1.1 	A bill for an act
1.2 	relating to human services; modifying authorization of PACE programs; 
1.3 	appropriating money;amending Minnesota Statutes 2009 Supplement, 
1.4 	section 256B.69, subdivision 23; Laws 2009, chapter 79, article 13, section 
1.5 	3, subdivision 8.
1.6 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.7 	Section 1. Minnesota Statutes 2009 Supplement, section 256B.69, subdivision 23, 
1.8 	is amended to read:
1.9 		Subd. 23.Alternative services; elderly and disabled persons. (a) The 
1.10 	commissioner may implement demonstration projects to create alternative integrated 
1.11 	delivery systems for acute and long-term care services to elderly persons and persons 
1.12 	with disabilities as defined in section 256B.77, subdivision 7a, that provide increased 
1.13 	coordination, improve access to quality services, and mitigate future cost increases. 
1.14 	The commissioner may seek federal authority to combine Medicare and Medicaid 
1.15 	capitation payments for the purpose of such demonstrations and may contract with 
1.16 	Medicare-approved special needs plans to provide Medicaid services. Medicare funds and 
1.17 	services shall be administered according to the terms and conditions of the federal contract 
1.18 	and demonstration provisions. For the purpose of administering medical assistance funds, 
1.19 	demonstrations under this subdivision are subject to subdivisions 1 to 22. The provisions 
1.20 	of Minnesota Rules, parts 9500.1450 to 9500.1464, apply to these demonstrations, 
1.21 	with the exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457, subpart 1, 
1.22 	items B and C, which do not apply to persons enrolling in demonstrations under this 
1.23 	section. An initial open enrollment period may be provided. Persons who disenroll from 
1.24 	demonstrations under this subdivision remain subject to Minnesota Rules, parts 9500.1450 
1.25 	to 9500.1464. When a person is enrolled in a health plan under these demonstrations and 
2.1 	the health plan's participation is subsequently terminated for any reason, the person shall 
2.2 	be provided an opportunity to select a new health plan and shall have the right to change 
2.3 	health plans within the first 60 days of enrollment in the second health plan. Persons 
2.4 	required to participate in health plans under this section who fail to make a choice of 
2.5 	health plan shall not be randomly assigned to health plans under these demonstrations. 
2.6 	Notwithstanding section 256L.12, subdivision 5, and Minnesota Rules, part 9505.5220, 
2.7 	subpart 1, item A, if adopted, for the purpose of demonstrations under this subdivision, 
2.8 	the commissioner may contract with managed care organizations, including counties, to 
2.9 	serve only elderly persons eligible for medical assistance, elderly and disabled persons, or 
2.10 	disabled persons only. For persons with a primary diagnosis of developmental disability, 
2.11 	serious and persistent mental illness, or serious emotional disturbance, the commissioner 
2.12 	must ensure that the county authority has approved the demonstration and contracting 
2.13 	design. Enrollment in these projects for persons with disabilities shall be voluntary. The 
2.14 	commissioner shall not implement any demonstration project under this subdivision for 
2.15 	persons with a primary diagnosis of developmental disabilities, serious and persistent 
2.16 	mental illness, or serious emotional disturbance, without approval of the county board of 
2.17 	the county in which the demonstration is being implemented.
2.18 	(b) Notwithstanding chapter 245B, sections 252.40 to 252.46, 256B.092, 256B.501 
2.19 	to 256B.5015, and Minnesota Rules, parts 9525.0004 to 9525.0036, 9525.1200 to 
2.20 	9525.1330, 9525.1580, and 9525.1800 to 9525.1930, the commissioner may implement 
2.21 	under this section projects for persons with developmental disabilities. The commissioner 
2.22 	may capitate payments for ICF/MR services, waivered services for developmental 
2.23 	disabilities, including case management services, day training and habilitation and 
2.24 	alternative active treatment services, and other services as approved by the state and by the 
2.25 	federal government. Case management and active treatment must be individualized and 
2.26 	developed in accordance with a person-centered plan. Costs under these projects may not 
2.27 	exceed costs that would have been incurred under fee-for-service. Beginning July 1, 2003, 
2.28 	and until four years after the pilot project implementation date, subcontractor participation 
2.29 	in the long-term care developmental disability pilot is limited to a nonprofit long-term 
2.30 	care system providing ICF/MR services, home and community-based waiver services, 
2.31 	and in-home services to no more than 120 consumers with developmental disabilities in 
2.32 	Carver, Hennepin, and Scott Counties. The commissioner shall report to the legislature 
2.33 	prior to expansion of the developmental disability pilot project. This paragraph expires 
2.34 	four years after the implementation date of the pilot project.
