordance with a person-centered plan. Costs under these projects may not <br/>
<a id="pl.3.3"></a><var>3.3</var>exceed costs that would have been incurred under fee-for-service. Beginning July 1, 2003, <br/>
<a id="pl.3.4"></a><var>3.4</var>and until four years after the pilot project implementation date, subcontractor participation <br/>
<a id="pl.3.5"></a><var>3.5</var>in the long-term care developmental disability pilot is limited to a nonprofit long-term <br/>
<a id="pl.3.6"></a><var>3.6</var>care system providing ICF/MR services, home and community-based waiver services, <br/>
<a id="pl.3.7"></a><var>3.7</var>and in-home services to no more than 120 consumers with developmental disabilities in <br/>
<a id="pl.3.8"></a><var>3.8</var>Carver, Hennepin, and Scott Counties. The commissioner shall report to the legislature <br/>
<a id="pl.3.9"></a><var>3.9</var>prior to expansion of the developmental disability pilot project. This paragraph expires <br/>
<a id="pl.3.10"></a><var>3.10</var>four years after the implementation date of the pilot project.<br/>
<a id="pl.3.11"></a><var>3.11</var>    (c) Before implementation of a demonstration project for disabled persons, the <br/>
<a id="pl.3.12"></a><var>3.12</var>commissioner must provide information to appropriate committees of the house of <br/>
<a id="pl.3.13"></a><var>3.13</var>representatives and senate and must involve representatives of affected disability groups <br/>
<a id="pl.3.14"></a><var>3.14</var>in the design of the demonstration projects.<br/>
<a id="pl.3.15"></a><var>3.15</var>    (d) A nursing facility reimbursed under the alternative reimbursement methodology <br/>
<a id="pl.3.16"></a><var>3.16</var>in section 
         <statute_ref>256B.434</statute_ref> may, in collaboration with a hospital, clinic, or other health care entity <br/>
<a id="pl.3.17"></a><var>3.17</var>provide services under paragraph (a). The commissioner shall amend the state plan and <br/>
<a id="pl.3.18"></a><var>3.18</var>seek any federal waivers necessary to implement this paragraph.<br/>
<a id="pl.3.19"></a><var>3.19</var>    (e) The commissioner, in consultation with the commissioners of commerce and <br/>
<a id="pl.3.20"></a><var>3.20</var>health, may approve and implement programs for all-inclusive care for the elderly (PACE) <br/>
<a id="pl.3.21"></a><var>3.21</var>according to federal laws and regulations governing that program and state laws or rules <br/>
<a id="pl.3.22"></a><var>3.22</var>applicable to participating providers. The process for approval of these programs shall <br/>
<a id="pl.3.23"></a><var>3.23</var>begin only after the commissioner receives grant money in an amount sufficient to cover <br/>
<a id="pl.3.24"></a><var>3.24</var>the state share of the administrative and actuarial costs to implement the programs during <br/>
<a id="pl.3.25"></a><var>3.25</var>state fiscal years 2006 and 2007. Grant amounts for this purpose shall be deposited in an <br/>
<a id="pl.3.26"></a><var>3.26</var>account in the special revenue fund and are appropriated to the commissioner to be used <br/>
<a id="pl.3.27"></a><var>3.27</var>solely for the purpose of PACE administrative and actuarial costs. A PACE provider is <br/>
<a id="pl.3.28"></a><var>3.28</var>not required to be licensed or certified as a health plan company as defined in section <br/>
<statute_ref><a id="pl.3.29"></a><var>3.29</var>62Q.01, subdivision 4
         </statute_ref>. Persons age 55 and older who have been screened by the county <br/>
<a id="pl.3.30"></a><var>3.30</var>and found to be eligible for services under the elderly waiver or community alternatives <br/>
<a id="pl.3.31"></a><var>3.31</var>for disabled individuals or who are already eligible for Medicaid but meet level of <br/>
