1.1A bill for an act1.2relating to state government; establishing the health and human services 1.3budget; making changes to children and family services, Department of 1.4Health, miscellaneous provisions, health licensing fees, health care, and 1.5continuing care; redesigning service delivery; making changes to chemical 1.6and mental health; modifying fee schedules; modifying program eligibility 1.7requirements; authorizing rulemaking; requiring reports; appropriating money 1.8for the Departments of Health and Human Services and other health-related 1.9boards and councils; making forecast adjustments;amending Minnesota Statutes 1.102010, sections 3.98, by adding a subdivision; 62D.08, subdivision 7; 62E.08, 1.11subdivision 1; 62E.14, by adding a subdivision; 62J.04, subdivisions 3, 9; 1.1262J.17, subdivision 4a; 62J.495, by adding a subdivision; 62J.497, by adding a 1.13subdivision; 62J.692; 62Q.32; 62U.04, subdivisions 3, 9; 62U.06, subdivision 2; 1.14119B.011, subdivision 13; 119B.035, subdivisions 1, 4; 119B.09, subdivision 1.1510, by adding subdivisions; 119B.13, subdivisions 1, 1a, 7; 144.05, by adding 1.16a subdivision; 144.1499; 144.1501, subdivisions 1, 4; 144.98, subdivisions 1.172a, 7, by adding subdivisions; 144A.102; 144A.61, by adding a subdivision; 1.18144E.123; 145.928, subdivision 2; 145.986, by adding subdivisions; 145A.17, 1.19subdivision 3; 148.07, subdivision 1; 148.108, by adding a subdivision; 148.191, 1.20subdivision 2; 148.212, subdivision 1; 148.231; 148B.17; 148B.33, subdivision 1.212; 148B.52; 150A.091, subdivisions 2, 3, 4, 5, 8, by adding a subdivision; 1.22151.07; 151.101; 151.102, by adding a subdivision; 151.12; 151.13, subdivision 1.231; 151.19; 151.25; 151.47, subdivision 1; 151.48; 152.12, subdivision 3; 157.15, 1.24by adding a subdivision; 245.50; 245A.14, subdivision 4; 246B.10; 252.025, 1.25subdivision 7; 252.27, subdivision 2a; 253B.212; 254B.03, subdivisions 1, 1.264; 254B.04, subdivision 1, by adding a subdivision; 254B.06, subdivision 2; 1.27256.01, subdivisions 14b, 24, 29, by adding subdivisions; 256.045, subdivision 1.284a; 256.969, subdivision 2b, by adding a subdivision; 256B.04, subdivision 1.2918; 256B.05, by adding a subdivision; 256B.055, subdivision 15; 256B.056, 1.30subdivisions 3, 4, by adding a subdivision; 256B.057, subdivision 9; 256B.06, 1.31subdivision 4; 256B.0625, subdivisions 8e, 13e, 13h, 17, 17a, 18, 31a, 41, by 1.32adding subdivisions; 256B.0631, subdivisions 1, 2, 3; 256B.0644; 256B.0657; 1.33256B.0659, subdivisions 11, 28; 256B.0751, subdivisions 1, 2, 3, 4, by adding 1.34subdivisions; 256B.0753, by adding a subdivision; 256B.0754, by adding a 1.35subdivision; 256B.0755, subdivision 4, by adding subdivisions; 256B.0756; 1.36256B.0911, subdivisions 1a, 3a, 4a, 6; 256B.0913, subdivision 4; 256B.0915, 1.37subdivisions 3a, 3b, 3e, 3h, 5, 10; 256B.0916, subdivision 6a; 256B.092, 1.38subdivisions 1a, 1b, 1e, 1g, 3, 8; 256B.0945, subdivision 4; 256B.14, by adding 1.39a subdivision; 256B.19, by adding a subdivision; 256B.37, subdivision 5; 2.1256B.431, subdivision 2r, by adding a subdivision; 256B.434, subdivision 2.24; 256B.437, subdivision 6; 256B.441, by adding a subdivision; 256B.48, 2.3subdivision 1; 256B.49, subdivisions 12, 13, 14, 15; 256B.5012, by adding 2.4subdivisions; 256B.69, subdivisions 3a, 4, 5a, 5c, 6, by adding subdivisions; 2.5256B.692, subdivisions 2, 5, 7, by adding a subdivision; 256B.694; 256B.76, 2.6subdivision 4; 256D.03, subdivision 3; 256D.031, subdivisions 6, 7, 10; 2.7256D.05, subdivision 1; 256D.06, subdivisions 1, 1b, 2; 256D.09, subdivision 2.86; 256D.44, subdivision 5; 256D.46, subdivision 1; 256D.49, subdivision 3; 2.9256G.02, subdivision 6; 256I.03, by adding a subdivision; 256I.04, subdivision 2.102b; 256I.05, subdivisions 1a, 1e, by adding a subdivision; 256J.20, subdivision 2.113; 256J.38, subdivision 1; 256J.53, subdivision 2; 256L.01, subdivision 4a; 2.12256L.02, subdivision 3; 256L.03, subdivisions 3, 5; 256L.04, subdivisions 1, 7; 2.13256L.05, subdivisions 2, 3a, 5, by adding a subdivision; 256L.07, subdivision 2.141; 256L.09, subdivision 4; 256L.11, subdivision 7; 256L.12, subdivision 2.159; 256L.15, subdivision 1a; 260C.157, subdivision 3; 260D.01; 297F.10, 2.16subdivision 1; 326B.175; 393.07, subdivisions 10, 10a; 402A.10, subdivisions 2.174, 5; 402A.15; 402A.18; 402A.20; 518A.51; Laws 2008, chapter 363, article 2.1818, section 3, subdivision 5; Laws 2009, chapter 79, article 8, sections 4, as 2.19amended; 51, as amended; article 13, section 3, subdivision 8, as amended; Laws 2.202010, First Special Session chapter 1, article 15, section 3, subdivision 6; article 2.2125, section 3, subdivision 6; proposing coding for new law in Minnesota Statutes, 2.22chapters 62E; 62J; 62U; 137; 144; 145; 148; 151; 256; 256B; 256L; 326B; 2.23402A; repealing Minnesota Statutes 2010, sections 62J.07, subdivisions 1, 2, 3; 2.2462J.17, subdivisions 1, 3, 5a, 6a, 8; 62J.321, subdivision 5a; 62J.381; 62J.41, 2.25subdivisions 1, 2; 144.1464; 145A.14, subdivisions 1, 2; 256.01, subdivision 2b; 2.26256.979, subdivisions 5, 6, 7, 10; 256.9791; 256.9862, subdivision 2; 256B.055, 2.27subdivision 15; 256B.057, subdivision 2c; 256D.46, subdivisions 2, 3; 256L.07, 2.28subdivision 7; 402A.30; 402A.45; Laws 2008, chapter 358, article 3, sections 8; 2.299; Laws 2009, chapter 79, article 3, section 18, as amended; article 5, sections 2.3055, as amended; 56; 57; 60; 61; 62; 63; 64; 65; 66; 68; 69; 79; Minnesota Rules, 2.31parts 3400.0130, subpart 8; 4651.0100, subparts 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 2.3212, 14, 15, 16, 16a, 18, 19, 20, 20a, 21, 22, 23; 4651.0110, subparts 2, 2a, 2.333, 4, 5; 4651.0120; 4651.0130; 4651.0140; 4651.0150; 9500.1243, subpart 3; 2.349500.1261, subparts 3, items D, E, 4, 5.2.35BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:2.36ARTICLE 12.37CHILDREN AND FAMILY SERVICES2.38    Section 1. Minnesota Statutes 2010, section 119B.011, subdivision 13, is amended to 2.39read:2.40    Subd. 13. Family. "Family" means parents, stepparents, guardians and their spouses, 2.41or other eligible relative caregivers and their spouses, and their blood related dependent 2.42children and adoptive siblings under the age of 18 years living in the same home including 2.43children temporarily absent from the household in settings such as schools, foster care, and 2.44residential treatment facilities or parents, stepparents, guardians and their spouses, or other 2.45relative caregivers and their spouses temporarily absent from the household in settings 2.46such as schools, military service, or rehabilitation programs. An adult family member who 2.47is not in an authorized activity under this chapter may be temporarily absent for up to 60 3.1days. When a minor parent or parents and his, her, or their child or children are living with 3.2other relatives, and the minor parent or parents apply for a child care subsidy, "family" 3.3means only the minor parent or parents and their child or children. An adult age 18 or 3.4older who meets this definition of family and is a full-time high school or postsecondary 3.5student may be considered a dependent member of the family unit if 50 percent or more of 3.6the adult's support is provided by the parents, stepparents, guardians, and their spouses or 3.7eligible relative caregivers and their spouses residing in the same household.3.8EFFECTIVE DATE.This section is effective April 16, 2012.3.9    Sec. 2. Minnesota Statutes 2010, section 119B.035, subdivision 1, is amended to read:3.10    Subdivision 1. Establishment. A family in which a parent provides care for the 3.11family's infant child may receive a subsidy in lieu of assistance if the family is eligible for 3.12or is receiving assistance under the basic sliding fee program. An eligible family must 3.13meet the eligibility factors under section 
         119B.09, except as provided in subdivision 4, 3.14and the requirements of this section. Subject to federal match and maintenance of effort 3.15requirements for the child care and development fund, and up to available appropriations, 3.16the commissioner shall provide assistance under the at-home infant child care program and 3.17for administrative costs associated with the program. The commissioner shall set aside 3.18two percent of the basic sliding fee child care appropriation under section 119B.03, for 3.19purposes of this section. At the end of a fiscal year, the commissioner may carry forward 3.20any unspent funds under this section to the next fiscal year within the same biennium for 3.21assistance under the basic sliding fee program.3.22    Sec. 3. Minnesota Statutes 2010, section 119B.035, subdivision 4, is amended to read:3.23    Subd. 4. Assistance. (a) A family is limited to a lifetime total of 12 months of 3.24assistance under subdivision 2. The maximum rate of assistance is equal to 90 64 percent 3.25of the rate established under section 
         119B.13 for care of infants in licensed family child 3.26care in the applicant's county of residence.3.27(b) A participating family must report income and other family changes as specified 3.28in the county's plan under section 
         119B.08, subdivision 3.3.29(c) Persons who are admitted to the at-home infant child care program retain their 3.30position in any basic sliding fee program. Persons leaving the at-home infant child care 3.31program reenter the basic sliding fee program at the position they would have occupied.3.32(d) Assistance under this section does not establish an employer-employee 3.33relationship between any member of the assisted family and the county or state.4.1    Sec. 4. Minnesota Statutes 2010, section 119B.09, is amended by adding a subdivision 4.2to read:4.3    Subd. 9a.Child care centers; assistance.(a) For the purposes of this subdivision, 4.4"qualifying child" means a child who satisfies both of the following:4.5(1) is not a child or dependent of an employee of the child care provider; and4.6(2) does not reside with an employee of the child care provider.4.7(b) Funds distributed under this chapter must not be paid for child care services 4.8that are provided for a child by a child care provider who employs either the parent of 4.9the child or a person who resides with the child, unless at all times at least 50 percent of 4.10the children for whom the child care provider is providing care are qualifying children 4.11under paragraph (a).4.12(c) If a child care provider satisfies the requirements for payment under paragraph 4.13(b), but the percentage of qualifying children under paragraph (a) for whom the provider 4.14is providing care falls below 50 percent, the provider shall have four weeks to raise the 4.15percentage of qualifying children for whom the provider is providing care to at least 50 4.16percent before payments to the provider are discontinued for child care services provided 4.17for a child who is not a qualifying child.4.18EFFECTIVE DATE.This section is effective January 1, 2013.4.19    Sec. 5. Minnesota Statutes 2010, section 119B.09, subdivision 10, is amended to read:4.20    Subd. 10. Payment of funds. All federal, state, and local child care funds must 4.21be paid directly to the parent when a provider cares for children in the children's own 4.22home. In all other cases, all federal, state, and local child care funds must be paid directly 4.23to the child care provider, either licensed or legal nonlicensed, on behalf of the eligible 4.24family. Funds distributed under this chapter must not be used for child care services that 4.25are provided for a child by a child care provider who resides in the same household or 4.26occupies the same residence as the child.4.27EFFECTIVE DATE.This section is effective March 5, 2012.4.28    Sec. 6. Minnesota Statutes 2010, section 119B.09, is amended by adding a subdivision 4.29to read:4.30    Subd. 13.Child care in the child's home.Child care assistance must only be 4.31authorized in the child's home if the child's parents have authorized activities outside of 4.32the home and if one or more of the following circumstances are met:5.1(1) the parents' qualifying activity occurs during times when out-of-home care is 5.2not available. If child care is needed during any period when out-of-home care is not 5.3available, in-home care can be approved for the entire time care is needed;5.4(2) the family lives in an area where out-of-home care is not available; or5.5(3) a child has a verified illness or disability that would place the child or other 5.6children in an out-of-home facility at risk or creates a hardship for the child and the family 5.7to take the child out of the home to a child care home or center.5.8EFFECTIVE DATE.This section is effective March 5, 2012.5.9    Sec. 7. Minnesota Statutes 2010, section 119B.13, subdivision 1, is amended to read:5.10    Subdivision 1. Subsidy restrictions. (a) Beginning July 1, 2006, the maximum rate 5.11paid for child care assistance in any county or multicounty region under the child care 5.12fund shall be the rate for like-care arrangements in the county effective January 1, 2006, 5.13increased by six percent.5.14    (b) Rate changes shall be implemented for services provided in September 2006 5.15unless a participant eligibility redetermination or a new provider agreement is completed 5.16between July 1, 2006, and August 31, 2006.5.17    As necessary, appropriate notice of adverse action must be made according to 5.18Minnesota Rules, part 3400.0185, subparts 3 and 4.5.19    New cases approved on or after July 1, 2006, shall have the maximum rates under 5.20paragraph (a), implemented immediately.5.21    (c) Every year, the commissioner shall survey rates charged by child care providers in 5.22Minnesota to determine the 75th percentile for like-care arrangements in counties. When 5.23the commissioner determines that, using the commissioner's established protocol, the 5.24number of providers responding to the survey is too small to determine the 75th percentile 5.25rate for like-care arrangements in a county or multicounty region, the commissioner may 5.26establish the 75th percentile maximum rate based on like-care arrangements in a county, 5.27region, or category that the commissioner deems to be similar.5.28    (d) A rate which includes a special needs rate paid under subdivision 3 or under a 5.29school readiness service agreement paid under section 119B.231, may be in excess of the 5.30maximum rate allowed under this subdivision.5.31    (e) The department shall monitor the effect of this paragraph on provider rates. The 5.32county shall pay the provider's full charges for every child in care up to the maximum 5.33established. The commissioner shall determine the maximum rate for each type of care 5.34on an hourly, full-day, and weekly basis, including special needs and disability care. The 6.1maximum payment to a provider for one day of care must not exceed the daily rate. The 6.2maximum payment to a provider for one week of care must not exceed the weekly rate.6.3(f) Child care providers receiving reimbursement under this chapter must not be paid 6.4activity fees or an additional amount above the maximum rates for care provided during 6.5nonstandard hours for families receiving assistance.6.6    (f) (g) When the provider charge is greater than the maximum provider rate allowed, 6.7the parent is responsible for payment of the difference in the rates in addition to any 6.8family co-payment fee.6.9    (g) (h) All maximum provider rates changes shall be implemented on the Monday 6.10following the effective date of the maximum provider rate.6.11EFFECTIVE DATE.This section is effective September 3, 2012, except the 6.12amendments to paragraph (e) are effective April 16, 2012.6.13    Sec. 8. Minnesota Statutes 2010, section 119B.13, subdivision 1a, is amended to read:6.14    Subd. 1a. Legal nonlicensed family child care provider rates. (a) Legal 6.15nonlicensed family child care providers receiving reimbursement under this chapter must 6.16be paid on an hourly basis for care provided to families receiving assistance.6.17(b) The maximum rate paid to legal nonlicensed family child care providers must be 6.1880 64 percent of the county maximum hourly rate for licensed family child care providers. 6.19In counties where the maximum hourly rate for licensed family child care providers is 6.20higher than the maximum weekly rate for those providers divided by 50, the maximum 6.21hourly rate that may be paid to legal nonlicensed family child care providers is the rate 6.22equal to the maximum weekly rate for licensed family child care providers divided by 50 6.23and then multiplied by 0.80 0.64. The maximum payment to a provider for one day of care 6.24must not exceed the maximum hourly rate times ten. The maximum payment to a provider 6.25for one week of care must not exceed the maximum hourly rate times 50.6.26(c) A rate which includes a special needs rate paid under subdivision 3 may be in 6.27excess of the maximum rate allowed under this subdivision.6.28(d) Legal nonlicensed family child care providers receiving reimbursement under 6.29this chapter may not be paid registration fees for families receiving assistance.6.30EFFECTIVE DATE.This section is effective April 16, 2012, except the 6.31amendment changing 80 to 64 and 0.80 to 0.64 is effective July 1, 2011.6.32    Sec. 9. Minnesota Statutes 2010, section 119B.13, subdivision 7, is amended to read:7.1    Subd. 7. Absent days. (a) Licensed child care providers may and license-exempt 7.2centers must not be reimbursed for more than 25 ten full-day absent days per child, 7.3excluding holidays, in a fiscal year, or for more than ten consecutive full-day absent days, 7.4unless the child has a documented medical condition that causes more frequent absences. 7.5Absences due to a documented medical condition of a parent or sibling who lives in the 7.6same residence as the child receiving child care assistance do not count against the 25-day 7.7absent day limit in a fiscal year. Documentation of medical conditions must be on the 7.8forms and submitted according to the timelines established by the commissioner. A public 7.9health nurse or school nurse may verify the illness in lieu of a medical practitioner. If a 7.10provider sends a child home early due to a medical reason, including, but not limited to, 7.11fever or contagious illness, the child care center director or lead teacher may verify the 7.12illness in lieu of a medical practitioner. Legal nonlicensed family child care providers 7.13must not be reimbursed for absent days. If a child attends for part of the time authorized to 7.14be in care in a day, but is absent for part of the time authorized to be in care in that same 7.15day, the absent time will must be reimbursed but the time will must not count toward the 7.16ten consecutive or 25 cumulative absent day limits limit. Children in families where at 7.17least one parent is under the age of 21, does not have a high school or general equivalency 7.18diploma, and is a student in a school district or another similar program that provides or 7.19arranges for child care, as well as parenting, social services, career and employment 7.20supports, and academic support to achieve high school graduation, may be exempt from 7.21the absent day limits upon request of the program and approval of the county. If a child 7.22attends part of an authorized day, payment to the provider must be for the full amount 7.23of care authorized for that day. Child care providers may must only be reimbursed for 7.24absent days if the provider has a written policy for child absences and charges all other 7.25families in care for similar absences.7.26    (b) Child care providers must be reimbursed for up to ten federal or state holidays 7.27or designated holidays per year when the provider charges all families for these days 7.28and the holiday or designated holiday falls on a day when the child is authorized to be 7.29in attendance. Parents may substitute other cultural or religious holidays for the ten 7.30recognized state and federal holidays. Holidays do not count toward the ten consecutive 7.31or 25 cumulative absent day limits limit.7.32    (c) A family or child care provider may must not be assessed an overpayment for an 7.33absent day payment unless (1) there was an error in the amount of care authorized for the 7.34family, (2) all of the allowed full-day absent payments for the child have been paid, or (3) 7.35the family or provider did not timely report a change as required under law.8.1    (d) The provider and family must receive notification of the number of absent days 8.2used upon initial provider authorization for a family and when the family has used 15 8.3cumulative absent days. Upon statewide implementation of the Minnesota Electronic 8.4Child Care System, the provider and family shall receive notification of the number of 8.5absent days used upon initial provider authorization for a family and ongoing notification 8.6of the number of absent days used as of the date of the notification.8.7    (e) A county may pay for more absent days than the statewide absent day policy 8.8established under this subdivision if current market practice in the county justifies payment 8.9for those additional days. County policies for payment of absent days in excess of the 8.10statewide absent day policy and justification for these county policies must be included in 8.11the county's child care fund plan under section 119B.08, subdivision 3.8.12EFFECTIVE DATE.This section is effective January 1, 2013.8.13    Sec. 10. [256.987] ELECTRONIC BENEFIT TRANSFER CARD.8.14    Subdivision 1.Electronic benefit transfer (EBT) card.Beginning July 1, 2011, 8.15cash benefits for the general assistance and Minnesota supplemental aid programs under 8.16chapter 256D and programs under chapter 256J must be issued on a separate EBT card 8.17with the name of the head of household printed on the card. This card must be issued 8.18within 30 calendar days of an eligibility determination. During the initial 30 calendar days 8.19of eligibility, a recipient may have cash benefits issued on an EBT card without a name 8.20printed on the card. This card may be the same card on which food support benefits are 8.21issued and does not need to meet the requirements of this section.8.22    Subd. 2.EBT card use restricted to Minnesota vendors.EBT cardholders 8.23receiving cash benefits under the general assistance and Minnesota supplemental aid 8.24programs under chapter 256D or programs under chapter 256J are prohibited from using 8.25their EBT cards at vendors located outside of Minnesota. This subdivision does not apply 8.26to food support benefits.8.27    Sec. 11. Minnesota Statutes 2010, section 256D.05, subdivision 1, is amended to read:8.28    Subdivision 1. Eligibility. (a) Each assistance unit with income and resources 8.29less than the standard of assistance established by the commissioner and with a member 8.30who is a resident of the state shall be eligible for and entitled to general assistance if 8.31the assistance unit is:8.32(1) a person who is suffering from a professionally certified permanent or temporary 8.33illness, injury, or incapacity which is expected to continue for more than 30 90 days and 8.34which prevents the person from obtaining or retaining employment;9.1(2) a person whose presence in the home on a substantially continuous basis is 9.2required because of the professionally certified illness, injury, incapacity, or the age of 9.3another member of the household;9.4(3) (2) a person who has been placed in, and is residing in, a licensed or certified 9.5facility for purposes of physical or mental health or rehabilitation, or in an approved 9.6chemical dependency domiciliary facility, if the placement is based on illness or incapacity 9.7and is according to a plan developed or approved by the county agency through its 9.8director or designated representative;9.9(4) (3) a person who resides in a shelter facility described in subdivision 3;9.10(5) (4) a person not described in clause (1) or (3) (2) who is diagnosed by a licensed 9.11physician, psychological practitioner, or other qualified professional, as developmentally 9.12disabled or mentally ill, and that condition prevents the person from obtaining or retaining 9.13employment;9.14(6) a person who has an application pending for, or is appealing termination of 9.15benefits from, the Social Security disability program or the program of supplemental 9.16security income for the aged, blind, and disabled, provided the person has a professionally 9.17certified permanent or temporary illness, injury, or incapacity which is expected to 9.18continue for more than 30 days and which prevents the person from obtaining or retaining 9.19employment;9.20(7) a person who is unable to obtain or retain employment because advanced age 9.21significantly affects the person's ability to seek or engage in substantial work;9.22(8) (5) a person who has been assessed by a vocational specialist and, in consultation 9.23with the county agency, has been determined to be unemployable for purposes of this 9.24clause; a person is considered employable if there exist positions of employment in the 9.25local labor market, regardless of the current availability of openings for those positions, 9.26that the person is capable of performing. The person's eligibility under this category must 9.27be reassessed at least annually. The county agency must provide notice to the person not 9.28later than 30 days before annual eligibility under this item ends, informing the person of the 9.29date annual eligibility will end and the need for vocational assessment if the person wishes 9.30to continue eligibility under this clause. For purposes of establishing eligibility under this 9.31clause, it is the applicant's or recipient's duty to obtain any needed vocational assessment;9.32(9) (6) a person who is determined by the county agency, according to permanent 9.33rules adopted by the commissioner, to be learning disabled have a condition that qualifies 9.34under Minnesota's special education rules as a specific learning disability, provided that if9.35a rehabilitation plan for the person is developed or approved by the county agency, and9.36the person is following the plan;10.1(10) a child under the age of 18 who is not living with a parent, stepparent, or legal 10.2custodian, and only if: the child is legally emancipated or living with an adult with the 10.3consent of an agency acting as a legal custodian; the child is at least 16 years of age 10.4and the general assistance grant is approved by the director of the county agency or a 10.5designated representative as a component of a social services case plan for the child; or the 10.6child is living with an adult with the consent of the child's legal custodian and the county 10.7agency. For purposes of this clause, "legally emancipated" means a person under the age 10.8of 18 years who: (i) has been married; (ii) is on active duty in the uniformed services of 10.9the United States; (iii) has been emancipated by a court of competent jurisdiction; or (iv) 10.10is otherwise considered emancipated under Minnesota law, and for whom county social 10.11services has not determined that a social services case plan is necessary, for reasons other 10.12than the child has failed or refuses to cooperate with the county agency in developing 10.13the plan;10.14(11) (7) a person who is eligible for displaced homemaker services, programs, or 10.15assistance under section 
         116L.96, but only if that person is enrolled as a full-time student;10.16(12) a person who lives more than four hours round-trip traveling time from any 10.17potential suitable employment;10.18(13) (8) a person who is involved with protective or court-ordered services that 10.19prevent the applicant or recipient from working at least four hours per day; or10.20(14) a person over age 18 whose primary language is not English and who is 10.21attending high school at least half time; or10.22(15) (9) a person whose alcohol and drug addiction is a material factor that 10.23contributes to the person's disability; applicants who assert this clause as a basis for 10.24eligibility must be assessed by the county agency to determine if they are amenable 10.25to treatment; if the applicant is determined to be not amenable to treatment, but is 10.26otherwise eligible for benefits, then general assistance must be paid in vendor form, for 10.27the individual's shelter costs up to the limit of the grant amount, with the residual, if 10.28any, paid according to section 
         256D.09, subdivision 2a; if the applicant is determined 10.29to be amenable to treatment, then in order to receive benefits, the applicant must be in 10.30a treatment program or on a waiting list and the benefits must be paid in vendor form, 10.31for the individual's shelter costs, up to the limit of the grant amount, with the residual, if 10.32any, paid according to section 
         256D.09, subdivision 2a.10.33(b) As a condition of eligibility under paragraph (a), clauses (1), (3) (2), (5) (4), 10.34(8) (5), and (9) (6), the recipient must complete an interim assistance agreement and 10.35must apply for other maintenance benefits as specified in section 
         256D.06, subdivision 11.15
         , and must comply with efforts to determine the recipient's eligibility for those other 11.2maintenance benefits.11.3(c) As a condition of eligibility under this section, the recipient must complete 11.4at least 20 hours per month of volunteer or paid work. The county of residence shall 11.5determine what may be included as volunteer work. Recipients must provide monthly 11.6proof of volunteer work on the forms established by the county. A person who is unable 11.7to obtain or retain 20 hours per month of volunteer or paid work due to a professionally 11.8certified illness, injury, disability, or incapacity must not be made ineligible for general 11.9assistance under this section.11.10(c) (d) The burden of providing documentation for a county agency to use to verify 11.11eligibility for general assistance or for exemption from the food stamp employment 11.12and training program is upon the applicant or recipient. The county agency shall use 11.13documents already in its possession to verify eligibility, and shall help the applicant or 11.14recipient obtain other existing verification necessary to determine eligibility which the 11.15applicant or recipient does not have and is unable to obtain.11.16    Sec. 12. Minnesota Statutes 2010, section 256D.06, subdivision 1, is amended to read:11.17    Subdivision 1. Eligibility; amount of assistance. General assistance shall be 11.18granted in an amount that when added to the nonexempt income actually available to the 11.19assistance unit, the total amount equals the applicable standard of assistance for general 11.20assistance. In determining eligibility for and the amount of assistance for an individual or 11.21married couple, the county agency shall disregard the first $50 $150 of earned income 11.22per month.11.23    Sec. 13. Minnesota Statutes 2010, section 256D.06, subdivision 1b, is amended to read:11.24    Subd. 1b. Earned income savings account. In addition to the $50 $150 disregard 11.25required under subdivision 1, the county agency shall disregard an additional earned 11.26income up to a maximum of $150 $500 per month for: (1) persons residing in facilities 11.27licensed under Minnesota Rules, parts 9520.0500 to 9520.0690 and 9530.2500 to 11.289530.4000, and for whom discharge and work are part of a treatment plan; and (2) 11.29persons living in supervised apartments with services funded under Minnesota Rules, 11.30parts 9535.0100 to 9535.1600, and for whom discharge and work are part of a treatment 11.31plan; and (3) persons residing in group residential housing, as that term is defined in 11.32section 
         256I.03, subdivision 3, for whom the county agency has approved a discharge plan 11.33which includes work. The additional amount disregarded must be placed in a separate 11.34savings account by the eligible individual, to be used upon discharge from the residential 12.1facility into the community. For individuals residing in a chemical dependency program 12.2licensed under Minnesota Rules, part 9530.4100, subpart 22, item D, withdrawals from 12.3the savings account require the signature of the individual and for those individuals with 12.4an authorized representative payee, the signature of the payee. A maximum of $1,00012.5$2,000, including interest, of the money in the savings account must be excluded from 12.6the resource limits established by section 
         256D.08, subdivision 1, clause (1). Amounts in 12.7that account in excess of $1,000 $2,000 must be applied to the resident's cost of care. If 12.8excluded money is removed from the savings account by the eligible individual at any 12.9time before the individual is discharged from the facility into the community, the money is 12.10income to the individual in the month of receipt and a resource in subsequent months. If 12.11an eligible individual moves from a community facility to an inpatient hospital setting, 12.12the separate savings account is an excluded asset for up to 18 months. During that time, 12.13amounts that accumulate in excess of the $1,000 $2,000 savings limit must be applied to 12.14the patient's cost of care. If the patient continues to be hospitalized at the conclusion of the 12.1518-month period, the entire account must be applied to the patient's cost of care.12.16    Sec. 14. Minnesota Statutes 2010, section 256D.06, subdivision 2, is amended to read:12.17    Subd. 2. Emergency need.(a) Notwithstanding the provisions of subdivision 1, a 12.18grant of emergency general assistance shall, to the extent funds are available, be made to 12.19an eligible single adult, married couple, or family for an emergency need, as defined in 12.20rules promulgated by the commissioner, where the recipient requests temporary assistance 12.21not exceeding 30 days if an emergency situation appears to exist and the individual or 12.22family is ineligible for MFIP or DWP or is not a participant of MFIP or DWP under 12.23written criteria adopted by the county agency. If an applicant or recipient relates facts 12.24to the county agency which may be sufficient to constitute an emergency situation, the 12.25county agency shall, to the extent funds are available, advise the person of the procedure 12.26for applying for assistance according to this subdivision. 12.27    (b) The applicant must be ineligible for assistance under chapter 256J, must have 12.28annual net income no greater than 200 percent of the federal poverty guidelines for the 12.29previous calendar year, and may receive an emergency general assistance grant is available 12.30to a recipient not more than once in any 12-month period. 12.31    (c) Funding for an emergency general assistance program is limited to the 12.32appropriation. Each fiscal year, the commissioner shall allocate to counties the money 12.33appropriated for emergency general assistance grants based on each county agency's 12.34average share of state's emergency general expenditures for the immediate past three fiscal 13.1years as determined by the commissioner, and may reallocate any unspent amounts to 13.2other counties. No county shall be allocated less than $1,000 for a fiscal year.13.3    (d) Any emergency general assistance expenditures by a county above the amount of 13.4the commissioner's allocation to the county must be made from county funds.13.5    Sec. 15. Minnesota Statutes 2010, section 256D.44, subdivision 5, is amended to read:13.6    Subd. 5. Special needs. In addition to the state standards of assistance established in 13.7subdivisions 1 to 4, payments are allowed for the following special needs of recipients of 13.8Minnesota supplemental aid who are not residents of a nursing home, a regional treatment 13.9center, or a group residential housing facility.13.10    (a) The county agency shall pay a monthly allowance for medically prescribed 13.11diets if the cost of those additional dietary needs cannot be met through some other 13.12maintenance benefit. The need for special diets or dietary items must be prescribed by 13.13a licensed physician. Costs for special diets shall be determined as percentages of the 13.14allotment for a one-person household under the thrifty food plan as defined by the United 13.15States Department of Agriculture. The types of diets and the percentages of the thrifty 13.16food plan that are covered are as follows:13.17    (1) high protein diet, at least 80 grams daily, 25 percent of thrifty food plan;13.18    (2) controlled protein diet, 40 to 60 grams and requires special products, 100 percent 13.19of thrifty food plan;13.20    (3) controlled protein diet, less than 40 grams and requires special products, 125 13.21percent of thrifty food plan;13.22    (4) low cholesterol diet, 25 percent of thrifty food plan;13.23    (5) high residue diet, 20 percent of thrifty food plan;13.24    (6) pregnancy and lactation diet, 35 percent of thrifty food plan;13.25    (7) gluten-free diet, 25 percent of thrifty food plan;13.26    (8) lactose-free diet, 25 percent of thrifty food plan;13.27    (9) antidumping diet, 15 percent of thrifty food plan;13.28    (10) hypoglycemic diet, 15 percent of thrifty food plan; or13.29    (11) ketogenic diet, 25 percent of thrifty food plan.13.30    (b) Payment for nonrecurring special needs must be allowed for necessary home 13.31repairs or necessary repairs or replacement of household furniture and appliances using 13.32the payment standard of the AFDC program in effect on July 16, 1996, for these expenses, 13.33as long as other funding sources are not available.13.34    (c) A fee for guardian or conservator service is allowed at a reasonable rate 13.35negotiated by the county or approved by the court. This rate shall not exceed five percent 14.1of the assistance unit's gross monthly income up to a maximum of $100 per month. If the 14.2guardian or conservator is a member of the county agency staff, no fee is allowed.14.3    (d) The county agency shall continue to pay a monthly allowance of $68 for 14.4restaurant meals for a person who was receiving a restaurant meal allowance on June 1, 14.51990, and who eats two or more meals in a restaurant daily. The allowance must continue 14.6until the person has not received Minnesota supplemental aid for one full calendar month 14.7or until the person's living arrangement changes and the person no longer meets the criteria 14.8for the restaurant meal allowance, whichever occurs first.14.9    (e) A fee of ten percent of the recipient's gross income or $25, whichever is less, 14.10is allowed for representative payee services provided by an agency that meets the 14.11requirements under SSI regulations to charge a fee for representative payee services. This 14.12special need is available to all recipients of Minnesota supplemental aid regardless of 14.13their living arrangement.14.14    (f)(1) Notwithstanding the language in this subdivision, an amount equal to the 14.15maximum allotment authorized by the federal Food Stamp Program for a single individual 14.16which is in effect on the first day of July of each year will be added to the standards of 14.17assistance established in subdivisions 1 to 4 for adults under the age of 65 who qualify 14.18as shelter needy and are: (i) relocating from an institution, or an adult mental health 14.19residential treatment program under section 
         256B.0622; (ii) eligible for the self-directed 14.20supports option as defined under section 
         256B.0657, subdivision 2; or (iii) home and 14.21community-based waiver recipients living in their own home or rented or leased apartment 14.22which is not owned, operated, or controlled by a provider of service not related by blood 14.23or marriage, unless allowed under paragraph (g).14.24    (2) Notwithstanding subdivision 3, paragraph (c), an individual eligible for the 14.25shelter needy benefit under this paragraph is considered a household of one. An eligible 14.26individual who receives this benefit prior to age 65 may continue to receive the benefit 14.27after the age of 65.14.28    (3) "Shelter needy" means that the assistance unit incurs monthly shelter costs that 14.29exceed 40 percent of the assistance unit's gross income before the application of this 14.30special needs standard. "Gross income" for the purposes of this section is the applicant's or 14.31recipient's income as defined in section 
         256D.35, subdivision 10, or the standard specified 14.32in subdivision 3, paragraph (a) or (b), whichever is greater. A recipient of a federal or 14.33state housing subsidy, that limits shelter costs to a percentage of gross income, shall not be 14.34considered shelter needy for purposes of this paragraph.14.35(g) Notwithstanding this subdivision, to access housing and services as provided 14.36in paragraph (f), the recipient may choose housing that may be owned, operated, or 15.1controlled by the recipient's service provider. In a multifamily building of more than four 15.2or more units, the maximum number of apartments at one address that may be used by 15.3recipients of this program shall be 50 percent of the units in a building. This paragraph 15.4expires on June 30, 2012 2014.15.5    Sec. 16. Minnesota Statutes 2010, section 256D.46, subdivision 1, is amended to read:15.6    Subdivision 1. Eligibility.A county agency must grant emergency Minnesota 15.7supplemental aid, to the extent funds are available, if the recipient is without adequate 15.8resources to resolve an emergency that, if unresolved, will threaten the health or safety of 15.9the recipient. For the purposes of this section, the term "recipient" includes persons for 15.10whom a group residential housing benefit is being paid under sections 256I.01 to 256I.06.15.11Applicants for or recipients of SSI or Minnesota supplemental aid who have emergency 15.12need may apply for emergency general assistance under section 256D.06, subdivision 2.15.13    Sec. 17. Minnesota Statutes 2010, section 256I.03, is amended by adding a subdivision 15.14to read:15.15    Subd. 8.Supplementary services."Supplementary services" means services 15.16provided to residents of group residential housing providers in addition to room and 15.17board including, but not limited to, oversight and up to 24-hour supervision, medication 15.18reminders, assistance with transportation, arranging for meetings and appointments, and 15.19arranging for medical and social services.15.20    Sec. 18. Minnesota Statutes 2010, section 256I.04, subdivision 2b, is amended to read:15.21    Subd. 2b. Group residential housing agreements.(a) Agreements between county 15.22agencies and providers of group residential housing must be in writing and must specify 15.23the name and address under which the establishment subject to the agreement does 15.24business and under which the establishment, or service provider, if different from the 15.25group residential housing establishment, is licensed by the Department of Health or the 15.26Department of Human Services; the specific license or registration from the Department 15.27of Health or the Department of Human Services held by the provider and the number 15.28of beds subject to that license; the address of the location or locations at which group 15.29residential housing is provided under this agreement; the per diem and monthly rates that 15.30are to be paid from group residential housing funds for each eligible resident at each 15.31location; the number of beds at each location which are subject to the group residential 15.32housing agreement; whether the license holder is a not-for-profit corporation under section 15.33501(c)(3) of the Internal Revenue Code; and a statement that the agreement is subject to 16.1the provisions of sections 
         256I.01 to 
         256I.06 and subject to any changes to those sections. 16.2Group residential housing agreements may be terminated with or without cause by either 16.3the county or the provider with two calendar months prior notice.16.4(b) Beginning July 1, 2011, counties must not enter into agreements with providers 16.5of group residential housing that are licensed as board and lodging with special services 16.6and that do not include a residency requirement of at least 20 hours per month of volunteer 16.7or paid work. A person who is unable to obtain or retain 20 hours per month of volunteer 16.8or paid work due to a professionally certified illness, injury, disability, or incapacity must 16.9not be made ineligible for group residential housing under this section.16.10    Sec. 19. Minnesota Statutes 2010, section 256I.05, subdivision 1a, is amended to read:16.11    Subd. 1a. Supplementary service rates. (a) Subject to the provisions of section 16.12256I.04, subdivision 3
         , the county agency may negotiate a payment not to exceed $426.37 16.13for other services necessary to provide room and board provided by the group residence 16.14if the residence is licensed by or registered by the Department of Health, or licensed by 16.15the Department of Human Services to provide services in addition to room and board, 16.16and if the provider of services is not also concurrently receiving funding for services for 16.17a recipient under a home and community-based waiver under title XIX of the Social 16.18Security Act; or funding from the medical assistance program under section 
         256B.0659, 16.19for personal care services for residents in the setting; or residing in a setting which 16.20receives funding under Minnesota Rules, parts 9535.2000 to 9535.3000. If funding is 16.21available for other necessary services through a home and community-based waiver, or 16.22personal care services under section 
         256B.0659, then the GRH rate is limited to the rate 16.23set in subdivision 1. Unless otherwise provided in law, in no case may the supplementary 16.24service rate exceed $426.37. The registration and licensure requirement does not apply to 16.25establishments which are exempt from state licensure because they are located on Indian 16.26reservations and for which the tribe has prescribed health and safety requirements. Service 16.27payments under this section may be prohibited under rules to prevent the supplanting of 16.28federal funds with state funds. The commissioner shall pursue the feasibility of obtaining 16.29the approval of the Secretary of Health and Human Services to provide home and 16.30community-based waiver services under title XIX of the Social Security Act for residents 16.31who are not eligible for an existing home and community-based waiver due to a primary 16.32diagnosis of mental illness or chemical dependency and shall apply for a waiver if it is 16.33determined to be cost-effective.16.34(b) The commissioner is authorized to make cost-neutral transfers from the GRH 16.35fund for beds under this section to other funding programs administered by the department 17.1after consultation with the county or counties in which the affected beds are located. 17.2The commissioner may also make cost-neutral transfers from the GRH fund to county 17.3human service agencies for beds permanently removed from the GRH census under a plan 17.4submitted by the county agency and approved by the commissioner. The commissioner 17.5shall report the amount of any transfers under this provision annually to the legislature.17.6(c) The provisions of paragraph (b) do not apply to a facility that has its 17.7reimbursement rate established under section 
         256B.431, subdivision 4, paragraph (c).17.8    (d) Beginning July 1, 2011, counties must not negotiate supplementary service rates 17.9with providers of group residential housing that are licensed as board and lodging with 17.10special services and that do not enforce a policy of sobriety on their premises.17.11    Sec. 20. Minnesota Statutes 2010, section 256I.05, subdivision 1e, is amended to read:17.12    Subd. 1e. Supplementary rate for certain facilities.(a) Notwithstanding the 17.13provisions of subdivisions 1a and 1c, beginning July 1, 2005, a county agency shall 17.14negotiate a supplementary rate in addition to the rate specified in subdivision 1, not to 17.15exceed $700 per month, including any legislatively authorized inflationary adjustments, 17.16for a group residential housing provider that:17.17(1) is located in Hennepin County and has had a group residential housing contract 17.18with the county since June 1996;17.19(2) operates in three separate locations a 75-bed facility, a 50-bed facility, and a 17.2026-bed facility; and17.21(3) serves a chemically dependent clientele, providing 24 hours per day supervision 17.22and limiting a resident's maximum length of stay to 13 months out of a consecutive 17.2324-month period.17.24(b) Notwithstanding the provisions of subdivisions 1a and 1c, beginning July 1, 17.252011, a county agency shall negotiate a supplementary rate in addition to the rate specified 17.26in subdivision 1, not to exceed $700 per month, including any legislatively authorized 17.27inflationary adjustments, for the group residential provider described under paragraph 17.28(a), not to exceed an additional 175 beds.17.29    Sec. 21. Minnesota Statutes 2010, section 256I.05, is amended by adding a subdivision 17.30to read:17.31    Subd. 1o.Supplemental rate adjustment.Notwithstanding any other provision to 17.32the contrary, board and lodging with services providers that receive a supplemental service 17.33rate in excess of the supplemental service rate established under subdivision 1, shall be 17.34reduced no more than $10.42 per bed per month.18.1    Sec. 22. Minnesota Statutes 2010, section 256J.20, subdivision 3, is amended to read:18.2    Subd. 3. Other property limitations. To be eligible for MFIP, the equity value of 18.3all nonexcluded real and personal property of the assistance unit must not exceed $2,000 18.4for applicants and $5,000 for ongoing participants. The value of assets in clauses (1) to 18.5(19) must be excluded when determining the equity value of real and personal property:18.6    (1) a licensed vehicle up to a loan value of less than or equal to $15,000 $10,000. If 18.7the assistance unit owns more than one licensed vehicle, the county agency shall determine 18.8the loan value of all additional vehicles and exclude the combined loan value of less than 18.9or equal to $7,500. The county agency shall apply any excess loan value as if it were 18.10equity value to the asset limit described in this section, excluding: (i) the value of one 18.11vehicle per physically disabled person when the vehicle is needed to transport the disabled 18.12unit member; this exclusion does not apply to mentally disabled people; (ii) the value of 18.13special equipment for a disabled member of the assistance unit; and (iii) any vehicle used 18.14for long-distance travel, other than daily commuting, for the employment of a unit member.18.15    To establish the loan value of vehicles, a county agency must use the N.A.D.A. 18.16Official Used Car Guide, Midwest Edition, for newer model cars. When a vehicle is not 18.17listed in the guidebook, or when the applicant or participant disputes the loan value listed 18.18in the guidebook as unreasonable given the condition of the particular vehicle, the county 18.19agency may require the applicant or participant document the loan value by securing a 18.20written statement from a motor vehicle dealer licensed under section 
         168.27, stating 18.21the amount that the dealer would pay to purchase the vehicle. The county agency shall 18.22reimburse the applicant or participant for the cost of a written statement that documents 18.23a lower loan value;18.24    (2) the value of life insurance policies for members of the assistance unit;18.25    (3) one burial plot per member of an assistance unit;18.26    (4) the value of personal property needed to produce earned income, including 18.27tools, implements, farm animals, inventory, business loans, business checking and 18.28savings accounts used at least annually and used exclusively for the operation of a 18.29self-employment business, and any motor vehicles if at least 50 percent of the vehicle's use 18.30is to produce income and if the vehicles are essential for the self-employment business;18.31    (5) the value of personal property not otherwise specified which is commonly 18.32used by household members in day-to-day living such as clothing, necessary household 18.33furniture, equipment, and other basic maintenance items essential for daily living;18.34    (6) the value of real and personal property owned by a recipient of Supplemental 18.35Security Income or Minnesota supplemental aid;19.1    (7) the value of corrective payments, but only for the month in which the payment 19.2is received and for the following month;19.3    (8) a mobile home or other vehicle used by an applicant or participant as the 19.4applicant's or participant's home;19.5    (9) money in a separate escrow account that is needed to pay real estate taxes or 19.6insurance and that is used for this purpose;19.7    (10) money held in escrow to cover employee FICA, employee tax withholding, 19.8sales tax withholding, employee worker compensation, business insurance, property rental, 19.9property taxes, and other costs that are paid at least annually, but less often than monthly;19.10    (11) monthly assistance payments for the current month's or short-term emergency 19.11needs under section 
         256J.626, subdivision 2;19.12    (12) the value of school loans, grants, or scholarships for the period they are 19.13intended to cover;19.14    (13) payments listed in section 
         256J.21, subdivision 2, clause (9), which are held 19.15in escrow for a period not to exceed three months to replace or repair personal or real 19.16property;19.17    (14) income received in a budget month through the end of the payment month;19.18    (15) savings from earned income of a minor child or a minor parent that are set aside 19.19in a separate account designated specifically for future education or employment costs;19.20    (16) the federal earned income credit, Minnesota working family credit, state and 19.21federal income tax refunds, state homeowners and renters credits under chapter 290A, 19.22property tax rebates and other federal or state tax rebates in the month received and the 19.23following month;19.24    (17) payments excluded under federal law as long as those payments are held in a 19.25separate account from any nonexcluded funds;19.26    (18) the assets of children ineligible to receive MFIP benefits because foster care or 19.27adoption assistance payments are made on their behalf; and19.28    (19) the assets of persons whose income is excluded under section 
         256J.21, 19.29subdivision 2
         , clause (43).19.30    Sec. 23. Minnesota Statutes 2010, section 256J.53, subdivision 2, is amended to read:19.31    Subd. 2. Approval of postsecondary education or training. (a) In order for a 19.32postsecondary education or training program to be an approved activity in an employment 19.33plan, the plan must include additional work activities if the education and training 19.34activities do not meet the minimum hours required to meet the federal work participation 20.1rate under Code of Federal Regulations, title 45, sections 261.31 and 261.35 participant 20.2must be working in unsubsidized employment at least 20 hours per week.20.3    (b) Participants seeking approval of a postsecondary education or training plan 20.4must provide documentation that:20.5    (1) the employment goal can only be met with the additional education or training;20.6    (2) there are suitable employment opportunities that require the specific education or 20.7training in the area in which the participant resides or is willing to reside;20.8    (3) the education or training will result in significantly higher wages for the 20.9participant than the participant could earn without the education or training;20.10    (4) the participant can meet the requirements for admission into the program; and20.11    (5) there is a reasonable expectation that the participant will complete the training 20.12program based on such factors as the participant's MFIP assessment, previous education, 20.13training, and work history; current motivation; and changes in previous circumstances.20.14(c) The hourly unsubsidized employment requirement does not apply for intensive 20.15education or training programs lasting 12 weeks or less when full-time attendance is 20.16required.20.17    Sec. 24. Minnesota Statutes 2010, section 260C.157, subdivision 3, is amended to read:20.18    Subd. 3. Juvenile treatment screening team. (a) The responsible social services 20.19agency shall establish a juvenile treatment screening team to conduct screenings and 20.20prepare case plans under this subdivision section 245.487, subdivision 3, and chapters 20.21260C and 260D. Screenings shall be conducted within 15 days of a request for a screening. 20.22The team, which may be the team constituted under section 
         245.4885 or 
         256B.092 or 20.23Minnesota Rules, parts 9530.6600 to 9530.6655, shall consist of social workers, juvenile 20.24justice professionals, and persons with expertise in the treatment of juveniles who are 20.25emotionally disabled, chemically dependent, or have a developmental disability. The team 20.26shall involve parents or guardians in the screening process as appropriate, and the child's 20.27parent, guardian, or permanent legal custodian under section 260C.201, subdivision 11. 20.28The team may be the same team as defined in section 
         260B.157, subdivision 3.20.29(b) The social services agency shall determine whether a child brought to its 20.30attention for the purposes described in this section is an Indian child, as defined in section 20.31260C.007, subdivision 21
         , and shall determine the identity of the Indian child's tribe, as 20.32defined in section 
         260.755, subdivision 9. When a child to be evaluated is an Indian child, 20.33the team provided in paragraph (a) shall include a designated representative of the Indian 20.34child's tribe, unless the child's tribal authority declines to appoint a representative. The 21.1Indian child's tribe may delegate its authority to represent the child to any other federally 21.2recognized Indian tribe, as defined in section 
         260.755, subdivision 12.21.3(c) If the court, prior to, or as part of, a final disposition, proposes to place a child:21.4(1) for the primary purpose of treatment for an emotional disturbance, a 21.5developmental disability, or chemical dependency in a residential treatment facility out 21.6of state or in one which is within the state and licensed by the commissioner of human 21.7services under chapter 245A; or21.8(2) in any out-of-home setting potentially exceeding 30 days in duration, including a 21.9postdispositional placement in a facility licensed by the commissioner of corrections or 21.10human services, the court shall ascertain whether the child is an Indian child and shall 21.11notify the county welfare agency and, if the child is an Indian child, shall notify the Indian 21.12child's tribe. The county's juvenile treatment screening team must either: (i) screen and 21.13evaluate the child and file its recommendations with the court within 14 days of receipt 21.14of the notice; or (ii) elect not to screen a given case and notify the court of that decision 21.15within three working days.21.16(d) If the screening team has elected to screen and evaluate the child, The child 21.17may not be placed for the primary purpose of treatment for an emotional disturbance, a 21.18developmental disability, or chemical dependency, in a residential treatment facility out of 21.19state nor in a residential treatment facility within the state that is licensed under chapter 21.20245A, unless one of the following conditions applies:21.21(1) a treatment professional certifies that an emergency requires the placement 21.22of the child in a facility within the state;21.23(2) the screening team has evaluated the child and recommended that a residential 21.24placement is necessary to meet the child's treatment needs and the safety needs of the 21.25community, that it is a cost-effective means of meeting the treatment needs, and that it 21.26will be of therapeutic value to the child; or21.27(3) the court, having reviewed a screening team recommendation against placement, 21.28determines to the contrary that a residential placement is necessary. The court shall state 21.29the reasons for its determination in writing, on the record, and shall respond specifically 21.30to the findings and recommendation of the screening team in explaining why the 21.31recommendation was rejected. The attorney representing the child and the prosecuting 21.32attorney shall be afforded an opportunity to be heard on the matter.21.33(e) When the county's juvenile treatment screening team has elected to screen and 21.34evaluate a child determined to be an Indian child, the team shall provide notice to the 21.35tribe or tribes that accept jurisdiction for the Indian child or that recognize the child as a 22.1member of the tribe or as a person eligible for membership in the tribe, and permit the 22.2tribe's representative to participate in the screening team.22.3(f) When the Indian child's tribe or tribal health care services provider or Indian 22.4Health Services provider proposes to place a child for the primary purpose of treatment 22.5for an emotional disturbance, a developmental disability, or co-occurring emotional 22.6disturbance and chemical dependency, the Indian child's tribe or the tribe delegated by 22.7the child's tribe shall submit necessary documentation to the county juvenile treatment 22.8screening team, which must invite the Indian child's tribe to designate a representative to 22.9the screening team.22.10    Sec. 25. Minnesota Statutes 2010, section 260D.01, is amended to read:22.11260D.01 CHILD IN VOLUNTARY FOSTER CARE FOR TREATMENT.22.12    (a) Sections 
         260D.01 to 
         260D.10, may be cited as the "child in voluntary foster care 22.13for treatment" provisions of the Juvenile Court Act.22.14    (b) The juvenile court has original and exclusive jurisdiction over a child in 22.15voluntary foster care for treatment upon the filing of a report or petition required under 22.16this chapter. All obligations of the agency to a child and family in foster care contained in 22.17chapter 260C not inconsistent with this chapter are also obligations of the agency with 22.18regard to a child in foster care for treatment under this chapter.22.19    (c) This chapter shall be construed consistently with the mission of the children's 22.20mental health service system as set out in section 
         245.487, subdivision 3, and the duties 22.21of an agency under section 
         256B.092, 260C.157, and Minnesota Rules, parts 9525.0004 22.22to 9525.0016, to meet the needs of a child with a developmental disability or related 22.23condition. This chapter:22.24    (1) establishes voluntary foster care through a voluntary foster care agreement as the 22.25means for an agency and a parent to provide needed treatment when the child must be in 22.26foster care to receive necessary treatment for an emotional disturbance or developmental 22.27disability or related condition;22.28    (2) establishes court review requirements for a child in voluntary foster care for 22.29treatment due to emotional disturbance or developmental disability or a related condition;22.30    (3) establishes the ongoing responsibility of the parent as legal custodian to visit the 22.31child, to plan together with the agency for the child's treatment needs, to be available and 22.32accessible to the agency to make treatment decisions, and to obtain necessary medical, 22.33dental, and other care for the child; and22.34    (4) applies to voluntary foster care when the child's parent and the agency agree that 22.35the child's treatment needs require foster care either:23.1    (i) due to a level of care determination by the agency's screening team informed by 23.2the diagnostic and functional assessment under section 
         245.4885; or23.3    (ii) due to a determination regarding the level of services needed by the responsible 23.4social services' screening team under section 
         256B.092, and Minnesota Rules, parts 23.59525.0004 to 9525.0016.23.6    (d) This chapter does not apply when there is a current determination under section 23.7626.556
          that the child requires child protective services or when the child is in foster care 23.8for any reason other than treatment for the child's emotional disturbance or developmental 23.9disability or related condition. When there is a determination under section 
         626.556 that 23.10the child requires child protective services based on an assessment that there are safety 23.11and risk issues for the child that have not been mitigated through the parent's engagement 23.12in services or otherwise, or when the child is in foster care for any reason other than 23.13the child's emotional disturbance or developmental disability or related condition, the 23.14provisions of chapter 260C apply.23.15    (e) The paramount consideration in all proceedings concerning a child in voluntary 23.16foster care for treatment is the safety, health, and the best interests of the child. The 23.17purpose of this chapter is:23.18    (1) to ensure a child with a disability is provided the services necessary to treat or 23.19ameliorate the symptoms of the child's disability;23.20    (2) to preserve and strengthen the child's family ties whenever possible and in the 23.21child's best interests, approving the child's placement away from the child's parents only 23.22when the child's need for care or treatment requires it and the child cannot be maintained 23.23in the home of the parent; and23.24    (3) to ensure the child's parent retains legal custody of the child and associated 23.25decision-making authority unless the child's parent willfully fails or is unable to make 23.26decisions that meet the child's safety, health, and best interests. The court may not find 23.27that the parent willfully fails or is unable to make decisions that meet the child's needs 23.28solely because the parent disagrees with the agency's choice of foster care facility, unless 23.29the agency files a petition under chapter 260C, and establishes by clear and convincing 23.30evidence that the child is in need of protection or services.23.31    (f) The legal parent-child relationship shall be supported under this chapter by 23.32maintaining the parent's legal authority and responsibility for ongoing planning for the 23.33child and by the agency's assisting the parent, where necessary, to exercise the parent's 23.34ongoing right and obligation to visit or to have reasonable contact with the child. Ongoing 23.35planning means:24.1    (1) actively participating in the planning and provision of educational services, 24.2medical, and dental care for the child;24.3    (2) actively planning and participating with the agency and the foster care facility 24.4for the child's treatment needs; and24.5    (3) planning to meet the child's need for safety, stability, and permanency, and the 24.6child's need to stay connected to the child's family and community.24.7    (g) The provisions of section 
         260.012 to ensure placement prevention, family 24.8reunification, and all active and reasonable effort requirements of that section apply. This 24.9chapter shall be construed consistently with the requirements of the Indian Child Welfare 24.10Act of 1978, United States Code, title 25, section 1901, et al., and the provisions of the 24.11Minnesota Indian Family Preservation Act, sections 
         260.751 to 
         260.835.24.12    Sec. 26. Minnesota Statutes 2010, section 393.07, subdivision 10a, is amended to read:24.13    Subd. 10a. Expedited issuance of food stamps. The commissioner of human 24.14services shall continually monitor the expedited issuance of food stamp benefits to ensure 24.15that each county complies with federal regulations and that households eligible for 24.16expedited issuance of food stamps are identified, processed, and certified within the time 24.17frames prescribed in federal regulations.24.18County food stamp offices shall screen and issue food stamps to applicants on the 24.19day of application. Applicants who meet the federal criteria for expedited issuance and 24.20have an immediate need for food assistance shall receive within two working dayseither:24.21(1) a manual Authorization to Participate (ATP) card; or24.22(2) the immediate issuance of food stamp coupons benefits.24.23The local food stamp agency shall conspicuously post in each food stamp office a 24.24notice of the availability of and the procedure for applying for expedited issuance and 24.25verbally advise each applicant of the availability of the expedited process.24.26    Sec. 27. Minnesota Statutes 2010, section 518A.51, is amended to read:24.27518A.51 FEES FOR IV-D SERVICES.24.28    (a) When a recipient of IV-D services is no longer receiving assistance under the 24.29state's title IV-A, IV-E foster care, medical assistance, or MinnesotaCare programs, the 24.30public authority responsible for child support enforcement must notify the recipient, 24.31within five working days of the notification of ineligibility, that IV-D services will be 24.32continued unless the public authority is notified to the contrary by the recipient. The 24.33notice must include the implications of continuing to receive IV-D services, including the 24.34available services and fees, cost recovery fees, and distribution policies relating to fees.25.1    (b) An application fee of $25 shall be paid by the person who applies for child 25.2support and maintenance collection services, except persons who are receiving public 25.3assistance as defined in section 
         256.741 and the diversionary work program under section 25.4256J.95
         , persons who transfer from public assistance to nonpublic assistance status, and 25.5minor parents and parents enrolled in a public secondary school, area learning center, or 25.6alternative learning program approved by the commissioner of education.25.7    (c) In the case of an individual who has never received assistance under a state 25.8program funded under Title IV-A of the Social Security Act and for whom the public 25.9authority has collected at least $500 of support, the public authority must impose an 25.10annual federal collections fee of $25 for each case in which services are furnished. This 25.11fee must be retained by the public authority from support collected on behalf of the 25.12individual, but not from the first $500 collected.25.13    (d) When the public authority provides full IV-D services to an obligee who has 25.14applied for those services, upon written notice to the obligee, the public authority must 25.15charge a cost recovery fee of one percent of the amount collected. This fee must be 25.16deducted from the amount of the child support and maintenance collected and not assigned 25.17under section 
         256.741 before disbursement to the obligee. This fee does not apply to an 25.18obligee who:25.19    (1) is currently receiving assistance under the state's title IV-A, IV-E foster care, 25.20medical assistance, or MinnesotaCare programs; or25.21    (2) has received assistance under the state's title IV-A or IV-E foster care programs, 25.22until the person has not received this assistance for 24 consecutive months.25.23     (e) When the public authority provides full IV-D services to an obligor who has 25.24applied for such services, upon written notice to the obligor, the public authority must 25.25charge a cost recovery fee of one percent of the monthly court-ordered child support and 25.26maintenance obligation. The fee may be collected through income withholding, as well 25.27as by any other enforcement remedy available to the public authority responsible for 25.28child support enforcement.25.29     (f) Fees assessed by state and federal tax agencies for collection of overdue support 25.30owed to or on behalf of a person not receiving public assistance must be imposed on the 25.31person for whom these services are provided. The public authority upon written notice to 25.32the obligee shall assess a fee of $25 to the person not receiving public assistance for each 25.33successful federal tax interception. The fee must be withheld prior to the release of the 25.34funds received from each interception and deposited in the general fund.25.35     (g) Federal collections fees collected under paragraph (c) and cost recovery 25.36fees collected under paragraphs (d) and (e), retained by the commissioner of human 26.1services, shall be considered child support program income according to Code of Federal 26.2Regulations, title 45, section 304.50, and shall be deposited in the special revenue fund 26.3account established under paragraph (i). The commissioner of human services must elect 26.4to recover costs based on either actual or standardized costs.26.5     (h) The limitations of this section on the assessment of fees shall not apply to 26.6the extent inconsistent with the requirements of federal law for receiving funds for the 26.7programs under Title IV-A and Title IV-D of the Social Security Act, United States Code, 26.8title 42, sections 601 to 613 and United States Code, title 42, sections 651 to 662.26.9     (i) The commissioner of human services is authorized to establish a special revenue 26.10fund account to receive the federal collections fees collected under paragraph (c) and cost 26.11recovery fees collected under paragraphs (d) and (e). A portion of the nonfederal share of 26.12these fees may be retained for expenditures necessary to administer the fees and must be 26.13transferred to the child support system special revenue account. The remaining nonfederal 26.14share of the federal collections fees and cost recovery fees must be retained by the 26.15commissioner and dedicated to the child support general fund county performance-based 26.16grant account authorized under sections 256.979 and 256.9791. The commissioner shall 26.17distribute the remaining nonfederal share of these fees to the counties quarterly using the 26.18methodology specified in section 256.979, subdivision 11. The funds received by the 26.19counties must be reinvested in the child support enforcement program, and the counties 26.20shall not reduce the funding of their child support programs by the amount of funding 26.21distributed.26.22    Sec. 28. GRANT PROGRAM TO PROMOTE HEALTHY COMMUNITY 26.23INITIATIVES.26.24    (a) The commissioner of human services must contract with the Search Institute to 26.25help local communities develop, expand, and maintain the tools, training, and resources 26.26needed to foster positive community development and effectively engage people in their 26.27community. The Search Institute must: (1) provide training in community mobilization, 26.28youth development, and assets getting to outcomes; (2) provide ongoing technical 26.29assistance to communities receiving grants under this section; (3) use best practices to 26.30promote community development; (4) share best program practices with other interested 26.31communities; (5) create electronic and other opportunities for communities to share 26.32experiences in and resources for promoting healthy community development; and (6) 26.33provide an annual report of the strong communities project.26.34    (b) Specifically, the Search Institute must use a competitive grant process to select 26.35four interested communities throughout Minnesota to undertake strong community 27.1mobilization initiatives to support communities wishing to catalyze multiple sectors to 27.2create or strengthen a community collaboration to address issues of poverty in their 27.3communities. The Search Institute must provide the selected communities with the 27.4tools, training, and resources they need for successfully implementing initiatives focused 27.5on strengthening the community. The Search Institute also must use a competitive 27.6grant process to provide four strong community innovation grants to encourage current 27.7community initiatives to bring new innovation approaches to their work to reduce poverty. 27.8Finally, the Search Institute must work to strengthen networking and information sharing 27.9activities among all healthy community initiatives throughout Minnesota, including 27.10sharing best program practices and providing personal and electronic opportunities for 27.11peer learning and ongoing program support.27.12(c) In order to receive a grant under paragraph (b), a community must show 27.13involvement of at least three sectors of their community and the active leadership of both 27.14youth and adults. Sectors may include, but are not limited to, local government, schools, 27.15community action agencies, faith communities, businesses, higher education institutions, 27.16and the medical community. In addition, communities must agree to: (1) attend training 27.17on community mobilization processes and strength-based approaches; (2) apply the assets 27.18getting to outcomes process in their initiative; (3) meet at least two times during the 27.19grant period to share successes and challenges with other grantees; (4) participate on an 27.20electronic listserv to share information throughout the period on their work; and (5) all 27.21communication requirements and reporting processes.27.22    (d) The commissioner of human services must evaluate the effectiveness of this 27.23program and must recommend to the committees of the legislature with jurisdiction over 27.24health and human services reform and finance by February 15, 2013, whether or not 27.25to make the program available statewide. The Search Institute annually must report to 27.26the commissioner of human services on the services it provided and the grant money 27.27it expended under this section.27.28EFFECTIVE DATE.This section is effective the day following final enactment.27.29    Sec. 29. CIRCLES OF SUPPORT GRANTS.27.30The commissioner of human services must provide grants to community action 27.31agencies to help local communities develop, expand, and maintain the tools, training, and 27.32resources needed to foster social assets to assist people out of poverty through circles of 27.33support. The circles of support model must provide a framework for a community to build 27.34relationships across class and race lines so that people can work together to advocate for 27.35change in their communities and move individuals toward self-sufficiency.28.1Specifically, circles of support initiatives must focus on increasing social capital, 28.2income, educational attainment, and individual accountability, while reducing debt, 28.3service dependency, and addressing systemic disparities that hold poverty in place. The 28.4effort must support the development of local guiding coalitions as the link between the 28.5community and circles of support for resource development and funding leverage.28.6EFFECTIVE DATE.This section is effective July 1, 2011.28.7    Sec. 30. PILOT PROJECT FOR HOMELESS ADULTS TO BE IN-HOME 28.8CARETAKERS OF FORECLOSED HOMES.28.9(a) Stepping Stone Emergency Housing may form a partnership with local banks 28.10who own foreclosed homes to:28.11(1) utilize foreclosed homes for graduates of Stepping Stone Emergency Housing to 28.12become in-home caretakers of those homes;28.13(2) provide the security needed by the homes' banking owners and others to help 28.14stabilize neighborhoods through carefully maintained homes that will prevent vandalism, 28.15squatters, and drug houses;28.16(3) provide transitional housing to up to four homeless clients per home after they 28.17graduate from emergency housing allowing the clients time to find permanent housing 28.18in a tight affordable housing market; and28.19(4) provide management of the project to ensure proper oversight for the homes' 28.20owners and support of the caretakers.28.21(b) This section expires June 30, 2013.28.22    Sec. 31. HOMELESS SHELTERS; SCHOOL DISTRICTS.28.23School districts may coordinate with local units of government and homeless 28.24services providers to use empty school buildings as homeless shelters.28.25    Sec. 32. REQUIREMENT FOR LIQUOR STORES, TOBACCO STORES, 28.26GAMBLING ESTABLISHMENTS, AND TATTOO PARLORS.28.27Liquor stores, tobacco stores, gambling establishments, and tattoo parlors must 28.28negotiate with their third-party processors to block EBT card cash transactions at their 28.29places of business and withdrawals of cash at automatic teller machines located in their 28.30places of business.28.31    Sec. 33. MINNESOTA EBT BUSINESS TASK FORCE.29.1    Subdivision 1.Members.The Minnesota EBT Business Task Force includes seven 29.2members, appointed as follows:29.3(1) two members of the Minnesota house of representatives, one appointed by the 29.4speaker of the house and one appointed by the minority leader;29.5(2) two members of the Minnesota senate, one appointed by the senate majority 29.6leader and one appointed by the senate minority leader;29.7(3) the commissioner of human services, or designee;29.8(4) an appointee of the Minnesota Grocers Association; and29.9(5) a credit card processor, appointed by the commissioner of human services.29.10    Subd. 2.Duties.The Minnesota EBT Business Task Force shall create a workable 29.11strategy to eliminate the purchase of tobacco and alcoholic beverages by recipients of the 29.12general assistance program and Minnesota supplemental aid program under Minnesota 29.13Statutes, chapter 256D, and programs under Minnesota Statutes, chapter 256J, using EBT 29.14cards. The task force will consider cost to the state, feasibility of execution at retail, and 29.15ease of use and privacy for EBT cardholders.29.16    Subd. 3.Report.The task force will report back to the legislative committees with 29.17jurisdiction over health and human services policy and finance by April 1, 2012, with 29.18recommendations related to the task force duties under subdivision 2.29.19    Subd. 4.Expiration.The task force expires on June 30, 2012.29.20    Sec. 34. STREAMLINING CHILDREN AND COMMUNITY SERVICES ACT 29.21REPORTING REQUIREMENTS.29.22    The commissioner of human services and county human services representatives, in 29.23consultation with other interested parties, shall develop a streamlined alternative to current 29.24reporting requirements related to the Children and Community Services Act service plan. 29.25The commissioner shall submit recommendations and draft legislation to the chairs and 29.26ranking minority members of the committees having jurisdiction over human services no 29.27later than November 15, 2012.29.28    Sec. 35.  REPEALER.29.29(a) Minnesota Statutes 2010, sections 256.979, subdivisions 5, 6, 7, and 10; 29.30256.9791; 256.9862, subdivision 2; and 256D.46, subdivisions 2 and 3, are repealed.29.31(b) Minnesota Rules, parts 3400.0130, subpart 8; and 9500.1261, subparts 3, items D 29.32and E, 4, and 5, are repealed effective September 3, 2012.30.1ARTICLE 230.2DEPARTMENT OF HEALTH30.3    Section 1. Minnesota Statutes 2010, section 62D.08, subdivision 7, is amended to read:30.4    Subd. 7. Consistent administrative expenses and investment income reporting.30.5(a) Every health maintenance organization must directly allocate administrative expenses 30.6to specific lines of business or products when such information is available. The definition 30.7of administrative expenses must be consistent with that of the National Association of 30.8Insurance Commissioners (NAIC) as provided in the most current NAIC blank. Remaining 30.9expenses that cannot be directly allocated must be allocated based on other methods, as 30.10recommended by the Advisory Group on Administrative Expenses. Health maintenance 30.11organizations must submit this information, including administrative expenses for dental 30.12services, using the reporting template provided by the commissioner of health.30.13(b) Every health maintenance organization must allocate investment income based 30.14on cumulative net income over time by business line or product and must submit this 30.15information, including investment income for dental services, using the reporting template 30.16provided by the commissioner of health.30.17    Sec. 2. Minnesota Statutes 2010, section 62J.04, subdivision 3, is amended to read:30.18    Subd. 3. Cost containment duties. The commissioner shall:30.19(1) establish statewide and regional cost containment goals for total health care 30.20spending under this section and collect data as described in sections 
         62J.38to 62J.41 and 30.2162J.40 to monitor statewide achievement of the cost containment goals; 30.22(2) divide the state into no fewer than four regions, with one of those regions being 30.23the Minneapolis/St. Paul metropolitan statistical area but excluding Chisago, Isanti, 30.24Wright, and Sherburne Counties, for purposes of fostering the development of regional 30.25health planning and coordination of health care delivery among regional health care 30.26systems and working to achieve the cost containment goals;30.27(3) monitor the quality of health care throughout the state and take action as 30.28necessary to ensure an appropriate level of quality;30.29(4) issue recommendations regarding uniform billing forms, uniform electronic 30.30billing procedures and data interchanges, patient identification cards, and other uniform 30.31claims and administrative procedures for health care providers and private and public 30.32sector payers. In developing the recommendations, the commissioner shall review the 30.33work of the work group on electronic data interchange (WEDI) and the American National 30.34Standards Institute (ANSI) at the national level, and the work being done at the state and 31.1local level. The commissioner may adopt rules requiring the use of the Uniform Bill 31.282/92 form, the National Council of Prescription Drug Providers (NCPDP) 3.2 electronic 31.3version, the Centers for Medicare and Medicaid Services 1500 form, or other standardized 31.4forms or procedures;31.5(5) undertake health planning responsibilities;31.6(6) authorize, fund, or promote research and experimentation on new technologies 31.7and health care procedures;31.8(7) within the limits of appropriations for these purposes, administer or contract for 31.9statewide consumer education and wellness programs that will improve the health of 31.10Minnesotans and increase individual responsibility relating to personal health and the 31.11delivery of health care services, undertake prevention programs including initiatives to 31.12improve birth outcomes, expand childhood immunization efforts, and provide start-up 31.13grants for worksite wellness programs;31.14(8) undertake other activities to monitor and oversee the delivery of health care 31.15services in Minnesota with the goal of improving affordability, quality, and accessibility of 31.16health care for all Minnesotans; and31.17(9) make the cost containment goal data available to the public in a 31.18consumer-oriented manner.31.19EFFECTIVE DATE.This section is effective July 1, 2011.31.20    Sec. 3. Minnesota Statutes 2010, section 62J.17, subdivision 4a, is amended to read:31.21    Subd. 4a. Expenditure reporting. Each hospital, outpatient surgical center, 31.22diagnostic imaging center, and physician clinic shall report annually to the commissioner 31.23on all major spending commitments, in the form and manner specified by the 31.24commissioner. The report shall include the following information:31.25    (a) a description of major spending commitments made during the previous year, 31.26including the total dollar amount of major spending commitments and purpose of the 31.27expenditures;31.28    (b) the cost of land acquisition, construction of new facilities, and renovation of 31.29existing facilities;31.30    (c) the cost of purchased or leased medical equipment, by type of equipment;31.31    (d) expenditures by type for specialty care and new specialized services;31.32    (e) information on the amount and types of added capacity for diagnostic imaging 31.33services, outpatient surgical services, and new specialized services; and31.34    (f) information on investments in electronic medical records systems.32.1For hospitals and outpatient surgical centers, this information shall be included in reports 32.2to the commissioner that are required under section 
         144.698. For diagnostic imaging 32.3centers, this information shall be included in reports to the commissioner that are required 32.4under section 
         144.565. For physician clinics, this information shall be included in reports 32.5to the commissioner that are required under section 62J.41. For all other health care 32.6providers that are subject to this reporting requirement, reports must be submitted to the 32.7commissioner by March 1 each year for the preceding calendar year.32.8EFFECTIVE DATE.This section is effective July 1, 2011.32.9    Sec. 4. Minnesota Statutes 2010, section 62J.495, is amended by adding a subdivision 32.10to read:32.11    Subd. 7.Exemption.Any clinical practice with a total annual net revenue of less 32.12than $500,000, and that has not received a state or federal grant for implementation 32.13of electronic health records, is exempt from the requirements of subdivision 1. This 32.14subdivision expires December 31, 2020.32.15    Sec. 5. Minnesota Statutes 2010, section 62J.497, is amended by adding a subdivision 32.16to read:32.17    Subd. 6.Additional standards for electronic prescribing.By January 1, 2012, 32.18the commissioner of health, in consultation with the Minnesota e-Health Advisory 32.19Committee, must develop a method for incorporation of the following transactions into the 32.20requirements and standards for electronic prescribing provided in subdivisions 2 and 3:32.21(1) submission of requests for a formulary exception based on information required 32.22on the form developed according to subdivision 4; and32.23(2) submission of prior authorization requests based on information required on the 32.24form developed according to subdivision 5.32.25    Sec. 6. Minnesota Statutes 2010, section 62J.692, is amended to read:32.2662J.692 MEDICAL EDUCATION.32.27    Subdivision 1. Definitions. For purposes of this section, the following definitions 32.28apply:32.29    (a) "Accredited clinical training" means the clinical training provided by a 32.30medical education program that is accredited through an organization recognized by the 32.31Department of Education, the Centers for Medicare and Medicaid Services, or another 32.32national body who reviews the accrediting organizations for multiple disciplines and 33.1whose standards for recognizing accrediting organizations are reviewed and approved by 33.2the commissioner of health in consultation with the Medical Education and Research 33.3Advisory Committee.33.4    (b) "Commissioner" means the commissioner of health.33.5    (c) "Clinical medical education program" means the accredited clinical training of 33.6physicians (medical students and residents), doctor of pharmacy practitioners, doctors 33.7of chiropractic, dentists, advanced practice nurses (clinical nurse specialists, certified 33.8registered nurse anesthetists, nurse practitioners, and certified nurse midwives), and 33.9physician assistants.33.10    (d) "Sponsoring institution" means a hospital, school, or consortium located in 33.11Minnesota that sponsors and maintains primary organizational and financial responsibility 33.12for a clinical medical education program in Minnesota and which is accountable to the 33.13accrediting body.33.14    (e) "Teaching institution" means a hospital, medical center, clinic, or other 33.15organization that conducts a clinical medical education program in Minnesota.33.16    (f) "Trainee" means a student or resident involved in a clinical medical education 33.17program.33.18    (g) "Eligible trainee FTE's" means the number of trainees, as measured by full-time 33.19equivalent counts, that are at training sites located in Minnesota with currently active 33.20medical assistance enrollment status and a National Provider Identification (NPI) number 33.21where training occurs in either an inpatient or ambulatory patient care setting and where 33.22the training is funded, in part, by patient care revenues. Training that occurs in nursing 33.23facility settings is not eligible for funding under this section.33.24    Subd. 3. Application process. (a) A clinical medical education program conducted 33.25in Minnesota by a teaching institution to train physicians, doctor of pharmacy practitioners, 33.26dentists, advanced dental therapists, chiropractors, or physician assistants is eligible for 33.27funds under subdivision 4 or 11, as appropriate, if the program:33.28(1) is funded, in part, by patient care revenues;33.29(2) occurs in patient care settings that face increased financial pressure as a result of 33.30competition with nonteaching patient care entities training activities; and33.31(3) emphasizes primary care or specialties that are in undersupply in Minnesota in 33.32rural areas or for racial, ethnic, or cultural populations in the state experiencing health 33.33disparities.33.34A clinical medical education program that trains pediatricians is requested to include 33.35in its program curriculum training in case management and medication management for 33.36children suffering from mental illness to be eligible for funds under subdivision 4.34.1(b) A clinical medical education program for advanced practice nursing, registered 34.2nurses, or licensed practical nurses is eligible for funds under subdivision 4 or 11, as 34.3appropriate, if the program meets the eligibility requirements in paragraph (a), clauses 34.4(1) to (3), and is sponsored by the University of Minnesota Academic Health Center, 34.5the Mayo Foundation, or institutions that are part of the Minnesota State Colleges and 34.6Universities system or members of the Minnesota Private College Council.34.7(c) Applications must be submitted to the commissioner by a sponsoring institution 34.8on behalf of an eligible clinical medical education program and must be received by 34.9October 31 of each year for distribution in the following year. An application for funds 34.10must contain the following information:34.11(1) the official name and address of the sponsoring institution and the official 34.12name and site address of the clinical medical education programs on whose behalf the 34.13sponsoring institution is applying;34.14(2) the name, title, and business address of those persons responsible for 34.15administering the funds;34.16(3) for each clinical medical education program for which funds are being sought; 34.17the type and specialty orientation of trainees in the program; the name, site address, and 34.18medical assistance provider number or National Provider Identification number (NPI) of 34.19each training site used in the program; the total number of trainees at each training site; 34.20and the total number of eligible trainee FTEs at each site; and34.21(4) other supporting information the commissioner deems necessary to determine 34.22program eligibility based on the criteria in paragraphs (a) and (b) and to ensure the 34.23equitable appropriate distribution of funds.34.24(d) An application must include the information specified in clauses (1) to (3) for 34.25each clinical medical education program on an annual basis for three consecutive years. 34.26After that time, an application must include the information specified in clauses (1) to (3) 34.27when requested, at the discretion of the commissioner:34.28(1) audited clinical training costs per trainee for each clinical medical education 34.29program when available or estimates of clinical training costs based on audited financial 34.30data;34.31(2) a description of current sources of funding for clinical medical education costs, 34.32including a description and dollar amount of all state and federal financial support, 34.33including Medicare direct and indirect payments; and34.34(3) other revenue received for the purposes of clinical training.34.35(e) An applicant that does not provide information requested by the commissioner 34.36shall not be eligible for funds for the current funding cycle.35.1    Subd. 4. Distribution of funds. (a) Following the distribution described under 35.2paragraph (b), the commissioner shall annually distribute the available medical education 35.3funds to all qualifying applicants based on a distribution formula that reflects a summation 35.4of two factors:35.5    (1) a public program volume factor, which is determined by the total volume of 35.6public program revenue received by each training site as a percentage of all public 35.7program revenue received by all training sites in the fund pool; and.35.8    (2) a supplemental public program volume factor, which is determined by providing 35.9a supplemental payment of 20 percent of each training site's grant to training sites whose 35.10public program revenue accounted for at least 0.98 percent of the total public program 35.11revenue received by all eligible training sites. Grants to training sites whose public 35.12program revenue accounted for less than 0.98 percent of the total public program revenue 35.13received by all eligible training sites shall be reduced by an amount equal to the total 35.14value of the supplemental payment.35.15    Public program revenue for the distribution formula includes revenue from medical 35.16assistance, prepaid medical assistance, general assistance medical care, and prepaid 35.17general assistance medical care. Training sites that receive no public program revenue 35.18are ineligible for funds available under this subdivision. For purposes of determining 35.19training-site level grants to be distributed under paragraph (a), total statewide average 35.20costs per trainee for medical residents is based on audited clinical training costs per trainee 35.21in primary care clinical medical education programs for medical residents. Total statewide 35.22average costs per trainee for dental residents is based on audited clinical training costs 35.23per trainee in clinical medical education programs for dental students. Total statewide 35.24average costs per trainee for pharmacy residents is based on audited clinical training costs 35.25per trainee in clinical medical education programs for pharmacy students. Training sites 35.26whose training-site level grant is less than $1,000, based on the formula described in this 35.27paragraph, are ineligible for funds available under this subdivision.35.28    (b) $5,350,000 $4,900,000 of the available medical education funds in fiscal year 35.292012 and $3,044,000 beginning in fiscal year 2013 shall be distributed to fund training 35.30designed to address health disparities as follows:35.31    (1) $1,475,000 $500,000 in fiscal year 2012 and $200,000 beginning in fiscal year 35.322013 to the University of Minnesota Medical Center-Fairview the White Earth Band of 35.33Ojibwe Indians according to section 145.9271;35.34    (2) $2,075,000 $600,000 in fiscal year 2012 and $200,000 beginning in fiscal 35.35year 2013 to the University of Minnesota School of Dentistry University of Minnesota 35.36according to section 137.395; and36.1(3) $500,000 in fiscal year 2012 and $200,000 beginning in fiscal year 2013 shall 36.2be distributed to the community health centers development grants program according 36.3to section 145.987;36.4(4) $500,000 in fiscal year 2012 and $200,000 beginning in fiscal year 2013 shall be 36.5distributed to the community mental health centers grant program according to section 36.6145.9272;36.7(5) $1,000,000 in fiscal year 2012 and $444,000 beginning in fiscal year 2013 shall 36.8be distributed to the health careers opportunities grant program according to section 36.9144.1499; and36.10    (3) (6) $1,800,000 to the Academic Health Center. $150,000 of the funds distributed 36.11to the Academic Health Center under this paragraph shall be used for a program to assist 36.12internationally trained physicians who are legal residents and who commit to serving 36.13underserved Minnesota communities in a health professional shortage area to successfully 36.14compete for family medicine residency programs at the University of Minnesota.36.15    (c) Funds distributed shall not be used to displace current funding appropriations 36.16from federal or state sources.36.17    (d) Funds shall be distributed to the sponsoring institutions indicating the amount 36.18to be distributed to each of the sponsor's clinical medical education programs based on 36.19the criteria in this subdivision and in accordance with the commissioner's approval letter. 36.20Each clinical medical education program must distribute funds allocated under paragraph 36.21(a) to the training sites as specified in the commissioner's approval letter. Sponsoring 36.22institutions, which are accredited through an organization recognized by the Department 36.23of Education or the Centers for Medicare and Medicaid Services, may contract directly 36.24with training sites to provide clinical training. To ensure the quality of clinical training, 36.25those accredited sponsoring institutions must:36.26    (1) develop contracts specifying the terms, expectations, and outcomes of the clinical 36.27training conducted at sites; and36.28    (2) take necessary action if the contract requirements are not met. Action may 36.29include the withholding of payments under this section or the removal of students from 36.30the site.36.31    (e) Any funds not distributed in accordance with the commissioner's approval letter 36.32must be returned to the medical education and research fund within 30 days of receiving 36.33notice from the commissioner. The commissioner shall distribute returned funds to the 36.34appropriate training sites in accordance with the commissioner's approval letter.37.1    (f) A maximum of $150,000 of the funds dedicated to the commissioner under 37.2section 
         297F.10, subdivision 1, clause (2), may be used by the commissioner for 37.3administrative expenses associated with implementing this section.37.4    Subd. 5. Report. (a) Sponsoring institutions receiving funds under this section 37.5must sign and submit a medical education grant verification report (GVR) to verify that 37.6the correct grant amount was forwarded to each eligible training site. If the sponsoring 37.7institution fails to submit the GVR by the stated deadline, or to request and meet 37.8the deadline for an extension, the sponsoring institution is required to return the full 37.9amount of funds received to the commissioner within 30 days of receiving notice from 37.10the commissioner. The commissioner shall distribute returned funds to the appropriate 37.11training sites in accordance with the commissioner's approval letter.37.12    (b) The reports must provide verification of the distribution of the funds and must 37.13include:37.14    (1) the total number of eligible trainee FTEs in each clinical medical education 37.15program;37.16    (2) the name of each funded program and, for each program, the dollar amount 37.17distributed to each training site;37.18    (3) documentation of any discrepancies between the initial grant distribution notice 37.19included in the commissioner's approval letter and the actual distribution;37.20    (4) a statement by the sponsoring institution stating that the completed grant 37.21verification report is valid and accurate; and37.22    (5) other information the commissioner, with advice from the advisory committee, 37.23deems appropriate to evaluate the effectiveness of the use of funds for medical education.37.24    (c) By February 15 of each year, the commissioner, with advice from the 37.25advisory committee, shall provide an annual summary report to the legislature on the 37.26implementation of this section.37.27    Subd. 6. Other available funds. The commissioner is authorized to distribute, in 37.28accordance with subdivision 4, funds made available through:37.29(1) voluntary contributions by employers or other entities;37.30(2) allocations for the commissioner of human services to support medical education 37.31and research; and37.32(3) other sources as identified and deemed appropriate by the legislature for 37.33inclusion in the fund.37.34    Subd. 7. Transfers from the commissioner of human services. Of the amount 37.35transferred according to section 
         256B.69, subdivision 5c, paragraph (a), clauses (1) to (4), 37.36$21,714,000 shall be distributed as follows:38.1(1) $2,157,000 shall be distributed by the commissioner to the University of 38.2Minnesota Board of Regents for the purposes described in sections 
         137.38 to 
         137.40;38.3(2) $1,035,360 shall be distributed by the commissioner to the Hennepin County 38.4Medical Center for clinical medical education;38.5(3) $17,400,000 shall be distributed by the commissioner to the University of 38.6Minnesota Board of Regents for purposes of medical education;38.7(4) $1,121,640 $1,021,640 shall be distributed by the commissioner to clinical 38.8medical education dental innovation grants in accordance with subdivision 7a; and38.9(5) $100,000 shall be distributed to the health careers opportunities grant program 38.10according to section 144.1499; and38.11(6) the remainder of the amount transferred according to section 
         256B.69, 38.12subdivision 5c, clauses (1) to (4), shall be distributed by the commissioner annually to 38.13clinical medical education programs that meet the qualifications of subdivision 3 based on 38.14the formula in subdivision 4, paragraph (a), or subdivision 11, as appropriate.38.15    Subd. 7a. Clinical medical education innovations grants. (a) The commissioner 38.16shall award grants to teaching institutions and clinical training sites for projects that38.17provide training to  increase dental access for underserved populations and promote 38.18innovative clinical training of dental professionals and for racial, ethnic, or cultural 38.19populations in the state experiencing health disparities. In awarding the grants, the 38.20commissioner, in consultation with the commissioner of human services, shall consider 38.21the following:38.22(1) potential to successfully increase access to an underserved population;38.23(2) the long-term viability of the project to improve access beyond the period 38.24of initial funding;38.25(3) evidence of collaboration between the applicant and local communities; and38.26(4) the efficiency in the use of the funding; and38.27(5) (3) the priority level of the project in relation to state clinical education, access, 38.28and health disparity workforce goals.38.29(b) The commissioner shall periodically evaluate the priorities in awarding the 38.30innovations grants in order to ensure that the priorities meet the changing workforce 38.31needs of the state.38.32    Subd. 8. Federal financial participation.  The commissioner of human services 38.33shall seek to maximize federal financial participation in payments for medical education 38.34and research costs.39.1    The commissioner shall use physician clinic rates where possible to maximize 39.2federal financial participation. Any additional funds that become available must be 39.3distributed under subdivision 4, paragraph (a), or 11, as appropriate.39.4    Subd. 9. Review of eligible providers. The commissioner and the Medical 39.5Education and Research Costs Advisory Committee may review provider groups included 39.6in the definition of a clinical medical education program to assure that the distribution of 39.7the funds continue to be consistent with the purpose of this section. The results of any 39.8such reviews must be reported to the Legislative Commission on Health Care Access.39.9    Subd. 11.Distribution of funds.(a) Upon receiving federal approval, the 39.10commissioner shall annually distribute the available medical education funds to all 39.11qualifying applicants based on the following distribution formula, which supersedes the 39.12formula described in subdivision 4, paragraphs (a) and (b):39.13(1) funds received pursuant to section 297F.10 shall be distributed to eligible clinical 39.14training sites using a public program volume factor, which is determined by the total 39.15volume of public program revenue received by each eligible training site as a percentage 39.16of all public program revenue received by all eligible training sites in the fund pool. Only 39.17clinical training that occurs in a hospital that reports financial, utilization, and services 39.18data to the commissioner of health, pursuant to sections 144.564 and 144.695 to 144.703 39.19and Minnesota Rules, chapter 4650, is eligible for funding under this clause; and39.20(2) funds transferred according to section 256B.69, subdivision 5c, paragraph (a), 39.21clauses (1) to (4), shall be distributed to eligible training sites based on the total number of 39.22eligible trainee FTEs and the total statewide average costs per FTE, by type of trainee, in 39.23each clinical medical education program. The number of eligible trainee FTEs for funds 39.24distributed under this clause is determined using the following steps:39.25(i) each FTE trainee from an advanced practice nursing, physician assistant, family 39.26medicine, internal medicine, general pediatrics, or psychiatry program is weighted at 1.25. 39.27Each FTE trainee from any other eligible training program is weighted at 1.0;39.28(ii) each FTE trainee at a clinical training site located in an isolated rural area 39.29according to the four category classification of the Rural Urban Commuting Area (RUCA) 39.30system developed for the United States Health Resources and Services Administration 39.31shall be weighted at the weight in item (i) multiplied by 1.5; each FTE trainee at a clinical 39.32training site located in a small rural area according to the RUCA system shall be weighted 39.33at the weight in item (i) multiplied by 1.25; each FTE trainee at a clinical training site 39.34located in a large rural area according to the RUCA system shall be weighted at the weight 39.35in item (i) multiplied by 1.1; and each FTE trainee at a clinical training site located in an 40.1urban area according to the RUCA system shall be weighted at the weight in item (i) 40.2multiplied by 1.0;40.3(iii) each FTE trainee at a clinical training site that is a hospital eligible for funding 40.4under clause (1) shall be weighted at the weight in item (ii) multiplied by 0.85; and each 40.5FTE trainee at a clinical training site that is an ambulatory, nursing home, or other eligible 40.6nonhospital setting shall be weighted at the weight in item (ii) multiplied by 1.15; and40.7(iv) grants to hospitals under this item are limited to a percentage share of the total 40.8pool of funds available under this item that is no more than 1.5 times the percentage of the 40.9hospital's total revenue that comes from public programs. Grants to hospitals in excess of 40.10this amount will be redistributed to other sites eligible for funding under this item. Each 40.11eligible clinical training site's grant under this item will be calculated by multiplying the 40.12training site's adjusted FTE count upon completion of items (i) to (iv) by the statewide 40.13average cost per trainee for each provider type to determine an adjusted clinical training 40.14cost for each site. The grant to each eligible clinical training site under this item shall 40.15equal that site's share of total adjusted clinical training costs for all eligible training sites 40.16receiving funding under this item. Any clinical training site with fewer than 0.1 FTE 40.17eligible trainees from all programs upon completion of items (i) to (iv) and any clinical 40.18training site that would receive less than a cumulative $1,000 under clauses (1) and (2) 40.19will be eliminated from the distribution.40.20(b) Public program revenue for the distribution formula includes revenue for the 40.21relevant MERC reporting period from medical assistance, prepaid medical assistance, 40.22general assistance medical care, MinnesotaCare, and prepaid general assistance medical 40.23care, as reported to the Department of Health pursuant to sections 144.562, 144.564, 40.24and 144.695 to 144.703 and Minnesota Rules, chapter 4650, by December 31 of the 40.25year in which the MERC application is submitted. Training sites that receive no public 40.26program revenue are ineligible for funds available under this subdivision. For purposes 40.27of determining training-site level grants to be distributed under paragraph (a), clause 40.28(2), total statewide average costs per trainee for medical residents is based on audited 40.29clinical training costs per trainee in primary care clinical medical education programs for 40.30medical residents. Total statewide average costs per trainee for dental residents is based 40.31on audited clinical training costs per trainee in clinical medical education programs for 40.32dental students. Total statewide average costs per trainee for pharmacy residents is based 40.33on audited clinical training costs per trainee in clinical medical education programs for 40.34pharmacy students.41.1    Sec. 7. [62U.15] ALZHEIMER'S DISEASE; PREVALENCE AND SCREENING 41.2MEASURES.41.3    Subdivision 1.Data from providers.(a) By July 1, 2012, the commissioner 41.4shall review currently available quality measures and make recommendations for future 41.5measurement aimed at improving assessment and care related to Alzheimer's disease and 41.6other dementia diagnoses, including improved rates and results of cognitive screening, 41.7rates of Alzheimer's and other dementia diagnoses, and prescribed care and treatment 41.8plans.41.9(b) The commissioner may contract with a private entity to complete the 41.10requirements in this subdivision. If the commissioner contracts with a private entity 41.11already under contract through section 62U.02, then the commissioner may use a sole 41.12source contract and is exempt from competitive procurement processes.41.13    Subd. 2.Learning collaborative.By July 1, 2012, the commissioner shall 41.14develop a health care home learning collaborative curriculum that includes screening and 41.15education on best practices regarding identification and management of Alzheimer's and 41.16other dementia patients under section 256B.0751, subdivision 5, for providers, clinics, 41.17care coordinators, clinic administrators, patient partners and families, and community 41.18resources including public health.41.19    Subd. 3.Comparison data.The commissioner, with the commissioner of human 41.20services, the Minnesota Board on Aging, and other appropriate state offices, shall jointly 41.21review existing and forthcoming literature in order to estimate differences in the outcomes 41.22and costs of current practices for caring for those with Alzheimer's disease and other 41.23dementias, compared to the outcomes and costs resulting from:41.24(1) earlier identification of Alzheimer's and other dementias;41.25(2) improved support of family caregivers; and41.26(3) improved collaboration between medical care management and community-based 41.27supports.41.28    Subd. 4.Reporting.By January 15, 2013, the commissioner must report to the 41.29legislature on progress toward establishment and collection of quality measures required 41.30under this section.41.31    Sec. 8. [137.395] EDUCATION AND TRAINING FOR HEALTH DISPARITY 41.32POPULATIONS.41.33    Subdivision 1.Condition.If the Board of Regents accepts the amount transferred 41.34under section 62J.692, subdivision 4, paragraph (b), clause (2), then it must be used for the 41.35purposes provided in this section.42.1    Subd. 2.Purpose.The Board of Regents, through the Academic Health Center, 42.2is required to implement a scholarship program in order to increase the number of 42.3graduates of the Academic Health Center programs who are from racial, ethnic, or cultural 42.4populations in the state that experience health disparities.42.5    Subd. 3.Scholarships.The Board of Regents is required to provide full 42.6scholarships to Academic Health Center programs for students who are from racial, ethnic, 42.7or cultural populations that experience health disparities. One-third of the scholarship 42.8funding available under this program must go to students at the University of Minnesota, 42.9Medical School, Duluth.42.10    Sec. 9. Minnesota Statutes 2010, section 144.05, is amended by adding a subdivision 42.11to read:42.12    Subd. 6.Elimination of certain provider reporting requirements; sunset of new 42.13requirements.(a) Notwithstanding any other law, rule, or provision to the contrary, 42.14effective July 1, 2012, the commissioner shall cease collecting from health care providers 42.15and purchasers all reports and data related to health care costs, quality, utilization, access, 42.16patient encounters, and disease surveillance and public health, and related to provider 42.17licensure, monitoring, finances, and regulation, unless the reports or data are necessary for 42.18federal compliance. For purposes of this subdivision, the term "health care providers and 42.19purchasers" has the meaning provided in section 62J.03, subdivision 8, except that it also 42.20includes nursing homes, health plan companies as defined in section 62Q.01, subdivision 42.214, and managed care and county-based purchasing plans delivering services under sections 42.22256B.69 and 256B.692.42.23(b) The commissioner shall present to the 2012 legislature draft legislation to repeal, 42.24effective July 1, 2012, the provider reporting requirements identified under paragraph (a) 42.25that are not necessary for federal compliance.42.26(c) The commissioner may establish new provider reporting requirements to take 42.27effect on or after July 1, 2012. These new reporting requirements must sunset five years 42.28from their effective date, unless they are renewed by the commissioner. All new provider 42.29reporting requirements and requests for their renewal shall not take effect unless they 42.30are enacted in state law.42.31    Sec. 10. Minnesota Statutes 2010, section 144.1499, is amended to read:42.32144.1499 PROMOTION OF HEALTH CARE AND LONG-TERM CARE 42.33CAREERS HEALTH CAREERS OPPORTUNITIES GRANT PROGRAM.43.1    Subdivision. 1.Program. The commissioner of health, in consultation with 43.2an organization representing health care employers, long-term care employers, and 43.3educational institutions, may make grants to qualifying consortia as defined in section 43.4116L.11, subdivision 4, for intergenerational programs to encourage middle and high 43.5school students to work and volunteer in health care and long-term care settings. 43.6To qualify for a grant under this section, a consortium shall:health care employers, 43.7educational institutions, and related organizations for eligible activities intended to 43.8increase the number of people from racial, ethnic, or cultural populations that experience 43.9health disparities who are entering health careers in Minnesota.43.10(1) develop a health and long-term care careers curriculum that provides career 43.11exploration and training in national skill standards for health care and long-term care and 43.12that is consistent with Minnesota graduation standards and other related requirements;43.13(2) offer programs for high school students that provide training in health and 43.14long-term care careers with credits that articulate into postsecondary programs; and43.15(3) provide technical support to the participating health care and long-term care 43.16employer to enable the use of the employer's facilities and programs for kindergarten to 43.17grade 12 health and long-term care careers education.43.18    Subd. 2.Eligible activities.Eligible activities must focus on students from racial, 43.19ethnic, or cultural populations experiencing health disparities. Eligible activities include 43.20the following:43.21(1) health careers exploration activities for students from racial, ethnic, or cultural 43.22populations experiencing health disparities;43.23(2) elementary, secondary, and postsecondary education activities to improve the 43.24academic readiness to enter health professions education programs for students from 43.25racial, ethnic, or cultural populations experiencing health disparities;43.26(3) health careers mentoring for students from racial, ethnic, or cultural populations 43.27experiencing health disparities, including support for faculty involved in mentoring these 43.28students enrolled in or interested in entering health professions education programs;43.29(4) secondary and postsecondary summer health care internships that provide 43.30students from racial, ethnic, or cultural populations experiencing health disparities with 43.31formal exposure to a health care profession in an employment setting;43.32(5) health careers preparation, guidance, and support for students from racial, ethnic, 43.33or cultural populations experiencing health disparities who are interested in entering health 43.34professions education programs;43.35(6) health careers preparation, guidance, and support for students from racial, 43.36ethnic, or cultural populations experiencing health disparities who are enrolled in health 44.1professions education programs and other activities to improve retention of these students 44.2in health professions education programs; or44.3(7) other activities the commissioner has reason to believe will prepare, attract, and 44.4educate for health careers students from racial, ethnic, or cultural populations experiencing 44.5health disparities.44.6    Subd. 3.Applications.Applicants seeking a grant must apply to the commissioner. 44.7Applications must include the following:44.8(1) a description of the need, challenges, or barriers that the proposed project will 44.9address;44.10(2) a detailed description of the project and how it proposes to address the challenges 44.11or barriers;44.12(3) a budget detailing all sources of funds for the project and how project funds 44.13will be used;44.14(4) baseline data showing the current percentage of program applicants and current 44.15students who are from racial, ethnic, or cultural populations experiencing health disparities;44.16(5) a description of achievable objectives that demonstrate how the project will 44.17contribute to increasing the number of students from racial, ethnic, or cultural populations 44.18experiencing health disparities who are entering health professions in Minnesota;44.19(6) a timeline for completion of the project;44.20(7) roles and capabilities of responsible individuals and organizations, including 44.21partner organizations;44.22(8) a plan to evaluate project outcomes; and 44.23(9) other information the commissioner believes necessary to evaluate the 44.24application.44.25    Subd. 4.Consideration of applications.The commissioner must review each 44.26application to determine whether or not the application is complete and whether 44.27the applicant and the project are eligible for a grant. In evaluating applications, the 44.28commissioner must evaluate each application based on the following:44.29(1) the extent to which the applicant has demonstrated that its project is likely 44.30to contribute to increasing the number of American Indians and underrepresented 44.31populations of color entering health professions in Minnesota;44.32(2) the application's clarity and thoroughness in describing the challenges and 44.33barriers it is addressing;44.34(3) the extent to which the applicant appears likely to coordinate  project efforts 44.35with other organizations;44.36(4) the reasonableness of the project budget; and45.1(5) the organizational capacity of the applicant and its partners.45.2The commissioner may also take into account other relevant factors. During 45.3application review the commissioner may request additional information about a proposed 45.4project, including information on project cost. Failure to provide the information requested 45.5disqualifies an applicant.45.6    Subd. 5.Program oversight.The commissioner shall determine the amount of a 45.7grant to be given to an eligible applicant based on the relative strength of each eligible 45.8application and the funds available to the commissioner. The commissioner may collect 45.9from grantees any information necessary to evaluate the program.45.10    Sec. 11. Minnesota Statutes 2010, section 144.1501, subdivision 1, is amended to read:45.11    Subdivision 1. Definitions. (a) For purposes of this section, the following definitions 45.12apply.45.13(b) "Dentist" means an individual who is licensed to practice dentistry.45.14(c) "Designated rural area" means:45.15(1) an area in Minnesota outside the counties of Anoka, Carver, Dakota, Hennepin, 45.16Ramsey, Scott, and Washington, excluding the cities of Duluth, Mankato, Moorhead, 45.17Rochester, and St. Cloud; or45.18(2) a municipal corporation, as defined under section 471.634, that is physically 45.19located, in whole or in part, in an area defined as a designated rural area under clause (1).45.20an area defined as a small rural area or isolated rural area according to the four category 45.21classifications of the Rural Urban Commuting Area system developed for the United 45.22States Health Resources and Services Administration.45.23(d) "Emergency circumstances" means those conditions that make it impossible for 45.24the participant to fulfill the service commitment, including death, total and permanent 45.25disability, or temporary disability lasting more than two years.45.26(e) "Medical resident" means an individual participating in a medical residency in 45.27family practice, internal medicine, obstetrics and gynecology, pediatrics, or psychiatry.45.28(f) "Midlevel practitioner" means a nurse practitioner, nurse-midwife, nurse 45.29anesthetist, advanced clinical nurse specialist, or physician assistant.45.30(g) "Nurse" means an individual who has completed training and received all 45.31licensing or certification necessary to perform duties as a licensed practical nurse or 45.32registered nurse.45.33(h) "Nurse-midwife" means a registered nurse who has graduated from a program of 45.34study designed to prepare registered nurses for advanced practice as nurse-midwives.46.1(i) "Nurse practitioner" means a registered nurse who has graduated from a program 46.2of study designed to prepare registered nurses for advanced practice as nurse practitioners.46.3(j) "Pharmacist" means an individual with a valid license issued under chapter 151.46.4(k) "Physician" means an individual who is licensed to practice medicine in the areas 46.5of family practice, internal medicine, obstetrics and gynecology, pediatrics, or psychiatry.46.6(l) "Physician assistant" means a person licensed under chapter 147A.46.7(m) "Qualified educational loan" means a government, commercial, or foundation 46.8loan for actual costs paid for tuition, reasonable education expenses, and reasonable living 46.9expenses related to the graduate or undergraduate education of a health care professional.46.10(n) "Underserved urban community" means a Minnesota urban area or population 46.11included in the list of designated primary medical care health professional shortage areas 46.12(HPSAs), medically underserved areas (MUAs), or medically underserved populations 46.13(MUPs) maintained and updated by the United States Department of Health and Human 46.14Services.46.15    Sec. 12. Minnesota Statutes 2010, section 144.1501, subdivision 4, is amended to read:46.16    Subd. 4. Loan forgiveness. The commissioner of health may select applicants 46.17each year for participation in the loan forgiveness program, within the limits of available 46.18funding. The commissioner shall distribute available funds for loan forgiveness 46.19proportionally among the eligible professions according to the vacancy rate for each 46.20profession in the required geographic area, facility type, teaching area, patient group, 46.21or specialty type specified in subdivision 2. The commissioner shall allocate funds for 46.22physician loan forgiveness so that 75 percent of the funds available are used for rural 46.23physician loan forgiveness and 25 percent of the funds available are used for underserved 46.24urban communities and pediatric psychiatry loan forgiveness. If the commissioner does 46.25not receive enough qualified applicants each year to use the entire allocation of funds for 46.26any eligible profession, the remaining funds may be allocated proportionally among the 46.27other eligible professions according to the vacancy rate for each profession in the required 46.28geographic area, patient group, or facility type specified in subdivision 2. Applicants are 46.29responsible for securing their own qualified educational loans. The commissioner shall 46.30select participants based on their suitability for practice serving the required geographic 46.31area or facility type specified in subdivision 2, as indicated by experience or training. 46.32The commissioner shall give preference to applicants from racial, ethnic, or cultural 46.33populations experiencing health disparities who are closest to completing their training46.34and who agree to serve in settings in Minnesota that provide health care services to at least 46.3550 percent American Indian or other populations of color, such as a federally recognized 47.1Native American reservation. For each year that a participant meets the service obligation 47.2required under subdivision 3, up to a maximum of four years, the commissioner shall make 47.3annual disbursements directly to the participant equivalent to 15 percent of the average 47.4educational debt for indebted graduates in their profession in the year closest to the 47.5applicant's selection for which information is available, not to exceed the balance of the 47.6participant's qualifying educational loans. Before receiving loan repayment disbursements 47.7and as requested, the participant must complete and return to the commissioner an affidavit 47.8of practice form provided by the commissioner verifying that the participant is practicing 47.9as required under subdivisions 2 and 3. The participant must provide the commissioner 47.10with verification that the full amount of loan repayment disbursement received by the 47.11participant has been applied toward the designated loans. After each disbursement, 47.12verification must be received by the commissioner and approved before the next loan 47.13repayment disbursement is made. Participants who move their practice remain eligible for 47.14loan repayment as long as they practice as required under subdivision 2.47.15    Sec. 13. [144.1503] HEALTH PROFESSIONS OPPORTUNITIES 47.16SCHOLARSHIP PROGRAM.47.17    Subdivision 1.Definitions.For purposes of this section, the following definitions 47.18apply: 47.19(a) "Certified clinical nurse specialist" means an individual licensed in Minnesota as 47.20a registered nurse and certified by a national nurse certification organization acceptable to 47.21the Minnesota Board of Nursing to practice as a clinical nurse specialist.47.22(b) "Certified nurse midwife" means an individual licensed in Minnesota as a 47.23registered nurse and certified by a national nurse certification organization acceptable to 47.24the Minnesota Board of Nursing to practice as a nurse midwife.47.25(c) "Certified nurse practitioner" means an individual licensed in Minnesota as a 47.26registered nurse and certified by a national nurse certification organization acceptable to 47.27the Minnesota Board of Nursing to practice as a nurse practitioner.47.28(d) "Chiropractor" means an individual licensed and regulated under sections 148.02 47.29to 148.108.47.30(e) "Dental therapist" means an individual licensed in the state and includes 47.31advanced dental therapists certified under section 150A.106.47.32(f) "Dentist" means an individual licensed in Minnesota as a dentist under chapter 47.33150A.47.34(g) "Eligible scholarship placement site" means a nonprofit, private, or public 47.35entity located in Minnesota that provides at least 50 percent of its health care services to 48.1American Indian or other populations of color, such as federally recognized American 48.2Indian reservations.48.3(h) "Emergency circumstances" means those conditions that make it impossible for 48.4the participant to fulfill the contractual requirements, including death, total and permanent 48.5disability, or temporary disability lasting more than two years.48.6(i) "Participant" means an individual receiving a scholarship under this program.48.7(j) "Physician assistant" means a person licensed in Minnesota under chapter 147A.48.8(k) "Primary care physician" means an individual licensed in Minnesota as a 48.9physician and board-certified in family practice, internal medicine, obstetrics and 48.10gynecology, pediatrics, geriatrics, emergency medicine, hospital medicine, or psychiatry.48.11(l) "Registered nurse" means an individual licensed by the Minnesota Board of 48.12Nursing to practice professional nursing.48.13    Subd. 2.Establishment and purpose.The commissioner shall establish a health 48.14professions opportunities scholarship program. The purpose of the program is to increase 48.15the number of students from racial, ethnic, or cultural populations experiencing health 48.16disparities who enter health professions.48.17    Subd. 3.Eligible students.To be eligible to apply to the commissioner for the 48.18scholarship program, an applicant must be:48.19(1) accepted for full-time study in a program of study that will result in licensure as 48.20a primary care physician, certified nurse practitioner, certified nurse midwife, certified 48.21clinical nurse specialist, chiropractor, physician assistant, registered nurse, dentist, or 48.22dental therapist;48.23(2) a Minnesota resident; and48.24(3) an individual from a racial, ethnic, or cultural population experiencing health 48.25disparities in the state.48.26    Subd. 4.Scholarship.The commissioner may award a scholarship for the cost of 48.27full tuition, fees, and living expenses up to $40,000 per year to eligible students. The 48.28commissioner will subtract the amount of other scholarship, grant, and gift awards to the 48.29participant from the award made by this program. Scholarship awards will be limited to 48.30the number of years for full-time enrollment in the applicant's program of study but will 48.31not include any years completed prior to applying. The commissioner shall determine the 48.32number of new scholarship awards made per fiscal year based on availability of state 48.33funding. Scholarship awards will be paid by the commissioner directly to the participant's 48.34educational institution after full-time enrollment is verified. Appropriations made to the 48.35scholarship program do not cancel and are available until expended.49.1    Subd. 5.Obligated service.A participant shall agree in contract to fulfill a 49.2three-year service obligation at an eligible scholar placement site upon completion of 49.3training, including residency, and obtaining Minnesota licensure. Participants must 49.4provide at least 32 hours of direct patient care per week for at least 45 weeks per year. 49.5Obligated service must start by March 31 of the year following completion of required 49.6training.49.7    Subd. 6.Affidavit of service required.Before starting a service obligation and 49.8annually thereafter, participants shall submit to the commissioner an affidavit of practice 49.9signed by a representative of their eligible scholar placement site verifying employment 49.10status and the number of weekly hours of direct patient care provided by the participant. 49.11Participants must also provide written notice to the commissioner within 30 days of:49.12(1) a change in name or address;49.13(2) a decision not to fulfill a service obligation; or49.14(3) cessation of obligated practice.49.15    Subd. 7.Penalty for nonfulfillment.If a participant does not complete the 49.16educational program, successfully obtain licensure, or fulfill the required minimum 49.17commitment of service according to subdivision 6, the commissioner of health shall collect 49.18from the participant the total amount awarded to the participant under the scholarship 49.19program plus interest at a rate established according to section 270C.40. Funds collected 49.20for nonfulfillment shall be credited to the health professions opportunities scholarship 49.21program. The commissioner shall allow waivers of all or part of the money owed the 49.22commissioner as a result of a nonfulfillment penalty due to emergency circumstances.49.23    Sec. 14. [144.586] PATIENT SAFETY SURVEY.49.24Hospitals licensed under section 144.55 must submit necessary information to the 49.25Leapfrog Group patient safety survey on an annual basis in order to publicly report patient 49.26safety information and track the progress of each hospital to improve quality, safety, 49.27and efficiency of care delivery.49.28    Sec. 15. Minnesota Statutes 2010, section 144.98, subdivision 2a, is amended to read:49.29    Subd. 2a. Standards.Notwithstanding the exemptions in subdivisions 8 and 9, the 49.30commissioner shall accredit laboratories according to the most current environmental 49.31laboratory accreditation standards under subdivision 1 and as accepted by the accreditation 49.32bodies recognized by the National Environmental Laboratory Accreditation Program 49.33(NELAP) of the NELAC Institute.50.1    Sec. 16. Minnesota Statutes 2010, section 144.98, subdivision 7, is amended to read:50.2    Subd. 7. Initial accreditation and annual accreditation renewal. (a) The 50.3commissioner shall issue or renew accreditation after receipt of the completed application 50.4and documentation required in this section, provided the laboratory maintains compliance 50.5with the standards specified in subdivision 2a, notwithstanding any exemptions under 50.6subdivisions 8 and 9, and attests to the compliance on the application form.50.7(b) The commissioner shall prorate the fees in subdivision 3 for laboratories 50.8applying for accreditation after December 31. The fees are prorated on a quarterly basis 50.9beginning with the quarter in which the commissioner receives the completed application 50.10from the laboratory.50.11(c) Applications for renewal of accreditation must be received by November 1 and 50.12no earlier than October 1 of each year. The commissioner shall send annual renewal 50.13notices to laboratories 90 days before expiration. Failure to receive a renewal notice does 50.14not exempt laboratories from meeting the annual November 1 renewal date.50.15(d) The commissioner shall issue all accreditations for the calendar year for which 50.16the application is made, and the accreditation shall expire on December 31 of that year.50.17(e) The accreditation of any laboratory that fails to submit a renewal application 50.18and fees to the commissioner expires automatically on December 31 without notice or 50.19further proceeding. Any person who operates a laboratory as accredited after expiration of 50.20accreditation or without having submitted an application and paid the fees is in violation 50.21of the provisions of this section and is subject to enforcement action under sections 50.22144.989
          to 
         144.993, the Health Enforcement Consolidation Act. A laboratory with expired 50.23accreditation may reapply under subdivision 6.50.24    Sec. 17. Minnesota Statutes 2010, section 144.98, is amended by adding a subdivision 50.25to read:50.26    Subd. 8.Exemption from national standards for quality control and personnel 50.27requirements.Effective January 1, 2012, a laboratory that analyzes samples for 50.28compliance with a permit issued under section 115.03, subdivision 5, may request 50.29exemption from the personnel requirements and specific quality control provisions for 50.30microbiology and chemistry stated in the national standards as incorporated by reference 50.31in subdivision 2a. The commissioner shall grant the exemption if the laboratory:50.32(1) complies with the methodology and quality control requirements, where 50.33available, in the most recent, approved edition of the Standard Methods for the 50.34Examination of Water and Wastewater as published by the Water Environment Federation; 50.35and51.1(2) supplies the name of the person meeting the requirements in section 115.73, or 51.2the personnel requirements in the national standard pursuant to subdivision 2a.51.3A laboratory applying for this exemption shall not apply for simultaneous 51.4accreditation under the national standard.51.5    Sec. 18. Minnesota Statutes 2010, section 144.98, is amended by adding a subdivision 51.6to read:51.7    Subd. 9.Exemption from national standards for proficiency testing frequency.51.8(a) Effective January 1, 2012, a laboratory applying for or requesting accreditation under 51.9the exemption in subdivision 8 must obtain an acceptable proficiency test result for each 51.10of the laboratory's accredited or requested fields of testing. The laboratory must analyze 51.11proficiency samples selected from one of two annual proficiency testing studies scheduled 51.12by the commissioner.51.13(b) If a laboratory fails to successfully complete the first scheduled proficiency 51.14study, the laboratory shall:51.15(1) obtain and analyze a supplemental test sample within 15 days of receiving the 51.16test report for the initial failed attempt; and51.17(2) participate in the second annual study as scheduled by the commissioner.51.18(c) If a laboratory does not submit results or fails two consecutive proficiency 51.19samples, the commissioner will revoke the laboratory's accreditation for the affected 51.20fields of testing.51.21(d) The commissioner may require a laboratory to analyze additional proficiency 51.22testing samples beyond what is required in this subdivision if information available to 51.23the commissioner indicates that the laboratory's analysis for the field of testing does not 51.24meet the requirements for accreditation.51.25(e) The commissioner may collect from laboratories accredited under the exemption 51.26in subdivision 8 any additional costs required to administer this subdivision and 51.27subdivision 8.51.28    Sec. 19. Minnesota Statutes 2010, section 144A.102, is amended to read:51.29144A.102 WAIVER FROM FEDERAL RULES AND REGULATIONS; 51.30PENALTIES.51.31(a) By January 2000, the commissioner of health shall work with providers to 51.32examine state and federal rules and regulations governing the provision of care in licensed 51.33nursing facilities and apply for federal waivers and identify necessary changes in state 51.34law to:52.1(1) allow the use of civil money penalties imposed upon nursing facilities to abate 52.2any deficiencies identified in a nursing facility's plan of correction; and52.3(2) stop the accrual of any fine imposed by the Health Department when a follow-up 52.4inspection survey is not conducted by the department within the regulatory deadline.52.5(b) By January 2012, the commissioner of health shall work with providers to 52.6examine state and federal rules and regulations governing the provision of care in licensed 52.7nursing facilities and apply for federal waivers and identify necessary changes in state 52.8law to:52.9(1) eliminate the requirement for written plans of correction from nursing homes for 52.10federal deficiencies issued at a scope and severity that is not widespread or in immediate 52.11jeopardy; and52.12(2) issue the federal survey form electronically to nursing homes.52.13The commissioner shall issue a report to the legislative chairs of the committees 52.14with jurisdiction over health and human services by January 31, 2012, on the status of 52.15implementation of this paragraph.52.16    Sec. 20. Minnesota Statutes 2010, section 144A.61, is amended by adding a 52.17subdivision to read:52.18    Subd. 9.Electronic transmission.The commissioner of health must accept 52.19electronic transmission of applications and supporting documentation for interstate 52.20endorsement for the nursing assistant registry.52.21    Sec. 21. Minnesota Statutes 2010, section 144E.123, is amended to read:52.22144E.123 PREHOSPITAL CARE DATA.52.23    Subdivision 1. Collection and maintenance. Until July 1, 2014, a licensee shall52.24may collect and provide prehospital care data to the board in a manner prescribed by the 52.25board. At a minimum, the data must include items identified by the board that are part of 52.26the National Uniform Emergency Medical Services Data Set. A licensee shall maintain 52.27prehospital care data for every response.52.28    Subd. 2. Copy to receiving hospital. If a patient is transported to a hospital, a copy 52.29of the ambulance report delineating prehospital medical care given shall be provided 52.30to the receiving hospital.52.31    Subd. 3. Review. Prehospital care data may be reviewed by the board or its 52.32designees. The data shall be classified as private data on individuals under chapter 13, the 52.33Minnesota Government Data Practices Act.53.1    Subd. 4.Penalty.Failure to report all information required by the board under this 53.2section shall constitute grounds for license revocation.53.3    Subd. 5.Working group.By October 1, 2011, the board must convene a working 53.4group composed of six members, three of which must be appointed by the board and three 53.5of which must be appointed by the Minnesota Ambulance Association, to redesign the 53.6board's policies related to collection of data from licenses. The issues to be considered 53.7include, but are not limited to, the following: user-friendly reporting requirements; data 53.8sets; improved accuracy of reported information; appropriate use of information gathered 53.9through the reporting system; and methods for minimizing the financial impact of data 53.10reporting on licenses, particularly for rural volunteer services. The working group must 53.11report its findings and recommendations to the board no later than January 1, 2014.53.12EFFECTIVE DATE.This section is effective the day following final enactment.53.13    Sec. 22. [145.9271] WHITE EARTH BAND URBAN CLINIC.53.14    Subdivision 1.Condition.If the White Earth Band of Ojibwe Indians accepts the 53.15amount transferred under section 62J.692, subdivision 4, paragraph (b), clause (1), then it 53.16must use the funds for purposes of this section.53.17    Subd. 2.Establish urban clinic.The White Earth Band of Ojibwe Indians shall 53.18establish and operate one or more health care clinics in the Minneapolis area or greater 53.19Minnesota to serve members of the White Earth Tribe and may use funds received under 53.20section 62J.692, subdivision 4, paragraph (b), clause (1), for application to qualify as a 53.21federally qualified health center.53.22    Subd. 3.Grant agreements.Before receiving the funds to be transferred under 53.23section 62J.692, subdivision 4, paragraph (b), clause (1), the White Earth Band of Ojibwe 53.24Indians is requested to submit to the commissioner of health a work plan and budget that 53.25describes its annual plan for the funds. The commissioner will incorporate the work 53.26plan and budget into a grant agreement between the commissioner and the White Earth 53.27Band of Ojibwe Indians. Before each successive disbursement, the White Earth Band of 53.28Ojibwe Indians is requested to submit a narrative progress report and an expenditure 53.29report to the commissioner.53.30    Sec. 23. [145.9272] COMMUNITY MENTAL HEALTH CENTER GRANTS.53.31    Subdivision 1.Definitions.For purposes of this section, "community mental 53.32health center" means an entity that is eligible for payment under section 256B.0625, 53.33subdivision 5.54.1    Subd. 2.Allocation of subsidies.The commissioner of health shall distribute, from 54.2money appropriated for this purpose, grants to community mental health centers operating 54.3in the state on July 1 of the year 2011 and each subsequent year for community mental 54.4health center services to low-income consumers and patients with mental illness. The 54.5amount of each grant shall be in proportion to each community mental health center's 54.6revenues received from state health care programs in the most recent calendar year for 54.7which data is available.54.8    Sec. 24. Minnesota Statutes 2010, section 145.928, subdivision 2, is amended to read:54.9    Subd. 2. State-community partnerships; plan. The commissioner, in partnership 54.10with culturally based community organizations; the Indian Affairs Council under section 54.113.922
         ; the Council on Affairs of Chicano/Latino People under section 
         3.9223; the Council 54.12on Black Minnesotans under section 
         3.9225; the Council on Asian-Pacific Minnesotans 54.13under section 
         3.9226; the Alliance for Racial and Cultural Health Equity; community 54.14health boards as defined in section 