2.35 	(c) Before implementation of a demonstration project for disabled persons, the 
2.36 	commissioner must provide information to appropriate committees of the house of 
3.1 	representatives and senate and must involve representatives of affected disability groups 
3.2 	in the design of the demonstration projects.
3.3 	(d) A nursing facility reimbursed under the alternative reimbursement methodology 
3.4 	in section 256B.434 may, in collaboration with a hospital, clinic, or other health care entity 
3.5 	provide services under paragraph (a). The commissioner shall amend the state plan and 
3.6 	seek any federal waivers necessary to implement this paragraph.
3.7 	(e) The commissioner, in consultation with the commissioners of commerce and 
3.8 	health, may approve and implement programs for all-inclusive care for the elderly (PACE) 
3.9 	according to federal laws and regulations governing that program and state laws or rules 
3.10 	applicable to participating providers. The process for approval of these programs shall 
3.11 	begin only after the commissioner receives grant money in an amount sufficient to cover 
3.12 	the state share of the administrative and actuarial costs to implement the programs during 
3.13 	state fiscal years 2006 and 2007. Grant amounts for this purpose shall be deposited in an 
3.14 	account in the special revenue fund and are appropriated to the commissioner to be used 
3.15 	solely for the purpose of PACE administrative and actuarial costs. A PACE provider is 
3.16 	not required to be licensed or certified as a health plan company as defined in section 
3.17 	62Q.01, subdivision 4. Persons age 55 and older who have been screened by the county 
3.18 	and found to be eligible for services under the elderly waiver or community alternatives 
3.19 	for disabled individuals or who are already eligible for Medicaid but meet level of 
3.20 	care criteria for receipt of waiver services may choose to enroll in the PACE program. 
3.21 	Medicare and Medicaid services will be provided according to this subdivision and 
3.22 	federal Medicare and Medicaid requirements governing PACE providers and programs. 
3.23 	PACE enrollees will receive Medicaid home and community-based services through the 
3.24 	PACE provider as an alternative to services for which they would otherwise be eligible 
3.25 	through home and community-based waiver programs and Medicaid State Plan Services. 
3.26 	The commissioner shall establish Medicaid rates for PACE providers that do not exceed 
3.27 	costs that would have been incurred under fee-for-service or other relevant managed care 
3.28 	programs operated by the state.
3.29 	(f) The commissioner shall seek federal approval to expand the Minnesota disability 
3.30 	health options (MnDHO) program established under this subdivision in stages, first to 
3.31 	regional population centers outside the seven-county metro area and then to all areas of 
3.32 	the state. Until July 1, 2009, expansion for MnDHO projects that include home and 
3.33 	community-based services is limited to the two projects and service areas in effect on 
3.34 	March 1, 2006. Enrollment in integrated MnDHO programs that include home and 
3.35 	community-based services shall remain voluntary. Costs for home and community-based 
3.36 	services included under MnDHO must not exceed costs that would have been incurred 
4.1 	under the fee-for-service program. Notwithstanding whether expansion occurs under 
4.2 	this paragraph, in determining MnDHO payment rates and risk adjustment methods for 
4.3 	contract years starting in 2012, the commissioner must consider the methods used to 
4.4 	determine county allocations for home and community-based program participants. If 
4.5 	necessary to reduce MnDHO rates to comply with the provision regarding MnDHO costs 
4.6 	for home and community-based services, the commissioner shall achieve the reduction by 
4.7 	maintaining the base rate for contract years 2010 and 2011 for services provided under the 
4.8 	community alternatives for disabled individuals waiver at the same level as for contract 
4.9 	year 2009. The commissioner may apply other reductions to MnDHO rates to implement 
4.10 	decreases in provider payment rates required by state law. In developing program 
4.11 	specifications for expansion of integrated programs, the commissioner shall involve and 
4.12 	consult the state-level stakeholder group established in subdivision 28, paragraph (d), 
4.13 	including consultation on whether and how to include home and community-based waiver 
4.14 	programs. Plans for further expansion of MnDHO projects shall be presented to the chairs 
4.15 	of the house of representatives and senate committees with jurisdiction over health and 
4.16 	human services policy and finance by February 1, 2007.
4.17 	(g) Notwithstanding section 256B.0261, health plans providing services under this 
4.18 	section are responsible for home care targeted case management and relocation targeted 
4.19 	case management. Services must be provided according to the terms of the waivers and 
4.20 	contracts approved by the federal government.