<a id="pl.3.32"></a><var>3.32</var>care criteria for receipt of waiver services may choose to enroll in the PACE program. <br/>
<a id="pl.3.33"></a><var>3.33</var>Medicare and Medicaid services will be provided according to this subdivision and <br/>
<a id="pl.3.34"></a><var>3.34</var>federal Medicare and Medicaid requirements governing PACE providers and programs. <br/>
<a id="pl.3.35"></a><var>3.35</var>PACE enrollees will receive Medicaid home and community-based services through the <br/>
<a id="pl.3.36"></a><var>3.36</var>PACE provider as an alternative to services for which they would otherwise be eligible <br/>
<a id="pl.4.1"></a><var>4.1</var>through home and community-based waiver programs and Medicaid State Plan Services. <br/>
<a id="pl.4.2"></a><var>4.2</var>The commissioner shall establish Medicaid rates for PACE providers that do not exceed <br/>
<a id="pl.4.3"></a><var>4.3</var>costs that would have been incurred under fee-for-service or other relevant managed care <br/>
<a id="pl.4.4"></a><var>4.4</var>programs operated by the state.<br/>
<a id="pl.4.5"></a><var>4.5</var>    (f) The commissioner shall seek federal approval to expand the Minnesota disability <br/>
<a id="pl.4.6"></a><var>4.6</var>health options (MnDHO) program established under this subdivision in stages, first to <br/>
<a id="pl.4.7"></a><var>4.7</var>regional population centers outside the seven-county metro area and then to all areas of <br/>
<a id="pl.4.8"></a><var>4.8</var>the state. Until July 1, 2009, expansion for MnDHO projects that include home and <br/>
<a id="pl.4.9"></a><var>4.9</var>community-based services is limited to the two projects and service areas in effect on <br/>
<a id="pl.4.10"></a><var>4.10</var>March 1, 2006. Enrollment in integrated MnDHO programs that include home and <br/>
<a id="pl.4.11"></a><var>4.11</var>community-based services shall remain voluntary. Costs for home and community-based <br/>
<a id="pl.4.12"></a><var>4.12</var>services included under MnDHO must not exceed costs that would have been incurred <br/>
<a id="pl.4.13"></a><var>4.13</var>under the fee-for-service program. Notwithstanding whether expansion occurs under <br/>
<a id="pl.4.14"></a><var>4.14</var>this paragraph, in determining MnDHO payment rates and risk adjustment methods for <br/>
<a id="pl.4.15"></a><var>4.15</var>contract years starting in 2012, the commissioner must consider the methods used to <br/>
<a id="pl.4.16"></a><var>4.16</var>determine county allocations for home and community-based program participants. If <br/>
<a id="pl.4.17"></a><var>4.17</var>necessary to reduce MnDHO rates to comply with the provision regarding MnDHO costs <br/>
<a id="pl.4.18"></a><var>4.18</var>for home and community-based services, the commissioner shall achieve the reduction by <br/>
<a id="pl.4.19"></a><var>4.19</var>maintaining the base rate for contract years 2010 and 2011 for services provided under the <br/>
<a id="pl.4.20"></a><var>4.20</var>community alternatives for disabled individuals waiver at the same level as for contract <br/>
<a id="pl.4.21"></a><var>4.21</var>year 2009. The commissioner may apply other reductions to MnDHO rates to implement <br/>
<a id="pl.4.22"></a><var>4.22</var>decreases in provider payment rates required by state law. In developing program <br/>
<a id="pl.4.23"></a><var>4.23</var>specifications for expansion of integrated programs, the commissioner shall involve and <br/>
<a id="pl.4.24"></a><var>4.24</var>consult the state-level stakeholder group established in subdivision 28, paragraph (d), <br/>
<a id="pl.4.25"></a><var>4.25</var>including consultation on whether and how to include home and community-based waiver <br/>