         145A.02; and tribal governments, shall develop and 54.15implement a comprehensive, coordinated plan to reduce health disparities in the health 54.16disparity priority areas identified in subdivision 1. 54.17    Sec. 25. [145.929] PROFESSIONALS FROM POPULATIONS WITH HEALTH 54.18DISPARITIES.54.19The commissioner of health shall survey the diversity of the work force for 54.20health-related professions and compare proportions in the allied health professions 54.21among populations experiencing health disparities, including cultural, racial, ethnic, 54.22and geographic factors, compared to the population of the state. Based on this survey, 54.23the commissioner shall determine on an annual basis the ratio of training and residency 54.24positions needed versus those available based on funding capacity.54.25    Sec. 26. Minnesota Statutes 2010, section 145.986, is amended by adding a subdivision 54.26to read:54.27    Subd. 7.Consultation and engagement of consumers and communities with 54.28poorer health and outcomes.Communities who receive state and federal health 54.29grants must demonstrate to the commissioner that the applicant or grantee consulted 54.30with and engaged local consumers, community organizations, and leaders representing 54.31the subgroups of the community that experience the greatest health disparities in the 54.32development of the local plan and that the plan incorporates components and activities 54.33that reflect the needs and preferences of these communities.  The plan must also include 55.1a process for ongoing consultation and engagement of these consumers, community 55.2organizations, and leaders in the implementation of the plan and activities funded by 55.3state grants.55.4    Sec. 27. Minnesota Statutes 2010, section 145.986, is amended by adding a subdivision 55.5to read:55.6    Subd. 8.Coordination with payment reform demonstration projects.A 55.7community who received a health improvement plan grant under this section and 55.8a payment reform demonstration project authorized under section 256B.0755 shall 55.9coordinate activities to improve the health of the communities and patients served by both 55.10the health improvement plan and the demonstration project provider.55.11    Sec. 28. [145.987] COMMUNITY HEALTH CENTERS DEVELOPMENT 55.12GRANTS FOR UNDERSERVED COMMUNITIES.55.13(a) The commissioner of health shall award grants from money appropriated for this 55.14purpose to expand community health centers, as defined in section 145.9269, subdivision 55.151, in the state through the establishment of new community health centers or sites in 55.16areas defined as small rural areas or isolated rural areas according to the four category 55.17classification of the Rural Urban Commuting Area system developed for the United States 55.18Health Resources and Services Administration or serving underserved patient populations 55.19who experience the greatest disparities in health outcomes.55.20(b) Grant funds may be used to pay for:55.21(1) costs for an organization to develop and submit a proposal to the federal 55.22government for the designation of a new community health center or site;55.23(2) costs of engaging underserved communities, health care providers, local 55.24government agencies, or businesses in a process of developing a plan for a new center or 55.25site to serve people in that community; and55.26(3) costs of planning, designing, remodeling, constructing, or purchasing equipment 55.27for a new center or site.55.28Funds may not be used for operating costs.55.29(d) A proposal must demonstrate that racial and ethnic communities to be served by 55.30the community health center were consulted with and participated in the development of 55.31the proposal.55.32(e) The commissioner shall award grants on a competitive basis based on the 55.33following criteria: 55.34(1) the unmet need in the underserved community;56.1(2) the degree of disparities in health outcomes in the underserved community; and56.2(3) the extent to which people from the underserved community participated in 56.3the development of the proposal.56.4    Sec. 29. Minnesota Statutes 2010, section 145A.17, subdivision 3, is amended to read:56.5    Subd. 3. Requirements for programs; process. (a) Community health boards 56.6and tribal governments that receive funding under this section must submit a plan to 56.7the commissioner describing a multidisciplinary approach to targeted home visiting for 56.8families. The plan must be submitted on forms provided by the commissioner. At a 56.9minimum, the plan must include the following:56.10    (1) a description of outreach strategies to families prenatally or at birth;56.11    (2) provisions for the seamless delivery of health, safety, and early learning services;56.12    (3) methods to promote continuity of services when families move within the state;56.13    (4) a description of the community demographics;56.14    (5) a plan for meeting outcome measures; and56.15    (6) a proposed work plan that includes:56.16    (i) coordination to ensure nonduplication of services for children and families;56.17    (ii) a description of the strategies to ensure that children and families at greatest risk 56.18receive appropriate services; and56.19    (iii) collaboration with multidisciplinary partners including public health, 56.20ECFE, Head Start, community health workers, social workers, community home 56.21visiting programs, school districts, and other relevant partners. Letters of intent from 56.22multidisciplinary partners must be submitted with the plan.56.23    (b) Each program that receives funds must accomplish the following program 56.24requirements:56.25    (1) use a community-based strategy to provide preventive and early intervention 56.26home visiting services;56.27    (2) offer a home visit by a trained home visitor. If a home visit is accepted, the first 56.28home visit must occur prenatally or as soon after birth as possible and must include a 56.29public health nursing assessment by a public health nurse;56.30    (3) offer, at a minimum, information on infant care, child growth and development, 56.31positive parenting, preventing diseases, preventing exposure to environmental hazards, 56.32and support services available in the community;56.33    (4) provide information on and referrals to health care services, if needed, including 56.34information on and assistance in applying for health care coverage for which the child or 57.1family may be eligible; and provide information on preventive services, developmental 57.2assessments, and the availability of public assistance programs as appropriate;57.3    (5) provide youth development programs when appropriate;57.4    (6) recruit home visitors who will represent, to the extent possible, the races, 57.5cultures, and languages spoken by families that may be served;57.6    (7) train and supervise home visitors in accordance with the requirements established 57.7under subdivision 4;57.8    (8) maximize resources and minimize duplication by coordinating or contracting 57.9with local social and human services organizations, education organizations, and other 57.10appropriate governmental entities and community-based organizations and agencies;57.11    (9) utilize appropriate racial and ethnic approaches to providing home visiting 57.12services; and57.13    (10) connect eligible families, as needed, to additional resources available in the 57.14community, including, but not limited to, early care and education programs, health or 57.15mental health services, family literacy programs, employment agencies, social services, 57.16and child care resources and referral agencies.57.17    (c) When available, programs that receive funds under this section must offer or 57.18provide the family with a referral to center-based or group meetings that meet at least 57.19once per month for those families identified with additional needs. The meetings must 57.20focus on further enhancing the information, activities, and skill-building addressed during 57.21home visitation; offering opportunities for parents to meet with and support each other; 57.22and offering infants and toddlers a safe, nurturing, and stimulating environment for 57.23socialization and supervised play with qualified teachers.57.24    (d) Funds available under this section shall not be used for medical services. The 57.25commissioner shall establish an administrative cost limit for recipients of funds. The 57.26outcome measures established under subdivision 6 must be specified to recipients of 57.27funds at the time the funds are distributed.57.28    (e) Data collected on individuals served by the home visiting programs must remain 57.29confidential and must not be disclosed by providers of home visiting services without a 57.30specific informed written consent that identifies disclosures to be made. Upon request, 57.31agencies providing home visiting services must provide recipients with information on 57.32disclosures, including the names of entities and individuals receiving the information and 57.33the general purpose of the disclosure. Prospective and current recipients of home visiting 57.34services must be told and informed in writing that written consent for disclosure of data is 57.35not required for access to home visiting services.58.1(f) Upon initial contact with a family, programs that receive funding under this 58.2section must request permission from the family to share with other family service 58.3providers information about services the family is receiving and unmet needs of the family 58.4in order to select a lead agency for the family and coordinate available resources. For 58.5purposes of this paragraph, the term "family service providers" includes local public 58.6health, social services, school districts, Head Start programs, health care providers, and 58.7other public agencies.58.8    Sec. 30. Minnesota Statutes 2010, section 157.15, is amended by adding a subdivision 58.9to read:58.10    Subd. 7a.Limited food establishment."Limited food establishment" means a food 58.11and beverage service establishment that primarily provides beverages that consist of 58.12combining dry mixes and water or ice for immediate service to the consumer. Limited 58.13food establishments must use equipment and utensils that are nontoxic, durable, and retain 58.14their characteristic qualities under normal use conditions and may request a variance for 58.15plumbing requirements from the commissioner.58.16    Sec. 31. Minnesota Statutes 2010, section 297F.10, subdivision 1, is amended to read:58.17    Subdivision 1. Tax and use tax on cigarettes. Revenue received from cigarette 58.18taxes, as well as related penalties, interest, license fees, and miscellaneous sources of 58.19revenue shall be deposited by the commissioner in the state treasury and credited as 58.20follows:58.21(1) $22,220,000 for fiscal year 2006 and $22,250,000 for fiscal year 2007 and each 58.22year thereafter must be credited to the Academic Health Center special revenue fund 58.23hereby created and is annually appropriated to the Board of Regents at the University of 58.24Minnesota for Academic Health Center funding at the University of Minnesota; and58.25(2) $8,553,000 for fiscal year 2006 and, $8,550,000 for fiscal year 2007 and, 58.26$8,337,000 for fiscal year 2012, and $6,781,000 each year thereafter must be credited to 58.27the medical education and research costs account hereby created in the special revenue 58.28fund and is annually appropriated to the commissioner of health for distribution under 58.29section 
         62J.692, subdivision 4 or 11, as appropriate; and58.30(3) the balance of the revenues derived from taxes, penalties, and interest (under 58.31this chapter) and from license fees and miscellaneous sources of revenue shall be credited 58.32to the general fund.58.33    Sec. 32. TRANSFER OF HEALTH QUALITY DATA COLLECTION.59.1    Subdivision 1.Transfer.The duties and activities of the commissioner of 59.2health conducted pursuant to Minnesota Statutes, chapter 62U, are transferred to the 59.3commissioner of human services.59.4    Subd. 2.Effect of transfer.Minnesota Statutes, section 15.039 applies to the 59.5transfer required in subdivision 1.59.6    Subd. 3.Effective date.The transfer required in subdivision 1 is effective July 1, 59.72011.59.8    Subd. 4.Suspended data collection.Data collection under Minnesota Statutes, 59.9section 62U.04, subdivision 4, is suspended, effective July 1, 2011.59.10    Subd. 5.Commissioner of human services.(a) During the 2012 legislative session, 59.11the commissioner of human services, in consultation with the revisor of statutes, shall 59.12submit to the legislature a bill making all statutory changes required by the reorganization 59.13required under subdivision 1.59.14(b) By July 1, 2013, the commissioner must make recommendations to the legislature 59.15for collection of encounter data for state health care programs, including SEGIP, through a 59.16mechanism that allows a third-party contractor to capture data as it is transmitted through 59.17existing claims processing mechanisms.59.18    Sec. 33. PATIENT AND COMMUNITY ENGAGEMENT IN PAYMENT 59.19REFORM AND HEALTH CARE PROGRAM REFORMS.59.20    Subdivision 1.Implementation of data system improvements.The commissioners 59.21of health and human services shall implement the recommendations regarding data on 59.22health disparities that were contained in the report prepared under Laws 2010, First 59.23Special Session chapter 1, article 19, section 23, in consultation with an advisory work 59.24group representing racial and ethnic groups and representatives of government and private 59.25sector health care organizations. Among other activities, the commissioners shall:59.26(1) continue engagement with diverse communities on collection of and access to 59.27racial and ethnic data from state agencies, health care providers, and health plans;59.28(2) develop a plan to make data more accessible to communities;59.29(3) develop consistent data elements across programs when feasible; and59.30(4) develop consistent policies on data sampling.59.31    Subd. 2.Patient and community engagement.The commissioner of health, in 59.32cooperation with the commissioners of human services and commerce, shall consult with 59.33an advisory committee representing racial and ethnic groups regarding the implementation 59.34of subdivision 1 and major agency activities related to state and federal health care reform, 59.35payment reform demonstration projects, state health care program reforms, improvements 60.1in quality and patient satisfaction measures, and major changes in state public health 60.2priorities and strategies.  At the request of the advisory committee established under Laws 60.32010, First Special Session chapter 1, article 19, section 23, the commissioner shall 60.4designate a private sector organization of multiple racial and ethnic groups to serve as the 60.5advisory committee under this subdivision.60.6    Sec. 34. EVALUATION OF HEALTH AND HUMAN SERVICES REGULATORY 60.7RESPONSIBILITIES.60.8(a) The commissioner of health, in consultation with the commissioner of human 60.9services, shall evaluate and recommend options for reorganizing health and human 60.10services regulatory responsibilities in both agencies to provide better efficiency and 60.11operational cost savings while maintaining the protection of the health, safety, and welfare 60.12of the public. Regulatory responsibilities that are to be evaluated are those found in 60.13Minnesota Statutes, chapters 62D, 62N, 62R, 62T, 144A, 144D, 144G, 146A, 146B, 60.14149A, 153A, 245A, 245B, and 245C, and sections 62Q.19, 144.058, 144.0722, 144.50, 60.15144.651, 148.511, 148.6401, 148.995, 256B.692, 626.556, and 626.557.60.16(b) The evaluation and recommendations shall be submitted in a report to the 60.17legislative committees with jurisdiction over health and human services no later than 60.18February 15, 2012, and shall include, at a minimum, the following:60.19(1) whether the regulatory responsibilities of each agency should be combined into 60.20a separate agency;60.21(2) whether the regulatory responsibilities of each agency should be merged into 60.22an existing agency;60.23(3) what cost savings would result by merging the activities regardless of where 60.24they are located;60.25(4) what additional costs would result if the activities were merged;60.26(5) whether there are additional regulatory responsibilities in both agencies that 60.27should be considered in any reorganization; and60.28(6) for each option recommended, projected cost and a timetable and identification 60.29of the necessary steps and requirements for a successful transition period.60.30    Sec. 35. TRANSFER OF THE HEALTH ECONOMICS PROGRAM.60.31    Subdivision 1.Transfer.The duties and activities of the health economics program 60.32at the Minnesota Department of Health conducted pursuant to Minnesota Statutes, chapter 60.3362J, are transferred to the commissioner of commerce.61.1    Subd. 2.Effect of transfer.Minnesota Statutes, section 15.039, applies to the 61.2transfer required in subdivision 1.61.3    Subd. 3.Commissioner of commerce.During the 2012 legislative session, the 61.4commissioner of commerce, in consultation with the revisor of statutes, shall submit to 61.5the legislature a bill making all statutory changes required by the reorganization required 61.6under subdivision 1.61.7    Subd. 4.Effective date.The transfer required in subdivision 1 is effective July 1, 61.82011.61.9    Sec. 36. STUDY OF FOR-PROFIT HEALTH MAINTENANCE 61.10ORGANIZATIONS.61.11The commissioner of health shall contract with an entity with expertise in health 61.12economics and health care delivery and quality to study the efficiency, costs, service 61.13quality, and enrollee satisfaction of for-profit health maintenance organizations, relative to 61.14not-for-profit health maintenance organizations operating in Minnesota and other states. 61.15The study findings must address whether the state of Minnesota could: (1) reduce medical 61.16assistance and MinnesotaCare costs and costs of providing coverage to state employees; 61.17and (2) maintain or improve the quality of care provided to state health care program 61.18enrollees and state employees if for-profit health maintenance organizations were allowed 61.19to operate in the state. The commissioner shall require the entity under contract to report 61.20study findings to the commissioner and the legislature by January 15, 2012.61.21    Sec. 37. MINNESOTA TASK FORCE ON PREMATURITY.61.22    Subdivision 1.Establishment.The Minnesota Task Force on Prematurity is 61.23established to evaluate and make recommendations on methods for reducing prematurity 61.24and improving premature infant health care in the state.61.25    Subd. 2.Membership; meetings; staff.(a) The task force shall be composed of at 61.26least the following members, who serve at the pleasure of their appointing authority:61.27(1) 15 representatives of the Minnesota Prematurity Coalition including, but not 61.28limited to, health care providers who treat pregnant women or neonates, organizations 61.29focused on preterm births, early childhood education and development professionals, and 61.30families affected by prematurity;61.31(2) one representative appointed by the commissioner of human services;61.32(3) two representatives appointed by the commissioner of health;61.33(4) one representative appointed by the commissioner of education; 62.1(5) two members of the house of representatives, one appointed by the speaker of 62.2the house and one appointed by the minority leader; and62.3(6) two members of the senate, appointed according to the rules of the senate.62.4(b) Members of the task force serve without compensation or payment of expenses.62.5(c) The commissioner of health must convene the first meeting of the Minnesota 62.6Task Force on Prematurity by July 31, 2011. The task force must continue to meet at 62.7least quarterly. Staffing and technical assistance shall be provided by the Minnesota 62.8Perinatal Coalition.62.9    Subd. 3.Duties.The task force must report the current state of prematurity in 62.10Minnesota and develop recommendations on strategies for reducing prematurity and 62.11improving premature infant health care in the state by considering the following:62.12(1) standards of care for premature infants born less than 37 weeks gestational age, 62.13including recommendations to improve hospital discharge and follow-up care procedures;62.14(2) coordination of information among appropriate professional and advocacy 62.15organizations on measures to improve health care for infants born prematurely;62.16(3) identification and centralization of available resources to improve access and 62.17awareness for caregivers of premature infants;62.18(4) development and dissemination of evidence-based practices through networking 62.19and educational opportunities; 62.20(5) a review of relevant evidence-based research regarding the causes and effects of 62.21premature births in Minnesota;62.22(6) a review of relevant evidence-based research regarding premature infant health 62.23care, including methods for improving quality of and access to care for premature infants; 62.24and62.25(7) identification of gaps in public reporting measures and possible effects of these 62.26measures on prematurity rates.62.27    Subd. 4.Report; expiration.(a) By November 30, 2011, the task force must submit 62.28a report on the current state of prematurity in Minnesota to the chairs of the legislative 62.29policy committees on health and human services.62.30(b) By January 15, 2013, the task force must report its final recommendations, 62.31including any draft legislation necessary for implementation, to the chairs of the legislative 62.32policy committees on health and human services.62.33(c) This task force expires on January 31, 2013, or upon submission of the final 62.34report required in paragraph (b), whichever is earlier.62.35    Sec. 38. NURSING HOME REGULATORY EFFICIENCY.63.1The commissioner of health shall work with stakeholders to review, develop, 63.2implement, and recommend legislative changes in the nursing home licensure process that 63.3address efficiency, eliminate duplication, and ensure positive resident clinical outcomes. 63.4The commissioner shall ensure that the changes are cost-neutral.63.5    Sec. 39.  REPEALER.63.6(a) Minnesota Statutes 2010, sections 62J.17, subdivisions 1, 3, 5a, 6a, and 8; 63.762J.321, subdivision 5a; 62J.381; 62J.41, subdivisions 1 and 2; and 144.1464, are repealed.63.8(b) Minnesota Statutes 2010, section 145A.14, subdivisions 1 and 2, are repealed 63.9effective January 1, 2012.63.10(c) Minnesota Rules, parts 4651.0100, subparts 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 63.1114, 15, 16, 16a, 18, 19, 20, 20a, 21, 22, and 23; 4651.0110, subparts 2, 2a, 3, 4, and 5; 63.124651.0120; 4651.0130; 4651.0140; and 4651.0150, are repealed effective July 1, 2011.63.13ARTICLE 363.14MISCELLANEOUS63.15    Section 1. Minnesota Statutes 2010, section 3.98, is amended by adding a subdivision 63.16to read:63.17    Subd. 5.Health note.The commissioner of health, in consultation with other state 63.18agencies, shall develop a report and recommendations for the legislature for a process 63.19through which a health impact review of proposed legislation may be requested by a 63.20legislative committee chair and ranking minority members of the house of representatives 63.21and senate committees with jurisdiction over health and human services finance and 63.22policy issues to estimate the impact of the proposed legislation on costs of health care for 63.23public employees, state health care programs, private employers, local governments, or 63.24Minnesota individuals and families, including costs related to the impact of the legislation 63.25on the health status of the state or a community. The commissioner may consult with 63.26local and private public health organizations and other persons or organizations in the 63.27development of the report and recommendations. The report and recommendations shall 63.28be provided to the legislature by January 15, 2012.63.29    Sec. 2. Minnesota Statutes 2010, section 245A.14, subdivision 4, is amended to read:63.30    Subd. 4. Special family day care homes. Nonresidential child care programs 63.31serving 14 or fewer children that are conducted at a location other than the license holder's 63.32own residence shall be licensed under this section and the rules governing family day 63.33care or group family day care if:64.1(a) the license holder is the primary provider of care and the nonresidential child 64.2care program is conducted in a dwelling that is located on a residential lot;64.3(b) the license holder is an employer who may or may not be the primary provider 64.4of care, and the purpose for the child care program is to provide child care services to 64.5children of the license holder's employees;64.6(c) the license holder is a church or religious organization;64.7(d) the license holder is a community collaborative child care provider. For 64.8purposes of this subdivision, a community collaborative child care provider is a provider 64.9participating in a cooperative agreement with a community action agency as defined in 64.10section 256E.31; or64.11(e) the license holder is a not-for-profit agency that provides child care in a dwelling 64.12located on a residential lot and the license holder maintains two or more contracts with 64.13community employers or other community organizations to provide child care services. 64.14The county licensing agency may grant a capacity variance to a license holder licensed 64.15under this paragraph to exceed the licensed capacity of 14 children by no more than five 64.16children during transition periods related to the work schedules of parents, if the license 64.17holder meets the following requirements:64.18(1) the program does not exceed a capacity of 14 children more than a cumulative 64.19total of four hours per day;64.20(2) the program meets a one to seven staff-to-child ratio during the variance period;64.21(3) all employees receive at least an extra four hours of training per year than 64.22required in the rules governing family child care each year;64.23(4) the facility has square footage required per child under Minnesota Rules, part 64.249502.0425;64.25(5) the program is in compliance with local zoning regulations;64.26(6) the program is in compliance with the applicable fire code as follows:64.27(i) if the program serves more than five children older than 2-1/2 years of age, 64.28but no more than five children 2-1/2 years of age or less, the applicable fire code is 64.29educational occupancy, as provided in Group E Occupancy under the Minnesota State 64.30Fire Code 2003, Section 202; or64.31(ii) if the program serves more than five children 2-1/2 years of age or less, the 64.32applicable fire code is Group I-4 Occupancies, as provided in the Minnesota State Fire 64.33Code 2003, Section 202; and64.34(7) any age and capacity limitations required by the fire code inspection and square 64.35footage determinations shall be printed on the license.; or65.1(f) the license holder is the primary provider of care and has located the licensed 65.2child care program in a commercial space, if the license holder meets the following 65.3requirements:65.4(1) the program is in compliance with local zoning regulations;65.5(2) the program is in compliance with the applicable fire code as follows:65.6(i) if the program serves more than five children older than 2-1/2 years of age, 65.7but no more than five children 2-1/2 years of age or less, the applicable fire code is 65.8educational occupancy, as provided in Group E Occupancy under the Minnesota State 65.9Fire Code 2003, Section 202; or65.10(ii) if the program serves more than five children 2-1/2 years of age or less, the 65.11applicable fire code is Group I-4 Occupancies, as provided under the Minnesota State Fire 65.12Code 2003, Section 202;65.13(3) any age and capacity limitations required by the fire code inspection and square 65.14footage determinations are printed on the license; and65.15(4) the license holder prominently displays the license issued by the commissioner 65.16which contains the statement "This special family child care provider is not licensed as a 65.17child care center."65.18    Sec. 3. Minnesota Statutes 2010, section 256.01, is amended by adding a subdivision 65.19to read:65.20    Subd. 33.Combined application form; referral of veterans.The commissioner 65.21shall modify the combined application form to add a question asking applicants: "Are 65.22you a United States military veteran?" The commissioner shall ensure that all applicants 65.23who identify themselves as veterans are referred to a county veterans service officer for 65.24assistance in applying to the United States Department of Veterans Affairs for any benefits 65.25for which they may be eligible.65.26    Sec. 4. Minnesota Statutes 2010, section 256B.14, is amended by adding a subdivision 65.27to read:65.28    Subd. 3a.Spousal contribution.(a) For purposes of this subdivision, the following 65.29terms have the meanings given:65.30(1) "commissioner" means the commissioner of human services;65.31(2) "community spouse" means the spouse, who lives in the community, of an 65.32individual receiving long-term care services in a long-term care facility or home care 65.33services pursuant to the Medicaid waiver for elderly services under section 256B.0915 65.34or the alternative care program under section 256B.0913. A community spouse does not 66.1include a spouse living in the community who receives a monthly income allowance 66.2under section 256B.058, subdivision 2, or who receives home care services or home 66.3and community-based services under section 256B.0915, 256B.092, or 256B.49, or the 66.4alternative care program under section 256B.0913;66.5(3) "cost of care" means the actual fee-for-service costs or capitated payments for 66.6the long-term care spouse;66.7(4) "department" means the Department of Human Services;66.8(5) "disabled child" means a blind or permanently and totally disabled son or 66.9daughter of any age as defined in the Supplemental Security Income program or the state 66.10medical review team;66.11(6) "income" means earned and unearned income, attributable to the community 66.12spouse, used to calculate the adjusted gross income on the prior year's income tax return. 66.13Evidence of income includes, but is not limited to, W-2 and 1099 forms; and66.14(7) "long-term care spouse" means the spouse who is receiving long-term care 66.15services in a long-term care facility or home care services pursuant to the Medicaid 66.16waiver for elderly services under section 256B.0915 or the alternative care program under 66.17section 256B.0913.66.18(b) The community spouse of a long-term care spouse who receives medical 66.19assistance or alternative care services has an obligation to contribute to the cost of care. 66.20The community spouse must pay a monthly fee on a sliding fee scale based on the 66.21community spouse's income. If a minor or disabled child resides with and receives care 66.22from the community spouse, then no fee shall be assessed.66.23(c) For a community spouse with an income equal to or greater than 250 percent of 66.24the federal poverty guidelines for a family of two and less than 545 percent of the federal 66.25poverty guidelines for a family of two, the spousal contribution shall be determined using 66.26a sliding fee scale established by the commissioner that begins at 7.5 percent of the 66.27community spouse's income and increases to 15 percent for those with an income of up to 66.28545 percent of the federal poverty guidelines for a family of two.66.29(d) For a community spouse with an income equal to or greater than 545 percent of 66.30the federal poverty guidelines for a family of two and less than 750 percent of the federal 66.31poverty guidelines for a family of two, the spousal contribution shall be determined using 66.32a sliding fee scale established by the commissioner that begins at 15 percent of the 66.33community spouse's income and increases to 25 percent for those with an income of up to 66.34750 percent of the federal poverty guidelines for a family of two.66.35(e) For a community spouse with an income equal to or greater than 750 percent of 66.36the federal poverty guidelines for a family of two and less than 975 percent of the federal 67.1poverty guidelines for a family of two, the spousal contribution shall be determined using 67.2a sliding fee scale established by the commissioner that begins at 25 percent of the 67.3community spouse's income and increases to 33 percent for those with an income of up to 67.4975 percent of the federal poverty guidelines for a family of two.67.5(f) For a community spouse with an income equal to or greater than 975 percent of 67.6the federal poverty guidelines for a family of two, the spousal contribution shall be 33 67.7percent of the community spouse's income.67.8(g) The spousal contribution shall be explained in writing at the time eligibility for 67.9medical assistance or alternative care is being determined. In addition to explaining the 67.10formula used to determine the fee, the commissioner shall provide written information 67.11describing how to request a variance for undue hardship, how a contribution may be 67.12reviewed or redetermined, the right to appeal a contribution determination, and that 67.13the consequences for not complying with a request to provide information shall be an 67.14assessment against the community spouse for the full cost of care for the long-term care 67.15spouse.67.16(h) The contribution shall be assessed for each month the long-term care spouse 67.17has a community spouse and is eligible for medical assistance payment of long-term 67.18care services or alternative care.67.19(i) The spousal contribution shall be reviewed at least once every 12 months and 67.20when there is a loss or gain in income in excess of ten percent. Thirty days prior to a 67.21review or redetermination, written notice must be provided to the community spouse 67.22and must contain the amount the spouse is required to contribute, notice of the right to 67.23redetermination and appeal, and the telephone number of the division at the department 67.24that is responsible for redetermination and review. If, after review, the contribution amount 67.25is to be adjusted, the commissioner shall mail a written notice to the community spouse 30 67.26days in advance of the effective date of the change in the amount of the contribution.67.27(1) The spouse shall notify the commissioner within 30 days of a gain or loss in 67.28income in excess of ten percent and provide the department supporting documentation to 67.29verify the need for redetermination of the fee.67.30(2) When a spouse requests a review or redetermination of the contribution amount, 67.31a request for information shall be sent to the spouse within ten calendar days after the 67.32commissioner receives the request for review.67.33(3) No action shall be taken on a review or redetermination until the required 67.34information is received by the commissioner.68.1(4) The review of the spousal contribution shall be completed within ten days after 68.2the commissioner receives completed information that verifies a loss or gain in income 68.3in excess of ten percent.68.4(5) An increase in the contribution amount is effective in the month in which the 68.5increase in spousal income occurs.68.6(6) A decrease in the contribution amount is effective in the month the spouse 68.7verifies the reduction in income, retroactive to no longer than six months.68.8(j) In no case shall the spousal contribution exceed the amount of medical assistance 68.9expended or the cost of alternative care services for the care of the long-term care spouse. 68.10Annually, upon redetermination, or at termination of eligibility, the total amount of 68.11medical assistance paid or costs of alternative care for the care of the long-term care spouse 68.12and the total amount of the spousal contribution shall be compared. If the total amount of 68.13the spousal contribution exceeds the total amount of medical assistance expended or cost 68.14of alternative care, then the department shall reimburse the community spouse the excess 68.15amount if the long-term care spouse is no longer receiving services, or apply the excess 68.16amount to the spousal contribution due until the excess amount is exhausted.68.17(k) A community spouse may request a variance by submitting a written request 68.18and supporting documentation that payment of the calculated contribution would cause 68.19an undue hardship. An undue hardship is defined as the inability to pay the calculated 68.20contribution due to medical expenses incurred by the community spouse. Documentation 68.21must include proof of medical expenses incurred by the community spouse since the last 68.22annual redetermination of the contribution amount that are not reimbursable by any public 68.23or private source, and are a type, regardless of amount, that would be allowable as a 68.24federal tax deduction under the Internal Revenue Code.68.25(1) A spouse who requests a variance from a notice of an increase in the amount 68.26of spousal contribution shall continue to make monthly payments at the lower amount 68.27pending determination of the variance request. A spouse who requests a variance from 68.28the initial determination shall not be required to make a payment pending determination 68.29of the variance request. Payments made pending outcome of the variance request that 68.30result in overpayment must be returned to the spouse, if the community spouse is no 68.31longer receiving services, or applied to the spousal contribution in the current year. If the 68.32variance is denied, the spouse shall pay the additional amount due from the effective date 68.33of the increase or the total amount due from the effective date of the original notice of 68.34determination of the spousal contribution.69.1(2) A spouse who is granted a variance shall sign a written agreement in which the 69.2spouse agrees to report to the commissioner any changes in circumstances that gave rise 69.3to the undue hardship variance.69.4(3) When the commissioner receives a request for a variance, written notice of a 69.5grant or denial of the variance shall be mailed to the spouse within 30 calendar days 69.6after the commissioner receives the financial information required in this clause. The 69.7granting of a variance will necessitate a written agreement between the spouse and the 69.8commissioner with regard to the specific terms of the variance. The variance will not 69.9become effective until the written agreement is signed by the spouse. If the commissioner 69.10denies in whole or in part the request for a variance, the denial notice shall set forth in 69.11writing the reasons for the denial that address the specific hardship and right to appeal.69.12(4) If a variance is granted, the term of the variance shall not exceed 12 months 69.13unless otherwise determined by the commissioner.69.14(5) Undue hardship does not include action taken by a spouse which divested or 69.15diverted income in order to avoid being assessed a spousal contribution.69.16(l) A spouse aggrieved by an action under this subdivision has the right to appeal 69.17under subdivision 4. If the spouse appeals on or before the effective date of an increase in 69.18the spousal fee, the spouse shall continue to make payments to the commissioner in the 69.19lower amount while the appeal is pending. A spouse appealing an initial determination 69.20of a spousal contribution shall not be required to make monthly payments pending an 69.21appeal decision. Payments made that result in an overpayment shall be reimbursed to the 69.22spouse if the long-term care spouse is no longer receiving services, or applied to the 69.23spousal contribution remaining in the current year. If the commissioner's determination is 69.24affirmed, the community spouse shall pay within 90 calendar days of the order the total 69.25amount due from the effective date of the original notice of determination of the spousal 69.26contribution. The commissioner's order is binding on the spouse and the department and 69.27shall be implemented subject to section 256.045, subdivision 7. No additional notice is 69.28required to enforce the commissioner's order.69.29(m) If the commissioner finds that notice of the payment obligation was given to 69.30the community spouse and the spouse was determined to be able to pay, but that the 69.31spouse failed or refused to pay, a cause of action exists against the community spouse 69.32for that portion of medical assistance payment of long-term care services or alternative 69.33care services granted after notice was given to the community spouse. The action may 69.34be brought by the commissioner in the county where assistance was granted for the 69.35assistance together with the costs of disbursements incurred due to the action. In addition 69.36to granting the commissioner a money judgment, the court may, upon a motion or order to 70.1show cause, order continuing contributions by a community spouse found able to repay 70.2the commissioner. The order shall be effective only for the period of time during which 70.3a contribution shall be assessed.70.4    Sec. 5. Minnesota Statutes 2010, section 326B.175, is amended to read:70.5326B.175 ELEVATORS, ENTRANCES SEALED.70.6    Except as provided in section 326B.188, it shall be the duty of the department and 70.7the licensing authority of any municipality which adopts any such ordinance whenever 70.8it finds any such elevator under its jurisdiction in use in violation of any provision of 70.9sections 
         326B.163 to 
         326B.178 to seal the entrances of such elevator and attach a notice 70.10forbidding the use of such elevator until the provisions thereof are complied with.70.11    Sec. 6. [326B.188] COMPLIANCE WITH ELEVATOR CODE CHANGES.70.12(a) This section applies to code requirements for existing elevators and related 70.13devices under Minnesota Rules, chapter 1307, where the deadline set by law for meeting 70.14the code requirements is January 29, 2012, or later.70.15(b) If the department or municipality conducting elevator inspections within its 70.16jurisdiction notifies the owner of an existing elevator or related device of the code 70.17requirements before the effective date of this section, the owner may submit a compliance 70.18plan by December 30, 2011. If the department or municipality does not notify the owner 70.19of an existing elevator or related device of the code requirements before the effective 70.20date of this section, the department or municipality shall notify the owner of the code 70.21requirements and permit the owner to submit a compliance plan by December 30, 2011, or 70.22within 60 days after the date of notification, whichever is later.70.23(c) Any compliance plan submitted under this section must result in compliance with 70.24the code requirements by the later of January 29, 2012, or three years after submission of 70.25the compliance plan. Elevators and related devices that are not in compliance with the 70.26code requirements by the later of January 29, 2012, or three years after the submission of 70.27the compliance plan may be taken out of service as provided in section 326B.175.70.28    Sec. 7. DEVELOPMENTAL DISABILITY WAIVERED SERVICES.70.29    Subdivision 1.Purpose.All individuals in the state of Minnesota who are eligible 70.30for developmental disability waivered services are entitled to receive adequate services, 70.31within the limits of available funding, to ensure their basic needs for housing, food, health, 70.32and safety are met.71.1    Subd. 2.Instructions to commissioner.(a) No later than November 1, 2011, 71.2the commissioner of human services shall convene a workgroup to define the essential 71.3services required to adequately meet the needs of individuals who receive developmental 71.4disability waivered services. The commissioner shall identify the essential services in 71.5each of the following tiers:71.6(1) tier 1, services and costs associated with safety, food, housing, and health care;71.7(2) tier 2, services and costs associated with enhancements toward self-sufficiency; 71.8and71.9(3) tier 3, services and costs associated with quality of life improvements.71.10(b) The commissioner, or designee, and a representative designated by the counties 71.11shall cochair the workgroup. The workgroup shall consider Tier 1 services to be the most 71.12important and of highest priority for available funds, and may choose to implement a policy 71.13that all waiver-eligible individuals receive Tier 1 services within the limits of available 71.14funding before services from Tier 2 or 3 are offered to waiver-eligible individuals.71.15    Sec. 8. ANALYSIS OF PROGRAMS AND THEIR EFFECT ON MARRIAGES; 71.16REPORT.71.17(a) The commissioner of human services shall conduct an analysis of how current 71.18human services programs affect the motivation and capacity of individuals to form and 71.19sustain marriages in which to raise children. Programs to be examined in this marriage 71.20impact analysis may include, but are not limited to, medical assistance, MinnesotaCare, 71.21Minnesota family investment program, child protection, child support enforcement, and 71.22child welfare services.71.23(b) Before January 1, 2012, the commissioner shall submit a report to the legislature 71.24describing the results of this analysis and outline proposals to improve the ability of 71.25human services programs to help people who are interested in marriage to form and 71.26sustain marriages in which to raise children. The commissioner shall ensure that experts 71.27on marriage are consulted on the process of conducting the analysis and writing the report.71.28    Sec. 9. INSTRUCTIONS TO COMMISSIONER.71.29To offset the cost of implementing Minnesota Statutes, section 256B.14, subdivision 71.303a, the commissioner of human services shall collect from each county its proportionate 71.31share of the cost based on population of the county. At the end of each fiscal year, the 71.32commissioner shall divide ten percent of all collections made under Minnesota Statutes, 71.33section 256B.14, subdivision 3a, between the counties based on the population of the 71.34county.72.1    Sec. 10. LEGISLATIVE APPROVAL FOR FEDERAL FUNDS.72.2The commissioners of human services and health shall not expend any funding 72.3received through federal grants or subsequent renewal of federal grants without the 72.4approval of three of the four chairs and ranking minority members of the legislative 72.5committees with jurisdiction over health and human services finance.72.6ARTICLE 472.7HEALTH LICENSING FEES72.8    Section 1. Minnesota Statutes 2010, section 148.07, subdivision 1, is amended to read:72.9    Subdivision 1. Renewal fees. All persons practicing chiropractic within this state, 72.10or licensed so to do, shall pay, on or before the date of expiration of their licenses, to the 72.11Board of Chiropractic Examiners a renewal fee set by the board in accordance with section 72.1216A.1283, with a penalty set by the board for each month or portion thereof for which a 72.13license fee is in arrears and upon payment of the renewal and upon compliance with all the 72.14rules of the board, shall be entitled to renewal of their license.72.15    Sec. 2. Minnesota Statutes 2010, section 148.108, is amended by adding a subdivision 72.16to read:72.17    Subd. 4.Animal chiropractic.(a) Animal chiropractic registration fee is $125.72.18(b) Animal chiropractic registration renewal fee is $75.72.19(c) Animal chiropractic inactive renewal fee is $25.72.20    Sec. 3. Minnesota Statutes 2010, section 148.191, subdivision 2, is amended to read:72.21    Subd. 2. Powers. (a) The board is authorized to adopt and, from time to time, revise 72.22rules not inconsistent with the law, as may be necessary to enable it to carry into effect the 72.23provisions of sections 
         148.171 to 
         148.285. The board shall prescribe by rule curricula 72.24and standards for schools and courses preparing persons for licensure under sections 72.25148.171
          to 
         148.285. It shall conduct or provide for surveys of such schools and courses 72.26at such times as it may deem necessary. It shall approve such schools and courses as 72.27meet the requirements of sections 
         148.171 to 
         148.285 and board rules. It shall examine, 72.28license, and renew the license of duly qualified applicants. It shall hold examinations 72.29at least once in each year at such time and place as it may determine. It shall by rule 72.30adopt, evaluate, and periodically revise, as necessary, requirements for licensure and for 72.31registration and renewal of registration as defined in section 
         148.231. It shall maintain a 72.32record of all persons licensed by the board to practice professional or practical nursing and 72.33all registered nurses who hold Minnesota licensure and registration and are certified as 73.1advanced practice registered nurses. It shall cause the prosecution of all persons violating 73.2sections 
         148.171 to 
         148.285 and have power to incur such necessary expense therefor. 73.3It shall register public health nurses who meet educational and other requirements 73.4established by the board by rule, including payment of a fee. Prior to the adoption of rules, 73.5the board shall use the same procedures used by the Department of Health to certify public 73.6health nurses. It shall have power to issue subpoenas, and to compel the attendance of 73.7witnesses and the production of all necessary documents and other evidentiary material. 73.8Any board member may administer oaths to witnesses, or take their affirmation. It shall 73.9keep a record of all its proceedings. 73.10(b) The board shall have access to hospital, nursing home, and other medical records 73.11of a patient cared for by a nurse under review. If the board does not have a written consent 73.12from a patient permitting access to the patient's records, the nurse or facility shall delete 73.13any data in the record that identifies the patient before providing it to the board. The board 73.14shall have access to such other records as reasonably requested by the board to assist the 73.15board in its investigation. Nothing herein may be construed to allow access to any records 73.16protected by section 
         145.64. The board shall maintain any records obtained pursuant to 73.17this paragraph as investigative data under chapter 13. 73.18(c) The board may accept and expend grants or gifts of money or in-kind services 73.19from a person, a public or private entity, or any other source for purposes consistent with 73.20the board's role and within the scope of its statutory authority.73.21(d) The board may accept registration fees for meetings and conferences conducted 73.22for the purposes of board activities that are within the scope of its authority.73.23    Sec. 4. Minnesota Statutes 2010, section 148.212, subdivision 1, is amended to read:73.24    Subdivision 1. Issuance. Upon receipt of the applicable licensure or reregistration 73.25fee and permit fee, and in accordance with rules of the board, the board may issue 73.26a nonrenewable temporary permit to practice professional or practical nursing to an 73.27applicant for licensure or reregistration who is not the subject of a pending investigation 73.28or disciplinary action, nor disqualified for any other reason, under the following 73.29circumstances:73.30(a) The applicant for licensure by examination under section 148.211, subdivision 73.311, has graduated from an approved nursing program within the 60 days preceding board 73.32receipt of an affidavit of graduation or transcript and has been authorized by the board to 73.33write the licensure examination for the first time in the United States. The permit holder 73.34must practice professional or practical nursing under the direct supervision of a registered 74.1nurse. The permit is valid from the date of issue until the date the board takes action on 74.2the application or for 60 days whichever occurs first. 74.3(b) The applicant for licensure by endorsement under section 
         148.211, subdivision 2, 74.4is currently licensed to practice professional or practical nursing in another state, territory, 74.5or Canadian province. The permit is valid from submission of a proper request until the 74.6date of board action on the application or for 60 days, whichever comes first. 74.7(c) (b) The applicant for licensure by endorsement under section 
         148.211, 74.8subdivision 2
         , or for reregistration under section 
         148.231, subdivision 5, is currently 74.9registered in a formal, structured refresher course or its equivalent for nurses that includes 74.10clinical practice. 74.11(d) The applicant for licensure by examination under section 148.211, subdivision 74.121, who graduated from a nursing program in a country other than the United States or 74.13Canada has completed all requirements for licensure except registering for and taking the 74.14nurse licensure examination for the first time in the United States. The permit holder must 74.15practice professional nursing under the direct supervision of a registered nurse. The permit 74.16is valid from the date of issue until the date the board takes action on the application or for 74.1760 days, whichever occurs first. 74.18    Sec. 5. Minnesota Statutes 2010, section 148.231, is amended to read:74.19148.231 REGISTRATION; FAILURE TO REGISTER; REREGISTRATION; 74.20VERIFICATION.74.21    Subdivision 1. Registration. Every person licensed to practice professional or 74.22practical nursing must maintain with the board a current registration for practice as a 74.23registered nurse or licensed practical nurse which must be renewed at regular intervals 74.24established by the board by rule. No certificate of registration shall be issued by the board 74.25to a nurse until the nurse has submitted satisfactory evidence of compliance with the 74.26procedures and minimum requirements established by the board.74.27The fee for periodic registration for practice as a nurse shall be determined by the 74.28board by rule law. A penalty fee shall be added for any application received after the 74.29required date as specified by the board by rule. Upon receipt of the application and the 74.30required fees, the board shall verify the application and the evidence of completion of 74.31continuing education requirements in effect, and thereupon issue to the nurse a certificate 74.32of registration for the next renewal period.74.33    Subd. 4. Failure to register. Any person licensed under the provisions of sections 74.34148.171
          to 
         148.285 who fails to register within the required period shall not be entitled to 74.35practice nursing in this state as a registered nurse or licensed practical nurse. 75.1    Subd. 5. Reregistration. A person whose registration has lapsed desiring to 75.2resume practice shall make application for reregistration, submit satisfactory evidence of 75.3compliance with the procedures and requirements established by the board, and pay the 75.4registration reregistration fee for the current period to the board. A penalty fee shall be 75.5required from a person who practiced nursing without current registration. Thereupon, the75.6registration certificate shall be issued to the person who shall immediately be placed on 75.7the practicing list as a registered nurse or licensed practical nurse.75.8    Subd. 6. Verification. A person licensed under the provisions of sections 
         148.171 to 75.9148.285
          who requests the board to verify a Minnesota license to another state, territory, 75.10or country or to an agency, facility, school, or institution shall pay a fee to the board75.11for each verification. 75.12    Sec. 6. [148.242] FEES.75.13The fees specified in section 148.243 are nonrefundable and must be deposited in 75.14the state government special revenue fund.75.15    Sec. 7. [148.243] FEE AMOUNTS.75.16    Subdivision 1.Licensure by examination.The fee for licensure by examination is 75.17$105.75.18    Subd. 2.Reexamination fee.The reexamination fee is $60.75.19    Subd. 3.Licensure by endorsement.The fee for licensure by endorsement is $105.75.20    Subd. 4.Registration renewal.The fee for registration renewal is $85.75.21    Subd. 5.Reregistration.The fee for reregistration is $105.75.22    Subd. 6.Replacement license.The fee for a replacement license is $20.75.23    Subd. 7.Public health nurse certification.The fee for public health nurse 75.24certification is $30.75.25    Subd. 8.Drug Enforcement Administration verification for Advanced Practice 75.26Registered Nurse (APRN).The Drug Enforcement Administration verification for 75.27APRN is $50.75.28    Subd. 9.Licensure verification other than through Nursys.The fee for 75.29verification of licensure status other than through Nursys verification is $20.75.30    Subd. 10.Verification of examination scores.The fee for verification of 75.31examination scores is $20.75.32    Subd. 11.Microfilmed licensure application materials.The fee for a copy of 75.33microfilmed licensure application materials is $20.76.1    Subd. 12.Nursing business registration; initial application.The fee for the initial 76.2application for nursing business registration is $100.76.3    Subd. 13.Nursing business registration; annual application.The fee for the 76.4annual application for nursing business registration is $25.76.5    Subd. 14.Practicing without current registration.The fee for practicing without 76.6current registration is two times the amount of the current registration renewal fee for any 76.7part of the first calendar month, plus the current registration renewal fee for any part of 76.8any subsequent month up to 24 months.76.9    Subd. 15.Practicing without current APRN certification.The fee for practicing 76.10without current APRN certification is $200 for the first month or any part thereof, plus 76.11$100 for each subsequent month or part thereof.76.12    Subd. 16.Dishonored check fee.The service fee for a dishonored check is as 76.13provided in section 604.113.76.14    Subd. 17.Border state registry fee.The initial application fee for border state 76.15registration is $50. Any subsequent notice of employment change to remain or be 76.16reinstated on the registry is $50.76.17    Sec. 8. Minnesota Statutes 2010, section 148B.17, is amended to read:76.18148B.17 FEES.76.19    Subdivision. 1.Fees; Board of Marriage and Family Therapy.Each board shall 76.20by rule establish The board's fees, including late fees, for licenses and renewals are 76.21established so that the total fees collected by the board will as closely as possible equal 76.22anticipated expenditures during the fiscal biennium, as provided in section 
         16A.1285. 76.23Fees must be credited to accounts the board's account in the state government special 76.24revenue fund. 76.25    Subd. 2.Licensure and application fees.Nonrefundable licensure and application 76.26fees charged by the board are as follows:76.27(1) application fee for national examination is $220;76.28(2) application fee for Licensed Marriage and Family Therapist (LMFT) state 76.29examination is $110;76.30(3) initial LMFT license fee is prorated, but cannot exceed $125;76.31(4) annual renewal fee for LMFT license is $125;76.32(5) late fee for initial Licensed Associate Marriage and Family Therapist LAMFT 76.33license renewal is $50;76.34(6) application fee for LMFT licensure by reciprocity is $340;77.1(7) fee for initial Licensed Associate Marriage and Family Therapist (LAMFT) 77.2license is $75;77.3(8) annual renewal fee for LAMFT license is $75;77.4(9) late fee for LAMFT renewal is $50;77.5(10) fee for reinstatement of license is $150; and 77.6(11) fee for emeritus status is $125.77.7    Subd. 3.Other fees.Other fees charged by the board are as follows:77.8(1) sponsor application fee for approval of a continuing education course is $60;77.9(2) fee for license verification by mail is $10;77.10(3) duplicate license fee is $25;77.11(4) duplicate renewal card fee is $10;77.12(5) fee for licensee mailing list is $60;77.13(6) fee for a rule book is $10; and77.14(7) fees as authorized by section 148B.175, subdivision 6, clause (7).77.15    Sec. 9. Minnesota Statutes 2010, section 148B.33, subdivision 2, is amended to read:77.16    Subd. 2. Fee. Each applicant shall pay a nonrefundable application fee set by 77.17the board under section 148B.17.77.18    Sec. 10. Minnesota Statutes 2010, section 148B.52, is amended to read:77.19148B.52 DUTIES OF THE BOARD.77.20(a) The Board of Behavioral Health and Therapy shall:77.21(1) establish by rule appropriate techniques, including examinations and other 77.22methods, for determining whether applicants and licensees are qualified under sections 77.23148B.50
          to 
         148B.593; 77.24(2) establish by rule standards for professional conduct, including adoption of a 77.25Code of Professional Ethics and requirements for continuing education and supervision;77.26(3) issue licenses to individuals qualified under sections 
         148B.50 to 
         148B.593; 77.27(4) establish by rule standards for initial education including coursework for 77.28licensure and content of professional education;77.29(5) establish, maintain, and publish annually a register of current licensees and 77.30approved supervisors;77.31(6) establish initial and renewal application and examination fees sufficient to cover 77.32operating expenses of the board and its agents in accordance with section 16A.1283;78.1(7) educate the public about the existence and content of the laws and rules for 78.2licensed professional counselors to enable consumers to file complaints against licensees 78.3who may have violated the rules; and78.4(8) periodically evaluate its rules in order to refine the standards for licensing 78.5professional counselors and to improve the methods used to enforce the board's standards.78.6(b) The board may appoint a professional discipline committee for each occupational 78.7licensure regulated by the board, and may appoint a board member as chair. The 78.8professional discipline committee shall consist of five members representative of the 78.9licensed occupation and shall provide recommendations to the board with regard to rule 78.10techniques, standards, procedures, and related issues specific to the licensed occupation.78.11    Sec. 11. Minnesota Statutes 2010, section 150A.091, subdivision 2, is amended to read:78.12    Subd. 2. Application fees. Each applicant shall submit with a license, advanced 78.13dental therapist certificate, or permit application a nonrefundable fee in the following 78.14amounts in order to administratively process an application:78.15(1) dentist, $140;78.16(2) full faculty dentist, $140;78.17(2) (3) limited faculty dentist, $140;78.18(3) (4) resident dentist or dental provider, $55;78.19(5) advanced dental therapist, $100;78.20(4) (6) dental therapist, $100;78.21(5) (7) dental hygienist, $55;78.22(6) (8) licensed dental assistant, $55; and78.23(7) (9) dental assistant with a permit as described in Minnesota Rules, part 78.243100.8500, subpart 3, $15.78.25    Sec. 12. Minnesota Statutes 2010, section 150A.091, subdivision 3, is amended to read:78.26    Subd. 3. Initial license or permit fees. Along with the application fee, each of the 78.27following applicants shall submit a separate prorated initial license or permit fee. The 78.28prorated initial fee shall be established by the board based on the number of months of the 78.29applicant's initial term as described in Minnesota Rules, part 3100.1700, subpart 1a, not to 78.30exceed the following monthly fee amounts:78.31(1) dentist or full faculty dentist, $14 times the number of months of the initial term;78.32(2) dental therapist, $10 times the number of months of the initial term;78.33(3) dental hygienist, $5 times the number of months of the initial term;78.34(4) licensed dental assistant, $3 times the number of months of the initial term; and79.1(5) dental assistant with a permit as described in Minnesota Rules, part 3100.8500, 79.2subpart 3, $1 times the number of months of the initial term.79.3    Sec. 13. Minnesota Statutes 2010, section 150A.091, subdivision 4, is amended to read:79.4    Subd. 4. Annual license fees. Each limited faculty or resident dentist shall submit 79.5with an annual license renewal application a fee established by the board not to exceed 79.6the following amounts:79.7(1) limited faculty dentist, $168; and79.8(2) resident dentist or dental provider, $59.79.9    Sec. 14. Minnesota Statutes 2010, section 150A.091, subdivision 5, is amended to read:79.10    Subd. 5. Biennial license or permit fees. Each of the following applicants shall 79.11submit with a biennial license or permit renewal application a fee as established by the 79.12board, not to exceed the following amounts:79.13(1) dentist or full faculty dentist, $336;79.14(2) dental therapist, $180;79.15(3) dental hygienist, $118;79.16(4) licensed dental assistant, $80; and79.17(5) dental assistant with a permit as described in Minnesota Rules, part 3100.8500, 79.18subpart 3, $24.79.19    Sec. 15. Minnesota Statutes 2010, section 150A.091, subdivision 8, is amended to read:79.20    Subd. 8. Duplicate license or certificate fee. Each applicant shall submit, with 79.21a request for issuance of a duplicate of the original license, or of an annual or biennial 79.22renewal certificate for a license or permit, a fee in the following amounts:79.23(1) original dentist, full faculty dentist, dental therapist, dental hygiene, or dental 79.24assistant license, $35; and79.25(2) annual or biennial renewal certificates, $10.79.26    Sec. 16. Minnesota Statutes 2010, section 150A.091, is amended by adding a 79.27subdivision to read:79.28    Subd. 16.Failure of professional development portfolio audit.A licensee shall 79.29submit a fee as established by the board not to exceed the amount of $250 after failing 79.30two consecutive professional development portfolio audits and, thereafter, for each failed 79.31professional development portfolio audit under Minnesota Rules, part 3100.5300.80.1    Sec. 17. [151.065] FEE AMOUNTS.80.2    Subdivision 1.Application fees.Application fees for licensure and registration 80.3are as follows:80.4(1) pharmacist licensed by examination, $130;80.5(2) pharmacist licensed by reciprocity, $225;80.6(3) pharmacy intern, $30;80.7(4) pharmacy technician, $30;80.8(5) pharmacy, $190;80.9(6) drug wholesaler, legend drugs only, $200;80.10(7) drug wholesaler, legend and nonlegend drugs, $200;80.11(8) drug wholesaler, nonlegend drugs, veterinary legend drugs, or both, $175;80.12(9) drug wholesaler, medical gases, $150;80.13(10) drug wholesaler, also licensed as a pharmacy in Minnesota, $125;80.14(11) drug manufacturer, legend drugs only, $200;80.15(12) drug manufacturer, legend and nonlegend drugs, $200;80.16(13) drug manufacturer, nonlegend or veterinary legend drugs, $175;80.17(14) drug manufacturer, medical gases, $150;80.18(15) drug manufacturer, also licensed as a pharmacy in Minnesota, $125;80.19(16) medical gas distributor, $75;80.20(17) controlled substance researcher, $50; and80.21(18) pharmacy professional corporation, $100.80.22    Subd. 2.Original license fee.The pharmacist original licensure fee, $130.80.23    Subd. 3.Annual renewal fees.Annual licensure and registration renewal fees 80.24are as follows:80.25(1) pharmacist, $130;80.26(2) pharmacy technician, $30;80.27(3) pharmacy, $190;80.28(4) drug wholesaler, legend drugs only, $200;80.29(5) drug wholesaler, legend and nonlegend drugs, $200;80.30(6) drug wholesaler, nonlegend drugs, veterinary legend drugs, or both, $175;80.31(7) drug wholesaler, medical gases, $150;80.32(8) drug wholesaler, also licensed as a pharmacy in Minnesota, $125;80.33(9) drug manufacturer, legend drugs only, $200;80.34(10) drug manufacturer, legend and nonlegend drugs, $200;80.35(11) drug manufacturer, nonlegend, veterinary legend drugs, or both, $175;80.36(12) drug manufacturer, medical gases, $150;81.1(13) drug manufacturer, also licensed as a pharmacy in Minnesota, $125;81.2(14) medical gas distributor, $75;81.3(15) controlled substance researcher, $50; and81.4(16) pharmacy professional corporation, $45.81.5    Subd. 4.Miscellaneous fees.Fees for issuance of affidavits and duplicate licenses 81.6and certificates are as follows:81.7(1) intern affidavit, $15;81.8(2) duplicate small license, $15; and81.9(3) duplicate large certificate, $25.81.10    Subd. 5.Late fees.All annual renewal fees are subject to a 50 percent late fee if 81.11the renewal fee and application are not received by the board prior to the date specified 81.12by the board.81.13    Subd. 6.Reinstatement fees.(a) A pharmacist who has allowed the pharmacist's 81.14license to lapse may reinstate the license with board approval and upon payment of any 81.15fees and late fees in arrears, up to a maximum of $1,000.81.16(b) A pharmacy technician who has allowed the technician's registration to lapse 81.17may reinstate the registration with board approval and upon payment of any fees and late 81.18fees in arrears, up to a maximum of $90.81.19(c) An owner of a pharmacy, a drug wholesaler, a drug manufacturer, or a medical 81.20gas distributor who has allowed the license of the establishment to lapse may reinstate the 81.21license with board approval and upon payment of any fees and late fees in arrears.81.22(d) A controlled substance researcher who has allowed the researcher's registration 81.23to lapse may reinstate the registration with board approval and upon payment of any fees 81.24and late fees in arrears.81.25(e) A pharmacist owner of a professional corporation who has allowed the 81.26corporation's registration to lapse may reinstate the registration with board approval and 81.27upon payment of any fees and late fees in arrears.81.28    Sec. 18. Minnesota Statutes 2010, section 151.07, is amended to read:81.29151.07 MEETINGS; EXAMINATION FEE.81.30The board shall meet at times as may be necessary and as it may determine to 81.31examine applicants for licensure and to transact its other business, giving reasonable 81.32notice of all examinations by mail to known applicants therefor. The secretary shall record 81.33the names of all persons licensed by the board, together with the grounds upon which 81.34the right of each to licensure was claimed. The fee for examination shall be in such the 82.1 amount as the board may determine specified in section 151.065, which fee may in the 82.2discretion of the board be returned to applicants not taking the examination.82.3    Sec. 19. Minnesota Statutes 2010, section 151.101, is amended to read:82.4151.101 INTERNSHIP.82.5Upon payment of the fee specified in section 151.065, the board may license register82.6as an intern any natural persons who have satisfied the board that they are of good moral 82.7character, not physically or mentally unfit, and who have successfully completed the 82.8educational requirements for intern licensure registration prescribed by the board. The 82.9board shall prescribe standards and requirements for interns, pharmacist-preceptors, and 82.10internship training but may not require more than one year of such training.82.11The board in its discretion may accept internship experience obtained in another 82.12state provided the internship requirements in such other state are in the opinion of the 82.13board equivalent to those herein provided.82.14    Sec. 20. Minnesota Statutes 2010, section 151.102, is amended by adding a subdivision 82.15to read:82.16    Subd. 3.Registration fee.The board shall not register an individual as a pharmacy 82.17technician unless all applicable fees specified in section 151.065 have been paid.82.18    Sec. 21. Minnesota Statutes 2010, section 151.12, is amended to read:82.19151.12 RECIPROCITY; LICENSURE.82.20The board may in its discretion grant licensure without examination to any 82.21pharmacist licensed by the Board of Pharmacy or a similar board of another state which 82.22accords similar recognition to licensees of this state; provided, the requirements for 82.23licensure in such other state are in the opinion of the board equivalent to those herein 82.24provided. The fee for licensure shall be in such the amount as the board may determine by 82.25rule specified in section 151.065.82.26    Sec. 22. Minnesota Statutes 2010, section 151.13, subdivision 1, is amended to read:82.27    Subdivision 1. Renewal fee. Every person licensed by the board as a pharmacist 82.28shall pay to the board a the annual renewal fee to be fixed by it specified in section 82.29151.065. The board may promulgate by rule a charge to be assessed for the delinquent 82.30payment of a fee. the late fee specified in section 151.065 if the renewal fee and 82.31application are not received by the board prior to the date specified by the board. It shall 82.32be unlawful for any person licensed as a pharmacist who refuses or fails to pay such any 83.1applicable  renewal or late fee to practice pharmacy in this state. Every certificate and 83.2license shall expire at the time therein prescribed.83.3    Sec. 23. Minnesota Statutes 2010, section 151.19, is amended to read:83.4151.19 REGISTRATION; FEES.83.5    Subdivision 1. Pharmacy registration. The board shall require and provide for the 83.6annual registration of every pharmacy now or hereafter doing business within this state. 83.7Upon the payment of a any applicable  fee to be set by the board specified in section 83.8151.065, the board shall issue a registration certificate in such form as it may prescribe to 83.9such persons as may be qualified by law to conduct a pharmacy. Such certificate shall be 83.10displayed in a conspicuous place in the pharmacy for which it is issued and expire on the 83.1130th day of June following the date of issue. It shall be unlawful for any person to conduct 83.12a pharmacy unless such certificate has been issued to the person by the board.83.13    Subd. 2. Nonresident pharmacies. The board shall require and provide for an 83.14annual nonresident special pharmacy registration for all pharmacies located outside of this 83.15state that regularly dispense medications for Minnesota residents and mail, ship, or deliver 83.16prescription medications into this state. Nonresident special pharmacy registration shall 83.17be granted by the board upon payment of any applicable fee specified in section 151.065 83.18and the disclosure and certification by a pharmacy:83.19    (1) that it is licensed in the state in which the dispensing facility is located and from 83.20which the drugs are dispensed;83.21    (2) the location, names, and titles of all principal corporate officers and all 83.22pharmacists who are dispensing drugs to residents of this state;83.23    (3) that it complies with all lawful directions and requests for information from 83.24the Board of Pharmacy of all states in which it is licensed or registered, except that it 83.25shall respond directly to all communications from the board concerning emergency 83.26circumstances arising from the dispensing of drugs to residents of this state;83.27    (4) that it maintains its records of drugs dispensed to residents of this state so that the 83.28records are readily retrievable from the records of other drugs dispensed;83.29    (5) that it cooperates with the board in providing information to the Board of 83.30Pharmacy of the state in which it is licensed concerning matters related to the dispensing 83.31of drugs to residents of this state;83.32    (6) that during its regular hours of operation, but not less than six days per week, for 83.33a minimum of 40 hours per week, a toll-free telephone service is provided to facilitate 83.34communication between patients in this state and a pharmacist at the pharmacy who has 84.1access to the patients' records; the toll-free number must be disclosed on the label affixed 84.2to each container of drugs dispensed to residents of this state; and84.3    (7) that, upon request of a resident of a long-term care facility located within the 84.4state of Minnesota, the resident's authorized representative, or a contract pharmacy or 84.5licensed health care facility acting on behalf of the resident, the pharmacy will dispense 84.6medications prescribed for the resident in unit-dose packaging or, alternatively, comply 84.7with the provisions of section 
         151.415, subdivision 5.84.8    Subd. 3. Sale of federally restricted medical gases. The board shall require and 84.9provide for the annual registration of every person or establishment not licensed as a 84.10pharmacy or a practitioner engaged in the retail sale or distribution of federally restricted 84.11medical gases. Upon the payment of a any applicable  fee to be set by the board specified 84.12in section 151.065, the board shall issue a registration certificate in such form as it may 84.13prescribe to those persons or places that may be qualified to sell or distribute federally 84.14restricted medical gases. The certificate shall be displayed in a conspicuous place in the 84.15business for which it is issued and expire on the date set by the board. It is unlawful for 84.16a person to sell or distribute federally restricted medical gases unless a certificate has 84.17been issued to that person by the board.84.18    Sec. 24. Minnesota Statutes 2010, section 151.25, is amended to read:84.19151.25 REGISTRATION OF MANUFACTURERS; FEE; PROHIBITIONS.84.20The board shall require and provide for the annual registration of every person 84.21engaged in manufacturing drugs, medicines, chemicals, or poisons for medicinal purposes, 84.22now or hereafter doing business with accounts in this state. Upon a payment of a any 84.23applicable fee as set by the board specified in section 151.065, the board shall issue a 84.24registration certificate in such form as it may prescribe to such manufacturer. Such 84.25registration certificate shall be displayed in a conspicuous place in such manufacturer's 84.26or wholesaler's place of business for which it is issued and expire on the date set by the 84.27board. It shall be unlawful for any person to manufacture drugs, medicines, chemicals, 84.28or poisons for medicinal purposes unless such a certificate has been issued to the person 84.29by the board. It shall be unlawful for any person engaged in the manufacture of drugs, 84.30medicines, chemicals, or poisons for medicinal purposes, or the person's agent, to sell 84.31legend drugs to other than a pharmacy, except as provided in this chapter.84.32    Sec. 25. Minnesota Statutes 2010, section 151.47, subdivision 1, is amended to read:84.33    Subdivision 1. Requirements. All wholesale drug distributors are subject to the 84.34requirements in paragraphs (a) to (f).85.1(a) No person or distribution outlet shall act as a wholesale drug distributor without 85.2first obtaining a license from the board and paying the required any applicable  fee85.3specified in section 151.065.85.4(b) No license shall be issued or renewed for a wholesale drug distributor to operate 85.5unless the applicant agrees to operate in a manner prescribed by federal and state law and 85.6according to the rules adopted by the board.85.7(c) The board may require a separate license for each facility directly or indirectly 85.8owned or operated by the same business entity within the state, or for a parent entity 85.9with divisions, subsidiaries, or affiliate companies within the state, when operations 85.10are conducted at more than one location and joint ownership and control exists among 85.11all the entities.85.12(d) As a condition for receiving and retaining a wholesale drug distributor license 85.13issued under sections 
         151.42 to 
         151.51, an applicant shall satisfy the board that it has 85.14and will continuously maintain: 85.15(1) adequate storage conditions and facilities;85.16(2) minimum liability and other insurance as may be required under any applicable 85.17federal or state law;85.18(3) a viable security system that includes an after hours central alarm, or comparable 85.19entry detection capability; restricted access to the premises; comprehensive employment 85.20applicant screening; and safeguards against all forms of employee theft;85.21(4) a system of records describing all wholesale drug distributor activities set forth 85.22in section 
         151.44 for at least the most recent two-year period, which shall be reasonably 85.23accessible as defined by board regulations in any inspection authorized by the board; 85.24(5) principals and persons, including officers, directors, primary shareholders, 85.25and key management executives, who must at all times demonstrate and maintain their 85.26capability of conducting business in conformity with sound financial practices as well 85.27as state and federal law;85.28(6) complete, updated information, to be provided to the board as a condition for 85.29obtaining and retaining a license, about each wholesale drug distributor to be licensed, 85.30including all pertinent corporate licensee information, if applicable, or other ownership, 85.31principal, key personnel, and facilities information found to be necessary by the board;85.32(7) written policies and procedures that assure reasonable wholesale drug distributor 85.33preparation for, protection against, and handling of any facility security or operation 85.34problems, including, but not limited to, those caused by natural disaster or government 85.35emergency, inventory inaccuracies or product shipping and receiving, outdated product 86.1or other unauthorized product control, appropriate disposition of returned goods, and 86.2product recalls;86.3(8) sufficient inspection procedures for all incoming and outgoing product 86.4shipments; and86.5(9) operations in compliance with all federal requirements applicable to wholesale 86.6drug distribution.86.7(e) An agent or employee of any licensed wholesale drug distributor need not seek 86.8licensure under this section.86.9(f) A wholesale drug distributor shall file with the board an annual report, in a 86.10form and on the date prescribed by the board, identifying all payments, honoraria, 86.11reimbursement or other compensation authorized under section 
         151.461, clauses (3) to 86.12(5), paid to practitioners in Minnesota during the preceding calendar year. The report 86.13shall identify the nature and value of any payments totaling $100 or more, to a particular 86.14practitioner during the year, and shall identify the practitioner. Reports filed under this 86.15provision are public data. 86.16    Sec. 26. Minnesota Statutes 2010, section 151.48, is amended to read:86.17151.48 OUT-OF-STATE WHOLESALE DRUG DISTRIBUTOR LICENSING.86.18(a) It is unlawful for an out-of-state wholesale drug distributor to conduct business 86.19in the state without first obtaining a license from the board and paying the required any 86.20applicable fee specified in section 151.065.86.21(b) Application for an out-of-state wholesale drug distributor license under this 86.22section shall be made on a form furnished by the board.86.23(c) No person acting as principal or agent for any out-of-state wholesale drug 86.24distributor may sell or distribute drugs in the state unless the distributor has obtained 86.25a license.86.26(d) The board may adopt regulations that permit out-of-state wholesale drug 86.27distributors to obtain a license on the basis of reciprocity to the extent that an out-of-state 86.28wholesale drug distributor:86.29(1) possesses a valid license granted by another state under legal standards 86.30comparable to those that must be met by a wholesale drug distributor of this state as 86.31prerequisites for obtaining a license under the laws of this state; and86.32(2) can show that the other state would extend reciprocal treatment under its own 86.33laws to a wholesale drug distributor of this state.86.34    Sec. 27. Minnesota Statutes 2010, section 152.12, subdivision 3, is amended to read:87.1    Subd. 3. Research project use of controlled substances. Any qualified person 87.2may use controlled substances in the course of a bona fide research project but cannot 87.3administer or dispense such drugs to human beings unless such drugs are prescribed, 87.4dispensed and administered by a person lawfully authorized to do so. Every person 87.5who engages in research involving the use of such substances shall apply annually for 87.6registration by the state Board of Pharmacy and shall pay any applicable fee specified in 87.7section 151.065, provided that such registration shall not be required if the person is 87.8covered by and has complied with federal laws covering such research projects.87.9ARTICLE 587.10HEALTH CARE87.11    Section 1. Minnesota Statutes 2010, section 62E.08, subdivision 1, is amended to read:87.12    Subdivision 1. Establishment. The association shall establish the following 87.13maximum premiums to be charged for membership in the comprehensive health insurance 87.14plan:87.15(a) the premium for the number one qualified plan shall range from a minimum of 87.16101 percent to a maximum of 125 percent of the weighted average of rates charged by 87.17those insurers and health maintenance organizations with individuals enrolled in:87.18(1) $1,000 annual deductible individual plans of insurance in force in Minnesota;87.19(2) individual health maintenance organization contracts of coverage with a $1,000 87.20annual deductible which are in force in Minnesota; and87.21(3) other plans of coverage similar to plans offered by the association based on 87.22generally accepted actuarial principles;87.23(b) the premium for the number two qualified plan shall range from a minimum of 87.24101 percent to a maximum of 125 percent of the weighted average of rates charged by 87.25those insurers and health maintenance organizations with individuals enrolled in:87.26(1) $500 annual deductible individual plans of insurance in force in Minnesota;87.27(2) individual health maintenance organization contracts of coverage with a $500 87.28annual deductible which are in force in Minnesota; and87.29(3) other plans of coverage similar to plans offered by the association based on 87.30generally accepted actuarial principles;87.31(c) the premiums for the plans with a $2,000, $5,000, or $10,000 annual deductible 87.32shall range from a minimum of 101 percent to a maximum of 125 percent of the weighted 87.33average of rates charged by those insurers and health maintenance organizations with 87.34individuals enrolled in:88.1(1) $2,000, $5,000, or $10,000 annual deductible individual plans, respectively, in 88.2force in Minnesota; and88.3(2) individual health maintenance organization contracts of coverage with a $2,000, 88.4$5,000, or $10,000 annual deductible, respectively, which are in force in Minnesota; or88.5(3) other plans of coverage similar to plans offered by the association based on 88.6generally accepted actuarial principles;88.7(d) the premium for each type of Medicare supplement plan required to be offered 88.8by the association pursuant to section 
         62E.12 shall range from a minimum of 101 percent 88.9to a maximum of 125 percent of the weighted average of rates charged by those insurers 88.10and health maintenance organizations with individuals enrolled in: 88.11(1) Medicare supplement plans in force in Minnesota;88.12(2) health maintenance organization Medicare supplement contracts of coverage 88.13which are in force in Minnesota; and88.14(3) other plans of coverage similar to plans offered by the association based on 88.15generally accepted actuarial principles; and88.16(e) the charge for health maintenance organization coverage shall be based on 88.17generally accepted actuarial principles.; and88.18(f) the premium for a high-deductible, basic plan offered under section 62E.121 shall 88.19range from a minimum of 101 percent to a maximum of 125 percent of the weighted 88.20average of rates charged by those insurers and health maintenance organizations offering 88.21comparable plans outside of the Minnesota Comprehensive Health Association.88.22The list of insurers and health maintenance organizations whose rates are used to 88.23establish the premium for coverage offered by the association pursuant to paragraphs (a) 88.24to (d) and (f) shall be established by the commissioner on the basis of information which 88.25shall be provided to the association by all insurers and health maintenance organizations 88.26annually at the commissioner's request. This information shall include the number of 88.27individuals covered by each type of plan or contract specified in paragraphs (a) to (d) and 88.28(f) that is sold, issued, and renewed by the insurers and health maintenance organizations, 88.29including those plans or contracts available only on a renewal basis. The information shall 88.30also include the rates charged for each type of plan or contract.88.31In establishing premiums pursuant to this section, the association shall utilize 88.32generally accepted actuarial principles, provided that the association shall not discriminate 88.33in charging premiums based upon sex. In order to compute a weighted average for each 88.34type of plan or contract specified under paragraphs (a) to (d) and (f), the association 88.35shall, using the information collected pursuant to this subdivision, list insurers and health 88.36maintenance organizations in rank order of the total number of individuals covered by 89.1each insurer or health maintenance organization. The association shall then compute 89.2a weighted average of the rates charged for coverage by all the insurers and health 89.3maintenance organizations by:89.4(1) multiplying the numbers of individuals covered by each insurer or health 89.5maintenance organization by the rates charged for coverage;89.6(2) separately summing both the number of individuals covered by all the insurers 89.7and health maintenance organizations and all the products computed under clause (1); and89.8(3) dividing the total of the products computed under clause (1) by the total number 89.9of individuals covered.89.10The association may elect to use a sample of information from the insurers and 89.11health maintenance organizations for purposes of computing a weighted average. In no 89.12case, however, may a sample used by the association to compute a weighted average 89.13include information from fewer than the two insurers or health maintenance organizations 89.14highest in rank order.89.15    Sec. 2. [62E.121] HIGH-DEDUCTIBLE, BASIC PLAN.89.16    Subdivision 1.Required offering.The Minnesota Comprehensive Health 89.17Association shall offer a high-deductible, basic plan that meets the requirements specified 89.18in this section. The high-deductible, basic plan is a one-person plan. Any dependents 89.19must be covered separately.89.20    Subd. 2.Annual deductible; out-of-pocket maximum.(a) The plan shall provide 89.21the following in-network annual deductible options: $3,000, $6,000, $9,000, and $12,000. 89.22The in-network annual out-of-pocket maximum for each annual deductible option shall be 89.23$1,000 greater than the amount of the annual deductible.89.24(b) The deductible is subject to an annual increase based on the change in the 89.25Consumer Price Index (CPI).89.26    Subd. 3.Office visits for nonpreventive care.The following co-payments shall 89.27apply for each of the first three office visits per calendar year for nonpreventive care:89.28(1) $30 per visit for the $3,000 annual deductible option;89.29(2) $40 per visit for the $6,000 annual deductible option;89.30(3) $50 per visit for the $9,000 annual deductible option; and89.31(4) $60 per visit for the $12,000 annual deductible option.89.32For the fourth and subsequent visits during the calendar year, 80 percent coverage is 89.33provided under all deductible options, after the deductible is met.89.34    Subd. 4.Preventive care.One hundred percent coverage is provided for preventive 89.35care, and no co-payment, coinsurance, or deductible requirements apply.90.1    Subd. 5.Prescription drugs.A $10 co-payment applies to preferred generic drugs. 90.2Preferred brand-name drugs require an enrollee payment of 100 percent of the health 90.3plan's discounted rate.90.4    Subd. 6.Convenience care center visits.A $20 co-payment applies for the first 90.5three convenience care center visits during a calendar year. For the fourth and subsequent 90.6visits during a calendar year, 80 percent coverage is provided after the deductible is met.90.7    Subd. 7.Urgent care center visits.A $100 co-payment applies for the first urgent 90.8care center visit during a calendar year. For the second and subsequent visits during a 90.9calendar year, 80 percent coverage is provided after the deductible is met.90.10    Subd. 8.Emergency room visits.A $200 co-payment applies for the first 90.11emergency room visit during a calendar year. For the second and subsequent visits during 90.12a calendar year, 80 percent coverage is provided after the deductible is met.90.13    Subd. 9.Lab and x-ray; hospital services; ambulance; surgery.Lab and x-ray 90.14services, hospital services, ambulance services, and surgery are covered at 80 percent 90.15after the deductible is met.90.16    Subd. 10.Eyewear.The health plan pays up to $50 per calendar year for eyewear.90.17    Subd. 11.Maternity.Maternity, labor and delivery, and postpartum care are not 90.18covered. One hundred percent coverage is provided for prenatal care and no deductible 90.19applies.90.20    Subd. 12.Other eligible health care services.Other eligible health care services 90.21are covered at 80 percent after the deductible is met.90.22    Subd. 13.Option to remove mental health and substance abuse coverage.90.23Enrollees have the option of removing mental health and substance abuse coverage in 90.24exchange for a reduced premium.90.25    Subd. 14.Option to upgrade prescription drug coverage.Enrollees have 90.26the option to upgrade prescription drug coverage to include coverage for preferred 90.27brand-name drugs with a $50 co-payment and coverage for nonpreferred drugs with a 90.28$100 co-payment in exchange for an increased premium.90.29    Subd. 15.Out-of-network services.(a) The out-of-network annual deductible is 90.30double the in-network annual deductible.90.31(b) There is no out-of-pocket maximum for out-of-network services.90.32(c) Benefits for out-of-network services are covered at 60 percent after the deductible 90.33is met.90.34(d) The lifetime maximum benefit for out-of-network services is $1,000,000.90.35    Subd. 16.Services not covered.Services not covered include: custodial care 90.36or rest care; most dental services; cosmetic services; refractive eye surgery; infertility 91.1services; and services that are investigational, not medically necessary, or received while 91.2on military duty.91.3    Sec. 3. Minnesota Statutes 2010, section 62E.14, is amended by adding a subdivision 91.4to read:91.5    Subd. 4f.Waiver of preexisting conditions for persons covered by healthy 91.6Minnesota contribution program.A person may enroll in the comprehensive plan with 91.7a waiver of the preexisting condition limitation in subdivision 3 if the person is eligible for 91.8the healthy Minnesota contribution program, and has been denied coverage as described 91.9under section 256L.031, subdivision 6.91.10    Sec. 4. Minnesota Statutes 2010, section 62J.04, subdivision 9, is amended to read:91.11    Subd. 9. Growth limits; federal programs. The commissioners of health and 91.12human services shall establish a rate methodology for Medicare and Medicaid risk-based 91.13contracting with health plan companies that is consistent with statewide growth limits. 91.14The methodology shall be presented for review by the Minnesota Health Care Commission 91.15and the Legislative Commission on Health Care Access prior to the submission of a 91.16waiver request to the Centers for Medicare and Medicaid Services and subsequent 91.17implementation of the methodology.91.18    Sec. 5. Minnesota Statutes 2010, section 62J.692, subdivision 9, is amended to read:91.19    Subd. 9. Review of eligible providers. The commissioner and the Medical 91.20Education and Research Costs Advisory Committee may review provider groups included 91.21in the definition of a clinical medical education program to assure that the distribution of 91.22the funds continue to be consistent with the purpose of this section. The results of any 91.23such reviews must be reported to the Legislative Commission on Health Care Access91.24chairs and ranking minority members of the legislative committees with jurisdiction over 91.25health care policy and finance.91.26    Sec. 6. [62J.824] BILLING FOR PROCEDURES TO CORRECT MEDICAL 91.27ERRORS PROHIBITED.91.28A health care provider shall not bill a patient, and shall not be reimbursed, for 91.29any operation, treatment, or other care that is provided to reverse, correct, or otherwise 91.30minimize the affects of an adverse health care event, as described in section 144.7065, 91.31subdivisions 2 to 7, for which that health care provider is responsible.92.1    Sec. 7. Minnesota Statutes 2010, section 62Q.32, is amended to read:92.262Q.32 LOCAL OMBUDSPERSON.92.3County board or community health service agencies may establish an office of 92.4ombudsperson to provide a system of consumer advocacy for persons receiving health 92.5care services through a health plan company. The ombudsperson's functions may include, 92.6but are not limited to:92.7(a) mediation or advocacy on behalf of a person accessing the complaint and appeal 92.8procedures to ensure that necessary medical services are provided by the health plan 92.9company; and92.10(b) investigation of the quality of services provided to a person and determine the 92.11extent to which quality assurance mechanisms are needed or any other system change 92.12may be needed. The commissioner of health shall make recommendations for funding 92.13these functions including the amount of funding needed and a plan for distribution. The 92.14commissioner shall submit these recommendations to the Legislative Commission on 92.15Health Care Access by January 15, 1996.92.16    Sec. 8. Minnesota Statutes 2010, section 62U.04, subdivision 3, is amended to read:92.17    Subd. 3. Provider peer grouping. (a) The commissioner shall develop a peer 92.18grouping system for providers based on a combined measure that incorporates both 92.19provider risk-adjusted cost of care and quality of care, and for specific conditions as 92.20determined by the commissioner. In developing this system, the commissioner shall 92.21consult and coordinate with health care providers, health plan companies, state agencies, 92.22and organizations that work to improve health care quality in Minnesota. For purposes of 92.23the final establishment of the peer grouping system, the commissioner shall not contract 92.24with any private entity, organization, or consortium of entities that has or will have a direct 92.25financial interest in the outcome of the system.92.26    (b) By no later than October 15, 2010, the commissioner shall disseminate 92.27information to providers on their total cost of care, total resource use, total quality of care, 92.28and the total care results of the grouping developed under this subdivision in comparison 92.29to an appropriate peer group. Any analyses or reports that identify providers may only be 92.30published after the provider has been provided the opportunity by the commissioner to 92.31review the underlying data and submit comments. Providers may be given any data for 92.32which they are the subject of the data. The provider shall have 30 days to review the data 92.33for accuracy and initiate an appeal as specified in paragraph (d).92.34    (c) By no later than January 1, 2011, the commissioner shall disseminate information 92.35to providers on their condition-specific cost of care, condition-specific resource use, 93.1condition-specific quality of care, and the condition-specific results of the grouping 93.2developed under this subdivision in comparison to an appropriate peer group. Any 93.3analyses or reports that identify providers may only be published after the provider has 93.4been provided the opportunity by the commissioner to review the underlying data and 93.5submit comments. Providers may be given any data for which they are the subject of the 93.6data. The provider shall have 30 days to review the data for accuracy and initiate an 93.7appeal as specified in paragraph (d).93.8(d) The commissioner shall establish an appeals process to resolve disputes from 93.9providers regarding the accuracy of the data used to develop analyses or reports. When 93.10a provider appeals the accuracy of the data used to calculate the peer grouping system 93.11results, the provider shall:93.12(1) clearly indicate the reason they believe the data used to calculate the peer group 93.13system results are not accurate;93.14(2) provide evidence and documentation to support the reason that data was not 93.15accurate; and93.16(3) cooperate with the commissioner, including allowing the commissioner access to 93.17data necessary and relevant to resolving the dispute.93.18If a provider does not meet the requirements of this paragraph, a provider's appeal shall be 93.19considered withdrawn. The commissioner shall not publish results for a specific provider 93.20under paragraph (e) or (f) while that provider has an unresolved appeal.93.21    (e) Beginning January 1, 2011, the commissioner shall, no less than annually, 93.22publish information on providers' total cost, total resource use, total quality, and the results 93.23of the total care portion of the peer grouping process. The results that are published must 93.24be on a risk-adjusted basis.93.25(f) Beginning March 30, 2011, the commissioner shall no less than annually publish 93.26information on providers' condition-specific cost, condition-specific resource use, and 93.27condition-specific quality, and the results of the condition-specific portion of the peer 93.28grouping process. The results that are published must be on a risk-adjusted basis.93.29(g) Prior to disseminating data to providers under paragraph (b) or (c) or publishing 93.30information under paragraph (e) or (f), the commissioner shall ensure the scientific 93.31validity and reliability of the results according to the standards described in paragraph (h). 93.32If additional time is needed to establish the scientific validity and reliability of the results, 93.33the commissioner may delay the dissemination of data to providers under paragraph (b) 93.34or (c), or the publication of information under paragraph (e) or (f). If the delay is more 93.35than 60 days, the commissioner shall report in writing to the Legislative Commission on 94.1Health Care Access chairs and ranking minority members of the legislative committees 94.2with jurisdiction over health care policy and finance the following information:94.3(1) the reason for the delay;94.4(2) the actions being taken to resolve the delay and establish the scientific validity 94.5and reliability of the results; and94.6(3) the new dates by which the results shall be disseminated.94.7If there is a delay under this paragraph, the commissioner must disseminate the 94.8information to providers under paragraph (b) or (c) at least 90 days before publishing 94.9results under paragraph (e) or (f).94.10(h) The commissioner's assurance of valid and reliable clinic and hospital peer 94.11grouping performance results shall include, at a minimum, the following:94.12(1) use of the best available evidence, research, and methodologies; and94.13(2) establishment of an explicit minimum reliability threshold developed in 94.14collaboration with the subjects of the data and the users of the data, at a level not below 94.15nationally accepted standards where such standards exist.94.16In achieving these thresholds, the commissioner shall not aggregate clinics that are not 94.17part of the same system or practice group. The commissioner shall consult with and solicit 94.18feedback from representatives of physician clinics and hospitals during the peer grouping 94.19data analysis process to obtain input on the methodological options prior to final analysis 94.20and on the design, development, and testing of provider reports.94.21    Sec. 9. Minnesota Statutes 2010, section 62U.04, subdivision 9, is amended to read:94.22    Subd. 9. Uses of information. (a) By no later As coverage is offered, sold, issued, 94.23or renewed, but not less  than 12 months after the commissioner publishes the information 94.24in subdivision 3, paragraph (e):94.25    (1) the commissioner of management and budget shall use the information and 94.26methods developed under subdivision 3 to strengthen incentives for members of the state 94.27employee group insurance program to use high-quality, low-cost providers;94.28    (2) all political subdivisions, as defined in section 
         13.02, subdivision 11, that offer 94.29health benefits to their employees must offer plans that differentiate providers on their 94.30cost and quality performance and create incentives for members to use better-performing 94.31providers;94.32    (3) all health plan companies shall use the information and methods developed 94.33under subdivision 3 to develop products that encourage consumers to use high-quality, 94.34low-cost providers; and95.1    (4) health plan companies that issue health plans in the individual market or the 95.2small employer market must offer at least one health plan that uses the information 95.3developed under subdivision 3 to establish financial incentives for consumers to choose 95.4higher-quality, lower-cost providers through enrollee cost-sharing or selective provider 95.5networks.95.6    (b) By January 1, 2011, the commissioner of health shall report to the governor 95.7and the legislature on recommendations to encourage health plan companies to promote 95.8widespread adoption of products that encourage the use of high-quality, low-cost providers. 95.9The commissioner's recommendations may include tax incentives, public reporting of 95.10health plan performance, regulatory incentives or changes, and other strategies.95.11    Sec. 10. Minnesota Statutes 2010, section 62U.06, subdivision 2, is amended to read:95.12    Subd. 2. Legislative oversight. Beginning January 15, 2009, the commissioner 95.13of health shall submit to the Legislative Commission on Health Care Access chairs and 95.14ranking minority members of the legislative committees with jurisdiction over health care 95.15policy and finance periodic progress reports on the implementation of this chapter and 95.16sections 
         256B.0751 to 
         256B.0754.95.17    Sec. 11. Minnesota Statutes 2010, section 256.01, is amended by adding a subdivision 95.18to read:95.19    Subd. 33.Contingency contract fees.When the commissioner enters into 95.20a contingency-based contract for the purpose of recovering medical assistance or 95.21MinnesotaCare funds, the commissioner may retain that portion of the recovered funds 95.22equal to the amount of the contingency fee.95.23    Sec. 12. Minnesota Statutes 2010, section 256.01, is amended by adding a subdivision 95.24to read:95.25    Subd. 34.Elimination of certain provider reporting requirements; sunset of 95.26new requirements.(a) Notwithstanding any other law, rule, or provision to the contrary, 95.27effective July 1, 2012, the commissioner shall cease collecting from health care providers 95.28and purchasers all reports and data related to health care costs, quality, utilization, access, 95.29patient encounters, and disease surveillance and public health, and related to provider 95.30licensure, monitoring, finances, and regulation, unless the reports or data are necessary for 95.31federal compliance. For purposes of this subdivision, the term "health care providers and 95.32purchasers" has the meaning provided in section 62J.03, subdivision 8, except that it also 95.33includes nursing homes, health plan companies as defined in section 62Q.01, subdivision 96.14, and managed care and county-based purchasing plans delivering services under sections 96.2256B.69 and 256B.692.96.3(b) The commissioner shall present to the 2012 legislature draft legislation to repeal, 96.4effective July 1, 2012, the provider reporting requirements identified under paragraph (a) 96.5that are not necessary for federal compliance.96.6(c) The commissioner may establish new provider reporting requirements to take 96.7effect on or after July 1, 2012. These new reporting requirements must sunset five years 96.8from their effective date, unless they are renewed by the commissioner. All new provider 96.9reporting requirements and requests for their renewal shall not take effect unless they 96.10are enacted in state law.96.11    Sec. 13. Minnesota Statutes 2010, section 256.969, subdivision 2b, is amended to read:96.12    Subd. 2b. Operating payment rates. In determining operating payment rates for 96.13admissions occurring on or after the rate year beginning January 1, 1991, and every two 96.14years after, or more frequently as determined by the commissioner, the commissioner 96.15shall obtain operating data from an updated base year and establish operating payment 96.16rates per admission for each hospital based on the cost-finding methods and allowable 96.17costs of the Medicare program in effect during the base year. Rates under the general 96.18assistance medical care, medical assistance, and MinnesotaCare programs shall not be 96.19rebased to more current data on January 1, 1997, January 1, 2005, for the first 24 months 96.20of the rebased period beginning January 1, 2009. For the first 24 months of the rebased 96.21period beginning January 1, 2011, rates shall not be rebased, except that a Minnesota 96.22long-term hospital shall be rebased effective January 1, 2011, based on its most recent 96.23Medicare cost report ending on or before September 1, 2008, with the provisions under 96.24subdivisions 9 and 23, based on the rates in effect on December 31, 2010. For subsequent 96.25rate setting periods in which the base years are updated, a Minnesota long-term hospital's 96.26base year shall remain within the same period as other hospitals. Effective January 1, 96.272013, rates shall be rebased at full value Rates must not be rebased to more current data 96.28for the first six months of the rebased period beginning January 1, 2013. The base year 96.29operating payment rate per admission is standardized by the case mix index and adjusted 96.30by the hospital cost index, relative values, and disproportionate population adjustment. 96.31The cost and charge data used to establish operating rates shall only reflect inpatient 96.32services covered by medical assistance and shall not include property cost information 96.33and costs recognized in outlier payments.97.1    Sec. 14. Minnesota Statutes 2010, section 256.969, is amended by adding a subdivision 97.2to read:97.3    Subd. 31.Initiatives to reduce incidence of low birth-weight.The commissioner 97.4shall require hospitals located in the seven-county metropolitan area, as a condition of 97.5contract, to implement strategies to reduce the incidence of low birth-weight in geographic 97.6areas identified by the commissioner as having a higher than average incidence of low 97.7birth-weight, with special emphasis on areas within a one-mile radius of the hospital. 97.8These strategies may focus on smoking prevention and cessation, ensuring that pregnant 97.9women get adequate nutrition, and addressing demographic, social, and environmental 97.10risk factors. The strategies must coordinate health care with social services and the 97.11local public health system, and offer patient education through appropriate means. 97.12The commissioner shall require hospitals to submit proposed initiatives for approval 97.13to the commissioner by January 1, 2012, and the commissioner shall require hospitals 97.14to implement approved initiatives by July 1, 2012. The commissioner shall evaluate 97.15the strategies adopted to reduce low birth-weight, and shall require hospitals to submit 97.16outcome and other data necessary for the evaluation.97.17    Sec. 15. Minnesota Statutes 2010, section 256B.04, subdivision 18, is amended to read:97.18    Subd. 18. Applications for medical assistance.(a) The state agency may 97.19take applications for medical assistance and conduct eligibility determinations for 97.20MinnesotaCare enrollees.97.21    (b) The commissioner of human services shall modify the Minnesota health care 97.22programs application form to add a question asking applicants: "Are you a United States 97.23military veteran?"97.24    Sec. 16. Minnesota Statutes 2010, section 256B.05, is amended by adding a 97.25subdivision to read:97.26    Subd. 5.Technical assistance.The commissioner shall provide technical assistance 97.27to county agencies in processing complex medical assistance applications, including but 97.28not limited to applications for long-term care services. The commissioner shall provide 97.29this technical assistance using existing financial resources.97.30    Sec. 17. Minnesota Statutes 2010, section 256B.055, subdivision 15, is amended to 97.31read:97.32    Subd. 15. Adults without children.(a) Medical assistance may be paid for a 97.33person who is:98.1(1) at least age 21 and under age 65;98.2(2) not pregnant;98.3(3) not entitled to Medicare Part A or enrolled in Medicare Part B under Title XVIII 98.4of the Social Security Act;98.5(4) not an adult in a family with children as defined in section 
         256L.01, subdivision 98.63a; and98.7(5) not described in another subdivision of this section.98.8(b) If the federal government eliminates the federal Medicaid match or reduces the 98.9federal Medicaid matching rate beyond any adjustment required as part of the annual 98.10recalculation of the state's overall Medicaid matching rate for persons eligible under this 98.11subdivision, the commissioner shall eliminate coverage for persons enrolled under this 98.12subdivision and suspend new enrollment under this subdivision effective on the date 98.13of the elimination or reduction.98.14EFFECTIVE DATE.The amendments to this section are effective the day 98.15following final enactment and expire January 1, 2014.98.16    Sec. 18. Minnesota Statutes 2010, section 256B.056, subdivision 3, is amended to read:98.17    Subd. 3. Asset limitations for individuals and families.(a) To be eligible for 98.18medical assistance, a person must not individually own more than $3,000 in assets, or if a 98.19member of a household with two family members, husband and wife, or parent and child, 98.20the household must not own more than $6,000 in assets, plus $200 for each additional 98.21legal dependent. In addition to these maximum amounts, an eligible individual or family 98.22may accrue interest on these amounts, but they must be reduced to the maximum at the 98.23time of an eligibility redetermination. The accumulation of the clothing and personal 98.24needs allowance according to section 
         256B.35 must also be reduced to the maximum at 98.25the time of the eligibility redetermination. The value of assets that are not considered in 98.26determining eligibility for medical assistance is the value of those assets excluded under 98.27the supplemental security income program for aged, blind, and disabled persons, with 98.28the following exceptions:98.29    (1) household goods and personal effects are not considered;98.30    (2) capital and operating assets of a trade or business that the local agency determines 98.31are necessary to the person's ability to earn an income are not considered;98.32    (3) motor vehicles are excluded to the same extent excluded by the supplemental 98.33security income program;98.34    (4) assets designated as burial expenses are excluded to the same extent excluded by 98.35the supplemental security income program. Burial expenses funded by annuity contracts 99.1or life insurance policies must irrevocably designate the individual's estate as contingent 99.2beneficiary to the extent proceeds are not used for payment of selected burial expenses; and99.3    (5) effective upon federal approval, for a person who no longer qualifies as an 99.4employed person with a disability due to loss of earnings, assets allowed while eligible 99.5for medical assistance under section 
         256B.057, subdivision 9, are not considered for 12 99.6months, beginning with the first month of ineligibility as an employed person with a 99.7disability, to the extent that the person's total assets remain within the allowed limits of 99.8section 
         256B.057, subdivision 9, paragraph (c).99.9    (b) No asset limit shall apply to persons eligible under section 256B.055, subdivision 99.1015.99.11EFFECTIVE DATE.This section is effective January 1, 2012.99.12    Sec. 19. Minnesota Statutes 2010, section 256B.056, subdivision 4, is amended to read:99.13    Subd. 4. Income. (a) To be eligible for medical assistance, a person eligible under 99.14section 
         256B.055, subdivisions 7, 7a, and 12, may have income up to 100 percent of 99.15the federal poverty guidelines. Effective January 1, 2000, and each successive January, 99.16recipients of supplemental security income may have an income up to the supplemental 99.17security income standard in effect on that date.99.18    (b) To be eligible for medical assistance, families and children may have an income 99.19up to 133-1/3 percent of the AFDC income standard in effect under the July 16, 1996, 99.20AFDC state plan. Effective July 1, 2000, the base AFDC standard in effect on July 16, 99.211996, shall be increased by three percent.99.22    (c) Effective July 1, 2002, to be eligible for medical assistance, families and children 99.23may have an income up to 100 percent of the federal poverty guidelines for the family size.99.24    (d) To be eligible for medical assistance under section 256B.055, subdivision 15, a 99.25person may have an income up to 75 percent of federal poverty guidelines for the family 99.26size.99.27    (e) (d) In computing income to determine eligibility of persons under paragraphs 99.28(a) to (d) (c) who are not residents of long-term care facilities, the commissioner shall 99.29disregard increases in income as required by Public Law Numbers 94-566, section 503; 99.3099-272; and 99-509. Veterans aid and attendance benefits and Veterans Administration 99.31unusual medical expense payments are considered income to the recipient.99.32EFFECTIVE DATE.This section is effective January 1, 2012.99.33    Sec. 20. Minnesota Statutes 2010, section 256B.06, subdivision 4, is amended to read:100.1    Subd. 4. Citizenship requirements. (a) Eligibility for medical assistance is limited 100.2to citizens of the United States, qualified noncitizens as defined in this subdivision, and 100.3other persons residing lawfully in the United States. Citizens or nationals of the United 100.4States must cooperate in obtaining satisfactory documentary evidence of citizenship or 100.5nationality according to the requirements of the federal Deficit Reduction Act of 2005, 100.6Public Law 109-171.100.7(b) "Qualified noncitizen" means a person who meets one of the following 100.8immigration criteria:100.9(1) admitted for lawful permanent residence according to United States Code, title 8;100.10(2) admitted to the United States as a refugee according to United States Code, 100.11title 8, section 1157;100.12(3) granted asylum according to United States Code, title 8, section 1158;100.13(4) granted withholding of deportation according to United States Code, title 8, 100.14section 1253(h);100.15(5) paroled for a period of at least one year according to United States Code, title 8, 100.16section 1182(d)(5);100.17(6) granted conditional entrant status according to United States Code, title 8, 100.18section 1153(a)(7);100.19(7) determined to be a battered noncitizen by the United States Attorney General 100.20according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, 100.21title V of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;100.22(8) is a child of a noncitizen determined to be a battered noncitizen by the United 100.23States Attorney General according to the Illegal Immigration Reform and Immigrant 100.24Responsibility Act of 1996, title V, of the Omnibus Consolidated Appropriations Bill, 100.25Public Law 104-200; or100.26(9) determined to be a Cuban or Haitian entrant as defined in section 501(e) of Public 100.27Law 96-422, the Refugee Education Assistance Act of 1980.100.28(c) All qualified noncitizens who were residing in the United States before August 100.2922, 1996, who otherwise meet the eligibility requirements of this chapter, are eligible for 100.30medical assistance with federal financial participation.100.31(d) All qualified noncitizens who entered the United States on or after August 22, 100.321996, and who otherwise meet the eligibility requirements of this chapter, are eligible for 100.33medical assistance with federal financial participation through November 30, 1996.100.34Beginning December 1, 1996, qualified noncitizens who entered the United States 100.35on or after August 22, 1996, and who otherwise meet the eligibility requirements of this 101.1chapter are eligible for medical assistance with federal participation for five years if they 101.2meet one of the following criteria:101.3(i) refugees admitted to the United States according to United States Code, title 8, 101.4section 1157;101.5(ii) persons granted asylum according to United States Code, title 8, section 1158;101.6(iii) persons granted withholding of deportation according to United States Code, 101.7title 8, section 1253(h);101.8(iv) veterans of the United States armed forces with an honorable discharge for 101.9a reason other than noncitizen status, their spouses and unmarried minor dependent 101.10children; or101.11(v) persons on active duty in the United States armed forces, other than for training, 101.12their spouses and unmarried minor dependent children.101.13Beginning December 1, 1996, qualified noncitizens who do not meet one of the 101.14criteria in items (i) to (v) are eligible for medical assistance without federal financial 101.15participation as described in paragraph (j).101.16Notwithstanding paragraph (j), beginning July 1, 2010, children and pregnant 101.17women who are noncitizens described in paragraph (b) or (e), are eligible for medical 101.18assistance with federal financial participation as provided by the federal Children's Health 101.19Insurance Program Reauthorization Act of 2009, Public Law 111-3.101.20(e) Noncitizens who are not qualified noncitizens as defined in paragraph (b), who 101.21are lawfully present in the United States, as defined in Code of Federal Regulations, title 101.228, section 
         103.12, and who otherwise meet the eligibility requirements of this chapter, are 101.23eligible for medical assistance under clauses (1) to (3). These individuals must cooperate 101.24with the United States Citizenship and Immigration Services to pursue any applicable 101.25immigration status, including citizenship, that would qualify them for medical assistance 101.26with federal financial participation.101.27(1) Persons who were medical assistance recipients on August 22, 1996, are eligible 101.28for medical assistance with federal financial participation through December 31, 1996.101.29(2) Beginning January 1, 1997, persons described in clause (1) are eligible for 101.30medical assistance without federal financial participation as described in paragraph (j).101.31(3) Beginning December 1, 1996, persons residing in the United States prior to 101.32August 22, 1996, who were not receiving medical assistance and persons who arrived on 101.33or after August 22, 1996, are eligible for medical assistance without federal financial 101.34participation as described in paragraph (j).101.35(f) Nonimmigrants who otherwise meet the eligibility requirements of this chapter 101.36are eligible for the benefits as provided in paragraphs (g) to (i). For purposes of this 102.1subdivision, a "nonimmigrant" is a person in one of the classes listed in United States 102.2Code, title 8, section 1101(a)(15).102.3(g) Payment shall also be made for care and services that are furnished to noncitizens, 102.4regardless of immigration status, who otherwise meet the eligibility requirements of 102.5this chapter, if such care and services are necessary for the treatment of an emergency 102.6medical condition, except for organ transplants and related care and services and routine 102.7prenatal care.102.8(h) For purposes of this subdivision, the term "emergency medical condition" means 102.9a medical condition that meets the requirements of United States Code, title 42, section 102.101396b(v).102.11(i)(1) Notwithstanding paragraph (h), services that are necessary for the treatment of 102.12an emergency medical condition are limited to the following:102.13(i) services delivered in an emergency room that are directly related to the treatment 102.14of an emergency medical condition;102.15(ii) services delivered in an inpatient hospital setting following admission from an 102.16emergency room or clinic for an acute emergency condition; and102.17(iii) follow-up services that are directly related to the original service provided to 102.18treat the emergency medical condition and that are covered by the global payment made 102.19to the provider.102.20    (2) Services for the treatment of emergency medical conditions do not include:102.21(i) services delivered in an emergency room or inpatient setting to treat a 102.22nonemergency condition;102.23(ii) organ and stem cell transplants and related care;102.24(iii) services for routine prenatal care;102.25(iv) continuing care, including long-term care, nursing facility services, home health 102.26care, adult day care, day training, or supportive living services;102.27(v) elective surgery;102.28(vi) outpatient prescription drugs, unless the drugs are administered or dispensed as 102.29part of an emergency room visit;102.30(vii) preventative health care and family planning services;102.31(viii) dialysis;102.32(ix) chemotherapy or therapeutic radiation services;102.33(x) rehabilitation services;102.34(xi) physical, occupational, or speech therapy;102.35(xii) transportation services;102.36(xiii) case management;103.1(xiv) prosthetics, orthotics, durable medical equipment, or medical supplies;103.2(xv) dental services;103.3(xvi) hospice care;103.4(xvii) audiology services and hearing aids;103.5(xviii) podiatry services;103.6(xix) chiropractic services;103.7(xx) immunizations;103.8(xxi) vision services and eyeglasses;103.9(xxii) waiver services;103.10(xxiii) individualized education programs; or103.11(xxiv) chemical dependency treatment.103.12(i) (j) Beginning July 1, 2009, pregnant noncitizens who are undocumented, 103.13nonimmigrants, or lawfully present as designated in paragraph (e) and who are not 103.14covered by a group health plan or health insurance coverage according to Code of 103.15Federal Regulations, title 42, section 457.310, and who otherwise meet the eligibility 103.16requirements of this chapter, are eligible for medical assistance through the period of 103.17pregnancy, including labor and delivery, and 60 days postpartum, to the extent federal 103.18funds are available under title XXI of the Social Security Act, and the state children's 103.19health insurance program.103.20(j) (k) Qualified noncitizens as described in paragraph (d), and all other noncitizens 103.21lawfully residing in the United States as described in paragraph (e), who are ineligible 103.22for medical assistance with federal financial participation and who otherwise meet the 103.23eligibility requirements of chapter 256B and of this paragraph, are eligible for medical 103.24assistance without federal financial participation. Qualified noncitizens as described 103.25in paragraph (d) are only eligible for medical assistance without federal financial 103.26participation for five years from their date of entry into the United States.103.27(k) (l) Beginning October 1, 2003, persons who are receiving care and rehabilitation 103.28services from a nonprofit center established to serve victims of torture and are otherwise 103.29ineligible for medical assistance under this chapter are eligible for medical assistance 103.30without federal financial participation. These individuals are eligible only for the period 103.31during which they are receiving services from the center. Individuals eligible under this 103.32paragraph shall not be required to participate in prepaid medical assistance.103.33    Sec. 21. Minnesota Statutes 2010, section 256B.0625, is amended by adding a 103.34subdivision to read:104.1    Subd. 1b.Care coordination services provided through pediatric hospitals.104.2(a) Medical assistance covers care coordination services provided by certain pediatric 104.3hospitals to children with high-cost medical conditions and children at risk of recurrent 104.4hospitalization for acute or chronic illnesses. There must be Level I and Level II pediatric 104.5care coordination services.104.6(b) Level I pediatric care coordination services are provided by advanced practice 104.7nurses employed by or under contract with pediatric hospitals that have a neonatal 104.8intensive care unit and are either recipients of payments to support the training of residents 104.9from an approved graduate medical residency program under United States Code, title 104.1042, section 256e, or the major pediatric teaching hospital affiliate of the University of 104.11Minnesota Medical School, and that meet the criteria in this subdivision.104.12(c) The services in paragraph (b) must be available through in-home video telehealth 104.13management and other methods, and must be designed to improve patient outcomes 104.14and reduce unnecessary hospital and emergency room utilization. The services must 104.15streamline communication, reduce redundancy, and eliminate unnecessary documentation 104.16through the use of a Web-accessible, uniform document that contains critical patient care 104.17management information, and which is accessible to all providers with patient consent. 104.18The commissioner shall develop the uniform document and associated Web site and shall 104.19implement procedures to assess patient outcomes and evaluate the effectiveness of the 104.20care coordination services provided under this subdivision.104.21(d) Medical assistance also covers, as durable medical equipment, computers, 104.22webcams, and other technology necessary to allow in-home video telehealth management.104.23(e) For purposes of paragraph (b), a child has a high-cost medical condition if 104.24inpatient hospital expenses for that child related to complex or chronic illnesses or 104.25conditions for the most recent calendar year exceeded $100,000, or if the expenses for that 104.26child are projected to exceed $100,000 for the current calendar year. For purposes of this 104.27subdivision, a child is at risk of recurrent hospitalization if the child was hospitalized three 104.28or more times for acute or chronic illness in the most recent calendar year.104.29(f) For purposes of paragraph (b), "care coordination" means collaboration between 104.30the advanced practice nurse and primary care physicians and specialists to manage 104.31care and reduce hospitalizations, patient case management, development of medical 104.32management plans for chronic illnesses and recurrent acute illnesses, oversight and 104.33coordination of all aspects of care in partnership with families, organization of medical 104.34information into a summary of critical information, coordination and appropriate 104.35sequencing of tests and multiple appointments, information and assistance with accessing 104.36resources, and telephone triage for acute illnesses or problems.105.1(g) The commissioner shall adjust managed care and county-based purchasing plan 105.2capitation rates to reflect savings from the coverage of this service.105.3(h) Level II pediatric care coordination services are provided by registered nurses 105.4employed by or under contract with a pediatric hospital that has been designated as 105.5an essential community provider under section 62Q.19, subdivision 1, clause (4), and 105.6has been a recipient of payments to support the training of residents from an approved 105.7graduate medical residency program pursuant to United States Code, title 42, section 105.8256e, and that meets the following criteria: 105.9(1) the services must be provided through telehealth management and other methods, 105.10be available on a regular schedule seven days per week, and be designed to provide 105.11collaboration in patient care as provided by the patient's family, primary care providers, 105.12and the hospital and specialized physicians;105.13(2) for purposes of this paragraph, a child has a high-cost medical condition if the 105.14child has a serious chronic physical disability caused by a congenital anomaly, birth 105.15injury or traumatic injury, complications which can be expected to cause further injury, 105.16hospitalization, or death, but that can be effectively addressed through ongoing family 105.17and primary care supported by communication of ongoing care information and care 105.18coordination; and 105.19(3) for purposes of this paragraph, "care coordination" means the ready availability 105.20of telehealth management services to support collaboration through a registered nurse 105.21between a child's family, the primary care professional that is available to care for the 105.22child, and appropriate professionals to address urgent questions about and minimize the 105.23consequences of medical complications, develop medical management plans for complex 105.24conditions, and avoid serious health consequences and hospitalizations to treat such 105.25complications.105.26EFFECTIVE DATE.This section is effective January 1, 2012.105.27    Sec. 22. Minnesota Statutes 2010, section 256B.0625, is amended by adding a 105.28subdivision to read:105.29    Subd. 3q.Evidence-based childbirth program.(a) The commissioner shall 105.30implement a program to reduce the number of elective inductions of labor prior to 39 105.31weeks' gestation. In this subdivision, the term "elective induction of labor" means the 105.32use of artificial means to stimulate labor in a woman without the presence of a medical 105.33condition affecting the woman or the child that makes the onset of labor a medical 105.34necessity. The program must promote the implementation of policies within hospitals 105.35providing services to recipients of medical assistance or MinnesotaCare that prohibit the 106.1use of elective inductions prior to 39 weeks' gestation, and adherence to such policies by 106.2the attending providers.106.3(b) For all births covered by medical assistance or MinnesotaCare on or after 106.4January 1, 2012, a payment for professional services associated with the delivery of a 106.5child in a hospital must not be made unless the provider has submitted information about 106.6the nature of the labor and delivery including any induction of labor that was performed 106.7in conjunction with that specific birth. The information must be on a form prescribed by 106.8the commissioner.106.9(c) The requirements in paragraph (b) must not apply to deliveries performed 106.10at a hospital that has policies and processes in place that have been approved by the 106.11commissioner which prohibit elective inductions prior to 39 weeks' gestation. A process 106.12for review of hospital induction policies must be established by the commissioner and 106.13review of policies must occur at the discretion of the commissioner. The commissioner's 106.14decision to approve or rescind approval must include verification and review of items 106.15including, but not limited to:106.16(1) policies that prohibit use of elective inductions for gestation less than 39 weeks;106.17(2) policies that encourage providers to document and communicate with patients a 106.18final expected date of delivery by 20 weeks' gestation that includes data from ultrasound 106.19measurements as applicable;106.20(3) policies that encourage patient education regarding elective inductions, and 106.21requires documentation of the processes used to educate patients;106.22(4) ongoing quality improvement review as determined by the commissioner; and106.23(5) any data that has been collected by the commissioner.106.24(d) All hospitals must report annually to the commissioner induction information 106.25for all births that were covered by medical assistance or MinnesotaCare in a format and 106.26manner to be established by the commissioner.106.27(e) The commissioner at any time may choose not to implement or may discontinue 106.28any or all aspects of the program if the commissioner is able to determine that hospitals 106.29representing at least 90 percent of births covered by medical assistance or MinnesotaCare 106.30have approved policies in place.106.31EFFECTIVE DATE.This section is effective January 1, 2012.106.32    Sec. 23. Minnesota Statutes 2010, section 256B.0625, subdivision 8e, is amended to 106.33read:107.1    Subd. 8e. Chiropractic services. Payment for chiropractic services is limited to 107.2one annual evaluation and 12 24 visits per year unless prior authorization of a greater 107.3number of visits is obtained.107.4    Sec. 24. Minnesota Statutes 2010, section 256B.0625, is amended by adding a 107.5subdivision to read:107.6    Subd. 8f.Acupuncture services.Medical assistance covers acupuncture, as defined 107.7in section 147B.01, subdivision 3, only when provided by a licensed acupuncturist or by 107.8another Minnesota licensed practitioner for whom acupuncture is within the practitioner's 107.9scope of practice and who has specific acupuncture training or credentialing.107.10    Sec. 25. Minnesota Statutes 2010, section 256B.0625, subdivision 13e, is amended to 107.11read:107.12    Subd. 13e. Payment rates. (a) The basis for determining the amount of payment 107.13shall be the lower of the actual acquisition costs of the drugs plus a fixed dispensing fee; 107.14the maximum allowable cost set by the federal government or by the commissioner plus 107.15the fixed dispensing fee; or the usual and customary price charged to the public. The 107.16amount of payment basis must be reduced to reflect all discount amounts applied to the 107.17charge by any provider/insurer agreement or contract for submitted charges to medical 107.18assistance programs. The net submitted charge may not be greater than the patient liability 107.19for the service. The pharmacy dispensing fee shall be $3.65, except that the dispensing fee 107.20for intravenous solutions which must be compounded by the pharmacist shall be $8 per 107.21bag, $14 per bag for cancer chemotherapy products, and $30 per bag for total parenteral 107.22nutritional products dispensed in one liter quantities, or $44 per bag for total parenteral 107.23nutritional products dispensed in quantities greater than one liter. Actual acquisition cost 107.24includes quantity and other special discounts except time and cash discounts. Effective 107.25July 1, 2009, The actual acquisition cost of a drug shall be estimated by the commissioner,107.26at average wholesale price minus 15 percent. The actual acquisition cost of antihemophilic 107.27factor drugs shall be estimated at the average wholesale price minus 30 percent. wholesale 107.28acquisition cost plus four percent for independently owned pharmacies located in a 107.29designated rural area within Minnesota, and at wholesale acquisition cost plus two percent 107.30for all other pharmacies. A pharmacy is "independently owned" if it is one of four or 107.31fewer pharmacies under the same ownership nationally. A "designated rural area" means 107.32an area defined as a small rural area or isolated rural area according to the four-category 107.33classification of the Rural Urban Commuting Area system developed for the United States 107.34Health Resources and Services Administration. Wholesale acquisition cost is defined as 108.1the manufacturer's list price for a drug or biological to wholesalers or direct purchasers 108.2in the United States, not including prompt pay or other discounts, rebates, or reductions 108.3in price, for the most recent month for which information is available, as reported in 108.4wholesale price guides or other publications of drug or biological pricing data. The 108.5maximum allowable cost of a multisource drug may be set by the commissioner and it 108.6shall be comparable to, but no higher than, the maximum amount paid by other third-party 108.7payors in this state who have maximum allowable cost programs. Establishment of the 108.8amount of payment for drugs shall not be subject to the requirements of the Administrative 108.9Procedure Act.108.10    (b) An additional dispensing fee of $.30 may be added to the dispensing fee paid 108.11to pharmacists for legend drug prescriptions dispensed to residents of long-term care 108.12facilities when a unit dose blister card system, approved by the department, is used. Under 108.13this type of dispensing system, the pharmacist must dispense a 30-day supply of drug. 108.14The National Drug Code (NDC) from the drug container used to fill the blister card must 108.15be identified on the claim to the department. The unit dose blister card containing the 108.16drug must meet the packaging standards set forth in Minnesota Rules, part 6800.2700, 108.17that govern the return of unused drugs to the pharmacy for reuse. The pharmacy provider 108.18will be required to credit the department for the actual acquisition cost of all unused 108.19drugs that are eligible for reuse. Over-the-counter medications must be dispensed in the 108.20manufacturer's unopened package. The commissioner may permit the drug clozapine to be 108.21dispensed in a quantity that is less than a 30-day supply.108.22    (c) Whenever a maximum allowable cost has been set for a multisource drug, 108.23payment shall be on the basis of the maximum allowable cost established by the 108.24commissioner unless prior authorization for the brand name product has been granted 108.25according to the criteria established by the Drug Formulary Committee as required by 108.26subdivision 13f, paragraph (a), and the prescriber has indicated "dispense as written" on 108.27the prescription in a manner consistent with section 
         151.21, subdivision 2.108.28    (d) The basis for determining the amount of payment for drugs administered in an 108.29outpatient setting shall be the lower of the usual and customary cost submitted by the 108.30provider or the amount established for Medicare by the106 percent of the average sales 108.31price as determined by the United States Department of Health and Human Services 108.32pursuant to title XVIII, section 1847a of the federal Social Security Act. If average sales 108.33price is unavailable, the amount of payment must be lower of the usual and customary cost 108.34submitted by the provider or the wholesale acquisition cost.108.35    (e) The commissioner may negotiate lower reimbursement rates for specialty 108.36pharmacy products than the rates specified in paragraph (a). The commissioner may 109.1require individuals enrolled in the health care programs administered by the department 109.2to obtain specialty pharmacy products from providers with whom the commissioner has 109.3negotiated lower reimbursement rates. Specialty pharmacy products are defined as those 109.4used by a small number of recipients or recipients with complex and chronic diseases 109.5that require expensive and challenging drug regimens. Examples of these conditions 109.6include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis 109.7C, growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms 109.8of cancer. Specialty pharmaceutical products include injectable and infusion therapies, 109.9biotechnology drugs, antihemophilic factor products, high-cost therapies, and therapies 109.10that require complex care. The commissioner shall consult with the formulary committee 109.11to develop a list of specialty pharmacy products subject to this paragraph. In consulting 109.12with the formulary committee in developing this list, the commissioner shall take into 109.13consideration the population served by specialty pharmacy products, the current delivery 109.14system and standard of care in the state, and access to care issues. The commissioner shall 109.15have the discretion to adjust the reimbursement rate to prevent access to care issues.109.16(f) Home infusion therapy services provided by home infusion therapy pharmacies 109.17must be paid at rates according to subdivision 8d.109.18EFFECTIVE DATE.This section is effective July 1, 2011, or upon federal 109.19approval, whichever is later.109.20    Sec. 26. Minnesota Statutes 2010, section 256B.0625, subdivision 13h, is amended to 109.21read:109.22    Subd. 13h. Medication therapy management services. (a) Medical assistance 109.23and general assistance medical care cover medication therapy management services for 109.24a recipient taking four three or more prescriptions to treat or prevent two one or more 109.25chronic medical conditions, or; a recipient with a drug therapy problem that is identified109.26by the commissioner or identified by a pharmacist and approved by the commissioner; or 109.27prior authorized by the commissioner that has resulted or is likely to result in significant 109.28nondrug program costs. The commissioner may cover medical therapy management 109.29services under MinnesotaCare if the commissioner determines this is cost-effective. For 109.30purposes of this subdivision, "medication therapy management" means the provision 109.31of the following pharmaceutical care services by a licensed pharmacist to optimize the 109.32therapeutic outcomes of the patient's medications:109.33    (1) performing or obtaining necessary assessments of the patient's health status;109.34    (2) formulating a medication treatment plan;110.1    (3) monitoring and evaluating the patient's response to therapy, including safety 110.2and effectiveness;110.3    (4) performing a comprehensive medication review to identify, resolve, and prevent 110.4medication-related problems, including adverse drug events;110.5    (5) documenting the care delivered and communicating essential information to 110.6the patient's other primary care providers;110.7    (6) providing verbal education and training designed to enhance patient 110.8understanding and appropriate use of the patient's medications;110.9    (7) providing information, support services, and resources designed to enhance 110.10patient adherence with the patient's therapeutic regimens; and110.11    (8) coordinating and integrating medication therapy management services within the 110.12broader health care management services being provided to the patient.110.13Nothing in this subdivision shall be construed to expand or modify the scope of practice of 110.14the pharmacist as defined in section 
         151.01, subdivision 27.110.15    (b) To be eligible for reimbursement for services under this subdivision, a pharmacist 110.16must meet the following requirements:110.17    (1) have a valid license issued under chapter 151;110.18    (2) have graduated from an accredited college of pharmacy on or after May 1996, or 110.19completed a structured and comprehensive education program approved by the Board of 110.20Pharmacy and the American Council of Pharmaceutical Education for the provision and 110.21documentation of pharmaceutical care management services that has both clinical and 110.22didactic elements;110.23    (3) be practicing in an ambulatory care setting as part of a multidisciplinary team or 110.24have developed a structured patient care process that is offered in a private or semiprivate 110.25patient care area that is separate from the commercial business that also occurs in the 110.26setting, or in home settings, excluding including long-term care and settings, group homes, 110.27if the service is ordered by the provider-directed care coordination team and facilities 110.28providing assisted living services; and110.29    (4) make use of an electronic patient record system that meets state standards.110.30    (c) For purposes of reimbursement for medication therapy management services, 110.31the commissioner may enroll individual pharmacists as medical assistance and general 110.32assistance medical care providers. The commissioner may also establish contact 110.33requirements between the pharmacist and recipient, including limiting the number of 110.34reimbursable consultations per recipient.110.35(d) If there are no pharmacists who meet the requirements of paragraph (b) practicing 110.36within a reasonable geographic distance of the patient, a pharmacist who meets the 111.1requirements may provide the services via two-way interactive video. Reimbursement 111.2shall be at the same rates and under the same conditions that would otherwise apply to 111.3the services provided. To qualify for reimbursement under this paragraph, the pharmacist 111.4providing the services must meet the requirements of paragraph (b), and must be located 111.5within an ambulatory care setting approved by the commissioner. The patient must also 111.6be located within an ambulatory care setting approved by the commissioner. Services 111.7provided under this paragraph may not be transmitted into the patient's residence.111.8(e) The commissioner shall establish a pilot project for an intensive medication 111.9therapy management program for patients identified by the commissioner with multiple 111.10chronic conditions and a high number of medications who are at high risk of preventable 111.11hospitalizations, emergency room use, medication complications, and suboptimal 111.12treatment outcomes due to medication-related problems. For purposes of the pilot 111.13project, medication therapy management services may be provided in a patient's home 111.14or community setting, in addition to other authorized settings. The commissioner may 111.15waive existing payment policies and establish special payment rates for the pilot project. 111.16The pilot project must be designed to produce a net savings to the state compared to the 111.17estimated costs that would otherwise be incurred for similar patients without the program. 111.18The pilot project must begin by January 1, 2010, and end June 30, 2012.111.19EFFECTIVE DATE.This section is effective July 1, 2011.111.20    Sec. 27. Minnesota Statutes 2010, section 256B.0625, subdivision 17, is amended to 111.21read:111.22    Subd. 17. Transportation costs. (a) Medical assistance covers medical 111.23transportation costs incurred solely for obtaining emergency medical care or transportation 111.24costs incurred by eligible persons in obtaining emergency or nonemergency medical 111.25care when paid directly to an ambulance company, common carrier, or other recognized 111.26providers of transportation services. Medical transportation must be provided by:111.27(1) an ambulance, as defined in section 