4.21 	Sec. 2. Laws 2009, chapter 79, article 13, section 3, subdivision 8, is amended to read:

4.22	Subd. 8.Continuing Care Grants
 					
4.23 	The amounts that may be spent from the 
4.24 	appropriation for each purpose are as follows:

4.25	(a) Aging and Adult Services Grants

4.26	Appropriations by Fund
	
4.27	General
	13,488,000
	15,779,000
	
4.28	Federal
	500,000
	0
	
4.29 	Base Adjustment. The general fund base is 
4.30 	increased by $5,751,000 in fiscal year 2012 
4.31 	and $6,705,000 in fiscal year 2013.
4.32 	Information and Assistance 
4.33 	Reimbursement. Federal administrative 
4.34 	reimbursement obtained from information 
5.1 	and assistance services provided by the 
5.2 	Senior LinkAge or Disability Linkage lines 
5.3 	to people who are identified as eligible for 
5.4 	medical assistance shall be appropriated to 
5.5 	the commissioner for this activity.
5.6 	Community Service Development Grant 
5.7 	Reduction.Of this appropriation, $154,000 
5.8 	in fiscal year 2011 and $139,000 in fiscal year 
5.9 	2012 shall be used to complete the actuarial 
5.10 	and administrative work necessary to begin 
5.11 	the operation of PACE under Minnesota 
5.12 	Statutes, section 256B.69, subdivision 23, 
5.13 	paragraph (e). Funding for community 
5.14 	service development grants must be reduced 
5.15 	by $251,000 for fiscal year 2010; $266,000 in 
5.16 	fiscal year 2011; $25,000 in fiscal year 2012; 
5.17 	and $25,000 in fiscal year 2013. Base level 
5.18 	funding shall be restored in fiscal year 2014.
5.19 	Senior Nutrition Use of Federal Funds.
5.20 	For fiscal year 2010, general fund grants 
5.21 	for home-delivered meals and congregate 
5.22 	dining shall be reduced by $500,000. The 
5.23 	commissioner must replace these general 
5.24 	fund reductions with equal amounts from 
5.25 	federal funding for senior nutrition from the 
5.26 	American Recovery and Reinvestment Act 
5.27 	of 2009.

5.28	(b) Alternative Care Grants
		50,234,000
		48,576,000
	
5.29 	Base Adjustment. The general fund base is 
5.30 	decreased by $3,598,000 in fiscal year 2012 
5.31 	and $3,470,000 in fiscal year 2013.
5.32 	Alternative Care Transfer. Any money 
5.33 	allocated to the alternative care program that 
5.34 	is not spent for the purposes indicated does 
6.1 	not cancel but must be transferred to the 
6.2 	medical assistance account.

6.3
6.4	(c) Medical Assistance Grants; Long-Term 
Care Facilities.
		367,444,000
		419,749,000

6.5
6.6	(d) Medical Assistance Long-Term Care 
Waivers and Home Care Grants
		854,373,000
		1,043,411,000
	
6.7 	Manage Growth in TBI and CADI 
6.8 	Waivers. During the fiscal years beginning 
6.9 	on July 1, 2009, and July 1, 2010, the 
6.10 	commissioner shall allocate money for home 
6.11 	and community-based waiver programs 
6.12 	under Minnesota Statutes, section 256B.49, 
6.13 	to ensure a reduction in state spending that is 
6.14 	equivalent to limiting the caseload growth of 
6.15 	the TBI waiver to 12.5 allocations per month 
6.16 	each year of the biennium and the CADI 
6.17 	waiver to 95 allocations per month each year 
6.18 	of the biennium. Limits do not apply: (1) 
6.19 	when there is an approved plan for nursing 
6.20 	facility bed closures for individuals under 
6.21 	age 65 who require relocation due to the 
6.22 	bed closure; (2) to fiscal year 2009 waiver 
6.23 	allocations delayed due to unallotment; or (3) 
6.24 	to transfers authorized by the commissioner 
6.25 	from the personal care assistance program 
6.26 	of individuals having a home care rating 
6.27 	of "CS," "MT," or "HL." Priorities for the 
6.28 	allocation of funds must be for individuals 
6.29 	anticipated to be discharged from institutional 
6.30 	settings or who are at imminent risk of a 
6.31 	placement in an institutional setting.
6.32 	Manage Growth in DD Waiver. The 
6.33 	commissioner shall manage the growth in 
6.34 	the DD waiver by limiting the allocations 
6.35 	included in the February 2009 forecast to 15 
6.36 	additional diversion allocations each month 
7.1 	for the calendar years that begin on January 
7.2 	1, 2010, and January 1, 2011. Additional 
7.3 	allocations must be made available for 
7.4 	transfers authorized by the commissioner 
7.5 	from the personal care program of individuals 
7.6 	having a home care rating of "CS," "MT," 
7.7 	or "HL."
7.8 	Adjustment to Lead Agency Waiver 
7.9 	Allocations. Prior to the availability of the 
7.10 	alternative license defined in Minnesota 
7.11 	Statutes, section 245A.11, subdivision 8, 
7.12 	the commissioner shall reduce lead agency 
7.13 	waiver allocations for the purposes of 
7.14 	implementing a moratorium on corporate 
7.15 	foster care.
7.16 	Alternatives to Personal Care Assistance 
7.17 	Services. Base level funding of $3,237,000 
7.18 	in fiscal year 2012 and $4,856,000 in 
7.19 	fiscal year 2013 is to implement alternative 
7.20 	services to personal care assistance services 
7.21 	for persons with mental health and other 
7.22 	behavioral challenges who can benefit 
7.23 	from other services that more appropriately 
7.24 	meet their needs and assist them in living 
7.25 	independently in the community. These 
7.26 	services may include, but not be limited to, a 
7.27 	1915(i) state plan option.