<a id="pl.4.26"></a><var>4.26</var>programs. Plans for further expansion of MnDHO projects shall be presented to the chairs <br/>
<a id="pl.4.27"></a><var>4.27</var>of the house of representatives and senate committees with jurisdiction over health and <br/>
<a id="pl.4.28"></a><var>4.28</var>human services policy and finance by February 1, 2007.<br/>
<a id="pl.4.29"></a><var>4.29</var>    (g) Notwithstanding section 
         <statute_ref>256B.0261</statute_ref>, health plans providing services under this <br/>
<a id="pl.4.30"></a><var>4.30</var>section are responsible for home care targeted case management and relocation targeted <br/>
<a id="pl.4.31"></a><var>4.31</var>case management. Services must be provided according to the terms of the waivers and <br/>
<a id="pl.4.32"></a><var>4.32</var>contracts approved by the federal government.<br/>
<br/>
<a id="bill.0.3.0"></a><a id="pl.4.33"></a><var>4.33</var>    Sec. 3. <b>APPROPRIATIONS.</b><br/>
<a id="pl.4.34"></a><var>4.34</var>    Subdivision 1. <b>Community service development reduction.</b> The appropriation <br/>
<a id="pl.4.35"></a><var>4.35</var>in Laws 2009, chapter 79, article 13, section 3, subdivision 8, paragraph (a), for <br/>
<a id="pl.5.1"></a><var>5.1</var>community service development grants, as amended by Laws 2009, chapter 173, article 2, <br/>
<a id="pl.5.2"></a><var>5.2</var>section 1, subdivision 8, paragraph (a), is reduced by $154,000 in fiscal year 2011. The <br/>
<a id="pl.5.3"></a><var>5.3</var>appropriation base is reduced by $139,000 for fiscal year 2012 and $0 for fiscal year 2013. <br/>
<a id="pl.5.4"></a><var>5.4</var>Notwithstanding any law or rule to the contrary, this provision expires June 30, 2012.<br/>
<a id="pl.5.5"></a><var>5.5</var>    Subd. 2. <b>Health care administration; PACE implementation funding.</b> For <br/>
<a id="pl.5.6"></a><var>5.6</var>fiscal year 2011, $145,000 is appropriated from the general fund to the commissioner of <br/>
<a id="pl.5.7"></a><var>5.7</var>human services to complete the actuarial and administrative work necessary to begin the <br/>
<a id="pl.5.8"></a><var>5.8</var>operation of PACE under Minnesota Statutes, section 256B.69, subdivision 23, paragraph <br/>
<a id="pl.5.9"></a><var>5.9</var>(e). Base level funding for this activity shall be $130,000 in fiscal year 2012 and $0 <br/>
<a id="pl.5.10"></a><var>5.10</var>in fiscal year 2013.<br/>
<a id="pl.5.11"></a><var>5.11</var>    Subd. 3. <b>Continuing care management; PACE implementation funding.</b> For <br/>
<a id="pl.5.12"></a><var>5.12</var>fiscal year 2011, $111,000 is appropriated from the general fund to the commissioner of <br/>
<a id="pl.5.13"></a><var>5.13</var>human services to complete the actuarial and administrative work necessary to begin the <br/>
<a id="pl.5.14"></a><var>5.14</var>operation of PACE under Minnesota Statutes, section 256B.69, subdivision 23, paragraph <br/>
<a id="pl.5.15"></a><var>5.15</var>(e). Base level funding for this activity shall be $101,000 in fiscal year 2012 and $0 in <br/>
<a id="pl.5.16"></a><var>5.16</var>fiscal year 2013. For fiscal year 2013 and beyond, the commissioner must work with <br/>
<a id="pl.5.17"></a><var>5.17</var>stakeholders to develop financing mechanisms to complete the actuarial and administrative <br/>
<a id="pl.5.18"></a><var>5.18</var>costs of PACE. The commissioner shall inform the chairs and ranking minority members <br/>
<a id="pl.5.19"></a><var>5.19</var>of the legislative committees with jurisdiction over health care funding by January 15, <br/>
<a id="pl.5.20"></a><var>5.20</var>2011, on progress to develop financing mechanisms.<br/>