         144E.001, subdivision 2;111.28(2) special transportation; or111.29(3) common carrier including, but not limited to, bus, taxicab, other commercial 111.30carrier, or private automobile.111.31(b) Medical assistance covers special transportation, as defined in Minnesota Rules, 111.32part 9505.0315, subpart 1, item F, if the recipient has a physical or mental impairment that 111.33would prohibit the recipient from safely accessing and using a bus, taxi, other commercial 111.34transportation, or private automobile.112.1The commissioner may use an order by the recipient's attending physician to certify that 112.2the recipient requires special transportation services. Special transportation providers shall 112.3perform driver-assisted services for eligible individuals. Driver-assisted service includes 112.4passenger pickup at and return to the individual's residence or place of business, assistance 112.5with admittance of the individual to the medical facility, and assistance in passenger 112.6securement or in securing of wheelchairs or stretchers in the vehicle. Special transportation 112.7providers must obtain written documentation from the health care service provider who 112.8is serving the recipient being transported, identifying the time that the recipient arrived. 112.9Special transportation providers may not bill for separate base rates for the continuation of 112.10a trip beyond the original destination. Special transportation providers must take recipients 112.11to the nearest appropriate health care provider, using the most direct route. The minimum 112.12medical assistance reimbursement rates for special transportation services are:112.13(1) (i) $17 for the base rate and $1.35 per mile for special transportation services to 112.14eligible persons who need a wheelchair-accessible van;112.15(ii) $11.50 for the base rate and $1.30 per mile for special transportation services to 112.16eligible persons who do not need a wheelchair-accessible van; and112.17(iii) $60 for the base rate and $2.40 per mile, and an attendant rate of $9 per trip, for 112.18special transportation services to eligible persons who need a stretcher-accessible vehicle;112.19(2) the base rates for special transportation services in areas defined under RUCA 112.20to be super rural shall be equal to the reimbursement rate established in clause (1) plus 112.2111.3 percent; and112.22(3) for special transportation services in areas defined under RUCA to be rural 112.23or super rural areas:112.24(i) for a trip equal to 17 miles or less, mileage reimbursement shall be equal to 125 112.25percent of the respective mileage rate in clause (1); and112.26(ii) for a trip between 18 and 50 miles, mileage reimbursement shall be equal to 112.27112.5 percent of the respective mileage rate in clause (1).112.28(c) For purposes of reimbursement rates for special transportation services under 112.29paragraph (b), the zip code of the recipient's place of residence shall determine whether 112.30the urban, rural, or super rural reimbursement rate applies.112.31(d) For purposes of this subdivision, "rural urban commuting area" or "RUCA" 112.32means a census-tract based classification system under which a geographical area is 112.33determined to be urban, rural, or super rural.112.34(e) Effective for services provided on or after July 1, 2011, nonemergency 112.35transportation rates, including special transportation, taxi, and other commercial carriers, 112.36are reduced 4.5 percent. Payments made to managed care plans and county-based 113.1purchasing plans must be reduced for services provided on or after January 1, 2012, 113.2to reflect this reduction.113.3    Sec. 28. Minnesota Statutes 2010, section 256B.0625, subdivision 17a, is amended to 113.4read:113.5    Subd. 17a. Payment for ambulance services.(a) Medical assistance covers 113.6ambulance services. Providers shall bill ambulance services according to Medicare 113.7criteria. Nonemergency ambulance services shall not be paid as emergencies. Effective 113.8for services rendered on or after July 1, 2001, medical assistance payments for ambulance 113.9services shall be paid at the Medicare reimbursement rate or at the medical assistance 113.10payment rate in effect on July 1, 2000, whichever is greater.113.11(b) Effective for services provided on or after July 1, 2011, ambulance services 113.12payment rates are reduced 4.5 percent. Payments made to managed care plans and 113.13county-based purchasing plans must be reduced for services provided on or after January 113.141, 2012, to reflect this reduction.113.15    Sec. 29. Minnesota Statutes 2010, section 256B.0625, subdivision 18, is amended to 113.16read:113.17    Subd. 18. Bus or taxicab transportation. To the extent authorized by rule of the 113.18state agency, medical assistance covers costs of the most appropriate and cost-effective 113.19form of transportation incurred by any ambulatory eligible person for obtaining 113.20nonemergency medical care.113.21    Sec. 30. Minnesota Statutes 2010, section 256B.0625, is amended by adding a 113.22subdivision to read:113.23    Subd. 25b.Authorization with third-party liability.(a) Except as otherwise 113.24allowed under this subdivision or required under federal or state regulations, the 113.25commissioner must not consider a request for authorization of a service when the recipient 113.26has coverage from a third-party payer unless the provider requesting authorization has 113.27made a good faith effort to receive payment or authorization from the third-party payer. 113.28A good faith effort is established by supplying with the authorization request to the 113.29commissioner the following:113.30(1) a determination of payment for the service from the third-party payer, a 113.31determination of authorization for the service from the third-party payer, or a verification 113.32of noncoverage of the service by the third-party payer; and114.1(2) the information or records required by the department to document the reason for 114.2the determination or to validate noncoverage from the third-party payer.114.3(b) A provider requesting authorization for services covered by Medicare is not 114.4required to bill Medicare before requesting authorization from the commissioner if the 114.5provider has reason to believe that a service covered by Medicare is not eligible for 114.6payment. The provider must document that, because of recent claim experiences with 114.7Medicare or because of written communication from Medicare, coverage is not available 114.8for the service.114.9(c) Authorization is not required if a third-party payer has made payment that is 114.10equal to or greater than 60 percent of the maximum payment amount for the service 114.11allowed under medical assistance.114.12    Sec. 31. Minnesota Statutes 2010, section 256B.0625, subdivision 31a, is amended to 114.13read:114.14    Subd. 31a. Augmentative and alternative communication systems. (a) Medical 114.15assistance covers augmentative and alternative communication systems consisting of 114.16electronic or nonelectronic devices and the related components necessary to enable a 114.17person with severe expressive communication limitations to produce or transmit messages 114.18or symbols in a manner that compensates for that disability.114.19(b) Until the volume of systems purchased increases to allow a discount price, the 114.20commissioner shall reimburse augmentative and alternative communication manufacturers 114.21and vendors at the manufacturer's suggested retail price for augmentative and alternative 114.22communication systems and related components. The commissioner shall separately 114.23reimburse providers for purchasing and integrating individual communication systems 114.24which are unavailable as a package from an augmentative and alternative communication 114.25vendor. Augmentative and alternative communication systems must be paid the lower 114.26of the: 114.27(1) submitted charge; or114.28(2)(i) manufacturer's suggested retail price minus 20 percent for providers that are 114.29manufacturers of augmentative and alternative communication systems; or114.30(ii) manufacturer's invoice charge plus 20 percent for providers that are not 114.31manufacturers of augmentative and alternative communication systems.114.32(c) Reimbursement rates established by this purchasing program are not subject to 114.33Minnesota Rules, part 9505.0445, item S or T.115.1    Sec. 32. Minnesota Statutes 2010, section 256B.0625, is amended by adding a 115.2subdivision to read:115.3    Subd. 55.Payment for multiple services provided on same day.The 115.4commissioner shall not prohibit payment, including any supplemental payments, for 115.5mental health services or dental services provided to a patient by a clinic or health care 115.6professional solely because the mental health services or dental services were provided on 115.7the same day as other covered health care services furnished by the same provider.115.8    Sec. 33. Minnesota Statutes 2010, section 256B.0625, is amended by adding a 115.9subdivision to read:115.10    Subd. 56.Medical care coordination.(a) Medical assistance covers in-reach 115.11community-based care coordination that is performed in a hospital emergency department 115.12as an eligible procedure under a state health care program or private insurance for a 115.13frequent user.115.14(b) Reimbursement must be made in 15-minute increments under current Medicaid 115.15mental health social work reimbursement methodology and allowed for up to 60 days 115.16posthospital discharge based upon the specific identified emergency department visit or 115.17inpatient admitting event. A frequent user who is participating in care coordination within 115.18a health care home framework is ineligible for reimbursement under this subdivision. 115.19Eligible in-reach care coordinators must hold a minimum of a bachelor's degree in social 115.20work, public health, corrections, or related field. The commissioner shall submit any 115.21necessary application for waivers to the Centers for Medicare and Medicaid Services to 115.22implement this subdivision.115.23(c) A frequent user is defined as an individual who:115.24(1) has frequented the hospital emergency department for services three or more 115.25times in the previous six consecutive months;115.26(2) would benefit from the provision of in-reach community-based services; and115.27(3) has two or more of the following risk factors:115.28(i) on one or more occasions within the last 24 months, the individual was diagnosed 115.29with a chronic or life-threatening condition that requires management of symptoms, 115.30medications, health care, or changes in lifestyle or risk-related behaviors that may 115.31include, but are not limited to, HIV/AIDS, hepatitis, diabetes, heart disease, hypertension, 115.32emphysema, asthma, or cancer;115.33(ii) on one or more occasions within the last 24 months, the individual was diagnosed 115.34or, in the judgment of an emergency department physician, would likely be diagnosed, 116.1if provided a mental assessment, with an Axis I or II mental disorder identified in the 116.2Diagnostic and Statistical Manual of Mental Disorders;116.3(iii) on one or more occasions within the last 24 months, the individual was 116.4diagnosed or, in the judgment of an emergency department physician, would likely be 116.5diagnosed, if provided an assessment, with a substance use problem that interferes with 116.6the individual's health or appropriate utilization of health services; or116.7(iv) the individual is currently experiencing homelessness. "Homelessness" means 116.8lacking a fixed, regular, or adequate nighttime residence or a primary nighttime residence 116.9that is a supervised publicly or privately operated shelter designed to provide temporary 116.10living accommodations or a public or private place not designed for, or ordinarily used 116.11as, regular sleeping accommodations for human beings.116.12(d) Any hospital choosing to participate in medical care coordination under this 116.13subdivision must, upon request by the commissioner of human services, make available 116.14program utilization data. Frequent users who are enrolled in a program must track:116.15(1) the total number of program participants in the frequent user program for a 116.16defined period of time established by the commissioner;116.17(2) the total number of program participants and what form of health care coverage 116.18they had at the time of enrollment and the number of beneficiaries who did not remain 116.19enrolled in the program for at least two months;116.20(3) the frequency of emergency department visits during the 12 months prior to 116.21enrollment in the program and associated costs to the hospital;116.22(4) the frequency of emergency department visits during the 12 months after 116.23program enrollment and the associated costs to the hospital;116.24(5) the total number of inpatient admissions during the 12 months immediately 116.25preceding enrollment and the associated costs to the hospital;116.26(6) the total number of inpatient admissions during the 12 months after enrollment in 116.27the program and the associated costs to the hospital;116.28(7) the total number of inpatient days during the 12 months immediately preceding 116.29enrollment and the associated costs to the hospital; and116.30(8) the total number of inpatient days during the 12 months after program enrollment 116.31and the associated costs to the hospital.116.32(e) For the purposes of this subdivision, "in-reach community-based care 116.33coordination" means the practice of a community-based worker with training, knowledge, 116.34skills, and ability to access a continuum of services, including housing, transportation, 116.35chemical and mental health treatment, employment, and peer support services, by working 116.36with an organization's staff to transition an individual back into the individual's living 117.1environment. In-reach community-based care coordination includes working with the 117.2individual during their discharge and for up to a defined amount of time in the individual's 117.3living environment, reducing the individual's need for readmittance.117.4    Sec. 34. Minnesota Statutes 2010, section 256B.0625, is amended by adding a 117.5subdivision to read:117.6    Subd. 57.Payment for Part B Medicare crossover claims.Effective for services 117.7provided on or after January 1, 2012, medical assistance payment for an enrollee's cost 117.8sharing associated with Medicare Part B is limited to an amount up to the medical 117.9assistance total allowed, when the medical assistance rate exceeds the amount paid by 117.10Medicare.117.11EFFECTIVE DATE.This section is effective January 1, 2012.117.12    Sec. 35. Minnesota Statutes 2010, section 256B.0625, is amended by adding a 117.13subdivision to read:117.14    Subd. 58.Early and periodic screening, diagnosis, and treatment services.117.15Medical assistance covers early and periodic screening, diagnosis, and treatment services 117.16(EPSDT). The payment amount for a complete EPSDT screening shall not exceed the rate 117.17established per Minnesota Rules, part 9505.0445, item M, effective October 1, 2010.117.18    Sec. 36. Minnesota Statutes 2010, section 256B.0625, is amended by adding a 117.19subdivision to read:117.20    Subd. 59.Services provided by advanced dental therapists and dental 117.21therapists.Medical assistance covers services provided by advanced dental therapists 117.22and dental therapists when provided within the scope of practice identified in sections 117.23150A.105 and 150A.106.117.24    Sec. 37. Minnesota Statutes 2010, section 256B.0625, is amended by adding a 117.25subdivision to read:117.26    Subd. 60.Payment for noncovered services.(a) Except when specifically 117.27prohibited by the commissioner or federal law, a provider may seek payment from the 117.28recipient for services not eligible for payment under the medical assistance program when 117.29the provider, prior to delivering the service, reviews and considers all other available 117.30covered alternatives with the recipient and obtains a signed acknowledgment from the 117.31recipient of the potential of the recipient's liability. The signed acknowledgment must be 117.32in a form approved by the commissioner.118.1    (b) Conditions under which a provider must not request payment from the recipient 118.2include, but are not limited to:118.3    (1) a service that requires prior authorization, unless authorization has been denied 118.4as not medically necessary and all other therapeutic alternatives have been reviewed;118.5    (2) a service for which payment has been denied for reasons relating to billing 118.6requirements;118.7    (3) standard shipping or delivery and setup of medical equipment or medical 118.8supplies;118.9    (4) services that are included in the recipient's long-term care per diem;118.10    (5) the recipient is enrolled in the restricted recipient program and the provider is 118.11one of a provider type designated for the recipient's health care services; and118.12    (6) the noncovered service is a prescriptive drug identified by the commissioner as 118.13having the potential for abuse and overuse, except where payment by the recipient is 118.14specifically approved by the commissioner on the date of service based upon compelling 118.15evidence supplied by the prescribing provider that establishes medical necessity for that 118.16particular drug.118.17    (c) The payment requested from recipients for noncovered services under this 118.18subdivision must not exceed the provider's usual and customary charge for the actual 118.19service received by the recipient. A recipient must not be billed for the difference between 118.20what medical assistance paid for the service or would pay for a less costly alternative 118.21service.118.22    Sec. 38. Minnesota Statutes 2010, section 256B.0631, subdivision 1, is amended to 118.23read:118.24    Subdivision 1. Co-payments Cost-sharing. (a) Except as provided in subdivision 118.252, the medical assistance benefit plan shall include the following co-payments cost-sharing118.26for all recipients, effective for services provided on or after October 1, 2003, and before 118.27January 1, 2009 July 1, 2011:118.28    (1) $3 per nonpreventive visit, except as provided in paragraph (c). For purposes 118.29of this subdivision, a visit means an episode of service which is required because of 118.30a recipient's symptoms, diagnosis, or established illness, and which is delivered in an 118.31ambulatory setting by a physician or physician ancillary, chiropractor, podiatrist, nurse 118.32midwife, advanced practice nurse, audiologist, optician, or optometrist;118.33    (2) $3 for eyeglasses;118.34    (3) $6 $3.50 for nonemergency visits to a hospital-based emergency room, except 118.35that this co-payment shall be increased to $20 upon federal approval; and119.1    (4) $3 per brand-name drug prescription and $1 per generic drug prescription, 119.2subject to a $12 per month maximum for prescription drug co-payments. No co-payments 119.3shall apply to antipsychotic drugs when used for the treatment of mental illness.;119.4(5) a family deductible equal to the maximum amount allowed under Code of 119.5Federal Regulations, title 42, part 447.54; and119.6    (b) Except as provided in subdivision 2, the medical assistance benefit plan shall 119.7include the following co-payments for all recipients, effective for services provided on 119.8or after January 1, 2009:119.9    (1) $3.50 for nonemergency visits to a hospital-based emergency room;119.10    (2) $3 per brand-name drug prescription and $1 per generic drug prescription, 119.11subject to a $7 per month maximum for prescription drug co-payments. No co-payments 119.12shall apply to antipsychotic drugs when used for the treatment of mental illness; and119.13    (3) (6) for individuals identified by the commissioner with income at or below 100 119.14percent of the federal poverty guidelines, total monthly co-payments cost-sharing must 119.15not exceed five percent of family income. For purposes of this paragraph, family income 119.16is the total earned and unearned income of the individual and the individual's spouse, if 119.17the spouse is enrolled in medical assistance and also subject to the five percent limit on 119.18co-payments cost-sharing.119.19    (c) (b) Recipients of medical assistance are responsible for all co-payments  and 119.20deductibles in this subdivision.119.21(c) Effective January 1, 2012, or upon federal approval, whichever is later, the 119.22following co-payments for nonpreventive visits shall apply to providers included in 119.23provider peer grouping:119.24(1) $3 for visits to providers whose average, risk-adjusted, total annual cost of 119.25care per medical assistance enrollee is at the 60th percentile or lower for providers of 119.26the same type;119.27(2) $6 for visits to providers whose average, risk-adjusted, total annual cost of care 119.28per medical assistance enrollee is greater than the 60th percentile but does not exceed the 119.2980th percentile for providers of the same type; and119.30(3) $10 for visits to providers whose average, risk-adjusted, total annual cost of 119.31care per medical assistance enrollee is greater than the 80th percentile for providers of 119.32the same type.119.33Each managed care and county-based purchasing plan shall calculate the average, 119.34risk-adjusted, total annual cost of care for providers under this paragraph using a 119.35methodology approved by the commissioner. The commissioner shall develop a 120.1methodology for calculating the average, risk-adjusted, total annual cost of care for 120.2fee-for-service providers.120.3(d) The commissioner shall seek any federal waivers and approvals necessary to 120.4increase the co-payment for nonemergency visits to a hospital-based emergency room 120.5under paragraph (a), clause (3), and to implement paragraph (c).120.6    Sec. 39. Minnesota Statutes 2010, section 256B.0631, subdivision 2, is amended to 120.7read:120.8    Subd. 2. Exceptions. Co-payments and deductibles shall be subject to the following 120.9exceptions:120.10(1) children under the age of 21;120.11(2) pregnant women for services that relate to the pregnancy or any other medical 120.12condition that may complicate the pregnancy;120.13(3) recipients expected to reside for at least 30 days in a hospital, nursing home, or 120.14intermediate care facility for the developmentally disabled;120.15(4) recipients receiving hospice care;120.16(5) 100 percent federally funded services provided by an Indian health service;120.17(6) emergency services;120.18(7) family planning services;120.19(8) services that are paid by Medicare, resulting in the medical assistance program 120.20paying for the coinsurance and deductible; and120.21(9) co-payments that exceed one per day per provider for nonpreventive visits, 120.22eyeglasses, and nonemergency visits to a hospital-based emergency room.120.23    Sec. 40. Minnesota Statutes 2010, section 256B.0631, subdivision 3, is amended to 120.24read:120.25    Subd. 3. Collection. (a) The medical assistance reimbursement to the provider shall 120.26be reduced by the amount of the co-payment or deductible, except that reimbursements 120.27shall not be reduced:120.28    (1) once a recipient has reached the $12 per month maximum or the $7 per month 120.29maximum effective January 1, 2009, for prescription drug co-payments; or120.30    (2) for a recipient identified by the commissioner under 100 percent of the federal 120.31poverty guidelines who has met their monthly five percent co-payment cost-sharing limit.120.32    (b) The provider collects the co-payment or deductible from the recipient. Providers 120.33may not deny services to recipients who are unable to pay the co-payment or deductible.121.1    (c) Medical assistance reimbursement to fee-for-service providers and payments to 121.2managed care plans shall not be increased as a result of the removal of co-payments or 121.3deductibles effective on or after January 1, 2009.121.4    Sec. 41. Minnesota Statutes 2010, section 256B.0644, is amended to read:121.5256B.0644 REIMBURSEMENT UNDER OTHER STATE HEALTH CARE 121.6PROGRAMS.121.7    (a) A vendor of medical care, as defined in section 
         256B.02, subdivision 7, and a 121.8health maintenance organization, as defined in chapter 62D, must participate as a provider 121.9or contractor in the medical assistance program, general assistance medical care program, 121.10and MinnesotaCare as a condition of participating as a provider in health insurance plans 121.11and programs or contractor for state employees established under section 
         43A.18, the 121.12public employees insurance program under section 
         43A.316, for health insurance plans 121.13offered to local statutory or home rule charter city, county, and school district employees, 121.14the workers' compensation system under section 
         176.135, and insurance plans provided 121.15through the Minnesota Comprehensive Health Association under sections 
         62E.01 to 121.1662E.19
         . The limitations on insurance plans offered to local government employees shall 121.17not be applicable in geographic areas where provider participation is limited by managed 121.18care contracts with the Department of Human Services.121.19    (b) For providers other than health maintenance organizations, participation in the 121.20medical assistance program means that:121.21     (1) the provider accepts new medical assistance, general assistance medical care, 121.22and MinnesotaCare patients;121.23    (2) for providers other than dental service providers, at least 20 percent of the 121.24provider's patients are covered by medical assistance, general assistance medical care, 121.25and MinnesotaCare as their primary source of coverage; or121.26    (3) for dental service providers, at least ten percent of the provider's patients are 121.27covered by medical assistance, general assistance medical care, and MinnesotaCare as 121.28their primary source of coverage, or the provider accepts new medical assistance and 121.29MinnesotaCare patients who are children with special health care needs. For purposes 121.30of this section, "children with special health care needs" means children up to age 18 121.31who: (i) require health and related services beyond that required by children generally; 121.32and (ii) have or are at risk for a chronic physical, developmental, behavioral, or emotional 121.33condition, including: bleeding and coagulation disorders; immunodeficiency disorders; 121.34cancer; endocrinopathy; developmental disabilities; epilepsy, cerebral palsy, and other 121.35neurological diseases; visual impairment or deafness; Down syndrome and other genetic 122.1disorders; autism; fetal alcohol syndrome; and other conditions designated by the 122.2commissioner after consultation with representatives of pediatric dental providers and 122.3consumers.122.4    (c) Patients seen on a volunteer basis by the provider at a location other than 122.5the provider's usual place of practice may be considered in meeting the participation 122.6requirement in this section. The commissioner shall establish participation requirements 122.7for health maintenance organizations. The commissioner shall provide lists of participating 122.8medical assistance providers on a quarterly basis to the commissioner of management and 122.9budget, the commissioner of labor and industry, and the commissioner of commerce. Each 122.10of the commissioners shall develop and implement procedures to exclude as participating 122.11providers in the program or programs under their jurisdiction those providers who do 122.12not participate in the medical assistance program. The commissioner of management 122.13and budget shall implement this section through contracts with participating health and 122.14dental carriers.122.15    (d) For purposes of paragraphs (a) and (b), participation in the general assistance 122.16medical care program applies only to pharmacy providers.122.17    (e) A provider described in section 256B.76, subdivision 5, may limit the eligibility 122.18of new medical assistance, general assistance medical care, and MinnesotaCare patients 122.19for specific categories of rehabilitative services, if medical assistance, general assistance 122.20medical care, and MinnesotaCare patients served by the provider in the aggregate exceed 122.2130 percent of the provider's overall patient population.122.22    Sec. 42. Minnesota Statutes 2010, section 256B.0751, subdivision 1, is amended to 122.23read:122.24    Subdivision 1. Definitions. (a) For purposes of sections 
         256B.0751 to 
         256B.0753, 122.25the following definitions apply.122.26    (b) "Commissioner" means the commissioner of human services.122.27    (c) "Commissioners" means the commissioner of humans services and the 122.28commissioner of health, acting jointly.122.29    (d) "Health plan company" has the meaning provided in section 
         62Q.01, subdivision 122.304.122.31    (e) "Personal clinician" means a physician licensed under chapter 147, a physician 122.32assistant licensed and practicing under chapter 147A, ora mental health professional 122.33licensed under section 245.462, subdivision 18, clauses (1) to (6); or 245.4871, subdivision 122.3427, clauses (1) to (6), or an advanced practice nurse licensed and registered to practice 122.35under chapter 148.123.1    (f) "State health care program" means the medical assistance, MinnesotaCare, and 123.2general assistance medical care programs.123.3    Sec. 43. Minnesota Statutes 2010, section 256B.0751, subdivision 2, is amended to 123.4read:123.5    Subd. 2. Development and implementation of standards. (a) By July 1, 2009, 123.6the commissioners of health and human services shall develop and implement standards 123.7of certification for health care homes for state health care programs. In developing these 123.8standards, the commissioners shall consider existing standards developed by national 123.9independent accrediting and medical home organizations. The standards developed by the 123.10commissioners must meet the following criteria:123.11    (1) emphasize, enhance, and encourage the use of primary care, and include the use 123.12of primary care physicians, advanced practice nurses, andmental health professionals, 123.13and physician assistants as personal clinicians but permitting multidisciplinary teams of 123.14other health professionals;123.15    (2) focus on delivering high-quality, efficient, and effective health care services123.16and providing, arranging, or coordinating related social and public health services and 123.17other services that directly affect an individual's health, access to services, quality and 123.18outcomes, and patient satisfaction;123.19    (3) encourage patient-centered care and services, including active participation by 123.20the patient and family or a legal guardian, or a health care agent as defined in chapter 123.21145C, as appropriate in decision making and care plan development, and providing care 123.22that is appropriate to the patient's race, ethnicity, and language;123.23    (4) provide patients with a consistent, ongoing contact with a personal clinician or 123.24team of clinical professionals to ensure continuous and appropriate care for the patient's 123.25condition;123.26    (5) ensure that health care homes develop and maintain appropriate comprehensive 123.27care and wellness plans for their patients with complex or chronic conditions, including an 123.28assessment of health risks and, chronic conditions, and socioeconomic factors affecting 123.29health and treatment;123.30    (6) enable and encourage utilization of a range of qualified health care professionals123.31and other professionals or services related to the health and treatment of the patient, 123.32including dedicated care coordinators, in a manner that enables providers to practice to 123.33the fullest extent of their license;123.34    (7) focus initially on patients who have or are at risk of developing chronic health 123.35conditions;124.1    (8) incorporate measures of quality, resource use, cost of care, and patient 124.2experience, with appropriate adjustments for socioeconomic factors;124.3    (9) ensure the use of health information technology and systematic follow-up, 124.4including the use of patient registries; and124.5    (10) encourage the use of scientifically based health care, patient decision-making 124.6aids that provide patients with information about treatment and service options and their 124.7associated benefits, risks, costs, and comparative outcomes, and other clinical decision 124.8support tools.124.9    (b) In developing these standards, the commissioners shall consult with national 124.10and local organizations working on health care home models, physicians, relevant 124.11state agencies, health plan companies, hospitals, other providers, patients, and patient 124.12advocates. The commissioners may satisfy this requirement by continuing the provider 124.13directed care coordination advisory committee.124.14    (c) For the purposes of developing and implementing these standards, the 124.15commissioners may use the expedited rulemaking process under section 
         14.389.124.16    Sec. 44. Minnesota Statutes 2010, section 256B.0751, subdivision 3, is amended to 124.17read:124.18    Subd. 3. Requirements for clinicians certified as health care homes. (a) A 124.19personal clinician or, a primary care clinic, or community mental health center eligible for 124.20payment under section 256B.0625, subdivision 5, may be certified as a health care home. 124.21If a primary care clinic or mental health center is certified, all of the primary care clinic's 124.22or mental health center's clinicians who may provide care to persons enrolled with the 124.23health care home must meet the criteria of a health care home. In order to be certified as 124.24a health care home, a clinician or, clinic, or community mental health center must meet 124.25the standards set by the commissioners in accordance with this section. Certification as 124.26a health care home is voluntary. In order to maintain their status as health care homes, 124.27clinicians or clinics must renew their certification annually.124.28    (b) Clinicians or, clinics, or mental health centers certified as health care homes must 124.29offer their health care home services to all their patients with complex or chronic health 124.30conditions who are interested in participation.124.31    (c) Health care homes must participate in the health care home collaborative 124.32established under subdivision 5.124.33    Sec. 45. Minnesota Statutes 2010, section 256B.0751, subdivision 4, is amended to 124.34read:125.1    Subd. 4. Alternative models and waivers of requirements.(a) Nothing in this 125.2section shall preclude the continued development of existing medical or health care 125.3home projects currently operating or under development by the commissioner of human 125.4services or preclude the commissioner from establishing alternative models and payment 125.5mechanisms for persons who are enrolled in integrated Medicare and Medicaid programs 125.6under section 
         256B.69, subdivisions 23 and 28, are enrolled in managed care long-term 125.7care programs under section 
         256B.69, subdivision 6b, are dually eligible for Medicare and 125.8medical assistance, are in the waiting period for Medicare, or who have other primary 125.9coverage.125.10(b) The commissioner of health shall modify the health care homes application 125.11for certification to add an item allowing an applicant to indicate status as a federally 125.12qualified health center or a federally qualified health center look-alike, as defined in 125.13section 145.9269, subdivision 1. Effective July 1, 2012, the commissioner shall certify as 125.14a health care home each applicant that indicates this status on a completed application for 125.15certification, without requiring the applicant to meet the standards in Minnesota Rules, 125.16part 4764.0040. In order to retain certification, a federally qualified health center or 125.17federally qualified health center look-alike certified under this paragraph must seek annual 125.18recertification by submitting a letter of intent stating its desire to be recertified but is not 125.19required to meet the standards for recertification in Minnesota Rules, part 4764.0040.125.20(c) The commissioner of health shall waive health care home certification 125.21requirements if an applicant demonstrates that compliance with a certification requirement 125.22will create a major financial hardship or is not feasible, and the applicant establishes an 125.23alternative way to accomplish the objectives of the certification requirement.125.24    Sec. 46. Minnesota Statutes 2010, section 256B.0751, is amended by adding a 125.25subdivision to read:125.26    Subd. 8.Coordination with local services.The health care home and the county 125.27shall coordinate care and services provided to patients enrolled with a health care home 125.28who have complex medical or socioeconomic needs or a disability, and who need and are 125.29eligible for additional local services administered by counties, including but not limited 125.30to waivered services, mental health services, social services, public health services, 125.31transportation, and  housing.  The coordination of care and services must be as provided in 125.32the plan established by the patient and health care home.125.33    Sec. 47. Minnesota Statutes 2010, section 256B.0751, is amended by adding a 125.34subdivision to read:126.1    Subd. 9.Patient choice of health care home.Notwithstanding section 256B.69, 126.2subdivisions 4 and 23, and subject to any necessary federal approval, the commissioner 126.3may require a patient enrolled in a state health care program through a managed care 126.4plan, county-based purchasing plan, fee-for-service, or demonstration project under 126.5section 256B.0755 to select a health care home and agree to receive primary care and 126.6care coordination services through the health care home as a condition of enrollment in 126.7the state health care program.  The patient must be allowed to choose from among all 126.8available qualified health care providers, including an essential community provider as 126.9defined in section  62Q.19,  if the provider is certified as a health care home and agrees to 126.10accept the terms, conditions, and payment rates for participation in the managed care plan, 126.11county-based purchasing plan, fee-for-service program, or demonstration project, except 126.12that reimbursement to federally qualified health centers and federally qualified health 126.13center look-alikes as defined in section 145.9269 must comply with federal law. 126.14    Sec. 48. Minnesota Statutes 2010, section 256B.0751, is amended by adding a 126.15subdivision to read:126.16    Subd. 10.Engagement of patients and communities in health care home.The 126.17commissioner of health shall require health care homes to demonstrate that their health 126.18care home patients, and the racial and ethnic communities of current or potential patients, 126.19participate in evaluating the health care home and recommending improvements and 126.20changes to the health care home's methods and procedures in order to improve health, 126.21quality, and patient satisfaction for patients from those communities. The commissioner 126.22shall consult with racial and ethnic communities to determine whether the requirements of 126.23this section and rules adopted under it are barriers to effective health care home methods 126.24and procedures for serving patients of racial and ethnic communities.126.25    Sec. 49. Minnesota Statutes 2010, section 256B.0753, is amended by adding a 126.26subdivision to read:126.27    Subd. 4.Waiver recipients.A health care home shall receive the highest care 126.28coordination payment established under section 256B.0753 for providing services to an 126.29enrollee receiving home and community-based waiver services.126.30    Sec. 50. Minnesota Statutes 2010, section 256B.0754, is amended by adding a 126.31subdivision to read:126.32    Subd. 3.Primary care provider tiering.(a) The commissioner shall establish 126.33a tiering system for all providers participating in Minnesota health care programs. 127.1The tiering system must differentiate providers on the basis of their ability to provide 127.2cost-effective, quality care and must incorporate the provider peer grouping measures 127.3established under section 62U.04. The tier assignments must be established annually based 127.4on the most recent peer grouping measures available. Differentiation of tier assignments 127.5must be statistically valid. The commissioner may set specific quality standards for 127.6providers designated as high-performing providers under this subdivision.127.7(b) The commissioner may adjust the rates paid to providers within each tier group 127.8established under paragraph (a) on an annual basis. Adjustments to rates shall not include 127.9the rate paid for care coordination services to certified health care homes under section 127.10256B.0753. Providers designated high-performing providers under paragraph (c) are not 127.11eligible for rate increases unless the provider also meets the cost and quality criteria 127.12associated with that tier level.127.13(c) Health care homes certified under section 256B.0751, rural health clinics, and 127.14federally qualified health care clinics are designated as high-performing providers under 127.15this subdivision.127.16(d) Providers reimbursed on a cost basis are subject to rate adjustments under this 127.17section.127.18(e) The commissioner may phase in the tiering system by service type. 127.19EFFECTIVE DATE.This section is effective one year from the public release of 127.20provider peer grouping measures under Minnesota Statutes, section 62U.04, or upon 127.21federal approval, whichever is later.127.22    Sec. 51. Minnesota Statutes 2010, section 256B.0755, subdivision 4, is amended to 127.23read:127.24    Subd. 4. Payment system. (a) In developing a payment system for health care 127.25delivery systems, the commissioner shall establish a total cost of care benchmark or a 127.26risk/gain sharing payment model to be paid for services provided to the recipients enrolled 127.27in a health care delivery system.127.28(b) The payment system may include incentive payments to health care delivery 127.29systems that meet or exceed annual quality and performance targets realized through 127.30the coordination of care.127.31(c) An amount equal to the savings realized to the general fund as a result of the 127.32demonstration project shall be transferred each fiscal year to the health care access fund.127.33(d) The total cost of care benchmark for demonstration projects must be no 127.34greater than the capitation rate that would have been paid to a managed care plan for a 127.35substantially similar enrollee population based on the per-member per-month rate in 128.1effect on December 31, 2010.  The commissioner shall  adjust benchmark payment rates 128.2for demonstration projects as necessary to reflect the higher level of service and cost 128.3necessary to serve a patient population with a higher incidence of socioeconomic barriers 128.4and complexity, and shall make corresponding reductions in payment rates for projects 128.5with a lower concentration of patients with socioeconomic barriers and complexity.128.6    Sec. 52. Minnesota Statutes 2010, section 256B.0755, is amended by adding a 128.7subdivision to read:128.8    Subd. 8.Coordination with local services.The health care home and the county 128.9shall coordinate care and services provided to patients enrolled in a demonstration project 128.10who have complex medical or socioeconomic needs or a disability, and who need and are 128.11eligible for additional local services administered by counties, including but not limited 128.12to waivered services, mental health services, social services, public health services, 128.13transportation, or housing.  The coordination of care and services must be as provided in 128.14the plan established by the patient and primary care provider or health care home.128.15    Sec. 53. Minnesota Statutes 2010, section 256B.0755, is amended by adding a 128.16subdivision to read:128.17    Subd. 9.Rural demonstration projects.For demonstration projects serving 128.18rural areas, the commissioner shall consult with rural hospitals, primary care providers, 128.19county boards, health plans, and other key stakeholders primarily domiciled in the 128.20service area regarding the development and approval of alternative rural health care 128.21delivery demonstration projects under this section. In addition to organizations eligible 128.22to establish a demonstration project under subdivision 1, a rural demonstration project 128.23may be established by a county public health or social services agency or a county-based 128.24purchasing plan. In a rural area where multiple, competing provider-based demonstration 128.25projects are not possible, the commissioner shall not approve more than one demonstration 128.26project to serve the primary geographic area and shall follow the applicable procedures 128.27and requirements in section 256B.692 regarding participation of county boards in 128.28reviewing and approving demonstration project proposals.128.29    Sec. 54. Minnesota Statutes 2010, section 256B.0755, is amended by adding a 128.30subdivision to read:128.31    Subd. 10.Patient choice of qualified provider.The commissioner shall implement 128.32and approve demonstration projects in a manner that allows a patient to choose a primary 128.33care provider and health care home from among all available qualified options.  The 129.1commissioner may require the patient to remain with the chosen provider, health care 129.2home, or demonstration project organization for a period of time determined by the 129.3commissioner.  The commissioner shall implement the demonstration projects in a manner 129.4that ensures that a patient has the option of receiving services, including health care home 129.5services, through a provider designated as an essential community provider under section 129.662Q.19. Demonstration projects and essential community providers must comply with 129.7section 62Q.19, subdivisions 3 to 7, for purposes of participation of providers in the 129.8demonstration project, except that reimbursement to federally qualified health centers 129.9and federally qualified health center look-alikes as defined in section 145.9269 must be 129.10in compliance with federal law.129.11    Sec. 55. Minnesota Statutes 2010, section 256B.0755, is amended by adding a 129.12subdivision to read:129.13    Subd. 11.Patient and community engagement.As a condition of approval of 129.14a demonstration project, the commissioner shall require the applicant to demonstrate 129.15that consumers and communities to be served under the project were consulted with and 129.16engaged in the process of developing the project proposal.  The proposal must identify the 129.17needs and preferences of consumers and communities that were identified through this 129.18process of consultation and engagement.  The consumers and communities consulted with 129.19and engaged in the development of the proposal must generally reflect the demographics, 129.20race, and ethnicity of those likely to be served under the demonstration project, with a 129.21special focus on those who experience the greatest health disparities.  The commissioner 129.22shall require that demonstration project providers continue to consult with and engage 129.23consumers and communities during implementation and operation of the demonstration 129.24project.129.25    Sec. 56. Minnesota Statutes 2010, section 256B.0755, is amended by adding a 129.26subdivision to read:129.27    Subd. 12.Care coordination system.The commissioner of human services, in 129.28consultation with the commissioner of health, shall convene an advisory committee of 129.29small, independent, rural, and safety net primary care clinics, community hospitals, 129.30mental health centers, dental clinics, and other providers to advise the commissioner 129.31on the establishment of a system that will allow providers participating in payment 129.32reform demonstration projects established under this section and section 256B.0756 to 129.33effectively coordinate and deliver care to patients.  In consultation with the advisory 129.34committee, the commissioner shall develop a plan for the care coordination system, issue a 130.1request for proposals, and contract with a vendor or vendors to establish and maintain the 130.2technology for the care coordination system.  Using appropriations made for this purpose, 130.3the commissioner shall fund the planning, development, and establishment of the system. 130.4Ongoing costs must be covered by payments made by the providers who use the system.130.5    Sec. 57. Minnesota Statutes 2010, section 256B.0755, is amended by adding a 130.6subdivision to read:130.7    Subd. 13.Approval and implementation.Beginning January 1, 2012, the 130.8commissioner of human services shall approve payment reform projects authorized under 130.9this section for medical assistance and MinnesotaCare. The commissioner may approve 130.10projects for persons enrolled in fee-for-service programs and may require managed care 130.11plans and county-based purchasing plans to contract with a demonstration project provider 130.12on the same terms, conditions, and payment arrangements as are established by the 130.13commissioner for fee-for-service programs.130.14    Sec. 58. Minnesota Statutes 2010, section 256B.0756, is amended to read:130.15256B.0756 HENNEPIN AND RAMSEY COUNTIES PILOT PROGRAM.130.16(a) The commissioner, upon federal approval of a new waiver request or amendment 130.17of an existing demonstration, may establish a pilot program in Hennepin County or 130.18Ramsey County, or both, to test alternative and innovative integrated health care delivery 130.19networks.130.20(b) Individuals eligible for the pilot program shall be individuals who are eligible for 130.21medical assistance under section 
         256B.055, subdivision 15, and who reside in Hennepin 130.22County or Ramsey County.130.23(c) Individuals enrolled in the pilot program shall be enrolled in an integrated 130.24health care delivery network in their county of residence. The integrated health care 130.25delivery network in Hennepin County shall be a network, such as an accountable care 130.26organization or a community-based collaborative care network, created by or including 130.27Hennepin County Medical Center. The integrated health care delivery network in Ramsey 130.28County shall be a network, such as an accountable care organization or community-based 130.29collaborative care network, created by or including Regions Hospital.130.30(d) The commissioner shall cap pilot program enrollment at 7,000 enrollees for 130.31Hennepin County and 3,500 enrollees for Ramsey County.130.32(e) In developing a payment system for the pilot programs, the commissioner shall 130.33establish a total cost of care for the recipients enrolled in the pilot programs that equals 131.1the cost of care that would otherwise be spent for these enrollees in the prepaid medical 131.2assistance program.131.3(f) Counties may transfer funds necessary to support the nonfederal share of 131.4payments for integrated health care delivery networks in their county. Such transfers per 131.5county shall not exceed 15 percent of the expected expenses for county enrollees.131.6(g) The commissioner shall apply to the federal government for, or as appropriate, 131.7cooperate with counties, providers, or other entities that are applying for any applicable 131.8grant or demonstration under the Patient Protection and Affordable Health Care Act, Public 131.9Law 111-148, or the Health Care and Education Reconciliation Act of 2010, Public Law 131.10111-152, that would further the purposes of or assist in the creation of an integrated health 131.11care delivery network for the purposes of this subdivision, including, but not limited to, a 131.12global payment demonstration or the community-based collaborative care network grants.131.13(h) A demonstration project established under this section must meet the 131.14requirements of section 256B.0755, subdivisions 8, 9, 10, and 11.131.15    Sec. 59. [256B.0758] PREGNANCY CARE HOMES.131.16    Subdivision 1.Definitions.(a) For purposes of this section, the following definitions 131.17apply.131.18(b) "Pregnancy care home" means a health care home certified by the commissioner 131.19of health under section 256B.0751 that provides pregnancy care services in a way that 131.20is patient-centered, outcome-driven, comprehensive, and coordinated, and meets the 131.21standards specified and developed under subdivision 3.131.22(c) "Pregnancy care services" means prenatal care, consultative perinatal services, 131.23intrapartum and postpartum care, and well-baby care for the first week.131.24(d) "State health care program" means the medical assistance and MinnesotaCare 131.25programs.131.26    Subd. 2.Development and implementation of standards.(a) The commissioners 131.27of human services and health shall develop and implement standards of certification 131.28of pregnancy care homes for state health care programs. In developing standards, the 131.29commissioners shall consult with representatives of the American College of Nurse 131.30Midwives, the American Congress of OB/GYN, the American Academy of Family 131.31Practice, the American Academy of Pediatrics, and relevant local consumer groups.131.32    Subd. 3.Criteria for development of standards.(a) A pregnancy care home must 131.33meet the general health care home standards developed by the commissioners under 131.34section 256B.0751, subdivision 2, paragraph (a), clauses (1) to (4), (6), and (8) to (10), and 131.35must also meet specific standards for pregnancy care homes. The specific standards for 132.1pregnancy care homes developed by the commissioners must meet the criteria specified 132.2in this subdivision.132.3(b) A pregnancy care home must provide pregnancy care services. Nonpregnancy 132.4complications, such as preexisting illness, shall be covered by medical assistance outside 132.5of the pregnancy care home. During a pregnancy episode, the pregnancy care home must 132.6coordinate necessary nonpregnancy health care services with the mother's primary care 132.7provider or another appropriate provider.132.8(c) Each pregnancy care home must have adequate malpractice insurance that meets 132.9the standards specified by the commissioners.132.10(d) A pregnancy care home may provide pregnancy services through any health care 132.11professional licensed to provide the service in Minnesota, including but not limited to 132.12licensed traditional midwives, certified nurse midwives, family practitioners, obstetricians, 132.13perinatologists, neonatologists, and other advanced practice registered nurses. 132.14(e) Pregnancy care within a pregnancy care home may be provided at any Minnesota 132.15facility licensed to provide pregnancy care and birth, including but not limited to 132.16freestanding birth centers, integrated birth centers, and hospitals. Each pregnancy care 132.17home must offer the option of midwife-directed pregnancy care services in a licensed 132.18integrated or freestanding birth center.132.19(f) A pregnancy care home must have a governing board comprised of at least 132.20eight members. One-half of the governing board members must be providers licensed to 132.21attend births.132.22(g) Each pregnancy care home must have a formal consultative relationship with at 132.23least one level III perinatal center to provide care for mothers and babies who develop 132.24pregnancy complications.132.25(h) Each pregnancy care home must comply with state and federal requirements for 132.26the use of interoperable electronic medical records.132.27(i) Each pregnancy care home must submit annual reports to the commissioners of 132.28human services and health that document:132.29(1) all relevant pregnancy care outcomes and patient satisfaction measures; and132.30(2) the financial status of the pregnancy care home.132.31All reports are public data under section 13.02.132.32(j) Each pregnancy care home must offer culturally competent  care coordination 132.33services in a manner that is consistent with health care home requirements.132.34(k) For the purposes of developing and implementing the standards in this 132.35subdivision, the commissioners may use the expedited rulemaking process under section 132.3614.389.133.1    Subd. 4.Certification process.Providers seeking certification as a pregnancy care 133.2home must apply to the commissioner of health. Providers certified by the commissioner 133.3of health may provide pregnancy care services through pregnancy care homes beginning 133.4July 1, 2012. Certification as a pregnancy care home is voluntary, except that beginning 133.5July 1, 2014, all nonemergency pregnancy care services covered under state health care 133.6programs must be provided through providers certified as pregnancy care homes.133.7    Subd. 5.Payments to pregnancy care homes.(a) The commissioner of human 133.8services, in coordination with the commissioner of health, shall develop a payment system 133.9that provides a single per-person payment to pregnancy care homes to cover all pregnancy 133.10care services provided to each mother and infant enrolled in a state health care program. 133.11Pregnancy care homes receiving payments under this subdivision remain eligible for care 133.12coordination payments under section 256B.0753.133.13(b) Payment amounts for pregnancy care homes shall be uniform statewide and 133.14determined annually by the commissioner, based initially upon a specified percentage 133.15of the calculated average cost of care for mothers and infants under state health care 133.16programs for the three most recent fiscal years for which cost information is available. 133.17Beginning July 1, 2014, statewide payment amounts for pregnancy care homes shall be 133.18determined annually by the commissioner by adjusting the current payment amount by 133.19a measure of medical inflation selected by the commissioner that best represents the 133.20change in the cost of pregnancy-related services provided to patients covered by private 133.21sector health coverage.133.22(c) Pregnancy care home payments must initially be made for pregnancy care 133.23services provided to pregnant women who are not high risk, beginning July 1, 2012. 133.24Beginning January 1, 2013, the commissioner shall phase in higher payments for high-risk 133.25pregnancy categories so that beginning July 1, 2014, pregnancy care services for all 133.26low-risk and high-risk pregnancies are reimbursed under this subdivision.133.27    Sec. 60. [256B.0759] CARE COORDINATION FOR ENROLLEES.133.28    Subdivision 1.Qualified enrollee.For purposes of this section, a "qualified 133.29enrollee" means: (1) a medical assistance enrollee eligible under this chapter; or (2) a 133.30MinnesotaCare enrollee eligible under chapter 256L.133.31    Subd. 2.Selection of primary care provider.The commissioner shall require 133.32qualified enrollees who do not have a designated medical condition to select a primary 133.33care provider and agree to receive primary care services from that provider as a condition 133.34of medical assistance or MinnesotaCare enrollment.134.1    Subd. 3.Selection of health care home; care coordination.(a) The commissioner 134.2shall require qualified enrollees who have a medical condition designated by the 134.3commissioner to select a health care home certified under section 256B.0751 and agree 134.4to receive primary care and care coordination services through that health care home as 134.5a condition of medical assistance or MinnesotaCare enrollment. For purposes of this 134.6subdivision, the commissioner shall designate medical conditions with a high likelihood 134.7of inappropriate inpatient hospital admissions for which care coordination and prior 134.8authorization of admissions are expected to improve the quality of care and lead to costs 134.9savings for state health care programs.134.10(b) The commissioner shall include on Minnesota health care program enrollment 134.11cards a designation as to whether an enrollee meets the criteria in paragraph (a). In order 134.12to receive medical assistance or MinnesotaCare payment for nonemergency inpatient 134.13hospital admissions for enrollees meeting the criteria in paragraph (a), a hospital must 134.14receive prior authorization from the enrollee's health care home.134.15EFFECTIVE DATE.This section is effective January 1, 2012, for MinnesotaCare 134.16enrollees not eligible for a federal match, and is effective January 1, 2012, or upon federal 134.17approval, whichever is later, for medical assistance enrollees and for MinnesotaCare 134.18enrollees eligible for a federal match.134.19    Sec. 61. [256B.0760] ELECTIVE SURGERY.134.20    Subdivision 1.Payment prohibition.The commissioner, in consultation with 134.21health care providers, health care homes certified under section 256B.0751, managed 134.22care plans providing services under section 256B.69, and county-based purchasing plans 134.23providing services under section  256B.692, shall identify elective or nonemergency 134.24surgical procedures for which less invasive and less costly alternative treatment methods 134.25are available, and shall prohibit payment for these elective or nonemergency surgical 134.26procedures if the alternative treatment methods have not first been evaluated for use 134.27and, if appropriate, provided to the enrollee.134.28    Subd. 2.Implementation.The commissioner shall implement the payment 134.29prohibitions in paragraph (a) for fee-for-service medical assistance providers by January 134.301, 2012, and shall require managed care and county-based purchasing plans to implement 134.31the payment prohibitions in paragraph (a) for providers employed or under contract for 134.32services provided to medical assistance and MinnesotaCare enrollees beginning January 134.331, 2012.134.34    Subd. 3.Reduction in capitation rates.The commissioner shall reduce medical 134.35assistance and MinnesotaCare capitation rates to managed care and county-based 135.1purchasing plans beginning January 1, 2012, to reflect cost-savings to plans resulting from 135.2implementation of the payment prohibitions required by this subdivision.135.3    Sec. 62. Minnesota Statutes 2010, section 256B.37, subdivision 5, is amended to read:135.4    Subd. 5. Private benefits to be used first. Private accident and health care 135.5coverage, including Medicare for medical services and coverage provided through the 135.6United States Department of Veterans Affairs, is primary coverage and must be exhausted 135.7before medical assistance or alternative care services are paid for medical services 135.8including home health care, personal care assistance services, hospice, supplies and 135.9equipment, or services covered under a Centers for Medicare and Medicaid Services 135.10waiver. When a person who is otherwise eligible for medical assistance has private 135.11accident or health care coverage, including Medicare or a prepaid health plan or coverage 135.12provided through the United States Department of Veterans Affairs, the private health care 135.13benefits available to the person must be used first and to the fullest extent.135.14    Sec. 63. Minnesota Statutes 2010, section 256B.69, subdivision 3a, is amended to read:135.15    Subd. 3a. County authority. (a) The commissioner, when implementing or 135.16administering the medical assistance prepayment program within a county, must include 135.17the county board in the process of development, approval, and issuance of the request for 135.18proposals to provide services to eligible individuals within the proposed county, including 135.19proposals for demonstration projects established under section 256B.0755. County boards 135.20must be given reasonable opportunity to make recommendations regarding assist in135.21the development, issuance, review of responses, and changes needed in the request for 135.22proposals. The commissioner must provide county boards the opportunity to review 135.23each proposal based on the identification of community needs under chapters 145A and 135.24256E and county advocacy activities. If a county board finds that a proposal does not 135.25address certain community needs, the county board and commissioner shall continue 135.26efforts for improving the proposal and network prior to the approval of the contract. 135.27The county board shall make recommendations determinations regarding the approval 135.28of local networks and their operations to ensure adequate local availability and access to 135.29covered services. The provider or health plan must respond directly to county advocates 135.30and the state prepaid medical assistance ombudsperson regarding service delivery and 135.31must be accountable to the state regarding contracts with medical assistance funds. The 135.32county board may recommend shall decide a maximum number of participating health 135.33plans including county-based purchasing plans after considering the size of the enrolling 135.34population; ensuring adequate access and capacity; considering the client and county 136.1administrative complexity; and considering the need to promote the viability of locally 136.2developed health plans, managed care plans, or demonstration projects established under 136.3section 256B.0755. The county board or a single entity representing a group of county 136.4boards and the commissioner shall mutually select one or more qualified health plans or 136.5county-based purchasing plans for participation at the time of initial implementation of the 136.6prepaid medical assistance program or a demonstration project established under section 136.7256B.0755 in that county or group of counties and at the time of contract renewal. The 136.8commissioner shall also seek input for contract requirements from the county or single 136.9entity representing a group of county boards at each contract renewal and incorporate 136.10those recommendations into the contract negotiation process.136.11    (b) At the option of the county board, the board may develop contract requirements 136.12related to the achievement of local public health goals and health care delivery and access 136.13goals to meet the health needs of medical assistance enrollees. These requirements must 136.14be reasonably related to the performance of health plan managed care or delivery system 136.15demonstration project functions and within the scope of the medical assistance benefit 136.16set. If the county board and the commissioner mutually agree to such requirements, the 136.17department The commissioner shall include such requirements in all health plan contracts 136.18governing the prepaid medical assistance program in that county at initial implementation 136.19of the program or demonstration project in that county and at the time of contract renewal. 136.20The county board may participate in the enforcement of the contract provisions related to 136.21local public health goals.136.22    (c) For counties in which a prepaid medical assistance program has not been 136.23established, the commissioner shall not implement that program if a county board submits 136.24an acceptable and timely preliminary and final proposal under section 
         256B.692, until 136.25county-based purchasing is no longer operational in that county. For counties in which 136.26a prepaid medical assistance program is in existence on or after September 1, 1997, the 136.27commissioner must terminate contracts with health plans according to section 
         256B.692, 136.28subdivision 5
         , if the county board submits and the commissioner accepts a preliminary and 136.29final proposal according to that subdivision. The commissioner is not required to terminate 136.30contracts that begin on or after September 1, 1997, according to section 
         256B.692 until 136.31two years have elapsed from the date of initial enrollment.136.32    (d) In the event that a county board or a single entity representing a group of county 136.33boards and the commissioner cannot reach agreement regarding: (i) the selection of 136.34participating health plans or demonstration projects under section 256B.0755 in that 136.35county; (ii) contract requirements; or (iii) implementation and enforcement of county 136.36requirements including provisions regarding local public health goals, the commissioner 137.1shall resolve all disputes after taking into account by approving the recommendations of 137.2a three-person mediation panel. The panel shall be composed of one designee of the 137.3president of the association of Minnesota counties, one designee of the commissioner of 137.4human services, and one person selected jointly by the designee of the commissioner of 137.5human services and the designee of the Association of Minnesota Counties. Within a 137.6reasonable period of time before the hearing, the panelists must be provided all documents 137.7and information relevant to the mediation. The parties to the mediation must be given 137.830 days' notice of a hearing before the mediation panel.137.9    (e) If a county which elects to implement county-based purchasing ceases to 137.10implement county-based purchasing, it is prohibited from assuming the responsibility of 137.11county-based purchasing for a period of five years from the date it discontinues purchasing.137.12    (f) The commissioner shall not require that contractual disputes between 137.13county-based purchasing entities and the commissioner be mediated by a panel that 137.14includes a representative of the Minnesota Council of Health Plans.137.15    (g) At the request of a county-purchasing entity, the commissioner shall adopt a 137.16contract reprocurement or renewal schedule under which all counties included in the 137.17entity's service area are reprocured or renewed at the same time.137.18    (h) The commissioner shall provide a written report under section 
         3.195 to the chairs 137.19of the legislative committees having jurisdiction over human services in the senate and the 137.20house of representatives describing in detail the activities undertaken by the commissioner 137.21to ensure full compliance with this section. The report must also provide an explanation 137.22for any decisions of the commissioner not to accept the recommendations of a county or 137.23group of counties required to be consulted under this section. The report must be provided 137.24at least 30 days prior to the effective date of a new or renewed prepaid or managed care 137.25contract in a county.137.26(i) This section also applies to other Minnesota health care programs administered 137.27by the commissioner, including but not limited to the MinnesotaCare program.137.28    Sec. 64. Minnesota Statutes 2010, section 256B.69, subdivision 4, is amended to read:137.29    Subd. 4. Limitation of choice. (a) The commissioner shall develop criteria to 137.30determine when limitation of choice may be implemented in the experimental counties. 137.31The criteria shall ensure that all eligible individuals in the county have continuing access 137.32to the full range of medical assistance services as specified in subdivision 6.137.33    (b) The commissioner shall exempt the following persons from participation in the 137.34project, in addition to those who do not meet the criteria for limitation of choice:138.1    (1) persons eligible for medical assistance according to section 
         256B.055, 138.2subdivision 1
         ;138.3    (2) persons eligible for medical assistance due to blindness or disability as 138.4determined by the Social Security Administration or the state medical review team, unless:138.5    (i) they are 65 years of age or older; or138.6    (ii) they reside in Itasca County or they reside in a county in which the commissioner 138.7conducts a pilot project under a waiver granted pursuant to section 1115 of the Social 138.8Security Act;138.9    (3) recipients who currently have private coverage through a health maintenance 138.10organization;138.11    (4) recipients who are eligible for medical assistance by spending down excess 138.12income for medical expenses other than the nursing facility per diem expense;138.13    (5) recipients who receive benefits under the Refugee Assistance Program, 138.14established under United States Code, title 8, section 1522(e);138.15    (6) children who are both determined to be severely emotionally disturbed and 138.16receiving case management services according to section 
         256B.0625, subdivision 20, 138.17except children who are eligible for and who decline enrollment in an approved preferred 138.18integrated network under section 
         245.4682;138.19    (7) adults who are both determined to be seriously and persistently mentally ill and 138.20received case management services according to section 
         256B.0625, subdivision 20;138.21    (8) persons eligible for medical assistance according to section 
         256B.057, 138.22subdivision 10
         ; and138.23    (9) persons with access to cost-effective employer-sponsored private health 138.24insurance or persons enrolled in a non-Medicare individual health plan determined to be 138.25cost-effective according to section 
         256B.0625, subdivision 15.138.26Children under age 21 who are in foster placement may enroll in the project on an elective 138.27basis. Individuals excluded under clauses (1), (6), and (7) may choose to enroll on an 138.28elective basis. The commissioner may enroll recipients in the prepaid medical assistance 138.29program for seniors who are (1) age 65 and over, and (2) eligible for medical assistance by 138.30spending down excess income.138.31    (c) The commissioner may allow persons with a one-month spenddown who are 138.32otherwise eligible to enroll to voluntarily enroll or remain enrolled, if they elect to prepay 138.33their monthly spenddown to the state.138.34    (d) The commissioner may require those individuals to enroll in the prepaid medical 138.35assistance program who otherwise would have been excluded under paragraph (b), clauses 138.36(1), (3), and (8), and under Minnesota Rules, part 9500.1452, subpart 2, items H, K, and L.139.1    (e) Before limitation of choice is implemented, eligible individuals shall be notified 139.2and after notification, shall be allowed to choose only among demonstration providers. 139.3The commissioner may assign an individual with private coverage through a health 139.4maintenance organization, to the same health maintenance organization for medical 139.5assistance coverage, if the health maintenance organization is under contract for medical 139.6assistance in the individual's county of residence. After initially choosing a provider, 139.7the recipient is allowed to change that choice only at specified times as allowed by the 139.8commissioner. If a demonstration provider ends participation in the project for any reason, 139.9a recipient enrolled with that provider must select a new provider but may change providers 139.10without cause once more within the first 60 days after enrollment with the second provider.139.11    (f) An infant born to a woman who is eligible for and receiving medical assistance 139.12and who is enrolled in the prepaid medical assistance program shall be retroactively 139.13enrolled to the month of birth in the same managed care plan as the mother once the 139.14child is enrolled in medical assistance unless the child is determined to be excluded from 139.15enrollment in a prepaid plan under this section.139.16(g) For an eligible individual under the age of 65, in the absence of a specific 139.17managed care plan choice by the individual, the commissioner shall assign the individual to 139.18the county-based purchasing plan, if any, in the county of the individual's residence. For an 139.19eligible individual over the age of 65, the commissioner shall make the default assignment 139.20on the county-based purchasing plan entering into a contract with the commissioner to 139.21serve this population and receiving federal approval as a special needs plan.139.22    Sec. 65. Minnesota Statutes 2010, section 256B.69, subdivision 5a, is amended to read:139.23    Subd. 5a. Managed care contracts. (a) Managed care contracts under this section 139.24and section 
         256L.12 shall be entered into or renewed on a calendar year basis beginning 139.25January 1, 1996. Managed care contracts which were in effect on June 30, 1995, and set to 139.26renew on July 1, 1995, shall be renewed for the period July 1, 1995 through December 139.2731, 1995 at the same terms that were in effect on June 30, 1995. The commissioner may 139.28issue separate contracts with requirements specific to services to medical assistance 139.29recipients age 65 and older.139.30    (b) A prepaid health plan providing covered health services for eligible persons 139.31pursuant to chapters 256B and 256L is responsible for complying with the terms of its 139.32contract with the commissioner. Requirements applicable to managed care programs 139.33under chapters 256B and 256L established after the effective date of a contract with the 139.34commissioner take effect when the contract is next issued or renewed.140.1    (c) Effective for services rendered on or after January 1, 2003, the commissioner 140.2shall withhold five percent of managed care plan payments under this section and 140.3county-based purchasing plan payments under section 
         256B.692 for the prepaid medical 140.4assistance program pending completion of performance targets. Each performance target 140.5must be quantifiable, objective, measurable, and reasonably attainable, except in the case 140.6of a performance target based on a federal or state law or rule. Criteria for assessment 140.7of each performance target must be outlined in writing prior to the contract effective 140.8date. The managed care plan must demonstrate, to the commissioner's satisfaction, 140.9that the data submitted regarding attainment of the performance target is accurate. The 140.10commissioner shall periodically change the administrative measures used as performance 140.11targets in order to improve plan performance across a broader range of administrative 140.12services. The performance targets must include measurement of plan efforts to contain 140.13spending on health care services and administrative activities. The commissioner may 140.14adopt plan-specific performance targets that take into account factors affecting only one 140.15plan, including characteristics of the plan's enrollee population. The withheld funds 140.16must be returned no sooner than July of the following year if performance targets in the 140.17contract are achieved. The commissioner may exclude special demonstration projects 140.18under subdivision 23.140.19    (d) Effective for services rendered on or after January 1, 2009, through December 140.2031, 2009, the commissioner shall withhold three percent of managed care plan payments 140.21under this section and county-based purchasing plan payments under section 
         256B.692 140.22for the prepaid medical assistance program. The withheld funds must be returned no 140.23sooner than July 1 and no later than July 31 of the following year. The commissioner may 140.24exclude special demonstration projects under subdivision 23.140.25(e) Effective for services provided on or after January 1, 2010, the commissioner 140.26shall require that managed care plans use the assessment and authorization processes, 140.27forms, timelines, standards, documentation, and data reporting requirements, protocols, 140.28billing processes, and policies consistent with medical assistance fee-for-service or the 140.29Department of Human Services contract requirements consistent with medical assistance 140.30fee-for-service or the Department of Human Services contract requirements for all 140.31personal care assistance services under section 
         256B.0659.140.32(f) Effective for services rendered on or after January 1, 2010, through December 140.3331, 2010, the commissioner shall withhold 4.5 percent of managed care plan payments 140.34under this section and county-based purchasing plan payments under section 
         256B.692 140.35for the prepaid medical assistance program. The withheld funds must be returned no 141.1sooner than July 1 and no later than July 31 of the following year. The commissioner may 141.2exclude special demonstration projects under subdivision 23.141.3(g) Effective for services rendered on or after January 1, 2011, the commissioner 141.4shall include as part of the performance targets described in paragraph (c) a reduction in 141.5the health plan's emergency room utilization rate for state health care program enrollees 141.6by a measurable rate of five percent from the plan's utilization rate for state health care 141.7program enrollees for the previous calendar year.141.8The withheld funds must be returned no sooner than July 1 and no later than July 31 141.9of the following calendar year if the managed care plan demonstrates to the satisfaction of 141.10the commissioner that a reduction in the utilization rate was achieved.141.11The withhold described in this paragraph shall continue for each consecutive 141.12contract period until the plan's emergency room utilization rate for state health care 141.13program enrollees is reduced by 25 percent of the plan's emergency room utilization 141.14rate for state health care program enrollees for calendar year 2009. Hospitals shall 141.15cooperate with the health plans in meeting this performance target and shall accept 141.16payment withholds that may be returned to the hospitals if the performance target is 141.17achieved. The commissioner shall structure the withhold so that the commissioner returns 141.18a portion of the withheld funds in amounts commensurate with achieved reductions in 141.19utilization less than the targeted amount. The withhold in this paragraph does not apply to 141.20county-based purchasing plans.141.21(h) Effective for services rendered on or after January 1, 2012, the commissioner 141.22shall include as part of the performance targets described in paragraph (c) a reduction in 141.23the plan's hospitalization rates or subsequent hospitalizations within 30 days of a previous 141.24hospitalization of a patient regardless of the reason for the hospitalization for state health 141.25care program enrollees by a measurable rate of five percent from the plan's utilization rate 141.26for state health care program enrollees for the previous calendar year.141.27The withheld funds must be returned no sooner than July 1 and no later than July 31 141.28of the following calendar year if the managed care plan or county-based purchasing plan 141.29demonstrates to the satisfaction of the commissioner that a reduction in the hospitalization 141.30rate was achieved.141.31The withhold described in this paragraph must continue for each consecutive 141.32contract period until the plan's subsequent hospitalization rate for state health care 141.33program enrollees is reduced by 25 percent of the plan's subsequent hospitalization rate 141.34for state health care program enrollees for calendar year 2010. Hospitals shall cooperate 141.35with the plans in meeting this performance target and shall accept payment withholds that 141.36must be returned to the hospitals if the performance target is achieved. The commissioner 142.1shall structure the withhold so that the commissioner returns a portion of the withheld 142.2funds in amounts commensurate with achieved reductions in utilization less than the 142.3targeted amount.142.4(h) (i) Effective for services rendered on or after January 1, 2011, through December 142.531, 2011, the commissioner shall withhold 4.5 percent of managed care plan payments 142.6under this section and county-based purchasing plan payments under section 
         256B.692 142.7for the prepaid medical assistance program. The withheld funds must be returned no 142.8sooner than July 1 and no later than July 31 of the following year. The commissioner may 142.9exclude special demonstration projects under subdivision 23.142.10(i) (j) Effective for services rendered on or after January 1, 2012, through December 142.1131, 2012, the commissioner shall withhold 4.5 percent of managed care plan payments 142.12under this section and county-based purchasing plan payments under section 
         256B.692 142.13for the prepaid medical assistance program. The withheld funds must be returned no 142.14sooner than July 1 and no later than July 31 of the following year. The commissioner may 142.15exclude special demonstration projects under subdivision 23.142.16(j) (k) Effective for services rendered on or after January 1, 2013, through December 142.1731, 2013, the commissioner shall withhold 4.5 percent of managed care plan payments 142.18under this section and county-based purchasing plan payments under section 
         256B.692 142.19for the prepaid medical assistance program. The withheld funds must be returned no 142.20sooner than July 1 and no later than July 31 of the following year. The commissioner may 142.21exclude special demonstration projects under subdivision 23.142.22(k) (l) Effective for services rendered on or after January 1, 2014, the commissioner 142.23shall withhold three percent of managed care plan payments under this section and 142.24county-based purchasing plan payments under section 
         256B.692 for the prepaid medical 142.25assistance program. The withheld funds must be returned no sooner than July 1 and 142.26no later than July 31 of the following year. The commissioner may exclude special 142.27demonstration projects under subdivision 23.142.28(l) (m) A managed care plan or a county-based purchasing plan under section 142.29256B.692 
         may include as admitted assets under section 
         62D.044 any amount withheld 142.30under this section that is reasonably expected to be returned.142.31(m) (n) Contracts between the commissioner and a prepaid health plan are exempt 142.32from the set-aside and preference provisions of section 
         16C.16, subdivisions 6, paragraph 142.33(a), and 7.142.34(n) (o) The return of the withhold under paragraphs (d), (f), and (h) to (k) is not 142.35subject to the requirements of paragraph (c).143.1    Sec. 66. Minnesota Statutes 2010, section 256B.69, subdivision 5c, is amended to read:143.2    Subd. 5c. Medical education and research fund. (a) The commissioner of human 143.3services shall transfer each year to the medical education and research fund established 143.4under section 
         62J.692, the following:143.5(1) an amount equal to the reduction in the prepaid medical assistance payments as 143.6specified in this clause. Until January 1, 2002, the county medical assistance capitation 143.7base rate prior to plan specific adjustments and after the regional rate adjustments under 143.8subdivision 5b is reduced 6.3 percent for Hennepin County, two percent for the remaining 143.9metropolitan counties, and no reduction for nonmetropolitan Minnesota counties; and after 143.10January 1, 2002, the county medical assistance capitation base rate prior to plan specific 143.11adjustments is reduced 6.3 percent for Hennepin County, two percent for the remaining 143.12metropolitan counties, and 1.6 percent for nonmetropolitan Minnesota counties. Nursing 143.13facility and elderly waiver payments and demonstration project payments operating 143.14under subdivision 23 are excluded from this reduction. The amount calculated under 143.15this clause shall not be adjusted for periods already paid due to subsequent changes to 143.16the capitation payments;143.17(2) beginning July 1, 2003, $4,314,000 from the capitation rates paid under this 143.18section;143.19(3) beginning July 1, 2002, an additional $12,700,000 from the capitation rates 143.20paid under this section; and143.21(4) beginning July 1, 2003, an additional $4,700,000 from the capitation rates paid 143.22under this section.143.23(b) This subdivision shall be effective upon approval of a federal waiver which 143.24allows federal financial participation in the medical education and research fund. Effective 143.25July 1, 2009, and thereafter, the transfers required by paragraph (a), clauses (1) to (4), 143.26shall not exceed the total amount transferred for fiscal year 2009. Any excess shall first 143.27reduce the amounts otherwise required to be transferred under paragraph (a), clauses 143.28(2) to (4). Any excess following this reduction shall proportionally reduce the transfers 143.29under paragraph (a), clause (1).143.30(c) Beginning July 1, 2009, of the amounts in paragraph (a), the commissioner shall 143.31transfer $21,714,000 each fiscal year to the medical education and research fund. The 143.32balance of the transfers under paragraph (a) shall be transferred to the medical education 143.33and research fund no earlier than July 1 of the following fiscal year.143.34(d) Beginning in fiscal year 2012, the commissioner shall reduce the amount 143.35transferred to the medical education research fund under paragraph (a), by $4,500,000 144.1each fiscal year. This reduction must be applied to the amount available for general 144.2distribution under section 62J.692, subdivision 7, clause (5).144.3    Sec. 67. Minnesota Statutes 2010, section 256B.69, subdivision 6, is amended to read:144.4    Subd. 6. Service delivery. (a) Each demonstration provider shall be responsible for 144.5the health care coordination for eligible individuals. Demonstration providers:144.6    (1) shall authorize and arrange for the provision of all needed health services 144.7including but not limited to the full range of services listed in sections 
         256B.02, 144.8subdivision 8
         , and 
         256B.0625 in order to ensure appropriate health care is delivered to 144.9enrollees. Notwithstanding section 
         256B.0621, demonstration providers that provide 144.10nursing home and community-based services under this section shall provide relocation 144.11service coordination to enrolled persons age 65 and over;144.12    (2) shall accept the prospective, per capita payment from the commissioner in return 144.13for the provision of comprehensive and coordinated health care services for eligible 144.14individuals enrolled in the program;144.15    (3) may contract with other health care and social service practitioners to provide 144.16services to enrollees; and144.17    (4) shall institute recipient grievance procedures according to the method established 144.18by the project, utilizing applicable requirements of chapter 62D. Disputes not resolved 144.19through this process shall be appealable to the commissioner as provided in subdivision 11.144.20    (b) Demonstration providers must comply with the standards for claims settlement 144.21under section 
         72A.201, subdivisions 4, 5, 7, and 8, when contracting with other health 144.22care and social service practitioners to provide services to enrollees. A demonstration 144.23provider must pay a clean claim, as defined in Code of Federal Regulations, title 42, 144.24section 447.45(b), within 30 business days of the date of acceptance of the claim.144.25(c) A demonstration provider must accept into its medical assistance and 144.26MinnesotaCare provider networks any health care or social service provider that agrees 144.27to accept payment, quality assurance, and other contract terms that the demonstration 144.28provider applies to other similarly situated providers in its provider network.144.29EFFECTIVE DATE.This section is effective January 1, 2012, and applies to 144.30provider contracts that take effect on or after that date.144.31    Sec. 68. Minnesota Statutes 2010, section 256B.69, is amended by adding a 144.32subdivision to read:144.33    Subd. 30.Provider payment rates.(a) Each managed care and county-based plan 144.34shall, by October 1, 2011, array all providers within each provider type, employed by or 145.1under contract with the plan, by their average total annual cost of care for serving medical 145.2assistance and MinnesotaCare enrollees for the most recent reporting year for which data 145.3is available, risk-adjusted for enrollee demographics and health status.145.4(b) Beginning January 1, 2012, and each contract year thereafter, each managed 145.5care and county-based purchasing plan shall implement a progressive payment withhold 145.6methodology for each provider type, under which the withhold for a provider increases 145.7proportionally as the provider's risk-adjusted total annual cost increases, relative to other 145.8providers of the same type. For purposes of this paragraph, the risk-adjusted total annual 145.9cost of care is the dollar amount calculated under paragraph (a).145.10(c) At the end of each contract year, each plan shall array all providers within each 145.11provider type by their average total annual cost of care for serving medical assistance and 145.12MinnesotaCare enrollees for that contract year, risk-adjusted for enrollee demographics 145.13and health status. For each provider whose risk-adjusted total annual cost of care is at or 145.14below a benchmark percentile established by the plan, the plan shall return the full amount 145.15of any withhold. For each provider whose risk-adjusted total annual cost of care is above 145.16the benchmark percentile, the plan shall return only the portion of the withhold sufficient 145.17to bring the provider's payment rate to the average for providers within the provider type 145.18whose risk-adjusted total annual cost of care is at the benchmark percentile. Each plan shall 145.19establish the benchmark percentile at a level that allows the plan to adjust expenditures for 145.20provider payments to reflect the reduction in capitation rates under paragraph (f).145.21(d) Each managed care and county-based purchasing plan must establish an appeals 145.22process to allow providers to appeal determinations of risk-adjusted total annual cost of 145.23care. Each plan's appeals process must be approved by the commissioner.145.24(e) The commissioner shall require each plan to submit to the commissioner, in 145.25the form and manner specified by the commissioner, all provider payment data and 145.26information on the withhold methodology that the commissioner determines is necessary 145.27to verify compliance with this subdivision.145.28(f) The commissioner, for the contract year beginning January 1, 2012, shall reduce 145.29plan capitation rates by 12 percent from the rates that would otherwise apply, absent 145.30application of this subdivision. The reduced rate shall be the historical base rate for 145.31negotiating capitation rates for future contract years. The commissioner may recommend 145.32additional reductions in capitation rates for future contract years to the legislature, if the 145.33commissioner determines this is necessary to ensure that health care providers under 145.34contract with managed care and county-based purchasing plans practice in an efficient 145.35manner.146.1(g) The commissioner of human services, in consultation with the commissioner of 146.2health, shall develop and provide to managed care and county-based purchasing plans, by 146.3September 1, 2011, standard criteria and definitions necessary for consistent calculation 146.4of the total annual risk-adjusted cost of care across plans. The commissioner may use 146.5encounter data collected under section 62U.04 to implement this subdivision, and may 146.6provide encounter data or analyses to plans. Section 62U.04, subdivision 4, paragraph 146.7(b), shall not apply to the commissioners of health and human services for purposes of 146.8this subdivision.146.9(h) For purposes of this subdivision, "provider" means a vendor of medical care 146.10as defined in section 256B.02, subdivision 7, for which sufficient encounter data on 146.11utilization and costs is available to implement this subdivision.146.12EFFECTIVE DATE.This section is effective the day following final enactment.146.13    Sec. 69. Minnesota Statutes 2010, section 256B.69, is amended by adding a 146.14subdivision to read:146.15    Subd. 31.Initiatives to reduce incidence of low birth weight.The commissioner 146.16shall require managed care and county-based purchasing plans as a condition of contract 146.17to implement strategies to reduce the incidence of low birth weight in geographic areas 146.18identified by the commissioner as having a higher than average incidence of low birth 146.19weight, with special emphasis on areas within a one-mile radius of hospitals within their 146.20provider networks. These strategies may focus on smoking prevention and cessation, 146.21ensuring that pregnant women get adequate nutrition, and addressing demographic, 146.22social, and environmental risk factors. The strategies must coordinate health care with 146.23social services and the local public health system, and offer patient education through 146.24appropriate means. The commissioner shall require plans to submit proposed initiatives 146.25for approval to the commissioner by January 1, 2012, and the commissioner shall require 146.26plans to implement approved initiatives by July 1, 2012. The commissioner shall evaluate 146.27the strategies adopted to reduce low birth weight and shall require plans to submit outcome 146.28and other data necessary for the evaluation.146.29    Sec. 70. Minnesota Statutes 2010, section 256B.69, is amended by adding a 146.30subdivision to read:146.31    Subd. 32.Health education.The commissioner shall require managed care and 146.32county-based purchasing plans, as a condition of contract, to provide health education, 146.33wellness training, and information about the availability and benefits of preventive 146.34services to all medical assistance and MinnesotaCare enrollees, beginning January 1, 147.12012. Plan initiatives developed or implemented to comply with this requirement must be 147.2approved by the commissioner.147.3    Sec. 71. Minnesota Statutes 2010, section 256B.692, subdivision 2, is amended to read:147.4    Subd. 2. Duties of commissioner of health. (a) Notwithstanding chapters 62D and 147.562N, a county that elects to purchase medical assistance in return for a fixed sum without 147.6regard to the frequency or extent of services furnished to any particular enrollee is not 147.7required to obtain a certificate of authority under chapter 62D or 62N. The county board 147.8of commissioners is the governing body of a county-based purchasing program. In a 147.9multicounty arrangement, the governing body is a joint powers board established under 147.10section 
         471.59.147.11    (b) A county that elects to purchase medical assistance services under this section 147.12must satisfy the commissioner of health that the requirements for assurance of consumer 147.13protection, provider protection, and, effective January 1, 2010, fiscal solvency of chapter 147.1462D, applicable to health maintenance organizations will be met according to the 147.15following schedule:147.16    (1) for a county-based purchasing plan approved on or before June 30, 2008, the 147.17plan must have in reserve:147.18    (i) at least 50 percent of the minimum amount required under chapter 62D as 147.19of January 1, 2010;147.20    (ii) at least 75 percent of the minimum amount required under chapter 62D as of 147.21January 1, 2011;147.22    (iii) at least 87.5 percent of the minimum amount required under chapter 62D as 147.23of January 1, 2012; and147.24    (iv) at least 100 percent of the minimum amount required under chapter 62D as 147.25of January 1, 2013; and147.26    (2) for a county-based purchasing plan first approved after June 30, 2008, the plan 147.27must have in reserve:147.28    (i) at least 50 percent of the minimum amount required under chapter 62D at the 147.29time the plan begins enrolling enrollees;147.30    (ii) at least 75 percent of the minimum amount required under chapter 62D after 147.31the first full calendar year;147.32    (iii) at least 87.5 percent of the minimum amount required under chapter 62D after 147.33the second full calendar year; and147.34    (iv) at least 100 percent of the minimum amount required under chapter 62D after 147.35the third full calendar year.148.1    (c) Until a plan is required to have reserves equaling at least 100 percent of the 148.2minimum amount required under chapter 62D, the plan may demonstrate its ability 148.3to cover any losses by satisfying the requirements of chapter 62N. Notwithstanding 148.4this paragraph and paragraph (b), a county-based purchasing plan may satisfy its fiscal 148.5solvency requirements by obtaining written financial guarantees from participating 148.6counties in amounts equivalent to the minimum amounts that would otherwise apply.148.7A county-based purchasing plan must also assure the commissioner of health that the 148.8requirements of sections 
         62J.041; 
         62J.48; 
         62J.71 to 
         62J.73; 
         62M.01 to 
         62M.16; all 148.9applicable provisions of chapter 62Q, including sections 
         62Q.075; 
         62Q.1055; 
         62Q.106; 148.1062Q.12
         ; 
         62Q.135; 
         62Q.14; 
         62Q.145; 
         62Q.19; 
         62Q.23, paragraph (c); 
         62Q.43; 
         62Q.47; 148.1162Q.50
         ; 
         62Q.52 to 
         62Q.56; 
         62Q.58; 
         62Q.68 to 
         62Q.72; and 
         72A.201 will be met.148.12    (d) All enforcement and rulemaking powers available under chapters 62D, 62J, 62M, 148.1362N, and 62Q are hereby granted to the commissioner of health with respect to counties 148.14that purchase medical assistance services under this section.148.15    (e) The commissioner, in consultation with county government, shall develop 148.16administrative and financial reporting requirements for county-based purchasing programs 148.17relating to sections 
         62D.041, 
         62D.042, 
         62D.045, 
         62D.08, 
         62N.28, 
         62N.29, and 
         62N.31, 148.18and other sections as necessary, that are specific to county administrative, accounting, and 148.19reporting systems and consistent with other statutory requirements of counties.148.20    (f) The commissioner shall collect from a county-based purchasing plan under 148.21this section the following fees:148.22    (1) fees attributable to the costs of audits and other examinations of plan financial 148.23operations. These fees are subject to the provisions of Minnesota Rules, part 4685.2800, 148.24subpart 1, item F;148.25    (2) an annual fee of $21,500, to be paid by June 15 of each calendar year, beginning 148.26in calendar year 2009; and148.27    (3) for fiscal year 2009 only, a per-enrollee fee of 14.6 cents, based on the number of 148.28enrollees as of December 31, 2008.148.29All fees collected under this paragraph shall be deposited in the state government special 148.30revenue fund.148.31    Sec. 72. Minnesota Statutes 2010, section 256B.692, subdivision 5, is amended to read:148.32    Subd. 5. County proposals. (a) On or before September 1, 1997, a county board 148.33that wishes to purchase or provide health care under this section must submit a preliminary 148.34proposal that substantially demonstrates the county's ability to meet all the requirements 148.35of this section in response to criteria for proposals issued by the department on or before 149.1July 1, 1997. Counties submitting preliminary proposals must establish a local planning 149.2process that involves input from medical assistance recipients, recipient advocates, 149.3providers and representatives of local school districts, labor, and tribal government to 149.4advise on the development of a final proposal and its implementation.149.5(b) The county board must submit a final proposal on or before July 1, 1998, that 149.6demonstrates the ability to meet all the requirements of this section, including beginning 149.7enrollment on January 1, 1999, unless a delay has been granted under section 
         256B.69, 149.8subdivision 3a
         , paragraph (g). 149.9(c) After January 1, 1999, for a county in which the prepaid medical assistance 149.10program is in existence, the county board must submit a preliminary proposal at least 15 149.11months prior to termination of health plan contracts in that county and a final proposal149.12that meets the requirements of this section six months prior to the health plan contract 149.13termination date in order to begin enrollment after the termination. Nothing in this section 149.14shall impede or delay implementation or continuation of the prepaid medical assistance 149.15program in counties for which the board does not submit a proposal, or submits a proposal 149.16that is not in compliance with this section.149.17(d) The commissioner is not required to terminate contracts for the prepaid medical 149.18assistance program that begin on or after September 1, 1997, in a county for which a 149.19county board has submitted a proposal under this paragraph, until two years have elapsed 149.20from the date of initial enrollment in the prepaid medical assistance program.149.21    Sec. 73. Minnesota Statutes 2010, section 256B.692, subdivision 7, is amended to read:149.22    Subd. 7. Dispute resolution. In the event the commissioner rejects a proposal 149.23under subdivision 6, the county board may request the recommendation decision of a 149.24three-person mediation panel. The commissioner shall resolve all disputes after taking 149.25into account by following the recommendations decision of the mediation panel. The 149.26panel shall be composed of one designee of the president of the Association of Minnesota 149.27Counties, one designee of the commissioner of human services, and one person selected 149.28jointly by the designee of the commissioner of human services and the designee of 149.29the Association of Minnesota Counties. Within a reasonable period of time before the 149.30hearing, the panelists must be provided all documents and information relevant to the 149.31mediation. The parties to the mediation must be given 30 days' notice of a hearing before 149.32the mediation panel.149.33    Sec. 74. Minnesota Statutes 2010, section 256B.692, is amended by adding a 149.34subdivision to read:150.1    Subd. 11.Patient choice of qualified provider.Effective January 1, 2012, a county 150.2board operating a county-based purchasing plan must ensure that each enrollee has the 150.3option of choosing a primary care provider or a health care home from all qualified 150.4providers who agree to accept the terms, conditions, and payment rates offered by the 150.5plan to similarly situated providers. Notwithstanding this requirement, reimbursement 150.6to federally qualified health centers and federally qualified health center look-alikes as 150.7defined in section 145.9269 must be in compliance with federal law.150.8    Sec. 75. Minnesota Statutes 2010, section 256B.694, is amended to read:150.9256B.694 SOLE-SOURCE OR SINGLE-PLAN MANAGED CARE 150.10CONTRACT.150.11    (a) Notwithstanding section 
         256B.692, subdivision 6, clause (1), paragraph (c), 150.12the commissioner of human services shall approve a county-based purchasing health 150.13plan proposal, submitted on behalf of Cass, Crow Wing, Morrison, Todd, and Wadena 150.14Counties, that requires county-based purchasing on a single-plan basis contract if the 150.15implementation of the single-plan purchasing proposal does not limit an enrollee's 150.16provider choice or access to services and all other requirements applicable to health plan 150.17purchasing are satisfied. The commissioner shall continue to use single-health plan, 150.18county-based purchasing arrangements for medical assistance and general assistance 150.19medical care programs and products for the counties that were in single-health plan, 150.20county-based purchasing arrangements on March 1, 2008. This paragraph does not require 150.21the commissioner to terminate an existing contract with a noncounty-based purchasing 150.22plan that had enrollment in a medical assistance program or product in these counties on 150.23March 1, 2008. This paragraph expires on December 31, 2010, or the effective date 150.24of a new contract for medical assistance and general assistance medical care managed 150.25care programs entered into at the conclusion of the commissioner's next scheduled 150.26reprocurement process for the county-based purchasing entities covered by this paragraph, 150.27whichever is later.150.28    (b) At the request of a county or group of counties, the commissioner shall consider, 150.29and may approve, contracting on a single-health plan basis with other county-based 150.30purchasing plans, or with other qualified health plans that have coordination arrangements 150.31with counties, to serve persons with a disability who voluntarily enroll, enrolled in 150.32Minnesota health care programs in order to promote better coordination or integration 150.33of health care services, social services and other community-based services, provided 150.34that all requirements applicable to health plan purchasing, including those in section 151.1256B.69, subdivision 23
         , are satisfied. Nothing in this paragraph supersedes or modifies 151.2the requirements in paragraph (a).151.3    Sec. 76. Minnesota Statutes 2010, section 256B.76, subdivision 4, is amended to read:151.4    Subd. 4. Critical access dental providers.  (a) Effective for dental services 151.5rendered on or after January 1, 2002, the commissioner shall increase reimbursements 151.6to dentists and dental clinics deemed by the commissioner to be critical access dental 151.7providers. For dental services rendered on or after July 1, 2007, the commissioner shall 151.8increase reimbursement by 30 percent above the reimbursement rate that would otherwise 151.9be paid to the critical access dental provider. The commissioner shall pay the managed 151.10care plans and county-based purchasing plans in amounts sufficient to reflect increased 151.11reimbursements to critical access dental providers as approved by the commissioner.151.12(b) The commissioner shall designate the following dentists and dental clinics as 151.13critical access dental providers:151.14    (1) nonprofit community clinics that:151.15(i) have nonprofit status in accordance with chapter 317A;151.16(ii) have tax exempt status in accordance with the Internal Revenue Code, section 151.17501(c)(3);151.18(iii) are established to provide oral health services to patients who are low income, 151.19uninsured, have special needs, and are underserved;151.20(iv) have professional staff familiar with the cultural background of the clinic's 151.21patients;151.22(v) charge for services on a sliding fee scale designed to provide assistance to 151.23low-income patients based on current poverty income guidelines and family size;151.24(vi) do not restrict access or services because of a patient's financial limitations 151.25or public assistance status; and151.26(vii) have free care available as needed;151.27    (2) federally qualified health centers, rural health clinics, and public health clinics;151.28    (3) county owned and operated hospital-based dental clinics;151.29(4) a dental clinic or dental group owned and operated by a nonprofit corporation in 151.30accordance with chapter 317A with more than 10,000 patient encounters per year with 151.31patients who are uninsured or covered by medical assistance, general assistance medical 151.32care, or MinnesotaCare; and151.33(5) a dental clinic associated with an oral health or dental education program owned 151.34and operated by the University of Minnesota or an institution within the Minnesota State 151.35Colleges and Universities system.152.1     (c) The commissioner may designate a dentist or dental clinic as a critical access 152.2dental provider if the dentist or dental clinic is willing to provide care to patients covered 152.3by medical assistance, general assistance medical care, or MinnesotaCare at a level which 152.4significantly increases access to dental care in the service area.152.5(d) Notwithstanding paragraph (a), critical access payments must not be made for 152.6dental services provided from April 1, 2010, through June 30, 2010.152.7EFFECTIVE DATE.This section is effective July 1, 2011.152.8    Sec. 77. [256B.7671] PATIENT-CENTERED DECISION-MAKING.152.9(a) For purposes of this section, "patient-centered decision-making process" means a 152.10process that involves directed interaction with the patient to assist the patient in arriving at 152.11an informed objective health care decision regarding the surgical procedure that is both 152.12informed and consistent with the patient's preference and values. The interaction may be 152.13conducted by a health care provider or through the electronic use of decision aids. If 152.14decision aids are used in the process, the aids must meet the criteria established by the 152.15International Patients Decision Aids Standards Collaboration or the Cochrane Decision 152.16Aid Registry.152.17(b) Effective January 1, 2012, the commissioner of human services shall require 152.18active participation in a patient-centered decision-making process before authorization is 152.19approved or payment reimbursement is provided for any of the following:152.20(1) a surgical procedure for abnormal uterine bleeding, benign prostate enlargement, 152.21chronic back pain, early stage of breast and prostate cancers, gastroesophageal reflux 152.22disease, hemorrhoids, spinal stenosis, temporomandibular joint dysfunction, ulcerative 152.23colitis, urinary incontinence, uterine fibroids, or varicose veins; and152.24(2) bypass surgery for coronary disease, angioplasty for stable coronary artery 152.25disease, or total hip replacement. 152.26(c) A list of the procedures in paragraph (b) shall be published in the State Register 152.27by October 1, 2011. The list shall be reviewed no less than every two years by the 152.28commissioner, in consultation with the commissioner of health. The commissioner 152.29shall hold a public forum and receive public comment prior to any changes to the list in 152.30paragraph (b). Any changes made shall be published in the State Register.152.31(d) Prior to receiving authorization or reimbursement for the procedures identified 152.32under this section, a health care provider must certify that the patient has participated in a 152.33patient-centered decision-making process. The format for this certification and the process 152.34for coordination between providers shall be developed by the Health Services Policy 152.35Committee under section 256B.0625, subdivision 3c.153.1(e) This section does not apply if any of the procedures identified in this section are 153.2performed under an emergency situation.153.3    Sec. 78. [256B.771] COMPLEMENTARY AND ALTERNATIVE MEDICINE 153.4DEMONSTRATION PROJECT.153.5    Subdivision 1.Establishment and implementation.The commissioner of 153.6human services, in consultation with the commissioner of health, shall contract 153.7with a Minnesota-based academic and research institution specializing in providing 153.8complementary and alternative medicine education and clinical services to establish and 153.9implement a five-year demonstration project in conjunction with federally qualified health 153.10centers and federally qualified health center look-alikes as defined in section 145.9269, to 153.11improve the quality and cost-effectiveness of care provided under medical assistance to 153.12enrollees with neck and back problems.  The demonstration project must maximize the use 153.13of complementary and alternative medicine-oriented primary care providers, including but 153.14not limited to physicians and chiropractors.  The demonstration project must be designed 153.15to significantly improve physical and mental health for enrollees who present with 153.16neck and back problems while decreasing medical treatment costs. The commissioner, 153.17in consultation with the commissioner of health, shall deliver services through the 153.18demonstration project beginning July 1, 2011, or upon federal approval, whichever is later.153.19    Subd. 2.RFP and project criteria.The commissioner, in consultation with the 153.20commissioner of health, shall develop and issue a request for proposal (RFP) for the 153.21demonstration project. The RFP must require the academic and research institution 153.22selected to demonstrate a proven track record over at least five years of conducting 153.23high-quality, federally funded clinical research. The institution and the federally qualified 153.24health centers and federally qualified health center look-alikes shall also:153.25(1) provide patient education, provider education, and enrollment training 153.26components on health and lifestyle issues in order to promote enrollee responsibility for 153.27health care decisions, enhance productivity, prepare enrollees to reenter the workforce, 153.28and reduce future health care expenditures;153.29(2) use high-quality and cost-effective integrated disease management that includes 153.30the best practices of traditional and complementary and alternative medicine;153.31(3) incorporate holistic medical care, appropriate nutrition, exercise, medications, 153.32and conflict resolution techniques;153.33(4) include a provider education component that makes use of professional 153.34organizations representing chiropractors, nurses, and other primary care providers 153.35and provides appropriate educational materials and activities in order to improve the 154.1integration of traditional medical care with licensed chiropractic services and other 154.2alternative health care services and achieve program enrollment objectives; and154.3(5) provide to the commissioner the information and data necessary for the 154.4commissioner to prepare the annual reports required under subdivision 6.154.5    Subd. 3.Enrollment.Enrollees from the program shall be selected by the 154.6commissioner from current enrollees in the prepaid medical assistance program who 154.7have, or are determined to be at significant risk of developing, neck and back problems. 154.8Participation in the demonstration project shall be voluntary.  The commissioner shall 154.9seek to enroll, over the term of the demonstration project, ten percent of current and 154.10future medical assistance enrollees who have, or are determined to be at significant risk 154.11of developing, neck and back problems.154.12    Subd. 4.Federal approval.The commissioner shall seek any federal waivers and 154.13approvals necessary to implement the demonstration project.154.14    Subd. 5.Project costs.The commissioner shall require the academic and research 154.15institution selected, federally qualified health centers, and federally qualified health center 154.16look-alikes to fund all net costs of the demonstration project.154.17    Subd. 6.Annual reports.The commissioner, in consultation with the commissioner 154.18of health, beginning December 15, 2011, and each December 15 thereafter through 154.19December 15, 2015, shall report annually to the legislature on the functional and mental 154.20improvements of the populations served by the demonstration project, patient satisfaction, 154.21and the cost-effectiveness of the program. The reports must also include data on hospital 154.22admissions, days in hospital, rates of outpatient surgery and other services, and drug 154.23utilization. The report, due December 15, 2015, must include recommendations on 154.24whether the demonstration project should be continued and expanded.154.25    Sec. 79. [256B.841] WAIVER APPLICATION AND PROCESS.154.26    Subdivision 1.Intent.It is the intent of the legislature that medical assistance be:154.27(1) a sustainable, cost-effective, person-centered, and opportunity-driven program 154.28utilizing competitive and value-based purchasing to maximize available service options; 154.29and154.30(2) a results-oriented system of coordinated care that focuses on independence 154.31and choice, promotes accountability and transparency, encourages and rewards healthy 154.32outcomes and responsible choices, and promotes efficiency.154.33    Subd. 2.Waiver application.(a) By September 1, 2011, the commissioner of 154.34human services shall apply for a waiver and any necessary state plan amendments from 154.35the secretary of the United States Department of Health and Human Services, including, 155.1but not limited to, a waiver of the appropriate sections of title XIX of the federal Social 155.2Security Act, United States Code, title 42, section 1396 et seq., or other provisions of 155.3federal law that provide program flexibility and under which Minnesota will operate all 155.4facets of the state's medical assistance program.155.5(b) The commissioner of human services shall provide the legislative committees 155.6with jurisdiction over health and human services finance and policy with the waiver 155.7application and financial and other related materials, at least ten days prior to submitting 155.8the application and materials to the federal Centers for Medicare and Medicaid Services.155.9(c) If the state's waiver application is approved, the commissioner of human services 155.10shall:155.11(1) notify the chairs of the legislative committees with jurisdiction over health and 155.12human services finance and policy and allow the legislative committees with jurisdiction 155.13over health and human services finance and policy to review the terms of the waiver; and155.14(2) not implement the waiver until ten legislative days have passed following 155.15notification of the chairs.155.16    Subd. 3.Rulemaking; legislative proposals.Upon acceptance of the terms of the 155.17waiver, the commissioner of human services shall:155.18(1) adopt rules to implement the waiver; and155.19(2) propose any legislative changes necessary to implement the terms of the waiver.155.20    Subd. 4.Joint commission on waiver implementation.(a) After acceptance 155.21of the terms of the waiver, the governor shall establish a joint commission on waiver 155.22implementation. The commission shall consist of eight members; four of whom shall 155.23be members of the senate, not more than three from the same political party, to be 155.24appointed by the Subcommittee on Committees of the senate Committee on Rules and 155.25Administration, and four of whom shall be members of the house of representatives, not 155.26more than three from the same political party, to be appointed by the speaker of the house.155.27(b) The commission shall:155.28(1) oversee implementation of the waiver;155.29(2) confer as necessary with state agency commissioners;155.30(3) make recommendations on services covered under the medical assistance 155.31program;155.32(4) monitor and make recommendations on quality and access to care under the 155.33global waiver; and155.34(5) make recommendations for the efficient and cost-effective administration of the 155.35medical assistance program under the terms of the waiver.156.1    Sec. 80. [256B.842] PRINCIPLES AND GOALS FOR MEDICAL ASSISTANCE 156.2REFORM.156.3    Subdivision 1.Goals for reform. In developing the waiver application and 156.4implementing the waiver, the commissioner of human services shall ensure that the 156.5reformed medical assistance program is a person-centered, financially sustainable, and 156.6cost-effective program.156.7    Subd. 2.Reformed medical assistance criteria.The reformed medical assistance 156.8program established through the waiver must:156.9(1) empower consumers to make informed and cost-effective choices about their 156.10health and offer consumers rewards for healthy decisions;156.11(2) ensure adequate access to needed services;156.12(3) enable consumers to receive individualized health care that is outcome-oriented 156.13and focused on prevention, disease management, recovery, and maintaining independence;156.14(4) promote competition between health care providers to ensure best value 156.15purchasing, leverage resources, and to create opportunities for improving service quality 156.16and performance;156.17(5) redesign purchasing and payment methods and encourage and reward 156.18high-quality and cost-effective care by incorporating and expanding upon current payment 156.19reform and quality of care initiatives, including but not limited to those initiatives 156.20authorized under chapter 62U; and156.21(6) continually improve technology to take advantage of recent innovations and 156.22advances that help decision makers, consumers, and providers make informed and 156.23cost-effective decisions regarding health care.156.24    Subd. 3.Annual report.The commissioner of human services shall annually 156.25submit a report to the governor and the legislature, beginning December 1, 2012, and each 156.26December 1 thereafter, describing the status of the administration and implementation 156.27of the waiver.156.28    Sec. 81. [256B.843] WAIVER APPLICATION REQUIREMENTS.156.29    Subdivision 1.Requirements for waiver request.The commissioner shall seek 156.30federal approval to:156.31(1) enter into a five-year agreement with the United States Department of Health and 156.32Human Services and Centers for Medicaid and Medicare Services (CMS) under section 156.331115a to waive provisions of title XIX of the federal Social Security Act, United States 156.34Code, title 42, section 1396 et seq., requiring:157.1(i) statewideness to allow for the provision of different services in different areas or 157.2regions of the state;157.3(ii) comparability of services to allow for the provision of different services to 157.4members of the same or different coverage groups;157.5(iii) no prohibitions restricting the amount, duration, and scope of services included 157.6in the medical assistance state plan;157.7(iv) no prohibitions limiting freedom of choice of providers; and157.8(v) retroactive payment for medical assistance, at the state's discretion;157.9(2) waive the applicable provisions of title XIX of the federal Social Security Act, 157.10United States Code, title 42, section 1396 et seq., in order to:157.11(i) expand cost sharing requirements above the five percent of income threshold for 157.12beneficiaries in certain populations;157.13(ii) establish health savings or power accounts that encourage and reward 157.14beneficiaries who reach certain prevention and wellness targets; and157.15(iii) implement a tiered set of parameters to use as the basis for determining 157.16long-term service care and setting needs;157.17(3) modify income and resource rules in a manner consistent with the goals of the 157.18reformed program;157.19(4) provide enrollees with a choice of appropriate private sector health coverage 157.20options, with full federal financial participation;157.21(5) treat payments made toward the cost of care as a monthly premium for 157.22beneficiaries receiving home and community-based services when applicable;157.23(6) provide health coverage and services to individuals over the age of 65 that are 157.24limited in scope and are available only in the home and community-based setting;157.25(7) consolidate all home and community-based services currently provided under 157.26title XIX of the federal Social Security Act, United States Code, title 42, section 1915(c), 157.27into a single program of home and community-based services that include options for 157.28consumer direction and shared living;157.29(8) expand disease management, care coordination, and wellness programs for all 157.30medical assistance recipients; and157.31(9) empower and encourage able-bodied medical assistance recipients to work, 157.32whenever possible.157.33    Subd. 2.Agency coordination.The commissioner shall establish an intraagency 157.34assessment and coordination unit to ensure that decision making and program planning for 157.35recipients who may need long-term care, residential placement, and community support 157.36services are coordinated. The assessment and coordination unit shall determine level of 158.1care, develop service plans and a service budget, make referrals to appropriate settings, 158.2provide education and choice counseling to consumers and providers, track utilization, 158.3and monitor outcomes. 158.4    Sec. 82. Minnesota Statutes 2010, section 256D.03, subdivision 3, is amended to read:158.5    Subd. 3. General assistance medical care; eligibility. (a) Beginning April 1, 158.62010 January 1, 2012, the general assistance medical care program shall be administered 158.7according to section 
         256D.031, unless otherwise stated, except for outpatient prescription 158.8drug coverage, which shall continue to be administered under this section and funded 158.9under section 256D.031, subdivision 9, beginning June 1, 2010.158.10    (b) Outpatient prescription drug coverage under general assistance medical care is 158.11limited to prescription drugs that:158.12    (1) are covered under the medical assistance program as described in section 158.13256B.0625, subdivisions 13
          and 13d; and158.14    (2) are provided by manufacturers that have fully executed general assistance 158.15medical care rebate agreements with the commissioner and comply with the agreements. 158.16Outpatient prescription drug coverage under general assistance medical care must conform 158.17to coverage under the medical assistance program according to section 
         256B.0625, 158.18subdivisions 13
          to 13h.158.19    (c) Outpatient prescription drug coverage does not include drugs administered in a 158.20clinic or other outpatient setting.158.21    (d) For the period beginning April 1, 2010, to May 31, 2010, general assistance 158.22medical care covers the services listed in subdivision 4.158.23EFFECTIVE DATE.This section is effective January 1, 2012.158.24    Sec. 83. Minnesota Statutes 2010, section 256D.031, subdivision 6, is amended to read:158.25    Subd. 6. Coordinated care delivery systems. (a) Effective June 1, 2010 January 158.261, 2012, the commissioner shall contract with hospitals or groups of hospitals, or 158.27county-based purchasing plans, that qualify under paragraph (b) and agree to deliver 158.28services according to this subdivision. Contracting hospitals or plans shall develop 158.29and implement a coordinated care delivery system to provide health care services to 158.30individuals who are eligible for general assistance medical care under this section and who 158.31either choose to receive services through the coordinated care delivery system or who are 158.32enrolled by the commissioner under paragraph (c). The health care services provided by 158.33the system must include: (1) the services described in subdivision 4 with the exception 158.34of outpatient prescription drug coverage but shall include drugs administered in a clinic 159.1or other outpatient setting; or (2) a set of comprehensive and medically necessary health 159.2services that the recipients might reasonably require to be maintained in good health and 159.3that has been approved by the commissioner, including at a minimum, but not limited 159.4to, emergency care, medical transportation services, inpatient hospital and physician 159.5care, outpatient health services, preventive health services, mental health services, 159.6and prescription drugs administered in a clinic or other outpatient setting. Outpatient 159.7prescription drug coverage is covered on a fee-for-service basis in accordance with section 159.8256D.03, subdivision 3, and funded under subdivision 9. A hospital or plan establishing a 159.9coordinated care delivery system under this subdivision must ensure that the requirements 159.10of this subdivision are met.159.11    (b) A hospital or group of hospitals, or a county-based purchasing plan established 159.12under section 256B.692, may contract with the commissioner to develop and implement a 159.13coordinated care delivery system as follows: if the hospital or group of hospitals or plan 159.14agrees to satisfy the requirements of this subdivision.159.15    (1) effective June 1, 2010, a hospital qualifies under this subdivision if: (i) during 159.16calendar year 2008, it received fee-for-service payments for services to general assistance 159.17medical care recipients (A) equal to or greater than $1,500,000, or (B) equal to or greater 159.18than 1.3 percent of net patient revenue; or (ii) a contract with the hospital is necessary to 159.19provide geographic access or to ensure that at least 80 percent of enrollees have access to 159.20a coordinated care delivery system; and159.21    (2) effective December 1, 2010, a Minnesota hospital not qualified under clause 159.22(1) may contract with the commissioner under this subdivision if it agrees to satisfy the 159.23requirements of this subdivision.159.24Participation by hospitals or plans shall become effective quarterly on June 1, September 159.251, December 1, or March 1 January 1, April 1, July 1, or October 1. Hospital or plan 159.26participation is effective for a period of 12 months and may be renewed for successive 159.2712-month periods.159.28    (c) Applicants and recipients may enroll in any available coordinated care delivery 159.29system statewide. If more than one coordinated care delivery system is available, the 159.30applicant or recipient shall be allowed to choose among the systems. The commissioner 159.31may assign an applicant or recipient to a coordinated care delivery system if no choice 159.32is made by the applicant or recipient. The commissioner shall consider a recipient's zip 159.33code, city of residence, county of residence, or distance from a participating coordinated 159.34care delivery system when determining default assignment. An applicant or recipient may 159.35decline enrollment in a coordinated care delivery system but services are only available 159.36through a coordinated care delivery system. Upon enrollment into a coordinated care 160.1delivery system, the recipient must agree to receive all nonemergency services through the 160.2coordinated care delivery system. Enrollment in a coordinated care delivery system is 160.3for six months and may be renewed for additional six-month periods, except that initial 160.4enrollment is for six months or until the end of a recipient's period of general assistance 160.5medical care eligibility, whichever occurs first. A recipient who continues to meet the 160.6eligibility requirements of this section is not eligible to enroll in MinnesotaCare during 160.7a period of enrollment in a coordinated care delivery system. From June 1, 2010, to 160.8February 28, 2011, applicants and recipients not enrolled in a coordinated care delivery 160.9system may seek services from a hospital eligible for reimbursement under the temporary 160.10uncompensated care pool established under subdivision 8. After February 28, 2011, 160.11services are available only through a coordinated care delivery system.160.12    (d) The hospital or plan may contract and coordinate with providers and clinics 160.13for the delivery of services and shall contract with essential community providers as 160.14defined under section 
         62Q.19, subdivision 1, paragraph (a), clauses (1) and (2), to the 160.15extent practicable. When contracting with providers and clinics, the hospital or plan 160.16shall give preference to providers and clinics certified as health care homes under section 160.17256B.0751. The hospital or plan must contract with federally qualified health centers or 160.18federally qualified health center look-alikes, as defined in section 145.9269, subdivision 1, 160.19that agree to accept the terms, conditions, and payment rates offered by the hospital or 160.20plan to similarly situated providers. If a provider or clinic or health center contracts with 160.21a hospital or plan to provide services through the coordinated care delivery system, the 160.22provider may not refuse to provide services to any recipient enrolled in the system, and 160.23payment for services shall be negotiated with the hospital or plan and paid by the hospital 160.24or plan from the system's allocation under subdivision 7.160.25    (e) A coordinated care delivery system must:160.26    (1) provide the covered services required under paragraph (a) to recipients enrolled 160.27in the coordinated care delivery system, and comply with the requirements of subdivision 160.284, paragraphs (b) to (g);160.29    (2) establish a process to monitor enrollment and ensure the quality of care provided;160.30    (3) in cooperation with counties, coordinate the delivery of health care services with 160.31existing homeless prevention, supportive housing, and rent subsidy programs and funding 160.32administered by the Minnesota Housing Finance Agency under chapter 462A; and160.33    (4) adopt innovative and cost-effective methods of care delivery and coordination, 160.34which may include the use of allied health professionals, telemedicine, patient educators, 160.35care coordinators, and community health workers.161.1    (f) The hospital or plan may require a recipient to designate a primary care provider 161.2or a primary care clinic. The hospital or plan may limit the delivery of services to a 161.3network of providers who have contracted with the hospital or plan to deliver services in 161.4accordance with this subdivision, and require a recipient to seek services only within this 161.5network. The hospital or plan may also require a referral to a provider before the service 161.6is eligible for payment. A coordinated care delivery system is not required to provide 161.7payment to a provider who is not employed by or under contract with the system for 161.8services provided to a recipient enrolled in the system, except in cases of an emergency. 161.9For purposes of this section, emergency services are defined in accordance with Code of 161.10Federal Regulations, title 42, section 438.114 (a).161.11    (g) A recipient enrolled in a coordinated care delivery system has the right to appeal 161.12to the commissioner according to section 
         256.045.161.13    (h) The state shall not be liable for the payment of any cost or obligation incurred 161.14by the coordinated care delivery system.161.15    (i) The hospital or plan must provide the commissioner with data necessary for 161.16assessing enrollment, quality of care, cost, and utilization of services. Each hospital or 161.17plan must provide, on a quarterly basis on a form prescribed by the commissioner for each 161.18recipient served by the coordinated care delivery system, the services provided, the cost of 161.19services provided, and the actual payment amount for the services provided and any other 161.20information the commissioner deems necessary to claim federal Medicaid match. The 161.21commissioner must provide this data to the legislature on a quarterly basis.161.22    (j) Effective June 1, 2010, The provisions of section 
         256.9695, subdivision 2, 161.23paragraph (b), do not apply to general assistance medical care provided under this section.161.24    (k) Notwithstanding any other provision in this section to the contrary, for 161.25participation beginning September 1, 2010, the commissioner shall offer the same contract 161.26terms related toshall negotiate an enrollment threshold formula and financial liability 161.27protections to with a hospital or group of hospitals or plan qualified under this subdivision 161.28to develop and implement a coordinated care delivery system as those contained in the 161.29coordinated care delivery system contracts effective June 1, 2010.161.30    (l) If sections 256B.055, subdivision 15, and 256B.056, subdivisions 3 and 4, are 161.31implemented effective July 1, 2010, this subdivision must not be implemented.161.32EFFECTIVE DATE.This section is effective January 1, 2012.161.33    Sec. 84. Minnesota Statutes 2010, section 256D.031, subdivision 7, is amended to read:161.34    Subd. 7. Payments; rate setting for the hospital coordinated care delivery 161.35system. (a) Effective for general assistance medical care services, with the exception 162.1of outpatient prescription drug coverage, provided on or after June 1, 2010, through a 162.2coordinated care delivery system, the commissioner shall allocate the annual appropriation 162.3for the coordinated care delivery system to hospitals or plans participating under 162.4subdivision 6 in quarterly payments, beginning on the first scheduled warrant on or after 162.5June 1, 2010 March 1, 2012. The payment shall be allocated among all hospitals or plans 162.6qualified to participate on the allocation date as follows: based upon the enrollment 162.7thresholds negotiated with the commissioner.162.8    (1) each hospital or group of hospitals shall be allocated an initial amount based on 162.9the hospital's or group of hospitals' pro rata share of calendar year 2008 payments for 162.10general assistance medical care services to all participating hospitals;162.11    (2) the initial allocations to Hennepin County Medical Center; Regions Hospital; 162.12Saint Mary's Medical Center; and the University of Minnesota Medical Center, Fairview, 162.13shall be increased to 110 percent of the value determined in clause (1);162.14    (3) the initial allocation to hospitals not listed in clause (2) shall be reduced a pro rata 162.15amount in order to keep the allocations within the limit of available appropriations; and162.16    (4) the amounts determined under clauses (1) to (3) shall be allocated to participating 162.17hospitals.162.18The commissioner may prospectively reallocate payments to participating hospitals or 162.19plans on a biannual basis to ensure that final allocations reflect actual coordinated care 162.20delivery system enrollment. The 2008 base year shall be updated by one calendar year 162.21each June 1, beginning June 1, 2011.162.22    (b) Beginning June 1, 2010, and every quarter beginning in June thereafter, the 162.23commissioner shall make one-third of the quarterly payment in June and the remaining 162.24two-thirds of the quarterly payment in July to each participating hospital or group of 162.25hospitals.162.26    (c) (b) In order to be reimbursed under this section, nonhospital providers of health 162.27care services shall contract with one or more hospitals or plans described in paragraph (a) 162.28to provide services to general assistance medical care recipients through the coordinated 162.29care delivery system established by the hospital or plan. The hospital or plan shall 162.30reimburse bills submitted by nonhospital providers participating under this paragraph at a 162.31rate negotiated between the hospital or plan and the nonhospital provider.162.32    (d) (c) The commissioner shall apply for federal matching funds under section 162.33256B.199
         , paragraphs (a) to (d), for expenditures under this subdivision.162.34    (e) (d) Outpatient prescription drug coverage is provided in accordance with section 162.35256D.03, subdivision 3
         , and paid on a fee-for-service basis under subdivision 9.163.1EFFECTIVE DATE.This section is effective January 1, 2012.163.2    Sec. 85. Minnesota Statutes 2010, section 256D.031, subdivision 10, is amended to 163.3read:163.4    Subd. 10. Assistance for veterans. Hospitals and plans participating in the 163.5coordinated care delivery system under subdivision 6 shall consult with counties, county 163.6veterans service officers, and the Veterans Administration to identify other programs for 163.7which general assistance medical care recipients enrolled in their system are qualified.163.8    Sec. 86. Minnesota Statutes 2010, section 256L.01, subdivision 4a, is amended to read:163.9    Subd. 4a. Gross individual or gross family income. (a) "Gross individual or gross 163.10family income" for nonfarm self-employed means income calculated for the 12-month163.11six-month period of eligibility using as a baseline the adjusted gross income reported 163.12on the applicant's federal income tax form for the previous year and adding back in 163.13depreciation, and carryover net operating loss amounts that apply to the business in which 163.14the family is currently engaged.163.15(b) "Gross individual or gross family income" for farm self-employed means 163.16income calculated for the 12-month six-month period of eligibility using as the baseline 163.17the adjusted gross income reported on the applicant's federal income tax form for the 163.18previous year.163.19(c) "Gross individual or gross family income" means the total income for all family 163.20members, calculated for the 12-month six-month period of eligibility.163.21    Sec. 87. Minnesota Statutes 2010, section 256L.02, subdivision 3, is amended to read:163.22    Subd. 3. Financial management. (a) The commissioner shall manage spending for 163.23the MinnesotaCare program in a manner that maintains a minimum reserve. As part of 163.24each state revenue and expenditure forecast, the commissioner must make an assessment 163.25of the expected expenditures for the covered services for the remainder of the current 163.26biennium and for the following biennium. The estimated expenditure, including the 163.27reserve, shall be compared to an estimate of the revenues that will be available in the health 163.28care access fund. Based on this comparison, and after consulting with the chairs of the 163.29house of representatives Ways and Means Committee and the senate Finance Committee, 163.30and the Legislative Commission on Health Care Access, the commissioner shall, as 163.31necessary, make the adjustments specified in paragraph (b) to ensure that expenditures 163.32remain within the limits of available revenues for the remainder of the current biennium 163.33and for the following biennium. The commissioner shall not hire additional staff using 164.1appropriations from the health care access fund until the commissioner of management 164.2and budget makes a determination that the adjustments implemented under paragraph (b) 164.3are sufficient to allow MinnesotaCare expenditures to remain within the limits of available 164.4revenues for the remainder of the current biennium and for the following biennium.164.5(b) The adjustments the commissioner shall use must be implemented in this order: 164.6first, stop enrollment of single adults and households without children; second, upon 45 164.7days' notice, stop coverage of single adults and households without children already 164.8enrolled in the MinnesotaCare program; third, upon 90 days' notice, decrease the premium 164.9subsidy amounts by ten percent for children in families with gross annual income above 164.10200 percent of the federal poverty guidelines; fourth, upon 90 days' notice, decrease the 164.11premium subsidy amounts by ten percent for children in families with gross annual income 164.12at or below 200 percent; and fifth, require applicants to be uninsured for at least six months 164.13prior to eligibility in the MinnesotaCare program. If these measures are insufficient to 164.14limit the expenditures to the estimated amount of revenue, the commissioner shall further 164.15limit enrollment or decrease premium subsidies.164.16EFFECTIVE DATE.This section is effective January 1, 2012, or upon federal 164.17approval, whichever is later, and expires June 30, 2013. The commissioner shall notify 164.18the revisor of statutes when federal approval is obtained and publish a notice in the State 164.19Register.164.20    Sec. 88. Minnesota Statutes 2010, section 256L.02, subdivision 3, is amended to read:164.21    Subd. 3. Financial management. (a) The commissioner shall manage spending for 164.22the MinnesotaCare program in a manner that maintains a minimum reserve. As part of 164.23each state revenue and expenditure forecast, the commissioner must make an assessment 164.24of the expected expenditures for the covered services for the remainder of the current 164.25biennium and for the following biennium. The estimated expenditure, including the 164.26reserve, shall be compared to an estimate of the revenues that will be available in the health 164.27care access fund. Based on this comparison, and after consulting with the chairs of the 164.28house of representatives Ways and Means Committee and the senate Finance Committee, 164.29and the Legislative Commission on Health Care Access, the commissioner shall, as 164.30necessary, make the adjustments specified in paragraph (b) to ensure that expenditures 164.31remain within the limits of available revenues for the remainder of the current biennium 164.32and for the following biennium. The commissioner shall not hire additional staff using 164.33appropriations from the health care access fund until the commissioner of management 164.34and budget makes a determination that the adjustments implemented under paragraph (b) 165.1are sufficient to allow MinnesotaCare expenditures to remain within the limits of available 165.2revenues for the remainder of the current biennium and for the following biennium.165.3(b) The adjustments the commissioner shall use must be implemented in this order: 165.4first, stop enrollment of single adults and households without children; second, upon 45 165.5days' notice, stop coverage of single adults and households without children already 165.6enrolled in the MinnesotaCare program; third, upon 90 days' notice, decrease the premium 165.7subsidy amounts by ten percent for families with gross annual income above 200 percent 165.8of the federal poverty guidelines; fourth, upon 90 days' notice, decrease the premium 165.9subsidy amounts by ten percent for families with gross annual income at or below 200 165.10percent; and fifth, require applicants to be uninsured for at least six months prior to 165.11eligibility in the MinnesotaCare program. If these measures are insufficient to limit the 165.12expenditures to the estimated amount of revenue, the commissioner shall further limit 165.13enrollment or decrease premium subsidies.165.14    Sec. 89. Minnesota Statutes 2010, section 256L.03, subdivision 3, is amended to read:165.15    Subd. 3. Inpatient hospital services. (a) Covered health services shall include 165.16inpatient hospital services, including inpatient hospital mental health services and inpatient 165.17hospital and residential chemical dependency treatment, subject to those limitations 165.18necessary to coordinate the provision of these services with eligibility under the medical 165.19assistance spenddown. The inpatient hospital benefit for adult enrollees who qualify under 165.20section 
         256L.04, subdivision 7, or who qualify under section 256L.04, subdivisions 1 and 165.212, with family gross income that exceeds 200 percent of the federal poverty guidelines or 165.22215 percent of the federal poverty guidelines on or after July 1, 2009, and who are not 165.23pregnant, is subject to an annual limit of $10,000.165.24    (b) Admissions for inpatient hospital services paid for under section 
         256L.11, 165.25subdivision 3
         , must be certified as medically necessary in accordance with Minnesota 165.26Rules, parts 9505.0500 to 9505.0540, except as provided in clauses (1) and (2):165.27    (1) all admissions must be certified, except those authorized under rules established 165.28under section 
         254A.03, subdivision 3, or approved under Medicare; and165.29    (2) payment under section 
         256L.11, subdivision 3, shall be reduced by five percent 165.30for admissions for which certification is requested more than 30 days after the day of 165.31admission. The hospital may not seek payment from the enrollee for the amount of the 165.32payment reduction under this clause.165.33EFFECTIVE DATE.This section is effective January 1, 2012, or upon federal 165.34approval, whichever is later, and expires June 30, 2013. The commissioner shall notify 166.1the revisor of statutes when federal approval is obtained and publish a notice in the State 166.2Register.166.3    Sec. 90. Minnesota Statutes 2010, section 256L.03, subdivision 5, is amended to read:166.4    Subd. 5. Co-payments and coinsurance Cost-sharing. (a) Except as provided in 166.5paragraphs (b) and, (c), and (h), the MinnesotaCare benefit plan shall include the following 166.6co-payments and coinsurance cost-sharing requirements for all enrollees:166.7    (1) ten percent of the paid charges for inpatient hospital services for adult enrollees, 166.8subject to an annual inpatient out-of-pocket maximum of $1,000 per individual;166.9    (2) $3 per prescription for adult enrollees;166.10    (3) $25 for eyeglasses for adult enrollees;166.11    (4) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an 166.12episode of service which is required because of a recipient's symptoms, diagnosis, or 166.13established illness, and which is delivered in an ambulatory setting by a physician or 166.14physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse, 166.15audiologist, optician, or optometrist; and166.16    (5) $6 for nonemergency visits to a hospital-based emergency room for services 166.17provided through December 31, 2010, and $3.50 effective January 1, 2011; and166.18(6) a family deductible equal to the maximum amount allowed under Code of 166.19Federal Regulations, title 42, part 447.54.166.20    (b) Paragraph (a), clause (1), does and paragraph (e) do not apply to parents and 166.21relative caretakers of children under the age of 21.166.22    (c) Paragraph (a) does not apply to pregnant women and children under the age of 21.166.23    (d) Paragraph (a), clause (4), does not apply to mental health services.166.24    (e) Adult enrollees with family gross income that exceeds 200 percent of the federal 166.25poverty guidelines or 215 percent of the federal poverty guidelines on or after July 1, 2009, 166.26and who are not pregnant shall be financially responsible for the coinsurance amount, if 166.27applicable, and amounts which exceed the $10,000 inpatient hospital benefit limit.166.28    (f) When a MinnesotaCare enrollee becomes a member of a prepaid health plan, 166.29or changes from one prepaid health plan to another during a calendar year, any charges 166.30submitted towards the $10,000 annual inpatient benefit limit, and any out-of-pocket 166.31expenses incurred by the enrollee for inpatient services, that were submitted or incurred 166.32prior to enrollment, or prior to the change in health plans, shall be disregarded.166.33(g) MinnesotaCare reimbursements to fee-for-service providers and payments to 166.34managed care plans or county-based purchasing plans shall not be increased as a result of 166.35the reduction of the co-payments in paragraph (a), clause (5), effective January 1, 2011.167.1(h) Effective January 1, 2012, the following co-payments for nonpreventive visits 167.2shall apply to enrollees who are adults without children eligible under section 256L.04, 167.3subdivision 7:167.4(1) $3 for visits to providers whose average, risk-adjusted, total annual cost of care 167.5per MinnesotaCare enrollee is at the 60th percentile or lower for providers of the same 167.6type;167.7(2) $6 for visits to providers whose average, risk-adjusted, total annual cost of care 167.8per MinnesotaCare enrollee is greater than the 60th percentile but does not exceed the 167.980th percentile for providers of the same type; and167.10(3) $10 for visits to providers whose average, risk-adjusted, total annual cost of 167.11care per MinnesotaCare enrollee is greater than the 80th percentile for providers of the 167.12same type.167.13Each managed care and county-based purchasing plan shall calculate the average, 167.14risk-adjusted, total annual cost of care for providers under this paragraph using a 167.15methodology that has been approved by the commissioner.167.16EFFECTIVE DATE.The amendments to paragraph (e) are effective January 1, 167.172012, or upon federal approval, whichever is later, and expires June 30, 2013. The 167.18commissioner shall notify the revisor of statutes when federal approval is obtained and 167.19publish a notice in the State Register.167.20    Sec. 91. [256L.031] HEALTHY MINNESOTA CONTRIBUTION PROGRAM.167.21    Subdivision 1.Defined contributions to enrollees.(a) Beginning January 1, 2012, 167.22the commissioner shall provide each MinnesotaCare enrollee eligible under section 167.23256L.04, subdivision 7, with gross family income equal to or greater than 133 percent 167.24of the federal poverty guidelines, with a monthly defined contribution to purchase health 167.25coverage under a health plan as defined in section 62A.011, subdivision 3. Beginning 167.26January 1, 2012, or upon federal approval, whichever is later, the commissioner shall 167.27provide each MinnesotaCare enrollee eligible under section 256L.04, subdivision 1, with 167.28gross family income equal to or greater than 133 percent of the federal poverty guidelines, 167.29with a monthly defined contribution to purchase health coverage under a health plan as 167.30defined in section 62A.011, subdivision 3, offered by a health plan company as defined 167.31in section 62Q.01, subdivision 4.167.32(b) Enrollees eligible under paragraph (a) shall not be charged premiums under 167.33section 256L.15 and are exempt from the managed care enrollment requirement of section 167.34256L.12.168.1(c) Sections 256L.03; 256L.05, subdivision 3; and 256L.11 do not apply to 168.2enrollees eligible under paragraph (a). Covered services, cost-sharing, disenrollment 168.3for nonpayment of premium, enrollee appeal rights and complaint procedures, and the 168.4effective date of coverage for enrollees eligible under paragraph (a) shall be as provided 168.5under the terms of the health plan purchased by the enrollee.168.6(d) Unless otherwise provided in this section, all MinnesotaCare requirements 168.7related to eligibility, income and asset methodology, income reporting, and program 168.8administration continue to apply to enrollees obtaining coverage under this section.168.9    Subd. 2.Use of defined contribution.An enrollee may use up to the monthly 168.10defined contribution to pay premiums for coverage under a health plan as defined in 168.11section 62A.011, subdivision 3.168.12    Subd. 3.Determination of defined contribution amount.(a) The commissioner 168.13shall determine the defined contribution sliding scale using the base contribution specified 168.14in paragraph (b) for the specified age ranges. The commissioner shall use a sliding scale 168.15for defined contributions that provides:168.16(1) persons with household incomes equal to 133 percent of the federal poverty 168.17guidelines with a defined contribution of 150 percent of the base contribution;168.18(2) persons with household incomes equal to 175 percent of the federal poverty 168.19guidelines with a defined contribution of 100 percent of the base contribution;168.20(3) persons with household incomes equal to or greater than 250 percent of 168.21the federal poverty guidelines with a defined contribution of 80 percent of the base 168.22contribution; and168.23(4) persons with household incomes in evenly spaced increments between the 168.24percentages of the federal poverty guideline specified in clauses (1) to (3) with a base 168.25contribution that is a percentage interpolated from the defined contribution percentages 168.26specified in clauses (1) to (3).