7.28	(e) Mental Health Grants

7.29	Appropriations by Fund
	
7.30	General
	77,739,000
	77,739,000
	
7.31	Health Care Access
	750,000
	750,000
	
7.32	Lottery Prize
	1,508,000
	1,508,000
	
7.33 	Funding Usage. Up to 75 percent of a fiscal 
7.34 	year's appropriation for adult mental health 
7.35 	grants may be used to fund allocations in that 
8.1 	portion of the fiscal year ending December 
8.2 	31.

8.3	(f) Deaf and Hard-of-Hearing Grants
		1,930,000
		1,917,000

8.4	(g) Chemical Dependency Entitlement Grants
		111,303,000
		122,822,000
	
8.5 	Payments for Substance Abuse Treatment.
8.6 	For services provided during fiscal years 
8.7 	2010 and 2011, county-negotiated rates and 
8.8 	provider claims to the consolidated chemical 
8.9 	dependency fund must not exceed rates 
8.10 	charged for these services on January 1, 2009. 
8.11 	For services provided in fiscal years 2012 
8.12 	and 2013, statewide average rates under the 
8.13 	new rate methodology to be developed under 
8.14 	Minnesota Statutes, section 254B.12, must 
8.15 	not exceed the average rates charged for these 
8.16 	services on January 1, 2009, plus $3,787,000 
8.17 	for fiscal year 2012 and $5,023,000 for fiscal 
8.18 	year 2013. Notwithstanding any provision 
8.19 	to the contrary in this article, this provision 
8.20 	expires on June 30, 2013.
8.21 	Chemical Dependency Special Revenue 
8.22 	Account. For fiscal year 2010, $750,000 
8.23 	must be transferred from the consolidated 
8.24 	chemical dependency treatment fund 
8.25 	administrative account and deposited into the 
8.26 	general fund.
8.27 	County CD Share of MA Costs for 
8.28 	ARRA Compliance. Notwithstanding the 
8.29 	provisions of Minnesota Statutes, chapter 
8.30 	254B, for chemical dependency services 
8.31 	provided during the period July 1, 2009, 
8.32 	to December 31, 2010, and reimbursed by 
8.33 	medical assistance at the enhanced federal 
8.34 	matching rate provided under the American 
8.35 	Recovery and Reinvestment Act of 2009, the 
9.1 	county share is 30 percent of the nonfederal 
9.2 	share.

9.3
9.4	(h) Chemical Dependency Nonentitlement 
Grants
		1,729,000
		1,729,000
	
9.5 	Base Adjustment. The general fund base is 
9.6 	decreased by $3,000 in each of fiscal years 
9.7 	2012 and 2013.

9.8	(i) Other Continuing Care Grants
		18,272,000
		13,139,000
	
9.9 	Base Adjustment. The general fund base is 
9.10 	increased by $7,028,000 in fiscal year 2012 
9.11 	and increased by $8,243,000 in fiscal year 
9.12 	2013.
9.13 	Technology Grants. $650,000 in fiscal 
9.14 	year 2010 and $1,000,000 in fiscal year 
9.15 	2011 are for technology grants, case 
9.16 	consultation, evaluation, and consumer 
9.17 	information grants related to developing and 
9.18 	supporting alternatives to shift-staff foster 
9.19 	care residential service models.
9.20 	Other Continuing Care Grants; HIV 
9.21 	Grants. Money appropriated for the HIV 
9.22 	drug and insurance grant program in fiscal 
9.23 	year 2010 may be used in either year of the 
9.24 	biennium.