168.27AgeMonthly Per-Person Base Contribution168.28Under 21$122.79168.2921-29122.79168.3030-31129.19168.3132-33132.38168.3234-35134.31168.3336-37136.06168.3438-39141.02168.3540-41151.25168.3642-43159.89168.3744-45175.08168.3846-47191.71169.148-49213.13169.250-51239.51169.352-53266.69169.454-55293.88169.556-57323.77169.658-59341.20169.760+357.19

169.8(b) The commissioner shall multiply the defined contribution amounts developed 169.9under paragraph (a) by 1.20 for enrollees who are denied coverage under an individual 169.10health plan by a health plan company and who purchase coverage through the Minnesota 169.11Comprehensive Health Association.169.12(c) Notwithstanding paragraphs (a) and (b), the monthly defined contribution shall 169.13not exceed 90 percent of the monthly premium for the health plan purchased by the 169.14enrollee. If the enrollee purchases coverage under a health plan that does not include 169.15mental health services and chemical dependency treatment services, the monthly defined 169.16contribution amount determined under this subdivision shall be reduced by five percent.169.17    Subd. 4.Administration by commissioner.The commissioner shall administer the 169.18defined contributions. The commissioner shall:169.19    (1) calculate and process defined contributions for enrollees; and169.20    (2) pay the defined contribution amount to health plan companies or the Minnesota 169.21Comprehensive Health Association, as applicable, for enrollee health plan coverage.169.22    Subd. 5.Assistance to enrollees.The commissioner of human services, in 169.23consultation with the commissioner of commerce, shall develop an efficient and 169.24cost-effective method of referring eligible applicants to professional insurance agent 169.25associations.169.26    Subd. 6.Minnesota Comprehensive Health Association (MCHA).Beginning 169.27January 1, 2012, MinnesotaCare enrollees who are denied coverage under an individual 169.28health plan by a health plan company are eligible for coverage through a health plan 169.29offered by the MCHA and may enroll in MCHA according to section 62E.14. Any 169.30difference between the revenue and covered losses to the MCHA related to implementation 169.31of this section shall be paid to the MCHA from the health care access fund.169.32    Subd. 7.Federal approval.The commissioner shall seek all federal waivers 169.33and approvals necessary to implement coverage under this section for MinnesotaCare 169.34enrollees eligible under section 256L.04, subdivision 1, with gross family incomes equal 169.35to or greater than 133 percent of the federal poverty guidelines, while continuing to 169.36receive federal matching funds.170.1    Sec. 92. Minnesota Statutes 2010, section 256L.04, subdivision 1, is amended to read:170.2    Subdivision 1. Families with children. (a) Families with Children with family 170.3income equal to or less than 275 percent of the federal poverty guidelines for the 170.4applicable family size and adults in families with children with family income equal to or 170.5less than 200 percent of the federal poverty guidelines for the applicable family size, shall 170.6be eligible for MinnesotaCare according to this section. All other provisions of sections 170.7256L.01
          to 
         256L.18, including the insurance-related barriers to enrollment under section 170.8256L.07
         , shall apply unless otherwise specified.170.9    (b) Parents who enroll in the MinnesotaCare program must also enroll their children, 170.10if the children are eligible. Children may be enrolled separately without enrollment by 170.11parents. However, if one parent in the household enrolls, both parents must enroll, unless 170.12other insurance is available. If one child from a family is enrolled, all children must 170.13be enrolled, unless other insurance is available. If one spouse in a household enrolls, 170.14the other spouse in the household must also enroll, unless other insurance is available. 170.15Families cannot choose to enroll only certain uninsured members.170.16    (c) Beginning October 1, 2003, the dependent sibling definition no longer applies 170.17to the MinnesotaCare program. These persons are no longer counted in the parental 170.18household and may apply as a separate household.170.19    (d) Beginning July 1, 2010, or upon federal approval, whichever is later, parents are 170.20not eligible for MinnesotaCare if their gross income exceeds $57,500.170.21    (e) Children formerly enrolled in medical assistance and automatically deemed 170.22eligible for MinnesotaCare according to section 256B.057, subdivision 2c, are exempt 170.23from the requirements of this section until renewal.170.24(f) [Reserved.]170.25EFFECTIVE DATE.This section is effective January 1, 2012, or upon federal 170.26approval, whichever is later, and expires June 30, 2013, except that the amendment 170.27striking paragraph (e) is effective retroactively from October 1, 2008, does not expire, 170.28and federal approval is no longer necessary. The commissioner shall notify the revisor of 170.29statutes when federal approval is obtained and publish a notice in the State Register.170.30    Sec. 93. Minnesota Statutes 2010, section 256L.04, subdivision 7, is amended to read:170.31    Subd. 7. Single adults and households with no children. (a) The definition of 170.32eligible persons, through December 31, 2011, includes all individuals and households with 170.33no children who have gross family incomes that are equal to or less than 200 percent 170.34of the federal poverty guidelines.171.1    (b) Effective July 1, 2009 January 1, 2012, the definition of eligible persons includes 171.2all individuals and households with no children who have gross family incomes that are 171.3greater than 75 percent of the federal poverty guidelines and equal to or less than 250 200171.4percent of the federal poverty guidelines. Effective July 1, 2013, the maximum income 171.5limit under this paragraph is increased to 250 percent of the federal poverty guidelines.171.6EFFECTIVE DATE.This section is effective January 1, 2012.171.7    Sec. 94. Minnesota Statutes 2010, section 256L.05, subdivision 2, is amended to read:171.8    Subd. 2. Commissioner's duties.(a) The commissioner or county agency shall 171.9use electronic verification as the primary method of income verification. If there is a 171.10discrepancy between reported income and electronically verified income, an individual 171.11may be required to submit additional verification. In addition, the commissioner shall 171.12perform random audits to verify reported income and eligibility. The commissioner 171.13may execute data sharing arrangements with the Department of Revenue and any other 171.14governmental agency in order to perform income verification related to eligibility and 171.15premium payment under the MinnesotaCare program.171.16(b) In determining eligibility for MinnesotaCare, the commissioner shall require 171.17applicants and enrollees seeking renewal of eligibility to verify both earned and unearned 171.18income. The commissioner shall also require applicants and enrollees to submit the 171.19names of their employers and a contact name with a phone number for each employer 171.20for purposes of verifying whether the applicant or enrollee, and any dependents, are 171.21eligible for employer-subsidized coverage. Data collected is nonpublic data as defined 171.22in section 13.02, subdivision 9.171.23    Sec. 95. Minnesota Statutes 2010, section 256L.05, subdivision 3a, is amended to read:171.24    Subd. 3a. Renewal of eligibility. (a) Beginning July 1, 2007 2011, an enrollee's 171.25eligibility must be renewed every 12 six months. The 12-month period begins in the 171.26month after the month the application is approved.171.27    (b) The first six-month period of eligibility begins the month the application is 171.28received by the commissioner. The effective date of coverage within the first six-month 171.29period of eligibility is as provided in subdivision 3. Each new period of eligibility must 171.30take into account any changes in circumstances that impact eligibility and premium 171.31amount. An enrollee must provide all the information needed to redetermine eligibility 171.32by the first day of the month that ends the eligibility period. If there is no change in 171.33circumstances, the enrollee may renew eligibility at designated locations that include 171.34community clinics and health care providers' offices. The designated sites shall forward 172.1the renewal forms to the commissioner. The commissioner may establish criteria and 172.2timelines for sites to forward applications to the commissioner or county agencies. The 172.3premium for the new period of eligibility must be received as provided in section 
         256L.06172.4in order for eligibility to continue.172.5    (c) An enrollee who fails to submit renewal forms and related documentation 172.6necessary for verification of continued eligibility in a timely manner shall remain eligible 172.7for one additional month beyond the end of the current eligibility period before being 172.8disenrolled. The enrollee remains responsible for MinnesotaCare premiums for the 172.9additional month.172.10    Sec. 96. Minnesota Statutes 2010, section 256L.05, subdivision 5, is amended to read:172.11    Subd. 5. Availability of private insurance. The commissioner, in consultation with 172.12the commissioners of health and commerce, shall provide information regarding the 172.13availability of private health insurance coverage and the possibility of disenrollment 172.14under section 
         256L.07, subdivision 1, paragraphs (b) and (c), to all: (1) families enrolled 172.15in the MinnesotaCare program whose gross family income is equal to or more than 225 172.16percent of the federal poverty guidelines; and (2) single adults and households without 172.17children enrolled in the MinnesotaCare program whose gross family income is equal to 172.18or more than 165 percent of the federal poverty guidelines. This information must be 172.19provided upon initial enrollment and annually thereafter. The commissioner shall also 172.20include information regarding the availability of private health insurance coverage in the 172.21notice of ineligibility provided to persons subject to disenrollment under section 
         256L.07, 172.22subdivision 1
         , paragraphs (b) and (c).172.23EFFECTIVE DATE.This section is effective January 1, 2012, and expires June 172.2430, 2013.172.25    Sec. 97. Minnesota Statutes 2010, section 256L.05, is amended by adding a subdivision 172.26to read:172.27    Subd. 6.Referral of veterans.The commissioner shall ensure that all applicants 172.28for MinnesotaCare with incomes less than 133 percent of the federal poverty guidelines 172.29who identify themselves as veterans are referred to a county veterans service officer for 172.30assistance in applying to the United States Department of Veterans Affairs for any veterans 172.31benefits for which they may be eligible.172.32    Sec. 98. Minnesota Statutes 2010, section 256L.07, subdivision 1, is amended to read:173.1    Subdivision 1. General requirements. (a) Children enrolled in the original 173.2children's health plan as of September 30, 1992, children who enrolled in the 173.3MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549, 173.4article 4, section 17, and children who have family gross incomes that are equal to or 173.5less than 150 percent of the federal poverty guidelines are eligible without meeting 173.6the requirements of subdivision 2 and the four-month requirement in subdivision 3, as 173.7long as they maintain continuous coverage in the MinnesotaCare program or medical 173.8assistance. Children who apply for MinnesotaCare on or after the implementation date 173.9of the employer-subsidized health coverage program as described in Laws 1998, chapter 173.10407, article 5, section 45, who have family gross incomes that are equal to or less than 150 173.11percent of the federal poverty guidelines, must meet the requirements of subdivision 2 to 173.12be eligible for MinnesotaCare.173.13    (b) Families enrolled in MinnesotaCare under section 
         256L.04, subdivision 1, whose 173.14income increases above 275 percent of the federal poverty guidelines, are no longer 173.15eligible for the program and shall be disenrolled by the commissioner. Beginning January 173.161, 2008,173.17(c) Individuals enrolled in MinnesotaCare under section 
         256L.04, subdivision 7, 173.18whose income increases above 200 percent of the federal poverty guidelines or 250 173.19percent of the federal poverty guidelines on or after July 1, 2009, the limits described 173.20in section 256L.04, subdivision 7, are no longer eligible for the program and shall be 173.21disenrolled by the commissioner.173.22(d) For persons disenrolled under this subdivision, MinnesotaCare coverage 173.23terminates the last day of the calendar month following the month in which the 173.24commissioner determines that the income of a family or individual exceeds program 173.25income limits.173.26    (b) (e) Notwithstanding paragraph (a), children may remain enrolled in 173.27MinnesotaCare if ten percent of their gross individual or gross family income as defined 173.28in section 
         256L.01, subdivision 4, is less than the annual premium for a six-month 173.29policy with a $500 deductible available through the Minnesota Comprehensive Health 173.30Association. Children who are no longer eligible for MinnesotaCare under this clause shall 173.31be given a 12-month notice period from the date that ineligibility is determined before 173.32disenrollment. The premium for children remaining eligible under this clause shall be the 173.33maximum premium determined under section 
         256L.15, subdivision 2, paragraph (b).173.34    (c) (f) Notwithstanding paragraphs (a) and (b) (e), parents are not eligible for 173.35MinnesotaCare if gross household income exceeds $57,500 for the 12-month $25,000 for 173.36the six-month period of eligibility.174.1EFFECTIVE DATE.This section is effective January 1, 2012, and expires June 174.230, 2013, except the amendments to the new paragraphs (e) and (f) are effective July 1, 174.32011, and do not expire.174.4    Sec. 99. Minnesota Statutes 2010, section 256L.07, subdivision 1, is amended to read:174.5    Subdivision 1. General requirements. (a) Children enrolled in the original 174.6children's health plan as of September 30, 1992, children who enrolled in the 174.7MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549, 174.8article 4, section 17, and children who have family gross incomes that are equal to or 174.9less than 150 percent of the federal poverty guidelines are eligible without meeting 174.10the requirements of subdivision 2 and the four-month requirement in subdivision 3, as 174.11long as they maintain continuous coverage in the MinnesotaCare program or medical 174.12assistance. Children who apply for MinnesotaCare on or after the implementation date 174.13of the employer-subsidized health coverage program as described in Laws 1998, chapter 174.14407, article 5, section 45, who have family gross incomes that are equal to or less than 150 174.15percent of the federal poverty guidelines, must meet the requirements of subdivision 2 to 174.16be eligible for MinnesotaCare.174.17    (b) Families enrolled in MinnesotaCare under section 
         256L.04, subdivision 1, whose 174.18income increases above 275 percent of the federal poverty guidelines the limits described 174.19in section 256L.04, subdivision 1, are no longer eligible for the program and shall be 174.20disenrolled by the commissioner.174.21(c) Beginning January 1, 2008, individuals enrolled in MinnesotaCare under section 174.22256L.04, subdivision 7
         , whose income increases above 200 percent of the federal poverty 174.23guidelines or 250 percent of the federal poverty guidelines on or after July 1, 2009, are no 174.24longer eligible for the program and shall be disenrolled by the commissioner.174.25(d) For persons disenrolled under this subdivision, MinnesotaCare coverage 174.26terminates the last day of the calendar month following the month in which the 174.27commissioner determines that the income of a family or individual exceeds program 174.28income limits.174.29    (b) (e) Notwithstanding paragraph (a), children may remain enrolled in 174.30MinnesotaCare if ten percent of their gross individual or gross family income as defined in 174.31section 
         256L.01, subdivision 4, is less than the annual premium for a policy with a $500 174.32deductible available through the Minnesota Comprehensive Health Association. Children 174.33who are no longer eligible for MinnesotaCare under this clause shall be given a 12-month 174.34notice period from the date that ineligibility is determined before disenrollment. The 175.1premium for children remaining eligible under this clause shall be the maximum premium 175.2determined under section 
         256L.15, subdivision 2, paragraph (b).175.3    (c) (f) Notwithstanding paragraphs (a) and (b) (e), parents are not eligible for 175.4MinnesotaCare if gross household income exceeds $57,500 for the 12-month period 175.5of eligibility.175.6EFFECTIVE DATE.The amendment in paragraph (b) is effective January 1, 2012, 175.7or upon federal approval whichever is later, and expires June 30, 2013. The commissioner 175.8shall notify the revisor of statutes when federal approval is obtained and publish a notice 175.9in the State Register.175.10    Sec. 100. Minnesota Statutes 2010, section 256L.09, subdivision 4, is amended to read:175.11    Subd. 4. Eligibility as Minnesota resident. (a) For purposes of this section, a 175.12permanent Minnesota resident is a person who has demonstrated, through persuasive and 175.13objective evidence, that the person is domiciled in the state and intends to live in the 175.14state permanently.175.15    (b) To be eligible as a permanent resident, an applicant must demonstrate the 175.16requisite intent to live in the state permanently by:175.17    (1) showing that the applicant maintains a residence at a verified address other than a 175.18place of public accommodation, unless the place of public accommodation is the person's 175.19primary or only residence, through the use of evidence of residence described in section 175.20256D.02, subdivision 12a
         , paragraph (b), clause (2) (1);175.21    (2) demonstrating that the applicant has been continuously domiciled in the state for 175.22no less than 180 days immediately before the application; and175.23    (3) signing an affidavit declaring that (A) the applicant currently resides in the state 175.24and intends to reside in the state permanently; and (B) the applicant did not come to the 175.25state for the primary purpose of obtaining medical coverage or treatment.175.26    (c) A person who is temporarily absent from the state does not lose eligibility for 175.27MinnesotaCare. "Temporarily absent from the state" means the person is out of the state 175.28for a temporary purpose and intends to return when the purpose of the absence has been 175.29accomplished. A person is not temporarily absent from the state if another state has 175.30determined that the person is a resident for any purpose. If temporarily absent from the 175.31state, the person must follow the requirements of the health plan in which the person is 175.32enrolled to receive services.175.33    Sec. 101. Minnesota Statutes 2010, section 256L.11, subdivision 7, is amended to read:176.1    Subd. 7. Critical access dental providers. Effective for dental services provided to 176.2MinnesotaCare enrollees on or after January 1, 2007, July 1, 2011, the commissioner shall 176.3increase payment rates to dentists and dental clinics deemed by the commissioner to be 176.4critical access providers under section 
         256B.76, subdivision 4, by 50 30 percent above 176.5the payment rate that would otherwise be paid to the provider. The commissioner shall 176.6pay the prepaid health plans under contract with the commissioner amounts sufficient to 176.7reflect this rate increase. The prepaid health plan must pass this rate increase to providers 176.8who have been identified by the commissioner as critical access dental providers under 176.9section 
         256B.76, subdivision 4.176.10    Sec. 102. Minnesota Statutes 2010, section 256L.12, subdivision 9, is amended to read:176.11    Subd. 9. Rate setting; performance withholds. (a) Rates will be prospective, 176.12per capita, where possible. The commissioner may allow health plans to arrange for 176.13inpatient hospital services on a risk or nonrisk basis. The commissioner shall consult with 176.14an independent actuary to determine appropriate rates.176.15    (b) For services rendered on or after January 1, 2004, the commissioner shall 176.16withhold five percent of managed care plan payments and county-based purchasing 176.17plan payments under this section pending completion of performance targets. Each 176.18performance target must be quantifiable, objective, measurable, and reasonably attainable, 176.19except in the case of a performance target based on a federal or state law or rule. Criteria 176.20for assessment of each performance target must be outlined in writing prior to the 176.21contract effective date. The managed care plan must demonstrate, to the commissioner's 176.22satisfaction, that the data submitted regarding attainment of the performance target is 176.23accurate. The commissioner shall periodically change the administrative measures used 176.24as performance targets in order to improve plan performance across a broader range of 176.25administrative services. The performance targets must include measurement of plan 176.26efforts to contain spending on health care services and administrative activities. The 176.27commissioner may adopt plan-specific performance targets that take into account factors 176.28affecting only one plan, such as characteristics of the plan's enrollee population. The 176.29withheld funds must be returned no sooner than July 1 and no later than July 31 of the 176.30following calendar year if performance targets in the contract are achieved.176.31(c) For services rendered on or after January 1, 2011, the commissioner shall 176.32withhold an additional three percent of managed care plan or county-based purchasing 176.33plan payments under this section. The withheld funds must be returned no sooner than 176.34July 1 and no later than July 31 of the following calendar year. The return of the withhold 176.35under this paragraph is not subject to the requirements of paragraph (b).177.1(d) Effective for services rendered on or after January 1, 2011, the commissioner 177.2shall include as part of the performance targets described in paragraph (b) a reduction in 177.3the plan's emergency room utilization rate for state health care program enrollees by a 177.4measurable rate of five percent from the plan's utilization rate for the previous calendar 177.5year.177.6The withheld funds must be returned no sooner than July 1 and no later than July 31 177.7of the following calendar year if the managed care plan demonstrates to the satisfaction of 177.8the commissioner that a reduction in the utilization rate was achieved.177.9The withhold described in this paragraph shall continue for each consecutive 177.10contract period until the plan's emergency room utilization rate for state health care 177.11program enrollees is reduced by 25 percent of the plan's emergency room utilization rate 177.12for state health care program enrollees for calendar year 2009. Hospitals shall cooperate 177.13with the health plans in meeting this performance target and shall accept payment 177.14withholds that may be returned to the hospitals if the performance target is achieved. The 177.15commissioner shall structure the withhold so that the commissioner returns a portion of 177.16the withheld funds in amounts commensurate with achieved reductions in utilization less 177.17than the targeted amount. The withhold described in this paragraph does not apply to 177.18county-based purchasing plans.177.19(e) Effective for services provided on or after January 1, 2012, the commissioner 177.20shall include as part of the performance targets described in paragraph (b) a reduction in 177.21the plan's hospitalization rate for a subsequent hospitalization within 30 days of a previous 177.22hospitalization of a patient regardless of the reason for the hospitalization for state health 177.23care program enrollees by a measurable rate of five percent from the plan's hospitalization 177.24rate for the previous calendar year.177.25The withheld funds must be returned no sooner than July 1 and no later than July 31 177.26of the following calendar year if the managed care plan or county-based purchasing plan 177.27demonstrates to the satisfaction of the commissioner that a reduction in the hospitalization 177.28rate was achieved.177.29The withhold described in this paragraph must continue for each consecutive 177.30contract period until the plan's subsequent hospitalization rate for state health care 177.31program enrollees is reduced by 25 percent of the plan's subsequent hospitalization rate 177.32for state health care program enrollees for calendar year 2010. Hospitals shall cooperate 177.33with the plans in meeting this performance target and shall accept payment withholds that 177.34must be returned to the hospitals if the performance target is achieved. The commissioner 177.35shall structure the withhold so that the commissioner returns a portion of the withheld 177.36funds in amounts commensurate with achieved reductions in utilizations less than the 178.1targeted amount. The withhold described in this paragraph does not apply to county-based 178.2purchasing plans.178.3(e) (f) A managed care plan or a county-based purchasing plan under section 178.4256B.692 
         may include as admitted assets under section 
         62D.044 any amount withheld 178.5under this section that is reasonably expected to be returned.178.6    Sec. 103. Minnesota Statutes 2010, section 256L.15, subdivision 1a, is amended to 178.7read:178.8    Subd. 1a. Payment options. The commissioner may offer the following payment 178.9options to an enrollee:178.10(1) payment by check;178.11(2) payment by credit card;178.12(3) payment by recurring automatic checking withdrawal;178.13(4) payment by onetime electronic transfer of funds;178.14(5) payment by wage withholding with the consent of the employer and the 178.15employee; or178.16(6) payment by using state tax refund payments.178.17The commissioner shall include information about the payment options on each 178.18premium notice. At application or reapplication, a MinnesotaCare applicant or enrollee 178.19may authorize the commissioner to use the Revenue Recapture Act in chapter 270A to 178.20collect funds from the applicant's or enrollee's refund for the purposes of meeting all or 178.21part of the applicant's or enrollee's MinnesotaCare premium obligation. The applicant or 178.22enrollee may authorize the commissioner to apply for the state working family tax credit 178.23on behalf of the applicant or enrollee. The setoff due under this subdivision shall not be 178.24subject to the $10 fee under section 
         270A.07, subdivision 1.178.25    Sec. 104. Laws 2008, chapter 363, article 18, section 3, subdivision 5, is amended to 178.26read:

178.27Subd. 5.Basic Health Care Grants

178.28(a) MinnesotaCare Grants

178.29Health Care Access-0-(770,000)

178.30Incentive Program and Outreach Grants.178.31Of the appropriation for the Minnesota health 178.32care outreach program in Laws 2007, chapter 179.1147, article 19, section 3, subdivision 7, 179.2paragraph (b):179.3(1) $400,000 in fiscal year 2009 from the 179.4general fund and $200,000 in fiscal year 2009 179.5from the health care access fund are for the 179.6incentive program under Minnesota Statutes, 179.7section 
         256.962, subdivision 5. For the 179.8biennium beginning July 1, 2009, base level 179.9funding for this activity shall be $360,000 179.10from the general fund and $160,000 from the 179.11health care access fund; and179.12(2) $100,000 in fiscal year 2009 from the 179.13general fund and $50,000 in fiscal year 2009 179.14from the health care access fund are for the 179.15outreach grants under Minnesota Statutes, 179.16section 
         256.962, subdivision 2. For the 179.17biennium beginning July 1, 2009, base level 179.18funding for this activity shall be $90,000 179.19from the general fund and $40,000 from the 179.20health care access fund.

179.21179.22(b) MA Basic Health Care Grants - Families and Children-0-(17,280,000)

179.23Third-Party Liability. (a) During 179.24fiscal year 2009, the commissioner shall 179.25employ a contractor paid on a percentage 179.26basis to improve third-party collections. 179.27Improvement initiatives may include, but not 179.28be limited to, efforts to improve postpayment 179.29collection from nonresponsive claims and 179.30efforts to uncover third-party payers the 179.31commissioner has been unable to identify.179.32(b) In fiscal year 2009, the first $1,098,000 179.33of recoveries, after contract payments and 179.34federal repayments, is appropriated to 180.1the commissioner for technology-related 180.2expenses.180.3Administrative Costs. (a) For contracts 180.4effective on or after January 1, 2009, 180.5the commissioner shall limit aggregate 180.6administrative costs paid to managed care 180.7plans under Minnesota Statutes, section 180.8256B.69
         , and to county-based purchasing 180.9plans under Minnesota Statutes, section 180.10256B.692
         , to an overall average of 6.6 6.1180.11percent of total contract payments under 180.12Minnesota Statutes, sections 
         256B.69 and 180.13256B.692
         , for each calendar year. For 180.14purposes of this paragraph, administrative 180.15costs do not include premium taxes paid 180.16under Minnesota Statutes, section 
         297I.05, 180.17subdivision 5
         , and provider surcharges paid 180.18under Minnesota Statutes, section 
         256.9657, 180.19subdivision 3
         .180.20(b) Notwithstanding any law to the contrary, 180.21the commissioner may reduce or eliminate 180.22administrative requirements to meet the 180.23administrative target under paragraph (a). 180.24(c) Notwithstanding any contrary provision 180.25of this article, this rider shall not expire.180.26Hospital Payment Delay. Notwithstanding 180.27Laws 2005, First Special Session chapter 4, 180.28article 9, section 2, subdivision 6, payments 180.29from the Medicaid Management Information 180.30System that would otherwise have been made 180.31for inpatient hospital services for medical 180.32assistance enrollees are delayed as follows: 180.33(1) for fiscal year 2008, June payments must 180.34be included in the first payments in fiscal 180.35year 2009; and (2) for fiscal year 2009, 181.1June payments must be included in the first 181.2payment of fiscal year 2010. The provisions 181.3of Minnesota Statutes, section 
         16A.124, 181.4do not apply to these delayed payments. 181.5Notwithstanding any contrary provision in 181.6this article, this paragraph expires on June 181.730, 2010.

181.8181.9(c) MA Basic Health Care Grants - Elderly and Disabled(14,028,000)(9,368,000)

181.10Minnesota Disability Health Options Rate 181.11Setting Methodology. The commissioner 181.12shall develop and implement a methodology 181.13for risk adjusting payments for community 181.14alternatives for disabled individuals (CADI) 181.15and traumatic brain injury (TBI) home 181.16and community-based waiver services 181.17delivered under the Minnesota disability 181.18health options program (MnDHO) effective 181.19January 1, 2009. The commissioner shall 181.20take into account the weighting system used 181.21to determine county waiver allocations in 181.22developing the new payment methodology. 181.23Growth in the number of enrollees receiving 181.24CADI or TBI waiver payments through 181.25MnDHO is limited to an increase of 200 181.26enrollees in each calendar year from January 181.272009 through December 2011. If those limits 181.28are reached, additional members may be 181.29enrolled in MnDHO for basic care services 181.30only as defined under Minnesota Statutes, 181.31section 
         256B.69, subdivision 28, and the 181.32commissioner may establish a waiting list for 181.33future access of MnDHO members to those 181.34waiver services.181.35MA Basic Elderly and Disabled 181.36Adjustments. For the fiscal year ending June 182.130, 2009, the commissioner may adjust the 182.2rates for each service affected by rate changes 182.3under this section in such a manner across 182.4the fiscal year to achieve the necessary cost 182.5savings and minimize disruption to service 182.6providers, notwithstanding the requirements 182.7of Laws 2007, chapter 147, article 7, section 182.871.

182.9(d) General Assistance Medical Care Grants-0-(6,971,000)

182.10(e) Other Health Care Grants-0-(17,000)

182.11MinnesotaCare Outreach Grants Special 182.12Revenue Account. The balance in the 182.13MinnesotaCare outreach grants special 182.14revenue account on July 1, 2009, estimated 182.15to be $900,000, must be transferred to the 182.16general fund.182.17Grants Reduction. Effective July 1, 2008, 182.18base level funding for nonforecast, general 182.19fund health care grants issued under this 182.20paragraph shall be reduced by 1.8 percent at 182.21the allotment level.182.22    Sec. 105. Laws 2010, First Special Session chapter 1, article 25, section 3, subdivision 182.236, is amended to read:

182.24Subd. 6.Health Care Grants

182.25(a) MinnesotaCare Grants998,000(13,376,000)

182.26This appropriation is from the health care 182.27access fund.182.28Health Care Access Fund Transfer to 182.29General Fund. The commissioner of 182.30management and budget shall transfer the 182.31following amounts in the following years 182.32from the health care access fund to the 182.33general fund: $998,000 $0 in fiscal year 183.12010; $176,704,000 $59,901,000 in fiscal 183.2year 2011; $141,041,000 in fiscal year 2012; 183.3and $286,150,000 in fiscal year 2013. If at 183.4any time the governor issues an executive 183.5order not to participate in early medical 183.6assistance expansion, no funds shall be 183.7transferred from the health care access 183.8fund to the general fund until early medical 183.9assistance expansion takes effect. This 183.10paragraph is effective the day following final 183.11enactment.183.12MinnesotaCare Ratable Reduction.183.13Effective for services rendered on or after 183.14July 1, 2010, to December 31, 2013, 183.15MinnesotaCare payments to managed care 183.16plans under Minnesota Statutes, section 183.17256L.12
         , for single adults and households 183.18without children whose income is greater 183.19than 75 percent of federal poverty guidelines 183.20shall be reduced by 15 percent. Effective 183.21for services provided from July 1, 2010, to 183.22June 30, 2011, this reduction shall apply to 183.23all services. Effective for services provided 183.24from July 1, 2011, to December 31, 2013, this 183.25reduction shall apply to all services except 183.26inpatient hospital services. Notwithstanding 183.27any contrary provision of this article, this 183.28paragraph shall expire on December 31, 183.292013.

183.30183.31(b) Medical Assistance Basic Health Care Grants - Families and Children-0-295,512,000

183.32Critical Access Dental. Of the general 183.33fund appropriation, $731,000 in fiscal year 183.342011 is to the commissioner for critical 183.35access dental provider reimbursement 183.36payments under Minnesota Statutes, section 184.1256B.76
          subdivision 4. This is a onetime 184.2appropriation.184.3Nonadministrative Rate Reduction. For 184.4services rendered on or after July 1, 2010, 184.5to December 31, 2013, the commissioner 184.6shall reduce contract rates paid to managed 184.7care plans under Minnesota Statutes, 184.8sections 
         256B.69 and 
         256L.12, and to 184.9county-based purchasing plans under 184.10Minnesota Statutes, section 
         256B.692, by 184.11three percent of the contract rate attributable 184.12to nonadministrative services in effect on 184.13June 30, 2010. Notwithstanding any contrary 184.14provision in this article, this rider expires on 184.15December 31, 2013.

184.16184.17(c) Medical Assistance Basic Health Care Grants - Elderly and Disabled-0-(30,265,000)

184.18184.19(d) General Assistance Medical Care Grants-0-(75,389,000)(59,583,000)

184.20The reduction to general assistance medical 184.21care grants is contingent upon the effective 184.22date in Laws 2010, First Special Session 184.23chapter 1, article 16, section 48. The 184.24reduction shall be reestimated based upon 184.25the actual effective date of the law. The 184.26commissioner of management and budget 184.27shall make adjustments in fiscal year 184.282011 to general assistance medical care 184.29appropriations to conform to the total 184.30expected expenditure reductions specified in 184.31this section.

184.32(e)  Other Health Care Grants-0-(7,000,000)

184.33Cobra Carryforward. Unexpended funds 184.34appropriated in fiscal year 2010 for COBRA 184.35grants under Laws 2009, chapter 79, article 185.15, section 78, do not cancel and are available 185.2to the commissioner for fiscal year 2011 185.3COBRA grant expenditures. Up to $111,000 185.4of the fiscal year 2011 appropriation for 185.5COBRA grants provided in Laws 2009, 185.6chapter 79, article 13, section 3, subdivision 185.76, may be used by the commissioner for costs 185.8related to administration of the COBRA 185.9grants.185.10    Sec. 106. COMMISSIONER'S ACTIONS; REPEAL OF EARLY MEDICAL 185.11ASSISTANCE EXPANSION.185.12    Effective January 1, 2012, the commissioner of human services shall suspend 185.13implementation and administration of Minnesota Statutes 2010, sections 256B.055, 185.14subdivision 15; 256B.056, subdivision 3, paragraph (b); and 256B.056, subdivision 4, 185.15paragraph (d). The commissioner shall refer persons enrolled under these provisions, and 185.16applicants for coverage under these provisions, to the general assistance medical care 185.17program established under Minnesota Statutes, section 256D.031.185.18    Sec. 107. GENERAL ASSISTANCE MEDICAL CARE PROGRAM; 185.19PROVISIONS REVIVED.185.20    Notwithstanding their contingent repeal in Laws 2010, First Special Session chapter 185.211, article 16, section 47, the following statutes are revived and have the force of law 185.22effective January 1, 2012:185.23    (1) Minnesota Statutes 2010, section 256D.03, subdivisions 3, 3a, 6, 7, and 8;185.24    (2) Minnesota Statutes 2010, section 256D.031, subdivisions 1, 2, 3, 4, 6, 7, and 185.2510; and185.26    (3) Laws 2010, chapter 200, article 1, section 18.185.27    Sec. 108. PLAN TO COORDINATE CARE FOR CHILDREN WITH 185.28HIGH-COST MENTAL HEALTH CONDITIONS.185.29The commissioner of human services shall develop and submit to the legislature 185.30by December 15, 2011, a plan to provide care coordination to medical assistance and 185.31MinnesotaCare enrollees who are children with high-cost mental health conditions. For 185.32purposes of this section, a child has a "high-cost mental health condition" if mental health 185.33and medical expenses over the past year totalled $100,000 or more. For purposes of this 186.1section, "care coordination" means collaboration between an advanced practice nurse and 186.2primary care physicians and specialists to manage care; development of mental health 186.3management plans for recurrent mental health issues; oversight and coordination of all 186.4aspects of care in partnership with families; organization of medical, treatment, and 186.5therapy information into a summary of critical information; coordination and appropriate 186.6sequencing of evaluations and multiple appointments; information and assistance with 186.7accessing resources; and telephone triage for behavior or other problems.186.8    Sec. 109. DATA ON CLAIMS AND UTILIZATION.186.9The commissioner of human services, in consultation with the Health and Human 186.10Services Reform Committee, shall develop and provide to the legislature by December 15, 186.112011, a methodology and any draft legislation necessary to allow for the release, upon 186.12request, of summary data as defined in Minnesota Statutes, section 13.02, subdivision 19, 186.13on claims and utilization for medical assistance, general assistance medical care, and 186.14MinnesotaCare enrollees at no charge to the University of Minnesota Medical School, the 186.15Mayo Medical School, Northwestern Health Sciences University, the Institute for Clinical 186.16Systems Improvement, and other research institutions to conduct analyses of health care 186.17outcomes and treatment effectiveness, provided the research institutions do not release 186.18private or nonpublic data or data for which dissemination is prohibited by law.186.19    Sec. 110. REDUCTION OF STATE-MANDATED ADMINISTRATIVE 186.20REPORTS.186.21(a) The commissioner of management and budget shall convene a report reduction 186.22working group of persons designated by the commissioners of health, human services, and 186.23commerce to eliminate redundant, unnecessary, obsolete, and low-priority state-mandated 186.24administrative reports required of health plans and county-based purchasing plans 186.25that serve persons enrolled in Minnesota health care programs. The commissioner of 186.26management and budget and the report reduction working group shall develop a plan to 186.27oversee the report reduction activities of the individual state agencies and coordinate the 186.28activities of multiple state agencies to consolidate reports or eliminate redundant reports 186.29required by more than one state agency on the same or a similar topic.186.30(b) The commissioners of health, human services, and commerce shall reduce, 186.31eliminate, or consolidate state-mandated reports according to the plan developed by the 186.32commissioner of management and budget through the report reduction working group. 186.33In addition to other report reduction actions the commissioners or the working group 186.34may undertake, the commissioners shall:187.1(1) collect encounter data, including provider payment data if collected, in a 187.2consolidated report provided to a single state agency, with the data collected by that state 187.3agency to be shared with other state agencies who need the data;187.4(2) collect only one provider network report annually through a single state agency, 187.5with the data collected by that state agency to be shared with other state agencies who 187.6need the data;187.7(3) collect only one standard financial report through a single state agency, with 187.8the data collected by that state agency to be shared with other state agencies who need 187.9the data.  Data collected must be of a nature and in a format to allow comparison of the 187.10cost-effectiveness of fee-for-service payment systems and prepaid programs administered 187.11by health plans and county-based purchasing plans;187.12(4) consolidate and simplify reports and documentation requirements relating to 187.13member communications and marketing materials, and establish a single review process 187.14for all programs, products, and agencies in order to ensure uniform and consistent 187.15regulation of  health plan contracts;187.16(5) consolidate state regulation and oversight of health plans and county-based 187.17purchasing plans so that activities of multiple agencies are administered through an 187.18efficient and uniform multiagency process of oversight and audits, with consistent 187.19standards, measures, and definitions for state oversight of quality, utilization management, 187.20care management, delegation accountability, access to care, appeals and grievances, and 187.21financial management;187.22(6) establish uniform requirements and procedures for denial, termination, or 187.23reduction of services and member appeals and grievances, and align state requirements 187.24and procedures with federal requirements and procedures; and187.25(7) reform the state's performance improvement projects, requirements, and 187.26procedures to be more flexible and efficient, and to place greater focus on measuring 187.27improvement of outcomes and less on mandating detailed or prescriptive requirements for 187.28specific performance improvement projects or activities.187.29(d) New reporting requirements or ad hoc report requests shall be established by a 187.30state agency only:187.31(1) if required by a federal agency;187.32(2) if needed for a state regulatory audit or corrective action plan; or187.33(3) after the completion of a review and analysis, and the development of 187.34recommendations by the commissioner of management and budget, in consultation 187.35with the report reduction working group, regarding the necessity, importance, and 187.36administrative cost of the new report, and after completing a review to determine 188.1whether the information sought can be obtained through another available state or federal 188.2report. The results of the review, analysis, and recommendations of the commissioner of 188.3management and budget must be provided to health plans and county-based purchasing 188.4plans for review and comment at least 60 days before a new report or requirement is 188.5established.188.6(e) To the extent possible, all state agencies shall use the procedures, reports, 188.7and audits of the Centers for Medicare and Medicaid Services instead of requiring an 188.8additional state-mandated report on the same or a similar topic.188.9(f) By January 15, 2012, the commissioner of management and budget shall provide 188.10a report on the activities and results of the report reduction project to the legislature. 188.11The report must include:188.12(1) a timetable for report reduction actions already taken or planned by the 188.13commissioners or the report reduction working group;188.14(2) the specific reports that have been or will be eliminated or consolidated;188.15(3) the amount of money that will be saved through reductions in administrative 188.16costs of health plans and county-based purchasing plans as a result of the report reduction 188.17project; and188.18(4) proposed legislation for changes to laws or rules that are needed to allow state 188.19agencies to further reduce, consolidate, or eliminate reports when the changes cannot 188.20be made administratively.188.21    Sec. 111. COMPETITIVE BIDDING PILOT.188.22For managed care contracts effective January 1, 2012, the commissioner of 188.23human services is required to establish a competitive price bidding pilot for nonelderly, 188.24nondisabled adults and children in medical assistance and MinnesotaCare in the 188.25seven-county metropolitan area. The pilot must allow a minimum of two managed care 188.26organizations to serve the metropolitan area. The pilot shall expire after two full calendar 188.27years on December 31, 2013. The commissioner of human service shall conduct an 188.28evaluation of the pilot to determine the cost-effectiveness and impacts to provider access at 188.29the end of the two-year period. The commissioner must consult with other states that have 188.30experience implementing competitive bidding in their medical assistance population and 188.31incorporate best practices from those states in designing this pilot. The commissioner, prior 188.32to implementation, must also consult with stakeholders on the design and implementation 188.33of the pilot, including providers, plans, advocacy groups, and other interested parties.188.34    Sec. 112. REQUEST FOR PROPOSAL; PROVIDER BILLING PATTERNS.189.1(a) The commissioner of human services shall issue a request for proposal, using 189.2existing resources, to identify abnormal provider billing patterns in order to prevent and 189.3identify improper medical assistance payments.189.4(b) The request for proposal must include the following requirements for the 189.5contractor:189.6(1) identification and reporting of improper claims, outlier claims, and improper 189.7payments, both prior to and subsequent to reimbursement; 189.8(2) utilization of fraud detection methods that maximize contemporary predictive 189.9analytic tools, including but not limited to identity analytics, link analysis, and matching 189.10capabilities; 189.11(3) utilization of data analytics that improve fraud detection through the identification 189.12of outlier reimbursement; 189.13(4) reduction in state expenditures by reducing or eliminating payouts of improper 189.14medical assistance claims; and 189.15(5) demonstrated success with other states and state agencies using the specified 189.16proposed solution, deployment, and implementation.  189.17(c) The commissioner shall enter into a contract for the services in this section by 189.18October 1, 2011. The contract must incorporate a performance-based vendor financing 189.19mechanism under which the vendor shares in the risk of the project's success.189.20    Sec. 113. HEALTH SERVICES POLICY COMMITTEE STUDIES.189.21(a) The commissioner of human services, through the health services policy 189.22committee established under Minnesota Statutes, section 256B.0625, subdivision 3c, shall 189.23identify and review medical assistance services provided by health care professionals who 189.24are not trained to provide the services in a high-quality manner. The commissioner shall 189.25develop a process to limit payment for medical assistance services to providers who are 189.26not appropriately trained to provide the service, and shall present recommendations and 189.27draft legislation by January 15, 2012, to the legislature.189.28(b) The commissioner of human services, through the health services policy 189.29committee established under Minnesota Statutes, section 256B.0625, subdivision 3c, shall 189.30study the effectiveness of new strategies for wound care treatment for medical assistance 189.31and MinnesotaCare enrollees with diabetes, including but not limited to the use of new 189.32wound care technologies, assessment tools, and reporting programs. The commissioner 189.33shall present recommendations by December 15, 2011, to the legislature on whether these 189.34new strategies for wound care treatment should be covered under medical assistance 189.35and MinnesotaCare.190.1    Sec. 114. SPECIALIZED MAINTENANCE THERAPY.190.2The commissioner of human services shall evaluate whether providing medical 190.3assistance coverage for specialized maintenance therapy for enrollees with serious and 190.4persistent mental illness who are at risk of hospitalization will improve the quality of 190.5care and lower medical assistance spending by reducing rates of hospitalization. The 190.6commissioner shall present findings and recommendations to the chairs and ranking 190.7minority members of the legislative committees with jurisdiction over health and human 190.8services finance and policy by December 15, 2011.190.9    Sec. 115. COVERAGE FOR LOWER-INCOME MINNESOTACARE 190.10ENROLLEES.190.11The commissioner of human services shall develop and present to the legislature, 190.12by December 15, 2011, a plan to redesign service delivery for MinnesotaCare enrollees 190.13eligible under Minnesota Statutes, section 256L.04, subdivisions 1 and 7, with incomes 190.14less than 133 percent of the federal poverty guidelines. The plan must be designed to 190.15improve continuity and quality of care, reduce unnecessary emergency room visits, and 190.16reduce average per-enrollee costs. In developing the plan, the commissioner shall consider 190.17innovative methods of service delivery, including but not limited to increasing the use 190.18and choice of private sector health plan coverage and encouraging the use of community 190.19health clinics, as defined in the federal Community Health Care Act of 1964, as health 190.20care homes.190.21    Sec. 116. DIRECTION TO COMMISSIONER; FEDERAL WAIVERS.190.22(a) The commissioner of human services shall apply to the Centers for Medicare 190.23and Medicaid Services (CMS) for federal waivers to cover:190.24(1) families with children eligible under Minnesota Statutes, section 256L.04, 190.25subdivision 1; and190.26(2) adults eligible under Minnesota Statutes, section 256L.04, subdivision 1, 190.27under the MinnesotaCare healthy Minnesota contribution program established under 190.28Minnesota Statutes, section 256L.031, by July 1, 2011. The commissioner shall report to 190.29the legislative committees with jurisdiction over health and human services policy and 190.30finance whether or not the federal waiver application was accepted within ten working 190.31days of receipt of the decision.190.32(b) The commissioner of human services shall apply to the CMS for a section 190.331115(a) demonstration waiver, and any other necessary federal waivers and amendments, 190.34including, but not limited to, a waiver of the appropriate sections of title XIX, United 191.1States Code, title 42, section 1396a, and a waiver of any applicable federal maintenance of 191.2effort provisions that would provide Minnesota with medical assistance program flexibility 191.3in exchange for federal budget certainty. The commissioner shall seek federal approval to 191.4enter into an agreement with CMS under which Minnesota would:191.5(1) accept an aggregate annual allotment for the medical assistance program, trended 191.6forward at an agreed upon rate, with protections to cover medical inflation and projected 191.7caseload growth; and191.8(2) receive federal waivers of Medicaid requirements related to: statewideness and 191.9comparability of services; the amount, duration, and scope of services; freedom of choice; 191.10cost-sharing; and other areas of program administration specified by the commissioner.191.11EFFECTIVE DATE.This section is effective the day following final enactment.191.12    Sec. 117. TRANSPARENCY AND QUALITY REPORTING FOR PUBLIC 191.13HEALTH CARE PROGRAMS.191.14When negotiating with external vendors to provide managed care services, the 191.15commissioner of human services shall require use of an advanced request for information 191.16tool. This tool must provide the department with an evidence-based assessment that 191.17focuses on the cost control, quality, and information transparency of the health care 191.18vendor. The assessment may include evidence-based performance measures that have 191.19been shown to influence better health, better health care, and more cost-effective use of 191.20resources including, but not limited to, areas that determine each plan's capabilities and 191.21performance with respect to:191.22(1) consumer engagement, support, and incentives;191.23(2) processes and outcomes for closing gaps in care according to clinical guideline 191.24expectations;191.25(3) provider management, including outcome and population-based reimbursement, 191.26transparent measurement of provider performance, and support of physician practice 191.27structures that lead to better care; and191.28(4) measures of clinical outcomes and waste approved by the National Quality 191.29Forum.191.30    Sec. 118. RISK CORRIDORS.191.31(a) Effective for services rendered on or after January 1, 2012, the commissioner 191.32shall establish risk corridors for state public programs that are actuarially sound for each 191.33managed care plan and each county-based purchasing plan. The risk corridors will be 191.34calculated annually based on the calendar year's net underwriting gain or loss. If the 192.1managed care plan or county-based purchasing plan has achieved a net underwriting gain 192.2of greater than three percent of revenue, 80 percent of any excess must be repaid to the 192.3commissioner by July 31 of the year following calculation of the risk corridor year, and 192.420 percent must be invested by the plan directly into programs for improving quality of 192.5care or access to care for state public health care program enrollees. If the managed 192.6care plan or county-based purchasing plan has incurred a net underwriting loss greater 192.7than three percent of total revenue, 50 percent of any excess must be repaid to the plan 192.8by the commissioner by July 31 of the year following calculation of the risk corridor 192.9year. Determination of total revenues and net underwriting gain or loss must be based 192.10on the Minnesota Supplement Report #1 which is filed on April 1 of the year following 192.11calculation of the risk corridor and adjusted for the actual withhold calculation under 192.12sections 256B.69, subdivision 5a, and 256L.12, subdivision 9. The report must be filed 192.13with and publicly disclosed by the Department of Health.192.14(b) For purposes of this section, "state public programs" means those prepaid 192.15medical assistance and MinnesotaCare programs for which a managed care plan or 192.16county-based purchasing plan contracts with the commissioner to provide coverage under 192.17sections 256B.69, 256B.692, and 256L.12. The risk corridors shall not apply to plans for 192.18persons who are enrolled in integrated Medicare and medical assistance programs under 192.19section 256B.69, subdivisions 23 and 28.192.20(c) This section expires January 1, 2014.192.21    Sec. 119. STUDY OF ENROLLED PROVIDER NETWORKS.192.22(a) The commissioner of human services shall present recommendations to the 192.23legislature by December 15, 2011, for a reformed health care delivery system under 192.24which enrolled provider networks provide basic health care services to qualified medical 192.25assistance and MinnesotaCare enrollees, supplemented by a major medical or stop-loss 192.26policy. For purposes of this section, "enrolled provider network" means a health care 192.27provider or group of health care providers that contracts with the commissioner to meet 192.28standards related to quality, affordability, and patient satisfaction for the provision of 192.29basic care services.192.30(b) The recommendations must address:192.31(1) eligibility, quality, reporting, fiscal solvency, and other criteria for enrolled 192.32provider networks;192.33(2) the geographic area of the state in which the reformed delivery system is to be 192.34implemented, including a schedule for any phase-in of the new delivery system;193.1(3) methods to coordinate care delivery through enrolled provider networks with 193.2care delivery through managed care and county-based purchasing plans, and the extent 193.3to which care delivery through enrolled provider networks should replace care delivery 193.4through managed care and county-based purchasing plans;193.5(4) the extent to which managed care and county-based purchasing plans should 193.6provide claims processing, administrative, quality assurance, and other services for 193.7enrolled provider networks and the commissioner;193.8(5) the definition of basic care services, criteria for stop-loss coverage or 193.9major-medical coverage, and the extent to which risk-sharing should be applied to 193.10enrolled provider networks;193.11(6) the extent to which certain health care services should continue to be delivered 193.12through fee-for-service;193.13(7) eligibility criteria for medical assistance and MinnesotaCare enrollees to be 193.14served by enrolled provider networks, and whether enrollee participation should be 193.15mandatory or voluntary;193.16(8) enrollee cost-sharing and premiums;193.17(9) methods to coordinate the delivery of care through enrolled provider networks 193.18with state and federal initiatives related to health care homes and care coordination, quality 193.19improvement, and payment reform; and193.20(10) the extent to which federal waivers and approval will be necessary for 193.21implementation.193.22(c) The report must include an estimate of the costs and savings to the state of 193.23delivering care through enrolled provider networks, and an implementation plan and 193.24timeline for establishing the reformed health care delivery system.193.25    Sec. 120.  REPEALER.193.26(a) Minnesota Statutes 2010, section 256.01, subdivision 2b, (performance 193.27payments) is repealed effective July 1, 2011.193.28(b) Minnesota Statutes 2010, section 62J.07, subdivisions 1, 2, and 3, (Legislative 193.29Commission on Health Care Access) are repealed.193.30(c) Laws 2009, chapter 79, article 5, section 64, (256L.07, subdivision 2) is repealed 193.31retroactively from July 1, 2009, and federal approval is no longer necessary.193.32(d) Laws 2009, chapter 79, article 5, section 65,  (256L.07, subdivision 3) is repealed 193.33retroactively from July 1, 2009, and federal approval is no longer necessary.194.1(e) Laws 2009, chapter 79, article 5, section 68,  (256L.15, subdivision 2, exemption 194.2of low-income children from MinnesotaCare premiums and insurance barriers) is 194.3repealed retroactively from July 1, 2009, and federal approval is no longer necessary.194.4(f) Minnesota Statutes 2010, section 256L.07, subdivision 7, exempting eligibility 194.5for children formally under medical assistance, is repealed retroactively from October 194.61, 2008, and federal approval is no longer necessary.194.7(g) The amendment in Laws 2009, chapter 79, article 5, section 55, as amended by 194.8Laws 2009, chapter 173, article 1, section 36, (256L.04, subdivision 1, children deemed 194.9eligible are exempt from eligibility requirements) is repealed retroactively from January 194.101, 2009, and federal approval is no longer necessary.194.11(h) Laws 2009, chapter 79, article 5, section 56,  (256L.04, subdivision 1b, 194.12exemption from income limit for children) is repealed retroactively from July 1, 2009, 194.13and federal approval is no longer necessary.194.14(i) Laws 2009, chapter 79, article 5, section 60, (256L.05, subdivision 1c, open 194.15enrollment and streamlined application) is repealed retroactively from July 1, 2009, 194.16and federal approval is no longer necessary.194.17(j) Laws 2009, chapter 79, article 5, section 66, (256L.07, subdivision 8, automatic 194.18eligibility certain children) is repealed retroactively from July 1, 2009, and federal 194.19approval is no longer necessary.194.20(k) The amendment in Laws 2009, chapter 79, article 5, section 57, (256L.04, 194.21subdivision 7a, ineligibility for adults with certain income) is repealed retroactively 194.22from July 1, 2009, and federal approval is no longer necessary.194.23(l) The amendment in Laws 2009, chapter 79, article 5, section 61,  (256L.05, 194.24subdivision 3, children eligibility following termination from foster care) is repealed 194.25retroactively from July 1, 2009, and federal approval is no longer necessary.194.26(m) The amendment in Laws 2009, chapter 79, article 5, section 62,  (256L.05, 194.27subdivision 3a, exemption from cancellation for nonrenewal for children) is repealed 194.28retroactively from July 1, 2009, and federal approval is no longer necessary.194.29(n) The amendment in Laws 2009, chapter 79, article 5, section 63,  (256L.07, 194.30subdivision 1, children whose gross family income is greater than 275 percent FPG 194.31may remain enrolled) is repealed retroactively from July 1, 2009, and federal approval is 194.32no longer necessary.194.33(o) The amendment in Laws 2009, chapter 79, article 5, section 64,  (256L.07, 194.34subdivision 2, exempts children from requirement not to have employer-subsidized 194.35coverage) is repealed retroactively from July 1, 2009, and federal approval is no longer 194.36necessary.195.1(p) The amendment in Laws 2009, chapter 79, article 5, section 65,  (256L.07, 195.2subdivision 3, requires children with family gross income over 200 percent of FPG 195.3to have had no health coverage for four months prior to application) is repealed 195.4retroactively from July 1, 2009, and federal approval is no longer necessary.195.5(q) The amendment in Laws 2009, chapter 79, article 5, section 68,  (256L.15, 195.6subdivision 2, children in families with income less than 200 percent FPG pay no 195.7premium) is repealed retroactively from July 1, 2009, and federal approval is no longer 195.8necessary.195.9(r) The amendment in Laws 2009, chapter 79, article 5, section 69,  (256L.15, 195.10subdivision 3, exempts children with family income below 200 percent FPG from 195.11sliding fee scale) is repealed retroactively from July 1, 2009, and federal approval is 195.12no longer necessary.195.13(s) Laws 2009, chapter 79, article 5, section 79,  (uncoded federal approval) is 195.14repealed the day following final enactment.195.15(t) Minnesota Statutes 2010, section 256B.057, subdivision 2c, (extended medical 195.16assistance for certain children) is repealed.195.17(u) The amendments in Laws 2008, chapter 358, article 3, sections 8; and 9, 195.18(renewal rolling month and premium grace month) are repealed.195.19    Sec. 121.  REPEALER; EARLY MEDICAL ASSISTANCE EXPANSION.195.20Minnesota Statutes 2010, section 256B.055, subdivision 15, is repealed January 195.211, 2012.195.22ARTICLE 6195.23CONTINUING CARE195.24    Section 1. Minnesota Statutes 2010, section 252.27, subdivision 2a, is amended to read:195.25    Subd. 2a. Contribution amount. (a) The natural or adoptive parents of a minor 195.26child, including a child determined eligible for medical assistance without consideration of 195.27parental income, must contribute to the cost of services used by making monthly payments 195.28on a sliding scale based on income, unless the child is married or has been married, 195.29parental rights have been terminated, or the child's adoption is subsidized according to 195.30section 
         259.67 or through title IV-E of the Social Security Act. The parental contribution 195.31is a partial or full payment for medical services provided for diagnostic, therapeutic, 195.32curing, treating, mitigating, rehabilitation, maintenance, and personal care services as 195.33defined in United States Code, title 26, section 213, needed by the child with a chronic 195.34illness or disability.196.1    (b) For households with adjusted gross income equal to or greater than 100 percent 196.2of federal poverty guidelines, the parental contribution shall be computed by applying the 196.3following schedule of rates to the adjusted gross income of the natural or adoptive parents:196.4    (1) if the adjusted gross income is equal to or greater than 100 percent of federal 196.5poverty guidelines and less than 175 percent of federal poverty guidelines, the parental 196.6contribution is $4 per month;196.7    (2) if the adjusted gross income is equal to or greater than 175 percent of federal 196.8poverty guidelines and less than or equal to 545 525 percent of federal poverty guidelines, 196.9the parental contribution shall be determined using a sliding fee scale established by the 196.10commissioner of human services which begins at one percent of adjusted gross income at 196.11175 percent of federal poverty guidelines and increases to 7.5 eight percent of adjusted 196.12gross income for those with adjusted gross income up to 545 525 percent of federal 196.13poverty guidelines;196.14    (3) if the adjusted gross income is greater than 545 525 percent of federal 196.15poverty guidelines and less than 675 percent of federal poverty guidelines, the parental 196.16contribution shall be 7.5 9.5 percent of adjusted gross income;196.17    (4) if the adjusted gross income is equal to or greater than 675 percent of federal 196.18poverty guidelines and less than 975 900 percent of federal poverty guidelines, the parental 196.19contribution shall be determined using a sliding fee scale established by the commissioner 196.20of human services which begins at 7.5 9.5 percent of adjusted gross income at 675 percent 196.21of federal poverty guidelines and increases to ten 12 percent of adjusted gross income for 196.22those with adjusted gross income up to 975 900 percent of federal poverty guidelines; and196.23    (5) if the adjusted gross income is equal to or greater than 975 900 percent of 196.24federal poverty guidelines, the parental contribution shall be 12.5 13.5 percent of adjusted 196.25gross income.196.26    If the child lives with the parent, the annual adjusted gross income is reduced by 196.27$2,400 prior to calculating the parental contribution. If the child resides in an institution 196.28specified in section 
         256B.35, the parent is responsible for the personal needs allowance 196.29specified under that section in addition to the parental contribution determined under this 196.30section. The parental contribution is reduced by any amount required to be paid directly to 196.31the child pursuant to a court order, but only if actually paid.196.32    (c) The household size to be used in determining the amount of contribution under 196.33paragraph (b) includes natural and adoptive parents and their dependents, including the 196.34child receiving services. Adjustments in the contribution amount due to annual changes 196.35in the federal poverty guidelines shall be implemented on the first day of July following 196.36publication of the changes.197.1    (d) For purposes of paragraph (b), "income" means the adjusted gross income of the 197.2natural or adoptive parents determined according to the previous year's federal tax form, 197.3except, effective retroactive to July 1, 2003, taxable capital gains to the extent the funds 197.4have been used to purchase a home shall not be counted as income.197.5    (e) The contribution shall be explained in writing to the parents at the time eligibility 197.6for services is being determined. The contribution shall be made on a monthly basis 197.7effective with the first month in which the child receives services. Annually upon 197.8redetermination or at termination of eligibility, if the contribution exceeded the cost of 197.9services provided, the local agency or the state shall reimburse that excess amount to 197.10the parents, either by direct reimbursement if the parent is no longer required to pay a 197.11contribution, or by a reduction in or waiver of parental fees until the excess amount is 197.12exhausted. All reimbursements must include a notice that the amount reimbursed may be 197.13taxable income if the parent paid for the parent's fees through an employer's health care 197.14flexible spending account under the Internal Revenue Code, section 125, and that the 197.15parent is responsible for paying the taxes owed on the amount reimbursed.197.16    (f) The monthly contribution amount must be reviewed at least every 12 months; 197.17when there is a change in household size; and when there is a loss of or gain in income 197.18from one month to another in excess of ten percent. The local agency shall mail a written 197.19notice 30 days in advance of the effective date of a change in the contribution amount. 197.20A decrease in the contribution amount is effective in the month that the parent verifies a 197.21reduction in income or change in household size.197.22    (g) Parents of a minor child who do not live with each other shall each pay the 197.23contribution required under paragraph (a). An amount equal to the annual court-ordered 197.24child support payment actually paid on behalf of the child receiving services shall be 197.25deducted from the adjusted gross income of the parent making the payment prior to 197.26calculating the parental contribution under paragraph (b).197.27    (h) The contribution under paragraph (b) shall be increased by an additional five 197.28percent if the local agency determines that insurance coverage is available but not 197.29obtained for the child. For purposes of this section, "available" means the insurance is a 197.30benefit of employment for a family member at an annual cost of no more than five percent 197.31of the family's annual income. For purposes of this section, "insurance" means health 197.32and accident insurance coverage, enrollment in a nonprofit health service plan, health 197.33maintenance organization, self-insured plan, or preferred provider organization.197.34    Parents who have more than one child receiving services shall not be required 197.35to pay more than the amount for the child with the highest expenditures. There shall 197.36be no resource contribution from the parents. The parent shall not be required to pay 198.1a contribution in excess of the cost of the services provided to the child, not counting 198.2payments made to school districts for education-related services. Notice of an increase in 198.3fee payment must be given at least 30 days before the increased fee is due.198.4    (i) The contribution under paragraph (b) shall be reduced by $300 per fiscal year if, 198.5in the 12 months prior to July 1:198.6    (1) the parent applied for insurance for the child;198.7    (2) the insurer denied insurance;198.8    (3) the parents submitted a complaint or appeal, in writing to the insurer, submitted 198.9a complaint or appeal, in writing, to the commissioner of health or the commissioner of 198.10commerce, or litigated the complaint or appeal; and198.11    (4) as a result of the dispute, the insurer reversed its decision and granted insurance.198.12    For purposes of this section, "insurance" has the meaning given in paragraph (h).198.13    A parent who has requested a reduction in the contribution amount under this 198.14paragraph shall submit proof in the form and manner prescribed by the commissioner or 198.15county agency, including, but not limited to, the insurer's denial of insurance, the written 198.16letter or complaint of the parents, court documents, and the written response of the insurer 198.17approving insurance. The determinations of the commissioner or county agency under this 198.18paragraph are not rules subject to chapter 14.198.19(j) Notwithstanding paragraph (b), for the period from July 1, 2010, to June 30, 198.202013, the parental contribution shall be computed by applying the following contribution 198.21schedule to the adjusted gross income of the natural or adoptive parents:198.22(1) if the adjusted gross income is equal to or greater than 100 percent of federal 198.23poverty guidelines and less than 175 percent of federal poverty guidelines, the parental 198.24contribution is $4 per month;198.25(2) if the adjusted gross income is equal to or greater than 175 percent of federal 198.26poverty guidelines and less than or equal to 525 percent of federal poverty guidelines, 198.27the parental contribution shall be determined using a sliding fee scale established by the 198.28commissioner of human services which begins at one percent of adjusted gross income 198.29at 175 percent of federal poverty guidelines and increases to eight percent of adjusted 198.30gross income for those with adjusted gross income up to 525 percent of federal poverty 198.31guidelines;198.32(3) if the adjusted gross income is greater than 525 percent of federal poverty 198.33guidelines and less than 675 percent of federal poverty guidelines, the parental contribution 198.34shall be 9.5 percent of adjusted gross income;198.35(4) if the adjusted gross income is equal to or greater than 675 percent of federal 198.36poverty guidelines and less than 900 percent of federal poverty guidelines, the parental 199.1contribution shall be determined using a sliding fee scale established by the commissioner 199.2of human services which begins at 9.5 percent of adjusted gross income at 675 percent of 199.3federal poverty guidelines and increases to 12 percent of adjusted gross income for those 199.4with adjusted gross income up to 900 percent of federal poverty guidelines; and199.5(5) if the adjusted gross income is equal to or greater than 900 percent of federal 199.6poverty guidelines, the parental contribution shall be 13.5 percent of adjusted gross 199.7income. If the child lives with the parent, the annual adjusted gross income is reduced by 199.8$2,400 prior to calculating the parental contribution. If the child resides in an institution 199.9specified in section 256B.35, the parent is responsible for the personal needs allowance 199.10specified under that section in addition to the parental contribution determined under this 199.11section. The parental contribution is reduced by any amount required to be paid directly to 199.12the child pursuant to a court order, but only if actually paid.199.13    Sec. 2. Minnesota Statutes 2010, section 256.01, subdivision 24, is amended to read:199.14    Subd. 24. Disability Linkage Line. The commissioner shall establish the Disability 199.15Linkage Line, ato serve as Minnesota's neutral access point for statewide consumer199.16disability information, referral, and assistance system for people with disabilities and 199.17chronic illnesses that. The Disability Linkage Line shall:199.18(1) deliver information and assistance based on national and state standards;199.19    (1) provides (2) provide information about state and federal eligibility requirements, 199.20benefits, and service options;199.21(3) provide benefits and options counseling;199.22    (2) makes (4) make referrals to appropriate support entities;199.23    (3) delivers information and assistance based on national and state standards;199.24    (4) assists (5) educate people to on their options so they can make well-informed 199.25decisions choices; and199.26    (5) supports (6) help support the timely resolution of service access and benefit 199.27issues.;199.28(7) inform people of their long-term community services and supports;199.29(8) provide necessary resources and supports that can lead to employment and 199.30increased economic stability of people with disabilities; and199.31(9) serve as the technical assistance and help center for the Web-based tool, 199.32Minnesota's Disability Benefits 101.org.199.33EFFECTIVE DATE.This section is effective July 1, 2011.199.34    Sec. 3. Minnesota Statutes 2010, section 256.01, subdivision 29, is amended to read:200.1    Subd. 29. State medical review team. (a) To ensure the timely processing of 200.2determinations of disability by the commissioner's state medical review team under 200.3sections 
         256B.055, subdivision 7, paragraph (b), 
         256B.057, subdivision 9, paragraph 200.4(j), and 
         256B.055, subdivision 12, the commissioner shall review all medical evidence 200.5submitted by county agencies with a referral and seek additional information from 200.6providers, applicants, and enrollees to support the determination of disability where 200.7necessary. Disability shall be determined according to the rules of title XVI and title 200.8XIX of the Social Security Act and pertinent rules and policies of the Social Security 200.9Administration.200.10    (b) Prior to a denial or withdrawal of a requested determination of disability due 200.11to insufficient evidence, the commissioner shall (1) ensure that the missing evidence is 200.12necessary and appropriate to a determination of disability, and (2) assist applicants and 200.13enrollees to obtain the evidence, including, but not limited to, medical examinations 200.14and electronic medical records.200.15(c) The commissioner shall provide the chairs of the legislative committees with 200.16jurisdiction over health and human services finance and budget the following information 200.17on the activities of the state medical review team by February 1 of each year:200.18(1) the number of applications to the state medical review team that were denied, 200.19approved, or withdrawn;200.20(2) the average length of time from receipt of the application to a decision;200.21(3) the number of appeals, appeal results, and the length of time taken from the date 200.22the person involved requested an appeal for a written decision to be made on each appeal;200.23(4) for applicants, their age, health coverage at the time of application, hospitalization 200.24history within three months of application, and whether an application for Social Security 200.25or Supplemental Security Income benefits is pending; and200.26(5) specific information on the medical certification, licensure, or other credentials 200.27of the person or persons performing the medical review determinations and length of 200.28time in that position.200.29(d) Any appeal made under section 
         256.045, subdivision 3, of a disability 200.30determination made by the state medical review team must be decided according to the 200.31timelines under section 
         256.0451, subdivision 22, paragraph (a). If a written decision is 200.32not issued within the timelines under section 
         256.0451, subdivision 22, paragraph (a), the 200.33appeal must be immediately reviewed by the chief appeals referee.200.34EFFECTIVE DATE.This section is effective July 1, 2011.200.35    Sec. 4. Minnesota Statutes 2010, section 256.045, subdivision 4a, is amended to read:201.1    Subd. 4a. Case management appeals temporary stay of demission.Any recipient 201.2of case management services pursuant to section 256B.092, who contests the county 201.3agency's action or failure to act in the provision of those services, other than a failure 201.4to act with reasonable promptness or a suspension, reduction, denial, or termination of 201.5services, must submit a written request for a conciliation conference to the county agency. 201.6The county agency shall inform the commissioner of the receipt of a request when it is 201.7submitted and shall schedule a conciliation conference. The county agency shall notify the 201.8recipient, the commissioner, and all interested persons of the time, date, and location of the 201.9conciliation conference. The commissioner may assist the county by providing mediation 201.10services or by identifying other resources that may assist in the mediation between the 201.11parties. Within 30 days, the county agency shall conduct the conciliation conference 201.12and inform the recipient in writing of the action the county agency is going to take and 201.13when that action will be taken and notify the recipient of the right to a hearing under this 201.14subdivision. The conciliation conference shall be conducted in a manner consistent with 201.15the commissioner's instructions. If the county fails to conduct the conciliation conference 201.16and issue its report within 30 days, or, at any time up to 90 days after the conciliation 201.17conference is held, a recipient may submit to the commissioner a written request for a 201.18hearing before a state human services referee to determine whether case management 201.19services have been provided in accordance with applicable laws and rules or whether the 201.20county agency has assured that the services identified in the recipient's individual service 201.21plan have been delivered in accordance with the laws and rules governing the provision 201.22of those services. The state human services referee shall recommend an order to the 201.23commissioner, who shall, in accordance with the procedure in subdivision 5, issue a final 201.24order within 60 days of the receipt of the request for a hearing, unless the commissioner 201.25refuses to accept the recommended order, in which event a final order shall issue within 90 201.26days of the receipt of that request. The order may direct the county agency to take those 201.27actions necessary to comply with applicable laws or rules. The commissioner may issue a 201.28temporary order prohibiting the demission of a recipient of case management services 201.29under section 256B.092 from a residential or day habilitation program licensed under 201.30chapter 245A, while a county agency review process or an appeal brought by a recipient 201.31under this subdivision is pending, or for the period of time necessary for the county agency 201.32to implement the commissioner's order. The commissioner shall not issue a final order 201.33staying the demission of a recipient of case management services from a residential or day 201.34habilitation program licensed under chapter 245A.201.35EFFECTIVE DATE.This section is effective January 1, 2012.202.1    Sec. 5. Minnesota Statutes 2010, section 256B.056, subdivision 3, is amended to read:202.2    Subd. 3. Asset limitations for individuals and families. (a) To be eligible for 202.3medical assistance, a person must not individually own more than $3,000 in assets, or if a 202.4member of a household with two family members, husband and wife, or parent and child, 202.5the household must not own more than $6,000 in assets, plus $200 for each additional 202.6legal dependent. In addition to these maximum amounts, an eligible individual or family 202.7may accrue interest on these amounts, but they must be reduced to the maximum at the 202.8time of an eligibility redetermination. The accumulation of the clothing and personal 202.9needs allowance according to section 
         256B.35 must also be reduced to the maximum at 202.10the time of the eligibility redetermination. The value of assets that are not considered in 202.11determining eligibility for medical assistance is the value of those assets excluded under 202.12the supplemental security income program for aged, blind, and disabled persons, with 202.13the following exceptions:202.14(1) household goods and personal effects are not considered;202.15(2) capital and operating assets of a trade or business that the local agency determines 202.16are necessary to the person's ability to earn an income are not considered;202.17(3) motor vehicles are excluded to the same extent excluded by the supplemental 202.18security income program;202.19(4) assets designated as burial expenses are excluded to the same extent excluded by 202.20the supplemental security income program. Burial expenses funded by annuity contracts 202.21or life insurance policies must irrevocably designate the individual's estate as contingent 202.22beneficiary to the extent proceeds are not used for payment of selected burial expenses; and202.23(5) effective upon federal approval, for a person who no longer qualifies as an 202.24employed person with a disability due to loss of earnings, assets allowed while eligible 202.25for medical assistance under section 
         256B.057, subdivision 9, are not considered for 12 202.26months, beginning with the first month of ineligibility as an employed person with a 202.27disability, to the extent that the person's total assets remain within the allowed limits of 202.28section 
         256B.057, subdivision 9, paragraph (c) (d).202.29(b) No asset limit shall apply to persons eligible under section 
         256B.055, subdivision 202.3015.202.31EFFECTIVE DATE.This section is effective January 1, 2014.202.32    Sec. 6. Minnesota Statutes 2010, section 256B.056, is amended by adding a 202.33subdivision to read:202.34    Subd. 5d.Spenddown adjustments.When income is projected for a six-month 202.35budget period, retroactive adjustments to income determined to be available to a person 203.1under section 256B.0575 must be made at the end of each six-month budget period 203.2based on changes occurring during the budget period. For changes occurring outside the 203.3six-month budget period, such retroactive adjustments are limited to the six full calendar 203.4months before the month the change is reported or discovered.203.5    Sec. 7. Minnesota Statutes 2010, section 256B.057, subdivision 9, is amended to read:203.6    Subd. 9. Employed persons with disabilities. (a) Medical assistance may be paid 203.7for a person who is employed and who:203.8(1) but for excess earnings or assets, meets the definition of disabled under the 203.9Supplemental Security Income program;203.10(2) is at least 16 but less than 65 years of age;203.11(3) meets the asset limits in paragraph (c) (d); and203.12(4) pays a premium and other obligations under paragraph (e).203.13    (b) For purposes of eligibility, there is a $65 earned income disregard. To be eligible 203.14for medical assistance under this subdivision, a person must have more than $65 of earned 203.15income. Earned income must have Medicare, Social Security, and applicable state and 203.16federal taxes withheld. The person must document earned income tax withholding. Any 203.17spousal income or assets shall be disregarded for purposes of eligibility and premium 203.18determinations.203.19(b) (c) After the month of enrollment, a person enrolled in medical assistance under 203.20this subdivision who:203.21(1) is temporarily unable to work and without receipt of earned income due to a 203.22medical condition, as verified by a physician, may retain eligibility for up to four calendar 203.23months; or203.24(2) effective January 1, 2004, loses employment for reasons not attributable to the 203.25enrollee, and is without receipt of earned income may retain eligibility for up to four 203.26consecutive months after the month of job loss. To receive a four-month extension, 203.27enrollees must verify the medical condition or provide notification of job loss. All other 203.28eligibility requirements must be met and the enrollee must pay all calculated premium 203.29costs for continued eligibility.203.30(c) (d) For purposes of determining eligibility under this subdivision, a person's 203.31assets must not exceed $20,000, excluding:203.32(1) all assets excluded under section 
         256B.056;203.33(2) retirement accounts, including individual accounts, 401(k) plans, 403(b) plans, 203.34Keogh plans, and pension plans; and203.35(3) medical expense accounts set up through the person's employer.; and204.1(4) spousal assets, including spouse's share of jointly held assets.204.2(d)(1) Effective January 1, 2004, for purposes of eligibility, there will be a $65 204.3earned income disregard. To be eligible, a person applying for medical assistance under 204.4this subdivision must have earned income above the disregard level.204.5(2) Effective January 1, 2004, to be considered earned income, Medicare, Social 204.6Security, and applicable state and federal income taxes must be withheld. To be eligible, 204.7a person must document earned income tax withholding.204.8(e)(1) A person whose earned and unearned income is equal to or greater than 100 204.9percent of federal poverty guidelines for the applicable family size must pay a premium 204.10to be eligible for medical assistance under this subdivision. (e) All enrollees must pay a 204.11premium to be eligible for medical assistance under this subdivision, except as provided 204.12under section 256.01, subdivision 18b.204.13(1) An enrollee must pay the greater of a $65 premium or the premium shall be204.14calculated based on the person's gross earned and unearned income and the applicable 204.15family size using a sliding fee scale established by the commissioner, which begins at 204.16one percent of income at 100 percent of the federal poverty guidelines and increases 204.17to 7.5 percent of income for those with incomes at or above 300 percent of the federal 204.18poverty guidelines. 204.19(2) Annual adjustments in the premium schedule based upon changes in the federal 204.20poverty guidelines shall be effective for premiums due in July of each year.204.21(2) Effective January 1, 2004, all enrollees must pay a premium to be eligible for 204.22medical assistance under this subdivision. An enrollee shall pay the greater of a $35 204.23premium or the premium calculated in clause (1).204.24(3) Effective November 1, 2003, All enrollees who receive unearned income must 204.25pay one-half of one five percent of unearned income in addition to the premium amount, 204.26except as provided under section 256.01, subdivision 18b.204.27(4) Effective November 1, 2003, for enrollees whose income does not exceed 200 204.28percent of the federal poverty guidelines and who are also enrolled in Medicare, the 204.29commissioner must reimburse the enrollee for Medicare Part B premiums under section 204.30256B.0625, subdivision 15, paragraph (a).204.31(5) (4) Increases in benefits under title II of the Social Security Act shall not be 204.32counted as income for purposes of this subdivision until July 1 of each year.204.33(f) A person's eligibility and premium shall be determined by the local county 204.34agency. Premiums must be paid to the commissioner. All premiums are dedicated to 204.35the commissioner.205.1(g) Any required premium shall be determined at application and redetermined at 205.2the enrollee's six-month income review or when a change in income or household size is 205.3reported. Enrollees must report any change in income or household size within ten days 205.4of when the change occurs. A decreased premium resulting from a reported change in 205.5income or household size shall be effective the first day of the next available billing month 205.6after the change is reported. Except for changes occurring from annual cost-of-living 205.7increases, a change resulting in an increased premium shall not affect the premium amount 205.8until the next six-month review.205.9(h) Premium payment is due upon notification from the commissioner of the 205.10premium amount required. Premiums may be paid in installments at the discretion of 205.11the commissioner.205.12(i) Nonpayment of the premium shall result in denial or termination of medical 205.13assistance unless the person demonstrates good cause for nonpayment. Good cause exists 205.14if the requirements specified in Minnesota Rules, part 9506.0040, subpart 7, items B to 205.15D, are met. Except when an installment agreement is accepted by the commissioner, 205.16all persons disenrolled for nonpayment of a premium must pay any past due premiums 205.17as well as current premiums due prior to being reenrolled. Nonpayment shall include 205.18payment with a returned, refused, or dishonored instrument. The commissioner may 205.19require a guaranteed form of payment as the only means to replace a returned, refused, 205.20or dishonored instrument.205.21(j) The commissioner shall notify enrollees annually beginning at least 24 months 205.22before the person's 65th birthday of the medical assistance eligibility rules affecting 205.23income, assets, and treatment of a spouse's income and assets that will be applied upon 205.24reaching age 65.205.25(k) For enrollees whose income does not exceed 200 percent of the federal poverty 205.26guidelines and who are also enrolled in Medicare, the commissioner shall reimburse 205.27the enrollee for Medicare part B premiums under section 256B.0625, subdivision 15, 205.28paragraph (a).205.29EFFECTIVE DATE.This section is effective January 1, 2014, for adults age 21 or 205.30older, and October 1, 2019, for children age 16 to before the child's 21st birthday.205.31    Sec. 8. Minnesota Statutes 2010, section 256B.0657, is amended to read:205.32256B.0657 SELF-DIRECTED SUPPORTS OPTION OPTIONS.205.33    Subdivision 1. Definition.(a) "Lead agency" has the meaning given in section 205.34256B.0911, subdivision 1a, paragraph (d).206.1(b) "Legal representative" means a legal guardian of a child or an adult, or parent of 206.2a minor child.206.3(c) "Individual representative" means an individual who has been authorized, in 206.4a written statement by the person or the person's legal representative, to speak on the 206.5person's behalf and help the person understand and make informed choices in matters 206.6related to identification of needs and choice of services and supports and assist the person 206.7to implement an approved support plan and has no financial interest in the provision of any 206.8services included in the individual's plan unless related by blood, adoption, or marriage.206.9(d) "Self-directed supports option options" means personal assistance, supports, 206.10items, and related services purchased under an approved budget plan and budget by a 206.11recipient.206.12    Subd. 2. Eligibility. (a) The self-directed supports option is available to a person 206.13who:206.14    (1) is a recipient of medical assistance as determined under sections 
         256B.055, 206.15256B.056
         , and 
         256B.057, subdivision 9;206.16    (2) is eligible for personal care assistance services under section 
         256B.0659, or 206.17for a home and community-based services waiver program under section 256B.0915, 206.18256B.092, or 256B.49, or alternative care under section 256B.0913;206.19    (3) lives in the person's own apartment or home, which is not owned, operated, or 206.20controlled by a provider of services not except for services provided by those related by 206.21blood or, adoption, marriage, or family foster care consistent with the requirements of 206.22section 256B.0651, subdivision 1, paragraph (e);206.23    (4) has the ability to hire, fire, supervise, establish staff compensation for, and 206.24manage the individuals providing services, and to choose and obtain items, related 206.25services, and supports as described in the participant's plan. If the recipient is not able 206.26to carry out these functions but has a legal guardian, individual representative,  or parent 206.27to carry them out, the guardian, individual representative,  or parent may fulfill these 206.28functions on behalf of the recipient; and206.29    (5) has not been excluded or disenrolled by the commissioner.206.30    (b) The commissioner may disenroll or, exclude, or require other measures such as 206.31training, increased assistance, reporting, or oversight for recipients, including guardians 206.32and,  parents, and individual representatives under the following circumstances:206.33    (1) recipients who have been restricted by the Primary Care Utilization Review 206.34Committee Minnesota restricted recipient program may be excluded for a specified time 206.35period;207.1    (2) recipients who exit the self-directed supports option during the recipient's 207.2service plan year shall not access the self-directed supports option for the remainder of 207.3that service plan year; and207.4    (3) when the department determines that the recipient cannot manage recipient 207.5responsibilities under the program.207.6(c) For vendors or other self-directed service providers, the commissioner may 207.7take any action authorized under surveillance and integrity review in Minnesota Rules, 207.8parts 9505.2160 to 9505.2245.207.9    Subd. 3. Eligibility for other services. Selection of the self-directed supports 207.10option by a recipient shall not restrict access to other medically necessary care and 207.11services furnished under the state plan medical assistance benefit, including home care 207.12targeted case management, except that a person receiving choosing lead agency managed207.13home and community-based waiver services, agency-provided personal care assistance 207.14services, a family support grant, or a consumer support grant is not eligible for funding 207.15under the self-directed supports option.207.16    Subd. 4. Assessment requirements. (a) The self-directed supports option 207.17assessment must meet the following requirements:207.18    (1) it shall be conducted by the county public health nurse or a certified public health 207.19nurse under contract with the county consistent with the requirements of personal care 207.20assistance services under section 256B.0659, subdivision 3a; home and community-based 207.21waiver services programs under section 256B.0915, 256B.092, or 256B.49; and the 207.22alternative care program under section 256B.0913, until section 256B.0911, subdivision 207.233a, has been implemented;207.24    (2) it shall be conducted face-to-face in the recipient's home initially, and at least 207.25annually thereafter; when there is a significant change in the recipient's condition; and 207.26when there is a change in the person's need for personal care assistance services under the 207.27programs listed in subdivision 2, paragraph (a), clause (2). A recipient who is residing in a 207.28facility may be assessed for the self-directed support option for the purpose of returning 207.29to the community using this option; and207.30    (3) it shall be completed using the format established by the commissioner.207.31    (b) The results of the personal care assistance assessment and recommendations shall 207.32be communicated to the commissioner and the recipient by the county public health nurse 207.33or certified public health nurse under contract with the county as required under section 207.34256B.0659, subdivision 3a. The person's annual and monthly average authorization for 207.35the self-directed budget amount shall be provided within 40 days after the personal care 207.36assessment or reassessment, or within ten days after a request not related to an assessment.208.1(c) The lead agency responsible for administration of home and community-based 208.2waiver services under section 256B.0915, 256B.092, or 256B.49, and alternative care 208.3under section 256B.0913, shall provide annual and monthly average authorization for the 208.4self-directed services budget amounts for all eligible persons within 40 days after an 208.5initial assessment or annual review and within ten days if requested at a time unrelated to 208.6the assessment or annual review.208.7    Subd. 5. Self-directed supports option plan requirements. (a) The plan and 208.8provider for the self-directed supports option must meet the following requirements:208.9    (1) the plan must be completed using a person-centered process that:208.10    (i) builds upon the recipient's capacity to engage in activities that promote 208.11community life;208.12    (ii) respects the recipient's preferences, choices, and abilities;208.13    (iii) involves families, friends, and professionals in the planning or delivery of 208.14services or supports as desired or required by the recipient; and208.15    (iv) addresses the need for personal care assistance and other services and supports208.16identified in the recipient's self-directed supports option assessment;208.17    (2) the plan shall be developed by the recipient, legal representative, or by the 208.18guardian of an adult recipient or by a parent or guardian of a minor child,managing 208.19partner, and may be assisted by a provider who meets the requirements established for 208.20using a person-centered planning process and shall be reviewed at least annually upon 208.21reassessment or when there is a significant change in the recipient's condition; and208.22    (3) the plan must include the total budget amount available divided into monthly 208.23amounts that cover the number of months of personal care assistance services or home 208.24and community-based waiver or alternative care authorization included in the budget. 208.25A recipient may reserve funds monthly for the purchase of items that meet the standards 208.26in subdivision 6, paragraph (a), clause (2), and are reflected in the support plan. The 208.27amount used each month may vary, but additional funds shall not be provided above the 208.28annual personal care assistance services authorized amount unless a change in condition 208.29is documented.208.30    (b) The commissioner or the commissioner's designee shall:208.31    (1) ensure that outreach activities and information materials on self-directed options 208.32are developed and provided across the state to persons who use or are seeking community 208.33support services;208.34    (1) (2) establish the format and criteria for the plan as well as the requirements for 208.35providers who assist with plan development;209.1    (2) (3) review the assessment and plan and, within 30 days after receiving the 209.2assessment and plan, make a decision on approval of the plan;209.3    (3) (4) notify the recipient, parent, or guardian legal representative, or individual 209.4representative of approval or denial of the plan and provide notice of the right to appeal 209.5under section 
         256.045; and209.6    (4) (5) provide a copy of the plan to the fiscal support entity selected by the recipient209.7from among at least three certified entities.209.8    (c) The commissioner shall:209.9    (1) establish provider enrollment requirements for provision of fiscal support entity 209.10services and person-centered support plan services, including benefits counseling to 209.11support employment; and209.12    (2) collect a fee to cover the costs of certifying providers for the services described 209.13in this subdivision.209.14    Subd. 6. Services covered. (a) Services covered under the self-directed supports 209.15option include:209.16    (1) personal care assistance services under section 
         256B.0659, and services under 209.17the home and community-based waivers, except those provided in licensed or registered 209.18residential settings unless the services are provided in a family foster care setting which 209.19meets the requirements of section 256B.0651, subdivision 1, paragraph (e); and209.20    (2) items, related services, and supports, including assistive technology, that increase 209.21independence or substitute for human assistance to the extent expenditures would 209.22otherwise be used for human assistance.209.23    (b) Items, supports, and related services purchased under this option shall not be 209.24considered home care services for the purposes of section 
         144A.43.209.25    Subd. 7. Noncovered services. Services or supports that are not eligible for 209.26payment under the self-directed supports option include:209.27    (1) services, goods, or supports that do not benefit the recipient;209.28    (2) any fees incurred by the recipient, such as Minnesota health care program fees 209.29and co-pays, legal fees, or costs related to advocate agencies;209.30    (3) insurance, except for insurance costs related to employee coverage or fiscal 209.31support entity payments;209.32    (4) room and board and personal items that are not related to the disability, except 209.33that medically prescribed specialized diet items may be covered if they reduce the need for 209.34human assistance;209.35    (5) home modifications that add square footage, except those modifications that 209.36configure a bathroom to accommodate a wheelchair;210.1    (6) home modifications for a residence other than the primary residence of the 210.2recipient, or in the event of a minor with parents not living together, the primary residences 210.3of the parents;210.4    (7) expenses for travel, lodging, or meals related to training the recipient, the 210.5parent or guardian of an adult recipient, or the parent or guardian of a minor child legal 210.6representative, or paid or unpaid caregivers that exceed $500 in a 12-month period;210.7    (8) experimental treatment;210.8    (9) any service or item to the extent the service or item is covered by other medical 210.9assistance state plan services, including prescription and over-the-counter medications, 210.10compounds, and solutions and related fees, including premiums and co-payments;210.11    (10) membership dues or costs, except when the service is necessary and appropriate 210.12to treat a physical condition or to improve or maintain the recipient's physical condition. 210.13The condition must be identified in the recipient's plan of care and monitored by a 210.14Minnesota health care program enrolled physician;210.15    (11) vacation expenses other than the cost of direct services;210.16    (12) vehicle maintenance or modifications not related to the disability;210.17    (13) tickets and related costs to attend sporting or other recreational events; and210.18    (14) costs related to Internet access, except when necessary for operation of assistive 210.19technology, to increase independence, or to substitute for human assistance.210.20    Subd. 8. Self-directed budget requirements.(a) The budget for the provision of 210.21the self-directed service option shall be established for persons eligible for personal care 210.22assistance services under section 256B.0659 based on:210.23    (1) assessed personal care assistance units, not to exceed the maximum number of 210.24personal care assistance units available, as determined by section 
         256B.0659; and210.25    (2) the personal care assistance unit rate:210.26    (i) with a reduction to the unit rate to pay for a program administrator as defined in 210.27subdivision 10; and210.28    (ii) an additional adjustment to the unit rate as needed to ensure cost neutrality for 210.29the state.210.30(b) The budget for persons eligible for programs listed in subdivision 2, paragraph 210.31(a), clause (2), is based on the approved budget methodologies for each program.210.32    Subd. 9. Quality assurance and risk management. (a) The commissioner 210.33shall establish quality assurance and risk management measures for use in developing 210.34and implementing self-directed plans and budgets that (1) recognize the roles and 210.35responsibilities involved in obtaining services in a self-directed manner, and (2) assure 210.36the appropriateness of such plans and budgets based upon a recipient's resources and 211.1capabilities. These measures must include (i) background studies, and (ii) backup and 211.2emergency plans, including disaster planning, and (iii) for persons using home and 211.3community-based waiver services, monitoring by the lead agency on quality assurance 211.4measures and recipient health, safety, and welfare.211.5    (b) The commissioner shall provide ongoing technical assistance and resource 211.6and educational materials for families and recipients selecting the self-directed option, 211.7including information on the quality assurance efforts.211.8    (c) Performance assessments measures, such as of a recipient's  functioning, 211.9satisfaction with the services and supports, and ongoing monitoring of health and 211.10well-being shall be identified in consultation with the stakeholder group.211.11    Subd. 10. Fiscal support entity. (a) Each recipient or legal representative shall 211.12choose a fiscal support entity provider certified by the commissioner to make payments 211.13for services, items, supports, and administrative costs related to managing a self-directed 211.14service plan authorized for payment in the approved plan and budget. Recipients The 211.15recipient or legal representative  shall also choose the payroll, agency with choice, or the 211.16fiscal conduit model of financial and service management.211.17    (b) The fiscal support entity:211.18    (1) may not limit or restrict the recipient's choice of service or support providers, 211.19including use of the payroll, agency with choice, or fiscal conduit model of financial 211.20and service management;211.21    (2) must have a written agreement with the recipient, individual representative,  or 211.22the recipient's legal representative that identifies the duties and responsibilities to be 211.23performed and the specific related charges;211.24    (3) must provide the recipient and the home care targeted case manager, legal 211.25representative, and individual representative with a monthly written summary of the 211.26self-directed supports option services that were billed, including charges from the fiscal 211.27support entity;211.28    (4) must be knowledgeable of and comply with Internal Revenue Service 211.29requirements necessary to process employer and employee deductions, provide appropriate 211.30and timely submission of employer tax liabilities, and maintain documentation to support 211.31medical assistance claims;211.32    (5) must have current and adequate liability insurance and bonding and sufficient 211.33cash flow and have on staff or under contract a certified public accountant or an individual 211.34with a baccalaureate degree in accounting; and211.35    (6) must maintain records to track all self-directed supports option services 211.36expenditures, including time records of persons paid to provide supports and receipts for 212.1any goods purchased. The records must be maintained for a minimum of five years from 212.2the claim date and be available for audit or review upon request. Claims submitted by 212.3the fiscal support entity must correspond with services, amounts, and time periods as 212.4authorized in the recipient's self-directed supports option plan.212.5    (c) The commissioner shall have authority to:212.6    (1) set or negotiate rates with fiscal support entities;212.7    (2) limit the number of fiscal support entities;212.8    (3) identify a process to certify and recertify fiscal support entities and assure fiscal 212.9support entities are available to recipients throughout the state; and212.10    (4) establish a uniform format and protocol to be used by eligible fiscal support 212.11entities.212.12    Subd. 11. Stakeholder consultation. The commissioner shall consult with 212.13a statewide consumer-directed self-directed  services stakeholder group, including 212.14representatives of all types of consumer-directed self-directed  service users, advocacy 212.15organizations, counties, and consumer-directed self-directed  service providers. The 212.16commissioner shall seek recommendations from this stakeholder group in developing, 212.17monitoring, evaluating, and modifying:212.18    (1) the self-directed plan format;212.19    (2) requirements and guidelines for the person-centered plan assessment and 212.20planning process;212.21    (3) implementation of the option and the quality assurance and risk management 212.22techniques; and212.23    (4) standards and requirements, including rates for the personal support plan 212.24development provider and the fiscal support entity; policies; training; and implementation; 212.25and212.26(5) the self-directed supports options available through the home and 212.27community-based waivers under section 256B.0916 and the personal care assistance 212.28program under section 256B.0659, including recommendations on possible ways to 212.29increase participation, improve flexibility, and provide incentives for recipients to 212.30participate in a life transition and crisis funding pool with others to save and contribute 212.31part of their authorized budgets, which can be carried over year to year and used according 212.32to priority standards under section 256B.092, subdivision 12, paragraph (a), clauses (1), 212.33(3), (4), (5), and (6).212.34The stakeholder group shall provide recommendations on the repeal of the personal 212.35care assistance choice option, transition issues, and whether the consumer support grant 212.36program under section 
         256.476 should be modified. The stakeholder group shall meet 213.1at least three times each year to provide advice on policy, implementation, and other 213.2aspects of consumer and self-directed services.213.3    Subd. 12. Enrollment and evaluation. Enrollment in the self-directed supports 213.4option is available to current personal care assistance recipients upon annual personal 213.5care assistance reassessment, with a maximum enrollment of 1,000 2,000 people in the 213.6first fiscal year of implementation and an additional 1,000 3,000 people in the second 213.7fiscal year. The commissioner shall evaluate the self-directed supports option during the 213.8first two years of implementation and make any necessary changes prior to the option 213.9becoming available statewide.213.10EFFECTIVE DATE.This section is effective July 1, 2012.213.11    Sec. 9. Minnesota Statutes 2010, section 256B.0659, subdivision 11, is amended to 213.12read:213.13    Subd. 11. Personal care assistant; requirements. (a) A personal care assistant 213.14must meet the following requirements:213.15    (1) be at least 18 years of age with the exception of persons who are 16 or 17 years 213.16of age with these additional requirements:213.17    (i) supervision by a qualified professional every 60 days; and213.18    (ii) employment by only one personal care assistance provider agency responsible 213.19for compliance with current labor laws;213.20    (2) be employed by a personal care assistance provider agency;213.21    (3) enroll with the department as a personal care assistant after clearing a background 213.22study. Except as provided in subdivision 11a, before a personal care assistant provides 213.23services, the personal care assistance provider agency must initiate a background study on 213.24the personal care assistant under chapter 245C, and the personal care assistance provider 213.25agency must have received a notice from the commissioner that the personal care assistant 213.26is:213.27    (i) not disqualified under section 
         245C.14; or213.28    (ii) is disqualified, but the personal care assistant has received a set aside of the 213.29disqualification under section 
         245C.22;213.30    (4) be able to effectively communicate with the recipient and personal care 213.31assistance provider agency;213.32    (5) be able to provide covered personal care assistance services according to the 213.33recipient's personal care assistance care plan, respond appropriately to recipient needs, 213.34and report changes in the recipient's condition to the supervising qualified professional 213.35or physician;214.1    (6) not be a consumer of personal care assistance services;214.2    (7) maintain daily written records including, but not limited to, time sheets under 214.3subdivision 12;214.4    (8) effective January 1, 2010, complete standardized training as determined 214.5by the commissioner before completing enrollment. The training must be available 214.6in languages other than English and to those who need accommodations due to 214.7disabilities. Personal care assistant training must include successful completion of the 214.8following training components: basic first aid, vulnerable adult, child maltreatment, 214.9OSHA universal precautions, basic roles and responsibilities of personal care assistants 214.10including information about assistance with lifting and transfers for recipients, emergency 214.11preparedness, orientation to positive behavioral practices, fraud issues, and completion of 214.12time sheets. Upon completion of the training components, the personal care assistant must 214.13demonstrate the competency to provide assistance to recipients;214.14    (9) complete training and orientation on the needs of the recipient within the first 214.15seven days after the services begin; and214.16    (10) be limited to providing and being paid for up to 275 hours per month, except 214.17that this limit shall be 275 hours per month for the period July 1, 2009, through June 30, 214.182011, of personal care assistance services regardless of the number of recipients being 214.19served or the number of personal care assistance provider agencies enrolled with. The 214.20number of hours worked per day shall not be disallowed by the department unless in 214.21violation of the law.214.22    (b) A legal guardian may be a personal care assistant if the guardian is not being paid 214.23for the guardian services and meets the criteria for personal care assistants in paragraph (a).214.24    (c) Effective January 1, 2010, persons who do not qualify as a personal care assistant 214.25include parents and stepparents of minors, spouses, paid legal guardians, family foster 214.26care providers, except as otherwise allowed in section 
         256B.0625, subdivision 19a, or 214.27staff of a residential setting. When the personal care assistant is a relative of the recipient, 214.28the commissioner shall pay 80 percent of the provider rate. For purposes of this section, 214.29relative means the parent or adoptive parent of an adult child, a sibling aged 16 years or 214.30older, an adult child, a grandparent, or a grandchild. 214.31    Sec. 10. Minnesota Statutes 2010, section 256B.0659, subdivision 28, is amended to 214.32read:214.33    Subd. 28. Personal care assistance provider agency; required documentation.214.34(a) Required documentation must be completed and kept in the personal care assistance 215.1provider agency file or the recipient's home residence. The required documentation 215.2consists of:215.3(1) employee files, including:215.4(i) applications for employment;215.5(ii) background study requests and results;215.6(iii) orientation records about the agency policies;215.7(iv) trainings completed with demonstration of competence;215.8(v) supervisory visits;215.9(vi) evaluations of employment; and215.10(vii) signature on fraud statement;215.11(2) recipient files, including:215.12(i) demographics;215.13(ii) emergency contact information and emergency backup plan;215.14(iii) personal care assistance service plan;215.15(iv) personal care assistance care plan;215.16(v) month-to-month service use plan;215.17(vi) all communication records;215.18(vii) start of service information, including the written agreement with recipient; and215.19(viii) date the home care bill of rights was given to the recipient;215.20(3) agency policy manual, including:215.21(i) policies for employment and termination;215.22(ii) grievance policies with resolution of consumer grievances;215.23(iii) staff and consumer safety;215.24(iv) staff misconduct; and215.25(v) staff hiring, service delivery, staff and consumer safety, staff misconduct, and 215.26resolution of consumer grievances;215.27(4) time sheets for each personal care assistant along with completed activity sheets 215.28for each recipient served; and215.29(5) agency marketing and advertising materials and documentation of marketing 215.30activities and costs; and215.31(6) for each personal care assistant, whether or not the personal care assistant is 215.32providing care to a relative as defined in subdivision 11.215.33(b) The commissioner may assess a fine of up to $500 on provider agencies that do 215.34not consistently comply with the requirements of this subdivision.216.1    Sec. 11. Minnesota Statutes 2010, section 256B.0911, subdivision 1a, is amended to 216.2read:216.3    Subd. 1a. Definitions. For purposes of this section, the following definitions apply:216.4    (a) "Long-term care consultation services" means:216.5    (1) assistance in identifying services needed to maintain an individual in the most 216.6inclusive environment;216.7    (2) providing recommendations on cost-effective community services that are 216.8available to the individual;216.9    (3) development of an individual's person-centered community support plan;216.10    (4) providing information regarding eligibility for Minnesota health care programs;216.11    (5) face-to-face long-term care consultation assessments, which may be completed 216.12in a hospital, nursing facility, intermediate care facility for persons with developmental 216.13disabilities (ICF/DDs), regional treatment centers, or the person's current or planned 216.14residence;216.15    (6) federally mandated screening to determine the need for an institutional level of 216.16care under subdivision 4a;216.17    (7) determination of home and community-based waiver service eligibility 216.18including level of care determination for individuals who need an institutional level of 216.19care as defined under section 
         144.0724, subdivision 11, or 
         256B.092, service eligibility 216.20including state plan home care services identified in sections 
         256B.0625, subdivisions 216.216
         , 7, and 19, paragraphs (a) and (c), and 
         256B.0657, based on assessment and support 216.22plan development with appropriate referrals, including the option for consumer-directed 216.23communityself-directed supports;216.24    (8) providing recommendations for nursing facility placement when there are no 216.25cost-effective community services available; and216.26    (9) assistance to transition people back to community settings after facility 216.27admission; and216.28(10) providing notice to the individual or legal representative of the annual and 216.29monthly average authorized amount for traditional agency services and self-directed 216.30services under section 256B.0657 for which the recipient is found eligible.216.31    (b) "Long-term care options counseling" means the services provided by the linkage 216.32lines as mandated by sections 
         256.01 and 
         256.975, subdivision 7, and also includes 216.33telephone assistance and follow up once a long-term care consultation assessment has 216.34been completed.216.35    (c) "Minnesota health care programs" means the medical assistance program under 216.36chapter 256B and the alternative care program under section 
         256B.0913.217.1    (d) "Lead agencies" means counties or a collaboration of counties, tribes, and health 217.2plans administering long-term care consultation assessment and support planning services.217.3EFFECTIVE DATE.This section is effective January 1, 2012.217.4    Sec. 12. Minnesota Statutes 2010, section 256B.0911, subdivision 3a, is amended to 217.5read:217.6    Subd. 3a. Assessment and support planning. (a) Persons requesting assessment, 217.7services planning, or other assistance intended to support community-based living, 217.8including persons who need assessment in order to determine waiver or alternative 217.9care program eligibility, must be visited by a long-term care consultation team within 217.1015 calendar 20 calendar days after the date on which an assessment was requested or 217.11recommended. After January 1, 2011, these requirements also apply to personal care 217.12assistance services, private duty nursing, and home health agency services, on timelines 217.13established in subdivision 5. Face-to-face assessments must be conducted according 217.14to paragraphs (b) to (i).217.15    (b) The county may utilize a team of either the social worker or public health nurse, 217.16or both. After January 1, 2011, lead agencies shall use certified assessors to conduct the 217.17assessment in a face-to-face interview. The consultation team members must confer 217.18regarding the most appropriate care for each individual screened or assessed.217.19    (c) The assessment must be comprehensive and include a person-centered 217.20assessment of the health, psychological, functional, environmental, and social needs of 217.21referred individuals and provide information necessary to develop a support plan that 217.22meets the consumers needs, using an assessment form provided by the commissioner.217.23    (d) The assessment must be conducted in a face-to-face interview with the person 217.24being assessed and the person's legal representative, as required by legally executed 217.25documents, and other individuals as requested by the person, who can provide information 217.26on the needs, strengths, and preferences of the person necessary to develop a support plan 217.27that ensures the person's health and safety, but who is not a provider of service or has any 217.28financial interest in the provision of services.217.29    (e) The person, or the person's legal representative, must be provided with 217.30written recommendations for community-based services, including consumer-directed217.31self-directed  options, or institutional care that include documentation that the most 217.32cost-effective alternatives available were offered to the individual. For purposes of 217.33this requirement, "cost-effective alternatives" means community services and living 217.34arrangements that cost the same as or less than institutional care. For persons determined 217.35ineligible for services defined under subdivision 1a, paragraph (a), clauses (7) to (9), the 218.1community support plan must also include the estimated annual and monthly average 218.2authorized budget amount for those services.218.3    (f) If the person chooses to use community-based services, the person or the person's 218.4legal representative must be provided with a written community support plan, regardless 218.5of whether the individual is eligible for Minnesota health care programs. The written 218.6community support plan must include:218.7    (1) a summary of assessed needs as defined in paragraphs (c) and (d);218.8    (2) the individual's options and choices to meet identified needs, including all 218.9available options for case management services and providers;218.10    (3) identification of health and safety risks and how those risks will be addressed, 218.11including personal risk management strategies;218.12    (4) referral information; and 218.13    (5) informal caregiver supports, if applicable.218.14    For persons determined eligible for services defined under subdivision 1a, paragraph 218.15(a), clauses (7) to (10), the community support plan must also include:218.16    (6) identification of individual goals;218.17    (7) identification of short-term and long-term service outcomes. Short-term service 218.18outcomes are defined as achievable within six months; 218.19    (8) a recommended schedule for case management visits. When achievement of 218.20short-term service outcomes may affect the amount of service required, the schedule must 218.21be at least every six months and must reflect evaluation and progress toward identified 218.22short-term service outcomes; and218.23    (9) the estimated annual and monthly budget amount for services.218.24    In addition, for persons determined eligible for state plan home care under 218.25subdivision 1a, paragraph (a), clause (8), the person or person's representative must also 218.26receive a copy of the home care service plan developed by a certified assessor.218.27A person may request assistance in identifying community supports without 218.28participating in a complete assessment. Upon a request for assistance identifying 218.29community support, the person must be transferred or referred to the services available 218.30under sections 
         256.975, subdivision 7, and 
         256.01, subdivision 24, for telephone 218.31assistance and follow up.218.32    (g) The person has the right to make the final decision between institutional 218.33placement and community placement after the recommendations have been provided, 218.34except as provided in subdivision 4a, paragraph (c).219.1    (h) The team must give the person receiving assessment or support planning, or 219.2the person's legal representative, materials, and forms supplied by the commissioner 219.3containing the following information:219.4    (1) the need for and purpose of preadmission screening if the person selects nursing 219.5facility placement;219.6    (2) the role of the long-term care consultation assessment and support planning in 219.7waiver and alternative care program eligibility determination;219.8    (3) information about Minnesota health care programs;219.9    (4) the person's freedom to accept or reject the recommendations of the team;219.10    (5) the person's right to confidentiality under the Minnesota Government Data 219.11Practices Act, chapter 13;219.12    (6) the long-term care consultant's decision regarding the person's need for 219.13institutional level of care as determined under criteria established in section 
         144.0724, 219.14subdivision 11
         , or 
         256B.092; and219.15(7) the person's right to appeal the decision regarding the need for nursing facility 219.16level of care or the county's final decisions regarding public programs eligibility according 219.17to section 
         256.045, subdivision 3.219.18    (i) Face-to-face assessment completed as part of eligibility determination for 219.19the alternative care, elderly waiver, community alternatives for disabled individuals, 219.20community alternative care, and traumatic brain injury waiver programs under sections 219.21256B.0915
         , 
         256B.0917, and 
         256B.49 is valid to establish service eligibility for no more 219.22than 60 calendar days after the date of assessment. The effective eligibility start date 219.23for these programs can never be prior to the date of assessment. If an assessment was 219.24completed more than 60 days before the effective waiver or alternative care program 219.25eligibility start date, assessment and support plan information must be updated in a219.26face-to-face visit and documented in the department's Medicaid Management Information 219.27System (MMIS). The updated assessment may be completed by face-to-face visit, written 219.28communication, or telephone as determined by the commissioner to establish statewide 219.29consistency. The effective date of program eligibility in this case cannot be prior to the 219.30date the updated assessment is completed.219.31EFFECTIVE DATE.This section is effective January 1, 2012.219.32    Sec. 13. Minnesota Statutes 2010, section 256B.0911, subdivision 4a, is amended to 219.33read:219.34    Subd. 4a. Preadmission screening activities related to nursing facility 219.35admissions. (a) All applicants to Medicaid certified nursing facilities, including certified 220.1boarding care facilities, must be screened prior to admission regardless of income, assets, 220.2or funding sources for nursing facility care, except as described in subdivision 4b. The 220.3purpose of the screening is to determine the need for nursing facility level of care as 220.4described in paragraph (d) and to complete activities required under federal law related to 220.5mental illness and developmental disability as outlined in paragraph (b).220.6(b) A person who has a diagnosis or possible diagnosis of mental illness or 220.7developmental disability must receive a preadmission screening before admission 220.8regardless of the exemptions outlined in subdivision 4b, paragraph (b), to identify the need 220.9for further evaluation and specialized services, unless the admission prior to screening is 220.10authorized by the local mental health authority or the local developmental disabilities case 220.11manager, or unless authorized by the county agency according to Public Law 101-508.220.12The following criteria apply to the preadmission screening:220.13(1) the county must use forms and criteria developed by the commissioner to identify 220.14persons who require referral for further evaluation and determination of the need for 220.15specialized services; and220.16(2) the evaluation and determination of the need for specialized services must be 220.17done by:220.18(i) a qualified independent mental health professional, for persons with a primary or 220.19secondary diagnosis of a serious mental illness; or220.20(ii) a qualified developmental disability professional, for persons with a primary or 220.21secondary diagnosis of developmental disability. For purposes of this requirement, a 220.22qualified developmental disability professional must meet the standards for a qualified 220.23developmental disability professional under Code of Federal Regulations, title 42, section 220.24483.430.220.25(c) The local county mental health authority or the state developmental disability 220.26authority under Public Law Numbers 100-203 and 101-508 may prohibit admission to a 220.27nursing facility if the individual does not meet the nursing facility level of care criteria or 220.28needs specialized services as defined in Public Law Numbers 100-203 and 101-508. For 220.29purposes of this section, "specialized services" for a person with developmental disability 220.30means active treatment as that term is defined under Code of Federal Regulations, title 220.3142, section 483.440 (a)(1).220.32(d) The determination of the need for nursing facility level of care must be made 220.33according to criteria established developed by the commissioner, and in section 
         144.0724, 220.34subdivision 11, and256B.092, using forms developed by the commissioner. Effective no 220.35sooner than on or after January 1, 2014, for individuals age 21 and older, and on or after 220.36October 1, 2019, for individuals under age 21, the determination of need for nursing 221.1facility level of care shall be based on criteria in section 144.0724, subdivision 11. In 221.2assessing a person's needs, consultation team members shall have a physician available for 221.3consultation and shall consider the assessment of the individual's attending physician, if 221.4any. The individual's physician must be included if the physician chooses to participate. 221.5Other personnel may be included on the team as deemed appropriate by the county.221.6    Sec. 14. Minnesota Statutes 2010, section 256B.0911, subdivision 6, is amended to 221.7read:221.8    Subd. 6. Payment for long-term care consultation services. (a) Seventy-five 221.9percent of the total payment for each county must be paid monthly by certified nursing 221.10facilities in the county. The monthly amount to be paid by each nursing facility for each 221.11fiscal year must be determined by dividing the county's annual allocation for long-term 221.12care consultation services by 12 to determine the monthly payment and allocating the 221.13monthly payment to each nursing facility based on the number of licensed beds in the 221.14nursing facility. Payments to counties in which there is no certified nursing facility must be 221.15made by increasing the payment rate of the two facilities located nearest to the county seat.221.16    (b) The commissioner shall include the total annual payment determined under 221.17paragraph (a) for each nursing facility reimbursed under section 
         256B.431 or 
         256B.434 221.18according to section 
         256B.431, subdivision 2b, paragraph (g).221.19    (c) In the event of the layaway, delicensure and decertification, or removal from 221.20layaway of 25 percent or more of the beds in a facility, the commissioner may adjust 221.21the per diem payment amount in paragraph (b) and may adjust the monthly payment 221.22amount in paragraph (a). The effective date of an adjustment made under this paragraph 221.23shall be on or after the first day of the month following the effective date of the layaway, 221.24delicensure and decertification, or removal from layaway.221.25    (d) Payments for long-term care consultation services are available to the county 221.26or counties to cover staff salaries and expenses to provide the services described in 221.27subdivision 1a. The county shall employ, or contract with other agencies to employ, within 221.28the limits of available funding, sufficient personnel to provide long-term care consultation 221.29services while meeting the state's long-term care outcomes and objectives as defined in 221.30section 
         256B.0917, subdivision 1. The county shall be accountable for meeting local 221.31objectives as approved by the commissioner in the biennial home and community-based 221.32services quality assurance plan on a form provided by the commissioner.221.33    (e) Notwithstanding section 
         256B.0641, overpayments attributable to payment of the 221.34screening costs under the medical assistance program may not be recovered from a facility.222.1    (f) The commissioner of human services shall amend the Minnesota medical 222.2assistance plan to include reimbursement for the local consultation teams.222.3    (g) The county may bill, as case management services, assessments, support 222.4planning, and follow-along provided to persons determined to be eligible for case 222.5management under Minnesota health care programs. No individual or family member 222.6shall be charged for an initial assessment or initial support plan development provided 222.7under subdivision 3a or 3b. Counties may set a fee schedule for initial assessments and 222.8support plan development for individuals who are not financially eligible for medical 222.9assistance or MinnesotaCare. The maximum fee must not be greater than the actual cost 222.10of the initial assessment and support plan development.222.11(h) The commissioner shall develop an alternative payment methodology for 222.12long-term care consultation services that includes the funding available under this 222.13subdivision, and sections 
         256B.092 and 
         256B.0659. In developing the new payment 222.14methodology, the commissioner shall consider the maximization of federal funding for 222.15this activity.222.16    Sec. 15. Minnesota Statutes 2010, section 256B.0913, subdivision 4, is amended to 222.17read:222.18    Subd. 4. Eligibility for funding for services for nonmedical assistance recipients.222.19    (a) Funding for services under the alternative care program is available to persons who 222.20meet the following criteria:222.21    (1) the person has been determined by a community assessment under section 222.22256B.0911
          to be a person who would require the level of care provided in a nursing 222.23facility, as determined under section 256B.0911, subdivision 4a, paragraph (d), but for 222.24the provision of services under the alternative care program. Effective January 1, 2011, 222.25this determination must be made according to the criteria established in section 144.0724, 222.26subdivision 11;222.27    (2) the person is age 65 or older;222.28    (3) the person would be eligible for medical assistance within 135 days of admission 222.29to a nursing facility;222.30    (4) the person is not ineligible for the payment of long-term care services by the 222.31medical assistance program due to an asset transfer penalty under section 
         256B.0595 or 222.32equity interest in the home exceeding $500,000 as stated in section 
         256B.056;222.33    (5) the person needs long-term care services that are not funded through other 222.34state or federal funding, or other health insurance or other third-party insurance such as 222.35long-term care insurance;223.1    (6) except for individuals described in clause (7), the monthly cost of the alternative 223.2care services funded by the program for this person does not exceed 75 percent of the 223.3monthly limit described under section 
         256B.0915, subdivision 3a. This monthly limit 223.4does not prohibit the alternative care client from payment for additional services, but in no 223.5case may the cost of additional services purchased under this section exceed the difference 223.6between the client's monthly service limit defined under section 
         256B.0915, subdivision 223.73
         , and the alternative care program monthly service limit defined in this paragraph. If 223.8care-related supplies and equipment or environmental modifications and adaptations are or 223.9will be purchased for an alternative care services recipient, the costs may be prorated on a 223.10monthly basis for up to 12 consecutive months beginning with the month of purchase. 223.11If the monthly cost of a recipient's other alternative care services exceeds the monthly 223.12limit established in this paragraph, the annual cost of the alternative care services shall be 223.13determined. In this event, the annual cost of alternative care services shall not exceed 12 223.14times the monthly limit described in this paragraph;223.15    (7) for individuals assigned a case mix classification A as described under section 223.16256B.0915, subdivision 3a
         , paragraph (a), with (i) no dependencies in activities of daily 223.17living, or (ii) only one dependency up to two dependencies in bathing, dressing, grooming, 223.18or walking, or (iii) a dependency score of less than three if eating is the only dependency223.19and eating when the dependency score in eating is three or greater as determined by 223.20an assessment performed under section 
         256B.0911, the monthly cost of alternative 223.21care services funded by the program cannot exceed $600 $593 per month for all new 223.22participants enrolled in the program on or after July 1, 2009 2011. This monthly limit 223.23shall be applied to all other participants who meet this criteria at reassessment. This 223.24monthly limit shall be increased annually as described in section 
         256B.0915, subdivision 223.253a
         , paragraph (a). This monthly limit does not prohibit the alternative care client from 223.26payment for additional services, but in no case may the cost of additional services 223.27purchased exceed the difference between the client's monthly service limit defined in this 223.28clause and the limit described in clause (6) for case mix classification A; and223.29(8) the person is making timely payments of the assessed monthly fee.223.30A person is ineligible if payment of the fee is over 60 days past due, unless the person 223.31agrees to:223.32    (i) the appointment of a representative payee;223.33    (ii) automatic payment from a financial account;223.34    (iii) the establishment of greater family involvement in the financial management of 223.35payments; or223.36    (iv) another method acceptable to the lead agency to ensure prompt fee payments.224.1    The lead agency may extend the client's eligibility as necessary while making 224.2arrangements to facilitate payment of past-due amounts and future premium payments. 224.3Following disenrollment due to nonpayment of a monthly fee, eligibility shall not be 224.4reinstated for a period of 30 days.224.5    (b) Alternative care funding under this subdivision is not available for a person 224.6who is a medical assistance recipient or who would be eligible for medical assistance 224.7without a spenddown or waiver obligation. A person whose initial application for medical 224.8assistance and the elderly waiver program is being processed may be served under the 224.9alternative care program for a period up to 60 days. If the individual is found to be eligible 224.10for medical assistance, medical assistance must be billed for services payable under the 224.11federally approved elderly waiver plan and delivered from the date the individual was 224.12found eligible for the federally approved elderly waiver plan. Notwithstanding this 224.13provision, alternative care funds may not be used to pay for any service the cost of which: 224.14(i) is payable by medical assistance; (ii) is used by a recipient to meet a waiver obligation; 224.15or (iii) is used to pay a medical assistance income spenddown for a person who is eligible 224.16to participate in the federally approved elderly waiver program under the special income 224.17standard provision.224.18    (c) Alternative care funding is not available for a person who resides in a licensed 224.19nursing home, certified boarding care home, hospital, or intermediate care facility, except 224.20for case management services which are provided in support of the discharge planning 224.21process for a nursing home resident or certified boarding care home resident to assist with 224.22a relocation process to a community-based setting.224.23    (d) Alternative care funding is not available for a person whose income is greater 224.24than the maintenance needs allowance under section 
         256B.0915, subdivision 1d, but equal 224.25to or less than 120 percent of the federal poverty guideline effective July 1 in the fiscal 224.26year for which alternative care eligibility is determined, who would be eligible for the 224.27elderly waiver with a waiver obligation.224.28    Sec. 16. Minnesota Statutes 2010, section 256B.0915, subdivision 3a, is amended to 224.29read:224.30    Subd. 3a. Elderly waiver cost limits. (a) The monthly limit for the cost of 224.31waivered services to an individual elderly waiver client except for individuals described 224.32in paragraph (b) shall be the weighted average monthly nursing facility rate of the case 224.33mix resident class to which the elderly waiver client would be assigned under Minnesota 224.34Rules, parts 9549.0050 to 9549.0059, less the recipient's maintenance needs allowance 224.35as described in subdivision 1d, paragraph (a), until the first day of the state fiscal year in 225.1which the resident assessment system as described in section 
         256B.438 for nursing home 225.2rate determination is implemented. Effective on the first day of the state fiscal year in 225.3which the resident assessment system as described in section 
         256B.438 for nursing home 225.4rate determination is implemented and the first day of each subsequent state fiscal year, the 225.5monthly limit for the cost of waivered services to an individual elderly waiver client shall 225.6be the rate of the case mix resident class to which the waiver client would be assigned 225.7under Minnesota Rules, parts 9549.0050 to 9549.0059, in effect on the last day of the 225.8previous state fiscal year, adjusted by the greater of any legislatively adopted home and 225.9community-based services percentage rate increase or the average statewide percentage 225.10increase in nursing facility payment rates adjustment.225.11    (b) The monthly limit for the cost of waivered services to an individual elderly 225.12waiver client assigned to a case mix classification A under paragraph (a) with:225.13(1) no dependencies in activities of daily living,; or225.14(2) only one dependency up to two dependencies in bathing, dressing, grooming, or225.15walking, or (3) a dependency score of less than three if eating is the only dependency,225.16and eating when the dependency score in eating is three or greater as determined by an 225.17assessment performed under section 256B.0911225.18 shall be the lower of the case mix classification amount for case mix A as determined 225.19under paragraph (a) or the case mix classification amount for case mix A$1,750 per 225.20month effective on October July 1, 2008 2011, per month for all new participants enrolled 225.21in the program on or after July 1, 2009 2011. This monthly limit shall be applied to all 225.22other participants who meet this criteria at reassessment. This monthly limit shall be 225.23increased annually as described in paragraph (a).225.24(c) If extended medical supplies and equipment or environmental modifications are 225.25or will be purchased for an elderly waiver client, the costs may be prorated for up to 225.2612 consecutive months beginning with the month of purchase. If the monthly cost of a 225.27recipient's waivered services exceeds the monthly limit established in paragraph (a) or 225.28(b), the annual cost of all waivered services shall be determined. In this event, the annual 225.29cost of all waivered services shall not exceed 12 times the monthly limit of waivered 225.30services as described in paragraph (a) or (b).225.31    Sec. 17. Minnesota Statutes 2010, section 256B.0915, subdivision 3b, is amended to 225.32read:225.33    Subd. 3b. Cost limits for elderly waiver applicants who reside in a nursing 225.34facility. (a) For a person who is a nursing facility resident at the time of requesting a 225.35determination of eligibility for elderly waivered services, a monthly conversion budget 226.1limit for the cost of elderly waivered services may be requested. The monthly conversion 226.2budget limit for the cost of elderly waiver services shall be the resident class assigned 226.3under Minnesota Rules, parts 9549.0050 to 9549.0059, for that resident in the nursing 226.4facility where the resident currently resides until July 1 of the state fiscal year in which 226.5the resident assessment system as described in section 
         256B.438 for nursing home rate 226.6determination is implemented. Effective on July 1 of the state fiscal year in which the 226.7resident assessment system as described in section 
         256B.438 for nursing home rate 226.8determination is implemented, the monthly conversion budget limit for the cost of elderly 226.9waiver services shall be based on the per diem nursing facility rate as determined by the 226.10resident assessment system as described in section 
         256B.438 for that resident residents226.11in the nursing facility where the resident elderly waiver applicant currently resides 226.12multiplied. The monthly conversion budget limit shall be calculated by multiplying the 226.13per diem by 365 and,  divided by 12, less and reduced by  the recipient's maintenance needs 226.14allowance as described in subdivision 1d. The initially approved monthly conversion rate 226.15may budget limit shall be adjusted by the greater of any subsequent legislatively adopted 226.16home and community-based services percentage rate increase or the average statewide 226.17percentage increase in nursing facility payment rates annually as described in subdivision 226.183a, paragraph (a). The limit under this subdivision only applies to persons discharged from 226.19a nursing facility after a minimum 30-day stay and found eligible for waivered services 226.20on or after July 1, 1997. For conversions from the nursing home to the elderly waiver 226.21with consumer directed community support services, the conversion rate limit is equal to 226.22the nursing facility rate per diem used to calculate the monthly conversion budget limit 226.23must be reduced by a percentage equal to the percentage difference between the consumer 226.24directed services budget limit that would be assigned according to the federally approved 226.25waiver plan and the corresponding community case mix cap, but not to exceed 50 percent.226.26    (b) The following costs must be included in determining the total monthly costs 226.27for the waiver client:226.28    (1) cost of all waivered services, including extended medical specialized supplies 226.29and equipment and environmental modifications and accessibility adaptations; and226.30    (2) cost of skilled nursing, home health aide, and personal care services reimbursable 226.31by medical assistance.226.32    Sec. 18. Minnesota Statutes 2010, section 256B.0915, subdivision 3e, is amended to 226.33read:226.34    Subd. 3e. Customized living service rate. (a) Payment for customized living 226.35services shall be a monthly rate authorized by the lead agency within the parameters 227.1established by the commissioner. The payment agreement must delineate the amount of 227.2each component service included in the recipient's customized living service plan. The 227.3lead agency shall ensure that there is a documented need within the parameters established 227.4by the commissioner for all component customized living services authorized.227.5(b) The payment rate must be based on the amount of component services to be 227.6provided utilizing component rates established by the commissioner. Counties and tribes 227.7shall use tools issued by the commissioner to develop and document customized living 227.8service plans and rates.227.9(c) Component service rates must not exceed payment rates for comparable elderly 227.10waiver or medical assistance services and must reflect economies of scale. Customized 227.11living services must not include rent or raw food costs.227.12    (d) With the exception of individuals described in subdivision 3a, paragraph (b), the 227.13individualized monthly authorized payment for the customized living service plan shall 227.14not exceed 50 percent of the greater of either the statewide or any of the geographic 227.15groups' weighted average monthly nursing facility rate of the case mix resident class 227.16to which the elderly waiver eligible client would be assigned under Minnesota Rules, 227.17parts 9549.0050 to 9549.0059, less the maintenance needs allowance as described 227.18in subdivision 1d, paragraph (a), until the July 1 of the state fiscal year in which the 227.19resident assessment system as described in section 
         256B.438 for nursing home rate 227.20determination is implemented. Effective on July 1 of the state fiscal year in which 227.21the resident assessment system as described in section 
         256B.438 for nursing home 227.22rate determination is implemented and July 1 of each subsequent state fiscal year, the 227.23individualized monthly authorized payment for the services described in this clause shall 227.24not exceed the limit which was in effect on June 30 of the previous state fiscal year 227.25updated annually based on legislatively adopted changes to all service rate maximums for 227.26home and community-based service providers.227.27(e) Effective July 1, 2011, the individualized monthly payment for the customized 227.28living service plan for individuals described in subdivision 3a, paragraph (b), must be the 227.29monthly authorized payment limit for customized living for individuals classified as case 227.30mix A, reduced by 25 percent. This rate limit must be applied to all new participants 227.31enrolled in the program on or after July 1, 2011, who meet the criteria described in 227.32subdivision 3a, paragraph (b). This monthly limit also applies to all other participants who 227.33meet the criteria described in subdivision 3a, paragraph (b), at reassessment.227.34    (e) (f) Customized living services are delivered by a provider licensed by the 227.35Department of Health as a class A or class F home care provider and provided in a 228.1building that is registered as a housing with services establishment under chapter 144D.228.2Licensed home care providers are subject to section 256B.0651, subdivision 14.228.3(g) A provider may not bill or otherwise charge an elderly waiver participant or their 228.4family for additional units of any allowable component service beyond those available 228.5under the service rate limits described in paragraph (d), nor for additional units of any 228.6allowable component service beyond those approved in the service plan by the lead agency.228.7    Sec. 19. Minnesota Statutes 2010, section 256B.0915, subdivision 3h, is amended to 228.8read:228.9    Subd. 3h. Service rate limits; 24-hour customized living services. (a) The 228.10payment rate for 24-hour customized living services is a monthly rate authorized by the 228.11lead agency within the parameters established by the commissioner of human services. 228.12The payment agreement must delineate the amount of each component service included in 228.13each recipient's customized living service plan. The lead agency shall ensure that there is a 228.14documented need within the parameters established by the commissioner for all component 228.15customized living services authorized. The lead agency shall not authorize 24-hour 228.16customized living services unless there is a documented need for 24-hour supervision.228.17(b) For purposes of this section, "24-hour supervision" means that the recipient 228.18requires assistance due to needs related to one or more of the following:228.19    (1) intermittent assistance with toileting, positioning, or transferring;228.20    (2) cognitive or behavioral issues;228.21    (3) a medical condition that requires clinical monitoring; or228.22    (4) for all new participants enrolled in the program on or after January July 1, 2011, 228.23and all other participants at their first reassessment after January July 1, 2011, dependency 228.24in at least two three of the following activities of daily living as determined by assessment 228.25under section 
         256B.0911: bathing; dressing; grooming; walking; or eating when the 228.26dependency score in eating is three or greater; and needs medication management and at 228.27least 50 hours of service per month. The lead agency shall ensure that the frequency and 228.28mode of supervision of the recipient and the qualifications of staff providing supervision 228.29are described and meet the needs of the recipient.228.30(c) The payment rate for 24-hour customized living services must be based on the 228.31amount of component services to be provided utilizing component rates established by the 228.32commissioner. Counties and tribes will use tools issued by the commissioner to develop 228.33and document customized living plans and authorize rates.228.34(d) Component service rates must not exceed payment rates for comparable elderly 228.35waiver or medical assistance services and must reflect economies of scale.229.1(e) The individually authorized 24-hour customized living payments, in combination 229.2with the payment for other elderly waiver services, including case management, must not 229.3exceed the recipient's community budget cap specified in subdivision 3a. Customized 229.4living services must not include rent or raw food costs.229.5(f) The individually authorized 24-hour customized living payment rates shall not 229.6exceed the 95 percentile of statewide monthly authorizations for 24-hour customized 229.7living services in effect and in the Medicaid management information systems on March 229.831, 2009, for each case mix resident class under Minnesota Rules, parts 9549.0050 229.9to 9549.0059, to which elderly waiver service clients are assigned. When there are 229.10fewer than 50 authorizations in effect in the case mix resident class, the commissioner 229.11shall multiply the calculated service payment rate maximum for the A classification by 229.12the standard weight for that classification under Minnesota Rules, parts 9549.0050 to 229.139549.0059, to determine the applicable payment rate maximum. Service payment rate 229.14maximums shall be updated annually based on legislatively adopted changes to all service 229.15rates for home and community-based service providers.229.16    (g) Notwithstanding the requirements of paragraphs (d) and (f), the commissioner 229.17may establish alternative payment rate systems for 24-hour customized living services in 229.18housing with services establishments which are freestanding buildings with a capacity of 229.1916 or fewer, by applying a single hourly rate for covered component services provided 229.20in either:229.21    (1) licensed corporate adult foster homes; or229.22    (2) specialized dementia care units which meet the requirements of section 
         144D.065 229.23and in which:229.24    (i) each resident is offered the option of having their own apartment; or229.25    (ii) the units are licensed as board and lodge establishments with maximum capacity 229.26of eight residents, and which meet the requirements of Minnesota Rules, part 9555.6205, 229.27subparts 1, 2, 3, and 4, item A.229.28(h) A provider may not bill or otherwise charge an elderly waiver participant or their 229.29family for additional units of any allowable component service beyond those available 229.30under the service rate limits described in paragraph (e), nor for additional units of any 229.31allowable component service beyond those approved in the service plan by the lead agency.229.32    Sec. 20. Minnesota Statutes 2010, section 256B.0915, subdivision 5, is amended to 229.33read:229.34    Subd. 5. Assessments and reassessments for waiver clients. (a) Each client 229.35shall receive an initial assessment of strengths, informal supports, and need for services 230.1in accordance with section 
         256B.0911, subdivisions 3, 3a, and 3b. A reassessment of a 230.2client served under the elderly waiver must be conducted at least every 12 months and 230.3at other times when the case manager determines that there has been significant change 230.4in the client's functioning. This may include instances where the client is discharged 230.5from the hospital. There must be a determination that the client requires nursing facility 230.6level of care as defined in section 
         144.0724, subdivision 11 256B.0911, subdivision 4a, 230.7paragraph (d), at initial and subsequent assessments to initiate and maintain participation 230.8in the waiver program.230.9(b) Regardless of other assessments identified in section 
         144.0724, subdivision 230.104, as appropriate to determine nursing facility level of care for purposes of medical 230.11assistance payment for nursing facility services, only face-to-face assessments conducted 230.12according to section 
         256B.0911, subdivisions 3a and 3b, that result in a nursing facility 230.13level of care determination will be accepted for purposes of initial and ongoing access to 230.14waiver service payment.230.15    Sec. 21. Minnesota Statutes 2010, section 256B.0915, subdivision 10, is amended to 230.16read:230.17    Subd. 10. Waiver payment rates; managed care organizations. The 230.18commissioner shall adjust the elderly waiver capitation payment rates for managed care 230.19organizations paid under section 
         256B.69, subdivisions 6a and 23, to reflect the maximum 230.20service rate limits for customized living services and 24-hour customized living services 230.21under subdivisions 3e and 3h for the contract period beginning October 1, 2009. Medical 230.22assistance rates paid to customized living providers by managed care organizations under 230.23this section shall not exceed the maximum service rate limits and component rates as 230.24determined by the commissioner under subdivisions 3e and 3h.230.25    Sec. 22. Minnesota Statutes 2010, section 256B.0916, subdivision 6a, is amended to 230.26read:230.27    Subd. 6a. Statewide availability of consumer-directed community self-directed 230.28 support services. (a) The commissioner shall submit to the federal Health Care Financing 230.29Administration by August 1, 2001, an amendment to the home and community-based 230.30waiver for persons with developmental disabilities under section 256B.092 and by April 1, 230.312005, for waivers under sections 256B.0915 and 256B.49,  to make consumer-directed 230.32community self-directed support services available in every county of the state by January 230.331, 2002.231.1(b) Until the waiver amendment for self-directed community supports under 231.2section 54 is effective, if a county declines to meet the requirements for provision of 231.3consumer-directed communityself-directed supports, the commissioner shall contract 231.4with another county, a group of counties, or a private agency to plan for and administer 231.5consumer-directed community self-directed  supports in that county.231.6(c) The state of Minnesota, county agencies, tribal governments, or administrative 231.7entities under contract to participate in the implementation and administration of the home 231.8and community-based waiver for persons with developmental disabilities, shall not be 231.9liable for damages, injuries, or liabilities sustained through the purchase of support by the 231.10individual, the individual's family, legal representative, or the authorized representative 231.11with funds received through the consumer-directed community self-directed support 231.12service under this section. Liabilities include but are not limited to: workers' compensation 231.13liability, the Federal Insurance Contributions Act (FICA), or the Federal Unemployment 231.14Tax Act (FUTA).231.15EFFECTIVE DATE.This section is effective July 1, 2011.231.16    Sec. 23. Minnesota Statutes 2010, section 256B.092, subdivision 1a, is amended to 231.17read:231.18    Subd. 1a. Case management administration and services. (a) The administrative 231.19functions of case management provided to or arranged for a person include:231.20(1) review of eligibility for services;231.21(2) screening;231.22(3) intake;231.23(4) diagnosis;231.24(5) the review and authorization of services based upon an individualized service 231.25plan; and231.26(6) responding to requests for conciliation conferences and appeals according 231.27to section 256.045 made by the person, the person's legal guardian or conservator, or 231.28the parent if the person is a minor. Case management services must be provided by a 231.29public or private agency that is enrolled as a medical assistance provider determined by 231.30the commissioner to meet all of the requirements in the approved federal waiver plans. 231.31Case management services cannot be provided to a recipient by a private agency that has 231.32any financial interest in the provisions of any other services included in the recipient's 231.33coordinated service and support plan.231.34(b) Case management service activities provided to or arranged for a person include231.35services must be provided to each recipient of home and community-based waiver 232.1services and available to those eligible for case management under sections 256B.0621 232.2and 256B.0924, subdivision 4, who choose this service. Case management services for an 232.3eligible person include:232.4(1) development of the individualcoordinated service and support plan;232.5(2) informing the individual or the individual's legal guardian or conservator, or 232.6parent if the person is a minor, of service options;232.7(3) consulting with relevant medical experts or service providers;232.8(4) assisting the person in the identification of potential providers;232.9(5) assisting the person to access services;232.10(6) coordination of services, including coordinating with the person's health care 232.11home or health coordinator, if coordination of long-term care or community supports and 232.12health care is not provided by another service provider;232.13(7) evaluation and monitoring of the services identified in the plan including at least 232.14one face-to-face visit with each person annually by the case manager; and232.15(8) annual reviews of service plans and services provided providing the lead agency 232.16with recommendations for service authorization based upon the individual's needs 232.17identified in the support plan within ten working days after receiving the community 232.18support plan from the certified assessor under section 256B.0911.232.19(c) Case management administration and service activities that are provided to the 232.20person with a developmental disability shall be provided directly by county agencies or 232.21under contract a public or private agency that is enrolled as a medical assistance provider 232.22determined by the commissioner to meet all of the requirements in section 256B.0621, 232.23subdivision 5, paragraphs (a) and (b), clauses (1) to (5), and has no financial interest in the 232.24provision of any other services to the person choosing case management service.232.25(d) Case managers are responsible for the administrative duties and service 232.26provisions listed in paragraphs (a) and (b). Case managers shall collaborate with 232.27consumers, families, legal representatives, and relevant medical experts and service 232.28providers in the development and annual review of the individualized service and 232.29habilitation plans.232.30(e) The Department of Human Services shall offer ongoing education in case 232.31management to case managers. Case managers shall receive no less than ten hours of case 232.32management education and disability-related training each year.232.33(f) Persons eligible for home and community-based waiver services may choose a 232.34case management service provider from among the public or private vendors enrolled 232.35according to paragraph (d).233.1(g) For persons eligible for case management under section 256B.0924, and 233.2Minnesota Rules, parts 9525.0004 to 9525.0036, the county or lead agency shall designate 233.3the case management service provider.233.4EFFECTIVE DATE.This section is effective January 1, 2013, except subdivision 233.51a, paragraph (b), clause (6), is effective July 1, 2011.233.6    Sec. 24. Minnesota Statutes 2010, section 256B.092, subdivision 1b, is amended to 233.7read:233.8    Subd. 1b. Individual Coordinated service and support plan.The individualEach 233.9recipient of case management services and any legal representative shall be provided a 233.10written copy of the coordinated service  and support plan must, which:233.11(1) includeis developed within ten working days after the case management service 233.12receives the community support plan from the certified assessor under section 256B.0911;233.13(2) includes the results of the assessment information on the person's need for 233.14service, including identification of service needs that will be or that are met by the person's 233.15relatives, friends, and others, as well as community services used by the general public;233.16(3) reasonably assures the health, safety, and welfare of the recipient;233.17(2) identify(4) identifies the person's preferences for services as stated by the person, 233.18the person's legal guardian or conservator, or the parent if the person is a minor;233.19(5) provides for an informed choice, as defined in section 256B.77, subdivision 2, 233.20paragraph (o), of service and support providers;233.21(3) identify(6) identifies long- and short-range goals for the person;233.22(4) identify (7) identifies specific services and the amount and frequency of the 233.23services to be provided to the person based on assessed needs, preferences, and available 233.24resources. The individual service plan shall also specify other services the person needs 233.25that are not available, and other services the person needs that are not available. The 233.26individual coordinated service and support plan shall also specify service outcomes and 233.27the provider's responsibility to monitor the achievement of the service outcomes;233.28(5) identify (8) identifies the need for an individual programindividual's provider 233.29plan to be developed by the provider according to the respective state and federal licensing 233.30and certification standards, and additional assessments to be completed or arranged by the 233.31provider after service initiation;233.32(6) identify (9) identifies provider responsibilities to implement and make 233.33recommendations for modification to the individualcoordinated service and support plan;233.34(7) include(10) includes notice of the right to have assessments completed and 233.35service plans developed within specified time periods, the right to appeal action or 234.1inaction, and the right to request a conciliation conference or a hearing an appeal under 234.2section 
         256.045;234.3(8) be (11) is agreed upon and signed by the person, the person's legal guardian 234.4or conservator, or the parent if the person is a minor, and the authorized county 234.5representative; and234.6(9) be (12) is reviewed by a health professional if the person has overriding medical 234.7needs that impact the delivery of services.234.8Service planning formats developed for interagency planning such as transition, 234.9vocational, and individual family service plans may be substituted for service planning 234.10formats developed by county agencies.234.11EFFECTIVE DATE.This section is effective January 1, 2013.234.12    Sec. 25. Minnesota Statutes 2010, section 256B.092, subdivision 1e, is amended to 234.13read:234.14    Subd. 1e. Case management service monitoring, coordination, and evaluation, 234.15and monitoring of services duties. (a) If the individualcoordinated service and support 234.16plan identifies the need for individual programprovider plans for authorized services, 234.17the case managermanagement service provider shall assure that individual programthe 234.18individual provider plans are developed by the providers according to clauses (2) to (5). 234.19The providers shall assure that the individual programprovider plans:234.20(1) are developed according to the respective state and federal licensing and 234.21certification requirements;234.22(2) are designed to achieve the goals of the individual service plan;234.23(3) are consistent with other aspects of the individualcoordinated service and 234.24support plan;234.25(4) assure the health and safety of the person; and234.26(5) are developed with consistent and coordinated approaches to services and service 234.27outcomes among the various service providers.234.28(b) The case managermanagement service provider shall monitor the provision of 234.29services:234.30(1) to assure that the individual service plan is being followed according to 234.31paragraph (a);234.32(2) to identify any changes or modifications that might be needed in the individual 234.33service plan, including changes resulting from recommendations of current service 234.34providers;235.1(3) to determine if the person's legal rights are protected, and if not, notify the 235.2person's legal guardian or conservator, or the parent if the person is a minor, protection 235.3services, or licensing agencies as appropriate; and235.4(4) to determine if the person, the person's legal guardian or conservator, or the 235.5parent if the person is a minor, is satisfied with the services provided.235.6(c) If the provider fails to develop or carry out the individual program provider plan 235.7according to paragraph (a), the case manager shall notify the person's legal guardian or 235.8conservator, or the parent if the person is a minor, the provider, the respective licensing 235.9and certification agencies, and the county board where the services are being provided. In 235.10addition, the case manager shall identify other steps needed to assure the person receives 235.11the services identified in the individualcoordinated service and support plan.235.12EFFECTIVE DATE.This section is effective January 1, 2012.235.13    Sec. 26. Minnesota Statutes 2010, section 256B.092, subdivision 1g, is amended to 235.14read:235.15    Subd. 1g. Conditions not requiring development of individuala coordinated 235.16service and support plan. Unless otherwise required by federal law, the county agency is 235.17not required to complete an individual a coordinated service and support plan as defined in 235.18subdivision 1b for:235.19(1) persons whose families are requesting respite care for their family member who 235.20resides with them, or whose families are requesting a family support grant and are not 235.21requesting purchase or arrangement of habilitative services; and235.22(2) persons with developmental disabilities, living independently without authorized 235.23services or receiving funding for services at a rehabilitation facility as defined in section 235.24268A.01, subdivision 6
         , and not in need of or requesting additional services.235.25EFFECTIVE DATE.This section is effective January 1, 2012.235.26    Sec. 27. Minnesota Statutes 2010, section 256B.092, subdivision 3, is amended to read:235.27    Subd. 3. Authorization and termination of services.County agency case 235.28managers Lead agencies, under rules of the commissioner, shall authorize and terminate 235.29services of community and regional treatment center providers according to individual235.30coordinated  service and support plans. Services provided to persons with developmental 235.31disabilities may only be authorized and terminated by case managers according to (1) 235.32rules of the commissioner and (2) the individualcoordinated service and support plan as 235.33defined in subdivision 1b. Medical assistance services not needed shall not be authorized 236.1by county agencies or funded by the commissioner. When purchasing or arranging for 236.2unlicensed respite care services for persons with overriding health needs, the county 236.3agency shall seek the advice of a health care professional in assessing provider staff 236.4training needs and skills necessary to meet the medical needs of the person.236.5EFFECTIVE DATE.This section is effective January 1, 2012.236.6    Sec. 28. Minnesota Statutes 2010, section 256B.092, subdivision 8, is amended to read:236.7    Subd. 8. Screening teamAdditional certified assessor duties. The screening team236.8certified assessor shall:236.9(1) review diagnostic data;236.10(2) review health, social, and developmental assessment data using a uniform 236.11screeningcomprehensive assessment tool specified by the commissioner;236.12(3) identify the level of services appropriate to maintain the person in the most 236.13normal and least restrictive setting that is consistent with the person's treatment needs;236.14(4) identify other noninstitutional public assistance or social service that may prevent 236.15or delay long-term residential placement;236.16(5) assess whether a person is in need of long-term residential care;236.17(6) make recommendations regarding placementservices and payment for: (i) social 236.18service or public assistance support, or both, to maintain a person in the person's own home 236.19or other place of residence; (ii) training and habilitation service, vocational rehabilitation, 236.20and employment training activities; (iii) community residential placement services; (iv) 236.21regional treatment center placement; or (v) (iv)  a home and community-based service 236.22alternative to community residential placement or regional treatment center placement;236.23(7) evaluate the availability, location, and quality of the services listed in clause 236.24(6), including the impact of placement alternativesservices and supports options on the 236.25person's ability to maintain or improve existing patterns of contact and involvement with 236.26parents and other family members;236.27(8) identify the cost implications of recommendations in clause (6) and provide 236.28written notice of the annual and monthly average authorized amount to be spent for 236.29services for the recipient;236.30(9) make recommendations to a court as may be needed to assist the court in making 236.31decisions regarding commitment of persons with developmental disabilities; and236.32(10) inform the person and the person's legal guardian or conservator, or the parent if 236.33the person is a minor, that appeal may be made to the commissioner pursuant to section 236.34256.045
         .237.1EFFECTIVE DATE.This section is effective January 1, 2012.237.2    Sec. 29. [256B.0961] STATE QUALITY ASSURANCE, QUALITY 237.3IMPROVEMENT, AND LICENSING SYSTEM.237.4    Subdivision 1.Scope.(a) In order to improve the quality of services provided to 237.5Minnesotans with disabilities and to meet the requirements of the federally approved 237.6home and community-based waivers under section 1915c of the Social Security Act, a 237.7State Quality Assurance, Quality Improvement, and Licensing System for Minnesotans 237.8receiving disability services is enacted. This system is a partnership between the 237.9Department of Human Services and the State Quality Council established under 237.10subdivision 3.237.11    (b) This system is a result of the recommendations from the Department of Human 237.12Services' licensing and alternative quality assurance study mandated under Laws 2005, 237.13First Special Session chapter 4, article 7, section 57, and presented to the legislature 237.14in February 2007.237.15    (c) The disability services eligible under this section include:237.16    (1) the home and community-based services waiver programs for persons with 237.17developmental disabilities under section 256B.092, subdivision 4, or section 256B.49, 237.18including traumatic brain injuries and services for those who qualify for nursing facility 237.19level of care or hospital facility level of care;237.20    (2) home care services under section 256B.0651;237.21    (3) family support grants under section 252.32;237.22    (4) consumer support grants under section 256.476;237.23    (5) semi-independent living services under section 252.275; and237.24    (6) services provided through an intermediate care facility for the developmentally 237.25disabled.237.26    (d) For purposes of this section, the following definitions apply:237.27    (1) "commissioner" means the commissioner of human services;237.28    (2) "council" means the State Quality Council under subdivision 3;237.29    (3) "Quality Assurance Commission" means the commission under section 237.30256B.0951; and237.31    (4) "system" means the State Quality Assurance, Quality Improvement and 237.32Licensing System under this section.237.33    Subd. 2.Duties of the commissioner of human services.(a) The commissioner of 237.34human services shall establish the State Quality Council under subdivision 3.238.1    (b) The commissioner shall initially delegate authority to perform licensing 238.2functions and activities according to section 245A.16 to a host county in Region 10. The 238.3commissioner must not license or reimburse a participating facility, program, or service 238.4located in Region 10 if the commissioner has received notification from the host county 238.5that the facility, program, or service has failed to qualify for licensure.238.6    (c) The commissioner may conduct random licensing inspections based on outcomes 238.7adopted under section 256B.0951, subdivision 3, at facilities or programs, and of services 238.8eligible under this section. The role of the random inspections is to verify that the system 238.9protects the safety and well-being of persons served and maintains the availability of 238.10high-quality services for persons with disabilities.238.11    (d) The commissioner shall ensure that the federal home and community-based 238.12waiver requirements are met and that incidents that may have jeopardized safety and health 238.13or violated services-related assurances, civil and human rights, and other protections 238.14designed to prevent abuse, neglect, and exploitation, are reviewed, investigated, and 238.15acted upon in a timely manner.238.16    (e) The commissioner shall seek a federal waiver by July 1, 2012 to allow 238.17intermediate care facilities for persons with developmental disabilities to participate in 238.18this system.238.19    Subd. 3.State Quality Council.(a) There is hereby created a State Quality 238.20Council which must define regional quality councils, and carry out a community-based, 238.21person-directed quality review component, and a comprehensive system for effective 238.22incident reporting, investigation, analysis, and follow-up.238.23    (b) By August 1, 2011, the commissioner of human services shall appoint the 238.24members of the initial State Quality Council. Members shall include representatives 238.25from the following groups:238.26    (1) disability service recipients and their family members; 238.27    (2) during the first two years of the State Quality Council, there must be at least three 238.28members from the Region 10 stakeholders. As regional quality councils are formed under 238.29subdivision 4, each regional quality council shall appoint one member;238.30    (3) disability service providers;238.31    (4) disability advocacy groups; and238.32    (5) county human services agencies and staff from the Departments of Human 238.33Services and Health, and Ombudsman for Mental Health and Developmental Disabilities.238.34    (c) Members of the council who do not receive a salary or wages from an employer 238.35for time spent on council duties may receive a per diem payment when performing council 238.36duties and functions.239.1    (d) The State Quality Council shall:239.2    (1) assist the Departments of Human Services and Health in fulfilling federally 239.3mandated obligations by monitoring disability service quality and quality assurance and 239.4improvement practices in Minnesota; and239.5    (2) establish state quality improvement priorities with methods for achieving results 239.6and provide an annual report to the legislative committees with jurisdiction over policy 239.7and funding of disability services on the outcomes, improvement priorities, and activities 239.8undertaken by the commission during the previous state fiscal year.239.9    (e) The State Quality Council, in partnership with the commissioner, shall:239.10    (1) approve and direct implementation of the community-based, person-directed 239.11system established in this section;239.12    (2) recommend an appropriate method of funding this system, and determine the 239.13feasibility of the use of Medicaid, licensing fees, as well as other possible funding options;239.14    (3) approve measurable outcomes in the areas of health and safety, consumer 239.15evaluation, education and training, providers, and systems;239.16    (4) establish variable licensure periods not to exceed three years based on outcomes 239.17achieved; and239.18    (5) in cooperation with the Quality Assurance Commission, design a transition plan 239.19for licensed providers from Region 10 into the alternative licensing system by July 1, 2013.239.20    (f) The State Quality Council shall notify the commissioner of human services that a 239.21facility, program, or service has been reviewed by quality assurance team members under 239.22subdivision 4, paragraph (b), clause (13), and qualifies for a license.239.23    (g) The State Quality Council, in partnership with the commissioner, shall establish 239.24an ongoing review process for the system. The review shall take into account the 239.25comprehensive nature of the system which is designed to evaluate the broad spectrum of 239.26licensed and unlicensed entities that provide services to persons with disabilities. The 239.27review shall address efficiencies and effectiveness of the system.239.28    (h) The State Quality Council may recommend to the commissioner certain 239.29variances from the standards governing licensure of programs for persons with disabilities 239.30in order to improve the quality of services so long as the recommended variances do 239.31not adversely affect the health or safety of persons being served or compromise the 239.32qualifications of staff to provide services.239.33    (i) The safety standards, rights, or procedural protections referenced under 239.34subdivision 2, paragraph (c), shall not be varied. The State Quality Council may make 239.35recommendations to the commissioner or to the legislature in the report required under 240.1paragraph (c) regarding alternatives or modifications to the safety standards, rights, or 240.2procedural protections referenced under subdivision 2, paragraph (c).240.3    (j) The State Quality Council may hire staff to perform the duties assigned in this 240.4subdivision.240.5    Subd. 4.Regional quality councils.(a) The commissioner shall establish, as 240.6selected by the State Quality Council, regional quality councils of key stakeholders, 240.7including regional representatives of:240.8    (1) disability service recipients and their family members;240.9    (2) disability service providers;240.10    (3) disability advocacy groups; and240.11    (4) county human services agencies and staff from the Departments of Human 240.12Services, and Health, and Ombudsman for Mental Health and Developmental Disabilities.240.13    (b) Each regional quality council shall:240.14    (1) direct and monitor the community-based, person-directed quality assurance 240.15system in this section;240.16    (2) approve a training program for quality assurance team members under clause 240.17(13);240.18    (3) review summary reports from quality assurance team reviews and make 240.19recommendations to the State Quality Council regarding program licensure;240.20    (4) make recommendations to the State Quality Council regarding the system;240.21    (5) resolve complaints between the quality assurance teams, counties, providers, 240.22persons receiving services, their families, and legal representatives;240.23    (6) analyze and review quality outcomes and critical incident data reporting 240.24incidents of life safety concerns immediately to the Department of Human Services 240.25licensing division;240.26    (7) provide information and training programs for persons with disabilities and their 240.27families and legal representatives on service options and quality expectations;240.28    (8) disseminate information and resources developed to other regional quality 240.29councils;240.30    (9) respond to state-level priorities;240.31    (10) establish regional priorities for quality improvement;240.32    (11) submit an annual report to the State Quality Council on the status, outcomes, 240.33improvement priorities, and activities in the region;240.34    (12) choose a representative to participate on the State Quality Council and assume 240.35other responsibilities consistent with the priorities of the State Quality Council; and241.1    (13) recruit, train, and assign duties to members of quality assurance teams, taking 241.2into account the size of the service provider, the number of services to be reviewed, 241.3the skills necessary for the team members to complete the process, and ensure that no 241.4team member has a financial, personal, or family relationship with the facility, program, 241.5or service being reviewed or with anyone served at the facility, program, or service. 241.6Quality assurance teams must be comprised of county staff, persons receiving services 241.7or the person's families, legal representatives, members of advocacy organizations, 241.8providers, and other involved community members. Team members must complete 241.9the training program approved by the regional quality council and must demonstrate 241.10performance-based competency. Team members may be paid a per diem and reimbursed 241.11for expenses related to their participation in the quality assurance process.241.12    (c) The commissioner shall monitor the safety standards, rights, and procedural 241.13protections for the monitoring of psychotropic medications and those identified under 241.14sections 245.825; 245.91 to 245.97; 245A.09, subdivision 2, paragraph (c), clauses (2) 241.15and (5); 245A.12; 245A.13; 252.41, subdivision 9; 256B.092, subdivision 1b, clause 241.16(7); 626.556; and 626.557.241.17    (d) The regional quality councils may hire staff to perform the duties assigned in 241.18this subdivision.241.19    (e) The regional quality councils may charge fees for their services.241.20    (f) The quality assurance process undertaken by a regional quality council consists of 241.21an evaluation by a quality assurance team of the facility, program, or service. The process 241.22must include an evaluation of a random sample of persons served. The sample must be 241.23representative of each service provided. The sample size must be at least five percent but 241.24not less than two persons served. All persons must be given the opportunity to be included 241.25in the quality assurance process in addition to those chosen for the random sample.241.26    (g) A facility, program, or service may contest a licensing decision of the regional 241.27quality council as permitted under chapter 245A.241.28    Subd. 5.Annual survey of service recipients.The commissioner, in consultation 241.29with the State Quality Council, shall conduct an annual independent statewide survey 241.30of service recipients, randomly selected, to determine the effectiveness and quality 241.31of disability services. The survey must be consistent with the system performance 241.32expectations of the Centers for Medicare and Medicaid Services (CMS) Quality 241.33Framework. The survey must analyze whether desired outcomes for persons with different 241.34demographic, diagnostic, health, and functional needs, who are receiving different types 241.35of services in different settings and with different costs, have been achieved. Annual 242.1statewide and regional reports of the results must be published and used to assist regions, 242.2counties, and providers to plan and measure the impact of quality improvement activities.242.3    Subd. 6.Mandated reporters.Members of the State Quality Council under 242.4subdivision 3, the regional quality councils under subdivision 4, and quality assurance 242.5team members under subdivision 4, paragraph (b), clause (13), are mandated reporters as 242.6defined in sections 626.556, subdivision 3, and 626.5572, subdivision 16.242.7EFFECTIVE DATE.(a) Subdivisions 1 to 6 are effective July 1, 2011.242.8    (b) The jurisdictions of the regional quality councils in subdivision 4 must be 242.9defined, with implementation dates, by July 1, 2012. During the biennium beginning July 242.101, 2011, the Quality Assurance Commission shall continue to implement the alternative 242.11licensing system under this section.242.12    Sec. 30. Minnesota Statutes 2010, section 256B.19, is amended by adding a 242.13subdivision to read:242.14    Subd. 2d.Obligation of local agency to process medical assistance applications 242.15within established timelines.(a) Except as provided in paragraph (b), when an individual 242.16submits an application for medical assistance and the applicant's eligibility is based on 242.17disability or on being age 65 or older, the county must determine the applicant's eligibility 242.18and mail a notice of its decision to the applicant within:242.19(1) 60 days from the date of the application for an individual whose eligibility 242.20is based on disability; or242.21(2) 45 days from the date of the application for an individual whose eligibility is 242.22based on being age 65 or older.242.23(b) The county must determine eligibility and mail a notice of its decision within the 242.24time frames stated in paragraph (a), except in the following circumstances: 242.25(1) the county cannot make a determination because, despite reasonable efforts by 242.26the county to communicate what is required, the applicant or an examining physician 242.27delays or fails to take a required action; or 242.28(2) there is an administrative or other emergency beyond the county's control.  For 242.29purposes of this clause, a staffing shortage does not constitute an emergency beyond 242.30the county's control.242.31For the events in either clause (1) or (2), the county must document in the applicant's 242.32case record the reason for delaying beyond the established time frames. 242.33(c) The county must not use the time frames established in paragraph (a) as a waiting 242.34period before determining eligibility or as a reason for denying eligibility because it has 242.35not determined eligibility within the established time frames.243.1(d) Effective July 1, 2011, unless one of the exceptions listed under paragraph (b) 243.2applies, if a county fails to comply with paragraph (a) and the applicant ultimately is 243.3determined to be eligible for medical assistance, the county is responsible for the entire 243.4cost of medical assistance services provided to the applicant by a nursing facility and not 243.5paid for by federal funds, from and including the first date of eligibility through the date 243.6on which the county mails written notice of its decision on the application. The applicable 243.7facility will bill and receive payment directly from the commissioner in customary 243.8fashion, and the commissioner shall deduct any obligation incurred under this paragraph 243.9from the amount due to the local agency under subdivision 1. 243.10(e) This subdivision supersedes subdivision 1, clause (2), if both apply to an 243.11applicant.243.12    Sec. 31. Minnesota Statutes 2010, section 256B.431, subdivision 2r, is amended to 243.13read:243.14    Subd. 2r. Payment restrictions on leave days.(a) Effective July 1, 1993, the 243.15commissioner shall limit payment for leave days in a nursing facility to 79 percent of that 243.16nursing facility's total payment rate for the involved resident. 243.17(b) For services rendered on or after July 1, 2003, for facilities reimbursed under this 243.18section or section 
         256B.434, the commissioner shall limit payment for leave days in a 243.19nursing facility to 60 percent of that nursing facility's total payment rate for the involved 243.20resident.243.21(c) For services rendered on or after July 1, 2011, for facilities reimbursed under 243.22this chapter, the commissioner shall limit payment for leave days in a nursing facility 243.23to 30 percent of that nursing facility's total payment rate for the involved resident, and 243.24shall allow this payment only when the occupancy of the nursing facility, inclusive of 243.25bed hold days, is equal to or greater than 96 percent, notwithstanding Minnesota Rules, 243.26part 9505.0415.243.27    Sec. 32. Minnesota Statutes 2010, section 256B.431, is amended by adding a 243.28subdivision to read:243.29    Subd. 44.Property rate increase for a facility in Bloomington effective 243.30November 1, 2010.Notwithstanding any other law to the contrary, money available for 243.31moratorium projects under section 144A.073, subdivision 11, shall be used, effective 243.32November 1, 2010, to fund an approved moratorium exception project for a nursing 243.33facility in Bloomington licensed for 137 beds as of November 1, 2010, up to a total 243.34property rate adjustment of $19.33.244.1    Sec. 33. Minnesota Statutes 2010, section 256B.434, subdivision 4, is amended to read:244.2    Subd. 4. Alternate rates for nursing facilities. (a) For nursing facilities which 244.3have their payment rates determined under this section rather than section 
         256B.431, the 244.4commissioner shall establish a rate under this subdivision. The nursing facility must enter 244.5into a written contract with the commissioner.244.6    (b) A nursing facility's case mix payment rate for the first rate year of a facility's 244.7contract under this section is the payment rate the facility would have received under 244.8section 
         256B.431.244.9    (c) A nursing facility's case mix payment rates for the second and subsequent years 244.10of a facility's contract under this section are the previous rate year's contract payment 244.11rates plus an inflation adjustment and, for facilities reimbursed under this section or 244.12section 
         256B.431, an adjustment to include the cost of any increase in Health Department 244.13licensing fees for the facility taking effect on or after July 1, 2001. The index for the 244.14inflation adjustment must be based on the change in the Consumer Price Index-All Items 244.15(United States City average) (CPI-U) forecasted by the commissioner of management and 244.16budget's national economic consultant, as forecasted in the fourth quarter of the calendar 244.17year preceding the rate year. The inflation adjustment must be based on the 12-month 244.18period from the midpoint of the previous rate year to the midpoint of the rate year for 244.19which the rate is being determined. For the rate years beginning on July 1, 1999, July 1, 244.202000, July 1, 2001, July 1, 2002, July 1, 2003, July 1, 2004, July 1, 2005, July 1, 2006, 244.21July 1, 2007, July 1, 2008, October 1, 2009, and October 1, 2010, October 1, 2011, and 244.22October 1, 2012. this paragraph shall apply only to the property-related payment rate, 244.23except that adjustments to include the cost of any increase in Health Department licensing 244.24fees taking effect on or after July 1, 2001, shall be provided. For the rate years beginning 244.25on October 1, 2011, and October 1, 2012, the rate adjustment under this paragraph shall 244.26be suspended. Beginning in 2005, adjustment to the property payment rate under this 244.27section and section 
         256B.431 shall be effective on October 1. In determining the amount 244.28of the property-related payment rate adjustment under this paragraph, the commissioner 244.29shall determine the proportion of the facility's rates that are property-related based on the 244.30facility's most recent cost report.244.31    (d) The commissioner shall develop additional incentive-based payments of up to 244.32five percent above a facility's operating payment rate for achieving outcomes specified 244.33in a contract. The commissioner may solicit contract amendments and implement those 244.34which, on a competitive basis, best meet the state's policy objectives. The commissioner 244.35shall limit the amount of any incentive payment and the number of contract amendments 244.36under this paragraph to operate the incentive payments within funds appropriated for this 245.1purpose. The contract amendments may specify various levels of payment for various 245.2levels of performance. Incentive payments to facilities under this paragraph may be in the 245.3form of time-limited rate adjustments or onetime supplemental payments. In establishing 245.4the specified outcomes and related criteria, the commissioner shall consider the following 245.5state policy objectives:245.6    (1) successful diversion or discharge of residents to the residents' prior home or other 245.7community-based alternatives;245.8    (2) adoption of new technology to improve quality or efficiency;245.9    (3) improved quality as measured in the Nursing Home Report Card;245.10    (4) reduced acute care costs; and245.11    (5) any additional outcomes proposed by a nursing facility that the commissioner 245.12finds desirable.245.13    (e) Notwithstanding the threshold in section 
         256B.431, subdivision 16, facilities that 245.14take action to come into compliance with existing or pending requirements of the life 245.15safety code provisions or federal regulations governing sprinkler systems must receive 245.16reimbursement for the costs associated with compliance if all of the following conditions 245.17are met:245.18    (1) the expenses associated with compliance occurred on or after January 1, 2005, 245.19and before December 31, 2008;245.20    (2) the costs were not otherwise reimbursed under subdivision 4f or section 245.21144A.071
          or 
         144A.073; and245.22    (3) the total allowable costs reported under this paragraph are less than the minimum 245.23threshold established under section 
         256B.431, subdivision 15, paragraph (e), and 245.24subdivision 16.245.25The commissioner shall use money appropriated for this purpose to provide to qualifying 245.26nursing facilities a rate adjustment beginning October 1, 2007, and ending September 30, 245.272008. Nursing facilities that have spent money or anticipate the need to spend money 245.28to satisfy the most recent life safety code requirements by (1) installing a sprinkler 245.29system or (2) replacing all or portions of an existing sprinkler system may submit to the 245.30commissioner by June 30, 2007, on a form provided by the commissioner the actual 245.31costs of a completed project or the estimated costs, based on a project bid, of a planned 245.32project. The commissioner shall calculate a rate adjustment equal to the allowable 245.33costs of the project divided by the resident days reported for the report year ending 245.34September 30, 2006. If the costs from all projects exceed the appropriation for this 245.35purpose, the commissioner shall allocate the money appropriated on a pro rata basis 245.36to the qualifying facilities by reducing the rate adjustment determined for each facility 246.1by an equal percentage. Facilities that used estimated costs when requesting the rate 246.2adjustment shall report to the commissioner by January 31, 2009, on the use of this 246.3money on a form provided by the commissioner. If the nursing facility fails to provide 246.4the report, the commissioner shall recoup the money paid to the facility for this purpose. 246.5If the facility reports expenditures allowable under this subdivision that are less than 246.6the amount received in the facility's annualized rate adjustment, the commissioner shall 246.7recoup the difference.246.8    Sec. 34. Minnesota Statutes 2010, section 256B.437, subdivision 6, is amended to read:246.9    Subd. 6. Planned closure rate adjustment. (a) The commissioner of human 246.10services shall calculate the amount of the planned closure rate adjustment available under 246.11subdivision 3, paragraph (b), for up to 5,140 beds according to clauses (1) to (4):246.12(1) the amount available is the net reduction of nursing facility beds multiplied 246.13by $2,080;246.14(2) the total number of beds in the nursing facility or facilities receiving the planned 246.15closure rate adjustment must be identified;246.16(3) capacity days are determined by multiplying the number determined under 246.17clause (2) by 365; and246.18(4) the planned closure rate adjustment is the amount available in clause (1), divided 246.19by capacity days determined under clause (3).246.20(b) A planned closure rate adjustment under this section is effective on the first day 246.21of the month following completion of closure of the facility designated for closure in the 246.22application and becomes part of the nursing facility's total operating payment rate.246.23(c) Applicants may use the planned closure rate adjustment to allow for a property 246.24payment for a new nursing facility or an addition to an existing nursing facility or as an 246.25operating payment rate adjustment. Applications approved under this subdivision are 246.26exempt from other requirements for moratorium exceptions under section 
         144A.073, 246.27subdivisions 2 and 3.246.28(d) Upon the request of a closing facility, the commissioner must allow the facility a 246.29closure rate adjustment as provided under section 
         144A.161, subdivision 10.246.30(e) A facility that has received a planned closure rate adjustment may reassign it 246.31to another facility that is under the same ownership at any time within three years of its 246.32effective date. The amount of the adjustment shall be computed according to paragraph (a).246.33(f) If the per bed dollar amount specified in paragraph (a), clause (1), is increased, 246.34the commissioner shall recalculate planned closure rate adjustments for facilities that 246.35delicense beds under this section on or after July 1, 2001, to reflect the increase in the per 247.1bed dollar amount. The recalculated planned closure rate adjustment shall be effective 247.2from the date the per bed dollar amount is increased.247.3(g) For planned closures approved after June 30, 2009, the commissioner of human 247.4services shall calculate the amount of the planned closure rate adjustment available under 247.5subdivision 3, paragraph (b), according to paragraph (a), clauses (1) to (4).247.6(h) Beginning July 16, 2011, the commissioner shall no longer approve planned 247.7closure rate adjustments under this subdivision.247.8    Sec. 35. Minnesota Statutes 2010, section 256B.441, is amended by adding a 247.9subdivision to read:247.10    Subd. 60.Rate increase for low-rate facilities.(a) Effective October 1, 2011, 247.11the commissioner shall adjust the operating payment rates of a nursing facility whose 247.12operating payment rate on September 30, 2011, is greater than the 95th percentile of all 247.13nursing facilities operating payment rates. The commissioner shall:247.14(1) array all operating payment rates in effect on September 30, 2011, at a case-mix 247.15weight equal to 1.00 (DDF) from lowest to highest;247.16(2) remove from the array any nursing facility determined by the commissioner to 247.17be providing specialized care, determined in accordance with criteria in subdivision 51a, 247.18paragraph (b), and any facilities receiving a rate increase under paragraph (c), clause (1);247.19(3) determine the 95th percentile of the array in clause (1);247.20(4) compute a reduction amount not to exceed three percent, if a facility's amount 247.21in clause (1) is greater than the amount computed in clause (3) by subtracting a facility's 247.22DDF rate in clause (1) from the amount computed in clause (3);247.23(5) compute the portion of each facility's DDF operating payment rate that is the 247.24direct care per diem based on the rates in effect on September 30, 2011; and247.25(6) determine the change for all other case-mix levels, by multiplying the amount in 247.26clause (4) by the percentage in clause (5) and by the corresponding case-mix weight for 247.27each care level. Add to this product the non-direct care per diem portion of the amount 247.28in clause (4).247.29(b) The total amount to be saved by the rate reductions will be computed. The 247.30commissioner shall:247.31(1) for each facility receiving a rate change in paragraph (a), multiply each case-mix 247.32level's rate change in paragraph (a), clause (6), by the corresponding case-mix resident 247.33days from the most recent cost report that has been desk audited; and247.34(2) sum all the products computed in clause (1).248.1(c) The amount of total payment reductions computed in paragraph (b) shall be 248.2distributed to the facilities with the lowest DDF operating payment rates determined in 248.3paragraph (a), clause (1). The commissioner shall:248.4(1) for nursing facilities located no more than one-quarter mile from a peer group 248.5with higher limits under either subdivision 50 or 51, give an operating rate adjustment. 248.6The operating payment rates of a lower-limit peer group facility must be adjusted to be 248.7equal to those of the nearest facility in a higher-limit peer group if that facility's RUG rate 248.8with a weight of 1.00 is higher than the lower-limit peer group facility. Peer groups are 248.9those defined in subdivision 30. The nearest facility must be determined by the most 248.10direct driving route;248.11(2) start with the facility or facilities with the lowest DDF operating payment rate 248.12and compute the amount of a rate adjustment needed to make the DDF rate equal to the 248.13DDF of the facility directly below it in the array;248.14(3) compute the rate increases for the other case-mix levels using the amount 248.15computed in clause (2), and the process stated in paragraph (a), clauses (5) and (6);248.16(4) compute the total amount the lowest facilities will receive using the process 248.17described in paragraph (b);248.18(5) compute the running total to be spent at all facilities receiving an increase under 248.19this paragraph by summing each facility's amount computed in clause (4); and 248.20(6) repeat the process in clauses (2) to (5) as long as the amount in clause (5) does 248.21not exceed the amount in paragraph (b), clause (2). In no case shall the DDF operating 248.22payment rate increase determined in clauses (2) to (6) exceed two percent.248.23    Sec. 36. Minnesota Statutes 2010, section 256B.48, subdivision 1, is amended to read:248.24    Subdivision 1. Prohibited practices. A nursing facility is not eligible to receive 248.25medical assistance payments unless it refrains from all of the following:248.26(a) Charging private paying residents rates for similar services which exceed those 248.27which are approved by the state agency for medical assistance recipients as determined by 248.28the prospective desk audit rate, except under the following circumstances:248.29(1) the nursing facility may:248.30(1)(i) charge private paying residents a higher rate for a private room,; and 248.31(2)(ii) charge for special services which are not included in the daily rate if medical 248.32assistance residents are charged separately at the same rate for the same services in 248.33addition to the daily rate paid by the commissioner.;249.1(2) effective July 1, 2011, through September 30, 2012, nursing facilities may charge 249.2private paying residents rates up to two percent higher than the allowable payment rate 249.3determined by the commissioner for the RUGS group currently assigned to the resident;249.4(3) effective October 1, 2012, through September 30, 2013, nursing facilities 249.5may charge private paying residents rates up to four percent higher than the allowable 249.6payment rate determined by the commissioner for the RUGS group currently assigned 249.7to the resident;249.8(4) effective October 1, 2013, through September 30, 2014, nursing facilities may 249.9charge private paying residents rates up to six percent higher than the allowable payment 249.10rate determined by the commissioner for the RUGS group currently assigned to the 249.11resident;249.12(5) effective October 1, 2014, nursing facilities may charge private paying 249.13residents up to eight percent higher than the allowable payment rate determined by the 249.14commissioner for the RUGS group currently assigned to the resident; and249.15(6) the higher private pay charges allowed in this paragraph shall be limited to actual 249.16costs per resident day, as determined by the commissioner, based on data provided in the 249.17statistical and cost report in section 256B.441.249.18Nothing in this section precludes a nursing facility from charging a rate allowable 249.19under the facility's single room election option under Minnesota Rules, part 9549.0060, 249.20subpart 11. Services covered by the payment rate must be the same regardless of payment 249.21source. Special services, if offered, must be available to all residents in all areas of the 249.22nursing facility and charged separately at the same rate. Residents are free to select 249.23or decline special services. Special services must not include services which must be 249.24provided by the nursing facility in order to comply with licensure or certification standards 249.25and that if not provided would result in a deficiency or violation by the nursing facility. 249.26Services beyond those required to comply with licensure or certification standards must 249.27not be charged separately as a special service if they were included in the payment rate for 249.28the previous reporting year. A nursing facility that charges a private paying resident a rate 249.29in violation of this clause is subject to an action by the state of Minnesota or any of its 249.30subdivisions or agencies for civil damages. A private paying resident or the resident's legal 249.31representative has a cause of action for civil damages against a nursing facility that charges 249.32the resident rates in violation of this clause. The damages awarded shall include three 249.33times the payments that result from the violation, together with costs and disbursements, 249.34including reasonable attorneys' fees or their equivalent. A private paying resident or the 249.35resident's legal representative, the state, subdivision or agency, or a nursing facility may 249.36request a hearing to determine the allowed rate or rates at issue in the cause of action. 250.1Within 15 calendar days after receiving a request for such a hearing, the commissioner 250.2shall request assignment of an administrative law judge under sections 
         14.48 to 
         14.56 to 250.3conduct the hearing as soon as possible or according to agreement by the parties. The 250.4administrative law judge shall issue a report within 15 calendar days following the close 250.5of the hearing. The prohibition set forth in this clause shall not apply to facilities licensed 250.6as boarding care facilities which are not certified as skilled or intermediate care facilities 250.7level I or II for reimbursement through medical assistance. 250.8(b)(1) Charging, soliciting, accepting, or receiving from an applicant for admission 250.9to the facility, or from anyone acting in behalf of the applicant, as a condition of 250.10admission, expediting the admission, or as a requirement for the individual's continued 250.11stay, any fee, deposit, gift, money, donation, or other consideration not otherwise required 250.12as payment under the state plan. For residents on medical assistance, medical assistance 250.13payment according to the state plan must be accepted as payment in full for continued 250.14stay, except where otherwise provided for under statute;250.15(2) requiring an individual, or anyone acting in behalf of the individual, to loan 250.16any money to the nursing facility;250.17(3) requiring an individual, or anyone acting in behalf of the individual, to promise 250.18to leave all or part of the individual's estate to the facility; or250.19(4) requiring a third-party guarantee of payment to the facility as a condition of 250.20admission, expedited admission, or continued stay in the facility.250.21Nothing in this paragraph would prohibit discharge for nonpayment of services in 250.22accordance with state and federal regulations.250.23(c) Requiring any resident of the nursing facility to utilize a vendor of health care 250.24services chosen by the nursing facility. A nursing facility may require a resident to use 250.25pharmacies that utilize unit dose packing systems approved by the Minnesota Board of 250.26Pharmacy, and may require a resident to use pharmacies that are able to meet the federal 250.27regulations for safe and timely administration of medications such as systems with specific 250.28number of doses, prompt delivery of medications, or access to medications on a 24-hour 250.29basis. Notwithstanding the provisions of this paragraph, nursing facilities shall not restrict 250.30a resident's choice of pharmacy because the pharmacy utilizes a specific system of unit 250.31dose drug packing.250.32(d) Providing differential treatment on the basis of status with regard to public 250.33assistance.250.34(e) Discriminating in admissions, services offered, or room assignment on the 250.35basis of status with regard to public assistance or refusal to purchase special services. 251.1Discrimination in admissions discrimination, services offered, or room assignment shall 251.2include, but is not limited to:251.3(1) basing admissions decisions upon assurance by the applicant to the nursing 251.4facility, or the applicant's guardian or conservator, that the applicant is neither eligible for 251.5nor will seekinformation or assurances regarding current or future eligibility for public 251.6assistance for payment of nursing facility care costs; and251.7(2) engaging in preferential selection from waiting lists based on an applicant's 251.8ability to pay privately or an applicant's refusal to pay for a special service.251.9The collection and use by a nursing facility of financial information of any applicant 251.10pursuant to a preadmission screening program established by law shall not raise an 251.11inference that the nursing facility is utilizing that information for any purpose prohibited 251.12by this paragraph.251.13(f) Requiring any vendor of medical care as defined by section 
         256B.02, subdivision 251.147
         , who is reimbursed by medical assistance under a separate fee schedule, to pay any 251.15amount based on utilization or service levels or any portion of the vendor's fee to the 251.16nursing facility except as payment for renting or leasing space or equipment or purchasing 251.17support services from the nursing facility as limited by section 
         256B.433. All agreements 251.18must be disclosed to the commissioner upon request of the commissioner. Nursing 251.19facilities and vendors of ancillary services that are found to be in violation of this provision 251.20shall each be subject to an action by the state of Minnesota or any of its subdivisions or 251.21agencies for treble civil damages on the portion of the fee in excess of that allowed by 251.22this provision and section 
         256B.433. Damages awarded must include three times the 251.23excess payments together with costs and disbursements including reasonable attorney's 251.24fees or their equivalent. 251.25(g) Refusing, for more than 24 hours, to accept a resident returning to the same 251.26bed or a bed certified for the same level of care, in accordance with a physician's order 251.27authorizing transfer, after receiving inpatient hospital services.251.28(h) For a period not to exceed 180 days, the commissioner may continue to make 251.29medical assistance payments to a nursing facility or boarding care home which is in 251.30violation of this section if extreme hardship to the residents would result. In these cases 251.31the commissioner shall issue an order requiring the nursing facility to correct the violation. 251.32The nursing facility shall have 20 days from its receipt of the order to correct the violation. 251.33If the violation is not corrected within the 20-day period the commissioner may reduce 251.34the payment rate to the nursing facility by up to 20 percent. The amount of the payment 251.35rate reduction shall be related to the severity of the violation and shall remain in effect 251.36until the violation is corrected. The nursing facility or boarding care home may appeal the 252.1commissioner's action pursuant to the provisions of chapter 14 pertaining to contested 252.2cases. An appeal shall be considered timely if written notice of appeal is received by the 252.3commissioner within 20 days of notice of the commissioner's proposed action.252.4In the event that the commissioner determines that a nursing facility is not eligible 252.5for reimbursement for a resident who is eligible for medical assistance, the commissioner 252.6may authorize the nursing facility to receive reimbursement on a temporary basis until the 252.7resident can be relocated to a participating nursing facility.252.8Certified beds in facilities which do not allow medical assistance intake on July 1, 252.91984, or after shall be deemed to be decertified for purposes of section 
         144A.071 only. 252.10    Sec. 37. Minnesota Statutes 2010, section 256B.49, subdivision 12, is amended to read:252.11    Subd. 12. Informed choice. Persons who are determined likely to require the 252.12level of care provided in a nursing facility as determined under sections 144.0724, 252.13subdivision 11, and section256B.0911, or a hospital shall be informed of the home and 252.14community-based support alternatives to the provision of inpatient hospital services or 252.15nursing facility services. Each person must be given the choice of either institutional or 252.16home and community-based services using the provisions described in section 
         256B.77, 252.17subdivision 2
         , paragraph (p).252.18    Sec. 38. Minnesota Statutes 2010, section 256B.49, subdivision 13, is amended to read:252.19    Subd. 13. Case management.(a) Each recipient of a home and community-based 252.20waiver under this section shall be provided case management services according to 252.21section 256B.092, subdivisions 1a, 1b, and 1e, by qualified vendors as described in the 252.22federally approved waiver application. The case management service activities provided 252.23will include:252.24    (1) assessing the needs of the individual within 20 working days of a recipient's 252.25request;252.26    (2) developing the written individual service plan within ten working days after the 252.27assessment is completed;252.28    (3) informing the recipient or the recipient's legal guardian or conservator of service 252.29options;252.30    (4) assisting the recipient in the identification of potential service providers;252.31    (5) assisting the recipient to access services;252.32    (6) coordinating, evaluating, and monitoring of the services identified in the service 252.33plan;252.34    (7) completing the annual reviews of the service plan; and253.1    (8) informing the recipient or legal representative of the right to have assessments 253.2completed and service plans developed within specified time periods, and to appeal county 253.3action or inaction under section 256.045, subdivision 3, including the determination of 253.4nursing facility level of care.253.5    (b) The case manager may delegate certain aspects of the case management service 253.6activities to another individual provided there is oversight by the case manager. The case 253.7manager may not delegate those aspects which require professional judgment including 253.8assessments, reassessments, and care plan development.253.9EFFECTIVE DATE.This section is effective January 1, 2012.253.10    Sec. 39. Minnesota Statutes 2010, section 256B.49, subdivision 14, is amended to read:253.11    Subd. 14. Assessment and reassessment. (a) Assessments of each recipient's 253.12strengths, informal support systems, and need for services shall be completed within 20 253.13working days of the recipient's request as provided in section 256B.0911. Reassessment 253.14of each recipient's strengths, support systems, and need for services shall be conducted 253.15at least every 12 months and at other times when there has been a significant change in 253.16the recipient's functioning.253.17(b) There must be a determination that the client requires a hospital level of care or a 253.18nursing facility level of care as defined in section 
         144.0724, subdivision 11 256B.0911, 253.19subdivision 4a, paragraph (d), at initial and subsequent assessments to initiate and 253.20maintain participation in the waiver program.253.21(c) Regardless of other assessments identified in section 
         144.0724, subdivision 4, as 253.22appropriate to determine nursing facility level of care for purposes of medical assistance 253.23payment for nursing facility services, only face-to-face assessments conducted according 253.24to section 
         256B.0911, subdivisions 3a, 3b, and 4d, that result in a hospital level of care 253.25determination or a nursing facility level of care determination must be accepted for 253.26purposes of initial and ongoing access to waiver services payment.253.27(d) Persons with developmental disabilities who apply for services under the nursing 253.28facility level waiver programs shall be screened for the appropriate level of care according 253.29to section 
         256B.092.253.30(e) Recipients who are found eligible for home and community-based services under 253.31this section before their 65th birthday may remain eligible for these services after their 253.3265th birthday if they continue to meet all other eligibility factors.253.33(f) The commissioner shall develop criteria to identify individuals whose level of 253.34functioning is reasonably expected to improve and reassess these individuals every six 253.35months. Individuals who meet these criteria must have a comprehensive transitional 254.1service plan developed under subdivision 15, paragraphs (b) and (c). Counties, case 254.2managers, and service providers are responsible for conducting these reassessments and 254.3shall complete the reassessments out of existing funds.254.4EFFECTIVE DATE.This section is effective January 1, 2012, except for paragraph 254.5(f), which is effective July 1, 2013.254.6    Sec. 40. Minnesota Statutes 2010, section 256B.49, subdivision 15, is amended to read:254.7    Subd. 15. Individualized Coordinated service and support plan; comprehensive 254.8transitional service plan; maintenance service plan. (a) Each recipient of home and 254.9community-based waivered services shall be provided a copy of the written coordinated254.10service and support plan which: that complies with the requirements of section 256B.092, 254.11subdivisions 1b and 1e.254.12(1) is developed and signed by the recipient within ten working days of the 254.13completion of the assessment;254.14(2) meets the assessed needs of the recipient;254.15(3) reasonably ensures the health and safety of the recipient;254.16(4) promotes independence;254.17(5) allows for services to be provided in the most integrated settings; and254.18(6) provides for an informed choice, as defined in section 256B.77, subdivision 2, 254.19paragraph (p), of service and support providers.254.20(b) In developing the comprehensive transitional service plan, the individual 254.21receiving services, the case manager, and the guardian, if applicable, will identify 254.22the transitional service plan fundamental service outcome and anticipated timeline to 254.23achieve this outcome. Within the first 20 days following a recipient's request for an 254.24assessment or reassessment, the transitional service planning team must be identified. A 254.25team leader must be identified who will be responsible for assigning responsibility and 254.26communicating with team members to ensure implementation of the transition plan and 254.27ongoing assessment and communication process. The team leader should be an individual, 254.28such as the case manager or guardian, who has the opportunity to follow the individual to 254.29the next level of service.254.30Within ten days following an assessment, a comprehensive transitional service plan 254.31must be developed incorporating elements of a comprehensive functional assessment and 254.32including short-term measurable outcomes and timelines for achievement of and reporting 254.33on these outcomes. Functional milestones must also be identified and reported according 254.34to the timelines agreed upon by the transitional service planning team. In addition, the 254.35comprehensive transitional service plan must identify additional supports that may assist 255.1in the achievement of the fundamental service outcome such as the development of greater 255.2natural community support, increased collaboration among agencies, and technological 255.3supports.255.4The timelines for reporting on functional milestones will prompt a reassessment of 255.5services provided, the units of services, rates, and appropriate service providers. It is 255.6the responsibility of the transitional service planning team leader to review functional 255.7milestone reporting to determine if the milestones are consistent with observable skills 255.8and that milestone achievement prompts any needed changes to the comprehensive 255.9transitional service plan.255.10For those whose fundamental transitional service outcome involves the need to 255.11procure housing, a plan for the individual to seek the resources necessary to secure 255.12the least restrictive housing possible should be incorporated into the plan, including 255.13employment and public supports such as housing access and shelter needy funding.255.14(c) Counties and other agencies responsible for funding community placement and 255.15ongoing community supportive services are responsible for the implementation of the 255.16comprehensive transitional service plans. Oversight responsibilities include both ensuring 255.17effective transitional service delivery and efficient utilization of funding resources.255.18(d) Following one year of transitional services, the transitional services planning 255.19team will make a determination as to whether or not the individual receiving services 255.20requires the current level of continuous and consistent support in order to maintain the 255.21individual's current level of functioning. Individuals who move from a transitional to a 255.22maintenance service plan must be reassessed to determine if the individual would benefit 255.23from a transitional service plan on at least an annual basis. This assessment should 255.24consider any changes to technological or natural community supports.255.25(b) (e) When a county is evaluating denials, reductions, or terminations of home 255.26and community-based services under section 
         256B.49 for an individual, the case manager 255.27shall offer to meet with the individual or the individual's guardian in order to discuss the 255.28prioritization of service needs within the individualized service plan, comprehensive 255.29transitional service plan, or maintenance service plan. The reduction in the authorized 255.30services for an individual due to changes in funding for waivered services may not exceed 255.31the amount needed to ensure medically necessary services to meet the individual's health, 255.32safety, and welfare.255.33EFFECTIVE DATE.This section is effective January 1, 2012, except for 255.34paragraphs (b), (c), and (d), which are effective July 1, 2013.256.1    Sec. 41. Minnesota Statutes 2010, section 256B.5012, is amended by adding a 256.2subdivision to read:256.3    Subd. 9.ICF/MR rate increase.Effective July 1, 2011, the commissioner shall 256.4increase the daily rate to $138.23 at an intermediate care facility for the developmentally 256.5disabled located in Clearwater County and classified as a class A facility with 15 beds.256.6EFFECTIVE DATE.This section is effective July 1, 2011.256.7    Sec. 42. Minnesota Statutes 2010, section 256B.5012, is amended by adding a 256.8subdivision to read:256.9    Subd. 10.ICF/MR rate adjustment.For each facility reimbursed under this 256.10section, except for a facility located in Clearwater County and classified as a class A 256.11facility with 15 beds, the commissioner shall decrease operating payment rates equal to ... 256.12percent of the operating payment rates in effect on June 30, 2011. For each facility, the 256.13commissioner shall apply the rate reduction, based on occupied beds, using the percentage 256.14specified in this subdivision multiplied by the total payment rate, including the variable rate 256.15but excluding the property-related payment rate, in effect on the preceding date. The total 256.16rate reduction shall include the adjustment provided in section 256B.501, subdivision 12.256.17    Sec. 43. Minnesota Statutes 2010, section 256G.02, subdivision 6, is amended to read:256.18    Subd. 6. Excluded time. "Excluded time" means:256.19(a) any period an applicant spends in a hospital, sanitarium, nursing home, shelter 256.20other than an emergency shelter, halfway house, foster home, semi-independent living 256.21domicile or services program, residential facility offering care, board and lodging facility 256.22or other institution for the hospitalization or care of human beings, as defined in section 256.23144.50
         , 
         144A.01, or 
         245A.02, subdivision 14; maternity home, battered women's shelter, 256.24or correctional facility; or any facility based on an emergency hold under sections 256.25253B.05, subdivisions 1 and 2
         , and 
         253B.07, subdivision 6;256.26(b) any period an applicant spends on a placement basis in a training and habilitation 256.27program, including a rehabilitation facility or work or employment program as defined 256.28in section 
         268A.01; or receiving personal care assistance services pursuant to section 256.29256B.0659; semi-independent living services provided under section 
         252.275, and 256.30Minnesota Rules, parts 9525.0500 to 9525.0660; day training and habilitation programs 256.31and assisted living services; and256.32(c) any placement for a person with an indeterminate commitment, including 256.33independent living.257.1EFFECTIVE DATE.This section is effective July 1, 2011.257.2    Sec. 44. Laws 2009, chapter 79, article 8, section 4, the effective date, as amended by 257.3Laws 2010, First Special Session chapter 1, article 24, section 12, is amended to read:257.4EFFECTIVE DATE.The This section is effective July 1, 2011 on or after January 257.51, 2014, for individuals age 21 and older, and on or after October 1, 2019, for individuals 257.6under age 21.257.7    Sec. 45. Laws 2009, chapter 79, article 8, section 51, the effective date, as amended by 257.8Laws 2010, First Special Session chapter 1, article 17, section 14, is amended to read:257.9EFFECTIVE DATE.This section is effective July 1, 2011 January 1, 2014.257.10    Sec. 46. Laws 2009, chapter 79, article 13, section 3, subdivision 8, as amended by 257.11Laws 2009, chapter 173, article 2, section 1, subdivision 8, and Laws 2010, First Special 257.12Session chapter 1, article 15, section 5, and article 25, section 16, is amended to read:

257.13Subd. 8.Continuing Care Grants

257.14The amounts that may be spent from the 257.15appropriation for each purpose are as follows:

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

257.17Base Adjustment. The general fund base is 257.18increased by $5,751,000 in fiscal year 2012 257.19and $6,705,000 in fiscal year 2013.257.20Information and Assistance 257.21Reimbursement. Federal administrative 257.22reimbursement obtained from information 257.23and assistance services provided by the 257.24Senior LinkAge or Disability Linkage lines 257.25to people who are identified as eligible for 257.26medical assistance shall be appropriated to 257.27the commissioner for this activity.257.28Community Service Development Grant 257.29Reduction. Funding for community service 257.30development grants must be reduced by 257.31$260,000 for fiscal year 2010; $284,000 in 258.1fiscal year 2011; $43,000 in fiscal year 2012; 258.2and $43,000 in fiscal year 2013. Base level 258.3funding shall be restored in fiscal year 2014.258.4Community Service Development Grant 258.5Community Initiative. Funding for 258.6community service development grants shall 258.7be used to offset the cost of aging support 258.8grants. Base level funding shall be restored 258.9in fiscal year 2014.258.10Senior Nutrition Use of Federal Funds.258.11For fiscal year 2010, general fund grants 258.12for home-delivered meals and congregate 258.13dining shall be reduced by $500,000. The 258.14commissioner must replace these general 258.15fund reductions with equal amounts from 258.16federal funding for senior nutrition from the 258.17American Recovery and Reinvestment Act 258.18of 2009.

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

258.20Base Adjustment. The general fund base is 258.21decreased by $3,598,000 in fiscal year 2012 258.22and $3,470,000 in fiscal year 2013.258.23Alternative Care Transfer. Any money 258.24allocated to the alternative care program that 258.25is not spent for the purposes indicated does 258.26not cancel but must be transferred to the 258.27medical assistance account.

258.28258.29(c) Medical Assistance Grants; Long-Term Care Facilities.367,444,000419,749,000

258.30258.31(d) Medical Assistance Long-Term Care Waivers and Home Care Grants853,567,0001,039,517,000

258.32Manage Growth in TBI and CADI 258.33Waivers. During the fiscal years beginning 258.34on July 1, 2009, and July 1, 2010, the 258.35commissioner shall allocate money for home 259.1and community-based waiver programs 259.2under Minnesota Statutes, section 
         256B.49, 259.3to ensure a reduction in state spending that is 259.4equivalent to limiting the caseload growth of 259.5the TBI waiver to 12.5 allocations per month 259.6each year of the biennium and the CADI 259.7waiver to 95 allocations per month each year 259.8of the biennium. Limits do not apply: (1) 259.9when there is an approved plan for nursing 259.10facility bed closures for individuals under 259.11age 65 who require relocation due to the 259.12bed closure; (2) to fiscal year 2009 waiver 259.13allocations delayed due to unallotment; or (3) 259.14to transfers authorized by the commissioner 259.15from the personal care assistance program 259.16of individuals having a home care rating 259.17of "CS," "MT," or "HL." Priorities for the 259.18allocation of funds must be for individuals 259.19anticipated to be discharged from institutional 259.20settings or who are at imminent risk of a 259.21placement in an institutional setting.259.22Manage Growth in DD Waiver. The 259.23commissioner shall manage the growth in 259.24the DD waiver by limiting the allocations 259.25included in the February 2009 forecast to 15 259.26additional diversion allocations each month 259.27for the calendar years that begin on January 259.281, 2010, and January 1, 2011. Additional 259.29allocations must be made available for 259.30transfers authorized by the commissioner 259.31from the personal care program of individuals 259.32having a home care rating of "CS," "MT," 259.33or "HL."259.34Adjustment to Lead Agency Waiver 259.35Allocations. Prior to the availability of the 259.36alternative license defined in Minnesota 260.1Statutes, section 
         245A.11, subdivision 8, 260.2the commissioner shall reduce lead agency 260.3waiver allocations for the purposes of 260.4implementing a moratorium on corporate 260.5foster care.260.6Alternatives to Personal Care Assistance 260.7Services. Base level funding of $3,237,000 260.8in fiscal year 2012 and $4,856,000 in 260.9fiscal year 2013 is to implement alternative 260.10services to personal care assistance services 260.11for persons with mental health and other 260.12behavioral challenges who can benefit 260.13from other services that more appropriately 260.14meet their needs and assist them in living 260.15independently in the community. These 260.16services may include, but not be limited to, a 260.171915(i) state plan option.

260.18(e) Mental Health Grants

260.19Appropriations by Fund260.20General77,739,00077,739,000260.21Health Care Access750,000750,000260.22Lottery Prize1,508,0001,508,000

260.23Funding Usage. Up to 75 percent of a fiscal 260.24year's appropriation for adult mental health 260.25grants may be used to fund allocations in that 260.26portion of the fiscal year ending December 260.2731.

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

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

260.30Payments for Substance Abuse Treatment.260.31For placements beginning during fiscal years 260.322010 and 2011, county-negotiated rates and 260.33provider claims to the consolidated chemical 260.34dependency fund must not exceed the lesser 260.35of:261.1(1) rates charged for these services on 261.2January 1, 2009; or261.3(2) 160 percent of the average rate on January 261.41, 2009, for each group of vendors with 261.5similar attributes.261.6Rates for fiscal years 2010 and 2011 must 261.7not exceed 160 percent of the average rate on 261.8January 1, 2009, for each group of vendors 261.9with similar attributes.261.10Effective July 1, 2010, rates that were above 261.11the average rate on January 1, 2009, are 261.12reduced by five percent from the rates in 261.13effect on June 1, 2010. Rates below the 261.14average rate on January 1, 2009, are reduced 261.15by 1.8 percent from the rates in effect on 261.16June 1, 2010. Services provided under 261.17this section by state-operated services are 261.18exempt from the rate reduction. For services 261.19provided in fiscal years 2012 and 2013, the 261.20statewide aggregate payment under the new 261.21rate methodology to be developed under 261.22Minnesota Statutes, section 
         254B.12, must 261.23not exceed the projected aggregate payment 261.24under the rates in effect for fiscal year 2011 261.25excluding the rate reduction for rates that 261.26were below the average on January 1, 2009, 261.27plus a state share increase of $3,787,000 for 261.28fiscal year 2012 and $5,023,000 for fiscal 261.29year 2013. Notwithstanding any provision 261.30to the contrary in this article, this provision 261.31expires on June 30, 2013.261.32Chemical Dependency Special Revenue 261.33Account. For fiscal year 2010, $750,000 261.34must be transferred from the consolidated 261.35chemical dependency treatment fund 262.1administrative account and deposited into the 262.2general fund.262.3County CD Share of MA Costs for 262.4ARRA Compliance. Notwithstanding the 262.5provisions of Minnesota Statutes, chapter 262.6254B, for chemical dependency services 262.7provided during the period October 1, 2008, 262.8to December 31, 2010, and reimbursed by 262.9medical assistance at the enhanced federal 262.10matching rate provided under the American 262.11Recovery and Reinvestment Act of 2009, the 262.12county share is 30 percent of the nonfederal 262.13share. This provision is effective the day 262.14following final enactment.

262.15262.16(h) Chemical Dependency Nonentitlement Grants1,729,0001,729,000

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

262.18Base Adjustment. The general fund base is 262.19increased by $2,639,000 in fiscal year 2012 262.20and increased by $3,854,000 in fiscal year 262.212013.262.22Technology Grants. $650,000 in fiscal 262.23year 2010 and $1,000,000 in fiscal year 262.242011 are for technology grants, case 262.25consultation, evaluation, and consumer 262.26information grants related to developing and 262.27supporting alternatives to shift-staff foster 262.28care residential service models.262.29Other Continuing Care Grants; HIV 262.30Grants. Money appropriated for the HIV 262.31drug and insurance grant program in fiscal 262.32year 2010 may be used in either year of the 262.33biennium.262.34Quality Assurance Commission. Effective 262.35July 1, 2009, state funding for the quality 263.1assurance commission under Minnesota 263.2Statutes, section 
         256B.0951, is canceled.263.3    Sec. 47. DIRECTIONS TO COMMISSIONER.263.4    Subdivision 1.Co-payments for home and community-based services.Upon 263.5federal approval, the commissioner of human services shall develop and implement a 263.6co-payment schedule for individuals receiving home and community-based services under 263.7Minnesota Statutes, chapter 256B.263.8    Subd. 2.Federal waiver amendment.The commissioner shall seek an amendment 263.9to the 1915c home and community-based waivers under Minnesota Statutes, sections 263.10256B.092 and 256B.49, to allow properly licensed residential programs under Minnesota 263.11Statutes, section 245A.02, subdivision 14, to provide residential services to up to eight 263.12individuals with physical or developmental disabilities, chronic illnesses, or traumatic 263.13brain injuries. A facility licensed for five to eight people must be an existing residential 263.14building, such as a duplex, that is owned by the same company and meets all other 263.15licensing requirements.263.16    Subd. 3.Recommendations for personal care assistance service changes.The 263.17commissioner shall consult with stakeholder groups, including counties, advocates, 263.18persons receiving personal care assistance services, and personal care assistance providers, 263.19and make recommendations to the legislature by February 1, 2014, on changes that could 263.20be made to the program to improve oversight, program efficiency, and cost-effectiveness.263.21    Subd. 4.Nursing facility pay-for-performance reimbursement system.263.22The commissioner of human services shall report to the legislative committees with 263.23jurisdiction over nursing facility policy and finance with recommendations for developing 263.24and implementing a pay-for-performance reimbursement system with a quality add-on by 263.25January 15, 2012.263.26    Subd. 5.ICF/MR transition plan.The commissioner of human services shall 263.27work with stakeholders to develop and implement a plan by June 30, 2013, to transition 263.28individuals currently residing in intermediate care facilities for persons with developmental 263.29disabilities into the least restrictive community settings possible. The plan must include a 263.30requirement for a cooperative planning process between the counties and providers for 263.31the downsizing or closure of intermediate care facilities for persons with developmental 263.32disabilities, with funding from the bed closures converting to home and community-based 263.33waiver funding to fund services for those leaving the intermediate care facilities for 263.34persons with developmental disabilities based on a plan approved by the commissioner. In 263.35order to facilitate this process, the commissioner shall provide information to facilities and 264.1counties about the number of people in facilities who have requested to move to home and 264.2community-based services. Individuals residing in intermediate care facilities for persons 264.3with developmental disabilities who choose to remain there or whose health or safety 264.4would be put at risk in a less restrictive setting may continue to reside in intermediate care 264.5facilities for persons with developmental disabilities.264.6    Subd. 6.Representative payee.The commissioner of human services shall make 264.7recommendations to the legislative committees with jurisdiction over health and human 264.8services policy and finance by January 15, 2012, on ways to better manage funds for 264.9persons who rely on a representative payee.264.10    Sec. 48. STATE PLAN AMENDMENT TO IMPLEMENT SELF-DIRECTED 264.11PERSONAL SUPPORTS.264.12By July 15, 2011, the commissioner shall submit a state plan amendment to 264.13implement Minnesota Statutes, section 256B.0657, as soon as possible upon federal 264.14approval.264.15    Sec. 49. AMENDMENT FOR SELF-DIRECTED COMMUNITY SUPPORTS.264.16By September 1, 2011, the commissioner shall submit an amendment to the home 264.17and community-based waiver programs consistent with implementing the self-directed 264.18option under Minnesota Statutes, section 256B.0657, through statewide enrolled providers 264.19contracted to provide outreach information, training, and fiscal support entity services to 264.20all eligible recipients choosing this option and with shared care in some types of services. 264.21The waiver amendment shall be consistent with changes in case management services 264.22under Minnesota Statutes, section 256B.092.264.23    Sec. 50. ESTABLISHMENT OF RATES FOR SHARED HOME AND 264.24COMMUNITY-BASED WAIVER SERVICES.264.25By January 1, 2012, the commissioner shall establish rates to begin paying for 264.26in-home services and personal supports under all of the home and community-based 264.27waiver services programs consistent with the standards in Minnesota Statutes, section 264.28256B.4912, subdivision 2.264.29    Sec. 51. ESTABLISHMENT OF RATE FOR CASE MANAGEMENT 264.30SERVICES.264.31By July 1, 2012, the commissioner shall establish the rate to be paid for case 264.32management services under Minnesota Statutes, sections 256B.0621, subdivision 2, clause 265.1(4), 256B.092, and 256B.49, consistent with the standards in Minnesota Statutes, section 265.2256B.4912, subdivision 2.265.3    Sec. 52. RECOMMENDATIONS FOR FURTHER CASE MANAGEMENT 265.4REDESIGN.265.5By February 1, 2012, the commissioner of human services shall develop a legislative 265.6report with specific recommendations and language for proposed legislation to be effective 265.7July 1, 2012, for the following:265.8(1) definitions of service and consolidation of standards and rates to the extent 265.9appropriate for all types of medical assistance case management services, including 265.10targeted case management under Minnesota Statutes, sections 256B.0621; 256B.0625, 265.11subdivision 20; and 256B.0924; mental health case management services for children 265.12and adults, all types of home and community-based waiver case management, and case 265.13management under Minnesota Rules, parts 9525.0004 to 9525.0036. This work shall be 265.14completed in collaboration with efforts under Minnesota Statutes, section 256B.4912;265.15(2) recommendations on county of financial responsibility requirements and quality 265.16assurance measures for case management; 265.17(3) identification of county administrative functions that may remain entwined in 265.18case management service delivery models; and265.19(4) implementation of a methodology to fully fund county case management 265.20administrative functions. 265.21    Sec. 53. MY LIFE, MY CHOICES TASK FORCE.265.22    Subdivision 1.Establishment.The My Life, My Choices Task Force is established 265.23to create a system of supports and services for people with disabilities governed by the 265.24following principles:265.25(1) freedom to act as a consumer of services in the marketplace;265.26(2) freedom to choose to take as much risk as any other citizen;265.27(3) more choices in levels of service that may vary throughout life;265.28(4) opportunity to work with a trusted partner and fiscal support entity to manage a 265.29personal budget and to be accountable for reporting spending and personal outcomes;265.30(5) opportunity to live with minimal constraints instead of minimal freedoms; and265.31(6) ability to consolidate funding streams into an individualized budget.265.32    Subd. 2.Membership.The My Life, My Choices Task Force shall consist of the 265.33lieutenant governor; the commissioner of human services, or designee; a representative of 265.34the Minnesota Chamber of Commerce; and the following to be appointed by the governor: 266.1one administrative law judge, one labor representative, two family members of people 266.2with disabilities, and one individual with disabilities. In addition, the following shall be 266.3appointed jointly by the speaker of the house and the senate Subcommittee on Committees 266.4of the Committee on Rules and Administration, a representative of a disability advocacy 266.5organization; a representative of a disability legal services advocacy organization; 266.6representatives of two nonprofit organizations, one of which serves all 87 counties; and 266.7a representative of a philanthropic organization. Appointed nongovernmental members 266.8of the task force shall serve as staff for the task force and take on the responsibilities of 266.9coordinating meetings, reporting on committee recommendations, and providing other 266.10staff support as needed to meet the responsibilities of the task force as described in 266.11subdivision 3. Legislative appointment of nongovernmental members of the task force 266.12shall be conditioned upon agreement from the appointees to provide staff assistance to 266.13execute the work of the task force. The chairs and ranking minority members of the 266.14legislative committees with jurisdiction over health and human services policy and finance 266.15shall serve as ex officio members.266.16    Subd. 3.Duties.The task force shall make recommendations, including proposed 266.17legislation, and report to the legislative committees with jurisdiction over health and 266.18human services policy and finance by November 15, 2011, on creating a system of 266.19supports and services for people with disabilities by July 1, 2012, as governed by the 266.20principles under subdivision 1. In making recommendations and proposed legislation, the 266.21council shall work in conjunction with the Consumer-Directed Community Supports Task 266.22Force and shall include self-directed planning, individual budgeting, choice of trusted 266.23partner, self-directed purchasing of services and supports, reporting of outcomes, ability 266.24to share in any savings, and any additional rules or laws that may need to be waived. 266.25Recommendations from the task force shall be fully implemented by July 1, 2013.266.26    Subd. 4.Expense reimbursement.The members of the task force shall not be 266.27reimbursed for expenses related to the duties of the task force. The task force shall be 266.28independently staffed and coordinated by nongovernmental appointees who serve on the 266.29task force, and no state funding shall be appropriated for expenses related to the task 266.30force under this section.266.31    Subd. 5.Expiration.The task force expires on July 1, 2013.266.32EFFECTIVE DATE.This section is effective the day following final enactment.267.1ARTICLE 7267.2REDESIGNING SERVICE DELIVERY267.3    Section 1. Minnesota Statutes 2010, section 119B.09, is amended by adding a 267.4subdivision to read:267.5    Subd. 4b.Electronic verification.County agencies are authorized to use all 267.6automated databases containing information regarding recipients' or applicants' income 267.7in order to determine eligibility for the child care assistance under this chapter. The 267.8information is sufficient to determine eligibility.267.9    Sec. 2. Minnesota Statutes 2010, section 256.01, subdivision 14b, is amended to read:267.10    Subd. 14b. American Indian child welfare projects. (a) The commissioner of 267.11human services may authorize projects to test tribal delivery of child welfare services to 267.12American Indian children and their parents and custodians living on the reservation. 267.13The commissioner has authority to solicit and determine which tribes may participate 267.14in a project. Grants may be issued to Minnesota Indian tribes to support the projects. 267.15The commissioner may waive existing state rules as needed to accomplish the projects. 267.16Notwithstanding section 
         626.556, the commissioner may authorize projects to use 267.17alternative methods of investigating and assessing reports of child maltreatment, provided 267.18that the projects comply with the provisions of section 
         626.556 dealing with the rights 267.19of individuals who are subjects of reports or investigations, including notice and appeal 267.20rights and data practices requirements. The commissioner may seek any federal approvals 267.21necessary to carry out the projects as well as seek and use any funds available to the 267.22commissioner, including use of federal funds, foundation funds, existing grant funds, 267.23and other funds. The commissioner is authorized to advance state funds as necessary to 267.24operate the projects. Federal reimbursement applicable to the projects is appropriated 267.25to the commissioner for the purposes of the projects. The projects must be required to 267.26address responsibility for safety, permanency, and well-being of children.267.27(b) For the purposes of this section, "American Indian child" means a person under 267.2818 years of age who is a tribal member or eligible for membership in one of the tribes 267.29chosen for a project under this subdivision and who is residing on the reservation of 267.30that tribe.267.31(c) In order to qualify for an American Indian child welfare project, a tribe must:267.32(1) be one of the existing tribes with reservation land in Minnesota;267.33(2) have a tribal court with jurisdiction over child custody proceedings;268.1(3) have a substantial number of children for whom determinations of maltreatment 268.2have occurred;268.3(4) have capacity to respond to reports of abuse and neglect under section 
         626.556;268.4(5) provide a wide range of services to families in need of child welfare services; and268.5(6) have a tribal-state title IV-E agreement in effect.268.6(d) Grants awarded under this section may be used for the nonfederal costs of 268.7providing child welfare services to American Indian children on the tribe's reservation, 268.8including costs associated with:268.9(1) assessment and prevention of child abuse and neglect;268.10(2) family preservation;268.11(3) facilitative, supportive, and reunification services;268.12(4) out-of-home placement for children removed from the home for child protective 268.13purposes; and268.14(5) other activities and services approved by the commissioner that further the goals 268.15of providing safety, permanency, and well-being of American Indian children.268.16(e) When a tribe has initiated a project and has been approved by the commissioner 268.17to assume child welfare responsibilities for American Indian children of that tribe under 268.18this section, the affected county social service agency is relieved of responsibility for 268.19responding to reports of abuse and neglect under section 
         626.556 for those children 268.20during the time within which the tribal project is in effect and funded. The commissioner 268.21shall work with tribes and affected counties to develop procedures for data collection, 268.22evaluation, and clarification of ongoing role and financial responsibilities of the county 268.23and tribe for child welfare services prior to initiation of the project. Children who have not 268.24been identified by the tribe as participating in the project shall remain the responsibility 268.25of the county. Nothing in this section shall alter responsibilities of the county for law 268.26enforcement or court services.268.27(f) Participating tribes may conduct children's mental health screenings under section 268.28245.4874, subdivision 1
         , paragraph (a), clause (14), for children who are eligible for the 268.29initiative and living on the reservation and who meet one of the following criteria:268.30(1) the child must be receiving child protective services;268.31(2) the child must be in foster care; or268.32(3) the child's parents must have had parental rights suspended or terminated.268.33Tribes may access reimbursement from available state funds for conducting the screenings. 268.34Nothing in this section shall alter responsibilities of the county for providing services 268.35under section 
         245.487.269.1(g) Participating tribes may establish a local child mortality review panel. In 269.2establishing a local child mortality review panel, the tribe agrees to conduct local child 269.3mortality reviews for child deaths or near-fatalities occurring on the reservation under 269.4subdivision 12
         . Tribes with established child mortality review panels shall have access 269.5to nonpublic data and shall protect nonpublic data under 
         subdivision 12, paragraphs (c) 269.6to (e). The tribe shall provide written notice to the commissioner and affected counties 269.7when a local child mortality review panel has been established and shall provide data upon 269.8request of the commissioner for purposes of sharing nonpublic data with members of the 269.9state child mortality review panel in connection to an individual case.269.10(h) The commissioner shall collect information on outcomes relating to child safety, 269.11permanency, and well-being of American Indian children who are served in the projects. 269.12Participating tribes must provide information to the state in a format and completeness 269.13deemed acceptable by the state to meet state and federal reporting requirements.269.14    (i) In consultation with the White Earth Band, the commissioner shall develop 269.15and submit to the chairs and ranking minority members of the legislative committees 269.16with jurisdiction over health and human services a plan to transfer legal responsibility 269.17for providing child protective services to White Earth Band member children residing in 269.18Hennepin County to the White Earth Band. The plan shall include a financing proposal, 269.19definitions of key terms, statutory amendments required, and other provisions required to 269.20implement the plan. The commissioner shall submit the plan by January 15, 2012.269.21    Sec. 3. Minnesota Statutes 2010, section 256.01, is amended by adding a subdivision 269.22to read:269.23    Subd. 14c.American Indian child welfare, social, and human services project; 269.24White Earth Band of Ojibwe.(a) The commissioner of human services shall enter into a 269.25contractual agreement as authorized under subdivision 2, paragraph (a), clause (7), with 269.26the White Earth Band of Ojibwe Indians for the tribe to provide all human services and 269.27public assistance programs that are under the supervision of the commissioner to tribal 269.28members who reside on the reservation. Grants may be issued to the White Earth Band 269.29of Ojibwe Indians to support the project. The commissioner may waive existing rules to 269.30support this project. The commissioner shall seek any federal approvals necessary to carry 269.31out the project as well as seek and use any funds available to the commissioner, including 269.32use of federal funds, foundation funds, existing grant funds, and other funds. The 269.33commissioner is authorized to advance state funds as necessary to operate the projects. 269.34Federal reimbursement applicable to the projects is appropriated to the commissioner for 269.35purposes of the project.270.1(b) The commissioner shall redirect all funds provided to Mahnomen County for 270.2these services, including administrative expenses, to the White Earth Band of Ojibwe 270.3Indians.270.4(c) The commissioner, in consultation with the tribe, is authorized to determine: (1) 270.5which programs not currently provided by the White Earth Band of Ojibwe Indians will be 270.6transferred to the tribe; and (2) the process by which the new programs will be transferred. 270.7In the case of a dispute, a two-thirds vote of the tribal council to transfer a program to 270.8the tribe must overrule the decision of the commissioner.270.9(d) When the commissioner approves transfer of programs and the tribe assumes 270.10responsibility under this section, Mahnomen County is relieved of responsibility for 270.11providing program services to tribal members who live on the reservation while the tribal 270.12project is in effect and funded. The commissioner shall seek and use any funds available, 270.13including federal funds, foundation funds, existing grant funds, and other state funds as 270.14available. 270.15(e) The tribe shall comply with all reporting and record keeping requirements under 270.16state and federal laws and rules.270.17    Sec. 4. [256.0145] COMPUTER SYSTEM SIMPLIFICATION.270.18    Subdivision 1.Reprogram MAXIS.The commissioner of human services, as part 270.19of the enterprise architecture project, shall reprogram the MAXIS computer system to 270.20automatically apply child support payments entered into the PRISM computer system to 270.21a MAXIS case file.270.22    Subd. 2.Program the social service information system.The commissioner of 270.23human services shall require all prepaid health plans to accept a billing format identical to 270.24the MMIS billing format for payment to county agencies for mental health targeted case 270.25management claims, elderly waiver claims, and other claim categories as added to the 270.26benefit set. The commissioner shall make any necessary changes to the SSIS system to 270.27bill prepaid health plans for those claims.270.28    Sec. 5. [256.0147] COUNTY ELECTRONIC VERIFICATION TO DETERMINE 270.29ELIGIBILITY.270.30County agencies are authorized to use all automated databases containing 270.31information regarding recipients' or applicants' income in order to determine eligibility 270.32for child support enforcement, general assistance, Minnesota supplemental aid, and 270.33programs, services, and supports under chapter 256J. The information is sufficient to 270.34determine eligibility. State and county caseworkers shall not be cited in error, as part of 271.1any audit and quality review, for an incorrect eligibility determination based on current but 271.2inaccurate information received through a state-approved electronic data source. If there 271.3is a potential error, the reviewer must forward a corrective action notice to the caseworker 271.4for proper and immediate correction. If the state or county caseworker has data available 271.5through client reporting, or other means, that are more accurate than state-approved 271.6electronic data, the caseworker should use the more accurate information in making the 271.7eligibility determination.271.8    Sec. 6. Minnesota Statutes 2010, section 256B.69, is amended by adding a subdivision 271.9to read:271.10    Subd. 30.Provision of required materials in alternative formats.(a) For the 271.11purposes of this subdivision, "alternative format" means a medium other than paper and 271.12"prepaid health plan" means managed care plans and county-based purchasing plans.271.13(b) A prepaid health plan may provide in an alternative format a provider directory 271.14and certificate of coverage, or materials otherwise required to be available in writing 271.15under Code of Federal Regulations, title 42, section 438.10, or under the commissioner's 271.16contract with the prepaid health plan, if the following conditions are met:271.17(1) the prepaid health plan, local agency, or commissioner, as applicable, informs the 271.18enrollee that:271.19(i) provision in an alternative format is available and the enrollee affirmatively 271.20requests of the prepaid health plan that the provider directory, certificate of coverage, 271.21or materials otherwise required under Code of Federal Regulations, title 42, section 271.22438.10, or under the commissioner's contract with the prepaid health plan be provided in 271.23an alternative format; and271.24(ii) a record of the enrollee request is retained by the prepaid health plan in the 271.25form of written direction from the enrollee or a documented telephone call followed by a 271.26confirmation letter to the enrollee from the prepaid health plan that explains that the 271.27enrollee may change the request at any time;271.28(2) the materials are sent to a secured mailbox and are made available at a 271.29password-protected secured Web site or on a data storage device if the materials contain 271.30enrollee data that is individually identifiable;271.31(3) the enrollee is provided a customer service number on the enrollee's membership 271.32card that may be called to request a paper version of the materials provided in an 271.33alternative format; and271.34(4) the materials provided in an alternative format meet all other requirements of 271.35the commissioner regarding content, size of typeface, and any required time frames for 272.1distribution. "Required time frames for distribution" must permit sufficient time for 272.2prepaid health plans to distribute materials in alternative formats upon receipt of enrollees' 272.3requests for the materials.272.4(c) A prepaid health plan may provide in an alternative format its primary care 272.5network list to the commissioner and to local agencies within its service area. The 272.6commissioner or local agency, as applicable, shall inform a potential enrollee of the 272.7availability of a prepaid health plan's primary care network list in an alternative format. If 272.8the potential enrollee requests an alternative format of the prepaid health plan's primary 272.9care network list, a record of that request shall be retained by the commissioner or local 272.10agency. The potential enrollee is permitted to withdraw the request at any time.272.11The prepaid health plan shall submit sufficient paper versions of the primary 272.12care network list to the commissioner and to local agencies within its service area to 272.13accommodate potential enrollee requests for paper versions of the primary care network 272.14list.272.15(d) A prepaid health plan may provide in an alternative format materials otherwise 272.16required to be available in writing under Code of Federal Regulations, title 42, section 272.17438.10, or under the commissioner's contract with the prepaid health plan, if the conditions 272.18of paragraphs (b), (c), and (e), are met for persons who are:272.19(1) enrolled in integrated Medicare and Medicaid programs under subdivisions 272.2023 and 28;272.21(2) enrolled in managed care long-term care programs under subdivision 6b;272.22(3) dually eligible for Medicare and medical assistance; or272.23(4) in the waiting period for Medicare.272.24(e) The commissioner shall seek any federal Medicaid waivers within 90 days after 272.25the effective date of this subdivision that are necessary to provide alternative formats of 272.26required material to enrollees of prepaid health plans as authorized under this subdivision.272.27(f) The commissioner shall consult with managed care plans, county-based 272.28purchasing plans, counties, and other interested parties to determine how materials 272.29required to be made available to enrollees under Code of Federal Regulations, title 42, 272.30section 438.10, or under the commissioner's contract with a prepaid health plan may 272.31be provided in an alternative format on the basis that the enrollee has not opted in to 272.32receive the alternative format. The commissioner shall consult with managed care 272.33plans, county-based purchasing plans, counties, and other interested parties to develop 272.34recommendations relating to the conditions that must be met for an opt-out process 272.35to be granted.273.1    Sec. 7. Minnesota Statutes 2010, section 256D.09, subdivision 6, is amended to read:273.2    Subd. 6. Recovery of overpayments. (a) If an amount of general assistance or 273.3family general assistance is paid to a recipient in excess of the payment due, it shall be 273.4recoverable by the county agency. The agency shall give written notice to the recipient of 273.5its intention to recover the overpayment.273.6(b) Except as provided for interim assistance in section 256D.06, subdivision 273.75, when an overpayment occurs, the county agency shall recover the overpayment 273.8from a current recipient by reducing the amount of aid payable to the assistance unit of 273.9which the recipient is a member, for one or more monthly assistance payments, until 273.10the overpayment is repaid. All county agencies in the state shall reduce the assistance 273.11payment by three percent of the assistance unit's standard of need in nonfraud cases and 273.12ten percent where fraud has occurred, or the amount of the monthly payment, whichever is 273.13less, for all overpayments.273.14(c) In cases when there is both an overpayment and underpayment, the county 273.15agency shall offset one against the other in correcting the payment.273.16(d) Overpayments may also be voluntarily repaid, in part or in full, by the individual, 273.17in addition to the aid reductions provided in this subdivision, to include further voluntary 273.18reductions in the grant level agreed to in writing by the individual, until the total amount 273.19of the overpayment is repaid.273.20(e) The county agency shall make reasonable efforts to recover overpayments to 273.21persons no longer on assistance under standards adopted in rule by the commissioner 273.22of human services. The county agency need not attempt to recover overpayments of 273.23less than $35 paid to an individual no longer on assistance if the individual does not 273.24receive assistance again within three years, unless the individual has been convicted of 273.25violating section 
         256.98.273.26(f) Establishment of an overpayment is limited to 12 months prior to the month of 273.27discovery due to agency error and six years prior to the month of discovery due to client 273.28error or an intentional program violation determined under section 256.046.273.29    Sec. 8. Minnesota Statutes 2010, section 256D.49, subdivision 3, is amended to read:273.30    Subd. 3. Overpayment of monthly grants and recovery of ATM errors.(a) When 273.31the county agency determines that an overpayment of the recipient's monthly payment 273.32of Minnesota supplemental aid has occurred, it shall issue a notice of overpayment 273.33to the recipient. If the person is no longer receiving Minnesota supplemental aid, the 273.34county agency may request voluntary repayment or pursue civil recovery. If the person is 273.35receiving Minnesota supplemental aid, the county agency shall recover the overpayment 274.1by withholding an amount equal to three percent of the standard of assistance for the 274.2recipient or the total amount of the monthly grant, whichever is less. 274.3(b) Establishment of an overpayment is limited to 12 months from the date of 274.4discovery due to agency error and six years prior to the month of discovery due to client 274.5error or an intentional program violation determined under section 256.046.274.6(c) For recipients receiving benefits via electronic benefit transfer, if the overpayment 274.7is a result of an automated teller machine (ATM) dispensing funds in error to the recipient, 274.8the agency may recover the ATM error by immediately withdrawing funds from the 274.9recipient's electronic benefit transfer account, up to the amount of the error. 274.10(d) Residents of nursing homes, regional treatment centers, andlicensed residential 274.11facilities with negotiated rates shall not have overpayments recovered from their personal 274.12needs allowance.274.13    Sec. 9. Minnesota Statutes 2010, section 256J.38, subdivision 1, is amended to read:274.14    Subdivision 1. Scope of overpayment.(a) When a participant or former participant 274.15receives an overpayment due to agency, client, or ATM error, or due to assistance received 274.16while an appeal is pending and the participant or former participant is determined 274.17ineligible for assistance or for less assistance than was received, the county agency must 274.18recoup or recover the overpayment using the following methods:274.19(1) reconstruct each affected budget month and corresponding payment month;274.20(2) use the policies and procedures that were in effect for the payment month; and274.21(3) do not allow employment disregards in section 
         256J.21, subdivision 3 or 4, in the 274.22calculation of the overpayment when the unit has not reported within two calendar months 274.23following the end of the month in which the income was received. 274.24(b) Establishment of an overpayment is limited to 12 months prior to the month of 274.25discovery due to agency error and six years prior to the month of discovery due to client 274.26error or an intentional program violation determined under section 256.046.274.27    Sec. 10. Minnesota Statutes 2010, section 393.07, subdivision 10, is amended to read:274.28    Subd. 10. Food stamp program; Maternal and Child Nutrition Act. (a) The local 274.29social services agency shall establish and administer the food stamp program according 274.30to rules of the commissioner of human services, the supervision of the commissioner as 274.31specified in section 
         256.01, and all federal laws and regulations. The commissioner of 274.32human services shall monitor food stamp program delivery on an ongoing basis to ensure 274.33that each county complies with federal laws and regulations. Program requirements to be 274.34monitored include, but are not limited to, number of applications, number of approvals, 275.1number of cases pending, length of time required to process each application and deliver 275.2benefits, number of applicants eligible for expedited issuance, length of time required 275.3to process and deliver expedited issuance, number of terminations and reasons for 275.4terminations, client profiles by age, household composition and income level and sources, 275.5and the use of phone certification and home visits. The commissioner shall determine the 275.6county-by-county and statewide participation rate.275.7(b) On July 1 of each year, the commissioner of human services shall determine a 275.8statewide and county-by-county food stamp program participation rate. The commissioner 275.9may designate a different agency to administer the food stamp program in a county if the 275.10agency administering the program fails to increase the food stamp program participation 275.11rate among families or eligible individuals, or comply with all federal laws and regulations 275.12governing the food stamp program. The commissioner shall review agency performance 275.13annually to determine compliance with this paragraph.275.14(c) A person who commits any of the following acts has violated section 
         256.98 or 275.15609.821
         , or both, and is subject to both the criminal and civil penalties provided under 275.16those sections:275.17(1) obtains or attempts to obtain, or aids or abets any person to obtain by means of a 275.18willful statement or misrepresentation, or intentional concealment of a material fact, food 275.19stamps or vouchers issued according to sections 
         145.891 to 
         145.897 to which the person 275.20is not entitled or in an amount greater than that to which that person is entitled or which 275.21specify nutritional supplements to which that person is not entitled; or275.22(2) presents or causes to be presented, coupons or vouchers issued according to 275.23sections 
         145.891 to 
         145.897 for payment or redemption knowing them to have been 275.24received, transferred or used in a manner contrary to existing state or federal law; or275.25(3) willfully uses, possesses, or transfers food stamp coupons, authorization to 275.26purchase cards or vouchers issued according to sections 
         145.891 to 
         145.897 in any manner 275.27contrary to existing state or federal law, rules, or regulations; or275.28(4) buys or sells food stamp coupons, authorization to purchase cards, other 275.29assistance transaction devices, vouchers issued according to sections 
         145.891 to 
         145.897, 275.30or any food obtained through the redemption of vouchers issued according to sections 275.31145.891
          to 
         145.897 for cash or consideration other than eligible food.275.32(d) A peace officer or welfare fraud investigator may confiscate food stamps, 275.33authorization to purchase cards, or other assistance transaction devices found in the 275.34possession of any person who is neither a recipient of the food stamp program nor 275.35otherwise authorized to possess and use such materials. Confiscated property shall be 275.36disposed of as the commissioner may direct and consistent with state and federal food 276.1stamp law. The confiscated property must be retained for a period of not less than 30 days 276.2to allow any affected person to appeal the confiscation under section 
         256.045.276.3(e) Food stamp overpayment claims which are due in whole or in part to client error 276.4shall be established by the county agency for a period of six years from the date of any 276.5resultant overpayment Establishment of an overpayment is limited to 12 months prior to 276.6the month of discovery due to agency error and six years prior to the month of discovery 276.7due to client error or an intentional program violation determined under section 256.046.276.8(f) With regard to the federal tax revenue offset program only, recovery incentives 276.9authorized by the federal food and consumer service shall be retained at the rate of 50 276.10percent by the state agency and 50 percent by the certifying county agency.276.11(g) A peace officer, welfare fraud investigator, federal law enforcement official, 276.12or the commissioner of health may confiscate vouchers found in the possession of any 276.13person who is neither issued vouchers under sections 
         145.891 to 
         145.897, nor otherwise 276.14authorized to possess and use such vouchers. Confiscated property shall be disposed of 276.15as the commissioner of health may direct and consistent with state and federal law. The 276.16confiscated property must be retained for a period of not less than 30 days.276.17(h) The commissioner of human services may seek a waiver from the United States 276.18Department of Agriculture to allow the state to specify foods that may and may not be 276.19purchased in Minnesota with benefits funded by the federal Food Stamp Program. The 276.20commissioner shall consult with the members of the house of representatives and senate 276.21policy committees having jurisdiction over food support issues in developing the waiver. 276.22The commissioner, in consultation with the commissioners of health and education, shall 276.23develop a broad public health policy related to improved nutrition and health status. The 276.24commissioner must seek legislative approval prior to implementing the waiver.276.25    Sec. 11. Minnesota Statutes 2010, section 402A.10, subdivision 4, is amended to read:276.26    Subd. 4. Essential human services or essential services. "Essential human 276.27services" or "essential services" means assistance and services to recipients or potential 276.28recipients of public welfare and other services delivered by counties or tribes that are 276.29mandated in federal and state law that are to be available in all counties of the state.276.30    Sec. 12. Minnesota Statutes 2010, section 402A.10, subdivision 5, is amended to read:276.31    Subd. 5. Service delivery authority. "Service delivery authority" means a single 276.32county, or group consortium of counties operating by execution of a joint powers 276.33agreement under section 
         471.59 or other contractual agreement, that has voluntarily 276.34chosen by resolution of the county board of commissioners to participate in the redesign 277.1under this chapter or has been assigned by the commissioner pursuant to section 402A.18. 277.2A service delivery authority includes an Indian tribe or group of tribes that have voluntarily 277.3chosen by resolution of tribal government to participate in redesign under this chapter.277.4    Sec. 13. Minnesota Statutes 2010, section 402A.15, is amended to read:277.5402A.15 STEERING COMMITTEE ON PERFORMANCE AND OUTCOME 277.6REFORMS.277.7    Subdivision 1. Duties. (a) The Steering Committee on Performance and Outcome 277.8Reforms shall develop a uniform process to establish and review performance and outcome 277.9standards for all essential human services based on the current level of resources available, 277.10and to shall develop appropriate reporting measures and a uniform accountability process 277.11for responding to a county's or human service delivery authority's failure to make adequate 277.12progress on achieving performance measures. The accountability process shall focus on 277.13the performance measures rather than inflexible implementation requirements.277.14(b) The steering committee shall:277.15(1) by November 1, 2009, establish an agreed-upon list of essential services;277.16(2) by February 15, 2010, develop and recommend to the legislature a uniform, 277.17graduated process, in addition to the remedies identified in section 
         402A.18, for responding 277.18to a county's failure to make adequate progress on achieving performance measures; and277.19(3) by December 15, 2012, for each essential service, make recommendations 277.20to the legislature regarding (1) (i) performance measures and goals based on those 277.21measures for each essential service, (2) and (ii) a system for reporting on the performance 277.22measures and goals, and (3) appropriate resources, including funding, needed to achieve 277.23those performance measures and goals. The resource recommendations shall take into 277.24consideration program demand and the unique differences of local areas in geography and 277.25the populations served. Priority shall be given to services with the greatest variation in 277.26availability and greatest administrative demands. By January 15 of each year starting 277.27January 15, 2011, the steering committee shall report its recommendations to the governor 277.28and legislative committees with jurisdiction over health and human services. As part of its 277.29report, the steering committee shall, as appropriate, recommend statutory provisions, rules 277.30and requirements, and reports that should be repealed or eliminated.277.31(c) As far as possible, the performance measures, reporting system, and funding 277.32shall be consistent across program areas. The development of performance measures shall 277.33consider the manner in which data will be collected and performance will be reported. 277.34The steering committee shall consider state and local administrative costs related to 277.35collecting data and reporting outcomes when developing performance measures. The 278.1steering committee shall correlate the performance measures and goals to available levels 278.2of resources, including state and local funding. The steering committee shall also identify 278.3and incorporate federal performance measures in its recommendations for those program 278.4areas where federal funding is contingent on meeting federal performance standards. The 278.5steering committee shall take into consideration that the goal of implementing changes 278.6to program monitoring and reporting the progress toward achieving outcomes is to 278.7significantly minimize the cost of administrative requirements and to allow funds freed 278.8by reduced administrative expenditures to be used to provide additional services, allow 278.9flexibility in service design and management, and focus energies on achieving program 278.10and client outcomes.278.11(d) In making its recommendations, the steering committee shall consider input from 278.12the council established in section 
         402A.20. The steering committee shall review the 278.13measurable goals established in a memorandum of understanding entered into under 278.14section 402A.30, subdivision 2, paragraph (b), and consider whether they may be applied 278.15as statewide performance outcomes.278.16(e) The steering committee shall form work groups that include persons who provide 278.17or receive essential services and representatives of organizations who advocate on behalf 278.18of those persons.278.19(f) By December 15, 2009, the steering committee shall establish a three-year 278.20schedule for completion of its work. The schedule shall be published on the Department of 278.21Human Services Web site and reported to the legislative committees with jurisdiction over 278.22health and human services. In addition, the commissioner shall post quarterly updates on 278.23the progress of the steering committee on the Department of Human Services Web site.278.24    Subd. 2. Composition. (a) The steering committee shall include:278.25(1) the commissioner of human services, or designee, and two additional 278.26representatives of the department;278.27(2) two county commissioners, representative of rural and urban counties, selected 278.28by the Association of Minnesota Counties;278.29(3) two county directors of human services, representative of rural and urban 278.30counties, selected by the Minnesota Association of County Social Service Administrators; 278.31and278.32(4) three clients or client advocates representing different populations receiving 278.33services from the Department of Human Services, who are appointed by the commissioner.278.34(b) The commissioner, or designee, and a county commissioner shall serve as 278.35cochairs of the committee. The committee shall be convened within 60 days of May 278.3615, 2009.279.1(c) State agency staff shall serve as informational resources and staff to the steering 279.2committee. Statewide county associations may assemble county program data as required.279.3(d) To promote information sharing and coordination between the steering committee 279.4and council, one of the county representatives from paragraph (a), clause (2), and one of the 279.5county representatives from paragraph (a), clause (3), must also serve as a representative 279.6on the council under section 402A.20, subdivision 1, paragraph (b), clause (5) or (6).279.7    Sec. 14. Minnesota Statutes 2010, section 402A.18, is amended to read:279.8402A.18 COMMISSIONER POWER TO REMEDY FAILURE TO MEET 279.9PERFORMANCE OUTCOMES.279.10    Subdivision 1. Underperforming county; specific service. If the commissioner 279.11determines that a county or service delivery authority is deficient in achieving minimum 279.12performance outcomes for a specific essential service, the commissioner may impose the 279.13following remedies and adjust state and federal program allocations accordingly:279.14(1) voluntary incorporation of the administration and operation of the specific 279.15essential service with an existing service delivery authority or another county. A 279.16service delivery authority or county incorporating an underperforming county shall 279.17not be financially liable for the costs associated with remedying performance outcome 279.18deficiencies;279.19(2) mandatory incorporation of the administration and operation of the specific 279.20essential service with an existing service delivery authority or another county. A 279.21service delivery authority or county incorporating an underperforming county shall 279.22not be financially liable for the costs associated with remedying performance outcome 279.23deficiencies; or 279.24(3) transfer of authority for program administration and operation of the specific 279.25essential service to the commissioner.279.26    Subd. 2. Underperforming county; more than one-half of service services. If 279.27the commissioner determines that a county or service delivery authority is deficient in 279.28achieving minimum performance outcomes for more than one-half of the defined essential 279.29service services, the commissioner may impose the following remedies:279.30(1) voluntary incorporation of the administration and operation of the specific279.31essential service services with an existing service delivery authority or another county. 279.32A service delivery authority or county incorporating an underperforming county shall 279.33not be financially liable for the costs associated with remedying performance outcome 279.34deficiencies;280.1(2) mandatory incorporation of the administration and operation of the specific280.2essential service services with an existing service delivery authority or another county. 280.3A service delivery authority or county incorporating an underperforming county shall 280.4not be financially liable for the costs associated with remedying performance outcome 280.5deficiencies; or 280.6(3) transfer of authority for program administration and operation of the specific280.7essential service services to the commissioner.280.8    Subd. 2a.Financial responsibility of underperforming county.A county subject 280.9to remedies under subdivision 1 or 2 shall provide to the entity assuming administration of 280.10the essential service or essential services the amount of nonfederal and nonstate funding 280.11needed to remedy performance outcome deficiencies.280.12    Subd. 3. Conditions prior to imposing remedies. Before the commissioner may 280.13impose the remedies authorized under this section, the following conditions must be met:280.14(1) the county or service delivery authority determined by the commissioner 280.15to be deficient in achieving minimum performance outcomes has the opportunity, in 280.16coordination with the council, to develop a program outcome improvement plan. The 280.17program outcome improvement plan must be developed no later than six months from the 280.18date of the deficiency determination; and280.19(2) the council has conducted an assessment of the program outcome improvement 280.20plan to determine if the county or service delivery authority has made satisfactory 280.21progress toward performance outcomes and has made a recommendation about remedies 280.22to the commissioner. The review assessment and recommendation must be made to the 280.23commissioner within 12 months from the date of the deficiency determination.280.24    Sec. 15. Minnesota Statutes 2010, section 402A.20, is amended to read:280.25402A.20 COUNCIL.280.26    Subdivision 1. Council. (a) The State-County Results, Accountability, and Service 280.27Delivery Redesign Council is established. Appointed council members must be appointed 280.28by their respective agencies, associations, or governmental units by November 1, 2009. 280.29The council shall be cochaired by the commissioner of human services, or designee, and a 280.30county representative from paragraph (b), clause (4) or (5), appointed by the Association 280.31of Minnesota Counties. Recommendations of the council must be approved by a majority 280.32of the voting council members. The provisions of section 
         15.059 do not apply to this 280.33council, and this council does not expire.280.34(b) The council must consist of the following members:281.1(1) two legislators appointed by the speaker of the house, one from the minority 281.2and one from the majority;281.3(2) two legislators appointed by the Senate Rules Committee, one from the majority 281.4and one from the minority;281.5(3) the commissioner of human services, or designee, and three employees from 281.6the department;281.7(4) two county commissioners appointed by the Association of Minnesota Counties;281.8(5) two county representatives appointed by the Minnesota Association of County 281.9Social Service Administrators; 281.10(6) one representative appointed by AFSCME as a nonvoting member; and281.11(7) one representative appointed by the Teamsters as a nonvoting member.281.12(c) Administrative support to the council may be provided by the Association of 281.13Minnesota Counties and affiliates.281.14(d) Member agencies and associations are responsible for initial and subsequent 281.15appointments to the council.281.16    Subd. 2. Council duties. The council shall:281.17(1) provide review of the service delivery redesign process, including proposed 281.18memoranda of understanding to establish a service delivery authority to conduct and 281.19administer experimental projects to test new methods and procedures of delivering 281.20services;281.21(2) certify, in accordance with section 402A.30, subdivision 4, the formation of 281.22a service delivery authority, including the memorandum of understanding in section 281.23402A.30, subdivision 2, paragraph (b);281.24(3) ensure the consistency of the memorandum of understanding entered into 281.25under section 402A.30, subdivision 2, paragraph (b), with the performance standards 281.26recommended by the steering committee and enacted by the legislature;281.27(4) (2) ensure the consistency of the memorandum of understanding, to the extent 281.28appropriate, or with other memorandum of understanding entered into by other service 281.29delivery authorities; 281.30(3) review and make recommendations on applications from a service delivery 281.31authority for waivers of statutory or rule program requirements that are needed for 281.32flexibility to determine the most cost-effective means of achieving specified measurable 281.33goals in a redesign of human services delivery;281.34(5) (4) establish a process to take public input on the service delivery framework 281.35specified in the memorandum of understanding in section 402A.30, subdivision 2, 282.1paragraph (b) scope of essential services over which a service delivery authority has 282.2jurisdiction;282.3(6) (5) form work groups as necessary to carry out the duties of the council under the 282.4redesign;282.5(7) (6) serve as a forum for resolving conflicts among participating counties and 282.6tribes or between participating counties or tribes and the commissioner of human services, 282.7provided nothing in this section is intended to create a formal binding legal process;282.8(8) (7) engage in the program improvement process established in section 
         402A.18, 282.9subdivision 3; and282.10(9) (8) identify and recommend incentives for counties and tribes to participate in 282.11human services service delivery authorities.282.12    Subd. 3.Program evaluation.By December 15, 2014, the council shall request 282.13consideration by the legislative auditor for a reevaluation under section 3.971, subdivision 282.147, of those aspects of the program evaluation of human services administration reported 282.15in January 2007 affected by this chapter.282.16    Sec. 16. [402A.35] DESIGNATION OF SERVICE DELIVERY AUTHORITY.282.17    Subdivision 1.Requirements for establishing a service delivery authority.282.18(a) A county, tribe, or consortium of counties is eligible to establish a service delivery 282.19authority if:282.20(1) the county, tribe, or consortium of counties is:282.21(i) a single county with a population of 55,000 or more;282.22(ii) a consortium of counties with a total combined population of 55,000 or more;282.23(iii) a consortium of four or more counties in reasonable geographic proximity 282.24without regard to population; or282.25(iv) one or more tribes with a total combined population of 25,000 or more.282.26The council may recommend that the commissioner of human services exempt a 282.27single county, tribe, or consortium of counties from the minimum population standard if 282.28the county, tribe, or consortium of counties can demonstrate that it can otherwise meet 282.29the requirements of this chapter.282.30(b) A service delivery authority shall:282.31(1) comply with current state and federal law, including any existing federal or state 282.32performance measures and performance measures under section 402A.15 when they are 282.33enacted into law, except where waivers are approved by the commissioner. Nothing 282.34in this subdivision requires the establishment of performance measures under section 283.1402A.15 prior to a service delivery authority participating in the service delivery redesign 283.2under this chapter;283.3(2) define the scope of essential services over which the service delivery authority 283.4has jurisdiction;283.5(3) designate a single administrative structure to oversee the delivery of those 283.6services included in a proposal for a redesigned service or services and identify a single 283.7administrative agent for purposes of contact and communication with the department;283.8(4) identify the waivers from statutory or rule program requirements that are needed 283.9to ensure greater local control and flexibility to determine the most cost-effective means of 283.10achieving specified measurable goals that the participating service delivery authority is 283.11expected to achieve;283.12(5) set forth a reasonable level of targeted reductions in overhead and administrative 283.13costs for each service delivery authority participating in the service delivery redesign; and283.14(6) set forth the terms under which a county, tribe, or consortium of counties may 283.15withdraw from participation.283.16(c) Once a county, tribe, or consortium of counties establishes a service delivery 283.17authority, no county, tribe, or consortium of counties that is a member of the service 283.18delivery authority may participate as a member of any other service delivery authority. 283.19The service delivery authority may allow an additional county, a tribe, or a consortium of 283.20counties to join the service delivery authority subject to the approval of the council and 283.21the commissioner.283.22(d) Nothing in this chapter precludes local governments from using sections 465.81 283.23and 465.82 to establish procedures for local governments to merge, with the consent 283.24of the voters. Nothing in this chapter limits the authority of a county board or tribal 283.25council to enter into contractual agreements for services not covered by the provisions 283.26of a memorandum of understanding establishing a service delivery authority with other 283.27agencies or with other units of government.283.28    Subd. 2.Relief from statutory requirements.(a) Unless otherwise identified in 283.29the memorandum of understanding, any county, tribe, or consortium of counties forming a 283.30service delivery authority is exempt from the provisions of sections 245.465; 245.4835; 283.31245.4874; 245.492, subdivision 2; 245.4932; 256F.13; 256J.626, subdivision 2, paragraph 283.32(b); and 256M.30.283.33(b) This subdivision does not preclude any county, tribe, or consortium of counties 283.34forming a service delivery authority from requesting additional waivers from statutory and 283.35rule requirements to ensure greater local control and flexibility.283.36    Subd. 3.Duties.The service delivery authority shall:284.1(1) within the scope of essential services set forth in the memorandum of 284.2understanding establishing the authority, carry out the responsibilities required of local 284.3agencies under chapter 393 and human services boards under chapter 402;284.4(2) manage the public resources devoted to human services and other public services 284.5delivered or purchased by the counties or tribes that are subsidized or regulated by the 284.6Department of Human Services under chapters 245 to 261;284.7(3) employ staff to assist in carrying out its duties;284.8(4) develop and maintain a continuity of operations plan to ensure the continued 284.9operation or resumption of essential human services functions in the event of any business 284.10interruption according to local, state, and federal emergency planning requirements;284.11(5) receive and expend funds received for the redesign process under the 284.12memorandum of understanding;284.13(6) plan and deliver services directly or through contract with other governmental, 284.14tribal, or nongovernmental providers;284.15(7) rent, purchase, sell, and otherwise dispose of real and personal property as 284.16necessary to carry out the redesign; and284.17(8) carry out any other service designated as a responsibility of a county.284.18    Subd. 4.Process for establishing a service delivery authority.(a) The county, 284.19tribe, or consortium of counties meeting the requirements of section 402A.30 and 284.20proposing to establish a service delivery authority shall present to the council:284.21(1) in conjunction with the commissioner, a proposed memorandum of understanding 284.22meeting the requirements of subdivision 1, paragraph (b), and outlining:284.23(i) the details of the proposal;284.24(ii) the state, tribal, and local resources, which may include, but are not limited to, 284.25funding, administrative and technology support, and other requirements necessary for 284.26the service delivery authority; and284.27(iii) the relief available to the service delivery authority if the resource commitments 284.28identified in item (ii) are not met; and284.29(2) a board resolution from the board of commissioners of each participating county 284.30stating the county's intent to participate, or in the case of a tribe, a resolution from tribal 284.31government, stating the tribe's intent to participate.284.32(b) After the council has considered and recommended approval of a proposed 284.33memorandum of understanding, the commissioner may finalize and execute the 284.34memorandum of understanding.284.35    Subd. 5.Commissioner authority to seek waivers.The commissioner may use the 284.36authority under section 256.01, subdivision 2, paragraph (l), to grant waivers identified as 285.1part of a proposed service delivery authority under subdivision 1, paragraph (b), clause 285.2(4), except that waivers granted under this section must be approved by the council under 285.3section 402A.20 rather than the Legislative Advisory Committee.285.4    Sec. 17. ALIGNMENT OF VERIFICATION AND REDETERMINATION 285.5POLICIES.285.6The commissioner of human services shall develop recommendations to align 285.7eligibility verification procedures for all health care, economic assistance, food support, 285.8child support enforcement, and child care programs. The commissioner shall report back 285.9to the chairs of the legislative committees with jurisdiction over these issues by January 285.1015, 2012, with recommendations and draft legislation to implement the alignment of 285.11eligibility verifications.285.12    Sec. 18. ALTERNATIVE STRATEGIES FOR CERTAIN 285.13REDETERMINATIONS.285.14The commissioner of human services shall develop and implement by January 15, 285.152012, a simplified process to redetermine eligibility for recipient populations in the medical 285.16assistance, Minnesota supplemental aid, food support, and group residential housing 285.17programs who are eligible based upon disability, age, or chronic medical conditions, and 285.18who are expected to experience minimal change in income or assets from month to month. 285.19The commissioner shall apply for any federal waivers needed to implement this section.285.20    Sec. 19. REQUEST FOR PROPOSALS; COMBINED ONLINE APPLICATION.285.21(a) The commissioner of human services shall issue a request for proposals for a 285.22contract to implement a phased-in integrated online eligibility and application portal for 285.23health care programs, if federal matching funds are available. The health care portal must 285.24be developed in phases with the capacity to integrate food support, cash assistance, and 285.25child care programs as funds are available. The request for proposals must require that the 285.26system recommended and implemented by the contractor:285.27(1) streamline eligibility determination and case processing in the state to support 285.28statewide eligibility processing;285.29(2) enable interested persons to determine eligibility for each program, and to apply 285.30for programs online in a manner that the applicant will be asked only those questions that 285.31relate to the programs the person is applying for;285.32(3) leverage technology that has been operational in production in other similar 285.33state environments; and286.1(4) include Web-based application and worker application processing support and 286.2opportunity for expansion.286.3(b) If responses to the request for proposals meet the requirements set forth, the 286.4commissioner shall enter into a contract for the services specified in paragraph (a) by 286.5January 31, 2012. The contract may incorporate a performance-based vendor financing 286.6option whereby the vendor shares the risk of the project's success. If the commissioner 286.7determines there is no adequate response to the request for proposals, the commissioner 286.8shall report this to the chairs and ranking minority members of the legislative committees 286.9with jurisdiction over health and human services prior to January 31, 2012.286.10EFFECTIVE DATE.This section is effective the day following final enactment.286.11    Sec. 20.  REPEALER.286.12(a) Minnesota Statutes 2010, sections 402A.30; and 402A.45, are repealed.286.13(b) Minnesota Rules, part 9500.1243, subpart 3, is repealed.286.14ARTICLE 8286.15CHEMICAL AND MENTAL HEALTH286.16    Section 1. Minnesota Statutes 2010, section 245.50, is amended to read:286.17245.50 INTERSTATE CONTRACTS, MENTAL HEALTH, CHEMICAL 286.18HEALTH, DETOXIFICATION SERVICES.286.19    Subdivision 1. Definitions. For purposes of this section, the following terms have 286.20the meanings given them.286.21    (a) "Bordering state" means Iowa, North Dakota, South Dakota, or Wisconsin.286.22    (b) "Receiving agency" means a public or private hospital, mental health center, 286.23chemical health treatment facility, detoxification facility, or other person or organization 286.24which provides mental health or, chemical health, or detoxification services under this 286.25section to individuals from a state other than the state in which the agency is located.286.26    (c) "Receiving state" means the state in which a receiving agency is located.286.27    (d) "Sending agency" means a state or county agency which sends an individual to a 286.28bordering state for treatment or detoxification under this section.286.29    (e) "Sending state" means the state in which the sending agency is located.286.30    Subd. 2. Purpose and authority. (a) The purpose of this section is to enable 286.31appropriate treatment or detoxification services to be provided to individuals, across state 286.32lines from the individual's state of residence, in qualified facilities that are closer to the 286.33homes of individuals than are facilities available in the individual's home state.287.1    (b) Unless prohibited by another law and subject to the exceptions listed in 287.2subdivision 3, a county board or the commissioner of human services may contract 287.3with an agency or facility in a bordering state for mental health or, chemical health, or 287.4detoxification services for residents of Minnesota, and a Minnesota mental health or,287.5chemical health, or detoxification agency or facility may contract to provide services to 287.6residents of bordering states. Except as provided in subdivision 5, a person who receives 287.7services in another state under this section is subject to the laws of the state in which 287.8services are provided. A person who will receive services in another state under this 287.9section must be informed of the consequences of receiving services in another state, 287.10including the implications of the differences in state laws, to the extent the individual will 287.11be subject to the laws of the receiving state.287.12    Subd. 3. Exceptions. A contract may not be entered into under this section for 287.13services to persons who:287.14    (1) are serving a sentence after conviction of a criminal offense;287.15    (2) are on probation or parole;287.16    (3) are the subject of a presentence investigation; or287.17    (4) have been committed involuntarily in Minnesota under chapter 253B for 287.18treatment of mental illness or chemical dependency, except as provided under subdivision 287.195.287.20    Subd. 4. Contracts. Contracts entered into under this section must, at a minimum:287.21    (1) describe the services to be provided;287.22    (2) establish responsibility for the costs of services;287.23    (3) establish responsibility for the costs of transporting individuals receiving 287.24services under this section;287.25    (4) specify the duration of the contract;287.26    (5) specify the means of terminating the contract;287.27    (6) specify the terms and conditions for refusal to admit or retain an individual; and287.28    (7) identify the goals to be accomplished by the placement of an individual under 287.29this section.287.30    Subd. 5. Special contracts; bordering states. (a) An individual who is detained, 287.31committed, or placed on an involuntary basis under chapter 253B may be confined or 287.32treated in a bordering state pursuant to a contract under this section. An individual 287.33who is detained, committed, or placed on an involuntary basis under the civil law of a 287.34bordering state may be confined or treated in Minnesota pursuant to a contract under 287.35this section. A peace or health officer who is acting under the authority of the sending 287.36state may transport an individual to a receiving agency that provides services pursuant to 288.1a contract under this section and may transport the individual back to the sending state 288.2under the laws of the sending state. Court orders valid under the law of the sending state 288.3are granted recognition and reciprocity in the receiving state for individuals covered by 288.4a contract under this section to the extent that the court orders relate to confinement for 288.5treatment or care of mental illness or, chemical dependency, or detoxification. Such 288.6treatment or care may address other conditions that may be co-occurring with the mental 288.7illness or chemical dependency. These court orders are not subject to legal challenge in 288.8the courts of the receiving state. Individuals who are detained, committed, or placed under 288.9the law of a sending state and who are transferred to a receiving state under this section 288.10continue to be in the legal custody of the authority responsible for them under the law 288.11of the sending state. Except in emergencies, those individuals may not be transferred, 288.12removed, or furloughed from a receiving agency without the specific approval of the 288.13authority responsible for them under the law of the sending state.288.14    (b) While in the receiving state pursuant to a contract under this section, an 288.15individual shall be subject to the sending state's laws and rules relating to length of 288.16confinement, reexaminations, and extensions of confinement. No individual may be sent 288.17to another state pursuant to a contract under this section until the receiving state has 288.18enacted a law recognizing the validity and applicability of this section.288.19    (c) If an individual receiving services pursuant to a contract under this section leaves 288.20the receiving agency without permission and the individual is subject to involuntary 288.21confinement under the law of the sending state, the receiving agency shall use all 288.22reasonable means to return the individual to the receiving agency. The receiving agency 288.23shall immediately report the absence to the sending agency. The receiving state has the 288.24primary responsibility for, and the authority to direct, the return of these individuals 288.25within its borders and is liable for the cost of the action to the extent that it would be 288.26liable for costs of its own resident.288.27    (d) Responsibility for payment for the cost of care remains with the sending agency.288.28    (e) This subdivision also applies to county contracts under subdivision 2 which 288.29include emergency care and treatment provided to a county resident in a bordering state.288.30    (f) If a Minnesota resident is admitted to a facility in a bordering state under this 288.31chapter, a physician, licensed psychologist who has a doctoral degree in psychology, or 288.32an advance practice registered nurse certified in mental health, who is licensed in the 288.33bordering state, may act as an examiner under sections 
         253B.07, 
         253B.08, 
         253B.092, 288.34253B.12
         , and 
         253B.17 subject to the same requirements and limitations in section 288.35253B.02, subdivision 7
         . Such examiner may initiate an emergency hold under section 288.36253B.05
          on a Minnesota resident who is in a hospital that is under contract with a 289.1Minnesota governmental entity under this section provided the resident, in the opinion of 289.2the examiner, meets the criteria in section 
         253B.05.289.3    (g) This section shall apply to detoxification services that are unrelated to treatment 289.4whether the services are provided on a voluntary or involuntary basis.289.5    Sec. 2. Minnesota Statutes 2010, section 246B.10, is amended to read:289.6246B.10 LIABILITY OF COUNTY; REIMBURSEMENT.289.7    The civilly committed sex offender's county shall pay to the state a portion of the 289.8cost of care provided in the Minnesota sex offender program to a civilly committed sex 289.9offender who has legally settled in that county. A county's payment must be made from 289.10the county's own sources of revenue and payments must equal ten 25 percent of the cost of 289.11care, as determined by the commissioner, for each day or portion of a day, that the civilly 289.12committed sex offender spends at the facility. If payments received by the state under this 289.13chapter exceed 90 75 percent of the cost of care, the county is responsible for paying the 289.14state the remaining amount. The county is not entitled to reimbursement from the civilly 289.15committed sex offender, the civilly committed sex offender's estate, or from the civilly 289.16committed sex offender's relatives, except as provided in section 
         246B.07.289.17EFFECTIVE DATE.This section is effective for all individuals who are civilly 289.18committed to the Minnesota sex offender program on or after August 1, 2011.289.19    Sec. 3. Minnesota Statutes 2010, section 252.025, subdivision 7, is amended to read:289.20    Subd. 7. Minnesota extended treatment options. The commissioner shall develop 289.21by July 1, 1997, the Minnesota extended treatment options to serve Minnesotans who 289.22have developmental disabilities and exhibit severe behaviors which present a risk to 289.23public safety. This program is statewide and must provide specialized residential services 289.24in Cambridge and an array of community-based services with sufficient levels of care 289.25and a sufficient number of specialists to ensure that individuals referred to the program 289.26receive the appropriate care. The individuals working in the community-based services 289.27under this section are state employees supervised by the commissioner of human services. 289.28No midcontract layoffs shall occur as a result of restructuring under this section, but 289.29layoffs may occur as a normal consequence of a low census or closure of the facility 289.30due to decreased census.290.1    Sec. 4. Minnesota Statutes 2010, section 253B.212, is amended to read:290.2253B.212 COMMITMENT; RED LAKE BAND OF CHIPPEWA INDIANS; 290.3WHITE EARTH BAND OF OJIBWE.290.4    Subdivision 1. Cost of care; commitment by tribal court order; Red Lake 290.5Band of Chippewa Indians. The commissioner of human services may contract with 290.6and receive payment from the Indian Health Service of the United States Department of 290.7Health and Human Services for the care and treatment of those members of the Red 290.8Lake Band of Chippewa Indians who have been committed by tribal court order to the 290.9Indian Health Service for care and treatment of mental illness, developmental disability, or 290.10chemical dependency. The contract shall provide that the Indian Health Service may not 290.11transfer any person for admission to a regional center unless the commitment procedure 290.12utilized by the tribal court provided due process protections similar to those afforded 290.13by sections 
         253B.05 to 
         253B.10.290.14    Subd. 1a.Cost of care; commitment by tribal court order; White Earth Band of 290.15Ojibwe Indians.The commissioner of human services may contract with and receive 290.16payment from the Indian Health Service of the United States Department of Health and 290.17Human Services for the care and treatment of those members of the White Earth Band 290.18of Ojibwe Indians who have been committed by tribal court order to the Indian Health 290.19Service for care and treatment of mental illness, developmental disability, or chemical 290.20dependency. The tribe may also contract directly with the commissioner for treatment 290.21of those members of the White Earth Band who have been committed by tribal court 290.22order to the White Earth Department of Health for care and treatment of mental illness, 290.23developmental disability, or chemical dependency. The contract shall provide that the 290.24Indian Health Service and the White Earth Band shall not transfer any person for admission 290.25to a regional center unless the commitment procedure utilized by the tribal court provided 290.26due process protections similar to those afforded by sections 253B.05 to 253B.10.290.27    Subd. 2. Effect given to tribal commitment order. When, under an agreement 290.28entered into pursuant to subdivision 1 subdivisions 1 or 1a, the Indian Health Service 290.29applies to a regional center for admission of a person committed to the jurisdiction of the 290.30health service by the tribal court as a person who is mentally ill, developmentally disabled, 290.31or chemically dependent, the commissioner may treat the patient with the consent of 290.32the Indian Health Service.290.33A person admitted to a regional center pursuant to this section has all the rights 290.34accorded by section 
         253B.03. In addition, treatment reports, prepared in accordance with 290.35the requirements of section 
         253B.12, subdivision 1, shall be filed with the Indian Health 290.36Service within 60 days of commencement of the patient's stay at the facility. A subsequent 291.1treatment report shall be filed with the Indian Health Service within six months of the 291.2patient's admission to the facility or prior to discharge, whichever comes first. Provisional 291.3discharge or transfer of the patient may be authorized by the head of the treatment facility 291.4only with the consent of the Indian Health Service. Discharge from the facility to the 291.5Indian Health Service may be authorized by the head of the treatment facility after notice 291.6to and consultation with the Indian Health Service.291.7    Sec. 5. Minnesota Statutes 2010, section 254B.03, subdivision 1, is amended to read:291.8    Subdivision 1. Local agency duties. (a) Every local agency shall provide chemical 291.9dependency services to persons residing within its jurisdiction who meet criteria 291.10established by the commissioner for placement in a chemical dependency residential 291.11or nonresidential treatment service subject to the limitations on residential chemical 291.12dependency treatment in section 254B.04, subdivision 1. Chemical dependency money 291.13must be administered by the local agencies according to law and rules adopted by the 291.14commissioner under sections 
         14.001 to 
         14.69.291.15    (b) In order to contain costs, the commissioner of human services shall select eligible 291.16vendors of chemical dependency services who can provide economical and appropriate 291.17treatment. Unless the local agency is a social services department directly administered by 291.18a county or human services board, the local agency shall not be an eligible vendor under 291.19section 
         254B.05. The commissioner may approve proposals from county boards to provide 291.20services in an economical manner or to control utilization, with safeguards to ensure that 291.21necessary services are provided. If a county implements a demonstration or experimental 291.22medical services funding plan, the commissioner shall transfer the money as appropriate.291.23    (c) A culturally specific vendor that provides assessments under a variance under 291.24Minnesota Rules, part 9530.6610, shall be allowed to provide assessment services to 291.25persons not covered by the variance.291.26    Sec. 6. Minnesota Statutes 2010, section 254B.03, subdivision 4, is amended to read:291.27    Subd. 4. Division of costs. Except for services provided by a county under 291.28section 
         254B.09, subdivision 1, or services provided under section 
         256B.69 or 
         256D.03, 291.29subdivision 4
         , paragraph (b), the county shall, out of local money, pay the state for 291.3016.14 22.95 percent of the cost of chemical dependency services, including those services 291.31provided to persons eligible for medical assistance under chapter 256B and general 291.32assistance medical care under chapter 256D. Counties may use the indigent hospitalization 291.33levy for treatment and hospital payments made under this section. 16.14 22.95 percent 291.34of any state collections from private or third-party pay, less 15 percent for the cost of 292.1payment and collections, must be distributed to the county that paid for a portion of the 292.2treatment under this section.292.3EFFECTIVE DATE.This section is effective for claims processed beginning 292.4July 1, 2011.292.5    Sec. 7. Minnesota Statutes 2010, section 254B.04, subdivision 1, is amended to read:292.6    Subdivision 1. Eligibility. (a) Persons eligible for benefits under Code of Federal 292.7Regulations, title 25, part 20, persons eligible for medical assistance benefits under 292.8sections 
         256B.055, 
         256B.056, and 
         256B.057, subdivisions 1, 2, 5, and 6, or who meet 292.9the income standards of section 
         256B.056, subdivision 4, and persons eligible for general 292.10assistance medical care under section 
         256D.03, subdivision 3, are entitled to chemical 292.11dependency fund services subject to the following limitations: (1) no more than three 292.12residential chemical dependency treatment episodes for the same person in a four-year 292.13period of time unless the person meets the criteria established by the commissioner of 292.14human services; and (2) no more than four residential chemical dependency treatment 292.15episodes in a lifetime unless the person meets the criteria established by the commissioner 292.16of human services. State money appropriated for this paragraph must be placed in a 292.17separate account established for this purpose. 292.18Persons with dependent children who are determined to be in need of chemical 292.19dependency treatment pursuant to an assessment under section 
         626.556, subdivision 10, or 292.20a case plan under section 
         260C.201, subdivision 6, or 
         260C.212, shall be assisted by the 292.21local agency to access needed treatment services. Treatment services must be appropriate 292.22for the individual or family, which may include long-term care treatment or treatment in a 292.23facility that allows the dependent children to stay in the treatment facility. The county 292.24shall pay for out-of-home placement costs, if applicable. 292.25(b) A person not entitled to services under paragraph (a), but with family income 292.26that is less than 215 percent of the federal poverty guidelines for the applicable family 292.27size, shall be eligible to receive chemical dependency fund services within the limit 292.28of funds appropriated for this group for the fiscal year. If notified by the state agency 292.29of limited funds, a county must give preferential treatment to persons with dependent 292.30children who are in need of chemical dependency treatment pursuant to an assessment 292.31under section 
         626.556, subdivision 10, or a case plan under section 
         260C.201, subdivision 292.326
         , or 
         260C.212. A county may spend money from its own sources to serve persons under 292.33this paragraph. State money appropriated for this paragraph must be placed in a separate 292.34account established for this purpose. 293.1(c) Persons whose income is between 215 percent and 412 percent of the federal 293.2poverty guidelines for the applicable family size shall be eligible for chemical dependency 293.3services on a sliding fee basis, within the limit of funds appropriated for this group for the 293.4fiscal year. Persons eligible under this paragraph must contribute to the cost of services 293.5according to the sliding fee scale established under subdivision 3. A county may spend 293.6money from its own sources to provide services to persons under this paragraph. State 293.7money appropriated for this paragraph must be placed in a separate account established 293.8for this purpose.293.9EFFECTIVE DATE.This section is effective for all chemical dependency 293.10residential treatment beginning on or after July 1, 2011.293.11    Sec. 8. Minnesota Statutes 2010, section 254B.04, is amended by adding a subdivision 293.12to read:293.13    Subd. 2a.Eligibility for treatment in residential settings.Notwithstanding 293.14provisions of Minnesota Rules, part 9530.6622, subparts 5 and 6, related to an assessor's 293.15discretion in making placements to residential treatment settings, a person eligible for 293.16services under this section must score at level 4 on assessment dimensions related to 293.17relapse, continued use, and recovery environment in order to be assigned to services with 293.18a room and board component reimbursed under this section.293.19    Sec. 9. Minnesota Statutes 2010, section 254B.06, subdivision 2, is amended to read:293.20    Subd. 2. Allocation of collections. The commissioner shall allocate all federal 293.21financial participation collections to a special revenue account. The commissioner shall 293.22allocate 83.86 77.05 percent of patient payments and third-party payments to the special 293.23revenue account and 16.14 22.95 percent to the county financially responsible for the 293.24patient.293.25EFFECTIVE DATE.This section is effective for claims processed beginning 293.26July 1, 2011.293.27    Sec. 10. Minnesota Statutes 2010, section 256B.0625, subdivision 41, is amended to 293.28read:293.29    Subd. 41. Residential services for children with severe emotional disturbance.293.30Medical assistance covers rehabilitative services in accordance with section 
         256B.0945293.31that are provided by a county or an American Indian tribe through a residential facility, 294.1for children who have been diagnosed with severe emotional disturbance and have been 294.2determined to require the level of care provided in a residential facility.294.3EFFECTIVE DATE.This section is effective October 1, 2011.294.4    Sec. 11. Minnesota Statutes 2010, section 256B.0945, subdivision 4, is amended to 294.5read:294.6    Subd. 4. Payment rates. (a) Notwithstanding sections 
         256B.19 and 
         256B.041, 294.7payments to counties for residential services provided by a residential facility shall only 294.8be made of federal earnings for services provided under this section, and the nonfederal 294.9share of costs for services provided under this section shall be paid by the county from 294.10sources other than federal funds or funds used to match other federal funds. Payment to 294.11counties for services provided according to this section shall be a proportion of the per 294.12day contract rate that relates to rehabilitative mental health services and shall not include 294.13payment for costs or services that are billed to the IV-E program as room and board.294.14    (b) Per diem rates paid to providers under this section by prepaid plans shall be 294.15the proportion of the per-day contract rate that relates to rehabilitative mental health 294.16services and shall not include payment for group foster care costs or services that are 294.17billed to the county of financial responsibility. Services provided in facilities located in 294.18bordering states are eligible for reimbursement on a fee-for-service basis only as described 294.19in paragraph (a) and are not covered under prepaid health plans.294.20    (c) Payment for mental health rehabilitative services provided under this section by 294.21or under contract with an American Indian tribe or tribal organization or by agencies 294.22operated by or under contract with an American Indian tribe or tribal organization must 294.23be made according to section 256B.0625, subdivision 34, or other relevant federally 294.24approved rate-setting methodology.294.25(d) The commissioner shall set aside a portion not to exceed five percent of the 294.26federal funds earned for county expenditures under this section to cover the state costs of 294.27administering this section. Any unexpended funds from the set-aside shall be distributed 294.28to the counties in proportion to their earnings under this section.294.29EFFECTIVE DATE.This section is effective October 1, 2011.294.30    Sec. 12. COMMUNITY MENTAL HEALTH SERVICES; USE OF 294.31BEHAVIORAL HEALTH HOSPITALS.294.32The commissioner shall issue a written report to the chairs and ranking minority 294.33members of the house and senate committees with jurisdiction of health and human 295.1services by December 31, 2011, on how the community behavioral health hospital 295.2facilities will be fully utilized to meet the mental health needs of regions in which the 295.3hospitals are located. The commissioner must consult with the regional planning work 295.4groups for adult mental health and must include the recommendations of the work groups 295.5in the legislative report. The report must address future use of community behavioral 295.6health hospitals that are not certified as Medicaid eligible by CMS or have a less than 65 295.7percent licensed bed occupancy rate, and using the facilities for another purpose that will 295.8meet the mental health needs of residents of the region. The regional planning work 295.9groups shall work with the commissioner to prioritize the needs of their regions. These 295.10priorities, by region, must be included in the commissioner's report to the legislature.295.11    Sec. 13. INTEGRATED DUAL DIAGNOSIS TREATMENT.295.12(a) The commissioner shall require individuals who perform chemical dependency 295.13assessments or mental health assessments to use approved screening tools in order to 295.14identify whether an individual who is the subject of the assessment has a co-occurring 295.15mental health or chemical dependency disorder. Screening for co-occurring disorders must 295.16begin no later than December 31, 2011.295.17(b) No later than October 1, 2011, the commissioner shall develop and implement a 295.18certification process for integrated dual diagnosis treatment providers.295.19(c) No later than December 31, 2011, the commissioner shall develop and implement 295.20a referral system so that individuals who, at screening, are identified with co-occurring 295.21disorders are referred to certified integrated dual diagnosis treatment providers.295.22(d) The commissioner shall apply for any federal waivers necessary to secure, to the 295.23extent allowed by law, federal financial participation for the provision of integrated dual 295.24diagnosis treatment to persons with co-occurring disorders.295.25    Sec. 14. STATE-OPERATED SERVICES FACILITIES.295.26    (a) The commissioner shall close the Willmar Community Behavioral Health 295.27Hospital no later than October 1, 2011.295.28    (b) The commissioner shall present a plan to the legislative committees with 295.29jurisdiction over health and human services finance no later than January 1, 2012, on 295.30how the department will:295.31    (1) accommodate the mental health needs of clients impacted by the closure or 295.32redesign of any state-operated services facilities; and295.33    (2) accommodate the state employees adversely affected by the closure or redesign 295.34of any state-operated services facilities.296.1    Sec. 15. REGIONAL TREATMENT CENTERS; EMPLOYEES; REPORT.296.2(a) No layoffs shall occur as a result of restructuring services at the Anoka-Metro 296.3Regional Treatment Center.296.4(b) The commissioner shall issue a report to the legislative committees with 296.5jurisdiction over health and human services finance no later than December 31, 2011, 296.6which provides the number of employees in management positions at the Anoka-Metro 296.7Regional Treatment Center and the Minnesota Security Hospital at St. Peter and the ratio 296.8of management to direct-care staff for each facility.296.9    Sec. 16. COMMISSIONER'S CRITERIA FOR RESIDENTIAL TREATMENT.296.10The commissioner shall develop specific criteria to approve treatment for individuals 296.11who require residential chemical dependency treatment in excess of the maximum allowed 296.12in section 254B.04, subdivision 1, due to co-occurring disorders, including disorders 296.13related to cognition, traumatic brain injury, or documented disability. Criteria shall be 296.14developed for use no later than October 1, 2011.296.15    Sec. 17.  REPEALER.296.16Laws 2009, chapter 79, article 3, section 18, as amended by Laws 2010, First Special 296.17Session chapter 1, article 19, section 19, is repealed.296.18ARTICLE 9296.19HEALTH AND HUMAN SERVICES APPROPRIATIONS

296.20Section 1.  SUMMARY OF APPROPRIATIONS.

296.21The amounts shown in this section summarize direct appropriations, by fund, made 296.22in this article.

296.2320122013Total296.24General$5,646,994,000$5,159,920,000$10,806,914,000296.25296.26State Government Special Revenue63,198,00063,154,000126,352,000296.27Health Care Access400,917,000409,880,000810,797,000296.28Federal TANF274,091,000282,814,000556,905,000296.29Lottery Prize Fund1,665,0001,665,0003,330,000296.30Total$6,386,865,000$5,917,433,000$12,304,298,000

296.31Sec. 2. HUMAN SERVICES APPROPRIATIONS.

296.32The sums shown in the columns marked "Appropriations" are appropriated to the 296.33agencies and for the purposes specified in this article. The appropriations are from the 297.1general fund, or another named fund, and are available for the fiscal years indicated 297.2for each purpose. The figures "2012" and "2013" used in this article mean that the 297.3appropriations listed under them are available for the fiscal year ending June 30, 2012, or 297.4June 30, 2013, respectively. "The first year" is fiscal year 2012. "The second year" is fiscal 297.5year 2013. "The biennium" is fiscal years 2012 and 2013.

297.6APPROPRIATIONS297.7Available for the Year297.8Ending June 30297.920122013

297.10297.11Sec. 3. COMMISSIONER OF HUMAN SERVICES

297.12Subdivision 1.Total Appropriation$6,215,925,000$5,756,045,000

297.13Appropriations by Fund297.1420122013297.15General5,564,174,0005,081,996,000297.16297.17State Government Special Revenue565,000565,000297.18Health Care Access387,143,000400,718,000297.19Federal TANF262,378,000271,101,000297.20Lottery Prize Fund1,665,0001,665,000

297.21Receipts for Systems Projects. 297.22Appropriations and federal receipts for 297.23information systems projects for MAXIS, 297.24PRISM, MMIS, and SSIS must be deposited 297.25in the state systems account authorized in 297.26Minnesota Statutes, section 256.014. Money 297.27appropriated for computer projects approved 297.28by the Minnesota Office of Enterprise 297.29Technology, funded by the legislature, 297.30and approved by the commissioner of 297.31Minnesota Management and Budget, may 297.32be transferred from one project to another 297.33and from development to operations as the 297.34commissioner of human services considers 297.35necessary. Any unexpended balance in 297.36the appropriation for these projects does 298.1not cancel but is available for ongoing 298.2development and operations.298.3Nonfederal Share Transfers. The 298.4nonfederal share of activities for which 298.5federal administrative reimbursement is 298.6appropriated to the commissioner may be 298.7transferred to the special revenue fund.298.8TANF Maintenance of Effort.298.9(a) In order to meet the basic maintenance 298.10of effort (MOE) requirements of the TANF 298.11block grant specified under Code of Federal 298.12Regulations, title 45, section 263.1, the 298.13commissioner may only report nonfederal 298.14money expended for allowable activities 298.15listed in the following clauses as TANF/MOE 298.16expenditures:298.17(1) MFIP cash, diversionary work program, 298.18and food assistance benefits under Minnesota 298.19Statutes, chapter 256J;298.20(2) the child care assistance programs 298.21under Minnesota Statutes, sections 119B.03 298.22and 119B.05, and county child care 298.23administrative costs under Minnesota 298.24Statutes, section 119B.15;298.25(3) state and county MFIP administrative 298.26costs under Minnesota Statutes, chapters 298.27256J and 256K;298.28(4) state, county, and tribal MFIP 298.29employment services under Minnesota 298.30Statutes, chapters 256J and 256K;298.31(5) expenditures made on behalf of 298.32noncitizen MFIP recipients who qualify 298.33for the medical assistance without federal 298.34financial participation program under 299.1Minnesota Statutes, section 256B.06, 299.2subdivision 4, paragraphs (d), (e), and (j);299.3(6) qualifying working family credit 299.4expenditures under Minnesota Statutes, 299.5section 290.0671; and299.6(7) qualifying Minnesota education credit 299.7expenditures under Minnesota Statutes, 299.8section 290.0674.299.9(b) The commissioner shall ensure that 299.10sufficient qualified nonfederal expenditures 299.11are made each year to meet the state's 299.12TANF/MOE requirements. For the activities 299.13listed in paragraph (a), clauses (2) to 299.14(7), the commissioner may only report 299.15expenditures that are excluded from the 299.16definition of assistance under Code of 299.17Federal Regulations, title 45, section 260.31.299.18(c) For fiscal years beginning with state fiscal 299.19year 2003, the commissioner shall assure 299.20that the maintenance of effort used by the 299.21commissioner of management and budget 299.22for the February and November forecasts 299.23required under Minnesota Statutes, section 299.2416A.103, contains expenditures under 299.25paragraph (a), clause (1), equal to at least 16 299.26percent of the total required under Code of 299.27Federal Regulations, title 45, section 263.1.299.28(d) Minnesota Statutes, section 256.011, 299.29subdivision 3, which requires that federal 299.30grants or aids secured or obtained under that 299.31subdivision be used to reduce any direct 299.32appropriations provided by law, do not apply 299.33if the grants or aids are federal TANF funds.299.34(e) Notwithstanding any contrary provision 299.35in this article, paragraph (a), clauses (1) to 300.1(7), and paragraphs (b) to (d), expire June 300.230, 2015.300.3Working Family Credit Expenditures 300.4as TANF/MOE. The commissioner may 300.5claim as TANF maintenance of effort up to 300.6$6,707,000 per year of working family credit 300.7expenditures for fiscal years 2012 and 2013.300.8Working Family Credit Expenditures 300.9to be Claimed for TANF/MOE. The 300.10commissioner may count the following 300.11amounts of working family credit 300.12expenditures as TANF/MOE:300.13(1) fiscal year 2012, $12,037,000;300.14(2) fiscal year 2013, $29,942,000;300.15(3) fiscal year 2014, $23,235,000; and300.16(4) fiscal year 2015, $23,198,000.300.17Notwithstanding any contrary provision in 300.18this article, this rider expires June 30, 2015.300.19TANF Transfer to Federal Child Care 300.20and Development Fund. (a) The following 300.21TANF fund amounts are appropriated 300.22to the commissioner for purposes of 300.23MFIP/Transition Year Child Care Assistance 300.24under Minnesota Statutes, section 119B.05:300.25(1) fiscal year 2012, $11,020,000;300.26(2) fiscal year 2013, $35,020,000;300.27(3) fiscal year 2014, $14,020,000; and300.28(4) fiscal year 2015, $14,020,000.300.29(b) The commissioner shall authorize the 300.30transfer of sufficient TANF funds to the 300.31federal child care and development fund to 300.32meet this appropriation and shall ensure that 300.33all transferred funds are expended according 301.1to federal child care and development fund 301.2regulations.301.3Food Stamps Employment and Training 301.4Funds. (a) Notwithstanding Minnesota 301.5Statutes, sections 256D.051, subdivisions 1a, 301.66b, and 6c, and 256J.626, federal food stamps 301.7employment and training funds received 301.8as reimbursement for child care assistance 301.9program expenditures must be deposited in 301.10the general fund. The amount of funds must 301.11be limited to $500,000 per year in fiscal 301.12years 2012 through 2015, contingent upon 301.13approval by the federal Food and Nutrition 301.14Service.301.15(b) Consistent with the receipt of these 301.16federal funds, the commissioner may 301.17adjust the level of working family credit 301.18expenditures claimed as TANF maintenance 301.19of effort. Notwithstanding any contrary 301.20provision in this article, this rider expires 301.21June 30, 2015.301.22ARRA Food Support Benefit Increases. 301.23The funds provided for food support benefit 301.24increases under the Supplemental Nutrition 301.25Assistance Program provisions of the 301.26American Recovery and Reinvestment Act 301.27(ARRA) of 2009 must be used for benefit 301.28increases beginning July 1, 2009.301.29Supplemental Security Interim Assistance 301.30Reimbursement Funds. $2,800,000 of 301.31uncommitted revenue available to the 301.32commissioner of human services for SSI 301.33advocacy and outreach services must be 301.34transferred to and deposited into the general 301.35fund by June 30, 2012.

302.1Subd. 2.Central Office Operations

302.2The amounts that may be spent from this 302.3appropriation for each purpose are as follows:

302.4(a) Operations

302.5Appropriations by Fund302.6General81,458,00080,335,000302.7Health Care Access11,742,00011,508,000302.8302.9State Government Special Revenue440,000440,000302.10Federal TANF222,000222,000

302.11DHS Receipt Center Accounting. The 302.12commissioner is authorized to transfer 302.13appropriations to, and account for DHS 302.14receipt center operations in, the special 302.15revenue fund.302.16Base Adjustment. The general fund base 302.17for fiscal year 2014 shall be increased by 302.18$79,000. This adjustment is onetime.

302.19(b) Children and Families

302.20Appropriations by Fund302.21General9,615,0009,417,000302.22Federal TANF2,160,0002,160,000

302.23Financial Institution Data Match and 302.24Payment of Fees. The commissioner is 302.25authorized to allocate up to $310,000 each 302.26year in fiscal years 2012 and 2013 from the 302.27PRISM special revenue account to make 302.28payments to financial institutions in exchange 302.29for performing data matches between account 302.30information held by financial institutions 302.31and the public authority's database of child 302.32support obligors as authorized by Minnesota 302.33Statutes, section 13B.06, subdivision 7.

302.34(c) Health Care

303.1Appropriations by Fund303.2General16,284,00016,030,000303.3Health Care Access22,574,00026,555,000

303.4Minnesota Senior Health Options 303.5Reimbursement. Federal administrative 303.6reimbursement resulting from the Minnesota 303.7senior health options project is appropriated 303.8to the commissioner for this activity.303.9Utilization Review. Federal administrative 303.10reimbursement resulting from prior 303.11authorization and inpatient admission 303.12certification by a professional review 303.13organization shall be dedicated to the 303.14commissioner for these purposes. A portion 303.15of these funds must be used for activities to 303.16decrease unnecessary pharmaceutical costs 303.17in medical assistance.303.18Base Adjustment. The general fund base 303.19shall be decreased by $2,000 in fiscal year 303.202014 and $114,000 in 2015.303.21The health care access fund base is decreased 303.22by $16,000 in fiscal year 2014 and $142,000 303.23in 2015.

303.24(d) Continuing Care

303.25Appropriations by Fund303.26General18,110,00018,011,000303.27303.28State Government Special Revenue125,000125,000

303.29Base Adjustment. The general fund base is 303.30decreased by $259,000 in each of fiscal years 303.312014 and 2015.

303.32(e) Chemical and Mental Health

303.33Appropriations by Fund303.34General4,194,0004,194,000303.35Lottery Prize157,000157,000

304.1Subd. 3.Forecasted Programs

304.2The amounts that may be spent from this 304.3appropriation for each purpose are as follows:

304.4(a) MFIP/DWP Grants

304.5Appropriations by Fund304.6General84,256,00091,212,000304.7Federal TANF84,425,00075,417,000

304.8(b) MFIP Child Care Assistance Grants55,726,00026,652,000

304.9(c) General Assistance Grants43,629,00042,440,000

304.10General Assistance Standard. The 304.11commissioner shall set the monthly standard 304.12of assistance for general assistance units 304.13consisting of an adult recipient who is 304.14childless and unmarried or living apart 304.15from parents or a legal guardian at $203. 304.16The commissioner may reduce this amount 304.17according to Laws 1997, chapter 85, article 304.183, section 54.304.19Emergency General Assistance. The 304.20amount appropriated for emergency general 304.21assistance funds is limited to no more 304.22than $7,889,812 in fiscal year 2012 and 304.23$7,889,812 in fiscal year 2013. Funds 304.24to counties shall be allocated by the 304.25commissioner using the allocation method 304.26specified in Minnesota Statutes, section 304.27256D.06.

304.28(d) Minnesota Supplemental Aid Grants38,091,00039,092,000

304.29Emergency Minnesota Supplemental 304.30Aid Funds. The amount appropriated for 304.31emergency Minnesota supplemental aid 304.32funds is limited to no more than $1,100,000 304.33in fiscal year 2012 and $1,100,000 in fiscal 304.34year 2013. Funds to counties shall be 305.1allocated by the commissioner using the 305.2allocation method specified in Minnesota 305.3Statutes, section 256D.46.

305.4(e) Group Residential Housing Grants121,092,000129,250,000

305.5(f) MinnesotaCare Grants351,927,000361,755,000

305.6This appropriation is from the health care 305.7access fund.

305.8(g) GAMC Grants120,000,000280,000,000

305.9Coordinated Care Delivery System. This 305.10appropriation is to fund coordinated care 305.11delivery systems under Minnesota Statutes, 305.12section 256D.031, subdivision 6.305.13Payments for Cost Settlements. The 305.14commissioner is authorized to use amounts 305.15repaid to the general assistance medical care 305.16program under Minnesota Statutes 2009 305.17Supplement, section 256D.03, subdivision 305.183, to pay cost settlements for claims for 305.19services provided prior to June 1, 2010. 305.20Notwithstanding any contrary provision in 305.21this article, this provision does not expire.305.22Base Adjustment. The general fund base is 305.23reduced by $120,000,000 in fiscal year 2014 305.24and by $280,000,000 in fiscal year 2015.

305.25(h) Medical Assistance Grants4,253,018,0003,602,473,000

305.26Managed Care Incentive Payments. The 305.27commissioner shall not make managed care 305.28incentive payments for expanding preventive 305.29services during fiscal years beginning July 1, 305.302011 and July 1, 2012.305.31Reduction of Rates for Congregate 305.32Living for Individuals with Lower Needs. 305.33Beginning October 1, 2011, lead agencies 306.1must reduce rates in effect on January 1, 306.22011, by ten percent for individuals with 306.3lower needs living in foster care settings 306.4where the license holder does not share the 306.5residence with recipients on the CADI, DD, 306.6and TBI waivers and customized living 306.7settings for CADI and TBI. Lead agencies 306.8must adjust contracts within 60 days of the 306.9effective date.306.10Reduction of Lead Agency Waiver 306.11Allocations to Implement Rate Reductions 306.12for Congregate Living for Individuals 306.13with Lower Needs. Beginning October 1, 306.142011, the commissioner shall reduce lead 306.15agency waiver allocations to implement the 306.16reduction of rates for individuals with lower 306.17needs living in foster care settings where the 306.18license holder does not share the residence 306.19with recipients on the CADI, DD, and TBI 306.20waivers and customized living settings for 306.21CADI and TBI.306.22Home and Community-Based Waiver 306.23Appropriations Limits.  Total state and 306.24federal funding for the biennium beginning 306.25on July 1, 2011, for the Medicaid home 306.26and community-based waivers for persons 306.27with disabilities including DD waiver under 306.28Minnesota Statutes, section 256B.092; and 306.29the CADI and TBI waivers under Minnesota 306.30Statutes, section 256B.49, are limited to 306.31the following amounts: the DD waiver 306.32is limited to $2,038,330,000; the CADI 306.33waiver is limited to $963,854,000;and the 306.34TBI waiver is limited to $206,408,000. Of 306.35these amounts, the commissioner shall set 306.36aside five percent of each waiver amount 307.1to manage emergency situations around the 307.2state. The commissioner must ensure that at 307.3least the same number of people are served 307.4on the home and community-based waiver 307.5programs as were served on March 30, 307.62010. Notwithstanding any law or rule to the 307.7contrary, in order to meet the funding limits 307.8in this provision, the commissioner may 307.9reduce or adjust benefits and services, reduce 307.10or adjust case-mix capitation rates, limit or 307.11freeze waiver enrollment, establish needed 307.12thresholds for service eligibility, adjust 307.13eligibility criteria to the extent allowable 307.14under federal regulations, establish prior 307.15authorization criteria, and adjust county home 307.16and community-based waiver allocations 307.17as needed. Priorities for the use of waiver 307.18slots must be for individuals anticipated to 307.19be discharged from an institutional setting or 307.20who are at imminent risk of an institutional 307.21placement. The limits include conversions 307.22and diversions, unless the commissioner has 307.23approved a plan to convert funding due to 307.24the restructuring, closure, or downsizing of 307.25a residential facility or nursing facility to 307.26serve directly affected individuals on the 307.27home and community-based waivers. The 307.28commissioner and counties are prohibited 307.29from reducing provider rates under this 307.30provision unless the reduction is due to a 307.31change in the type or amount of services to be 307.32delivered. The commissioner shall maintain 307.33the waiting list and access to the waiver.307.34Management of Fee-for-Service Spending. 307.35Total state and federal funding for the 307.36biennium beginning on July 1, 2011, for 308.1fee-for-service medical assistance basic care 308.2for the elderly and persons with disabilities 308.3is limited to $2,536,949,000. Total state and 308.4federal funding for the biennium beginning 308.5July 1, 2011, for fee-for-service medical 308.6assistance basic care for adults without 308.7children is limited to $526,251,000.308.8(1) Total state and federal funding for 308.9fee-for-service medical assistance basic care 308.10for the elderly and persons with disabilities is 308.11limited to $950,183,000 for fiscal year 2012 308.12and $1,115,961,000 for fiscal year 2013.308.13(2) The commissioner shall contract with 308.14a vendor to manage spending within these 308.15limits, beginning January 1, 2012. The 308.16vendor selected may:308.17(i) manage and coordinate the care provided 308.18by high-cost providers;308.19(ii) implement payment reform initiatives to 308.20encourage efficient and cost-effective service 308.21provision;308.22(iii) identify and deny payment for 308.23unnecessary services; and308.24(iv) implement other initiatives proven to 308.25improve the efficiency of fee-for-service care 308.26delivery.308.27The contract with the vendor must be 308.28on a contingency basis, under which the 308.29vendor retains six percent of any savings 308.30obtained from management of fee-for-service 308.31spending.308.32(3) The commissioner, by October 1, 2012, 308.33shall evaluate the extent to which initiatives 308.34implemented by the vendor will be successful 309.1in managing spending within the specified 309.2limits. If the commissioner determines 309.3that the vendor will not be successful in 309.4managing spending within the specified 309.5limits, the commissioner shall reduce medical 309.6assistance provider payments by an amount 309.7sufficient to comply with the spending 309.8limits. In implementing rate reductions, the 309.9commissioner shall exempt payments to 309.10nursing facilities and providers of home and 309.11community-based waiver services.309.12Contingent Rate Reductions. If 309.13the commissioner determines that 309.14implementation of the global waiver under 309.15Minnesota Statutes, sections 256B.841, 309.16256B.842, and 256B.843, will not achieve a 309.17state general fund savings of $300,000,000 309.18for the biennium beginning July 1, 2011, the 309.19commissioner shall calculate an estimate of 309.20the shortfall in savings, and, for the fiscal 309.21year beginning July 1, 2012, shall reduce 309.22medical assistance provider payment rates, 309.23including but not limited to rates to individual 309.24health care providers and provider agencies, 309.25hospitals, nursing facilities, other residential 309.26settings, and capitation rates provided to 309.27managed care and county-based purchasing 309.28plans, by the amount necessary to recoup the 309.29shortfall in savings over that fiscal year.

309.30(i) Alternative Care Grants44,630,00044,689,000

309.31Alternative Care Transfer. Any money 309.32allocated to the alternative care program that 309.33is not spent for the purposes indicated does 309.34not cancel but shall be transferred to the 309.35medical assistance account.

310.1(j) Chemical Dependency Entitlement Grants104,113,000127,281,000

310.2Subd. 4.Grant Programs

310.3The amounts that may be spent from this 310.4appropriation for each purpose are as follows:

310.5(a) Support Services Grants

310.6Appropriations by Fund310.7General8,715,0008,715,000310.8Federal TANF96,525,00090,611,000

310.9MFIP Consolidated Fund Grants. The 310.10TANF fund base is reduced by $14,000,000 310.11each year beginning in fiscal year 2012.310.12Subsidized Employment Funding Through 310.13ARRA. The commissioner is authorized to 310.14apply for TANF emergency fund grants for 310.15subsidized employment activities. Growth 310.16in expenditures for subsidized employment 310.17within the supported work program and the 310.18MFIP consolidated fund over the amount 310.19expended in the calendar year quarters in 310.20the TANF emergency fund base year shall 310.21be used to leverage the TANF emergency 310.22fund grants for subsidized employment and 310.23to fund supported work. The commissioner 310.24shall develop procedures to maximize 310.25reimbursement of these expenditures over the 310.26TANF emergency fund base year quarters, 310.27and may contract directly with employers 310.28and providers to maximize these TANF 310.29emergency fund grants.310.30Healthy Communities. $150,000 in fiscal 310.31year 2012 and $150,000 in fiscal year 2013 310.32are appropriated from the general fund to 310.33the commissioner of human services for 310.34contracting with the Search Institute to 311.1promote healthy community initiatives. 311.2The commissioner may expend up to five 311.3percent of the appropriation to provide for 311.4the program evaluation.311.5Circles of Support. $200,000 in fiscal year 311.62012 and $200,000 in fiscal year 2013 are 311.7appropriated from the general fund to the 311.8commissioner of human services for the 311.9purpose of providing grants to community 311.10action agencies for circles of support 311.11initiatives.311.12Northern Connections. $100,000 is 311.13appropriated in fiscal year 2012 and 311.14$100,000 is appropriated in fiscal year 2013 311.15from the general fund to the commissioner 311.16of human services for a grant to expand 311.17Northern Connections workforce program 311.18that provides one-stop supportive services 311.19to individuals as they transition into the 311.20workforce to up to two interested counties in 311.21rural Minnesota.

311.22311.23(b) Basic Sliding Fee Child Care Assistance Grants38,131,00041,035,000

311.24Base Adjustment. The general fund base is 311.25decreased by $1,131,000 in fiscal year 2014 311.26and $1,126,000 in fiscal year 2015.311.27Child Care and Development Fund 311.28Unexpended Balance. In addition to 311.29the amount provided in this section, the 311.30commissioner shall expend $5,000,000 311.31in fiscal year 2012 from the federal child 311.32care and development fund unexpended 311.33balance for basic sliding fee child care under 311.34Minnesota Statutes, section 119B.03. The 311.35commissioner shall ensure that all child 312.1care and development funds are expended 312.2according to the federal child care and 312.3development fund regulations.

312.4(c) Child Care Development Grants1,487,0001,487,000

312.5(d) Child Support Enforcement Grants50,00050,000

312.6Federal Child Support Demonstration 312.7Grants. Federal administrative 312.8reimbursement resulting from the federal 312.9child support grant expenditures authorized 312.10under section 1115a of the Social Security 312.11Act is appropriated to the commissioner for 312.12this activity.

312.13(e) Children's Services Grants

312.14Appropriations by Fund312.15General46,788,00046,788,000312.16Federal TANF140,000140,000

312.17Adoption Assistance and Relative Custody 312.18Assistance Payments. $1,661,000 each 312.19year is for continuation of current payments 312.20for adoption assistance and relative custody 312.21assistance.312.22Adoption Assistance and Relative Custody 312.23Assistance Transfer.  The commissioner 312.24may transfer unencumbered appropriation 312.25balances for adoption assistance and relative 312.26custody assistance between fiscal years and 312.27between programs.312.28Privatized Adoption Grants. Federal 312.29reimbursement for privatized adoption grant 312.30and foster care recruitment grant expenditures 312.31is appropriated to the commissioner for 312.32adoption grants and foster care and adoption 312.33administrative purposes.313.1Adoption Assistance Incentive Grants.313.2Federal funds available during fiscal year 313.32012 and fiscal year 2013 for adoption 313.4incentive grants are appropriated to the 313.5commissioner for these purposes.

313.6(f) Children and Community Services Grants64,301,00064,301,000

313.7(g) Children and Economic Support Grants16,755,00016,265,000

313.8Long-term homeless services. $700,000 313.9is appropriated from the federal TANF 313.10fund for the biennium beginning July 313.111, 2011, to the commissioner of human 313.12services for long-term homeless services 313.13for low-income homeless families under 313.14Minnesota Statutes, section 256K.26. This 313.15is a onetime appropriation and is not added 313.16to the base.313.17Base Adjustment. The general fund base 313.18is increased by $491,000 in fiscal year 2014 313.19only.

313.20(h) Health Care Grants

313.21Appropriations by Fund313.22General195,000-0-313.23Health Care Access900,000900,000

313.24Surplus Appropriation Canceled. Of the 313.25appropriation in Laws 2009, chapter 79, 313.26article 13, section 3, subdivision 6, paragraph 313.27(e), for the COBRA premium state subsidy 313.28program, $11,750,000 must be canceled in 313.29fiscal year 2011. This provision is effective 313.30the day following final enactment.313.31Grant Cancellation. Effective for the 313.32biennium beginning July 1, 2011, the 313.33following appropriations are canceled: (1) a 313.34general fund appropriation of $205,000 for 314.1the U Special Kids program; (2) a general 314.2fund appropriation of $90,000 for medical 314.3assistance outreach grants; and (3) a health 314.4care access fund appropriation of $40,000 for 314.5MinnesotaCare outreach grants.314.6State Subsidy Program for Community 314.7Mental Health Centers. $100,000 is 314.8appropriated from the general fund to 314.9the commissioner of human services for 314.10the biennium beginning July 1, 2011, to 314.11provide onetime grants to establish new 314.12community mental health centers that are 314.13eligible for payment under Minnesota 314.14Statutes, section 256B.0625, subdivision 5. 314.15In awarding grants, the commissioner shall 314.16give preference to areas of the state that 314.17lack access to mental health services or are 314.18underserved.

314.19(i) Aging and Adult Services Grants18,734,00018,910,000

314.20Aging Grants Reduction. Effective July 314.211, 2011, funding for grants made under 314.22Minnesota Statutes, sections 256.9754 and 314.23256B.0917, subdivision 13, is reduced by 314.24$3,600,000 for each year of the biennium. 314.25These reductions are onetime and do 314.26not affect base funding for the 2014-2015 314.27biennium. Grants made during the 2012-2013 314.28biennium under Minnesota Statutes, section 314.29256B.9754, must not be used for new 314.30construction or building renovation.314.31Essential Community Support Grant 314.32Delay. Essential community supports 314.33grants under Minnesota Statutes, section 314.34256B.0917, subdivision 14, is reduced 314.35by $6,410,000 in fiscal year 2012 and 315.1$7,279,000 in fiscal year 2013. Base level 315.2funding for fiscal year 2014 is reduced by 315.3$5,919,000. These reductions are onetime 315.4and do not affect base level funding for fiscal 315.5year 2015.

315.6(j) Deaf and Hard-of-Hearing Grants1,936,0001,767,000

315.7(k) Disabilities Grants22,025,00023,863,000

315.8Money Follows the Person Rebalancing 315.9Demonstration Project. Notwithstanding 315.10the provisions of Minnesota Statutes, section 315.11256.011, subdivision 3, estimated general 315.12fund savings resulting from the operation of 315.13the Money Follows the Person federal grant 315.14fund must be retained within the medical 315.15assistance general fund appropriation for the 315.16payment of federally required rebalancing 315.17expenditures. If a rebalancing expenditure 315.18is not eligible for medical assistance, the 315.19corresponding portion of estimated savings 315.20must be transferred to and paid from a special 315.21revenue account established for this purpose. 315.22Money in the account does not cancel and 315.23is appropriated to the commissioner for the 315.24purposes of the demonstration project.315.25Region 10. Any unspent allocation for 315.26Region 10 Quality Assurance from the 315.27biennium beginning on July 1, 2009, may be 315.28carried over into the biennium beginning on 315.29July 1, 2011.315.30Local Planning Grants for Creating 315.31Alternatives to Congregate Living for 315.32Individuals with Lower Needs. The 315.33commissioner shall make available a total 315.34of $250,000 per year in local planning 315.35grants, beginning July 1, 2011, to assist 316.1lead agencies and provider organizations in 316.2developing alternatives to congregate living 316.3within the available level of resources for the 316.4home and community-based services waivers 316.5for persons with disabilities.

316.6(l) Adult Mental Health Grants

316.7Appropriations by Fund316.8General77,539,00077,539,000316.9Lottery Prize Fund1,508,0001,508,000

316.10Funding Usage. Up to 75 percent of a fiscal 316.11year's appropriation for adult mental health 316.12grants may be used to fund allocations in that 316.13portion of the fiscal year ending December 316.1431.316.15Base Adjustment. The lottery prize fund 316.16base for this program shall be increased by 316.17$78,000 in each of fiscal years 2014 and 316.182015.

316.19(m) Children's Mental Health Grants16,682,00016,682,000

316.20Funding Usage. Up to 75 percent of a fiscal 316.21year's appropriation for children's mental 316.22health grants may be used to fund allocations 316.23in that portion of the fiscal year ending 316.24December 31.

316.25316.26(n) Chemical Dependency Nonentitlement Grants1,336,0001,336,000

316.27Subd. 5.State-Operated Services

316.28Transfer Authority Related to 316.29State-Operated Services. Money 316.30appropriated for state-operated services 316.31may be transferred between fiscal years 316.32of the biennium with the approval of the 316.33commissioner of management and budget.

316.34(a) State-Operated Services Mental Health115,286,000115,135,000

317.1State-Operated Services.  To achieve these 317.2savings, the commissioner shall close the 317.3Willmar Community Behavioral Health 317.4Hospital no later than October 1, 2011, and 317.5shall close the inpatient child and adolescent 317.6behavioral health service program in 317.7Willmar, the subacute mental health facility 317.8in Wadena, and the community behavioral 317.9health hospitals in Alexandria, Annandale, 317.10Baxter, Bemidji, Fergus Falls, and Rochester 317.11no later than October 1, 2012.317.12Base Adjustment. The general fund base is 317.13reduced by $8,443,000 in fiscal year 2014 317.14and $11,543,000 in fiscal year 2015.

317.15(b) Minnesota Security Hospital69,582,00069,582,000

317.16Subd. 6.Sex Offender Program70,416,00067,570,000

317.17Transfer Authority Related to Minnesota 317.18Sex Offender Program. Money 317.19appropriated for the Minnesota sex offender 317.20program may be transferred between fiscal 317.21years of the biennium with the approval 317.22of the commissioner of management and 317.23budget.317.24Minnesota Sex Offender Program 317.25Reduction.  The fiscal year 2011 general 317.26fund appropriation for Minnesota sex 317.27offender services under Laws 2009, chapter 317.2879, article 13, section 3, subdivision 10, 317.29paragraph (b), is reduced by $3,000,000.

317.30Subd. 7.Technical Activities78,206,000102,551,000

317.31This appropriation is from the federal TANF 317.32fund.

317.33Sec. 4. COMMISSIONER OF HEALTH

318.1Subdivision 1.Total Appropriation$147,939,000$136,632,000

318.2Appropriations by Fund318.320122013318.4General77,634,00072,738,000318.5318.6State Government Special Revenue45,268,00045,325,000318.7Health Care Access13,774,0009,162,000318.8Federal TANF11,713,00011,713,000

318.9The amounts that may be spent for each 318.10purpose are specified in the following 318.11subdivisions.

318.12318.13Subd. 2.Community and Family Health Promotion

318.14Appropriations by Fund318.15General50,430,00045,690,000318.16318.17State Government Special Revenue1,033,0001,033,000318.18Health Care Access2,918,0002,459,000318.19Federal TANF11,713,00011,713,000

318.20TANF Appropriations. (1) $1,156,000 of 318.21the TANF funds is appropriated each year to 318.22the commissioner for family planning grants 318.23under Minnesota Statutes, section 145.925.318.24(2) $3,579,000 of the TANF funds is 318.25appropriated each year to the commissioner 318.26for home visiting and nutritional services 318.27listed under Minnesota Statutes, section 318.28145.882, subdivision 7, clauses (6) and (7). 318.29Funds must be distributed to community 318.30health boards according to Minnesota 318.31Statutes, section 145A.131, subdivision 1.318.32(3) $2,000,000 of the TANF funds is 318.33appropriated each year to the commissioner 318.34for decreasing racial and ethnic disparities 318.35in infant mortality rates under Minnesota 318.36Statutes, section 145.928, subdivision 7.319.1(4) $4,978,000 of the TANF funds is 319.2appropriated each year to the commissioner 319.3for the family home visiting grant program 319.4according to Minnesota Statutes, section 319.5145A.17. $4,000,000 of the funding must 319.6be distributed to community health boards 319.7according to Minnesota Statutes, section 319.8145A.131, subdivision 1. $978,000 of 319.9the funding must be distributed to tribal 319.10governments based on Minnesota Statutes, 319.11section 145A.14, subdivision 2a.319.12(5) The commissioner may use up to 6.23 319.13percent of the funds appropriated each fiscal 319.14year to conduct the ongoing evaluations 319.15required under Minnesota Statutes, section 319.16145A.17, subdivision 7, and training and 319.17technical assistance as required under 319.18Minnesota Statutes, section 145A.17, 319.19subdivisions 4 and 5.319.20TANF Carryforward. Any unexpended 319.21balance of the TANF appropriation in the 319.22first year of the biennium does not cancel but 319.23is available for the second year.

319.24Subd. 3.Policy Quality and Compliance

319.25Appropriations by Fund319.26General10,434,00010,230,000319.27319.28State Government Special Revenue14,026,00014,083,000319.29Health Care Access10,856,0006,703,000

319.30MERC Fund Transfers. The commissioner 319.31of management and budget shall transfer 319.32$9,800,000 from the MERC fund to the 319.33general fund by October 1, 2011.319.34Comprehensive Advanced Life Support.319.35Of the general fund appropriation, $31,000 320.1each year is added to the base of the 320.2comprehensive advanced life support 320.3(CALS) program under Minnesota Statutes, 320.4section 144.6062.320.5Unused Federal Match Funds. Of the 320.6funds appropriated in Laws 2009, chapter 320.779, article 13, section 4, subdivision 3, for 320.8state matching funds for the federal Health 320.9Information Technology for Economic and 320.10Clinical Health Act, $2,800,000 is transferred 320.11to the health care access fund by October 1, 320.122011.320.13Advisory Committee on Patient and 320.14Community Engagement. $50,000 is 320.15appropriated  to the commissioner of health 320.16to provide a grant to a private sector 320.17organization designated as the advisory 320.18committee on patient and community 320.19engagement to be used by the organization 320.20for:320.21(1) per diems and expenses for persons who 320.22serve on the designated organization's board; 320.23and 320.24(2) expenses for conducting focus groups, 320.25community engagement events, surveys, and 320.26other activities undertaken by the designated 320.27organization to obtain information, input, 320.28and preferences from diverse communities 320.29for purposes of community engagement in 320.30health system issues.320.31Health Careers Opportunities Grants. 320.32$447,000 each year is appropriated to the 320.33commissioner of health from the health 320.34care access fund for the health careers 321.1opportunities grant program under Minnesota 321.2Statutes, section 144.1499.321.3Health Professions Opportunities 321.4Scholarship Program. $63,000 each year is 321.5appropriated to the commissioner of health 321.6from the health care access fund for the 321.7health professions opportunities scholarship 321.8program under Minnesota Statutes, section 321.9144.1503. $138,000 in fiscal year 2012 and 321.10$276,000 each year thereafter is appropriated 321.11to the commissioner of health from the 321.12general fund for the health professions 321.13opportunities scholarship program under 321.14Minnesota Statutes, section 144.1503.321.15Base Level Adjustment. The state 321.16government special revenue fund base shall 321.17be reduced by $141,000 in fiscal years 2014 321.18and 2015. The health care access base shall 321.19be increased by $600,000 in fiscal year 2014.

321.20Subd. 4.Health Protection

321.21Appropriations by Fund321.22General9,370,0009,370,000321.23321.24State Government Special Revenue30,209,00030,209,000

321.25Subd. 5.Administrative Support Services7,400,0007,448,000

321.26Sec. 5. COUNCIL ON DISABILITY$524,000$524,000

321.27321.28321.29Sec. 6. OMBUDSMAN FOR MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES$1,655,000$1,655,000

321.30Funds appropriated for fiscal year 2011 are 321.31available until expended.

321.32Sec. 7. OMBUDSPERSON FOR FAMILIES$265,000$265,000

321.33Sec. 8. HEALTH-RELATED BOARDS

322.1Subdivision 1.Total Appropriation$17,365,000$17,264,000

322.2This appropriation is from the state 322.3government special revenue fund. The 322.4amounts that may be spent for each  purpose 322.5are specified in the following  subdivisions.

322.6Subd. 2.Board of Chiropractic Examiners469,000469,000

322.7Subd. 3.Board of Dentistry1,959,0001,914,000

322.8Health Professional Services Program.322.9$834,000 in fiscal year 2012 and $804,000 in 322.10fiscal year 2013 from the state government 322.11special revenue fund are for the health 322.12professional services program.

322.13322.14Subd. 4.Board of Dietetic and Nutrition Practice110,000110,000

322.15322.16Subd. 5.Board of Marriage and Family Therapy192,000167,000

322.17Rulemaking. Of this appropriation, $25,000 322.18in fiscal year 2012 is for rulemaking. This is 322.19a onetime appropriation.

322.20Subd. 6.Board of Medical Practice3,866,0003,866,000

322.21Subd. 7.Board of Nursing3,545,0003,545,000

322.22322.23Subd. 8.Board of Nursing Home Administrators2,153,0002,145,000

322.24Rulemaking. Of this appropriation, $44,000 322.25in fiscal year 2012 is for rulemaking. This is 322.26a onetime appropriation.322.27Electronic Licensing System Adaptors.322.28Of this appropriation, $761,000 in fiscal 322.29year 2013 from the state government special 322.30revenue fund is to the administrative services 322.31unit to cover the costs to connect to the 322.32e-licensing system. Minnesota Statutes, 322.33section 16E.22. Base level funding  for this 323.1activity in fiscal year 2014 shall be  $100,000. 323.2Base level funding for this activity in fiscal 323.3year 2015 shall be $50,000.323.4Development and Implementation of a 323.5Disciplinary, Regulatory, Licensing and 323.6Information Management System. Of this 323.7appropriation, $800,000 in fiscal  year 2012 323.8and $300,000 in fiscal year 2013 are  for the 323.9development of a shared system.   Base level 323.10funding for this activity in fiscal year  2014 323.11shall be $50,000.323.12Administrative Services Unit - Operating 323.13Costs. Of this appropriation, $526,000 323.14in fiscal year 2012 and $526,000 in 323.15fiscal year 2013 are for operating costs 323.16of the administrative services unit. The 323.17administrative services unit may receive 323.18and expend reimbursements for services 323.19performed by other agencies.323.20Administrative Services Unit - Retirement 323.21Costs. Of this appropriation in fiscal year 323.222012, $225,000 is for onetime retirement 323.23costs in the health-related boards. This 323.24funding may be transferred to the health 323.25boards incurring those costs for their 323.26payment. These funds are available either 323.27year of the biennium.323.28Administrative Services Unit - Volunteer 323.29Health Care Provider Program. Of this 323.30appropriation, $150,000 in fiscal year 2012 323.31and $150,000 in fiscal year 2013 are to pay 323.32for medical professional liability coverage 323.33required under Minnesota Statutes, section 323.34214.40.324.1Administrative Services Unit - Contested 324.2Cases and Other Legal Proceedings.324.3Of  this appropriation, $200,000 in fiscal 324.4year  2012 and $200,000 in fiscal year 324.52013  are for costs of contested case 324.6hearings  and other unanticipated costs of 324.7legal  proceedings involving health-related 324.8boards funded under this section. Upon 324.9certification of a health-related board to the 324.10administrative services unit that the costs 324.11will be incurred and that there is insufficient 324.12money available to pay for the costs out of 324.13money currently available to that board, the 324.14administrative services unit is authorized 324.15to transfer money from this appropriation 324.16to the board for payment of those costs 324.17with the approval of the commissioner of 324.18finance. This appropriation does not cancel. 324.19Any unencumbered and unspent balances 324.20remain available for these expenditures in 324.21subsequent fiscal years.

324.22Subd. 9.Board of Optometry106,000106,000

324.23Subd. 10.Board of Pharmacy1,977,0001,980,000

324.24Prescription Electronic Reporting. Of 324.25this appropriation, $356,000 in fiscal year 324.262012 and $356,000 in fiscal year 2013 from 324.27the state government special revenue fund 324.28are to the board to operate the prescription 324.29electronic reporting system in Minnesota 324.30Statutes, section 152.126. Base level funding 324.31for this activity in fiscal year 2014 shall be 324.32$356,000.

324.33Subd. 11.Board of Physical Therapy389,000345,000

325.1Rulemaking. Of this appropriation, $44,000 325.2in fiscal year 2012 is for rulemaking. This is 325.3a onetime appropriation.

325.4Subd. 12.Board of Podiatry75,00075,000

325.5Subd. 13.Board of Psychology846,000846,000

325.6Subd. 14.Board of Social Work1,036,0001,053,000

325.7Subd. 15.Board of Veterinary Medicine228,000229,000

325.8325.9Subd. 16.Board of Behavioral Health and Therapy414,000414,000

325.10325.11Sec. 9. EMERGENCY MEDICAL SERVICES BOARD$2,742,000$2,742,000

325.12Of the appropriation, $700,000 in fiscal year 325.132012 and $700,000 in fiscal year 2013 are 325.14for the Cooper/Sams volunteer ambulance 325.15program under Minnesota Statutes, section 325.16144E.40.325.17    Sec. 10. Minnesota Statutes 2010, section 256.01, is amended by adding a subdivision 325.18to read:325.19    Subd. 33.Federal administrative reimbursement dedicated.Federal 325.20administrative reimbursement resulting from the following activities is appropriated to the 325.21commissioner for the designated purposes:325.22(1) reimbursement for the Minnesota senior health options project; and325.23(2) reimbursement related to prior authorization and inpatient admission certification 325.24by a professional review organization. A portion of these funds must be used for activities 325.25to decrease unnecessary pharmaceutical costs in medical assistance.325.26    Sec. 11. Laws 2010, First Special Session chapter 1, article 15, section 3, subdivision 325.276, is amended to read:

325.28Subd. 6.Continuing Care Grants

325.29(a) Aging and Adult Services Grants(3,600,000)(3,600,000)

325.30Community Service/Service Development 325.31Grants Reduction. Effective retroactively 326.1from July 1, 2009, funding for grants made 326.2under Minnesota Statutes, sections 
         256.9754326.3and 
         256B.0917, subdivision 13, is reduced 326.4by $5,807,000 for each year of the biennium. 326.5Grants made during the biennium under 326.6Minnesota Statutes, section 
         256.9754, shall 326.7not be used for new construction or building 326.8renovation.326.9Aging Grants Delay. Aging grants must be 326.10reduced by $917,000 in fiscal year 2011 and 326.11increased by $917,000 in fiscal year 2012. 326.12These adjustments are onetime and must not 326.13be applied to the base. This provision expires 326.14June 30, 2012.

326.15326.16(b) Medical Assistance Long-Term Care Facilities Grants(3,827,000)(2,745,000)

326.17ICF/MR Variable Rates Suspension.326.18Effective retroactively from July 1, 2009, 326.19to June 30, 2010, no new variable rates 326.20shall be authorized for intermediate care 326.21facilities for persons with developmental 326.22disabilities under Minnesota Statutes, section 326.23256B.5013, subdivision 1
         .326.24ICF/MR Occupancy Rate Adjustment 326.25Suspension. Effective retroactively from 326.26July 1, 2009, to June 30, 2011, approval 326.27of new applications for occupancy rate 326.28adjustments for unoccupied short-term 326.29beds under Minnesota Statutes, section 326.30256B.5013, subdivision 7
         , is suspended.

326.31326.32(c) Medical Assistance Long-Term Care Waivers and Home Care Grants(2,318,000)(5,807,000)

326.33Developmental Disability Waiver Acuity 326.34Factor. Effective retroactively from January 326.351, 2010, the January 1, 2010, one percent 327.1growth factor in the developmental disability 327.2waiver allocations under Minnesota Statutes, 327.3section 
         256B.092, subdivisions 4 and 5, 327.4that is attributable to changes in acuity, 327.5is suspended to June 30, 2011 2012. 327.6Notwithstanding any law to the contrary, this 327.7provision does not expire.

327.8(d) Adult Mental Health Grants(5,000,000)-0-

327.9(e) Chemical Dependency Entitlement Grants(3,622,000)(3,622,000)

327.10327.11(f) Chemical Dependency Nonentitlement Grants(393,000)(393,000)

327.12327.13(g) Other Continuing Care Grants-0-(2,500,000)(1,414,000)

327.14Other Continuing Care Grants Delay.327.15Other continuing care grants must be reduced 327.16by $1,414,000 in fiscal year 2011 and 327.17increased by $1,414,000 in fiscal year 2012. 327.18These adjustments are onetime and must not 327.19be applied to the base. This provision expires 327.20June 30, 2012.

327.21(h) Deaf and Hard-of-Hearing Grants-0-(169,000)

327.22Deaf and Hard-of-Hearing Grants Delay.327.23Effective retroactively from July 1, 2010, 327.24deaf and hard-of-hearing grants must be 327.25reduced by $169,000 in fiscal year 2011 and 327.26increased by $169,000 in fiscal year 2012. 327.27These adjustments are onetime and must not 327.28be applied to the base. This provision expires 327.29June 30, 2012.327.30    Sec. 12. TRANSFERS.327.31    Subdivision 1.Grants.The commissioner of human services, with the approval 327.32of the commissioner of management and budget, and after notification of the chairs of 327.33the senate health and human services budget and policy committee and the house of 327.34representatives health and human services finance committee, may transfer unencumbered 328.1appropriation balances for the biennium ending June 30, 2013, within fiscal years among 328.2the MFIP; general assistance; general assistance medical care under Minnesota Statutes 328.32009 Supplement, section 256D.03, subdivision 3; medical assistance; MFIP child care 328.4assistance under Minnesota Statutes, section 119B.05; Minnesota supplemental aid; 328.5and group residential housing programs, and the entitlement portion of the chemical 328.6dependency consolidated treatment fund, and between fiscal years of the biennium.328.7    Subd. 2.Administration.Positions, salary money, and nonsalary administrative 328.8money may be transferred within the Departments of Health and Human Services as the 328.9commissioners consider necessary, with the advance approval of the commissioner of 328.10management and budget. The commissioner shall inform the chairs of the senate health 328.11and human services budget and policy committee and the house of representatives health 328.12and human services finance committee quarterly about transfers made under this provision.328.13    Sec. 13. INDIRECT COSTS NOT TO FUND PROGRAMS.328.14The commissioners of health and human services shall not use indirect cost 328.15allocations to pay for the operational costs of any program for which they are responsible.328.16    Sec. 14. EXPIRATION OF UNCODIFIED LANGUAGE.328.17All uncodified language contained in this article expires on June 30, 2013, unless a 328.18different expiration date is explicit.328.19    Sec. 15. EFFECTIVE DATE.328.20The provisions in this article are effective July 1, 2011, unless a different effective 328.21date is specified.328.22ARTICLE 10328.23HUMAN SERVICES FORECAST ADJUSTMENTS

328.24328.25Section 1. DEPARTMENT OF HUMAN SERVICES FORECAST ADJUSTMENT APPROPRIATIONS.

328.26The sums shown are added to, or if shown in parentheses, are subtracted from the 328.27appropriations in Laws 2009, chapter 79, article 13, as amended by Laws 2009, chapter 328.28173, article 2; Laws 2010, First Special Session chapter 1, articles 15, 23, and 25; and 328.29Laws 2010, Second Special Session chapter 1, article 3, to the commissioner of human 328.30services and for the purposes specified in this article. The appropriations are from the 328.31general fund or another named fund and are available for the fiscal year indicated for 329.1each purpose. The figure "2011" used in this article means that the appropriation or 329.2appropriations listed are available for the fiscal year ending June 30, 2011.

329.3329.4Sec. 2. COMMISSIONER OF HUMAN SERVICES

329.5Subdivision 1.Total Appropriation$(235,463,000)

329.6Appropriations by Fund329.72011329.8General(381,869,000)329.9Health Care Access169,514,000329.10Federal TANF(23,108,000)

329.11The amounts that may be spent for each 329.12purpose are specified in the following 329.13subdivisions.

329.14Subd. 2.Revenue and Pass-through732,000

329.15This appropriation is from the federal TANF 329.16fund.

329.17329.18Subd. 3.Children and Economic Assistance Grants

329.19Appropriations by Fund329.20General(7,098,000)329.21Federal TANF(23,840,000)

329.22(a) MFIP/DWP Grants

329.23Appropriations by Fund329.24General18,715,000329.25Federal TANF(23,840,000)

329.26(b) MFIP Child Care Assistance Grants(24,394,000)

329.27(c) General Assistance Grants(664,000)

329.28(d) Minnesota Supplemental Aid Grants793,000

329.29(e) Group Residential Housing Grants(1,548,000)

329.30Subd. 4.Basic Health Care Grants

329.31Appropriations by Fund329.32General(335,050,000)329.33Health Care Access169,514,000

329.34(a) MinnesotaCare Grants169,514,000

330.1This appropriation is from the health care 330.2access fund.

330.3330.4(b) Medical Assistance Basic Health Care - Families and Children(49,368,000)

330.5330.6(c) Medical Assistance Basic Health Care - Elderly and Disabled(43,258,000)

330.7330.8(d) Medical Assistance Basic Health Care - Adults without Children(242,424,000)

330.9Subd. 5.Continuing Care Grants(39,721,000)

330.10330.11(a) Medical Assistance Long-Term Care Facilities(14,627,000)

330.12330.13(b) Medical Assistance Long-Term Care Waivers(44,718,000)

330.14(c) Chemical Dependency Entitlement Grants19,624,000

330.15    Sec. 3. Laws 2010, First Special Session chapter 1, article 25, section 3, subdivision 6, 330.16is amended to read:

330.17Subd. 6.Health Care Grants

330.18(a) MinnesotaCare Grants998,000(13,376,000)

330.19This appropriation is from the health care 330.20access fund.330.21Health Care Access Fund Transfer to 330.22General Fund. The commissioner of 330.23management and budget shall transfer the 330.24following amounts in the following years 330.25from the health care access fund to the 330.26general fund: $998,000 $0 in fiscal year 330.272010; $176,704,000 $59,901,000 in fiscal 330.28year 2011; $141,041,000 in fiscal year 2012; 330.29and $286,150,000 in fiscal year 2013. If at 330.30any time the governor issues an executive 330.31order not to participate in early medical 330.32assistance expansion, no funds shall be 330.33transferred from the health care access 330.34fund to the general fund until early medical 331.1assistance expansion takes effect. This 331.2paragraph is effective the day following final 331.3enactment.331.4MinnesotaCare Ratable Reduction.331.5Effective for services rendered on or after 331.6July 1, 2010, to December 31, 2013, 331.7MinnesotaCare payments to managed care 331.8plans under Minnesota Statutes, section 331.9256L.12
         , for single adults and households 331.10without children whose income is greater 331.11than 75 percent of federal poverty guidelines 331.12shall be reduced by 15 percent. Effective 331.13for services provided from July 1, 2010, to 331.14June 30, 2011, this reduction shall apply to 331.15all services. Effective for services provided 331.16from July 1, 2011, to December 31, 2013, this 331.17reduction shall apply to all services except 331.18inpatient hospital services. Notwithstanding 331.19any contrary provision of this article, this 331.20paragraph shall expire on December 31, 331.212013.

331.22331.23(b) Medical Assistance Basic Health Care Grants - Families and Children-0-295,512,000

331.24Critical Access Dental. Of the general 331.25fund appropriation, $731,000 in fiscal year 331.262011 is to the commissioner for critical 331.27access dental provider reimbursement 331.28payments under Minnesota Statutes, section 331.29256B.76
          subdivision 4. This is a onetime 331.30appropriation.331.31Nonadministrative Rate Reduction. For 331.32services rendered on or after July 1, 2010, 331.33to December 31, 2013, the commissioner 331.34shall reduce contract rates paid to managed 331.35care plans under Minnesota Statutes, 331.36sections 
         256B.69 and 
         256L.12, and to 332.1county-based purchasing plans under 332.2Minnesota Statutes, section 
         256B.692, by 332.3three percent of the contract rate attributable 332.4to nonadministrative services in effect on 332.5June 30, 2010. Notwithstanding any contrary 332.6provision in this article, this rider expires on 332.7December 31, 2013.

332.8332.9(c) Medical Assistance Basic Health Care Grants - Elderly and Disabled-0-(30,265,000)

332.10332.11(d) General Assistance Medical Care Grants-0-(75,389,000)(59,583,000)

332.12The reduction to general assistance medical 332.13care grants is contingent upon the effective 332.14date in Laws 2010, First Special Session 332.15chapter 1, article 16, section 48. The 332.16reduction shall be reestimated based upon 332.17the actual effective date of the law. The 332.18commissioner of management and budget 332.19shall make adjustments in fiscal year 332.202011 to general assistance medical care 332.21appropriations to conform to the total 332.22expected expenditure reductions specified in 332.23this section.

332.24(e)  Other Health Care Grants-0-(7,000,000)

332.25Cobra Carryforward. Unexpended funds 332.26appropriated in fiscal year 2010 for COBRA 332.27grants under Laws 2009, chapter 79, article 332.285, section 78, do not cancel and are available 332.29to the commissioner for fiscal year 2011 332.30COBRA grant expenditures. Up to $111,000 332.31of the fiscal year 2011 appropriation for 332.32COBRA grants provided in Laws 2009, 332.33chapter 79, article 13, section 3, subdivision 332.346, may be used by the commissioner for costs 332.35related to administration of the COBRA 332.36grants.333.1    Sec. 4. EFFECTIVE DATE.333.2This article is effective the day following final enactment.